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Objective: Several features of the surface electromyography (sEMG) signal are related to muscle activity and fatigue. However, the time-evolution of these features are non-stationary and vary between subjects. The aim of this study is to investigate the use of adaptive algorithms to forecast sEMG feature of the trunk muscles., Methods: Shallow models and a deep convolutional neural network (CNN) were used to simultaneously learn and forecast 5 common sEMG features in real-time to provide tailored predictions. This was investigated for: up to a 25 second horizon; for 14 different muscles in the trunk; across 13 healthy subjects; while they were performing various exercises., Results: The CNN was able to forecast 25 seconds ahead of time, with 6.88% mean absolute percentage error and 3.72% standard deviation of absolute percentage error, across all the features. Moreover, the CNN outperforms the best shallow model in terms of a figure of merit combining accuracy and precision by at least 30% for all the 5 features., Conclusion: Even though the sEMG features are non-stationary and vary between subjects, adaptive learning and forecasting, especially using CNNs, can provide accurate and precise forecasts across a range of physical activities., Significance: The proposed models provide the groundwork for a wearable device which can forecast muscle fatigue in the trunk, so as to potentially prevent low back pain. Additionally, the explicit real-time forecasting of sEMG features provides a general model which can be applied to many applications of muscle activity monitoring, which helps practitioners and physiotherapists improve therapy.

Aim: Abdominal cavity access accounts for 50% of complications during laparoscopic surgery. Different safety maneuvers have been used to try to diminish these. Our study aims to establish the usefulness of Palmer's test in the correct positioning of the Veress needle and the reduction of complications during laparoscopic access maneuvers, when used in addition to the determination of intraabdominal pressure., Methods: Prospective observational analytic multi-centered cohort study with 370 patients undergoing gynecologic laparoscopy between July 2014 and November 2019, comparing the additional use of Palmer's test in 185 patients (Palmer-Test-Yes, PTY), with intraabdominal pressure determination alone in 185 patients (Palmer-Test-No, PTN)., Results: Intergroup homogeneity was described for the basic characteristics of both population samples, except for mean age and percentage of previous laparotomy. A total of 19 complications were recorded, 10 in PTY and 9 in PTN, with no significant differences (P = 0.814). No differences were found in the analysis of these complications, except for the rate of conversion to laparotomy, which occurred four times in the PTY group and none in PTN (P = 0.044). Furthermore, no differences were found once fixed for the history of previous laparotomy (P = 514.), nor for the percentage of successful access after the first attempt between both groups (P = 0.753)., Conclusion: Palmer's test, when used in addition to intraabdominal pressure determination, has not shown to be effective in preventing failed access to abdominal cavity or reducing complications associated with access maneuvers with the Veress needle. Hence, its systematic use is not justified, since it could generate a sense of false security., (© 2020 Japan Society of Obstetrics and Gynecology.)

Secondary prevention after acute coronary syndromes should be aimed at reducing the risk of further adverse cardiovascular events, thereby improving quality of life, and lengthening survival. Despite compelling evidence from large randomized controlled trials, secondary prevention is not fully implemented in most cases after hospitalization for acute coronary syndrome. The Lazio Region (Italy) has about 5.3 million inhabitants (9% of the entire Italian population). Every year about 11 000 patients are admitted for acute coronary syndrome in hospitals of the Lazio Region. Most of these patients receive state-of-the art acute medical and interventional care during hospitalization. However, observational data suggest that after discharge acute coronary syndrome patients are neither properly followed nor receive all evidence-based treatments. This consensus document has been developed by 11 Scientific Societies of Cardiovascular and Internal Medicine in order develop a sustainable and effective clinical approach for secondary cardiovascular prevention after acute coronary syndrome in the local scenario of the Lazio Region. An evidence-based simplified decalogue for secondary cardiovascular prevention is proposed as the cornerstone of clinical intervention, taking into account regional laws and relative shortage of resources. The following appropriate interventions should be consistently applied: smoking cessation, blood pressure control (blood pressure < 130/80 mmHg), optimal lipid management (LDL cholesterol < 80 mmHg), weight and diabetes management, promotion of physical activity and rehabilitation, correct use of antiplatelet agents, beta-blockers, renin-angiotensin-aldosterone system blockers.

The purpose of this study was to investigate the relationship between the changes in mean skin temperature and the energy expenditure induced by drinking coffee containing 4 mg of caffeine/kg body weight. Twelve healthy, weight-stable subjects were studied (five males, seven females; mean age +/- s.d., 25.3 +/- 3.3 years; BMI 22.5 +/- 3.1). Energy expenditure (EE) was measured by open-circuit indirect calorimetry, and skin temperature was determined with thermometric probes applied to the four body regions indicated by Ramanathan (chest, arm, thigh, calf). The calorimetric and thermometric measurements were carried out for 120 min with the participants lying down quietly. A significant correlation was found between the total thermogenic responses (net responses) and the temperature changes between 90 and 120 min from the coffee intake. Multiple regression analysis using mean EE after coffee intake as the dependent variable, and mean skin temperature and body weight as the independent variables yields the following equation: EE (kcal/min/m2) = -1.44 + 0.052 (mean skin temperature) + 0.004 (body weight). (r = 0.71 and P = 0.01) Our results indicate that small interindividual differences in mean skin temperature could explain energy expenditure differences in subjects with the same body weight, body composition and physical activity. This, in turn, could help explain variations in proneness to obesity.

A total of 1552 antepartum nonstress tests performed during the week before delivery are analyzed with respect to both reactivity and the presence of pathologic baseline patterns (tachycardia, bradycardia, diminished beat-to-beat variability) or decelerations. Correlation with mode of delivery and condition of the newborn infant shows that, irrespective of nonstress test reactivity, the presence of baseline anomalies and/or decelerations is associated with significantly increased perinatal morbidity and mortality. Nonstress test analysis, if systematic, that is, not restricted to reactivity alone, makes it possible to better detect fetuses at high perinatal risk, in which case closer surveillance would be indicated.

A Listeria infection of a twin pregnancy had induced a partus immaturus at 23 weeks. One foetus died in utero of a widespread foeto-placental granulomatosis, while the other one, dying sub-partu, showed only retroplacental abcesses. The unequal extent of the infection in the two placentas -- of diamniotic, dichorionic type -- is interpreted as different stages of the same disease; it could be due to a different resistance to the germ between the two dizygotic foetuses.