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Background: Recently, a specific methodology has been defined, using transperineal ultrasound, for the differential diagnosis of middle compartment prolapse [uterine prolapse (UP) or cervical elongation (CE) without UP] based on the difference in the pubis-uterine fundus distance at rest and with the Valsalva maneuver, with a cutoff point of 15 mm. The objective of this study was to validate the diagnostic utility of a ≥15 mm difference between the pubis-uterine fundus distance at rest and during the Valsalva maneuver to define UP in a multicenter study. Methods: This prospective multicenter observational study included 94 patients (UP =51; CE without UP =43). The clinical examination was based on the International Continence Society Pelvic Organ Prolapse Quantification (ICS POP-Q) system for assessing pelvic organ prolapse (POP) and patients were candidates for corrective surgery of the middle compartment of the pelvic floor (correction of UP or CE without UP). The ultrasound study was performed by transperineal ultrasound (B-mode) with the patient undergoing dorsal lithotomy. The distance evaluation was performed in relation to the posteroinferior pubic margin in the midsagittal plane, with reference to the uterine fundus (established as the most distal hyperechogenic) line from the pubis to the uterine fundus at rest and with the Valsalva maneuver. We defined UP detected using UP as a difference of ≥15 mm between the pubis-uterine fundus distance at rest and with the Valsalva maneuver. Agreement between the clinical and ultrasound diagnosis of UP was assessed using the Cohen kappa coefficient of agreement and its 95% CIs. Results: The ultrasound diagnosis of global UP at the three centers showed very good agreement, with a kappa index of 0.826 (0.71, 0.94). The agreement of ultrasound with the clinical diagnosis of UP using the ICS POP-Q system was very good for each of the hospitals [Hospital 1: 0.814 (0.64, 0.98), Hospital 2: 0.847 (0.64, 1) and Hospital 3: 0.824 (0.59, 1)]. Conclusions: A difference of ≥15 mm between the pubis-uterine fundus distance at rest and during the Valsalva maneuver for the diagnosis of UP presents very good agreement with the results of clinical evaluation with the ICS POP-Q system.

Background and purpose Some studies have shown that air pollution, often assessed by thin particulate matter with diameter below 2.5 µg/m3 (PM2.5), may contribute to severe COVID‐19 courses, as well as play a role in the onset and evolution of multiple sclerosis (MS). However, the impact of air pollution on COVID‐19 has never been explored specifically amongst patients with MS (PwMS). This retrospective observational study aims to explore associations between PM2.5 and COVID‐19 severity amongst PwMS. Methods Data were retrieved from an Italian web‐based platform (MuSC‐19) which includes PwMS with COVID‐19. PM2.5 2016–2018 average concentrations were provided by the Copernicus Atmospheric Monitoring Service. Italian patients inserted in the platform from 15 January 2020 to 9 April 2021 with a COVID‐19 positive test were included. Ordered logistic regression models were used to study associations between PM2.5 and COVID‐19 severity. Results In all, 1087 patients, of whom 13% required hospitalization and 2% were admitted to an intensive care unit or died, were included. Based on the multivariate analysis, higher concentrations of PM2.5 increased the risk of worse COVID‐19 course (odds ratio 1.90; p = 0.009). Conclusions Even if several other factors explain the unfavourable course of COVID‐19 in PwMS, the role of air pollutants must be considered and further investigated., Air pollution, often assessed by particulate matter with diameter below 2.5 µg/m3, may contribute to severe COVID‐19 courses. 1087 patients were included, of whom 13% required hospitalization and 2% were admitted to an intensive care unit or died. Even if several other factors explain the unfavourable course of COVID‐19 in patients with multiple sclerosis, the role of air pollutants must be considered and further investigated.

Small satellite technologies, particularly CubeSats, are enabling breakthrough research in space. Over the past 15 years, NASA Ames Research Center has developed and flown half a dozen biological CubeSats in low Earth orbit (LEO) to conduct space biology and astrobiology research investigating the effects of the space environment on microbiological organisms. These studies of the impacts of radiation and reduced gravity on cellular processes include dose-dependent interactions with antimicrobial drugs, measurements of gene expression and signaling, and assessment of radiation damage. BioSentinel, the newest addition to this series, will be the first deep space biological CubeSat, its heliocentric orbit extending far beyond the radiation-shielded environment of low Earth orbit. BioSentinel's 4U biosensing payload, the first living biology space experiment ever conducted beyond the Earth-Moon system, will use a microbial bioassay to assess repair of radiation-induced DNA damage in eukaryotic cells over a duration of 6-12 months. Part of a special collection of articles focused on BioSentinel and its science mission, this article describes the design, development, and testing of the biosensing payload's microfluidics and optical systems, highlighting improvements relative to previous CubeSat life-support and bioanalytical measurement technologies.

Resumen Introduccion La deteccion precoz del cancer de cervix requiere la implementacion de programas de cribado del virus del papiloma humano (VPH). Sin embargo, existen discrepancias en la optimizacion de esas estrategias. Se evalua el rendimiento de 10 protocolos basados en tecnicas moleculares, citologicas o combinadas en cribado primario. Material y metodos Se disena un estudio ciego, prospectivo e intervencionista en 1.977 mujeres de 35 anos. La determinacion molecular se realizo por la plataforma Cobas 4800 HPV. Los analisis citologicos se realizaron en las mismas muestras sin conocimiento del resultado molecular. Todas las mujeres en las que se detectaba VPH-16/VPH-18 o presentaban alteracion citologica y deteccion de otros genotipos de alto riesgo (VPHar) eran derivadas a colposcopia. Resultados El ensayo molecular detecto presencia de VPHar en el 12,5% de las mujeres, mientras solo el 8,1% de las citologias fueron patologicas. El 19,5% de las pacientes derivadas a colposcopia revelaron lesiones de alto grado, estando VPH-16 presente en el 65,3% de ellas. En 6 de esas ocasiones (VPH-16 siempre presente) la citologia habia sido informada como normal. El seguimiento al ano de las mujeres con citologia normal y deteccion de VPHar identifico una lesion HSIL/CIN2+ (asociada a VPH-33). En el estudio comparativo con otras estrategias el protocolo denominado CRYGEN 16/18 rindio el mejor equilibrio de sensibilidad y especificidad con la menor derivacion a colposcopia. Conclusiones La realizacion de deteccion molecular de VPH con genotipado parcial en primera linea, al menos VPH-16, con derivacion directa a colposcopia, aumenta la tasa de deteccion de lesiones HSIL/CIN2+.

We performed a retrospective analysis of the patients assessed at our memory unit for whom Alzheimer disease (AD) cerebrospinal fluid biomarker results were available. We selected patients diagnosed with mild cognitive impairment due to AD (National Institute on Aging-Alzheimer's Association clinical criteria), confirmed neuropsychological deficit, a Global Deterioration Scale score of 3, and an abnormal profile of cerebrospinal fluid biomarkers. Of the 588 cases reviewed, 110 met the inclusion criteria. During follow-up, 50 cases (45.45%) progressed to dementia due to AD. Baseline levels of total and phosphorylated tau were higher in the group of patients that progressed to dementia than in those remaining with mild cognitive impairment. After adjusting for age, sex, history of hypertension, diabetes, and educational level, a 10% increase in total tau protein values was associated with a 7.60% increase in the risk of progression to dementia (hazard ratio: 2.22; 95% confidence interval, 1.28-3.84]; P = .004). Among patients with mild cognitive impairment due to AD and abnormal cerebrospinal fluid biomarker profiles, progressively higher concentrations of total or phosphorylated tau were associated with increased risk of progression to dementia.

