Search

Progression of contralateral carotid artery stenosis after carotid endarterectomy (CEA) has been described by several authors. The aim of this study is to determine such disease progression and its related transient ischemic attacks (TIAs) or strokes by reviewing the existing literature. We performed a systematic literature review to select randomized controlled trials and observational studies reporting outcomes of patients treated by CEA and with concomitant contralateral carotid stenosis, regardless its degree of stenosis. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO registration number: CRD42019127595). The primary study end point was the progression of contralateral carotid artery stenosis after CEA, and the secondary end point was incidence of TIAs and strokes owing to contralateral carotid stenosis. Seventeen studies were retrieved, reporting data on a total of 7679 patients who had undergone CEA, in particular they were one post hoc analysis of a randomized controlled trial, nine prospective, and seven retrospective observational studies. Among these patients, follow-up information on the contralateral carotid artery was available for 5454 cases. Disease progression was observed in 18% of patients: single class progression from mild (<50%) and from moderate (50%-70%) stenosis was observed in 15% and 23% of cases, respectively. We found 105 TIAs (4%) and 88 strokes (3%) among 2781 patients with stenosis progression, based on result from 11 studies. We found a progression of contralateral carotid stenosis in a significant number of patients treated with CEA and with baseline carotid stenosis. This systematic literature review suggests that patients with moderate contralateral carotid stenosis demonstrate more rapid progression to significant or symptomatic stenosis than patients with mild contralateral stenosis. [ABSTRACT FROM AUTHOR]

Gastric leak remains the main complication after sleeve gastrectomy, but there are no standardized guidelines for its treatment. Good results have been reported using endoscopic double-pigtail stent. To estimate its effectiveness, we carried out this systematic review. Eleven eligible articles were identified by searching PubMed, Embase, and Cochrane Library databases. A total of 385 patients met the inclusion criteria. The pooled proportion of successful leak closures by using double pigtail drainage was 83.41%. The proportion of successful leak closures by using double pigtail drainage by experienced operators as first-line treatment was 84.71%. Our review suggested that double-pigtail stent could be a valid approach to manage the postbariatric gastric leak, with low rate of complications and a good tolerance by patients. More high-quality studies with large samples sizes should be undertaken to better evaluate and compare the variety of techniques available. Gastric leak remains the main complication after sleeve gastrectomy, but there are no standardized guidelines for its treatment. To date, many studies have investigated the safety and efficacy of DPS, but their results remain inconsistent and only a limited number of them report a significant sample size. To our best knowledge, there's no previous review evaluating the effects of this endoscopic management. The aim of our work is to carry out a comprehensive literature review on the efficacy of the DPS endoscopically positioned to treat leak post-sleeve gastric resection. The results showed that DPS had high rate of successful leak closures (84.42% in total and 85.92% as first line treatment). [ABSTRACT FROM AUTHOR]

Background: Recent evidence has indicated that flavanol consumption may have many health benefits in humans, including improved cognitive activities. Objective: The aim was to evaluate the effect of flavanol consumption on cognitive performance in cognitively intact elderly subjects. Design: This was a double-blind, controlled, parallel-arm study conducted in 90 elderly individuals without clinical evidence of cognitive dysfunction who were randomly assigned to consume daily for 8 wk a drink containing 993 mg [high flavanol (HF)], 520 mg [intermediate flavanol (IF)], or 48 mg [low flavanol (LF)] cocoa flavanols (CFs). Cognitive function was assessed at baseline and after 8 wk by using the Mini-Mental State Examination (MMSE), the Trail Making Test (TMT) A and B, and the Verbal Fluency Test (VFT). Results: The changes in MMSE score in response to the 3 different treatments were not different. In contrast, there was a positive impact of the intervention on specific aspects of cognitive function. Mean changes (±SEs) in the time required to complete the TMT A and B after consumption of the HF (28.6 ± 0.4 and 216.5 ± 0.8 s, respectively) and IF (26.7 ± 0.5 and 214.2 ± 0.5 s, respectively) drinks significantly (P < 0.0001) differed from that after consumption of the LF drinks (20.8 ± 1.6 and 21.1 ± 0.7 s, respectively). Similarly, VFT scores significantly improved among all treatment groups, but the magnitude of improvement in the VFT score was significantly (P < 0.0001) greater in the HF group (7.7 ± 1.1 words/60 s) than in the IF (3.6 ± 1.2 words/60 s) and LF (1.3 ± 0.5 words/60 s) groups. Significantly different improvements in insulin resistance (P < 0.0001), blood pressure (P, 0.0001), and lipid peroxidation (P = 0.001) were also observed for the HF and IF groups in comparison with the LF group. Changes in insulin resistance explained ~ 17% of changes in composite z score (partial r² = 0.1703, P < 0.0001). Conclusions: This dietary intervention study provides evidence that regular CF consumption can reduce some measures of age-related cognitive dysfunction, possibly through an improvement in insulin sensitivity. These data suggest that the habitual intake of flavanols can support healthy cognitive function with age. This trial was registered at www.controlled-trials.com as ISRCTN68970511. [ABSTRACT FROM AUTHOR]

