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Background Arthroplasties in elderly patients are surgeries performed to ensure their quality of life. Perioperative care with specific nutrients can improve nutrition status and metabolic response to orthopedic surgeries, such as total knee arthroplasty (TKA) and total hip arthroplasty (THA). Methods Retrospective study with elderly patients divided into 2 groups: control and immunonutrition. The immunonutrition group was instructed to start oral intake of the nutrition supplement 5 days before and to resume it 5 days after arthroplasty (200 mL, 3 times per day). The following were analyzed as primary and secondary outcomes: length of stay (LOS), infectious and noninfectious complications, need for intensive care unit (ICU), transfusion requirement, and C‐reactive protein. Results A total of 3015 elderly patients met the inclusion criteria: control group (n = 1398) and immunonutrition group (n = 1617). Overall, 81.2% were women and mean age was 72.6 ± 6.9 years. Immunonutrition group had a shorter LOS in hours (32.0 ± 19.4 vs 56.0 ± 26.4; P < .001) and lower rates of infectious complications (2.2% vs 4.6%; P < .001). Noninfectious complications and need for ICU also had lower rates in the immunonutrition group. In the logistic regression analysis, immunonutrition reduced the chance of infectious complications by 55% (odds ratio [OR], 0.45; 95% CI, 0.30–0.68; P < .001) even after adjusting for variables (OR, 0.45; 95% CI, 0.28–0.71; P < .001). Conclusion Perioperative immunonutrition in elderly patients undergoing THA or TKA may shorten postoperative LOS and reduce infectious and noninfectious complications and transfusion requirement.

The Solanum glaucophyllum Desf. has been used to treat and prevent diseases in human and veterinary medicine. On the other hand, plant poisoning causes several bone diseases, among them osteoporosis, which is characterized by osteoblastic hypoplasia. Because the osteoblast is a cell derived from the differentiation of mesenchymal stem cells (MSCs) from bone marrow, the hypothesis is that the plant reduces the osteogenic differentiation of MSCs. The objective of this study was to evaluate the effects of S. glaucophyllum Desf. extract on MSCs cultured in osteogenic differentiation medium. We determined by liquid chromatography that 1 ml of plant extract contained 3.8 μl of 1,25(OH)2 D3 (calcitriol). Four groups of MSCs cultivated in osteogenic medium were evaluated as follows: (a) treated with 100 μl of extract/L containing 0.4 μg/L of calcitriol; (b) treated with 1 ml of extract/L containing 4 μg/L of calcitriol; (c) treated with 5 ml of extract/L containing 20 μg/L of calcitriol; and (d) a control group without extract. We performed alkaline phosphatase activity assay, analysis of MTT conversion to formazan, and evaluated the percentage of cells, and number and diameter of mineralization nodules. The expression of gene transcripts for osteopontin, bone sialoprotein and BMP-2 was analysed by RT-qPCR. After 21 days, there was a significant reduction in MTT conversion to formazan in treated groups, of the cellularity in the group with 5 ml of extract/L, and in the number and size of mineralization nodules in the groups treated with 1 and 5 ml of extract/L. The 5 ml extract/L concentration also reduced transcript expression of osteopontin. It is concluded that S. glaucophyllum Desf. at concentrations of 1 and 5 ml extract/L reduced mineralized matrix synthesis in MSCs cultivated in osteogenic differentiation medium, which suggests that this is one of the mechanisms by which osteoporosis occurs in intoxicated animals.

Background: Psoriasis (Ps) is a chronic systemic autoimmune disease associated with pruritus in 64–98% of patients. However, few modestly sized studies assess factors associated with psoriatic pruritus. Objective: To investigate factors associated with Ps pruritus intensity. Methods: Psoriasis patients 18years or older seen in one of 155 centres in Italy between September 2005 and 2009 were identified from the Italian PsoCare registry. Patients without cutaneous psoriasis and those with missed information on pruritus were excluded. Results: We identified 10802 patients, with a mean age 48.8±14.3years. Mild itch was present in 33.2% of patients, moderate in 34.4%, severe in 18.7% and very severe in 13.7%. Higher itch intensity was associated with female gender, lower educational attainment compared to university degree, pustular psoriasis, psoriasis on the head, face, palmoplantar areas, folds and genitalia, more severe disease, disease duration

Because of the COVID‐19 emergency, on March 9, 2020 Italy went in lock‐down imposing the closure of non‐urgent outpatient clinics devoted to care of chronic, severe, inflammatory skin diseases that require periodic follow‐up. In this emergency situation, due to the lack of a teledermatology platform and in order not to leave our vulnerable high‐need patients without proper follow‐up, we started a teledermatologic service in smartworking using phone calls and emails. The total number of patients scheduled was 195; in 12 cases we were not able to talk to the patients. Remote monitoring was performed in 183 patients (126 moderate to severe psoriasis, 10 severe acne, 11 severe atopic dermatitis, 11 hidradenitis suppurativa, 9 blistering autoimmune diseases, 16 other autoimmune skin diseases). During remote‐visits several interventions were conducted: triage for COVID‐19 suspected symptoms, email check of clinical pictures and of laboratory examinations, advices for topical and systemic therapy continuation or discontinuation/switch and re‐schedule of next appointment. Only 5 patients required personal office visit (2.6%), reducing consistently the number of face‐to face visits. Our real‐life experience shows that remote monitoring was effective in preventing unnecessary worsening of severe chronic skin diseases and poor outcomes due to withdrawal of current therapy. This article is protected by copyright. All rights reserved.

