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Bedside lung ultrasound (LUS) can play a role in the setting of the SarsCoV2 pneumonia pandemic. To evaluate the clinical and LUS features of COVID-19 in the ED and their potential prognostic role, a cohort of laboratory-confirmed COVID-19 patients underwent LUS upon admission in the ED. LUS score was derived from 12 fields. A prevalent LUS pattern was assigned depending on the presence of interstitial syndrome only (Interstitial Pattern), or evidence of subpleural consolidations in at least two fields (Consolidation Pattern). The endpoint was 30-day mortality. The relationship between hemogasanalysis parameters and LUS score was also evaluated. Out of 312 patients, only 36 (11.5%) did not present lung involvment, as defined by LUS score < 1. The majority of patients were admitted either in a general ward (53.8%) or in intensive care unit (9.6%), whereas 106 patients (33.9%) were discharged from the ED. In-hospital mortality was 25.3%, and 30-day survival was 67.6%. A LUS score > 13 had a 77.2% sensitivity and a 71.5% specificity (AUC 0.814; p < 0.001) in predicting mortality. LUS alterations were more frequent (64%) in the posterior lower fields. LUS score was related with P/F (R 2 0.68; p < 0.0001) and P/F at FiO 2  = 21% (R 2 0.59; p < 0.0001). The correlation between LUS score and P/F was not influenced by the prevalent ultrasound pattern. LUS represents an effective tool in both defining diagnosis and stratifying prognosis of COVID-19 pneumonia. The correlation between LUS and hemogasanalysis parameters underscores its role in evaluating lung structure and function., (© 2021. The Author(s).)

Background: COVID-19 is an emerging infectious disease, that is heavily challenging health systems worldwide. Admission Arterial Blood Gas (ABG) and Lung Ultrasound (LUS) can be of great help in clinical decision making, especially during the current pandemic and the consequent overcrowding of the Emergency Department (ED). The aim of the study was to demonstrate the capability of alveolar-to-arterial oxygen difference (AaDO 2 ) in predicting the need for subsequent oxygen support and survival in patients with COVID-19 infection, especially in the presence of baseline normal PaO 2 /FiO 2 ratio (P/F) values., Methods: A cohort of 223 swab-confirmed COVID-19 patients underwent clinical evaluation, blood tests, ABG and LUS in the ED. LUS score was derived from 12 ultrasound lung windows. AaDO 2 was derived as AaDO 2 = ((FiO 2 ) (Atmospheric pressure - H 2 O pressure) - (PaCO 2 /R)) - PaO 2 . Endpoints were subsequent oxygen support need and survival., Results: A close relationship between AaDO 2 and P/F and between AaDO 2 and LUS score was observed (R 2 = 0.88 and R 2 = 0.67, respectively; p < 0.001 for both). In the subgroup of patients with P/F between 300 and 400, 94.7% ( n = 107) had high AaDO 2 values, and 51.4% ( n = 55) received oxygen support, with 2 ICU admissions and 10 deaths. According to ROC analysis, AaDO 2 > 39.4 had 83.6% sensitivity and 90.5% specificity (AUC 0.936; p < 0.001) in predicting subsequent oxygen support, whereas a LUS score > 6 showed 89.7% sensitivity and 75.0% specificity (AUC 0.896; p < 0.001). Kaplan-Meier curves showed different mortality in the AaDO 2 subgroups ( p = 0.0025)., Conclusions: LUS and AaDO 2 are easy and effective tools, which allow bedside risk stratification in patients with COVID-19, especially when P/F values, signs, and symptoms are not indicative of severe lung dysfunction.

Skin malignant melanoma is a highly angiogenic cancer, necessitating early diagnosis for positive prognosis. The current diagnostic standard of biopsy and histological examination inevitably leads to many unnecessary invasive excisions. Here, we propose a non-invasive method of identification of melanoma based on blood flow dynamics. We consider a wide frequency range from 0.005-2 Hz associated with both local vascular regulation and effects of cardiac pulsation. Combining uniquely the power of oscillations associated with individual physiological processes we obtain a marker which distinguishes between melanoma and atypical nevi with sensitivity of 100% and specificity of 90.9%. The method reveals valuable functional information about the melanoma microenvironment. It also provides the means for simple, accurate, in vivo distinction between malignant melanoma and atypical nevi, and may lead to a substantial reduction in the number of biopsies currently undertaken.

