Assessment of depression in medical patients: a systematic review of the utility of the beck depression inventory-II

To perform a systematic review of the utility of the Beck Depression Inventory for detecting depression in medical settings, this article focuses on the revised version of the scale (Beck Depression Inventory-II), which was reformulated according to the DSM-IV criteria for major depression. We examined relevant investigations with the Beck Depression Inventory-II for measuring depression in medical settings to provide guidelines for practicing clinicians. Considering the inclusion and exclusion criteria seventy articles were retained. Validation studies of the Beck Depression Inventory-II, in both primary care and hospital settings, were found for clinics of cardiology, neurology, obstetrics, brain injury, nephrology, chronic pain, chronic fatigue, oncology, and infectious disease. The Beck Depression Inventory-II showed high reliability and good correlation with measures of depression and anxiety. Its threshold for detecting depression varied according to the type of patients, suggesting the need for adjusted cut-off points. The somatic and cognitive-affective dimension described the latent structure of the instrument. The Beck Depression Inventory-II can be easily adapted in most clinical conditions for detecting major depression and recommending an appropriate intervention. Although this scale represents a sound path for detecting depression in patients with medical conditions, the clinician should seek evidence for how to interpret the score before using the Beck Depression Inventory-II to make clinical decisions

Comparison of flow cytometry and indirect immunofluorescence assay in the diagnosis and cure criterion after therapy of American tegumentary leishmaniasis by anti-live Leishmania (Viannia) braziliensis immunoglobulin G

The aim of this study was to compare the techniques of indirect immunofluorescence assay (IFA) and flow cytometry to clinical and laboratorial evaluation of patients before and after clinical cure and to evaluate the applicability of flow cytometry in post-therapeutic monitoring of patients with American tegumentary leishmaniasis (ATL). Sera from 14 patients before treatment (BT), 13 patients 1 year after treatment (AT), 10 patients 2 and 5 years AT were evaluated. The results from flow cytometry were expressed as levels of IgG reactivity, based on the percentage of positive fluorescent parasites (PPFP). The 1:256 sample dilution allowed us to differentiate individuals BT and AT. Comparative analysis of IFA and flow cytometry by ROC (receiver operating characteristic curve) showed, respectively, AUC (area under curve) = 0.8 (95% CI = 0.64–0.89) and AUC = 0.90 (95% CI = 0.75–0.95), demonstrating that the flow cytometry had equivalent accuracy. Our data demonstrated that 20% was the best cut-off point identified by the ROC curve for the flow cytometry assay. This test showed a sensitivity of 86% and specificity of 77% while the IFA had a sensitivity of 78% and specificity of 85%. The after-treatment screening, through comparative analysis of the technique performance indexes, 1, 2 and 5 years AT, showed an equal performance of the flow cytometry compared with the IFA. However, flow cytometry shows to be a better diagnostic alternative when applied to the study of ATL in the cure criterion. The information obtained in this work opens perspectives to monitor cure after treatment of ATL.

