Cirurgia de revascularização miocárdica na fase aguda do infarto: análise dos fatores preditores de mortalidade intra-hospitalar

OBJETIVO: A cirurgia de revascularização miocárdica (CRM) na fase aguda do infarto do miocárdio (IAM) está associada a aumento do risco operatório. O objetivo do estudo foi determinar fatores preditores de mortalidade intra-hospitalar nos pacientes submetidos a CRM no IAM. MÉTODOS: Durante três anos, todos os pacientes submetidos a CRM no IAM foram analisados retrospectivamente, utilizando o banco de dados institucional. Sessenta variáveis por paciente foram avaliadas: 49 variáveis pré-operatórias provenientes dos escores 2000 Bernstein-Parsonnet e EuroSCORE; 4 variáveis pré-operatórias não consideradas por esses escores (tempo entre o IAM e a CRM, valor máximo de CKMB, valor máximo de troponina e supradesnivelamento do segmento ST) e 7 variáveis intraoperatórias [uso de circulação extracorpórea (CEC), tempo de CEC, tipo de cardioplegia, endarterectomia, número de enxertos, uso da artéria torácica interna e revascularização completa]. Análise univariada e multivariada para o desfecho mortalidade intra-hospitalar foram realizadas. RESULTADOS: O tempo médio entre o IAM e a CRM foi de 3,8 ± 3 dias. A mortalidade global foi 19%. Na análise multivariada: idade > 65 anos [OR 16,5 (IC 1,8-152), P=0,013]~ CEC >108 minutos [OR 40 (IC 2,7-578), P=0,007], creatinina > 2 mg/dl [OR 35,5 (IC 1,7-740), P=0,021] e pressão pulmonar sistólica > 60 mmHg [OR 31(IC 1,6-591), P=0,022] foram preditores de mortalidade intra-hospitalar. CONCLUSÃO: Variáveis pré-operatórias clássicas como idade > 65 anos, creatinina > 2 mg/dl e pressão pulmonar sistólica > 60 mmHg foram preditoras de mortalidade intra-hospitalar nos pacientes operados de revascularização miocárdica na fase aguda do infarto.

Correlação das imagens da ressonância magnética e observação intra operatória nas lesões traumáticas da coluna vertebral

OBJETIVO: Avaliar a acurácia e a reprodutibilidade das imagens da ressonância magnética (RM) nas lesões ligamentares traumáticas da coluna vertebral. MÉTODOS: Estudo retrospectivo para avaliação das imagens da RM de 32 pacientes com lesões traumáticas da coluna vertebral submetidos a tratamento cirúrgico. A avaliação das lesões do complexo ligamentar posterior (CLP) por imagens da RM foi realizada independentemente por dois radiologistas. Um grupo de pacientes tinha exames com inclusão de sequência com supressão de gordura sensível ao líquido (STIR ou SPAIR T2), além das imagens de rotina e no outro grupo os exames de RM não incluíam imagens com a supressão da gordura. As avaliações dos exames de imagem foram comparadas com as observações obtidas durante o ato cirúrgico. Foi realizada a analise de reprodutibilidade intra e interobservador entre os dois radiologistas pelo cálculo do coeficiente Kappa. RESULTADOS: Foi observada lesão do CLP em 21/32 pacientes. De forma geral a sensibilidade da RM para lesões do CLP variou entre 88,9% a 100% e a especificidade entre 0 e 50%. A concordância entre a avaliação dos radiologistas foi maior nos exames de ressonância magnética sem a supressão da gordura (Κ=0,6) do que nos exames que incluíram sequências com supressão (Κ=0,34). CONCLUSÃO: A avaliação de lesões dos ligamentos posteriores por meio da RM pelos radiologistas resultou em boa sensibilidade em relação aos achados cirúrgicos, porém com baixa especificidade, reproduzindo resultados da literatura. Na casuística atual a utilização do sinal de edema presente nas sequências com supressão de gordura diminuiu a concordância interobservador.

