A Cloud-based System to Protect Against Industrial Multi-risk Events☆

Abstract Industrial areas frequently present a high concentration of production operations which are source of anthropic risks. For this reason Smart Public Safety is receiving an increasing attention from industry, research and authorities. Moreover, due the consequences of global warming, these areas could be subject to risk events with increased probability with respect to the past. Information technologies enable an innovative approach towards safety management, which relies on the evolution of tools for environmental monitoring and citizens' interaction. This work presents the preliminary results of the Italian research project SIGMA - sensor Integrated System in cloud environment for the Advanced Multi-risk Management. The proposed system includes a continuous monitoring of the different information sources, thus reducing human control as much as possible. At the same time, the communication system manages multiple data flows in a flexible way, adapting itself to different working scenarios, enabling smarter applications. SIGMA intends to acquire, integrate and compute heterogeneous data, coming from various sensor networks in order to provide useful insights for the monitoring, forecasting and management of risk situations through services provided to citizens and businesses, both public and private. Based on the integration of different interoperating components, the system is able to provide a complete emergency management framework through simulations/optimizations and heterogeneous data manipulation tools. The prototype solution is detailed by a use case application in an industrial area located in the region of Sicily, Italy. In particular, web based modular applications connected through SIGMA allow the monitoring of the industrial environment through data gathering from different sensor networks, such as outdoor sensors mounted in the surroundings of large industrial areas, and support of the design of the logistics network aimed at covering the industrial risks

Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy

Aims Highly active antiretroviral therapy (HAART) dramatically reduces human immunodeficiency virus (HIV)-associated morbidity and mortality, but adverse effects of HAART are becoming an increasing challenge, especially in the setting of acute coronary syndromes (ACS). We thus performed a comprehensive review of studies focusing on ACS in HIV patients. Methods and results MEDLINE/PubMed was systematically screened for studies reporting on ACS in HIV patients. Baseline, treatment, and outcome data were appraised and pooled with random-effect methods computing summary estimates [95% confidence intervals (CIs)]. A total of 11 studies including 2442 patients were identified, with a notably low prevalence of diabetes [10.86 (4.11, 17.60); 95% CI]. Rates of in-hospital death were 8.00% (2.8, 12.5; 95% CI), ascribable to cardiovascular events for 7.90% (2.43, 13.37; 95% CI), with 2.31% (0.60, 4.01; 95% CI) developing cardiogenic shock. At a median follow-up of 25.50 months (11.25, 42; 95% CI), no deaths were recorded, with an incidence of 9.42% of acute myocardial infarction (2.68, 16.17; 95% CI) and of 20.18% (9.84, 30.51; 95% CI) of percutaneous coronary revascularization. Moreover, pooled analysis of the studies reporting incidence of acute myocardial infarction in patients exposed to protease inhibitors showed an overall significant risk of 2.68 (odds ratio 1.89, 3.89; 95% CI). Conclusion Human immunodeficiency virus patients admitted for ACS face a substantial short-term risk of death and a significant long-term risk of coronary revascularization and myocardial infarction, especially if receiving protease inhibitors

Bowel preparation for elective colorectal resection: multi-treatment machine learning analysis on 6241 cases from a prospective Italian cohort

background current evidence concerning bowel preparation before elective colorectal surgery is still controversial. this study aimed to compare the incidence of anastomotic leakage (AL), surgical site infections (SSIs), and overall morbidity (any adverse event, OM) after elective colorectal surgery using four different types of bowel preparation. methods a prospective database gathered among 78 Italian surgical centers in two prospective studies, including 6241 patients who underwent elective colorectal resection with anastomosis for malignant or benign disease, was re-analyzed through a multi-treatment machine-learning model considering no bowel preparation (NBP; No. = 3742; 60.0%) as the reference treatment arm, compared to oral antibiotics alone (oA; No. = 406; 6.5%), mechanical bowel preparation alone (MBP; No. = 1486; 23.8%), or in combination with oAB (MoABP; No. = 607; 9.7%). twenty covariates related to biometric data, surgical procedures, perioperative management, and hospital/center data potentially affecting outcomes were included and balanced into the model. the primary endpoints were AL, SSIs, and OM. all the results were reported as odds ratio (OR) with 95% confidence intervals (95% CI). results compared to NBP, MBP showed significantly higher AL risk (OR 1.82; 95% CI 1.23-2.71; p = .003) and OM risk (OR 1.38; 95% CI 1.10-1.72; p = .005), no significant differences for all the endpoints were recorded in the oA group, whereas MoABP showed a significantly reduced SSI risk (OR 0.45; 95% CI 0.25-0.79; p = .008). conclusions MoABP significantly reduced the SSI risk after elective colorectal surgery, therefore representing a valid alternative to NBP