Statistical properties of Radio Halos and the re-acceleration model

Galaxy clusters occupy a special position in the cosmic hierarchy as they are the largest bound structures in the Universe. There is now general agreement on a hierarchical picture for the formation of cosmic structures, in which galaxy clusters are supposed to form by accretion of matter and merging between smaller units. During merger events, shocks are driven by the gravity of the dark matter in the diffuse barionic component, which is heated up to the observed temperature. Radio and hard-X ray observations have discovered non-thermal components mixed with the thermal Intra Cluster Medium (ICM) and this is of great importance as it calls for a “revision” of the physics of the ICM. The bulk of present information comes from the radio observations which discovered an increasing number of Mpcsized emissions from the ICM, Radio Halos (at the cluster center) and Radio Relics (at the cluster periphery). These sources are due to synchrotron emission from ultra relativistic electrons diffusing through µG turbulent magnetic fields. Radio Halos are the most spectacular evidence of non-thermal components in the ICM and understanding the origin and evolution of these sources represents one of the most challenging goal of the theory of the ICM. Cluster mergers are the most energetic events in the Universe and a fraction of the energy dissipated during these mergers could be channelled into the amplification of the magnetic fields and into the acceleration of high energy particles via shocks and turbulence driven by these mergers. Present observations of Radio Halos (and possibly of hard X-rays) can be best interpreted in terms of the reacceleration scenario in which MHD turbulence injected during these cluster mergers re-accelerates high energy particles in the ICM. The physics involved in this scenario is very complex and model details are difficult to test, however this model clearly predicts some simple properties of Radio Halos (and resulting IC emission in the hard X-ray band) which are almost independent of the details of the adopted physics. In particular in the re-acceleration scenario MHD turbulence is injected and dissipated during cluster mergers and thus Radio Halos (and also the resulting hard X-ray IC emission) should be transient phenomena (with a typical lifetime <» 1 Gyr) associated with dynamically disturbed clusters. The physics of the re-acceleration scenario should produce an unavoidable cut-off in the spectrum of the re-accelerated electrons, which is due to the balance between turbulent acceleration and radiative losses. The energy at which this cut-off occurs, and thus the maximum frequency at which synchrotron radiation is produced, depends essentially on the efficiency of the acceleration mechanism so that observations at high frequencies are expected to catch only the most efficient phenomena while, in principle, low frequency radio surveys may found these phenomena much common in the Universe. These basic properties should leave an important imprint in the statistical properties of Radio Halos (and of non-thermal phenomena in general) which, however, have not been addressed yet by present modellings. The main focus of this PhD thesis is to calculate, for the first time, the expected statistics of Radio Halos in the context of the re-acceleration scenario. In particular, we shall address the following main questions: • Is it possible to model “self-consistently” the evolution of these sources together with that of the parent clusters? • How the occurrence of Radio Halos is expected to change with cluster mass and to evolve with redshift? How the efficiency to catch Radio Halos in galaxy clusters changes with the observing radio frequency? • How many Radio Halos are expected to form in the Universe? At which redshift is expected the bulk of these sources? • Is it possible to reproduce in the re-acceleration scenario the observed occurrence and number of Radio Halos in the Universe and the observed correlations between thermal and non-thermal properties of galaxy clusters? • Is it possible to constrain the magnetic field intensity and profile in galaxy clusters and the energetic of turbulence in the ICM from the comparison between model expectations and observations? Several astrophysical ingredients are necessary to model the evolution and statistical properties of Radio Halos in the context of re-acceleration model and to address the points given above. For these reason we deserve some space in this PhD thesis to review the important aspects of the physics of the ICM which are of interest to catch our goals. In Chapt. 1 we discuss the physics of galaxy clusters, and in particular, the clusters formation process; in Chapt. 2 we review the main observational properties of non-thermal components in the ICM; and in Chapt. 3 we focus on the physics of magnetic field and of particle acceleration in galaxy clusters. As a relevant application, the theory of Alfv´enic particle acceleration is applied in Chapt. 4 where we report the most important results from calculations we have done in the framework of the re-acceleration scenario. In this Chapter we show that a fraction of the energy of fluid turbulence driven in the ICM by the cluster mergers can be channelled into the injection of Alfv´en waves at small scales and that these waves can efficiently re-accelerate particles and trigger Radio Halos and hard X-ray emission. The main part of this PhD work, the calculation of the statistical properties of Radio Halos and non-thermal phenomena as expected in the context of the re-acceleration model and their comparison with observations, is presented in Chapts.5, 6, 7 and 8. In Chapt.5 we present a first approach to semi-analytical calculations of statistical properties of giant Radio Halos. The main goal of this Chapter is to model cluster formation, the injection of turbulence in the ICM and the resulting particle acceleration process. We adopt the semi–analytic extended Press & Schechter (PS) theory to follow the formation of a large synthetic population of galaxy clusters and assume that during a merger a fraction of the PdV work done by the infalling subclusters in passing through the most massive one is injected in the form of magnetosonic waves. Then the processes of stochastic acceleration of the relativistic electrons by these waves and the properties of the ensuing synchrotron (Radio Halos) and inverse Compton (IC, hard X-ray) emission of merging clusters are computed under the assumption of a constant rms average magnetic field strength in emitting volume. The main finding of these calculations is that giant Radio Halos are naturally expected only in the more massive clusters, and that the expected fraction of clusters with Radio Halos is consistent with the observed one. In Chapt. 6 we extend the previous calculations by including a scaling of the magnetic field strength with cluster mass. The inclusion of this scaling allows us to derive the expected correlations between the synchrotron radio power of Radio Halos and the X-ray properties (T, LX) and mass of the hosting clusters. For the first time, we show that these correlations, calculated in the context of the re-acceleration model, are consistent with the observed ones for typical µG strengths of the average B intensity in massive clusters. The calculations presented in this Chapter allow us to derive the evolution of the probability to form Radio Halos as a function of the cluster mass and redshift. The most relevant finding presented in this Chapter is that the luminosity functions of giant Radio Halos at 1.4 GHz are expected to peak around a radio power » 1024 W/Hz and to flatten (or cut-off) at lower radio powers because of the decrease of the electron re-acceleration efficiency in smaller galaxy clusters. In Chapt. 6 we also derive the expected number counts of Radio Halos and compare them with available observations: we claim that » 100 Radio Halos in the Universe can be observed at 1.4 GHz with deep surveys, while more than 1000 Radio Halos are expected to be discovered in the next future by LOFAR at 150 MHz. This is the first (and so far unique) model expectation for the number counts of Radio Halos at lower frequency and allows to design future radio surveys. Based on the results of Chapt. 6, in Chapt.7 we present a work in progress on a “revision” of the occurrence of Radio Halos. We combine past results from the NVSS radio survey (z » 0.05 − 0.2) with our ongoing GMRT Radio Halos Pointed Observations of 50 X-ray luminous galaxy clusters (at z » 0.2−0.4) and discuss the possibility to test our model expectations with the number counts of Radio Halos at z » 0.05 − 0.4. The most relevant limitation in the calculations presented in Chapt. 5 and 6 is the assumption of an “averaged” size of Radio Halos independently of their radio luminosity and of the mass of the parent clusters. This assumption cannot be released in the context of the PS formalism used to describe the formation process of clusters, while a more detailed analysis of the physics of cluster mergers and of the injection process of turbulence in the ICM would require an approach based on numerical (possible MHD) simulations of a very large volume of the Universe which is however well beyond the aim of this PhD thesis. On the other hand, in Chapt.8 we report our discovery of novel correlations between the size (RH) of Radio Halos and their radio power and between RH and the cluster mass within the Radio Halo region, MH. In particular this last “geometrical” MH − RH correlation allows us to “observationally” overcome the limitation of the “average” size of Radio Halos. Thus in this Chapter, by making use of this “geometrical” correlation and of a simplified form of the re-acceleration model based on the results of Chapt. 5 and 6 we are able to discuss expected correlations between the synchrotron power and the thermal cluster quantities relative to the radio emitting region. This is a new powerful tool of investigation and we show that all the observed correlations (PR − RH, PR − MH, PR − T, PR − LX, . . . ) now become well understood in the context of the re-acceleration model. In addition, we find that observationally the size of Radio Halos scales non-linearly with the virial radius of the parent cluster, and this immediately means that the fraction of the cluster volume which is radio emitting increases with cluster mass and thus that the non-thermal component in clusters is not self-similar.

