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ABSTRACTGeneralized pustular psoriasis (GPP) is a rare chronic inflammatory skin disease that can lead to life-threatening complications and require emergency medical treatment. Recurrent GPP flares are characterized by the sudden onset of widespread erythematous skin rash with sterile pustules, at times associated with fever, chills, general malaise, and other systemic inflammatory manifestations. Systemic complications such as cardiorespiratory failure, infections, and sepsis are potentially life-threatening and can result in an emergency department visit and/or hospitalization. Acute GPP episodes can be difficult to recognize and diagnose. The low incidence of the disease, its relapsing nature, the unpredictability of flare onset, and the lack of standardized diagnostic criteria are major obstacles to achieving rapid recognition and diagnosis in both the emergency department and the hospital setting.There is scarce evidence supporting the efficacy and safety of treatments commonly used for GPP; consequently, there is an unmet need for therapies that specifically target the condition. Our aim is to present a multidisciplinary approach to GPP to achieve a rapid diagnosis ensuring that the patient receives the most appropriate treatment for their pathology. The main recommendation for primary care and emergency physicians is to contact a dermatologist immediately for advice or to refer the patient when GPP or a flare is suspected.

Oncoplastic breast-conserving surgery (OBCS) is increasingly used to treat breast cancer with the dual purpose of performing a radical oncological resection while minimizing the risk of post-operative deformities. The aim of the study was to evaluate the patient outcomes after Level II OBCS as regards oncological safety and patient satisfaction. Between 2015 and 2020, a cohort of 109 women consecutively underwent treatment for breast cancer with bilateral oncoplastic breast-conserving volume displacement surgery; patient satisfaction was measured with BREAST-Q questionnaire. The 5-year overall survival and disease-free survival were 97% (95%CI 92, 100) and 94% (95%CI 90, 99), respectively. In two patients (1.8%), mastectomy was finally performed due to margin involvement. The median patient-reported score for “satisfaction with breast” (BREAST-Q) was 74/100. Factors associated with a lower aesthetic satisfaction index included: location of tumour in central quadrant (p= 0.007); triple negative breast cancer (p= 0.045), and re-intervention (p= 0.044). OBCS represents a valid option in terms of oncological outcomes for patients otherwise candidate to more extensive breast conserving surgery; the high satisfaction index also suggests a superiority in terms of aesthetic outcomes.

IntroductionWhile there are no pharmacological treatments with proven efficacy for coronavirus disease 2019 (COVID-19), tocilizumab has emerged as a candidate therapy. Some aspects of this therapy are still unknown, including the optimal timing of administration.ObjectiveThis observational study aimed to compare the 90-day mortality in two cohorts of patients when the drug was administered within the first 10 days from onset of symptoms or after day 11.MethodsPatients hospitalised with severe COVID-19 pneumonia who had received tocilizumab were divided into two groups according to when the medication was administered. The primary outcome was 90-day mortality. Secondary outcomes were 30-day mortality, clinical improvement on a 6-item scale by day 6, biomarker improvement by day 6, radiological image improvement by day 10 and SaO2quotient by day 6. The results in the two groups were compared. Additionally, adverse events relating to tocilizumab were recorded.ResultsA total of 112 patients were analysed. Both groups were epidemiologically comparable. The results obtained in the primary efficacy variable of the study (90-day mortality) showed a statistically significant difference in the subgroups according to the time of administration of tocilizumab (18.6% vs 5.0%, p=0.048). There was clinical improvement in 24.1% of patients at 6 days, with similar behaviour in both subgroups. No statistically significant differences were found in the percentage of patients who achieved radiological improvement at 10 days or in the other inflammatory parameters, with the exception of significant reductions in lactate dehydrogenase and C-reactive protein. Administration of tocilizumab was not associated with relevant adverse events.ConclusionTo our knowledge, this is the first report of data regarding the timing of administration of tocilizumab in patients with COVID-19 pneumonia. A strategy involving tocilizumab administration after 10 days from onset of symptoms may decrease mortality. Further randomised controlled trials are needed to confirm this emerging hypothesis.

ABSTRACTCommunities of Practice (CoP) have the potential to transform the workplace into learning organisations that prioritise each and every child’s learning and foster collective responsibility, encouraging teachers to see themselves as change agents beyond their classrooms. Previous manifestations of collaborative teaming approaches have met with mixed success for reasons explored within this article. Still, these kinds of work spaces, when sustained over time, can transform the organisational culture of a school. In this article, we share a research-based framework designed to cultivate truly collaborative workplaces. This Community of Practice (CoP) Cookie framework is a major focus at the University of Florida Lastinger Center for Learning, an organisation dedicated to creating equitable education systems for teachers and students. The framework consists of four key elements: content, conditions, processes, and structures. We have implemented this framework repeatedly, honing our approach and contributing to educators’ success. At the end of the paper, a case study illustrates the approach in the hopes that other educators can learn from the lessons we have learned.

