mid-DeepLabv3+: A Novel Approach for Image Semantic Segmentation Applied to African Food Dietary Assessments.

Recent decades have witnessed the development of vision-based dietary assessment (VBDA) systems. These systems generally consist of three main stages: food image analysis, portion estimation, and nutrient derivation. The effectiveness of the initial step is highly dependent on the use of accurate segmentation and image recognition models and the availability of high-quality training datasets. Food image segmentation still faces various challenges, and most existing research focuses mainly on Asian and Western food images. For this reason, this study is based on food images from sub-Saharan Africa, which pose their own problems, such as inter-class similarity and dishes with mixed-class food. This work focuses on the first stage of VBDAs, where we introduce two notable contributions. Firstly, we propose mid-DeepLabv3+, an enhanced food image segmentation model based on DeepLabv3+ with a ResNet50 backbone. Our approach involves adding a middle layer in the decoder path and SimAM after each extracted backbone feature layer. Secondly, we present CamerFood10, the first food image dataset specifically designed for sub-Saharan African food segmentation. It includes 10 classes of the most consumed food items in Cameroon. On our dataset, mid-DeepLabv3+ outperforms benchmark convolutional neural network models for semantic image segmentation, with an mIoU (mean Intersection over Union) of 65.20%, representing a +10.74% improvement over DeepLabv3+ with the same backbone.

Medical conditions of children and young people with Down syndrome.

BACKGROUND: The life expectancy of people with Down syndrome (DS) has significantly increased in the last decades. We describe the congenital malformations and main comorbidities of a cohort of children and young people with DS and analyse their differences according to age and gender groups. METHODS: This retrospective cross-sectional study was conducted at DS centre of Bambino Gesù Children's Hospital in Rome (Italy). The period for reviewing all electronic health records ran from July 2016 to September 2017. We collected data on clinical conditions and compared them with the general paediatric population. Moreover, we compared the main comorbidities, dental diseases and body mass index data between age groups. RESULTS: Seven hundred sixty-three children and young people with DS included in this study were aged 7.45 ± 5.49 years. Gender distribution included 58.19% male patients. The majority of our population (71.04%) came from central regions of Italy. Respiratory diseases (19%), congenital heart defects (72.23%), malocclusions (58.62%), astigmatism (20.31%), farsightedness (16.51%), near-sightedness (12.19%) and autoimmune hypothyroidism (3.28%) were more frequent in our population compared with the typical paediatric population. Upper respiratory tract infections and underweight were significantly more frequent in the youngest children, whereas dental diseases, refractive errors, obesity and autoimmune hypothyroidism increased over age. CONCLUSIONS: Children and young people with DS present a high prevalence of potentially treatable medical conditions making multidisciplinary teams a mandatory need for this population.

Atrioventricular canal defect and genetic syndromes: The unifying role of sonic hedgehog.

The atrioventricular canal defect (AVCD) is a congenital heart defect (CHD) frequently associated with extracardiac anomalies (75%). Previous observations from a personal series of patients with AVCD and "polydactyly syndromes" showed that the distinct morphology and combination of AVCD features in some of these syndromes is reminiscent of the cardiac phenotype found in heterotaxy, a malformation complex previously associated with functional cilia abnormalities and aberrant Hedgehog (Hh) signaling. Hh signaling coordinates multiple aspects of left-right lateralization and cardiovascular growth. Being active at the venous pole the secondary heart field (SHF) is essential for normal development of dorsal mesenchymal protrusion and AVCD formation and septation. Experimental data show that perturbations of different components of the Hh pathway can lead to developmental errors presenting with partially overlapping manifestations and AVCD as a common denominator. We review the potential role of Hh signaling in the pathogenesis of AVCD in different genetic disorders. AVCD can be viewed as part of a "developmental field," according to the concept that malformations can be due to defects in signal transduction cascades or pathways, as morphogenetic units which may be altered by Mendelian mutations, aneuploidies, and environmental causes.

Psychological factors associated with NAFLD/NASH: a systematic review.

OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) represents one of the most common chronic liver diseases worldwide. So far, the pathogenesis of NAFLD and its more severe variant nonalcoholic steatohepatitis (NASH) is yet unclear, with many mechanisms being proposed as possible causes. This article aims to review the psychological factors associated with NAFLD/NASH. MATERIALS AND METHODS: Three main categories of factors have been investigated: emotional, cognitive and behavioral. Five electronic databases were searched, limited to studies published in the English language, during the period 2005-2015: PubMed, Thomson ISI - Web of Science, Scopus, ProQuest, and ScienceDirect. RESULTS: Results indicated the most relevant emotional factors to be depression and anxiety. The areas of investigation for cognitive functioning concern those contents and processes related to the ability to initiate and maintain lifestyle changes. The most important behavioral factors identified are physical activity, nutrition/food intake and substance consumption: coffee, alcohol, cigarettes. CONCLUSIONS: Some of the factors identified act as protective factors, other as vulnerability factors. NAFLD/NASH may be considered a cognitive-behavioral disease, the most effective management being lifestyle changes, with emphasis on diet and exercise.

