The Use of Six Sigma to Assess Two Prostheses for Immediate Breast Reconstruction

Breast reconstruction is fundamental and urgent for patients in order to avoid future psychological and physical issues. That’s why immediate breast reconstruction has been requested increasingly in the last years. In this study two prosthesis with different structures and properties were compared according the aesthetic appearance (BREAST-Q© was employed) and five complications (seroma, hematoma, infections, dehiscence and red breast syndrome). The overall population was composed by 56 patients: 24 received a Tutomesh prosthesis and 32 received a Surgimend prosthesis. The DMAIC (define, measure, analyse, improve and control) cycle was implemented as a problem-solving strategy of the Six Sigma to compare the prostheses. While statistically significant difference between the two groups wasn’t found according to the overall BREAST-Q© (p-value = 0.674), the number of complications of the two groups resulted statistically different (p-value of chi-square test less than 0.001). Although it is not possible to understand from this study the reasons of the differences between the complications, this research proved that Surgimend and Tutomesh prostheses can be both implanted safely for immediate breast reconstruction since the higher costs of Surgimend could be neutralized with its lower hospitalization compared to Tutomesh. © 2021, Springer Nature Switzerland AG

Precision medicine and machine learning towards the prediction of the outcome of potential celiac disease

Potential Celiac Patients (PCD) bear the Celiac Disease (CD) genetic predisposition, a significant production of antihuman transglutaminase antibodies, but no morphological changes in the small bowel mucosa. A minority of patients (17%) showed clinical symptoms and need a gluten free diet at time of diagnosis, while the majority progress over several years (up to a decade) without any clinical problem neither a progression of the small intestine mucosal damage even when they continued to assume gluten in their diet. Recently we developed a traditional multivariate approach to predict the natural history, on the base of the information at enrolment (time 0) by a discriminant analysis model. Still, the traditional multivariate model requires stringent assumptions that may not be answered in the clinical setting. Starting from a follow-up dataset available for PCD, we propose the application of Machine Learning (ML) methodologies to extend the analysis on available clinical data and to detect most influent features predicting the outcome. These features, collected at time of diagnosis, should be capable to classify patients who will develop duodenal atrophy from those who will remain potential. Four ML methods were adopted to select features predictive of the outcome; the feature selection procedure was indeed capable to reduce the number of overall features from 85 to 19. ML methodologies (Random Forests, Extremely Randomized Trees, and Boosted Trees, Logistic Regression) were adopted, obtaining high values of accuracy: all report an accuracy above 75%. The specificity score was always more than 75% also, with two of the considered methods over 98%, while the best performance of sensitivity was 60%. The best model, optimized Boosted Trees, was able to classify PCD starting from the selected 19 features with an accuracy of 0.80, sensitivity of 0.58 and specificity of 0.84. Finally, with this work, we are able to categorize PCD patients that can more likely develop overt CD using ML. ML techniques appear to be an innovative approach to predict the outcome of PCD, since they provide a step forward in the direction of precision medicine aimed to customize healthcare, medical therapies, decisions, and practices tailoring the clinical management of PCD children

Molecular phylogeny of Nassauvia (Asteraceae, Mutisieae) based on nrDNA ITS sequences

