De novo subacute cutaneous lupus erythematosus-like eruptions in the setting of programmed death-1 or programmed death ligand-1 inhibitor therapy: clinicopathological correlation.

Immune checkpoint inhibitors (ICI) may cause eruptions resembling cutaneous autoimmune diseases. There are six cases of immunotherapy-associated subacute cutaneous lupus erythematosus (SCLE) in the literature. We present details of five patients referred to the Skin Toxicity Program at the Dana-Farber Cancer Institute/Brigham and Women's Cancer Center who developed de novo immunotherapy-associated SCLE-like eruptions, along with clinicopathological correlation and highlight potential mechanistic features and important diagnostic points. Two patients were maintained on topical corticosteroids, antihistamines and photoprotection. One had complete clearance and two had improvement with addition of hydroxychloroquine. Four patients continued their immunotherapy uninterrupted, while one had immunotherapy suspended for a month before restarting at full dose. Histopathologically, this series illustrates the temporal evolution of ICI-induced immune cutaneous reactions with SCLE subtype. Looking beyond the universally present lichenoid infiltrate, features of evolving SCLE were evident. We hypothesize that programmed death-1 blockade may induce immunological recognition of previously immunologically tolerated drug antigens, leading to epitope spreading and the SCLE phenotype.

Chemical and enzymatic stability evaluation of lipoamino acid esters of idebenone.

Lipophilic conjugates of idebenone (IDE) with short-chain alkylamino acids were previously synthesized and evaluated in vitro for their antioxidant properties. In this study, their susceptibility to chemical and enzymatic hydrolysis was evaluated. Results indicated that these derivatives release the parent drug quantitatively via enzymatic hydrolysis by serum and liver esterases, with a cleavage rate related to the length of the alkyl side chain. Consequently, the present lipoamino acid conjugates of IDE are prodrugs and their in vivo effects are mediated through the parent compound released in the body.

Meta-analysis as a source of evidence in gastroenterology: a critical approach.

Meta-analysis is increasingly used in hepatogastroenterology. Meta-analysis is of value to provide a systematic review of related trials and to display their results in an objective, easily understandable manner. When the trials are sufficiently homogeneous, meta-analysis can document the superiority, (a), or the lack of superiority (b) of a treatment with respect to another (e.g., (a) Interferon plus ribavirin vs Interferon for chronic hepatitis; (b) 5-ASA vs sulfasalazine for maintaining remission in ulcerative colitis). However the interpretation of meta-analysis requires caution. Meta-analysis can be unreliable or unstable if based on a few, small trials (e.g., Tamoxifen vs non-active treatment for hepatocellular carcinoma), or if distorted by confounding variables and publication bias (e.g., glucocorticoids vs standard treatment in alcoholic hepatitis). Eventually, qualitative heterogeneity makes the pooled results of meta-analysis meaningless or questionable (e.g., endoscopic sclerotherapy for prevention of first variceal bleeding in cirrhosis) and should prompt the search for its sources to plan future studies. Finally, meta-analysis of trials measuring the treatment effect of a drug vs a placebo when an active drug is available for comparison provides the limited informative content for the physician of the individual trials (e.g. 5-ASA vs placebo for maintaining remission in ulcerative colitis).

Three-dimensional facial morphometry and conventional cephalometrics: a correlation study.

The purpose of this study was to compare the correlation between three-dimensional soft tissue measurements obtained with three-dimensional digital infrared photogrammetry and two-dimensional data obtained with conventional cephalometry. Facial morphometry was investigated in a group of 20 healthy young men using both systems on each subject. From the lateral radiographs, conventional two-dimensional cephalometric hard and soft tissue data were calculated, while three-dimensional linear and angular soft tissue measurements were computed from the infrared photogrammetry. The correlations between the two sets of measurements were calculated. Three-dimensional soft tissue measurements correlated to cephalometric data primarily contained information useful for esthetic analysis. The soft tissue infrared measurements also allowed evaluation of the general hard tissue situation. Since the soft tissue measurements are calculated with a noninvasive system, they could be computed more frequently during treatment and be used to supplement pretreatment and posttreatment radiographs.

Smoking habits and recurrence in Crohn's disease.

BACKGROUND/AIMS: Smoking may be a risk factor for surgical recurrence of Crohn's disease. However, other variables associated with recurrence could be confounding factors for smoking. The aim of this study was to evaluate the role of smoking as an independent predictor of clinical, surgical, and endoscopic recurrence. METHODS: In a series of 182 patients who underwent surgery for Crohn's disease, a multivariate analysis was performed that included all of the significant variables associated with recurrence: sex, age at diagnosis, time between onset of symptoms and surgery, site of disease, indication for surgery, extent of disease, extraintestinal manifestation, and smoking habit. RESULTS: Independent predictors of clinical recurrence by the Cox proportional hazard model were smoking (hazard ratio, 1.46; 95% confidence interval [CI], 1.1-1.8), extraintestinal manifestations (hazard ratio, 1.61; 95% CI, 1.0-2.5), and extent of disease (hazard ratio, 1.57; 95% CI, 1.0-2.4). Smoking was the only significant predictor of surgical recurrence (hazard ratio, 2.0; 95% CI, 1.2-2.3). For endoscopic recurrence, logistic regression showed that smoking (odds ratio, 2.2; 95% CI, 1.2-3.8) and extent of disease (odds ratio, 2.6; 95% CI, 1.0-6.7) were predictive factors of recurrence. CONCLUSIONS: Smoking is an independent risk factor for clinical, surgical, and endoscopic recurrence in Crohn's disease.

Epidemiology of Crohn's disease in Sicily: a hospital incidence study from 1987 to 1989. "The Sicilian Study Group of Inflammatory Bowel Disease".

An epidemiologic study of Crohn's disease was carried out in the Province of Palermo, Italy, between 1987 and 1989. The incidence of first hospitalization was prospectively evaluated in this period. A total of 103 patients (59 males, 44 females) were diagnosed. The standardized annual incidence was 2.7/100,000. The incidence was quite constant during the 3 years of the study (1987: 2.9/100,000; 1988: 2.4/100,000; 1989: 2.99/100,000). Incidence rates were slightly higher in men than in women. The disease had a bimodal age distribution in female (with peaks at age 20-29 and 60-69) and males (with peaks at age 30-39, 40-49). No cases were observed at age 0-9. The incidence of Crohn's disease in southern Italy is comparable to that reported in northern Europe.

[Epidemiology of caries and periodontal disease. Survey of 5,000 recruits]. / Epidemiologia di carie e parodontopatie. Indagine su 5000 militari di leva.

An epidemiological survey about the prevalence of caries and periodontal disease has been carried out by the Authors on 5000 subjects chosen among recruits coming from different regions of Italy. The results has been particularly evaluated in reference to social and cultural status, geographic origin and immigration and previous dentistry therapies.