Numerical modeling as a tool for evaluating the renewability of geothermal resources: the case study of the Euganean Geothermal System (NE Italy).

Renewable natural resources are strategic for reducing greenhouse gas emissions and the human footprint. The renewability of these resources is a crucial aspect that should be evaluated in utilization of scenario planning. The renewability of geothermal resources is strictly related to the physical and geological processes that favor water circulation and heating. In the Veneto region (NE Italy), thermal waters of the Euganean Geothermal System are the most profitable regional geothermal resource, and its renewability assessment entails the evaluation of fluid and heat recharge, regional and local geological settings, and physical processes controlling system development. This renewability assessment is aimed at defining both the importance of such components and the resource amount that can be exploited without compromising its future preservation. In the second part of the twentieth century, the Euganean thermal resource was threatened by severe overexploitation that caused a sharp decrease in the potentiometric level of the thermal aquifers. Consequently, regulation for their exploitation is required. In this work, the renewability of the Euganean Geothermal System was assessed using the results from numerical simulations of fluid flow and heat transport. The simulations were based on a detailed hydrogeological reconstruction that reproduced major regional geological heterogeneities through a 3D unstructured mesh, while a heterogeneous permeability field was used to reproduce the local fracturing of the thermal aquifers. The model results highlight the role played by the resolved structural elements, in particular the subsurface high-angle faults of the exploitation field, and by the anomalous regional crustal heat flow affecting the central Veneto region.

Dental Age Estimation Helps Create a New Identity.

Age estimation involves the reconstruction of age by biological parameters such as skeletal and dental development in minors, or reduction of pulp chamber in adults, to gain indications concerning the chronological age of the person. In most cases, it is needed in forensic scenarios to verify if the supposed age of an individual is correct; in exceptional cases, age estimation is instead required by judicial authorities to create a new identity usually in persons who do not remember who they are.This article aims at reporting the case of J. who was found in 2005 with signs of amnesia because he did not remember his name and age. After several unsuccessful attempts at identifying him, the judicial authority decided to assign a new identity, which was to be constructed according to the real biological data of the individual. The help of a forensic pathologist and a forensic odontologist was then requested, and age estimation was reached by applying methods for adults based on the physiological reduction of pulp chamber. Dental age estimation yielded a final result of approximately 31 years, which was the new age assigned to the person.This article shows a peculiar application of dental age estimation, which can be used not only to ascertain or deny supposed age, but is sometimes needed to create a new identity.

Linear immunoglobulin a bullous dermatosis: need for an agreement on diagnostic criteria.

Linear immunoglobulin A bullous dermatosis (LABD) is a rare, heterogeneous, autoimmune blistering disorder. Although the main characteristics of the disease seem to be well identified, international accepted diagnostic criteria are lacking. Several authors suggested their own criteria, but they are often not complete or even in contrast with clinical and immunopathological findings from the literature, while others are too selective. In this review, the current views and the problems with the definition of reliable diagnostic criteria for LABD will be discussed.

Assessing transmissivity from specific capacity in an alluvial aquifer in the middle Venetian plain (NE Italy).

Defining aquifer permeability distribution accurately over large areas is often debated in hydrogeology. The operational efforts to calculate hydraulic conductivity with classical aquifer tests are significant; however, accurate knowledge of permeability areal distribution is fundamental both from a hydrogeological and a modeling standpoint. This paper presents an empirical relationship between the transmissivity (T) and the specific capacity (SC) values obtained from experimental aquifer and well tests. All experimental values were obtained from 50 mm wells in middle Venetian plain artesian gravel aquifers. Many other authors have presented empirical relationships between T and SC, but most are related to fissured/karst aquifers, and only a few concern alluvial porous aquifers. Analysis of the T vs. SC relationship standardized residuals shows that a linear relationship produces statistically significant normal residuals compared with an exponential relationship.

Etanercept downregulates the Th17 pathway and decreases the IL-17+/IL-10+ cell ratio in patients with psoriasis vulgaris.

