Correction to: Using sentiment analysis to evaluate the impact of the COVID-19 outbreak on Italy's country reputation and stock market performance

[This corrects the article DOI: 10.1007/s10260-023-00690-5.].

Using sentiment analysis to evaluate the impact of the COVID-19 outbreak on Italy's country reputation and stock market performance

During the recent Coronavirus disease 2019 (COVID-19) outbreak, the microblogging service Twitter has been widely used to share opinions and reactions to events. Italy was one of the first European countries to be severely affected by the outbreak and to establish lockdown and stay-at-home orders, potentially leading to country reputation damage. We resort to sentiment analysis to investigate changes in opinions about Italy reported on Twitter before and after the COVID-19 outbreak. Using different lexicons-based methods, we find a breakpoint corresponding to the date of the first established case of COVID-19 in Italy that causes a relevant change in sentiment scores used as a proxy of the country's reputation. Next, we demonstrate that sentiment scores about Italy are associated with the values of the FTSE-MIB index, the Italian Stock Exchange main index, as they serve as early detection signals of changes in the values of FTSE-MIB. Lastly, we evaluate whether different machine learning classifiers were able to determine the polarity of tweets posted before and after the outbreak with a different level of accuracy.

Threshold-based Naïve Bayes classifier

The Threshold-based Naïve Bayes (Tb-NB) classifier is introduced as a (simple) improved version of the original Naïve Bayes classifier. Tb-NB extracts the sentiment from a Natural Language text corpus and allows the user not only to predict how much a sentence is positive (negative) but also to quantify a sentiment with a numeric value. It is based on the estimation of a single threshold value that concurs to define a decision rule that classifies a text into a positive (negative) opinion based on its content. One of the main advantage deriving from Tb-NB is the possibility to utilize its results as the input of post-hoc analysis aimed at observing how the quality associated to the different dimensions of a product or a service or, in a mirrored fashion, the different dimensions of customer satisfaction evolve in time or change with respect to different locations. The effectiveness of Tb-NB is evaluated analyzing data concerning the tourism industry and, specifically, hotel guests’ reviews from all hotels located in the Sardinian region and available on Booking.com. Moreover, Tb-NB is compared with other popular classifiers used in sentiment analysis in terms of model accuracy, resistance to noise and computational efficiency.

Cost-Utility Analysis of Pharmacogenetic Testing Based on CYP2C19 or CYP2D6 in Major Depressive Disorder: Assessing the Drivers of Different Cost-Effectiveness Levels from an Italian Societal Perspective

Background and Objectives

Major depressive disorder (MDD) is a common and severe psychiatric disorder that has enormous economical and societal costs. As pharmacogenetics is one of the key tools of precision psychiatry, we analyze the cost–utility of test screening of CYP2C19 and CYP2D6 for patients suffering from major depressive disorder (MDD) and try to understand the main drivers that influence the cost–utility.

Methods

We developed two pharmacoeconomic nonhomogeneous Markov models to test the cost–utility, from an Italian societal perspective, of pharmacogenetic testing genetic to characterize the metabolizing profiles of cytochrome P450 (CYP) 2C19 and CYP2D6 in a hypothetical case study of patients suffering from major depressive disorder (MDD). The model considers different scenarios of adjustment of antidepressant treatment according to the patient’s metabolizing profile or treatment over a period of 18 weeks. The uncertainty of model parameters is tested through both a probabilistic sensitivity analysis and a one-way deterministic sensitivity analysis, and these results are used in a post-hoc analysis to understand the main drivers of three alternative cost-effectiveness levels (“poor,” “standard,” and “high”). These drivers are first evaluated from an exploratory multidimensional perspective and next from a predictive perspective as the probability that a patient belongs to a specific cost-effectiveness level is estimated on the basis of a restricted set of parameters used in the original pharmacoeconomic model.

