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Abstract Background Approximately 5% of patients with an acute coronary syndrome are discharged from the emergency room with an erroneous diagnosis of non-cardiac chest pain. Highly accurate non-invasive stress imaging is valuable for assessment of low-risk chest pain patients to prevent these errors. Adenosine stress cardiovascular magnetic resonance (AS-CMR) is an imaging modality with increasing application. The goal of this study was to evaluate the negative prognostic value of AS-CMR among low-risk acute chest pain patients. Methods We studied 103 patients, mean 56.7 ± 12.3 years of age, with chest pain and no electrocardiographic evidence of ischemia and negative cardiac biomarkers of necrosis, who were admitted to the Cardiac Decision Unit of our institution. All patients underwent AS-CMR. A negative AS-CMR was defined as absence of all the following: regional wall motion abnormalities at rest; perfusion defects during stress (adenosine) and rest; and myocardial scar on late gadolinium enhancement images. The patients were followed for a mean of 277 (range 161-462) days. The primary end point was defined as the combination of cardiac death, nonfatal acute myocardial infarction, re-hospitalization for chest pain, obstructive coronary artery disease (>50% coronary stenosis on invasive angiography) and coronary revascularization. Results In 14 patients (13.6%), AS-CMR was positive. The remaining 89 patients (86.4%), who had negative AS-CMR, were discharged. No patient with negative AS-CMR reached the primary end-point during follow-up. The negative predictive value of AS-CMR was 100%. Conclusion AS-CMR holds promise as a useful tool to rule out significant coronary artery disease in patients with low-risk chest pain. Patients with negative AS-CMR have an excellent short and mid-term prognosis.

Abstract Background In the past two decades, genetic testing for cancer risk assessment has entered mainstream clinical practice due to the availability of low-cost panels of multiple cancer-associated genes. However, the clinical value of multiple-gene panels for cancer susceptibility is not well established, especially in cases where panel testing identifies more than one pathogenic variant. The risk for specific malignancies as a result of a mutated gene is complex and likely influenced by superimposed modifier variants and/or environmental effects. Recent data suggests that the combination of multiple pathogenic variants may be fewer than reported by chance, suggesting that some mutation combinations may be detrimental. Management of patients with “incidentally” discovered mutations can be particularly challenging, especially when established guidelines call for radical procedures (e.g. total gastrectomy in CDH1) in patients and families without a classic clinical history concerning for that cancer predisposition syndrome. Case presentation We present two cases, one of an individual and one of a family, with multiple pathogenic mutations detected by multi-gene panel testing to highlight challenges practitioners face in counseling patients about pathogenic variants and determining preventive and therapeutic interventions. Conclusions Ongoing investigation is needed to improve our understanding of inherited susceptibility to disease in general and cancer predisposition syndromes, as this information has the potential to lead to the development of more precise and patient-specific counseling and surveillance strategies. The real-world adoption of new or improved technologies into clinical practice frequently requires medical decision-making in the absence of established understanding of gene-gene interactions. In the meantime, practitioners must be prepared to apply a rationale based on currently available knowledge to clinical decision-making. Current practice is evolving to rely heavily on clinical concordance with personal and family history in making specific therapeutic decisions.

Although there are limited data regarding the formation of coronary artery aneurysms (CAAs) after drug-eluting stent (DES) implantation, CAAs appear to be a rare complication of coronary stenting. The exact mechanism of CAA formation is unknown, but several hypotheses have been proposed. As the use of DES increases, the clinical significance of these findings will become clearer. We report on a patient who developed multiple CAAs in 2 different locations after sirolimus-eluting stent implantation.

Background: In developed countries, cardiovascular disease is the most common cause of both death and functional disability. The last decades, scientific community shows an increasing interest exploring the relationship between religious and health factors. Aim: The aim of the present study was to explore associations between factors related to religiosity and self-reported Coronary Heart Disease (CHD). Material and Method: This was a descriptive observational study, conducted during a 2-year period. The final studied sample consist- ed of 1062 citizens of Greece. Data collection was performed by using a special designed questionnaire based on relevant literature review. Results: Half of the studied sample was men, (n=529, 49.9%). The majority of participants (77.1%) was living in urban areas of the coun- try and was mean educated (67.1%). When asked about their employment status, most of them (65%) answered that they were profes- sionally active. As far as their medical history is concerned, the majority of participants (88%) had no CHD history, no history of diabetes mellitus (90.3%), no history of dyslipidemias (71.8%) and no history of hypertension (71.8%). Moreover, 29.9% of the participants were overweight. Religious fasting follows 51.4% of the sample and the reason for fasting is because the church imposes fasting rules. The factor "fasting" was also related to CHD occurrence, as those who were following religious fasting had no history of CHD. A significant difference was found between responders with conscious belief in God and CHD occurrence. Conclusion: The findings of this study suggest that factors related to religiosity, such as doubt in God belief and religious fasting may influence CHD incidence. Prospective cohort studies and clinical trial studies that specifically designed to assess the effect of religiosity on CHD outcome are necessary to be conducted. [ABSTRACT FROM AUTHOR]

