Cultural landscape: Towards the design of a nocturnal lightscape

The current debate on the cultural landscape is focused on an inclusive definition. It proposes active enhancement practices and local planning tools that are also dedicated to the study of scenic-perceptive components and visual values. However, the current indications are limited to the definition of day images of sites, and are not based on investigations of the corresponding nocturnal images. The legislation and the recommendations in force in the field of lighting supply performance requirements, related to street and urban lighting, do not provide any indications regarding territorial contexts or widespread heritage sites. This paper presents a critical analysis of the lighting condition of different territorial contexts, places of widespread heritage, in particular with reference to the Italian context. The present situation has been investigated through a qualitative analysis, based on a comparison between day and night images, and a quantitative analysis, developed through a measurement campaign on representative case studies of the recurrent territorial context. In most cases, an absence of a specific lighting design strategy, aimed at defining a suitable nocturnal perception of the cultural landscape, has emerged from the collected data. The aim of the work has been to underline the importance of the study of nocturnal images and to show the possibility of developing an analysis and design methodology for these contexts. This approach should be based on a systemic vision, which should allow not only single monuments to be valorised, but also the places and landscapes that characterise a territory from a morphological and cultural point of view

Safety of vedolizumab in liver transplant recipients : a systematic review

Background: The management of inflammatory bowel disease in patients who have previously undergone liver transplantation can be a clinical challenge. There are serious concerns among physicians regarding the use of biologics for treating such immuno-compromised patients. Objective: We performed a systematic review on vedolizumab therapy in transplant recipients to assess its safety. Methods: PubMed/Embase/Scopus were searched up to November 2018 to identify papers regarding liver transplant recipients and therapy with vedolizumab. Primary outcomes were adverse events. Secondary outcomes were liver transplant and inflammatory bowel disease outcomes. Results: Eight studies (31 patients) were included. Nine out of 31 patients experienced an infection within a mean follow-up time ranging from 5\u201320 months. No malignancies were reported. Inflammatory bowel disease clinical response was experienced by 20/26 patients. Abnormalities in liver tests were recorded in 2/22 patients. Conclusion: Vedolizumab may be considered safe for treating inflammatory bowel disease in liver transplant recipients. Caution is recommended for patients with an unstable liver graft function

New horizons in hepatitis C antiviral therapy with direct-acting antivirals

Most direct-acting antivirals (DAAs) that are being developed as therapy against hepatitis C virus target the NS3/4A protease, the NS5A protein, and the NS5B polymerase. The latter enzyme offers different target sites: the catalytic domain for nucleos(t)ide analogues as well as a number of allosteric sites for nonnucleos(t)ide inhibitors. Two NS3/4A protease inhibitors have been approved recently, and more than 40 new NS3/4A, NS5A, or NS5B inhibitors are in development. These agents can achieve very high cure rates when combined with pegylated interferon-\u3b2 and ribavirin and show promising clinical results when administered in all-oral combinations. In addition to the more canonical drug targets, new alternative viral targets for small-molecule drug development are emerging, such as p7 or NS4B and viral entry. Future research will need to define well-tolerated and cost-effective DAA combinations that provide the highest rates of viral eradication in all patients (including those with advanced liver disease), the broadest spectrum of action on viral genotypes showing minimal or no clinical resistance, and the shortest treatment duration

Hepatorenal syndrome and novel advances in its management

Hepatorenal syndrome is a complication of end stage liver disease. It is a unique form of functional renal failure related to kidney vasoconstriction in the absence of underlying kidney pathology. Hepatorenal syndrome is classified into 2 types: type-1 HRS shows a rapid and progressive decline in renal function with a very poor prognosis (median survival of about 2 weeks); type-2 HRS has a more stable kidney failure, with a median survival of 6 months; its main clinical manifestation is refractory ascites. The most appropriate therapy for HRS is liver transplantation but only a minority of HRS patients undergo the procedure due to the high mortality; survival among liver transplant recipients is lower in HRS than among their counterparts without HRS. A large body of evidence, based on observational studies and randomized controlled trials, has been accumulated in the last decade showing that terlipressin represents a milestone in the management of HRS. According to our meta-analysis of randomized trials comparing terlipressin vs. placebo (five trials, n=243 patients), the pooled rate of patients who reversed HRS by terlipressin was 8.09 (95% CI, 3.52; 18.59) (P<0.001). Among vasoconstrictors, terlipressin (a V1 vasopressin agonist) is the most widely used; however, noradrenaline is another good choice. Vasoconstrictor drugs alone or with albumin reduce mortality compared with no intervention or albumin (RR of mortality, 0.82; 95% Confidence Intervals, 0.70; 0.96) (P<0.01). Two series of patients with HRS recurrence after the first treatment have recently shown that long-term therapy with terlipressin and albumin is beneficial as a bridge to liver transplant. Nevertheless, recovery of renal function can be achieved in less than 50% of patients with HRS after terlipressin use and the recovery of renal function may also be partial in patients who are defined full responders. Renal replacement therapy should not be considered a first-line therapy for HRS Clinical trials are under way in order to assess efficacy and safety of novel therapeutic agents for the treatment of type-1 and type-2 HRS

Management and monitoring of public buildings through ICT based systems: Control rules for energy saving with lighting and HVAC services

Abstract The presented work addresses the topic of energy savings in existing public buildings, when no significant retrofits on building envelope or plants can be done and savings can be achieved by designing intelligent ICT-based service to monitor and control environmental conditions, energy loads and plants operation. At the end of 2010 the European Commission, within the Seventh Framework Program, has founded a project entitled "Smart Energy Efficient Middleware for Public Spaces" (SEEMPubS). To achieve this goal the project will implement, in a set of demonstrator buildings, an interoperable web-based software and hardware solution for real-time monitoring and control of lighting, heating, ventilation and air conditioning services, through both wired and wireless sensor networks. In this paper the first phase of the project, concerning the selection of the environments to be used as demonstrator and the definition of the control and monitoring strategies to reduce energy consumptions for lighting and air conditioning, are presented

Individualized hepatocellular carcinoma risk : the challenges for designing successful chemoprevention strategies

Hepatocellular carcinoma (HCC) develops in the context of environmental risk factors like chronic viral hepatitis, diabetes and alcohol exposure, often associated to an increased risk of cirrhosis. Antiviral treatments that are effective to counteract hepatitis B and C may also attenuate the risk of tumor development. However, since hepatitis B-related carcinogenesis is promoted independently of the onset of cirrhosis, such antiviral treatments as nucleo(t)side analogs can promote regression of cirrhosis, prevent clinical decompensation and variceal bleeding but not HCC. This means that in successfully treated patients with cirrhosis, HCC is often the consequence of their extended survival. In hepatitis C patients, a sustained virological response to interferon-based therapies can reduce the rate of HCC development, even in patients with cirrhosis who experience histological regression of their liver disease. Future therapies aimed at this endpoint in at risk populations should take into consideration pretreatment patient stratification for host, viral and environmental risk factors. In this context the recent discovery of single nucleotide polymorphisms involved in the immune system function and tumorigenesis, might permit enrollment of populations of patients enriched with HCC risk factors for targeted chemopreventive therapies. This could finally pave the way to personalized algorithms, as already seen in the diagnosis and treatment schemes for chemoprevention