Identification of the novel HLA-DPA1*01:130 allele by next-generation sequencing

The novel HLA-DPA1*01:130 allele differs from HLA-DPA1*01:03:01:03 by one nucleotide substitution in Exon 3.

The new HLA-DQB1*05:304 allele identified in an Italian patient

DQB1*05:304 allele was identical to DQB1*05:02:01 except for a single nucleotide substitution.

Laser-assisted blepharoplasty: An innovative safe and effective technique

BACKGROUND

Blepharoplasty is one of the most popular esthetic procedures with an acceptable risk profile and a relatively quick procedure.

METHODS

The aim was to evaluate the efficacy and safety of a new CO2 and 1540-nm laser-assisted blepharoplasty technique applied to the upper and lower eyelids. A total of 38 patients were enrolled. Photographs were taken before the treatment and at 6-month follow-up. One "blind" observer assessed the performance of this technique by ranking the results in four categories of eyelid esthetic: 1 = no or poor results (0%-25%), 2 = slight improvement (25%-50%), 3 = moderate improvement (50%-75%) and 4 = marked improvement (75%-100%). All possible complications were monitored.

RESULTS

Thirty-two patients (84 %) achieved marked improvement, four patients (11%) moderate improvement, two patients (5 %) slight improvement, while zero subjects (0%) poor or no improvement. No serious adverse effects were observed.

CONCLUSIONS

Our results from clinical evaluations suggest that the CO2 and 1540-nm laser assisted blepharoplasty is proved to be a sophisticate intervention efficacious in improving the treatment of patients with various degrees of eyelid and periocular aging and also in reducing downtime.

Treatment of benign hyperpigmentations and pigmented scars by 755 alexandrite laser comparing the Single Pass versus MultiPass (MoveoPL) emission in skin types I-IV

Lasers are effective treatments for benign hyperpigmentations but may be difficult especially in darker skin type. In this randomized split-face controlled study on benign hyperpigmentations and pigmented scars, we compare the standard Single Pass (SP) emission with the MultiPass emission (MoveoPL) 755 alexandrite laser. Patients, skin types I-IV, with solar lentigines and ephelides of the face, chest, and hands and patients with pigmented scars of the legs, underwent laser treatment, by treating one side of the body or half scar using the SP and the other side using MoveoPL. Improvements according to a grading score system, side effects, and patient satisfaction were recorded. About 63 patients were enrolled. An overall improvement of benign hyperpigmentations and pigmented scars was recorded, with a grading score (±SD) of 2.8 ± 0.8 for SP and 3.6 ± 0.5 for MoveoPL (range, 0-4). SP emission showed best results in skin types I-II whereas MotusPL obtained successfully results in all the phototypes analyzed (types I-IV). Patients preferred MoveoPL as it was associated with fewer side effects. Both standard SP and MoveoPL emission are effective and safe. MoveoPL showed a higher efficacy and safety profile for the treatment of hyperpigmentations.

Combined pulsed dye laser and Q-switched Nd:YAG laser intraumatic facial tattoo removal: A case series

Traumatic tattoos can be treated with several methods, including mechanical and chemical devices. However, they are rarely used due to the high risk of permanent side effects such as scarring and depigmentation. Recently, laser devices, especially the Q-switched (QS) laser and the pulsed dye laser (PDL), applied in combination, have achieved complete clearance of the lesions without any risk of side effects. Herein, we reported three cases of traumatic facial tattoos successfully treated with combined PDL and QS Nd:YAG laser.

Identification of the novel allele, HLA-A*02:653, in an Italian patient

HLA-A*02:653 differs from A*02:01:01:01 by a C to T substitution in exon 2.

Characterization of the novel HLA-C*02:106 allele in a hematopoietic stem cell volunteer donor

HLA-C*02:106 allele differs from C*02:02:02:01 by a C to T substitution in exon 4.

In vivo non-invasive monitoring of collagen remodelling by two-photon microscopy after micro-ablative fractional laser resurfacing

Non-linear optical microscopy is becoming popular as a non-invasive in vivo imaging modality in dermatology. In this study, combined TPF and SHG microscopy were used to monitor collagen remodelling in vivo after micro-ablative fractional laser resurfacing. Papillary dermis of living subjects, covering a wide age range, was imaged immediately before and forty days after treatment. A qualitative visual examination of acquired images demonstrated an age-dependent remodelling effect on collagen. Additional quantitative analysis of new collagen production was performed by means of two image analysis methods. A higher increase in SHG to TPF ratio, corresponding to a stronger treatment effectiveness, was found in older subjects, whereas the effect was found to be negligible in young, and minimal in middle age subjects. Analysis of collagen images also showed a dependence of the treatment effectiveness with age but with controversial results. While the diagnostic potential of in vivo multiphoton microscopy has already been demonstrated for skin cancer and other skin diseases, here we first successfully explore its potential use for a non-invasive follow-up of a laser-based treatment.

