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Cardiovascular (CV) diseases account for over 4 million deaths every year in Europe and over 220 000 deaths in Italy, representing the leading cause of morbidity and mortality worldwide. The European Society of Cardiology (ESC) guidelines have visionary included in the at very high CV risk group patients without previous acute ischemic events, such as those with subclinical atherosclerosis, chronic coronary syndrome or peripheral arterial disease, familial hypercholesterolemia, diabetes mellitus with target organ damage or multiple associated risk factors, and those with high calculated CV risk score, recommending to consider them and to achieve the same LDL-cholesterol targets as for secondary prevention patients. The aim of this position paper is to provide an updated overview of ESC guidelines that focuses on these patient categories to raise awareness within the clinical community regarding CV risk reduction in this specific epidemiological context.

The survival of pediatric cancer patients has significantly increased thanks to the improvement of oncological treatments. Therefore, it is of utmost importance to manage short- and long-term cardiovascular complications. In pediatric cardio-oncology, there are no recognized guidelines as in adults. Several recommendations and many indications have been derived from the data obtained in the adult cancer population, resulting in greater discrepancies in the clinical management of patients. The aim of this position paper of the Italian Society of Pediatric Cardiology (SICP) is to collect the main evidence regarding the diagnosis, prevention, treatment and follow-up of cardiotoxicity in children, to provide useful indications for clinical practice, and to promote a network between pediatric centers.

Interventions targeting cognitive control processes, such as Executive Functions (EF) have recently been experimented to enhance early math skills. This pilot study explored the feasibility and effectiveness of an intervention integrating EF activities into the mathematical domain among second-grade students. One hundred and four typically-developing-children were assigned to either a group that underwent the intervention (Trained Group; n = 58) or a group that continued with daily didactic activities (Control Group; n = 46). The training lasted for 8 weeks and included both home-based digital and school-based paper activities. According to teachers' feedback, the intervention was highly appreciated by children and compatible with classical school curricula. The Trained Group improved in behavioral self-regulation, math abilities and problem-solving in comparison to the Control Group. Notably, within the Trained Group, benefits of the training were higher in children with high working memory. This training offers a model to support math learning in primary school, considering inter-individual differences in EF.

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.

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.

Objective: This paper aims to describe the 2023 update position paper on MRONJ developed by the Italian Societies of Oral Pathology and Medicine (SIPMO) and of Maxillofacial Surgery (SICMF)., Methods: This is the second update following the 2013 and 2020 Italian position papers by the Expert panel, which is a representation of the two scientific societies (SIPMO and SICMF). The paper is based on an extensive analysis of the available literature from January 2003 to February 2020, and the subsequent review of literature conducted between March 2020 and December 2022 to include all new relevant published papers to confirm or modify the previous set of recommendations., Results: This position paper highlights the main issues of MRONJ on risk estimates, disease definition, diagnostic pathway, individual risk assessment, and the fundamental role of imaging in the diagnosis, classification, and management of MRONJ., Conclusion: The Expert Panel confirmed the MRONJ definition, the diagnostic work-up, the clinical-radiological staging system and the prophylactic drug holiday, as recognized by SIPMO-SICMF; while, it presented novel indications regarding the categories at risk of MRONJ, the prevention strategies, and the treatment strategies associated with the therapeutic drug holiday., (© 2024 The Authors. Oral Diseases published by Wiley Periodicals LLC.)

Despite the implementation of preventive measures to counteract the obesity epidemics, the prevalence of childhood obesity is still alarming all over the world. Childhood obesity is the most common risk factor for both cardiovascular and metabolic diseases. In fact, an earlier onset of obesity can cause a greater risk of adiposity tracking across the lifespan and consequently a longer exposure to cardiometabolic risk factors. Accumulating evidence provided by prospective and intervention studies demonstrated the link between pediatric obesity and selected subclinical signs of cardiovascular damage (atherosclerosis and left ventricular hypertrophy), or fatal and not fatal cardiovascular events as early as 40 years of age.The numerous guidelines and scientific documents published in the last years demonstrate the relevance of assessing cardiometabolic risk factors in children and adolescents with OB.This Position paper, released by experts of the "Childhood Obesity study group" within the Italian Society for Pediatric Endocrinology and Diabetology, aims to review the assessment of cardiometabolic risk factors and comorbidities in children and adolescents with OW/OB on the light of the most recent scientific evidence.The main recommendations are: (a) early detection of comorbidities, including hypertension, dyslipidemia, prediabetes/type 2 diabetes, metabolic dysfunction-associated steatotic liver disease, polycystic ovary syndrome, inactivity, obstructive sleep apnea and decline in kidney function; (b) weight loss treatment, which is associated with a reduction of all cardiometabolic risk factors; (c) specific treatment of comorbidities, through lifestyle modifications or pharmacological treatment added to lifestyle for suitable individuals; d). monitoring comorbidities for mitigating future morbidity and mortality., (© 2024. The Author(s).)

Background: Voluntary PCa screening frequently results in excessive use of unnecessary diagnostic tests and an increasing risk of detection of indolent PCa and unaffordable costs for the various national health systems. In this scenario, the Italian Society of Urology (Società Italiana di Urologia, SIU) proposes an organized flow chart guiding physicians to improve early diagnosis of significant PCa avoiding unnecessary diagnostic tests and prostate biopsy., Methods: According to available evidence and international guidelines [i.e., European Association of Urology (EAU), American Association of Urology (AUA) and National Comprehensive Cancer Network (NCCN)] on PCa, a Panel of expert urologists selected by Italian Society of Urology (SIU, Società Italiana di Urologia) proposed some indications to develop a stepwise diagnostic pathway based on the diagnostic tests mainly used in the clinical practice. The final document was submitted to six expert urologists for external revision and approval. Moreover, the final document was shared with patient advocacy groups., Results: In voluntary men and symptomatic patients with elevated PSA value (>3 ng/mL), the Panel strongly discourage the use of antibiotic agents in absence of urinary tract infection confirmed by urine culture. DRE remains a key part of the urologic physical examination helping urologists to correctly interpret PSA elevation and prioritizing the execution of multiparametric Magnetic Resonance Imaging (mpMRI) in presence of suspicious PCa. Men with negative mpMRI and low clinical suspicion of PSA (PSA density < 0.20 ng/mL/cc, negative DRE findings, no family history) can be further monitored. Men with negative mpMRI and a higher risk of PCa (familial history, suspicious DRE, PSAD>0.20 ng/mL/cc or PSA>20 ng/mL) should be considered for systematic prostate biopsy. While PI-RADS 4-5 lesions represent a strong indication for prostate biopsy, PI-RADS 3 lesions should be further stratified according to PSAD values and prostate biopsy performed when PSAD is higher than 0.20. Accreditation, certification, and quality audits of radiologists and centers performing prostatic mpMRI should be strongly considered. The accessibility and/or the waiting list for MRI examinations should be also evaluated in the diagnostic pathway. The panel suggests performing transperineal or transrectal targeted plus systematic biopsies as standard of care., Conclusions: Scientific societies must support the use of shared diagnostic pathway with the aim to increase the early detection of significant PCa reducing a delayed diagnosis of advanced PCa. Moreover, a shared diagnostic pathway can reduce the incorrect use of antibiotic, the number of unnecessary laboratory and radiologic examinations as well as of prostate biopsies.

Multi-modal therapies for gynecological cancers management may determine a wide range of side effects which depend on therapy-related factors and patient characteristics and comorbidities. Curative or adjuvant pelvic radiotherapy is linked with acute and late toxicity due to irradiation of organs at risk, as small and large bowel, rectum, bladder, pelvic bone, vagina and bone marrow. Successful toxicity management varies with its severity, Radiation Centre practice and experience and skills of radiation oncologists. This position paper was designed by the Italian Association of Radiation and Clinical Oncology Gynecology Study Group to provide radiation oncologists with evidence-based strategies to prevent and manage acute and late toxicities and follow-up recommendations for gynecological cancer patients submitted radiotherapy. Six workgroups of radiation oncologists with over 5 years of experience in gynecologic cancers were setup to investigate radiotherapy-related toxicities. For each topic, PubMed database was searched for relevant English language papers from January 2005 to December 2022. Titles and abstracts of results were checked to verify suitability for the document. Reference lists of selected studies and review papers were added if pertinent. Data on incidence, etiopathogenesis, prevention, treatment and follow-up of acute and late side effects for each organ at risk are presented and discussed., (© 2024. The Author(s).)

Competing Interests: Conflict of interest Cristina Rigamonti receives speaking engagements and travel grants from Advanz Pharma, Roche, and Abbvie. Nora Cazzagon receives speaker fees from Intercept and Advanz, and serves on advisory boards for Albireo, IPSEN, and Orphalan, also receiving travel grants from Orphalan and IPSEN. Luigi Muratori has received speaker fees from Advanz. Alessio Gerussi receives speaker fees from Advanz and consults for CAMP4 Therapeutics, Ipsen, and Signant Health. Marco Carbone consults for Ipsen, Advanz, GSK, Albireo, Cymabay, Mayoly, Echosens, and IHEP, and serves on advisory boards for Ipsen, Cymabay, and Dr. Falk.

