Studi epidemiologici su Pseudomonas syringae pv.actinidiae agente causale del cancro batterico in actinidia

Il cancro batterico dell’actinidia causato da Pseudomonas syringae pv.actinidiae (Psa) suscita grande interesse a livello globale a partire dal 2008. La malattia è comparsa in Giappone e in due anni ha avuto una diffusione epidemica in tutte le aree di coltivazione mondiale di actinidia. Gravi perdite economiche hanno attirato l’attenzione internazionale su questa problematica e grandi sforzi sono stati rivolti allo studio di questo patosistema ancora poco conosciuto. E’ emerso infatti che il patogeno può rimanere in fase latente per lunghi periodi senza causare sintomi caratteristici nelle piante infette, e che dalla comparsa dei sintomi la pianta muore nell’arco di un paio d’anni. Il monitoraggio ed il controllo della situazione è perciò di fondamentale importanza ed è ancora più importante prevenire la comparsa di nuovi focolai di infezione. A questo proposito sarebbe opportuno l’impiego di materiale vegetale di propagazione non infetto, ma in molti casi questo diventa difficile, dal momento che il materiale impiegato è generalmente quello asintomatico, non analizzato precedentemente per la presenza del patogeno. Negli ultimi anni sono state perciò messe a punto molte tecniche molecolari per l’identificazione di Psa direttamente da materiale vegetale. L’obiettivo di questo lavoro è stato quello di studiare l’epidemiologia di Psa in piante adulte infette e di verificare l’efficacia di metodi di diagnosi precoce per prevenire la malattia. A tale scopo il lavoro sperimentale è stato suddiviso in diverse fasi: i) studio della localizzazione, traslocazione e sopravvivenza di Psa nelle piante, a seguito di inoculazione in piante adulte di actinidia di ceppi marcati Psa::gfp; ii) studio della capacità di Psa di essere mantenuto in germogli di actinidia attraverso sette generazioni di micropropagazione dopo l’inoculazione delle piante madri con lo stesso ceppo marcato Psa::gfp; iii) studio ed applicazioni di un nuovo metodo di diagnosi precoce di Psa basato sull’analisi molecolare del “pianto”.

Ricerche sul lessico della provvidenza in Agostino

Questa ricerca è un’indagine semasiologica del lessico agostiniano della provvidenza divina, costituito dalle parole-chiave prouidentia, prouideo, prouidens, prouidus, prouisio, prouisor, prouisus, e dai lessemi in relazione logico-sintattica diretta con esse. La prospettiva è sia sincronica (si considerano tutte le attestazioni delle parole-chiave presenti nel corpus agostiniano), sia diacronica: si soppesano di volta in volta analogie e differenze agostiniane rispetto agli antecedenti, nell’intento di arricchire il panorama dei possibili modelli lessicali latini (pagani, biblici, patristici) di Agostino. I dati lessicali sono stati raccolti in una banca dati appositamente costituita, selezionati secondo i criteri di frequenza e pregnanza semantica, e analizzati per nuclei tematici, coincidenti in parte con i capitoli della tesi. Si studiano dapprima i lessemi che esprimono il governo della provvidenza (le famiglie lessicali di administro, guberno e rego, e altri lessemi che designano l’azione della provvidenza); sono poi analizzati lessemi e iuncturae in cui prevale l’idea del mistero della provvidenza. Gli ultimi due capitoli sono dedicati al tema della cura divina, e a quello della cosiddetta “pedagogia divina”: attraverso i segni esteriori, la provvidenza ‘richiama’ l’uomo a rientrare in se stesso. Un’appendice approfondisce infine l’uso agostiniano di Sap 6,16 e Sap 8,1. L’apporto di Agostino al lessico filosofico latino va individuato a livello semantico più che nell’innovazione lessicale. Accanto a suffissazione, composizione, calco, la metafora svolge un ruolo essenziale nella formazione del lessico dell’Ipponate, e proviene spesso da altre lingue tecniche oppure è radicata nel patrimonio di immagini tradizionali della religione pagana. Il debito di Agostino è indubbiamente verso Cicerone, ma anche verso Seneca, per l’uso in ambito esistenziale-biografico di alcuni lessemi. Agostino li trasferisce però dal piano umano a quello divino, come nel caso del concetto di admonitio: parte integrante del programma filosofico senecano; ‘richiamo’ della provvidenza per Agostino, concetto che risente anche dell’apporto di retorica ed esegesi.