Primary neuroendocrine tumours of the kidney are rare, and their pathophysiology is uncertain; since their discovery in 1966, they have been described only a few times in the literature. We present a case of a well-differentiated neuroendocrine tumour of the kidney in an asymptomatic patient, which required a multidisciplinary approach by the hospital’s team, including precise surgical treatment and an effective radiopathological diagnosis. The patient underwent right radical nephrectomy. During follow-up, he remained asymptomatic, and no metastases or complications were identified.

Background and purpose: Real-world data on alemtuzumab are limited and do not provide evidence of its effectiveness after various disease-modifying therapies (DMTs). Our aim was to provide real-world data on the impact of clinical variables and previous DMTs on clinical response to alemtuzumab. Methods: Sixteen Italian multiple sclerosis centers retrospectively included patients who started alemtuzumab from January 2015 to December 2018, and recorded demographics, previous therapies, washout duration, relapses, Expanded Disability Status Scale (EDSS) score, and magnetic resonance imaging data. Negative binomial regression models were used to assess the effect of factors on annualized relapse (ARR) after alemtuzumab initiation. Results: We studied 322 patients (mean age 36.8years, median EDSS score 3, median follow-up 1.94years). Previous treatments were: fingolimod (106), natalizumab (80), first-line oral agents (56), first-line injectables (interferon/glatiramer acetate; 30), and other drugs (15). Thirty-five patients were treatment-naïve. The pre-alemtuzumab ARR was 0.99 and decreased to 0.13 during alemtuzumab treatment (p&nbsp

Background The COronaVIrus Disease 2019 (COVID-19) has spread in Italy since February 2020, inducing the government to call for lockdown of any activity, apart primary needs, during the months March–May 2020. During the lockdown, a reduction of admissions and hospitalizations for ischemic diseases was noticed. Purpose of this study was to observe if there has been the same reduction trend in Accident & Emergency (A&E) unit admissions also for obstetric-gynecological conditions. Methods Medical records and electronic clinical databases were searched for all patients who were admitted to the obstetric A&E department or hospitalized at the Gynecology and Obstetrics Unit of University hospital of Naples Federico II, during the quarter March–May in the years 2019 and 2020. The mean ± standard deviation (SD) of monthly admission to the obstetric A&E department and hospitalization of the year 2020 was compared with that of the year 2019, using the unpaired T test with α error set to 0.05 and 95% confidence intervals (95% CI). Results Admissions were 1483 in the year 2020 and 1786 in 2019. Of total, 1225 (37.5%) women were hospitalized: 583 in the year 2020, 642 in 2019. Mean ± SD of patients monthly admitted to our obstetric A&E department was 494 ± 33.7 in the year 2020, and 595.3 ± 30.9 in 2019, with a mean difference of − 101.3 (95% CI − 103.5 to − 99.1; p p Conclusion A significant decrease in the mean of monthly admissions and hospitalizations during the COVID-19 pandemic when compared to the previous year was found also for obstetric–gynecological conditions. Further studies are necessary to assess COVID-19 impact and to take the most appropriate countermeasures.

Objectives To assess the toxicity patterns and effectiveness of doublet chemotherapy when administered at reduced doses of 20% (FOLFOX or FOLFIRI) in combination with anti-EGFR antibodies (cetuximab or panitumumab) in old, vulnerable patients with metastatic colorectal cancer (mCRC). Patients and methods We performed a retrospective observational study of RAS and BRAF wild-type, vulnerable patients aged ≥70 years with previously untreated mCRC. The primary endpoint was safety, and secondary endpoints were overall response rate (ORR), progression-free survival (PFS), and overall survival (OS). Results One hundred and eighteen patients were collected from 14 selected Italian centres. The median age was 75 (range, 70–85). Geriatric screening by G8 tool gave a score ≤ 14 in all patients. In total, 75 and 43 patients received FOLFOX or FOLFIRI, respectively, in combination with panitumumab (53%) or cetuximab (47%). The overall incidence of grade (G) 3–4 neutropenia was 11.8%, and for skin rash 11%. The most frequent adverse events were G1–2 skin rash (49.1%), G1–2 diarrhea (21.1%) and G1–2 nausea (17.7%). The ORR was 57.3%. Stable disease was observed in 29.1% of patients, with a disease control rate of 86.4%. With a median follow-up of 18 months, the median PFS was 10.0 months (95% confidence interval [CI]: 8.5–11.4), while the median OS was 18.0 months (95% CI: 16.0–19.9). No statistically significant difference was observed between the regimens in terms of ORR, PFS (p = 0.908), and OS (p = 0.832). Conclusion This study shows that with an appropriate design, including reduced doses, vulnerable older patients best tolerate chemotherapy when combined with anti-EGFR antibodies.

Resumen Introduccion El compromiso de la articulacion coxofemoral en la artritis reumatoide se asocia a discapacidad y menor calidad de vida. En la actualidad no existen estudios que evaluen sus alteraciones en etapas subclinicas. Objetivo Determinar la prevalencia del compromiso subclinico de cadera mediante el uso del ultrasonido. Material y metodos Estudio descriptivo de corte transversal, enfocado en pacientes con diagnostico establecido de artritis reumatoide, segun los criterios clasificatorios de la EULAR/ACR 2010, que presentaron o no dolor en la articulacion coxofemoral durante el examen fisico, comparados con individuos sanos. Se investigo la presencia de distension de la capsula articular, bursitis del iliopsoas, erosiones, osteofitos, remodelacion articular y senal Doppler de poder. Las imagenes fueron interpretadas por un reumatologo experto en US, cegado a las variables clinicas, demograficas y de laboratorio. Resultados Se evaluaron en total 234 caderas; 37 (31,6%) pacientes con artritis reumatoide sintomaticos de la cadera, 40 (34,1%) pacientes con artritis reumatoide subclinica y 40 (34,1%) sujetos sanos. La prevalencia de sinovitis de la capsula articular fue del 48,6% para los pacientes con artritis reumatoide sintomatica, del 20% para los pacientes con artritis reumatoide subclinica y del 15% para los sujetos sanos. El grupo de pacientes con artritis reumatoide subclinica presento una mayor frecuencia de osteofitos y remodelacion articular. Conclusiones Se confirmo el valor del ultrasonido en el diagnostico subclinico de la patologia inflamatoria de la articulacion coxofemoral. No se evidenciaron asociaciones significativas entre los hallazgos del US con la actividad de la enfermedad, ni con los valores de estudios de laboratorio.

Resumen Introduccion La variabilidad glucemica (VG) hace referencia a las oscilaciones en los niveles de glucosa en sangre y podria influir en el pronostico del ictus. Objetivo: Analizar el efecto de la VG en la evolucion del infarto cerebral agudo (IC). Metodos Analisis exploratorio del estudio GLIAS-II (multicentrico, prospectivo y observacional). Se midieron los niveles de glucemia capilar cada cuatro horas durante las primeras 48 horas y la VG se definio como la desviacion estandar de los valores medios. Variables principales: mortalidad y muerte o dependencia a los tres meses. Variables secundarias: porcentaje de complicaciones intrahospitalarias y de recurrencia de ictus, e influencia de la via de administracion de insulina sobre la VG. Resultados Se incluyeron 213 pacientes. Los pacientes que fallecieron (N = 16;7,8%) presentaron mayores valores de VG (30,9 mg/dL vs. 23,3 mg/dL; p = 0,05). En el analisis de regresion logistica ajustado por edad y comorbilidad, tanto la VG (OR = 1,03; IC del 95%: 1,003-1,06: p = 0,03) como la gravedad del IC (OR = 1,12; IC del 95%: 1,04-1,2; p = 0,004) se asociaron de forma independiente con la mortalidad a los tres meses. No se encontro asociacion entre la VG y las demas variables de estudio. Los pacientes que recibieron tratamiento con insulina subcutanea mostraron una mayor VG que los tratados con insulina intravenosa (38,9 mg/dL vs. 21,3 mg/dL; p Conclusiones Valores elevados de VG durante las primeras 48 horas tras el IC se asociaron de forma independiente con la mortalidad. La administracion subcutanea de insulina podria condicionar una mayor VG que la via intravenosa.