Renal denervation (RDN) is a safe and effective strategy for the treatment of difficult to treat hypertension. The blood pressure (BP)-lowering efficacy of RDN is comparable to those of many single antihypertensive medications and it allows to consider the RDN as a valuable option for the treatment of difficult to treat hypertension together with lifestyle modifications and medical therapy. A multidisciplinary team is of pivotal importance from the selection of the patient candidate for the procedure to the post-procedural management. Further studies are needed to investigate the effect of RDN on clinical outcomes and to better identify the predictors of BP response to RDN in order to recognize the patients who are more likely to benefit from the procedure.

Introduction: Advancements in monoclonal antibodies, tyrosine kinase inhibitors, and antibody drug conjugates (ADCs) have notably enhanced outcomes for metastatic HER2-positive breast cancer patients. Despite the expanding treatment options and clinical complexities, determining the optimal sequence of HER2-targeted therapies remains partly uncertain, influenced by various factors., Methods: To refine HER2-positive metastatic breast cancer management, particularly regarding tucatinib's position, a Steering Committee of leading oncologists in breast cancer care devised a panel of statements via a Delphi approach, focusing on five key topics: general clinical management, therapeutic approaches for patients with HER2-positive breast cancer and brain metastases, treatment sequence, and tucatinib's safety and efficacy., Results: A total of 29 statements were deliberated, with strong consensus achieved for most. However, no consensus emerged regarding the management of brain progression alongside stable extracranial disease: 48 % advocated for switching to tucatinib, while 53 % favored a stereotactic brain radiotherapy (SBRT) approach if feasible., Conclusion: The unanimous consensus attained in this Delphi panel, particularly regarding tucatinib's efficacy and safety, underscores oncologists' recognition of its clinical significance based on existing trial data. These findings align closely with current literature, shedding light on areas necessitating further investigation, not thoroughly explored in prior studies. Moreover, the results underscore the scarcity of data on managing brain progression alongside stable extracranial disease, emphasizing the imperative for dedicated research to address these gaps and yield definitive insights., Competing Interests: Declaration of competing interest PC: Consulting or Advisory Role: Daiichi Sankyo/Lilly, Reveal Genomics, Gilead Sciences; Speakers' Bureau: Roche/Genentech, Novartis, AstraZeneca, Lilly, BMS; Research Funding: Merck KGaA (Inst); Patents, Royalties, Other Intellectual Property: HER2Dx patent; Expert Testimony: AstraZeneca. EC: reports consulting fees from Novartis, Lilly, Pfizer, Roche, AstraZeneca, and Daiichi Sankyo; speaker's bureau from Lilly, Pfizer, AstraZeneca, and Daiichi Sankyo; and travel and accommodations from Pfizer and Roche. GC: received honoraria for speaker's engagement: Roche, Seattle Genetics, Novartis, Lilly, Pfizer, Foundation Medicine, NanoString, Samsung, Celltrion, BMS, MSD; Honoraria for providing consultancy: Roche, Seattle Genetics, NanoString; Honoraria for participating in Advisory Board: Roche, Lilly, Pfizer, Foundation Medi-cine, Samsung, Celltrion, Mylan; Honoraria for writing engagement: Novartis, BMS; Honoraria for participation in Ellipsis Scientific Affairs Group; Institutional research funding for conducting phase I and II clinical trials: Pfizer, Roche, Novartis, Sanofi, Celgene, Servier, Orion, AstraZeneca, Seattle Genetics, AbbVie, Tesaro, BMS, Merck Serono, Merck Sharp Dome, Janssen-Cilag, Philogen, Bayer, Medivation, MedI- mmune MDL: advisory boards, activities as a speaker, travel grants, consultancy: Eli Lilly, Novartis, Seagen, Takeda, Roche, Daiichi Sankyo, Tomalab, Gilead, Genetic, Menarini, Sophos, AstraZeneca, Pfizer, Sanofi, Ipsen, Pierre Fabre, GSK. AG: research funding to the Institution: AstraZeneca, Pfizer, Janssen, Roche, MSD, Daichii-Sankyo, GSK/Tesaro, HiFiBio, Merck, Boehringer-Ingelheim, Exelixis, Bayer, Incyte, Bayer, Aileron; travel, accommodation, expenses: Gentili. LDM: advisory role for Agendia, Amgen, AstraZeneca, Collage SpA, Daiichi Sankyo, Eli Lilly, Exact Sciences, Gilead, GSK, Havas Life, Pfizer, Pierre Fabre, Roche, Seagen Int, Stemline Menarini and Uvet; personal fees as an invited speaker for Accademia Nazionale Medicina, Andromeda E20, Aristea, Delphi international, Editree, Eli Lilly, Ipsen, Meeting SrL, MSD, Novartis, Over Srl, Prex Srl, Symposia and Vyvamed Srl; personal fees for writing engagements for Edizioni Minerva Medica, Pensiero Scientifico Editore and Roche; personal consultancy fees from Eli Lilly, Gilead, Kardo Srl and Sharing Progress in Cancer Care (SPCC)—Switzerland; personal fees for author slide kits from Forum service and Think2it; personal fees for interviews from Infomedica Srl and Think2it; institutional funding as a local PI from AstraZeneca, Daiichi Sankyo, Eli Lilly, Gilead, Novartis, Novella Clinical, Roche and Seagen; institutional funding as a national coordinating PI from Roche; institutional research grant from Pfizer; and non-remunerated product samples from FoundationOne. AG: received advisory role from AstraZeneca, Daiichi, Eisai, Lilly, Novartis, Pfizer, Roche, Seagen, Gilead, Teva, and Gentili; lecture honoraria from Novartis, Pfizer, Gilead, Roche, Eisai, Seagen, Teva, and Gentili; and research support from Roche, Eisai, Gilead, and Pharmanutra AL: Research support: Roche, Agendia, Lilly, Pfizer, Novartis, Merck Sharp&Dhome, Gilead, Daiichi Sankyo; Consulting/advisor: Lilly, Roche, Pfizer, Novartis; Speaker's Bureaus: Lilly, Astrazeneca, Merck Sharp&Dhome, Pfizer, Novartis; Travel support: Roche, Pfizer, Astrazeneca, Merck Sharp&Dhome. MM: Honoraria: Roche/Genentech, Lilly, Pfizer, Novartis, Pierre Fabre, Seagen; Consulting or Advisory Role: Roche/Genentech, Novartis, Pfizer, Lilly, AstraZeneca, Daiichi-Sankyo; Speakers' Bureau: Lilly/ImClone, Lilly/ImClone, Roche/Genentech, Pierre Fabre; Research Funding: Novartis (Inst), Roche (Inst), Puma Biotechnology (Inst); Travel, Accommodations, Expenses: Daiichi-Sankyo; Other Relationship: Roche, Novartis. FPo: advisory board from AstraZeneca; speaking honoraria and travel grants from Eli Lilly, Novartis, Seagen, Daichii Sankyo, and Gilead. AP: reports grants and personal fees from NanoString Technologies, Veracyte, Novartis, AstraZeneca, DaiichiSankyo, and Roche; in addition, A. Prat has a patent for DNADX pending. FPu: reports honoraria for advisory boards, activities as a speaker, travel grants, research grants from Amgen - Astrazeneca - Daiichi Sankyo - Celgene - Eisai - Eli Lilly- Exact Sciences- Gilead - Ipsen – Menarini- MSD - Novartis - Pierre Fabre - Pfizer - Roche - Seagen - Takeda – Viatris; Research funding from Astrazeneca – Eisai – Roche. CS: consultancy or advisory role for AstraZeneca, Ax's Consulting, Byondis, Daiichi Sankyo, Eisai, Exact Sciences, Exeter, F. Hoffmann-La Roche Ltd., International Society for the Study and Exchange of evidence from Clinical research And Medical experience (ISSECAM), Medical Statistics Consulting, MediTech, Merck Sharp and Dohme Corp, Novartis, Pfizer, Philips, Pierre Fabre, PintPharma, Puma, Roche, Sanofi, Seagen, Zymeworks, and research funding from Aragon, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Byondis, CytomX, Daiichi Sankyo, F. Hoffmann-La Roche Ltd., Genentech, German Breast Group Forchungs, GlaxoSmithKline, Immunomedics, Innoup, International Breast Cancer Study Group (IBCSG), Lilly, Macrogenics, Medica Scientia Innovation Research, Menarini Ricerche, Merck Sharp and Dohme Corp, Merus, Millennium, Novartis, Pfizer, Piqur, Puma, Roche, Sanofi, Seagen, Synthon, and Zenith., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

