Outcome a lungo termine dei pazienti pediatrici con rene singolo. Valutazione di marker laboratoristici e strumentali di danno renale

Obiettivi: valutare in pazienti con rene singolo congenito la correlazione tra il filtrato glomerulare misurato con il DTPA (DTPA-VFG) e 1) marker laboratoristici di danno renale (creatinina, cistatinaC, proteinuria) 2) formule per stimare il filtrato glomerulare 3) parametri di valutazione della crescita renale ecografica. Materiali e metodi: Sono stati arruolati 118 pazienti con rene singolo congenito tra 0 e 18 anni. Sono stati valutati a ogni visita altezza, creatinina, cistatinaC, proteinuria e lunghezza ecografica renale. E’ stato calcolato il filtrato stimato con formule basate sulla creatinina (Schwartz), sulla cistatina C (Zappitelli, Filler, Grubb e Bokenkamp) e su entrambe (equazione di Zappitelli). La crescita renale è stata valutata come rapporto lunghezza ecografica/altezza corporea (USL/H), differenza percentuale tra lunghezza renale misurata e attesa per età (delta%) e presenza o meno d’ipertrofia compensatoria. In 74 bambini è stata misurata la DTPA-VFG. Risultati: Il follow-up è di 2.1 ± 0.9 anni. Il 65% sono maschi. Nessun paziente ha sviluppato danno renale cronico. La media del DTPA-VFG era di 135±44ml/min/1.73m², il valore medio della creatinina 0.47±0.17mg/dl e di cistatinaC di 1±0.4mg/L. La lunghezza ecografica renale media era di 100±17 mm, il rapporto USL/H medio di 0.8±0,1 e il delta% di 1,13±11,4, il 66% presentava ipertrofia renale. Le uniche correlazioni significative con DTPA-VFG sono inversa con la creatinina (p=<.001) e lineare con USL/H (p=<.001). Discussione: Lo studio ha mostrato che come per altre nefrouropatie, la creatina e l’ecografia renale siano due strumenti validi per il follow-up dei pazienti con rene singolo congenito. Il limite principale è dovuto al fatto che nessuno dei pazienti ha sviluppato danno renale cronico e pertanto non è stato possibile stabilire dei cutt-off di rischio per parametri quali USL/H.

Molekulare und supramolekulare Eigenschaften von neuen Donor-Akzeptor-Polymeren

Die organische Halbleitertechnologie befindet sich seit Jahrzehnten im Focus des Interesses, da sie eine kostengünstige und umweltverträgliche Alternative zu anorganischen Silizium-basierten Halbleitern darstellt. Die Möglichkeit der gezielten Funktionalisierung von definierten Strukturen durch synthetische Methoden, welche eine große Vielfalt an Materialien ermöglicht, steht dabei besonders im Vordergrund. Die Modifikation von physikalischen Eigenschaften ermöglicht dabei eine stark erleichterte Anpassung für den geplanten Anwendungsbereich. Im Rahmen der vorliegenden Dissertation wurden organische Halbleitermaterialien basierend auf Cyclopenta[2,1-b:3,4-b']dithiophen (CDT) dargestellt und hinsichtlich ihrer strukturellen und elektronischen Eigenschaften untersucht. In Kombination mit Benzo[c][1,2,5]thiadiazol (BTZ) und weiteren Akzeptoren wurden zunächst Donor(D)-Akzeptor(A)-Polymere synthetisiert und Struktur-Eigenschaft-Beziehungen aufgestellt. So konnte ein sehr hochmolekulares Polymer CDT-BTZ-Polymer (Mn = 36 kg mol-1, PDI = 2.6) erhalten werden, welches sich durch eine hohe lamellare Ordnung und eine gemessene Ladungsträgermobilität in FETs von über 5.0 cm2V-1s-1 bei Raumtemperatur auszeichnete; bei niedrigen Temperaturen (240 K) war letztgenannte 6.5 cm2V-1s-1. Aufgrund dieses hohen Ladungstransports und der Abwesenheit niedermolekularer Polymerketten innerhalb des Polymers konnte erstmals eine Messung eines HALL-Effektes bewerkstelligt werden. Dies war der erste Beweis eines Band-artigen Ladungstransportes an einem Polymerhalbleiter. Des Weiteren wurde durch synthetische Veränderung der Grundstruktur des Polymers zu längeren Alkylketten eine anisotrope Anordnung der Polymerketten erreicht und die Ladungsträgermobilität (6.5 cm2V-1s-1 bei Raumtemperatur) weiter gesteigert. Darauf aufbauend wurde der Einfluss von stereoisomeren Seitenketten an CDT-BTZ-Polymeren auf Packungsverhalten, Parametern (Sperrstrom, Einschaltstrom) in FETs und Löslichkeit in organischen Lösungsmitteln untersucht. Durch cis-trans-Isomerisierung der Seitenketten wurde hier eine neue Methode zur Optimierung des Packungsverhaltens von Polymeren in dünnen Filmen und Lösung gefunden. Zuletzt wurden D-π-A-Farbstoffen, welche CDT als Verbrückungseinheit (π) beinhalten, dargestellt. Durch Variation von D und A konnten Struktur-Eigenschaft-Beziehungen in der Anwendung in Solarzellen (Feststoffsolarzellen, Flüssigsolarzellen) gefunden werden. Die Untersuchungen der photoinduzierten Absorption und der Photolumisenzenzquantenausbeute lieferten dabei Erklärungen für physikalische Prozesse wie Ladungsinjektion- und rekombination.