Results

The models for CYP2C19 and CYP2D6 indicate that screening has an incremental cost-effectiveness ratio of 60,000€ and 47,000€ per quality-adjusted life year (QALY), respectively. The probabilistic sensitivity analysis shows that the treatments are cost-effective for a 75,000€ willingness to pay (WTP) threshold in 58% and 63% of the Monte Carlo replications, respectively. The post-hoc analysis highlights the factors that allow us to clearly discriminates poor cost-effectiveness from high cost-effectiveness scenarios and demonstrates that it is possible to predict with reasonable accuracy the cost-effectiveness of a genetic test and the associated therapeutic pattern.

Conclusions

Our findings suggest that screenings for both CYP2C19 and CYP2D6 enzymes for patients with MDD are cost-effective for a WTP threshold of 75,000€ per QALY, and provide relevant suggestions about the most important aspects to be further explored in clinical studies aimed at addressing the cost-effectiveness of genetic testing for patients diagnosed with MDD.

Protocol for a pharmacogenetic study of antidepressants: characterization of drug-metabolizing profiles of cytochromes CYP2D6 and CYP2C19 in a Sardinian population of patients with major depressive disorder

The effectiveness of antidepressants shows high interindividual variability ranging from full symptomatologic remission to treatment-resistant depression. Many factors can determine the variation in the clinical response, but a fundamental role is played by genetic variation within the genes encoding for the enzymes most involved in the metabolism of antidepressant drugs: the CYP2D6 and CYP2C19 isoforms of the cytochrome P450 system. This study is poised to clarify whether the different metabolizing phenotypes related to CYP2D6 and CYP2C19 could have an impact on the clinical efficacy of antidepressants and whether the frequency of these phenotypes of metabolization shows differences in the population of Sardinian patients compared to other Caucasian populations. The sample is being recruited from patients followed-up and treated at the Psychiatric Unit of the Department of Medical Science and Public Health, University of Cagliari and the University Hospital Agency of Cagliari (Italy). The study design includes three approaches: (1) a pharmacogenetic analysis of 80 patients diagnosed with MDD resistant to antidepressant treatment compared to 80 clinically responsive or remitted patients; (2) a prospective arm (N = 30) of the study where we will test the impact of genetic variation within the CYP2D6 and CYP2C19 genes on clinical response to antidepressants and on their serum levels and (3) the assessment of the socio-economic impact of antidepressant therapies, and estimation of the cost-effectiveness of the pharmacogenetic test based on CYP genes.

Reliability and reproducibility of the new AO/OTA 2018 classification system for proximal humeral fractures: a comparison of three different classification systems

Background

The classification systems for proximal humeral fractures routinely used in clinical practice include the Neer and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 2007 systems. Currently used systems have low inter- and intraobserver reliability. In 2018, AO/OTA introduced a new classification system with the aim of simplifying the coding process, in which the Neer four-part classification was integrated into the fracture description. The aim of the present work is to assess the inter- and intraobserver agreement of the new AO/OTA 2018 compared with the Neer and AO/OTA 2007 classifications.

Materials and methods

A total of 116 radiographs of consecutive patients with proximal humeral fracture were selected and classified by three observers with different levels of experience. All three observers independently reviewed and classified the images according to the Neer, AO/OTA 2007, and new AO/OTA 2018 systems. To determine the intraobserver agreement, the observers reviewed the same set of radiographs after an interval of 8 weeks. The inter- and intraobserver agreement were determined through Cohen’s kappa coefficient analysis.

Results

The new AO/OTA 2018 classification showed substantial mean inter- (k = 0.67) and intraobserver (k = 0.75) agreement. These results are similar to the reliability observed for the Neer classification (interobserver, k = 0.67; intraobserver, k = 0.85) but better than those found for the AO/OTA 2007 system, which showed only moderate inter- (k = 0.57) and intraobserver (k = 0.58) agreement. The two more experienced observers showed better overall agreement, but no statistically significant difference was found. No differences were found between surgical experience and agreement regarding specific fracture types or groups.

