Treatment of striae distensae with non-ablative fractional laser: clinical and in vivo microscopic documentation of treatment efficacy.

The efficacy of NAFL in the treatment of striae distensae (SD) has been demonstrated. Nevertheless, the base for this improvement has not been clarified yet. The aim of this study is to describe in vivo variations occurring in the skin after the treatment, using reflectance confocal microscopy (RCM). Ten patients asking for the treatment of SD were enrolled. Clinical and RCM images were acquired before the treatment, immediately after 1 and 6 months after the first treatment. One thousand five hundred forty-nanometer laser treatments were performed every 4 weeks for 6 sessions. Efficacy was estimated through the evaluation of pre- and post-treatment clinical pictures by two expert and independent physicians and with GAIS. Improvement of SD was observed in 80% of patients. Temporary erythema and edema were reported. RCM revealed the dissolution of collagen bundles and the appearance of new papillae, as compared to baseline. NAFL represents an effective and safe treatment modality for SD. We report herein in vivo variations occurring in SD after NAFL treatment.

Telangiectasia of the face: risk factors for reappearance in patients treated with dye laser.

BACKGROUND: Lasers can be successfully used in the treatment of facial telangiectasias. Nevertheless, reappearance of telangiectasias after successful laser treatment is a significant problem. Risk factors involved in the reappearance have not been previously investigated. OBJECTIVE: To evaluate whether personal, clinical and behavioural factors can influence the recurrence or new appearance of telangiectasias after treatment. METHODS: Four hundred and fifteen women and 69 men obtaining complete clearance after laser treatment were included in the study and the role of different risk factors in the reappearance of telangiectasias was analysed. Immunocompromised patients were excluded. A statistical analysis was then performed. RESULTS: Twenty four percent of women and 14.5% of men enrolled showed a persistent clearance after treatment. In women in whom telangiectasias reappeared, logistic regression highlighted the importance of tanning addiction, aesthetic medicine and surgery procedures as risk factors, while therapy for menopause was found to be a protective factor. Hypertension was found to be a risk factor in men. CONCLUSIONS: The efficacy of laser for treatment of telangiectasias of the face has been previously proven. Nevertheless, this is the first study presenting an analysis of risk factors involved in the new appearance of telangiectasias after the clearance induced by therapy.

Risk factors for recurrence after successful treatment of warts: the role of smoking habits.

BACKGROUND: Several therapies have been proposed for cutaneous warts without results concerning factors affecting recurrences. OBJECTIVE: To determine the importance of individual characteristics and different therapy modalities in the occurrence of relapses. METHODS: Observational prospective cohort study including 199 patients affected by multiple plantar warts treated as follows: 49 with keratolytics, 50 with CO2 laser, 50 with pulsed dye laser (PDL) and 50 with cryotherapy. Personal data were evaluated through a questionnaire, and treatment information was collected. A Cox regression analysis was performed to identify independent factors for relapse occurrence. RESULTS: Of patients, 57.8% showed a persistent clearance of warts after treatment with a higher recurrence-free interval when treated with PDL. Accordingly, the risk of recurrence was increased with CO2 laser [hazard ratio (HR) 2.92, 95% confidence interval (CI) 1.49-5.74] and keratolytic treatment (HR 3.23, 95% CI 1.60-6.54), as compared to PDL. Furthermore, the multivariate analysis highlighted a higher risk of recurrence in patients between 26 and 35 years (HR 1.88, 95% CI 1.03-3.45), older than 35 (HR 2.23, 95% CI 1.23-4.07) and smokers (HR 4.90, 95% CI 3.09-7.78). CONCLUSIONS: Pulsed dye laser is characterized by the lowest rate of recurrence. Furthermore, our study highlights that the risk of warts relapse is 5-fold higher in smokers compared to non-smokers, revealing the importance of the effects of smoking on inflammation and immune response.

