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Unreinforced masonry is the most diffused construction material in the major part of historical centers in Europe. In a building subjected to earthquake forces the contribution of in-plane shear resistance of the masonry walls is a determinant factor for the stability of the whole structure. In particular, the masonry piers are the structural elements subjected to the combination of normal and shear forces. In general, ductile tools to model the in plane behaviour of masonry are always welcome in order to evaluate the capacity of walls subjected to vertical and horizontal actions. In this framework, two no-tension approaches to model the behaviour of masonry walls loaded with in-plane forces, involving a minimum energy procedure, are presented. Both the procedures allow the representation of the stress maps in the panel in case of monotonic increase of shear load. The results of the numerical analyses are compared and discussed., Frattura ed Integrità Strutturale, 14 (51)

Important advances achieved in pharmacological cancer treatment have led progressively to a reduction in mortality from many forms of cancer, and increasing numbers of previously incurable patients can now hope to become cancer-free. Yet, to achieve these improved outcomes a high price has been paid in terms of untoward side effects associated with treatment, cardio-toxicity in particular. Several recent studies have reported that cardiac troponin assay using high-sensitivity methods (hs-cTn) can enable the early detection of myocardial injury related to chemotherapy or abuse of drugs that are potentially cardiotoxic. Several authors have recently suggested that changes in hs-cTn values enable the early diagnosis of cardiac injury from chemotherapy, thus potentially benefitting cancer patients with increased troponin values by initiating early cardioprotective therapy. However, large randomised clinical trials are needed in order to evaluate the cost/benefit ratio of standardised protocols for the early detection of cardiotoxicity using the hs-cTn assay in patients treated with chemotherapy.

In many seismically active regions of the world there are large numbers of masonry buildings. Most of these buildings have not been designed for seismic loads. Recent earthquakes have shown that many of these buildings are seismically vulnerable and should be considered for retrofitting. Different conventional and unconventional retrofitting techniques are available to increase the strength and/or ductility of unreinforced masonry (URM) walls. This paper reviews and discusses seismic retrofitting of masonry walls with emphasis on the conventional techniques. Retrofitting procedures are discussed with regard to a case study: a stone masonry building in Irpinia region, damaged by the 1980 earthquake. The interventions are evaluated by means of finite elements with a macroelement obtained with an homogenization technique. Linear and nonlinear procedures are compared, and peculiarities of each procedure are shown

Settlements severely affect historic masonry arch bridges worldwide. There are countless examples of structural dislocations and ruins in recent years due to severe settlements at the base of pier foundations, often caused by shipworm infestation of wooden foundations or scouring and riverbed erosion phenomena. The present paper proposes an original way to approach the failure analysis of settled masonry arch bridges. The proposed method combines two different 2D numerical models for the prediction of masonry arch bridge capacity against settlements and for safety assessment. The first one is the Piecewise Rigid Displacement method, i.e. a block-based limit analysis approach using the well known Heyman's hypotheses; the second one is a continuous Finite Element approach. The case study of the four-span Deba Bridge (Spain, 2018) failure is presented with the aim to illustrate how the methods work. The failure analysis produced satisfactory results by applying both methods separately, in confirmation of their reliability. Their combination also allowed to obtain a significantly reduction in computational cost and an improvement of prediction accuracy. A sensitivity and a path-following analysis were also performed with the aim to demonstrate the robustness of the presented method. The obtained simulations highlighted that the results do not depend on the friction angle and that a proper prediction of the evolution of the structural behavior can be obtained only taking into account geometric nonlinearities. Such results demonstrate once again that in settled masonry arches geometry prevails over the mechanical parameters. The current study paves the way for the fruitful use of the proposed approaches for a wider range of applications, as, for example, the mechanism identification or the displacement capacity assessment of masonry structures under overloading as seismic loads.

In recent years, the formulation of some immunoassays with high-sensitivity analytical performance allowed the accurate measurement of cardiac troponin I (cTnI) and T (cTnT) levels in reference subjects. Several studies have demonstrated the association between the risk of major cardiovascular events and cardiac troponin concentrations even for biomarker values within the reference intervals. High-sensitivity cTnI and cTnT methods (hs-cTn) enable to monitor myocardial renewal and remodelling, and to promptly identify patients at highest risk ofheart failure. An early and effective treatment of individuals at higher cardiovascular risk may revert the initial myocardial remodelling and slow down heart failure progression. Specific clinical trials should be carried out to demonstrate the efficacy and efficiency of the general population screening by means of cost-benefit analysis, in order to better identify individuals at higher risk for heart failure (HF) progression with hs-cTn methods.

The present paper concerns an approach to the structural identification of tall buildings. The identification is based on a large number of experimental data obtained on a scaled model. The procedure consists in steps of system identification by means of a refined finite element model which is the base for the evaluation of a simplified one dimensional scheme. The parameters accuracy of this last one has been determined with reference to a refined schematization. The approach is model updating, based on the first three experimental natural frequencies and modes. The case study is a structure in Naples, made by two reinforced concrete towers, linked at the top by a steel girder with suspended storeys, while the foundation slab is based on a reinforced concrete piled group.

We formulate a novel procedure for the limit analysis of two-dimensional masonry structures subject to arbitrary loading conditions. The proposed approach works in the framework of free discontinuity methods, on examining collapse mechanisms that exhibit free crack opening discontinuities. The load bearing capacity and the collapse mechanism of the structure are obtained through a fully variational approach, by minimizing a kinetic functional that admits the collapse crack pattern as a variable. Numerical examples illustrate the practical application of the proposed procedure to the limit analysis of a variety of masonry walls and arches subject to foundation settlements, vertical and horizontal forces.

