The performances of the national logistic systems: what strategies to reduce the Italian gap?

The Italian logistics suffer a strong competitive gap in comparison with the other European countries. This performance deficit generates 7.5 billion euro additional congestion costs for the Italian system: the reduction of the logistic costs would have a remarkable impact on the competitiveness of the Italian undertakings. Consequently, it is absolutely necessary to start effective policies in order to mind the gap with the competitors and to remove the infrastructural bottlenecks. In order to take up these challenges, two main knots must be untied: the infrastructure financing and the impact of the structure of the logistic sector on the overall system performance. As regards the former issue, the situation is very critical for those Member States (Italy) reporting infrastructure gap: the evolution of EU scenario pushes towards a more and more intense pressure on the public spending containment. With regard to the latter, Italy suffers from a low average dimension of the logistic operators. This paper suggests feasible solutions to solve the above mentioned problems.national logistic system, performance gap, Private Public Partnership, national champions, city logistics, industrial policy

The performances of the national logistic systems: what strategies to reduce the Italian gap?

The Italian logistics suffer a strong competitive gap in comparison with the other European countries. This performance deficit generates 7.5 billion euro additional congestion costs for the Italian system: the reduction of the logistic costs would have a remarkable impact on the competitiveness of the Italian undertakings. Consequently, it is absolutely necessary to start effective policies in order to mind the gap with the competitors and to remove the infrastructural bottlenecks. In order to take up these challenges, two main knots must be untied: the infrastructure financing and the impact of the structure of the logistic sector on the overall system performance. As regards the former issue, the situation is very critical for those Member States (Italy) reporting infrastructure gap: the evolution of EU scenario pushes towards a more and more intense pressure on the public spending containment. With regard to the latter, Italy suffers from a low average dimension of the logistic operators. This paper suggests feasible solutions to solve the above mentioned problems

A Combined Procedure of Intrastromal Corneal Rings Explantation and Penetrating Keratoplasty in a Patient With Keratoconus: A Case Report

Keratoconus is a non-inflammatory and degenerative corneal ectasia that determinate progressive steepening of paracentral cornea with development of irregular astigmatism and visual function deterioration. According to the stage of the pathology, different methods of correction can be used: rigid contact lenses may be used to alter corneal shape and partially correct astigmatism, corneal collagen cross-linking (CXL) and intrastromal corneal ring segment (ICRS) implantation can reinforce corneal stroma to slow disease progression. Late-stage treatment comprehend anterior lamellar keratoplasty or penetrating keratoplasty. We evaluated a 31-year-old patient who was subjected to bilateral ICRS implantation combined with CXL due to keratoconus. This led, after 9 months, to ring extrusion in his left eye, corneal thinning and microperforation into the aqueous chamber with residual irregular astigmatism of 4.50 D. cyl. 10°. The patient underwent ICRS explantation and PKP during the same surgical session. After 15 months of follow-up, the BCVA was 0.2 LogMAR with a residual astigmatism of 6.3 dpt

358 Clinical characteristic and natural history of chemotherapy induced dilated cardiomyopathy

Abstract Chemotherapy can lead to chemotherapy-induced dilated cardiomyopathy (CI-DCM), recognized as one of the Non-ischaemic Dilated Cardiomyopathy (DCM) phenotypes characterized by worse outcome. Evidences on a direct comparison between idiopathic-DCM (iDCM) and CI-DCM still lack. We included all the consecutive patients enrolled in the Trieste Muscle Heart Disease Registry. C-DCM was defined according to current recommendations. Uni- and multivariable analysis and Kaplan-Meier were performed. The primary outcome was all-cause death and the secondary outcomes were cardiac death and a composite of heart failure hospitalization, heart transplantation, ventricular assist-device implantation and major ventricular arrhythmias. The study included 511 patients (499 patients affected by iDCM and 52 patients affected by CI-DCM). Compared to iDCM, CI-DCM patients were older (51 ± 14 years vs. 58 ± 3 years respectively, P < 0.001) and had a higher LVEF (35%±10 vs. 32%±9, P = 0.03). CI-DCM patients had a higher incidence of all-cause of death compared to iDCM (36.5% vs. 8.4%, P < 0.001), while the incidence of cardiac death (7% in the CI-DCM group vs. 4% in the iDCM group, P = 0. 232) and of the composite secondary outcome was comparable amongst the two groups. At multivariable analysis, the diagnosis of CI-DCM was an independent predictor of primary outcome incidence (HR: 5.79, 95% CI: 1.83–18.27), P = 0.003, together atrial fibrillation. In a well-selected DCM cohort, patients with a chemotherapic etiology had a higher incidence of all-cause mortality compared to iDCM, while the incidence of cardiac adverse events was comparable among CI-DCM and iDCM

