Worldwide expert recommendations for the diagnosis and management of vitiligo: Position statement from the international Vitiligo Task Force-Part 2: Specific treatment recommendations.

BACKGROUND: The treatment of vitiligo can be challenging. Up-to-date agreed consensus recommendations on the use of topical and systemic therapies to facilitate the clinical management of vitiligo are currently lacking. OBJECTIVES: To develop internationally agreed-upon expert-based recommendations for the treatment of vitiligo. METHODS: In this consensus statement, a consortium of 42 international vitiligo experts and four patient representatives participated in different online and live meetings to develop a consensus management strategy for vitiligo. At least two vitiligo experts summarized the evidence for different topics included in the algorithms. A survey was then given to a core group of eight experts to resolve the remaining issues. Subsequently, the recommendations were finalized and validated based on further input from the entire group during two live meetings. RESULTS: The recommendations provided summarize the latest evidence regarding the use of topical therapies (steroids, calcineurin inhibitors and Jak-inhibitors) and systemic therapies, including steroids and other systemic immunomodulating or antioxidant agents. The different modalities of phototherapies (NB-UVB, photochemotherapy, excimer devices and home phototherapy), which are often combined with other therapies, are also summarized. Interventional approaches as well as depigmentation strategies are presented for specific indications. Finally, the status of innovative and targeted therapies under development is discussed. CONCLUSIONS: This international consensus statement culminated in expert-based clinical practice recommendations for the treatment of vitiligo. The development of new therapies is ongoing in vitiligo, and this will likely improve the future management of vitiligo, a disease that still has many unmet needs.

Worldwide expert recommendations for the diagnosis and management of vitiligo: Position statement from the International Vitiligo Task Force Part 1: towards a new management algorithm.

BACKGROUND: The treatment of vitiligo can be challenging and depends on several factors such as the subtype, disease activity, vitiligo extent, and treatment goals. Vitiligo usually requires a long-term approach. To improve the management of vitiligo worldwide, a clear and up-to-date guide based on international consensus with uniform stepwise recommendations is needed. OBJECTIVES: To reach an international consensus on the nomenclature and to develop a management algorithm for the diagnosis, assessment, and treatment of vitiligo. METHODS: In this consensus statement, a consortium of 42 international vitiligo experts and four patient representatives participated in online and live meetings to develop a consensus management strategy for vitiligo. At least two vitiligo experts summarized the evidence of topics included in the algorithms. A survey was utilized to resolve remaining issues among a core group of eight experts. Subsequently, the unanimous recommendations were finalized and validated based on further input from the entire group during two live meetings. RESULTS: The algorithms highlight the importance of shared decision-making. Dermatologists are encouraged to provide patients with detailed explanations of the prognosis and expected therapeutic outcomes based on clinical examination. The treatment goal should be discussed and clearly emphasized to patients given the different approaches for disease stabilization and repigmentation. The evaluation of disease activity remains a cornerstone in the tailor-made approach to vitiligo patients. CONCLUSIONS: These new treatment algorithms are intended to guide clinical decision-making in clinical practice. Promising novel therapies for vitiligo are on the horizon, further highlighting the need for reliable outcome measurement instruments and greater emphasis on shared decision-making.

Evaluation of the Resolution in Inverse Scattering of Dielectric Cylinders for Medical Applications.

The inverse scattering problem has numerous significant applications, including in geophysical explorations, medical imaging, and radar imaging. To achieve better performance of the imaging system, theoretical knowledge of the resolution of the algorithm is required for most of these applications. However, analytical investigations about the resolution presently feel inadequate. In order to estimate the achievable resolution, we address the point spread function (PSF) evaluation of the scattered field for a single frequency and the multi-view case both for the near and the far fields and the scalar case when the angular domain of the incident field and observation ranges is a round angle. Instead of the common free space condition, an inhomogeneous background medium, consisting of a homogeneous dielectric cylinder with a circular cross-section in free space, is assumed. In addition, since the exact evaluation of the PSF can only be accomplished numerically, an analytical approximation of the resolution is also considered. For the sake of its comparison, the truncated singular value decomposition (TSVD) algorithm can be used to implement the exact PSF. We show how the behavior of the singular values and the resolution change by varying the permittivity of the background medium. The usefulness of the theoretical discussion is demonstrated in localizing point-like scatterers within a dielectric cylinder, so mimicking a scenario that may occur in breast cancer imaging. Numerical results are provided to validate the analytical investigations.