A case of acute generalized exanthematous pustulosis due to amoxicillin-clavulanate with multiple positivity to beta-lactam patch testing.

We present a case of acute generalized exanthematous pustolosis (AGEP) induced by amoxicillin-clavulanate. Clinical diagnosis was confirmed by symptoms presentation and  histological features (Euroscar score point compatible with definite diagnosis). Patch testing performer six months later confirmed sensitization to the culprit drug and showed positivity also to other beta-lactam antibiotics (penicillin G and cephalexin). We believe that a T cell delayed response to betalactams common ring could be involved.

Dynamics of self-generated, large amplitude magnetic fields following high-intensity laser matter interaction.

The dynamics of magnetic fields with an amplitude of several tens of megagauss, generated at both sides of a solid target irradiated with a high-intensity (~10(19) W/cm(2)) picosecond laser pulse, has been spatially and temporally resolved using a proton imaging technique. The amplitude of the magnetic fields is sufficiently large to have a constraining effect on the radial expansion of the plasma sheath at the target surfaces. These results, supported by numerical simulations and simple analytical modeling, may have implications for ion acceleration driven by the plasma sheath at the rear side of the target as well as for the laboratory study of self-collimated high-energy plasma jets.

Development of a novel large bandwidth front-end system for high peak power OPCPA systems.

We present the development of a laser system capable of generating bandwidths sufficient to support a sub 30 fs pulse at 910 nm. These pulses have been amplified to 500 mJ of energy at 2 Hz in two stages. The contrast measurements show that the initial seed is clean and suggests that the close in contrast is limited by the evaluation stretcher and compressor. Such a system is suitable for seeding high energy high power OPCPA systems based on KD*P.

Magnetically guided fast electrons in cylindrically compressed matter.

Fast electrons produced by a 10 ps, 160 J laser pulse through laser-compressed plastic cylinders are studied experimentally and numerically in the context of fast ignition. K(α)-emission images reveal a collimated or scattered electron beam depending on the initial density and the compression timing. A numerical transport model shows that implosion-driven electrical resistivity gradients induce strong magnetic fields able to guide the electrons. The good agreement with measured beam sizes provides the first experimental evidence for fast-electron magnetic collimation in laser-compressed matter.

Electric and magnetic fields do not modify the biochemical properties of FRTL-5 cells.

BACKGROUND: Electric and magnetic fields (EMF) might be involved in human disease and numerous research and scientific reviews have been conducted to address this question. In particular thyroid structural and functional alterations caused by various forms of non-ionizing radiation have been described. AIM: The aim of this study was to analyze the possible effects of EMF on thyroid, in particular we analyzed the effects caused by a GSM (Global System for Mobile Communications) signal (900 MHz) on cultured thyroid cells (FRTL- 5). MATERIAL AND METHODS: The experimental setup was designed in order to expose samples to a radiofrequency wave in well-controlled conditions. We used the FRTL-5 cell line, an epithelial monoclonal continuous cell line derived from Fisher rat thyroid tissue growing as monolayer, expressing the TSH receptor and the sodium-iodide symporter (NIS). FRTL-5 were subsequently irradiate for 24, 48, and 96 h with EMF (800-900 MHz, power-frequency of mobile communication systems) and iodide uptake and cAMP production were measured. RESULTS: The irradiation of cells with EMF at 900 Mhz for 24, 48, and 96 h did not influence the level of cAMP production and was not able to modify iodide accumulation in FRTL- 5 cells with respect to basal conditions. CONCLUSIONS: In conclusion, EMF do not seem to be able to interfere with the biochemical properties of FRTL-5 cells in vitro.

The Piemonte Regional Allergy Network: a model of healthcare organization.

