Freight distribution with electric vehicles: A case study in Sicily. Delivery van development

Abstract A change in the logistics sector in terms of environmental sustainability is necessary to support the achievement of the social challenges associated with freight transport. Unfortunately, the policy responses to solving congestion and emissions issues are mainly dedicated to the movement of people. The most valued opportunities to reduce the negative effects of freight delivery (the goal of EU policy is CO2 free urban logistics by 2030) regards both the use of electric vehicles to perform the distribution and the introduction of distribution centres that encourage the use of light commercial vehicles. However, the combination of zero emission vehicles in logistic and transportation activities requires some additional challenges from the organizational and operational point of view. In order to avoid the delocalization of polluting emissions it is necessary that the production of electricity related to the new needs comes from renewable sources preferably distributed throughout the territory. This paper explores the integration of electric vehicles in logistics operations executed through light commercial vehicles, taking into consideration, during the design phase of a new concept delivery van, the technical connections with the production systems and its possible applications also in areas other than urban. The results of the case study presented encourage the development of a type of vehicle with features not yet covered by the market and which are of particular relevance for sustainable logistics applied to small towns or small islands, which are widespread in Italy

Freight distribution with electric vehicles: A case study in Sicily. RES, infrastructures and vehicle routing

Abstract This paper deals with the issue of the production of electricity required for an electric delivery van to carry out its daily mission. In particular, the technical solutions adopted for the generation and management of energy from renewable energy sources will be illustrated. Subsequently a vehicle routing problem with time windows is formulated in order to optimize the freight distribution at urban level completing the exploration of two aspects, infrastructures and management of the service, considered fundamental for dealing with the distribution of freight in a system scenario. The article describes a case study for the delivery of freight within the last mile in which the installation of renewable energy production plants is proposed in the same place where the urban distribution center has been planned. The area dedicated to freight handling is thus proposed in the work as an energy platform as well as logistics. The optimization of a freight delivery service is performed in order to reduce the energy used by the vehicle in its daily travels and some aspects related to the governance (i.e. time windows allowed for the delivery/pick-up operations) are included in the problem constraints. A test application, considering a set of 84 retailers, has been carried out as case study in the Capo d'Orlando municipality (Sicily, Italy)

Detection of peripheral vascular stenosis by assessing skeletal muscle flow reserve

ObjectivesWe sought to determine whether the severity of peripheral arterial disease (PAD) can be assessed by measuring blood flow reserve in limb skeletal muscle with contrast-enhanced ultrasound (CEU).BackgroundNoninvasive imaging of distal limb perfusion could improve management of patients with PAD by evaluating the impact of large and small vessel disease, and collateral flow.MethodsIn 12 dogs, blood flow in the quadriceps femoris was measured by CEU at rest and during either electrostimulated contractile exercise or adenosine infusion. Femoral artery blood flow was measured by Doppler ultrasound. Studies were performed in the absence and presence of either moderate or severe stenosis (pressure gradient of 10 to 20 mm Hg and >20 mm Hg, respectively).ResultsResting femoral artery blood flow progressively decreased with stenosis severity, while resting skeletal muscle flow was reduced only with severe stenosis (52 ± 21% of baseline, p < 0.05), indicating the presence of collateral flow. Skeletal muscle flow reserve during contractile exercise or adenosine decreased incrementally with increasing stenosis severity (p < 0.01). The stenotic pressure gradient correlated with skeletal muscle flow reserve for exercise and adenosine (r = 0.70 for both, p < 0.01).ConclusionsContrast-enhanced ultrasound of limb skeletal muscle can be used to assess the severity of PAD by measuring muscle flow reserve during either contractile exercise or pharmacologic vasodilation. Unlike currently used methods, this technique may provide a measure of the physiologic effects of large- and small-vessel PAD, and the influence of collateral perfusion

Evaluation of the Biodegradable Peripheral Igaki-Tamai Stent in the Treatment of De Novo Lesions in the Superficial Femoral Artery

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Exercise induced atrio-ventricular (AV) block during nuclear perfusion stress testing: a case report