Background: In the past two decades, genetic testing for cancer risk assessment has entered mainstream clinical practice due to the availability of low-cost panels of multiple cancer-associated genes. However, the clinical value of multiple-gene panels for cancer susceptibility is not well established, especially in cases where panel testing identifies more than one pathogenic variant. The risk for specific malignancies as a result of a mutated gene is complex and likely influenced by superimposed modifier variants and/or environmental effects. Recent data suggests that the combination of multiple pathogenic variants may be fewer than reported by chance, suggesting that some mutation combinations may be detrimental. Management of patients with "incidentally" discovered mutations can be particularly challenging, especially when established guidelines call for radical procedures (e.g. total gastrectomy in CDH1) in patients and families without a classic clinical history concerning for that cancer predisposition syndrome. Case presentation: We present two cases, one of an individual and one of a family, with multiple pathogenic mutations detected by multi-gene panel testing to highlight challenges practitioners face in counseling patients about pathogenic variants and determining preventive and therapeutic interventions. Conclusions: Ongoing investigation is needed to improve our understanding of inherited susceptibility to disease in general and cancer predisposition syndromes, as this information has the potential to lead to the development of more precise and patient-specific counseling and surveillance strategies. The real-world adoption of new or improved technologies into clinical practice frequently requires medical decision-making in the absence of established understanding of gene-gene interactions. In the meantime, practitioners must be prepared to apply a rationale based on currently available knowledge to clinical decision-making. Current practice is evolving to rely heavily on clinical concordance with personal and family history in making specific therapeutic decisions. [ABSTRACT FROM AUTHOR]

In this paper, we propose a solution to support big data processing with MapReduce inside a wireless sensor network (WSN). The proposed framework provides a simple MapReduce interface, whose implementation can be dynamically loaded into the appropriate nodes. The execution of map and reduce functions inside the network is achieved by leveraging software defined networking principles and in particular by enhancing the SDN-WISE protocol on both the Controller and the sensor node sides. On the Controller side, the proposed framework introduces a functionality, which evaluates the optimal deployment of the processing functions in the network taking the typical WSN requirements into account and enforces it by instructing the flow tables to forward traffic from the mappers to the appropriate reducers. Then, on the node side, SDN-WISE is integrated with Contiki, a widely popular operating system for sensor nodes, which has the capability to load and execute new functions without service disruption, i.e., on the fly. The proposed framework is evaluated considering different network topologies and approaches about the data processing location. [ABSTRACT FROM PUBLISHER]

The Web is rapidly becoming the prime medium for human socialization. As it evolves towards an information-centric operation, it records everything and forgets nothing, assuming that every online resource disclosed by people (photos, posts, multimedia files, etc.) is permanently valid and is to be stored forever. However, throughout their lives, people tend to change, both in their habits as well as in their views and opinions. In many situations, as the years go by, information released loses relevance or people may decide they no longer want others to access information they have previously published. The work presented in this paper strives for a new information persistence paradigm, whereby the enforcement of “digital forgetting” is implemented over an information-centric model for the Internet. The defined solution enables the definitive elimination of digital objects, either on-demand or on a pre-scheduled basis, and, hence, their “forgetting.” The solution, conceived within the framework of the European project CONVERGENCE, is based on the employment of metadata descriptions about resources, which unambiguously identify their rightful owners. This additional data is efficiently bound to the resource through the use of an extended version of the MPEG-21 Digital Item specification, and its prescriptions are enforced by CONVERGENCE's distributed provisions. [ABSTRACT FROM PUBLISHER]

This paper presents an integrated security architecture for heterogeneous distributed systems. Based on the MPEG-21 standard data structures and the MPEG-M standard services, the proposed architecture provides a unified, fine-grained solution for protecting each information unit circulated in the system. In this context, a novel scheme for translating the access control rules, initially expressed by means of the standard MPEG-21 Rights Expression Language, into Ciphertext-Policy Attribute-Based Encryption access trees is introduced, thereby enabling offline authorization based on the users' attributes, also encapsulated and certified using MPEG-21 licenses. The proposed framework provides a detailed approach in all the steps of the information protection process, from attribute acquisition to data encryption and decryption. [ABSTRACT FROM AUTHOR]

ABSTRACT Information-centric networking (ICN) is an emerging networking paradigm, which is considered as a possible solution for the next generation Internet. Several research projects have been funded by the state and the industry towards the specification and implementation of ICN solutions, whereas Internet Research Task Force has established a research group for this reason, the Information-Centric Networking Research Group. However, the use of ICN in action will be decided on the basis of its performance in several disciplines that, eventually, concern the users expectations from their applications over the future Internet. Currently, statistics suggest that, in the near future, the Internet bandwidth will be mainly consumed by multimedia and peer-to-peer applications. Furthermore, social networking applications become more and more popular both to end-users and businesses. This special issue includes papers illustrating how information-centric networks can effectively address practical issues rising in ICN deployments considering multimedia applications and social networking technologies. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The capacitated minimum spanning tree (CMST) problem is fundamental to the design of centralized communication networks. In this paper we consider the multi-level capacitated minimum spanning tree problem, a generalization of the well-known CMST problem. Based on work previously done in the field, three heuristics are presented, addressing unit and non-unit demand cases. The proposed heuristics have been also integrated into a mixed integer programming solver. Evaluation results are presented, for an extensive set of experiments, indicating the improvements that the heuristics bring to the particular problem. [ABSTRACT FROM AUTHOR]