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Petruzzi M.,University of Bari | Lucchese A.,The Second University of Naples | Lajolo C.,Catholic University Sacro Cuore | Campus G.,University of Sassari | And 2 more authors.
Dermatology | Year: 2013

Background: Treatment of oral lichen planus (OLP) is a major challenge for clinicians and patients. There is limited scientific evidence about topical treatment with retinoids. We conducted a literature review of data on the effectiveness and safety of topical retinoids in OLP patients. Materials and Methods: We searched the MEDLINE, Embase and Cochrane databases for articles on topical retinoids treatment on OLP patients (searches from 1970 to February 2012). Results: Sixteen studies (280 OLP patients topically treated with different classes of retinoids) met the inclusion criteria. Isotretinoin was the most frequently employed retinoid in the treatment of OLP. The clinical and/or histopathological efficacy of retinoids was recorded in the majority of the selected studies. A transient and moderate burning sensation was the most frequently reported side effect. Conclusions: Topical retinoids appear as an alternative choice in OLP treatment. Whether keratotic OLP better responds to topical retinoids than erosive OLP is still an open question that deserves further comparative and controlled clinical trials. The benefits and harms of using topical retinoids in people with OLP require thorough evaluation in properly designed controlled studies. © 2013 S. Karger AG, Basel.

Mussini C.,University of Modena and Reggio Emilia | Cossarizza A.,University of Modena and Reggio Emilia | Sabin C.,University College London | Babiker A.,Medical Research Council Clinical Trials Unit | And 6 more authors.
AIDS | Year: 2011

Objective: Treatment guidelines recommend initiation of therapy for individuals experiencing rapid CD4 cell decline. It is not known, however, whether the rate of CD4 cell decline before combination antiretroviral therapy (cART) is related to immunological response following cART. Methods: We estimated precART and postcART CD4 cell slopes by mixed models and categorized patients into two groups according to whether estimated precART slopes were above or below the 75th percentile. We compared immunological responses of the two groups through both mixed models and survival techniques. Models were stratified by CD4 cell at baseline, adjusted for HIV RNA, age, sex, HIV transmission group, year of seroconversion, initiation during primary infection, hepatitis C virus and hepatitis B virus serostatus, and cART class. Results: Of 2038 eligible patients, 1531 and 507 experienced median (interquartile range) precART CD4 cell slope of -105 (-471 to -61) and -42 (-62 to +80) cells/μl, respectively, over 2 years. After adjusting for potential confounders, individuals with shallower decline experienced a slower rate of CD4 cell recovery following cART initiation of +9.5 [95% confidence interval (CI) +6.6 to +12.2] compared to +13.9 (+13.0 to +14.8) cells/μl per month among those with steeper precART decline (P < 0.001). After stratifying by the baseline CD4 cell count, the adjusted relative hazard of an increase from baseline of more than 50 cells/μl was 0.70 (95% CI 0.62-0.79) for those with a shallower vs. steeper precART decline. Conclusion: Findings highlight the existence of a subgroup of individuals with shallower precART CD4 cell decline who experience poorer CD4 cell increases after cART; new studies in this group may provide information to optimize responses to therapy. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Rizza S.,University of Rome Tor Vergata | Muniyappa R.,U.S. National Institutes of Health | Iantorno M.,U.S. National Institutes of Health | Kim J.-A.,University of Alabama at Birmingham | And 7 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2011