Conclusions

The results showed that the Neer system still represents the more reliable and reproducible classification. However, the new AO/OTA 2018 classification improved the agreement among observers compared with the AO/OTA 2007 system, while still maintaining substantial descriptive power and simplifying the coding process. The universal modifiers and qualifications, despite their possible complexity, allowed a more comprehensive fracture definition without negatively affecting the reliability or reproducibility of the classification system.

Level of evidence: Level III, diagnostic studies

Sexual disability in patients with chronic non-specific low back pain-a multicenter retrospective analysis

[Purpose] Oswestry Disability Index includes an item (Oswestry Disability Index-8) aiming to assess sexual disability associated to low back pain. The aim of this study is to investigate the percentage of participants who answered the Oswestry Disability Index-8, and the relevance and characteristics of sexual disability due to low back pain in Italian patients. [Participants and Methods] Design: multicenter retrospective analysis. Population: six hundred and ninety-seven outpatients with non-specific low back pain. Variables: pain characteristics (amount, localization, and duration of perceived pain), disability, and psychological variables (anxiety, depression, catastrophizing, kinesiophobia, pain acceptance, and pain vigilance and awareness). [Results] Seventy-seven participants (11.05%) did not answer the Oswestry Disability Index-8. The odds of being not responding to the Oswestry Disability Index-8 item appeared related to age (odds=7.50 for over 60), gender (odds=2.65 for females), and marital status (odds=2.33 for not married). Concerning the psychological variables, Activity Avoidance (coefficient=0.071), Depression (coefficient=0.068), and Rumination (coefficient=0.031) showed a positive impact on sexual disability. [Conclusion] In Italian patients, the percentage of not-responding to Oswestry Disability Index-8 was relatively low. In addition, sexual disability was related to depression, activity avoidance, and rumination.

Development of the Italian version of the High-Activity Arthroplasty Score (HAAS-I) following hip and knee total arthroplasty: cross-cultural adaptation, reliability, validity and sensitivity to change

BACKGROUND

The number of physically active individuals who develop knee and hip arthritis and who undergo arthroplasties of these joints ie ever increasing. It has become necessary to develop evaluation scales which address the specific issues raised by such individuals. The High Activity Arthroplasty Score is one such scales, originally developed in English.

METHODS

The HAAS-I was developed by means of forward-backward translation, a final review by an expert committee and a test of the pre-final version to establish its correspondence with the original English version. The psychometric testing included reliability by means of internal consistency (Cronbach's alpha) and test-retest reliability (intraclass correlation coefficients) and construct validity by Pearson's correlations with a pain intensity numerical rating scale (NRS), the Western Ontario and McMaster University index (WOMAC, for THA subjects), the Knee injury and Osteoarthritis Outcome Scale (KOOS; for TKA subjects) and the Short-Form 36 Health Survey (SF-36).

RESULTS

The questionnaire was administered to 67 subjects with THA and 61 with TKA and proved to be acceptable. The questionnaire showed good internal consistency (0.85 for THA and 0.91 for TKA) and a high level of test-retest reliability (ICC = 0.97 with 95% CI 0.95-0.98 for THA; ICC = 0.95 with 95% CI 0.92-0.98 for TKA). There was a moderate correlation between the HAAS-I and NRS (r = - 0.40), there was a high correlation between the HAAS-I and WOMAC (r = - 0.68) and there were moderate to high correlations between the HAAS-I and SF-36 subscales (r = 0.34 to 0.63) for THA. There was a moderate correlation between the HAAS-I and NRS (r = - 0.77); there was a high correlation between the HAAS-I and KOOS subscales (r = - 0.79 to r = - 0.91); and there were low correlations between the HAAS-I and SF-36 subscales (r = 0.01 to 0.29) for TKA.

CONCLUSIONS

The HAAS-I was successfully translated into Italian and proved to have good psychometric properties that replicated the results of existing versions. Its use is recommended for clinical and research purposes.

