Efficacy of intradermal hyaluronic acid plus polynucleotides in vulvovaginal atrophy: a pilot study.

OBJECTIVE: This study aimed to evaluate the safety and efficacy of vulvovaginal intradermal injections of polynucleotides (PN) combined with hyaluronic acid (HA) in postmenopausal women affected by vulvovaginal atrophy (VVA). MATERIALS AND METHODS: Postmenopausal women affected by VVA were treated with vulvar and vaginal intradermal injections of one prefilled syringe of 2 ml PN/HA every 2 weeks for four sessions. Patients were evaluated at T0 (baseline), T1 (after session 4) and T2 (1 month after session 4). Evaluation of the treatment was assessed by three international validated questionnaires: Vaginal Health Index (VHI), Vulvar Health Index (VuHI) and Female Sexual Function Index (FSFI). The Wilcoxon matched-paired signed-rank test was used to compare the differences in VHI, VuHI, FSFI and FSFI domains within the groups. Statistical significance was set at p < 0.05. RESULTS: Fifty patients were included in the study (mean age 59.9 ± 7.6 years). Overall, the VHI, VuHI and FSFI reported statistically significant differences between baseline and T1 (p < 0.001) and between baseline and T2 (p < 0.001). All FSFI domains registered a statistically significant increase between baseline and T2 (p < 0.001). No complications or side effects were observed. CONCLUSIONS: Vulvovaginal intradermal injection of PN/HA is a safe, effective treatment, is not expensive and is a reproducible procedure in postmenopausal women with VVA.

Papel de la cirugía conservadora testicular en el manejo conservador de masas testiculares pequeñas: perspectivas oncológicas y funcionales / Role of testis sparing surgery in the conservative management of small testicular masses: oncological and functional perspectives

Introducción: La orquiectomía radical (OR) se considera todavía la opción estándar de atención para los tumores malignos de células germinales, que representan la gran mayoría de las masas testiculares palpables. En pacientes diagnosticados con pequeñas masas testiculares la cirugía conservadora testicular (CCT) podría ser un tratamiento alternativo a la OR. El objetivo de esta revisión actualizada es evaluar las indicaciones actuales para la CCT y debatir los resultados oncológicos y funcionales de los pacientes sometidos a cirugía conservadora testicular por pequeñas masas testiculares. Adquisición de la evidencia: Se ha llevado a cabo una revisión no sistemática de la literatura empleando la base de datos Medline, que incluyó un protocolo de texto libre utilizando los términos «cirugía conservadora de los testículos», «cirugía conservadora testicular», «orquiectomía parcial», «tumor de testículo», «tumor del cordón sexual» y «función testicular». También se evaluaron otros estudios significativos citados en las listas de referencia de los trabajos seleccionados. Síntesis de la evidencia: Aún no se ha registrado ningún ensayo controlado aleatorizado comparando la CCT con la OR. En aquellos pacientes con testículos contralaterales normales el uso de la CCT todavía resulta controvertido. En casos seleccionados de masas gonadales < 2 cm la CCT parece ser una opción terapéutica segura y viable. El análisis de secciones congeladas permite distinguir entre neoplasias benignas y malignas durante la CCT. Los resultados del seguimiento a medio y largo plazo no mostraron ningún riesgo significativo de recidiva local y a distancia en las principales series de la literatura. Conclusiones: La CCT es un tratamiento efectivo para las pequeñas masas testiculares en pacientes seleccionados, limitando los sobretratamientos quirúrgicos innecesarios, sin comprometer los resultados oncológicos y funcionales. Se requieren más estudios para confirmar la seguridad oncológica

Introduction: Radical orchiectomy (RO) is still considered the standard of care for malignant germ cell tumors, which represent the vast majority of the palpable testicular masses. In those patients diagnosed with small testicular masses (STMs), testis-sparing surgery (TSS) could be an alternative treatment to RO. The aim of this updated review is to evaluate the current indications for TSS, and discuss the oncological and functional results of patients who had undergone organ-sparing surgery for STMs. Evidence acquisition: A non-systematic review of the Literature using the Medline database has been performed, including a free-text protocol using the terms «testis sparing surgery», «testicular sparing surgery», «partial orchiectomy», «testis tumor», «sex cord tumor», and «testis function». Other significant studies cited in the reference lists of the selected papers were also evaluated. Evidence synthesis: No randomized controlled trials comparing TSS with radical orchiectomy have been reported yet. In those patients with normal contra-lateral testis, the use of TSS is still controversial. In selected cases of gonadal masses < 2 cm, TSS seems to be a safe and feasible treatment option. Frozen section examination allows us to discriminate between benign and malignant neoplasms during TSS. Intermediate and long-term follow-up results showed no significant risk of local and distant recurrences in the main series reported in the literature. Conclusions: TSS is an effective treatment for STMs in selected patients, limiting the unnecessary surgical over-treatments, without compromising the oncological and functional outcomes. Further studies are needed in order to confirm the oncological safety

Sex differences in the rapid and the sustained antidepressant-like effects of ketamine in stress-naïve and "depressed" mice exposed to chronic mild stress.

