Using Business Intelligence Tools to Support Medical Validation of Laboratory Tests

Modern clinical laboratories have to confirm that the procedures used for specific tests are reliable and valid. There are several sources of errors and interferences that can invalidate the results. Medical validation refers to the plausibility check of the test results. Implausible results indicate that something might went wrong with a sample retrieved from the patient, e.g., the blood sample got contaminated with another fluid, which requires re-examination. Here, we describe how an integrated R-based business intelligence (BI) tool can be developed that increase the efficiency of the medical validation at the Institute of Clinical Chemistry (ICC) of the University Hospital Zurich. A BI software environment allowed us to digitalize steps in the validation process that were manually done in Excel worksheets, e.g., importing the data, calculating percentiles, and producing graphical outputs

Are you planning to be a radiation oncologist? A survey by the young group of the Italian Association of Radiotherapy and Clinical Oncology (yAIRO)

Background and purpose The Young Section of the Italian Association of Radiotherapy and Clinical Oncology (yAIRO) circulated an online questionnaire survey among residents currently enrolled within Italian radiotherapy residency schools to investigate the profiles, motivations, knowledge of the radiotherapy discipline, organizations and the needs of younger members.Materials and Methods The survey was developed by the yAIRO steering committee and included questions about the demo-graphic characteristics of the residents (Profile A), the background of their clinical experience during the school of medicine and national residency admission test performance (Profile B) and the residents' knowledge of the scientific associations active in the field of radiotherapy (Profile C).Results Out of 400 residents actually in training, 134 responded to the questionnaire (response rate 33.5%). According to most of the residents, radiotherapy was not adequately studied during the medical school (n. 95; 71%) and an Internship in Radiotherapy was not mandatory (n. 99; 74%). Only a minority of the residents had chosen to complete a master's degree thesis in radiotherapy (n. 12; 9%). A low percentage of the residents stated that they were aware of the Italian Association of Radiotherapy and Clinical Oncology (AIRO), its young section (yAIRO) and the European Society for Radiotherapy and Oncology (ESTRO) when they were in School of Medicine (respectively, 11%, 7% and 13%).Conclusions The results of the survey require a profound reflection on the current teaching methods of Radiation Oncology in our country, highlighting the need for a better integration in the framework of the School of Medicine core curriculum

Dental Ritual Mutilations and Forensic Odontologist Practice: a Review of the Literature

Uvod: Etnička sakaćenja imaju antropološko značenje, kako u suvremenom tako i u nekadašnjem ljudskom ponašanju, ovisno o geografskim, religioznim i kulturnim čimbenicima koji znatno mogu pomoći forenzičnom stomatologu u postupku izrade dentalnog profila. Sakaćenje zuba i ukrasi na njima bili su, i još uvijek jesu, uobičajeni među mnogim etničkim skupinama i kulturama. Kroz povijest ljudskoga roda zdravlje zuba bilo je simbol mladosti, ljepote i snage, ali može imati i druga značenja. Sakaćenje zuba obilježje je mnogih nestalih kultura i prakticiralo se uglavnom tijekom religijskih rituala, u estetske svrhe i kao simbol pripadnosti određenoj socijalnoj skupini. No slični običaji i danas su uobičajeni u nekim područjima diljem svijeta. Materijali i metode: Članak je zapravo sustavni pregled literature o ritualnom sakaćenju zuba iz ranih 1960-ih, a uključeni su i podatci s PubMeda, Scopusa i Google Scolara. Istaraživanje je namjerno ograničeno na ritualno sakaćenje koje se može definirati kao bilo koje nepovratno narušavanje integriteta ljudskoga organizma učinjeno u ritualne svrhe i bez namjere liječenja. Zato su isključeni svi slučajevi pojedinačnih ili višestrukih samovađenja zuba učinjenih iz psihotičnih razloga te oralno sakaćenje djece jer se takva praksa u nekim etničkim skupinama smatra terapijskom. Zaključak: Spoznaje o promjenama na zubima nakon oralnoga sakaćenja važne su pri identifikaciji živih ili umrlih osoba, ili čak ljudskih ostataka jer odaju odgovarajuće informacije o etničkom i kulturološkom podrijetlu subjekta. U ovom članku navedena su i neka medicinskopravna stajališta o sakaćenju zuba, a namijenjena su doktorima dentalne medicine.Background: Ethnic mutilations have a social and anthropological significance both in contemporary and past human behavior, influenced by geographic, religious and cultural factors which can greatly help forensic odontologist’s practice in dental profiling process. ental ritual mutilations and dental decorations were - and still are - practiced among many ethnic groups and cultures. Throughout the history of humanity, having healthy teeth has a symbolic meaning of youth, beauty and strength, but it can also have other meanings. Dental ritual mutilations were documented in many cultures in the past and were practiced mainly for religious rituals purposes, for esthetic reasons and because they represented a symbol of status or of belonging to a particular social group. Similar rituals are still performed. Material and Method: The present paper is a systematic review of the literature reporting on dental ritual mutilations from the early 1960s and is included in Pubmed, Scopus and Googlescholar. The research was deliberately limited only to the ritual mutilations, which can be defined as “any irreversible impairment of the integrity of the human organism, made with a ritual purpose and without any curative aim”. Therefore all the articles dealing with single or multiple dental self extractions of psychotic origins were excluded, as well as the infant oral mutilations, since the practice is deemed to have therapeutical effects among ethnic groups dedited to this practice. Conclusions: The knowledge of dental alteration due to oral mutilations can be a powerful tool for the identification procedures of living or dead persons or even in human remains especially providing relevant information about the ethnic origins and the cultural background of a subject. Some medical legal issues for the odontologist about dental mutilation are also addressed in the paper

