Prevalence of maternal antenatal anxiety and its association with demographic and socioeconomic factors: A multicentre study in Italy.

BACKGROUND: Maternal antenatal anxiety is very common, and despite its short- and long-term effects on both mothers and fetus outcomes, it has received less attention than it deserves in scientific research and clinical practice. Therefore, we aimed to estimate the prevalence of state anxiety in the antenatal period, and to analyze its association with demographic and socioeconomic factors. METHODS: A total of 1142 pregnant women from nine Italian healthcare centers were assessed through the state scale of the State-Trait Anxiety Inventory and a clinical interview. Demographic and socioeconomic factors were also measured. RESULTS: The prevalence of anxiety was 24.3% among pregnant women. There was a significantly higher risk of anxiety in pregnant women with low level of education (p < 0.01), who are jobless (p < 0.01), and who have economic problems (p < 0.01). Furthermore, pregnant women experience higher level of anxiety when they have not planned the pregnancy (p < 0.01), have a history of abortion (p < 0.05), and have children living at the time of the current pregnancy (p < 0.05). CONCLUSION: There exists a significant association between maternal antenatal anxiety and economic conditions. Early evaluation of socioeconomic status of pregnant women and their families in order to identify disadvantaged situations might reduce the prevalence of antenatal anxiety and its direct and indirect costs.

Surface Termination of Fe3O4(111) Films Studied by CO Adsorption Revisited.

Although the (111) surface of Fe3O4 (magnetite) has been investigated for more than 20 years, substantial controversy remains in the literature regarding the surface termination proposed based on structural and adsorption studies. The present article provides density functional theory results that allow to rationalize experimental results of infrared reflection-absorption spectroscopy and temperature-programmed desorption studies on CO adsorption, thus leading to a unified picture in which the Fe3O4(111) surface is terminated by a 1/4 monolayer of tetrahedrally coordinated Fe3+ ions on top of a close-packed oxygen layer as previously determined by low energy electron diffraction. However, surface defects play a crucial role in adsorption properties and may dominate chemical reactions on Fe3O4(111) when exposed to the ambient.

Overexpression of EZH2 in multiple myeloma is associated with poor prognosis and dysregulation of cell cycle control.

Myeloma is heterogeneous at the molecular level with subgroups of patients characterised by features of epigenetic dysregulation. Outcomes for myeloma patients have improved over the past few decades except for molecularly defined high-risk patients who continue to do badly. Novel therapeutic approaches are, therefore, required. A growing number of epigenetic inhibitors are now available including EZH2 inhibitors that are in early-stage clinical trials for treatment of haematological and other cancers with EZH2 mutations or in which overexpression has been correlated with poor outcomes. For the first time, we have identified and validated a robust and independent deleterious effect of high EZH2 expression on outcomes in myeloma patients. Using two chemically distinct small-molecule inhibitors, we demonstrate a reduction in myeloma cell proliferation with EZH2 inhibition, which leads to cell cycle arrest followed by apoptosis. This is mediated via upregulation of cyclin-dependent kinase inhibitors associated with removal of the inhibitory H3K27me3 mark at their gene loci. Our results suggest that EZH2 inhibition may be a potential therapeutic strategy for the treatment of myeloma and should be investigated in clinical studies.

Selective FLT3 inhibition of FLT3-ITD+ acute myeloid leukaemia resulting in secondary D835Y mutation: a model for emerging clinical resistance patterns.

