Obesity and Male Reproduction: Do Sirtuins Play a Role?

Obesity is a major current public health problem of global significance. A progressive sperm quality decline, and a decline in male fertility, have been reported in recent decades. Several studies have reported a strict relationship between obesity and male reproductive dysfunction. Among the many mechanisms by which obesity impairs male gonadal function, sirtuins (SIRTs) have an emerging role. SIRTs are highly conserved nicotinamide adenine dinucleotide (NAD+)-dependent deacetylases that play a role in gene regulation, metabolism, aging, and cancer. SIRTs regulate the energy balance, the lipid balance, glucose metabolism, and adipogenesis, but current evidence also indicates a role for SIRTs in male reproduction. However, the majority of the studies have been conducted in animal models and very few have been conducted with humans. This review shows that SIRTs play an important role among the molecular mechanisms by which obesity interferes with male fertility. This highlights the need to deepen this relationship. It will be of particular interest to evaluate whether synthetic and/or natural compounds capable of modifying the activity of SIRTs may also be useful for the treatment of obesity and its effects on gonadal function. Although few studies have explored the role of SIRT activators in obesity-induced male infertility, some molecules, such as resveratrol, appear to be effective in modulating SIRT activity, as well as counteracting the negative effects of obesity on male fertility. The search for strategies to improve male reproductive function in overweight/obese patients is a challenge and understanding the role of SIRTs and their activators may open new interesting scenarios in the coming years.

[Experimenting an instrument for cancer screening programming in Italy]. / Sperimentazione di uno strumento per la programmazione dei programmi di screening oncologici in Italia.

Increased participation in cancer screening programs is undoubtedly a primary objective in Public Health. The Green and Kreuter model, structured in an Access program, was presented to the Regional Coordinators for cancer screening during specific training events. This survey was carried out to verify their appreciation of the model and whether those who participated in the project intended to use the program.

Performance of interferon-γ release assays in the diagnosis of confirmed active tuberculosis in immunocompetent children: a new systematic review and meta-analysis.

BACKGROUND: Tuberculosis (TB) is a global public health problem, causing morbidity and mortality in adults and children. The most reliable diagnostic tools currently available are the in vivo Tuberculin Skin Test (TST) and the ex vivo Interferon-γ release assays (IGRAs). Several clinical, radiological, and bacteriological features make the detection of active (overt disease) TB in children difficult. Although recently developed immunological assays such as QuantiFERON-TB Gold In-Tube (QFT-IT) and T-SPOT®.TB are commonly used to identify active TB in adults, different evidence is required for diagnosis in children. The purpose of this study was to reassess the sensitivity and specificity of IGRAs in detecting microbiologically confirmed active TB in immunocompetent children. METHODS: A systematic review and meta-analysis of studies reporting on the diagnostic accuracy of tests for TB in immunocompetent children aged 0-18 years, with confirmation by positive M. tuberculosis cultures, were undertaken. Electronic databases were searched up to September 2015 and study quality assessment was performed using QUADAS-2. RESULTS: Fifteen studies were included in our meta-analysis. Results showed that there were no significant differences in sensitivity between TST (88.2%, 95% confidence interval [CI] 79.4-94.2%), QFT-IT (89.6%, 95% CI 79.7-95.7%) and T SPOT (88.5%, 95% CI 80.4-94.1%). However, both QFT-IT (95.4%, 95% CI 93.8-96.6%) and T-SPOT (96.8%, 95% CI 94.2-98.5%) have significantly higher specificity than TST (86.3%, 95% CI 83.9-88.6%). CONCLUSIONS: QFT-IT and T-SPOT have higher specificity than TST for detecting active TB cases in immunocompetent children.

Investigation of emergency department abandonment rates using machine learning algorithms in a single centre study.

