Exploring sexual function in adrenal insufficiency: findings from the Dual RElease hydrocortisone versus conventionAl glucocorticoid replaceMent therapy in hypocortisolism (DREAM) trial.

BACKGROUND: Data on sexual function in patients with adrenal insufficiency are scarce and largely controversial. OBJECTIVES: To investigate sexual dysfunction in patients with primary and secondary adrenal insufficiency and the effects of switching to once-daily dual-release hydrocortisone on sexual function in outcome assessors blinded, randomized, multicenter, active comparator clinical trial. MATERIALS AND METHODS: Eighty-nine adrenal insufficiency patients on conventional, multiple daily doses of glucocorticoid replacement, enrolled in the Dual RElease hydrocortisone versus conventionAl glucocorticoid replaceMent in hypocortisolism (DREAM) trial, were randomly assigned to continue their therapy or to switch to an equivalent dose of dual-release hydrocortisone. Sixty-three patients (34 women) consented to sex steroid measurements and questionnaires completion for quality of life (Addison's disease-specific quality-of-life questionnaire) and sexual function evaluation (female sexual function index for women, International Index of Erectile Function-Erectile Function for men) at baseline and 24 weeks after randomization. RESULTS: At baseline, sexual dysfunction was observed in 41% of women and 59% of men with adrenal insufficiency. In both sexes, no associations were found between sexual function and hormone levels, whereas Addison's disease-specific quality-of-life questionnaire total and fatigue domain scores positively correlated with total female sexual function index and International Index of Erectile Function-Erectile Function scores. At 24 weeks, there was no significant difference either in sexual function or sex steroid levels between study groups. In the dual-release hydrocortisone group, the variation in the female sexual function index desire domain score was positively associated with the change in Addison's disease-specific quality-of-life questionnaire's symptom domain score (ρ = 0.478, p = 0.045). DISCUSSION: Sexual dysfunction is common in adrenal insufficiency patients and is likely explained by multiple factors. dual-release hydrocortisone treatment is not directly associated with sexual function improvement, but an indirect effect mediated by quality-of-life amelioration cannot be excluded.

Engaging Parents in Technology-Assisted Interventions for Childhood Adversity: Systematic Review.

BACKGROUND: Youth mental health problems are a major public health concern and are strongly associated with adverse childhood experiences (ACEs). Technology-assisted parenting programs can intervene with ACEs that are within a parent's capacity to modify. However, engagement with such programs is suboptimal. OBJECTIVE: This review aims to describe and appraise the efficacy of strategies used to engage parents in technology-assisted parenting programs targeting ACEs on the behavioral and subjective outcomes of engagement. METHODS: Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines, we conducted a systematic review of peer-reviewed papers that described the use of at least 1 engagement strategy in a technology-assisted parenting program targeting ACEs that are within a parent's capacity to modify. A total of 8 interdisciplinary bibliographic databases (CENTRAL, CINAHL, Embase, OVID MEDLINE, OVID PsycINFO, Scopus, ACM, and IEEE Xplore) and gray literature were searched. The use of engagement strategies and measures was narratively synthesized. Associations between specific engagement strategies and engagement outcomes were quantitatively synthesized using the Stouffer method of combining P values. RESULTS: We identified 13,973 articles for screening. Of these, 156 (1.12%) articles were eligible for inclusion, and 29 (18.2%) of the 156 were associated with another article; thus, 127 studies were analyzed. Preliminary evidence for a reliable association between 5 engagement strategies (involving parents in a program's design, delivering a program on the web compared to face-to-face, use of personalization or tailoring features, user control features, and provision of practical support) and greater engagement was found. Three engagement strategies (professional support features, use of videos, and behavior change techniques) were not found to have a reliable association with engagement outcomes. CONCLUSIONS: This review provides a comprehensive assessment and description of the use of engagement strategies and engagement measures in technology-assisted parenting programs targeting parenting-related ACEs and extends the current evidence with preliminary quantitative findings. Heterogeneous definition and measurement of engagement and insufficient engagement outcome data were caveats to this synthesis. Future research could use integrated definitions and measures of engagement to support robust systematic evaluations of engagement in this context. TRIAL REGISTRATION: PROSPERO CRD42020209819; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209819.

