41 research outputs found

    Effects of intensive lifestyle changes on erectile dysfunction in men

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    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

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

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    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)

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    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

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

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    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.

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    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

    Dipeptidyl peptidase-4 inhibitors in type 2 diabetes therapy--focus on alogliptin.

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    Type 2 diabetes mellitus is a complex and progressive disease that is showing an apparently unstoppable increase worldwide. Although there is general agreement on the first-line use of metformin in most patients with type 2 diabetes, the ideal drug sequence after metformin failure is an area of increasing uncertainty. New treatment strategies target pancreatic islet dysfunction, in particular gut-derived incretin hormones. Inhibition of the enzyme dipeptidyl peptidase-4 (DPP-4) slows degradation of endogenous glucagon-like peptide-1 (GLP-1) and thereby enhances and prolongs the action of the endogenous incretin hormones. The five available DPP-4 inhibitors, also known as ‘gliptins’ (sitagliptin, vildagliptin, saxagliptin, linagliptin, alogliptin), are small molecules used orally with similar overall clinical efficacy and safety profiles in patients with type 2 diabetes. The main differences between the five gliptins on the market include: potency, target selectivity, oral bioavailability, long or short half-life, high or low binding to plasma proteins, metabolism, presence of active or inactive metabolites, excretion routes, dosage adjustment for renal and liver insufficiency, and potential drug–drug interactions. On average, treatment with gliptins is expected to produce a mean glycated hemoglobin (HbA(1c)) decrease of 0.5%–0.8%, with about 40% of diabetic subjects at target for the HbA(1c) goal <7%. There are very few studies comparing DPP-4 inhibitors. Alogliptin as monotherapy or added to metformin, pioglitazone, glibenclamide, voglibose, or insulin therapy significantly improves glycemic control compared with placebo in adult or elderly patients with inadequately controlled type 2 diabetes. In the EXAMINE trial, alogliptin is being compared with placebo on cardiovascular outcomes in approximately 5,400 patients with type 2 diabetes. In clinical studies, DPP-4 inhibitors were generally safe and well tolerated. However, there are limited data on their tolerability, due to their relatively recent marketing approval. Alogliptin will be used most when avoidance of hypoglycemic events is paramount, such as in patients with congestive heart failure, renal failure, and liver disease, and in the elderly

    "Single-Surgeon" versus "Dual-Surgeon" Robot-Assisted Radical Prostatectomy and Pelvic Lymph-nodes Dissection: Comparative Analysis of Perioperative Outcomes

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    Purpose: To compare the perioperative outcomes of robot-assisted radical prostatectomy (RARP) with pelvic lymph-nodes dissection (PLND) when the same surgeon performs RARP and PLND versus one surgeon performs RARP and another surgeon performs PLND. Materials and methods: From January 2022 to March 2023, data of consecutive patients who underwent RARP with PLND were prospectively collected. The surgeries were performed by two "young" surgeons with detailed profile. Specifically for the study purpose, one surgeon performed RARP, and the other surgeon performed PLND. A set of surgeries performed according to the standard setup (i.e., the same surgeon performing both RARP and PLND) was retrieved from the institutional database and used as comparator arm. To test the study hypothesis, patients were divided into two groups: "dual-surgeon" versus "single-surgeon". Results: Fifty patients underwent RARP and PLND performed according to dual-surgeon setup and were compared to the last 50 procedures performed according to the standard single-surgeon setup. Patients in the groups had comparable baseline characteristics. Dual-surgeon interventions had significantly shorter median total operative (194 [IQR 178-215] versus 174 [IQR 146-195] minutes, p&lt;0.001) and console time (173 [IQR 158-194] versus 154 [IQR 129-170] minutes, p&lt;0.001). No significant differences were found in terms of blood loss, intraoperative complications, postoperative outcomes, and final pathology results. Conclusions: The present analysis found that when RARP and PLND are split onto two surgeons, the operative time is shorter by 20 minutes compared to when a single surgeon performs RARP and PLND. This is an interesting finding that could sponsor further studies

    Efficacy and safety of insulin-GLP-1 receptor agonists combination in type 2 diabetes mellitus: a systematic review

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    Introduction: Attaining optimal glycemic targets in patients with type 2 diabetes is often hard and compromised by the shortcomings of the several treatments. Areas covered: When glycemic levels are not adequately controlled, an association of GLP-1 receptor agonists and insulin therapy can be adopted. In order to assess the benefit/risk profile of this combination therapy, a literature search of randomized clinical trials was performed.Eighteen trials matched the inclusion criteria. In 10 studies, GLP-1 receptor agonists were added on to an existing regimen, whereas insulin added to an existing GLP-1 receptor agonists regimen occurred in 2 studies. Six studies compared GLP-1 receptor agonists with short acting insulin as a treatment strategy to intensify basal insulin therapy. Expert opinion: Clinical trials herein reviewed demonstrated the safety and the efficacy of combining GLP-1 receptor agonists with basal insulin, with most studies showing equal or slightly superior efficacy, as compared with the addition of prandial insulin, associated with weight loss and less hypoglycemia
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