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Management of late onset hypogonadism (LOH) is not homogenous. The aim of the study is to observe the management of patients with low testosterone (T) in highly specialized Italian centres. The SIAMO-NOI is an observational longitudinal disease registry for the evaluation of the clinical management of patients with low T levels (total T < 12 nmol/L, calculated free T < 225 pmol/l or already in treatment) in 15 Italian centers members of the Italian Society for Andrology and Sexual Medicine (SIAMS). Clinical and biochemical data were collected for four visits during 12 months of observation. 432 patients (mean age 50.9 ± 14.9 years) were enrolled. Of them, 247 men were receiving androgen therapy, whereas 145 were naive. After the first visit (V0), 80 men started androgen therapy, whereas 55 remained untreated during the entire observation. Younger age [odds ratio (OR) 0.57 (0.35–0.92)], total T < 8 nmol/l [OR 4.69 (1.59–13.81)], complaining at least one sexual symptom [OR 11.55 (2.01–66.35)] and reporting more severe lower urinary tract symptoms [OR 1.27 (1.01–1.60)] predicted starting an androgen therapy. Sixty-four men started therapy immediately after V0 and maintained it until the observation end. When compared to V0, they reported an increase in all the domains of the International Index of Erectile Function-15 (IIEF-15), in the sexual and physical subdomains of the Aging Male Scale as well as in the International Prostate Symptom Score. Conversely, the untreated group reported a significant improvement, although lower than the treated group, only in the erectile function domain of the IIEF-15. Management of LOH in SIAMS centres is in line with the international guidelines and the newest knowledge about the role of T on prostate health. Androgen therapy is associated with an improvement in all the aspects of sexual life and in the perception of physical strength.

Hypoparathyroidism and hypocalcemia are two of the most frequent clinical characteristics of 22q11-deletion syndrome (22q11DS). The aim of this study was to evaluate bone metabolism and density in a cohort of patients affected by 22q11DS. In 8 pediatric patients (mean age 11.5 years; range 7–16.4) affected by 22q11DS, creatinine, albumin, total and ionized calcium, phosphate, 25(OH) vitamin D, parathyroid hormone, osteocalcin, C-terminal telopeptide and interleukin 6 were assessed. Furthermore, bone mineral density (BMD) was determined by dual-energy X-ray absorptiometry procedure. 14 healthy children were considered as controls. Most of the studied subjects were overweight and lacked quality physical activity. 40 % of the subjects had reduced calcium levels in the absence of related clinical symptoms and all patients also had inadequate levels of Vitamin D. The values of L1-L4 BMD were within the reference range in all patients (zscore <2). However, after comparing the age-matched indexes of bone mineralization of patients with those of controls, the former had lower bone mineralization indexes than the latter. In pediatric patients with 22q11DS, an initial and slight bone loss is evident. The incidence of hypocalcemia is underestimated because hypocalcemia is asymptomatic. Several factors contribute to bone impairment in children who still have to achieve bone mass peak. Therefore, we suggest strict monitoring of bone metabolism as well as BMD measurement in patients affected by 22q11DS.

Background:Hirsutism is defined as the presence of excessive terminal hair in androgen-dependent areas of a woman’s body. Regarding this it has been suggested that Lavender and Tea tree oils may have antiandrogenic activities. Aim:To evaluate therapy based on Lavender and Tea tree oils in women suffering from mild idiopathic hirsutism (IH). Subjects and methods:A prospective, open-label, placebo-controlled, randomized study was performed: women affected by mild IH were randomly assigned to receive oil spray containing Lavender and Tea tree oils (group T) (no.=12) or placebo (group P) (no.=12) twice a day for 3 months in areas affected by hirsutism. Evaluation of hirsutism was carried out at baseline and after 3 months by Ferriman-Gallwey score and by measuring hair diameter taken from some body areas. A hematological and hormonal evaluation was carried out at baseline and after 3 months. Results:No significant variations were found in any of the hormones studied in groups T and P between baseline and after 3 months. A statistically significant decrease of hirsutism total score and of hair diameter was found in group T, while no statistically significant difference in these two parameters was observed in group P; in group T percentual reduction of hair diameter was significantly greater than in group P. Conclusions:Lavender and Tea tree oils applied locally on skin could be effective in reducing mild IH; this treatment could represent a safe, economic and practical instrument in the cure of this disease.

