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Objective To test the hypothesis that endogenous testosterone (ET) density could be associated with tumor load (TL) in patients with intermediate risk (IR) prostate cancer (PCa). Materials and methods Endogenous testosterone density (ETD, ratio between ET and prostate volume [PV]), biopsy positive cores density (BPCD, the ratio between the number of positive cores and PV) and prostate-specific antigen density (PSAD, ratio between total PSA and PV) were retrospectively evaluated on a prospectively collected data on 430 patients with IR PCa submitted to radical prostatectomy (RP). Tumor load (TL) was measured as the percentage of prostatic volume occupied by cancer at final pathology. Unfavorable disease (UD) was defined as tumor upgrading (ISUP grading group 4, 5) and/or upstaging (pT3a or 3b) in prostate specimens. Associations were assessed by the logistic regression and linear regression models. Results Overall, UD, which was detected in 122 out of 430 IR patients (28.4%), was predicted by BPCD (odd ratio, OR = 1.356; 95% CI 1.048–1.754; p = 0.020) with a sensitivity 98.4% and overall accuracy 71.9%. On multivariate analysis, BPCD was independently predicted by PSAD (regression coefficient, b = 1.549; 95% CI 0.936–2.162; p b = 0.032; 95% CI 0.023–0.040; p b = 0.009; 95% CI 0.005–0.014; p 1.0%/mL had significantly lower ET levels. Conclusions As ETD increased, BPCD and TL increased, accordingly; furthermore, patients with lower ET levels were more likely to have occult UD. The influence of tumor load, and unfavorable disease on ET and ETD needs to be addressed by further studies.

The relationship between prostatic chronic inflammation (PCI) and prostate cancer (PCa) is unclear and controversial. Some authors reported that a history of chronic prostatitis may be correlated with PCa induction, while others associate chronic inflammation with less aggressive disease or consider inflammation as a possible protective factor against PCa. Four different types of prostatitis are known: bacterial acute prostatic inflammation, bacterial chronic prostatic inflammation, abacterial prostatitis/chronic pelvic pain syndrome, and asymptomatic prostatic chronic inflammation. Prostatic inflammation is underestimated during daily clinical practice, and its presence and degree often go unmentioned in the pathology report of prostate biopsies. The goal of this report is to further our understanding of how PCI influences the biology of PCa. We investigated the main pathogenetic mechanisms responsible for prostatic inflammation, including the cellular response and inflammatory mediators to describe how inflammation modifies the prostatic environment and can lead to benign or malignant prostatic diseases. We found that prostatic inflammation might have a pivotal role in the pathogenesis of prostatic diseases. Details about PCI in all prostate biopsy reports should be mandatory. This will help us better understand the prostatic microenvironment pathways involved in PCa biology, and it will allow the development of specific risk stratification and a patient-tailored therapeutic approach to prostatic diseases.

Background: Lung cancer is the neoplasm with the highest prevalence and mortality rates in the world. Most patients with lung cancer that are symptomatic have hemoptysis, coughing, shortness of breath, chest pain and persistent infections. Less than 10% of patients are asymptomatic when the tumor is detected as an incidental finding. Objective: The present expert review aims to describe the use of radiological imaging modalities for the diagnosis of lung cancer. Methods: Some papers were selected from the international literature, by using mainly Pubmed as a source. Results: Chest x-ray (CXR) is the first investigation performed during the workup of suspected lung cancer. In the absence of a rib erosion, CXR cannot distinguish between benign and malignant masses, therefore computed tomography (CT) with contrast enhancement should be performed in order to obtain a correct staging. Magnetic resonance imaging of the chest is considered a secondary approach as the respiratory movement affects the overall results. Conclusion: Radiological imaging is essential for the management of patients affected by lung cancer.

The proposal to strengthen scientific production at the university level has dimensions, components and characteristics and a structure designed based on the theoretical contributions of this research and the results obtained in each objective addressed, considering that scientific research is an indicator of the quality of the processes in the university environment, so it must be increased by virtue of the results of the work carried out by the research professors and students.

Higher Education Institutions in all regions must submit to internal and external evaluations carried out with transparency, carried out by independent experts. In the CEAACES evaluation model, research is included as one of the most important processes within university management. An evaluation was carried out at the University of Guayaquil in 2013, being evaluated in category “D”. The scientific production of the FCM was 2%, it ranked last in all the criteria, and it did not meet the requirements for accreditation, due to the tiny percentage that was maintained. Users' perception regarding scientific production is very important for the faculty of medical sciences.

Objective: To evaluate the predictors of the risk of long-term hospital readmission after radical prostatectomy (RP) in a single tertiary referral center where both open RP (ORP) and robot assisted RP (RARP) are performed. Materials and Methods: The risk of readmission was evaluated by clinical, pathological, and perioperative factors. Skilled and experienced surgeons performed the 2 surgical approaches. Patients were followed for complications and hospital readmission for a period of 6 months. The association of factors with the risk of readmission was assessed by Cox’s multivariate proportional hazards. Results: From December 2013 to 2017, 885 patients underwent RP. RARP was performed in 733 cases and ORP in 152 subjects. Extended pelvic lymph node dissection (ePLND) was performed in 479 patients. Hospital readmission was detected in 46 cases (5.2%). Using a multivariate model, independent factors associated with the risk of hospital readmission were seminal vesicle invasion (hazard ratio [HR] 2.065; 95% CI 1.116–3.283; p = 0.021), ORP (HR 3.506; 95% CI 1.919–6.405; p < 0.0001), and ePLND (HR 5.172; 95% CI 1.778–15.053; p < 0.0001). Conclusions: In a large single tertiary referral center, independent predictors of the risk of long-term hospital readmission after RP included ORP, ePLND, and seminal vesicle invasion. When surgery is chosen as a primary treatment of PCA, patients should be informed of the risk of long-term hospital readmission and its related risk factors.