The Allergology Hospital Network and Regional Register for Severe Allergic Reactions (Regional Observatory) is the Piemonte Health Authority new challenge. It satisfied the need to promote and monitor the best practice among a variegated pool of specialists and to define both state of the art and evolution of efficiency and efficacy of standard working process. Harmonization in clinical daily activities and report of severe allergic reactions notified to Regional Observatory, had been gained by mean of a customized Information Technology (IT) solution. The overall target is to ensure a correct diagnostic treatment to patients with severe allergic reactions preventing possible future reactions. Statistics data as a whole, provide basilar epidemiological information to allocate both economical and human resources and to fulfill the rising of health diseases. Piemonte Allergology Medical Network with the Regional Register are an Italian unique and innovative project. It would represent a benchmark for other medical branches.

Observation of magnetized soliton remnants in the wake of intense laser pulse propagation through plasmas.

Slowly evolving, regularly spaced patterns have been observed in proton projection images of plasma channels drilled by intense (≳10¹9 W cm⁻²) short (∼1 ps) laser pulses propagating in an ionized gas jet. The nature and geometry of the electromagnetic fields generating such patterns have been inferred by simulating the laser-plasma interaction and the following plasma evolution with a two-dimensional particle-in-cell code and the probe proton deflections by particle tracing. The analysis suggests the formation of rows of magnetized soliton remnants, with a quasistatic magnetic field associated with vortexlike electron currents resembling those of magnetic vortices.

D2-40 highlights lymphatic vessel proliferation of angiolymphoid hyperplasia with eosinophilia.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a benign, uncommon idiopathic condition, characterized by cutaneous papules or nodules, whose etiopathogenesis is still unclear. It has been considered an angioproliferating lesion (epithelioid hemangioma) since histologically it is marked by a proliferation of blood vessels, accompanied by an inflammatory infiltrate, consisting mainly of lymphocytes and eosinophils. We present a case of ALHE assessed immunohistochemically for D2-40-a new marker for lymphatic endothelial cells. A biopsy specimen obtained from the same anatomical area of a healthy individual served as a normal control. The ALHE specimen showed increased number of lymphatic vessels when stained for D2-40, whereas the endothelial cells lining blood vessels were negative. The specificity of D2-40 for lymphatic vessels was further substantiated by studying Factor VIII-related antigen expression in consecutive sections of both ALHE and the control specimen. A reverse pattern was appreciated-blood vessels showed Factor VIII positive labeling, whereas lymphatic endothelial cells remained unlabeled. We therefore assume that apart from the lymphocytic infiltrate in the lesion, the recognized lymphoid component in ALHE is due to lymphatic vessel proliferation as well. Hence, this condition may be considered as possibly derived from lymphatic endothelium.

Tracking propagation of ultrashort intense laser pulses in gases via probing of ionization.

We use optical interferometry to study the propagation of femtosecond laser pulses in gases. We show the measurements of propagation in a nitrogen gas jet and we compare the results with propagation in He under the same irradiation conditions. We find that in the case of nitrogen, the detailed temporal structure of the laser pulse can be tracked and visualized by measuring the phase and the resulting electron-density map. A dramatically different behavior occurs in He gas jets, where no details of the temporal structure of the laser pulse are visible. These observations are explained in terms of the ionization dynamics of nitrogen compared to helium. These circumstances make N2 gas sensitive to variations in the electric field and, therefore, allow the laser-pulse temporal and spatial structures to be visualized in detail.

A case of protracted hypotension as unique symptom of a biphasic anaphylaxis to amoxicillin.

We are reporting a case of one patient who have experienced itching of palms and soles, thorax erythema, conjunctive injection immediately after oral administration of amoxicillin, and hypotension after 3 hours. In E.D. hypotension was monitored because he was a cardiopatic but it wasn't treated even if it was protracted. A positive result of immediate-reading intradermal test with amoxicillin at 2 mg/ml concentration was found confirming the diagnosis of allergic biphasic anaphylaxis to amoxicillin.

Time-resolved thermally induced aberrations in a flash-lamp pumped Nd:Glass disk amplifier using a 2 × 2 position sensitive detector array.

