Search

Gastroenterology, Digestive Endoscopy and Hepatology have faced significant improvements in terms of diagnosis and therapy in the last decades. However, many fields still remain poorly explored, and many questions unanswered. Moreover, basic-science, as well as translational and clinical discoveries, together with technology advancement will determine further steps toward a better, refined care for many gastroenterological disorders in the future. Therefore, the Young Investigators of the Italian Society of Gastroenterology (SIGE) joined together, offering a perspective on major future innovations in some hot clinical topics in Gastroenterology, Endoscopy, and Hepatology, as well as the current pitfalls and the grey zones.

Hard disk drive failures are one of the most common causes of service downtime in data centers. Predictive maintenance techniques have been adopted to extend the Remaining Useful Life (RUL) of these drives, and minimize service shortage and data loss. Several approaches based on machine and deep learning techniques have been proposed to address these issues, mostly exploiting models based on Self-Monitoring analysis and Reporting Technology (SMART) attributes. While these models have proven to be reliable, their performance is affected by the lack of information about the proximity of disk failure in time. Moreover, many of these techniques are sensitive to the highly unbalanced nature of existing data-sets, in terms of good to failed hard disk ratio. In this paper, we propose a LSTM based model combining SMART attributes and temporal analysis for estimating a hard drive health status according to its time to failure. Our approach outperforms state-of-the-art methods when evaluated on two data-sets, one containing hourly samples from 23,395 disks and the other reporting daily samples from 29,878 disks. Experimental results showed that our approach is well suited to data-sets with different sampling periods, being able to predict hard drive health status up to 45 days before failure.

Soft electronics have been widely applied to wearable electronics, hand gesture detection and human robot interaction (HRI). Soft wrist-worn sensor system (SWSS) with electromyography (EMG), strain/pressure sensing abilities has been created for continuous hand gesture recognition, which includes multi-source data sensing, data collection and process, and wireless communication. SWSS is conformal contact with skin surface as the softness of SWSS, and it would improve the wearability with the wrist during long-term hand gesture monitoring. Linear discriminant analysis (LDA) and support vector machines (SVM) algorithms are applied to hand gesture recognition with average accuracy 83.67%, 86.8% for Group #1 (wrist flexion (WF), wrist extension (WE), finger flexion (FF), finger extension (FE), radial deviation (RD), and ulnar deviation (UD)) and 84.71%, 88.53% for Group #2 (sign language 0-9 digits), respectively. It is found that the recognition accuracy has just a little decreased during the long-term hand gesture detection at different sessions (at initial time, one day after, three days after and seven days after). This paper demonstrated the feasibility of gesture recognition via SWSS on wrist, and it could be integrated into wrist-worn electronic system for human robot interaction.

This paper presents the results of an experimental study on a full-scale precast concrete frame reinforced with glass fibre reinforced polymer (GFRP) bars that was tested to failure under lateral cyclic loading. Within the frame four different pocket connections are tested that will lead to accelerated construction. Traditionally, a pocket connection is comprised of a column that is extended into a recessed portion of the connecting beam and the pocket is filled with grout to create a moment-resisting connection. In order to accelerate the construction process, quicker setting epoxy resin was used in place of grout. The results show that while the epoxy resin could significantly accelerate and simplify the construction procedure due to its workability in addition to its high early strength and non-shrinkable properties, its thickness and low modulus of elasticity significantly affected the performance of the pocket joint. The test frame showed a flag-shaped hysteretic behaviour with narrow loops and small residual displacement thus illustrating desirable frame self-centring behaviour. This self-centring behaviour was due to rocking of the column in the pocket connection. The frame displaced with a large displacement ductility of approximately 7.0, however, the level of energy dissipation and damping ratio was very low when compared with conventional concrete structures. This experimental study shows that pocket connections can be used for GFRP reinforced precast concrete elements, however, they should be designed carefully to account for the lower stiffness of GFRP reinforcement. Also, to avoid premature failure and achieve a higher capacity of the pocket connections, the material used in the pocket to fill the gap between column and beam is recommended to have higher strength and elastic modulus compared to the surrounding precast concrete. Refereed/Peer-reviewed

In recent years the constant development of diagnostic techniques has contributed to improving the prognosis of many diseases. Among all, oncological diseases remain those in which a correct and early diagnosis can not only significantly improve the patient’s quality of life but also impact the effectiveness of the therapy itself. Artificial Intelligence can provide valuable aid to this need through the development of predictive models to support the physicians in the diagnosis of the disease. The project “Synergy-Net: Research and Digital Solutions in the Fight Against Oncological Diseases”, born from the collaboration between the Department of Medical and Advanced Surgical Sciences of the University of Campania “L. Vanvitelli”, the National Informatics Inter-University Consortium (National Informatics Inter-University Consortium), Lab ITEM “C. Savy” and Bollino IT S.p.A., aims at the realisation of a technological platform to support the early oncological diagnosis based on the integration of an interoperable communication and clinical data management system leveraging AI. The project has a deeply interdisciplinary nature (lung cancer, breast cancer, colorectal cancer, gastrointestinal carcinomas, prostate cancer, thyroid cancer and malignant skin tumours), which requires the collaboration of very different professionals, including general practitioners, specialist doctors, radiologists, surgeons, pathologists, molecular biologists and oncologists, as well as the support of a team of researchers for aspects related to machine learning and expert system development in health care. The core of the project consists in the creation of a Computer-Aided Detection/Diagnosis (Computer-Aided Detection/Diagnosis) system that, based on Machine Learning and Deep Learning techniques, assists the operator in the analysis of screening data such as anamnestic information, blood tests, instrumental and diagnostic images. The assistance to the operator is achieved by suggesting the portions of information (e.g. regions in an X-ray image) on which to focus more attention. The use of the system will help the physician in the development of increasingly personalised diagnostic and therapeutic strategies, meeting the criteria of tailored therapy/surgery, a desirable objective of any cancer prevention program.

Background Chemotherapy-induced neutropenia (CIN) has been demonstrated to be a prognostic factor in several cancer conditions. We previously found a significant prognostic value of CIN on overall survival (OS), in a pooled dataset of patients with advanced non-small-cell lung cancer (NSCLC) receiving first line chemotherapy from 1996 to 2001. However, the prognostic role of CIN in NSCLC is still debated. Methods We performed a post hoc analysis pooling data prospectively collected in six randomized phase 3 trials in NSCLC conducted from 2002 to 2016. Patients who never started chemotherapy and those for whom toxicity data were missing were excluded. Neutropenia was categorized on the basis of worst grade during chemotherapy: absent (grade 0), mild (grade 1–2), or severe (grade 3–4). The primary endpoint was OS. Multivariable Cox model was applied for statistical analyses. In the primary analysis, a minimum time (landmark) at 180 days from randomization was applied in order to minimize the time-dependent bias. Results Overall, 1529 patients, who received chemotherapy, were eligible; 572 of them (who received 6 cycles of treatment) represented the landmark population. Severe CIN was reported in 143 (25.0%) patients and mild CIN in 135 (23.6%). At multivariable OS analysis, CIN was significantly predictive of prognosis although its prognostic value was entirely driven by severe CIN (hazard ratio [HR] of death 0.71; 95%CI: 0.53–0.95) while it was not evident with mild CIN (HR 1.21; 95%CI: 0.92–1.58). Consistent results were observed in the out-of-landmark group (including 957 patients), where both severe and mild CIN were significantly associated with a reduced risk of death. Conclusion The pooled analysis of six large trials of NSCLC treatment shows that CIN occurrence is significantly associated with a longer overall survival, particularly in patients developing severe CIN, confirming our previous findings.

