Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center

Most cases of sporadic primary hyperparathyroidism present disturbances in a single parathyroid gland and the surgery of choice is adenomectomy. Conversely, hyperparathyroidism associated with multiple endocrine neoplasia type 1 (hyperparathyroidism/multiple endocrine neoplasia type 1) is an asynchronic, asymmetrical multiglandular disease and it is surgically approached by either subtotal parathyroidectomy or total parathyroidectomy followed by parathyroid auto-implant to the forearm. In skilful hands, the efficacy of both approaches is similar and both should be complemented by prophylactic thymectomy. In a single academic center, 83 cases of hyperparathyroidism/ multiple endocrine neoplasia type 1 were operated on from 1987 to 2010 and our first surgical choice was total parathyroidectomy followed by parathyroid auto-implant to the non-dominant forearm and, since 1997, associated transcervical thymectomy to prevent thymic carcinoid. Overall, 40% of patients were given calcium replacement (mean intake 1.6 g/day) during the first months after surgery, and this fell to 28% in patients with longer follow-up. These findings indicate that several months may be needed in order to achieve a proper secretion by the parathyroid auto-implant. Hyperparathyroidism recurrence was observed in up to 15% of cases several years after the initial surgery. Thus, long-term follow-up is recommended for such cases. We conclude that, despite a tendency to subtotal parathyroidectomy worldwide, total parathyroidectomy followed by parathyroid auto-implant is a valid surgical option to treat hyperparathyroidism/multiple endocrine neoplasia type 1. Larger comparative systematic studies are needed to define the best surgical approach to hyperparathyroidism/multiple endocrine neoplasia type 1.

Analisi e valutazione delle performance acustiche degli aeromobili nella fase di atterraggio

Nella tesi si analizzano le principali fonti del rumore aeronautico, lo stato dell'arte dal punto di vista normativo, tecnologico e procedurale. Si analizza lo stato dell'arte anche riguardo alla classificazione degli aeromobili, proponendo un nuovo indice prestazionale in alternativa a quello indicato dalla metodologia di certificazione (AC36-ICAO) Allo scopo di diminuire l'impatto acustico degli aeromobili in fase di atterraggio, si analizzano col programma INM i benefici di procedure CDA a 3° rispetto alle procedure tradizionali e, di seguito di procedure CDA ad angoli maggiori in termini di riduzione di lunghezza e di area delle isofoniche SEL85, SEL80 e SEL75.

The photosynthetic bacterial reaction center in native and artificial envirnoments: effects on light-induced electron transfer

