Uniformizing (proximal) Δ-topologies

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Tonsillectomy and residents: a safe match?

Letter to the Edito

Kisspeptin receptor on the sperm surface reflects epididymal maturation in the dog

Alongside the well-known central modulatory role, the Kisspeptin system, comprising Kiss1, its cleavage products (Kisspeptins), and Kisspeptin receptor (Kiss1R), was found to regulate gonadal functions in vertebrates; however, its functional role in the male gamete and its localization during maturation have been poorly understood. The present study analyzed Kisspeptin system in dog testis and spermatozoa recovered from different segments of the epididymis, with focus on Kiss1R on sperm surface alongside the maturation during epididymal transit, demonstrated by modification in sperm kinetic, morphology, and protamination. The proteins Kiss1 and Kiss1R were detected in dog testis. The receptor Kiss1R only was detected in total protein extracts from epididymis spermatozoa, whereas dot blot revealed Kiss1 immunoreactivity in the epidydimal fluid. An increase of the Kiss1R protein on sperm surface along the length of the epididymis, with spermatozoa in the tail showing plasma membrane integrity and Kiss1R protein (p < 0.05 vs. epididymis head and body) was observed by flow cytometry and further confirmed by epifluorescence microscopy and Western blot carried on sperm membrane preparations. In parallel, during the transit in the epididymis spermatozoa significantly modified their ability to move and the pattern of motility; a progressive increase in protaminization also occurred. In conclusion, Kisspeptin system was detected in dog testis and spermatozoa. Kiss1R trafficking toward plasma membrane along the length of the epididymis and Kiss1 in epididymal fluid suggested a new functional role of the Kisspeptin system in sperm maturation and storage

Pleiotropic Outcomes of Glyphosate Exposure: From Organ Damage to Effects on Inflammation, Cancer, Reproduction and Development.

Glyphosate is widely used worldwide as a potent herbicide. Due to its ubiquitous use, it is detectable in air, water and foodstuffs and can accumulate in human biological fluids and tissues representing a severe human health risk. In plants, glyphosate acts as an inhibitor of the shi-kimate pathway, which is absent in vertebrates. Due to this, international scientific authorities have long‐considered glyphosate as a compound that has no or weak toxicity in humans. Howev-er, increasing evidence has highlighted the toxicity of glyphosate and its formulations in animals and human cells and tissues. Thus, despite the extension of the authorization of the use of glypho-sate in Europe until 2022, several countries have begun to take precautionary measures to reduce its diffusion. Glyphosate has been detected in urine, blood and maternal milk and has been found to induce the generation of reactive oxygen species (ROS) and several cytotoxic and genotoxic effects in vitro and in animal models directly or indirectly through its metabolite, ami-nomethylphosphonic acid (AMPA). This review aims to summarize the more relevant findings on the biological effects and underlying molecular mechanisms of glyphosate, with a particular focus on glyphosateʹs potential to induce inflammation, DNA damage and alterations in gene expression profiles as well as adverse effects on reproduction and development

Management of idiopathic epistaxis in adults: what's new? [Il trattamento dell’epistassi idiopatica nell’adulto: cosa c’è di nuovo?]

L’epistassi è uno dei disturbi più comuni per il quale il paziente si rivolge spesso al pronto soccorso. Questa revisione della letteratura sipropone di valutare sistematicamente e criticamente gli studi scientifici riguardo il trattamento dell’epistassi idiopatica al fine di ottenere utili spunti per la pratica clinica. La ricerca è stata eseguita nei database elettronici: PubMed, Embase, Cochrane e Central. I criteri di inclusione sono stati: studi clinici controllati retrospettivi o prospettici o randomizzati o studi su modelli animali che includevano i risultati nella gestione dell’epistassi idiopatica. Sono stati individuati 23 articoli che soddisfano i criteri di inclusione. Il tamponamento nasale rappresenta ancora l’approccio di prima linea all’epistassi, anche se è evidente dalla letteratura che sia il meno efficace ma il più associato a ricoveri ospedalieri di maggior durata rispetto alla chirurgia endoscopica basata sull’elettrocoagulazione. In conclusione appare sempre più evidente che la cauterizzazione dovrebbe essere l’approccio di prima linea per l’alto tasso di costo-efficacia e il basso rischio di complicanze. Tuttavia, ulteriori ricerche urgenti sono necessarie per validare l’efficacia dei nuovi biomateriali nel trattamento dell’epistassi.Epistaxis is one of the most common complaints presenting to emergency departments. The aim of this study is to systematically review and critically evaluate the evidence relating to treatment of idiopathic epistaxis for guiding best practice. A comprehensive review of the English language literature was performed using PubMed, Embase, Cochrane Library and Central electronic databases. The inclusion criteria were: retrospective or prospective or randomised controlled clinical trials which included outcomes in the management of idiopathic epistaxis. Twentythree articles met inclusion criteria and were reviewed. Nasal packing still represents the first-line approach to epistaxis, although, at present, it appears that there is clear evidence in the literature to suggest that it is less effective and associated with more admissions and longer hospital stays than endoscopic electrocoagulation-based management of epistaxis. In conclusion, cauterisation should be the first-line approach for its high cost-effectiveness rate and low risk of complications. Further research is urgently needed to assess the efficacy of new biomaterials

