Prevalence of Non-erosive Esophageal Phenotypes in Children. A European Multicenter Study

Background/aims: Since available data on pediatric non-erosive esophageal phenotypes (NEEPs) are scant, we investigated their prevalence and the phenotype-dependent treatment response in these children. Methods: Over a 5-year period, children with negative upper endoscopy, who underwent esophageal pH-impedance (off-therapy) for persisting symptoms not responsive to proton pump inhibitor (PPI)-treatment, were recruited. Based on the results of acid reflux index (RI) and symptom association probability (SAP), patients were categorized into: (1) abnormal RI (non-erosive reflux disease [NERD]), (2) normal RI and abnormal SAP (reflux hypersensitivity [RH]), (3) normal RI and normal SAP (functional heartburn [FH]), and (4) normal RI and not-reliable SAP (normal-RI-not otherwise-specified [normal-RI-NOS]). For each subgroup, treatment response was evaluated. Results: Out of 2333 children who underwent esophageal pH-impedance, 68 cases, including 18 NERD, 14 RH, 26 FH, and 10 normal-RI-NOS were identified as fulfilling the inclusion criteria and were analyzed. Considering symptoms before endoscopy, chest pain was more reported in NERD than in other cases (6/18 vs 5/50, P = 0.031). At long-term follow-up of 23 patients (8 NERD, 8 FH, 2 RH, and 5 normal-RI-NOS): 17 were on PPIs and 2 combined alginate, 1 (FH) was on benzodiazepine + anticholinergic, 1 (normal-RI-NOS) on citalopram, and 3 had no therapy. A complete symptom-resolution was observed in 5/8 NERD, in 2/8 FH, and in 2/5 normal-RI-NOS. Conclusions: FH may be the most common pediatric NEEP. At long-term follow-up, there was a trend toward a more frequent complete symptom resolution with PPI-therapy in NERD patients while other groups did not benefit from extended acid-suppressive-treatment

OPTIMAL DESIGN AND MULTIBODY ANALYSIS OF RZEPPA PILOT-LEVER JOINT

Abstract. Rzeppa pilot-lever joint represents a classical solution to the problem of transmitting torque between angularly misaligned shafts. Homokineticity is one of the most important requirement in industrial applications. The Myard’s theorem gives the geometrical conditions which ensure the satisfaction of such requirement. In this paper two different original proofs of this theorem are offered. An algorithm for the optimal kinematic synthesis of the pilot-lever mechanism is then proposed. The pilot lever mechanism is designed to minimize the maximum angle between the transmission and the homokinetic plane. Finally, a multibody dynamic analysis of the Rzeppa pilot-lever joint is made by means of a commercial software. The modeling of contact conditions between the balls the the guides is in particular discussed. Finally, the contact forces between spheres and guides for different angles between input and output shafts are computed. 1 Ettore Pennestrì, P.P. Valentini, R. Stefanell

KINEMATIC ANALYSIS OF SPATIAL LINKAGES WITH DIMENSIONAL AND GEOMETRIC TOLERANCES

Design robustness is somewhat connected to tolerances. In fact, the lower is the sensitivity of the kinematic function to the deviations of manufacturing process, the higher is the robustness of the design. In this investigation is described a tolerance analysis method based on dual vectors kinematic modeling of spatial linkages and on Monte Carlo simulation of the random variables. In the present analysis the hypothesis of rigid bodies is valid and only kinematic variables are considered in output. The method is applied to a Cardan joint modelled as an RCCC linkage with main dimensions considered as stochastic variables with Gaussian distribution. Dual vectors are well known in kinematic analysis and synthesis of spatial mechanisms. When compared with traditional vectorial methods, dual vectors show an enhanced capability to model misalignments among kinematic pairs axes. Although this is not the first time that dual vectors are used for the kinematic and dynamic analysis of spatial mechanisms with manufacturing errors, the present use of dual vectors to model joint clearances ∗ Address all correspondence to this author

Applicazioni di tecniche di simulazione multibody nella progettazione industriale

Questo lavoro intende riassumere alcune delle attività di ricerca svolte presso il Dipartimento di Ingegneria Meccanica dell’Università di Tor Vergata che hanno avuto come oggetto l’impiego di metodologie di modellazione CADmultibody per la progettazione in applicazioni industriali. La rassegna dei vari casi di studio analizzati vuole essere di esempio su come i settori applicativi che possono beneficiare di tali tecniche sono molteplici e le tipologie di investigazione sono molto ampie

Pharmacare 2019

[Italiano]: Questo volume intende offrire una sintesi efficace ed esaustiva dei dati relativi ai consumi e alla spesa dei farmaci erogati a carico del Servizio Sanitario Regionale (SSR) della Campania in regime di assistenza convenzionata per l’anno 2019. Sulla base delle informazioni fornite da una banca dati che copre una popolazione assistibile di circa sei milioni di abitanti rappresentativa del 10% circa della popolazione nazionale, è stata tracciata una correlazione tra la prevalenza delle patologie presenti nel territorio e il corrispondente utilizzo dei farmaci, suggerendo al contempo valide interpretazioni sui principali fattori che influenzano la variabilità nelle prescrizioni. È stata inoltre dedicata un’accurata analisi ai profili prescrittivi delle principali categorie terapeutiche, con particolare attenzione ai regimi di politerapia negli over 65, alle differenze di genere nell’utilizzo dei farmaci e ai profili di utilizzo dei farmaci nei pazienti con COVID-19. È stata così realizzata una dettagliata panoramica sull’uso dei farmaci in termini di spesa, volumi e tipologia all’interno dell’ambito territoriale, che vuole candidarsi quale strumento di monitoraggio a supporto dei decisori, utile sia per la pianificazione di interventi di sanità pubblica, sia per l’identificazione di potenziali aree di miglioramento ./[English]: This volume aims to offer an effective and comprehensive summary of the data on consumption and expenditure of drugs dispensed by the Regional Health Service (SSR) of Campania region under health care agreements during the year 2019. By using information supplied by a database covering a population of about six million inhabitants, a correlation has been drawn between the prevalence of diseases in the area and the corresponding use of drugs, suggesting at the same time useful interpretations of the main factors influencing the variability in prescriptions. A thorough analysis was then conducted on the prescribing profiles of the main therapeutic categories, particularly focused on polypharmacy regimens in the over-65s, gender differences in medication use, and medication use profiles in patients with COVID-19. A detailed overview of medication use in terms of expenditure, volume and type within the region has thus been created, which aims to be a monitoring tool to support decision-makers, useful both for the planning of public health interventions, and for the identification of potential areas of improvement in these contexts

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Frequency of Left Ventricular Hypertrophy in Non-Valvular Atrial Fibrillation

Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 \ub1 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index 640.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc 652 seen in 93% of LVH and in 73% of patients without LVH (p <0.05). Women with LVH had a higher prevalence of concentric hypertrophy than men (46% vs 29%, p = 0.0003). Logistic regression analysis demonstrated that female gender (odds ratio [OR] 2.80, p <0.0001), age (OR 1.03 per year, p <0.001), hypertension (OR 2.30, p <0.001), diabetes (OR 1.62, p = 0.004), and previous MI (OR 1.96, p = 0.001) were independently associated with LVH. In conclusion, patients with NVAF have a high prevalence of LVH, which is related to female gender, older age, hypertension, and previous MI. These patients are at high thromboembolic risk and deserve a holistic approach to cardiovascular prevention