Expression and distribution of key proteins of the endocannabinoid system in the human seminal vesicles.

The endocannabinoid system (ECS), comprising the cannabinoid receptors (CBR), their ligands, and enzymes controlling the turnover of endocannabinoids, has been suggested to be involved in male reproductive function. As information is scarce on the expression of the ECS in human male reproductive tissues, this study aimed to investigate by means of molecular biology (RT-PCR) and immunohistochemistry/immunofluorescence the expression and distribution of CB1 and CB2, GPR55 (an orphan G protein-coupled receptor that recognises cannabinoid ligands) and FAAH (isoforms 1 and 2) in the human seminal vesicles (SV). The specimens expressed PCR products corresponding to CB1 (66 bp), CB2 (141 bp), GPR55 (112 bp), FAAH1 (260 bp) and FAAH2 (387 bp). Immumohistochemistry revealed dense expression of CB1, CB2 and GPR55 located to the pseudo-stratified columnar epithelium and varicose nerves (also characterised by the expression of vasoactive intestinal polypeptide and calcitonin gene-related peptide). Cytosolic staining for FAAH1 and FAAH2 was seen in cuboidal cells of all layers of the epithelium. No immunoreactivity was detected in the smooth musculature or nerve fibres. CB1, CB2, GPR55, FAAH1 and FAAH2 are highly expressed in the human SV. Considering their localisation, the ECS may be involved in epithelial homeostasis, secretory function or autonomic mechano-afferent signalling.

Efficacy and safety of dapoxetine in treatment of premature ejaculation: an evidence-based review.

BACKGROUND: Premature ejaculation (PE) is a major issue in male sexual health, with a global prevalence estimated to be between 20% and 40%, making it the most common sexual dysfunction in men. PE causes distress and reduced quality of life for patients and has a negative impact on interpersonal relationships. Historically, it has been treated with cognitive therapy, behavioural methods and off-label use of selective serotonin reuptake inhibitors (SSRIs) usually used to treat depression and other psychological disorders. Dapoxetine is the only SSRI specifically designed to treat PE. MECHANISM OF ACTION: Dapoxetine hydrochloride is a potent inhibitor of serotonin reuptake transporters. Dapoxetine is suited for 'on-demand' treatment of PE because of its rapid absorption and short initial half-life. EFFICACY: Evidence from published studies showed that dapoxetine 30 mg or 60 mg taken 'on-demand' results in a significant increase in intravaginal ejaculatory latency time (IELT) when compared with placebo. Most patient-reported outcomes are clearly improved relative to placebo following dapoxetine therapy, indicating greater control over ejaculation, more satisfaction with intercourse, less ejaculation-related distress and significantly reduced interpersonal difficulties. SAFETY: The most common adverse events with dapoxetine are nausea, dizziness, somnolence, headache, diarrhoea and insomnia. Usually they do not lead to drug discontinuation. CONCLUSION: Dapoxetine is the only effective and safe available on-label oral treatment for PE, and its use can result in better quality of life for the patient and their sexual partner.

Arthroscopic treatment of post-traumatic elbow stiffness.

AIM: The treatment of post-traumatic elbow stiffness has seen many important changes over the years, particularly through the development of arthroscopy, greater knowledge of anatomy and improvements in operative techniques, that reduce the incidence of complications and facilitate postoperative recovery. In this study mid-term clinical results of arthroscopy for post-traumatic elbow stiffness are evaluated in 15 sporting patients, with an average age of 32 years. METHODS: Eight patients reported post-traumatic stiffness due to fracture of the radial head, 3 to fracture-dislocation, 1 to fracture of the radial diaphysis complicated by osteosynthesis, and the remaining 3 patients to stress syndromes with osteochondral detachment. Surgical treatment consists in debridement, arthroscopic capsular release, and removal of bone fragments by arthroscopy. Patients were followed up from 4 up to 36 months, with a mean follow-up time of 18 months. RESULTS: Results obtained have been good to excellent in 84% of cases with an average range in postoperative movement of 13 degrees-137 degrees and reduction in pain symptomatology. The statistic results obtained from this study, under the same conditions and with a confidence interval = 0.01, show that the treatment will have favorable outcomes in 63% of patients of entire population (0.6285

Weed control in rice with metham-sodium.

