SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3-6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Intelligenza Artificiale e rinegoziazione delle locazioni commerciali colpite dalle sopravvenienze connesse alla pandemia. Il Progetto A.I.A.CO.

Il contributo rielabora il resoconto dell’attività di ricerca svolta nell’àmbito del Progetto A.I.A.CO. (Artificial Intelligence for contract law Against Covid-19), che si propone l’obiettivo di indagare il possibile utilizzo dell’intelligenza artificiale nella risoluzione delle problematiche sollevate dall’emergenza sanitaria relativamente alla sorte dei contratti ad esecuzione continuata, periodica o differita, oltre che nella gestione delle sopravvenienze in generale. In particolare, il sistema di algoritmi equitativi frutto dell’attività svolta dal team di ricerca è in grado, limitatamente alle locazioni commerciali, di facilitare la rideterminazione – sia giudiziale che extragiudiziale – dei canoni di locazione e garantire la conservazione dei contratti. This paper is the report of the research carried out within the «AI.A.CO. Project» (Artificial Intelligence for Contract Law Against Covid-19) which aims to investigate the possibility of using Artificial Intelligence (AI) to solve the legal issues raised by the Covid-19 emergency about the fate of contracts with continuous or periodical or deferred execution, as well as to deal with exceptional events and contingencies. Limited in particular to commercial leases, the system of “equitable algorithms” elaborated, thanks to AI, is capable to facilitate redetermination – both judicial and extrajudicial – of the rents and guarantee the conservation of contracts

Design of Quality Aspects in Service Oriented Architecture through Service Level Agreements

This chapter gives a solution to design Service Oriented Architectures which defines and manages Service Level Agreements to enforce Quality of Services and achieves adaptivity at runtime. The validation of this proposed approach is performed through an actual case study in the context of the multimedia application domain.</jats:p

A Look on Engineering Non-Functional Properties in Service Oriented Architectures

The aim of this chapter is to provide an overview on non-functional issues in service oriented architectures. First, it introduces the non-functional requirements which should be addressed in service-oriented architectures and the challenging issues they raise (i.e., specification, conflicts, run-time management). Second, it presents the available approaches related to the engineering of non-functional issues. Third, it discusses the possible future trends regarding this topic.</jats:p

QSAR Models for Predicting Enzymatic Hydrolysis of New Chemical Entities as an Effective Tool in “Soft-Drug” Design

The work described here is aimed at developing QSAR models capable of predicting in vitro human plasma lability/stability. They were built based on a dataset comprising about 200 known compounds. 3D structures of the molecules were drawn, optimized and submitted to the calculation of molecular descriptors that enabled selecting different TR/TS set pairs, subsequently exploited to develop QSAR models. Several 'machine learning' algorithms were explored in order to obtain suitable classification models, which were then validated on the relevant TS sets. Moreover the predictive ability of the best performing models was assessed on a Prediction set (PS) comprising about 40 molecules, not strictly related, from a structural point of view, to the initial dataset, but (obviously) comprised within the validity domain of the QSAR models obtained. The study allowed selecting predictive models enabling the classification of New Chemical Entities with regard to hydrolysis rate, that may be exploited for soft-drug design