Risk prediction of clinical adverse outcomes with machine learning in a cohort of critically ill patients with atrial fibrillation

Critically ill patients affected by atrial fibrillation are at high risk of adverse events: however, the actual risk stratification models for haemorrhagic and thrombotic events are not validated in a critical care setting. With this paper we aimed to identify, adopting topological data analysis, the risk factors for therapeutic failure (in-hospital death or intensive care unit transfer), the in-hospital occurrence of stroke/TIA and major bleeding in a cohort of critically ill patients with pre-existing atrial fibrillation admitted to a stepdown unit; to engineer newer prediction models based on machine learning in the same cohort. We selected all medical patients admitted for critical illness and a history of pre-existing atrial fibrillation in the timeframe 01/01/2002-03/08/2007. All data regarding patients' medical history, comorbidities, drugs adopted, vital parameters and outcomes (therapeutic failure, stroke/TIA and major bleeding) were acquired from electronic medical records. Risk factors for each outcome were analyzed adopting topological data analysis. Machine learning was used to generate three different predictive models. We were able to identify specific risk factors and to engineer dedicated clinical prediction models for therapeutic failure (AUC: 0.974, 95%CI: 0.934-0.975), stroke/TIA (AUC: 0.931, 95%CI: 0.896-0.940; Brier score: 0.13) and major bleeding (AUC: 0.930:0.911-0.939; Brier score: 0.09) in critically-ill patients, which were able to predict accurately their respective clinical outcomes. Topological data analysis and machine learning techniques represent a concrete viewpoint for the physician to predict the risk at the patients' level, aiding the selection of the best therapeutic strategy in critically ill patients affected by pre-existing atrial fibrillation

Joint Geophysical‐Petrological Modeling on the Ivrea Geophysical Body Beneath Valsesia, Italy: Constraints on the Continental Lower Crust

Abstract One of the few near‐complete continental crustal sections exposed on Earth's surface is the Ivrea‐Verbano Zone (Western Alps, Italy), which is considered as a petro‐geophysical reference of the continental lithosphere. Exposed peridotite slivers embedded in lower crustal rocks at the surface and large density, seismic velocity anomalies of the Ivrea Geophysical Body in the subsurface suggest that mantle‐like rocks are located as shallow as a few kilometers depth, but the actual composition of the rocks producing these anomalies is unknown. Here we investigate how the published seismological and new gravimetric data in the location of Valsesia could be reconciled with petrologic data and models of the Ivrea‐Verbano Zone. We use the Perple_X software to calculate densities and compressional wave velocities for a range of possible deep crustal rock types. We argue that amphibole gabbros (18 km depth) provide the best fit to the joint geophysical and petrologic constraints, whereas residual ultramafic rocks and anhydrous gabbros are inconsistent with the existing data. This indicates that the Ivrea Geophysical Body beneath the Valsesia area in the Ivrea‐Verbano Zone preserves the structure of an igneous complex formed during magmatic underplating from the crystallization of hydrous mafic magmas. This would imply melting of a damp mantle source that produced a continental crust of an original thickness of up to ∼48 km in the Permian, of which ∼30 km are exposed at Earth's surface today

Polycyclic Aromatic hydrocarbon (PAH) accumulation in different common sole tissues by Quechers method.

The evaluation of polycyclic aromatic hydrocarbon (PAH) level in environmental matrices and the edible part of aquatic organisms is an important issue (1). PAH bioaccumulation is a complex phenomenon governed by many factors including their physicochemical characteristics, environmental conditions and the characteristics of the species itself (2; 3). This study extends our knowledge of the bioaccumulation of PAHs in marine organisms and investigates its possible determinants. The aims were to analyze and evaluate the residue levels and distribution of PAH in the tissue of common sole individuals (S. solea) collected from three areas of the northern Adriatic Sea and to examine the main factors involved in PAH bioaccumulation, namely the lipid content of tissue, biometric characteristics of fish, environmental features and physicochemical properties (e.g. Kow) of PAHs to establish which factors exert a major influence on PAH bioaccumulation in fish tissue. The Quechers (QUick Easy CHeap Effective Rugged and Safe) method was applied and developed for the extraction and purification steps of PAHs from fish tissue(4). At the same time, the ultrasonic bath and liquid-liquid separation were performed for the PAH extraction from marine sediments (5). PAH identification and quantification in fish tissue and surface sediment samples were performed by the same methods using an HPLC system (Ultimate 3000, Thermo Scientific) equipped with a fluorescence detector (RF-2000, Thermo Scientific). The whole analytical procedure was validated by analyzing the reference materials (IAEA code 106, code 408 and code 383) and the recovery fell with the confidence interval of 95%. Statistical analysis of method performance data, in particularly the evaluation of the linearity range and LOD, LOQ quantification, was performed using Statgraphics Plus software, version 5.1 (6). A p value lower than 0.05 was considered to indicate significance, while a p value higher than 0.05 was considered to indicate not significance (n.s.). The content of the total PAHs was measured in muscle, liver and gill tissue of S. solea individuals caught in the Venice Lagoon, off Chioggia and the Po Delta (Table 1). The average total PAH concentration was 6.7 ng g-1 d.w. (range: 1.3-16.3 ng g-1 d.w.), 13.1 ng g-1 d.w. (range: 2.1-31.8 ng g-1 d.w.) and 32.0 ng g-1 d.w. (range: 2.0-112.6 ng g-1 d.w.), in muscle, liver and gill tissue, respectively. Therefore, a significantly higher PAH accumulation in gills, followed by liver and muscle was found (p < 0.05). The sediment concentrations of total PAHs were also measured to understand how the sampling areas affected their bioaccumulation in fish tissues. PAH concentrations were highest in the Venice Lagoon and the Po Delta (980±2 ng g-1 d.w and 625±62 ng g-1 d.w, respectively) and lowest in the off Chioggia (58±2 ng g-1 d.w). The impact of PAHs was higher on biota and sediment form the coastal areas (the Venice Lagoon and the Po Delta), which are characterized by dense human settlements and activities as well as direct and indirect discharges. Correlations were observed between several factors, especially the lipid content of tissue, the octanol-water partition coefficient (Kow) of PAHs and the body size of fish, in relation to PAH bioaccumulation in fish tissue (Table 2). Our finding suggests that a quota of PAHs accumulation in gill and liver tissues depend on PAH physico chemical features, such as Kow. Although, a positive relationship between lipid content and total PAH levels was found in the three tissues, the degree of significance was not significant. Moreover, PAH tissue concentrations decreases with the increase in body size, in line with the data reported by other authors (7; 8) may be due to a relatively low resistance of PAHs to biotransformation and a high depuration rates by adult organisms. The main factors determining PAH bioaccumulation in S. solea tissue in the Adriatic Sea were closely related to their environment

