Translation and cultural adaptation of the Italian version of the Paediatric Palliative Screening Scale.

The number of children eligible for Paediatric Palliative Care has dramatically increased over the years, with few tools that can help with early identification. The Paediatric Palliative Screening Scale is a dedicated German, English, and Portuguese screening tool. We aimed to translate and perform a cultural adaptation to the Italian setting of the Paediatric Palliative Screening Scale. This paper was a descriptive observational cross-sectional study. We carried it out in two consecutive steps: (1) translation and back translation and (2) cultural adaptation through a Delphi process. Twenty Paediatric Palliative Care national experts were invited to judge the content and structure of the translated scale and to assess the appropriateness and clarity of each question. Consensus was defined as 70% or more of experts agreeing with each item's appropriateness and clarity. The Italian version of the Paediatric Palliative Screening Scale was obtained after two rounds of Delphi. After the second round of consultation, a substantial increase in experts' consensus was found, especially for questions 1.1, 3.2 and 3.3 (from 56.3 to 93.8%), and reaching more than 83% for all the revised items. CONCLUSIONS: The Paediatric Palliative Screening Scale is a reliable tool that can assist in timely evaluating children who qualify for Paediatric Palliative Care. The tool can be used in Italian healthcare settings with its cultural adaptation. WHAT IS KNOWN: • Despite the lack of early diagnosis techniques, there is a significant increase in the number of children entitled to Paediatric Palliative Care. • A specific screening tool called the Paediatric Palliative Screening Scale determines a child's suitability for paediatric palliative treatment. WHAT IS NEW: • The Paediatric Palliative Screening Scale is necessary to assess the psychosocial needs of patients eligible for Paediatric Palliative Care. The Italian scale has good content and face validity ensuring equivalence between the original and target populations.

A dynamic upper atmosphere of Venus as revealed by VIRTIS on Venus Express.

The upper atmosphere of a planet is a transition region in which energy is transferred between the deeper atmosphere and outer space. Molecular emissions from the upper atmosphere (90-120 km altitude) of Venus can be used to investigate the energetics and to trace the circulation of this hitherto little-studied region. Previous spacecraft and ground-based observations of infrared emission from CO2, O2 and NO have established that photochemical and dynamic activity controls the structure of the upper atmosphere of Venus. These data, however, have left unresolved the precise altitude of the emission owing to a lack of data and of an adequate observing geometry. Here we report measurements of day-side CO2 non-local thermodynamic equilibrium emission at 4.3 microm, extending from 90 to 120 km altitude, and of night-side O2 emission extending from 95 to 100 km. The CO2 emission peak occurs at approximately 115 km and varies with solar zenith angle over a range of approximately 10 km. This confirms previous modelling, and permits the beginning of a systematic study of the variability of the emission. The O2 peak emission happens at 96 km +/- 1 km, which is consistent with three-body recombination of oxygen atoms transported from the day side by a global thermospheric sub-solar to anti-solar circulation, as previously predicted.

South-polar features on Venus similar to those near the north pole.

Venus has no seasons, slow rotation and a very massive atmosphere, which is mainly carbon dioxide with clouds primarily of sulphuric acid droplets. Infrared observations by previous missions to Venus revealed a bright 'dipole' feature surrounded by a cold 'collar' at its north pole. The polar dipole is a 'double-eye' feature at the centre of a vast vortex that rotates around the pole, and is possibly associated with rapid downwelling. The polar cold collar is a wide, shallow river of cold air that circulates around the polar vortex. One outstanding question has been whether the global circulation was symmetric, such that a dipole feature existed at the south pole. Here we report observations of Venus' south-polar region, where we have seen clouds with morphology much like those around the north pole, but rotating somewhat faster than the northern dipole. The vortex may extend down to the lower cloud layers that lie at about 50 km height and perhaps deeper. The spectroscopic properties of the clouds around the south pole are compatible with a sulphuric acid composition.

Radiological findings in mammary autologous fat injections: a multi-technique evaluation.

