RESUMEN
PURPOSE: The lack of inter-method agreement can produce inconsistent results in neuroimaging studies. We evaluated the intra-method repeatability and the inter-method reproducibility of two widely-used automatic segmentation methods for brain MRI: the FreeSurfer (FS) and the Statistical Parametric Mapping (SPM) software packages. METHODS: We segmented the gray matter (GM), the white matter (WM) and subcortical structures in test-retest MRI data of healthy volunteers from Kirby-21 and OASIS datasets. We used Pearson's correlation (r), Bland-Altman plot and Dice index to study intra-method repeatability and inter-method reproducibility. In order to test whether different processing methods affect the results of a neuroimaging-based group study, we carried out a statistical comparison between male and female volume measures. RESULTS: A high correlation was found between test-retest volume measures for both SPM (r in the 0.98-0.99 range) and FS (r in the 0.95-0.99 range). A non-null bias between test-retest FS volumes was detected for GM and WM in the OASIS dataset. The inter-method reproducibility analysis measured volume correlation values in the 0.72-0.98 range and the overlap between the segmented structures assessed by the Dice index was in the 0.76-0.83 range. SPM systematically provided significantly greater GM volumes and lower WM and subcortical volumes with respect to FS. In the male vs. female brain volume comparisons, inconsistencies arose for the OASIS dataset, where the gender-related differences appear subtler with respect to the Kirby dataset. CONCLUSIONS: The inter-method reproducibility should be evaluated before interpreting the results of neuroimaging studies.
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Encéfalo/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodos , Imagen por Resonancia Magnética , Programas Informáticos , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: Recent retrospective studies suggest that beta-adrenergic blocking drugs (BB) are associated with improved outcomes in patients with a range of cancers. Although limited and discordant data suggest that BB may increase overall survival (OS) in localized breast cancer (BC), there is no information on the effects of BB in women with advanced BC. PATIENTS AND METHODS: To explore the association between BB use and BC outcomes, we retrospectively reviewed ROSE/TRIO-012, a double-blinded, multinational phase III trial that randomized 1144 patients with HER2-negative advanced BC to first-line docetaxel in combination with ramucirumab or placebo. We compared progression-free survival (PFS), OS, overall response rate, and clinical benefit rate in patients who received BB to those who did not. RESULTS: 153/1144 (13%) patients received BB; 62% prior to enrolment and 38% began after enrolment. Median PFS in BB treated patients was longer than in patients who did not receive them (10.3 versus 8.3 months; HR 0.81; 95% CI 0.66-0.99; P = 0.038). Patients treated with BB only after enrolment had even higher median PFS (15.5 versus 8.3 months, P < 0.001). In the TNBC subset, median PFS was 13.0 months with BB, compared to 5.2 months without BB (HR 0.52; 95% CI 0.34-0.79; P = 0.002). The benefit of BB intake in PFS was independent of treatment-emergent hypertension (P = 0.476) but associated with treatment arm (P = 0.037). The test for interactions between BB and treatment arm was not significant (P = 0.276). No differences were seen in OS, overall response rate, or clinical benefit rate. A validation dataset analysis had consistent but less substantial improved outcomes for women with node positive operable breast cancer receiving BB in the BCIRG-005 trial. CONCLUSIONS: In this exploratory analysis, BB intake was associated with significant improvement in PFS, particularly in patients with TNBC and patients not previously exposed to BB. CLINICAL TRIAL NUMBER: NCT00703326.
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Antagonistas Adrenérgicos beta/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Taxoides/administración & dosificación , Anticuerpos Monoclonales Humanizados , Neoplasias de la Mama/patología , Supervivencia sin Enfermedad , Docetaxel , Método Doble Ciego , Femenino , Humanos , Placebos , Receptor ErbB-2/metabolismo , Estudios Retrospectivos , Análisis de Supervivencia , Taxoides/uso terapéutico , RamucirumabRESUMEN
Premature ejaculation (PE) is considered to be the most common male sexual dysfunction. The realization that PE may co-exist with ED prompted the use of PDE5-i's alone or in combination with selective serotonin reuptake inhibitors (SSRIs) for treating ejaculatory disorders. Until recently, there was little evidence that PDE5-i's alone may have a role in the treatment of PE in the absence of ED, and current available treatments include only on-demand dapoxetine. However, available data indicate that there is clinical, anatomical, physiological, pharmacological and genetic evidence to explain the efficacy of PDE5-i's. Nine manuscripts that examined the efficacy of PDE5-i's in the treatment of PE, alone or in combination with SSRIs, were retrieved. All studies reported some significant changes in the intravaginal ejaculatory latency time and sexual satisfaction scores, although not all were clinically meaningful. Well-designed multicenter studies are urgently required to further elucidate the efficacy and safety, as well as the mechanisms of action of PDE5-i's in the treatment of PE. The aim of this review is to discuss basic rationale and to show clinical evidence sustaining the possibility to use off-label PDE5-i's to treat PE.
