The Interactive Effect of GHR-Exon 3 and -202 A/C IGFBP3 Polymorphisms on rhGH Responsiveness and Treatment Outcomes in Patients with Turner Syndrome

Context: There is great interindividual variability in the response to recombinant human (rh) GH therapy in patients with Turner syndrome (TS). Ascertaining genetic factors can improve the accuracy of growth response predictions. Objective: The objective of the study was to assess the individual and combined influence of GHR-exon 3 and -202 A/C IGFBP3 polymorphisms on the short-and long-term outcomes of rhGH therapy in patients with TS. Design and Patients: GHR-exon 3 and -202 A/C IGFBP3 genotyping (rs2854744) was correlated with height data of 112 patients with TS who remained prepubertal during the first year of rhGH therapy and 65 patients who reached adult height after 5 +/- 2.5 yr of rhGH treatment. Main Outcome Measures: First-year growth velocity and adult height were measured. Results: Patients carrying at least one GHR-d3 or -202 A-IGFBP3 allele presented higher mean first-year growth velocity and achieved taller adult heights than those homozygous for GHR-fl or -202 C-IGFBP3 alleles, respectively. The combined analysis of GHR-exon 3 and -202 A/C IGFBP3 genotypes showed a clear nonadditive epistatic influence on adult height of patients with TS treated with rhGH (GHR-exon 3 alone, R-2 = 0.27; -202 A/C IGFBP3, R-2 = 0.24; the combined genotypes, R-2 = 0.37 at multiple linear regression). Together with clinical factors, these genotypes accounted for 61% of the variability in adult height of patients with TS after rhGH therapy. Conclusion: Homozygosity for the GHR-exon3 full-length allele and/or the -202C-IGFBP3 allele are associated with less favorable short-and long-term growth outcomes after rhGH treatment in patients with TS. (J Clin Endocrinol Metab 97: E671-E677, 2012)

Co-presentation of human T-cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis and adult-onset infective dermatitis associated with HTLV-1 infection

Background  Human T-cell lymphotropic virus type 1 (HTLV-1) is the etiologic agent of adult T-cell leukemia/lymphoma (ATLL), HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), infective dermatitis associated with HTLV-1 (IDH), and various other clinical conditions. Several of these diseases can occur in association. Objective  Report an association of diseases related to HTLV-1 infection, occurring in an unusual age group. Methods  Dermatological and laboratory exams were consecutively performed in HTLV-1-infected individuals from January 2008 to July 2010 in the HTLV Outpatient Clinic at the Institute of Infectious Diseases “Emilio Ribas” in São Paulo, Brazil. Results  A total of 193 individuals (73 HAM/TSP and 120 asymptomatic carriers) were evaluated, three of which were associated with adult-onset IDH and HAM/TSP. In all three cases, the patients were affected by IDH after the development and progression of HAM/TSP-associated symptoms. Limitations  Small number of cases because of the rarity of these diseases. Conclusion  We draw attention to the possibility of co-presentation of adult-onset IDH in patients with a previous diagnosis of HAM/TSP, although IDH is a disease classically described in children. Thus, dermatologists should be aware of these diagnoses in areas endemic for HTLV-1 infection.

Non-neoplastic bulky mediastinal mass presentation in an adolescent patient: a case report

Abstract : Introduction Mediastinal masses in pediatric patients are very heterogeneous in origin and etiology. In the first decade of life, 70% of the mediastinal masses are benign whereas malignant tumors are more frequent in the second decade of life. Among the mediastinal masses, lymph nodes are the most common involved structures and could be enlarged due to a lymphoma, leukemia, metastatic disease, or due to infectious diseases as sarcoidosis, tuberculosis and others. Case presentation. We report a case of a 13-year-old Caucasian girl who came to the emergency room with a history of intermittent fever, weight loss and night sweating for at least 1 month. A radiologic image work-up presented an anterior and posterior mediastinal mass. The 18F-fluorodeoxyglucose positron emission tomography presented a high maximum standard uptake value, which directed our decision for mediastinal biopsy for diagnostic elucidation. Histologic examination described the mass as granulomatous tuberculosis. The patient was treated with anti-tuberculosis therapy and developed a full clinical recovery. Conclusions . The present case report demonstrates that a bulky mediastinal lymphadenopathy detected on 18F-fluorodeoxyglucose positron emission tomography is not always a malignant lesion, and in countries where tuberculosis is endemic, this etiology should not be forgotten during clinical investigations. There is a need for more accurate cut-off values for this technology; meanwhile, the further investigation of patients with bulky mediastinal masses with procedures such as the open biopsy is indispensable.