AIM: To describe the radiological appearance of normal and pathological findings resulting from mammary autologous fat injections (lipofilling). MATERIALS AND METHODS: Informed consent and institutional review board approval were obtained. From January 2008 to December 2010, all patients that had undergone breast lipofilling at our institution (Catholic University) were consecutively enrolled. The site and amount of autologous fat injections were known. Mammography, ultrasonography, and magnetic resonance imaging (MRI) were prospectively obtained preoperatively, and 6 and 12 months after the procedure. Normal and pathological findings were described. RESULTS: Twenty-four patients (mean age 50.8 ± 10.5 years; range 26-70 years) were included. Fourteen patients underwent lipofilling after mastectomy, eight after wide local excision, one as a treatment for a congenital asymmetry, and one as a treatment for Poland syndrome. No severe complications were observed after treatment. Normal findings due to lipofilling ("oil cysts") were identified in 23 cases using ultrasound and in 16 using MRI. Liponecrosis, the most frequently observed complication, was detected in four cases using ultrasound and in eight by MRI. In one case mammography showed calcific fat necrosis. Mean amount of fat injected was 114.8 ± 55 ml. The average amount of fat grafted in patients who developed liponecrosis was 158.4 ± 42.7 versus 104.6 ± 52.3 ml (p = 0.0043, t-test). In one case breast cancer recurrence was diagnosed. CONCLUSION: Normal findings due to lipofilling are better identified by ultrasound, and pathological findings are best identified using MRI. Liponecrosis most frequently occurs when large amounts of fat are injected. In the authors' experience lipofilling does not interfere with breast cancer early diagnosis.

The role of oxidized regenerate cellulose to prevent cosmetic defects in oncoplastic breast surgery.

BACKGROUND: Breast conserving surgery (BCS) combined with postoperative radiotherapy has become the gold standard of locoregional treatment for the majority of patients with early-stage breast cancer, offering equivalent survival and improved body image and lifestyle scores as compared to mastectomy. In an attempt to optimize the oncologic safety and cosmetic results of BCS, oncoplastic procedures (OPP) have been introduced in recent years combining the best principles of surgical oncology with those of plastic surgery. However, even with the use of OPP, cosmetic outcomes may result unsatisfying when a large volume of parenchyma has to be removed, particularly in small-medium size breasts. AIM: The aim of this article is to report our preliminary results with the use of oxidized regenerate cellulose (ORC) (Tabotamp fibrillar, Johnson & Johnson; Ethicon, USA) as an agent to prevent cosmetic defects in patients undergoing OPP for breast cancer and to analyze the technical refinements that can enhance its efficacy in optimizing cosmetic defects. METHODS: Different OPP are selected based on the location and size of the tumor as well as volume and shape of the breast. After excision of the tumor, glandular flaps are created by dissection of the residual parenchyma from the pectoralis and serratus muscles and from the skin. After careful haemostasis, five layers of ORC are positioned on the pectoralis major in the residual cavity and covered by advancement of the glandular flaps. Two additional layers of ORC are positioned above the flaps and covered by cutaneous-subcutaenous flaps. RESULTS: The use of ORC after OPP has shown promising preliminary results, indicating a good tolerability and positive effects on cosmesis. CONCLUSIONS: This simple and reliable surgical technique may allow not only to reduce the rate of post-operative bleeding and infection at the surgical site but also to improve cosmetic results.

[Prevention of vertical transmission of the human immunodeficiency virus type 1 in Uruguay: 1987-2009. An analysis of measures adopted]. / Prevención de la transmisión materno-infantil del virus de inmunodeficiencia humana de tipo 1 en Uruguay: 1987-2009. Análisis de las diferentes medidas adoptadas.

