Typology
operator:
and / or
Language
operator:
and / or
Date
operator:
and / or
Rights
operator:
and / or
2023
Journal article
Open Access
GPU accelerated digital twins of the human heart open new routes for cardiovascular research
Viola F., Del Corso G., De Paulis R., Verzicco R.
The recruitment of patients for rare or complex cardiovascular diseases is a bottleneck for clinical trials and digital twins of the human heart have recently been proposed as a viable alternative. In this paper we present an unprecedented cardiovascular computer model which, relying on the latest GPU-acceleration technologies, replicates the full multi-physics dynamics of the human heart within a few hours per heartbeat. This opens the way to extensive simulation campaigns to study the response of synthetic cohorts of patients to cardiovascular disorders, novel prosthetic devices or surgical procedures. As a proof-of-concept we show the results obtained for left bundle branch block disorder and the subsequent cardiac resynchronization obtained by pacemaker implantation. The in-silico results closely match those obtained in clinical practice, confirming the reliability of the method. This innovative approach makes possible a systematic use of digital twins in cardiovascular research, thus reducing the need of real patients with their economical and ethical implications. This study is a major step towards in-silico clinical trials in the era of digital medicine.Source: SCIENTIFIC REPORTS, vol. 13
DOI: 10.1038/s41598-023-34098-8
Metrics:
Viola F., Del Corso G., De Paulis R., Verzicco R.
The recruitment of patients for rare or complex cardiovascular diseases is a bottleneck for clinical trials and digital twins of the human heart have recently been proposed as a viable alternative. In this paper we present an unprecedented cardiovascular computer model which, relying on the latest GPU-acceleration technologies, replicates the full multi-physics dynamics of the human heart within a few hours per heartbeat. This opens the way to extensive simulation campaigns to study the response of synthetic cohorts of patients to cardiovascular disorders, novel prosthetic devices or surgical procedures. As a proof-of-concept we show the results obtained for left bundle branch block disorder and the subsequent cardiac resynchronization obtained by pacemaker implantation. The in-silico results closely match those obtained in clinical practice, confirming the reliability of the method. This innovative approach makes possible a systematic use of digital twins in cardiovascular research, thus reducing the need of real patients with their economical and ethical implications. This study is a major step towards in-silico clinical trials in the era of digital medicine.Source: SCIENTIFIC REPORTS, vol. 13
DOI: 10.1038/s41598-023-34098-8
Metrics:
See at:
CNR IRIS 
| ISTI Repository | www.nature.com | CNR IRIS 
2023
Journal article
Open Access
Six-food elimination diet is less effective during pollen season in adults with eosinophilic esophagitis sensitized to pollens
Visaggi P, Savarino E, Del Corso G, Hunter H, Baiano Svizzero F, Till Sj, Jason D, Wong T, De Bortoli N, Zeki S
The role of inhaled and swallowed aeroallergens in treatment outcomes of adult patients with eosinophilic esophagitis (EoE) is unclear. We hypothesized that the pollen season contributes to the failure of the 6-food elimination diet (SFED) in EoE. We compared outcomes of patients with EoE who underwent SFED during vs outside of the pollen season. Consecutive adult patients with EoE who underwent SFED and skin prick test (SPT) for birch and grass pollen were included. Individual pollen sensitization and pollen count data were analyzed to define whether each patient had been assessed during or outside of the pollen season after SFED. All patients had active EoE (>=15 eosinophils/high-power field) before SFED and adhered to the diet under the supervision of a dietitian. Fifty-eight patients were included, 62.0% had positive SPT for birch and/or grass, whereas 37.9% had negative SPT. Overall, SFED response was 56.9% (95% confidence interval, 44.1%-68.8%). When stratifying response according to whether the assessment had been performed during or outside of the pollen season, patients sensitized to pollens showed significantly lower response to SFED during compared with outside of the pollen season (21.4% vs 77.3%; P = 0.003). In addition, during the pollen season, patients with pollen sensitization had significantly lower response to SFED compared with those without sensitization (21.4% vs 77.8%; P = 0.01). Pollens may have a role in sustaining esophageal eosinophilia in sensitized adults with EoE despite avoidance of trigger foods. The SPT for pollens may identify patients less likely to respond to the diet during the pollen season.Source: THE AMERICAN JOURNAL OF GASTROENTEROLOGY
DOI: 10.14309/ajg.0000000000002357
Metrics:
Visaggi P, Savarino E, Del Corso G, Hunter H, Baiano Svizzero F, Till Sj, Jason D, Wong T, De Bortoli N, Zeki S
The role of inhaled and swallowed aeroallergens in treatment outcomes of adult patients with eosinophilic esophagitis (EoE) is unclear. We hypothesized that the pollen season contributes to the failure of the 6-food elimination diet (SFED) in EoE. We compared outcomes of patients with EoE who underwent SFED during vs outside of the pollen season. Consecutive adult patients with EoE who underwent SFED and skin prick test (SPT) for birch and grass pollen were included. Individual pollen sensitization and pollen count data were analyzed to define whether each patient had been assessed during or outside of the pollen season after SFED. All patients had active EoE (>=15 eosinophils/high-power field) before SFED and adhered to the diet under the supervision of a dietitian. Fifty-eight patients were included, 62.0% had positive SPT for birch and/or grass, whereas 37.9% had negative SPT. Overall, SFED response was 56.9% (95% confidence interval, 44.1%-68.8%). When stratifying response according to whether the assessment had been performed during or outside of the pollen season, patients sensitized to pollens showed significantly lower response to SFED during compared with outside of the pollen season (21.4% vs 77.3%; P = 0.003). In addition, during the pollen season, patients with pollen sensitization had significantly lower response to SFED compared with those without sensitization (21.4% vs 77.8%; P = 0.01). Pollens may have a role in sustaining esophageal eosinophilia in sensitized adults with EoE despite avoidance of trigger foods. The SPT for pollens may identify patients less likely to respond to the diet during the pollen season.Source: THE AMERICAN JOURNAL OF GASTROENTEROLOGY
DOI: 10.14309/ajg.0000000000002357
Metrics:
See at:
CNR IRIS | journals.lww.com | CNR IRIS
2023
Journal article
Restricted
Comparison of drugs for active eosinophilic oesophagitis: systematic review and network meta-analysis
Visaggi P, Barberio B, Del Corso G, De Bortoli N, Black Kj, Ford Ac Savarino E
Background: There is currently no recommendation regarding preferred drugs for active eosinophilic oesophagitis (EoE) because their relative efficacy is unclear. We conducted an up-to-date network meta-analysis to compare proton pump inhibitors, off-label and EoE-specific topical steroids, and biologics in EoE. Methods: We searched MEDLINE, Embase, Embase Classic and the Cochrane Central Register of Controlled Trials from inception to June 2023. We included randomised controlled trials (RCTs) comparing efficacy of all drugs versus each other, or placebo, in adults and adolescents with active EoE. Results were reported as pooled relative risks with 95% CIs to summarise effect of each comparison tested, with drugs ranked according to P score Results: Seventeen RCTs were eligible for systematic review. Of these, 15 studies containing 1813 subjects with EoE reported extractable data for the network meta-analysis. For histological remission defined as <=6 eosinophils/high-power field (HPF), lirentelimab 1 mg/kg monthly ranked first. For histological remission defined as <=15 eosinophils/HPF, budesonide orally disintegrating tablet (BOT) 1 mg two times per day ranked first. For failure to achieve symptom improvement, BOT 1 mg two times per day and budesonide oral suspension (BOS) 2 mg two times per day were significantly more efficacious than placebo. For failure to achieve endoscopic improvement based on the EoE Endoscopic Reference Score, BOT 1 mg two times per day and BOS 1 mg two times per day or 2 mg two times per day were significantly more efficacious than placebo. Conclusions: Although this network meta-analysis supports the efficacy of most available drugs over placebo for EoE treatment, significant heterogeneity in eligibility criteria and outcome measures among available trials hampers the establishment of a solid therapeutic hierarchy.Source: GUT, vol. 72 (issue 11), pp. 2019-2030
