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Multimodality Imaging in the Diagnosis of an Early Tako-Tsubo Syndrome Recurrence
No full textWe report the case of an 80 yo female patient with cardiovascular risk factors and previous diagnosis of Tako-Tsubo syndrome, who was referred to our institution one year after a previous diagnosis, due to symptoms suggestive of acute coronary syndrome (SCA) after severe emotional stress. After ruling out suspected CAD by cardiac computed tomography (CCT) and subsequent invasive coronary angiography (ICA) confirming no significant stenosis but presence of vulnerable plaque, the patient underwent further investigation by cardiac magnetic resonance (CMR) that confirmed a clinical picture compatible with recurrence of Tako-Tsubo syndrome. Our case underlines the importance of multimodality imaging to guide diagnosis and treatment in this specific clinical scenario
Computed tomography-derived score as a predictor of major adverse cardiovascular events in patients with severe aortic stenosis
No full textBackground and aims The prognostic significance of global calcium burden—including coronary artery (CAC), mitral annular (MAC), aortic valve (AVC), and thoracic aortic calcification (TAC)—as assessed by cardiac computed tomography (CCT), remains incompletely understood in patients with severe aortic stenosis (AS) undergoing aortic valve replacement (AVR). This study aimed to evaluate the prognostic impact of overall calcification burden in patients with severe AS undergoing AVR. Methods A retrospective analysis of 313 patients with severe AS undergoing CCT before AVR between 2016 and 2019 was conducted. MAC, CAC, AVC were quantified using established scoring methods. For TAC, a total thoracic aortic (TTA) score was developed by evaluating calcifications in the ascending, descending and aortic arch. MAC, CAC, AVC, and TTA were integrated into a comprehensive scoring system, the New Total Calcium (NTC) score, using Random Forest models. Outcomes considered included MACE, all-cause mortality, and non-cardiovascular mortality over a 60-month follow-up. Results Among 313 patients (mean age 81 years), 93% underwent transcatheter AVR. Severe CAC and MAC were observed in 11% and 7.7% of patients, respectively. During follow-up, 48% of patients died, with non-cardiovascular deaths accounting for 34% and MACE occurring in 43%. In this predominantly TAVR population, the TTA score predicted MACE ( p = 0.01), all-cause mortality (p = 0.01), and non-cardiovascular mortality ( p = 0.005). The NTC score demonstrated high prognostic accuracy for MACE at 1-, 2-, and 3-years, with AUC values of 0.91, 0.80, and 0.81, respectively. Validation in an external cohort of 100 patients confirmed its robustness. Conclusions In this predominantly transcatheter AVR cohort, the NTC score is a promising tool for risk stratification in patients with severe AS. These findings are primarily applicable to transcatheter AVR patients, and further validation in SAVR populations is warranted
The Carter Administration and the Eastern Mediterranean in the Cold War (1977 – 1981)
No full textThis article analyses the strategic priorities of the Carter administration in the Eastern Mediterranean during the Cold War, with a focus on strengthening ties with Greece and Turkey. It sheds light on how this approach affected regional dynamics and the complex relationships between the region’s key players. Through an examination of US and British archival sources, the article evaluates the influence of American foreign policy under Carter’s leadership, as well as the specific actions taken to promote US interests in the Eastern Mediterranean. It also explores the contributions of key figures within the Carter administration’s foreign policy team in shaping policies for the Eastern Mediterranean
Nasal Cytology Is Useful for Evaluating and Monitoring the Therapeutic Response to Biologics in Chronic Rhinosinusitis with Nasal Polyposis
No full textBackground/Objectives: In recent years, the recognition that type 2 inflammation plays a leading role in CRSwNP has enabled the more tailored treatment of the disease through improved patient endotyping. We studied 45 patients with severe CRSwNP who were treated with dupilumab or mepolizumab. The aim was to evaluate the efficacy of these treatments on endoscopic, clinical and patient reported parameters, and to assess whether nasal cytology could be useful for identifying responsive patients and monitoring their response to biologic drugs. Methods: Follow-up visits were scheduled at baseline (T0), and at 3 (T3), 6 (T6), 12 (T12), and 24 months (T24). At each visit, patients underwent blood analysis, nasal endoscopy, and nasal scraping for cytology. They also completed the SNOT-22 questionnaire, a visual analog scale (VAS) for nasal obstruction and smell perception, and the Asthma Control Test (ACT) test in cases of concomitant asthma. Results: Biological therapy demonstrated broad efficacy in disease management, based on both clinical and cytological findings. The Nasal Polyp Score, SNOT-22 questionnaire, VAS scores for nasal obstruction and smell, and ACT score showed progressive improvement. Blood eosinophil counts and total IgE levels also decreased over time (T0 vs. T24: p = 0.008 and p < 0.001, respectively). At nasal cytology, a reduction in eosinophil cell count and in the mixed mast cell-eosinophil pattern during treatment with both biologics were observed (T0 vs. T24: p < 0.001). Positive effects were typically recorded within six months of treatment and were sustained after two years. Conclusions: Although the histological evaluation of infiltrated tissues remains the gold standard for assessing mucosal eosinophilia, nasal cytology appears to be a simpler, non-invasive, and repeatable method for evaluating local eosinophilia. Identifying endotypes and assessing the severity of inflammation are crucial for predicting the efficacy of different treatment options
La Corte costituzionale fa saltare il tetto massimo delle sei mensilità indennizzabili per i licenziamenti nelle piccole imprese: invasione nel campo del legislatore o ripristino della legalità costituzionale?
