Technostress: The impact of technology on Italian dermatologists' burnout.

Dermatologists' burnout is a growing phenomenon. During the last years, an important role on medical stress is played by the ever-increasing use of common technological devices (smartphones, smartwatches, PCs and tablets). The aim of the study was to investigate whether digital technology use causes burnout among Italian dermatologists, using a survey conducted among a group of Italian dermatologists. The final sample contained 194 responses valid for analysis. A positive and significant relationship between technostress, assessed through Technostress Inventory and burnout, assessed through Maslach Burnout Inventory, among Italian dermatologists was found. Our data seems suggesting a close relationship between technostress and dermatologist burnout.

Cutaneous melanoma associated with naevi prevalence: A 15-year cross-sectional retrospective study.

BACKGROUND/OBJECTIVES: Melanoma may develop de novo or naevus associated (NAM). The exact prevalence and features of NAM are not fully elucidated. METHODS: A 15-year cross-sectional retrospective study was performed of all melanoma cases diagnosed and treated at the skin cancer centre of the University of Naples Federico II from September 2003 to August 2018. Data collected included patient's age, gender, melanoma anatomic site, Breslow thickness, and histolopathology including melanoma-associated lesion characteristics. RESULTS: A total of 1986 melanomas were included in the study. Based on histolopathogical examination, NAM represented 8.4% (n = 167) with de novo melanoma representing the great majority of the melanomas (91.6%). NAM was significantly more common in younger age compared to de novo melamoma (mean age 48 ± 14.9 vs 54.3 ± 15.9 years, P < 0.001), and more frequently involved the trunk (62.3% vs 51.8% P = 0.01). Mean Breslow thickness was significantly higher in de novo melanoma  compared to NAM (0.97 ± 1.48 mm vs 0.83 ± 0.95, P < 0.001). However, in situ melanoma was more commonly observed in de novo melanoma (n = 640, 35.2%) rather than NAM (n = 41, 24.5%; P < 0.01) whereas invasive melanoma represented 75.5% (n = 126) of NAM and 64.8% (n = 1179) of de novo melanoma, P < 0.01. CONCLUSIONS: NAM represent a small percentage of melanomas (8.4%) compared to de novo melanoma. NAM appeared to be significantly more common in younger age and more frequently involved the trunk, being associated with an overall better prognosis, due to a lower mean Breslow thickness respect to de novo melanoma.

Dermoscopic patterns of intradermal naevi.

BACKGROUND: Intradermal naevi represent a benign histopathological variant of common melanocytic naevi. Studies describing dermoscopic criteria of dermal naevi are very limited. OBJECTIVES: To identify dermoscopic features of dermal naevi in order to facilitate differential diagnosis from malignant lesions. METHODS: A 15-year retrospective study was performed to evaluate the dermoscopic characteristics of 202 dermal naevi, histopathologically diagnosed through the analysis of digital dermoscopic images performed with polarised light dermoscopy. For each lesion, vascular pattern, pigment pattern and other dermoscopic clues were evaluated. RESULTS: 147 Unna naevi and 55 Miescher naevi were included in the study. Brown pigment (37.1%) was the pigment pattern most frequently observed in both Unna and Miescher naevi, followed by cobblestone pattern (30.6%) in Unna naevi and white areas (23.6%) and dotted/globule pattern (20%) in Miescher naevi. As regards the vascular patterns, the polymorphic one was the most frequently observed (34.6%). The combination between comma-shaped and arborising vessels was the most common among all naevi. CONCLUSIONS: Our study describes the dermoscopic features of dermal naevi that may help to differentiate them from malignant lesions such as basal cell carcinoma, amelanotic melanoma and Spitz naevi.

How to Increase Adherence and Compliance in Acne Treatment? A Combined Strategy of SMS and Visual Instruction Leaflet.

