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Background: Little is known about the involvement of human herpesviruses 6 and 7 (HHV-6 and HHV-7) in autoimmune connective tissue diseases (ACTD). Objective: To determine the prevalence of active infection with HHV-6 and HHV-7 in patients with ACTD. Study design: The presence and quantity of HHV-6 DNA was determined by quantitative real-time PCR in a cross-sectional study of serum, peripheral blood mononuclear cells, and tissues obtained from 58 ACTD patients and 38 healthy subjects (HS). Specific anti-HHV-6 antibody titer was also measured. Results: HHV-6 serum viremia occurred in a significantly higher proportion of ACTD patients compared to HS [26/58 (44.8%) vs. 1/38 (2.6%), p = 0.001] with the highest reactivation frequency [7/10 (70%)] observed in patients with scleroderma. Moreover, HHV-6 in serum was associated with ACTD activity (22/38 vs. 4/20, p < 0.05). Higher titers of HHV-6 antibodies were found in ACTD patients than in HS, although HHV-6 seroprevalence among patients with ACTD and HS was similar. HHV-7 viremia was not detected in any patients or HS controls. Conclusion: The frequent reactivation of HHV-6 in scleroderma and other ACTD, especially when active, suggests that HHV-6 may play a role in the pathogenesis of these diseases. © 2009 Elsevier B.V. All rights reserved

Recent research in economics suggests a positive association between self-esteem and earnings. A major problem in this literature is that from simple cross-sectional wage regressions it is not possible to conclude that self-esteem has a causal impact on earnings. While classical measurement error leads to an attenuation bias, reverse causality and omitted variable are likely to drive the OLS coefficient on self-esteem upward. Using the National Longitudinal Survey of Youth (NLSY) that administered the Rosenberg Self-Esteem Scale during the 1980 and 1987 interviews, I provide further evidence for the existence of a self-esteem premium by exploiting variation in these measures in the two years. I show that the estimated impact of self-esteem in 1987 on earnings is about two times greater than previous OLS estimates would imply. The main explanation for this result is the large extent of measurement error in the reported self-esteem measure.

Pityriasis rosea is an acute, self-healing exanthem characterized by oval erythematous-squamous lesions of the trunk and limbs, that usually spares face, scalp, palms, and soles. Constitutional symptoms, which have the character of true prodromes; clinical features, which resemble those of the known exanthems; and many epidemiologic data all suggest an infectious origin. A host of infectious agents have been incriminated, but, recently, human herpesvirus 6 and 7 have been extensively studied. The goal of this review is to outline the epidemiologic, clinical, histologic, and ultrastructural features of pityriasis rosea, but mainly to stress its possible human herpesvirus nature. In addition, clues have been added to help the reader to go through the complex subtleties of the virologic investigation. © 2008 American Academy of Dermatology, Inc.

The heterodimeric cytokine IL-12 (composed of a p35 and a p40 subunit) is produced primarily by monocytes, macrophages and B cells. In vitro and in vivo experiments have demonstrated the crucial role of IL-12 in initiating and establishing both innate immunity and T cell-mediated resistance to intracellular pathogens, including Leishmania donovani, Toxoplasma gondii, Listeria monocytogenes, and Mycobacterium tuberculosis. Assessment of cytokine expression has thus become crucial to understand host responses to infections. In this study, by using the reverse transcriptase-real time PCR we developed a highly specific and sensitive assay to quantitatively evaluate IL-12p40 mRNA transcription levels in peripheral blood mononuclear cells (PBMCs) stimulated with PHA vs. unstimulated cells. We also used the ELISA to evaluate bioactive IL-12 release in culture supernatants. We provide evidence that IL-12 p40 mRNA levels were significantly up-regulated in PHA-activated PBMCs. These results were correlated with data of IL-12 levels obtained by ELISA.

