True and false aneurysms (FA) of the subclavian artery are at high risk of rupture due to their localization and proximity/closeness to the articular bone structures of the upper thoracic outlet and shoulders. Surgical and endovascular treatments are good options to avoid complications such as aneurysms rupture, thrombosis and distal embolism alone or in combination. Self-expandable (SE) covered stents are the most used devices for the treatment of subclavian artery aneurysms. We report on a case of post traumatic left intra-thoracic subclavian artery FA treated using endovascular technique, highlighting the usefulness of the new covered Gore Viabahn VBX-BE stent-graft that combines the advantages of a high radial strength of a BE stent with the deliverability and conformability of a SE stent.

Background and aim:Chronic rhinosinusitis (CRS) is a chronic and recurrent disease that negatively affects patients’ quality of life. CRS has two main phenotypes: CRS with nasal polyps (CRSwNP) and CRS without polyps (CRSsNP). Minimal research has been conducted to study the variability in patients’ characteristics. Therefore, we conducted this study to examine these differences.Methods:A retrospective cohort study included patients with both CRSwNP and CRSsNP. Outcomes included symptom severity, radiographic severity, and number of sinus surgeries. Symptom severity was assessed using the Sino-nasal Outcome Test and the Lund-Mackay CT score was used to determine radiographic severity. Further subgroup analysis was done based on the presence or absence of comorbid asthma.Results:A total of 110 and 106 patients were included in the CRSwNP and CRSsNP groups, respectively. The mean age in the CRSwNP and CRSsNP groups was 50.2 and 48.7, and the proportion of female patients was 40.9% and 58.5%, respectively. No significant difference in symptom severity was noted between CRSwNP and CRSsNP group (68.1±18.6 vs. 73.2±21.27; P=0.097), while the Lund-Mackay score was significantly lower in the CRSsNP group (7.4±2.3 vs. 11.9±3.6; P=0.016). Also, the number of surgeries was significantly lower in the CRSsNP group as compared to the CRSwNP group (P=0.023). Subgroup analysis revealed statistically significant differences between those with and without asthma in patients with CRSwNP in terms of Lund-Mackay scores and number of surgeries (P=0.038 and 0.043), respectively. However, no significant differences were noted in the CRSsNP group (P>0.05).Conclusions:There is a clear variability in the characteristics of patients with CRSsNP and CRSwNP. A similar difference was noted in the CRSwNP group when patients were stratified based on the presence of absence of asthma. This warrants further investigation of potential correlation with the prognosis and optimum treatment strategies of this patient population (www.actabiomedica.it)

Background:The need to determine prognostic factors that can predict a particularly severe or, conversely, the benign course of COVID-19 is particularly perceived in the Emergency Department (ED), considering the scarcity of resources for a conspicuous mass of patients. The aim of our study was to identify some predictors for 30-day mortality among some clinical, laboratory, and ultrasound variables in a COVID-19 patients population.Methods:Prospective single-center pilot study conducted in an ED of an University Hospital. A consecutive sample of confirmed COVID-19 patients with acute respiratory failure was enrolled from March 8th, to April 15th, 2020.Results:143 patients were enrolled. Deceased patients (n = 65) were older (81 vs. 61 years, p <0.001), and they had more frequently a history of heart disease, neurological disease, or chronic obstructive pulmonary disease (p-values = 0.026, 0.025, and 0.034, respectively) than survived patients. Troponin I and presepsin had a significant correlation with a worse outcome. Troponin achieved a sensitivity of 77% and a specificity of 82% for a cut-off value of 27.6 ng/L. The presepsin achieved a sensitivity of 54% and a specificity of 92% for a cut-off value of 871 pg/mL.Conclusion:In a population of COVID-19 patients with acute respiratory failure in an ED, presepsin and troponin I are accurate predictors of 30-day mortality. Presepsin is highly specific and could permit the early identification of patients who could benefit from more intensive care as soon as they enter the ED. Further validation studies are needed to confirm this result. (www.actabiomedica.it)

Learning-to-Rank models based on additive ensembles of regression trees have been proven to be very effective for scoring query results returned by large-scale Web search engines. Unfortunately, the computational cost of scoring thousands of candidate documents by traversing large ensembles of trees is high. Thus, several works have investigated solutions aimed at improving the efficiency of document scoring by exploiting advanced features of modern CPUs and memory hierarchies. In this article, we present Q uick S corer , a new algorithm that adopts a novel cache-efficient representation of a given tree ensemble, performs an interleaved traversal by means of fast bitwise operations, and supports ensembles of oblivious trees. An extensive and detailed test assessment is conducted on two standard Learning-to-Rank datasets and on a novel very large dataset we made publicly available for conducting significant efficiency tests. The experiments show unprecedented speedups over the best state-of-the-art baselines ranging from 1.9 × to 6.6 × . The analysis of low-level profiling traces shows that Q uick S corer efficiency is due to its cache-aware approach in terms of both data layout and access patterns and to a control flow that entails very low branch mis-prediction rates.