Abdominal drainage after elective colorectal surgery: propensity score-matched retrospective analysis of an Italian cohort

background: In italy, surgeons continue to drain the abdominal cavity in more than 50 per cent of patients after colorectal resection. the aim of this study was to evaluate the impact of abdominal drain placement on early adverse events in patients undergoing elective colorectal surgery. methods: a database was retrospectively analysed through a 1:1 propensity score-matching model including 21 covariates. the primary endpoint was the postoperative duration of stay, and the secondary endpoints were surgical site infections, infectious morbidity rate defined as surgical site infections plus pulmonary infections plus urinary infections, anastomotic leakage, overall morbidity rate, major morbidity rate, reoperation and mortality rates. the results of multiple logistic regression analyses were presented as odds ratios (OR) and 95 per cent c.i. results: a total of 6157 patients were analysed to produce two well-balanced groups of 1802 patients: group (A), no abdominal drain(s) and group (B), abdominal drain(s). group a versus group B showed a significantly lower risk of postoperative duration of stay >6 days (OR 0.60; 95 per cent c.i. 0.51-0.70; P < 0.001). a mean postoperative duration of stay difference of 0.86 days was detected between groups. no difference was recorded between the two groups for all the other endpoints. conclusion: this study confirms that placement of abdominal drain(s) after elective colorectal surgery is associated with a non-clinically significant longer (0.86 days) postoperative duration of stay but has no impact on any other secondary outcomes, confirming that abdominal drains should not be used routinely in colorectal surgery

Dual oral antiplatelet therapy and unplanned surgery: possible role for intravenous platelet glycoprotein receptor inhibitors

[No abstract available

Retrograde percutaneous recanalization of coronary chronic total occlusions: Outcomes from 17 patients

Given their suboptimal success rates, coronary chronic total occlusions (CTO) represent one of the last challenges of percutaneous coronary intervention (PCI). Among several novel techniques, the retrograde approach is one of the most promising, but it is still incompletely described. We report our 5-year experience in retrograde PCI for CTOs. We abstracted patient and procedural data on all cases with attempted retrograde approach. End-points were technical and procedural success, plus long-term major adverse cardiovascular events (MACE). The retrograde approach was used in 17 patients, with procedural success in 12 (71%), including 9 CTOs of right coronary, 2 of left circumflex, and 2 of left main arteries. Conversely, 4 cases of technical failure and 1 post-procedural myocardial infarction in an otherwise angiographically successful procedure were found. Causes of retrograde failure were: inability to deliver the balloon through the chosen collateral in 2 cases, inability to retrogradely cross the distal stump with the wire in 1 case, and interruption of the procedure due to rupture of a minor septal collateral branch during attempts at advancing the non-inflated balloon in 1 case. In all patients with retrograde failure, subsequent antegrade attempts could be carried out, with ultimate success in everybody. Follow-up at 24 +/- 21 months showed an overall MACE rate of 23%. In conclusion, the retrograde approach appears feasible and safe, and its application can be envisioned as a promising alternative strategy in selected patients in whom antegrade approaches fail or are deemed unsafe. (C) 2007 Elsevier Ireland Ltd. All rights reserved

The retrograde coronary approach for chronic total occlusions: Mid-term results and technical tips & tricks

