Discovering location based services: A unified approach for heterogeneous indoor localization systems

The technological solutions and communication capabilities offered by the Internet of Things paradigm, in terms of raising availability of wearable devices, the ubiquitous internet connection, and the presence on the market of service-oriented solutions, have allowed a wide proposal of Location Based Services (LBS). In a close future, we foresee that companies and service providers will have developed reliable solutions to address indoor positioning, as basis for useful location based services. These solutions will be different from each other and they will adopt different hardware and processing techniques. This paper describes the proposal of a unified approach for Indoor Localization Systems that enables the cooperation between heterogeneous solutions and their functional modules. To this end, we designed an integrated architecture that, abstracting its main components, allows a seamless interaction among them. Finally, we present a working prototype of such architecture, which is based on the popular Telegram application for Android, as an integration demonstrator. The integration of the three main phases –namely the discovery phase, the User Agent self-configuration, and the indoor map retrieval/rendering– demonstrates the feasibility of the proposed integrated architectur

Bacterial stimuli activate nitric oxide colonic mucosal production in diverticular disease. Protective effects ofL. casei DG® (Lactobacillus paracaseiCNCM I-1572)

Background: Micro-inflammation and changes in gut microbiota may play a role in the pathogenesis of diverticular disease (DD). Objective: The objective of this article is to evaluate the expression of nitric oxide (NO)-related mediators and S100B in colonic mucosa of patients with DD in an ex vivo model of bacterial infection. Methods: Intestinal biopsies obtained from patients with diverticulosis, symptomatic uncomplicated diverticular disease (SUDD) and SUDD with previous acute diverticulitis (SUDD+AD) were stimulated with the probiotic L. casei DG® (LCDG) and/or the pathogen enteroinvasive Escherichia coli (EIEC). S100B, NO release and iNOS expression were then evaluated. Results: Basal iNOS expression was significantly increased in SUDD and SUDD+AD patients. Basal NO expression was significantly increased in SUDD+AD. No differences in S100B release were found. In all groups, iNOS expression was significantly increased by EIEC and reduced by LCDG. In all groups, except for SUDD+AD, EIEC significantly increased NO release, whereas no increase was observed when LCDG was added to biopsies. EIEC did not induce significant changes in S100B release. Conclusions: Colonic mucosa of patients with DD is characterized by a different reactivity toward pathogenic stimuli. LCDG plays a role in counteracting the pro-inflammatory effects exerted by EIEC, suggesting a beneficial role of this probiotic in DD

Synchronous Bilateral Paget's Disease of the Nipple Associated with Bilateral Breast Carcinoma

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Influenza vaccine effectiveness for the elderly: a cohort study involving General Practitioners from Abruzzo, Italy

Introduction. In all Italian regions influenza vaccine is routinely administered to the elderly population. However, vaccination impact has been rarely evaluated because of the high costs of conventional cohort investigations. A promising low-cost alter- native approach uses administrative discharge data to derive vaccine effectiveness indicators (hospitalizations and/or deaths) and involves General Practitioners (GPs) to document the exposure. We conducted a cohort analysis using such approach to assess influenza vaccine effectiveness and to investigate the feasibility and validity of that methodology for routine vaccine evaluation. Methods. During October 2006, all GPs from two Local Health Units (LHUs) were requested to indicate immunization status of all their patients in a specific form containing patient?s demo- graphic records. Immunization status information were also collected from Prevention Departments. Main outcomes were hospitalizations for influenza and/or pneumonia. Analyses were based upon random-effect logistic regression. Results. Of a total of 414 GPs assisting 103,162 elderly, 116 GPs (28%) provided data on 32,457 individuals (31.5%). The sample was representative and had an overall 66.2% vaccina- tion rate. During the first semester 2007, the hospitalization rate was low in the sample, with only 7 elderly patients admitted for influenza and 135 for pneumonia. At either bivariate or multi- variate analysis, vaccination did not significantly reduce the risk of in-hospital death, influenza or pneumonia admission. Discussion. The study had minimal costs, recruited a large and representative sample size, and had no evidence of a substantial selection bias. Administrative and GP?s data may be successively pooled to provide routine assessment of vaccination effectiveness

Value of split-bolus multidetector-row CT technique in the quantitative assessment of pancreatic enhancement [Pankreatik tutulumun kantitatif değerlendirilmesinde bölünmüş-bolus multidetektör-dizi BT tekniğinin değeri]

