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Introduction. According to the National Oncological Plan 2023-2027 on the importance of multidisciplinary and interactive e-learning training, the Italian Melanoma Intergroup (IMI) has developed MelaMEd (Melanoma Multimedia Education), a national project for general practitioners (GPs) on the prevention and detection of cutaneous melanoma through an online platform and an online course. MelaMEd enables participants to (1) recognize skin lesions that require specialist dermatological assessment, (2) select patients at high risk of melanoma and (3) be informed of the diagnosis and treatment pathway of patients with melanoma. Methods. A free online platform and online course were developed and launched in June 2022. Before starting the course, enrolled participants fill out a pre-training questionnaire concerning the basic knowledge of the disease and the recognition and management of suspicious lesions. After the course, participants will fill out the same questionnaire again. The online course will end in December 2023. Here we present a preliminary analysis of the pre-training results (January 2023-July 2023). The data have been analyzed descriptively. Results. So far, five healthcare centers have participated in the project for a total of 1320 participants. Of these, 298 compiled the pre-training questionnaire. Forty-seven percent of them were aged

Abstract Pedestrian groups are commonly found in crowds but research on their social aspects is comparatively lacking. To fill that void in literature, we study the dynamics of collision avoidance between pedestrian groups (in particular dyads) and individual pedestrians in an ecological environment, focusing in particular on (i) how such avoidance depends on the group’s social relation (e.g. colleagues, couples, friends or families) and (ii) its intensity of social interaction (indicated by conversation, gaze exchange, gestures etc). By analyzing relative collision avoidance in the “center of mass” frame, we were able to quantify how much groups and individuals avoid each other with respect to the aforementioned properties of the group. A mathematical representation using a potential energy function is proposed to model avoidance and it is shown to provide a fair approximation to the empirical observations. We also studied the probability that the individuals disrupt the group by “passing through it” (termed as intrusion). We analyzed the dependence of the parameters of the avoidance model and of the probability of intrusion on groups’ social relation and intensity of interaction. We confirmed that the stronger social bonding or interaction intensity is, the more prominent collision avoidance turns out. We also confirmed that the probability of intrusion is a decreasing function of interaction intensity and strength of social bonding. Our results suggest that such variability should be accounted for in models and crowd management in general. Namely, public spaces with strongly bonded groups (e.g. a family-oriented amusement park) may require a different approach compared to public spaces with loosely bonded groups (e.g. a business-oriented trade fair).

Autoimmune bullous diseases are a heterogeneous group of rare conditions clinically characterized by the presence of blisters and/or erosions on the skin and on the mucous membranes. Practically, they can be divided into two large groups: the pemphigoid group and the pemphigus group, depending on the depth of the autoimmune process on the skin. Family history of autoimmune disease can often be found, and demonstrating that genetic predisposition is crucial in the development of them. Moreover, numerous environmental risk factors, such as solar radiation, drugs and infections, are known. This study aimed to evaluate how seasonality can affect the trend of BP and PV, especially considering the number of hospitalizations recorded over the course of individual months. The total number of hospitalizations in the twelve months of the year was evaluated. Further, blood chemistry assay and, for some patients, enzyme-linked immunosorbent assay were executed in order to evaluate antibodies. Regarding the severity of the disease BPDAI (Bullous Pemphigoid Area Index) and PDAI (Pemphigus Disease Area Index), score systems were used. Results showed a complex interplay between environmental factors such as seasons and autoimmune conditions.

Pemphigus is a chronic autoimmune bullous disease, associated with the production of autoantibodies directed against desmosomal proteins, such as desmogleins 1 and 3 (DSG1 and DSG3). Herein we present the case of an 83-year-old woman who referred to us with suspicious cicatricial alopecia of the scalp and a small, eroded lesion of the forehead, previously labeled as atrophic actinic keratosis after a skin biopsy. In our clinic, after a careful examination of the case, we decided to undergo two new skin biopsies of the scalp, in the suspicion of an inflammatory disease.

