One of the most important abilities of a tumor is to establish a state of immunosuppression inside the tumor microenvironment. This is made possible through numerous mechanisms of tumor immune escape that have been identified in experimental studies during the last decades. In addition, the hepatic microenvironment is commonly oriented towards a state of immune tolerance because the liver receives blood from the hepatic arteries and portal veins containing a variety of endogenous antigens. Therefore, the hepatic microenvironment establishes an autoimmune tolerance, preventing an autoimmune reaction in the liver. On this basis, hepatic tumor cells may escape the immune system, avoiding being recognized and destroyed by immune cells. Moreover, since the etiology of Hepatocellular Carcinoma (HCC) is often related to cirrhosis, and hepatitis B or C, this tumor develops in the context of chronic inflammation. Thus, the HCC microenvironment is characterized by important immune cell infiltration. Given these data and the poor prognosis of advanced HCC, different immunotherapeutic strategies have been developed and evaluated for these patients. In this review, we describe all the clinical applications of immunotherapy for advanced HCC, from the drugs that have already been approved to the ongoing clinical trials.

Rationale:According to scientific literature, cryoablation (CA) and electrochemotherapy (ECT) have been used for the treatment of small renal masses. However, no data have been published regarding the combination of these techniques as therapy of primary kidney cancers. Therefore, we report the case of an old woman affected by localized kidney cancer and discuss the potential therapeutic application of CA combined with subsequent deep ECT in this setting.Patient concerns:An 85 years-old-woman was evaluated because of a localized kidney cancer. Her background history included long-time hypertension and diabetes mellitus in drug treatment.Diagnoses:In February 2018, the follow-up contrast enhancement computed tomography (ceCT) documented a suspected 18×10 mm metastasis at the lower right lobe of the lung. The ceCT also showed a suspected primary malignancy of 25×18 mm at right kidney.Interventions:The kidney cancer was treated with a two-phase procedure: percutaneous CA and subsequent deep ECT.Outcomes:Patient obtained a complete response according to modified Response Evaluation Criteria in Solid Tumors, without renal function or quality of life impairment. No procedure-related complications were observed. Moreover, a shorter period of hospitalization and convalescence were needed respect to standard surgery. No sign of relapse was observed during follow-up period.Lessons:This combined strategy proved to be safe and effective. Moreover, the application of these blended loco-regional techniques showed several other advantages such as reduced hospitalization and a shorter period of convalescence respect to standard surgery.

This scoping review aims to check the existing international literature related to the placement and management of central venous catheters (CVCs) in adults and compare them with the Good Practices published by the Italian Society of anesthesiology intensive care (hereafter “SIAARTI Good Practices”) and the protocols written by the Italian Expert group on long-term central venous accesses (hereafter “GAVeCeLT Protocols”) and verify the existence of experiences focused on the daily assessment of the implantation site and on educational interventions on awake patients or caregivers to enhance their empowerment. A systematic search approach has been applied. Our composite research question has been primarily defined by the PICO: only patients over 18 years of age with CVC for any clinical reason except for kidney replacement therapy; placement and management of CVCs with procedures recommended by the recent international guidelines/bundles and specific educational interventions are the interventions to be compared with standard CVC placement and management without any educational interventions. In total, two different types of outcomes have been taken into consideration: catheter-related complications rate (A) and patient/caregiver involvement (B). Eligible articles have been limited to Systematic Review OR Meta-analysis OR Guidelines in Human field, focusing on adults, English language only, from January 2015 to December 2020. Searched Medical Subject Headings (MeSHs) Terms were “venous” AND “catheters,” and the correspondence with the designed PICO framework was then checked directly by the authors. A comprehensive search was conducted by two reviewers on 15 February 2021 in four databases, and 32 full-text articles were finally included and qualitatively assessed. The included articles appear to be in line with the indications provided by the available Italian Good Practices and explain the complexity of this procedure. The need to promote the use of bundles and checklists related to CVC placement and dressing procedures comes to light. These organizational technologies can be implemented following the creation of teams dedicated to venous access that are subjected to continuous training. As regards the impact of educational initiatives, implementing paths of health education and proper hospital discharge preparation for both healthcare workers and families increases safety for the patient with CVC.