Cutaneous squamous cell carcinoma (CSCC) represents the most common malignant tumour of the feline skin. Emerging evidence suggests that the phosphatidylinositol 3-kinase/Akt/mammalian target of rapamycin (PI3K/Akt/mTOR) signalling pathway may represent a potential target for pharmacological intervention in human and canine CSCC.The present study aimed to explore the expression pattern and status of activation of relevant signalling proteins of the PI3K/Akt/mTOR signalling pathway in feline CSCC.The expression of pEGFRThe immunodetection using phosphospecific antibodies to detect the activated forms of signalling proteins showed that the PI3K/Akt/mTOR signalling pathway is frequently activated in feline CSCCs, and may be independent of the activation of EGFR. The results also showed that PTEN expression is not significantly altered in feline CSCCs.Our study shows that the persistent activation of the PI3K/Akt/mTOR signalling pathway represents a key event in feline CSCC, pointing to this signalling pathway being a potential therapeutic target in feline patients with CSCC.Le carcinome épidermoïde cutané (CSCC) représente la tumeur maligne la plus fréquente de la peau chez le chat. Des preuves émergentes suggèrent que la voie de signal PI3K/Akt/mTOR (phosphatidylinositol 3-kinase/Akt/mammalian cible de rapamycine) pourrait représenter une cible potentielle pour le traitement pharmacologique de CSCC du chien et de l’homme. HYPOTHÈSES/OBJECTIFS: L’étude a pour objectif d’explorer le patron d’expression et le statut d’activation des protéines de la voie de signal PI3K/Akt/mTOR dans les CSCC du chat. MÉTHODES: L’expression de pEGFRTyr1068, pAktSer473, pS6Ser235/236 combinée avec Ki-67, et PTEN protéine suppresseur de tumeur a été évaluée par analyse immunohistochimique dans 45 échantillons de CSCC félins à l’aide de microéchantillons tissulaires. RÉSULTATS: L’immunodétection utilisant des anticorps phosphospécifiques pour détecter les formes activées de protéines de signal a montré que la voie de signal PI3K/Akt/mTOR est fréquemment activée dans les CSCC félins et pourrait être indépendant de l’activation de EGFR. Les résultats ont aussi montré que l’expression de PTEN n’est pas significativement altérée dans les CSCC du chat.Notre étude montre que l’activation persistante de la voie de signal PI3K/Akt/mTOR représente un événement clé dans les CSCC félins, pointant cette voie de signal comme potentielle cible thérapeutique chez les chats atteints de CSCC.INTRODUCCIÓN: el carcinoma cutáneo de células escamosas (CSCC) representa el tumor maligno más común de la piel felina. Nuevas evidencias sugieren que la vía de señalización fosfatidilinositol 3-quinasa /Akt/diana en mamífero de la rapamicina (PI3K/Akt /mTOR) puede representar un objetivo potencial para la intervención farmacológica en el CSCC humano y canino. HIPÓTESIS/OBJETIVOS: el presente estudio tuvo como objetivo explorar el patrón de expresión y el estado de activación de proteínas de señalización relevantes en la vía de señalización PI3K/Akt/mTOR en CSCC felinos. MÉTODOS: se evaluó la expresión de pEGFRDas kutane Plattenepithelkarzinom (CSCC) stellt den häufigsten bösartigen Tumor der Katzenhaut dar. Entstehende Evidenz deutet darauf, dass der Signalweg von Phosphatidylinositol 3-Kinase/Akt/Säugetier Target von Rapamycin (PI3K/Akt/mTOR) als möglicher Angriffspunkt einer pharmakologischen Intervention beim CSCC des Menschen und des Hundes dienen könnte.Die vorliegende Studie zielte darauf ab, das Exprimierungsmuster und den Status der Aktivierung relevanter Signalproteine des PI3K/Akt/mTOR Signalwegs des CSCCs der Katze zu untersuchen.Die Exprimierung von pEGFRDie Immundetektion mittels Phospho-spezifischer Antikörper, um die aktivierten Formen des Signalproteins zu finden, zeigte, dass der PI3K/Akt/mTOR Signalweg häufig bei felinen CSCCs aktiviert wird und von der Aktivierung von EGFR unabhängig sein könnte. Die Ergebnisse zeigten, dass die Exprimierung von PTEN bei felinen CSCCs nicht signifikant verändert waren.Unsere Studie zeigt, dass die persistierende Aktivierung des PI3K/Akt/mTOR Signalweges ein Schlüsselevent beim felinen CSCC darstellt, was zeigt, dass dieser Signalweg ein potentieller therapeutischer Ansatzpunkt für feline Patienten mit CSCC sein könnte.背景: 膚扁平上皮癌 (CSCC) は、猫の皮膚の最も一般的な悪性腫瘍である。新たなエビデンスは、ホスファチジルイノシトール3-キナーゼ/ Akt /哺乳類のラパマイシン標的 (PI3K / Akt / mTOR) シグナル伝達経路が、ヒトおよびイヌのCSCCにおける薬理学的介入の潜在的な標的となる可能性があることを示唆している。 仮説/目的: 本研究は、ネコのCSCCにおけるPI3K / Akt / mTORシグナル伝達経路の関連するシグナル伝達タンパク質の発現パターンおよび活性化の状態を調査することを目的としている。 方法: Ki-67と組み合わせたpEGFRTyr1068、pAktSer473、pS6Ser235 / 236、および腫瘍抑制タンパク質PTENの発現を、組織マイクロアレイ法を使用して、ネコCSCCの45サンプルで免疫組織化学的分析によって評価した。 結果: リン酸化特異的抗体を使用してシグナル伝達タンパク質の活性化型を検出する免疫検出は、PI3K / Akt / mTORシグナル伝達経路がネコのCSCCで頻繁に活性化され、EGFRの活性化とは無関係である可能性があることを示した。結果は、PTEN発現がネコのCSCCで有意に変化しないことも示した。 結論と臨床的重要性: 我々の研究は、PI3K / Akt / mTORシグナル伝達経路の持続的な活性化がネコCSCCの重要なイベントであり、このシグナル伝達経路がCSCCに罹患したネコの潜在的な治療標的であることを示している。.背景: 皮肤鳞状细胞癌(CSCC)是猫皮肤最常见的恶性肿瘤。新出现的证据表明, 磷脂酰肌醇3-激酶/Akt/哺乳动物雷帕霉素靶蛋白(PI3K/Akt/mTOR)信号通路可能代表人和犬CSCC药理学干预的潜在靶点。 假设/目的: 本研究旨在探索猫CSCC的PI3K/Akt/mTOR信号通路相关信号蛋白的表达模式和活化状态。 方法: 45只CSCC猫样本, 使用组织微阵列, 经免疫组化分析, 评估其pEGFRO carcinoma de células escamosas (CCE) representa o tumor maligno mais comum da pele de felinos. Evidências recentes sugerem que a via de sinalização da fosfatidilinositol 2-quinase/Akt/alvo mamífero da rapamicina (PI3K/Akt/mTOR) pode ser um alvo potencial de intervenções farmacológicas no CCE humano e canino. HIPÓTESE/OBJETIVOS: O presente estudo objetivou explorar o padrão de expressão e o status de ativação das proteínas sinalizadoras relevantes da via de sinalização PI3K/Akt/mTOR no CCE felino. MÉTODOS: A expressão de pEGFRA imunodetecção utilizando anticorpos fosfoespecíficos para detectar as formas ativas de proteínas de sinalização demonstraram que a via de sinalização PI3K/Akt/mTOR é frequentemente ativada no CCE felino, e pode ser independente da ativação de EGFR. Os resultados também demonstram que a expressão de PTEN não está significativamente alterada no CCE felino. CONCLUSÕES E IMPORTÂNCIA CLÍNICA: Nosso estudo revelou que a ativação persistente da via de sinalização PI3K/Akt/mTOR representa um evento chave na CCE felina, indicando que esta via de sinalização representa um alvo terapêutico potencial em pacientes felinos com CCE.

