Analysis of Routine and Integrative Data from Clostridioides difficile Infection Diagnosis and the Consequent Observations

Abstract: Background: Clostridioides difficile Infection (CDI) is an acute disease that needs a fast proper treatment. Unfortunately, the diagnosis, and above all the understanding of the results, remain arduous. Objective: This study analyzed routine and integrative results of all fecal samples from patients over time. Our aim was to understand the dynamics of CDI infection and the meaning of \u201cdifficult to interpret\u201d results, to make physicians better understand the various tools they can use. Methods: We evaluated routine results obtained from 815 diarrheal stools with Enzyme Immunoassay (EIA) that detects C. difficile Glutamate Dehydrogenase (GDH) antigen and toxin B. We also reanalyzed a part of samples using integrative tests: a Real-time polymerase chain reaction (RT-PCR) for C. difficile toxin B gene (tcdB) and the automated immunoassay VIDAS C. difficile system for GDH and toxins A/B. Results: EIA GDH positivity increased through multiple testing over time, with a P value <0.001, depicting a sort of bacterial growth curve. Eighty-five percent of GDH positive/toxin B negative, i.e., discrepant, samples PCR were tcdB positive, 61.5% of discrepant tcdB positive samples were VIDAS toxins A/B positive, and 44.4% of GDH EIA negative stools were VIDAS GDH positive. Conclusion: The results confirmed the low sensitivity of the EIA system for C. difficile GDH and toxins, questioned the use of the latter for concluding any CDI diagnostic algorithm, and led us to indicate the algorithm beginning with tcdB molecular research, and continuing in positive cases with VIDAS CD GDH method, as the most effective for CDI

Solitary fibrous tumor

Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm which may be found everywhere in the body. It is now distinguished into two forms, pleural and extrapleural, which morphologically resemble each other. Abdominal localizations are quite rare, with 10 cases only reported in bladder; rarely they can be source of paraneoplastic syndromes (i.e., hypoglycemia secondary to insulin-like growth factor). In April 2006 a 74-year-old white male presented with chills, diaphoresis and acute abdominal pain with hematuria. At admission in emergency he underwent an abdominal Xray (no pathological findings) and an ultrasound examination of the kidneys and urinary tract, which revealed a pelvic hyperechogenic neoformation measuring approximately 10×8×7 cm, compressing the bladder. Blood chemistry at admission revealed only a mild neutrophilic leucocytosis (WBC 16600, N 80%, L 11%), elevated fibrinogen and ESR, and hypoglycemia (38 mg/dL). Macro scopic hematuria was evident, while urinocolture was negative. Contrast enhanced CT scan of the abdomen and pelvic region revealed a large round neoformation dislocating the bladder, with an evident contrast-enhanced periphery and a central necrotic area. Continuous infusion of glucose 5% solution was necessary in order to maintain blood glucose levels above 50 mg/dL. The patient underwent complete surgical resection of an ovoidal mass coated by adipose tissue, with well delimited margins; histological findings were consistent with solitary fibrous tumor (SFT). Hypoglycemia resolved completely with removal of the growth. In this case report we describe a SFT growing in the bladder, a quite rare localization, which presented a unique hypoglycemia. In contrast to the majority of cases reported in the literature, the behavior of this SFT was not aggressive, and, since the patient is still alive, surgical resection was considered conclusive

Epidemiology of Clostridium Difficile Infection in a Large Hospital in Northern Italy: Questioning the Ward-Based Transmission

