Fiberoptic monitoring of central venous oxygen saturation (PediaSat) in small children undergoing cardiac surgery: continuous is not continuous

Background: Monitoring of superior vena cava saturation (ScvO2) has become routine in the management of pediatric patients undergoing cardiac surgery. The objective of our study was to evaluate the correlation between continuous ScvO2 by the application of a fiber-optic oximetry catheter (PediaSat) and intermittent ScvO2 by using standard blood gas measurements. These results were compared to those obtained by cerebral near infrared spectroscopy (cNIRS). Setting: Tertiary pediatric cardiac intensive care unit (PCICU). Methods and main results: A retrospective study was conducted in consecutive patients who were monitored with a 4.5 or 5.5 F PediaSat catheter into the right internal jugular vein. An in vivo calibration was performed once the patient was transferred to the PCICU and re-calibration took place every 24 hours thereafter. Each patient had a NIRS placed on the forehead. Saturations were collected every 4 hours until extubation. Ten patients with a median age of 2.2 (0.13-8.5) years and a weight of 12.4 (3.9-24) kg were enrolled. Median sampling time was 32 (19-44) hours: 64 pairs of PediaSat and ScVO2 saturations showed a poor correlation (r=0.62, 95% CI 44-75; p<0.0001) and Bland Altman analysis for repeated measures showed an average difference of 0.34 with a standard deviation of 7,9 and 95% limits of agreement from -15 to 16. Thirty-six pairs of cNIRS and ScVO2 saturations showed a fair correlation (r=0.79, 95% CI 0.60-0.89; p<0.0001) an average difference of -1.4 with a standard deviation of 6 and 95% limits of agreement from -13 to 10. Analysis of median percentage differences between PediaSat and ScvO2 saturation over time revealed that, although not statistically significant, the change in percentage saturation differences was clinically relevant after the 8th hour from calibration (from -100 to +100%). Conclusion: PediaSat catheters showed unreliable performance in our cohort. It should be further investigated whether repeating calibrations every 8 hours may improve the accuracy of this system. CNIRS may provide similar results with a lower invasiveness

Incidence of lymphomas in inflammatory bowel disease: report of an emblematic case, systematic review, and meta-analysis

IntroductionOver the past 20 years, the increasing use of combined therapy with immunosuppressants and biologic agents has markedly reduced the use of steroids in the management of inflammatory bowel diseases (IBD). However, medical therapy seems to promote, in the long run, carcinogenesis resulting in an increased risk of developing different types of malignancies, including lymphomas. The aim of this study was to systematically review the current incidence and prognosis of lymphoid neoplasms occurring in patients with IBD.MethodsStudies analyzing the incidence of lymphomas in subjects of age &gt;18 years affected by IBD were included in this systematic review and meta-analysis. Studies focusing on pediatric populations, not reporting person-years of follow-up, or with a duration &lt; 1 year were excluded. PubMed, Embase, Web of Science Core Collection, and Cochrane Central Register were searched from inception through January 2022. Publication bias within studies was assessed using Begg's and Egger's tests and random effects model. Quantitative results were synthesized using relative-risk meta-analysis. PRISMA guidelines were used to carry out this systematic review (PROSPERO Registration Number: CRD42023398348).ResultsA total of 345 studies published between 1985 and 2022, with a total of 6,17,386 patients were included in the meta-analysis. Substantial heterogeneity between studies prevented the pooling of estimates (I2 = 97.19%). Evidence of publication bias was overall low (p = 0.1941). Patients affected by Crohn's disease (CD) were 1,86,074 (30.13%), while 2,78,876 (46.17%) were diagnosed with UC. The remaining 23.7% of cases were diagnosed with indeterminate colitis. Immunomodulators and biologic therapy were used in 24,520 (5.27%), and 17,972 (3.86%) patients, respectively. Reported incidence rates for lymphoma in IBD ranged from 0.0/100,000 person/years (py) (95% CI 0.0–3.7/100,000) to 89/100,000 py (95% CI 36–160/100,000). Reported incidence rates of lymphoma in CD ranged from 0.0/100,000 py (95% CI 0.0–3.7/100,000) to 91/100,000 py (95% CI 18–164/100,000). For UC, the incidence rate ranged from 0.0/100,000 py (95% CI 0.0–3.7/100,000) to 95/100,000 py (95% CI 0–226/100,000). Male-to-female ratio was ~4:1. Therapy with immunomodulators was directly associated with an increased incidence of lymphoma (p &lt; 0.0001). Evidence of publication bias was overall low (p = 0 .1941).ConclusionsThe evidence arising from this study highlights a correlation between the use of immunomodulators and subsequent lymphoma development. Combined multidisciplinary approach and long-term follow-up are warranted in order to decrease mortality deriving from the coexistence of both conditions.Systematic review registrationIdentifier: CRD42023398348