Slender walls with discontinuities at their bases, such as flag walls or walls with door openings or access, are common in Chilean practice because of the architectural requirements at facades, first floors, and underground levels. However, there is limited information about the behavior of such elements, and no designs or guidelines in the current codes consider the effects of discontinuities at the base. In this work, two analytical models are presented that estimate the yield displacement, yield curvature, and ultimate curvature of walls with openings, such as flag walls (setback), based on the dimensions of the opening and the longitudinal boundary steel ratio calibrated from a parametric analysis of a nonlinear finite element model. The results indicate that these discontinuities can have a major impact on the elastic displacement, reducing it because of the presence of a more rigid section above the opening, and also on the inelastic component, by increasing the curvature (and the strain) at the wall base because the opening tends to confine the plastic hinge within that area.

Fil: Martinez, Daniel Emilio. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Centro Cientifico Tecnologico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencia Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; Argentina. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Instituto de Geologia de Costas y del Cuaternario. Provincia de Buenos Aires. Gobernacion. Comision de Investigaciones Cientificas. Instituto de Geologia de Costas y del Cuaternario; Argentina

SUMMARY Previous earthquakes, such as the 2010 Maule earthquake in Chile, have demonstrated the need to establish suitable predictors of compressive or tensile strains in concrete or steel in reinforced concrete shear walls, which can provide limit states or confinement requirements. Slender walls are commonly controlled by flexural deformations that can be divided into elastic and inelastic components. This study provides calibrated expressions for the elastic and inelastic components of flexural deformations using a fiber model for slender walls. These expressions are obtained for rectangular and T-shaped walls. The elastic component is dependent on the axial load and the boundary steel reinforcement ratio. The impact of wall coupling is investigated, which requires a correction for the elastic component. The investigation of the inelastic component is based on a plastic hinge model, in which the length of the plastic hinge is a function of the lateral inelastic drift of the wall among other parameters. The traditional linear inelastic curvature distribution over the wall height is also modified for cases with steel reinforcement with a long yield plateau or low strain hardening, which results in a larger curvature at the wall base. The distribution is validated with experimental data from the literature. Copyright © 2016 John Wiley & Sons, Ltd.

We describe a computational approach for the automatic recognition and classification of atomic species in scanning tunnelling microscopy images. The approach is based on a pipeline of image processing methods in which the classification step is performed by means of a Fuzzy Clustering algorithm. As a representative example, we use the computational tool to characterize the nanoscale phase separation in thin films of the Fe-chalcogenide superconductor FeSex Te1-x , starting from synthetic data sets and experimental topographies. We quantify the stoichiometry fluctuations on length scales from tens to a few nanometres.

Objectives Performance improvement programs in emergency medicine (EM) have evolved beyond peer reviews of referred cases and now encompass a large set of quality metrics that are measured proactively. However, peer review of cases continues to be an important element of performance improvement, and selection of cases tends to be driven by an ad hoc referral process based on concerns about problems with care in the emergency department (ED). In the past decade, there has been widespread hospital adoption of rapid response teams (RRTs) that respond to patients who decline clinically to reduce adverse outcomes. In an effort to cast a wider net, to take a more systematic approach, and to avoid “blind spots” from individual variability in criteria for referring cases, the institution instituted a new process for selecting cases for ED peer review based on RRT activations within 24 hours of admission from the ED. The hypothesis was that a formal process for review of these activation cases would increase the number of cases for peer review. Methods This was a prospective, observational study conducted from July 1, 2012, to June 30, 2013, at an urban, academic medical center with an EM residency program. A new automated monthly report was created, capturing all RRT activations within 24 hours of admission from the ED. All events were reviewed by three physicians from the ED performance improvement committee to examine for systems issues, individual provider issues, or both, that might yield opportunities for improvement. Cases with potential opportunities were reviewed by the full ED performance improvement committee. Cases were classified according to the indication for response team activation using the system outlined by the U.S. Agency for Healthcare Research and Quality. Results During the study period 61,814 patients were treated in the