Treatment of newly diagnosed severe aplastic anemia in children: Evidence-based recommendations.

Severe aplastic anemia (SAA) is a rare potentially fatal hematologic disorder. Although overall outcomes with treatment are excellent, there are variations in management approach, including differences in treatment between adult and pediatric patients. Certain aspects of treatment are under active investigation in clinical trials. Because of the rarity of the disease, some pediatric hematologists may have relatively limited experience with the complex management of SAA. The following recommendations reflect an up-to-date evidence-based approach to the treatment of children with newly diagnosed SAA.

Treatment of relapsed/refractory severe aplastic anemia in children: Evidence-based recommendations.

Severe aplastic anemia (SAA) is a rare potentially fatal hematologic disorder. Although overall outcomes with treatment are excellent, there are variations in management approach, including differences in treatment between adult and pediatric patients. Certain aspects of treatment are under active investigation in clinical trials. Because of the rarity of the disease, some pediatric hematologists may have relatively limited experience with the complex management of SAA. The following recommendations reflect an up-to-date evidence-based approach to the treatment of children with relapsed or refractory SAA.

Triadic influence as a proxy for compatibility in social relationships.

Networks of social interactions are the substrate upon which civilizations are built. Often, we create new bonds with people that we like or feel that our relationships are damaged through the intervention of third parties. Despite their importance and the huge impact that these processes have in our lives, quantitative scientific understanding of them is still in its infancy, mainly due to the difficulty of collecting large datasets of social networks including individual attributes. In this work, we present a thorough study of real social networks of 13 schools, with more than 3,000 students and 60,000 declared positive and negative relationships, including tests for personal traits of all the students. We introduce a metric-the "triadic influence"-that measures the influence of nearest neighbors in the relationships of their contacts. We use neural networks to predict the sign of the relationships in these social networks, extracting the probability that two students are friends or enemies depending on their personal attributes or the triadic influence. We alternatively use a high-dimensional embedding of the network structure to also predict the relationships. Remarkably, using the triadic influence (a simple one-dimensional metric) achieves the best accuracy, and adding the personal traits of the students does not improve the results, suggesting that the triadic influence acts as a proxy for the social compatibility of students. We postulate that the probabilities extracted from the neural networks-functions of the triadic influence and the personalities of the students-control the evolution of real social networks, opening an avenue for the quantitative study of these systems.

Case report: Daratumumab treatment in pre-transplant alloimmunization and severe hemolytic anemia.

Daratumumab, a CD38 monoclonal antibody that has been FDA-approved to treat multiple myeloma, has acquired popularity and is used off-label for both auto- and alloantibody mediated disorders, particularly in refractory/resistant circumstances. Much of the published data for its use in pediatric blood disorders has been in post-transplant autoimmune cytopenias. Here we describe three patients in whom daratumumab was used outside of post-transplant autoimmune cytopenias, highlighting further potential uses of this medication.

An Extracytoplasmic Function Sigma Factor Required for Full Virulence in Xanthomonas citri pv. citri.

The genus Xanthomonas includes more than 30 phytopathogenic species that infect a wide range of plants and cause severe diseases that greatly impact crop productivity. These bacteria are highly adapted to the soil and plant environment, being found in decaying material, as epiphytes, and colonizing the plant mesophyll. Signal transduction mechanisms involved in the responses of Xanthomonas to environmental changes are still poorly characterized. Xanthomonad genomes typically encode several representatives of the extracytoplasmic function σ (σECF) factors, whose physiological roles remain elusive. In this work, we functionally characterized the Xanthomonas citri pv. citri EcfL, a σECF factor homologous to members of the iron-responsive FecI-like group. We show that EcfL is not required or induced during iron starvation, despite presenting the common features of other FecI-like σECF factors. EcfL positively regulates one operon composed of three genes that encode a TonB-dependent receptor involved in cell surface signaling, an acid phosphatase, and a lectin-domain containing protein. Furthermore, we demonstrate that EcfL is required for full virulence in citrus, and its regulon is induced inside the plant mesophyll and in response to acid stress. Together, our study suggests a role for EcfL in the adaptation of X. citri to the plant environment, in this way contributing to its ability to cause citrus canker disease. IMPORTANCE The Xanthomonas genus comprises a large number of phytopathogenic species that infect a wide variety of economically important plants worldwide. Bacterial adaptation to the plant and soil environment relies on their repertoire of signal transduction pathways, including alternative sigma factors of the extracytoplasmic function family (σECF). Here, we describe a new σECF factor found in several Xanthomonas species, demonstrating its role in Xanthomonas citri virulence to citrus plants. We show that EcfL regulates a single operon containing three genes, which are also conserved in other Xanthomonas species. This study further expands our knowledge on the functions of the widespread family of σECF factors in phytopathogenic bacteria.

