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BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders during childhood, however the diagnosis procedure remains challenging as it is non-standardized, multi-parametric and highly dependent on subjective evaluation of the perceived behavior. OBJECTIVE To address the challenges of existing procedures for ADHD diagnosis, the ADHD360 project aims to develop a platform for (a) early detection of ADHD by assessing the user’s likelihood of having ADHD characteristics and (b) providing complementary training for ADHD management. METHODS A two-phase pilot study was designed to evaluate the ADHD360 platform, including ADHD and non-ADHD participants aged 7-16 years. Machine Learning methods were used to detect discriminative gameplay patterns among the two groups (ADHD, non-ADHD) and estimate a player’s likelihood of having ADHD characteristics. RESULTS A preliminary analysis of collected data showed that the trained models achieve high performance in correctly predicting a user’s label (ADHD or non-ADHD) from his gameplay session in the ADHD360 platform. CONCLUSIONS ADHD360 is characterized by notable capacity to discriminate player gameplay behavior as either ADHD or non-ADHD. Therefore, the ADHD360 platform could be a valuable complementary tool for early ADHD detection. CLINICALTRIAL ClinicalTrials.gov NCT04362982

Multiple myeloma is a clonal proliferation of the plasma cell line that accounts for approximately 10% of all hematological malignancies. It is characterized by abnormal growth of plasma cells producing monoclonal immunoglobulin or light chain (paraprotein), with subsequent development of osteolytic bone lesions, anemia, hypercalcemia, and renal failure. In 3-6% of myeloma patients, more than one monoclonal protein (usually two) is discovered, with different heavy or light chain or both. These additional monoclonal proteins may be identified at the time of diagnosis or appear later during an observation or therapy. The authors describe two patients with biclonal myeloma, one diagnosed during evaluation for newly discovered renal failure, and one identified in the course of treatment of monoclonal gammopathy. The discussion of the diagnosis, natural history, and prognosis in patients with biclonal myeloma are also reported.

Cheese whey exploitation in a biorefinery manner is proposed involving anaerobic acidogenesis by a UASB mixed anaerobic culture and alcoholic fermentation by kefir. Both cultures were immobilized on γ-alumina. The produced organic acids (OAs) and ethanol could be esterified to obtain a novel ester-based biofuel similar to biodiesel. During acidogenesis, lactic acid-type fermentation occurred leading to 12 g L −1 total OAs and 0.2 g L −1 ethanol. The fermented substrate was subsequently supplied to a second bioreactor with immobilized kefir, which increased the OAs content (15 g L −1 ), especially lactic acid, and slightly the ethanol concentration (0.3–0.4 g L −1 ). To further increase ethanol concentration, a second experiment was conducted supplying whey firstly to the immobilized kefir bioreactor and then pumping the effluent into the acidogenesis bioreactor, resulting in 40% increase of OAs and 10-fold higher ethanol content. The residual sugar was ∼50% of the initial whey lactose; consequently, future research could result to further increase of ethanol and OAs.

Spacing between the maxillary anterior teeth is a common concern for young patients and their parents. Patients often consider a diastema to be an annoying but minor problem; they might consult their general dentists for help, or try to address the issue themselves by applying elastic "gap bands." Moreover, parents, without any informed consent, sometimes accept this erroneous method as an easy and inexpensive treatment approach. A 9-year-old boy had severe acute periodontitis involving the maxillary central incisors caused by the placement of an elastic band and its apical migration. Despite periodontal and surgical interventions, the maxillary central incisors were finally extracted, and the patient started orthodontic treatment. The orthodontic treatment plan included maxillary lateral incisor substitution to replace the lost central incisors and mesialization of the maxillary posterior dentition. An interdisciplinary approach with excellent cooperation among the orthodontist, general dentist, and other dental specialists obtained an esthetically pleasing and optimized functional result. Treating the diastema between the anterior teeth with elastic gap bands and without fixed orthodontic appliances should be avoided. Patients should seek proper orthodontic advice for even small-scale orthodontic problems to prevent catastrophic outcomes, as exhibited in this case report.

