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The assessment of the structural safety of buildings, with the related outcomes and other structural information, is typically reported in un-structured sets of documents (tables, drawings, reports, etc.). This happens even if Building Information Modelling (BIM) workflows, platforms, and standards are adopted. Generally, the BIM database provides input data for the structural design, but most of the data produced by structural designers, according to the structural codes, do not fully integrate into the BIM database along with other context-related information. These data are not easily recorded, especially in openBIM standard file formats such as Industry Foundation Classes (IFC). In the context of digital procedures for permit applications pertaining to seismic structural engineering, the authors propose an openBIM approach for the integration of structural information to support the activities of building authorities’ bodies (BABs). The proposed framework has led to the development of an Information Delivery Manual (IDM) and a Model View Definition (MVD), considering the IFC schema, for the integration and exchange of information within a BIM-based environment. Successively, the authors implemented the proposed IDM/MVD solution in a case study that provided an effective workflow for innovative future delivery of necessary information to building authorities to obtain seismic authorization permits.

There has been a significant increase in studies related to Industry 4.0 alongside the development of new technologies, devices and software, becoming one of the most relevant topics for years within the so-called Fourth Industrial Revolution (4IR). The Architecture, Engineering and Construction sector (AEC) sector is one step behind other engineering fields in productivity, and digitalisation can help reduce this gap. Building Information Modelling (BIM) implementation in various project phases with other technologies such as the Internet of Things, Big Data, Blockchain or Geographic Information System (GIS) are the main drivers of Smart Construction. This paper provides an updated state-of-art of the BIM applications through different civil engineering projects and towards the use of new Information and Communication Technologies (ICTs). Hence, the integration of BIM in the Facility Management through ICTs allows decision making based on data analysis and the optimization of available resources.

This paper investigates the creation and use of integrated IFC models to modernise traditional processes for applications to building authorities for structural engineering approvals and permits. First, we provide a brief overview of e-permit systems in the AEC sector, with the focus on solutions that implement openBIM standards like IFC, MVD, and IDM. Second, we conduct a study on the information requirements of Italy’s seismic-authorisation processes relating specifically to the field of structural engineering. Third, we describe preliminary research on defining the structural engineering information that needs to be incorporated in the IFC format for e-permitting scopes. Fourth, we present our early work on the development of an MVD that would enable the automatic extraction of integrated IFC models. Fifth, we illustrate the reference workflow of the Str.E.Pe. project and propose a preliminary proof-of-concept that makes use of an IFC model, which has been integrated with structural information to support the activities of the building authority in Avellino. The officers there have developed a SWOT analysis using IFC models to assist them in assessing the compliance of structural projects with seismic requirements. Finally, the paper sets out additional research we intend to undertake and our conclusions.

Regulatory activity concerning the management of existing bridges has recently been affected by updates, for instance, in Italy, which calls for a speedy and pragmatic approach based on new technologies such as building information modeling (BIM), when dealing with the survey and risk classification as well as the evaluation and monitoring of structural safety. This paper focuses on the development and integration of a digital solution, based principally on the specific framework developed by the authors, which supports BIM modeling and information management activities, in the structural setting under investigation, through the use of several technologies and tools, namely BIM-authoring, CDE platform and visual programming, in addition to programming in Python. Starting from the organization of a specific BIM object library and the initial data, inserted by means of a custom-made input environment, it was possible to reproduce digital models of bridges in accordance with specific information requirements following the new Level of Information Need setting. The applicability of the proposal is tested on two judiciously chosen real-life cases with different characteristics. Through this implementation, a series of advantages emerge, including expediting traditional procedures for BIM modeling, accessibility and traceability of information—which are constantly updated to support the monitoring of structural safety over time—and the decision-making process related to the bridge management context.