Congenital Ewing Sarcoma Presenting as a Rapidly Growing Neck Mass in a Newborn.

BACKGROUND: Ewing sarcoma (EWS) is an aggressive soft-tissue and bone malignancy. Congenital EWS is extremely rare, and its presenting features can be unique from that of EWS occurring in older children. CLINICAL FINDINGS: A full-term female infant with a neck mass present at birth was admitted to a level I nursery with an otherwise well appearance and normal vital signs. After consultation with a neonatologist, she was transferred to a neonatal intensive care unit where she developed sudden respiratory collapse from rapid growth of the mass causing airway obstruction, leading to emergent intubation. Ultrasound and MRI scans of the neck mass demonstrated cystic and vascular components, and a timely biopsy revealed small round blue cells with diffuse CD99 expression and chromosomal translocation 11;22. PRIMARY DIAGNOSIS: Ewing sarcoma. INTERVENTIONS: An accelerated workup for EWS was done due to the patient's critical status. On day of life (DOL) 8, she was started on treatment of EWS as per the current standard-of-care AEWS0031. On DOL 24, she underwent tracheostomy placement. OUTCOMES: The patient completed 14 total cycles of chemotherapy and is more than 12 months old. Her tracheostomy was decannulated at 6 months of age. PRACTICE RECOMMENDATIONS: The rarity of EWS in neonates and its presentation as a neck mass make this disease difficult to recognize unless clinicians have a high index of suspicion. The aims of this case report are to increase awareness of malignancy as a potential cause of neck masses in neonates and to prompt nurses and physicians to prepare for airway stabilization at appropriate levels of care if a neck mass is present at birth.

Clinical Features, Cancer Biology, Transplant Approach and Other Integrated Management Strategies for Wiskott-Aldrich Syndrome.

Wiskott-Aldrich syndrome (WAS) is a rare X-linked recessive inborn error of immunity (IEI) first described in 1937. Classic WAS is characterized by the triad of thrombocytopenia with small platelets, recurrent infections due to combined immunodeficiency, and eczema. Hematopoietic stem cell transplantation (HSCT) was the only curative option available for five decades, with excellent outcomes reported for matched sibling donors (MSD) and matched unrelated donors (MUD). More recently, alternative donor transplants such as umbilical cord blood (UCB) and haploidentical transplant have emerged as viable options due to improvements in better graft selection, cell dosing, and effective allograft manipulation measures. Gene therapy is another potential curative option with promising results, yet currently is offered only as part of a clinical trial.

Competing for congestible goods: experimental evidence on parking choice.

Congestible goods describe situations in which a group of people share or use a public good that becomes congested or overexploited when demand is low. We study experimentally a congestible goods problem of relevance for parking design, namely how people choose between a convenient parking lot with few spots and a less convenient one with unlimited space. We find that the Nash equilibrium predicts reasonably well the competition for the convenient parking when it has few spots, but not when it has more availability. We then show that the Rosenthal equilibrium, a bounded-rational approach, is a better description of the experimental results accounting for the randomness in the decision process. We introduce a dynamical model that shows how Rosenthal equilibria can be approached in a few rounds of the game. Our results give insights on how to deal with parking problems such as the design of parking lots in central locations in cities and open the way to better understand similar congestible goods problems in other contexts.

Hierarchical clustering of bipartite data sets based on the statistical significance of coincidences.

