The authors reply: Letter on: 'Pitfalls in the measurement of muscle mass: a need for a reference standard' by Clark et al.

However, semantics aside, we think that DXA can indeed serve as a reference standard for measuring muscle mass. Obviously, CT and MRI are advanced techniques that can and have been used to obtain important information such as muscle size/volume and more recently amount and distribution of intra- and intermuscular adipose tissue. Also individual muscles can be assessed separately. However, with respect to muscle mass, the comparison of DXA with CT/MRI is rather difficult because DXA and QCT/MRI measure different physical parameters

AIRO Breast Cancer Group Best Clinical Practice 2022 Update

Introduction: Breast cancer is the most common tumor in women and represents the leading cause of cancer death. Radiation therapy plays a key-role in the treatment of all breast cancer stages. Therefore, the adoption of evidence-based treatments is warranted, to ensure equity of access and standardization of care in clinical practice.Method: This national document on the highest evidence-based available data was developed and endorsed by the Italian Association of Radiation and Clinical Oncology (AIRO) Breast Cancer Group.We analyzed literature data regarding breast radiation therapy, using the SIGN (Scottish Intercollegiate Guidelines Network) methodology (www.sign.ac.uk). Updated findings from the literature were examined, including the highest levels of evidence (meta-analyses, randomized trials, and international guidelines) with a significant impact on clinical practice. The document deals with the role of radiation therapy in the treatment of primary breast cancer, local relapse, and metastatic disease, with focus on diagnosis, staging, local and systemic therapies, and follow up. Information is given on indications, techniques, total doses, and fractionations.Results: An extensive literature review from 2013 to 2021 was performed. The work was organized according to a general index of different topics and most chapters included individual questions and, when possible, synoptic and summary tables. Indications for radiation therapy in breast cancer were examined and integrated with other oncological treatments. A total of 50 questions were analyzed and answered.Four large areas of interest were investigated: (1) general strategy (multidisciplinary approach, contraindications, preliminary assessments, staging and management of patients with electronic devices); (2) systemic therapy (primary, adjuvant, in metastatic setting); (3) clinical aspects (invasive, non-invasive and micro-invasive carcinoma; particular situations such as young and elderly patients, breast cancer in males and cancer during pregnancy; follow up with possible acute and late toxicities; loco-regional relapse and metastatic disease); (4) technical aspects (radiation after conservative surgery or mastectomy, indications for boost, lymph node radiotherapy and partial breast irradiation).Appendixes about tumor bed boost and breast and lymph nodes contouring were implemented, including a dedicated web application. The scientific work was reviewed and validated by an expert group of breast cancer key-opinion leaders.Conclusions: Optimal breast cancer management requires a multidisciplinary approach sharing therapeutic strategies with the other involved specialists and the patient, within a coordinated and dedicated clinical path. In recent years, the high-level quality radiation therapy has shown a significant impact on local control and survival of breast cancer patients. Therefore, it is necessary to offer and guarantee accurate treatments according to the best standards of evidence-based medicine

Inclusion of functional measures and frailty in the development and evaluation of medicines for older adults

The International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) E7, the guidance for the conduct of clinical trials in people older than age 65 years, dates from 1994. Since then, the inclusion of older people in clinical trials has hardly improved, particularly for the oldest old age group (individuals older than age 75 years), which is the fastest growing demographic bracket in the EU. Even though most medications are taken by this group, relevant endpoints and safety outcomes for this cohort are rarely included and reported, both in clinical trials and regulatory approval documents. To improve the critical appraisal and the regulatory review of medicines taken by frail older adults, eight recommendations are presented and discussed in this Health Policy. These recommendations are brought together from different perspectives and experience of the treatment of older patients. On one side, the perspective of medical practitioners from various clinical disciplines, with their direct experience of clinical decision making; on the other, the perspective of regulators assessing the data submitted in medicine registration dossiers, their relevance to the risk-benefit balance for older patients, and the communication of the findings in the product information. Efforts to improve the participation of older people in clinical trials have been in place for more than a decade, with little success. The recommendations presented here are relevant for stakeholders, authorities, pharmaceutical companies, and researchers alike, as the implementation of these measures is not under the capacity of a single entity. Improving the inclusion of frail older adults requires awareness, focus, and action on the part of those who can effect a much needed change

A Multidimensional Evaluation for Regenerative Strategies: Towards a Circular City-Port Model Implementation

The Metropolitan City of Naples represents the experimentation context of a Circular Economy Model, to verify the potential that the city-port system can make explicit and operative the principles of a type of economy that identifies new and innovative waste resources development opportunities. The principles and tools of the Circular Economy require an appropriate declination and interpretation for the specific context and highlight how the waste resources can be identified not only among the environmental ones but also among the cultural and social ones. At the same time, it is relevant to understand how it is possible to identify in the urban and territorial regeneration processes a selection of actions, which can activate, promote and consolidate circular, synergic and symbiotic processes. Through the implementation of the approaches and techniques of Multi-Criteria Decision Analysis (MCDA), it was possible to analyse two regeneration scenarios and select the actions recognised as priorities, to make operational the Circular Economy principles. In this paper, starting from a selection of relevant indicators, capable of explaining the components of a circular and sustainable territorial system, a multidimensional and cross-scale decision support system was elaborated to identify the key components of a territorial regeneration process for the San Giovanni a Teduccio port area of the city of Naples

ADAPTIVE REUSE STRATEGIES FOR A REGENERATIVE DESIGN: A MULTI-METHODOLOGICAL DECISION-MAKING PROCESS FOR MONTALBANO JONICO

The work presents the results of a multidisciplinary study aimed at responding to the requests of the Administration of Montalbano Jonico, a Municipality of the Piana del Metapontino, in Basilicata Region, South of Italy. Collecting some of the challenges that Matera, Capital of Culture 2019, launch through the slogan “open future” that sees Basilicata at the centre of an integrated and multidirectional development, which intercepts the European and international scene, the study aims to verify the potential directions of the transformation of the territory of Montalbano Jonico, considering its “instinctive capacity” and adaptive to changes and network relationships, tangible and intangible, which also include users, an active part in guiding changes and building values. The activation of an adaptive reuse strategy starts from the redevelopment and re-functionalization of a historic building, the Casino Federici, as component of the complex matrix of the Montalbano Jonico territory and of the Metapontino Plain, identifying an operational model that uses regenerative design as an opportunity to co-create possible futures