Automated service provisioning and hierarchical SLA management in 5G systems

Empowered by network softwarization, 5G systems have become the key enabler to foster the digital transformation of the vertical industries by expanding the scope of traditional mobile networks and enriching the network service offerings. To make this a reality, we propose an automation solution for vertical services provisioning and hierarchical Service Level Agreement (SLA) management. Service scaling is one of the most essential operations to adapt the service deployments and resource allocations to ensure SLA fulfilment. Three different scaling levels are addressed in this work: application-, service- and resource-level. We have implemented our solution in a proof-of-concept of a virtualized mobile network platform, spanning over three geographically-distributed sites. To evaluate our solution, we leverage field tests, focusing on automotive vertical services comprising a mission-critical application (collision-avoidance) and an entertainment one (video streaming). The results demonstrate the excellent performance of our solution, and its ability to automatically deploy vertical services and ensure their SLAs through different levels of service scaling.This work has been partially supported by European Commission H2020 5GPPP through the 5G-TRANSFORMER and 5GROWTH projects (Grants No. 761536 and 856709)

Minimal Extrathyroidal Extension in Predicting 1-Year Outcomes: A Longitudinal Multicenter Study of Low-to-Intermediate-Risk Papillary Thyroid Carcinoma (ITCO#4)

Background: The role of minimal extrathyroidal extension (mETE) as a risk factor for persistent papillary thyroid carcinoma (PTC) is still debated. The aim of this study was to assess the clinical impact of mETE as a predictor of worse initial treatment response in PTC patients and to verify the impact of radioiodine therapy after surgery in patients with mETE. Methods: We reviewed all records in the Italian Thyroid Cancer Observatory (ITCO) database and selected 2237 consecutive patients with PTC who satisfied the inclusion criteria (PTC with no lymph node metastases and at least 1 year of follow-up). For each case, we considered initial surgery, histological variant of PTC, tumor diameter, recurrence risk class according to the American Thyroid Association (ATA) risk stratification system, use of radioiodine therapy, and initial therapy response, as suggested by ATA guidelines. Results: At 1-year follow-up, 1831 patients (81.8%) had an excellent response, 296 (13.2%) had an indeterminate response, 55 (2.5%) had a biochemical incomplete response, and 55 (2.5%) had a structural incomplete response. Statistical analysis suggested that mETE (odds ratio [OR] 1.16, p=0.65), tumor size >2 cm (OR 1.45, p=0.34), aggressive PTC histology (OR 0.55, p=0.15), and age at diagnosis (OR 0.90, p=0.32) were not significant risk factors for a worse initial therapy response. When evaluating the combination of mETE, tumor size, and aggressive PTC histology, the presence of mETE with a >2 cm tumor was significantly associated with a worse outcome (OR 5.27, 95% CI, p=0.014). The role of radioiodine ablation in patients with mETE was also evaluated. When considering radioiodine treatment, propensity score-based matching was performed, and no significant differences were found between treated and non-treated patients (p=0.24). Conclusions: This study failed to show the prognostic value of mETE in predicting initial therapy response in a large cohort of PTC patients without lymph node metastases. The study suggests that the combination of tumor diameter and mETE can be used as a reliable prognostic factor for persistence and could be easily applied in clinical practice to manage PTC patients with low-to-intermediate risk of recurrent/persistent disease

Autosomal dominant nocturnal frontal lobe epilepsy seizure characterization through wavelet transform of eeg records and self organizing maps

In this paper, a Manifold Learning approach for the automatic detection of Autosomal Dominant Nocturnal Frontal Lobe Epilepsy seizures is presented, with the aim to support neurologists in the labelling efforts. Features extracted from polysomnography signals are used in order to detect and discriminate seizure epochs. This task has been addressed by mapping the electroencephalographic signal epochs in different regions of the features space. The result is a Self Organizing Map, which allows to investigate over not straightforward relations in the complex input space for the characterization of seizures

Is it Possible to avoid rh-TSH test in Patients with Differentiated Thyroid Carcinoma by Using the Association between Ablation and Suppressive Thyroglobulin?

