Hypertension, hypercholesterolemia, hyperaldosteronism: a genetic perspective for personalized therapy.

Essential, primary, or idiopathic hypertension is defined as high BP in which secondary causes such as renovascular disease, renal failure, pheochromocytoma, hyperaldosteronism, or other causes of secondary hypertension are not present. Essential hypertension accounts for 80-90% of all cases of hypertension; it is a heterogeneous disorder, with different patients having different causal factors that may lead to high BP. Life-style, diet, race, physical activity, smoke, cultural level, environmental factors, age, sex and genetic characteristics play a key role in the increasing risk. Conversely to the essential hypertension, secondary hypertension is often associated with the presence of other pathological conditions such as dyslipidaemia, hypercholesterolemia, diabetes mellitus, obesity and primary aldosteronism. Amongst them, primary aldosteronism represents one of the most common cause of secondary hypertension, with a prevalence of 5-15% depending on the severity of blood pressure. Besides high blood pressure values, a principal feature of primary aldosteronism is the hypersecretion of mineralcorticoid hormone, aldosterone, in a manner that is fairly autonomous of the renin-angiotensin system. Primary aldosteronism is a heterogeneous pathology that may be divided essentially in two groups, idiopathic and familial form. Despite all this knowledge, there are so many hypertensive cases that cannot be explained. These individuals apparently seem to be healthy, but they have a great risk to develop CVD. The lack of known risk factors makes difficult their classification in a scale of risk. Over the last three decades a good help has been given by the pharmacogenetics/pharmacogenomics, a new area of the traditional pharmacology that try to explain and find correlations between genetic variation, (rare variations, SNPs, mutations), and the risk to develop a particular disease.

Chemische und physikalische Charakterisierung von Aerosolpartikeln aus besonderen anthropogenen Emissionsquellen : ein integrativer Ansatz mittels online (HR-ToF-AMS)- und komplementärer offline (ATR-FTIR-Spektroskopie)-Analytik

Die Gesundheitseffekte von Aerosolpartikeln werden stark von ihren chemischen und physikalischen Eigenschaften und somit den jeweiligen Bildungsprozessen und Quellencharakteristika beeinflusst. Während die Hauptquellen der anthropogenen Partikelemissionen gut untersucht sind, stellen die spezifischen Emissionsmuster zahlreicher kleiner Aerosolquellen, welche lokal und temporär zu einer signifikanten Verschlechterung der Luftqualität beitragen können, ein Forschungsdesiderat dar.rnIn der vorliegenden Arbeit werden in kombinierten Labor- und Feldmessungen durch ein integratives Analysekonzept mittels online (HR-ToF-AMS ) und filterbasierter offline (ATR-FTIR-Spektroskopie ) Messverfahren die weitgehend unbekannten physikalischen und chemischen Eigenschaften der Emissionen besonderer anthropogener Aerosolquellen untersucht. Neben einem Fußballstadion als komplexe Mischung verschiedener Aerosolquellen wie Frittieren und Grillen, Zigarettenrauchen und Pyrotechnik werden die Emissionen durch Feuerwerkskörper, landwirtschaftliche Intensivtierhaltung (Legehennen), Tief- und Straßenbauarbeiten sowie abwasserbürtige Aerosolpartikel in die Studie mit eingebunden. Die primären Partikelemissionen der untersuchten Quellen sind vorrangig durch kleine Partikelgrößen (dp < 1 µm) und somit eine hohe Lungengängigkeit gekennzeichnet. Dagegen zeigen die Aerosolpartikel im Stall der landwirtschaftlichen Intensivtierhaltung sowie die Emissionen durch die Tiefbauarbeiten einen hohen Masseanteil von Partikeln dp > 1 µm. Der Fokus der Untersuchung liegt auf der chemischen Charakterisierung der organischen Partikelbestandteile, welche für viele Quellen die NR-PM1-Emissionen dominieren. Dabei zeigen sich wichtige quellenspezifische Unterschiede in der Zusammensetzung der organischen Aerosolfraktion. Die beim Abbrand von pyrotechnischen Gegenständen freigesetzten sowie die abwasserbürtigen Aerosolpartikel enthalten dagegen hohe relative Gehalte anorganischer Substanzen. Auch können in einigen spezifischen Emissionen Metallverbindungen in den AMS-Massenspektren nachgewiesen werden. Über die Charakterisierung der Emissionsmuster und -dynamiken hinaus werden für einige verschiedenfarbige Rauchpatronen sowie die Emissionen im Stall der Intensivtierhaltung Emissionsfaktoren bestimmt, die zur quantitativen Bilanzierung herangezogen werden können. In einem weiteren Schritt werden anhand der empirischen Daten die analytischen Limitierungen der Aerosolmassenspektrometrie wie die Interferenz organischer Fragmentionen durch (Hydrogen-)Carbonate und mögliche Auswertestrategien zur Überwindung dieser Grenzen vorgestellt und diskutiert.rnEine umfangreiche Methodenentwicklung zur Verbesserung der analytischen Aussagekraft von organischen AMS-Massenspektren zeigt, dass für bestimmte Partikeltypen einzelne Fragmentionen in den AMS-Massenspektren signifikant mit ausgewählten funktionellen Molekülgruppen der FTIR-Absorptionsspektren korrelieren. Bedingt durch ihre fehlende Spezifität ist eine allgemeingültige Interpretation von AMS-Fragmentionen als Marker für verschiedene funktionelle Gruppen nicht zulässig und häufig nur durch die Ergebnisse der komplementären FTIR-Spektroskopie möglich. Des Weiteren wurde die Verdampfung und Ionisation ausgewählter Metallverbindungen im AMS analysiert. Die Arbeit verdeutlicht, dass eine qualitative und quantitative Auswertung dieser Substanzen nicht ohne Weiteres möglich ist. Die Gründe hierfür liegen in einer fehlenden Reproduzierbarkeit des Verdampfungs- und Ionisationsprozesses aufgrund von Matrixeffekten sowie der in Abhängigkeit vorangegangener Analysen (Verdampferhistorie) in der Ionisationskammer und auf dem Verdampfer statt-findenden chemischen Reaktionen.rnDie Erkenntnisse der Arbeit erlauben eine Priorisierung der untersuchten anthropogenen Quellen nach bestimmten Messparametern und stellen für deren Partikelemissionen den Ausgangpunkt einer Risikobewertung von atmosphärischen Folgeprozessen sowie potentiell negativen Auswirkungen auf die menschliche Gesundheit dar. rn

