La giustizia tributaria in Cassazione: problemi e prospettive

Una montagna di ricorsi, sempre pi\uf9 alta. Con questa immagine, allo stesso tempo sintetica ed efficace, si pu\uf2 descrivere lo status quo del contenzioso fiscale presso la Corte di Cassazione. Era gi\ue0 molto alta prima del Covid-19: oltre 50.000 procedimenti, pi\uf9 della met\ue0 di quelli complessivamente pendenti avanti le sezioni civili. Rallentamento (forte) da emergenza epidemiologica e scongelamento delle impugnazioni post \u201cpaci fiscali\u201d la alzeranno ulteriormente. Stima previsionale per la fine del 2020: 70.000 circa. Nel 2019 \u2013per la prima volta dalla sua istituzione (1999)- la Sezione specializzata, magistrati e personale ausiliario, con uno sforzo davvero notevole ha raggiunto il \u201csaldo attivo\u201d: definiti superiori alle sopravvenienze. La \u201cmontagna\u201d aveva quindi incominciato ad abbassarsi e con essa, finalmente, era iniziata la discesa dei tempi di giustizia. Certo di poco, ma era comunque l\u2019avvio di un\u2019auspicabile e da pi\uf9 parti auspicata inversione di tendenza, che tuttavia nell\u2019immediato sar\ue0 assai complesso, se non impossibile, proseguire. A questo punto le sole misure organizzative interne e la legislazione \u201cestravagante\u201d si palesano sempre meno adeguate ed appare invece sempre pi\uf9 necessaria un\u2019azione \u2013 legislativa/organizzativa- sistematica che si fondi su di un\u2019ampia riflessione di sistema, che investighi le cause ed indichi i rimedi di questa \u201ccrisi dell\u2019arretrato\u201d e quindi della nomofilachia tributaria. Si evidenzia dunque il bisogno di un pensiero lungo e largo, che partendo dalla \u201cridotta\u201d della Corte, vada oltre, pi\uf9 nel profondo, attraverso le problematiche ordinamentali e procedurali fino alla stessa configurazione generale del diritto dei tributi. Abbiamo scelto tre autorevoli tributaristi accademici per costituire con le loro considerazioni un punto di avvio di questo percorso intellettuale

Trends in influenza coverage rates in five consecutive immunisation seasons in the Local Health Unit of Ferrara (North Italy).

Seasonal influenza epidemics yearly affects 5-15% of the world’s population, resulting in 3-5 million serious cases and up to 650,000 deaths. Elderly, pregnant women and individuals with underlying conditions are at increased risk of complications. According to the Italian National Immunization Prevention Plan 2017-2019, these categories benefit from free vaccination. Influenza coverage rate in Italy are not optimal. The study investigated the coverage rate in five consecutive influenza seasons (2010/2011-2014/2015) in Local Health Unit (LHU) of Ferrara (Italy). The amount of delivered vaccinations was not constant, with a decreasing trend. An increase in coverage with increasing age was observed, but in no immunisation seasons the 75% target of over-65 years old individuals immunised was achieved. As number of delivered doses and coverage rates decreased, the percentage of immunisations delivered by the General Practitioners (GPs) increased. The District with the lowest vaccination coverage was the Western District. In elderly, coverage rates in South-Eastern and North-Central District were higher with a statistically significant difference compared to Western District. Higher levels of immunisation were observed in South-Eastern District in the pediatric age and in North-Central District in adult age group with a statistically significant difference. The trend in the LHU of Ferrara was similar to regional and national data, conditioned in the 2014/2015 season by the spreading of worrying news, although unfounded, on the safety of the vaccine. The GPs were essential in ensuring vaccine uptake, growing the percentage of delivered doses and achieving as much as possible effective elderly immunisatio

Psoriasis remission after gastric bypass surgery: a case report

Case reports suggest that gastric bypass surgery in patients with psoriasis may result in complete remission of the disease. A substantial weight loss is achieved in the months following surgery, which is likely to reduce psoriasis symptoms and risk of comorbidities. A 50-year-old man was followed in our Department for several years. He had severe plaque psoriasis requiring superpotent topical steroids and methotrexate. His medical history included morbid obesity (138 kg), dyslipidemia , hypertension and positive family history for psoriasis. He underwent gastric bypass surgery on November 2011. Eight months later, his weight decreased to 86 kg, and he noted a marked improvement in his psoriasis, with reduction of body surface area involvement. In our opinion weight loss may be a useful adjunctive therapy for obese patients with psoriasis

Unexpected Pulmonary Embolism Late After Recovery from Mild COVID-19?

