Adaptive conflict-free optimization of rule sets for network security packet filtering devices

Packet filtering and processing rules management in firewalls and security gateways has become commonplace in increasingly complex networks. On one side there is a need to maintain the logic of high level policies, which requires administrators to implement and update a large amount of filtering rules while keeping them conflict-free, that is, avoiding security inconsistencies. On the other side, traffic adaptive optimization of large rule lists is useful for general purpose computers used as filtering devices, without specific designed hardware, to face growing link speeds and to harden filtering devices against DoS and DDoS attacks. Our work joins the two issues in an innovative way and defines a traffic adaptive algorithm to find conflict-free optimized rule sets, by relying on information gathered with traffic logs. The proposed approach suits current technology architectures and exploits available features, like traffic log databases, to minimize the impact of ACO development on the packet filtering devices. We demonstrate the benefit entailed by the proposed algorithm through measurements on a test bed made up of real-life, commercial packet filtering devices

Real Time Identification of SSH Encrypted Application Flows by Using Cluster Analysis Techniques

Abstract. The identification of application flows is a critical task in order to manage bandwidth requirements of different kind of services (i.e. VOIP, Video, ERP). As network security functions spread, an increasing amount of traffic is natively encrypted due to privacy issues (e.g. VPN). This makes ineffective current traffic classification systems based on ports and payload inspection, e.g. even powerful Deep Packet Inspection is useless to classify application flow carried inside SSH sessions. We have developed a real time traffic classification method based on cluster analysis to identify SSH flows from statistical behavior of IP traffic parameters, such as length, arrival times and direction of packets. In this paper we describe our approach and relevant obtained results. We achieve detection rate up to 99.5 % in classifying SSH flows and accuracy up to 99.88 % for application flows carried within those flows, such as SCP, SFTP and HTTP over SSH

Long non-coding RNA GAS5 and miR-126-3p as molecular biomarkers of response to sorafenib in human cancer cells.

lncRNAs and microRNAs are implicated in several biological functions and their dysregulation is frequently found in cancer. To better understand the molecular mechanism of the multikinase inhibitor sorafenib, we profiled the expression of a panel of ncRNAs in a sorafenib-treated hepatocellular carcinoma (HCC) cell line. Among the most modulated, we found the dysregulation of the lncRNAs GAS5, HOTTIP and HOXA-AS2 and the miR-126-3p in HCC, renal and breast carcinoma cell lines. The diagnostic performance of GAS5 and miR-126-3p was verified in solid and liquid biopsies from HCC patients. miR-126-3p was decreased in HCC tissues respect to their correspondent peri-tumoral tissues. The levels of circulating miR-126-3p and GAS5 were significantly higher and lower respectively, in HCC patients respect to healthy subjects. This study highlighted that GAS5 and miR-126-3p were involved in the response to sorafenib of different cancer cell types and they were good diagnostic biomarkers of HCC in liquid biopsies

Repeated Cytoreduction Combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Selected Patients Affected by Peritoneal Metastases: Italian PSM Oncoteam Evidence

The reiteration of surgical cytoreduction (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients affected by recurrent peritoneal metastases is still questioned regarding safety and effectiveness. This study evaluates the safety, efficacy, and associated factors of iterative CRS combined with HIPEC. This multicentric retrospective study collected data from four surgical oncology centers, on iterative HIPEC. We gathered data on patient and cancer characteristics, the peritoneal cancer index (PCI), completeness of cytoreduction (CC), postoperative complications, and overall survival (OS). In the study period, 141 CRS-plus-HIPECs were performed on 65 patients. Nine patients underwent three iterative procedures, and one underwent five. No increased incidence of complications after the second or third procedure was observed. Furthermore, operative time and hospitalization stay were significantly shorter after the second than after the first procedure (p p = 0.061). Concomitant hepatic-CRC-metastasis did not compromise the CRS-plus-HIPEC safety and efficacy. This multicentric experience encourages repeated CRS-plus-HIPEC, showing promising results

Experienced Use of Dexmedetomidine in the Intensive Care Unit: A Report of a Structured Consensus

OBJECTIVE: Management of pain, agitation and delirium (PAD) remains to be a true challenge in critically ill patients. The pharmacological proprieties of dexmedetomidine (DEX) make it an ideal candidate drug for light and cooperative sedation, but many practical questions remain unanswered. This structured consensus from 17 intensivists well experienced on PAD management and DEX use provides indications for the appropriate use of DEX in clinical practice. METHODS: A modified RAND/UCLA appropriateness method was used. In four predefined patient populations, the clinical scenarios do not properly cope by the current recommended pharmacological strategies (except DEX), and the possible advantages of DEX use were identified and voted for agreement, after reviewing literature data. RESULTS: Three scenarios in medical patients, five scenarios in patients with acute respiratory failure undergoing non-invasive ventilation, three scenarios in patients with cardiac surgery in the early postoperative period and three scenarios in patients with overt delirium were identified as challenging with the current PAD strategies. In these scenarios, the use of DEX was voted as potentially useful by most of the panellists owing to its specific pharmacological characteristics, such as conservation of cognitive function, lack of effects on the respiratory drive, low induction of delirium and analgesia effects. CONCLUSION: DEX might be considered as a first-line sedative in different scenarios even though conclusive data on its benefits are still lacking

