A Wearable Wireless Magnetic Eye-Tracker, In-Vitro and In-Vivo Tests.

A wireless, wearable magnetic eye tracker is described and characterized. The proposed instrumentation enables simultaneous evaluation of eye and head angular displacements. Such a system can be used to determine the absolute gaze direction as well as to analyze spontaneous eye re-orientation in response to stimuli consisting in head rotations. The latter feature has implications to analyze the vestibulo-ocular reflex and constitutes an interesting opportunity to develop medical (oto-neurological) diagnostics. Details of data analysis are reported together with some results obtained in-vivo or with simple mechanical simulators that enable measurements under controlled conditions.

Modified Spear flap for the reconstruction of a full-thickness defect of the nasal ala.

Various options are available for the reconstruction of full-thickness defects of the nasal ala with different advantages and disadvantages, but none are fully satisfactory. We present the case of a 57- year-old man with a recurrent basal cell carcinoma of the right nasal ala and nearby cheek and upper lip. Tumour clearance was achieved after two stages of 'fresh/frozen' Tübingen technique, resulting in a 2.0×2.0 cm full-thickness defect of the lateral right ala. The wound involved the alar rim, groove and adjacent check and upper lip. Reconstruction was successfully achieved with a nasolabial turnover flap (modified Spear flap) in a single stage. The surgical procedure and subsequent outcomes are illustrated. Our experience shows the effectiveness of the nasolabial turnover flap for a single-stage repair of full-thickness defects of the nasal area and adjacent tissue.

An innovative eye-tracker: Main features and demonstrative tests.

We present a set of results obtained with an innovative eye-tracker based on magnetic dipole localization by means of an array of magnetoresistive sensors. The system tracks both head and eye movements with a high rate (100-200 Sa/s) and in real time. A simple setup is arranged to simulate head and eye motions and to test the tracker performance under realistic conditions. Multimedia material is provided to substantiate and exemplify the results. A comparison with other available technologies for eye-tracking is drawn, discussing advantages (e.g., precision) and disadvantages (e.g., invasivity) of the diverse approaches, with the presented method standing out for low cost, robustness, and relatively low invasivity.

Fast switching coil system for sample premagnetization in an unshielded ultra-low-field nuclear magnetic resonance experiment.

We present a system developed to premagnetize liquid samples in an ultra-low-field nuclear magnetic resonance experiment. Liquid samples of a few milliliters are exposed to a magnetic field of about 70 mT, which is abruptly switched off, to leave a transverse microtesla field, where nuclei start precessing. An accurate characterization of the transients and intermediate field level enables a reliable operation of the detection system, which is based on an optical magnetometer.

Tuscan Consensus on the diagnosis, treatment and follow up of adult atopic dermatitis.

Atopic dermatitis (AD) is an inflammatory disease with a chronic-relapsing course that is intensely itchy. A correct diagnosis of AD in adults and consequently appropriate clinical therapeutic management is a critical issue for extreme clinical expression heterogeneity and various grades of disease severity. In order to ensure high levels of care and standardization of clinical therapeutic management of Adult AD, the decision was taken to create an AD Tuscan Consensus Group (the Group), to work on and validate a consensus based regional clinical-therapeutic management model. The aims of the Group were to find agreement on the criteria for diagnosis, scoring of severity, multidisciplinary approach and treatment of adult atopic dermatitis and to create an easier way for patients to access specialized dermatology outpatient services and importantly to reduce waiting lists and costs related to the management of AD. The Tuscan Consensus Group adopted a simplified Delphi method, in three principal steps: 1) literature metanalysis and critical review of patient's clinical experience to identify the main areas considered questionable or uncertain; 2) discussion of those areas requiring consensus and statement definition through four different sub-committees (diagnosis, severity evaluation, scoring and comorbidities); 3) a consensus based simplified process with final approval of each statement by plenary vote with approval >80% of the participants. The Group here presents and discusses the consensus based recommendation statements on adult atopic dermatitis.

Correction to: Thick melanoma in Tuscany.

This corrects the article DOI: 10.23736/S0392-0488.17.05584-5.

When basal cell carcinomas became giant: an Italian multicenter study.