Convolutional Neural Networks (CNNs) are opening for unprecedented scenarios in fields where designing effective features is tedious even for domain experts. This is the case of medical imaging, i.e. procedures acquiring images of a human body interior for clinical proposes. Despite promising, we argue that CNNs naive use may not be effective since “medical images are more than pictures”. A notable example is breast Dynamic Contrast Enhanced-Magnetic Resonance Imaging (DCE-MRI), in which the kinetic of the injected Contrast Agent (CA) is crucial for lesion classification purposes. Therefore, in this work we introduce a new GAN like approach designed to simultaneously learn how to disentangle the CA effects from all the other image components while performing the lesion classification: the generator is an intrinsic Deforming Autoencoder (DAE), while the discriminator is a CNN. We compared the performance of the proposed approach against some literature proposals (both classical and CNN based) using patient-wise cross-validation. Finally, for the sake of completeness, we also analyzed the impact of variations in some key aspect of the proposed solution. Results not only show the effectiveness of our approach ( + 8 % AUC w.r.t. the runner-up) but also confirm that all the approach’s components effectively contribute to the solution.

The adoption of IoT for smart health applications is a relevant tool for distributed and intelligent automatic diagnostic systems. This work proposes the development of an integrated solution to monitor maternal and fetal signals for high-risk pregnancies based on IoT sensors, feature extraction based on data analytics, and an intelligent diagnostic aid system based on a 1-D convolutional neural network (CNN) classifier. The fetal heart rate and a group of maternal clinical indicators, such as the uterine tonus activity, blood pressure, heart rate, temperature, and oxygen saturation are monitored. Multiple data sources generate a significant amount of data in different formats and rates. An emergency diagnostic subsystem is proposed based on a fog computing layer and the best accuracy was 92.59% for both maternal and fetal emergency. A smart health analytics system is proposed for multiple feature extraction and the calculation of linear and nonlinear measures. Finally, a classification technique is proposed as a prediction system for maternal, fetal, and simultaneous health status classification, considering six possible outputs. Different classifiers are evaluated and a proposed CNN presented the best results, with the F1-score ranging from 0.74 to 0.91. The results are validated based on the diagnosis provided by two specialists. The results show that the proposed system is a viable solution for maternal and fetal ambulatory monitoring based on IoT.

Introduction This retrospective consecutive study compared standalone implantation of multiple (2–3) trabecular micro-bypass stents (iStent inject ± iStent) (Multi-Stent group) vs trabeculectomy + mitomycin C (Trab group) in moderate to severe open-angle glaucoma (OAG). Methods Eligible patients underwent Multi-Stent or Trab surgery from 2018 to 2020 and had at least 3-month follow-up; visual field mean deviation (VF MD) − 6 dB or worse; inadequate prior response to maximum medications ± laser procedures; and had trabeculectomy as their next planned intervention. Primary effectiveness, safety-adjusted treatment success, was defined as ≥ 20% intraocular pressure (IOP) reduction on the same or fewer medications, without clinically significant safety events (severe complications, secondary surgeries, reinterventions). Secondary effectiveness included mean IOP and medications; qualified and complete attainment of target IOP (≤ 21/18/15/12 mmHg and > 6 mmHg); health-economic and quality-of-life (QoL) measures; and 2-vs-3-stent subgroup analysis. Results The baseline groups (n = 70 Multi-Stent/40 Trab) were similar: mean IOP (21.1 mmHg/22.3 mmHg); medications (2.87/3.10 medications); disease stage (30%/35% severe); VF MD (− 10.1 dB/− 10.4 dB); and mean last follow-up (LFU, 13.1 months/15.7 months) (all differences non-significant). Primary effectiveness: treatment success at LFU was 62.9% vs 30.0% in Multi-Stent vs Trab eyes, respectively (p = 0.001). Secondary effectiveness: At LFU in Multi-Stent vs Trab groups, respectively: mean IOP decreased by 31% to 14.2 mmHg (p

Background Patients who require readmission to an intensive care unit (ICU) after transfer to a lower level of care (“bounceback”) suffer from increased mortality and longer hospital stays. We aimed to create a multifaceted standardized transfer process for patients moving from the neurointensive care unit (neuro-ICU) to a lower level of care. We hypothesized that this process would lead to improvement in provider-rated safety and a decreased rate of bouncebacks to the neuro-ICU after transfer. Methods The study took place at the Hospital of the University of Pennsylvania from October 2018 to October 2020. A standardized five-step transfer process was created and implemented for transferring patients from the neuro-ICU to a lower level of care. Patient care providers completed a survey before and after implementation of the protocol to assess a variety of components related to safety concerns when transferring patients. The rate of bouncebacks pre and post intervention was calculated by using a two-sample Wilcoxon rank-sum test, and disposition at discharge was calculated by using Fisher’s exact test. Results Of the 1176 total patient transfers out of the neuro-ICU, 29 patients bounced back within 48 h. The average age of patients who bounced back was 63.3 years old, with a similar distribution among men and women. The most common reason for bounceback was respiratory distress, followed by cardiac arrhythmia, stroke, and sepsis. Implementation of the standardized process led to a decrease in provider-rated concern of overall safety (5 to 3, p = 0.008). There was improvement in transfer delays due to bed availability (3 to 4.5, p = 0.020), identification of high-risk patients (5 to 6, p = 0.021), patient assignment to the appropriate level of care (5 to 6, p = 0.019), and use of the electronic medical record handoff indicator (5 to 6, p = 0.003). There was no statistically significant difference in terms of patient bounceback rate after implementation of the process (2.4% vs. 2.5%, p = 1.00) or patient disposition at discharge (p = 0.553). Conclusions Patients who bounceback to the neuro-ICU within 48 h had an increased length of hospital stay, had an increased length of ICU stay, and were more likely to be intubated for more than 96 h. Implementation of a standardized five-step transfer process from the neuro-ICU to a lower level of care resulted in improvement in multiple provider-rated safety outcomes and identification of high-risk patients but led to no difference in the patient bounceback rate or patient disposition at discharge. Supplementary Information The online version contains supplementary material available at 10.1007/s12028-021-01385-z.

Background: Clinical features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection seem to differ in children compared to that in adults. It has been hypothesized that the lower clinical severity in children could be influenced by differential expression of the main host functional receptor to SARS-CoV-2, the angiotensin-converting enzyme 2 (ACE2), but data are still conflicting. To explore the origin of age-dependent clinical features of coronavirus disease 2019 (COVID-19), we comparatively evaluated the expression in children and adult subjects of the most relevant mediators of the SARS-CoV-2 infection: ACE2, angiotensin-converting enzyme 1 (ACE1), transmembrane serine protease-2 (TMPRSS2), and neuropilin-1 (NRP1), at upper respiratory tract and small intestine level.Methods: The expression of ACE2, ACE1, TMPRSS2, and NRP1 in nasal epithelium and in small intestine epithelium was investigated by quantitative real-time PCR analysis.Results: We found no differences in ACE2, ACE1, and TMPRSS2 expression in the nasal epithelium comparing children and adult subjects. In contrast, nasal epithelium NRP1 expression was lower in children compared to that in adults. Intestinal ACE2 expression was higher in children compared to that in adults, whereas intestinal ACE1 expression was higher in adults. Intestinal TMPRSS2 and NRP1 expression was similar comparing children and adult subjects.Conclusions: The lower severity of SARS-CoV-2 infection observed in children may be due to a different expression of nasal NRP1, that promotes the virus interaction with ACE2. However, the common findings of intestinal symptoms in children could be due to a higher expression of ACE2 at this level. The insights from these data will be useful in determining the treatment policies and preventive measures for COVID-19.

