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  • 1
    Online Resource
    Online Resource
    Modulation of SERCA in Patients with Persistent Atrial Fibrillation Treated by Epicardial Thoracoscopic Ablation: The CAMAF Study
    MDPI AG ; 2020
    In:  Journal of Clinical Medicine Vol. 9, No. 2 ( 2020-02-17), p. 544-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 9, No. 2 ( 2020-02-17), p. 544-
    Abstract: Objectives: To evaluate atrial fibrillation (AF) recurrence and Sarcoplasmic Endoplasmic Reticulum Calcium ATPase (SERCA) levels in patients treated by epicardial thoracoscopic ablation for persistent AF. Background: Reduced levels of SERCA have been reported in the peripheral blood cells of patients with AF. We hypothesize that SERCA levels can predict the response to epicardial ablation. Methods: We designed a prospective, multicenter, observational study to recruit, from October 2014 to June 2016, patients with persistent AF receiving an epicardial thoracoscopic pulmonary vein isolation. Results: We enrolled 27 patients. Responders (n = 15) did not present AF recurrence after epicardial ablation at one-year follow-up; these patients displayed a marked remodeling of the left atrium, with a significant reduction of inflammatory cytokines, B type natriuretic peptide (BNP), and increased levels of SERCA compared to baseline and to nonresponders (p 〈 0.05). Furthermore, mean AF duration (Heart rate (HR) 1.235 (1.037–1.471), p 〈 0.05), Left atrium volume (LAV) (HR 1.755 (1.126–2.738), p 〈 0.05), BNP (HR 1.945 (1.895–1.999), p 〈 0.05), and SERCA (HR 1.763 (1.167–2.663), p 〈 0.05) were predictive of AF recurrence. Conclusions: Our data indicate for the first time that baseline values of SERCA in patients with persistent AF might be predictive of failure to epicardial ablative approach. Intriguingly, epicardial ablation was associated with increased levels of SERCA in responders. Therefore, SERCA might be an innovative therapeutic target to improve the response to epicardial ablative treatments.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm9020544
    Language: English
    Publisher: MDPI AG
    Publication Date: 2020
    detail.hit.zdb_id: 2662592-1
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  • 2
    Online Resource
    Online Resource
    Stress, Resilience, and Well-Being in Italian Children and Their Parents during the COVID-19 Pandemic
    MDPI AG ; 2020
    In:  International Journal of Environmental Research and Public Health Vol. 17, No. 22 ( 2020-11-10), p. 8297-
    Details
    In: International Journal of Environmental Research and Public Health, MDPI AG, Vol. 17, No. 22 ( 2020-11-10), p. 8297-
    Abstract: The novel coronavirus (COVID-19) outbreak has forced parents and children to adopt significant changes in their daily routine, which has been a big challenge for families, with important implications for family stress. In this study, we aimed to analyze the potential risk and protective factors for parents’ and children’s well-being during a potentially traumatic event such as the COVID-19 quarantine. Specifically, we investigated parents’ and children’s well-being, parental stress, and children’s resilience. The study involved 463 Italian parents of children aged 5–17. All participants completed an online survey consisting of the Psychological General Well Being Index (PGWB) to assess parental well-being, the Strengths and Difficulties Questionnaire (SDQ) to measure children’s well-being, the Parent Stress Scale (PSS) to investigate parental stress, and the Child and Youth Resilience Measure (CYRM-R) to measure children’s resilience. The results show that confinement measures and changes in daily routine negatively affect parents’ psychological dimensions, thus exposing children to a significant risk for their well-being. Our results also detect some risk factors for psychological maladjustments, such as parental stress, lower levels of resilience in children, changes in working conditions, and parental psychological, physical, or genetic problems. In this study, we attempted to identify the personal and contextual variables involved in the psychological adjustment to the COVID-19 quarantine to identify families at risk for maladjustment and pave the way for ad hoc intervention programs intended to support them. Our data show promising results for the early detection of the determinants of families’ psychological health. It is important to focus attention on the needs of families and children—including their mental health—to mitigate the health and economic implications of the COVID-19 pandemic.
