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Obesity is a chronic and relapsing disease due to the coexistence of a patient with predisposing individual characteristics and an obesogenic environment. The recent acquisition of detailed knowledge on the mechanisms underlying the energetic homeostasis paved the way to more effective therapeutic hypotheses as compared to traditional treatments. Since obesity is a complex issue, it requires a multidisciplinary approach which is difficult to implement. However, new drugs appear promising. Currently, therapeutic success is discrete in the short term, but unsatisfying in the long term due to the high probability of body weight gain. Cardiologists play a key role in managing patients with obesity, but they are not used to manage them. The aim of this document is to summarize knowledge that clinicians need to have to appropriately manage these patients. The paper emphasizes the pivotal role of an appropriate relationship with the patient to embark on a successful treatment journey. We analyze the criteria commonly used to diagnose obesity and point out strengths and limitations of different criteria. Furthermore, we discuss the figure of the obesitologist and the role of the cardiologist. In addition, we report the main components of an effective therapeutic strategy, from educational questions to pharmacological options.

Cardio-oncology rehabilitation (CORE) is not only an essential component of cancer rehabilitation, but also a pillar of preventive cardio-oncology. CORE is a comprehensive model based on a multitargeted approach and its efficacy has been widely documented; when compared to an "exercise only" program, comprehensive CORE demonstrates a better outcome. It involves nutritional counseling, psychological support and cardiovascular risk assessment, and it is directed to a very demanding population with a heavy burden of cardiovascular diseases driven by physical inactivity, cancer therapy-induced metabolic derangements and cancer therapy-related cardiovascular toxicities. Despite its usefulness, CORE is still underused in cancer patients and we are still at the dawning of remote models of rehabilitation (telerehabilitation). Not all cardio-oncology rehabilitation is created equal: a careful screening procedure to identify patients who will benefit the most from CORE and a multidisciplinary customized approach are mandatory to achieve a better outcome for cancer survivors throughout their cancer journey.The aim of this position paper is to provide an updated review of CORE not only for cardiologists dealing with this peculiar patient population, but also for oncologists, primary care providers, patients and caregivers. This multidisciplinary team should help cancer patients to maintain a healthy and active life before, during and after cancer treatment, in order to improve quality of life and to fight health inequities.

Scientific societies promote numerous activities, including the training of professionals. With the continuous growing of knowledge and the availability of new evidence in the cardiological field, the achievement and maintenance of knowledge and know-how is difficult. The evolving educational needs of professionals in cardiology have been analyzed during the 2023 ANMCO General States. Furthermore, the initiatives implemented to meet professionals' needs after the university medical training have been discussed. In this document, we report the main and most innovative training activities promoted by ANMCO, from distance training to simulation training, including courses for master's degree, training to and through clinical research and the potential role of teaching hospitals.

For over 40 years, clinical research has been one of the most important aims of the Italian Association of Hospital Cardiologists (ANMCO), being an essential tool in pursuing promotion and fulfillment of good clinical practices in prevention, treatment and rehabilitation of cardiovascular diseases. Since 1992, with the creation of the Research Center (now part of the Heart Care Foundation), ANMCO is capable of independently and professionally managing all the aspects related to planning, management, and publication of the results of clinical studies. The other strength of ANMCO is the network built in Cardiology Departments on the whole territory of Italy, a human capital that allows ANMCO to deal with the new scientific challenges, in a context of profound changes in the social, economic, technological, and methodological setting. This document is based on the debate about the state of clinical research in Italy and the role of ANMCO in this setting that took place during the 2023 ANMCO States General.

Technological innovation provides easily accessible tools capable of simplifying healthcare processes. Notably, digital technology application in the cardiology field can improve prognosis, reduce costs, and lead to an overall improvement in healthcare. The digitization of health data, with the use of electronic health records and of electronic health files in Italy, represents one of the fields of application of digital technologies in medicine. The 2023 States General of the Italian Association of Hospital Cardiologists (ANMCO) provided an opportunity to focus attention on the potential benefits and critical issues associated with the implementation of the aforementioned digital tools, artificial intelligence, and telecardiology. This document summarizes key aspects that emerged during the event.