Riprogettazione dei processi e informatizzazione di un reparto manutenzione. Il caso de "il Resto del Carlino"

In un contesto dinamico come quello odierno la competitività delle imprese è profondamente legata alla capacità di gestire i propri processi aziendali e di intervenire su di essi. Ciò presuppone un cambio di paradigma, da “qual è il mio ruolo nell’azienda?” a “qual è il mio ruolo nei processi aziendali?”, ovvero l’abbandono della logica funzionale a favore di quella per processi. Tale progetto di tesi, nato dal mio tirocinio in Poligrafici Printing S.p.a. (polo industriale del quotidiano “Il Resto del Carlino”), si pone l’obiettivo di illustrare, facilitare e promuovere la gestione per processi e la riprogettazione di questi ultimi come strumento per raggiungere flessibilità, controllo ed efficienza operativa, con particolare riferimento all’informatizzazione di un reparto manutenzione.

Dispositivi per l'assistenza "home care" dei pazienti diabetici

L’ obiettivo della tesi proposta è volto ad illustrare come la malattia diabetica può essere gestita a livello domiciliare attraverso dispositivi di monitoraggio della glicemia sempre più innovativi. La malattia diabetica è un disturbo metabolico che ha come manifestazione principale un aumento del livello di zucchero nel sangue (glicemia) dovuto ad una ridotta produzione di insulina, l’ormone secreto dal pancreas per utilizzare gli zuccheri e gli altri componenti del cibo e trasformarli in energia. È una delle patologie croniche a più ampia diffusione nel mondo, in particolare nei Paesi industrializzati, e costituisce una delle più rilevanti e costose malattie sociali della nostra epoca, soprattutto per il suo carattere di cronicità, per la tendenza a determinare complicanze nel lungo periodo e per il progressivo spostamento dell’insorgenza verso età giovanili. Le tecnologie applicate alla terapia del diabete hanno consentito negli ultimi vent’anni di raggiungere traguardi molto importanti, soprattutto per quanto riguarda l’ottimizzazione del controllo assiduo dei valori glicemici cercando di mantenerli il più costante possibile e ad un livello simile a quello fisiologico. La comunicazione medico-paziente è stata rivoluzionata dalla telemedicina che, offrendo la possibilità di una comunicazione agevole, permette di ottimizzare l’utilizzo dei dati raccolti attraverso l’automonitoraggio glicemico e di facilitare gli interventi educativi. I glucometri, che misurano la glicemia ‘capillare’, insieme ai microinfusori, sistemi di erogazione dell’insulina sia in maniera continua (fabbisogno basale), che ‘a domanda’ (boli prandiali), hanno sostanzialmente modificato l’approccio e la gestione del diabete da parte del medico, ma soprattutto hanno favorito al paziente diabetico un progressivo superamento delle limitazioni alle normali attività della vita imposte dalla malattia. Con il monitoraggio continuo della glicemia 24 ore su 24 infatti, si ha avuto il vantaggio di avere a disposizione un elevato numero di misurazioni puntiformi nell’arco della giornata attraverso sensori glicemici, che applicati sulla pelle sono in grado di ‘rilevare’ il valore di glucosio a livello interstiziale, per diversi giorni consecutivi e per mezzo di un trasmettitore wireless, inviano le informazioni al ricevitore che visualizza le letture ottenute dal sensore. In anni recenti, il concetto di SAP (Sensor-Augmented Insulin Pump) Therapy, è stato introdotto a seguito di studi che hanno valutato l’efficacia dell’utilizzo della pompa ad infusione continua di insulina (CSII, continuous subcutaneous insulin infusion) associato ai sistemi di monitoraggio in continuo della glicemia (CGM, continuous glucose monitoring) per un significativo miglioramento del controllo glicemico e degli episodi sia di ipoglicemia sia di iperglicemia prolungata. Oggi, grazie ad una nuova funzione è possibile interrompere automaticamente l’erogazione di insulina da parte del microinfusore quando la glicemia, rilevata dal sensore, scende troppo velocemente e raggiunge un limite di allarme. Integrare lettura della glicemia, infusione e sospensione automatica dell’erogazione di insulina in caso di ipoglicemia ha ovviamente aperto la porta al pancreas artificiale.