No full textIl contributo esamina la sentenza n. 118 del 2025 della Corte costituzionale, che ha dichiarato l’illegittimità dell’art. 9 del d.lgs. n. 23 del 2015 nella parte in cui prevedeva un tetto massimo di sei mensilità all’indennità per i lavoratori illegittimamente licenziati nelle piccole imprese. La decisione è collocata nel più ampio filone giurisprudenziale successivo alle riforme del 2012 e del 2015 e viene analizzata alla luce del dibattito sulla “politicità” della Corte. L’indagine si concentra su tre profili: tecnica decisoria, utilizzo del parametro di ragionevolezza e natura delle valutazioni operate, con particolare riguardo all’anacronismo del criterio del numero dei dipendenti. Si sostiene che, nonostante i possibili sintomi di politicità, nella pronuncia in esame prevalga l’anima giurisdizionale, in quanto l’intervento si colloca nel solco del sindacato sugli automatismi legislativi e salvaguarda la discrezionalità del legislatore.The article examines Constitutional Court judgment no. 118 of 2025, which declared unconstitutional
Article 9 of Legislative Decree no. 23 of 2015 insofar as it set a maximum limit of six months’
compensation for workers unlawfully dismissed in small undertakings. The decision is situated within
the broader line of case law developed after the 2012 and 2015 labour market reforms and is analysed
in light of the debate on the “political” dimension of the Court’s activity. The inquiry focuses on three
aspects: the decisional technique employed, the use of the reasonableness test, and the nature of the
evaluative judgments underpinning the ruling, particularly regarding the obsolescence of the sole
criterion of the number of employees as an indicator of a firm’s economic strength. It is argued that,
despite potential signs of politicisation, the judicial dimension prevails in this judgment, as the Court’s
intervention remains within the boundaries of reasonableness review and preserves legislative
discretion
Bariatric Surgery Outcomes in an Italian Single-Center Study: Does Chronotype Matter?
No full textBackground: Chronotype reflects an individual’s intrinsic circadian preference for the timing of daily behaviors, including sleep, eating, and physical activity. It influences not only biological rhythms but also lifestyle patterns that may impact metabolic health. In the context of bariatric surgery, numerous factors may affect postoperative outcomes such as weight loss and the risk of weight regain. Given the growing interest in chronobiology and its relevance to obesity management, this study aimed to explore whether chronotype is significantly associated with key weight loss outcomes following bariatric surgery at 6 and 12 months post-intervention. Methods: A total of 263 patients underwent bariatric surgery at a single center. Baseline assessments included anthropometric, biochemical, and behavioral evaluations, including chronotype categorization. Postoperative outcomes at 6 and 12 months included absolute weight, BMI, percentage of initial body weight loss (%IBWL), and percentage of excess body weight loss (ëWL). Results: There was no significant difference among the three different chronotypes (evening, intermediate, and morning chronotype) in terms of absolute weight, BMI, %EWL and %IBWL at 6 and 12 months after surgery. Conclusions: Our results suggest that chronotype does not seem to play a critical role in weight loss outcomes in bariatric surgery patients, characterized by severe obesity. Further studies are needed to more thoroughly assess the impact of chronotype on bariatric surgery outcomes and a more detailed characterization of chronotype itself in these patients could be decisive
Systemic barriers and untapped potentials: a SWOT study on the implementation of natural/small water retention measures in Europe
No full textThere is strong evidence that ecosystem-based approaches, such as Natural/Small Water Retention Measures (NSWRMs) can be an important solution to problems associated with managing water quality and quantity, soil erosion, and nutrient loss. Moreover, they deliver multiple co-benefits such as increased biodiversity, climate change adaptation and mitigation, alongside aesthetic and recreational functions. However, despite their apparent advantages and significant political momentum for their expanded deployment, implementation of NSWRMs remains slow. This study asks why this is the case and employs a methodologically rigorous variant of the SWOT framework combining qualitative and quantitative (scoring and cluster analysis) elements to assess the exact barriers and potentials for increasing the NSWRMs’ implementation across Europe. The empirical analysis draws on case studies of fourteen small watersheds distributed across twelve European countries to explore the factors affecting the NSWRMs adoption, evaluate their relative importance, and identify necessary intervention areas for their better uptake. Our findings indicate that the main drivers for NSWRMs implementation are high knowledge availability through formal and informal networks, as well as support through advisory services. On the other hand, the main hindrances are inadequate financing schemes but also uncertain societal attitudes and perceptions. Financing schemes rarely account for indirect costs, and bureaucratic procedures further discourage practitioners from pursuing these measures. Negative attitudes are linked to mismatched time horizons as well as the gap between theoretical benefits and practical implementation challenges
Public Administration for Sustainable Development
No full textIl volume analizza il ruolo della pubblica amministrazione nella realizzazione dello sviluppo sostenibile all’interno dei sistemi di governance contemporanei. L’opera colloca il diritto amministrativo nel contesto della doppia transizione digitale e ambientale, evidenziando come le istituzioni pubbliche siano chiamate ad attuare obiettivi definiti politicamente in un quadro caratterizzato da innovazione tecnologica, vincoli ecologici e interdipendenza economica.
