La relazione fra alcune variabili macroeconomiche e i mercati automobilistici europei: un'analisi di cointegrazione

In questa tesi si analizza la misura in cui le variabili macroeconomiche - tasso d'inflazione, Pil pro capite, grazzo del petrolio e tasso d'interesse. Influenzano le immatricolazioni di automobili sia a livello europeo che nell'ottica di singolo paese. L'analisi di cointegrazione indica che solo in Francia il livello di immatricolazioni tende a seguire un equilibrio nel lungo periodoope

The Zonal and Seasonal CO2 Marginal Emissions Factors for the Italian Power Market

This paper estimates the seasonal and zonal CO2 marginal emissions factors (MEFs) from electricity production in the Italian electricity system. The inclusion of the zonal configura- tion of the Italian wholesale power market leads to a complete measurement of marginal emission factors which takes into account the heterogeneous distribution of RES power plants, their penetration rate and their variability within the zonal power generation mix. This article relies on a flexible econometric approach that includes the fractional cointe- gration methodology to incorporate the typical features of long-memory processes into the estimation of MEFs. We find high variability in annual MEFs estimated at the zonal level. Sardinia reports the highest MEF (0.7189 tCO2/MWh), followed by the Center South (0.7022 tCO2/MWh), the Center North (0.4236 tCO2/MWh), the North (0.2018 tCO2/ MWh) and Sicily (0.146 tCO2/MWh). The seasonal analysis also shows a large variability of MEFs in each zone across time. The heterogeneity of results leads us to recommend that policymakers consider the zonal configuration of the power market and the large seasonal variability related to carbon emissions and electricity generation when designing incentives for renewable energy sources expansion and for achieving emission reduction targets

What was the survival of megaprostheses in lower limb reconstructions after tumor resections?

Analisi retrospettiva delle ricostruzioni dell'arto inferiore con protesi modulariBackground: Prosthetic replacement is the most commonly used option for reconstruction of osteoarticular bone loss resulting from bone neoplasm resection or prosthetic failure. Starting in late 2001, we began exclusively using a single system for large-segment osteoarticular reconstruction after tumor resection; to our knowledge, there are no published series from one center evaluating the use of this implant. Questions/purposes: We investigated the following issues: (1) What is the overall survival, excluding local tumor recurrence, for these endoprostheses used for tumor reconstructions of the lower extremities (knee and hip)? (2) What types of failure were observed in these reconstructions? (3) Do the survival and complications vary according to site of implant? Methods: Between September 2001 and March 2012, we exclusively used this implant for tumor reconstructions. During that time, 278 patients underwent tumor reconstructions of the hip or knee, of whom 200 (72%) were available at a minimum 2 years followup. Seventy-eight patients were excluded from the study for insufficient followup as a result of early death (42) or loss at followup (36). The reconstruction types were the following: proximal femur (69 cases), distal femur (87), proximal tibia (32), and total knee (12). Failures were classified according to the Henderson classification. Nine patients among those with followup shorter than 2 years had presented one or more failures and they were included in our analysis but separately evaluated. Results: Overall survival (no further surgical procedures of any type after primary surgery), excluding Type 5 failure (tumor recurrence), was 75.9% at 5 years and 66.2% at 10 years. Seventy-one failures occurred in 58 implants (29%). Mechanical failures accounted for 59.2% and nonmechanical failures for 40.8%. The first causes of failure of the implants were the result of soft tissue failure in 6%, aseptic loosening in 3%, structural failure in 7%, infection in 8.5%, and tumor recurrence in 4.5% of the whole series. Nine implants sustained two or more failures. Overall incidence of infection was 9.5%. No statistically significant differences were observed according to anatomical site. Conclusions: Like in the case with many such complex oncologic reconstructions, the failure rate at short- to midterm in this group was over 20%. Comparative trials are called for to ascertain whether one implant is superior to another. Infection and structural failure were the most frequent modes of failure in our experience. Level of Evidence: Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Levels of silver ions in body fluids and clinical results in silver-coated megaprostheses after tumour, trauma or failed arthroplasty

