Plaque-Type Psoriasis Treated with Calcipotriene Plus Betamethasone Dipropionate Aerosol Foam: A Prospective Study on Clinical and Dermoscopic Predictor Factors in Response Achievement and Retention

Introduction: Little information on possible local factors that can influence the achievement and retention of response of plaque-type psoriasis to calcipotriene plus betamethasone dipropionate aerosol foam is available. The aim of this study was to assess possible correlations between baseline clinical/dermoscopic features of psoriatic plaques and therapeutic response, and between residual dermoscopic findings in clinically improved/healed lesions and post-treatment relapse. Methods: For each target lesion, we calculated the local psoriasis severity index and assessed dermoscopic findings at baseline and at the end of a 4-week treatment, correlating the therapeutic outcome with the initial clinical and dermoscopic features. The lesions were also followed for a 4-week post-treatment period, and possible associations between relapse and (1) baseline clinical/dermoscopic features and (2) dermoscopic findings detected at the end of the treatment were assessed. Results: A total of 105 lesions from 35 patients were included in the analysis. After 4\ua0weeks of therapy, 13 lesions showed no/limited improvement, while partial and optimal response were observed in 51 and 41 plaques, respectively. Poor outcomes were correlated with both legs localization\ua0and degree of lesion infiltration at baseline. Similarly, presence of globular vessels at baseline dermoscopy was more commonly associated with no/limited response and lesions on the legs, particularly those showing resistance to treatment. A correlation was also found between dotted vessels on the baseline dermoscopic examination and good outcomes (partial/optimal response). After a 4-week post-treatment follow-up, 58.7% of the lesions achieving improvement at the end of the therapy showed relapse, with a correlation between recurrence and vessel persistence\ua0on dermoscopy at the end of the therapy. Conclusion: Clinical response of plaque-type psoriasis to calcipotriol/betamethasone dipropionate spray foam may be adversely affected by the degree of infiltration of lesions at baseline and by legs\ua0localization, and the presence of globular vessels at the baseline dermoscopic assessment is related to poor outcomes. A significant post-treatment relapse rate was observed, and persistence of vascular changes on dermoscopy seems to play a role in promoting disease recurrence

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Increased C-reactive protein concentration and suicidal behavior in people with psychiatric disorders: A systematic review and meta-analysis

Objective: Suicide is a leading cause of death worldwide. Identifying factors associated with suicidality (suicidal ideation [SI]/suicidal behavior) could increase our understanding of the pathophysiological underpinnings of suicide and improve its prevention. Methods: We conducted a systematic review (PubMed/PsycInfo/Cochrane databases, up to September 2020) and random-effect meta-analysis including observational studies comparing peripheral C-reactive protein (CRP) levels in suicidal versus non-suicidal patients affected by any psychiatric disorder and healthy controls (HC). Primary outcome was the CRP standardized mean difference (SMD) between patients with high suicidality versus those with absent or low suicidality. Secondary outcomes were SMD of CRP levels between those with suicide attempt versus no suicide attempt, as well as between those with (high) versus low or absent SI. Quality of included studies was measured with Newcastle-Ottawa scale. Results: Out of initial 550 references, 21 observational studies involving 7682 subjects (7445 with mood disorders or first-episode psychosis, 237 HC) were included. A significant association of CRP levels with suicidality (SMD 0.688, 95% CI 0.476–0.9, p < 0.001) emerged. CRP levels were higher in individuals with high SI (SMD 1.145, 95% CI 0.273–2.018, p = 0.010) and in those with suicide attempt (SMD 0.549, 95%CI 0.363–0.735, p < 0.001) than non-suicidal individuals (either patients or HC). Main analyses were confirmed in sensitivity analysis (removing HC), and after adjusting for publication bias. The cross-sectional design of included studies, and the high heterogeneity of diagnosis and treatment limit the generalizability of these results. Median quality of included studies was high. Conclusion: CRP is associated with higher suicidality in patients with mental disorders. Large cohort studies longitudinally monitoring CRP levels are needed to explore its longitudinal association with suicidality

How can we improve antidepressant adherence in the management of depression? A targeted review and 10 clinical recommendations.

