Camera di Commercio di Firenze

Surgical and endovascular procedures to treat varicose veins in the territory of the Greater Saphenous Vein (GSV) are burdened by a variable rate of groin recurrences. In the case of surgical procedures, they are due to the development of tortuous vessels leading to the formation of a cavernoma in the site of the previous Saphenous-Femoral Junction, after crossectomy, or to a by-pass of the metallic clip, after crossotomy. In the case of endovascular procedures, groin recurrences are, instead, mainly represented by rectilinear vessels due to the progression of the incompetence within an antigravitational Sapheno-Femoral Junction (SFJ) tributary, most often the Anterior Saphenous Vein (ASV), and rarely by tortuous vessels leading to the formation of a cavernoma in the distal part of the stump always resulting from the procedure. In this paper we suggest a coherent hypothesis to explain the occurrence of groin recurrences after surgical and endovascular procedures based upon experimental studies and observational data. Recurrences due to pelvic shunts or to incompetent thigh perforator veins, are not considered.

Legal proceedings for medical negligence usually origin from painful events and their management is often complex, also at an emotional level, both for the families involved and for the physicians assumed to carry responsibility. Many of these aspects are unfamiliar and unclear to the doctors themselves who then need to interact, together with their lawyers, with judges who must take serious decisions on technical facts not easy to be fully comprehended by non-medical persons.On the basis of our different and highly specific personal experience, we have tried to clarify some of the fundamental issues concerning medico-legal cases. Accordingly, we have discussed the different types of guilt, made the distinction between civil and penal cases, with special focus on one issue which is particularly critical, namely that of the importance of guidelines. We have presented some examples of clinical cases and highlighted some glaring differences existing in the management of medico-legal cases between Italy and the United States. Despite obvious complexities, these differences might suggest some approaches toward the simplification of these proceedings and the shortening of the time involved to reach a conclusion.

Wilson's disease is a rare autosomal recessive neurometabolic disorder of copper metabolism, whose treatment consists of metal ion excretion with the use of copper chelating agents, among which D-penicillamine is used most frequently.Skin adverse effects of long-term administration of D-penicillamine are usually associated with the local occurrence of elastosis perforans serpiginosa.We present a devastating case, occurred in a 42-year-old woman, whose skin was beyond the typical figurate papular and keratotic lesions, as a whole apparently not affected skin was indurated, with a generalized 'cardboard' consistency reminiscent of scleroderma and/or scleromyxedema, simulating the "sharpei sign" on trunk.This peculiar presentation was significantly different than other previous skin changes associated to D-penicillamine administration.

The article focuses on two collectors – Nélie Jacquemart André, who was French, and Isabella Stewart Gardner, who was American. Both ladies created fascinating collections at the turn of the 19th and 20th centuries including a wide range of art objects from different periods. The core of these private collections was the art of the Italian Renaissance. The study deals with the questions of the formation of these sets of Renaissance works of art, methods of acquisitions, the nature of collection objects, and especially installation principles applied in two museum collections that are now publicly accessible – the Musée Jacquemart-André in Paris and the Isabella Stewart Gardner Museum in Boston.

article: Application of localized cryotherapy (-160 °C) on tennis leg injury: tissue remodeling and recovery in an elite Italian soccer player - Medicina dello Sport 2021 September;74(3):537-46 - Minerva Medica - Journals

Dynamic Fractioning of the Gravitational Hydrostatic Pressure (DFGHSP) is a pillar of a hemodynamic model of the venous pathophysiology. It describes how the valvo-muscular pump varies the distal venous pressure in the lower limbs. It results from an inductive reasoning based on clinical signs and instrumental data at rest and during the action of the valvo-muscular pump of the calf. It does not claim to be the final truth, but a new "as if" model that improved the diagnosis and the treatment of the venous insufficiency (CHIVA, French acronym for Cure Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire) according to several randomized studies and meta-analyses. That approach overturns the classic diagnosis and treatment of venous insufficiency because it is conservative and opposes the widely spread destructive based view. It needs a minimal study of basic fluid mechanics which can explain venous hemodynamics, the core of venous pathophysiology. The proposed DFGHSP fluid mechanics model is compared with the hemodynamic clinical and instrumental data in order to assess its pathophysiologic relevance.

This paper proposes a methodology for modeling mothballing decisions in order to better study the different strategies adopted by power plants owners and their impact on power systems (in particular generation adequacy). A system dynamic approach is adopted to build a model which represents investment, mothballing and shutdown decisions in an energy-only market. The results obtained with the proposed modelling methodology highlight the importance of considering mothballing in long term simulation models of power markets. They show how models which neglect mothballing decisions might overestimate or underestimated the level of available capacity, therefore leading to inappropriate policy choices. The proposed methodology could better inform policymakers on their decisions.

TPS1100 Background: Anthracyclines and trastuzumab play a key-role in preoperative and adjuvant breast cancer (BC) treatment, and showed a significant survival benefit in several trials. Although acute cardiac toxicity is infrequent and usually reversible in a dose-dependent manner, published data evidenced a clinically relevant early late cardiac toxicity, with a chronic progressive deterioration of left ventricular ejection fraction (LVEF), up to congestive heart failure (CHF). Late toxicity occurs in most cases within the first year following chemotherapy completion, but an echocardiographic monitoring is strongly recommended even after a longer time. Recent studies highlighted that the evaluation of myocardial strain could be a refined predictive marker of early cardiac dysfunction after anthracyclines exposure. The aim of our study is to find out the best approach as cardiac toxicity prevention in non-metastatic BC patients undergoing anthracycline-based chemotherapy, with or without subsequent anti-HER2 therapy. Methods: This is a randomized phase III, four-arm, single-blind, placebo-controlled study that aims to evaluate the effect of bisoprolol (5 mg, twice daily), ramipril (5 mg, twice daily), or both drugs, compared to placebo, on anthracycline therapy induced LVEF dysfunction for non-metastatic disease. Cardioprotection is administered for one year, or until the end of trastuzumab (if HER2 positive). All patients undergo cardiac surveillance with echocardiogram and speckle tracking strain at baseline and every three months, until 2 years. Primary endpoint is maximum change in LVEF. Assuming a cardiac toxicity incidence of 40%, with a 15% reduction in both arms to reach the outcome, a sample of 120 patients per arm provides a 90% statistical power, for a total of 480 enrolled patients. The analysis is based on intent-to-treat. Exclusion criteria are: history of CTCAE (v.4) grade > 2 symptomatic CHF, previous myocardial infarction, significant symptoms (grade > 2) relating to LVEF dysfunction, valvular disease, cardiac arrhythmia (grade > 3). Clinical trial information: NCT2236806.