Background The effect of pityriasis rosea (PR) on the outcome of pregnancy has not been previously reported. Objective We sought to investigate the possible impact of PR in pregnant women. Methods In all, 38 women who developed PR during pregnancy were observed. In one of them, who developed PR at 10 weeks' gestation and aborted 2 weeks later, plasma, peripheral blood mononuclear cells, maternal skin, and placental and embryonic tissues were studied by quantitative calibrated real-time polymerase chain reaction for human herpesviruses (HHV)-6 and -7. Controls included plasma from 36 healthy blood donors, plasma and paraffin-embedded tissue sections from 12 patients with other dermatitides, and from placental and embryonic tissues from one woman who presented with a 19-week intrauterine fetal death. Results Of the 38 women, 9 had a premature delivery and 5 miscarried. In particular, 62% of the women who developed PR within 15 weeks' gestation aborted. Neonatal hypotonia, weak motility, and hyporeactivity were noted in 6 cases. In the patient studied in detail, HHV-6 DNA was detected in plasma, peripheral blood mononuclear cells, skin, and placenta and embryonic tissues, whereas HHV-7 DNA was absent. HHV-6 p41 antigen was detected by immunohistochemistry in skin lesions, placenta, and embryonic tissues. No herpesvirus DNA was detected in plasma and tissues from control subjects. Limitations This is a case series study with a small number of patients. Conclusion PR may be associated with an active HHV-6 infection. In pregnancy, PR may foreshadow premature delivery with neonatal hypotonia and even fetal demise especially if it develops within 15 weeks' gestation.

In this paper we explore the effects of redistributive policies in a job search model where different degrees of self-confidence generate different arrival rates of new jobs. We find that the job search model is an useful framework to address behavioral concerns about personal motivation. We find that self-confidence and effort are complements in the performance of search activity. Moreover rewards, i.e. moving to better jobs, are negative reinforces for self-confidence if the distribution of wages is stationary. We analyze the effect of redistributing policies of opportunities that aim to compress the distribution of the job arrival rates. Finally the presence of social norms generates multiple equilibria.

To elucidate the role of human herpesvirus (HHV)-6 and -7 (HHV-7) in pityriasis rosea (PR), we measured their DNA load in plasma, peripheral blood mononuclear cells (PBMC), and tissues using a calibrated quantitative real-time PCR assay. We also studied HHV-6- and HHV-7-specific antigens in skin by immunohistochemistry and anti-HHV-7 neutralizing activity using a syncytia-inhibition test. Plasma and PBMC were obtained from 31 PR patients (14 children, 17 adults), 12 patients with other dermatites, and 36 blood donors. Skin biopsies were obtained from 15 adults with PR and 12 with other dermatites. HHV-6 and HHV-7 DNA were detected in 17% and in 39% of PR plasmas, respectively, but in no controls. HHV-7 viremia was associated with a higher PBMC load and, in adults, with systemic symptoms. HHV-7, but not HHV-6, levels in PBMC were higher in PR patients than in controls. HHV-6 and HHV-7 antigens were found only in PR skin (17% and 67% of patients analyzed, respectively), indicating a productive infection. Syncytia-neutralizing antibodies were found in PR patients and controls, but their titers were lower in patients with HHV-7 viremia. These data confirm the causal association between PR and active HHV-7 or, to a lesser extent, HHV-6 infection.

Sir, Serum IgA class anti-endomysial antibodies (EMA) are markers of coeliac disease and dermatitis herpetiformis (DH) and are useful in monitoring compliance to diet. Their overall sensitivity for the diagnosis of DH is about 80% and their specificity around 96% (1). As anti-gliadin antibodies (AGA) have already been reported in pemphigus (2, 3), the presence of AGA in another patient with pemphigus may not surprise, but the finding of IgA-EMA in yet another, and the response of both patients to a gluten-free diet treatment are worthy of attention.