The COVID-19 pandemic drastically changed our way of living. To minimize life losses, multi-level strategies requiring collective efforts were adopted while waiting for the vaccines' rollout. The management of such complex processes has taken benefit from the rising framework of the Internet of Things (IoT), and particularly the Radiofrequency Identification (RFID) since it is probably the most suitable approach to both the micro (user) and the macro (processes) scale. Hence, a single infrastructure can support both the logistic and monitoring issues related to the war against a pandemic. Based on the COVID-19 experience, this paper is a survey on how state-of-the-art RFID systems can be employed in facing future pandemic outbreaks. The three pillars of the contrast of the pandemic are addressed: 1) use of Personal Protective Equipment (PPE), 2) access control and social distancing, and 3) early detection of symptoms. For each class, the envisaged RFID devices and procedures are discussed based on the available technology and the current worldwide research. This survey that RFID could generate an extraordinary amount of data so that complementary paradigms of Edge Computing and Artificial intelligence can be tightly integrated to extract profiles and identify anomalous events in compliance with privacy and security., 21 pages. Accepted for publication in IEEE Journal of Radio Frequency Identification

Since the onset of the COVID-19 pandemic, in the last year many researchers have focused their efforts on limiting the spread of the virus. Along with the rush in the developing of vaccines, wearable technologies appeared to be excellent candidates for the early detection of infected individuals and the remote monitoring in hospitals and homes, by fostering the reduction of the contacts between caregivers and patients, while ensuring their safety. The wearable and epidermal Radio Frequency IDentification (RFID) sensors offer nowadays a wide selection of comfortable devices, able to wirelessly monitor a significant set of physiological parameters. In particular, this short review will focus on the monitoring of body temperature and respiratory function, highly affected by the SARS-CoV-2 virus, providing an overview of the current state of the art of RFID sensors, thus envisaging the benefits they can offer for the current and future pandemics.

Fever detection in cattle is today a time-consuming manual procedure. Isolating infected animals to avoid the spread of the diseases is therefore not straightforward with the consequence of massive dose of antibiotics delivered to the whole cattle. This work proposes a subdermal implantable flexible battery-less wireless sensor for un-cooperative monitoring of core temperature in pigs. The sensor consists in a shaped loop antenna sewed into a textile scaffold, as anti-migration support, for a natural integration with the animal fatty tissue. By resorting to the UHF-RFID communication protocol, the device can be interrogated from a distance of up to 1.7 m that is compatible with the automatic temperature reading when the animal approaches the cattle feeder.

Introduction: To test the hypothesis that basal total testosterone (TT) levels are associated with International Society of Urologic Pathology (ISUP) tumor grade groups at the time of diagnosis of prostate cancer (PCA). Methods: From November 2014 to March 2018, preoperative TT and PSA were measured in 601 consecutive patients who were not under androgen deprivation and undergoing surgery for PCA. Patients were classified into low (ISUP 1; reference group), intermediate (ISUP 2/3), and high (ISUP 4/5) tumor grade groups. The association of TT and other clinical factors with tumor groups was evaluated by multinomial multivariate regression analysis. Results: 218 patients (36.3%) were biopsy low grade (ISUP 1), 297 (49.4%) intermediate grade (ISUP 2/3), and 86 (14.3) high grade (ISUP 4/5). Median basal circulating TT levels progressively increased as tumor grade groups increased. On multivariate models, TT, among other clinical factors, was positively associated with the risk of intermediate (OR 1.001; p = 0.023) and high tumor grades (OR 1.002, p = 0.022) compared to low-grade cancers. Conclusions: Increased endogenous circulating basal TT levels were positively associated with ISUP tumor grade groups at the time of diagnosis indicating a close association with tumor biology. Basal TT levels may reflect the heterogeneity of the cancer population.

Introduction: To assess the association of prostate volume index (PVI), defined as the ratio of the central transition zone volume to the peripheral zone volume, and prostatic chronic inflammation (PCI) as predictors of prostate cancer (PCA) risk in patients presenting with normal digital rectal exam and prostate-specific antigen (PSA) ≤10 ng/mL at baseline random biopsies. Methods: We evaluated patients with a negative digital rectal examination (DRE) and a PSA ≤10 ng/mL who underwent initial baseline prostate biopsy from 2010 to 2017. Parameters evaluated included age, PSA, total prostate volume (TPV), PSA density (PSAD), PVI and PCI. All patients underwent 14 core trans-perineal standard biopsies. The association of factors with the risk of PCA was evaluated by logistic regression analysis, utilizing 2 multivariate models: model I included age, TPV, PVI and PCI; model II included age, PSAD, PVI and PC. Results: Overall, 564 Caucasian patients were included. PCA and PCI were detected in 242 (42.9%) and 129 (22.9%) cases respectively. In patients with PCA, the median PVI was 0.83 (interquartile range [IQR] 0.62–1.04). In patients with PCI, the median PVI was 1.12 (IQR 0.81–1.47). In model I, age (OR 1.080) TPV (OR 0.961), PVI (OR 0.517) and PCI (OR 0.249) were associated with PCA risk. In model II, the age (OR 1.074), PSAD (OR 3.080), PVI (OR 0.361) and PCI (OR 0.221) were associated with PCA risk. Conclusions: Higher PVI and PCI predicted decreased PCA risk in patients presenting with normal DRE, and a PSA ≤10ng/mL at baseline random biopsy. In this subset of patients, PVI is able to differentiate patients with PCI or PCA.