High-energy view of radio galaxies: prospects for the new generation of Cherenkov telescopes

I Nuclei Galattici Attivi (AGN) sono sorgenti luminose e compatte alimentate dall'accrescimento di materia sul buco nero supermassiccio al centro di una galassia. Una frazione di AGN, detta "radio-loud", emette fortemente nel radio grazie a getti relativistici accelerati dal buco nero. I Misaligned AGN (MAGN) sono sorgenti radio-loud il cui getto non è allineato con la nostra linea di vista (radiogalassie e SSRQ). La grande maggioranza delle sorgenti extragalattiche osservate in banda gamma sono blazar, mentre, in particolare in banda TeV, abbiamo solo 4 MAGN osservati. Lo scopo di questa tesi è valutare l'impatto del Cherenkov Telescope Array (CTA), il nuovo strumento TeV, sugli studi di MAGN. Dopo aver studiato le proprietà dei 4 MAGN TeV usando dati MeV-GeV dal telescopio Fermi e dati TeV dalla letteratura, abbiamo assunto come candidati TeV i MAGN osservati da Fermi. Abbiamo quindi simulato 50 ore di osservazioni CTA per ogni sorgente e calcolato la loro significatività. Assumendo una estrapolazione diretta dello spettro Fermi, prevediamo la scoperta di 9 nuovi MAGN TeV con il CTA, tutte sorgenti locali di tipo FR I. Applicando un cutoff esponenziale a 100 GeV, come forma spettrale più realistica secondo i dati osservativi, prevediamo la scoperta di 2-3 nuovi MAGN TeV. Per quanto riguarda l'analisi spettrale con il CTA, secondo i nostri studi sarà possibile ottenere uno spettro per 5 nuove sorgenti con tempi osservativi dell'ordine di 250 ore. In entrambi i casi, i candidati migliori risultano essere sempre sorgenti locali (z<0.1) e con spettro Fermi piatto (Gamma<2.2). La migliore strategia osservativa per ottenere questi risultati non corrisponde con i piani attuali per il CTA che prevedono una survey non puntata, in quanto queste sorgenti sono deboli, e necessitano di lunghe osservazioni puntate per essere rilevate (almeno 50 ore per studi di flusso integrato e 250 per studi spettrali).

Progettazione e sintesi di coppie ioniche ("soft salts") basate su complessi Ir(III) tetrazolici.

