Artificial Intelligence in the Intensive Care Unit

AbstractThe diffusion of electronic health records collecting large amount of clinical, monitoring, and laboratory data produced by intensive care units (ICUs) is the natural terrain for the application of artificial intelligence (AI). AI has a broad definition, encompassing computer vision, natural language processing, and machine learning, with the latter being more commonly employed in the ICUs. Machine learning may be divided in supervised learning models (i.e., support vector machine [SVM] and random forest), unsupervised models (i.e., neural networks [NN]), and reinforcement learning. Supervised models require labeled data that is data mapped by human judgment against predefined categories. Unsupervised models, on the contrary, can be used to obtain reliable predictions even without labeled data. Machine learning models have been used in ICU to predict pathologies such as acute kidney injury, detect symptoms, including delirium, and propose therapeutic actions (vasopressors and fluids in sepsis). In the future, AI will be increasingly used in ICU, due to the increasing quality and quantity of available data. Accordingly, the ICU team will benefit from models with high accuracy that will be used for both research purposes and clinical practice. These models will be also the foundation of future decision support system (DSS), which will help the ICU team to visualize and analyze huge amounts of information. We plea for the creation of a standardization of a core group of data between different electronic health record systems, using a common dictionary for data labeling, which could greatly simplify sharing and merging of data from different centers

GREEN WATER LOADING ON A DECK STRUCTURE

At the previous Workshop, a numerical investigation of water-on-deck phenomena was presented by the same au- thors. A two-dimensional problem was considered. The ef- fect of main wave- and body-parameters was studied. The fully nonlinear problem was solved by boundary-integral e- quations. Here, we discuss a continuation of that activity. Results from an on-going experimental investigation are p- resented, together with the analysis of the interaction of the fluid on the deck with superstructures

An investigation of water on deck phenomena

Shipping of water on deck represents a danger both for moored (as FPSO) and for advancing ships. When a compact mass of water (\u27green water\u27) is shipped onto the deck, the fluid moves with high speed, being able to damage superstructures and equipments and to be a risk for human lives. Also, the shipped water can significantly alter the dynamics of smaller vessels. Such events make the green water loads an important parameter to take into account even at design stage and call for predictive tools. However, knowledge about the physics involved is still limited and motivates increasing research effort

Numerical Simulation of Heavy Water Shipping

Rough-sea conditions can result in shipping of water on the deck of vessels. In particular, our ongoing investigation is focused on the bow-deck wetness in head-sea conditions for a moored ship, i.e. without forward speed. Though in practice three-dimensional effects matter, two-dimensional investigations are undertaken to gain basic insights, before developing more realistic three-dimensional approaches. In previous Workshops, a combined numerical-experimental analysis has been presented. In particular, a potential flow model has been assumed and a Mixed Eulerian-Lagrangian method has been adopted to solve the unsteady interaction between the body and the free surface. The Boundary Element Method (BEM) has been used as numerical solver. In the experiments, a two-dimensional nearly-rectangular ship model has been placed in a narrow wave flume, and the first water-on-deck event due to incoming waves generated by a flap wavemaker has been investigated. The model is fixed and resembles the centerplane of a ship. Comparisons confirmed the validity of the adopted flow model and the efficiency of the BEM in capturing the water shipping from a global point of view as well as in predicting some local features, such as the initial pressure along a superstructure under the impact of the shipped water

Mechanistic and Physiological Implications of the Interplay among Iron-Sulfur Clusters in [FeFe]-Hydrogenases. A QM/MM Perspective