We report the case of a patient with chronic granulomatous disease and acne treated with isotretinoin, who developed a diffuse staphylococcal skin infection during the therapy. Chronic granulomatous disease is a rare genetic disorder characterized by an altered innate immunity with an increased risk of potentially lethal bacterial and fungal infections. Although chronic granulomatous disease is rare, acne is a common manifestation in these patients, but there are no data about the gold standard therapy.

Abstract The paper presents a case of lentigo maligna melanoma of the scalp in an elderly patient treated for the nodular part with surgery and the residual melanoma in situ with 5% Imiquimod and subsequently with 3.75% Imiquimod (each concentration for 4 months, 5 times per week), with complete regression of the lesion. 3.75% Imiquimod, which is already used for the treatment of actinic keratosis, could be a useful weapon with the same effectiveness and fewer side effects compared to 5% Imiquimod.

Since the beginning of the covid-vaccine campaign, a lot of local and systemic dermatologic reactions happening after the administration of Coronavirus disease 2019 (COVID-19) vaccines have been described, even if their exact biological mechanism is still debated. In this paper we report 4 cases of cutaneous manifestations arose within ten days after the first dose of messenger RNA (mRNA)-based COVID-19 vaccination: one case of giant urticaria, one case of head and neck redness and two cases of Erythema Multiforme (EM). In our experience these reactions were mild, transient and all of them resolved, not recurring after the second dose, so these manifestations shouldn’t be considered as an absolute contraindication to the second dose of vaccine, that to date is fundamental.

Pemphigus vulgaris (PV) is a rare, potentially lethal blistering disease typically occurring in adulthood and characterized by autoantibodies directed against mucocutaneous desmosomal proteins. Clinically, flaccid vesicles, bullae and erosions after breakage are the main clinical features. According to the literature, the incidence of PV is rare in the pediatric population, ranging from 1 to 4% of reported cases. We describe an interesting case of a 12-year-old boy with severe PV that was referred to our university hospital for a mucocutaneous disease resistant to anti-infective therapy. Following the appearance of bullous lesions on the skin, antibody screening for autoimmune diseases showed positivity for PV and corticosteroid therapy was started. In view of the numerous adverse effects, we decided to set up biological therapy with rituximab, which was interrupted due to the onset of an urticarial reaction. Further second-line therapies were therefore attempted, with only a partial response. For this reason, a desensitizing therapy with rituximab was decided, thus allowing a clear improvement in the clinical picture and quality of life of the patient. To the best of our knowledge, this is the first report of a child with severe PV resistant to conventional therapies and with an urticarial reaction to rituximab. This case highlights that despite PV being extremely rare in the pediatric population, this diagnosis should not be entirely discounted. In case of severe clinical manifestations, rituximab represents a valid option in children and desensitization tests should be recommended in the presence of hypersensitivity to this drug.

This work presents a simulation model for unsignalized crosswalks which takes into account collisions between vehicles and pedestrians, thus allowing to assess the estimated yearly pedestrian fatality. In particular, we focus on a method to calibrate such a model combining measurable crosswalk characteristics, such as maximum speed limit or drivers' compliance, with statistical data for past accidents obtained from local municipality. In order to perform simulations under realistic conditions, we constructed a one-week scenario where pedestrian and vehicle traffic vary using specific patterns each hour of the week. The constructed traffic profile is based on openly available data and the suitability for the scenario considered (a crosswalk in Milan, Italy) is investigated showing that cultural/lifestyle elements determine the variation of weekly traffic. Simulations using the constructed one-week scenario were used to obtain the only non-measurable parameter which account for pedestrians' and drivers' distraction. In addition, we also focused on the presence of elderly pedestrians which have different physiological characteristics compared to adults or children and are becoming an important part of the population in several countries around the globe. The simulation model presented here and the method suggested for calibration may be employed in different contexts, thus allowing to build an important tool to be used not only for transportation efficiency/optimization but also for safety analysis. Keywords: Traffic simulation, Accident prevention, Unsignalized crosswalk, Vehicle-pedestrian interaction, Weekly traffic variation