Desfechos intra-hospitalares e preditores de mortalidade no infarto agudo do miocárdio com choque cardiogênico tratados por angioplastia primária: dados do registro InCor

INTRODUÇÃO: O choque cardiogênico é a maior causa de morte em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento de ST (IAMCSST). O presente estudo avaliou pacientes com IAMCSST e choque cardiogênico submetidos a intervenção coronária percutânea primária com o objetivo de estabelecer seu perfil e os preditores de mortalidade hospitalar. MÉTODOS: Registro unicêntrico, incluindo 100 pacientes avaliados no período de 2001 a 2009 quanto a características clínicas, angiográficas e do procedimento, e a desfechos intra-hospitalares. Por análise multivariada foram determinados preditores independentes da mortalidade hospitalar. RESULTADOS: Com relação às características clínicas, foi observada alta prevalência de fatores de risco, sendo a taxa de sucesso angiográfico de 92%, apesar da complexidade das lesões (83,1% do tipo B2/C). A artéria mais acometida foi a descendente anterior (45%), tendo o padrão multiarterial ocorrido em 73% dos casos. A taxa de mortalidade foi de 45%, sendo seus preditores independentes o padrão multiarterial [odds ratio (OR) 2,62; intervalo de confiança de 95% (IC 95%) 1,16-5,90] e o fluxo coronário TIMI < 3 ao final do procedimento (OR 2,11, IC 95% 1,48-3,02). CONCLUSÕES: Os pacientes com IAMCSST complicado por choque cardiogênico apresentaram características clínicas e angiográficas de alto risco e, apesar do alto sucesso angiográfico do procedimento, altas taxas de mortalidade. Foram preditores independentes de mortalidade o padrão multiarterial e fluxo TIMI < 3 ao final do procedimento.

Relaciones jerárquicas intra e interespecíficas entre Parablennius parvicornis y Mauligobius maderensis

Se estudia la relación de dominancia entre dos especies de peces (Parablennius parvicornis y Mauligobius maderensis) que conviven en los charcos del intermareal rocoso de las Islas Canarias. Ambas especies mostraron un patrón de jerarquía lineal basado en ataques. Se discute la jerarquía interespecífica y el cambió de rol al enfrentarse individuos de la misma especie e individuos de especies diferentes. Parablennius parvicornis mostró un comportamiento de cooperación intraespecífica y de codominancia frente a Mauligobius maderensis.It is studied the relationship of dominance between two fish species (Mauligobius maderensis and Parablennius parvicornis) which coexist in the same intertidal pools at the rocky shore of the Canary Islands. Both species showed a pattern of linear hierarchy based in attacks. It is discussed the intraspecific hierarchy and variations in the role of individuals when confronted against coespecifics or individuals of a different species. Parablennius parvicornis showed intraspecific cooperation and codominance against Mauligobius maderensis.

Effetto crowding e dislessia evolutiva: un confronto inter e intra-linguistico

Crowding is defined as the negative effect obtained by adding visual distractors around a central target which has to be identified. Some studies have suggested the presence of a marked crowding effect in developmental dyslexia (e.g. Atkinson, 1991; Spinelli et al., 2002). Inspired by Spinelli’s (2002) experimental design, we explored the hypothesis that the crowding effect may affect dyslexics’ response times (RTs) and accuracy in identification tasks dealing with words, pseudowords, illegal non-words and symbolstrings. Moreover, our study aimed to clarify the relationship between the crowding phenomenon and the word-reading process, in an inter-language comparison perspective. For this purpose we studied twenty-two French dyslexics and twenty-two Italian dyslexics (total forty-four dyslexics), compared to forty-four subjects matched for reading level (22 French and 22 Italians) and forty-four chronological age-matched subjects (22 French and 22 Italians). Children were all tested on reading and cognitive abilities. Results showed no differences between French and Italian participants suggesting that performances were homogenous. Dyslexic children were all significantly impaired in words and pseudowords reading compared to their normal reading controls. Regarding the identification task with which we assessed crowding effect, both accuracy and RTs showed a lexicality effect which meant that the recognition of words was more accurate and faster in words than pseudowords, non-words and symbolstrings. Moreover, compared to normal readers, dyslexics’ RTs and accuracy were impaired only for verbal materials but not for non-verbal material; these results are in line with the phonological hypothesis (Griffiths & Snowling, 2002; Snowling, 2000; 2006) . RTs revealed a general crowding effect (RTs in the crowding condition were slower than those recorded in the isolated condition) affecting all the subjects’ performances. This effect, however, emerged to be not specific for dyslexics. Data didn’t reveal a significant effect of language, allowing the generalization of the obtained results. We also analyzed the performance of two subgroups of dyslexics, categorized according to their reading abilities. The two subgroups produced different results regarding the crowding effect and type of material, suggesting that it is meaningful to take into account also the heterogeneity of the dyslexia disorder. Finally, we also analyzed the relationship of the identification task with both reading and cognitive abilities. In conclusion, this study points out the importance of comparing visual tasks performances of dyslexic participants with those of their reading level-matched controls. This approach may improve our comprehension of the potential causal link between crowding and reading (Goswami, 2003).