Effects of Dual-Release Hydrocortisone on Bone Metabolism in Primary and Secondary Adrenal Insufficiency: A 6-Year Study.

Context: Patients with primary (PAI) and secondary adrenal insufficiency (SAI) experience bone metabolism alterations, possibly due to excessive replacement. Dual-release hydrocortisone (DR-HC) has shown promising effects on several parameters, but bone metabolism has seldom been investigated. Objective: We evaluated the long-term effects of once-daily DR-HC on bone in PAI and SAI. Methods: Patients on immediate-release glucocorticoid therapy were evaluated before and up to 6 years (range, 4-6) after switching to equivalent doses of DR-HC, yielding data on bone turnover markers, femoral and lumbar spine bone mineral density (BMD), and trabecular bone score (TBS). Results: Thirty-two patients (19 PAI, 18 female), median age 52 years (39.4-60.7), were included. At baseline, osteopenia was observed in 38% of patients and osteoporosis in 9%, while TBS was at least partially degraded in 41.4%. Higher body surface area-adjusted glucocorticoid doses predicted worse neck (P < .001) and total hip BMD (P < .001). Longitudinal analysis showed no significant change in BMD. TBS showed a trend toward decrease (P = .090). Bone markers were stable, albeit osteocalcin levels significantly varied. PAI and SAI subgroups behaved similarly, as did patients switching from hydrocortisone or cortisone acetate. Compared with men, women exhibited worse decline in TBS (P = .017) and a similar trend for neck BMD (P = .053). Conclusion: After 6 years of chronic DR-HC replacement, BMD and bone markers remained stable. TBS decline is more likely due to an age-related derangement of bone microarchitecture rather than a glucocorticoid effect. Our data confirm the safety of DR-HC replacement on bone health in both PAI and SAI patients.

Practical two-photon-absorption cross sections and spectra of eosin and hematoxylin.

We experimentally investigate the two-photon absorption cross sections and spectra of eosin and hematoxylin for applications in nonlinear microscopy. The experiments are carried out on pure samples of the two dyes in DI-water solvent with different concentrations, in the typical range employed in standard staining procedures. Nonlinear fluorescence is excited by a line-shaped beam emitted by a Ti:Sapphire mode-locked laser in the wavelength range from 740 to 880 nm and is detected through a microscope setup. The two-photon absorption spectral response is systematically analyzed and discussed. Finally, the staining is applied on biological tissue samples, which are imaged by two-photon microscopy. Our results show that the employed dyes are fully suitable for applications in nonlinear imaging.

Control measurements for lasers in physiotherapy.

OBJECTIVES: In physical rehabilitation, is diffused the skin irradiation with near infrared laser at a fluence below 140 J/cm2, achieving a bio-stimulating effect that is due to the absorption of radiation in mitochondria rather than the simple heating of tissues. METHODS: In order to deliver radiation without thermal damage of the skin, are used radiation pulses which duration does not allow heat accumulation and propagation far from the irradiated target; this requires laser sources with average power below 10 W implying a safety classification as "potentially dangerous for eye and skin", or "class 4" according to the applicable international standards. In this paper, 6 laser therapy devices, of 5 different manufactures and models have been analyzed from the point of view of actual radiation output and user safety. In each case, one or more of the characteristic declared by the manufacturer in the user manual have been found different from the actual measured value. RESULTS: The actual accessible energy levels have been found to be complying with risk class 3B. The impact of the new version of the Standard IEC 60825-1 (2014), is also discussed, considering in particular the possible classification in the new class 1C, and the maximum permissible levels for pulsed lasers. CONCLUSIONS: An extension of the measurement protocols is proposed in order to assure effective and safe use of laser in physical therapy.

First results on Ge resonant laser photoionization in hollow cathode lamp.

