Aggressiveness in Italian Children with ADHD: MAOA Gene Polymorphism Involvement

ADHD is a neurodevelopmental disorder that children and adults can develop. A complex interplay of genetic and environmental factors may underlie interindividual variability in ADHD and potentially related aggressive behavior. Using high-resolution molecular biology techniques, we investigated the impact of some MAOA and SLC6A4 variations on ADHD and aggressive behavior in a group of 80 Italian children with ADHD and in 80 healthy controls. We found that homozygous genotypes of MAOA rs6323 and rs1137070 were associated with an increased risk of ADHD (p = 0.02 and p = 0.03, respectively), whereas the heterozygous genotypes (GT of rs6323 and CT of rs1137030) (p = 0.0002 and p = 0.0006) were strongly linked to a lower risk of developing this disorder. In patients with aggressive behavior, we highlighted only a weak negative association of both MAOA polymorphisms (heterozygous genotypes) with aggressiveness, suggesting that these genotypes may be protective towards specific changes in behavior (p = 0.05). Interestingly, an increase in the GG genotype of rs6323 (p = 0.01) and a decrease in GT genotype (p = 0.0005) was also found in patients without aggressive behavior compared to controls. Regarding 5HTT gene genotyping, no allele and genotype differences have been detected among patients and controls. Our work shows that defining a genetic profile of ADHD may help in the early detection of patients who are more vulnerable to ADHD and/or antisocial and aggressive behavior and to design precision-targeted therapies.

[Therapeutic Plasma Exchange in a Patient with Chronic Hemodialysis and a New Diagnosis of Myasthenia Gravis]

Case ReportC.S.T. (♂, 71 years old) is a patient with multiple and severe comorbidities, undergoing thrice-weekly chronic hemodialysis since 2008 due to the progression of post-lithiasic uropathy. Over the past 2 months, the patient had been experiencing progressive ptosis of the eyelids, muscle weakness, and ultimately dysphagia and dysarthria that emerged in the last few days. Urgently admitted to the Neurology department, electromyography (EMG) was performed, leading to a diagnosis of predominant cranial myasthenia gravis (with borderline anti-acetylcholine receptor antibody serology). Prompt treatment with pyridostigmine and steroids was initiated. Considering the high risk of acute myasthenic decompensation, therapeutic plasma exchange (TPE) with centrifugation technique was promptly undertaken after femoral CVC placement. TPE sessions were alternated with hemodialysis. The patient's condition complicated after the third TPE session, with septic shock caused by Methicillin-Sensitive Staphylococcus Aureus (MSSA). The patient was transferred to the Intensive Care Unit (ICU). Due to hemodynamic instability, continuous veno-venous hemodiafiltration (CVVHDF) with citrate anticoagulation was administered for 72 hours. After resolving the septic condition, intermittent treatment with Acetate-Free Biofiltration (AFB) technique was resumed. The patient completed the remaining three TPE sessions and, once the acute condition was resolved, was transferred back to Neurology. Here, the patient continued the treatment and underwent a rehabilitation program, showing significant motor and functional recovery until discharge. Conclusions. The multidisciplinary interaction among Nephrologists, Neurologists, Anesthesiologists, and experts from the Immunohematology and Transfusion Medicine Service enabled the management and treatment of a rare condition (MG) in a high-risk chronic hemodialysis patient.

[New Mutation of CYP24A1 in a Case of Idiopathic Infantile Hypercalcemia Diagnosed in Adulthood]

Mutations in the 24-hydroxylase gene CYP24A1 have been recognized as causes of childhood idiopathic hypercalcemia (IIH), a rare disease (incidence <1:1,000,000 live births) characterized by increased vitamin D sensitivity, with symptomatic severe hypercalcemia. IIH was first described in Great Britain two years after the start of a program of vitamin D supplementation in milk for the prevention of rickets, manifesting in about 200 children with severe hypercalcemia, dehydration, growth failure, weight loss, muscle hypotonia, and nephrocalcinosis. The association between the epidemic occurrence of IIH and vitamin D administration was quickly attributed to intrinsic hypersensitivity to vitamin D, and the pathogenic mechanism was recognized in the inactivation of Cytochrome P450 family 24 subfamily A member 1 (CYP24A1), which was identified as the molecular basis of the pathology. The phenotypic spectrum of CYP24A1 mutation can be variable, manifesting predominantly with childhood onset and severe symptomatology (severe hypercalcemia, growth retardation, lethargy, muscle hypotonia, dehydration), but also with juvenile-adult onset forms with nephrolithiasis, nephrocalcinosis, and alterations in phosphocalcium homeostasis. We describe the case of a patient in whom the diagnosis of IIH was made in adulthood, presenting with finding of nephrocalcinosis in childhood, and with subsequent onset of severe hypercalcemia with hypercalciuria, hypoparathyroidism, hypervitaminosis D, and recurrent renal lithiasis. Genetic investigation revealed the presence in homozygosity of the c_428_430delAAG_p.Glu143del variant in the CYP24A1 gene with autosomal recessive transmission, a mutation not reported in the literature.