Acquired resistance to selective FLT3 inhibitors is an emerging clinical problem in the treatment of FLT3-ITD(+) acute myeloid leukaemia (AML). The paucity of valid pre-clinical models has restricted investigations to determine the mechanism of acquired therapeutic resistance, thereby limiting the development of effective treatments. We generated selective FLT3 inhibitor-resistant cells by treating the FLT3-ITD(+) human AML cell line MOLM-13 in vitro with the FLT3-selective inhibitor MLN518, and validated the resistant phenotype in vivo and in vitro. The resistant cells, MOLM-13-RES, harboured a new D835Y tyrosine kinase domain (TKD) mutation on the FLT3-ITD(+) allele. Acquired TKD mutations, including D835Y, have recently been identified in FLT3-ITD(+) patients relapsing after treatment with the novel FLT3 inhibitor, AC220. Consistent with this clinical pattern of resistance, MOLM-13-RES cells displayed high relative resistance to AC220 and Sorafenib. Furthermore, treatment of MOLM-13-RES cells with AC220 lead to loss of the FLT3 wild-type allele and the duplication of the FLT3-ITD-D835Y allele. Our FLT3-Aurora kinase inhibitor, CCT137690, successfully inhibited growth of FLT3-ITD-D835Y cells in vitro and in vivo, suggesting that dual FLT3-Aurora inhibition may overcome selective FLT3 inhibitor resistance, in part due to inhibition of Aurora kinase, and may benefit patients with FLT3-mutated AML.

Pressure ulcers in cancer palliative care patients.

Terminally ill cancer patients are considered at high risk for pressure ulcers because of their clinical condition. However, in Italy, data about pressure ulcers and their prevalence are insufficient. This paper reports a study on pressure ulcers incidence and prevalence in a population of oncology patients cared for in an Italian palliative care service. A retrospective analysis of 414 clinical records of patients admitted over 6 months showed a prevalence of pressure ulcers of 22.9% and an incidence of 6.7%. Karnofsky Performance Scale Index scores, age and length of the stay were significantly related to the pressure sore development. These results support the need to focus attention on pressure ulcers prevention and treatment in terminally ill cancer patients, and to further define specific guidelines aimed at warranting patients' comfort and quality of life.

Morphology of polystyrene films deposited by RF plasma.

A new plasma reactor, set up with a large planar inductively coupled source, is used for the first time to deposit a polymer coating (pPS) from a styrene monomer. This work is devoted to the relationship between external plasma parameters and substrate topography, and pPS coating morphology, which is investigated by scanning electron microscopy and atomic force microscopy. Stainless steel, gold and glass surfaces are used as substrates. It is clearly demonstrated that the film morphology can be controlled by adjustment of RF input power, pressure. The analysis performed further reveals that the pPS film's characteristics strongly depend on the substrate topography and its electrical potential during the discharge. Finally, the plasma duration also strongly influences the morphology of the films. The morphologies obtained include smooth films without any specific feature, worm-like structures, particles (nanometer- and micrometer-sized) associated along preferential directions and randomly distributed particles (micrometer-sized). The intrinsic topography of the substrate influences the film structure in the case of thin films (thickness lower than about 100 nm). Polymerization is suggested to take place at the surface in contact with the discharge rather than in the gas phase. Nucleation and growth start preferentially on substrate defects such as polishing scratches.

[Accessibility and quality of Italian health and social services: the experiences of patients with neurofibromatosis type 1 and of their relatives]. / Accessibilità e qualità dei servizi socio-sanitari italiani: le esperienze dei pazienti con neurofibromatosi tipo 1 e dei loro familiari.

Opinions of patients and relatives about their experiences with health and social services were assessed in a pilot study. The study was carried out in collaboration with two patients' Associations of Neurofibromatosis, "Neurofibromatosi--Onlus" and "LINFA--Onlus". An ad-hoc questionnaire was developed by the Italian National Centre of Rare Diseases and was sent to the Responsibles of the two aforementioned patients' Associations. The Responsibles distributed the questionnaire to their members by mail. The questionnaire investigated, using 5-level Likert scales, the following topics: quality and accessibility of health services (diagnostic exams, pharmacological therapies, rehabilitation, psychological support), quality and accessibility of social services (school, vocational training, health information, information on legal matters and rights). Finally, the questionnaire investigated also opinions about improvements of public health and social services in the last three years. Overall, 79 out 144 questionnaires were filled by patients or their relatives. The most frequent negative experiences concerned vocational training and both health and legal information. The most frequent positive opinions were reported for the human relationships with health professionals. This pilot study seems to point out a promising way to investigate systematically opinions of patients suffering from rare diseases and their relatives.