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Eyaculación/efectos de los fármacos , Inhibidores de Fosfodiesterasa/uso terapéutico , Disfunciones Sexuales Fisiológicas/tratamiento farmacológico , Disfunciones Sexuales Psicológicas/tratamiento farmacológico , Ensayos Clínicos como Asunto , Eyaculación/fisiología , Humanos , Masculino , Disfunciones Sexuales Fisiológicas/fisiopatología , Disfunciones Sexuales Psicológicas/fisiopatologíaRESUMEN
The application of digital pulse amplitude by fingertip peripheral arterial tonometry (PAT) device in patients with erectile dysfunction (ED) has never been performed. We investigated the diagnostic value of reactive hyperaemia (RH) and augmentation index (AI) as evaluated using PAT in men with ED of any origin. A total of 40 patients underwent diagnostic investigation for ED, including dynamic penile duplex ultrasound (PDU) and PAT device. Moreover, 30 patients without ED served as controls. According to PDU cutoff at 35 cm/sec, patients were divided into vascular (n = 30) and nonvascular (n = 10) ED aetiology. Moreover, controls with (n = 10) or without (n = 20) vascular risk factors (VRFs) were studied in a separate analysis. Average RH-PAT was not different in men with or without ED (P = 0.56) independently of VRFs. The AI was higher in men with ED compared with the controls (P < 0.0001) as well as when controlled for the presence or absence of VRFs (P < 0.0001). An inverse relationship between AI and PSV was also found (r² = -0.72, P < 0.0001). In conclusion, an increased AI but not an impaired RH-PAT is present in men with vascular ED independently of VRFs and may represent an early detection of vascular impairment that may precede endothelial dysfunction in populations at low risk for developing vascular ED.
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Endotelio Vascular/fisiopatología , Disfunción Eréctil/fisiopatología , Manometría/métodos , Pene/irrigación sanguínea , Enfermedades Vasculares/diagnóstico , Adulto , Anciano , Arterias/fisiopatología , Presión Sanguínea/fisiología , Estudios de Casos y Controles , Elasticidad/fisiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Sensibilidad y Especificidad , Enfermedades Vasculares/epidemiología , Enfermedades Vasculares/fisiopatologíaRESUMEN
This paper is an Italian Expert Consensus Document on multidimensional treatment of obesity and eating disorders. The Document is based on a wide survey of expert opinion. It presents, in particular, considerations regarding how clinicians go about choosing the most appropriate site of treatment for a given patient suffering from obesity and/or eating disorders: outpatient, partial hospitalization, residential rehabilitation centre, inpatient hospitalization. In a majority of instances obesity and eating disorders are long-term diseases and require a multiprofessional team-approach. In determining an initial level of care or a change to a different level of care, it is essential to consider together the overall physical condition, medical complications, disabilities, psychiatric comorbidity, psychology, behaviour, family, social resources, environment, and available services. We first created a review manuscript, a skeleton algorithm and two rating scales, based on the published guidelines and the existing research literature. As the second point we highlighted a number of clinical questions that had to be addressed in the specific context of our National Health Service and available specialized care units. Then we submitted eleven progressive revisions of the Document to the experts up to the final synthesis that was approved by the group. Of course, from point to point, some of the individual experts would differ with the consensus view. The document can be viewed as an expert consultation and the clinical judgement must always be tailored to the particular needs of each clinical situation. We will continue to revise the Document periodically based on new research information and on reassessment of expert opinion to keep it up-to-date. The Document was not financially sponsored.
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Atención Ambulatoria , Testimonio de Experto , Trastornos de Alimentación y de la Ingestión de Alimentos/diagnóstico , Trastornos de Alimentación y de la Ingestión de Alimentos/terapia , Hospitalización , Obesidad/diagnóstico , Obesidad/terapia , Grupo de Atención al Paciente , Tratamiento Domiciliario , Algoritmos , Atención Ambulatoria/normas , Anorexia Nerviosa/diagnóstico , Anorexia Nerviosa/terapia , Trastorno por Atracón/diagnóstico , Trastorno por Atracón/terapia , Bulimia Nerviosa/diagnóstico , Bulimia Nerviosa/terapia , Comorbilidad , Consenso , Centros de Día , Evaluación de la Discapacidad , Trastornos de Alimentación y de la Ingestión de Alimentos/fisiopatología , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Trastornos de Alimentación y de la Ingestión de Alimentos/rehabilitación , Adhesión a Directriz , Humanos , Italia , Actividad Motora , Programas Nacionales de Salud , Estado Nutricional , Obesidad/fisiopatología , Obesidad/psicología , Obesidad/rehabilitación , Guías de Práctica Clínica como Asunto , Tratamiento Domiciliario/normas , Factores de Riesgo , Medio Social , CaminataRESUMEN
BACKGROUND: Obese individuals often present comorbidities while they appear protected against the development of osteoporosis. However, few and contradictory data are now available on skeletal modifications in obese patients. The aim of this study was to characterise bone mineral density (BMD) in overweight (BMI > 25 < 29.9) and obese (BMI > 30) patients. METHODS: We selected 398 patients (291 women, 107 men, age 44.1 + 14.2 years, BMI 35.8 + 5.9 kg/m(2)) who underwent clinical examination, blood tests and examination of body composition. Subjects with chronic conditions or taking medications interfering with bone metabolism, hormonal and nutritional status and recent weight loss were excluded. RESULTS: Interestingly, 37% (n = 146) of this population showed a significantly lower than expected lumbar BMD: 33% (n = 98) of women showed a T-score -1.84 +/- 0.71, and 45% (n = 48) of men showed a T-score -1.88 +/- 0.64. When the population was divided into subgroups based on different BMI, it was noted that overweight (BMI > 25 < 29.9) was neutral or protective for BMD, whereas obesity (BMI > 30) was associated with a low bone mass, compatible with a diagnosis of osteoporosis. No differences were observed in hormones and lipid profiles among subgroups. CONCLUSIONS: Our results indicate that a subpopulation of obese patients has a significant low lumbar BMD than expected for age. Thus, a careful characterisation of skeletal metabolism might be useful in all obese individuals to avoid fragility fractures later in life.