In questo lavoro di tesi sperimentale si è sintetizzata e caratterizzata la prima classe di complessi tetrazolici di Ir(III) anionici con formula generale [Ir(C^N)2(L)2]-, in cui oltre ai leganti ciclometallanti ”C^N” quali 2-fenilpiridinato (ppy) o 2-(2,4-difluorofenil)piridinato (F2ppy), sono stati introdotti due anioni tetrazolato (L) come il 5-fenil tetrazolato (Tph) oppure 5-(4-cianofenil) tetrazolato (TphCN). I complessi di Ir(III) anionici ottenuti si sono mostrati intensamente fosforescenti, con emissioni centrate nella regione del blu o del verde (460 < λmax<520 nm). I derivati anionici sono stati poi combinati con complessi Ir(III) tetrazolici cationici in grado di fornire emissione nella regione del rosso (λmax > 650 nm), formando così i primi esempi di coppie ioniche (“soft salts”) a matrice puramente tetrazolica. In tutti i casi si è osservato come il colore emesso da parte dei soft salts sia il risultato di una vera propria sintesi additiva delle emissioni derivanti da componenti ioniche con proprietà fotoemittive differenti. La sostanziale assenza di fenomeni di energy o electron transfer tra la componente anionica e cationica e il giusto bilancio tra le emissioni blu o verdi e rosse si sono tradotte, in taluni casi, nell’ottenimento di luce bianca, con la possibilità di variare ulteriormente i colori emessi in seguito all’allontanamento dell’ossigeno molecolare disciolto nelle soluzioni dei soft salts stessi.

Resistive-Polymer Versus Forced-Air Warming: Comparable Efficacy in Orthopedic Patients

BACKGROUND: Several adverse consequences are caused by mild perioperative hypothermia. Maintaining normothermia with patient warming systems, today mostly with forced air (FA), has thus become a standard procedure during anesthesia. Recently, a polymer-based resistive patient warming system was developed. We compared the efficacy of a widely distributed FA system with the resistive-polymer (RP) system in a prospective, randomized clinical study. METHODS: Eighty patients scheduled for orthopedic surgery were randomized to either FA warming (Bair Hugger warming blanket #522 and blower #750, Arizant, Eden Prairie, MN) or RP warming (Hot Dog Multi-Position Blanket and Hot Dog controller, Augustine Biomedical, Eden Prairie, MN). Core temperature, skin temperature (head, upper and lower arm, chest, abdomen, back, thigh, and calf), and room temperature (general and near the patient) were recorded continuously. RESULTS: After an initial decrease, core temperatures increased in both groups at comparable rates (FA: 0.33 degrees C/h +/- 0.34 degrees C/h; RP: 0.29 degrees C/h +/- 0.35 degrees C/h; P = 0.6). There was also no difference in the course of mean skin and mean body (core) temperature. FA warming increased the environment close to the patient (the workplace of anesthesiologists and surgeons) more than RP warming (24.4 degrees C +/- 5.2 degrees C for FA vs 22.6 degrees C +/- 1.9 degrees C for RP at 30 minutes; P(AUC) <0.01). CONCLUSION: RP warming performed as efficiently as FA warming in patients undergoing orthopedic surgery.

Crystallization, optimization and preliminary X-ray characterization of a metal-dependent PI-PLC from Streptomyces antibioticus

A recombinant metal-dependent phosphatidylinositol-specific phospholipase C (PI-PLC) from Streptomyces antibioticus has been crystallized by the hanging-drop method with and without heavy metals. The native crystals belonged to the orthorhombic space group P222, with unit-cell parameters a = 41.26, b = 51.86, c= 154.78 A. The X-ray diffraction results showed significant differences in the crystal quality of samples soaked with heavy atoms. Additionally, drop pinning, which increases the surface area of the drops, was also used to improve crystal growth and quality. The combination of heavy-metal soaks and drop pinning was found to be critical for producing high-quality crystals that diffracted to 1.23 A resolution.

