Preterm Infants' Pose Estimation with Spatio-Temporal Features

Objective: Preterm infants' limb monitoring in neonatal intensive care units (NICUs) is of primary importance for assessing infants' health status and motor/cognitive development. Herein, we propose a new approach to preterm infants' limb pose estimation that features spatio-temporal information to detect and track limb joints from depth videos with high reliability. Methods: Limb-pose estimation is performed using a deep-learning framework consisting of a detection and a regression convolutional neural network (CNN) for rough and precise joint localization, respectively. The CNNs are implemented to encode connectivity in the temporal direction through 3D convolution. Assessment of the proposed framework is performed through a comprehensive study with sixteen depth videos acquired in the actual clinical practice from sixteen preterm infants (the babyPose dataset). Results: When applied to pose estimation, the median root mean square distance, computed among all limbs, between the estimated and the ground-truth pose was 9.06 pixels, overcoming approaches based on spatial features only (11.27 pixels). Conclusion: Results showed that the spatio-temporal features had a significant influence on the pose-estimation performance, especially in challenging cases (e.g., homogeneous image intensity). Significance: This article significantly enhances the state of art in automatic assessment of preterm infants' health status by introducing the use of spatio-temporal features for limb detection and tracking, and by being the first study to use depth videos acquired in the actual clinical practice for limb-pose estimation. The babyPose dataset has been released as the first annotated dataset for infants' pose estimation

The Wonder of Colors and the Principle of Ariadne

The Principle of Ariadne, formulated in 1988 ago by Walter Carnielli and Carlos Di Prisco and later published in 1993, is an infinitary principle that is independent of the Axiom of Choice in ZF, although it can be consistently added to the remaining ZF axioms. The present paper surveys, and motivates, the foundational importance of the Principle of Ariadne and proposes the Ariadne Game, showing that the Principle of Ariadne, corresponds precisely to a winning strategy for the Ariadne Game. Some relations to other alternative. set-theoretical principles are also briefly discussed

The babyPose dataset

none5noThe database here described contains data relevant to preterm infants' movement acquired in neonatal intensive care units (NICUs). The data consists of 16 depth videos recorded during the actual clinical practice. Each video consists of 1000 frames (i.e., 100s). The dataset was acquired at the NICU of the Salesi Hospital, Ancona (Italy). Each frame was annotated with the limb-joint location. Twelve joints were annotated, i.e., left and right shoul- der, elbow, wrist, hip, knee and ankle. The database is freely accessible at http://doi.org/10.5281/zenodo.3891404. This dataset represents a unique resource for artificial intelligence researchers that want to develop algorithms to provide healthcare professionals working in NICUs with decision support. Hence, the babyPose dataset is the first annotated dataset of depth images relevant to preterm infants' movement analysis.openMigliorelli L.; Moccia S.; Pietrini R.; Carnielli V.P.; Frontoni E.Migliorelli, L.; Moccia, S.; Pietrini, R.; Carnielli, V. P.; Frontoni, E

Effect of preoperative pulmonary hemodynamic and cardiopulmonary bypass on lung function in children with congenital heart disease

