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importanza dello sviluppo di una rete di professionisti (medici internisti, medici di medicina dello sport) per sensibilizzare i pazienti sottoposti a trapianto di rene all'efgfettuazione di attività fisica con e senza supervisione. Il progetto è stato approvato dal Centro Nazionale Trapianti

On one hand the incessant and constant technological and instrumental progress in the medical fieldhas allowed to increase knowledge and to reach new objectives. On the other hand, however, it has also raised the risk linked to professional responsibility, regarding informed consent and law 24/2017 of the Italian Republic, better known as Gelli Bianco. In this work an analysis of relevant literature will be presented, followed by a study on the role of new devices on responsibility profiles in otolaryngology. According to the analysis of the Italian law and considering the weaknesses ofthe above mentioned guidelines, pending legal administrative clarifications, we believe an operational protocol can be proposed in case of application of therapeutical innovations, especially about experimental introductions. Consequently, in our opinion, the risk of incrimination persists in case of use of innovative procedures in the absence of a formal shared opinion expressed in guidelines or in good practices, which still need a satisfactory definition.

PANDAS are known as the spectrum of autoimmune pathologies related to a previous or current infection by group A beta-hemolytic streptococcus (SBEGA), dealing with several neuropsychiatric manifestations that mainly affect pediatric age. The main features consist of behavioral disease or movement disease characterized by acute-onset, presenting especially through infant period or adolescence. Specific manifestations, occurring during the progression of the disease, are the presence of otorhinolaryngologic symptoms (ENT) and orofacial movement disorders associated with temporomandibular joint pain.We enrolled 130 children (5-15 years) with a clinical diagnosis of PANDAS between 2012 and 2018. Participants were assessed using ENT specific parameters, PSG to examine respiratory disorders and conventional audiological evaluation. Descriptive and comparative statistical analyses were performed with a control group of 51 healthy patients.The prevalence of ENT symptoms associated was significantly detected in 88 patients of 130 in Group A (relative frequency (%) 67.6; p=0.041) and in 51 patients of 130 in the control Group B (relative frequency (%) 39.2; p=0.063). In relation to prevalence of SDB, 54 subjects have presented nocturnal respiratory obstructive symptoms from mild to severe (relative frequency (%) 61.3; p=0.033) vs. 20 patients of Group B (relative frequency (%) 39.2; p=0.055). The obstructive severity average type was correlated to the consensual adenotonsillar development (size 3-4), (relative frequency (%) 45.4; p=0.047). The audiological deficits found were mostly of transmissive type with OME correlated and linked to the presence of occasional episodes of AOM. The four PANDAS patients who presented orobuccal dystonia (relative frequency (%) 4.54; p=0.091) achieved an improvement of the algic symptoms through the exercises of self-rehabilitation.Findings from our study show that respiratory diseases, characterizing a group of patients with pandas, are the direct consequences of the malformed or hypertrophic condition and suggesting in these conditions surgical therapy as an approaching tool.

Buckling collapse of reinforcing bars in concrete members is usually observed in framed structures after severe earthquakes. Second order effects modify the compressive response of steel bars, reducing ductility and affecting the post-elastic branch. Literature investigations show that instability can involve more stirrups, or it can be limited to the pitch. If the critical length is not carefully estimated, transverse steel’s failure can be achieved in brittle manner, causing the sudden loss of confinement in the inner concrete. This paper presents the results of a theoretical investigation, aiming to evaluate the reliability of different approaches for calculating critical conditions of longitudinal bars. A discrete mechanical model is proposed, based on the solution of a continuous beam with elastic supports. It allows describing transition from local to global buckling, on the basis of the relative stiffness between stirrups and bar. Two other approaches with different computational efforts are also analyzed for comparison. In particular, non-linear finite element analyses are performed, including the effect of hardening in the constitutive law of steel and finally, comparisons are made with a simplified closed-form solution proposed in the literature. This last comparison allows to evaluate the reliability of simplified expressions, able to give design provisions.

L'incamiciatura metallica di pilastri in c.a. mediante angolari e calastrelli (steel jacketing) è una tecnica comunemente adottata, per migliorare la capacità resistente e deformativa di edifici esistenti. Nel caso in cui gli angolari non siano direttamente posti in contatto con le zone nodali (in corrispondenza di travi e solai), la definizione del modello computazionale della sezione trasversale deve essere gestita con cautela poiché differente è il regime di trasferimento degli sforzi che si instaura. Nel caso di applicazione di uno strato intermedio di malta fra acciaio e calcestruzzo, l'effettiva capacità di carico degli angolari è funzione della pressione di laterale confinamento, della la coesione e del coefficiente di attrito fra i materiali. L'attribuzione di tali parametri meccanici non è immediata e la definizione del modello computazionale richiede accorgimenti specifici. Il presente studio è dedicato all'implementazione di un modello numerico per le sezioni in c.a. rinforzate, includente gli effetti dell'interazione attritiva di interfaccia. Il modello è calibrato e validato attraverso il confronto con i risultati di una campagna sperimentale su campioni di colonne rinforzate soggette a compressione e pressoflessione. Sulla base dei risultati viene infine proposta una procedura analitica semplificata per la definizione dei domini di resistenza delle sezioni rinforzate, fornendo i parametri di taratura del legame stress-block per il calcestruzzo