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Background: The discharge from the hospital of insulin-treated hyperglycemic patients is always challenging. This is even more so in patients requiring glucocorticoid treatment, such as those with COVID-19. Patients and Method: A retrospective monocentric study of 23 inpatients was conducted with newly diagnosed or already known diabetes mellitus (DM) who were naïve to insulin treatment, and who were hospitalized with COVID-19 in non-critical settings and then discharged. Patients were followed up for one month after discharge for the management of insulin treatment by a multi-professional team through phone consultations. Results: Insulin prescriptions at discharge were 24.6 ± 14 U/day injected in 2 ± 1.5 daily shots. A mean of three phone consultations was required. One month later, the mean insulin reduction was 1.5 ± 1.3 shots and 6 ± 5 U/day. All patients reached their glycemic target without hypoglycemic events, drop-outs, or readmissions. Conclusion: This study demonstrates the feasibility, efficacy, and safety of a multi-professional approach through telemedicine for managing DM patients after discharge during COVID-19.

The hypothalamic–pituitary–adrenal axis is a tightly regulated system that represents one of the body’s mechanisms for responding to acute and chronic stress. Prolonged stress and/or inadequate regulation of the stress system can lead to a condition of chronic hypercortisolism or, in some cases, a blunted cortisol response to stress, contributing to insulin resistance, increased adiposity and type 2 diabetes mellitus. Moreover, acute and chronic stress can exacerbate or worsen metabolic conditions by supporting an inflammatory state and a tight relationship between stress, inflammation and adipose tissue has been reported and has been a growing subject of interest in recent years. We reviewed and summarized the evidence supporting hypothalamic–pituitary–adrenal axis dysregulation as an important biological link between stress, obesity, inflammation and type 2 diabetes mellitus. Furthermore, we emphasized the possible role of infectious-related stress such as SarsCov2 infection in adrenal axis dysregulation, insulin resistance and diabetes in a bidirectional link. Understanding and better defining the links between stress and obesity or diabetes could contribute to further definition of the pathogenesis and the management of stress-related complications, in which the HPA axis dysregulation has a primary role.

Objectives: During this ongoing pandemic of coronavirus disease 2019 (COVID-19), procalcitonin (PCT) assay has proven to be a useful tool in assisting clinicians to diagnose bacterial superinfection. However, in the absence of signs of infection or at resolution thereof, inappropriately and persistently high PCT may suggest and reveal the presence of other pathologies. We report a patient with acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia in whom persistence of initially elevated PCT during recovery prompted the diagnosis of medullary thyroid cancer (MTC). Case report: A 43- year-old man presented with a two-day history of fever, sneezing, sore throat and dry cough. Physical exam revealed decreased sounds and coarse crackles in both lung bases at auscultation. Medical history was positive for cognitive impairment since birth, arterial hypertension, systemic lupus erythematosus with nephritis. Initial studies included mild lymphocytopenia 650/µl (760 - 5000), D-Dimer 0.73 µg/ml (< 0.5), C reactive protein (CRP) of 62 mg/l (< 5) and PCT of 94 ng/ml (0.00 - 0.10). Positivity for SARS-Cov-2 RNA was detected and chest computerized tomography showed bilateral ground-glass opacities in the basilar lung zones and hyperdense and irregular foci in the thoracic vertebral bodies. Empirical antibiotic therapy was started and was maintained for seven days but, despite clinical improvement and the normalization of CRP, serum PCT was persistently high (84 ng/ml). Serum calcitonin (CTN) was 2120 pg/ml (normal up to 12 pg/ml). Neck ultrasound revealed inhomogeneously echogenic lymph nodes with small punctate calcifications and a non-homogeneous thyroid with multiple nodules. Cytological examination by fine needle aspiration and CTN measurement on washing liquid confirmed the suspicion of MTC. The patient underwent total thyroidectomy with bilateral cervical lymph node dissection. Histological analysis confirmed MTC of right thyroid lobe and metastasis at lymph nodes of the central right midneck area. Blood tests performed 48 hours after surgery showed a lowering of CTN (986 pg/mL) and PCT (16 ng/mL). A 6-months follow up showed persistent increased CTN and PCT levels (921 pg/ml and 16 ng/ml, respectively) while a (18)F-fluorodihydro-xyphenylalanine ((18)F-DOPA) PET did not reveal any suspicious fixations at thyroid lodge and cervical lymph node stations while multiple osteoblastic foci in the skeletal area were described. A close follow-up was planned with establishment of the results of RET gene analysis. Discussion: Although CTN is the gold standard biochemical parameter for the diagnosis and follow-up of MTC, PCT can be useful as a biochemical marker of MTC suspicion in patients with inflammatory conditions and persistently elevated PCT even after resolution. In the present CASE, high levels of PCT in a patient with Covid-19 pneumonia without signs of bacterial infection, allowed to diagnose MCT. Conclusion: In the absence of any other signs of infection, a complete clinical assessment, including neck palpation, CTN measurement and thyroid ultrasound should be performed in the presence of persistently elevated PCT.