Risk factors for obstructive sleep apnea syndrome in children: state of the art

The obstructive sleep apnea syndrome (OSAS) represents only part of a large group of pathologies of variable entity called respiratory sleep disorders (RSD) which include simple snoring and increased upper airway resistance syndrome (UARS). Although the etiopathogenesis of adult OSAS is well known, many aspects of this syndrome in children are still debated. Its prevalence is about 2% in children from 2 to 8 years of age, mostly related to the size of the upper airways adenoid tissue. Several risk factors linked to the development of OSAS are typical of the pediatric age. The object of this paper is to analyze the state of the art on this specific topic, discussing its implications in terms of diagnosis and management

Trans-oral robotic surgery for the management of oropharyngeal carcinomas: A 9-year institutional experience

Trans-oral robotic surgery (TORS) has changed surgical management of patients with oropharyngeal squamous cell carcinomas (OPSCC). In this study we present surgical and oncologic outcomes of patients with oropharyngeal squamous cell carcinomas, treated using TORS, with and without an adjuvant therapy. Sixty patients with oropharyngeal squamous cell carcinomas treated with TORS between January 2008 and December 2017 have been retrospectively evaluated considering clinicopathologic features, disease characteristics, adjuvant treatments and oncological outcomes. TORS was performed for OPSCC to the base of tongue in 41.7%, tonsils in 46.7%, soft palate and posterior pharyngeal wall in 3.3% and 5%, respectively. Neck dissection was performed in 43.3% of patients. Management strategies included surgery alone in 30%, TORS and adjuvant radiotherapy in 33.3%, and TORS plus adjuvant chemotherapy in 36.7%. The 5-year overall survival of the total group was 77.6%, the 5-year disease-free survival rate was 85.2%, and the 5-year local recurrence-free survival rate was 90.6%. Finally, in selected patients TORS appears to yield similar oncologic outcomes and functional outcomes to traditional techniques and non-operative treatment with a possible benefit on long-term quality of life. The future offers exciting opportunities to combine TORS and radiotherapy in unique ways. However, further research is urgently needed to clarify the indications for adjuvant therapy following TORS resections

Palatal surgery in a transoral robotic setting (TORS): preliminary results of a retrospective comparison between uvulopalatopharyngoplasty (UPPP), expansion sphincter pharyngoplasty (ESP) and barbed repositioning pharyngoplasty (BRP)

Negli ultimi anni si è diffusa lopinione che la chirurgia multilivello nel trattamento della sindrome delle apnee ostruttive garantisca risultati pià soddisfacenti. Lobiettivo del nostro lavoro è quello di confrontare tre tecniche palatali associate alla TORS: luvulopalatofaringoplastica (UPPP), lexpansion sphincter pharyngoplasy (ESP) e la barbed repositioning pharingoplasty (BRP). Trenta pazienti, trattati con TORS, tonsillectomia e settoturbinoplastica e chirurgia palatale sono stati retrospettivamente studiati. I seguenti valori pre e post-operatori sono stati presi in considerazione: AHI, ESS, VAS per la valutazione del dolore, tempi operatori palatali, data di dimissione e complicanze (tipi ed incidenza). Sia la BRP che lESP hanno garantito dei valori postoperatorio di AHI inferiori rispetto allUPPP con un maggior tasso di successo chirurgico. Dallaltra parte non è stato possibile dimostrare una superiorità della BRP sullESP. I tempi operatori più lunghi sono stati registrati nel gruppo ESP mentre i più brevi sono stati riscontrati nel gruppo BRP. Riassumendo, ESP e BRP sono risultate più efficaci dellUPPP in un setting robotico multilivello. Inoltre, essendo una tecnica rapida, di facile apprendimento e dal basso tasso di complicanze, la BRP si presenta come una valida opzione chirurgica nel trattamento dellOSAS

Multi-systemic alterations by chronic exposure to a low dose of bisphenol a in drinking water: Effects on inflammation and nad+-dependent deacetylase sirtuin1 in lactating and weaned rats

Bisphenol A (BPA) is largely used as a monomer in some types of plastics. It accumulates in tissues and fluids and is able to bypass the placental barrier, affecting various organs and systems. Due to huge developmental processes, children, foetuses, and neonates could be more sensitive to BPA-induced toxicity. To investigate the multi-systemic effects of chronic exposure to a low BPA dose (100 µg/L), pregnant Wistar rats were exposed to BPA in drinking water during gestation and lactation. At weaning, newborn rats received the same treatments as dams until sex maturation. Free and conjugated BPA levels were measured in plasma and adipose tissue; the size of cerebral ventricles was analysed in the brain; morpho-functional and molecular analyses were carried out in the liver with a focus on the expression of inflammatory cytokines and Sirtuin 1 (Sirt1). Higher BPA levels were found in plasma and adipose tissue from BPA treated pups (17 PND) but not in weaned animals. Lateral cerebral ventricles were significantly enlarged in lactating and weaned BPA-exposed animals. In addition, apart from microvesicular steatosis, liver morphology did not exhibit any statistically significant difference for morphological signs of inflammation, hypertrophy, or macrovesicular steatosis, but the expression of inflammatory cytokines, Sirt1, its natural antisense long non-coding RNA (Sirt1-AS LncRNA) and histone deacetylase 1 (Hdac1) were affected in exposed animals. In conclusion, chronic exposure to a low BPA dose could increase the risk for disease in adult life as a consequence of higher BPA circulating levels and accumulation in adipose tissue during the neonatal period