Syndromic non-compaction of the left ventricle: associated chromosomal anomalies.

Non-compaction of the left ventricle (NCLV) is a cardiomyopathy characterized by prominent left ventricular trabeculae and deep intertrabecular recesses. Associated extracardiac anomalies occur in 14-66% of patients of different series, while chromosomal anomalies were reported in sporadic cases. We investigated the prevalence of chromosomal imbalances in 25 syndromic patients with NCLV, using standard cytogenetic, subtelomeric fluorescent in situ hybridization, and array-comparative genomic hybridization (CGH) analyses. Standard chromosome analysis disclosed an abnormality in three (12%) patients, including a 45,X/46,XX mosaic, a 45,X/46,X,i(Y)(p11) mosaic, and a de novo Robertsonian 13;14 translocation in a child affected by hypomelanosis of Ito. Cryptic chromosome anomalies were found in six (24%) cases, including 1p36 deletion in two patients, 7p14.3p14.1 deletion, 18p subtelomeric deletion, 22q11.2 deletion associated with velo-cardio-facial syndrome, and distal 22q11.2 deletion, each in one case. These results recommend accurate clinical evaluation of patients with NCLV, and suggest that chromosome anomalies occur in about one third of syndromic NCLV individuals, without metabolic/neuromuscular disorder. Array-CGH analysis should be included in the diagnostic protocol of these patients, because different submicroscopic imbalances are causally associated with this disorder and can pinpoint candidate genes for this cardiomyopathy.

Nitrogen removal performance of intermittently aerated membrane bioreactor treating black water.

The study investigated the effect of intermittent aeration on the nitrogen removal performance of a membrane bioreactor (MBR) treating black water. A pilot-scale MBR with an effective volume of 630 L operating as a sequencing batch reactor (SBR) with intermittent aeration was used in the experiments. Substrate feeding was limited to the initial non-aerated phase. The MBR unit was sustained at a steady state at a sludge age of 60 d with a biomass concentration of around 10,000 mg/L for 3 months. The treated black water could be characterized with an average COD of 950 mg/L and total nitrogen of 172 mg/L, corresponding to a low COD/N ratio of 5.5. The selected MBR scheme was quite effective, reducing COD down to 26 mg/L, providing effective nitrification and yielding a total oxidized nitrogen concentration under 10 mg N/L. The nitrogen removal performance was substantially better than the level predicted by process stoichiometry, due to multiple anoxic configuration inducing additional nitrogen removal. Dissolved oxygen profiles associated with the cyclic operation of the system suggested that the incremental nitrogen removal could be attributed to simultaneous nitrification-denitrification, a commonly observed mechanism in MBR systems sustained at high biomass concentrations.

RASopathies: Clinical Diagnosis in the First Year of Life.

Diagnosis within Noonan syndrome and related disorders (RASopathies) still presents a challenge during the first months of life, since most clinical features used to differentiate these conditions become manifest later in childhood. Here, we retrospectively reviewed the clinical records referred to the first year of life of 57 subjects with molecularly confirmed diagnosis of RASopathy, to define the early clinical features characterizing these disorders and improve our knowledge on natural history. Mildly or markedly expressed facial features were invariably present. Congenital heart defects were the clinical issue leading to medical attention in patients with Noonan syndrome and LEOPARD syndrome. Feeding difficulties and developmental motor delay represented the most recurrent features occurring in subjects with cardiofaciocutaneous syndrome and Costello syndrome. Thin hair was prevalent among SHOC2 and BRAF mutation-positive infants. Café-au-lait spots were found in patients with LS and PTPN11 mutations, while keratosis pilaris was more common in individuals with SOS1, SHOC2 and BRAF mutations. In conclusion, some characteristics can be used as hints for suspecting a RASopathy during the first months of life, and individual RASopathies may be suspected by analysis of specific clinical signs. In the first year of life, these include congenital heart defects, severity of feeding difficulties and delay of developmental milestones, hair and skin anomalies, which may help to distinguish different entities, for their subsequent molecular confirmation and appropriate clinical management.