Background: In accordance with the scientific literature heavy alcohol consumption (>50g per day) represents a risk factor for several diseases development, including cancer. However, the oncogenic role of light alcohol drinking ( Objective: To assess the scientific knowledge about light alcohol consumption and the risk of malignancy onset. Methods: To collect the scientific evidences regarding this topic the keywords “light alcohol drinking”, “light alcohol consumption” and “cancer”, were used. Papers published during the last 15 years were analyzed, in order to select the most recent evidence. Meta-analyses with well-defined levels of alcohol intake were included in the present review. Other studies that focused on biochemical, molecular and genetic aspects, as well as duplicate articles, were excluded. : Furthermore, a possible protective role of light alcohol consumption on the development of bladder, kidney and ovarian cancer and Non Hodgkin Lymphoma was observed. Results: Twenty-nine large, meta-analyses were included in this review. Light alcohol drinking was not associated with an increased risk of cancer occurrence, with the exception of breast and prostate cancer and melanoma. Conclusion: Light alcohol drinking was not associated with the development of several malignancies, except for a light increase of melanoma, breast cancer in women and prostate cancer in men.

BACKGROUND: The SARS-CoV-2 lockdown resulted in deep changes of lifestyles, promoting in many people the onset of psychological symptoms generally associated with drug and alcohol abuse. The aim was to assess the variation of alcohol drinking habits in a sample of Italian citizens during lockdown and to identify the psychosocial factors surrounding it. METHODS: An online anonymous questionnaire was created and submitted from 9th April 2020 to 28th April 2020. Questions were related to personal psychosocial details and alcohol drinking habits during the lockdown, including Alcohol Use Disorders Identification Test (AUDIT C) questions. RESULTS: On a total of 1234 surveys the increase of both anxiety and fear was largely detected (63% and 61% respectively). The 18% increased alcohol consumption during the lockdown and it showed a significant correlation with anxiety and fear experienced (both p

Total and subtotal sternectomy oncological defects can result in large deficits in the chest wall, disrupting the biomechanics of respiration. Reviewing the current literature involving respiratory function and rib motion after sternectomy, autologous rigid reconstruction was determined to provide the optimal reconstructive option. We describe a novel technique for sternal defect reconstruction utilizing a double-barrel, longitudinally oriented, vascularized free fibula flap associated with rib titanium plates fixation. Our reconstructive approach was able to deliver a physiological reconstruction, providing rigid support and protection while allowing articulation with adjacent ribs and preservation of chest wall mechanics.

Eye movement detection has attracted increasing attention in the fields of safety driving, eye motion tracking, psychological assessment and telemedicine. Soft multi-functional electronic skin (SMFES) is designed to collect electrooculogram (EOG), skin temperature and sweat signals simultaneously for eye movement detection. Serpentine structure is adopted to ensure the stretchability of SMFES for satisfying large deformation ( > 30 % ) of the soft skin surface. The paper demonstrates that EOG, skin temperature and sweat signals are successfully collected under different eye movements. The feature data from EOG, skin temperature and sweat signals are extracted with different eye movements, and the principal component analysis (PCA) method is adopted to reduce the dimensionality of the feature space. The paper also proposes an intelligent data fusion algorithm for eye movement classification whose input vector is represented by the first three principal components. Adaptive neuro fuzzy inference system (ANFIS) is built to classify and recognize the eye movements (Up, Down, Left, and Right). Furthermore, experiments have demonstrated that ANFIS algorithm achieves 90% recognition accuracy of such eye movements. This work demonstrates that SMFES integrated with data fusion algorithm can successfully solve the eye movement tracking problem, with significant impact in safety driving and wearable electronics.

No robust evidence is provided by literature regarding the management of intracranial hypertension following severe traumatic brain injury (TBI). This is mostly due to the lack of prospective randomized controlled trials (RCTs), the presence of studies containing extreme heterogeneously collected populations and controversial considerations about chosen outcome. A scientific society should provide guidelines for care management and scientific support for those areas for which evidence-based medicine has not been identified. However, RCTs in severe TBI have failed to establish intervention effectiveness, arising the need to make greater use of tools such as Consensus Conferences between experts, which have the advantage of providing recommendations based on experience, on the analysis of updated literature data and on the direct comparison of different logistic realities. The Italian scientific societies should provide guidelines following the national laws ruling the best medical practice. However, many limitations do not allow the collection of data supporting high levels of evidence for intracranial pressure (ICP) monitoring and decompressive craniectomy (DC) in patients with severe TBI. This intersociety document proposes best practice guidelines for this subsetting of patients to be adopted on a national Italian level, along with joint statements from "TBI Section" of the Italian Society of Neurosurgery (SINch) endorsed by the Neuroanesthesia and Neurocritical Care Study Group of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). Presented here is a recap of recommendations on management of ICP and DC supported a high level of available evidence and rate of agreement expressed by the assemblies during the more recent consensus conferences, where members of both groups have had a role of active participants and supporters. The listed recommendations have been sent to a panel of experts consisting of the 107 members of the "TBI Section" of the SINch and the 111 members of the Neuroanesthesia and Neurocritical Care Study Group of the SIAARTI. The aim of the survey was to test a preliminary evaluation of the grade of predictable future adherence of the recommendations following this intersociety proposal. The following recommendations are suggested as representing best clinical practice, nevertheless, adoption of local multidisciplinary protocols regarding thresholds of ICP values, drug therapies, hemostasis management and perioperative care of decompressed patients is strongly recommended to improve treatment efficiency, to increase the quality of data collection and to provide more powerful evidence with future studies. Thus, for this future perspective a rapid overview of the role of the multimodal neuromonitoring in the optimal severe TBI management is also provided in this document. It is reasonable to assume that the recommendations reported in this paper will in future be updated by new observations arising from future trials. They are not binding, and this document should be offered as a guidance for clinical practice through an intersociety agreement, taking in consideration the low level of evidence.

The GIM2 phase III trial demonstrated the benefit of dose-dense chemotherapy in node-positive early breast cancer (eBC). To better define the dose-dense effect in the hormone receptor-positive subgroup, we evaluated its benefit through a composite measure of recurrence risk. We conducted an ancillary analysis of the GIM2 trial evaluating the absolute treatment effect through a composite measure of recurrence risk (CPRS) in patients with hormone receptor-positive HER2-negative eBC. CPRS was estimated through Cox proportional hazards models applied to the different clinicopathological features. The treatment effect was compared to the values of CPRS by using the Sub-population Treatment Effect Pattern Plot (STEPP) process. The Disease-Free Survival (DFS)-oriented STEPP analysis showed distinct patterns of relative treatment effect with respect to CPRS. Overall, 5-year DFS differed across CPRS quartiles ranging from 95.2 to 66.4%. Each CPRS quartile was characterized by a different patients’ composition, especially for age, lymph node involvement, tumor size, estrogen and progesterone receptor expression, and Ki-67. A number needed to treat of 154 and 6 was associated with the lowest and the highest CPRS quartile, respectively. Dose-dense adjuvant chemotherapy showed a consistent benefit in node-positive eBC patients with hormone receptor-positive HER2-negative disease, but its effect varied according to CPRS.

The term Body Sensor Network (BSN) was introduced less than twenty years ago. Since then, tremendous technical development and social changes attracted researchers from very diverse fields allowing to establish an incredibly rich interdisciplinary ecosystem. Although many former challenges have been tackled by consolidated literature, still today new research opportunities stem from recent advancements in IoT, machine learning, communication technologies, bio-materials and microelectronics. This work has a twofold objective: on the one hand aims to briefly review the state-of-the-art on more consolidated BSN literature and on the other hand surveys recent advancements enabled by Edge computing, microelectronics and communication novelty. An analysis of success stories of wearable devices, emerging real-world applications, and most recent research frontiers in the BSN domain complete the survey.

