Scritti in onore di Pellegrino Capaldo

La qualità dei servizi è stata riconosciuta come un rilevante aspetto caratterizzante la performance dell’azienda pubblica, analogamente alla capacità di operare secondo criteri di efficienza e nel rispetto dei vincoli di bilancio. Sebbene sia possibile riscontrare alcuni significativi casi di adozione di politiche di customer satisfaction nelle amministrazioni pubbliche italiane, a tutt’oggi il tema presenta significative criticità, specialmente in ordine agli aspetti metodologici e agli strumenti operativi che consentano di integrare dette politiche nel sistema di programmazione e controllo delle aziende che erogano tali servizi. Il presente lavoro adotta una diversa prospettiva di analisi del miglioramento della performance in ottica di “customer satisfaction”, rispetto a quella tradizionalmente utilizzata, specie con riferimento al settore pubblico. Piuttosto che focalizzare soltanto l’interazione tra “cliente/utente” esterno all’amministrazione pubblica e unità direttamente preposte all’erogazione dei servizi, in questa sede si propone di una chiave di lettura di tipo interistituzionale. Tale prospettiva è volta a comprendere le criticità e i generatori di prestazione connessi allo svolgimento dei processi gestionali da cui deriva il conseguimento di “prodotti” dell’attività amministrativa a beneficio dei “clienti/utenti” interni ed esterni, rispetto all’amministrazione pubblica. La rappresentazione della “catena del valore” alla luce della quale sia possibile esplicitare le responsabilità e i connessi indicatori di performance volti a collegare in sequenza diverse unità di “back-office” nel settore pubblico, ai fini del miglioramento del servizio all’utenza finale, costituisce un momento fondamentale per internalizzare nella pubblica amministrazione gli stimoli provenienti dalle tradizionali indagini di “customer satisfaction” e tradurli in concreti miglioramenti ai processi gestionali e ai connessi “prodotti” dell’attività amministrativa

Editorial on the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) guideline on clinical indications for CT colonography in the colorectal cancer diagnosis

European Society of Gastrointestinal Endoscopy (ESGE)-European Society of Gastrointestinal and Abdominal Radiology (ESGAR) guideline was generated jointly by a team of researchers, including gastrointestinal radiologists and endoscopists, and represents the first full collaborative effort between the two specialties after years of turf battles involving CT colonography (CTC) and colonoscopy (CS). This guideline has a main educational purpose and it represents the attempt to find a consensus about the use of CTC in clinical practice based on the best current available evidence. Thus, it should not be considered as rules for establishing a legal standard of care. Main recommendations include the use of CTC as the radiological examination of choice for the diagnosis of colorectal neoplasia, the use of CTC in the case of incomplete CS, and the possible use of CTC as an acceptable and equally sensitive alternative for patients with symptoms suggestive of colorectal cancer (CRC), when CS is contraindicated or not possible. ESGE-ESGAR guideline does not recommend CTC for population screening, but considers that CTC may be proposed as a CRC screening test on an individual basis (opportunistic screening) provided the screenee is adequately informed about test characteristics, benefits and risks. With regard to patient management, referral for endoscopic polypectomy in patients with at least one polyp ≥6 mm in diameter detected at CTC is recommended, considering surveillance only in case polyp removal is not possible. Knowledge about CTC is in continuous evolution and this means that a revision might be necessary in the future as new data appear

Key Factors in Delisting Process in Italy: Empirical Evidence

We investigated the characteristics and motives ofItalian voluntary delisting observing a period of eleven years,2001 to 2011. The final sample is made up of 53 industrialcompanies, compared with a control sample of 106 companiesstill listed in the period. Main goal is to assess if any signals canpredict a delisting operation for listed companies in Italy and ifItalian market shows differences with previous investigation inContinental Europe and US.Practical implications of results achieved can help to highlighton Public to Private phenomenon in Italy, still not enoughobserved considering the high number of delisted companies inthe last decade relating to a relative small number of listedcompanie