    Type of Medium: Online Resource
    ISSN: 1660-4601
    URL: Article
    DOI: 10.3390/ijerph17228297
    Language: English
    Publisher: MDPI AG
    Publication Date: 2020
    detail.hit.zdb_id: 2175195-X
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  • 3
    Online Resource
    Online Resource
    Preventive Measures against Pandemics from the Beginning of Civilization to Nowadays—How Everything Has Remained the Same over the Millennia
    MDPI AG ; 2022
    In:  Journal of Clinical Medicine Vol. 11, No. 7 ( 2022-04-01), p. 1960-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 11, No. 7 ( 2022-04-01), p. 1960-
    Abstract: As of 27 March 2022, the β-coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected more than 487 million individuals worldwide, causing more than 6.14 million deaths. SARS-CoV-2 spreads through close contact, causing the coronavirus disease 2019 (COVID-19); thus, emergency lockdowns have been implemented worldwide to avoid its spread. COVID-19 is not the first infectious disease that humankind has had to face during its history. Indeed, humans have recurrently been threatened by several emerging pathogens that killed a substantial fraction of the population. Historical sources document that as early as between the 10th and the 6th centuries BCE, the authorities prescribed physical–social isolation, physical distancing, and quarantine of the infected subjects until the end of the disease, measures that strongly resemble containment measures taken nowadays. In this review, we show a historical and literary overview of different epidemic diseases and how the recommendations in the pre-vaccine era were, and still are, effective in containing the contagion.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm11071960
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2662592-1
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  • 4
    Online Resource
    Online Resource
    Role of 18F-FDG PET/CT Radiomics Features in the Differential Diagnosis of Solitary Pulmonary Nodules: Diagnostic Accuracy and Comparison between Two Different PET/CT Scanners
    MDPI AG ; 2021
    In:  Journal of Clinical Medicine Vol. 10, No. 21 ( 2021-10-29), p. 5064-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 10, No. 21 ( 2021-10-29), p. 5064-
    Abstract: The aim of this retrospective study was to investigate the ability of 18 fluorine-fluorodeoxyglucose positron emission tomography/CT (18F-FDG-PET/CT) metrics and radiomics features (RFs) in predicting the final diagnosis of solitary pulmonary nodules (SPN). We retrospectively recruited 202 patients who underwent a 18F-FDG-PET/CT before any treatment in two PET scanners. After volumetric segmentation of each lung nodule, 8 PET metrics and 42 RFs were extracted. All the features were tested for significant differences between the two PET scanners. The performances of all features in predicting the nature of SPN were analyzed by testing three classes of final logistic regression predictive models: two were built/trained through exploiting the separate data from the two scanners, and the other joined the data together. One hundred and twenty-seven patients had a final diagnosis of malignancy, while 64 were of a benign nature. Comparing the two PET scanners, we found that all metabolic features and most of RFs were significantly different, despite the cross correlation being quite similar. For scanner 1, a combination between grey level co-occurrence matrix (GLCM), histogram, and grey-level zone length matrix (GLZLM) related features presented the best performances to predict the diagnosis; for scanner 2, it was GLCM and histogram-related features and metabolic tumour volume (MTV); and for scanner 1 + 2, it was histogram features, standardized uptake value (SUV) metrics, and MTV. RFs had a significant role in predicting the diagnosis of SPN, but their accuracies were directly related to the scanner.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm10215064
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2662592-1
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  • 5
    Online Resource
    Online Resource
    Metformin Therapy Effects on the Expression of Sodium-Glucose Cotransporter 2, Leptin, and SIRT6 Levels in Pericoronary Fat Excised from Pre-Diabetic Patients with Acute Myocardial Infarction
    MDPI AG ; 2021
    In:  Biomedicines Vol. 9, No. 8 ( 2021-07-28), p. 904-
    Details
    In: Biomedicines, MDPI AG, Vol. 9, No. 8 ( 2021-07-28), p. 904-