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Índice de Masa Corporal , Densidad Ósea/fisiología , Obesidad/fisiopatología , Osteoporosis/fisiopatología , Adulto , Estudios de Cohortes , Femenino , Humanos , Vértebras Lumbares/fisiología , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Osteoporosis/complicacionesRESUMEN
BACKGROUND: Obesity is an increasing health problem and surgery seems to be the only treatment effective in achieving weight loss without relapse. Among bariatric techniques, many differences exist in terms of weight loss and resolution of comorbidities. Up to now, there are no prospective studies comparing long-term effects of malabsorptive vs restrictive techniques. OBJECTIVE: In this study, cardiometabolic risk factors and body composition changes after malabsorptive biliointestinal bypass (BIBP) and restrictive laparoscopic adjustable gastric banding (LAGB) were compared during a 4-year follow-up. DESIGN: Prospective, case-control and cohort study. PATIENTS: In all, 80 obese subjects, matched for weight and age. Altogether, 40 patients underwent BIBP and 40 underwent LAGB. MEASUREMENTS: Weight, body composition, fasting and post-loading plasma glucose and insulin, homeostatic model assessment index (HOMA-I), lipid profile, blood pressure (BP), erythrocyte sedimentation rate and fibrinogen were monitored at baseline, 12 and 48 months. RESULTS: At 12 months after surgery, a significant reduction in body mass index, total fat mass (FM), trunk FM (trFM), trFM/legs FM (lFM) ratio (trFM/lFM), triglycerides, BP and inflammation markers was observed in both groups. BIBP patients showed a significant reduction in total cholesterol (Tot-C), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), whereas the LAGB group showed a significant increase of HDL-C. A further improvement of all the parameters evaluated was seen in the BIBP group at 48 months after surgery. CONCLUSIONS: Both bariatric procedures exerted positive effects on cardiometabolic risk factors and on weight loss in the population studied, but on the long-term period, HOMA-I, Tot-C/HDL-C ratio and body composition improvements were more evident after BIBP. We conclude that malabsorptive BIBP seems to be more effective than LAGB in treating visceral obesity and its metabolic complications.
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Cirugía Bariátrica/métodos , Composición Corporal/fisiología , Obesidad/cirugía , Pérdida de Peso/fisiología , Adulto , Cirugía Bariátrica/efectos adversos , Índice de Masa Corporal , Estudios de Casos y Controles , Femenino , Gastroplastia/efectos adversos , Gastroplastia/métodos , Humanos , Masculino , Obesidad/sangre , Obesidad/complicaciones , Estudios Prospectivos , TiempoRESUMEN
AIM: To investigate efficacy and safety of two different preparations of testosterone undecanoate (TU) in 52 hypogonadal men [mean age 57 yr and mean testosterone (T) < 320 ng/dl] with metabolic syndrome (MS). SUBJECTS AND METHODS: Randomized, double-blind, double-dummy study with three parallel treatment arms [oral TU; transdermal placebo gel (P); im TU] administration for 12 months (mo). Each subject was randomized (1:1:3) to receive either oral TU (2 capsules of 40 mg/twice per day at breakfast and dinner, equalling a total dose of 160 mg/day; no.=10) for 6 mo and continued with im TU for further 6 mo, or P (3-4 g/day; no.=10) and im TU (1000 mg/12 weeks from week 6; no.=32) for 12 mo. RESULTS: After 6 mo, im TU increased T and free- T levels (p<0.0001), and improved metabolic parameters [reduction in Homeostasis Model Assessment (HOMA) index, p<0.0001; waist circumference and fat mass, p<0.001, respectively], in International Index of Erectile Function-5 and Aging Males' Symptoms scores (p<0.01, respectively). After 12 months, im TU produced further increases in T and free- T levels (p<0.0001) and metabolic parameters (reduction in HOMA-index, p<0.0001; waist circumference p<0.0001; fat mass, p<0.001). No major adverse event due to T treatment occurred. CONCLUSIONS: Clinical efficacy of T replacement therapy in hypogonadal men with MS is reached when its plasmatic levels approach into the medium-high range of normality (>5 ng/ml), although subjective threshold values may be different. Administration of im TU was more effective than oral TU to reach the target for T levels and to improve MS parameters. TU was safe over 12 months and discontinuation rates were similar to placebo.