Acne is a chronic inflammatory disease of the pilosebaceous unit and its etiology is complex and multifactorial. The role of the diet in its pathogenesis is still debated. The purpose of this study was to assess the association between MD and IGF-1 in acne patients and, as secondary objective, the role of systemic treatment on IGF-1 serum levels, in accordance to the patients’ diet. This study included 35 patients aged 14-30 years affected by acne and treated in line with the EDF guidelines. Patients were divided into 2 groups based on a questionnaire score assessing the adherence to the Mediterranean diet: the Mediterranean Group (score ≥ 6) and the Western Group (score < 5). IGF-1 serum levels were measured in all patients before and after treatment and then compared to healthy population. IGF-1 levels were higher in patients than in controls and in the Western group than in the Mediterranean group. We speculate that the Mediterranean diet can have a protective role in the pathogenesis of acne by acting on the systemic route of IGF-1.

Soft tissues perineurioma is a rare nerve sheath tumor that affects most of all the subcutaneous tissue. Even if it could present as a large mass, it is a benign neoplasm for whom a complete surgical excision represents the gold standard treatment. Considering that it usually affects acral sites of young people, can be challenging to perform a reconstructive surgery that allows a full functional recovery. We report the case of a woman in her 20s presenting a perineurioma of the sole of the foot, a nodule of about 2 cm of diameter that compromised the support of the foot on the ground. We performed a radical surgical excision with no recurrence after 3 years of follow up and we obtained a full functional recovery thanks to an autologous full-thickness skin graft.

Dermatoses affecting palms may represent a dermatologic challenge from both the diagnostic, and therapeutic point of view. Patients with supposedly occupational dermatitis can spend months or even years in a frustrating attempt to avoid contact with possible irritants or allergens. To underline the importance of a thorough unbiased analysis of the patient’s history and clinical features, we present the iconic case of a bricklayer affected by a chronic, disabling desquamation of palms which in the end was classified as keratolysis exfoliativa (KE) attributed to ranolazine-intake, an antianginal drug. To the best of our knowledge, this specific adverse effect of drug-induced KE of palms has never been reported before in association with ranolazine.

Vitiligo is an acquired pigmentary disorder afflicting 0.5-2% of the world population for both sexes and all races with a capricious and unpredictable course. It has a complex etiology and varies in its manifestation, progression and response to treatment. Even if the precise aetiology and pathobiology of the disease are complex and still debated, recent evidence supports that vitiligo is a T CD8+ cell-mediated autoimmune disease triggered by oxidative stress. To date no clinical, biological and histological criteria allow us to establish the prognosis with certainty. The choice of the best therapy for adult and childhood vitiligo is based on various factors, such as the patient’s age, psychological condition and expectations, distribution and extension of skin lesions, type of vitiligo (stable or not) and availability and cost of therapeutic options. Since vitiligo has a deep psychological impact on patients and their quality of life, treating the disease is very important. As dermatologists, we have important goals in the treatment of vitiligo patients: stabilization of the disease progression, repigmentation of the lesions and especially the persistence of the aforementioned repigmentation. Although several medical and surgical therapeutic options have been proposed, no definite cure has yet been developed and the long-term persistence of repigmentation is unpredictable. We review the different therapeutic options with particular attention on the recurrence rate.

Improvements in the design of pedestrian facilities have reduced the frequency of crowd accidents, and safety is now generally ensured in well-planned crowd events. However, congestion and inefficient use of infrastructures still remain an issue. To guarantee comfort and reduce close contacts between people, there are circumstances when crowd density may have to be reduced well below safety limits. Although research has given a lot of attention to extreme scenarios, methods to improve non-critical conditions have been little explored. In addition, crowd sensing technology is still mostly used for data collection and direct use on crowd management is rare. In this work, we present a system aimed at computing optimal egress time for groups of people leaving a complex facility. We show that, if egress starting time is accurately computed for each group based on actual crowd conditions, density can be greatly reduced without having a large effect on the total egress time of the whole crowd. To show the efficacy of such a system, a small-scale experiment is conducted where all components are tested in a simple scenario. As a result, an increase in total egress time by only 5% allowed to reduce maximum density by 35%.

