Evaluation of efficacy of oxygen-enriched oil-based gel dressing in patients who underwent surgical repair of distal hypospadias: a prospective randomised clinical trial.

PURPOSE: This study aimed to evaluate the efficacy of oxygen-enriched oil-based gel dressing on wound healing and postoperative outcome in children who underwent distal hypospadias repair. METHODS: We included all patients with distal hypospadias, who underwent Snodgrass urethroplasty and preputioplasty over an 18-months period. The patients were randomized in two groups according to the type of medication: oxygen-enriched oil-based gel (G1) and hyaluronic acid cream (G2). After discharge, parents changed the dressing twice a day for 2-3 weeks postoperatively. The patients were evaluated at 7, 14, 21, 30, 60 and 180 postoperative days and thereafter annually. RESULTS: One-hundred and fourteen patients (median age 18 months) were included in the study and randomized in two groups, each of 57 patients. The wound healing was significantly faster in G1 compared with G2 (p = 0.001). G1 reported significantly higher SWAS and modified HOPE scores compared with G2 (p = 0.001) at all steps of follow-up. No adverse skin reactions occurred. Foreskin dehiscence and re-operations rates were significantly lower in G1 compared with G2 (p = 0.001). Postoperative foreskin retractability was better in G1, with a significantly higher incidence of secondary phimosis in G2 (p = 0.001). The median treatment costs were significantly lower in G1 compared with G2 (p = 0.001). CONCLUSION: Postoperative dressing using oxygen-enriched oil-based gel was highly effective, promoting a faster wound healing in patients who underwent distal hypospadias repair. It reported a lower incidence of foreskin dehiscence and better foreskin retractability compared with the control group. It was cost-effective and clinically safe without allergy or intolerance to the product.

(-)-Epicatechin in the prevention of tumor necrosis alpha-induced loss of Caco-2 cell barrier integrity.

An increased permeability of the intestinal barrier is proposed as a major event in the pathophysiology of inflammatory bowel diseases (IBD). Tumor necrosis alpha (TNFα) plays a central role in IBD pathogenesis, in part promoting tight function (TJ) barrier dysfunction. Food extracts enriched in (-)-epicatechin (EC) prevent the development or improve the progression of IBD in animal models. This study investigated the capacity of EC to inhibit TNFα-induced permeabilization of Caco-2 cell monolayers, characterizing the underlying mechanisms. Caco-2 cells differentiated into intestinal epithelial cells were incubated in the absence/presence of TNFα, with or without the addition of 0.5-5 µM EC. TNFα triggered cell monolayer permeabilization, decreasing transepithelial electrical resistance (TEER) and increasing the paracellular transport of fluorescein sulfonic acid. The permeabilizing effects of TNFα were not due to Caco-2 cell apoptosis as evaluated by DNA fragmentation, caspase 3 and 9 activation, and cell morphology. EC prevented TNFα-triggered Caco-2 monolayer permeabilization and acted inhibiting the associated: (i) NADPH oxidase (NOX)-mediated increased oxidant production, (ii) NF-κB (IκBα phosphorylation, p50 and RelA nuclear transport, and nuclear NF-κB-DNA binding) and ERK1/2 activation, (iii) increased myosin light kinase expression, and decreased TJ protein ZO-1 levels. In summary, EC prevented TNFα-mediated Caco-2 cell barrier permeabilization in part through the inhibition of NOX/NF-κB activation and downstream TJ disruption. Diets rich in EC could contribute to ameliorate IBD-associated increased intestinal permeability.

Perceived Social Support Mediates the Relationship between Use of Greenspace and Geriatric Depression: A Cross-Sectional Study in a Sample of South-Italian Older Adults.