Objectives: To assess the performance of LIAISON® BRAHMS PCT® II GEN (DiaSorin, Saluggia, Italy) in procalcitonin (PCT) determination by comparing it to the assay reference method B·R·A·H·M·S PCT KRYPTOR (Thermo Fisher Scientific Clinical Diagnostics, Hennigsdorf, Germany) and assessing its ability to discriminate between healthy subjects and patients with suspected infection. Methods: Diagnostic performance was evaluated on: a) 193 selected samples covering the assay range, whose procalcitonin levels were already evaluated with the B·R·A·H·M·S PCT® KRYPTOR; b) prospective samples: 150 apparently healthy specimens obtained from a blood bank, 161 hospitalized patients (not with specific pathologies), 243 apparently healthy children. Results: The comparison of LIAISON® BRAHMS PCT® II GEN to the reference method B·R·A·H·M·S PCT KRYPTOR yielded high correlation coefficients: slope of Deming fit equal to 1.04 (95% CI: 0.99–1.09) with an intercept equal to 0.05 (95% CI: −0.09 to 0.19) and a high concordance (98.4% (95% CI: 95.5–99.7%)) at the 0.5 ng/mL cut-off. Moreover, the results obtained using prospective samples showed: (i) no samples with PCT concentration >0.5 ng/mL (cut-off) for the apparently healthy adults (highest value=0.033 ng/mL, 95th percentile and 97.5th percentile 0.5 ng/mL for hospitalized patients (highest value=0.715 ng/mL, 95th percentile: 0.054 ng/mL; 97.5th percentile: 0.088 ng/mL); (iii) 3 samples >0.5 ng/mL for the healthy children population (highest value=0.713 ng/mL, 95th percentile: 0.155 ng/mL; 97.5th percentile: 0.275 ng/mL). Conclusion: The fully automated LIAISON® BRAHMS PCT® II GEN agrees well with the reference method and is suitable for early diagnosis of sepsis, severe bacterial infection and guiding antibiotic therapy. Keywords: PCT, Bacterial infections, Sepsis, Antibiotic treatment, Automated diagnostic detection methods

Background: Few reports exist on the relationship of the left ventricular diastolic dysfunction (LVDD) with its most important features including enlargement of the left atrium and left ventricular hypertrophy (LVH), and with the right ventricular (RV) function. Objective: To determine the correlation between the left atrial size and the RV function and dimensions in patients with and without LVDD and LVH. Methods: Fifty patients were included, 25 (40% men) of them with LVDD, aged 67.1 ± 10.6 years (study group) and 25 without LVDD (52% men) aged 49.9 ± 16.3 years (control group). Patients underwent transthoracic echocardiography with evaluation of the left atrial size and volume (LAV), LVDD, LVH, and RV function and dimensions. P-values < 0.05 were considered statistically significant. Results: LAV > 34 mL/m2 and left atrial size > 40 mm were associated with lower absolute values of tricuspid annular plane systolic excursion (TAPSE) and RV lateral S' (p ≤ 0.001, Pearson's correlation coefficient -0.4 and -0.38, respectively) in the study group. Patients in the study group showed higher incidence of LVH (p = 0.02) and greater left atrial diameter (p = 0.03) compared with the control group. In addition, greater left atrial diameter (p = 0.02) and LAV (p = 0.01) values were found in patients with LVDD grade II compared with LVDD grade I. Conclusions: The present study determined, for the first time, the correlation of left atrial enlargement with progressive RV dysfunction in patients with LVDD. Resumo Fundamentos: A relação entre a disfunção diastólica do ventrículo esquerdo (DDVE), seus achados mais importantes, como aumento do átrio esquerdo e hipertrofia ventricular esquerda (HVE), e a função do ventrículo direito (VD) tem pouca documentação na literatura científica. Objetivo: Avaliar a correlação entre o tamanho atrial esquerdo em indivíduos com e sem DDVE e HVE e função e dimensões do VD. Métodos: Foram selecionados 50 pacientes, sendo 25 com DDVE (grupo de estudo [GE]; 67,1 ± 10,6 anos; 40% homens) e 25 sem DDVE (grupo-controle [GC]; 49,9 ± 16,3 anos; 52% homens). Os pacientes foram submetidos a ecocardiografia transtorácica com avalição do tamanho e volume atrial esquerdo (VAE), DDVE, HVE, dimensões e função do VD. Valores de p < 0,05 indicaram significância estatística. Resultados: VAE > 34 ml/m2 e tamanho atrial esquerdo > 40 mm apresentaram menores valores absolutos de excursão sistólica do plano do anel tricúspide (TAPSE) e S' lateral do VD (p ≤ 0,001, coeficiente de correlação de Pearson de -0,4 e -0,38, respectivamente) no GE. O GE apresentou maior incidência de HVE e maior diâmetro atrial esquerdo quando comparado ao GC (p = 0,02 e p = 0,03, respectivamente). O GE apresentou maior diâmetro e VAE nos indivíduos com DDVE grau II quando comparados aos indivíduos com DDVE grau I (p = 0,02 e p = 0,01, respectivamente). Conclusões: O presente estudo permitiu correlacionar de maneira inédita o aumento atrial esquerdo com diminuição progressiva da função ventricular direita em pacientes com disfunção diastólica de VE.

The objective of the present work is to develop an automated numerical method for the analysis of thin masonry shells. The material model for masonry that we adopt is the so-called "normal rigid no-tension" (NRNT) material; and for such a material, the kinematical and the safe theorems of limit analysis are valid. The present study focuses on the application of the second theorem to masonry vaults and domes, being devoted to the determination of a class of purely compressive stress regimes, which are balanced with the load. The mere existence of such a class is a proof that the structure is safe, and members of this class may be used to assess the geometric degree of safety of the structure and to estimate bounds on the thrust forces exerted by the structure on its boundary. The problem is reduced to the equilibrium of a membrane S and can be formulated in terms of projected stresses defined on the planform Ω of S. The search of the stress reduces to the solution of a second-order pde, in terms of the stress potential F. In order that the membrane stress on S be compressive, the potential F must be concave. As for the thrust line in an arch, the surface S is not fixed and may be changed, given that it remains inside the masonry. Under these simplifying assumptions, the whole class of equilibrated stress regimes for a masonry shell is obtained by moving and deforming S inside the masonry, and also, for any fixed shape, by changing the boundary data for F, that is the distribution of thrust forces along the boundary. The search for a feasible stress state on a convenient membrane surface, to be chosen with a trial and error procedure, requires a substantial effort and may be unrewarded. Then, the main object of the present work, is to produce a computer code that can handle numerically the interplay of the shape controlled by a function f, and of the stress potential F, by developing a convergent optimization scheme able to give a safe state under the given material and geometrical constraints, namely the concavity of F and the inclusion of f within the masonry. Two simple cases, are exposed in detail to illustrate the method.