Ricardo Augusto Paletta Guedes,1 Daniela Marcelo Gravina,1 Vanessa Maria Paletta Guedes,1 Alfredo Chaoubah2 1Glaucoma Department, Paletta Guedes Eye Institute, Juiz de Fora, MG, Brazil; 2Statistics Department, Federal University of Juiz De Fora, Juiz de Fora, MG, BrazilCorrespondence: Ricardo Augusto Paletta GuedesGlaucoma Department, Paletta Guedes Eye Institute, 79, Oscar Vidal streeet, Juiz de Fora, MG, 36010-060, BrazilTel: +55 32 3213-1927Email palettaguedes@yahoo.comIntroduction: This retrospective comparative study assessed real-world effectiveness and safety of first-generation (iStent®) and second-generation (iStent inject®) trabecular micro-bypass stents with cataract surgery in patients with open-angle glaucoma (OAG).Material and Methods: Through a 24-month postoperative follow-up, the effectiveness was quantified by intraocular pressure (IOP) reduction; mean glaucoma medication reduction; proportional analysis of eyes meeting IOP cutoffs (< 18, < 15, < 12 mmHg) either with or without medications; and proportional analysis of medication burden. Safety measures included visual acuity, adverse events, and secondary surgery.Results: A total of 82 consecutive eyes (39 iStent, 43 iStent inject) with a 24-month follow-up were analyzed. Most eyes (74.4%) had primary open-angle glaucoma, with the remainder having pseudoexfoliative or pigmentary glaucoma; all eyes had mild-to-moderate disease. At 24 months postoperative, the mean IOP was lower, and the percent reduction from baseline was greater, in iStent inject eyes (26.0% reduction, 17.7mmHg to 13.1mmHg) than in iStent eyes (9.8% reduction, 16.4mmHg to 14.8mmHg) (between-groups comparison, p=0.019). Within each group, the postoperative IOP reduction was greater in eyes with higher baseline IOP (p< 0.001). Medication burden decreased significantly in both groups, from 1.74 to 0.51 mean medications for iStent (70.7% reduction, p< 0.0001), and 2.19 to 0.65 for iStent inject (70.3% reduction, p< 0.0001). Both groups exhibited excellent safety.Conclusion: iStent or iStent inject with phacoemulsification produced significant IOP and medication reductions, with effects enduring for two years. IOP reductions were greater for iStent inject than for iStent. Within each group, higher preoperative IOP was associated with greater postoperative IOP reduction.Keywords: iStent, iStent inject, trabecular micro-bypass, micro-invasive, MIGS

Fear of falling (FOF) has important clinical and psychological consequences. This study evaluated the factors associated with FOF in hemodialysis patients and compared with the FOF reported by age–gender matched individuals without chronic kidney disease. This cross sectional study included hemodialysis group (n = 60, 55.4 ± 7.6 years, 55.0% male) and control group (n = 40, 55.1 ± 7.5 years, 52.5% male). FOF was assessed by the Falls Efficacy Scale International (FES-I). Physical function was evaluated using the Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go test, 4-m gait speed, isometric handgrip force and 10-repetition sit-to-stand test. The physical and mental components of quality of life was evaluated by 36-Item Short Form Health Survey. The FES-I score was higher in the hemodialysis group compared to the control group (28.2 ± 9.7 vs. 23.3 ± 5.1, p = 0.020). In addition, the prevalence of individuals with a higher concern about falling was greater in the hemodialysis group (41.7 vs. 17.5%, p = 0.033). Multiple linear regression showed that the FES-I score was associated with the Mini-BESTest score and the physical component summary of quality of life (coefficient of determination of 0.51 and an adjusted coefficient of determination of 0.46). FOF was associated with poor postural balance and reduced physical component of quality of life in patients on hemodialysis and these patients showed higher FOF compared to individuals without chronic kidney disease.

Introduction Rapid palatal expansion is a common therapy during orthodontic treatment and could be a preliminary step for correcting different malocclusions; furthermore, this treatment could be necessary at any age. Different anchorage approaches have been proposed to obtain an effective skeletal result, although every device produces both dental and skeletal effects. This study aimed to compare the dentoskeletal effects of a bone-borne palatal expander considering 2 groups of patients of different ages. Methods Twenty-four patients consecutively treated were included in the study; patients were divided into 2 groups according to their age: group 1 with age ≤16 years and group 2 patients >16 years. All patients had a preexpansion cone-beam computed tomography scan; a second scan was required at the end of activations. All patients received a bone-borne appliance anchored on 4 miniscrews. Results Significant intragroup differences were found for maxillary width and dental diameters. No significant differences were found between groups with regard to longitudinal changes, except for the maxillary right plane. Conclusions The use of bone-borne maxillary expansion was effective in generating palatal widening both in growing and young adult patients. No significant skeletal or dental differences were found between groups.

Anthropogenic impacts on Posidonia oceanica meadows have led to a decline of this ecosystem throughout the Mediterranean. Transplantations have often been prescribed as a compensation measure to mitigate the impacts caused by coastal maritime works. Here a Q methodology approach was used to investigate the stakeholders’ attitudes in four case studies of P. oceanica transplants realized in Italian waters. Twenty-two respondents were asked to score 37 statements, and the resultant Q-sorting was analyzed via an inverse PCA using the KADE software. Four discourses, corresponding to the significant axes in the factorial analysis were identified: science and conservation (F1), oriented at a rigorous scientific approach, engineering and industry (F2), oriented at the economic development, environmentalism and participation (F3), oriented at the conservation of seagrass meadows, and transplantation-oriented (F4), oriented at the realization of transplants as compensation measures. The main conflicts and agreements between discourses are assessed and discussed, based on the analysis of the distinguishing statements that contributed to consensus or disagreement among discourses. The benefits of the Q methodology in the identification and mediation of conflicts in the four case studies are discussed, and its potential as a powerful aid in the development of a good environmental governance is acknowledged.

The rigid-frame bridges with a fully continuous moment connection between the superstructure and substructure piers are suitable for high-seismic regions; however, research on the response of these...

Efforts have been made to determine new predictors of morbidity and mortality in patients with severe burn injuries. This prospective cohort study aimed to determine the association of serum albumin concentration on admission and renal failure, pulmonary infection, sepsis, and death in patients with burn injuries. We included 141 patients, aged >18 years, who were admitted to our institution between April and August 2018. Among them, 59.1% were male and 83.8% had burns covering 2.2 g/dL (odds ratios [OR]: 18.7; 95% confidence interval [CI]: 4.9 to 70.8). Serum albumin ≤2.2 g/dL was also significantly associated with pulmonary infection (OR: 13.1, 95% CI: 3.8 to 45.7), renal failure (OR: 30.2, 95% CI: 7.4 to 122.3), and sepsis (OR: 16.9, 95% CI: 4.9 to 58.3). Serum albumin concentration cut-points and ABSIs were determined to be death predictors using areas under the receiver operating characteristic curves (AUCs). The AUCs with albumin or ABSI alone were 0.89 (95% CI: 0.79 to 0.98) and 0.92 (95% CI: 0.87 to 0.96), respectively. The AUC including both albumin and ABSI was 0.96 (95% CI: 0.90 to 0.98), indicating that the combination is a better death predictor than either measure alone. We confirmed that burn patients with a serum albumin concentration ≤2.2 g/dL on admission have substantially increased morbidity and mortality.

The ever-growing aging of the population has emphasized the importance of in-home AAL (Ambient Assisted Living) services for monitoring and improving its well-being and health, especially in the context of care facilities (retirement villages, clinics, senior neighborhood, etc). The paper proposes a novel simulation-driven platform named E-ALPHA (Edge-based Assisted Living Platform for Home cAre) which supports both Edge and Cloud Computing paradigm to develop innovative AAL services in scenarios of different scales. E-ALPHA flexibly combines Edge, Cloud or Edge/Cloud deployments, supports different communication protocols, and fosters the interoperability with other IoT platforms. Moreover, the simulation-based design helps in preliminary assessing (i) the expected performance of the service to be deployed according to the infrastructural characteristics of each specific small, medium and large scenario; and (ii) the most appropriate applications/platform configuration for a real deployment (kind and number of involved devices, Edge- or Cloud-based deployment, required connectivity type, etc). In this direction, two different use cases modeled according to realistic input (coming from past experience involving real testbed) are shown in order to demonstrate the potentials of the proposed simulation-driven AAL platform.

