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Video Objective Laparoscopic sacrocolpopexy (LSC) is known to achieve lower recurrence rates, shorter recovery time, and less dyspareunia. However, LSC is problematic because it requires specific laparoscopic skills and the laparoscopy takes longer than other competing operations. In this video, we present the surgical techniques for LSC we are using with a view to shortening operation times and reducing complications. We named this approach Time Sparing Sacrocolpexy (TSS) Design Prospective Clinical Trial Setting San Carlo di Nancy Hospital GVM Care & Research, Rome Patients: Ninety women with symptomatic stage 3 or greater POP underwent LSC in our hospital between November 2016 and January 2019. Interventions Ninety women with symptomatic stage 3 or greater POP underwent LSC in our hospital between November 2016 and January 2019. In the first 80 operations we followed the nerve-preserving technique described by Ercoli et al. in 2017. In the final 10 operations we modified the technique in order to reduce operative time. The main changes were: (1) Use of Bipolar loop to cut the cervix instead of the monopolar hook, (2) make a stitch on the meshes in order to reduce the time of introduction e positioning of them in the pelvis, (3) replacing part of the classic LSC stitches with (i) AbstackT fixations to fix meshes to the anterior and posterior vaginal wall, but maintaining nonabsorbable stitches at the urethrovesical junction, at the cervix, at the level of levator ani muscle and at the sacrum. Measurements and Main Results Operative Time. Intra and post operative related complications. The operation time decreased (around 40%) as the surgical technique improved through experience. No major intra- or postoperative complications occurred. Conclusion These modifications to the technique will help shorten operation times and reduce complications of LSC.

This paper presents a variability study of several engineering properties of tire-derived aggregate based on a comprehensive literature survey of experimental test programs. The dry compacted unit weight, cohesion intercept, friction angle, constrained modulus, and modified secondary compression index were evaluated and compared to the engineering parameter variability of natural soils. A series of regression analyses were performed to investigate the presence and significance of scale-dependency. The results of the variability analysis indicate that unit weight has the lowest value of coefficient of variation (COV) whereas the shear strength parameters, constrained modulus, and compression index have COV values that are substantially higher. Regression analyses indicated that unit weight and constrained modulus showed the greatest sensitivity to changes in maximum tire particle size. A nonstatistical investigation was used to further investigate the variability and scale-dependency of the shear strength parameters. Using Mohr-Coulomb failure criterion and assuming that cohesion is negligible, the analysis showed a scale-independent relationship which is consistent with the statistical findings for cohesion and friction angle.

Two experiments investigated spontaneous class grouping behavior by human-enculturated and language-reared bonobos (Pan paniscus) and common chimpanzees (P. troglodytes). In experiment 1, three chimpanzees ranging in age from 6 to 18 years were presented with six objects. The objects embodied three conditions: additive, multiplicative and disjoint classes. All chimpanzees spontaneously produced single- and two-category classifying. In experiment 2, six chimpanzees ranging in age from 6 to 21 years were presented with 12 objects in the same class conditions. Chimpanzees mainly produced single-category classifying. Their two-category classifying was more rudimentary than that found in experiment 1. Chimpanzees did not produce any three-category classifying which would be necessary to construct the hierarchies that humans begin to construct during early childhood.

The development of spontaneous object manipulation in 5 chimpanzees (Pan troglodytes) from ages 15 to 54 months was investigated, focusing on formal properties of subjects’ acts and the objects they manipulated. Young chimpanzees’ manipulation progress from serial one-at-a-time acts on one object to parallel two-at-a-time acts on two or more objects. With age, simultaneous acts become increasingly transformational and identical or reciprocal to each other. Moreover, the class properties of objects manipulated simultaneously change. When presented with objects belonging to two different classes, subjects shift, with age, from manipulating different objects to manipulating identical or similar objects. In all these respects young chimpanzee’ development is similar to human infants’. In others it differs. Most especially, the onset age is later and the development is slower as well as less structurally complex.