Ruolo dell'elastometria pulsata monodimensionale ad ultrasuoni (fibroscan) nella stadiazione della fibrosi epatica in pazienti sottoposti a trapianto ortotopico di fegato con recidiva di epatite C

PREMESSA: La progressione della recidiva d’epatite C è accelerata nei pazienti sottoposti a trapianto di fegato e ciò ha portato alla necessità di sviluppare nuove e validate metodiche non invasive per la quantificazione e la misura della fibrosi epatica. SCOPI: Stabilire l’efficacia dell’elastometria epatica (Fibroscan®) e dei parametri sierici di fibrosi, attualmente disponibili nella pratica clinica, per predire il grado di fibrosi nei pazienti sottoposti a trapianto epatico. METODI: La correlazione fra fibrosi epatica, determinata mediante biopsia epatica ed esame istologico, e Fibroscan® o indici clinico-sierologici di fibrosi (Benlloch, Apri, Forns, Fibrotest and Doppler resistance index), è stata studiata in pazienti che avevano ricevuto un trapianto ortotopico di fegato con evidenza di recidiva d’epatite da HCV. Un totale di 36 pazienti, con la seguente classificazione istologica: fibrosi secondom METAVIR F1=24, F2=8, F3=3, F4=1, sono stati arruolati nella popolazione oggetto di studio. Un totale di 29 individui volontari sani sono serviti come controllo. Le differenze fra gli stadi di fibrosi sono state calcolate mediante analisi statistica non parametrica. Il miglior cut-off per la differenziazione di fibrosi significativa (F2-F4) è stato identificato mediante l’analisi delle curve ROC. RISULTATI: La rigidità epatica ha presentato valori di 4.4 KPa (2.7-6.9) nei controlli (mediane e ranges), con valori in tutti i soggeti <7.0 KPa; 7.75 KPa (4.2-28.0) negli F1; 16.95 KPa (10.2-31.6) negli F2; 21.10 KPa nell’unico paziente F4 cirrotico. Le differenze sono state statisticamente significative per i soggetti controllo versus F1 e F2 (p<0.0001) e per F1 versus F2 (p<0.0001). Un cut-off elastografico di 11.2 KPagarantisce 88% di Sensibilità, 90% di Specificità, 79% di PPV e 95% di NPV nel differenziare i soggetti F1 dagli F2-F4. Le AUROC, relativamente alla capacità di discriminare fra i differenti gradi di fibrosi, evidenziavano un netto vantaggio per il Fibroscan® rispetto ad ognuno degli indici non invasivi di fibrosi. CONCLUSIONI: L’elastometria epatica presenta una buona accuratezza diagnostica nell’identificare pazienti con fibrosi epatica di grado significativo, superiore a quella di tutti gli altri test non invasivi al momento disponibili nella clinica, nei pazienti portatori di trapianto epatico ortotopico da cadavere con recidiva di HCV.

X-Ray studies of the physics of matter around super-massive black-holes in nearby Seyfert galaxies

Seyfert galaxies are the closest active galactic nuclei. As such, we can use them to test the physical properties of the entire class of objects. To investigate their general properties, I took advantage of different methods of data analysis. In particular I used three different samples of objects, that, despite frequent overlaps, have been chosen to best tackle different topics: the heterogeneous BeppoS AX sample was thought to be optimized to test the average hard X-ray (E above 10 keV) properties of nearby Seyfert galaxies; the X-CfA was thought the be optimized to compare the properties of low-luminosity sources to the ones of higher luminosity and, thus, it was also used to test the emission mechanism models; finally, the XMM–Newton sample was extracted from the X-CfA sample so as to ensure a truly unbiased and well defined sample of objects to define the average properties of Seyfert galaxies. Taking advantage of the broad-band coverage of the BeppoS AX MECS and PDS instruments (between ~2-100 keV), I infer the average X-ray spectral propertiesof nearby Seyfert galaxies and in particular the photon index (~1.8), the high-energy cut-off (~290 keV), and the relative amount of cold reflection (~1.0). Moreover the unified scheme for active galactic nuclei was positively tested. The distribution of isotropic indicators used here (photon index, relative amount of reflection, high-energy cut-off and narrow FeK energy centroid) are similar in type I and type II objects while the absorbing column and the iron line equivalent width significantly differ between the two classes of sources with type II objects displaying larger absorbing columns. Taking advantage of the XMM–Newton and X–CfA samples I also deduced from measurements that 30 to 50% of type II Seyfert galaxies are Compton thick. Confirming previous results, the narrow FeK line is consistent, in Seyfert 2 galaxies, with being produced in the same matter responsible for the observed obscuration. These results support the basic picture of the unified model. Moreover, the presence of a X-ray Baldwin effect in type I sources has been measured using for the first time the 20-100 keV luminosity (EW proportional to L(20-100)^(−0.22±0.05)). This finding suggests that the torus covering factor may be a function of source luminosity, thereby suggesting a refinement of the baseline version of the unifed model itself. Using the BeppoSAX sample, it has been also recorded a possible correlation between the photon index and the amount of cold reflection in both type I and II sources. At a first glance this confirms the thermal Comptonization as the most likely origin of the high energy emission for the active galactic nuclei. This relation, in fact, naturally emerges supposing that the accretion disk penetrates, depending to the accretion rate, the central corona at different depths (Merloni et al. 2006): the higher accreting systems hosting disks down to the last stable orbit while the lower accreting systems hosting truncated disks. On the contrary, the study of the well defined X–C f A sample of Seyfert galaxies has proved that the intrinsic X-ray luminosity of nearby Seyfert galaxies can span values between 10^(38−43) erg s^−1, i.e. covering a huge range of accretion rates. The less efficient systems have been supposed to host ADAF systems without accretion disk. However, the study of the X–CfA sample has also proved the existence of correlations between optical emission lines and X-ray luminosity in the entire range of L_(X) covered by the sample. These relations are similar to the ones obtained if high-L objects are considered. Thus the emission mechanism must be similar in luminous and weak systems. A possible scenario to reconcile these somehow opposite indications is assuming that the ADAF and the two phase mechanism co-exist with different relative importance moving from low-to-high accretion systems (as suggested by the Gamma vs. R relation). The present data require that no abrupt transition between the two regimes is present. As mentioned above, the possible presence of an accretion disk has been tested using samples of nearby Seyfert galaxies. Here, to deeply investigate the flow patterns close to super-massive black-holes, three case study objects for which enough counts statistics is available have been analysed using deep X-ray observations taken with XMM–Newton. The obtained results have shown that the accretion flow can significantly differ between the objects when it is analyzed with the appropriate detail. For instance the accretion disk is well established down to the last stable orbit in a Kerr system for IRAS 13197-1627 where strong light bending effect have been measured. The accretion disk seems to be formed spiraling in the inner ~10-30 gravitational radii in NGC 3783 where time dependent and recursive modulation have been measured both in the continuum emission and in the broad emission line component. Finally, the accretion disk seems to be only weakly detectable in rk 509, with its weak broad emission line component. Finally, blueshifted resonant absorption lines have been detected in all three objects. This seems to demonstrate that, around super-massive black-holes, there is matter which is not confined in the accretion disk and moves along the line of sight with velocities as large as v~0.01-0.4c (whre c is the speed of light). Wether this matter forms winds or blobs is still matter of debate together with the assessment of the real statistical significance of the measured absorption lines. Nonetheless, if confirmed, these phenomena are of outstanding interest because they offer new potential probes for the dynamics of the innermost regions of accretion flows, to tackle the formation of ejecta/jets and to place constraints on the rate of kinetic energy injected by AGNs into the ISM and IGM. Future high energy missions (such as the planned Simbol-X and IXO) will likely allow an exciting step forward in our understanding of the flow dynamics around black holes and the formation of the highest velocity outflows.

