European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 1: treatment delivery and established indications – actinic keratoses, Bowen''s disease and basal cell carcinomas

Topical photodynamic therapy (PDT) is a widely approved therapy for actinic keratoses, Bowen''s disease (squamous cell carcinoma in situ), superficial and certain thin basal cell carcinomas. Recurrence rates when standard treatment protocols are used are typically equivalent to existing therapies, although inferior to surgery for nodular basal cell carcinoma. PDT can be used both as lesional and field therapies and has the potential to delay/reduce the development of new lesions. A protocol using daylight to treat actinic keratoses is widely practised, with conventional PDT using a red light after typically a 3-h period of occlusion employed for other superficial skin cancer indications as well as for actinic keratoses when daylight therapy is not feasible. PDT is a well-tolerated therapy although discomfort associated with conventional protocol may require pain-reduction measures. PDT using daylight is associated with no or minimal pain and preferred by patient. There is an emerging literature on enhancing conventional PDT protocols or combined PDT with another treatment to increase response rates. This guideline, published over two parts, considers all current approved and emerging indications for the use of topical PDT in dermatology, prepared by the PDT subgroup of the European Dermatology Forum guidelines committee. It presents consensual expert recommendations reflecting current published evidence

Pediatric lymphoma patients in Malawi present with poor health-related quality of life at diagnosis and improve throughout treatment and follow-up across all Pediatric PROMIS-25 domains

Background: Patient-reportedoutcomes (PROs) that assess health-related quality of life (HRQoL) are increasingly important components of cancer care and research that are infrequently used in sub-Saharan Africa (SSA). Methods: We administered the Chichewa Pediatric Patient-Reported Outcome Measurement Information System Pediatric (PROMIS)-25 at diagnosis, active treatment, and follow-up among pediatric lymphoma patients in Lilongwe, Malawi. Mean scores were calculated for the six PROMIS-25 HRQoL domains (Mobility, Anxiety, Depressive Symptoms, Fatigue, Peer Relationships, Pain Interference). Differences in HRQoL throughout treatment were compared using the minimally important difference (MID) and an ANOVA analysis. Kaplan–Meier survival estimates and Cox hazard ratios for mortality are reported. Results: Seventy-five children completed PROMIS-25 surveys at diagnosis, 35 (47%) during active treatment, and 24 (32%) at follow-up. The majority of patients died (n = 37, 49%) or were lost to follow-up (n = 6, 8%). Most (n = 51, 68%) were male, median age was 10 (interquartile range [IQR] 8–12), 48/73 (66%) presented with advanced stage III/IV, 61 (81%) were diagnosed with Burkitt lymphoma and 14 (19%) Hodgkin lymphoma. At diagnosis, HRQoL was poor across all domains, except for Peer Relationships. Improvements in HRQoL during active treatment and follow-up exceeded the MID. On exploratory analysis, fair-poor PROMIS Mobility <40 and severe Pain Intensity = 10 at diagnosis were associated with increased mortality risk and worse survival, but were not statistically significant. Conclusions: Pediatric lymphoma patients in Malawi present with poor HRQoL that improves throughout treatment and survivorship. Baseline PROMIS scores may provide important prognostic information. PROs offer an opportunity to include patient voices and prioritize holistic patient-centered care in low-resource settings

Partie II : analyse comparative des politiques de logement.