Evaluation of the Number of Degrees of Freedom of the Field Scattered by a 3D Geometry.

The solution to an ill-posed linear inverse problem requires the use of regularization methods to achieve a stable approximation solution. One powerful approach is the truncated singular value decomposition (TSVD), but it requires an appropriate choice of the truncation level. One suitable option is to take into account the number of degrees of freedom (NDF) of the scattered field, which is defined by the step-like behavior of the singular values of the relevant operator. Then, the NDF can be estimated as the number of singular values preceding the knee or the exponential decay. Therefore, an analytical estimation of the NDF is significant for obtaining a stable, regularized solution. This paper addresses the analytical estimation of the NDF of the field scattered by the surface of a cube geometry for a single frequency and the multi-view case in the far-zone. In addition, a method is proposed to find the minimum numbers of plane waves and their directions to achieve the total estimated NDF. The main results are that the NDF is related to the measure of the surface of the cube and can be achieved by only considering a limited number of impinging plane waves. The efficiency of the theoretical discussion is demonstrated through a reconstruction application for microwave tomography of a dielectric object. Numerical examples are provided to confirm the theoretical results.

Performance of the Linear Model Scattering of 2D Full Object with Limited Data.

Inverse scattering problems stand at the center of many important imaging applications, such as geophysical explorations, radar imaging, and synthetic-aperture radar (SAR). Several methods have been proposed to solve them when the full data are available, usually providing satisfactory reconstructions. However, it is impossible to acquire the full data in many practical circumstances, such as target detection and ground penetrating radar (GPR); consequently, only limited data are available. Thus, this paper focuses on the mathematical analysis and some numerical simulations to estimate the achievable resolution in reconstructing an object from the knowledge of the scattered far-field when only limited data are available, with multi-view excitations at a single frequency. We focus on 2D full rectangular geometry as the investigation domain (ID). We also examine the number of degrees of freedom (NDF) and evaluate the point spread function (PSF). In particular, the NDF of the considered geometry can be estimated analytically. An approximated closed-form evaluation of the PSF is recalled, discussed, and compared with the exact one. Moreover, receiving, transmission, and angle sensing modes are considered to apply the analysis to more realistic scenarios to highlight the difference between the corresponding NDF and the resulting resolution performances. Finally, interesting numerical applications of the resolution analysis for the localization of a collection of point-like scatterers are presented to illustrate how it matches the expectations.

Assessment of Non-cultured Autologous Epidermal Cell Grafting Resuspended in Hyaluronic Acid for Repigmenting Vitiligo and Piebaldism Lesions: A Randomized Clinical Trial.

The aim of this study was to assess the efficacy of non-cultured autologous epidermal cell grafting resuspended in hyaluronic acid, performed using a ready-to-use kit, compared with hyaluronic acid alone (neutral comparator) for repigmenting vitiligo and piebaldism lesions at 6 months. Two identified paired lesions per patient were randomized to be treated by either device. Devices with a ready-to-use kit were prepared by separate health professionals, to maintain blinding. A skin biopsy was digested using trypsin, and cells resuspended in hyaluronic acid solution. Among 38 patients screened, 36 (94.7%) patients, corresponding to 72 lesions, were analysed. For difficult-to-treat lesions, defined as those located on the wrist, elbow, and hands (n = 30), no repigmentation ≥ 50% was observed. For all other locations (n = 42), the success rate was significantly higher (p = 0.021) in the ready-to-use kit group (47.6% vs 9.5%) at 6 months and was maintained until 12 months. In conclusion, a single application of non-cultured epidermal cellular grafting using a ready-to-use kit was efficient at 6 months and at 1-year follow-up.