Studio di macromolecole associate alla calcificazione in organismi marini

Lo studio riportato in questa tesi ha come scopo l’osservazione e la comprensione dei processi molecolari associati alla deposizione di CaCO3 nei polimorfi di calcite e aragonite nel mollusco gasteropode Haliotis rufescens. In particolare l’attenzione si è focalizzata sullo strato glicoproteico (green layer) che si trova inserito all’interno dell’ipostraco o strato madreperlaceo. Studi precedenti suggeriscono l’ipotesi che il green layer sia una struttura polifunzionale che svolge un ruolo attivo nell’induzione di crescita dei cristalli di carbonato di calcio nella conchiglia. All’analisi microscopica il green layer si presenta come un foglietto trilaminato. Sugli strati esterni è depositata aragonite nella forma prismatica da una parte e sferulitica dall’altra. All’interno è racchiuso un core proteico, formato da glicoproteine e ricco di chitina. Questa struttura tripartita conferisce al guscio calcareo nuove proprietà meccaniche, come la resistenza alle fratture molto maggiore rispetto al minerale naturale. Il green layer è stato trattato in ambiente alcalino, l’unico in grado di solubilizzarlo. È stato ottenuto del materiale proteico che è stato caratterizzato utilizzando SDS-PAGE, colorato con Blu Comassie e all’argento per visualizzarne la componente peptidica. Il green layer è fluorescente, sono state quindi eseguite analisi spettroscopiche sull’estratto peptidico per determinarne le proprietà chimo fisiche (dipendenza dal pH dell’intensità di fluorescenza). Sono stati eseguiti esperimenti di crescita dei cristalli di CaCO3 in ambiente saturo di CaCl2 in assenza e presenza del peptide e in assenza e presenza di Mg++. I cristalli sono stati osservati al microscopio elettronico a scansione (SEM) e al microscopio confocale. Da un punto di vista spettroscopico si osserva che, eccitando l’estratto alcalino del green layer a 280 nm e 295 nm, lunghezze d’onda caratteristiche degli aminoacidi aromatici, si ottiene uno spettro di emissione che presenta una forte banda centrata a 440 nm e una spalla a circa 350 nm, quest’ultima da ascrivere all’emissione tipica di aminoacidi aromatici. L’emissione di fluorescenza dell’estratto dal green layer dipende dal pH per tutte le bande di emissione; tale effetto è particolarmente visibile per lo spettro di emissione a 440 nm, la cui lunghezza d’onda di emissione e l’intensità dipendono dalla ionizzazione di aminoacidi acidi (pKa = 4) e dell’istidina (pKa = 6.5 L’emissione a 440 nm proviene invece da un’eccitazione il cui massimo di eccitazione è centrato a 350 nm, tipica di una struttura policiclica aromatica. Poiché nessun colorante estrinseco viene isolato dalla matrice del green layer a seguito dei vari trattamenti, tale emissione potrebbe derivare da una modificazione posttraduzionale di aminoacidi le cui proprietà spettrali suggeriscono la formazione di un prodotto di dimerizzazione della tirosina: la ditirosina. Questa struttura potrebbe essere la causa del cross-link che rende resistente il green layer alla degradazione da parte di agenti chimici ed enzimatici. La formazione di ditirosina come fenomeno post-traduzionale è stato recentemente acquisito come un fenomeno di origine perossidativa attraverso la formazione di un radicale Tyr ed è stato osservato anche in altri organismi caratterizzati da esoscheletro di tipo chitinoso, come gli insetti del genere Manduca sexta. Gli esperimenti di cristallizzazione in presenza di estratto di green layer ne hanno provato l’influenza sulla nucleazione dei cristalli. In presenza di CaCl2 avviene la precipitazione di CaCO3 nella fase calcitica, ma la conformazione romboedrica tipica della calcite viene modificata dalla presenza del peptide. Inoltre aumenta la densità dei cristalli che si aggregano a formare strutture sferiche di cristalli incastrati tra loro. Aumentando la concentrazione di peptide, le sfere a loro volta si uniscono tra loro a formare strutture geometriche sovrapposte. In presenza di Mg++, la deposizione di CaCO3 avviene in forma aragonitica. Anche in questo caso la morfologia e la densità dei cristalli dipendono dalla concentrazione dello ione e dalla presenza del peptide. È interessante osservare che, in tutti i casi nei quali si sono ottenute strutture cristalline in presenza dell’estratto alcalino del green layer, i cristalli sono fluorescenti, a significare che il peptide è incluso nella struttura cristallina e ne induce la modificazione strutturale come discusso in precedenza. Si osserva inoltre che le proprietà spettroscopiche del peptide in cristallo ed in soluzione sono molto diverse. In cristallo non si ha assorbimento alla più corta delle lunghezze d’onda disponibili in microscopia confocale (405 nm) bensì a 488 nm, con emissione estesa addirittura sino al rosso. Questa è un’indicazione, anche se preliminare, del fatto che la sua struttura in soluzione e in cristallo è diversa da quella in soluzione. In soluzione, per un peptide il cui peso molecolare è stimato tra 3500D (cut-off della membrana da dialisi) e 6500 D, la struttura è, presumibilmente, totalmente random-coil. In cristallo, attraverso l’interazione con gli ioni Ca++, Mg++ e CO3 -- la sua conformazione può cambiare portando, per esempio, ad una sovrapposizione delle strutture aromatiche, in modo da formare sistemi coniugati non covalenti (ring stacking) in grado di assorbire ed emettere luce ad energia più bassa (red shift).