Objectives During this ongoing pandemic of coronavirus disease 2019 (COVID-19), procalcitonin (PCT) assay has proven to be a useful tool in assisting clinicians to diagnose bacterial superinfection. However, in the absence of signs of infection or at resolution thereof, inappropriately and persistently high PCT may suggest and reveal the presence of other pathologies. We report a patient with acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia in whom persistence of initially elevated PCT during recovery prompted the diagnosis of medullary thyroid cancer (MTC). Case report A 43- year-old man presented with a two-day history of fever, sneezing, sore throat and dry cough. Physical exam revealed decreased sounds and coarse crackles in both lung bases at auscultation. Medical history was positive for cognitive impairment since birth, arterial hypertension, systemic lupus erythematosus with nephritis. Initial studies included mild lymphocytopenia 650/μl (760 – 5000), D-Dimer 0.73 μg/ml (< 0.5), C reactive protein (CRP) of 62 mg/l (< 5) and PCT of 94 ng/ml (0.00 – 0.10). Positivity for SARS-Cov-2 RNA was detected and chest computerized tomography showed bilateral ground-glass opacities in the basilar lung zones and hyperdense and irregular foci in the thoracic vertebral bodies. Empirical antibiotic therapy was started and was maintained for seven days but, despite clinical improvement and the normalization of CRP, serum PCT was persistently high (84 ng/ml). Serum calcitonin (CTN) was 2120 pg/ml (normal up to 12 pg/ml). Neck ultrasound revealed inhomogeneously echogenic lymph nodes with small punctate calcifications and a non-homogeneous thyroid with multiple nodules. Cytological examination by fine needle aspiration and CTN measurement on washing liquid confirmed the suspicion of MTC. The patient underwent total thyroidectomy with bilateral cervical lymph node dissection. Histological analysis confirmed MTC of right thyroid lobe and metastasis at lymph nodes of the central right midneck area. Blood tests performed 48 hours after surgery showed a lowering of CTN (986 pg/mL) and PCT (16 ng/mL). A 6-months follow up showed persistent increased CTN and PCT levels (921 pg/ml and 16 ng/ml, respectively) while a (18)F-fluorodihydro-xyphenylalanine ((18)F-DOPA) PET did not reveal any suspicious fixations at thyroid lodge and cervical lymph node stations while multiple osteoblastic foci in the skeletal area were described. A close follow-up was planned with establishment of the results of RET gene analysis. Discussion Although CTN is the gold standard biochemical parameter for the diagnosis and follow-up of MTC, PCT can be useful as a biochemical marker of MTC suspicion in patients with inflammatory conditions and persistently elevated PCT even after resolution. In the present CASE, high levels of PCT in a patient with Covid-19 pneumonia without signs of bacterial infection, allowed to diagnose MCT. Conclusion In the absence of any other signs of infection, a complete clinical assessment, including neck palpation, CTN measurement and thyroid ultrasound should be performed in the presence of persistently elevated PCT.

Although trichoscopic criteria indicative of disease severity and inflammatory activity have been recently proposed, the potential use of reflectance confocal microscopy (RCM) in the evaluation of the inflammatory stage of FD has never been published to date. Our study investigated RCM features of 14 patients with a histopathological diagnosis of FD, evaluating clinical and trichoscopic findings. RCM findings were divided into 2 main patterns: “follicular” and “interfollicular.” Our results suggest a potential role for RCM as a noninvasive, fast technique for a complementary investigation in the diagnostic process, as well as in the therapeutic management decision.