Rasopathies are a group of phenotypically overlapping conditions that include Noonan, Noonan with multiple lentigines, Noonan with loose anagen hair, Costello, Cardio-facio-cutaneous, and Neurofibromatosis-Noonan syndromes. Noonan syndrome with loose anagen hair (NS-LAH) is clinically characterized by prominent forehead, macrocephaly, growth hormone deficiency, sparse, loose and slow-growing anagen hair, hyperpigmented skin with eczema or ichthyosis, mild psychomotor delays, hypernasal voices, and attention deficit hyperactivity disorder. Variants in SHOC2 are responsible for the majority of the cases. Gripp et al. identified four unrelated individuals with similar phenotype to NS-LAH with pathogenic variants in PPP1CB. In this study, we present one family and one patient with NS-LAH and variants in PPP1CB. The first patient belongs to a family with a likely pathogenic variant, c.545T>A (p.Met182Lys), the first family published so far with a variant in this gene. The second patient harbors a de novo pathogenic variant, c.146C>G (p.Pro49Arg). This study presents two additional patients with this rare syndrome in order to increase the clinical characterization of the syndrome and provide more evidence of the pathogenicity of the c.545T>A (p.Met182Lys) variant in PPP1CB, a gene recently associated with NS-LAH.

The new concept of renewable energy communities introduced by the Revised European Directive on the promotion of renewable sources (2018/2001) has opened new possibilities for microgrids. In fact, it permits to enhance the value of the energy produced by renewable sources sharing it inside an “energy community” and to increase the social welfare. In this article, the authors investigated about the actual legislation framework on energy communities at the European and Italian level, highlighting regulatory problems and barriers that are delaying their constitutions. The authors propose a “power sharing model” (PSM), which is useful for energy communities based on the sharing of renewables and other energy services. The PSM is suitable for both the building level and larger communities. PSM has been analyzed through a case study that regards the preliminary study of a smart microgrid that should be realized in Campobasso, Italy, to connect buildings of the public administration. This scenario was investigated through a simulation conducted in Simulink environment where the control strategy was implemented, and the results were compared to a traditional configuration for renewable sources integration. The results highlight the adequacy of PSM for the energy community for the building's microgrids application.

Introduction: The immunosuppressive efficiency obtained in the last decades in kidney transplantation significantly improved graft survival. However, there is still a high risk and incidence of cancer in transplant patients strongly and directly related to the type of immunosuppression. An increasing body of evidence suggests that the PI3K/Akt/mTOR pathway may play a pivotal role in the development and progression of several neoplastic diseases. Case Presentation: We describe a 47-year-old male patient who received a cadaveric primary renal transplant in November 2008 developing a poorly differentiated infiltrating and ulcerated squamous cell carcinoma (SCC) at the eye level. In this patient, the modification of an immunosuppressive regimen with introduction of rapamycin (mTOR) inhibitors and withdrawal of calcineurin inhibitors (CNIs) led to the resolution of this severe condition. Conclusion: The introduction of mTOR inhibitors and withdrawal of CNIs in kidney-transplanted patients with de novo eye SCC should be considered in this clinical setting.

Background Complex elbow injuries (CEIs) are severe and rare lesions, difficult to treat correctly due to the different patterns of clinical presentations. Standard methods cannot often be applied. The main goals of the treatment are performing a stable osteosynthesis of all fractures, obtaining a concentric and stable reduction of the elbow by repairing the soft tissue constraint lesions, and allowing early motion. Since the introduction of virtual reality (VR) approaches in clinical practice, three-dimensional (3D) computed tomography (CT) and 3D printing have revolutionised orthopaedic surgeries, thus helping to understand the anatomy and the pathology of complex cases. Case description We discussed a case of CEI, characterised by an extended soft tissue (IIIB Gustilo classification) and neurovascular lesions associated with bone loss in a young female patient. Olecranon fracture was type IIIB according to Mayo classification. We outlined the steps of a pluri-tissue reconstructive approach and stressed the importance of 3D printing in the preoperative planning for such cases. Finally, peculiar final functional patient outcomes were reported. Conclusion In this case, we found out that triceps reinsertion and scar process may provide for the joint stability in a low-demanding patient. 3D printing and VR approaches in clinical practice can be useful in the management of CEIs associated with an important bone and soft tissue loss. How to cite this article Facco G, Politano R, Marchesini A, et al. A Peculiar Case of Open Complex Elbow Injury with Critical Bone Loss, Triceps Reinsertion, and Scar Tissue might Provide for Elbow Stability? Strategies Trauma Limb Reconstr 2021;16(1):53–59.

Artículo escrito por un elevado número de autores, solo se referencian el que aparece en primer lugar, el nombre del grupo de colaboración, si le hubiere, y los autores pertenecientes a la UAM, Background: There has been resurgence in the use of bismuth quadruple therapy (proton pump inhibitor, bismuth, tetracycline and metronidazole) for treating Helicobacter pylori infection thanks to a three-in-one single-capsule formulation. Objective: To evaluate the effectiveness and safety of the single-capsule bismuth quadruple therapy. Methods: Data were collected in a multicentre, prospective registry of the clinical practice of gastroenterologists on the management of H. pylori infection, where patients were registered at the Asociación Española de Gastroenterologia REDCap database on an electronic case report form until January 2020. Effectiveness by modified intention-to-treat and per-protocol as well as multivariable analysis were performed. Independent factors evaluated were: age, gender, indication, compliance, proton pump inhibitor dose and treatment line. Results: Finally, 2100 patients were prescribed single-capsule bismuth quadruple therapy following the technical sheet (i.e., three capsules every 6 h for 10 days). The majority of these patients were naive (64%), with an average age of 50 years, 64% women and 16% with peptic ulcer. An overall modified intention-to-treat effectiveness of 92% was achieved. Eradication was over 90% in first-line treatment (95% modified intention-to-treat, n = 1166), and this was maintained as a rescue therapy, both in second (89% modified intention-to-treat, n = 375) and subsequent lines of therapy (third to sixth line: 92% modified intention-to-treat, n = 236). Compliance was the factor most closely associated with treatment effectiveness. Adverse events were generally mild to moderate, and 3% of patients reported a severe adverse event, leading to discontinuation of treatment in 1.7% of cases. Conclusions: Single-capsule bismuth quadruple therapy achieved H. pylori eradication in approximately 90% of patients in real-world clinical practice, both as a first-line and rescue treatment, with good compliance and a favourable safety profile, The author(s) would like to thank the Spanish Association of Gastroenterology (AEG) for providing the electronic case report form service free of charge. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was promoted and funded by the European Helicobacterand Microbiota Study Group, and received support from the Spanish Association of Gastroenterology (AEG) and the Centro de Investigación Biomedica en Red de Enfermedades Hepaticas y Digestivas

Background: Bismuth quadruple (BQT) and non-bismuth quadruple (N-BQT) therapies are the recommended first-line treatments for Helicobacter (H.) pylori infection. Objective: To compare the efficacy of BQT and N-BQT in clinical practice in an area with high clarithromycin resistance, choosing the regimen on the basis of previous exposure to clarithromycin. Methods: A total of 404 consecutive Hpylori-positive, naïve patients were enrolled. A total of 203 patients without previous exposure to clarithromycin received N-BQT, 100 patients for 10days and 103 for 14days, whereas 201 with previous exposure to clarithromycin received 10-day BQT. Efficacy and treatment-related adverse events were assessed. Results and Conclusions: Eradication rates by intention-to-treat analysis were 88.2% for N-BQT and 91.5% for BQT (P=.26); per-protocol analysis eradication rates were 91.2% and 95.8% for N-BQT and BQT, respectively (P=.07). Eradication rates were significantly higher with 14-day than 10-day CT (P&nbsp

Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by neoplastic transformation of pluripotent cells due to a typical cytogenetic and molecular mutation known as Philadelphia (Ph) chromosome. In 2001, the introduction of the tyrosine kinasis inhibitor (TKI) imatinib as a therapeutic strategy for CML with PH chromosome mutation represented an important step towards treatment of these patients, and nowadays, this drug represents the gold therapeutic standard in this clinical setting. A second generation of TKIs (dasatinib, nilotinib, and bosutinib) showed an effective action in all patients with mutations resistant to imatinib. Ponatinib is a third-generation TKI and is the only inhibitor with activity against T3151 mutation. The impact of ponatinib on cardiovascular events was first evaluated in the PACE trial. We therefore report and discuss most relevant evidence currently available on cardiovascular events associated with the use of ponatinib. Though many exams can be used for diagnosis and follow-up of this kind of cardiotoxicity, echocardiography seems to have a pivotal role thanks to its feasibility, availability, and low cost.

Nowadays, the nonalcoholic fatty liver disease represents the main chronic liver disease in the Western countries, and the correct medical therapy remains a big question for the scientific community. The aim of our study was to evaluate the effect derived from the administration for six months of silybin with vitamin D and vitamin E (RealSIL 100D®) on metabolic markers, oxidative stress, endothelial dysfunction, and worsening of disease markers in nonalcoholic fatty liver disease patients. We enrolled 90 consecutive patients with histological diagnosis of nonalcoholic fatty liver disease and 60 patients with diagnosis of reflux disease (not in therapy) as healthy controls. The nonalcoholic fatty liver disease patients were randomized into two groups: treated (60 patients) and not treated (30 patients). We performed a nutritional assessment and evaluated clinical parameters, routine home tests, the homeostatic model assessment of insulin resistance, NAFLD fibrosis score and fibrosis-4, transient elastography and controlled attenuation parameter, thiobarbituric acid reactive substances, tumor necrosis factor α, transforming growth factor β, interleukin-18 and interleukin-22, matrix metalloproteinase 2, epidermal growth factor receptor, insulin growth factor-II, cluster of differentiation-44, high mobility group box-1, and Endocan. Compared to the healthy controls, the nonalcoholic fatty liver disease patients had statistically significant differences for almost all parameters evaluated at baseline (p<0.05). Six months after the baseline, the proportion of nonalcoholic fatty liver disease patients treated that underwent a statistically significant improvement in metabolic markers, oxidative stress, endothelial dysfunction, and worsening of disease was greater than not treated nonalcoholic fatty liver disease patients (p<0.05). Even more relevant results were obtained for the same parameters by analyzing patients with a concomitant diagnosis of metabolic syndrome (p<0.001). The benefit that derives from the use of RealSIL 100D could derive from the action on more systems able to advance the pathology above all in that subset of patients suffering from concomitant metabolic syndrome.

Background: SMA1 natural history is characterized by early development of chronic respiratory failure. Respiratory interventions in type 1 SMA infants are subject to great practice variability. Nusinersen, has been recently approved in Argentina. The advent of novel treatments has highlighted the need for natural history studies reporting disease progression in type 1 SMA. Objective: To analyze the progression, respiratory interventions and survival based on the type of respiratory support in type 1SMA patients, in a third level pediatric hospital in Argentina. Methods: Cohort of SMA1 patients followed at the Interdisciplinary Program for the Study and Care of Neuromuscular Patients (IPNM). Patient survival was analyzed by using the Kaplan-Meier method. Log-rank test was performed to compare the survival curve for three respiratory intervention groups. Results: 59 patients. Mean age of symptom onset was 2.19 (±1.4) months, age at diagnosis was 3.9 (±2.1) months. Patients developed respiratory failure at 5.82 months (±2.32) and 13.8 months (±5.6) in Type 1B and Type 1C, respectively (p

PRECIS An older age, a low number of baseline glaucoma medications, an early glaucoma stage, lower intraocular pressure (IOP) values during the first postoperative month, and combined surgery are possible predictors of unqualified success after a trabecular by-pass microinvasive glaucoma surgery (MIGS) procedure. PURPOSE The purpose of this study was to identify the potential predictors of unqualified success (IOP

Outflow tract (OT) premature ventricular contractions (PVCs) are commonly found in clinical practice; in most cases, PVCs are benign and observed in structurally normal hearts, not requiring any therapeutic intervention. In this study, we therefore sought to evaluate with cardiac magnetic resonance (CMR) patients with PVC and apparently normal heart at echocardiographic examination, in order to identify possible substrates linked with higher prevalence of arrhythmias or structural heart disease. Thirty-three consecutive patients with frequent PVCs originating from the ventricular OT (right and left) were enrolled in the study and assessed by echocardiography and CMR. All patients had normal baseline electrocardiogram. CMR showed structural changes in 5 patients out of 33; in 3 cases, areas of fibrosis limited in one case to the middle basal segments of the interventricular septum and in two patients to the middle basal segments of the inferior-lateral wall were found. In 2 other cases, however, late gadolinium enhancement showed significant anomalies characterized in one patient by extensive areas of subepicardial fibrosis of the left ventricle, suitable with arrhythmogenic left dominant dysplasia; in another patient, a marked trabeculation of left ventricular medium apical segments suitable with non-compaction myocardium was present. CMR may identify cases of structural heart disease in subjects with OT PVCs and apparently normal electrocardiogram and echocardiogram examinations. A preliminary screening with CMR may be considered before any further invasive electrophysiology assessment and therapeutic planning.

Over the years, reviews in behavior analysis have sought to identify the most prolific researchers and institutions. The goal of these reviews was to offer one resource for behavior analysts to ide...

Erythropoietin-producing hepatocellular receptors (Eph) promote the onset and sustain the progression of cancers such as colorectal cancer (CRC), in which the A2 subtype of Eph receptor expression has been shown to correlate with a poor prognosis and has been identified as a promising therapeutic target. Herein, we investigated, in vitro and in vivo, the effects of treatment with GLPG1790, a potent pan-Eph inhibitor. The small molecule has selective activity against the EphA2 isoform in human HCT116 and HCT15 CRC cell lines expressing a constitutively active form of RAS concurrently with a wild-type or mutant form of p53, respectively. GLPG1790 reduced EPHA2 phosphorylation/activation and induced G1/S cell-cycle growth arrest by downregulating the expression of cyclin E and PCNA, while upregulating p21Waf1/Cip1 and p27Cip/Kip. The inhibition of ephrin signaling induced quiescence in HCT15 and senescence in HCT116 cells. While investigating the role of CRC-related, pro-oncogenic p53 and RAS pathways, we found that GLPG1790 upregulated p53 expression and that silencing p53 or inhibiting RAS (human rat sarcoma)/ERKs (extracellular signal-regulated kinase) signaling restrained the ability of GLPG1790 to induce senescence in HCT116 cells. On the other hand, HCT15 silencing of p53 predisposed cells to GLPG1790-induced senescence, whilst no effects of ERK inhibition were observed. Finally, GLPG1790 hindered the epithelial-mesenchymal transition, reduced the migratory capacities of CRC, and affected tumor formation in xenograft models in vivo more efficiently using HCT116 than HCT15 for xenografts. Taken together, our data suggest the therapeutic potential of GLPG1790 as a signal transduction-based therapeutic strategy in to treat CRC.

