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We aimed to predict antipsychotic prescription patterns for people with schizophrenia using machine learning (ML) algorithms.In a cross-sectional design, a sample of community mental health service users (SUs; n = 368) with a primary diagnosis of schizophrenia was randomly selected. Socio-demographic and clinical features, including the number, total dose, and route of administration of the antipsychotic treatment were recorded. Information about the number and the length of psychiatric hospitalization was retrieved. Ordinary Least Square (OLS) regression and ML algorithms (i.e., random forest [RF], supported vector machine, K-nearest neighborhood, and Naïve Bayes) were used to estimate the predictors of total antipsychotic dosage and prescription of antipsychotic polytherapy (APP).The strongest predictor of the total dose was APP. The number of Community Mental Health Centers (CMHC) contacts was the most important predictor of APP and, with APP omitted, of dosage. Treatment with anticholinergics predicted APP, emphasizing the strong correlation between APP and higher antipsychotic dose. RF performed better than OLS regression and the other ML algorithms in predicting both antipsychotic dose (root square mean error = 0.70, R2 = 0.31) and APP (area under the receiving operator curve = 0.66, true positive rate = 0.41, and true negative rate = 0.78).APP is associated with the prescription of higher total doses of antipsychotics. Frequent attenders at CMHCs, and SUs recently hospitalized are often treated with APP and higher doses of antipsychotics. Future prospective studies incorporating standardized clinical assessments for both psychopathological severity and treatment efficacy are needed to confirm these findings.

International audience; This article presents a procedure for optimizing the charge comparison method (CCM) used for pulse shape discrimination (PSD). Without prior knowledge of the signals or the readout system, our procedure automatically optimizes the integration periods maximizing the discrimination ability of the radiation detector. This procedure is innovative in its adaptability and automation without being complicated to implement on a standard computer. Another advantage of this approach is the possibility to use it even if the operation of the readout system and the recording process of the signal is not fully known. Therefore, it enables all detection systems generating signals whose temporal evolution depends on the origin to optimize the integration periods of the CCM. Our procedure is based on verifying that two criteria are met in terms of the number of components and the correlation of Gaussian fits made on the distribution of the tail-to-total integral resulting from the CCM. We tested the procedure for different application cases. First, the optimization of the integration periods of the CCM was performed for the discrimination between fast neutrons and gamma rays with a plastic scintillator and a silicon photomultiplier (SiPM) in the energy range [250 keVee; 4.5 MeVee]. The integration periods, from the laboratory's experience with photomultiplier tubes (PMTs) and plastic scintillators, gave a Figure of Merit (FoM) of 0.58 corresponding to a rejection ratio (RR) of 8.6%. The procedure improved the FoM up to 0.88 corresponding to a RR of 1.9%. We also applied the procedure to the discrimination between beta and gamma rays with a PMT and a phoswich organic detector and to the discrimination between signals collected from neutrons or partial discharges within a fission chamber.

Background: N-methyl-glycine (sarcosine) may improve symptoms of schizophrenia via NMDA-receptor modulation. We undertook a systematic review and meta-analysis to determine the short- and long-term effectiveness of sarcosine for schizophrenia. Research design and methods: The databases Medline, Scopus, EMBASE, Cochrane Library, and PsycINFO were searched. We included six independent randomized controlled trials of sarcosine as add-on treatment to current antipsychotic medication, involving 234 adult participants with schizophrenia, and reporting data on symptom severity. Standardized mean differences (SMDs) were used to assess continuous outcomes. Results: In all of the trials, sarcosine was administered orally at 2 g/day. Treatment with sarcosine did not show a significant effect size at any of the pre-established time points (2, 4, 6, or >6 weeks), due to marked quantitative heterogeneity. However, sarcosine was associated with significant reductions of symptom severity in the subgroups of people with chronic schizophrenia and no treatment resistance (namely, without added-on clozapine) in relation to the SMD after 6 weeks treatment at −0.36 and −0.31, respectively. Conclusions: People with chronic and non-refractory schizophrenia may benefit from the use of sarcosine as an add-on treatment to antipsychotic medication. Due to the good tolerability of this compound, future trials with larger sample sizes appear worthwhile.