In vivo non-invasive monitoring of collagen remodelling by two-photon microscopy after micro-ablative fractional laser resurfacing

Non-linear optical microscopy is becoming popular as a non-invasive in vivo imaging modality in dermatology. In this study, combined TPF and SHG microscopy were used to monitor collagen remodelling in vivo after micro-ablative fractional laser resurfacing. Papillary dermis of living subjects, covering a wide age range, was imaged immediately before and forty days after treatment. A qualitative visual examination of acquired images demonstrated an age-dependent remodelling effect on collagen. Additional quantitative analysis of new collagen production was performed by means of two image analysis methods. A higher increase in SHG to TPF ratio, corresponding to a stronger treatment effectiveness, was found in older subjects, whereas the effect was found to be negligible in young, and minimal in middle age subjects. Analysis of collagen images also showed a dependence of the treatment effectiveness with age but with controversial results. While the diagnostic potential of in vivo multiphoton microscopy has already been demonstrated for skin cancer and other skin diseases, here we first successfully explore its potential use for a non-invasive follow-up of a laser-based treatment.

Prospective assessment of peripheral neuropathy in Duodopa-treated parkinsonian patients

BACKGROUND

Although peripheral neuropathies (PN) have been described in patients with Parkinson's disease (PD) treated with oral dopaminergic therapies, anecdotal reports of subacute severe PN have been reported during treatment with enteral levodopa/carbidopa infusion (Duodopa).

AIM OF THE STUDY

We prospectively assessed clinical and electrophysiological data of 15 consecutive patients with PD treated with Duodopa for a mean follow-up of 9 months.

METHODS

Nerve conduction studies and a clinical evaluation with a standardized battery of peripheral neuropathy scales were performed at baseline and after a mean follow-up of 9 months.

RESULTS

At baseline, mild signs of PN were observed in three subjects, and vitamin B12 serum levels were found to correlate with the amplitude of sural sensory action potentials. Follow-up data were available for 10/15 subjects: one patient developed a subacute sensory-motor PN and three subjects with pre-existing PN showed a moderate worsening of electrophysiological and clinical features. Subclinical electrophysiological alterations of peripheral nerves were observed in two subjects. No significant changes were observed in vitamin B12, folate, homocysteine and methylmalonic acid levels.

CONCLUSIONS

In this consecutive series of patients treated with Duodopa, we observed one subacute sensory-motor PN and few length-dependent alterations of peripheral nerves, similar to those described during oral levodopa treatment.

Island flaps in the repair of medial canthus: report of 8 cases

Reconstruction of the medial canthus following skin cancer excision is often challenging because of the complex anatomy and the cosmetic relevance of that region. The island pedicle advancement flap is an extremely versatile flap, which is commonly used to close defects in different body areas, including face, trunk, and extremities. We report our favourable experience with the use of island flaps, mobilized from the nasal saddle or lateral nasal side wall in 8 patients who had skin defects on the medial canthus region after Mohs micrographic surgery for basal cell carcinomas.

Genotypes and haplotypes in the 3' untranslated region of the HLA-G gene and their association with clinical outcome of hematopoietic stem cell transplantation for beta-thalassemia

Polymorphisms in the 3' untranslated region (3'UTR) of HLA-G, an important player in immunological tolerance, could be involved in post-transcriptional expression control, and their association with different clinical immune-related conditions including autoimmunity and transplantation is of mounting interest. Most studies have focused on a 14 base pair (bp) insertion/deletion (ins/del), while additional single-nucleotide polymorphisms (SNPs) in the HLA-G 3'UTR have been described but not extensively investigated for their clinical relevance. Here we have comparatively studied the association between 3'UTR haplotypes of HLA-G, or the 14 bp ins/del, with clinical outcome of HLA-identical sibling hematopoietic stem cell transplantation (HSCT) in 147 Middle Eastern beta-thalassemia patients. Sequence based typing of 3'UTR HLA-G polymorphisms in the patients and in 102 healthy Italian blood donors showed strong linkage disequilibrium between the 14 bp ins/del and five 3'UTR SNPs, which together could be arranged into eight distinct haplotypes based on expectation-maximization studies, with four predominant haplotypes (UTRs1-4). After HSCT, we found a moderate though not significant association between the presence of UTR-2 in double dose and protection from acute graft versus host disease (hazard ratio (HR) 0.45, 95% confidence intervals (CI): 0.14-1.45; P = 0.18), an effect that was also seen when the corresponding 14 bp ins/ins genotype was considered alone (HR 0.42, 95% CI: 0.16-1.06; P = 0.07). No association was found with rejection or survival. Taken together, our data show that there is no apparent added value of considering entire 3'UTR HLA-G haplotypes for risk prediction after allogeneic HSCT for beta-thalassemia.

