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Bloodstream cholesterol is a central contributor to atherosclerotic cardiovascular diseases. For several decades, low-density lipoprotein cholesterol (LDL-C) has been the main biomarker for the prediction of cardiovascular events and therapeutic target of lipid-lowering treatments. More recently, several findings have supported the greater reliability of non-high-density lipoprotein cholesterol (non-HDL-C) as a predictive factor and possible therapeutic target in refining antiatherogenic treatments, especially among patients with lower LDL-C and higher triglyceride values. This article discusses the limits of current standard methods for assessing LDL-C levels and emphasizes the persistent residual cardiovascular risk in patients treated with lipid-lowering agents on the basis of recommended LDL-C targets. It highlights that patients with controlled LDL-C and non-targeted non-HDL-C have a higher cardiovascular risk. The article focuses on the role of non-HDL-C as a better predictor of atherosclerotic disease as compared with LDL-C and as a therapeutic target. Finally, this article includes an executive summary aimed at refining preventive approaches in atherosclerotic cardiovascular disease., (Copyright © 2021 Italian Federation of Cardiology - I.F.C. All rights reserved.)

The COVID-19 pandemic represents an unprecedented event that has brought deep changes in hospital facilities with reshaping of the health system organization, revealing inadequacies of current hospital and local health systems. When the COVID-19 emergency will end, further evaluation of the national health system, new organization of acute wards, and a further evolution of the entire health system will be needed to improve care during the chronic phase of disease. Therefore, new standards for healthcare personnel, more efficient organization of hospital facilities for patients with acute illnesses, improvement of technological approaches, and better integration between hospital and territorial services should be pursued. With experience derived from the COVID-19 pandemic, new models, paradigms, interventional approaches, values and priorities should be suggested and implemented.

The European Society of Cardiology guidelines on non-ST-elevation acute coronary syndromes suggest different temporal strategies for the angiographic study depending on the risk profile. The scientific evidence underlying the guideline recommendations and the critical issues currently existing in Italy that often do not allow either an extended strategy of revascularization within 24 h or the application of the principle of the same day transfer from a spoke to a hub center are analyzed. The position paper focuses, in particular, on the subgroup of patients with a defined diagnosis of non-ST-elevation myocardial infarction by proposing a timing of coronary angiography/revascularization that takes into account the available scientific evidence and the organizational possibilities of a considerable part of national cardiology services.

Objective: The COVID-19 pandemic has caused significant impact on healthcare systems worldwide. The rate of infected healthcare workers is > 10% in Italy. Within this dramatic scenario, the development of new personal protective equipment (PPE) devices is mandatory. This study focuses on validation of modified full-face snorkel masks (MFFSM) as safe and protective equipment against SARS-CoV-2 infection during diagnostic and therapeutic procedures on the upper aerodigestive tract., Methods: Five different MFFSM were tested during otolaryngological surgery and in anaesthesia procedures. Data were collected through an online survey to assess the feedback of operators. pO 2 and pCO 2 monitoring values during procedures were recorded in selected cases., Results: All five MFFSM tested were easy to use and gave all operators a sound "feeling" of protection. All clinicians involved had common agreement regarding safety and the user-friendly format., Conclusions: In the future, specific development of different type of masks for protection in the operating room, intensive care units and/or office will be possible as a joint venture between clinicians and developers. Goals for clinicians include better definition of needs and priorities, while developers can devote their expertise to produce devices that meet medical requirements., (Copyright © 2020 Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale, Rome, Italy.)

Introduction: Adolescents' cigarette smoking is related to several factors. The aim of this study among high school students was to test the hypothesis that factors related to smoking behavior could differ in early (14-16-year-old students, younger age group) vs. late (17-21-year-old students, older age group) adolescence., Methods: The smoking behavior of 910 students was evaluated by a questionnaire. Students were categorized on the basis of their lifetime smoking behavior as never, former, occasional and regular smoker. Data were analyzed using Student's t-test, chi-square test and multinomial logistic regression analysis., Results: In multinomial logistic regression analysis, variables related to adolescents' smoking behavior for both age groups were: positive attitude toward smoking (P < 0.001), illicit drug use (younger age group, P < 0.001; older age group, P = 0.003), smoking at home with parents (younger age group, P = 0.038; older age group, P < 0.001) and get drunk at least once (younger age group, P = 0.002; older age group, P = 0.026). In the younger age group, a significant association was also found between students' smoking behavior and having smoked a cigar at least once (P = 0.006) and smoking behavior of the best friend of the same sex (P = 0.001), whereas the relationship with the hours spent with friends of the opposite sex was of borderline significance (P = 0.058). In the older age group, other factors related to adolescent's smoking behavior were minimizing health consequences of smoking (P = 0.002) and the hours spent with friends of the same sex (P = 0.026)., Conclusion: Our study demonstrates that, as adolescence advances, factors related to smoking behavior can vary.