Background. Blastomycosis-like pyoderma is a disorder of uncertain etiology that has been described in association with a variety of underlying conditions, including inflammatory and neoplastic pathologic conditions and in association with a primary immunodeficiency state. The response to therapy, antibiotics in particular, is said to be variable or poor. Methods. We examined two patients with blastomycosis-like pyoderma in whom no underlying pathologic or immunologic abnormalities were found. We treated them with antibiotics according to bacterial resistance tests. In the second case topical disodium chromoglycate was added. Results. Treatment cleared or markedly improved the lesions. Conclusions. Antibiotic treatment guided by susceptibility tests is recommended. The addition of topical disodium chromoglycate may be useful.

In this paper we explore the effects of redistributive policies in a job search model where different degrees of self-confidence generate different arrival rates of new jobs. We find that the job search model is an useful framework to address behavioral concerns about personal motivation. We find that self-confidence and effort are complements in the performance of search activity. Moreover rewards, i.e. moving to better jobs, are negative reinforces for self-confidence if the distribution of wages is stationary. We analyze the effect of redistributing policies of opportunities that aim to compress the distribution of the job arrival rates. Finally the presence of social norms generates multiple equilibria.

In a previous study we detected virions with electron microscopy features of human herpes viruses in the supernatant of cocultured mononuclear cells from patients with acute pityriasis rosea. Because of their morphology and of polymerase chain reaction studies, we ascribed them to human herpes virus 7.To find such virions in the lesional skin of pityriasis rosea patients.Skin specimens from lesions of 21 patients with acute pityriasis rosea were examined by elecron microscopy.In 15 (71%) patients, human herpes virus particles in various stages of morphogenesis were detected. Mature enveloped virions appeared as typical human herpes virus virions, measuring about 160-200 nm in diameter and containing an electrodense cylindrical core, a capsid, an envelope with typical spikes and a very distinct tegument layer between the capsid and the envelope. They were very similar to those we reported in the supernatant of co-cultured circulating mononuclear cells from patients with pityriasis rosea.Our results confirm our previous findings and provides further evidence of a viral etiology for pityriasis rosea.

Background: Antibodies to stratified epithelia characterize chronic ulcerative stomatitis, an entity that very closely resembles erosive lichen planus both clinically and histologically. These antibodies are directed against a 70-kd antigen. Objective: Our aim was to verify whether antibodies to stratified epithelia are present in patients with common lichen planus. Patients and methods: One hundred thirty-eight patients with various forms of lichen planus were studied. Indirect immunofluorescence was performed on both monkey esophagus and HEp2-2000 cells. Immunoblotting was done with cultured keratinocytes used as the source antigen. Results: Nineteen patients had antibodies to stratified epithelia (in 9 directed against an antigen of 70 kd). Forty-eight patients had circulating antibodies detected by indirect immunofluorescence on both monkey esophagus and HEp2-2000 cells (in 7 directed against an antigen of 70 kd). Indirect immunofluorescence was positive only on HEp2-2000 cells in 21 patients. Indirect immunofluorescence was negative in 50 patients on both HEp2-2000 cells and monkey esophagus. None of the last 71 patients had antibodies directed to an antigen of 70 kd. Limitations: This is a serological study; results from direct immunofluorescence studies would be interesting. Conclusion: Antibodies to stratified epithelia directed to an antigen of 70 kd are not exclusive to chronic ulcerative stomatitis, but are also present in some patients with lichen planus. © 2007 American Academy of Dermatology, Inc.

ity except the one by Szlachic et al,10 who conducted a remarkable epidemiologic study. They concluded that “H pylori expressing CagA [is found] in the majority of [rosacea] cases,” that “eradication of H pylori leads to a dramatic improvement of... rosacea,” and that “rosacea could be considered as one of the major extragastric symptoms of H pylori infection.” There are now other indicators of H pylori activity that may yield better information than serology. 5. Oral metronidazole was known to alleviate rosacea long before H pylori was discovered. Only its activity on H pylori can explain why it works in rosacea. So far, other explanations have not been supported by experimental evidence. Demodex folliculorum was found to survive in metronidazole concentrations much higher than those attainable in the blood,11 and the claimed antiinflammatory activity of topical metronidazole still awaits a scientific demonstration. In our experience (unpublished data), topical metronidazole may even have an irritative capacity, which is in contrast with the findings of other reports.