Lipid profiles and outcome in patients treated by intravenous thrombolysis for cerebral ischemia

OBJECTIVE:To determine whether low low-density lipoprotein cholesterol (LDL-C) but not high-density lipoprotein cholesterol (HDL-C) and triglyceride concentrations are associated with worse outcome in a large cohort of ischemic stroke patients treated with IV thrombolysis. METHODS:Observational multicenter post hoc analysis of prospectively collected data in stroke thrombolysis registries. Because of collinearity between total cholesterol (TC) and LDL-C, we used 2 different models with TC (model 1) and with LDL-C (model 2). RESULTS:Of the 2,485 consecutive patients, 1,847 (74%) had detailed lipid profiles available. Independent predictors of 3-month mortality were lower serum HDL-C (adjusted odds ratio [(adj)OR] 0.531, 95% confidence interval [CI] 0.321-0.877 in model 1; (adj)OR 0.570, 95% CI 0.348-0.933 in model 2), lower serum triglyceride levels ((adj)OR 0.549, 95% CI 0.341-0.883 in model 1; (adj)OR 0.560, 95% CI 0.353-0.888 in model 2), symptomatic ICH, and increasing NIH Stroke Scale score, age, C-reactive protein, and serum creatinine. TC, LDL-C, HDL-C, and triglycerides were not independently associated with symptomatic ICH. Increased HDL-C was associated with an excellent outcome (modified Rankin Scale score 0-1) in model 1 ((adj)OR 1.390, 95% CI 1.040-1.860). CONCLUSION:Lower HDL-C and triglycerides were independently associated with mortality. These findings were not due to an association of lipid concentrations with symptomatic ICH and may reflect differences in baseline comorbidities, nutritional state, or a protective effect of triglycerides and HDL-C on mortality following acute ischemic stroke.

A GABA(A) receptor of defined subunit composition and positioning: concatenation of five subunits

We show that the five subunits of a gamma-aminobutyric acid type A receptor (GABA(A) receptor) can be concatenated to yield a functional receptor. This concatenated receptor alpha(1)-beta(2)-alpha(1)-gamma(2)-beta(2) has the advantage of a known subunit arrangement. Most of its functional properties are not significantly different from a receptor formed by individual subunits. Extent of expression amounted to about 40% of that of non-concatenated receptors in Xenopus oocytes, after injection of oocytes with comparable amounts of cRNA coding for concatenated and non-concatenated receptors. The ability to express receptors consisting of five subunits enables detailed studies of GABA(A) receptor subtype selective compounds.

Effects of sleep fragmentation on the arousability to resistive loading in NREM and REM sleep in normal men

STUDY OBJECTIVE: In healthy subjects, arousability to inspiratory resistive loading is greater during rapid eye movement (REM) sleep compared with non-REM (NREM) sleep but is poorest in REM sleep in patients with sleep apnea. We therefore examined the hypothesis that sleep fragmentation impairs arousability, especially from REM sleep. DESIGN: Two blocks of 3 polysomnographies (separated by at least 1 week) were performed randomly. An inspiratory-loaded night followed either 2 undisturbed control nights (LN(C)) or 2 acoustically fragmented nights (LN(F)) SETTING: Sleep laboratory. PARTICIPANTS: Sixteen healthy men aged 20 to 29 years. INTERVENTIONS: In both loaded nights, an inspiratory resistive load was added via a valved facemask every 2 minutes during sleep and turned off either when arousal occurred or after 2 minutes. MEASUREMENTS AND RESULTS: During LN(F), arousability remained significantly greater in REM sleep (71% aroused within 2 minutes) compared with stage 2 (29%) or stage 3/4 (16%) sleep. After sleep fragmentation, arousability was decreased in stage 2 sleep (LN(F): 29%; LN(C): 38%; p < .05) and low in early REM sleep, increasing across the night (p < .01). In stage 3/4 sleep, neither an attenuation nor a change across the night was seen after sleep fragmentation. CONCLUSIONS: Mild sleep fragmentation is already sufficient to attenuate arousability in stage 2 sleep and to decrease arousability in early, compared with late, REM sleep. This means that sleep fragmentation affects the arousal response to increasing resistance and that the effects are different in stage 2 and REM sleep. The biologic reason for this increase in the arousal response in REM sleep across the night is not clear.

Two neighboring residues of loop A of the alpha1 subunit point towards the benzodiazepine binding site of GABAA receptors

Benzodiazepines are widely used drugs exerting sedative, anxiolytic, muscle relaxant, and anticonvulsant effects by acting through specific high affinity binding sites on some GABA(A) receptors. It is important to understand how these ligands are positioned in this binding site. We are especially interested here in the conformation of loop A of the alpha(1)beta(2)gamma(2) GABA(A) receptor containing a key residue for the interaction of benzodiazepines: alpha(1)H101. We describe a direct interaction of alpha(1)N102 with a diazepam- and an imidazobenzodiazepine-derivative. Our observations help to better understand the conformation of this region of the benzodiazepine pocket in GABA(A) receptor.

