Phytotherapic approach in menopause: light and darkness.

INTRODUCTION: Menopause is a critical period of the woman life, characterized by a peculiar modification in estrogens concentration and accompanied by different signs and symptoms. To prevent and contrast unfavorable consequences of menopause, different therapeutic approaches could be evaluated. The hormone replacement therapy (HRT) is the most known, but it has several contraindications. The increasing interest in phytotherapy introduces the necessity for endocrinologist involved in menopause to suggest different therapeutic approaches, considering the state of health of patient and the real efficacy of the drugs. We aim to outline the main phytotherapy treatments to choose in menopause. EVIDENCE ACQUISITION: This review is based on focused research of the current literature on PubMed and Scopus such as research databases. We selected 4120 papers through these keywords: "MENOPAUSE" AND "phytotherapy," "natural therapy," "phytoterapy drugs." Then, the literature was scanned selecting English papers of last 10 years (last research on October 1, 2021), excluding reviews. Separately, two researchers MGT and CP examined and read 212 full selected papers. We included clinical trials and randomized clinical trials written in English and excluded duplicates, animal studies and studies with lack of group of interest, non-relevant outcomes, inappropriate methodology. Retrospective studies, case reports, case series, original articles, brief communications, and letter to the editor were included in our research. We furthermore completed our research by the examination of every study's bibliography. EVIDENCE SYNTHESIS: Phytotherapy involves the use of plants or plant extracts for the treatment of diseases thanks to the activities of their compounds and metabolites. In particular, many of them have an estrogen-like activity and are identified as phytoestrogens, because thanks to their chemical structure are able to bind the estrogen receptors and carry out biological estrogenic or antiestrogenic activities. The supplementing diet with these compounds can ensure an advantage on various aspects of the climacteric syndrome and some of them also have a beneficial impact on cardiovascular risk, bone health and sleep complaint. These substances can be used with safety due to their good tolerability and low rate of side effects. There are no known serious adverse events associated with their consumption, but as a precaution, its use is not recommended during pregnancy and in association with hormonal therapies or in women with hormone responsive cancers. CONCLUSIONS: Phytotherapy must be considered an interesting tool in the treatment of signs and symptoms in selected menopause woman.

Obesity in childhood: how to improve male adolescence incoming.

Earlier or delayed puberty can be determined by numerous causes, but the exact mechanisms are not fully known. Anyway, those may be independent from the hypothalamic-pituitary-gonadal axis involvement. Certainly, obesity is one of the main factors. In fact, obesity and infertility are strongly linked. For this reason, we want to analyse the relationship between puberty and obesity and give an updated state-of-the-art starting by discussing a 14-year-old obese boy's clinical case. Literature data are conflicting. Main criticisms are related to study design and evaluation criteria. Indeed, examined populations are not homogeneous by age, Tanner stage and BMI classification. The obesity epidemic is involved in earlier puberty, and puberty seems to be anticipated in all BMI groups. Very few studies evaluate the level of adiposity in the diagnosis of obesity. However, the role of the adipose tissue is crucial for hormone synthesis and regulation. Therefore, fat mass age-related and not simply BMI has to be considered by clinicians for appropriate diagnosis. Regarding the clinical case, in three months our patient recovered delayed pubertal development following an anti-inflammatory and antioxidant Mediterranean Diet. Loss of weight, as in decrease of fat mass but saving of lean mass, increased testicular volume and testosterone levels occurred. Puberty depends on several factors, including obesity. Further studies are needed to evaluate age groups, Tanner stage, diet and lifestyle, ethnicity and above all the fat/lean mass ratio. Lack of adequate tools could hinder a clinician's ability to recognize when or if therapeutic intervention is needed.

Exposure to artificial light at night: A common link for obesity and cancer?

Exposure to artificial light at night (ALAN) has been associated with disruption of the circadian system, which has been pointed out to have detrimental effects on health. Exposure to outdoor ALAN is very frequent in industrialised countries due to nocturnal light pollution and the relevant involvement of the total workforce in shift work and night work. Ecological and epidemiologic studies highlight the association between exposure to ALAN and several diseases, mainly obesity and cancer. More recently, also indoor ALAN exposure has been investigated. Among several multifactorial mechanisms linking ALAN exposure and health risks, suppression of melatonin secretion plays a pivotal role leading to alterations in circadian rhythm patterns, that are detrimental in terms of appetite regulation, and dysfunctions in metabolic signalling and cell growth in cancer. In addition, gut dysbiosis, inflammation, hypovitaminosis D, imbalance in cytokine secretion and levels are responsible for the multiple relationship linking circadian dysregulation due to ALAN exposure and obesity, and cancer. Therefore, the current manuscript summarises human and basic studies pointing out the impact of ALAN exposure on health, mostly focusing on obesity and cancer. Based on extant evidence, prevention strategies for obesity and cancer should be prompted, targeting exposure to ALAN.