DOI: 10.1136/gutjnl-2023-329873
Metrics:
Visaggi P, Barberio B, Del Corso G, De Bortoli N, Black Kj, Ford Ac Savarino E
Background: There is currently no recommendation regarding preferred drugs for active eosinophilic oesophagitis (EoE) because their relative efficacy is unclear. We conducted an up-to-date network meta-analysis to compare proton pump inhibitors, off-label and EoE-specific topical steroids, and biologics in EoE. Methods: We searched MEDLINE, Embase, Embase Classic and the Cochrane Central Register of Controlled Trials from inception to June 2023. We included randomised controlled trials (RCTs) comparing efficacy of all drugs versus each other, or placebo, in adults and adolescents with active EoE. Results were reported as pooled relative risks with 95% CIs to summarise effect of each comparison tested, with drugs ranked according to P score Results: Seventeen RCTs were eligible for systematic review. Of these, 15 studies containing 1813 subjects with EoE reported extractable data for the network meta-analysis. For histological remission defined as <=6 eosinophils/high-power field (HPF), lirentelimab 1 mg/kg monthly ranked first. For histological remission defined as <=15 eosinophils/HPF, budesonide orally disintegrating tablet (BOT) 1 mg two times per day ranked first. For failure to achieve symptom improvement, BOT 1 mg two times per day and budesonide oral suspension (BOS) 2 mg two times per day were significantly more efficacious than placebo. For failure to achieve endoscopic improvement based on the EoE Endoscopic Reference Score, BOT 1 mg two times per day and BOS 1 mg two times per day or 2 mg two times per day were significantly more efficacious than placebo. Conclusions: Although this network meta-analysis supports the efficacy of most available drugs over placebo for EoE treatment, significant heterogeneity in eligibility criteria and outcome measures among available trials hampers the establishment of a solid therapeutic hierarchy.Source: GUT, vol. 72 (issue 11), pp. 2019-2030
DOI: 10.1136/gutjnl-2023-329873
Metrics:
See at:
Gut | gut.bmj.com | CNR IRIS | CNR IRIS | Gut
2021
Journal article
Open Access
On the electrophysiology of the atrial fast conduction system: an uncertain quantification study
Del Corso Giulio, Verzicco Roberto, Viola Francesco
Cardiac modeling entails the epistemic uncertainty of the input parameters, such as bundles and chambers geometry, electrical conductivities and cell parameters, thus calling for an uncertainty quantification (UQ) analysis. Since the cardiac activation and the subsequent muscular contraction is provided by a complex electrophysiology system made of interconnected conductive media, we focus here on the fast conductivity structures of the atria (internodal pathways) with the aim of identifying which of the uncertain inputs mostly influence the propagation of the depolarization front. Firstly, the distributions of the input parameters are calibrated using data available from the literature taking into account gender differences. The output quantities of interest (QoIs) of medical relevance are defined and a set of metamodels (one for each QoI) is then trained according to a polynomial chaos expansion (PCE) in order to run a global sensitivity analysis with non-linear variance-based Sobol' indices with confidence intervals evaluated through the bootstrap method. The most sensitive parameters on each QoI are then identified for both genders showing the same order of importance of the model inputs on the electrical activation. Lastly, the probability distributions of the QoIs are obtained through a forward sensitivity analysis using the same trained metamodels. It results that several input parameters-including the position of the internodal pathways and the electrical impulse applied at the sinoatrial node-have a little influence on the QoIs studied. Vice-versa the electrical activation of the atrial fast conduction system is sensitive on the bundles geometry and electrical conductivities that need to be carefully measured or calibrated in order for the electrophysiology model to be accurate and predictive.Source: ACTA MECHANICA SINICA, vol. 37 (issue 2), pp. 264-278
DOI: 10.1007/s10409-021-01067-1
Project(s): A commercial intelligence platform to optimise farm productivity
Metrics:
Del Corso Giulio, Verzicco Roberto, Viola Francesco
Cardiac modeling entails the epistemic uncertainty of the input parameters, such as bundles and chambers geometry, electrical conductivities and cell parameters, thus calling for an uncertainty quantification (UQ) analysis. Since the cardiac activation and the subsequent muscular contraction is provided by a complex electrophysiology system made of interconnected conductive media, we focus here on the fast conductivity structures of the atria (internodal pathways) with the aim of identifying which of the uncertain inputs mostly influence the propagation of the depolarization front. Firstly, the distributions of the input parameters are calibrated using data available from the literature taking into account gender differences. The output quantities of interest (QoIs) of medical relevance are defined and a set of metamodels (one for each QoI) is then trained according to a polynomial chaos expansion (PCE) in order to run a global sensitivity analysis with non-linear variance-based Sobol' indices with confidence intervals evaluated through the bootstrap method. The most sensitive parameters on each QoI are then identified for both genders showing the same order of importance of the model inputs on the electrical activation. Lastly, the probability distributions of the QoIs are obtained through a forward sensitivity analysis using the same trained metamodels. It results that several input parameters-including the position of the internodal pathways and the electrical impulse applied at the sinoatrial node-have a little influence on the QoIs studied. Vice-versa the electrical activation of the atrial fast conduction system is sensitive on the bundles geometry and electrical conductivities that need to be carefully measured or calibrated in order for the electrophysiology model to be accurate and predictive.Source: ACTA MECHANICA SINICA, vol. 37 (issue 2), pp. 264-278
DOI: 10.1007/s10409-021-01067-1
Project(s): A commercial intelligence platform to optimise farm productivity
Metrics:
See at:
IRIS Cnr | IRIS Cnr | Acta Mechanica Sinica | Acta Mechanica Sinica | Archivio della Ricerca - Università di Roma Tor vergata | CNR IRIS | Acta Mechanica Sinica
2023
Contribution to journal
Restricted
P132 Six-food elimination diet is less effective during pollen season in adult patients with eosinophilic esophagitis sensitized to pollens
Visaggi P., Savarino E., Del Corso G., Hunter H., Baiano Svizzero F., Dunn J., Wong T., Till S., De Bortoli N., Zeki S.
An abstract is not availableSource: GUT, vol. 72 supplementary 2, pp. 124-125
DOI: 10.1136/gutjnl-2023-bsg.203
Metrics:
Visaggi P., Savarino E., Del Corso G., Hunter H., Baiano Svizzero F., Dunn J., Wong T., Till S., De Bortoli N., Zeki S.
An abstract is not availableSource: GUT, vol. 72 supplementary 2, pp. 124-125
DOI: 10.1136/gutjnl-2023-bsg.203
Metrics:
2022
Journal article
Open Access
A fast computational model for the electrophysiology of the whole human heart
Del Corso G., Verzicco R., Viola F.
In this study we present a novel computational model for unprecedented simulations of the whole cardiac electrophysiology. According to the heterogeneous electrophysiologic properties of the heart, the whole cardiac geometry is decomposed into a set of coupled conductive media having different topology and electrical conductivities: (i) a network of slender bundles comprising a fast conduction atrial network, the AV-node and the ventricular bundles; (ii) the Purkinje network; and (iii) the atrial and ventricular myocardium. The propagation of the action potential in these conductive media is governed by the bidomain/monodomain equations, which are discretized in space using an in- house finite volume method and coupled to three different cell models, the Courtemanche model [1] for the atrial myocytes, the Stewart model [2] for the Purkinje Network and the ten Tusscher-Panfilov model [3] for the ventricular myocytes. The developed numerical model correctly reproduces the cardiac electrophysiology of the whole human heart in healthy and pathologic conditions and it can be tailored to study and optimize resynchronization therapies or invasive surgical procedures. Importantly, the whole solver is GPU-accelerated using CUDA Fortran providing an unprecedented speedup, thus opening the way for systematic parametric studies and uncertainty quantification analyses. (c) 2022 Elsevier Inc. All rights reserved.Source: JOURNAL OF COMPUTATIONAL PHYSICS, vol. 457
DOI: 10.1016/j.jcp.2022.111084
DOI: 10.2139/ssrn.3977804
DOI: 10.48550/arxiv.2112.12854
Metrics:
Del Corso G., Verzicco R., Viola F.