Psoriasis and alopecia areata (AA) are among the most prevalent autoimmune inflammatory diseases, affecting 1% to 4%1 and 0.1% to 0.2%2 of the worldwide population, respectively. Alopecia, decreased hair density, thin hair, and an increased number of dystrophic bulbs have been described in the context of the psoriatic plaques and thought to be causally associated with psoriasis.3, 4 Nevertheless, most patients with psoriatic alopecia experience complete regrowth of scalp hair after successful treatment of their scalp psoriasis.3 Among systemic treatments, methotrexate and retinoids are known to be associated with alopecia,5, 6 whereas there are conflicting results about anti–tumor necrosis factor (TNF) and alopecia areata.7, 8 Few epidemiologic studies found that patients with psoriasis are at greater risk of AA development.9, 10 It is estimated that patients with psoriasis have a 2.5-fold higher risk of AA development and are more likely to have at least 1 other autoimmune disease (odds ratio [OR], 1.6; confidence interval [CI], 1.5-1.7) or even 2 other autoimmune diseases (OR, 1.9; CI, 1.6-2.4).9 A recent retrospective study found that vitiligo was the most frequent skin autoimmune disease associated with psoriasis, followed by AA and chronic urticaria.7, 10 The most frequent association seems to be scalp psoriasis and AA.7, 9 Although some investigators found that psoriatic arthritis (PsA) might represent a protective factor,9, 10 others found that patients with AA are more frequently affected by either psoriasis or PsA.11, 12 Several studies also found a high prevalence of comorbid conditions as atopic dermatitis, diabetes, thyroiditis, celiac disorder, psoriasis, and PsA among individuals with AA.11, 12 We describe 4 patients affected by psoriasis and concomitant AA, emphasizing the clinical and dermoscopic characteristics, and correlation of the hair loss with antipsoriatic treatment. The collected data are summarized in Table I. Table I Summarized clinical features of the reported patients

Aberrant CGG trinucleotide amplification within the FMR1 gene, which spans approximately 38 Kb of genomic DNA is almost always what leads to fragile X syndrome (FXS). However, deletions of part or the entire FMR1 gene can also cause FXS. Both CGG amplification-induced silencing and deletions result in the absence of the FMR1 gene product, FMRP. Here, we report a rare case of germinal mosaicism of a deletion encompassing approximately 300 Kb of DNA, which by removing the entire FMR1 gene led to FXS. The male proband, carrying the deletion, presented in clinic with the typical features of FXS. His mother was analyzed by FISH on metaphase chromosomes with cosmid probe c22.3 spanning the FMR1 locus, and she was found not to carry the deletion on 30 analyzed cells from peripheral blood lymphocytes. Prenatal examination of the mother's third pregnancy showed that the male fetus also had the same deletion as the proband. Following this prenatal diagnosis, FISH analysis in the mother was expanded to 400 metaphases from peripheral lymphocytes, and a heterozygous FMR1 deletion was found in three. Although this result could be considered questionable from a diagnostic point of view, it indicates that the deletion is in the ovary's germinal cells.

A reduction in bone mineral density (BMD) is common in primary hyperparathyroidism (PHPT), above all at cortical sites. Guidelines for the management of asymptomatic PHPT (aPHPT) recommend a BMD evaluation at the lumbar spine, hip, and forearm. Surgery is recommended for patients with a T-score less than or equal to -2.5 at any of these sites. However, a BMD evaluation at the forearm is not routinely performed.To evaluate the impact of measuring forearm BMD in the clinical management of aPHPT.We retrospectively reviewed a prospective database of 172 patients with aPHPT, selecting the 116 patients in whom a dual x-ray absorptiometry (DXA) scan had been performed at all 3 sites.Seventy-four out of 116 patients had a densitometric diagnosis of osteoporosis (OP) at any site, and the forearm was the only site involved in 13/74 (group A, 17.6% of osteoporotic patients and 11.2% of the whole aPHPT cohort). Patients belonging to group A were significantly older than the other aPHPT patients, whereas no difference was found in biochemical measurements. Six out of 13 patients belonging to group A (5.2% of the whole aPHPT cohort) fulfilled surgical criteria based only on a forearm T-score.DXA at 3 sites revealed OP at the forearm, but not at the other sites, in 11.2% of aPHPT patients. Half of these cases met surgical criteria based on this one factor alone. These patients did not show any clinical (except age) or biochemical differences from the other patients. The implementation of forearm DXA increases the rate of patients with aPHPT meeting surgical criteria.