The influence of infill walls on seismic behavior of a historical building in Shanghai

Seismic assessment and seismic strengthening are the key issues need to be figured out during the process of protection and reusing of historical buildings. In this thesis the seismic behaviors of the hinged steel structure, a typical structure of historical buildings, i.e. hinged steel frames in Shanghai, China, were studied based on experimental investigations and theoretic analysis. How the non-structural members worked with the steel frames was analyzed thoroughly. Firstly, two 1/4 scale hinged steel frames were constructed based on the structural system of Bund 18, a historical building in Shanghai: M1 model without infill walls, M2 model with infill walls, and tested under the horizontal cyclic loads to investigate their seismic behavior. The Shaking Table Test and its results indicated that the seismic behavior of the hinged steel frames could be improved significantly with the help of non-structural members, i.e., surrounding elements outside the hinged steel frames and infilled walls. To specify, the columns are covered with bricks, they consist of I shape formed steel sections and steel plates, which are clenched together. The steel beams are connected to the steel column by steel angle, thus the structure should be considered as a hinged frame. And the infilled wall acted as a compression diagonal strut to withstand the horizontal load, therefore, the seismic capacity and stiffness of the hinged steel frames with infilled walls could be estimated by using the equivalent compression diagonal strut model. A SAP model has been constructed with the objective to perform a dynamic nonlinear analysis. The obtained results were compared with the results obtained from Shaking Table Test. The Test Results have validated that the influence of infill walls on seismic behavior can be estimated by using the equivalent diagonal strut model.

The transcriptional regulator megakaryoblastic leukemia-1 mediates serum response factor-independent activation of tenascin-C transcription by mechanical stress

The extracellular matrix protein tenascin-C (TNC) is up-regulated in processes influenced by mechanical stress, such as inflammation, tissue remodeling, wound healing, and tumorigenesis. Cyclic strain-induced TNC expression depends on RhoA-actin signaling, the pathway that regulates transcriptional activity of serum response factor (SRF) by its coactivator megakaryoblastic leukemia-1 (MKL1). Therefore, we tested whether MKL1 controls TNC transcription. We demonstrate that overexpression of MKL1 strongly induces TNC expression in mouse NIH3T3 fibroblasts and normal HC11 and transformed 4T1 mammary epithelial cells. Part of the induction was dependant on SRF and a newly identified atypical CArG box in the TNC promoter. Another part was independent of SRF but required the SAP domain of MKL1. An MKL1 mutant incapable of binding to SRF still strongly induced TNC, while induction of the SRF target c-fos was abolished. Cyclic strain failed to induce TNC in MKL1-deficient but not in SRF-deficient fibroblasts, and strain-induced TNC expression strongly depended on the SAP domain of MKL1. Promoter-reporter and chromatin immunoprecipitation experiments unraveled a SAP-dependent, SRF-independent interaction of MKL1 with the proximal promoter region of TNC, attributing for the first time a functional role to the SAP domain of MKL1 in regulating gene expression.

Pentraxins and atherosclerosis: the role of PTX3

Pentraxins are a family of evolutionarily conserved multifunctional pattern-recognition proteins characterized by a cyclic multimeric structure. Based on the primary structure of the subunit, the pentraxins are divided into two groups: short pentraxins and long pentraxins. C-reactive protein (CRP) and serum amyloid P-component (SAP) are the two short pentraxins. The prototype protein of the long pentraxin group is pentraxin 3 (PTX3). CRP and SAP are produced primarily in the liver in response to IL-6, while PTX3 is produced by a variety of tissues and cells and in particular by innate immunity cells in response to proinflammatory signals and Toll-like receptor (TLR) engagement. PTX3 interacts with several ligands, including growth factors, extracellular matrix components and selected pathogens, playing a role in complement activation and facilitating pathogen recognition by phagocytes, acting as a predecessor of antibodies. In addition, PTX3 is essential in female fertility by acting as a nodal point for the assembly of the cumulus oophorus hyaluronan-rich extracellular matrix. Here we will concisely review the general properties of PTX3 in the context of the pentraxin superfamily and discuss recent data suggesting that PTX3 plays a cardiovascular protective effect. PTX3 may represent a new marker in vascular pathology which correlates with the risk of developing vascular events.