UNLABELLED: The prevention of vertical transmission (VT) of human immunodeficiency virus (HIV) is a priority as it generally is an avoidable disease. AIM: To describe Uruguay's experience of VT during 23 years and the preventive measures adopted. PATIENTS AND METHODS: Children of HIV positive mothers born between January 1987 and December 2009 were followed. The mother, pregnancy and children dependent variables were analysed. Infants were classified as infected, not infected, exposed but still in evaluation, or withdrawn of the protocol. The different measures implemented were analyzed. RESULTS: There were 1353 children of HIV positive mothers; 204 (15.1%) infants were infected. The percentage of VT diminished throughout the years; between 2003 and 2009 it decreased to 6%. Protective factors against HIV VT were antiretroviral therapy (ARV) during pregnancy, elective caesarean section and not to nurse the newborn infant. Women who did not receive AlRV had a percentage of VT of 50.3 %. CONCLUSION: The VT has diminished in Uruguay. Special efforts must be done to screen all pregnant women, to improve diagnosis during pregnancy and to implement suitable ARV as occurs in developed countries.

[European evolution of the copayment in health costs: possible developments and reorganization proposals for Italian health care system. The role of additional kind of assistance]. / L'evoluzione della compartecipazione alla spesa sanitaria in Europa: possibili scenari evolutivi e proposte di riorganizzazione in Italia. Il ruolo delle forme integrative di assistenza.

The ticket, once considered just dissuasive or control instrument, has become citizens sharing of the costs of activities, services and performance of NHS. The difficult economic situation, that applies the main European countries, is leading in Italy to an increase measures of copayment. The use of over-sharing may drive, however, to important consequences in terms of equity, efficiency and cost containment of health. Copayment does not reduce the overall burden of spending, because often counterbalanced by a concomitant increase in private spending. In fact, Italian private expenditure on health "out of pocket" is the highest in Europe and more Italians discover the "low cost health care." The Authors propose to limite the introduction of new ticket or exacerbate the existing, focusing on the adherence of citizens to health and social integrative funds, that are now present on the national scene with about 5 million of members.

[Modalities for access to networks of palliative care and pain management in Lazio: level of information for health personnel aware of the Policlinico Tor Vergata]. / Modalità per l'accesso alle reti di cure palliative e terapia del dolore nel Lazio: grado di informazione del personale sanitario del Policlinico Tor Vergata.

Law no. 38 of 2010 introduces for the first time protection for access to Palliative Care and Pain Management. It was interesting to evaluate the level of knowledge among health care workers at the Policlinico Tor Vergata, procedures relating to such access through the administration of a questionnaire. The questionnaire divided into a general part and the two sections (A and B) The general part concerns the health operator respect to age, gender, profession, and his role within the operating unit of the hospital. The section A and B, is to understand if the operator knows Palliative Care, and Pain Therapy, as he became aware of the two arguments, and if they have been addressed during the university courses he attended. The analysis of the data examined show a general confusion distributed evenly among all professionals. Is greater knowledge of pain therapy compared to Palliative Care.

Interplay between serum osteocalcin and insulin sensitivity in primary hyperparathyroidism.

Osteocalcin (OC) has been proposed as a regulator of insulin sensitivity in both humans and other animals. Primary hyperparathyroidism (PHPT) is characterized by high OC levels and insulin resistance. The aim of this study was to evaluate whether in PHPT the link between OC levels and blood markers of insulin resistance was maintained. In a consecutive series of 219 adult PHPT patients, serum OC as well as fasting insulin and glucose levels were measured. Insulin sensitivity was estimated by homeostatic model assessment (HOMA2-S%). The same parameters were evaluated in a subgroup of 45 patients after parathyroidectomy (PTX). PHPT patients were characterized by markedly high OC levels. After subdividing them according to glucose tolerance, it was found that OC was similar in subjects with normal glucose tolerance (NGT) and impaired glucose tolerance (IGT), while diabetic subjects had lower serum OC than those with NGT (P < 0.02) or IGT (P < 0.04). OC was negatively associated with fasting glucose and positively associated with HOMA2-S%. OC independently predicted HOMA2-S% in a multivariate analysis. In the subgroup of surgically cured PHPT patients, OC levels significantly decreased after PTX, while HOMA2-S% did not change. Our findings indicate that in PHPT there is a positive relationship between OC and glucose metabolism, OC being one of the predictors of insulin sensitivity. However, data in surgically cured patients, showing OC normalization in spite of unchanged HOMA2-S%, suggest that OC does not likely play a major role in affecting insulin sensitivity in PHPT.

