In our experience, the use of VAC therapy for the management of SWD was considerably effective in decreasing mortality (SWD related), incidence of complications and need for surgical procedures; thus, leading to a significant reduction of costs.

Decarbonizing the cold chain is a priority for sustainability due to the increasing demand for chilled/frozen food and pharmaceutics. Refrigerated transport requires additional fuel for refrigeration other than for traction. Photovoltaic panels on the vehicle rooftop, a battery bank, and a power conversion system can replace the diesel engine driving the transport refrigerated unit. In long-haul deliveries, vehicles cross zones with different climate conditions, which affect both refrigeration requirements and photovoltaic energy conversion. Mandatory driver’s breaks and rest also affect delivery timing and energy consumption. A multiperiod, multizone optimization model is developed to size the onboard photovoltaic system, based on features of the delivery tour. The model is applied to a palletized chilled food delivery from North-Eastern Italy, showing a payback time of around four years, which can drop under two years for expected reduction of component costs. Economic and environmental performances can be increased by also allowing refrigerated products on-board during the return journey, leading to more fuel savings. Photovoltaic-integrated long-haul delivery for frozen products is not convenient at current market costs. Different climate conditions are tested, showing the model ability to act as a decision support tool to foster renewable energy penetration into the cold chain.

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Background and aim: Hemocompatibility of left ventricular assist devices (LVADs) represents one of their main target. Currently, third generation-fully-magnetically-levitated LVAD (HeartMate 3, HM3) has shown high hemocompatibility. Aim of this retrospective study was to evaluate the impact of different antithrombotic strategies in HM3 patients. Methods: Patients were monitored by clinical evaluation, classical laboratory, thromboelastometry (ROTEM) and aggregometry (Multiplate) in the postoperative period and at follow-up. Based on therapeutic options, our population (=25 patients, from November 2015 to March 2018) wad divided in: Group A (=15 patients, 60%) with antiplatelet + anticoagulant medications and Group B (=10 patients, 40%) with anticoagulant medication alone. Primary outcome was freedom from thromboembolic and/or hemorrhagic events. For the assessment of asymptomatic neurologic events, patients were explored with MiniMental-State-Examination (MMSE) and Brief-Neuropsychological-Examination 2 (ENB2). Results: At surgery, mean age was 61.5 ± 5.6 years and 4 patients (16%)were in INTERMACS profile 1, 15 (60%) in profile 2–3 and 6 (24%) in profile 4. Overall 10 patients (Group A = 9, 40% vs Group B = 1, 10%, p = 0.0177) had bleedings. In particular, cerebral hemorrhage in 1 (Group A), gastrointestinal bleeding in 5 (Group A), late onset chest bleeding in 2 (Group A), minor bleeding in 6 (5 Group A, 1 Group B). No thromboembolic events were reported. At follow-up ENB2 showed significant improvement of patients’ neuropsychological performance (p = 0.006), whereas MMSE results remained stable (p = 0.1). Conclusions: Heartmate 3 is a highly hemocompatible device. In our experience, anticoagulation alone is a safe and effective therapy as it prevents both thrombotic and hemorrhagic events.