When some 'entities' are related by the 'features' they share they are amenable to a bipartite network representation. Plant-pollinator ecological communities, co-authorship of scientific papers, customers and purchases, or answers in a poll, are but a few examples. Analyzing clustering of such entities in the network is a useful tool with applications in many fields, like internet technology, recommender systems, or detection of diseases. The algorithms most widely applied to find clusters in bipartite networks are variants of modularity optimization. Here, we provide a hierarchical clustering algorithm based on a dissimilarity between entities that quantifies the probability that the features shared by two entities are due to mere chance. The algorithm performance is O(n^{2}) when applied to a set of n entities, and its outcome is a dendrogram exhibiting the connections of those entities. Through the introduction of a 'susceptibility' measure we can provide an 'optimal' choice for the clustering as well as quantify its quality. The dendrogram reveals further useful structural information though-like the existence of subclusters within clusters or of nodes that do not fit in any cluster. We illustrate the algorithm by applying it first to a set of synthetic networks, and then to a selection of examples. We also illustrate how to transform our algorithm into a valid alternative for one-mode networks as well, and show that it performs at least as well as the standard, modularity-based algorithms-with a higher numerical performance. We provide an implementation of the algorithm in python freely accessible from GitHub.

Real time comprehension of Spanish articles in children with developmental language disorder: Empirical evidence from eye movements.

Function words and, more specifically, articles have been widely indicated as one of the main sources of difficulty for children with Developmental Language Disorder (DLD). The present study is the first to assess the online comprehension of Spanish articles in bilingual children with DLD. In an eye tracking experiment, we monitored participants' eye movements as they listened to Spanish articles embedded in structurally simple sentences. Ninety-six subjects from four different groups were evaluated: 24 children with DLD (average age 7;08), 24 children with the same chronological age (average age 7;08), 24 younger children matched for mean length utterance (average age 6;08), and 24 adults (average age 22;05). We calculated the proportion between the preference for the correct visual referent and a competitor object. Our results suggest that children with DLD are capable of timely comprehension of Spanish articles in real time and within simple sentence structures. However, we observed a strong effect of chronological age in the sample of interest; younger children with DLD are able to identify the correct referent, but this preference is weaker compared to the older children with DLD. We also observed local differences between the DLD group, and the other two children control groups, particularly when the chronological age group is introduced as a factor. These findings suggest a developmental trajectory that is different in the DLD group relative to children with typical language development. Notwithstanding, in spite of the article production difficulties previously reported, children with DLD in the present sample appear to be able to comprehend Spanish articles in the current experimental conditions.

Adolescent Friendly Services: quality assessment with simulated users.

OBJECTIVE: To assess the quality of adolescent friendly health services. METHODS: Qualitative assessment using the simulated user technique in first level clinics of Health Services of Morelos, Mexico, during 2018. Ten out of 17 facilities with non-exclusive adolescent friendly services were randomly selected. An additional facility with exclusive adolescent friendly services was included as an intensive subsample. Four adolescents served as simulated users interpreting different cases in the clinics. The total of 43 semi-structured exit interviews were conducted, and two nominal groups were made to assess the perceived quality from the adolescents' perception of friendliness and experience. Thematic analysis of the data obtained was performed. RESULTS: Staff attitude was highlighted as a key element in the adolescents' experience. Failures were found, such as the existence of bureaucratic barriers to access, lack of signage in clinics, lack of privacy and confidentiality, failure of physical examination during the appointment and lack of monitoring of the reasons for appointment. The exclusive clinic for adolescents offered more appropriate friendly services compared with nonexclusive clinics. CONCLUSION: Although the service is accessible in most of the clinics visited, it is still far from being friendly according to international recommendations. The exclusive clinic for adolescents stood out for having better structured mechanisms that can be implemented in nonexclusive clinics to improve the care process.

Mean Airway Pressure As a Predictor of 90-Day Mortality in Mechanically Ventilated Patients.

