Evoluzione e prospettiva dei sistemi previdenziali in Italia ed Europa: gli investimenti etici dei fondi pensione

L'elaborato si costituisce di tre capitoli. Nel primo viene trattata la problematica sempre più importante circa le pensioni il cui ammontare è in continua diminuzione. Insieme a questo ho trattato l'argomento secondo cui abbiamo sempre meno nati e sempre più pensionati, dunque problematiche nel coprire i benefici previdenziali. Nella seconda parte viene trattato l'aspetto normativo, sia a livello Europeo che Italiano e varie proposte di riforma adottate. L'ultima parte tratta un argomento delicato quale quello dei fondi di investimento etici e più in generale della finanza etica come nuova opportunità/alternativa. My work is based on three chapters. The first touches the huge problem of pensions, in particular there is a focus on the growing 'old age' population and the lack of youngers that pay pension benefits. The second part is about rules and proposal, at Italian and European law level. Third part touches the SRIs as Social Responsible Investments as an innovative way of making finance, in the whole contest of ethical finance

Left Ventricular Trabeculations Decrease the Wall Shear Stress and Increase the Intra-Ventricular Pressure Drop in CFD Simulations

The aim of the present study is to characterize the hemodynamics of left ventricular (LV) geometries to examine the impact of trabeculae and papillary muscles (PMs) on blood flow using high performance computing (HPC). Five pairs of detailed and smoothed LV endocardium models were reconstructed from high-resolution magnetic resonance images (MRI) of ex-vivo human hearts. The detailed model of one LV pair is characterized only by the PMs and few big trabeculae, to represent state of art level of endocardial detail. The other four detailed models obtained include instead endocardial structures measuring ≥1 mm2 in cross-sectional area. The geometrical characterizations were done using computational fluid dynamics (CFD) simulations with rigid walls and both constant and transient flow inputs on the detailed and smoothed models for comparison. These simulations do not represent a clinical or physiological scenario, but a characterization of the interaction of endocardial structures with blood flow. Steady flow simulations were employed to quantify the pressure drop between the inlet and the outlet of the LVs and the wall shear stress (WSS). Coherent structures were analyzed using the Q-criterion for both constant and transient flow inputs. Our results show that trabeculae and PMs increase the intra-ventricular pressure drop, reduce the WSS and disrupt the dominant single vortex, usually present in the smoothed-endocardium models, generating secondary small vortices. Given that obtaining high resolution anatomical detail is challenging in-vivo, we propose that the effect of trabeculations can be incorporated into smoothed ventricular geometries by adding a porous layer along the LV endocardial wall. Results show that a porous layer of a thickness of 1.2·10−2 m with a porosity of 20 kg/m2 on the smoothed-endocardium ventricle models approximates the pressure drops, vorticities and WSS observed in the detailed models.This paper has been partially funded by CompBioMed project, under H2020-EU.1.4.1.3 European Union’s Horizon 2020 research and innovation programme, grant agreement n◦ 675451. FS is supported by a grant from Severo Ochoa (n◦ SEV-2015-0493-16-4), Spain. CB is supported by a grant from the Fundació LaMarató de TV3 (n◦ 20154031), Spain. TI and PI are supported by the Institute of Engineering in Medicine, USA, and the Lillehei Heart Institute, USA.Peer ReviewedPostprint (published version

Post vaccinal temporary sensorineural hearing loss

In our systematic research we identified four studies concerning the onset of neurological adverse events following vaccination and two excluding this association. A 33-year-old Italian man, belonging to the Italian Army was hospitalized because he suffered from vertigo, nausea and sudden right hearing loss not classified (NDD), that set in 24 h after the administration of tetanus-diphtheria and meningococcal vaccines. Some neurological events arising after vaccination are very difficult to treat. In our case, the functional recovery on low and medium frequencies was possible about 6 months after the morbid event

Effects of detailed ventricular anatomy on the blood flow

The presented study is a preliminary test and analysis of the role of trabeculae and papillary muscles in the hemodynamics of the left ventricle (LV)

