Background
Imiquimod 3.75% cream (Zyclara® Meda, Stockholm, Sweden) is a new field‐directed therapy for actinic keratosis (AK).
Objectives
The aim is to evaluate efficacy and the morphologic dynamic ...changes induced by this treatment by means of dermatoscopy and reflectance confocal microscopy (RCM) of imiquimod 3.75% cream for the treatment of AKs of the face or scalp and to evaluate.
Methods
Thirty‐two patients were treated with Imiquimod 3.75% cream. Demographic parameters, AK‐FAS and AKASI scores and side‐effects were collected. RCM and dermatoscopy on one target AKs were performed at each visit. We collected images at baseline (T0), after 1 week from the end of the first 2‐week cycle (T1), after 1 week from the end of the entire treatment (T2) and 2 months after the end of treatment (T3).
Results
One target representative AK in the selected area of treatment of each patient was analysed. All dermoscopic and confocal parameters were reduced 2 months after the end of the therapy (T3) with a substantial reduction of AKASI and AK‐FAS scores, and 17 cases (54.8%) were completely solved. Confocal microscopic analysis showed a reduction of keratinocytes disarray in 77.4% of cases; none showed crusts and parakeratosis. Inflammation was considerably decreased and was observed only in 12.9% of patients at the last visit. This improvement was not assessed on dermatoscopy because of inflammation and background erythema, which adversely influenced the assessments. LSRs were observed in almost all the patients during treatment being more severe after the first cycle of treatment (T1).
Conclusions
Imiquimod 3.75% cream is effective in treating clinical and subclinical AKs with an easy management of side‐effects. Dermatoscopy and mostly RCM allow non‐invasive monitoring of treatment response in vivo.
Purpose
Poor response to bariatric surgery, namely insufficient weight loss (IWL) or weight regain (WR), is a critical issue in the treatment of obesity. The purpose of our study was to assess the ...efficacy, feasibility, and tolerability of very low-calorie ketogenic diet (VLCKD) for the management of this condition.
Methods
A real-life prospective study was conducted on twenty-two patients who experienced poor response after bariatric surgery and followed a structured VLCKD. Anthropometric parameters, body composition, muscular strength, biochemical analyses, and nutritional behavior questionnaires were evaluated.
Results
A significant weight loss (mean 14.1 ± 4.8%), mostly due to fat mass, was observed during VLCKD with the preservation of muscular strength. The weight loss obtained allowed patients with IWL to reach a body weight significantly lower than that obtained at the post-bariatric surgery nadir and to report the body weight of patients with WR at the nadir observed after surgery. The significantly beneficial changes in nutritional behaviors and metabolic profiles were observed without variations in kidney and liver function, vitamins, and iron status. The nutritional regimen was well tolerated, and no significant side effects were detected.
Conclusion
Our data demonstrate the efficacy, feasibility, and tolerability of VLCKD in patients with poor response after bariatric surgery.
Background
Treatment for cellulite above the knees is increasingly requested. However, a classification of cellulite of this area has not yet been developed.
Objective
To validate the proposed knee ...cellulite severity score (KCSS) for the assessment of cellulite and skin laxity above the knee.
Materials and methods
Based on standardized photographs of cellulite and skin laxity above the knees of 57 females (114 knees), three key morphological aspects of cellulite were identified. A photonumeric KCSS was developed and validated by three independent assessors.
Results
The three key cellulite morphological features (number of depressions, depth of depressions and presence of laxity) are each graded from 0 to 3, producing a classification of no lesions (0), mild (1–3), moderate (4–6) and severe (7–9). Evaluators at different time points repeated similar classifications (intraclass correlation coefficient >0.9), which were also similar among the assessors (inter‐observer reliability >0.9). All three key morphological aspects were deemed necessary, and positively contributed, to the overall scale (item‐total correlation analysis values >0.89, P < 0.05).
Conclusions
The KCSS is a consistent, comprehensive, reliable, and reproducible tool for standardized and objective assessment of the severity of cellulite and skin laxity above the knees.
Background
In vivo reflectance confocal microscopy significantly improves melanoma diagnosis as compared to clinical/dermoscopic examination alone. Several confocal criteria have been described ...allowing to differentiate melanoma from nevi; by combining different criteria, three pure confocal scores (Pellacani 2005, Segura 2009 and Pellacani 2012) and one mixed dermoscopic/confocal score (Borsari 2018) were constructed.
Objective
Our aim was to externally validate and compare the performance of these confocal scores.
Methods
We retrospectively enrolled excised melanocytic lesions which underwent confocal examination in a 2‐year period. Lesions located on the face and acral sites were excluded. Both dermoscopic and confocal criteria considered in the four scores were evaluated by experts. Subsequently, specificity and sensitivity levels for each score were calculated, together with the positive and negative predictive values and likelihood ratios; also, receiver operating characteristic curves were constructed.