Rituximab in people living with HIV affected by immune-mediated renal diseases: a case-series

Over the last two decades, rituximab (RTX) has played an important role in the treatment of some lymphoproliferative malignancies and immune-mediated diseases. RTX administration is generally safe and well-tolerated, but side effects including late-onset neutropenia, hypogammaglobulinemia, hepatitis B reactivation and rare cases of progressive multifocal leukoencephalopathy have been observed after its administration. Although there are no absolute contraindications regarding its use in people living with HIV (PLWH), the prescription of this drug has been principally limited in patients with oncohematological diseases. In this report, we described the outcome of four PLWH who underwent RTX therapy after the diagnosis of immune-mediated renal disease. The main RTX-associated adverse effects were leukopenia, late-onset neutropenia and decline of CD4+ and CD8+ T-cell counts. In addition, two of the four patients experienced pneumonia requiring hospitalization within six months from the last RTX infusion. We suggest that RTX should be used with caution in PLWH until further evidence emerges on its safety profile in this vulnerable population.

Role of saccharides on thermal stability of phycocyanin in aqueous solutions

The effect of heat and equivalent thermal effect ( [Formula: see text] ) on discolouration of Spirulina algae extracts in water, sucrose and trehalose solutions at different concentration was investigated and kinetics of phycocyanin degradation evaluated by spectrophotometric and circular dichroism. At constant temperature, colour loss increased at increasing time and decreased at increasing solute concentration. Circular dichroism confirmed relation between colour loss and protein structure destabilization, and the thermostabilising effect of saccharides with sucrose performing better than trehalose. Apparent constant rate values determined by the Weibullian probabilistic model describe the corresponding phycocyanin degradation kinetics; a linear correlation between the activation energy and a_w of the solutions has been found. Origin of phycocyanin and system saccharide concentration resulted significant discriminant factors on the discolouration when [Formula: see text] was taken into account. Results may find application in product formulation and processing optimisation, thereby the use of Spirulina extracts as colouring foodstuff could be enhanced.

Veterinary-focused assessment with sonography for trauma-airway, breathing, circulation, disability and exposure: a prospective observational study in 64 canine trauma patients

OBJECTIVE

To describe the technique and findings of the 'veterinary focused assessment with sonography for trauma-airway, breathing, circulation, disability and exposure' protocol in dogs suffering from trauma.

MATERIALS AND METHODS

Prospective observational study on a new point-of-care ultrasound protocol on 64 dogs suffering from trauma and comparison of findings with radiology.

RESULTS

Comparison of the results of this new ultrasound protocol for trauma patients with radiography findings for pneumothorax, pleural effusion, alveolar-interstitial syndrome and abdominal effusion revealed positive agreement of 89, 83, 100 and 87% and negative agreement of 76, 83, 76 and 92%, respectively. Novel findings of the 'veterinary focused assessment with sonography for trauma-airway, breathing, circulation, disability and exposure' exam, which were not previously reported for dogs undergoing focused assessment with sonography for trauma, included alveolar-interstitial syndrome (suggestive of pulmonary contusions), diaphragmatic hernia, retroperitoneal effusion and tracheal injury. Our new technique may also help identify increased intracranial pressure via changes in optic nerve sheath diameter and haemodynamic instability through the evaluation of the caudal vena cava and cardiac function.

CLINICAL SIGNIFICANCE

The described ultrasound examination protocol can be rapidly performed on dogs suffering from trauma during resuscitation and it may detect injuries previously undetectable using other veterinary point-of-care ultrasound protocols.

Physician-patient communication and patient-reported outcomes in the actinic keratosis treatment adherence initiative (AK-TRAIN): a multicenter, prospective, real-life study of treatment satisfaction, quality of life and adherence to topical field-directed therapy for the treatment of actinic keratosis in Italy

BACKGROUND

Patients with multiple actinic keratoses (AKs) should be treated with field-directed therapy. Such treatments challenge patients' adherence due to out-of-pocket costs, length of treatment and severity of local skin reactions (LSRs). Effective physician-patient communication (PPC) may buffer therapy-related distress, thus improving quality of life, treatment satisfaction and adherence.

OBJECTIVES

We evaluated the interplay between PPC, LSR intensity (safety) and lesion clearance rates (effectiveness) on treatment satisfaction, quality of life and treatment adherence among patients with multiple AKs receiving topical field-directed therapies.

