Accademia Italiana Medicina Osteopatica

Background: Intravenous fluids modify acid-base balance by changing plasma strong ion difference (SIDPL) and total non-volatile weak acids. Experimental data suggest that pre-infusion plasma bicarbonate (HCO3-) may further modulate these effects. We tested this hypothesis in a large cohort of postoperative ICU patients receiving intravenous fluids. Methods: We retrospectively analyzed all-consecutive post-operative ICU admissions over a 21-month period who received fluid therapy. Fluid inputs/outputs, plasma electrolytes, and arterial blood gases were collected from admission to 9:00 A.M. of postoperative day one. Average SID of infused fluids (SIDINF) was calculated, and SIDPL and standard base excess variations (ΔSBE) were assessed. Patients were stratified by SIDINF tertiles (low, <41.0 mEq/L; medium, 41.2-54.6 mEq/L; high, ≥55.0 mEq/L), median pre-infusion HCO3- (24.3 [22.4-26.3] mmol/L), and tertiles of SIDINF-HCO3- difference. Results: Among 650 admissions, 641 were included (83% elective surgery). Pre-infusion acid-base was, as average, within normal ranges. Total infused volume averaged 2327 ± 1111 mL. Across SIDINF tertiles, ΔSBE increased from 1.2 ± 3.4 to 3.0 ± 3.0 and 3.4 ± 3.0 mmol/L (p < 0.001), paralleled by ΔSIDPL rise (0.6 ± 2.3, 1.3 ± 2.4 and 1.4 ± 2.3 mEq/L, respectively; p = 0.004). For any given SIDINF, patients with lower pre-infusion HCO3- showed greater ΔSBE and ΔSIDPL (p < 0.001). When analyzed by tertiles of SIDINF-HCO3- difference, ΔSBE rose from 1.0 ± 3.2 to 2.7 ± 2.9 and 4.0 ± 3.0 mmol/L (p < 0.001), with amplified effects at higher infused volume (>2500 mL). Conclusions: In postoperative ICU patients, fluid-induced acid-base changes are largely driven by SIDINF-HCO3- difference, supporting individualized fluid selection based on baseline HCO3-.

Background and ObjectivesAnticoagulation in patients with intracerebral hemorrhage (ICH) and atrial fibrillation reduces the risk of ischemic stroke (IS), but also potentially causes an excess risk of recurrent ICH. In this context, we assessed the role of neuroimaging in identifying patients with particular susceptibility to IS or ICH, potentially allowing for individualized risk stratification.MethodsIn PRESTIGE-AF, a prospective, randomized clinical trial conducted across 75 hospitals in 6 European countries, participants with spontaneous ICH and atrial fibrillation were randomized to treatment with direct oral anticoagulants or no anticoagulation. Within a prespecified imaging subanalysis, we centrally assessed brain CT and MRI scans at baseline using established scales and definitions. We performed Cox regression analyses to investigate associations of neuroimaging findings with recurrent ICH and IS.ResultsPRESTIGE-AF included 319 patients, and 313 had neuroimaging of sufficient quality (median age 79 years, 35.5% female). MRI was available in 170 patients (54.3%). During a median follow-up of 1.4 years, 13 patients had recurrent ICH and 22 patients had IS. ICH recurrence was not associated with lobar vs nonlobar hematoma location or the overall category of probable cerebral amyloid angiopathy (p > 0.2). However, there was an increased risk of recurrent ICH in patients with cortical superficial siderosis (hazard ratio [HR] 7.7, 95% CI 1.4–42.2) and chronic intracerebral macrohemorrhages on MRI (HR 9.1, 95% CI 1.8–46.8). Patients with nonlobar ICH were at increased risk of IS (HR 9.1, 95% CI 1.2–67.7).DiscussionNeuroimaging contributes to the identification of patients with ICH and atrial fibrillation at particularly high risk of recurrent ICH or IS, emphasizing its role in clinical decision making. MRI allows for the assessment of relevant neuroimaging markers that can aid the risk assessment in affected patients. Major study limitations include the modest number of outcome events, with confirmation of our findings needed in larger collaborations.Trial Registration InformationClinicalTrials.gov NCT03996772; first submitted June 21, 2019; first patient enrolled: May 31, 2019; available at clinicaltrials.gov/study/NCT03996772.