WSES worldwide emergency general surgery formation and evaluation project

Optimal management of emergency surgical patients represents one of the major health challenges worldwide. Emergency general surgery (EGS) was identified as multidisciplinary surgery performed for traumatic and non-traumatic acute conditions during the same admission in the hospital. EGS represents the easiest viable way to provide affordable and high-quality level of care to emergency surgical and trauma patients. It may result from the association of different physicians with other specialties in a cooperative model. The World Society of Emergency Surgery (WSES) has been working on the EGS organization and implementation since its foundation believing in the need of common benchmarks for training and educational programs throughout the world. This is a plea in different languages to all World Prime Ministers and Presidents to support the creation in all nations of an organized hub-spoke system for emergency general surgery to improve standards of care and to save lives.Peer reviewe

The Congress Impact Factor: A proposal from board members of the World Society of Emergency Surgeons.it (WSES) and Academy of Emergency Medicine and Care (AcEMC) [version 2; referees: 2 approved]

Many scientific congresses and conferences are held every year around the world. The aim of the World Society of Emergency Surgeons.it (WSES) and Academy of Emergency Medicine and Care (AcEMC) was to develop a simple mathematical parameter as an indicator of academic quality and scientific validity of a congress. In this opinion article, a new metric, the Congress Impact Factor (IFc), is proposed taking into consideration the widely used Impact Factor as an indicator of journals’ prestige and using H-index analysis. The IFc is derived from the mathematical ratio between the mean H-index of invited lecturers normalized for lecture topic and number of lectures in the conference. In case of multiple sessions, the mean of all IFc is calculated along with its standard deviation.  We conclude that the IFc can be a useful measure for evaluating and comparing congress prestige, and may also represent a potentially useful parameter for improving academic curriculum and helping participants to choose the more prestigious meetings for their education

2019 WSES guidelines for the management of severe acute pancreatitis.

Although most patients with acute pancreatitis have the mild form of the disease, about 20-30% develops a severe form, often associated with single or multiple organ dysfunction requiring intensive care. Identifying the severe form early is one of the major challenges in managing severe acute pancreatitis. Infection of the pancreatic and peripancreatic necrosis occurs in about 20-40% of patients with severe acute pancreatitis, and is associated with worsening organ dysfunctions. While most patients with sterile necrosis can be managed nonoperatively, patients with infected necrosis usually require an intervention that can be percutaneous, endoscopic, or open surgical. These guidelines present evidence-based international consensus statements on the management of severe acute pancreatitis from collaboration of a panel of experts meeting during the World Congress of Emergency Surgery in June 27-30, 2018 in Bertinoro, Italy. The main topics of these guidelines fall under the following topics: Diagnosis, Antibiotic treatment, Management in the Intensive Care Unit, Surgical and operative management, and Open abdomen

Superiority of the new sex-adjusted models to remove the female disadvantage restoring equity in liver transplant allocation

Background and Aims: Model for End-stage Liver Disease (MELD) and MELDNa are used worldwide to guide graft allocation in liver transplantation (LT). Evidence exists that females are penalized in the present allocation systems. Recently, new sex-adjusted scores have been proposed with improved performance respect to MELD and MELDNa. GEMA-Na, MELD 3.0, and sex-adjusted MELDNa were developed to improve the 90-day dropout prediction from the list. The present study aimed at evaluating the accuracy and calibration of these scores in an Italian setting. Methods: The primary outcome of the present study was the dropout from the list up to 90 days because of death or clinical deterioration. We retrospectively analysed data from 855 adults enlisted for liver transplantation in the Lazio region (Italy) (2012–2018). Ninety-day prediction of GEMA-Na, MELD 3.0 and sex-adjusted MELDNa with respect to MELD and MELDNa was analysed. Brier score and Brier Skill score were used for accuracy, and the Greenwood-Nam- D'Agostino test was used to evaluate the calibration of the models. Results: GEMA-Na (concordance = .82, 95% CI = .75–. 89), MELD 3.0 (concordance = .81, 95% CI = .74–. 87) and sex-adjusted MELDNa (concordance = .81, 95% CI = .74–.88) showed the best 90-day dropout prediction. GEMA-Na showed a higher increase in accuracy with respect to MELD (p = .03). No superiority was shown with respect to MELDNa. All the tested scores showed a good calibration of the models. Using GEMA-Na instead of MELD would potentially save one in nine dropouts and could save one dropout per 285 patients listed