Treatment of segregated black/grey domestic wastewater using constructed wetlands in the Mediterranean basin: the zer0-m experience.

Concerns about water shortage and pollution have received increased attention over the past few years, especially in developing countries with warm climate. In order to help local water management in these countries, the Euro-Mediterranean Regional Programme (MEDA) has financed the Zer0-m project (E-mail: www.zer0-m.org). As a part of this project, several constructed wetland (CW) pilot systems with different pre-treatments have been implemented in four Technological Demonstration Centres in Egypt, Morocco, Tunisia and Turkey. The aim of this research was to establish appropriate designs for treatment of segregated domestic black (BW) and grey water (GW). We tested several different multistage CW configurations, consisting of horizontal and vertical subsurface flow CW for secondary treatment and free water systems as tertiary stage. CW removal efficiencies of TSS, COD, BOD(5), N-NH(4)(+), N-NO(3)(-), N(tot), total coliforms (TC) were evaluated for each of the implemented systems. The results from this study demonstrate the potential of CWs as a suitable technology for treating segregated domestic wastewater. A very efficient COD reduction (up to 98%) and nitrification (92-99%) was achieved for BW and GW in all systems. CW effluent concentrations were below 15 mg/L for BOD(5), 1 mg/L for N-NO(3)(-) and 0.5 mg/L for N-NH(4)(+) together with acceptable TC counts. Based on these results, we suggest adopting the design parameters used in this study for the treatment of segregated wastewater in the Mediterranean area.

Biological and oxidative treatment of cotton textile dye-bath effluents by fixed and fluidized bed reactors.

A treatability study for highly polluted and recalcitrant azo reactive dye-baths from cotton textile dyeing processes was conducted by using fixed and up-flow fluidized bed type reactors packed with brown coal. Ozone oxidation was carried out to assess the combination of biological and chemical oxidation. COD removal efficiencies ranged from 70% to 93%, and up to 99% color removal was attained. At a COD loading rate of 25.5 x 10(-6) gCOD/m(2)-d, COD removal was 85%. Breakthrough of the brown coal used occurred at total organic loading of 0.090 gCOD/g coal. Biodegradable and inert COD fractions of the remazol dye-bath were assessed by BOD(28) and oxygen uptake rate (OUR) measurements. 50% of total COD was initially inert. The inert fraction was reduced by adsorption and ozone oxidation by 65% and 40%, respectively. Brown coal is an inexpensive material and the system has economical and operational advantages as compared to treatment options such as advanced oxidation processes (AOPs) using UV, O(3), H(2)O(2) or electrocoagulation.

Nevirapine hypersensitivity.

Treatment of HIV-1 infections with nevirapine is associated with skin and liver toxicity. These two organ toxicities range from mild to severe, in rare cases resulting in life-threatening liver failure or toxic epidermal necrolysis. The study of the mechanistic steps leading to nevirapine-induced skin rash has been facilitated by the discovery of an animal model in which nevirapine causes a skin rash in rats that closely mimics the rash reported in patients. The similarity in characteristics of the rash between humans and rats strongly suggests that the basic mechanism is the same in both. The rash is clearly immune-mediated in rats, and partial depletion of CD4(+) T cells, but not CD8(+) T cells, is protective. We have demonstrated that the rash is related to the 12-hydroxylation of nevirapine rather than to the parent drug. This is presumably because the 12-hydroxy metabolite can be converted to a reactive quinone methide in skin, but that remains to be demonstrated. Although the rash is clearly related to the 12-hydroxy metabolite rather than the parent drug, cells from rechallenged animals respond ex vivo to the parent drug by producing cytokines such as interferon-gamma with little response to the 12-hydroxy metabolite, even when the rash was induced by treatment with the metabolite rather than the parent drug. This indicates that the response of T cells in vitro cannot be used to determine what caused an immune response. We are now studying the detailed steps by which the 12-hydroxy metabolite induces an immune response and skin rash. This animal model provides a unique tool to study the mechanistic details of an idiosyncratic drug reaction; however, it is likely that there are significant differences in the mechanisms of different idiosyncratic drug reactions, and therefore the results of these studies cannot safely be generalized to all idiosyncratic drug reactions.

Women's health and reproductive rights: Romanian experience.