Experimental Validation of a Microwave Imaging Method for Shallow Buried Target Detection by Under-Sampled Data and a Non-Cooperative Source.

In microwave imaging, it is often of interest to inspect electrically large spatial regions. In these cases, data must be collected over a great deal of measurement points which entails long measurement time and/or costly, and often unfeasible, measurement configurations. In order to counteract such drawbacks, we have recently introduced a microwave imaging algorithm that looks for the scattering targets in terms of equivalent surface currents supported over a given reference plane. While this method is suited to detect shallowly buried targets, it allows one to independently process all frequency data, and hence the source and the receivers do not need to be synchronized. Moreover, spatial data can be reduced to a large extent, without any aliasing artifacts, by properly combining single-frequency reconstructions. In this paper, we validate such an approach by experimental measurements. In particular, the experimental test site consists of a sand box in open air where metallic plate targets are shallowly buried a (few cm) under the air/soil interface. The investigated region is illuminated by a fixed transmitting horn antenna, whereas the scattered field is collected over a planar measurement aperture at a fixed height from the air-sand interface. The transmitter and the receiver share only the working frequency information. Experimental results confirm the feasibility of the method.

Scattered Far-Field Sampling in Multi-Static Multi-Frequency Configuration.

This paper deals with an inverse scattering problem under a linearized scattering model for a multi-static/multi-frequency configuration. The focus is on the determination of a sampling strategy that allows the reduction of the number of measurement points and frequencies and at the same time keeping the same achievable performance in the reconstructions as for full data acquisition. For the sake of simplicity, a 2D scalar geometry is addressed, and the scattered far-field data are collected. The relevant scattering operator exhibits a singular value spectrum that abruptly decays (i.e., a step-like behavior) beyond a certain index, which identifies the so-called number of degrees of freedom (NDF) of the problem. Accordingly, the sampling strategy is derived by looking for a discrete finite set of data points for which the arising semi-discrete scattering operator approximation can reproduce the most significant part of the singular spectrum, i.e., the singular values preceding the abrupt decay. To this end, the observation variables are suitably transformed so that Fourier-based arguments can be used. The arising sampling grid returns several data that is close to the NDF. Unfortunately, the resulting data points (in the angle-frequency domain) leading to a complicated measurement configuration which requires collecting the data at different spatial positions for each different frequency. To simplify the measurement configuration, a suboptimal sampling strategy is then proposed which, by an iterative procedure, enforces the sampling points to belong to a rectangular grid in the angle-frequency domain. As a result of this procedure, the overall data points (i.e., the couples angle-frequency) actually increase but the number of different angles and frequencies reduce and lead to a measurement configuration that is more practical to implement. A few numerical examples are included to check the proposed sampling scheme.

The Vitiligo Working Group recommendations for narrowband ultraviolet B light phototherapy treatment of vitiligo.

BACKGROUND: Treatment of vitiligo with narrowband ultraviolet B light (NBUVB) is an important component of the current standard of care. However, there are no consistent guidelines regarding the dosing and administration of NBUVB in vitiligo, reflected by varied treatment practices around the world. OBJECTIVE: To create phototherapy recommendations to facilitate clinical management and identify areas requiring future research. METHODS: The Vitiligo Working Group (VWG) Phototherapy Committee addressed 19 questions regarding the administration of phototherapy over 3 conference calls. Members of the Photomedicine Society and a group of phototherapy experts were surveyed regarding their phototherapy practices. RESULTS: Based on comparison and analysis of survey results, expert opinion, and discussion held during conference calls, expert recommendations for the administration of NBUVB phototherapy in vitiligo were created. LIMITATIONS: There were several areas that required further research before final recommendations could be made. In addition, no standardized methodology was used during literature review and to assess the strength of evidence during the development of these recommendations. CONCLUSION: This set of expert recommendations by the VWG is based on the prescribing practices of phototherapy experts from around the world to create a unified, broadly applicable set of recommendations on the use of NBUVB in vitiligo.