La valutazione degli effetti delle politiche di coesione dell'Unione europea sulla crescita regionale

This PhD thesis aims at providing an evaluation of EU Cohesion policy impact on regional growth. It employs methodologies and data sources never before applied for this purpose. Main contributions to the literature concerning EU regional policy effectiveness have been extensively analysed. Moreover, having carried out an overview of the current literature on Cohesion Policy, we deduce that this work introduces innovative features in the field. The work enriches the current literature with regards to two aspects. The first aspect concerns the use of the instrument of Regression Discontinuity Design in order to examine the presence of a different outcome in terms of growth between Objectives 1 regions and non-Objective 1 regions at the cut-off point (75 percent of EU-15 GDP per capita in PPS) during the two programming periods, 1994-1999 and 2000-2006. The results confirm a significant difference higher than 0.5 percent per year between the two groups. The other empirical evaluation regards the study of a cross-section regression model based on the convergence theory that analyses the dependence relation between regional per capita growth and EU Cohesion policy expenditure in several fields of interventions. We have built a very fine dataset of spending variables (certified expenditure), using sources of data directly provided from the Regional Policy Directorate of the European Commission.

Bedeutung endogener und exogener Quellen reaktiver Sauerstoffspezies für die Entstehung des malignen Melanoms

Bedeutung endogener und exogener Quellen reaktiver Sauerstoffspezies für die Entstehung des malignen Melanoms Um zu überprüfen, ob reaktive Sauerstoffspezies (ROS) an der Entstehung des malignen Melanoms ursächlich beteiligt sind, wurde in dieser Arbeit der Einfluss von Mitochondrien als endogener und Licht als exogener ROS-Quelle untersucht.Nach Bestrahlung mit Licht (Halogenlampe 1000 W, 1125 kJ/m² zwischen 400-800 nm) reagierten M8,99-Melanomzellen sensitiver mit der Bildung oxidativer DNA-Basenmodifikationen als Hautfibroblasten des gleichen Melanompatienten. In einer anderen Melanomzelle (M2/02) war ein klarer Reparaturdefekt oxidativer DNA-Schäden zu beobachten. Bei viermaliger Bestrahlung mit Licht im Abstand von zwei Stunden (je 450 k/m²) nahm die Zahl induzierter oxidativer DNA-Modifikationen und Mikrokerne stetig zu. Durch Mehrfachbestrahlung mit Kantenfilter (? > 395 nm) konnte gezeigt werden, dass ein Teil der Mikrokerne im Bereich sichtbaren Lichts entsteht. Mitochondrien könnten als endogene Hauptquelle für ROS an der Entstehung oxidativer DNA-Modifikationen und des malignen Melanoms beteiligt sein. Die Abwesenheit der mitochondrialen Atmungskette bewirkte in dieser Arbeit eine nachhaltige Abnahme der intrazellulären ROS-Bildung bzw. ihre Stimulation durch mitochondriale Gifte eine starke Zunahme. Da in beiden Fällen kein Effekt auf die Zahl der oxidativen DNA-Modifikationen zu beobachten war, kann die mitochondriale ROS-Produktion nicht auf diesem Weg zur Melanom-Entstehung beitragen.

Ultrafeine Aerosolpartikel in der Stratosphäre

Ein neu konstruierter Kondensationskernzähler COPAS (COndensation PArticle counting System) für in-situ-Messungen der Konzentration von Aitken-Teilchen und ultrafeinen Aerosolpartikeln wurde im Rahmen dieser Arbeit erstmals erfolgreich bei Flugzeugmessungen eingesetzt. COPAS ist ein für flugzeuggestützte Messungen an Bord des Forschungsflugzeuges „Geophysica“ in der oberen Troposphäre und unteren Stratosphäre angepaßtes und voll automatisiertes System. Die Verfahrensweise, die Aerosolpartikel des Größenbereichs mit Durchmessern d < 100 nm zum Anwachsen zu bringen, um sie mittels optischer Detektion zu erfassen, ist im COPAS durch das Prinzip der thermischen Diffusion realisiert, wodurch eine kontinuierliche Messung der Aerosolkonzentration mit der untersten Nachweisgrenze für Partikeldurchmesser von d = 6 nm gewährleistet ist. Durch die Verwendung einer Aerosolheizung ist die Unterscheidung von volatilem und nichtvolatilem Anteil des Aerosols mit COPAS möglich. In umfassenden Laborversuchen wurde das COPAS-System hinsichtlich der unteren Nachweisgrenze in Abhängigkeit von der Betriebstemperatur und bei verschiedenen Druckbedingungen charakterisiert sowie die Effizienz der Aerosolheizung bestimmt. Flugzeuggestützte Messungen fanden in mittleren und polaren Breiten im Rahmen des EUPLEX-/ENVISAT-Validierungs–Projektes und in den Tropen während der TROCCINOX/ENVISAT-Kampagne statt. Die Messungen der vertikalen Konzentrationsverteilung des Aerosols ergaben in polaren Breiten eine Zunahme der Konzentration oberhalb von 17 km innerhalb des polaren Vortex mit hohem Anteil nichtvolatiler Partikel von bis zu 70 %. Als Ursache hierfür wird der Eintrag von meteoritischen Rauchpartikeln aus der Mesosphäre in die obere und mittlere Stratosphäre des Vortex angesehen. Ferner konnte in der unteren Stratosphäre des polaren Vortex der Einfluß troposphärischer Luft aus niedrigen Breiten festgestellt werden, die sich in einer hohen Variabilität der Aerosolpartikelkonzentration manifestiert. In tropischen Breiten wurde die Tropopausenregion untersucht. Dabei wurden Konzentrationen von bis zu 104 ultrafeiner Aerosolpartikel mit 6 nm < d < 14 nm pro cm-3 Luft gemessen, deren hoher volatiler Anteil einen sicheren Hinweis darauf gibt, daß die Partikel durch den Prozeß der homogenen Nukleation gebildet wurden. Damit konnte erstmals die Schlußfolgerungen von Brock et al. (1995) durch direkte Messungen der ultrafeinen Partikelkonzentration weitergehend belegt werden, daß in der tropischen Tropopausenregion die Neubildung von Aerosolpartikeln durch homogene Nukleation stattfindet. Die vertikalen Verteilungen der stratosphärischen Aerosolpartikelkonzentration mittlerer Breiten verdeutlichen die Ausbildung einer über 6 Jahre hinweg nahezu konstanten Hintergrundkonzentration des stratosphärischen Aerosols unter vulkanisch unbeeinflußten Bedingungen. Ferner gibt die vergleichende Untersuchung der stratosphärischen Aerosolpartikelkonzentration aus polaren, mittleren und tropischen Breiten Aufschluß über den Transport und die Prozessierung des stratosphärischen Aerosols und insbesondere über den Austausch von Luftmassen zwischen der Stratosphäre und der Troposphäre.