Recombinant GH therapy is normally administered to GH-deficient children in order to achieve a satisfactory height — the main target during childhood and adolescence. However, the role of GH does not end once final height has been reached, but continues during the so-called transition period. In this phase of life, the body undergoes several changes, both physical and psychological, that culminate in adulthood. During this period, GH has a part in numerous metabolic functions. These include the lipid profile, where it increases HDL and reduces LDL, with the global effect of cardiovascular protection. It also has important effects on body composition (improved muscle strength and lean body mass and reduced body fat), the achievement of proper peak bone density, and gonad maturation. Retesting during the transition period, involving measurement of IGF-I plus a provocative test (insulin tolerance test or GHRH + arginine test), is thus necessary to establish any persistent GH deficiency requiring additional replacement therapy. The close cooperation of the medical professionals involved in the patient’s transition from a pediatric to an adult endocrinologist is essential. The aim of this review is to point out the main aspects of GH treatment on body composition, metabolic and gonad functions in the transition period.

Sucralfate is a drug used in the treatment of gastric and duodenal ulcer; it is cytoprotective and able to increase the bioavailability of several growth factors, modulating the wound healing process. In this study we tested the possible therapeutic effect of Sucralfate in the treatment of ulcerative lesion occurring in uterine cervix; to investigate such effect we used an experimental rat model of cervicitis in which the uPAR and EGFR expression were evaluated. Cervicitis was induced in wild and ovariectomized wistar female rats by an acetic acid-soaked tampon. The animals were divided into two main groups (4 and 7 days) and Sucralfate was administered topically until the day they were sacrificed. In order to distinguish physiological and drug-induced healing, quantitative and qualitative uPAR and EGFR expression were evaluated by using Western Blot and Immunohistochemistry techniques. Western Blot analysis demonstrated an increased expression of both receptors after 4 days from wounding in wild and ovariectomized animals. In particular in ovariectomized animals the expression of uPAR and EGFR increased after 4 days while it reduced following the administration of Sucralfate. In wild rats the same was observed for uPAR expression, while EGFR was different; in fact, its expression increased significantly at day 4 in the animals treated with the drug and only at day 7 in those untreated. Immunohistochemistry highlighted a noteworthy epithelial colocalization of EGFR and uPAR after 4 days in the animals treated with Sucralfate. We conclude that Sucralfate can promote the healing of ulcerative cervicitis and moreover, it reduces the normal healing time because of its modulatory property on uPAR and EGFR expression.

In this study, we investigated the effect of 1,25(OH)2D3on proteinuria and on the alteration of slit diaphragm-associated proteins induced by anti-Thy 1.1 in Wistar rats. Four groups of animals were studied: group I, anti-Thy 1.1 treated rats; group II, anti-Thy1.1 treated group that at day 2, after the onset of overt proteinuria, started the treatment with 1,25(OH)2D3; group III, normal control rats injected with vehicle alone; group IV, rats that received only 1,25(OH)2D3. At day 2, in group I and II, before the administration of 1,25(OH)2D3, protein excretion was significantly increased when compared to controls. Overt proteinuria was maintained until day 14 in group I whereas in group II protein excretion was significantly reduced from day 3 to day 14. Moreover, treatment with 1,25(OH)2D3abrogated podocytes injury, detected as desmin expression and loss of nephrin and zonula occludens-1 (ZO-1), two slit diaphragm-associated proteins, and glomerular polyanion staining, that were observed in group I. In conclusion, these results suggest that 1,25(OH)2D3administrated with a therapeutic regiment may revert proteinuria, counteracting glomerular podocyte injury.

