Analysis of health care and actual needs of patients with psoriasis: a survey on the Italian population

Background: Over recent years the public health system has shown increasing interest in patients' views for use as guideline criteria in evaluating the quality of assistance above all for those patients with chronic diseases. Hence the interest in psoriasis, which is a chronic disease frequently associated with diabetes mellitus, hypertension, obesity, and cardiovascular diseases. The aims of our study were to describe clinic characteristics of patients with psoriasis, the quality of the assistance perceived by patients arrived at outpatients clinics and the information received, in order to identify areas in Italy requiring improvement. Methods: 1954 patients, aged between 18 and 85 years, were consecutively enrolled at outpatients clinics across 21 Italian provinces over the period December 2004 - January 2006. A standardized questionnaire was developed in collaboration with an Italian Association of Psoriatic Patients ( A. DI. PSO) and tested in a pilot study. The questionnaire was divided into three sections: the first section included social, demographic and individual variables; the second concerned the quality of the assistance perceived by the patients at public dermatologic clinics and the third focused on the need of information requirements of patients with psoriasis. The chi(2) test was used to estimate the association between the categorical variables under study. Kruskal-Wallis test was applied to the interval and ordinal variables. Results: The presence of psoriatic arthritis was reported in 26.0% of patients. Associated chronic diseases included depression (15.4%), hypertension (13.3%), obesity (8.9%) and type 2 diabetes mellitus (7.3%). The study highlighted the need of improvements of health care services at public dermatologic clinics especially in overcoming architectonic barriers and reducing appointment wait-times, particularly in South Italy. However, patients reported a positive relationship with Health System employers due to the confidentiality. This positive impression was confirmed by the observation that dermatologists were considered the best source of information about therapies on psoriasis. Conclusion: Our study allowed to identify critical aspects which could be tackled through initiatives with the aim of improving these emerged needs

Terapia endodontica in seguito ad avulsione dentaria: revisione della letteratura.

INTRODUZIONE E SCOPO DELLO STUDIO In seguito al reimpianto di un elemento dentario avulso è facile incorrere in processi infettivi e di riassorbimento. A tal proposito critica è la condizione endodontica; la polpa necrotica può infatti facilmente infettarsi. Un’adeguata terapia endodontica si rileva quindi fondamentale per impedire o arrestare le possibili complicanze. Questo studio si pone l’obiettivo di eseguire una revisione sistematica della letteratura e di valutare quale debba essere la corretta gestione endodontica in seguito a reimpianto.MATERIALI E METODI Si esegue una ricerca della letteratura ponendo come domanda chiave quale debba essere la terapia endodontica del dente avulso e reimpiantato.Utilizzando quindi il catalogo MeSH si restringe il campo di ricerca tramite il termine booleano AND e lo si limita ai Major Topics. La stringa ottenuta viene applicata a PubMed.Gli item ricavati vengono sottoposti quindi ad una ulteriore analisi effettuata tramite valori descritti dal Center for Evidence-Based Medicine e dal Clinical Appraisal Skill Programme del National Health Service (UK).CONCLUSIONI La revisione della letteratura di tipo sistematico permette di vagliare oggettivamente la moltitudine di articoli oggi disponibili rendendo quindi più semplice il compito al clinico che quotidianamente affronta le diverse tematiche.Questo studio ha posto un quesito che è però rimasto irrisolto, in quanto la terapia endodontica dell’elemento avulso con dry-time > 1 ora permane argomento di discussione.Esiste una dicotomia tra chi sostiene la necessità di intervenire extra-oralmente e chi invece intra-oralmente. Si pone quindi la necessità di eseguire ulteriori studi clinici con rigidi protocolli

The Potential of Smartlnb Networks for Rainfall Estimation

NEFOCAST is a research project that aims at retrieving rainfall fields from channel attenuation measurements on satellite links. Rainfall estimation algorithms rely on the deviation of the measured Es/N0 from the clear-sky conditions. Unfortunately, clear-sky measurements exhibit signal fluctuations (due to a variety of causes) which could generate false rain detections and reduce estimation accuracy. In this paper we first review the main causes of random amplitude fluctuations in the received Es/N0, and then we present an adaptive tracking algorithm based on two Kalman filters: one that tracks slow changes in Es/N0 due to external causes and another which tracks fast Es/N0 variations due to rain. A comparison of the outputs of the two filters confirms the reliability of the rainfall rate estimate

Disentangling thermal and nonthermal excited states in a charge-transfer insulator by time- and frequency-resolved pump-probe spectroscopy

Time- and frequency-resolved pump-probe optical spectroscopy is used to investigate the effects of the impulsive injection of delocalized excitations through a charge-transfer process in insulating CuGeO3. A large broadening of the charge-transfer edge is observed on the sub-ps time scale. The modification of this spectral feature cannot be attributed to the local increase in the effective temperature, as a consequence of the energy absorbed by the pump pulse. The measured modifications of the optical properties of the system are consistent with the creation of a nonthermal state, metastable on the picosecond time scale, after the pump-induced impulsive modification of the electron interactions

