A genetic algorithm for the design of a fuzzy controller for active queue management

Active queue management (AQM) policies are those policies of router queue management that allow for the detection of network congestion, the notification of such occurrences to the hosts on the network borders, and the adoption of a suitable control policy. This paper proposes the adoption of a fuzzy proportional integral (FPI) controller as an active queue manager for Internet routers. The analytical design of the proposed FPI controller is carried out in analogy with a proportional integral (PI) controller, which recently has been proposed for AQM. A genetic algorithm is proposed for tuning of the FPI controller parameters with respect to optimal disturbance rejection. In the paper the FPI controller design metodology is described and the results of the comparison with random early detection (RED), tail drop, and PI controller are presented

Mechanical rotational thrombectomy in long femoropopliteal artery and stent occlusion in COVID-19 patient: Case report

Introduction: Coronavirus disease-19 (COVID-19) has been increasingly associated with thromboembolic complications. COVID-19 infection has a thrombogenic potential for stents. Herein, we report a case of stent thrombosis in diabetic obese patient COVID-19 positive where was previously released a Multilayer Flow Modulator stent (MFM) for large popliteal aneurysm. Case report: A 78-year-old male was referred to our hospital for fever and acute pain in the left leg. At history, the same patient had endovascular procedure for a large symptomatic popliteal aneurysm, treated through release of three MFM. The pulmonary CT scan showed COVID-19 infection with confirm of rhino-laryngeal swab. Duplex ultrasound and CT-angiography showed complete thrombosis of stents. The treatment consisted of mechanical thrombectomy using an 8Fr catheter Rotarex plus release of Vibahn stent-graft. Discussion: COVID-19 patients can present arterial occlusion. In literature are not reported cases about thrombosis peripheral stent. Minimally invasive approaches in redo-procedure reduce risk of infection. Rotarex device was used in revascularization of acute and subacute iliac and femoropopliteal arteries. The goal is to have a debulking, to avoid an incomplete deployment of stent-graft. In our precedent experience, MFM and stent-graft to treatment of popliteal aneurism were safe. It is important to monitor these patients for early identification of failure and rapprochement. In this case, the COVID-19 infection was determinant in promoting thrombosis. Conclusions: COVID-19 increases risk of thrombosis stent. In our experience debulking through Rotarex and stenting, were decisive factors for revascularization and limb salvage

Adjustable Velcro® Compression Devices are More Effective than Inelastic Bandages in Reducing Venous Edema in the Initial Treatment Phase: A Randomized Controlled Trial

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Unmet needs in ANCA-associated vasculitis: Physicians’ and patients’ perspectives

In recent years, clinical research has increased significantly and therapies for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis have improved. However, there are still unanswered questions and unmet needs about AAV patients. The purpose of this review is to examine the frontiers of research related to emerging biomarkers eventually predicting relapse, and new therapeutic approaches, not to mention new quality of life assessment tools. Identifying predictors of relapse may help optimize therapeutic strategies, minimize disease recurrence, and reduce treatment-related side effects. In addition, it is important to recognize that patients may suffer long-term consequences of the disease and its treatment, which, although life-saving, is often associated with significant side effects. Our goal, therefore, is to highlight what has been achieved, the pitfalls, and what still needs to be done, comparing the views of physicians and patients

18F-FDG PET-Derived Volume-Based Parameters to Predict Disease-Free Survival in Patients with Grade III Breast Cancer of Different Molecular Subtypes Candidates to Neoadjuvant Chemotherapy

We investigated whether baseline [F-18] Fluorodeoxyglucose (F-18-FDG) positron emission tomography (PET)-derived semiquantitative parameters could predict disease-free survival (DFS) in patients with grade III breast cancer (BC) of different molecular subtypes candidate to neoadjuvant chemotherapy (NAC). For each F-18-FDG-PET/CT scan, the following parameters were calculated in the primary tumor (SUVmax, SUVmean, MTV, TLG) and whole-body (WB_SUVmax, WB_MTV, and WB_TLG). Receiver operating characteristic (ROC) analysis was used to determine the capability to predict DFS and find the optimal threshold for each parameter. Ninety-five grade III breast cancer patients with different molecular types were retrieved from the databases of the University Hospital of Padua and the University Hospital of Ferrara (luminal A: 5; luminal B: 34; luminal B-HER2: 22; HER2-enriched: 7; triple-negative: 27). In luminal B patients, WB_MTV (AUC: 0.75; best cut-off: WB_MTV > 195.33; SS: 55.56%, SP: 100%; p = 0.002) and WB_TLG (AUC: 0.73; best cut-off: WB_TLG > 1066.21; SS: 55.56%, SP: 100%; p = 0.05) were the best predictors of DFS. In luminal B-HER2 patients, WB_SUVmax was the only predictor of DFS (AUC: 0.857; best cut-off: WB_SUVmax > 13.12; SS: 100%; SP: 71.43%; p < 0.001). No parameter significantly affected the prediction of DFS in patients with grade III triple-negative BC. Volume-based parameters, extracted from baseline F-18-FDG PET, seem promising in predicting recurrence in patients with grade III luminal B and luminal B- HER2 breast cancer undergoing NAC