INTRODUCTION: Acne is a common skin disease with important psychosocial impact. Often inadequate compliance affects the efficacy of the therapy. Because of emerging use of mobile and electronic health technology, the recent literature evaluated the helpfulness of the tools in medication adherence. The first goal of our study was to evaluate the adherence to therapy with topical adapalene 0.3%/benzoyl peroxide (A-BPO) 2.5% in different groups of patients who received explicative information supported by different strategies. The second goal was to evaluate the patient's quality of life and skin parameters. MATERIALS AND METHODS: We enrolled 126 subjects with mild to severe acne vulgaris. They were randomized into 3 groups of 42 patients each and applied daily topical A-BPO (0.3%, 2.5%) for 12 weeks. The first group (G1) was trained on the gel application by an explicative leaflet. The second group (G2) received the same instructions as group 1 and a daily SMS to remind them of the application of the product. The third group (G3) only received standard instructions. Evaluations were performed at the beginning of treatment (T0) and after 12 weeks (T1): assessment of acne severity using the Investigator's Global Assessment (IGA) Scale for Acne Severity, quality of life by the Cardiff Acne Disability Index (CADI) and the Patient-Doctor Relationship Depth-of-Relationship Scale (PDRDS), skin pH, grade of hydration and adherence to treatment with a 7-day recall calendar were also measured. RESULTS: After 12 weeks of therapy, we observed a reduction in IGA in all groups confirming the clinical efficacy of the product. In the multiple comparison analysis of IGA score reduction, a significant difference was found in G2 versus G1 and G2 versus G3, while the G1 versus G3 comparison was not statistically significant. However, the leaflet group (G1) showed better results compared to the no-leaflet group (G3). Supporting these data, we observed that adherence days correlated positively with the improvement of the single parameters. Moreover, we observed that SMS and leaflet groups had a greater improvement in quality of life evaluated by CADI and PDRDS scores. CONCLUSIONS: According to our data, this experimental setup based on text message service and leaflet service is inexpensive and easy to use. Physicians could consider using these items in their practice to enhance patient adherence and satisfaction as well as treatment outcome.

Management of clinical and subclinical actinic keratoses with histological and immunohistochemical assessments by confocal microscopy.

Reflectance confocal microscopy has been used to monitor treatment efficacy in non-melanoma skin cancer, but few studies have compared different therapies using the same confocal criteria. We compare a single score designed in previous study to evaluate confocal, histological, and immunohistochemical results obtained before and after two treatments of actinic keratosis (AK) and in field cancerisation area. Thirty volunteer male patients, aged >50-year old, with at least three clinically visible AKs on the bald scalp, were included in this study: 15 patients were submitted to 3% diclofenac therapy and 15 to 5% fluorouracil therapy. Confocal imaging was performed on a 5 × 5 cm skin area. In five patients of each group we performed cutaneous biopsies. Scaling, upper nucleated cells, and inflammatory cells showed a higher percentage reduction in field cancerisation, especially in diclofenac treatment group, while in AK inflammatory cells showed a greater percentage reduction in 5-fluorouracil treatment group. Both therapies are efficacious, but their effectiveness is different on the single parameters of the confocal, histology, immunohistochemically.

Concordance Analysis of Lower Third Molar Surgery Classifications: A Comparative Study.

The high frequency and complexity of mandibular third molar (M3M) surgery have led several authors to the development of classification systems for better evaluation and management in oral surgery. This study compared the classifications of Juodzabalys and Daugela et al. (JD), Sammartino et al., Chang et al., Jhamb et al., Maglione et al., and Nemsi et al. to understand the concordance between the scores of M3M surgery. Two types of analysis were conducted: the relationship between the M3M and the inferior alveolar nerve (IAN), and the overall difficulty score based on the tooth's angulation and its spatial position with the adjacent structure. The analysis of the classifications on the relationship between M3M and IAN resulted in a concordance of 26.1%. In the pairwise comparisons, the classifications of Nemsi et al. and Jhamb et al. showed the highest concordance of 59.5%. Analyzing the total scores difficulty, the JD et al., Chang et al., and Sammartino et al. classifications demonstrated a concordance level of 25.5%. A pairwise assessment revealed a higher concordance degree between the classifications of Sammartino et al. and Chang et al. (57.4%). The results highlight the limits in establishing a comprehensive and objective classification for the surgical difficulty of M3M, possibly attributed to variations in the methodology for computing total scores. An objective, automated, and non-operator-dependent classification method for assessing the surgical difficulty of M3M is still needed.