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Hipogonadismo/tratamiento farmacológico , Testosterona/análogos & derivados , Administración Oral , Composición Corporal/efectos de los fármacos , Humanos , Hipogonadismo/sangre , Inyecciones Intramusculares/economía , Seguro de Servicios Farmacéuticos , Italia , Masculino , Síndrome Metabólico/tratamiento farmacológico , Síndrome Metabólico/fisiopatología , Persona de Mediana Edad , Erección Peniana/efectos de los fármacos , Testosterona/administración & dosificación , Testosterona/sangre , Testosterona/economíaRESUMEN
Premature ejaculation (PE) is thought to be the most common male sexual dysfunction; however, the prevalence of lifelong (LL)-PE is relatively low. The aim of this study was to investigate the effects of on-demand vardenafil (10 mg) to modify the intravaginal ejaculatory latency time (IELT) in men with LL-PE without erectile dysfunction. Forty-two men (18-35 years) were enrolled in a 16-week, double-blind, placebo-controlled, cross-over study. Primary end point was the modification from baseline of IELT assessed by stopwatch technique; secondary end points were post-ejaculatory refractory time (PERT) and variations of scores at the Index of Premature Ejaculation questionnaire. The changes in geometric mean IELT were superior after taking vardenafil (0.6+/-0.3 vs 4.5+/-1.1 min, P<0.01), compared with placebo (0.7+/-0.3 vs 0.9+/-1.0 min, ns). PERT dropped significantly after vardenafil (16.7+/-2.0 vs 4.3+/-0.9 min, P<0.001), compared with placebo (15.3+/-2.2 vs 15.8+/-2.3 min). Patients who took vardenafil (vs placebo) reported significantly (P<0.01) increased ejaculatory control (6+/-2 vs 16+/-2), improved overall sexual satisfaction (7+/-2 vs 15+/-1) and distress (4+/-1 vs 8+/-1) scores, respectively. Multiple regression analysis (r(2)=0.86) for IELT by the number of attempts at sexual intercourse showed significant differences between the slopes of lines for placebo and vardenafil (P<0.0001). The most common adverse events for vardenafil (vs placebo) were headache (10 vs 3%), flushing (12 vs 0%) and dyspepsia (10 vs 0%), which tended to disappear over the time. In conclusion, in our study, vardenafil increased IELT and reduced PERT in men with LL-PE. Besides, improvements in confidence, perception of ejaculatory control and overall sexual satisfaction were reported.
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Eyaculación/efectos de los fármacos , Imidazoles/uso terapéutico , Inhibidores de Fosfodiesterasa/uso terapéutico , Piperazinas/uso terapéutico , Disfunciones Sexuales Fisiológicas/tratamiento farmacológico , Adolescente , Adulto , Coito/fisiología , Coito/psicología , Estudios Cruzados , Método Doble Ciego , Femenino , Humanos , Imidazoles/administración & dosificación , Imidazoles/efectos adversos , Masculino , Inhibidores de Fosfodiesterasa/efectos adversos , Piperazinas/administración & dosificación , Piperazinas/efectos adversos , Estudios Prospectivos , Disfunciones Sexuales Fisiológicas/psicología , Sulfonas/administración & dosificación , Sulfonas/efectos adversos , Sulfonas/uso terapéutico , Encuestas y Cuestionarios , Triazinas/administración & dosificación , Triazinas/efectos adversos , Triazinas/uso terapéutico , Diclorhidrato de Vardenafil , Adulto JovenRESUMEN
The aim of our study is to evaluate in Systemic Sclerosis (SSc) male patients the tadalafil effects on Raynaud's phenomenon and on AM and ET-1 plasma levels. In an open-label study 20 consecutive male patients with SSc were enrolled and received 10 mg of tadalafil daily for 12 weeks. The primary endpoint was the subjective reduction of frequency and duration of Raynaud's attacks measured with a 10-point Raynaud's Condition Score; the secondary aim was to modify Adrenomedullin (AM) and Endothelin-1 (ET-1) plasma levels. After the treatment Raynaud's phenomenon was improved by once-daily tadalafil (decrease of mean number of Raynaud's attacks and of Raynaud's Condition Score) and plasma AM and ET-1 levels decreased. The results of our study lead us to postulate the beneficial effect of adding long term inhibition of Phosphodiesterase type 5 to Systemic Sclerosis' therapy.