In the era of direct oral anticoagulants, vitamin K antagonists retain a clinically relevant role in thrombotic disorders. In Italy, approximately 20% of the patients on anticoagulant therapies receives a VKA, in most cases warfarin. The optimal management of this drug is challenging and cannot disregard its intricate and unpredictable pharmacokinetic properties and patient's thrombotic and bleeding risk. Several clinical issues encountered during warfarin treatment are still unanswered and are tentatively addressed by physicians. In this regard, the Italian Federation of Centers for the diagnosis of thrombotic disorders and the Surveillance of the Antithrombotic therapies (FCSA) provides some experience-based good clinical practice's suggestions on the following topics: (1) how to start the anticoagulant treatment with warfarin and warfarin induction regimen; (2) how to manage a subtherapeutic INR value; (3) how to manage a supratherapeutic INR value in asymptomatic patients; and (4) how to manage the association of warfarin with interfering drugs., Competing Interests: S.G. received honoraria for speaking at symposia from Pfizer and Daiichi-Sankyo and supports for attending meetings from Bayer, Daiichi-Sankyo, and Pfizer. P. B. received honoraria for lectures and/or participation on advisory board from Daiichi Sankyo, Pfizer, Bristol-Myers Squibb, Astra-Zeneca, Exeltis. D.B. received honoraria for lectures from Aspen and Werfen. C.A. received honoraria for lectures from Bayer. E.G. received honoraria for lectures from Sanofi and Italfarmaco, and for participation on advisory board from Roche, Sanofi Genzyme, and Novo Nordisk. G.M. received honoraria for lectures and for participation on advisory board: Bayer, Roche, Exeltis. G.R. declares no conflict of interest; A.S. received honoraria for lectures, manuscript writing, and/or participation on advisory board from Daiichi Sankyo, Bayer, Pfizer, Bristol-Myers Squibb, Boehringer Ingelheim, Sanofi, Werfen, Viatris, Alexion, and Roche. V.T. declared no conflict of interest. S.T. received honoraria for lectures and for participation on advisory board from Werfen, Stago, Italfarmaco, Pfizer, Bristol-Myers Squibb, and Sanofi. D.P. received honoraria for educational events from Pfizer, Daiichi-Sankyo, and Boehringer., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

The management of anticoagulant therapy in pregnant women with mechanical heart valves (MHVs) is difficult and often challenging even for clinicians experienced in the field. These pregnancies, indeed, are burdened with higher rates of complications for both the mother and the fetus, compared to those in women without MHVs. The maternal need for an optimal anticoagulation as provided by vitamin K antagonists is counterbalanced by their teratogen effect on the embryo and fetus. On the other hand, several concerns have been raised about the efficacy of heparins in pregnant women with MHVs, considering the high risk of thrombotic complications in these patients. Therefore, numerous clinical issues about the management of pregnant women with MHVs remain unanswered, such as the selection of the best anticoagulant agent, the optimal anticoagulation levels to be achieved and maintained, and the evaluation of long-term effects for both the mother and the fetus. Based on a comprehensive review of the current literature, the Italian Federation of the Centers for the Diagnosis and the Surveillance of the Antithrombotic Therapies (FCSA) proposes experience-based suggestions and expert opinions. Particularly, this consensus document aims at providing practical guidance for clinicians dealing with pregnant women with MHVs, to optimize maternal and fetal outcomes while guaranteeing adequate anticoagulation. Finally, FCSA highlights the need for the creation of multidisciplinary teams experienced in the management of pregnant women with MHVs during pregnancy, delivery, and postpartum , in order to better deal with such complex clinical issues and provide a comprehensive counseling to these patients., Competing Interests: A.S. received honoraria for lectures, manuscript writing, and/or participation on advisory board from Daiichi Sankyo, Bayer, Pfizer, Bristol-Myers Squibb, Novartis, Viatris, Sanofi, Werfen, Boehringer-Ingelheim, Alexion, and Roche. All other authors have nothing to declare., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Cardiovascular magnetic resonance (CMR) and computed tomography (CCT) are advanced imaging modalities that recently revolutionized the conventional diagnostic approach to congenital heart diseases (CHD), supporting echocardiography and often replacing cardiac catheterization. This is the second of two complementary documents, endorsed by experts from the Working Group of the Italian Society of Pediatric Cardiology and the Italian College of Cardiac Radiology of the Italian Society of Medical and Interventional Radiology, aimed at giving updated indications on the appropriate use of CMR and CCT in different clinical CHD settings, in both pediatrics and adults. In this article, support is also given to radiologists, pediatricians, cardiologists, and cardiac surgeons for indications and appropriateness criteria for CMR and CCT in the most referred CHD, following the proposed new criteria presented and discussed in the first document. This second document also examines the impact of devices and prostheses for CMR and CCT in CHD and additionally presents some indications for CMR and CCT exams when sedation or narcosis is needed., (Copyright © 2024 Italian Federation of Cardiology - I.F.C. All rights reserved.)

Liver transplant oncology (TO) represents an area of increasing clinical and scientific interest including a heterogeneous group of clinical-pathological settings. Immunosuppressive management after LT is a key factor relevantly impacting result. However, disease-related guidance is still lacking, and many open questions remain in the field. Based on such a substantial lack of solid evidences, the Italian Board of Experts in Liver Transplantation (I-BELT) (a working group including representatives of all national transplant centers), unprecedently promoted a methodologically sound consensus conference on the topic, based on the GRADE approach. The group final recommendations are herein presented and commented. The 18 PICOs and Statements and their levels of evidence and grades of recommendation are reported and grouped into seven areas: (1) risk stratification by histopathological and bio-molecular parameters and role of mTORi post-LT; (2) steroids and HCC recurrence; (3) management of immunosuppression when HCC recurs after LT; (4) mTORi monotherapy; (5) machine perfusion and HCC recurrence after LT; (6) physiopathology of tumor-infiltrating lymphocytes and immunosuppression, the role of inflammation; (7) immunotherapy in liver transplanted patients. The interest in mammalian targets of rapamycin inhibitors (mTORi), for steroid avoidance and the need for a reduction to CNI exposure emerged from the consensus process. A selected list of unmet needs prompting further investigations have also been developed. The so far heterogeneous and granular approach to immunosuppression in oncologic patients deserves greater efforts for a more standardized therapeutic response to the different clinical scenarios. This consensus process makes a first unprecedented step in this direction, to be developed on a larger scale., (© 2024. Italian Society of Surgery (SIC).)

Introduction: Paget's disease of bone is a focal skeletal disorder causing bone deformities and impairing bone quality. Despite the prevalence of asymptomatic cases is increasing, the progression of the disease can lead to invalidating complications that compromise the quality of life. Doubts on clinical and therapeutic management aspects exist, although beneficial effects of antiresorptive drugs, particularly bisphosphonates are known. However, limited information is available from randomized controlled trials on the prevention of disease complications so that somewhat contrasting positions about treatment indications between expert panels from the main scientific societies of metabolic bone diseases exist. This task force, composed by expert representatives appointed by the Italian Society of Osteoporosis, Mineral Metabolism and Skeletal Diseases and members of the Italian Association of Paget's disease of bone, felt the necessity for more specific and up to date indications for an early diagnosis and clinical management., Methods: Through selected key questions, we propose evidence-based recommendations for the diagnosis and treatment of the disease. In the lack of good evidence to support clear recommendations, available information from the literature together with expert opinion of the panel was used to provide suggestions for the clinical practice., Results and Conclusion: Description of the evidence quality and support of the strength of the statements was provided on each of the selected key questions. The diagnosis of PDB should be mainly based on symptoms and the typical biochemical and radiological features. While treatment is mandatory to all the symptomatic cases at diagnosis, less evidence is available on treatment indications in asymptomatic as well as in previously treated patients in the presence of biochemical recurrence. However, given the safety and long-term efficacy of potent intravenous bisphosphonates such as zoledronate, a suggestion to treat most if not all cases at the time of diagnosis was released., (© 2024. The Author(s).)