Highlights of thirty-year experience of CO2 laser use at the Florence (Italy) department of dermatology

The CO₂ laser has been used extensively in dermatological surgery over the past 30 years and is now recognised as the gold standard for soft tissue vaporization. Considering that the continuous wave CO₂ laser delivery system and the newer “superpulsed” and scanned CO₂ systems have progressively changed our practice and patient satisfaction, a long range documentation can be useful. Our experience has demonstrated that the use of CO₂ laser involves a reduced healing time, an infrequent need for anaesthesia, reduced thermal damage, less bleeding, less inflammation, the possibility of intra-operative histologic and/or cytologic examination, and easy access to anatomically difficult areas. Immediate side effects have been pain, erythema, edema, typically see with older methods, using higher power. The percentage of after-treatment keloids and hypertrophic scars observed was very low (~1%) especially upon the usage of lower parameters. The recurrence of viral lesions (condylomas and warts) have been not more frequent than those due to other techniques. Tumor recurrence is minor compared with radiotherapy or surgery. This method is a valid alternative to surgery and/or diathermocoagulation for microsurgery of soft tissues. Our results are at times not consistent with those published in the literature, stressing the concept that multicentric studies that harmonization methodology and the patient selection are vital.

Characterization of the novel HLA-C*07:195 allele in an Italian hematopoietic stem cell volunteer donor, detected by sequence-based typing

The new allele shows one nucleotide change from C*07:02:01:01 at 351 nt from C to A, resulting in an amino acid change at codon 93 of exon 3 from H to Q.

Letter: The "reading man" flap in facial reconstruction: report of 12 cases

Reconstruction of defects in the infraorbital, malar, and temporal areas after tumor resection may present problems such as distortion of anatomic points and extra normal skin removal. The "reading man" flap is a recent local flap procedure, which has been used to solve those problems. We report our experience with this procedure, which has been used for the closure of circular defects in 12 patients (7 men and 5 women), aged 68 to 86 years (mean age: 77 years), who had undergone surgical excisions of basal cell carcinomas of the temporal, malar, and infraorbital regions. The functional and aesthetical results were satisfactory in all cases. In our experience, the "reading man" flap is a useful option for the reconstruction of circular defects in these facial areas.

Fractional CO2 laser: a new therapeutic system forphotobiomodulation of skin remodeling and cytokineproduction in the course of tissue reparation

Eighteen female patients with the signs of photoageing underwent skin rejuvenation using a fractional CO2 laser (SmartXide DOT, DEKA M.E.L.A., Florence, Italy) with varying energy density (2.07, 2.77 and 4.15 J/cm2). Clinical efficacy of the said laser irradiation parameters was assessed in all of the subjects, and the skin cytokine profile was studied by using the immunohistochemistry technique based on skin tissue samples taken prior to the treatment, right after the treatment and in 3 and 30 days. There were significant improvements in the wrinkle and skin texture condition, and hyperpigmentation was reduced as a result of the treatment, which proves the efficacy of using the fractional CO2 laser for the skin photorejuvenation. The technique ensures good clinical results and is distinguished by a short rehabilitation period and excellent safety profile. In the course of the immunohistochemistry, a relation between the skin cytokine production, reepithelization and laser irradiation density was established.

Identification of the new HLA-A*31:48 allele in an Italian patient

Human leukocyte antigen (HLA) class I sequence-based typing (SBT) for hematopoietic unrelated donor searching in an Italian Caucasian patient showed the presence of a novel HLA-A allele defined as A*31:48. HLA-A*31:48 has one nucleotide change from A*31:01:02 at nt 727 from C to T, resulting in an amino acid change at codon 219 of exon 4 from Arg to Trp.

Kaposi Sarcoma of the Penis in an HIV-Negative Patient

Background:

The penis is an unusual site of presentation for Kaposi sarcoma, especially in immunocompetent patients.

Case Presentation:

A 52-year-old human immunodeficiency virus (HIV)-seronegative man presented with a reddish, 8 mm in diameter nodule on the glans penis near the coronal sulcus. Histopathology after excision of the lesion was consistent with Kaposi sarcoma. No other cutaneous or mucosal manifestations were present. After a follow-up period of 2 years, no recurrence was observed.

Conclusion:

This unusual case suggests that Kaposi sarcoma should be considered in the differential diagnosis of macular, papular, and nodular lesions involving the penis.