In this study we present a novel computational model for unprecedented simulations of the whole cardiac electrophysiology. According to the heterogeneous electrophysiologic properties of the heart, the whole cardiac geometry is decomposed into a set of coupled conductive media having different topology and electrical conductivities: (i) a network of slender bundles comprising a fast conduction atrial network, the AV-node and the ventricular bundles; (ii) the Purkinje network; and (iii) the atrial and ventricular myocardium. The propagation of the action potential in these conductive media is governed by the bidomain/monodomain equations, which are discretized in space using an in- house finite volume method and coupled to three different cell models, the Courtemanche model [1] for the atrial myocytes, the Stewart model [2] for the Purkinje Network and the ten Tusscher-Panfilov model [3] for the ventricular myocytes. The developed numerical model correctly reproduces the cardiac electrophysiology of the whole human heart in healthy and pathologic conditions and it can be tailored to study and optimize resynchronization therapies or invasive surgical procedures. Importantly, the whole solver is GPU-accelerated using CUDA Fortran providing an unprecedented speedup, thus opening the way for systematic parametric studies and uncertainty quantification analyses. (c) 2022 Elsevier Inc. All rights reserved.Source: JOURNAL OF COMPUTATIONAL PHYSICS, vol. 457
DOI: 10.1016/j.jcp.2022.111084
DOI: 10.2139/ssrn.3977804
DOI: 10.48550/arxiv.2112.12854
Metrics:
See at:
arXiv.org e-Print Archive | Journal of Computational Physics | Journal of Computational Physics | Journal of Computational Physics | IRIS Cnr | SSRN Electronic Journal | doi.org | Archivio della Ricerca - Università di Roma Tor vergata | IRIS Cnr | Archivio della Ricerca - Università di Roma Tor vergata | CNR IRIS
2024
Journal article
Embargo
Adaptive behaviors, esophageal anxiety and hypervigilance modify the association between dysphagia perception and histological disease activity in eosinophilic esophagitis
Visaggi P., Del Corso G., Solinas I., Ovidi F., Adamo G., Dulmin I., Baiano Svizzero F., Bellini M., Savarino E. V., De Bortoli N.
Background aims: Esophageal symptom-specific anxiety, hypervigilance, and adaptive behaviors at mealtime may affect dysphagia reporting in patients with eosinophilic esophagitis (EoE) but this has not been investigated. Moreover, the relationship between such confounding factors and histological disease activity (HDA) is unclear. Methods: This was a prospective study on adults with EoE. Dysphagia, anxiety, and hypervigilance were assessed using specific questionnaires (i.e., mDSQ, DSS, and EHAS). Adaptive behaviors were assessed using the Pisa EoE Adaptation Questionnaire. Appropriate statistics was used to investigate correlation between dysphagia, anxiety, hypervigilance, adaptive behaviors and HDA. Results: Ninety-five patients were included. Esophageal anxiety, hypervigilance, and use of adaptive behaviors were found in about 50% of EoE patients. Esophageal anxiety and hypervigilance were significantly higher (p=0.03 for both) and adaptive behaviors were significantly more prevalent in histologically active EoE compared to EoE in remission (76.8% vs 25.6%, p<0.001). As a standalone measurement, mDSQ and DSS had AUROC of 77.7% and 75.3% for predicting HDA. Adjustments of mDSQ and DSS based on individual EHAS scores and adaptive behaviors at mealtime significantly improved the AUROC of mDSQ and DSS to 86.6% and 84.3%, respectively (p<0.05 for both). Conclusions: Higher esophageal anxiety, hypervigilance and use of adaptive behaviors are associated with active EoE and represent clinical markers of HDA. Adaptive behaviours provide complementary clinical information that is not detected by symptoms alone. The assessment of anxiety, hypervigilance, and adaptive behaviors improves the correlation between clinical and HDA in EoE.Source: THE AMERICAN JOURNAL OF GASTROENTEROLOGY
DOI: 10.14309/ajg.0000000000003272
Metrics:
Visaggi P., Del Corso G., Solinas I., Ovidi F., Adamo G., Dulmin I., Baiano Svizzero F., Bellini M., Savarino E. V., De Bortoli N.
Background aims: Esophageal symptom-specific anxiety, hypervigilance, and adaptive behaviors at mealtime may affect dysphagia reporting in patients with eosinophilic esophagitis (EoE) but this has not been investigated. Moreover, the relationship between such confounding factors and histological disease activity (HDA) is unclear. Methods: This was a prospective study on adults with EoE. Dysphagia, anxiety, and hypervigilance were assessed using specific questionnaires (i.e., mDSQ, DSS, and EHAS). Adaptive behaviors were assessed using the Pisa EoE Adaptation Questionnaire. Appropriate statistics was used to investigate correlation between dysphagia, anxiety, hypervigilance, adaptive behaviors and HDA. Results: Ninety-five patients were included. Esophageal anxiety, hypervigilance, and use of adaptive behaviors were found in about 50% of EoE patients. Esophageal anxiety and hypervigilance were significantly higher (p=0.03 for both) and adaptive behaviors were significantly more prevalent in histologically active EoE compared to EoE in remission (76.8% vs 25.6%, p<0.001). As a standalone measurement, mDSQ and DSS had AUROC of 77.7% and 75.3% for predicting HDA. Adjustments of mDSQ and DSS based on individual EHAS scores and adaptive behaviors at mealtime significantly improved the AUROC of mDSQ and DSS to 86.6% and 84.3%, respectively (p<0.05 for both). Conclusions: Higher esophageal anxiety, hypervigilance and use of adaptive behaviors are associated with active EoE and represent clinical markers of HDA. Adaptive behaviours provide complementary clinical information that is not detected by symptoms alone. The assessment of anxiety, hypervigilance, and adaptive behaviors improves the correlation between clinical and HDA in EoE.Source: THE AMERICAN JOURNAL OF GASTROENTEROLOGY
DOI: 10.14309/ajg.0000000000003272
Metrics:
See at:
The American Journal of Gastroenterology | CNR IRIS | CNR IRIS | journals.lww.com
2020
Journal article
Open Access
Sensitivity analysis of an electrophysiology model for the left ventricle: Sensitivity analysis of an electrophysiology model for the left ventricle
Del Corso G, Verzicco R, Viola F
Modelling the cardiac electrophysiology entails dealing with the uncertainties related to the input parameters such as the heart geometry and the electrical conductivities of the tissues, thus calling for an uncertainty quantification (UQ) of the results. Since the chambers of the heart have different shapes and tissues, in order to make the problem affordable, here we focus on the left ventricle with the aim of identifying which of the uncertain inputs mostly affect its electrophysiology. In a first phase, the uncertainty of the input parameters is evaluated using data available from the literature and the output quantities of interest (QoIs) of the problem are defined. According to the polynomial chaos expansion, a training dataset is then created by sampling the parameter space using a quasi-Monte Carlo method whereas a smaller independent dataset is used for the validation of the resulting metamodel. The latter is exploited to run a global sensitivity analysis with nonlinear variance-based indices and thus reduce the input parameter space accordingly. Thereafter, the uncertainty probability distribution of the QoIs are evaluated using a direct UQ strategy on a larger dataset and the results discussed in the light of the medical knowledge.Source: JOURNAL OF THE ROYAL SOCIETY INTERFACE (PRINT), vol. 17 (issue 171)
DOI: 10.1098/rsif.2020.0532
Metrics:
Del Corso G, Verzicco R, Viola F
Modelling the cardiac electrophysiology entails dealing with the uncertainties related to the input parameters such as the heart geometry and the electrical conductivities of the tissues, thus calling for an uncertainty quantification (UQ) of the results. Since the chambers of the heart have different shapes and tissues, in order to make the problem affordable, here we focus on the left ventricle with the aim of identifying which of the uncertain inputs mostly affect its electrophysiology. In a first phase, the uncertainty of the input parameters is evaluated using data available from the literature and the output quantities of interest (QoIs) of the problem are defined. According to the polynomial chaos expansion, a training dataset is then created by sampling the parameter space using a quasi-Monte Carlo method whereas a smaller independent dataset is used for the validation of the resulting metamodel. The latter is exploited to run a global sensitivity analysis with nonlinear variance-based indices and thus reduce the input parameter space accordingly. Thereafter, the uncertainty probability distribution of the QoIs are evaluated using a direct UQ strategy on a larger dataset and the results discussed in the light of the medical knowledge.Source: JOURNAL OF THE ROYAL SOCIETY INTERFACE (PRINT), vol. 17 (issue 171)
DOI: 10.1098/rsif.2020.0532
Metrics:
See at:
Journal of The Royal Society Interface | Journal of The Royal Society Interface | Journal of The Royal Society Interface | Journal of The Royal Society Interface | Archivio della Ricerca - Università di Roma Tor vergata | CNR IRIS | Archivio della Ricerca - Università di Roma Tor vergata | CNR IRIS | Journal of The Royal Society Interface | royalsocietypublishing.org | Journal of The Royal Society Interface
2023
Journal article
Restricted
Ambulatory pH-impedance findings confirm that grade B esophagitis provides objective diagnosis of gastroesophageal reflux disease
Visaggi P., Del Corso G., Gyawali C. P., Ghisa M., Baiano Svizzero F., Stefani Donati D., Venturini A., Savarino V., Penagini R., Zeki S., Bellini M., Savarino E. V., De Bortoli N.