SARS-CoV-2 infection is associated with an increased risk of venous thromboembolism (VTE), which is common during active illness but unusual in milder cases and after healing. We describe a case of bilateral acute pulmonary embolism occurring 3 months after recovery from a paucisymptomatic SARS-CoV-2 infection. The only VTE risk factor demonstrable was a history of previous SARS-CoV-2 infection, with laboratory signs of residual low-grade inflammation. Clinicians should be aware of VTE as a potential cause of sudden dyspnoea after COVID-19 resolution, especially in the presence of persistent systemic inflammation

Analysis of multi-year near-surface ozone observations at the WMO/GAW "Concordia" station (75°06′S, 123°20′E, 3280 m a.s.l. – Antarctica)

Abstract This work focuses on the near-surface O3 variability over the eastern Antarctic Plateau. In particular, eight years (2006–2013) of continuous observations at the WMO/GAW contributing station "Concordia" (Dome C–DMC: 75°06′S, 123°20′E, 3280 m) are presented, in the framework of the Italian Antarctic Research Programme (PNRA). First, the characterization of seasonal and diurnal O3 variability at DMC is provided. Then, for the period of highest data coverage (2008–2013), we investigated the role of specific atmospheric processes in affecting near-surface summer O3 variability, when O3 enhancement events (OEEs) are systematically observed at DMC (average monthly frequency peaking up to 60% in December). As deduced by a statistical selection methodology, these OEEs are affected by a significant interannual variability, both in their average O3 values and in their frequency. To explain part of this variability, we analyzed OEEs as a function of specific atmospheric variables and processes: (i) total column of O3 (TCO) and UV-A irradiance, (ii) long-range transport of air masses over the Antarctic Plateau (by Lagrangian back-trajectory analysis – LAGRANTO), (iii) occurrence of "deep" stratospheric intrusion events (by using the Lagrangian tool STLEFLUX). The overall near-surface O3 variability at DMC is controlled by a day-to-day pattern, which strongly points towards a dominating influence of processes occurring at "synoptic" scales rather than "local" processes. Even if previous studies suggested an inverse relationship between OEEs and TCO, we found a slight tendency for the annual frequency of OEEs to be higher when TCO values are higher over DMC. The annual occurrence of OEEs at DMC seems related to the total time spent by air masses over the Antarctic plateau before their arrival to DMC, suggesting the accumulation of photochemically-produced O3 during the transport, rather than a more efficient local production. Moreover, the identification of recent (i.e., 4-day old) stratospheric intrusion events by STEFLUX suggested only a minor influence (up to 3% of the period, in November) of "deep" events on the variability of near-surface summer O3 at DMC

Echocardiographically defined haemodynamic categorization predicts prognosis in ambulatory heart failure patients treated with sacubitril/valsartan

Aim: Echo-derived haemodynamic classification, based on forward-flow and left ventricular (LV) filling pressure (LVFP) correlates, has been proposed to phenotype patients with heart failure and reduced ejection fraction (HFrEF). To assess the prognostic relevance of baseline echocardiographically defined haemodynamic profile in ambulatory HFrEF patients before starting sacubitril/valsartan. Methods and results: In our multicentre, open-label study, HFrEF outpatients were classified into 4 groups according to the combination of forward flow (cardiac index; CI:< or ≥2.0 L/min/m2 ) and early transmitral Doppler velocity/early diastolic annular velocity ratio (E/e': ≥ or <15): Profile-A: normal-flow, normal-pressure; Profile-B: low-flow, normal-pressure; Profile-C: normal-flow, high-pressure; Profile-D: low-flow, high-pressure. Patients were started on sacubitril/valsartan and followed-up for 12.3 months (median). Rates of the composite of death/HF-hospitalization were assessed by multivariable Cox proportional-hazards models. Twelve sites enrolled 727 patients (64 ± 12 year old; LVEF: 29.8 ± 6.2%). Profile-D had more comorbidities and worse renal and LV function. Target dose of sacubitril/valsartan (97/103 mg BID) was more likely reached in Profile-A (34%) than other profiles (B: 32%, C: 24%, D: 28%, P < 0.001). Event-rate (per 100 patients per year) progressively increased from Profile-A to Profile-D (12.0%, 16.4%, 22.9%, and 35.2%, respectively, P < 0.0001). By covariate-adjusted Cox model, profiles with low forward-flow (B and D) remained associated with poor outcome (P < 0.01). Adding this categorization to MAGGIC-score and natriuretic peptides, provided significant continuous net reclassification improvement (0.329; P < 0.001). Intermediate and high-dose sacubitril/valsartan reduced the event's risk independently of haemodynamic profile. Conclusions: Echocardiographically-derived haemodynamic classification identifies ambulatory HFrEF patients with different risk profiles. In real-world HFrEF outpatients, sacubitril/valsartan is effective in improving outcome across different haemodynamic profiles