New sst4/5-selective somatostatin peptidomimetics based on a constrained tryptophan scaffold

The synthesis and biological evaluation of four peptidomimetic analogs of somatostatin based on a constrained Trp residue, 3-amino-indolo[2,3-c]azepin-2-one (Aia), are reported. It is shown that dipeptidomimetics with a D-Aia-Lys sequence, functionalized with N- and C-terminal aromatic substituents, display a good selectivity for both sst4 and sst5. This study allowed us to identify a new highly potent sst5 agonist with good selectivity over the other receptors, except versus sst4.

Meperidine and skin surface warming additively reduce the shivering threshold: a volunteer study

INTRODUCTION: Mild therapeutic hypothermia has been shown to improve outcome for patients after cardiac arrest and may be beneficial for ischaemic stroke and myocardial ischaemia patients. However, in the awake patient, even a small decrease of core temperature provokes vigorous autonomic reactions-vasoconstriction and shivering-which both inhibit efficient core cooling. Meperidine and skin warming each linearly lower vasoconstriction and shivering thresholds. We tested whether a combination of skin warming and a medium dose of meperidine additively would reduce the shivering threshold to below 34 degrees C without producing significant sedation or respiratory depression. METHODS: Eight healthy volunteers participated on four study days: (1) control, (2) skin warming (with forced air and warming mattress), (3) meperidine (target plasma level: 0.9 mug/ml), and (4) skin warming plus meperidine (target plasma level: 0.9 mug/ml). Volunteers were cooled with 4 degrees C cold Ringer lactate infused over a central venous catheter (rate asymptotically equal to 2.4 degrees C/hour core temperature drop). Shivering threshold was identified by an increase of oxygen consumption (+20% of baseline). Sedation was assessed with the Observer's Assessment of Alertness/Sedation scale. RESULTS: Control shivering threshold was 35.5 degrees C +/- 0.2 degrees C. Skin warming reduced the shivering threshold to 34.9 degrees C +/- 0.5 degrees C (p = 0.01). Meperidine reduced the shivering threshold to 34.2 degrees C +/- 0.3 degrees C (p < 0.01). The combination of meperidine and skin warming reduced the shivering threshold to 33.8 degrees C +/- 0.2 degrees C (p < 0.01). There were no synergistic or antagonistic effects of meperidine and skin warming (p = 0.59). Only very mild sedation occurred on meperidine days. CONCLUSION: A combination of meperidine and skin surface warming reduced the shivering threshold to 33.8 degrees C +/- 0.2 degrees C via an additive interaction and produced only very mild sedation and no respiratory toxicity.

Covalent modification of GABAA receptor isoforms by a diazepam analogue provides evidence for a novel benzodiazepine binding site that prevents modulation by these drugs

Classical benzodiazepines, for example diazepam, interact with alpha(x)beta(2)gamma(2) GABA(A) receptors, x = 1, 2, 3, 5. Little is known about effects of alpha subunits on the structure of the binding pocket. We studied here the interaction of the covalently reacting diazepam analog 7-Isothiocyanato-5-phenyl-1,3-dihydro-2H-1,4-benzodiazepin-2-one (NCS compound) with alpha(1)H101Cbeta(2)gamma(2) and with receptors containing the homologous mutation, alpha(2)H101Cbeta(2)gamma(2), alpha(3)H126Cbeta(2)gamma(2) and alpha(5)H105Cbeta(2)gamma(2). This comparison was extended to alpha(6)R100Cbeta(2)gamma(2) receptors as this mutation conveys to these receptors high affinity towards classical benzodiazepines. The interaction was studied at the ligand binding level and at the functional level using electrophysiological techniques. Results indicate that the geometry of alpha(6)R100Cbeta(2)gamma(2) enables best interaction with NCS compound, followed by alpha(3)H126Cbeta(2)gamma(2), alpha(1)H101Cbeta(2)gamma(2) and alpha(2)H101Cbeta(2)gamma(2), while alpha(5)H105Cbeta(2)gamma(2) receptors show little interaction. Our results allow conclusions about the relative apposition of alpha(1)H101 and homologous positions in alpha(2), alpha(3), alpha(5) and alpha(6) with the position occupied by -Cl in diazepam. During this study we found evidence for the presence of a novel site for benzodiazepines that prevents modulation of GABA(A) receptors via the classical benzodiazepine site. The novel site potentially contributes to the high degree of safety to some of these drugs. Our results indicate that this site may be located at the alpha/beta subunit interface pseudo-symmetrically to the site for classical benzodiazepines located at the alpha/gamma interface.

