Anxiety, depression, urinary continence, and sexuality in patients undergoing radical prostatectomy: preliminary findings.

OBJECTIVES: Evaluate the relationship between psychological distress, namely anxiety and depression, with urinary continence and recovery of erectile function in patients undergoing radical prostatectomy (RP). METHODS: We retrospectively analyzed data from 33 consecutive patients who underwent RP in a single tertiary-referral academy between 01/2018 to 01/2019. We used the International Index of Erectile Function (IIEF-15), the Sexual Complaints Screener for Men (SCS-M), and the Hospital Anxiety and Depression Scale (HADS), validated questionnaires for the assessment of sexual function, anxiety, and depression experiences, respectively. These questionnaires were administered at the pre-surgical visit, after surgery, and at intermediate follow-ups (three, six, and twelve months). RESULTS: The analysis of the questionnaires completed during follow-up shows that erectile function is the most affected, with 90% erectile dysfunction (ED) at three months after surgery. In terms of emotional states, anxiety prevails in the first months following surgery and is statistically significantly associated with incontinence (p = 0.02). Depressive symptoms, on the other hand, appear later and prevail over anxiety at six months after surgery, although not statistically significant. CONCLUSIONS: In the early post-surgical phase anxiety and ED are the most frequently detected components, while depressive experiences and decreased desire, typical of later stages, have not yet fully emerged.

Italian Versions of the 12-Item Sexual Distress Scale (SDS) and the 5-Item Sexual Distress Scale-Short Form (SDS-SF): Psychometric Properties.

The study aimed to analyze the psychometric properties of the Italian versions of the 12-item Sexual Distress Scale (SDS) and the 5-item Sexual Distress Scale-Short Form (SDS-SF). A total sample of 2291 adults (1361 women, 930 men) participated through a web survey completing the SDS, the FSFI, the IIEF, the PANAS and the SCL-90-R. The results supported the adequacy of both the SDS and SDS-SF factor structures, good reliability (respectively, α = .96 and .92), discriminant validities and strong associations with satisfaction, fear, depression, and psychoticism. SDS and SDS-SF may facilitate the assessment of sexual distress for both clinical and research purposes.

Polariton-mediated energy transfer between organic dyes in a strongly coupled optical microcavity.

Strongly coupled optical microcavities containing different exciton states permit the creation of hybrid-polariton modes that can be described in terms of a linear admixture of cavity-photon and the constituent excitons. Such hybrid states have been predicted to have optical properties that are different from their constituent parts, making them a test bed for the exploration of light-matter coupling. Here, we use strong coupling in an optical microcavity to mix the electronic transitions of two J-aggregated molecular dyes and use both non-resonant photoluminescence emission and photoluminescence excitation spectroscopy to show that hybrid-polariton states act as an efficient and ultrafast energy-transfer pathway between the two exciton states. We argue that this type of structure may act as a model system to study energy-transfer processes in biological light-harvesting complexes.

Plasmons due to the interplay of Dirac and Schrödinger fermions.

We study the interplay between Dirac and Schrödinger fermions in the polarization properties of a two-dimensional electron gas (2DEG). Specifically, we analyze the low-energy sector of narrow-gap semiconductors described by a two-band Kane model. In the context of quantum spin Hall insulators, particularly, in Hg(Cd)Te quantum wells, this model is named the Bernevig-Hughes-Zhang model. Interestingly, it describes electrons with intermediate properties between Dirac and Schrödinger fermions. We calculate the dynamical dielectric function of such a model at zero temperature within random phase approximation. Surprisingly, plasmon resonances are found in the intrinsic (undoped) limit, whereas they are absent-in that limit-in graphene as well as ordinary 2DEGs. Additionally, we demonstrate that the optical conductivity offers a quantitative way to identify the topological phase of Hg(Cd)Te quantum wells from a bulk measurement.

Time reversal symmetric topological exciton condensate in bilayer HgTe quantum wells.

We investigate a bilayer system of critical HgTe quantum wells, each featuring a spin-degenerate pair of massless Dirac fermions. In the presence of an electrostatic interlayer Coulomb coupling, we determine the exciton condensate order parameter of the system self-consistently. Calculating the bulk topological Z2 invariant of the resulting mean-field Hamiltonian, we discover a novel time reversal symmetric topological exciton condensate state, coined the helical topological exciton condensate. We argue that this phase can exist for experimentally relevant parameters. Interestingly, due to its multiband nature, the present bilayer model exhibits a nontrivial interplay between spontaneous symmetry breaking and topology: Depending on which symmetry the condensate order parameter spontaneously picks in combined orbital and spin space, stable minima in the free energy corresponding to both trivial and nontrivial gapped states can be found.

