Search

Background: In the region of Piedmont, in Northern Italy, formal monitoring of antimicrobial stewardship (AMS) programs has been in place since 2012. The objective of our study was to provide an updated assessment of AMS programs operating in our region, and to assess the impact of the COVID-19 pandemic on stewardship activities. Methods: A retrospective observational study was conducted to investigate AMS programs implemented in acute-care trusts participating in a broader healthcare-associated infections and antimicrobial resistance (AMR) prevention and control program, promoted by the regional health department. Within this program, structure, process, and outcome indicators of AMS programs were investigated, using a previously developed scoring system. Differences between scores prior to (2019) and during the pandemic (2021) were assessed. Linear regression was used to assess whether the 5-year trends (2017–2021) in outcome measures in relation to structure and process scores were statistically significant. Compound annual growth rates (CAGR) for each outcome were calculated to illustrate changes in outcome rates over time. Results: All public trusts in the Region (20) and a small number of private institutions (3) provided data for this study. A modest, non-significant improvement was found for 2021 structure, process, and total scores compared to respective 2019 scores. A significant improvement was found concerning the definition of a formal mission statement, whereas significantly less trusts included monitoring adherence to antimicrobial policy or treatment guidelines in their programs. Overall consumption of antibiotics for systemic use saw an increase in 2021, with 2021 recording the highest median overall consumption compared to all previous years considered in this study. Methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant enterobacteria (CRE) rates decreased over the 5-year period. Significant downwards trends in MRSA rates were identified for high-outlier structure and process groups. Conclusions: Results of this study suggest AMS programs in Piedmont were not set back following the pandemic. This outcome was possible thanks to well-established programs, coordinated within a regional framework. Continued efforts should be dedicated to supporting AMS programs and contrasting AMR, even when the focus is shifted towards other public health emergencies. [ABSTRACT FROM AUTHOR]

Background: In November 2022, Italy participated in the third edition of the European Centre for disease prevention and control (ECDC) point prevalence survey (PPS) of healthcare-associated infections (HAIs) in acute-care hospitals. A questionnaire based on the WHO infection prevention and control assessment framework (IPCAF) was included, which aims to investigate multimodal strategies for the implementation of IPC interventions. Methods: A PPS was conducted using the ECDC PPS protocol version 6.0. The Regional health authority of the region of Piedmont, in north-western Italy, chose to enlist all public acute-care hospitals. Data were collected within one day per each ward, within 3 weeks in each hospital, at hospital, ward and patient level. A score between 0–1 or 0–2 was assigned to each of the 9 items in the IPCAF questionnaire, with 14 points representing the best possible score. HAI prevalence was calculated at the hospital-level as the percentage of patients with at least one HAI over all included patients. Relations between HAI prevalence, IPCAF score, and other hospital-level variables were assessed using Spearman's Rho coefficient. Results: In total, 42 acute-care hospitals of the region of Piedmont were involved, with a total of 6865 included patients. All participant hospitals reported they employed multimodal strategies to implement IPC interventions. The median IPCAF overall score was 11/14 (interquartile range, IQR: 9.25–12). The multimodal strategy with the highest level of adherence was education and training, followed by communication and reminders. Strategies with the lowest level of adherence were safety climate and culture of change, and system change. Overall HAI prevalence was 8.06%. A weak to moderate inverse relation was found between IPCAF score and HAI prevalence (Spearman's Rho -0.340, p 0.034). No other significant correlation was found. Conclusions: This study found a high self-reported overall level of implementation of multimodal strategies for IPC in the region. Results of this study suggest the relevance of the multimodal approach and the validity of the IPCAF score in measuring IPC programs, in terms of effectiveness of preventing HAI transmission. [ABSTRACT FROM AUTHOR]

Passive acoustics are widely used to monitor the presence of dolphins in the marine environment. This study aims to introduce a low-cost and homemade approach for assembling a complete underwater microphone (i.e., the hydrophone), employing cheap and easy to obtain components. The hydrophone was assembled with two piezo disks connected in a balanced configuration and encased in a plastic container filled with plastic foam. The hydrophone's performance was validated by direct comparison with the commercially available AS-1 hydrophone (Aquarian Hydrophones, Anacortes, U.S.) on different underwater acoustic signals: artificial acoustic signals (ramp and multitone signals) and various dolphin vocalizations (whistle, echolocation clicks, and burst pulse signals). The sensitivity of the device's performance to changes in the emission source position was also tested. The results of the validation procedure on both artificial signals and real dolphin vocalizations showed that the significant cost savings associated with cheap technology had a minimal effect on the recording device's performance within the frequency range of 0–35 kHz. At this stage of experimentation, the global cost of the hydrophone could be estimated at a few euros, making it extremely price competitive when compared to more expensive commercially available models. In the future, this effective and low-cost technology would allow for continuous monitoring of the presence of free-ranging dolphins, significantly lowering the total cost of autonomous monitoring systems. This would permit broadening the monitored areas and creating a network of recorders, thus improving the acquisition of data. [ABSTRACT FROM AUTHOR]