Comparison between immunoradiometric and fluorimetric brain natriuretic peptide determination in patients with congestive heart failure.

UNLABELLED: This study compared two different methods, namely the immunoradiometric (IRMA) and fluorimetric (FIA), in order to determine plasma brain natriuretic peptide (BNP) in congestive heart failure (CHF) patients. METHODS: CHF in-patients underwent echocardiography and plasma BNP determination using both two methods. The echocardiograms analysed left ventricular end-systolic (LVESV) and end-diastolic (LVEDV) volumes and systolic dysfunction [left ventricular ejection fraction (LVEF) <50%]. RESULTS: Seventy-three (71% males, age 67 ± 9.6 yr) patients were enrolled, 31.5% affected by valvular heart disease. The mean LVEF was 39.8 ± 14.1%; in 26 (35%) a hypertensive etiology emerged. The immunoradiometric assay (IRMA) BNP was found to be significantly lower than the FIA determination 116.5 ± 149 pg/ml vs 267.3 ± 285.6 pg/ml; p=0.0001) and the two methods were closely correlated (r=0.89; p=0.00001). Logistic regression demonstrated a significant correlation between BNP, LVEF, and LVESV/LVEDV (r=-0.45, p=0.0003; r=-0.48, p=0.00001; r=0.22 p=0.003; r=0.34 p=0.0001; r=0.13 p=0.02; r=0.28 p=0.001 IRMA and FIA, respectively). IRMA BNP and FIA BNP significantly increased according to the worsening functional class [from 34.3 ± 60.2 pg/ml in NYHA (New York Heart Association) I to 555.5 ± 273.1 pg/ml in NYHA IV; from 86.1 ± 162.1 pg/ml in NYHA I to 1070 ± 42.2 pg/ml in NYHA IV, respectively]. In severe systolic dysfunction (LVEF<30%), receiver operating characteristic analysis revealed a satisfactorily sensitivity and specificity using a cut-off point of 50.6 pg/ml with IRMA and 243 pg/ml with FIA. In mild systolic dysfunction (LVEF<50%), a good sensitivity and specificity using a cut-off point of 42 pg/ml with IRMA and 182 pg/ml with FIA emerged. CONCLUSIONS: In CHF patients both BNP methods correlated with NYHA class, LVEF, and ventricular volumes.

Insulin resistance is not coupled with defective insulin secretion in primary hyperparathyroidism.

AIMS: An increased frequency of both impaired glucose tolerance and Type 2 diabetes mellitus (DM) has been reported in primary hyperparathyroidism (pHPT), thus we sought to investigate insulin sensitivity and insulin secretion in a large series of pHPT patients. SUBJECTS AND METHODS: One hundred and twenty-two consecutive pHPT patients without known DM were investigated [age (mean +/- sd) 59.3 +/- 13.6 years, body mass index (BMI) 25.7 +/- 4.2 kg/m(2); serum calcium 2.8 +/- 0.25 mmol/l; PTH 203.2 +/- 145.4 ng/l]. Sixty-one control subjects were matched, according to the degree of glucose tolerance, in a 2 : 1 patient:control ratio. Fasting- and oral glucose tolerance test-derived estimates of insulin sensitivity and secretion were determined by means of the quantitative insulin sensitivity check index (QUICKI) and the insulin sensitivity index (ISI) composite. RESULTS: Both the QUICKI and ISI composite were lower in pHPT patients than control subjects (P < 0.03 and P < 0.05, respectively) after adjusting for age, systolic blood pressure and BMI. Conversely, all insulin secretion estimates were significantly increased in pHPT patients than in control subjects (P < 0.04 and P < 0.03, respectively) and after adjusting for age, systolic blood pressure and BMI. Log serum calcium levels were negatively associated with the QUICKI and log ISI composite (R = -0.30, P = 0.001; R = -0.23, P = 0.020, respectively) in pHPT patients. Serum calcium levels significantly and independently contributed to impaired insulin sensitivity in multivariate analysis (QUICKI as dependent variable: beta = -0.31, P = 0.004, R(2) = 0.15; log ISI composite as dependent variable: beta = -0.29, P = 0.005, R(2) = 0.16). CONCLUSIONS: Our study confirms a reduction in both basal and stimulated insulin sensitivity in primary hyperparathyroidism, in spite of increased insulin secretion. Moreover, our data show for the first time a significant relationship between hypercalcaemia and insulin sensitivity in this condition.