Over the latest years, a worrying progressive reduction of medical specialists has been observed in Italy and in other European and non-European countries. This trend is assuming alarming proportions, especially considering the continuous population aging and the concomitant increase in the prevalence of chronic cardiovascular disease. The underlying reasons are complex and multifactorial. The purpose of this document, derived from the collegial discussion held during the 2023 ANMCO States General is to highlight the current critical issues regarding the lack of healthcare personnel in the cardiology field, examining the current and future Italian situation and proposing some potential strategies to counteract this alarming phenomenon.

Over the last two decades, cardiovascular diseases have become the leading cause of chronic disease morbidity and mortality in Italy. Therefore, the chronic cardiovascular care landscape has evolved rapidly in an era of unprecedented demand. Furthermore, the COVID-19 pandemic has highlighted significant deficiencies in existing health and social care systems, especially in the management of chronic cardiovascular disease. In this scenario, the National Reform for Recovery and Resilience (PNRR) may represent a unique opportunity for the development of a new integrated care system between hospital and community. The Italian Association of Hospital Cardiologists (ANMCO) recognizes the need for a statement on the integrated cardiological community care to guide health professionals caring for people with chronic cardiovascular conditions. The aim of the present statement is to outline the evidence for a modern integrated cardiological community care identifying challenges and offering advice for a future transdisciplinary and multi-organizational approach to ensure best practice in the management of chronic cardiovascular disease.

This article examines blue paper as an ecological solution in drawing practice by investigating the questions of when and under which circumstances German artists in the early sixteenth century decided to use blue paper. Blue paper had several aesthetic, symbolic, and economic functions, often both referencing a geographic relationship to Italy and its tradition of drawing on blue paper, and also engaging in a world of play and imitation in workshop practices. For a better understanding of the early modern paper ecologies within which artists worked, it is necessary to regard paper production within a broader socio-cultural range, thus not only as an exchange between paper makers but also with consideration of other crafts as well as the impact of new technologies. From there we can reconsider our relationship to nature.

Advances in writing technologies have fostered the gradual move from Paper-Based (PB) to Computer-Based (CB) writing assessment in foreign language (FL) education. The trend was further boosted by the outburst of the Covid-19 pandemic, which led to drastic changes in teaching and assessment practices. In higher education (HE) contexts, writing assessment in English as a foreign language (EFL) is more and more often managed by means of online learning platforms, where students create and submit written assignments on the computer. This paper examines a sample of 100 EFL exam essays completed by 100 Italian university students. Half of the essays were computer-typed on Moodle from home during the Covid-19 lockdown, whereas the other half were handwritten on paper during a face-to-face exam session after the Covid-19 emergency. The study presented herein compares the amount and types of formal errors in the CB and PB written assignments respectively. The results of the comparison may be useful to suggest hypotheses on the impact that both writing modality and environment can have on the quality of EFL writing in assessment contexts.

This article proceeds to analyze the Atlante freddo trilogy, focusing particularly on the interplay between fictional creation and the author’s cognizance of crime chronicles explored in his non-fictional works. From this vantage point, Bernardi’s novels emerge as an experimental terrain wherein he probes conceivable narratives, employing the narrative as a pretext to delineate the locales and dynamics of contemporary society. The trilogy by Bernardi directs attention to a spectrum of concerns, encompassing the marginalization of the foreigner, the erosion of the media’s informative function, and the interrelation between minor and major criminal activities. Ultimately, a comparative analysis between Bernardi and Carlotto is introduced, primarily examining ideological and thematic alignments.

In the last decades, because of the improvements in the percutaneous treatment of coronary heart disease, valvular heart disease, congenital heart defects, and the increasing number of cardiac resynchronization therapy and cardioverter-defibrillator implantations, the interventional cardiologists' radio-exposure has importantly risen, causing concerns for ionizing radiation-associated diseases such as cancer and neurodegenerative disorders. Consequently, the radiation exposure issue importantly affects operators' safety. However, our knowledge of this field is poor and most operators are unaware to be at risk, especially because of the absence of effective preventive measures. The aim of this ANMCO position paper is to improve the awareness of operators and identify new ways of reducing operator ionizing radiation dose and minimizing the risk.