In this thesis we focussed on the characterization of the reaction center (RC) protein purified from the photosynthetic bacterium Rhodobacter sphaeroides. In particular, we discussed the effects of native and artificial environment on the light-induced electron transfer processes. The native environment consist of the inner antenna LH1 complex that copurifies with the RC forming the so called core complex, and the lipid phase tightly associated with it. In parallel, we analyzed the role of saccharidic glassy matrices on the interplay between electron transfer processes and internal protein dynamics. As a different artificial matrix, we incorporated the RC protein in a layer-by-layer structure with a twofold aim: to check the behaviour of the protein in such an unusual environment and to test the response of the system to herbicides. By examining the RC in its native environment, we found that the light-induced charge separated state P+QB - is markedly stabilized (by about 40 meV) in the core complex as compared to the RC-only system over a physiological pH range. We also verified that, as compared to the average composition of the membrane, the core complex copurifies with a tightly bound lipid complement of about 90 phospholipid molecules per RC, which is strongly enriched in cardiolipin. In parallel, a large ubiquinone pool was found in association with the core complex, giving rise to a quinone concentration about ten times larger than the average one in the membrane. Moreover, this quinone pool is fully functional, i.e. it is promptly available at the QB site during multiple turnover excitation of the RC. The latter two observations suggest important heterogeneities and anisotropies in the native membranes which can in principle account for the stabilization of the charge separated state in the core complex. The thermodynamic and kinetic parameters obtained in the RC-LH1 complex are very close to those measured in intact membranes, indicating that the electron transfer properties of the RC in vivo are essentially determined by its local environment. The studies performed by incorporating the RC into saccharidic matrices evidenced the relevance of solvent-protein interactions and dynamical coupling in determining the kinetics of electron transfer processes. The usual approach when studying the interplay between internal motions and protein function consists in freezing the degrees of freedom of the protein at cryogenic temperature. We proved that the “trehalose approach” offers distinct advantages with respect to this traditional methodology. We showed, in fact, that the RC conformational dynamics, coupled to specific electron transfer processes, can be modulated by varying the hydration level of the trehalose matrix at room temperature, thus allowing to disentangle solvent from temperature effects. The comparison between different saccharidic matrices has revealed that the structural and dynamical protein-matrix coupling depends strongly upon the sugar. The analyses performed in RCs embedded in polyelectrolyte multilayers (PEM) structures have shown that the electron transfer from QA - to QB, a conformationally gated process extremely sensitive to the RC environment, can be strongly modulated by the hydration level of the matrix, confirming analogous results obtained for this electron transfer reaction in sugar matrices. We found that PEM-RCs are a very stable system, particularly suitable to study the thermodynamics and kinetics of herbicide binding to the QB site. These features make PEM-RC structures quite promising in the development of herbicide biosensors. The studies discussed in the present thesis have shown that, although the effects on electron transfer induced by the native and artificial environments tested are markedly different, they can be described on the basis of a common kinetic model which takes into account the static conformational heterogeneity of the RC and the interconversion between conformational substates. Interestingly, the same distribution of rate constants (i.e. a Gamma distribution function) can describe charge recombination processes in solutions of purified RC, in RC-LH1 complexes, in wet and dry RC-PEM structures and in glassy saccharidic matrices over a wide range of hydration levels. In conclusion, the results obtained for RCs in different physico-chemical environments emphasize the relevance of the structure/dynamics solvent/protein coupling in determining the energetics and the kinetics of electron transfer processes in a membrane protein complex.

Liver transplantation for transthyretin amyloidosis: experience of a single center in Italy

Liver transplantation is the only definitive treatment for transthyretin amyloidosis, with an excellent 5-year survival in endemic countries where the Met30 mutation is predominant. We report our experience of liver transplantation for transthyretin amyloidosis. We reviewed the clinical records of 17 transplanted patients (11 males, 6 females; age at liver transplant: 45.7±11.7 years). We had a wide spectrum of non-Met30 mutations (52.9%), with a predominance of Gln89 (23.5%). Five-year survival after transplantation was 43.8%; at multivariate analysis, both non-Met30 mutations (HR 17.3, 95% CI 1.03-291.7) and modified BMI (HR 0.50, 95% CI 0.29-0.87) showed significant and independent prognostic roles (P=0.048 and P=0.015, respectively). Five out of the 9 non-Met30 carriers received combined heart transplantation because of severe cardiomyopathy; they showed a trend towards a better prognosis vs. the 4 patients who did not receive combined heart transplantation (although not statistically significant; P=0.095). At follow-up, no significant improvement of transthyretin amyloidosis manifestations was observed. The results of liver transplantation for transthyretin amyloidosis in our population are poorer than those reported in the literature probably because of the high prevalence of non-Met30 mutations.

Il problema del risparmio energetico nei data center

Con la crescente diffusione del web e dei servizi informatici offerti via internet, è aumentato in questi anni l’utilizzo dei data center e conseguentemente, il consumo di energia elettrica degli stessi. Il problema ambientale che comporta l’alto fabbisogno energetico, porta gli operatori di data center ad utilizzare tecniche a basso consumo e sistemi efficienti. Organizzazioni ambientali hanno rilevato che nel 2011 i consumi derivanti dai data center raggiungeranno i 100 milioni di kWh, con un costo complessivo di 7,4 milioni di dollari nei soli Stati Uniti, con una proiezione simile anche a livello globale. La seguente tesi intende valutare le tecniche in uso per diminuire il consumo energetico nei data center, e quali tecniche vengono maggiormente utilizzate per questo scopo. Innanzitutto si comincerà da una panoramica sui data center, per capire il loro funzionamento e per mostrare quali sono i componenti fondamentali che lo costituiscono; successivamente si mostrerà quali sono le parti che incidono maggiormente nei consumi, e come si devono effettuare le misurazioni per avere dei valori affidabili attraverso la rilevazione del PUE, unità di misura che valuta l’efficienza di un data center. Dal terzo capitolo si elencheranno le varie tecniche esistenti e in uso per risolvere il problema dell’efficienza energetica, mostrando alla fine una breve analisi sui metodi che hanno utilizzato le maggiori imprese del settore per risolvere il problema dei consumi nei loro data center. Lo scopo di questo elaborato è quello di capire quali sono le tecniche e le strategie per poter ridurre i consumi e aumentare l’efficienza energetica dei data center.