Rosaria Di Lorenzo,1 Giulio Cabri,2 Eleonora Carretti,3 Giacomo Galli,4 Nina Giambalvo,4 Giulia Rioli,4 Serena Saraceni,4 Giulia Spiga,4 Cinzia Del Giovane,5 Paola Ferri6 1Mental Health Department, Service of Psychiatric Diagnosis andTreatment in NOCSAE General Hospital, 2Private Accredited Psychiatric Hospital villa Igea, Modena, 3Nursing Home of Rubiera, Reggio Emilia, 4Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, 5PhD Statistics Unit, Department of Diagnostic, Clinical and Public Health Medicine, 6Department of Diagnostic, Clinical and Public Health Medicine, Universityof Modena and Reggio Emilia, Modena, Italy Purpose: To investigate the perception of dignity among patients hospitalized in a psychiatric setting using the Patient Dignity Inventory (PDI), which had been first validated in oncologic field among terminally ill patients. Patients and methods: After having modified two items, we administered the Italian version of PDI to all patients hospitalized in a public psychiatric ward (Service of Psychiatric Diagnosis and Treatment of a northern Italian town), who provided their consent and completed it at discharge, from October 21, 2015 to May 31, 2016. We excluded minors and patients with moderate/severe dementia, with poor knowledge of Italian language, who completed PDI in previous hospitalizations and/or were hospitalized for 1 (Kaiser’s criterion), which explained>80% of total variance with good internal consistency: 1) “Loss of self-identity and social role”, 2)“Anxiety and uncertainty for future” and 3) “Loss of personal autonomy”. The PDI and the three-factor scores were statistically significantly positively correlated with the Hamilton Scales for Depression and Anxiety but not with other scale scores. Conclusion: Our preliminary research suggests that PDI can be a reliable tool to assess patients’ dignity perception in a psychiatric setting, until now little investigated, helping professionals to improve quality of care and patients to accept treatments. Keywords: dignity experience, Patient Dignity Inventory, patients hospitalized in a psychiatric ward, factor analysis, validation study, dignity distress measurement

International audience; Xenon high temperature fission chamber, designed for sodium-cooled fast reactors, unlike the argon filled fission chambers, can operate at temperatures greater than 500◦C without partial-discharges and discriminate neutrons and partial-discharges at temperatures up to 650◦C.

Paschen’s law gives the inception voltage for an electrical discharge as a function of the product of gas pressure and the gap distance between the two infinite planar electrodes. It is known that the deviations from Paschen’s law occur when the temperature is increased. Historically, two theoretical corrections, the Peek and Dumbar corrections, are proposed to predict the deviation from Paschen’s law by increasing the temperature. To carry out an experimental investigation on the deviation from Paschen’s law by increasing the temperature, a customized system was designed, which can operate at temperatures up to 400 °C and at pressure up to 1 MPa, calculated at room temperature, with an interelectrode distance between $100~\mu \text{m}$ and 6.6 mm and an error on the interelectrode distance measurement of $20~\mu \text{m}$ . In this paper, first, the results from the experimental investigation on the deviation from Paschen’s law at temperature up to 400 °C are presented. The results are then compared with theoretical corrections, and finally, a theory to explain the results is proposed and discussed.

During the operation of the Superphenix and Phenix reactors, an aberrant electrical signal was detected from the fission chambers used for neutron flux monitoring. This signal, thought to be due to partial electrical discharge (PD) is similar to the signal resulting from neutron interactions, and is generated in fission chambers at temperatures above 400 °C. This paper reports work on the characterization and localization of the source of this electrical signal in a High Temperature Fission Chamber (HTFC). The relation between the shape of the PD signal and various parameters (nature and pressure of the chamber filling gas, electrode gap distance, and fission chamber geometry) are first described. Next, experiments designed to identify the location within the chambers where the PD are being generated are presented. After verification and refinement of the results of these localization studies, it should be possible to propose changes to the fission chamber in order to reduce or eliminate the PD signal.

Paschen's law gives the discharge inception voltage as a function of the product of gas pressure and the gap distance between two infinite planar electrodes. It is known that deviations from Paschen's law occur when temperature is increased.