Abstract is missing (Quiz)

This study focuses on social pedestrian groups in public spaces and makes an effort to identify the type of social relation between the group members. As a first step for this identification problem, we focus on dyads (i.e. 2 people groups). Moreover, as a mutually exclusive categorization of social relations, we consider the domain-based approach of Bugental, which precisely corresponds to social relations of colleagues, couples, friends and families, and identify each dyad with one of those relations. For this purpose, we use anonymized trajectory data and derive a set of observables thereof, namely, inter-personal distance, group velocity, velocity difference and height difference. Subsequently, we use the probability density functions (pdf) of these observables as a tool to understand the nature of the relation between pedestrians. To that end, we propose different ways of using the pdfs. Namely, we introduce a probabilistic Bayesian approach and contrast it to a functional metric one and evaluate the performance of both methods with appropriate assessment measures. This study stands out as the first attempt to automatically recognize social relation between pedestrian groups. Additionally, in doing that it uses completely anonymous data and proves that social relation is still possible to recognize with a good accuracy without invading privacy. In particular, our findings indicate that significant recognition rates can be attained for certain categories and with certain methods. Specifically, we show that a very good recognition rate is achieved in distinguishing colleagues from leisure-oriented dyads (families, couples and friends), whereas the distinction between the leisure-oriented dyads results to be inherently harder, but still possible at reasonable rates, in particular if families are restricted to parent-child groups. In general, we establish that the Bayesian method outperforms the functional metric one due, probably, to the difficulty of the latter to learn observable pdfs from individual trajectories.

[This corrects the article DOI: 10.1371/journal.pone.0208496.].

In this work, we investigate properties of bidirectional pedestrian streams by studying different experimental datasets from multiple authors. Through the comparison of a scenario where lanes naturally form with two others where lane formation is either obstructed or facilitated, we show the relationship of different pedestrian quantities in regard to the flow ratio (or directional split). On this scope, two measures to account for the degree of congestion and self-organization are introduced. The analysis of the results reveals that the balanced case (where flow is almost equal in both directions) has very peculiar properties which depends on the existence or not of organized lanes and their stability. While the balanced case generally shows the highest level of congestion, this property can quickly change after lanes are formed and when they remain stable. An in-depth investigation revealed that capacity in bidirectional streams is characterized by a dual nature: conflicts with the counter flow and self-organization in lanes. Both aspects have been described using a mathematical model which allowed to define a function for capacity in relation with flow ratio and environmental/cognitive aspects. The expression for capacity proposed in our work agrees with several studies from the literature, eventually allowing to understand the differences among them. We believe our function for capacity enables a more universal treatment of bidirectional streams compared to previous definitions, since it allows to account for steady and non-steady state conditions which represent important mechanisms in their dynamics. The framework introduced here may also help measuring the influence of environmental/cognitive changes in relation with the capacity of bidirectional pedestrian streams.

Abstract is missing (Short communication)

In the absence of any other lesions on the body, the diagnosis of localized genital psoriasis can be difficult, requiring further examinations including a biopsy. We report a case of psoriatic pseudobalanitis circinata triggered by a herpes virus infection, and we discuss the Koebner phenomenon and the therapeutic management of psoriasis of the genital area.

Pemphigus vulgaris (PV) is an autoimmune blistering disease whose pathogenesis involves both humoral and cell-mediated immune response. Though the pathogenetic role of autoantibodies directed against desmoglein 3 is certain, a number of other factors have been suggested to determine acantholysis in PV. In this study we examined the possible role of CD8+ T cells in the development of acantholysis by a passive transfer of PV autoantibodies using CD8 deficient mice, and we also studied the inflammatory infiltrate of PV skin lesions by immunohistochemical staining. The results of the immunohistochemical staining to study the expression of CD3, CD4, and CD8 in PV skin lesions showed that CD4+ are more expressed than CD8+ in the inflammatory infiltrate of PV lesions, confirming the data of the previous literature. The passive transfer study showed a lower incidence of pemphigus in the group of CD8 deficient mice compared to the control one of wild-type mice. These results suggest that CD8+ T cells may play a role in the pathogenesis of PV, perhaps through the Fas/FasL pathway.