Although the heterogeneity of the therapeutic response to TNF-α blockers seems to be mainly due to genetic factors, several studies showed that a range of factors may influence it. The aim of our study was to investigate the impact of patients' demographic and clinical characteristics on primary response to an anti-TNF-α therapy in psoriatic patients. We retrospectively examined the relationship between various clinical and demographic features and response to treatment with etanercept, adalimumab, and infliximab, evaluated as PASI75 and average PASI improvement at weeks 12, 16, and 14, respectively. We analyzed data obtained from 199 patients. A better response to the treatment was significantly associated with male gender (OR = 2.59), coexistence of psoriatic arthritis (OR = 1.97), and PASI ≤15 at baseline (OR = 0.91). The present study supports that some clinical factors may be potential predictors of response to anti-TNF-α agents in psoriatic patients.

Objective: Vitamin D deficiency (VDD) was previously associated with larger adenoma size in primary hyperparathyroidism (PHPT), but this topic was not addressed in patients with the mild/asymptomatic form of the disease (aPHPT). Methods: We retrospectively retrieved from our series of patients affected by PHPT, 96 consecutive subjects with aPHPT in whom 25-hydroxyvitamin D (25OHD) levels had been assayed and compared those results with localizing imaging studies. Results: Twenty-five of 96 patients had VDD (25OHD

Alopecia Areata (AA) is an organ-specific autoimmune disorder that targets anagen phase hair follicles. The course is unpredictable and current available treatments have variable efficacy. Nowadays, there is relatively little evidence on treatment of AA from well-designed clinical trials. Moreover, none of the treatments or devices commonly used to treat AA are specifically approved by the Food and Drug Administration (FDA). The Italian Study Group for Cutaneous Annexial Disease of the Italian Society of dermatology (SIDeMaST) proposes these Italian guidelines for diagnosis and treatment of Alopecia Areata deeming useful for the daily management of the disease. This article summarizes evidence-based treatment associated with expert-based recommendations.

Nail toxicities, such as paronychia and pyogenic granuloma-like lesions, are well-recognized side effects of epidermal growth factor receptor inhibitor (EGFR-I) therapy that can significantly impair patient's quality of life and compliance to anticancer treatment. Numerous therapeutic options are available, with variable rates of success. Recently, topical β-blockers have emerged as a novel, non-invasive treatment strategy. We tested the effectiveness of topical timolol 0.5% gel, twice daily, under occlusion for 30 days, on paronychia and periungual pyogenic granuloma-like lesions in 9 patients being treated with EGFR-I. We also reviewed the available literature on this topic, which is the use of topical β-blockers in the management of EGFR-I-induced nail toxicities. We assessed 25 lesions consistent with the diagnosis of EGFR-I-induced pyogenic granuloma-like lesions and paronychia (21 diagnosed as pyogenic granuloma-like, and four as paronychia). Thirteen of the 25 lesions achieved complete resolution, 9/25 reached at least improvement, and only 3/25 did not respond to the intervention. As for the review, four papers met the scope of our research. The results confirmed at least partial benefit in the majority of treated patients. Among current strategies, high-potency topical corticosteroids are a well-known treatment option especially for paronychia, targeting the inflammatory component of such lesions; nevertheless, the management of pyogenic granuloma-like lesion is often more complex and the success rate is variable. Nail plate avulsion and phenol chemical matricectomy are not highly effective and display some degree of invasiveness. Topical β-blockers seem to be promising alternatives, especially in fragile cancer patients who may be unsuitable candidates for an invasive procedure.

Mild primary hyperparathyroidism (PHPT) was recently clearly defined for the first time. Our study was thus aimed to pinpoint proportion and clinical characteristics of this kind of patients. We retrospectively evaluated our series of 360 consecutive patients with PHPT, selecting those with all features allowing a correct classification (serum total and ionized calcium, phosphate, creatinine, PTH, 25OHD, urinary calcium, renal and neck ultrasound, MIBI scintiscan, and DEXA at lumbar spine, femoral neck, and distal third of radius). Patients were defined asymptomatic (aPHPT) when bone or kidney was not involved and no hypercalcemic symptom occurred; mild PHPT was defined as aPHPT not meeting updated surgical criteria. Seventy-five patients among 172 classified as aPHPT had all available data required for surgical evaluation and could be evaluated. Sixty/75 met surgical criteria and the remaining 15 were classified as mild. Mild PHPT patients had lower total and ionized calcium, urinary calcium, and PTH levels than aPHPT meeting surgical criteria, while vitamin D levels and BMD were similar. Mild PHPT strictly defined according to the last consensus represents a small subgroup with a less active form of the disease.