INTRODUCTION:The Lyon Consensus designates Los Angeles (LA) grade C/D esophagitis or acid exposure time (AET) >6% on impedance-pH monitoring (MII-pH) as conclusive for gastroesophageal reflux disease (GERD). We aimed to evaluate proportions with objective GERD among symptomatic patients with LA grade A, B, and C esophagitis on endoscopy.METHODS:Demographics, clinical data, endoscopy findings, and objective proton-pump inhibitor response were collected from symptomatic prospectively enrolled patients from 2 referral centers. Off-therapy MII-pH parameters included AET, number of reflux episodes, mean nocturnal baseline impedance, and postreflux swallow-induced peristaltic wave index. Objective GERD evidence was compared between LA grades.RESULTS:Of 155 patients (LA grade A: 74 patients, B: 61 patients, and C: 20 patients), demographics and presentation were similar across LA grades. AET >6% was seen in 1.4%, 52.5%, and 75%, respectively, in LA grades A, B, and C. Using additional MII-pH metrics, an additional 16.2% with LA grade A and 47.5% with LA grade B esophagitis had AET 4%-6% with low mean nocturnal baseline impedance and postreflux swallow-induced peristaltic wave index; there were no additional gains using the number of reflux episodes or symptom-reflux association metrics. Compared with LA grade C (100% conclusive GERD based on endoscopic findings), 100% of LA grade B esophagitis also had objective GERD but only 17.6% with LA grade A esophagitis (P < 0.001 compared with each). Proton-pump inhibitor response was comparable between LA grades B and C (74% and 70%, respectively) but low in LA grade A (39%, P < 0.001).DISCUSSION:Grade B esophagitis indicates an objective diagnosis of GERD.Source: THE AMERICAN JOURNAL OF GASTROENTEROLOGY, vol. 118 (issue 5), pp. 794-801
DOI: 10.14309/ajg.0000000000002173
Metrics:
Visaggi P., Del Corso G., Gyawali C. P., Ghisa M., Baiano Svizzero F., Stefani Donati D., Venturini A., Savarino V., Penagini R., Zeki S., Bellini M., Savarino E. V., De Bortoli N.
INTRODUCTION:The Lyon Consensus designates Los Angeles (LA) grade C/D esophagitis or acid exposure time (AET) >6% on impedance-pH monitoring (MII-pH) as conclusive for gastroesophageal reflux disease (GERD). We aimed to evaluate proportions with objective GERD among symptomatic patients with LA grade A, B, and C esophagitis on endoscopy.METHODS:Demographics, clinical data, endoscopy findings, and objective proton-pump inhibitor response were collected from symptomatic prospectively enrolled patients from 2 referral centers. Off-therapy MII-pH parameters included AET, number of reflux episodes, mean nocturnal baseline impedance, and postreflux swallow-induced peristaltic wave index. Objective GERD evidence was compared between LA grades.RESULTS:Of 155 patients (LA grade A: 74 patients, B: 61 patients, and C: 20 patients), demographics and presentation were similar across LA grades. AET >6% was seen in 1.4%, 52.5%, and 75%, respectively, in LA grades A, B, and C. Using additional MII-pH metrics, an additional 16.2% with LA grade A and 47.5% with LA grade B esophagitis had AET 4%-6% with low mean nocturnal baseline impedance and postreflux swallow-induced peristaltic wave index; there were no additional gains using the number of reflux episodes or symptom-reflux association metrics. Compared with LA grade C (100% conclusive GERD based on endoscopic findings), 100% of LA grade B esophagitis also had objective GERD but only 17.6% with LA grade A esophagitis (P < 0.001 compared with each). Proton-pump inhibitor response was comparable between LA grades B and C (74% and 70%, respectively) but low in LA grade A (39%, P < 0.001).DISCUSSION:Grade B esophagitis indicates an objective diagnosis of GERD.Source: THE AMERICAN JOURNAL OF GASTROENTEROLOGY, vol. 118 (issue 5), pp. 794-801
DOI: 10.14309/ajg.0000000000002173
Metrics:
See at:
The American Journal of Gastroenterology | Archivio della Ricerca - Università di Pisa | Archivio istituzionale della ricerca - Università di Padova | IRIS Cnr | CNR IRIS | IRIS Cnr | The American Journal of Gastroenterology
2022
Journal article
Open Access
Improving Pediatric/Neonatology Residents' Newborn Resuscitation Skills With a Digital Serious Game: DIANA
Bardelli S., Del Corso G., Ciantelli M., Del Pistoia M., Lorenzoni F., Fossat N., Scaramuzzo R. T., Cuttano A.
Background:Serious games, and especially digital game based learning (DGBL) methodologies, have the potential to strengthen classic learning methodology in all medical procedures characterized by a flowchart (e.g., neonatal resuscitation algorithm). However, few studies have compared short- and long-term knowledge retention in DGBL methodologies with a control group undergoing specialist training led by experienced operators. In particular, resident doctors' learning still has limited representation in simulation-based education literature. Objective:A serious computer game DIANA (DIgital Application in Newborn Assessment) was developed, according to newborn resuscitation algorithm, to train pediatric/neonatology residents in neonatal resuscitation algorithm knowledge and implementation (from procedure knowledge to ventilation/chest compressions rate). We analyzed user learning curves after each session and compared knowledge retention against a classic theoretical teaching session. Methods:Pediatric/neonatology residents of the Azienda Ospedaliera Universitaria Pisana (AOUP) were invited to take part in the study and were split into a game group or a control group; both groups were homogeneous in terms of previous training and baseline scores. The control group attended a classic 80 min teaching session with a neonatal trainer, while game group participants played four 20 min sessions over four different days. Three written tests (pre/immediately post-training and at 28 days) were used to evaluate and compare the two groups' performances. ResultsForty-eight pediatric/neonatology residents participated in the study. While classic training by a neonatal trainer demonstrated an excellent effectiveness in short/long-term knowledge retention, DGBL methodology proved to be equivalent or better. Furthermore, after each game session, DGBL score improved for both procedure knowledge and ventilation/chest compressions rate. Conclusions:In this study, DGBL was as effective as classic specialist training for neonatal resuscitation in terms of both algorithm memorization and knowledge retention. User appreciation for the methodology and ease of administration, including remotely, support the use of DGBL methodologies for pediatric/neonatology residents education.Source: FRONTIERS IN PEDIATRICS, vol. 10
DOI: 10.3389/fped.2022.842302
Metrics:
Bardelli S., Del Corso G., Ciantelli M., Del Pistoia M., Lorenzoni F., Fossat N., Scaramuzzo R. T., Cuttano A.