Context: Hesperidin, a citrus flavonoid, and its metabolite hesperetin may have vascular actions relevant to their health benefits. Molecularandphysiological mechanisms of hesperetin actions are unknown. Objective: We tested whether hesperetin stimulates production of nitric oxide (NO) from vascular endothelium and evaluated endothelial function in subjects with metabolic syndrome on oral hesperidin therapy. Design, Setting, and Interventions: Cellular mechanisms of action of hesperetin were evaluated in bovine aortic endothelial cells (BAEC) in primary culture. A randomized, placebo-controlled, double-blind, crossover trial examined whether oral hesperidin administration (500 mg once daily for 3 wk) improves endothelial function in individuals with metabolic syndrome (n = 24). Main Outcome Measure: We measured the difference in brachial artery flow-mediated dilation between placebo and hesperidin treatment periods. Results: Treatment of BAEC with hesperetin acutely stimulated phosphorylation of Src, Akt, AMP kinase, and endothelial NO synthase to produce NO; this required generation of H2O2. Increased adhesion of monocytes to BAEC and expression of vascular cell adhesion molecule-1 in response to TNF-α treatment was reduced by pretreatment with hesperetin. In the clinical study, when compared with placebo, hesperidin treatment increased flow-mediated dilation (10.26±1.19 vs. 7.78± 0.76%; P = 0.02) and reduced concentrations of circulating inflammatory biomarkers (high-sensitivity C-reactive protein, serum amyloid A protein, soluble E-selectin). Conclusions: Novel mechanisms for hesperetin action in endothelial cells inform effects of oral hesperidin treatment to improve endothelial dysfunction and reduce circulating markers of inflammation in our exploratory clinical trial. Hesperetin has vasculoprotective actions that may explain beneficial cardiovascular effects of citrus consumption. Copyright © 2011 by The Endocrine Society.

Babiloni C.,University of Foggia | Vecchio F.,Fatebenefratelli for Research AFaR | Infarinato F.,IRCCS San Raffaele Pisana | Buffo P.,University of Rome La Sapienza | And 7 more authors.
Cortex | Year: 2011

Here we describe a methodological approach for the simultaneous electroencephalographic (EEG) recording in musicians playing in ensemble. Four professional saxophonists wore pre-wired EEG caps (30 electrodes placed according to an augmented 10-20 system; cephalic reference and ground). Each cap was connected to a single multi-channel amplifier box [Brain Explorer (BE), EB-Neuro©]. The four boxes converged to a single workstation equipped with a software (GALILEO NT, EB-Neuro©) allowing the simultaneous recording of sounds, digital trigger, and EEG-electrooculographic (EOG)-electromyographic (EMG) data, and providing a separate output file for each individual. Noteworthy, the subjects were electrically decoupled to satisfy international safety guidelines. The quality of the EEG data was confirmed by the rate of artifact-free EEG epochs (about 80%) and by EEG spectral features. During the resting state, dominant EEG power density values were observed at alpha band (8-12Hz) in posterior cortex. The quality of EMG can be used to identify " on" and " off" states of the musicians' motor performance, thus potentially allowing the investigation of the relationships between EEG dynamics and different characteristics of the specific performance. During the music performance, alpha power density values decreased in amplitude in several cortical regions, whereas power density values enhanced within narrow high-frequency bands. In conclusion, the present methodological approach appeared to be suitable for simultaneous EEG recordings in musicians playing in ensemble. © 2011 Elsevier Srl.

Pelone F.,Catholic University Sacro Cuore | Kringos D.S.,University of Amsterdam | Kringos D.S.,NIVEL Netherlands Institute for Health Services Research | Spreeuwenberg P.,NIVEL Netherlands Institute for Health Services Research | And 2 more authors.
International Journal for Quality in Health Care | Year: 2013

Objective: To measure the relative efficiency of primary care (PC) in turning their structures into services delivery and turning their services delivery into quality outcomes. Design: Cross-sectional study based on the dataset of the Primary Healthcare Activity Monitor for Europe project. Two Data Envelopment Analysis models were run to compare the relative technical efficiency. A sensitivity analysis of the resulting efficiency scores was performed. Setting: PC systems in 22 European countries in 2009/2010. Main Outcome Measures: Model 1 included data on PC governance, workforce development and economic conditions as inputs and access, coordination, continuity and comprehensiveness of care as outputs. Model 2 included the previous process dimensions as inputs and quality indicators as outputs. Results: There is relatively reasonable efficiency in all countries at delivering as many as possible PC processes at a given level of PC structure. It is particularly important to invest in economic conditions to achieve an efficient structure-process balance. Only five countries have fully efficient PC systems in turning their services delivery into high quality outcomes, using a similar combination of access, continuity and comprehensiveness, although they differ on the adoption of coordination of services. There is a large variation in efficiency levels obtained by countries with inefficient PC in turning their services delivery into quality outcomes. Conclusions: Maximizing the individual functions of PC without taking into account the coherence within the health-care system is not sufficient from a policymaker's point of view when aiming to achieve efficiency. © The Author 2013. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

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