The incessant diffusion of smart wearable devices and Body Area Networks (BANs) systems is pushing more and more researches on human activity recognition. Previous studies usually adopted fixed time window or chose an optimal window size depending on the characteristics of the activity. In this paper, we propose an adaptive time window-based algorithm of activity recognition, which addresses the problem of different types of activities having different time duration that usually causes poor recognition results. Multivariate Gaussian Distribution (MGD) method was used to detect the signal difference between each determined time window and the defined activity characteristics, and we more accurately define the time window size for each activity. To evaluate the proposed algorithm, we focused on the activities performed by wheelchair users in their daily life, so as to provide them with better healthcare services. We construct two different datasets, respectively considering static and dynamic wheelchair user activities on different ground surfaces. Then, we use time window expansion and contraction method to determine and dynamically adjust the window size for each activity. Different comparison criteria such as recognition precision and F-score were used to evaluate our algorithm. Experiment results revealed that, according to F-score, the proposed algorithm performs 15.3% better than traditional methods in static conditions. In dynamic scenarios we observed 6.4% and 24.5% improvements on flat and rough floors, respectively.

The increasing scope of sensitive personal information that is collected and stored in wearable healthcare devices includes physical, physiological, and daily activities, which makes the security of these devices very essential. Gait-based identity recognition is an emerging technology, which is increasingly used for the access control of wearable devices, due to its outstanding performance. However, gait-based identity recognition of elderly users is more challenging than that of young adults, due to significant intra-subject gait fluctuation, which becomes more pronounced with user age. This study introduces a gait-based identity recognition method used for the access control of elderly people-centred wearable healthcare devices, which alleviates the intra-subject gait fluctuation problem and provides a significant recognition rate improvement, as compared to available methods. Firstly, a gait template synthesis method is proposed to reduce the intra-subject gait fluctuation of elderly users. Then, an arbitration-based score level fusion method is defined to improve the recognition accuracy. Finally, the proposed method feasibility is verified using a public dataset containing acceleration signals from three IMUs worn by 64 elderly users with the age range from 50 to 79 years. The experimental results obtained prove that the average recognition rate of the proposed method reaches 96.7%. This makes the proposed method quite lucrative for the robust gait-based identification of elderly users of wearable healthcare devices.

Clinical Practice Points • Metastatic colorectal cancer is one of the most common causes of cancer death worldwide. • Primary and acquired resistance mechanisms to anti-EGFR treatment are a challenging topic with several clinical implications. • Primary resistance is defined by the presence of activating mutations in BRAF and RAS genes before treatment initiation, while acquired resistance refers to the selection of pre-existing mutant clones or de novo acquisition of mutations under the pressure of anti EGFR treatment. • Testing mutations in RAS and BRAF genes as predictive biomarkers is mandatory. • Liquid biopsy has acquired growing importance and showed to be reliable when compared to tissue NGS. • Liquid biopsy offers a full overview of the genetic landscape of the disease, overcoming spatial and temporal heterogeneity, when compared to tissue biopsy. • Liquid biopsy can be used to capture the changes in biology of cancer cells under the selective pressure of targeted agents over time. • Using complementary techniques allows to increase the diagnostic power and the biological significance of the results.

Background and aim: Bismuth quadruple therapy (BQT) or non-bismuth quadruple therapy (i.e., concomitant therapy) (CT) is the first-line regimens to eradicate H. pylori infection in areas with high prevalence of clarithromycin (CLA) resistance. Guidelines suggest that in areas of high prevalence of H. pylori strains with double resistance (i.e., CLA + metronidazole), BQT should be preferred to CT. The aim of this study was to evaluate the efficacy and safety of BQT administered through the three-in-one pill (Pylera) formulation in a large series of H. pylori–infected patients, naive to treatment in a region with high CLA and dual resistance.Patients and methods: We treated 250 patients (148 F and 102 M, mean age 48.6 years) with H. pylori infection naïve to treatment. Patients received esomeprazole 40 mg bid and Pylera 3 tablets qid for 10 days. Diagnosis of H. pylori infection was through 13C urea breath test (13C UBT), or stool antigen test or histology, as appropriate. The evaluation of eradication was through 13C UBT at least 45 days after the end of therapy. Incidence of treatment-related adverse events (TRAEs) was assessed through a questionnaire at the end of treatment. Compliance was considered good if at least 90% of medication had been taken. Statistical analysis was per intention-to-treat e per protocol (PP). 95% confidence intervals (CIs) were calculated.Results: 1) 13 patients (5.2%) discontinued therapy due to side effects; 2) eradication rates in ITT and PP were 227/250 (90.8%; 95% CI 86.3–93.7%) and 226/237 (95.3%; 95% CI 91–99%), respectively; 3) the prevalence of TRAEs was 26.8%; and 4) adherence to treatment was good with compliance greater than 90%.Conclusion: In this real-life study, we demonstrate that in an area with a high prevalence of H. pylori strains with CLA or CLA + metronidazole resistance, BQT using Pylera is an effective therapeutic strategy with ITT eradication rates higher than 90%; this therapy is associated with good compliance and low incidence of side effects.

Lung ultrasound imaging is reaching growing interest from the scientific community. On one side, thanks to its harmlessness and high descriptive power, this kind of diagnostic imaging has been largely adopted in sensitive applications, like the diagnosis and follow-up of preterm newborns in neonatal intensive care units. On the other side, state-of-the-art image analysis and pattern recognition approaches have recently proven their ability to fully exploit the rich information contained in these data, making them attractive for the research community. In this work, we present a thorough analysis of recent deep learning networks and training strategies carried out on a vast and challenging multicenter dataset comprising 87 patients with different diseases and gestational ages. These approaches are employed to assess the lung respiratory status from ultrasound images and are evaluated against a reference marker. The conducted analysis sheds some light on this problem by showing the critical points that can mislead the training procedure and proposes some adaptations to the specific data and task. The achieved results sensibly outperform those obtained by a previous work, which is based on textural features, and narrow the gap with the visual score predicted by the human experts., Comment: 7 pages

In this paper, the different possibilities and innovations related to sustainable aquaculture in the Mediterranean area are discussed, while different maricultural methods, and the role of Integrated Multi-Trophic Aquaculture (IMTA) in supporting the exploitation of the ocean’s resources, are also reviewed. IMTA, and mariculture in general, when carefully planned, can be suitable for environmental restoration and conservation purposes. Aquaculture, especially mariculture, is a sector that is progressively increasing in parallel with the increase in human needs; however, several problems still affect its development, mainly in relation to the choice of suitable sites, fodder production, and the impact on the surrounding environment. A current challenge that requires suitable solutions is the implementation of IMTA. Unfortunately, some criticisms still affect this approach, mostly concerning the commercialization of new products such as invertebrates and seaweeds, notwithstanding their environmentally friendly character. Regarding the location of a suitable site, mariculture plans are currently displaced from inshore to offshore, with the aim of reducing the competition for space with other human activities carried out within coastal waters. Moreover, in open water, waste loading does not appear to be a problem, but high-energy waters increase maintenance costs. Some suggestions are given for developing sustainable mariculture in the Mediterranean area, where IMTA is in its infancy and where the scarce nutrients that characterize offshore waters are not suitable for the farming of both filter feeder invertebrates and macroalgae. From the perspective of coupling mariculture activity with restoration ecology, the practices suggested in this review concern the implementation of inshore IMTA, creating artificially controlled gardens, as well as offshore mussel farming coupled with artificial reefs, while also hypothesizing the possibility of the use of artificially eutrophized areas.