Background: Muscle co-contraction plays a significant role in motion control. Available detection methods typically only provide information in the time domain. The current investigation proposed a novel approach for muscle co-contraction detection in the time–frequency domain, based on continuous wavelet transform (CWT). Methods: In the current study, the CWT-based cross-energy localization of two surface electromyographic (sEMG) signals in the time–frequency domain, i.e., the CWT coscalogram, was adopted for the first time to characterize muscular co-contraction activity. A CWT-based denoising procedure was applied for removing noise from the sEMG signals. Algorithm performances were checked on synthetic and real sEMG signals, stratified for signal-to-noise ratio (SNR), and then validated against an approach based on the acknowledged double-threshold statistical algorithm (DT). Results: The CWT approach provided an accurate prediction of co-contraction timing in simulated and real datasets, minimally affected by SNR variability. The novel contribution consisted of providing the frequency values of each muscle co-contraction detected in the time domain, allowing us to reveal a wide variability in the frequency content between subjects and within stride. Conclusions: The CWT approach represents a relevant improvement over state-of-the-art approaches that provide only a numerical co-contraction index or, at best, dynamic information in the time domain. The robustness of the methodology and the physiological reliability of the experimental results support the suitability of this approach for clinical applications. [ABSTRACT FROM AUTHOR]

Background: Muscular-activity timing is useful information that is extractable from surface EMG signals (sEMG). However, a reference method is not available yet. The aim of this study is to investigate the reliability of a novel machine-learning-based approach (DEMANN) in detecting the onset/offset timing of muscle activation from sEMG signals. Methods: A dataset of 2880 simulated sEMG signals, stratified for signal-to-noise ratio (SNR) and time support, was generated to train a hidden single-layer fully-connected neural network. DEMANN's performance was evaluated on simulated sEMG signals and two different datasets of real sEMG signals. DEMANN was validated against different reference algorithms, including the acknowledged double-threshold statistical algorithm (DT). Results: DEMANN provided a reliable prediction of muscle onset/offset in simulated and real sEMG signals, being minimally affected by SNR variability. When directly compared with state-of-the-art algorithms, DEMANN introduced relevant improvements in prediction performances. Conclusions: These outcomes support DEMANN's reliability in assessing onset/offset events in different motor tasks and the condition of signal quality (different SNR), improving reference-algorithm performances. Unlike other works, DEMANN's adopts a machine learning approach where a neural network is trained by only simulated sEMG signals, avoiding the possible complications and costs associated with a typical experimental procedure, making this approach suitable to clinical practice. [ABSTRACT FROM AUTHOR]

Machine-learning techniques are suitably employed for gait-event prediction from only surface electromyographic (sEMG) signals in control subjects during walking. Nevertheless, a reference approach is not available in cerebral-palsy hemiplegic children, likely due to the large variability of foot-floor contacts. This study is designed to investigate a machine-learning-based approach, specifically developed to binary classify gait events and to predict heel-strike (HS) and toe-off (TO) timing from sEMG signals in hemiplegic-child walking. To this objective, sEMG signals are acquired from five hemiplegic-leg muscles in nearly 2500 strides from 20 hemiplegic children, acknowledged as Winters’ group 1 and 2. sEMG signals, segmented in overlapping windows of 600 samples (pace = 5 samples), are used to train a multi-layer perceptron model. Intra-subject and inter-subject experimental settings are tested. The best-performing intra-subject approach is able to provide in the hemiplegic population a mean classification accuracy (±SD) of 0.97±0.01 and a suitable prediction of HS and TO events, in terms of average mean absolute error (MAE, 14.8±3.2 ms for HS and 17.6±4.2 ms for TO) and F1-score (0.95±0.03 for HS and 0.92±0.07 for TO). These results outperform previous sEMG-based attempts in cerebral-palsy populations and are comparable with outcomes achieved by reference approaches in control populations. In conclusion, the findings of the study prove the feasibility of neural networks in predicting the two main gait events using surface EMG signals, also in condition of high variability of the signal to predict as in hemiplegic cerebral palsy. [ABSTRACT FROM AUTHOR]

In this article, a self-contained procedure to estimate the vertical, medial–lateral, and anterior–posterior displacement of a single sacrum-worn inertial measurement unit (IMU) is presented, which can be related to the human body center of mass (CoM) displacement during treadmill walking through an adaptation of the sacral marker method. Furthermore, a magnetometer-free custom sensor-fusion algorithm for orientation estimation is proposed alongside a practical alignment procedure to refer relative IMU orientation estimation to a ground-fixed reference frame. Twelve healthy subjects performed two trials of treadmill walking at 3, 4, and 5 km/h for 150 s, with a sacrum-worn IMU. Orientation and displacement estimations were then compared with those obtained from an optoelectronic measurement system. Roll, pitch, and yaw angles showed root mean square error (RMSE) lower than 2° for walking trials at 3, 4, and 5 km/h, with Pearson’s correlation coefficient higher than 0.90 for each angle. Displacement accuracy was evaluated in terms of peak-to-trough distances and RMSE. Mean errors resulted lower than 1 mm for each axis of interest and for each gait speed, with RMSE not higher than 2.5 mm. The proposed off-line algorithm can be used in low-budget and infrastructure-free environments, to achieve reliable CoM displacement estimation during cyclic activities such as treadmill walking. [ABSTRACT FROM AUTHOR]

