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Background. Devices for mechanical cardiopulmonary resuscitation (CPR) are recommended when high quality CPR cannot be provided. Different devices are available, but the literature is poor in direct comparison studies. Our aim was to assess whether the type of mechanical chest compressor could affect the probability of return of spontaneous circulation (ROSC) and 30-day survival in Out-of-Hospital Cardiac Arrest (OHCA) patients as compared to manual standard CPR. Methods. We considered all OHCAs that occurred from 1 January 2015 to 31 December 2022 in seven provinces of the Lombardy region equipped with three different types of mechanical compressor: Autopulse®(ZOLL Medical, MA), LUCAS® (Stryker, MI), and Easy Pulse® (Schiller, Switzerland). Results. Two groups, 2146 patients each (manual and mechanical CPR), were identified by propensity-score-based random matching. The rates of ROSC (15% vs. 23%, p < 0.001) and 30-day survival (6% vs. 14%, p < 0.001) were lower in the mechanical CPR group. After correction for confounders, Autopulse® [OR 2.1, 95%CI (1.6–2.8), p < 0.001] and LUCAS® [OR 2.5, 95%CI (1.7–3.6), p < 0.001] significantly increased the probability of ROSC, and Autopulse® significantly increased the probability of 30-day survival compared to manual CPR [HR 0.9, 95%CI (0.8–0.9), p = 0.005]. Conclusion. Mechanical chest compressors could increase the rate of ROSC, especially in case of prolonged resuscitation. The devices were dissimilar, and their different performances could significantly influence patient outcomes. The load-distributing-band device was the only mechanical chest able to favorably affect 30-day survival.

Background: it is unknown if a correlation between the OHCA and COVID-19 daily incidence is present both during the first and second pandemic wave at a provincial level. Methods: We considered all the OHCAs occurred in the provinces of Pavia, Lodi, Cremona, Mantua and Varese, in Lombardy Region (Italy), from 21/02/2020 to 31/12/2020. We divided study period into period 1, the first 157 days after the outbreak and including the first pandemic wave (21/02/2020-26/07/2020) and period 2, the second 158 days including the second pandemic wave (27/07/2020-31/12/2020). We calculated the cumulative, daily and 7-days incidence of OHCA and COVID-19 expressed per 100,000 inhabitants for the whole territory and for each province separately for both periods. Findings: A significant correlation between the daily incidence of COVID-19 and the daily incidence of OHCA was observed both during the first and the second pandemic period in the whole territory (R=0.4, p

Point-of-care lung sonography has theoretical usefulness in numerous diseases; however clinical indications and the impact of this technique have not been fully investigated. We aimed to describe the current use of point-of-care lung sonography.A 2-year prospective observational study was performed by pulmonologists in an Italian university hospital. Techniques, indications, consequences of lung sonography, and barriers to the examination were analyzed.A total of 1150 lung sonographic examinations were performed on 951 patients. The most common indications were diagnosis and follow-up of pleural effusion in 361 cases (31%), evaluation of lung consolidation (322 [28%]), acute heart failure (195 [17%]), guide to pleural procedures (117 [10%]), pneumothorax (54 [5%]) and acute exacerbations of chronic obstructive pulmonary disease (30 [3%]). The mean duration of the examination ± SD was 6 ± 4 minutes. The transducers most frequently used were convex (746 [65%]) and linear (161 [14%]), whereas in 205 examinations (18%), both transducers were used. According to the judgment of the caring clinician, 51% of the examinations were clinically relevant.Point-of-care lung sonography performed by pulmonologists is quick and feasible and could be widely used for different clinical indications with a potentially high clinical impact. The widespread use of this technique may have a relevant clinical impact in several indications.

Background: Despite theoretical usefulness of point-of-care lung ultrasonography in numerous diseases, indications, impact and accuracy of the technique is unknown. Methods: A two years prospective observational study was performed by pulmonologists of Italian University Hospital. Technique, clinical indications, consequences of lung ultrasound and barriers to the ultrasound examination were analyzed. Overall accuracy of lung ultrasound was calculated for all the first diagnoses of lung consolidation, interstitial syndrome, and pneumothorax, by comparing the ultrasound pattern with the adjudicated final clinical diagnosis based on a hospital chart review. Results: 1150 lung ultrasounds were performed. The most common indications were diagnosis and follow-up of pleural effusion in 361 cases (31%), evaluation of lung consolidation (322, 28%), acute heart failure (195, 17%), guide to pleural procedures (117, 10%), pneumothorax (54, 5%) and acute exacerbations of chronic obstructive pulmonary disease (30, 3%). The mean duration time of the examination was 6 ± 4 minutes. Ultrasound correctly identified the final diagnosis in 564/574 cases (98%, IC 95%, 97% - 99%). According to the judgment of the caring clinician, 51% of the exams were clinically relevant. Conclusions: Lung ultrasound performed at the point-of-care by pulmonologists is a rapid and accurate clinical tool.

Encephalocraniocutaneous lipomatosis (ECCL) is a rare neurocutaneous syndrome that include skin, ocular, and neurological disorders. This study describes the case of a 16-year-old girl that came to observation for the treatment of a congenital alopecia causing great psychological distress. After two expansion procedures the hairless patch was restored with high patient satisfaction. The case met all the criteria for definite diagnosis of ECCL.

