An artificial neural network approach for modelling the ward atmosphere in a medical unit

Artificial neural networks (ANNs) have been developed, implemented and tested on the basis of a four-year-long experimental data set, with the aim of analyzing the performance and clinical outcome of an existing medical ward, and predicting the effects that possible readjustments and/or interventions on the structure may produce on it. Advantages of the ANN technique over more traditional mathematical models are twofold: on one hand, this approach deals quite naturally with a large number of parameters/variables, and also allows to identify those variables which do not play a crucial role in the system dynamics; on the other hand, the implemented ANN can be more easily used by a staff of non-mathematicians in the unit, as an on-site predictive tool. As such, the ANN model is particularly suitable for the case study. The predictions from the ANN technique are then compared and contrasted with those obtained from a generalized kinetic approach previously proposed and tested by the authors. The comparison on the two case periods shows the ANN predictions to be somewhat closer to the experimental values. However, the mean deviations and the analysis of the statistical coefficients over a span of multiple years suggest the kinetic model to be more reliable in the long run, i.e., its predictions can be considered as acceptable even on periods that are quite far away from the two case periods over which the many parameters of the model had been optimized. The approach under study, referring to paradigms and methods of physical and mathematical models integrated with psychosocial sciences, has good chances of gaining the attention of the scientific community in both areas, and hence of eventually obtaining wider diffusion and generalization.

Immunogenicity and safety after the third dose of BNT162b2 anti-SARS-CoV-2 vaccine in patients with solid tumors on active treatment: a prospective cohort study

Background: Although a full course of coronavirus disease 2019 (COVID-19) vaccine is effective in cancer patients, the duration of the protection and the efficacy of a booster dose against the new variants remain unknown. We prospectively evaluated the immunogenicity of the third dose of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) BNT162b2 messenger RNA vaccine in cancer patients undergoing active treatment. Patients and methods: Patients with solid cancer, vaccinated with a booster dose during active treatment, were enrolled in this study. Patients were classified into SARS-CoV-2 naïve (without previous COVID-19 infection) and SARS-CoV-2 experienced (with previous COVID-19 infection). Neutralizing antibody (NT Ab) titer and total anti-Spike immunoglobulin G (IgG) concentration were quantified in serum. Heparinized whole blood samples were used for SARS-CoV-2 Interferon Gamma Release Assay (IGRA). The primary endpoint was to assess the increase of IgG antibody level between baseline and 3 weeks after the booster. Results: One hundred and forty-two consecutive patients were recruited. In SARS-CoV-2-naïve subjects, the median level of IgG was 157 BAU/ml [interquartile range (IQR) 62-423 BAU/ml] at T0 and reached a median of 2080 BAU/ml (IQR 2080-2080 BAU/ml) at 3 weeks after booster administration (T1; P < 0.0001). A median 16-fold increase of SARS-CoV-2 NT Ab titer (IQR 4-32) was observed in naïve subjects (from median 20, IQR 10-40, to median 640, IQR 160-640; P < 0.0001). Median interferon-γ level at T1 was significantly higher than that measured at T0 in SARS-CoV-2-naïve subjects (P = 0.0049) but not in SARS-CoV-2-experienced patients. The median level of SARS-CoV-2 NT Abs was 32-fold lower against Omicron compared to the wild-type strain (P = 0.0004) and 12-fold lower compared to the Delta strain (P = 0.0110). Conclusions: The third dose is able to trigger both the humoral and the cell-mediated immune response in cancer patients on active treatment. Our preliminary data about the neutralization of the SARS-CoV-2 vaccine against variants of concern seem to confirm the lower vaccine activity

Analysis of the humoral and cellular immune response after a full course of BNT162b2 anti-SARS-CoV-2 vaccine in cancer patients treated with PD-1/PD-L1 inhibitors with or without chemotherapy: an update after 6 months of follow-up