A energia solar é considerada um dos recursos de energia renovável mais importantes para diminuir a dependência de combustíveis fósseis. Portanto, este estudo tem como objetivo realizar uma revisão sistemática da literatura sobre pesquisas de alto impacto sobre os impactos ambientais evitados com o uso da energia solar fotovoltaica no setor industrial para investigar tendências neste corpo da literatura. Para tanto, foram aplicados filtros ao portfólio bruto entre 209 artigos e selecionados 22 para identificar os estudos mais relevantes e de alto impacto na área. Os resultados mostram as principais tendências do referido corpo da literatura, as possíveis conexões da energia solar fotovoltaica e os impactos ambientais na indústria, bem como os principais investigadores que realizam os estudos. Este estudo fornece uma visão geral dos impactos evitados com o uso da energia solar fotovoltaica nas possibilidades de pesquisas futuras.

Long bone metastases are a disease of high social importance. The goals of surgical treatment are to relieve pain, maintain or restore joint function, and prevent or treat pathological fractures. "Oligometastases" is a disease with a limited number (3-5) of metastatic lesions in the same body district, where an aggressive treatment can be carried out with "curative" intent. This study aimed to evaluate patients with bone metastases surgically treated to determine how surgical treatment can influence prognosis and quality of life, comparing solitary metastasis, oligometastases, and multiple metastases.This is a retrospective analysis of 130 patients with long bone metastases surgically treated between October 2015 and August 2019: 40 patients had solitary metastasis; 38 had less than three metastases (oligometastases), and 52 had multiple metastases. Surgery was resection and reconstruction with a cemented prosthesis (95) or nailing (35).Overall survival was significantly better in patients with solitary metastasis or oligometastases than in those with multiple metastases (p0.0001). Patients treated with resection and prosthesis had significantly better survival than those treated with nailing (p0.0001). Implant complications requiring surgical revision occurred in 20 patients treated with prostheses, while no complications occurred in patients treated with nailing.Survival of cancer patients has improved in the last two decades, leading to an increase of diagnosed metastases. Patients with oligometastases have a survival similar to those with a single metastasis. Optimal implants survival curves should stay above the curves of patients survival.Since there are no differences in survival, patients with oligometastases should be treated as patients with a solitary lesion, with more aggressive surgery (wide resection and reconstruction with prosthesis). Intramedullary nailing is still indicated in metaphyseal or diaphyseal metastases in patients with advanced disease or poor prognosis when the life expectancy does not overcome the expected survival of the nail, avoiding the need for further surgery.

Forest production and growth are obtained from statistical models that allow the generation of information at the tree or forest stand level. Although the use of regression models is common in forest measurement, there is a constant search for estimation procedures that provide greater accuracy. Recently, machine learning techniques have been used with satisfactory performance in measuring forests. However, methods such as Adaptive Neuro-Fuzzy Inference System (ANFIS) and Random Forest are relatively poorly studied for predicting the volume of wood in eucalyptus plantations in Brazil. Therefore, it is essential to check whether these techniques can provide gains in terms of accuracy. Thus, this study aimed to evaluate the use of Random Forest and ANFIS techniques in the prognosis of forest production. The data used come from continuous forest inventories carried out in stands of eucalyptus clones. The data were divided into 70% for training and 30% for validation. The algorithms used to generate rules in ANFIS were Subtractive Clustering and Fuzzy-C-Means. Besides, training was done with the hybrid algorithm (descending gradient and least squares) with the number of seasons ranging from 1 to 20. Several RFs were trained, varying the number of trees from 50 to 850 and the number of observations by five leaves to 35. Artificial neural networks and decision trees were also trained to compare the feasibility of the techniques. The evaluation of the estimates generated by the techniques for training and validation was calculated based on the following statistics: correlation coefficient (r), relative Bias (RB), and the relative root mean square error (RRMSE) in percentage. In general, the techniques studied in this work showed excellent performance for the training and validation data set with RRMSE values 0.98. The RF presented inferior statistics about the ANFIS for the prognosis of forest production. The Subtractive Clustering (SC) and Fuzzy-C-Means (FCM) algorithms provide accurate baseline and volume projection estimates; both techniques are good alternatives for selecting variables used in modeling forest production.

Periprosthetic femoral re-fractures (PFRFs) represent an emerging challenge for orthopaedic surgeons, since their incidence is growing in the last years, but very few experiences about their management have been currently published. The present study aims to (1) introduce, for the first time, an etiologic classification for PRFRs and (2) to provide surgical and pharmacological tips for the correct management of these injuries. Periprosthetic femoral re-fractures (PFRFs) could be classified into traumatic-PFRFs (T-PFRFs) and pathological-PFRFs (P-PFRFs). T-PFRFs, i.e. the "true" periprosthetic re-fractures, present as new fracture lines occurring proximally or distally to a previous periprosthetic fracture, that has correctly healed. They are generally unpredictable injuries but, in selected cases, it is possible to predict them by analyzing the construct used in the treatment of the previous periprosthetic fracture. P-PFRFs, on the other hand, define re-fractures occurring on a previous periprosthetic non-union or delayed union: the new fracture line appears in the same district of the old one. According to the etiologic factors influencing the P-PFRFs pathogenesis, it is possible to define re-fractures caused by mechanical failures, biological failures, septic failures and multifactorial failures, i.e., a combination of the previously mentioned concerns. A successful postoperative outcome, following the surgical management of PFRFs, requires the correct identification of all the underlying causes, which should be promptly and appropriately managed.

A Smart Factory exploits information and communication technologies (ICT) to improve the production process and the working environment, usually addressing safety concerns. To this concern, factory-grade fire protection systems are governed by several procedures and standards whose application often becomes definitely challenging when the factory premises are dispersed across multiple administrative domains. In such contexts, the Smart Factory approach can prove very effective in the management and coordination of the factory-level fire protection system. However, a catastrophic event may compromise the ICT infrastructure, affecting communication among factory domains and therefore its smart services. A strategy to cope with the latter may be the introduction of mechanisms to handle data analysis on-site for a prompt response while enabling seamless data distribution and processing among neighbouring (federated) ICT infrastructures and emergency operators. In this work, a novel software-defined approach for the adaptive management of a Smart Factory infrastructure is proposed, centered around business logic rewiring and reconfiguration at run-time across different factory domains. Thereby, even in the case of catastrophic (e.g., potentially disruptive) events, working devices of the emergency system can go on with their operations, including transferring data to rescuers and others emergency control systems. To demonstrate the effectiveness of the proposed Software Defined Factory approach, a Federated Fire Protection System operating in an industrial setting is implemented as a case study, able to promptly react and adapt to infrastructure-critical fires and their consequences by leveraging all information and computing facilities pooled over Cloud/Fog/Edge devices spanning the premises.