METHODS

In this observational, multicentre, longitudinal, cohort study, we included 1136 adult patients with discrete, clinically detectable, visible, multiple (three or more lesions in a 25 cm² area), Grade I/II AKs, for whom the attending dermatologist has prescribed treatment with a topical field-directed therapy. We matched self-reported data and medical information recorded by dermatologists in standard clinical forms. Patients were followed up at two time points (T1: 8 days; T2: 25-30 days) RESULTS: Most patients were elderly, married, men with poor socio-economic status and multiple lesions of the scalp or face. The majority (n = 961) had a prescription of ingenol mebutate (IMB) and 175 received either diclofenac 3% in hyaluronic acid (DHA) or imiquimod 5% (IMQ). Clearance rate at 1 month was 84%. Most patients felt very supported (n = 819, 73%) and rated dermatologist's explanations very clear (n = 608, 54%). Treatment satisfaction (effectiveness and convenience scales) increased along the follow-up, especially for those on IMB (Δ_pre-post  = -4.00; other: Δ_pre-post  = -0.25; interaction P < 0.001). Communication clarity was associated with higher treatment satisfaction scores (β = 0.4-0.6, P < 0.01) and lower risk of non-adherence among IMB patients (risk difference: 16%, P < 0.01).

CONCLUSION

Communication clarity was associated with patient-reported outcomes and adherence beyond AK-related clinical parameters. Our study questions the current episodic approach to AK management and provides the rationale to develop chronic care models fostering patients' engagement and treatment alliance.

Plasma Exchange Treatment in Rapidly Progressive Glomerulonephritis Associated with Antineutrophil Cytoplasmic Autoantibodies

This study reports on 12 patients with acute renal failure due to biopsy-proven rapidly progressive glomerulonephritis and signs of systemic disease in whom antineutrophil cytoplasmic autoantibodies (ANCA) were detected by indirect immunofluorescence (IIF) on alcohol-fixed neutrophils and assessed in serial determinations by ELISA. The diagnosis was: Wegener's granulomatosis in nine patients who showed a diffuse cytoplasmic pattern at IIF (c-ANCA), and microscopic polyarteritis in three where a perinuclear pattern (pANCA) was seen.

All patients underwent a course of plasma exchange - PE - (3-10 sessions per patient) associated with steroids and cyclophosphamide. The ANCA titer dropped steeply during PE in all cases and was followed by disappearance of systemic symptoms and renal function improvement within four weeks. After a follow-up period of 50 ± 31.2 months all patients were alive without signs of disease activity; ten had stable renal function, with serum creatinine 1.8 ± 0.7 mg/dl; two had entered regular dialysis treatment after 44 and 82 months.

Our results suggest that the rapid removal of ANCA by means of PE can help control disease activity and reduce the risk of death or end-stage renal disease.

Serum Lipoprotein (a) and Coronary Artery Disease in Uremic Patients on Chronic Hemodialysis

There is convincing clinical and experimental evidence to support the notion that lipoprotein(a) [Lp(a)] is atherogenic. Patients undergoing chronic hemodialysis have an increased risk of atherosclerotic cardiovascular complications. In the present study, we investigated the possible relation between the alteration, if any, in serum Lp(a) and coronary artery disease in such patients. The mean serum concentration of Lp(a) tended to be higher in the 64 hemodialysis patients than in the 30 normal controls (15.1 ± 15.2 vs. 9.7 ± 10.4 mg/dl). However the difference did not reach statistical significance. The prevalence of levels above 30 mg/dl was 14% (9/64) and 10% (3/10), respectively, and the difference was also not statistically significant. Eleven hemodialysis patients with coronary artery disease had a significantly higher mean serum concentration of Lp(a) than the unaffected 53 (33.7 ± 18.4 vs. 11.1 ± 11.2 mg/dl, p < 0.001). Elevated levels were present in 63.6% (7/11) and 3.8% (2/53), respectively (p<0.01). Other parameters of lipid metabolism were not different between the two groups. We observed statistically significant positive correlations of Lp(a) to total cholesterol, LDL cholesterol and apolipoprotein B in controls, in hemodialysis patients as a whole and in those without coronary artery disease. No such correlations were obtained when hemodialysis patients with coronary artery disease were analysed separately. It is concluded that firstly, high serum levels of Lp(a) in hemodialysis patients are strongly associated with coronary artery disease, as well as in the general population; and secondly, abnormalities in the metabolism of Lp(a) may underlie atherogenesis in these patients, independently of alterations in other lipid constituents

A new H2 (+) source: Conceptual study and experimental test of an upgraded version of the VIS-Versatile ion source

The versatile ion source is an off-resonance microwave discharge ion source which produces a slightly overdense plasma at 2.45 GHz of pumping wave frequency extracting more than 60 mA proton beams and 50 mA He(+) beams. DAEδALUS and IsoDAR experiments require high intensities for H2 (+) beams to be accelerated by high power cyclotrons for neutrinos generation. In order to fulfill the new requirements, a new plasma chamber and injection system has been designed and manufactured for increasing the H2 (+) beam intensity. In this paper the studies for the increasing of the H2 (+)/p ratio and for the design of the new plasma chamber and injection system will be shown and discussed together with the experimental tests carried out at Istituto Nazionale di Fisica Nucleare-Laboratori Nazionali del Sud (INFN-LNS) and at Best Cyclotron Systems test-bench in Vancouver, Canada.