Background: The durability of immunogenicity of SARS-CoV-2 vaccination in cancer patients remains to be elucidated. We prospectively evaluated the immunogenicity of the vaccine in triggering both the humoral and the cell-mediated immune response in cancer patients treated with anti-programmed cell death protein 1/programmed death-ligand 1 with or without chemotherapy 6 months after BNT162b2 vaccine. Patients and methods: In the previous study, 88 patients were enrolled, whereas the analyses below refer to the 60 patients still on immunotherapy at the time of the follow-up. According to previous SARS-CoV-2 exposure, patients were classified as SARS-CoV-2-naive (without previous SARS-CoV-2 exposure) and SARS-CoV-2-experienced (with previous SARS-CoV-2 infection). Neutralizing antibody (NT Ab) titer against the B.1.1 strain and total anti-spike immunoglobulin G concentration were quantified in serum samples. The enzyme-linked immunosorbent spot assay was used for quantification of anti-spike interferon-γ (IFN-γ)-producing cells/106 peripheral blood mononuclear cells. Fifty patients (83.0%) were on immunotherapy alone, whereas 10 patients (7%) were on chemo-immunotherapy. We analyzed separately patients on immunotherapy and patients on chemo-immunotherapy. Results: The median T-cell response at 6 months was significantly lower than that measured at 3 weeks after vaccination [50 interquartile range (IQR) 20-118.8 versus 175 IQR 67.5-371.3 IFN-γ-producing cells/106 peripheral blood mononuclear cells; P < 0.0001]. The median reduction of immunoglobulin G concentration was 88% in SARS-CoV-2-naive subjects and 2.1% in SARS-CoV-2-experienced subjects. SARS-CoV-2 NT Ab titer was maintained in SARS-CoV-2-experienced subjects, whereas a significant decrease was observed in SARS-CoV-2-naive subjects (from median 1 : 160, IQR 1 : 40-1 : 640 to median 1 : 20, IQR 1 : 10-1 : 40; P < 0.0001). A weak correlation was observed between SARS-CoV-2 NT Ab titer and spike-specific IFN-γ-producing cells at both 6 months and 3 weeks after vaccination (r = 0.467; P = 0.0002 and r = 0.428; P = 0.0006, respectively). Conclusions: Our work highlights a reduction in the immune response in cancer patients, particularly in SARS-CoV-2-naive subjects. Our data support administering a third dose of COVID-19 vaccine to cancer patients treated with programmed cell death protein 1/programmed death-ligand 1 inhibitors

Allergy in adolescent population (14-18 years) living in campania region (southern Italy). a multicenter study

Adolescents (Ad) constitute a difficult to manage population among individuals suffering from asthma. The aim of our study was to assess the prevalence, clinical characteristics and age of onset of allergic sensitization and clinical symptoms in a sample of atopic Ad living in the Campania region (Southern Italy). Sixteen Allergy units or Centers belonging to the Italian Association of Hospital and Territorial Allergologists (AAIITO, Campania region) participated in this cross-sectional study. A case report form (CRF) was specifically designed for this study and commercial allergen extracts used for screening SPTs were provided by ALK-Abelló Group (Milan, Italy). A total of 443 patients were examined (females, f 220, 49.6 %; males, m 223, 50.3%). Dust mites represent the most common sensitizing agents in allergic Ad living in Campania region (Dermatoph. pteronyssinus 67.4% and Dermatoph. farinae 66.5%), followed by Parietaria (58.9%), grasses (45.8%), Artemisia vulgaris (16.7%), Olea Europaea (32.2%), dog dander (17.1%), cat dander (20.0%), Alternaria alternata (8.1%), Cupressus sempervirens (4.9%), Betula pendula (4.7%), other allergens (19.4%). An interesting comparison has been made between clinical data of our Ad with data of elderly patients (E). The role of allergic sensitization is significantly higher in Ad compared to E. Dermatophagoides pteronyssinus is the first sensitizing allergen in Ad and the last in E. Parietaria constitutes the first sensitizing pollen both in Ad and E, the percentage of sensitization is higher in Ad. Another important difference is the higher prevalence of As, as only symptom, in E compared to Ad (19.7% versus 7.6%). In conclusion, our findings confirm the high prevalence and clinical significance of airway allergic sensitization in the adolescents living in Campania region

