A prompt diagnosis of late-onset congenital diaphragmatic hernia with Point of Care Ultrasound (POCUS) in a Pediatric Emergency Department.

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First diagnosis of multisystem inflammatory syndrome in children (MIS-C): an analysis of PoCUS findings in the ED

Children with multisystem inflammatory syndrome (MIS-C) tend to develop a clinical condition of fluid overload due both to contractile cardiac pump deficit and to endotheliitis with subsequent capillary leak syndrome. In this context, the ability of point-of-care ultrasound (PoCUS) to simultaneously explore multiple systems and detect polyserositis could promote adequate therapeutic management of fluid balance. We describe the PoCUS findings in a case-series of MIS-C patients admitted to the Emergency Department. At admission 10/11 patients showed satisfactory clinical condition without signs and symptoms suggestive for cardiovascular impairment/shock, but PoCUS showed pathological findings in 11/11 (100%). In particular, according to Rapid Ultrasound in SHock (RUSH) protocol, cardiac hypokinesis was detected in 5/11 (45%) and inferior vena cava dilatation in 3/11 (27%). Peritoneal fluid was reported in 6/11 cases (54%). Lung ultrasound (LUS) evaluation revealed an interstitial syndrome in 11/11 (100%), mainly localized in posterior basal lung segments. We suggest PoCUS as a useful tool in the first evaluation of children with suspected MIS-C for the initial therapeutic management and the following monitoring of possible cardiovascular deterioration

A retrospective multicentric observational study of trastuzumab emtansine in HER2 positive metastatic breast cancer: A real-world experience

We addressed trastuzumab emtansine (T-DM1) efficacy in HER2+ metastatic breast cancer patients treated in real-world practice, and its activity in pertuzumab-pretreated patients. We conducted a retrospective, observational study involving 23 cancer centres, and 250 patients. Survival data were analyzed by Kaplan Meier curves and log rank test. Factors testing significant in univariate analysis were tested in multivariate models. Median follow-up was 15 months and median T-DM1 treatment-length 4 months. Response rate was 41.6%, clinical benefit 60.9%. Median progression-free and median overall survival were 6 and 20 months, respectively. Overall, no differences emerged by pertuzumab pretreatment, with median progression-free and median overall survival of 4 and 17 months in pertuzumab-pretreated (p=0.13), and 6 and 22 months in pertuzumab-na\uc3\uafve patients (p=0.27). Patients who received second-line T-DM1 had median progression-free and median overall survival of 3 and 12 months (p=0.0001) if pertuzumab-pretreated, and 8 and 26 months if pertuzumab-na\uc3\uafve (p=0.06). In contrast, in third-line and beyond, median progression-free and median overall survival were 16 and 18 months in pertuzumab-pretreated (p=0.05) and 6 and 17 months in pertuzumab-na\uc3\uafve patients (p=0.30). In multivariate analysis, lower ECOG performance status was associated with progression-free survival benefit (p < 0.0001), while overall survival was positively affected by lower ECOG PS (p < 0.0001), absence of brain metastases (p 0.05), and clinical benefit (p < 0.0001). Our results are comparable with those from randomized trials. Further studies are warranted to confirm and interpret our data on apparently lower T-DM1 efficacy when given as second-line treatment after pertuzumab, and on the optimal sequence order

SURVEYING TO UNDERSTANDING AND VALORIZING THE URBAN IMAGE: THE ISOLA SACRA AREA IN FIUMICINO. EL LEVANTAMIENTO PARA EL CONOCIMIENTO Y LA MEJORA DE LA IMAGEN URBANA: LA ZONA DE ISOLA SACRA EN FIUMICINO