Negative environmental changes generally addressed as ‘syndromes’ areevaluated in the context of Soil Degradation (SD) and interpreted by usinga ‘Land-Use/Land Cover Changes’ (LULCCs) framework in order to dis-entangle ‘past trajectories’, ‘present patterns’, and ‘future changes’. Thisapproach allows to discuss the potential impact on SD processes and itrepresents an informed basis for identifying measurable outcomes of SD.This study focuses on the case of Emilia Romagna, a region located inthe North of Italy with high-value added agricultural productions. A multi-temporal analysis of land-use changes between 1954 and 2008 has been proposed, discussing the evolution of associated SD syndromes in EmiliaRomagna. The contributing information have been used as a baseline forSustainable Land Management (SLM) strategies. This framework of analysisprovides useful tools to investigate and to monitor the effects of SD in theMediterranean basin where several regions underwent common developmentpatterns yelding global pathological symptoms of environmental degradation.

Federated Learning (FL) has attracted significant interest given its prominent advantages and applicability in many scenarios. However, it has been demonstrated that sharing updated gradients/weights during the training process can lead to privacy concerns. In the context of the Internet of Things (IoT), this can be exacerbated due to Intrusion Detection Systems (IDS), which are intended to detect security attacks by analyzing the devices' network traffic. Our work provides a comprehensive evaluation of Differential Privacy (DP) techniques, which are applied during the training of an FL-enabled IDS for Industrial IoT (IIoT). Unlike previous approaches, we deal with non-iid data over the recent ToN_IoT dataset and compare the accuracy obtained considering different privacy requirements and aggregation functions, namely FedAvg and the recently proposed Fed+. According to our evaluation, the use of Fed+ in our setting provides similar results even when noise is included in the federated training process.

Objective To evaluate the incidence of significant intraoperative electrophysiological signal changes during surgical positioning, and to assess the effectiveness of head and neck repositioning on the restoration of signals, among patients undergoing surgery for cervical myelopathy. Material and methods We used multimodal intraoperative monitoring (somatosensory [SEP] and motor evoked potentials [MEP] and spontaneous electromyography) before and after patients’ positioning in a consecutive cohort of 103 patients operated for symptomatic cervical myelopathy. Significant changes were defined as > 50% attenuation in amplitude or > 10% increase in latency of SEP, or abolishment or 50–80% attenuation of MEP. Results Out of 103 patients (34.9% female, median age 54.5 years) 88 underwent laminectomy (85.4%) and 15 (14.6%) anterior approach. At the time of positioning, signal alterations occurred in 44 patients (42.7%), yet only 11 patients (10.7%) showed alarming changes. Immediate neck repositioning of these resulted in complete (n = 6) or partial (n = 4) restoration of potentials, yielding no postoperative deficits. The patient in which signals could not be restored after repositioning resulted in added postoperative deficit. The accuracy (true positives plus true negatives) of monitoring to detect new neurological deficits was 99.0% (102/103) for the entire cohort, and 100% (11/11) for those showing significant changes at the moment of positioning. Overall, only 1 patient, with non-significant SEP attenuation, experienced a new postoperative deficit, yielding a 0.97% rate of false negatives. Conclusion Among patients undergoing surgery for cervical myelopathy, 10.7% showed alarming electrophysiological signal changes at the time of positioning. Immediate repositioning of the neck resulted in near always restoration of potentials and avoidance of added neurological damage. Complete or partial restoration of potentials after repositioning yielded no postoperative deficits.

Aims: Here in we evaluated the association between the use of Hydrochlorothiazide (HCTZ) and the risk of NMSC both, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Background: Even though the use of HCTZ is not linked with the development of serious adverse drug reactions, non-melanoma skin cancer (NMSC) has been reported in patients treated with the drug in recent years, most likely due to its photosensitizing ability. Objective: To evaluate the statistically significant difference (P Methods: We performed a retrospective study on patients referred to general practitioners who developed skin cancer or NMSC whether or not they were treated with antihypertensive drugs. Controls were matched with the test by age and sex. We calculated odds ratios (ORs) for skin cancer and NMSC associated with hydrochlorothiazide using conditional logistic regression. Results: We enrolled 19,320 patients in the present study, out of a total of 10,110 (52.3%) who were treated with antihypertensive drugs. Of 10,110 patients, 3,870 were treated with HCTZ (38.3%). During the study, we failed to report an increased risk of NMSC in HCTZ-treated vs. untreated patients. Gender stratification revealed an OR for NMSC of 1.36 for men and 0.56 for women. We did not find a dose-response relationship between HCTZ use and NMSC. Conclusions: In the present study, we failed to report an association between the use of HCTZ and the development of NMSC.

In this paper 5 different case studies of solar hybrid heating and cooling networks serving 5 different school buildings assumed as representative of the 5 provinces of the Campania region (southern Italy) have been modelled, dynamically simulated and analyzed by means of the software TRNSYS over a 5-year period. The plants are based on the operation of solar thermal collectors coupled with a seasonal borehole thermal energy storage; the solar field is also integrated with photovoltaic panels coupled with an electric energy storage; a solar-powered adsorption system is used for covering the cooling requirements. Specific weather data files have been developed for each city based on 1-year in-situ hourly measurements to accurately take into account the influence of climatic conditions on systems’ performance; the effects of thermo-physical properties of underground associated to the different locations have also been taken into consideration according to measured data available in the literature. The proposed systems have been compared with conventional Italian heating and cooling plants from energy, environmental and economic points of view in order to assess the potential benefits, highlight the effects of both weather data and characteristics of underground as well as promote the diffusion of solar systems for Italian applications.

Background & Aims The Pre-TACE-Predict model was devised to assess prognosis of patients treated with trans-arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). However, before entering clinical practice, a model should demonstrate that it performs a useful role. Methods We performed an independent external validation of the Pre-TACE model in a cohort that differs in setting and time period from the one that generated the original model. Data from 826 patients treated with TACE for naïve HCC (2008-2018) were used to assess calibration and discrimination of the Pre-TACE-Predict model. Results The four risk-categories identified by the Pre-TACE-Predict model had gradient monotonicity, with median survivals of 52.0, 36.2, 29.9, and 14.1 months respectively. However, predicted survivals systematically underestimated observed survivals (R2: 0.667). A recalibration was adopted maintaining fixed the prognostic index and modifying the baseline survival function. This resulted in an almost perfect calibration (R2: 0.995) in all the four risk categories. Cox regressions showed that aetiology and macrovascular invasion, included in the Pre-TACE-Predict model, had no prognostic impact in the present study population, and that coefficients for tumour size and multiplicity were overestimated. The c-index was similar to that of the m-HAP-III, but higher than those of HAP, m-HAP-II and the six-and-twelve models. Conclusions The recalibration of Pre-TACE-Predict model improved the estimation of survival probabilities of HCC patients treated with TACE. The highest discriminatory ability of the Pre-TACE-model in comparison to other available models, together with risk stratification and recalibration, makes it the best prognostic tool currently available for these patients.

The molecular pathways which promote lung cancer cell features have been broadly explored, leading to significant improvement in prognostic and diagnostic strategies. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have dramatically altered the treatment approach for patients with metastatic non-small cell lung cancer (NSCLC). Latest investigations by using next-generation sequencing (NGS) have shown that other oncogenic driver mutations, believed mutually exclusive for decades, could coexist in EGFR-mutated NSCLC patients. However, the exact clinical and pathological role of concomitant genomic aberrations needs to be investigated. In this systematic review, we aimed to summarize the recent data on the oncogenic role of concurrent genomic alterations, by specifically evaluating the characteristics, the pathological significance, and their potential impact on the treatment approach.

