Efficacy and safety of antegrade sclerotherapy for varicocele in pediatric patients: A systematic review.

OBJECTIVES: Antegrade sclerotherapy (Tauber's) procedure has been extensively used for the minimally-invasive treatment of varicocele; however, the results in the pediatric population are less defined. This systematic review evaluates the efficacy and safety of antegrade sclerotherapy for varicocele in the pediatric population. EVIDENCE ACQUISITION: The review was conducted following the PRISMA guidelines. Systematic research of available literature in English language from 1980 until May 2022 was conducted through EMBASE, MEDLINE, Cochrane Library, and NIH Registry of Clinical Trials. For each study, information was gathered regarding the study design, the inclusion/exclusion criteria, the indications for treatment, the success rate and the complications. When available, the details about sperm analysis were reported. EVIDENCE SYNTHESIS: The 10 studies were included in the final sample (564 patients). Median age of patients ranged 13.3-15.3 years. The indications for scleroembolization varied in the different studies, while most studies included patients with clinical G2-G3 varicocele and clinical symptoms or testicular asymmetry. The treatment was successful in 88%-98% of the patients, while the complication rate was <5%. CONCLUSION: Tauber's sclerotherapy is a safe and effective treatment for varicocele also in the pediatric population. Further studies with standardized inclusion criteria are needed to provide higher level of evidence and compare the outcomes of antegrade sclerotherapy with the other available techniques.

microRNA165 and 166 modulate response of the Arabidopsis root apical meristem to salt stress.

In plants, developmental plasticity allows for the modulation of organ growth in response to environmental cues. Being in contact with soil, roots are the first organ that responds to various types of soil abiotic stress such as high salt concentration. In the root, developmental plasticity relies on changes in the activity of the apical meristem, the region at the tip of the root where a set of self-renewing undifferentiated stem cells sustain growth. Here, we show that salt stress promotes differentiation of root meristem cells via reducing the dosage of the microRNAs miR165 and 166. By means of genetic, molecular and computational analysis, we show that the levels of miR165 and 166 respond to high salt concentration, and that miR165 and 166-dependent PHABULOSA (PHB) modulation is central to the response of root growth to this stress. Specifically, we show that salt-dependent reduction of miR165 and 166 causes a rapid increase in PHB expression and, hence, production of the root meristem pro-differentiation hormone cytokinin. Our data provide direct evidence for how the miRNA-dependent modulation of transcription factor dosage mediates plastic development in plants.

Defining growth requirements of microgreens in space cultivation via biomass production, morpho-anatomical and nutritional traits analysis.

During long-term manned missions to the Moon or Mars, the integration of astronauts' diet with fresh food rich in functional compounds, like microgreens, could strengthen their physiological defenses against the oxidative stress induced by the exposure to space factors. Therefore, the development of targeted cultivation practices for microgreens in space is mandatory, since the cultivation in small, closed facilities may alter plant anatomy, physiology, and resource utilization with species-specific responses. Here, the combined effect of two vapor pressure deficit levels (VPD: 0.14 and 1.71 kPa) and two light intensities (150 and 300 µmol photons m-2 s-1 PPFD) on two species for microgreen production (Brassica oleracea var. capitata f. sabauda 'Vertus' and Raphanus raphanistrum subsp. sativus 'Saxa'), was tested on biomass production per square meter, morpho-anatomical development, nutritional and nutraceutical properties. Microgreens were grown in fully controlled conditions under air temperature of 18/24°C, on coconut fiber mats, RGB light spectrum and 12 h photoperiod, till they reached the stage of first true leaves. At this stage microgreens were samples, for growth and morpho-anatomical analyses, and to investigate the biochemical composition in terms of ascorbic acid, phenols, anthocyanin, carotenoids, carbohydrates, as well as of anti-nutritional compounds, such as nitrate, sulfate, and phosphate. Major differences in growth were mostly driven by the species with 'Saxa' always presenting the highest fresh and dry weight as well as the highest elongation; however light intensity and VPDs influenced the anatomical development of microgreens, and the accumulation of ascorbic acid, carbohydrates, nitrate, and phosphate. Both 'Saxa' and 'Vertus' at low VPD (LV) and 150 PPFD increased the tissue thickness and synthetized high ß-carotene and photosynthetic pigments. Moreover, 'Vertus' LV 150, produced the highest content of ascorbate, fundamental for nutritional properties in space environment. The differences among the treatments and their interaction suggested a relevant difference in resource use efficiency. In the light of the above, microgreens can be considered suitable for cultivation in limited-volume growth modules directly onboard, provided that all the environmental factors are combined and modulated according to the species requirements to enhance their growth and biomass production, and to achieve specific nutritional traits.

