Effetto dell'analgesia epidurale sulla progressione della testa fetale valutata mediante ecografia 3D

Introduzione: L'analgesia epidurale è stata messa in correlazione con l'aumento della durata del secondo stadio del travaglio e del tasso di utilizzo della ventosa ostetrica. Diversi meccanismi sono stati ipotizzati, tra cui la riduzione di percezione della discesa fetale, della forza di spinta e dei riflessi che promuovono la progressione e rotazione della testa fetale nel canale del parto. Tali parametri sono solitamente valutati mediante esame clinico digitale, costantemente riportato essere poco accurato e riproducibile. Su queste basi l'uso dell'ecografia in travaglio, con introduzione di diversi parametri ecografici di valutazione della discesa della testa fetale, sono stati proposti per supportare la diagnosi clinica nel secondo stadio del travaglio. Scopi dello studio: studiare effetto dell’analgesia epidurale sulla progressione della testa fetale durante il II stadio del travaglio valutata mediante ecografia intrapartum. Materiali e metodi: una serie di pazienti nullipare a basso rischio a termine (37+0-42+0) sono state reclutate in modo prospettico nella sala parto del nostro Policlinico Universitario. In ciascuna di esse abbiamo acquisito un volume ecografico ogni 20 minuti dall’inizio della fase attiva del secondo stadio fino al parto ed una serie di parametri ecografici sono stati ricavati in un secondo tempo (angolo di progressione, distanza di progressione distanza testa sinfisi pubica e midline angle). Tutti questi parametri sono stati confrontati ad ogni intervallo di tempo nei due gruppi. Risultati: 71 pazienti totali, di cui 41 (57.7%) con analgesia epidurale. In 58 (81.7%) casi il parto è stato spontaneo, mentre in 8 (11.3%) e 5 (7.0%) casi rispettivamente si è ricorsi a ventosa ostetrica o taglio cesareo. I valori di tutti i parametri ecografici misurati sono risultati sovrapponibili nei due gruppi in tutti gli intervalli di misurazione. Conclusioni: la progressione della testa fetale valutata longitudinalmente mediante ecografia 3D non sembra differire significativamente nelle pazienti con o senza analgesia epidurale.

Uso combinato di ecografia e stereofotogrammetria per l'analisi delle variazioni architetturali del muscolo in funzione della posizione articolare

Lo scopo di questo lavoro di tesi è stato quello di indagare come differenti angoli all’articolazione di caviglia possono influenzare l’architettura del muscolo Tibiale Anteriore, architettura che sua volta può influenzare la lettura degli elettromiogrammi superficiali. Questo è stato fatto attraverso l’utilizzo combinato di sistemi ecografici e stereofotogrammetrici, che nel loro complesso permettono la ricostruzione del volume della struttura di interesse. Dalle immagini ecografiche 3D è stato possibile valutare le modifiche dell’angolo di pennazione del muscolo, che ha mostrato differenze significative tra due condizioni di osservazione, ovvero passando dalla condizione con caviglia in posizione neutra a dorsiflessa e passando dalla posizione dorsiflessa a quella plantarflessa. Dalla ricostruzione del volume è stato possibile stimare le variazioni di spessore e larghezza del muscolo. Da queste stime sono state riscontrate differenze significative passando dalla condizione con caviglia in posizione neutra a dorsiflessa e passando dalla posizione dorsiflessa a quella plantarflessa, principalmente nella porzione più mediale del muscolo.

Minimal Criteria for the Diagnosis of Avulsion of the Puborectalis Muscle by Tomographic Ultrasound

Introduction and hypothesis Puborectalis avulsion is a likely etiological factor for female pelvic organ prolapse(FPOP). We performed a study to establish minimal sonographic criteria for the diagnosis of avulsion. Methods We analysed datasets of 764 women seen at a urogynecological service. Offline analysis of ultrasound datasets was performed blinded to patient data. Tomographic ultrasound imaging (TUI) was used to diagnose avulsion of the puborectalis muscle. Results Logistic regression modelling of TUI data showed that complete avulsion is best diagnosed by requiring the three central tomographic slices to be abnormal. This finding was obtained in 30% of patients and was associated with symptoms and signs of FPOP (P<0.001). Lesser degrees of trauma (‘partial avulsion’) were not associated with symptoms or signs of pelvic floor dysfunction. Conclusions Complete avulsion of the puborectalis muscle is best diagnosed on TUI by requiring all three central slices to be abnormal. Partial trauma seems of limited clinical relevance.

