35 Electrophysiology and electrostimulation: experience

Abstract In the last 50 years, cardiac electrophysiology has undergone rapid technological development which has led to a numerical increase in both patients who have been able to benefit from the therapies of rediscovery and rhythm control, and of the devices. The activity of an electrophysiology and electrostimulation room is based on the intensive use of ionizing radiation even if electrophysiology studies, ablation, and cryoablation techniques have benefited from the support of computerized electroanatomical mapping systems with consequent dose reduction. Over the years, the instruments to be managed inside the room have increased both in complexity and numerically. Starting from the biventricular PM, we go through the implantation of subcutaneous defibrillators up to the transseptal ablations. Patient management requires additional skills that each member of the team must possess. Continuous training and updates are of fundamental importance. The purpose of this work is our experience based on the activity now more 10 years

Genetic determinants in a critical domain of ns5a correlate with hepatocellular carcinoma in cirrhotic patients infected with hcv genotype 1b

HCV is an important cause of hepatocellular carcinoma (HCC). HCV NS5A domain‐1 interacts with cellular proteins inducing pro‐oncogenic pathways. Thus, we explore genetic variations in NS5A domain‐1 and their association with HCC, by analyzing 188 NS5A sequences from HCV genotype‐1b infected DAA‐naïve cirrhotic patients: 34 with HCC and 154 without HCC. Specific NS5A mutations significantly correlate with HCC: S3T (8.8% vs. 1.3%, p = 0.01), T122M (8.8% vs. 0.0%, p < 0.001), M133I (20.6% vs. 3.9%, p < 0.001), and Q181E (11.8% vs. 0.6%, p < 0.001). By multivariable analysis, the presence of >1 of them independently correlates with HCC (OR (95%CI): 21.8 (5.7–82.3); p < 0.001). Focusing on HCC‐group, the presence of these mutations correlates with higher viremia (median (IQR): 5.7 (5.4–6.2) log IU/mL vs. 5.3 (4.4–5.6) log IU/mL, p = 0.02) and lower ALT (35 (30–71) vs. 83 (48–108) U/L, p = 0.004), suggesting a role in enhancing viral fitness without affecting necroinflammation. Notably, these mutations reside in NS5A regions known to interact with cellular proteins crucial for cell‐cycle regulation (p53, p85‐PIK3, and β‐ catenin), and introduce additional phosphorylation sites, a phenomenon known to ameliorate NS5A interaction with cellular proteins. Overall, these results provide a focus for further investigations on molecular bases of HCV‐mediated oncogenesis. The role of these NS5A domain‐1 mutations in triggering pro‐oncogenic stimuli that can persist also despite achievement of sustained virological response deserves further investigation

Acute Delta Hepatitis in Italy spanning three decades (1991–2019): Evidence for the effectiveness of the hepatitis B vaccination campaign

Updated incidence data of acute Delta virus hepatitis (HDV) are lacking worldwide. Our aim was to evaluate incidence of and risk factors for acute HDV in Italy after the introduction of the compulsory vaccination against hepatitis B virus (HBV) in 1991. Data were obtained from the National Surveillance System of acute viral hepatitis (SEIEVA). Independent predictors of HDV were assessed by logistic-regression analysis. The incidence of acute HDV per 1-million population declined from 3.2 cases in 1987 to 0.04 in 2019, parallel to that of acute HBV per 100,000 from 10.0 to 0.39 cases during the same period. The median age of cases increased from 27 years in the decade 1991-1999 to 44 years in the decade 2010-2019 (p < .001). Over the same period, the male/female ratio decreased from 3.8 to 2.1, the proportion of coinfections increased from 55% to 75% (p = .003) and that of HBsAg positive acute hepatitis tested for by IgM anti-HDV linearly decreased from 50.1% to 34.1% (p < .001). People born abroad accounted for 24.6% of cases in 2004-2010 and 32.1% in 2011-2019. In the period 2010-2019, risky sexual behaviour (O.R. 4.2; 95%CI: 1.4-12.8) was the sole independent predictor of acute HDV; conversely intravenous drug use was no longer associated (O.R. 1.25; 95%CI: 0.15-10.22) with this. In conclusion, HBV vaccination was an effective measure to control acute HDV. Intravenous drug use is no longer an efficient mode of HDV spread. Testing for IgM-anti HDV is a grey area requiring alert. Acute HDV in foreigners should be monitored in the years to come

Financing innovation in agri-food industries: an analysis of the Italian micro, small and medium enterprises

Purpose This work aims to investigate the current financial structure of Italian agri-food micro, small and medium enterprises (MSMEs) to understand how MSMEs face innovation challenges, which are also required to support sustainable development. Design/methodology/approach To reach the goal, an empirical longitudinal analysis is performed on a sample of Italian agri-food firms. In detail, to highlight the changes in the use of financial sources between 2013 and 2019, a descriptive ratio analysis is carried out on the data extracted by the AIDA database. In addition, statistical analyses were performed, including t-tests and U Mann–Whitney. Finally, a fixed-effects model is created to analyse the panel data. To ensure homogeneity, the sub-sectors of production and transformation are separately considered. Findings The financial structure analysis shows an increase in the equity percentage in the funding sources, attributable to an attempt to compensate for the reduction of banks' funding. However, even though this change has not compromised firms' profitability, the undercapitalisation of companies is still present. Therefore, more equity investments are required to support the innovation process. Originality/value The value of the present research is to highlight the choice of using new alternative financing sources instead of traditional banks' credit to implement sustainable and innovative development Italian agri-food sector (AFS). This choice is forced by reducing finance from banks and other financial institutions because of the credit crunch. This issue is even more relevant, considering that MSMEs have structural financial problems but have to fulfil the mission of pursuing innovation in the same way as large companies. Therefore, this paper expands the literature on agri-food, delving into an issue typical of MSMEs and combining agri-food with the need for innovation

“BIG DIGITAL BANK” VS "LOCAL BANK": HOW TO COPE WITH THE CONTROVERSIAL SITUATIONS?

