Paper‐Based Wearable Patches for Real‐Time, Quantitative Lactate Monitoring

Abstract Wearable sensors are establishing themselves as options for real‐time continuous health monitoring in health care and wellness. In particular, the use of flexible interfaces that conform to the skin have attracted considerable interest for the extraction of meaningful pathophysiological information through continuous and painless sampling and analysis of biofluids. In contrast, conventional techniques for biomarkers analysis are difficult to adapt to real‐time portable monitoring due to their invasive sampling protocols, biosample preparation and reagent stabilization. Here a shelf‐stable, non‐invasive, paper‐based colorimetric wearable lactate sensor is reported. This sensor exploits the ability of silk to control the concentration, print, and functionally preserve labile transducing biomolecules in the format of a shelf‐stable digital patch for optical readout. This novel approach overcomes major challenges associated with the commercialization of colorimetric wearable sensors (e.g., enzyme thermal instability, narrow sensing range, low sensitivity, and qualitative response) by showing a combination of unprecedented stability (i.e., up to 2 years in refrigerated conditions), wide sensing range, and high sensitivity. Additionally, real‐time quantitative signal readouts are achieved using machine learning‐driven image analysis enabling physiological status evaluation with a simple smartphone camera

Coagulation activation in children with sickle cell disease is associated with cerebral small vessel vasculopathy.

BACKGROUND:Thrombotic complications in Sickle Cell Disease (SCD) arise since infancy, but the role of the coagulation system in children has been poorly explored. To determine its role in the development of clinical complications in childhood we measured coagulation and endothelial parameters in children with SCD at steady state. METHODS:Markers of thrombin generation, fibrin dissolution and endothelial activation were evaluated in 38 children with SS-Sβ°, 6 with SC disease and 50 age and blood group matched controls. Coagulation variables were correlated with markers of hemolysis and inflammation, with the presence of cerebral and lung vasculopathy and with the frequency of clinical complications. RESULTS:SS-Sβ° patients presented higher levels of factor VIII, von Willebrand factor antigen (VWF:Ag) and collagen binding activity, tissue plasminogen activator antigen (t-PA:Ag), D-dimer, p-selectin, prothrombin fragment1+2 (F1+2) and lower ADAMTS-13:activity/VWF:Ag (p<0.05) compared to controls and SC patients. In SS-Sβ° patients coagulation variables correlated positively with markers of inflammation, hemolysis, and negatively with HbF (p<0.05). Patients with cerebral silent infarcts showed significant decrease in t-PA:Ag and ADAMTS-13 Antigen and a tendency toward higher D-dimer, F1+2, TAT compared to patients without them. D-dimer was associated with a six fold increased risk of cerebral silent infarcts. No correlation was found between coagulation activation and large vessel vasculopathy or other clinical events except for decreased t-PA:Ag in patients with tricuspid Rigurgitant Velocity >2.5m/sec. CONCLUSIONS:SS-Sβ° disease is associated with extensive activation of the coagulation system at steady state since young age. ADAMTS-13 and t-PA:Ag are involved in the development of cerebral silent infarcts

Coagulation Activation in Children with Sickle Cell Disease Is Associated with Cerebral Small Vessel Vasculopathy

BACKGROUND: Thrombotic complications in Sickle Cell Disease (SCD) arise since infancy, but the role of the coagulation system in children has been poorly explored. To determine its role in the development of clinical complications in childhood we measured coagulation and endothelial parameters in children with SCD at steady state. METHODS: Markers of thrombin generation, fibrin dissolution and endothelial activation were evaluated in 38 children with SS-Sβ°, 6 with SC disease and 50 age and blood group matched controls. Coagulation variables were correlated with markers of hemolysis and inflammation, with the presence of cerebral and lung vasculopathy and with the frequency of clinical complications. RESULTS: SS-Sβ° patients presented higher levels of factor VIII, von Willebrand factor antigen (VWF:Ag) and collagen binding activity, tissue plasminogen activator antigen (t-PA:Ag), D-dimer, p-selectin, prothrombin fragment1+2 (F1+2) and lower ADAMTS-13:activity/VWF:Ag (p<0.05) compared to controls and SC patients. In SS-Sβ° patients coagulation variables correlated positively with markers of inflammation, hemolysis, and negatively with HbF (p<0.05). Patients with cerebral silent infarcts showed significant decrease in t-PA:Ag and ADAMTS-13 Antigen and a tendency toward higher D-dimer, F1+2, TAT compared to patients without them. D-dimer was associated with a six fold increased risk of cerebral silent infarcts. No correlation was found between coagulation activation and large vessel vasculopathy or other clinical events except for decreased t-PA:Ag in patients with tricuspid Rigurgitant Velocity >2.5m/sec. CONCLUSIONS: SS-Sβ° disease is associated with extensive activation of the coagulation system at steady state since young age. ADAMTS-13 and t-PA:Ag are involved in the development of cerebral silent infarcts

Hematological Values of 38 children with SS-Sβ° and 6 with SC Sickle Cell Disease.

