Associazione Italiana Arbitri

Breast surgery is a cornerstone of breast cancer (BC) treatment and has distinctive features that distinguish it from other subspecialties within general surgery. BC management requires multidisciplinary competencies, with specialized training and dedicated care shown to improve patient outcomes. Breast surgery training should become a critical priority within residency programs. We conducted a cross-sectional survey during the 2025 Italian Society of Breast Surgeon (ANISC) annual meeting, to explore the opinions of breast surgery consultants and residentsregarding the current state of breast surgery training, as well as future perspectives for its improvement. A total of 126 participants (77% consultants, 23% residents) completed the survey. Most of the participants (49.2%) worked in medium-volume Breast Units and had > 10 years of clinical practice (45.2%). Overall, 67.5% of respondents judged their training only partially satisfactory, while 23.8% were completely dissatisfied. The majority (58.7%) supported a hybrid model with three years of general surgery followed by two years exclusively dedicated to breast surgery. Most respondents endorsed mandatory training periods in complementary specialties (79.4%) and rotations in peripheral Breast Units (69.8%). Notably, 88.1% favored the development of a vertical breast surgeon profile, capable of independently managing both oncologic and reconstructive procedures. This is the first national survey exploring breast care professionals’ perspectives on surgical training in Italy. Only 8.7% considered the current system adequate to meet clinical needs. The strong demand for structured and specialized programs, together with the recognition of a vertical breast surgeon figure, highlights the urgent need to redefine breast surgery training pathway.

Transcervical femoral neck fractures (TFNFs) are among the most devastating fragility fractures in theelderly. TFNF are associated with excess 1-year mortality rates ranging from 15% to 30%. Treatments include conservative methods, internal fixation, and arthroplasty (partial or total hip arthroplasty). This study aims to analyze the changes in incidences of TFNF in the Italian population between 2001 and 2023 and the evolution of the choices of treatment. Using hospital discharge record (HDR) data from 2001 to 2023, records with ICD9-CM codes for femoral neck fractures (820.0 and 820.1) among diagnoses were selected and categorized into four treatment groups: totalarthroplasty,partial arthroplasty, fixation, and conservative. Time series were analyzed with stratification by sex and age. The extracted data included 1,120,724 records of TFNFs, with 871,161 cases treated surgically (total or partial arthroplasty or internal fixation) and 249,563 treated conservatively; the average patient age was 79.1years, with a higher proportion of women (72.8%). Partial hip arthroplasty was the preferred treatment overall. For younger patients, in the age classes < 45 and 45-54 years, fixation was the most chosen treatment. Over time, the use of the conservative treatment decreased from 27.5% in 2001 to 14.6% of cases in 2023. The use of partial and total hip arthroplasty increased from 40% and 13.3% in 2001 to 44.5% and 24.3% in 2023, respectively. Over the past two decades, Italy experienced declining age-adjusted incidence rates of TFNF despite persistent crude numbers (approximately 50,000 cases per year) owing to demographic aging. Partial hip arthroplasty (PHA) remained the preferred treatment, while total hip arthroplasty (THA) went from being the least used to the second-most performed treatment through the 23 observed years. Level of evidence level 1, population-based study.

Floating offshore wind (FOW) is emerging as a pivotal option for countries characterized by deep-water basins, where fixed-bottom technologies are not viable. Yet, the Mediterranean context still lacks integrated assessments for FOW. The objective of the present study is twofold: firstly, to quantify short- and medium-term costs, full-time equivalent (FTE) employees, and social acceptability of developing FOW in the Italian and Mediterranean context; and secondly, to assess the impact of national targets. The analysis adopts an integrated and replicable framework that combines techno-economic modelling, assessment of direct, indirect and induced employment, and public-acceptance evaluation, validated through a deep literature review and continuous consultation with stakeholders. Short-term capital expenditure is estimated in a range of 4.85-5.91 M€/MW, declining in the medium-term up to 4.13 M€/MW as learning, supply-chain maturation and port-hub industrialisation materialise. Correspondingly, the levelized cost of energy ranges from 150 to 280 €/ MWh in the short term and from 125 to 200 euro per MWh in the medium term. The FOW manufacturing, installation and construction phases have the potential to generate 14.4 kFTE/GW, whereas operations sustain approximately 1 kFTE/GW per year. Supply-chain localisation is crucial, with a domestic-production pathway retaining 77% of potential employment, compared with 39% in import-reliant scenarios. This study demonstrates that FOW power industry has the potential to generate billions in investment, high added value and tens of thousands of employees. Yet, this potential can only be realised through the implementation of an integrated vision that combines policy, training, energy planning and infrastructure. • A comprehensive framework assesses the Mediterranean floating offshore wind sector. • Integrated techno-economic, employment and social analyses have been conducted. • Shipyard conversion to energy hub for floating offshore wind. • Levelized costs of energy of floating offshore wind have been assessed. • FOW supply-chain can generate 14.4 kFTE/GW and 1 kFTE/GW/year during operation.