Prevention and control of surgical site infections: review of the Basel Cohort Study

INTRODUCTION: Surgical site infections (SSI) are the most common hospital-acquired infections among surgical patients, with significant impact on patient morbidity and health care costs. The Basel SSI Cohort Study was performed to evaluate risk factors and validate current preventive measures for SSI. The objective of the present article was to review the main results of this study and its implications for clinical practice and future research. SUMMARY OF METHODS OF THE BASEL SSI COHORT STUDY: The prospective observational cohort study included 6,283 consecutive general surgery procedures closely monitored for evidence of SSI up to 1 year after surgery. The dataset was analysed for the influence of various potential SSI risk factors, including timing of surgical antimicrobial prophylaxis (SAP), glove perforation, anaemia, transfusion and tutorial assistance, using multiple logistic regression analyses. In addition, post hoc analyses were performed to assess the economic burden of SSI, the efficiency of the clinical SSI surveillance system, and the spectrum of SSI-causing pathogens. REVIEW OF MAIN RESULTS OF THE BASEL SSI COHORT STUDY: The overall SSI rate was 4.7% (293/6,283). While SAP was administered in most patients between 44 and 0 minutes before surgical incision, the lowest risk of SSI was recorded when the antibiotics were administered between 74 and 30 minutes before surgery. Glove perforation in the absence of SAP increased the risk of SSI (OR 2.0; CI 1.4-2.8; p <0.001). No significant association was found for anaemia, transfusion and tutorial assistance with the risk of SSI. The mean additional hospital cost in the event of SSI was CHF 19,638 (95% CI, 8,492-30,784). The surgical staff documented only 49% of in-hospital SSI; the infection control team registered the remaining 51%. Staphylococcus aureus was the most common SSI-causing pathogen (29% of all SSI with documented microbiology). No case of an antimicrobial-resistant pathogen was identified in this series. CONCLUSIONS: The Basel SSI Cohort Study suggested that SAP should be administered between 74 and 30 minutes before surgery. Due to the observational nature of these data, corroboration is planned in a randomized controlled trial, which is supported by the Swiss National Science Foundation. Routine change of gloves or double gloving is recommended in the absence of SAP. Anaemia, transfusion and tutorial assistance do not increase the risk of SSI. The substantial economic burden of in-hospital SSI has been confirmed. SSI surveillance by the surgical staff detected only half of all in-hospital SSI, which prompted the introduction of an electronic SSI surveillance system at the University Hospital of Basel and the Cantonal Hospital of Aarau. Due to the absence of multiresistant SSI-causing pathogens, the continuous use of single-shot single-drug SAP with cefuroxime (plus metronidazole in colorectal surgery) has been validated.

Incorporation of a preexisting scar in the star-flap technique for nipple reconstruction

This report describes the authors' currently favored method of nipple reconstruction in cases of a pre-existing scar on the breast mound that passes through the intended site of nipple reconstruction.

Reconstruction of large supra-eyebrow and forehead defects using the hatchet flap principle and sparing sensory nerve branches

To reconstruct a forehead defect, a plastic surgeon must be knowledgeable about the neural, vascular, and muscular anatomy. The position of fixed structures such as eyebrows and hairline should be respected. For the past 5 years, we have used double hatchet flaps for reconstruction of relatively large supra-eyebrow and forehead defects. Because this flap does not appear to be among the techniques used by young plastic surgeons, we thought that it would be valuable to report our experience.

An early warning system for hypoglycemic/hyperglycemic events based on fusion of adaptive prediction models

Early warning of future hypoglycemic and hyperglycemic events can improve the safety of type 1 diabetes mellitus (T1DM) patients. The aim of this study is to design and evaluate a hypoglycemia/hyperglycemia early warning system (EWS) for T1DM patients under sensor-augmented pump (SAP) therapy.