A critical problem that Emergency Departments (EDs) must address is overcrowding, as it causes extended waiting times and increased patient dissatisfaction, both of which are immediately linked to a greater number of patients who leave the ED early, without any evaluation by a healthcare provider (Leave Without Being Seen, LWBS). This has an impact on the hospital in terms of missing income from lost opportunities to offer treatment and, in general, of negative outcomes from the ED process. Consequently, healthcare managers must be able to forecast and control patients who leave the ED without being evaluated in advance. This study is a retrospective analysis of patients registered at the ED of the "San Giovanni di Dio e Ruggi d'Aragona" University Hospital of Salerno (Italy) during the years 2014-2021. The goal was firstly to analyze factors that lead to patients abandoning the ED without being examined, taking into account the features related to patient characteristics such as age, gender, arrival mode, triage color, day of week of arrival, time of arrival, waiting time for take-over and year. These factors were used as process measures to perform a correlation analysis with the LWBS status. Then, Machine Learning (ML) techniques are exploited to develop and compare several LWBS prediction algorithms, with the purpose of providing a useful support model for the administration and management of EDs in the healthcare institutions. During the examined period, 688,870 patients were registered and 39188 (5.68%) left without being seen. Of the total LWBS patients, 59.6% were male and 40.4% were female. Moreover, from the statistical analysis emerged that the parameter that most influence the abandonment rate is the waiting time for take-over. The final ML classification model achieved an Area Under the Curve (AUC) of 0.97, indicating high performance in estimating LWBS for the years considered in this study. Various patient and ED process characteristics are related to patients who LWBS. The possibility of predicting LWBS rates in advance could be a valid tool quickly identifying and addressing "bottlenecks" in the hospital organization, thereby improving efficiency.

New Insights of Target Therapy: Effects of Tyrosine Kinase Inhibitors on Male Gonadal Function: A Systematic Review.

The number of cancer patients undergoing chronic treatment with target therapy is increasing. Although much is known about the toxicity of conventional anticancer therapies, evidence on the effects of tyrosine kinase inhibitors (TKIs) on fertility is still lacking. Therefore, this review was undertaken to evaluate the effects of TKIs on male gonadal function. A comprehensive search of PubMed and Scopus databases was conducted, focusing on the effects of TKIs on spermatogenesis and testicular endocrine function. We included animal studies, observational studies, and case reports published up to December 31, 2023. Identified articles were reviewed and analyzed to evaluate the impact of TKIs on the male gonad. Their long-term effects, the reversibility of the observed changes, and the underlying molecular mechanisms involved were recorded. The findings emerging on the effects of TKIs on male gonadal function are conflicting. Although specific TKIs (imatinib, gefitinib, sorafenib, sunitinib, quizartinib, dasatinib, and nilotinib) have been identified as potentially as potential interfering with spermatogenesis and hormone production, the extent and severity of these effects may vary from patient to patient and between different drugs within this drug class. Experimental studies on mouse models have suggested a potential interference with spermatogenesis. Evidence also suggests that TKIs affects the hypothalamic-pituitary-testicular axis, decreasing serum testosterone and gonadotropin levels. The effects of TKIs on male gonadal function highlight the need for personalized treatment choices. Potential fertility concerns can help minimize adverse effects and improve patient outcomes. Addressing the potential impact of TKIs on male fertility helps optimize cancer treatment and survival outcomes.

Impact of COVID-19 on testicular function: a systematic review and meta-analysis.

