A pilot study to compare two different hyaluronic acid compounds for treatment of knee osteoarthritis.

Osteoarthritis is characterized by progressive articular cartilage degeneration, changes in subchondral bone and synovial inflammation, leading to pain and disability. Viscosupplementation with hyaluronic acid has been widely investigated due to the viscoelastic properties of this compound to manage pain improving the ability to perform daily activities in patients affected by osteoarthritis. In the present study we investigated the clinical effectiveness of viscosupplementation with a new highly cross-linked hyaluronic acid, Variofill®, in patients affected by bilateral knee osteoarthritis in comparison with the widely used Synvisc®. A total of 20 patients, aged between 24–74 years and affected by bilateral knee osteoarthritis, participated in this pilot randomized triple-blind clinical study. They received two injections (2 ml each) of Synvisc® in their left knee and 2 injections (2 ml each) of Variofill® in their right knee spaced 15 days apart. Visual Analogue Scale and Western Ontario McMaster Universities Osteoarthritis Index score were used to evaluate the efficacy of hyaluronic acid injections before and 3 and 6 months after treatment. Both treatment regimens resulted in a significant improvement vs baseline in all endpoints at 3 and 6 months (p < 0.001). Treatment with Variofill® resulted in a high percentage improvement in Visual Analogue Scale pain, Western Ontario McMaster Universities Osteoarthritis Index score pain and physical activity, when compared to Synvisc® viscosupplementation, at 6 months (p < 0.05). These results are encouraging for larger clinical trials with Variofill® in larger cohorts of patients affected by osteoarthritis of the knee

Stem cells in clinical practice: applications and warnings

Stem cells are a relevant source of information about cellular differentiation, molecular processes and tissue homeostasis, but also one of the most putative biological tools to treat degenerative diseases. This review focuses on human stem cells clinical and experimental applications. Our aim is to take a correct view of the available stem cell subtypes and their rational use in the medical area, with a specific focus on their therapeutic benefits and side effects. We have reviewed the main clinical trials dividing them basing on their clinical applications, and taking into account the ethical issue associated with the stem cell therapy

Étude comparative de l’administration militaire de l’Italie et de la France au Fezzan libyen. Un cas de modèle colonial en continuité (1930-1951)

IT) Il presente studio analizza lo sviluppo strutturale di una breve presenza coloniale, temporalmente consecutiva. Nel quadro di una ricerca di storia comparata, l’obiettivo è quello di descrivere il processo di instaurazione, esecuzione e governance di una duplice amministrazione coloniale europea: quella dell’Italia fascista e della Francia nel Fezzan libico. Si tratta anzitutto di precisare in che modo le zone desertiche del Sud libico divengono, progressivamente, un oggetto di contesa strategica tra le potenze imperiali, tali da rendere necessaria l’urgenza del ricorso ad una gestione amministrativa a carattere esclusivamente militare. Il nucleo centrale dell’elaborato indaga sulla maniera in cui dette strutture amministrative sono state concepite e messe in pratica da parte dei rispettivi militari impegnati sul posto, e il loro effettivo impatto sul tessuto sociale regionale. Nelle conclusioni, si evocano gli elementi di continuità e discontinuità tra le due esperienze; inoltre, tenuto conto del periodo storico preso in considerazione, compreso tra la piena realizzazione del colonialismo italiano in Libia e l’avvio del processo di transizione che porta il Paese nord africano verso l’indipendenza, si analizzano le conseguenze della gestione amministrativa in termini di costruzione identitaria dello Stato postcoloniale. EN) Desert Libya’s region of Fezzan presents an interesting case of a consecutive colonial military administration. A fascist italian period of ten years is followed by a french shortest-term direct administration of eight years. The research highlights the emergence to bridge an historical gap. In the framework of a comparative study, the main goal of the thesis is to investigate the development of the administrative changeover from fascist Italy to France in the region, illustrating the establishment of the double administration managed by soldiers of the two colonial powers, its impact toward the social regional structures and its elements of continuity and change. The period we take into consideration extends from 1930 to 1951, between the full realization of the italian colonization of Libya, through the so-called fascist “pacification”, and the transition process of the Independent Libyan State. This leads to explore a final understanding hypothesis, concerning the repercussion of this military continuum administration on the independence process of Libya

Anterior-to-Posterior Migration of a Lumbar Disc Sequestration. Surgical Remarks and Technical Notes about a Tailored Microsurgical Discectomy

