Repeated or intermittent levosimendan treatment in advanced heart failure: An updated meta-analysis.

Abstract Introduction Advanced heart failure is a malignant disease characterized by a debilitating late course, with increasingly frequent hospitalisations and high rate of mortality. Levosimendan, an inodilator developed for the treatment of acutely decompensated chronic heart failure, has been recently proposed also as a repetitive treatment of advanced heart failure. Several studies on the use of levosimendan in this settings report mortality data. Independent meta-analyses on the effect on mortality of repetitive or intermittent levosimendan administration in advanced heart failure has been published but were criticized in regard to the selection of the studies. Meanwhile new data became available. We therefore updated the selection of studies and re-analyzed all the available data. Methods & results Data from seven randomized trial and a total of 438 adult patients using intermittent levosimendan in a cardiological setting were included in the present analysis. The average follow-up period was 8±3.8months. The use of levosimendan was associated with a significant reduction in mortality at the longest follow-up available [41 of 257 (16%) in the levosimendan group vs. 39 of 181 (21.5%) in the control arm, OR=0.54 (95% CI 0.32–0.91), p for effect=0.02, p for heterogeneity=0.64, I2=0%]. Conclusions The updated results suggest that repetitive or intermittent levosimendan administration in advanced heart failure is associated with a significant reduction in mortality at the longest follow-up available. There is therefore a strong rationale for a randomized clinical trial with adequate power on mortality

Radiomics for identification of active bone marrow from ct: An exploratory study

The radiation dose received by the pelvic Bone Marrow (BM) is a predictive factor for Hematologic Toxicity (HT) occurrence in the treatment of anal cancer. For this reason it is important to avoid BM during radiotherapy. In particular, the standard strategy in these cases consists in the identification of hematopoietically active BM (actBM), i.e. the part of BM in charge of blood cells generation, on 18 FDG-PET, FLT-PET or MRI, but no approached have been developed for identifying actBM from CT images. This exploratory study aims to use radiomics for detecting actBM on CT sequences. Our approach is based on the extraction of 36 first-order and texture (second-order) features for each CT slice. These features are used as input of a Decision Tree (DT) classifier able to discriminate between active and inactive BM regions on the images. This method was applied to five patients affected by carcinoma of the anal canal and the obtained actBM segmentation was compared with the standard actBM identification from 18 FDG-PET (reference standard, RS). Our results show that actBM identification in lumbosacral and iliac structures using radiomics overlaps the RS for more than 75% in 4 out of 5 patients

Comparison of different classifiers to recognize active bone marrow from CT images

One of the main problems during in the treatment of anal cancer with chemotherapy and radiation is the occurrence of Hematologic Toxicity (HT). In particular, during radiotherapy it is crucial to spare Bone Marrow (BM), since the radiation dose received by BM in pelvic bones predicts the onset of HT. In this direction, the most popular strategies are based on the identification of the hematopoietically active BM (actBM), that is the part of BM in charge of blood cells generation, using MRI, SPECT or PET, but no approached have been proposed based on CT. In this study we compare four different classifiers in recognizing actBM from CT images using 36 radiomic features. We used Genetic Algorithms (GAs) to simultaneously optimize the feature subsets and the classifier parameters, separately for three pelvic subregions: iliac bone marrow (IBM), lower pelvis bone marrow (LPBM), and lumbosacral bone marrow (LSBM). The obtained classifiers were applied to CT sequences of a cohort of 25 patients affected by carcinoma of the anal canal. Classifiers results were compared with the actBM identified from 18FDG-PET (reference standard, RS). It emerged that the performances of the 4 classifiers are similar and they are satisfactory for IBM and LSBM subregions (Dice > 0.7) whereas they are poor for LPBM (Dice < 0.5)

Left ventricular (LV) pacing in newborns and infants. Echo assessment of LV systolic function and synchrony at 5-year follow-up

Background: Small retrospective studies reported that left ventricular (LV) pacing is likely to preserve LV function in children with isolated congenital complete atrioventricular block (CCAVB). The aim of this study was to prospectively evaluate LV contractility and synchrony in a cohort of neonates/infants at pacemaker implantation and follow-up. Methods: Patients with CCAVB who underwent LV pacing were evaluated with electrocardiogram and echocardiogram in a single-center, prospective study. Data were collected at implantation, at 1-month and every year of follow-up, up to 5 years. LV ventricular dimensions (diameters and volumes), systolic function (ejection fraction [EF] and global longitudinal strain [GLS]), and synchrony were evaluated. Data are reported as median (25th-75th centiles). Results: Twenty consecutive patients with CCAVB underwent pacemaker implantation (12 single-chamber pacemaker [VVIR] and eight dual-chamber pacemaker [DDD]) with epicardial leads: 17 on the LV apex and three on the free wall. Age at implantation was 0.3 months (1 day-4.5 months). Patients showed good clinical status, normal LV dimensions, preserved systolic function, and synchrony at 60 (30-60) months follow-up. EF increased to normal values in patients with preimplantation EF&nbsp;&lt;50%. Presence of antibodies and pacing mode (DDD vs VVIR) had no impact on the outcome. Conclusions: LV pacing preserved LV systolic function and synchrony in neonates and infants with CCAVB at 5-year follow-up. LV EF improved in patients with low preimplantation EF. Pacing mode or the presence of autoantibodies did not demonstrated an impact on LV contractility and synchrony