The recent Fourth Workshop on the Management of Asymptomatic primary hyperparathyroidism (PHPT) maintained the threshold of 60 mL/min for decreased renal function, below which surgery is recommended. This study investigated the relationship between different stages of renal insufficiency and parathyroid hormone (PTH) levels in an updated case series of PHPT patients.This was a retrospective, cross-sectional study involving 379 consecutive PHPT patients. Biochemical evaluation included total and ionized serum calcium, phosphate, creatinine, immunoreactive intact PTH, and 25-hydroxyvitamin D3 (25[OH]D3) levels in the fasting state. Glomerular filtration rate (GFR) was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.Mean CKD-EPI estimated GFR was 81.9 ± 20.3 mL/min/1.73 m(2), and median GFR was 84.0 mL/min/1.73 m(2) (interquartile range, 26.8 mL/min/1.73 m(2)). The patients were divided into 5 groups according to the Kidney Disease: Improving Global Outcomes 2012 guidelines: group 1 with normal or increased GFR (90 mL/min/1.73 m(2)); group 2 with mild GFR decrease (60 to 89 mL/min/1.73 m(2)); group 3a with mild to moderate GFR decrease (45 to 59 mL/min/1.73 m(2)); group 3b with moderate to severe GFR decrease (30 to 44 mL/min/1.73 m(2)); and group 4 with severe GFR decrease (30 mL/min/1.73 m(2)). Among the 5 groups of patients, serum calcium levels were different (P = .025), whereas 25(OH)D3 levels were not (P = .36). PTH levels were comparable across groups 1 through 3a, but they were significantly higher in groups 3b and 4 (P.0001).In our series of PHPT patients, PTH levels did not rise as a result of renal impairment until GFR decreased below 45 mL/min/1.73 m(2).

Formation of densely packed thin films of semiconductor nanocrystals is advantageous for the exploitation of their unique optoelectronic properties for real-world applications. Here we investigate the fundamental role of the structure of the bridging ligand on the optoelectronic properties of the resulting hybrid film. In particular, we considered hybrid films formed using the same CdSe nanocrystals and two organic ligands that have the same bidentate dithiocarbamate binding moiety, but differ in their bridging structures, one bridged by ethylene, the other by phenylene that exhibits conjugation. Based on the results of photo-excited carrier dynamics experiments combined with theoretical calculations on the electronic states of bridged CdSe layers, we show that only the phenylene-based ligand presents a strong hybridization of the molecular HOMO state with CdSe layers, that is a marker of formation of an effective bridge. We argue that this hybridization spread favors the hopping of photo-excited carriers between nanocrystals, which may explain the reported larger photo-currents in phenylene-based hybrid films than those observed in ethylene-based ones. [Figure not available: see fulltext.] © 2017 Tsinghua University Press and Springer-Verlag GmbH Germany

We use two-dimensional electronic spectroscopy (2DES) to disentangle the separate electron and hole relaxation pathways and dynamics of CdTe nanorods on a sub-100 fs time scale. By simultaneously exciting and probing the first three excitonic transitions (S1, S2, and S3) and exploiting the unique combination of high temporal and spectral resolution of 2DES, we derive a complete picture for the state-selective carrier relaxation. We find that hot holes relax from the 1Σ3/2 to the 1Σ1/2 state (S2 → S1) with 30 ± 10 fs time constant, and the hot electrons relax from the Σ′ to the Σ state (S3 → S1) with 50 ± 10 fs time constant. This observation would not have been possible with conventional transient absorption spectroscopy due to the spectral congestion of the transitions and the very fast relaxation time scales.

