Comparing Results of Five Glomerular Filtration Rate-Estimating Equations in the Korean General Population. MDRD Study, Revised Lund-Malmö, and Three CKD-EPI Equations

Estimated glomerular filtration rate (eGFR) is a widely used index of kidney function. Recently, new formulas such as the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations or the Lund-Malmö equation were introduced for assessing eGFR. We compared them with the Modification of Diet in Renal Disease (MDRD) Study equation in the Korean adult population. METHODS: The study population comprised 1,482 individuals (median age 51 [42-59] yr, 48.9% males) who received annual physical check-ups during the year 2014. Serum creatinine (Cr) and cystatin C (CysC) were measured. We conducted a retrospective analysis using five GFR estimating equations (MDRD Study, revised Lund-Malmö, and Cr and/or CysC-based CKD-EPI equations). Reduced GFR was defined as eGFR <60 mL/min/1.73 m². RESULTS: For the GFR category distribution, large discrepancies were observed depending on the equation used; category G1 (≥90 mL/min/1.73 m²) ranged from 7.4-81.8%. Compared with the MDRD Study equation, the other four equations overestimated GFR, and CysC-based equations showed a greater difference (-31.3 for CKD-EPI(CysC) and -20.5 for CKD-EPI(Cr-CysC)). CysC-based equations decreased the prevalence of reduced GFR by one third (9.4% in the MDRD Study and 2.4% in CKD-EPI(CysC)). CONCLUSIONS: Our data shows that there are remarkable differences in eGFR assessment in the Korean population depending on the equation used, especially in normal or mildly decreased categories. Further prospective studies are necessary in various clinical settings

Machine Learning and MADIT methodology for the fake news identification: the persuasion index

[EN] The phenomenon of fake news has grown concurrently with the rise of social networks that allow people to directly access news without the mediation of reliable sources. Recognizing news as fake is a difficult task for humans, and even tougher for a machine. This proposal aims to redesign the problem: from a check of truthfulness of news content, to the analysis of texts’ persuasion level. That is how information is introduced to the reader, assuming that fake news is aimed at persuading towards the reality of sense they intend to convey. M.A.D.I.T. methodology has been chosen. It is useful to describe how texts are built, overcoming the content/structure analysis level and stressing the study of Discursive Repertories: discursive modalities of reality of sense building, classified into real and fake news categories thanks to the Machine learning application. For the dataset building 7,387 news have been analysed. The results highlight different profiles of text building between the two groups: the different and typical discursive repertories allow to validate the methodological approach as a good predictor of the persuasion level of texts, not only of news, but also of information in domains such as the economic financial one (e.g. GameStop event).Orrù, L.; Moro, C.; Cuccarini, M.; Paita, M.; Dalla Riva, MS.; Bassi, D.; Da San Martino, G.... (2022). Machine Learning and MADIT methodology for the fake news identification: the persuasion index. En 4th International Conference on Advanced Research Methods and Analytics (CARMA 2022). Editorial Universitat Politècnica de València. 165-172. https://doi.org/10.4995/CARMA2022.2022.1508116517

Use of Bioelectrical Impedance Vector Analysis in Dyspneic patients

In patients presenting to Emergency Department with Shortness of Breath a fast diagnosis distinguishing between lung or cardiac diseases is mandatory.Quantitative assessment of congestion could be useful in the management of acute heart failure (AHF) patients. No data are available on the diagnostic and prognostic role of quantitative fluid retention evaluated by bioelectrical impedance vector analysis (BIVA) in AHF patients at the moment of their emergency department (ED) presentation. Conclusions: In AHF patients a quantitative evaluation of fluid congestive status obtained by BIVA at ED arrival provides significant additive diagnostic and 30-day prognostic value to BNP. This could lead to a better management of these patients with possible improvement in reducing subsequent CV events after hospital discharge

Interventi psicologici erogati da assistenti virtuali per promuovere il benessere mentale