Background and aims Obesity-related cardiometabolic risk factors associate with COVID-19 severity and outcomes. Epicardial adipose tissue (EAT) is associated with cardiometabolic disturbances, is a source of proinflammatory cytokines and a marker of visceral adiposity. We investigated the relation between EAT characteristics and outcomes in COVID-19 patients. Methods and results This post-hoc analysis of a large prospective investigation included all adult patients (≥18 years) admitted to San Raffaele University Hospital in Milan, Italy, from February 25th to April 19th, 2020 with confirmed SARS-CoV-2 infection who underwent a chest computed tomography (CT) scan for COVID-19 pneumonia and had anthropometric data available for analyses. EAT volume and attenuation (EAT-At, a marker of EAT inflammation) were measured on CT scan. Primary outcome was critical illness, defined as admission to intensive care unit (ICU), invasive ventilation or death. Cox regression and regression tree analyses were used to assess the relationship between clinical variables, EAT characteristics and critical illness. One-hundred and ninety-two patients were included (median [25th-75th percentile] age 60 years [53-70], 76% men). Co-morbidities included overweight/obesity (70%), arterial hypertension (40%), and diabetes (16%). At multivariable Cox regression analysis, EAT-At (HR 1.12 [1.04-1.21]) independently predicted critical illness, while increasing PaO2/FiO2 was protective (HR 0.996 [95% CI 0.993; 1.00]). CRP, plasma glucose on admission, EAT-At and PaO2/FiO2 identified five risk groups that significantly differed with respect to time to death or admission to ICU (log-rank p, Graphical abstract Image 1

PURPOSE To present a dataset of computational digital breast phantoms derived from high-resolution three-dimensional (3D) clinical breast images for the use in virtual clinical trials in two-dimensional (2D) and 3D x-ray breast imaging. ACQUISITION AND VALIDATION METHODS Uncompressed computational breast phantoms for investigations in dedicated breast CT (BCT) were derived from 150 clinical 3D breast images acquired via a BCT scanner at UC Davis (California, USA). Each image voxel was classified in one out of the four main materials presented in the field of view: fibroglandular tissue, adipose tissue, skin tissue, and air. For the image classification, a semi-automatic software was developed. The semi-automatic classification was compared via manual glandular classification performed by two researchers. A total of 60 compressed computational phantoms for virtual clinical trials in digital mammography (DM) and digital breast tomosynthesis (DBT) were obtained from the corresponding uncompressed phantoms via a software algorithm simulating the compression and the elastic deformation of the breast, using the tissue's elastic coefficient. This process was evaluated in terms of glandular fraction modification introduced by the compression procedure. The generated cohort of 150 uncompressed computational breast phantoms presented a mean value of the glandular fraction by mass of 12.3%; the average diameter of the breast evaluated at the center of mass was 105 mm. Despite the slight differences between the two manual segmentations, the resulting glandular tissue segmentation did not consistently differ from that obtained via the semi-automatic classification. The difference between the glandular fraction by mass before and after the compression was 2.1% on average. The 60 compressed phantoms presented an average glandular fraction by mass of 12.1% and an average compressed thickness of 61 mm. DATA FORMAT AND ACCESS The generated digital breast phantoms are stored in DICOM files. Image voxels can present one out of four values representing the different classified materials: 0 for the air, 1 for the adipose tissue, 2 for the glandular tissue, and 3 for the skin tissue. The generated computational phantoms datasets were stored in the Zenodo public repository for research purposes (http://doi.org/10.5281/zenodo.4529852, http://doi.org/10.5281/zenodo.4515360). POTENTIAL APPLICATIONS The dataset developed within the INFN AGATA project will be used for developing a platform for virtual clinical trials in x-ray breast imaging and dosimetry. In addition, they will represent a valid support for introducing new breast models for dose estimates in 2D and 3D x-ray breast imaging and as models for manufacturing anthropomorphic physical phantoms.

Background and Purpose: Clinical trials on stroke prevention in patients with atrial fibrillation have consistently shown clinical benefit from either warfarin or non–vitamin K antagonist oral anticoagulants (NOACs). NOAC-treated patients have consistently reported to be at lower risk for intracerebral hemorrhage (ICH) than warfarin-treated patients. The aims of this prospective, multicenter, multinational, unmatched, case-control study were (1) to investigate for risk factors that could predict ICH occurring in patients with atrial fibrillation during NOAC treatment and (2) to evaluate the role of CHA 2 DS 2 -VASc and HAS-BLED scores in the same setting. Methods: Cases were consecutive patients with atrial fibrillation who had ICH during NOAC treatment. Controls were consecutive patients with atrial fibrillation who did not have ICH during NOAC treatment. As within the CHA 2 DS 2 -VASc and HAS-BLED scores there are some risk factors in common, several multivariable logistic regression models were performed to identify independent prespecified predictors for ICH events. Results: Four hundred nineteen cases (mean age, 78.8±8.1 years) and 1526 controls (mean age, 76.0±10.3 years) were included in the study. From the different models performed, independent predictors of ICH were increasing age, concomitant use of antiplatelet agents, active malignancy, high risk of fall, hyperlipidemia, low clearance of creatinine, peripheral artery disease, and white matter changes. Low doses of NOACs (given according to label or not) and congestive heart failure were inversely associated with the risk of ICH. HAS-BLED and CHA 2 DS 2 -VASc scores performed poorly in predicting ICH with areas under the curves of 0.496 (95% CI, 0.468–0.525) and 0.530 (95% CI, 0.500–0.560), respectively. Conclusions: Several risk factors were associated to ICH in patients treated with NOACs for stroke prevention but not HAS-BLED and CHA 2 DS 2 -VASc scores.

Resumen Introduccion y objetivos La evolucion a largo plazo de los pacientes que padecen sincope, una vez descartada su etiologia cardiaca, no se ha descrito en profundidad. Se describe la evolucion a largo plazo de esta poblacion. Metodos Durante 147 meses, se estudio a todos los pacientes remitidos a nuestra unidad de sincope tras haberse descartado una causa cardiaca. Resultados Se incluyo a 589 pacientes consecutivos, 313 de ellos mujeres (53,1%), con una mediana de 52 [34-66] anos. A 405 (68,8%) se les diagnostico sincope vasovagal (SVV); a 65 (11%), sincope por hipotension ortostatica (SHO), y a 119 (20,2%), sincope de etiologia desconocida (SED). Durante una mediana de 52 [28-89] meses de seguimiento, 220 (37,4%) tuvieron recurrencias (el 21,7%, 2 o mas recurrencias) y se produjeron 39 muertes (6,6%). La recurrencia del sincope se produjo en el 41% de los pacientes con SVV, el 35,4% del grupo con SHO y el 25,2% del de SED (p = 0,006). La recurrencia se correlaciono en el analisis multivariado con la edad (p = 0,002), el sexo femenino (p Conclusiones En los pacientes con sincope de origen no cardiaco, a los 52 meses de seguimiento, la tasa de recurrencias es del 37,4% y la de mortalidad, del 6,6%. Hay mas recurrencias en los pacientes con perfil neuromediado y mas mortalidad en los pacientes con perfil no neuromediado.

