The role of sentinel node tumor burden in modeling the prognosis of melanoma patients with positive sentinel node biopsy: an Italian melanoma intergroup study (N = 2,086)

Background The management of melanoma patients with metastatic melanoma in the sentinel nodes (SN) is evolving based on the results of trials questioning the impact of completion lymph node dissection (CLND) and demonstrating the efficacy of new adjuvant treatments. In this landscape, new prognostic tools for fine risk stratification are eagerly sought to optimize the therapeutic path of these patients. Methods A retrospective cohort of 2,086 patients treated with CLND after a positive SN biopsy in thirteen Italian Melanoma Centers was reviewed. Overall survival (OS) was the outcome of interest; included independent variables were the following: age, gender, primary melanoma site, Breslow thickness, ulceration, sentinel node tumor burden (SNTB), number of positive SN, non-sentinel lymph nodes (NSN) status. Univariate and multivariate survival analyses were performed using the Cox proportional hazard regression model. Results The 3-year, 5-year and 10-year OS rates were 79%, 70% and 54%, respectively. At univariate analysis, all variables, except for primary melanoma body site, were found to be statistically significant prognostic factors. Multivariate Cox regression analysis indicated that older age (P < 0.0001), male gender (P = 0.04), increasing Breslow thickness (P < 0.0001), presence of ulceration (P = 0.004), SNTB size (P < 0.0001) and metastatic NSN (P < 0.0001) were independent negative predictors of OS. Conclusion The above results were utilized to build a nomogram in order to ease the practical implementation of our prognostic model, which might improve treatment personalization

Forecasting Bond Risk Premia Using Technical Analysis

This paper is selected as one of the Top Ten Paper in Forecasting in SSRN

PRINCIPIO DI PRECAUZIONE E RESPONSABILITÀ CIVILE - UN'ANALISI DI DIRITTO COMPARATO

The main objective of the thesis is to check the incidence of the precautionary principle on the regulatory framework of European and American systems, and this both in an \u201cex ante\u201d perspective of protection (i.e. at the regulatory level), and in an \u201cex post\u201d one (i.e. in terms of civil liability), in order to assess if it could be cited for compensatory purposes. In particular, the thesis is divided into four chapters, in which are progressively examined, on the one hand, the definitory issues of the precautionary principle and the welcome it received in the various jurisdictions, on the other, in which areas this principle found main application, and, above all, if this application encountered uniform rules; then it moves on to examine which are the models of risk regulation adopted by various jurisdictions, if these are precautionary oriented and if there are conflicts of jurisdiction (positive or negative) with regard to the preparation, management and application of precautionary rules; finally, it addresses the issue of the compatibility or not of the precautionary principle with civil liability, considering, on the one hand, the procedures by which is possible to complain a violation of precautionary rules that implied a risk of damage or possible future damages, secondly, whether it should be recognized a non-traditional \u201cTort for Risk", and if it would be compatible or not with the current architecture of civil liability rules

Chronic urticaria. I

n

Different role of secretory IgA in the pathogenesis of RAST-positive and RAST-negative atopic dermatitis.

Secretory-IgA (SIgA) concentrations were determined in whole saliva, unstimulated or stimulated by lemon juice, of thirty-eight children with atopic dermatitis, which comprised three adolescents, sixteen with IgE detected by RAST to one or more common allergen and twenty-two without specific IgE by RAST. There were thirty healthy controls matched for age and sex. The mean amount of total IgE was significantly greater in the RAST-positive than in the RAST-negative group. The mean SIgA concentration in unstimulated saliva of the RAST-positive atopic dermatitis group was less than that of the RAST-negative atopic dermatitis group and control groups, through the mean concentrations of SIgA of stimulated saliva were not significantly different in the three groups. It is suggested that the pathogenesis of atopic dermatitis may differ in children with or without specific-IgE antibodies; in those who were RAST-positive deficient exclusion of allergen by the intestinal barrier contributed to the pathogenesis, but not in those who were RAST-negative

Scleredema of Buschke after upper respiratory tract infection. A case report

Scleredema of Buschke (SB) is a rare condition characterised by a diffuse, symmetrical, non-pitting induration of the skin usually affecting the neck, shoulders, trunk, face and arms. Following the classification of Graff (1968), SB can be classified in: 1) self-limiting SB following acute infection; 2) chronic and non-progressive SB, associated with tumors (myeloma, paraproteinaemia, insulinoma) or endocrine disease (hyperparathyroidism); 3) SB with chronic progression, associated with diabetes. Differential diagnose as to be done with sclerodermia, localized and generalized morphea, cutaneous mucinosis, pseudoscleroderma, localized scleromixedema, trichinosis and subcutaneous fat necrosis. We describe a 68 years old patient, non diabetic, who developed induration of the skin involved thorax, neck, arms and face three weeks after a pharyngitis due to Staphylococcus β-haemoliticus. The infection was treated with amoxicilline 2g/day for 12 days. Laboraory data were negative as instrumental examination. Histopathology and direct immunofluorescence were performed on a skin specimen taken from the neck; direct immunofluorescence was negative while the histology disclosed a typical pattern of SB with sclerosis of derma and deposition of mucin between the collagen bundles. The patient was treated with prednisone 25 mg on every other day for 45 days with resolution of the scleredema. Two weeks after the therapy the patient presented again progressive induration of the skin at the same areas. Laboratory data and instrumental examination were negative and in about three weeks he presented a spontaneous and progressive regression of the skin involvement. Considering the absence of diabetes or other diseases described in association with SB, and the history of a previous acute infection, we concluded with a diagnose of SB type 1 (Graff, 1968). Many hypothesis were proposed about the pathogenesis of SB considering the relationship whit the associated disease; considering the literature, an hypothesis about the pathogenetic role of immunoglobulines in acute infection is proposed

Keratoacanthoma in vitiligo lesion after UVB narrowband phototherapy.

The treatment of vitiligo is still a challenge. Among various therapeutic modalities, phototherapy with UVB narrowband (UVB-NB) is presently considered a treatment of choice for this skin disease. The exact skin cancer risk deriving from UVB-NB is a serious concern to be determined. We report a case of keratoacanthoma developed in the vitiligo area during a prolonged course of UVB-NB therapy