A growing body of evidence is suggestive for the beneficial role of contact with greenspace (e.g., use of greenspace, visual access to greenspace, etc.) on mental health (e.g., depression, anxiety, etc.). In addition, several studies have pointed out the benefits of social support and social interaction on psychological wellbeing. Even if evidence on the association between contact with greenspace and perceived social support were mixed, it was supposed that the use of greenspace could enhance social interactions and perceived social support, especially among older adults. The present study aims to explore the effect of use of greenspace on geriatric depression in a sample of South-Italian older adults and the mediating role of perceived social support in this association. A structural equation model was tested in a sample of 454 older adults (60-90 years old) residing in the Metropolitan Area of Bari, Apulia. The fit indices revealed the goodness of fit of the model (CFI = 0.934; TLI = 0.900; IFI = 0.911; NFI = 0.935; RMSEA = 0.074; SRMR = 0.056). Results showed that the use of greenspace was inversely associated with geriatric depression through perceived social support. These findings underlined the relevance of perceived social support on the pathway linking use of greenspace and geriatric depressive symptoms. This evidence may be useful to policymakers to plan interventions for promoting physical access to greenspace and social participation in an age-friendly city framework.

Objective greenness, connectedness to nature and sunlight levels towards perceived restorativeness in urban nature.

The beneficial effect of exposure to nature and immersion in natural environments on perceived well-being is well established. Nevertheless, we acknowledge an emerging need to disentangle the role of specific environmental features from individual factors that encourage a positive person-environment interaction. This study aimed at evaluating the associations between four buffer distances of greenness and dimensions of perceived restorativeness, with connectedness towards nature (CTN) as a confounder variable, in a sample of 312 visitors to a large urban park. Variables investigating ecosystem services (ES, e.g., thermal comfort) were included as covariates. Results revealed differentiated effects of greenness level, sunlight intensity, and connectedness to nature in the pathways towards dimensions of restorativeness. Greenness level at 300 m was associated with Fascination, Scope, and Being Away, while at 500 m was associated with Coherence, Scope, and Being Away. ES was found to be associated with Coherence, while CTN with the other three dimensions of restorativeness. The moderating effect of sunlight level in the relationship between NDVI buffer distances and the total score of perceived restorativeness was also confirmed. The present work is intended to offer insights on the interplay between environmental features and individual differences for implications in several contexts, including the opportunity to develop tailor-made planning for urban forestry.

The Prevalence of Amnestic and Non-Amnestic Mild Cognitive Impairment and Its Association with Different Lifestyle Factors in a South Italian Elderly Population.

Mild Cognitive Impairment (MCI) is a transition stage between normal aging and dementia and can be useful to monitor the cognitive status of people at risk of dementias. Our aims were to investigate the prevalence of amnestic and non-amnestic MCI in a South Italian elderly population, and to identify socio-demographic, clinical and lifestyle factors associated with MCI. A cross-sectional retrospective population study on 839 community-dwelling participants over 60 years of age was carried out. Elderly people were administered a brief neuropsychological screening to identify their cognitive and functional status, and a questionnaire to investigate several socio-demographic, clinical, and lifestyle factors. Prevalence estimate for MCI was 12.0% (95% CI: 10.0-14.5%), for amnestic MCI was 7.4% (95% CI: 5.8-9.4%), and for non-amnestic MCI was 4.6% (95% CI: 3.4-6.4%), for people older than 60 years of age. Logistic regression models, corrected for age, sex, and education, revealed a significant association of MCI with the following factors: age, education, intellectual activities, and topographical disorientation. On the other hand, education, clinical factors (e.g., depression level and perceived physical pain), lifestyle factors (e.g., smoking, alcohol, and leisure/productive activities), dietary habits, quality of life, and self-reported topographical disorientation were non-significantly associated with MCI. Prevalence estimates and the association of MCI and its subtypes with risk and protective factors were discussed in comparison with the most recent systematic reviews and meta-analyses.

Long-Term Exposure to Greenspace and Cognitive Function during the Lifespan: A Systematic Review.

Recent advances in environmental psychology highlighted the beneficial role of greenspace exposure on cognition. We conducted a systematic review of the available studies on the association of long-term exposure to greenspace and cognitive functions across the lifespan. PRISMA guidelines and the PECOs method were applied to screen for eligible studies. Twenty-five studies from Scopus, PubMed, and PsycINFO met the inclusion criteria. Six studies were longitudinal and nineteen cross-sectional. Fifteen studies focused on schoolchildren, six studies on adults, and four on the elderly. Twenty studies used the NDVI to assess greenspace exposure and the remaining used other indexes. Eight studies employed academic achievement as the outcome, eight studies global cognition, six studies attention/executive functions, and three studies memory. The evidence was inconsistent but suggestive for a beneficial role of greenspace exposure on cognitive functions. Further studies are required, especially among adults and older people, by adopting longitudinal designs.