Ceftazidime-avibactam resistance in Klebsiella pneumoniae sequence type 37: a decade of persistence and concealed evolution

The first reports of carbapenem-resistant Enterobacterales in our hospital date back to 2006. In that period, few ertapenem-resistant but meropenem-susceptible Klebsiella pneumoniae isolates belonging to sequence type (ST) 37 were retrieved from clinical samples. These strains produced the CTX-M-15 extended spectrum β-lactamase, OmpK35 was depleted due to a nonsense mutation, and a novel OmpK36 variant was identified. Yet, starting from 2010, Klebsiella pneumoniae carbapenemase (KPC)-producing ST512 isolates started prevailing and ST37 vanished from sight. Since 2018 the clinical use of the combination of ceftazidime-avibactam (CZA) has been introduced in clinical practice for the treatment of bacteria producing serine-β-lactamases, but KPC-producing, CZA-resistant K. pneumoniae are emerging. In 2021, four CZA-resistant ST37 isolates producing KPC variants were isolated from the same number of patients. blaKPC gene cloning in Escherichia coli was used to define the role of those KPC variants on CZA resistance, and whole genome sequencing was performed on these isolates and on three ST37 historical isolates from 2011. CZA resistance was due to mutations in the blaKPC genes carried on related pKpQIL-type plasmids, and three variants of the KPC enzyme have been identified in the four ST37 strains. The four ST37 isolates were closely related to each other and to the historical isolates, suggesting that ST37 survived without notice in our hospital for 10 years, waiting to re-emerge as a CZA-resistant K. pneumoniae clone. The ancestor of these contemporary isolates derives from ST37 wild-type porin strains, with no other mutations in chromosomal genes involved in conferring antibiotic resistance (parC, gyrA, ramR, mgrB, pmrB)

Klebsiella pneumoniae infections in COVID-19 patients: a two-month retrospective analysis in an Italian hospital

Italy has experienced one of the harshest and earliest COVID-19 epidemics, with the number of patients infected that followed, from the end of February up to the end of March, an exponential trend [1]. Between the 6 March and the 2 May, 394 patients were confirmed positive for SARS-CoV-2 at the University Hospital of Rome Policlinico Umberto I (PUI) [2]. At the PUI, 5 COVID-19 devoted wards were organized, including two brand new ICUs, counting 32 dedicated to COVID-19 patients: the first was the old general ICU converted into a dedicated COVID-19 ICU, while the second was created in the spaces of four operating rooms (new ICU). In the period of this study, a total of 80 COVID-19-affected patients were hospitalized in the two ICUs at PUI. Among them, 65 patients were screened for carbapenemase producing Enterobacterales (CPE) colonization (Brilliance™ CRE medium plates, Oxoid LTD, Basingstoke, UK): 41 out of 47 SARS-CoV-2 patients hospitalised in the old ICU and 24 out of 33 in the new one. Carbapenemase-producing K. pneumoniae were detected in 14/41 patients (34%) only in the old ICU. No CPE were detected from rectal swabs tested in patients hospitalized in the new ICU. In the same period, 11 CPEs were identified from the 39 rectal swabs out of 48 SARS-CoV-2-negative patients (28%) hospitalized in the non-COVID-ICU of the same hospital. Seven COVID-19 patients developed CPE co-infection (5 bronchoalveolar lavages and 2 blood cultures tested positives for carbapenemase-producing K. pneumoniae), while in the non-COVID-19 ICU 7 bloodstream infections (BSIs) also occurred (Table 1). Symptomatic patients were successfully treated with ceftazidime-avibactam

Ventricular anatomical complexity and sex differences impact predictions from electrophysiological computational models