A survey on preferences, attitudes, and perspectives of Italian urology trainees: implications of the novel national residency matching program.

BACKGROUND: Since 2014, a new residency program selection process has been established with a national examination. The aim of this study was to assess characteristics, career goals, and practice preferences of current Italian urology residents. METHODS: A web-based survey of 25 items performed from May 2021 to September 2021 was sent to 585 Italian urology residents. Descriptive analyses were conducted to describe the surveys' domains: demographics characteristics, studies, plans for fellowship training, interest in the urology field, and career expectations. RESULTS: Four hundred and one residents completed the online survey (response rate 68.5%). Most residents were male (70.3%), with a median of 29 (IQR 28-31) years. Urology was the first chosen School in 325 (81.0%) cases, and 174 (43.4%) trainees have chosen to remain in the same University. Uro-oncology was the main field, and endourology the main subspeciality of interest, respectively. More than 40.0% of residents expressed a good level of satisfaction for the training urological course. 232 (57.2%) residents were strongly interested in seeking a hospital career, followed by private career (43.4%) and academic career (20%). CONCLUSIONS: After the introduction of the novel national residency matching program the Italian Urology trainees showed a good satisfaction level. Further improvements of the Italian residency programs should be focused on the training network within and outside the main School of Urology.

AstroBio-CubeSat: A lab-in-space for chemiluminescence-based astrobiology experiments.

Space exploration is facing a new era in view of the planned missions to the Moon and Mars. The development and the in-flight validation of new technologies, including analytical and diagnostic platforms, is pivotal for exploring and inhabiting these extreme environments. In this context, biosensors and lab-on-chip devices can play an important role in many situations, such as the analysis of biological samples for assessing the impact of deep space conditions on man and other biological systems, environmental and food safety monitoring, and the search of molecular indicators of past or present life in extra-terrestrial environments. Small satellites such as CubeSats are nowadays increasingly exploited as fast and low-cost platforms for conducting in-flight technology validation. Herein, we report the development of a fully autonomous lab-on-chip platform for performing chemiluminescence-based bioassays in space. The device was designed to be hosted onboard the AstroBio CubeSat nanosatellite, with the aim of conducting its in-flight validation and evaluating the stability of (bio)molecules required for bioassays in a challenging radiation environment. An origami-like microfluidic paper-based analytical format allowed preloading all the reagents in the dried form on the paper substrate, thus simplifying device design and analytical protocols, facilitating autonomous assay execution, and enhancing the stability of reagents. The chosen approach should constitute the first step to implement a mature technology with the aim to conduct life science research in space (e.g., for evaluation the effect of deep space conditions on living organisms or searching molecular evidence of life) more easily and at lower cost than previously possible.

Robotic partial nephrectomy for complex kidney cyst in a 4-year old boy: Points of technique.

Complex kidney cysts are rarely observed in childhood. In adult patients, when radiological studies found a suspicious renal lesion, the gold standard is surgical asportation. The robotic surgery is well known as a secure procedure for treatment these patients, and is nowadays a real alternative also for pediatric patients. The challenges in children surgery are linked to anesthesiologic gestion, smaller operative fields, the need of specific instruments and more delicate tissue handling. We present a step-by-step video description of a robotic partial nephrectomy for a renal multicystic mass in a 4 year-old child.

It's Time for a Change: The Role of Gibberellin in Root Meristem Development.

One of the most amazing characteristics of plants is their ability to grow and adapt their development to environmental changes. This fascinating feature is possible thanks to the activity of meristems, tissues that contain lasting self-renewal stem cells. Because of its simple and symmetric structure, the root meristem emerged as a potent system to uncover the developmental mechanisms behind the development of the meristems. The root meristem is formed during embryogenesis and sustains root growth for all the plant's lifetime. In the last decade, gibberellins have emerged as a key regulator for root meristem development. This phytohormone functions as a molecular clock for root development. This mini review discusses the latest advances in understanding the role of gibberellin in root development and highlights the central role of this hormone as developmental timer.

Safety of robot-assisted radical prostatectomy in an Italian spoke hospital: Long-term oncologic and functional outcomes with median 11.3 years follow-up.