"The White Road" di Neil Gaiman: una proposta di traduzione

L'obiettivo del presente elaborato è di fornire una proposta di traduzione dall'inglese all'italiano del poema "The White Road" di Neil Gaiman, pubblicato in Ruby Slippers, Golden Tears (1995) e in Smoke and Mirrors (1998). L'elaborato è articolato in: una breve presentazione dell’autore, con accento sui temi ricorrenti presenti nelle sue opere; una descrizione del testo scelto, sia in termini di struttura che di contenuti e riferimenti culturali; la proposta di traduzione con testo originale a fronte; un’analisi dei problemi traduttivi riscontrati con le relative soluzioni adottate.

Test sperimentali e modellazione di una torre di lavaggio per la filtrazione di particolato sottile in impianti di combustione delle biomasse

This study investigates biomass and particulate matter also known as PM produced from the combustion of a domestic boiler powered by mais and how to separate PM from the stream of smoke output from the boiler using wet scrubber with structured packing. Sperimentations show the inefficiency of the separator used, so we provide an optimization of the structured packing changing geometric parameters as angle of the bend or thickness of the channels. In order to obtain a higher separation efficiency we remove the structured packinkg and introduce a packed bed composed of spheres of polyethylene with a diameter of 3 mm.

Definizione del sistema di acquisizione e controllo di una sala prova motori

L’obiettivo della tesi è l’integrazione di alcuni dispositivi AVL e di un motore elettrico passo-passo lineare all’interno di un sistema di controllo e acquisizione dati per una sala prova motori. La sala prove in cui è svolto il lavoro è quella del laboratorio Hangar del Dipartimento di Ingegneria Industriale di Forlì. Inizialmente viene proposta una breve descrizione della sala prove; essa è divisa in una parte hardware, in cui vengono spiegati i principali device utilizzati per il controllo, e in una parte software, in cui vengono descritti i programmi utilizzati (LabView e TestIT). Successivamente, i capitoli centrali, si occuperanno dei componenti AVL e del motore lineare utilizzati in sala. Per quanto riguarda AVL i dispositivi da integrare sono la bilancia per il carburante 733s e lo smoke meter 415s. Si traccia quindi una descrizione degli impianti e si indicano i principi operativi. Entrambi sfruttano il linguaggio seriale, quindi si procede con la creazioni di un’interfaccia grafica in grado di convertire i comandi desiderati dall’utente in codice ASCII. Allo stesso modo viene affrontato il motore lineare NEMA. In questo caso il dialogo avviene tramite una connessione Ethernet. La parte centrale si conclude con un capitolo nel quale si spiega l’introduzione dei VI all’interno di TestIT e le problematiche che ne possono scaturire. Nell’appendice finale saranno descritte brevemente le connessioni pratiche e gli interventi di progettazione avvenuti per organizzare il rack.

