A Smart Grid for the city of Rome: A Cost Benefit Analysis

In this work, the JRC applies its Smart Grid CBA methodology to a full-scale project rather than only to a small-size demonstrative one. To this end, the JRC and ACEA - one of Italy’s biggest Distribution System Operators (DSOs), in charge of managing the distribution system of Rome - teamed up to study the merits of deploying Smart Grid technologies (preliminarily tested in a pilot project) in a big city like the Italian capital, hosting several million electricity users. The ACEA Smart Grid Pilot Project (named "Malagrotta" after the area where pilot solutions were first realised) is the starting point for this study, as it displays many of the characteristics of emerging Smart Grids projects and interconnects several diversified generation facilities (like biogas, waste-to-electricity and PV plants) and consumption centres. This study illustrates the outcome of the application of the JRC Cost Benefit Analysis (CBA) to a) the ACEA Smart Grids pilot project; and b) the planned deployment of Smart Grid technologies (tested in the ACEA Smart Grids pilot project) to the whole of the city of Rome. The CBA is conducted from both the private investor’s and the societal perspective, in order to assess whether scaling up the Smart Grid pilot project benefits the distribution operator and the citizens. Finally, this report shows how the JRC's CBA methodology can be effectively used to assess the financial and economic viability of real Smart Grids projects and help the investment decisions of DSOs.JRC.F.3-Energy Security, Systems and Marke

An Edge-Based Architecture to Support Efficient Applications for Healthcare Industry 4.0

Edge computing paradigm has attracted many interests in the last few years as a valid alternative to the standard cloud-based approaches to reduce the interaction timing and the huge amount of data coming from Internet of Things (IoT) devices toward the Internet. In the next future, Edge-based approaches will be essential to support time-dependent applications in the Industry 4.0 context; thus, the paper proposes BodyEdge, a novel architecture well suited for human-centric applications, in the context of the emerging healthcare industry. It consists of a tiny mobile client module and a performing edge gateway supporting multiradio and multitechnology communication to collect and locally process data coming from different scenarios; moreover, it also exploits the facilities made available from both private and public cloud platforms to guarantee a high flexibility, robustness, and adaptive service level. The advantages of the designed software platform have been evaluated in terms of reduced transmitted data and processing time through a real implementation on different hardware platforms. The conducted study also highlighted the network conditions (data load and processing delay) in which BodyEdge is a valid and inexpensive solution for healthcare application scenarios

Data integration and conceptual modelling of the Larderello geothermal area, Italy

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Tumor Cell Plasticity and Angiogenesis in Human Melanomas

Recent molecular studies provide evidence for a significant transcriptional plasticity of tumor cell subpopulations that facilitate an active contribution to tumor vasculature. This feature is accompanied by morphological changes both in vitro and in vivo. Herein, we investigated the morphological plasticity of tumor cells with special focus on vasculogenic mimicry and neovascularisation in human melanoma and mouse xenografts of human melanoma cell lines. In melanoma xenograft experiments, different vessel markers and green fluorescent protein expression were used to show how melanoma cells contribute to neovascularization. Additionally, we analyzed neovascularization in 49 primary melanomas and 175 melanoma metastases using immunostaining for blood (CD34) and lymphatic (D2–40) vessel-specific markers. We found significantly more lymphatic vessels in primary melanomas than in melanoma metastases (p<0.0001). In contrast to the near absence of lymphatic vessels within metastases, we found extensive blood micro-neovascularization. Blood micro-neovascularization was absent in micro metastases (less than 2 mm). A significant inverse correlation between Glut-1 expression (implying local hypoxia) and the presence of microvessels indicates their functional activity as blood vessels (p<0.0001). We suggest that the hypoxic microenvironment in metastases contributes to a phenotype switch allowing melanoma cells to physically contribute to blood vessel formation

Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach

BackgroundPerforated peptic ulcer (PPU) remain a surgical emergency accounting for 37% of all peptic ulcer-related deaths. Surgery remains the standard of care. The benefits of laparoscopic approach have been well-established even in the elderly. However, because of inconsistent results with specific regard to some technical aspects of such technique surgeons questioned the adoption of laparoscopic approach. This leads to choose the type of approach based on personal experience. The aim of our study was to critically appraise the use of the laparoscopic approach in PPU treatment comparing it with open procedure.MethodsA retrospective study with propensity score matching analysis of patients underwent surgical procedure for PPU was performed. Patients undergoing PPU repair were divided into: Laparoscopic approach (LapA) and Open approach (OpenA) groups and clinical-pathological features of patients in the both groups were compared.ResultsA total of 453 patients underwent PPU simple repair. Among these, a LapA was adopted in 49% (222/453 patients). After propensity score matching, 172 patients were included in each group (the LapA and the OpenA). Analysis demonstrated increased operative times in the OpenA [OpenA: 96.4 +/- 37.2 vs LapA 88.47 +/- 33 min, p = 0.035], with shorter overall length of stay in the LapA group [OpenA 13 +/- 12 vs LapA 10.3 +/- 11.4 days p = 0.038]. There was no statistically significant difference in mortality [OpenA 26 (15.1%) vs LapA 18 (10.5%), p = 0.258]. Focusing on morbidity, the overall rate of 30-day postoperative morbidity was significantly lower in the LapA group [OpenA 67 patients (39.0%) vs LapA 37 patients (21.5%) p = 0.002]. When stratified using the Clavien-Dindo classification, the severity of postoperative complications was statistically different only for C-D 1-2.ConclusionsBased on the present study, we can support that laparoscopic suturing of perforated peptic ulcers, apart from being a safe technique, could provide significant advantages in terms of postoperative complications and hospital stay

Gastro-intestinal emergency surgery: Evaluation of morbidity and mortality. Protocol of a prospective, multicenter study in Italy for evaluating the burden of abdominal emergency surgery in different age groups. (The GESEMM study)

Gastrointestinal emergencies (GE) are frequently encountered in emergency department (ED), and patients can present with wide-ranging symptoms. more than 3 million patients admitted to US hospitals each year for EGS diagnoses, more than the sum of all new cancer diagnoses. In addition to the complexity of the urgent surgical patient (often suffering from multiple co-morbidities), there is the unpredictability and the severity of the event. In the light of this, these patients need a rapid decision-making process that allows a correct diagnosis and an adequate and timely treatment. The primary endpoint of this Italian nationwide study is to analyze the clinicopathological findings, management strategies and short-term outcomes of gastrointestinal emergency procedures performed in patients over 18. Secondary endpoints will be to evaluate to analyze the prognostic role of existing risk-scores to define the most suitable scoring system for gastro-intestinal surgical emergency. The primary outcomes are 30-day overall postoperative morbidity and mortality rates. Secondary outcomes are 30-day postoperative morbidity and mortality rates, stratified for each procedure or cause of intervention, length of hospital stay, admission and length of stay in ICU, and place of discharge (home or rehabilitation or care facility). In conclusion, to improve the level of care that should be reserved for these patients, we aim to analyze the clinicopathological findings, management strategies and short-term outcomes of gastrointestinal emergency procedures performed in patients over 18, to analyze the prognostic role of existing risk-scores and to define new tools suitable for EGS. This process could ameliorate outcomes and avoid futile treatments. These results may potentially influence the survival of many high-risk EGS procedure

Prospective evaluation of omentoplasty in preventing leakage of colorectal anastomosis

PURPOSE: The aim of this study was to investigate the role of omentoplasty, by means of intact omentum, in preventing anastomotic leakages after rectal resection. METHODS: Between 1992 and 1997 a total of 112 patients (64 males) with a mean age of 64.7 (range, 39-83) years were randomly assigned to undergo omentoplasty (Group A) or not (Group B) to reinforce the colorectal anastomosis after anterior resection for rectal cancer. The primary end point was anastomotic leakage; the secondary end point included morbility and mortality related to omentoplasty. RESULTS: The two groups were comparable in terms of preoperative and intraoperative characteristics. Staple-ring disruption at plain abdominal radiographs was detected in seven instances in Group A and in ten in Group B patients (P = not significant). Two leakages were evident clinically in Group A and seven in Group B (P < 0.05). Three leaks were documented radiologically in Group A and eight in Group B (P = not significant). No complications related to omentoplasty were observed in Group A. There were two repeat operations for anastomotic leakage in Group B. At follow-up, one stricture developed in Group A and three in Group B (P = not significant) CONCLUSIONS: Despite a similar incidence of staple-ring defects, a strikingly lower rate of clinically and radiologically detected leaks developed in patients submitted to omentoplasty. Although not affecting the incidence of anastomotic disruption, omentoplasty seems to contain the severity of anastomotic leakage

