Maternal collapse: Challenging the four-minute rule

AbstractIntroductionThe current approach to, cardiopulmonary resuscitation of pregnant women in the third trimester has been to adhere to the “four-minute rule”: If pulses have not returned within 4min of the start of resuscitation, perform a cesarean birth so that birth occurs in the next minute. This investigation sought to re-examine the evidence for the four-minute rule.MethodsA literature review focused on perimortem cesarean birth was performed using the same key words that were used in formulating the “four-minute rule.” Maternal and neonatal injury free survival rates as a function of arrest to birth intervals were determined, as well as actual incision to birth intervals.ResultsBoth maternal and neonatal injury free survival rates diminished steadily as the time interval from maternal arrest to birth increased. There was no evidence for any specific survival threshold at 4min. Skin incision to birth intervals of 1min occurred in only 10% of women.ConclusionOnce a decision to deliver is made, care providers should proceed directly to Cesarean birth during maternal cardiac arrest in the third trimester rather than waiting for 4min for restoration of the maternal pulse. Birth within 1min from the start of the incision is uncommon in these circumstances

Virtual and augmented reality as enablers for improving the service on distributed assets

The evolution of Augment and Virtual Reality is enabling new solutions. This paper addresses creation of applications to support service and maintenance of distributed systems. Indeed this approach could be applied to devices provided as service for industrial and individual use and could introduce new capabilities in terms of training for operators, control and remote service support. The paper presents a case study devoted to lead the introduction of these innovative solutions in industrial and health care system

Usefulness of hybrid SPECT/CT for the 99mTc-HMPAO-labeled leukocyte scintigraphy in a case of cranial osteomyelitis

Cranial osteomyelitis is a potentially fatal lesion. White blood cell scanning (WBC) with 99mTc-hexamethylpropylene amine oxime (HMPAO) has proven highly sensitive and specific in the diagnosis and follow-up of patients with suspected osteomyelitis. In this report we show the usefulness of SPECT and transmission CT performed simultaneously using a hybrid imaging device for the functional anatomic mapping of soft tissue and cranial bone infections. 99mTc-HMPAO-labeled leukocytes scintigraphy was performed on an elderly diabetic man with an intracranial mass lesion and with suspected temporal bone infection. Planar scans were acquired 30 min, 4 h, and 24 h after injection. SPECT/CT was obtained 6 h after tracer injection, using a dual-head camera coupled with a low-power X-ray tube. The scintigraphic results were matched with the results of surgery and of clinical follow-up. The planar images alone were true-positives for abscess in this patient. SPECT/CT improves the accuracy of 99mTc-HMPAO scintigraphy especially in discriminating between soft-tissue and bone involvement. In fact, SPECT/CT also showed temporal bone osteomyelitis. This result indicates that SPECT/CT performed using a hybrid device can improve imaging with 99mTc-HMPAO-labeled leukocytes in patients with suspected osteomyelitis by providing accurate anatomic localization and precise definition of the extent of infection

Perampanel and Visuospatial Skills in Children With Epilepsy

Introduction: Perampanel (PER) is a non-competitive AMPA glutamate receptor antagonist approved for focal and generalized seizures as add-on therapy. PER does not seem to negatively affect the cognitive profile in children and adolescents, but its influence on visuospatial abilities is still to be assessed. The aim of our study was to assess visuospatial skills through a standardized neuropsychological evaluation in adolescents taking PER for 12 months. Methods: Our sample included 46 adolescents aged 12–18 years with focal and generalized drug-resistant epilepsy already in therapy with one or two antiseizure medications. Changes in visuospatial perception and memory were assessed by the Rey–Osterrieth Complex Figure Test at baseline (before taking PER) and after 12 months of pharmacological treatment. Executive functions and non-verbal intelligence were also assessed at baseline. Results: After 12 months of PER therapy, the mean scores on the Rey–Osterrieth Complex Figure Test remained almost unchanged for both visuospatial perception and visuospatial memory skills. At baseline, visuospatial memory was related to executive function, and visuospatial perception was related to executive function and non-verbal intelligence. Conclusions: Adjunctive treatment with PER did not negatively affect visuospatial skills. No adverse event effects have been reported after 12 months of follow-up, and this suggests a good tolerability in the middle-to-long term

