Effects of intensive lifestyle changes on erectile dysfunction in men

Introduction. Limited data are available supporting the notion that treatment of lifestyle risk factors may improve erectile dysfunction (ED). Aim. In the present study, we analyzed the effect of a program ofchanging in lifestyle designed to improve erectile function in subjects with ED or at increasing risk for ED. Methods. Men were identified in our database of subjects participating in randomized controlled trials evaluating the effect of lifestyle changes. A total of 209 subjects were randomly assigned to one of the two treatment groups. The 104 men randomly assigned to the intervention program received detailed advice about how to reduce body weight, improve quality of diet, and increase physical activity. The 105 subjects in the control group were given general information about healthy food choices and general guidance on increasing their level of physical activity. Main Outcome Measures. Changes in erectile function score (International Index of Erectile Function-5 [IIEF-5]; items 5, 15, 4, 2, and 7 from the full-scale IIEF-15) and dependence of the restoration of erectile function on the changes in lifestyle that were achieved. Results. Erectile function score improved in the intervention group. At baseline, 35 subjects in the intervention group and 38 subjects in the control group had normal erectile function (34% and 36%, respectively). After 2 years, these figures were 58 subjects in the intervention group and 40 subjects in the control group, respectively (56% and 38%, P = 0.015). There was a strong correlation between the success score and restoration of erectile function. Conclusions. It is possible to achieve an improvement of erectile function in men at risk by means of nonpharmacological intervention aiming at weight loss and increasing physical activity. © 2009 International Society for Sexual Medicine

Transperineal Laser Ablation for Focal Therapy of Localized Prostate Cancer: 12-Month Follow-up Outcomes from a Single Prospective Cohort Study

Introduction and objectives: to evaluate the oncological and functional outcomes of transperineal laser ablation (TPLA) as the focal therapy for localized prostate cancer (PCa) after a 12-month follow-up. Materials and methods: patients with low- and intermediate-risk localized PCa were prospectively treated with focal TPLA between July 2021 and December 2022. The inclusion criteria were the following: clinical stage < T2b; PSA < 20 ng/mL; International Society of Urological Pathology (ISUP) grade ≤ 2; MRI-fusion biopsy-confirmed lesion classified as PI-RADS v2.1 ≥ 3. Intra-, peri-, and post-operative data were collected. Variables including age, PSA, prostate volume (PVol), Charlson’s Comorbidity Index (CCI), International Prostate Symptom Score (IPSS) with QoL score, International Index of Erectile Function (IIEF-5), International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF), and Male Sexual Health Questionnaire—Ejaculatory Dysfunction Short Form (MSHQ-EjD) were collected at baseline and at 3, 6 and 12 months after TPLA. Post-operative mpMRI was performed at 3 and 12 months. Finally, all patients underwent prostatic re-biopsy under fusion guidance at 12 months. The success of this technique was defined as no recurrence in the target treated lesion at the 12-month follow up. Results: Twenty-four patients underwent focal TPLA. Baseline features were age [median 67 years (IQR 12)], PSA [5.7 ng/mL (3.9)], PVol [49 mL (27)], CCI [0 (0)], IPSS [11 (9)], IPSS-QoL [2 (2)], IIEF-5 [21 (6)], ICIQ-SF [0 (7)], MSHQ-EjD ejaculation domain [14 (4)] and bother score [0 (2)]. Median operative time was 34 min (IQR 12). Median visual analogue scale (VAS) 6 h after TPLA was 0 (IQR 1). The post-operative course was regular for all patients, who were discharged on the second post-operative day and underwent catheter removal on the seventh post-operative day. No patient had incontinence at catheter removal. A significant reduction in PSA (p = 0.01) and an improvement in IPSS (p = 0.009), IPSS-QoL (p = 0.02) and ICIQ-SF scores (p = 0.04) compared to baseline were observed at the 3-month follow-up. Erectile and ejaculatory functions did not show any significant variation during the follow-up. No intra- and peri-operative complications were recorded. Three Clavien–Dindo post-operative complications were recorded (12%): grade 1 (two cases of urinary retention) and grade 2 (one case of urinary tract infection). At the 12-month follow-up, eight patients showed mpMRI images referable to suspicious recurrent disease (PIRADS v2.1 ≥ 3). After re-biopsy, 7/24 patients’ (29%) results were histologically confirmed as PCa, 3 of which were recurrences in the treated lesion (12.5%). The success rate was 87.5%. Conclusions: the focal TPLA oncological and functional results seemed to be encouraging. TPLA is a safe, painless, and effective technique with a good preservation of continence and sexual outcomes. Recurrence rate at 12 months was about 12.5%