Angiosarcoma (AS) represents a rare and aggressive vascular sarcoma, posing distinct challenges in clinical management compared to other sarcomas. While the current European Society of Medical Oncology (ESMO) clinical practice guidelines for sarcoma treatment are applicable to AS, its unique aggressiveness and diverse tumor presentations necessitate dedicated and detailed clinical recommendations, which are currently lacking. Notably, considerations regarding surgical extent, radiation therapy (RT), and neoadjuvant/adjuvant chemotherapy vary significantly in localized disease, depending on each different site of onset. Indeed, AS are one of the sarcoma types most sensitive to cytotoxic chemotherapy. Despite this, uncertainties persist regarding optimal management across different clinical presentations, highlighting the need for further investigation through clinical trials. The Italian Sarcoma Group (ISG) organized a consensus meeting on April 1st, 2023, in Castel San Pietro, Italy, bringing together Italian sarcoma experts from several disciplines and patient representatives from "Sofia nel Cuore Onlus" and the ISG patient advocacy working group. The objective was to develop specific clinical recommendations for managing localized AS within the existing framework of sarcoma clinical practice guidelines, accounting for potential practice variations among ISG institutions. The aim was to try to standardize and harmonize clinical practices, or at least highlight the open questions in the local management of the disease, to define the best evidence-based practice for the optimal approach of localized AS and generate the recommendations presented herein., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: None of the authors has any interests to report directly related to this manuscript. Outside the scope of this manuscript: Elena Palassini, Institutional Research Funding: Deciphera Pharmaceuticals, Blueprint Medicines, Cogent Biosciences, Amgen/Dompè, Bayer, GlaxoSmith Kline, Novartis, Pfizer, PharmaMar, Eisai, Eli Lilly, Advenchen Laboratories , Arog, Epizyme, Karyopharm Therapeutics, SpringWorks Ther,Daiichi Sankyo, Boehringer Ingelheim, Rain Therapeutics, Foghorn Ther Inc, Hutchinson MediPharam Lt, INBRX, PTC Ther. Giacomo Giulio Baldi, consulting fees from Eli Lilly, Pharmamar, AboutEvents; honoraria from Pharmamar, Eli Lilly, Glaxo Smith Kline, Merck Sharp & Dome, Eisai, Istituto Gentili; support for attending meetings and/or travels from Novartis, Pharmamar, Eli Lilly; participation on advisory board from Pharmamar, Eli Lilly, Glaxo Smith Kline, Merck Sharp & Dome, Eisai. Sara Sulfaro, Marta Barisella, Giuseppe Bianchi, Domenico Campanacci, Marco Fiore, Marco Gambarotti, Massimiliano Gennaro, Carlo Morosi, no conflict of interests to declare. Federico Navarria, travel grants from Pharmamar, Boehringer Ingelheim. Claudia Sangalli, advisory board from Boehringer Ingelheim, Astra Zeneca. Rossella Bertulli, travel grants from PharmaMar. Institutional Research Funding: Deciphera Pharmaceuticals, Blueprint Medicines, Cogent Biosciences, Amgen/Dompè, Bayer, GlaxoSmith Kline, Novartis, Pfizer, PharmaMar, Eisai, Eli Lilly, Advenchen Laboratories , Arog, Epizyme, Karyopharm Therapeutics, SpringWorks Ther,Daiichi Sankyo, Boehringer Ingelheim, Rain Therapeutics, Foghorn Ther Inc, Hutchinson MediPharam Lt, INBRX, PTC Ther. Alexia Bertuzzi, Roberto Biagini, Angela Bonadonna, Antonella Brunello, Dario Callegaro, no conflict of interests to declare. Ferdinando Cananzi, speaking fee from Istituto Gentili. Marco Cianchetti, Paola Collini(,) Danila Comandini, Annalisa Curcio, no conflict of interests to declare. Lorenzo D’Ambrosio, advisory board: PSI CRO Italy, GSK, AstraZeneca, Boehringer Ingelheim, Eisai. Meeting participation: GSK, AstraZeneca, PharmaMar. Martino De Pas, participation on advisory board from Glaxo Smith Kline, Boehringer Ingelheim. Trial support from: Pfizer, BluPrint Medicine, Gilead, Amgen, Merck. Angelo Paolo Dei Tos, no conflict of interests to declare. Virginia Ferraresi, Travel grants from PharmaMar, Gentili, Boehringer Ingelheim. Advisory Board: SERB Pharmaceuticals. Andrea Ferrari, Alessandro Franchi, no conflict of interests to declare. Anna Maria Frezza, Institutional Research Funding: Deciphera Pharmaceuticals, Blueprint Medicines, Cogent Biosciences, Amgen/Dompè, Bayer, GlaxoSmith Kline, Novartis, Pfizer, PharmaMar, Eisai, Eli Lilly, Advenchen Laboratories , Arog, Epizyme, Karyopharm Therapeutics, SpringWorks Ther,Daiichi Sankyo, Boehringer Ingelheim, Rain Therapeutics, Foghorn Ther Inc, Hutchinson MediPharam Lt, INBRX, PTC Ther. Elena Fumagalli, Advisory Board from Deciphera Pharmaceuticals. Institutional Research Funding: Deciphera Pharmaceuticals, Blueprint Medicines, Cogent Biosciences, Amgen/Dompè, Bayer, GlaxoSmith Kline, Novartis, Pfizer, PharmaMar, Eisai, Eli Lilly, Advenchen Laboratories , Arog, Epizyme, Karyopharm Therapeutics, SpringWorks Ther,Daiichi Sankyo, Boehringer Ingelheim, Rain Therapeutics, Foghorn Ther Inc, Hutchinson MediPharam Lt, INBRX, PTC Ther. Matteo Ghilli, Daniela Greto, no conflict of interests to declare. Giovanni Grignani, advisory board from Pharmamar, Incyte, Merck, Novartis, Deciphera,Bayer. Michele Guida, advisory board from Bristol Myers Squibb, Merck Sharp & Dohme, Novartis, Pierre Fabre. Toni ibrahim, advisory board and consultation fees from Amgen, Glaxosmithkline, PharMamar and Istituto Gentili. Travel grants from Istitaka Gentili and Pharmamar. Marco Krengli, Roberto Luksch, Andrea Marrari, Marinella Mastore, Alessandra Merlini, no conflict of interests to declare. Giuseppe Maria Milano, Advisory board from Bayer, GSK, SERBS Pharmaceuticals. Piera Navarria, Maria Abbondanza Pantaleo, Antonina Parafioriti, no conflict of interests to declare. Ilaria Pellegrini, Institutional Research Funding: Deciphera Pharmaceuticals, Blueprint Medicines, Cogent Biosciences, Amgen/Dompè, Bayer, GlaxoSmith Kline, Novartis, Pfizer, PharmaMar, Eisai, Eli Lilly, Advenchen Laboratories , Arog, Epizyme, Karyopharm Therapeutics, SpringWorks Ther,Daiichi Sankyo, Boehringer Ingelheim, Rain Therapeutics, Foghorn Ther Inc, Hutchinson MediPharam Lt, INBRX, PTC Ther. Elisabetta Pennacchioli, Marco Rastrelli, Elisabetta Setola, Salvatore Tafuto, Salvatore Turano, Sergio Valeri, Bruno Vincenzi, Viviana Vitolo, Andrei Ivanescu, Fiammetta Paloschi, no conflict of interests to declare. Paolo Giovanni Casali, Institutional Research Funding: Deciphera Pharmaceuticals, Blueprint Medicines, Cogent Biosciences, Amgen/Dompè, Bayer, GlaxoSmith Kline, Novartis, Pfizer, PharmaMar, Eisai, Eli Lilly, Advenchen Laboratories , Arog, Epizyme, Karyopharm Therapeutics, SpringWorks Ther,Daiichi Sankyo, Boehringer Ingelheim, Rain Therapeutics, Foghorn Ther Inc, Hutchinson MediPharam Lt, INBRX, PTC Ther. Alessandro Gronchi, no conflict of interests to declare. Silvia Stacchiotti, personal financial interests (honoraria, consultancy or advisory role): Aadi, Astex Pharmaceuticals, Bavarian Nordic, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Deciphera, Epizyme, Gentili, GSK, Agenus, Ikena, MaxiVAX, Novartis, PharmaMar, Pharma Essentia, Rain Therapeutics, Servier. Support for attending meetings and/or travel Pharmamar; Institutional financial interests: Advenchen, Bayer, Blueprint, Daiichi Sankyo, Deciphera, Epizyme, Eli Lilly, GSK, Hutchinson, Inhibrx, Karyopharm, Novartis, PharmaMar, Rain Therapeutics, SpringWorks; unpaid Member of the Scientifc Advisory Board of the Chordoma Foundation, Member of the Scientifc Advisory Board of the Desmoid Foundation, Member of the Scientifc Advisory Board of the Epithelioid Hemangioendothelioma Group, Member of the Scientifc Advisory Board of the Leiomyosarcoma Foundation., (Copyright © 2024. Published by Elsevier Ltd.)

Background: In response to the imperative need for standardized support for adolescent Gender Dysphoria (GD), the Italian Academy of Pediatrics, in collaboration with the Italian Society of Pediatrics, the Italian Society for Pediatric Endocrinology and Diabetes, Italian Society of Adolescent Medicine and Italian Society of Child and Adolescent Neuropsychiatry is drafting a position paper. The purpose of this paper is to convey the author's opinion on the topic, offering foundational information on potential aspects of gender-affirming care and emphasizing the care and protection of children and adolescents with GD., Main Body: Recognizing that adolescents may choose interventions based on their unique needs and goals and understanding that every individual within this group has a distinct trajectory, it is crucial to ensure that each one is welcomed and supported. The approach to managing individuals with GD is a multi-stage process involving a multidisciplinary team throughout all phases. Decisions regarding treatment should be reached collaboratively by healthcare professionals and the family, while considering the unique needs and circumstances of the individual and be guided by scientific evidence rather than biases or ideologies. Politicians and high court judges should address discrimination based on gender identity in legislation and support service development that aligns with the needs of young people. It is essential to establish accredited multidisciplinary centers equipped with the requisite skills and experience to effectively manage adolescents with GD, thereby ensuring the delivery of high-quality care., Conclusion: Maintaining an evidence-based approach is essential to safeguard the well-being of transgender and gender diverse adolescents., (© 2024. The Author(s).)

