Never too late to be anxious: validation of the Geriatric Anxiety Inventory, Italian version.

AIM: The aim of this work was to validate the Italian version of GAI (GAI-It) and its short form (GAI-It SF) in an over 65-population. METHODS: In 3 recruitment areas across Italy, two raters reciprocally blind to results assessed eligible subjects; a semi-structured diagnostic clinical interview was performed by a psychiatrist. RESULTS: Among the 76 enrolled subjects (mean age 72.7±6.8 years), anxiety symptoms were very common: 69.7% (moderate/ severe HADS-Anxiety), 76.3% (moderate/severe STAI-state), 71.0% (moderate/severe STAI-trait), 61.8% (GAI), 55.3% (GAI-SF). Sensitivity, specificity and positive predictive value of GAI confirmed a good reliability of the Italian version, with Cronbach's Alpha equal to 0.93 for GAI-It and to 0.77 for GAI-It SF, indicating a very good and good construct validity, respectively, of the scales. The Pearson correlation index demonstrated a moderately positive correlation among GAI, GAI-SF and STAI. CONCLUSIONS: Our data confirm the validity of GAI-It as a valuable instrument to assess anxiety in an elderly population, for clinical and research purposes.

Clinically used selective oestrogen receptor modulators increase LDL receptor activity in primary human lymphocytes.

BACKGROUND AND PURPOSE: Treatment with selective oestrogen receptor modulators (SERMs) reduces low-density lipoprotein (LDL) cholesterol levels. We assessed the effect of tamoxifen, raloxifene and toremifene and their combinations with lovastatin on LDL receptor activity in lymphocytes from normolipidaemic and familial hypercholesterolaemic (FH) subjects, and human HepG2 hepatocytes and MOLT-4 lymphoblasts. EXPERIMENTAL APPROACH: Lymphocytes were isolated from peripheral blood, treated with different compounds, and 1,1'-dioctadecyl-3,3,3,3'-tetramethylindocarbocyanine perchlorate (DiI)-labelled LDL uptake was analysed by flow cytometry. KEY RESULTS: Tamoxifen, toremifene and raloxifene, in this order, stimulated DiI-LDL uptake by lymphocytes by inhibiting LDL-derived cholesterol trafficking and subsequent down-regulation of LDL receptor expression. Differently to what occurred in HepG2 and MOLT-4 cells, only tamoxifen consistently displayed a potentiating effect with lovastatin in primary lymphocytes. The SERM-mediated increase in LDL receptor activity was not altered by the anti-oestrogen ICI 182,780 nor was it reproduced by 17ß-oestradiol. However, the tamoxifen-active metabolite endoxifen was equally effective as tamoxifen. The SERMs produced similar effects on LDL receptor activity in heterozygous FH lymphocytes as in normal lymphocytes, although none of them had a potentiating effect with lovastatin in heterozygous FH lymphocytes. The SERMs had no effect in homozygous FH lymphocytes. CONCLUSIONS AND IMPLICATIONS: Clinically used SERMs up-regulate LDL receptors in primary human lymphocytes. There is a mild enhancement between SERMs and lovastatin of lymphocyte LDLR activity, the potentiation being greater in HepG2 and MOLT-4 cells. The effect of SERMs is independent of oestrogen receptors but is preserved in the tamoxifen-active metabolite endoxifen. This mechanism may contribute to the cholesterol-lowering action of SERMs.

Definition of a multi-criteria, web-based approach to managing the illegal dumping of solid waste in Italian villages.

The aim of this study is to define a multi-criteria, web-based approach that can be used to manage the illegal dumping of solid waste, which is a serious environmental concern both in developing and developed countries. A simplified web-based geographic information system (SI-WEB-GIS) was designed to identify illegal dumpsites, and to allow sharing resources among authorities, technicians and citizens. A self-made multi-criteria technique was designed to establish the intervention priorities, in seven steps: (1) constructing the alternatives matrix; (2) giving a qualitative value or a combination of qualitative values to each individual dumpsite and to all criteria; (3) giving a numeric value to each qualitative value or combination of qualitative values in the alternatives matrix (three methods were adopted); (4) calculating the Average Hazard Index (AHI); (5) ranking the dumpsites of each alternatives matrix, in the order of decreasing AHI; (6) comparing the first 50% of the dumpsites in the three rankings, in order to evaluate which had the most intervention priorities and (7) performing a sensitivity analysis, giving different priorities to the four criteria adopted (relative quantity of waste, soil permeability level, pollution targets and types of solid waste). The application of the multi-criteria, web-based approach to managing the illegal dumping of solid waste allows minimizing the total social cost of pollution, rehabilitating dumpsites and monitoring illegal dumping. Although the system was applied to a village in Southern Italy, with around 14,000 inhabitants, it can easily be customized for use in similar villages in Italy and in other countries.