Igneous processes in the small bodies of the Solar System II: Small satellites and dwarf planets.

Evidence of hot and cold igneous processes has been reported in small satellites and dwarf planets of the Solar System. Olivine and pyroxenes were detected in the spectral bands of both small satellites and dwarf planets. The aqueously altered form of olivine and serpentine has been detected in the spectrums of Ceres and Miranda hinting at possible hydrothermal processes in their interiors. Once more, the ubiquitous distribution of 26Al in the planetary nebula, then evolving in the protoplanetary disk, contributed to the primordial widespread heating. Volcanism, or cryovolcanism, then developed only in those bodies where long-lived radiogenic elements, and/or tidal processes, were available.

Promotion of Physical Activity Among University Students With Social Media Or Text Messaging: A Systematic Review.

Regular physical exercise lowers the risk of all-cause mortality and various chronic diseases. New technologies, such as smartphones and social media, have been used successfully as health promotion tools in college populations. The purpose of this study was to conduct a systematic review of studies examining the effectiveness of interventions that used modern technologies, as with social media or text messaging, to promote physical activity or reducing sedentary behavior in college students. The systematic review was conducted on the PubMed and SCOPUS databases, considering studies published from 2012 to 2022. For a total of 19 articles selected, an evidence table was drawn up, and the quality of the studies was assessed using the PRISMA checklist. The interventions differed enormously in design, from the strategies implemented to the types of outcome considered. Fifteen of the 19 studies demonstrated an improvement in participants' physical activity levels, 3 studies found no such improvement, and 1 reported a worsening of baseline activity levels. Interventions to improve college students' physical activity levels through the use of social media and/or text messaging tend to be effective. However, many factors can influence the effectiveness of such interventions. For example, a gender-related difference emerged in student participation, and the interventions proved more effective if they were accompanied by the creation of social groups.

Exploring the impact of solar radiation on skin microbiome to develop improved photoprotection strategies.

The skin microbiome undergoes constant exposure to solar radiation (SR), with its effects on health well-documented. However, understanding SR's influence on host-associated skin commensals remains nascent. This review surveys existing knowledge on SR's impact on the skin microbiome and proposes innovative sun protection methods that safeguard both skin integrity and microbiome balance. A team of skin photodamage specialists conducted a comprehensive review of 122 articles sourced from PubMed and Research Gateway. Key terms included skin microbiome, photoprotection, photodamage, skin cancer, ultraviolet radiation, solar radiation, skin commensals, skin protection, and pre/probiotics. Experts offered insights into novel sun protection products designed not only to shield the skin but also to mitigate SR's effects on the skin microbiome. Existing literature on SR's influence on the skin microbiome is limited. SR exposure can alter microbiome composition, potentially leading to dysbiosis, compromised skin barrier function, and immune system activation. Current sun protection methods generally overlook microbiome considerations. Tailored sun protection products that prioritize both skin and microbiome health may offer enhanced defense against SR-induced skin conditions. By safeguarding both skin and microbiota, these specialized products could mitigate dysbiosis risks associated with SR exposure, bolstering skin defense mechanisms and reducing the likelihood of SR-mediated skin issues.

Variant of TYR and autoimmunity susceptibility loci in generalized vitiligo.