Asunto(s)
Adrenomedulina/sangre , Carbolinas/administración & dosificación , Carbolinas/uso terapéutico , Endotelina-1/sangre , Enfermedad de Raynaud/complicaciones , Enfermedad de Raynaud/tratamiento farmacológico , Esclerodermia Sistémica/complicaciones , Adulto , Esquema de Medicación , Femenino , Humanos , Masculino , Inhibidores de Fosfodiesterasa/administración & dosificación , Inhibidores de Fosfodiesterasa/uso terapéutico , Enfermedad de Raynaud/sangre , Esclerodermia Sistémica/sangre , Esclerodermia Sistémica/tratamiento farmacológico , TadalafiloRESUMEN
Aim of the study was to evaluate whether endothelial dysfunction is a marker of erectile dysfunction (ED) in recreational drug abuse. Sixty-four non-consecutive men complaining of ED from at least 3 months were included. All patients underwent detailed history about recreational drug abuse and were then submitted to dynamic penile duplex ultrasound (PDU). According to pharmaco-stimulated peak systolic velocity (PSV) cutoff at 35 cm s(-1), patients were divided into two groups: organic (O; n=30) and non-organic (NO; n=34) ED. All subjects and 7 healthy age-matched subjects as controls, underwent veno-occlusive plethysmography (VOP) for the evaluation of endothelium-dependent dilatation of brachial arteries. Blood pressure, total and free testosterone, prolactin, estradiol, low-density lipoprotein and high-density lipoprotein cholesterol were also evaluated; patients were classified with regard to insulin resistance through the HOMA-IR index. Cannabis smoking was more frequent in O-ED vs NO-ED (78% vs 3%, P<0.001) in the absence of any concomitant risk factor or comorbidity for ED. VOP studies revealed impaired endothelium-dependent vasodilatation in O-ED but not in NO-ED and controls (12+/-6 vs 32+/-4 and 34+/-5 ml min(-1), respectively; P=0.003). Overall patients showed a direct relationship between HOMA-IR and PSV (r(2)=0.47, P<0.0001), which was maintained in men with organic ED (r(2)=0.62, P<0.0001). In cannabis consumers, a direct relationship between HOMA-IR and VOP was also found (r(2)=0.74, P<0.0001). Receiver-operating characteristic (ROC) curve analysis revealed that VOP values below 17.22 ml min(-1) were suggestive for vasculogenic ED. We conclude that early endothelial damage may be induced by chronic cannabis use (and endocannabinoid system activation); insulin resistance may be the hallmark of early endothelial dysfunction and may concur to determine vascular ED in the absence of obesity. Further studies are warranted to establish a direct relationship between cannabis abuse, onset of insulin resistance and development of vascular ED.
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Endotelio Vascular/fisiopatología , Disfunción Eréctil/diagnóstico , Disfunción Eréctil/etiología , Abuso de Marihuana/complicaciones , Adulto , Disfunción Eréctil/sangre , Humanos , Masculino , Flujo Sanguíneo Regional/efectos de los fármacos , Estudios Retrospectivos , Factores de TiempoRESUMEN
AIMS: Erectile dysfunction (ED) is a common comorbidity in men with diabetes mellitus. Tadalafil 10 or 20 mg taken on demand is efficacious and safe for men with diabetes and ED. Recently, continuous treatment with tadalafil has been proposed, addressing ED management as any other chronic condition. This study examined whether once-daily tadalafil 2.5 and 5 mg is efficacious for men with diabetes and ED. METHODS: This randomized, double-blind, placebo-controlled, multicentre, 12-week study enrolled 298 men with diabetes and ED to once-daily treatment with placebo, tadalafil 2.5 mg or tadalafil 5 mg. Primary efficacy measures were International Index of Erectile Function Erectile Function (IIEF EF) Domain score, and patient success rates for vaginal penetration and completion of intercourse. Patient satisfaction, endothelial function biomarkers, and safety were also assessed. RESULTS: Patients receiving either dose of tadalafil had clinically and statistically significant improvements in IIEF EF and statistically significant improvements in mean success rates for vaginal penetration, completion of intercourse, and overall treatment satisfaction (P < or = 0.005 tadalafil vs. placebo, all measures). Endothelial dysfunction biomarkers were unchanged. The most common adverse events were headache, back pain and dyspepsia. CONCLUSIONS: In this first study of men with diabetes and ED, once-daily tadalafil 2.5 and 5 mg was efficacious and well tolerated, suggesting this may be an alternative to on-demand treatment for some men, eliminating the need to plan sex within a limited timeframe.