Results
A total of 389 patients with 422 lesions were retrospectively enrolled, of which 162 (38.4%) were melanomas and 260 (61.6%) were nevi (189 common and 71 Spitz/Reed nevi). The highest sensitivity levels were recorded for Segura 2009 with cut‐off ≥−1 (92.0%), while Pellacani 2005 with cut‐off ≥5 achieved the highest specificity (69.6%). The score by Borsari et al. showed the highest levels of positive and negative predictive values (59.8% and 91.5%) and likelihood ratios (2.4 and 0.1) as well as the highest area under the curve values (0.76; 95% CI 0.72–0.81; P < 0.001).
Conclusions
High levels of accuracy were found for each of the four considered scores. No differences were found among scores in confirming melanoma diagnosis when positive; however, the score by Borsari 2018 was the best in excluding melanoma diagnosis when negative.
Several recent hydrocarbon discoveries were detected in extensional areas located around fault-bounded tectonic highs. These tectonically-controlled mini-basins are diffusely characterised by ...terrestrial and shallow-marine successions with complex geometrical relationships. The degree of seismic resolution and the punctual well-log lithostratigraphic data do not allow suitable reconstructions of these plays and, thus, the use of good outcrop analogues is crucial in their reservoir characterisations.
In this paper, we present the results of a sedimentological study carried on continental deposits filling a segment of the Oligo-Miocene south-eastern basin margin of the Sardinia Graben System, in the central-western Mediterranean. This well-exposed terrestrial succession results from the erosion of Palaeozoic metamorphic and magmatic basement rocks exposed along the basin margin. Continental, coarse-grained eluvio-colluvial, alluvial and fluvial sediments exhibit changes both in thickness and lateral extensions due to the existence of several endorheic depocentres, which were aligned along major normal faults.
Based on the stratigraphic and sedimentological analysis of a number of exposed stratigraphic sections, the main depositional processes are identified for each specific facies association. Due to the grain-size of the dominant deposits, porosity is estimated by using an image analysis software on high-resolution digital photographs from a number of outcrop samples. The results show how porosity changes dramatically across the reconstructed sections due to the complexity of the reciprocal geometrical passages among all these lithofacies.
The dominance of colluvial/alluvial fans or river braidplain systems and the different nature of sediment occupying each depositional areas are interpreted as the response to the interplay between the capacity generated by the vertical tectonic displacement of major normal-faults and the interception of the base-level with the topography of these mini-basins. Our observations suggest six possible depositional scenarios that resume as many reservoir types in fault-controlled half-grabens with dominant continental lithofacies.
•Hydrocarbon resources often occupy fault-bounded tectonic margins of extensional basins.•Sediments are often continental, coarse-grained but under a good seismic resolution.•The upper Oligocene of the Sardinian Graben System represents a good analogue for these systems.•Indirect porosity estimations indicate trends among colluvial, alluvial and fluvial deposits.•Six fault-controlled half-graben depositional/reservoir models are thus proposed.
Background
Cutaneous malignant melanoma metastases differential diagnosis is challenging, as clinical and dermoscopic features can simulate primary melanoma or other benign or malignant skin ...neoplasms, and in‐vivo reflectance confocal microscopy could assist. Our aim was to identify specific reflectance confocal microscopy features for cutaneous malignant melanoma metastases, and epidermal and dermal involvement.
Methods
A retrospective, multicentre observational study of lesions with proven cutaneous malignant melanoma metastases diagnosis between January 2005 and December 2016. Lesions were retrospectively assessed according to morphological features observed at reflectance confocal microscopy. Potential homogeneous subgroups of epidermal or dermal involvement were investigated with cluster analysis.
Results
Cutaneous malignant melanoma metastases (51 lesions in 29 patients) exhibited different frequencies of features according to metastasis dermoscopy patterns. Lesions classified at dermoscopy with nevus‐like globular and non‐globular patterns were more likely to be epidermotropic, showing characteristics of epidermal and dermal involvement at reflectance confocal microscopy. Other dermoscopy pattern classifications were more likely to be dermotropic, showing characteristics od dermal involvement at reflectance confocal microscopy. Distinguishing features at reflectance confocal microscopy included irregular (78%) and altered (63%) epidermis, pagetoid infiltration (51%), disarranged junctional architecture (63%), non‐edged papillae (76%), dense and sparse, and cerebriform nests in the upper dermis (74%), and vascularity (51%). Cluster analysis identified three groups, which were retrospectively correlated with histopathological diagnoses of dermotropic and epidermotropic diagnoses (P < 0.001). The third cluster represents lesions with deep dermis morphological changes, which were too deep for evaluation with reflectance confocal microscopy.
Conclusions
Specific reflectance confocal microscopy features of cutaneous malignant melanoma metastases for correct diagnosis, and subtype diagnosis, seem achievable in most cases where morphological alterations are located above the deep dermis.
