Original Data Vs High Performance Augmented Data for ANN Prediction of Glycemic Status in Diabetes Patients

In the following article a comparative analysis between Original Data (OD) and Augmented Data (AD) are carried out for the prediction of glycemic status in patients with diabetes. Specifically, the OD concerning the time series of the glycemic status of a patient are compared with AD. The AD are obtained by the randomised average with five different ranges, and are processed by a Machine Learning (ML) algorithm for prediction. The adopted ML algorithm is the Artificial Neural Network (ANN) Multilayer Perceptron (MLP). In order to optimise the prediction two different data partitioning scenarios selecting training datasets are analysed. The results show that the algorithm performances related to the use of AD through the randomisation of data in different ranges around the average value, are better than the OD data processing about the minimization of statistical errors in self learning models. The best achieved error decrease is of 75.4% if compared with ANN-MLP processing of the original dataset. Furthermore, in the paper is added a linked discussion about the economic and managerial impact of AD in the healthcare sector

life threatening acute myocardial infarction due to left main dissection during radiofrequency transcatheter ablation of atrial tachycardia

n/

Hereditary Juvenile Haemochromatosis and Idiopathic Dilated Cardiomyopathy

Hereditary hemochromatosis (HH), a common autosomal recessive disease, is characterized by excessive iron overload/toxicity in multiple organs (joints, liver, heart, pancreas, pituitary, adrenals and skin). Symptoms and signs depend upon the location of the excess iron deposition. Dilated cardiomyopathy is a typical complication of HH. Juvenile haemochromatosis is a rare disorder of iron metabolism with clinical manifestations before 30 years of age. Two common mutations of the haemochromatosis associated gene (HFE), cys282tyr (C282Y) and his63asp (H63D), have been implicated in the HH. These genes also appear to be modulators in cardiovascular disease. In fact the HFE gene defects are related to idiopathic dilated cardiomyopathy (IDCM) in some patients, even though the results of genotype analyses were conflicting. In this case report we investigate a 21 year-old male patient affected by juvenile haemochromatosis associated with heterozygosity for the H63D mutation with an idiopathic dilated cardiomyopathy

Accuracy of Intravascular Ultrasound Evaluation for the Assessment of Native Valve Measures in Patients Undergoing TAVI: Preliminary Results

Transcatheter aortic valve implantation (TAVI) technique represents a real revolution in the field of interventional cardiology and medicine, in particular for the treatment of severe aortic valve stenosis in elderly patients or in patients when the periprocedural risk for the traditional surgical option is considered too high, as an alternative to the traditional aortic valve replacement. Although experience on the valves of the last generation is still limited in terms of time, the data currently available are definitely moving in the direction of a minimum hospital mortality (1%) as well as a drastic reduction in the incidence of complications when compared to the devices of the previous generation. Finally, the evolution of specified materials of the newest generation have greatly enhanced safety and efficacy of TAVI procedures in the last years. In order to ensure the selection of the most appropriate valve and the success of the procedure, the role of cardiac imaging (computed tomography scan evaluation and angiography) is crucial. These examinations require the use of contrast medium in patients suffering from renal dysfunction at the baseline. The need for fluoroscopy and angiography using contrast agents to aid positioning of the valve may lead to contrast-induced nephropathy (CIN) as one form or one etiology of acute kidney injury (AKI), which is associated with increased morbidity and mortality. The aim of our study is to investigate the accuracy of intravascular ultrasound (IVUS-a technique which does not need contrast) for the assessment of native valve measures in patients undergoing TAVI by comparing values obtained with IVUS to those ones previously obtained in the same patients with computed tomography (CT) scans

Safety and effectiveness of the transsubclavian approach for transcatheter aortic valve implantation with the 14-F CoreValve Evolut R device

International audienceAims - In addition to the transfemoral route, common approaches for transcatheter aortic valve implantation (TAVI) are the transapical and transaortic ones. Yet, these are associated with morbidity. The transsubclavian approach (TSA) is an alternative to minimize invasiveness. Methods - Fifteen consecutive patients underwent TAVI via TSA using the CoreValve Evolut R. The 14F delivery system without sheath was directly introduced into the artery. Results - Success was 100%; contrast volume was 99.4 ± 29.58 ml. Patients were extubated after 1.66 ± 0.89 h. Hemoglobin drop was 0.64 ± 0.28 g/dl. There were no complications. Hospital stay was 4.53 ± 1.24 days: 11 patients were discharged home, the remainder to rehabilitation. Conclusion - TSA is associated with limited morbidity, early patient mobilization, short hospitalization

An Unusual Case of Acute Myopericarditis Possibly Due to Food Poisoning

The manuscript describes the case of a 23 year-old woman, with acute myopericarditis associated with food poisoning without other cardiovascular disease. The patient had a history of hypothyroidism, treated with levothyroxine 75 μg/d, however she was clinically and biochemically euthyroid. We present a discussion of this rare association, followed by clinical presentation and treatment. This case report underlines the importance of considering possible cardiac complications when treating patients with food poisoning

Correlation between endothelial dysfunction and myocardial damage in acute phase of Tako-Tsubo cardiomyopathy: brachial flow mediated dilation as a potential marker for assessment of patient with Tako-Tsubo.

Takotsubo cardiomyopathy (TTC) is characterized by transient systolic ventricular dysfunction. It is supposed to be caused by a cathecolaminergic wave which leads to myocardial stunning through a massive action on beta2-adrenoreceptor. Moreover, beta2-receptor hyperactivity negatively influences endothelial function. It can be detected by brachial flow mediated dilation (b-FMD) which assesses endothelium regulated vasomotility. The study aim is to analyze the b-FMD variability during hospitalization in 50 patients admitted with TTC. In addition, we investigated a possible correlation between b-FMD at admission and both length of hospital stay (LOHS) and troponin I peak. We detected b-FMD by measuring the hypoxic induced vasoreactivity through assessing brachial artery dilation after 5 min of iatrogenic ischemia obtained by inflating a sphygmomanometer cuff. Artery diameter modifications were assessed by high-resolution ultrasound, and a dedicated software calculated accurately the percentage of dilation after ischemia by comparing it to the basal. These values were measured at admission and on discharge. The obtained values were compared for each patient to explore their variability during hospitalization. Moreover, the correlation between the b-FMD at admission and both the troponin I peak and the LOHS was investigated. There was a statistical significant difference between mean FMD measured at admission and at discharge (respectively 1.54 ± 0.34 and 8.92 ± 2.48%; p < 0.001). Moreover, we found a significant negative correlation between troponin I peak and FMD values at admission (r = - 0.7645; p < 0.001) and a significant inverse correlation between FMD at admission and LOHS (r = - 0.7543; p < 0.001). There is a significant improvement of b-FMD during hospitalization in patients admitted for Tako-Tsubo Cardiomyopathy. Moreover, for the first time, a direct correlation among b-FMD, troponin I peak and LOHS has been detected

Dissezione aortica acuta durante tentativo inefficace di impianto transcatetere di protesi aortica totalmente riposizionabile e recuperabile

Aortic injury is a rare but severe complication that may occur during transcatheter aortic valve implantation (TAVI). Few patients with type A dissection are treated surgically because of the high rate of postoperative mortality and neurological complications in this high-risk population; thoracic endovascular aortic repair is rare too, and technically challenging because of the anatomical variations of spiral type A aortic dissection. Sometimes a watchful waiting strategy could be the best solution. We report the case of an acute, extended aortic type A dissection occurred during a TAVI procedure, probably due to the rupture of the dedicated sheath, and conservatively managed