Blunt femoropopliteal trauma in a child: Is stenting a good option?

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Effects of Therapy with Maraviroc on the Carotid Intima Media Thickness in HIV-1/HCV Co-infected Patients

To evaluate, in human immunodeficiency virus-hepatitis C virus co-infected patients, the impact of C-C chemokine receptor type 5 (CCR5) antagonist maravirocbased antiretroviral therapy on the carotid intima media thickness and on atheromasic plaques. Patients and Methods: In this pilot prospective study, 12 HIV-HCV co-infected patients underwent color-Doppler ultrasonography before and 48 weeks after switching to a dual therapy based on maraviroc plus protease inhibitors boosted with ritonavir. Changes of intima media thickness, inflammatory and endothelial adhesion biomarkers levels, Veterans Aging Cohort Study index and Framingham risk score were evaluated. Results: At baseline 11 (91.6%) patients showed pathological ultrasonographic findings. After 48 weeks, two patients showed an amelioration of intima media thickness. Of the remaining patients with plaques, four showed a reduction of the previously diagnosed plaque; no patients worsened. Conclusion: Our data suggest that CCR5 inhibition could reduce the development of atherosclerosis especially in the non-calcific stage and could play an important role in the blockade of atheromasic plaque progression

Association between mothers' screening uptake and daughters' HPV vaccination: A quasi-experimental study on the effect of an active invitation campaign

Objectives In Emilia-Romagna, the Human Papillomavirus (HPV) vaccination campaign started in 2008 offering free vaccines for 1996 and 1997 cohorts. Systematic active invitation was implemented for the 1997 cohort. Our study aimed at measuring the impact of the active invitation campaign on HPV vaccine coverage and on coverage inequalities in 11-year-old girls. Second, we evaluated the effect of the HPV vaccination campaign on participation in cervical cancer screening by mothers of target girls. Methods We collected information on vaccination status for girls residing in Reggio Emilia in 2008 and mothers' screening history, before and after the 2008 vaccination campaign. Log-binomial regression models were performed to estimate Relative Risk (RR) and 95% confidence intervals (CIs) of being vaccinated as regarded citizenship, siblings, mothers' education, marital status and screening history, stratified by birth cohort. We also calculated RR of receiving a Pap test after the vaccination campaign as regarded education, daughter's cohort and mothers' decision to have their daughter vaccinated. Interaction between education and cohort in mothers overdue for Pap testing was calculated. Results Vaccination coverage was 46.3% for the uninvited cohort (1046/2260) and 77.9% for the invited cohort (1798/2307). In the uninvited cohort, daughters' vaccination showed association with mothers' education (8 to 11 years of education vs. graduated mothers, RR 1.61 95% CI 1.14-2.28), citizenship (foreigners vs. Italians, RR 0.45 95% CI 0.37-0.56) and screening history (regular vs. non-participant; RR 1.72 95% CI 1.26-2.36). In the invited cohort, only a slight association with screening history persisted (regular vs. non-participant; RR 1.20 95% CI 1.04-1.40). Highly educated under-screened mothers of the invited cohort showed a higher probability of receiving a Pap test after the vaccination campaign period (RR 1.27 95% CI 1.04-1.56) compared with those not invited, Conclusion Active invitation could increase overall HPV immunisation coverage and reduce socio-demographic inequalities and the association with mothers' screening participation

From Heterogeneous Sensor Networks to Integrated Software Services: Design and Implementation of a Semantic Architecture for the Internet of Things at ARCES@UNIBO

The Internet of Things (IoTs) is growing fast both in terms of number of devices connected and of complexity of deployments and applications. Several research studies an- alyzing the economical impact of the IoT worldwide identify the interoperability as one of the main boosting factor for its growth, thanks to the possibility to unlock novel commercial opportunities derived from the integration of heterogeneous systems which are currently not interconnected. However, at present, interoperability constitutes a relevant practical issue on any IoT deployments that is composed of sensor platforms mapped on different wireless technologies, network protocols or data formats. The paper addresses such issue, and investigates how to achieve effective data interoperability and data reuse on complex IoT deployments, where multiple users/applications need to consume sensor data produced by heterogeneous sensor networks. We propose a generic three-tier IoT architecture, which decouples the sensor data producers from the sensor data consumers, thanks to the intermediation of a semantic broker which is in charge of translating the sensor data into a shared ontology, and of providing publish-subscribe facilities to the producers/consumers. Then, we describe the real-world implementation of such architecture devised at the Advanced Research Center on Electronic System (ARCES) of the University of Bologna. The actual system collects the data produced by three different sensor networks, integrates them through a SPARQL Event Processing Architecture (SEPA), and supports two front- end applications for the data access, i.e. a web dashboard and an Amazon Alexa voice service

The impact of chest CT body composition parameters on clinical outcomes in COVID-19 patients