Background:Serious games, and especially digital game based learning (DGBL) methodologies, have the potential to strengthen classic learning methodology in all medical procedures characterized by a flowchart (e.g., neonatal resuscitation algorithm). However, few studies have compared short- and long-term knowledge retention in DGBL methodologies with a control group undergoing specialist training led by experienced operators. In particular, resident doctors' learning still has limited representation in simulation-based education literature. Objective:A serious computer game DIANA (DIgital Application in Newborn Assessment) was developed, according to newborn resuscitation algorithm, to train pediatric/neonatology residents in neonatal resuscitation algorithm knowledge and implementation (from procedure knowledge to ventilation/chest compressions rate). We analyzed user learning curves after each session and compared knowledge retention against a classic theoretical teaching session. Methods:Pediatric/neonatology residents of the Azienda Ospedaliera Universitaria Pisana (AOUP) were invited to take part in the study and were split into a game group or a control group; both groups were homogeneous in terms of previous training and baseline scores. The control group attended a classic 80 min teaching session with a neonatal trainer, while game group participants played four 20 min sessions over four different days. Three written tests (pre/immediately post-training and at 28 days) were used to evaluate and compare the two groups' performances. ResultsForty-eight pediatric/neonatology residents participated in the study. While classic training by a neonatal trainer demonstrated an excellent effectiveness in short/long-term knowledge retention, DGBL methodology proved to be equivalent or better. Furthermore, after each game session, DGBL score improved for both procedure knowledge and ventilation/chest compressions rate. Conclusions:In this study, DGBL was as effective as classic specialist training for neonatal resuscitation in terms of both algorithm memorization and knowledge retention. User appreciation for the methodology and ease of administration, including remotely, support the use of DGBL methodologies for pediatric/neonatology residents education.Source: FRONTIERS IN PEDIATRICS, vol. 10
DOI: 10.3389/fped.2022.842302
Metrics:
See at:
Frontiers in Pediatrics | IRIS Cnr | IRIS Cnr | Frontiers in Pediatrics | IRIS Cnr | CNR IRIS
2023
Journal article
Open Access
High-fidelity model of the human heart: an immersed boundary implementation
Viola F., Del Corso G., Verzicco R.
Computer simulations of cardiovascular flows can be key to improving the predictingcapabilities of standard diagnostic tools, to refine surgical techniques and perform virtualtests of innovative prosthetic devices. The reliability of simulations, however, depends onthe fidelity level of the model, which, for the heart, involves the interconnected multi-physics dynamics of the various systems: the human heart is among the most complexorgans, and simulating its dynamics is an ambitious undertaking from both the modelingand computational viewpoints. In this paper we present a multiphysics computationalmodel of the human heart accounting simultaneously for the electrophysiology, the elasto-mechanics, and the hemodynamics, including their multiway coupled interactions referredto as fluid-structure-electro interaction (FSEI). The developed tool embodies accuracy,versatility, and computational efficiency, thus allowing cardiovascular simulations of phys-iologic and pathologic configurations within a time to solution compatible with the clinicalpractice and without resorting to large-scale supercomputers. Results are shown for healthyconditions and for myocardial infarction with the aim of assessing the reliability ofthe model and proving its predicting capabilities, which could be used to anticipate theoutcome of surgical procedures or support clinical decisionsSource: PHYSICAL REVIEW FLUIDS, vol. 8
DOI: 10.1103/physrevfluids.8.100502
Project(s): CARDIOTRIALS
Metrics:
Viola F., Del Corso G., Verzicco R.
Computer simulations of cardiovascular flows can be key to improving the predictingcapabilities of standard diagnostic tools, to refine surgical techniques and perform virtualtests of innovative prosthetic devices. The reliability of simulations, however, depends onthe fidelity level of the model, which, for the heart, involves the interconnected multi-physics dynamics of the various systems: the human heart is among the most complexorgans, and simulating its dynamics is an ambitious undertaking from both the modelingand computational viewpoints. In this paper we present a multiphysics computationalmodel of the human heart accounting simultaneously for the electrophysiology, the elasto-mechanics, and the hemodynamics, including their multiway coupled interactions referredto as fluid-structure-electro interaction (FSEI). The developed tool embodies accuracy,versatility, and computational efficiency, thus allowing cardiovascular simulations of phys-iologic and pathologic configurations within a time to solution compatible with the clinicalpractice and without resorting to large-scale supercomputers. Results are shown for healthyconditions and for myocardial infarction with the aim of assessing the reliability ofthe model and proving its predicting capabilities, which could be used to anticipate theoutcome of surgical procedures or support clinical decisionsSource: PHYSICAL REVIEW FLUIDS, vol. 8
DOI: 10.1103/physrevfluids.8.100502
Project(s): CARDIOTRIALS
Metrics:
See at:
Archivio della Ricerca - Università di Roma Tor vergata | IRIS Cnr | IRIS Cnr | Physical Review Fluids | Physical Review Fluids | Archivio della Ricerca - Università di Roma Tor vergata | CNR IRIS
2023
Contribution to journal
Restricted
938 Impedance-PH findings confirm that Grade B esophagitis provides objective diagnosis of gastroesophageal reflux disease
Visaggi P., Gyawali C. P., Del Corso G., Ghisa M., Baiano Svizzero F., Stefani Donati D., Venturini A., Savarino V., Penagini R., Bellini M., Zeki S., Savarino E. V., De Bortoli N.
An abstract is not availableSource: GASTROENTEROLOGY, vol. 164 (issue 6, Supplement), p. 202
DOI: 10.1016/s0016-5085(23)01446-4
Metrics:
Visaggi P., Gyawali C. P., Del Corso G., Ghisa M., Baiano Svizzero F., Stefani Donati D., Venturini A., Savarino V., Penagini R., Bellini M., Zeki S., Savarino E. V., De Bortoli N.
An abstract is not availableSource: GASTROENTEROLOGY, vol. 164 (issue 6, Supplement), p. 202
DOI: 10.1016/s0016-5085(23)01446-4
Metrics:
2022
Journal article
Restricted
Efficacy of a Second PPI Course After Steroid-Induced Remission in Eosinophilic Esophagitis Refractory to Initial PPI Therapy
Visaggi P., Baiano Svizzero F., Del Corso G., Bellini M., Savarino E., De Bortoli N.
INTRODUCTION:Eosinophilic esophagitis (EoE) requires maintenance therapy to avoid recurrence. We investigated the efficacy of a second course of proton pump inhibitors (scPPIs) to maintain steroid-induced histological remission (HR) in patients with EoE who had previously failed induction of remission with PPIs. METHODS:We retrospectively included 18 patients who achieved HR with topical steroids but could not be maintained on long-term topical steroids. Treatment outcomes were assessed after 12 weeks of scPPIs. RESULTS:Most of the patients (67%) maintained HR with high-dose PPI monotherapy at week 12. DISCUSSION:scPPIs might work as a maintenance strategy in primary PPI nonresponder EoE patients.Source: THE AMERICAN JOURNAL OF GASTROENTEROLOGY, vol. 117 (issue 10), pp. 1702-1705
DOI: 10.14309/ajg.0000000000001943
Metrics:
Visaggi P., Baiano Svizzero F., Del Corso G., Bellini M., Savarino E., De Bortoli N.