COL4A1/A2 disorders are rare, congenital, multisystem disorders caused by mutations in the COL4Α1 or COL4Α2 genes, which encode α chains of collagen IV. There are no curative treatments at present, and intervention is focused on managing the symptoms. Associazione Famiglie COL4A1/A2 was established in 2021 to provide support for patients and their families, and to promote research into the basic mechanisms of the disorders. As part of FEBS Letters's series on patient advocacy for rare disorders, we interviewed Francesca Manodoro, Vice-President and Treasurer of Associazione Famiglie COL4A1-A2, Tom Van Agtmael, Professor of Matrix Biology and Disease at the University of Glasgow, and Simona Balestrini, Associate Professor of Child Neurology at the University of Florence, on the history of the organisation, ongoing research into these conditions, and the challenges in securing funding for research and translating basic research findings into the clinic.

Approximately 27.6% of Italian beaches are currently affected by erosion, despite the widespread implementation of coastal defence structures. Around 10,500 installations—mainly groins and detached breakwaters—occupy nearly 24.6% of the national shoreline. Although primarily designed to protect tourist beaches, these hard-engineered structures often degrade coastal landscapes, alter nearshore circulation, and pose risks to swimmers. Nevertheless, beaches remain a fundamental asset for the “3S” (Sun, Sea, Sand) tourism sector, which contributes approximately 2.2% to Italy’s GDP, accounting for over 175 million tourists’ overnight stays in 2024, frequently concentrated near protected coastal zones. In this study, drowning incidents along the Italian coastline were analyzed using press reports complemented by official statistics. Between 2016 and 2021, an average of 145 fatalities occurred per bathing season. Sudden drownings following medical emergencies accounted for 41% of cases, non-swimmers for 18%, accidental falls into the water for 3%, and water sports activities for an additional 3%. Rip currents on natural beaches were responsible for 22% of drownings, whereas those generated by coastal defence structures accounted for 12%. A further 12% of non-swimmer fatalities are suspected to have resulted from falls into depressions or channels formed in proximity to these structures. Evidence from previous studies and seabed morphology analyses indicates that coastal defence structures can generate rip currents through two main mechanisms: (1) hydraulic pressure exerted against groins, which drives offshore flow, and (2) water outflow between pairs of breakwaters resulting from wave setup behind them. Both processes, though often less intense, are also observed near submerged structures. The erosional channels formed by these currents may persist well beyond storm events, maintaining dangerous conditions for bathers. As Italy continues to rely predominantly on hard coastal protection measures, improving the understanding of drowning dynamics associated with these structures is crucial. This should be accompanied by regulatory updates requiring designers and coastal managers to systematically assess related hazards and to propose effective mitigation and safety strategies.

Sub-clinical ketosis (SCK) significantly affects post-partum dairy cow performance and welfare. A total of 11,327,959 test-day (TD) records over two years on 1.76 million Holstein cow lactations and 2840 farms were processed to ascertain thresholds for milk acetone (mACE) and β-hydroxybutyrate (mBHB) as indicators of SCK on the basis of a significant milk yield loss at the TD. The set thresholds for mACE and mBHB were 0.10 mmol/L and 0.14 mmol/L, respectively. The prevalence of SCK in the population during the first 60 days in milk (DIM) was estimated based on herd size and milk yields, utilizing one or both of these metabolites surpassing their respective thresholds. Analyzing both mACE and mBHB together revealed a higher occurrence of SCK in small herds (fewer than 100 cows) and a lower occurrence in the two most productive milk categories. The prevalence had an inverse relationship with the daily milk yield at 60 DIM, indicating a surprisingly high frequency of low-productivity herds in the risk classes exceeding 30%. These results suggest that assessing SCK prevalence through the combined evaluation of mACE and mBHB is a more effective approach than using the milk fat to protein ratio, especially when considering different herd sizes and daily milk yield at 60 DIM.