In insects, different pigments, such as melanins and pterins, are involved in thermoregulation. The degree of melanisation often varies along geographical gradients, according to the so-called thermal melanism hypothesis, i.e. darker forms are found in colder places because they can warm up more quickly. Similarly, pterins work as heat sinks and thus are expected to be more abundant in colder sites. Cities, which are warmer than surrounding areas (Urban Heat Island (UHI) effect), might also be expected to influence pigmentation, although studies are lacking. Here, we sampled workers of the social paper wasp Polistes dominula (Christ, 1791) (Vespidae) across an urbanisation gradient in an Italian metropolis and used iNaturalist pictures of this species across Italy to study pigmentation patterns at both urban and larger geographical scales. We found a lower yellow intensity of abdominal spots at warmer locations. Scanning Electron Microscopy strongly suggested that yellow colouration is due xanthopterin, known to be the heat sink molecule in other social vespids. Thus, wasps from warmer (i.e., urban) environments are likely to have fewer xanthopterin granules, in line with the lack of need for heat storage due to the local thermal gradient (UHI effect). At the country level, we found that wasps at higher latitudes had smaller yellow spots on the thorax and only two spots instead of four at higher altitudes, in full accordance with the thermal melanism hypothesis. In conclusion, climatic conditions seem to affect insect colour patterns both along urban and wider geographical gradients, although colour changes may affect different body parts and pigments likely according to different needs., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Cilostazol is a quinolinone-derivative selective phosphodiesterase inhibitor and is a platelet-aggregation inhibitor and arterial vasodilator for the symptomatic treatment of intermittent claudication (IC). Cilostazol has been shown to improve walking distance for patients with moderate to severe disabling intermittent claudication who do not respond to exercise therapy and who are not candidates for vascular surgical or endovascular procedures. Several studies evaluated the pharmacological effects of cilostazol for restenosis prevention and indicated a possible effect on re-endothelialization mediated by hepatocyte growth factor and endothelial precursor cells, as well as inhibiting smooth muscle cell proliferation and leukocyte adhesion to endothelium, thereby exerting an anti-inflammatory effect. These effects may suggest a potential effectiveness of cilostazol in preventing restenosis and promoting the long-term outcome of revascularization interventions. This review aimed to point out the role of cilostazol in treating patients with peripheral arterial disease, particularly with IC, and to explore its possible role in restenosis after lower limb revascularization.

The present paper reflects the position of the Italian Association for Neuroendocrine Tumors (Itanet), the Italian Society of Gastroenterology (SIGE), and the Italian Society of Digestive Endoscopy (SIED) regarding the management of patients affected by gastric, duodenal, and rectal neuroendocrine neoplasms (NENs) amenable to endoscopic treatment. The key questions discussed in this paper are summarized in Table 1. Data were extracted from the MEDLINE database through searches; expert opinions and recommendations are provided in accordance with the available scientific evidence and the authors' expertise. Recommendations are presented alongside a level of evidence and grade of recommendation based on the GRADE system. This paper specifically focuses on subgroups of NENs considered suitable for endoscopic management according to current international guidelines: i. well-differentiated gastric neuroendocrine tumors (gNET) type 1 < 2 cm and selected cases of type 3; ii. well-differentiated duodenal, non-functioning, non-ampullary NET with size < 2 cm; and well-differentiated rectal NET with size < 2 cm., Competing Interests: Conflict of interest None., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Pulmonary embolism (PE) is a potentially life-threatening condition that remains a major global health concern. Noteworthy, patients with high- and intermediate-high-risk PE pose unique challenges because they often display clinical and hemodynamic instability, thus requiring rapid intervention to mitigate the risk of clinical deterioration and death. Importantly, recovery from PE is associated with long-term complications such as recurrences, bleeding with oral anticoagulant treatment, pulmonary hypertension, and psychological distress. Several novel strategies to improve risk factor characterization and management of patients with PE have recently been introduced. Accordingly, this position paper of the Working Group of Interventional Cardiology of the Italian Society of Cardiology deals with the landscape of high- and intermediate-high risk PE, with a focus on bridging the gap between the evolving standards of care and the current clinical practice. Specifically, the growing importance of catheter-directed therapies as part of the therapeutic armamentarium is highlighted. These interventions have been shown to be effective strategies in unstable patients since they offer, as compared with thrombolysis, faster and more effective restoration of hemodynamic stability with a consistent reduction in the risk of bleeding. Evolving standards of care underscore the need for continuous re-assessment of patient risk stratification. To this end, a multidisciplinary approach is paramount in refining selection criteria to deliver the most effective treatment to patients with unstable hemodynamics. In conclusion, the current management of unstable patients with PE should prioritize tailored treatment in a patient-oriented approach in which transcatheter therapies play a central role., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Biliary tract cancers (BTCs) represent a spectrum of malignancies associated with a dismal prognosis. Recent genomic profiling studies have provided a deeper understanding of the complex and heterogenous molecular landscape of BTCs, identifying several actionable genetic alterations, and expanding treatment options. Due to the high number and complexity of genetic alterations which require testing, next-generation sequencing (NGS) is currently the preferred approach over conventional methods (i.e., immunohistochemistry, fluorescence in-situ hybridization and PCR) for molecular profiling of BTCs and should be performed upfront in all BTC patients. However, BTC sampling often yields low tumor cellularity tissue, hampering NGS analysis. Future perspectives to overcome this obstacle include liquid biopsy and optimization of biopsy protocols. In this position paper, the authors discuss the current histopathologic, molecular, and therapeutic landscape of BTCs, provide a critical overview of the available testing methods for molecular diagnostics, and propose a practical diagnostic algorithm for molecular testing of BTC samples., Competing Interests: Declaration of Competing Interest All other authors declare that they have no conflict of interest related to the present work. Conflict of interest statement MF has been involved in consulting/advisory roles in Astellas Pharma, Pierre Fabre, MSD, AstraZeneca, Janssen, GlaxoSmithKline, BMS, Incyte, Amgen, Novartis and Roche, and received research funding from Astellas Pharma, QED Therapeutics, Diaceutics and Macrophage Pharma. NN has been involved in consulting/advisory roles in MSD, Bayer, Biocartis, Illumina, Incyte, Roche, BMS, Merck, Thermofisher, AstraZeneca, Eli Lilly, Novartis; financial support to research projects (institutional grants) from Merck, Thermofisher, QIAGEN, Roche, AstraZeneca, Biocartis, Illumina, Sophia genetics; non-financial interests President of the International Quality Network for Pathology (IQN Path) and Past President of the Italian Cancer Society (SIC). GP has been involved in consulting/advisory roles in Roche, Illumina, Novartis, Lilly, AstraZeneca, Exact Sciences, ADS Biotech. GT has received honoraria from Molteni, Novartis and Pharmamar. AS has received consulting fees from Amgen, AstraZeneca, Basilea, Incyte, and Ipsen and lecture fees from Amgen, Incyte, Ipsen, Merck Serono, Roche, and Sanofi. LR has received consulting fees from AstraZeneca, Basilea, Bayer, BMS, Eisai, Exelixis, Genenta, Hengrui, Incyte, Ipsen, IQVIA, Jazz Pharmaceuticals, MSD, Nerviano Medical Sciences, Roche, Servier, Taiho Oncology, and Zymeworks; lecture fees from AstraZeneca, Bayer, BMS, Eisai, Incyte, Ipsen, Merck Serono, Roche, and Servier; travel expenses from AstraZeneca; and institutional research funding from Agios, AstraZeneca, BeiGene, Eisai, Exelixis, Fibrogen, Incyte, Ipsen, Lilly, MSD, Nerviano Medical Sciences, Roche, and Zymeworks. FG has been involved in consulting/advisory roles in MSD and GlaxoSmithKline; lecture fees from MSD, Incyte and GlaxoSmithKline., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: De-escalation of axillary surgery in breast cancer (BC) management began when sentinel lymph node biopsy (SLNB) replaced axillary lymph node dissection (ALND) as standard of care in patients with node-negative BC. The second step consolidated ALND omission in selected subgroups of BC patients with up to two macrometastases and recognized BC molecular and genomic implication in predicting prognosis and planning adjuvant treatment. Outcomes from the recent RxPONDER and monarchE trials have come to challenge the previous cut-off of two SLN in order to inform decisions on systemic therapies for hormone receptor-positive (HR+), human epidermal growth factor receptor type-2 (HER2) negative BC, as the criteria included a cut-off of respectively three and four SLNs. In view of the controversy that this may lift in surgical practice, the Italian National Association of Breast Surgeons (Associazione Nazionale Italiana Senologi Chirurghi, ANISC) reviewed data regarding the latest trials on this topic and proposes an implementation in clinical practice., Material and Methods: We reviewed the available literature offering data on the pathological nodal status of cN0 breast cancer patients., Results: The rates of pN2 status in cN0 patients ranges from 3.5 % to 16 %; pre-surgical diagnostic definition of axillary lymph node status in cN0 patients by ultrasound could be useful to inform about a possible involvement of ≥4 lymph nodes in this specific sub-groups of women., Conclusions: The Italian National Association of Breast Surgeons (ANISC) considers that for HR + HER2-/cN0-pN1(sn) BC patients undergoing breast conserving treatment the preoperative workup should be optimized for a more detailed assessment of the axilla and the technique of SLNB should be optimized, if considered appropriate by the surgeon, not considering routine ALND always indicated to determine treatment recommendations according to criteria of eligibility to RxPONDER and monarch-E trials., (© 2024 Published by Elsevier Ltd.)