Statins could increase the effectiveness of Helicobacter pylori eradication therapies due to their anti-inflammatory effect. The aim of this study was to analyze the impact of this therapeutic association in real life. This is a multicenter, prospective, non-interventional study aimed at evaluating the management of H. pylori by European gastroenterologists. Patients were registered in an e-CRF by AEG-REDCap from 2013 to 2020. The association between statin use and H. pylori eradication effectiveness was evaluated through multivariate analysis. Overall, 9988 and 705 patients received empirical and culture-guided treatment, respectively. Overall, statin use was associated with higher effectiveness in the empirical group (OR = 1.3, 95%CI = 1.1–1.5), but no association was found with first-line treatment effectiveness (N = 7738), as an exception, statin use was specifically associated with lower effectiveness of standard triple therapy (OR = 0.76, 95%CI = 0.59–0.99). In the rescue therapy empirical group (N = 2228), statins were associated with higher overall effectiveness (OR = 1.9, 95%CI = 1.4–2.6). However, sub-analyses by treatment schemes only confirmed this association for the single-capsule bismuth quadruple therapy (OR = 2.8, 95%CI = 1.3–5.7). No consistent association was found between statin use and H. pylori therapy effectiveness. Therefore, the addition of statins to the usual H. pylori treatment cannot be currently recommended to improve cure rates.

Background: Bacterial antibiotic resistance changes over time depending on multiple factors, therefore, it is essential to monitor the susceptibility trends to reduce the resistance impact on the effectiveness of various treatments. Objective: To conduct a time-trend analysis of Helicobacter pylori resistance to antibiotics in Europe. Methods: The international prospective European Registry on Helicobacter pylori Management (Hp-EuReg) collected data on all infected adult patients diagnosed with culture and antimicrobial susceptibility testing positive results that were registered at AEG-REDCap e-CRF until December 2020. Results: Overall, 41,562 patients were included in the Hp-EuReg. Culture and antimicrobial susceptibility testing were performed on gastric biopsies of 3974 (9.5%) patients, of whom 2852 (7%) were naive cases included for analysis. The number of positive cultures decreased by 35% from the period 2013–2016 to 2017–2020. Concerning naïve patients, no antibiotic resistance was found in 48% of the cases. The most frequent resistances were reported against metronidazole (30%), clarithromycin (25%), and levofloxacin (20%), whereas resistances to tetracycline and amoxicillin were below 1%. Dual and triple resistances were found in 13% and 6% of the cases, respectively. A decrease (p &lt, 0.001) in the metronidazole resistance rate was observed between the 2013–2016 (33%) and 2017–2020 (24%) periods. Conclusion: Culture and antimicrobial susceptibility testing for Helicobacter pylori are scarcely performed (&lt, 10%) in Europe. In naïve patients, Helicobacter pylori resistance to clarithromycin remained above 15% throughout the period 2013–2020 and resistance to levofloxacin, as well as dual or triple resistances, were high. A progressive decrease in metronidazole resistance was observed.

Glass fiber reinforced polymer (GFRP) is an effective alternative reinforcing solution to tackle problems associated with steel corrosion in reinforced concrete structures located in harsh environments. However, there are multiple construction challenges when cast-in-place GFRP reinforced concrete is used. Cast-in-place concrete is both labor and time intensive on account of timely assembly of falsework and formwork as well as pouring and curing of concrete. To avoid such challenges and accelerate the construction process , GFRP reinforced precast concrete elements can be used to avoid corrosion problems , improve the quality of the construction and reduce the associated risk and total cost. While GFRP reinforced precast concrete elements exhibit behavior comparable to those reinforced with steel, research on connections between precast elements is limited. This study aims to investigate the performance of bent cap connections for GFRP precast concrete elements for applications in bridge and jetty structures. An experimental investigation was designed and conducted on a large-scale concrete frame constructed out of GFRP reinforced precast concrete elements with four different types of pocketless connections. The effectiveness of using epoxy resin rather than conventional cement grout to accelerate the construction process was investigated. Also investigated were the effect of pre-stressing, the number of connecting reinforcement elements, and the type of reinforcement (i.e. bars and bolts). The frame was subjected to cyclic lateral loading and was tested in two stages. Results and discussion on the general behavior, failure modes, energy dissipation , damping ratio and ductility were presented. The results of the pocketless test frame were also compared with a similar frame tested previously by the same research group where pocket connections were used to transfer moment between the beam and column members. The results showed that using connecting bars/bolts in pocketless connections outperform the behavior of pocket connections. This study concluded that avoiding pockets and providing the integrity of the beam-column joint through bolt/bar connection can improve the general performance of the beam-column connection compared to connections with pockets. This method also increases the speed of construction and simplifies the manufacturing procedure.

Various bi-directional associations exist between oral health and gastro-intestinal diseases. The oral microbiome plays a role in the gastro-intestinal carcinogenesis and fusobacteria are the most investigated bacteria involved. This paper aims to review the current knowledge and report the preliminary data on salivary levels of Fusobacterium nucleatum, Porphyromonas gingivalis and Candida albicans in subjects with different gastro-intestinal conditions or pathologies, in order to determine any differences. The null hypothesis was “subjects with different gastro-intestinal diseases do not show significant differences in the composition of the oral microbiota”. Twenty-one subjects undergoing esophagastroduodenoscopy or colonscopy were recruited. For each subject, a salivary sample was collected before the endoscopy procedure, immediately stored at −20 °C and subsequently used for genomic bacterial DNA extraction by real-time PCR. Low levels of F. nucleatum and P. gingivalis were peculiar in the oral microbiota in subjects affected by Helicobater pylori-negative chronic gastritis without cancerization and future studies will elucidate this association. The level of C. albicans did not statistically differ among groups. This preliminary study could be used in the future, following further investigation, as a non-invasive method for the search of gastrointestinal diseases and associated markers.

Metabolic- (dysfunction) associated fatty liver disease (MAFLD) represents the predominant hepatopathy and one of the most important systemic, metabolic-related disorders all over the world associated with severe medical and socio-economic repercussions due to its growing prevalence, clinical course (steatohepatitis and/or hepatocellular-carcinoma), and related extra-hepatic comorbidities. To date, no specific medications for the treatment of this condition exist, and the most valid recommendation for patients remains lifestyle change. MAFLD has been associated with metabolic syndrome; its development and progression are widely influenced by the interplay between genetic, environmental, and nutritional factors. Nutrigenetics and nutrigenomics findings suggest nutrition’s capability, by acting on the individual genetic background and modifying the specific epigenetic expression as well, to influence patients’ clinical outcome. Besides, immunity response is emerging as pivotal in this multifactorial scenario, suggesting the interaction between diet, genetics, and immunity as another tangled network that needs to be explored. The present review describes the genetic background contribution to MAFLD onset and worsening, its possibility to be influenced by nutritional habits, and the interplay between nutrients and immunity as one of the most promising research fields of the future in this context.

With the growing number of digital medical imaging records, the need for an automatic procedure to retrieve only data of interest is of increasing importance. A Picture Archiving and Communication System (PACS) provides effective storage and retrieval based on TAGs but does not allow us for query by example. A possible solution is to use a Content-Based Image Retrieval (CBIR) system, namely a system able to retrieve images from a database based on the similarity to a given reference image. The features used to describe the images strongly affect both the performance and the applicability of CBIR to medical images, motivating for the finding of a suitable set of feature for realizing an effective CBIR based PACS. In recent years, Deep Learning (DL) approaches outperformed classical machine learning methods in many computer vision applications, thanks to their ability to learn compact hierarchical features of input data that well fit the specific task to solve. In this paper we introduce a simple yet effective modular architecture to implement a “Smart PACS”, namely a PACS exploiting a deep-based CBIR compatible with the classical Hospital Information System (HIS) infrastructure. The feature extraction relies on Convolutional Neural Networks, a DL approach commonly applied in image processing, while the image indexing and look-up are based on Apache Solr. As application case-study, we analysed the need for a physician to obtain all the images of past studies having similar traits with the patient under analysis.