Quality of life and psychological impact in patients with atopic dermatitis

Atopic dermatitis (AD) is a dermatological disorder that affects patients' mental health and psychological state in complex ways. The importance of understanding the entire scope of this burden is well recognized, but there is limited comprehensive information about the resulting stress on adult patients with AD. This study aimed to determine the degree of psychological stress in patients with AD compared to healthy participants. A total of 352 adult patients participated in this cross-sectional study-174 with AD and 178 healthy participants. Demographic and clinical data were collected. Itch and sleep disturbance were assessed using a numeric rating scale and a visual analogue scale. The 20-item Toronto Alexithymia Scale (TAS-20) and Beck Depression Inventory (BDI) questionnaires were administered to assess the symptoms of alexithymia and depression. Quality of life (QOL) was assessed in AD patients using the Dermatology Quality Index. In our study, we found high TAS-20 and BDI scores among patients with AD. The prevalence of alexithymic personality features was 56.3% in patients with AD versus 21.3% in healthy controls (p < 0.001). Based on BDI scoring (BDI-21 > 13), depression was suspected in a significantly higher number of patients with AD than in the control group (56.9% (99/174) vs. 15.7% (28/178); p < 0.0001). Eczema Area and Severity Index (EASI) score did not show any significant correlations with psychological parameters. Among clinical parameters, only sleep disturbance was positively correlated with depression (R = 0.307, p < 0.005). Our data show that the severity index score as a representative factor of skin involvement has a limited role in predicting the effect of skin diseases on mental status. Screening and assessment for psychiatric disorders, QOL, and sleep disturbance in patients with atopic dermatitis cannot be neglected by physicians and they should be treated in clinical practice with the consideration of psychosomatic approaches

Guselkumab for treatment of moderate-to-severe plaque psoriasis: real-life effectiveness and drug-survival for up to 148 weeks

Background: Real-world data are useful to guide the management of psoriasis. Here, we present data on the effectiveness and survival of guselkumab in moderate-to-severe chronic plaque psoriasis for up to 148 weeks. Research design and methods: Cross-sectional study of 122 patients receiving guselkumab (100 mg at weeks 0 and 4, and then every 8 weeks thereafter) for>12 weeks, from November 2018 to April 2022. Main outcome measures: Clinical features and drug survival were analyzed up to 148 weeks. Results: Obese patients (32.8%) and those receiving prior biologics (64.8%) were included. Guselkumab treatment was associated with a rapid decrease in PASI, from 16.2 to 3.2 at week 12, and long-term improvements in all subgroups (97.6%, 82.9%, and 63.4% of patients, respectively, achieved PASI 75, 90, and 100 after 148 weeks). More non-obese than obese patients achieved PASI 100 at week 148 (86.4% vs 38.9%), as did bio-naïve vs bio-experienced patients (86.7% vs 50.0%). Previous biologic therapy was a negative prognostic factor for achieving PASI 100 over the long-term by multivariate analysis (p = 0.005). Overall, 96% of patients were on treatment after 2 years. Conclusions: Real-world data confirm the long-term effectiveness of guselkumab in patients with psoriasis

Long-term ustekinumab therapy of psoriasis in patients with coexisting rheumatoid arthritis and Sjögren syndrome. Report of two cases and review of literature

Background: Inteleukin (IL)12 and IL23 are two main cytokines involved in the pathogenesis of immune-mediated disease. IL12 is produced by macrophages and B lymphocytes and mediates differentiation of Th1 lymphocytes, while IL23 is a pro-inflammatory cytokine essential for the differentiation of Th17 cells. Ustekinumab is a human monoclonal antibody directed against the p40 protein subunit shared by IL12 and IL23, therefore it blocks the signal transmission of both cytokines. Main observations: We present two cases and discuss the long-term efficacy of ustekinumab as a treatment of psoriasis in patients affected by autoimmune diseases, rheumatoid arthritis and Sjögren’s syndrome, who presented with severe psoriasis after anti-TNF treatment. Conclusions: To the best of our knowledge, these are the first cases reported in the literature describing the long-term good efficacy of ustekinumab not only on paradoxical forms of psoriasis induced by anti-TNF-α drugs, but also on the articular involvement in a patient affected by RA and in a patient affected by Sjögren syndrome