The Medical Care Continuity (MCC) project. A pilot study of video-assisted home care within the eTEN European Community program. The Italian experience.

GOALS OF WORK: This study aimed to use an integrated system (Medical Care Continuity (MCC) system) consisting of computer, video telephone, and a high-definition camera to monitor at home chemotherapy side effects in cancer outpatients. PATIENTS AND METHODS: The system allowed 24 h/day video consultation with an intermediate medical call center with possible connection to a specialized hospital if necessary. All patients were provided with internationally validated and project-oriented questionnaires exploring patients' health status and opinions on usefulness and complexity of study devices. The content of each call was recorded on a computer database. An approximate estimate of avoided hospital admissions was calculated. MAIN RESULTS: Median duration of experimentation and frequency of patient/doctor contacts were 2.1 months and 4.2 contact per week, respectively. Overall, a 98% positive opinions on the experimental system was reported at the end of the study by all participants, with a 21% conversion rate with respect to the opinions gathered at study entry. Changes in patient management after a medical call were made in 32% of cases. It was calculated that approximately 2.2 per month unnecessary hospital admissions were avoided. CONCLUSIONS: The MCC system was well managed by both patients and caregivers. These results show that it has the potential to improve medical assistance by virtue of a constant access to medical advice and reduce unnecessary hospital admissions.

B-type natriuretic peptide levels and insulin resistance in patients with severe ischemic myocardial dysfunction.

B-type natriuretic peptide (BNP) is an important clinical parameter of severity in congestive heart failure (CHF). Recent findings suggest a close relation between lipid and glucose metabolism and the natriuretic peptide axis, even if conflicting data exist on the relationship between natriuretic peptide levels and insulin resistance (IR). Thus, we sought to investigate potential relations between BNP level and IR in 134 patients with severe ischemic myocardial dysfunction [mean+/-SD: age =64.8+/-9.6 yr, male/female =104/30; body mass index (BMI) =25.5+/-4.05 kg/m2, 26.1% diabetics; ejection fraction (EF) = 30.2+/-7.7%]. In univariate analysis, an inverse relationship between BNP levels and EF% was observed (R=-0.43, p=0.0006). Moreover, we found an inverse association between BNP levels and BMI (R=-0.27, p=0.036), and also between BNP and homeostasis model assessment of insulin resistance (HOMA-IR) (R=-0.27, p=0.039). In multivariate analysis, EF% and HOMA-IR were significantly and independently associated with logarithmically transformed BNP levels (beta=-0.40, p=0.019 and beta=-0.26, p=0.042, respectively; R2=0.36). In conclusion, in patients with severe ischemic myocardial dysfunction EF and IR are independently associated with BNP levels explaining about 1/3 of the variability of this parameter. Multiple potential mechanisms may underlie this association, but it seems now clinically important to take into account also metabolic features when interpreting plasma natriuretic peptide concentrations obtained for diagnostic or prognostic purposes.

Happy Air: a school-based educational program to maximize detection of asthma in children.

OBJECTIVE: To investigate whether an active partnership among school, parents, and pediatricians allows early identification and treatment of asthmatic children. METHODS: An asthma educational program (Happy Air), based on a strong family-physician-school interrelationship, was performed in six primary schools (2,765 children) before administering a screening questionnaire to the parents. RESULTS: A high response rate (96%) demonstrated 2,649 responders available for the asthma screening: 135 children (5%) received a diagnosis of asthma, of which 37 (27%) were recognized de novo. CONCLUSION: The active participation of school and parents is the determining factor for the success of an asthma screening program.

The long QT syndrome in pediatric age: prognosis and risk factor.