Factors predicting mortality after tips for refractory ascites: a single center experience

Introduction: Transjugular intrahepatic porto-systemic shunt (TIPS) is an accepted indication for treating refractory ascites. Different models have been proposed for the prediction of survival after TIPS; aim of present study was to evaluate the factors associated with mortality after TIPS for refractory ascites. Methods: Seventy-three consecutive patients undergoing a TIPS for refractory ascites in our centre between 2003 and 2008, were prospectively recorded in a database ad were the subject of the study. Mean follow-up was 17±2 months. Forty patients were awaiting liver transplantation (LT) and 12 (16.4%) underwent LT during follow-up. Results: Mean MELD at the moment of TIPS was 15.7±5.3. Overall mortality was 23.3% (n=17) with a mean survival after TIPS of 17±14 months. MELD score (B=0.161, p=0.042), AST (B= 0.020, p=0.090) and pre-TIPS HVPG (B=0.016, p=0.093) were independent predictors of overall mortality. On multivariate analysis MELD (B=0.419, p=0.018) and pre-TIPS HVPG (B=0.223, p=0.060) independently predicted 1 year survival. Patients were stratified into categories of death risk, using ROC curves for the variables MELD and HVPG. Patients with MELD<10 had a low probability of death after TIPS (n=6, 16% mortality); patients with HVPG <16 mmHg (n=6) had no mortality. Maximum risk of death was found in patients with MELD score 19 (n=16, 31% mortality) and in those with HVPG 25 mmHg (n=27, 26% mortality). Conclusions: TIPS increases overall survival in patients with refractory ascites. Liver function (assessed by MELD), necroinflammation (AST) and portal hypertension (HVPG) are independent predictors of survival; patients with MELD>19 and HVPG>25 mmHg are at highest risk of death after TIPS

Sviluppo di un simulatore per la propagazione del calore nei data center

Questa tesi tratta lo sviluppo di un software in grado di simulare le dinamiche tra fluidi e oggetti considerando la propagazione del calore in vista di possibili applicazioni rivolte ad ambienti in cui lo stato termico del sistema e' critico (data center).

Spektroelektrochemische Untersuchungen mittels oberflächenverstärkter Infrarotabsorptionsspektroskopie (SEIRAS) an Multi-Redox-Center-Proteinen in einer biomimetischen Membranumgebung