The aim of this systematic review was to assess the effect of systematic extraction protocols during orthodontic fixed appliance treatment on the soft tissue profile of human patients. Nine databases were searched until December 2016 for controlled clinical studies including premolar extraction or nonextraction treatment. After elimination of duplicate studies, data extraction, and risk-of-bias assessment according to the Cochrane guidelines, random-effects meta-analyses of mean differences (MD) or standardized mean differences (SMD) and their 95% CIs were performed, followed by subgroup, meta-regression, and sensitivity analyses. Extraction treatment was associated with increased lower lip retraction (24 studies; 1,456 patients; MD = 1.96 mm), upper lip retraction (21 studies; 1,149 patients; MD = 1.26 mm), nasolabial angle (21 studies; 1,089 patients; MD = 4.21°), soft-tissue profile convexity (six studies; 408 patients; MD = 1.24°), and profile pleasantness (three studies; 249 patients; SMD = 0.41). Patient age, extraction protocol, and amount of upper incisor retraction during treatment were significantly associated with the observed extraction effects, while the quality of evidence was very low in all cases due to risk of bias, baseline confounding, inconsistency, and imprecision. Although tooth extractions seem to affect patient profile, existing studies are heterogenous and no consistent predictions of profile response can be made.

AimsAccumulating evidence suggests idiopathic recurrent pericarditis as a disease of probable autoinflammatory origin, and thus anakinra could be of benefit. The goal of this systematic review was to assess the efficacy and safety of anakinra in this context.MethodsReports relevant to anakinra administration in patients with idiopathic recurrent pericarditis published up to October 2014 were searched in several databases. All references found, upon initial assessment at title and abstract level for suitability, were consequently retrieved as full reports for further appraisal.ResultsAmong 12 citations retrieved, nine reports (four case series and five case reports with 34 patients, 20 men, mean age 26.8 years) were assessed. The mean disease duration was 31 months and the number of recurrences 8.2. Anakinra was generally administered as a daily subcutaneous injection of 100mg or as a mean dose of 1.1mg/kg/d in weight-adjusted regimens. The mean full-dose duration was 9.2 months. C-reactive protein normalized within 7.1 days, and steroids were withdrawn within 62 days. Dose tapering was adopted in 64.7% of patients, leading to recurrence in 26% of cases. In a 28.3-month follow-up, eight out of 34 patients (23.5%) were disease free without treatment, after having received anakinra for 10.4months overall. Anakinra was proved well tolerated, with mild local reaction being reported in 44% of patients.ConclusionAnakinra is a highly effective, rapidly acting, well tolerated and steroid-sparing agent. Recurrences after drug discontinuation are a matter of concern. Randomized trials are required to confirm these findings and address the most effective treatment protocol.

The object of the current study was to develop a new process for continuous Feta-type cheese production using a biocatalyst consisting of immobilized rennin on a tubular cellulose/starch gel (TC/SG) composite, which has been proven to be an appropriate carrier for enzyme immobilization. Different methodologies were used in order to prepare four biocatalysts. The most effective was selected for cheese production in a 1L continuous system, providing two economically useful results for the dairy industries: (i) increase of productivity by the continuous coagulation of milk, and (ii) saving of the rennin enzyme expenses of the batch coagulation of milk. The criteria used to choose the appropriate biocatalyst was based on the time of coagulation in successive batches, the concentration of immobilized rennin combined with the filter efficiency and its application in the continuous system. Physicochemical analyses of the cheeses at various stages of the ripening were performed. No significant differences compared to cheeses prepared with the traditional method were found. Aroma compounds were determined by SPME GC-MS.

Objective:Little is known regarding the clinical course and prognosis of resistant hypertension (RHT). We evaluated predictors of persistent RHT and the associated cardiovascular risk.Methods:We studied 1911 treated hypertensive patients (aged 5911 years, 49% men) for a mean period of 3.9 years. At baseline, clinical data were collected and patients underwent echocardiographic measurements, routine blood testing and additional workup for exclusion of secondary causes of RHT (office-based uncontrolled hypertension under at least three drugs including a diuretic or controlled hypertension under four or more drugs). Endpoint of interest was the composite of coronary artery disease and stroke.Main results:Four groups were identified depending on presence or absence of RHT at baseline and follow-up: 1153 patients (60%) never having RHT, 189 (10%) with resolved RHT, 204 (11%) with incident RHT and 365 (19%) with persistent RHT. Two-thirds of the patients with RHT at baseline remained resistant at the end of the study. Independent variables associated with both incident and persistent RHT were diabetes mellitus, history of cardiovascular disease, hypertension duration, SBP, left ventricular hypertrophy and glomerular filtration rate. Persistent RHT compared with never-having RHT was associated with a 2.2-fold increased risk for cardiovascular morbidity (95% CI: 1.21-4.05, P=0.01) after adjustment for risk factors.Conclusion:In treated hypertensive patients, among prospective RHT dynamic patterns, persistent RHT is frequent and independently associated with adverse cardiovascular prognosis.