Nowadays, a progressive and exponential increase in the use of invasive and non-invasive instrumental diagnostics and therapeutic services has been shown. Although unnecessary, instrumental examinations are often largely prescribed, replacing clinical evaluation. Their correct use, on the contrary, would address precise epidemiological and clinical contexts. Therefore identifying whether a test or procedure is appropriate or not plays a crucial role in clinical practice. Several documents from scientific societies and expert groups indicate the most appropriate cardiovascular diagnostic and therapeutic procedures. The international Choosing Wisely campaign invited the main scientific societies to identify five techniques or treatments used in their field that are often unnecessary and may potentially damage patients. The Italian Association of Hospital Cardiologists (ANMCO) joined the project identifying the five cardiological practices in our country at greater risk of inappropriateness in 2014. This list has recently been updated. Moreover, possible solutions to this problem have been proposed.

La professionalització dels intèrprets en l’àmbit jurídic està guanyant importància a Espanya a causa de les directives de la Unió Europea sobre els drets processals de persones sospitoses o acusades d’algun delicte. A això s’hi ha d’afegir la prolongada crisi humanitària, que ha sensibilitzat l’opinió pública sobre la qualitat de la interpretació proporcionada per diverses ONG i altres organismes que s’ocupen dels sol·licitants d’asil. Actualment, els proveïdors de serveis privats contracten els intèrprets en funció de les llengües que necessitin o que estiguin disponibles, sense exigir-los una formació específica. En aquest article, analitzem la qualitat percebuda dels serveis d’interpretació i el paper de l’intèrpret des de diverses perspectives, incloses les dels agents de les ONG (assessors jurídics, treballadors socials i psicòlegs) i els advocats que participen en aquesta mena de processos, seguint mètodes d’investigació descriptiva. A continuació, tractarem les diferents percepcions sobre la figura de l’intèrpret que tenen els diferents professionals que intervenen en el procediment de sol·licitud d’asil, amb l’objectiu d’obtenir una imatge vàlida, basada en dades, de la interpretació en el context de la sol·licitud d’asil a Espanya. S’espera que aquesta informació serveixi per omplir el buit que existeix en el desenvolupament professional dels intèrprets com a part essencial dels processos d’asil i, el que és més important, com a garantia dels drets humans. També contribuirà a sensibilitzar els professionals que desenvolupen la seva feina amb l’ajuda d’intèrprets.

Članak donosi neobjavljene i u to vrijeme neke objavljene dokumente o Stepincu iz Meštrovićeva arhiva na Sveučilištu Notre Dame u Indiani, SAD, na kojem je Meštrović predavao od 1955. godine do svoje smrti 1962. godine. Uz ostale, donosi se Meštrovićevo pismo kardinalu Spellmanu iz 1954. godine označeno oznakom „povjerljivo“, pismo Alojzija Stepinca Meštroviću od 3. listopada 1956. godine, Meštrovićeva čestitka Stepincu u povodu njegova 60. rođendana, prepiska sa č. s. Reginom Mary C. S. J. nakon Meštrovićeva posjeta Stepincu 1959. godine. U članku su dokumenti dijelom transkribirani i prikazani su, tj. obrađeni najvažniji sadržaji. Dokumenti su nastali u razdoblju od 1949. do 1960. godine. Dokumentacija pokazuje da je Ivan Meštrović iznimno poštovao Stepinca te ga je smatrao nevinim u odnosu na sva nedjela koja su mu se u montiranom sudskom procesu i u javnosti stavljala na teret.