PURPOSE: To evaluate circulating and lesional CD4(+) and CD8(+) cells belonging to Th1, Th2, and Th17 patterns as well as IL-10(+) cells before and after a 12-week lasting course with etanercept or acitretin in patients with psoriasis. METHODS: 15 patients were given etanercept 50 mg twice weekly and 15 patients acitretin 0,4 mg/kg/day, both for 12 weeks. At the baseline and at the end of the treatment, blood and skin samples were taken to investigate IL-4, IL-8, IL-10, IL-17, and IFN-γ-producing CD4(+) and CD8(+) cells. As controls, 10 healthy controls (HC) and 6 atopic dermatitis (AD) patients were included into the study. RESULTS: Psoriasis patients showed augmented IL-17- and IL-8-producing CD4(+) cells in the blood than HC and AD patients. In the skin lesions, IL-17(+) cells were more represented in psoriasis than in AD, while the number of IL-4-producing cells was reduced in psoriasis patients than in AD ones. Etanercept was able to significantly reduce the number of IL-17- and IL-8-producing CD4(+) and CD8(+) cells both in skin and blood, as well as to augment the proportion of IL-10-producing CD4(+) cells in the skin of psoriatic patients, while acitretin was not. CONCLUSIONS: Our results confirmed the role of Th17 cells in the pathogenesis of psoriasis. Etanercept, but not acitretin, was able to downregulate the Th17 pathway and to increase the percentages of IL-10-producing cells in the skin.

Newly described clinical and immunopathological feature of dermatitis herpetiformis.

Dermatitis herpetiformis (DH) is an inflammatory cutaneous disease with typical histopathological and immunopathological findings clinically characterized by intensely pruritic polymorphic lesions with a chronic-relapsing course. In addition to classic clinical manifestations of DH, atypical variants are more and more frequently reported and histological and immunological are added to them, whereas the impact on quality of life of patients with DH is increasingly important to a certain diagnosis. The aim of this paper is to describe all the possible clinical, histological, and immunological variants of DH in order to facilitate the diagnosis of a rare disease and, therefore, little known.

Dermatitis herpetiformis: from the genetics to the development of skin lesions.

Dermatitis herpetiformis (DH) is a rare autoimmune disease linked to gluten sensitivity with a chronic-relapsing course. It is currently considered to be the specific cutaneous manifestation of celiac disease (CD). Both conditions are mediated by the IgA class of autoantibodies, and the diagnosis of DH is dependent on the detection of granular deposits of IgA in the skin. There is an underlying genetic predisposition to the development of DH, but environmental factors are also important. This paper describes these different factors and discusses the known mechanism that lead to the development of skin lesions.

Anti-desmoplakin antibodies in erythema multiforme and Stevens-Johnson syndrome sera: pathogenic or epiphenomenon?

The pathophysiology of erythema multiforme (EM), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) is unclear. Whether autoantibodies against desmoplakin (Dp) I and II play a pathogenic role or result from an epitope spreading phenomenon is uncertain. Our aim was to characterize the keratinocyte antigens recognized in EM, TEN and SJS. Of 33 patients studied, 2 had TEN, 1 SJS, 9 EM major and 21 EM minor, according to Roujeau's criteria. All sera were studied by indirect immunofluorescence (IIF), immunoblotting and immunoprecipitation. Twenty normal sera were used as controls. 10/33 sera reacted with polypeptides of 215 and/or 250-kDa molecular mass, which co-migrate with Dp I and II as assessed by an anti-Dp I and II monoclonal antibody on IB. In IP, none of the anti-Dp I and -Dp II 10 patient sera immunoprecipitated Dp I and/or II from radiolabeled keratinocyte extracts. Two of 10 patient sera (SJS, EM minor) reacted with DpI and II when denaturated by the IB procedure. The reactivity against intracellular antigens DpI and II as denaturated proteins may result from the epidermal damage produced by aggressive autoreactive T cells, playing therefore only a secondary role in the pathogenesis of the disease.

Treating psoriasis with etanercept in italian clinical practice: prescribing practices and duration of remission following discontinuation.