ED, and 13,067 were admitted to inpatient status. Thirty-two RRT activations within 24 hours of admission from the ED occurred among these admitted patients, representing 0.24% of admissions (95% confidence interval [CI] = 0.16% to 0.33%). Of the 32 cases, only one was also referred independently for ED performance improvement review via the traditional ad hoc process. During the same period of time, 85 cases were referred to the ED performance improvement committee via the traditional ad hoc referral process. Thus, the RRT cases added an additional 31 cases, or 36.5%, to the 85 cases reviewed in ED performance improvement. Of the 32 cases, two were determined by the performance improvement committee to have individual provider factors in their ED care, which contributed to the clinical decline triggering the response teams; none had system factors. Most of the response team activations were for neurologic changes (n = 13) and respiratory status changes (n = 12). In two cases there was long-term morbidity or mortality related to the team activation event; in neither of these cases were ED system or individual provider factors judged to have contributed. Conclusions The review of RRT activations within 24 hours of admission from the ED significantly supplemented the typical ad hoc referral system for peer review of cases, highlighting cases that likely would not have received attention within the ED. This novel and unique case review process revealed opportunities for education and performance improvement. This and other systematic approaches to case detection may be useful adjuncts to traditional case referrals for review. Resumen Objetivos Los programas de mejora del rendimiento (MR) en Medicina de Urgencias y Emergencias (MUE) han evolucionado mas alla de las revisiones por pares de los casos referidos y actualmente abarcan un amplio conjunto de indicadores de calidad que son medidos de forma proactiva. Sin embargo, la revision por pares de los casos continua siendo un elemento importante de la MR, y la seleccion de los casos tiende a ser llevada a cabo por un proceso de referencia ad hoc basado en las preocupaciones acerca de los problemas de la atencion en el servicio de urgencias (SU). En la ultima decada, ha habido una adopcion generalizada en los hospitales de los equipos de respuesta rapida (ERR), que responden a los pacientes que empeoran clinicamente con el fin de reducir los resultados adversos. En un esfuerzo por lanzar una red mas amplia, para adoptar un enfoque mas sistematico y para evitar los “puntos ciegos” de la variabilidad individual en los criterios de los casos referidos, la institucion inicio un nuevo proceso para seleccionar los casos del SU basado en la revision por pares en las activaciones de los ERR en las primeras 24 horas del ingreso desde el SU (ERR24SU). La hipotesis fue que un proceso formal para la revision de casos de los ERR24SU aumentaria el numero de casos para la revision por pares. Metodos Estudio observacional prospectivo llevado a cabo en un centro medico universitario urbano con un programa de residencia en MUE desde el 1 de julio de 2012 hasta el 30 de junio 2013. Se creo un nuevo informe mensual automatizado, que capturo todos los eventos de los ERR24SU. Todos los eventos se revisaron ​​por tres medicos de la comision de MR del SU para examinar los sistemas y/o problemas del sanitario individual que podrian generar oportunidades para la mejora. Los casos con oportunidades potenciales se revisaron ​​por todo el comite de MR del SU. Los casos se clasificaron segun la indicacion para la activacion de los ERR usando el sistema descrito por la Agency for Healthcare Research and Quality. Resultados Durante el periodo de estudio 61.814 pacientes fueron atendidos en el SU y 13.067 fueron hospitalizados. Treinta y dos eventos de los ERR24SU ocurrieron en estos pacientes ingresados​​, lo que represento un 0,24% de los ingresos (IC 95% = 0,16% al 0,33%). De los 32 casos de los ERR24SU, solo uno se remitio tambien de forma independiente para su revision al comite de MR del SU a traves del proceso tradicional ad hoc. Durante el mismo periodo de tiempo, 85 casos se remitieron a la comision de MR SU a traves del proceso de remision tradicional ad hoc. Por lo tanto, los casos de los ERR24SU anaden 31 casos adicionales, o un 36,5%, a los 85 casos examinados en la MR SU. De los 32 de los casos ERR24SU, en dos el comite de MR determino que habia factores individuales del sanitario en la atencion en el SU que contribuyeron al deterioro clinico y desencadenaron el ERR; mientras que en ninguno hubo factores relacionados con el sistema. La mayoria de activaciones de los ERR fueron por alteraciones neurologicas (n = 13) y cambios del estado respiratorio (n = 12). En dos casos hubo morbilidad o mortalidad a largo plazo relacionada con el evento del ERR, y en ninguno de estos casos se juzgo que los factores del sanitario individual o del sistema hubieran contribuido. Conclusiones El proceso de los ERR24SU suplementa de forma significativa el sistema referido ad hoc tipico para la revision por pares de los casos, y detecta casos que probablemente no habrian sido considerados en el SU. Este proceso de revision de casos novedoso y unico revelo oportunidades para la formacion y la MR. Esta y otras aproximaciones sistematicas de deteccion del caso pueden ser complementos de utilidad a los casos tradicionales referidos para su revision.