The aim of this work was to analyze the influence of sex hormones and anatomical details (trabeculations and false tendons) on the electrophysiology of healthy human hearts. Additionally, sex- and anatomy-dependent effects of ventricular tachycardia (VT) inducibility are presented. To this end, four anatomically normal, human, biventricular geometries (two male, two female), with identifiable trabeculations, were obtained from high-resolution, ex-vivo MRI and represented by detailed and smoothed geometrical models (with and without the trabeculations). Additionally one model was augmented by a scar. The electrophysiology finite element model (FEM) simulations were carried out, using O’Hara-Rudy human myocyte model with sex phenotypes of Yang and Clancy. A systematic comparison between detailed vs smooth anatomies, male vs female normal hearts was carried out. The heart with a myocardial infarction was subjected to a programmed stimulus protocol to identify the effects of sex and anatomical detail on ventricular tachycardia inducibility. All female hearts presented QT-interval prolongation however the prolongation interval in comparison to the male phenotypes was anatomy-dependent and was not correlated to the size of the heart. Detailed geometries showed QRS fractionation and increased T-wave magnitude in comparison to the corresponding smoothed geometries. A variety of sustained VTs were obtained in the detailed and smoothed male geometries at different pacing locations, which provide evidence of the geometry-dependent differences regarding the prediction of the locations of reentry channels. In the female phenotype, sustained VTs were induced in both detailed and smooth geometries with RV apex pacing, however no consistent reentry channels were identified. Anatomical and physiological cardiac features play an important role defining risk in cardiac disease. These are often excluded from cardiac electrophysiology simulations. The assumption that the cardiac endocardium is smooth may produce inaccurate predictions towards the location of reentry channels in in-silico tachycardia inducibility studiesJA-S, FS, GH and MV are supported by the European Union’s Horizon 2020 research and innovation programme under grant agreements No 675451 (Compbiomed project phase 1) and No 823712 (CompBioMed project, phase 2) and project No 777204 (SilicoFCM project). Part of the simulation computing hours were provided by the CompBioMed project phase 1. JA-S was awarded computation time from Red Espanola de Supercomputacion (RES). (Activity IDs: FI-2018-2-0049 and BCV-2019-2-0014) JA-S is funded by a Ramon y Cajal fellowship (RYC-2017-22532), Ministerio de Ciencia e Innovacion, Spain; and by Plan Estatal de Investigacion Cientifica y Tecnica y de Innovacion 2017-2020 from the Ministerio de Ciencia e Innovacion y Universidades (PID2019-104356RBC41/AEI/10.13039/501100011033): meHeart ME PID2019-104356RB-C44. CB is funded by the Torres Quevedo Program (PTQ2018-010290), Ministerio de Ciencia e Innovacion, Spain. MV, GH and CB are funded by the Spanish Neotec project EXP - 00123159/SNEO-20191113 Generador de corazones virtuales. LKGM was funded by Fundacion Carolina-BBVA. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. There was no additional external funding received for this study.Peer Reviewed"Article signat per 11 autors/es: Pablo Gonzalez-Martin,Federica Sacco,Constantine Butakoff,Ruben Doste,Carlos Bederian,Lilian K. Gutierrez Espinosa de los Monteros,Guillaume Houzeaux,Paul A. Iaizzo,Tinen L. Iles,Mariano Vazquez,Jazmin Aguado-Sierra"Postprint (published version

1,3-di(benzo[d]oxazol-5-yl)urea acts as either adventitious rooting adjuvant or xylogenesis enhancer in carob and pine microcuttings depending on the presence/absence of exogenous indole-3-butyric acid