Cx36 makes channels coupling human pancreatic β-cells, and correlates with insulin expression

Previous studies have documented that the insulin-producing β-cells of laboratory rodents are coupled by gap junction channels made solely of the connexin36 (Cx36) protein, and have shown that loss of this protein desynchronizes β-cells, leading to secretory defects reminiscent of those observed in type 2 diabetes. Since human islets differ in several respects from those of laboratory rodents, we have now screened human pancreas, and islets isolated thereof, for expression of a variety of connexin genes, tested whether the cognate proteins form functional channels for islet cell exchanges, and assessed whether this expression changes with β-cell function in islets of control and type 2 diabetics. Here, we show that (i) different connexin isoforms are differentially distributed in the exocrine and endocrine parts of the human pancreas; (ii) human islets express at the transcript level different connexin isoforms; (iii) the membrane of β-cells harbors detectable levels of gap junctions made of Cx36; (iv) this protein is concentrated in lipid raft domains of the β-cell membrane where it forms gap junctions; (v) Cx36 channels allow for the preferential exchange of cationic molecules between human β-cells; (vi) the levels of Cx36 mRNA correlated with the expression of the insulin gene in the islets of both control and type 2 diabetics. The data show that Cx36 is a native protein of human pancreatic islets, which mediates the coupling of the insulin-producing β-cells, and contributes to control β-cell function by modulating gene expressio

Cx36 makes channels coupling human pancreatic β-cells, and correlates with insulin expression

Previous studies have documented that the insulin-producing beta-cells of laboratory rodents are coupled by gap junction channels made solely of the connexin36 (Cx36) protein, and have shown that loss of this protein desynchronizes beta-cells, leading to secretory defects reminiscent of those observed in type 2 diabetes. Since human islets differ in several respects from those of laboratory rodents, we have now screened human pancreas, and islets isolated thereof, for expression of a variety of connexin genes, tested whether the cognate proteins form functional channels for islet cell exchanges, and assessed whether this expression changes with beta-cell function in islets of control and type 2 diabetics. Here, we show that (i) different connexin isoforms are differentially distributed in the exocrine and endocrine parts of the human pancreas; (ii) human islets express at the transcript level different connexin isoforms; (iii) the membrane of beta-cells harbors detectable levels of gap junctions made of Cx36; (iv) this protein is concentrated in lipid raft domains of the beta-cell membrane where it forms gap junctions; (v) Cx36 channels allow for the preferential exchange of cationic molecules between human beta-cells; (vi) the levels of Cx36 mRNA correlated with the expression of the insulin gene in the islets of both control and type 2 diabetics. The data show that Cx36 is a native protein of human pancreatic islets, which mediates the coupling of the insulin-producing beta-cells, and contributes to control beta-cell function by modulating gene expression.The Swiss National Science Foundation (310000-122430 to P.Me), the Juvenile Diabetes Research Foundation (1-2005-1084 to V.C., 1-2007-158 to P.Me), the National Institute of Health (DK55183 to V.C.), the European Union (FP6-Integrated Project EuroDia LSHM-CT-2006-518153 to P.Ma; FP-7 BETAIMAGE 222980 to P.Me), Novo Nordisk (to P.Me) and The Larry L. Hillblom Foundation (to V.C.). Image analysis was performed at The National Center for Microscopy and Imaging Research (NIH grant RR4050 to M. Ellisman). Fresh human islets were provided by the Cell Isolation and Transplantation Cente