Recombinant expression of molluscan hemocyanin (KLH) substructures in a prokaryotic system: E. coli

The recombinant expression of 19 different substructures of KLH in the prokaryotic sys-tem E. coli has been successfully achieved: each one of the eight single FUs a to h of both isoforms, KLH1 and KLH2, two substructures consisting of two consecutive FUs (KLH1-bc and KLH1-gh) as well as a cDNA encompassing KLH1-abc. All recombinant proteins, fused to an N-terminal 6xHis tag, have successfully been detected by immuno precipitation using monoclonal α-His-antibodies and polyclonal α-KLH1- and α-KLH2-antibodies. One exception remained: SP-KLH2-a, which was not detected by the α-His-antibodies. This allows speculations as to whether the coexpressed signal peptide can lead, at one hand, to the secretion of the recombinant protein, and on the other to the simultaneous cut-off of the leader peptide, which results in the splitting off of even more N-terminal 6xHis tag, leading to failed recognition by the appropriate antibodies. The comparison of native KLH with recombinantly expressed prokaryotic (E. coli) and eukaryotic (Sf9 insect cells) KLH was done using FU-1h. The weak detection by the polyclonal α-KLH1-antibodies of both recombinantly expressed proteins showed that the native protein was the best recognized. For the prokaryotic one, both the denaturation applied for solubilisation of the bacterial inclusion bodies and the inability of bacterial cells to add N-linked glycosylation, are the reason for the poor hybridization. In contrast, KLH1-h expressed in eukaryotic insect cells is likely to be glycosylated. The incubation with the α-KLH1-antibodies resulting in the same weak detection, however, revealed that the linked carbohydrate side chains are not those expected. The establishment of SOE-PCR, together with further improvement, has enabled the generation of a clone encompassing the complete subunit KLH1-abcdefgh. The se-quence analysis compared to the original KLH1 sequence showed, however, that the resulting recombinant protein is defective in two histidines, required for the copper bind-ing sites in FU-1b and FU-1d and in three disulfide bridges (FU-1a, FU-1b and FU 1g). This is due to polymerase-related nucleotide exchanges, resulting in a changed amino acid sequence. Nevertheless, all eight potential N-glycosylation sites are present, leading to the speculation that the recombinant protein can in theory be fully glycosylated, which is the most important aspect for the clinical applicability of recombinant KLH as an im-munotherapeutic agent. The improvement of this method elaborated during the present work indicates bright prospects for the future generation of a correct cDNA sequence encoding for the complete KLH2 subunit.

Accuratezza diagnostica dell'ecografia con mezzo di contrasto nel predire l'evoluzione a breve termine in pazienti con morbo di Crohn

Obiettivi. L’ecografia con mezzo di contrasto (CEUS) può fornire informazioni sulla microvascolarizzazione della parete intestinale nella malattia di Crohn. L’infiammazione della parete intestinale non sembra essere correlata alla quantità di parete vascolarizzata (studi di pattern di vascolarizzazione, SVP) ma all’intensità del flusso di parete in un determinato periodo di tempo (studi di intensità-tempo, SIT). Scopo dello studio è valutare se gli studi SVP e/o SIT mediante CEUS siano in grado di mostrare il reale grado d’infiammazione della parete vascolare e se possano predire l’attività di malattia a 3 mesi. Materiali e metodi: 30 pazienti con malattia di Crohn venivano sottoposti a SVP e SIT mediante CEUS e venivano rivisti dopo 3 mesi. L’eCografia era eseguita con uno strumento dedicato con un software particolare per il calcolo delle curve intensità-tempo e con l’ausilio di un mezzo di contrasto (Sonovue). L’analisi quantitativa consisteva nella misura dell’area sotto la curva (AUC) (con cut-off tra malattia attiva e inattiva di 15) e di un intensità media (IM) con un cut-off di 10. Tutti gli esami venivano registrati e analizzati in modo digitale. Risultati: A T0: CDAI era inferiore a 150 in 22 pazienti e superiore a 150 in 8 pazienti; a T3: CDAI era inferiore a 150 in 19 pazienti e superiore a 150 in 11 pazienti. A T0 sia la CEUS SPV che la SIT evidenziavano bassa specificità, accuratezza diagnostica e valore predittivo negativo; a T3 la CEUS SVP mostrava bassa sensibilità e accuratezza diagnostica rispetto alla SIT che era in grado, in tutti i casi tranne uno, di predire l’attività clinica di malattia a tre mesi. Conclusioni: in questo studio, la CEUS-SIT ha mostrato buona accuratezza diagnostica nel predire l’attività clinica di malattia nel follow-up a breve termine di pazienti con malattia di Crohn.

