11 research outputs found
Small Renal Masses: Developing a Robust Radiomic Signature
No full text(1) Background and (2) Methods: In this retrospective, observational, monocentric study, we selected a cohort of eighty-five patients (age range 38-87 years old, 51 men), enrolled between January 2014 and December 2020, with a newly diagnosed renal mass smaller than 4 cm (SRM) that later underwent nephrectomy surgery (partial or total) or tumorectomy with an associated histopatological study of the lesion. The radiomic features (RFs) of eighty-five SRMs were extracted from abdominal CTs bought in the portal venous phase using three different CT scanners. Lesions were manually segmented by an abdominal radiologist. Image analysis was performed with the Pyradiomic library of 3D-Slicer. A total of 108 RFs were included for each volume. A machine learning model based on radiomic features was developed to distinguish between benign and malignant small renal masses. The pipeline included redundant RFs elimination, RFs standardization, dataset balancing, exclusion of non-reproducible RFs, feature selection (FS), model training, model tuning and validation of unseen data. (3) Results: The study population was composed of fifty-one RCCs and thirty-four benign lesions (twenty-five oncocytomas, seven lipid-poor angiomyolipomas and two renal leiomyomas). The final radiomic signature included 10 RFs. The average performance of the model on unseen data was 0.79 +/- 0.12 for ROC-AUC, 0.73 +/- 0.12 for accuracy, 0.78 +/- 0.19 for sensitivity and 0.63 +/- 0.15 for specificity. (4) Conclusions: Using a robust pipeline, we found that the developed RFs signature is capable of distinguishing RCCs from benign renal tumors
Chronic Pain in the Elderly with Cognitive Decline: A Narrative Review
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No full textPAGE TWO
DAILY PALO ALTO TIMES, THURSDAY. JAN. 7, 1915.
S>aibg fttmee Bbitorial page
H. W. SIMKINS
-W. II. KKLLT
doctor ritVata. on wah oocw
I From Literary Digest)
Wounded in hi* desresl affec-
' tlona by shot* from both site* of
th-**warring boats, a Herman profe*-
o*4ft of Rngllsh philosophy has died
-*-»f heartbreak. So It la reported of
Vrofeaaor Kwald Klugel, who for
* th* paat \wenty year* and more has
been connected with 1-eland fit an-
ford University. He wa* nn cnthn-,
aia*tic scholar of Anglo-Saxon and
Chaucerian lore, and in the latter
fleld enjoyed nn International reputation. Klaht year* ago. at the Instigation of the Carnegie Foundation for tbe Adavncement of Learning, he undertook the compilation
of a concordance to Chauc«r. Thi*
was to be s monumental work In
twelve volume*. Diligence nnd an*
thuilaam marked the profensor'* labor, but at ht*'death he had pro-
•greased only a* far aa the teller V.
j\ friend, Valentine lioehnei*, of Lot*
Angeles writes of him:
"When tii-- European war broke
out ll unnerved Professor Huge)
completely. He wu* of (lermsn
birth, hla father waa l>r. Felix Flu-
gel* the author of tbe well-known
flerman-Knellsh dictionary in tbren
volume*!. He had been tin enthusiastic atudent of English phllrttogy
■and literntuir and had --petit some
lime stTOxford University a* a student tn the native inlr. HI* heart
and soul were wrap) up In (Jermanlc
and Anglo-Saxon tradition*., nnd t
see the two nations, of whom h
nnd alwsy* thouicht ■■« mother nnd
•dnughter, entering Into deadly com-
*tax with each oilier waa more thai
Mi tender nature could bear. II
finally sneeumbed to the strain.