Effects of Baryon Mass Loss on Profiles of Large Galactic Dark Matter Haloes

We perform controlled numerical experiments to asses the effect of baryon mass loss on the inner structure of large galactic dark matter haloes. This mass expulsion is intended to mimic both the supernovae and AGN feedbacks, as well as the evolution of stellar populations. This study is meant in particular for precursors of massive Early Type Galaxies, wherein strong AGN feedback (often dubbed "QSO mode" in galaxy formation models) has been proposed to remove on a short timescale, of the order of a few dynamical times, a substantial fraction of their baryons. In a previous paper we evaluated the observational consequences (size increase) of this process on the galactic structure (Ragone-Figueroa & Granato 2011). Here we focus on the distribution of dark matter in the galactic region. It is shown that the inner region of the DM halo expands and its density profile flattens by a sizeable amount, with little dependence on the expulsion timescale. We also evaluate the effect of the commonly made approximation of treating the baryonic component as a potential that changes in intensity without any variation in shape. This approximation leads to some underestimates of the halo expansion and its slope flattening. We conclude that cuspy density profiles in ETGs could be difficult to reconcile with an effective AGN (or stellar) feedback during the evolution of these systems.Comment: 9 Pages, 5 figures, MNRAS accepted. Final version with minor revisio

Apolipoprotein E in idiopathic nephrotic syndrome and focal segmental glomerulosclerosis

Apolipoprotein E in idiopathic nephrotic syndrome and focal segmental glomerulosclerosis.BackgroundHyperlipemia characterizes nephrotic syndrome (NS) and contributes to the progression of the underlying nephropathy. The data in the literature support an implication of apolipoprotein E (apoE) in both hyperlipemia and focal segmental glomerulosclerosis (FSGS), a malignant condition associated with NS.MethodsThe apoE genotype was determined in 209 nephrotic patients, who were classified according to age and their response to steroids as resistant children (N = 96) and adults (43), and steroid dependent (33) and steroid responder (37) children. A total of 123 presented the histological features of FSGS. In a subgroup of 28 patients, serum and urinary levels of apoE and renal deposits were evaluated by immunofluorescence.ResultsThe allelic frequencies of the three major haplotypes γ2, γ3, and γ4 were the same in nephrotic patients versus controls, and homozygosity for γ3γ3 was comparably the most frequent genotype (70 vs. 71%) followed by γ3γ4, γ2γ3, γ2γ4, γ4γ4. Serum levels of apoE were fivefold higher in NS and in FSGS patients than in controls, with a direct correlation with hypercholesterolemia and proteinuria. ApoE genotypes did not influence serum levels. Urinary levels were 1/10,000 of serum with an increment in nephrotic urines. Finally, immunofluorescence demonstrated the absence of apoE in sclerotic glomeruli, while comparably nephrotic patients with membranous nephropathy had an increased glomerular expression of apoE.ConclusionsApoE is dysregulated in NS with a marked increment in serum, which is a part of the complex lipid metabolism. Down-regulation of glomerular apoE instead is a peculiarity of FSGS and may contribute to the pathogenesis of the disease. The normal distribution of apoE genotypes in nephrotic patients with FSGS excludes a pathogenetic role of genetic variants

Clinical characteristics and molecular aspects of low-grade serous ovarian and peritoneal cancer: a multicenter, observational, retrospective analysis of MITO Group (MITO 22)