In children with congenital heart disease (CHD), pulmonary blood flow (Qp) contributes to alterations of pulmonary mechanics and gas exchange, while cardiopulmonary bypass (CPB) induces lung edema. We aimed to determine the effect of hemodynamics on lung function and lung epithelial lining fluid (ELF) biomarkers in biventricular CHD children undergoing CPB. CHD children were classified as high Qp (n = 43) and low Qp (n = 17), according to preoperative cardiac morphology and arterial oxygen saturation. We measured ELF surfactant protein B (SP-B) and myeloperoxidase activity (MPO) as indexes of lung inflammation and ELF albumin as index of alveolar capillary leak in tracheal aspirate (TA) samples collected before surgery and in 6 hourly intervals within 24 h after surgery. At the same time points, we recorded dynamic compliance and oxygenation index (OI). The same biomarkers were measured in TA samples collected from 16 infants with no cardiorespiratory diseases at the time of endotracheal intubation for elective surgery. Preoperative ELF biomarkers in CHD children were significantly increased than those found in controls. In the high Qp, ELF MPO and SP-B peaked 6 h after surgery and tended to decrease afterward, while they tended to increase within the first 24 h in the low Qp. ELF albumin peaked 6 h after surgery and decreased afterwards in both CHD groups. Dynamic compliance/kg and OI significantly improved after surgery only in the High Qp. Conclusion: In CHD children, lung mechanics, OI, and ELF biomarkers were significantly affected by CPB, according to the preoperative pulmonary hemodynamics.What is Known:• Congenital heart disease children, before cardiopulmonary run, exhibit changes in respiratory mechanics, gas exchange, and lung inflammatory biomarkers that are related to the preoperative pulmonary hemodynamics.• Cardiopulmonary bypass induces alteration of lung function and epithelial lining fluid biomarkers according to preoperative hemodynamics.What is New:• Our findings can help to identify children with congenital heart disease at high risk of postoperative lung injury who may benefit of tailored intensive care strategies, such as non-invasive ventilation techniques, fluid management, and anti-inflammatory drugs that can improve cardiopulmonary interaction in the perioperative period

Pre-surgery urine metabolomics may predict late neurodevelopmental outcome in children with congenital heart disease

Background: From fetal life until cardiac surgery, complex congenital heart diseases (CHD) exhibit different hemodynamic and oxygenation patterns that can lead to alteration of the metabolic profile. We used a metabolomic approach to identify urine metabolic markers before cardiac surgery, aiming to define the physiology of patients with complex CHD and to contribute to predict their neurodevelopmental outcome. Methods: In a prospective, observational, single-center study we enrolled 28 patients with complex biventricular and univentricular CHD aged less than 5 years, on stable hemodynamic conditions, and with no genetic anomalies. We analyzed urine samples, collected at the induction of anesthesia, by 1H NMR spectroscopy. Profiles of 1H NMR spectra were submitted to unsupervised (principal component) and supervised (partial least squares-discriminant) multivariate analysis. Neurodevelopment was assessed by neuropsychological and adaptive functioning testing. Results: Principal components analysis divided CHD patients metabolic profiles in two distinct clusters (RED and BLACK). Metabolic profiles belonging to the RED cluster showed higher levels of accumulation of citric acid cycle intermediates and glucose compared to the profiles in the BLACK cluster, indicating a possible switching to anaerobic metabolism. Patients belonging to the RED cluster were significantly more prone to show an adverse neurodevelopment pattern (p = 0.01). Conclusions: The application of metabolomic analysis to CHD children permitted a deeper insight on their metabolic status that could help to obtain a better understanding of the physiological implications and to predict long-term neurodevelopmental outcome. © 201

Surfactant lung delivery with LISA and InSurE in adult rabbits with respiratory distress

Background In preterm infants, InSurE (Intubation–Surfactant–Extubation) and LISA (less invasive surfactant administration) techniques allow for exogenous surfactant administration while reducing lung injury associated with mechanical ventilation. We compared the acute pulmonary response and lung deposition of surfactant by LISA and InSurE in surfactant-depleted adult rabbits. Methods Twenty-six spontaneously breathing surfactant-depleted adult rabbits (6–7 weeks old) with moderate RDS and managed with nasal continuous positive airway pressure were randomized to 3 groups: (1) 200 mg/kg of surfactant by InSurE; (2) 200 mg/kg of surfactant by LISA; (3) no surfactant treatment (Control). Gas exchange and lung mechanics were monitored for 180 min. After that, surfactant lung deposition and distribution were evaluated monitoring disaturated-phosphatidylcholine (DSPC) and surfactant protein C (SP-C), respectively. Results No signs of recovery were found in the untreated animals. After InSurE, oxygenation improved more rapidly compared to LISA. However, at 180’ LISA and InSurE showed comparable outcomes in terms of gas exchange, ventilation parameters, and lung mechanics. Neither DSPC in the alveolar pool nor SP-C signal distributions in a frontal lung section were significantly different between InSurE and LISA groups. Conclusions In an acute setting, LISA demonstrated efficacy and surfactant lung delivery similar to that of InSurE in surfactant-depleted adult rabbits. Impact Although LISA technique is gaining popularity, there are still several questions to address. This is the first study comparing LISA and InSurE in terms of gas exchange, ventilation parameters, and lung mechanics as well as surfactant deposition and distribution. In our animal study, three hours post-treatment, LISA method seems to be as effective as InSurE and showed similar surfactant lung delivery. Our findings provide some clarifications on a fair comparison between LISA and InSurE techniques, particularly in terms of surfactant delivery. They should reassure some of the concerns raised by the clinical community on LISA adoption in neonatal units