Space Agencies recognize the importance of crew health to mission success. Wireless wearable devices may provide an independent monitoring of vital signs with no human intervention. Among several options, epidermal sensors based on Radio frequency Identification (RFID) are attractive for the extreme simplicity and comfort, but they offer a poor read distance. The reliability of RFID links involving epidermal antennas that are worn by astronaut is here investigated by first introducing a computational model based on Ray Tracing and then by a preliminary application to a living module of the International Space Station. Numerical results indicate that, thanks to multipath, much longer read distances than in the free space can be achieved with even the possibility to establish a communication link when reader and tags are partially in NLOS configuration.

To evaluate the factors associated with the risk of hospital readmission after robot assisted radical prostatectomy (RARP) with or without extended pelvic lymph node dissection (ePLND) for prostate cancer (PCA) over a long term. The risk of readmission was evaluated by clinical, pathological, and perioperative factors. Skilled and experienced surgeons performed the procedures. Patients were followed for complications and hospital readmission for a period of six months. The logistic regression model and Cox’s proportional hazards assessed the association of factors with the risk of readmission. From January 2013 to December 2018, 890 patients underwent RARP; ePLND was performed in 495 of these patients. Hospital readmission was detected in 25 cases (2.8%); moreover, it was more frequent when RARP was performed with ePLND (4.4% of cases) than without (0.8% of patients). On the final multivariate model, ePLND was the only independent factor that was positively associated with the risk of hospital readmission (hazard ratio, HR = 5935; 95%CI 1777–19,831; p = 0.004). Over the long term after RARP for PCA, the risk of hospital readmission is associated with ePLND. In patients who underwent RARP and ePLND, 4.4% of them had a readmission, compared to RARP alone, in which only 0.8% of cases had a readmission. When ePLND is planned for staging pelvic lymph nodes, patients should be informed of the increased risk of hospital readmission.

To evaluate the prevalence of the general and uroflowmetry (UF)-related anxiety in patients performing UF, and to assess whether anxiety may affect patient's micturition at UF.This prospective study recruited candidates to UF. Recorded data were: demographics, lower urinary tract symptoms (LUTS) and anxiety questionnaires (IPSS, ICIQ-FLUTS, GAD-7, APAIS-M), UF parameters, linker-type scale for UF satisfaction/reproducibility and discomfort.We enrolled 167 patients (non-naïve 59.3%). One hundred twenty-five were men. General anxiety was found in 55.3% of patients (63.2% naïve), and UF-related anxiety in 41.3% (46.5% non-naïve). No significantly different rate of anxiety was found between naïve and non-naïve patients. A significant difference was found between IPSS total score in patients without anxiety (10.9 ± 6.4) and subjects with anxiety (16.9 ± 7.3; P0001). According to the ICIQ-FLUTS questionnaire, only the subscore F was significantly greater in women with a high level of general and UF-related anxiety (7.8 ± 6.1 vs 12 ± 4.9; P.001). A low UF satisfaction/reproducibility was reported by 27.5% of patients, in 21.7% of subjects with general anxiety, and 36.6% of patients with UF-related anxiety. High discomfort was recorded in 58.1% of patients. Anxiety affected women twice more than men, and patients with high anxiety had worse urinary symptoms. Non-naïve anxious patients had lower reproducibility of micturition and higher discomfort than naïve anxious candidates to UF.Several patients showed high general and UF-related anxiety at UF, had worse subjective feelings about the reproducibility of their habitual micturition patterns. In anxious patients, knowledge of UF did not avoid a lower reproducibility of micturition, nor a more considerable discomfort.

Background The aim of this study is to evaluate factors (clinical, pathological and perioperative) associated with the risk of hospital readmission after radical prostatectomy (RP) over the long term in a single tertiary referral center where both open RP (ORP) and robot assisted RP (RARP) are performed. Methods From January 2013 to December 2018 patients older than 18 years, who provided signed consent and underwent open or robot assisted radical prostatectomy were enrolled and retrospectively evaluated. Patients who underwent any previous prostate cancer (PCA) treatments were excluded. Specifically, skilled and experienced surgeons performed the two surgical approaches. Patients were followed for complications and hospital readmission (RAD) for a period of six months. The association of factors with the risk of readmission was assessed by Cox's multivariate proportional hazards. Results A total of 1062 patients underwent RP. RARP was performed in 891 cases and ORP in 171 subjects. Extended pelvic lymph node dissection (ePLND) was performed in 651 patients. Hospital readmission occurred in 53 cases (5%). Based on the final multivariate model, independent factors associated with the risk of hospital readmission were seminal vesicle invasion (HR=2.093; 95% CI: 1.177-3.722), ORP (HR=4.393; 95% CI: 2.516-7.672) and ePLND (HR=4.418; 95% CI: 1.544-12.639). Conclusions ORP, ePLND and seminal vesicle invasion are independent predictors of the risk of hospital readmission over the long term at a large single tertiary referral center. When surgery is chosen as a primary treatment of PCA, patients should be informed of the risk of hospital readmission and related risk factors. Assessing seminal vesicle invasion by preoperative clinical staging identifies locally advanced disease, which is associated with an increased risk of hospital readmission.