The 3D NAND Flash memory technology is the main building block of storage architectures such as multimedia cards and Solid-State Drives. Applications ranging from mobile to high-performance computing are continuously calling for an increased storage density, requiring massive scaling efforts at the device and array level. This leads to a natural degradation of the functional metrics of the technology while exposing new reliability issues that jeopardize the inherent memory trade-off with performance. A simple device optimization would be insufficient to tackle the problem. In this work, we show through some case studies how a cross-layer approach spanning from devices and circuits to system-level optimizations is mandatory for future storage systems development.

Pleural mesothelioma (PM) is an aggressive tumor with few therapeutic options. Although patients with epithelioid PM (ePM) survive longer than non-epithelioid PM (non-ePM), heterogeneity of tumor response in ePM is observed. The role of the tumor immune microenvironment (TIME) in the development and progression of PM is currently considered a promising biomarker. A few studies have used high-throughput technologies correlated with TIME evaluation and morphologic and clinical data. This study aimed to identify different morphological, immunohistochemical, and transcriptional profiles that could potentially predict the outcome. A retrospective multicenter cohort of 129 chemonaive PM patients was recruited. Tissue slides were reviewed by dedicated pathologists for histotype classification and immunophenotype of tumor-infiltrating lymphocytes (TILs) and lymphoid aggregates or tertiary lymphoid structures (TLS). ePM (n = 99) survivors were further classified into long (>36 months) or short (<12 months) survivors. RNAseq was performed on a subset of 69 samples. Distinct transcriptional profiling in long and short ePM survivors was found. An inflammatory background with a higher number of B lymphocytes and a prevalence of TLS formations were detected in long compared to short ePM survivors. These results suggest that B cell infiltration could be important in modulating disease aggressiveness, opening a pathway for novel immunotherapeutic approaches.

e24128 Background: In recent years, an ever greater importance is given to the needs of cancer patients which could impact medical treatments, adherence and compliance, and patients’ quality of life (Teo et al. 2019; NCCN, 2015). However, recognizing and addressing the needs of patients may not be enough. Indeed, on one hand, needs that clinicians might consider as 'important' could play a marginal role, and – on the other hand – needs that clinicians may perceive as 'unimportant' may be central for patients. An innovative approach – psychometric network analysis (PNA; Epskamp, 2017) – was used to assess the network among needs ( nodes). Notably, the more a central node (need) is modified (addressed), the more a cascade change will occur in all the other nodes (needs). This study aimed to evaluate: (A) the structure of relationships among needs ( edges) of cancer patients, (B) which needs ( nodes) are the most relevant ( central), and (C) play a key role in the network. Methods: Patients ( n = 511; mean age = 65.95, SD = 12.72; 280 males) were enrolled at the Oncology Day Hospital at the “Presidio Ospedaliero” of Saronno, ASST Valle Olona, Italy. Patients were tested with the Need Evaluation Questionnaire (NEQ) which is composed of 23 items that investigate as many needs – divided into 4 areas: (1) information about diagnosis/prognosis, (2) information about exams and treatment, (3) communicative, and (4) relational needs. Results: Preliminary analysis revealed that all of the items were informative (SDitem &lt; 2.5SDall_itemsSD) and there was no redundancy between items (redundancy index &lt; 0.25). An Ising model (5,000 nonparametric bootstraps) with LASSO regularized nodewise logistic regression was performed. PNA showed a high accuracy: CS-coefficient = 0.56. On one hand, PNA showed that item#2 ( “I need more information about my future condition”; z = 2.039), item#17 ( “I need to speak with a psychologist”; z = 1.209), and item#13 ( “I need to be reassured more by the doctors”; z = 1.201) were the strongest (central) nodes. On the other hand, item#14 ( “ I need the hospital to provide better services”; z = -2.261) was the weakest node in the network. Conclusions: These findings show useful implications for clinical practice. Clinical interventions should address the needs showing the strongest connections in the network. These central nodes can influence all the other connected needs, thus representing important needs to be targeted by clinicians – allowing to tailoring more targeted and efficient therapeutic approaches to meet patients’ needs, with beneficial effects for medical treatments and quality of life.

