Ospedale Regionale di Locarno

Exercise-induced purpura is a distinctive condition occurring after prolonged physical exertion. It is often misdiagnosed as an immune-mediated vasculitis, raising concerns about autoimmune disorders. Although this condition affects physically active individuals, it remains underrepresented in comprehensive reviews on purpura and nontraumatic sports dermatology. To enhance awareness about this condition and to advance understanding of its clinical and histologic features, we conducted a systematic literature review. This study was preregistered in the International Prospective Register of Systematic Reviews (CRD42024557652). The United States National Library of Medicine, Excerpta Medica, and Google Scholar were screened for the terms "exercise-induced vasculitis" OR "exercise-induced purpura" OR "exercise-induced capillaritis." Data extraction encompasses demographics, symptoms, time latency and recovery, predisposing factors, ancillary tests (blood values and histology), and popular terminology. We identified 40 typical cases and three case series reporting an additional 71 individuals. Exercise-induced purpura predominantly affected middle-aged women, often in association with chronic venous disease. Petechiae, purpura, or ecchymoses-often accompanied by burning, itching, or mild pain-appeared within 24 hours after prolonged physical activity, especially in warm conditions, and characteristically involved the lower limbs, sparing areas covered by clothing. Symptoms and lesions resolved spontaneously within 1 to 2 weeks. Laboratory tests were unremarkable, and histology revealed leukocytoclastic vasculitis without IgA deposits. Exercise-induced purpura deserves greater visibility in sports medicine due to its frequency, benign course, and potential for misdiagnosis. Diagnosis is clinical. Early recognition avoids unnecessary investigations and unwarranted concern.

Rare cancers combine low incidence with high biological heterogeneity and multi-institutional care trajectories. These features make single-center learning structurally incomplete and render pathway fragmentation a dominant driver of preventable harm, variability, and waste. In this context, care quality is best understood as a property of pathway integrity across routing, diagnostics (imaging/biopsy planning), multidisciplinary intent-setting, definitive treatment, and surveillance-rather than as a department-level attribute. To define a pragmatic, transferable operating blueprint for a rare-cancer Learning Health System (LHS) that turns routine care into continuous, auditable learning under explicit governance, while maintaining claims discipline and protecting measurement validity. We synthesize an implementation-oriented operating model using the Swiss Sarcoma Network (SSN) as an exemplar. The blueprint couples clinical governance (Integrated Practice Unit logic, hub-and-spoke routing, auditable multidisciplinary team decision systems) with an interoperable real-world-time data backbone designed for benchmarking, pathway mapping, and feedback. The operating logic is expressed as a closed-loop control cycle: capture → harmonize → benchmark → learn → implement → re-measure, with explicit owners, minimum requirements, and failure modes. Results/Blueprint: (i) The model specifies a minimal set of data primitives-time-stamped and traceable decision points covering baseline and tumor characteristics, pathway timing, treatment exposure, outcomes and complications, and feasible longitudinal PROMs and PREMs; (ii) a VBHC-ready, multi-domain measurement backbone spanning outcomes, harms, timeliness, function, process fidelity, and resource stewardship; and (iii) two non-negotiable validity guardrails: explicit applicability ("N/A") rules and mandatory case-mix/complexity stratification. Implementation is treated as a governed step with defined workflow levers, fidelity criteria, balancing measures, and escalation thresholds to prevent "dashboard medicine" and surrogate-driven optimization. This perspective contributes an operating model-not a platform or single intervention-that enables credible improvement science and establishes prerequisites for downstream causal learning and minimum viable digital twins. By distinguishing enabling infrastructure from the governed clinical system as the primary intervention, the blueprint supports scalable, learnable excellence in rare-cancer care while protecting against gaming, inequity, and inference drift. Distinct from generic LHS or VBHC frameworks, this blueprint specifies validity gates required for rare-cancer benchmarking-explicit applicability ("N/A") rules, denominator integrity/capture completeness disclosure, anti-gaming safeguards, and escalation governance. These elements are critical in rare cancers because small denominators, high heterogeneity, and multi-institutional pathways otherwise make benchmarking prone to artifacts and unsafe inferences.

Branchial cleft cysts are congenital anomalies derived from the branchial apparatus, most commonly presenting as lateral neck masses. Intrathyroidal localization is exceedingly rare and may mimic malignancy both radiologically and cytologically-particularly when squamous cells are identified and misinterpreted as malignant. Surgical resection is often required to achieve a definitive diagnosis. Our report highlights the diagnostic challenges of such lesions and underscores the importance of integrating clinical, cytological, and imaging data.