BACKGROUND: Giant basal cell carcinoma (GBCC) is a basal cell carcinoma (BCC) enlarged in a diameter more than 5 cm. Since GBCCs are a highly infrequent entity and the occurrence rate is approximately 0.5-1% out of all BCC types, only anecdotal cases are reported, and causes and characteristics inducing development of this tumor are not defined. OBJECTIVES: Evaluate causative factors and clinico-histological characteristics of GBCCs. METHODS: The study is a 6-month, hospital-based case series study performed in 12 Italian dermatologic centers. RESULTS: A total of 59 cases and 458 control BCCs were collected. No significant differences existed between the two groups if we take into account social or cultural factors. The average duration of GBCCs is considerably longer than controls. GBCCs are located on unexposed areas while BCCs are on areas not usually covered by clothes. Superficial histological subtype was more frequent in the BCCs group, while infiltrative in GBCCs. GBCCs showed significantly higher local invasiveness, and greater metastatic capacity. More than half of GBCCs had been previously treated with one or more treatments. CONCLUSIONS: Patients with GBCCs appear to belong to two categories: (i) those who present with GBCC due to delay in accessing medical attention, and (ii) those who have BCCs previously treated with inappropriate strategies. Only very few cases can be carried out with intrinsic biological features of tumor aggressiveness. Social and cultural conditions do not appear to be involved in the development of GBCCS. These observations may help clinicians in selecting correct therapeutic strategies in the treatment of BCCs, which give rise to GBCC.

Thick melanoma in Tuscany.

BACKGROUND: The epidemiologic trends of cutaneous melanoma are similar in several countries with a Western-type lifestyle, where there is a progressively increasing incidence and a low but not decreasing mortality - even increasing in selected cases, especially in the older age groups. Also in Tuscany there is a steady rise in the incidence with prevalence of in situ and invasive thin melanomas, with also an increase of thick melanomas. It is necessary to reduce the frequency of thick melanomas to reduce specific mortality. The objective of the current survey has been to compare, in the Tuscany population, by a case-case study, thin and thick melanoma cases, trying to find out those personal and tumor characteristics which may help to customize preventive interventions. METHODS: The study included nine centers involved in the melanoma diagnosis. A consecutive series of incident invasive melanomas diagnosed in a period of about 18 months (July 2010 to December 2011) was collected and matched according in a ratio of one thick melanoma (cutoff thickness: 1 mm) every two thin melanomas. The investigators filled in a questionnaire on patients' self-reported sun exposure, way of melanoma detection, awareness and performance of self-skin examination, as well as propensity to prevention in general. RESULTS: The results of this survey confirm that older age and the lower education level are associated with a later detection. The habit of performing skin self-examination is crucial in the early diagnosis of thick melanoma. The results of this survey seem to suggest that population aged over 50 years, with few total and few atypical nevi, and limited sun exposure and burning are at higher risk of late diagnosis. It can be assumed that part of the population is not effectively reached by prevention campaigns because they do not recognize themselves as being at risk for skin cancers. CONCLUSIONS: In order to achieve a higher rate of early diagnosis of skin melanoma, a new strategy must be implemented. It could be useful to rethink educational campaigns - which seem to unintentionally leave out subjects more at risk for melanoma - and to renew the active involvement of the general practitioners.

Tuscan consensus on the use of UVBnb phototherapy in the treatment of psoriasis.

Psoriasis (PSO) is traditionally defined as an immune-mediated, inflammatory dermatological disease characterized by a chronic-relapsing course and associated with multifactorial inheritance (genetic predisposition and influence of various environmental factors). Considered until recently a dermatological disease only, today PSO is correctly known as a systemic one because of the involvement of multiple organs with important impact on social life and relationships. PSO is found in the 0.3-4.6% of the world's population, while its prevalence in the Italian population is estimated at 2.8%. Therefore, if we consider that in Tuscany more than 100,000 people out of 3,672,202 suffer of psoriasis, it is of paramount importance to focus on a shared clinical and therapeutic protocol to manage the disease. With the aim of ensuring diagnostic-therapeutic suitability, high levels of care and standardization of treatment, a unique clinical-therapeutic management model has been developed and validated in Tuscany, involving all accredited regional dermatological centers. Among the possible alternatives to be implemented in the treatment of patients with mild, moderate-severe psoriasis, UVBnb phototherapy is widely used alone or in association with other systemic and non-systemic devices. Despite this, there is still no universally shared therapeutic protocol. In this context the CO.FO.TO working group (Consensus Fototerapia Toscana) is born with the aim of defining and validating the main guidelines in the use of phototherapy with UVBnb in psoriasis; the guidelines are based both on the real-life experience of the different centers of reference in the region and on the revision of the recent literature.