{shortly before l-rofeesoi i-iugei'*
-death he tiad printed snd setil out
a pamphlet tti.-it contnlned *omo
■ 'tiieolnRiriu observations" nn tho
war situation Thev dealt wllh the
attitude*' of both warring and nen
trnl nation- *
1 lm
In vi
iked the dally
for
help ni m
in -
whl
le they fonicht
bloody battlr-
on
the
une side, and
111,
Ihe othei
pn
iyed
for peace at
the
saint' lliiif
ihr
if *
ere furnishing
ia
warring nn
Hon
K til
e Instruments
*Ot 1
leslructlon
H
m m
rote:
Kant that 'God' Is a pustulate of
practical reason.' we surely must
grant that everybody haa a right
and a duty to communicate with thl*
flod' by prayer and—actloa. But
be should certainly not address 'bla'
flod as the source of love while
drawing the aword. He ought tb
restrict hlmaelf to the Invocation of
God aa the source of 'Justice' and
'truth' nnd consecrate hlmaelf a
fighter for the cauae of juatlce and
truth."
If the "prayer* to the different
wargods" be an anachronism nnd
the po-.itive of blaapfaemy." he say*,
he ahould rail "the supplying of dynamite to warring nation* In com hi-
nation with prayers Tor peace- the
superlative of blasphemy and hypocrisy." .More explicitly:
"Do American firm* really ship
on weekdays aucb goods aa will help
to protract tbe war. and do their
principal* nnd clerka really pray on
Sunday* for the stopping of tbe war*
Doe* the American government
countenance aucb thing*? Do thc
American jieople approve of auch
things? Do American minister*
know of auch thing*?
"If they do. thnn I beg to makefile following theological suggestion:
"Since pear* prayers sre addrest
on Sundays to the name deity which {
on wcekdnvt neems lo send his hie***1
Ingu to tlie commerce „f thl* pro**
perotta country. I nuggest that jou1
■ ahould, tn the Uitartat of your mei**]
I Cantlle pnr|jtliIon**r'*. .-ntdresn now '
.-ind then a fervent prayer for the
f.afe <■ md net and h:ipp) arrival of j
Hie dynamite and gunimwder at the
foreign harbor*, that the dynamite';
may blast away the night of dark-;
tie** In those heathen land*, nn I;
that more and more and more •urn
order* may come, forever nnd ever* I
"Of eonraa on the -.aim* Sund-iyij
ou which you pray for dynamite or-[
der», you ought not to pray for a
siir-wly . per-cit- how could more or*
dem be nili'd If peace should come?
(The*rt must t>e logic in everything' l
No.\<m might alternate nnd pray one
Sunday for peace (as our Prealdent
told ua to do) and tbe next for dy*
nanilta orders (or perhaps all th*
rest of the fifty-one Sundays?)."
Why Oe B.«l* twattew Sten.sT
No nature student sums y*t to hare
discovered for what reason aea la awal
low atones, tbongh tbe fact te a well
established one. Certainly the stones
are not taken In for ballaat for the
empty seals keep down aa easily aa th*
other* Tbey are not swallowed for
lb* purpose of grinding op food, for
they -ara found In th* etomacba ot
nursing pupa. Ther ar* not taken ta
with tbe food becauae they are fonnd
In the .atomacba of both young aeala
and tn thoee that live in th* open eea
aod feed on sqoid- Yet It la evident
that the** thing* are not a wallowed
haphazard, but are eelected with Con-
alderable care from tbe article* strewn
along the shore, and tbat a preference
ta exhibited for rounded object* 1-hla
is shown by the fact that, aa a rule.
only articles of.one kind are found tn
any one aeal'a stomach
The Night Writer*
Writers who habitually work at nlghL
and all nlgbt. frequently get at range '
nervous fancies. Huxlry aald, "Wben
I am working kt night I not only hear I
burglars moving about but I actually
sec them looking tim-ugh th* crack in
the door at me."
Wllkle Coltina wss a habitual nlgbt
worker until he wa* frtghtencd out of
It by tbe appearance of another Wltki*
Cotllna, who aat down at the table with
him and tried to monopolize the desk.
There waa a struggle, and tbe inkstand wa* up**t. When tbe real Wllkle Collins came Xf* hlmaelf, aura
enough, the Ink won running over the
writing table, proof enough of a etrog-
gle. After lhat Ur. Colltas gave op
nlgbt work.
On Ou
lent
"Can you make me a sheet Iron mandolin r
"I might, bui It wouldn't have much
tun-. What du you want of a sheet-
Iron mandolin. ouyhowT*
Tm trying m *crcnadc a girl, and
tbey bavo n bulldog. I've busted aev-
eral uistrumunta on blm. Next time I
amaab blm I wnnt to -nn ti blm good."