Hybrid energy systems are an interesting solution for the electrification of remote, off-grid users, which usually are obligated to satisfy their electricity demand by means of quite old technologies, like for example diesel generators. An energy mix including also renewable energy sources (such as wind and PV) would lead to a reduction of supply costs and is therefore being increasingly appreciated. In the present study, a sizing strategy was developed based on a long-term energy production cost analysis, able to predict the optimum configuration of a hybrid PV-wind-diesel stand-alone system. With respect to conventional practical design approaches already available in the literature, a more realistic description of the problem was here provided, since the present analysis relies in the use of actual machines data, realistic system constraints and cost functions, which led to the identification of some trends that are usually neglected by the optimization processes using continuous variables for the power outputs of renewable energy sources. The approach was tested on an isolated mountain chalet in Italian Alps. The hybrid system was optimized based on the maximum long-term saving with respect to a conventional diesel engine configuration. The results for this case study showed that the optimal solution was not that including the maximum allowed contribution from renewables, highlighting the existence of an optimized energy mix between the three sources. Accumulation batteries were also able to induce a reduction of both the fuel consumption and the engine transitory usage. According to the present results, a properly sized hybrid system could provide notable money and pollution savings for a remote consumer with respect to a diesel-only configuration.

International audience; Under given temperature and bias voltage conditions, partial discharges can create pulses in fission chambers. Based on experimental results, this phenomenon is in-depth investigated and discussed. A pulse-shape-analysis technique is proposed to discriminate neutron-induced pulses from partial-discharge-induced ones.

Purpose To assess the long-term incidence of febrile urinary tract infection (fUTI) in children treated by endoscopic injection of dextranomer/hyaluronic acid (DxHA) for vesicoureteral reflux (VUR). Materials and methods Prospective study from January 2002 to December 2009 in children treated at our institution for VUR by endoscopic injection of DxHA. All children underwent clinical and renal/bladder ultrasound follow up at 3 months after procedure, then annually. Post-operative voiding cystourethrogram (VCUG) control was performed only for patients with recurrent fUTI. Results 227 children (177 female) were included. Mean patient age at inclusion was 4.7 years. The mean duration of follow-up was 51.6 months. During follow-up, 18.9% had one or several fUTIs, of whom 48.8% had VUR at VCUG. No recurrence of fUTI was observed after 4 years of follow-up. We identified three risk factors for fUTI recurrence: cystitis cystica at the time of injection (p = 0.007), preoperative renal scarring (p = 0.018), and the disappearance of the implant at 3-month follow-up ultrasound (p = 0.037). Conclusions The long-term incidence of recurrent fUTI after endoscopic treatment of VUR is low. Our data show that the clinical results of endoscopic treatment should be interpreted with a follow up of at least 4 years.

