Treni merci lunghi e pesanti in esercizio: analisi sulla resistenza dei ganci ed evidenze sperimentali sugli effetti termici in frenatura / Long and heavy freight trains in operation: analysis on the strength of couplings and test evidences on thermal effects during braking

The so-called heavy freight trains (over 1600 t), sometimes even long (740-750 m), are now among the leaders of the future of rail transport of goods. The aim of this paper is to analyse, both theoretically and experimentally, the impact that this solution may have on the traction units (hooks with their traction castle or yoke) and the braking system. Concerning the traction units, the technical reference in Italy, no longer binding from 2021, is Tab. 20, art. 61, of the General Preface of the Timetable of Services (named PGOS) containing the correlations between the maximum towed mass and the plan-altimetric characteristics of the line (performance grade). This reference is questioned and compared with other foreign institutional sources and with analytical calculations referring to “quasi- static” conditions of the trainset, departing from a standstill, and again in “dynamic” conditions at high speeds. As far as the analysis in the braking phase is concerned, this was carried out by means of thermal evaluations on data collected from experimental observations compared with data available in the literature. Among the main results, considering a precautionary limit hook load of 400 kN, both in the quasi-static and dynamic conditions, it appears that the maximum load section or degree of performance on which a train of 2000 t can circulate is 15/16, corresponding approximately to an equivalent resistance deriving from the infrastructure (i.e. gradient and resistance in curves) of 15‰, without prejudice to the possibility of using thrust or booster locomotives at the rear, in compliance with the provisions of art. 60 of the mentioned PGOS. The thermal evaluations of the braking system confirmed that the maximum values reached are compatible with those in the literature and that the behaviour of the braking blocks is different according to their type

Triplets versus doublets, with or without cisplatin, in the first-line treatment of stage IIIB-IV non-small cell lung cancer (NSCLC) patients: a multicenter randomised factorial trial (FAST)

BACKGROUND: The FAST is a 2 7 2 factorial trial addressing two questions: (1) the role of replacing cisplatin (P) with a non-platinum agent, vinorelbine (N), and (2) the role of adding a third agent, ifosfamide (I), in a doublet based on gemcitabine (G). METHODS: A total of 433 stage IIIB-IV non-small cell lung cancer (NSCLC) patients were randomised to one of four arms: gemcitabine-cisplatin (GP), gemcitabine-vinorelbine, gemcitabine-ifosfamide- cisplatin or gemcitabine-ifosfamide-vinorelbine. Two comparisons were performed: N- vs P-containing regimens and I-triplets vs non-I doublets. RESULTS: For N- vs P-containing regimens, adjusted overall survival was 9.7 vs 11.3 months (P=0.044), progression-free survival was 4.9 vs 6.4 months (P=0.020) and response rate was 24% vs 31% (P=0.124), respectively. No statistically significant difference was observed between doublets and triplets. Grade 3-4 haematological toxicity was significantly more frequent in P-containing therapy; grade 3-4 leucopenia was significantly more common in triplets. Concerning non-haematological toxicity, grade 3-4 nausea-vomiting was significantly increased in P-containing regimens. CONCLUSIONS: This trial provides evidence of a slight survival superiority of GP-containing regimens over platinum-free N-containing chemotherapy. This trial also confirms that the addition of a third chemotherapy agent (I) to a standard G-based doublet does not improve treatment outcome. \ua9 2012 Cancer Research UK. All rights reserved

Effects of pre‐operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or >= 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care