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(1) Background: Assessment of right ventricular (RV) function has become increasingly important in echocardiography due to its prognostic significance in cardiac and systemic diseases. (2) Objectives: Tricuspid Annular Plane Systolic Excursion (TAPSE) and Tissue Doppler Imaging (TDI S′) are commonly used methods to assess RV function. The aim of this study was to compare the reproducibility of TAPSE and TDI S′ among experienced operators. (3) Methods: A study was conducted on 100 consecutive patients with systemic sclerosis undergoing echocardiography evaluation screening for pulmonary hypertension. Standardized echocardiography images were acquired using a Philips EPIQ system (Philips Healthcare, Amsterdam, The Netherlands), measuring TAPSE and TDI S′. Five operators independently analyzed the images, with each blinded to the results. Exclusion criteria included pathological TAPSE or TDI S′ values, as well as indirect echocardiography signs of pulmonary hypertension. (4) Results: The study’s results indicate that there was superior inter-operator agreement for TDI S′ (ICC = 0.891) compared to TAPSE (ICC = 0.47). The mean TAPSE measurements ranged from 23.49 mm to 23.99 mm, while TDI S′ values ranged from 12.16 cm/s to 12.35 cm/s, with TDI S′ showing narrower confidence intervals. (5) Conclusions: Echocardiographic assessment of right ventricular (RV) function is crucial in clinical practice. Tissue Doppler imaging-derived systolic velocity (TDI S′) demonstrated superior reproducibility compared to tricuspid annular plane systolic excursion (TAPSE) in evaluating RV function. This enhanced reproducibility supports the routine incorporation of TDI S′ as a highly reproducible parameter within a multiparametric assessment framework.

Objective: COVID-19 pandemic represents a serious health emergency that severely compromised our Public Health system, resulting in a rapid and forced reorganization and involved the management of chronic diseases too. The Scleroderma Unit of Modena and Reggio Emilia follows more than 600 patients suffering from systemic sclerosis (SSc) and recently became the referral center (HUB) in Emilia-Romagna for this rare connective tissue disease. The aim of the present study was to evaluate the extent by which the lockdown and the pandemic has impacted the activity of admissions to Scleroderma Unit of Modena and Reggio Emilia. Methods: Our daily clinical activity is characterized by outpatient visits, videocapillaroscopy exam, ulcers treatment, therapeutic infusions in day hospital regimen, multidisciplinary visits following our dedicated SSc care pathway, and clinical trials. Our activity has been quickly rescheduled to ensure the proper assistance to our SSc patients during the COVID-19 pressure. Results: The use of telemedicine has certainly assured a robust continuity of health care. Furthermore, telephone pre-triage, nurse/medical triage, proper physical distancing and use of PPE/DPI allowed us to re-organize and continue SSc daily activity. Specifically, therapeutic infusions in day hospital regimen and outpatient visits, including ulcers treatment, was guaranteed and maximized. Conclusion: The management of scleroderma patients by an expert specialist reference center is crucial in order to ensure continuity of care and pursue the best SSc practice.

How does a redistribution of trade gains affect welfare when income inequality matters? To answer this question, we extend the [1] model to unionized labor markets and heterogeneous workers. As redistribution schemes, we consider unemployment benefits that are financed either by a wage tax, a payroll tax or a profit tax. Assuming that welfare declines in income inequality, we find that welfare increases up to a maximum in the case of wage tax funding, while welfare declines weakly (sharply) if a profit tax (payroll tax) is implemented. These effects are caused by the wage tax neutrality (due to union wage setting) and by a profit tax-induced decline in long-term unemployment. As a result, the government's optimal redistribution scheme is to finance unemployment benefits by a wage tax.

Systemic sclerosis (SSc) is a connective tissue disease at the interface between inflammation and autoimmunity progressively leading to diffuse microvascular and fibrotic involvement of the skin and of multiple internal organs. Approximately, 20-40% of SSc patients suffer from cutaneous calcinosis, a debilitating manifestation due to calcium salt deposition in soft connective tissues, causing pain, ulceration, infection, and deformities, responsible of severe functional limitations. Pathomechanisms are poorly understood as well as markers/molecules capable to predict the risk of patients to develop calcinosis. An observational study was performed in 51 female patients, 25 with and 26 without calcinosis to compare clinical and laboratory parameters and to evaluate pro- and anti-calcifying circulating markers and the serum calcification potential (T50). Moreover, calcinosis samples were analyzed to characterize their mineral composition. Data demonstrate statistically significant differences in the prevalence of clinical manifestations and ACA and Scl70 autoantibodies in SSc patient with calcinosis compared to those without calcinosis. In SSc patients with calcinosis, serum levels of BMP-4 are higher, fetuin A might be regarded as a potential circulating prognostic marker and a negative correlation was observed between T50 and the global score of clinical manifestations, suggesting a potential predictive role of pro- and anti-calcifying molecules in SSc patients. Furthermore, calcinosis samples were characterized by the co-existence of phosphate and carbonate minerals with different stability and solubility. Further investigations on circulating markers in larger patient cohorts, especially at the early stages and throughout the natural course of the disease, may clarify their pathogenetic role in the SSc-related cutaneous calcinosis.

How are unemployment and output affected if wages are set on the sector level rather than firm level? We take a new look at this question, allowing for heterogeneous firms and rent-sharing motives. Without these motives, employment and output are lower under sector-level wage-setting due to higher wage markups. With rent-sharing motives, however, firm selection is higher under sector-level wage-setting, which tends to increase employment and output, thus counteracting the markup effect. Simulations show that the firm-selection effect decreases the difference between the two unionization structures substantially but it does not change the signs of the effects on output and employment.