Masonry railways bridges were built and are still in use all over Europe and in many other countries all over the world. Limit analysis is widely adopted to assess the equilibrium of these structur...

BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease. Studies have suggested a possible prognostic role of copeptin in determining the rate of progressive kidney function decline in ADPKD patients. However, it remains unresolved whether the changes in copeptin levels are specific for ADPKD or merely reflect a decline in glomerular filtration rate (GFR) regardless of the etiology of chronic kidney disease (CKD). METHODS We performed a case-control study in ADPKD and non-ADPKD (control) patients. Patients were categorized based on the GFR-category (G-stage, KDIGO). We evaluated urea, creatinine, cystatin C, and copeptin in plasma and correlated these levels with estimated glomerular filtration rate (eGFR) (CKD-EPI). All p-values were two sided, and p

Masonry structural modelling needs of a completely different methodology from the ones adopted for ductile structures. In fact, the concepts of strength, stiffness and elastic stability, fundamental for the latter structures, play a marginal role in masonry mechanics. In this respect, Heyman's theory, gives a modern turn to the old methods of masonry design, adopting a set of very simple and clear mechanical hypotheses. In these papers, the basic ingredients of a new method based on unilateral equilibrium and rigid block kinematics, which may allow the implementation of Heyman's model for masonry on a computer, is introduced. In particular a simple method based on energy minimisation, with the possibility of combining the effects of loads and settlements on real masonry structures, is developed.

This paper deals with the analysis of fracture identification of a generic masonry structure subjected to loads and to kinematical actions (settlements, distorsions). The masonry is composed of normal rigid no-tension material (NRNT), that is a Heyman’s material treated as a continuous body. An energy minimum criterion is used to solve the equilibrium problem, using continuous (C°) displacement fields and adopting a classical Finite Element approximation for the geometrical description. Some examples illustrate the way in which our approximate method detects crack patterns in some simple cases. The C° method, though more cumbersome form the numerical point of view, exhibits great efficiency in the identification of the exact location and orientation of the crack system, compared to methods based on discontinuous displacement fields.

SummaryBackground: The measurement of 25OH vitamin D continues to grow in clinical laboratories. The aim of this multicenter study was to compare the results of seven automated commercial immunoassays with a reference HPLC technique.Methods: One hundred and twenty consecutive outpatient serum samples were centrifuged, divided in aliquots, frozen and shipped to the participating laboratories. 25OH Vita - min D was measured with a reference HPLC system and with seven automated commercial immunoassays (Roche Cobas E601, Beckman Coulter Unicel DXI 800, Ortho Vitros ES, DiaSorin Liaison, Siemens Advia Centaur, Abbott Architect i System and IDS iSYS).Results: Compared to the reference method, the regression coefficients ranged from 0.923 to 0.961 (all pConclusions:The excellent correlation with the reference HPLC technique attests that all seven automated immuno - assays may be reliably used for routine assessment of 25OH-D in clinical laboratories. The significant bias among the different methods seems mostly attributable to the lack of standardization and calls for additional efforts for improving harmonization of 25OH-D immunoassays.

Resumo Introduction: Valvular deposits of calcium quantified by transthoracic echocardiography are associated with the occurrence of systemic atherosclerotic disease, but its prognostic value and influence of associated cardiovascular risk factors have not been defined yet. Objectives: To correlate the valvular cardiac calcium index by transthoracic echocardiography with cardiovascular risk factors and presence of coronary artery disease (CAD). Methods: We selected 203 patients (61.2 ± 14.3 years; 57.6% females) who underwent transthoracic echocardiography with cardiac calcium index quantification. The presence or absence of CAD, hypertension, diabetes mellitus (DM), dyslipidemia, and smoking was assessed. Results: Age above 65 years (p < 0.001) and the presence of hypertension (p < 0.001) showed a significant correlation with the presence of cardiac calcification, whereas DM (p = 0.056) and CAD (p = 0.08) showed only a trend toward a correlation with calcification. Mitral valve calcification alone correlated significantly with age above 65 years (p < 0.001), presence of CAD (p = 0.004), hypertension (p = 0.054), and DM (p = 0.07). On multivariate analysis, CAD (odds ratio [OR] 3.39, 95% confidence interval [95%CI] 1.58-7.29, p = 0.002) and age > 65 years (OR 1.05, 95%CI 1.02-1.08, p = 0.003) correlated significantly and independently with mitral valve calcification. Aortic valve calcification alone showed no correlation with the presence of CAD (p = 0.435), but correlated significantly with age above 65 years (p < 0.001) and hypertension (p < 0.001). On multivariate analysis, only age (OR 1.1, 95%CI 1.06-1.14, p < 0.001) remained independently and significantly correlated with aortic calcification. Conclusion: Age above 65 years and hypertension were independent risk factors for the presence of valvular cardiac calcification, with mitral valve calcification alone emerging as significantly and independently associated with the presence of CAD. Resumo Introdução: Depósitos valvares de cálcio quantificados por ecocardiografia transtorácica estão associados à presença de doença aterosclerótica sistêmica, embora seu valor prognóstico e a influência de fatores de risco cardiovascular associados ainda não estejam definidos. Objetivos: Correlacionar o índice de calcificação cardíaca valvar pela ecocardiografia transtorácica com fatores de risco cardiovascular e presença de doença arterial coronariana (DAC). Métodos: Foram selecionados 203 pacientes (61,2 ± 14,3 anos; 57,6% do sexo feminino) que realizaram ecocardiografia transtorácica com quantificação do índice de cálcio cardíaco. A presença ou não de DAC, hipertensão arterial sistêmica (HAS), diabetes mellitus (DM), dislipidemia e tabagismo foi avaliada. Resultados: Idade acima de 65 anos (p < 0,001) e presença de HAS (p < 0,001) mostraram correlação significativa com a presença de calcificação cardíaca, enquanto que o DM (p = 0,056) e a DAC (p = 0,08) apresentaram apenas uma tendência a se correlacionar com a mesma. A calcificação isolada da valva mitral mostrou correlação significativa com idade acima de 65 anos (p < 0,001), presença de DAC (p = 0,004), HAS (p = 0,054) e DM (p = 0,07), sendo que na análise multivariada a DAC (odds ratio [OR] 3,39, intervalo de confiança de 95% [IC95%] 1,58-7,29, p = 0,002) e idade > 65 anos (OR 1,05, IC95% 1,02-1,08, p = 0,003) mostraram correlação significativa e independente com calcificação mitral. A calcificação isolada da valva aórtica não mostrou correlação com a presença de DAC (p = 0,435), mas apresentou uma correlação significativa com idade acima de 65 anos (p < 0,001) e HAS (p < 0,001). Na análise multivariada, apenas a idade (OR 1,1, IC95% 1,06-1,14, p < 0,001) manteve uma correlação independente e significativa com calcificação aórtica. Conclusão: Idade acima de 65 anos e hipertensão arterial sistêmica foram fatores de risco independentes para a presença de calcificação cardíaca valvar, sendo que a calcificação isolada da valva mitral esteve associada de forma significativa e independente com a presença de DAC.

Background:Systematic difference between thyroid-stimulating hormone (TSH) immunoassays may produce misleading interpretation when samples of the same patients are measured with different methods. The study aims were to evaluate whether systematic differences are present among TSH immunoassays, and whether it is possible to obtain a better harmonization among TSH methods using results obtained in external quality assessment (EQA) schemes.Methods:Seven Italian clinical laboratories measured TSH in 745 serum samples of healthy subjects and patients with thyroid disorders. These samples were also re-measured by two reference laboratories of the study with the six TSH immunoassays most popular in Italy after 2 months of storage at −80 °C. Moreover, these data were compared to 53,823 TSH measurements, obtained by laboratories participant to 2012–2015 EQA annual cycles in 72 quality control samples (TSH concentrations from about 0.1 mIU/L to 18.0 mIU/L). TSH concentrations were recalibrated using a mathematical approach based on the principal component analysis (PCA).Results:Systematic differences were found between the most popular commercially available TSH immunoassays. TSH concentrations measured by the clinical laboratories were very closely correlated to those measured with the same method by reference laboratories after 2 months of storage at −80 °C. After recalibration using the PCA approach the variation of TSH values significantly decreased from a median pre-calibration value of 13.53% (10.79%–16.53%) to 9.63% (6.90%–13.21%) after recalibration.Conclusions:Our data suggest that EQA schemes are useful to improve harmonization among TSH immunoassays and also to produce some mathematical formulas, which can be used by clinicians to better compare TSH values measured with different methods.

Aim of the study Recently, Beckman Coulter Diagnostics set up a new TSH immunoassay for the automated DxI platform. The aim of this study was to evaluate and compare the analytical performance and clinical results of this method with those of previous method. Material and methods A multicenter study (named TSH ELAS Study) was organized using 593 serum samples, collected from healthy subjects and patients with thyroid disorders, and 13 control samples, circulated in an External Quality Assessment (EQA) scheme. Results The values of LoB and LoD, and LoQ at 20% CV were 0.0004 mIU/L, 0.001 mIU/L and 0.0023 mIU/L, respectively. Moreover, TSH concentrations > 0.01 mIU/L actually show imprecision values lower than 5% CV. This new TSH assay showed a systematic underestimation (on average of 6.25%) compared to old method, which is mainly due to larger differences between methods for samples with low TSH concentrations, related to the better analytical sensitivity of new compared to old method. In a reference population, including 279 apparently healthy adult subjects, Caucasian volunteers (mean age 43.6 years, age 20–63 years, 138 women and 141 males) the distribution of TSH concentrations was: mean (CI 95%) 1.694 mIU/L (1.588–1.779), median 1.495 mIU/L (1.412–1.588 mIU/L), 97.5th percentile 3.707 mIU/L. Conclusions The new TSH immunoassay for DxI platform shows some relevant improvements compared to the previous one: use of the most recent WHO 3rd IRP 81/563 standard and monoclonal antibodies (instead of polyclonal antibodies of the old method), and better analytical sensitivities and reproducibility.

In this paper the lower bound theorem of limit analysis for No-Tension materials is applied to study the equilibrium of spiral vaults, modeled as continuous unilateral membranes. The most efficient approach to the equilibrium of a thin shell is the covariant representation proposed by Pucher and adopted in the present study. Statically admissible singular stresses in the form of line or surface Dirac deltas and lying inside the masonry, are taken into account. The unilateral restrictions require that the Airy stress function representing the stress, be concave. The case study is a helical stair with a central pillar in Sanfelice Palace in Naples, whose structure is a tuff masonry spiral vault. The maps of the stress corresponding to two different stress functions and the safety factors in the two cases are provided.

This paper presents some numerical simulations, aimed to the assessment of the structural performance of masonry walls, reinforced with FRP composite materials. The problem is modeled in two dimensions, and the effects of seismic loads and of foundation settlements are studied numerically. The tool we use to perform the numerical analysis, is a new minimization software developed by the authors to analyze masonry constructions, modeled as unilateral structures. The material model we adopt, no-tension with elastic-plastic (associated) behavior in compression, is path-dependent and rate-independent. The trajectory of the system, under a given loading history, is approximated as a sequence of minimizers of a path dependent form of energy, updated at each stage of the step-by-step, time-discretized procedure. The results we obtain confirm that the application of fiber reinforced composites must be done carefully, since the increase of strength in some structural elements, due to the retrofitting, may prevent the structure from developing its natural, stress relieving, kinematics. �� 2014 Published by Elsevier Ltd.

The idea of a no-tension (NT) material underlies the design of masonry structures since antiquity. Based on the NT model, the safety of the structure is a problem of geometry rather than of strength materials, in the same spirit of the “rules of proportion” of the medieval building tradition. The use of singular stress fields for equilibrium problems of NT materials in 2d, has been recently proposed by Lucchesi et al. to produce statically admissible stress fields; here we introduce a simple way to construct singular stresses, based on the Airy’s stress formulation. We interpret the singular part of such stress fields as axial contact forces acting on ideal 1d structures arising inside the body, in the same spirit of Strut and Tie methods. A number of simple problems of equilibrium concerning typical walls, arches and portals, is solved in terms of stress fields having regular and singular parts, by adopting the direct and the stress function formulation. The validity of the rules of proportion described by Derand and Gil is also verified.

This paper is devoted to the application of unilateral models to the stress analysis of masonry structures. Some 2d applications of what we can call the simplified masonry-like model for masonry, are discussed and studied. The results here presented demonstrate that the unilateral model for masonry can be a useful tool for modeling real masonry structures. The main technique here employed for applying the No-Tension model to structures is the systematic use of singular stress and strain fields within the frame set by the theorems of Limit Analysis. A number of simple examples is discussed to illustrate the method.

In the present paper, on assuming that the material has infinite friction and no cohesion,i.e. it is No-Tension in the sense of Heyman, we study the equilibrium of cross vaults of unequal rise, such as those of some Romanesque and Gothic churches. In particular the case study of the lateral cross vaults of the Cathedral of the old town of Caserta is analyzed. The scope of the paper is not to study in detail and quantitatively any particular vault, rather we give a compressive equilibrium solution (compatible with the unilateral material assumption) for the general case of cross vaults, constructed on arches of unequal rise, and loaded by a uniform load.For the purpose of the structural analysis, the vault is modelled as a thin shell made of Rigid No-Tension material. The webs of the vault that we consider, are supported on two crossing ribs. To obtain the axial force inside the ribs, equilibrated and singular stress fields (that is stress fields concentrated on curves and balanced with the loads) are constructed.An estimate of the thrust forces transmitted by the vault to the peripheral arches and walls is also obtained, so that the stability of these structures can be checked.

Background The aim of this study is to evaluate whether it is possible to reduce the between-methods variability of troponin I (cTnI) immunoassays using mathematical algorithms calculated from the results of both patients' samples and quality control materials distributed in an external quality assessment (EQA) scheme. Methods We collected 122 heparinized plasma samples of patients admitted to the emergency department with thoracic pain or supraventricular tachyarrhythmia. Moreover, we also analyzed 20 control samples distributed in an EQA and 26 plasma pools prepared from healthy subjects and patients with myocardial infarction. We evaluated 4 different methods for cTnI assay: STAT Architect High Sensitive TnI (Abbott Diagnostics), ADVIA Centaur Troponin I Ultra (Siemens Healthcare Diagnostics), ST AIA-Pack cTnI Third Generation (Tosoh Bioscience), and Access AccuTnI + 3 (Beckman Coulter Diagnostics). Results Systematic differences between cTnI methods were observed. However, correlation coefficients (R from 0.976 to 0.990) between the log-transformed cTnI values measured in all 168 samples were significantly better (p = 0.0037) than those obtained considering only the 122 patients' samples. cTnI values measured in EQA and pool samples were included within the 95% prediction intervals of linear regressions calculated with those of patients' samples. After the recalibration of cTnI values based on the robust principal component analysis approach the between-methods variability decreased significantly (about 40% around the cut off values). Conclusions Our pilot study suggests that EQA schemes for cTnI immunoassay methods, based on both quality control samples with tested commutability and robust statistical analyses, are able to evaluate between-methods variability as well as allow a reliable recalibration and harmonization of results.

INTRODUCAO: A cirurgia cardiaca minimamente invasiva e videoassistida (CCVA) tem aumentado em popularidade nos ultimos 15 anos. As pequenas incisoes tem sido associadas a um bom efeito estetico e menor trauma cirurgico, consequentemente, menor dor e rapida recuperacao pos-operatoria. OBJETIVOS: Apresentar nossa casuistica com CCVA, apos 6 anos de uso do metodo. METODOS: Cento e trinta e seis pacientes foram submetidos a CCVA, apos consentimento escrito, entre setembro de 2005 e outubro de 2011, sendo 50% do sexo masculino, com idade de 47,8 ± 15,4 anos, divididos em dois grupos: com circulacao extracorporea (CEC) (GcCEC=105 pacientes): valvopatia mitral (47/105), valvopatia aortica (39/105) e cardiopatia congenita (19/105) e sem CEC (GsCEC=31 pacientes): ressincronizacao cardiaca (18/31), tumor cardiaco (4/31) e revascularizacao miocardica minimamente invasiva (6/31). No GcCEC, foi realizada minitoracotomia direita (3 a 5 cm) e acesso femoral para canulacao periferica. RESULTADOS: No GcCEC, a media de dias em UTI (DUTI) e de internacao hospitalar (DH) foi, respectivamente, 2,4 ± 4,5 dias e 5,0 ± 6,8 dias. Doze pacientes apresentaram complicacoes no pos-operatorio e cinco (4,8%) foram a obito. Noventa e tres (88,6%) pacientes evoluiram sem intercorrencias, foram extubados no centro cirurgico, permanecendo 1,8 ± 0,9 DUTI e 3,6 ± 1,3 DH. No GsCEC, foram 1,3 ± 0,7 DUTI e 2,9 ± 1,4 DH, sem intercorrencias ou obitos. CONCLUSAO: Os resultados encontrados nesta casuistica sao comparaveis aos da literatura mundial e confirmam o metodo como opcao a tecnica convencional.

Nell’anziano variazioni clinicamente significative della concentrazione degli ormoni steroidei testosterone ed estradiolo sono presenti nel maschio, nel deficit androgenico dell’adulto e nella ginecomastia, e nella femmina, nella sindrome climaterica: in queste condizioni il dosaggio dei due steroidi ha un importante ruolo nella diagnosi o nel monitoraggio di terapie specifiche sostitutive.

Minimum incision techniques in cardiac surgery have been on the rise after their inclusion in videothoracoscopy. Video-assisted minimally invasive cardiac surgery is considered by many centers in the world to be the approach of choice for treatment of mitral and aortic valve diseases. The aim of this is study is to report a case of valve repair in a patient with mitral restenosis after surgical repair 12 years before. Through a minimally invasive and totally endoscopic procedure, it was possible to successfully perform a mitral commissurotomy with only videoscopic support, and without any incisions larger than those needed to introduce the trocars for instrumentation.

INTRODUÇÃO: Cirurgias cardíacas videoassistidas minimamente invasivas têm sido realizadas em grandes centros mundiais, incluindo procedimentos valvares, coronários e congênitos. OBJETIVO: Apresentar nossa primeira casuística com videocirurgia cardíaca, por meio da experiência adquirida com cirurgia geral e torácica. MÉTODOS: Sempre que houve possibilidade de se realizar uma cirurgia cardíaca por acesso minimamente invasivo, esta foi a abordagem inicialmente utilizada. A toracoscopia esquerda foi utilizada em quatro casos: (1) ligadura de fistula coronário-pulmonar sintomática, (2) implante de eletrodo epicárdico em ventrículo esquerdo para ressincronização ventricular, (3) retirada de lipoma gigante de pericárdio com pedículo em átrio esquerdo e (4) ressecção de hemangio-lipoma de mediastino. Toracoscopia direita com bypass cardiopulmonar via artéria e veia femorais e parada cardíaca em fibrilação ventricular com hipotermia moderada, foram realizados nos seguintes casos: (5) paciente com estenose mitral pós-plastia, com anel de Carpentier 12 anos antes. Foi realizada comissurotomia anterior e posterior com sucesso, sem toracotomia, (6) paciente com miocardiopatia dilatada idiopática, fibrilação atrial de alta resposta e insuficiência mitral importante, realizada plastia mitral com anel de Gregori e ablação de veias pulmonares com cateter de radiofreqüência (MAZE modificada). Neste caso, uma minitoracotomia ântero-lateral direita de 6 cm foi utilizada. RESULTADOS: Nenhum óbito ocorreu nesta série e o resultado cirúrgico em todos os casos foi altamente satisfatório, sendo que todos os pacientes receberam alta hospitalar com média de 5,5 + 5 dias após a intervenção. CONCLUSÃO: Nossa experiência inicial neste campo demonstra a eficácia e exeqüibilidade de introdução deste tipo de técnica em nosso meio.

The astronauts on board the International Space Station (ISS) are only the most visible part of a much larger team engaged around the clock in the performance of science and technical activities in space. The bulk of such team is scattered around the globe in five major Mission Control Centers (MCCs), as well as in a number of smaller payload operations centres. Communication between the crew in space and the flight controllers at those locations is an essential element and one of the key drivers to efficient space operations. Such communication can be carried out in different forms, depending on available technical assets and the selected operational approach for the activity at hand. This paper focuses on operational voice communication and provides a quantitative overview of the balance achieved in the Columbus program between collaborative space/ground operations and autonomous on-board activity execution. An interpretation of the current situation is provided, together with a description of potential future approaches for deep space exploration missions.

In the present paper, we apply the theorems of limit analysis to vaults modeled as masonry-like materials, that is, unilateral continuous bodies. On allowing for singular stresses, we consider statically admissible stress field concentrated on surfaces lying inside the masonry. Such structures are unilateral membranes, whose geometry is described a la Monge , and the equilibrium of them, under vertical loads, is formulated in the Pucher form. The problem is reduced to pere roca a single partial differential equation of the second order where the shape f and the stress function F appear symmetrically. The unilateral restrictions require that the membrane surface lies in between the extrados and intrados surfaces of the vault and that the stress function be concave. Such a constraint is, in general, not satisfied on a given shape for given loads: in such a case, the shape has to be modified to fit the constraint. In a sense, the unilateral assumption renders the membrane an underdetermined structure that must adapt its shape in order to satisfy the unilateral restrictions. A number of simple examples are presented to illustrate how the method works.

Sequential dialysis techniques (i.e pure ultrafiltration followed by dialysis) have been used in the past, due to their capability to remove large volumes of fluids without inducing hemodynamic instability. The disadvantages of inadequate efficiency and lack of technology lead to the decline of such methods. Hemofiltration (HF) and hemodiafiltration (HDF) are recently being utilized in a greater proportion thanks to on-line fluid preparation systems. Each process (HF and HDF) has its own benefits in the removal of small, medium and high-molecular weight substances and in hemodynamic stability. Sequential convective therapies (SCT) such as hemofiltration-hemodiafiltration in sequence (HF-HDF) may combine the benefits and eliminate the disadvantages of each method and should be studied in order to explore their potential application in modern dialysis. Furthermore they can be easily applied nowadays, due to the development of new sophisticated dialysis machines. In order to evaluate the feasibility, safety, efficiency and tolerance of different SCT methods we studied 3 schedules: SCT1: 1h pre-dilution HF followed by 3h of postdilution HDF (in the HF mode we lost 25% of the total fluid that had to be removed). SCT2: 1h pre-dilution HF followed by 3h of post-dilution HDF (in the HF mode we lost 50% of the total fluid that had to be removed). SCT3: 2h pre-dilution HF followed by 2h of post-dilution HDF (in the HF mode we lost 50% of the total fluid that had to be removed). We studied 6 chronic hemodialysis patients using the same machine (AK200 ULTRA), with on-line fluid preparation system and the same type of dialyzer (Polyflux 210). SCT schedules were compared to on-line HF, on-line HDF and high flux dialysis performed with the same dialyzers. The treatments resulted safe, easy, feasible and well tolerated with an improved hemodynamic response to high volume convective therapies. Adequacy of treatment was satisfactory in all SCT schedules while middle molecular weight solute clearance and removal resulted higher in treatments with higher convective component. SCT might represent an interesting option for the future especially in patients with hemodynamic instability and requirements for interventions during treatment.

Background: The prevalence of Helicobacter pylori increases with age. However, data regarding the effects of anti-H. pylori treatments in the elderly are very scarce. Methods: To evaluate the effect of three lansoprazole-based, 7 day, triple-therapy regimens on H. pylori eradication rates, symptomatology, chronic gastritis activity and serological markers of H. pylori infection in elderly subjects, we studied 150 symptomatic patients over 60 years of age with H. pylori-positive duodenal ulcer (DU, n = 34), gastric ulcer (GU, n = 19) or chronic gastritis (CG, n = 97). Patients were consecutively treated with one of the following regimens: (A) lansoprazole (LNS) 30 mg b.i.d. + clarithromycin (CLR) 250 mg b.i.d. + metronidazole (MTR) 250 mg q.i.d.; (B) LNS 30 mg b.i.d. + amoxycillin (AMOX) 1 g b.i.d. + MTR 250 mg q.i.d.; and (C) LNS 30 mg b.i.d. + CLR 250 mg b.i.d. + AMOX 1 g b.i.d. Results: Two months after therapy, the eradication rates of the three treatments, expressed using both intention-to-treat and per-protocol analyses were, respectively; group A, 86 and 91.5%; group B, 80 and 87%; group C, 82 and 89.1%. After therapy, a significant reduction in epigastric pain (P < 0.001), heartburn (P = 0.02), dyspepsia (P < 0.001) and vomiting (P < 0.005) was observed independently of the success of H. pylori eradication. A significantly higher percentage of asymptomatic patients were in the GU-DU group than in CG group (87.7 vs 70.0%, P = 0.032). After therapy, 33 subjects still suffered from symptoms. Persistence of symptoms was significantly associated with an endoscopic diagnosis of oesophagitis and not with H. pylori infection. Patients cured of H. pylori infection showed a significant decrease in the histological activity of both antral and body gastritis (P < 0.0001), a significant drop in immunoglobulin (Ig) G anti-H. pylori antibodies (P < 0.0001) and pepsinogen (PG) C (P< 0.0001) and an increase in the PGA/PGC ratio (P < 0.0001). Conclusions: The 7 day, lansoprazole-based triple therapy was well tolerated and highly effective in the cure of H. pylori infection, the reduction of symptoms, chronic gastritis activity and serum levels of IgG anti-H. pylori antibodies and PGC. Persistence of symptoms after therapy was significantly higher in CG than GU and DU patients and was significantly associated with oesophagitis.

Uremia is associated with a state of immune dysfunction, increasing infection and malignancy rates. Dysregulation of homeostasis may be directly related to abnormal apoptosis regulation, a process which is crucial for the maintenance of the biologic system. Abnormal apoptosis rates (ARs) have been reported in the literature. We performed a longitudinal study over a 10-week period in three groups of uremic subjects-hemodialysis (HD), peritoneal dialysis (PD), and predialysis chronic renal failure (CRF). Our results showed that ARs were consistent over the observed period. Monocytes extracted from HD and CRF subjects had higher ARs compared to PD and controls (HD: 26.06 +/- 8.82; CRF: 26.96 +/- 12.81; PD: 14.77 +/- 5.87; C: 11.42 +/- 4.60) when placed in culture medium. The plasma of HD and CRF subjects when incubated with U937 cells had a stronger apoptogenic potential compared with PD and controls (HD: 26.08 +/- 11.39; CRF: 24.87 +/- 9.07; PD: 12.13 +/- 4.51; C: 11.69 +/- 4.02). Inflammatory markers (C-reactive protein [CRP], procalcitonin) and cytokines (interleukin [IL]-1beta, IL-2, IL-10) had a generally poor correlation except for tumor necrosis factor (TNF)-alpha (p < 0.001). The phagocytic ability of U937 cells when incubated with the various plasma demonstrated impaired response in the HD and CRF subjects (HD: 27.56 +/- 6.67; CRF: 30.24 +/- 9.08; PD: 36.55 +/- 9.80; C: 40.04 +/- 6.98). These results suggest continuous renal purification, such as in continuous ambulatory peritoneal dialysis (CAPD), may have advantages over intermittent therapies in regulating apoptosis and maintaining biologic function and homeostasis.

Background Two new immunoassay methods for aldosterone assay using automated platforms recently became available into market. The main aim of the present study is to evaluate the analytical performance of these automated direct immunoassay methods, and also to compare their analytical characteristics to those of the most popular RIA and EIA methods used in an Italian External Quality Assessment (EQA) study. Methods In this study analytical performances of two aldosterone immunoassays using the IDS iSYS and DiaSorin LIAISON fully automated platforms, were evaluated. Results obtained with the two platforms in EDTA plasma samples of healthy subjects and patients were compared with those obtained by RIA and EIA methods used in the Italian EQA scheme, named Immunocheck study. Results The two automated methods showed similar analytical performances: LoD 83.9 vs 92.2 pmol/L, LoQ 104.4 vs 111.1 pmol/L, respectively; moreover, the within-run and total imprecision values showed CV% between 8.1 and 14.1 for samples with 180.8 and 387.2 pmol/L concentration for both methods. There was a close linear regression between methods, however we found a significant proportional bias between LIAISON and iSYS methods. The EQA samples results obtained with these two methods were highly correlated to the consensus mean values. Conclusions Our data indicate that aldosterone values measured with the two automated methods actually show better reproducibility, shorter laboratory Turn Around Time (TAT) and require less “hands on labor” compared to RIA and EIA immunoassays. However, in our study significant bias was observed in result comparison, this means that translating aldosterone concentration in clinical information an appropriate definition of reference ranges for each method is mandatory.

Introduction and Aims: Medical problems occur at high altitude. The classical physiological responses to high altitude include hyperventilation, polycythemia and hypoxiemia. Type 1 diabetes (T1D) can participate in extreme altitude mountaineering. The prevalence of acute kidney injury (AKI) at high altitude is not known. We studied the renal function, by urinary Neutrophil gelatinase-associated lipocalin (uNGAL) in high altitude, as a promising biomarker for early detection of AKI. Methods: The 2012 ADIQ Expedition team included 4 male Caucasians participants (prt): two with T1D and two non-diabetics. Urine Glucose, Protein, Urobilinogen, pH, Specific Gravity, Blood, Ketones, Nitrite and Leucocytes were determinated on-site by Aution Sticks. The uCreatinine and uUrea were measured by F360 analyzer. uNGAL concentration was measured by the ARCHITECT urine NGAL assay. Microalbumin concentration was obtained by Beckman Image. Urine Total Protein measured by Dimension Vista analyser. The data has been normalized for urinary creatinine. Results: All expedition prt collected the urine samples (5000, 5600 m). The urinary qualitative results by dipstick evaluation showed normal values in all cases. The values of glycaemia in T1D prt were high after arrival at basecamp (without presence of ketones). The uNGAL concentrations and uNGAL/uCrea ratios were also lower than 132 ng/ml (cut-off of uNGAL) in all participants. Conclusions: All the prt had normal uNGAL during the time of expedition, suggesting normal renal activity also confirmed by the analysis of the other parameters. The renal function in T1D prt was preserved despite the abnormal metabolic state represented by hyperglycemia. In this type of activity, level of training is especially important.