BACKGROUND: Generalized vitiligo is an autoimmune disease characterized by melanocyte loss, which results in patchy depigmentation of skin and hair, and is associated with an elevated risk of other autoimmune diseases. METHODS: To identify generalized vitiligo susceptibility loci, we conducted a genomewide association study. We genotyped 579,146 single-nucleotide polymorphisms (SNPs) in 1514 patients with generalized vitiligo who were of European-derived white (CEU) ancestry and compared the genotypes with publicly available control genotypes from 2813 CEU persons. We then tested 50 SNPs in two replication sets, one comprising 677 independent CEU patients and 1106 CEU controls and the other comprising 183 CEU simplex trios with generalized vitiligo and 332 CEU multiplex families. RESULTS: We detected significant associations between generalized vitiligo and SNPs at several loci previously associated with other autoimmune diseases. These included genes encoding major-histocompatibility-complex class I molecules (P=9.05x10(-23)) and class II molecules (P=4.50x10(-34)), PTPN22 (P=1.31x10(-7)), LPP (P=1.01x10(-11)), IL2RA (P=2.78x10(-9)), UBASH3A (P=1.26x10(-9)), and C1QTNF6 (P=2.21x10(-16)). We also detected associations between generalized vitiligo and SNPs in two additional immune-related loci, RERE (P=7.07x10(-15)) and GZMB (P=3.44x10(-8)), and in a locus containing TYR (P=1.60x10(-18)), encoding tyrosinase. CONCLUSIONS: We observed associations between generalized vitiligo and markers implicating multiple genes, some associated with other autoimmune diseases and one (TYR) that may mediate target-cell specificity and indicate a mutually exclusive relationship between susceptibility to vitiligo and susceptibility to melanoma.

Igneous processes in the small bodies of the Solar System I. Asteroids and comets.

Igneous processes were quite widespread in the small bodies of the Solar System (SBSS) and were initially fueled by short-lived radioisotopes, the proto-Sun, impact heating, and differentiation heating. Once they finished, long-lived radioisotopes continued to warm the active bodies of the Earth, (possibly) Venus, and the cryovolcanism of Enceladus. The widespread presence of olivine and pyroxenes in planets and also in SBSS suggests that they were not necessarily the product of igneous processes and they might have been recycled from previous nebular processes or entrained in comets from interstellar space. The difference in temperature between the inner and the outer Solar System has clearly favored thermal annealing of the olivine close to the proto-Sun. Transport of olivine within the Solar System probably occurred also due to protostellar jets and winds but the entrainment in SBSS from interstellar space would overcome the requirement of initial turbulent regime in the protoplanetary nebula.

Sverdrup-Henson crater: A candidate location for the first lunar South Pole settlement.

Robotic and manned exploration of the Moon is the next target in Solar System exploration. The availability of in situ resources such as water ice, iron oxides, helium-3, and rare earth elements, combined with permanently sunlit areas, provides the opportunity for the first settlement, either human or robotic, on the Moon. We used several selection criteria (abundance of water ice, the slope of terrain, usable energy sources, communications, and base expandability) to identify a suitable area for a future base in the southern polar crater Sverdrup-Henson. Due to the higher abundance of water ice, we found that the Sverdrup-Henson site is better suited to host a base than the nearby craters de Gerlache and Shackleton. The crater floor is partly in permanent shadow and exhibits numerous signatures of water ice. Since water ice is essential for rocket fuel production and human survival, its presence is necessary for a first settlement. Sverdrup-Henson has a flat floor ideal for building and safe traversing, is accessible from the surrounding intercrater plains, and has nearby locations suitable for communications and solar power production. Thus, the Sverdrup-Henson site holds great potential for future missions. We propose further exploration of this area through in situ measurements to better constrain available resources.

Using Failure Mode, Effect and Criticality Analysis to improve safety in the cancer treatment prescription and administration process.