We analyze the role of institutional founding conditions and institutional legacy for universities' self-representation in terms of diversity. Based on 374 universities located in the Czech Republic, France, Germany, Hungary, Italy, and Poland, we can differentiate between a more idealistic understanding (logic of inclusion and equality) and a more market-oriented understanding (market logic) of diversity. Our findings show that the founding phase has no significant effect on the likelihood of a university focusing on a market-oriented understanding of diversity--however, we observe an imprinting effect with respect to the adoption of a diversity statement in general and an equity-oriented statement. Moreover, our findings show that there is a socialistic heritage for universities in Central and Eastern European (CEE) countries that is at work and still influences universities' understandings of diversity today.

This paper explores the knowledge network structure of foreign research literature by applying the qualitative comparative analysis (QCA) method to the field of information science and library science (ISLS) from the perspective of the cocitation of social network actors such as authors, institutions, countries, and literature, and it further reveals the future application trends of this method. [Method/process] Based on 86 journals in the ISLS field that were downloaded from the Web of Science using the QCA method, the social network analysis (SNA) method and the visual analysis tool Gephi are used to analyse the author cooperation network, the research institution cooperation network, the national cooperation network, the cocitation network, the cutting-edge trends, etc., of journal papers. The analysis shows that the QCA method covers a wide range within the field of ISLS, but the research topics involved in this field are not concentrated, and the author cooperation network has scale-free characteristics. The application of the QCA method is still dominant in European and American countries, and China, the USA, and Italy all play key roles in the national cooperation network. Finally, the institutional cooperation network has certain small group attributes. [ABSTRACT FROM AUTHOR]

Background. Gender gap is a neologism that identifies the disparity between social and professional conditions experienced by females compared to males. The disparity increases as one ascends the academic hierarchy. In recent years, the debate has expanded, and more options have been planned for the elimination of the current gender gap. Methods. This research was conducted by examining the landscape of the gender gap, particularly in the academic forensic medicine field. Our analysis involved reviewing papers published between 2006 and 2024, identified through electronic database searches (PubMed). The search terms used were: "gender gap" AND "academic" AND "medicine" AND "leadership." In total, we analyzed 85 papers. Additionally, we examined data from forensic medicine residency programs. Conclusions. The representation of women in medicine is well-known. Despite the increasing number of women in leadership positions in medicine, they still lag significantly behind men. These data highlight a situation that could be seen as grounds for an accusation of "academic abuse". In the Italian forensic residency programs, less than 20% are led by women, and among these, not all hold the rank of full professor. Although a certain rebalancing is already underway, the gap is still significant. There are already regulations obliging local authorities to promote gender equality in councils, companies, and institutions under their jurisdiction. It would be desirable to consider minimum quotas for female participation in university competitions. This would be a first step toward eliminating the gender gap in academic and forensic medical fields. [ABSTRACT FROM AUTHOR]

Purpose: This study deals with the main issues concerning the interplay between homeownership and labour market outcomes, namely (1) the relation between homeownership and labour market outcomes, at both the individual level and the aggregate level, and (2) the relation between homeownership and human capital. Design/methodology/approach: This paper is both theoretical and empirical. A search and matching model of the labour market is developed to explain the strong relation between mortgage markets and wages. A regional panel analysis in Italy is used to verify the interplay between homeownership and wages. Findings: Homeownership is not, by itself, a condition for receiving higher wages, but rather higher wages increase the probability to become a homeowner, since they positively affect the probability of acquiring a mortgage from the bank. Eventually, wages cause homeownership, but the reverse may not be true. Research limitations/implications: The paper focuses on the labour market, while the housing market model is restricted to the mortgage market. Practical implications: The positive effect of homeownership on wages is hard to theoretically formalise and is not empirically proven. Before investigating a (potential) bidirectional relationship between homeownership and labour market outcomes, therefore, the related literature should assume a new theoretical link between homeowners and wages. Social implications: The result that "homeownership is not, by itself, a condition for receiving higher wages" has positive implications for human and social development. If homeownership could lead to better labour market outcomes, indeed, socio-economic inequalities would increase in the society, because homeownership would be the starting point of a "lucky" circle that increases the well-being of people who are already wealthy. Originality/value: First, this study clearly explains why the microeconomic result that homeowners are more likely to be employed than tenants is consistent – at the aggregate level – with a negative relation between homeownership and better labour market outcomes. Second, the related literature has largely ignored the social implications of the topic. A potential bidirectional relation between homeownership and (better) labour market outcomes, indeed, could imply an increase in the well-being of people who are already wealthy. [ABSTRACT FROM AUTHOR]

Purpose: The paper delves into the international expansion of luxury SMEs to investigate their internationalization pathways, namely how the internationalization process unfolds in terms of timing of entry into foreign markets, the geographic scope of operations and the scale. The paper examines also the determinants of the internationalization pathways as a set of factors that contribute to developing an asset of foreignness. Design/methodology/approach: The paper adopts a multiple case study approach and reports findings from four cases of Italian SMEs operating in the luxury fashion industry. Findings: SMEs' specific characteristics at the firm and entrepreneurial levels (i.e. craftsmanship, quality, product creativity, entrepreneurial mindset), country of origin attributes (e.g. Italy's positive image) and the inherently global nature of the luxury industry, can turn foreignness into an asset of foreignness that allows luxury fashion SMEs to pursue internationalization pathways of born globals. Originality/value: The paper highlights that the global luxury market is not the exclusive domain of MNEs and sheds light on luxury SMEs, overlooked by extant literature. The paper also contributes to understanding early internationalization by highlighting a potential link between internationalization pathways and foreignness and discussed the asset of foreignness by extending it to SMEs. [ABSTRACT FROM AUTHOR]

Although the relationship between religion and football has gained considerable interest during the last twenty years, scant attention has been paid to the relationship between pilgrimage and football. This paper seeks to advance the study of this relationship through an exploration of collective memory about football disasters that throws fresh light on central themes within pilgrimage studies—pilgrimage as both a journey to a sacred place and the performance of diverse rituals at such places. The paper explores, in particular, the ways in which three different tragedies involving English football clubs have been commemorated through journeys to and ritual performance at places seen as sacred to those involved in commemoration—football stadiums and urban spaces, and cathedrals and pilgrimage shrines in England, Germany and Italy. Through this analysis, we seek to show how the commemoration of football disaster is linked to pilgrimage as a process where people seek healing and reconciliation through the public performance of rituals that link the local to the global. [ABSTRACT FROM AUTHOR]

Recent technological advancements are transforming the architecture, engineering and construction (AEC) industry, focusing on digitalization and automation opportunities as drivers for improvement. In a realm as complex as building permitting, the drive for automation should be anchored in a comprehensive understanding of the process it seeks to transform. Furthermore, analyzing the process from a global perspective is essential for identifying opportunities for improvement. This article addresses the need for a systematic and robust approach to evaluate and compare building permit processes globally. Traditional approaches for process comparisons fail to capture the intricacies of a building permit process. Hence, in this paper, the authors propose and introduce the Process Analysis and Comparative Evaluation methodology, PACE-BP, which was tailored for building permit processes. The proposed method relies on a previously developed framework for process mapping which provides a comparable data set of building permit process maps in different countries. The comparative evaluation is then performed by assessing the maps based on predefined indicators, which are used to compile a representative vector for each process. The computational method for compiling the vectors and calculating the similarity measures between pairs of processes is described in detail. The application of PACE-BP for analyzing and comparing building permit processes in Germany, the US, Israel, and Italy is demonstrated in this paper. Our findings challenge the pursuit of a universal "best practice," emphasizing the need to balance priorities and stakeholder's objectives. The PACE-BP method is a powerful tool for policymakers and stakeholders, providing meaningful insight into existing processes and pinpointing drawbacks and limitations in current practices, while revealing opportunities for improvement. [ABSTRACT FROM AUTHOR]

The fluidity, adaptability and complexity of a dancer's movement are often used as examples of how dance at a level of mastery is embodied. The freedom this gives the dancer to choose what and how they move is enjoyed at a subconscious level, with often tacit knowledge driving the artistic and technical brilliance. The topic of embodied agency in dance becomes more complicated when examining dance for the older person who has had little training. Embodiment is not straight forward, particularly if one examines dancing for the older adult with a neurodegenerative condition, which disrupts cognition and physical movement. Yet, as I argue, embodied agency is a key vision for socially engaged dance practices, particularly using improvisation. In the paper I examine how centring the amateur older dancer with a neurological condition means looking again at embodied agency and what it could mean in this context, as well as what the conditions are that might make it work. The paper takes the example of Dance Well, a group of community dancers in Italy that accommodates people with Parkinson's and others, including those seeking asylum. With this example I draw upon ideas from research I co-led to name some of the tacit soft skills--such as empathy and understanding and appreciating difference--developed through Dance Well's engagement with the local community, which, I now suggest, led to a process of embodied agency. I argue that in identifying this anoetic knowing, it is clear that embodied agency is not just aboutmastery of movement, but about important relational skills that are embodied and practiced through dancing, even by those with little formal dance training. I argue that moving together whilst embodying soft skill qualities may nurture an environment that could enable the transformation of relationships between those dancing and contribute to the creation of an important and meaningful activity within the community. In this way, the paper outlines ideas on how embodied agency through dancing may contribute to a vision of social justice and a characterization of embodiment that emphasizes the recognition of each other's humanity. [ABSTRACT FROM AUTHOR]