Late Development of Bile Duct Cancer in Patients Who Had Biliary-Enteric Drainage for Benign Disease: A Follow-Up Study of More Than 1,000 Patients

OBJECTIVE: To evaluate the correlation between biliary-enteric surgical drainage and the late development of cholangiocarcinoma of the biliary tract. SUMMARY BACKGROUND DATA: In patients with biliary-enteric drainage, reflux of intestinal contents into the bile duct may occur and cause cholangitis, which is regarded as the most serious complication of these procedures. Lithiasis of the biliary tract and a previous biliary-enteric anastomosis have both been suggested to favor the late onset of cholangiocarcinoma. METHODS: Consecutive patients (n = 1,003) undergoing three different procedures of biliary-enteric anastomosis (transduodenal sphincteroplasty, choledochoduodenostomy, and hepaticojejunostomy) between 1967 and 1997 were included in this study. The postoperative clinical course and long-term outcome were evaluated by a retrospective review of the hospital records and follow-up. Mean follow-up was 129.6 months. RESULTS: Fifty-five (5.5%) cases of primary bile duct cancer were found among the 1,003 patients at intervals of 132 to 218 months from biliary-enteric anastomosis. The incidence of cholangiocarcinoma in the three groups was 5.8% in transduodenal sphincteroplasty patients, 7.6% in choledochoduodenostomy patients, and 1.9% in hepaticojejunostomy patients. The incidence of malignancy related to the different underlying diagnosis was 5.9%, 7.2%, and 1.9% in patients with choledocholithiasis, sphincter of Oddi stenosis, and postoperative benign stricture, respectively. Although only one patient who developed cholangiocarcinoma had previous concurrent lithiasis of the biliary tract, 40 patients had experienced mostly severe, recurrent cholangitis. No case of malignancy occurred in patients scored as having no cholangitis in the early and long-term postoperative outcome. Univariate and multivariate analyses have shown the presence of cholangitis as the only factor affecting the incidence of cholangiocarcinoma. CONCLUSIONS: Chronic inflammatory changes consequent to biliary-enteric drainage should be closely monitored for the late development of biliary tract malignancies

Mesenteric venous thrombosis: multidisciplinary therapeutic approach

Mesenteric venous thrombosis is a particular form of intestinal ischemia related to high mortality. The lack of a characteristic clinical picture often leads to a difficult diagnostic and therapeutic classification. We report the case of a young woman, using estrogenic and progestinic oral therapy, affected by a severe form of mesenteric thrombosis and complicated by segmental post ischemic stenosis of small intestine

Lightweight Reinforcement Learning for Energy Efficient Communications in Wireless Sensor Networks

High-density communications in wireless sensor networks (WSNs) demand for new approaches to meet stringent energy and spectrum requirements. We turn to reinforcement learning, a prominent method in artificial intelligence, to design an energy-preserving MAC protocol, with the aim to extend the network lifetime. Our QL-MAC protocol is derived from Q-learning, which iteratively tweaks the MAC parameters through a trial-and-error process to converge to a low energy state. This has a dual benefit of 1) solving this minimization problem without the need of predetermining the system model and 2) providing a self-adaptive protocol to topological and other external changes. QL-MAC self-adjusts the WSN node duty-cycle, reducing energy consumption without detrimental effects on the other network parameters. This is achieved by adjusting the radio sleeping and active periods based on traffic predictions and transmission state of neighboring nodes. Our findings are corroborated by an extensive set of experiments carried out on off-the-shelf devices, alongside large-scale simulations. INDEX TERMS Wireless sensor network, artificial intelligence, reinforcement learning, energy-efficient network, medium access control