Sostenibilit\ue0 ambientale dei biocombustibili legnosi: importanza della filiera corta

Il legno \ue8 un materiale disponibile in abbondanza e, se la foresta \ue8 gestita in modo sostenibile, pu\uf2 rappresentare una fonte illimitata di materia prima per diversi settori industriali: dalla costruzione fino alla produzione di energia. Nel settore forestale, come in quello industriale, la domanda di una documentazione relativa alle sue prestazioni ambientali \ue8 in forte crescita. Per esempio, la certificazione ambientale di un prodotto da costruzione diventa necessaria in vista dell\u2019applicazione dei Criteri Ambientali Minimi (CAM) all\u2019edilizia a partire dall\u20191 gennaio 2021 mentre \ue8 gi\ue0 inclusa nella certificazione di qualit\ue0 dei biocombustibili solidi quali pellet (ENplus), bricchetti, cippato e legna da ardere (Biomassplus). Grazie alla competitivit\ue0 del costo della legna da ardere rispetto agli altri combustibili, l\u2019Italia storicamente ha una forte propensione all\u2019utilizzo di questo biocombustibile; tuttavia negli ultimi anni, si \ue8 sempre pi\uf9 sviluppato il mercato di importazione di legna da ardere, in particolar modo proveniente dall\u2019Est-Europa e dai Balcani. Il trasporto su strada della legna da ardere comporta degli input energetici nella filiera e conseguentemente delle emissioni di CO2. Questo studio confronta due diversi approcci di filiera: una filiera corta, in cui la legna da ardere \ue8 prodotta nella regione Veneto e in particolare in Cansiglio, e una filiera lunga, nella quale i tronchi per la produzione della legna da ardere vengono importati da paesi confinanti con l\u2019Italia. I tre obiettivi dello studio sono quelli di (i) valutare l\u2019impatto ambientale delle due filiere utilizzando 4 categorie di impatto, due globali (il potenziale di riscaldamento globale e il potenziale di riduzione dell\u2019ozono) e due locali (la formazione di smog fotochimico e la tossicit\ue0 umana); (ii) eseguire un\u2019analisi di sensitivit\ue0 per determinare la distanza critica del trasporto di legna da ardere e (iii) valutare la compensazione di CO2 in foresta. La metodologia adottata per la valutazione degli impatti ambientali delle due filiere \ue8 l\u2019analisi del ciclo di vita. Lo studio ha evidenziato che, nel caso della filiera corta, la fase critica del ciclo di vita \ue8 la combustione, mentre le operazioni forestali e il trasporto su strada hanno un contributo marginale sull\u2019impatto globale. Passando alla filiera lunga, escludendo le emissioni di CO2 di origine biogenica, il trasporto su strada diventa la fase critica

The Role of Early Revascularization and Biomarkers in the Management of Diabetic Foot Ulcers: A Single Center Experience

Diabetic neuropathy and Peripheral Arterial Disease (PAD) are the main etiological factors in foot ulceration. Herein, we report our experience of diabetic foot ulceration (DFU) management, with an analysis of the relationship between the rate of lower extremity amputation, in persons with infected DFU, after revascularization procedures performed to prevent major amputation. This study highlights the role of different biomarkers, showing their usefulness and potentiality in diabetic foot ulcer management, especially for the early diagnosis and therapy effectiveness monitoring. A retrospective analysis, from September 2016 to January 2021, of diabetic patients presenting diabetic foot with DFU, was performed. All patients were treated with at least one vascular procedure (endovascular, open, hybrid procedures) targeting PAD lesions. Outcomes measured were perioperative mortality and morbidity. Freedom from occlusion, primary and secondary patency, and amputation rate were registered. A total of 267 patients, with a mean age of 72.5 years, were included in the study. The major amputation rate was 6.2%, minor amputation rate was 17%. In our experience, extreme revascularization to obtain direct flow reduced the rate of amputations, with an increase in ulcer healing