Geochronology, geochemistry and isotopic compositions of the volcanic rocks from oceanic (Hawaii) and continental (Eifel) intra-plate environments

The Eifel volcanism is part of the Central European Volcanic Province (CEVP) and is located in the Rhenish Massif, close to the Rhine and Leine Grabens. The Quaternary Eifel volcanism appears to be related to a mantle plume activity. However, the causes of the Tertiary Hocheifel volcanism remain debated. We present geochronological, geochemical and isotope data to assess the geotectonic settings of the Tertiary Eifel volcanism. Based on 40Ar/39Ar dating, we were able to identify two periods in the Hocheifel activity: from 43.6 to 39.0 Ma and from 37.5 to 35.0 Ma. We also show that the pre-rifting volcanism in the northernmost Upper Rhine Graben (59 to 47 Ma) closely precede the Hocheifel volcanic activity. In addition, the volcanism propagates from south to north within the older phase of the Hocheifel activity. At the time of Hocheifel volcanism, the tectonic activity in the Hocheifel was controlled by stress field conditions identical to those of the Upper Rhine Graben. Therefore, magma generation in the Hocheifel appears to be caused by decompression due to Middle to Late Eocene extension. Our geochemical data indicate that the Hocheifel magmas were produced by partial melting of a garnet peridotite at 75-90 km depth. We also show that crustal contamination is minor although the magmas erupted through a relatively thick continental lithosphere. Sr, Nd and Pb isotopic compositions suggest that the source of the Hocheifel magmas is a mixing between depleted FOZO or HIMU-like material and enriched EM2-like material. The Tertiary Hocheifel and the Quaternary Eifel lavas appear to have a common enriched end-member. However, the other sources are likely to be distinct. In addition, the Hocheifel lavas share a depleted component with the other Tertiary CEVP lavas. Although the Tertiary Hocheifel and the Quaternary Eifel lavas appear to originate from different sources, the potential involvement of a FOZO-like component would indicate the contribution of deep mantle material. Thus, on the basis of the geochemical and isotope data, we cannot rule out the involvement of plume-type material in the Hocheifel magmas. The Ko’olau Scientific Drilling Project (KSDP) has been initiated in order to evaluate the long-term evolution of Ko’olau volcano and obtain information about the Hawaiian mantle plume. High precision Pb triple spike data, as well as Sr and Nd isotope data on KSDP lavas and Honolulu Volcanics (HVS) reveal compositional source variations during Ko’olau growth. Pb isotopic compositions indicate that, at least, three Pb end-members are present in Ko’olau lavas. Changes in the contributions of each component are recorded in the Pb, Sr and Nd isotopes stratigraphy. The radiogenic component is present, at variable proportion, in all three stages of Ko’olau growth. It shows affinities with the least radiogenic “Kea-lo8” lavas present in Mauna Kea. The first unradiogenic component was present in the main-shield stage of Ko’olau growth but its contribution decreased with time. It has EM1 type characteristics and corresponds to the “Ko’olau” component of Hawaiian mantle plume. The second unradiogenic end-member, so far only sampled by Honololu lavas, has isotopic characteristics similar to those of a depleted mantle. However, they are different from those of the recent Pacific lithosphere (EPR MORB) indicating that the HVS are not derived from MORB-related source. We suggest, instead, that the HVS result from melting of a plume material. Thus the evolution of a single Hawaiian volcano records the geochemical and isotopic changes within the Hawaiian plume.