Background Incidence rates of malignant melanoma have been increasing worldwide and metastatic melanoma is still a significant problem despite widespread prevention programmes. Objectives We made a systemic review of all metastasized melanoma patients treated at the Department of Dermatology, Medical University of Graz in the years 2000–2010 and looked at the kind of melanoma type, e.g. if it has been slowly growing superficial spreading melanoma (SSM) or fast growing nodular melanoma (NM). Methods Histological slides and clinical images of patients treated at our department between 2000 and 2010, who received chemotherapy because of proven metastatic disease were analysed with regard to growth type of their primary tumours. Results A total of 88 patients met the inclusion criteria. Mean age of all patients was 57 years (median 59 years, SD ± 15 years). Of these 88 patients 51 patients (58%) (28 male patients and 23 female patients) had SSM; mean age 58 years (median 58 years, SD ± 14 years) and 37 patients (42%) (18 male patients and 19 female patients) had NM; mean age 56 years (median 61 years, SD ± 17 years). Mean Breslow thickness in the SSM group was 2.26 mm (median: 1.6 mm, SD ± 2.11 mm). In the NM group, mean Breslow thickness was 4.59 mm (median: 3.50 mm, SD ± 4.07 mm). When separated by gender, 46 melanomas were seen in the male group (28 SSM and 18 NM) and 42 melanomas in the female group (23 SSM and 19 NM). Conclusions Our results showed that more than half of the patients with metastatic disease had SSMs and not, as suspected, NMs. As SSMs are growing over a longer period to become invasive and potentially metastatic, there might be a chance to focus primary and secondary prevention programmes not only on fast growing tumours but also on slowly changes of tumours.