Abstract Background and aims Diabetic women have a more adverse plasma lipid profile than men. Sex differences in dietary habits may play a role, but are little investigated. The study evaluates the ...quality of diet, adherence to the nutritional recommendations of the Diabetes and Nutrition Study Group and their relation with plasma lipid in men and women with diabetes. Methods and results We studied 2573 people, aged 50–75, enrolled in the TOSCA.IT study (clinicaltrials.gov; NCT00700856). Plasma lipids were measured centrally. Diet was assessed with a semi-quantitative food frequency questionnaire. Women had a more adverse plasma lipid profile than men. Women consumed significantly more legumes, vegetables, fruits, eggs, milk, vegetable oils, and added sugar, whereas men consumed more starchy foods, soft drinks and alcoholic beverages. This stands for a higher proportion (%) of energy intake from saturated fat and added sugar (12.0 ± 2.4 vs 11.5 ± 2.5 and 3.4 ± 3.2 vs 2.3 ± 3.2, P < 0.04), and a higher intake of fiber (11.2 ± 2.8 vs 10.4 ± 2.6 g/1000 Kcal/day) in women. Adherence to the recommendations for saturated fat and fiber consumption was associated with significantly lower LDL-cholesterol regardless of sex. Adherence to the recommendations for added sugars was associated with significantly lower triglycerides and higher HDL-cholesterol in men and women. Conclusions Men and women with diabetes show significant differences in adherence to nutritional recommendations, but sex differences in plasma lipid profile are unlikely to be explained by nutritional factors. Adherence to the nutritional recommendations is associated with a better plasma lipid profile regardless of sex, thus reinforcing the importance of substituting saturated for unsaturated fat sources, increasing fiber and reducing added sugar intake.
The purpose of this paper is to present a complete stratigraphic framework for the modern Simeto River delta (eastern Sicily, Italy) by the description of its geomorphology and sedimentology, which ...allow an analysis of its recent evolution.
The Simeto River delta represents an asymmetric wave-influenced delta which developed during the Holocene by prograding into the Catania Gulf.
This delta represents a good example of a Mediterranean-type system, characterized by a micro-tidal regime and moderate wave energy; the peculiar distribution of sedimentary facies both in the subaerial and in the subaqueous sectors is interpreted as the response of the system to the intimate interaction of geological and, in recent times, anthropogenic coastal activity.
The integration of a large amount of historical data allows the definition of prograding and retrograding pattern within the delta and the cyclical shifting of the river mouth over the last two centuries. A hypothetical model is proposed to explain this phenomenon, and it is suggested that this may be a characteristic of several Mediterranean-type deltas.
Progradation of the delta ended during the early–middle XIX Century after which it began to retreat. The retreat of the coastline accelerated after the 1950s when owing to the construction of embankments on the delta plain and, since 1970s, increasing diversion of water resources in the upper part of the Simeto River drainage basin, the sediment input of the river to the Ionian Sea sharply decreased. This caused a dramatic change of the deltaic morphology and significant coastal land loss.
The morphological and sedimentary features of the Simeto River fully reflect the processes of its adaptation to the persistence of coastal human activity within an active geological setting.
Coarse-grained, fluvially-dominated Gilbert-type braid deltas represent a volumetrically significant component of the Potenza Basin sedimentary infill, a small thrust-top structural depression that ...developed during the Pliocene in the Southern Apennines (Italy). Excellent exposure shows vertical and lateral relationships among facies assemblages that identify a suite of deltaic and non-deltaic depositional environments occupying semi-confined marine embayments along the southern–western basin margin. The succession is around 50 m thick and consists mainly of shoreface and offshore sands and clays, moderately wave-worked and covered by shoal-water deltaic clinostratified gravels.
The deltas are organized into two vertically-stacked sequences that display well-developed angular-to-tangential foresets and poorly-preserved topsets, and a suite of internal depositional architectures consisting of alternating progradational and aggradational geometries that were controlled by high-frequency, relative sea-level changes in a relatively slowly subsiding basin.
The common element that characterizes all the depositional architectures detected within the two main studied sections is the constant influence of coastal uplift on the deltaic systems during sediment accumulation. The tectonic control of the basin margin from which the deltas were sourced forced a forward-stepping (basinward) arrangement of stacked Gilbert-type braid deltas, and these produced clinoforms that become progressively younger toward the basin depocentre. The deltaic sequences show different offsets in their along-dip arrangement suggesting that the coastal margin was inclined at varying angles depending on the rates of the tectonic uplift.
Two end-members of Gilbert-type delta architectures are represented by concave- and flat-bottom deltas, prograding onto a mudstone and calcareous substrate, respectively. These two different Gilbert-type models reflect a different style of delta accretion during progradation, due to the response of the substrate to the erosion exerted from gravel avalanches.
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