Environmental factors in autoimmune bullous diseases with focusing on seasonality: new insights

Autoimmune bullous diseases are a heterogeneous group of rare conditions clinically characterized by the presence of blisters and/or erosions on the skin and on the mucous membranes. Practically, they can be divided into two large groups: the pemphigoid group and the pemphigus group, depending on the depth of the autoimmune process on the skin. Family history of autoimmune disease can often be found, and demonstrating that genetic predisposition is crucial in the development of them. Moreover, numerous environmental risk factors, such as solar radiation, drugs and infections, are known. This study aimed to evaluate how seasonality can affect the trend of BP and PV, especially considering the number of hospitalizations recorded over the course of individual months. The total number of hospitalizations in the twelve months of the year was evaluated. Further, blood chemistry assay and, for some patients, enzyme-linked immunosorbent assay were executed in order to evaluate antibodies. Regarding the severity of the disease BPDAI (Bullous Pemphigoid Area Index) and PDAI (Pemphigus Disease Area Index), score systems were used. Results showed a complex interplay between environmental factors such as seasons and autoimmune conditions

Accuracy of the WatchBP office ABI device for office blood pressure measurement over a wide range of arm sizes

The aim of this study was to determine the accuracy of the WatchBP Office ABI monitor for office blood pressure measurement over a wide range of arm circumferences using the ANSI/AAMI/ISO 81060-2:2013 protocol. The device accuracy was tested in 88 participants whose mean\ub1SD age was 54.5\ub117.6 years, whose arm circumference was 30.6\ub18.3\u2009cm (range: 15-46\u2009cm), and whose entry blood pressure (BP) was 138.3\ub123.4\u2009mmHg for systolic and 83.7\ub114.6\u2009mmHg for diastolic BP. Four cuffs (small, standard, large, and extra-large) suitable for arm circumferences ranging from 14.0 to 52.0\u2009cm were used. The mean device-observer difference in the 264 separate BP data pairs was 0.7\ub13.8\u2009mmHg for systolic BP and was 0.0\ub13.7\u2009mmHg for diastolic BP. These data were in agreement with criterion 1 of the ANSI/AAMI/ISO 81060-2:2013 standard requirements ( 645\ub18\u2009mmHg). Moreover, criterion 2 was satisfied, the mean\ub1SD device-observer difference of the 88 participants being 0.7\ub13.1 and 0.0\ub13.2\u2009mmHg, respectively, for systolic and diastolic BP. Good agreement between observer and device was present across the whole range of arm circumferences. These data show that the Microlife WatchBP Office ABI monitor satisfied the ANSI/AAMI/ISO 81060-2:2013 standard requirements across a wide range of arm sizes

Validation of the A&D UM-211 device for office blood pressure measurement according to the European Society of Hypertension International Protocol revision 2010

The aim of this study was to define the accuracy of UM-211, an automated oscillometric device for office use coupled to several cuffs for different arm sizes, according to the International Protocol of the European Society of Hypertension. The validation was performed in 33 individuals. Their mean age was 59.6\ub112.9 years, systolic blood pressure (BP) was 144.3\ub121.5\u2009mmHg (range: 96-184\u2009mmHg), diastolic BP was 86.8\ub118.5\u2009mmHg (range: 48-124\u2009mmHg), and arm circumference was 30.2\ub14.3\u2009cm (range: 23-39\u2009cm). Four sequential readings were taken by observers 1 and 2 using a double-headed stethoscope and a mercury sphygmomanometer, whereas three BP readings were taken by the supervisor using the test instrument. The differences between the readings provided by the device and the mean observer measurements were calculated. Therefore, each device measurement was compared with the previous and the next mean observer measurement. The validation results fulfilled all the 2010 European Society of Hypertension revision Protocol criteria for the general population and passed all validation grades. On average, the device overestimated systolic BP by 1.7\ub12.4\u2009mmHg and diastolic BP by 1.7\ub12.5\u2009mmHg. These data show that the UM-211 device coupled to several cuffs for different ranges of arm circumference met the requirements for validation according to the International Protocol and can be recommended for clinical use in the adult population. However, these results mainly apply to the use of the 22-32 and the 31-45\u2009cm cuffs

Validation of the UEBE Visomat Double Comfort upper arm blood pressure monitor, in oscillometric mode, for clinic use and self-measurement in a general population according to the European Society of Hypertension International Protocol, revision 2010.