725. Correction of Laminin-5-Deficient Junctional Epidermolysis Bullosa by Transplantation of Genetically Modified Epidermal Stem Cells. A Phase-I Clinical Trial

Mutations in genes encoding the laminin-5 heterotrimer, a key component of the epidermal-dermal junction, cause junctional epidermolysis bullosa (JEB), a severe and often fatal skin adhesion defect. Epidermal stem cells isolated from patients affected by |[beta]|3 chain-deficient JEB were transduced with a retroviral vector expressing a |[beta]|3 cDNA, and used to generate uniformly transduced cultured skin implants. The transgene was steadily expressed for >160 cell doublings in culture, leading to restoration of normal laminin 5 levels, assembly of functional hemidesmosomes, and full phenotypic correction. Cloning and sequencing of vector integrations showed that <20 stem cells are responsible for long-term maintenance of a transplantable skin culture. A phase-I clinical trial started in October 2005, aimed at proving the safety of the transduction/transplantation procedure, and analyzing persistence of transgene expression and long-term survival of transduced stem cells. The first patient was a 30-yr-old male affected by non-lethal JEB, carrying a null mutation in one LAMB3 allele and a point mutation (E212K) in the other one. The mutation affects the assembly of the laminin-5 heterotrimer, present at residual levels (<5%) in vitro and in vivo. Six genetically modified, cultured epidermal sheets of 100 sq cm were transplanted on both legs after removal of the outer skin layer using a minimally invasive technique. The procedure was well tolerated, and the patient discharged after five days. Engraftment was completed after 10 days, and transplanted skin remained stable on both legs in the absence of blistering or inflammation for the duration of the follow-up (4 months at the time of writing). 3-mm punch biopsies were taken 1 and 3 months after transplantation, and analyzed for vector presence by quantitative PCR and for protein expression by immunohistochemistry. A vector signal compatible with full transduction of the transplanted epidermis was observed at both time points. Synthesis and assembly of normal levels of heterotrimeric laminin-5 and |[alpha]|6|[beta]|4 integrin was observed at the level of the basal lamina in all biopsies, together with the development of a firmly adherent, fully differentiated epidermis. Epidermal stem cells (p64+) were detected in the basal layer of the transplanted skin in normal numbers. These data show that gene therapy of JEB by transplantation of genetically corrected stem cells is feasible, and leads to full phenotypic correction of the adhesion defect in vivo. Safety studies are under way, which include detection or humoral or cytotoxic immune responses against laminin-5, and ex vivo cloning and sequencing of the integrated proviruses

Keratinocytes enriched for stem cells are protected from anoikis via an integrin signaling pathway in a Bcl-2 dependent manner

AbstractBecause inhibition of integrin signaling induces apoptosis, we investigated whether keratinocytes expressing β1 and α6β4 integrins (enriched for stem cells) are protected from cell death. Keratinocytes rapidly adhering to type IV collagen expressed highest levels of β1 and α6β4 and of the anti-apoptotic stem cell marker p63. Apoptotic cells were significantly higher in slowly adhering than in rapidly adhering keratinocytes. Anti-β1 integrin caused a significant increase in apoptotic cells, while it decreased Bcl-2 levels in stem keratinocytes. Bax and Bad proteins were higher in slowly adhering than in rapidly adhering cells. By contrast, Bcl-2, Bcl-x and Mcl-1 proteins were highest in rapidly adhering keratinocytes and nearly absent in slowly adhering cells. After addition of anti-β1 integrin, the apoptotic rate was significantly higher in HaCaT cells not expressing Bcl-2 than in controls. These results indicate that keratinocytes enriched for stem cells are protected from apoptosis via β1 integrin, in a Bcl-2 dependent manner

Rivascolarizzazione pulpare in seguito a reimpianto dentale: caso clinico.

INTRODUZIONE E SCOPO DELLO STUDIO In seguito ad avulsione dentaria il processo di guarigione del fascio vascolo-nervoso determina il piano terapeutico.Studi effettuati sulla reazione della polpa hanno permesso di identificare diversi processi di guarigione.Numerosi studi eseguiti hanno portato ad osservare la formazione di tessuto duro lungo le pareti dentinali circa 17 giorni dopo il reimpianto; mentre si osservano nuove fibre nervose circa un mese dopo. Studi di tipo microangiografico hanno dimostrato la presenza di nuovi vasi già a 4 giorni dal reimpianto; dopo 10 giorni sono stati rilevati vasi nel terzo apicale e dopo 30 giorni nell’intera camera pulpare. Lo scopo di questo studio è quello di presentare un caso clinico di rivascolarizzazione pulpare in seguito a reimpianto.MATERIALI E METODI Il paziente, di 8 anni, presenta entrambi gli incisivi centrali superiori avulsi in seguito ad un incidente sportivo.Giunge all’osservazione 30 minuti dopo il trauma, con gli elementi dentari conservati in soluzione fisiologica sin dai primi istanti. Entrambi gli elementi presentano apice beante e non completa formazione della radice.Seguendo le linee guida della IADT si decide di reimpiantare gli elementi e di eseguire uno splintaggio semi-flessibile.Si eseguono successivi controlli clinici e radiografici a 1-3-6 e 12 mesi.CONCLUSIONI Nei denti con incompleta formazione radicolare è possibile andare incontro a rivascolarizzazione; tuttavia i test elettrici e termici non sono affidabili in seguito a traumi dentali, in quanto possono dare falsi negativi. La valutazione clinica di un dente traumatizzato però richiede uno studio sintomatico, visivo e radiografico. Se il dente diviene necrotico o infetto si può andare incontro ad un processo di riassorbimento radicolare che può condurre alla perdita del dente in breve tempo.Una diminuzione della dimensione della camera pulpare o del canale radicolare sull’immagine radiografica è un segno affidabile della vitalità pulpare.Il caso discusso rappresenta la possibilità di rivascolarizzazione in seguito a reimpianto a breve termine