IntroductionGrowing evidence has been collected over the complex, intertwined pathophysiological connection among subclinical cardiovascular (CV) disease, i.e. atherosclerosis, systemic low pro-inflammatory states and psychiatric disorders/symptomatology (anxiety, depression), with controversial results.AimAim of this study was to investigate the possible link between subclinical CV risk factors (atherosclerosis), depressive symptoms, and inflammation.MethodsCross-sectional study. Inclusion criteria: outpatients aged ≥40 years, attending colonoscopy after positive faecal occult blood test, negative medical history for cancer. Collected data: blood pressure, glycaemia, lipid profile, waist circumference, BMI, PCR (C reactive protein), LPS (bacterial lipopolysaccharide), ultrasound carotid intima-media thickness (c-IMT). Psychometric tests: HADS, TCI, IMSA, SF36. Statistical analysis performed with STATA13.ResultsThe 54 patients enrolled were equally distributed by gender. CV risk factors were common in the study population, with 33 patients (61.11%) with hypertension, 14 (25.93%) with hyperglycaemia, 20 (37.4%) with hypertriglyceridemia, 19 (35.19%) with low HDL and 64.81% with overweight. High levels of PCR were found in 24 subjects (44.44%). Right c-IMT was increased in 26.41% of the sample, and 11.32% had an atheromatous plaque. Left c-IMT was increased in 24.53% of patients, with a plaque in 7.55% of them. Clinically relevant depressive symptoms were found in the 18.87% of the sample and were statistically significantly associated with PCR (OR = 28.63; P = 0.01).ConclusionsEvidence contributing to the so-called “inflammation theory” of depression and supporting the association between mood and CV disorders was here collected, supporting the need for a multidisciplinary approach to the diagnosis and treatment of such conditions, assuming a clinically-translated PNEI (psycho-neuro-endocrino-immunological) perspective.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionMetabolic syndrome (MetS) is defined by metabolic and cardio-vascular impairments and is frequently associated with anxiety and depressive disorders. Both MetS and anxiety-depressive syndromes feature similar systemic inflammatory alterations. Inflammation of the large bowel is also a key factor for the development of colorectal cancer (CRC).ObjectiveTo measure the prevalence of MetS and symptoms of anxiety and depression among patients undergoing colonoscopy.MethodsCross-sectional study. Patients undergoing colonoscopy aged 40 or more, with negative history for neoplasia or inflammatory bowel disease, were enrolled. Data collected: colonoscopy outcome, presence/absence of MetS (IDF and ATP III criteria), presence/absence of depressive and anxiety symptoms assessed with HADS.ResultsThe sample was made up of 53 patients (female 24, 45.3%). Mean age was 60.66 ± 9.08. At least one adenoma was found to 23 patients (43.3%). Prevalence of MetS ranged from 34% to 36% (ATP III and IDF criteria, respectively). Prevalence of depressive and anxiety symptoms was 20% and 33%, respectively.ConclusionPrevalence of MetS, anxiety and depressive symptoms among patients undergoing colonoscopy was higher than in the general population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionAnxiety disorders and Cardiovascular (CV) diseases, among the most common disorders in Western World, are often comorbid. A chronic systemic inflammatory state might be a shared underlining pathophysiological mechanism.AimsTo investigate the association between anxiety symptoms, CV risks factors and inflammatory markers in an outpatient sample.MethodsCross-sectional study. Inclusion criteria: outpatients aged ≥40 years, attending colonoscopy after positive faecal occult blood test, negative medical history for cancer. Collected data: blood pressure, glycaemia, lipid profile, waist circumference, BMI, PCR (C Reactive Protein), LPS (bacterial Lipopolysaccharide). Psychometric tests: HADS, TCI, IMSA, SF36. Statistical analysis performed with STATA13.ResultsFifty four patients enrolled (27 males, 27 females). Sixteen patients (30.19%) were positive for anxiety symptoms. Thirty-three patients (61.11%) had hypertension, 14 (25.93%) hyperglycaemia and 64.81% were overweight, with frank obesity (BMI≥ 30) in 11 subjects (20.37%). Anxiety symptoms were associated with low hematic HDL values (OR = 0.01; P = 0.01) and high concentration of triglycerides (OR = 0.023; P = 0.02) at the multiple regression model. At the univariate logistic analysis, anxiety was associated with LPS (OR = 1.06; P = 0.04).ConclusionsFurther evidence over the epidemiological link between common mental disorders and CV diseases was collected, with possible hints on pathophysiology and causative mechanisms related to inflammation. The importance of screening for anxiety and depression in medical populations is confirmed. Suggestions on future availability of screening tools based on inflammatory-related indicators should be the focus of future research.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Congenital paraspinal arteriovenous fistulae are rare and usually diagnosed after neurologic or cardiovascular manifestations. They may be discovered unexpectedly in children during clinical examination, which reveals the presence of a vascular murmur. The association with multicystic kidney is exceptional. We report 1 case with thoracic localization of a congenital paraspinal arteriovenous fistula associated with a multicystic kidney in a 3-year-old boy who was treated by endovascular embolization.