OBJECTIVE: To validate the UEBE Visomat Double Comfort, an upper arm blood pressure monitor designed for self-measurement of blood pressure and for clinical use in a general population according to the European Society of Hypertension International Protocol revision 2010. METHODS: The device is provided with two operational modalities, a microphonic mode and an oscillometric mode. In this study, the oscillometric modality was tested. Device evaluation was performed in 33 participants with a mean \ub1 standard deviation age of 56.3 \ub1 20.0 years (range, 25-85 years). Their systolic blood pressure was 140.4 \ub1 27.7 mmHg, diastolic blood pressure was 86.8 \ub1 17.2 mmHg, and arm circumference was 29.3 \ub1 3.9 cm. RESULTS: The protocol requirements were followed precisely. The device passed all of the requirements fulfilling the standards of the protocol. Mean blood pressure differences between device and observer were -0.9 \ub1 4.1 mmHg for systolic blood pressure and -0.1 \ub1 3.3 mmHg for diastolic blood pressure. CONCLUSION: As the Visomat Double Comfort in the oscillometric modality has achieved the required standards, it is recommended for clinical use in an adult population

Validation of the A&D UM-201 device for office blood pressure measurement according to the European Society of Hypertension International Protocol Revision 2010

The aim of this study was to determine the accuracy of the A&D UM-201 device coupled to several cuffs for different arm sizes for office blood pressure (BP) measurement according to the International Protocol of the European Society of Hypertension. Evaluation was carried out in 33 individuals. The mean age of the individuals was 59.3\ub113.2 years, systolic BP was 145.4\ub120.6\u2009mmHg (range: 109-186\u2009mmHg), diastolic BP was 87.3\ub118.0\u2009mmHg (range: 50-124\u2009mmHg), and arm circumference was 30.4\ub14.2\u2009cm (range: 23-39\u2009cm). The protocol requirements were followed precisely. The UM-201 monitor passed all requirements, fulfilling the standards of the protocol. On average, the device overestimated systolic BP by 3.0\ub12.1\u2009mmHg and diastolic BP by 2.6\ub12.0\u2009mmHg. These data show that the A&D UM-201 device coupled to several cuffs for different ranges of arm circumference fulfilled the requirements for validation by the International Protocol and can be recommended for clinical use in the adult population

Alteration of cholinergic system in keratinocytes cells produces acantholysis: a possible use of cholinergic drugs in pemphigus vulgaris

Human epidermis shows a non-neuronal cholinergic system including keratinocyte (kc) acetylcholine (Ach) axis which is composed by enzymes and two families of Ach receptors (muscarinic and nicotinic receptors). The activity of these two receptors can regulate the interkeratinocytes and kcs-extracellular matrix adhesion modifying the regulation of intercellular adhesion molecules like cadherins and integrins. Some authors demonstrate that acantholysis in pemphigus depends not only on anti desmogleins antibodies (abs) (mostly IgG) but even on other abs directed against kc membrane antigens (e.g. anti Ach receptors Abs). In the early phase of pemphigus pathogenesis, anti Ach receptors Abs block Ach signaling essential for cell shape and intercellular adhesion and increase the phosphorylation of adhesion molecules. Combined with the action of abs antidesmogleins, anti Ach receptors Abs cause the acantholytic phenomenon. In vitro experiments show that high doses of Ach in acantholytic kcs can rapidly reverse this pathologic event. In vivo experiments using neonatal mice model of Pemphigus have demonstrated that cholinergic agonists reduce these lesions. Therapy with pyridostigmine bromide and Nicotinamide per os or pilocarpine used topically, drugs that present cholinomimetic effects, has lead to encouraging results in patients affected by Pemphigus disease. Cholinergic agents could have a strategic role in the therapy of pemphigus since they could be responsible for the early stage of acantholytic diseases

Only troncoconical cuffs can provide accurate blood pressure measurements in people with severe obesity

Rectangular (cylindrical) cuffs and bladders are currently used for blood pressure (BP) measurement at the upper arm. However, large arms have a troncoconical shape, which make cylindrical cuffs potentially unsuitable. Aim of this study was to investigate the effect of the shape of the cuff on BP measurement in very obese participants