During the past decade, one of the most striking discoveries in the treatment of major depression was the clinical finding that a single infusion of a sub-anesthetic dose of the N-methyl-d-aspartate receptor antagonist ketamine produces a rapid (i.e. within a few hours) and long-lasting (i.e. up to two weeks) antidepressant effect in both treatment-resistant depressed patients and in animal models of depression. Notably, converging clinical and preclinical evidence support that responsiveness to antidepressant drugs is sex-differentiated. Strikingly, research regarding the antidepressant-like effects of ketamine has focused almost exclusively on the male sex. Herein we report that female C57BL/6J stress-naïve mice are more sensitive to the rapid and the sustained antidepressant-like effects of ketamine in the forced swim test (FST). In particular, female mice responded to lower doses of ketamine (i.e. 3mg/kg at 30 min and 5mg/kg at 24h post-injection), doses that were not effective in their male counterparts. Moreover, tissue levels of the excitatory amino acids glutamate and aspartate, as well as serotonergic activity, were affected in a sex-dependent manner in the prefrontal cortex and the hippocampus, at the same time-points. Most importantly, a single injection of ketamine (10mg/kg) induced sex-dependent behavioral effects in mice subjected to the chronic mild stress (CMS) model of depression. Intriguingly, female mice were more reactive to the earlier effects of ketamine, as assessed in the open field and the FST (at 30 min and 24h post-treatment, respectively) but the antidepressant potential of the drug proved to be longer lasting in males, as assessed in the splash test and the FST (days 5 and 7 post-treatment, respectively). Taken together, present data revealed that ketamine treatment induces sex-dependent rapid and sustained neurochemical and behavioral antidepressant-like effects in stress-naïve and CMS-exposed C57BL/6J mice.

Role of testis sparing surgery in the conservative management of small testicular masses: oncological and functional perspectives.

INTRODUCTION: Radical orchiectomy (RO) is still considered the standard of care for malignant germ cell tumours, which represent the vast majority of the palpable testicular masses. In those patients diagnosed with small testicular masses (STMs), testis-sparing surgery (TSS) could be an alternative treatment to RO. The aim of this updated review is to evaluate the current indications for TSS, and discuss the oncological and functional results of patients who had undergone organ-sparing surgery for STMs. EVIDENCE ACQUISITION: A non-systematic review of the Literature using the Medline database has been performed, including a free-text protocol using the terms "testis-sparing surgery", "testicular sparing surgery", "partial orchiectomy", "testis tumour", "sex cord tumour", and "testis function". Other significant studies cited in the reference lists of the selected papers were also evaluated. EVIDENCE SYNTHESIS: No randomized controlled trials comparing TSS with radical orchiectomy have been reported yet. In those patients with normal contra-lateral testis, the use of TSS is still controversial. In selected cases of gonadal masses < 2 cm, TSS seems to be a safe and feasible treatment option. Frozen section examination allows us to discriminate between benign and malignant neoplasms during TSS. Intermediate and long-term follow-up results showed no significant risk of local and distant recurrences in the main series reported in the literature. CONCLUSIONS: TSS is an effective treatment for STMs in selected patients, limiting the unnecessary surgical over-treatments, without compromising the oncological and functional outcomes. Further studies are needed in order to confirm the oncological safety.

[Retrospective study on the effects of a whey protein concentrate on body composition in 262 sarcopenic tube fed patients]. / Studio retrospettivo sugli effetti di un concentrato di proteine del siero del latte sulla composizione corporea di 262 pazienti in nutrizione enterale affetti da sarcopenia.

AIM: As pointed in ESPEN guidelines on the use of bioelectrical impedance analysis (BIA), "body cell mass (BCM) is the protein rich compartment which is affected in catabolic states, and loss of BCM is associated with poor clinical outcome". Whey proteins are known to improve lean mass in many conditions. We retrospectively evaluated the effects of a WP concentrate with high cysteine content (WPHCC) on BCM of 262 sarcopenic tube fed patients (pts). METHODS: Two hundred sixty-two sarcopenic tube fed pts (130 males, mean age 68,1±15,6 years) were given daily supplemental WPHCC (0.7±0.2 g/kg body weight) after their usual feeding formula, with the aim to improve their BCM. Each patient received a multifrequency impedance test before and after the beginning of WPHCC supplementation (mean follow-up: 4.2±2.8 months). Fifty percent of patients were affected by neurodegenerative diseases, 36% by cancer, 14% by other conditions. RESULTS: BCM, body weight and fat mass significantly improved (P<0.01) after treatment. No severe side effects were recorded. A slight increase in blood urea was observed. CONCLUSION: In our population WPHCC have been safe and effective in improving BCM. WPHCC could be useful to improve BCM in sarcopenic tube fed pts, although renal function should be monitored.