INTRODUCTION: Studies investigating the effects of SARS-CoV-2 on male reproductive function are few and heterogeneous, and results are often conflicting. This systematic review and meta-analysis was carried out on studies conducted in men with active or anamnestic SARS-CoV-2 infection to evaluate its consequences on the male sex hormone profile and semen parameters. MATERIALS AND METHOD: This meta-analysis follows the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocols. PubMed, Scopus, Cochrane, and Embase databases were searched to identify relevant studies. We originally selected 3553 articles. After the eligibility phase, 16 articles met our inclusion criteria encompassing 11 case-control studies and 5 cohort studies (2 prospective and 3 retrospective studies). We performed the quantitative analysis with Comprehensive Meta-Analysis Software. Cochran-Q and heterogeneity (I2) indexes were used to assess statistical heterogeneity. Sensitivity analysis and publication bias tests were also performed. RESULTS: Overall, 1250 patients with active or recent (up to 80 days before) COVID-19 infection and 1232 matched healthy controls were included. Sperm concentration, total sperm count, and total motility were significantly lower in patients compared with controls. Patients also showed lower levels of total testosterone and follicle-stimulating hormone, and higher levels of luteinizing hormone, 17ß-estradiol, and prolactin compared with healthy controls. None of the included studies found the presence of SARS-CoV-2 mRNA in the semen of infected patients. CONCLUSION: The present systematic review and meta-analysis suggests the presence of an association between SARS-CoV-2 infection and primary testicular damage manifested with a picture of altered steroidogenesis and worsening spermatogenesis. The absence of the virus in the seminal fluid indicates a low possibility of sexual transmission of the infection to partners and offspring. However, our findings mostly show short-term follow-up, while few studies have considered the long-term consequences of the viral infection, thus further studies are needed to evaluate the long-term consequences on male reproductive health.

Wait watchers: the application of a waiting list active management program in ambulatory care.

OBJECTIVE: This study describes and evaluates the application of a waiting list management program in ambulatory care. DESIGN: Waiting list active management survey (telephone call and further contact); before and after controlled trial. SETTING: Local Health Trust in Veneto Region (North-East of Italy) in 2008-09. PARTICIPANTS: Five hundred and one people on a 554 waiting list for C Class ambulatory care diagnostic and/or clinical investigations (electrocardiography plus cardiology ambulatory consultation, eye ambulatory consultation, carotid vessels Eco-color-Doppler, legs Eco-color-Doppler or colonoscopy, respectively). INTERVENTION: Active list management program consisting of a telephonic interview on 21 items to evaluate socioeconomic features, self-perceived health status, social support, referral physician, accessibility and patients' satisfaction. A controlled before-and-after study was performed to evaluate anonymously the overall impact on patients' self-perceived quality of care. MAIN OUTCOME MEASURES: The rate of patients with deteriorating healthcare conditions; rate of dropout; interviewed degree of satisfaction about the initiative; overall impact on citizens' perceived quality of care. RESULTS: 95.4% patients evaluated the initiative as useful. After the intervention, patients more likely to have been targeted with the program showed a statistically significant increase in self-reported quality of care. CONCLUSIONS: Positive impact of the program on some dimensions of ambulatory care quality (health status, satisfaction, willingness to remain in the queue), thus confirming the outstanding value of 'not to leave people alone' and 'not to leave them feeling themselves alone' in healthcare delivery.

Impact of COVID-19 on Fetal Outcomes in Pregnant Women: A Systematic Review and Meta-Analysis.