-Kansas Cltr Jourunl.
"If ii mnn does not know- what
blnaphemy consists of, pray lei blm
read allusions to the prater* uttered
before tho battles of thl* war. ll la
not 'Hod' Hint tlie pruycri- nre nd-
-drest lo. but 'our' Hod, h •paetAc
ally national Hod apparently. • * •
"I nak. Hn* llie world really made
any theological pi ok res* since nlio-
rlglnal day*? Are we really still
polythelat* with national wargods*'
'Or have we higher conception* of
the 'Creator of Heaven and Ksrth.'
nay. of million* of world* and world |
systems? Una Giordano Ilrtiiio died!
for nothing*' Have the Copernl ■
cute*. Galileo*. Newton-.. Kant*|
lived in vain?
"Laat Sum!.!■- the sunset was M.I
beautiful and calm and overwhelm-j
Ingly serene thst 1 thought In looking iii the evening star, emerging!
from n world of purple blue: 'How |
may we dare to pray now to thej
-eternal prim tplc of onlei. Iieautv,.
und love with commercial echouaa]
in our head .ind with blood-tlripping|
hands'" All I could pray wai: May
the dead beroea steep In peace nnd
may JitHtlce prevail, nnd common
-sense, and fairness: mav peace
•rome, thy kingdom come!* • • •
"If wc believe wllh Iiiininnuet
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A new national survey of centers for cognitive disorders and dementias in Italy
No full textIntroduction: A new national survey has been carried out by the Italian Centers for Cognitive Disorders and Dementias (CCDDs). The aim of this new national survey is to provide a comprehensive description of the characteristics, organizational aspects of the CCDDs, and experiences during the COVID-19 pandemic.
Methods: A list of all national CCDDs was requested from the delegates of each Italian region. The online questionnaire is divided in two main sections: a profile section, containing information on location and accessibility, and a data collection form covering organization, services, treatments, activities, and any service interruptions caused by the COVID-19 outbreak.
Results: In total, 511 out of 534 (96%) facilities completed the profile section, while 450 out of 534 (84%) CCDDs also completed the data collection form. Almost half of the CCDDs (55.1%) operated for 3 or fewer days a week. About one-third of the facilities had at least two professional figures among neurologists, geriatricians and psychiatrists. In 2020, only a third of facilities were open all the time, but in 2021, two-thirds of the facilities were open.
Conclusion: This paper provides an update on the current status of CCDDs in Italy, which still shows considerable heterogeneity. The survey revealed a modest improvement in the functioning of CCDDs, although substantial efforts are still required to ensure the diagnosis and care of patients with dementia
The Profile of the Italian Centers for Cognitive Disorders and Dementia in the Context of New Drugs in Alzheimer's Disease
No full textBackground: The wait for the upcoming disease-modifying therapies (DMT) for Alzheimer's disease in Europe is raising questions about the preparedness of national healthcare systems to conduct accurate diagnoses and effective prescriptions. In this article, we focus on the current situation in Italy. Objective: The primary goal is to propose a profile of the Italian Centers for Cognitive Disorders and Dementias (CCDDs) that could be taken into consideration by regional and autonomous provincial authorities when deciding on the prescribing centers for DMT. Methods: Based on responses to a national survey on CCDDs in Italy, we identified the CCDDs that meet the requirements for effective prescription: 1) Multidisciplinary team; 2) Minimum Core Test for the neuropsychological assessment; 3) PET, CSF, and Brain MRI assessments. Univariate and multivariate comparisons were conducted between CCDDs that met the criteria and the others. Results: Only 10.4% of CCDDs met the requirements for effective DMT prescription, mainly located in Northern Italy. They are also characterized by longer opening hours, a higher number of professionals, a university location, and a higher frequency of conducting genetic tests, and could potentially result in prescribing centers. Conclusions: The findings suggest that the Italian national healthcare system may benefit from further enhancements to facilitate the effective prescription of DMTs. This could involve initiatives to reduce fragmentation, ensure adequate resources and equipment, and secure sufficient funding to support this aspect of healthcare delivery