An incidental diagnosis of SARS-CoV-2 pneumonia with magnetic resonance imaging

The Coronavirus disease 2019 (COVID-19) is caused by the human severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. The most common clinical findings related to COVID-19 are fever and cough, with the proportion of patients developing interstitial pneumonia. Other symptoms include dyspnea, expectoration, headache, anosmia, ageusia, myalgia and malaise. To date, the diagnostic criteria for COVID-19 include nasopharyngeal and oropharyngeal swabs. Computed tomography (CT) scans of the thorax showing signs of interstitial pneumonia are important in the management of respiratory disease and in the evaluation of lung involvement. hi the literature, there are few cases of COVID-19 pneumonia diagnosis made using magnetic resonance imaging (MRI). In our report, we describe a case of accidental detection of findings related to interstitial pneumonia in a patient who underwent abdominal MRI for other clinical reasons. A 71-year-old woman was referred to our department for an MRI scan of the abdomen as her oncological follow-up. She was asymptomatic at the time of the examination and had passed the triage carried out on all the patients prior to diagnostic tests during the COVID-19 pandemic. The images acquired in the upper abdomen showed the presence of areas of altered signal intensity involving asymmetrically both pulmonary lower lobes, with a patchy appearance and a preferential peripheral subpleural distribution. We considered these features as highly suspicious for COVID-19 pneumonia. The nasopharyngeal swab later confirmed the diagnosis of SARS-CoV-2 infection. There are limited reports about MRI features of COVID-19 pneumonia, considering that high-resolution chest CT is the imaging technique of choice to diagnose pneumonia. Nevertheless, this clinical case confirmed that it is possible to detect MRI signs suggestive of COVID-19 pneumonia. The imaging features described could help in the evaluation of the lung parenchyma to assess the presence of signs suggestive of COVID-19 pneumonia, especially in asymptomatic patients during the pandemic phase of the disease

An Untargeted Metabolomics Investigation of Jiulong Yak (Bos grunniens) Meat by 1H-NMR

Yak represents the main meat source for Tibetan people. This work aimed to investigate the metabolome of raw meat from Jiulong yaks, focusing on specimens farmed and harvested locally through traditional procedures. Untargeted nuclear magnetic resonance spectroscopy (1H-NMR) was selected as the analytical platform. Samples from longissimus thoracis, trapezius, triceps brachii and biceps femoris muscles, with different prevalences of red and white fibers, were selected. Among the fifty-three metabolites quantified in each of them, carnitine, carnosine, creatine and taurine are known for their bioactive properties. Twelve molecules were found to be differently concentrated in relation to muscle type. Longissimus thoracis, compared to biceps femoris, had higher concentrations of carnosine and formate and lower concentrations of mannose, inosine, threonine, IMP, alanine, valine, isoleucine, tyrosine, phenylalanine and leucine. A metabolic pathway analysis suggested that the main pathways differing among the muscles were connected to the turnover of amino acids. These results contribute to a deeper understanding of yak raw meat metabolism and muscle type differences, which can be used as an initial reference for the meat industry to set up muscle-specific investigations. The possibility of simultaneously quantifying several bioactive compounds suggests that these investigations could revolve around meat's nutritional value

Dynamic MR of the pelvic floor. Influence of alternative methods to draw the pubococcygeal line (PCL) on the grading of pelvic floor descent

Objective: To evaluate the impact of the pubococcygeal line (PCL) position on hiatal descent grading, comparing the method recommended by the official guidelines with the other two most common methods reported in literature. Methods: Female patients prospectively included performed dynamic-MR (1,5 T) in supine position. Rectum and vagina were filled with ultrasound gel. MR protocol included TSE T2 weighted sequences on axial/sagittal/coronal planes and steady-state sequences (FIESTA) on midsagittal plane during three phases (rest, strain and defecation). On each phase, the posterior point of PCL was traced in the region recommended by the official guidelines (last coccygeal joint or PCLcc) and in the other two regions: coccyx's tip (PCLtip) and sacrococcygeal joint (PCLsc). The resulting grades of pelvic floor descent (according to HMO-System) were compared. Inter-reader and intra-reader agreement were evaluated. Results: The final population consisted of 60 patients (56yy±10). No significant differences in grading were observed using PCLtip and PCLcc in all phases (p = 0.3016/0.0719/0.0719 during rest/strain/defecation). Using PCLsc, the grading was significantly overestimated compared to PCLcc in all phases (p = 0.0041/0.0001/0.0001 during rest/strain/defecation). Inter-reader and intra-reader agreement were significantly higher using PCLtip (p < 0.05). Conclusions: PCLtip is a reliable and highly reproducible option to the official PCLcc to correctly grade the pelvic floor descent and could be used when the PCLcc is not clearly visible. The use of PCLsc overestimates the grading compared to the official PCLcc and should not be used to avoid wrong patients’ management