Feature Extraction From Multitemporal SAR Images Using Selforganizing Map Clustering and Object-Based Image Analysis

We introduce a new architecture for feature extraction from multitemporal synthetic aperture radar (SAR) data. Its the purpose is to combine classic SAR processing and geographical object-based image analysis to provide a robust unsupervised tool for information extraction from time series images. The architecture takes advantage from the characteristics of the recently introduced RGB products of the Level-1 α and Level-1β families, and employs self-organizing map clustering and object-based image analysis. In particular, the input products are clustered using color homogeneity and automatically enriched with a semantic attribute referring to clusters' color, providing a preclassification mask. Then, in the frame of an application-oriented object-based image analysis, opportune layers measuring scattering and geometric properties of candidate objects are evaluated, and an appropriate rule-set is implemented in a fuzzy system to extract the feature of interest. The obtained results have been compared with those given by existing techniques and turned out to provide high degree of accuracy and negligible false alarms. The discussion is supported by an example concerning small reservoir mapping in semiarid environment.</p

Multitemporal Level-1β Products:Definitions, Interpretation, and Applications

In this paper, we present a new framework for the fusion, representation, and analysis of multitemporal synthetic aperture radar (SAR) data. It leads to the definition of a new class of products representing an intermediate level between the classic Level-1 and Level-2 products. The proposed Level-1 β products are particularly oriented toward nonexpert users. In fact, their principal characteristics are the interpretability and the suitability to be processed with standard algorithms. The main innovation of this paper is the design of a suitable RGB representation of data aiming to enhance the information content of the time-series. The physical rationale of the products is presented through examples, in which we show their robustness with respect to sensor, acquisition mode, and geographic area. A discussion about the suitability of the proposed products with Sentinel-1 imagery is also provided, showing the full compatibility with data acquired by the new European Space Agency sensor. Finally, we propose two applications based on the use of Kohonen's self-organizing maps dealing with classification problems.</p

Towards operationalizing UNESCO Recommendations on “Historic Urban Landscape”: a position paper

<p>This position paper critically analyses the process to implement the UNESCO Recommendation on the Historic Urban Landscape (2011), exploring evaluation tools, innovative business / management models and financing tools for the conservation and regeneration of Historic Urban Landscape (HUL), to make it operational in the perspective of a circular economy model of sustainable development for city / territory system regeneration. Through evaluation tools, it is possible to pass from general principles to operational practices; to produce empirical evidence of the economic, social and environmental benefits of HUL integrated conservation and regeneration. The challenge of generating a symbiosis between conservation and transformation issues requires adequate evaluation methods, business, management and financing tools, engaging civil society and local stakeholders, capturing both HUL tangible and intangible values to turn the historic urban landscape into a driver of sustainable growth. The analysis carried out in this paper shows that through the suggested tools it is possible to make operational the UNESCO Recommendations, transforming conflicts into opportunities, producing economic attractiveness and strengthen social awareness and cohesion.</p

Novel ATP13A2 (PARK9) homozygous mutation in a family with marked phenotype variability

Mutations in the ATP13A2 (PARK9) and FBXO7 (PARK15) genes are linked to different forms of autosomal recessive juvenile-onset neurodegenerative diseases with overlapping phenotypes, including levodopa-responsive parkinsonism, pyramidal disturbances, cognitive decline, and supranuclear gaze disturbance. However, the associated genotypes and phenotypes are poorly characterized due to the small number of patients described. Here, we report clinical, instrumental, and genetic findings in an Italian family with novel PARK9 and PARK15 mutations. The proband developed a severe progressive phenotype including juvenile-onset parkinsonism, pyramidal disturbances, cognitive decline, and oculomotor abnormalities. On the contrary, his brother only shows mild abnormalities (pyramidal, cognitive, and oculomotor) on the neurological examination at the age of 31 years. These two brothers both carry a novel homozygous PARK9 missense (p.G877R) and a novel heterozygous PARK15 mutation (p.R481C). The PARK9 mutation replaces a crucial residue for the ATPase activity, and is therefore most likely a loss-of-function mutation and disease-causing in homozygous state. The pathogenic significance of the PARK15 single heterozygous mutation remains unclear. In both sibs, DaTSCAN single photon emission computed tomography showed marked nigrostriatal dopaminergic defects, and transcranial magnetic stimulation detected prolonged central motor conduction time. MRI, including T2*-weighted imaging, detected no evidence of brain iron accumulation. This family, the third reported with homozygous PARK9 mutations and the first with mutations in two genes for atypical juvenile parkinsonism, illustrates that PARK9-linked disease might display wide intra-familial clinical variability and milder phenotypes, suggesting the existence of strong, still unknown, modifiers