Introduction
Daylight photodynamic therapy (DL‐PDT) with methyl aminolevulinate (MAL) is a simplified PDT procedure that was recently shown in a few trials to be effective for grade I actinic ...keratosis (AK), with improved tolerability and reduced time of clinical attendance as compared to conventional PDT (c‐PDT).
Objective
To evaluate the efficacy and tolerability of DL‐PDT vs. c‐PDT with MAL in the treatment of grade I AK on the face and scalp in Italy.
Methods
Thirty‐five patients with AKs on the face (n = 17) or scalp (n = 18) were prospectively enrolled in an intra‐patient, left‐right, prospective, comparison study between DL‐PDT and c‐PDT at a single centre between September and October 2013. Weather conditions and outdoor temperature during daylight exposure were recorded for each DL‐PDT session. Pain was assessed after the PDT session and local adverse events 2 days after treatment. Lesion response rate was evaluated on both sides at 3 months. AKs with complete regression were followed until 6 months. Patient's preference for either treatment was recorded.
Results
There was no difference in complete response (CR) rate of AK I at 3 months between DL‐PDT and c‐PDT (87% vs. 91%; RR = 0.96; P = 0.16). A lower CR rate was observed with DL‐PDT than with c‐PDT for AK II (36% vs. 61%; RR = 0.58, P = 0.06) and III (25% vs. 46%; RR = 0.50, P = 0.20). Recurrence rate at 6 months was slightly higher for cleared AK I after DL‐PDT than after c‐PDT (17% vs. 12%, RR = 1.50, P < 0.05). DL‐PDT was associated with lower pain (ΔVAS = −2.2, P < 0.01) and reduced severity of local adverse events (ΔLSR = −1.4, P < 0.01) than c‐PDT. Increasing outdoor temperature was associated with the efficacy of DL‐PDT and the severity of adverse events. DL‐PDT was preferred by 88% of the patients.
Conclusion
MAL DL‐PDT showed similar efficacy to c‐PDT in the treatment of AK I of the face/scalp but was less effective than c‐PDT for AKs II and III. DL‐PDT was better tolerated being associated with lower pain and occurrence of fewer adverse events. Clinical response to DL‐PDT was significantly moderated by outdoor temperature, increasing at higher temperatures.
The Hedgehog (Hh) pathway is a crucial regulator of muscle development during embryogenesis. We have previously demonstrated that Sonic hedgehog (Shh) regulates postnatal myogenesis in the adult ...skeletal muscle both directly, by acting on muscle satellite cells, and indirectly, by promoting the production of growth factors from interstitial fibroblasts. Here, we show that in mdx mice, the murine equivalent of Duchenne muscular dystrophy in humans, progression of the dystrophic pathology corresponds to progressive inhibition of the Hh signaling pathway in the skeletal muscle. We also show that the upregulation of the Hh pathway in response to injury and during regeneration is significantly impaired in mdx muscle. Shh treatment increases the proliferative potential of satellite cells isolated from the muscles of mdx mice. This treatment also increases the production of proregenerative factors, such as insulin-like growth factor-1 and vascular endothelial growth factor, from fibroblasts isolated from the muscle of mdx mice. In vivo, overexpression of the Hh pathway using a plasmid encoding the human Shh gene promotes successful regeneration after injury in terms of increased number of proliferating myogenic cells and newly formed myofibers, as well as enhanced vascularization and decreased fibrosis.
Acute SARS-CoV-2 respiratory disease is an infectious respiratory disease caused by the virus SARS-CoV-2 belonging to the coronaviridae family. A pandemic is still present as of May 2020. In addition ...to causing pneumonia, SARS-CoV-2 may induce a direct damage to the heart, causing myocarditis, with significant impairment of cardiac contractility, and/or pericarditis. Elderly patients and those with cardiovascular risk factors, such as hypertension and diabetes mellitus, are at increased risk of heart complications from COVID-19. In this review, we focused on the correlation between COVID-19 infection and the high sensitivity troponin T and I, and their significance in the development of myocarditis. Data emerging from the studies so far conducted indicate that a high value of high-sensitivity troponin represents a negative prognostic indicator when associated with heart damage on an infectious-inflammatory basis (i.e. myopericarditis). We should identify a safe and clear diagnostic algorithm, possibly combining patient clinical history, troponin levels and cardiac ultrasound findings that could help us in the prediction of myopericarditis.
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. An association between increased venous ...thromboembolism in patients with pneumonia-related to COVID-19 has not yet been well described.
We aimed to illustrate cases of pulmonary thromboembolism in patients with acute respiratory distress syndrome related to COVID-19 treated in our intensive care unit. The medical records of patients affected by COVID-19 with acute respiratory distress syndrome in our institute from 1/3/2020 to 31/3/2020 were retrospectively reviewed.