Contesto: Dalla letteratura emerge un bisogno sempre maggiore di supporto psicologico da parte della popolazione e questo aumenta se si considerano popolazioni vulnerabili a situazioni di stress. La strategia adottata dell’OMS per la promozione della salute mentale si basa su principi di inclusività e scalabilità, con particolare attenzione al ruolo delle tecnologie digitali. Qui si inseriscono i nostri interventi di Virtual Coaching, basati su tecniche Mindfulness e ACT, per donne in gravidanza o con tumore al seno. Metodo: Gli interventi prevedono l’adozione di assistenti virtuali in grado di erogare sessioni psicoeducative, monitorare e supportare l’utente in diverse situazioni. Tali interventi saranno sviluppati seguendo un approccio partecipativo, che consenta di progettarli nel modo più accettabile e coinvolgente per le utenti. Risultati attesi: Il lavoro di progettazione è attualmente in corso. Ci si aspetta un miglioramento del benessere generale e un aumento della flessibilità psicologica. La valutazione dell’esperienza d’uso sarà la base per il perfezionamento di questi e di futuri interventi nell’ambito delle terapie digitali. Discussione: Questi interventi aiuteranno a far fronte alle richieste odierne della società, fornendo strumenti a servizio del sistema sanitario. Il pilotaggio degli interventi per la sanità digitale si rivela una fase cruciale dell'approccio progettuale incentrato sull'utente e utile in termini di efficacia, scalabilità e inclusività

The emerging role of biomarkers and bio-impedance in evaluating hydration status in patients with acute heart failure.

The quantitative and qualitative estimation of total body fl uid content has proven to be crucial for both diagnosis and prognosis assessment in patients with heart failure. The aim of this review is to summarize the current techniques for assessing body hydration status as well as the principal biomarkers associated with acute heart failure (AHF). Although clinical history, physical examination and classical imaging techniques (e.g., standard radiography and echocardiography) still represent the cornerstones, novel and promising tools, such as biomarkers and bio-electrical impedance are achieving an emerging role in clinical practice for the assessment of total body fluid content. In the acute setting, the leading advantages of these innovative methods over device are representedby the much lower invasiveness and the reasonable costs, coupled with an easier and faster application. This article is mainly focused on AHF patients, not only because the overall prevalence of this disease is dramatically increasing worldwide, but also because it is well-known that their fluid overload has a remarkable diagnostic and prognostic significance. It is thereby conceivable that the bio-electrical vector analysis (BIVA) coupled with laboratory biomarkers might achieve much success in AHF patient management in the future, especially for assisting diagnosis, risk stratifi cation, and therapeutic decision-making

Interventi psicologici erogati da assistenti virtuali per promuovere il benessere mentale

Contesto: Dalla letteratura emerge un bisogno sempre maggiore di supporto psicologico da parte della popolazione e questo aumenta se si considerano popolazioni vulnerabili a situazioni di stress. La strategia adottata dell’OMS per la promozione della salute mentale si basa su principi di inclusività e scalabilità, con particolare attenzione al ruolo delle tecnologie digitali. Qui si inseriscono i nostri interventi di Virtual Coaching, basati su tecniche Mindfulness e ACT, per donne in gravidanza o con tumore al seno. Metodo: Gli interventi prevedono l’adozione di assistenti virtuali in grado di erogare sessioni psicoeducative, monitorare e supportare l’utente in diverse situazioni. Tali interventi saranno sviluppati seguendo un approccio partecipativo, che consenta di progettarli nel modo più accettabile e coinvolgente per le utenti. Risultati attesi: Il lavoro di progettazione è attualmente in corso. Ci si aspetta un miglioramento del benessere generale e un aumento della flessibilità psicologica. La valutazione dell’esperienza d’uso sarà la base per il perfezionamento di questi e di futuri interventi nell’ambito delle terapie digitali. Discussione: Questi interventi aiuteranno a far fronte alle richieste odierne della società, fornendo strumenti a servizio del sistema sanitario. Il pilotaggio degli interventi per la sanità digitale si rivela una fase cruciale dell'approccio progettuale incentrato sull'utente e utile in termini di efficacia, scalabilità e inclusività

Bioactive adrenomedullin, proenkephalin A and clinical outcomes in an acute heart failure setting