Background: Coronavirus disease (COVID-19) is a pandemic causing respiratory symptoms, taste alterations, olfactory disturbances, and cutaneous, cardiovascular, and neurological manifestations. Recently, research interest has shifted to reproductive health to understand the factors predisposing to COVID-19 infection in pregnancy, the consequences of the infection on the fetus and on the mother, and possible vertical transmission through the placenta. Pregnancy does not increase the risk of SARS-CoV-2 infection, according to studies. However, contrary to non-pregnant women, pregnancy worsens the clinical outcome of COVID-19. Studies investigating the effects of COVID-19 on pregnancy women are heterogeneous, and the results are often conflicting. Objectives: The goal of the current work was to offer a thorough and up-to-date systematic review of, and meta-analysis on, the impact of COVID-19 on ovarian function, pregnancy, and fetal outcomes. Search strategy: This meta-analysis (PROSPERO n. CRD42023456904) was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocols. The search for relevant material was conducted using PubMed, Scopus, Cochrane, and Embase databases, through to 15 December 2022. Selection criteria: Original articles on fertile pregnant women or women attempting to become pregnant, with an active case of, or history of, SARS-CoV-2 infection were included, and reproductive function was compared to that of uninfected women. Data collection and analysis: The effects of COVID-19 on female reproductive function, particularly ovarian function, the profile of female sex hormones, pregnancy outcomes and fetal outcomes were the focus of our search. Quantitative analysis was performed with Comprehensive Meta-Analysis Software. The standard difference of the mean was calculated for the statistical comparison between cases and controls. Cochran's Q test and heterogeneity (I2) indexes were used to assess statistical heterogeneity. Sensitivity analysis and publication bias tests were also performed. Main Results: Twenty-eight articles met our inclusion criteria, for a total of 27,383 patients pregnant or looking to have offspring, with active or anamnestic COVID-19, and 1,583,772 uninfected control women. Our study revealed that there was no significant difference between COVID-19 patients and the control group in terms of maternal characteristics such as age, body mass index (BMI) and comorbidities that could affect pregnancy and fetal outcomes. The risk of a miscarriage or Cesarean delivery was significantly lower, while the risk of fetal death or premature delivery was significantly higher in COVID-19 patients than in the controls. None of the included studies evaluated hormonal profiles or investigated the presence of infertility. Conclusions: Maternal comorbidities, age, and BMI do not raise the risk of COVID-19. However, pregnant women with COVID-19 had a lower risk of miscarriage and Cesarean delivery, possibly because of better prenatal care and high levels of observation during labor. COVID-19 during pregnancy increases the risk of fetal death and premature delivery.

A Regressive Model to Study the Hospitalization for Laparoscopic Appendectomy: A Multicenter Study.

Appendicitis is a most common abdominal condition worldwide, and appendectomy especially laparoscopic appendectomy is among the most commonly performed general surgeries. In this study, data were collected from patients who underwent laparoscopic appendectomy surgery at the Evangelical Hospital "Betania" in Naples, Italy. Linear multiple regression was used to obtain a simple predictor that can also assess which of the independent variables considered to be a risk factor. The model with R2 of 0.699 shows that comorbidities and complications during surgery are the main risk factors for prolonged LOS. This result is validated by other studies conducted in the same area.

Effect of Clinical and Demographic Variables on the Hospital Stay of Patients Undergoing Total Knee Arthroplasty.

The knee is the joint most affected by osteoarthritis and in its severe form can significantly affect people's physical and functional abilities. The increased demand for surgery leads to greater attention by health care management to be able to keep costs down. A major expense item for this procedure is Length of Stay (LOS). In this study, several Machine Learning algorithms were tested in order to construct not only a valid predictor of LOS but also to know among the selected variables the main risk factors. To do so, activity data from the Evangelical Hospital "Betania" in Naples, Italy, from 2019-2020 were used. Among the algorithms, the best are the classification algorithms with accuracy values exceeding 90%. Finally, the results are in line with those shown by two other comparison hospitals in the area.

The Classification Algorithms Applied to the Inpatient Stay for Lower Limb Surgery.

The revolutions of recent years in health care have involved several areas ranging from patient treatment to resource management. Therefore, several strategies have been put in place to increase patient value while trying to reduce spending. Several indicators have arisen to evaluate the performance of healthcare processes. The main one is Length of Stay (LOS). In this study, classification algorithms were used to predict the LOS of patients undergoing lower extremity surgery, an increasingly common condition given the progressive aging of the population. The context is the Evangelical Hospital "Betania" in Naples (Italy) in 2019-2020, which augments a multicenter study conducted by the same research team on several hospitals in southern Italy. All selected algorithms show an Accuracy above 90% but among them, the best is Logistic Regression with a value reaching 94%.

Modeling Cholecystectomy Hospital Stay Through a Linear Approach.