A Serum Metabolomic Signature for the Detection and Grading of Bladder Cancer

Bladder cancer has a high incidence and is marked by high morbidity and mortality. Early diagnosis is still challenging. The objective of this study was to create a metabolomics-based profile of bladder cancer in order to provide a novel approach for disease screening and stratification. Moreover, the study characterized the metabolic changes associated with the disease. Serum metabolomic profiles were obtained from 149 bladder cancer patients and 81 healthy controls. Different ensemble machine learning models were built in order to: (1) differentiate cancer patients from controls; (2) stratify cancer patients according to grading; (3) stratify patients according to cancer muscle invasiveness. Ensemble machine learning models were able to discriminate well between cancer patients and controls, between high grade (G3) and low grade (G1-2) cancers and between different degrees of muscle invasivity; ensemble model accuracies were ≥80%. Relevant metabolites, selected using the partial least square discriminant analysis (PLS-DA) algorithm, were included in a metabolite-set enrichment analysis, showing perturbations primarily associated with cell glucose metabolism. The metabolomic approach may be useful as a non-invasive screening tool for bladder cancer. Furthermore, metabolic pathway analysis can increase understanding of cancer pathophysiology. Studies conducted on larger cohorts, and including blind trials, are needed to validate results

Prevalence and Predictors of Burnout Syndrome among Italian Psychologists following the First Wave of the COVID-19 Pandemic: A Cross-sectional Study

Introduction: The main objective of this study was to assess the prevalence and predictors of Burnout Syndrome (BOS) among Italian psychologists following the first wave of COVID-19 pandemic. As a secondary objective, geographical differences in the prevalence of BOS symptoms were investigated across regional macro-areas in this category of workers. Methods: Using a non-probabilistic convenience sample, four-hundred sixty-eight participants responded to an online survey which included psychometric valid questions from the Maslach Burnout Inventory and The Big Five Inventory-10. Descriptive and inferential statistics were utilized to analyze the data. Results: The overall prevalence of BOS in the study sample was nearly 17%, although no statistically significant differences were noted among volunteer (17.5%) and non-volunteer group (16.2%). Statistically significant differences were found in the Depersonalization (DP) levels. Prevalence of BOS varied across Italian regional macro areas. Neuroticism was positively associated with Emotional Exhaustion (EE) and DP. Agreeableness was negatively associated with EE and DP. Openness was negatively associated with DP. The only personality trait that did not reach any significance level across BOS dimensions was Conscientiousness. Telematic approach was positively associated with DP. Discussion and Conclusions: In Italy, during the COVID-19 pandemic, psychologists who offer services in a volunteering setting are at high risk of developing BOS. Policymakers should develop guidelines for training and prevention programs to contain BOS and preserving the quality of care, through workplace health promotion and occupational health surveillance programs

Changes in renal function after nephroureterectomy for upper urinary tract carcinoma: analysis of a large multicenter cohort (Radical Nephroureterectomy Outcomes (RaNeO) Research Consortium)

Purpose To investigate prevalence and predictors of renal function variation in a multicenter cohort treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods Patients from 17 tertiary centers were included. Renal function variation was evaluated at postoperative day (POD)-1, 6 and 12 months. Timepoints differences were Delta 1 = POD-1 eGFR - baseline eGFR; Delta 2 = 6 months eGFR - POD-1 eGFR; Delta 3 = 12 months eGFR - 6 months eGFR. We defined POD-1 acute kidney injury (AKI) as an increase in serum creatinine by >= 0.3 mg/dl or a 1.5 1.9-fold from baseline. Additionally, a cutoff of 60 ml/min in eGFR was considered to define renal function decline at 6 and 12 months. Logistic regression (LR) and linear mixed (LM) models were used to evaluate the association between clinical factors and eGFR decline and their interaction with follow-up. Results A total of 576 were included, of these 409(71.0%) and 403(70.0%) had an eGFR < 60 ml/min at 6 and 12 months, respectively, and 239(41.5%) developed POD-1 AKI. In multivariable LR analysis, age (Odds Ratio, OR 1.05, p < 0.001), male gender (OR 0.44, p = 0.003), POD-1 AKI (OR 2.88, p < 0.001) and preoperative eGFR < 60 ml/min (OR 7.58, p < 0.001) were predictors of renal function decline at 6 months. Age (OR 1.06, p < 0.001), coronary artery disease (OR 2.68, p = 0.007), POD-1 AKI (OR 1.83, p = 0.02), and preoperative eGFR < 60 ml/min (OR 7.80, p < 0.001) were predictors of renal function decline at 12 months. In LM models, age (p = 0.019), hydronephrosis (p < 0.001), POD-1 AKI (p < 0.001) and pT-stage (p = 0.001) influenced renal function variation (ss 9.2 +/- 0.7, p < 0.001) during follow-up. Conclusion Age, preoperative eGFR and POD-1 AKI are independent predictors of 6 and 12 months renal function decline after RNU for UTUC