Esofagitis eosinofílica: una patología infravalorada. Nuestra experiencia / Eosinophilic esophagitis: an underevaluated condition. Our experience

Objetivos. El objetivo de esta revisión es presentar nuestra experiencia en esta patología emergente y, principalmente, ayudar a mejorar su sospecha diagnostica. Material y métodos. Realizamos una revisión de la literatura para analizar la epidemiologia, fisiopatología, diagnostico y manejo de la esofagitis eosinofílica (EE), a propósito de 4 casos diagnosticados en nuestro centro durante el año 2011, en los que se ha llegado al (..) (AU)(

Objectives. The aim of this review is to present our experience in this emerging disease and mainly help improve diagnostic suspicion. Material and methods. We reviewed the literature in order to analyze the epidemiology, pathophysiology, diagnosis and management of eosinophilic esophagi is (EE), we describe 4 cases diagnosed in our hospital during 2011 after an emergency admission by food impaction .Results. The age of our patients was 7-11 years, males in all cases. All patients had a history of allergies, and the impaction had been preceded by episodes of (..) (AU)

Tumores corticosuprarrenales pediátricos: imagen de adenomas y carcinomas / Adrenocortical tumors in children: imaging adenomas and carcinomas

Objetivo. El propósito de la revisión es mostrar las características de imagen que presentan los tumores corticosuprarrenales pediátricos (TCSP). Material y métodos. Se realiza una revisión retrospectiva de los pacientes diagnosticados de TCSP en nuestro hospital terciario en el periodo comprendido entre los años 2000 y 2010, desde el punto de vista radiológico y anatomopatológico. Se estudian las características radiológicas mediante ecografía, tomografía computarizada (TC) y resonancia magnética (RM), que ayudarán a orientar la lesión hacia benignidad o malignidad, y el seguimiento de imagen. Resultados Se presentan 8 TCSP: 5 carcinomas, 2 adenomas y un tumor borderline; se clasifican 2 en estadio I, uno en estadio II, 3 en estadio III y 2 en estadio IV. La radiología permitió el diagnóstico de carcinoma en estadio IV en 2 casos, dada la presencia de metástasis iniciales en un paciente y el gran tamaño y desestructuración tumoral en otro, desarrollando posteriormente metástasis. En los otros 6 casos el diagnóstico radiológico fue de aproximación respecto a su naturaleza de carcinoma o adenoma. Conclusiones. Los TCSP son raros en la infancia. Engloban las entidades de adenoma y carcinoma, siendo difíciles de diferenciar histológica y radiológicamente en ausencia de infiltración vascular y/o metástasis. En un paciente en edad pediátrica la combinación de una masa suprarrenal y signos clínicos de hiperfunción corticosuprarrenal es virtualmente diagnóstica de TCSP (AU)

Objective. This article aims to show the imaging characteristics of pediatric adrenocortical tumors. Material and methods. We review the imaging and histological findings in patients diagnosed with pediatric adrenocortical tumors at our tertiary hospital between 2000 and 2010. We analyze the findings at ultrasonography, computed tomography, and magnetic resonance imaging that can help orient the diagnosis toward benign or malignant lesions and guide imaging follow-up. Outcome. We found 8 adrenocortical tumors in children: 5 carcinomas, 2 adenomas, and 1 borderline tumor. Two tumors were classified as stage I, 1 as stage II, 3 as stage III, and 2 as stage IV. Imaging enabled the diagnosis of stage IV carcinoma in 2 cases, due to the presence of initial metastases in one patient and to size of the tumor and structural changes in the other, who later developed metastases. In the other 6 cases, the imaging studies oriented the diagnosis toward carcinoma or adenoma. Conclusions. Adrenocortical tumors are rare in children. Adrenocortical tumors include adenomas and carcinomas, and in the absence of vascular infiltration and/or metastases it is difficult to differentiate between the two types by imaging and histology. The combination of an adrenal mass and clinical signs of adrenocortical hyperfunction in a child is virtually diagnostic of an adrenocortical tumor (AU)

[Adrenocortical tumors in children: imaging adenomas and carcinomas]. / Tumores corticosuprarrenales pediátricos: imagen de adenomas y carcinomas.