Background: Most cigarette smokers take up their habit during adolescence. The aim of this study was to compare the age at which the students of a metropolitan high school and those of a non-metropolitan high school start smoking., Methods: Nine hundred and seventy-eight students (55.6% males, mean age 15.8 +/- 1.5 years) in a big city (Naples) and 467 (50.3% males, mean age 16 +/- 1.5 years) in a small town (Capua-CE) filled in a questionnaire on cigarette smoking. Two hundred and nine (21.4%) students (99 males, 110 females, mean age 16.5 +/- 1.3 years) in Naples and 99 (21.2%) students (59 males, 40 females, mean age 16.8 +/- 1.3 years) in Capua stated that they had smoked at least one cigarette in the last week and were considered as smokers., Results: The age at which adolescents start smoking did not differ between the big and the small city (Naples 14.9 +/- 1.5 years; Capua 14.9 +/- 1.6 years; p = 0.849) nor between sexes, both in Naples (males 14.9 +/- 1.5 years, females 14.8 +/- 1.4 years; p = 0.576) and in Capua (males 14.8 +/- 1.6 years, females 15 +/- 1.5 years; p = 0.379). Both in Naples and in Capua, no relation was found between the age at which the adolescent starts smoking and the smoking habits of the father, mother, siblings, best friend of the same sex, best friend of the opposite sex and friends. In Naples, the age at which the adolescent started smoking was related to the number of cigarettes he or she smoked in the last week (p = 0.004) and to the number of cigarettes smoked per day by the father (p = 0.001)., Conclusions: In adolescents, the age at which the habit of smoking is taken up does not differ both between a big and a small city and between sexes; in the big city, the age at which the adolescent started smoking was related to the number of cigarettes he or she smoked in the last week and to the number of cigarettes smoked per day by the father.

Background: Smoking is the leading preventable cause of death. Most cigarette smokers take up the habit during adolescence. The purpose of this study was to assess the prevalence of cigarette smoking behavior among the students of a metropolitan high school as compared to those attending a non-metropolitan high school, examining age, sex and demographic and socioeconomic differences, as well as the influence of smoking models (family members and friends) on smoking behavior among adolescents., Methods and Results: Nine hundred seventy-eight students (544 males, 434 females; mean age 15.8 +/- 1.5 years) attending a high school in the city of Naples and 467 students (235 males, 232 females; mean age 16 +/- 1.5 years) from a high school of Capua, a small town 40 kilometers away from Naples, filled out an extensive questionnaire on smoking. The prevalence of smokers was 24.2% (males 21.8%, females 28.2%; p = 0.02) in Naples and 23.8% in Capua (males 29.8%, females 19.2%; p < 0.001) and was related to age (p < 0.001) both in Naples and in Capua. In Naples, smoking behavior among male students was associated with smoking by sibling (p = 0.00005), whereas an association with father (p = 0.0003), mother (p = 0.00005), parental (p = 0.0002) and sibling (p = 0.00002) smoking was observed among females. In Capua, an association was evident only between smoking in female students and sibling smoking habits (p = 0.02). In both Naples and Capua, smoking status of the students was related to smoking habits of best friends of the same sex, best friends of the opposite sex and friends. Multivariate analysis showed an independent relationship in Naples between adolescent smoking behavior and smoking status of siblings (p = 0.01), best friends of the same sex (p < 0.001) and best friends of the opposite sex (p < 0.001). In males, smoking behavior was associated with the smoking behavior of best friends of the same (p < 0.001) and of the opposite sex (p = 0.01), whereas in females, it was linked with the smoking behavior of siblings (p = 0.05), mother (p < 0.05) and best friends of the same sex (p < 0.001). In Capua, student smoking was related to smoking among friends (p < 0.001) and this held true for both males (p = 0.05) and females (p < 0.0001)., Conclusions: The prevalence of smoking habits among teenagers is similar in two distinct populations of high school students from a city and from a small town. Smoking showed a higher prevalence among females in the city and among males in the small town. It increases with age and is related to peer and family smoking models. This study has identified several variables associated with smoking status among adolescents. We thus feel that these findings may contribute to a better understanding of smoking behavior among teenagers and may have prevention implications.

Taste disorders can a rise from lesions of peripheral receptors, taste control pathways or cortical area involvement. Among peripheral lesions, trauma of the tongue and oropharynx are the most common. Iatrogenic lesions of facial and glossopharingeal nerves are very important in Forensic Medicine, while there are different opinions about taste alterations due to head injuries; hypogeusia associated to smell disorders are found in 0.4-0.5% of patient after head trauma with good prognosis (90% healing) while qualitative disorders are more common (30%). The Authors describe clinical methodologies for taste evaluation and their application in Forensic Medicine. Forensic estimation of taste disorders con be classified by two main groups: study of cause relation between the occurrence and damage and quantitative valuation of the damage in three different juridical ambits: Penal, Civil, Insurance and foresight. In Penal Right taste damages could be classified among personal lesion crimes and can be classified as serious (permanent injury of taste) ore very serious (complete lost of taste function). Italian Legislation equipare the 5 sense organs. In Civil Right evaluation the so-called "biologic damage" and working ability are considered; this means very different evaluations. In the most recent baremes, generic damage is estimated by different Authors from 0 to 10% while with regard to specific working capacity, common evaluation criteria does not exist. In Insurance taste disorders evaluation is based only on working ability and not on biologic damage. In the previdenzial ambit, taste disorders are not even included in the most recent tables of permanent invalidity estimation. The Authors propose new and more efficacious valutation criteria for taste disorders in all ambits, hoping for more interest in the Forensic aspects of taste, a too often forgotten sensory function.

The authors think that the evolutionary perspective is fundamental in family diagnosis. Therefore, they remark the value and the limits of the use of "normal" life cycle of the family as a map to evaluate the family, to assign meaning to its difficulties and to single out the possible goals of therapy. By means of a case example, the authors show how it is possible to utilize profitably the idea of life cycle, bearing in mind the cultural context of the family.