Image-Guided Pediatric Surgery Using Indocyanine Green (ICG) Fluorescence in Laparoscopic and Robotic Surgery.

Background: Indocyanine green (ICG)-guided near-infrared fluorescence (NIRF) has been recently adopted in pediatric minimally invasive surgery (MIS). This study aimed to report our experience with ICG-guided NIRF in pediatric laparoscopy and robotics and evaluate its usefulness and technique of application in different pediatric pathologies. Methods: ICG technology was adopted in 76 laparoscopic and/or robotic procedures accomplished in a single division of pediatric surgery over a 24-month period (January 2018-2020): 40 (37 laparoscopic, three robotic) left varicocelectomies with intra-operative lymphography; 13 (10 laparoscopic, three robotic) renal procedures: seven partial nephrectomies, three nephrectomies, and three renal cyst deroofings; 12 laparoscopic cholecystectomies; five robotic tumor excisions; three laparoscopic abdominal lymphoma excisions; three thoracoscopic procedures: two lobectomies and one lymph node biopsy for suspected lymphoma. The ICG solution was administered into a peripheral vein in all indications except for varicocele and lymphoma in which it was, respectively, injected into the testis body or the target organ. Regarding the timing of the administration, the ICG solution was administered intra-operatively in all indications except for cholecystectomy in which the ICG injection was performed 15-18 h before surgery. Results: No conversions to open or laparoscopy occurred. No adverse and allergic reactions to ICG or other postoperative complications were reported. Conclusions: Based upon our 2 year experience, we believe that ICG-guided NIRF is a very useful tool in pediatric MIS to perform a true imaged-guided surgery, allowing an easier identification of anatomic structures and an easier surgical performance in difficult cases. The most common applications in pediatric surgery include varicocele repair, difficult cholecystectomy, partial nephrectomy, lymphoma, and tumors excision but further indications will be soon discovered. ICG-enhanced fluorescence was technically easy to apply and safe for the patient reporting no adverse reactions to the product. The main limitation is represented by the specific equipment needed to apply ICG-guided NIRF in laparoscopic procedures, that is not available in all centers whereas the ICG system Firefly® is already integrated into the robotic platform.

Pediatric Endoscopic Hidradenitis Treatment: A New Minimally Invasive Treatment for Pediatric Patients with Hidradenitis Suppurativa.

Background: Hidradenitis suppurativa (HS) is infrequent in the pediatric population. When indicated, surgery is often invasive, painful, and with significant recurrence rate. We aimed to report our preliminary experience using a new endoscopic technique to treat this pathology. Materials and Methods: We reported the data of 11 patients (9 girls and 2 boys) with average age of 15.7 years (range 14-17) with HS, who were operated using endoscopic procedure for a 15-month period. Six patients presented axillary, inguinal, and inframammary localizations, 3 patients presented axillary and inguinal localizations, and 2 patients presented only inguinal localization. Pediatric endoscopic hidradenitis treatment (PEHT) followed the same principles of pediatric endoscopic pilonidal sinus treatment (PEPSiT). The fistuloscope was introduced into the different holes, and after using an endobrush, all tracts were cauterized using monopolar electrode or laser energy, and finally the granulation tissues were removed using graspers. At the end of the procedure, all the holes were filled with oxygen-enriched oil-based gel and covered with fat gauze. Results: The average operative time was 47 minutes (range 30-80). All procedures were performed in a day surgery setting or with an overnight hospitalization. All patients reported no pain postoperatively and performed a local dressing with silver sulfadiazine spray and oxygen-enriched oil-based gel two times per day for 1 month postoperatively. At the longest follow-up of 1 year, the lesions were completely healed in all cases. Two patients (18%) developed further lesions in different untreated localizations that were successfully treated using PEHT. Conclusions: PEHT is a minimally invasive, effective, and safe treatment option for pediatric patients with HS. All patients reported a painless postoperative period and excellent results. Postoperative local dressings using oxygen-enriched oil-based gel and silver sulfadiazine spray are fundamental to achieve the complete healing. However, a further evidence with larger series and longer follow-up is required to confirm these preliminary results.

Treatment of kidney diseases in the thermal springs of Pithecusa during the XVIII Century.

