Ultrasonographic diagnosis of placenta accreta spectrum (PAS) disorder: Ideation of an ultrasonographic score and correlation with surgical and neonatal outcomes

The objective of this study was to evaluate a novel ultrasonographic scoring system for the diagnosis of PAS and the prediction of maternal and neonatal outcomes. In this retrospective study, 138 patients with at least one previous caesarean section (CS) and placenta previa were included. They were divided into four groups ranging from Group 0 (Non PAS) to Group 3 (Placenta Percreta) according to the histological or surgical confirmation. Their ultrasound examinations during pregnancy were reviewed according to the nine different ultrasound signs reported by the European Working Group on Abnormally Invasive Placenta. For each parameter, 0 to 2 points were assigned. The sum of the points reflects the severity of PAS with a maximum score of 20. The scoring system revealed good performances in evaluation metrics, with an overall accuracy of 94%. In addition to this, patients’ characteristics and surgical and neonatal outcomes were analyzed with an evidence of higher incidence of complications in severe forms. Our study suggests that antenatal ultrasonographic diagnosis of PAS is feasible with sufficient level of accuracy. This will be important in identifying high-risk patients and implementing preventive strategy

Computer aided detection of clustered microcalcifications in digitized mammograms using Gabor functions

This paper presents a multiresolution approach to the computer aided detection of clustered microcalcifications in digitized mammograms based on Gabor elementary functions. A bank of Gabor functions with varying spatial extent and tuned to different spatial frequencies is used for the extraction of microcalcifications characteristics. Classification is performed by an Artificial Neural Network with supervised learning.First results show that most microcalcifications, isolated or clustered, are detected by our algorithm with a 95\% value both for sensibility and specificity as measured on a test data set

Experimental Validation of a Sensorized Ring Based on Optical Fiber for Strain Monitoring of Morphing Structure

An original monitoring (Monito-Ring) system based on chirped grating fiber optic sensor for structural strain modulation is presented. One of the main targets is to measure deformations of deformable morphing structures which may show large, global displacements. During operation, indeed, it is not often possible to connect sensors directly to the structural element because the strain which occurs is much more than the standard one can handle. Modulations are then necessary to keep the measured strain low. The proposed solution was conceived to overcome this limitation assuring a suitable reduction of the revealed strain. Factors between 1 and several tenth of thousands can be achieved. This article deals with the analytical study first, and then numerical and experimental validation of the device

Seventeen-year trend (2001\u20132017) in pacemaker and implantable cardioverter-defibrillator utilization based on hospital discharge database data: An analysis by age groups

Aims: To analyze temporal trends (2001 -2017) of Pacemakers (PM) and Implantable Cardioverter-Defibrillators (ICD) procedures in Italy, according to the national Hospital Discharge Database (HDD). Methods: Frequency and implant rate (IR) in the Italian population were analyzed by age groups (<50, 50\u201379, 6580 years). Results: From 2001 (2009 for Cardiac Resynchronization Therapy-Defibrillator \u2013 CRT-D) to 2017, first PM implants (1stPM) increased from 36,823 (637/million inhabitants) to 49,716 (820/million), ICD implants from 3,141 (54/million) to 24,255 (400/million) and CRT-D from 2,915 (49/million, 16.5% of ICD) to 8,595 (142/million, 35.4% of ICD). ICD implants due to ventricular tachycardia or ventricular fibrillation decreased from 55.6% to 13.5% and from 15.9% to 4.5% respectively, while the proportion increased among patients with heart failure (from 22.9% to 46.8%), hypertension (from 11.1% to 15.0%), diabetes (from 6.5% to 10.9%), and renal insufficiency (from 4.4% to 7.6%). Both PM and ICD procedures markedly increased in patients 6580 years old. However, while IR for ICDs increased from 82/million to 1,038/million inhabitants, IR of 1stPM only changed from 6,111/million to 6,212/million as the population in this age group nearly doubled in Italy. Conclusion: Since 2001, the increase of 1stPM in Italy was mainly due to the ultra-octogenarian population growth. No differences were observed for IR in each PM age group, while the absolute number and IR increased in all groups (especially 6580 years old) for ICDs and CRT-Ds. An increase in comorbidities and a reduction in implants for secondary prevention were observed in the ICD population

Damage detection of CFRP stiffened panels by using cross-correlated spatially shifted distributed strain sensors

