The impact of age on prevalence of positive skin prick tests and specific IgE tests

SummaryAging is associated with modifications of the immune system, defined as immunosenescence. This could contribute to a reduced prevalence of allergic disease in the elderly population. In this regard, atopy has rarely been considered in the clinical assessment of the geriatric respiratory patient. This article is a review of the available literature assessing the impact of age on atopy. In the majority of papers, we found a lower prevalence of atopy in the most advanced ages, both in healthy subjects and in individuals affected by allergic respiratory diseases. Unfortunately, no large, longitudinal studies performed in the general population have been conducted to further explore this observation. Although available data seem to favor the decline of allergen sensitization with age, the prevalence of allergic sensitizations in the elderly population with respiratory symptoms is substantial enough to warrant evaluation of the atopic condition. From a clinical perspective, allergic reactions in older adults can have the same or even worse manifestations compared to young people. For this reasons, the evaluation of the atopic condition also in the geriatric patient is recommended. Thus, the role of atopy as it pertains to the diagnosis, therapy (adoption of preventive measure such as removal of environmental allergen or immunotherapy), and prognosis (influence on morbidity and mortality) of chronic respiratory illnesses in the elderly is addressed

By promoting cell differentiation, miR-100 sensitizes basal-like breast cancer stem cells to hormonal therapy

Basal-like breast cancer is an aggressive tumor subtype with a poor response to conventional therapies. Tumor formation and relapse are sustained by a cell subset of Breast Cancer Stem Cells (BrCSCs). Here we show that miR-100 inhibits maintenance and expansion of BrCSCs in basal-like cancer through Polo-like kinase1 (Plk1) down-regulation. Moreover, miR-100 favors BrCSC differentiation, converting a basal like phenotype into luminal. It induces the expression of a functional estrogen receptor (ER) and renders basal-like BrCSCs responsive to hormonal therapy. The key role played by miR-100 in breast cancer free-survival is confirmed by the analysis of a cohort of patients' tumors, which shows that low expression of miR-100 is a negative prognostic factor and is associated with gene signatures of high grade undifferentiated tumors. Our findings indicate a new possible therapeutic strategy, which could make aggressive breast cancers responsive to standard treatments

Erratum: By promoting cell differentiation, miR-100 sensitizes basal-like breast cancer stem cells to hormonal therapy

This article has been corrected: Due to errors in image assembly, the flow cytometry profiles depicting the isotype matched control (IMC) for CD49f on both scramble (scr) and miR-100 reported in Figure 6 are incorrect. Additionally, we noticed that the IMC reported for CD24 and CD10 in miR-100 are the same. Being both CD24 allophycocianin (APC) and CD10 APC IgG1, they should have the same IMC, as already reported. The corrected Figure 6 is shown below. The authors declare that these corrections do not change the results or conclusions of this paper

The effect of borderline pulmonary hypertension on survival in chronic lung disease

Background: the impact of the new "borderline" hemodynamic class for pulmonary hypertension (PH) (mean pulmonary artery pressure [mPAP], 21-24 mm Hg and pulmonary vascular resistance, [PVR], ≥3 wood units, [WU]) in chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) is unclear. Objectives: the aim of this study was to assess the effect of borderline PH (BLPH) on survival in COPD and ILD patients. Method: survival was analyzed from retrospective data from 317 patients in 12 centers (Italy, Spain, UK) comparing four hemodynamic groups: the absence of PH (NoPH; mPAP <21 mm Hg or 21-24 mm Hg and PVR <3 WU), BLPH (mPAP 21-24 mm Hg and PVR ≥3 WU), mild-moderate PH (MPH; mPAP 25-35 mm Hg and cardiac index [CI] ≥2 L/min/m2), and severe PH (SPH; mPAP ≥35 mm Hg or mPAP ≥25 mm Hg and CI <2 L/min/m2). Results: BLPH affected 14% of patients; hemodynamic severity did not predict survival when COPD and ILD patients were analyzed together. However, survival in the ILD cohort for any PH level was worse than in NoPH (3-year survival: NoPH 58%, BLPH 32%, MPH 28%, SPH 33%, p = 0.002). In the COPD cohort, only SPH had reduced survival compared to the other groups (3-year survival: NoPH 82%, BLPH 86%, MPH 87%, SPH 57%, p = 0.005). The mortality risk correlated significantly with mPAP in ILD (hazard ratio [HR]: 2.776, 95% CI: 2.057-3.748, p < 0.001) and notably less in COPD patients (HR: 1.015, 95% CI: 1.003-1.027, p = 0.0146). Conclusions: in ILD, any level of PH portends worse survival, while in COPD, only SPH presents a worse outcome

Sildenafil in severe pulmonary hypertension associated with chronic obstructive pulmonary disease: A randomized controlled multicenter clinical trial