Prevalencia de parasitosis intestinales en el Ambulatorio Militar "La Rosaleda" 2004 / Prevalence of the intestinal diseases parasitic in the Ambulatory Military La Rosaleda 2004

Conocer la prevalencia y la distribución por edad y sexo de parasitosis intestinales producidas por Entamoeba histolytica, Blastocystis hominis Endolimax nana, en la población del Ambulatorio Militar "La Rosaleda" 2004. Estudio descriptivo transversal de prevalencia con análisis bivariado de 754 pacientes de diversas edades y sexo, que asistieron durante el año 2004 al Ambulatorio Militar "La Rosaleda". Se les realizó examen simple de heces y coloración rápida con lugol. Se estudiaron 754 pacientes, 402 femeninos y 352 masculino, con edades comprendidas entre 0-94 años. La prevalencia de las parasitosis intestinales fue de 17,37 por ciento, obteniendo la mayor tasa Blastocystis hominis. La prevalencia general de Blastocystis hominis fue 10,34 por ciento, Entamoeba histolytica 4,64 por ciento, siendo los grupos etarios más afectados de 3-10 años y 21-35 años, en ambas parasitosis y ambos sexos. En el caso de Endolimax nana la prevalencia fue 2,39 por ciento, siendo más frecuente en mujeres con edades entre 36-50 años. El área de influencia del Ambulatorio Militar "La Rosaleda" está constituida por comunidades que cuentan con adecuada provisión de servicios básicos (agua potable, disposición de aguas servidas). Llama la atención la alta prevalencia de estas parasitosis en la población, sobre todo en adultos jóvenes. De esta información se puede inferir que la vía de transmisión más probable es a través de alimentos contaminados. La investigación parasitológica de los establecimientos de comida rápida y ambulante de la zona puede servir de base para estudios posteriores.

Muscarinic receptors, leukotriene B4 production and neutrophilic inflammation in COPD patients.

BACKGROUND: Acetylcholine (ACh) plays an important role in smooth muscle contraction and in the development of airway narrowing; preliminary evidences led us to hypothesize that ACh might also play a role in the development of airways inflammation in chronic obstructive pulmonary disease (COPD). METHODS: We evaluated the concentrations of leukotriene B4 (LTB4) in induced sputum, and the expression of Ach M1, M2, and M3 receptors in sputum cells (SC) obtained from 16 patients with COPD, 11 smokers, and 14 control subjects. The SC were also treated with ACh and the production of LTB4 assessed in the presence or absence of a muscarinic antagonist (oxitropium). In blood monocytes, we evaluated LTB4 release and activation of the extracellular signal-regulated kinases (ERK) pathway after treatment with Ach. RESULTS: The LTB4 concentrations were higher in COPD than in controls (P < 0.01) and correlated with the number of neutrophil (P < 0.01). The M3 receptors expression was increased in COPD subjects when compared to smokers and control (P < 0.05 and 0.0001, respectively), while M2 expression resulted decreased (P < 0.05 and 0.01). The ACh-induced LTB(4) production was observed in peripheral blood monocytes, and was sensitive to ERK inhibition. Similarly, ACh significantly increased neutrophil chemotactic activity and LTB4 released from SC of COPD patients only, and these effects were blocked by pretreatment with the inhibitor of ERK pathway PD98059. CONCLUSIONS: The results obtained show that muscarinic receptors may be involved in airway inflammation in COPD subjects through ACh-induced, ERK1/2-dependent LTB4 release. Muscarinic antagonism may contribute to reduce neutrophil infiltration and activation in COPD.

[Accessibility and quality to health social services in Italy for the patients with rare diseases: the opinion of associations]. / Accessibilità e qualita dei servizi socio-sanitari italiani per i pazienti con malattie rare: il parere delle associazioni.