Cholecystectomy is among the most frequent procedures in general surgery. In the healthcare facility organization, it is important to evaluate all interventions and procedures that have a great impact on health management and that have a clear effect on the Length of Stay (LOS). The LOS represents, in fact, an indicator of performance and measure the goodness of a health process. This study was conducted with the aim of providing LOS for all patients undergoing cholecystectomy at the "A.O.R.N. A. Cardarelli" of Naples. Data were collected in the two years 2019 and 2020 and included 650 patients. A MLR model is created in the work to predict the value of LOS as a function of the following variables: gender, age, pre-operative LOS, presence of comorbidities and complication during surgery. The results obtained are as follows: R=0.941 and R2=0.885.

COVID-19 in Eye Surgery: The Case of a University Hospital.

Coronavirus epidemic has quickly become a global health threat. The ophthalmology department, like all other departments, have adopted resource management and personnel adjustment maneuvers. The aim of this work was to describe the impact of covid on the Ophthalmology Department of University Hospital "Federico II" of Naples. In the study logistical regression was used for a comparison between the pandemic and the previous period, analyzing patient features. The analysis showed a decrease in the number of accesses; reduction of the length of stay; and the statistically dependent variables are as follows: LOS, discharge procedures and admission procedure.

Predicting In-Hospital Mortality During the COVID-19 Pandemic in Patients with Heart Failure: A Single-Center Exploratory Study.

The aim of this study was to investigate whether exposure to the pandemic was associated with increased in-hospital mortality for health failure. We collected data from patients hospitalized between 2019 and 2020 and we assessed the likelihood of in-hospital death. Although the positive association of exposure to the COVID period with an increased in-hospital mortality is not statistically significant, this may underscore other factors that may influence mortality. Our study was designed to contribute to a better understanding of the impact of the pandemic on in-hospital mortality and to identify potential areas for intervention in patient care.

Is It Time for Andrology and Endocrinology Professionals in Assisted Reproduction Centers?

Epidemiologists indicate that about half of the couple's infertility cases are due to a male factor. Despite this, the role of andrologists or endocrinologists in assisted reproductive technique (ART) centers is still underestimated. According to our literature review, this reduces the chance of a thorough clinical evaluation of the male partners, which, sometimes consists only in a mere semen analysis, usually performed by laboratory technicians. A more complete diagnostic process could lead to the identification of potentially treatable causes of infertility, the recognition of diseases that require immediate treatment, and to the discovery of genetic diseases and, therefore, transmissible to the offspring. It can also increase the success rate of ART resulting in less psychological and financial burden for both public health resources and infertile couples. The presence of medical personnel with andrological and endocrinological skills in the ART centers represents the first step in creating 'precision medicine'. We hope that the guidelines of the various scientific societies will clearly contemplate this possibility.

Evaluation of different machine learning algorithms for predicting the length of stay in the emergency departments: a single-centre study.

Background: Recently, crowding in emergency departments (EDs) has become a recognised critical factor impacting global public healthcare, resulting from both the rising supply/demand mismatch in medical services and the paucity of hospital beds available in inpatients units and EDs. The length of stay in the ED (ED-LOS) has been found to be a significant indicator of ED bottlenecks. The time a patient spends in the ED is quantified by measuring the ED-LOS, which can be influenced by inefficient care processes and results in increased mortality and health expenditure. Therefore, it is critical to understand the major factors influencing the ED-LOS through forecasting tools enabling early improvements. Methods: The purpose of this work is to use a limited set of features impacting ED-LOS, both related to patient characteristics and to ED workflow, to predict it. Different factors were chosen (age, gender, triage level, time of admission, arrival mode) and analysed. Then, machine learning (ML) algorithms were employed to foresee ED-LOS. ML procedures were implemented taking into consideration a dataset of patients obtained from the ED database of the "San Giovanni di Dio e Ruggi d'Aragona" University Hospital (Salerno, Italy) from the period 2014-2019. Results: For the years considered, 496,172 admissions were evaluated and 143,641 of them (28.9%) revealed a prolonged ED-LOS. Considering the complete data (48.1% female vs. 51.9% male), 51.7% patients with prolonged ED-LOS were male and 47.3% were female. Regarding the age groups, the patients that were most affected by prolonged ED-LOS were over 64 years. The evaluation metrics of Random Forest algorithm proved to be the best; indeed, it achieved the highest accuracy (74.8%), precision (72.8%), and recall (74.8%) in predicting ED-LOS. Conclusions: Different variables, referring to patients' personal and clinical attributes and to the ED process, have a direct impact on the value of ED-LOS. The suggested prediction model has encouraging results; thus, it may be applied to anticipate and manage ED-LOS, preventing crowding and optimising effectiveness and efficiency of the ED.