Vascular Causes of Dysphonia: A Case Series with Different Etiologies

Pierino Spadafora,1 Andrea Esposito,2 Caterina Giannitto,3 Letizia Di Meglio,1 Nunzio Paolo Nuzzi,3 Gianpaolo Carrafiello2 1Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, Milan, 20122, Italy; 2Foundation IRCCS Ca' Granda Maggiore Policlinico Hospital, Radiology Department, Milan, Italy; 3Humanitas Research Hospital, Radiology Department, Milan, 20013, ItalyCorrespondence: Pierino SpadaforaPostgraduate School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono 7, Milan, 20122, ItalyEmail [email protected] EspositoFoundation IRCCS Ca' Granda Maggiore Policlinico Hospital, Radiology Department, Via F. Sforza 35, Milan, 20122, ItalyEmail [email protected]: Dysphonia is a frequent and often disabling condition that can be caused by a multitude of circumstances. Differential diagnosis of dysphonia comprehends many different etiologies and many causative agents (neoplasms, inflammations, traumatic injuries) that can occur in a large anatomical space (from the encephalic trunk to the upper mediastinum). It is fundamental to remember that vascular etiologies are responsible for some rare cases of dysphonia. In the radiological database of two urban academic hospitals, from 2012 to 2020, we sought patients who underwent CT or MRI for dysphonia, selecting only the ones with an underlying clinically confirmed vascular etiology. We present three emblematic cases with different vascular etiologies: a ductus arteriosus aneurysm, a left internal carotid artery dilatation, a laryngeal arteriovenous malformation (AVM). Vascular causes of dysphonia are rare, but especially in these cases an accurate and prompt diagnosis is fundamental, in particular considering that the underlying cardiovascular anomaly can often pose a higher risk for the patient than the hoarseness itself. Diagnostic imaging plays a fundamental role in detecting the most common causes of dysphonia but it is very important that radiologists take the vascular causes into account so as not to miss them and to obtain a correct diagnosis.Keywords: dysphonia, thoracic aorta, arteriovenous malformation, carotid artery, patent ductus arteriosu

The Clinical Impact of Methotrexate-Induced Stroke-Like Neurotoxicity in Paediatric Departments: An Italian Multi-Centre Case-Series

IntroductionStroke-like syndrome (SLS) is a rare subacute neurological complication of intrathecal or high-dose (>= 500 mg) Methotrexate (MTX) administration. Its clinical features, evoking acute cerebral ischaemia with fluctuating course symptoms and a possible spontaneous resolution, have elicited interest among the scientific community. However, many issues are still open on the underlying pathogenesis, clinical, and therapeutic management and long-term outcome. Materials and MethodsWe retrospectively analyzed clinical, radiological and laboratory records of all patients diagnosed with SLS between 2011 and 2021 at 4 National referral centers for Pediatric Onco-Hematology. Patients with a latency period that was longer than 3 weeks between the last MTX administration of MTX and SLS onset were excluded from the analysis, as were those with unclear etiologies. We assessed symptom severity using a dedicated arbitrary scoring system. Eleven patients were included in the study. ResultsThe underlying disease was acute lymphoblastic leukemia type B in 10/11 patients, while fibroblastic osteosarcoma was present in a single subject. The median age at diagnosis was 11 years (range 4-34), and 64% of the patients were women. Symptoms occurred after a mean of 9.45 days (+/- 0.75) since the last MTX administration and lasted between 1 and 96 h. Clinical features included hemiplegia and/or cranial nerves palsy, paraesthesia, movement or speech disorders, and seizure. All patients underwent neuroimaging studies (CT and/or MRI) and EEG. The scoring system revealed an average of 4.9 points (+/- 2.3), with a median of 5 points (maximum 20 points). We detected a linear correlation between the severity of the disease and age in male patients. ConclusionsSLS is a rare, well-characterized complication of MTX administration. Despite the small sample, we have been able to confirm some of the previous findings in literature. We also identified a linear correlation between age and severity of the disease, which could improve the future clinical management

Measuring cognitive impairment and monitoring cognitive decline in Huntington's disease:a comparison of assessment instruments