•Differences in vancomycin minimum inhibitory concentration (MIC) by different susceptibility testing methods.•Monitor local status of vancomycin MICs.•Vancomycin MIC creep is a regional problem.

Glutaric aciduria type I (GA-1) is an inborn error of metabolism with a severe neurological phenotype caused by the deficiency of glutaryl–coenzyme A dehydrogenase (GCDH), the last enzyme of lysine catabolism. Current literature suggests that toxic catabolites in the brain are produced locally and do not cross the blood-brain barrier. In a series of experiments using knockout mice of the lysine catabolic pathway and liver cell transplantation, we uncovered that toxic GA-1 catabolites in the brain originated from the liver. Moreover, the characteristic brain and lethal phenotype of the GA-1 mouse model was rescued by two different liver-directed gene therapy approaches: Using an adeno-associated virus, we replaced the defective Gcdhgene or we prevented flux through the lysine degradation pathway by CRISPR deletion of the aminoadipate-semialdehyde synthase (Aass) gene. Our findings question the current pathophysiological understanding of GA-1 and reveal a targeted therapy for this devastating disorder.

La situación anatómica de la articulación acromioclavicular nos permite realizar una evaluación mediante la observación y la palpación más sencilla que en la articulación glenohumeral. Sin embargo, el dolor proveniente de la misma puede irradiar a diferentes zonas del hombro, del brazo y del cuello y solaparse con otras afecciones. Por ello, es importante conocer las diferentes maniobras exploratorias, así como estar familiarizado con la interpretación de las pruebas de imagen.

F-doped ZnO films (FZO) of about 400 nm thicknesses were prepared on glass substrates by the chemical spray pyrolysis technique. X-ray diffraction patterns showed that the undoped and F-doped ZnO films exhibit the hexagonal wurtzite crystal structure with a preferential orientation along [002] direction. No secondary phase is observed in F-doped ZnO films. All films exhibit a transmittance around 80% in the visible range. Photoluminescence spectra at room temperature of undoped and F doped ZnO thin films are presented. The wide PL bands centered at 510 and 680 nm are characteristic of deep levels of oxygen vacancies in the ZnO matrix, and zinc interstitial position. The FZO films are degenerate and exhibit n-type electrical conductivity. The lowest electrical resistivity was 7.6 10−3 Ω cm.

L’étude MATURE a évalué l’efficacité, la sécurité, la tolérance et la pharmacocinétique de l’auto-injecteur (AI) 2mL de sécukinumab 300mg chez les patients atteints de psoriasis en plaques modéré à sévère. Nous rapportons ici les résultats de l’analyse du critère principal jusqu’à la semaine 16.

Little is yet known about the origin and protective mechanism of free nucleic acids in plasma. We investigated the possibility of these free nucleic acids being particle associated. Plasma samples from colon cancer patients and cell culture media were subjected to various antibody incubations, ultracentrifugation, and RNA extraction protocols for total RNA, epithelial RNA, and mRNA. Flow cytometry using a Ber-EP4 antibody and confocal laser microscopy after staining with propidium iodide were also performed. mRNA levels of the LISCH7 and SDHA genes were determined in cells and in culture media. Ber-EP4 antibody and polystyrene beads coated with oligo dT sequences were employed. We observed that, after incubation, total RNA and mRNA were always detected after membrane digestion, and that epithelial RNA was detected before this procedure. In ultracentrifugation, mRNA was caught in the supernatant only if a former lysis mediated or in the pellet if there was no previous digestion. Flow cytometry determinations showed that antibody-coated microbeads keep acellular structures bearing epithelial antigens apart. Confocal laser microscopy made 1- to 2-microm-diameter particles perceptible in the vicinity of magnetic polystyrene beads. Relevant differences were observed between mRNA of cells and culture media, as there was a considerable difference in LISCH7 mRNA levels between HT29 and IMR90 cell co-cultures and their culture media. Our results support the view that extracellular RNA found in plasma from cancer patients circulates in association with or is protected in a multiparticle complex, and that an active release mechanism by tumor cells may be a possible origin.

Results for a conducting polymer poly(3-methylthiophene) are presented with demonstration that the electrochemical deposition proceeds favourably through 3D instantaneous nucleation and growth. The polymer film is insulating at sufficiently negative 0.1 V or positive 1.6 V electrochemical potentials in propylene carbonate + LiClO4solution. When the solution was H2SO4the film was insulating in 0.5 V or 1.1 V. The macrogrowth occurred in three dimensions and showed disordered rough structures. According to the results for t<1 s the fractal dimension Ds=2.5 was obtained and for t>1 s this parameter was 2.0. The band gap energy of these material is ?1 eV characteristic for the polymer materials in oxidized state. This films have a lot of free charge carriers and this characteristic confers conductive properties to the material.