Leser-Trélat syndrome in patients affected by six multiple metachronous primitive cancers

Leser-Trélat syndrome is characterized by the eruptive appearance of multiple seborrheic keratoses in association with underlying malignant disease. Usually, the sign of Leser-Trélat is associated with adenocarcinoma, most frequently of the colon, breast, or stomach, but also of the lung, kidney, liver, and pancreas. Herein, we present a case that we believe is the first report of the sign of Leser-Trélat in association with occult gastric adenocarcinoma and the anamnestic oncologic history of five other multiple primitive cancers. Epidermal growth factor receptor (EGFR) immunohistochemical expression analysis of multiple seborrheic keratoses revealed an intense membranous staining in the basal keratinocytes and in all the upper epidermal layers. Patients with the sign of Leser-Trélat should undergo a diagnostic screening programme for malignant disease along with patients with known Leser-Trélat syndrome who present with a recent acute and florid eruption of their seborrheic keratoses. We propose the importance of combining the molecular features of multiple seborrheic keratoses with EGFR immunohistochemistry analyses to determine the likelihood of Leser-Trélat syndrome and the consequent high risk of underlying multiple visceral malignancies

Rainfall Field Reconstruction by Opportunistic Use of the Rain-Induced Attenuation on Microwave Satellite Signals: The July 2021 Extreme Rain Event in Germany as a Case Study

This paper presents a practical application of an opportunistic technique for the estimation of rainfall intensity and accumulated precipitation. The proposed technique is based upon signal strength measurements made by commercial-grade interactive satellite terminals. By applying some processing, the rain-induced attenuation on the microwave downlink from the satellite is first evaluated; then the rain attenuation is eventually mapped into a rainfall rate estimate via a tropospheric model. This methodology has been applied to a test area of 30×30 km2 around the city of Dortmund (North Rhine-Westphalia, upper basin of Ermscher river), for the heavy rain event that devastated western Germany in July, 2021. A rainfall map on this area is obtained from the measurements collected by a set of satellite terminals deployed in the region, and successfully compared with a map obtained with a conventional weather radar

Evaluation of virological response and resistance profile in HIV-1 infected patients starting a first-line integrase inhibitor-based regimen in clinical settings

Background: Virological response and resistance profile were evaluated in drug-naïve patients starting their first-line integrase inhibitors (INIs)-based regimen in a clinical setting. Study design: Virological success (VS) and virological rebound (VR) after therapy start were assessed by survival analyses. Drug-resistance was evaluated at baseline and at virological failure. Results: Among 798 patients analysed, 38.6 %, 27.1 % and 34.3 % received raltegravir, elvitegravir and dolutegravir, respectively. Baseline resistance to NRTIs, NNRTIs, PIs and INIs was: 3.9 %, 13.9 %, 1.6 % and 0.5 %, respectively. Overall, by 12 months of treatment, the probability of VS was 95 %, while the probability of VR by 36 months after VS was 13.1 %. No significant differences in the virological response were found according to the INI used. The higher pre-therapy viremia strata was (&lt;100,000 vs. 100,000-500,000 vs. &gt; 500,000 copies/mL), lower was the probability of VS (96.0 % vs. 95.2 % vs. 91.1 %, respectively, P &lt; 0.001), and higher the probability of VR (10.2 % vs. 15.8 % vs. 16.6 %, respectively, P = 0.010). CD4 cell count &lt;200 cell/mm3 was associated with the lowest probability of VS (91.5 %, P &lt; 0.001) and the highest probability of VR (20.7 %, P = 0.008) compared to higher CD4 levels. Multivariable Cox-regression confirmed the negative role of high pre-therapy viremia and low CD4 cell count on VS, but not on VR. Forty-three (5.3 %) patients experienced VF (raltegravir: 30; elvitegravir: 9; dolutegravir: 4). Patients failing dolutegravir did not harbor any resistance mutation either in integrase or reverse transcriptase. Conclusions: Our findings confirm that patients receiving an INI-based first-line regimen achieve and maintain very high rates of VS in clinical practice