Total Cost of Ownership of Digital vs. Analog Radio-Over-Fiber Architectures for 5G Fronthauling

The article analyzes the total cost of ownership (TCO) of 5G fronthauling solutions based on analog and digital radio-over-fiber (RoF) architectures in cloud radio access networks (C-RANs). The capital and operational expenditures (CAPEX, OPEX) are assessed, for a 10-year period, considering three different RoF techniques: intermediate frequency analog RoF (IF-A-RoF), digital signal processing (DSP) assisted analog RoF (DSP-A-RoF), and digital RoF (D-RoF) based on the common public radio interface (CPRI) specifications. The greenfield deployment scenario under exam includes both fiber trenching (FT) and fiber leasing (FL) options. The TCO is assessed while varying (i) the number of aggregated subcarriers, (ii) the number of three-sector antennas located at the base station, and (iii) the mean fiber-hop length. The comparison highlights the significance that subcarrier aggregation has on the cost efficiency of the analog RoF solutions. In addition, the analysis details the contribution of each cost category to the overall CAPEX and OPEX values. The obtained results indicate that subcarrier aggregation via DSP results in high cost efficiency for a mobile fronthaul network, while a CPRI-based architecture together with FL brings the highest OPEX value

An Insight into the Total Cost of Ownership of 5G Fronthauling

This paper provides an assessment of the total cost of ownership (TCO) of a number of 5G fronthauling solutions based on digital and analog radio-over-fiber (RoF) architectures in cloud radio access network (C-RAN). We computed the capital and operational expenditures (CAPEX, OPEX) in the case of an optical fiber aggregation network based on a ring topology. Three different RoF architectures were considered: intermediate frequency analog RoF (IF-A-RoF), digital signal processing assisted analog RoF (DSP-A-RoF), and digital RoF (D-RoF) based on the common public radio interface (CPRI). A greenfield scenario considering both fiber deployment and fiber leasing was analyzed. The results presented in the paper show how the TCO changes with the number of aggregated carriers for the considered RoF architectures and fiber deployment strategy. They also reveal the impact that each cost category has on the overall CAPEX and OPEX value

What to start with in first line treatment of chronic hepatitis B patients: an Italian multicentre observational cohort, HBV-RER study group

Treatment options for chronic hepatitis B (CHB) are pegylated interferon (Peg-IFN) in minimal-mild liver fibrosis and nucleot(s)ide analogues (NUC) in more advanced disease. Since little is known about their use in daily clinical practice, we conducted a multicentre prospective study to investigate treatment regimens applied to na\uefve CHB patients in real life. HBV-RER is an observational multicentre Italian network that collect clinic and virologic data of patients with CHB. Among the 2527 CHB patients seen during the study period (2009 - 2012), 502 patients started a first line antiviral treatment. Liver biopsy was performed in 30.9% of the patients, with high levels of fibrosis being detected in 19.4% of them. In 216 patients (43%) Peg-IFN was used as first-line therapy while the remaining patients started NUC therapy (entecavir and tenofovir in 75%, lamivudine in 15%, telbivudine and adefovir 10%). By multivariate logistic regression, an age under 40 (OR 0.92, 95%IC 0.90-0.94; p <0.001) and the execution of liver biopsy (OR 3.83; 95%IQR 1.76-8.36; p <0.001) were the only determinants of choice between Peg-IFN vs NUC. Peg-IFN was expected to be used in first-line treatment for CHB in 70% of the patients based on Italian recommendations, but a much lower proportion of patients were actually treated with Peg-IFN with a limited use of the biopsy. Thus, in daily clinical practice physicians prefer to use NUCs, presumably because of their optimal tolerability and anti-viral efficacy, even if they frequently require life-long treatment as opposed to the short duration of Peg-IFN

Fluid optimization in liver surgery

Abstract Study's purposes: to reduce bleeding, hepatectomies are usually performed mantaining low central pressure(CVP) combined with extraepatic control flow and this management can lead hemodynamic instability and reduction of in oxygen delivery. This study analyses hemodynamic changes and so the derived fluid management in patients undergoing liver resection , through the Vigileo/flow Trac system. Basic procedures Seventeen patients were included. Low CVP, below 4 mmHg, was reached by loop diuretics. Hemodynamic parameters were recorded and blood gas analysis was also performed. At the end of resection, fluid replacement was carried out with 500 ml of crystalloid solution in 20 minutes evaluating changes in CVP, cardiac index(CI) and stroke volume variation (SVV). Main findings: during Pringle maneuver, cardiac index resulted stable trough a modification of hert rate and vascular resitence (p0.01) about 7% despite a CVP of 5 mmHg. Conclusion: We suppose that SVV can replace CVP in major hepatectomy management. Regarded results we can conclude that a good peripheral perfusion can be reached also with a fluid restrictive regimen avoiding overload and postoperative edema

The Present Profile of Chronic Hepatitis B Virus Infection Highlights Future Challenges: An analysis of the Multicenter Italian MASTER-B Cohort