Background Leprosy is far from being eliminated with more than 200 000 new cases detected (NCD)/year. Objective Retrospective analysis between 2003 and 2009 to compare the New Case Detected Rate (NCDR) observed in Italy in the immigrant population with the NCDR of the same population in their country of origin to verify if the cases observed are those expected or not. Methods Leprosy statistics were retrieved from the Italian leprosy register and from official WHO data. Results The NCD in Italy were lower than expected, from 2003 when the expected number of NCD was 40.5 between the legally resident immigrants, but only one case was diagnosed (98% of lower from the expected), to 2009 when four NCD were diagnosed and 41 were expected (90% lower from expected). Conclusions This study points out a discrepancy between the observed and the expected cases of leprosy in Italy. Specifically, the number of NCD was less than expected for each studied year. Of course our data do not represent a validation, but only an indication of the leprosy diagnosis in Italy. Difficulty in accessing the health systems, fear of segregation, ignorance and illegal immigrant status with consequent fear of police arrest are possible explaining factors. The critical issue anyhow is the medical expertise. The role of the dermatologist is fundamental. For these reasons, there is still a need for wide spread leprosy teaching programmes. Although with few limitations, this study represents a first approach to validate the accuracy in leprosy diagnosis in Italy. © 2011 The Authors. Journal of the European Academy of Dermatology and Venereology

Summary Phaeohyphomycosis is a distinct mycotic infection of the skin or internal organs caused by darkly pigmented (dematiaceous) fungi, which are widely distributed in the environment. Phaeohyphomycosis is most frequently an opportunistic infection in immunosuppressed patients (HIV, corticotherapy, transplant patients) or is frequently associated with chronic diseases and diabetes. The spectrum of the disease is broad and includes superficial infections, onychomycosis, subcutaneous infections, keratitis, allergic disease, pneumonia, brain abscesses and disseminated disease. Rarely, immunocompetent patients may be affected. We describe two new cases of subcutaneous phaeohyphomycosis in immunocompetent patients: in the first patient, the causative agent was Exophiala jeanselmei, a common cause of phaeohyphomycosis; and in the second, Cladophialophora carrionii, which could be identified by culture. Cladophialophora carrionii is mainly the aetiological agent of chromoblastomycosis and only rarely the cause of phaeohyphomycosis. The first patient was treated with surgical excision and oral itraconazole, and the second patient responded to oral itraconazole only. Lesions improved in both patients and no recurrence was observed at follow-up visits.

Background Telemedicine could be useful in countries like Italy to meet the needs of elderly patients and in particular in those in precarious general conditions, for whom travelling even short distances can pose considerable practical and economical difficulties. Objective The aim of this study was to determine the efficacy of store-and-forward teledermatology vs face-to-face consultations in elderly patients. Methods A total of 130 geriatric patients with skin diseases requiring dermatological examination were enrolled. The patients examined, consisting of 60 men (46.15%) and 70 women (53.85%), were aged between 66 and 97 years (mean age 80.58 years). Three dermatologists of the department, with equal experience took turns in face-to-face examination and teledermatology (store-and-forward). To compare face-to-face dermatological examinations with the asynchronous store-and-forward approach of teledermatology, we considered diagnostic agreement (ICD-9 code), therapeutic agreement and concordance of diagnostic confidence. Results One hundred and fourteen of 130 patients were diagnosed with the same ICD-9 code, making a total observed agreement of 87.7% with a Cohen's κ estimated of 0.863. Agreement between therapies was 69.6% (Cohen's κ = 0.640). As it concerns diagnostic confidence, dermatologists appeared generally slightly less certain of their diagnosis by telemedicine. Conclusions Store-and-forward teledermatology can improve diagnostic and therapeutic care for skin disease in elderly who lack easy and/or direct access to dermatologists.

Purpose: The aim of this work is to present an updated implementation of total skin electron therapy (TSET) using IAEA TRS-398 code of practice for absolute dosimetry and taking advantage of the use of radiochromic films. The optimization of quality control tests is also included. Methods: A Varian 2100 C/D linear accelerator equipped with the special procedure HDTSe{sup -} (high dose rate total skin electron mode, E=6 MeV) was employed to perform TSET irradiations using the modified Stanford technique. The commissioning was performed following the AAPM report 23 recommendations. In particular, for dual-field beams irradiation, the optimal tilt angle was investigated and the dose distribution in the treatment plane was measured. For a complete six dual-field beams irradiation, the treatment skin dose on the surface of a cylindrical phantom was evaluated by radiochromic films and the B factor which relates the single dual-field skin dose to the six dual-field skin dose was assessed. Since the TRS-398 reference conditions do not meet the requirements of TSET absolute dosimetry, GafChromic EBT films were also employed to check and validate the application of the protocol. Simplified procedures were studied to verify beam constancy in PMMA phantoms without the more difficult setup of totalmore » skin irradiation. Results: The optimized geometrical setup for dual-field beams was: Tilt angle={+-}19 deg., SSD=353 cm, and the beam degrader (200x100x1 cm{sup 3}) placed at 320 cm from the source. As regards to dose homogeneity in the treatment plane, for dual-field beams irradiation, the mean relative dose value was 97%{+-}5% (normalizing to 100% at the calibration point level). For six dual-field beams irradiation, the multiplication factor B was 2.63. In addition, beam quality, dose rate, and bremsstrahlung contribution were also suitable for TSET treatments. The TRS-398 code of practice was used for TSET dosimetry, as dose measurements performed by ionization chamber and radiochromic film agreed within 2.5%. Simplified quality control tests and baseline values were presented in order to check flatness, symmetry, and field size with radiochromic films and output and beam quality constancy with ionization chamber. Short-term reproducibility and MU linearity tests were also included. Conclusions: Commissioning parameters met the requirements of TSET treatments and the matching of AAPM guidelines with the IAEA code of practice was successful. Frequent beam performance controls can be easily performed through the presented quality assurance tests. Radiochromic dosimetry facilitated the TSET commissioning and played a major role to validate the application of TRS-398.« less