This paper concerns the first phase of a study about the perception of social and health needs of people with rare diseases. The study was performed by the National Center for Rare Diseases at the Italian National Institute of Health (Istituto Superiore di Sanità - ISS). The project wants to be an example of collaboration between the research and the association worlds. Responsible of Associations of Patients and their relatives were asked their opinion about the accessibility and quality of important features of health and social services (accessibility and quality of diagnostic, pharmacological, psychological and rehabilitative interventions, social support, school and vocational training, information that was given to relatives). An ad hoc questionnaire was developed through focus groups. The questionnaire was completed by 108 associations (26,5% of the associations thar are recorded in the ISS database). Average scores showed satisfaction only for some variables and a negative gradient north-south was observed. The most frequent complaints were about information, quality of school and job training services and availability of psychological support. The study showed an high level of dissatisfaction with availability, quality and integration health and social services.

[Assessment of working conditions in health care workers]. / La valutazione della condizione lavorativa in popolazioni del settore sanitario.

OBJECTIVE: Validation and first use of a self-completed questionnaire to assess opinion on working conditions in health professionals. METHODS: The questionnaire consisted of 40 items. It was developed via review of the literature and two focus groups. A reliability test-retest study was performed on 45 health professionals with different roles. Factorial validity and internal consistency of each derived subscale were evaluated on a wide sample of 514 professionals. In addition, the opinion of the health care professionals was evaluated and possible relationships were tested between total and subscale scores and the following variables: age, sex, professional role and years in the job. RESULTS: Weighted kappa was higher than 0.60 for 95% of the items, higher than 0.70 for 43% and higher than 0.80 for 20%. Factor analysis revealed that six factors--work content and organisation, physical fatigue, relationships, mental stress, hours of work, and physical environment--explained 57% of total variance. Cronbach's alpha coefficient of the subscales ranged from 0.70 to 0.91. Low levels of satisfaction in dfferent job aspects were found among general hospital staff. They were particularly dissatisfied with personal growth and development, fairness in incentives, dissemination of information, environment, support of new ideas and skills, career opportunities. In particular, satisfaction differed among the various professional roles. DISCUSSION: The questionnaire was found reliable and had a coherent factor structure, with six factors or subscales that showed good internal consistency. This questionnaire may be useful to assess satisfaction with work in health care staff. The preliminary results of its use suggest that satisfaction with different aspects of work is low.

Effect of cilomilast (Ariflo) on TNF-alpha, IL-8, and GM-CSF release by airway cells of patients with COPD.

BACKGROUND: Inflammation in chronic obstructive pulmonary disease (COPD) is characterised by increased neutrophilic infiltration of the airways. Cilomilast, a novel selective phosphodiesterase 4 inhibitor in clinical development for COPD treatment, exerts anti-inflammatory effects. The ability of cilomilast to inhibit the release of neutrophil chemoattractants such as tumour necrosis factor (TNF)-alpha, interleukin (IL)-8, and granulocyte-macrophage colony stimulating factor (GM-CSF) by bronchial epithelial cells and sputum cells isolated from 10 patients with COPD, 14 normal controls, and 10 smokers was investigated. METHODS: Bronchial epithelial cells obtained by bronchial brushing and sputum cells isolated from induced sputum samples were cultured for 24 hours in the presence or absence of cilomilast (1 micro M). After incubation the supernatants were harvested and the levels of mediators measured by ELISA. Chemotactic activity in supernatants was also measured using a Boyden chamber. RESULTS: TNF-alpha and IL-8 release by bronchial epithelial cells and sputum cells was higher in patients with COPD than in controls (p<0.0001) and smokers (p<0.0001). GM-CSF was only detectable in sputum cell supernatants and its level was higher in patients with COPD than in controls and smokers (p<0.0001, respectively). Cilomilast significantly reduced TNF-alpha release by bronchial epithelial cells and sputum cells (p=0.005) and GM-CSF release by sputum cells (p=0.003), whereas IL-8 release was not statistically inhibited. Supernatants of sputum cells and bronchial epithelial cells treated with cilomilast significantly decreased neutrophil chemotaxis (p<0.006 and p<0.008, respectively). CONCLUSIONS: Cilomilast inhibits the production of some neutrophil chemoattractants by airway cells. This drug may play a role in the resolution of neutrophilic inflammation associated with COPD and cigarette smoke.

Increased levels of elastase and alpha1-antitrypsin in sputum of asthmatic patients.