Objectives In an acute heart failure (AHF) setting, proenkephalin A 119-159 (penKid) has emerged as a promising prognostic marker for predicting worsening renal function (WRF), while bioactive adrenomedullin (bio-ADM) has been proposed as a potential marker for congestion. We examined the diagnostic value of bio-ADM in congestion and penKid in WRF and investigated the prognostic value of bio-ADM and penKid regarding mortality, rehospitalisation and length of hospital stay in two separate European AHF cohorts. Methods Bio-ADM and penKid were measured in 530 subjects hospitalised for AHF in two cohorts: Swedish HeArt and bRain failure inVESTigation trial (HARVEST-Malmö) (n=322, 30.1% female; mean age 75.1+11.1 years; 12 months follow-up) and Italian GREAT Network Rome study (n=208, 54.8% female; mean age 78.5+9.9 years; no follow-up available). Results PenKid was associated with WRF (area under the curve (AUC) 0.65, p<0.001). In multivariable logistic regression analysis of the pooled cohort, penKid showed an independent association with WRF (adjusted OR (aOR) 1.74, p=0.004). Bio-ADM was associated with peripheral oedema (AUC 0.71, p<0.001), which proved to be independent after adjustment (aOR 2.30, p<0.001). PenKid was predictive of in-hospital mortality (OR 2.24, p<0.001). In HARVEST-Malmö, both penKid and bio-ADM were predictive of 1-year mortality (aOR 1.34, p=0.038 and aOR 1.39, p=0.030). Furthermore, bio-ADM was associated with rehospitalisation (aOR 1.25, p=0.007) and length of hospital stay (β=0.702, p=0.005). Conclusion In two different European AHF cohorts, bio-ADM and penKid perform as suitable biomarkers for early detection of congestion severity and WRF occurrence, respectively, and are associated with pertinent clinical outcomes

The use of discharge haemoglobin and NT-proBNP to improve short and long-term outcome prediction in patients with acute heart failure

AIMS: To examine the prognostic value of admission (A) and discharge (D) haemoglobin (Hb) and its relationship with N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) in patients hospitalised for acute heart failure (AHF). The outcomes of interests were rehospitalisation or death after one, six or twelve months after discharge. METHODS: 317 hospitalised AHF patients (74.7±9.4 years) were enrolled in two academic centres in Belgrade and Rome. Laboratory analyses, including NT-proBNP were assessed at admission, and Hb also at discharge. Patients were divided into two groups according to the presence of anaemia. Follow-up contact was made by telephone. Statistical analyses were performed using SPSS software version 21.0. RESULTS: According to A and DHb levels (&lt;120 g/l for women and &lt;130 g/l for men), anaemia was present in 55% and 62% of patients, respectively ( P=0.497). Lower DHb was associated with the rehospitalisation risk after one (OR=0.96, P=0.004), six (OR=0.97, P&lt;0.001) and 12 months (OR=0.97, P&lt;0.001). For every g/l decrease of DHb, the risk of rehospitalisation after one year was increased by 3.3%. In the first six months, DHb contributed to increased risk of death (OR=0.97, P=0.005), but NT-proBNP showed greater power (OR=2.1, P&lt;0.001). CONCLUSIONS: In AHF patients discharge anaemia is a strong predictor for short and long-term rehospitalisation, while NT-proBNP seems to be a better predictor for mortality. Discharge Hb and NT-proBNP should be assessed together in order to detect the patients with higher risk of future death and rehospitalisation

Cardiovascular health of nonagenarians in southern Italy: a cross-sectional, home-based pilot study of longevity.

BackgroundThe Cilento region of southern Italy has a high prevalence of nonagenarians and centenarians. Few studies of the oldest old have included echocardiographic and/or electrocardiographic data, in a home-based setting.ObjectivesThe objective of this pilot study was to delineate the key lifestyle, medical, echocardiographic, and electrocardiographic features of a sample of nonagenarians and centenarians and their younger cohabitants from Cilento, via a comprehensive, home-based cardiovascular assessment. The ultimate aim is to identify the cardiovascular profile and lifestyle factors associated with longevity.MethodsTwenty-six nonagenarians and centenarians (mean age 94 ± 3 years) and 48 younger cohabitants aged 50-75 years (mean 62 ± 5) underwent a comprehensive cardiovascular evaluation in their homes.ResultsIn contrast to their younger cohabitants, nonagenarians and centenarians did not smoke, had lower fasting glucose levels, and lower LDL cholesterol despite being half as likely to be taking statins, and showing similar adherence to a Mediterranean diet. Over half of nonagenarians and centenarians (15/26) remained autonomous with their activities of daily living. Prevalence of self-reported coronary artery disease and stroke among nonagenarians and centenarians was low (11.5%), though a significant number had atrial fibrillation (31%) or congestive heart failure (27%). Although 62% of nonagenarians and centenarians had at least moderate valvular disease on echocardiography, less than 25% of those affected reported dyspnea.ConclusionNonagenarians and centenarians in the Cilento region had a healthy metabolic profile and a low prevalence of clinical cardiovascular disease. Even among nonagenarians and centenarians with structural heart abnormalities, report of symptoms is low. Larger studies in the Cilento population may help elucidate the mechanisms underlying cardiovascular health in the oldest old