Finding the Wolf in Sheep's Clothing: The 4Kscore Is a Novel Blood Test That Can Accurately Identify the Risk of Aggressive Prostate Cancer

Better biomarkers that can discriminate between aggressive and indolent phenotypes of prostate cancer are urgently needed. In the first 20 years of the prostate-specific antigen (PSA) era, screening for prostate cancer has successfully reduced prostate cancer mortality, but has led to significant problems with overdiagnosis and overtreatment. As a result, many men are subjected to unnecessary prostate biopsies and overtreatment of indolent cancer in order to save one man from dying of prostate cancer. A novel blood test known as the 4Kscore\uae Test (OPKO Lab, Nashville, TN) incorporates a panel of four kallikrein protein biomarkers (total PSA, free PSA, intact PSA, and human kallikrein-related peptidase 2) and other clinical information in an algorithm that provides a percent risk for a high-grade (Gleason score 65 7) cancer on biopsy. In 10 peer-reviewed publications, the four kallikrein biomarkers and algorithm of the 4Kscore Test have been shown to improve the prediction not only of biopsy histopathology, but also surgical pathology and occurrence of aggressive, metastatic disease. Recently, a blinded prospective trial of the 4Kscore Test was conducted across the United States among 1012 men. The 4Kscore Test replicated previous European results showing accuracy in predicting biopsy outcome of Gleason score 65 7. In a recent case-control study nested within a population-based cohort from V\ue4sterbotten, Sweden, the four kallikrein biomarkers of the 4Kscore Test also predicted the risk for aggressive prostate cancer that metastasized within 20 years after the test was administered. These results indicate that men with an abnormal PSA or digital rectal examination result, and for whom an initial or repeat prostate biopsy is being considered, would benefit from a reflex 4Kscore Test to add important information to the clinical decision-making process. A high-risk 4Kscore Test result may be used to select men with a high probability of aggressive prostate cancer who would benefit from a biopsy of the prostate to prevent an adverse and potentially lethal outcome from prostate cancer. Men with a low 4Kscore Test result may safely defer biopsy

Optimal Sizing and Environ-Economic Analysis of PV-BESS Systems for Jointly Acting Renewable Self-Consumers

Future residential applications could benefit from nanogrids that integrate photovoltaics (PV) and battery energy storage systems (BESS), especially after the establishment of recent European Community directives on renewable energy communities (RECs) and jointly acting renewable self-consumers (JARSCs). These entities consist of aggregations of users who share locally produced energy with the aim of gaining economic, environmental, and social benefits by enhancing their independence from the electricity grid. In this regard, the sizing of the PV and BESS systems is an important aspect that results in a trade-off from technical, economic, and environmental perspectives. To this end, this paper presents an investigation on the optimal PV-BESS system sizing of a condominium acting as a JARSC community, which includes a common PV plant and EMS, operated by rule-based criteria. PV-BESS sizing results are investigated from economic and environmental perspectives, considering a case study located in Milan, Italy. In these regards, in addition to the common techno-economic criteria, carbon dioxide emissions are considered with particular attention, as their reduction is the driving ethos behind recent EU directives

Strategie di controllo dei vettori associati ai giallumi della vite.

Flavescence dor\ue9e and Bois noir are grapevine yellows diseases of great economic importance in European viticulture. They are associated with \u201cCa. Phytoplasma vitis\u201d and \u201cCa. Phytoplasma solani\u201d transmitted by the Cicadellidae Scaphoideus titanus Ball and by the Cixiidae Hyalesthes obsoletus Signoret, respectively. The control strategies of these diseases are based on rouging of infected plants, source of phytoplasmas, and on vectors control before they are able to inoculate the pathogens in healthy plants. Since plant sources of phytoplasmas external to vineyards are implicated in the epidemiology of these diseases, control strategies must be implemented at territorial level and involve all the growers. From 2014, according to CE Directive 128/2009 on \u201cSustainable use of pesticides\u201d, all growers must adopt alternative methods to chemical control in order to reduce the use of pesticides. In this contribution we aim to review current monitoring and control techniques as well as the new perspectives in the control of the grapevine yellows diseases in an Integrated Pest Management context

Human immunodeficiency virus and sexually transmitted disease disparities among transgender persons

Experiencies of transphobic discrimination and victimization negatively impact on mental health, and the lack of social support has been found to be associated with a higher rate of undiagnosed HIV infection. To accurately assess the prevalence of HIV infection and other sexually transmitted diseases in the transgender population it is essential to create centres that can offer a comprehensive, multidisciplinary and adequate support to these patients