Individuals who reside in a country without regular authorisation generally find it difficult to access public medical services beyond emergency treatment. Even in countries with universal healthcare, there is often a gap between rights on paper and their implementation. Civil society organisations (CSOs) fill this gap by providing medical services to vulnerable populations, including irregular migrants. What, if any, are the ethical dilemmas that arise for CSO staff when delivering such services in countries with universal healthcare? Under what conditions do these dilemmas arise? And what strategies do CSO staff use to mitigate them? We answer these questions using 40 semi-structured interviews with CSO staff working in two European countries with high levels of irregularity, universal healthcare provisions on paper, and significant differences in approaches and availability of public services for irregular migrants: Italy and Spain. We show that CSO staff providing medical services to irregular migrants in places with universal healthcare coverage face a fundamental dilemma between humanitarianism and equity. CSO staff respond to the humanitarian belief in the value of taking all possible steps to prevent or alleviate human suffering, thus promoting a decent quality of life that includes access to both emergency and non-emergency care. In doing so, however, they run the risk of substituting rather than complementing public provisions, thereby preventing governments from assuming responsibility for these services in the long term. Individuals who acknowledge the existence of this dilemma generally oppose the creation of parallel structures; that is, services specifically developed for irregular migrants outside the public system; while those who ignore it essentially subscribe to a tiered system, giving up on considerations of equity. We argue that CSOs involved in the provision of healthcare to irregular migrants do not simply provide services; they also play an inherently political role. [ABSTRACT FROM AUTHOR]

The paper aimed to investigate the influence, on the assessment of the structural safety level of an existing r.c building, of the different choices that the technician in charge of a structural evaluation (the "analyst") can make regarding the structural elements to be tested to obtain a prescribed level of knowledge. To this end, the case study of a reinforced concrete framed structure built in the 1960s in Italy was investigated by means of numerical analyses. The probability distribution of the estimated safety levels was evaluated in the paper by means of a Monte Carlo approach, considering the alternative selections of elements done by a large number of analysts, and the probability of unsuccessful safety estimations is discussed for the knowledge levels considered in the Italian technical codes and the Eurocodes. [ABSTRACT FROM AUTHOR]

The aim of this paper is to examine if and how the reclassification of platform workers from self-employment status to employment status can provide them with adequate social security protection. Little is known about how this transition would guarantee platform workers adequate social protection within the social protection scheme for employees. National social security schemes, in particular income replacement benefit schemes, often (still) depart from the standard employment relationship, leading to lower protection for atypical work forms. Platform workers combine several of the characteristics of atypical forms of work, such as low earnings, irregular working patterns and working. Integrating platform workers into employee social security schemes faces additional challenges due to the online nature of their work, algorithmic management, high levels of unpaid labor, and employer identification difficulties. This paper focuses on unemployment protection, as EU Member States struggle to provide adequate protection for workers with irregular work patterns and income fluctuations, in the case of (short term) income replacement benefits. By constructing nine ideal work patterns reflective of diverse nature of platform work and current practices among platform work, we analyse how different types of 'employed' platform workers may fare within the legislation of three EU countries (Belgium, Italy, and the Netherlands). This approach allows us to assess the applicability of unemployment protection to different working patterns among 'employed' platform workers, considering formal, effective, and adequate access to unemployment schemes as outlined in the Council Recommendation on access to social protection for workers and the self-employed (2019). [ABSTRACT FROM AUTHOR]

This paper retraces the history of Italy's first-generation rent control—a strict system of nominal rent freezes—from its adoption in 1915 to its final dismantling in 1978. It investigates the political and economic reasons why this policy was adopted, removed, intensified, or lightened at different times. In addition, this paper reports data on the evolution of rents in various Italian cities over the period considered, drawing them partly from published statistical sources and partly from archival research. In particular, it presents original data on controlled and uncontrolled rents in nineteen Italian cities between 1953 and 1975 (with gaps), taken from the Istat historical archive. [ABSTRACT FROM AUTHOR]

Background: Potentially inappropriate polypharmacy (PIP) is among the major factors leading to adverse drug reactions, increased healthcare costs, reduced medication adherence, and worsened patient conditions. This study aims to identify existing interventions implemented to monitor and manage polypharmacy in the Italian setting. Methods: A systematic literature review (PROSPERO: CRD42023457049) was carried out according to the PRISMA statement guidelines. PubMed, Embase, ProQuest, and Web of Science were queried without temporal constraints, encompassing all published papers until October 2023. Inclusion criteria followed the PICO model: patients with polypharmacy; interventions to monitor/manage polypharmacy regimen versus no/any intervention; outcomes in terms of intervention effectiveness and cost variation. Results: After duplicate deletion, 153 potentially relevant publications were extracted. Following abstract and full-text screenings, nine articles met the inclusion criteria. Overall, 78% (n = 7) were observational studies, 11% (n = 1) were experimental studies, and 11% (n = 1) were two-phase studies. A total of 44% (n = 4) of the studies involved patients aged ≥ 65 years, while 56% (n = 5) were disease-specific. Monitoring was the most prevalent choice of intervention (67%; n = 6). Outcomes were mainly related to levels of polypharmacy (29%; n = 6) and comorbidities (29%; n = 6), effectiveness rates (14%; n = 3), and avoidable costs (9%; n = 2). Conclusions: This review outlines that Italy is still lacking in interventions to monitor/manage PIP, addressing an unmet need in developing patient-tailored strategies for reducing health-system burden. [ABSTRACT FROM AUTHOR]

The task of change detection (CD) in optical and SAR images is an ever-evolving and demanding subject within the realm of remote sensing (RS). It holds great significance to identify the target areas by using complementary information between the two. Due to the distinct imaging mechanisms employed by optical and SAR sensors, effectively and accurately identifying changing regions can be challenging. To this end, a novel heterogeneous RS images CD network (Twin-Depthwise Separable Convolution Connect Network, TDSCCNet) is proposed in this paper. Image domain transformation is a front-end task, while the back-end employs a single-branch bilayer depthwise separable convolutionconnected encoder-decoder to accomplish CD work. Specifically, first, the cycle-consistent adversarial network (CycleGAN) serves to integrate the optical and SAR visual domains, and a consistent feature expression is obtained. Second, the single-branch encoder structure of bilayer depthwise separable convolution is employed to realize change feature extraction. Finally, the multiscale connected decoder reconstructed by change map is utilized to reconstruct the original images and solve the local discontinuities and holes in the binary change map. Multiscale loss is designated for optimizing the global and local effects to alleviate the class imbalance problem. It was tested on four representative datasets from Gloucester, Shuguang Village, Italy and WV-3 datasets with an overall accuracy of 97.36%, 97.01%, 97.62%, and 98.01% respectively. By comparing the existing methods, experimental results confirmed the effectiveness of the proposed method. [ABSTRACT FROM AUTHOR]

The few existing studies in international literature about students with learning disabilities' postsecondary persistence and academic performances show varied outcomes. Rigorous research has been limited. Moreover, in Italy there is a dearth of public data on students' careers and clearly a deficiency regarding literature on this topic. To tackle this situation, propensity score matching techniques were used in this paper to compare data about persistence and academic success of students who reported a learning disability with those who did not, all enrolled in a large University in Northern Italy. Once potential confounders were taken into account, our findings indicated that students with an attested learning disability were as likely to persist in academic context as peers without any LD. However, for what concerns academic performances, the outcomes varied according to the measures being used. Although there were no significant differences between the two groups in terms of the number of course credits (ECTS) earned, students with learning disabilities continued to lag behind their counterparts without disabilities concerning first-year grade point average achieved. This paper includes final recommendations for future research, in order to fill existing gaps in methodology and area of study. [ABSTRACT FROM AUTHOR]

This article analyses the ongoing processes in the organisational field of Italian schools in light of the innovations induced by digital education policies. Specifically, it focuses on the relationship between actors and digital policies concerning the experience of distance learning (DL) that characterised the period of the COVID-19 pandemic. The paper reflects on DL outcomes regarding the three expectations that have often characterised the rhetoric associated with the promotion of digital educational policies, namely: the raising of learning levels, the development of digital competences and the increase in school inclusion. Through an analysis of a series of empirical studies exploring the point of view of the paper, this paper highlights what progress has been made in the digital schooling in Italy and what are still its main limitations. The results of the study show both the limits of the effectiveness of educational policies constructed with a top-down approach and highlight the potential for policy recalibration offered by a reorganisation of the decision-making process through the active involvement of all the actors in the educational system. [ABSTRACT FROM AUTHOR]