P1517: HUMORAL AND CELLULAR IMMUNE RESPONSES TO SARS-COV-2 NATURAL INFECTION OR VACCINATION IN PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA (CLL): A STUDY BY ERIC, THE EUROPEAN RESEARCH INITIATIVE ON CLL
No full textNeuropsychological tests at the Italian Centers for Cognitive Disorders and Dementias: results from a survey on 450 specialized services
No full textBackground: The Italian Fund for Alzheimer’s and other dementias approved in 2020 enabled the conducting of a survey in the Italian Centers for Cognitive Disorders and Dementias (CCDDs) to analyse the organization, the administrative features and the professionals’ characteristics. Aims: To investigate the current use of neuropsychological (NP) tests in Italian CCDDs and the association between the use of a basic set of tests for neuropsychological assessment (NPA) and organizational/structural characteristics of CCDDs. Methods: A survey was conducted with an online questionnaire in all CCDDs between July 2022 and February 2023. To verify the use of a comprehensive NPA in the diagnosis of cognitive disorders and dementia, we identified a minimum core test (MCT). Results: The CCDDs using a Minimum Core Test (MCT) significantly increased from 45.7% in 2015 to the current 57.1%. Territorial CCDDs using MCT significantly increased from 24.9% in 2015 to 37% in 2022 (p = 0.004). As multivariable results, the presence of psychologist/neuropsychologist in the staff and the University-based/IRCCS CCDDs increased the probability of using MCT (OR = 9.2; 95% CI 5.6–15.0; p < 0.001 and OR = 5.4; 95% CI 1.9–15.9; p = 0.002, respectively), while CCDDs in Southern Italy-Islands showed a lower probability than those in the North (OR = 0.4; 95% CI 0.2–0.7; p = 0.001). Discussion: Almost half of CCDDs (43%) do not use MCT in their clinical practice. The presence of the psychologist/neuropsychologist on the staff has a key role in the adoption of MCT and regional differences have increased over the past years. NPA is crucial in the diagnostic process and in characterizing risk profiles in order to implement targeted interventions for risk reduction. Conclusions: Our results could help to identify good practices aimed at improving dementia diagnosis. An intervention by health policymakers is urgently needed with the aim of improving diagnostic appropriateness and overcoming regional differences
The Italian dementia with Lewy bodies study group (DLB-SINdem): toward a standardization of clinical procedures and multicenter cohort studies design
No full textDementia with Lewy bodies (DLB) causes elevated outlays for the National Health Systems due to high institutionalization rate and patients’ reduced quality of life and high mortality. Furthermore, DLB is often misdiagnosed as Alzheimer’s disease. These data motivate harmonized multicenter longitudinal cohort studies to improve clinical management and therapy monitoring. The Italian DLB study group of the Italian Neurological Society for dementia (SINdem) developed and emailed a semi-structured questionnaire to 572 national dementia centers (from primary to tertiary) to prepare an Italian large longitudinal cohort. The questionnaire surveyed: (1) prevalence and incidence of DLB; (2) clinical assessment; (3) relevance and availability of diagnostic tools; (4) pharmacological management of cognitive, motor, and behavioural disturbances; (5) causes of hospitalization, with specific focus on delirium and its treatment. Overall, 135 centers (23.6 %) contributed to the survey. Overall, 5624 patients with DLB are currently followed by the 135 centers in a year (2042 of them are new patients). The percentage of DLB patients was lower (27 ± 8 %) than that of Alzheimer’s disease and frontotemporal dementia (56 ± 27 %) patients. The majority of the centers (91 %) considered the clinical and neuropsychological assessments as the most relevant procedure for a DLB diagnosis. Nonetheless, most of the centers has availability of magnetic resonance imaging (MRI; 95 %), electroencephalography (EEG; 93 %), and FP-CIT single photon emission-computerized tomography (SPECT; 75 %) scan for clinical applications. It will be, therefore, possible to recruit a large harmonized Italian cohort of DLB patients for future cross-sectional and longitudinal multicenter studies
A new national survey of centers for cognitive disorders and dementias in Italy