Adherence to antidepressants is crucial for optimal treatment outcomes when treating depressive disorders. However, poor adherence is common among patients prescribed antidepressants. This targeted review summarizes the main factors associated with poor adherence, interventions that promote antidepressant adherence, pharmacological aspects related to antidepressant adherence, and formulates 10 clinical recommendations to optimize antidepressant adherence. Patient-related factors associated with antidepressant non-adherence include younger age, psychiatric and medical comorbidities, cognitive impairment, and substance use disorders. Prescriber behavior-related factors include neglecting medical and family histories, selecting poorly tolerated antidepressants, or complex antidepressant regimens. Multi-disciplinary interventions targeting both patient and prescriber, aimed at improving antidepressant adherence, include psychoeducation and providing the patient with clear behavioral interventions to prevent/minimize poor adherence. Regarding antidepressant choice, agents with individually tailored tolerability profile should be chosen. Ten clinical recommendations include four points focusing on the patient (therapeutic alliance, adequate history taking, measurement of depressive symptoms, and adverse effects improved access to clinical care), three focusing on prescribing practice (psychoeducation, individually tailored antidepressant choice, simplified regimen), two focusing on mental health services (improved access to mental health care, incentivized adherence promotion and monitoring), and one relating to adherence measurement (adherence measurement with scales and/or therapeutic drug monitoring)

Evaluation of kinetic phosphorescence analysis for the determination of uranium

In the past, New Brunswick Laboratory (NBL) has used a fluorometric method for the determination of sub-microgram quantities of uranium. In its continuing effort to upgrade and improve measurement technology, NBL has evaluated the commercially-available KPA-11 kinetic phosphorescence analyzer (Chemchek, Richland, WA). The Chemchek KPA-11 is a bench-top instrument which performs single-measurement, quench-corrected analyses for trace uranium. It incorporates patented kinetic phosphorimetry techniques to measure and analyze sample phosphorescence as a function of time. With laser excitation and time-corrected photon counting, the KPA-11 has a lower detection limit than conventional fluorometric methods. Operated with a personal computer, the state-of-the-art KPA-11 offers extensive time resolution and phosphorescence lifetime capabilities for additional specificity. Interferences are thereby avoided while obtaining precise measurements. Routine analyses can be easily and effectively accomplished, with the accuracy and precision equivalent to the pulsed-laser fluorometric method presently performed at NBL, without the need for internal standards. Applications of kinetic phosphorimetry at NBL include the measurement of trace level uranium in retention tank, waste samples, and low-level samples. It has also been used to support other experimental activities at NBL by the measuring of nanogram amounts of uranium contamination (in blanks) in isotopic sample preparations, and the determining of elution curves of different ion exchange resins used for uranium purification. In many cases, no pretreatment of samples was necessary except to fume them with nitric acid, and then to redissolve and dilute them to an appropriate concentration with 1 M HNO{sub 3} before measurement. Concentrations were determined on a mass basis ({micro}g U/g of solution), but no density corrections were needed since all the samples (including the samples used for calibration) were in the same density matrix (1 M HNO{sub 3}). A statistical evaluation of the determination of uranium using kinetic phosphorimetry is described in this report, along with a discussion of the method, and an evaluation of the use of plastic versus quartz cuvettes. Measurement with a precision of {+-} 3--4% relative standard deviation (RSD) and an accuracy of better than {+-} 2% relative difference (RD) are obtained in the 0.0006 to 5 {micro}g U/g-solution range. The instrument detection limit is 0.04 ppb (4 x 10{sup {minus}5} {micro}g U/g solution) using quartz cells, and 0.11 ppb (11 x 10{sup {minus}5} {micro}g U/g solution) using disposable methacrylate cuvettes

Balancing risks and benefits of cannabis use: umbrella review of meta-analyses of randomised controlled trials and observational studies