The phylogeny of the genus Nassauvia and closely related genera was reconstructed using sequences from the internal transcribed spacer regions (ITS) of nuclear ribosomal DNA. The genus Triptilion is nested within Nassauvia, making the latter genus paraphyletic. Neither of the two subgenera Nassauvia and Strongyloma is resolved as monophyletic, and none of the sections of subgenus Nassauvia is recovered as monophyletic. The evolution of the compound secondary inflorescences has been complex in Nassauvia, with the highly aggregated forms representing the original condition in the genus. However, the ancestral condition is equivocal in several clades, and there are alternative reconstructions for the gains?losses of the variously aggregated conditions. There has been at least one gain of solitary capitula in Nassauvia. The evolution of flavonoid chemistry has been complex in Nassauvia, and flavonoids are of limited phylogenetictaxonomic utility in the genus. Gains?losses of flavonols occur only on terminals whereas changes in flavones and C-glycosyl flavones occur at various levels in the tree. Gains?losses of methylation of flavones and flavonols occur only on terminals.Nassauvia and closely related genera was reconstructed using sequences from the internal transcribed spacer regions (ITS) of nuclear ribosomal DNA. The genus Triptilion is nested within Nassauvia, making the latter genus paraphyletic. Neither of the two subgenera Nassauvia and Strongyloma is resolved as monophyletic, and none of the sections of subgenus Nassauvia is recovered as monophyletic. The evolution of the compound secondary inflorescences has been complex in Nassauvia, with the highly aggregated forms representing the original condition in the genus. However, the ancestral condition is equivocal in several clades, and there are alternative reconstructions for the gains?losses of the variously aggregated conditions. There has been at least one gain of solitary capitula in Nassauvia. The evolution of flavonoid chemistry has been complex in Nassauvia, and flavonoids are of limited phylogenetictaxonomic utility in the genus. Gains?losses of flavonols occur only on terminals whereas changes in flavones and C-glycosyl flavones occur at various levels in the tree. Gains?losses of methylation of flavones and flavonols occur only on terminals.Fil: Maraner, Fabrizio. Universidad de Viena; AustriaFil: Samuel, Rosabelle. Universidad de Viena; AustriaFil: Stuessy, Tod F.. Universidad de Viena; AustriaFil: Crawford, Daniel J.. University of Kansas; Estados UnidosFil: Crisci, Jorge Victor. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. División de Plantas Vasculares; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Pandey, A.. University Of Delhi; IndiaFil: Mort, Mark E.. University of Kansas; Estados Unido

Global stability condition for collocation methods for Volterra integral equations of the second kind

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Post-exposure prophylaxis with sotrovimab for Omicron (B.1.1.529) SARS-CoV-2 variant during the aplastic phase of autologous stem cell transplantation

Background To date, there is no information on the safety and efficacy of the novel anti-sarbecoviruses monoclonal antibody sotrovimab administered, as a post-exposure prophylactic measure, during the aplastic phase of autologous stem cell transplantation (ASCT). Methods We describe the outcomes of a Multiple Myeloma (MM) patient, who was threateningly exposed to the Omicron (B.1.1.529) SARS-CoV-2 variant, two days after having received a myeloablative regimen of high-dose melphalan. The patient fulfilled all CDC criteria for prolonged close contacts with an index patient who tested positive for a molecular nasopharyngeal swab (Omicron; B.1.1.529) soon after admission to the ward. Given the high risks of morbidity and mortality in the case of COVID-19 developing during the aplastic phase of transplantation, we adopted a post-exposure prophylaxis intervention based on intravenous (i.v.) sotrovimab

Stromboli: a natural laboratory of environmental science

The science of environment is per se multi- and inter-disciplinary. It is not possible to separate the role of the physical, chemical, biological, and anthropic factors, respectively. Research must therefore rely on suitable natural laboratories, where all different effects can be simultaneously monitored and investigated. Stromboli is a volcanic island slightly North of Sicily, within a tectonic setting characterised by a Benioff zone, curved like a Greek theatre, opened towards the Tyrrhenian Sea, with deep earthquakes. Moreover, it is a unique volcano in the world in that since at least ~ 3000 years ago, it has exploded very regularly, about every 15^20 min. Hence, it is possible to monitor statistically phenomena occurring prior, during, and after every explosion. The Istituto Nazionale di Geofisica e Vulcanologia (INGV) has recently established a permanent Laboratory and an extensive interdisciplinary programme is being planned. A few main classes of items are to be considered including: (1) matter exchange (solid, liquid, gas, chemistry); (2) thermal and/or radiative coupling; (3) electromagnetic coupling; (4) deformation; (5) biospheric implications; and (6) anthropic relations since either the times of the Neolithic Revolution. Such an entire multidisciplinary perspective is discussed, being much beyond a mere volcanological concern. We present here the great heuristic potential of such a unique facility, much like a natural laboratory devoted to the investigation of the environment and climate.Published429-442JCR Journalreserve

Towards generalized measures grasping CA dynamics

In this paper we conceive Lyapunov exponents, measuring the rate of separation between two initially close configurations, and Jacobians, expressing the sensitivity of a CA's transition function to its inputs, for cellular automata (CA) based upon irregular tessellations of the n-dimensional Euclidean space. Further, we establish a relationship between both that enables us to derive a mean-field approximation of the upper bound of an irregular CA's maximum Lyapunov exponent. The soundness and usability of these measures is illustrated for a family of 2-state irregular totalistic CA