No full textIntroduction: A new national survey has been carried out by the Italian Centers for Cognitive Disorders and Dementias (CCDDs). The aim of this new national survey is to provide a comprehensive description of the characteristics, organizational aspects of the CCDDs, and experiences during the COVID-19 pandemic. Methods: A list of all national CCDDs was requested from the delegates of each Italian region. The online questionnaire is divided in two main sections: a profile section, containing information on location and accessibility, and a data collection form covering organization, services, treatments, activities, and any service interruptions caused by the COVID-19 outbreak. Results: In total, 511 out of 534 (96%) facilities completed the profile section, while 450 out of 534 (84%) CCDDs also completed the data collection form. Almost half of the CCDDs (55.1%) operated for 3 or fewer days a week. About one-third of the facilities had at least two professional figures among neurologists, geriatricians and psychiatrists. In 2020, only a third of facilities were open all the time, but in 2021, two-thirds of the facilities were open. Conclusion: This paper provides an update on the current status of CCDDs in Italy, which still shows considerable heterogeneity. The survey revealed a modest improvement in the functioning of CCDDs, although substantial efforts are still required to ensure the diagnosis and care of patients with dementia
Effects on the incidence of cardiovascular events of the addition of pioglitazone versus sulfonylureas in patients with type 2 diabetes inadequately controlled with metformin (TOSCA.IT): a randomised, multicentre trial
No full textBACKGROUND:
The best treatment option for patients with type 2 diabetes in whom treatment with metformin alone fails to achieve adequate glycaemic control is debated. We aimed to compare the long-term effects of pioglitazone versus sulfonylureas, given in addition to metformin, on cardiovascular events in patients with type 2 diabetes.
METHODS:
TOSCA.IT was a multicentre, randomised, pragmatic clinical trial, in which patients aged 50-75 years with type 2 diabetes inadequately controlled with metformin monotherapy (2-3 g per day) were recruited from 57 diabetes clinics in Italy. Patients were randomly assigned (1:1), by permuted blocks randomisation (block size 10), stratified by site and previous cardiovascular events, to add-on pioglitazone (15-45 mg) or a sulfonylurea (5-15 mg glibenclamide, 2-6 mg glimepiride, or 30-120 mg gliclazide, in accordance with local practice). The trial was unblinded, but event adjudicators were unaware of treatment assignment. The primary outcome, assessed with a Cox proportional-hazards model, was a composite of first occurrence of all-cause death, non-fatal myocardial infarction, non-fatal stroke, or urgent coronary revascularisation, assessed in the modified intention-to-treat population (all randomly assigned participants with baseline data available and without any protocol violations in relation to inclusion or exclusion criteria). This study is registered with ClinicalTrials.gov, number NCT00700856.
FINDINGS:
Between Sept 18, 2008, and Jan 15, 2014, 3028 patients were randomly assigned and included in the analyses. 1535 were assigned to pioglitazone and 1493 to sulfonylureas (glibenclamide 24 [2%], glimepiride 723 [48%], gliclazide 745 [50%]). At baseline, 335 (11%) participants had a previous cardiovascular event. The study was stopped early on the basis of a futility analysis after a median follow-up of 57·3 months. The primary outcome occurred in 105 patients (1·5 per 100 person-years) who were given pioglitazone and 108 (1·5 per 100 person-years) who were given sulfonylureas (hazard ratio 0·96, 95% CI 0·74-1·26, p=0·79). Fewer patients had hypoglycaemias in the pioglitazone group than in the sulfonylureas group (148 [10%] vs 508 [34%], p<0·0001). Moderate weight gain (less than 2 kg, on average) occurred in both groups. Rates of heart failure, bladder cancer, and fractures were not significantly different between treatment groups.
INTERPRETATION:
In this long-term, pragmatic trial, incidence of cardiovascular events was similar with sulfonylureas (mostly glimepiride and gliclazide) and pioglitazone as add-on treatments to metformin. Both of these widely available and affordable treatments are suitable options with respect to efficacy and adverse events, although pioglitazone was associated with fewer hypoglycaemia events