A combined proteomics, metabolomics and in vivo analysis approach for the characterization of probiotics in large-scale production

The manufacturing processes of commercial probiotic strains may be affected in different ways in the attempt to optimize yield, costs, functionality, or stability, influencing gene expression, protein patterns, or metabolic output. Aim of this work is to compare different samples of a high concentration (450 billion bacteria) multispecies (8 strains) formulation produced at two different manufacturing sites, United States of America (US) and Italy (IT), by applying a combination of functional proteomics, metabolomics, and in vivo analyses. Several protein-profile differences were detected between IT-and US-made products, with Lactobacillus paracasei, Streptococcus thermophilus, and Bifidobacteria being the main affected probiotics/microorganisms. Performing proton nuclear magnetic spectroscopy (1H-NMR), some discrepancies in amino acid, lactate, betaine and sucrose concentrations were also reported between the two products. Finally, we investigated the health-promoting and antiaging effects of both products in the model organism Caenorhabditis elegans. The integration of omics platforms with in vivo analysis has emerged as a powerful tool to assess manufacturing procedures

Imaging assessment and clinical significance of pneumatosis in adult patients.

Gas detection in the bowel wall and in portomesenteric venous vessels in adults has long been related to intestinal infarction and poor outcome; many case reports have shown that pneumatosis may be associated with a large variety of pathological situations, ranging from absolutely benign and asymptomatic forms to abdominal catastrophes. Several studies have been conducted on this topic with different conclusions, probably due to differences in population so that the clinical value of these signs is still questioned. Intestinal pneumatosis, especially if presenting with a band-like pattern and if associated with portomesenteric vein gas, when observed in an acute abdominal setting should raise the suspicion of mesenteric infarct and prompt a careful search for other signs of intestinal involvement, so as not to miss cases of life-threatening intestinal infarct or allow them to further evolve into extensive necrosis with worse prognosis. In this review we illustrate the most relevant aspects of these debated but significant radiological signs

Genetic and epigenetic changes in primary metastatic and nonmetastatic colorectal cancer

Colorectal cancer (CRC) develops as multistep process, which involves genetic and epigenetic alterations. K-Ras, p53 and B-Raf mutations and RASSF1A, E-Cadherin and p16INK4A promoter methylation were investigated in 202 CRCs with and without lymph node and/or liver metastasis, to assess whether gene abnormalities are related to a metastogenic phenotype. K-Ras, B-Raf and p53 mutations were detected in 27, 3 and 32% of the cases, with K-Ras mutations significantly associated with metastatic tumour (P=0.019). RASSF1A, E-Cadherin and p16INK4A methylation was documented in 20, 44 and 33% of the cases with p16INK4A significantly associated with metastatic tumours (P=0.001). Overall, out of 202 tumours, 34 (17%) did not show any molecular change, 125 (62%) had one or two and 43 (21%) three or more. Primary but yet metastatic CRCs were prevalent in the latter group (P=0.023) where the most frequent combination was one genetic (K-Ras in particular) and two epigenetic alterations. In conclusion, this analysis provided to detect some molecular differences between primary metastatic and nonmetastatic CRCs, with K-Ras and p16INK4A statistically altered in metastatic tumours; particular gene combinations, such as coincidental K-Ras mutation with two methylated genes are associated to a metastogenic phenotype

The Italian consensus to virtual colonoscopy

OBJECTIVES: To produce an informed consent for CT colonography (CTC), to be diffused by the Italian Society of Radiology, aimed to make patients and referring physicians aware of CTC examination protocol, advantages and disadvantages, limits and potential related risks. MATERIALS AND METHODS: Delphi method was used to create a consensus among experts on an informed consent for CTC. The overall agreement among different consulted specialists was evaluated and ranked using the Cronbach's correlation coefficient (α) at two time points: after the first and the second 'round' of consultation. RESULTS: The Cronbach index was 0.84 at the end of the first round and 0.93 at the end of the second round. The number of disagreements dropped from an overall of 11-5, from the first to the second round. CONCLUSIONS: The experts were able to produce an informed consent for CTC, hoping that this may be the beginning of a process focused on implementation of quality standards in CTC