Development and performance assessment of a Plasma Focus electron beam generator for Intra-Operative Radiation Therapy

The Plasma Focus is a device designed to generate a plasma sheet between two coaxial electrodes by means of a high voltage difference. The plasma is then driven to collapse into a “pinch”, where thermonuclear conditions prevail. During the “pinch phase” charged particles are emitted, with two main components: an ion beam peaked forward and an electron beam directed backward. The electron beam emitted backward by Plasma Focus devices is being investigated as a radiation source for medical applications, using it to produce x-rays by interaction with appropriate targets (through bremsstrahlung and characteristic emission). A dedicated Plasma Focus device, named PFMA-3 (Plasma Focus for Medical Applications number 3), has been designed, put in operation and tested by the research groups of the Universities of Bologna and Ferrara. The very high dose rate (several gray per discharge, in less than 1 µs) is a peculiarity of this device that has to be investigated, as it might modify the relative biological effectiveness (RBE). Aim of this Ph.D. project was to investigate the main physical properties of the low-energy x-ray beams produced by a Plasma Focus device and their potential medical applications to IORT treatments. It was necessary to develop the optimal geometrical configuration; to evaluate the x-rays produced and their dose deposited; to estimate the energy electron spectrum produced in the “pinch phase”; to study an optimal target for the conversion of the x-rays; to conduct simulations to study the physics involved; and in order to evaluate the radio-biological features of the beam, cell holders had to be developed for both irradiations and cell growth conditions.

Trattamento delle lesioni osteocondrali di grado I e II mediante infiltrazione intra-articolare di fattori di crescita autologhi (plasma rich in platelets)

The use of Platelet-rich plasma (PRP), a platelet concentrate made of autogenous blood, is becoming use in the treatment of some orthopaedic diseases. The aim of this study is to assess the effect of PRP on articular cartilage defects in a rabbit model (10 subjects). Twenty osteochondral defects created in the femoropatellar groove, were in ten cases left untreated and in ten cases treated with autogenous PRP. PRP was obtained using a double centrifugation of the rabbit’s blood harvested before the operation. 30 days after the lesion was made in both knee, the left one in each rabbit was treated by a PRP injection, followed by other two injection at 45 and 60 days. Tissue specimens were assessed by macroscopic examination and histological evaluation, that showed a better healing of the lesions in the knee treated with PRP injections.

Studio dei semiochimici coinvolti nelle interazioni intra- e inter-specifiche in Gonocerus acuteangulatus (Goeze) (Heteroptera: Coreidae) in vista di un loro impiego nella difesa del nocciolo.

Gonocerus acuteangulatus (Hemiptera: Coreidae) è considerato uno dei principali fitofagi del nocciolo, in grado di causare con l’attività trofica pesanti perdite quali-quantitative di produzione. Nel triennio sono state quindi condotte indagini sulla bioetologia di G. acuteangulatus volte a: I) studiare comportamento alimentare ed effetti sulla produzione corilicola, II) identificare i feromoni e valutarne l’attività mediante biosaggi fisiologici e comportamentali in laboratorio, semi-campo e campo, III) rilevare le piante ospiti alternative al nocciolo. Mediante isolamento di adulti del coreide su rami di nocciolo con frutti è stata confermata l’assenza di correlazione fra entità del danno e numerosità degli individui presenti in corileto. Dalle analisi sensoriali su nocciole sane e danneggiate è emerso che le alterazioni causate delle punture di nutrizione sono rese più evidenti da conservazione e tostatura. Variazioni di tempi e temperature di tostatura potrebbero mitigare gli effetti del cimiciato. Nello studio dei feromoni, G. acuteangulatus, molto mobile nell’ambiente, è risultato poco adatto ai biosaggi in condizioni artificiali, come quelle in olfattometro e semi-campo. Le femmine sono tuttavia apparse attrattive per adulti di entrambi i sessi, mentre la miscela feromonale sintetizzata ha mostrato un’azione attrattiva, seppure non costante. Pertanto, ulteriori ripetizioni sono necessarie per convalidare questi risultati preliminari, modificando le condizioni di saggio in relazione alle caratteristiche della specie. Infine è stata accertata la preferenza del fitofago per alcune specie vegetali rispetto al nocciolo. Nel corso del triennio, popolazioni molto consistenti di G. acuteangulatus sono state rilevate su bosso, ciliegio di Santa Lucia, rosa selvatica, sanguinello, spino cervino, in corrispondenza del periodo di comparsa e maturazione dei frutti. Nell’impostazione di una strategia di difesa a basso impatto ambientale, l’attrattività di queste piante, in sinergia con eventuali feromoni di aggregazione, potrebbe essere utilmente sfruttata, per mantenere il coreide lontano dalla coltura.

