Ruolo prognostico dell'ipertensione endocranica precoce nell'ESA

RIASSUNTO L’emorragia sub-aracnoidea rimane una patologia devastante con una mortalità immediata prima di ricevere cure mediche del 12%, una mortalità aggiuntiva del 40-50% entro un mese dal ricovero ospedaliero e un 30% di invalidità tra i sopravvissuti. Nonostante i progressi in ambito chirurgico, anestesiologico e radiologico, mortalità e morbidità rimangono elevate, soprattutto per le forme ad alto grado (H-H 4-5). Mentre tradizionalmente la letteratura si concentra sugli eventi tardivi che portano al vasospasmo tra il III e il XIV giorno dall’emorragia subaracnoidea, nuovi studi si focalizzano sul danno cerebrale precoce (EBI) e sui meccanismi fisiopatologici che insorgono immediatamente dopo la rottura dell’aneurisma. Sebbene siano numerosi i fattori chiamati in causa come responsabili di EBI, il principale evento immediato al momento della rottura e nelle prime 24-48 h è l’incremento della pressione intracranica, che costituisce il trigger per una serie di modificazioni fisiopatologiche che portano alla morte neuronale. L’incremento della pressione endocranica nel paziente con trauma cranico è stato ampiamente studiato e riconosciuto come fattore in grado di condizionare negativamente la prognosi; al contrario è poco studiato l’effetto dell’ipertensione endocranica precoce sull’outcome dei pazienti con ESA. Il monitoraggio della pressione intracranica è una procedura diffusamente impiegata nei pazienti con ESA-grave, ma il timing del posizionamento non è precisamente standardizzato e sono scarsi i dati in letteratura sulla misurazione della PIC nelle prime 24 h. Tipologia di studio: osservazionale retrospettivo. Obiettivi dello studio: valutazione dell’incidenza dell’ipertensione endocranica precoce nei pazienti con ESA di alto grado (H-H 4-5). Valutazione dell’impatto dell’ipertensione endocranica precoce sulla mortalità, sull’outcome neurologico a 15 e 30 giorni e sull’insorgenza di lesioni ischemiche. Pazienti arruolati: 62 pazienti con emorragia sub aracnoidea ad alto grado (H-H 4-5) sottoposti ad early treatment (chirurgico o endovascolare) e monitoraggio precoce della pressione endocranica (entro 24 ore) e ricoverati presso la Terapia Intensiva Neurochirurgica dell’Azienda Ospedaliera Pisana nel periodo compreso tra gennaio 2005 e dicembre 2011. Risultati e conclusioni: nel nostro studio si è osservato un'incidenza di ipertensione endocranica precoce nel 45% dei casi, contro un’incidenza di vasospasmo e di risanguinamento del 20% e del 3%. Allo scopo di valutare l’impatto dell’ipertensione endocranica precoce su mortalità, outcome e lesioni ischemiche, sono stati esclusi pazienti che presentavano fattori di rischio aggiuntivi per ischemie cerebrali e danno neurologico e complicanze che condizionavano la prognosi quali il risanguinamento ed il vasospasmo. Tra i 47 pazienti selezionati abbiamo individuato due gruppi in base della presenza o meno di ipertensione endocranica precoce (gruppo1: 21 pazienti PIC>20 mmHg, gruppo 2: 26pazienti PIC<20mmhg). I due gruppi studiati omogenei per età media, SAPS II score, gravità del quadro neurologico, timing del trattamento e tipologia di trattamento medico, differiscono in modo statisticamente significativo per mortalità (χ2 Yates =18,31;p< 0,0001), per outcome neurologico a 15 giorni ( χ2 Yates = 25,061; p<0,0001) e 30 giorni(χ2 Yates = 26,535; p<0,0001) e per l’insorgenza di lesioni ischemiche precoci (χ2 Yates = 10,365; p<0,0013). Le curve di sopravvivenza eseguite sul gruppo senza ipertensione endocranica precoce (PIC30 mmHg) differiscono in modo statisticamente significativo (LogRank test p<0,0001); si deduce che non solo la presenza di ipertensione endocranica precoce, ma anche il valore che questa raggiunge nelle prime 24 ore condiziona la sopravvivenza dei pazienti studiati. Con i limiti legati allo studio retrospettivo e al piccolo campione di pazienti indagato, il nostro lavoro evidenzia un’incidenza di ipertensione endocranica precoce in quasi la metà dei pazienti con ESA di alto grado e suggerisce un ruolo prognostico negativo dell’ipertensione endocranica precoce.