Prediction of Hospital Length Stay for Patients Undergoing Mastectomy.

The prolonged length of stay is an important aspect to be considered for the healthcare management since this affect both the health-related expenditure of the hospital and the quality of the offered service. In the light of these consideration is important for hospitals to be able to predict the LOS of patients and to work on the principal aspect affecting it in order to reduce LOS as much as possible. In this work we focus on patients undergoing mastectomy. The data were collected form 989 patients who underwent mastectomy surgery in the Surgery Department of the AORN "A. Cardarelli" of Naples. Different models have been tested and characterized and the one with the best performance was identified.

The Role of Irisin throughout Women's Life Span.

Since its discovery, much attention has been drawn to irisin's potential role in metabolic and reproductive diseases. This narrative review summarizes and updates the possible role played by this fascinating molecule in different physiological (puberty and menopause) and pathological (polycystic ovary syndrome (PCOS), functional hypothalamic amenorrhea (FHA), endometriosis, and gestational diabetes) conditions that can affect women throughout their entire lives. Irisin appears to be an important factor for the hypothalamic-pituitary-gonadal axis activation, and appears to play a role in the timing of puberty onset. Serum irisin levels have been proposed as a biomarker for predicting the future development of gestational diabetes (GDM). Its role in PCOS is still controversial, although an "irisin resistance" mechanism has been hypothesized. In addition to its impact on metabolism, irisin also appears to influence bone health. Irisin levels are inversely correlated with the prevalence of fractures in postmenopausal women. Similar mechanisms have also been postulated in young women with FHA. In clinical settings, further controlled, prospective and randomized clinical trials are needed to investigate the casual relationship between irisin levels and the conditions described and, in turn, to establish the role of irisin as a prognostic/diagnostic biomarker or a therapeutic target.

Is reprocessing after disuse a safety procedure for bronchoscopy?: A cross-sectional study in a teaching hospital in Rome.

A bacteriological assessment of flexible bronchoscopes that were stored after a reprocessing procedure was performed to determine whether reprocessing removes microbiological contamination and whether the instruments could be used safely after extended storage without repeating the disinfection before bronchoscopy. The microbiological quality of manual and automated reprocessed bronchoscopes was examined by collecting a pre-reprocessing and a post-reprocessing liquid sample from the stored instruments' channels. A qualitative microbiological analysis was performed to evaluate bacterial contamination. Among the 264 pre-reprocessing bronchoscopes, 10 were contaminated (13 human flora strains and 1 environmental strain were detected). After reprocessing, 8 were decontaminated and 2 remained contaminated. Furthermore, 12 other bronchoscopes had a new contamination post-reprocessing (11 human flora and 3 environmental strains were detected). In addition, 2 sampled bronchoscopes were contaminated both pre- and posttreatment. Our findings support the suggestion that reprocessing after storage can be avoided in the safe usage of the instrument if earlier decontaminations are performed correctly. Having found that reprocessing could contaminate bronchoscopes, additional studies are needed to identify the risk factors for contamination and avoid controversial suggestions for first-use reprocessing.