In occasione del cinquecentenario della morte di Raffaello Sanzio (1483-1520) si propone un testo agile e informato per scoprire dipinti e architetture eseguiti a Roma dall\u2019arrivo nell\u2019Urbe nel 1508 alla morte nel 1520. Aggiornate e complete dei dati essenziali, le schede esplicative illustrano l\u2019ampio ventaglio della produzione matura del Raffaello pittore, dagli affreschi alle pale d\u2019altare ai ritratti eseguiti per Roma o oggi l\uec conservati, e permettono di individuare e di comprendere le tracce dell\u2019attivit\ue0 del Raffaello architetto. Si svolge attraverso le opere il racconto dell\u2019appassionante stagione romana dell\u2019artista, impegnato nel continuo rinnovamento del proprio linguaggio di pittore nel dialogo travolgente con Michelangelo, nella gara con Sebastiano del Piombo, nella spinta possente delle sollecitazioni fornite dal repertorio antico della scultura, nel nuovo impegno come caposcuola, alla guida di una bottega che far\ue0 da modello per tutto il secolo e oltre, e si segue il definirsi proprio a Roma dei suoi interessi di architetto e degli obiettivi che egli matura sul fronte dell\u2019architettura moderna su sollecitazione di Bramante e poi di altri, nella sfida costituita dal confronto con i resti degli edifici antichi, in uno scambio costante con gli umanisti, come Pietro Bembo e Fra Giocondo, suoi ferventi interlocutori, committenti, sostenitori. Il testo non trascura di segnalare le opere non accessibili legate all\u2019operato del Sanzio, quali, in Vaticano, le Logge o l\u2019Appartamento del cardinal Bibbiena, o quelle che da architetto egli non pot\ue9 realizzare ma di cui ci restano suoi progetti, o che vennero distrutte (Palazzo Branconio dell\u2019Aquila), e dedica un\u2019attenzione speciale, per la forza del suo rapporto con il presente, alla lettera a Leone X scritta da Raffaello e da Baldassarre Castiglione, riconosciuta come primo documento di una consapevole riflessione sull\u2019urgenza della conservazione dell\u2019architettura e dell\u2019arte del passato alla quale oggi pi\uf9 di allora siamo chiamati a rispondere

Earlier initiation of antiretroviral treatment coincides with an initial control of the HIV-1 sub-subtype F1 outbreak among men-having-sex-with-men in Flanders, Belgium

Human immunodeficiency virus type 1 (HIV-1) non-B subtype infections occurred in Belgium since the 1980s, mainly amongst migrants and heterosexuals, whereas subtype B predominated in men-having-sex-with-men (MSM). In the last decade, the diagnosis of F1 sub-subtype in particular has increased substantially, which prompted us to perform a detailed reconstruction of its epidemiological history. To this purpose, the Belgian AIDS Reference Laboratories collected HIV-1 pol sequences from all sub-subtype F1-infected patients for whom genotypic drug resistance testing was requested as part of routine clinical follow-up. This data was complemented with HIV-1 pol sequences from countries with a high burden of F1 infections or a potential role in the global origin of sub-subtype F1. The molecular epidemiology of the Belgian subtype F1 epidemic was investigated using Bayesian phylogenetic inference and transmission dynamics were characterized based on birth-death models. F1 sequences were retained from 297 patients diagnosed and linked to care in Belgium between 1988 and 2015. Phylogenetic inference indicated that among the 297 Belgian F1 sequences, 191 belonged to a monophyletic group that mainly contained sequences from people likely infected in Belgium (OR 26.67, 95% CI 9.59-74.15), diagnosed in Flanders (OR 7.28, 95% CI 4.23-12.53), diagnosed at a recent stage of infection (OR 7.19, 95% CI 2.88-17.95) or declared to be MSM (OR 34.8, 95% CI 16.0-75.6). Together with a Spanish clade, this Belgian clade was embedded in the genetic diversity of Brazilian subtype F1 strains and most probably emerged after one or only a few migration events from Brazil to the European continent before 2002. The origin of the Belgian outbreak was dated back to 2002 (95% higher posterior density 2000-2004) and birth-death models suggested that its extensive growth had been controlled (R < 1) by 2012, coinciding with a time period where delay in antiretroviral treatment initiation substantially declined. In conclusion, phylogenetic reconstruction of the Belgian HIV-1 sub-subtype F1 epidemic illustrates the introduction and substantial dissemination of viral strains in a geographically restricted risk group that was most likely controlled by effective treatment as prevention