Business Intelligence per la Supply Chain

Si presenta un caso d'uso di Business Intelligence per misurare e controllare le prestazioni di una Supply Chain, con lo scopo di ottimizzare le decisioni aziendali. Si descrive inizialmente la struttura della rete logistica, la gestione della catena logistica d'approvvigionamento e di distribuzione. Approfondendo il campo d’indagine, il lavoro, successivamente, si concentra sullo studio dell’analisi di scorte e flussi logistici di un caso aziendale reale, presentando i risultati di implementazione di un sistema di reporting e dei possibili sviluppi futuri

Comparison of the TaqMan and LightCycler systems in pharmacogenetic testing: evaluation of the CYP2C9*2/*3 polymorphisms.

Background: Pharmacogenetic testing for drugmetabolizing enzymes is not yet widely used in clinical practice. Methods: In an attempt to facilitate the application of this procedure, we have compared two real-time PCRbased methods, the TaqMan_ and the LightCycler_ for the pharmacogenetic evaluation of CYP2C9*2/*3 polymorphisms. Results and Conclusion: Both procedures are suitable for pharmacogenetic studies. The TaqMan procedure was less expensive in terms of cost per sample, but the TaqMan apparatus is more expensive than the LightCycler apparatus

The NW sector of the Sicily Channel: geometry and evolution of inverted structural lineaments

The 3-D trend of anticline axial planes, fault planes and surfaces has been reconstructed in the offshore area between the Egadi Islands and the Sciacca High from the interpretation of multichannel seismic reflection profiles and well data (available from the VIDEPI project database). In particular, isopach maps generated for the five seismic units of age between Cretaceous and Quaternary allowed highlighting the space-time migration of the tectonic processes. The western portion of the studied area covers the submerged prolongation of the inner sector of the Sicilian-Maghrebian chain, limited in the NW and in the SE by two tectonic lineaments running along the western and eastern margins of the Adventure Bank: the Maghrebian Thrust Front and Adventure Thrust Front, respectively (see Argnani et al., 1986). The eastern portion is characterized by transpressive zones orientated NNE-SSW identifying the Separation Belt that partly corresponds to the foreland area which contains the Gela Nappe Thrust. Age constraints indicate that contraction related to the Sicilian-Maghrebian fold and thrust belt migrated progressively towards the southeast. The emplacement of the western front is attributable to the Middle-Upper Miocene while that of the eastern front is Plio-Pleistocene. Within this tectonic framework, two tectonic basins were identified on the basis of the different trend, age and evolution. The Adventure foredeep exhibits the maximum thickness of 500 m in correspondence of the Adventure Plateau. Here, the younger Gela foredeep displays minor depth showing a thickness increase towards the Gela Nappe and the Pantelleria graben. Positive inversion structures form by the Plio-Pleistocene compressional reactivation of preexisting structures limiting the Saccense and Trapanese domains were recognized the offshore sector between Mazara and Sciacca. Moreover, a correlation between the Campobello di Mazara-Castelvetrano alignment as proposed by Barreca et al., 2013, Ferranti et al., this meeting, and the tectonic units recognized in their offshore prolongation has been recognized. Therefore, we propose that in this area contractional tectonics is still active (see also Pepe et al., this meeting), and occurs on high-angle, NW-dipping crustal ramps (Monaco et al., 1996)

Architecture and Pliocene to Recent evolution of the offshore prolongation of the Granitola - Castelvetrano Thrust System (Sicily Channel)