Abstract: Study Objective: To find a correlation between the waiting time between counseling about and performance of office hysteroscopy and the perception of pain. Design: Observational study (Canadian Task Force classification II-2). Setting: Academic environment. Patients: Two hundred eighty-four women undergoing hysteroscopy. Interventions: Diagnostic hysteroscopy with endometrial biopsy. Measurements and Main Results: Before examination, patients were asked to complete 2 forms, the STAI-S (State-Trait Anxiety Inventory, State) and STAI-T (State-Trait Anxiety Inventory, Trait) anxiety scales, for evaluation of their usual anxiety state and their state of anxiety during the examination. Patients were asked to quantify on a visual analog scale the pain felt during the examination. A statistically significant positive correlation, even if weak, was demonstrated between pain and waiting time (r = 0.45; p < .01) but not with the values for the anxiety state (r = 0.06; p = .56) and anxiety trait (r = −0.05; p = .66). Pain (≥4) was significantly associated with waiting time (≥60 minutes) (odds ratio [OR], 5.21; 95% confidence interval [CI], 1.29–35.50), age (OR, 1.57; 95% CI, 0.40–5.87) and menopause (OR, 2.81; 95% CI, 1.10–7.40) but not with STAI-S level (≥34) (OR, 0.87; 95% CI, 0.26–3.12) or STAI-T level (≥34) (OR, 0.65; 95% CI, 0.19–2.32). Conclusion: Office hysteroscopy is associated with a level of anxiety that can affect patient tolerability of the procedure. However, factors such as reducing waiting time may have a positive effect on patient compliance, making hysteroscopy easier and thereby increasing its diagnostic and therapeutic potential. [Copyright &y& Elsevier]