IntroductionPro-inflammatory states of the large bowel have a multifactorial aetiology, including metabolism, atherogenesis, and psychological determinants. Inflammation plays a role in depressive and anxiety disorders, is tightly associated with early pro-atherogenetic alterations and metabolic dysregulation, and is also a key factor for the development of colorectal cancer.AimTo investigate the association between pro-atherogenetic factors, metabolic status, psychological assessment and presence of colorectal adenomas.MethodsCase-control study, approved by the local Ethic Committee. Patients aged 40 or more and undergoing colonoscopy for positive faecal blood test and/or abdominal symptoms, with a negative history for neoplasia or inflammatory bowel diseases, were enrolled. For each patient the following data were collected: waist and hip circumferences, BMI, arterial pressure, fasten serum glycemia, current medications. Beside colonoscopy, carotid intima-media thickness (IMT) was assessed by means of echographic evaluation. Psychometric assessment included HADS, TCI, IMSA, SF-36. Statistics performed with SigmaPlot v.12 Platform.ResultsPreliminary results are available for 18 patients (male/female 8/10) Mean age 62.6 ± 8.4. Ten patients had at least one adenoma, 8 patients had no lesions. The following differences were noticeable: HADS-depression (mean ± SD) adenoma vs. no-adenoma: 4.9 ± 3.2 vs. 1.7 ± 1.8 (P < .01); IMT median value adenoma vs. no-adenoma: 793 vs. 638 micrometers (P = .04); Body weight (mean ± SD) adenoma vs. no-adenoma: 66.4 ± 8.7 kg vs. 80.9 ± 15.3 kg (P = .03); waist circumference (mean ± SD) adenoma vs. no-adenoma: 105.2 ± 13.4 cm vs. 89.5 ± 4.7 cm (P < .01).ConclusionsPreliminary data from PNEI-MO Research Group support the relation between systemic inflammation, psychological status and development of precancerous colorectal cancer lesions. Depression seems associated with the presence of colorectal adenomas.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Neoplastic invasion of the inferior vena cava due to renal tumors (especially Wilms' tumor) is uncommon in children. The tumor thrombus, according to the aggressiveness of the original neoplasm, can extend in diverse ways, obliterate the vascular lumen completely, and even reach the right atrium. The luminal thrombus might be accompanied by the involvement of the caval wall, which requires wide vascular resection. The purpose of this paper is to present our experience with 7 children, aged 18 months and 6 years, affected by caval invasion due to Wilms' tumor. Furthermore, the diagnostic techniques and the surgical treatment in simple caval thrombosis and in associated invasion of the caval wall are described.

Congenital paraspinal arteriovenous fistulae are rare and usually diagnosed after neurologic or cardiovascular manifestations. They may be discovered unexpectedly in children during clinical examination, which reveals the presence of a vascular murmur. The association with multicystic kidney is exceptional. We report 1 case with thoracic localization of a congenital paraspinal arteriovenous fistula associated with a multicystic kidney in a 3-year-old boy who was treated by endovascular embolization.

Adrenocortical tumors in children are extremely rare, accounting only for 0.3-0.4% of all neoplasms in this age. Most frequently they secrete hormones, resulting in virilization, Cushing's syndrome or feminization, while the non-functioning ones are unusual. The authors describe 12 cases observed in 13 years (1976-1989), with a mean age of 5 years. 9 cases showed virilization, 4 presented with Cushing's syndrome and in 5 patients an abdominal mass was palpable. One case was affected by Beckwith-Wiedemann's syndrome. I.V. urography was performed in 8 patients, arteriography in 4 and since 1982 all patients were submitted to abdominal sonography and CT scan or MR imaging. Urinary 17-ketosteroids, 17-hydroxycorticoids and serum testosterone and cortisol were tested in all children. Dexamethasone suppression test was performed in 7. All patients were treated with surgery which seems to be the most suitable treatment, while the real effectiveness of treatment by drug therapy with suppressors of steroidogenesis is not confirmed in children. Histopathological examination showed typical features of adenoma in 5 cases, of adenocarcinoma in 4, while three cases revealed border line forms classified as "atypical adenomas". At the moment 10 patients are alive with a follow-up ranging from 18 months to 14 years, while 2 children with adenocarcinoma are dead.

Fetus in fetu, or parasitic twin, is an uncommon condition in which a malformed fetus grows within the body of its twin. It is almost always detected as an abdominal mass in infancy: 41 cases have been reported since 1806 and 89% of the patients were less than 1 year old. We have reviewed the literature and report three new cases from our own experience. All patients available were considered from the point of view of their clinical findings, preoperative diagnosis, surgical and anatomic-histological aspects. We also suggest the possibility of including those cases otherwise defined as teratomas with a high grade of structural complexity (limbs, well formed organs, or parts of systems) in this pathological group even if they do not show a real vertebral column according to Willis' definition.

Two cases of multicystic mesenchymal hamartoma of the liver in children are described. In both cases noninvasive imaging techniques (ultrasound, CT or MR, radionuclide scan) showed a bulky cystic mass suggesting a correct preoperative diagnosis, while selective arteriography defined the operability of the tumor.