Airborne virus transmission under different weather conditions.

The COVID19 infection is known to disseminate through droplets ejected by infected individuals during coughing, sneezing, speaking, and breathing. The spread of the infection and hence its menace depend on how the virus-loaded droplets evolve in space and time with changing environmental conditions. In view of this, we investigate the evolution of the droplets within the purview of the Brownian motion of the evaporating droplets in the air with varying weather conditions under the action of gravity. We track the movement of the droplets until either they gravitationally settle on the ground or evaporate to aerosols of size 2 µm or less. Droplets with radii 2 µm or less may continue to diffuse and remain suspended in the air for a long time. The effects of relative humidity and temperature on the evaporation are found to be significant. We note that under strong flowing conditions, droplets travel large distances. It is found that the bigger droplets fall on the ground due to the dominance of gravity over the diffusive force despite the loss of mass due to evaporation. The smaller evaporating droplets may not settle on the ground but remain suspended in the air due to the dominance of the diffusive force. The fate of the intermediate size droplets depends on the weather conditions and plays crucial roles in the spread of the infection. These environment dependent effects indicate that the maintenance of physical separation to evade the virus is not corroborated, making the use of face masks indispensable.

Transmission of airborne virus through sneezed and coughed droplets.

The spread of COVID19 through droplets ejected by infected individuals during sneezing and coughing has been considered a matter of key concern. Therefore, a quantitative understanding of the propagation of droplets containing the virus assumes immense importance. Here, we investigate the evolution of droplets in space and time under varying external conditions of temperature, humidity, and wind flow by using laws of statistical and fluid mechanics. The effects of drag, diffusion, and gravity on droplets of different sizes and ejection velocities have been considered during their motion in air. In still air, we found that bigger droplets traverse a larger distance, but smaller droplets remain suspended in air for a longer time. Therefore, in still air, the horizontal distance that a healthy individual should maintain from an infected one is based on the bigger droplets, but the time interval to be maintained is based on the smaller droplets. We show that in places with wind flow, the lighter droplets travel a larger distance and remain suspended in air for a longer time. Therefore, we conclude that both temporal and geometric distance that a healthy individual should maintain from an infected one is based on the smaller droplets under flowing air, which makes the use of a mask mandatory to prevent the virus. Maintenance of only stationary separation between healthy and infected individuals is not substantiated. The quantitative results obtained here will be useful to devise strategies for preventing the spread of other types of droplets containing microorganisms.

Clinical outcomes and quality of life associated with the use of a biosynthetic mesh for complex ventral hernia repair: analysis of the "Italian Hernia Club" registry.

With the development of newer meshes and approaches to hernia repair, it is currently difficult to evaluate their performances while considering the patients' perspective. The aim of the study was to assess the clinical outcomes and quality of life consequences of abdominal hernia repairs performed in Italy using Phasix and Phasix ST meshes through the analysis of real-world data to support the choice of new generation biosynthetic meshes. An observational, prospective, multicentre study was conducted in 10 Italian clinical centres from May 2015 to February 2018 and in 15 Italian clinical centres from March 2018 to May 2019. The evaluation focused on patients with VHWG grade II-III who underwent primary ventral hernia repair or incisional hernia intervention with a follow-up of at least 18 months. Primary endpoints included complications' rates, and secondary outcomes focused on patient quality of life as measured by the EuroQol questionnaire. Seventy-five patients were analysed. The main complications were: 1.3% infected mesh removal, 4.0% superficial infection requiring procedural intervention, 0% deep/organ infection, 8.0% recurrence, 5.3% reintervention, and 6.7% drained seroma. The mean quality of life utility values ranged from 0.768 (baseline) to 0.967 (36 months). To date, Phasix meshes have proven to be suitable prostheses in preventing recurrence, with promising outcomes in terms of early and late complications and in improving patient quality of life.

Cortical BOLD responses to moderate- and high-speed motion in the human visual cortex.