Aim: We aimed to test a new teledermatologic method that permits to match a high level of diagnostic accuracy, comparable with or higher to that of the "Store and Forward" method, with the highest handiness, comparable to that achievable with a video call, without suffering from the limitations of the two methods., Methods: We used latest-generation cell phones with a HSDPA network broad-band internet access system for video calling and for sending via e-mail high-definition images, chosen by the specialist-at-a-distance during the video call, in times comparable to those achievable with fixed-wired access systems. We tested the diagnostic reliability, the compliance and the efficacy of the method., Results: We found a significant concordance both between direct and via video call description of the objective signs and between direct and on high definition image description. The Spearman Rank showed a higher correlation between direct observation and high definition image observation than between direct and via video call observation: this last finding matched the experimenters' subjective experience. The compliance was positive and the efficacy comparable with the ambulatorial follow-up., Conclusion: In conclusion, the "Phone and Mail" method can be seen as being capable of joining together the necessary diagnostic precision and effectiveness with a high degree of practicality and simplicity, thanks to the ease of use of the cell phone, within the reach of everybody, to the ubiquity of its utilization, to the allowed rapidity of diagnosis, practically in real time, and to the low cost of the system.

Functional microcirculatory aspects of burned sites were examined including areas of self-healed burns, and grafted areas. Donor areas were also examined. In 10 patients with burns in the lower limbs, both self-healed and with grafts, the microcirculatory response was evaluated by Laser Doppler flowmetry (LDF) measuring for each site the resting flux at 36 degrees, the postural venular-arteriolar reflex (VAR) and the flux at 41 degrees (heating). The first evaluation was carried out on discharge, and subsequently at approximately 45 day intervals during uniform therapy follow-up (elastocompression). The burn-affected area (self-healed, graft) and those donor areas present should increase resting flux by comparison with control areas. This was particularly so in the self-healed burn, which does however tend to converge in time towards control values. Response to stress tests (VAR and heating) presents percentage variations similar to normal skin in the various areas, with the exception of the grafted areas which present a reduced response in the 1st weeks following engraftment. No significant differences in response to heating were detected. It can be suggested that these differences are due to anatomic variations in revascularization and healing in the different areas as well as to alterations in microvascular innervation and local response to vasoactive substances.

Background: Early surgical intervention is still the most successful therapy for patients with melanoma. The results obtained with medical therapies are still quite disappointing, with better results observed in soft tissue and lymph node metastasis. There currently is no standardized adjuvant therapy for primary melanoma. On the basis of the activity demonstrated in vitro against melanoma cell lines and the results obtained in many clinical trials in patients with advanced melanoma, the authors chose to study the use of recombinant interferon-alpha (IFN-alpha) as adjuvant therapy for patients with Stage I and Stage II melanoma., Methods: A randomized multicenter trial based on the use of recombinant IFN-alpha-2b for 3 years at the dose of 3 MU given intramuscularly 3 times a week for a period of 6 months with a 1-month interval between cycles was conducted in Stage I and Stage II melanoma patients (using the American Joint Committee on Cancer classification). The efficacy of this treatment was evaluated calculating the incidence of recurrence after 3 and 5 years., Results: Results were collected at the end of the treatment period and after 5 years of follow-up for a smaller number of patients. Statistical evaluation showed a significant difference between treated patients and untreated controls with regard to progression of the disease. In particular, IFN-alpha appears to be more effective in patients with worse prognosis lesions., Conclusions: IFN-alpha appears to be effective as adjuvant therapy for high risk melanoma patients and the risk/benefit ratio appears to be very favorable. The authors' next goal is to separate those patients who might benefit from adjuvant therapy from those who are cured after the surgical intervention only.