This paper presents a cross-correlation function-based method applied to a spatially shifted differential strain readout vectors using distributed sensors under backscattering random noise and impact excitations. Structural damage is generated by low/medium energy impact on two aeronautical 24-ply CFRP (carbon fiber reinforced plastic) stiffened panels. Two different drop impact locations, two different sensor layouts and two different post-impact solicitations are provided for a skin-stringer debonding detection and length estimation. The differential signal with respect to an arbitrarily selected grounding is used. Then the effects of noise filtering are evaluated post-processing the differential signal by cross-correlating two strain vectors having one sensor gauge position lag. A Rayleigh backscattering sensing technology, with 5 mm of spatial resolution, is used to log the strain map. The results show a good coherence with respect to the NDI (nondestructive inspection) performed by ultrasonic C-scan (an ultrasonic imaging system) flaw detector

Un registro multiregionale italiano dei traumi gravi: ragioni, metodologia e risultati iniziali

Objective: project aiming at the establishment of the first Italian multiregional trauma registry and to evaluate its initial achievements. Design: Descriptive + Cohort comparison. Setting: 3 Italian hospitals, referral centers for severely traumatized patients. Patients: Trauma victims admitted between 1/7/2004 and 30/09/2004 with an Injury Severity Score (ISS>15) or requiring early admission to intensive care. Interventions: None. Measures: Indicators of quality of clinical data bases partly devised and partly derived from literature. Ten main descriptive variables of the patients with ISS>15, in general and by hospital: type of trauma, mechanism of injury, age, gender, ISS, RTS, TRISS, call-to-hospital and admission-to-ward intervals, outcome at 30 days. Results: A system of data collection on severely injured patients has been established, whose characteristics fulfill the expectations and compare well with the available references. Some aspects deserve improvement, namely the reporting of pre-hospital times by one hospital. The previous esteems on the number of cases (about 300/year/hospital) are confirmed. A substantial homogeneity among the various hospitals in regard to the main trauma descriptive variables exists. Conclusions: The project's aims have been nearly successfully attained so far. Positive future developments of the registry are possible: usage for quality improvement and research, linkage to other European registries and participation of other hospitals

The first italian trauma registry of national relevance: methodology and initial results

Objective To describe and discuss the ongoing endeavor to establish a multiregional trauma registry in Italy. Methods Design: Prospective observational analysis by description and cohort comparison. Setting: Three Italian hospitals, referral centers for severely traumatized patients. Patients: trauma victims admitted between 1 July 2004 and 28 February 2005 with an Injury Severity Score >15 or requiring early admission to intensive care. Interventions: None. Measures: Compilation rates for some 'sentry' variables. Total number of patients and Injury Severity Score. Ten widely used descriptive variables (type of trauma, mechanism of injury, age, gender, Injury Severity Score, Revised Trauma Score, Prognostic Severity Index, 'call-to-hospital' and 'admission-to-ward' intervals, and outcome at 30 days) measured in the subgroup with Injury Severity Score >15, in general and by hospital. Results A trauma registry has been established that fit the present organization of trauma care in Italy. It seems to compare well with the references available in the literature. Five hundred and forty-nine patients have been enrolled so far. The compilation rate has been well above 70% for all variables in all hospitals, except pre-hospital times in two hospitals. A substantial homogeneity exists among the hospitals in the general characteristics of the patients with Injury Severity Score >15. Conclusions The project has achieved its goals so far. The previous estimates on the number of cases (about 300/year/hospital) are confirmed and major shortcomings in methodology seem unlikely. Therefore, positive future developments are possible: usage for quality improvement and research, linkage to other European registries and participation of other hospitals

Registro Italiano dei Traumi Gravi multiregionale

The establishment of integrated extra- and intra- hospital care systems for trauma patients (Trauma System or SIAT) has in the past led to a considerable reduction in the mortality rate of trauma victims. One essential component of the Trauma System is the Trauma Register (TR), which is considered an indispensable tool for improving the quality of care in the trauma field. The aim of this article is to describe an innovative project that aims to create the first Italian multi-regional severe trauma register. The project involved three Italian hospitals with 2nd level Emergency Admissions Departments. The database includes all the trauma victims hospitalised in the three participating hospitals between 1st July 2004 and 30th June 2005 with an Injury Severity Score (ISS) > 15 or that were admitted directly to the resuscitation unit. The project resulted in the creation of a severe trauma data recording system, which meets expectations and which would appear to be of a good quality, in relation to the literature available. To date, most of the aims of the project have been achieved. We can therefore expect further positive evolutions, such as the use of the register to improve the quality of treatment and research, participation in a European-scale register and the participation of other hospitals