Gemelli decision tree Algorithm to Predict the need for home monitoring or hospitalization of confirmed and unconfirmed COVID-19 patients (GAP-Covid19): preliminary results from a retrospective cohort study.

OBJECTIVE: To develop a deep learning-based decision tree for the primary care setting, to stratify adult patients with confirmed and unconfirmed coronavirus disease 2019 (COVID-19), and to predict the need for hospitalization or home monitoring. PATIENTS AND METHODS: We performed a retrospective cohort study on data from patients admitted to a COVID hospital in Rome, Italy, between 5 March 2020 and 5 June 2020. A confirmed case was defined as a patient with a positive nasopharyngeal RT-PCR test result, while an unconfirmed case had negative results on repeated swabs. Patients' medical history and clinical, laboratory and radiological findings were collected, and the dataset was used to train a predictive model for COVID-19 severity. RESULTS: Data of 198 patients were included in the study. Twenty-eight (14.14%) had mild disease, 62 (31.31%) had moderate disease, 64 (32.32%) had severe disease, and 44 (22.22%) had critical disease. The G2 value assessed the contribution of each collected value to decision tree building. On this basis, SpO2 (%) with a cut point at 92 was chosen for the optimal first split. Therefore, the decision tree was built using values maximizing G2 and LogWorth. After the tree was built, the correspondence between inputs and outcomes was validated. CONCLUSIONS: We developed a machine learning-based tool that is easy to understand and apply. It provides good discrimination in stratifying confirmed and unconfirmed COVID-19 patients with different prognoses in every context. Our tool might allow general practitioners visiting patients at home to decide whether the patient needs to be hospitalized.

Iodine solubility and speciation in glasses.

The study of iodine in glasses and melts is critical in many areas, from geosciences to materials science to waste management. Glasses in the ternary system Na2O-B2O3-SiO2 were studied with the goal of identifying a glass matrix able to dissolve large quantities of this element, and to identify the main parameters affecting the solubility of iodine. Two sets of experiments were carried out: the first one with the aim of determining the solubility limit of iodine, and the second one to identify the structural variations occurring within the glass network upon iodine incorporation, and to identify the parameters influencing the most both iodine solubility and speciation. We demonstrated that there is a strong dependence of iodine incorporation on bulk chemistry and glass physical properties. A solubility limit of ~5 mol% I has been assessed for B2O3-rich glasses and of ~1 mol% for SiO2-rich ones, and this composition dependence has been explained by considering the fragility parameter of the glass network. Structural variations in the iodine local environment and in the glass network were characterized by Raman, X-ray Absorption Spectroscopy, and 11B NMR. Spectroscopy data point out the coexistence of different I species within the glasses, with iodide being the predominant one, surrounded by Na+ ions.

Combined Differential scanning calorimetry, Raman and Brillouin spectroscopies: A multiscale approach for materials investigation.

A new experimental setup combining DSC, Raman and Brillouin spectroscopies was developed. In order to estimate its accuracy and stability a study of silicon and the alpha-beta quartz phase transition were performed. The data obtained demonstrated good agreement with previous studies using these three different techniques. For quartz, the temperature behavior of its 147 cm-1 Raman mode was studied in detail. Using a two-phonon coupling treatment of the Raman band, we show for the first time that its behavior can be well described by Landau theory of first-order phase transitions. The combined DSC-Raman-Brillouin technique is a powerful tool for material science capable of studying thermal, structural and elastic properties simultaneously.

IGF-1 abuse in sport: clinical and medico-legal aspects.

The frequent revisions of prohibited substances list established by WADA are aimed at keeping up with those drugs that, being increasingly used in medicine and in sports, play on one side a therapeutic role and, on the other, a doping role. Among the various hormone substances widely used in sports, the authors draw particular attention on IGF-1, a growth factor that is rapidly widespreading among athletes. Moreover, IGF-1 diffusion is not exclusively correlated with the doping phenomenon, being various the pathological conditions that may require the therapeutic use of this substance. As a consequence, during pathologies or medical treatments of various nature, the athletes should be informed of the IGF-1 administration because, if they are not duly apprised, they risk undergoing unjust sanctions from the competent authority. In fact, the athlete is given the possibility of communicating, before using, he is taking a medication of the WADA list for therapeutic reasons by applying for a TUE (Therapeutic Use Exemption). If this application is accepted on certified clinical grounds, the athlete will be allowed to use that substance even during sports competitions. However, the IGF-1 detection in the athlete's body shows, at the present state-of-art, two different problems: the first one has a technical character and concerns the differential diagnosis between the quantity of the physiologically produced substance and the quantity of the exogenously administrated substance; the second problem has an economic character and regards to the high cost of the analysis and, consecutively, the necessity of finding a well-equipped laboratory centre.

[Locally recurrent rectal cancer. Our experience]. / Recidiva locoregionale da cancro del retto operato. Esperienza personale.

The aim of this study was to describe the personal experience in the treatment of 31 patients (19 males, 12 females) with local recurrence following surgery for rectal adenocarcinoma. The exeresis of recurrence was possible in 17 patients (6 Miles, 9 Hartmann, 1 re-resection, 1 transanal resection); of these, only 6 patients reported an improvement of the quality of life. Patients surgically treated and patients with recurrence inoperable and submitted to palliative treatment (colostomy, pain control, radio- and/or chemotherapy) showed similar survival rates.