Background: Cutaneous infectious and inflammatory diseases may contain a significant number of CD30-positive cells, thus mimicking lymphomatoid papulosis (LyP) or anaplastic large cell lymphoma. Methods: We reviewed our cases of non-neoplastic skin conditions with large, CD30-positive cells and searched the literature for similar cases. Results: A total of 28 cases were included in the study: Milker’s nodule (n = 8), Herpes simplex virus infection (n = 7), lymphomatoid drug reaction (n = 3), molluscum contagiosum (n = 3), nodular scabies (n = 2), leishmaniasis (n = 1), syphilis (n = 1), pernio (n = 1), ruptured infundibular cyst (n = 1) and pseudolymphoma in a scar (n = 1). CD30-positive cells were often arranged in clusters and revealed both Golgi and membrane positivity, similar to what was observed in LyP and CD30+ anaplastic large T-cell lymphoma. Conclusions: Analysis of our data and of those published in the literature shows that viruses and drugs are the most common cause for occurrence of large CD30-positive cells in cutaneous pseudolymphomatous infiltrates. Arrangement of these large, CD30-positive cells in small clusters is not unique to cutaneous CD30-positive lymphomas, and in many cases a precise diagnosis can be made only upon accurate clinicopathological correlation or using ancillary methods such as polymerase chain reaction analysis for viral DNA.

Background/purpose: Polymorphic light eruption (PLE) is a common photodermatosis of potential autoimmune origin, and an overlap with lupus erythematosus (LE) has been described. Plasmacytoid dendritic cell (PDC)-induced expression of interferon (IFN)-α has been found to be present in LE skin lesions and plays a pivotal role in the pathogenesis of LE by promoting autoimmunity. We therefore asked whether PDCs may also be involved in the pathogenesis of PLE and searched for those cells [which can be identified by their high levels of interleukin (IL)-3 receptor α chain (CD123), combined with other cell markers such as CD68] in skin lesions. Methods: Paraffin-embedded biopsy specimens from a total of 27 patients with clinically and histologically confirmed PLE (nine women, mean age 32.7 years, age range 18–43), LE (seven women, four men, CCLE: n=4, SCLE: n=2, lupus tumidus: n=5, mean age 48.5 years, age range 41–65) or psoriasis (four women, three men, mean age 43.3 years, age range 19–54) (as control group) were analyzed by immunohistochemical CD68/CD123 double staining. Quantification of the immunohistochemical staining was performed by visual cell counting of CD68−/CD123+, CD68+/123–, and CD68+/CD123+ cells separately in the epidermis and dermis of the samples in at least 10 random fields per sample at × 400 microscopic magnification by two of the investigators in a blinded fashion. Results: Microscopic examination of the immunohistochemically stained sections revealed that CD68+/CD123+ cells were present in most specimens obtained from LE [10/11 (91%)] and psoriasis [6/7 (86%)] patients but not at all in those obtained from PLE patients. Quantification and statistical analysis of the dermal infiltrate revealed that CD68+/CD123+ cells were present at a mean±SEM field density of 5.6±1.3 in LE, 1.6±0.6 in psoriasis but totally absent in PLE (P=0.0010 vs. LE, P=0.0135 vs. psoriasis by an unpaired Student's t-test). Conclusion: The results confirm the potential significance of PDCs in LE and psoriasis, however the absence of PDCs in PLE contradicts the hypothesis that these cells might play a role in the latter disease.

Telemedicine is the practice of healthcare using interactive processes of communication to facilitate healthcare delivery, including diagnosis, consultation and treatment, as well as education and transfer of medical data. The aim of teledermatology, just as telemedicine, is to promote best practice procedures and to improve the consistency and competence of health care.To investigate the diagnostic additive value of second opinion teleconsulting in patients with challenging dermatoses, among dermatologists working in two different dermatology departments.Thirty-three cases of patients with challenging inflammatory and neoplastic skin diseases at the University of L'Aquila Department of Dermatology were sent for teleconsultation to the Department of Dermatology, Medical University of Graz, Austria.All cases were selected in the outpatient service in L'Aquila. After face-to-face consultation with a local colleague had been completed, images were sent using a store-and-forward (SAF)-based system (http://www.telederm.org) to Graz. Histopathological examination together with follow-up of the patient represents the diagnostic gold standard for this study.Telediagnosis was correct in 26 of 33 (78.8%) cases. Sixteen of 33 cases (48.5%) had already been diagnosed face-to-face by at least one of the two dermatologists in L'Aquila. In 10 of 33 cases (30.3%), the correct diagnosis was made in teleconsultation only.Second opinion teleconsulting may represent an additive value in the diagnosis of numerous challenging inflammatory and neoplastic skin diseases. It may be particularly useful as a best practice model for smaller departments in order to discuss and/or to confirm diagnoses and also for the management of patients with unusual difficult dermatoses.

