ReportFlow: an application for EEG visualization and reporting using cloud platform

Background

The cloud is a promising resource for data sharing and computing. It can optimize several legacy processes involving different units of a company or more companies. Recently, cloud technology applications are spreading out in the healthcare setting as well, allowing to cut down costs for physical infrastructures and staff movements. In a public environment the main challenge is to guarantee the patients’ data protection. We describe a cloud-based system, named ReportFlow, developed with the aim to improve the process of reporting and delivering electroencephalograms.

Methods

We illustrate the functioning of this application through a use-case scenario occurring in an Italian hospital, and describe the corresponding key encryption and key management used for data security guarantee. We used the X² test or the unpaired Student t test to perform pre-post comparisons of some indexes, in order to evaluate significant changes after the application of ReportFlow.

Results

The results obtained through the use of ReportFlow show a reduction of the time for exam reporting (t = 19.94; p < 0.001) and for its delivering (t = 14.95; p < 0.001), as well as an increase of the number of neurophysiologic examinations performed (about 20%), guaranteeing data integrity and security. Moreover, 68% of exam reports were delivered completely digitally.

Conclusions

The application resulted to be an optimal solution to optimize the legacy process adopted in this scenario. The comparative pre-post analysis showed promising preliminary results of performance. Future directions will be the creation and release of certificates automatically.

Hippotherapy in neurodevelopmental disorders: a narrative review focusing on cognitive and behavioral outcomes

Hippotherapy (HT) is a rehabilitative tool inducing psychological and motor improvements using human-horse interaction. HT provides sensory stimulation to the rider through the rhythmic and repetitive movements of the horse, facilitating communication between patients and healthcare professionals, favoring the establishment of a therapeutic alliance. The purpose of this review is to evaluate the effects of HT treatment on cognitive-behavioral processes in neurodevelopmental disorders. We screened studies published between 2002 and 2020 on PubMed, Scopus, Cochrane, and Web of Sciences databases. The search combined the following terms: "hippotherapy"; "horseback riding"; "equine-assisted therapy"; "developmental disorder"; "autism spectrum disorder"; "dyspraxia"; "infantile cerebral palsy"; and "attention-deficit/hyperactivity disorder". This review shows that HT can be a valuable tool for the treatment of developmental disorders. The psychological, cognitive and relational areas could benefit from the animal-child interaction to promote child autonomy, self-esteem, self-efficacy and openness to others. Physical, motor and psychosocial benefits were found in adolescents with anxiety and/or depression disorders, in autism spectrum disorders, dyspraxia, as well as in infantile cerebral palsy and attention deficit hyperactivity disorder. HT could be considered an alternative therapeutic tool thanks to the relationship between patient-horse-instructor and to the sensory-motor and cognitive stimulation that enforce learning processes.

Donkey Therapy and Hippotherapy: Two Faces of the Same Coin?

Animal-assisted interventions are considered an innovative rehabilitation approach to improve social, emotional, and physical domains in several diseases. Among such treatments, the equine-assisted activities and therapies have been developed to support the conventional approaches. There is growing evidence on the beneficial effects of hippotherapy, whereas few data are available regarding donkey therapy. Herein, we compare such treatments, hypothesizing their best application field to reach the proper therapeutic outcomes.

Treatment of Periodontal Ligament Stem Cells with MOR and CBD Promotes Cell Survival and Neuronal Differentiation via the PI3K/Akt/mTOR Pathway

Periodontal ligament mesenchymal stem cells (hPDLSCs), as well as all mesenchymal stem cells, show self-renewal, clonogenicity, and multi-tissue differentiation proprieties and can represent a valid support for regenerative medicine. We treated hPDLSCs with a combination of Moringin (MOR) and Cannabidiol (CBD), in order to understand if treatment could improve their survival and their in vitro differentiation capacity. Stem cells survival is fundamental to achieve a successful therapy outcome in the re-implanted tissue of patients. Through NGS transcriptome analysis, we found that combined treatment increased hPDLSCs survival, by inhibition of apoptosis as demonstrated by enhanced expression of anti-apoptotic genes and reduction of pro-apoptotic ones. Moreover, we investigated the possible involvement of PI3K/Akt/mTOR pathway, emphasizing a differential gene expression between treated and untreated cells. Furthermore, hPDLSCs were cultured for 48 h in the presence or absence of CBD and MOR and, after confirming the cellular viability through MTT (3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazoliumbromide) assay, we examined the presence of neuronal markers, through immunofluorescence analysis. We found an increased expression of Nestin and GAP43 (growth associated protein 43) in treated cells. In conclusion, hPDLSCs treated with Moringin and Cannabidiol showed an improved survival capacity and neuronal differentiation potential.