[Abdominal Wells rectopexy with patch micromesh PTFE (Goretex)]. / Rettopessi per via addominale secondo Wells con patch mycromesh PTFE (Goretex).

The aim of this study is to discuss the surgical treatment of rectal prolapse. The surgical therapy offers many different options. Beginning from 1970 the anterior rectopexy has been considered a technique with good results, also in the elderly patient, when the general conditions allow it. Author's experience concerns the surgical treatment of 4 patients (2 males and 2 females) with complete symptomatic rectal prolapse, treated with anterior access laparotomy with the technique of Wells, leaving 1/3 of anterior rectal wall free from suture. Patients had a regular postoperative course; only in 1 case there was a delay of the canalization. At 1 year after the rectopexy the results are satisfactory, with absence of recurrence and troubles of the evacuation. The high percentage of successes of the anterior rectopexy is founded on: 1) the mobilization of the rectum, complete or only posterior; the rectal vessels must be respected, but there isn't consent on the opportunity of the section of the lateral ligaments. It may cause a denervation of the anorectum with an alteration of the fecal evacuation; and 2) the process of cicatritation by the employment of mesh and PTFE material that fix the rectum to the sacred maintains it as in the desired position.

[Use of prostheses in the treatment of large laparoceles]. / L'impiego di protesi nel trattamento dei grossi laparoceli.

The Authors report a series of 18 cases of large laparoceles treated with the use of Dacron prosthesis which was installed according to Rives' technique. They observed 0% of recurrence, 1 case (5%) of mortality for pulmonary embolism, 3 cases (16%) of pulmonary embolism and 1 case (5%) of surgical wound infection.

[Diaphragmatic hernias due to "strain": apropos a case report]. / Le ernie diaframmatiche "da sforzo": a proposito di un caso osservato.

After a brief report on the pathophysiology of diaphragmatic hernias, the authors describe a case of strain diaphragmatic hernia. Considering the rarity and the difficulty to make an immediate diagnosis of this pathology, the authors stress diagnostic problems of strain chest pain and surgical treatment of strain diaphragmatic hernias.

[Biliary ileus: review of the literature and presentation of 7 cases]. / Ileo biliare: revisione della letteratura e presentazione di 7 casi.

The authors report 7 cases of gallstone ileus out of 452 intestinal obstructions corresponding to an incidence of 0.04%. The late references on the subject show that gallstone ileus is an unusual condition which gives rise to surgical approach problems and operating mortality since it is a typical seniors' disease. Some Authors support the "one stage" repair for cholecystoduodenal fistula and gallstone ileus, whereas others suggest firstly to resolve the gallstone ileus with the enterolithotomy and then to perform the operation for gallstone disease. The authors treated six cases with the enterolithotomy and one case with the "one stage" procedure, both the treatments were successful as all the patients survived even if affected by easily controlled complications.

[Use of fibrin tissue adhesive (Tissucol) in Mallory-Weiss syndrome]. / L'uso del Tissucol nella sindrome di Mallory-Weiss.

The Authors report a case of Mallory-Weiss syndrome satisfactorily treated with Tissucol by endoscopy. Good results are underlined.

Inoculation of guinea pigs with varicella-zoster virus via the respiratory route.

Guinea pigs were inoculated by the respiratory route with wild-type (Cyr) or vaccine (Oka) strain varicella zoster virus (VZV). Wild-type cell-free virus obtained by sonication produced neutralizing antibody responses in steroid-treated animals when given via the intratracheal route, and induced neutralizing antibody as well as a pneumonitis in normal animals when given via the intrabronchial (i.b.) route. A humoral response also followed i.b. instillation of cell-associated wild-type or vaccine strain VZV. Prior i.b. administration of thioglycollate or exposure to hyperoxia altered the number and function of pulmonary macrophages, respectively, but viral susceptibility of the guinea pigs was not enhanced. Both strains of VZV could be isolated from bronchial washings up to 48 hours after i.b. instillation of cell-associated virus, but neither strain was isolated thereafter from cultures of bronchial washings or explanted lung tissues.

Dose-related effect of acetylsalicylic acid on replication of varicella zoster virus in vitro.

Cultivation of human embryonic lung (HEL) cells in media containing acetylsalicylic acid (ASA) at 100 micrograms/ml and maintenance at this level after inoculation with either cell-free varicella zoster virus (VZV) or virus-infected cells resulted in a 2- to 4-fold increase in yields of cell-free virus released by sonication. The degree of enhancement was dependent upon multiplicity of infection and time of harvest. Enhanced viral yields were not consistently accompanied by an increase in the number of infected cells, nor was VZV plaque formation in HEL indicator cells significantly increased in the presence of ASA at 100 micrograms/ml. In the presence of ASA at 500-1000 micrograms/ml, VZV plaque formation was inhibited; this inhibition was partially reversible, depending on concentration and period of exposure to ASA. These findings may bear on the apparent association between ASA ingestion and the development of Reye syndrome after infection with varicella virus.