RATIONALE: Cannabis use is common among adolescents and some research suggests that adolescent cannabis use increases the risk for depression, anxiety, and cognitive impairments in adulthood. In human studies, however, confounds may affect the association between cannabis use and the development of brain disorders. OBJECTIVES: These experiments investigated the effects of adolescent exposure to either cannabis smoke or THC on anxiety- and depressive-like behavior and cognitive performance in adulthood in Long-Evans rats. METHODS: Adolescent rats of both sexes were exposed to either cannabis smoke from postnatal days (P) 29-49 or ascending doses of THC from P35-45. When the rats reached adulthood (P70), anxiety-like behavior was investigated in the large open field and elevated plus maze, depressive-like behavior in the sucrose preference and forced swim tests, and cognitive function in the novel object recognition test. RESULTS: Despite sex differences on some measures in the open field, elevated plus maze, forced swim, and novel object recognition tests, there were no effects of either adolescent cannabis smoke or THC exposure, and only relatively subtle interactions between exposure conditions and sex, such that sex differences on some performance measures were slightly attenuated. CONCLUSION: Neither cannabis smoke nor THC exposure during adolescence produced robust alterations in adult behavior after a period of abstinence, suggesting that adverse effects associated with adolescent cannabis use might be due to non-cannabinoid concomitants of cannabis use.

Objective to determine the clinical significance of ground glass pulmonary nodules, either pure (GGNs) or mixed with the presence of solid component (MPNs), in patients with known pulmonary or extra-thoracic malignancies and to evaluate the role of computed tomography (CT) and positron emission tomography (PET)/CT in their diagnosis and follow-up. Methods A total of 130 nodules in 68 patients were revealed: 119 GGNs and 11 MPNs. GGN lesions were found in 58 patients, MPNs in eight, and in two cases, both. The median diameter of the nodules was 7 mm (3–30 mm). Moreover, 27 patients, who had a pars-solid >5 mm in the GGN or a pure GGN with a diameter > 5 mm, underwent FDG PET/CT. The median follow-up with CT was >3 years. Results The comparison between the first and the last positive CT scan showed that GGNs and/or MPNs remained unchanged for a median period of 18 months (range 11–48 months) in 53 patients, they disappeared after a median of 3.5 months (range 2–11 months) in 12 and increased in diameter after a median period of 17 months (range 12–67 months) in 3. In particular of these latter patients, two had malignant lesions. Only three patients with a single nodule showed a significant uptake of FDG at PET/CT. Conclusion in the evaluation of GGNs and MNPs, CT examinations performed after 3 months often showed some changes, mainly with respect to nodules disappearing. PET/CT often plays no role but it can exclude malignancy at the end of staging. Finally, in patients with known pulmonary or extra-thoracic malignancies showing GGNs or MPNs, a 3-year CT follow up is justified, due to the slow growth rate of these lesions.

International audience; This paper investigates the effects of the track geometry irregularities on the wheel-rail dynamic interactions and the rail fatigue initiation through the application of the Dang Van criterion, that supposes an elastic shakedown of the structure. The irregularities are modelled , using experimental data, as a stochastic field which is representative of the considered railway network. The tracks thus generated are introduced as the input of a railway dynamics software to characterize the stochastic contact patch and the parameters on which it depends: contact forces and wheelset-rail relative position. A variance-based global sensitivity analysis is performed on quantities of interest representative of the dynamic behaviour of the system, with respect to the stochastic geometry irregularities and for different curve radius classes and operating conditions. The estimation of the internal stresses and the fatigue index being more time-consuming than the dynamical simulations, the sensitivity analysis is performed through a metamodel, whose input parameters are the wheel-rail relative position and velocity. The coefficient of variation of the number of fatigue cycles, when the simulations are performed with random geometry irregularities, varies between 0.13 and 0.28. In a large radius curve, the most influent irregularity is the horizontal curvature, while, in a tight curve, the gauge becomes more important.

Background To evaluate the role of computed tomography (CT) and positron emission tomography (PET)/CT in patients with thymic cancer and thymoma at initial staging. Methods We retrospectively reviewed CT and PET/CT scans of 26 patients with a thymic cancer (n = 9) or thymoma (n = 17). Chest CT findings documented were qualitative and quantitative. Both qualitative and semiquantitative data were recovered by PET/CT. The comparisons among histological entities, outcome, and qualitative data from CT and PET/CT were made by non-parametric analysis. Results PET/CT resulted positive in 15/17 patients with thymoma. CT was available in 5/9 (56%) patients with thymic cancer and in 3/17 with thymoma. All quantitative CT parameters were significantly higher in patients with thymic cancer than thymoma (maximum axial diameter: 45 vs. 20 mm, maximum longitudinal diameter: 69 vs. 21 mm and volume: 77.91 vs. 4.52 mL; all P < 0.05). Conversely, only metabolic tumor volume (MTV) and total lesion glycolysis were significantly different in patients with thymic cancer than thymoma (126.53 vs. 6.03 cm3 and 246.05 vs. 20.32, respectively; both P < 0.05). After a median follow-up time of 17.45 months, four recurrences of disease occurred: three in patients with thymic cancer and one with a type B2 thymoma. CT volume in patients with recurrent disease was 102.19 mL versus a median value of 62.5 mL in six disease-free patients. MTV was higher in the recurrent than disease-free patient subset (143.3 vs. 81.13 cm3), although not statistically significant (P = 0.075). Conclusion Our preliminary results demonstrated that both morphological and metabolic volume could be useful from a diagnostic and prognostic point of view in thymic cancer and thymoma patients. A large multi-center clinical trial experience for confirming the findings of this study seems mandatory.