Reciprocal modulation of circulating CD4+CD25+bright T cells induced by extracorporeal photochemotherapy in cutaneous T-cell lymphoma and chronic graft-versus-host-disease patients

The mechanisms of action of extracorporeal photochemotherapy (ECP) in cutaneous T-cell lymphoma (CTCL) are poorly understood. Recently, ECP has been shown to induce an increase in regulatory T cell (Treg) expression and functional activities in Graft-versus-host-disease (GvHD), whereas no data are available in CTCL patients. The aim of this study is to evaluate whether ECP is able to modulate the expression levels of the circulating CD4+CD25+bright subset in CTCL patients and whether these modifications are related to the disease course. The patient population included 43 CTCL and 15 chronic GvHD patients treated by ECP at our institutions since 1992. The expression of the circulating CD4+CD25+bright subset was analysed at baseline and sequentially during treatment by flow-cytometry. Fifty healthy donors were used as controls. The baseline circulating CD4+CD25+bright percentage values in CTCL (median: 4.3 percent) were similar to those of healthy donors, whereas GvHD showed significantly lower values (median: 1.5 percent; p<0.001). During treatment, CTCL patients were characterised by an early decrease (from 4.3 percent to 2.4 percent median after 6 months). The CD4+CD25+bright decrease was associated to the disease course, as it occurred in 91.3 percent of responding but in only 25 percent of PD patients (p=0.0001). On the other hand, a significant increase of CD4+CD25+bright cells was observed in GvHD. ECP induces a reciprocal modulation of the circulating CD4+CD25+bright cells in CTCL and GvHD, with a downregulation in CTCL potentially associated with the response mechanisms.

Dermal suspension flaps for McKissock's vertical bipedicle flap vs. classical McKissock's technique: comparison of aesthetic results and patient satisfaction

McKissock's vertical bipedicle flaps technique is a common technique used in reduction mammaplasty. This technique includes a well-vascularised dermal-parenchymal pedicle for safe nipple-areola transposition, but it has been criticised as resulting in a flat breast with inadequate projection after long-term follow-up. Various techniques in which dermal suspension flaps are used have demonstrated decreased secondary ptosis. We used a dermal suspension flap technique for the vertical bipedicled flap of the McKissock's breast reduction and compared it with classical McKissock's technique by review of the patient charts, photographic analysis and patient-satisfaction questionnaire. Evaluations and measurements with postoperative photographs for the dermal brassiere group compared with the classical McKissock breasts were found to be statistically different. There were no differences in complication rates and patient satisfaction between the groups. McKissock's technique with dermal suspension flap is an easy and uncomplicated modification that provides additional advantages for prevention of the secondary ptosis of the reduced breasts in the long term.

Evaluation of alloderm and autologous skin in quadriceps muscles of rats for injection laryngoplasty

There are three surgical methods utilized in treating glottic insufficiency: laryngeal framework surgery, reinnervation procedures and injection medialization. The trend towards the use of less invasive procedures led us to focus on injection medialization in this study. The advantages of vocal fold injection are that the procedure requires no external incisions, is easily applicable and can be applied in an office setting. Furthermore, injection medialization is applicable in cases of atrophic vocal fold and vocal fold scarring. In developing injection medialization, laryngologists are in search of an "ideal material" that should be biocompatible and resistant to resorption. In the initial applications of this method, synthetic materials were used. In the past 2 decades, however, researchers have become more and more interested in the advantages of biological materials. In our animal study, we investigated the behavior of AlloDerm and autologous skin injected in the quadriceps muscles of rats. The materials were easily injected. Histopathological and volumetric analyses were done; the rats were sacrificed the 1st day post-injection and subsequently in the 1st, 3rd and 6th months. AlloDerm's absorption levels were generally high, and its inflammation and fibrosis levels were low and medium. In the 6th month, histiocytic foreign body reaction was observed. The mean graft yield was 4.5%. Autologous skin results for inflammation and fibrosis levels were similar to those of AlloDerm. However, no foreign body reaction was observed in AS injected muscle. The graft yield was 74.6%. The growth of keratin cysts had an effect on the results of the graft yield.