Electric field control of spin rotation in bilayer graphene.

The manipulation of the electron spin degree of freedom is at the core of the spintronics paradigm, which offers the perspective of reduced power consumption, enabled by the decoupling of information processing from net charge transfer. Spintronics also offers the possibility of devising hybrid devices able to perform logic, communication, and storage operations. Graphene, with its potentially long spin-coherence length, is a promising material for spin-encoded information transport. However, the small spin-orbit interaction is also a limitation for the design of conventional devices based on the canonical Datta-Das spin field-effect transistors. An alternative solution can be found in magnetic doping of graphene or, as discussed in the present work, in exploiting the proximity effect between graphene and ferromagnetic oxides (FOs). Graphene in proximity to FO experiences an exchange proximity interaction, that acts as an effective Zeeman field for electrons in graphene, inducing a spin precession around the magnetization axis of the FO. Here we show that in an appropriately designed double-gate field-effect transistor, with a bilayer graphene channel and FO used as a gate dielectric, spin-precession of carriers can be turned ON and OFF with the application of a differential voltage to the gates. This feature is directly probed in the spin-resolved conductance of the bilayer.

Predicting mortality in non-variceal upper gastrointestinal bleeders: validation of the Italian PNED Score and Prospective Comparison with the Rockall Score.

OBJECTIVES: We sought (i) to validate a new prediction rule of mortality (Progetto Nazionale Emorragia Digestiva (PNED) score) on an independent population with non-variceal upper gastrointestinal bleeding (UGIB) and (ii) to compare the accuracy of the Italian PNED score vs. the Rockall score in predicting the risk of death. METHODS: We conducted prospective validation of analysis of consecutive patients with UGIB at 21 hospitals from 2007 to 2008. Outcome measure was 30-day mortality. All the variables used to calculate the Rockall score as well as those identified in the Italian predictive model were considered. Calibration of the model was tested using the chi2 goodness-of-fit and performance characteristics with receiver operating characteristic (ROC) analysis. The area under the ROC curve (AUC) was used to quantify the diagnostic accuracy of the two predictive models. RESULTS: Over a 16-month period, data on 1,360 patients were entered in a national database and analyzed. Peptic ulcer bleeding was recorded in 60.7% of cases. One or more comorbidities were present in 66% of patients. Endoscopic treatment was delivered in all high-risk patients followed by high-dose intravenous proton pump inhibitor in 95% of them. Sixty-six patients died (mortality 4.85%; 3.54-5.75). The PNED score showed a high discriminant capability and was significantly superior to the Rockall score in predicting the risk of death (AUC 0.81 (0.72-0.90) vs. 0.66 (0.60-0.72), P<0.000). Positive likelihood ratio for mortality in patients with a PNED risk score >8 was 16.05. CONCLUSIONS: The Italian 10-point score for the prediction of death was successfully validated in this independent population of patients with non-variceal gastrointestinal bleeding. The PNED score is accurate and superior to the Rockall score. Further external validation at the international level is needed.

Which psychosocial variables affect drive the most? Analysis of sexual desire in a group of Italian men.

Literature lacks wide studies on variables affecting sexual desire in men. Aim of this study was to explore the role of some psychosocial variables such as quality of life, sexual function, distress, sexual satisfaction, psychological symptoms, emotions, alexithymia, couple adjustment, sexism, dysfunctional beliefs, cognitive schemas, and modes. A self-administered survey reached 450 heterosexual Italian men (age 31.36 ± 10.73). Results showed "orgasmic function", "lack of erotic thoughts", "erection concerns thoughts", "hostile sexism", and "positive affect" as the main sexual desire predictors. "Depression", "premature ejaculation severity", "sexual distress", "sexual conservatism", and "helpless" predicted in minor manner sexual desire levels. Analyzed variables could represent key factors in the assessment and therapy of sexual desire problems.

Predictive factors of mortality from nonvariceal upper gastrointestinal hemorrhage: a multicenter study.