We investigated the BOLD response of visual cortical and sub-cortical regions to fast drifting motion presented over wide fields, including the far periphery. Stimuli were sinusoidal gratings of 50% contrast moving at moderate and very high speeds (38 and 570 °/s), projected to a large field of view (~60°). Both stimuli generated strong and balanced responses in the lateral geniculate nucleus and the superior colliculus. In visual cortical areas, responses were evaluated at three different eccentricities: central 0-15°; peripheral 20-30°; and extreme peripheral 30-60°. "Ventral stream" areas (V2, V3, V4) preferred moderate-speeds in the central visual field, while motion area MT+ responded equally well to both speeds at all eccentricities. In all other areas and eccentricities BOLD responses were significant and equally strong for both types of moving stimuli. Support vector machine showed that the direction of the fast-speed motion could be successfully decoded from the BOLD response in all visual areas, suggesting that responses are mediated by motion mechanisms rather than being an unspecific preference for fast rate of flicker. The results show that the visual cortex responds to very fast motion, at speeds generated when we move our eyes rapidly, or when moving objects pass by closely.

Budget Impact Analysis of a Biosynthetic Mesh for Incisional Hernia Repair.

PURPOSE: With the development of newer prostheses for hernia repair, it is nowadays difficult to understand the total cost of managing patients treated with these advanced medical devices, especially in the complex abdomen, in which various complications may occur. The aim of this study was to determine the economic implications of these prostheses in order to inform decision making in the management of incisional hernia repair. METHODS: A budget impact analysis model was developed to evaluate the economic consequences related to the management of patients undergoing complex (Centers for Disease Control and Prevention wound class II-III or Ventral Hernia Working Group grade 2/3) incisional hernia repair through biosynthetic, synthetic, or biological meshes, from the hospital perspective in Italy. The model was populated with complication rates mainly retrieved from the literature to compare the current scenario with 60%, 10%, and 30% rates of synthetic, biosynthetic, and biological mesh utilization, respectively, with future hypothetical scenarios that consider increasing rates of biosynthetic mesh utilization with respect to the other types of mesh in the next 5 years. Hospital costs of the different events were estimated based on health care resource consumption derived from an electronic survey addressed to key opinion leaders in the field. FINDINGS: The analysis compared the current scenario with future hypothetical scenarios that consider increasing utilization rates of biosynthetic meshes of 25%, 38%, and 44% in the next 1, 3, and 5 years, as estimated by clinicians. Considering 40,000 incisional hernia repairs per year, an increasing use of the biosynthetic meshes may result in a decrease in the total hospital budget of about €153 million in the next 5 years, with a savings per patient of about €770. IMPLICATIONS: The findings of this study support the use of biosynthetic meshes for complex abdominal wall repairs in Italy, showing a potential decrease in the hospital budget in Italy after the diffusion of the new biosynthetic prostheses. Further studies and data from clinical practice would provide additional information to increase the understanding of the economic sustainability of these advanced devices.

Area Prostriata in the Human Brain.

Area prostriata is a cortical area at the fundus of the calcarine sulcus, described anatomically in humans [1-5] and other primates [6-9]. It is lightly myelinated and lacks the clearly defined six-layer structure evident throughout the cerebral cortex, with a thinner layer 4 and thicker layer 2 [10], characteristic of limbic cortex [11]. In the marmoset and rhesus monkey, area prostriata has cortical connections with MT+ [12], the cingulate motor cortex [8], the auditory cortex [13], the orbitofrontal cortex, and the frontal polar cortices [14]. Here we use functional magnetic resonance together with a wide-field projection system to study its functional properties in humans. With population receptive field mapping [15], we show that area prostriata has a complete representation of the visual field, clearly distinct from the adjacent area V1. As in the marmoset, the caudal-dorsal border of human prostriata-abutting V1-represents the far peripheral visual field, with eccentricities decreasing toward its rostral boundary. Area prostriata responds strongly to very fast motion, greater than 500°/s. The functional properties of area prostriata suggest that it may serve to alert the brain quickly to fast visual events, particularly in the peripheral visual field.