The aim of this study is to quantitatively assess radiation comma, and pancreatic enhancement by split-bolus intravenous injection of contrast material using 64-slice CT. Single-pass split-bolus MDCT of the chest and abdomen was performed in 37 patients (female: 18, male: 9; mean age, 66.1±14.2 years; range 17-80 years) without pancreatic disease. Regions of interest in the pancreatic head, body and tail were drawn, and mean attenuation values for pancreatic parenchymal phase (PPP) of the standard MDCT protocol and split-bolus were calculated. P<0.05 was considered statistically significant. Mean effective dose by split-bolus was measured. In all MDCT examinations split-bolus protocol allowed acquisition of optimal images. Mean pancreatic enhancement was higher by split-bolus with respect to PPP of standard triphasic MDCT (131.35 HU±20.63 vs 126.1 HU±20.01). Reduction of dose using MDCT split-bolus was approximately 17%. In conclusion MDCT split-bolus protocol provides an optimal pancreatic enhancement, significantly greater than the enhancement of standard MDCT on PPP which confers an advantage for the detection and staging of pancreatic tumors

The lymphatic drain of below-knee malignant melanoma. Is the popliteal fossa a ghost station?

Sentinel lymph node biopsy is fundamental in the staging of primary cutaneous melanoma (PCL), but reported lymphoscintigraphic patterns are very heterogeneous. In this systematic review, we evaluated the role of the popliteal station in below-knee PCL. A systematic search of literature through was conducted on the electronic databases PubMed, SCOPUS and Web of Science (WOS) to identify eligible studies. A total of 22 studies (n=5,673 patients) were included. The average Breslow thickness of PCL was 2.86 mm. During the analysis of the included articles, it was not possible to classify patients into the 3 Menes popliteal drainage pattern, obtained by lymphoscintigraphy. The analysis of lymphatic drainage in patients undergoing lymphoscintigraphy for melanoma of the lower extremities below the knee was reported in 5,637 patients and the lymphatic popliteal drainage was reported only in 5.64% (320 patients). The rate of popliteal lymph nodes melanoma metastases was 1.48%: they were located exclusively at the popliteal level in 0.60%, at the popliteal and inguinal levels in 0.39%, at the popliteal and iliac level in 0.02% and at the groin level in 0.48%. In conclusion, the most common lymphoscintigraphic pattern is represented by popliteal nodes in-transit or interval nodes, so metastases from below-knee melanomas commonly transit through popliteal nodes stations and arrive to inguinal nodes stations. The popliteal nodes are the primary station in about 5.64% of cases. Larger studies are needed to corroborate these findings

A multi-domain ontology on healthy ageing for the characterization of older adults status and behaviour

Ageing is a multi-factorial physiological process and the development of novel IoT systems, tools and devices, specifically targeted to older people, must be based on a holistic framework built on robust scientific knowledge in different health domains. Furthermore, interoperability must be guaranteed using standardized frameworks or approaches. These aspects still largely lack in the specific literature. The main aim of the paper is to develop a new ontology (the NESTORE ontology) to extend the available ontologies provided by universAAL-IoT (uAAL-IoT). The ontology is based on a multidomain healthy ageing holistic model, structuring well-assessed scientific knowledge, specifically targeted to healthy older adults aged between 65 and 75. The tool is intended to support, and standardize heterogeneous data about ageing in compliance with the uAAL-IoT framework. The NESTORE ontology covers all the relevant concepts to represent 3 significant domains of ageing: (1) Physiological Status and Physical Activity Behaviour; (2) Nutrition; and (3) Cognitive and Mental Status and Social Behaviour. In total, 12 sub-ontologies were modelled with more than 60 classes and sub-classes referenced among them by using more than 100 relations and around 20 enumerations. The proposed ontology increases the uAAL collection by 40%. NESTORE ontology provides innovation both in terms of semantic content and technological approach. The thorough use of this ontology can support the development of a decision support system, to promote healthy ageing, with the capacity to do dynamic multi-scale modelling of user-specific data based on the semantic annotations of users’ profile

Machine Learning for Early Diagnosis of ATTRv Amyloidosis in Non-Endemic Areas: A Multicenter Study from Italy