I Valori del Museo. Politiche di indirizzo e strategie di gestione.

Il volume tratta i temi più recenti nell'ambito della Museologia Scientifica: dai nuovi criteri per la valutazione del bene culturale alle recenti tecnologie per il restauro di un bene scientifico; dalle schede catalografiche approntate con l'ICCD per le varie tipologie di beni scientifici alle moderne indicazioni per gli allestimenti delle Collezioni scientifiche

Privacy by Design in Distributed Mobility Data

Movement data are sensitive, because people’s whereabouts may allow re- identification of individuals in a de-identified database and thus can poten- tially reveal intimate personal traits, such as religious or sexual preferences. In this thesis, we focus on a distributed setting in which movement data from individual vehicles are collected and aggregated by a centralized station. We propose a novel approach to privacy-preserving analytical processing within such a distributed setting, and tackle the problem of obtaining aggregated traffic information while preventing privacy leakage from data collection and aggregation. We study and analyze three different solutions based on the differential privacy model and on sketching techniques for efficient data compression. Each solution achieves different a trade-off between privacy protection and utility of the transformed data. Using real-life data, we demonstrate the effectiveness of our approaches in terms of data utility preserved by the data transformation, thus bringing empirical evidence to the fact that the privacy-by-design paradigm in big data analysis has the potential of delivering high data protection combined with high quality even in massively distributed techno-social systems

Towards a Digital Ecosystem of Trust: Ethical, Legal and Societal Implications

The European vision of a digital ecosystem of trust rests on innovation, powerful technological solutions, a comprehensive regulatory framework and respect for the core values and principles of ethics. Innovation in the digital domain strongly relies on data, as has become obvious during the current pandemic. Successful data science, especially where health data are concerned, necessitates establishing a framework where data subjects can feel safe to share their data. In this paper, methods for facilitating data sharing, privacy-preserving technologies, decentralization, data altruism, as well as the interplay between the Data Governance Act and the GDPR, are presented and discussed by reference to use cases from the largest pan-European social science data research project, SoBigData++. In doing so, we argue that innovation can be turned into responsible innovation and Europe can make its ethics work in digital practice

Where do migrants and natives belong in a community : a Twitter case study and privacy risk analysis

Today, many users are actively using Twitter to express their opinions and to share information. Thanks to the availability of the data, researchers have studied behaviours and social networks of these users. International migration studies have also benefited from this social media platform to improve migration statistics. Although diverse types of social networks have been studied so far on Twitter, social networks of migrants and natives have not been studied before. This paper aims to fill this gap by studying characteristics and behaviours of migrants and natives on Twitter. To do so, we perform a general assessment of features including profiles and tweets, and an extensive network analysis on the network. We find that migrants have more followers than friends. They have also tweeted more despite that both of the groups have similar account ages. More interestingly, the assortativity scores showed that users tend to connect based on nationality more than country of residence, and this is more the case for migrants than natives. Furthermore, both natives and migrants tend to connect mostly with natives. The homophilic behaviours of users are also well reflected in the communities that we detected. Our additional privacy risk analysis showed that Twitter data can be safely used without exposing sensitive information of the users, and minimise risk of re-identification, while respecting GDPR

Correction to: Cultural dimensions in online purchase behavior: evidence from a cross-cultural study

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Privacy-by-design in big data analytics and social mining