Die optische Eigenschaften sowie der Oberflächenverstärkungseffekt von rauen Metalloberflächen sowie Nanopartikeln wurden intensiv für den infraroten Bereich des Spektrums in der Literatur diskutiert. Für die Präparation solcher Oberflächen gibt es prinzipiell zwei verschiedene Strategien, zum einen können die Nanopartikel zuerst ex-situ synthetisiert werden, der zweite Ansatz beruht darauf, dass die Nanopartikel in-situ hergestellt und aufgewachsen werden. Hierbei wurden beide Ansätze ausgetestet, dabei stellte sich heraus, dass man nur mittels der in-situ Synthese der Goldnanopartikel in der Lage ist nanostrukturierte Oberflächen zu erhalten, welche elektronisch leitfähig sind, nicht zu rau sind, um eine Membranbildung zu ermöglichen und gleichzeitig einen optimalen Oberflächenverstärkungseffekt zeigen. Obwohl keine ideale Form der Nanopartikel mittels der in-situ Synthese erhalten werden können, verhalten sich diese dennoch entsprechend der Theorie des Oberflächenverstärkungseffekts. Optimierungen der Form und Grösse der Nanopartikel führten in dieser Arbeit zu einer Optimierung des Verstärkungseffekts. Solche optimierten Oberflächen konnten einfach reproduziert werden und zeichnen sich durch eine hohe Stabilität aus. Der so erhaltene Oberflächenverstärkungseffekt beträgt absolut 128 verglichen mit dem belegten ATR-Kristall ohne Nanopartikel oder etwa 6 mal, verglichen mit der Oberfläche, die bis jetzt auch in unserer Gruppe verwendet wurde. Daher können nun Spektren erhalten werden, welche ein deutlich besseres Signal zu Rauschverhältnis (SNR) aufweisen, was die Auswertung und Bearbeitung der erhaltenen Spektren deutlich vereinfacht und verkürzt.rnNach der Optimierung der verwendeten Metalloberfläche und der verwendeten Messparameter am Beispiel von Cytochrom C wurde nun an der Oberflächenbelegung der deutlich größeren Cytochrom c Oxidase gearbeitet. Hierfür wurde der DTNTA-Linker ex-situ synthetisiert. Anschließend wurden gemischte Monolagen (self assembeld monolayers) aus DTNTA und DTP hergestellt. Die NTA-Funktionalität ist für die Anbindung der CcO mit der his-tag Technologie verantwortlich. Die Kriterien für eine optimale Linkerkonzentration waren die elektrischen Parameter der Schicht vor und nach Rekonstitution in eine Lipidmembran, sowie Elektronentransferraten bestimmt durch elektrochemische Messungen. Erst mit diesem optimierten System, welches zuverlässig und reproduzierbar funktioniert, konnten weitere Messungen an der CcO begonnen werden. Aus elektrochemischen Messungen war bekannt, dass die CcO durch direkten Elektronentransfer unter Sauerstoffsättigung in einen aktivierten Zustand überführt werden kann. Dieser aktivierte Zustand zeichnet sich durch eine Verschiebung der Redoxpotentiale um etwa 400mV gegenüber dem aus Gleichgewichts-Titrationen bekannten Redoxpotential aus. Durch SEIRAS konnte festgestellt werden, dass die Reduktion bzw. Oxidation aller Redoxzentren tatsächlich bei den in der Cyclovoltammetrie gemessenen Potentialen erfolgt. Außerdem ergaben die SEIRA-Spektren, dass durch direkten Elektronentransfer gravierende Konformationsänderungen innerhalb des Proteins stattfinden. rnBisher war man davon ausgegangen, aufgrund des Elektronentransfers mittels Mediatoren, dass nur minimale Konformationsänderungen beteiligt sind. Vor allem konnte erstmaligrnder aktivierte und nicht aktivierte Zustand der Cytochrom c Oxidase spektroskopisch nachweisen werden.rn

Riorganizzazione di un distribution center mediante le tecniche di lean production: il caso Gambro Dasco spa

La Lean Production è un tema di estrema attualità per tutte le aziende che abbiano compreso l’importanza di produrre di più, con le risorse che si hanno a disposizione, eliminando sistematicamente tutte le attività che non creano valore aggiunto. La Produzione Snella è diventato un metodo per incrementare la competitività, riducendo l’incertezza e aumentando il servizio fornito al cliente. Nella realtà attuale vi è ancora una scarsa diffusione dei concetti Lean. Le cause di questo problema sono imputabili soprattutto alla cultura del management aziendale, alla mancanza di efficaci strumenti tecnologici a supporto, e in alcuni casi, la scarsa disponibilità delle imprese ad abbracciare la filosofica “snella”. La presente tesi, dopo una panoramica introduttiva su l’origine e l’evoluzione del Pensiero Snello e l’analisi di tutti i tools disponibili per combattere lo spreco; si propone di analizzare l’applicazione degli stessi in Gambro Dasco, multinazionale biomedicale leader nella vendita delle sue apparecchiature per dialisi.