Background: Hereditary transthyretin amyloidosis with polyneuropathy (ATTRv) is an adult-onset multisystemic disease, affecting the peripheral nerves, heart, gastrointestinal tract, eyes, and kidneys. Nowadays, several treatment options are available; thus, avoiding misdiagnosis is crucial to starting therapy in early disease stages. However, clinical diagnosis may be difficult, as the disease may present with unspecific symptoms and signs. We hypothesize that the diagnostic process may benefit from the use of machine learning (ML). Methods: 397 patients referring to neuromuscular clinics in 4 centers from the south of Italy with neuropathy and at least 1 more red flag, as well as undergoing genetic testing for ATTRv, were considered. Then, only probands were considered for analysis. Hence, a cohort of 184 patients, 93 with positive and 91 (age- and sex-matched) with negative genetics, was considered for the classification task. The XGBoost (XGB) algorithm was trained to classify positive and negative TTR mutation patients. The SHAP method was used as an explainable artificial intelligence algorithm to interpret the model findings. Results: diabetes, gender, unexplained weight loss, cardiomyopathy, bilateral carpal tunnel syndrome (CTS), ocular symptoms, autonomic symptoms, ataxia, renal dysfunction, lumbar canal stenosis, and history of autoimmunity were used for the model training. The XGB model showed an accuracy of 0.707 ± 0.101, a sensitivity of 0.712 ± 0.147, a specificity of 0.704 ± 0.150, and an AUC-ROC of 0.752 ± 0.107. Using the SHAP explanation, it was confirmed that unexplained weight loss, gastrointestinal symptoms, and cardiomyopathy showed a significant association with the genetic diagnosis of ATTRv, while bilateral CTS, diabetes, autoimmunity, and ocular and renal involvement were associated with a negative genetic test. Conclusions: Our data show that ML might potentially be a useful instrument to identify patients with neuropathy that should undergo genetic testing for ATTRv. Unexplained weight loss and cardiomyopathy are relevant red flags in ATTRv in the south of Italy. Further studies are needed to confirm these findings

Transcriptomic profiling of calcified aortic valves in clonal hematopoiesis of indeterminate potential carriers

Clonal hematopoiesis of indeterminate potential (CHIP) is characterized by the presence of clones of mutated blood cells without overt blood diseases. In the last few years, it has emerged that CHIP is associated with atherosclerosis and coronary calcification and that it is an independent determinant of cardiovascular mortality. Recently, CHIP has been found to occur frequently in patients with calcific aortic valve disease (CAVD) and it is associated with a poor prognosis after valve replacement. We assessed the frequency of CHIP by DNA sequencing in the blood cells of 168 CAVD patients undergoing surgical aortic valve replacement or transcatheter aortic valve implantation and investigated the effect of CHIP on 12 months survival. To investigate the pathological process of CAVD in CHIP carriers, we compared by RNA-Seq the aortic valve transcriptome of patients with or without CHIP and non-calcific controls. Transcriptomics data were validated by immunohistochemistry on formalin-embedded aortic valve samples. We confirm that CHIP is common in CAVD patients and that its presence is associated with higher mortality following valve replacement. Additionally, we show, for the first time, that CHIP is often accompanied by a broad cellular and humoral immune response in the explanted aortic valve. Our results suggest that an excessive inflammatory response in CHIP patients may be related to the onset and/or progression of CAVD and point to B cells as possible new effectors of CHIP-induced inflammation

Small vessel disease and biomarkers of endothelial dysfunction after ischaemic stroke

Abstract Introduction: Although pathogenesis of small vessel disease is poorly understood, increasing evidence suggests that endothelial dysfunction may have a relevant role in development and progression of small vessel disease. In this crosssectional study, we investigated the associations between imaging signs of small vessel disease and blood biomarkers of endothelial dysfunction at two different time points in a population of ischaemic stroke patients. Patients and methods: In stroke patients treated with intravenous thrombolysis, we analysed blood levels of von Willebrand factor, intercellular adhesion molecule-1, vascular cell adhesion molecule-1 and vascular endothelial growth factor. Three reviewers independently assessed small vessel disease features using computed tomography. At baseline and 90 days after the index stroke, we tested the associations between single and combined small vessel disease features and levels of blood biomarkers using linear regression analysis adjusting for age, sex, hypertension, diabetes, smoke. Results: A total of 263 patients were available for the analysis. Mean age (SD) was 69 (13) years, 154 (59%) patients were male.We did not find any relation between small vessel disease and endothelial dysfunction at baseline. At 90 days, leukoaraiosis was independently associated with intercellular adhesionmolecule-1 (b¼0.21; p¼0.016) and vascular cell adhesionmolecule- 1 (b¼0.22; p¼0.009), and lacunes were associated with vascular endothelial growth factor levels (b¼0.21; p¼0.009) whereas global small vessel disease burden was associated with vascular endothelial growth factor (b¼0.26; p¼0.006). Discussion: Leukoaraiosis and lacunes were associated with endothelial dysfunction, which could play a key role in pathogenesis of small vessel disease