    Abstract: Background and purpose: pericoronary fat over-inflammation might lead to the development and destabilization of coronary plaque in patients with pre-diabetes (PDM). Notably, pericoronary fat could over-express the sodium-glucose cotransporter 2 (SGLT2) and leptin, along with decreased sirtuin 6 (SIRT6) expression in PDM vs. normoglycemic (NG) patients undergoing coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI). However, in the current study, we evaluated inflammatory markers, SGLT2, SIRT6, and leptin levels in pericoronary fat and, subsequently, 12-month prognosis comparing PDM to NG subjected to CABG for AMI. In addition, we evaluated in PDM patients the effects of metformin therapy on SIRT6 expression, leptin, and SGLT2 levels, and assessed its beneficial effect on nitrotyrosine and inflammatory cytokine levels. Methods: we studied AMI patients referred for CABG, divided into PDM and NG-patients. PDM patients were divided into never-metformin users and metformin users. Finally, we evaluated major adverse cardiac events (MACE) at a 12-month follow-up. Results: the MACE was 9.1% in all PDM and 3% in NG patients (p 〈 0.05). Metformin users presented a significantly lower MACE rate in PDM than never-metformin users (p 〈 0.05). PDM showed higher inflammatory cytokines, 3-nitrotyrosine levels, SGLT2, and leptin content, and decreased SIRT6 protein levels in pericoronary fat compared to NG-patients (p 〈 0.05). PDM never-metformin-users showed higher SGLT2 and leptin levels in pericoronary fat than current-metformin-users (p 〈 0.05). Conclusions: metformin therapy might ameliorate cardiovascular outcomes by reducing inflammatory parameters, SGLT2, and leptin levels, and finally improving SIRT6 levels in AMI-PDM patients treated with CABG.
    Type of Medium: Online Resource
    ISSN: 2227-9059
    URL: Article
    DOI: 10.3390/biomedicines9080904
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2720867-9
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  • 6
    Online Resource
    Online Resource
    Unattended versus Attended Blood Pressure Measurement: Relationship with Retinal Microcirculation
    MDPI AG ; 2022
    In:  Journal of Clinical Medicine Vol. 11, No. 23 ( 2022-11-25), p. 6966-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 11, No. 23 ( 2022-11-25), p. 6966-
    Abstract: Though the relationship between both “attended” and “unattended” BP and several forms of target organ damage have been evaluated, data on retinal arteriolar alterations are lacking. The aim of our study was to evaluate the relationship between “attended” or “unattended” BP values and retinal arteriolar changes in consecutive individuals undergoing a clinical evaluation and assessment of retinal fundus at an ESH Excellence Centre. An oscillometric device programmed to perform 3 BP measurements, at 1 min intervals and after 5 min of rest was used on all individuals to measure BP with the patient alone in the room (“unattended”) or in the presence of the physician (“attended”) in the same day in a random order. The retinal arteriole’s wall thickness (WT) was measured automatically by a localization algorithm as the difference between external (ED) and internal diameter (ID) by adaptive optics (RTX-1, Imagine Eyes, Orsay, Francia). Media-to-lumen ratio (WLR) of the retinal arterioles and cross-sectional area (WCSA) of the vascular wall were calculated. Results: One-hundred-forty-two patients were examined (mean age 57 ± 12 yrs, 48% female, mean BMI 26 ± 4). Among them, 60% had hypertension (84% treated) and 11% had type 2 diabetes mellitus. Unattended systolic BP (SBP) was lower as compared to attended SBP (129 ± 14.8. vs. 122.1 ± 13.6 mmHg, p 〈 0.0001). WLR was similarly correlated with unattended and attended SBP (r = 0.281, p 〈 0.0001 and r = 0.382, p 〈 0.0001) and with unattended and attended diastolic BP (r = 0.34, p 〈 0.001 and r = 0.29, p 〈 0.0001). The differences between correlations were not statistically significant (Steiger’s Z test). Conclusion: The measurement of “unattended” or “attended” BP provides different values, and unattended BP is lower as compared to attended BP. In this study a similar correlation was observed between attended and unattended BP values and structural changes of retinal arterioles.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm11236966
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
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  • 7
    Online Resource
    Online Resource
    Machine Learning Approaches with Textural Features to Calculate Breast Density on Mammography
    MDPI AG ; 2023