Interactive application in spanish sign language for a public transport environment

[ES] En este trabajo se presenta el diseño de una herramienta multimedia que traduce a la lengua de signos españolas los mensajes de avisos que puede proporcionar un sistema de megafonía. El objetivo del trabajo es proporcionar una herramienta que mejore la inclusión social de las personas con discapacidades auditivas. Con este propósito, se han seleccionado el entorno y los mensajes de audio habituales en un aeropuerto para desarrollar este proyecto piloto. Por último, los audios se han traducido a lengua de signos españolas sintetizando un avatar usando la técnica de animación de rotoscopía a partir de la grabación en vídeo de un traductor. Los resultados finales han sido evaluados por personas sordas.

User interaction widgets for interactive theorem proving

Matita (that means pencil in Italian) is a new interactive theorem prover under development at the University of Bologna. When compared with state-of-the-art proof assistants, Matita presents both traditional and innovative aspects. The underlying calculus of the system, namely the Calculus of (Co)Inductive Constructions (CIC for short), is well-known and is used as the basis of another mainstream proof assistant—Coq—with which Matita is to some extent compatible. In the same spirit of several other systems, proof authoring is conducted by the user as a goal directed proof search, using a script for storing textual commands for the system. In the tradition of LCF, the proof language of Matita is procedural and relies on tactic and tacticals to proceed toward proof completion. The interaction paradigm offered to the user is based on the script management technique at the basis of the popularity of the Proof General generic interface for interactive theorem provers: while editing a script the user can move forth the execution point to deliver commands to the system, or back to retract (or “undo”) past commands. Matita has been developed from scratch in the past 8 years by several members of the Helm research group, this thesis author is one of such members. Matita is now a full-fledged proof assistant with a library of about 1.000 concepts. Several innovative solutions spun-off from this development effort. This thesis is about the design and implementation of some of those solutions, in particular those relevant for the topic of user interaction with theorem provers, and of which this thesis author was a major contributor. Joint work with other members of the research group is pointed out where needed. The main topics discussed in this thesis are briefly summarized below. Disambiguation. Most activities connected with interactive proving require the user to input mathematical formulae. Being mathematical notation ambiguous, parsing formulae typeset as mathematicians like to write down on paper is a challenging task; a challenge neglected by several theorem provers which usually prefer to fix an unambiguous input syntax. Exploiting features of the underlying calculus, Matita offers an efficient disambiguation engine which permit to type formulae in the familiar mathematical notation. Step-by-step tacticals. Tacticals are higher-order constructs used in proof scripts to combine tactics together. With tacticals scripts can be made shorter, readable, and more resilient to changes. Unfortunately they are de facto incompatible with state-of-the-art user interfaces based on script management. Such interfaces indeed do not permit to position the execution point inside complex tacticals, thus introducing a trade-off between the usefulness of structuring scripts and a tedious big step execution behavior during script replaying. In Matita we break this trade-off with tinycals: an alternative to a subset of LCF tacticals which can be evaluated in a more fine-grained manner. Extensible yet meaningful notation. Proof assistant users often face the need of creating new mathematical notation in order to ease the use of new concepts. The framework used in Matita for dealing with extensible notation both accounts for high quality bidimensional rendering of formulae (with the expressivity of MathMLPresentation) and provides meaningful notation, where presentational fragments are kept synchronized with semantic representation of terms. Using our approach interoperability with other systems can be achieved at the content level, and direct manipulation of formulae acting on their rendered forms is possible too. Publish/subscribe hints. Automation plays an important role in interactive proving as users like to delegate tedious proving sub-tasks to decision procedures or external reasoners. Exploiting the Web-friendliness of Matita we experimented with a broker and a network of web services (called tutors) which can try independently to complete open sub-goals of a proof, currently being authored in Matita. The user receives hints from the tutors on how to complete sub-goals and can interactively or automatically apply them to the current proof. Another innovative aspect of Matita, only marginally touched by this thesis, is the embedded content-based search engine Whelp which is exploited to various ends, from automatic theorem proving to avoiding duplicate work for the user. We also discuss the (potential) reusability in other systems of the widgets presented in this thesis and how we envisage the evolution of user interfaces for interactive theorem provers in the Web 2.0 era.