INTRODUCTION:Eosinophilic esophagitis (EoE) requires maintenance therapy to avoid recurrence. We investigated the efficacy of a second course of proton pump inhibitors (scPPIs) to maintain steroid-induced histological remission (HR) in patients with EoE who had previously failed induction of remission with PPIs. METHODS:We retrospectively included 18 patients who achieved HR with topical steroids but could not be maintained on long-term topical steroids. Treatment outcomes were assessed after 12 weeks of scPPIs. RESULTS:Most of the patients (67%) maintained HR with high-dose PPI monotherapy at week 12. DISCUSSION:scPPIs might work as a maintenance strategy in primary PPI nonresponder EoE patients.Source: THE AMERICAN JOURNAL OF GASTROENTEROLOGY, vol. 117 (issue 10), pp. 1702-1705
DOI: 10.14309/ajg.0000000000001943
Metrics:
See at:
IRIS Cnr | Archivio della Ricerca - Università di Pisa | Archivio istituzionale della ricerca - Università di Padova | IRIS Cnr | CNR IRIS | IRIS Cnr | The American Journal of Gastroenterology
2023
Contribution to journal
Restricted
Sa1268 Six-food elimination diet is less effective during pollen season in adult patients with eosinophilic esophagitis sensitized to pollens
Visaggi P., Savarino E. V., Del Corso G., Hunter H., Baiano Svizzero F., Dunn J. M., Wong T., De Bortoli N., Zeki S.
An abstract is not availableSource: GASTROENTEROLOGY, vol. 164 (issue 6, Supplement), p. 345
DOI: 10.1016/s0016-5085(23)01801-2
Metrics:
Visaggi P., Savarino E. V., Del Corso G., Hunter H., Baiano Svizzero F., Dunn J. M., Wong T., De Bortoli N., Zeki S.
An abstract is not availableSource: GASTROENTEROLOGY, vol. 164 (issue 6, Supplement), p. 345
DOI: 10.1016/s0016-5085(23)01801-2
Metrics:
See at:
Gastroenterology | IRIS Cnr | CNR IRIS | IRIS Cnr
2024
Journal article
Open Access
Association between Ustekinumab trough levels, Serum IL-22, and Oncostatin M levels and clinical and biochemical outcomes in patients with Crohn’s Disease
Bertin L., Barberio B., Gubbiotti A., Bertani L., Costa F., Ceccarelli L., Visaggi P., Bodini G., Pasta A., Sablich R., Urbano M. T., Ferronato A., Buda A., De Bona M., Del Corso G., Massano G., Angriman I., Scarpa M., Zingone F., Savarino E.
Background: Ustekinumab (UST) has demonstrated effectiveness in treating patients with Crohn's disease. Monitoring treatment response can improve disease management and reduce healthcare costs. We investigated whether UST trough levels (TLs), serum IL22, and Oncostatin M (OSM) levels could be early indicators of non-response by analysing their correlation with clinical and biochemical outcomes in CD. Methods: Patients with CD initiating UST treatment from October 2018 to September 2020 were enrolled at six Italian centres for inflammatory bowel disease (IBD). Clinical and biochemical data were collected at four time points: baseline, second subcutaneous (SC) dose, fourth SC dose, and 52 weeks. TLs were measured during maintenance, at the second SC dose, and at the fourth SC dose. IL-22 and OSM serum levels were assessed at baseline and the second SC dose. We analysed whether TLs, IL22 levels, and OSM serum levels were associated with clinical response, clinical remission, biochemical remission, and endoscopic remission using the appropriate statistical tests. Results: Out of eighty-four initially enrolled patients, five were lost to follow-up, and eleven discontinued the drug before 52 weeks. At the 52-week time point, 47% achieved biochemical remission based on faecal calprotectin levels, and 61.8% achieved clinical remission. TLs at the second SC dose significantly correlated with biochemical remission at the same time point (p = 0.011). However, TLs did not correlate with clinical remission. Baseline OSM levels did not correlate with biochemical or clinical remission or response. IL22 levels notably decreased during UST therapy (p = 0.000), but its values did not correlate with biochemical or clinical remission. Conclusions: UST is an effective therapy for patients with CD. TLs measured at the second SC dose significantly correlated with biochemical remission, emphasising their potential role in treatment monitoring. Levels of OSM and IL-22, despite a significant decrease in the latter during therapy, did not exhibit correlations with clinical or biochemical outcomes in our study. Further studies are needed to confirm these findings.Source: JOURNAL OF CLINICAL MEDICINE, vol. 13 (issue 6)
DOI: 10.3390/jcm13061539
Metrics:
Bertin L., Barberio B., Gubbiotti A., Bertani L., Costa F., Ceccarelli L., Visaggi P., Bodini G., Pasta A., Sablich R., Urbano M. T., Ferronato A., Buda A., De Bona M., Del Corso G., Massano G., Angriman I., Scarpa M., Zingone F., Savarino E.
Background: Ustekinumab (UST) has demonstrated effectiveness in treating patients with Crohn's disease. Monitoring treatment response can improve disease management and reduce healthcare costs. We investigated whether UST trough levels (TLs), serum IL22, and Oncostatin M (OSM) levels could be early indicators of non-response by analysing their correlation with clinical and biochemical outcomes in CD. Methods: Patients with CD initiating UST treatment from October 2018 to September 2020 were enrolled at six Italian centres for inflammatory bowel disease (IBD). Clinical and biochemical data were collected at four time points: baseline, second subcutaneous (SC) dose, fourth SC dose, and 52 weeks. TLs were measured during maintenance, at the second SC dose, and at the fourth SC dose. IL-22 and OSM serum levels were assessed at baseline and the second SC dose. We analysed whether TLs, IL22 levels, and OSM serum levels were associated with clinical response, clinical remission, biochemical remission, and endoscopic remission using the appropriate statistical tests. Results: Out of eighty-four initially enrolled patients, five were lost to follow-up, and eleven discontinued the drug before 52 weeks. At the 52-week time point, 47% achieved biochemical remission based on faecal calprotectin levels, and 61.8% achieved clinical remission. TLs at the second SC dose significantly correlated with biochemical remission at the same time point (p = 0.011). However, TLs did not correlate with clinical remission. Baseline OSM levels did not correlate with biochemical or clinical remission or response. IL22 levels notably decreased during UST therapy (p = 0.000), but its values did not correlate with biochemical or clinical remission. Conclusions: UST is an effective therapy for patients with CD. TLs measured at the second SC dose significantly correlated with biochemical remission, emphasising their potential role in treatment monitoring. Levels of OSM and IL-22, despite a significant decrease in the latter during therapy, did not exhibit correlations with clinical or biochemical outcomes in our study. Further studies are needed to confirm these findings.Source: JOURNAL OF CLINICAL MEDICINE, vol. 13 (issue 6)
DOI: 10.3390/jcm13061539
Metrics:
See at:
Journal of Clinical Medicine | Archivio istituzionale della ricerca - Università di Padova | IRIS Cnr | IRIS Cnr | CNR IRIS
2023
Journal article
Restricted
Artificial Intelligence tools for the diagnosis of eosinophilic esophagitis in adults reporting dysphagia: development, external validation, and software creation for point-of-care use
Visaggi P., Del Corso G., Baiano Svizzero F., Ghisa M., Bardelli S., Venturini A., Stefani Donati D., Barberio B., Marciano E., Bellini M., Dunn J., Wong T., De Bortoli N., Savarino E., Zeki S.
