An image-based modeling framework for patient-specific computational hemodynamics

We present a modeling framework designed for patient-specific computational hemodynamics to be performed in the context of large-scale studies. The framework takes advantage of the integration of image processing, geometric analysis and mesh generation techniques, with an accent on full automation and high-level interaction. Image segmentation is performed using implicit deformable models taking advantage of a novel approach for selective initialization of vascular branches, as well as of a strategy for the segmentation of small vessels. A robust definition of centerlines provides objective geometric criteria for the automation of surface editing and mesh generation. The framework is available as part of an open-source effort, the Vascular Modeling Toolkit, a first step towards the sharing of tools and data which will be necessary for computational hemodynamics to play a role in evidence-based medicine.     

Prolonged distal motor latency of median nerve does not improve diagnostic accuracy for CIDP

Journal of Neurology - Compression of the median nerve at the carpal tunnel can give demyelinating features and result in distal motor latency (DML) prolongation fulfilling the EFNS/PNS...     

Breastfeeding Shows a Protective Trend toward Adolescents with Higher Abdominal Adiposity

ObjectiveThe question of whether breastfeeding has a protective effect against the development of overweight or obesity later in life remains controversial, especially during adolescence. The objective was to assess the relationship between breastfeeding and adolescents’ body composition.MethodsThe HELENA study is a cross-sectional study involving 3,528 adolescents from 10 European cities. The outcome measures were body weight and height, subscapular skinfolds as well as waist circumferences. Breastfeeding, smoking status, and parental socioeconomic status were assessed by self-administered questionnaires. Dietary intake was recorded using two 24-hour recall surveys. Two adjustment approaches were used: i) covariance analysis adjusted for confounding factors (propensity score adjustment) and ii) multivariate quantile regression.ResultsAfter adjustment, no significant associations were observed between breastfeeding and body composition parameters (BMI Z-score; sum of skinfolds; waist-to-height ratio). An adjusted quantile regression analysis showed a non-significant trend for a protective effect of breastfeeding toward the highest percentiles of adiposity in boys but not in girls. This is of particular interest with respect to the superiority of the waist-to-height ratio over waist circumference and BMI for detecting cardiometabolic risk factors.ConclusionThis first European study, including a large set of factors influencing adolescents’ body composition, showed a non-significant trend toward a protective effect of breastfeeding on highest percentiles of adolescent''s abdominal adiposity.Key Words: Breastfeeding, Body composition, Adolescents, Waist-to-height ratio, BMI, Propensity score     

Rethinking hospital psychiatry in Italy in light of COVID-19 experience

BACKGROUNDItaly retains a distinctive organization of mental health services according to a community-based model of care with a multidisciplinary team serving a well-defined catchment area under the coordination of the local department of mental health. The coronavirus disease 2019 (COVID-19) pandemic is forcing Italian mental health services to develop new organizational strategies at all levels of care in order to face the associated challenges.AIMTo explore factors associated with changes in psychiatric admissions to an inpatient psychiatric unit located in Lombardia Region, Italy.METHODSAll hospital admissions (n = 44) were recorded to an inpatient psychiatric unit during a three month national lockdown in Italy in 2020 and compared with those occurring over the same time period in 2019 (n = 71). For each admission, a 20-item checklist was completed to identify factors leading to admission. Statistical analyses were performed using Statistical Package for Social Sciences for Windows, release 11.0. Chi-square test (or Fisher’s exact test) and Mann-Whitney U-test were applied, where appropriate.RESULTSHospital admissions dropped by 38% during the COVID-19 pandemic. No significant differences were found in demographics, clinical variables associated with hospital admissions and length of stay between 2019 and 2020. Compared with 2019, a significantly greater proportion of hospital admissions in 2020 were related to difficulties in organizing care programs outside the hospital (chi-square = 4.91, df 1, one-way P = 0.035) and in patients’ family contexts (chi-square = 3.71, df 1, one-way P = 0.049). On the other hand, logistic and communication difficulties pertaining to residential facilities and programs were significantly more common in 2019 than in 2020 (chi-square = 4.38, df 1, one-way P = 0.032).CONCLUSIONAdmissions to the inpatient psychiatric unit dropped significantly during the COVID-19 pandemic in 2020, with difficulties in organizing care programs outside the hospital and in patients’ family contexts occurring more frequently compared with 2019.     

Relationship between circadian rhythms and blood pressure and the pathogenesis of cerebrovascular insufficiency]

Cerebrovascular accidents occur more frequently during the morning, less frequently during the night, whether due to thrombosis or embolism. In cases with hypertension, however, there have been noted a more uniform distribution of these complications throughout the day. The preponderance in the morning of the number of accidents in non-embolic subjects, depends probably on the state of the autonomic nervous system during the night, which gives rise to a dilated and hypotonic microcirculation. Autoregulation is, in this way, reduced and the physiological increase in blood pressure during the morning may induce a break through of autoregulation. In embolic subjects, on the other hand, an important role may be played by heart arrhythmias which occur usually during the waking hours. In hypertensives, the microcirculatory bed is restricted and cerebro-vascular resistance relatively constant. The brain, paradoxically, is thus better defended against any moderate increase in blood pressure and fluctuations in blood pressure throughout 24 hours, which may leave cerebral autoregulation unchanged, which probably explains the more uniform distribution of cerebro-vascular accidents throughout the 24 hour period.     

Inter-rater reliability of the EEG reading in patients with childhood idiopathic epilepsy

The level of agreement in the interpretation of EEG records by different experienced readers working in three child neurology tertiary centers has been evaluated. EEG recordings randomly chosen from patients with idiopathic epilepsy were included. Optimal or suboptimal agreement was found for presence of ictal and interictal discharges. Contrary to ictal discharges, the distribution and location of interictal discharges was not unanimously interpreted and agreement was unsatisfactory when assessing the background activity.