A detailed Brillouin light scattering (BLS) investigation of spin waves in Co(20 nm)/Cr(dCr)/Co(20 nm) symmetric trilayer with wedge-shaped Cr interlayer has been carried out. Results showed that the interlayer exchange coupling oscillates, with antiferromagnetic peaks near the Cr layer thickness of 0.7 and 2.5 nm. These oscillations can be satisfactorily reproduced by a calculation based on the RKKY theory. An independent confirmation of the results obtained by BLS has been derived by measuring the saturation field of the longitudinal hysteresis loop as a function of the Cr thickness by magneto-optic Kerr effect magnetometry. Using the magnetic parameter determined by the above analysis, we have calculated the Brillouin cross section for the different Cr spacer thickness obtaining a very good agreement with the measured spectra.

Reactive oxygen species have been implicated in the pathophysiology of renal ischemia reperfusion injury. Antioxidants including polyphenolics have been found to protect renal cells from the cellular injury induced by ischemia and reperfusion. Resveratrol, a stilbene polyphenol found in grapes and red wine, has recently been found to protect isolated rat heart from ischemia reperfusion injury. This study was sought to determine if resveratrol could also protect renal cells from ischemic injury. Male Wistar rats were treated with control, resveratrol (0.23 μg/kg), vehicle used to solubilize resveratrol, and resveratrol plus L-NAME (15 mg/kg body wt), a nitric oxide blocker. Our results demonstrated that resveratrol administration reduced the mortality of ischemic rats from 50% to 10% and renal damage was reduced as indicated by histologic examination and serum creatinine level. The short-term administration of resveratrol also inhibited renal lipid peroxidation induced by ischemia and reperfusion both in cortex and in medulla. Electron paramagnetic resonance detected an increased formation of nitric oxide in the resveratrol-treated kidney that was reduced to the baseline value after treating the rats with L-NAME in addition to resveratrol. The results suggest that resveratrol reduced the renal ischemia reperfusion injury through a nitric oxide-dependent mechanism.

Background Anti-neutrophil cytoplasmic autoantibodies (ANCA) have been described in patients suffering from systemic vasculitis such as Wegener granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome and other pathological conditions. In this paper we report a greater incidence of ANCA in hemodialysis patients as compared to peritoneal dialysis patients, predialytic uremic patients and non-renal patients; a possible role for dialysis bioincompatibility in ANCA generation was also investigated.Methods A total of 335 uremics in substitutive treatment (176 in hemodialytic treatment and 159 in peritoneal dialysis) were examined for ANCA positivity. A total of 189 patients with advanced renal failure in conservative treatment and 100 healthy subjects were used as control. The dialysis techniques were standard hemodialysis (n = 119), low volume hemodiafiltration (n = 26) and hemofiltration (n = 31). ANCA positivity was examined by immunofluorescence (IF): diffuse finely granular staining was considered as classical positive reaction (C-ANCA) and P-ANCA was diagnosed if a perinuclear staining was observed. EIA for proteinase-3 (anti PR-3) and myeloperoxidase-antibodies (anti-MPO) were also performed.Results In non-renal patients and in patients with pre-dialytic renal insufficiency none were found ANCA positive. In peritoneal dialysis patients all but one were ANCA negative with IF, with all EIA test resulting negative. In hemodialytic patients, a positive IF test was found in 26 (14.7%) for P-ANCA and in 5 (2.8%) for C-ANCA; using the EIA test 23 (13%) patients were positive for MPO and 12 (6.8%) for PR-3.Conclusions No correlation with age, primary renal diseases, dialytic age, dialysis membrane materials was found; regarding the different extracorporeal dialytic techniques a higher incidence (p < 0.02) was detected in patients undergoing HDF. Backfiltration of contaminated dialysate may induce ANCA via an increased cytokine generation. (Int J Artif Organs 2000; 23: 97–103)