The Osteopathy Students Analysis (OSA) aims to profile osteopathy students in Italy as a target population in terms of sociodemographic characteristics, geographical distribution, health status, and previous and ongoing education specifications. The OSA used a cross-sectional design. A Web-based survey was distributed to the Italian Osteopathic Education Institutions (OEIs). The OSA survey was composed of items organised into four sections: 1. Sociodemographic characteristics (11 items); 2. Geographical distribution (5 items); 3. Health status (3 items); 4. Previous and ongoing education specifications (16 items). A descriptive sample population analysis was performed. Dichotomous and categorical variables were presented as frequencies and percentages, and continuous variables were displayed as means and standard deviations. Some variables were analysed using a pentenary distribution. 49 out of the 61 OEIs identified matched the inclusion criteria, and among these, 22 accepted to propose the enrolment of their students into the study. The survey was administered to 4,720 students from all the participant OEIs. A total of 3,762 students responded to the survey, accounting for an estimated response rate of 53.7%. The majority of respondents were men (54%), with an average age of 26.9 ± 6.5 years. Almost the totality of the sample was composed of the European ethnic group (99.1%). Respondents were predominantly born in Italy (97.2%). The majority of the sample reported being in good (49.5%) to excellent (38.6%) health. To date, osteopathy students are almost evenly distributed between the two types of curricula (T1 = 46.6%; T2 = 53.4%). The OSA is the first study that aims to profile Italian osteopathy students as a target population in terms of sociodemographic characteristics, geographical distribution, health status, and previous and ongoing education specifications. Future studies should focus on investigating the correlation between the sociodemographic characteristics of students and their academic performance.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease, characterized by the progressive loss of motor neurons, which leads to a reduction in strength and exercise capacity. Although the concept of “Exercise is Medicine” is accepted for many diseases, the role of exercise in individuals with ALS is still debated. The aim of this study was to propose a tailored exercise training program that was both safe and effective for individuals with ALS, and to evaluate the effects of this combined, moderate-intensity, aerobic and strength training program on aerobic capacities, strength, and physical function. Sixteen individuals with ALS were randomly assigned to either a training (three times a week for 12 weeks; TRAIN, n = 8) or usual care (continued their usual standard of care and served as control; UC, n = 8) group. Peak power, peak oxygen uptake, as well as the gas exchange threshold (GET) during a cardiopulmonary exercise test (CPET) on a cycle ergometer, and the maximal strength (1RM) of the knee extensor muscles, were evaluated before and after 12 weeks. Participants also performed the “Timed Up and Go” (TUG) and the “6-min walking” (6MWT) tests. The ALS Functional Rating Scale revisited (ALSFRS-R), the ALS Severity Scale (ALS-SS), and the McGill quality of life (QoL) questionnaire were also measured. The GET increased from 0.94 ± 0.08 to 1.06 ± 0.10 L min–1 in TRAIN (p = 0.009) and decreased from 0.79 ± 0.17 to 0.72 ± 0.17 L min–1 in UC (p = 0.001). There was a significant difference between groups for changes in TUG (9.1 ± 5.5% improvement in TRAIN and 56.8 ± 18.5% worsening in UC, p = 0.002), ALSFRS-R (4.7 ± 2.6% decrease in TRAIN and 23.0 ± 5.6% decrease in UC, p = 0.007), and for the ALS-SS (2.2 ± 2.1% decrease in TRAIN and 12.4 ± 4.4% decrease in UC, p = 0.04). Even if the 1RM of the knee-extensor muscles showed a tendency to increase in TRAIN (70.1 ± 30.0%, p = 0.07), there was not a statistically significant difference (p = 0.57) with respect to the changes in the UC group (44.9 ± 20.7% increase, p = 0.11). This study showed that a combined moderate-intensity aerobic and strength training program, tailored to the physical capacities of each individual, can improve aerobic fitness and maintain physical function in individuals with ALS.