The Italian banking system has changed profoundly and nowadays banks have to adapt their strategies to attain an adequate level of profitability (Mattei, 2019). Digitalization and mergers and acquisitions (M&A) are useful to obtain this result. However, at the same time, they can have a negative impact on the relationship between the bank and the territory, compromising the local economic growth (Caporale, Di Colli, Di Salvo, & Lopez, 2016). The objective of this work is to understand if any strategies could be undertaken to maintain the territorial relationship even when M&A and digitalization have become necessary. The methodology used is an ethnographic exploratory single case study (Yin, 1984). The information collected using semi-structured interviews is interpreted through qualitative inductive content analysis (Elo & Kyngäs, 2008). The interviews suggest that even when M&A and digitalization have a negative impact on the relationship between bank and territory, these two processes, if well-managed, could both improve the bank‟s profitability and the contact with the local reality. Therefore, if a strategic management process is defined in advance, it is possible to maintain, or, even gain profitability

The New Trend of the Financial Strategies in an Increasing Industry as Food: an Analysis of the Italian Context

The agri-food supply chain includes all activities relevant to the production, processing, distribution and marketing of food products and it is based on small and medium enterprises (SMEs), which are generally characterized by more difficulties in accessing finance (Birley and Niktari, 1995; Larsen and Lewis, 2007) than big firms. This industry must face the increased demand that is caused by the population growing (European Parliament, 2019), which will result in a persistent development of the performance through an innovation process. Nevertheless, if on one hand, the implementation of new technologies is useful to increase efficiency, on the other hand, it needs to be supported by adequate financing sources. The agriculture and food sectors have historically been supported by banks, but, in the actual context, after the banks’ consolidation in the 1990s and the financial crisis in 2008, there are many restrictions for these instruments (Nassr and Wehinger, 2015) which could compromise this innovation process. For this reason, nowadays, the scenario has sensibly changed and the use of alternative sources of financing, such as crowdfunding and venture/angel capitalists (Klerx, 2015), has constantly increased (Mondelli, 2012). The present study wants to provide a brief analysis of the SMEs and their difficulties in accessing finance, trying to find new solutions to support innovation and this is done through an analysis of the agri-food sector in Italy. This sector is characterized by growing performance in both agriculture and food and beverage industries (ISTAT, 2019a, ISTAT, 2019b) and by the huge presence of SMEs. For this reason, it can be considered a clear example of this changing situation. The analysis is done on a sample of 351 Italian firms, whose financial structure is examined to highlight the change in the use of financial sources. The findings suggest that this change is happening since the number of firms with a D/E ratio higher than 1 are increasing in the period analyzed (2013-2018) and, in general, firms are changing their financial structure, reducing Debt and increasing Equity, probably because of the credit crunch (Nassr and Wehinger, 2015). Considering the relevance of this industry in Italy, the value of the paper is to highlight the necessity to change the financial structure of the firms belonging to this sector because of the credit crunch and illustrate how it can be done. Limitations may concern the discretional choice of the indicators considered in the analysis

Does Gender Enter into the Non-Performing Loans’ Management?

In recent years several routes have been entered to face the existing discrimination in the access to credit between male and female. In this framework, the initiatives undertaken by the United Nations and the national governments have shown growing attention in order to alleviate the gender gap in various economic sectors. Among those, the non-performing loan one, given the recent economic and pandemic crises, is registering a fast increase. The objective of this work is to examine if and how gender is considered among the evaluation criteria of non-performing loans (NPLs) portfolios. An inductive content analysis has been carried out on 30 documents relating to NPLs. Specifically, the sample is made up of official publications and reports published on the websites of European and National Institutions, supervisory authorities, main banks groups, specialized sectorial consultancies and leading servicers. The analysis of the documents shows that, at present, gender is not particularly taken into consideration when banks and servicers illustrate their NPLs portfolio. On the contrary, it is possible to find classifications based on other variables (e.g. geographical position, business sector or presence of guarantees). Therefore, it is possible to conclude that gender – so far - does not appear to be an element that is considered when discussing the management of NPLs. This work is the first part of broader empirical research intended to open a debate about the relevance of the gender factor in the management of NPLs. In fact, while the gender variable seems to be taken into account as an element for granting credit, it is not considered for its management

Corporate governance, CSR and financial performances: what types of relationships exist between these dimensions?

Starting from the assumption that Corporate Social Responsibility (CSR) performances and financial performances are the results of the plan of actions of companies and depend on the financial and sustainability policies, the aim of this paper is to understand, thanks to a traditional literature review, what kind of relationship exists between the companies’ strategy and the composition of the corporate governance, already identified from scholars. From this, it is possible to hypothesize, thank the support of the literature, others types of relations not yet test, enclosing these in a framework that will be used in a following part of the present research