Frontiers of robotic endoscopic capsules: a review

Digestive diseases are a major burden for society and healthcare systems, and with an aging population, the importance of their effective management will become critical. Healthcare systems worldwide already struggle to insure quality and affordability of healthcare delivery and this will be a significant challenge in the midterm future. Wireless capsule endoscopy (WCE), introduced in 2000 by Given Imaging Ltd., is an example of disruptive technology and represents an attractive alternative to traditional diagnostic techniques. WCE overcomes conventional endoscopy enabling inspection of the digestive system without discomfort or the need for sedation. Thus, it has the advantage of encouraging patients to undergo gastrointestinal (GI) tract examinations and of facilitating mass screening programmes. With the integration of further capabilities based on microrobotics, e.g. active locomotion and embedded therapeutic modules, WCE could become the key-technology for GI diagnosis and treatment. This review presents a research update on WCE and describes the state-of-the-art of current endoscopic devices with a focus on research-oriented robotic capsule endoscopes enabled by microsystem technologies. The article also presents a visionary perspective on WCE potential for screening, diagnostic and therapeutic endoscopic procedures.

Italian expert consensus for the management of actinic keratosis in immunocompetent patients

Actinic keratosis (AK) is a common skin disease which can potentially progress to invasive squamous cell carcinoma (iSCC). Given that mortality rates and health-care cost associated with iSCC are substantial, the management of AK represents an important public health issue. Several effective lesion-directed and field-directed treatments are available. Ablative procedures (e.g. cryosurgery, excision, laser ablation, curettage alone or with electrodessication) are considered cost-effective options for solitary lesions. Field-directed therapies (e.g. Ingenol Mebutate, imiquimod, PDT, 5-Fluorouracile, diclofenac 3%, 5-FU + Salicylic acid) can be used over large epidermal surfaces and are directed to treat both individual visible lesions and cancerization fields. In order to provide guidance for management choice in clinical practice, several guidelines concerning the diagnosis and treatment of AK have been published in the past decade. However, the introduction of novel therapeutic options requires continuous updates of recommendations and adaptation to national contexts. The present review summarizes the existing evidence and reports the results of a consensus workshop on the management of AK.

Bloating is associated with worse quality of life, treatment satisfaction, and treatment responsiveness among patients with constipation-predominant irritable bowel syndrome and functional constipation

BACKGROUND

The management of bloating is unclear and its relationship with patients' well-being and treatment satisfaction independent of other abdominal symptoms is uncharacterized. We evaluated the association of bloating with patient-reported outcomes.

METHODS

Thirty-nine centers for functional gastrointestinal disorders joined the laxative inadequate relief survey. We enrolled 2203 consecutive outpatients with functional constipation (FC) or constipation-predominant irritable bowel syndrome (IBS-C) in two cross-sectional waves. Both wave 1 and 2 included the SF-12, the patient assessment of constipation-symptoms (PAC-SYM), and the treatment satisfaction questionnaire for medication (TSQM-2). Wave 2 only included a global rating of change (GRC) scale to assess patients' assessment of efficacy concerning treatment switches occurred in the 3 months prior to the interview. Bloating in the abdomen was defined on the basis of PAC-SYM item 3.

KEY RESULTS

The average age was 50.1 years (SD, 16.7) and 82.1% of patients were women. The prevalence of bloating was 91.6% (n = 1970). Bloating was associated with SF-12 Physical Composite Score (p < 0.01), SF-12 Mental Composite Score (p < 0.01), GRC (p < 0.01), Satisfaction with treatment effectiveness (p < 0.01), convenience of administration (p < 0.01), and side effects (p < 0.01) after adjustment for possible confounders.

CONCLUSIONS & INFERENCES

Our data suggest that patients regard bloating as a key element in assessing clinical changes and treatments' efficacy as this symptom exerts a strong influence on patient-reported outcomes independent of possible confounders and other symptoms of constipation. Our data provide the rationale to investigate the efficacy and tolerability of new treatments specifically addressing this important, yet disregarded, patients' complain.

A three-dimensional numerical modelling of the PHOENIX-SPES charge breeder based on the Langevin formalism

A Charge Breeder (CB) is a crucial device of an ISOL facility, allowing post-acceleration of radioactive ions: it accepts an incoming 1+ beam, then multiplying its charge with a highly charged q+ beam as an output. The overall performances of the facility (intensity and attainable final energy) critically depend on the charge breeder optimization. Experimental results collected along the years confirm that the breeding process is still not fully understood and room for improvements still exists: a new numerical approach has been therefore developed and applied to the description of a (85)Rb(1+) beam capture by the plasma of the 14.5 GHz PHOENIX ECR-based CB, installed at the Laboratoire de Physique Subatomique et de Cosmologie (LPSC), and adopted for the Selective Production of Exotic Species project under construction at Laboratori Nazionali di Legnaro. The results of the numerical simulations, obtained implementing a plasma-target model of increasing accuracy and different values for the plasma potential, will be described along the paper: results very well agree with the theoretical predictions and with the experimental results obtained on the LPSC test bench.