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PRUDEnce: A system for assessing privacy risk vs utility in data sharing ecosystems

Data describing human activities are an important source of knowledge useful for understanding individual and collective behavior and for developing a wide range of user services. Unfortunately, this kind of data is sensitive, because people’s whereabouts may allow re-identification of individuals in a de-identified database. Therefore, Data Providers, before sharing those data, must apply any sort of anonymization to lower the privacy risks, but they must be aware and capable of controlling also the data quality, since these two factors are often a trade-off. In this paper we propose PRUDEnce (Privacy Risk versus Utility in Data sharing Ecosystems), a system enabling a privacy-aware ecosystem for sharing personal data. It is based on a methodology for assessing both the empirical (not theoretical) privacy risk associated to users represented in the data, and the data quality guaranteed only with users not at risk. Our proposal is able to support the Data Provider in the exploration of a repertoire of possible data transformations with the aim of selecting one specific transformation that yields an adequate trade-off between data quality and privacy risk. We study the practical effectiveness of our proposal over three data formats underlying many services, defined on real mobility data, i.e., presence data, trajectory data and road segment data

Highlights of New Strategies to Increase the Efficacy of Transition Metal Complexes for Cancer Treatments

Although important progress has been made, cancer still remains a complex disease to treat. Serious side effects, the insurgence of resistance and poor selectivity are some of the problems associated with the classical metal-based anti-cancer therapies currently in clinical use. New treatment approaches are still needed to increase cancer patient survival without cancer recurrence. Herein, we reviewed two promising-at least in our opinion-new strategies to increase the efficacy of transition metal-based complexes. First, we considered the possibility of assembling two biologically active fragments containing different metal centres into the same molecule, thus obtaining a heterobimetallic complex. A critical comparison with the monometallic counterparts was done. The reviewed literature has been divided into two groups: the case of platinum; the case of gold. Secondly, the conjugation of metal-based complexes to a targeting moiety was discussed. Particularly, we highlighted some interesting examples of compounds targeting cancer cell organelles according to a third-order targeting approach, and complexes targeting the whole cancer cell, according to a second-order targeting strategy

A new system for quantitative evaluation of infant gaze capabilities in a wide visual field.

Background: The visual assessment of infants poses specific challenges: many techniques that are used on adults are based on the patient’s response, and are not suitable for infants. Significant advances in the eye-tracking have made this assessment of infant visual capabilities easier, however, eye-tracking still requires the subject’s collaboration, in most cases and thus limiting the application in infant research. Moreover, there is a lack of transferability to clinical practice, and thus it emerges the need for a new tool to measure the paradigms and explore the most common visual competences in a wide visual field. This work presents the design, development and preliminary testing of a new system for measuring infant’s gaze in the wide visual field called CareToy C: CareToy for Clinics. Methods: The system is based on a commercial eye tracker (SmartEye) with six cameras running at 60 Hz, suitable for measuring an infant’s gaze. In order to stimulate the infant visually and audibly, a mechanical structure has been designed to support five speakers and five screens at a specific distance (60 cm) and angle: one in the centre, two on the right-hand side and two on the left (at 30° and 60° respectively). Different tasks have been designed in order to evaluate the system capability to assess the infant’s gaze movements during different conditions (such as gap, overlap or audiovisual paradigms). Nine healthy infants aged 4–10 months were assessed as they performed the visual tasks at random. Results: We developed a system able to measure infant’s gaze in a wide visual field covering a total visual range of ±60° from the centre with an intermediate evaluation at ±30°. Moreover, the same system, thanks to different integrated software, was able to provide different visual paradigms (as gap, overlap and audio-visual) assessing and comparing different visual and multisensory sub-competencies. The proposed system endowed the integration of a commercial eye-tracker into a purposive setup in a smart and innovative way. Conclusions: The proposed system is suitable for measuring and evaluating infant’s gaze capabilities in a wide visual field, in order to provide quantitative data that can enrich the clinical assessment