AIM: Long QT syndrome is a rare arrhythmic disease with a low incidence in the general population. There are no sure clinical or electrocardiographic parameters that could lead to a correct prognostic stratification in patients affected by this syndrome. The correlation between the incidence of a sudden death or dangerous ventricular arrhythmias and the duration of QTc interval is still a controversial topic. METHODS: Twenty nine children affected by QT long syndrome were admitted to the Division of Pediatric Cardiology of the Casa del Sole Hospital of Palermo (Italy). Their diagnosis was made by electrocardiogram (ECG). The average age of the patients was 7.6 years. The average follow-up was 4 years and three months. A therapy with beta-blocker was administered to all the children. During the follow-up of 4 year and three months, patients were genotyped. Twenty-three out of 29 children had at least one relative affected by the syndrome. Three of them had a familiar dead because of this syndrome and everyone had a duration of maximum QTc higher than the cut off (P=0.0002). All the people who died had not followed the therapy with beta-blocker. Patients with a maximum QTc recorded <500 had not familiar death by this syndrome. RESULTS: Holter and echocardiogram recorded periodically during the observation did not show dangerous arrhythmic events. All children maintained a good health during the follow-up. CONCLUSION: Although conducted on a small study population, the data analysis recorded during this study suggests that in patients affected by QT long syndrome younger than 16 years old undergoing a beta-blocker therapy the prognosis is excellent. The duration of QTc interval appears as a negative prognostic factor, although the beta-blocker therapy has been reduced considerably the incidence of sudden death.

Multi-scale analysis of the toraymyxin adsorption cartridge. Part II: computational fluid-dynamic study.

Extracorporeal endotoxin removal by means of the Toraymyxin device is based on the ability of polymyxin B to bind endotoxins with a high specificity. The endotoxins/polymyxin molecular interactions were computationally analyzed in a parallel work (Part I). In this paper we investigate with a multi-scale approach the phenomena involving blood and plasma fluid dynamics inside the device. The macro- and mesoscale phenomena were studied by means of 3D models using computational fluid dynamics. The flow behavior in the sorbent material was focused, modeling the sorbent as a homogeneous porous medium at the macroscale level, or accounting for the realistic geometry of its knitted fibers at the mesoscale level. A microscale model was then developed to analyze the behavior of endotoxin molecules subjected to the competition of flow drag and molecular attraction by fiber-grafted polymyxin B. The macroscale results showed that a very regular flow field develops in the sorbent, furthermore supplying the peak velocity to be input in the lower-scale model. The mesoscale analysis yielded the realistic range for wall shear stresses (WSSs) acting on fiber walls. With WSS values in the entire range, the results of the microscale analysis demonstrated that the capability of polymyxin B to capture endotoxin molecules from the flow extends at distances one order of magnitude greater than the characteristic distance of the stable intermolecular bond. We conclude that the use of an integrated, multi-scale analysis allows for a comprehensive understanding of the complex mechanisms involved in endotoxin sorption phenomena with immobilized polymyxin B.

Body composition in HIV-infected children: relations with disease progression and survival.

BACKGROUND: Malnutrition is common in HIV-infected children, but the body compartment that is most affected has been ill defined. OBJECTIVES: Our objectives were to 1) compare the fat-free mass (FFM) of children with HIV infection with that of control children, 2) assess the contribution of FFM to body weight in HIV-infected children compared with that of control children, and 3) study the relations between body weight, FFM, and mortality. DESIGN: A cross-sectional study was performed in 86 HIV-infected and 113 uninfected children (mean ages: 6.9 and 7.7 y, respectively). FFM was estimated from single-frequency bioelectrical impedance analysis by using 3 different published equations; a further estimate was obtained from triceps-skinfold-thickness measurements. RESULTS: All 4 estimates of body composition showed that FFM in HIV-infected children was significantly less than in control children of similar age. However, FFM as a percentage of body weight was not significantly different between groups. In the whole group of infected children, an age-specific z score < -2 for weight and for FFM was significantly associated with an increased risk of death [relative risk (95% CI) = 11.4 (3.1, 41.0) and 5.1 (1.5, 18.2), respectively]; when only children with more severe disease were considered, only z score for weight was significantly associated with an increased risk [4.6 (1.4, 14.9)]. CONCLUSIONS: These findings suggest that no preferential catabolism of FFM occurs in HIV-infected children and that body weight for age is a better prognostic indicator than is FFM estimated by bioelectrical impedance analysis.