Electromagnetic analysis of the plasma chamber of an ECR-based charge breeder

The optimization of the efficiency of an ECR-based charge breeder is a twofold task: efforts must be paid to maximize the capture of the injected 1+ ions by the confined plasma and to produce high charge states to allow post-acceleration at high energies. Both tasks must be faced by studying in detail the electrons heating dynamics, influenced by the microwave-to-plasma coupling mechanism. Numerical simulations are a powerful tools for obtaining quantitative information about the wave-to-plasma interaction process: this paper presents a numerical study of the microwaves propagation and absorption inside the plasma chamber of the PHOENIX charge breeder, which the selective production of exotic species project, under construction at Legnaro National Laboratories, will adopt as charge breeder. Calculations were carried out with a commercial 3D FEM solver: first, all the resonant frequencies were determined by considering a simplified plasma chamber; then, the realistic geometry was taken into account, including a cold plasma model of increasing complexity. The results gave important information about the power absorption and losses and will allow the improvement of the plasma model to be used in a refined step of calculation reproducing the breeding process itself.

Recent progress in plasma modelling at INFN-LNS

At Istituto Nazionale di Fisica Nucleare - Laboratori Nazionali del Sud (INFN-LNS), the development of intense ion and proton sources has been supported by a great deal of work on the modelling of microwave generated plasmas for many years. First, a stationary version of the particle-in-cell code was developed for plasma modelling starting from an iterative strategy adopted for the space charge dominated beam transport simulations. Electromagnetic properties of the plasma and full-waves simulations are now affordable for non-homogenous and non-isotropic magnetized plasma via "cold" approximation. The effects of Coulomb collisions on plasma particles dynamics was implemented with the Langevin formalism, instead of simply applying the Spitzer 90° collisions through a Monte Carlo technique. A wide database of different cross sections related to reactions occurring in a hydrogen plasma was implemented. The next step consists of merging such a variety of approaches for retrieving an "as-a-whole" picture of plasma dynamics in ion sources. The preliminary results will be summarized in the paper for a microwave discharge ion source designed for intense and high quality proton beams production, proton source for European Spallation Source project. Even if the realization of a predictive software including the complete processes involved in plasma formation is still rather far, a better comprehension of the source behavior is possible and so the simulations may support the optimization phase.

Experimental investigation of non-linear wave to plasma interaction in a quasi-flat magnetostatic field

A characterization of wave-to-plasma interaction in a quasi-flat magnetostatic field at 3.75 GHz has been carried out by using a small-wire movable RF antenna, connected to a spectrum analyzer. The coupling between electromagnetic and electrostatic waves leads to a characteristic spectral emission in low frequency range and around the pumping wave frequency. The most relevant results consist in the broadening of the pumping wave spectrum above critical RF power thresholds and in the generation of sidebands of the pumping frequency, with corresponding components in low frequency domain. The non-linearities are accompanied by the generation of overdense plasmas and intense fluxes of X-rays.

Injection of auxiliary electrons for increasing the plasma density in highly charged and high intensity ion sources

Different electron guns based on cold- or hot-cathode technologies have been developed since 2009 at INFN for operating within ECR plasma chambers as sources of auxiliary electrons, with the aim of boosting the source performances by means of a higher plasma lifetime and density. Their application to microwave discharge ion sources, where plasma is not confined, has required an improvement of the gun design, in order to "screen" the cathode from the plasma particles. Experimental tests carried out on a plasma reactor show a boost of the plasma density, ranging from 10% to 90% when the electron guns are used, as explained by plasma diffusion models.

Antibiotic therapy in the management of atopic dermatitis

Atopic dermatitis (AD), also known as atopic eczema, is a syndrome characterized by a chronic eczematous dermatitis, with associated pruritus, characteristic age-specific morphology and distribution of lesions and recurrent nature. Secondary infections in patients with AD are very common and difficult to treat. S. aureus colonizes almost all eczematous lesions in atopic patients and releases several super-antigens and exotoxins (i.e., toxic shock syndrome toxin-1, enterotoxins A-D, etc.), which sustain inflammatory reactions and promote tachyphylaxis. The topical antibiotics most commonly prescribed for mild/moderate secondary infections are gentamicin, fusidic acid and mupirocine. This article reviews existing therapeutic options and provides guidance for the management of secondary skin infection among patients with AD.

Treatment adherence and real-life effectiveness of topical therapy in patients with mild or moderate psoriasis: uptake of scientific evidence in clinical practice and dermatologists' preferences for alternative treatment options

AIM

Topical corticosteroids and the vitamin D analogue calcipotriol are the cornerstone of therapy for patients with mild-to-moderate plaque psoriasis. Lack of patients' adherence leads to suboptimal effectiveness of topical therapy in real-life practice. The fixed combination betamethasone/calcipotriol gel is more effective and safe than the administration of single components and may enhance patients' adherence. We aimed at evaluating the pattern of care and dermatologists' expert opinion toward the available topical treatments for the management of mild-to-moderate psoriasis in Italy.