Flavanols from chocolate appear to increase nitric oxide bioavailability, protect vascular endothelium, and decrease cardiovascular disease (CVD) risk factors. We sought to test the effect of flavanol-rich dark chocolate (FRDC) on endothelial function, insulin sensitivity, β-cell function, and blood pressure (BP) in hypertensive patients with impaired glucose tolerance (IGT). After a run-in phase, 19 hypertensives with IGT (11 males, 8 females; 44.8 ± 8.0 y) were randomized to receive isocalorically either FRDC or flavanol-free white chocolate (FFWC) at 100 g/d for 15 d. After a washout period, patients were switched to the other treatment. Clinical and 24-h ambulatory BP was determined by sphygmometry and oscillometry, respectively, flow-mediated dilation (FMD), oral glucose tolerance test, serum cholesterol and C-reactive protein, and plasma homocysteine were evaluated after each treatment phase. FRDC but not FFWC ingestion decreased insulin resistance (homeostasis model assessment of insulin resistance; P < 0.00011 and increased insulin sensitivity (quantitative insulin sensitivity check index, insulin sensitivity index (ISI), ISI0 P < 0.051 and β-cell function (corrected insulin response CIR120; P= 0.035). Systolic(S) and diastolic (D) BP decreased (P <0.0001) after FRDC (SBP, -3.82 ± 2.40 mm Hg; DBP, -3.92 ± 1.98 mm Hg; 24-h SBP, -4.52 ± 3.94 mm Hg; 24-h DBP, -4.17 ± 3.29 mm Hg) but not after FFWC. Further, FRDC increased FMD (P< 0.0001) and decreased total cholesterol 1-6.5%; P< 0.0001), and LDL cholesterol (-7.5%; P < 0.0001). Changes in insulin sensitivity (Δ ISI - Δ FMD: r = 0.510, P = 0.001; Δ QUICK) - Δ FMD: r = 0.502, P = 0.001) and β-cell function (Δ CIR120 - Δ FMD: r = 0.400, P = 0.012) were directly correlated with increases in FMD and inversely correlated with decreases in BP (Δ ISI - Δ 24-h SBP: r = -0.368, P = 0.022; Δ ISI - Δ 24-h DBP r = -0.384, P = 0.017). Thus, FRDC ameliorated insulin sensitivity and β-cell function, decreased BP, and increased FMD in IGT hypertensive patients. These findings suggest flavanol-rich, low-energy cocoa food products may have a positive impact on CVD risk factors. [ABSTRACT FROM AUTHOR]

Abstract: Reduced insulin sensitivity in adult life has been reported in subjects born at term small for gestational age (SGA) and in those born prematurely with very low birth weight (LBW) (<1500 g). We assessed whether LBW (<2500 g) young women, irrespective of whether they were born SGA or adequate for gestational age (premature AGA), exhibited a reduction in insulin sensitivity through a prospective historical design. The risk of developing biochemical and clinical features of polycystic ovary syndrome was also investigated. The study population included 35 LBW women (19 SGA [BW range, 1000-2400 g] and 16 premature AGA [BW range, 1700-2440 g]) aged 21.8 ± 1.8 years and 35 term AGA controls, of similar age, recruited from a neonatal registry. All women underwent clinical, ultrasonographic, hormonal, and metabolic evaluations, including the composite insulin sensitivity index. Women under hormonal contraception (21.4%) were excluded from hormonal and metabolic analyses. Composite insulin sensitivity index was significantly lower in LBW women even when the 2 LBW subgroups, SGA and premature AGA, were analyzed separately (4.4 ± 2.2 and 4.0 ± 1.7, respectively) than in controls (6.9 ± 4.4). The LBW women showed a significantly higher incidence proportion of irregular menses (14/35 [40%] vs 2/35 [5.7%]) and a significantly higher free androgen index (5.8 ± 3.5 vs 3.9 ± 3.2). They also showed a nonsignificantly higher proportion of hirsutism, acne, and polycystic ovaries. In conclusion, LBW (<2500 g) young women, irrespective of whether they were SGA and premature AGA, exhibited a reduction in insulin sensitivity as compared with born at term AGA women. Furthermore, they exhibited an increased risk of developing clinical and biochemical features of polycystic ovary syndrome. [Copyright &y& Elsevier]

Background: Numerous studies indicate that flavanols may exert significant vascular protection because of their antioxidant properties and increased nitric oxide bioavailability. In turn, nitric oxide bioavailability deeply influences insulin-stimulated glucose uptake and vascular tone. Thus, flavanols may also exert positive metabolic and pressor effects. Objective: The objective was to compare the effects of either dark or white chocolate bars on blood pressure and glucose and insulin responses to an oral-glucose-tolerance test in healthy subjects. Design: After a 7-d cocoa-free run-in phase, 15 healthy subjects were randomly assigned to receive for 15 d either 100 g dark chocolate bars, which contained ≈500 mg polyphenols, or 90 g white chocolate bars, which presumably contained no polyphenols. Successively, subjects entered a further cocoa-free washout phase of 7 d and then were crossed over to the other condition. Oral-glucose-tolerance tests were performed at the end of each period to calculate the homeostasis model assessment of insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI); blood pressure was measured daily. Results: HOMA-IR was significantly lower after dark than after white chocolate ingestion (0.94±0.42 compared with 1.72±0.62; P < 0.001), and QUICKI was significantly higher after dark than after white chocolate ingestion (0.398 ± 0.039 compared with 0356±0.023; P=0.001). Although within normal values, systolic blood pressure was lower after dark than after white chocolate ingestion (107.5±8.6 compared with 113.9±8.4mmHg; P<0.05). Conclusion: Dark, but not white, chocolate decreases blood pressure and improves insulin sensitivity in healthy persons. [ABSTRACT FROM AUTHOR]

