Perinatal Hypoxic-Ischemic Encephalopathy: epileptic and paretic outcome at one year of age

<p>Abstract</p> <p>Background</p> <p>The issue concerning neurologic outcome in patients with perinatal Hypoxic-Ischemic Encephalopathy (H.I.E) has inspired many studies which tried to identify adequate prognostic factors. Our work aims to find among neonatal parameters:</p> <p indent="1">- factors which help to predict the risk to develop both Cerebral Palsy (CP) and secondary Epilepsy at one year of age in subjects affected by perinatal Hypoxic-Ischemic Encephalopathy,</p> <p indent="1">- correlations between the neonatal parameters and the variable severity of above mentioned sequelae.</p> <p>Methods</p> <p>We have recruited 32 subjects, whose history and neuroimages suggested a perinatal H.I.E and we have retrospectively analysed clinical-instrumental parameters at birth and at one year of age.</p> <p>Results</p> <p>At one year cut-off, 9 patients developed both secondary epilepsy and CP (28%), whereas the other subjects showed only motor delay (31%), only secondary epilepsy (3%) or only CP (38%). Patients with both the severest sequelae were essentially term infants (only 2/9 were pre-term infants), with normal weight (only 3 LBW) and 7 of them with early pathologic EEG and neuroimages pointing out cortex injuries (typical of term infants). A statistic analysis showed the following correlations: birth weight and global prognosis (χ²= 14,03; p = 0,04); neonatal clinical pattern and CP's severity (χ²= 14,03; p = 0,0009); early EEG and CP's severity (χ²= 4,32; p = 0,04); epileptic onset age and CP and Epilepsy's severity (F = 16,01; p = 0,005).</p> <p>Birth weight represented a predictive factor of early neurological outcome (<1,5 kg birth weight neonates are not at risk of both epilepsy and CP); neonatal clinical pattern and early EEG were correlated with variable severity of CP; an epileptic exordium in the first 6 months led up to a more severe epileptic and paretic outcome.</p> <p>Conclusion</p> <p>From a clinical point of view it is of crucial importance to have some parameters which enable to discriminate patients at risk of more severe sequelae from those at risk of moderate severity outcome.</p

Obesity can influence children’s and adolescents’ airway hyperresponsiveness differently

BACKGROUND: Literature is still arguing about a possible relationship between airway hyperresponsiveness (AHR) and body mass index (BMI). This study aimed at evaluating the influence of BMI on AHR and pulmonary function in children and adolescents that performed a methacholine test for suggestive asthma symptoms. METHODS: 799 consecutive children/adolescents (535 M; mean age: 15 ± 3 yrs; median FEV(1)% predicted: 101.94% [93.46-111.95] and FEV(1)/FVC predicted: 91.07 [86.17-95.38]), were considered and divided into underweight, normal, overweight and obese. Different AHR levels were considered as moderate/severe (PD(20) ≤ 400 μg) and borderline (PD(20) > 400 μg). RESULTS: 536 children/adolescents resulted hyperreactive with a median PD(20) of 366 μg [IQR:168–1010.5]; 317 patients were affected by moderate/severe AHR, whereas 219 showed borderline hyperresponsiveness. Obese subjects aged > 13 years showed a lower (p = 0.026) median PD(20) (187μg [IQR:110–519]) compared to overweight (377 μg [IQR:204–774]) and normal-weight individuals’ values (370.5 μg [IQR:189–877]). On the contrary, median PD(20) observed in obese children aged ≤ 13 years (761 μg [IQR:731–1212]) was higher (p = 0.052) compared to normal-weight children’s PD20 (193 μg [IQR:81–542]) and to obese adolescents’ values (aged > 13 years) (p = 0.019). Obesity was a significant AHR risk factor (OR:2.853[1.037-7.855]; p = 0.042) in moderate/severe AHR adolescents. Females showed a higher AHR risk (OR:1.696[1.046-2.751] p = 0.032) compared to males. A significant relationship was found between BMI and functional parameters (FEV(1), FVC, FEV(1)/FVC) only in hyperreactive females. CONCLUSIONS: Obesity seems to influence AHR negatively in female but not in male adolescents and children. In fact, AHR is higher in obese teenagers, in particular in those with moderate/severe hyperresponsiveness, and may be mediated by obesity-associated changes in baseline lung function

