Introduction
Bipolar Disorder (BD) is a life-course illness with evidence of a progressive nature. Although different staging models have been proposed from a theoretical perspective,longitudinal ...studies are scarce.
Objectives
The aim of the present study was to apply four staging models in a sample of BD patients and to observe their progression in 10 years of retrospective evaluation.
Methods
In a naturalistic sample of 100 BD patients, a retrospective assessment of clinical stages across 10 years of observation at six time points (T0: 2010; T1: 2013; T2: 2015; T3: 2018; T4: 2019; T5:2020) was performed according to the BD staging models (Berk et al., 2007; Kapczinski et al., 2009; Kupka et al., 2012 and Duffy et al., 2014). Socio-demographic and clinical variables were collected and the staging progression across time was analyzed.
Results
A significant progressive staging worsening emerged over 10 years of BD observation for each examined model (p<0.001). Moreover, for all considered staging approaches, stage values were lower over the time points for BD II, lower number of lifetime episodes and hospitalizations (p<0.05). Finally, the stage increase was associated with a lower age at first elevated episode (p<0.05).
Conclusions
Present preliminary results confirm the relevance of illness onset and early intervention in BD, given their role in patients classified into worse clinical staging. There is an emerging need of a standardized universal staging model in order to better characterize BD patients, their treatment and their clinical course.
Disclosure
No significant relationships.
IntroductionThe longitudinal course of bipolar disorder (BD) is related to an active process of neuroprogression, associated with brain changes and functional impairment (Berk et al., Bipolar Disord ...2014; 16(5):471-7). Several clinical factors may influence illness trajectories, including the number of episodes and hospitalizations, the presence of comorbidities, stressful life events and familiarity for psychiatric disorders (Post. Braz J Psychiatry 2020;42(5):552-557). Trying to better define such progression, several authors conceptualized different staging models for BD, each one emphasizing different aspects of illness.ObjectivesIn the present study, we focused on the Kupka & Hilleghers staging model, owing to its favorable ratio between the number of classes and transitions (Kupka & Hilleghers. Tijdschr Psychiatr 2012; 54(11):949-956). The aim was to investigate the transition of a sample of 100 BD patients through the different stages of illness across 10 years of observation, analyzing the potential role of clinical variables on the risk of illness progression.MethodsClinical stages of 100 BD patients (53 BDI and 47 BDII) were retrospectively assessed according to the model proposed by Kupka & Hilleghers at four time points: T0 (2010), T1 (2015), T2 (2018) and T3 (2020, at inclusion). Multistate Model using the mstate package in R and Markov model with stratified hazards were used for statistical analysis, to assess transition intensities across illness stages and the potential role of clinical variables on the risk of progression.ResultsA significant stage progression emerged during the observation period (Figure 1). More in detail, high hazard of transition from stage 2 to stage 3 was observed (Figure 2). A significant effect on the transition rate from 3 to 4 was found for higher number of affective episodes lifetime (> 3 episodes) (p=0.03) and for elevated predominant polarity (p=0.01). Overall, the average time subjects spent in stage 0 was 30.8 years and for stage 1 was 0.78 years. After BD onset, patients spent an average of 0.78 years in stage 2, 6.21 years in stage 3 and 2.23 in stage 4.Image:Image 2:ConclusionsPresent preliminary results confirm the progressive nature of the disorder. An increased risk of transition across stages emerged for patients with higher number of episodes lifetime and with elevated predominant polarity, confirming the need of improving timing and accuracy of diagnosis and therapeutic interventions. Further studies are warranted with the aim of define a universal staging model for BD.Disclosure of InterestNone Declared
Abstract
The use of driving-simulator is increasing wide-spreading in the whole automotive sector. The adoption of driving simulator indeed allows evaluating the design choices directly during the ...design stage thought the man-machine interaction, where “man” means the driver while “machine” means the mathematical model of the car traduced to the driver thought a different machine: the driving simulator. In this research activity a questionnaire was developed to evaluate the performances of a driving simulator focusing on two main aspects. The first one regards the ability of the driving simulator to accurately reproduce the driving feelings without inducing motion sickness sensations. The second instead regards the ability of the driver to objectively judge the vehicle performances throughout a set of parameters. All these aspects were firstly numerically investigated implementing different models showing different dynamics characteristics and successively verified by experimental test at the driving simulator. The drivers scores, about both the accuracy of the mathematical model and the driving simulator, were analysed in order to understand if their feelings match the real behaviour imposed to the car.