Background: Coronary chronic total occlusions (CTO) remain a challenging lesion subset for interventional cardiologists. The retrograde approach is a novel but still incompletely described technique. We report our 5-year-long experience in retrograde percutaneous coronary intervention (PCI) for CTOs. Methods: We abstracted patient and procedural data on all cases with attempted retrograde approach by means of a native septal or epicardial collateral pathway. End-points were wiring, angiographic and procedural success, plus long-term major adverse cardiovascular events (MACE). Results: The retrograde approach was used in 18 patients, including 11 CTOs of right coronary artery (RCA), 3 of left circumflex (LCX), and 4 of left anterior descending (LAD), with procedural success in 12 (67%). Conversely, two cases of wiring failures, three angiographic failures despite successful retrograde wiring, and one postprocedural myocardial infarction in an otherwise angiographically successful procedure were found. Causes of wiring failure were inability to retrogradely cross the distal (1) or the proximal stump (1) with the wire, while angiographic failures were due to interruption of the procedure due to rupture of a minor septal collateral branch during attempts at advancing the noninflated balloon (1) or persistent inability to deliver the balloon through the chosen collateral (2). Follow-up at a mean of 15 months showed MACE had occurred in five (28%) subjects. Conclusions: The retrograde approach appears feasible and safe in the percutaneous management of coronary occlusions, and its application can be envisioned as a promising alternative in selected patients in whom antegrade approaches fail or are unsafe. © 2007, the Authors

Early and Long-Term Results of Percutaneous Coronary Intervention for Unprotected Left Main Trifurcation Disease

Objectives: We aimed to conduct a retrospective cohort study focusing on our 5-year experience in the percutaneous treatment of unprotected left main (ULM) trifurcation disease. Background: Percutaneous treatment of ULM trifurcation remains a challenging and rare procedure for most interventional cardiologists. Moreover, data on long-term outcomes are lacking. Methods: We retrieved all patients with ULM trifurcation disease treated percutaneously at our Institution since 2002, and adjudicated baseline, procedural, and outcome data. The primary end point was the long-term rate of major adverse cardiovascular events (MACE, i.e., cardiac death, myocardial infarction, bypass surgery, or target vessel revascularization). Results: A total of 27 patients underwent percutaneous coronary intervention with stent implantation for ULM trifurcation disease, with 14 (52%) cases of true trifurcations, i.e., with concomitant significant stenoses of the distal ULM/ostial left anterior descending plus ostial ramus intermedius and ostial circumflex. Bare-metal stents were implanted in 8 (29%) patients and drug-eluting stents (DES) in 26 (96%), with a main branch stent only strategy in 11 (40%), T stenting in 9 (33%), and V stenting in 6 (27%). Procedural and clinical success occurred in 26 (96%), with one postprocedural death. Angiographic follow-up was obtained in 22 patients (81%), and clinical follow-up was completed in all subjects after a median of 28 +/- 17 months, showing overall MACE in 9 (33%), with cardiac death in 4 (15%), myocardial infarction in 1 (4%), coronary artery bypass grafting (CABG) in 4 (15%), and percutaneous target vessel revascularization in 5 (19%). Definite stent thrombosis was adjudicated in 1 (3%) patient. Treatment of a true trifurcation lesion and recurrence of angina during follow-up were significantly associated with an increased risk of MACE (P = 0.029 and P = 0.050, respectively). Conclusions: Percutaneous treatment of ULM trifurcation disease is feasible, associated with favorable mid-term results, and may be considered given its low invasiveness in patients at high surgical risk or with multiple comorbidities. (C) 2008 Wiley-Liss, Inc

The future of new aortic valve replacement approaches

Aortic valve disease is a growing cause of mortality and morbidity, especially in developed countries. Whereas medical therapy is associated with an ominous prognosis, since the 1970s, surgical valve replacement has represented a standard therapy for fit patients. Indeed, this approach is safe and feasible in younger patients without comorbidities. However, in unfit patients, surgery may be associated with a very high risk. The advent of transcatheter valve replacement techniques, by means of percutaneous or transapical approaches, has been recently introduced into mainstream clinical practice and is likely to radically change the treatment of aortic valve disease. At present, further data are needed to thoroughly appraise the long-term risk-benefit balance of transcatheter valve replacement techniques. For this reason, it can only be considered for high surgical risk patients, but early results are so promising that in the future, transcatheter aortic valve implantation could became the first therapeutic choice, even for low-risk patients. © 2010 Future Medicine Ltd