Wearable and interactive mixed reality solutions for fault diagnosis and assistance in manufacturing systems: Implementation and testing in an aseptic bottling line

Thanks to the spread of technologies stemming from the fourth industrial revolution, also the topic of fault diagnosis and assistance in industrial contexts has benefited. Indeed, several smart tools were developed for assisting with maintenance and troubleshooting, without interfering with operations and facilitating tasks. In line with that, the present manuscript aims at presenting a web smart solution with two possible applications installed on an Android smartphone and Microsoft HoloLens. The solution aims at alerting the operators when an alarm occurs on a machine through notifications, and then at providing the instructions needed for solving the alarm detected. The two devices were tested by the operators of an industrial aseptic bottling line consisting of five machines in real working conditions. The usability of both devices was positively rated by these users based on the System Usability Scale (SUS) and additional appropriate statements. Moreover, the in situ application brought out the main difficulties and interesting issues for the practical implementation of the solutions tested

Traumatic brain injury and suicide risk

Among the various consequences of traumatic brain injury (TBI), evidence supports the notion that individuals exposed to such events may be at higher risk of suicide. We therefore aim at reviewing the literature by focusing on possible association between TBI and features of the suicidal spectrum, such as suicidal ideation, suicide attempts and completed suicides. We carried out a computerized search for reports of studies involving TBI and suicide risk. A total of 35 reports provide data with preliminary support of this association. Seven articles showed a direct correlation between TBI and completed suicides. Thirteen articles have shown a direct relationship between TBI and suicide attempts; five articles demonstrated a positive correlation with suicidal ideation and suicidality. We also found negative results failing to show a correlation between TBI and completed suicides (one article), suicide attempts (one article) and suicidality (one article). In addition, one article showed that patients who received psychological treatment (CBT therapy) after suffering a head injury showed a significant reduction in suicidal ideation. These preliminary findings encourage further testing of the association between TBI and suicide risk regardless of the psychiatric history. Furthermore, those who have a history of psychiatric illness before the TBI present a greater risk of suicide than those who do not have psychiatric precedents

TREATMENT OF CLASS I MALOCCLUSION WITH FRANKEL APPLIANCE

Aim. The aim of this paper is to evaluate the effect of the Frankel in child with class I malocclusion, maxillary and mandibular contraction, and anterior teeth crowding. Materials and methods. 5 patients with a class I division I malocclusion, maxillary and mandibular contraction and anterior crowding was enrolled in the present study. All patients presented with a stage CS2, CS3 or CS4. Patients with CS5 were not enrolled in the study. Before wearing the Frankel, on each patient head radiographs were taken in lateral plane with the head fixed in a cephalostat with a filmfocus distance of 4 m and a midsagittal-to-film distance of 0,1 m. Cephalometric analysis and casts analysis was performed before phase 1 treatment (T1), and immediately following phase 2 treatment (T2). In addition to standard cephalometric evaluation, another analysis, based on the distance of the basion, A and B to the T line, was done. Patients were instructed to wear the Frankel for 16 hours per day, during the night and afternoon, removing it only to eat and brush. Active treatment lasted 24 months for all patients. A statistical analysis of cephalometric and casts values before and after treatment was done.Results. After 24 months of treatment the cephalometric effects observed were: an increase of the anterior facial height (mean 3,8 mm), an increase of the distance of the basion to the T line (mean 3,6 mm), a incisors tip control (upper incisors mean 0°, lower incisors - 3,2°) and a sagittal maxillary growth control (the mean distance of A to T line was 0°, the mean distance of B to T line was of - 2,2 mm). On cast authors observed an expansion of the upper and lower arches (anterior upper arch expansion mean 2 mm, posterior upper arch expansion mean 2,5 mm; lower arch mean 1 mm) with anterior crowding resolution and incisors sagittal control. Conclusions. Authors evaluated that Frankel had a great repeal to control jaw growth, an increase of maxillary and mandibular expansion, an increase of the anterior facial height with a good control of incisors inclination