Background: Lung ultrasound is a non-radiating accurate alternative tool to chest X-ray (CXR) in the diagnosis of community-acquired pneumonia (CAP) in adults. Objectives: The aim of our study was to define the accuracy of ultrasound in the diagnosis of CAP in children. Methods: 107 consecutive children with suspected CAP underwent clinical examination, blood sample analysis, CXR and lung ultrasound on admission to the Pediatric Department of the San Paolo Hospital. The diagnosis of pneumonia was made by an independent committee of physicians on the basis of the overall clinical and CXR data. Results: The diagnosis of CAP was confirmed by the committee in 81 patients (76%). Ultrasound and CXR were performed in all patients. Ultrasound had a sensitivity of 94% and specificity of 96%, while CXR showed a sensitivity of 82% and a specificity of 94%. In patients with CAP, ultrasound revealed subpleural consolidations with air bronchogram in 70 cases and focal B-lines in 6. A parapneumonic pleural effusion was detected in 17 patients by ultrasound, while only 11 of them could be detected by CXR. Conclusions: In our series, lung ultrasound was highly accurate for the diagnosis of CAP in hospitalized children. These results provide the rationale for a multicenter study in children.

Exercise is integral to the life of T1DM subjects. Several factors influence the metabolic response to exercise in these patients. Despite physical and psychological benefits of exercise, its hypo- and hyperglycemic effects may cause discouragement from participation in sports and games.To use existing evidence from literature to provide practical indications for the management of insulin therapy in subjects with T1DM who practice sports or physical activities.Bibliographic research was performed on PubMed and the main Systematic Review and Guidelines database were also searched.Existing guidelines are useful but the exact adjustments of insulin dose must be made on an individual basis and these adjustments can be made only by "trial and error" approach.These clinical indications may be a starting point from which health care providers can find practical advices for each patient.

Introduction. Partial liquid ventilation (PLV) is emerging as an alternative strategy of ventilation in neonatal acute respiratory failure. The literature reports the treatment with PLV of infants ventilated with conventional mandatory ventilation only: we describe a case of an infant treated with PLV during HFOV and chest drainage of Pnx. Case. An AGA male infant born at 40 weeks' gestation developed progressive respiratory failure and on the 2nd day of life was intubated and mechanically ventilated with SIMV. On the 3rd day he required drainage of a left hemothorax and suffered a pulmonary hypertension without response to iNO that successively normalized. On the 8th day a chest radiograph showed a persistent interstitial pulmonary emphysema (PIPE). At the beginning of the 4th week of life the infant developed a bilateral pneumothorax and, after pleural drainage, he was treated with HFOV (Babylog 8000®, Drager,). The HFOV setting was gradually increased until a MAP of 25 cmH2O with a FiO2 of 100%, but after a further episode of desaturation we were not able to increase the SaO2 over the 50% and to normalize the gas exchange; we decided, after parental informed consent, to perform PLV as compassionate treatment. From the side port of the tracheal tube we instilled 15 ml/Kg of PFC (Rimar 101®,Miteni,Italy) at a rate of 3 ml/min, maintaining HFOV at the same setting and keeping continuous pleural drainage(-10 cmH2O), until a column of PFC welled up in the endotracheal tube during transient disconnection from the ventilator and replaced the PFC loss through evaporation (about 5 ml/Kg) every hour. After 1 hour of PLV we observed an increase of SaO2 over 90% and a decrease of MAP from 25 to 21 cmH2O, an increase of OI from 60 to 25 and of PaCO2 from 68 to 55 mmHg. We stopped PLV at the end of a 48 hour period when the SaO2 was 93%, the MAP 20 cmH2O, the OI 25 and the PaCO2 58 mmHg, without deterioration of the respiratory function. Successively, due to the persistence of Pnx, a thoracotomy was performed and bilateral broncho-pleural fistulas were successfully treated; the middle lobe, because entirely dysplastic, was resected and the lung hystology confirmed the diagnosis of PIPE in association with pulmonary dysplasia. Finally, the infant, due to intractable respiratory failure, joined a lung transplantation program and is now waiting for donor organs. Conclusion. This case suggests that PLV can be safe and beneficial also during HFOV and pleural drainage and that it may be useful in the treatment of acute worsening of chronic lung injuries.

Background Pollution has been suggested as a precipitating factor for cardiovascular diseases via a series of different mechanisms. However, data about the link between the different air pollutants and the risk of out-of-hospital cardiac arrest (OHCA) are limited and controversial. Purpose The primary aim of this study is to examine the impact of short-term exposure to particulate and gaseous pollutants on the incidence of OHCA in a vast metropolitan and rural area that encompasses four provinces of the Po Valley in Northern Italy, one of the most polluted areas in Italy and Europe due to its levels of industrialization and high population density. The secondary aim of this study is to look for a dose-effect curve, which could help predict OHCA incidence based on the concentration of pollutants in a specific area. Methods This is a retrospective analysis of prospectively collected data both in the OHCA registry (Lombardia CARe) and in the database of the regional agency for environmental protection (ARPA) of the Lombardy region. All medical OHCAs and the mean daily concentration of pollutants including fine particulate matter (PM10, PM2.5), benzene (C6H6), carbon monoxide (CO), nitrogen dioxide (NO2), sulphur dioxide (SO2) and ozone (O3) were considered from January 1st to December 31st, 2019 in the southern part of the Lombardy region (provinces of Pavia, Lodi, Cremona and Mantua; 7863 km2; about 155ehab724.2654 inhabitants). Days were divided into high or low incidence of OHCA according to the median daily incidence. A Probit dose-response analysis and both uni- and multivariable logistic regression models were provided for each pollutant. Results The median daily incidence of OHCA was 0.3 cases/100,000 inhabitants. Benzene was the pollutant with the greatest difference between days at high and low incidence of OHCA [0.7 (IQR 0.4–1.2) vs 0.4 (IQR 0.3–0.7), p Conclusions Our results clarify the link between pollutants and the acute risk of cardiac arrest suggesting the need of both improving the air quality and integrating pollution data in future models. Funding Acknowledgement Type of funding sources: None.