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BACKGROUND: The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures. METHODS: Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023. RESULTS: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patients directives, family feelings and representatives desires, and all decisions should be shared. CONCLUSIONS: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes.

Core-collapse supernovae are among the most magnificent events in theobservable universe. They produce many of the chemical elements necessary forlife to exist and their remnants -- neutron stars and black holes -- areinteresting astrophysical objects in their own right. However, despitemillennia of observations and almost a century of astrophysical study, theexplosion mechanism of core-collapse supernovae is not yet well understood.Hyper-Kamiokande is a next-generation neutrino detector that will be able toobserve the neutrino flux from the next galactic core-collapse supernova inunprecedented detail. We focus on the first 500 ms of the neutrino burst,corresponding to the accretion phase, and use a newly-developed, high-precisionsupernova event generator to simulate Hyper-Kamiokande's response to fivedifferent supernova models. We show that Hyper-Kamiokande will be able todistinguish between these models with high accuracy for a supernova at adistance of up to 100 kpc. Once the next galactic supernova happens, thisability will be a powerful tool for guiding simulations towards a precisereproduction of the explosion mechanism observed in nature.

Hyper-Kamiokande is the next generation underground water Cherenkov detectorthat builds on the highly successful Super-Kamiokande experiment. The detectorwhich has an 8.4~times larger effective volume than its predecessor will belocated along the T2K neutrino beamline and utilize an upgraded J-PARC beamwith 2.6~times beam power. Hyper-K's low energy threshold combined with thevery large fiducial volume make the detector unique, that is expected toacquire an unprecedented exposure of 3.8~Mton$\cdot$year over a period of20~years of operation. Hyper-Kamiokande combines an extremely diverse scienceprogram including nucleon decays, long-baseline neutrino oscillations,atmospheric neutrinos, and neutrinos from astrophysical origins. The scientificscope of this program is highly complementary to liquid-argon detectors forexample in sensitivity to nucleon decay channels or supernova detection modes.Hyper-Kamiokande construction has started in early 2020 and the experiment isexpected to start operations in 2027. The Hyper-Kamiokande collaboration ispresently being formed amongst groups from 19 countries including the UnitedStates, whose community has a long history of making significant contributionsto the neutrino physics program in Japan. US physicists have played leadingroles in the Kamiokande, Super-Kamiokande, EGADS, K2K, and T2K programs.

We report the occurrence of Staphylococcus lugdunensis cutaneous infection with sporotrichoid distribution of the left lower limb of a 60-year-old man. Recent studies have confirmed that Staphylococcus lugdunensis is a significant pathogen in causing skin and soft tissue infections that usually manifest in abscesses, surgical wound infections, and cellulitis. It used to be considered a skin commensal bacteria, but if unrecognized it can lead to  fulminant endocarditis, meningitis, skin abscesses, peritonitis, and spondylodiscitis.

We describe the case of an elderly woman who acquired a Mycobacterium marinum infection following skin exposure to the bacteria through a small wound on her right ring finger, obtained while preparing fish. The resultant sporotrichoid nodules of the right hand and the distal forearm, refractory to the initial therapy with doxycycline and rifampicin, were successfully treated with oral regimen of clarithromycin.

Malignant melanoma presenting as a giant cutaneous mass is rarely observed in clinical practice. A few patients with giant melanoma have been reported, Herein, we document our experience with a patient with giant cutaneous melanoma of the abdomen and review the features of previously reported individuals.

B-cell chronic lymphocytic leukemia (B-CLL) is a low-grade lymphoproliferative disease. Cutaneous involvement of B-CLL is limited and, in most cases, it represents non-specific manifestations related to an impaired immune system. Leukemic skin infiltrates (leukemia cutis) occur in 4–20% of patients. Herein we report the case of a 65-year-old woman with B-CLL presenting with papular, nodular, and plaque skin infiltrates affecting the nose, mimicking granulomatous rosacea. We discuss several aspects of rare cutaneous manifestations of B-CLL involving the face.