Clean Colon Software Program (CCSP), Proposal of a standardized Method to quantify Colon Cleansing During Colonoscopy: Preliminary Results

Background and study aims: Neoplastic lesions can be missed during colonoscopy, especially when cleansing is inadequate. Bowel preparation scales have significant limitations and no objective and standardized method currently exists to establish colon cleanliness during colonoscopy. The aims of our study are to create a software algorithm that is able to analyze bowel cleansing during colonoscopies and to compare it to a validate bowel preparation scale. Patients and methods: A software application (the Clean Colon Software Program, CCSP) was developed. Fifty colonoscopies were carried out and video-recorded. Each video was divided into 3 segments: cecum-hepatic flexure (1st Segment), hepatic flexure-descending colon (2nd Segment) and rectosigmoid segment (3rd Segment). Each segment was recorded twice, both before and after careful cleansing of the intestinal wall. A score from 0 (dirty) to 3 (clean) was then assigned by CCSP. All the videos were also viewed by four endoscopists and colon cleansing was established using the Boston Bowel Preparation Scale. Interclass correlation coefficient was then calculated between the endoscopists and the software. Results: The cleansing score of the prelavage colonoscopies was 1.56\ub10.52 and the postlavage one was 2,08\ub10,59 (P<0.001) showing an approximate 33.3% improvement in cleansing after lavage. Right colon segment prelavage (0.99\ub10.69) was dirtier than left colon segment prelavage (2.07\ub10.71). The overall interobserver agreement between the average cleansing score for the 4 endoscopists and the software pre-cleansing was 0.87 (95% CI, 0.84\u20130.90) and post-cleansing was 0.86 (95% CI, 0.83\u20130.89). Conclusions: The software is able to discriminate clean from non-clean colon tracts with high significance and is comparable to endoscopist evaluation

Cardiac Cell Senescence and Redox Signaling

Aging is characterized by a progressive loss of the ability of the organism to cope with stressors and to repair tissue damage. As a result, chronic diseases, including cardiovascular disease, increase their prevalence with aging, underlining the existence of common mechanisms that lead to frailty and age-related diseases. In this frame, the progressive decline of the homeostatic and reparative function of primitive cells has been hypothesized to play a major role in the evolution of cardiac pathology to heart failure. Although initially it was believed that reactive oxygen species (ROS) were produced in an unregulated manner as a byproduct of cellular metabolism, causing macromolecular damage and aging, accumulating evidence indicate the major role played by redox signaling in physiology. Aim of this review is to critically revise evidence linking ROS to cell senescence and aging and to provide evidence of the primary role played by redox signaling, with a particular emphasis on the multifunctional protein APE1/Ref in stem cell biology. Finally, we will discuss evidence supporting the role of redox signaling in cardiovascular cells

Hyponatremia and Bone Fractures: An Intriguing and Often Overlooked Association

Hyponatremia and Bone Fractures: An Intriguing and Often Overlooked Associatio

La liaison fructueuse: Laboratory and emergency medicine

La liaison fructueuse: Laboratory and emergency medicin

Is Google Trends a reliable tool for digital epidemiology? Insights from different clinical settings

Internet-derived information has been recently recognized as a valuable tool for epidemiological investigation. Google Trends, a Google Inc. portal, generates data on geographical and temporal patterns according to specified keywords. The aim of this study was to compare the reliability of Google Trends in different clinical settings, for both common diseases with lower media coverage, and for less common diseases attracting major media coverage. We carried out a search in Google Trends using the keywords "renal colic", "epistaxis", and "mushroom poisoning", selected on the basis of available and reliable epidemiological data. Besides this search, we carried out a second search for three clinical conditions (i.e., "meningitis", "Legionella Pneumophila pneumonia", and "Ebola fever"), which recently received major focus by the Italian media. In our analysis, no correlation was found between data captured from Google Trends and epidemiology of renal colics, epistaxis and mushroom poisoning. Only when searching for the term "mushroom" alone the Google Trends search generated a seasonal pattern which almost overlaps with the epidemiological profile, but this was probably mostly due to searches for harvesting and cooking rather than to for poisoning. The Google Trends data also failed to reflect the geographical and temporary patterns of disease for meningitis, Legionella Pneumophila pneumonia and Ebola fever. The results of our study confirm that Google Trends has modest reliability for defining the epidemiology of relatively common diseases with minor media coverage, or relatively rare diseases with higher audience. Overall, Google Trends seems to be more influenced by the media clamor than by true epidemiological burden