Background Chronic hepatitis B virus (HBV) infection remains a primary cause of morbidity and mortality worldwide. Aim The study is aimed at updating the clinical and epidemiological profile of chronic HBV infection in Italy. Methods. A cross-sectional multicenter prospective study enrolled consecutive HBsAg positive patients seen in 73 Italian centers in the period 2012-2015. Individual patient data were collected using an electronic platform and analyzed using standard statistical methods. Results Among 2,877 HBsAg positive individuals (median age 49.8 years, 68% males), 27% were non-Italian natives (NINs); 20% had chronic infection, 58.5% chronic hepatitis and 21.5% cirrhosis. Among NINs, age was younger, male gender was less prevalent and liver disease less advanced than in Italians (all p&lt;0.0001). HBeAg positive cases were 23.6% among NINs vs 8.2% in Italians (p&lt;0.0001); HDV coinfections 11.1% vs 7.3% (p=0.006) and HCV coinfections 2.3% vs 4.2% (p=0.017), respectively. Anti-HDV or anti-HCV antibodies were detected more frequently in patients with cirrhosis. Fifty percent of NINs with cirrhosis were aged below 45 years. Conclusion The study offers an insight into the evolving burden of chronic hepatitis B virus infection in the near future and highlights new territories for public health interventions

Changing the Face of Chronic Hepatitis B. Final Report of the Master-B Italian Cohort

Background: Chronic HBV infection is still a major health prob- lem in Europe, intensified by increasing immigration from endemic areas. The Master-B study was aimed at defining the current profile of chronic HBV-infected individuals and their long-term clinical outcome. Methods: Consecutive HBsAg-posi- tive patients seen in 77 Italian specialized centers were enrolled from June 2009 to December 2011, using an elec- tronic CRF. HIV-positive patients were excluded. Follow- up data are recorded at least twice a year. We present the baseline characteristics from the final database of 2920 patients. Results: Males were 68.6%; age 49.4±14.3; BMI 25.3±3.8; 26.7% were immigrants, mainly from Eastern Europe, Asia or Africa. Laboratory features included : mean ALT 64±163; 12.3% HBeAg-positive; anti-HDV in 159/1936 (pos/tested; 8.2%) and anti-HCV positive in 81/2170 (3.7%), alcohol use (&gt;3 drinks/day) in &lt;3%; 41.9 % had undergone liver biopsy. Overall, 22% of the patients had cirrhosis, 29% of whom with decompensation, 58.3% chronic hepatitis and 19.5% were inactive carriers. As compared with Italian patients, immigrants were younger (37±11 vs 53.4±13.1 P&lt;0.001), more fre- quently HBeAg-positive (23.4% vs 8.2% P&lt;0.001), anti-HDV- positive (10.9 % vs 7.2 %; P&lt;0.02) and less frequently had undergone liver biopsy. Previous antiviral treatment was recorded in 33% of the cases and at the time of enrolment 35% of the patients were being treated with antivirals (50% of cir- rhotics). Conclusions: Chronic HBV infection shows an evolving burden due to the growing cohort of non-Italian patients, who show higher rates of HBeAg or presence of anti-HDV. There are still barriers to access medical care for cirrhotic patients since 50% of them did not receive antiviral treatment when first seen in the specialized centers

The present profile of chronic hepatitis B virus infection highlights future challenges: An analysis of the Multicenter Italian MASTER-B cohort

Background: Chronic hepatitis B virus (HBV) infection remains a primary cause of morbidity and mortality worldwide. Aim: The study is aimed at updating the clinical and epidemiological profile of chronic HBV infection in Italy. Methods: A cross-sectional multicenter prospective study enrolled consecutive HBsAg positive patients seen in 73 Italian centers in the period 2012\u20132015. Individual patient data were collected using an electronic platform and analyzed using standard statistical methods. Results: Among 2877 HBsAg positive individuals (median age 49.8 years, 68% males), 27% were non-Italian natives (NINs); 20% had chronic infection, 58.5% chronic hepatitis and 21.5% cirrhosis. Among NINs, age was younger, male gender was less prevalent and liver disease less advanced than in Italians (all p &lt; 0.0001). HBeAg positive cases were 23.6% among NINs vs 8.2% in Italians (p &lt; 0.0001); HDV coinfections 11.1% vs 7.3% (p = 0.006) and HCV coinfections 2.3% vs 4.2% (p = 0.017), respectively. Anti-HDV or anti-HCV antibodies were detected more frequently in patients with cirrhosis. Fifty percent of NINs with cirrhosis were aged below 45 years. Conclusion: The study offers an insight into the evolving burden of chronic hepatitis B virus infection in the near future and highlights new territories for public health interventions

Predictive Value of MR-proADM in the Risk Stratification and in the Adequate Care Setting of COVID-19 Patients Assessed at the Triage of the Emergency Department

In the past two pandemic years, Emergency Departments (ED) have been overrun with COVID-19-suspicious patients. Some data on the role played by laboratory biomarkers in the early risk stratification of COVID-19 patients have been recently published. The aim of this study is to assess the potential role of the new biomarker mid-regional proadrenomedullin (MR-proADM) in stratifying the in-hospital mortality risk of COVID-19 patients at the triage. A further goal of the present study is to evaluate whether MR-proADM together with other biochemical markers could play a key role in assessing the correct care level of these patients. Data from 321 consecutive patients admitted to the triage of the ED with a COVID-19 infection were analyzed. Epidemiological; demographic; clinical; laboratory; and outcome data were assessed. All the biomarkers analyzed showed an important role in predicting mortality. In particular, an increase of MR-proADM level at ED admission was independently associated with a threefold higher risk of IMV. MR-proADM showed greater ROC curves and AUC when compared to other laboratory biomarkers for the primary endpoint such as in-hospital mortality, except for CRP. This study shows that MR-proADM seems to be particularly effective for early predicting mortality and the need of ventilation in COVID-19 patients admitted to the ED