BACKGROUND: Administering cancer drugs is a high-risk process, and mistakes can have fatal consequences. Failure Mode, Effect and Criticality Analysis (FMECA) is a widely recognized method for identifying and preventing potential risks, applied in various settings, including healthcare. The aim of this study was to recognize potential failures in cancer treatment prescription and administration, with a view to enabling the adoption of measures to prevent them. METHODS: This study consists of a FMECA. A team of resident doctors in public health at the University of Padua examined the cancer chemotherapy process with the support of a multidisciplinary team from the Veneto Institute of Oncology (an acknowledged comprehensive cancer center), and two other provincial hospitals. A diagram was drafted to illustrate 9 different phases of chemotherapy, from the adoption of a treatment plan to its administration, and to identify all possible failure modes. Criticality was ascertained by rating severity, frequency and likelihood of a failure being detected, using adapted versions of already published scales. Safety strategies were identified and summarized. RESULTS: Twenty-two failure modes came to light, distributed over the various phases of the cancer treatment process, and seven of them were classified as high risk. All phases of the cancer chemotherapy process were defined as potentially critical and at least one action was identified for a single high-risk failure mode. To reduce the likelihood of the cause, or to improve the chances of a failure mode being detected, a total of 10 recommendations have been identified. CONCLUSIONS: FMECA can be useful for identifying potential failures in a process considered to be at high risk. Safety strategies were devised for each high-risk failure mode identified.

Expert opinion about laser and intense pulsed light (IPL)-induced leukoderma or vitiligo: a cross-sectional survey study.

Vitiligo patients may desire laser hair removal, skin rejuvenation, vascular treatments, and other laser or intense pulsed light (IPL) assisted treatments. However, there is a risk of inducing new depigmented patches (Koebner phenomenon). In absence of guidelines on the safe use of laser or IPL in vitiligo patients, dermatologists tend to be reluctant to administer these treatments. The aim of this survey study was to provide an estimation of the occurrence and related risk factors of laser/IPL-induced leukoderma or vitiligo. A cross-sectional survey study was performed among 15 vitiligo experts from 11 countries, with 14 questions about affected patients, involved laser/IPL treatments and the physicians' approach. In a total of 11,300 vitiligo patients, laser/IPL-induced leukoderma or vitiligo was reported in 30 patients (0.27%). Of these, 12 (40%) patients had a medical history of vitiligo and seven (58%) of these patients had stable (> 12 months) vitiligo before the treatment. Most frequently reported were hair removal procedures and localization of the face and legs. Side effects like blistering, crusting, and erosions occurred in 56.7% of the cases. These vitiligo experts based their advice on the risk of the laser treatment on stability of the vitiligo (43%) and activity signs (50%), and 50% discuss the risks before starting a laser treatment. Relevant activity signs are the Koebner phenomenon (57.1%), confetti-like lesions (57.1%) and hypochromic borders (50%). Laser-induced leukoderma or vitiligo is an uncommon phenomenon. Remarkably, a minority had a medical history of vitiligo of which 58% were stable. Consequently, most cases could not have been prevented by not treating vitiligo patients. However, a majority had laser/IPL-induced skin damage. Therefore, caution is advised with aggressive settings and test-spots prior to the treatment are recommended. This study showed significant variation in the current recommendations and approach of vitiligo experts regarding laser/IPL-induced leukoderma or vitiligo.

Altered predictive control during memory suppression in PTSD.

Aberrant predictions of future threat lead to maladaptive avoidance in individuals with post-traumatic stress disorder (PTSD). How this disruption in prediction influences the control of memory states orchestrated by the dorsolateral prefrontal cortex is unknown. We combined computational modeling and brain connectivity analyses to reveal how individuals exposed and nonexposed to the 2015 Paris terrorist attacks formed and controlled beliefs about future intrusive re-experiencing implemented in the laboratory during a memory suppression task. Exposed individuals with PTSD used beliefs excessively to control hippocampal activity during the task. When this predictive control failed, the prediction-error associated with unwanted intrusions was poorly downregulated by reactive mechanisms. This imbalance was linked to higher severity of avoidance symptoms, but not to general disturbances such as anxiety or negative affect. Conversely, trauma-exposed participants without PTSD and nonexposed individuals were able to optimally balance predictive and reactive control during the memory suppression task. These findings highlight a potential pathological mechanism occurring in individuals with PTSD rooted in the relationship between the brain's predictive and control mechanisms.