<p>Hematological Values of 38 children with SS-Sβ° and 6 with SC Sickle Cell Disease.</p

Markers of endothelial activation, thrombin generation and fibrinolysis for SS/Sβ° patients, SC patients and Controls.

<p>Factor VIII (FVIII), von Willebrand factor antigen (VWF:Ag) and collagen binding activity (VWF:CB), ADAMTS13 antigen (ADAMTS13:Ag) and activity (ADAMTS13:act), Nitric Oxide (NO), Prothrombin Fragment 1+2 (F1+2), Thrombin Antithrombin Complexes (TAT), Plasminogen activator inhibitor-1 antigen (PAI-1:Ag), tissue plasminogen activator antigen (t-PA:Ag). </p

Comparison of mean haematological and coagulation variables ± SD between SS- Sβ° patients with Silent Infarcts and without Silent Infarcts.

<p>Fctor VIII (FVIII), von Willebrand factor antigen (VWF:Ag) and collagen binding activity (VWF:CB), ADAMTS13 antigen (ADAMTS13:Ag) and activity (ADAMTS13:act), Nitric Oxide (NO), Prothrombin Fragment 1+2 (F1+2), Thrombin Antithrombin Complexes (TAT), Plasminogen activator inhibitor-1 antigen (PAI-1:Ag), tissue plasminogen activator antigen (t-PA:Ag). </p

Use and prescription appropriateness of drugs for peptic ulcer and gastrooesophageal reflux disease in hospitalized older people.

Purpose The aims of this study were to assess the prevalence of use and prescription appropriateness of drugs for peptic ulcer and gastrooesophageal reflux disease (GERD) at hospital admission and discharge. Methods Patients aged 65 years or more hospitalized from 2010 to 2016 in 101 Italian internal medicine and geriatric wards in the context of the REPOSI register were scrutinized to assess if they were prescribed with drugs for peptic ulcer and GERD at hospital admission and discharge. Appropriateness of prescription was assessed considering the presence of specific conditions (i.e., history of peptic ulcer or gastrointestinal hemorrhages, advanced age, Helicobacter Pylori) or gastro-toxic drug combinations, according to the criteria provided by the reimbursement rules of the Agenzia Italiana del Farmaco (NOTA 1 and 48). Results Among 4715 enrolled patients, 3899 were discharged alive. At hospital discharge, 2412 (61.9%, 95%CI: 60.3–63.4%) patients were prescribed with drugs for peptic ulcer and GERD, a 12% of increase from hospital admission. Almost half of the patients (N = 1776, 45.6%, 95%CI: 44.0–47.1%) were inappropriately prescribed or not prescribed: among the drugs for peptic ulcer and GERD users, about 60% (1444/2412) were overprescribed, and among nonusers, 22% (332/1487) were underprescribed. Among patients newly prescribed at hospital discharge, 60% (392/668) were inappropriately prescribed. The appropriateness of drugs for peptic ulcer and GERD therapy decreased by 3% from hospital admission to discharge. Conclusions Hospitalization missed the opportunity to improve the quality of prescription of this class of drug

Patterns of infections in older patients acutely admitted to medical wards: data from the REPOSI register

No abstract availabl

Inappropriate prescription of benzodiazepines in acutely hospitalized older patients.

Benzodiazepines (BDZs) are widely prescribed in older people. The aims of the study are to assess the prevalence of inappropriate prescription of BZDs and the associated factors in acutely hospitalized older patients. Patients aged 65 years or more hospitalized from 2010 to 2017 in more than 100 Italian internal medicine and geriatric wards in the frame of the REPOSI register were included if prescribed with BDZs at hospital admission or discharge. Appropriateness of prescription was assessed according to the 2015 Beers criteria and their modified French and German versions. Among 4681 patients discharged from hospital, 15% (N = 710) were discharged with BDZs, and 62% of them (N = 441, 95% CI: 58.5%-65.6%) were inappropriately prescribed, being prescribed with BDZ to be always avoided in the elderly (45%), at higher doses than recommended (31%) or with no appropriate clinical conditions (19%). From admission to discharge the prevalence of inappropriate BDZ prescription decreased by 4%, but 62% of patients inappropriately prescribed at admission were still inappropriately prescribed at discharge. Among the 179 patients first prescribed at the time of discharge, half were inappropriately prescribed. Being female (OR 1.32, 95%CI 0.95-1.85), enrolled in REPOSI during the years 2016 and 2017 (OR 1.94, 95%CI 1.10-3.39; OR 1.57, 95%CI 0.95-2.58) and living in nursing homes (OR 2.04, 95%CI 0.95-4.37) were associated with an increased risk to be inappropriately prescribed. This study shows a high prevalence of inappropriate use of BDZ in acutely hospitalized older patients both at hospital admission and discharge