Introduction: Infection in megaprostheses remains an unsolved problem, with a rate of occurrence ranging from 5% to 12%. Silver coating of medical devices has recently been proposed to reduce infection rate because of the antibacterial effect of silver. This innovation could be particularly interesting for megaprostheses, but few data have been reported in the literature. Materials and methods: From June 2010 to August 2014 a modified MegaC System megaprosthesis with an innovative peripheral silver-added layer of titanium alloy ('Porag') was implanted in 33 patients after previous infection (21 patients) or at high risk for infection because of local or general conditions (12 patients). Previous infection followed megaprosthesis or standard arthroplasty procedures in 14 patients and trauma surgery in seven patients. A proximal femur replacement was performed in 13 patients, distal femur replacement in 13, total femur in one, and knee arthrodesis in six. Clinical results and levels of silver in blood, urine and wound drains were examined. Results: Minimum follow-up of the patients was one year (average 25.9 months).There was no infection during the first two years after surgery in the 12 patients who received a silver-coated megaprosthesis and had no previous history of infection. An infection developed in one patient at 25 months after surgery following two further surgical procedures.Infection recurred at seven months and 24 months in two out of the 21 patients (9.5%) who had received the implant because of previous septic complications.There was no clinical evidence of argyria, and no local or systemic side effects related to silver were detected.Mean levels of silver ranging from 0.41 to 5.33. μg/L in blood and from 0.28 to 0.86. μg/L in urine were detected at 24. h to 36 months after surgery. Conclusions: Silver-coated megaprostheses showed promising results in this series in terms of prevention of infection in a high-risk group of patients, many of whom had a history of infection. No side-effects were detected. The circulating silver levels confirm both the persistence of silver-coating activity after three years and the safety of silver-coated implants. Longer follow-up and larger series are needed

NTRK Fusions Detection in Paediatric Sarcomas to Expand the Morphological Spectrum and Clinical Relevance of Selected Entities

Undifferentiated round cell sarcomas (URCS) of soft tissue and bone and tumours of uncertain differentiation (TUD) are commonly ascribed to a subset of neoplasms with low frequency of NTRK gene fusions. However, more recently NTRK-rearranged round and spindle cell tumours have been noted in case reports and in limited or heterogeneous cohorts. The aim of our study was to investigate the presence of NTRK gene fusions in a large retrospective cohort of paediatric URCS and TUD after a systematic review of the diagnosis, according to the recently updated WHO classification scheme. One-hundred and five patients with diagnosis of URCS or TUD, involving the bone or soft tissue, were retrospectively evaluated. After the case selection and the histopathological review of the case cohort, pan-Trk immunohistochemistry (IHC) testing was performed on formalin-fixed paraffin-embedded (FFPE) tissues. Tumour RNA was extracted from FFPE tissue and subjected to next-generation sequencing (NGS) library preparation, using a 10-gene NGS fusion panel, sequenced on an Illumina MiSeq. The NGS-positive cases were further confirmed by real-time PCR. On immunohistochemical screening, 12/105 (11.4%) cases were positive using the pan-Trk antibody, showing three different staining patterns with the cytoplasmic distribution being most common. Molecular analysis using NGS and confirmed by the real-rime PCR detected two positive cases for the ETV6-NTRK3 fusion. The histological pattern of the two positive cases, together with the demonstration of the NTRK rearrangement, leaded to re-classify these previously not otherwise specified sarcomas with uncertain differentiation into the emerging category of NTRK-rearranged neoplasms. In addition, we found the two NTRK fused neoplasms showing a clinical indolent course, in contrast with literature

The zonal and seasonal CO₂ marginal emissions factors for the Italian power market