Portal hypertension: a comparison between portal-venous pressure measurement and ARFI measurement of liver and spleen stiffness

PURPOSE. Portal pressure is measured invasively as Hepatic Venous Pressure Gradient (HVPG) in the angiography room. Liver stiffness measured by Fibroscan was shown to correlate with HVPG values below 12 mmHg. This is not surprising, since in cirrhosis the increase of portal pressure is not directly linked with liver fibrosis and consequently to liver stiffness. We hypothesized that, given the spleen’s privileged location upstream to the whole portal system, splenic stiffness could provide relevant information about portal pressure. Aim of the study was to assess the relationship between liver and spleen stiffness measured by Virtual Touch™ (ARFI) and HVPG in cirrhotic patients. METHODS. 40 consecutive patients (30 males, mean age 62y, mean BMI=26, mean Child-Pugh A6, mean platelet count=92.000/mmc, 19 HCV+, 7 with ascites) underwent to ARFI stiffness measurement (10 valid measurements in right liver lobe both surface and centre, left lobe and 20 in the spleen) and HPVG, blindly to each other. Median ARFI values of 10 samplings on every liver area and of 20 samplings on spleen were calculated. RESULTS. Stiffness could be easily measured in all patients with ARFI, resulting a mean of 2,61±0,76, 2,5±0,62 and 2,55±0,66 m/sec in the liver areas and 3.3±0,5 m/s in the spleen. Median HPVG was 14 mmHg (range 5-27); 28 patients showed values ≥10 mmHg. A positive significant correlation was found between spleen stiffness and HPVG values (r=0.744, p<0.001). No significant correlation was found between all liver stiffness and HVPG (p>0,05). AUROC was calculated to test spleen stiffness ability in discriminating patients with HVPG ≥10. AUROC = 0.911 was obtained, with sensitivity of 69% and specificity of 91% at a cut-off of 3.26 m/s. CONCLUSION. Spleen stiffness measurement with ARFI correlates with HVPG in patients with cirrhosis, with a potential of identifying patients with clinically significant portal hypertension.

Optimierung der Pharmakotherapie schizophrener Patienten durch objektive Symptomerfassung und Therapeutisches Drug Monitoring

Der Erfolg einer Schizophrenie-Behandlung ist zum größten Teil abhängig vom Ansprechen des Patienten auf seine antipsychotische Medikation. Welches Medikament und welche Dosis bei einem individuellen Patienten wirksam sind, kann derzeit erst nach mehrwöchiger Behandlung beurteilt werden. Ein Grund für variierendes Therapieansprechen sind variable Plasmakonzentrationen der Antipsychotika. Ziel dieser Arbeit war es, zu untersuchen, in wieweit der Therapieerfolg zu einem frühen Zeitpunkt der Behandlung durch objektive Symptomerfassung vorhersagbar ist und welche Faktoren die hohe Variabilität der Antipsychotikaspiegel im Blut beeinflussen. rnEine 18-monatige naturalistische klinische Studie an schizophrenen Patienten wurde durchgeführt, um folgende Fragen zu beantworten: Kann man das Therapieansprechen prädizieren und welche Instrumente sind dafür geeignet? Die Psychopathologie wurde anhand zweier Messskalen (Brief Psychiatric Rating Scale, BPRS und Clinical Global Impressions, CGI) wöchentlich ermittelt, um die Besserung der Krankheitssymptome im Verlauf von 8 Wochen zu bewerten. Therapiebegleitend wurden noch die Serum-Konzentrationen der Antipsychotika gemessen. Objektive Symptomerfassung durch BPRS oder CGI waren als Messinstrumente geeignet, Therapieansprechen vorherzusagen. Bezogen auf den Behandlungsbeginn war eine Verminderung der Symptome hoch prädiktiv für späteres Therapieversagen oder -ansprechen. Eine Verminderung um mehr als 36,5% auf der BPRS Skala in Woche 2 wurde als signifikanter Schwellenwert für Nichtansprechen ermittelt. Patienten, deren Symptombesserung unterhalb des Schwellenwertes lag, hatten eine 11,2-fach höhere Wahrscheinlichkeit, am Ende der Studie nicht auf ihre medikamentöse Therapie anzusprechen als die Patienten, die sich um mindestens 36,5% verbesserten. Andere Faktoren, wie Alter, Geschlecht, Dauer der Erkrankung oder Anzahl der stationären Aufenthalte hatten keinen Einfluss auf die Prädiktion des Therapieansprechens. Therapeutische Antipsychotika-Spiegel übten einen positiven Einfluss auf die Ansprechrate aus. Bei Patienten mit therapeutischen Spiegeln war das Ansprechen rascher und die Ansprechrate größer als unter denjenigen deren Spiegel außerhalb der therapeutisch üblichen Bereiche lag. rnEine wichtige Voraussetzung für den Einsatz von TDM ist das Vorhandensein einer präzisen, reproduzierbaren, zeit- und kostensparenden analytischen Methode zur quantitativen Bestimmung der untersuchten Substanzen. Die Entwicklung und Validierung einer solchen geeigneten Methode wurde für den Nachweis von Haloperidol vorgenommen. Eine HPLC-Methode mit Säulenschaltung erwies sich für TDM geeignet. rnBasierend auf den Ergebnissen der eigenen klinischen Studie zur Response Prädiktion wurde untersucht, welche Faktoren die Variabilität der Pharmakokinetik von Antipsychotika beeinflussen. Die Variabilität der Pharmakokinetik ist ein Grund für fehlendes oder unzureichendes Ansprechen. Es wurde zum einen der Einfluss der galenischen Formulierung auf die Freisetzung und zum anderen der Einfluss von entzündlichen Prozessen auf die Metabolisierung eines Antipsychotikums untersucht. Dazu wurden Patientendaten retrospektiv ausgewertet.rnDie Analyse von 247 Serumspiegeln von Patienten, die mit Paliperidon in OROS®Formulierung, einer neu eingeführten Retardform, behandelt wurden, zeigte, dass die intraindividuelle Variabilität der Talspiegel (Vk) von Paliperidon 35% betrug. Er war damit vergleichbar wie für nicht retardiertes Risperidon 32% (p=n.s.). Die Retardierung hatte demnach keinen Varianz mindernden Effekt auf die Talspiegel des Antipsychotikums. Der Wirkstoff-Konzentrations-Bereich lag bei 21-55 ng/ml und entsprach ebenfalls nahezu dem therapeutischen Bereich von Risperidon (20-60 ng/ml). rnEntzündliche Prozesse können die Metabolisierung von Medikamenten verändern. Dies wurde bisher für Medikamente nachgewiesen, die über CYP1A2 abgebaut werden. Durch die eigene Analyse von 84 Patienten-Serumspiegeln konnte festgestellt werden, dass die Metabolisierung von Quetiapin während eines entzündlichen Prozesses beeinträchtigt war, wahrscheinlich durch Hemmung von CYP3A4. Dies sprach dafür, dass auch Wirkstoffe, die über CYP3A4 abgebaut werden, während eines entzündlichen Prozesses im Körper in ihrer Pharmakokinetik beeinträchtigt sein können. Aus diesem Grund sollte während einer Infektion unter der Therapie mit Quetiapin besonders auf die Nebenwirkungen geachtet werden und der Serumspiegel sollte in dieser Zeit überwacht werden, um den Patienten vor eventuellen Nebenwirkungen oder sogar Intoxikationen zu schützen. rnDie Befunde dieser Arbeit zeigen, dass bei einer Behandlung schizophrener Patienten mit Antipsychotika die Messung der Psychopathologie zur Vorhersage des Therapieansprechens und die Messung der Blutspiegel zur Identifizierung von Faktoren, die die pharmakokinetische Variabilität bedingen, geeignet sind. Objektive Symptomerfassung und Therapeutisches Drug Monitoring sind demnach Instrumente, die für die Steuerung der antipsychotischen Pharmakotherapie genutzt werden sollten.rn