BACKGROUND: conventional antipsoriatic therapies are often administered until remission, with treatment resumed in the case of relapse, in order to reduce the likelihood of cumulative, dose-dependent toxicities. Biological agents have been safely used in continuous therapy. OBJECTIVE: to assess the use of etanercept for psoriasis in clinical practice in Italy. METHODS: this was an observational study carried out in 13 dermatological centres across Italy in patients with plaque psoriasis (with a Psoriasis Area and Severity Index [PASI] score >or=10) treated with etanercept. The study comprised a treatment and subsequent discontinuation period. Patients were eligible if they had plaque psoriasis and had begun treatment with etanercept between 1 September 2007 and 1 April 2008. Patients were evaluable for the duration of discontinuation analysis if they achieved a PASI reduction >or=50% (PASI50) and a PASI score <10 at the end of treatment. Etanercept treatment was restarted if the PASI score reached >or=10 or the patient had a clinical relapse. Data were collected retrospectively up to June 2008 and prospectively between July 2008 and January 2009. Patients received etanercept during the treatment period, followed by no etanercept treatment (other psoriasis treatment permitted) during the discontinuation period, and etanercept again during re-treatment. The main outcome measures were: PASI scores (type A responders: PASI reduction >or=75% [PASI75]; type B responders: PASI50 and PASI final score <10), Dermatology Life Quality Index (DLQI) scores and body surface area (BSA) involvement. Time from discontinuation to re-treatment was evaluated. Use of other antipsoriatic medications was recorded throughout. RESULTS: eighty-five patients were evaluable for the treatment period. Overall, 55 (64.7%) of these patients were prescribed etanercept 50 mg twice weekly. The mean treatment duration was approximately 25 weeks. In total, 79 patients (92.9%) were considered type B responders and 77 of these patients were evaluable for the duration of discontinuation analysis. Overall, 68/85 (80%) were type A responders. During the treatment period, 7/85 (8.2%) patients received other antipsoriatic therapies. Improvements in mean DLQI score (-71.5%) and mean BSA involvement (-79.2%) were also observed. Etanercept was well tolerated. During the discontinuation period, 40/77 (51.9%) patients used other antipsoriatic medications (group 1) and 37/77 (48.1%) did not (group 2). The mean duration of discontinuation was significantly longer in group 1 (174 days) than in group 2 (117 days, log-rank test: p = 0.0013). CONCLUSION: in clinical practice, the duration of discontinuation from etanercept was in accordance with previously reported data, and was longer in patients who received other antipsoriatic drugs during discontinuation of etanercept than in those who did not. High rates of PASI50 and PASI75 response were obtained with etanercept, and these rates were higher than those observed in controlled clinical studies. Etanercept treatment was flexible, effective and well tolerated, and was associated with improved quality of life.

Naturally occurring regulatory T cells in mucous membrane pemphigoid lesions.

BACKGROUND: A growing body of evidence suggests the involvement of naturally occurring CD4+ CD25+ regulatory (nTreg) T cells in autoimmune diseases. OBJECTIVE: To evaluate the expression of some nTreg markers in mucous membrane pemphigoid (MMP) lesions. METHODS: Lesional biopsies from six patients with untreated MMP were stained immunohistochemically with anti-CD25, -FoxP3, -CD103, and -CCR5. RESULTS: All of the stained cells, both in MMP lesions and controls, were observed in the interstitial lamina propria or dermis. Positive cell counts of all the markers studied were low or very low in all sections, and significantly higher in MMP specimens than in healthy controls. CONCLUSIONS: The expression of CCR5 and CD103, which mediate recruitment into peripheral tissues, indicates that CD25+ FoxP3+ nTreg cells may be present in MMP lesions according to a specific homing. nTreg cells may contribute to directing the MMP immunoinflammation towards chronicity, and thus favor the cicatricial evolution of lesions.

Specific dermatoses of pregnancy other than pemphigoid gestationis.