Selective Laser Sintering versus Multi Jet Fusion: A Comprehensive Comparison Study Based on the Properties of Glass Beads-Reinforced Polyamide 12

Selective laser sintering (SLS) and multi jet fusion (MJF) are the most widespreadpowder bed fusion additive manufacturing techniques for fabricating polymericparts since they offer great designflexibility, productivity, and geometricalaccuracy. However, these technologies differ in the thermal energy source usedto melt the powders as well as the innovative use of printing agents featured inthe latter one to promote material consolidation and to avoid thermal bleeding atthe part contours. The use of a single powder made of glass beads-reinforcedpolyamide 12 (PA12/GB) for the fabrication of MJF and SLS samples makespossible a systematic comparison of the printed parts properties. A thoughtfulanalysis of the microstructure and mechanical properties of the samples revealsdifferences and peculiarities between the two technologies. SLS exhibits lowerporosity and higher mechanical performances when the parts are printed alongthe build plane thanks to the powerful heating ensured by the laser. In contrast,MJF samples show higher mechanical isotropy with greatflexural and tensilebehavior for vertically oriented parts. The role of glass beads in the materialbehavior is defined by their mechanical properties, meaning higher rigidity andlower strength compared to neat PA12, and fracture mechanism

Neuropsychological profile, emotional/behavioral problems, and parental stress in children with neurodevelopmental disorders

Background: The aim of our study was to trace a specific neuropsychological profile, to investigate emotional-behavioral problems and parental stress in children with Autism Spectrum Disorder Level 1/High functioning (ASD-HF), Specific Learning Disorders (SLD) and Attention Deficit/Hyperactivity Disorder (ADHD) disorders and to highlight similarities and differences among the three groups. Methods: We retrospectively collected the data from a total of 62 subjects with ASD-HF (n = 19) ADHD (n = 21), SLD (n = 22) and 20 typical development. All the participants underwent neuropsychological standardized test for the evaluation of cognitive profile (Wechsler Intelligence Scale for Children Fourth Edition-WISC-IV), behavioral and emotional problems (Child Behavior CheckList CBCL), and parental stress (Parental Stress Index Short Form-PSI-SF). The scores of the ASD-HF, ADHD, and SLD groups were compared using non-parametric statistic methods (Kruskall-Wallis H test and U Mann-Whitney for post-hoc analysis). Results: The ASD-HF group were significantly higher in all areas of the WISC-IV than the other two clinical groups. The SLD group performed significantly lower than ASD-HF in Working Memory Index. The SLD group showed lower scores on the somatic problems subscale than the other two groups. In the Difficult Child subscale of the PSI-SF, parents of ADHD children scored lower than the mothers of SLD subjects and higher than the fathers of SLD subjects. In all three groups there are specific deficiencies compared to the control group in the cognitive profile, behavioral and emotional problems, and parental stress. Conclusions: Our comparative analysis highlighted similarities and differences in three groups of children with different neurodevelopmental disorders, helping to better define cognitive, behavioral, and emotional characteristics of these children and parental stress of their parents

Social Cognition in Neurodevelopmental Disorders and Epilepsy

Introduction: The purpose of our study was to perform a comparative analysis of social cognition in children and adolescents with epilepsy, autism spectrum disorder (ASD), specific learning disorder (SLD) and in typical development (TD) controls. The secondary aim was to relate social cognition to some clinical and demographic characteristics. Methods: Our work is a transversal observational study. The recruits were 179 children and adolescents aged between 6 and 18 years diagnosed with epilepsy, ASD, or SLD and 32 subjects with TD. All the participants underwent neuropsychological assessment of Emotion Recognition (ER) and Theory of Mind (ToM) skills. Results: All three clinical groups performed significantly worse than controls in ER and ToM. The ASD group achieved significantly lower performance than the other groups; however, the scores of SLD and epilepsy groups were comparable. The ER performances are related to non-verbal intelligence only in the group with epilepsy. Conclusion: Children and adolescents with focal epilepsy, SLD, or ASD may present a deficit of varying extent in emotion recognition and ToM, compared with TD peers. These difficulties are more pronounced in individuals with ASD, but impairment worthy of clinical attention also emerges in individuals with SLD and epilepsy