International audience; This paper describes the construction of a stochastic model of urban railway track geometry irregularities, based on experimental data. The considered irregularities are track gauge, su-perelevation, horizontal and vertical curvatures. They are modelled as random fields whose statistical properties are extracted from a large set of on-track measurements of the geometry of an urban railway network. About 300 to 1000 terms are used in the Karhunen-Lò eve/Polynomial Chaos expansions to represent the random fields with appropriate accuracy. The construction of the random fields is then validated by comparing on-track measurements of the contact forces and numerical dynamics simulations for different operational conditions (train velocity and car load) and horizontal layouts (alignment, curve). The dynamics simulations are performed both with and without randomly generated geometrical irregularities for the track. The power spectrum densities obtained from the dynamics simulations with the model of geometrical irregularities compare extremely well with those obtained from the experimental contact forces. Without irregularities, the spectrum is 10 to 50 dB too low.

Numerous component models have been proposed in the literature, a testimony of a subject domain rich with technical and scientific challenges, and considerable potential. Unfortunately however, the reported level of adoption has been comparatively low. Where successes were had, they were largely facilitated by the manifest endorsement, where not the mandate, by relevant stakeholders, either internal to the industrial adopter or with authority over the application domain. The work presented in this paper stems from a comprehensive initiative taken by the European Space Agency (ESA) and its industrial suppliers. This initiative also enjoyed significant synergy with interests shown for similar goals by the telecommunications and railways domain, thanks to the interaction between two parallel project frameworks. The ESA effort aimed at favouring the adoption of a software reference architecture across its software supply chain. The center of that strategy revolves around a component model and the software development process that builds on it. This paper presents the rationale, the design and implementation choices made in their conception, as well as the feedback obtained from a number of industrial case studies that assessed them.

A large proportion of the requirements on embedded real-time systems stems from the extra-functional dimensions of time and space determinism, dependability, safety and security, and it is addressed at the software level. The adoption of a sound software architecture provides crucial aid in conveniently apportioning the relevant development concerns. This paper takes a software-centered interpretation of the ISO 42010 notion of architecture, enhancing it with a component model that attributes separate concerns to distinct design views. The component boundary becomes the border between functional and extra-functional concerns. The latter are treated as decorations placed on the outside of components, satisfied by implementation artifacts separate from and composable with the implementation of the component internals. The approach was evaluated by industrial users from several domains, with remarkably positive results.

The purpose of this study was to determine likelihood of malignancy for indeterminate lung nodules identified on CT comparing two standardized models with (18)F-FDG PET/CT.Fifty-nine cancer patients with indeterminate lung nodules (solid tumors; diameter, ≥5 mm) on CT had FDG PET/CT for lesion characterization. Mayo Clinic and Veterans Affairs Cooperative Study models of likelihood of malignancy were applied to solitary pulmonary nodules. High probability of malignancy was assigned a priori for multiple nodules. Low (5%), intermediate (5-60%), and high (60%) pretest malignancy probabilities were analyzed separately. Patients were reclassified with PET/CT. Histopathology or 2-year imaging follow-up established diagnosis. Outcome-based reclassification differences were defined as net reclassification improvement. A null hypothesis of asymptotic test was applied.Thirty-one patients had histology-proven malignancy. PET/CT was true-positive in 24 and true-negative in 25 cases. Negative predictive value was 78% and positive predictive value was 89%. On the basis of the Mayo Clinic model (n=31), 18 patients had low, 12 had intermediate, and one had high pretest likelihood; on the basis of the Veterans Affairs model (n=26), 5 patients had low, 20 had intermediate, and one had high pretest likelihood. Because of multiple lung nodules, 28 patients were classified as having high malignancy risk. PET/CT showed 32 negative and 27 positive scans. Net reclassification improvements respectively were 0.95 and 1.6 for Mayo Clinic and Veterans Affairs models (both p0.0001). Fourteen of 31 (45.2%) and 12 of 26 (46.2%) patients with low and intermediate pretest likelihood, respectively, had positive findings on PET/CT for the Mayo Clinic and Veterans Affairs models, respectively. Of 15 patients with high pretest likelihood and negative findings on PET/CT, 13 (86.7%) did not have lung malignancy.PET/CT improves stratification of cancer patients with indeterminate pulmonary nodules. A substantial number of patients considered at low and intermediate pretest likelihood of malignancy with histology-proven lung malignancy showed abnormal PET/CT findings.

To assess the addition value of ¹⁸F-Fluorodeoxyglucose (FDG) PET/computed tomography (FDG-PET/CT) vs. CT in detecting early metastatic deposits in bone marrow (BM).From January 2009 to December 2010, 198 consecutive patients (88 male, 110 female; median age: 64 years) were retrospectively examined. All patients underwent ¹⁸F-FDG-PET/CT for disease evaluation: 65 for lung cancer, 66 for breast cancer, 57 for lymphoma and 10 for multiple myeloma. All scans were reviewed by a radiologist and a specialist in nuclear medicine for the identification of bone lesions. The presence of BM metastases was confirmed by biopsy, sequential PET/CT scan or magnetic resonance imaging when available. A patient-based analysis was performed.Investigating the presence of skeletal metastasis, 94 (48%) patients had positive and 104 (52%) negative CT scan whereas 110 (56%) had positive and 88 (44%) negative FDG-PET/CT scan (P0.001). The two imaging modalities were concordant in 178 (90%) patients for bone lesions; on the contrary 20 (10%) patients had discordant results (P0.001). In 21 out of 178 concordant patients BM lesions were identified both in CT and FDG-PET, whereas nine out of the 20 discordant patients showed BM involvement at PET/CT only. Overall, PET/CT was able to identify 30 (15%) patients with BM lesions. In these latter patients, the maximum standardized uptake value (SUVmax) for BM metastases was 7.9±4.5 (range: 3.1-19.0), resulting slightly higher in patients with negative than positive CT scan (8.3±5.1 vs. 7.8±4.3, respectively; P=0.79).FDG-PET/CT resulted more accurate than CT in early detection of BM metastases. The FDG-PET/CT images improve the staging of about 15% of our study population. PET/CT detected BM lesions mainly on the basis of their increased metabolic activity rather than on anatomical alterations. Moreover, it provided an accurate identification of tumour viability that was useful for treatment planning and follow-up.