IntroductionResearch indicates that the sexual support needs of patients with anorectal malformations (ARM) and Hirschsprung disease (HD) are often not addressed by patients, parents, and healthcare professionals (HPs) in their interactions. An international support website was developed to empower stakeholders, by addressing identified barriers. This study aimed to explore the empowerment potential of this disease-specific tool.Materials and MethodsTwo online surveys were disseminated between May 1 and October 1, 2023; one for HPs and another for patients/parents. The surveys sought to assess and understand the website's expected empowerment effect. Empowerment was conceptualized using patient/professional empowerment models. Data were descriptively analyzed.ResultsA total of 12 patients (ARM,n = 11; HD,n = 1), 17 parents (ARM,n = 9; HD,n = 8), and 20 HPs responded to the survey. HPs largely expected the website to have a positive empowerment effect, by providing a sense of meaning, information, support, and opportunities to learn and grow. Less of an effect was expected for “freeing up resources.” For patients and parents, an empowerment effect was also expected, by generating the knowledge, skills, attitudes, and self-awareness necessary to influence their own behavior and by providing a sense of meaning and coherence. Respondents experienced the website positively, yet one patient and one parent considered the website “fully complete.” Inclusivity, cultural sensitivity, and accessibility were highlighted as focus points.ConclusionTo increase the website's empowerment potential, attention should be paid to inclusivity, cultural sensitivity, and accessibility, as well as its implementation within the (institutional) contexts where patients, parents, and HPs interact.

ABSTRACT Background Adolescents with eating disorders (ED) often show a strong ambivalence about their symptoms. If they perceive their behaviour as helpful, they can lack the motivation to change. This is a challenge for psychotherapists working in this area. Context In this paper we report on using the Trauma Treatment through Art Therapy (TT-AT) protocol with a group of three adolescents who had been diagnosed with ED and additional symptoms and were attending a day hospital, in central Italy. Approach The TT-AT art therapy protocol was initially developed in Tanzania for patients diagnosed with post-traumatic stress disorders, to address their symptoms and related needs, in six areas of life: (1) Emotions; (2) Relationships; (3) Self-Esteem; (4) Conflict Awareness; (5) Distancing from the Past; (6) Personal Resources. The protocol has then been applied internationally, to address a variety of disturbances. It is piloted here with adolescents diagnosed with ED, with the aim of helping them to mobilise their motivation to change. Outcomes Throughout the six sessions, all three patients moved from feeling stuck, to acknowledging a need to change. This made them receptive to the treatment offered in the Clinic. The therapy experience of one of the adolescents is presented more in detail. Implications for Research Research into art therapy interventions with adolescents with ED is needed. The protocol is clearly described and can be easily replicated for research. Conclusions Our experience suggests that this protocol may be a useful component in a multi-modal treatment of adolescents with ED. Plain-language summary Adolescents who experience eating disorders are often trapped in their behaviour, because in some way they perceive it as helpful. They may feel sad and lonely, but they are somehow attached to their negative emotions, and say that they cannot change. This is a major obstacle, as it makes it difficult to engage them in a therapeutic process. Art therapy has been used in the field of eating disorders, with a variety of approaches. Here we describe piloting the TT-AT (Trauma Treatment through Art Therapy) protocol to a small group of adolescents, who presented with eating disorders and additional symptoms (self-injury and suicidal ideations) and were attending a day hospital in central Italy. The TT-AT protocol is an innovative six-session intervention that has now been piloted in several countries, with individuals with a variety of psychological disturbances. It has been developed following the guidelines of the International Society of Traumatic Stress Studies (ISTSS), which recommends focusing on six areas: (1) Emotions; (2) Relationships; (3) Self-Esteem; (4) Conflict Awareness; (5) Distancing from the Past; (6) Personal Resources. The protocol is based on six art therapy workshops, one for each symptom/need mentioned by the ISTSS. The three adolescents attended all six sessions. During the last session, they all said they had developed more self-awareness, and they also acknowledged some change that they described visually in the second body outline. This made them more receptive to the treatment offered in the Clinic. The therapy experience of one of the three adolescents is presented more in detail, together with the six images she made in response to the workshops. The results suggest that this protocol may be a useful component in a multi-modal treatment of adolescents with ED.