Analisi fosfo-proteomica di campioni di tumore: il problema della stratificazione dei pazienti ed eterogeneità intra-tumorale nell'era della terapia personalizzata

Nella presente tesi indaghiamo la potenzialità di LCM e Reverse Phase Protein microarray negli studi clinici. Si analizza la possibilità di creare una bio banca con line cellular primarie, al fine di conseguire drug test di sensibilità prima di decidere il trattamento da somministrare ai singoli pazienti. Sono stati ottenuti profili proteomici da biopsie pre e post terapia. I risultati dimostrano che questa piattaforma mostra il meccanismo di resistenza acquisito durante la terapia biologica. Questo ci ha portato ad analizzare una possibile stratificazione per pazienti con mCRC . I dati hanno rivelato distinti pathway di attivazione tra metastasi resecabile e non resecabili. I risultati mostrano inoltre due potenziali bersagli farmacologici. Ma la valutazione dell'intero tumore tramite singole biopsie sembra essere un problema a causa dell’eterogeneità intratumorale a livello genomico. Abbiamo indagato questo problema a livello dell'architettura del segnale in campioni di mCRC e ccRCC . I risultati indicano una somiglianza complessiva nei profili proteomici all'interno dello stesso tumore. Considerando che una singola biopsia è rappresentativa di un intera lesione , abbiamo studiato la possibilità di creare linee di cellule primarie, per valutare il profilo molecolare di ogni paziente. Fino ad oggi non c'era un protocollo per creare linee cellulari immortalizzate senza alcuna variazione genetica . abbiamo cosiderato, però, l'approccio innovativo delle CRCs. Ad oggi , non è ancora chiaro se tali cellule mimino il profilo dei tessuti oppure I passaggi in vitro modifichino i loro pathways . Sulla base di un modello di topo , i nostri dati mostrano un profilo di proteomica simile tra le linee di cellule e tessuti di topo LCM. In conclusione, i nostri dati dimostrano l'utilità della piattaforma LCM / RPPA nella sperimentazione clinica e la possibilità di creare una bio - banca di linee cellulari primarie, per migliorare la decisione del trattamento.

Intra- and interspecific competition in western barbastelle bats (Barbastella barbastellus, SCHREBER 1774)

In the present thesis I examined individual and sex-specific habitat use and site fidelity in the western barbastelle bat, Barbastella barbastellus, using data from a four-year monitoring in a Special Area of Conservation in Rhineland-Palatinate, Germany. The western barbastelle occurs in central and southern Europe from Portugal to the Caucasus, but is considered to be rare in large parts of its range. Up to now, long-term field studies to assess interannual site fidelity and the possible effects of intra- and interspecific competition have not been studied in this species. Nevertheless, such data provide important details to estimate the specific spatial requirements of its populations, which in turn can be incorporated in extended conservation actions. I used radio-telemetry, home range analyses und automated ultrasound detection to assess the relation between landscape elements and western barbastelle bats and their roosts. In addition, I estimated the degree of interspecific niche overlap with two selected forest-dwelling bat species, Bechstein's bat (Myotis bechsteinii) and the brown long-eared bat (Plecotus auritus). Intra- and interannual home range overlap analyses of female B. barbastellus revealed that fidelity to individual foraging grounds, i.e. a traditional use of particular sites, seems to effect the spatial distribution of home ranges more than intraspecific competition among communally roosting females. The results of a joint analysis of annual maternity roost selection and flight activities along commuting corridors highlight the necessity to protect roost complexes in conjunction with commuting corridors. Using radio-tracking data and an Euclidean distance approach I quantified the sex-specific and individual habitat use by female and male western barbastelle bats within their home ranges. My data indicated a partial sexual segregation in summer habitats. Females were found in deciduous forest patches and preferably foraged along linear elements within the forest. Males foraged closer to forest edges and in open habitats. Finally, I examined the resource partitioning between the western barbastelle bat and two syntopic bat species with a potential for interspecific competition due to similarities in foraging strategies, prey selection and roost preferences. Simultaneous radio-tracking of mixed-species pairs revealed a partial spatial separation of the three syntopic bat species along a gradient from the forest to edge habitats and open landscape. Long-eared bats were found close to open habitats which were avoided by the other two species. B. barbastellus preferred linear landscape elements (edge habitats) and forests, M. bechsteinii also preferred forest habitats. Only little overlap in terms of roost structure and tree species selection was found.