80936 research outputs found
Sort by
Cardiac rehabilitation in patients with atrial fibrillation
No full textCardiovascular diseases (CVD) remain the leading cause of morbidity and mortality worldwide, accounting for significant public health and economic burdens. Cardiac rehabilitation (CR) is a comprehensive, multidisciplinary program designed to aid patients in recovering from cardiac events and to prevent further complications. The aim of CR is to improve their quality of life and prognosis. It involves continued prognostic stratification, clinical stabilization, optimization of pharmacological and non-pharmacological therapy, management of comorbidities, treatment of disabilities, reinforcement of secondary prevention interventions, and maintenance of adherence to therapy. The most recent European Society of Cardiology guidelines for the diagnosis and management of atrial fibrillation (AF) emphasize the importance of cardiorespiratory fitness, recommending that patients engage in moderate-intensity exercise and remain physically active to prevent AF incidence or recurrence. Through this symbiotic relationship, CR addresses all aspect of cardiac fitness in AF management. The program's structured exercise regimens are specifically tailored to address the challenges associated with AF, promoting overall cardiovascular health and reducing the risk for cardiac death. CR is also crucial for emotional well-being, offering support and coping mechanisms for the psychological impact of AF, beyond the physical training program. CR programs involve a multidisciplinary approach that is carried out collaboratively by a team of healthcare professionals, including nurses, physiotherapists, psychologists, and dietitians. Moreover, CR in AF patients aims to carry out comprehensive patient support through clinical stabilization and therapy optimization interventions, prescription and implementation of physical activity, educational support on lifestyle risk factors and social-emotional distress, and periodic assessment of outcomes. This narrative review aims to elucidate the role of CR in AF patients, shedding light on the potential benefits and challenges associated with integrating rehabilitation programs into the care of individuals with AF
Updates, Applications and Future Directions of Deep Learning for the Images Processing in the Field of Cranio-Maxillo-Facial Surgery
No full textThe entry of artificial intelligence, in particular deep learning models, into the study of medical–clinical processes is revolutionizing the way of conceiving and seeing the future of medicine, offering new and promising perspectives in patient management. These models are proving to be excellent tools for the clinician through their great potential and capacity for processing clinical data, in particular radiological images. The processing and analysis of imaging data, such as CT scans or histological images, by these algorithms offers aid to clinicians for image segmentation and classification and to surgeons in the surgical planning of a delicate and complex operation. This study aims to analyze what the most frequently used models in the segmentation and classification of medical images are, to evaluate what the applications of these algorithms in maxillo-facial surgery are, and to explore what the future perspectives of the use of artificial intelligence in the processing of radiological data are, particularly in oncological fields. Future prospects are promising. Further development of deep learning algorithms capable of analyzing image sequences, integrating multimodal data, i.e., combining information from different sources, and developing human–machine interfaces to facilitate the integration of these tools with clinical reality are expected. In conclusion, these models have proven to be versatile and potentially effective tools on different types of data, from photographs of intraoral lesions to histopathological slides via MRI scans
Oligometastatic Mesothelioma Treated with Ablative Radiotherapy (OMAR): A Multicenter Study
No full textBackground/objectives: This multicenter retrospective study aims to evaluate the role of Ablative Radiotherapy (RT) in patients with unresectable pleural mesothelioma (PM) who experienced radiological progression after at least one line of chemotherapy, with a maximum involvement of three pleural or extrapleural sites. Methods: Adult patients (≥18 years) with PM treated with stereotactic radiotherapy between 2011 and 2022, limited to a maximum of three pleural or extrapleural sites, were included in the analysis. Ablative RT was required to be administered with radical intent. Endpoints were time to further systemic therapy (TFST), local control (LC), progression-free survival (PFS), overall survival (OS), and acute and late radiotherapy-related toxicity. Results: A total of 56 patients were identified from six Italian and one Swiss radiotherapy center. Treatment was generally well tolerated. Ten patients experienced grade 1 or 2 acute toxicity, while four patients reported persistent chest pain, with one case reaching grade 3 as late toxicity. The median TFST was 18.6 months, with TFST rates of 61.7% and 46.4% at 12 and 24 months, respectively. The median OS was 37.63 months, with 1- and 2-year OS rates of 85.2% and 65.6%. Local control was favorable (79% at 1 year), but most patients experienced disease recurrence outside the SABR treatment volume. The median disease progression-free survival (DPFS) was 8.17 months, with 1- and 2-year DPFS rates of 36% and 19%, respectively. Smoking history correlated with OS and DPFS in univariate analysis, while statistical significance for OS was maintained in multivariate analysis. Additionally, nodal status and PTV volume were associated with OS. Conclusion: SABR is a safe and effective approach for the treatment of oligorecurrent/oligoprogressive PM. The time to further systemic therapy was extended up to 18 months. At two years, 10% of patients remained disease-free, and more than half were alive at three years, suggesting a potentially indolent biological behavior in oligometastatic PM
The behaviour of micro-injection moulding inserts produced with material jetting technology