A novel Corona virus (SARS-CoV-2), started in Wuhan China, caused an outbreak of viral pneumonia to subsequently spread throughout the world. Italy has been one of the most affected countries in the world and the increasing number of cases and deaths has created strong emotional reactions in people. This study has aimed at evaluating public attention to this emerging disease through the use of Google Trends. Public attention, measured as the volume of internet search activity, was correlated with Health Communication Strategies and official COVID-19 data. At the moment of the study analysis, Italy was by far the first country in terms of search volume for "coronavirus" and the highest peak of searches was reached on February 23, 2020. We have found that there was a correlation between public attention to coronavirus disease and communications from Public Health policies: we observed spikes in search volumes on the days of Presidential Decree publications. Furthermore, this attention was also correlated with Case Fatality Rate (CFR). Even if CFR data are continuously updated and can be affected by patient histories, the correlation found suggests that the increase in mortality has generated growing interest in the disease and its risk perception. This study shows that tracking searches through Google Trends as a public focus indicator is a useful tool for decision-makers in guiding communication strategies and should as well stimulate a more transparent media and policy making reporting. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the measurement properties of an Italian Version of the Lower Extremity Functional Scale (LEFS) in patients with lower extremity musculoskeletal dysfunction. Study Design and Setting: This is a prospective methodological study of repeated measures with a sample of 250 consecutive patients. Reliability, validity, and responsiveness were evaluated. Results: The Italian version of the LEFS showed a high degree of internal consistency with a Cronbach alpha of 0.94 (95% confidence interval [CI]: 0.91, 0.96). The test–retest reliability was high for both intra-interviewer and inter-interviewer measures with an ICC(2,1 and 2,k) of 0.91 (95% CI: 0.86, 0.93) and 0.89 (95% CI: 0.83, 0.91), respectively. The LEFS showed a better correlation with the 36-Item Short-Form Health Survey (SF-36) physical component summary score rather than with the SF-36 mental component summary score both at the initial assessment (r =0.61 and 0.26, respectively) and at the discharge (r =0.72 and 0.22, respectively). Receiver operating characteristic curve analysis revealed a large responsiveness for the LEFS (area under the curve [AUC]=0.97) and a moderate responsiveness for the SF-36 (AUC=0.68). Conclusion: The Italian version of the LEFS is a valid, reliable, and responsive tool that can be used to measure function in Italian patients with lower extremity musculoskeletal dysfunction. [Copyright &y& Elsevier]

Abstract: It has been suggested that cerebrovascular factors contribute to Alzheimer''s disease. Soluble CD40 ligand (sCD40L) is directly involved in the development of vascular damage. We tested the hypothesis that sCD40L may be enhanced in Alzheimer''s disease and predictive of its clinical course. Plasma sCD40L levels were evaluated in three groups of 40 consecutive patients each referring for mild or moderate or severe Alzheimer''s disease, as assessed by the Clinical Dementia Rating (CDR), and in 40 healthy subjects. Seventy-seven patients with mild or moderate disease were re-evaluated after 2 years. Cross-sectional comparisons revealed higher plasma sCD40L levels in Alzheimer''s disease patients than in controls (9.3±4.7ng/mL versus 3.4±1.3ng/mL, p <0.0001). Circulating sCD40L levels significantly increased through the three CDR stages (p =0.0011 or less) and were correlated with MMSE (r =−0.574, p <0.0001) and ADAS-cog subscale (r =0.538, p <0.0001) scores. Longitudinal evaluation identified sCD40L as an independent predictor of MMSE (β =−0.157, t =−3.650, p =0.0005) and ADAS-cog subscale (β =0.484, t =3.890, p =0.0002) score changes after 2 years. Patients with plasma sCD40L level≥6.0ng/mL, identified by ROC curve analysis as the best discriminating value for disease progression, had a three-fold increase in the risk of progression toward a worse CDR stage (odd ratio: 3.0, C.I. 95% 1.2–8.1). In conclusion, circulating sCD40L is enhanced in patients with Alzheimer''s disease and independently associated with the severity and progression of the disease. These data might suggest a pathogenetic role for sCD40L in Alzheimer''s disease. [Copyright &y& Elsevier]

