Follicular nodules (Thy3) of the thyroid: is total thyroidectomy the best option?

BACKGROUND: Identification of the best management strategy for nodules with Thy3 cytology presents particular problems for clinicians. This study investigates the ability of clinical, cytological and sonographic data to predict malignancy in indeterminate nodules with the scope of determining the need for total thyroidectomy in these patients. METHODS: The study population consisted of 249 cases presenting indeterminate nodules (Thy3): 198 females (79.5%) and 51 males (20.5%) with a mean age of 52.43 ± 13.68 years. All patients underwent total thyroidectomy. RESULTS: Malignancy was diagnosed in 87/249 patients (34.9%); thyroiditis co-existed in 119/249 cases (47.79%) and was associated with cancer in 40 cases (40/87; 45.98%). Of the sonographic characteristics, only echogenicity and the presence of irregular margins were identified as being statistically significant predictors of malignancy. 52/162 benign lesions (32.1%) and 54/87 malignant were hypoechoic (62.07%); irregular margins were present in 13/162 benign lesions (8.02%), and in 60/87 malignant lesions (68.97%). None of the clinical or cytological features, on the other hand, including age, gender, nodule size, the presence of microcalcifications or type 3 vascularization, were significantly associated with malignancy. CONCLUSIONS: The rate of malignancy in cytologically indeterminate lesions was high in the present study sample compared to other reported rates, and in a significant number of cases Hashimoto’s thyroiditis was also detected. Thus, considering the fact that clinical and cytological features were found to be inaccurate predictors of malignancy, it is our opinion that surgery should always be recommended. Moreover, total thyroidectomy is advisable, being the most suitable procedure in cases of multiple lesions, hyperplastic nodular goiter, or thyroiditis; the high incidence of malignancy and the unreliability of intraoperative frozen section examination also support this preference for total over hemi-thyroidectomy

PREDICTION OF OPTIMAL WARFARIN MAINTENANCE DOSE USING ADVANCED ARTIFICIAL NEURAL NETWORKS

Introduction. The individual response to vitamin K antagonists (VKA) is highly variable, being influenced by clinical factors and genetic variants of enzymes that are involved in the metabolism of VKA (CYP2C)) and vitamin K (VKORC1). Currently, the dose of VKA is adjusted based on measurements of the prothrombin time. In the last years, mathematical algorithms were developed for estimating the appropriate VKA dose, based on different mathematical approaches working on clinical and genetic data. Artificial Neural Networks (ANN) are computerized algorithms resembling interactive processes of the human brain, which allow to study very complex non-linear phenomena like biological systems. Aim. To evaluate the performance of new generation ANN on a large data base of patients on chronic VKA treatment. Methods. Clinical and genetic data from 377 patients (186 m; 191 f) treated with a VKA (warfarin) average weekly maintenance dose (WMD) of 23.7 mg (11.5 SD) were used to create a dose algorithm. Forty-eight variables, including demographic, clinical and genetic data (5 CYP2C9 and 3 VKORC1 genetic variants) were entered into Twist\uae system, which can select fundamental variables during their evolution in search for the best predictive model. The final model, based on 23 variables expressed a functional approximation of the actual dose within a validation protocol based on a tripartite division of the data set (training, testing, validation). Results. In the validation cohort, the pharmacogenetic algorithm reached high accuracy, with an average absolute error of 5.7 mg WMD. In the subset of patients requiring 6421 mg (45 % of the cohort) and 21-49 mg (51 % of the cohort) the absolute error was 3.86 mg and 5.45 with a high percentage of subjects being correctly identified (72%, 74% respectively). Conclusion. ANN can be applied successfully for VKA maintenance dose prediction and represent a robust basis for a prospective multicentre clinical trial of the efficacy of genetically informed dose estimation for patients who require VKA

The vascular flora of the Marine Protected Area of "Capo Carbonara" (SE-Sardinia)

This study aims at presenting an updated inventory of the vascular flora of the Capo Carbonara Marine Protected Area, including the Sites of Community Importance “Isola dei Cavoli, Serpentara, Punta Molentis e Campulongu” and partially of “Costa di Cagliari”, in Sardinia (Italy). A total of 653 taxa are reported, 84% of which are native (5% endemics) and 16% non-native (10% neophytes, 6% archaeophytes). The native component includes 406 species, 135 subspecies, two variety and one hybrid, belonging to 75 families and 313 genera. The non-native taxa are 94 species, 13 subspecies, one variety and one hybrid, belonging to 40 families and 81 genera. Life-form analysis of native species revealed a prevalence of therophytes (49%) followed by hemicryptophytes (21%), geophytes (14%) and chamaephytes (7%). Therophytes (33%) fol lowed by phanerophytes (32%) are prevalent among the non-native taxa. Biogeographically, among native species, the Mediterranean element is largely prevailing (81%), mainly consisting of Circum-Mediterranean (39%) and Euro-Mediterranean (27%) taxa, while the American ele ment (35%) prevails over the Mediterranean species (29%) among the non-native taxa. Among endemics, the Sardo-Corsican taxa are dominant (55%), followed by Sardo-Corsican-Tuscan Archipelago (14%) and Sardinian (10%) taxa

Seed germination report for Limonium merxmuelleri subsp. merxmuelleri (Plumbaginaceae)