    The aims of this study were to investigate the prevalence of cryofibrinogenemia in a cohort of patients with systemic sclerosis (SSc) regardless of clinical manifestations, who were admitted to our hospital and determine the associations among CF positivity, disease features and ongoing therapies. This was a monocentric and retrospective study. The inclusion criteria were a diagnosis of SSc (according to the ACR/EULAR 2013 classification criteria), regular administration of i.v. prostanoids, and CF testing between February 2020 and February 2022. Data on demographic, clinical, and immunological features and ongoing treatments were retrospectively collected. Categorical data were compared with the chi-square test or Fisher’s exact test, while quantitative variables comparisons were carried out with Student’s t test or Mann‒Whitney test. In total, 101 SSc patients were ultimately enrolled. The majority of patients were female (92.1%) and had the limited cutaneous form of SSc (81.2%). CF positivity was observed in 69.3% of the patients, whereas only 9% presented cryoglobulins and CF. CF positivity was negatively associated to RNAP3 antibodies ( p  = 0.027). No direct associations with specific clinical phenotypes were observed. No associations with immunosuppressive treatments were identified, however a positive association with nifedipine administration ( p  = 0.040), and a negative association with endothelin receptor antagonists (ERAs) plus phosphodiesterase-5 (PDE5) inhibitors regimen ( p  = 0.031) were observed. Macitentan administration was also associated to CF cryocrit ≥ 1% ( p  = 0.045). Among patients who were not treated with ERAs, an estimated pulmonary artery systolic pressure ≥ 30 mmHg was significantly associated with CF positivity ( p  = 0.025). Moreover, a cryocrit ≥3% was associated with a relative risk of 3.44 (95% CI 1.26–9.39, p  = 0.016) for digital amputation and 5.17 (95% CI 1.18–22.6, p  = 0.029) for death. Isolated CF is a frequent phenomenon observed in SSc patients and is associated with a higher administration of vasoactive drugs, probably identifying a SSc clinical phenotype with a more severe microvascular involvement. Moreover, a higher cryocrit is associated with an increased risk of death and digital amputations. Screening SSc patients for CF would represent an opportunity to provide better therapeutic approaches by anticipating ERA administration in an earlier phase, thereby preventing the manifestation of severe microvascular involvement. Key Points • Cryofibrinogen is a cryoprotein that can cause microangiopathic damage. • Isolated cryofibrinogenemia is common in patients with systemic sclerosis. • SSc patients should be tested for cryofibrinogen because a high cryocrit (≥ 3%) is associated with death and/or digital amputation due to necrosis. • Cryofibrinogen is associated with indirect markers of pulmonary arterial hypertension in patients not treated with endothelin receptor agonists (ERAs). • ERAs could play a role in preventing cryofibrinogen damage.

We analyze the effects of unionization on the decision of a firm to de-locate internationally. In a model in which home and foreign workers are perfect substitutes and firms have an informational advantage concerning their productivity, the union offers a menu of wage–employment contracts. Because firms’ outside options (producing abroad) depend on productivity, the problem is characterized by countervailing incentives. With the foreign profit sufficiently increasing in productivity, the overstating incentive dominates in equilibrium. Contracts are then characterized by overemployment. The union also affects the extensive margin. High-productivity firms are excluded because this narrows the possibility to overstate productivity, which saves on information rent. Using a numerical simulation, we show that these effects are quantitatively sizable. Nous analysons les effets que peut engendrer le syndicalisme lorsqu’une entreprise décide de délocaliser sa production à l’étranger. Dans un modèle où les travailleurs locaux et étrangers sont parfaitement interchangeables et où les entreprises possèdent un avantage informationnel relativement à leur productivité, les syndicats peuvent proposer toute une série de contrats salariaux. Étant donné que les options extérieures d’une entreprise (produire à l’étranger) sont tributaires de la productivité, le problème est caractérisé par les mesures incitatives compensatoires. Le profit à l’étranger augmentant suffisamment en productivité, les mesures compensatoires surévaluées prédominent au sein de cet équilibre, ce qui se caractérise par un suremploi. Les syndicats peuvent également avoir une incidence sur la marge extensive. Les entreprises à forte productivité sont exclues car la possibilité de surévaluer leur production diminue, réduisant ainsi la rente informationnelle. À l’aide d’une simulation numérique, nous montrons que ces effets sont quantitativement mesurables.

Este trabalho evidencia processos de assimilação e incorporação de repertório entre instrumentos musicais análogos-o oboé e o saxofone,tendo como base a Fantasia Sul América para oboé solo, de Claudio Santoro (1983). Os procedimentos utilizados incluementrevista com o saxofonista brasileiro Dílson Florêncio (2019) e uma breve revisão histórica em torno do IV Concurso Sul América de Música -Jovens Concertistas Brasileiros, realizado no Rio de Janeiro em 1985. Os resultados da pesquisa apontam signif icativa visibilidade da obra averiguada através da repercussão midiática na plataforma digital do Yo u Tub e, programas de recitais e a ampla divulgação de edições não of iciais da versão para saxofone a partir do manuscrito entre saxofonistas.

Trade unions are typically able to convert their industrial power into political power. We show that, depending on the constellation of parameters, stronger trade unions may improve welfare in terms of an increase in aggregate employment and output if they successfully lobby for lower trade barriers set by the government.