Fine particulate matter measurements in Swiss restaurants, cafés and bars: what is the effect of spatial separation between smoking and non-smoking areas?

We performed 124 measurements of particulate matter (PM(2.5)) in 95 hospitality venues such as restaurants, bars, cafés, and a disco, which had differing smoking regulations. We evaluated the impact of spatial separation between smoking and non-smoking areas on mean PM(2.5) concentration, taking relevant characteristics of the venue, such as the type of ventilation or the presence of additional PM(2.5) sources, into account. We differentiated five smoking environments: (i) completely smoke-free location, (ii) non-smoking room spatially separated from a smoking room, (iii) non-smoking area with a smoking area located in the same room, (iv) smoking area with a non-smoking area located in the same room, and (v) smoking location which could be either a room where smoking was allowed that was spatially separated from non-smoking room or a hospitality venue without smoking restriction. In these five groups, the geometric mean PM(2.5) levels were (i) 20.4, (ii) 43.9, (iii) 71.9, (iv) 110.4, and (v) 110.3 microg/m(3), respectively. This study showed that even if non-smoking and smoking areas were spatially separated into two rooms, geometric mean PM(2.5) levels in non-smoking rooms were considerably higher than in completely smoke-free hospitality venues. PRACTICAL IMPLICATIONS: PM(2.5) levels are considerably increased in the non-smoking area if smoking is allowed anywhere in the same location. Even locating the smoking area in another room resulted in a more than doubling of the PM(2.5) levels in the non-smoking room compared with venues where smoking was not allowed at all. In practice, spatial separation of rooms where smoking is allowed does not prevent exposure to environmental tobacco smoke in nearby non-smoking areas.

Consensus Report: 2nd European Workshop on Tobacco Use Prevention and Cessation for Oral Health Professionals

Tobacco use has been identified as a major risk factor for oral disorders such as cancer and periodontal disease. Tobacco use cessation (TUC) is associated with the potential for reversal of precancer, enhanced outcomes following periodontal treatment, and better periodontal status compared to patients who continue to smoke. Consequently, helping tobacco users to quit has become a part of both the responsibility of oral health professionals and the general practice of dentistry. TUC should consist of behavioural support, and if accompanied by pharmacotherapy, is more likely to be successful. It is widely accepted that appropriate compensation of TUC counselling would give oral health professionals greater incentives to provide these measures. Therefore, TUC-related compensation should be made accessible to all dental professionals and be in appropriate relation to other therapeutic interventions. International and national associations for oral health professionals are urged to act as advocates to promote population, community and individual initiatives in support of tobacco use prevention and cessation (TUPAC) counselling, including integration in undergraduate and graduate dental curricula. In order to facilitate the adoption of TUPAC strategies by oral health professionals, we propose a level of care model which includes 1) basic care: brief interventions for all patients in the dental practice to identify tobacco users, assess readiness to quit, and request permission to re-address at a subsequent visit, 2) intermediate care: interventions consisting of (brief) motivational interviewing sessions to build on readiness to quit, enlist resources to support change, and to include cessation medications, and 3) advanced care: intensive interventions to develop a detailed quit plan including the use of suitable pharmacotherapy. To ensure that the delivery of effective TUC becomes part of standard care, continuing education courses and updates should be implemented and offered to all oral health professionals on a regular basis.

Hair analysis for Delta9-tetrahydrocannabinolic acid A--new insights into the mechanism of drug incorporation of cannabinoids into hair

