Combining Parametric and Non-parametric Algorithms for a Partially Unsupervised Classification of Multitemporal Remote-Sensing Images

In this paper, we propose a classification system based on a multiple-classifier architecture, which is aimed at updating land-cover maps by using multisensor and/or multisource remote-sensing images. The proposed system is composed of an ensemble of classifiers that, once trained in a supervised way on a specific image of a given area, can be retrained in an unsupervised way to classify a new image of the considered site. In this context, two techniques are presented for the unsupervised updating of the parameters of a maximum-likelihood (ML) classifier and a radial basis function (RBF) neural-network classifier, on the basis of the distribution of the new image to be classified. Experimental results carried out on a multitemporal and multisource remote-sensing data set confirm the effectiveness of the proposed system

PTPA variants and impaired PP2A activity in early-onset parkinsonism with intellectual disability

The protein phosphatase 2A complex (PP2A), the major Ser/Thr phosphatase in the brain, is involved in a number of signalling pathways and functions, including the regulation of crucial proteins for neurodegeneration, such as alpha-synuclein, tau and LRRK2. Here, we report the identification of variants in the PTPA/PPP2R4 gene, encoding a major PP2A activator, in two families with early-onset parkinsonism and intellectual disability. We carried out clinical studies and genetic analyses, including genome-wide linkage analysis, whole-exome sequencing, and Sanger sequencing of candidate variants. We next performed functional studies on the disease-associated variants in cultured cells and knock-down of ptpa in Drosophila melanogaster. We first identified a homozygous PTPA variant, c.893T&gt;G (p.Met298Arg), in patients from a South African family with early-onset parkinsonism and intellectual disability. Screening of a large series of additional families yielded a second homozygous variant, c.512C&gt;A (p.Ala171Asp), in a Libyan family with a similar phenotype. Both variants co-segregate with disease in the respective families. The affected subjects display juvenile-onset parkinsonism and intellectual disability. The motor symptoms were responsive to treatment with levodopa and deep brain stimulation of the subthalamic nucleus. In overexpression studies, both the PTPA p.Ala171Asp and p.Met298Arg variants were associated with decreased PTPA RNA stability and decreased PTPA protein levels; the p.Ala171Asp variant additionally displayed decreased PTPA protein stability. Crucially, expression of both variants was associated with decreased PP2A complex levels and impaired PP2A phosphatase activation. PTPA orthologue knock-down in Drosophila neurons induced a significant impairment of locomotion in the climbing test. This defect was age-dependent and fully reversed by L-DOPA treatment. We conclude that bi-allelic missense PTPA variants associated with impaired activation of the PP2A phosphatase cause autosomal recessive early-onset parkinsonism with intellectual disability. Our findings might also provide new insights for understanding the role of the PP2A complex in the pathogenesis of more common forms of neurodegeneration.</p

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Also: to be published on Information Fusion Combining Parametric and Non-parametric Algorithms for a Partially Unsupervised

Abstract. In this paper, we propose a classification system based on a multiple-classifier architecture, which is aimed at updating land-cover maps by using multisensor and/or multisource remote-sensing images. The proposed system is composed of an ensemble of classifiers that, once trained in a supervised way on a specific image of a given area, can be retrained in an unsupervised way to classify a new image of the considered site. In this context, two techniques are presented for the unsupervised updating of the parameters of a maximum-likelihood (ML) classifier and a radial basis function (RBF) neural-network classifier, on the basis of the distribution of the new image to be classified. Experimental results carried out on a multitemporal and multisource remote-sensing data set confirm the effectiveness of the proposed system

Preliminary follow-up data of an Italian multicenter cohort of paediatric anti-N-methyl-D-aspartate receptor encephalitis

Objective: To provide data on long-term follow-up of a cohort of children with anti-NMDAR encephalitis, focusing on disease course and outcome, with respect to treatment received. Methods: Data were collected through a questionnaire sent to the main Italian paediatric neurology centres, including both follow-up data of patients reported in the first Italian multicenter series of paediatric anti-NMDAR encephalitis in 2015, and new cases. Results: 35 children with anti-NMDAR encephalitis, from 14 Italian centres, were included (22 females; median age at onset 9.1 years, range 1.2-17.7). Prodromal symptoms occurred in 32.3% cases, behavioural/psychiatric disturbances in 100%, movement disorder in 100%, language disturbances in 97.1%, hyporeactivity/vigilance disturbances/catatonia in 91.4%, epileptic seizures in 85.7%, sleep disturbances in 78.8%, dysautonomias in 71.4%. Dysautonomias were more frequent in patients 12 years old than in younger children (90.9% vs. 62.5%, respectively). In the acute phase, median mRS in the whole cohort was 5 (range 3-5). All patients had positive anti-NMDAR antibodies in serum and/or CSF; tumour was detected in 1. All patients received first-line immune therapy, whereas second-line treatments were used in 45.7% at first event. 22.8% patients relapsed. Median mRS at follow-up was 1 (range 0-5) (length of follow-up: median 22 months, range 4-137). In the patients previously reported in 2015, there was a slight improvement in outcome with longer follow-up (mRS 0: 55.5% vs. 77.8%, respectively). Patients who received second- line immune therapy at the first episode of anti-NMDAR encephalitis were less likely to relapse than those who only received first-line treatments (6.2% vs. 36.8%, respectively). Conclusions: In our cohort, dysautonomias are more frequent in older children, and outcome tends to improve with time. Our data suggests that the use of second-line immune therapy reduces the rate of relapse in paediatric anti-NMDAR encephalitis. This represents to date the largest Italian series on paediatric anti-NMDAR encephalitis