Study of thiabendazole resistance and volatile organic compounds production of Penicillium expansum strains

The years of excessive use of thiabendazole to control Penicillium expansum has induced the development of resistance. Sensitivity of fourty eight strains collected from orchards and packinghouses in Emilia Romagna to pure and commercial TBZ was determined in vitro on TBZ amended medium (400μg/mL). Out of 48 strains, 35 were thiabendazole-sensitive (S) and 13 were thiabendazole-resistant (R). Microtiter assay adapted to P. expansum, showed EC50 values ranging from 54 to 320 μg/mL for ten TBZ-resistant strains. At the highest dose (50 μg/mL), resistant strains growth was not inhibited and the reported MICs value were >1000 μg/mL. Therefore, preliminary screening combined with microtiter assay, can be a good strategy to test susceptibility to TBZ. Mutations in the β-tubulin gene were studied on amino acid sequences from residue 167 to residue 357 of 10 P. expansum strains. Mutation at codon 198 was associated with TBZ-resistance. However, its absence in 3 resistant strains can be explained by the involvement of other mechanisms. Moreover, a P. expansum strain LB8/99 showed good antifungal effect against some fungal pathogens through double petri dish assay. It inhibited both mycelium growth and conidia germination of B. cinerea, C. acutatum, and M. laxa, and reduced significantly by 53% and 18% respectively P. expansum. Three major VOCS: geosmin, phenethyl alcolhol (PEA) and an unknown substance were identified by GC-MS analysis. Consistent fumigation of fungal pathogens with PEA (1230 mg/mL), inhibited both conidia germination and mycelium growth of all pathogens, except conidia germination of P. expansum that was reduced by 90% with respect to control. While, the concentration of PEA produced naturally by LB8/99 was ineffective in controlling the pathogens and seemed to have a synergic or additive effect with the other VOCS. Investigations to study the biofumigant effect of LB8/99 on other commodities like seeds and seedlings are in progress.

I diritti particolari dei soci nelle S.r.l.

Il tema oggetto della presente tesi di dottorato trae spunto dall'analisi dell'art. 2468 c.c. nel quale può dirsi contenuto il nucleo fondamentale della disciplina della partecipazione sociale. In primo luogo vi è un'analisi comparata dell'istituto in esame con quelli previsti negli altri paesi europei. Dopo una breve analisi di diritto comparato ci si è concentrati sulla legislazione italiana ed, in particolare, l'elaborato cerca di dare una risposta ai seguenti interrogativi: a) quali sono i “particolari diritti” ex art. 2468 c.c.? b) si può parlare di “categorie speciali di partecipazioni”? Con riferimento al primo interrogativo va considerato che il modello legale prevede che i diritti particolari attribuibili ai soci riguardano l’amministrazione della società o la distribuzione degli utili. Tale disciplina sussiste quando l’atto costitutivo attribuisce i particolari diritti senza disporre nulla sulla loro trasferibilità, modificabilità ed inerenza alla partecipazione sociale piuttosto che alla persona del socio. Ci si è chiesti quali siano i confini delle due categorie espressamente previste dall’art. 2468, 3 c.c. e se tale previsione sia tassativa piuttosto che esemplificativa, aprendosi quindi la strada alla libera determinabilità dei diritti sociali, alla stregua di quanto sancisce l’art. 2348, 2 c.c., in merito alle azioni “speciali”. Si giunge così alla conclusione che la previsione sia esemplificativa e che anche nelle s.r.l. le parti sono libere di attribuire ai soci diritti sociali diversi da quelli derivanti dal modello legale, nei limiti derivanti da specifiche norme imperative. Nel secondo capitolo sono stati approfonditi i principi dettati dall’art. 2468 c.c., la natura di tali "particolari diritti" ed i loro profili di qualificazione nonché le loro esplicazioni contenutistiche Nel terzo capitolo si è analizzato cosa accade ai "particolari diritti" in caso di vicende modificative. Nel quarto capitolo poi è stato affrontata la controversa questione relativa alla possibilità di creare delle “categorie di quote”.