A novel technique of measuring the prompt, thermally induced wave-front aberrations in a large aperture flash-lamp pumped Nd3+ glass disk amplifier is presented. Implementing a 2 × 2 lens array and a 2 × 2 position sensitive detector array as a diagnostic system, the wave-front profile was successfully reconstructed for the first five Zernike terms for a temporal window of 8.5 ms.

Suspected acute allergic reactions: analysis of admissions to the Emergency Department of the AOU Maggiore della Carità Hospital in Novara from 2003 to 2007.

OBJECTIVE OF THE STUDY: The aim of our work is to ascertain the frequency and the impact of acute allergic reactions on the routine of a highly-specialized Emergency Department collecting information on the admission, the typology of symptoms and the degree of severity calculating the incidence and the outcomes of the events. MATERIALS AND METHODS: The study started the 1 July 2006 and the records of the Emergency Department of the Maggiore della Carità Hospital in Novara were consulted retrospectively in the period between the 1 January 2003 and the 31 December 2006, and prospectively up to the 31 December 2007, using keywords that could identify admission for suspected allergic reactions. Information relating to internal medicine and/or pediatric cases were examined, excluding all surgical and/or trauma cases. The number ofadmissions per year was considered broken down by clinical signs, triage assessment upon admission and discharge outcome. RESULTS: Admissions to the Emergency Department during the period under consideration were 165,120 with 6107 suspected cases of allergic reactions. The symptoms most frequently reported both in adults (A) and children (C < or =18 years old), were: hives 37%, asthma 20.65 (A)% and 27.4% (C); drug allergy 7.5% (A) and 6.1% (C). Reactions to Hymenoptera venom were less frequent, 4.7% (A) and 1.27% (C); the frequency of angioedema, conjunctivitis and rhinitis was between 1 and 4%. The incidence of food allergies (1.4%) and anaphylaxis (0.8%) was comparable for all ages. The triage assessment showed a significant percentage of "yellow" and "red" codes, with 362 cases (5.9%) and 71 cases (1.16%) respectively. A total of 151 patients was hospitalized, no one classified as "white" code. Death occurred in 7 cases: 4 "yellow" codes and 3 "red" codes, respectively. A more detailed specialistic evaluation was recommended in only 10% of the patients. CONCLUSIONS: Admissions to the Emergency Department for suspected allergic reaction are proportional to the number of overall admissions for internal medicine cases and do not appear to be related to the general increase of allergies in the population. This led us to focus our attention on how allergic diseases impact the work of an Emergency Department and how to describe the discharge diagnosis better. A significant number of descriptive diagnoses also turned out to be inaccurate and did not allow the syndrome to be identified properly. The analysis of this information aims to be a stimulus to improve the emergency clinical approach used for allergic diseases and to plan the adequate management ofallergic patients after they have been treated in hospital.

Air pollution deposition on a roadside vegetation barrier in a Mediterranean environment: Combined effect of evergreen shrub species and planting density.

Leaf deposition of PM10-100, PM2.5-10, PM0.2-2.5 and of 21 elements was investigated in a roadside vegetation barrier formed by i) two evergreen shrub species (Photinia × fraseri, Viburnum lucidum), with ii) two planting densities (0.5, 1.0 plant m-2), at iii) three distances from the road (2.0, 5.5, 9.0 m), at iv) two heights from the ground (1.5, 3.0 m), and on v) three dates (Aug, Sep, Oct). The presence of black and brown on-leaf PM10-100 and their element composition were detected by microscopy and image analysis. Pollutant deposition was also measured using passive samplers at five distances from the road (2.0, 5.5, 9.0, 12.5, 19.5 m) in the area of the barrier and in an adjacent lawn area. V. lucidum had more PM2.5-10 and PM0.2-2.5 on leaves than P. × fraseri, while most elements were higher in P. × fraseri. Most pollutants decreased at increasing distances from the road and were higher at 1.5 m from the ground compared to 3.0 m. Higher planting density in P. × fraseri enhanced the deposition of PM10-100 and PM2.5-10, while in V. lucidum, the planting density did not affect the depositions. Black PM10-100 decreased a long distance from the road and was entirely composed of carbon and oxygen, which was thus identified as black carbon from fuel combustion. The vegetation barrier had a higher deposition of most PM fractions at 5.5-12.5 m, while in the lawn area, depositions did not change. At 19.5 m, the PM10-100 was 32% lower behind the barrier than in the lawn area. In conclusion, the vegetation barrier changed the deposition dynamics of pollutants compared to the lawn area. These results strengthen the role of vegetation barriers and shrub species against air pollution and may offer interesting insights for the use of new road green infrastructures to improve air quality.