Key stereoelectronic properties of Desulfovibrio desulfuricans [FeFe]-hydrogenase (DdH) were investigated by quantum mechanical description of its complete inorganic core, which includes a Fe6S6 active site (the H-cluster), as well as two ancillary Fe4S4 assemblies (the F and F' clusters). The partially oxidized, active-ready form of DdH is able to efficiently bind dihydrogen, thus starting H-2 oxidation catalysis. The calculations allow us to unambiguously assign a mixed Fe(H)Fe(I) state to the catalytic core of the active-ready enzyme and show that H-2 uptake exerts subtle, yet crucial influences on the redox properties of DdH. In fact, H-2 binding can promote electron transfer from the H-cluster to the solvent-exposed F'-cluster, thanks to a 50% decrease of the energy gap between the HOMO (that is localized on the H-cluster) and the LUMO (which is centered on the F'-cluster). Our results also indicate that the binding of the redox partners of DdH in proximity of its F'-cluster can trigger one-electron oxidation of the H-2-bound enzyme, a process that is expected to have an important role in H-2 activation. Our findings are analyzed not only from a mechanistic perspective, but also in consideration of the physiological role of DdH. In fact, this enzyme is known to be able to catalyze both the oxidation and the evolution of H-2, depending on the cellular metabolic requirements. Hints for the design of targeted mutations that could lead to the enhancement of the oxidizing properties of DdH are proposed and discussed

A recalcitrant case of folliculitis decalvans: imaging and treatment options

Folliculitis decalvans (FD) is a rare form of scarring alopecia, presenting with tufted hairs, follicular papules or pustules. It is the most common of neutrophilic alopecia, often associated with pruritus and pain. Currently, the cause of FD is still unknown. Scalp colonization by staphylococcus aureus seems to induce a severe inflammatory reaction with consequent destruction of hair follicles. All patients with active FD should be treated because the disease destroys hair follicles and causes permanent hair loss. Multiple treatments exist, but often provide only transitory or modest improvement. For this reason FD can negatively affect patient’s quality of life. A 46-year-old man presented with 15-year history of FD characterized by recurrent purulent follicular lesion on occipital side of the scalp and consequent scarring alopecia. His medical history was unremarkable, but he was distressed by the appearance of the lesions and hair loss. He was treated with different therapies such as doxycycline, rifampicin and hydroxychloroquine with poor results. He underwent two sessions of photodynamic treatment with methyl aminolevulinate at 2-week interval. At first, he was achieved benefit, but after 2 months there was recurrence and further progression of the disease. Based on literature reports, we decided to treat with long-pulse ND:Yag laser. We started at 30 J/cm2 and then we improved dose until 80 J/cm2. A total of 7 treatments in an 8-12 weeks inter-treatment interval were performed with successfully outcome, without relapse for more than 18 months of follow up. We monitored scalp inflammation with reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) during patient’s treatment. Both technologies represent non-invasive diagnostic tool and their application on inflammatory skin diseases has increased in the last years. ND:Yag laser is useful therapy option in the treatment of recalcitrant FD. Our experience allowed us to monitor the evolution of inflammatory reaction, confirmed treatment’s efficacy over the clinical examination

Therapeutic Effectiveness of Nutrition Therapy in Pediatric Patients with Chronic Liver Diseases Awaiting Liver Transplantation

Abstract It is important to prevent protein/calorie malnutrition in children with end stage liver diseases prior to transplantation. This study involved 34 patients between the ages of 10 and 156 months (mean value 25.69 months 32.2) (13 females and 21 males) on the liver transplant waiting list. Data collected as of three months before transplant and up to ten months after the procedure concerned gender, age, weight, height, Pediatric End Stage Liver Disease Score, baseline pathology, type of nutrition, type of transplant, immunosuppression, pulse steroid therapy, length of stay, and post transplant complications. Linear regression analysis showed that the length of hospital stay was 24.5 days more for females than for males, but also that intensive nutrition therapy shortens this stay for both female patients (P = 0.085) and younger patients (P = 0.023). The study population was divided into two groups according to the different nutritional therapies adopted. The Student’s t-test and Mann-Whitney test evidenced that the group receiving intensive nutrition therapy grew taller compared with the group following an oral diet (mean -1.37 and Prob = 0.043); that females grew taller compared to males (mean -1.65 +/- 0.56); and that there was an increase in height among the children in the group receiving intensive nutrition therapy despite the presence (-1.37 +/- 0.56) or absence (-14.8 +/- 5.44 and Prob = 0.035) of complications, and despite the administration (-1.03 +/- 0.33) or non administration (-1.48 +/- 0.55 and Prob = 0.019) of steroids. Intensive nutrition therapy enhances the velocity of growth in height and shortens the length of hospital stay, thus optimizing the final prognosis of the baseline pathology