Metodi di misurazione e implicazioni dell'albuminuria e della proteinuria nel cane

La proteinuria è un marker di danno renale nel cane. L’obiettivo dello studio è di valutare la capacità del dipstick urinario e dell’UPC di diagnosticare precocemente l’albuminuria nel cane. Sono stati raccolti 868 campioni di urina, con sedimento spento e assenza di ematuria, nell’Ospedale Didattico Veterinario della Facoltà di Medicina Veterinaria di Bologna. Per 550 campioni è stata effettuata l’analisi delle urine, la misurazione dell’UPC e dell’UAC, mentre UPC e UAC sono stati misurati in tutti gli 868 campioni. I campioni di urina sono stati analizzati con il metodo dipstick mediante lettura automatizzata. Utilizzando come valore di riferimento l’UAC è stata valutata l’accuratezza diagnostica del dipstick urinario e dell’UPC. L’intervallo di riferimento dell’UAC (0-0,024) è stato determinato utilizzando 60 cani sani. I dati raccolti sono stati classificati utilizzando differenti cut-off per il peso specifico urinario (1012 o 1030), per la proteinuria al dipstick (30 o 100 mg/dl), per l’UPC (0,2) e per l’UAC (0,024). Sono stati valutati l’agreement diagnostico e la correlazione di Spearman tra dipstick, UPC e UAC. E’ stata stimata l’accuratezza diagnostica misurando l’area al di sotto della curva di ROC nell’analisi dell’UAC. Il livello di significatività è stato definito per p < 0,05. Indipendentemente dal peso specifico urinario, l’agreement diagnostico tra dipstick, UPC e UAC è risultato forte (k=0,62 e k=0,61, rispettivamente; p<0,001) con valori di dipstick ≥30 mg/dl, debole (k=0,27 e k=0,26, rispettivamente; p<0,001) con valori di dipstick ≥100 mg/dl. L’accuratezza diagnostica del dipstick messa a confronto con UPC e con UAC è molto buona (AUC 0,84 e 0,84, rispettivamente; p<0,001) e i risultati negativi al dipstick presentano il 100% di sensitività. UPC e UAC sono fortemente correlate (r=0,90; p<0,001). Mettendo a confronto UPC e UAC, l’accuratezza diagnostica è risultata eccellente (AUC 0,94; p<0,001), con massima sensitività e specificità per UPC≥0.3.

Il monitoraggio della qualità di vita e dei bisogni di pazienti oncologici e caregiver: il caso ANT

La Fondazione ANT rappresenta una delle più ampie esperienze al mondo di assistenza socio-sanitaria gratuita a domicilio ai malati di tumore, tramite équipe di specialisti costituite da medici, psicologi e infermieri. La patologia oncologica ha un enorme impatto sul benessere dei pazienti. Un modo per raggruppare i diversi sintomi di disagio psicologico è utilizzare il concetto di distress, che sarebbe importante monitorare in modo semplice e veloce. Primo studio: 66 pazienti oncologici (40% uomini; età media 54 anni) in cure palliative domiciliari. Il 79% dei pazienti ha mostrato livelli clinicamente significativi di distress. Il 55% dei partecipanti allo studio ha riportato alti livelli di ansia, e l'81% dei pazienti ha riportato alti livelli di depressione. Dall'analisi delle curve ROC il singolo item del Distress Thermometer, con un cut-off maggiore o uguale a 4, è stato in grado di rilevare il 97% dei soggetti con punteggi clinici di ansia e depressione, quindi può essere utilizzato anche come uno strumento di screening precoce rapido ed affidabile per i disturbi dell'umore. I familiari sono la prima risorsa dei malati di tumore, e l'identificazione dei loro bisogni è utile per individuare chi ha maggiore necessità di aiuto ed in quali aree. Secondo studio: 115 caregiver di pazienti oncologici (37% uomini; età media 52 anni). Di seguito i bisogni più frequenti. Salute psicofisica: “preoccupazioni circa il/la paziente” (72%), ansia (53%) e rabbia (52%). Informazioni: “come prendersi cura del paziente” (64%), “terapie alternative e/o complementari” (64%) e “come gestire lo stress” (57%). Servizi e strutture sanitarie: “un operatore di riferimento”, (65%), “cure infermieristiche a domicilio” (62%), “indicazioni su servizi ospedalieri” (57%), ed “assistenza per caregiver, ad esempio consulenza psicologica” (55%). Il monitoraggio dei bisogni consentirebbe un'ottimizzazione dell'assistenza, prevenendo situazioni che potrebbero compromettere il benessere della famiglia e la qualità dell'assistenza fornita al paziente.