It's not always varicocele: A strange case of Zinner syndrome

A 42-year-old man presented with a huge varicocele. The patient was completely asymptomatic and he did not complain of dysuria, perineal discomfort, or ejaculatory pain. During the visit, the mass mimicked a varicocele and during the Valsalva maneuver a reflux was documented by colour Doppler ultrasound and an abdominal ultrasound revealed an agenesis of the right kidney and a 4.5-cm diameter intra-prostatic cyst. An abdominal and pelvis magnetic resonance imaging was then performed, which confirmed the right renal agenesis, with an epididymal enlargement in the body and tail. This is a unique case of Zinner syndrome in which the patient presented with a paratesticular mass mimicking a varicocele. \ua9 2015 Canadian Urological Association

A conservative treatment for eosinophilic cystitis

Introduction: Eosinophilic cystitis is a rare condition which causes common symptoms and may mimic other conditions. Eosinophilic cystitis has several causes such as hypereosinophilic syndrome, inflammatory diseases, neoplasia, parasites or fungal infection, IgE-related diseases, Drug Reaction and Eosinophilia and Systemic Symptoms (DRESS) syndrome, or Churg-Strauss syndrome. Therefore, differential diagnosis is difficult. Case presentation: We report the case of a middle-aged man affected by eosinophilic cystitis with persistent hematuria and other peculiar symptoms that may be brought back to hypereosinophilic crisis. Conclusion: Conservative approach is preferred, avoiding radical cystectomy rather than corticosteroid, antihistaminic and second line therapy. Hyperbaric therapy is an innovative approach for severe relapsing gross hematuria without specific literature and should be studied for further indications

Prevention and treatment of infectious complications after urogenital prosthesis surgery

Prostheses are widely used in urogenital surgery for many decades and have gained a fundamental role in the management of multiple diseases with good results in terms of functionality, aesthetic outcomes and patients\u2019 satisfaction. It is remarkable that prosthetic device vary in term of mechanical sophistication, costs and surgical implantation techniques ranging from simple device widely used in urological practice like testicular prosthesis to highly sophisticated devices as Inflatable Penile Prosthesis (IPP) and Artificial Urinary Sphincter (AUS). Despite continuous implementations of the devices and improvements of surgical implantation techniques infective complications are still fearful and not uncommon events. Risk of infection depends on patients\u2019 individual features, perioperative strategies, implantation techniques and prosthetic devices. Prevent these complications is imperative because the management of prosthesis infection requires removal of the device in most cases. Centres that plan prosthetic implantations should based on these strategies protocols in order to prevent as far as possible infective complications

Functionally graded ultra-high temperature ceramics: From thermo-elastic numerical analysis to damage tolerant composites

To maximize the toughening contributions due to fiber bridging and residual stresses upon layering, ultra-high temperature ceramics containing variable amounts of short carbon fiber in functionally graded stacking sequences were designed and characterized. Stress fields evaluated by finite element model on (AB)nA and more complex asymmetric architectures were compared to the experimental fracture toughness pointing to an effective toughness increment in those structures where the notch fell in zones of residual compression. For the best composite, toughness at room temperature achieved 7 MPa·m0.5 and further increased to 10 MPa·m0.5 when tested at 1500 °C within a light ZrB2-based composite with density below 4 g/cm3. According to the numerical simulations and the effective microstructural features of the composites, the main guidelines for the realization of ceramics with simultaneous failure tolerance and ablation resistance were established.Peer ReviewedPostprint (published version

Is there a place for nutritional supplements in the treatment of idiopathic male infertility?

Objective: Infertility affects 15% of couples in fertile age. Male factor is a cause of infertility in almost half of cases, mainly due to oligoasthenoteratozoospermia (OAT). The purpose of this study is to review the effects of nutritional supplements as medical treatment for idiopathic male infertility. Material and methods: A Pub Med and Medline review of the published studies utilizing nutritional supplements for the treatment of male infertility has been performed. Results: Clinical trials on Vitamin E, Vitamin A, Vitamin C. Arginine, Carnitine, N-Acetyl-Carnitine, Glutathione, Coenzyme Q10, Selenium and Zinc were reviewed. Although there is a wide variability in selected population, dose regimen and final outcomes, nutritional supplements both alone and in combination seems to be able to improve semen parameters (sperm count, sperm motility and morphology) and pregnancy rate in infertile men. Conclusions: There are rising evidences from published randomized trials and systematic review suggesting that nutritional supplementation may improve semen parameters and the likelihood of pregnancy in men affected by OAT. This improvement, however, is not consistent and there is a wide variation in the treatment regimens used. Well designed and adequately powered RCTs are needed to better clarify the role of nutritional supplements as treatment for male infertility