Asunto(s)
Carbolinas/administración & dosificación , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Disfunción Eréctil/tratamiento farmacológico , Inhibidores de Fosfodiesterasa/administración & dosificación , Adulto , Anciano , Coito/psicología , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Índice de Severidad de la Enfermedad , Tadalafilo , Resultado del TratamientoRESUMEN
OBJECTIVE: Diabetic patients have a reduced endothelial response to phosphodiesterase-5 inhibitors. The aim of this study was to determine the effects of chronic therapy with sildenafil on endothelial function in patients with Type 2 diabetes mellitus (DM2). METHODS: In a double-blind, placebo-controlled parallel design, 20 patients without erectile dysfunction randomly received a loading dose of sildenafil (100 mg) for 3 days, followed by either sildenafil 25 mg three times a day (t.d.s.) for 4 weeks or sildenafil 25 mg t.d.s. for 4 days followed by placebo t.d.s. for 3 weeks. RESULTS: After 1 week, flow-mediated dilatation (FMD) improved significantly (> 50% compared with baseline) in patients allocated to both sildenafil arms (62 and 64%, respectively). In patients allocated to chronic sildenafil, a progressive increase in percentage of patients with FMD improvement was noted (78, 86 and 94% at 2, 3 and 4 weeks, respectively) while a progressive decrease in the placebo group occurred (45, 18 and 6% at 2, 3 and 4 weeks, respectively). At the end of the study, a significant improvement in FMD compared with baseline was noted after chronic sildenafil (FMD from 6.8 +/- 0.5 to 12.5 +/- 0.7%, P = 0.01 vs. baseline). A decrease in endothelin-1 levels and an increase in nitrite/nitrate levels were found after chronic sildenafil; significant changes from baseline in C-reactive protein, interleukin 6, intercellular adhesion molecule and vascular adhesion molecule levels were also found. CONCLUSIONS: In DM2 patients, daily sildenafil administration improves endothelial function and reduces markers of vascular inflammation, suggesting that the diabetes-induced impairment of endothelial function may be improved by prolonged phosphodiesterase-5 inhibition.
Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Angiopatías Diabéticas/tratamiento farmacológico , Endotelio Vascular/efectos de los fármacos , Inhibidores de Fosfodiesterasa/administración & dosificación , Piperazinas/administración & dosificación , Sulfonas/administración & dosificación , Vasodilatadores/administración & dosificación , Adulto , Anciano , Biomarcadores/metabolismo , Arteria Braquial/fisiopatología , Proteína C-Reactiva/metabolismo , Moléculas de Adhesión Celular/metabolismo , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/fisiopatología , Angiopatías Diabéticas/sangre , Angiopatías Diabéticas/fisiopatología , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Humanos , Interleucina-6/metabolismo , Masculino , Persona de Mediana Edad , Purinas/administración & dosificación , Citrato de Sildenafil , Resultado del Tratamiento , Vasodilatación/efectos de los fármacosRESUMEN
Few active substances with fungicide activity can be used in organic farming, above all copper and sulphur. The copper is the only substance that can be used against downy mildew; however, since it causes problems of environmental impact, incompatible with organic farming's objective of environmentally friendly farming, the Commission of the European Communities has fixed a ceiling on use expressed in terms of kilograms of copper per hectare per year (Regulation EC n. 473/2002). In order to identify natural products that are able to carry out an anti-downy mildew activity, and to evaluate the effectiveness of low rate copper formulations that can reduce the quantities of copper compound, four-year experimental trials were carried out in organic vineyards. The trials have been carried out according to the Guidelines EPPO/OEPP PP 1/31 (3). Among the low rate copper formulations, copper hydroxide and copper sulphate have been tested. Among the natural substances alternative to copper formulations we have tested: phytostimulant, homeopathic products, acid clay-based products (bentotamnio), resistance promoters (chitosan and lignosulfonate), plant extracts (orange extract, propolis and equisetum) and potassium bicarbonate. All natural substances, with the exception of plant extracts and potassium bicarbonate, were tested in association with low rate copper formulations. In the trials it has been possible to test the effectiveness of different formulations in condition of high, medium and low pressure of Plasmopara viticola (Berk. et Curt.) Berl. et De Toni. Both the copper compounds and the natural products were able to guarantee a satisfactory protection in condition of low and medium pressure of downy mildew. The trial carried out in 2004 was characterized by high pressure of P. viticola; under this condition only the copper formulations produced a satisfactory protection against downy mildew. However, in 2004, we tested only two products alternative to copper compounds. Further studies are needed to verify if the formulations alternative to copper, that gave good results in condition of low and medium pressure of P. viticola, are able to guarantee a satisfactory protection even in condition of high pressure of downy mildew. We would like to highlight that in the four-years of trials the copper formulations tested always guaranteed a metallic copper quantity under 6 kg/ha that is the maximum limit of use/year imposed by Regulation EC n. 473/2002.