In the field of infrastructure, the development and application of the openBIM (open Building Information Modeling) approach and related standards (principally Industry Foundation Classes) remain limited with regard to processes in O&M (Operation and Maintenance) phases, as well as the broader context of AM (Asset Management). This article deals with the activities carried out as part of a pilot project based on the need to manage the operation and assess the condition and value of existing infrastructure along the Cancello–Benevento railway line. The principal goal was to systematize information by digitalizing the infrastructure, in order to enable the assessment of possible performance gaps (compared to national railway standards) in the event of integration within the national infrastructure. In compliance with the project requirements, a digitalization strategy was designed for the definition of surveying activities and the implementation of openBIM systems for the development of an object library and a federated digital model, structured within the collaborative platform that was used, and allowing management, maintenance, and subsequent financial evaluation in the broader context of asset management. The project involved the collaboration of railway operators, a university, and a software company that implemented innovative concepts concerning IFC (specifically, IFC4x2 was used) through the development of dedicated software solutions. The digital solution we proposed enabled the use of digital models as access keys to survey and maintenance information (ERP platforms used by the railway operators) that was available in real time. This project was nominated at the buildingSMART awards 2021 and was one of three finalists in the “Asset Management Using openBIM” category.

Up to 40% of elderly patients with untreated diffuse large B-cell lymphoma (DLBCL) given a regimen of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone every 21 days (R-CHOP21) relapse or develop refractory disease. Lenalidomide has high activity in relapsed or refractory aggressive B-cell lymphomas. In phase 2 of the REAL07 trial, we aimed to establish the safety and efficacy of the combination of lenalidomide and R-CHOP21 in elderly patients with untreated DLBCL. REAL07 was an open-label, multicentre trial that was done in 13 centres in Italy and one in Germany. Eligible patients were aged 60–80 years; had newly diagnosed, untreated, CD20-positive, Ann Arbor stage II–IV DLBCL or grade 3b follicular lymphoma; had an Eastern Cooperative Oncology Group performance status of 0–2; had an International Prognostic Index (IPI) risk of low-intermediate, intermediate-high, or high; and were fit according to comprehensive geriatric assessment. Participants were to receive 15 mg oral lenalidomide on days 1–14 of six 21-day cycles, and standard doses of R-CHOP21 chemotherapy (375 mg/m2 intravenous rituximab, 750 mg/m2 intravenous cyclophosphamide, 50 mg/m2 intravenous doxorubicin, and 1·4 mg/m2 intravenous vincristine on day 1, and 40 mg/m2 oral prednisone on days 1–5). The primary endpoint was frequency of overall response (complete response [CR] and partial response [PR]), which was assessed by 18F-fluorodeoxyglucose (18F-FDG) PET at the end of the treatment. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00907348. 49 patients were included in phase 2: nine had been enrolled into phase 1 between Oct 23, 2008, and June 4, 2009, and had received the maximum tolerated dose of 15 mg lenalidomide; and 40 were enrolled into phase 2 between April 28, 2010, and June 3, 2011. 45 patients (92%, 95% CI 81–97) achieved a response (42 [86%] CR; three [6%] PR). Three patients (6%) did not respond and one (2%) died for reasons unrelated to treatment or disease. 277 (94%) of 294 planned cycles of lenalidomide and R-CHOP21 were completed. Grade 3–4 neutropenia was reported in 87 cycles (31%), grade 3–4 leukopenia in 77 (28%), and grade 3–4 thrombocytopenia in 35 (13%). No grade 4 non-haematological adverse events were reported. No patients died during the study as a result of toxic effects. Lenalidomide with R-CHOP21 is effective and safe in elderly patients with untreated DLBCL. Fondazione Italiana Linfomi and Celgene.