Specific dermatoses of pregnancy are skin disorders that occur specifically during or immediately after pregnancy and cannot be found in non-pregnant patients. According to the current consensus, they include atopic eruption of pregnancy (AEP), polymorphic eruption of pregnancy (PEP), pemphigoid gestationis (PG), and intrahepatic cholestasis of pregnancy (ICP). The diagnosis of specific dermatoses of pregnancy can be challenging due to their variation in clinical presentation; moreover, the tests currently available do not always provide the clue for the diagnosis. However, some distinctive features may be helpful to differentiate between such entities. Accordingly, the knowledge of specific dermatoses of pregnancy and of their management is critical, since their early recognition may allow to provide care for the mother and prevent potential increased fetal risk. In fact, while AEP and PEP do not affect maternal and fetal prognosis, PG and, mainly, ICP are associated to maternal complications as well as the risk of fetal loss. In this paper, the epidemiology, pathogenesis, clinical features as well as management of AEP and PEP are reviewed in detail, while PG is described in another article of this issue. Moreover, the main features of ICP, which cannot be considered a primarily skin disease but may be managed first by dermatologists, are reported.

Immunopathogenesis of folliculitis decalvans: clues in early lesions.

Folliculitis decalvans (FD) is a rare variant of primary cicatricial alopecia, for which the etiopathogenesis remains unclear. Our purpose was to evaluate whether certain immunologic mechanisms might have a significant role in the pathogenesis of FD. Lesional scalp biopsy specimens from 7 patients with FD, 7 with lichen planopilaris, and 4 with alopecia areata were studied immunohistochemically by using monoclonal antibodies to CD1a, CD3, CD4, CD8, CD20, CD25, HLA-DR, interleukin (IL)-1beta, IL-4, IL-8, interferon gamma, tumor necrosis factor alpha, basic fibroblast growth factor (b-FGF), transforming growth factor (TGF)-beta, endothelial leukocyte adhesion molecule 1, intercellular adhesion molecule (ICAM)-1, and vascular cell adhesion molecule. We showed that early FD lesions are characterized by an infiltration of activated T-helper cells, featuring mixed TH1/TH2 polarization. IL-8 and ICAM-1 may contribute to the infiltration of neutrophils, whereas b-FGF and TGF-beta may represent important mediators of the fibrosis that characterizes late-phase FD.

Ocular involvement in pemphigus.

PURPOSE: To report the occurrence of ocular involvement in the setting of pemphigus and discuss its relationship with disease activity and prognostic significance. DESIGN: Retrospective case reports. METHODS: Five patients, aged 38 to 65 years, diagnosed with pemphigus according to clinical, histopathologic, and immunopathologic criteria (n = 4 pemphigus vulgaris; n = 1 superficial pemphigus) developed ocular symptoms and signs consistent with the disease, ranging from mild conjunctivitis to blisters and prominent erosions of the bulbar/palpebral conjunctiva or at the eyelid margin. RESULTS: Ocular involvement in our series mostly followed skin disease or represented the stigmata of quiescent localized pemphigus. One of five patients had fatal outcome from myocardial infarction, whereas in the remaining cases significant improvement was achieved with oral prednisolone. CONCLUSIONS: Ocular pemphigus is probably underdiagnosed and its frequency appears underestimated. It does not seem to correlate with disease severity, but may persist chronically after healing of cutaneous lesion.

Serum levels of the Th1 promoter IL-12 and the Th2 chemokine TARC are elevated in erythema multiforme and Stevens-Johnson syndrome/toxic epidermal necrolysis and correlate with soluble Fas ligand expression. An immunoenzymatic study from the Italian Group of Immunopathology.

