Prevenzione delle recidive nel paziente precedentemente trattato con isotretinoina orale

Gli autori presentano la loro esperienza relativa alla prevenzione delle recidive nel paziente acneico precedentemente trattato con isotretinoina orale. In particolare, gli autori dimostrano che, alla fine della terapia con isotretinoina orale, l'utilizzodi un retinoide topico (adapalene allo 0,1% o isotretinoina allo 0,05% o tretinoina allo 0,05%), per un periodo continuativo di 6-8 mesi, limita, in modo statisticamente significativo, la comparsa delle recidive

epiluminescence microscopy in cutaneous larva migrans

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Back and Forth: Reverse Phase Transitions in Numerical Relativity Simulations

Multi-messenger observations of binary neutron star mergers provide a uniqueopportunity to constrain the dense-matter equation of state. Although it isknown from quantum chromodynamics that hadronic matter will undergo a phasetransition to exotic forms of matter, e.g., quark matter, the onset density ofsuch a phase transition cannot be computed from first principles. Hence, itremains an open question if such phase transitions occur inside isolatedneutron stars or during binary neutron star mergers, or if they appear at evenhigher densities that are not realized in the Cosmos. In this article, weperform numerical-relativity simulations of neutron-star mergers andinvestigate scenarios in which the onset density of such a phase transition isexceeded in at least one inspiralling binary component. Our simulations revealthat shortly before the merger it is possible that such stars undergo a"reverse phase transition", i.e., densities decrease and the quark core insidethe star disappears leaving a purely hadronic star at merger. After the merger,when densities increase once more, the phase transition occurs again and leads,in the cases considered in this work, to a rapid formation of a black hole. Wecompute the gravitational-wave signal and the mass ejection for our simulationsof such scenarios and find clear signatures that are related to the postmergerphase transition, e.g., smaller ejecta masses due to the softening of theequation of state through the quark core formation. Unfortunately, we do notfind measurable imprints of the reverse phase transition.<br

Prevention of relapses in patients previously treated with oral isotretinoin for severe acne. Results of a multicentre, randomized, retrospective, sponsor-free study

Introduction: After a systemic treatment with oral isotretinoin, acne therapy must be continued with topical products in order to avoid possible relapses. The aim of this study was to assess whether a topical retinoid is an effective choice in the prevention of relapses. Methods: Patients who were successfully treated with oral isotretinoin for severe acne, at the end of the therapy were randomized into two groups: the first one was treated with a topical retinoid (0.05% tretinoin or 0.05% isotretinoin or 0.1 % adapalene, 1 application/day for 6-8 months); the second group was not treated (only detergents and moisturizers were allowed). Follow up was >6 months. Results: At the end of the study, 2/37 patients (5.4%) treated with topical retinoids developed a relapse; in the group of patients who were not treated, 7/31 patients (22.6%) developed a relapse (p< 0.05). Conclusions: On the basis of the results of this study, topical retinoids are helpful in the prevention of relapses of acne in patients previously treated with oral isotretinoin

Clindamycin phospate-zinc acetate versus clindamycin phosphate-zinc acetate + adapalene in the treatment of mild to moderate acne. Results of a multicentre, randomized, retrospective, sponsor-free study

Introduction: The aim of the present study was to evaluate the efficacy and the response in patients with mild to moderate acne of a clindamycin phosphate-zinc acetate topical therapy in comparison with clindamycin phosphate-zinc acetate plus adapalene. Methods: Patients with mild to moderate acne were randomized into two groups and treated, respectively, with a gel containing 1 % clindamycin phosphate-0.5% zinc acetate (2 applications/day for 12 weeks) or with the same gel (1 application/day for 12 weeks) plus a gel containing 0.1% adapalene (1 application/day for 12 weeks). No other topical or systemic drugs were allowed, except for a detergent and a sunscreen. Acne severity and treatment efficacy were evaluated by means of the Global Acne Grading System (GAGS). Results: At the end of the study, 63 patients were considered evaluable (29 patients in the group treated with clindamycin-zinc and 34 in the group treated with clindamycin-zinc and adapalene). Significant clinical improvement (maggiore/uguale 50% from baseline) was observed in 12/29 patients (41.4%) in the group treated with clindamycin-zinc and in 22/34 patients (64.7%) in the group treated with clindamycin-zinc and adapalene (p< 0.05). Irritant contact dermatitis was observed in 12 patients (3 in the group treated with clindamycin-zinc and 9 in the group treated with clindamycin-zinc and adapalene); in the latter group, two patients stopped the treatment. Conclusions: On the basis of the results of this study, which is the first one on the activity and tolerability of the association clindamycin-zinc, the latter association is less effective than the association clindamycin-zinc and adapalene