Background Mucosal healing (MH) evaluated by endoscopy is a novel target of therapy in UC as it is associated with improved long-term outcomes. It is defined based on the Mayo endoscopic score (MES), but it is still to define whether a value of MES 0 or 1 should be the target. The purpose of this paper is to present the results of a systematic review with meta-analysis which compares long-term outcomes of patients in steroid-free clinical remission with MES 0 with those with MES 1. Methods A systematic electronic search of the literature was performed using Medline, Scopus, and CENTRAL through December 2020 (PROSPERO n:CRD42020179333). The studies concerned UC patients, in steroid-free clinical remission, with MES of 0 or 1, and with at least 12-months of follow-up. Results Out of 4611 citations, 15 eligible studies were identified. Increases in clinical relapse among patients with MES 1 were observed in all the studies included in this review, suggesting that MES of 1 have a higher risk of relapse than a score of 0. MES 0 patients displayed a lower risk of clinical relapse (OR 0.33; 95% CI 0.26–0.43; I 2 13%) irrespective of the follow-up time (12-months or longer). On the other hand, no differences were found comparing MES 0 versus MES 1 about the risk of hospitalization or colectomy. Conclusions MES 0 is associated with a lower rate of clinical relapse than is MES 1. For this reason, MES 0, rather than MES 0–1, should be considered the therapeutic target for patients with UC.

The prognosis of young patients with diffuse large B-cell lymphoma at high risk (age-adjusted International Prognostic Index [aa-IPI] score 2 or 3) treated with R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisone) is poor. The aim of this study was to investigate the possible benefit of intensification with high-dose chemotherapy and autologous stem-cell transplantation as part of first-line treatment in these patients. We did a multicentre, open-label, randomised, controlled, phase 3 trial with a 2 × 2 factorial design to compare, at two different R-CHOP dose levels, a full course of rituximab-dose-dense chemotherapy (no transplantation group) versus an abbreviated course of rituximab-dose-dense chemotherapy followed by consolidation with R-MAD (rituximab plus high-dose cytarabine plus mitoxantrone plus dexamethasone) and high-dose BEAM chemotherapy (carmustine, etoposide, cytarabine, and melphalan) plus autologous stem-cell transplantation (transplantation group) in young patients (18–65 years) with untreated high-risk diffuse large B-cell lymphoma (aa-IPI score 2–3). At enrolment, patients were stratified according to aa-IPI score and randomly assigned (1:1:1:1) to receive R-CHOP (intravenous rituximab 375 mg/m2, cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, and vincristine 1·4 mg/m2 on day 1, plus oral prednisone 100 mg on days 1–5) delivered in a 14-day cycle (R-CHOP-14) for eight cycles; high-dose R-CHOP-14 (R-MegaCHOP-14; R-CHOP-14 except for cyclophosphamide 1200 mg/m2 and doxorubicin 70 mg/m2) for six cycles; R-CHOP-14 for four cycles followed by R-MAD (intravenous rituximab 375 mg/m2 on day 1 or 4 plus intravenous cytarabine 2000 mg/m2 and dexamethasone 4 mg/m2 every 12 h on days 1–3 plus intravenous mitoxantrone 8 mg/m2 on days 1–3) plus BEAM (intravenous carmustine 300 mg/m2 on day −7, intravenous cytarabine 200 mg/m2 twice a day on days −6 to −3, intravenous etoposide 100 mg/m2 twice a day on days −6 to −3, plus intravenous melphalan 140 mg/m2 on day −2) and autologous stem-cell transplantation (day 0); or R-MegaCHOP-14 for four cycles followed by R-MAD plus BEAM and autologous stem-cell transplantation. The primary endpoint was failure-free survival at 2 years in the intention-to-treat population. This study is registered with EudraCT (2005-002181-14; 2007-000275-42) and with ClinicalTrials.gov, number NCT00499018. Between Jan 10, 2006, and Sept 8, 2010, 399 patients were randomly assigned to receive transplantation (n=199) or no transplantation (n=200); 203 patients were assigned to receive R-CHOP-14 and 196 were assigned to receive R-MegaCHOP-14. With a median follow-up of 72 months (IQR 57–88), 2-year failure-free survival was 71% (95% CI 64–77) in the transplantation group versus 62% (95% CI 55–68) in the no transplantation group (hazard ratio [HR] 0·65 [95% CI 0·47–0·91]; stratified log-rank test p=0·012). No difference in 5-year overall survival was observed between these groups (78% [95% CI 71–83] versus 77% [71–83]; HR 0·98 [0·65–1·48]; stratified log-rank test p=0·91). Grade 3 or worse haematological adverse events were reported in 183 (92%) of 199 patients in the transplantation group versus 135 (68%) of 200 patients in the no transplantation group. Grade 3 or worse non-haematological adverse events were reported in 90 (45%) versus 31 (16%); the most common grade 3 or worse non-haematological adverse event was gastrointestinal (49 [25%] vs 19 [10%]). Treatment-related deaths occurred in 13 (3%) patients; eight in the transplantation group and five in the no transplantation group. Abbreviated rituximab-dose-dense chemotherapy plus R-MAD plus BEAM and autologous stem-cell transplantation reduced the risk of treatment failure compared with full course rituximab-dose-dense chemotherapy in young patients with diffuse large B-cell lymphoma at high risk. However, these results might not be clinically meaningful, since this improvement did not reflect an improvement in overall survival. These results do not support further consideration of the use of intensification of R-CHOP as an upfront strategy in patients with diffuse large B-cell lymphoma with poor prognosis. Fondazione Italiana Linfomi.