L’analisi offre una ricostruzione sistematica della governance amministrativa nei sistemi giuridici multilivello, con particolare riferimento all’Unione europea. Vengono esaminati l’organizzazione delle amministrazioni pubbliche, la natura dei poteri amministrativi e dei processi decisionali, nonché i principi fondamentali che guidano l’azione amministrativa, tra cui sussidiarietà, proporzionalità, trasparenza e diritto alla buona amministrazione.
Su questa base, il volume affronta alcuni ambiti centrali della governance contemporanea, tra cui il rapporto tra servizi pubblici essenziali e diritto della concorrenza, la regolazione ambientale e i suoi principi fondamentali, e l’impatto delle tecnologie digitali, dei dati e dell’intelligenza artificiale sui processi decisionali pubblici. Ne emerge l’idea che una governance sostenibile dipenda dalla capacità delle amministrazioni di operare in modo legale, razionale ed efficace entro i limiti dello Stato di diritto.This book explores the role of public administration in advancing sustainable development within contemporary systems of governance. It examines how administrative law operates in a context shaped by the twin transition of digital transformation and environmental sustainability, where public institutions must implement politically defined objectives under conditions of technological change, ecological constraints, and economic interdependence.
The analysis develops a systematic account of administrative governance in multi-level legal systems, with particular attention to the European Union. It discusses the organization of public bodies, the nature of administrative powers and decision-making processes, and the fundamental principles guiding administrative action, including subsidiarity, proportionality, transparency, and the right to good administration.
Building on this framework, the book addresses key domains of contemporary governance, including essential public services and EU competition law, environmental regulation and its core principles, and the growing role of digital technologies, data, and artificial intelligence in administrative decision-making. It argues that sustainable governance depends on strengthening the capacity of public administrations to act lawfully, rationally, and effectively within the limits of the rule of law
Validation of the Institute Mutualiste Montsouris system for the stratification of laparoscopic liver resections: an international multicenter study
No full textBackground: The Institut Mutualiste Montsouris (IMM) 3-level complexity classification has been validated for laparoscopic liver resection (LLR) in several studies with small sample size. However, it has not been well-validated in large studies down to the individual procedure type. Hence, in order to address current limitations in the studies validating the IMM complexity classification, we performed an international multicenter study to validate the IMM complexity classification across its three complexity levels and the categorization of the 11 distinct procedure types. Methods: A retrospective cohort study of 22,252 patients undergoing LLR across 64 centers worldwide between 2005 and 2021 was performed. Baseline characteristics and perioperative outcomes were analyzed across the three difficulty levels and 11 procedure types of the IMM complexity classification. Results: A total of 14,765 patients were included in our final analysis. The main indications for LLR in our study was hepatocellular carcinoma or intrahepatic cholangiocarcinoma (n=7,781, 52.7%) followed by liver metastasectomy (n=3,911, 26.5%). In terms of underlying liver pathology, 5,127 (34.7%) cases had cirrhosis, and 1,214 (8.3%) had portal hypertension. Perioperative outcomes including operative time, open conversion rate, intraoperative blood loss, need for intraoperative blood transfusion, need for Pringle's application, length of stay, postoperative morbidity, major postoperative morbidity and 90-day mortality all demonstrated a significant increasing trend with increasing IMM complexity grades (P<0.001). These trends remained significant following adjustment for baseline characteristics (P<0.001). Notably, when examining the 11 LLR procedure types, all procedures within each IMM complexity grade were individually higher than all procedures in the preceding complexity grade for operative time, blood loss, length of stay, postoperative morbidity and major postoperative morbidity. Conclusions: The three IMM complexity grades were well associated with LLR complexity as determined by key surrogate perioperative measures. Our findings also supported the categorization of the 11 distinct LLR procedures into the three complexity levels