Single-shot frequency-resolved optical gating for retrieving the pulse shape of high energy picosecond pulses.

Accurate characterization of laser pulses used in experiments is a crucial step to the analysis of their results. In this paper, a novel single-shot frequency-resolved optical gating (FROG) device is described, one that incorporates a dispersive element which allows it to fully characterize pulses up to 25 ps in duration with a 65 fs per pixel temporal resolution. A newly developed phase retrieval routine based on memetic algorithms is implemented and shown to circumvent the stagnation problem that often occurs with traditional FROG analysis programs when they encounter a local minimum.

Pharmacoeconomics of subcutaneous allergen immunotherapy.

The current burden of allergic diseases, estimated by both direct and indirect costs, is very relevant. In fact the cost estimation for rhinitis amount globally to 4-10 billion dollars/year in the U.S. and to an average annual cost of 1089 euros per child/adolescent and 1543 euros per adult in Europe. The estimated annual costs in Northern America for asthma amounted to 14 billion dollars. Consequently, preventive strategies aimed at reducing the clinical severity of allergy are potentially able to reduce its costs. Among them, specific immunotherapy (SIT) joins to the preventive capacity the carryover effect once treatment is discontinued. A number of studies, mainly conducted in the US and Germany demonstrated a favourable cost-benefit balance. In the nineties, most surveys on patients with allergic rhinitis and asthma reported significant reductions of the direct and indirect costs in subjects treated with SIT compared to those treated with symptomatic drugs. This is fully confirmed in recent studies conducted in European countries: in Denmark the direct cost per patient/year of the standard care was more than halved following SIT; in Italy a study on Parietaria allergic patients demonstrated a significant difference in favor of SIT plus drug treatment for three years versus drug treatment alone, with a cost reduction starting from the 2nd year and increasing to 48% at the 3rd year, with a highly statistical significance which was maintained up to the 6th year, i.e. 3 years after stopping immunotherapy, corresponding to a net saving for each patient at the final evaluation of 623 euros per year; in France a cost/efficacy analysis comparing SIT and current symptomatic treatment in adults and children with dust mite and pollen allergy showed remarkable savings with SIT for both allergies in adults and children.

Economic evaluation of sublingual immunotherapy: an analysis of literature.

Allergic rhinitis and asthma constitute a global health problem because of their very high prevalence and the consequent burden of disease, concerning medical and economical issues. Among the treatments of allergy, specific immunotherapy has the capacity to favourably alter the natural history of the disease both during and after its performance and thus to reduce the direct and indirect costs of allergic rhinitis and asthma. A number of studies reported such cost reduction for traditional, subcutaneous immunotherapy and recent data demonstrate that also sublingual immunotherapy (SLIT) is associated to economic advantages and/or monetary savings, specifically in terms of reduction of disease economic burden. Only few formal economic assessments of SLIT have been carried out so far, this article will present and discuss the published studies addressed to this issue. The data obtained, although the number of studies is still limited, provide preliminary evidence supporting a SLIT effect on sparing costs for respiratory allergy.