СОВРЕМЕННЫЕ ТЕХНОЛОГИИ ПРОФИЛАКТИКИ ИНФЕКЦИОННЫХ ОСЛОЖНЕНИЙ У НЕДОНОШЕННЫХ ДЕТЕЙ

The objective was to develop mathematical and statistical models forecast the success of prevention of infectious genesis of complications in premature infants with very low birth weight during the inpatient nursing care when used in programs of the therapy probiotic form based on Enterococcus faecium L3. We proposed the mathematical discriminant model forecast the success of prevention of infectious complications based on observations of 55 premature infants with very low birth weight in the second stage of nursing in a specialized department of pathology of newborn hospital and analysis of outcomes for the formation of infectious complicationsin 51 children. This model is based on the following six symptoms: 1) burdened obstetric and gynecological history mother; 2) the presence of chronic intoxication with the mother; 3) delivery is by caesarean section; 4) of the number of E. coli in the feces of children in real time polymerase chain reaction (relative to the norm values); 5) eosinophilia in the clinical analysis of blood; 6) use as a supplement to the diet of children probiotic liquid form on the basis of E. faecium L3. This model has a sufficiently high information capacity (80.4%) and statistically significant (p&lt;0,01) for the prediction of the success of the prevention of infectious complications in premature infants with very low birth weight.Цель работы – разработка математико-статистической модели прогноза успешности профилактики осложнений инфекционного генеза у недоношенных новорожденных детей с очень низкой массой тела в период стационарного этапа выхаживания при использовании в программах терапии пробиотической формы на основе Enterococcus faecium L3. На основании наблюдения 55 недоношенных новорожденных детей с очень низкой массой тела при рождении на втором этапе выхаживания в условиях специализированного отделения патологии новорожденных стационара и анализа исходов по формированию инфекционных осложнений у 51 ребенка предложена математическая дискриминантная модель прогноза успешности профилактики инфекционных осложнений, основанная на следующих шести признаках: 1) отягощенный акушерско-гинекологический анамнез матери; 2) наличие у матери хронической интоксикации; 3) родоразрешение методом кесарева сечения; 4) количество эшерихий в фекалиях детей по данным полимеразной цепной реакции в реальном времени (относительно значений нормы); 5) эозинофилия в клиническом анализе крови; 6) использование в качестве дополнения к питанию жидкой пробиотической формы E. faecium L3. Данная модель обладает достаточно высокой информационной способностью (80,4%) и статистической значимостью (p&lt;0,01) для прогнозирования успешности профилактики инфекционных осложнений у недоношенных с очень низкой массой тела

HIDRAdisk: validation of an innovative visual tool to assess the burden of hidradenitis suppurativa

Background Hidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin disease characterized by painful inflamed nodules, recurrent abscesses and fistulas located in apocrine gland–bearing body sites. The negative impact of HS on patient's quality of life (QoL) has been reported to be greater than other dermatologic conditions as psoriasis and atopic eczema, and its improvement is an important goal in disease management. Nowadays, there are no specific validated QoL instruments available for HS and generic dermatologic questionnaires are used. Objective The objective of this study was to demonstrate the validity, reliability and responsiveness of HIDRAdisk, a new innovative tool designed for rapid assessment of HS burden and, at the same time, an intuitive graphic visualization of the measurement outcome. Methods A multicentre, longitudinal, observational study was conducted to validate the HIDRAdisk compared with other validated questionnaires [Skindex‐16, Dermatology Life Quality Index (DLQI), Work Productivity and Activity Impairment–General Health (WPAI:GH)] and to evaluate its correlation with disease severity in Italian patients with any degree of HS severity, as measured by Hurley stage and HS Physician Global Assessment (HS‐PGA). Results A total of 140 patients (59% women; mean age 34.9 ± 11.0 years) were enrolled in 27 dermatologic centres. HIDRAdisk showed a strong correlation with Skindex‐16 and DLQI, and a good one with WPAI:GH (correlation coefficient: 0.7568, 0.6651 and 0.5947, respectively) and a statistically significant correlation with both Hurley stage and HS‐PGA. Very good internal consistency (Cronbach coefficient &gt;0.80; intraclass correlation coefficient &gt;0.6), with correlation between the 10 items, good test–retest reliability (Spearman correlation coefficient, 0.8331; P &lt; 0.0001) and responsiveness to changes were demonstrated. Conclusion Our study shows that HIDRAdisk, a short and innovative visual HS QoL instrument, has been psychometrically validated in Italian language and it may help improve the management of HS once implemented in routine clinical practice