Extrusion of disc material within the spinal canal complicates up to 28.6% of lumbar disc herniations. Due to the anatomical "corridors" created by the anterior midline septum and lateral membranes, relocation occurs with an anterior and anterolateral axial topography. Posterior migration is an extremely rare condition and anterior-to-posterior circumferential migration is an even rarer condition. Its radiological feature can be enigmatic and since, in more than 50% of cases, clinical onset is a hyperacute cauda equina syndrome, it may imply a difficult surgical decision in emergency settings. Surgery is the gold standard but when dealing with such huge sequestrations, standard microdiscectomy must be properly modified in order to minimize the risk of surgical trauma or traction on the nerve roots

A Preliminary Clinical Study

Background. Telangiectasia is the dilation of dermal capillaries mainly due to hypertension and vein insufficiency. Treatments of choice for this condition are sclerotherapy with foam liquid or intradermal fiber optic laser energy delivery. Aim. The aim of this study was to assess the efficacy of a new therapeutic approach consisting in the use of polymerized hyaluronic acid mesotherapic injections following sclerotherapy in the areas of the skin affected by telangiectasia in patients without major vein insufficiency. Materials and Methods. A total of 20 women, aged between 19 and 64 years, affected by recurrent lower leg telangiectasia, were included in this study. Patients were preliminarily submitted to echo color Doppler sonography to rule out severe saphenofemoral valve and lower limb major vein insufficiency. All patients underwent 3 sessions a month of polidocanol 1% capillary injections for 2 months. This was followed by 0.1 ml cross-linked hyaluronic acid introduction in the polidocanol 1% needle track. A total of 50 mesotherapic injections (0.05 ml each) were performed on the skin surface where an ice pack was previously applied for 4 to 5 minutes. A follow-up visit was performed at 3 months. The results, based on photographic examination, were rated as follows: poor improvement (0%-50%), good improvement (51%-75%), and very good improvement (76%-100%). The side effects of the clinical procedure, in terms of pain, itching, paresthesia, ecchymosis, and relapse of telangiectasia over the treated skin surface, as well as a persisting pigmentation in the injection spots and induced benefits related to leg heaviness and comfort, were recorded. Results. In total, 6 patients displayed a slight venous insufficiency, 3 patients displayed patent venous insufficiency, and 11 patients did not show any venous insufficiency. Before treatment, itching was present in 18 out of 20 patients, paresthesia in 15 out of 20 patients, ecchymosis in 16 out of 20 patients, and leg heaviness in 15 out of 20 patients. At the 3-month follow-up, an improvement of 0% to 50% was observed in 4 patients who had a relapse in telangiectasia. A 51% to 75% improvement was observed in 3 patients and a 76% to 100% improvement occurred in 13 patients. At the 3-month follow-up, itching persisted only in 4 patients; paresthesia was absent in 12 patients, while 3 patients still presented this symptom; ecchymosis was absent in 16 patients; 15 patients reported a feeling of lightweight legs. Among the patients with relapsing telangiectasia, 2 patients reported pigmentation due to hemosiderin deposit in the skin at the 3-month follow-up. The slight venous insufficiency, observed at the beginning of the study, improved in 5 out of 6 patients. The patients' compliance with the procedure was high and 16 out of 20 patients declared their willingness to repeat the whole clinical procedure, if necessary. Conclusions. This pilot clinical study supports the use of hyaluronic acid mesotherapic injections following sclerotherapy for treatment of lower leg telangiectasia without major venous insufficiency. We propose that the prolonged persistence of cross-linked hyaluronic acid, across the microvascular venous areas, is able to induce a stronger stromal tissue, thus preventing relapse. Further clinical studies, comparing this new approach with existing clinical procedures, are needed in a larger number of patients

Combination Therapy of Hyaluronic Acid Mesotherapic Injections and Sclerotherapy for Treatment of Lower Leg Telangiectasia Without Major Venous Insufficiency: A Preliminary Clinical Study