Asthma and chronic bronchitis are inflammatory diseases associated with remodeling of the extracellular matrix (ECM). Elastin, a major component of the ECM in the airways, has been previously found to be disrupted in asthma and chronic bronchitis. This study was aimed at evaluating whether elastin disruption might be associated with an imbalance between elastase (active and total) and alpha1-proteinase inhibitor (alpha1-PI), the main inhibitor of elastase. We measured elastase and alpha1-PI in induced sputum obtained from 16 control subjects, 10 healthy smokers, 19 asthmatic patients, and 10 chronic bronchitis patients. We also assessed the possible origin of elastase, evaluating its levels in sputum with reference to differential cell counts. We found that in induced sputum obtained from asthmatic and chronic bronchitis patients, the levels of both total and active elastase were significantly increased as compared with those of control subjects and healthy smokers and were significantly correlated with the percentage of neutrophils. In addition, in asthma and chronic bronchitis patients, the levels of active and total elastase were inversely correlated with the degree of airway obstruction as assessed from FEV1 values. This study shows that airway inflammation in asthma and chronic bronchitis is associated with high levels of active elastase, which may play a role in the pathogenesis of airway remodeling.

[Peritoneal mesothelioma and abdominal hernias]. / Mesotelioma peritoneale ed ernie addominali.

In a review of 720 cases of peritoneal mesothelioma described in Medical Literature, there have been 361 patients for whom the diagnosis has been confirmed by necropsy, 294 by bioptic laparotomy and another 65, where there is no precise information on the method of histopathological diagnosis. Exposure to asbestos can be observed in 55% of the cases studied from the 1960's onwards. As for pathogenesis, amongst other irritant stimuli, it is noteworthy that abdominal hernias provoke mild but chronic reactions on peritoneal serosa. These hernias are to be found in at least 40 of the subjects affected by peritoneal mesothelioma. Reported sites: Inguinal in 28 cases; umbilical in 3 cases; diaphragmatic hiatus in 5 cases; in one case, the site has not been stated. In many cases, hernias may occur as the result of an increase in the endoabdominal pressure caused by ascites or they can be symptomatic of a metastasis of a peritoneal mesothelioma which has spread in a pre-established hernial sac; there are, however, clear examples of primitive, malignant, mesothelial neoplasia of the hernial sac, which can spread throughout the peritoneal cavity months or even years later.

[Pericardial mesothelioma. Evolution and update in the last decade]. / Mesotelioma pericardico. Evoluzione ed aggiornamento nell'ultimo decennio.

Pericardial mesothelioma: epidemiological updating on the last decade. In the last decade, 109 cases of primitive malignant pericardial mesothelioma, histologically proved and reported in world medical literature have been added to the 206 cases described in a previous article. This illness, although rare, has been found more frequently in Japan (25 subjects) and in USSR (21 subjects). From the table in annex, the following points emerge: a) On average, pericardial mesothelioma tends to develop in fairly young people (compared to pleural or peritoneal mesothelioma). b) There is more proof that asbestos has an harmful effect on pericardial serosa. c) The most frequent clinical diagnoses refer mainly to acute pericarditis, constrictive pericarditis, cardiac tamponade and sometimes to various types of coronary heart disease, which autoptical examination reveals to be due to the presence of an external compression of the coronary arteries by pericardial mesothelioma. d) This illness, perhaps because of greater research and improved diagnostical means seems to be increasing when compared to the previous period (although this does not appear to be the case in our country).

[Malignant mesothelioma of the tunica vaginalis of the testis. Here again asbestos?]. / Mesotelioma maligno della tunica vaginale propria del testicolo. Anche qui l'asbesto?

Malignant mesothelioma of the tunica vaginalis testis is a fairly rare disease, but it seems to have become more common in the last few years, according to epidemiological data. At least 45 cases have been reported in medical literature, 29 of which originating from Anglo-Saxon countries. Asbestos is the aetiological factor that is becoming more apparent also in this location of mesothelioma. From Fligiel's first case to the latest published by Tyagi, there have been 11 established cases of exposure to asbestos, which is equivalent of at least 31.5% among those affected by the illness. In many cases, furthermore, this noxious substance has not even been investigated.