Background: Clostridium Difficile infection (CDI) is considered a ward-based nosocomial infection, due to contagion among patients. Molecular studies recently questioned ward-based contact for disease spread. Objective: To investigate whether it is plausible that CDI spread in San Martino Hospital of Genoa was due to a ward-based contact and patientto- patient diffusion. Methods: We conducted a retrospective cohort study of CDI cases from April 2010 to March 2015. We referred to Hospital data set and Admission Service. Multilevel modelling approach and ecological analysis were used to assess C. difficile infection risk according to wards and time of occurrence. Six representative CD strains were ribotyped to assess a possible equivalence. Results: The assessment of 514 CDI cases showed that the risk of disease and rate of incidence in wards were independent, while frequency of cases and number of wards involved exhibited a positive relationship, excluding the typical epidemic pattern of contagious diffusion, i.e., many cases in few wards. The extra-binomial variability due to ward clustering was not significant, indicating homogeneity in the probability of CDI occurrence across all wards. Three hundred sixty-eight patients changed ward, without showing connection between the frequency of cases in new wards and incidence among new subjects. Trigonometric components described a significant contribution of seasonality, with excess of CDI cases during the winter months. Molecular analysis showed different ribotypes of CD strains from the same ward. Conclusion: From our results it seems unlikely that in our institution CDI occurrence is due to ward-based contact and inter-human contagion of the organism

A new concept of highly modular ASV for extremely shallow water applications

This paper describe SWAMP, a prototype Autonomous Surface Vehicle (ASV) representing the base for the design and development of an innovative class of reliable modular reconfigurable lightweight ASVs for extremely shallow water applications. The design of SWAMP-class ASVs is based on a holistic approach involving different aspects of robotics such as the use of soft materials, the mechanical design of innovative propulsion system integrated with the vessel hull, the adoption of modular mechanical and computing architecture able to support multi-agent distributed GNC systems

The architecture of information processing in biological systems

Biological systems process information at different scales and adapt to their changing environment. Informed both by experimental observations and theoretical constraints, we propose a chemical model for sensing that incorporates energy consumption, information storage, and negative feedback. We show that a biochemical architecture enclosing these minimal mechanisms leads to the emergence of dynamical memory and adaptation. Crucially, adaptation is associated with both an increase in the mutual information between external and internal variables and a reduction of dissipation of the internal chemical processes. By simultaneously minimizing energy consumption and maximizing information, we find that far-from-equilibrium sensing dominates in the low-noise regime. Our results, in principle, can be declined at different biological scales. We employ our model to shed light on large-scale neural adaptation in zebrafish larvae under repeated visual stimulation. We find striking similarities between predicted and observed behaviors, capturing the emergent adaptation of neural response. Our framework draws a path toward the unraveling of the essential ingredients that connect information processing, adaptation, and memory in biological systems

MACHINE LEARNING TO SUPPORT INDUSTRIAL DIGITALIZATION AND BUSINESS TRANSFORMATION

This paper addresses use of Artificial Intelligence (AI) and in particular Intelligent Agents (IA) in order to evaluate efficiency of information exchange and awareness in Small and Medium Enterprise (SME), with particular attention to digital transformation. To perform required experimentation, the authors have developed a Serious Game (SG) named JANUS, in which the player interacts with intelligent agents representing a virtual company and its actions aim to acquire as much as possible data about the organization

Safety of belimumab in association with denosumab in a patient affected by Lupus Erythematosus: a case report

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease characterized by multisystemic involvement. Owing to multifactorial etiologies, low bone mineral density (BMD) osteoporosis (OP) and fragility fractures (FFx) have been very frequently documented in these patients. Appropriate treatments to minimize underlying immunologic disease activity remain mandatory, and the development of strategies to prevent and treat important complications as osteoporosis is needed.We present the clinical case of a female SLE patient treated simultaneously with belimumab (anti-BLyS) for the underlying disease, and denosumab (anti-RANKL) for concomitant severe osteoporosis. As these monoclonal antibodies have been recently introduced into the market, their combination has not been reported in literature yet. In this case, the combined administration proved a viable option for a SLE patient with osteoporosis and bisphosphonates contraindications