Valutazione della cardiotossicità in pazienti oncologici mediante tecniche ecocardiografiche

L'elaborato si inserisce in un progetto sviluppato presso l'Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.) di Meldola che riguarda la valutazione di parametri cardiologici che possano risultare indici predittivi di uno scompenso cardiaco in pazienti affetti da linfoma. Tutti i soggetti considerati nel progetto sono stati sottoposti a trattamenti chemioterapici facenti uso di antracicline e la cui funzionalità cardiaca è stata controllata periodicamente tramite ecografia bidimensionale e volumetrica, utilizzando il sistema VividE9 della GE Healthcare. L'obiettivo dell'analisi è quello di ricercare se oltre alla frazione di eiezione esistono parametri più predittivi di una eventuale cardiotossicità come gli strain, calcolati attraverso l'ausilio della tecnica ecografica.

Diagnosi prenatale delle malformazioni fetali: ecografia e risonanza magnetica a confronto in 11 anni di esperienza

Obiettivo: Valutare l’accuratezza reciproca dell’ecografia “esperta” e della risonanza magnetica nelle diagnosi prenatale delle anomalie congenite. Materiali e metodi: Sono stati retrospettivamente valutati tutti i casi di malformazioni fetali sottoposte a ecografia “esperta” e risonanza magnetica nel nostro Policlinico da Ottobre 2001 a Ottobre 2012. L’età gestazionale media all’ecografia e alla risonanza magnetica sono state rispettivamente di 28 e 30 settimane. La diagnosi ecografica è stata confrontata con la risonanza e quindi con la diagnosi postnatale. Risultati: sono stati selezionati 383 casi, con diagnosi ecografica o sospetta malformazione fetale “complessa” o anamnesi ostetrica positiva infezioni prenatali, valutati con ecografia “esperta”, risonanza magnetica e completi di follow up. La popolazione di studio include: 196 anomalie del sistema nervoso centrale (51,2%), 73 difetti toracici (19,1%), 20 anomalie dell’area viso-collo (5,2%), 29 malformazioni del tratto gastrointestinale (7,6%), 37 difetti genito-urinari (9,7%) e 28 casi con altra indicazione (7,3%). Una concordanza tra ecografia, risonanza e diagnosi postnatale è stata osservata in 289 casi (75,5%) ed è stata maggiore per le anomalie del sistema nervoso centrale 156/196 casi (79,6%) rispetto ai difetti congeniti degli altri distretti anatomici 133/187 (71,1%). La risonanza ha aggiunto importanti informazioni diagnostiche in 42 casi (11%): 21 anomalie del sistema nervoso centrale, 2 difetti dell’area viso collo, 7 malformazioni toraciche, 6 anomalie del tratto gastrointestinale, 5 dell’apparato genitourinario e 1 caso di sospetta emivertebra lombare. L’ecografia è stata più accurata della risonanza in 15 casi (3,9%). In 37 casi (9,7%) entrambe le tecniche hanno dato esito diverso rispetto agli accertamenti postnatali. Conclusioni: l’ecografia prenatale rimane a tutt’oggi la principale metodica di imaging fetale. In alcuni casi complessi e/o dubbi sia del sistema nervoso centrale sia degli altri distretti anatomici la risonanza può aggiungere informazioni rilevanti.

Structural and chemical basis for anticancer activity of a series of 'beta'-tubulin ligands: molecular modeling and 3D QSAR studies

An important approach to cancer therapy is the design of small molecule modulators that interfere with microtubule dynamics through their specific binding to the ²-subunit of tubulin. In the present work, comparative molecular field analysis (CoMFA) studies were conducted on a series of discodermolide analogs with antimitotic properties. Significant correlation coefficients were obtained (CoMFA(i), q² =0.68, r²=0.94; CoMFA(ii), q² = 0.63, r²= 0.91), indicating the good internal and external consistency of the models generated using two independent structural alignment strategies. The models were externally validated employing a test set, and the predicted values were in good agreement with the experimental results. The final QSAR models and the 3D contour maps provided important insights into the chemical and structural basis involved in the molecular recognition process of this family of discodermolide analogs, and should be useful for the design of new specific ²-tubulin modulators with potent anticancer activity.