Production and release of antimicrobial and immune defense proteins by mammary epithelial cells following Streptococcus uberis infection of sheep

Investigating the innate immune response mediators released in milk has manifold implications, spanning from elucidation of the role played by mammary epithelial cells (MECs) in fighting microbial infections to the discovery of novel diagnostic markers for monitoring udder health in dairy animals. Here, we investigated the mammary gland response following a two-step experimental infection of lactating sheep with the mastitis-associated bacterium Streptococcus uberis. The establishment of infection was confirmed both clinically and by molecular methods, including PCR and fluorescent in situ hybridization of mammary tissues. Proteomic investigation of the milk fat globule (MFG), a complex vesicle released by lactating MECs, enabled detection of enrichment of several proteins involved in inflammation, chemotaxis of immune cells, and antimicrobial defense, including cathelicidins and calprotectin (S100A8/S100A9), in infected animals, suggesting the consistent involvement of MECs in the innate immune response to pathogens. The ability of MECs to produce and release antimicrobial and immune defense proteins was then demonstrated by immunohistochemistry and confocal immunomicroscopy of cathelicidin and the calprotectin subunit S100A9 on mammary tissues. The time course of their release in milk was also assessed by Western immunoblotting along the course of the experimental infection, revealing the rapid increase of these proteins in the MFG fraction in response to the presence of bacteria. Our results support an active role of MECs in the innate immune response of the mammary gland and provide new potential for the development of novel and more sensitive tools for monitoring mastitis in dairy animals

Immunological and Molecular Correlates of Disease Recurrence after Liver Resection for Hepatocellular Carcinoma

The definition of the risk of hepatocellular carcinoma (HCC) recurrence after resection represents a central issue to improve the clinical management of patients. In this study we examined the prognostic relevance of infiltrating immune cell subsets in the tumor (TIL) and in nontumorous (NT) liver (LIL), and the expression of immune-related and lineage-specific mRNAs in HCC and NT liver derived from 42 patients. The phenotype of infiltrating cells was analyzed by flow cytometry, and mRNA expression in liver tissue was examined by real-time reverse transcription (RT)-PCR. The tumor immune microenvironment was enriched in inhibitory and dysfunctional cell subsets. Enrichment in CD4+ T-cells and in particular CD4 and CD8+ memory subsets within TIL was predictive of better overall survival (OS) and time to recurrence (TTR). Increased programmed death ligand 1 (PDL1) mRNA content and higher prevalence of invariant NKT (iNKT) cells were associated with shorter OS and TTR, respectively. By combined evaluation of infiltrating cell subsets along with mRNA profiling of immune and tumor related genes, we identified the intratumoral frequency of memory T-cells and iNKT-cells as well as PDL1 expression as the best predictors of clinical outcome. HCC infiltrate is characterized by the expression of molecules with negative regulatory function that may favor tumor recurrence and poor survival

Economic consequences of investing in anti-HCV antiviral treatment from the Italian NHS perspective : a real-world-based analysis of PITER data

OBJECTIVE: We estimated the cost consequence of Italian National Health System (NHS) investment in direct-acting antiviral (DAA) therapy according to hepatitis C virus (HCV) treatment access policies in Italy. METHODS: A multistate, 20-year time horizon Markov model of HCV liver disease progression was developed. Fibrosis stage, age and genotype distributions were derived from the Italian Platform for the Study of Viral Hepatitis Therapies (PITER) cohort. The treatment efficacy, disease progression probabilities and direct costs in each health state were obtained from the literature. The break-even point in time (BPT) was defined as the period of time required for the cumulative costs saved to recover the Italian NHS investment in DAA treatment. Three different PITER enrolment periods, which covered the full DAA access evolution in Italy, were considered. RESULTS: The disease stages of 2657 patients who consecutively underwent DAA therapy from January 2015 to December 2017 at 30 PITER clinical centres were standardized for 1000 patients. The investment in DAAs was considered to equal €25 million, €15 million, and €9 million in 2015, 2016, and 2017, respectively. For patients treated in 2015, the BPT was not achieved, because of the disease severity of the treated patients and high DAA prices. For 2016 and 2017, the estimated BPTs were 6.6 and 6.2 years, respectively. The total cost savings after 20 years were €50.13 and €55.50 million for 1000 patients treated in 2016 and 2017, respectively. CONCLUSIONS: This study may be a useful tool for public decision makers to understand how HCV clinical and epidemiological profiles influence the economic burden of HCV