Background: The follow-up of differentiated thyroid cancers is based on neck ultrasonography and serum thyroglobulin assay (Tg), during l-T4 therapy and after recombinant human TSH administration; this test appears quite expensive, considering that only a small percentage of patients with undetectable Tg on TSH suppression therapy shows a response after TSH stimulation. Objectives: The aim of our study was to verify whether low levels of serum thyroglobulin at the time of remnant ablation (A-Tg) associated with undetectable thyroglobulin levels on TSH suppression (S-Tg), have sufficient negative predictive value for recurrence of disease, thus avoiding rh-TSH test in Differentiated Thyroid Cancer patients. Methods: we retrospectively enrolled 975 DTC patients treated with thyroidectomy+131-I remnant ablation showing undetectable S-Tg measured after 12 months follow-up. The availability of A-Tg and rh-TSH stimulated Tg (R-Tg) obtained 1 year later were considered as inclusion criteria. Patients with positive circulating Ab-Tg and/or histological dedifferentiation were excluded. Patients were subdivided in high and low risk of recurrence according to the criteria proposed by the European Thyroid Cancer Taskforce. Results: Using rh-TSH test as gold standard, the NPV for A-Tg<10 μg/L was 98.5% in group A (low risk patients) and 95.5% in group B (high risk patients); it significantly raised to 99.2% in group A (p-value 0.03) and 99.3% in group B (p-value 0.02) when the association between A-Tg<10 μg/L and S-Tg<0.6 μg/L was considered. When we evaluated the whole population the negative predictive value was 97% for A-Tg<10 μg/L alone, raising to 99.3% when associated with S-Tg<0.6 μg/L (p-value<0.008). Conclusion: our data confirmed the very high negative predictive value of the association between low levels of A-Tg and undetectable S-Tg in the early risk stratification of differentiated thyroid cancer patients, leading to avoid rh-TSH test with an important economic impact

Epilessia mioclonica progressiva o epilessia parziale continua?

2019 (AOU Cagliari): 23enne ricoverato per mioclonie capo e collo. Esordio nel 2012: crisi in addormentamento e sonno. 2013: due crisi, introdotto Levetiracetam; sostituito da Carbamazepina e Clonazepam. 2014 (Istituto Neurologico Besta): mioclonie spontanee volto e arto superiore sinistro, parestesie arto inferiore sinistro. Sospetta epilessia parziale continua associata a crisi sensitive in encefalite immunomediata, pratica Metilprednisolone e Immunoglobuline; anticorpi anti–SNC e NMDAR negativi, bande oligoclonali liquorali. Benessere fino al 2016: ricomparsa di mioclonie e crisi; bassa positività IgG anti GAD anti GRUR3; reazione oligoclonale liquorale. Praticati immunoglobuline e cortisone: remissione clinica. 2017 (Nuoro): cluster di crisi; a Topiramato, Clonazepam e Valproato viene aggiunto Lacosamide. 2017–2018 (Fondazione Mondino): diagnosi di Epilessia parziale continua farmacoresistente: pratica steroide ad alte dosi e Immunoglobuline. Benessere fino a settembre 2018: ripresa clonie e aumento crisi. Test genetici: Mutazione GABRB3, gene dosage normale. Negatività POLG1, MERRF, MELAS Esami Neurofisiologici: MEG (2014): Generatore attività epilettica intercritica in giro precentrale e postcentrale destro. VideoEEG (2019): attività parossistica focale frontotemporale intercritica; pattern mioclonico in veglia e sonno; struttura del sonno regolarmente organizzata ma elevata instabilità. Neuroimmagini: PET (2014): ipometabolismo frontoparietale destro. RM encefalo (2019): nella norma. Attualmente Lacosamide, Topiramato, Perampanel, Clonazepam. La definizione eziologica appare incerta: assenza di alterazioni cerebrali e anticorpi anti–SNC e dubbia risposta all’immunoterapia escluderebbero una genesi autoimmune; test genetici negativi escluderebbero un’encefalopatia mioclonica progressiva se confermati da pannello allargato e analisi dell’esoma; il ruolo dell’infiammazione nelle crisi da epilessia parziale continua non progressiva spiegherebbe la risposta alle immunoglobuline

A data-driven approach to refine predictions of differentiated thyroid cancer outcomes: a prospective multicenter study

Context The risk stratification of patients with differentiated thyroid cancer (DTC) is crucial in clinical decision making. The most widely accepted method to assess risk of recurrent/persistent disease is described in the 2015 American Thyroid Association (ATA) guidelines. However, recent research has focused on the inclusion of novel features or questioned the relevance of currently included features. Objective To develop a comprehensive data-driven model to predict persistent/recurrent disease that can capture all available features and determine the weight of predictors. Methods In a prospective cohort study, using the Italian Thyroid Cancer Observatory (ITCO) database (NCT04031339), we selected consecutive cases with DTC and at least early follow-up data (n = 4773; median follow-up 26 months; interquartile range, 12-46 months) at 40 Italian clinical centers. A decision tree was built to assign a risk index to each patient. The model allowed us to investigate the impact of different variables in risk prediction. Results By ATA risk estimation, 2492 patients (52.2%) were classified as low, 1873 (39.2%) as intermediate, and 408 as high risk. The decision tree model outperformed the ATA risk stratification system: the sensitivity of high-risk classification for structural disease increased from 37% to 49%, and the negative predictive value for low-risk patients increased by 3%. Feature importance was estimated. Several variables not included in the ATA system significantly impacted the prediction of disease persistence/recurrence: age, body mass index, tumor size, sex, family history of thyroid cancer, surgical approach, presurgical cytology, and circumstances of the diagnosis. Conclusion Current risk stratification systems may be complemented by the inclusion of other variables in order to improve the prediction of treatment response. A complete dataset allows for more precise patient clustering