Differentiation between external contamination and incorporation of drugs or their metabolites from inside the body via blood, sweat or sebum is a general issue in hair analysis and of high concern when interpreting analytical results. In hair analysis for cannabinoids the most common target is Delta9-tetrahydrocannabinol (THC), sometimes cannabidiol (CBD) and cannabinol (CBN) are determined additionally. After repeated external contamination by cannabis smoke these analytes are known to be found in hair even after performing multiple washing steps. A widely accepted strategy to unequivocally prove active cannabis consumption is the analysis of hair extracts for the oxidative metabolite 11-nor-9-carboxy-THC (THC-COOH). Although the acidic nature of this metabolite suggests a lower rate of incorporation into the hair matrix compared to THC, it is not fully understood up to now why hair concentrations of THC-COOH are generally found to be much lower (mostly <10 pg/mg) than the corresponding THC concentrations. Delta9-Tetrahydrocannabinolic acid A (THCA A) is the preliminary end product of the THC biosynthesis in the cannabis plant. Unlike THC it is non-psychoactive and can be regarded as a 'precursor' of THC being largely decarboxylated when heated or smoked. The presented work shows for the first time that THCA A is not only detectable in blood and urine of cannabis consumers but also in THC positive hair samples. A pilot experiment performed within this study showed that after oral intake of THCA A on a regular basis no relevant incorporation into hair occurred. It can be concluded that THCA A in hair almost exclusively derives from external contamination e.g. by side stream smoke. Elevated temperatures during the analytical procedure, particularly under alkaline conditions, can lead to decarboxylation of THCA A and accordingly increase THC concentrations in hair. Additionally, it has to be kept in mind that in hair samples tested positive for THCA A at least a part of the 'non-artefact' THC probably derives from external contamination as well, because in condensate of cannabis smoke both THC and THCA A are present in relevant amounts. External contamination by side stream smoke could therefore explain the great differences in THC and THC-COOH hair concentrations commonly found in cannabis users.

Reduction of Transient Particulate Matter Spikes with Decision Tree Based Control

Decision trees have been proposed as a basis for modifying table based injection to reduce transient particulate spikes during the turbocharger lag period. It has been shown that decision trees can detect particulate spikes in real time. In well calibrated electronically controlled diesel engines these spikes are narrow and are encompassed by a wider NOx spike. Decision trees have been shown to pinpoint the exact location of measured opacity spikes in real time thus enabling targeted PM reduction with near zero NOx penalty. A calibrated dimensional model has been used to demonstrate the possible reduction of particulate matter with targeted injection pressure pulses. Post injection strategy optimized for near stoichiometric combustion has been shown to provide additional benefits. Empirical models have been used to calculate emission tradeoffs over the entire FTP cycle. An empirical model based transient calibration has been used to demonstrate that such targeted transient modifiers are more beneficial at lower engine-out NOx levels.

Developing a smoking cessation program for Turkish-speaking migrants in Switzerland: novel findings and promising effects

Introduction: Recent studies show that smoking prevalence in the Turkish-speaking migrant population in Switzerland is substantially higher than in the general population. A specific group treatment for Turkish-speaking migrants was developed and tested in order to provide the migrant population with equal access to smoking cessation programs and to improve the migration-sensitive quality of such programs by sociocultural targeting. Methods: The evaluation of the program included quantitative (questionnaires t1 and t2 and follow-up by telephone) and qualitative methods (participant observation and semi-structured interviews). Results: The results showed that 37.7% of the 61 participants were smoke free at the 12-month follow-up. The factors of being in a partnership and using nicotine replacement products during the program were positively associated with successful cessation. We also demonstrated the importance of “strong ties” (strong relationships between participants) and the sensitivity of the program to sociocultural (e.g., social aspects of smoking in Turkish culture, which were addressed in relapse prevention), socioeconomic (e.g., low financial resources, which were addressed by providing the course for free), and migration-specific (e.g., underdeveloped access to smoking cessation programs, which was addressed using outreach strategy for recruiting) issues. Conclusions: Overall, the smoking cessation program was successfully tested and is now becoming implemented as a regular service of the Swiss Public Health Program for Tobacco Prevention (by the Swiss Association for Smoking Prevention).

Analysis and Prediction of Transient Opacity Spikes Using Dimensional Modeling

Dimensional modeling, GT-Power in particular, has been used for two related purposes-to quantify and understand the inaccuracies of transient engine flow estimates that cause transient smoke spikes and to improve empirical models of opacity or particulate matter used for engine calibration. It has been proposed by dimensional modeling that exhaust gas recirculation flow rate was significantly underestimated and volumetric efficiency was overestimated by the electronic control module during the turbocharger lag period of an electronically controlled heavy duty diesel engine. Factoring in cylinder-to-cylinder variation, it has been shown that the electronic control module estimated fuel-Oxygen ratio was lower than actual by up to 35% during the turbocharger lag period but within 2% of actual elsewhere, thus hindering fuel-Oxygen ratio limit-based smoke control. The dimensional modeling of transient flow was enabled with a new method of simulating transient data in which the manifold pressures and exhaust gas recirculation system flow resistance, characterized as a function of exhaust gas recirculation valve position at each measured transient data point, were replicated by quasi-static or transient simulation to predict engine flows. Dimensional modeling was also used to transform the engine operating parameter model input space to a more fundamental lower dimensional space so that a nearest neighbor approach could be used to predict smoke emissions. This new approach, intended for engine calibration and control modeling, was termed the "nonparametric reduced dimensionality" approach. It was used to predict federal test procedure cumulative particulate matter within 7% of measured value, based solely on steady-state training data. Very little correlation between the model inputs in the transformed space was observed as compared to the engine operating parameter space. This more uniform, smaller, shrunken model input space might explain how the nonparametric reduced dimensionality approach model could successfully predict federal test procedure emissions when roughly 40% of all transient points were classified as outliers as per the steady-state training data.