Ageing and prostate: age-related changes in androgen receptors of epithelial cells from benign hypertrophic glands compared with cancer.

Total and nuclear androgen receptors (AR) were studied from epithelial cells in internal and external prostatic zones in 51- to 86-year-old individuals with benign prostatic hyperplasia (BPH) (n = 68) and prostatic cancer (n = 9). We focussed on the role played by androgens on those processes, despite the fact that at these ages, its secretion has normally decreased. In BPH, the nuclear AR do not change, but total measured androgen receptors rise with age (r = 0.5, P < 0.01). Total or nuclear AR do not correlate with gland volume, despite its increase with age (r = 0.8, P < 0.05). In prostates less than 180 cc in volume, there is a significant correlation between size, serum total testosterone level (r = 0.53, P < 0.05) and prostatic specific antigen (PSA) (r = 0.63, P < 0.05). The amount of nuclear AR in cells from the external zone (infiltrated by cancer or healthy) is two times greater than in those from the internal region. Total receptor content of the external zone cells is also high, but the sample is too small to demonstrate an age dependence. The results suggest that ageing is accompanied by an accumulation of non-nuclear AR in the cytosol, that does not play a role in the development of BPH because the amount of nuclear receptors remains unaltered. The enrichment in nuclear receptors of the external zone cells, independently of the presence of cancer, points to a greater androgen dependence in these cells than in cells of the internal region.

Erythropoietin upregulates the expression of its own receptor in TF-1 cell line.

In the erythroleukemia cell line TF-1, recombinant human erythropoietin (rHEpo), but not c-kit ligand, enhanced the number of cells expressing the erythropoietin receptor (EpoR), as measured by flow-cytometric analysis of binding of the biotin-labeled Epo. Moreover, 125I-Epo binding and Scatchard analyses, indicated that TF-1 cells, maintained in standard conditions with IL-3, and those stimulated with c-kit ligand, bear a single class of EpoR. On the other hand, cells cultured in the presence of rHEpo had a higher number of receptors than IL-3 or c-kit ligand-stimulated cells, and had two binding sites with different affinities for the ligand. EpoR mRNA expression was higher in cells exposed to rHEpo than in IL-3 or c-kit-stimulated cells. This difference may have been dependent on either a higher level of transcription or an increased stability of mRNA. The observed changes of EpoR in rHEpo-stimulated TF-1 cell line could cooperate, together with the alteration of the gene (3' end deletion), in the occurrence of the erythroleukemic process. Changes induced in EpoR by rHEpo were not accompanied by an increase in the expression of glycophorin A or globin chain mRNAs. This may suggest that rHEpo is unable to induce erythroid differentiation in TF-1 cells. The results also indicate that this cell line could be a model for the investigation of the role of transcription factor(s) in the expression of EpoR, and for the study of the mechanism(s) underlying the changes in the number and affinity of the cell receptors.

[Determination of prolactin secretion in idiopathic galactorrhea]. / Valutazione della secrezione di prolattina nella galattorrea idiopatica.

We have studied 15 women with idiopathic galactorrhoea and normal serum PRL basal values, regularly menstruating, with normal x-ray of the sella turcica and mammography. The patients were not suffering from other endocrine diseases nor taking medications known to cause galactorrhoea. These subjects and 5 normal women were submitted to an evaluation of the serum PRL circadian rhythm, to TRH test for PRL and TSH, metoclopramide test for PRL, and basal determination of TT3 and TT4. The results did not show any significant difference between the two groups and did not reveal any abnormality of PRL secretion in the patients. These data, resulting from a homogeneous series of patients, support the hypothesis of an increased sensitivity of breast receptors to PRL, or of the secretion of heterogeneous forms of PRL, biologically active on mammary tissue, but not detected by current RIA methods for PRL.