Our center registered a high prevalence of thromboembolic events among 62 patients affected by acute respiratory distress syndrome related to COVID-19 despite a regular antithrombotic prophylaxis. Out of these, 32 patients were transferred to other hospitals, and 30 were treated in our center. Venous thromboembolism was registered in 12 (19.3%) cases. In particular, 11 diagnoses of pulmonary embolism and 1 diagnosis of deep vein thrombosis were formulated. We described a case series of venous thromboembolism in nine patients treated in our Intensive Care Unit (ICU). Main pulmonary arteries were always involved in these patients. None of them died.
In conclusion, critically ill patients with ARDS related to COVID-19 may have an increased risk of VTE that could be a leading cause of mortality. These patients require a high index of clinical suspicion and an accurate diagnostic approach, in order to immediately start an appropriate anticoagulant treatment.
Among the genes involved in obesity, the Fat mass and obesity-associated gene (FTO) is certainly one of the most known and the relation between FTO rs9939609 and BMI is highly discussed; ...nevertheless, data about its influence on body composition are limited.
We carried out a study on a sample of 1066 Italian subjects, whose body composition and FTO rs9939609 were analyzed.
We found significant relations between FTO with arm (p=0.01), abdomen (p=0.00), and trunk circumferences (p=0.00), BMI (p=0.01), FM% (p=0.00), and android FM% (p=0.01), whereas no relations were found between FTO and both gynoid fat and lean mass.
To conclude, the relation between FTO and BMI is confirmed and is related specifically with android FM%. These results indicated that FTO rs9939609 may be a genetic etiological factor for obesity. Indeed, the specificity for the android FM% would indicate FTO as an etiological factor in the development of cardiovascular diseases.
Mild Traumatic Brain Injury (MTBI) in anticoagulated patients is a common challenge for Emergency Department (ED) Physicians. Anticoagulation is considered a risk factor for developing delayed ...intracranial hemorrhage (ICH) after MTBI. The occurrence of this event in patients on Vitamin K Antagonists (VKA) or Direct Oral Anticoagulants (DOACs) remains unclear. Primary endpoint: to analyze the role of anticoagulants as risk factors for developing delayed ICH after MTBI and evaluate the indications to repeat a cranial computed tomography (CT) after a period of observation. Secondary endpoint: to assess the difference in the prevalence rate of delayed ICH in patients on VKA versus those on DOACs.
We evaluated all consecutive patients admitted to our ED for MTBI, which had a control CT for late ICH after a negative CT at admission. We used a propensity score match (PSM) on factors affecting the need for oral anticoagulation to adjust the comparison between anticoagulated vs. non-anticoagulated patients for the baseline clinical characteristics.
Among 685 patients enrolled, 15 (2.2%) developed ICH at control CT. After PSM, the incidence of ICH, although slightly higher, was not statistically different in anticoagulated patients vs. non-anticoagulated (2.3% vs. 0.6%, p=0.371). Among the 111 patients on VKA, 5 (4.5%) had a late ICH, compared to 4 out of 99 (4.0%) on DOACs; the difference was not statistically significant (p=0.868).
The risk of developing delayed ICH after MTBI in patients on anticoagulation therapy is low. After correction for baseline covariates, the risk does not appear higher compared to non-anticoagulated patients. Thus, a routine control CT scan seems advisable only for patients presenting a clinical deterioration. Larger, prospective trials are required to clarify the safety profile of DOACs vs. VKA in MTBI.
Lipedema is a disorder of adipose tissue characterized by abnormal subcutaneous fat deposition, leading to swelling and enlargement of the lower limbs and trunk. The aim of this study was to evaluate ...the lipedema phenotype by investigating the role of polymorphisms related to IL-6 (rs1800795) gene in people with diagnosis of lipedema. The second aim was to identify indicators of body composition, useful for a differential analysis between subjects with lipedema and the control group.
Two groups are involved in the study, 45 women with lipedema (LIPPY) and 50 women randomly chosen from the population as Control (CTRL). Clinical and demographical variables recorded include weight, height, body mass index (BMI) and circumference measurements. Body composition (Fat mass, FM; lean mass, LM) was assessed by Dual-energy X-ray Absorptiometry (DXA). The genetic tests for IL-6 (rs18oo795) gene were performed for both groups, using a saliva sample.
The study of the relationship between the IL-6 (rs1800795) gene polymorphism, the anthropometric values and the body composition indices has provided the following significant results: subjects with diagnosis of lipedema present statistically significant increased values with regard to weight, BMI, waist, abdomen and hip circumferences, arms, legs and whole FM (% and kg), gynoid FM (kg), legs LM (kg) and ASMMI. Moreover, the value of the waist hip ratio was found to be decreased.