Coronary plaque composition of culprit/target lesions according to the clinical presentation: a virtual histology intravascular ultrasound analysis

AIMS: To evaluate the plaque composition obtained by virtual histology (VH) IVUS according to the clinical presentation and to compare those data to previously published histopathology data. METHODS AND RESULTS: VH was performed on 95 de novo significant lesions (>75% stenosis) in 85 patients [28 acute coronary syndrome (ACS) patients, 30 lesions; 57 stable angina pectoris (SAP) patients, 65 lesions]. There were a higher prevalence of positive remodelling (47 vs. 22%, P=0.013), thrombus (20 vs. 1.5%, P=0.0037), and echo-lucent area (23.3 vs. 7.7%, P=0.047) in ACS patients. At the minimal lumen site, fibrous plaque area was significantly larger in ACS lesions than in SAP lesions (66.0+/-10.7 vs. 61.4+/-8.9%, P=0.034), whereas necrotic core and dense calcium plaque area were smaller in ACS lesions (Necrotic core: 6.8+/-6.0 vs. 11.0+/-8.3%, P=0.02; Dense calcium: 2.6+/-3.0 vs. 4.9+/-5.8%, P=0.03). No differences in rate of thin cap fibroatheroma, thick fibrotheroma, or for the presence of multiple necrotic core layers were observed between both groups. CONCLUSION: Plaque composition obtained by VH-IVUS shows less necrotic core and more fibrous tissue in ACS compared to SAP lesions, which is in contradiction with previously published histopathologic data.

Heart rate variability does not discriminate between different levels of haemodynamic responsiveness during surgical anaesthesia

BACKGROUND: Hypnotic depth but not haemodynamic responsiveness is measured with EEG-based monitors. In this study we compared heart rate variability (HRV) in unstimulated patients and stimulation-induced HRV at different levels of anaesthesia. METHODS: A total of 95 ASA I or II patients were randomly assigned to five groups (Group 1: BIS 45(5), remifentanil 1 ng ml(-1); Group 2: BIS 45(5), remifentanil 2 ng ml(-1); Group 3: BIS 45(5), remifentanil 4 ng ml(-1); Group 4: BIS 30(5), remifentanil 2 ng ml(-1); Group 5: BIS 60(5), remifentanil 2 ng ml(-1)). A time- and frequency-domain analysis of the RR interval (RRI) from the electrocardiogram was performed. HRV before induction, before and after a 5 s tetanic stimulus of the ulnar nerve, and before and after tracheal intubation was compared between groups, between stimuli, and between responders to intubation [systolic arterial pressure (SAP) increase >20 mm Hg, a maximal heart rate (HR) after intubation >90 min(-1) or both] and non-responders (anova). RESULTS: Induction of anaesthesia significantly lowered HR and HRV. Mean RRI before stimulation was higher in G3 than in G1, G2, and G4 (P < 0.001), whereas the other HRV parameters were similar. Intubation induced a greater HRV response than tetanic stimulation. The mean RRI after intubation was lower in G3 compared with the other groups and the sd of the RRI after tetanic stimulation was lower in G3 compared with G5. Otherwise, unstimulated HRV and stimulation-induced HRV were similar in responders and non-responders. CONCLUSION: HRV parameters discriminate between awake and general anaesthesia, are different after tracheal intubation and a 5 s ulnar nerve stimulation, but do not discriminate between different levels of haemodynamic responsiveness during surgical anaesthesia.

Distally based abductor hallucis muscle flap: anatomic basis and clinical application

Although rarely used, the abductor hallucis muscle has its indications in coverage of small defects at the medial aspect of the hindfoot as a proximally based muscle flap. The authors describe a 69-year-old female patient in whom the abductor hallucis muscle was used as a distally based flap to reconstruct a defect in the forefoot. An anatomic study was undertaken on two cadaveric feet to explore the practicality of the distally based abductor hallucis muscle flap before it was applied clinically. The distally based abductor muscle flap receives its blood supply from minor and major pedicles in a retrograde fashion from both the dorsal arterial network and the deep plantar system, through communicating branches with the medial plantar artery distally. Transposition of the distally based hallucis flap is only advisable in individuals who have no vascular compromise in the lower leg and foot. To the authors' knowledge, this modification has not yet been described in the available literature.