In this work we study the ultrafast exciton dynamics in CdTe nanorods by using two-dimensional electronic spectroscopy (2DES). By simultaneously exciting the lowest three excitonic transitions (i.e. S1, S2 and S3) we extract the electron and hole relaxation pathways, owing to the combined temporal and spectral resolution of 2DES. In particular, we directly observe hot hole relaxation from the second to the first exciton state in about 30 fs by excitation of the S2 transition. Additionally, we extract a direct charge relaxation to S1 by disentangling the overlapping bleach and excited state induced energy level shifts after excitation of S3.

Objective (1) To evaluate the prevalence of silent nephrolithiasis in patients with primary hyperparathyroidism (PHPT) compared with controls, and (2) To characterize clinically PHPT patients with silent renal stones. Methods We reviewed clinical data for 141 patients with PHPT and without symptoms or history of nephrolithiasis in whom renal ultrasonography was performed at diagnosis. A total of 141 sex- and age- matched subjects with abdomen ultrasonography obtained for reasons different from urinary symptoms served as controls. Results Silent nephrolithiasis was more prevalent in PHPT patients than in controls (11.35% vs. 2.13%, P = .003). Among patients with PHPT, those with silent renal stones showed higher serum calcium and parathyroid hormone levels and met surgical criteria, regardless of nephrolithiasis, more frequently than those without renal stones. Conclusion The prevalence of silent nephrolithiasis is increased in patients with PHPT as compared with controls. Moreover, it seems likely that silent renal stone disease could identify a subset of PHPT patients with more severe disease. Accordingly, we suggest ultrasonographic screening of nephrolithiasis in all PHPT patients. Further studies are needed to better characterize this clinical entity. (Endocr Pract. 2014;20:1137-1142)

The correlation between molecular scale morphology and charge generation across hybrid photovoltaic interfaces made of metal oxides (ZnO and TiO2) and a prototypical electron donor polymer, P3HT, is investigated. Device characterization and UV-NIR transient absorption spectroscopy are used to demonstrate that the local disorder of the polymer chains on the surface of the metal–oxide film provides better electron injection efficiencies than the crystalline phases, though the latter are essential for energy and charge transport. An unambiguous spectroscopic tool is also demonstrated to probe the occupation of the conduction band of ZnO following the electron injection from the polymer through the ultrafast tracking of the Burstein-Moss effect.

SummaryBackground Vitamin D deficiency (VDD) is common in patients with primary hyperparathyroidism (pHPT), and this could affect the clinical expression of the disease. However, few North American or North European studies have addressed this issue, showing vitamin D repletion in only about one-third of the patients. Subjects and methods Vitamin D status was evaluated both in an observational study in a series of 206 consecutive patients with pHPT at diagnosis and in a case-control analysis with 113 age- and sex-matched healthy blood donors. Vitamin D status was assessed by measuring plasma 25-hydroxy-vitamin D (25OHD) levels and was defined as VDD or severe VDD if 25OHD was

We present a joint experimental and theoretical study of the early stage dynamics of photoexcited charges in a prototypical organic/inorganic interface. By using femtosecond pump probe experiments we compared the photophysic of a layer-by-layer hybrid structure obtained by alternating CdSe nanocrystals and poly(p-styrenesulphonic acid) and the same CdSe nanocrystals capped with hexadec-ylamine and stearic acid diluted in solutions. While in the LBL structure it is dear the appearance of a long-lived charged state, no evidence of this is instead found in the diluted solutions. Density functional calculations indicate that these states are localized dose to the nanoparticle surface, and that electrons and holes are separated across the hybrid interface, pointing out the effects of surfactant capping molecules on the optoelectronic properties of the interface. Our combined approach, allowing for unique access to the photoexcited electronic structure, opens the possibility to the fine tailoring of hybrid organic/semiconducting layers for photovoltaic applications.