Social innovation has been associated with contributing to 'valuable' rural development; however, usually, the impact of social innovation has been identified in the aftermath of its development or implementation. This might be too narrow an approach, as an ongoing social innovation process in itself may already lead to effects that contribute to regional and social changes in a local community and beyond. This paper argues that collaborative valuation processes are embedded in social innovation processes, generating effects that contribute to rural development. Focusing on a case study that exemplifies social innovation processes in agriculture and food production carried out by a rural collaborative community in southern Italy, we demonstrate how three valuation phases, such as contestations and negotiations of norms, symbolic capital accumulation and recognition of actions, as well as re-definitions of values, impact community development through joint sense-making, empowerment and societal change. Our empirical results suggest the close intertwining of both social innovation and valuation processes. The empirical results demonstrate how collective valuation processes have micro-effects on the agro-economic system, on local socio-cultural processes, and on place-making activities. Methodologically, this paper builds on ethnographic methods, including participatory observations, semi-structured interviews, oral histories, and socio-spatial analysis investigating moments of valuation embedded in daily collaborative practices. [ABSTRACT FROM AUTHOR]

Introduction: This paper describes the peculiarities of the plasma-derived medicinal product (PDMP) market and illustrates the results of a review of the literature on policies aimed at counteracting the shortage of PDMPs. Characteristics of PDMPs: Plasma is primarily used for the industrial production of blood products (80%). The demand for PDMPs, particularly immunoglobulins (IGs), is increasing. However, the production of PDMPs is complex, long (7-12 months), and expensive, accounting, according to US estimates, for 57% of the total costs of PDMPs compared to 14% for small molecules. PDMP market: Unexpected increases in clinical need cannot be addressed in the short term. Once the demand for some diseases is satisfied, the collection and fractionation of plasma will only be used to supply some specific patients. Hence, the full weight of the marginal costs, which remain constant, are borne by a few products. According to last liter economics, the industry stops producing when the marginal revenue equals the marginal cost, thereby reducing the convenience of producing the most commonly used PDMPs (albumin and IG). The imbalance between the demand and supply of PDMPs was exacerbated by the COVID-19 pandemic, which further increased the cost of plasma collection. Shortage issue and possible solutions: Policies to counteract this imbalance have also been discussed. If the demand is inappropriate, it should be reduced. If the demand is appropriate and supply cannot be increased, the demand should be prioritized for patients for whom PDMPs are the only available treatment. If the shortage depends on insufficient supply and technical and allocative efficiency, both production and supply should be improved, together with incentives for all stakeholders involved in the PDMP market to increase the sustainability of production/supply. The paper is focused on this second issue, that is supply-driven unbalance. [ABSTRACT FROM AUTHOR]

This paper focuses on four e-initiatives that were precipitated by the coronavirus outbreak in Italy. These experiences played a relevant role in developing multilevel solidarity (from the local to the global level) both online and offline. They are represented by the hashtags "#iorestoacasa" (I stay at home) and "#andràtuttobene" (everything will be alright), "performances on the balcony," "influencers' campaigns," and "altruism and e-parochialism." These experiences represent revealing examples essential to understand the benefits that a mediated form of solidarity can produce. This is particularly important given the challenges that solidarity faces due to the technological acceleration imposed by the pandemic, which is likely to influence social relationships even in the post-pandemic era. Four lessons can be learned from these expressions of e-solidarity related to the capacity of information and communication technologies to (1) promote unconditioned altruism; (2) fight "parochialism" when the same disadvantaged condition is shared; (3) their capacity to develop a multilevel sense of community by connecting the local experience to the global dimension; and (4) to mediate between institutional sources and people, and connect family members, friends, vulnerable people with neighbors, and the global community. This last point suggests that the pandemic has offered fertile ground for both mechanical and organic forms of solidarity to emerge. On the one hand, it created a collective conscience based on shared vulnerabilities and interdependence. On the other hand, it is based on individualization and diversity. Indeed, these examples of Durkheimian collective effervescence show the paradox of a form of collective individualized and mediated solidarity, which is typical of contemporary society. [ABSTRACT FROM AUTHOR]

Background: Particularly at the beginning of the pandemic, adults aged 65 and older were portrayed as a homogeneously vulnerable population due to the elevated health risks associated with contracting the COVID-19 disease. This portrayal, combined with travel restrictions, closures of economic sectors, country-wide lockdowns, and suggestions by governmental authorities to limit social contact, had important implications for the wellbeing of older individuals. However, older adults are a heterogeneous population who relies on different resources to cope with stressful periods, like the COVID-19 pandemic. Simultaneously, countries also employed differentmeasures to contain the virus. Research thus far has focused on the short-termconsequences of the pandemic, but studies have yet to address its long-term consequences. Objectives: We explore older adults' lived experiences nearly 2 years after the pandemic onset. Moreover, we focus on the bordering countries of Switzerland and Italy, who employed contrasting containmentmeasures. This paper analyzes (1) Howthe COVID-19 pandemic impacted the experiences of wellbeing of older adults in these regions and (2) How older adults coped with the stressors brought about by the pandemic, in particular social distancing. Methods: The paper draws on 31 semi-structured interviews with 11 Swiss natives residing in Switzerland, 10 Italian migrants residing in Switzerland, and 10 Italian natives residing in Italy. Interviews were conducted from December 2021 to March 2022. Results: Coping mechanisms of the three groups related to acceptance, hobbies, cognitive reframing, telephone use, vaccine use and social distancing. However, results show heterogeneous experiences of wellbeing, with Swiss natives sharing more positive narratives than the other two groups. Moreover, Italian migrants and Italian natives expressed the long-term negative consequences of the pandemic on their experienced wellbeing. [ABSTRACT FROM AUTHOR]

The accurate prediction of heavy precipitation in convective environments is crucial because such events, often occurring in Italy during the summer and fall seasons, can be a threat for people and properties. In this paper, we analyse the impact of satellite-derived surface-rainfall-rate data assimilation on the Weather Research and Forecasting (WRF) model's precipitation prediction, considering 15 days in summer 2022 and 17 days in fall 2022, where moderate to intense precipitation was observed over Italy. A 3DVar realised at CNR-ISAC (National Research Council of Italy, Institute of Atmospheric Sciences and Climate) is used to assimilate two different satellite-derived rain rate products, both exploiting geostationary (GEO), infrared (IR), and low-Earth-orbit (LEO) microwave (MW) measurements: One is based on an artificial neural network (NN), and the other one is the operational P-IN-SEVIRI-PMW product (H60), delivered in near-real time by the EUMETSAT HSAF (Satellite Application Facility in Support of Operational Hydrology and Water Management). The forecast is verified in two periods: the hours from 1 to 4 (1–4 h phase) and the hours from 3 to 6 (3–6 h phase) after the assimilation. The results show that the rain rate assimilation improves the precipitation forecast in both seasons and for both forecast phases, even if the improvement in the 3–6 h phase is found mainly in summer. The assimilation of H60 produces a high number of false alarms, which has a negative impact on the forecast, especially for intense events (30 mm/3 h). The assimilation of the NN rain rate gives more balanced predictions, improving the control forecast without significantly increasing false alarms. [ABSTRACT FROM AUTHOR]

Radionuclide contamination is a serious health issue caused by nuclear experiments and plant accidents, as seen for the Chernobyl and Fukushima nuclear plants. Italy has been especially interested in northwestern alpine regions, as have several other nations. The aim of this work was to indagate 134Cs and 137Cs contamination in wild boars, which were considered bioindicators sampled in the Chisone/Germanasca Valley and the Pellice Valley districts (Piedmont, Italy) in two hunting seasons (2014 and 2016). In the 2014 season, only the livers of the animals (n = 48) were sampled, whereas in 2016, five different anatomical sampling sites were sampled for each animal (n = 16). The analyses were conducted in an accredited laboratory (Agenzia Regionale per la Protezione dell'Ambiente–ARPA) by the aid of an HPGe detector (Ortec) with a relative efficiency of 50%. In general, the contamination levels registered in 2014 were under the detection limit for 134Cs and low for 137Cs (Chisone/Germanasca valley: min: 0.0, max: 23.9 median 11.0 Bq/kg vs Pellice valley: min 0, max: 31.7, median: 9.6 Bq/kg) and no health concern can be supposed. In the first-year samples, the liver showed a negative correlation between age and contamination level. In the second year of sampling, low levels were confirmed (min: 3.1 Bq/kg, max: 113.3; median 17.7 Bq/kg). Multiple sampling from the same animal showed that the diaphragm (median = 27.7 Bq/kg) kidney (27.4) and tongue (27.6) were more contaminated than the liver (17.7) and spleen (15.3). Moreover, a linear mixed model revealed a negative organ-by-age interaction, meaning that interorgan differences in contamination level were greater in younger (5–11 months) than in older (18–36 months) animals. Different feeding habits can be the explanation. Our paper shows that muscle sites (diaphragm and tongue) can be useful for radionuclide pollution surveillance in wild boar populations and that younger animals show more interorgan variability in contamination levels than older animals. More investigations are needed to confirm this correlation and to fulfill the request for more data to achieve better risk assessment. [ABSTRACT FROM AUTHOR]