Therapeutic use of pulsed electromagnetic field therapy reduces prostate volume and lower urinary tract symptoms in benign prostatic hyperplasia.

BACKGROUND: Benign prostatic hyperplasia (BPH) etiology remains poorly understood, but chronic low-grade inflammation plays a role. Pulsed electromagnetic field therapy (PEMF) (1-50 Hz) is effective in reducing tissue inflammation. OBJECTIVES: We designed a pilot study to evaluate the effects of PEMF on prostate volume (PV) in BPH. MATERIALS AND METHODS: This is a prospective interventional trial on 27 naive patients with BPH and lower urinary tract symptoms (LUTS). At baseline (V0 ), all patients had blood tests, transrectal ultrasound, and questionnaires (IPSS, IIEF-15) and received a perineal PEMF device (Magcell® Microcirc, Physiomed Elektromedizin). PEMF was delivered on perineal area 5 minutes twice daily for 28 days, then (V1 ) all baseline evaluations were repeated. Afterward, nine patients continued therapy for 3 more months (PT group) and 15 discontinued (FU group). A 4-month evaluation (V2 ) was performed in both groups. RESULTS: A reduction was observed both at V1 and at V2 in PV: PVV0 44.5 mL (38.0;61.6) vs PVV1 42.1 mL (33.7;61.5, P = .039) vs PVV2 41.7mL (32.7;62.8, P = .045). IPSS was reduced both at V1 and at V2 : IPSSV0 11 (5.7;23.2) vs IPSSV1 10 (6;16, P = .045) vs IPSSV2 9 (6;14, P = .015). Baseline IPSS was related to IPSS reduction both at V1 (rs  = 0.313;P = .003) and at V2 (rs  = 0.664;P < .001). PV reduction in patients without metabolic syndrome (ΔPVV1nMetS -4.7 mL, 95%CI -7.3;-2.0) was greater than in affected patients (ΔPVV1MetS 1.7 mL, 95%CI -2.69;6.1)(P = .017, Relative RiskMetS  = 6). No changes were found in gonadal hormones or sexual function. DISCUSSION: PEMF was able to reduce PV after 28 days of therapy. Symptoms improved in a short time, with high compliance and no effects on hormonal and sexual function or any side effects. Patients with moderate-severe LUTS and without MetS seem to benefit more from this treatment. CONCLUSION: PEMF reduces PV and improves LUTS in a relative short time, in BPH patients. These benefits seem greater in those patients with moderate-severe LUTS but without MetS.

Testicular ultrasound score: A new proposal for a scoring system to predict testicular function.

BACKGROUND: Testicular ultrasound (US) is routinely employed in the evaluation of reproductive and sexual function. However, its use for characteristics other than testicular volume is hampered by a lack of information on the prognostic value of its findings, which to date have only been incorporated in a score proposed by Lenz et al in 1993. OBJECTIVES: We sought to explore whether testicular US examination can predict the quality of spermatogenesis and provide information on testicular endocrine function. MATERIALS AND METHODS: We retrospectively reviewed 6210 testicular US examinations, finally selecting examinations from 2230 unique men. The following variables were considered: bitesticular volume and testicular asymmetry, parenchymal echotexture, echogenicity and presence of microlithiasis, solid lesions and varicocoele. Concurrent fasting hormonal data were available for 1160 men, while 979 had a semen sample available from the same day as the US examination. RESULTS: We derived a new US score, termed TU score, that can predict both impaired spermatogenesis (AUC 0.73, sensitivity 72%, specificity 61%, P < .001) and hypogonadism (AUC 0.71, sensitivity 71%, specificity 53%, P < .001) more accurately than the Lenz's score. In a multivariate analysis, a reduced sperm composite index (defined as total spermatozoa × total motility × normal forms) was independently predicted by bitesticular volume and by inhomogeneous echotexture, while hypogonadism was independently predicted also by reduced echogenicity and presence of microlithiasis. DISCUSSION AND CONCLUSIONS: We describe the testicular US characteristics that are independently associated with impaired spermatogenesis and hypogonadism and propose the TU score as a simple screening method for use in subjects referred for testicular US.