Non-invasive and simple to measure biomarkers are still an unmet need for myotonic dystrophy type 1 (DM1). Indeed, muscle biopsies can be extremely informative, but their invasive nature limits their ...application. Extracellular microRNAs are emerging humoral biomarkers and preliminary studies identified a group of miRNAs that are deregulated in the plasma or serum of small groups of DM1 patients. Here we adopted very stringent selection and normalization criteria to validate or disprove these miRNAs in 103 DM1 patients and 111 matched controls. We confirmed that 8 miRNAs out of 12 were significantly deregulated in DM1 patients: miR-1, miR-27b, miR-133a, miR-133b, miR-206, miR-140-3p, miR-454 and miR-574. The levels of these miRNAs, alone or in combination, discriminated DM1 from controls significantly, and correlated with both skeletal muscle strength and creatine kinase values. Interestingly, miR-133b levels were significantly higher in DM1 female patients. Finally, the identified miRNAs were also deregulated in the plasma of a small group (n = 30) of DM2 patients. In conclusion, this study proposes that miRNAs might be useful as DM1 humoral biomarkers.
Association between dependence on oxygen therapy (OT) and natural disease progression in people with cystic fibrosis (pwCF) has not been estimated yet. The aim of this study is to understand the ...prognosis for pwCF on OT, evaluating how the transition probabilities from being alive without lung transplantation (LTx) to LTx and to death, and from being alive after LTx to death change in pwCF with and without OT.
We used 2008-2017 data from the 35-country European CF Society Patient Registry. A multi-state model was fitted to assess the effects of individual risk factors on transition probabilities.
We considered 48,343 pwCF aged from 6 to 50 years. OT (HR 5.78, 95% CI: 5.32-6.29) and abnormal FEV
(HR 6.41, 95% CI: 5.28-7.79) were strongly associated with the probability of having LTx; chronic infection with
complex (HR 3.19, 95% CI: 2.78-3.67), abnormal FEV
(HR 5.00, 95% CI: 4.11-6.08) and the need for OT (HR 4.32, 95% CI: 3.93-4.76) showed the greatest association with the probability of dying without LTx. Once pwCF received LTx, OT (HR 1.75, 95% CI: 1.41-2.16) and abnormal FEV
(HR 1.63, 95% CI: 1.18-2.25) were the main factors associated with the probability of dying. An association of gross national income with the probability of receiving LTx and with the probability of dying without LTx was also found.
Oxygen therapy is associated with poor survival in pwCF with and without LTx; harmonization of CF care throughout European countries and minimization of the onset of pulmonary gas exchange abnormalities using all available means remains of paramount importance.
The association between dietary patterns and head and neck cancer has rarely been addressed.
We used individual-level pooled data from five case–control studies (2452 cases and 5013 controls) ...participating in the International Head and Neck Cancer Epidemiology consortium. A posteriori dietary patterns were identified through a principal component factor analysis carried out on 24 nutrients derived from study-specific food-frequency questionnaires. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated using unconditional logistic regression models on quintiles of factor scores.
We identified three major dietary patterns named ‘animal products and cereals’, ‘antioxidant vitamins and fiber’, and ‘fats’. The ‘antioxidant vitamins and fiber’ pattern was inversely related to oral and pharyngeal cancer (OR = 0.57, 95% CI 0.43–0.76 for the highest versus the lowest score quintile). The ‘animal products and cereals’ pattern was positively associated with laryngeal cancer (OR = 1.54, 95% CI 1.12–2.11), whereas the ‘fats’ pattern was inversely associated with oral and pharyngeal cancer (OR = 0.78, 95% CI 0.63–0.97) and positively associated with laryngeal cancer (OR = 1.69, 95% CI 1.22–2.34).
These findings suggest that diets rich in animal products, cereals, and fats are positively related to laryngeal cancer, and those rich in fruit and vegetables inversely related to oral and pharyngeal cancer.