The island of Pithecusa (Ischia) is a volcanic island in the Tyrrhenian Sea in the north end of the Gulf of Naples at about 30 kilometers from the same city. Pithecusa is very popular for its hot springs which even the ancients used. This report aims to analyze the renal therapeutic benefits of the Pithacusa thermal mineral spring through a review of two different manuscripts: i) "Di Napoli il seno cratero"(The gulf of Naples) of Domenico Antonio Parrino (1642-1708) and ii) "De' rimedi naturali che sono nell'isola di Pithecusa oggi detta Ischia"(On the natural cures of the island of Pithecusa known today as Ischia)of Giulio Iasolino (1583-1622). These two manuscripts published during the 18th century and both manuscripts highlight the thermal virtues of the thermal springs of Pithecusa. In the past natural remedies were important in the treatment of different diseases including that of thermal springs dating back to ancient Rome. Thermal springs were used to treat spasms, skin diseases, hair loss and various renal ailments. Both manuscripts describe the thermal springs in Ischia and their therapeutic benefits in medical diseases.

Arnaldo Da Villanova medieval physician (1235-1311). A first approach.

Arnaldo de Villanova, was a Catalan Physician, born in Villanova de Grau, a suburb of Valencia - Spain about 1235. He died off the coast of Genoa in 1311 during a sea voyage departing from Messina in Sicily, during a diplomatic mission by Pope Clement V in Avignon on orders by the King of Sicily. He was a so famous and clever scientist of the thirteenth century, to give his name to the Universitary Hospital of Montpellier - France. His interests ranged from theology, to politics, medicine, and anymore alchemy. He was an adviser and physician of Kings of Aragon, like Peter III the Great (1276-1285) and James II the Right (1285-1327), of Robert of Angi (1309-1343) of Naples, and of Popes, like Innocenzo V (1276), Bonifacio VIII (1294-1303), Benedetto XI (1303-1304), Clemente V (1305-1314), and of the King of Sicily Federico II of Aragon (1296-1337). For the Pope Bonifacio VIII, suffering from renal colic due to kidney stones, he prescribed Hydrotherapy with Fiuggi Thermal water, that was specially transported for him from its source to Rome and Anagni, in jars wrapped in coarse carpets or wool fabrics, to better maintain the source temperature. In addition in July of 1301, he also produced an astrological seal (Talisman) made of gold loaded of virtues, obtained exposing the seal to the power of the Sun, in those days in the Leo Constellation. This seal was worn by the Pope in an hernial belt of leather to support the kidney,probably to improve hisnephroptosis. Arnaldo produced this seal according to what was described in the book Picatrix - The goal of the wise of the Arabic astronomer and alchemist "Abu l-Qasim Maslama b.- Ahmad al-Majriti, known with the pseudonym Ghayat al hakim died in Cordova about 1008. Ten years later, after his mysterious death at sea on a Sicilian royal ship, his body was not buried at sea, but was reported in Sicily and buried in the Federician Castle of Montalbano of Elicona at the end of Peloritans Mountains near Milazzo, about 90 km from Messina, where he loved to stay and to write.

The concept of the urine test and specific reaction of the urine in various diseases according to Enrico Cauchi - member of the medical council of Malta (1933).

The Study of urine from the outset has always aroused the interest of scientists and physicians all over the world, from ancient Greeks and Romans to Hindus , Hulcos in Mexico, Australian native etc. The urine in such case was considered not only as a waste product but also as a therapeutic product. In the late XIX century scientific knowledge had already identified the function of substances that favor the increase of urinary output, and physicians over the centuries have always tried to analyze urine in various ways. In Cauchis work in 1933 all chemistry and pathophysiological knowledge of the time was condensed. Cauchi signed the preface as Member of the medical council of Malta. He was a medical doctor of the early20thcentury, He wrote about the physiopathology of urine ranging from chemical and physical behavior, to the analysis of sediments and the special reactions of the urine in various pathologies. In particular Cauchi emphasizes the main diseases of the time combines the behavior of the reaction of urine as a diagnostic and prognostic instrument, stressing the importance of the urine test and describing the method used for analysis at the time. The analyses of the text in the issue seems to belong to archaic medicine, and it is difficult to think today, that what was presented as very up-to-date- science at that time, took place only 80 years ago. Reading the full original text with today experience we are led to consider the increasing importance that scientific community gave in the past, and still gives to urine test.