Aims Strategies to prevent adverse left ventricular (LV) remodelling after myocardial infarction have included several traditional approaches and novel cell-based or gene therapies. Delivery of growth factors in post-infarction heart failure has emerged as a valuable alternative strategy. Our aim was to investigate the effects of sequential release of vascular endothelial growth factor (VEGF) and insulin-like growth factor-1 (IGF-1) from biodegradable gelatin microspheres in experimental heart failure. Methods and results Gelatin hydrogel microspheres were known to guarantee a sustained release of encapsulated growth factors, characterized by an initial burst followed by a slower release. Rats with moderate myocardial infarction were randomized to receive empty microspheres (MI), microspheres loaded with IGF-1 or VEGF, or a combination thereof (DUAL). Myocardial injections of microspheres were performed at the time of surgery, and treatment lasted 4 weeks. Echocardiography, LV catheterization, morphometric histology and immunohistochemistry, and molecular assessment of downstream mediators [e.g. Akt, endothelial nitric oxide synthase (eNOS), and sarco/endoplasmic reticulum calcium ATPase-2 (SERCA-2)] were assessed at the end of the treatment period. Infarct sizes were 33 ± 2, 28 ± 4, 24 ± 3, and 16 ± 3% in the MI, IGF-1, VEGF, and DUAL groups, respectively. IGF-1 attenuated LV remodelling, improved LV systolic and diastolic function, increased myocyte size, and reduced apoptotic deaths, capillary loss, and indexes of inflammation. VEGF-treated animals displayed a marked myocardial neoangiogenesis that led to the formation of mature vessels if combined with IGF-1 delivery. Downstream effects of IGF-1 were principally mediated by the Akt–mTOR (mammalian target of rapamycin)-dependent pathway, and both growth factors, particularly VEGF, induced a robust and sustained increase of eNOS. Conclusion IGF-1 and VEGF exerted complementary therapeutic effects in post-infarction heart failure. Biodegradable gelatin microspheres provide sustained and controlled growth factor release locally, exposing myocardial tissue without the side effects of systemic administration.

The aim of the study was to compare the efficacy and safety of singledose prulifloxacin vs. single-dose pefloxacin in the treatment of patients with acute uncomplicated urinary tract infections. Two hundred and thirty-one female out-patients were considered microbiologically evaluable and randomly treated with 600 mg prulifloxacin (116 patients) or 800 mg pefloxacin (115 patients). The most commonly isolated uropathogen at baseline was Escherichia coli (71.4%), followed by Proteus mirabilis (10.8%) and Klebsiella pneumoniae (7.8%). Five-seven days posttreatment, the eradication rate was 97.4% and 92.2% in the prulifloxacin and pefloxacin group, respectively. The one-tailed 95% confidence interval analysis showed the equivalence of treatments. Four weeks from treatment no relapses, reinfections or superinfections were observed. The clinical success rates were 92.2% in the prulifloxacin and 84.3% pefloxacin groups. The safety profile was very good with both drugs. The results of the study make it possible to consider prulifloxacin a possible therapeutic option in patients with acute uncomplicated UTIs.

Objectives- The aim of our study was to test the effect of a more viscous compound than existent hyaluronic acid formulation in helping to restore a defective glycosaminoglycan layer, and therefore in improving Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS) symptoms when administered intravesically in IC/PBS patients. Methods- A total of 23 female patients completed the study. Patients received endovesical administration of hyaluronic acid and chondroitin sulfate in normal saline, 40 ml, weekly for 12 weeks and then bi-weekly for 6 months, if there was initial response. Results- After 12 weeks treatment both Interstitial Cystitis Symptom and Problem Index (ICSI/ICPI), pelvic pain and Urgency/Frequency Symptom Scale (PUF) showed a mean significant improvement, which was maintained thereafter. The average number of voidings and mean voiding volumes revealed significant improvement after the 12 weeks treatment period, with a significant reduction and increase, respectively. Mean voiding volume increased from 143 ml to 191, which apparently was not reflected in a corresponding reduction of number of daily voids (from 15,5 to 14). VAS values decreased from 5,4 to 3,6 (pain) and from 6,0 to 3,5 (urgency) after the treatment cycle, showing a significant improvement. Conclusions- In our preliminary experience, the administration of intravesical hyaluronic acid plus chondroitine sulphate appears to be a safe and efficacious method of treatment in IC/PBS.

The authors point out the clinical usefulness and optimal tolerability of Fentiazac in patients suffering from tuberculosis and whose condition requires therapeutic intervention with non-steroid anti-inflammatory drugs.

Objective: The aim of the present work was to measure the pain threshold in hypertensive patients with a new auto-algometry method. Design and Setting: Auto-algometry consists of asking the subjects to push their fingers against a fixed round-tip needle until they feel a pain sensation. An electronic force transducer permits the measurement of the force applied by the subjects and storage of the data on a personal computer. Eight tests are performed twice on each subject on the tip and back of four fingers. For each test, the maximal applied force (grams) is defined as pain threshold. The overall discomfort during the entire procedure is reported by the subjects on a 0 (no discomfort) to 10 (intolerable pain) scale. Patients and Interventions: A group of hypertensive patients (n = 22) and a group of normotensive subjects (n = 22) underwent the auto-algometry examination. Results: The pain threshold was higher in hypertensive patients compared with normotensive subjects. All discomfort scores referred by the subjects fell within the 4–6 range. Conclusion: The data obtained from this study indicate that the auto-algometer as described here can detect hypoalgesia associated with hypertension.