In the framework of the research and development activities of the SPES project regarding the optimization of the radioactive beam production, a dedicated experimental study has been recently started in order to investigate the possibility of in-source ionization of germanium using a set of tunable dye lasers. Germanium is one of the beams to be accelerated by the SPES ISOL facility, which is under construction at Legnaro INFN Laboratories. The three-step, two color ionization schemes have been tested using a Ge hollow cathode lamp. The slow and the fast optogalvanic signals were detected and averaged by an oscilloscope as a proof of the laser ionization inside the lamp. As a result, several wavelength scans across the resonances of ionization schemes were collected with the fast optogalvanic signal. Some comparisons of ionization efficiency for different ionization schemes were made. Furthermore, saturation curves of the first excitation transitions have been obtained. This investigation method and the setup built in the laser laboratory of the SPES project can be applied for the photo-ionization scheme studies also for the other possible radioactive elements.

Laser system generating 250-mJ bunches of 5-GHz repetition rate, 12-ps pulses.

We report on a high-energy solid-state laser based on a master-oscillator power-amplifier system seeded by a 5-GHz repetition-rate mode-locked oscillator, aimed at the excitation of the dynamic Casimir effect by optically modulating a microwave resonator. Solid-state amplifiers provide up to 250 mJ at 1064 nm in a 500-ns (macro-)pulse envelope containing 12-ps (micro-)pulses, with a macro/micropulse format and energy resembling that of near-infrared free-electron lasers. Efficient second-harmonic conversion allowed synchronous pumping of an optical parametric oscillator, obtaining up to 40 mJ in the range 750-850 nm.

High-gain diode-pumped amplifier for generation of microjoule-level picosecond pulses.

A diode-pumped single-pass amplifier system relying on two grazing-incidence Nd:YVO(4) slabs was developed to increase the energy of low-repetition-rate pulses from a decimated low-power cw mode-locked oscillator. Single-pass unsaturated gain up to 1.3x10(5) was achieved, and amplified pulses of 10-muJ energy and 8.0-ps duration were obtained. Efficient second harmonic generation (SHG) at 532 nm was achieved, as well as traveling-wave parametric conversion in the range 770-1020 nm (signal) and 1110-1720 nm (idler).

Multi-GHz tunable-repetition-rate mode-locked Nd:GdVO4 laser.

We report on a simple design for a multi-GHz tunable-repetition-rate diode-pumped picosecond laser. Using a plano-Brewster Nd:GdVO4 crystal in a V-folded cavity employing only readily available commercial components, we achieved passive mode-locking with 4.4-ps pulses tunable in the range 2.5-2.7 GHz. This laser is meant to be employed in the MIR experiment that aims at the detection of the Schwinger radiation (dynamical Casimir effect).

Diode-pumped passively mode-locked and passively stabilized Nd3+:BaY2F8 laser.

Continuous-wave mode locking (CW-ML) of a diode-pumped Nd3+:BaY2F8 laser is reported for the first time to our knowledge. Pulses as short as 4.8 ps were measured with a total output power of approximately 1 W at 1049 nm, corresponding to 3.4 W of absorbed power from the pump diode at 806 nm. A novel technique for passive stabilization of CW-ML has been demonstrated.

DNASER I: layout and data analysis.

We present the DNA analyzer (DNASER), a novel bioinstrumentation for real-time acquisition and elaboration of images from fluorescent DNA microarrays. A white light beam illuminates the target sample allowing the images grabbing on a high sensibility and wide-band charge-coupled device camera (ORCA II-Hamamatsu). This high-performance device permits to acquire images faster and of higher quality than the traditional systems. The DNA microarrays images are processed to recognize the DNA chip spots, to analyze their superficial distribution on the glass slide and to evaluate their geometric and intensity properties. Differently form conventional techniques, the spots analysis is fully automated and the DNASER does not require any additional information about the DNA microarray geometry. The DNASER hardware and software architecture is illustrated. Preliminary results are shown from experiments performed on real DNA samples.