The simple solution processability at room temperature exposes lead halide perovskite semiconductors to a non-negligible level of unintentional structural and chemical defects. Ascertained that their primary optoelectronic properties meet the requirement for high efficiency optoelectronic technologies, a lack of knowledge about the nature of defects and their role in the device operation currently is a major challenge for their market-scale application due to the issues with stability and reliability. Here, we use excitation correlation photoluminescence (ECPL) spectroscopy to investigate the recombination dynamics of the photogenerated carriers in lead bromide perovskites and quantitatively describe the carrier trapping dynamics within a generalization of the Shockley-Read-Hall formalism. The superior sensitivity of our spectroscopic tool to the many-body interactions enables us to identify the energetics of the defects. In fact, in the case of polycrystalline films, depending on the synthetic route, we demonstrate the presence of both deep and shallow carrier traps. The shallow defects, which are situated at about 20 meV below the conduction band, dope the semiconductor, leading to a substantial enhancement of the photoluminescence quantum yield despite carrier trapping. At excitation densities relevant for lasing, we observe breakdown of the rate-equation model, indicating a buildup of a highly correlated regime of the photocarrier population that suppresses the nonradiative Auger recombination. Furthermore, we demonstrate that colloidal nanocrystals represent virtually defect-free systems, suffering from nonradiative quenching only due to subpicosecond Auger-like interactions at high excitation density. By correlating the fabrication conditions to the nonradiative loss channels, this work provides guidelines for material engineering towards superior optoelectronic devices.

The simple solution processability at room temperature exposes lead halide perovskite semiconductors to a non-negligible level of unintentional structural and chemical defects. Ascertained that their primary optoelectronic properties meet the requirement for high efficiency optoelectronic technologies, a lack of knowledge about the nature of defects and their role in the device operation currently is a major challenge for their market-scale application due to the issues with stability and reliability. Here, we use excitation correlation photoluminescence (ECPL) spectroscopy to investigate the recombination dynamics of the photogenerated carriers in lead bromide perovskites and quantitatively describe the carrier trapping dynamics within a generalization of the Shockley–Read–Hall formalism. The superior sensitivity of our spectroscopic tool to the many-body interactions enables us to identify the energetics of the defects. In fact, in the case of polycrystalline films, depending on the synthetic route, we demonstrate the presence of both deep and shallow carrier traps. The shallow defects, which are situated at about 20 meV below the conduction band, dope the semiconductor, leading to a substantial enhancement of the photoluminescence quantum yield despite carrier trapping. At excitation densities relevant for lasing, we observe breakdown of the rate-equation model, indicating a buildup of a highly correlated regime of the photocarrier population that suppresses the nonradiative Auger recombination. Furthermore, we demonstrate that colloidal nanocrystals represent virtually defect-free systems, suffering from nonradiative quenching only due to subpicosecond Auger-like interactions at high excitation density. By correlating the fabrication conditions to the nonradiative loss channels, this work provides guidelines for material engineering towards superior optoelectronic devices.

Background Despite recent advances in the treatment of psoriasis, the therapeutic options for nail psoriasis are very limited, particularly when this is the only manifestation of the disease. Objective We performed a randomized controlled open-label study to assess the efficacy and safety of a topical treatment with tacrolimus 0.1% ointment in nail psoriasis. Methods In each patient, tacrolimus 0.1% ointment was prescribed for application only on the affected nails of a randomly selected hand for 12 weeks, whereas nails of the other hand did not receive any treatment. Severity of nail psoriasis was evaluated using the Nail Psoriasis Severity Index (NAPSI) score. Results We enrolled 21 consecutive psoriatic patients. At week 12, a statistically significant (P

Here we show an innovative, simple and reliable method to fabricate micro-lasers by self-assembly of rod-shaped nanocrystals. We use dot/rod core/shell CdSe/CdS nanorods to form optical micro-resonators by exploiting their self-organization into well-defined coffee stain rings. The fabrication process merely consists of capillary jet deposition of a nanorod solution onto a glass substrate, and is scalable, economic, and highly reproducible. Upon optical pumping of the micro-resonators we obtain laser emission in the red or in the blue-green spectral region, demonstrating lasing both from core and shell transitions, with low pumping thresholds. Modeling by full-wave numerical simulations according to generalized (i. e. scattering) formulation of laser theory demonstrates lasing from complex modes of the self-assembled cavity.