Topical formulations of delta-aminolevulinic acid for the treatment of actinic keratosis: Characterization and efficacy evaluation.

Actinic keratosis (AK) is a pre-cancerous disease, with worldwide increasing incidence, which consists in squamous cutaneous lesion caused by excessive exposure to ultraviolet radiation. An established treatment option is photodynamic therapy (PDT), based on light, oxygen and a photosensitizer. The most widely used is 5-aminolevulinic acid (ALA) which however, being a hydrophilic molecule, has difficultly penetrating the skin to achieve the desired therapeutic effect. To solve this limit, the present study provides for the development of three galenic gel formulations (Natrosol, Sepigel and Carbopol) containing 10% w/w of ALA for the treatment of AK with PDT and their comparison with a lipophilic cream used in the Hospital. The aim of this study is to offer an appealing topical treatment that improves patients' observance and compliance. Formulations were characterized in terms of chemical, physical and microbiological stability, viscosity and pH. An HPLC-DAD analytical method was also developed and validated. Sepigel gel resulted the best gel formulation in terms of technological characteristics and stability. A comparative study between this gel and the lipophilic cream was assessed, by evaluating the therapeutic efficacy and the compliance of the patients.

Reconstruction of a large leg defect with a combined hatchet flap technique.

The repair of lower leg defects, not amenable to primary closure, may be challenging, since the skin at this level is scarcely elastic and difficult to mobilize. Local skin flaps are generally utilized only to restore moderately sized losses, whereas grafting becomes a realistic choice in presence of larger wounds. We present the case of a 70-year-old man with a wide defect on his right leg following the surgical excision of a squamous cell carcinoma. The wound was successfully closed with a combination of three hatchet flaps. The various steps of the procedure and the subsequent outcome are illustrated. Our choice proved to be an easy, time-sparing, but effective reconstructive solution for a large skin defect involving the leg.

A low noise modular current source for stable magnetic field control.

A low cost, stable, programmable, unipolar current source is described. The circuit is designed in view of a modular arrangement, suitable for applications where several DC sources must be controlled at once. A hybrid switching/linear design helps in improving the stability and in reducing the power dissipation and cross-talking. Multiple units can be supplied by a single DC power supply, while allowing for a variety of maximal current values and compliance voltages at the outputs. The circuit is analogically controlled by a unipolar voltage, enabling current programmability and control through commercial digital-to-analogue conversion cards.

Tuscan consensus on the diagnosis, treatment and follow-up of moderate-to-severe psoriasis.

BACKGROUND: Psoriasis is traditionally defined as an inflammatory chronic-relapsing disease of the skin. As widely demonstrated, this disease is also associated with multiple comorbidities: arthropathy, inflammatory bowel disease, metabolic, cardiovascular, ocular and psychological disorders. The disease also has a significant impact on patients' quality of life, whose work ability decreases considerably with clear consequences for the social costs. Therefore, if we consider that in Tuscany, more than 100,000 people out of 3,672,202 suffer from psoriasis, it is of paramount importance focusing the attention on a rational model of clinical and therapeutic management of the disease. All the leading experts in Tuscany have come together with the aim of defining unanimously accepted regional guidelines for the diagnosis, treatment, follow-up and management of psoriasis, and of providing practical guidance/protocol on diagnosis, treatment, follow-up and management of special cases of moderate-to-severe plaque psoriasis. METHODS: In a working group formed ad hoc, the main topics have been discussed and approved by plenary vote. RESULTS: Diagnosis must include a proper general health condition overview, a careful evaluation of skin and joints, the assessment and management of other comorbidities and the definition of disease severity. With regards to the therapy the best time to start a systemic treatment, the therapeutic goal, the most appropriate drug and blood tests to be performed in case of moderate severe-psoriasis have been taken into account. During follow-up, proper monitoring of systemic therapy and its management in the long term has also been suggested. Eventually, the experts have addressed the problem of how to manage the disease in special conditions, such as during surgery, pregnancy, in children and in case of infections (HBV, HCV, HIV). CONCLUSIONS: The main aim of this Consensus was to find agreement on the criteria for diagnosis, treatment and follow-up of psoriasis, shared by all the Dermatologic Therapy Units of Tuscany. A need to create an easier way for the patient to access specialized dermatology outpatient services, and to reduce the waiting list and costs related to the management of psoriasis has been stressed. Most importantly, during the Consensus all of the participants agreed on the central role of the patient, and on the need of a multidisciplinary management of the disease which requires communication among specialists and regional centers in order to build on existing experience.