BACKGROUND Subcutaneous T-cell lymphoma (STCL) represents a controversial entity and a confused concept in the field of cutaneous T-cell lymphomas (CTCLs). Recently, alpha/beta+/CD8+ STCL has been recognized by the new World Health Organization (WHO)-European Organization for Research and Treatment of Cancer (EORTC) classification of primary cutaneous lymphomas as a distinct entity in the group of CTCLs. OBSERVATIONS We reviewed a series of 53 biopsies from 26 patients (F : M = 19:7; median age: 48; range 18-87) of cutaneous B- and T-cell lymphomas characterized by prominent involvement of the subcutaneous tissue. We could classify our cases according to the following seven categories--(i) STCL: n = 16; (ii) extranodal NK/T-cell lymphoma, nasal type: n = 2; (iii) cutaneous gamma/delta T-cell lymphoma: n = 2; (iv) anaplastic CD30+ large T-cell lymphoma: n = 1; (v) diffuse large B-cell lymphoma, secondary cutaneous: n = 3; (vi) lymphoplasmacytic lymphoma, secondary cutaneous: n = 1; (vii) specific cutaneous manifestations of myelogenous leukemia: n = 1. CONCLUSIONS We demonstrated the protean nature of lymphomas with prominent involvement of the subcutaneous fat tissues. The term STCL should be restricted to a homogeneous group of cases characterized morphologically by an exclusive involvement of subcutaneous tissues, immunohistochemically by a T-cytotoxic alpha/beta phenotype, and biologically by a relatively good prognosis.

A 10-year-old male Briard dog was presented because of listlessness, abnormal gait, fever, inappetence, and seizures. A non-pigmented growth was observed in the ventral quadrant of the left iris. Thoracic radiographs revealed multiple pulmonary metastases and the owner opted for killing. On necropsy, lung masses and nodules in left iris, right adrenal medulla, and brain were detected. Histologically the primary tumour was diagnosed as pulmonary adenocarcinoma with predominant solid pattern. Metastases to regional lymph nodes, uvea, adrenal medulla, and brain were recognized. The metastatic behaviour resembled that occurring in humans. To the authors' knowledge, this is the first report of a pulmonary adenocarcinoma with metastasis to the uvea in a dog.

Innovation in manufacturing is driven by the globalization of competition, differentiation in demand, the shortening of the product lifecycle and the managerial innovations adopted by companies in response to the environment. Innovation has generated the new modular production system that allows greater product variety and variability. This new modular pattern in manufacturing determines a change in the priority list concerning human factors. Cognitive cooperation among all stakeholders in the manufacturing process, from suppliers to managers and workers, becomes the new focal point that must be developed and supported to ensure excellent performance of the modular factory and reasonable margins of identification for the persons performing the processes. The authors argue that both change management practices of a prescriptive type and those based solely on commitment are bound to fail in the medium term, as they are unable to address the autogenous character of change. If long-lasting change is to be generated, managers must understand and define the desires, intentions, and values denoting the subjective and collective identities of communities of persons at work; they must not be interested in direct self-promotion of that particular type of change that fits in with their own original characters and their history. This pragmatic principle applies both to the internal processes of the modular factory and to those external processes that link the company to its suppliers. In sum, it is the authors' view that the new horizons of human factors in manufacturing no longer rely on the best match between people, technologies, and the organization, as the capability to create cognitive spaces to construct new meanings. © 2005 Wiley Periodicals, Inc. Hum Factors Man 15: 403–419, 2005.

The purpose of this study was to investigate gene expression in Alzheimer's disease (AD), the most common form of senile dementia. We utilized the microarray technology to simultaneously compare the expression profile of 12,000 human genes in cerebral cortex of AD and normal aging. To identify gene expression related to neurodegeneration, beside the presence of amyloid deposition, we used control brains with abundant amyloid plaques, derived from cognitively normal elderly subjects. The microarray analysis indicated that 314 genes were differentially expressed in AD cerebral cortex, with differences greater than 5 folds in 25 genes. RT-PCR performed on a selected group of genes confirmed the increased expression of the interferon-induced protein 3 in AD brain. This protein, which is highly inducible by both type I and type II interferons, was not previously associated with the neurodegenerative disease.