Background. Telangiectasia is the dilation of dermal capillaries mainly due to hypertension and vein insufficiency. Treatments of choice for this condition are sclerotherapy with foam liquid or intradermal fiber optic laser energy delivery. Aim. The aim of this study was to assess the efficacy of a new therapeutic approach consisting in the use of polymerized hyaluronic acid mesotherapicinjections following sclerotherapy in the areas of the skin affected by telangiectasia in patients without major vein insufficiency. Materials and Methods. A total of 20 women, aged between 19 and 64 years, affected by recurrent lower leg telangiectasia, were included in this study. Patients were preliminarily submitted to echo color Doppler sonography to rule out severe saphenofemoral valve and lower limb major vein insufficiency. All patients underwent 3 sessions a month of polidocanol 1% capillary injections for 2 months. This was followed by 0.1 ml cross-linked hyaluronic acid introduction in the polidocanol 1% needle track. A total of 50 mesotherapic injections (0.05 ml each) were performed on the skin surface where an ice pack was previously applied for 4 to 5 minutes. A follow-up visit was performed at 3 months. The results, based on photographic examination, were rated as follows: poor improvement (0%-50%), good improvement (51%-75%), and very good improvement (76%-100%). The side effects of the clinical procedure, in terms of pain, itching, paresthesia, ecchymosis, and relapse of telangiectasia over the treated skin surface, as well as a persisting pigmentation in the injection spots and induced benefits related to leg heaviness and comfort, were recorded. Results. In total, 6 patients displayed a slight venous insufficiency, 3 patients displayed patent venous insufficiency, and 11 patients did not show any venous insufficiency. Before treatment, itching was present in 18 out of 20 patients, paresthesia in 15 out of 20 patients, ecchymosis in 16 out of 20 patients, and leg heaviness in 15 out of 20 patients. At the 3-month follow-up, an improvement of 0% to 50% was observed in 4 patients who had a relapse in telangiectasia. A 51% to 75% improvement was observed in 3 patients and a 76% to 100% improvement occurred in 13 patients. At the 3-month follow-up, itching persisted only in 4 patients; paresthesia was absent in 12 patients, while 3 patients still presented this symptom; ecchymosis was absent in 16 patients; 15 patients reported a feeling of lightweight legs. Among the patients with relapsing telangiectasia, 2 patients reported pigmentation due to hemosiderin deposit in the skin at the 3-month follow-up. The slight venous insufficiency, observed at the beginning of the study, improved in 5 out of 6 patients. The patients’ compliance with the procedure was high and 16 out of 20 patients declared their willingness to repeat the whole clinical procedure, if necessary. Conclusions. This pilot clinical study supports the use of hyaluronic acid mesotherapic injections following sclerotherapy for treatment of lower leg telangiectasia without major venous insufficiency. We propose that the prolonged persistence of cross-linked hyaluronic acid, across the microvascular venous areas, is able to induce a stronger stromal tissue, thus preventing relapse. Further clinical studies, comparing this new approach with existing clinical procedures, are needed in a larger number of patients

Monocentric single-arm study of desmopressin acetate efficacy on nocturnal polyuria in the elderly.

AIM OF THE STUDY We designed a retrospective, monocentric, observational study to assess the efficacy and short-term side effect profile of desmopressin, a synthetic analogue of antidiuretic hormone, in 42 elderly patients affected by nocturnal polyuria (NP), a subset of nocturia (nocturnal overproduction of urine at night), which is characterised by nocturnal urine volume (NVU) exceeding 33% of the 24-hours total urine output. METHODS USED TO CONDUCT THE STUDY The subjects had NP and included 25 males, which had benign prostatic hyperplasia (12 out of 25 had been surgically or endoscopically operated) and 15 females that had increased urinary frequency, night-time voiding, loss of bladder control and recurrent bladder infections, due to perineal wall weakness and vaginal or bladder prolapse. Patients recorded the number of voids during waking hours using a digital continuous urine meter. The quality of life (QoL) and efficacy of desmopressin were assessed at baseline and 12 weeks after treatment using the International Consultation on Incontinence Questionnaire Nocturia Quality of Life Module (ICIQ-Nqol) and International Prostate Symptom Score questionnaire (IPPS-Q8). The dosage of desmopressin acetate varied according to the discretion of the physician, usually beginning with one tablet before going to bed at night for 3 months. The dose was increased at 1-week intervals if a reduction in the NVU or night-time frequency was not achieved. RESULTS OF THE STUDY We found that desmopressin treatment reduced the nocturnal voided volume (P < .0001), ICIQ-Nqol (P < .0001) and IPPS-Q8 (P < .0001). No significant serum sodium alterations or modifications in serum creatine, potassium, or body weight were observed in all the patients. No adverse effects were observed. CONCLUSIONS DRAWN FROM THE STUDY AND CLINICAL IMPLICATIONS Our findings show efficacy of desmopressin in the elderly for NP treatment supporting further clinical trials in larger cohorts of patients

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 &lt; 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 &lt; 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

How the andrological sector suffered from the dramatic Covid 19 outbreak in Italy: supportive initiatives of the Italian Association of Andrology (SIA)

The possible strategies for the remodulation of the andrological activity were discussed and shared within a team of national experts belonging to the Italian Society of Andrology (SIA). Initiatives for andrologists. With the various provisions of the Prime Minister that have followed all the national and local scientific meetings were canceled. In order to compensate for this abrupt lack of opportunities for scientific meetings, a cycle of live reports was activated on YOUTUBE by recognized experts, to cover many different andrological topics. The YOUTUBE channel was chosen as it can be easily followed by each member without having to download any streaming program, with the possibility to consult the contents without any time limitation. Initiatives for patients In this new context, non-urgent outpatient activities (such as Andrology) have been suspended throughout the national territory