INTRODUCTION: Robot-assisted radical prostatectomy (RARP) long-term oncologic outcomes were published in few studies. This paper provides a complete overview of RARP long-term oncologic and functional results produced in an Italian spoke hospital. METHODS: From December 2004 to December 2010, 300 consecutive patients with prostate cancer were treated with extraperitoneal RARP. Biochemical recurrence-free survival (BCRFS), salvage therapy-free survival (STFS), prostate cancer specific survival (PCa-SS), and overall survival (OS) were estimated using the Kaplan-Meier analysis and log-rank test. Cox proportional hazard regression analysis was performed to identify predictors of BCR and ST. Crude rates of continence and potency recovery after surgery were reported. RESULTS: Median follow-up was 135.6 months (IQR 20-184). At 15 years, BCR-FS, ST-FS, PCa-SS, and OS rates were 78% (95% CI 0.73-0.83), 85% (95% CI 0.81 -0.89), 98% (95% CI 0.97-100), and 89% (95% CI 0.84-0.94), respectively. On multivariate analysis, biopsy ISUP grade ⩾2, clinical stage ⩾pT3a, D'Amico high-risk patients subgroup, pathologic ISUP grade ⩾2, and multifocal/extensive positive margins were independent predictors of BCR. The same risk factors plus D'Amico intermediate risk patients subgroup were independent predictors of ST. After surgery, 280 (93.3%) and 93 (35.2%) patients experienced continence and potency recovery, respectively. The retrospective nature of the analysis and some selection biases represent the principal limitations of the study. CONCLUSION: The results showed in the present study match those obtained in referral centers and this is an evidence against the general belief that best prostate cancer care in provided in high volume hospitals and against centralization. Adverse characteristics of the tumor remain the best predictors of BCR and ST.

Pre and postoperative imaging in patients undergoing pyeloplasty: A survey of current adult and paediatric practice.

BACKGROUND: Imaging to be used during the workup and follow-up of patients undergoing pyeloplasty is still controversial. Present survey aimed at assessing variations in pre- and post-operative imaging between adults and paediatric specialists in patients undergoing pyeloplasty. METHODS: A survey of members of the 'Italian Society of Urology' (SIU) and the 'Italian Society of Paediatric Urology' (SIUP) was conducted using an online platform. RESULTS: Respondents included 87 (74.4%) adult and 30 (25.6%) paediatric specialists. Adult specialists were significantly more likely to use a CT scan during preoperative workup (p = 0.001) and postoperative follow-up (p < 0.001). In contrast, paediatric specialists were significantly more likely to recommend voiding cystourethrography during the workup (p < 0.001) and an MRI in cases requiring additional diagnostic study (<0.001). Adult specialists reported to deal significantly more commonly with symptomatic or complicated hydronephroses (p < 0.001). The majority of respondents recommend an ultrasound scan at 1-3 months as first postoperative investigation. Two-third also recommended a nuclear scintigraphy, but 67.8% of adult specialists recommended to perform it within 6 months of surgery whereas 76.7% of paediatric specialists between 6 and 12 months (p < 0.001). CONCLUSIONS: Present survey suggests quite a significant variation between adult and paediatric specialists in pre- and post-operative assessment of patients requiring pyeloplasty. This may just reflect different attitudes that could be improved with appropriate studies, or essential differences in the condition or the characteristics of treated patients. In any case, such differences are important and should be taken into account.

The Analysis of Gravitropic Setpoint Angle Control in Plants.

The history of research on gravitropism has been largely confined to the primary root-shoot axis and to understanding how the typically vertical orientation observed there is maintained. Many lateral organs are gravitropic too and are often held at specific non-vertical angles relative to gravity. These so-called gravitropic setpoint angles (GSAs) are intriguing because their maintenance requires that root and shoot lateral organs are able to effect tropic growth both with and against the gravity vector. This chapter describes methods and considerations relevant to the investigation of mechanisms underlying GSA control.

Metabolic syndrome and risk of prostate cancer: a systematic review and meta-analysis.

INTRODUCTION: Emerging evidence supports the hypothesis that metabolic syndrome is associated with cancer pathogenesis. In particular regarding prostate cancer, observational studies from various settings report different results. This systematic review and meta-analysis aimed to provide a quantitative estimate of the association between metabolic syndrome in prostate cancer, in particular Gleason Score >6, accounting for different study designs. EVIDENCE ACQUISITION: Systematic research of available literature in English language until 2020 was conducted through in Embase, Medline, Cochrane Library and NIH Registry of Clinical Trials. For each study, information regarding the study design, the population, the definition of metabolic syndrome, data relating to prostate cancer were collected, the association between MetS and outcome of interest was determined by calculating the generic inverse variance with random effects method. EVIDENCE SYNTHESIS: In the final sample 19 studies were included with total of 114,329 patients, 29.4% met the criteria for metabolic syndrome. We report a significant association between metabolic syndrome and prostate cancer in cross-sectional studies (OR=1.30; 95% CI: 1.13-1.49) and for patients with clinically significant prostate cancer (OR=1.56; 95% CI: 1.23-1.99). Association between metabolic syndrome and prostate cancer combining all studies, in cohort studies and case-control studies was not significant. CONCLUSIONS: Growing evidence support the association between metabolic syndrome and prostate cancer, bias derived from observational studies might conceal further findings.