Parkinson's disease: autoimmunity and neuroinflammation

Parkinson's disease is a neurodegenerative disease that causes the death of dopaminergic neurons in the substantia nigra. The resulting dopamine deficiency in the basal ganglia leads to a movement disorder that is characterized by classical parkinsonian motor symptoms. Parkinson's disease is recognized as the most common neurodegenerative disorder after Alzheimer's disease. PD ethiopathogenesis remains to be elucidated and has been connected to genetic, environmental and immunologic conditions. The past decade has provided evidence for a significant role of the immune system in PD pathogenesis, either through inflammation or an autoimmune response. Several autoantibodies directed at antigens associated with PD pathogenesis have been identified in PD patients. This immune activation may be the cause of, rather than a response to, the observed neuronal loss. Parkinsonian motor symptoms include bradykinesia, muscular rigidity and resting tremor. The non-motor features include olfactory dysfunction, cognitive impairment, psychiatric symptoms and autonomic dysfunction. Microscopically, the specific degeneration of dopaminergic neurons in the substantia nigra and the presence of Lewy bodies, which are brain deposits containing a substantial amount of α-synuclein, have been recognized. The progression of Parkinson's disease is characterized by a worsening of motor features; however, as the disease progresses, there is an emergence of complications related to long-term symptomatic treatment. The available therapies for Parkinson's disease only treat the symptoms of the disease. A major goal of Parkinson's disease research is the development of disease-modifying drugs that slow or stop the neurodegenerative process. Drugs that enhance the intracerebral dopamine concentrations or stimulate dopamine receptors remain the mainstay treatment for motor symptoms. Immunomodulatory therapeutic strategies aiming to attenuate PD neurodegeneration have become an attractive option and warrant further investigation

A thiocarbonate sink on the enzymatic energy landscape of aerobic CO oxidation? Answers from DFT and QM/MM models of Mo–Cu CO-dehydrogenases

We present a theoretical investigation providing key insights on a long-standing controversial issue that dominated the debate on carbon monoxide oxidation by Mo–Cu CO-dehydrogenases. Previous investigations gravitate around the possible occurrence of a thiocarbonate intermediate, that was repeatedly reported to behave as a thermodynamic sink on the catalytic energy landscape. By using a hierarchy of quantum mechanical and hybrid quantum/classical models of the enzyme, we show that no such energy sink is present on the catalytic energy profile. Consequent perspectives for the definition of a novel mechanistic proposal for the enzyme-catalyzed CO-oxidation are discussed in light of the recent literature

Laryngeal sensitivity in patients with amyotrophic lateral sclerosis

Recent studies have shown the involvement of the sensory nervous system in patients with amyotrophic lateral sclerosis (ALS). The aim of our study was to investigate the correlation between the laryngeal sensitivity deficit and the type of ALS onset (bulbar or spinal) in a large series of 114 consecutive ALS patients. Participants were subdivided into two groups, bulbar and spinal ALS, according to the clinical onset of disease and submitted to a clinical and instrumental evaluation of swallowing, including a fiber-optic endoscopic evaluation of swallowing with sensory testing. Dysphagia severity was scored using the Penetration–Aspiration Scale (PAS) and the Pooling score (P-score). In addition, three patients with laryngeal sensitivity deficit were submitted to a laryngeal biopsy to assess the status of the sensory innervation. All patients showed a normal glottal closure during phonation and volitional cough. Fifty-six subjects (49%), 14 spinal- and 42 bulbar-onset ALS, showed dysphagia at the first clinical observation (PAS score >1; P-score >5). Dysphagia resulted more frequently in bulbar-onset ALS (P < 0.01). Thirty-eight (33%) patients had a sensory deficit of the larynx. The sensory deficit of the larynx was significantly more frequent in bulbar-onset ALS (P < 0.01). The sensory deficit of the larynx among dysphagic patients was also significantly more frequent in bulbar-onset ALS (P = 0.02). Several abnormalities were found in all three subjects who underwent a laryngeal biopsy: in one patient, no intraepidermal fiber was found; in the other two, the fibers showed morphological changes. Our observations are important to consider for assessment and management of dysphagia in patients with AL