This paper describes and evaluates physical parameterizations accounting for the effect of rooftop mitigation strategies (RMSs) on the urban environment, in the context of the mesoscale model Weather Research and Forecasting (WRF). Through the new implementation, the sensitivity of near‐surface air temperature and building energy consumption to different RMSs is evaluated by means of numerical simulations in idealized urban areas, for typical summer and winter conditions. Rooftop mitigation strategies considered include cool roofs, green roofs, and rooftop photovoltaic panels. The reference case simulations are performed assuming buildings made by bricks, with roof composed of clay tiles. Results indicate that near‐surface air temperature is reduced by cool and green roofs during summer: cool roofs are the most efficient in decreasing air temperature, followed by irrigated green roofs. Photovoltaic panels, instead, induce a temperature increase during daytime and a small decrease during nighttime. Cool roofs reveal to be the most efficient strategy in reducing the energy consumption by air conditioning systems. During wintertime, green roofs maintain a higher near‐surface air temperature than clay tile roofs and largely decrease energy consumption. Even PVPs increase air temperature, as in the summer case. On the other hand, cool roofs reduce near‐surface air temperature during daytime, inducing an increase in energy consumption. The results presented here show that the parameterization schemes implemented in the WRF model can be a valuable tool to evaluate the effects of mitigation strategies in the urban environment. The increasing number and duration of heatwaves is increasing the heat stress for people living in the cities, and largely increase the use of energy resources. To face this problem, the deployment of rooftop mitigation strategies (RMSs) such as cool roofs, green roofs, and rooftop photovoltaic panels is starting to be adopted worldwide, with the aim of improving thermal comfort for citizens and diminishing the energy demand for heating/cooling of buildings. This article presents the implementation of new numerical schemes, to consider the effect of the above‐mentioned roof mitigation strategies on the urban environment, incorporated in the Weather Research and Forecasting (WRF) mesoscale numerical weather prediction model. Different urban configurations have been investigated, varying the height of the buildings and the distance between them, in order to cover a large spectrum of possible cities. Results show that all the rooftop technologies tested in this work decrease air temperature and energy consumption during summer. The effect of RMSs increases with decreasing building height and with increasing building packing density. Results point out that advanced parameterization schemes are needed to simulate the feedback between buildings and the atmosphere, which can be used by urban planners as decision supporting tools to improve the sustainability of urban areas. New parameterizations of rooftop mitigations strategies are developed and implemented into the Weather Research and Forecasting (WRF) modelThe new implementations include green roofs and photovoltaic panels, coupled with the BEP + BEM urban canopy modelsSensitivity tests are conducted in order to evaluate the effect of RMSs on near‐surface air temperature and energy consumption New parameterizations of rooftop mitigations strategies are developed and implemented into the Weather Research and Forecasting (WRF) model The new implementations include green roofs and photovoltaic panels, coupled with the BEP + BEM urban canopy models Sensitivity tests are conducted in order to evaluate the effect of RMSs on near‐surface air temperature and energy consumption