OBJECTIVES: To determine the association between mean airway pressure and 90-day mortality in patients with acute respiratory failure requiring mechanical ventilation and to compare the predictive ability of mean airway pressure compared with inspiratory plateau pressure and driving pressure. DESIGN: Prospective observational cohort. SETTING: Five ICUs in Lima, Peru. SUBJECTS: Adults requiring invasive mechanical ventilation via endotracheal tube for acute respiratory failure. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of potentially eligible participants (n = 1,500), 65 (4%) were missing baseline mean airway pressure, while 352 (23.5%) were missing baseline plateau pressure and driving pressure. Ultimately, 1,429 participants were included in the analysis with an average age of 59 ± 19 years, 45% female, and a mean PaO2/FIO2 ratio of 248 ± 147 mm Hg at baseline. Overall, 90-day mortality was 50.4%. Median baseline mean airway pressure was 13 cm H2O (interquartile range, 10-16 cm H2O) in participants who died compared to a median mean airway pressure of 12 cm H2O (interquartile range, 10-14 cm H2O) in participants who survived greater than 90 days (p < 0.001). Mean airway pressure was independently associated with 90-day mortality (odds ratio, 1.38 for difference comparing the 75th to the 25th percentile for mean airway pressure; 95% CI, 1.10-1.74) after adjusting for age, sex, baseline Acute Physiology and Chronic Health Evaluation III, baseline PaO2/FIO2 (modeled with restricted cubic spline), baseline positive end-expiratory pressure, baseline tidal volume, and hospital site. In predicting 90-day mortality, baseline mean airway pressure demonstrated similar discriminative ability (adjusted area under the curve = 0.69) and calibration characteristics as baseline plateau pressure and driving pressure. CONCLUSIONS: In a multicenter prospective cohort, baseline mean airway pressure was independently associated with 90-day mortality in mechanically ventilated participants and predicts mortality similarly to plateau pressure and driving pressure. Because mean airway pressure is readily available on all mechanically ventilated patients and all ventilator modes, it is a potentially more useful predictor of mortality in acute respiratory failure.

Adolescent friendly services: quality assessment with simulated users / Servicios amigables para adolescentes: evaluación de la calidad con usuarios simulados

ABSTRACT OBJECTIVE To assess the quality of adolescent friendly health services. METHODS Qualitative assessment using the simulated user technique in first level clinics of Health Services of Morelos, Mexico, during 2018. Ten out of 17 facilities with non-exclusive adolescent friendly services were randomly selected. An additional facility with exclusive adolescent friendly services was included as an intensive subsample. Four adolescents served as simulated users interpreting different cases in the clinics. The total of 43 semi-structured exit interviews were conducted, and two nominal groups were made to assess the perceived quality from the adolescents' perception of friendliness and experience. Thematic analysis of the data obtained was performed. RESULTS Staff attitude was highlighted as a key element in the adolescents' experience. Failures were found, such as the existence of bureaucratic barriers to access, lack of signage in clinics, lack of privacy and confidentiality, failure of physical examination during the appointment and lack of monitoring of the reasons for appointment. The exclusive clinic for adolescents offered more appropriate friendly services compared with nonexclusive clinics. CONCLUSION Although the service is accessible in most of the clinics visited, it is still far from being friendly according to international recommendations. The exclusive clinic for adolescents stood out for having better structured mechanisms that can be implemented in nonexclusive clinics to improve the care process.

RESUMEN OBJETIVO Evaluar la calidad de los servicios de salud amigables para adolescentes. MÉTODOS Evaluación cualitativa utilizando la técnica de usuario simulado en clínicas de primer nivel de los Servicios de Salud de Morelos, México durante 2018. Se seleccionaron aleatoriamente 10 de 17 establecimientos con servicios amigables no exclusivos para adolescentes. Se incluyó adicionalmente un centro con servicios amigables exclusivo para adolescentes como submuestra de tipo intensivo. Cuatro adolescentes fungieron como usuarios simulados interpretando diferentes casos de consulta en las clínicas. Se realizaron 43 entrevistas semiestructuradas de salida y se hicieron dos grupos nominales para evaluar la calidad percibida a partir de la percepción de amigabilidad y la experiencia de los adolescentes. Se realizó análisis temático de los datos obtenidos. RESULTADOS La actitud del personal destacó como un elemento clave para la experiencia de los adolescentes. Se encontraron fallas como la existencia de barreras burocráticas para el acceso, falta de señalamientos en las clínicas, falta de privacidad y confidencialidad, fallas en la exploración física durante la consulta y falta de seguimiento de los motivos de consulta. La clínica exclusiva para adolescentes ofreció servicios amigables más adecuados en comparación con las clínicas no exclusivas. CONCLUSIÓN Aunque en la mayoría de los establecimientos visitados el servicio es accesible, aun distan de cumplir con las características de amigabilidad de acuerdo con las recomendaciones internacionales. La clínica exclusiva para adolescentes destacó al contar con mecanismos mejor estructurados que pueden ser implementados en clínicas no exclusivas para mejorar el proceso de atención.

Large scale and information effects on cooperation in public good games.