A multi-centric observational study on heterotopic ossification in severely brain injured patients with disorders of consciousness: preliminary data

Aims: to identify occurrence of neurogenic heterotopic ossification (NHO) in patients with prolonged disorder of consciousness (DoC) and possible risk factors. Design: Multi-center observational study. Setting: twenty-three intensive neurorehabilitation units. Subjects: two hundred and seventy-eight patients with prolonged disorder of consciousness (DoC; 150 in vegetative state and 128 in minimally conscious state) of different aetiology (vascular 125, traumatic=83; anoxic=56 brain injury and other brain aetiologies=14). Main Measures: at study entry: clinical evaluation by the Coma Recovery Scale-Revised (CRS-R), Disability Rating Scale (DRS), Early Rehabilitation Barthel Index (ERBI), Clinical Feature Scale (CFS); presence of ventilator support, spasticity, bone fractures. Within 3 months after admission: clinical evidence of NHO (i.e. limited range of motion and/or joint pain and/or local inflammation) confirmed by standard radiological and/or sonographic evaluation and presence of paroxysmal sympathetic hyperactivity (PSH). Results: Thirty-one patients (11.2%) developed NHO. Presence of abnormal ossifications was significantly higher in patients in VS than in patients in MCS and in patients with traumatic brain injury. Moreover patients with NHO showed higher DRS category and total score, higher occurrence of limb spasticity and bone fractures at study entry than patients without NHO. Patients with NHO did not differ from patients without NHO for sex, age, time post-injury, CRS-R and ERBI total scores, presence of non-invasive ventilator support at study entry and presence of PSH. Conclusions: Our findings suggest a relation between development of NHO and clinical diagnosis, functional disability status and aetiology in patients with DoC. Moreover, we identified spasticity and bone fractures as possible risk factors for occurrence of NHO in patients with severe brain injury and DoC

Hypertension and migraine comorbidity: prevalence and risk of cerebrovascular events: evidence from a large, multicenter, cross-sectional survey in Italy (MIRACLES study)

OBJECTIVES: To estimate the prevalence of hypertension-migraine comorbidity; to determine their demographic and clinical characteristics versus patients with hypertension or migraine alone; and to see whether a history of cerebrovascular events was more common in the comorbidity group. METHODS: The MIRACLES, multicenter, cross-sectional, survey included 2973 patients with a known diagnosis of hypertension or migraine in a general practitioner setting in Italy. RESULTS: Five hundred and seventeen patients (17%) suffered from hypertension-migraine comorbidity, whereas 1271 (43%) suffered from hypertension only, and 1185 (40%) from migraine only. In the comorbidity group, the onset of comorbidity occurred at about 45 years of age, with migraine starting significantly later than in the migraine-only group, and hypertension significantly before than in the hypertension-only group; a familial history of both hypertension and migraine had a significantly higher frequency as compared with the hypertension and migraine group. Compared to hypertension (3.1%) and migraine (0.7%), the comorbidity group had a higher prevalence (4.4%) of history of cerebrovascular events, with an odds ratio of a predicted history of stroke/transient ischemic attack (TIA) of 1.76 [95% confidence interval (CI) 1.01-3.07] compared to the hypertension group. In patients without other recognized risk factors for stroke, stroke/TIA occurred more frequently in the comorbidity group, compared to the hypertension group. In the age range 40-49 years, prevalence of history of stroke/TIA was five-fold greater (4.8% in comorbidity vs. 0.9% in hypertension group). CONCLUSION: This cross-sectional study indicates that the prevalence of comorbidity hypertension-migraine is substantial and that patients with comorbidity have a higher probability of history of cerebrovascular events, compared to hypertensive patient