OBJECTIVES: From an Italian Registry of patients with upper gastrointestinal hemorrhage (UGIH), we assessed the clinical outcomes and explored the roles of clinical, endoscopic, and therapeutic factors on 30-day mortality in a real life setting. METHODS: Prospective analysis of consecutive patients endoscoped for UGIH at 23 community and tertiary care institutions from 2003 to 2004. Covariates and outcomes were defined a priori and 30-day follow-up obtained. Logistic regression analysis identified predictors of mortality. RESULTS: One thousand and twenty patients were included. A total of 46 patients died for an overall 4.5% mortality rate. In all, 85% of deaths were associated with one or more major comorbidity. Sixteen of 46 patients (35%) died within the first 24 h of the onset of bleeding. Of these, eight had been categorized as ASA class 1 or 2 and none of them was operated upon, despite a failure of endoscopic intention to treatment in four. Regression analysis showed advanced age, presence of severe comorbidity, low hemoglobin levels at presentation, and worsening health status as the only independent predictors of 30-day mortality (P < 0.001). The acute use of a PPI exerted a protective effect (OR 0.23, 95% CI 0.09-0.73). Recurrent bleeding was low (3.2%). Rebleeders accounted for only 11% of the total patients deceased (OR 3.27, 95% CI 1.5-11.2). CONCLUSIONS: These results indicate that 30-day mortality for nonvariceal bleeding is low. Deaths occurred predominantly in elderly patients with severe comorbidities or those with failure of endoscopic intention to treatment.

Cerebral vasomotor reactivity is reduced in patients with erectile dysfunction.

BACKGROUND: Erectile dysfunction (ED) is not only evidence of diffuse atherosclerosis but also an index of early endothelial damage. We investigated cerebrovascular reactivity, expression of early arterial damage, in patients with isolated ED (ED+) and controls (ED-). MATERIALS AND METHODS: Fifteen ED+ and 15 ED- subjects, matched for age (ED+: 58+/-6, ED-: 59 +/- 4 years) and vascular risk factors, were submitted to carotid duplex ultrasound and transcranial Doppler. Cerebrovascular reactivity was assessed on both middle cerebral arteries simultaneously calculating (a) the total vasomotor range (VMR) measured after breath holding and hyperventilation and (b) the rate of change (VMR/CO(2)) after breath holding. RESULTS: Carotid Duplex scanning showed a light carotid stenosis only in 3 (2 in the ED+ and 1 in the ED- group). No differences were observed in intima-media thickness between ED+ and ED-. Slightly slower mean middle cerebral artery flow velocities were observed in ED+ with respect to ED-. ED+ patients showed a reduced VMR (p < 0.001) and a slower VMR/CO(2) rate of change (p < 0.001) compared to ED-. CONCLUSIONS: The reduced reactivity in patients with isolated ED may represent a marker of early cerebral vasomotor dysfunction due to subclinical endothelial damage.

Delayed ejaculation and alexithymia: what is the relationship?

Delayed Ejaculation (DE) is probably the least studied and understood of the male sexual dysfunctions (MSD). There is still little unanimity concerning its psychological/interpersonal aetiology. Previous studies found that MSD are strongly related with alexithymia, a multifaceted personality construct that describes a disturbance in the regulation of emotions.The aim of this study was to investigate the presence of alexithymia in men with DE and correlate alexithymia levels with DE severity. According to specific features of the symptoms, we hypothesized that alexithymia would not be correlated with this specific sexual disorder. 54 outpatients with a diagnosis of DE assessed at the Institute of Clinical Sexology and the Urology Department of Sapienza, University in Rome were enrolled in the study. DE was diagnosed after a specialist examination and according to Diagnostic and Statistical Manual of Mental Disorders -IV-TR criteria. Participants were provided with the Toronto Alexithymia Scale (20 items; TAS-20), a self-measure of the Intravaginal Ejaculation Latency Time and an ad hoc questionnaire to collect anamnestic data. 9.3% of patients could be categorized as alexithymics, 9.3% of them as borderline, while 81.4% of the sample was found to be non-alexithymic. The overall average TAS-20 score was 45.46. Results show that alexithymia is correlated neither with the presence of DE nor with its severity, in contrast to other MSDs, where this condition was found in about 30% of patients. The data presented suggest that DE, although not correlated to alexithymia, is probably related to other psychogenic features such as hypercontrol configuration. This paper can contribute to the understanding of DE, by excluding one of the possible etiological factors, previously found to be important in the onset and the maintenance of the other MSDs. More studies are needed in order to better understand DE and provide recommendations about treatment.

A randomized, placebo-controlled, preoperative trial of allopurinol in subjects with colorectal adenoma.