Radiological evaluation by magnetic resonance of the 'new anatomy' of transsexual patients undergoing male to female sex reassignment surgery.

Magnetic resonance (MR) is the best way to assess the new anatomy of the pelvis after male to female (MtF) sex reassignment surgery. The aim of the study was to evaluate the radiological appearance of the small pelvis after MtF surgery and to compare it with the normal women's anatomy. Fifteen patients who underwent MtF surgery were subjected to pelvic MR at least 6 months after surgery. The anthropometric parameters of the small pelvis were measured and compared with those of ten healthy women (control group). Our personal technique (creation of the mons Veneris under the pubic skin) was performed in all patients. In patients who underwent MtF surgery, the mean neovaginal depth was slightly superior than in women (P=0.009). The length of the inferior pelvic aperture and of the inlet of pelvis was higher in the control group (P<0.005). The inclination between the axis of the neovagina and the inferior pelvis aperture, the thickness of the mons Veneris and the thickness of the rectovaginal septum were comparable between the two study groups. MR consents a detailed assessment of the new pelvic anatomy after MtF surgery. The anthropometric parameters measured in our patients were comparable with those of women.

Positron-emission tomography in imaging and staging prostate cancer.

With increasing application of positron-emission tomography (PET) imaging, familiarity with the applications of PET in genitourinary oncology, especially prostate-cancer (PCa) imaging, becomes important. PET studies provide functional information using radiolabeled tracers, with fluoro-dexoxy-glucose (FDG) being the most commonly used. Nevertheless FDG has limitations for evaluation of PCa patients and therefore alternative tracers are being investigated. To date, the best results have been obtained with 11C-choline and 11C-acetate PET, which seem to demonstrate similar values in this field. We review the current role of PET in PCa patients based on data published in the literature as well as our own experience. Most studies of PET imaging of PCa address three goals: a) detecting primary PCa; b) staging PCa; and c) assessing PCa recurrence. From available results, routine clinical use of 11C-choline PET cannot be recommended for detecting and staging primary PCa. At present, the only clinical indication for imaging PCa with 11C-choline-PET is evaluation of suspected recurrence after treatment.

[An atypical bone metastasis of hepatocellular carcinoma: case report and review of the literature]. / Una metastasi ossea atipica in corso di epatocarcinoma: descrizione del caso clinico ed analisi della letteratura.

Bone metastases are a quite frequent complication of hepatocellular carcinoma (HCC). They are a substantial fraction (about 14-28%) of the metastatic locations of this neoplasm. Recent studies are indicative of the clinical usefulness of local therapy of HCC bone metastasis, expecially if they are single locations. The presence of a single bone metastasis does not seem to influence short term prognosis of the primary neoplasm and, furthermore, its treatment by radiation, chemio-embolization or surgery may obtain long-term pain control, without the side effects of analgesic drugs. Most frequently, bone metastases of HCC appear in the spine, femur, humerus or ribs. In the last years, some atypical locations, as jaws, gums and skull, were reported. In this paper, we report the case of a painful bone metastasis of HCC, localized at the second phalanx of the second finger of the right hand. To our knowledge, until now only two cases of HCC metastatic location at the bones of the hand have been reported. The lesion has been treated by surgical ablation, obtaining long-term pain remission and the withdrawal of the analgesic drugs. Few weeks later, another bone metastasis appeared, located at the second phalanx of the third finger of the same hand, indicating in this subject a peculiar "metastatic tropism".

Indoor air quality in the university libraries of Modena (Italy).

We carried out a survey in 16 libraries of the University of Modena, Northern Italy, to assess the indoor exposure to volatile organic compounds (VOCs), including formaldehyde, and total dusts. Data were collected on the main structural characteristics of the buildings; indoor microclimate parameters, such as temperature, relative humidity and ventilation rate were measured and air samples taken inside and outside the libraries. The mean value of total dusts was 190 +/- 130 microg/m3 with a wide range of values. Formaldehyde was found in only ten out of 16 libraries and the indoor concentrations ranged from 1.70 to 67.8 microg/m3 with an average value of 32.7 +/- 23.9 microg/m3. On the whole, VOCs were present in all the libraries investigated with an average value was 433 +/- 267 microg/m3 (range 102-936 microg/m3). No correlation was found among VOCs, formaldehyde and total dusts nor was a significant association observed with microclimatic parameters or the structural characteristics of the buildings. The general situation found in this study suggests no major problems related to indoor pollution. However, some of the pollutants investigated such as total dust and total VOCs deserve further investigation. It is important to identify the possible sources of contaminants and to define the relationship between indoor and outdoor levels of pollutants more accurately, taking into account the effects of air recycling due to natural ventilation systems.