Resumen Objetivo El consenso de Baveno VI para el cribado endoscopico de varices esofagogastricas recomienda evitar la endoscopia en algunos pacientes. Bajo esta estrategia, podrian pasar desapercibidas lesiones no relacionadas con hipertension portal, algunas de ellas potencialmente graves. El objetivo de este estudio es determinar la prevalencia de dichas lesiones e identificar los factores clinicos asociados a las mismas. Pacientes y metodos Estudio transversal unicentrico sobre una cohorte consecutiva de pacientes cirroticos sometidos a endoscopia digestiva alta en el contexto de un programa de cribado de varices esofagogastricas entre noviembre del 2013 y noviembre del 2018. Se analizaron los factores de riesgo para la presencia de lesiones no relacionadas con hipertension portal mediante regresion logistica uni y multivariante. Resultados Se incluyo a 379 pacientes. La etiologia mayoritaria de la cirrosis fue etilica (n = 229; 60,4%). La prevalencia de lesiones endoscopicas no relacionadas con hipertension portal fue del 39,6% (n = 150). Entre los 96 pacientes con enfermedad peptica (25,3%) se tomo test de ureasa en 54 (56,2%), siendo positiva en 24 (44,4%). La presencia de lesiones endoscopicas no relacionadas con hipertension portal no estuvo influida por la edad (p = 1), el genero (p = 0,28), la funcion hepatica (MELD p = 0,20, Child-Pugh p = 0,77) o la presencia de datos ecograficos de hipertension portal (p = 0,14). Los pacientes fumadores presentaron tendencia a mayor prevalencia de lesiones endoscopicas no relacionadas con la hipertension portal (43,2% vs. 34,6%; p = 0,09), particularmente ulcera peptica (6,4% vs. 0,6%; p = 0,05) y duodenitis peptica (17,3% vs. 6,3%; p = 0,002). El tabaquismo activo fue el unico factor predictivo independiente de ulcus o duodenitis peptica (odds ratio = 2,56; intervalo de confianza del 95%: 1,18-5,56; p = 0,017). Conclusiones El tabaquismo activo aumenta el riesgo de lesiones endoscopicas no relacionadas con hipertension portal, lo cual deberia ser investigado en profundidad para redefinir el cribado endoscopico en pacientes fumadores con cirrosis hepatica.

Resumen Introduccion y objetivos El acceso transaxilar (ATx) se ha convertido en el acceso alternativo al transfemoral (ATF), mas utilizado en pacientes sometidos a implante percutaneo de valvula aortica (TAVI). El objetivo principal de este estudio es comparar la mortalidad total hospitalaria y a los 30 dias de los pacientes incluidos en el registro espanol de TAVI a los que se trato por acceso ATx frente a ATF. Metodos Se analizo a todos los pacientes incluidos en el registro espanol de TAVI tratados por ATx o ATF. Los eventos hospitalarios y a los 30 dias de seguimiento se definieron segun las recomendaciones de la Valve Academic Research Consortium. Se evaluo el impacto de la via de acceso mediante emparejamiento por puntuacion de propension segun las caracteristicas clinicas y ecograficas. Resultados Se incluyo a 6.603 pacientes, 191 (2,9%) tratados por ATx y 6.412 con ATF. Despues del ajuste (grupo de ATx, n = 113; grupo de ATF, n = 3.035), el exito del dispositivo fue similar entre ambos grupos (el 94% en el grupo de ATx frente al 95% en el de ATF; p = 0,95); sin embargo, se observo un incremento en la tasa de infarto agudo de miocardio (OR = 5,3; IC95%, 2,0-13,8; p = 0,001), complicaciones renales (OR = 2,3; IC95%, 1,3-4,1; p = 0,003) e implante de marcapasos (OR = 1,6; IC95%, 1,01-2,6; p = 0,03) en el grupo de ATx comparado con el de ATF. De mismo modo, la mortalidad hospitalaria y a los 30 dias fueron superiores en el grupo de ATx (respectivamente, OR = 2,2; IC95%, 1,04-4,6; p = 0,039; y OR = 2,3; IC95%, 1,2-4,5; p = 0,01). Conclusiones El ATx se asocia con un aumento en la mortalidad total tanto hospitalaria como a los 30 dias frente al ATF. Ante estos resultados, el ATx debe considerarse solo en caso de que el ATF no sea posible.

Pulmonary hypertension (PH) often complicates chronic left-sided heart failure, with a remarkable impact on quality of life, exercise capacity, and survival. PH in chronic left-sided heart failure (PH-LHD) is not only caused by backward transmission of pressures but also involves impairment of atrial function, inflammation, and vasoconstriction. Once the left atrium loses its reservoir capacity, usually pulmonary vascular resistances increase. Right atrial dilation commonly represents the first sign of PH-LHD, before right ventricle dilatation and systolic dysfunction develop, leading to right heart insufficiency, and ultimately, right heart failure.

Resumen Introduccion El envejecimiento de la poblacion infectada por VIH podria relacionarse con prescripciones de medicacion potencialmente inadecuadas, interacciones medicamentosas y falta de adherencia terapeutica. Los criterios PIMDINAC buscan analizar conjuntamente estos problemas. El objetivo del estudio es determinar la prevalencia de los criterios PIMDINAC en una poblacion VIH de edad avanzada. Metodos Estudio observacional, transversal y multicentrico que incluyo pacientes mayores de 65 anos en seguimiento farmacoterapeutico entre febrero-abril de 2020. La variable principal fue el porcentaje de cumplimiento de los criterios PIMDINAC. Resultados Se incluyeron 47 pacientes, registrandose un PIMDINAC total en un 12,5%. De forma aislada, se detecto no adherencia al tratamiento concomitante en un 65,6% de los pacientes, medicacion potencialmente inadecuada en un 48,9% e interacciones medicamentosas en un 25,2%. El numero de farmacos y la polifarmacia se relacionaron con una mayor aparicion de criterios PIMDINAC. Conclusion La prevalencia de criterios PIMDINAC en pacientes VIH de edad avanzada es elevada.

Background: The long-term outcomes following surgical resection for pancreatic ductal adenocarcinoma (PDAC) remains poor, with only 20% of patients surviving 5 years after pancreatectomy. Patient selection for surgery remains sub-optimal largely due to the absence of consideration of aggressive tumor biology. Objective: The aim of this study was to evaluate traditional staging criteria for PDAC in the setting of molecular subtypes. Methods: Clinicopathological data were obtained for 5 independent cohorts of consecutive unselected patients, totaling n = 1298, including n = 442 that underwent molecular subtyping. The main outcome measure was disease-specific survival following surgical resection for PDAC stratified according to the American Joint Commission for Cancer (TNM) staging criteria, margin status, and molecular subtype. Results: TNM staging criteria and margin status confers prognostic value only in tumors with classical pancreatic subtype. Patients with tumors that are of squamous subtype, have a poor outcome irrespective of favorable traditional pathological staging [hazard ratio (HR) 1.54, 95% confidence interval (CI) 1.04–2.28, P = 0.032]. Margin status has no impact on survival in the squamous subtype (16.0 vs 12.1 months, P = 0.374). There were no differences in molecular subtype or gene expression of tumors with positive resection margin status. Conclusions: Aggressive tumor biology as measured by molecular subtype predicts poor outcome following pancreatectomy for PDAC and should be utilized to inform patient selection for surgery.

Data mining for healthcare is an interdisciplinary field of study that originated in database statistics and is useful in examining the effectiveness of medical therapies. Machine learning and data visualization Diabetes-related heart disease is a kind of heart disease that affects diabetics. Diabetes is a chronic condition that occurs when the pancreas fails to produce enough insulin or when the body fails to properly use the insulin that is produced. Heart disease, often known as cardiovascular disease, refers to a set of conditions that affect the heart or blood vessels. Despite the fact that various data mining classification algorithms exist for predicting heart disease, there is inadequate data for predicting heart disease in a diabetic individual. Because the decision tree model consistently beat the naive Bayes and support vector machine models, we fine-tuned it for best performance in forecasting the likelihood of heart disease in diabetes individuals.