Arterial stiffness indexes and serum cytokine levels in seronegative spondyloarthritis: relationships between stiffness markers and metabolic and immunoinflammatory variables

OBJECTIVE

The aim of this study was to investigate the relationship between immunoinflammatory markers and indexes of arterial stiffness in patients with seronegative spondyloarthritis (SpA).

METHOD

We enrolled consecutive patients with inflammatory seronegative SpA referred to a rheumatology outpatient clinic. Control subjects were patients admitted in the same period for any cause other than chronic inflammatory disease or acute cardiovascular and cerebrovascular events. Carotid-femoral pulse wave velocity (PWV) was measured and the aortic pressure waveform was used to calculate the augmentation index (Aix). We also evaluated plasma levels of C-reactive protein (CRP), interleukin (IL)-1β, tumour necrosis factor (TNF)-α, and interleukin (IL)-6 as markers of immunoinflammatory activation.

RESULTS

This study enrolled 53 patients with SpA and 55 control subjects. After adjustment for blood glucose, cholesterol, and triglyceride levels, and systolic (SBP) and diastolic blood pressure (DBP), patients with seronegative SpA showed higher mean PWV and Aix compared to controls. Moreover, in patients with seronegative SpA, we observed higher mean plasma levels of IL-6, IL-1β, and TNF-α in subjects with mean PWV > 8 m/s in comparison with those with PWV < 8 m/s. Multivariate analysis revealed a significant association between PWV > 8 m/s and male gender, age, diabetes, hypertension, low density lipoprotein cholesterol (LDL-C) > 120 mg/dL, total cholesterol (TC) > 200 mg/dL, coronary artery disease (CAD), microalbuminuria, carotid plaque, and plasma levels of IL-6, IL-1β, and TNF-α.

CONCLUSIONS

These findings emphasize the role of inflammatory variables and metabolic factors in indexes of high arterial stiffness. Thus, an inflammatory-metabolic background may influence the pathogenesis of increased arterial stiffness in seronegative inflammatory arthritis.

Ischemic stroke in patients with diabetic foot

AIM

The diabetic foot syndrome is the most frequent cause of hospitalization of diabetic patients and one of the economically most demanding complications of diabetes. People with diabetes have been shown to have higher mortality than people without diabetes, but the cerebrovascular risk profile of these patients is not fully evaluated. The aim of our study was to evaluate the possible role of diabetic foot as a cerebrovascular risk marker in type 2 diabetic patients.

METHODS

We enrolled 102 type 2 diabetes patients with diabetic foot and 123 diabetic patients without diabetic foot.

RESULTS

Statistically significant differences were found in the distribution of the main cardiovascular risk factors with exception of hypertension. We observed a higher prevalence of previous cerebrovascular events (transient ischemic attack, ischemic stroke) and of incidence of new onset cerebrovascular events at a 5-year follow-up. Regarding clinical subtype of ischemic stroke classified according to Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification on a retrospective and prospective basis, we observed a higher prevalence of both the lacunar and large artery atherosclerosis subtype with a slight higher prevalence of lacunar subtype in patients with diabetic foot.

CONCLUSION

Our results show a worse cerebrovascular risk profile in diabetic patients with diabetic foot than in diabetic subjects without foot ulceration with a higher prevalence of cardiovascular risk factors and of anamnestic cerebrovascular events and incidence of new cerebrovascular events at a 5-year follow-up.

Efficacy evaluation of prostaglandin E1 against placebo in patients with progressive systemic sclerosis and significant Raynaud's phenomenon

BACKGROUND

Raynaud's phenomenon, due to connective tissue diseases, is difficult to treat successfully. Symptomatic improvement has been reported using nifedipine or iloprost, but adverse side effects may limit their use. The purpose of this study was to examine the effects of PGE1 (Alprostadil) in patients with scleroderma and severe Raynaud's disease.

METHODS

Twelve females, aged 50-67 years, were included in the study with six of them receiving a 3-hour infusion of alprostadil at the standard dosage of 60 micrograms in 250 cc of physiological infusion for six consecutive days and the remaining six receiving placebo (250 cc of physiological infusion administered in the same manner).

RESULTS

After infusion, blood flow, digitally measured by telethermography was increased only in patients treated with alprostadil. The number, frequency and severity of attacks recorded were reduced only in patients treated with alprostadil. No side effects were recorded during and after the infusion.

CONCLUSION

In conclusion, alprostadil is effective in the management of Raynaud's phenomenon, due to scleroderma.