Behavioral Analysis for Virtualized Network Functions : A SOM-based Approach

In this paper, we tackle the problem of detecting anomalous behaviors in a virtualized infrastructure for network function virtualization, proposing to use self-organizing maps for analyzing historical data available through a data center. We propose a joint analysis of system-level metrics, mostly related to resource consumption patterns of the hosted virtual machines, as available through the virtualized infrastructure monitoring system, and the application-level metrics published by individual virtualized network functions through their own monitoring subsystems. Experimental results, obtained by processing real data from one of the NFV data centers of the Vodafone network operator, show that our technique is able to identify specific points in space and time of the recent evolution of the monitored infrastructure that are worth to be investigated by a human operator in order to keep the system running under expected conditions

SOM-based behavioral analysis for virtualized network functions

In this paper, we propose a mechanism based on Self-Organizing Maps for analyzing the resource consumption behaviors and detecting possible anomalies in data centers for Network Function Virtualization (NFV). Our approach is based on a joint analysis of two historical data sets available through two separate monitoring systems: system-level metrics for the physical and virtual machines obtained from the monitoring infrastructure, and application-level metrics available from the individual virtualized network functions. Experimental results, obtained by processing real data from one of the NFV data centers of the Vodafone network operator, highlight some of the capabilities of our system to identify interesting points in space and time of the evolution of the monitored infrastructure

Forecasting Operation Metrics for Virtualized Network Functions

Network Function Virtualization (NFV) is the key technology that allows modern network operators to provide flexible and efficient services, by leveraging on general-purpose private cloud infrastructures. In this work, we investigate the performance of a number of metric forecasting techniques based on machine learning and artificial intelligence, and provide insights on how they can support the decisions of NFV operation teams. Our analysis focuses on both infrastructure-level and service-level metrics. The former can be fetched directly from the monitoring system of an NFV infrastructure, whereas the latter are typically provided by the monitoring components of the individual virtualized network functions. Our selected forecasting techniques are experimentally evaluated using real-life data, exported from a production environment deployed within some Vodafone NFV data centers. The results show what the compared techniques can achieve in terms of the forecasting accuracy and computational cost required to train them on production data

Use of narrative medicine to identify key factors for effective doctor–patient relationships in severe asthma

Background: In this project the authors use a narrative medicine (NM) approach to assess the promotion of trust in the relationship between physicians and their asthma patients. Methods: Following a NM educational course for physicians, a research was carried out in which at least 5 written narratives (parallel charts) for each participating physician were collected and qualitatively analysed according to Bury's classification and the Grounded Theory. Results: The results of this study were of speculative and clinical interest. In particular, 66 participants wrote 314 narratives (246 on adult and 68 on paediatric patients). As a result of applying the NM approach, when the relationships remained problematic, many physicians wrote with a moral style about their adult (67%), and paediatric patients (33%) - especially in cases of asthmatic children's or adolescents' overprotective or absent families (40%) -. On the contrary, physicians who were able to listen to their patients with empathy (35%) made more shared decisions with patients, even with those they initially had a bad relationship. The used words of welcome, interest and acceptance were promoting patients' trust that lead to restoring their activities in 45% of cases, according to physicians self-reporting. Conclusions: These approaches of NM are useful in daily clinical practice, with the goal of improving the quality of life (QOL) of patients with severe asthma, even in cases in which the doctor-patient relationship isn't initially good

METACOHORTS for the study of vascular disease and its contribution to cognitive decline and neurodegeneration: an initiative of the Joint Programme for Neurodegenerative Disease Research