Inflammation and oxidative stress play a crucial role in the development of colorectal cancer (CRC) and interference with these mechanisms represents a strategy in CRC chemoprevention. Allopurinol, a safe molecular scavenger largely used as antigout agent, has been shown to increase survival of patients with advanced CRC and to reduce CRC incidence in long-term gout users in epidemiologic studies. We conducted a randomized, double-blind, placebo-controlled preoperative trial in subjects with colorectal adenomatous polyps to assess the activity of allopurinol on biomarkers of colorectal carcinogenesis. After complete colonoscopy and biopsy of the index polyp, 73 subjects with colorectal adenomas were assigned to either placebo or one of two doses of allopurinol (100 mg or 300 mg) and treated for four weeks before polyp removal. Change of Ki-67 labeling index in adenomatous tissue was the primary endpoint. Secondary endpoints were the immunohistochemical (IHC) expression of NF-κB, ß-catenin, topoisomerase-II-α, and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) in adenomatous polyps and normal adjacent colonic tissue. Compared with placebo, Ki-67 levels were not significantly modulated by allopurinol, whereas ß-catenin and NF-κB expression levels decreased significantly in adenomatous tissue, with a mean change from baseline of -10.6%, 95% confidence interval (CI), -20.5 to -0.7, and -8.1%, 95% CI, -22.7 to 6.5, respectively. NF-κB also decreased significantly in normal adjacent tissue (-16.4%; 95% CI, -29.0 to -3.8). No dose-response relationship was noted, except for NF-κB expression in normal tissue. Allopurinol can inhibit biomarkers of oxidative activation in colon adenomatous polyps and normal adjacent tissue. Further studies should define its potential chemopreventive activity.

Cyclosporine as monotherapy for psoriasis in the setting of chronic HCV infection: a forgotten therapeutical option.

BACKGROUND: Treatment of psoriasis in the setting of chronic hepatitis C virus (HCV) infection is difficult, because standard therapies like methotrexate are associated with increased hepatic toxicity. Due to the HCV suppressive effect. Cyclosporine may represent a valid systemic alternative for psoriatic-HCV patients. OBJECTIVES: In this study, we report the successful usage of intermittent cycles of cyclosporine in the setting of chronic HCV infection and we try to call the attention once again in a very effective and forgotten therapeutic option for severe chronic plaque psoriasis. OBSERVATION: We describe a 48 years - old patient who has a 20 year history of severe chronic plaque psoriasis and HCV infection (aminotransferase levels are three times normal; HCV genotype 2a-2c and HCV-RNA titer of 2.050.000 UI-ml). Five courses (range of duration of three to six months) of oral cyclosporine (5 mg/kg/day) were followed during a 38 month period. The viral load and the transaminases' levels diminished during the 38 months of intermittent cyclosporine therapy to the lowest level measured at 36th month. The good psoriatic response was associated to a slight improvement of the liver condition, even though the HCV-RNA was reduced by less than 1 log10 without normalization of aminotransferase' levels. CONCLUSION: The reduced liver toxicity, the potential anti-HCV properties and the well-known systemic anti-inflammatory effect, make cyclosporine a good alternative for recalcitrant psoriatic patients with HCV-liver disease.

Dysregulation of emotions and premature ejaculation (PE): alexithymia in 100 outpatients.

INTRODUCTION: There is still a lack of agreement on etiology, definition, and mechanisms that underlie premature ejaculation (PE) as well as on the different role and interaction between psychological and biological factors. Alexithymia is a deficit in identifying and communicating emotions that is presumed to play an important role in psychosomatic diseases. The influences of alexithymic features on sexuality are still understudied. AIM: Following a previous report on the relationship between alexithymia and erectile dysfunction, the objective of this study was the investigation of alexithymic features in patients with lifelong PE compared with controls, and the relationship between alexithymia level and PE severity. METHODS: We assessed 100 consecutive outpatients with lifelong PE (age range 20-60). A control group of 100 male volunteers was recruited for the control group. The two groups were comparable in age, marital status, and socioeconomic characteristics. MAIN OUTCOME MEASURES: The Toronto Alexithymia Scale (TAS-20) was employed for the assessment of alexithymia. The premature ejaculation severity index was used as self-report measure of PE severity on a multidimensional perspective. RESULTS: Our data show significantly higher scores of alexithymia in patients with PE than in the control group (P < 0.001), and a positive correlation between alexithymia level and PE severity (P < 0.002). With regard to TAS-20 subfactors, an externally oriented cognitive style shows the highest correlation with PE severity (P < 0.001) and the most significant difference in the comparison between PE and control group (P < 0.001). CONCLUSION: These findings suggest that alexithymic features, and in particular, an externally oriented cognitive style, can be seen as possible risk and/or maintenance factors for PE, and may contribute to a more serious manifestation of this condition. Alexithymia could represent an important variable for an integrated diagnosis and treatment of PE in a modern somatopsychic and holistic viewpoint.