Objectives To discuss the current knowledge of 3 recently discovered human herpesviruses (HHV-6, HHV-7, and HHV-8), and to provide a dermatological point of view. Data Sources References identified from bibliographies of pertinent articles in the English language. Study Selection and Data Extraction Articles were selected according to their impact factor and the interest for dermatologists. Data Synthesis As the other members of the family Herpesviridae, HHV-6, HHV-7, and HHV-8 may cause a primary infection, establish latent infection in a specific set of cells of their host, and then reactivate if conditions of altered immunity develop. The main pathological conditions associated with them are discussed. Conclusions Human herpesvirus 6, HHV-7, and HHV-8 have provided new insights in some dermatological diseases. Although new studies are needed, they may have a profound impact on dermatology in the years to come.

• Background.— Erythema multiforme (EM) has been rarely reported in Epstein-Barr virus (EBV)—associated diseases; this includes patients with chronic fatigue syndrome who have chronic or recurrent and disabling illness and an abnormal antibody reactivity to EBV. We describe a patient fulfilling the chronic fatigue syndrome diagnostic criteria who had developed an unusually persistent EM resistant to corticosteroids therapy. The EBV DNA was studied in skin EM lesions, throat washings, peripheral mononuclear cells, and plasma. The EBV antigens were studied in skin EM lesions and in mononuclear cells. The patient was followed up to 2 years. Observations.— The patient had abnormal titers of antibodies against various EBV antigens and by immunofluorescence she disclosed the EBV nuclear antigen and the viral capsid antigen in the blood vessels of the affected skin. The dot blot hybridization assay detected viral DNA in throat washings and mononuclear cells, but not in plasma. The presence of the viral genomic content in lesional skin is suggested by the autoradiographic signal and by the difference from appropriate control specimens. Skin lesions and constitutional symptoms cleared after acyclovir sodium therapy and recurred after discontinuation of this therapy. Conclusions.— This is the first EM case in which evidence of the EBV causal role has been provided. The association with chronic fatigue syndrome suggests the EBV role in selected cases of this syndrome. ( Arch Dermatol. 1992;128:217-222)

To the Editor.— Schwannomas (neurilemomas) are rare benign nerve tumors, usually presenting as solitary encapsulated subcutaneous nodules adherent to a peripheral nerve. It is most uncommon for schwannomas to possess multinodular intertwining characteristics (ie, a plexiform pattern). Plexiform schwannomas (PS) have often been confused with plexiform neurofibromas. 1 Unlike the latter, which have a strong association with neurofibromatosis (NF), PS seem to affect exclusively the skin as solitary or multiple lesions. 2,3 Nonetheless, there seems to be a small but definite association between PS and NF, 2 and, recently, multiple cutaneous plexiform schwannomas (MCPS) have been reported in Japan as a marker of a novel neurocutaneous syndrome, neurilemomatosis (NL). 4 We report a case of MCPS with multiple tumors of the central nervous system in the absence of any cutaneous and genetic marker for NF. Report of a Case.— An 18-year-old normally intelligent woman was born to a family without

BACKGROUND. Cancers of the anal canal are rare, but their frequency is constantly increasing. Only 10-20% of the patients develop a local recurrence and about 20% distant visceral metastases. OBJECTIVE. To report what we believe to be the first case of skin metastases of epidermoid anal canal carcinoma mimicking a typical clinical pattern of prostatic adenocarcinoma metastases.