We assessed the impact of chest CT body composition parameters on outcomes and disease severity at hospital presentation of COVID-19 patients, focusing also on the possible mediation of body composition in the relationship between age and death in these patients. Chest CT scans performed at hospital presentation by consecutive COVID-19 patients (02/27/2020-03/13/2020) were retrospectively reviewed to obtain pectoralis muscle density and total, visceral, and intermuscular adipose tissue areas (TAT, VAT, IMAT) at the level of T7-T8 vertebrae. Primary outcomes were: hospitalization, mechanical ventilation (MV) and/or death, death alone. Secondary outcomes were: C-reactive protein (CRP), oxygen saturation (SO2), CT disease extension at hospital presentation. The mediation of body composition in the effect of age on death was explored. Of the 318 patients included in the study (median age 65.7 years, females 37.7%), 205 (64.5%) were hospitalized, 68 (21.4%) needed MV, and 58 (18.2%) died. Increased muscle density was a protective factor while increased TAT, VAT, and IMAT were risk factors for hospitalization and MV/death. All these parameters except TAT had borderline effects on death alone. All parameters were associated with SO2 and extension of lung parenchymal involvement at CT; VAT was associated with CRP. Approximately 3% of the effect of age on death was mediated by decreased muscle density. In conclusion, low muscle quality and ectopic fat accumulation were associated with COVID-19 outcomes, VAT was associated with baseline inflammation. Low muscle quality partly mediated the effect of age on mortality.We assessed the impact of chest CT body composition parameters on outcomes and disease severity at hospital presentation of COVID-19 patients, focusing also on the possible mediation of body composition in the relationship between age and death in these patients. Chest CT scans performed at hospital presentation by consecutive COVID-19 patients (02/ 27/2020-03/13/2020) were retrospectively reviewed to obtain pectoralis muscle density and total, visceral, and intermuscular adipose tissue areas (TAT, VAT, IMAT) at the level of T7-T8 vertebrae. Primary outcomes were: hospitalization, mechanical ventilation (MV) and/or death, death alone. Secondary outcomes were: C-reactive protein (CRP), oxygen saturation (SO2), CT disease extension at hospital presentation. The mediation of body composition in the effect of age on death was explored. Of the 318 patients included in the study (median age 65.7 years, females 37.7%), 205 (64.5%) were hospitalized, 68 (21.4%) needed MV, and 58 (18.2%) died. Increased muscle density was a protective factor while increased TAT, VAT, and IMAT were risk factors for hospitalization and MV/death. All these parameters except TAT had borderline effects on death alone. All parameters were associated with SO2 and extension of lung parenchymal involvement at CT; VAT was associated with CRP. Approximately 3% of the effect of age on death was mediated by decreased muscle density. In conclusion, low muscle quality and ectopic fat accumulation were associated with COVID-19 outcomes, VAT was associated with baseline inflammation. Low muscle quality partly mediated the effect of age on mortality

FATAL DOG ATTACKS: AN EIGHT-YEAR STUDY FROM 2009 TO 2016 IN ITALY

Domesticated animals, particularly dogs, have provided companionship, labor, recreation, and entertainment for humans. However, as the result of the most diverse causes, this interaction has not been free of conflicts. The alarming statistics reported around the world have shown that dog attacks today represent a health hazard where prevention strategies have not always been successful 1,2. Most of the dogs involved in these events are known to the victim or belong to him. The researchers identified a striking co-occurrence of multiple, controllable factors: no able- bodied person being present to intervene; the victim having no familiar relationship with the dog(s); the dog(s) owner failing to neuter/spay the dog(s); a victim’s compromised ability, whether based on age or physical condition, to manage their interactions with the dog(s); the owner keeping dog(s) as resident dog(s), rather than as family pet(s); the owner’s prior mismanagement of the dog(s); and the owner’s abuse or neglect of dog(s). Four or more of these factors were present in 80.5% of cases; breed was not one of those factors. This DBRF study was based primarily on media reports to identified the Italian number of fatal dog attacks, victims' sex and age and the breed of the dogs. From our study we found 19 DBRFs in Italy from 2009 to 2016 (2,37 cases for year); these data are sharply increased in relationship with previous study that describes 32 DWARFs between 1984 to 2009 3 with a frequency of 1,28 cases for year. We do not find a significantly difference on victim’s sex (8 women against 11 male). As previously described, we confirm that dogs are known to the victim or belong to him (14 cases); in 4 of the other cases where the victim did not know the dog, the aggression was carried out by mongrel dogs. As previously described, the victims are often over 65 years old (47,4%) or under 5 years old (42,1%). Finally we do not find a race dog that was more likely to injure a human rather another race. We know poorly on aggression causes, for example, if the death is caused by the human aggressor to the dog or if it is an unexplained event. Certainly, when DBRF occurs leads emotional implications in public opinion: it should promote the use of targeted studies, which still lack both internationally and, to a greater extent, national

Welcoming teleretinography into diabetes integrated care

Integrated Care (IC) is a perfect fit for people with diabetes. Fundus examination (FE) is a disease marker for diabetologists and identifies potentially blinding complications (Diabetic Retinopathy, DR). In our Diabetes Clinic (DC) in Pescara, Italy, FE is possibly provided with telemedicine in same day as other exams, avoiding it to be a standalone clinical one; images taken with a retinal digital camera are graded by a remote ophthalmologist within a shared Electronic Health Record (EHR), immediately readable by other stakeholders; a dedicated care path to the Eye Clinic, University of Chieti-Pescara is provided for urgent cases. Personnel’s worktime shortening allows gaining time for ophthalmologists’ eye examinations in outpatient settings and other stakeholders’ work in the DC. The need for a DR digital screening system is growing worldwide: our experience confirms the ease of implementation, and the advantage of sharing clinical data with all stakeholders when working within an EHR, aiming to optimize an IC effective system