Denture stomatitis (DS) is an inflammatory status of oral mucosae frequently observed in denture wearers, and mainly associated with oral overgrowth of Candida albicans. DS is the cause of multiple visits to the dental office and is thought to enhance the risk of systemic infections. The treatment of DS mainly relies upon improvement of oral hygiene measures and prescription of topical or systemic antifungal agents, and disinfectants that, although effective, are not without drawbacks. Since, in recent years, some probiotics were investigated as a means to contrast oral colonization by Candida spp., this study was designed to preliminarily evaluate the effects of probiotic strain Streptococcus salivarius K12, in subjects affected by DS, and the duration of these effects. Fifty adult denture wearers affected by DS were enrolled and randomly divided into two groups: the experimental group was instructed to perform careful oral and denture hygiene and to assume the probiotic preparation for 30 days; the control group received only oral hygiene instructions. Patients were evaluated for signs of DS at the beginning of the study, at the end of treatment and 30 days later. Microbiological samples were obtained at the beginning of the study and at the end of treatment to quantify Candida albicans cells. Experimental treatment reduced clinical signs and symptoms of DS and the count of C. albicans. The clinical effects of experimental treatment were still evident after 30 days, suggesting that administration of probiotic strain Streptococcus salivarius K12 could be a promising approach in the treatment of DS. [ABSTRACT FROM AUTHOR]

The functional reach test (FRT) is widely used for assessing dynamic balance stability in elderly and pathological subjects. Force platforms (FPs) represent a fundamental part of the instrumented FRT experimental setup due to the central role of center-of-pressure (COP) displacement in FRT analysis. Recently, the nintendo wii balance board (NBB) has been suggested as a low-cost and reliable device for ground reaction force and COP measurement in poorly dynamic motor tasks. Therefore, this paper aimed to compare NBB-COP data with those obtained from a laboratory-grade platform during FRT. Data from 48 healthy subjects were simultaneously acquired from both devices. FP-COP and NBB-COP trajectories showed a remarkable correlation in both directions ( ${r}>\textsf {0.990}$ ) and low root-mean-square error values (1.14 ± 0.88 mm and 0.55 ± 0.28 mm for anterior–posterior and medial–lateral direction). Fixed biases between COP-based parameters did not exceed 2% of the FP outcomes with high consistency throughout the present measurement range (ICC consistency always >0.950). Only the COP mean velocity exhibited a tendency toward proportional errors, which can be adjusted by a calibration of NBB data. Findings of this paper confirmed the NBB validity for COP measurement in a widely used motor task as the functional reach, supporting the feasibility of NBB in research scenarios. [ABSTRACT FROM AUTHOR]

The use of anaesthetic drugs in the treatment of oral aphthosis is one of the pharmaceutical possibilities that a doctor can use for the most painful forms. Normally, Lidocaine or Diclofenac is used to treat this disease, but they can be used for a very limited time and so they are of little practical use. In this study, the authors have used Ropivacaine whose pharmaceutical kinetics allows the analgesic effect to be active for 60 to 90 minutes. In our research, we compared 8 groups of patients who have been given 3 principal pharmaceutical products: one group was given an anaesthetic drug, one had a topical medication administered which is often used for the treatment of aphthous lesions, and the last group was given a multivitamin. These pharmaceutical products were used alone and in various possible combinations in the 8 groups. The results of this study are very interesting and show that in all the groups that used anaesthetics there was more satisfaction on the patients' part because their pain level became more manageable right after the first application of the drug and the patients could carry on with their normal lives. [ABSTRACT FROM AUTHOR]

Background: Urban dwellers represent half the world's population and are increasing worldwide. Their health and behaviours are affected by the built environment and green areas may play a major role in promoting physical activity, thus decreasing the burden of chronic diseases, overweight and inactivity. However, the availability of green areas may not guarantee healthy levels of physical activity among the urban dwellers. It is therefore necessary to study how the perceived characteristics of green areas affect physical activity. Methods: Data from the EURO-URHIS 2 survey of residents of 13 cities across the UK were analyzed and a multivariable model was created in order to assess the association between their perceptions of the green areas in their neighbourhood and their engagement in physical activity. Results were adjusted for age, gender and other potential confounders. Results: Those who felt unable to engage in active recreational activities in their local green spaces were significantly less likely to carry out moderate physical exercise for at least 60 min per week (adjusted OR: 0.50; 95% 0.37-0.68). Availability of green areas within walking distance did not affect engagement in physical activity. Other characteristics such as accessibility and safety may play an important role. Conclusion: This study showed that the presence of green space may not itself encourage the necessary preventative health behaviours to tackle physical inactivity in urban populations. Development of more appropriate green spaces may be required. Further research is needed to shed light on the types green spaces that are most effective. [ABSTRACT FROM AUTHOR]