Reassessing the faunal assemblages of the late pleistocene stratified karst filling from avetrana (Apulia, Southern Italy): The BED 8, palaeoenvironment and biochronology

The late Quaternary vertebrate deposit of the stratified karst filling from Avetrana (Apulia, Italy) was the subject of an intensive excavation campaign in 2003, followed by numerous subsequent investigations and collections of fossil remains. In this work, the biochronological implications and the palaeoenvironmental reconstruction of the area in the Late Pleistocene are updat-ed and improved based on the more recent observations (2012-2013). In particular, the faunal assemblage found in the uppermost stratum (bed 8) of the fossiliferous deposit is analysed where the proportion of wolf remains increases sharply against the underly-ing layers. A synthesis and a recapitulation of the vertebrate assemblages recovered in the entire stratified karst filling are also given.New observations on the preservation of the bone remains and population analyses of representative mammal species (Canis lupus, Bos primigenius, Cervus elaphus, Dama dama and Sus scrofa) show that bed 8 displays features indicating its origination in sedimentary, climatic and environmental conditions quite different from those of underlying beds. Up to bed 7, the stratified karst filling and its faunal assemblages were generated by a succession of catastrophic mass mortality events in a very short time alter-nated with moments of quiet deposition, during the early Late Pleistocene (MIS 5e). Instead, bed 8 deposited over a longer timespan, probably to be placed between the beginning of last glacial period and early MIS 3, when a puddle of water or a pond was likely at the top of the residual cavity filling.Lithic artefacts recovered in bed 8 and in bed 6 only testifies the attendance of Neanderthal humans in the surrounding of Avetra-na

Development of a portable hypoxia chamber for ultra-high dose rate laser-driven proton radiobiology applications

Background: There is currently significant interest in assessing the role of oxygen in the radiobiological effects at ultra-high dose rates. Oxygen modulation is postulated to play a role in the enhanced sparing effect observed in FLASH radiotherapy, where particles are delivered at 40-1000 Gy/s. Furthermore, the development of laser-driven accelerators now enables radiobiology experiments in extreme regimes where dose rates can exceed 10^9 Gy/s, and predicted oxygen depletion effects on cellular response can be tested. Access to appropriate experimental environments, allowing measurements under controlled oxygenation conditions, is a key requirement for these studies. We report on the development and application of a bespoke portable hypoxia chamber specifically designed for experiments employing laser-driven sources, but also suitable for comparator studies under FLASH and conventional irradiation conditions. Materials and Methods: We used oxygen concentration measurements to test the induction of hypoxia and the maintenance capacity of the chambers. Cellular hypoxia induction was verified using hypoxia inducible factor-1α immunostaining. Calibrated radiochromic films and GEANT-4 simulations verified the dosimetry variations inside and outside the chambers. We irradiated hypoxic human skin fibroblasts (AG01522B) and patient-derived glioblastoma (E2) cancer stem cells with laser-driven protons, conventional protons and reference 225 kVp X-rays to quantify DNA DSB damage and repair under hypoxia. We further measured the oxygen enhancement ratio for cell survival exposed to cyclotron-accelerated protons and X-rays in the normal fibroblast and radioresistant GBM stem cells. Results: Oxygen measurements showed that our chambers maintained a radiobiological hypoxic environment for at least 45 minutes and pathological hypoxia for up to 24 hrs after disconnecting the chambers from the gas supply. We observed a significant reduction in the 53BP1 foci induced by laser-driven protons, conventional protons and X-rays in the hypoxic cells compared to normoxic cells at 30 minutes post-irradiation. Under hypoxic irradiations, the Laser-driven protons induced significant residual DNA DSB damage in hypoxic AG01522 cells compared to the conventional dose rate protons suggesting an important impact of these extreme high dose-rate exposures. We obtained an oxygen enhancement ratio (OER) of 2.1 ± 0.108 and 2.501 ±0.125 respectively for the AG01522 and patient derived GBM stem cells for the X-rays using our hypoxia chambers for irradiation. Conclusion:We demonstrated the design and application of portable hypoxia chambers for studying cellular radiobiological endpoints after laser-driven protons at ultra-high dose, conventional protons and X-ray exposures. Good levels of reduced oxygen concentration could be maintained in the absence of external gassing to quantify hypoxic effects and the data obtained provided an indication of an enhanced residual DNA DSB damage under hypoxic conditions at ultra-high dose rate compared to the conventional protons or X-rays

Risposta ormonale all'esercizio fisico negli ipertesi essenziali e nei pazienti con iperaldosteronismo primario.