Aim: To assess the potential role of 18F-Fluorodeoxiglucose (FDG) Positron Emission Tomography (PET)/Computed Tomography (CT) in characterizing indeterminate lung nodules detected at CT scan in patients previously treated for a breast cancer (BC). Materials and Methods: Twenty-nine consecutive BC patients (28 females, mean age 65 ± 12 years) with evidence of indeterminate lung nodules at contrast-enhanced CT (CECT) scan (lesions with axial diameter ≥8 mm) were retrospectively analysed: all patients underwent 18F-FDG PET/CT within a mean 2 ± 1 months from CECT imaging. PET/CT was considered positive in the presence of abnormal FDG uptake in the pulmonary nodules and/or in other organs. The nature of lung nodules was defined at histopathology and/or imaging follow-up. Results: Fourteen (48%) patients showed negative and 15 (52%) positive PET/CT scan in the lungs: of these 15 patients, 7 (47%) had pathologic FDG-uptake in lungs only, whereas 8 (53%) showed abnormal FDG-uptake also in sites different from lungs. At histology and/or imaging follow-up, five (17%) patients were considered positive for BC lung metastases while in seven (24%) a second cancer was diagnosed. In this subset of patients, the sensitivity and specificity for FDG PET/CT in revealing lung lesions were 17% and 100%, respectively, for nodules

When the task befalls you to devise a novel component-oriented approach for real-time embedded systems you first dutifully undertake a thorough scrutiny of the import and pitfalls of previous attempts. This is what we have done for the last couple of years, in the context of an initiative promoted by the European Space Agency for the creation of a component model to serve the development of new-generation on-board software. In this paper we recapitulate the lessons we learned in that effort.

In high-integrity systems, the focus of the development process is geared to assuring that the assertions made on the system are both correct (i.e., semantically sustainable) and feasible (i.e., true at run time). Some of those assertions take effect in the non-functional domain, that is, in how the system is realized and behaves in time, space and communication during execution; others in the functional domain, and thus concern what outputs the system produces for its inputs. In this paper, we address the problem of achieving correct specification and handling of non-functional attributes, with particular regard to the concurrent structure of the system, the safeness of the interaction protocols engaged in it, and the guarantee that its timing feasibility can be statically verified. Our approach is based on a Model-Driven Engineering methodology, in which correctness can be ensured by construction or verified at a high level of abstraction, while the runtime implementation structure and code are automatically generated. We employ the Ravenscar Computation Model (RCM) and focus, in particular, on aerospace applications, which impose stringent requirements on correctness properties. We discuss an algebraic formalization of our model based on graph theory which we use to prove safe termination in systems compliant with RCM, and show how to use the MAST+ static analyzer to verify the timing aspects. We finally illustrate the results of a prototype tool that was developed for evaluation by major industrial players in the European space industry.

Nitrate-stimulated head-up tilt testing (HUT) is currently recommended to confirm the diagnosis of vasovagal syncope in subjects with syncope of unknown origin. Given the few data currently available, the aim of this study was to assess correlations between nitrate-induced HUT outcomes and the clinical characteristics of patients.Two hundred and thirty consecutive, otherwise healthy subjects with a history of recurrent unexplained syncope underwent HUT. After 10 min supine rest, they were tilted to 70 degrees , and the test was potentiated by the administration of 300 microg of nitroglycerin after 20 min.Out of 178 subjects who underwent nitroglycerin administration during HUT, 95 fainted. At univariate Cox regression analysis, a reduced probability of VVS occurrence after nitrates was associated with greater systolic blood pressure and body mass index values, to male gender and smoking. At multivariate Cox regression analysis, only male gender (HR = 0.61; P = 0.039) and smoking (HR = 0.18; P = 0.001) remained significantly associated with HUT outcomes during the pharmacological phase of the test.Smokers and males are less likely to faint after nitrate administration during HUT than non-smokers and females. Further studies should clarify the possibility of improving the diagnostic power of HUT in these patients.

This research evaluated the effectiveness of a school-based intervention by the classroom teacher compared to a nutritionist-based intervention in promoting fruit and vegetable consumption in children. The name of this study was “Bring some fruit to school” (“Porta la frutta a scuola” in Italian). In this randomized controlled trial, the primary end point was an increase in the children's consumption of fruit, vegetables, and legumes and a decrease in consumption of chips and sugar-sweetened drinks. Twenty fourth-grade elementary classes enrolling 521 students were assigned to 1 of the 2 nutrition education interventions. At 36 weeks, 471 students had completed the study. At the end of the study, the teacher intervention group (n = 228) increased consumption of fruit, vegetables, and legumes in 107 (47%), 132 (58%), and 73 (32%) children, respectively, and a decrease in consumption of chips and sugar-sweetened drinks in 106 (47%) and 78 (34%), respectively; the nutritionist intervention group (n = 243) reported increased consumption of fruit and vegetables in 121 (26%) and 86 (18.2%) but decreased consumption of legumes in 12 (3%) of children, respectively, and a decrease in the consumption of chips and sugar-sweetened drinks in 88 (19%) and 13 (3%), respectively. This study implies that nutrition education intervention by teachers may promote fruit, vegetable, and legume consumption in elementary school–age children.