High tibial osteotomy in varus knees: indications and limits

Opening wedge high tibial osteotomy (OWHTO) is a surgical procedure that aims to correct the weight-bearing axis of the knee, moving the loads laterally from the medial compartment. Conventional indications for OWHTO are medial compartment osteoarthritis and varus malalignment of the knee; recently OWHTO has been used successfully in the treatment of double and triple varus. OWHTO, in contrast to closing wedge high tibial osteotomy, does not require fibular osteotomy or peroneal nerve dissection, or lead to disruption of the proximal tibiofibular joint and bone stock loss. For these reasons, interest in this procedure has grown in recent years. The aim of this study is to review the literature on OWHTO, considering indications and prognostic factors (body mass index, grade of osteoarthritis, instability, range of movement and age), outcomes at mid-term follow-up, and limits of the procedure (slope modifications, patellar height changes and difficulties in conversion to a total knee arthroplasty)

Safety of pregnancy after breast cancer in young women with hormone receptor-positive disease: a systematic review and meta-analysis

Breast cancer; Oncofertility; PregnancyCàncer de mama; Oncofertilitat; EmbaràsCáncer de mama; Oncofertilidad; EmbarazoBackground Despite increasing evidence on the safety of pregnancy after anticancer treatments in breast cancer survivors, many physicians and patients remain concerned about a potential risk of pregnancy specifically in the case of hormone receptor-positive breast cancer. Materials and methods A systematic literature search of Medline, Embase and Cochrane library with no language or date restriction up to 31 March 2023 was carried out. To be included, articles had to be retrospective and prospective case-control and cohort studies as well as clinical trials comparing survival outcomes of premenopausal women with or without a pregnancy after prior diagnosis of hormone receptor-positive breast cancer. Disease-free survival (DFS) and overall survival (OS) were the outcomes of interest. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Study protocol is registered in PROSPERO (n. CRD42023394232). Results Out of 7796 screened studies, 8 were eligible to be included in the final analysis. A total of 3805 patients with hormone receptor-positive invasive early breast cancer were included in these studies, of whom 1285 had a pregnancy after breast cancer diagnosis. Median follow-up time ranged from 3.8 to 15.8 years and was similar in the pregnancy and non-pregnancy cohorts. In three studies (n = 987 patients) reporting on DFS, no difference was observed between patients with and those without a subsequent pregnancy (HR 0.96, 95% CI 0.75-1.24, P = 0.781). In the six studies (n = 3504 patients) reporting on OS, patients with a pregnancy after breast cancer had a statistically significant better OS than those without a pregnancy (HR 0.46, 95% CI 0.27-0.77, P < 0.05). Conclusions This systematic review and meta-analysis of retrospective cohort studies provides updated evidence that having a pregnancy in patients with prior history of hormone receptor-positive invasive early breast cancer appears safe without detrimental effect on prognosis.This work was partially supported by the Italian Association for Cancer Research (‘Associazione Italiana per la Ricerca sul Cancro’, AIRC) [grant number MFAG 2020 ID 24698] and by Italian Ministry of Health—5 x 1000 funds (years 2021-2022)

A preliminary experiment combining marine robotics and citizenship engagement using imitation learning

In this paper, we describe a preliminary experiment of citizenship engagement in the context of marine robotics using imitation learning to train a controller that mimics human behavior. The experiment has been carried out during the Festival della Comunicazione in Camogli, Italy, in September 2019. In more detail, citizens have been asked to pilot a small, light, and safe autonomous surface vehicle in front of a crowded public beach with the goal of performing an S-shaped path. The trajectories and controls performed by non-expert human operators have been recorded with the aim of training an imitation system that, after collecting a sufficient number of trajectory-control pairs, has been able to drive the vehicle without human intervention. To learn the human behavior, echo state networks have been employed as approximating architectures. The resulting controller turned out to be very effective in successfully performing the considered experiment with a reduced amount of training trajectories by imitating the human behavior also in unknown situations. The success of this experiment may pave the way to new research processes where citizens are actively engaged. Copyright (C) 2020 The Authors