Background. Exercise causes enhanced sympathetic discharge and results in physiologic tachycardia. However, in some patients with a diseased conduction system resulting from acute ischemia, exercise can precipitate heart block. Methods and results. In this report we describe a 51 years old male patient with transient advanced degree atrioventricular (AV) block developed during recovery from exercise stress testing, resolved after the administration of atropine. Nuclear perfusion imaging demostrated stress-induced ischemia of the inferior-apical segments, and recovery of perfusion in the images obtained at rest. Coronarography showed critical stenosis of the right coronary artery, which was treated by percutaneous coronary intervention (PCI) and drug eluting stent (DES) deployment. Conclusion. Nuclear myocardial perfusion imaging provides noninvasive evidence that transient ischemia of the infero- apical segment can result in advanced degree AV block in patient with critical severe right coronary disease

Mortality Not Correlated With Paclitaxel Exposure

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1-Year Results of Paclitaxel-Coated Balloons for Long Femoropopliteal Artery Disease

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Spectral CT Imaging of Prosthetic Valve Embolization after Transcatheter Aortic Valve Implantation

Transcatheter heart valve (THV) embolization is a rare complication of transcatheter aortic valve implantation (TAVI) generally caused by malpositioning, sizing inaccuracies and pacing failures. The consequences are related to the site of embolization, ranging from a silent clinical picture when the device is stably anchored in the descending aorta to potentially fatal outcomes (e.g., obstruction of flow to vital organs, aortic dissection, thrombosis, etc.). Here, we present the case of a 65-year-old severely obese woman affected by severe aortic valve stenosis who underwent TAVI complicated by embolization of the device. The patient underwent spectral CT angiography that allowed for improved image quality by means of virtual monoenergetic reconstructions, permitting optimal pre-procedural planning. She was successfully re-treated with implantation of a second prosthetic valve a few weeks later.</p

Three-year sustained clinical efficacy of drug-coated balloon angioplasty in a real-world femoropopliteal cohort

Purpose:To report the 36-month outcomes from the prospective, multicenter, single-arm IN.PACT Global Study (ClinicalTrials.govidentifier NCT01609296) evaluating the performance of the IN.PACT Admiral drug-coated balloon (DCB) in real-world patients with femoropopliteal occlusive disease.Materials and Methods:The IN.PACT Global Study was conducted at 64 international sites and enrolled 1535 patients with complex lesions, which included bilateral disease, multiple lesions, de novo in-stent restenosis, long lesions, and chronic total occlusions. The predefined full clinical cohort included 1406 patients (mean age 68.6 years; 67.8% men) with claudication or rest pain treated with the study DCB. Mean lesion length was 12.09 +/- 9.54 cm; 18.0% had in-stent restenosis, 35.5% were totally occluded, and 68.7% were calcified. Freedom from clinically-driven target lesion revascularization (CD-TLR) was evaluated through 36 months. The safety composite endpoint was freedom from device- and procedure-related death through 30 days and freedom from major target limb amputation and clinically-driven target vessel revascularization within 36 months. All safety and revascularization events were reviewed by an independent clinical events committee.Results:The Kaplan-Meier estimate of freedom from CD-TLR through 36 months was 76.9%. The composite safety endpoint was achieved in 75.6% of patients. The 36-month all-cause mortality rate was 11.6%, and the major target limb amputation rate was 1.0%. The Kaplan-Meier estimate of freedom from CD-TLR through 36 months was significantly lower in patients with chronic limb-threatening ischemia (CLTI) compared with claudicants (67.6% vs 78.0%; p=0.003). Lesions affecting both the superficial femoral artery (SFA) and popliteal artery had lower Kaplan-Meier freedom from CD-TLR through 36 months (69.2%) than either isolated SFA (79.7%) or popliteal artery lesions (76.5%; log- rank p<0.001). Predictors of CD-TLR through 36 months included increased lesion length, reference vessel diameter <= 4.5 mm, in-stent restenosis, bilateral disease, CLTI, and hyperlipidemia.Conclusion:DCB angioplasty with the IN.PACT Admiral DCB for femoropopliteal disease in a diverse and complex real-world population is associated with sustained clinical efficacy and low rates of reinterventions at 3 years after the initial procedure