Abstract BACKGROUND In glioblastoma (GBM) patients two factors are relevant for prediction of survival: MGMT promoter hypermethylation, which improves the patient’s response to temozolomide (TMZ), and the extent of resection (EOR), with a better overall survival (OS) described in patients subjected to gross total resection (GTR). The aim of our study is to analyze the level of concordance between the results obtained with the standard non-quantitative MGMT analysis methods compared to the quantitative real-time method EpiDirect® and to verify whether the different levels (frequencies) of MGMT promoter hypermethylation, assessed by EpiDirect®, can better predict the response to GBM treatment. MATERIAL AND METHODS MGMT promoter methylation in GBM IDH1 wt cases diagnosed from 2004 to 2022 in two neurosurgical centers (EOC and Insubria University Hospital, Italy) and treated by temozolomide (TMZ) was evaluated for diagnosis by sodium bisulfite pretreatment and methylation-specific PCR (MSP) and then we tested the samples by the new real-time EpiDirect® (Pentabase ApS, Denmark). Cohen index and Kaplan-Meier curves were evaluated for statistics. RESULTS We enrolled 119 GBM cases treated by standard adjuvant partial brain radiation and TMZ based chemotherapy for which MGMT promoter methylation data by MSP or by PCR-pyrosequencing were available for diagnostic purposes. With the common standard methods 41/119 (34.5%) cases were methylated in the MGMT promoter (M) and 72/119 (60.5%) were unmethylated (UM). In addition, 6/119 cases (5.05%) were not evaluable. By EpiDirect® all the cases provided reproducible results, MGMT M was detected in 45/119 cases (37.8%) and UM in 74/119 (62.2%). Comparing Epidirect® to the commonly used methodologies, nine evaluable cases (5 M and 4 UM cases), corresponding to 8% of the entire cohort, showed discrepant methylation results. Despite this, the level of concordance between methodologies was high (K Cohen index corresponding to 0.829). The comparisons of OS, progression-free survival and time-to-progression in the five categories corresponding to different MGMT promoter methylation levels identified by Epidirect® resulted in not statistical significant results considering the whole cohort and then the different kind of surgery (biopsy, partial resection or GTR) (p›0.05). CONCLUSION EpiDirect® is a robust methodology enabling a faster, more sensible and easier evaluation of cases even in presence of a highly damaged DNA. In addition, it shares a high level of superimposition with the most diffused technologies currently used for assessing the MGMT promoter methylation for diagnostic purposes. The EpiDirect® ability to quantify the percentage of MGMT promoter methylation is another advantage of this methodology however we found that it has not clinical relevance on survival.

<bold>Background:</bold> Pulmonary embolism (PE) is a major health burden. Its acute management has been extensively studied permitting in the past decades progress on mortality. Recent studies showed that number of patients complains of long-term symptoms after a PE. Up to half of patients report dyspnea months after acute PE. The term post-PE syndrome was proposed as definition for all the manifestations after PE that cannot be associated to other causes. These symptomatic patients seem to have a higher morbidity and therefore to consume more healthcare resources. <bold>Objectives:</bold> The aim of this study is to analyses which are the preexisting conditions associated with a dyspnea after PE. <bold>Methods:</bold> This study is a post-hoc analysis on a large cohort of PE patients (n=508) followed with a dyspnea-based algorithm (INPUT study). We analyzed which baseline characteristics of these patients were significantly associated with a NYHA functional class ≥ II after an acute PE. <bold>Results:</bold> 19% of the patients in the cohort presented new dyspnea during the two years following an acute PE. Multivariate and univariate analysis showed that higher BMI (OR 1.08), female sex (OR 2.48) and CETPH were significantly associated with dyspnea. Age, smoking status, anticoagulation type, active cancer, cause of PE were not significantly associated with dyspnea. <bold>Conclusions:</bold> Dyspnea is a frequent complain after a PE. Pre-existing characteristics such BMI and female sex may play a role in its development. The comorbidities probably also play a relevant role in the development of a dyspnea after a PE. Further studies are needed to assess and help patient with persisting respiratory symptoms after PE.

Anaphylaxis is a serious systemic reaction by immediate hypersensitivity, secondary to the release of mediators active on vascular and bronchial muscles such as histamine, prostaglandins, leukotrienes etc. Exposure to an allergen in a sensitized patient

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For decades beta-blockers are a heterogenous group of drugs with diverse pharmacological properties, used in the treatment of high blood pressure. However, their benefit as therapy for hypertension without concomitant compelling indications is controversial. In this article we will discuss the concept of sympathetic overdrive and the theoretical rationale of the use of beta-blockers as antihypertensive drugs. The differences between beta-blockers' generations in terms of anti-hypertensive efficacy and side effects are discussed. Finally, we review the position of the last European guidelines published in 2023 about beta-blockers in the management of arterial hypertension.

AimsPulmonary hypertension (PH) is a complex clinical condition, and left heart disease is the leading cause. Little is known about the epidemiology and prognosis of combined post- and pre-capillary PH (CpcPH).Methods and resultsThis retrospective analysis of the Swiss PH Registry included incident patients with CpcPH registered from January 2001 to June 2019 at 13 Swiss hospitals. Patient baseline characteristics [age, sex, mean pulmonary artery pressure (mPAP), pulmonary artery wedge pressure (PAWP), pulmonary vascular resistance (PVR), and risk factors, including World Health Organization (WHO)-functional class (FC), 6 min walk distance (6MWD), and N-terminal pro-brain natriuretic peptide (NT-proBNP), treatment, days of follow-up, and events (death or loss to follow-up) at last visit] were analysed by Kaplan–Meier and Cox regression analyses. Two hundred and thirty-one patients (59.3% women, age 65 ± 12 years, mPAP 48 ± 11 mmHg, PAWP 21 ± 5 mmHg, PVR 7.2 ± 4.8 WU) were included. Survival analyses showed a significantly longer survival for women [hazard ratio (HR) 0.58 (0.38–0.89); P = 0.01] and a higher mortality risk for mPAP > 46 mmHg [HR 1.58 (1.03–2.43); P = 0.04] but no association with age or PVR. Patients stratified to high risk according to four-strata risk assessment had an increased mortality risk compared with patients stratified to low-intermediate risk [HR 2.44 (1.23–4.84); P = 0.01]. A total of 46.8% of CpcPH patients received PH-targeted pharmacotherapy; however, PH-targeted medication was not associated with longer survival.ConclusionAmong patients with CpcPH, women and patients with an mPAP ≤46 mmHg survived longer. Furthermore, risk stratification by using non-invasively assessed risk factors, such as WHO-FC, 6MWD, and NT-proBNP, as proposed for pulmonary arterial hypertension, stratified survival in CpcPH, and might be helpful in the management of these patients.