Resumen Introduccion La videocapilaroscopia del lecho ungular es una herramienta no invasiva para la evaluacion de la microcirculacion periferica; la indicacion principal es el estudio del fenomeno de Raynaud. Luego de una revision de la literatura, no hay informacion clara sobre los motivos de remision, presencia de hallazgos clinicos de enfermedades autoinmunes, frecuencia de patrones de autoanticuerpos y hallazgos capilaroscopicos especificos. Objetivo Describir los hallazgos sociodemograficos, clinicos, paraclinicos y capilaroscopicos de sujetos remitidos a un servicio de capilaroscopia en el noroccidente colombiano. Metodos Estudio retrospectivo de 2015 a 2018. Las variables categoricas se expresaron en frecuencias absolutas y porcentajes, y las variables cuantitativas en media y desviacion estandar o mediana con rango intercuartilico, dependiendo de la distribucion de los datos. Resultados Se realizaron 318 capilaroscopias por primera vez. El principal motivo de remision fue el fenomeno de Raynaud (n = 134; 42,1%). El patron capilaroscopico basal mas frecuente fue el normal (n = 123; 38,7%). De las 12 capilaroscopias que presentaron un patron no especifico en un seguimiento de seis meses, solo una (8,3%) progreso a un patron de esclerodermia. En los sujetos con esclerosis sistemica, el hallazgo clinico mas frecuente fue la esclerodactilia (n = 34; 37,8%), y 42/44 individuos (95,4%) tenian anticuerpos antinucleares positivos; el patron mas frecuente fue el centromerico (n = 27; 64,3%). Conclusiones La razon principal de remision para realizar una capilaroscopia fue el fenomeno de Raynaud; mas de un tercio de los sujetos tenian hallazgos capilaroscopicos normales. La esclerodactilia fue el hallazgo clinico mas frecuente en pacientes con patron capilaroscopico de esclerodermia.

The Multi-Swarm approach allows the use of multiple configurations between two or more populations of particles, where each one can present different approaches (e.g. lbest, gbest, Unified, Guaranteed-Convergence) directed towards improving the optimization process. This article presents a proposal for local/global stochastic interconnection applied to the context of the Multi-Swarm algorithm, as well as for incrementing a local search method for refining previously obtained solutions. Two proposals are introduced for this new Multi-Swarm PSO (MSO). The first one is the inclusion of "counterpart particles", which establishes a sub-topology between inter-swarm particles, accessed by migration and evaluability rules. The other involves using customized crossover operators and is based on the BLX scheme (Blend Crossover) with direction information used as a reference for establish a subspace search around the particles. Performance and robustness of the new approaches were assessed by ten constrained engineering design optimization problems (COPs), as is compared to other solutions already published in the scientific literature. Results indicate significant performance improvements for all 10 COPs when compared to concurrent-based MSOs. By making available new references from other swarms, the counterpart particles approach tends to improve the optimization process in the search space, while an intermediate layer of local search based on a modified directed BLX crossover should provide an extra search around the particle, and thus, refining previously obtained solutions.

The demand for entrepreneurship to become more prevalent in societies worldwide highlights the need to better understand entrepreneurial intentions (EI). This is particularly important for African nations characterised by significant poverty and low income. Drawing on the Theory of Planned Behaviour (TPB) this paper explores potential predictors of these intentions in two countries that differ considerably in their economic situation and culture. It chiefly focuses on SEI as socially desired, yet still unexplored phenomenon. The current study differentiates between social (SEI) and commercial (CEI) entrepreneurial intentions and explores their antecedents among university students in Namibia (n = 223) and Germany (n = 1326). The results suggest that TPB only poorly predicts SEI, particularly in Namibia. However, they support universally positive effect of perceived behavioural control on formation of CEI in both countries. This study contributes to emerging research into antecedents of SEI. It also highlights the need to test exploratory power of recognised theories such as TPB within different contexts and types of entrepreneurial activity.

Resumen Introduccion La vitamina D y los polimorfismos en el receptor de vitamina D (VDR) se asocian con enfermedades autoinmunes, incluido el lupus eritematoso sistemico (LES). El objetivo de este estudio es analizar la asociacion genetica entre los polimorfismos de VDR (TaqI, ApaI, BsmI y FokI) y la susceptibilidad al LES, asi como su relacion con los niveles sericos de vitamina D en poblacion del Caribe colombiano. Metodologia Estudio de casos y controles. Se incluyeron 133 pacientes adultos con diagnostico de LES y 100 individuos sanos. Los polimorfismos VDR fueron genotipados por RT-PCR y sondas Taqman®. Se estimaron asociaciones alelicas, genotipicas y haplotipicas. Las concentraciones sericas de vitamina D fueron cuantificadas por Elisa. Se establecieron valores de 30 a 100 ng/ml como rango normal de referencia. Valores p Resultados Se observo una alta prevalencia de LES en pacientes femeninas (94%) y se asocio a mayor riesgo de LES (OR: 10,8; IC 95%: 4,7-24,6; p Conclusion En este estudio, el polimorfismo VDR rs2228570 y el haplotipo ACCA se asociaron a mayor riesgo de LES en poblacion adolescente.

Single arm, quasi-experimental study design.To describe the effects of whole-body cryotherapy on pain, disability, and serum inflammatory markers in patients with chronic low back pain.A quasi-experimental trial was performed on adult patients between 18 and 65 years with chronic low back pain. After obtaining informed consent, participants underwent 20 sessions of whole-body cryotherapy (at -160 °C) during a 5-week time span. Patient reported pain and disability measures (Pain Numerical Rating Scale [PNRS], Oswestry Disability Index [OSI], and Roland Morris Questionnaire [RMQ]) were obtained at each of the twenty sessions. Blood samples were obtained to analyze serum inflammatory markers at baseline, 10th and 20th session.Forty-one participants were included in the study. A significant decrease was observed between the initial and final PNRS, ODI, and RMQ scores (p 0.001). A significant reduction in the PNRS was found after 4 sessions of whole-body cryotherapy (p 0.001). We observed decreasing values of pro-inflammatory serum marker IL-2 (p = 0.046) and a significant increase in the anti-inflammatory serum marker IL-10 (p = 0.003). No adverse events were reported during the study.Whole-body cryotherapy is an effective therapy for pain and disability treatment in chronic low back pain. It also produces changes in serum markers of inflammation, decreasing pro-inflammatory markers and increasing anti-inflammatory markers.

Revisões de literatura são utilizadas para levantamento de evidências de intervenções na área de saúde. Estudos têm apresentado problemas relacionados à busca de bibliografia para levantamento de evidência na Análise do Comportamento. O objetivo do presente estudo foi avaliar a utilização de uma plataforma de currículos acadêmicos (Plataforma Lattes) para busca de artigos fundamentados na Análise do Comportamento que se relacionavam com temas da área de saúde. Uma busca foi realizada para as áreas do conhecimento por meio dos descritores “Psicologia da Saúde” e “Análise do Comportamento”. Os currículos encontrados na Plataforma Lattes foram explorados para busca de artigos publicados nos últimos cinco anos. O uso de um repositório de currículos acadêmicos mostrou-se uma ferramenta possível para levamento de literatura — evidências.