METHODS

We enrolled 242 Italian dermatologists and collected information related to their practice pattern and opinion toward available topical treatments with a face-to-face structured interview. We evaluated dermatologists' ratings of therapy with 16 items tapping their opinion toward the relevance and satisfaction toward 8 therapy attributes in clinical practices which tapped aspects of real-life effectiveness, adherence promotion, toxicity, convenience of use. Ratings occurred along a 10-point scale. We compared single-attribute and weighted overall therapy ratings across alternative treatment options with random-intercept linear models to account for ratings clustering within dermatologists.

RESULTS

There was a wide variation in practice patterns: 1/3 of dermatologist had seen more than 30 patients with psoriasis while around 1/4 had seen less than 10 patients. The fixed combination betamethasone/calcipotriol gel was considered superior to monotherapies in all the eight attributes considered which tapped aspects of real-life effectiveness, adherence promotion, toxicity, convenience of use.

CONCLUSION

Participant dermatologists' strongly preferred the fixed betamethasone/calcipotriol combination gel over both the fixed combination ointment formulation and corticosteroid or vitamin D analogues monotherapies. Such findings are in line with evidence from randomized controlled trials and few observational studies demonstrating superior clinical outcomes, quality of life, tolerability and lower risk of side effect in patients treated with the fixed combination of betamethasone/calcipotriol gel.

Note: Enhanced production of He⁺ from the Versatile Ion Source (VIS) in off-resonance configuration

The Versatile Ion Source (VIS) is a microwave discharge ion source installed at INFN-LNS and here used as test-bench for the production of high intensity low emittance proton beams and for studies on plasma physics. A series of measurements have been carried out with VIS in order to test the source with light ions. In particular a He(+) beam has been characterized in terms of plasma discharge parameters. The experiment has been triggered by the observation of X-radiation emission from the plasma for some configuration of the magnetic field profile. The plasma electron energy distribution function is in fact modified when in some regions of the plasma chamber under-resonance discharge takes place, fulfilling the condition that allows the electromagnetic wave to electrostatic wave conversion. These tests allowed obtaining more than 50 mA of He(+) beams.

Fusidic acid in skin infections and infected atopic eczema

Skin infections represent an important public health issue and cost-driver. Additionally, chronic skin lesions are sometimes colonized by Gram-negative species. Topical therapies are a key component in the management of mild-to-moderate skin infections. In such cases, topical antibiotics may be preferable to systemic treatment, since they maximize the effective doses at the site of infection while minimizing the systemic side effects of the drugs. However, the prevalence of resistant strains is steadily increasing and cases of sensitization are not uncommon. As a consequence, the ideal topical antibiotic should be selective (thus, minimizing cross-resistance), have weak sensitization potential, penetrate the skin efficiently, reach adequate local doses at the site of infection, and finally be available in different formulations matching patients' preferences and needs. Fusidic acid (FA) is a selective antibiotic available in several topical formulations. Pharmacokinetic and pharmacodynamic studies have shown that, contrary to other topical antibiotics such as gentamicin or mupirocin, FA reaches high antimicrobial concentration at deep skin layers after topical application either on intact or damaged epidermis. Several randomized controlled trials demonstrated that FA, in its various topical formulations, is very effective in treating skin infections, given its high bactericidal activity against S. aureus (including strains resistant to penicillin, methicillin, ampicillin, cloxacillin), S. epidermidis, Streptococcus pyogenes, Propionibacterium acnes, Corinebatteria, Clostridia. Additionally, FA presents a low risk of resistance even in methicillin-resistant S. aureus strains, a common pathogen implied in the etiology of skin infections and infected atopic eczema. Such feature makes FA particularly useful in the management of these medical conditions. Finally, possibly due to its large steric effect, FA has proved a very low risk of contact sensitization. Overall, data on FA efficacy, safety, sensitization potential, resistance profile and spectrum selectivity make it a first-choice option in the treatment of primary and secondary skin infection.

Physicians' concerns towards prescription adherence and treatment effectiveness in the clinical management of actinic keratosis

AIM

We report concerns toward prescription adherence and treatment effectiveness in the clinical management of actinic keratosis (AK) in Italy.

METHODS

We carried out a cross-sectional web-based survey among Italian dermatologists across Italy. Physicians were asked to answer a self-administered questionnaire about their concerns around AK therapy and barriers to patients' adherence. Each physician also profiled his last patient and answered items concerning his experience with topical treatments and the suitability of current and future treatment options for the profiled patient.

RESULTS

Fifty practitioners answered the survey. Most dermatologists agreed that field-therapy is a key element for the management of AK in most patients, and 76% (N.=38) agreed that topical treatments were the best option in such cases given their ability to target subclinical lesions. However most interviewee underlined the importance of fostering patients' adherence and minimizing side effects in order to maximize benefits from therapy.