Thoracoabdominal-aortoiliac multidetector-row CT angiography at 80 and 100 kVp: assessment of image quality and radiation dose

OBJECTIVE: To compare image quality and radiation dose of thoracoabdominal computed tomography (CT) angiography at 80 and 100 kVp and to assess the feasibility of reducing contrast medium volume from 60 to 45 mL at 80 kVp. MATERIALS AND METHODS: This retrospective study had institutional review board approval; informed consent was waived. Seventy-five patients who had undergone thoracoabdominal 64-section multidetector-row CT angiography were divided into 3 groups of 25 patients each. Patients of groups A (tube voltage, 100 kVp) and B (tube voltage, 80 kVp) received 60 mL of contrast medium at 4 mL/s. Patients of group C (tube voltage, 80 kVp) received 45 mL of contrast medium at 3 mL/s. Mean aortoiliac attenuation, image noise, and contrast-to-noise ratio were assessed. The measurement of radiation dose was based on the volume CT dose index. Three independent readers assessed the diagnostic image quality. RESULTS: Mean aortoiliac attenuation for group B (621.1 +/- 90.5 HU) was significantly greater than for groups A and C (485.2 +/- 110.5 HU and 483.1 +/- 119.8 HU; respectively) (P < 0.001). Mean image noise was significantly higher for groups B and C than for group A (P < 0.05). The contrast-to-noise ratio did not significantly differ between the groups (group A, 35.0 +/- 13.8; group B, 31.7 +/- 10.1; group C, 27.3 +/- 11.5; P = 0.08). Mean volume CT dose index in groups B and C (5.2 +/- 0.4 mGy and 4.9 +/- 0.3 mGy, respectively) were reduced by 23.5% and 27.9%, respectively, compared with group A (6.8 +/- 0.8 mGy) (P < 0.001). The average overall diagnostic image quality for the 3 groups was graded as good or better. The score for group A was significantly higher than that for group C (P < 0.01), no difference was seen between group A and B (P = 0.92). CONCLUSIONS: Reduction of tube voltage from 100 to 80 kVp for thoracoabdominal CT angiography significantly reduces radiation dose without compromising image quality. Reduction of contrast medium volume to 45 mL at 80 kVp resulted in lower but still diagnostically acceptable image quality.

The Effect of Heat Treatment of Forages on Degradation Kinetics and Escape Protein Concentration

An in situ study was conducted to evaluate the effects of heat treatments on the degradation kinetics and escape protein concentrations of forages (alfalfa and berseem clover). Alfalfa collected at 4 and 7 weeks post-harvest and berseem clover collected at 5 and 7 weeks postharvest were freeze-dried and then heated to 100, 125, and 150o C for 2 hours. Heat treatment effects were determined by placing two bags of sample (for each treatment, maturity, and forage species for a given incubation times) into the rumen of one fistulated steer fed alfalfa hay. Bags were incubated for periods of 0 to 48 hours. Increasing levels of heat treatments of forages increased concentrations of neutral detergent fiber (NDF), acid detergent fiber (ADF), and acid detergent insoluble nitrogen (ADIN) and non-degradable protein (NDP), potentially degradable protein proportion (PDP), and protein escaping rumen degradation (PEP) while decreasing water soluble protein (WSP) and the rates of crude protein (CP), except immature berseem clover and cell wall (CW) degradation. PEP was greater and rate of CP degradation was lower at 100 and 150o C compared to 125o C in immature berseem clover.