Stress distribution in the cervical region of an upper central incisor in a 3D finite element model

The aim of this study was to evaluate the stress distribution in the cervical region of a sound upper central incisor in two clinical situations, standard and maximum masticatory forces, by means of a 3D model with the highest possible level of fidelity to the anatomic dimensions. Two models with 331,887 linear tetrahedral elements that represent a sound upper central incisor with periodontal ligament, cortical and trabecular bones were loaded at 45º in relation to the tooth's long axis. All structures were considered to be homogeneous and isotropic, with the exception of the enamel (anisotropic). A standard masticatory force (100 N) was simulated on one of the models, while on the other one a maximum masticatory force was simulated (235.9 N). The software used were: PATRAN for pre- and post-processing and Nastran for processing. In the cementoenamel junction area, tensile forces reached 14.7 MPa in the 100 N model, and 40.2 MPa in the 235.9 N model, exceeding the enamel's tensile strength (16.7 MPa). The fact that the stress concentration in the amelodentinal junction exceeded the enamel's tensile strength under simulated conditions of maximum masticatory force suggests the possibility of the occurrence of non-carious cervical lesions such as abfractions.

Dynamical Lorentz symmetry breaking in 3D and charge fractionalization

We analyze the breaking of Lorentz invariance in a 3D model of fermion fields self-coupled through four-fermion interactions. The low-energy limit of the theory contains various submodels which are similar to those used in the study of graphene or in the description of irrational charge fractionalization.

Density functional theory investigation of 3d, 4d, and 5d 13-atom metal clusters

The knowledge of the atomic structure of clusters composed by few atoms is a basic prerequisite to obtain insights into the mechanisms that determine their chemical and physical properties as a function of diameter, shape, surface termination, as well as to understand the mechanism of bulk formation. Due to the wide use of metal systems in our modern life, the accurate determination of the properties of 3d, 4d, and 5d metal clusters poses a huge problem for nanoscience. In this work, we report a density functional theory study of the atomic structure, binding energies, effective coordination numbers, average bond lengths, and magnetic properties of the 3d, 4d, and 5d metal (30 elements) clusters containing 13 atoms, M(13). First, a set of lowest-energy local minimum structures (as supported by vibrational analysis) were obtained by combining high-temperature first- principles molecular-dynamics simulation, structure crossover, and the selection of five well-known M(13) structures. Several new lower energy configurations were identified, e. g., Pd(13), W(13), Pt(13), etc., and previous known structures were confirmed by our calculations. Furthermore, the following trends were identified: (i) compact icosahedral-like forms at the beginning of each metal series, more opened structures such as hexagonal bilayerlike and double simple-cubic layers at the middle of each metal series, and structures with an increasing effective coordination number occur for large d states occupation. (ii) For Au(13), we found that spin-orbit coupling favors the three-dimensional (3D) structures, i.e., a 3D structure is about 0.10 eV lower in energy than the lowest energy known two-dimensional configuration. (iii) The magnetic exchange interactions play an important role for particular systems such as Fe, Cr, and Mn. (iv) The analysis of the binding energy and average bond lengths show a paraboliclike shape as a function of the occupation of the d states and hence, most of the properties can be explained by the chemistry picture of occupation of the bonding and antibonding states.

Improved finite element for 3D laminate frame analysis including warping for any cross-section

The most ordinary finite element formulations for 3D frame analysis do not consider the warping of cross-sections as part of their kinematics. So the stiffness, regarding torsion, should be directly introduced by the user into the computational software and the bar is treated as it is working under no warping hypothesis. This approach does not give good results for general structural elements applied in engineering. Both displacement and stress calculation reveal sensible deficiencies for both linear and non-linear applications. For linear analysis, displacements can be corrected by assuming a stiffness that results in acceptable global displacements of the analyzed structure. However, the stress calculation will be far from reality. For nonlinear analysis the deficiencies are even worse. In the past forty years, some special structural matrix analysis and finite element formulations have been proposed in literature to include warping and the bending-torsion effects for 3D general frame analysis considering both linear and non-linear situations. In this work, using a kinematics improvement technique, the degree of freedom ""warping intensity"" is introduced following a new approach for 3D frame elements. This degree of freedom is associated with the warping basic mode, a geometric characteristic of the cross-section, It does not have a direct relation with the rate of twist rotation along the longitudinal axis, as in existent formulations. Moreover, a linear strain variation mode is provided for the geometric non-linear approach, for which complete 3D constitutive relation (Saint-Venant Kirchhoff) is adopted. The proposed technique allows the consideration of inhomogeneous cross-sections with any geometry. Various examples are shown to demonstrate the accuracy and applicability of the proposed formulation. (C) 2009 Elsevier Inc. All rights reserved.