The present report illustrates the first germination data of Limonium merxmuelleri subsp. merxmuelleri, a pioneer species of mine waste materials of Iglesiente region (South-West Sardinia). After harvesting, seeds were subjected to germination tests at the Sardinian Germplasm Bank (BG-SAR). The results show a high germination capability and germination rate at each tested temperature, with a slight germination reduction at the highest temperature (25°C) that simulates the aridity of the summer period

A blockchain-based distributed paradigm to secure localization services

In recent decades, modern societies are experiencing an increasing adoption of interconnected smart devices. This revolution involves not only canonical devices such as smartphones and tablets, but also simple objects like light bulbs. Named the Internet of Things (IoT), this ever-growing scenario offers enormous opportunities in many areas of modern society, especially if joined by other emerging technologies such as, for example, the blockchain. Indeed, the latter allows users to certify transactions publicly, without relying on central authorities or intermediaries. This work aims to exploit the scenario above by proposing a novel blockchain-based distributed paradigm to secure localization services, here named the Internet of Entities (IoE). It represents a mechanism for the reliable localization of people and things, and it exploits the increasing number of existing wireless devices and blockchain-based distributed ledger technologies. Moreover, unlike most of the canonical localization approaches, it is strongly oriented towards the protection of the users’ privacy. Finally, its implementation requires minimal efforts since it employs the existing infrastructures and devices, thus giving life to a new and wide data environment, exploitable in many domains, such as e-health, smart cities, and smart mobility

Nationwide analysis of open groin hernia repairs in Italy from 2015 to 2020

Introduction: Inguinal hernia repair is one of the most commonly performed operations in general surgery. A total of 130.000 inguinal hernia repairs are performed yearly in Italy, and approximately 20 million inguinal hernias are treated worldwide annually. This report represents the trend analysis in inguinal hernia repair in Italy from a nationwide dataset for the 6-year period from 2015 to 2020. Materials and methods: Based on regional hospital discharge records, all the inguinal hernia repairs performed in public and private hospitals in Italy between 2015 and 2020 were reviewed based on diagnosis and procedure codes. For the aim of this study, data from the AgeNas (The National Agency for Regional Health Services) data source were analyzed. Results: Elective inguinal hernia repairs outnumbered urgent operations over the 6-year study period, ranging from 122,737 operations in 2015 to 65,780 in 2020 as absolute numbers, and from 87.96 to 83.3% of total procedures in 2019 and 2020 respectively, with an annual change ranging from - 66.58%, between 2020 and 2019, to - 2.49%, between 2019 and 2018 (mean = - 18.74%; CI =- 46.7%-9.22%; p < 0.0001). Conclusions: This large-scale review of groin hernia data from a nationwide Italian dataset provides a unique opportunity to obtain a snapshot of open groin hernia repair activity. More specifically, there is a trend to perform more elective than urgent procedures and there is a steady decrease in the amount of open hernia repairs in favor to laparoscopy

Popularity prediction of instagram posts

Predicting the popularity of posts on social networks has taken on significant importance in recent years, and several social media management tools now offer solutions to improve and optimize the quality of published content and to enhance the attractiveness of companies and organizations. Scientific research has recently moved in this direction, with the aim of exploiting advanced techniques such as machine learning, deep learning, natural language processing, etc., to support such tools. In light of the above, in this work we aim to address the challenge of predicting the popularity of a future post on Instagram, by defining the problem as a classification task and by proposing an original approach based on Gradient Boosting and feature engineering, which led us to promising experimental results. The proposed approach exploits big data technologies for scalability and efficiency, and it is general enough to be applied to other social media as well

Dabigatran overload in acute kidney injury: haemodialysis or idarucizumab? A case report and proposal for a decisional algorithm

Dabigatran overload has been reported in acute kidney injury (AKI), leading to occasional major bleeding. Haemodialysis (HD) was the method used for reversing dabigatran anticoagulant effects before the approval of idarucizumab, which is now indicated for dabigatran reversal in major bleeding or surgical emergencies. There have been reports of rebound of dabigatran levels following idarucizumab administration in AKI, requiring HD to achieve effective dabigatran clearance. However, a decisional algorithm to individualize treatments for dabigatran overload seems lacking. We present a case of dabigatran accumulation in obstructive AKI with minor bleeding that was successfully treated with HD and tranexamic acid without using idarucizumab, and propose a decision-making algorithm including different pathways in the management of suspected dabigatran overload in AKI

CulturAI: Semantic Enrichment of Cultural Data Leveraging Artificial Intelligence

In this paper, we propose an innovative tool able to enrich cultural and creative spots (gems, hereinafter) extracted from the European Commission Cultural Gems portal, by suggesting relevant keywords (tags) and YouTube videos (represented with proper thumbnails). On the one hand, the system queries the YouTube search portal, selects the videos most related to the given gem, and extracts a set of meaningful thumbnails for each video. On the other hand, each tag is selected by identifying semantically related popular search queries (i.e., trends). In particular, trends are retrieved by querying the Google Trends platform. A further novelty is that our system suggests contents in a dynamic way. Indeed, as for both YouTube and Google Trends platforms the results of a given query include the most popular videos/trends, such that a gem may constantly be updated with trendy content by periodically running the tool. The system has been tested on a set of gems and evaluated with the support of human annotators. The results highlighted the effectiveness of our proposal