Within the realm of evaluating self-monitoring plans, developed based on the Hazard Analysis and Critical Control Points (HACCP) method and adopted by food companies, little research has been done concerning the quality of the plans. The Servizio di Igiene degli Alimenti e della Nutrizione (Food and Nutrition Health Service) of the Local Health Authority of Foggia, Italy, has conducted research with the aim to adopt a system of indexes and indicators for the qualitative evaluation of HACCP plans. The critical areas considered were the following: simplicity, specificity, feasibility and adherence. During the period from January 2004 to June 2005, the evaluation grid was used in examining 250 HACCP self-monitoring plans of food companies. For the analysis of the determining factor four groups were considered, with reference to HACCP self-monitoring plans designed: group 1 - with the aid of a qualified team, group 2 - with the aid of an unqualified team, group 3 - with the aid of an unqualified expert, group 4 – without the aid of an expert. The mean values of the measures elaborated decrease towards insufficiency moving from group 1 to group 4. In particular, collaboration by teams of unqualified experts brought about drafting unacceptable HACCP plans on the levels of specificity and adherence, with respect to the HACCP method. The method proposed of the analysis of the indexes and indicators beginning with an evaluation sheet can also help the individual company to better adjust contribution by internal or external professionals to the company.

The calculated dynamic response of an excited rotating system can be significantly affected by uncertainties in its mechanical properties, such as mass, stiffness, geometrical imperfections, or loadings. For this reason, it is essential to understand and quantify the influence of uncertain parameters on the predicted rotor response. This paper aims to optimize the propagation of random input uncertainties for a rotordynamic problem and assess their influence on the dynamic behaviour of an unbalanced rotor. The Harmonic balance method (HBM) and a non-intrusive Polynomial Chaos Expansion (PCE) are used to evaluate the stochastic response of a finite element rotor. The proposed stochastic approach is based on a numerical quadrature calculation of integrals for finding the coefficients of the PCE. The method is initially applied to evaluate the stochastic response of a linear rotodynamic system, leading to the original concept of stochastic Campbell diagram and further extended to nonlinear rotordynamic problems, using the Asymptotic Numerical Method (ANM).

This paper presents the implementation of Carrier Sense Multiple Access with Collision Avoidance (CSMA/CA) Medium Access Control (MAC) protocol based on the IEEE 802.15.6 standard on a hardware platform developed for Wireless Body Area Network (WBAN) applications. The CSMA/CA allows each node to detect an ongoing transmission and consequently wait until the channel is idle. A testing campaign has been conducted in order to evaluate the performance of the protocol in terms of packet loss rate, average packet delay and network throughput.

When designing complex real-time software, it is very difficult to predict how design decisions may impact the system timing behavior. Usually, the industrial practices rely on the subjective judgment of experienced software architects and developers. This is however risky since eventual timing errors are only detected after implementation and integration, when the software execution can be tested on system level, under realistic conditions. At this stage, timing errors may be very costly and time consuming to correct. Therefore, to overcome this problem we need an efficient, reliable and automated timing estimation method applicable already at early design stages and continuing throughout the whole development cycle. Formal timing analysis appears at first sight to be the adequate candidate for this purpose. However, its use in the industry is conditioned by a smooth and seamless integration in the software development process. This is not an easy task due to the semantic mismatches between the design and analysis models but also due to the missing link between the analysis and the testing phase after code implementation. In this paper, we present a timing analysis framework we developed in the context of the industrial design of satellite on-board software, allowing an early integration and full automation of formal timing verification activities in the development process of real-time embedded software, as a mean to decrease the design time and reduce the risks of costly timing failures.

The aim of this article is to retrospectively evaluate the patient characteristics and the most common infectious diseases in immigrant patients hospitalized in 46 Italian infectious disease clinics during 2002. The main Italian infectious disease clinics were invited to fill in a questionnaire that regarded the number and type of hospital admissions, the country of origin, and demographic features (age, sex, and resident state) of immigrants. A total of 46 clinics including 2255 patients participated in the study. Most patients were men (63%) with an age between 16 and 40 years (63.4%) covered by the National Health Service (71%) and coming from Africa (44.3%). The main infectious diseases observed were: 378 (16.76%) cases of HIV infection, 303 (13.43%) cases of tuberculosis diseases, 282 (12.5%) cases of various forms of viral hepatitis, 177 (7.84%) cases of respiratory diseases, and 196 (8.69%) gastrointestinal diseases. Tropical diseases found were 134 (5.94%) including 95 cases of malaria (70.9%). In conclusion, a broad range of diseases was noted in immigrants which were directly correlated with conditions of poverty. Only a few tropical diseases were diagnosed and therefore the immigrant should not be considered as an infectious disease carrier.