Surfactant lung delivery with LISA and InSurE in adult rabbits with respiratory distress

Background: In preterm infants, InSurE (Intubation\u2013Surfactant\u2013Extubation) and LISA (less invasive surfactant administration) techniques allow for exogenous surfactant administration while reducing lung injury associated with mechanical ventilation. We compared the acute pulmonary response and lung deposition of surfactant by LISA and InSurE in surfactant-depleted adult rabbits. Methods: Twenty-six spontaneously breathing surfactant-depleted adult rabbits (6\u20137 weeks old) with moderate RDS and managed with nasal continuous positive airway pressure were randomized to 3 groups: (1) 200 mg/kg of surfactant by InSurE; (2) 200 mg/kg of surfactant by LISA; (3) no surfactant treatment (Control). Gas exchange and lung mechanics were monitored for 180 min. After that, surfactant lung deposition and distribution were evaluated monitoring disaturated-phosphatidylcholine (DSPC) and surfactant protein C (SP-C), respectively. Results: No signs of recovery were found in the untreated animals. After InSurE, oxygenation improved more rapidly compared to LISA. However, at 180\u2019 LISA and InSurE showed comparable outcomes in terms of gas exchange, ventilation parameters, and lung mechanics. Neither DSPC in the alveolar pool nor SP-C signal distributions in a frontal lung section were significantly different between InSurE and LISA groups. Conclusions: In an acute setting, LISA demonstrated efficacy and surfactant lung delivery similar to that of InSurE in surfactant-depleted adult rabbits. Impact: Although LISA technique is gaining popularity, there are still several questions to address. This is the first study comparing LISA and InSurE in terms of gas exchange, ventilation parameters, and lung mechanics as well as surfactant deposition and distribution.In our animal study, three hours post-treatment, LISA method seems to be as effective as InSurE and showed similar surfactant lung delivery.Our findings provide some clarifications on a fair comparison between LISA and InSurE techniques, particularly in terms of surfactant delivery. They should reassure some of the concerns raised by the clinical community on LISA adoption in neonatal units

Breastfeeding of Very Preterm Infants at Discharge from Nicu: Results from the Italian Area-Based "Action" Study

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A coalgebraic perspective on logical interpretations

In Computer Science stepwise refinement of algebraic specifications is a well-known formal methodology for rigorous program development. This paper illustrates how techniques from Algebraic Logic, in particular that of interpretation, understood as a multifunction that preserves and reflects logical consequence, capture a number of relevant transformations in the context of software design, reuse, and adaptation, difficult to deal with in classical approaches. Examples include data encapsulation and the decomposition of operations into atomic transactions. But if interpretations open such a new research avenue in program refinement, (conceptual) tools are needed to reason about them. In this line, the paper’s main contribution is a study of the correspondence between logical interpretations and morphisms of a particular kind of coalgebras. This opens way to the use of coalgebraic constructions, such as simulation and bisimulation, in the study of interpretations between (abstract) logics.Fundação para a Ciência e a Tecnologia (FCT