The problem of public good provision is central in economics and touches upon many challenging societal issues, ranging from climate change mitigation to vaccination schemes. However, results which are supposed to be applied to a societal scale have only been obtained with small groups of people, with a maximum group size of 100 being reported in the literature. This work takes this research to a new level by carrying out and analysing experiments on public good games with up to 1000 simultaneous players. The experiments are carried out via an online protocol involving daily decisions for extended periods. Our results show that within those limits, participants' behaviour and collective outcomes in very large groups are qualitatively like those in smaller ones. On the other hand, large groups imply the difficulty of conveying information on others' choices to the participants. We thus consider different information conditions and show that they have a drastic effect on subjects' contributions. We also classify the individual decisions and find that they can be described by a moderate number of types. Our findings allow to extend the conclusions of smaller experiments to larger settings and are therefore a relevant step forward towards the understanding of human behaviour and the organisation of our society.

Author Correction: Group size effects and critical mass in public goods games.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Cáncer de próstata y polimorfismos de la glutation s-transferasa en una población venezolana / Prostate cancer and polymorphisms of the glutathione s-transferase in a population Venezuelan

En vista de la alta prevalencia del cáncer de próstata en la población venezolana y la ausencia de un patrón genético conocido en relación a la expresión de las enzimas Glutatión S-transferasas, se estudió la relación entre la expresión de un polimorfismo nulo de estas enzimas y la presencia de cáncer de adenocarcinoma prostática Métodos: Se incluyen 100 individuos para el muestreo no probabilístico, 50 pacientes con diagnóstico de adenocarcinoma de próstata comprobado mediante biopsia y 50 controles con hiperplasia prostática benigna demostrada mediante tacto y corroborada por ultrasonido transrectal, provenientes de los principales hospitales del país, se procedió a tomar muestra de sangre y mediante reacción de cadena de polimerasa, se determinó la presencia o ausencia de los genes para las enzimas Glutatión S-transferasa Mu 1 (GST M) y glutatión S-transferasa theta 1 (GST T1). Resultados: se logró evidenciar que el genotipo nulo se encontró en 40 y 24% de los pacientes mientras que para los controles fue de 38% y 22% respectivamente, demostrando que en la población venezolana estudiada no existen diferencias significativas entre casos y controles. Conclusiones: No se pudo demostrar una diferencia significativa entre los dos grupos estudiados. Recomendaciones: A pesar de nuestros hallazgos, se necesitan estudios futuros con muestras de mayor tamaño para dilucidar la posible asociación entre este patrón enzimático con el riesgo de presentar cáncer de próstata(AU)

Prostate cancer presents with a high incidence in the Venezuelan population. there is no known genetic pattern related to the expression of drug metabolizing enzymes Glutathione S-transferases. Methods: We proceeded to study the possible correlation between null polymorphism for these enzymes and prostate adenocarcinoma. the sample included 100 patients recruited from the Urology Department of three University Hospitals in Caracas, Venezuela, 50 cancer patients and 50 cancer free controls. Blood samples were drawn from each patient and polymorphisms for Glutathione S-transferase Mu 1 (GST M1) and Glutathione-sS-transferase theta 1(GST T1) were determined by polymerase chain reaction from lymphocytes. Results: Null genotype was found in 40% and 24% of cancer patients whereas the percentage in controls was 38 and 22% respectively, showing no statistically significant differences between the two groups. Conclusions: It was not possible to show a significant difference between the two groups. Recommendations: Due to the small size of the sample, it would be necessary to explore further in a larger population sample to determine whether there is an association between the expression of these enzymes and prostate cancer(AU)

Group size effects and critical mass in public goods games.

Understanding whether the size of the interacting group has an effect on cooperative behavior has been a major topic of debate since the seminal works on cooperation in the 1960s. Half a century later, scholars have yet to reach a consensus, with some arguing that cooperation is harder in larger groups, while others that cooperation is easier in larger groups, and yet others that cooperation attains its maximum in intermediate size groups. Here we add to this field of work by reporting a two-treatment empirical study where subjects play a Public Goods Game with a Critical Mass, such that the return for full cooperation increases linearly for early contributions and then stabilizes after a critical mass is reached (the two treatments differ only on the critical mass). We choose this game for two reasons: it has been argued that it approximates real-life social dilemmas; previous work suggests that, in this case, group size might have an inverted-U effect on cooperation, where the pick of cooperation is reached around the critical mass. Our main innovation with respect to previous experiments is that we implement a within-subject design, such that the same subject plays in groups of different size (from 5 to 40 subjects). Groups are formed at random at every round and there is no feedback. This allows us to explore if and how subjects change their choice as a function of the size of the group. We report three main results, which partially contrast what has been suggested by previous work: in our setting (i) the critical mass has no effect on cooperation; (ii) group size has a positive effect on cooperation; (iii) the most chosen option (played by about 50% of the subjects) is All Defection, followed by All Cooperation (about 10% of the subjects), whereas the rest have a slight trend to switch preferentially from defection to cooperation as the group size increases.