Background and Objectives: Conflicting evidence is reported regarding any association between colonic diverticula with colorectal adenomas or cancer. The present study aimed to evaluate, in a cohort of Caucasian patients, the association between colonic diverticula and colorectal polyps and cancer. Materials and Methods: All consecutive patients undergoing colonoscopy at our institution were included in the study. The presence and location of diverticula, polyps, and cancers were recorded. Histologically, polyps were classified as adenoma (with low or high dysplasia), hyperplastic, or inflammatory. The relative risk of the association of polyps and cancer with diverticula was assessed. Multiple logistic regression analyses, including age, sex, family history for colorectal cancer (CRC), and family history for diverticula, were carried out. Results: During the study period, 1490 patients were enrolled; 37.2% (n = 555) showed colonic diverticula or polyps or CRC (308 males, mean age 66 years). Particularly, 12.3% (n = 183) patients presented only diverticula, 13.7% (n = 204) only polyps or cancer, 11.3% (n = 168) both diseases, and 62.7% (n = 935) neither diverticula nor polyps and cancer. A total of 38 patients presented colorectal cancer, 17 of which had also diverticula. A significant increase in relative risk (RR 2.81, 95% CI 2.27–3.47, p < 0.0001) of colorectal adenoma and cancer in patients with colonic diverticula was found. At multivariate analysis, only diverticula resulted to be significantly associated with colorectal adenomas and cancer (Odds Ratio, OR 3.86, 95% CI 2.90–5.14, p < 0.0001). Conclusions: A significant association of colonic diverticula with colorectal adenoma or cancer was found. This implies that patients with colonic diverticula require a vigilant follow-up procedure for the prevention of colorectal cancer from those applicable to the general population.

Background and Aim: Many investigations have demonstrated that changes in body weight are frequent in patients with coeliac disease (CD) after a gluten-free diet (GFD); conversely data on the metabolic syndrome (MS) and hepatic steatosis (HS) are still rare. The aim is to evaluate the prevalence of MS and HS in patients with CD, before and after a GFD. Methods: One hundred eighty-five coeliac adult patients were enrolled in the study. Diagnosis of MS was made according to the current international criteria including waist circumference (WC), hypertension, reduction of high-density lipoprotein (HDL) cholesterol, hypertriglyceridemia, and hyperglycemia. Body mass index (BMI), hypercholesterolemia, and HS were also assessed. Results: CD patients showed an increased risk of developing both MS and HS after following a GFD. MS was reported in 3.24% of the cases at the time of CD diagnosis and in 14.59% after GFD (p < 0.0001). HS was reported in 1.7% at the time of diagnosis and in 11.1% after GFD (p < 0.0001). With regard to metabolic sub-categories, the prevalence of the increase in WC, hypertension, reduction of HDL cholesterol, hyperglycemia, hypercholesterolemia, and BMI > 25 was significantly higher after GFD compared to baseline at CD diagnosis. Conclusion: In CD patients, following a GFD maybe can contribute to the development of MS and HS. Patients should be informed about this possible risk.