Traduttori specializzati e business center nel processo di internazionalizzazione d'impresa: Studio esplorativo e prospettive future

This exploratory study aims at investigating the professional opportunities available to a specialised translator within the process of international business development. Firstly, the analysis focuses on a review of the theoretical principles affirming the need of a fine-tuned language strategy, especially in the process of internationalization, managed by professionals with translation, language and cultural skills. Against this background, the focus is on the role played by a specialised translator within this process. With the aim of exploring the translator’s role within this process, the analysis focuses on business centers in Italy, which bring together demand and supply of language services and services for company internationalisation. According to the results that shows the opportunities available to a specialised translator with extra skills, the analysis focuses on the placement of this professional within the process. A specialised translator can be a language and cultural consultant for the internationalised company, as well as a Project Manager working for its international development. The conclusions describe the role which a specialised translator with economic or international marketing skills might play within this framework, and pave the way for future developments of this analysis.

Controllo generalizzato via software di dispositivi per l'interconnessione flessibile di data center

La tesi riguarda le gestione via software di dispositivi che interconnettono componenti hardware di forwarding in una rete.

Endovascular treatment of popliteal artery aneurysms: a single-center experience

PURPOSE: To evaluate the use of covered stent-grafts in the endovascular treatment (ET) of popliteal artery aneurysms (PAAs). MATERIALS AND METHODS: A retrospective analysis was conducted over a period of 52 months in 18 consecutive patients (17 men; mean age +/- SD, 70 years +/- 11) undergoing ET of PAAs with the Viabahn endograft in a single center. Patient symptoms, aneurysm characteristics, technical outcomes, complications, and follow-up were assessed. RESULTS: Aneurysm diameters ranged from 12 to 51 mm with a mean of 30 mm (+/-11). Thirteen aneurysms (72.2%) were partially thrombosed and 12 patients (66.6%) had symptoms of lower limb ischemia at presentation (11 chronic and one acute). The technical success rate was 94%. Intraprocedural emboli and endoleak occurred in one and two patients, respectively. Fourteen patients were available for follow-up after successful treatment, with a mean follow-up time of 15 months (range, 7-37 months). All stent-grafts were patent after 1 month, with no mortality or limb loss. The primary patency rate with complete exclusion of the aneurysm at 6 months was 86%. Pre- and postprocedural noninvasive arterial studies were available in 10 patients, demonstrating improvement of the ankle-brachial index from 0.96 +/- 0.41 to 1.17 +/- 0.18, respectively (P = .06). CONCLUSIONS: Endovascular stent-graft repair of PAAs is a feasible treatment option. However, further follow-up studies regarding the durability of results are required.

Tailored total lymphoid irradiation in heart transplant patients: 10-years experience of one center

To assess safety and efficacy of tailored total lymphoid irradiation (tTLI) in cardiac transplant patients.

A longitudinal three-center study of dental arch relationship in patients with bilateral cleft lip and palate

OBJECTIVE: To compare and evaluate longitudinally the dental arch relationships from 4.5 to 13.5 years of age with the Bauru-BCLP Yardstick in a large sample of patients with bilateral cleft lip and palate (BCLP). DESIGN: Retrospective longitudinal intercenter outcome study. PATIENTS: Dental casts of 204 consecutive patients with complete BCLP were evaluated at 6, 9, and 12 years of age. All models were identified only by random identification numbers. SETTING: Three cleft palate centers with different treatment protocols. MAIN OUTCOME MEASURES: Dental arch relationships were categorized with the Bauru-BCLP yardstick. Increments for each interval (from 6 to 9 years, 6 to 12 years, and 9 to 12 years) were analyzed by logistic and linear regression models. RESULTS: There were no significant differences in outcome measures between the centers at age 12 or at age 9. At age 6, center B showed significantly better results (p=.027), but this difference diminished as the yardstick score for this group increased over time (linear regression analysis), the difference with the reference category (center C, boys) for the intervals 6 to 12 and 9 to 12 years being 10.4% (p=.041) and 12.9% (p=.009), respectively. CONCLUSIONS: Despite different treatment protocols, dental arch relationships in the three centers were comparable in final scores at age 9 and 12 years. Delaying hard palate closure and employing infant orthopedics did not appear to be advantageous in the long run. Premaxillary osteotomy employed in center B appeared to be associated with less favorable development of the dental arch relationship between 9 and 12 years.