Infliximab efficacy in nail psoriasis. A retrospective study in 48 patients

BACKGROUND

Nail psoriasis occurs in up to half of psoriatic patients and can lead to significant physical impairment and pain. To date, patients and clinicians are actually dissatisfied by current therapeutic approaches.

OBJECTIVE

Our main aim is to evaluate Infliximab efficacy in nail psoriasis.

METHODS

We performed an open-label and uncontrolled retrospective study considering all psoriatic patients presenting recalcitrant nail involvement and receiving Infliximab in our Department during the period between January 2008 and March 2009. We calculated nail psoriasis severity index (NAPSI) score at 0, 14, 22 and 38 weeks and percentage of patients achieving NAPSI-50,-75,-90 at 14, 22 and 38 weeks.

RESULTS

We observed a rapid nail improvement in most cases after 22 weeks of Infliximab therapy, but a complete nail clearing was reached in only five (10.4%) patients. We don't have a follow-up longer than 38 weeks to assess long-term efficacy of this treatment in nail psoriasis.

CONCLUSIONS

Infliximab, in our experience, has proved to be effective in reducing nail lesions and, in some cases, even clearing them. Our data demonstrate long-term efficacy of this biological agent in nail psoriasis.

Comparison of body weight and clinical-parameter changes following the treatment of plaque psoriasis with biological therapies

OBJECTIVE

This study is a retrospective analysis evaluating the presence of comorbidities, as well as the changes in body weight and clinical parameters in psoriasis patients following treatment with anti-TNF-alpha agents and with the anti-CD11a agent efalizumab.

RESEARCH DESIGN AND METHODS

A total of 268 patients affected by chronic plaque psoriasis, and receiving systemic monotherapy with efalizumab, etanercept, or infliximab, were included. The follow-up period was 2, 4 and 6 months.

MAIN OUTCOME MEASURES

Clinical data including age, gender, weight, type and severity of psoriasis and age of onset were collected. Severity of psoriasis was assessed according to the Psoriasis Area and Severity Index (PASI) and body surface area (BSA).

RESULTS

Hypertension and hyperlipidaemia were the comorbidities present with the higher frequency in our group of patients. PASI score was reduced by between 43.8 and 52% in all treatment groups. No relevant blood chemistry changes were observed following therapy, with the exception of a decrease in neutrophils and an increase in leukocyte numbers reported in the efalizumab and etanercept groups. Interestingly, after 6 months of therapy, the weight of the patients remained unvaried in those taking efalizumab (-0.05%) but was moderately increased in the etanercept (+0.72%) and in infliximab groups (+0.3%).

CONCLUSIONS

The present study shows that there were clinically significant differences in weight gain effects between efalizumab and anti-TNF-alpha agents in psoriatic patients. The changes in body weight gain increase did not reach statistical significance, although there is a trend towards this, and this may be due to the relatively small number of patient studied.

Rituximab in dermatological diseases

Rituximab is a chimeric monoclonal antibody currently used for the treatment of non-Hodgkin lymphoma that targets the transmembrane protein CD20 of B cells. Recently it has also been used for the treatment of several autoimmune diseases, including skin disorders such as Paraneoplastic Pemphigus, Pemphigus Vulgaris, Pemphigus Foliaceus, Mucosal pemphigoid, Bullous pemphigoid, Epidermolysis bullosa acquisita, Systemic lupus erythematous and Dermatomyositis. Frequently all these conditions required intolerably high doses of corticosteroids and additional immunosoppressants, which can increase the risk of severe adverse events. Therefore, new therapeutic options are needed for such patients. The intent of the authors in this review is to provide the reader with a panoramic view of the studies reported to date.

Identification of a novel HLA-B*07 allele in an Iranian family: B*0769

New allele B*0769 showed one nucleotide difference with B*0732 at codon 272 (TTC-->TGC).

Radiation therapy in urinary cancer: state of the art and perspective

Invasive urinary tumours are relatively rare, and their treatment may cause important changes in urinary, sexual and social functions. A systematic review of external radiation therapy studies in urinary cancers was performed. This synthesis of the literature is based on data from meta-analyses, randomised and prospective trials and retrospective studies. There are few controlled clinical trials using adjuvant or radical radiotherapy with or without chemotherapy in cancer of the kidney, ureter and urethra. There are several reports on multimodality treatment in invasive bladder cancer: intravesical surgery and neoadjuvant chemotherapy to radiotherapy or concomitant radiochemotherapy with organ preservation. The conclusions reached for renal cancer are controversial, and data on cancers of the urethra and ureter are few and inconclusive. Sufficient data now exist in the literature to demonstrate that conservative management with organ preservation is a valuable alternative to radical cystectomy, the traditional gold standard, in invasive bladder cancer.