BACKGROUND: Low-grade serous ovarian and peritoneal cancer (LGSC) is a rare disease and few data on the clinical and genomic landscape have been published.METHODS: A retrospective analysis of patients diagnosed with LGSC between 1996 and 2019 was conducted in MITO centers. Objective Response Rate (ORR) to treatments, progression-free survival (PFS) and overall survival (OS) were assessed. Additionally, the tumor molecular profile of 56 patients was evaluated using the Next Generation Sequencing (NGS) FoundationOne CDX (Foundation Medicine (R)).RESULTS: A total of 128 patients with complete clinical data and pathologically confirmed diagnosis of LGSC were identified. ORR to first and subsequent therapies were 23.7% and 33.7%, respectively. PFS was 43.9 months (95% CI:32.4-53.1) and OS was 105.4 months (95% CI: 82.7-not reached). The most common gene alterations were: KRAS (n = 12, 21%), CDKN2A/B (n = 11, 20%), NRAS (n = 8, 14%), FANCA (n = 8, 14%), NF1 (n = 7, 13%) and BRAF (n = 6, 11%). Unexpectedly, pathogenetic BRCA1 (n = 2, 4%), BRCA2 (n = 1, 2%) and PALB2 (n = 1, 2%) mutations were found.CONCLUSIONS: MITO 22 suggests that LGSC is an heterogenous disease for both its clinical behavior in response to standard therapies and its molecular alterations. Future prospective studies should test treatments according to biological and molecular tumor's characteristics

Monitoring and predicting the risk of violence in residential facilities. No difference between patients with history or with no history of violence

none34noopende Girolamo, Giovanni; Buizza, Chiara; Sisti, Davide; Ferrari, Clarissa; Bulgari, Viola; Iozzino, Laura; Boero, Maria Elena; Cristiano, Giuseppe; De Francesco, Alessandra; Giobbio, Gian Marco; Maggi, Paolo; Rossi, Giuseppe; Segalini, Beatrice; Candini, Valentina; Andreose, Suor; Basso, Pasquale; Beneduce, Rossella; Bertolotti, Pietro; Braida, Vanda; Bonelli, Marina; Bongiorno, Fanny; Bussi, Riccardo; Castagno, Elisa; Dominicis, Fabio; Ghersi, Loredana; Greppo, Stefania; Sodano, Alessandro Jaretti; Leporatti, Massimo; Presti, Eleonora Lo; Milone, Valeria; Panigada, Fausto; Pasquadibisceglie, Livia; Rigamonti, Danilo; Rillosi, Lucianade Girolamo, Giovanni; Buizza, Chiara; Sisti, Davide; Ferrari, Clarissa; Bulgari, Viola; Iozzino, Laura; Boero, Maria Elena; Cristiano, Giuseppe; De Francesco, Alessandra; Giobbio, Gian Marco; Maggi, Paolo; Rossi, Giuseppe; Segalini, Beatrice; Candini, Valentina; Andreose, Suor; Basso, Pasquale; Beneduce, Rossella; Bertolotti, Pietro; Braida, Vanda; Bonelli, Marina; Bongiorno, Fanny; Bussi, Riccardo; Castagno, Elisa; Dominicis, Fabio; Ghersi, Loredana; Greppo, Stefania; Sodano, Alessandro Jaretti; Leporatti, Massimo; Presti, Eleonora Lo; Milone, Valeria; Panigada, Fausto; Pasquadibisceglie, Livia; Rigamonti, Danilo; Rillosi, Lucian

Colorectal surgery in Italy during the Covid19 outbreak: a survey from the iCral study group

Background The COVID19 pandemic had a deep impact on healthcare facilities in Italy, with profound reorganization of surgical activities. The Italian ColoRectal Anastomotic Leakage (iCral) study group collecting 43 Italian surgical centers experienced in colorectal surgery from multiple regions performed a quick survey to make a snapshot of the current situation. Methods A 25-items questionnaire was sent to the 43 principal investigators of the iCral study group, with questions regard- ing qualitative and quantitative aspects of the surgical activity before and after the COVID19 outbreak. Results Two-thirds of the centers were involved in the treatment of COVID19 cases. Intensive care units (ICU) beds were partially or totally reallocated for the treatment of COVID19 cases in 72% of the hospitals. Elective colorectal surgery for malignancy was stopped or delayed in nearly 30% of the centers, with less than 20% of them still scheduling elective colo- rectal resections for frail and comorbid patients needing postoperative ICU care. A significant reduction of the number of colorectal resections during the time span from January to March 2020 was recorded, with significant delay in treatment in more than 50% of the centers. Discussion Our survey confirms that COVID19 outbreak is severely affecting the activity of colorectal surgery centers partici- pating to iCral study group. This could impact the activity of surgical centers for many months after the end of the emergency