Cystic mucinous adenocarcinoma of the lung: a case report

Mucinous cystic tumors of the lung are uncommon, the preoperative pathologic diagnosis is difficult and their biological behavior is still controversial. We report the case of a patient with a clinically benign cystic lesion that post-operatively showed to be consistent with an invasive adenocarcinoma arising in a mucinous cystadenoma of the lung

Frequency of left ventricular hypertrophy in non-valvular atrial fibrillation

Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 \ub1 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index 640.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc 652 seen in 93% of LVH and in 73% of patients without LVH (p <0.05). Women with LVH had a higher prevalence of concentric hypertrophy than men (46% vs 29%, p = 0.0003). Logistic regression analysis demonstrated that female gender (odds ratio [OR] 2.80, p <0.0001), age (OR 1.03 per year, p <0.001), hypertension (OR 2.30, p <0.001), diabetes (OR 1.62, p = 0.004), and previous MI (OR 1.96, p = 0.001) were independently associated with LVH. In conclusion, patients with NVAF have a high prevalence of LVH, which is related to female gender, older age, hypertension, and previous MI. These patients are at high thromboembolic risk and deserve a holistic approach to cardiovascular prevention

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

A cloud-based flexible solution for psychometric tests validation, administration and evaluation

Psychological tests generally provide an evaluation scale to evaluate whether or not the subject manifests some traits. Such kind of tests are generally used for attitude evaluation, personal selection, educational and rehabilitation purposes, as well as for the diagnosis of cognitive disorders. The use of test and other questions-based diagnostic tools, represents one of the main and principal actions in order to start a clinical and therapeutic path, as well as for the evaluation and assessment of the possible educational and rehabilitation effort. Unfortunately such tests are generally the result of a long and difficult process of validation for their standardization, simplification and reorganizations driven by operations performed by means of complex statistical methods. In the work presented on this paper we developed a unified cloud-based resource for the management and execution of all the task related to psychometric testing, from the creation of a test, to its validation and use. The solution has been designed to grant maximum flexibility allocating resources on a cloud service. Such resources can be used as a remote support for the psychologists designing and administering the test, as well as computing platform to unburden the single terminals of the heavy computations required during the standardization procedure. Moreover, by means of the distributed database, our solution is also able to support the simplification and reorganization process, as well as to serve as online platform for the administration and consequent scoring of the finalized and standardized test

Optimal thicknesses determination in a multilayer structure to improve the SPP efficiency for photovoltaic devices by an hybrid FEM — Cascade Neural Network based approach

As the global energy needs to grow, there is increasing interest in the electricity generation by photovoltaics (PVs) devices or solar cells. Analytical and numerical methods are used in literature to study the propagation of surface plasmon polaritons (SPP) but the optimal thicknesses in a multilayer structure can’t be established for an optimal propagation by these. In this paper a new method based on cascade Neural Network (NN) is used to predict the propagation characteristics of a multilayer plasmonic structure and coupling FEM analysis of the involved electromagnetic field. The trained NNs are able to provide the required optimal values of the SPP propagation with good accuracy at different value of thicknesses in the multilayer structure

Effects of anti-aldosteronic agents in resistant hypertension

Hypertension is defined resistant (or refractory) when it is not possible to reach the target values of blood pressure despite the contemporary use of three antihypertensive drugs at optimised dosage (1). Today difficult control of hypertension is more and more frequent in clinical practice. In recent years the role of anti-aldosteronic agents has appeared useful in the treatment of resistant hypertension; this condition seems to be related to the increase of the mean age. Subjects suffering from resistant hypertension mostly show an isolated high systolic pressure. In addition to advanced age, factors commonly associated are: increased levels of aldosterone and intravascular volume, chronic kidney disease, diabetes mellitus, obesity; and therefore these subjects are more exposed to organ damage (2). In some recent trials anti-aldosteronic agents have demonstrated positive effects in ruling hypertension and in reducing organ damage (3) and among the different antialdosteronic agents canrenone showed a smaller occurrence of side effects (impotence and gynaecomastia in males, menstrual pains in females) and so a wider tolerability in comparison with spironolactone and eplerenone (4). However, hyperkalaemia is the most important side effect of all these agents; the principal contraindications are severe renal failure and high levels of serum potassium. Moreover it is necessary to use these drugs with attention if they are combined with ace-inhibitors or angiotensin II receptors blockers, because they can increase kalaemia too. Conclusion In conclusion, scientific data indicate a positive role of these drugs both in the control of resistant hypertension and in the prevention (or at least in the reduction) of organ damage (5,6,7,8). For this reason, it is hoped that there will be a wider use of these agents in clinical practice, of course when they are not contraindicated