In this paper we present the design, implementation and experimental evaluation of Kerberos, an architecture for the detection of frauds in current generation Voice over IP (VoIP) networks. Kerberos is fed by an On-line Charging System (OCS) generating events associated with the setup, evolution and tear-down of end-user calls in a VoIP network compliant with the IP Multimedia Subsystem (IMS) specification. Such events are properly correlated in order to identify, in real-time, patterns associated with a fraudulent utilization of the Operator's resources. The detection phase can in turn trigger the subsequent remediation actions. Communication between the OCS and Kerberos is based on an asynchronous paradigm, whereas event correlation and analysis are effectively realized through a Complex Event Processing approach. The paper will shed light on both the design and the implementation of the system, whose performance is then evaluated by relying on a real-world dataset of Call Detail Record (CDR) events provided by Tiscali, a well known Italian Operator.

Bill Jordan and Mark Drakeford, Basingstoke, Palgrave Macmillan, 2012, 212 pp., £22.99, ISBN: 1981137020635 (pbk.) At the 2013 World Economic Forum in Davos, Christine Lagarde, the head of the Inte...

This paper concerns the problem of minimizing the maximum link utilization of IP telecommunication networks under the joint use of traditional IGP routing protocols, such as IS–IS and OSPF, and the more sophisticated MPLS-TE technology. It is shown that the problem of choosing the optimal routing, both under working conditions and under single link failure scenarios, can be cast as a linear program of reasonable size. The proposed model is validated by a computational experimentation performed on synthetic and real networks: the obtained results show that the new approach considerably reduces the maximum link utilization of the network with respect to simply optimizing the IGP weights, at the cost of adding a limited number of label switched paths (LSPs). Optimizing the set of IGP weights within the overall approach further improves performances. The computational time needed to solve the models matches well with real-time requirements, and makes it possible to consider network design problems.

Abstract The Sardinian Cainozoic rifted basin is a useful model for studying the stratigraphic response to the Oligo-Miocene structural extension in the western Mediterranean because it allows precise observations on the relationship between sedimentation and normal faulting based on outcrops and seismic reflection data. The purpose of this paper, essentially of stratigraphic nature is to propose a chronology as precise as possible of the tectonic events and of the sedimentary formations. Indeed the tectono-sedimentary framework is complex, characterized by an extreme facies variability, from continental to marginal transitional and to marine environments (shallow-water, hemipelagic). Rifting, active calc-alkaline volcanism and sea-level changes caused rapid physiographical evolution, which controlled progressive marine ingression. New chronobiostratigraphical data presented in this paper allow correlating the sequences, defining their environment and depth of deposition and specifying precisely the timing of pre-, syn-, and post-rift stages in the Oligo-Miocene graben system. In southwestern Sardinia during the middle-late Eocene, after the Pyrenean phase, a continental graben (Cixerri), W-E oriented, preceded the Oligo-Miocene extension, which reactivated inherited Eocene and Palaeozoic faults. The calc-alkaline volcanic activity ranging from 32 to 13 Ma, provides a good estimate for the time span of the west-dipping Apenninic subduction responsible for the continental extension and the oceanic accretion in the western Mediterranean. In Sardinia the Oligo-Miocene extensional tectonics started in a continental environment, preceding the earliest calc-alkaline volcanic products (32 Ma). The marine ingression is dated to the late Chattian-Aquitanian interval and corresponds to a rapid deepening of the Oligo-Miocene graben system of tectonic origin. The end of the rifting i.e. the end of normal faulting activity is pre-middle Burdigalian in age. When Sardinia was in the post-rift stage, extension continued until late Burdigalian – Langhian in the Algero-Provençal basin with oceanic accretion and rotation of the Corsica-Sardinia block (CSB).

A malposition of the median arcuate ligament (MAL) is a rare entity causing the celiac axis compression syndrome (CACS), first described by Harjola in 1963. The presence of anomalous fibrous diaphragmatic bands of the diaphragm compresses the celiac axis, especially during the expiration. In this report we present the fourth case in literature that was ever successfully treated by laparoscopy. A 38-year-old male presented with a history of intermittent epigastric pain, 15 kg weight loss caused by inappetence and frequent diarrhoea, over a 5-year period. The clinical examination revealed only a loud systolic bruit in the epigastrium, with loss of intensity during deep inspiration. Suspecting CACS, a spiral CT angiography was requested. The CT demonstrated the MAL crossing anteriorly to the celiac artery (CA) and the sagittal and the tridimensional reconstructions demonstrated the CA narrowing due to compression, while the superior mesenteric artery (SMA) was normal. The MAL was laparoscopically divided, releasing the celiac axis. The surgical time was 130 minutes, without significant blood losses. At 3-months follow-up, the CT-scan demonstrated no evidence of CACS with complete recovery.