Asunto(s)
Agricultura/métodos , Cobre/farmacología , Oomicetos/efectos de los fármacos , Control Biológico de Vectores/métodos , Vitis/microbiología , Cobre/efectos adversos , Cobre/análisis , Relación Dosis-Respuesta a Droga , Fungicidas Industriales/farmacología , Oomicetos/crecimiento & desarrollo , Contaminantes del Suelo/análisisRESUMEN
Plant protection in conventional farming, and even more so in organic farming, requires careful and prudent action agro-environmental monitoring and epidemic risk assessment. Often, however, the plant protection products are distributed in a non-targeted way, even when reduced incidence of pests do not require any treatment. In order to optimize the treatments against downy mildew, multi-annual field trials, both in conventional and organic vineyards, have been carried out. In all farms were considered 3 thesis: 1 untreated control thesis (Test), in order to follow the coarse of infection, 1 standard farm reference thesis (St), where the treatments were carried out according to the usual farm procedures and 1 experimental thesis (X). Guideline EPPO/OEPP PP 1/31 (3) have been carried out. We monitored different environmental parameters capable to influence Plasmopora viticola (Berk. and Curt.) Berl. and De Toni development. In fact by a network of RTUs (Remote Terminal Units) distributed all over the vineyards transmitting every 15 minutes via radio or via GPRS to a centralized Data Base 12 environmental parameters: time, data, precipitation, soil temperature, solar radiation, wind direction, wind speed, atmospheric relative humidity, atmospheric temperature, leaf wetness, soil humidity to cm 20 and soil humidity to cm 40. In different phenological growth stages we carried out careful disease assessments on leaves and bunches to evaluate the onset and development of P. viticola. We have studied the downy mildew infections through monitoring the environmental parameters, knowledge of P. viticola biological cycle, the evaluation of cultivar sensibility, the agricultural production method and the area characteristics, to try to optimize the anti- downy mildew treatments. The achieved results have underlined the possibility to obtain a satisfactory protection against P. viticola by correct placing of treatments. In experimental thesis (X) the number of treatments was generally lower than the number made on the thesis standard (ST), with efficacy comparable if not better. This result is most evident in conventional farms where surveillance is less accurate because is can also use plant protection products with a curative action. The trial showed the possibility of obtaining real cost containment management and a lower environmental impact associated with reduced fungicidal treatments.
Asunto(s)
Agricultura/métodos , Oomicetos/efectos de los fármacos , Control Biológico de Vectores/métodos , Control de Plagas/métodos , Vitis/microbiología , Monitoreo del Ambiente/métodos , Fungicidas Industriales/farmacología , Oomicetos/crecimiento & desarrolloRESUMEN
OBJECTIVE: To investigate the psychometric properties of the Body Uneasiness Test (BUT) in a large sample of subjects with obesity seeking treatment. BUT is a 71-item self-report questionnaire in two parts: BUT-A which measures weight phobia, body image concerns, avoidance, compulsive self-monitoring, detachment and estrangement feelings towards one's own body (depersonalization); and BUT-B, which looks at specific worries about particular body parts or functions. METHODS: We recruited a clinical sample of 1,812 adult subjects (age range 18-65 years, females 1,411, males 401) with obesity (Body Mass Index, BMI > or = 30 kg/m2) and a normal weight (BMI value between 18.5 and 25 kg/m2) non-clinical sample of 457 adult subjects (females 248, males 209) with an Eating Attitudes Test-26 (EAT-26) score under the cut-off point 20 (scores > or = 20 indicate possible cases of eating disorders). RESULTS: The exploratory and confirmatory analyses confirmed a structural five-factor model for BUT-A and an eight-factor model for BUT-B. Internal consistency was satisfactory. Concurrent validity with Binge Eating Scale (BES) and Three-Factor Eating Questionnaire (TFEQ) was evaluated. The authors calculated mean values for BUT scores in adult (18-65 years) patients with obesity, and evaluated the influence of gender, age and BMI. Females obtained statistically significant higher scores than males in all age groups and in all classes of obesity; patients with obesity, compared with normal weight subjects, generally obtained statistically significant higher scores, but few differences could be attributed to the influence of BMI. CONCLUSION: The BUT can be a valuable multidimensional tool for the clinical assessment of body uneasiness in obesity; the scores of its sub-scales do not show a linear correlation with BMI values.
Asunto(s)
Imagen Corporal , Obesidad/psicología , Psicometría , Encuestas y Cuestionarios , Adolescente , Adulto , Factores de Edad , Anciano , Índice de Masa Corporal , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de Referencia , Reproducibilidad de los Resultados , Factores SexualesRESUMEN
The organic viticulture assumes a decisive role in the national agricultural sector. More impelling problems in the management of organic vineyards are represented from the plants pathology defence and particularly of Plasmopara viticola containment. Copper represents one of the few usable fungicides in the organic farming and the only effective against downy mildew. With Regulation EC n. 473/2002, fixed maximum quantity usable of copper compounds, owing to the environment problems due to the copper accumulation in the soil. To reduce quantity of metal copper or replace it with natural products, are conducted field trials with copper compounds at a low rate or alternative to copper products. Besides, we are estimating possibility to reduce the operations against P. viticola optimizing fungicidal treatments. Field trials in the organic farms located near Rome, have been carried out. Guidelines EPPO/OEPP PP 1/31 (3) have been carried out. The results of the trials have showed that, using cupric products with low metallic content, to reduce copper quantities used, always allowed to respect the limits established by Regulation EC. The alternative products that were investigated have not guaranteed, instead, an adequate protection in high pressure of grapevine downy mildew. It was possible to reduce treatments against P. viticola through control of different environmental parameters. The trials confirm that the copper is indispensable for plant protection in organic farming as it is not possible to replace it with natural extracts substances. We can reduce, instead, the copper quantities used trough the use of new products with low quantity metal copper or through the evaluation of climatic and pedologic data that allow to rationalize the fungicidal treatments.