Background: Despite increased awareness of eosinophilic esophagitis (EoE), the diagnostic delay has remained stable over the past 3 decades. There is a need to improve the diagnostic performance and optimize resources allocation in the setting of EoE. Objective: We developed and validated 2 point-of-care machine learning (ML) tools to predict a diagnosis of EoE before histology results during office visits. Methods: We conducted a multicenter study in 3 European tertiary referral centers for EoE. We built predictive ML models using retrospectively extracted clinical and esophagogastroduodenoscopy (EGDS) data collected from 273 EoE and 55 non-EoE dysphagia patients. We validated the models on an independent cohort of 93 consecutive patients with dysphagia undergoing EGDS with biopsies at 2 different centers. Models' performance was assessed by area under the curve (AUC), sensitivity, specificity, and positive and negative predictive values (PPV and NPV). The models were integrated into a point-of-care software package. Results: The model trained on clinical data alone showed an AUC of 0.90 and a sensitivity, specificity, PPV, and NPV of 0.90, 0.75, 0.80, and 0.87, respectively, for the diagnosis of EoE in the external validation cohort. The model trained on a combination of clinical and endoscopic data showed an AUC of 0.94, and a sensitivity, specificity, PPV, and NPV of 0.94, 0.68, 0.77, and 0.91, respectively, in the external validation cohort. Conclusion: Our software-integrated models (https://webapplicationing.shinyapps.io/PointOfCare-EoE/) can be used at point-of-care to improve the diagnostic workup of EoE and optimize resources allocation.Source: JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE, vol. 12 (issue 4)
DOI: 10.1016/j.jaip.2023.12.031
Metrics:
Visaggi P., Del Corso G., Baiano Svizzero F., Ghisa M., Bardelli S., Venturini A., Stefani Donati D., Barberio B., Marciano E., Bellini M., Dunn J., Wong T., De Bortoli N., Savarino E., Zeki S.
Background: Despite increased awareness of eosinophilic esophagitis (EoE), the diagnostic delay has remained stable over the past 3 decades. There is a need to improve the diagnostic performance and optimize resources allocation in the setting of EoE. Objective: We developed and validated 2 point-of-care machine learning (ML) tools to predict a diagnosis of EoE before histology results during office visits. Methods: We conducted a multicenter study in 3 European tertiary referral centers for EoE. We built predictive ML models using retrospectively extracted clinical and esophagogastroduodenoscopy (EGDS) data collected from 273 EoE and 55 non-EoE dysphagia patients. We validated the models on an independent cohort of 93 consecutive patients with dysphagia undergoing EGDS with biopsies at 2 different centers. Models' performance was assessed by area under the curve (AUC), sensitivity, specificity, and positive and negative predictive values (PPV and NPV). The models were integrated into a point-of-care software package. Results: The model trained on clinical data alone showed an AUC of 0.90 and a sensitivity, specificity, PPV, and NPV of 0.90, 0.75, 0.80, and 0.87, respectively, for the diagnosis of EoE in the external validation cohort. The model trained on a combination of clinical and endoscopic data showed an AUC of 0.94, and a sensitivity, specificity, PPV, and NPV of 0.94, 0.68, 0.77, and 0.91, respectively, in the external validation cohort. Conclusion: Our software-integrated models (https://webapplicationing.shinyapps.io/PointOfCare-EoE/) can be used at point-of-care to improve the diagnostic workup of EoE and optimize resources allocation.Source: JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE, vol. 12 (issue 4)
DOI: 10.1016/j.jaip.2023.12.031
Metrics:
See at:
The Journal of Allergy and Clinical Immunology In Practice | Archivio istituzionale della ricerca - Università di Padova | IRIS Cnr | CNR IRIS | IRIS Cnr
2022
Journal article
Open Access
Chicago classification v4.0 protocol improves specificity and accuracy of diagnosis of oesophagogastric junction outflow obstruction
Visaggi P., Ghisa M., Del Corso G., Baiano Svizzero F., Mariani L., Tolone S., Frazzoni M., Buda A., Bellini M., Savarino V., Penagini R., Gyawali C. P., Savarino E. V., De Bortoli N.
Background: Chicago classification version 4.0 (CCv4.0) introduced stringent diagnostic criteria for oesophagogastric junction outflow obstruction (EGJOO), in order to increase the clinical relevance of the diagnosis, although this has not yet been demonstrated. Aims: To determine the prevalence of EGJOO using CCv4.0 criteria in patients with CCv3.0-based EGJOO, and to assess if provocative manoeuvres can predict a conclusive CCv4.0 diagnosis of EGJOO. Methods: Clinical presentation, high resolution manometry (HRM) with rapid drink challenge (RDC), and timed barium oesophagogram (TBE) data were extracted for patients diagnosed with EGJOO as per CCv3.0 between 2018 and 2020. Patients were then re-classified according to CCv4.0 criteria, using clinically relevant symptoms (dysphagia and/or chest pain), and abnormal barium emptying at 5 min on TBE. Receiver operating characteristic (ROC) analyses identified HRM predictors of EGJOO. Results: Of 2010 HRM studies, 144 (7.2%) fulfilled CCv3.0 criteria for EGJOO (median age 61 years, 56.9% female). Upon applying CCv4.0 criteria, EGJOO prevalence decreased to 1.2%. On ROC analysis, integrated relaxation pressure during RDC (RDC-IRP) was a significant predictor of a conclusive EGJOO diagnosis by CCv4.0 criteria (area under the curve: 96.1%). The optimal RDC-IRP threshold of 16.7 mm Hg had 87% sensitivity, 97.1% specificity, 95.7% negative predictive value and 91.3% positive predictive value for a conclusive EGJOO diagnosis; lower thresholds (10 mmHg, 12 mmHg) had better sensitivity but lower specificity. Conclusion: CCv4.0 criteria reduced the prevalence of EGJOO by 80%, thereby refining the diagnosis and identifying clinically relevant outflow obstruction. Elevated RDC-IRP can predict conclusive EGJOO per CCv4.0.Source: ALIMENTARY PHARMACOLOGY & THERAPEUTICS, vol. 56 (issue 4), pp. 606-613
DOI: 10.1111/apt.17101
Project(s): Mechanism Guided Therapy for Laryngopharyngeal Reflux, Training Grant in Gastroenterology
Metrics:
Visaggi P., Ghisa M., Del Corso G., Baiano Svizzero F., Mariani L., Tolone S., Frazzoni M., Buda A., Bellini M., Savarino V., Penagini R., Gyawali C. P., Savarino E. V., De Bortoli N.
Background: Chicago classification version 4.0 (CCv4.0) introduced stringent diagnostic criteria for oesophagogastric junction outflow obstruction (EGJOO), in order to increase the clinical relevance of the diagnosis, although this has not yet been demonstrated. Aims: To determine the prevalence of EGJOO using CCv4.0 criteria in patients with CCv3.0-based EGJOO, and to assess if provocative manoeuvres can predict a conclusive CCv4.0 diagnosis of EGJOO. Methods: Clinical presentation, high resolution manometry (HRM) with rapid drink challenge (RDC), and timed barium oesophagogram (TBE) data were extracted for patients diagnosed with EGJOO as per CCv3.0 between 2018 and 2020. Patients were then re-classified according to CCv4.0 criteria, using clinically relevant symptoms (dysphagia and/or chest pain), and abnormal barium emptying at 5 min on TBE. Receiver operating characteristic (ROC) analyses identified HRM predictors of EGJOO. Results: Of 2010 HRM studies, 144 (7.2%) fulfilled CCv3.0 criteria for EGJOO (median age 61 years, 56.9% female). Upon applying CCv4.0 criteria, EGJOO prevalence decreased to 1.2%. On ROC analysis, integrated relaxation pressure during RDC (RDC-IRP) was a significant predictor of a conclusive EGJOO diagnosis by CCv4.0 criteria (area under the curve: 96.1%). The optimal RDC-IRP threshold of 16.7 mm Hg had 87% sensitivity, 97.1% specificity, 95.7% negative predictive value and 91.3% positive predictive value for a conclusive EGJOO diagnosis; lower thresholds (10 mmHg, 12 mmHg) had better sensitivity but lower specificity. Conclusion: CCv4.0 criteria reduced the prevalence of EGJOO by 80%, thereby refining the diagnosis and identifying clinically relevant outflow obstruction. Elevated RDC-IRP can predict conclusive EGJOO per CCv4.0.Source: ALIMENTARY PHARMACOLOGY & THERAPEUTICS, vol. 56 (issue 4), pp. 606-613
DOI: 10.1111/apt.17101
Project(s): Mechanism Guided Therapy for Laryngopharyngeal Reflux
, Training Grant in Gastroenterology Metrics:
See at:
Alimentary Pharmacology & Therapeutics | Neurogastroenterology & Motility | Journal of Neurogastroenterology and Motility | Journal of Neurogastroenterology and Motility | IRIS Cnr | IRIS Cnr | Journal of Neurogastroenterology and Motility | Journal of Neurogastroenterology and Motility | Esophagus | Clinical Gastroenterology and Hepatology | Digestive and Liver Disease | Archivio istituzionale della ricerca - Università di Padova | Neurogastroenterology & Motility | Neurogastroenterology & Motility | Neurogastroenterology & Motility | The American Journal of Gastroenterology | University of Michigan: Deep Blue | University of Michigan: Deep Blue | University of Michigan: Deep Blue | University of Michigan: Deep Blue | University of Michigan: Deep Blue | University of Michigan: Deep Blue | eScholarship - University of California | Neurogastroenterology & Motility | Clinical Gastroenterology and Hepatology | Recolector de Ciencia Abierta, RECOLECTA | Archivio della Ricerca - Università di Pisa | Archivio della Ricerca - Università di Pisa | Archivio istituzionale della ricerca - Università di Padova | Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" | CNR IRIS | Esophagus | Neurogastroenterology & Motility | Neurogastroenterology & Motility | Neurogastroenterology & Motility | Neurogastroenterology & Motility | Neurogastroenterology & Motility | Neurogastroenterology & Motility | pubmed.ncbi.nlm.nih.gov | Clinical Gastroenterology and Hepatology | Esophagus | Esophagus | The American Journal of Gastroenterology | Alimentary Pharmacology & Therapeutics | Neurogastroenterology & Motility | Neurogastroenterology & Motility | Neurogastroenterology & Motility | Clinical Gastroenterology and Hepatology | Neurogastroenterology & Motility | Neurogastroenterology & Motility | Clinical Gastroenterology and Hepatology | The American Journal of Gastroenterology | Neurogastroenterology & Motility | Clinical Gastroenterology and Hepatology
2023
Contribution to journal
Restricted
P133 Gastroesophageal reflux disease is uncommon in patients with eosinophilic esophagitis refractory to proton pump inhibitors
Visaggi P., Del Corso G., Baiano Svizzero F., Dunn J., Wong T., Savarino E., De Bortoli N., Zeki S.