Interactive theorem provers: issues faced as a user and tackled as a developer

Interactive theorem provers (ITP for short) are tools whose final aim is to certify proofs written by human beings. To reach that objective they have to fill the gap between the high level language used by humans for communicating and reasoning about mathematics and the lower level language that a machine is able to “understand” and process. The user perceives this gap in terms of missing features or inefficiencies. The developer tries to accommodate the user requests without increasing the already high complexity of these applications. We believe that satisfactory solutions can only come from a strong synergy between users and developers. We devoted most part of our PHD designing and developing the Matita interactive theorem prover. The software was born in the computer science department of the University of Bologna as the result of composing together all the technologies developed by the HELM team (to which we belong) for the MoWGLI project. The MoWGLI project aimed at giving accessibility through the web to the libraries of formalised mathematics of various interactive theorem provers, taking Coq as the main test case. The motivations for giving life to a new ITP are: • study the architecture of these tools, with the aim of understanding the source of their complexity • exploit such a knowledge to experiment new solutions that, for backward compatibility reasons, would be hard (if not impossible) to test on a widely used system like Coq. Matita is based on the Curry-Howard isomorphism, adopting the Calculus of Inductive Constructions (CIC) as its logical foundation. Proof objects are thus, at some extent, compatible with the ones produced with the Coq ITP, that is itself able to import and process the ones generated using Matita. Although the systems have a lot in common, they share no code at all, and even most of the algorithmic solutions are different. The thesis is composed of two parts where we respectively describe our experience as a user and a developer of interactive provers. In particular, the first part is based on two different formalisation experiences: • our internship in the Mathematical Components team (INRIA), that is formalising the finite group theory required to attack the Feit Thompson Theorem. To tackle this result, giving an effective classification of finite groups of odd order, the team adopts the SSReflect Coq extension, developed by Georges Gonthier for the proof of the four colours theorem. • our collaboration at the D.A.M.A. Project, whose goal is the formalisation of abstract measure theory in Matita leading to a constructive proof of Lebesgue’s Dominated Convergence Theorem. The most notable issues we faced, analysed in this part of the thesis, are the following: the difficulties arising when using “black box” automation in large formalisations; the impossibility for a user (especially a newcomer) to master the context of a library of already formalised results; the uncomfortable big step execution of proof commands historically adopted in ITPs; the difficult encoding of mathematical structures with a notion of inheritance in a type theory without subtyping like CIC. In the second part of the manuscript many of these issues will be analysed with the looking glasses of an ITP developer, describing the solutions we adopted in the implementation of Matita to solve these problems: integrated searching facilities to assist the user in handling large libraries of formalised results; a small step execution semantic for proof commands; a flexible implementation of coercive subtyping allowing multiple inheritance with shared substructures; automatic tactics, integrated with the searching facilities, that generates proof commands (and not only proof objects, usually kept hidden to the user) one of which specifically designed to be user driven.

Automatic initialization for facial analysis in interactive robotics

[EN]This paper focuses on four different initialization methods for determining the initial shape for the AAM algorithm and their particular performance in two different classification tasks with respect to either the facial expression DaFEx database and to the real world data obtained from a robot’s point of view.

Analysis of the influence of epitope flanking regions on MHC class I restricted antigen presentation

Peptides presented by MHC class I molecules for CTL recognition are derived mainly from cytosolic proteins. For antigen presentation on the cell surface, epitopes require correct processing by cytosolic and ER proteases, efficient TAP transport and MHC class I binding affinity. The efficiency of epitope generation depends not only on the epitope itself, but also on its flanking regions. In this project, the influence of the C-terminal region of the model epitope SIINFEKL (S8L) from chicken ovalbumin (aa 257-264) on antigen processing has been investigated. S8L is a well characterized epitope presented on the murine MHC class I molecule, H-2Kb. The Flp-In 293Kb cell line was transfected with different constructs each enabling the expression of the S8L sequence with different defined C-terminal flanking regions. The constructs differed at the two first C-terminal positions after the S8L epitope, so called P1’ and P2’. At these sites, all 20 amino acids were exchanged consecutively and tested for their influence on H-2Kb/S8L presentation on the cell surface of the Flp-In 293Kb cells. The detection of this complex was performed by immunostaining and flow cytometry. The prevailing assumption is that proteasomal cleavages are exclusively responsible for the generation of the final C-termini of CTL epitopes. Nevertheless, recent publications showed that TPPII (tripeptidyl peptidase II) is required for the generation of the correct C-terminus of the HLA-A3-restricted HIV epitope Nef(73-82). With this background, the dependence of the S8L generation on proteasomal cleavage of the designed constructs was characterized using proteasomal inhibitors. The results obtained indicate that it is crucial for proteasomal cleavage, which amino acid is flanking the C-terminus of an epitope. Furthermore, partially proteasome independent S8L generation from specific S8L-precursor peptides was observed. Hence, the possibility of other existing endo- or carboxy-peptidases in the cytosol that could be involved in the correct trimming of the C-terminus of antigenic peptides for MHC class I presentation was investigated, performing specific knockdowns and using inhibitors against the target peptidases. In parallel, a purification strategy to identify the novel peptidase was established. The purified peaks showing an endopeptidase activity were further analyzed by mass spectrometry and some potential peptidases (like e.g. Lon) were identified, which have to be further characterized.

Interactive simulation of flexible parts

Computer simulations play an ever growing role for the development of automotive products. Assembly simulation, as well as many other processes, are used systematically even before the first physical prototype of a vehicle is built in order to check whether particular components can be assembled easily or whether another part is in the way. Usually, this kind of simulation is limited to rigid bodies. However, a vehicle contains a multitude of flexible parts of various types: cables, hoses, carpets, seat surfaces, insulations, weatherstrips... Since most of the problems using these simulations concern one-dimensional components and since an intuitive tool for cable routing is still needed, we have chosen to concentrate on this category, which includes cables, hoses and wiring harnesses. In this thesis, we present a system for simulating one dimensional flexible parts such as cables or hoses. The modeling of bending and torsion follows the Cosserat model. For this purpose we use a generalized spring-mass system and describe its configuration by a carefully chosen set of coordinates. Gravity and contact forces as well as the forces responsible for length conservation are expressed in Cartesian coordinates. But bending and torsion effects can be dealt with more effectively by using quaternions to represent the orientation of the segments joining two neighboring mass points. This augmented system allows an easy formulation of all interactions with the best appropriate coordinate type and yields a strongly banded Hessian matrix. An energy minimizing process accounts for a solution exempt from the oscillations that are typical of spring-mass systems. The use of integral forces, similar to an integral controller, allows to enforce exactly the constraints. The whole system is numerically stable and can be solved at interactive frame rates. It is integrated in the DaimlerChrysler in-house Virtual Reality Software veo for use in applications such as cable routing and assembly simulation and has been well received by users. Parts of this work have been published at the ACM Solid and Physical Modeling Conference 2006 and have been selected for the special issue of the Computer-Aided-Design Journal to the conference.

Strategie competitive nel settore dei videogiochi: Il caso di take-two interactive

Partendo da un’analisi di mercato che si sviluppa meglio con una segmentazione, andremo ad analizzare il settore degli editori di videogiochi, le loro quote di mercato e come si stanno evolvendo per rimanere al passo con la tecnologia in un settore con forte competizione. Lo scopo di questa tesi è spiegare il successo della Take Two Interactive descrivendo la sua storia, le strategia che ha adottato negli anni per arrivare a competere con altri grandi editori e come si sta approcciando alle nuove tecnologie, all’evoluzione dei comportamenti d’acquisto dei consumatori e ai nuovi mercati emergenti.