For the first time, we suggested that IL-6 gene polymorphism could characterize subjects with lipedema respect to Normal Weight Obese and obese subjects. The intra-group comparisons (LIPPY carriers vs. LIPPY non-carriers and CTRL carriers vs. CTRL non-carriers) showed no statistically significant values. In contrast, the inter-group comparisons (LIPPY non-carriers vs. CTRL non-carriers and LIPPY carriers vs. CTRL carriers) resulted statistically significant. We have identified other indices, such as leg index, trunk index, abdominal index, total index, that could be promising clinical tools for diagnosis of the lipedema phenotype and for predicting the evolution of the disease.
Acute alcohol intoxication is actually a common admission cause in the Emergency Department and represents an increasing public health burden, in particular among adolescents. It involves possible ...and significant illness and injury, which can quickly get worse and may need to be managed in the emergency room.
We conducted a narrative review of the literature regarding the effectiveness of first aid role of the Emergency Department setting.
This review included eighteen studies about alcohol intoxication management in the Emergency Department; most of all highlights the emerging phenomenon in Europe and around the world of acute alcohol intoxication management in first aid. The treatment of acute alcohol intoxication depends on general clinical conditions of the patient, vital signs, hemodynamic stability, cognitive state, alcohol-related complications, which are closely related to the blood alcohol concentration. At the same time, symptoms could be extremely variable due to individual differences in alcohol metabolism. In case of mild-moderate intoxication (blood alcohol concentration < 1 g/L), no drugs are necessary. In case of severe intoxication (blood alcohol concentration > 1 g/L), it is necessary to support with intravenous fluids, treat hypoglycemia, hypotension, hypothermia and electrolyte imbalance, administer complex B and C vitamins and accelerate alcohol elimination from blood with metadoxine. Unlike adults, adolescents are more exposed to the toxic effect of alcohol (because of their immature hepatic alcohol dehydrogenase activity), and then, acute alcohol-related complications are more frequent and dangerous in young people than in adult population. In many cases, patients affected by acute alcohol intoxication referring to an Emergency Department have mild-moderate transitory symptoms that do not require the use of drugs; they can benefit from a clinical observation, with a clinical course often completed within 24 hours with a favorable outcome. Clinical observation with vital signs control is necessary also to evaluate the possible development of the alcohol withdrawal syndrome (that involves a specific treatment) and to evaluate also possible pathological complications of the organism, above all acute liver damage.
Patients affected by acute alcohol intoxication are the best candidates to apply the rules of the Temporary Observation Unit in the Emergency Department, because of a clinical course often completed within 24 hours, a favorable outcome and without the need for hospitalization. In many cases, hospitalization could be not necessary, but the patient affected by Alcohol Use Disorder must be referred to an Alcohol Addiction Unit for the follow-up, to reduce the risk of alcohol relapse and complications related to alcohol abuse, and financial costs of hospitalization.
Aim: In this study the effects of environmental and structural features of two different neonatal intensive care unit (NICU) settings on the time course of psychological distress in mothers of ...preterm infants were investigated.
Methods: Levels of psychological distress in 21 mothers of premature infants hospitalized in the NICU of the Salesi Hospital were compared with levels of psychological distress in 21 mothers of premature infants from the NICU of the Sant'Orsola Hospital at three different times during hospitalization.
Results: Data showed that mothers from the NICU of the Salesi Hospital, where there is no presence of any specialized figure and the access for parents to the unit is ruled by time schedules, reported higher levels of psychological distress than mothers from the NICU of the Sant'Orsola Hospital, characterized by the continuous presence and contact with the medical staff, which included physiotherapists and clinical psychologists, and free access to the unit for parents. Moreover, levels of psychological distress increased over time in mothers from the Salesi Hospital while levels of distress decreased or were simply maintained over time in mothers from the Sant'Orsola Hospital.
Conclusions: The present findings suggest that providing mothers with the opportunity of discussing the infant's clinical state with health professionals and receiving psychological support on a regular basis may reduce stressful feelings.
We imaged the position of the naked-eye burst, GRB080319B, before, during, and after its gamma-ray activity with sub-second temporal resolution using the TORTORA wide-field camera. The burst optical ...prompt emission, which reached 5.3 mag, has been detected, and its periodic optical variability has been discovered in the form of four equidistant flashes with a duration of several seconds. We also detected a strong correlation (r {approx} 0.82) between optical and gamma-ray light curves with a 2 s delay of the optical emission with respect to the gamma-ray emission. The revealed temporal structure of the optical light curve in comparison with the gamma-ray light curve can be interpreted in the framework of the model of shell collisions in the ejecta containing a significant neutron component. All observed emission features reflect the non-stationary behavior of the burst internal engine-supposedly, a hyperaccreting solar-mass black hole formed in the collapse of a massive stellar core.
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