Numerical methods for the dispersion analysis of Guided Waves

The use of guided ultrasonic waves (GUW) has increased considerably in the fields of non-destructive (NDE) testing and structural health monitoring (SHM) due to their ability to perform long range inspections, to probe hidden areas as well as to provide a complete monitoring of the entire waveguide. Guided waves can be fully exploited only once their dispersive properties are known for the given waveguide. In this context, well stated analytical and numerical methods are represented by the Matrix family methods and the Semi Analytical Finite Element (SAFE) methods. However, while the former are limited to simple geometries of finite or infinite extent, the latter can model arbitrary cross-section waveguides of finite domain only. This thesis is aimed at developing three different numerical methods for modelling wave propagation in complex translational invariant systems. First, a classical SAFE formulation for viscoelastic waveguides is extended to account for a three dimensional translational invariant static prestress state. The effect of prestress, residual stress and applied loads on the dispersion properties of the guided waves is shown. Next, a two-and-a-half Boundary Element Method (2.5D BEM) for the dispersion analysis of damped guided waves in waveguides and cavities of arbitrary cross-section is proposed. The attenuation dispersive spectrum due to material damping and geometrical spreading of cavities with arbitrary shape is shown for the first time. Finally, a coupled SAFE-2.5D BEM framework is developed to study the dispersion characteristics of waves in viscoelastic waveguides of arbitrary geometry embedded in infinite solid or liquid media. Dispersion of leaky and non-leaky guided waves in terms of speed and attenuation, as well as the radiated wavefields, can be computed. The results obtained in this thesis can be helpful for the design of both actuation and sensing systems in practical application, as well as to tune experimental setup.

L'impegno la passione l'obbedienza. Olinto Marella intellettuale e sacerdote tra Otto e Novecento

È importante ricordare che l’attuale Archivio Marella (AM) è stato costituito sotto la direzione del prof.re Mauro Pesce insieme alla dott.ssa Donatella Micheletti negli anni 1981-1983, dopo che Edero Gattamorta aveva contribuito in modo determinante a raccogliere il materiale che veniva inseguito inserito e pubblicato nel lavoro di tesi: Olinto Marella (1882-1969). Rinvenimento e sistemazione dell’archivio. Schizzo biografico, AA 1975-76, relatore Mauro Pesce, Università Bologna, Facoltà Scienze Politiche. I nuclei principali del materiale conservato nell’archivio riguardano: 1) la vita di Marella; 2) le iniziative caritative di M. dalla metà degli anni trenta in poi; 3) la famiglia Marella, soprattutto lo zio G. M. Marella; 4) la biblioteca. Già nella Guida alla consultazione dell’archivio curata da M. Pesce e stampata nel 1984 si rilevava come il materiale inventariato dal dr. E. Gattamorta nel 1975-76 del settore b) e quello del settore c) fosse assolutamente provvisorio e in parte non catalogato

Valutazione dell'efficacia dell'infusione intraepatica di cellule staminali (SC) autologhe CD133+ in pazienti affetti da cirrosi ed insufficienza epatica di grado avanzato