Metam-sodium is a soil fumigant with herbicidal properties. A field experiment was conducted in 2000 at Copiano (Pavia, Italy) to determine the efficacy of three rates of metam-sodium (300, 450 and 600 l/ha) at three different planting times (5, 12 and 18 days after chemical treatments) for the control of weeds in rice cultivation. The study mainly focused on the control of red rice (Oryza sativa var. selvatica), a weed which is worldwide distributed in rice fields and difficult to eradicate Test design was a split-plot with four replications. The main plot size was 13, 5 by 15 m and the subplot size was 13, 5 by 5 m. The chemical treatments were carried out as pre-sowing. Two days after chemical treatments, all field plots were flooded with 10 cm of water as practiced locally. An early variety of rice (Loto) was sown at 150 kg/ha. Weed control was visually evaluated as a percentage of ground covering by all weeds and by each weed individually at three, four and five weeks after treatments. Observations were made also on rice selectivity, and rice grain yield was assessed at the end. Metam-sodium did not injure the rice plants. Metam-sodium at 450 l/ha controlled 100%, 97% and 92% of red rice at the first, second and third observations, respectively. Good results were also obtained with metam-sodium at 300 and 600 l/ha, which controlled 94 to 82% of red rice during the season. Echinochloa crus-galli was better controlled with the higher rates of metam-sodium, particularly in the early part of the season. Metam-sodium did not show enough efficacy in this study against Heteranthera reniformis, Bulboschoenus maritimus and Lindernia spp. The best rice grain yield was obtained with all rates of metam-sodium, when rice was sown 5 days after treatment.

Metabolic syndrome in white European men presenting for primary couple's infertility: investigation of the clinical and reproductive burden.

Despite complex interactions between obesity, dyslipidemia, hyperinsulinaemia, and the reproductive axis, the impact of metabolic syndrome on human male reproductive function has not been analysed comprehensively. Complete demographic, clinical, and laboratory data from 1337 consecutive primary infertile men were analysed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (categorised 0 vs. 1 vs. 2 or higher). NCEP-ATPIII criteria were used to define metabolic syndrome. Semen analysis values were assessed based on the 2010 World Health Organisation (WHO) reference criteria. Descriptive statistics and logistic regression models tested the association between semen parameters and clinical characteristics and metabolic syndrome. Metabolic syndrome was found in 128 (9.6%) of 1337 men. Patients with metabolic syndrome were older (p < 0.001) and had a greater Charlson Comorbidity Index of 1 or higher (chi-square: 15.6; p < 0.001) compared with those without metabolic syndrome. Metabolic syndrome patients had lower levels of total testosterone (p < 0.001), sex hormone-binding globulin (p = 0.004), inhibin B (p = 0.03), and anti-Müllerian hormone (p = 0.009), and they were hypogonadal at a higher rate (chi-square: 32.0; p < 0.001) than patients without metabolic syndrome. Conversely, the two groups did not differ significantly in further hormonal levels, semen parameters, and rate of either obstructive or non-obstructive azoospermia. At multivariate logistic regression analysis, testicular volume (OR: 0.90; p = 0.002) achieved independent predictor status for WHO pathological semen concentration; conversely, age, Charlson Comorbidity Index scores, metabolic syndrome, and inhibin B values did not. No parameters predicted normal sperm morphology and total progressive motility. Metabolic syndrome accounts for roughly 9% of men presenting for primary couple's infertility. Although metabolic syndrome patients have a lower general male health status, semen analysis values seem independent of the presence of metabolic syndrome.

Lower urinary tract symptoms among Caucasian-European men who have sex with men: findings from a real-life survey.