OBJECTIVE: This article aims to show the imaging characteristics of pediatric adrenocortical tumors. MATERIAL AND METHODS: We review the imaging and histological findings in patients diagnosed with pediatric adrenocortical tumors at our tertiary hospital between 2000 and 2010. We analyze the findings at ultrasonography, computed tomography, and magnetic resonance imaging that can help orient the diagnosis toward benign or malignant lesions and guide imaging follow-up. OUTCOME: We found 8 adrenocortical tumors in children: 5 carcinomas, 2 adenomas, and 1 borderline tumor. Two tumors were classified as stage I, 1 as stage II, 3 as stage III, and 2 as stage IV. Imaging enabled the diagnosis of stage IV carcinoma in 2 cases, due to the presence of initial metastases in one patient and to size of the tumor and structural changes in the other, who later developed metastases. In the other 6 cases, the imaging studies oriented the diagnosis toward carcinoma or adenoma. CONCLUSIONS: Adrenocortical tumors are rare in children. Adrenocortical tumors include adenomas and carcinomas, and in the absence of vascular infiltration and/or metastases it is difficult to differentiate between the two types by imaging and histology. The combination of an adrenal mass and clinical signs of adrenocortical hyperfunction in a child is virtually diagnostic of an adrenocortical tumor.

[Eosinophilic esophagitis: an underevaluated condition. Our experience]. / Esofagitis eosinofílica: una patología infravalorada. Nuestra experiencia.

OBJECTIVES: The aim of this review is to present our experience in this emerging disease and mainly help improve diagnostic suspicion. MATERIAL AND METHODS: We reviewed the literature in order to analyze the epidemiology, pathophysiology, diagnosis and management of eosinophilic esophagitis (EE), we describe 4 cases diagnosed in our hospital during 2011 after an emergency admission by food impaction. RESULTS: The age of our patients was 7-11 years, males in all cases. All patients had a history of allergies, and the impaction had been preceded by episodes of dysphagia. In esophagoscopy we observed nonspecific macroscopic findings. The results of biopsies showed the presence of an infiltration of eosinophils in the mucosa over 15 per high power field. All patients were referred to the gastroenterology section of our hospital. DISCUSSION: Eosinophilic esophagitis is a primary disease of esophagus, defined as the presence of symptoms of esophageal dysfunction (mainly dysphagia and food impaction), associated to at least one esophageal biopsy with more than 15 eosinophils in high-power field and the exclusion of gastroesophageal reflux. The diagnosis is clinical, endoscopic and pathologic. It requires an upper endoscopy to evaluate characteristic findings and biopsies for histology. Current treatments include diet therapy based on avoiding exposure to certain food allergens.

Similar cardiac remodelling after transcatheter atrial septal defect closure in children and young adults.

OBJECTIVE: To study the cardiac geometric changes after transcatheter closure of large atrial septal defects (ASDs) according to patient age at the time of the procedure. DESIGN: Prospective echocardiographic follow-up study. SETTING: Tertiary referral centre. PATIENTS AND INTERVENTION: 25 asymptomatic patients younger than 16 years (median 8 years; group 1) and 21 asymptomatic adults (median 38 years; group 2) underwent percutaneous closure of large ASD with the Amplatzer septal occluder device (mean 25 (SD 7) mm). MAIN OUTCOME MEASURES: Cardiac remodelling was assessed by M mode and two dimensional echocardiography one and six months after ASD closure. RESULTS: By six months, right atrial volume decreased from 31 (15) to 19 (5) ml/m(2) (p < 0.001) and right ventricular (RV) transverse diameter decreased from 29.8 (8.6) to 23.2 (5.6) mm/m(2) (p < 0.001). Conversely, left atrial volume did not change significantly (from 18 (6) to 20 (6) ml/m(2), NS) and left ventricular (LV) transverse diameter increased from 27.8 (6.4) to 31.8 (7.3) mm/m(2) (p < 0.05). Ventricular remodelling resulted in an RV:LV diameter ratio decrease from 1.1 (0.2) to 0.7 (0.1) (p < 0.001). The magnitude and time course of cardiac remodelling did not differ significantly between the age groups. Indeed, right atrial volume decreased by 33 (26)% versus 37 (23)%, RV diameter decreased by 26 (10)% versus 20 (13)%, LV diameter increased by 17 (15)% versus 15 (10)%, and RV:LV diameter ratio decreased by 36 (8)% versus 27 (15)% in groups 1 and 2, respectively. CONCLUSIONS: Cardiac remodelling after percutaneous ASD closure seems to be independent of the patient's age at the time of the procedure up to early adulthood. Thus, postponing ASD closure for a few years may be a reasonable option for potentially suitable asymptomatic children.

[The dependence medical index (DMI): validation and comparison with the activity daily living and the instrumental activity daily living]. / L'indice medico di non autosufficienza: validazione e comparazione con le scale ADL e IADL.