Seasonal variation in the frequency of myocardial infarction diagnosed in a large emergency department of a European country with a temperate climate

Previous studies at different latitudes showed that acute myocardial infarction (AMI) exhibits a seasonal variation, with higher frequency in spring and winter. We conducted a retrospective analysis to verify whether the frequency of AMI cases diagnosed in the emergency department (ED) may follow a seasonal pattern in a European country with a temperate climate. A retrospective analysis was performed in the hospital database of the University Hospital of Parma (northwestern Italy), to retrieve the total number of AMI cases diagnosed in the ED during the entire year 2010. The search for AMI cases was conducted using both ICD-9 codes and related diagnostic terms. The seasonality was defined according to the typical equinoxes and solstices at the latitude of the study. A total of 83,919 patients visited the ED of the University Hospital of Parma during the year 2010, 502 (0.6%) of whom with a final diagnosis of AMI (mean age, 73±14 years; 188 women and 314 men). The largest frequency of AMIs was observed in autumn (n=148; 29%), followed by winter (n=136, 27%), whereas the lowest frequencies were recorded in spring (n=110; 22%) and summer (n=108; 22%). The difference in frequency distribution of AMI cases across the four seasons of the year was found to be statistically significant (P&lt;0.001), and this trend was independent from sex and age. Compared to the summer period (i.e., the season with the lowest frequency of AMI cases), the relative risk (RR) for AMI was significantly higher in autumn (1.37; 95% CI, 1.15-1.63; P&lt;0.001) and winter (1.26; 95% CI, 1.05-1.51; P=0.013), but not in spring (1.02; 95% CI, 0.83-1.24; P=0.857). Compared to the spring period, the RR for AMI was found also to be significantly higher in autumn (1.34; 95% CI, 1.13-1.60; P&lt;0.001) and winter (1.24; 95% CI, 1.03-1.48; P=0.021)

Is digital epidemiology the future of clinical epidemiology?

[no abstract available

Red blood cell distribution width: A marker of anisocytosis potentially associated with atrial fibrillation

The incorporation of biomarkers in the actually used risk scores seem to be helpful for early identifying atrial fibrillation (AF) patients at higher risk. The aim of this critical review of the scientific literature is to investigate the potential clinical significance of red blood cell distribution width (RDW) in AF. A systematic electronic search was carried out to identify all articles describing an epidemiological association between RDW and AF in adult human populations. Data abstraction was conducted on a final number of 35 articles (13 cross-sectional, 12 prospective and 10 retrospective studies). The results of these epidemiological investigations were all virtually concordant to emphasize that an enhanced RDW value is not only a predictive factor and a marker of AF but its measurement may also be helpful for predicting the risk of developing many adverse complications in patients with AF, such as recurrence and duration of AF, hospitalization for heart failure, bleeding, left atrial thrombosis and stasis, thromboembolic events and mortality. AF patients with RDW values exceeding the local reference range may be more aggressively investigated and managed, in order to identify and attenuate the impact of possible underlying disorders causing both anisocytosis and AF

Verifica di un generatore di vapore industriale a tubi di fumo

L'obiettivo del progetto di Tesi è il confronto tra un nuovo generatore di vapore, recentemente installato presso Cereal Docks Marghera S.r.l. e la vecchia caldaia sostituita. Inizialmente vengono riportati i dati dimensionali del generatore e calcolate le propriet termofisiche dei fumi. Viene poi eseguita una verifica termica utile ad analizzare l'esattezza dei dati calcolati. Successivamente si mettono a confronto i rendimenti delle due caldaie e si calcola la prevalenza teorica del ventilatore, valutando il corretto funzionamento o meno del bruciatore installato. I risultati ottenuti dimostrano che la caldaia in grado di sostituire adeguatamente la precedente. Inoltre, la verifica termica dimostra che i calcoli svolti sulle propriet dei fumi sono sufficientemente precisi ed stato dimostrato che il bruciatore compatibile con la nuova caldaiaopenEmbargo per motivi di segretezza e/o di proprietà dei risultati e/o informazioni sensibil