In-hospital mortality of hematopoietic stem cell transplantation among children with nonmalignancies: A nationwide study in the United States from 2000 to 2012.

BACKGROUND: Hematopoietic stem cell transplant (HSCT) can cure or alleviate a wide range of nonmalignant childhood conditions. However, few studies have examined longitudinal national trends of frequency or short-term complications of HSCT before 2006 when an HSCT became a reportable procedure by US law. By using a US nationally representative database, we conducted nationwide longitudinal analyses on demographics, in-hospital mortality, and short-term complications in nonmalignant HSCT from 2000 to 2012. PROCEDURE: We analyzed 2504 admissions for children < 20 years old who underwent an allogeneic HSCT for a nonmalignant condition by using the Kids' Inpatient Database for the years 2000, 2003, 2006, 2009, and 2012. Changes in in-hospital mortality and other outcomes were assessed over the study period using weighted analyses, which enabled generation of national estimates in each year. RESULTS: The number of admissions for HSCT increased from 334 to 667 from 2000 to 2012, respectively; among them, the use of bone marrow decreased (66.5% to 34.1%, P < 0.001). In-hospital mortality declined (13.4% to 7.1%, P = 0.04), as did bacteremia (28.7% to 10.1%, P < 0.001) and vascular catheter infections (18.8% to 8.7%, P = 0.006), but cytomegalovirus infections increased (4.9% to 15.9%, P < 0.001), as did adenovirus infections (1.8% to 6.9%, P < 0.001) from 2000 to 2012. CONCLUSION: Population-based analyses demonstrated a substantial expansion of the utilization of HSCT occurred for pediatric nonmalignancies from 2000 to 2012 in the United States, whereas the in-hospital mortality declined by approximately a half. Further research is needed to identify distinct contributing factors.

Sterol-standardized phytopharmaceutical from ground cherry: Corticoid-like properties on human keratinocytes and fibroblasts and its effects in a randomized double-blind placebo-controlled clinical trial.

BACKGROUND: Topical corticosteroids have been the most commonly prescribed drugs to treat skin inflammation, but their uses can lead to several adverse effects. Nowadays, new pharmacological strategies have been evaluated to improve dermatologic efficacy and reduce adverse effects, including natural products. OBJECTIVES: The aim of this study was to evaluate and compare the effects of a plant sterol standardized supercritical CO2 phytopharmaceutical of Physalis angulata L. with hydrocortisone on the immune and inflammatory mediators, and skin repair components production. Moreover, we studied effects of both products on the skin microcirculation and temperature in a double-blind placebo-controlled clinical trial. METHODS: Both products were evaluated on the immune (IL-6, IL-10, INF-γ, TNF-α, and IL-1α), inflammatory (COX-2, LOX, PLA2 , PGE2 , LTB4 , histamine, and NF-κB), and repair components (TGF-ß, GM-CSF, collagen, and GAG) production on human keratinocytes and fibroblast in non-stimulated and LPS-stimulated conditions. Indeed, in a randomized double-blind placebo-controlled clinical trial, we evaluated the effects of the both creams on the skin microcirculation and temperature using laser Doppler and infrared thermometer, respectively. RESULTS: Physalis angulata acted on the skin, modulating immune status and inflammatory response producing corticoid-like effects, but different of hydrocortisone, increased skin repair factors. The effects of phytopharmaceutical cream in the clinical trial promoted a better reduction in skin microcirculation and temperature than hydrocortisone. CONCLUSIONS: Taken together, the results indicate that sterol standardized CO2 supercritical preparation of P angulata is a new and innovative phytopharmaceutical with multiple pharmacological effects potentially useful as human skin protective product, particularly against cutaneous inflammatory disorders.