Progettare una Città Queer

Le città sono organismi complessi nei quali, specialmente negli ultimi anni, è aumentata l’attenzione alle relazioni sociali, e alle presenze umane e non umane che abitano lo spazio pubblico, in una dimensione di prossimità, in cui flussi, interazioni e relazioni assumono sempre più valore e necessitano di maggiore cura. Lo spazio pubblico è spazio collettivo e condiviso, luogo in cui avviene (o dovrebbe avvenire) l’interazione sociale, la costruzione della comunità e la pratica della democrazia. In questa prospettiva, lo spazio urbano deve essere accogliente e farsi carico della pluralità delle diverse individualità, facilitando la coesione sociale tra i suoi abitanti grazie al suo essere accessibile, inclusivo, sicuro e fluido. Gli spazi pubblici sono stati storicamente progettati per sostenere i ruoli di genere tradizionali, basati sull'esperienza maschile considerata erroneamente neutra. Per questo motivo è importante capire come le persone e i loro corpi vivono e abitano gli spazi pubblici urbani. Storicamente, lo spazio queer e il senso di appartenenza e sicurezza ad esso associati non sono legati esclusivamente alla fisicità dello spazio in sé, molti altri fattori entrano in gioco. Quali sono questi fattori? Come si può definire e progettare uno spazio queer? Non si tratta di progettare PER le persone queer, ma progettare CON le persone queer, in modo queer, adottando un approccio dal basso verso l'alto, coinvolgendo direttamente gli attori locali delle diverse comunità e soggettività queer che abitano lo spazio pubblico. In questo contesto si inserisce il corso Temporary and Inclusive Urban Solutions della Scuola del Design del Politecnico di Milano tenutosi tra maggio e giugno 2023. Il corso si è focalizzato sulla progettazione di soluzioni temporanee per la città inclusiva, in stretto contatto con le realtà locali, esplorando il rapporto tra il concetto stesso di queerness e lo spazio pubblico, con l’obiettivo di definire, attraverso la progettazione partecipata, come la città di Milano possa essere più queer, inclusiva, accessibile, ospitale e attraente. Nove gruppi di studenti e studentesse hanno lavorato in alcuni spazi dei nove Municipi della città di Milano coinvolgendo diversi stakeholder in sessioni di co-design e workshop al fine di progettare insieme ai possibili utenti delle installazioni urbane temporanee. I partner del corso sono stati i 9 Municipi del Comune di Milano e varie associazioni LGBTQ+ operanti sul territorio Milanese, come CIG Arcigay, PoliEdro, Agedo, Famiglie Arcobaleno, GayMinOut, ALA Milano e Pride Sport Milano. Le soluzioni urbane temporanee progettate dagli studenti e dalle studentesse hanno prodotto nove scenari per la città di oggi e del futuro, in cui lo spazio pubblico si trasforma in spazio di incubazione di pratiche sociali, in cui le comunità creative agiscono per creare nuove soluzioni a problemi quotidiani che la società non sempre è in grado di risolvere, indagando le opportunità per migliorare il senso di appartenenza ai quartieri e alla città

Application of the spac method to ambient noise recorded in the vesuvius area (italy)

Noise measurements were recorded using a dense short-period seismic array in Terzigno (Naples), a town that is located about 6 km from the Vesuvius crater. The aim of this study was to calculate a surface velocity model of the area under investigation through the application of the Spatial Autocorrelation (SPAC) method, with the hypotheses that ambient noise is stationary both in time and space, and that it is composed of surface dispersive waves. The correct knowledge of the surface structure is an important goal in site-effects studies. Correlation coefficients were calculated as functions of the azimuth on noise recorded at pairs of equally spaced stations in the frequency range of 1-8 Hz. Then, the spatial average correlation coefficients were compared to estimates over long-term recordings. The results appear to validate the hypothesis that ambient noise can be considered as a stochastic process. The correlation-frequency curves have been fitted to Bessel functions, from which the Rayleigh wave dispersion curve has been calculated. A velocity model has been derived from the dispersion curve using both trial and error and a standard inversion procedure. The results are consistent with those obtained from array measurements in the area in other studies (Scarpa et al., 2003)

Comparison of the intestinal microbiome of italian patients with multiple sclerosis and their household relatives

Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system, caused by a combination of genetic and environmental factors. In recent years, a role in MS pathogenesis was assigned to the gut microbiota. However, different signatures of gut dysbiosis have been shown to depend on environmental factors, like diet and lifestyle. In this study, we compared the gut microbiome in MS patients and their household healthy relatives sharing lifestyle and environmental factors. Faecal metagenomic DNA was extracted and the V3-V4 regions of the conserved bacterial 16S ribosomal RNA gene were amplified and sequenced. While overall bacterial communities were similar, specific families differed between healthy and MS subjects. We observed an increase in Ruminococcaceae, Christensenellaceae, Desulfovibrionaceae, Clostridiales, and Family XIII in MS patients, while Bacteroidaceae, Tannerellaceae, Veillonellaceae, and Burkholderiaceae were more abundant in healthy controls. In addition, principle coordinate analysis showed that the gut microbiome of all MS patients formed a cluster being less diverse than the household relatives and that gut microbiota of MS patients with EDSS 4.5-7 formed a distinct cluster in respect to their controls. Overall, our study is consistent with the hypothesis that MS patients have gut microbial dysbiosis and evidenced the importance of environmental factors in shaping the gut microbiome

Janus kinase (JAK) 2 V617F mutation as the cause of primary thrombocythemia in acromegaly with severe visceromegaly and divergence between growth hormone and insulin-like growth factor-1 concentrations during the follow-up: causal or casual association?