The statement by Lebbe et al 1 that the detection of human herpesvirus (HHV) 8 sequences in peripheral blood mononuclear cells (PBMCs) of patients with Kaposi sarcoma (KS) is related to the tumor burden seems hazardous. This conclusion is contrary to all we know of HHV biological behavior. For none of the HHVs has the amount or even the existence of latently infected cells been correlated with a clinical disease or viral diffusion in other tissues. Indeed, some, if not all, of the known HHVs are carried by PBMCs in healthy individuals. For example, in Italy, using polymerase chain reaction (PCR), we recently detected HHV-7 DNA sequences in PBMCs in 11 (44%) of 25 healthy individuals.2 As for HHV-8, its sequence has been detected in the blood of healthy individuals. This virus is so widespread that in the American population approximately 25% of adults and 2% to 8% of children

REPORT OF A CASE A 67-year-old woman presented for an array of small red lesions. The number of lesions increased during the weeks before her presentation; a few of them had been present for years. She suffered from epistaxis for 5 months. Blood flow was so copious that she was hospitalized; no definite diagnosis had been made there. The bleeding contributed to her poor general condition, for which she received many transfusions. She denied any similar condition in her family. On examination, some small telangiectases were seen on her face, trunk, limbs, palms, and periungual areas (Fig 1). They were more numerous on the nasal and conjunctival mucosa. The mucosa of the lips, gums, tongue, and the entire mouth was also involved (Figs 2 and 3). Routine laboratory tests revealed the following results or values: hypochromic microcytic anemia (erythrocytes, 3.4×10 9 /L, with hemoglobin, 0.79; hematocrit, 0.27; and mean corpuscular

Excerpt To the Editor:Cutaneous adverse reactions to tamoxifen are very rare. We report a case in which tamoxifen appeared to cause purpuric vasculitis. A 56-year-old woman presented with a 15-mont...

This article studies crime rates’ response to economic conditions. Using a longitudinal data set covering about 20 countries over the period 1970-2010, we investigate whether crime rates respond asymmetrically to increases in unemployment and recoveries in economic conditions. We find a positive response of crime rates on variation in unemployment rates, but we do not find compelling evidence of asymmetric responses to positive and negative variations in the economic cycle.

Within the clinical spectrum of erythema multiforme, two subgroups have been recently identified: recurrent erythema multiforme and the rare persistent erythema multiforme. Two additional cases of persistent erythema multiforme are described. Lesions were widespread and resistant to traditional therapies. One of the patients had an underlying malignancy; the other exhibited a symptom complex characterized by fatigue, fever, sore throat and lymphadenopathy, and an abnormal Epstein-Barr virus serologic profile suggestive of endogenous reactivation of Epstein-Barr virus infection.

Innovation, Unemployment and Policy in the Theories of Growth and Distribution increases our understanding about the more relevant economic determinants and policy aspects of the interdependence between economic growth and income distribution.

Pityriasis rosea (PR) may have atypical presentations as regards morphology and distribution of the lesions. Recently, several forms of PR considered atypical for the course of the disease have been described. Differently from the typical PR that resolves within 2-12 weeks, relapsing and persistent PR forms (lasting longer than 12 weeks) have been described in adults and children. Lesions of the oral mucosa in PR may be more common than as reported in the literature. Formerly, the occurrence of oral lesions in PR has been considered more frequent in dark-skinned patients compared to light-skinned patients. However, in 12 Caucasian adult patients with persistent PR that have been recently described, oral lesions were very common (75% of cases). Another study on the clinical features and virological parameters of 31 Caucasian children with PR showed that painless oropharyngeal lesions were present in 35% of them, a rate much higher than those reported in adult dark-skinned (9%) and Caucasian patients (16%) with typical PR.

Il contributo descrive gli elementi caratteristici della pianificazione strategica, mettendo in evidenza le problematiche derivanti dall'assunzione di questo strumento da volontario a obbligatorio per le Città metropolitane. In particolare, nel contributo, si immaginano alcune soluzioni che tengano conto della conservazione della natura essenzialmente partecipativa del piano strategico, ma che allo stesso tempo possano consentire una sua produzione in atto di indirizzo generale.