One of the most dramatic chapters in the history of women's reproductive rights ended in Romania in 1989. For over 23 years, Romania had pursued a rigidly enforced pronatalist policy, banning the importation of contraceptives, strictly prohibiting most abortions, and imposing a tax on childless couples. The aim of this study was to explore, through individual in-depth interviews, psychosocial antecedents and consequences of the Romanian policy. The study group consisted of 50 women, aged between 18 and 55 years, with diverse sociodemographic and educational characteristics. The interviews focused on sexuality education, sexual experiences, reproductive events, and partner relations. The results show that women's private behavior and efforts to regulate their fertility prevailed over public policies, regardless of personal risks or costs to health. Concluding observations summarize major findings, results from a 1993 national household survey on reproductive health, and a commentary on the need for ongoing sexuality and contraceptive education and counseling.

Post-traumatic stress disorders; psychophysiological and medical aspects.

Post-traumatic stress disorder (PTSD) is a psychobiological concept. Distressing events outside the range of usual human experience produce several somatovegetative and especially several psychic disturbances. The psychoneuroendocrine mechanisms of PTSD concern the impact of cognitive factors, a disorder of arousal and alterations of the central sympathoadrenal system and of the noradrenergic mediation. The authors exhibited the influence of stressful events (uprising of December 1989 in Romania) on the intestinal and noncoronary cardiovascular complains and analysed five cases of PTSD, treated in the last three years.

Analysis of psychophysiological mechanism with cardiovascular risks.

The review summarises newer findings on the relations between personality and behavioural traits and the risk factors for coronary heart disease (CHD). After a critical analysis of the type of A behavioural pattern (TABP), the role of hostility as a crucial element of this behaviour is underlined. Emphasis is put on the cardiovascular overarousal on the psychophysiological mechanisms of TABP and on the relationship proved by the authors too, between TABP and diseases other than CHD. It appears justified to consider TABP rather as a "disease prone behaviour" especially among stress vulnerable subjects.

Cardiovascular complaints following the uprising of December 1989 in Romania.

The cardiovascular system may react to stress either by coronary events, such as angina pectoris or myocardial infarction, or by non-coronary responses, such as rises in blood pressure or non-specific circulatory disorders and chest pain. There is contradictory information about the cardiovascular reactions to war stress. The aim of this study was to investigate the effects of stress produced by the uprising of December 1989 in Romania on the cardiovascular system. Cases referred from 21 to 31 December 1989 to the emergency department of the largest university clinic of the Cluj district, and those admitted there, were analysed and compared with cases referred in the same periods in 1988, 1990 and 1991 and from 1 to 10 January 1990. There was a significant increase in non-coronary cardiovascular complaints referred for consultation in the first 10 days from the beginning of the uprising in Cluj and a non-significant increase in the following 10 days, but no increase in consultations for complaints of coronary origin due to unstable angina and acute myocardial infarction or changes in hospital admissions. In conclusion, the stress produced by the uprising in Romania was correlated with a higher incidence of non-coronary cardiovascular complaints but no alteration in coronary events (unstable angina, acute myocardial infarction), or in hospital admissions for cardiovascular complaints.

Psychoneuroimmunology.

The recent findings on the close relation between the nervous and immune systems have led to the developing of a new interdisciplinary field: psychoneuroimmunology. This review outlines the topic of the research, the limits and the future trends of psychoneuroimmunology, emphasizing the reciprocal relationship between biological and psychological processes.

Irritable bowel syndrome complaints following the uprising of December 1989 in Romania.

Irritable bowel syndrome has a strong psychogenic component. One of its features is the influence of stress on the clinical state. An increased amount of irritable-bowel-like symptoms within the first month following the uprising in Romania in December 1989 is reported. These symptoms seem to be related to the impressive amount of stress developed by dramatic events presented live on television and watched by the population. Several new cases as compared to the previous year were also reported by our group for the study of psychogenic factors in irritable bowel syndrome.

Psychophysiological assessment of cardiovascular risk factors.

An overview of recent data concerning the evaluation of overall risk for CHD shows the drawbacks of existing formulae. On this basis a more complete screening score and a new mathematic formula for computing the probability of risk for CHD have been assessed. Besides the primary and classical risk factors the latter also includes psychophysiological variables concerning stress and coronary prone behaviour. Five modalities to estimate the overall risk have been used in cases with various risks and the new formula has been applied to a group of 93 textile workers. The results certify the good differentiation power of the proposed formula.

Some specific features of exercise stress in athletes.

Stress factors which can elicit several psychoemotional, neuromotor and cardiovascular reactions in athletes before or during training and competition are discussed. The authors' data concern firstly the significance of ACTH depletion. Exploration of the neuromotor system, the flicker test, evaluation of the urinary excretion of amine metabolites and several types of questionnaires (related to stress, anxiety and coronary risk factors) in a group of 35 athletes have outlined their psychophysiological reactions and behaviour. The necessity to prevent and manage distress phenomena found in 20 subjects is considered.