Numerose evidenze sperimentali hanno dimostrato il contributo delle cellule staminali (SC) di derivazione midollare nei processi di rigenerazione epatica dopo danno tissutale. E’ cresciuto pertanto l’interesse sul loro potenziale impiego in pazienti con cirrosi. Questo studio si proponeva di valutare la fattibilità e la sicurezza della reinfusione intraepatica di cellule staminali midollari autologhe CD133+ in 12 pazienti con insufficienza epatica terminale. Previa mobilizzazione nel sangue periferico mediante somministrazione di granulocyte-colony stimulating factor (G-CSF) alla dose di 7,5 mcg/Kg/b.i.d. e raccolta per leucoaferesi (solo se la concentrazione di CD133 + SC era > 8/μL), le cellule CD133+ altamente purificate sono state reinfuse in arteria epatica a partire da 5x104/Kg fino a 1x106/kg. Nei tre giorni successivi è stato somministrato G-CSF per favorire l’espansione e l’attecchimento delle cellule. Durante la fase della mobilizzazione e quella della reinfusione sono stati eseguiti saggi biologici quali: caratterizzazione fenotipica delle SC circolanti, saggi clonogenici, valutazione della concentrazione sierica del Hepatocyte Growth Factor (HGF), Stromal-Derived Factor-1 (SDF-1) ed il Vascular-Endotelial Growth Factor (VEGF) e caratterizzazione fenotipica delle CD133+SC purificate. Fino ad oggi sono stati reinfusi 12 pazienti. Questi dati preliminari suggeriscono che è possibile mobilizzare e reinfondere un numero considerevole di SC autologhe CD133+ altamente purificate in pazienti con ESLD . Gli studi biologici mostrano che: il numero di progenitori ematopoietici ed endoteliali circolanti è aumentato dopo il trattamento con G–CSF; le SCs CD133+ altamente purificato esprimono marcatori emopoietici ed endoteliali; la concentrazione sierica di HGF, SDF-1, VEGF e la capacità clonogenica di progenitori emopoietici sono aumentati durante la mobilitazione e nelle fasi di reinfusione; il potenziale clonogenico dei progenitori endoteliali mostra espressione variabile.

A Semantic-based Framework for Digital Survey of Architectural Heritage

The research aims at developing a framework for semantic-based digital survey of architectural heritage. Rooted in knowledge-based modeling which extracts mathematical constraints of geometry from architectural treatises, as-built information of architecture obtained from image-based modeling is integrated with the ideal model in BIM platform. The knowledge-based modeling transforms the geometry and parametric relation of architectural components from 2D printings to 3D digital models, and create large amount variations based on shape grammar in real time thanks to parametric modeling. It also provides prior knowledge for semantically segmenting unorganized survey data. The emergence of SfM (Structure from Motion) provides access to reconstruct large complex architectural scenes with high flexibility, low cost and full automation, but low reliability of metric accuracy. We solve this problem by combing photogrammetric approaches which consists of camera configuration, image enhancement, and bundle adjustment, etc. Experiments show the accuracy of image-based modeling following our workflow is comparable to that from range-based modeling. We also demonstrate positive results of our optimized approach in digital reconstruction of portico where low-texture-vault and dramatical transition of illumination bring huge difficulties in the workflow without optimization. Once the as-built model is obtained, it is integrated with the ideal model in BIM platform which allows multiple data enrichment. In spite of its promising prospect in AEC industry, BIM is developed with limited consideration of reverse-engineering from survey data. Besides representing the architectural heritage in parallel ways (ideal model and as-built model) and comparing their difference, we concern how to create as-built model in BIM software which is still an open area to be addressed. The research is supposed to be fundamental for research of architectural history, documentation and conservation of architectural heritage, and renovation of existing buildings.

On the flavor problem in strongly coupled theories

rnThis thesis is on the flavor problem of Randall Sundrum modelsrnand their strongly coupled dual theories. These models are particularly wellrnmotivated extensions of the Standard Model, because they simultaneously address rntherngauge hierarchy problem and the hierarchies in the quarkrnmasses and mixings. In order to put this into context, special attention is given to concepts underlying therntheories which can explain the hierarchy problem and the flavor structure of the Standard Model (SM). ThernAdS/CFTrnduality is introduced and its implications for the Randall Sundrum model withrnfermions in the bulk andrngeneral bulk gauge groups is investigated. It will be shown that the differentrnterms in the general 5D propagator of a bulk gauge field can be related tornthe corresponding diagrams of the strongly coupled dual, which allows for arndeeperrnunderstanding of the origin of flavor changing neutral currents generated by thernexchange of the Kaluza Klein excitations of these bulk fields.rnIn the numerical analysis, different observables which are sensitive torncorrections from therntree-levelrnexchange of these resonances will be presented on the basis of updatedrnexperimental data from the Tevatron and LHC experiments. This includesrnelectroweak precision observables, namely corrections to the S and Trnparameters followed by corrections to the Zbb vertex, flavor changingrnobservables with flavor changes at one vertex, viz. BR (Bd -> mu+mu-) and BR (Bs -> mu+mu-), and two vertices,rn viz. S_psiphi and |eps_K|, as well as bounds from direct detectionrnexperiments. rnThe analysis will show that all of these bounds can be brought in agreement withrna new physics scale Lambda_NP in the TeV range, except for the CPrnviolating quantity |eps_K|, which requires Lambda_NP= Ord(10) TeVrnin the absencernof fine-tuning. The numerous modifications of the Randall Sundrum modelrnin the literature, which try to attenuate this bound are reviewed andrncategorized.rnrnSubsequently, a novel solution to this flavor problem, based on an extendedrncolor gauge group in the bulk and its thorough implementation inrnthe RS model, will be presented, as well as an analysis of the observablesrnmentioned above in the extended model. This solution is especially motivatedrnfromrnthe point of view of the strongly coupled dual theory and the implications forrnstrongly coupled models of new physics, which do not possess a holographic dual,rnare examined.rnFinally, the top quark plays a special role in models with a geometric explanation ofrnflavor hierarchies and the predictions in the Randall-Sundrum model with andrnwithout the proposed extension for the forward-backward asymmetryrnA_FB^trnin top pair production are computed.

Gewebeprotektive und antiinflammatorische Wirkung von humanem Choriogonadotropin in Mausmodellen mit autoimmunem Leberschaden

Während der Schwangerschaft kommt es häufig zu einer spontanen Verbesserung von klinischen Symptomen der autoimmunen Hepatitis und anderen Th1-vermittelten Autoimmunerkrankungen. Die Gründe hierfür sind bis heute noch nicht vollständig aufgeklärt. Eines der wichtigsten Hormone in der Schwangerschaft ist das humane Choriogonadotropin (hCG), welches schon in der frühen Schwangerschaft eine entscheidende Rolle spielt. Es sorgt für die Stimulation des Corpus luteums, wodurch es zur Ausschüttung von Progesteron kommt und somit die Einnistung der Blastozyte gewährleistet und die Abstoßung des Embryos verhindert wird. In dieser Arbeit wurden Effekt und Signalweg von hCG in primären murinen und humanen Hepatozyten sowie in Mausmodellen mit T-Zell-abhängigem Leberschaden untersucht. hCG führte sowohl bei akuten als auch bei chronischen Leberschäden zu einer drastischen Senkung der Aspartat-Aminotransferase, einem Indikator für Lebererkrankungen. Die Histologie der Leber hCG-behandelter Tiere wies außerdem signifikant weniger apoptotische Zellen und eine deutliche Reduktion infiltrierender CD4+ T-Zellen auf. Die Analyse des hCG-Signalweges zeigte, dass hCG die Langlebigkeitsproteine Foxo3a und Sirt1 reguliert. Die Aktivierung des PI3-Kinase/Akt-Signalweges durch hCG führte zu einem Transport des Transkriptionsfaktors Foxo3a aus dem Zellkern, wodurch die proapoptotischen Zielgene Bim und Puma nicht mehr transkribiert werden können. Eine zusätzliche Hemmung von Foxo3a erfolgte durch die Aktivierung der Deacetylase Sirt1, indem diese phosphoryliert wird und in den Zellkern transloziert. In weiteren Untersuchungen wurde der immunsuppressive Effekt von hCG näher betrachtet. Dabei stellte sich heraus, dass hCG effektiv die proteolytische Aktivität der Caspase-3 in Hepatozyten hemmt, wodurch die Ausschüttung der biologisch aktiven Form von Interleukin-16, einem chemotaktischen Faktor für CD4+ Zellen, herabgesetzt wird. Dadurch wird die Leber erfolgreich vor der Infiltration durch autoaggressive CD4+ Zellen geschützt. IL-16 spielt bei vielen inflammatorischen Krankheiten eine Rolle, was auch in dieser Arbeit durch den Nachweis hoher IL-16-Konzentrationen in Seren von Patienten mit autoimmuner Hepatitis bestätigt werden konnte. Die in dieser Studie beschriebene Wirkung von hCG und die Tatsache, dass hCG ein bereits bewährtes und auf Nebenwirkungen getestetes Medikament bei Infertilität ist, macht es zu einem idealen Kandidaten für immunsuppressive Therapieansätze bei akuten und chronisch entzündlichen Lebererkrankungen.

Il modello di Kaluza: unificazione tra gravità ed elettromagnetismo

Una teoria di unificazione ha il notevole compito di fornire un modello in grado di unificare le forze fondamentali della natura in una sola. Storicamente uno dei primi tentativi è rappresentato dal modello di Kaluza, che propone una formulazione unificata di gravità ed elettromagnetismo. In 4 dimensioni il campo gravitazionale e il campo elettromagnetico sono entità nettamente separate. Tale dualismo può essere superato estendendo la teoria della Relatività Generale ad uno spaziotempo a 5 dimensioni. Se alle consuete 4 si aggiunge una quinta dimensione spaziale, allora si dimostra che la gravità e l’elettromagnetismo possono essere visti come la manifestazione di un unico campo di forza, che è interpretabile in termini della geometria dello spaziotempo a 5 dimensioni. Nonostante i suoi intrinseci limiti, il modello di Kaluza rappresenta comunque un punto di partenza per molte altre teorie di campo unificato più moderne e a più di 5 dimensioni. L'obiettivo è di sviluppare le linee fondamentali del modello di Kaluza. Preliminarmente si riportano i risultati principali dell'elettromagnetismo e della Relatività Generale, dato che il modello si formula a partire da questi. Si stabilisce la condizione di cilindro, secondo cui le quantità fisiche non subiscono variazioni nella quinta dimensione. Si ipotizza un ansatz per il tensore metrico 5D e si scrivono le equazioni di campo unitario e della geodetica, come estensioni a 5 dimensioni di quelle in 4. Si dimostra che il campo unitario in 4 dimensioni si separa nel campo scalare costante, nel campo elettromagnetico e nel campo gravitazionale. Le componenti quadridimensionali della geodetica 5D riconducono a quella 4D e alle leggi del moto 4D in presenza dei campi gravitazionale ed elettromagnetico. Inoltre si interpreta la carica elettrica come la quinta componente della velocità covariante 5D.

Rolle der FOS-Proteine und des MAPK-Signallings in der Regulation der zellulären Antwort auf genotoxischen Stress