With the growing knowledge about the role of inflammatory processes in the pathogenesis of atherosclerotic lesions, inflammation has been identified as a cardiovascular risk factor and therapeutic target to reduce the residual risk in patients with atherosclerotic disease. Several therapeutic agents with anti-inflammatory action have been tested to evaluate their efficacy and safety in the context of atherosclerotic cardiovascular diseases. Among these, colchicine, a drug with multiple therapeutic effects including anti-inflammatory action, in randomized clinical trials conducted in the setting of atherosclerotic cardiovascular disease secondary prevention, significantly reduced the risk of adverse cardiovascular events.This position paper of the Italian Association of Hospital Cardiologists (ANMCO) summarizes the main biological mechanisms through which colchicine contributes to the inhibition of inflammatory processes that increase the atherosclerotic cardiovascular risk. Furthermore, the document reports the available evidence on clinical impact of colchicine treatment in the reduction of residual cardiovascular risk in chronic and acute coronary syndromes. Finally, practical information is provided regarding the use of this drug in this specific clinical setting, emphasizing precautions and possible side effects.

The number of cardiac implantable electronic device (CIED) implantations has increased over recent years as a result of population growth, increasing life expectancy, adoption of guidelines, and better access to healthcare. Device-related infection is, however, one of the most serious complications of CIED therapy associated with significant morbidity, mortality, and financial healthcare burden. Although many preventive strategies such as administration of intravenous antibiotic therapy before implantation are well recognized, uncertainties still exist about other regimens. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, anti-bacterial envelopes, prolonged antibiotics post-implantation, and others. The key aspect to successful treatment of definite CIED infections is complete removal of all parts of the system and transvenous hardware, including the device and all leads. Thus, transvenous lead extraction has been increasing. Expert consensus statements on how to prevent, diagnose, and treat CIED infections and on lead extraction have been published by the European Heart Rhythm Association in 2020 and 2018, respectively. The aim of this AIAC position paper is to describe the current knowledge on the risks for device-related infections and to assist healthcare professionals in their clinical decision making regarding its prevention, diagnosis, and management by providing the latest update of the most effective strategies.

Over the last decade, pharmacological therapies for primary and secondary prevention of chronic coronary syndromes enriched with new agents have been demonstrated to be effective in reducing cardiovascular adverse events. However, currently available evidence on treatment for anginal symptom control is weaker. This position paper of the Italian Association of Hospital Cardiologists (ANMCO) aims to briefly report evidence that supports the use of anti-ischemic drugs for chronic coronary syndromes. Furthermore, we propose a therapeutic algorithm for the choice of the most appropriate drug on the basis of the clinical characteristics of the individual patient.

Research focused on lipid-lowering treatments has led to the development of new therapeutic options aimed at cardiovascular risk reduction. Gene silencing represents one of the most innovative approaches to reduce low-density lipoprotein cholesterol (LDL-C). Inclisiran is a small interfering RNA that inhibits proprotein convertase subtilisin/kexin type 9 synthesis and promotes LDL-C clearance by enhancing LDL-C receptor expression on hepatocyte cell surface. Several clinical studies have demonstrated inclisiran efficacy in terms of LDL-C reduction (~50%) with a dosage regimen of 300 mg administered twice a year after the first two doses administered at time 0 and after 90 days. Inclisiran use has recently been approved by the European and American drug regulatory agencies as a therapeutic option in addition to the maximum tolerated statin therapy in adults with primary hypercholesterolemia or mixed dyslipidemia who need further LDL-C reduction.

This paper discusses the results of an intervarsity picture kamishibai-storytelling workshop that integrated communication skills and art via the online real-time conference system, Zoom©. As in previous years, the goal of the annual summer drama workshop was to support the participants’ communication and leadership skills. In the light of the COVID-19 pandemic however, the chief purpose of the 2020 Online Summer English Drama Kamishibai Workshop was to support the mental well-being of students. Thirteen low-to-intermediate level English language students, both English language majors and non-majors from three different universities in Japan worked together for the workshop project in three 90-minute online slots over two days in August 2020. After learning the basic theory and techniques of the storytelling art, students were divided into groups to create their original English kamishibai story to perform online. In the preparation stage, each student created their own work using simple A4 paper sheets and pens, and these were amalgamated with other members of their group to form a coherent narrative. At the end of the third session, each group presented their work on Zoom©, and these performances demonstrated the students’ creativity through unique plots and characters. Their feedback indicated that they developed stress-tolerance and resilience, both features of negative capability.