Background Pulmonary hypertension (PH) is a well-known independent prognostic factor in chronic obstructive pulmonary disease (COPD) and a sufficient criterion for lung transplant candidacy. Limited data are currently available on the hemodynamic and clinical effect of phosphodiesterase 5 inhibitors in patients with severe PH associated with COPD. This study assessed the effect of sildenafil on pulmonary hemodynamics and gas exchange in severe PH associated with COPD. Methods After screening, this multicenter, randomized, placebo-controlled double-blind trial randomized patients to receive 20 mg sildenafil or placebo 3 times a day (ratio 2:1) for 16 weeks. The primary end point was the reduction in pulmonary vascular resistance. Secondary end points included BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index, 6-minute walk test, and quality of life questionnaire. Changes in the partial pressure of arterial oxygen were evaluated as a safety parameter. Results The final population included 28 patients, 18 in the sildenafil group and 10 in the placebo group. At 16 week, patients treated with sildenafil had a decrease in pulmonary vascular resistance (mean difference with placebo –1.4 WU; 95% confidence interval, ≤ –0.05; p = 0.04). Sildenafil also improved the BODE index, diffusion capacity of the lung for carbon monoxide percentage, and quality of life. Change from baseline in the partial pressure of arterial oxygen was not significantly different between the sildenafil and placebo groups. Conclusions This pilot study found that treatment with sildenafil reduced pulmonary vascular resistance and improved the BODE index and quality of life, without a significant effect on gas exchange

Turismo, territorio, identit\ue0. Ricerche ed esperienze nell'area mediterranea

Tutta una serie di fattori hanno portato alla formazione di un mercato turistico globale, che viene ad offrirsi con i suoi modelli standardizzati (forme organizzative, modalit\ue0 di insediamento, comportamenti) ai turisti di tutto il mondo. Le differenze tra i luoghi, che costituiscono uno dei pi\uf9 importanti fondamenti della motivazione turistica, vengono cos\uec esposte al rischio di venire ridotte, mascherate o anche del tutto cancellate dalla diffusione dei modelli dominanti. La difesa del patrimonio naturale e culturale di ogni specifica regione e la sua valorizzazione quale segno dell'identit\ue0 locale vengono rese pi\uf9 difficili, ma al tempo stesso diventano pi\uf9 importanti, sia per i fruitori esterni, che per quelli interni. Il presente volume affronta questo problema e raccoglie studi su numerose localit\ue0 e regioni turistiche dell'area mediterranea, documentando esperienze e processi in atto finalizzati a cogliere le opportunit\ue0 che si offrono oggi alla valorizzazione delle risorse pi\uf9 specifiche di ogni luogo. Particolare attenzione viene riservata ai processi di aggregazione imprenditoriale e territoriale che si propongono di utilizzare proprio la specificit\ue0 dell'offerta locale per penetrare pi\uf9 efficacemente le grandi reti infrastrutturali della dimensione globale

Real world experience with teriflunomide in multiple sclerosis: the TER-Italy study

Objective To identify baseline factors associated with disease activity in patients with relapsing-remitting multiple sclerosis (RRMS) under teriflunomide treatment.Methods This was an independent, multi-centre, retrospective post-marketing study. We analysed data of 1,507 patients who started teriflunomide since October 2014 and were regularly followed in 28 Centres in Italy. We reported the proportions of patients who discontinued treatment (after excluding 32 lost to follow-up) and who experienced clinical disease activity, i.e., relapse(s) and/or confirmed disability worsening, as assessed by the Expanded Disability Status Scale (EDSS). Decision tree-based analysis was performed to identify baseline factors associated with clinical disease activity during teriflunomide treatment.Results At database lock (September 2020), approximately 29% of patients (430 out of 1,475) discontinued teriflunomide because of disease activity (similar to 46%), adverse events (similar to 37%), poor tolerability (similar to 15%), pregnancy planning (similar to 2%). Approximately 28% of patients experienced disease activity over a median follow-up of 2.75 years: similar to 9% had relapses but not disability worsening; similar to 13% had isolated disability worsening; similar to 6% had both relapses and disability worsening. The most important baseline factor associated with disease activity (especially disability worsening) was an EDSS &gt; 4.0 (p &lt; 0.001). In patients with moderate disability level (EDSS 2.0-4.0), disease activity occurred more frequently in case of &gt;= 1 pre-treatment relapses (p = 0.025). In patients with milder disability level (EDSS &lt; 2.0), disease activity occurred more frequently after previous exposure to &gt;= 2 disease-modifying treatments (p = 0.007).Conclusions Our study suggests a place-in-therapy for teriflunomide in naive patients with mild disability level or in those who switched their initial treatment for poor tolerability. Adverse events related with teriflunomide were consistent with literature data, without any new safety concern