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Key Clinical Message There is no consensus regarding the therapeutic approach of breast neuroendocrine carcinomas (NECs). As most NECs are hormone receptor positive and HER‐2 negative, we suggest that endocrine‐based strategies may play a leading role. Here, we report a new treatment strategy by incorporating CDK4/6 inhibitors in the therapeutic armamentarium. Abstract Primary neuroendocrine neoplasms of the breast constitute a rare entity. They are characterized by predominant neuroendocrine differentiation and are further divided into well‐differentiated neuroendocrine tumors and poorly differentiated (high‐grade) neuroendocrine carcinomas (NECs). Regarding their therapeutic approach, there are no standardized guidelines. Herein, we present the first case ever reported, concerning a female patient with de novo metastatic breast NEC who received hormonal therapy, a combination of a CDK4/6 inhibitor palbociclib with letrozole and triptorelin, as first‐line treatment with significant clinical and radiological response. As most NECs are estrogen receptor and/or progesterone receptor positive and HER‐2 negative, we suggest that hormonal therapy may play a leading role even in the first‐line setting. The present report provides a new treatment strategy by incorporating CDK4/6 inhibitors in the therapeutic armamentarium of breast NECs.

Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory condition that often goes undiagnosed despite the availability of spirometry for diagnosis, and its exact prevalence remains uncertain. Exhaled breath has been proposed as a source of relevant health information, particularly Volatile Organic Compounds (VOCs), which can be easily obtained and applied in clinical practice. In this study, exhaled breath samples were collected from patients diagnosed with COPD of varying severity during their stable condition using specialized RTubeVOC tubes. Volatile compounds from the air samples were extracted using a 50/30 µm divinylbenzene/carboxen/polydimethylsiloxane (DVB/CAR/PDMS) fiber and the analysis was performed using gas chromatography/mass spectrometry (GC/MS) technique. The patients were divided into two groups based on their history of exacerbations, and the aim was to identify VOCs associated with the risk of future COPD exacerbation, thus allowing for more personalized and objective COPD treatment. Blood eosinophil content was also taken into consideration. A panel of distinguishing mass-spectral features was identified between the two patient groups. The discriminating exhaled molecules were heptane 2,2,4,6,6-pentamethyl, gamma-terpinene, 2-ethylhexanol, and undecane demonstrating the potential of analyzing VOCs in exhaled breath for the detection and management of COPD, offering a promising avenue to improve COPD management and treatment approaches.

Background: Uric acid (UA) is the final product of purine metabolism and a marker of oxidative stress that may be involved in the pathophysiology of cardiovascular and thromboembolic disease. The aim of the current study is to investigate the potential value of UA to creatinine ratio (UA/Cr) as a diagnostic tool for the outcome of patients admitted with acute pulmonary embolism (PE) and the correlations with other parameters. Methods: We evaluated 116 patients who were admitted for PE in a respiratory medicine department. PE was confirmed with computed tomography pulmonary angiography. Outcomes evaluated were hospitalization duration, mortality or thrombolysis and a composite endpoint (defined as mortality or thrombolysis). Patients were assessed for PE severity with the PE Severity Index (PESI) and the European Society of Cardiology (ESC) 2019 risk stratification. Results: The median (interquartile range) UA/Cr level was 7.59 (6.3–9.3). UA/Cr was significantly associated with PESI (p < 0.001), simplified PESI (p = 0.019), and ESC 2019 risk stratification (p < 0.001). The area under the curve (AUC) for prediction of 30-day mortality by UA/Cr was 0.793 (95% CI: 0.667–0.918). UA/Cr levels ≥7.64 showed 87% specificity and 94% negative predictive value for mortality. In multivariable analysis UA/Cr was an independent predictor of mortality (HR (95% CI): 1.620 (1.245–2.108), p < 0.001) and composite outcome (HR (95% CI): 1.521 (1.211–1.908), p < 0.001). Patients with elevated UA/Cr levels (≥7.64) had longer hospitalization (median (IQR) 7 (5–11) vs. 6 (5–8) days, p = 0.006)), higher mortality (27.3% vs. 3.2%, p = 0.001) and worse composite endpoint (32.7% vs. 3.4%, p < 0.001). Conclusion: Serum UA/Cr ratio levels at the time of PE diagnosis are associated with disease severity and risk stratification, and may be a useful biomarker for the identification of patients at risk of adverse outcomes.