Vitamin D deficiency is very common in elderly people. We investigated whether a diet contained 400 IU of vitamin D per day for 10 weeks could increase plasma levels of 25-hydroxyvitamin-D3, a good measure of body status for vitamin D. The study groups included 232 subjects, aged 65-74 years (114 men and 118 women), who were assigned at random into two groups: 98 participants in intervention group received a diet which included 400 IU of vitamin D, and 134 in control group were given a diet without the Vitamin D addition. At the conclusion of the study, the intervention group showed a 102.3% increase of 25(OH)D3 plasma levels (40.2 nmol/L to 81.3 nmol/L, p 0.05). The difference, also evaluated by Mantel-Haenszel estimate, at the end of study between two groups was highly significant (p < 0.0001). This suggest that a diet contained 400 IU/d of vitamin D could improve vitamin D status in elderly people. A daily intake of 400 UI of vitamin D with diet must be recommended for elderly people to prevent hypovitaminosis D and to reduce risks of bone loss and fracture.

An elevated level of total plasma homocysteine (tHcy) is considered to be a predictor of the mortality risk for all diseases. A high consumption of vegetables and citrus fruit, both good sources of folate, decreases the concentration of tHcy. We investigated if supplementation of concentrated fruit and vegetables is able to decrease tHcy concentrations. For this purpose, we used a product that is presently on the market, made up of fruit and vegetable powders. 26 subjects participated in a cross-over design intervention trial. At the end of the study, each participant received 2 capsules of fruit and 2 capsules of vegetables a day for 4 weeks and then acted his/her own control for another 4 weeks. Daily extract intake decreased plasma tHcy from an expected mean ± SD level of 12.71 ± 3.23 umol/L observed after the 28-day control period to 7.98 ± 1.70 umol/L, a difference of 4.73 ± 1.153 (p Elevated tHcy is a risk factor causally linked to chronic disease. The plasma tHcy concentration was decreased as a result of taking a powdered fruit and vegetable extract on a daily basis.

As a consequence of the increasing complexity of modern real-time applications, the need for an efficient, reliable and automated performance estimation method throughout the whole development cycle becomes essential. Model-based formal timing analysis appears at first sight to be the adequate candidate for this purpose. However, its use in the industry is conditioned by a smooth and seamless integration in the development process. This is not an easy task due to the semantic mismatches between the design and timing analysis models but also due to the missing links to the testing phase after code implementation. In this paper, we present a model-based timing analysis framework we developed in the industrial context of satellite on-board software. The framework enables overcoming the above mentioned problems, thus allowing a fully integration and automation of model-based timing verification activities in the development process, as a mean to shorten the design time and reduce risks of timing failures.

The haemodialysis patients are an high risk population for hepatitis viral infections. While the incidence of HBV has decreased worldwide, HCV is now the major cause of viral infection in these patients. The aim of our study was to define a complete map of patients undergoing routine replacement therapy by haemodialysis in the province of Foggia, Southern Italy, who were HCV Ab positive, the presence of viraemia and their genotypes; moreover, we investigated the probable factors involved in determining the infection as well as the means of prevention. Materials and methods: We enrolled 330 patients treated in four haemodialysis centres (DC) and six secondary units; mean age was 57 years and mean duration of dialysis 76 months. Samples were drawn to determine cytolysis indexes and the HCV Ab status; in HCV positive patients, we also looked for viraemia and HCV genotypes. Data were analysed by a transversal cross-section study. Results and conclusions: Prevalence of HCV infection was 0.43 (males 0.45, females 0.42). The risk of contracting the infection was shown to be significantly different in the various DCs and did not seem to be related to the severity of the preventive measures. There was no significant difference between the various DCs in the comparison between the odds of HCV-RNA+ and HCV-RNA− patients. No significant prevalence of a given genotype emerged from a cross-sectional study related to the comparison between different genotypes. Moreover, transfusions of blood products seemed to have no significant relation to HCV infection. Finally, patients treated with haemodialysis for more than 36 months run a seven time greater risk of contracting HCV infection.

Background Inadequate blood pressure control and poor adherence to treatment remain among the major limitations in the management of hypertensive patients, particularly of those at high risk of cardiovascular events. Preliminary evidence suggests that home blood pressure telemonitoring (HBPT) might help increasing the chance of achieving blood pressure targets and improve patient’s therapeutic adherence. However, all these potential advantages of HBPT have not yet been fully investigated. Methods/design The purpose of this open label, parallel group, randomized, controlled study is to assess whether, in patients with high cardiovascular risk (treated or untreated essential arterial hypertension - both in the office and in ambulatory conditions over 24 h - and metabolic syndrome), long-term (48 weeks) blood pressure control is more effective when based on HBPT and on the feedback to patients by their doctor between visits, or when based exclusively on blood pressure determination during quarterly office visits (conventional management (CM)). A total of 252 patients will be enrolled and randomized to usual care (n=84) or HBPT (n=168). The primary study endpoint will be the rate of subjects achieving normal daytime ambulatory blood pressure targets ( Discussion The TELEBPMET Study will show whether HBPT is effective in improving blood pressure control and related medical and economic outcomes in hypertensive patients with metabolic syndrome. It will also provide a comprehensive understanding of the psychological determinants of medication adherence and blood pressure control of these patients. Trial registration Clinical Trials.gov: NCT01541566

In high-integrity systems a rising portion of software assets and development activities address quality and conformance issues in several non-functional dimensions. For those systems the software architecture acquires a prominent role: it does in fact express the framework that hosts the required functionalities, while the principles and guarantees that underpin its definition assure the desired non-functional quality on the software product. A software reference architecture holds for a set of systems and prescribes the form that concrete software architectures have to have for those systems. The software reference architecture can thus be seen as a generic software architecture, whose assets are recognized by domain stakeholders as befitting the construction of a given class of systems, for which they have been proven to meet the applicable industrial needs and technical requirements. This paper discusses the rationale for the understanding and definition of a software reference architecture and present its use in an initiative promoted by the European Space Agency for its future satellite systems.