No full textThe increasing interest in additive manufacturing and advancements in precision and production quality have sparked attention to its use in industrial prototyping. High-performance polymer resins enhance flexibility in mass production processes like micro-injection moulding. This flexibility allows for reconfigurable moulds using resin inserts, enabling the transition of devices, such as microfluidics, from labs to large-scale production. Despite progress, limitations exist in additive manufacturing, including the minimum size of microstructures and the brittle behaviour of resin inserts during moulding cycles, impacting overall production capacity. This study focuses on using a micro-injection moulding machine to reproduce PMMA thin plates with single straight microchannels (250 μm) and with different side wall angles (0°, 15°, and 30°), investigating the best compromise between capability and insert resistance to moulding cycles. A careful study of the dynamics leading to the insert failure and the resin limits was carried out. The results showed that it is possible to produce about 15 micro-structured thin plates with good accuracy using a resin insert realised with Material Jetting technology
Association of the overlap of cognitive impairment and depression with 6-month mortality in hospitalized older adults: results from the Re.Po.SI register
No full textBackground: When admitted to hospital for unplanned medical needs, the complexity of multiple conditions, including cognitive and mental health, might put older people at greater risk, affecting their survival. This study aimed to investigate the prevalence of cognitive impairment versus cognitive impairment with depression and their association with six-month mortality in older people after an unplanned hospital admission in Italy. Methods: In Re.Po.SI. a multi-centre study performed in Italy, standardized web-based case report forms were used to collect data on socio-demographic factors, clinical parameters, diagnoses, treatment history and at discharge, clinical events during hospitalization, and outcome data was collected. A comprehensive geriatric assessment was conducted using Cumulative Illness Rating Scale (CIRS), Geriatric Depression Scale (GDS-4), Barthel Index, and Short Blessed Test (SBT). To explore the interrelationship between depression and cognitive impairment, a variable categorized the study population into four mutually exclusive groups. This variable assessed the association between its categories and six-month mortality in a Cox multivariate analysis. Results: One thousand nine hundred fifty six participants were included, with a median age of 80 years (IQR: 73–85). Those who died within six months were likely to be older (82 vs. 79 years), male (56.2% vs. 47.2%), had moderately reduced ability to perform daily activities (82.0 vs. 93.0), exhibited greater illness severity (CIRS-IS: 1.8 vs. 1.6), had more chronically prescribed medications (6.0 vs. 5.0), and had a worse SBT score (10.0 vs. 7.0). When stratified based on cognitive impairment and depression, one-third had neither condition (33.2%), 21.9% had depression, 20.7% had a cognitive impairment, and 24.3% had both conditions. Six-month mortality was higher among people with cognitive impairment only (33.2%) followed by those with both conditions (28.8%), and depression only (22.7%). The unadjusted semi-parametric survival analysis revealed that the hazard ratio (HR) for people with cognitive impairment only was 2.08, for those with both conditions HR was 1.75, and for people with depression only HR was 1.30. Conclusion: While depression alone may contribute to mortality risk, cognitive impairment appears to play a more substantial role in increasing the risk of dying within 6 month from an acute hospitalization. Further research is needed to confirm these finding
On the applicability of speckle pattern imaging combined with AI for raw milk classification
No full textThis work demonstrates the high potential of an innovative technique for raw milk classification based on the integration of speckle pattern imaging and artificial intelligence. By exciting speckle patterns with a semiconductor laser and collecting experimental images with a CMOS camera, a total of 20 samples of raw cow milk with similar nutritional contents were tested during 4 Campaigns. Data analysis was conducted leveraging one common feature-based machine learning model and one state-of-the-art image-based deep learning model for speckle patterns. This study aims to provide in-depth insights to the community on how this measurement technique can be applied to raw cow milk samples and how the prediction models tested perform due to the similarity of the nutritional components of the samples. The machine learning model was trained on a set of 16 custom features, while the deep learning model used speckle pattern images as input. Both types of data were standardized dataset-wise beforehand using z-score. The best machine learning and deep learning models achieved 95% accuracy. The study highlights that the nutritional similarity of the samples highly impacts the models’ confusion in both cases, especially when Campaigns conducted at different sample temperatures were not included in the training. Overall, the analysis technique presented leveraging uncertainty metrics is a stepping stone toward relevant advances in the field of milk analysis
A European survey on allogeneic haematopoietic cell transplantation for myelofibrosis on behalf of the Chronic Malignancies Working Party of the EBMT: focus on 'real world' experience of JAK inhibitors, splenomegaly management and novel agents in the transplant algorithm
No full text: Allogeneic haematopoietic cell transplantation (allo-HCT) remains the only potentially curative option for patients with myelofibrosis (MF), yet the integration of JAK inhibitors (JAKi) and novel agents into transplant pathways has created increasing complexity. To capture current real-world practice, the EBMT Chronic Malignancies Working Party conducted a survey of 19 high-volume European centres performing MF allo-HCT. Most centres (68%) routinely initiated JAKi, primarily ruxolitinib, in transplant-eligible patients prior to conditioning, with goals of splenomegaly reduction and symptom control. Management of ruxolitinib intolerance or resistance was heterogeneous, with strategies including switching to alternative JAKi, proceeding directly to allo-HCT, or enroling in clinical trials. Peri-transplant approaches also varied: over half of centres continued ruxolitinib throughout conditioning, while others employed tapering or abrupt discontinuation. Experience with newer JAKi and investigational therapies was limited. Post-transplant, most centres did not routinely reintroduce JAKi, although some used them for relapse or GVHD mitigation. Notably, many centres reported transplant delays due to prolonged medical therapy, with adverse consequences including disease progression. These findings highlight significant heterogeneity in practice, which is likely to increase as more novel agents are integrated in treatment algorithms. Harmonised, multidisciplinary guidelines to optimise timing and outcomes for MF patients eligible for allo-HCT are needed