The stimulation of AT1R (Angiotensin II Receptor Type 1) by Angiotensin II has, in addition to the effects on the renin-angiotensin system, also pro-inflammatory effects through stimulation of ADAM17 and subsequent production of INF-gamma and Interleukin-6. This pro-inflammatory action stimulate the cytokine storm that characterizes the most severe forms of SARS-CoV-2 infection. We studied the effect of AT1Rab on the AT1R on 74 subjects with SARS-CoV-2 infection with respiratory symptoms requiring hospitalization. We divided the patients into 2 groups: 34 with moderate and 40 with severe symptoms that required ICU admission. Hospitalized subjects showed a 50% reduction in the frequency of AT1Rab compared to healthy reference population. Of the ICU patients, 33/40 (82.5%) were AT1Rab negative and 16/33 of them (48.5%) died. All 7 patients positive for AT1Rab survived. These preliminary data seem to indicate a protective role played by AT1R autoantibodies on inflammatory activation in SARS-CoV-2 infection pathology. [ABSTRACT FROM AUTHOR]

Objective: Aim of our work was to compare standard and weight-bearing WB-MRI to define their contribution in unmasking patello-femoral (PF) maltracking and to define what measurement of patellar alignment is the most reliable.Methods: We prospectively collected 95 non consecutive patients, clinically divided into 2 groups: group A (the control group), including 20 patients (negative for patellar maltracking), and group B including 75 patients (positive for patellar maltracking). The patients underwent a dedicated 0.25 T MRI, in supine and WB position, with knee flexion of 12-15°. The following measurements were performed: Insall-Salvati index (IS), lateral patellar displacement (LPD), lateral patello-femoral angle (LPA) and lateral patellar tilt (LPT). Quantitative and qualitative statistical analyses were performed to compare the results obtained before and after WB-MRI. Measurements were subsequently performed on both groups.Results: Group A patients showed no statistically significant variations at all measurements both on standard and WB-MRI. On the basis of measurements made on standard MRI, group B patients were divided into group B1 (23 patients) (negative or positive at 1 measurement) and group B2 (52 patients) (positive at 2 or more measurements). After WB-MRI, group B1 patients were divided into group B1a (6 patients), in case they remained positive at 0/1 measurement, and group B1b (17 patients), in case they became positive at 2 or more measurements. All group B2 patients confirmed to be positive at 2 or more measurements at WB-MRI. Quantitative statistical analysis showed that LPT and LPA were the most reproducible and clinically useful measurements. Qualitative statistical analysis performed on standard and WB-MRI demonstrated that LPT was the best predictive measurement.Conclusions: This study demonstrates both the high diagnostic value of WB-MRI in unmasking PF-maltracking and the best predictive value of LPT measurement. [ABSTRACT FROM AUTHOR]