Asunto(s)
Agricultura/métodos , Cobre/farmacología , Oomicetos/efectos de los fármacos , Control Biológico de Vectores/métodos , Contaminantes del Suelo/efectos adversos , Vitis/microbiología , Relación Dosis-Respuesta a Droga , Fungicidas Industriales/farmacología , Oomicetos/crecimiento & desarrollo , Contaminantes del Suelo/análisisRESUMEN
The powdery mildew represents one of the diseases which affect the grape, it is diffused in all agricultural regions with variable intensity and epidemic course in operation of many microclimatic factors. The powdery mildew of grape is caused from Uncinala necator (Schw.) Burr. (nowadays named Erysiphe necator Schwein.); it is controlled with systemic therapy and contact chemicaL products. In some vineyards located in Latium (central Italy), different field trials have been carried out purposely to rationalize the treatments against E. necator. We have studied the powdery mildew infections through monitoring a set of environmental parameters, the evaluation of cultivar sensibility, the agricultural production method and the area characteristics. We have analysed the following environmental parameters monitoring every 15 minutes: precipitation, soil temperature, solar radiation, wind direction, wind speed, atmospheric relative humidity, atmospheric temperature, leaf wetness, soil humidity to cm 20 and soil humidity to cm 40. Besides, we have used Artificial Intelligence analysis techniques to try to forecast U. necator infections. Guideline EPPO/OEPP PP 1/4 (4) has been used. The trials were conducted in conventional and organic farms. In 2 conventional farms and in organic farm we have considered 1 untreated control thesis, in order to follow the course of infection, 1 standard farm reference thesis (standard), where the treatments were carried out according to the usual farm procedures and 1 thesis where the treatments were carried out according to examining the environmental data. In another conventional vineyard, we have considered only 1 untreated control thesis and 1 standard farm reference thesis (standard) to study disease trend. The achieved results have underlined the possibility (through the knowledge of data pedoclimatic and cultural) to position the treatments against the powdery mildew so that to reduce their number. The lower number of treatments that could follow as a result of environmental data to analyse could bring a series of evident economic and ecologic advantages for the farms.
Asunto(s)
Agricultura/métodos , Ascomicetos/efectos de los fármacos , Fungicidas Industriales/farmacología , Control de Plagas/métodos , Vitis/microbiología , Control Biológico de Vectores , VinoRESUMEN
This paper describes the further results of the study that has been described in session 5 of the 58th International Symposium on Crop Protection (Ghent 2006). Since then our attention has been focused on verifying the previous communication results working on a two years basis data set belonging to a specific farm. The choice of using data from a single farm derives from the considerations that have been explained in the previous study in which it was clear that an efficient forecasting Artificial Neural Network (ANN) model can be created only in restricted (or at least comparable) pedoclimatic areas. On the basis of the matured experience, at the moment we have realized an ANN which, being trained on 2005 year data, elaborating the following year data is capable of correctly predicting the real Plasmopara viticola (Berk. et Curt.) Berl. et De Toni outbreak, never giving false negative signals (no alarm in presence of infection on the field) and, finally, giving few other alarms which are totally comparable with the ones given by the most common statistical instrument used in this field trials. We confirm the advantages of this approach in terms of: (a) Management and optimization improvement of agricultural activities. (b) Reduction of plant protection products use. (c) Quality improvement of the final product for a real lowering of plant protection products use. (d) Reduction of environmental impact. (e) A more efficient management of the climate changes.
Asunto(s)
Agricultura/métodos , Modelos Biológicos , Redes Neurales de la Computación , Oomicetos/crecimiento & desarrollo , Vitis/microbiología , Clima , Predicción , Modelos Teóricos , Control de Plagas/métodos , Factores de TiempoRESUMEN
Aim of our study was to assess the stress risk at work in a group of nurses. 197 workers (nurses, auxiliary, physiotherapists, midwives and technicians of laboratory) were enrolled divided in two sets respectively of 100 people (subset A) with daily and nightly shifts and 97 (subset B) only daily workers. The mean age was 43.29 years (DS +/- 8.13) in subset A and 46.85 years (DS +/- 7.48) in subset B. For the survey S-90, a questionnaire composed by 90 items faces to frame some of the possible factors of risk has been used and the relative effects on health's state induced by the occupational stress were analyzed. The results show a possible greater risk of daily sleepiness in workers with nightly job. The majority of hypertension workers in subgroup B could depend more on the elevated mean age of this sample. Although a greater perception of the psychological load has been found, statistically meaningful association between the insurgence of gastrointestinal symptoms and shift was not showed.