Optimization and public transport tendering: a case study in Southern Italy.

This article presents a multi-start heuristic approach to a design problem motivated by a real-world application in the Italian transport system. Specifically, it focuses on the problem of designing optimal lots in the public transport organization. In defining lots (in terms of number, size, and boundaries) both cost and service level have to be considered. Under certain assumptions, we model the problem as a graph partitioning problem and consider the same performance measure indicated by the relevant decree-law enacted by the Italian Ministry of Transport. The multi-start algorithm proposed for individuating high-quality solutions for the problem uses adaptive large neighbourhood search. The results of a computational study based on real data from a region in Southern Italy are reported.

Laparoscopic ventral hernia repair: Results of a two thousand patients prospective multicentric database.

Laparoscopic incisional and ventral hernia repair (LIVHR) has been largely employed by the surgical community worldwide, despite the use of different types of mesh and fixation devices. A large nationwide prospective multicentric database collected 2005 operations from 8 high-volume centers, to investigate the perioeperative and long-term outcomes. The laparoscopic operations were completed in 1979 patients (98.7%), with a mean age of 60.7 years and a Body Mass Index of 28.8 kg/m2. Two hundred and one patient (18.8%) had a previous failed open repair. The average surface areas of the major defects were 47.4 and 18.2 cm 2 for postincisional and primary hernias. The mean operation time and postoperative stay were 94.4 min and s 3.7 days, respectively. We collected a total of 50 (2.5%) intraoperative and 414 (20.6%) postoperative complications, with reoperation needed in 38 cases (1.8%). After a mean follow-up period of 24 months, we recorded 62 (3.8%) confirmed recurrences. Length of surgery, hospital stay, and a previous recurrence were all risk factors for recurrence. Primary hernias had better perioperative outcomes compared to incisional hernias, except for the pain. The laparoscopic approach of both post-incisional and primary hernias seemed to be safe and feasible in short-to medium-term periods.

Intraoperative finding of Amyand's hernia in a recurrent inguinal hernia: report of a case.

INTRODUCTION: The finding of the vermiform appendix within an inguinal hernia is a rare entity 2,3. An inflamed or non-inflamed vermiform appendix in an inguinal hernia sac is named Amyand's hernia in honor to the surgeon Claudius Amyand who published the first case of perforated appendicitis within inguinal hernia in a boy caused by ingested pin. OBJECTIVE: The aim of this study was to report our intraoperative findings with this entity. MATERIAL AND METHODS: We report a case of 47 year old male patient with a recurrent right inguinal hernia. We were not able to review the previous operative notes . The patient underwent an elective redo-redo inguinal hernia repair under local anesthesia with I.V. sedation; a normal appearing appendix with an adhesive plug were explored within a direct hernia sac. Adhesions were divided by sharp dissection, an appendectomy was performed and the plug excised. A modified Bassini repair was performed and the patient admitted to the hospital. RESULTS: The patient's postoperative course was unremarkable; he was discharged home on postoperative day 3. At one week follow-up we found no complications. CONCLUSION: The finding of the appendix in an inguinal hernia is a rare entity that is difficult to diagnose preoperatively. Treatment includes appendectomy and herniorraphy. The use of prosthetic mesh depends on the status of the appendix, patient's condition and hernia findings.

Does endothelial nitric oxide synthase gene variation play a role in the occurrence of hypertension in pregnancy?

OBJECTIVE: Nitric oxide is suggested to play a role in the development of preeclampsia. METHODS: We studied 61 patients with gestational hypertension (GH), 77 with GH and significant proteinuria (urine protein excretion > or = 300 mg/24 h), 82 with essential hypertension (EH) and 188 normotensive women with at least one normal pregnancy. MAIN OUTCOME MEASURE(S): A polymorphism within the constitutive endothelial nitric oxide synthase (ecNOS) gene in various types of hypertension in pregnancy was explored. RESULTS: Allelic and genotypic frequencies did not differ between controls and case groups. A significant difference was observed between the frequency of the rare allele in GH patients and that in EH group (chi2: 4.47, P <.04). This difference approximated the significance when GH subjects with or without proteinuria were grouped (chi2 square: 3.33; P =.068). Cigarette smoking or gravidity did not interact with the ecNOS polymorphism in identifying different types of hypertension in this setting. CONCLUSION: Our findings argue against an association between ecNOS polymorphism and preeclampsia and support the hypothesis for a different pathogenesis of GH in respect to EH.

Preventing adverse obstetric outcomes in women with genetic thrombophilia.

OBJECTIVE: To improve fetomaternal outcomes in women with obstetric complications and inherited causes of thrombophilia. DESIGN: Clinical trial. SETTING: Thrombophilic women with previous unexplained adverse outcomes. PATIENT(S): Twenty-five women with previous severe obstetric complications were treated during and after pregnancy. INTERVENTION(S): Low fixed dose of heparin or aspirin. MAIN OUTCOME MEASURE(S): Fetomaternal outcome. RESULT(S): Low fixed dose of heparin were administered to 24 pregnant women, aspirin to 7. Overall, among 31 treated pregnant women, 28 (90.3%) compared to 4 of 58 (6.9%) in previous pregnancies had a good obstetric outcome. Two fetal losses <14 weeks gestation and a fetal growth restriction were registered. All newborns, except one, were in the tenth centile or above. All babies were discharged in good clinical status. In the treated pregnancies, no thrombosis or pharmacological side effect was recorded. CONCLUSION(S): Heparin prophylaxis at fixed low doses and possibly aspirin could be efficacious in preventing adverse outcomes in women carrying inherited thrombophilia with previous poor obstetric outcomes.

Lower birth-weight in neonates of mothers carrying factor V G1691A and factor II A(20210) mutations.

BACKGROUND AND OBJECTIVES: Inherited thrombophilia has been associated with fetal and maternal complications of pregnancy. It is reasonable to suppose that an imbalance of maternal hemostasis could lead to decreased fetal growth. DESIGN AND METHODS: We retrospectively investigated the birth-weight of neonates in relation to the presence of factor V G1691A and factor II A(20210) mutations in the mothers. Overall, 755 women (194 with a history of unexplained recurrent pregnancy loss, 202 with gestational hypertension with or without proteinuria, 359 with at least one uneventful pregnancy) and 1100 alive neonates were considered. RESULTS: Among 980 neonates from mothers without mutations, 136 (13.9%) weighed <2500 grams, whereas 34 out 123 (27.6%) neonates from mothers carrying the factor V G1691A or factor II A(20210) mutation were under this birth-weight (OR: 2.4, 95%CI: 1.5- 3.7). Adjusting for diagnosis, parity, and age, the risk of having a baby <2500 grams was 2.0 (95%CI: 1.1-3.6) in women carrying factor V G1691A or factor II A(20210) mutation. When we analyzed all the neonates according to growth centiles and the presence of a thrombophilic mutation in the mothers, we found 142 (14.5%) and 28 (22.8%) neonates under the 10th centile from mothers without and with thrombophilic mutations, respectively (OR: 1.7, 95%-CI: 1.1-2.7). Adjusting for confounding variables (diagnosis, parity and age), the association between thrombophilic mutations and <10th growth centile did not change (OR: 1.7, 95% CI: 1.0-3.0). INTERPRETATION AND CONCLUSIONS: Mothers carrying the factor V G1691A or factor II A(20210) mutation have a significantly higher risk of delivering neonates with a lower birth-weight.