This paper estimates the seasonal and zonal CO2 marginal emissions factors (MEFs) from electricity production in the Italian electricity system. The inclusion of the zonal configuration of the Italian wholesale power market leads to a complete measurement of marginal emission factors which takes into account the heterogeneous distribution of RES power plants, their penetration rate and their variability within the zonal power generation mix. This article relies on a flexible econometric approach that includes the fractional cointegration methodology to incorporate the typical features of long-memory processes into the estimation of MEFs. We find high variability in annual MEFs estimated at the zonal level. Sardinia reports the highest MEF (0.7189 tCO2/MWh), followed by the Center South (0.7022 tCO2/MWh), the Center North (0.4236 tCO2/MWh), the North (0.2018 tCO2/MWh) and Sicily (0.146 tCO2/MWh). The seasonal analysis also shows a large variability of MEFs in each zone across time. The heterogeneity of results leads us to recommend that policymakers consider the zonal configuration of the power market and the large seasonal variability related to carbon emissions and electricity generation when designing incentives for Renewable Energy Sources (RES) expansion and for achieving emission reduction targets

TRAPIANTI DI PERONE VASCOLARIZZATO AUTOLOGO NELLE RICOSTRUZIONI ONCOLOGICHE DEGLI ARTI SUPERIORI: INDICAZIONI E RISULTATI

Introduzione: Lo scopo del presente studio è stato quello di rivedere la nostra casistica delle ricostruzioni degli arti superiori con perone vascolarizzato (PV), dopo resezioni oncologiche intercalari o articolari, e valutare le complicanze, la sopravvivenza degli impianti e i risultati funzionali. Materiali e Metodi: Dal 1994 al 2015 presso la SOD Ortopedia Oncologica e Ricostruttiva di Firenze, sono stati trattati 37 con resezione del tumore dell’arto superiore e ricostruzione con PV. 26 maschi e 11 femmine, con un’età media di 24 anni (3-67). 28 pazienti sono stati trattati per tumori maligni (11 osteosarcoma, 9 sarcoma di Ewing, altri 8) e 9 per lesioni benigne aggressive (7 tumore a cellule giganti, 1 ciste aneurismatica dell’osso, 1 tumore desmoide). In 22 casi la resezione ha coinvolto l’omero, in 14 il radio. I tipi di ricostruzione sono stati: 15 intercalari diafisari (12 PV, 3 PV + innesto massivo omologo); 12 peroni vascolarizzati in accrescimento in età pediatrica (8 dell’omero prossimale, 4 radio distale); 7 artrodesi di polso; 2 ricostruzioni dell’omero prossimale con innesto massivo + PV. Risultati: Ad un follow-up medio di 104 mesi (2-219), 27 pazienti erano liberi da malattia, 6 liberi da malattia dopo escissione di recidiva locale o di metastasi, 4 deceduti a causa della malattia. In 13 casi si è verificata la frattura del perone, guarita dopo il trattamento conservativo in 7 casi e nuova osteosintesi in 4 casi, mentre in 2 casi l’innesto è stato rimosso e sostituito con una protesi modulare (1) o protesi composita (1). Una pseudoartrosi è stata osservata in 3 casi e un paziente ha ricevuto innesti auto-loghi dalla cresta iliaca. Infezione profonda si è verificata in 2 casi che hanno richiesto la revisione chirurgica con la rimozione del trapianto. Le curve di Kaplan-Meier hanno mostrato una sopravvivenza dell’impianto a 5 e 10 anni dell’86%. Tutte le complicanze si sono verificate entro due anni dalla chirurgia iniziale. Il punteggio MSTS (valutato in 32 pazienti) è stato eccellente in 21 casi, buono in 7 e mediocre in 3 casi. Discussione: Nonostante l’incidenza delle complicanze complicazioni, la ricostruzione biologica con PV ha dimostrato di essere una valida opzione nelle ricostruzioni dopo resezione oncologica dell’arto superiore. Tutti i tipi e le sedi di ricostruzione, si sono dimostrate efficaci e di lunga durata. Le ricostruzione epifisiaria nei bambini in accrescimento è una valida opzione ricostruttiva. Nelle ricostruzione intercalari dell’arto superiore il PV può essere usato da solo e l’associazione con l’innesto massivo non sembra necessaria. Le artrodesi di polso hanno avuto il più alto tasso di successo a lungo termine. Conclusioni: L’innesto di PV ha dimostrato di essere una soluzione efficace per le ricostruzioni dell’arto superiore in caso di resezioni intercalari, articolari dell’omero prossimale in età pediatrica e nell’artrodesi di polso