BACKGROUND: No data exist as to Th2 chemokines in erythema multiforme (EM) and Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). OBJECTIVE: To evaluate thymus- and activation-regulated chemokine (TARC), macrophage-derived chemokine (MDC) and regulated upon activation, normal T-lymphocyte-expressed and secreted chemokine (RANTES) expression in EM and SJS/TEN and to correlate with the serum levels of the Th1 promoter interleukin (IL)-12 and soluble Fas ligand (sFasL). MATERIALS AND METHODS: IL-12, sFasL, TARC, MDC and RANTES expression were analyzed by ELISA techniques in 31 untreated EM (n = 24) or SJS/TEN (n = 7) patients and in 28 healthy donors (HD). RESULTS: EM and SJS/TEN exhibited significantly higher levels of TARC, IL-12 and sFasL with respect to HD. TARC upregulation paralleled both the IL-12 (p = 0.0225) and sFasL increase (p = 0.0194). CONCLUSIONS: Our results support a role of TARC in the pathophysiology of EM/SJS/TEN and confirm the coexistence of a Th2 response in addition to the predominant Th1 profile.

Cutis marmorata telangiectatica congenita and chronic autoimmune urticaria in a young man.

A 20-year-old man with mental impairment, was referred to us for evaluation of recurring idiopathic urticaria episodes, characterized by a diffuse spreading of wheals and severe itching lacking response to traditional antihistamines. Upon physical examination, he showed a persistent, generalized, reticular, red-bluish vascular skin pattern in association with diffuse arborizing telangiectasias. Such lesions were present from an early age. Laboratory and instrumental tests, performed in order to exclude any condition associated with livedo did not evidence pathological results. He was found to be positive for antinuclear autoantibodies (ANA; 1:640). Histopathologically, numerous dilated capillary vessels associated with sparse extravasated erythrocytes were observed in the upper dermis. We performed an autologous serum skin test (ASST), which resulted in a positive, suggesting an autoimmune basis of the condition. On the basis of clinical and histopathological findings, and in the absence of other clinical and laboratory data suggesting other neoplastic, immunological or systemic diseases, the diagnosis of cutis marmorata telangiectatica congenita (CMTC) associated with chronic autoimmune urticaria (CAIU) was made. CMTC is a rare congenital vascular disorder, consisting in an anomalous, persistent, red-bluish marbling of the skin, that can be associated with a wide spectrum of cutaneous and extracutaneous anomalies. In our case, neither physical examination nor instrumental investigation demonstrated any of these anomalies, with the exception of cognitive impairment. We report this case because of the rarity of a diagnosis of CMTC in an adult patient, because this condition has almost always previously been diagnosed in infancy, or it comes to observation because of the presence of associated disorders, as in our case for chronic urticaria.

Geostatistics as a tool to improve the natural background level definition: An application in groundwater.

The Natural Background Level (NBL), suggested by UE BRIDGE project, is suited for spatially distributed datasets providing a regional value that could be higher than the Threshold Value (TV) set by every country. In hydro-geochemically dis-homogeneous areas, the use of a unique regional NBL, higher than TV, could arise problems to distinguish between natural occurrences and anthropogenic contaminant sources. Hence, the goal of this study is to improve the NBL definition employing a geostatistical approach, which reconstructs the contaminant spatial structure accounting geochemical and hydrogeological relationships. This integrated mapping is fundamental to evaluate the contaminant's distribution impact on the NBL, giving indications to improve it. We decided to test this method on the Drainage Basin of Venice Lagoon (DBVL, NE Italy), where the existing NBL is seven times higher than the TV. This area is notoriously affected by naturally occurring arsenic contamination. An available geochemical dataset collected by 50 piezometers was used to reconstruct the spatial distribution of arsenic in the densely populated area of the DBVL. A cokriging approach was applied exploiting the geochemical relationships among As, Fe and NH4+. The obtained spatial predictions of arsenic concentrations were divided into three different zones: i) areas with an As concentration lower than the TV, ii) areas with an As concentration between the TV and the median of the values higher than the TV, and iii) areas with an As concentration higher than the median. Following the BRIDGE suggestions, where enough samples were available, the 90th percentile for each zone was calculated to obtain a local NBL (LNBL). Differently from the original NBL, this local value gives more detailed water quality information accounting the hydrogeological and geochemical setting, and contaminant spatial variation. Hence, the LNBL could give more indications about the distinction between natural occurrence and anthropogenic contamination.