High-resolution, seismic profiles were recorded in the offshore of Mazara - Punta Granitola with the purpose of reconstructing the architecture and Pliocene to Recent evolution of the south-west prolongation of the Granitola- Castelvetrano Thrust System, identified as an active structure possibly related to destructive historical earthquakes (Barreca et al., 2014; Ferranti et al., this meeting). A number of seismic units were identified. The oldest one is interpreted as representative of the Lower Pliocene pelagic deposits known in the region as Trubi. Lower-middle Pleistocene calcarenites are widespread along the continental shelf (CS) between Mazara del Vallo while their top rapidly deepens moving southeast-ward Capo Granitola. In this area, lower-middle Pleistocene calcarenites are unconformably overlain by the late Pleistocene- Holocene deposits. These latter are thin or absent NW of Punta Granitola along the CS, at water depth less than ~30 m, suggesting that this sector experienced uplift during the Quaternary. Small scale, NW- and SE-displacing reverse faults are observed along the CS where they cut the lower-middle Pleistocene calcarenites and offset the seafloor. South-eastwards, south-east-verging, reverse faults affect lower-middle Pleistocene calcarenites as well as the late Pleistocene-Holocene layers, suggesting that fault displacement acted during the post-LGM. Growth folding of Upper Pleistocene-Holocene deposits and thrust faults, predominantly dipping to the NW, affecting Pliocene rocks are observed in the immediate offshore Capo Granitola. The integration of the new data with those obtained from multi-channel profiles suggests that the active folds and thrusts are the uppermost expression of steep crustal ramps (Monaco et al., 1996; Lavecchia et al., 2007; Meccariello et al., this meeting) which upthrust the Saccense platform at depth

Tonsillectomy and residents: a safe match?

Letter to the Edito

Dissection with harmonic scalpel versus cold instruments in parotid surgery.

The harmonic scalpel (HS) has been used successfully in several head and neck surgical procedures. Some authors highlighted its advantages in reducing operative time, blood loss, and damages to surrounding tissue. In our study, we compared the results obtained during parotidectomy using the HS with the traditional approach to determine the benefits of the HS.130 patients with benign parotid tumors were enrolled and randomized into two groups for this prospective study. 63 patients underwent HS parotidectomy, and 67 patients received a parotidectomy using cold instruments and bipolar electrocautery hemostatic control (CI). 20 HS and 2 CI patients did not meet the inclusion criteria requirements, and were excluded.The admission time was significantly shorter in the HS group than the CI group (3.9 ± 1.2 days and 4.7 ± 1.4 days, respectively, p < 0.01). In the early post-operative period, 84\% of HS patients and 60\% of CI cases showed no facial nerve impairment (p = 0.01). Significantly more CI patients than HS patients showed the onset of Frey's syndrome (29\% and 9\%, respectively, p = 0.01). Multivariate stepwise regression analysis confirmed the reduction in admission length (Odds Ratio (OR): 0.62; p = 0.02) and the lower risk of Frey's syndrome (OR: 0.29; p = 0.04) in HS compared to CI parotidectomies.In parotid surgery, the HS is useful in preventing Frey's syndrome and reducing early transitory facial nerve dysfunction and admission times, and results in decreased medical costs and increased quality of life

Long-term subjective outcomes of barbed reposition pharyngoplasty for obstructive sleep apnea syndrome treatment

Background: The purpose of this study was to evaluate long-term subjective outcomes of barbed reposition pharyngoplasty for obstructive sleep apnea syndrome (OSAS) treatment using a specific questionnaire, the Palate Postoperative Problem Score (PPOPS). Methods: 140 patients who underwent barbed reposition pharyngoplasty (BRP) surgery in the Morgagni Pierantoni Hospital of Forlì, Italy were enrolled in the study. Postoperative outcomes were evaluated in a short- and long-term follow-up using the PPOPS questionnaire. The average period of follow-up was 26 months. All patients received the PPOPS questionnaire by telephone in a period between April and August 2019. Results: 51% of patients complained of swallowing problems after surgery. In 91% of cases, the problem cleared up spontaneously. At the time of the interview, only 9% of patients had a residual swallowing difficult. At the time of PPOPS evaluation, rhinolalia was observed in 8% of patients, whereas nose regurgitation was present in 2% of patients. In 20% of patients, the foreign body sensation was present during follow-up. The value of apnea-hypopnea index (AHI) reduced from the preoperative value of 31.5 to the postoperative value of 11.4. Conclusions: BRP surgery proved to be an effective technique, appreciated by the majority of patients. Use of the PPOPS questionnaire has demonstrated that the BRP technique seems to ensure efficacy and lower morbidity, with few complications after surgery

Is open tracheotomy performed by residents in otorhinolaryngology a safe procedure? a retrospective cohort study.