Abstract
Explicit simulation is an extensively tool used by automotive designer both for car-performance analysis in standard operating condition and both in drive-simulator, whom exploits the ...computational ability of this codes to operate in real-time. The computational capability of these simulation tools however implies a reduced set of information available in simulation results. Regards automotive sector, with a particular focus on suspension system, the confined number of information in structural terms (states of solicitation on components and constraint) can be a strong limitation in their massive use. In this context, the objective of this activity is to propose a calculation method, as simple as accurate, that foresees to characterize the suspension by an implicit multibody model, and then using the information already available in explicit multibody model (wheel motion and external forces at the contact patch) allows estimating whichever force in all points of the suspension. The results obtained with the proposed method were compared with those outcoming from ADAMS/Car supplying in all cases, good results.
It is debated whether percutaneous revascularization (PCI) of total coronary chronic occlusion (CTO) is superior to optimal medical therapy (OMT) in improving symptoms, left ventricular (LV) function ...and major adverse cardiac/cerebrovascular events (MACCE). Furthermore, CTO-PCI is a challenging technique, with lower success rate than in other settings. A systematic analysis of baseline LV function, infarction extent and ischaemic burden to predict response to revascularization has never been performed.
To establish a CMR protocol to identify patients (pts) who can benefit most from CTO-PCI. Myocardial viability/ischaemia retains high biological plausibility as predictors of response to revascularization. Therefore, baseline viability (necrotic tissue extent, response to inotropic stimulation) and ischaemia (perfusion defect, wall motion abnormality during stress) will be studied as potential predictors of mechanical LV segmental improvement and ischaemic burden reduction in CTO territory (primary endpoint), LV remodelling and global function, Seattle Angina Questionnaire, and MACCE improvement (secondary endpoints) in the follow-up.
Pts with CTO suitable for PCI undergo stress-CMR for viability/ischaemia assessment. Pts with normal LV function undergo adenosine, those with moderately-reduced ejection fraction (EF) and wall motion abnormalities high-dose dobutamine, pts with EF <35% low-dose dobutamine. All pts undergo late gadolinium enhancement and repeat the same scan at 12 ± 3 months, regardless of PCI success or decision for OMT.
A multi-parameter CMR protocol tailored on pts characteristics to study viability/ischaemia could help in identifying responders in terms of LV function, ischaemic burden and clinical outcome among pts suitable for CTO-PCI, improving selection of best candidates to percutaneous revascularization.
•CTO-PCI has not demonstrated a clear benefit as compared to optimal medical therapy.•This is likely related to lack of proper patient selection and CTO-PCI related complications rate.•A Multiparameter CMR assessment of viability/ischaemia will be correlated to mechanical, ischaemic, clinical response to PCI.•The study results may help guide clinical management of patients candidate to CTO-PCI, optimizing the risk-to-benefit ratio.
Purpose
To evaluate the reliability and validity of the Italian version of the Infant-Toddler Meaningful Auditory Integration Scale (I-IT-MAIS), and to assess the normal trajectory of early ...prelingual auditory (EPLAD) development from birth to 24 months in a group of normal-hearing Italian children using the I-IT-MAIS.
Methods
The study consisted of four phases: item generation, reliability analysis, assessment of the normal trajectory for EPLAD, and validity analysis. A group of 120 normal-hearing children and a group of 31 deaf children wearing hearing aids and on a waiting list for cochlear implantation were enrolled. All the parents completed the I-IT-MAIS. Sixty of them completed the I-IT-MAIS twice, 2 weeks apart, for test–retest reliability analysis. The I-IT-MAIS scores were used to assess the normal trajectory of EPLAD development from birth to 24 months in normal-hearing children. For criterion validity analysis, the I-IT-MAIS scores were correlated with production of infant scale evaluation (PRISE) scores in 60 normal-hearing children. For discriminant validity analysis, the I-IT-MAIS scores obtained in normal and deaf children were compared.
Results
Internal consistency of I-IT-MAIS was satisfactory as well as individual item reliability, test–retest reliability, and discriminant validity. EPLAD development in normal-hearing Italian-speaking children was evaluated. As far as the criterion validity of the I-IT-MAIS is concerned, a strong correlation between I-IT-MAIS and PRISE scores was found.
Conclusion
I-IT-MAIS is reliable and valid. Its application is recommended for clinical practice and outcome research.
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