CONCLUSION

We showed that features of current therapeutic options for field-directed therapy (namely long duration of treatment, intensity and duration of local skin reaction) raise practitioners' concerns toward patients' prescription adherence and real-world effectiveness.

Physicians' opinions and clinical practice patterns for actinic keratosis management in Italy

AIM

We report dermatologists' opinions and clinical practice patterns about clinical factors driving decision making in the management of actinic keratosis (AK) in Italy.

METHODS

We carried out a cross-sectional survey among 33 Italian dermatologists. Physicians were asked to report their management choices in consecutive patients with AK seen at their practice within 2 weeks since study initiation. We collected patients' clinical and socio-demographic characteristics with a standardized data collection form and assessed physicians' opinions on AK management with a self-reported questionnaire.

RESULTS

Six hundred fifty-seven patients with new, single AK lesions without evidence of photo-damaged skin in the surrounding areas, were predominantly treated with lesion-directed therapies (primarily cryotherapy). In contrast, physicians preferentially prescribed field-directed therapies to patients with multiple lesions and evidence of photo-damaged skin in AK surrounding areas. However we observed a wide variation in treatment choices and physicians' opinions on AK management. Dermatologists underlined the importance of fostering patients' adherence and minimize therapy side effects.

CONCLUSION

Overall, our results show that current guidelines regarding management of AK are only partially integrated in dermatology practice. The active dissemination of up-to-date national guidelines might help harmonize clinical decision making in this complex and fast growing therapeutic area.

X-ray spectroscopy of warm and hot electron components in the CAPRICE source plasma at EIS testbench at GSI

An experimental campaign aiming to detect X radiation emitted by the plasma of the CAPRICE source - operating at GSI, Darmstadt - has been carried out. Two different detectors (a SDD - Silicon Drift Detector and a HpGe - hyper-pure Germanium detector) have been used to characterize the warm (2-30 keV) and hot (30-500 keV) electrons in the plasma, collecting the emission intensity and the energy spectra for different pumping wave frequencies and then correlating them with the CSD of the extracted beam measured by means of a bending magnet. A plasma emissivity model has been used to extract the plasma density along the cone of sight of the SDD and HpGe detectors, which have been placed beyond specific collimators developed on purpose. Results show that the tuning of the pumping frequency considerably modifies the plasma density especially in the warm electron population domain, which is the component responsible for ionization processes: a strong variation of the plasma density near axis region has been detected. Potential correlations with the charge state distribution in the plasma are explored.

Improved design of proton source and low energy beam transport line for European Spallation Source

The design update of the European Spallation Source (ESS) accelerator is almost complete and the construction of the prototype of the microwave discharge ion source able to provide a proton beam current larger than 70 mA to the 3.6 MeV Radio Frequency Quadrupole (RFQ) started. The source named PS-ESS (Proton Source for ESS) was designed with a flexible magnetic system and an extraction system able to merge conservative solutions with significant advances. The ESS injector has taken advantage of recent theoretical updates and new plasma diagnostics tools developed at INFN-LNS (Laboratori Nazionali del Sud, Istituto Nazionale di Fisica Nucleare). The design strategy considers the PS-ESS and the low energy beam transport line as a whole, where the proton beam behaves like an almost neutralized non-thermalized plasma. Innovative solutions have been used as hereinafter described. Thermo-mechanical optimization has been performed to withstand the chopped beam and the misaligned focused beam over the RFQ input collimator; the results are reported here.

A double-layer based model of ion confinement in electron cyclotron resonance ion source

The paper proposes a new model of ion confinement in ECRIS, which can be easily generalized to any magnetic configuration characterized by closed magnetic surfaces. Traditionally, ion confinement in B-min configurations is ascribed to a negative potential dip due to superhot electrons, adiabatically confined by the magneto-static field. However, kinetic simulations including RF heating affected by cavity modes structures indicate that high energy electrons populate just a thin slab overlapping the ECR layer, while their density drops down of more than one order of magnitude outside. Ions, instead, diffuse across the electron layer due to their high collisionality. This is the proper physical condition to establish a double-layer (DL) configuration which self-consistently originates a potential barrier; this "barrier" confines the ions inside the plasma core surrounded by the ECR surface. The paper will describe a simplified ion confinement model based on plasma density non-homogeneity and DL formation.

Lung ultrasound in the ICU: from diagnostic instrument to respiratory monitoring tool

Imaging has greatly contributed to the understanding of lung disease in the critically ill and currently serves as a tool to diagnose lung pathology, monitor its course, and guide clinical management. Lung ultrasound is a real-time imaging modality that is simple, non-invasive, potentially ubiquitous, and free of ionizing radiation. Its increasing popularity and supporting research data substantiate its role as an emerging technique for bedside chest imaging in critical care. Furthermore, the International Consensus Conference on Lung ultrasound (ICC-LUS) promoted by the World Interactive Network Focused on Critical UltraSound (WINFOCUS) recently standardized the nomenclature and technique for lung ultrasound, and provided recommendations supporting its use in clinical practice. While the utility of lung ultrasound in the emergency setting is unquestioned, its potential role in the more complex and resource-rich intensive care environment is still under investigation. The purpose of this paper was to describe current and potential uses of lung ultrasound in the specific setting of adult intensive care, with an emphasis on respiratory monitoring, and to provide a framework for the practical application of this tool at the bedside.