Background: Self-reported health status (SRHS) reflects an individual's perception of their social, biological and psychological health, and has been linked to increased mortality risk and increased use of health services. Having a psychological co-morbidity can reduce health outcomes and increase healthcare costs. This paper investigates the relationship between SRHS and signs of psychological distress (PD) in European urban settings. Methods: The study sample comprised 20 439 adult respondents to surveys conducted across 37 urban areas. Data on SRHS, signs of PD and potential confounders were analysed in a multivariable logistic regression. Results: After adjusting for potential confounders (gender, age, time lived in country and regularity of contact with family and friends), a significant association was found between PD and self-reported poor health for all urban areas, particularly in Western European countries (adjusted OR = 3.615, 95% CI: 3.333-3.920 P < 0.001). Time lived in country of residence, financial stability and regularity of contact with family and friends were negatively associated with signs of PD in the adjusted model. Conclusions: There is a statistically significant association between self-reported poor health and signs of PD. Although the relationship was present in all geographical locations, the confounders were protective factors for Western European countries. Since the two factors are linked, interventions that target one might reduce the impact on both. Further study into causality would be of use in predicting future healthcare costs, which could be reduced by integrating their management. [ABSTRACT FROM AUTHOR]

Background: Reduced physical activity is a known risk factor for many illnesses. Research in adolescent populations found increased physical activity levels improves objective health outcomes, but there is conflicting evidence regarding the relationship between physical activity levels and self-reported health status. Aims: To synthesise current evidence on the association between physical activity and self-reported health status in adolescents. Secondary objectives are to assess whether the relationship is dose dependant, and the appropriateness of WHO recommendations on adolescents' physical activity. Methods: The main databases were searched using keywords for the main outcome of interest (health status, health behaviour and self-perception) and exposure of interest (motor activity, physical activity and exercise), supplemented with manual searches, secondary citation and reference searches. Quality appraisal was carried out using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Results: Eleven studies entered this review. Nine studies reported a significant relationship between increased levels of physical activity and improved self-reported health status, however two did not. Two studies followed up participants and found that the relationship persisted over time. Two papers described a dose-response relationship. Improvements in self-perceived health can be observed even below the current recommended levels of physical activity. Conclusion: The review supports initiatives to encourage adolescents to engage in physical activity as it improves self-reported health status. Sub- optimal levels of physical activity can also be beneficial. Further research should use standardised measurement scales and objectively measured physical activity levels. The roles of gender, income and culture should be further investigated. [ABSTRACT FROM AUTHOR]

Background: Engaging in regular physical activity has a beneficial impact on both physical health and on subjective health indicators. The aims of this study were (i) to assess the association between physical activity levels and self- reported health status in European adolescents and (ii) to identify any differences in the distribution of adolescents reporting good health between active and inactive subjects across urban areas. Methods: The study sample comprised 13 783 15-year olds from 21 urban areas across Europe who participated in the European Urban Health Indicators System Part 2 youth survey in 2010/11. Data collected on physical activity levels, self-rated health status and covariates including gender, BMI, socioeconomic status and sedentary behaviour were analyzed in a multivariable logistic regression model. Results: High levels of physical activity (OR: 1.607, 95% CI: 1.245-2.074, P<0.001) were associated with self-rated 'good health' across the cohort as a whole. All cities except lasi showed a positive association between high levels of physical activity and good health. This was significant in four cases: Amsterdam, Cardiff, Greater Manchester and Merseyside (P=0.035, 0.016, 0.010 and 0.049, respectively). Only 13.3% of the cohort met the current WHO physical activity level recommendations. Conclusion: High levels of physical activity are positively associated with self-rated 'good health' status in European adolescents. Alarming levels of physical inactivity make it a priority to encourage greater engagement in physical activity. Promotion of physical activity should be specifically tailored to each urban area. [ABSTRACT FROM AUTHOR]

For the assessment of glucose tolerance from IVGTT data in Zucker rat, minimal model methodology is reliable but time- and money-consuming. This study aimed to validate for the first time in Zucker rat, simple surrogate indexes of insulin sensitivity and secretion against the glucose-minimal-model insulin sensitivity index (SI) and against first- (Φ1) and second-phase (Φ2) β-cell responsiveness indexes provided by C-peptide minimal model. Validation of the surrogate insulin sensitivity index (ISI) and of two sets of coupled insulin-based indexes for insulin secretion, differing from the cut-off point between phases (FPIR3-SPIR3, t = 3 min and FPIR5-SPIR5, t = 5 min), was carried out in a population of ten Zucker fatty rats (ZFR) and ten Zucker lean rats (ZLR). Considering the whole rat population (ZLR+ZFR), ISI showed a significant strong correlation with SI (Spearman’s correlation coefficient, r = 0.88; P<0.001). Both FPIR3 and FPIR5 showed a significant (P<0.001) strong correlation with Φ1 (r = 0.76 and r = 0.75, respectively). Both SPIR3 and SPIR5 showed a significant (P<0.001) strong correlation with Φ2 (r = 0.85 and r = 0.83, respectively). ISI is able to detect (P<0.001) the well-recognized reduction in insulin sensitivity in ZFRs, compared to ZLRs. The insulin-based indexes of insulin secretion are able to detect in ZFRs (P<0.001) the compensatory increase of first- and second-phase secretion, associated to the insulin-resistant state. The ability of the surrogate indexes in describing glucose tolerance in the ZFRs was confirmed by the Disposition Index analysis. The model-based validation performed in the present study supports the utilization of low-cost, insulin-based indexes for the assessment of glucose tolerance in Zucker rat, reliable animal model of human metabolic syndrome. [ABSTRACT FROM AUTHOR]