Great control over size, shape and optical properties is now possible in colloidal Cd-based nanocrystals, which has paved the way for many fundamental studies and applications. One popular example of such class of nanocrystals is represented by CdSe(spherical core)/CdS(rod shell) nanorods. These can be nearly monodisperse in size and shape and have strong and stable photoluminescence that is tunable in the visible range (mainly by varying the size of the CdSe core). The corresponding Zn-based core/shell nanorods would be good candidates for tunable emission in the blue-UV region. However, while the synthesis of ZnS nanocrystals with elongated shapes has been demonstrated based on the oriented-attachment mechanism, elongated ZnS shells are difficult to fabricate because the more common cubic phase of ZnS has a highly symmetric crystal structure. We report here a procedure based on a sequence of two cation exchange reactions, namely, Cd(2+)⇒Cu(+) and then Cu(+)⇒Zn(2+), by which we transform colloidal CdSe(core)/CdS(shell) nanorods first into into Cu(2)Se/Cu(2)S nanorods, which are then converted into blue-UV fluorescent ZnSe(core)/ZnS(shell) nanorods. The procedure transfers the morphological and structural information of the initial Cd-based nanorods to the Zn-based nanorods. Therefore, the final nanoparticles are made by a ZnSe dot embedded in a rod-shaped shell of wurtzite ZnS. Since in the starting Cd-based nanorods the size of the CdSe core and the length of the CdS shell can be well controlled, the same holds for the final Zn-based rods. In the second step of the exchange reaction (Cu(+)⇒Zn(2+)), a large excess of Zn(2+) ions added over the Cu(+) ions present in the Cu(2)Se/Cu(2)S nanorods is the key requisite to obtain bright, band-edge emission (with quantum yields approaching 15%) with narrow line widths (approaching 75 meV). In these ZnSe/ZnS nanorods, photogenerated carriers appear to be more confined in the core region compared to their parent CdSe/CdS nanorods.

Osteocalcin (OC) has been proposed as a regulator of insulin sensitivity in both humans and other animals. Primary hyperparathyroidism (PHPT) is characterized by high OC levels and insulin resistance. The aim of this study was to evaluate whether in PHPT the link between OC levels and blood markers of insulin resistance was maintained. In a consecutive series of 219 adult PHPT patients, serum OC as well as fasting insulin and glucose levels were measured. Insulin sensitivity was estimated by homeostatic model assessment (HOMA2-S%). The same parameters were evaluated in a subgroup of 45 patients after parathyroidectomy (PTX). PHPT patients were characterized by markedly high OC levels. After subdividing them according to glucose tolerance, it was found that OC was similar in subjects with normal glucose tolerance (NGT) and impaired glucose tolerance (IGT), while diabetic subjects had lower serum OC than those with NGT (P < 0.02) or IGT (P < 0.04). OC was negatively associated with fasting glucose and positively associated with HOMA2-S%. OC independently predicted HOMA2-S% in a multivariate analysis. In the subgroup of surgically cured PHPT patients, OC levels significantly decreased after PTX, while HOMA2-S% did not change. Our findings indicate that in PHPT there is a positive relationship between OC and glucose metabolism, OC being one of the predictors of insulin sensitivity. However, data in surgically cured patients, showing OC normalization in spite of unchanged HOMA2-S%, suggest that OC does not likely play a major role in affecting insulin sensitivity in PHPT.

Context: The recent Third International Workshop on the Management of Asymptomatic Primary Hyperparathyroidism (PHPT) set 60 ml/min as the precise level of glomerular filtration rate (GFR) below which surgery is recommended because it is considered a threshold of concern in patients with PHPT. Objective: The aim of the study was to investigate the relationship between different stages of renal insufficiency and PTH levels in PHPT patients. Design: We conducted a cross-sectional study. Patients and Methods: We studied 294 consecutive PHPT patients. Biochemical evaluation included total and ionized serum calcium, phosphate, creatinine, immunoreactive intact PTH, and 25-hydroxyvitamin D3 levels in the fasting state. GFR was assessed with the Modification of Diet in Renal Disease Study formula. Results: The mean GFR of the whole group of PHPT patients was 92.3 ± 31.6 ml/min · 1.73 m2. The patients were divided into four groups according to National Kidney Foundation Disease Outcomes Quality Initiative (K/DOQI) guidelines: group 1 with normal or increased GRF (>90 ml/min · 1.73 m2; n = 153); group 2 with mild decreased GFR (60–89 ml/min · 1.73 m2; n = 90); group 3 with moderately decreased GFR (30–59 ml/min · 1.73 m2; n = 45); and group 4 with severely decreased GFR ( Conclusion: In our series of PHPT patients, only a severe impairment of GFR was characterized by a further PTH increase. These findings challenge the concept of a PTH elevation below the threshold of 60 ml/min of GFR. In a large series of contemporary PHPT patients, only a severe impairment of glomerular filtration rate (i.e.