Background/Objectives: Vacuum-assisted breast biopsy (VABB) is widely used for the diagnosis of nonpalpable breast cancer but is not considered definitive treatment because microscopic residual disease may persist within or around the biopsy cavity. The ARTHE phase I trial evaluated a cavity-targeted radionuclide strategy based on same-session sequential intralesional administration of avidin followed by [90Y]Y-DOTA-biotin after VABB. Methods: Eighteen women with nonpalpable breast cancer measuring ≤15 mm and a skin-to-cavity distance ≥ 13 mm were treated in three sequential activity-escalation cohorts. The primary objective was to assess acute local and systemic safety, including dose-limiting toxicity. The protocol-specified co-primary objective was to evaluate preliminary antitumor activity, assessed as breast-only pathologic complete response (pCR) at surgery. Given the phase I single-arm design, pCR was analyzed descriptively. The protocol-specified secondary objective was patient-specific dosimetry. Additional exploratory assessments included post-injection biodistribution and integration with subsequent breast-conserving surgery. Results: No dose-limiting toxicities, grade ≥ 3 adverse events, clinically relevant hematologic toxicity, treatment discontinuations, hospitalizations, or treatment-related surgical delays were observed. Local toxicity was limited to grade 1 injection-site pain and/or erythema. Post-injection imaging consistently demonstrated focal intralesional localization without clinically relevant extra-lesional uptake. All patients underwent breast-conserving surgery 4–7 weeks after treatment. No residual tumor cellularity (RTC), from either invasive or in situ carcinoma, was identified in the breast surgical specimen in 5/18 patients (27.8%). However, because diagnostic VABB may have removed part or all of the malignant lesion, the absence of residual carcinoma at surgery cannot be attributed specifically to the radionuclide treatment. Conclusions: The intralesional avidin-mediated local trapping strategy using [90Y]Y-DOTA-biotin after VABB was feasible, showed favorable acute and short-term tolerability, was associated with early focal localization on post-injection imaging, and was compatible with standard breast-conserving surgery. Controlled studies are warranted to determine the therapeutic contribution of this post-biopsy cavity-targeted strategy, optimize administered activity, and refine patient selection.
Objectives: Sepsis is the leading cause of death in the ICU. Early recognition and immediate management of the causes of sepsis is the focus of this work, aimed at evaluating one of the early-onset biomarkers in the phases of organ dysfunction typical of sepsis. To evaluate the performance of mid-region pro-adrenomedullin (MR-proADM) as an early biomarker of endothelial dysfunction and prognosis in critically ill patients with suspected sepsis. Methods: In this prospective observational cohort, 150 adult patients admitted to the Intensive Care Units (ICU) of AUSL Romagna from April to October 2025 were enrolled. Plasmmatic MR-proADM was quantified at baseline (t0), 24 hours (t24), and 48 hours (t48) using the LIAISON® BRAHMS MR-PROADM™ chemiluminescent assay. Patients were stratified according to blood culture results: culture negative, Gram negative and Gram-positive bacteremia. The primary outcomes were MR-proADM kinetics and association with 7- and 28-day mortality. Secondary outcome included comparison with C-reactive protein (CRP) trends. Results: MR-proADM levels were significantly higher in Gram-negative bacteremia than in the Gram-positive and culture-negative groups at all time points. Non-survivors showed persistently elevated or increasing MR-proADMs, while survivors showed declining trends. CRP showed slower kinetics and poor discrimination between infection categories. Conclusions: MR-proADM identifies early endothelial dysfunction and predicts outcomes in sepsis. Its early kinetic changes outperform CRP for prognosis but require validation in larger cohorts to establish clinical cut-offs and utility in antimicrobial decision support.
The direct anterior approach (DAA) in total hip arthroplasty (THA) offers advantages in muscle preservation and early recovery but is challenged by a steep learning curve that may affect outcomes. This systematic review analyzed complication and reoperation rates during the learning phase of DAA in primary THA. A comprehensive search of PubMed, Cochrane Library, and Web of Science, was performed according to PRISMA guidelines. Studies reporting complications and reoperations during the DAA learning curve were included. Data on demographics, surgical volume, and adverse events were extracted. The primary outcomes were complication and reoperation prevalence with 95
Rinderpest eradication is often presented as a landmark in veterinary public health; less systematically examined are its medium- and long-term implications for pastoral systems that rely on mobility and collective rangeland use. This narrative review synthesises historical and contemporary evidence on (i) how rinderpest shocks interacted with pastoral livelihoods during the African pandemic and subsequent outbreaks, and (ii) how eradication-era approaches to surveillance, vaccination logistics and field delivery shaped later models for controlling transboundary animal diseases. It is argued that the same features underpinning pastoral resilience–mobility, flexible herd management, and social networks–may also increase disease exposure and hinder sustained access to veterinary services, particularly where service delivery models remain campaign-centred and externally financed. Although the eradication of rinderpest produced substantial welfare gains, these benefits were uneven and were often limited by the ongoing burden of other infectious diseases (e.g., peste des petits ruminants, foot-and-mouth disease) and by under-resourced routine animal health systems. Lessons for current eradication initiatives can be drawn: credible surveillance needs to be embedded within locally legitimate institutions; vaccination strategies should be aligned with seasonal mobility and market networks; and enabling environments for Community Animal Health Workers are essential to sustain coverage beyond time-limited programmes. These insights help reposition rinderpest eradication as both a success story and a cautionary case for designing equitable, durable animal health services in pastoral settings following a One Health approach.
Abstract Background The scope of medical conditions addressed in Emergency Departments (ED) increases with growing numbers of older patients among the ED patient population. More information on their chief complaints and related treatment outcomes is essential to ensure high-quality ED care. The objective of this study was to describe the pattern of chief complaints of older ED patients and evaluate the associations between these complaints and outcomes such as mortality and hospital admission. Methods This secondary analysis is based on the observational ‘Epidemiology of Geriatric patients in Europe’ (EGERS) study. This prospective, routine data cross-sectional study was conducted in 36 EDs across 9 European countries. Data collection from routine clinical records of all patients aged 65 and older over a 7-day period from October 19 to November 30, 2020 during the Covid-19 pandemic. Patients with one documented non-traumatic chief complaint were analyzed. Descriptive statistics, logistic regression, and general linear mixed models were used to assess factors associated with hospital admission and in-hospital mortality. Odds ratios (OR) and 95% confidence intervals (CI) were reported. Results The study population consisted of 2,794 patients with one specified chief complaint. The mean age was 77.4 (± 8.2) years. The most frequent chief complaints were shortness of breath, abdominal pain, chest pain, weakness and fatigue, and extremity pain and numbness, representing 59% of the cohort. Highest age (≥ 85), geriatric risks (i.e. presence of dementia/Alzheimer’s disease (AD), home help service or previous falls), polypharmacy, and shortness of breath increased the odds of being admitted to hospital (OR 1.4 [1.2–1.9]; OR 1.6 [1.3–1.9]; OR 1.3 [1.1–1.6]; OR 3.0 [2.4–3.8]), while female sex was negatively associated with admission (OR 0.7 [0.6–0.8]). Shortness of breath was positively associated with in-hospital mortality (OR 2.2 [1.4–4.3]). Conclusion Older patients frequently require hospital admission. As chief complaints do not reflect underlying condition or severity, structured evaluation, staff training and geriatric specific care pathways may improve care and reduce adverse clinical outcomes.