Background: T-wave alternans (TWA) is usually performed at accelerated heart rates (HR) during exercise, while recovery TWA is typically not analyzed. Consequently, it is still unknown if TWA shows a HR-dependent hysteresis or not. Thus, the aim of the present study was to investigate TWA dependency on HR during both the exercise and recovery phases of an ergometer test, and to evaluate if recovery TWA may contribute to identify subjects at increased risk of arrhythmic events.Methods: Our HR adaptive match filter was used to identify TWA from electrocardiographic recordings acquired during a bicycle ergometer test in 266 patients with implanted cardio-defibrillator. During the 4-year follow-up, 76 patients developed tachycardia or ventricular fibrillation (ICD_Cases) and 190 did not (ICD_Controls).Results: TWA was statistically lower during exercise than recovery for HRs between 75 and 110 bpm (16-21 μV vs 20-27 μV; P < 0.05), and reverse for HRs between 120 and 130 bpm (41-51 μV vs 28 μV; P < 0.05). ICD_Cases and ICD_Controls showed significantly different TWA at 80 bpm (20 μV vs 15 μV; P < 0.05) and 140 bpm (15 μV vs 22 μV; P < 0.05) during exercise, and at 90 bpm (38 μV vs 21 μV; P < 0.05) and 95 bpm (33-24 μV vs 28 μV; P < 0.05) during recovery.Conclusions: TWA shows a HR-dependent hysteresis and there is a different behavior of TWA in ICD_Cases and ICD_Controls groups. Consequently, beside exercise TWA also recovery TWA may contribute to identify subjects at increased risk of arrhythmic events. [ABSTRACT FROM AUTHOR]

A C-peptide-based assessment of β-cell function was performed here in the Zucker fatty rat, a suitable animal model of human metabolic syndrome. To this aim, a 90-min intravenous glucose tolerance test (IVGTT) was performed in seven Zucker fatty rats (ZFR), 7-to-9week-old, and seven age-matched Zucker lean rats (ZLR). The minimal model of C-peptide (CPMM), originally introduced for humans, was adapted to Zucker rats and then applied to interpret IVGTT data. For a comprehensive evaluation of glucose tolerance in ZFR, CPMM was applied in combination with the minimal model of glucose kinetics (GKMM). Our results showed that the present CPMM-based interpretation of data is able to: 1) provide a suitable fit of C-Peptide data; 2) achieve a satisfactory estimation of parameters of interest 3) quantify both insulin secretion by estimating the time course of pre-hepatic secretion rate, SR(t), and total insulin secretion, TIS, and pancreatic sensitivity by means of three specific indexes of β-cell responsiveness to glucose stimulus (first-phase, Ф1, second-phase, Ф2, and steady-state, Фss, never assessed in Zucker rats before; 4) detect the significant enhancement of insulin secretion in the ZFR, in face of a severe insulin-resistant state, previously observed only using a purely experimental approach. Thus, the methodology presented here represents a reliable tool to assess β-cell function in the Zucker rat, and opens new possibilities for the quantification of further processes involved in glucose homeostasis such as the hepatic insulin degradation. [ABSTRACT FROM AUTHOR]

Introduction. This study aims to investigate the reasons that discourage the patients affected by OSAS to undergo orthognathic surgery and compares the postoperative discomfort of phase I (soft tissue surgery) and phase II (orthognathic surgery) procedures for treatment of OSAS. Material and Methods. A pool of 46 patients affected by OSAS was divided into two groups: “surgery patients” who accepted surgical treatments of their condition and “no surgery patients” who refused surgical procedures. The “surgery patients” group was further subdivided into two arms: patients who accepted phase I procedures (IP) and those who accepted phase II (IIP). To better understand the motivations behind the refusal of II phase procedures, we asked the patients belonging to both the IP group and “no surgery” group to indicate the main reason that influenced their decision to avoid II phase procedures. We also monitored and compared five parameters of postoperative discomfort: pain, painkiller assumption, length of hospitalization, foreign body sensation, and diet assumption following IP and IIP procedures. Results. The main reason to avoid IIP procedures was the concern of a more severe postoperative discomfort. Comparison of the postoperative discomfort following IP versus IIP procedures showed that the former scored worse in 4 out of 5 parameters analyzed. Conclusion. IIP procedures produce less postoperative discomfort. IIP procedures, namely, orthognathic surgery, should be the first choice intervention in patients affected by OSAS and dentoskeletal malformation. [ABSTRACT FROM AUTHOR]

Objective. Systemic lupus erythematosus (SLE) is treated with anti-inflammatory and immunosuppressive drugs and off-label biologics. Belimumab is the first biologic approved after 50 years as an add-on therapy for active disease. This paper summarizes a health technology assessment performed in Italy. Methods. SLE epidemiology and burden were assessed using the best published international and national evidences and efficacy and safety of belimumab were synthesized using clinical data. A cost-effectiveness analysis was performed by a lifetime microsimulation model comparing belimumab to standard of care (SoC). Organizational and ethical implications were discussed. Results. Literature review showed that SLE affects 47 per 100,000 people for a total of 28,500 patients in Italy, 50% of whom are affected by active form of the disease despite SoC. These patients, if autoantibodies and anti-dsDNA positive with low complement, are eligible for belimumab. SLE determines work disability and a 2-5-fold increase inmortality. Belimumab with SoCmay prevent 4,742 flares in three years being cost-effective with an incremental costeffectiveness ratio of C32,859 per quality adjusted life year gained. From the organizational perspective, the development of clear and comprehensive clinical pathways is crucial. Conclusions. The assessment supports the use of belimumab into the SLE treatment paradigm in Italy. [ABSTRACT FROM AUTHOR]

