Monsters begat by quantifiers?

It is common practice in formal semantics to assume that the context specifies an assignment of values to variables and that the same variables that receive contextually salient values when they occur free may also be bound by quantifiers and λs. These assumptions are at work to provide a unified account of indexical and bound uses of third person pronouns, namely an account by which the same lexical item is involved in both uses. One apparent consequence of this approach is that quantifiers and λs are monsters in Kaplan's sense. We argue that this consequence can, and should, be avoided. We explore an alternative unified account based on the idea that variable assignments occur both as coordinates of the context and as coordinates of the circumstance of evaluation. The outcome is a non indexical account of free third person pronouns and a new conception of the role and structure of assignment functions

Androgen deprivation therapy (castration therapy) and pedophilia: What's new

Andrology is a constantly evolving discipline, embracing social problems like pedophilia and its pharmacological treatment. With regard to chemical castration, the andrologist may perform an important role as part of a team of specialists. At present, no knowledge is available regarding hormonal, chromosomal or genetic alterations involved in pedophilia. International legislation primarily aims to defend childhood, but does not provide for compulsory treatment. We reviewed international literature that, at present, only comprises a few reports on research concerning androgen deprivation. Most of these refer to the use of leuprolide acetate, rather than medroxyprogesterone and cyproterone acetate, which present a larger number of side effects. Current opinions on chemical castration for pedophilia are discordant. Some surveys confirm that therapy reduces sexual thoughts and fantasies, especially in recidivism. On the other hand, some authors report that chemical castration does not modify the pedophile's personality. In our opinion, once existing legislation has changed, andrologists could play a significant role in the selection of patients to receive androgen deprivation therapy, due in part to their knowledge about its action and side effects

The role of diallyl thiosulfinate associated with nuciferine and diosgenin in the treatment of premature ejaculation: a pilot study

Objective: To assess the efficacy and safety of an association of diallyl thiosulfinate with nuciferine and diosgenin in the treatment of a group of patients suffering from premature ejaculation (PE), primary or secondary to erectile dysfunction (ED). Materials and methods: From July 2015 to October 2016, 143 patients (mean age 25.3; range 18-39) affected by PE completed the study and were finally analyzed in this phase I study. All patients, after clinical assessment and laboratory evaluation were asked to take an association of diallyl thiosulfinate with nuciferine and diosgenin as oral tablet, once a day, on alternate days, for three months. At the baseline and after three months of treatment, each patient was asked to complete the following questionnaires: International Index of Erectile Function (IIEF-5), Premature Ejaculation Diagnostic Tool (PEDT), Male Sexual Health Questionnaire (MSHQ). Results: A statistical significant improvement in terms of erectile function, comparing the IIEF-5 value at baseline and follow-up visit was found (respectively IIEF-5: 8.7 vs 14.01; p < 0.001). Moreover, at follow-up visit, 97/143 men (67.8%) referred a subjective improvement of the erection quality and a better control of the ejaculation (PROs). The IELT improved too between the baseline evaluation and the follow-up visit (p < 0.001). Conclusion: In conclusion, our study, even if supported by preliminary results, showed how Diallyl Thiosulfinate, Nuciferine and Diosgenin is able to improve the control of ejaculation in patients suffering from PE, primary or secondary to ED without any significant adverse effects

Mass spectrometry in the diagnosis of thyroid disease and in the study of thyroid hormone metabolism

The importance of thyroid hormones in the regulation of development, growth, and energy metabolism is well known. Over the last decades, mass spectrometry has been extensively used to investigate thyroid hormone metabolism and to discover and characterize new molecules involved in thyroid hormones production, such as thyrotropin-releasing hormone. In the earlier period, the quantification methods, usually based on gas chromatography-mass spectrometry, were complicated and time consuming. They were mainly focused on basic research, and were not suitable for clinical diagnostics on a routine basis. The development of the modern mass spectrometers, mainly coupled to liquid chromatography, enabled simpler sample preparation procedures, and the accurate quantification of thyroid hormones, of their precursors, and of their metabolites in biological fluids, tissues, and cells became feasible. Nowadays, molecules of physiological and pathological interest can be assayed also for diagnostic purposes on a routine basis, and mass spectrometry is slowly entering the clinical laboratory. This review takes stock of the advancements in the field of thyroid metabolism that were carried out with mass spectrometry, with special focus on the use of this technique for the quantification of molecules involved in thyroid diseases

Perineal and robot-assisted vesico-urethral reconstruction for anastomotic strictures after RP