Dementia is a global problem and major target for health care providers. Although up to 45% of cases are primarily or partly due to cerebrovascular disease, little is known of these mechanisms or treatments because most dementia research still focuses on pure Alzheimer's disease. An improved understanding of the vascular contributions to neurodegeneration and dementia, particularly by small vessel disease, is hampered by imprecise data, including the incidence and prevalence of symptomatic and clinically “silent” cerebrovascular disease, long-term outcomes (cognitive, stroke, or functional), and risk factors. New large collaborative studies with long follow-up are expensive and time consuming, yet substantial data to advance the field are available. In an initiative funded by the Joint Programme for Neurodegenerative Disease Research, 55 international experts surveyed and assessed available data, starting with European cohorts, to promote data sharing to advance understanding of how vascular disease affects brain structure and function, optimize methods for cerebrovascular disease in neurodegeneration research, and focus future research on gaps in knowledge. Here, we summarize the results and recommendations from this initiative. We identified data from over 90 studies, including over 660,000 participants, many being additional to neurodegeneration data initiatives. The enthusiastic response means that cohorts from North America, Australasia, and the Asia Pacific Region are included, creating a truly global, collaborative, data sharing platform, linked to major national dementia initiatives. Furthermore, the revised World Health Organization International Classification of Diseases version 11 should facilitate recognition of vascular-related brain damage by creating one category for all cerebrovascular disease presentations and thus accelerate identification of targets for dementia prevention

Nuova Antologia Militare. Rivista interdisciplinare della Società Italiana di Storia Militare, n. 3, fascicolo 9: Storia Militare Medievale, a cura di Marco Merlo, Antonio Musarra, Fabio Romanoni e Peter Sposato (gennaio 2022), pp. 632

Nuova Antologia Militare. Rivista interdisciplinare della Società Italiana di Storia Militare, n. 3, fascicolo 9: Storia Militare Medieval

Nuova Antologia Militare. Rivista interdisciplinare della Società Italiana di Storia Militare, n. 2, fascicolo 5: Storia Militare Medievale, a cura di Marco Merlo, Antonio Musarra Fabio Romanoni e Peter Sposato (gennaio 2021), pp. 493.

Nuova Antologia Militare. Rivista interdisciplinare della Società Italiana di Storia Militare, n. 2, fascicolo 5: Storia Militare Medievale, a cura di Marco Merlo, Antonio Musarra Fabio Romanoni e Peter Sposato (gennaio 2021), pp. 493, disponibile on-line all’indirizzo: www.nam-sism.or

Clinical Asthma Remission Obtained with Biologics in Real Life: Patients’ Prevalence and Characteristics

Background: The prevalence of clinical asthma remission with biologics in severe asthma has not been well understood yet. We do not even know whether there might be characteristics that identify subjects prone to remission of the disease. Materials and Methods: Retrospectively, four groups of severe asthmatics already treated with Omalizumab, Mepolizumab, Benralizumab and Dupilumab (302, 55, 95 and 34 patients, respectively) for at least 12 months were considered. The number of individuals with clinical asthma remission was sought in each group. This was considered when patients, after a treatment of at least 1 year with one of the aforesaid biologics, showed the disappearance of asthma symptoms (ACT ≥ 20), zero exacerbations, suspension of oral corticosteroids and a FEV1% ≥ 80%. Baseline characteristics of patients with and without remission were also taken into account. Results: The prevalence of asthma remission after a mean of 37.8 ± 19.2, 13.5 ± 1.7, 15.4 ± 5.5 and 12 ± 0 months of Omalizumab, Mepolizumab, Benralizumab and Dupilumab treatments was 21.8%, 23.6%, 35.8% and 23.5%, respectively. For each biologic, different baseline characteristics, seem to be associated with failure to achieve clinical asthma remission. Older age, higher BMI, a later age of asthma onset, rhinitis/sinusitis/nasal polyposis, comorbidities and a greater asthma severity may be the characteristics of a suboptimal response to biologic treatments. Conclusion: All biologics have the potential to induce disease remission in severe asthmatics. For each biologic, there may be several markers that can identify the patients who will not achieve asthma remission. It would be important to detect them (by carrying out targeted studies) as they would allow us to select the best biologic that may induce clinical asthma remission on a larger number of patients