An abstract is not availableSource: GUT, vol. 72 supplementary 2
DOI: 10.1136/gutjnl-2023-bsg.204
Metrics:
Visaggi P., Del Corso G., Baiano Svizzero F., Dunn J., Wong T., Savarino E., De Bortoli N., Zeki S.
An abstract is not availableSource: GUT, vol. 72 supplementary 2
DOI: 10.1136/gutjnl-2023-bsg.204
Metrics:
2024
Other
Open Access
U-ProBE: a graphical Python interface to handle uncertainties in deep learning models
Bandini L., Bacciu D., Del Corso G., Caudai C.
La piattaforma U-Probe mira ad essere un supporto ad un crescente numero di utilizzatori che hanno necessità di valutare le performances di un modello e soprat- tutto la sua incertezza. Per questo motivo la piattaforma è dotata di una intuitiva interfaccia grafica semplice da utilizzare anche per i non addetti ai lavori. L’analisi dell’incertezza delle predizioni di un modello di Machine Learning o Deep Learning può essere effettuata utilizzando varie tecniche. Alcune di queste sono intrusive (anche dette by design), tali tecniche vanno a modificare l’architettura in- troducendo strumenti probabilistici che possono fornire importanti indicazioni sulle caratteristiche delle predizioni, a livello di affidabilità e incertezza. Tali tecniche comprendono ad esempio le Bayesian Neural Networks, i Variational Autoencoders ed i Deep Gaussian Processes. Sono tecniche molto performanti, sia nel mitigare l’overfitting che nell’uncertainty quantification, di contro sono però molto costose e richiedono molte risorse di calcolo e di tempo per l’allenamento dei modelli. Esistono poi le tecniche semi-intrusive, i cui più conosciuti rappresentanti sono i Deep En- semble; esse rappresentano una ampia classe di approcci che in generale combinano più modelli secondo criteri specifici in modo da valutare l’efficienza, l’incertezza e l’affidabilità delle predizioni senza interferire troppo con le architetture di partenza, ma richiedendo comunque un ampio dispendio di risorse. In questo lavoro abbiamo deciso di utilizzare per i nostri scopi esclusivamente metodi post-hoc, cioè non intrusivi, come il Trust Score ed il Monte Carlo Dropout, che sono in grado di fare efficaci valutazioni sull’incertezza delle predizioni quando il modello è stato già allenato, senza andare a interferire con le fasi di apprendimento o a modificare i parametri già imparati dal modello durante la back propagation. Tali metodi sono leggermente meno performanti dei metodi intrusivi, ma hanno il vantaggio di essere estremamente più rapidi e meno costosi.
Bandini L., Bacciu D., Del Corso G., Caudai C.
La piattaforma U-Probe mira ad essere un supporto ad un crescente numero di utilizzatori che hanno necessità di valutare le performances di un modello e soprat- tutto la sua incertezza. Per questo motivo la piattaforma è dotata di una intuitiva interfaccia grafica semplice da utilizzare anche per i non addetti ai lavori. L’analisi dell’incertezza delle predizioni di un modello di Machine Learning o Deep Learning può essere effettuata utilizzando varie tecniche. Alcune di queste sono intrusive (anche dette by design), tali tecniche vanno a modificare l’architettura in- troducendo strumenti probabilistici che possono fornire importanti indicazioni sulle caratteristiche delle predizioni, a livello di affidabilità e incertezza. Tali tecniche comprendono ad esempio le Bayesian Neural Networks, i Variational Autoencoders ed i Deep Gaussian Processes. Sono tecniche molto performanti, sia nel mitigare l’overfitting che nell’uncertainty quantification, di contro sono però molto costose e richiedono molte risorse di calcolo e di tempo per l’allenamento dei modelli. Esistono poi le tecniche semi-intrusive, i cui più conosciuti rappresentanti sono i Deep En- semble; esse rappresentano una ampia classe di approcci che in generale combinano più modelli secondo criteri specifici in modo da valutare l’efficienza, l’incertezza e l’affidabilità delle predizioni senza interferire troppo con le architetture di partenza, ma richiedendo comunque un ampio dispendio di risorse. In questo lavoro abbiamo deciso di utilizzare per i nostri scopi esclusivamente metodi post-hoc, cioè non intrusivi, come il Trust Score ed il Monte Carlo Dropout, che sono in grado di fare efficaci valutazioni sull’incertezza delle predizioni quando il modello è stato già allenato, senza andare a interferire con le fasi di apprendimento o a modificare i parametri già imparati dal modello durante la back propagation. Tali metodi sono leggermente meno performanti dei metodi intrusivi, ma hanno il vantaggio di essere estremamente più rapidi e meno costosi.
2025
Other
Open Access
Time series scribe: open-source platform for enhanced annotation in multi-channel signal processing
Del Corso G., Kanka S., Bardelli S., Visaggi P., Colantonio S.
Multi-channel temporal signal annotation for training predictive models requires open source software tools that are easy to use and adaptable to different real-world applications. This is especially true in the analysis of biological and medical signals, where the annotation process is not carried out by data scientists. Therefore, this technical report proposes an open source Python software package that allows the annotation of time signals through the use of an intuitive graphical interface. In particular, the annotation of the refluxes in a ph-impedance signal has been taken as a case study.DOI: 10.32079/isti-tr-2025/001
Metrics:
Del Corso G., Kanka S., Bardelli S., Visaggi P., Colantonio S.
Multi-channel temporal signal annotation for training predictive models requires open source software tools that are easy to use and adaptable to different real-world applications. This is especially true in the analysis of biological and medical signals, where the annotation process is not carried out by data scientists. Therefore, this technical report proposes an open source Python software package that allows the annotation of time signals through the use of an intuitive graphical interface. In particular, the annotation of the refluxes in a ph-impedance signal has been taken as a case study.DOI: 10.32079/isti-tr-2025/001
Metrics: