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In accordance with all the most recent international guidelines, the variation of circulating levels of cardiac troponins I and T, measured with high-sensitivity methods (hs-cTnI and hs-cTnT), should be used for the detection of acute myocardial injury. Recent experimental and clinical evidences have demonstrated that the evaluation of hs-cTnI and hs-cTnT variations is particularly relevant: a) for the differential diagnosis of Acute Coronary Syndromes (ACS) in patients admitted to the Emergency Department (ED); b) for the evaluation of cardiovascular risk in patients undergoing major cardiac or non-cardiac surgery, and in asymptomatic subjects of the general population aged >55 years and with co-morbidities; c) for the evaluation of cardiotoxicity caused by administration of some chemotherapy drugs in patients with malignant tumors. The aim of this document is to discuss the fundamental statistical and biological considerations on the intraindividual variability of hs-cTnI and hs-cTnT over time in the same individual. Firstly, it will be discussed in detail as the variations of circulating levels strictly depend not only on the analytical error of the method used but also on the intra-individual variability of the biomarker. Afterwards, the pathophysiological interpretation and the clinical relevance of the determination of the variability of the hs-cTnI and hs-cTnT values ​​ in patients with specific clinical conditions are discussed. Finally, the evaluation over time of the variation in circulating levels of hs-cTnI and hs-cTnT is proposed for a more accurate estimation of cardiovascular risk in asymptomatic subjects from the general population.

The execution of interventions in the road network for its expansion or improvement implies interference in several types of reliefs, including undulated and mountainous. Considering the great variety of physical and anthropic factors coexisting along the routes of interest and emphasizing the occurrence of extreme rainfall events, the need to previously evaluate the susceptibility to mass movement on the hillsides bordering the roads becomes increasingly higher. The existence of studies to identify unstable areas aims to prevent the occurrence of inconvenience to users due to traffic interruption, damage to infrastructure and even fatalities. In the present research, shallow translational and rotational landslides were analyzed for a stretch of the BR-280 highway, located in Corupá and São Bento south, in the north of Santa Catarina. For this, maps of the physical environment identification were surveyed, and laboratory tests were performed to obtain the soil resistance parameters. With the data obtained, the interpretation of translational and rotational landslides was made, through the SHALSTAB and Bishop models, respectively, which were spatially applied in a Geographic Information System (GIS). Thus, a semaphore pattern was adopted for the union of translational and rotational landslide results, which indicates, on the map, the areas of greater instability, which require more attention, leading to the application of preventive measures, such as containment and drainage works.

The European Space Agency’s ANALOG-1 experiment is the culmination of 12 distinct METERON experiments carried out since 2011. These all address aspects of teleoperating a robotic asset from an orbital platform, i.e., technical implementation, user interfaces, autonomy and operations. The ANALOG-1 technology demonstration and operations concept experiment is based upon the surface mission scenario segment of the notional EL3 sample return mission. This segment focuses on the control of a lunar surface robotic asset from the Earth and from the Lunar Gateway. The experiment is taking place in two parts, with the first successfully completed from the ISS in November 2019. It assessed the effectiveness of a state-of-the-art robotic control interface to control a complex mobile robot from orbit, as well as evaluating the scientific interactions, during robotic-assisted geology exploration, between crew in orbit and scientists on the ground. Luca Parmitano operated the robot while he was on the ISS. For this experiment, a complex control station had been installed on the ISS. The experiment demonstrated the advantage of having an immersive control station and high level of robotic dexterity, with Luca finishing all his assigned and secondary geology targets ahead of time.

Major adverse cardiovascular events are frequently observed in patients undergoing major non-cardiac surgery during the peri-operative period. At this time, the possibility to predict cardiovascular events remains limited, despite the introduction of several algorithms to calculate the risk of adverse events, mainly death and major adverse cardiovascular events (MACE) based on the clinical history, risk factors (sex, age, lipid profile, serum creatinine) and non-invasive cardiac exams (electrocardiogram, echocardiogram, stress tests). The cardiac-specific biomarkers natriuretic peptides (NPs) and cardiac troponins (cTn) have been proposed as additional tools for risk prediction in the peri-operative period, particularly for the identification of myocardial injury in patients undergoing major non-cardiac surgery. The prognostic information from the measurement of BNP/NT-proBNP and hs-cTn is independent and complementary to other important indicators of risk, also including ECG and imaging techniques. Elevated levels of cardiac-specific biomarkers before surgery are associated with a markedly higher risk of MACE during the peri-operative period. BNP/NT-proBNP and hs-cTn should be measured in all patients during the clinical evaluation before surgery, particularly during intermediate- or high-risk surgery, in patients aged65 years and/or with comorbidities. Several questions remain to be assessed in dedicated clinical studies, such as how to optimize the management of patients with raised cardiac specific biomarkers before surgery, and whether a strategy based on biomarker measurement improves patient outcomes and is cost-effective.

Truss structures composed of members that work exclusively in tension or in compression appear in several problems of science and engineering, e.g., in the study of the resisting mechanisms of masonry structures, as well as in the design of spider web-inspired web structures. This work generalizes previous results on the existence of cable webs that are able to support assigned sets of nodal forces under tension. We extend such a problem to the limit analysis of compression-only 'strut nets' subjected to fixed and variable nodal loads. These systems provide discrete element models of masonry bodies, which lie inside the polygon/polyhedron with vertices at the points of application of the given forces ('underlying masonry structures'). It is assumed that fixed nodal forces are combined with variable forces growing proportionally to a scalar multiplier (load multiplier), and that the supporting strut net is subjected to kinematic constraints at given nodal positions., Comment: 20 pages, 10 figures

Serial measurements of cardiac troponin are recommended by international guidelines to diagnose myocardial infarction (MI) since 2000. However, some relevant differences exist between the three different international guidelines published between 2020 and 2021 for the management of patients with chest pain and no ST-segment elevation. In particular, there is no agreement on the cut-offs or absolute change values to diagnose non-ST-segment elevation MI (NSTEMI). Other controversial issues concern the diagnostic accuracy and cost-effectiveness of cut-off values for the most rapid algorithms (0 h/1 h or 0 h/2 h) to rule-in and rule-out NSTEMI

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

Serial measurements of cardiac troponin are recommended by international guidelines to diagnose myocardial infarction (MI) since 2000. However, some relevant differences exist between the three different international guidelines published between 2020 and 2021 for the management of patients with chest pain and no ST-segment elevation. In particular, there is no agreement on the cut-offs or absolute change values to diagnose non-ST-segment elevation MI (NSTEMI). Other controversial issues concern the diagnostic accuracy and cost-effectiveness of cut-off values for the most rapid algorithms (0 h/1 h or 0 h/2 h) to rule-in and rule-out NSTEMI. Finally, another important point is the possible differences between demographic and clinical characteristics of patients enrolled in multicenter trials compared to those routinely admitted to the Emergency Department in Italy. The Study Group of Cardiac Biomarkers, supported by the Italian Scientific Societies Società Italiana di Biochimica Clinica, Italian Society of the European Ligand Assay Society, and Società Italiana di Patolgia Clinica e Medicina di Laboratorio decided to revise the document previously published in 2013 about the management of patients with suspected NSTEMI, and to provide some suggestions for the use of these biomarkers in clinical practice, with a particular focus on the Italian setting.

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.

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.

Within the frame of parametric design, in the present work we focus on a very special objective, namely parametrically generating families of purely compressed shells. A similar task can be pursued by adopting for the equilibrium analysis the so-called Thrust Network Analysis for which the shell structure is condensed into a network of bars. Here instead, we adopt a continuum approach, namely the so-called Membrane Equilibrium Analysis. With this continuum approach, a purely compressed membrane equilibrium solution is searched by solving a scalar second-order partial differential equation representing the transverse equilibrium equation of the membrane. The shell is compressed if the membrane surface is contained within the volume of the shell and if the stress potential is concave. For a given shell, the main difficulty is represented by the fulfillment of the concavity constraint for the stress potential. In the present study, this difficulty is overcome by assigning families of convenient concave stress potentials and considering the shape as the unknown. By considering stress potentials or boundary data controlled by a few parameters, such variable parameters can be manipulated in order to alter the end result. Other methods tackling the stress function with the help of a computer, exist in the literature, but the main contribution of the present paper is the shape analysis of compression-only shells with the help of finite element apparatus. A few illustrative examples are presented to demonstrate the method.

L’insufficienza surrenalica (IS) e una condizione clinica, potenzialmente pericolosa per la vita, determinata dalla diminuita produzione o azione degli ormoni glucocorticoidi, accompagnata o meno da carenza di mineralcorticoidi o androgeni surrenalici. E dovuta a un’alterazione dell’asse ipotalamo-ipofisi-surrene, per cause surrenaliche [insufficienza surrenalica primaria (ISP) o morbo di Addison], ipofisarie (insufficienza surrenalica secondaria) o ipotalamiche (insufficienza surrenalica terziaria). La prevalenza dell’ISP in Europa e di circa 100 casi per milione, l’incidenza 5 casi per milione/anno, con una frequenza maggiore nella quarta decade di vita e nel sesso femminile. Oggi l’82% dei casi di ISP ha eziologia autoimmune, il 9% infettiva e il 9% da altre cause. L’IS si differenzia in una forma acuta, che costituisce un’emergenza clinica con le manifestazioni proprie dello shock ipovolemico, e una forma cronica, caratterizzata da sintomi e segni che si aggravano progressivamente in base al grado e alla velocita di distruzione del surrene: astenia generalizzata, anoressia, calo ponderale, ipotensione, ipoglicemia, iperpigmentazione cutanea, amenorrea e diminuzione della libido, anemia e depressione. Le presenti raccomandazioni pratiche della Societa Italiana di Patologia Clinica e Medicina di Laboratorio riprendono quelle della Endocrine Society del 2016 preparate utilizzando il sistema Grade. Le raccomandazioni principali ribadiscono che: (1) la misura basale di cortisolo sierico totale (CST), l’indice di cortisolo libero (ICL) e il cortisolo salivare del mattino (CSM), associati alla misura della corticotropina (ACTH), rappresentano i test di ingresso per la diagnosi di ISP (test combinato basale); (2) rilevare un valore elevato di renina attiva, associato a un valore basso-normale di aldosterone suggerisce l’esecuzione del test combinato basale; (3) rilevare un valore basso di deidroepiandrosterone solfato (DHEAS) suggerisce l’esecuzione del test combinato basale; (4) rilevare un valore di $\text{CST}

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

In the present paper we propose a new class of analytical solutions for the equilibrium problem of a prismatic sand pile under gravity, capturing the effects of the history of the sand pile formation on the stress distribution. The material is modeled as a continuum composed by a cohesionless granular material ruled by Coulomb friction, that is a material governed by the Mohr-Coulomb yield condition. The closure of the balance equations is obtained by considering a special restriction on stress, namely a special form of the stress tensor relative to a special curvilinear, locally non-orthogonal, reference system. This assumption generates a class of closed-form equilibrium solutions, depending on three parameters. By tuning the value of the parameters a family of equilibrium solutions is obtained, reproducing closely some published experimental data, and corresponding to different construction histories, namely, for example, the deposition from a line source and by uniform raining. The repertoire of equilibrated stress fields that we obtain in two special cases contains an approximation of the Incipient Failure Everywhere (IFE) solution and a closed-form description of the arching phenomenon. © 2016, Elsevier Ltd. All rights reserved.

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...

Size-dependent flexural nonlinear free vibrations of geometrically imperfect straight Bernoulli-Euler functionally graded nano-beams are investigated by the stress-driven nonlocal integral model (SDM). By using the Galerkin method, the governing equations is reduced to a nonlinear ordinary differential equation. The closed form analytical solution of the nonlinear natural flexural frequency for Simply-Supported, Clamped-Simply Supported and Clamped-Clamped nano-beams is then established using the Hamiltonian approach to nonlinear oscillators. Effects of nonlocal scale parameter and an initial axial tension force on fundamental frequencies are examined and compared with those obtained by Eringen’s nonlocal model. It is shown that the nonlinear approach based on nonlocal stress model, with the appropriate constitutive boundary conditions, is capable of capturing the dynamical responses of the nano-beams and provides an advantageous method for the design and the optimization of a wide range of nano-scaled beam-like components of Nano-Electro-Mechanical-Systems (NEMS).

The friction stir welding (FSW) or friction stir spot welding (FSSW) with non-consumable tool is one of the established processes for joining of thermoplastics/low melting point metals/alloys. But hitherto little has been reported on joining of similar/dissimilar thermoplastics with FSSW especially with use of semi-consumable/consumable tool. The present study deals with thermo-mechanical investigations for FSSW of thermoplastics with fully/semi-consumable tool as a novel method. The FSSW was performed on 3D printed functional prototypes of acrylonitrile butadiene styrene (ABS) reinforced with 15% Al powder (by weight) as ABS-15Al, with polyamide (PA)6 reinforced with 50%Al powder (by weight) as PA6-50Al. The online monitoring by thermal imaging camera and axial force measurements was performed to investigate variations in tensile, thermal and morphological properties. The influence of input process variables (namely: rotational speed, plunge depth and stirring time) of FSSW joints has been explored. The results of study suggest that for joining of ABS-15Al substrates with PA6-50Al, rotational speed 1400 rpm, plunge depth 2 mm and stirring time 15 s are the best settings from multifactor optimization view point. Further the tensile properties of ABS-15Al joints prepared by FSSW are comparable to virgin ABS thus made it suitable for maintenance and repair applications.

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.

Fabry disease (FD) is an X-linked monogenic disorder caused by mutations in the GLA gene which leads to a deficiency of the functionally active lysosomal α-galactosidase A enzyme. Here, we report on a family of five members: unaffected parents, one unaffected son, and another son and daughter both carrying the same mutation (p.G138E) in the GLA gene. Genotype analysis using intragenic GLA markers confirmed the maternal origin of the mutation. The affected son and daughter carried the same mutation; however, it was not detected in the peripheral blood, buccal cells, and urinary sediment cells of their mother. Moreover, the unaffected son without the alteration in the GLA gene carried the same maternal chromosome X (disease-associated) haplotype. To the best of our knowledge, this study represents the first case of maternal germline mosaicism in FD.

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.

La sindrome di Cushing e un complesso di segni e sintomi determinato da un’esposizione cronica a elevati livelli di glucorticoidi circolanti di cui si distinguono una forma esogena (iatrogenica) e una forma endogena. La maggior parte dei casi di sindrome di Cushing ACTH-dipendente e rappresentata dalla malattia di Cushing, ovvero da tumori ipofisari che producono ACTH, mentre le forme di sindrome di Cushing ACTH-indipendente sono riconducibili a tumori surrenalici, in prevalenza benigni, che producono cortisolo. La presentazione clinica e, in genere, caratterizzata da obesita centrale, strie rubrae, acne, irsutismo, astenia muscolare e osteoporosi, disfunzioni gonadiche (nel maschio ipogonadismo ipogonadotropo, nella femmina cicli oligo- o anovulatori), ipertensione arteriosa, alterazioni metaboliche (diabete mellito e iperlipidemia), disturbi neuropsichiatrici (depressione e psicosi), anche se le forme subcliniche sono piu frequenti di quelle conclamate e si riscontrano nel 5–20% dei casi di incidentaloma surrenalico. La revisione della letteratura successiva alle linee guida della Endocrine Society ha confermato nel complesso le raccomandazioni del 2008: diagnostic odd ratio e number needed to diagnose dimostrano che il cortisolo libero urinario, il cortisolo salivare notturno e il cortisolo sierico totale dopo test al desametasone 1 mg overnight raggiungono performance diagnostiche e analitiche molto soddisfacenti e comparabili. Le presenti raccomandazioni pratiche della Societa Italiana di Patologia Clinica e Medicina di Laboratorio riprendono quelle della Endocrine Society del 2008, privilegiando tuttavia il ruolo della raccolta di almeno 2 campioni di cortisolo salivare notturno, determinato con metodo immunometrico e con attenta valutazione del relativo cut-off, o con metodo LC-MS/MS. Si conferma l’importanza di standardizzare la fase della raccolta della saliva utilizzando un dispositivo adeguato e istruzioni dettagliate per il paziente. Si ribadisce di non eseguire per lo screening della sindrome di Cushing i seguenti test: cortisolo sierico e ACTH plasmatico, prelevati casualmente nel corso della giornata, 17-chetosteroidi urinari, test di tolleranza all’insulina, test alla loperamide e test al DST 8 mg.