Objective: To systematically assess credibility and certainty of associations between cannabis, cannabinoids, and cannabis based medicines and human health, from observational studies and randomised controlled trials (RCTs). Design: Umbrella review. Data Sources: PubMed, PsychInfo, Embase, up to 9 February 2022. Eligibility criteria for selecting studies: Systematic reviews with meta-analyses of observational studies and RCTs that have reported on the efficacy and safety of cannabis, cannabinoids, or cannabis based medicines were included. Credibility was graded according to convincing, highly suggestive, suggestive, weak, or not significant (observational evidence), and by GRADE (Grading of Recommendations, Assessment, Development and Evaluations) (RCTs). Quality was assessed with AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews 2). Sensitivity analyses were conducted. Results: 101 meta-analyses were included (observational=50, RCTs=51) (AMSTAR 2 high 33, moderate 31, low 32, or critically low 5). From RCTs supported by high to moderate certainty, cannabis based medicines increased adverse events related to the central nervous system (equivalent odds ratio 2.84 (95% confidence interval 2.16 to 3.73)), psychological effects (3.07 (1.79 to 5.26)), and vision (3.00 (1.79 to 5.03)) in people with mixed conditions (GRADE=high), improved nausea/vomit, pain, spasticity, but increased psychiatric, gastrointestinal adverse event, and somnolence among others (GRADE=moderate). Cannabidiol improved 50% reduction of seizures (0.59 (0.38 to 0.92)) and seizure events (0.59 (0.36 to 0.96)) (GRADE=high), but increased pneumonia, gastrointestinal adverse events, and somnolence (GRADE=moderate). For chronic pain, cannabis based medicines or cannabinoids reduced pain by 30% (0.59 (0.37 to 0.93), GRADE=high), across different conditions (n=7), but increased psychological distress. For epilepsy, cannabidiol increased risk of diarrhoea (2.25 (1.33 to 3.81)), had no effect on sleep disruption (GRADE=high), reduced seizures across different populations and measures (n=7), improved global impression (n=2), quality of life, and increased risk of somnolence (GRADE=moderate). In the general population, cannabis worsened positive psychotic symptoms (5.21 (3.36 to 8.01)) and total psychiatric symptoms (7.49 (5.31 to 10.42)) (GRADE=high), negative psychotic symptoms, and cognition (n=11) (GRADE=moderate). In healthy people, cannabinoids improved pain threshold (0.74 (0.59 to 0.91)), unpleasantness (0.60 (0.41 to 0.88)) (GRADE=high). For inflammatory bowel disease, cannabinoids improved quality of life (0.34 (0.22 to 0.53) (GRADE=high). For multiple sclerosis, cannabinoids improved spasticity, pain, but increased risk of dizziness, dry mouth, nausea, somnolence (GRADE=moderate). For cancer, cannabinoids improved sleep disruption, but had gastrointestinal adverse events (n=2) (GRADE=moderate). Cannabis based medicines, cannabis, and cannabinoids resulted in poor tolerability across various conditions (GRADE=moderate). Evidence was convincing from observational studies (main and sensitivity analyses); in pregnant women, small for gestational age (1.61 (1.41 to 1.83)), low birth weight (1.43 (1.27 to 1.62)); in drivers, car crash (1.27 (1.21 to 1.34)); and in the general population, psychosis (1.71 (1.47 to 2.00)). Harmful effects were noted for additional neonatal outcomes, outcomes related to car crash, outcomes in the general population including psychotic symptoms, suicide attempt, depression, and mania, and impaired cognition in healthy cannabis users (all suggestive to highly suggestive). Conclusions: Convincing or converging evidence supports avoidance of cannabis during adolescence and early adulthood, in people prone to or with mental health disorders, in pregnancy and before and while driving. Cannabidiol is effective in people with epilepsy. Cannabis based medicines are effective in people with multiple sclerosis, chronic pain, inflammatory bowel disease, and in palliative medicine, but not without adverse events

Frictional behavior of steel-PTFE interfaces for seismic isolation

The widespread use of sliding bearings for the seismic isolation of structures requires detailed knowledge of their behavior and improved modeling capability under seismic conditions. The paper summarizes the results of a large experimental investigation on steel–PTFE interfaces, aimed at evaluating the effects of sliding velocity, contact pressure, air temperature and state of lubrication on the mechanical behavior of steel-PTFE sliding bearings. Based on the experimental outcomes, two different mathematical models have been calibrated, which are capable of accounting for the investigated parameters in the evaluation of the sliding friction coefficient. The first model is basically an extension of the model proposed by Constantinou et al. (1990) Journal of Earthquake Engineering, 116(2), 455–472, while the second model is derived from the one proposed by Chang et al. (1990) Journal of Engineering Mechanics, 116, 2749–2763. Expressions of the model parameters as a function of bearing pressure and air temperature are presented for lubricated and non-lubricated sliding surfaces. Predicted and experimental results are finally compared

Therapeutic management of classic lichen planopilaris: a systematic review

Enzo Errichetti, Matteo Figini, Margherita Croatto, Giuseppe Stinco Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy Abstract: Several treatment strategies have been proposed in classic lichen planopilaris (LPP), although no gold standard therapeutic approach has been recognized so far due to the variable and, sometimes, contradictory results reported in the literature, as well as due to the lack of guidelines and randomized controlled trials. In the present review, we sought to provide an updated overview on the treatment of classic LPP by analyzing the level of evidence of published studies, also proposing a possible therapeutic strategy according to the findings highlighted in this systematic review. Keywords: lichen planopilaris, management, therapy, treatmen