The sensor-based biomechanical risk assessment at the base of the need for revising of standards for human ergonomics

Due to the epochal changes introduced by “Industry 4.0”, it is getting harder to apply the varying approaches for biomechanical risk assessment of manual handling tasks used to prevent work-related musculoskeletal disorders (WMDs) considered within the International Standards for ergonomics. In fact, the innovative human–robot collaboration (HRC) systems are widening the number of work motor tasks that cannot be assessed. On the other hand, new sensor-based tools for biomechanical risk assessment could be used for both quantitative “direct instrumental evaluations” and “rating of standard methods”, allowing certain improvements over traditional methods. In this light, this Letter aims at detecting the need for revising the standards for human ergonomics and biomechanical risk assessment by analyzing the WMDs prevalence and incidence; additionally, the strengths and weaknesses of traditional methods listed within the International Standards for manual handling activities and the next challenges needed for their revision are considered. As a representative example, the discussion is referred to the lifting of heavy loads where the revision should include the use of sensor-based tools for biomechanical risk assessment during lifting performed with the use of exoskeletons, by more than one person (team lifting) and when the traditional methods cannot be applied. The wearability of sensing and feedback sensors in addition to human augmentation technologies allows for increasing workers’ awareness about possible risks and enhance the effectiveness and safety during the execution of in many manual handling activities

Elderly and Children Are Not The Only Victims of Foreign Body Airway Obstruction in Italy (A National Media-Based Survey)

Choking is a relevant public health problem. Data in medical literature are scarce and fatal events are dramatically under-reported.The aim of this manuscript is to give a real estimation of this problem and to raise awareness about this topic.Materials and methods. All deaths caused by choking reported by Italian Mass Media over a two years period were collected. Suspected sudden infant death syndrome was an exclusion criteria.Results. 76 deaths due to foreign body airway obstruction were identified, 51% during 2018 and 49% in 2019, without identifiable time clusters. Choking affected every age, including pre-scholar children (25%), children 6 to 18 years old (3%), adults (38%), and elderly patients (34%). Witnessed cases were 61 (80%) but in almost half 26 cases (42%) the fatal event occurred before or without first aid maneuvers being performed.Conclusion. On the Italian territory, during a 2 years period, three cases per month of fatal choking due to foreign-body airway obstruction occurred, many of them in adult patients (38%). Italian people seem not to be educated to provide first aid in these settings

Пожилые люди и дети — не единственные жертвы обструкции дыхательных путей инородными предметами в Италии (Национальное исследование на основе анализа СМИ)

Choking is a relevant public health problem. Data in medical literature are scarce and fatal events are dramatically under-reported.The aim of this manuscript is to give a real estimation of this problem and to raise awareness about this topic.Materials and methods. All deaths caused by choking reported by Italian Mass Media over a two years period were collected. Suspected sudden infant death syndrome was an exclusion criteria.Results. 76 deaths due to foreign body airway obstruction were identified, 51% during 2018 and 49% in 2019, without identifiable time clusters. Choking affected every age, including pre-scholar children (25%), children 6 to 18 years old (3%), adults (38%), and elderly patients (34%). Witnessed cases were 61 (80%) but in almost half 26 cases (42%) the fatal event occurred before or without first aid maneuvers being performed.Conclusion. On the Italian territory, during a 2 years period, three cases per month of fatal choking due to foreign-body airway obstruction occurred, many of them in adult patients (38%). Italian people seem not to be educated to provide first aid in these settings.Асфиксия (удушье) является серьезной проблемой общественного здравоохранения. Данные медицинской литературы по этой проблеме скудны, а сообщения о смертельных исходах резко занижены.Цель публикации — оценить реальную частоту асфиксии и повысить осведомленность о ней.Материалы и методы. Собрали все случаи смерти от асфиксии, о которых итальянские СМИ сообщали в течение двух лет. Критерием исключения было подозрение на синдром внезапной детской смерти.Результаты. Выявили 76 смертей вследствие обструкции дыхательных путей инородным телом — 51% в 2018 году и 49% в 2019 году ото всех случаев асфиксии, без каких-либо определенных временных предпочтений по накоплению случаев в течение года. Асфиксию наблюдали среди лиц всех возрастов, включая детей дошкольного возраста (25%), детей от 6 до 18 лет (3%), взрослых (38%) и пожилых пациентов (34%). В присутствии свидетелей произошел 61 случай (80%), при этом почти в половине смертельных случаев (26, что составило 42%) смерть наступила до или без проведения мероприятий по оказанию первой помощи.Заключение. На территории Италии в течение двух лет ежемесячно происходило по три случая смертельной асфиксии вследствие обструкции дыхательных путей посторонними предметами, много случаев обнаружено в когорте пациентов зрелого возраста (38%). Такие данные СМИ свидетельствуют о том, что население Италии не обучено оказывать первую помощь, необходимую в таких случаях