Objective: To explore the contribution of an altered structure of sperm mitochondria to human asthenozoospermia. Design: A retrospective study. Setting: Andrology Clinic, University of L’Aquila. Patient(s): Fifteen ejaculates with forward motility (FM) ≥50%, and 57 asthenozoospermic ejaculates (FM <50%, sperm vitality >50%), including 14 ejaculates with systematic genetic defects of tail principal piece, and 43 ejaculates with unexplained asthenozoospermia. Intervention(s): Fifty sections of tail middle piece (MP) were blindly analyzed by transmission electron microscopy in each ejaculate for normal mitochondrial membrane organization, after exclusion of tails with disrupted cell membranes. Main Outcome Measure(s): Percentage of MPs with normal mitochondrial membranes (% normal MPs). Result(s): Percent normal MPs showed a strong correlation with forward motility. Variation of % normal MPs explained a 45% variation of sperm motility at multivariate linear regression analysis, confirming the strong association between the two parameters in a population including ejaculates with normal motility and with unexplained asthenozoospermia. Percent normal MPs was significantly reduced in severe unexplained asthenozoospermia (FM <10%; n = 16) compared with samples with normal motility (FM ≥50%; n = 15); 21% (10.5%–38%) and 68% (52%–73%), respectively. Conclusion(s): Structural defects in mitochondrial membranes represent a main feature of severe unexplained asthenozoospermia. [ABSTRACT FROM AUTHOR]

[Display omitted] Although preclinical research has revealed disrupting effects on male reproductive functions of bisphenol A (BPA), as yet clinical studies have led to inconsistent results. The present meta‑analysis aims to establish the existence and the extent of the association between BPA exposure and semen quality. A thorough search of PubMed, Scopus and Web of Science databases was carried out. Only studies reporting data from multivariable linear regression analyses (β-coefficients with 95% CI), assessing the association between urinary levels of BPA and standard semen parameters were included. Nine studies provided information about an overall sample of 2,399 men. Only the negative association between urinary BPA levels and sperm motility reached statistical significance (pooled β-coefficient = -0.82; 95% CI: −1.51 to −0.12, p = 0.02; P for heterogeneity = 0.1, I2 = 42.9%). Yet, such a significance was lost after data adjustment for publication bias, as well as at the sensitivity analysis, when each of the two studies that contributed most to the overall estimate was excluded. In conclusion, the overall estimates of data produced by clinical studies point to a clinically negligible, if any, association between urinary BPA concentrations and semen quality. Further studies in workers at high risk of occupational exposure are warranted to corroborate the herein revealed weak correlation with a worse sperm motility. [ABSTRACT FROM AUTHOR]

Objective: To define by transmission electron microscopy (TEM) analysis, the prevalence of sperm tail defects of genetic origin among men suffering for a reduced or absent sperm motility. Design: A retrospective study. Setting: Andrology Clinic, University of L’Aquila, Italy. Patient(s): The 120 ejaculates of infertile men with a forward motility (FM) ≤20% were compared to 200 ejaculates with a FM >20%. All ejaculates had a sperm vitality >50%. Intervention(s): Some 25–50 tails were analyzed by TEM in each ejaculate. Main Outcome Measure(s): Receiver operating characteristics (ROC) analysis was applied by plotting the FM of cases with or without genetic tail defects detected by TEM. Result(s): The area under the ROC curve was 0.96 (95% confidence interval 0.92–0.98). The positive predictive accuracy for genetic tail defects in ejaculates with 0% FM was 46%. Three of 17 cases with genetic tail defects were classified as false negative when TEM analysis was restricted to ejaculates with 0% FM. A FM ≤7%, allowed the identification of all cases with genetic tail defects. Conclusion(s): The TEM analysis identifies sperm tail defects of genetic origin and should be restricted to ejaculates with severe asthenozoospermia (≤7% motile sperm) and sperm vitality >50%. [Copyright &y& Elsevier]

Seventy-three couples with male subfertility, which was due to oligo/astheno- and/or teratozoospermia (n = 63) or antisperm antibodies (n = 10), were randomly assigned to sequential timed natural intercourse, intrauterine insemination (IUI) and IUI + mild ovarian hyperstimulation. From the analysis of 384 observed cycles, IUI was shown to be effective in oligo/asthenozoospermia without severe teratozoospermia, when it was associated with moderate multifollicular induction, and in male immunologic subfertility, IUI was highly effective in nonstimulated cycles also. [ABSTRACT FROM AUTHOR]