Asexual propagation in Ceratonia siliqua L. (carob), species of economic value, is difficult because of adventitious rooting recalcitrance. In Pinus radiata adventitious rooting of hypocotyl cuttings is enhanced by two urea-derivatives, 1,3-di(benzo[d]oxazol-5-yl)urea (5-BDPU) and 1,3-di(benzo[d]oxazol-6-yl)urea (6-BDPU), combined with exogenous indole-3-butyric acid (IBA). The research was aimed to define the role of these urea-derivatives in adventitious root (AR) formation of carob, and to identify morphogenic roles induced in carob, but also in pine, a distantly-related forest species. In carob, 5-BDPU (10 μM) highly promoted AR formation in combination with IBA (1 μM) when applied for 3 days, followed by a transfer onto hormone free medium (HF) up to culture end (4 weeks). IBA alone (1 μM) was more effective than IBA + kinetin (Kin, 10 nM), whereas Kin alone and 5-BDPU alone were not AR-inductive. The histological analysis showed that the cambial cells initiated the ARs, and similar numbers of AR-primordia were visible at day 12, independently of the AR-inductive treatment (i.e., IBA, IBA + 5-BDPU, IBA + Kin). No cutting treated with Kin alone, and rare HF (±5-BDPU)-treated ones, showed AR-primordia at day 12. The number of AR-forming explants increased under IBA + 5-BDPU. By contrast, the cambial cells were stimulated to initiate deuteroxylem instead of ARs under 5-BDPU alone. The histological analysis in pine microcuttings treated with IBA and/or 5-BDPU at the same concentrations confirmed that 5-BDPU applied alone enhanced xylogenesis, highlighting that this urea-derivative exhibits a dual morphogenic role being involved in the switching between adventitious rooting and xylogenesis depending on the presence of exogenous auxin in both species

Ophthalmic complications of Lemierre syndrome

PURPOSE: Lemierre syndrome is a life-threatening condition characterized by head/neck bacterial infection, local suppurative thrombophlebitis and septic embolic complications in a range of sites of distant organs. No prior study focused on the course and characteristics of ophthalmic complications of Lemierre syndrome. METHODS: We analysed data of 27 patients with ophthalmic complications from a large cohort of 712 cases with Lemierre syndrome reported globally between 2000 and 2017. We focused on initial manifestations, early (in-hospital) course and long-term ophthalmic deficits at the time of hospital discharge or during postdischarge follow-up. The study protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO (CRD42016052572). RESULTS: Nine (33%) patients were women; the median age was 20 (Q1-Q3: 15-33) years. Fusobacterium spp. was involved in 56% of cases. The most prevalent initial manifestations were decreased vision (35%) and periocular oedema (38%), followed by impaired eye movements/nerve palsy (28%) and proptosis (28%). Venous involvement, notably cerebral vein thrombosis (70%) and ophthalmic vein thrombosis (55%), explained the symptomatology in most cases. Septic embolism (7%), orbital abscesses (2%) and carotid stenosis (14%) were also present. Ophthalmic sequelae were reported in 9 (33%) patients, often consisting of blindness or reduced visual acuity, and nerve paralysis/paresis. CONCLUSION: Ophthalmic complications represent a severe manifestation of Lemierre syndrome, often reflecting an underlying cerebral vein thrombosis. Visual acuity loss and long-term severe complications are frequent. We call for an interdisciplinary approach to the management of patients with Lemierre syndrome and the routine involvement of ophthalmologists

Genome-based retrospective analysis of a Providencia stuartii outbreak in Rome, Italy. Broad spectrum IncC plasmids spread the NDM carbapenemase within the hospital

Providencia stuartii is a member of the Morganellaceae family, notorious for its intrinsic resistance to several antibiotics, including last-resort drugs such as colistin and tigecycline. Between February and March 2022, a four-patient outbreak sustained by P. stuartii occurred in a hospital in Rome. Phenotypic analyses defined these strains as eXtensively Drug-Resistant (XDR). Wholegenome sequencing was performed on the representative P. stuartii strains and resulted in fully closed genomes and plasmids. The genomes were highly related phylogenetically and encoded various virulence factors, including fimbrial clusters. The XDR phenotype was primarily driven by the presence of the (NDM)-N-bla- 1 metallo- beta-lactamase alongside the rmtC 16S rRNA methyltransferase, conferring resistance to most beta-lactams and every aminoglycoside, respectively. These genes were found on an IncC plasmid that was highly related to an NDM-IncC plasmid retrieved from a ST15 Klebsiella pneumoniae strain circulating in the same hospital two years earlier. Given its ability to acquire resistance plasmids and its intrinsic resistance mechanisms, P. stuartii is a formidable pathogen. The emergence of XDR P. stuartii strains poses a significant public health threat. It is essential to monitor the spread of these strains and develop new strategies for their control and treatment