The coronary artery fistulas (FAC) are rare and often found occasionally. The conventional treatment can be made by surgical closure with median thoracotomy or with embolization by catheterization. We describe an innovative technique to ligature of FAC, on a full endoscopy. Women, 45 years with symptomatic fistula between coronary artery anterior descending and trunk artery pulmonary, which took thoracoscopy left, pericardiotomy and ligation of fistula with metal clip without thoracotomy. There were no complications, stayed 24 hours in the ICU and was in hospital 4 days. The technique was effective, allows easy accessibility surgical and quick post-operative recovery.

Assay by ultrasensitive methods of serum prostate-specific antigen (PSA) recently demonstrated that many women have detectable levels of this molecule. Interestingly, serum PSA concentrations were higher in hirsute than in nonhirsute subjects, suggesting that, also in females, PSA may be regulated by androgens. To establish the potential for this assay as a biochemical marker of androgen action in women, we studied 40 hirsute subjects recruited in a double-blind, placebo-controlled, 6-month trial assessing the effects of 3 different antiandrogen drugs: spironolactone, flutamide, or finasteride. In each subject, serum PSA, free testosterone, and 3alpha-androstanediol glucuronide were determined at baseline and at the end of treatments. At baseline, PSA concentrations were higher in these 40 women than in 19 nonhirsute healthy controls (12.9+/-1.5 vs. 4.9+/-0.7 pg/mL, P = 0.03) and significantly correlated with serum free testosterone (r = 0.37, P

sentant un syndrome de detresse respiratoire L'aginine-vasopressine (AVP), le peptide natriuretique auriculaire humain (hANP) et le bilan electrolytique du liquide corporeal ont ete etudies durant les cinq premiers jours de vie de onze enfants prematures (poids a la naissance) sous ventilation mecanique pour RDS. Les concentrations plasmatiques du hANP et urinaire de l'AVP ont ete determinees par radio-immunologie le premier, le troisieme et le cinquieme jour. Les taux d'arginine-vasopressine dans les urines sont restes constamment eleves pendant toute la periode d'etude (moyenne ± SD 13,5 ± 7,8 1 er jour, 12,0 ± 9,9 3 e jour, 13,2 ±.5,1 ng/l 5 e jour, p = ns), par contre le hANP plasmatique s'etait accru de facon significative au troisieme jour (626 ± 495 vs. 298 ± 240 pg/ml 1 er jour, p

Acute kidney injury (AKI) is a common and serious condition, currently diagnosed by functional biomarkers, such as serum creatinine measurements. Unfortunately, creatinine increase is a delayed and unreliable indicator of AKI. The lack of early biomarkers of structural kidney injury has hampered our ability to translate promising experimental therapies to human AKI. The recent discovery, translation and validation of neutrophil gelatinase-associated lipocalin (NGAL), possibly the most promising novel AKI biomarker, is reviewed here. NGAL may be measured by several methods both in plasma and urine for the early diagnosis of AKI and for the prediction of clinical outcomes, such as dialysis requirement and mortality, in several common clinical scenarios, including in the intensive care unit, cardiac surgery and renal damage due the exposition to toxic agent and drugs, and renal transplantation. Furthermore, the predictive properties of NGAL, may play a critical role in expediting the drug development process. A systematic review of literature data indicates that further studies are necessary to establish accurate reference population values according to age, gender and ethnicity, as well as reliable and specific decisional values concerning the more common clinical settings related to AKI. Furthermore, proper randomized clinical trials on renal and systemic outcomes comparing the use of NGAL vs. standard clinical practice are still lacking and accurate cost-benefit and/or cost-utility analyses for NGAL as biomarker of AKI are also needed. However, it is important to note that NGAL, in the absence of diagnostic increases in serum creatinine, is able to detect some patients affected by subclinical AKI who have an increased risk of adverse outcomes. These results also suggest that the concept and definition of AKI might need to be reassessed.

We studied platelet aggregation and secretion in 48 patients with ischemic stroke, within 24 h of onset of symptoms, and 17 healthy controls. Aggregation was studied in platelet-rich plasma with the impedance method. As markers of dense and α-granule secretion we used adenosine triphosphate (ATP) and platelet factor 4 (PF4), respectively. Furthermore, we determined the basal platelet serotonin levels as an indicator of previous in vivo platelet activation. Platelet aggregation and secretion of ATP and PF4 were significantly increased in the patients in response to 1.0 and 2.0 µg/ml collagen. Similarly, the patients exhibited significantly increased platelet aggregation and PF4 secretion induced by 1.0 and 10 µmol/l adenosine diphosphate. Platelet aggregation in response to 1.0 µmol/l of platelet-activating factor was similar in patients and controls, but the parallel ATP secretion was significantly higher in patients. Platelets in patients thus exhibited an enhanced responsiveness to all three agonists, suggesting a general lower threshold for activation. The basal platelet levels of serotonin were significantly decreased in patients, indicating a previous in vivo platelet activation. Our data suggest that platelets are hyperaggregable with an increased secretion in the acute phase of cerebral infarct. Apart from the established importance of platelet hyperaggregatability in clot formation, platelet hypersecretion of serotonin and α-granule proteins may be of significance in the pathophysiology of ischemic stroke.

We examined association of inducible myocardial perfusion defects with cardiorenal biomarkers, and of diminished left ventricular ejection fraction (LVEF) with kidney injury marker plasma neutrophil gelatinase-associated lipocalin (NGAL). Patients undergoing nuclear myocardial perfusion stress imaging were divided into 2 groups. Biomarkers were analyzed pre- and poststress testing. Compared to the patients in the low ischemia group (n=16), the patients in the high ischemia group (n=18) demonstrated a significantly greater rise in cardiac biomarkers plasma BNP, NT-proBNP and cTnI. Subjects were also categorized based on pre- or poststress test detectable plasma NGAL. With stress, the group with no detectable NGAL had a segmental defect score 4.2 compared to 8.2 (P=.06) in the detectable NGAL group, and 0.9 vs. 3.8 (P=.03) at rest. BNP rose with stress to a greater degree in patients with detectable NGAL (10.2 vs. 3.5 pg/mL,P=.03). LVEF at rest and with stress was significantly lower in the detectable NGAL group; 55.8 versus 65.0 (P=.03) and 55.1 vs. 63.8 (P=.04), respectively. Myocardial perfusion defects associate with biomarkers of cardiac stress, and detectable plasma NGAL with significantly lower LVEF, suggesting a specific heart-kidney link.