Background & aims Severe acute COVID-19 has taken on pandemic proportions with growing interest in identification of prognostic factors for mortality. Standardized bioelectrical impedance (BI) phase angle (SPhA), which is PhA adjusted by age and sex, has been related to mortality in patients with several diseases but never investigated in COVID-19. Inflammation, a consequence of COVID-19 infection, affects fluid status (hydration) and can be identified with PhA. The aim of this study was to determine the predictive role of PhA on 90 days survival of adults with COVID-19. Methods We studied 127 consecutive patients diagnosed with COVID-19. BI measurements determined with a 50 kHz phase-sensitive BI device, body composition parameters and laboratory markers were evaluated as predictors of mortality. Results Non-surviving COVID-19 patients had significantly lower PhA and SPhA values (p

Objective To describe 5-year postoperative outcomes of a small series of Fuchs’ endothelial dystrophy (FED) patients who underwent Descemet stripping only (DSO) with a scraping technique. Methods DSO technique and early clinical outcomes of 5 patients with mild central FED were previously reported. In the same cohort of patients, corrected distance visual acuity, central corneal ultrasound pachymetry, refractive spherical equivalent, endothelial cell count, slit-lamp photography, and corneal Scheimpflug tomography were obtained at baseline, 6 months, and 1 and 5 years postoperatively. No patient used topical Rho-kinase inhibitors at any point in time. Results One patient (20%) failed to clear the early postoperative edema and 1 patient (20%) developed corneal decompensation 1 year after DSO. Both patients underwent successful Descemet stripping automated endothelial keratoplasty. The remaining 3 patients had stable corrected distance visual acuity, progressive reduction of corneal ultrasound pachymetry, and mild myopic shift of the refractive spherical equivalent over the follow-up time. An improvement in posterior stromal opacities and irregular astigmatism was observed, whereas posterior elevation at Scheimpflug tomography remained unchanged. Conclusion At 5 years postoperatively, DSO with a scraping technique and without Rho-kinase inhibitors resulted in sustained clinical amelioration of 3 of 5 patients (60%) with mild FED.

Introduction The present work is an observational study of a series of variables regarding overall survival and disease-free survival in patients diagnosed with primary liposarcoma. Methods The study is prospective with retrolective data collection that includes all patients with primary liposarcoma referred to Hospital Son Espases University Hospital, Palma de Mallorca, Spain from January 1990 to December 2019. Results The study includes 50 patients and the compartment surgery was performed in 18 patients (36%) of cases. The mean overall survival of the sample was 15.57 years (95% CI: 12.02–19.12) and the mean disease-free survival was 6.70 years (95% CI: 4.50–8.86). Conclusion Compartment surgery has not shown benefits in terms of overall survival and disease-free survival. The ASA classification (≥3) predicts a poor prognosis in both overall survival and disease-free survival. Resection with free margins, described on the pathological results and defined in this work as R0, show better disease-free survival.

Resumen Introduccion La implementacion del diagnostico en un solo paso (DUSP) de la infeccion activa por virus de la hepatitis C (VHC) conjuntamente con la incorporacion de alertas informativas ha demostrado que reduce de forma significativa, respecto al diagnostico tradicional, la cifra de pacientes que no eran remitidos para valoracion terapeutica. Metodos A partir de la implementacion en 2018 del DUSP en los servicios de microbiologia de los hospitales del Servicio Gallego de Salud (SERGAS), se identifican y caracterizan de manera retrospectiva los nuevos diagnosticos de infeccion activa por VHC. Resultados En 2018 se identificaron mediante DUSP un total de 258 pacientes con infeccion activa por VHC desconocida (70,2% hombres, mediana de edad de 52 anos) procedentes de consultas de unidades de atencion primaria y especializada en un 54,8% y 39,8%, respectivamente, asi como de otras localizaciones en un 5,4%. De los 258 pacientes, el 81,0% fueron derivados para valoracion terapeutica, con una mediana de 54 dias desde su diagnostico. En el 58,3% de los casos se determino el DUSP mediante carga viral, el genotipo predominante fue el 1a (30,7%), un 52,1% fue tratado y se observo una respuesta viral sostenida en el 93,7% de estos. Conclusion La implementacion en toda Galicia del DUSP de la hepatitis C conjuntamente con alertas informativas ha permitido obtener, en conjunto, tasas de derivacion para tratamiento similares a las obtenidas en otros estudios. Sin embargo, existe una amplia variabilidad entre los distintos centros, que exigen la incorporacion de mejoras, como la formacion o la utilizacion de medidas de rescate para su optimizacion.

Background Treatment options for metastatic renal cell carcinoma (mRCC) include cytoreductive nephrectomy (CN) and systemic therapy (ST). Results from the CARMENA and SURTIME trials suggest that CN before ST may not be the optimal treatment strategy for mRCC. Objective To use real-world data to evaluate and compare outcomes for patients with mRCC who underwent CN before, after, or without ST to those patients who only received ST. Design, setting, and participants The Canadian Kidney Cancer information system (CKCis) database was used to identify patients diagnosed with mRCC between January 2011 and April 2020. Only patients with synchronous disease, treated within 12 mo from their initial RCC diagnosis, with International Metastatic Renal Cell Carcinoma Database Consortium intermediate/high risk, and confirmed RCC histology were included. Outcome measurements and statistical analysis Patients were classified into four groups according to the initial treatment received for mRCC. Inverse probability of treatment weighting using propensity scores was used to balance the treatment groups. Cox proportional hazards models were used to assess the impact of CN after adjusting for potential confounding variables in the weighted cohorts. Results and limitations A total of 788 patients were included in the study cohort. Of these 383 patients underwent CN before ST, 73 underwent CN after ST, 80 underwent CN only, and 252 patients received ST only. The median patient age was 63 yr and 73% of the cohort were men. In weighted analysis, the groups undergoing CN before ST (hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.52–0.82) and CN after ST (HR 0.41, 95% CI 0.28–0.60) both had better survival compared to the ST only group. No survival benefit was observed for CN only compared to ST only, or for CN before ST compared to CN after ST. Conclusions We evaluated the association between different sequences of treatment with CN and survival in patients with mRCC using CKCis real world data. The results demonstrate that the selected patients who undergo CN, whether performed before or after ST, have an associated improvement in survival. Patient summary Two of the treatment options for metastatic kidney cancer are surgery and systemic therapy (chemotherapy or immunotherapy). We used data from the Canadian Kidney Cancer information system to determine whether there are differences in survival according to the sequencing of these treatments. Patients who had both surgery and systemic therapy, regardless of which treatment was first, had better survival than patients who only received systemic therapy.

With the significant impact of Internet services and the evolution in the hardware and software fields, the Internet size and usage scope are continuously covering smaller and resource-constrained devices. Such devices, commonly called IoT devices, with sensing/actuation capabilities, are now capable of managing the complexity of communications over the Internet. However, considering the current IoT ecosystem, this field is still fragmented with respect to the communication technologies, protocols, and data formats used by the different providers. This heterogeneity makes IoT devices/systems unable to communicate seamlessly, leading to limited cooperation and tightly coupled deployments. To overwhelm the interoperability barriers in IoT, we propose, in this paper, a Cloud-based approach with a Dynamic Domain Name System (DDNS) mechanism enabling the IoT devices to communicate using the REST model. An approach that follows the Web of things (WoT) paradigm. In particular, the system enables the IoT devices' hosted resources (e.g., sensors and actuators) to be steered using globally resolvable (over the Internet) Uniform Resource Locators (URLs) even when deployed behind Network Address Translators (i.e., NATs). Besides, the solution considers security aspects related to data transmission by leveraging the use of HTTPS with a Dynamic machnism managing Domain Validation (DV) certificates.