Die mittlere Überlebenszeit nach Erkennung eines Glioblastoms ohne Behandlung liegt bei 3 Monaten und kann durch die Behandlung mit Temozolomid (TMZ) auf etwa 15 Monate gesteigert werden. Neben TMZ sind die chlorethylierenden Nitrosoharnstoffe die meistversprechendsten und am häufigsten eingesetzten Chemotherapeutika in der Gliomtherapie. Hier liegt die mittlere Überlebenszeit bei 17,3 Monaten. Um die Therapie des Glioblastoms noch effektiver zu gestalten und Resistenzen zu begegnen, werden unterschiedlichste Ansätze untersucht. Eine zentrale Rolle spielen hierbei das activator protein 1 (AP-1) und die mitogen aktivierten Proteinkinasen (MAPK), deren Funktion in bisherigen Arbeiten noch unzureichend beleuchtet wurde.rnBesonders mit der Rolle des AP-1-bildenden Proteins FRA-1 in der Therapie des Glioblastoms haben sich bisher nur wenige Arbeiten beschäftigt, weshalb im ersten Teil der vorliegenden Arbeit dessen Funktion in der Regulation der Chemosensitivität gegenüber dem chlorethylierenden Agenz ACNU genauer untersucht wurde. Es konnte gezeigt werden, dass die FRA 1-Expression durch Behandlung mit ACNU induziert wird. Die Induktion erfolgte über die beiden MAPKs ERK1/2 und p38K. JNK hatte keinen Einfluss auf die Induktion. Durch die Herunterregulation der FRA-1-Expression mit Hilfe von siRNA und eines shRNA exprimierenden Plasmids kam es zu einer signifikanten Sensitivierung gegenüber ACNU. Dabei konnte gezeigt werden, dass die Herunterregulation der FRA-1-Expression in einer verminderten AP 1-Bildung, bedingt durch eine reduzierte Menge an FRA-1 im AP-1-Komplex resultiert. Die Sensitivierung gegenüber ACNU ist weder durch eine Veränderung in der DNA-Reparatur, noch in der Modulation der FAS-Ligand- bzw. FAS-Rezeptor-Expression bedingt. Auch die hier untersuchten BCL 2-Familienmitglieder wiesen keine Unterschiede in der Expression durch Modulation der FRA 1-Expression auf. Allerdings kam es durch die verminderte FRA-1-Expression zu einer Reduktion der Zellzahl in der G2/M-Phase nach Behandlung mit ACNU. Diese ging einher mit einer reduzierten Menge an phosphoryliertem und unphosphoryliertem CHK1, weshalb davon auszugehen ist, dass FRA 1 nach ACNU-Behandlung in Gliomzellen vor der Apoptose schützt, indem es modulierend auf die Zellzykluskontrolle einwirkt.rnIm zweiten Teil dieser Arbeit wurde die Regulation der apoptotischen Antwort nach Behandlung mit ACNU und TMZ genauer beleuchtet, wobei ein spezielles Augen¬merk auf AP 1 und die MAPKs gelegt wurde. Hier konnte gezeigt werden, dass die Apoptose nach Behandlung mit ACNU bzw. TMZ sowohl durch Spaltung von Pro-Caspase 8, als auch Pro-Caspase 9 eingeleitet wird. Dabei akkumulierte in beiden Fällen p53 vermehrt im Zellkern. Eine Inhibierung der transkriptionellen Aktivität von p53 führte nach ACNU-Behandlung zu einer Sensitivierung der Zellen, nach TMZ-Behandlung kam es zu einem leichten Anstieg in der Vitälität. Der FAS-Rezeptor wurde nach ACNU- und nach TMZ-Behandlung aktiviert und auch die DNA-Reparaturproteine DDB2 und XPC wurden in beiden Fällen vermehrt exprimiert. Für die MAPKs JNK und ERK1/2 konnte gezeigt werden, dass diese pro-apoptotisch wirken. Die AP-1-Bildung nach ACNU-Behandlung erfolgte bereits nach 24 h und war von langer Dauer, wohingegen nach TMZ-Behandlung nur eine transiente AP 1-Bildung zu relativ späten Zeitpunkten detektiert werden konnte. Ebenso konnte für das AP-1-Zielgen FAS-Ligand nach ACNU-Behandlung eine relativ schnelle, lang anhaltende Aktivierung detektiert werden, wohingegen nach TMZ-Behandlung zu einem späten Zeitpunkt ein kurzer Anstieg im Signal zu verzeichnen war. In späteren Experimenten konnte gezeigt werden, dass das BCL-2-Familienmitglied BIM eine zentrale Rolle in der Regulation des intrinsischen Apoptosesignalweges nach Behandlung mit ACNU und TMZ spielt. Die hier entstanden Ergebnisse tragen entscheidend zum Verständnis der durch diese beiden Agenzien gesteuerten, apoptotischen Signalwege bei und bieten eine fundierte Grundlage für weitere Untersuchungen.rn