Anthocyanins protect human endothelial cells from mild hyperoxia damage through modulation of Nrf2 pathway.

The detrimental effects of high oxygen supplementation have been widely reported. Conversely, few is known about the effects of exposure to mild hyperoxic conditions, an interesting issue since the use of oxygen-enriched mixture is now increasingly used in clinical practice and especially for professional and recreational reasons. Our study investigated if in vitro exposure of human umbilical vein endothelial cells (HUVECs) to moderate hyperoxia (O2 32 %) induces cellular alterations, measured as changes in cell signaling pathways. Furthermore, by means of an ex vivo experimental model where human volunteers were used as bioreactors, we studied whether anthocyanin metabolites are able to protect HUVECs against mild hyperoxia-induced damage. We observed that the cytotoxic effect of mild hyperoxia came along with a significant decrease in nuclear accumulation of the transcription factor Nrf2, as well as in the expression of Nrf2-regulated antioxidant and cytoprotective genes. Furthermore, under normoxic conditions, anthocyanin metabolites appeared able to activate the Nrf2 pathway, through the involvement of specific kinases (ERK1/2); this adaptive effect may explain the protective effect observed in mild hyperoxia-exposed HUVECs following anthocyanin pretreatment. This study confirms that dietary anthocyanins and/or their metabolites can protect endothelial cells against mild hyperoxia-induced alterations acting as cell signaling modulators.

Cellular adaptive response to glutathione depletion modulates endothelial dysfunction triggered by TNF-α.

Several interrelated cellular signaling molecules are involved in modulating adaptive compensatory changes elicited by low exposures to toxins and other stressors. The most prominent example of signaling pathway typically involved in this adaptive stress response, is represented by the activation of a redox-sensitive gene regulatory network mediated by the NF-E2-related factor-2 (Nrf2) which is intimately involved in mediating the Antioxidant Responsive Element (ARE)-driven response to oxidative stress and xenobiotics. We investigated if Nrf2 pathway activation following intracellular glutathione depletion through buthionine sulfoximine (BSO) exposure, might be able to alter the response to TNF-α, a proinflammatory cytokine, in cultured human umbilical vein endothelial cells. Herein, we revealed that such a change in the cellular redox status is able to reduce TNF-α induced endothelial activation (as shown by a decreased gene expression of adhesion molecules) by activating an adaptive response mediated by an increased Nrf2 nuclear translocation and overexpression of the ARE genes HO-1 and NQO-1. Furthermore, we have demonstrated the involvement of ERK1/2 kinases in Nrf2 nuclear translocation activated by BSO-induced glutathione depletion. The coordinate induction of endogenous cytoprotective proteins through adaptive activation of Nrf2 pathway is a field of great interest for potential application in prevention and therapy of inflammatory diseases such as atherosclerosis.

Simvastatin administration ameliorates neurobehavioral consequences of subarachnoid hemorrhage in the rat.

In the present study we assessed the neuroprotective effects of simvastatin in a rodent model of experimental subarachnoid hemorrhage (SAH). Based on recent data showing the role of statins not only in lowering the level of cholesterol but also in preventing cardiac and cerebrovascular damage in risk population, and in decreasing vasospasm and delayed ischemia after aneurysmal SAH, we investigated the neuroprotective effects of intraperitoneal administration of simvastatin (40 mg/kg/day for 5 consecutive days) in Sprague-Dawley rats 30 min after SAH, as compared to vehicle-treated SAH animals. We employed a battery of well-characterized tests to assess memory, learning, motivational, balance, and behavioral performances. On days 1-4 post-SAH, simvastatin-treated rats have significantly improved beam balance scores (days 1-2, p<0.001; days 3-4, p<0.01), beam balance times (days 1-4, p<0.01), and latency to traverse the beam (days 1-3, p<0.01; day 2, p<0.005; day 4, p<0.0001) in comparison with control groups that, conversely, were not protected against SAH-related body weight changes. These results demonstrate that the administration of simvastatin may represent a beneficial therapeutic approach able to reduce post-SAH cognitive dysfunction.