Surgical or percutaneous tracheotomy is one of the commonest operations in the ENT practice and one of the first procedures to be taught to residents. No study exists that demonstrates the safety of this surgical procedure performed by unexperienced surgeons. The purpose was to compare outcomes of tracheotomies performed by supervised residents and surgeons in terms of postoperative complications and mortality, and identify risk factors for the onset of complications. Retrospective cohort study. Otolaryngology-Head and Neck Surgery Department, University of Florence, Italy. We included all patients undergoing tracheotomy from July 2008 to January 2013 and compared tracheotomies performed by supervised residents or surgeons. During the study period, 304 patients were submitted to tracheotomy. Patients operated by surgeons had a significantly higher number of tracheal rings fracture (p = 0.05), subcutaneous emphysema (p = 0.003) and tracheostomy tube displacement (p = 0.003), while supervised residents had a higher number of tracheitis/pneumonia (p = 0.04) as early complications. Patients operated by supervised residents had a significantly higher number of tube obstructions as late complication (p = 0.04). Using multivariate model, risk factors for early postoperative complications were male sex (p = 0.04) and delayed time to substitution with cuffless tube (p = 0.01), while only a trend to statistical significance was observed for urgent tracheotomies concerning the risk for late postoperative complications (p = 0.08). The current practice where residents perform tracheotomies supervised by a surgeon should not be disheartened. Our study demonstrates that it is safe and does not lead to higher risk of complications nor negatively affects the quality of care

Allergic fungal rhinosinusitis infiltrating anterior skull base and clivus.

Bone erosion and skull base invasion are often suggestive of a malignant mass in paranasal and nasal cavities. Nevertheless, forms of chronic rhinosinusitis, such as allergic fungal rhinosinusitis (AFRS), could mimic malignant features. Here, we report AFRS patient with orbital, anterior cranial fossa, Turkish saddle and clivus erosion. A 48-year-old Caucasian female with history of drug-resistant headache, nasal obstruction and anosmia was referred to our institution. Imaging showed hyperdense featureless tissue with signs of medial orbital wall, cribiform lamina and clivus erosions and encasement of right internal carotid artery. Massive amounts of thick and grayish mucoid material were evacuated during surgery. In case of bony erosion, malignancy should always be excluded. Often the correct diagnosis will be obtained only by operative specimens. AFRS could usually be managed endoscopically. Appropriate medical management of the AFRS should be administered in order to prevent relapses

Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer?

To assess the clinical utility of elective neck dissection in node-negative recurrent laryngeal carcinoma after curative radiotherapy for initial early glottic cancer.A retrospective review was undertaken of 110 consecutive early glottic cancer patients who developed laryngeal recurrence after radiotherapy (34 recurrent T1, 36 recurrent T2, 29 recurrent T3 and 11 recurrent T4a) and received salvage laryngeal surgery between 1995 and 2005.Six patients presented with laryngeal and neck recurrence and underwent salvage laryngectomy with therapeutic neck dissection, 97 patients with recurrent node-negative tumours underwent salvage laryngeal surgery without neck dissection and only 7 underwent elective neck dissection. No occult positive lymph nodes were documented in neck dissection specimens. During follow up, only three patients with neck failure were recorded, all in the group without neck dissection. There was no significant association between the irradiation field (larynx plus neck vs larynx) and the development of regional failure. A higher rate of post-operative pharyngocutaneous fistula development occurred in the neck dissection group than in the group without neck dissection (57.2 per cent vs. 13.4 per cent, p = 0.01). Multivariate logistic regression analysis showed that early (recurrent tumour-positive, node-positive) or delayed (recurrent tumour-positive, node-negative) neck relapse was not significantly related to the stage of the initial tumour or the recurrent tumour. An age of less than 60 years was significantly associated with early neck failure (recurrent tumour-positive, node-positive).Owing to the low occult neck disease rate and high post-operative fistula rate, elective neck dissection is not recommended for recurrent node-negative laryngeal tumours after radiation therapy if the initial tumour was an early glottic cancer