AIM: The aim of this study was the validation of the dependence medical index (DMI), a disability medical assessment tool in the elderly. METHODS: Study sample included 1054 subjects aged 65 and over, consecutively admitted to the University Department of Geriatric Medicine of Turin, Italy. A total of 356 of these subjects was classified as dependent to activity of daily living (ADL) and instrumental activity of daily living (IADL) scales. Some conditions causing medical dependence were detected, such as strength and/or motility impairment, incontinence, pressure sores, disturbances in speech and communication, decline in sight and/or hearing, terminal illness (death expected within 6 months), need for multiple and complex therapies, episodic disorientation, dizziness with tendency to fall, use of the wheel-chair. The relationship between dependence and the DMI was studied by discriminant analysis. A scale was created using the discriminant scores of each 15 medical indications for disability. RESULTS: The discriminant model of DMI was validated by cross-validation statistical method: its application permitted to classify correctly 73.1% of the sample. The DMI permitted to classify the dependent subjects in variable percentages: from 67% (DMI score > or =1) to 90% (DMI score > or =7). The best ratio between specificity and sensibility was for score 4 to DMI. CONCLUSION: The conclusion is drawn that DMI can be used to detect and evaluate the disability for medical reasons in elderly people.

Relaxation of insulin-like growth factor 2 imprinting and discordant methylation at KvDMR1 in two first cousins affected by Beckwith-Wiedemann and Klippel-Trenaunay-Weber syndromes.

Beckwith-Wiedeman syndrome (BWS) and Klippel-Trenaunay-Weber syndrome (KTWS) are different human disorders characterized, among other features, by tissue overgrowth. Deregulation of one or more imprinted genes located at chromosome 11p15.5, of which insulin-like growth factor 2 (IGF2) is the most likely candidate, is believed to cause BWS, whereas the etiology of KTWS is completely obscure. We report a case of BWS and a case of KTWS in a single family. The probands, sons of two sisters, showed relaxation of the maternal IGF2 imprinting, although they inherited different 11p15.5 alleles from their mothers and did not show any chromosome rearrangement. The patient with BWS also displayed hypomethylation at KvDMR1, a maternally methylated CpG island within an intron of the KvLQT1 gene. The unaffected brother of the BWS proband shared the same maternal and paternal 11p15.5 haplotype with his brother, but the KvDMR1 locus was normally methylated. Methylation of the H19 gene was normal in both the BWS and KTWS probands. Linkage between the insulin-like growth factor 2 receptor (IGF2R) gene and the tissue overgrowth was also excluded. These results raise the possibility that a defective modifier or regulatory gene unlinked to 11p15.5 caused a spectrum of epigenetic alterations in the germ line or early development of both cousins, ranging from the relaxation of IGF2 imprinting in the KTWS proband to disruption of both the imprinted expression of IGF2 and the imprinted methylation of KvDMR1 in the BWS proband. Analysis of these data also indicates that loss of IGF2 imprinting is not necessarily linked to alteration of methylation at the KvDMR1 or H19 loci and supports the notion that IGF2 overexpression is involved in the etiology of the tissue hypertrophy observed in different overgrowth disorders, including KTWS.

The H19 endodermal enhancer is required for Igf2 activation and tumor formation in experimental liver carcinogenesis.

The expression of the linked but reciprocally imprinted Igf2 and H19 genes is activated in adult liver in the course of tumor development. By in situ hybridization analysis we have shown that both the Igf2 and H19 RNAs are expressed in the majority of the neoplastic nodules, and that hepatocellular carcinomas are developed in an experimental model of liver carcinogenesis. H19 is also highly activated in smaller and less distinct hyperplastic regions. The few neoplastic areas showing Igf2 but no H19 RNA display loss of the maternally inherited allele at the Igf2/H19 locus. These data are compatible with the existence of a common activation mechanism of these two genes during liver carcinogenesis and with a stronger H19 induction in the pre-neoplastic lesions. By using mice carrying a deletion of the H19 endodermal enhancer, we show that this regulatory element is necessary for the activation of the Igf2 and H19 genes upon induction of liver carcinogenesis. Furthermore, multiple sites of the H19 endodermal enhancer region become hypersensitive to DNase I when the carcinogenesis process is induced. Lastly, liver tumors developed in mice paternally inheriting the H19 enhancer deletion are found to have marked growth delays, increased frequency of apoptotic nuclei, and lack of Igf2 mRNA expression, thus indicating that this regulatory element plays a major role in the progression of liver carcinogenesis, since it is required for the activation of the anti-apoptotic Igf2 gene.

Role of histone acetylation and DNA methylation in the maintenance of the imprinted expression of the H19 and Igf2 genes.

H19 and Igf2 are linked and reciprocally imprinted genes. We demonstrate that the histones associated with the paternally inherited and unexpressed H19 allele are less acetylated than those associated with the maternal expressed allele. Cell growth in the presence of inhibitors of either histone deacetylase or DNA methylation activated the silent Igf2 allele, whereas derepression of the silent H19 allele required combined inhibition of DNA methylation and histone deacetylation. Our results indicate that histone acetylation as well as DNA methylation contribute to the somatic maintenance of H19 and Igf2 imprinting and that silencing of the imprinted alleles of these two genes is maintained via distinct mechanisms.