Vesico-urethral anastomotic stricture (VUAS) following radical prostatectomy is a rare clinical condition in the robot-assisted procedure era, due to the improved magnification of the surgical field and the perfect knowledge of the anatomic structures deputed to maintaining the mechanisms for urinary continence. Improvements in surgical technique such as muco-mucosal apposition, tension-free anastomosis, water-tight vesico-urethral suture, have been recognized as significant contributors to precise vesico-urethral reconstruction. Conversely, excessive intraoperative blood loss, urinary extravasation and previous history of trans-urethral prostatectomy have been commonly cited as predisposing factors for the development of postoperative scars. Terminology used in the definition of VUAS distinguishes the condition from bladder neck contracture (BNC) and identifies the exact site of the contracture/stenosis/stricture. The majority of cases involves the bladder neck and bulbo-membranous urethra mainly in patients who received radical prostatectomy plus adjuvant radiotherapy. Diagnosis of VUAS is mainly based on symptoms and retrograde urethro-cystogram imaging to identify whether or not the sphincter mechanism is involved and the length of the strictured segment, although delineation of the precise anatomy is often complex. Stricture length is a significant factor for prognosis and correlates with probability of recurrence after reparative surgeries such as urethral dilation, trans-urethral scar incision or resection and perineal urethral buccal mucosa repair. Results obtained via different surgical techniques are amply described, with the hindrance of VUAS and BNC often not being properly distinguished in the reported series of patients treated. Notwithstanding, a 0 to 69% success rate has been reported for patients with bladder neck stricture after urethral dilation and/or cold-knife incision and/or holmium laser incision and/or trans urethral resection, while a 60 to 93% success rate was obtained for patients treated via an abdominal and/or perineal approach. Repair of a long-length urethral stricture often implies the complete loss of urinary continence, whilst it does not appear to have significant impact on sexual potency if previously preserved. The risk of developing VUAS/BNC as a complication after radical prostatectomy falls from 30% of patients treated by Retropubic Radical Prostatectomy (RRP) to less than 5% of patients who received Robotic Assisted Radical Prostatectomy (RARP). Subjects with a histological diagnosis of T3 cancer, positive surgical margins and/or Gleason score >7 and treated by RARP who required early adjuvant radiotherapy, reported an overall 8.4% rate of VUAS. Lavollè et al. treated six patients with anastomotic stricture who had previously undergone radical prostatectomy by extraperitoneal robot-assisted vesico-urethral reconstruction obtaining a 50% success rate. Dinerman et al. presented a case report on a patient with long-length post prostatectomy vesico-urethral stricture by combining robotic-abdominal and open-perineal surgical procedure. The combined abdomino-perineal approach allows to provide “complete” scar removal and a new vesico-urethral anastomosis at a lower risk of developing subsequent recurrences of the stricture also in patients with long-length strictures. An extensive dissection of the bladder neck and bulbo-membranous urethra does imply the complete loss of urinary continence, that can however be recovered through subsequent or concomitant artificial sphincter implant. This novel combined technique was adopted on a series of three patients of whom two previously treated by RARP and one by RRP

Managing female urinary incontinence: A regional prospective analysis of cost-utility ratios (curs) and effectiveness

Introduction: To evaluate the cost-utility of incontinence treatments, particularly anticholinergic therapy, by examining costs and quality-adjusted life years. Materials and methods: A prospective cohort study of women who were consecutively referred by general practitioners (GPs) to the Urology Department because of urinary incontinence. The primary outcome was evaluation of the cost-utility of incontinence treatments (surgery, medical therapy and physiotherapy) for stress and/or urgency incontinence by examining costs and quality-adjusted life years. Results: 137 consecutive female patients (mean age 60.6 ± 11.6; range 36-81) were enrolled and stratified according to pathologies: SUI and UUI. Group A: SUI grade II-III: 43 patients who underwent mid-urethral sling (MUS); Group B: SUI grade I-II 57 patients who underwent pelvic floor muscle exercise and Group C: UUI: 37 patients who underwent antimuscarinic treatment with 5 mg solifenacin daily. The cost utility ratio (CUR) was estimated as saving more than €1200 per QALY for surgery and physiotherapy and as costing under € 100 per QALY for drug therapy. Conclusions: This study shows that appropriate diagnosis and treatment of a patient with incontinence lowers National Health Service costs and improves the benefits of treatment and quality of life

Can daily intake of aspirin and/or statins influence the behavior of non-muscle invasive bladder cancer? A retrospective study on a cohort of patients undergoing transurethral bladder resection

Background: This study aimed to evaluate the behavior of non-muscle-invasive bladder cancer (NMIBC) in patients submitted to transurethral bladder resection (TURB) comparing subjects in chronic therapy with aspirin, statins, or both drugs to untreated ones. Methods: This retrospective study was conducted on 574 patients diagnosed with NMIBC who underwent TURB between March 2008 and April 2013. The study population was divided into two main groups: treated (aspirin and/or statins) and untreated. The treated group was further divided into three therapeutic subgroups: Group A (100 mg of aspirin, daily for at least two years); Group B (20 mg or more of statins, daily for at least two years); and Group C (100 mg of aspirin and 20 mg of statins together). The mean follow-up of patients was 45.06 months. Results: No significant differences were observed among the different groups at baseline. On multivariate analysis, statin treatment, smokers and high stage disease (T1) achieved the level of independent risk factor for the occurrence of a recurrence. When patients were stratified according to the different treatment; patients treated with statins (Group B) presented an higher rate of failure (56/91 patients; 61.5%) when compared to Group A (42/98 patients; 42.9%), Group C (56/98; 57.1%) and (133/287 patients; 46.3%). This difference corresponds to a significant difference in recurrence failure free survival (p = 0.01). Conclusions: Our results suggest that long-term treatment with aspirin in patients with NMIBC might play a role on reducing the risk of tumor recurrence. In contrast, in our investigation data from statins and combination treatment groups showed increased recurrence rates. A long-term randomized prospective study could definitively assess the possible role of this widely used drugs in NMIBC