BACKGROUND: Prevalence of and severity of lower urinary tract symptoms (LUTS) according to male sexual orientation have been scantly analysed. We aimed to assess the prevalence and severity of LUTS in a cohort of Caucasian-European men who have sex with men seeking medical help for uroandrologic reasons other than LUTS. METHODS: Data from 949 consecutive individuals in an outpatient setting were analysed. Severity of LUTS was measured with the International Prostate Symptom Score (IPSS). Men with storage symptoms scored 1-3 and ⩾ 4 (of 15), and voiding symptoms scored 1-4 and ⩾ 5 (of 20) were considered as having mild and moderate-to-severe symptoms, respectively. For individual symptoms, patients with scores ⩾ 1 were deemed symptomatic (according to Apostolidis et al.(15)). Descriptive statistics and logistic regression models tested the association between LUTS and sexual orientation. RESULTS: Complete data were available for 213 (22.4%) men who have sex with men (MSM) and 736 (77.6%) heterosexuals (mean age (s.d.): 41.0 (12.2) vs 39.9 (12.1) years). Compared with heterosexuals, MSM reported higher rates of total IPSS scores suggestive of moderate (21.6% vs 20%) and severe LUTS (3.8% vs 2.4%) (P=0.004). Similarly, MSM showed higher rates of mild (48.8% vs 45.2%) and moderate-to-severe (39.4% vs 30.4%) storage symptoms (all P<0.001), and of mild (45.1% vs 34.8%) and moderate-to-severe (20.2% vs 19.2%) voiding symptoms (all P<0.01). MSM status was an independent predictor of mild voiding symptoms (odds ratio (OR): 1.40; P=0.004), moderate-to-severe storage symptoms (OR: 1.40; P=0.04) and severe total IPSS (OR: 1.49; P=0.03), after adjusting for other variables. CONCLUSIONS: These findings suggest a higher prevalence and severity of LUTS in MSM compared with heterosexual men seeking medical help for uroandrologic reasons other than LUTS.

A conjugate heat transfer procedure for gas turbine blades.

A conjugate heat transfer procedure, allowing for the use of different solvers on the solid and fluid domain(s), is presented. Information exchange between solid and fluid solution is limited to boundary condition values, and this exchange is carried out at any pseudo-time step. Global convergence rate of the procedure is, thus, of the same order of magnitude of stand-alone computations.

Correlation between helper/suppressor ratio and IgA levels in the peripheral blood from patients with liver diseases.

The correlation between serum immunoglobulin levels and "helper/suppressor" (T4/T8) ratio has been investigated in 45 patients with biopsy proven liver diseases (22 with ALD, 16 with CAH and 7 with VHR). In the ALD and CAH groups the T4/T8 ratio was significantly higher than in normal controls and a strong correlation was noticed with IgA, but not IgG and IgM levels. The same correlation was found in the VHR group as well, even if the mean value for the T4/T8 ratio in these patients was not significantly above that of normal controls. The pathogenetic significance of these findings is discussed.

Successful meropenem therapy of a brain abscess and meningitis arising from acute purulent otomastoiditis: case report.

We describe a case of a 25-year-old female with an acute left otomastoiditis, accompanied by a left temporal extradural abscess with moderate perifocal edema and meningitis. Intravenous meropenem (2 g 8-hourly) and intravenous methylprednisolone (40 mg once daily) were commenced empirically. Teicoplanin (400 mg once daily intravenously) was added after 5 days when culture results were available. Teicoplanin was discontinued on day 25 but meropenem and methylprednisolone were continued for a further 15 days, after which the abscess completely resolved without sequelae. No treatment-induced adverse effects or seizures were observed. Thus, in selected patients, antibacterials (in conjunction with a corticosteroid) may be successfully used without surgery to treat brain abscesses and in such circumstances meropenem is a useful option for empiric therapy.

Drug-resistance of Mycobacterium tuberculosis in time.

Tuberculosis is heavily worldwide spreading in the last years. More and more signalations seem to indicate that the incidence of drug-resistant Mycobacteria is increasing in almost all industrialized countries. The authors have carried on a study on the percentage of drug-resistant strains of Mycobacterium Tuberculosis (MT) among isolates from patients affected by active pulmonary tuberculosis hospitalized through the years 1992-94. Out of 59 isolates of MT, 20.3% were drug-resistant: 25% of them to 2 drugs and 16.6% to 3 or more drugs. Resistance to single drug was so distributed: Streptomycin 11.8%, Isoniazid 6.7%, Rifampycin 3.4%, Ethambutol 6.7%, Ansamycin 3.4%, Pyrazinamide 5.0%, Ethionamide 1.7%. These results were confronted with analogous data on MT drug-resistance collected in the same hospital division in the years 1978-82 and 1985-87. The data analysis shows that actual incidence of drug resistant strains of MT is only slightly decreased but quite similar to that observed in 1978-82, except for Ethambutol, while there is a remarkable reduction vs. 1985-87; in that period, in fact, the highest incidence of drug resistance was recorded. The authors' conclusion is that only little differences were observed in the total amount of resistant strains of MT through 20 years; they also outline that resistance to Ansamycin, most recent out of all tested drugs, is quite similar to that observed for Rifampycin, that is chemically analogous.