AbstractBackground:Recombinant human erythropoietin (rHuEpo) is the treatment of choice in anemia associated with end–stage renal disease. Its major side effect is hypertension, which occurs in 8–30% of uremic patients. The exact mechanism of rHuEpo–induced hypertension has not been fully elucidated, and several possibilities have been proposed, such as a direct vascular effect of the drug with a shift in the balance of constrictor and relaxing endothelial factors (endothelins and nitric oxide (NO)). Recent papers suggested an enhanced rather than reduced activity of endogenous NO system in rats with normal renal function and rHuEpo–induced hypertension. Our study was designed to verify whether, in spite of enhanced activity of the renal NO system, rHuEpo may affect endothelium–dependent (acetylcholine–induced) and/or endothelium–independent (sodium nitroprusside–induced) vasorelaxation and to evaluate basal NO release by the infusion of NG–nitro–L–arginine methyl ester (L–NAME) in an isolated and perfused rat kidney model. Methods: To investigate this hypothesis, we have determined systemic and renal NO activity in Wistar rats treated with a hypertensive dose of rHuEpo (150 IU/kg b.w. every other day for 2 weeks) by measuring stable NO metabolites (NO2+NO3) in the urine and have also evaluated variations in renal vascular resistance after the injection of Ach, SNP and the infusion of L–NAME. Results: Hematocrit, hemoglobin concentration and arterial blood pressure were significantly increased in the treated group as compared with the controls. Urinary excretion of NO2+NO3was significantly higher in treated than in the controls (438±66 vs. 294±36 nM/ml/min, p<0.01, respectively). There were no significant differences in the dose–response curves to Ach and SNP between the two groups. The renal vasoconstriction following the infusion of L–NAME was also similar in the two groups. Conclusions: The analysis of our results seems to indicate that the endogenous NO system activity was enhanced in rHuEpo–induced hypertension in rats with normal renal function and a resistance to NO was not developed in renal circulation. Further studies seem to be necessary to better clarify the exact mechanisms underlying the development of rHuEpo–induced hypertension.

Introduction Postdilution hemofiltration with a polyamide membrane is a renal replacement technique widely used, but very little information is available regarding the biocompatibility of this treatment. In this paper we report the results of an acute study of the biocompatibility of polyamide hemofiltration.Patients and methods Complement activation such as C3a and C5a Des Arg (RIA), granulocyte degranulation like alpha 1 elastase intradialytic increase (ELISA) and the expression of high affinity membrane receptors for IL-2 (anti-TAC) were determined. Beta 2-microglobulin (RIA) intradialytic decrease, as well as its convective removal, was evaluated. The nature of protein layer adsorbed onto the polyamide membrane, at the end of the dialytic session was investigated with a new immunohistochemical tecnique. Cell-associated cytokine concentration (like IL-1 beta and IL-1Ra - ELISA) was determined on mononuclear cell lysates.Results A low degree of complement activation was detected with the polyamide membrane when data were adjusted for hemoconcentration and for 1 m2of membrane surface area. An important convective removal not only of Beta 2-microglobulin (258±20 mg/session), but also of the activated anaphylatoxins (225±76 ng/ml for C3a and 22.5±4 ng/ml for C5a) was revealed. A marked deposition of all coagulation factors with no detectable amount of immunoglobulins and complement factors was revealed on the polyamide membrane at the end of the dialytic session. No intradialytic (for IL-1beta) (from 14.1±3.0 to 13.5±2.9 pg/ 2.5 x 106cell) and interdialytic (for IL-1Ra) (from 4572±1076 to 5408±615 pg/ 2.5 x 106cell) cell-associated cytokine expression was induced by hemofiltration.Discussion and Conclusion Polyamide hemofiltration is a highly biocompatible technique due to the use of a synthetic membrane with a sterile reinfusion fluid and the convective removal of the activated anaphylatoxins and Beta 2-microglobulin.

In order to investigate the nature of the protein layer deposited on hemodialysis membranes we developed a direct immunohistochemical technique using fluoresceinated antibodies to plasma proteins. Fifteen patients on regular dialytic treatment were dialyzed with CU, HE, PAN, PS and PMMA and the dialyzers analyzed at the end of a standard dialytic session. Snap frozen sections of hollow fiber devices were treated with flourescein-isothiocyanate conjugated antibodies for IgG, IgA, IgM, C3c, fibrinogen, factor VIII, factor Xllla-s, antithrombin III, fibrinogen degradation products (PDF) and plasminogen. Protein deposits were evaulated by a quantitative criteria, which evaluates the intensity of fluorescence and the area of the capillary wall occupied by this fluorescence by using an image analysis software. The coagulation cascade is activated by all membranes and similar deposits of these proteins were revealed, whereas important differences in C3c deposition were found.