Somatosympathetic reflexes were studied in young hyperinsulinemic, insulin-resistant (Zucker fatty) rats (ZFR) and a related control (Zucker lean) strain (ZLR). Glucose metabolism was characterized by minimal model analysis of intravenous glucose tolerance test data. Seven-week-old ZFR (n = 18) and ZLR (n = 17) were studied under pentobarbital anesthesia. Mean body weight and plasma glucose and insulin concentration were significantly greater (P < 0.05) in ZFR than in ZLR, whereas basal values of mean arterial pressure (MAP) and heart rate (HR) were not significantly different. Increments of MAP (ΔMAP) and HR (AHR) elicited by electrical stimulation of the sciatic nerve (5-s trains of 100 pulses, 0.5-ms pulse duration, 100- to 400-μA pulse intensity) were significantly higher (ANOVA, P < 0.05) in ZFR at each level of stimulus intensity. Regression analysis showed a linear increase in ΔMAP and AHR with increasing sciatic nerve stimulus intensity. Pressor responses to phenylephrine after ganglionic blockade demonstrated that vascular reactivity to adrenergic stimulation is not increased in ZFR compared with ZLR. Thus this factor does not contribute to enhancement of somatosympathetic reflexes observed in this strain. Insulin sensitivity in ZFR was one-fourth (P < 0.05) that in ZLR. These results suggest that stronger sympathetic nervous reactivity in ZFR is associated with a severe insulin-resistant state before the onset of hypertension and support the hypothesis that insulin-mediated stimulation of the sympathetic nervous system is involved in the development of cardiovascular diseases related to alterations of glucose metabolism. [ABSTRACT FROM AUTHOR]

Nowadays, breast cancer is the most frequent cancer among women. Early detection is a critical issue that can be effectively achieved by machine learning (ML) techniques. Thus in this article, the methods to improve the accuracy of ML classification models for the prognosis of breast cancer are investigated. Wrapper-based feature selection approach along with nature-inspired algorithms such as Particle Swarm Optimization, Genetic Search, and Greedy Stepwise has been used to identify the important features. On these selected features popular machine learning classifiers Support Vector Machine, J48 (C4.5 Decision Tree Algorithm), Multilayer-Perceptron (a feed-forward ANN) were used in the system. The methodology of the proposed system is structured into five stages which include (1) Data Pre-processing; (2) Data imbalance handling; (3) Feature Selection; (4) Machine Learning Classifiers; (5) classifier's performance evaluation. The dataset under this research experimentation is referred from the UCI Machine Learning Repository, named Breast Cancer Wisconsin (Diagnostic) Data Set. This article indicated that the J48 decision tree classifier is the appropriate machine learning-based classifier for optimum breast cancer prognosis. Support Vector Machine with Particle Swarm Optimization algorithm for feature selection achieves the accuracy of 98.24%, MCC = 0.961, Sensitivity = 99.11%, Specificity = 96.54%, and Kappa statistics of 0.9606. It is also observed that the J48 Decision Tree classifier with the Genetic Search algorithm for feature selection achieves the accuracy of 98.83%, MCC = 0.974, Sensitivity = 98.95%, Specificity = 98.58%, and Kappa statistics of 0.9735. Furthermore, Multilayer Perceptron ANN classifier with Genetic Search algorithm for feature selection achieves the accuracy of 98.59%, MCC = 0.968, Sensitivity = 98.6%, Specificity = 98.57%, and Kappa statistics of 0.9682. [ABSTRACT FROM AUTHOR]

Adaptive variability during walking is typical of child motor development. It has been reported that neurological disorders could affect this physiological phenomenon. The present work is designed to assess the adaptive variability of muscular recruitment during hemiplegic walking and to detect possible changes compared to control populations. In the attempt of limiting the complexity of computational procedure, the easy-to-measure coefficient of variation (CV) index is adopted to assess surface electromyography (sEMG) variability. The target population includes 34 Winters' type I and II hemiplegic children (H-group). Two further healthy populations, 34 age-matched children (C-group) and 34 young adults (A-group), are involved as controls. Results show a significant decrease (p < 0.05) of mean CV for gastrocnemius lateralis (GL) in H-group compared to both C-group (15% reduction) and A-group (35% reduction). Reductions of mean CV are detected also for tibialis anterior (TA) in H-group compared to C-group (7% reduction, p > 0.05) and A-group (15% reduction, p < 0.05). Lower CVs indicate a decreased intra-subject variability of ankle-muscle activity compared to controls. Novel contribution of the study is twofold: (1) To propose a CV-based approach for an easy-to-compute assessment of sEMG variability in hemiplegic children, useful in different experimental environments and different clinical purposes; (2) to provide a quantitative assessment of the reduction of intra-subject variability of ankle-muscle activity in mild-hemiplegic children compared to controls (children and adults), suggesting that hemiplegic children present a limited capability of adapting their muscle recruitment to the different stimuli met during walking task. This finding could be very useful in deepening the knowledge of this neurological disorder. [ABSTRACT FROM AUTHOR]