In questo studio analizzeremo come i mediatori ormonali più importanti coinvolti nella risposta ad uno stress acuto, quindi ad un esercizio fisico intenso, possano variare da uno stato di riposo ad uno stato di massima richiesta metabolica. L’ormone ipofisario ACTH, attraverso l’asse ipotalamo-ipofisi-surrene, è il mediatore che interviene nella regolazione della risposta ad eventi stressanti. In numerosi studi si è visto che il rilascio di aldosterone è indotto da modificazioni acute dei livelli di ACTH dovute alle fluttuazioni circadiane della sua secrezione, da infusioni esogene di ACTH sintetico. È nostro interesse, invece, valutare la risposta dell’aldosterone all’ACTH in seguito ad uno stress fisico. Lo scopo di questo studio è duplice: • valutare la risposta ormonale dopo un esercizio fisico intenso e progressivo in soggetti con ipertensione essenziale e con iperaldosteronismo primitivo, ponendo particolare attenzione alle variazioni dell’aldosterone ed alle differenze nei due gruppi. • valutare se i pazienti con iperaldosteronismo primario presentano un danno d’organo maggiore rispetto agli ipertesi essenziali, confrontando i parametri ecocardiografici di riferimento. I pazienti in esame sono stati sottoposti a tre prelievi ematici: a riposo, all’apice di uno sforzo fisico massimale ed incrementale, attraverso il cicloergometro, e dopo sei minuti di riposo. Sono stati valutati i valori ematici di ACTH, Renina attiva, aldosterone, cortisolo, e catecolamine. Abbiamo valutato attraverso l’ecocardiografia gli spessori parietali e del setto interventricolare, misurato la camera ventricolare sinistra, calcolato l’indice di massa miocardica e valutato eventuali segni di disfunzione diastolica attraverso il doppler tissutale dell’anello mitralico. Attraverso l’ecocolor doppler dei vasi cerebro afferenti abbiamo ricercato la presenza di placche aterosclerotiche, valutato lo spessore medio intimale della carotide comune di destra e di sinistra, ad 1 cm dalla biforcazione carotide. L’aumento dei valori plasmatici di aldosterone, all’apice dello sforzo fisico, si è verificato sia in pazienti con ipertensione arteriosa essenziale sia in quelli che presentano un iperaldosteronismo primitivo; ci saremmo aspettati un maggior aumento in quest’ultimi, per via della più cospicua sensibilità all’azione dell’ACTH in questo gruppo, testimoniata da precedenti studi. Dai nostri dati, il rapporto incrementale dell’aldosterone è più alto nel gruppo di pazienti con iperaldosteronismo piuttosto che nei pazienti ipertesi essenziali. Ciò è abbastanza significativo per confermare le nostre ipotesi preliminari: i pazienti con iperaldosteronismo sono esposti a livelli plasmatici più alti di aldosterone rispetto agli ipertesi essenziali a seguito di un esercizio fisico; è presente, in loro, una correlazione molto più significativa fra i valori di ACTH e di aldosterone a riposo, all’apice dello sforzo e nel recupero. L’aldosterone comporta un danno d’organo cardiovascolare indipendente dallo stress emodinamico. Da questo studio appare chiaro come i pazienti con iperaldosteronismo primario, i quali sono esposti a elevati livelli plasmatici dell’ormone, presentino un rimodellamento cardiaco patologico maggiore rispetto ai pazienti con ipertensione arteriosa essenziale: avranno un cuore più fibrotico che presenterà una massa ventricolare maggiore ed una funzione di riempimento ventricolare alterata, accompagnata da danno vascolare con ispessimento medio intimale. È infine emerso che i pazienti con una maggiore massa ventricolare ed una peggiore funzione diastolica sono coloro che al prelievo effettuato all’apice dell’esercizio fisico presentavano valori maggiori di aldosterone

A Strategy for Deployment of Thorium and U233 (In Italy)

Thorium is an unavoidable nuclear fuel generator and a gigantic energy source, should nuclear technology become a strategy for the electricity production in regions like EU or in Countries like Italy. The history of the exploitation of thorium in nuclear technology provides a number of dead-end endeavors; at the same time, a large number of initiatives and ideas are fluorescent in various parts of the world dealing with the deployment of thorium as nuclear fuel. After examining the history and the current trends, the present paper deals with a dream project (for Italy): the 233U extracted from a thorium breeder reactor is stored to constitute an energy deposit, suitable for decades energy consumption, which has the potential to make stable the energy market, without targeting electricity production in the Country. Three topics touched in the paper are: a) 233U generation details; b) chemical separation of fissile and fertile materials; c) challenges for a nuclear reactor to produce electricity, desalinated water and fissile material, simultaneously