Hunting for warped extra dimensions via loop-induced processes

This thesis is on loop-induced processes in theories with warped extra dimensions where the fermions and gauge bosons are allowed to propagate in the bulk, while the Higgs sector is localized on or near the infra-red brane. These so-called Randall-Sundrum (RS) models have the potential to simultaneously explain the hierarchy problem and address the question of what causes the large hierarchies in the fermion sector of the Standard Model (SM). The Kaluza-Klein (KK) excitations of the bulk fields can significantly affect the loop-level processes considered in this thesis and, hence, could indirectly indicate the existence of warped extra dimensions. The analytical part of this thesis deals with the detailed calculation of three loop-induced processes in the RS models in question: the Higgs production process via gluon fusion, the Higgs decay into two photons, and the flavor-changing neutral current b → sγ. A comprehensive, five-dimensional (5D) analysis will show that the amplitudes of the Higgs processes can be expressed in terms of integrals over 5D propagators with the Higgs-boson profile along the extra dimension, which can be used for arbitrary models with a compact extra dimension. To this end, both the boson and fermion propagators in a warped 5D background are derived. It will be shown that the seemingly contradictory results for the gluon fusion amplitude in the literature can be traced back to two distinguishable, not smoothly-connected incarnations of the RS model. The investigation of the b → sγ transition is performed in the KK decomposed theory. It will be argued that summing up the entire KK tower leads to a finite result, which can be well approximated by a closed, analytical expression.rnIn the phenomenological part of this thesis, the analytic results of all relevant Higgs couplings in the RS models in question are compared with current and in particular future sensitivities of the Large Hadron Collider (LHC) and the planned International Linear Collider. The latest LHC Higgs data is then used to exclude significant portions of the parameter space of each RS scenario. The analysis will demonstrate that especially the loop-induced Higgs couplings are sensitive to KK particles of the custodial RS model with masses in the multi tera-electronvolt range. Finally, the effect of the RS model on three flavor observables associated with the b → sγ transition are examined. In particular, we study the branching ratio of the inclusive decay B → X_s γ

Building Information Modeling: analisi e utilizzo

Dalla raffigurazione artistica fino alla modellazione digitale, passando per il disegno tecnico, la rappresentazione del progetto d’architettura ha conosciuto nel tempo evoluzioni significative che solo di recente hanno raggiunto l’apice nell’utilizzo di modelli cognitivi in grado di collezionare ed organizzare il patrimonio di informazioni che gravitano attorno all’intero processo edilizio. L’impiego sempre più diffuso dello strumento informatico, insieme al coordinamento delle specializzazioni nelle molte discipline coinvolte nel progetto, ha favorito negli ultimi anni l’adozione del Building Information Modeling un processo che permette di rivoluzionare il mondo delle costruzioni, coprendo molteplici aspetti del ciclo di vita per un manufatto edilizio. Questa Tesi intende presentare in maniera specifica le tappe che hanno consentito il formarsi del BIM. La migliore capacità di gestione, un linguaggio comune tra i progettisti, un’ottimizzazione di risorse e costi, unito ad un controllo convincente ed accurato delle fasi di lavoro, sono alcune delle potenzialità non ancora completamente espresse dal Building Information Modeling che è destinato a divenire una consapevolezza strategica nel bagaglio culturale del professionista contemporaneo.

Benchmarking in the SWISSspine registry: results of 52 Dynardi lumbar total disc replacements compared with the data pool of 431 other lumbar disc prostheses