La intención del estudio es convertir en científico un proceso de conocimiento, de análisis e interpretación crítica de la complejidad urbana condicionada no solo por factores arquitectónicos sino también, por aspectos culturales, políticos y económicos. El objetivo consiste en partir de la comprensión de un lugar, para llegar a la elaboración de proyectos que sean capaces de reinterpretar la historia y a estimular y respaldar un debate siempre abierto en la perspectiva cada vez más amplia de la gestión del patrimonio cultural italiano. El área de estudio elegida es Isola Sacra, en el municipio de Fiumicino, encerrada entre Ostia Antica y el puerto de Trajano, inmersa dentro del parque natural de la costa romana. Es una isla auténtica, situada en la desembocadura del río Tíber, formada artificialmente por el alargamiento del canal que se excavó en la época de la antigua Ropa para conectar el río con el puerto imperial. Desde los años setenta, de manera intermitente, la zona ha sufrido muchos cambios en la construcción, debido principalmente al desarrollo del aeropuerto de Fiumicino. A partir de los numerosos estudios realizados a nivel nacional en este territorio articulado y complejo, uno de los objetivos es recavar la documentación existente para tratar de implementar un sistema que ya se ha estudiado y organizado con el fin de hacer frente con conocimiento a la gestión y/o a la futura distribución/expansión del área. La intención es aquella de estructurar y convertir en estándar un procedimiento basado en metodologías integradas para llegar a conocer este territorio; todos los análisis directos e indirectos, las comparaciones entre documentos históricos y actuales, las operaciones de descubrimiento a diferentes escalas, la investigación fotográfica del lugar y la elaboración de datos de levantamiento contribuirán a definir y realizar representaciones significativas del contexto urbano y de los episodios seleccionados como muestra para sugerir la valorización y la recalificación.The study aims to provide a scientific basis for the process of understanding, analyzing and critical interpretation of urban complexity, which is affected not only by architectural factors but also by cultural, political and economic aspects. The objective is to start from the knowledge thus gained about a place, which can then lead to projects capable of reinterpreting history as well as stimulating and sustaining the ongoing debate in the broader panorama of managing Italy’s cultural heritage. The area selected for investigation is Isola Sacra, a portion of the municipality of Fiumicino between Ostia Antica and Portus, now part of the Roman coastline nature reserve. It is an artificial island, created at the mouth of the Tiber during Trajan’s reign, when a navigable canal was extended to link the river to the Imperial port. During the 1970s, the town saw many construction projects in alternating stages, largely in connection with the development of Fiumicino airport. Starting from the numerous studies conducted of this complex and many-faceted area in Italy, one of this paper’s goals is to carry out a systematic review of the existing documentation, determining what has already been studied and organizing what can still be done in order to develop a well-informed approach to managing the area or doing further work on it. The intention is to establish a standard procedure based on integrated methods that will enable us to gain a better understanding of this area: all of the direct and indirect analyses, comparisons between historical and current documentation, surveying operations at various scales, the photographic investigation of the area and processing of survey data will all contribute to producing significant representations of the urban setting and of the individual episodes that were sampled in order to suggest approaches to valorizing and renewing the area

Basosquamous Carcinoma: Comprehensive Clinical and Histopathological Aspects, Novel Imaging Tools, and Therapeutic Approaches

Basosquamous carcinoma (BSC), an uncommon and aggressive nonmelanoma skin cancer exhibiting characteristics ranging from basal cell carcinoma (BCC) to squamous cell carcinoma (SCC), is a subject of controversy in terms of its classification, pathogenesis, histologic morphology, biologic behavior, prognosis, and management. This narrative review is based on an electronic search of English-language articles in PubMed that included the terms “basosquamous carcinoma” and/or “metatypical carcinoma of the skin” in their titles. The review aims to succinctly present and assess current data on the epidemiology, clinical presentation, dermoscopic, LC-OCT, and histopathologic characteristics, as well as the genetics and management of BSC, providing insight into this intriguing entity. As a conclusion, dermoscopy, deep incisional biopsies, and immunohistologic techniques should be applied in clinically suspicious lesions to achieve an early diagnosis and better prognosis of this tumor. Surgical treatments, including wide excision and Mohs’ micrographic surgery, remain the treatment of choice. Finally, Hedgehog pathway inhibitors and checkpoint inhibitors, must be thoroughly investigated with large controlled trials, since they may offer an alternative solution to irresectable or difficult-to-treat locally advanced cases of basosquamous carcinoma

Cemiplimab in Ultra-Octogenarian Patients with Cutaneous Squamous Cell Carcinoma: The Real-Life Experience of a Tertiary Referral Center

Background: The incidence of cutaneous squamous cell carcinoma (cSCC) is rapidly increasing, paralleling the aging of the population. cSCC predominantly affects chronically sun-exposed areas, such as the head and neck region. At our tertiary center, a multidisciplinary approach to non-melanoma skin cancer is provided for locally advanced cSCC. Methods: We retrospectively revised all patients with locally advanced/metastatic cSCC treated with anti-PD1 antibody (Cemiplimab) at our Institution from January 2020 to March 2023 (minimum follow-up of 4 months on treatment). Results: Overall, we consecutively treated 20 ultra-octogenarian patients, of whom 15 were males and 5 were females (median age: 86.9 years). Despite age, a median number of concomitant drugs, and comorbidities, efficacy, and safety were superimposable with the available literature. No patients reported treatment-related adverse events of grade 3 or higher. Grade 2 adverse events were reported in 25% of patients. Overall, the response rate was 65%, with 50% partial responses and 20% long-lasting stable disease. The median duration of response was 14 months. The G8 elderly score was assessed in all patients, and the median score was 12 (range 9–14). Conclusions: Among ultra-octogenarian patients, a clinical benefit from Cemiplimab was obtained in most, including tumor shrinkage and pain relief. Cemiplimab confirmed its effectiveness in elderly patients in a real-life setting, with no new safety concerns