A solid-like FEM for geometrically non-linear 3D frames

This study presents a solid-like finite element formulation to solve geometric non-linear three-dimensional inhomogeneous frames. To achieve the desired representation, unconstrained vectors are used instead of the classic rigid director triad; as a consequence, the resulting formulation does not use finite rotation schemes. High order curved elements with any cross section are developed using a full three-dimensional constitutive elastic relation. Warping and variable thickness strain modes are introduced to avoid locking. The warping mode is solved numerically in FEM pre-processing computational code, which is coupled to the main program. The extra calculations are relatively small when the number of finite elements. with the same cross section, increases. The warping mode is based on a 2D free torsion (Saint-Venant) problem that considers inhomogeneous material. A scheme that automatically generates shape functions and its derivatives allow the use of any degree of approximation for the developed frame element. General examples are solved to check the objectivity, path independence, locking free behavior, generality and accuracy of the proposed formulation. (C) 2009 Elsevier B.V. All rights reserved.

A FEM procedure based on positions and unconstrained vectors applied to non-linear dynamic of 3D frames

This study presents an alternative three-dimensional geometric non-linear frame formulation based on generalized unconstrained vector and positions to solve structures and mechanisms subjected to dynamic loading. The formulation is classified as total Lagrangian with exact kinematics description. The resulting element presents warping and non-constant transverse strain modes, which guarantees locking-free behavior for the adopted three-dimensional constitutive relation, Saint-Venant-Kirchhoff, for instance. The application of generalized vectors is an alternative to the use of finite rotations and rigid triad`s formulae. Spherical and revolute joints are considered and selected dynamic and static examples are presented to demonstrate the accuracy and generality of the proposed technique. (C) 2010 Elsevier B.V. All rights reserved.

Experimental study of a Tollmien-Schlichting wave interacting with a shallow 3D roughness element

The paper is devoted to an experimental study of the effect of a shallow 3D roughness element on the evolution of a 2D Tollmien-Schlichting wave in a Blasius boundary layer. The experiments were carried out under controlled disturbance conditions on an airfoil section which could provide a long run with zero pressure gradient flow. A pneumatically driven slit source was used to introduce the Tollmien-Schilichting wave upstream of the lower branch of the neutral stability curve. A few wavelengths downstream, the T-S wave interacts with a cylindrical roughness element. The height of the roughness was slowly oscillating in time, which allows a continuous measurement of the T-S wave response downstream the roughness. The oscillation frequency was approximately 1500 times lower than the frequency of the studied Tollmien-Schlichting wave and therefore, behaved as a steady roughness with respect to the T-S wave. Hot wire anemometry was used to measure wall normal profiles and spanwise scans close to the maximum of the eigenfunction of the T-S wave. The oscillation of the roughness and the synchronization of all-equipments permitted the use of ensemble average techniques. Two different amplitudes of T-S waves with a non-dimensional frequency of F120E-06 were studied. They show a strong amplification of the disturbances in a small spanwise wave number range. The analysis of the wall normal T-S profiles suggests the growth of oblique modes.

3D CFD Simulation of Vortex-induced Vibration of Cylinder

The 3D flow around a circular cylinder free to oscillate transversely to the free stream was simulated using Computational Fluid Dynamics (CFD) and the Spalart-Allmaras Detached Eddy Simulation (DES) turbulence model for a Reynolds number Re = 10(4). Simulations were carried out for a small mass-damping parameter m*zeta = 0.00858, where m* = 3.3 and zeta = 0.0026. We found good agreement between the numerical results and experimental data. The simulations predicted the high observed amplitudes of the upper branch of vortex-induced vibrations for low mass-damping parameters.

3D-Pharmacophore mapping of thymidine-based inhibitors of TMPK as potential antituberculosis agents

Tuberculosis (TB) is the primary cause of mortality among infectious diseases. Mycobacterium tuberculosis monophosphate kinase (TMPKmt) is essential to DNA replication. Thus, this enzyme represents a promising target for developing new drugs against TB. In the present study, the receptor-independent, RI, 4D-QSAR method has been used to develop QSAR models and corresponding 3D-pharmacophores for a set of 81 thymidine analogues, and two corresponding subsets, reported as inhibitors of TMPKmt. The resulting optimized models are not only statistically significant with r (2) ranging from 0.83 to 0.92 and q (2) from 0.78 to 0.88, but also are robustly predictive based on test set predictions. The most and the least potent inhibitors in their respective postulated active conformations, derived from each of the models, were docked in the active site of the TMPKmt crystal structure. There is a solid consistency between the 3D-pharmacophore sites defined by the QSAR models and interactions with binding site residues. Moreover, the QSAR models provide insights regarding a probable mechanism of action of the analogues.