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.

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.

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” material. For such a material, the kinematical and the safe theorems of Limit Analysis are valid, and the present study focusses on the application of the second theorem to masonry vaults and domes. In particular, the method we propose is 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. By taking up the simplified model of Heyman, the equilibrium problem for the membrane S can be formulated in terms of projected stresses defined on the planform of . The search of the stress reduces to the solution of a second order pde, in terms of the stress potential . In order that the membrane stress on be compressive, the potential must be concave. As for the thrust line in an arch, the surface 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 inside the masonry, and also, for any fixed shape, by changing the boundary data for , that is the distribution of thrust forces along the boundary.

This paper presents the results of a laboratory study of three expansive soil samples collected on the SC-112, an unpaved state road that connects the city of Rio Negrinho to Vila Volta Grande in Santa Catarina State, Brazil. The road's lack of pavement inhibits the development of the region by obstructing traffic during the rainy season. The study estimated the percentage of lime that would need to be added to the soil to minimize expansion of the soil and evaluated changes in the physical and mechanical characteristics of the soil. The study used the miniature, compacted, tropical (MCT) classification, which was developed in Brazil to study the properties and behavior of tropical soils. The following tests were used to study the physical and mechanical characteristics of the soil samples, soil–lime mixtures, and lime: Atterberg limits, grain size, compaction, California bearing ratio, MCT soil disk method, and chemical analysis of the lime. Lime requirements were estimated with the lime fixation point, pH, and MCT soil disk methods. The results of plasticity limit tests showed that the base exchange reactions of lime with the soil occur immediately after the addition of water to the soil–lime mixture. Use of the MCT methodology tests showed that the natural soil samples with the addition of lime changed their behavior from nonlateritic to lateritic. The addition of 3% lime to two soils and 2% to the third soil caused physical and mechanical changes in the soils that allow their use as subgrade of low-volume road pavement.

It is well known that the results of immunoassay methods can be affected by specific or non-specific interferences, ranging from 0.4% to 4.0%. The presence of interference may greatly compromise the accuracy of immunoassay analyses causing an error in the measurement, producing false-positive or false-negative results. From a clinical point of view, these analytical errors may have serious implications for patient care because they can cause misdiagnosis or inappropriate treatment. Unfortunately, it is a very difficult task to identify the irregular analytical errors related to immunoassay methods because they are not detectable by normal laboratory quality control procedures, are reproducible within the test system, may be clinically plausible and are relatively rare. The first line of defense against erroneous results is to use in laboratory practice only immunoassay systems with the highest level of robustness against interference. The second line of defense is always taking into account the possibility of interference in immunoassay results. A correct approach should be addressed on identification of samples at high risk of interference. The attainment of this goal requires a critical review of the test result in relation to patient’s clinical conditions and literature data, taking into account the analytical characteristics of the immunoassay system. The experts in immunoassay systems should make every effort to find some specific and reliable quality indicators for irregular analytical errors in order to better detect and monitor erroneous immunoassay results due to specific or non-specific interferences.

Vitamin D deficiency is becoming an increasing problem worldwide. It should not be underestimated, not only due to the well-known consequences vitamin D deficiency has on bone health, but primarily because recent studies have shown how the biologically active form of vitamin D - 1,25(OH)2D - is involved in many biological processes, including immune system modulation. Moreover, the presence of a vitamin D receptor was discovered in almost all immune cells and some of its polymorphisms were found to be associated with increased incidence of autoimmune diseases. This finding led to a proposed link between vitamin D deficiency and autoimmune diseases. Patients affected by various autoimmune diseases showed low levels of vitamin D. However, it is not always clear whether vitamin D deficiency is the cause or rather a consequence of the disease. Limitations of the studies, such as the small number of patients, heterogeneity of selected groups, environmental conditions, methods used to measure vitamin D serum concentration and other confounding factors do not lead to unequivocal results to demonstrate a direct link between low vitamin D levels and autoimmune disease. Therefore, randomized trials are needed to clarify conflicting results.