Post-tuberculosis chronic empyema of the "forty years after".

The authors present 110 cases of patients hospitalized in the last 5 years, with long-term disabling sequelae of pulmonary tuberculosis. Twelve out of them (= 10.9%) suffered from post-tuberculous chronic empyema, with an average latency period of 44.83 years between the acute tuberculous illness and the clinical manifestation of the empyema. Nine of the patients had been treated with collapsotherapy, induced by artificial intrapleural pneumothorax, 1 with thoracoplasty, and 2 only with late and inadequate anti-mycobacterial chemotherapy. Eleven patients (91.6%) also had a cutaneous fistula (7 cases) and/or a bronchopleural fistula (4 cases). The authors show how the issue of tuberculous sequelae is a significant not only from the numerical standpoint, but also for the seriousness of the caused pathological conditions, often posing problems for differential diagnosis. Moreover, they stress how tuberculosis should never be neglected or considered last in the differential diagnosis of empyema and pyopneumothorax.

Experimental infection of European wild swine (Sus scrofa L.) with pseudorabies virus.

Experimental infection with pseudorabies virus was carried out by oral exposure of four young wild swine held in contact with two unexposed controls. No disease was observed but virological procedures indicated that the virus was shed in saliva and, in one case, in the nasal discharge, with subsequent infection of the control animals. After slaughter the virus was reisolated from the tonsils but not from lungs and brain. Virus reisolation from the tonsils was obtained in two animals after the throat swabs became negative. Virus neutralizing antibodies were detected.

[Prevalence of antibodies against the hepatitis B virus in alcoholic liver diseases]. / Prevalenza degli anticorpi contro il virus dell'epatite B nelle epatopatie alcoliche.

The prevalence of serum antibody to hepatitis B virus antigen (anti-HBs and anti-HBc) were determined in biopsy proven alcoholic liver disease (n = 60), compared with: an age and sex-matched hospital control population (n = 60), HBsAg-negative chronic liver disease (n = 27), renal unit patients (n = 32) and volunteer blood donors (n = 286). All sera were HBsAg negative (RIA). The prevalence of total hepatitis B virus antibody was significantly increased (p less than 0,001) in alcoholic liver disease (71%), as well as in renal unit patients (65%) and non-alcoholic liver disease (66%), versus hospital controls (35%) and blood donors (43%). These data suggest that hepatitis B virus infection might be a factor in selecting which alcoholic patients go to develop hepatic damage.

[Erythrocyte indices in smokers and heroin addicts]. / Indici eritrocitari in fumatori ed eroinomani.

Red blood cells values of 100 male heroin addicts, 100 male smokers and 100 normal men, all of like age, have been examined. Nearly all of the heroin addicts are heavy cigarette smokers. The GRC/mm3, Hb g%, Ht%, MCHC and MCV values did not show significant statistical differences between the three groups, except the MCV in the average appeared 2,8 mu3 higher in the smokers, than the normal non smokers. In heroin addicts there did not appear any variation related to abnormalities in liver function and dependency life time. The differences between the results of our studies and the literature are determined from a longer exposition to the damage caused from heroin and smoke.

[The history of nasal valve surgery]. / Storia della chirurgia della valvola nasale.