    In:  Current Oncology Vol. 30, No. 1 ( 2023-01-07), p. 839-853
    Details
    In: Current Oncology, MDPI AG, Vol. 30, No. 1 ( 2023-01-07), p. 839-853
    Abstract: Background: breast cancer (BC) is the world’s most prevalent cancer in the female population, with 2.3 million new cases diagnosed worldwide in 2020. The great efforts made to set screening campaigns, early detection programs, and increasingly targeted treatments led to significant improvement in patients’ survival. The Full-Field Digital Mammograph (FFDM) is considered the gold standard method for the early diagnosis of BC. From several previous studies, it has emerged that breast density (BD) is a risk factor in the development of BC, affecting the periodicity of screening plans present today at an international level. Objective: in this study, the focus is the development of mammographic image processing techniques that allow the extraction of indicators derived from textural patterns of the mammary parenchyma indicative of BD risk factors. Methods: a total of 168 patients were enrolled in the internal training and test set while a total of 51 patients were enrolled to compose the external validation cohort. Different Machine Learning (ML) techniques have been employed to classify breasts based on the values of the tissue density. Textural features were extracted only from breast parenchyma with which to train classifiers, thanks to the aid of ML algorithms. Results: the accuracy of different tested classifiers varied between 74.15% and 93.55%. The best results were reached by a Support Vector Machine (accuracy of 93.55% and a percentage of true positives and negatives equal to TPP = 94.44% and TNP = 92.31%). The best accuracy was not influenced by the choice of the features selection approach. Considering the external validation cohort, the SVM, as the best classifier with the 7 features selected by a wrapper method, showed an accuracy of 0.95, a sensitivity of 0.96, and a specificity of 0.90. Conclusions: our preliminary results showed that the Radiomics analysis and ML approach allow us to objectively identify BD.
    Type of Medium: Online Resource
    ISSN: 1718-7729
    URL: Article
    DOI: 10.3390/curroncol30010064
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2270777-3
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  • 8
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    Online Resource
    A Multimodal Knowledge-Based Deep Learning Approach for MGMT Promoter Methylation Identification
    MDPI AG ; 2022
    In:  Journal of Imaging Vol. 8, No. 12 ( 2022-12-03), p. 321-
    Details
    In: Journal of Imaging, MDPI AG, Vol. 8, No. 12 ( 2022-12-03), p. 321-
    Abstract: Glioblastoma Multiforme (GBM) is considered one of the most aggressive malignant tumors, characterized by a tremendously low survival rate. Despite alkylating chemotherapy being typically adopted to fight this tumor, it is known that O(6)-methylguanine-DNA methyltransferase (MGMT) enzyme repair abilities can antagonize the cytotoxic effects of alkylating agents, strongly limiting tumor cell destruction. However, it has been observed that MGMT promoter regions may be subject to methylation, a biological process preventing MGMT enzymes from removing the alkyl agents. As a consequence, the presence of the methylation process in GBM patients can be considered a predictive biomarker of response to therapy and a prognosis factor. Unfortunately, identifying signs of methylation is a non-trivial matter, often requiring expensive, time-consuming, and invasive procedures. In this work, we propose to face MGMT promoter methylation identification analyzing Magnetic Resonance Imaging (MRI) data using a Deep Learning (DL) based approach. In particular, we propose a Convolutional Neural Network (CNN) operating on suspicious regions on the FLAIR series, pre-selected through an unsupervised Knowledge-Based filter leveraging both FLAIR and T1-weighted series. The experiments, run on two different publicly available datasets, show that the proposed approach can obtain results comparable to (and in some cases better than) the considered competitor approach while consisting of less than 0.29% of its parameters. Finally, we perform an eXplainable AI (XAI) analysis to take a little step further toward the clinical usability of a DL-based approach for MGMT promoter detection in brain MRI.
    Type of Medium: Online Resource
    ISSN: 2313-433X
    URL: Article
    DOI: 10.3390/jimaging8120321
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2824270-1
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