Background Progressive cognitive decline is an inevitable feature of Huntington’s disease (HD) but specific criteria and instruments are still insufficiently developed to reliably classify patients into categories of cognitive severity and to monitor the progression of cognitive impairment. Methods We collected data from a cohort of 180 positive gene-carriers: 33 with premanifest HD and 147 with manifest HD. Using a specifically developed gold-standard for cognitive status we classified participants into those with normal cognition, those with mild cognitive impairment, and those with dementia. We administered the Parkinson’s Disease-Cognitive Rating Scale (PD-CRS), the MMSE and the UHDRS cogscore at baseline, and at 6-month and 12-month follow-up visits. Cutoff scores discriminating between the three cognitive categories were calculated for each instrument. For each cognitive group and instrument we addressed cognitive progression, sensitivity to change, and the minimally clinical important difference corresponding to conversion from one category to another. Results The PD-CRS cutoff scores for MCI and dementia showed excellent sensitivity and specificity ratios that were not achieved with the other instruments. Throughout follow-up, in all cognitive groups, PD-CRS captured the rate of conversion from one cognitive category to another and also the different patterns in terms of cognitive trajectories. Conclusion The PD-CRS is a valid and reliable instrument to capture MCI and dementia syndromes in HD. It captures the different trajectories of cognitive progression as a function of cognitive status and shows sensitivity to change in MCI and dementia

Complications of mechanical thrombectomy for acute ischemic stroke: Incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke

BACKGROUND: There are limited data concerning procedure-related complications of endovascular thrombectomy for large vessel occlusion strokes. AIMS: We evaluated the cumulative incidence, the clinical relevance in terms of increased disability and mortality, and risk factors for complications. METHODS: From January 2011 to December 2017, 4799 patients were enrolled by 36 centers in the Italian Registry of Endovascular Stroke Treatment. Data on demographic and procedural characteristics, complications, and clinical outcome at three months were prospectively collected. RESULTS: The complications cumulative incidence was 201 per 1000 patients undergoing endovascular thrombectomy. Ongoing antiplatelet therapy (p < 0.01; OR 1.82, 95% CI: 1.21-2.73) and large vessel occlusion site (carotid-T, p < 0.03; OR 3.05, 95% CI: 1.13-8.19; M2-segment-MCA, p < 0.01; OR 4.54, 95% CI: 1.66-12.44) were associated with a higher risk of subarachnoid hemorrhage/arterial perforation. Thrombectomy alone (p < 0.01; OR 0.50, 95% CI: 0.31-0.83) and younger age (p < 0.04; OR 0.98, 95% CI: 0.97-0.99) revealed a lower risk of developing dissection. M2-segment-MCA occlusion (p < 0.01; OR 0.35, 95% CI: 0.19-0.64) and hypertension (p < 0.04; OR 0.77, 95% CI: 0.6-0.98) were less related to clot embolization. Higher NIHSS at onset (p < 0.01; OR 1.04, 95% CI: 1.02-1.06), longer groin-to-reperfusion time (p < 0.01; OR 1.05, 95% CI: 1.02-1.07), diabetes (p < 0.01; OR 1.67, 95% CI: 1.25-2.23), and LVO site (carotid-T, p < 0.01; OR 1.96, 95% CI: 1.26-3.05; M2-segment-MCA, p < 0.02; OR 1.62, 95% CI: 1.08-2.42) were associated with a higher risk of developing symptomatic intracerebral hemorrhage compared to no/asymptomatic intracerebral hemorrhage. The subgroup of patients treated with thrombectomy alone presented a lower risk of symptomatic intracerebral hemorrhage (p < 0.01; OR 0.70; 95% CI: 0.55-0.90). Subarachnoid hemorrhage/arterial perforation and symptomatic intracerebral hemorrhage after endovascular thrombectomy worsen both functional independence and mortality at three-month follow-up (p < 0.01). Distal embolization is associated with neurological deterioration (p < 0.01), while arterial dissection did not affect clinical outcome at follow-up. CONCLUSIONS: Complications globally considered are not uncommon and may result in poor clinical outcome. Early recognition of risk factors might help to prevent complications and manage them appropriately in order to maximize endovascular thrombectomy benefits

IL RAPPORTO TRA RISPARMIATORI E BANCHE DOPO IL 2000: UN NUOVO MATRIMONIO DOPO I TRADIMENTI?

Nel corso dell'ultimo decennio le abitudini del risparmiatore italiano sono state oggetto di radicali mutamenti imputabili ad una serie di fattori di carattere sia strutturale che congiunturale. Alla crescente alfabetizzazione finanziaria e alle rilevanti prospettive offerte dalle tecnologie dell' informazione, si è contrapposto un diffuso clima di sfiducia alimentato da una difficile congiuntura economica, dagli effetti della bolla finanziaria degli anni novanta e, da ultimo, dai noti scandali finanziari che hanno coinvolto realtà produttive nazionali di particolare rilievo. Il lavoro ricostruisce sotto i profili sia concettuali che quantitavi il mutamento nei comportamenti del consumatore privato di prodotti bancari con particolare riferimento alla sua domanda di servizi finanziari con l'intento di fornire una serie di indicazioni utili a comprendere le direttrici lungo le quali si dovrebbe sviluppare nel prossimo futuro la relazione tra istituti bancari e clienti.risparmio tradito, indebitamento, attività finanziarie, fiducia