Nasal valve surgery involves the Nasal Valve Area and its deformities, as well as its surrounding structures. Since there is no single technique to solve every type of pathology, there are numerous works on this topic in the literature. The rhinologist to perform such surgery should thoroughly deal with all the components (i.e. nasal valve area, nasal bones, tip, spine, vestibulum and turbinates). However, even more so, he should be able to precisely locate the cartilaginous and/or osseous structural deformity impairing nasal air flow. Therefore, intuition and experience play a key role in planning such surgery. It is not easy to recognize the unique, or even more difficult, the partial defect the correction of which would improve overall nasal function. Every surgical technique has some "biologic cost": sclerosis, adhesions, and scar retraction. However, in this case the surgery could prove even more biologically costly as it could worsen the already poor nasal breathing. Therefore, the surgeon must strictly follow two basic rules: a) employ a proper approach to the region; b) do not endanger nasal valve function to satisfy esthetics. Valve area anomalies can be divided into primary and secondary. The latter are caused by trauma or surgery (1.2%). Among the wide range of techniques mentioned in the literature, the authors prefer the anatomical, surgical classification by Zijilker and Quaedvilieg as it incorporates the philosophy the rhinosurgeon must keep in mind when aiming to restore both nasal functions and esthetics through different, specific techniques.

[Surveillance of adverse reactions of drugs and monitoring of drug prescriptions as routine in hospital activities]. / La sorveglianza delle reazioni avverse da farmaci e il monitoraggio delle prescrizioni mediche come attività "normali" di reparti ospedalieri.

Since January 1988 is taking place a multicentre experience on pharmaco-epidemiology named ARIES (Adverse Reaction Identification Evaluation System), with two primary aims: surveillance of drug adverse reactions and monitoring of medical prescriptions. At present 5 departments of internal medicine are involved in the study. The factual cooperation of the departmental doctors depends on the evaluation of benefits and costs of the study. The benefits for doctor are: (a) the possibility of contributing to the research in a field which has not been systematically investigated in a hospital setting; b) the acquisition of skill in monitoring adverse reactions: to facilitate doctors cooperation an algorithm has been developed to select the events to be entered into the system; c) the possibility of evaluating and improving the prescription habits. At present, data on 9,000 patients and 60,000 prescriptions are available. As an example of utilization study, we report a research on antibiotics prescribed for bronchopneumonia in two departments involved in the ARIES project. The remarkable differences in the prescription settings lead to some rethinking on the strategies of such different prescription choices. In each department, the contribution of doctors is integrated by a monitor, entering additional information on drugs and patients into the system. Thanks to the cooperation of doctors and contribution of monitors, the pharmaco-epidemiology research may become a "normal" component of the hospital activities, thus allowing to systematically retrieve and process some basic knowledges, which are not routinely used, derived from the daily activity of the departmental doctor.

[Dysmetabolic syndrome related to HIV-1 protease inhibitors. Review of the literature and personal data]. / Sindrome dismetabolica da inibitori della HIV-1 proteasi. Revisione della letteratura e dati personali.

HIV-positive patients receiving antiretroviral therapy with HIV-1 protease-inhibitors (PI) frequently show insulin-resistance, impaired glucose tolerance, hypertriglyceridaemia and lipodystrophy (LD). LD has often been reported only after the beginning of PI therapy. Some authors link LD to HIV chronic infection, some others suggest that PIs increase pre-existent disturb. Preliminary data of an observational study drawn in IV day-hospital of Spallanzani Institute in Rome showed hypertriglyceridaemia in 36.4% and hyperglycaemia in 11.2% of patients treated with PI. Carr suggests that such drugs should have this lipid-increasing effect because of their inhibition of low density lipoprotein-receptor-related protein, cytoplasmic retinoic-acid binding protein type 1 and P450 3A cytochrome. This theory doesn't explain why both untreated patients and treated with only reverse transcriptase inhibitors show sometimes the same disorders. According to another hypothesis Tumor necrosis factor-alpha, through inhibition of lipoprotein-lipase, would determine high fat-storage in the adipose tissue. Cardiovascular risk factors have always to be assessed before starting a therapy with PI. Glycaemia, triglyceridaemia, cholesterolaemia have to be performed every three months during the treatment and, if necessary, C-Peptide and insulinaemia too. A treatment with lipid-lowering drugs is always recommended in patients with hypertriglyceridaemia > 500 mg/dl and/or hypercholesterolaemia LDL > 190 mg/dl in two following checks. Fibrates have proven to be effective in reducing hypertriglyceridaemia, but there is no certainty that such therapies could have good effects on the LD itself too.