Advantages and Applications of Transforming Empirical Model Input Space with Dimensional Models

Model-based calibration of steady-state engine operation is commonly performed with highly parameterized empirical models that are accurate but not very robust, particularly when predicting highly nonlinear responses such as diesel smoke emissions. To address this problem, and to boost the accuracy of more robust non-parametric methods to the same level, GT-Power was used to transform the empirical model input space into multiple input spaces that simplified the input-output relationship and improved the accuracy and robustness of smoke predictions made by three commonly used empirical modeling methods: Multivariate Regression, Neural Networks and the k-Nearest Neighbor method. The availability of multiple input spaces allowed the development of two committee techniques: a 'Simple Committee' technique that used averaged predictions from a set of 10 pre-selected input spaces chosen by the training data and the "Minimum Variance Committee" technique where the input spaces for each prediction were chosen on the basis of disagreement between the three modeling methods. This latter technique equalized the performance of the three modeling methods. The successively increasing improvements resulting from the use of a single best transformed input space (Best Combination Technique), Simple Committee Technique and Minimum Variance Committee Technique were verified with hypothesis testing. The transformed input spaces were also shown to improve outlier detection and to improve k-Nearest Neighbor performance when predicting dynamic emissions with steady-state training data. An unexpected finding was that the benefits of input space transformation were unaffected by changes in the hardware or the calibration of the underlying GT-Power model.

Spatio-temporal Associations Between GOES Aerosol Optical Depth Retrievals and Ground-Level PM2.5

We assess the strength of association between aerosol optical depth (AOD) retrievals from the GOES Aerosol/Smoke Product (GASP) and ground-level fine particulate matter (PM2.5) to assess AOD as a proxy for PM2.5 in the United States. GASP AOD is retrieved from a geostationary platform and therefore provides dense temporal coverage with half-hourly observations every day, in contrast to once per day snapshots from polar-orbiting satellites. However, GASP AOD is based on a less-sophisticated instrument and retrieval algorithm. We find that correlations between GASP AOD and PM2.5 over time at fixed locations are reasonably high, except in the winter and in the western U.S. Correlations over space at fixed times are lower. Simple averaging over time actually reduces correlations over space dramatically, but statistical calibration allows averaging over time that produces strong correlations. These results and the data density of GASP AOD highlight its potential to help improve exposure estimates for epidemiological analyses. On average 40% of days in a month have a GASP AOD retrieval compared to 14% for MODIS and 4% for MISR. Furthermore, GASP AOD has been retrieved since November 1994, providing the possibility of a long-term record that pre-dates the availability of most PM2.5 monitoring data and other satellite instruments.

Prospectively assessed incidence, severity, and determinants of respiratory symptoms in the first year of life

Respiratory symptoms are common in infancy. Nevertheless, few prospective birth cohort studies have studied the epidemiology of respiratory symptoms in normal infants. The aim of this study was to prospectively obtain reliable data on incidence, severity, and determinants of common respiratory symptoms (including cough and wheeze) in normal infants and to determine factors associated with these symptoms. In a prospective population-based birth cohort, we assessed respiratory symptoms during the first year of life by weekly phone calls to the mothers. Poisson regression was used to examine the association between symptoms and various risk factors. In the first year of life, respiratory symptoms occurred in 181/195 infants (93%), more severe symptoms in 89 (46%). The average infant had respiratory symptoms for 4 weeks and 90% had symptoms for less than 12 weeks (range 0 to 23). Male sex, higher birth weight, maternal asthma, having older siblings and nursery care were associated with more, maternal hay fever with fewer respiratory symptoms. The association with prenatal maternal smoking decreased with time since birth. This study provides reliable data on the frequency of cough and wheeze during the first year of life in healthy infants; this may help in the interpretation of published hospital and community-based studies. The apparently reduced risk in children of mothers with hayfever but no asthma, and the decreasing effect of prenatal smoke exposure over time illustrate the complexity of respiratory pathology in the first year of life.

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis. Based on the limited evidence available, inhaled short-acting beta(2)-agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop. Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit. Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.