The SWISSspine registry is the first mandatory registry of its kind in the history of Swiss orthopaedics and it follows the principle of "coverage with evidence development". Its goal is the generation of evidence for a decision by the Swiss federal office of health about reimbursement of the concerned technologies and treatments by the basic health insurance of Switzerland. Recently, developed and clinically implemented, the Dynardi total disc arthroplasty (TDA) accounted for 10% of the implanted lumbar TDAs in the registry. We compared the outcomes of patients treated with Dynardi to those of the recipients of the other TDAs in the registry. Between March 2005 and October 2009, 483 patients with single-level TDA were documented in the registry. The 52 patients with a single Dynardi lumbar disc prosthesis implanted by two surgeons (CE and OS) were compared to the 431 patients who received one of the other prostheses. Data were collected in a prospective, observational multicenter mode. Surgery, implant, 3-month, 1-year, and 2-year follow-up forms as well as comorbidity, NASS and EQ-5D questionnaires were collected. For statistical analyses, the Wilcoxon signed-rank test and chi-square test were used. Multivariate regression analyses were also performed. Significant and clinically relevant reduction of low back pain and leg pain as well as improvement in quality of life was seen in both groups (P < 0.001 postop vs. preop). There were no inter-group differences regarding postoperative pain levels, intraoperative and follow-up complications or revision procedures with a new hospitalization. However, significantly more Dynardi patients achieved a minimum clinically relevant low back pain alleviation of 18 VAS points and a quality of life improvement of 0.25 EQ-5D points. The patients with Dynardi prosthesis showed a similar outcome to patients receiving the other TDAs in terms of postoperative low back and leg pain, complications, and revision procedures. A higher likelihood for achieving a minimum clinically relevant improvement of low back pain and quality of life in Dynardi patients was observed. This difference might be due to the large number of surgeons using other TDAs compared to only two surgeons using the Dynardi TDA, with corresponding variations in patient selection, patient-physician interaction and other factors, which cannot be assessed in a registry study.

Safety, effectiveness and predictors for early reoperation in therapeutic and prophylactic vertebroplasty: short-term results of a prospective case series of patients with osteoporotic vertebral fractures

Abstract Introduction Vertebroplasty (VP) is a cost-efficient alternative to kyphoplasty; however, regarding safety and vertebral body (VB) height restoration, it is considered inferior. We assessed the safety and efficacy of VP in alleviating pain, improving quality of life (QoL) and restoring alignment. Methods In a prospective monocenter case series from May 2007 until July 2008, there were 1,408 vertebroplasties performed during 319 interventions in 306 patients with traumatic, lytic and osteoporotic fractures. The 249 interventions in 233 patients performed because of osteoporotic vertebral fractures were analyzed regarding demographics, treatment and radiographic details, pain alleviation (VAS), QoL improvement (NASS and EQ-5D), complications and predictors for new fractures requiring a reoperation. Results The osteoporotic patient sample consisted of 76.7% (179) females with a median age of 80 years. A total of 54 males had a median age of 77 years. On average, there were 1.8 VBs fractured and 5 VBs treated. The preoperative pain was assessed by the visual analog scale (VAS) and decreased from 54.9 to 40.4 pts after 2 months and 31.2 pts after 6 months. Accordingly, the QoL on the EQ-5D measure (−0.6 to 1) improved from 0.35 pts before surgery to 0.56 pts after 2 and to 0.68 pts after 6 months. The preoperative Beck Index (anterior height/posterior height) improved from a mean of 0.64 preoperative to 0.76 postoperative, remained stable at 2 months and slightly deteriorated to 0.72 at 6 months postoperatively. There were cement leakages in 26% of the fractured VBs and in 1.4% of the prophylactically cemented VBs; there were symptoms in 4.3%, and most of them were temporary hypotension and one pulmonary cement embolism that remained asymptomatic. The univariate regression model revealed a tendency for a reduced risk for new or refractures on radiographs (OR = 2.61, 95% CI 0.92–7.38, p = 0.12) and reoperations (OR = 2.9, 95% CI 0.94–8.949, p = 0.1) when prophylactic augmentation was performed. The final multivariate regression model revealed male patients to have an about three times higher refracture risk (radiographic) (OR = 2.78, p = 0.02) at 6 months after surgery. Patients with a lumbar index fracture had an about three to five times higher refracture/reoperation risk than patients with a thoracic (OR = 0.33/0.35, p = 0.009/0.01) or thoracolumbar (OR = 0.32/0.22, p = 0.099/0.01) index fracture. Conclusion If routinely used, VP is a safe and efficacious treatment option for osteoporotic vertebral fractures with regard to pain relief and improvement of the QoL. Even segmental realignment can be partially achieved with proper patient positioning. Certain patient or fracture characteristics increase the risk for early radiographic refractures or new fractures, or a reoperation; a consequent prophylactic augmentation showed protective tendencies, but the study was underpowered for a final conclusion.