OBJECTIVE: An increased prevalence of hematological abnormalities is reported in acromegaly, but to date no reports about the presence of the Janus Kinase (JAK) 2 mutation in acromegalic patients have been described. DESIGN: We report the complex clinical presentation of the unique case, never described, of acromegaly due to GH-secreting pituitary adenoma associated with JAK2 V617F mutation. RESULTS: The patient shows primary thrombocythemia and myelofibrosis, due to JAK2 V617F mutation, severe visceromegaly and a peculiar clinical course of the disease characterized by discrepant values of GH and IGF-1 during somatostatin analog (SA) treatment despite a significant reduction in pituitary adenoma size and therapeutic resistance both to SA and pegvisomant. CONCLUSIONS: The presence of JAK2 V617F mutation is a cause of primary thrombocythemia and myelofibrosis in acromegaly. In this patient, a peculiar clinical course of acromegaly was observed, with the difficulty in controlling the disease. More data, on a larger cohort of patients, could clarify whether JAK2 V617F mutation has a serious impact on the clinical features and course of acromegaly.OBJECTIVE: An increased prevalence of hematological abnormalities is reported in acromegaly, but to date no reports about the presence of the Janus Kinase (JAK) 2 mutation in acromegalic patients have been described. DESIGN: We report the complex clinical presentation of the unique case, never described, of acromegaly due to GH-secreting pituitary adenoma associated with JAK2 V617F mutation. RESULTS: The patient shows primary thrombocythemia and myelofibrosis, due to JAK2 V617F mutation, severe visceromegaly and a peculiar clinical course of the disease characterized by discrepant values of GH and IGF-1 during somatostatin analog (SA) treatment despite a significant reduction in pituitary adenoma size and therapeutic resistance both to SA and pegvisomant. CONCLUSIONS: The presence of JAK2 V617F mutation is a cause of primary thrombocythemia and myelofibrosis in acromegaly. In this patient, a peculiar clinical course of acromegaly was observed, with the difficulty in controlling the disease. More data, on a larger cohort of patients, could clarify whether JAK2 V617F mutation has a serious impact on the clinical features and course of acromegaly

Allelic Variants of HLA-C Upstream Region, PSORS1C3, MICA, TNFA and Genes Involved in Epidermal Homeostasis and Barrier Function Influence the Clinical Response to Anti-IL-12/IL-23 Treatment of Patients with Psoriasis

Several biologic therapies have been developed to treat moderate-to-severe psoriasis, with patients exhibiting different clinical benefits, possibly due to the heterogeneity of pathogenic processes underlying their conditions. Ustekinumab targets the IL-12/IL-23-p40 subunit and inhibits type-1 and type-17 T-cell responses. Although ustekinumab is effective as both short- and long-term treatment, therapeutic response varies considerably among patients. Ustekinumab biosimilars will be commercialized in the very next future, likely broadening the use of this drug in the treatment of psoriasis patients. Our pharmacogenomic study evaluated the influence of 417 single-nucleotide polymorphisms (SNPs) in psoriasis-risk alleles on the clinical response to ustekinumab in a cohort of 152 patients affected by moderate-to-severe plaque-type psoriasis. Differences in SNP pattern characterizing HLA-Cw6(+) or HLA-Cw6(-) patients, showing high or low responses to ustekinumab, were also analysed. We identified twelve SNPs in HLA-C upstream region (rs12189871, rs4406273, rs9348862 and rs9368670), PSORS1C3 (rs1265181), MICA (rs2523497), LCE3A-B intergenic region (rs12030223, rs6701730), CDSN (rs1042127, rs4713436), CCHCR1 (rs2073719) and in TNFA (rs1800610) genes associated with excellent response to ustekinumab. We also found that HLA-Cw6(+) and HLA-Cw6(-) patients carried out distinct patterns of SNPs associated with different clinical responses. The assessment of HLA-C alleles, together with other genetic variants, could be helpful for defining patients who better benefit from anti-IL-12/IL-23 therapy