The impact of COVID-19 pandemic on urological emergencies: a single-center experience.

PURPOSE: COVID-19 pandemic represents a novel challenge for healthcare systems, and it affects even the daily urological practice. Italy was the first country after China to experience a lock-down period. Our objective is to determine whether, during the COVID-19 period, there has been any modification in urological emergencies. METHODS: we retrospectively reviewed urgent urological consultations requested by the Emergency Department (ED) of Padua University Hospital in the 36-day period between February 22nd and March 30th, 2020 and compared them to the prior year cases within a similar time frame (February 24th to March 31st, 2019). Pediatric population (age < 15 years); surgical complications and traumas were excluded to avoid confounding from the reduction of activities during the lockdown. The number of daily consultations, the number of invasive procedures performed and admissions were evaluated, together with the predictors of admission were identified through multivariate logistic regression models. RESULTS: The final sample resulted in 107 consultations performed in 2020 and 266 in 2019. A higher number of daily consultations was performed during 2019 (7.33 vs 2.97, p < 0.001). Similarly, the number of daily-invasive procedures was higher in 2019 (p = 0.006), while there was no difference in the number of daily admissions (15 vs 12, p = 0.80). On multivariate analysis, the year (2020 vs 2019, OR 2.714, 95% CI 1.096-6.757, p = 0.0297) was a significant predictor of admission. CONCLUSIONS: Urgent urology practice was affected during COVID-19 pandemic with a remarkable reduction in urgent urological consultations; furthermore, a higher risk of admissions was observed in 2020. The consequences of a potentially delayed diagnosis remain to be determined.

Self-reported outcomes after the onset of puberty in patients undergoing primary distal hypospadias repair by the tubularized incised plate technique combined with preputial reconstruction vs. circumcision: A norm related study.

PURPOSE: We assessed self-reported outcomes after the onset of puberty in patients undergoing tubularized incised plate (TIP) repair in combination with preputial reconstruction (PR) or circumcision for primary distal hypospadias, in comparison to normal controls. MATERIAL AND METHODS: Out of 498 patients undergoing primary distal hypospadias repairs between 2001 and 2012, 83 underwent TIP repair associated with PR or circumcision before age 10-year, and had a Tanner stage ≥2 at study. Outcomes were assessed by online self-administration of validated questionnaires and additional non-validated questions. Results were compared between patients undergoing TIP repair vs. normal age-matched controls (healthy volunteers), and, between patients undergoing PR vs. circumcision. RESULTS: Forty-one of the 83 eligible patients completed the study (response rate 49.3%). Of these, 26 had undergone PR. Median post-operative follow-up was 11.8 (range 6.5-16.2) years. The control group included 45 healthy boys. Comparing groups, there were no statistically significant differences in the cosmetic aspect of the penis, patient perception of penile appearance, and quality of life. Irrespective of preputial management, patients reported fear of being teased for the appearance of their genitalia much more commonly than controls (p = 0.02), but this did not affect their relationship patterns and quality of life. CONCLUSION: Self-reported outcomes after the onset of puberty were not significantly different between patients undergoing primary TIP repair of distal hypospadias in childhood and normal controls. Patients were significantly more commonly feared of being teased for their genital appearance, but this did not interfere with their social skills. Preputial management, namely PR vs. circumcision, did not affect the outcome.

Treatment of Penile Prosthesis Implant's Infection.

INTRODUCTION: Penile prosthesis implant is a safe and effective option in erectile dysfunction patients, being implant procedures safe with a low risk of infection. However, when infection occurs, it represents a concrete problem for both surgeon and patient. METHODS: This is a comprehensive review of all issues relating to prosthesis infection, including causes and risk factors, methods of prevention, and management. We analyzed all preoperative and perioperative factors, which can play a role in infection of the device. RESULTS: Infection of penile prosthesis implant is hard to manage and correct. While the incidence of infection following first implant is up to 3%, in cases of re-implant surgery, the rate can reach as high as 18%. Many articles were found addressing prevention and treatment of penile prosthesis infection, and many analyzed all relevant pre- and perioperative factors associated with penile prosthesis implant. Although such factors have been well studied, there is no clear consensus worldwide on certain topics. CONCLUSIONS: Penile prosthesis implant is a safe and effective option. Despite infection is a rare event, surgeons should follow strictly pre-, intra- and postoperative recommendations in order to reduce the risk of device's infection. An appropriate antibiotic therapy should be tailored on patient's characteristics and pathogens isolated.