[Job Demands-Resources, exhaustion and work engagement in a long-term care institution]

In this study, we aimed at testing the main hypotheses of the Job Demands-Resources model (JD-R) in a sample of employees (n = 205, mainly healthcare workers) of a long-term care institution located in Northern Italy. Hierarchical linear regression analyses show that almost all job demands considered were significantly associated with higher general psycho-physical exhaustion (beta ranging from 0.14 to 0.29), whereas more unfavourable scores in all job resources were associated with lower work engagement (from -0.27 to -0.51). However, also significant cross-over associations were observed, mainly between job resources and exhaustion, with effect sizes comparable with those found for the relationships between job demands and exhaustion. Hence, our study only partially supports the JD-R model. Implications of results for work-related stress management are finally discussed.

A 3D Monte Carlo code for the modeling of plasma dynamics and beam formation mechanism in electron cyclotron resonance ion sources

The code here presented is the first part of a Monte Carlo (MC) self-consistent 3D plasma simulator. It is yet able to solve the equation of motion for thousands of independent charged particles. The procedure allows to understand the consequences of each phenomenon introduced in the evolution steps of the code. MC random selection of starting parameters is used for each particles; the environmental conditions enclosed in the simulation are ECRIS magnetic field, resonant electromagnetic wave, initial plasma density distribution and MC calculation of Spitzer collision. The results of the first simulations explain some typical effects as the hollow beam formation and the main plasma deconfinement mechanism.

[Progress of PTSD symptoms following workplace robbery: gender and age differences in a sample of bank employees]

This study is aimed at assessing gender-and age-related differences in PTSD symptoms in bank employees exposed to robbery and subsequently involved in Psychological Debriefing (PD). The study included 49 females and 51 males (average age 40.9). Impact of Event Scale (IES) was administered before PD (T0) and after 45 days (T1); Post-traumatic Checklist (PCL) only at T1. The sample exhibited a significant decrease in IES score regardless of gender. Female employees obtained higher IES and PCL scores. No age differences were observed. Consistent with most studies, our results may be explained by a higher susceptibility in women.

[Biological risk prevention in agriculture and animal breeding: immunization strategies]

Vaccine preventable diseases are, so far, a main focus of Public Health programmes all over the world since people still die in consequence of Dyphteria or Tetanus. Biological risk is widely represented in agriculture and animal breeding, due to environmental characteristics and to injury typology. Moreover, aged people and migrants represent a significant part of the workforce. These two groups are, for instance, more exposed to Clostridium tetani infection because not fully immunized. Among infectious diseases that can affect agricultural workers, just tetanus can be well controlled by immunization programmes. Teaching and training activities are the most important tools to get protection against Leptospira interrogans, Salmonella spp and hepatitis E Virus infection. As for every training activity, linguistic and cultural barriers have to be taken into account.

Note: Dead time causes and correction method for single photon avalanche diode devices

Single photon avalanche diode (SPAD) is the new generation of Geiger-Muller (GM) detectors, developed with semiconductor technology, and able to detect single photons, mainly in visible range. In this work we study the signal generation process and the dead time (DT) mechanisms of the device under a constant light regime. According to our results, it is possible to discriminate low rate signals from afterpulse and noise production and, moreover, to overcome the saturation effect due to the dead time losses. Starting from hybrid DT model [S. H. Lee and R. P. Gardner, Appl. Radiat. Isot. 53, 731 (2000)] we have been able to evaluate the real amount of incident photon rate up to 10(7) cps using a passive quenched device with 0.97 mus total dead time. In this way the passive quenched SPAD achieves the same performance of the active quenched one showing that relatively complex data analysis and complex device implementation are comparable solutions for constant light measurement. We also analyze some effects, lacking in GM counter, which should be introduced in the analysis of semiconductor device, as afterpulse, reduced photon detection efficiency, and noise production.

Plasma ion dynamics and beam formation in electron cyclotron resonance ion sources

In electron cyclotron resonance ion sources it has been demonstrated that plasma heating may be improved by means of different microwave to plasma coupling mechanisms, including the "frequency tuning" and the "two frequency heating." These techniques affect evidently the electron dynamics, but the relationship with the ion dynamics has not been investigated in details up to now. Here we will try to outline these relations: through the study of ion dynamics we may try to understand how to optimize the electron cyclotron resonance ion sources brightness. A simple model of the ion confinement and beam formation will be presented, based on particle-in-cell and single particle simulations.