Artificial neural networks were satisfactorily implemented for assessing gait events from different walking data. This study aims to propose a novel approach for recognizing gait phases and events, based on deep-learning analysis of only sagittal knee-joint angle measured by a single electrogoniometer per leg. Promising classification/prediction performances have been previously achieved by surface-EMG studies; thus, a further aim is to test if adding electrogoniometer data could improve classification performances of state-of-the-art methods. Gait data are measured in about 10,000 strides from 23 healthy adults, during ground walking. A multi-layer perceptron model is implemented, composed of three hidden layers and a one-dimensional output. Classification/prediction accuracy is tested vs. ground truth represented by foot–floor-contact signals, through samples acquired from subjects not seen during training phase. Average classification-accuracy of 90.6 ± 2.9% and mean absolute value (MAE) of 29.4 ± 13.7 and 99.5 ± 28.9 ms in assessing heel-strike and toe-off timing are achieved in unseen subjects. Improvement of classification-accuracy (four points) and reduction of MAE (at least 35%) are achieved when knee-angle data are used to enhance sEMG-data prediction. Comparison of the two approaches shows as the reduction of set-up complexity implies a worsening of mainly toe-off prediction. Thus, the present electrogoniometer approach is particularly suitable for the classification tasks where only heel-strike event is involved, such as stride recognition, stride-time computation, and identification of toe walking. [ABSTRACT FROM AUTHOR]

Hemiplegia is a neurological disorder that is often detected in children with cerebral palsy. Although many studies have investigated muscular activity in hemiplegic legs, few EMG-based findings focused on unaffected limb. This study aimed to quantify the asymmetric behavior of lower-limb-muscle recruitment during walking in mild-hemiplegic children from surface-EMG and foot-floor contact features. sEMG signals from tibialis anterior (TA) and gastrocnemius lateralis and foot-floor contact data during walking were analyzed in 16 hemiplegic children classified as W1 according to Winter' scale, and in 100 control children. Statistical gait analysis, a methodology achieving a statistical characterization of gait by averaging surface-EMG-based features, was performed. Results, achieved in hundreds of strides for each child, indicated that in the hemiplegic side with respect to the non-hemiplegic side, W1 children showed a statistically significant: decreased number of strides with normal foot-floor contact; decreased stance-phase length and initial-contact sub-phase; curtailed, less frequent TA activity in terminal swing and a lack of TA activity at heel-strike. The acknowledged impairment of anti-phase eccentric control of dorsiflexors was confirmed in the hemiplegic side, but not in the contralateral side. However, a modified foot-floor contact pattern is evinced also in the contralateral side, probably to make up for balance requirements. [ABSTRACT FROM AUTHOR]

Correctly identifying gait phases is a prerequisite to achieve a spatial/temporal characterization of muscular recruitment during walking. Recent approaches have addressed this issue by applying machine learning techniques to treadmill-walking data. We propose a deep learning approach for surface electromyographic (sEMG)-based classification of stance/swing phases and prediction of the foot–floor-contact signal in more natural walking conditions (similar to everyday walking ones), overcoming constraints of a controlled environment, such as treadmill walking. To this aim, sEMG signals were acquired from eight lower-limb muscles in about 10.000 strides from 23 healthy adults during level ground walking, following an eight-shaped path including natural deceleration, reversing, curve, and acceleration. By means of an extensive evaluation, we show that using a multi layer perceptron to learn hidden features provides state of the art performances while avoiding features engineering. Results, indeed, showed an average classification accuracy of 94.9 for learned subjects and 93.4 for unlearned ones, while mean absolute difference ( ± S D ) between phase transitions timing predictions and footswitch data was 21.6 ms and 38.1 ms for heel-strike and toe off, respectively. The suitable performance achieved by the proposed method suggests that it could be successfully used to automatically classify gait phases and predict foot–floor-contact signal from sEMG signals during level ground walking. [ABSTRACT FROM AUTHOR]

