Late-onset Hypogonadism: bone health.

Background: Bone health is underdiagnosed and undermanaged in men. Bone loss occurs in men with hypogonadism and in aging men. Thus, patients with a diagno- sis of late-onset hypogonadism (LOH) are at risk of osteoporosis and osteoporotic fractures. Objectives: To provide an update on research data and clinical implications regarding bone health in men with LOH by reviewing literature articles on this issue. Materials and Methods: A thorough search of listed publications in PubMed on bone health in older men with hypogonadism was performed, and other articles derived from these publications were further identified. Results: Late-onset Hypogonadism may be associated with reduced bone mineral density (BMD). In a pathophysiological perspective, the detrimental effects of testos- terone (T) deficiency on BMD are partly ascribed to relative estrogen deficiency and both serum T and serum estradiol (E2) need to be above 200 ng/dL and 20 pg/mL to prevent bone loss. The effects of exogenous T on BMD are controversial, but most of the studies confirm that testosterone replacement therapy (TRT) increases BMD and prevents further bone loss in men with hypogonadism. No data are available on TRT and the prevention of fractures. Discussion and Conclusion: In men with documented LOH, a specific clinical workup should be addressed to the diagnosis of osteoporosis in order to program subsequent follow-up and consider specific bone active therapy. TRT should be started according to guidelines of male hypogonadism while keeping in mind that it may also have posi- tive effects also on bone health in men with LOH

Iris: Interactive all-in-one graphical validation of 3D protein model iterations

Iris validation is a Python package created to represent comprehensive per-residue validation metrics for entire protein chains in a compact, readable and interactive view. These metrics can either be calculated by Iris, or by a third-party program such as MolProbity. We show that those parts of a protein model requiring attention may generate ripples across the metrics on the diagram, immediately catching the modeler's attention. Iris can run as a standalone tool, or be plugged into existing structural biology software to display per-chain model quality at a glance, with a particular emphasis on evaluating incremental changes resulting from the iterative nature of model building and refinement. Finally, the integration of Iris into the CCP4i2 graphical user interface is provided as a showcase of its pluggable design

Aging and sex hormones in males

Several large cohort studies have disclosed the trajectories of sex steroids changes overtime in men and their clinical significance. In men the slow, physiological decline of serum testosterone (T) with advancing age overlaps with the clinical condition of overt, pathological hypogonadism. In addition, the increasing number of comorbidities, together with the high prevalence of chronic diseases, all further contribute to the decrease of serum T concentrations in the aging male. For all these reasons both the diagnosis of late-onset hypogonadism (LOH) in men and the decision about starting or not T replacement treatment remain challenging. At present, the biochemical finding of T deficiency alone is not sufficient for diagnosing hypogonadism in older men. Coupling hypogonadal symptoms with documented low serum T represents the best strategy to refine the diagnosis of hypogonadism in older men and to avoid unnecessary treatments

The endocrine role of estrogens on human male skeleton

Before the characterization of human and animal models of estrogen deficiency, estrogen action was confined in the context of the female bone. These interesting models uncovered a wide spectrum of unexpected estrogen actions on bone in males, allowing the formulation of an estrogen-centric theory useful to explain how sex steroids act on bone in men. Most of the principal physiological events that take place in the developing and mature male bone are now considered to be under the control of estrogen. Estrogen determines the acceleration of bone elongation at puberty, epiphyseal closure, harmonic skeletal proportions, the achievement of peak bone mass, and the maintenance of bone mass. Furthermore, it seems to crosstalk with androgen even in the determination of bone size, a more androgen-dependent phenomenon. At puberty, epiphyseal closure and growth arrest occur when a critical number of estrogens is reached. The same mechanism based on a critical threshold of serum estradiol seems to operate in men during adulthood for bone mass maintenance via the modulation of bone formation and resorption in men. This threshold should be better identified in-between the ranges of 15 and 25 pg/mL. Future basic and clinical research will optimize strategies for the management of bone diseases related to estrogen deficiency in men

Estrogens and male reproduction

The chapter deals with the study of estrogen role in male reproduction, in particulare the role on hypothalamic-pituitary-gonadal axi

The representations of teachers’ role identity. A study on the “professional common sense”

The innovations introduced within a social and organizational context -the school context, in the case study discussed here- challenge the established systems of practices as well as people’s shared representations of their role and professional identity (Jensen & Wagoner, 2009; Castro & Batel, 2008). The innovations may even encourage the production of conflicting meanings (Elcheroth, Doise, & Reicher, 2011) able to facilitate or, on the other hand, hinder the expected transformations. Therefore, the study of the shared symbolic meanings may contribute to the acknowledgement of the dynamics of development of a system in terms of resistance or adhesion to change… which is a mandatory issue for the school system

Operating Room Management after 2008 Economic Crisis in Italy: A Literary Review

The 2008 financial crisis has changed administration methods of various activities and productive services, including health services.  In fact in Italy  it was necessary  a deep reorganization of the healthcare system due to a strong reduction in the  funds allocated to the health sector. Consequently the management of the hospital operative theaters like operating rooms (OR) has become a priority aspect in the health administration. In this context we performed a literary review about experiences or projects of operating room management (ORM) carried out in Italy between 2007 and nowadays. We searched Medline database and we found 12 articles meeting the inclusion criteria. Only one paper was submitted in 2007, the remain were drafted in the following years. The italian regions represented are mostly of the north center area. The topics discussed are heterogeneous: ORM reorganizations in clinical hospitals, simulations of models aimed to resolve OR slots assignment, surgical waiting lists management, OR process analysis and ORM literary review. Overall the results show that interest and competence for the ORM are quickly increasing in Italy. In fact, because OR are the most expansive and the most productive areas of every hospitals, it’s of paramount relief to implement strategies in order to optimize OR quality and minimize the non-productive and unnecessary costs, especially in the current period of austerity measures and continuous cuts to public funds. Keywords: hospitals, management, crisis, resources, surgery, healthcare, OR