Spatial and temporal flower presentation in Apiaceae-Apioideae

Alle Doldengewächse (Apiaceae), darunter die größte, weltweit verbreitete Unterfamilie der Apioideen, weisen in ihren Blütenständen sehr einheitliche Merkmale auf. Die ‚Doppeldolden´ werden aus kleinen, weißen oder gelben Blüten gebildet und von vielen unspezialisierten Insekten besucht. Der uniforme Eindruck, der damit erweckt wird, ist unter Umständen ein Grund, dass die zugrundeliegende Morphologie bislang wenig untersucht wurde. Gegenstand der vorliegenden Dissertation ist es daher, die ‚verborgene Diversität´ im Blütenstandsbereich der Apiaceae -Apioideen mit dem Ziel darzustellen, den Einfluss der Architektur der Pflanzen auf die Art der Blütenpräsentation in Raum und Zeit und damit auf das Reproduktionssystem der Art zu ermitteln. Im ersten Kapitel zeigt der Vergleich von neun ausgewählten Arten, dass in den selbstfertilen und unspezifisch bestäubten Pflanzen durch Synchronisation und Rhythmik in der Präsentation von Blüten Fremdbefruchtung gefördert wird. Entweder durchlaufen die Pflanzen dabei nur eine getrennte männliche und weibliche Blühphase (Xanthoselinum alsaticum) oder der moduläre Bau der Pflanzen führt zu einer Folge männlicher und weiblicher Blühphasen (multizyklische Dichogamie). Die Diözie in Trinia glauca kann in diesem Zusammenhang als eine Trennung der Blühphasen auf verschiedengeschlechtliche Individuen gesehen werden. Für die andromonözischen Arten wird gezeigt, dass der Anteil funktional männlicher Blüten mit steigender Doldenordnung nicht einheitlich zu- oder abnimmt. Dadurch fungieren die Pflanzen zu verschiedenen Zeiten und mit unterschiedlicher Stärke eher als Pollenrezeptoren oder Pollendonatoren. Es wird deutlich, dass das ‚uniforme Muster‘ der Apioideen mit Dolden verschiedener Ordnungen, dichogamen Blüten und deren diversen Geschlechtsausbildungen ein komplexes Raum-Zeit-Gefüge zur Optimierung des Reproduktionssystems darstellt. Das zweite Kapitel stellt die Ergebnisse von Manipulationsexperimenten (Handbestäubung, Bestäuberabschirmung, Entfernen von Dolden niedriger Ordnung) an Chaerophyllum bulbosum dar, die zeigen, dass das Raum-Zeit-Gefüge in der Präsentation der Blüten der Art erlaubt, flexibel auf Umwelteinflüsse zu reagieren. Es stellt sich heraus, dass mechanische Beschädigungen kaum Einfluss auf den Andromonöziegrad und prozentualen Fruchtansatz der Individuen nehmen. Grundvoraussetzung der Reaktionsfähigkeit ist wiederum deren modulärer Bau. Dieser erlaubt es den Pflanzen, zusammen mit dem andromonöziebedingten Reservoir an - geschlechtlich flexiblen - männlichen Blüten, in den später angelegten Dolden fehlenden Fruchtansatz der Blüten früh blühender Dolden zu kompensieren. Im dritten Kapitel wird eine vergleichende Merkmalsanalyse an 255 Apioideen-Arten vorgelegt, die alle Verwandtschaftskreise, Wuchsformen und Verbreitungsgebiete der Gruppe repräsentieren. Ziel der Analyse war die Identifizierung von Merkmalssyndromen, die den Zusammenhang zwischen Architektur und Reproduktionssystem verdeutlichen sollten. Interessanterweise sind die einzigen Merkmale, die miteinander einhergehen, Protogynie und die graduelle Abnahme männlicher Blüten mit steigender Doldenordnung. Alle anderen Merkmale variieren unabhängig voneinander und erzeugen auf vielen verschiedenen Wegen immer wieder das gleiche Funktionsmuster, das als ‚breeding syndrome‘ der Apioideae gedeutet werden kann. Die Arbeit leistet einen wichtigen Beitrag zum Verständnis der Blütenstände der Apiaceen und darüber hinaus zu morphologischer Variation in ‚unspezialisierten‘ Reproduktionssystemen. Offensichtlich liegt in den Apioideen der Selektionsdruck auf der Aufrechterhaltung der generalisistischen Bestäubung und überprägt alle morphologisch-phylogenetischen Merkmalsvarianten.

Acute coronary syndromes in young patients: Presentation, treatment and outcome

Background: Acute coronary syndromes (ACS) in very young patients have been poorly described. We therefore evaluate ACS in patients aged 35 years and younger. Methods: In this prospective cohort study, 76 hospitals treating ACS in Switzerland enrolled 28,778 patients with ACS between January 1, 1997, and October 1, 2008. ACS definition included ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). Results: 195 patients (0.7%) were 35 years old or younger. Compared to patients N35 years, these patients were more likely to present with chest pain (91.6% vs. 83.7%; P=0.003) and less likely to have heart failure (Killip class II to IV in 5.2% vs. 23.0%; Pb0.001). STEMI was more prevalent in younger than in older patients (73.1% vs. 58.3%; Pb0.001). Smoking, family history of CAD, and/or dyslipidemia were important cardiovascular risk factors in young patients (prevalence 77.2%, 55.0%, and 44.0%). The prevalence of overweight among young patients with ACS was high (57.8%). Cocaine abuse was associated with ACS in some young patients. Compared to older patients, young patients were more likely to receive early percutaneous coronary interventions and had better outcome with fewer major adverse cardiac events. Conclusions: Young patients with ACS differed from older patients in that the younger often presented with STEMI, received early aggressive treatment, and had favourable outcomes. Primary prevention of smoking, dyslipidemia and overweight should be more aggressively promoted in adolescence.