Background: Granulomatous interstitial nephritis in sarcoidosis (sGIN) is generally clinically silent, but in <1% causes acute kidney injury (AKI)., Methods: This Italian multicentric retrospective study included 39 sarcoidosis-patients with renal involvement at renal biopsy: 31 sGIN-AKI, 5 with other patterns (No-sGIN-AKI), 3 with nephrotic proteinuria. We investigate the predictive value of clinical features, laboratory, radiological parameters and histological patterns regarding steroid response. Primary endpoint: incident chronic kidney disease (CKD) beyond the 1°follow-up (FU) year; secondary endpoint: response at 1°line steroid therapy; combined endpoint: the association of initial steroid response and outcome at the end of FU., Results: Complete recovery in all 5 No-sGIN-AKI-patients, only in 45% (13/29) sGIN-AKI-patients (p=0.046) (one lost in follow-up, for another not available renal function after steroids). Nobody had not response. Primary endpoint of 22 sGIN-AKI subjects: 65% (13/20) starting with normal renal function developed CKD (2/22 had basal CKD; median FU 77 months, 15-300). Combined endpoint: 29% (6/21) had complete recovery and final normal renal function (one with renal relapse), 48% (10/21) had partial recovery and final CKD (3 with renal relapse, of whom one with basal CKD) (p=0.024). Acute onset and hypercalcaemia were associated to milder AKI and better recovery than subacute onset and patients without hypercalcaemia, women had better endpoints than men. Giant cells, severe interstitial infiltrate and interstitial fibrosis seemed negative predictors in terms of endpoints., Conclusions: sGIN-AKI-patients with no complete recovery at 1°line steroid should be treated with other immunosuppressive to avoid CKD, in particular if males with subacute onset and III stage-not hypercalcaemic AKI., Competing Interests: Special thanks to Jacqueline Rodriguez, who revised the manuscript for English language, and to Claudia Giuliani, for graphic support. We express gratitude to Immunopathology Group of Italian Society of Nephrology and to ACSI Onlus “Amici contro la Sarcoidosi Italia”, the Italian national society of Sarcoidosis patients.Francesco Rastelli and Ivano Baragetti were responsible for the work. Other authors contributed to the data collection and reviewed and revised the manuscript as supervisors.Each author declares that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangement etc.) that might pose a conflict of interest in connection with the submitted article., (Copyright: © 2021 SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES.)

Background: Fetal well-being evaluation may be accomplished by monitoring cardiac activity through fetal electrocardiography. Direct fetal electrocardiography (acquired through scalp electrodes) is the gold standard but its invasiveness limits its clinical applicability. Instead, clinical use of indirect fetal electrocardiography (acquired through abdominal electrodes) is limited by its poor signal quality., Objective: Aim of this study was to evaluate the suitability of the Segmented-Beat Modulation Method to denoise indirect fetal electrocardiograms in order to achieve a signal-quality at least comparable to the direct ones., Method: Direct and indirect recordings, simultaneously acquired from 5 pregnant women during labor, were filtered with the Segmented-Beat Modulation Method and correlated in order to assess their morphological correspondence. Signal-to-noise ratio was used to quantify their quality., Results: Amplitude was higher in direct than indirect fetal electrocardiograms (median:104 µV vs. 22 µV; P=7.66·10 -4 ), whereas noise was comparable (median:70 µV vs. 49 µV, P=0.45). Moreover, fetal electrocardiogram amplitude was significantly higher than affecting noise in direct recording (P=3.17·10 -2 ) and significantly in indirect recording (P=1.90·10 -3 ). Consequently, signal-to-noise ratio was initially higher for direct than indirect recordings (median:3.3 dB vs. -2.3 dB; P=3.90·10 -3 ), but became lower after denoising of indirect ones (median:9.6 dB; P=9.84·10 -4 ). Eventually, direct and indirect recordings were highly correlated (median: ρ=0.78; P<10 -208 ), indicating that the two electrocardiograms were morphologically equivalent., Conclusion: Segmented-Beat Modulation Method is particularly useful for denoising of indirect fetal electrocardiogram and may contribute to the spread of this noninvasive technique in the clinical practice.

Background: Indirect fetal electrocardiography is preferable to direct fetal electrocardiography because of being noninvasive and is applicable also during the end of pregnancy, besides labor. Still, the former is strongly affected by noise so that even R-peak detection (which is essential for fetal heart-rate evaluations and subsequent processing procedures) is challenging. Some fetal studies have applied the Pan-Tompkins' algorithm that, however, was originally designed for adult applications. Thus, this work evaluated the Pan-Tompkins' algorithm suitability for fetal applications, and proposed fetal adjustments and optimizations to improve it., Method: Both Pan-Tompkins' algorithm and its improved version were applied to the "Abdominal and Direct Fetal Electrocardiogram Database" and to the "Noninvasive Fetal Electrocardiography Database" of Physionet. R-peak detection accuracy was quantified by computation of positive-predictive value, sensitivity and F1 score., Results: When applied to "Abdominal and Direct Fetal Electrocardiogram Database", the accuracy of the improved fetal Pan-Tompkins' algorithm was significantly higher than the standard (positive-predictive value: 0.94 vs. 0.79; sensitivity: 0.95 vs. 0.80; F1 score: 0.94 vs. 0.79; P<0.05 in all cases) on indirect fetal electrocardiograms, whereas both methods performed similarly on direct fetal electrocardiograms (positive-predictive value, sensitivity and F1 score all close to 1). Improved fetal Pan-Tompkins' algorithm was found to be superior to the standard also when applied to "Noninvasive Fetal Electrocardiography Database" (positive-predictive value: 0.68 vs. 0.55, P<0.05; sensitivity: 0.56 vs. 0.46, P=0.23; F1 score: 0.60 vs. 0.47, P=0.11)., Conclusion: In indirect fetal electrocardiographic applications, improved fetal Pan-Tompkins' algorithm is to be preferred over the standard, since it provides higher R-peak detection accuracy for heart-rate evaluations and subsequent processing.