A decade of insertable cardiac monitors with remote monitoring in pediatric patients

Background: Remote monitoring-enabled insertable cardiac monitors (ICMs) are useful tools for arrhythmias and symptom management. This study sought to evaluate the outcome of ICM implantation in a large, heterogeneous cohort of pediatric and young adult patients. Methods: Single centre, retrospective analysis of patients who underwent ICM implantation in 2010–2019. Patients were analysed according to age, symptoms, arrhythmias and underlying heart disease. Results: A total of 200 consecutive patients (58% male), aged 11.5 ± 5.8 years at ICM implantation, were included. Follow-up was 31 ± 18 months. Electrophysiologic study (EPS) was initially performed in 123 patients and was negative in 85%. Patients had no heart disease (57.5%), congenital heart defects (21%), channelopathies (14.5%), cardiomyopathies/heart tumors (8%). The commonest symptoms were syncope/presyncope (45.5%) and palpitations (12.5%). A definite diagnosis was made in 63% of patients (positive diagnosis in 25%, negative in 38%) after 8 (2–19) months of monitoring. EPS results and the presence/absence of an arrhythmia before ICM implantation had no impact on the diagnostic yield. Symptomatic patients as well as patients without structural heart disease showed higher diagnostic yield. Patients with a positive diagnosis underwent pacemaker/implantable cardioverter-defibrillator implantation (13%), pharmacological treatment (10.5%), or catheter ablation (1.5%). Conclusions: In a large cohort of 200 children and young adults, ICMs with remote monitoring showed a high diagnostic yield (63%), especially in symptomatic patients and in patients without structural heart disease

Proteolytic Activity and Production of &#947;-Aminobutyric Acid by Streptococcus thermophilus Cultivated in Microfiltered Pasteurized Milk

A set of 191 strains of Streptococcus thermophilus were preliminarily screened for the presence of the genes codifying for cell envelope-associated proteinase (prtS) and for glutamate decarboxylase (gadB) responsible for \u3b3-aminobutyric acid (GABA) production. The growth and proteolytic activity of the gadB-positive strains (9 presenting the prtS gene and 11 lacking it) were studied in microfiltered pasteurized milk. Degradation of both caseins (capillary electrophoresis) and soluble nitrogen fractions (HPLC) and changes in the profile of free amino acids (FAAs; ion-exchange chromatography) were evaluated at inoculation and after 6 and 24 h of incubation at 41 \ub0C. None of the strains was capable of hydrolyzing caseins and \u3b2-lactoglobulin, and only two hydrolyzed part of \u3b1-lactalbumin, these proteins being present in their native states in pasteurized milk. Contrarily, most strains were able to hydrolyze peptones and peptides. For initial growth, most strains relied on the FAAs present in milk, whereas, after 6 h, prtS+ strains released variable amounts of FAA. One prtS+ strain expressed a PrtS- phenotype, and two prtS- strains showed a rather intense proteolytic activity. Only five strains (all prtS+) produced GABA, in variable quantities (up to 100 mg/L) and at different rates, depending on the acidification strength. Addition of glutamate did not induce production of GABA in nonproducing strains that, however, unexpectedly were shown to adopt the degradation of arginine into citrulline and ornithine as an alternative acid resistance system and likely as a source of ATP

A robust genetic algorithm for learning temporal specifications from data

We consider the problem of mining signal temporal logical requirements from a dataset of regular (good) and anomalous (bad) trajectories of a dynamical system. We assume the training set to be labeled by human experts and that we have access only to a limited amount of data, typically noisy. We provide a systematic approach to synthesize both the syntactical structure and the parameters of the temporal logic formula using a two-steps procedure: first, we leverage a novel evolutionary algorithm for learning the structure of the formula; second, we perform the parameter synthesis operating on the statistical emulation of the average robustness for a candidate formula w.r.t. its parameters. We compare our results with our previous work [9] and with a recently proposed decision-tree [8] based method. We present experimental results on two case studies: an anomalous trajectory detection problem of a naval surveillance system and the characterization of an Ineffective Respiratory effort, showing the usefulness of our work