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Purpose: Normative male genital measurements are clinically useful and temporal changes would have important implications. The aim of the present study is to characterize the trend of worldwide penile length over time. Materials and Methods: A systematic review and meta-analysis using papers from PubMed, Embase, and Cochrane Library from inception to April 2022 was performed. PRISMA guidelines were used for abstracting data and assessing data quality and validity. Pooled means and standard deviations for flaccid, stretched, and erect length were obtained. Subgroup analyses were performed by looking at differences in the region of origin, population type, and the decade of publication. Metaregression analyses were to adjusted for potential confounders. Results: Seventy-five studies published between 1942 and 2021 were evaluated including data from 55,761 men. The pooled mean length estimates were flaccid length: 8.70 cm (95% CI, 8.16–9.23), stretched length: 12.93 cm (95% CI, 12.48–13.39), and erect length: 13.93 cm (95% CI, 13.20–14.65). All measurements showed variation by geographic region. Erect length increased significantly over time (QM=4.49, df=2, p=0.04) in several regions of the world and across all age groups, while no trends were identified in other penile size measurements. After adjusting for geographic region, subject age, and subject population; erect penile length increased 24% over the past 29 years. Conclusions: The average erect penis length has increased over the past three decades across the world. Given the significant implications, attention to potential causes should be investigated.

Objective: Robot-assisted partial nephrectomy (RAPN) has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses. The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses, large tumors (cT2-T3), renal cell carcinoma in solitary kidney, recurrent tumors, completely endophytic and hilar masses, and simultaneous and multiple tumors. Methods: A comprehensive search in the PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers. The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered. The secondary endpoint was to evaluate the surgical and functional outcomes. Results: After screening 1250 records, 43 full-text manuscripts were selected, comprising over 8500 patients. Twelve and thirteen studies reported data for endophytic and hilar renal masses, respectively. Five and three studies reported outcomes for cT2-T3 and solitary kidney patients, respectively. Four studies focused on redo-RAPN for recurrent tumors. Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney. Conclusion: Over the past decade, evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown. Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes, the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result. Certainly, a higher likelihood of complication might be expected when facing extremely challenging cases. However, none of these indications should be considered per se an exclusion criterion for performing RAPN. Ultimately, a risk-adapted approach should be employed.

Entrepreneurial contexts may be marked by the presence of a 'cultural environment' that stimulates knowledge and innovation adoption, while other contexts may act as barriers toward change and innovation. Moreover, multiple paths of multifunctional agriculture bring about a call for "multifunctional farm advisory services" (MFAS), which consider both private and public goods provided by the farming sector. Set against the background of multiple roles of agriculture, how to identify sound and pertinent knowledge becomes of paramount, to specify the roles of agricultural extensionists and the mechanisms of governance of MFAS within the setting up of the Agricultural Knowledge and Innovation System (AKIS). Our aim of the study is either to analyze attitudes toward the privatization of extension services within a predominantly public system of regional governance and to identify advisors' profile and their suitability with the modern vision of multifunctional agriculture through the emergence of MFAS. Empirical analysis evidences the presence of a diversified set of advisory services with different degrees of coherence with the multifunctional agricultural model. Also, the more advisory services are oriented towards empowering multifunctional agriculture the less the propensity towards their privatization. The cluster analysis has demonstrated a relatively good advisor's capability to deal with the new demands of multifunctional agriculture. The idea of MFAS has important theoretical implications that the paper tries to excavate through the analysis of the mechanisms of governance (public/private) and the identification of the advisors' profile facing the growing complexity of the farming sector, grounded on multifunctional agriculture. The study tries to fill a gap in the literature, by providing an original contribution to modeling the profile of advisors in charge of supporting the transition towards multifunctionality.

People's habits changed during the COVID-19 pandemic and the consequent containment policies, with numerous implications in all fields. In particular, restrictions had important consequences for drinking water consumption. The present work analyses this influence in the Soccavo district of Naples (Campania), in Italy, during the two periods of strongest restrictions in 2020: the national Lockdown (March 11–May 3) and the autumn Red Zone (November 16–December 6). A large amount of data, referred to single-household flowmeters connected to a Smart Water Grid acquisition system, was collected for the years 2019 (considered the average reference year) and 2020. The first step was the preliminary filtering of the data, by identification and elimination of anomalies and outliers, as well as anomalous annual patterns, through clustering and classification. The second step consisted of the comparison of the same meters in two consecutive years considering the daily and weekly average hourly patterns, the average daily patterns of midweek days, Saturdays, and Sundays, respectively, and the total daily volumes. The results are consistent with those in the literature. Some general trends in literature data were sought and pointed out in the present paper. HIGHLIGHTS The work focuses on the consequences of COVID-19 containment policies on drinking water consumption.; Analysis of Soccavo district (Naples, Italy) data showed how restrictions affected patterns and increased volume consumption.; Literature data comparison revealed that the peak coefficient increased more for big cities and volume consumption more for small cities.; Results provide counsels to manage future critical situations.;

ObjectiveInflammation has been associated with an increased risk for cancer development, while innate immune system activation could counteract the risk for malignancies. Familial Mediterranean fever (FMF) is a severe systemic inflammatory condition and also represents the archetype of innate immunity deregulation. Therefore, the aim of this study is to investigate the risk for cancer development in FMF.MethodsThe risk ratio (RR) for malignancies was separately compared between FMF patients and fibromyalgia subjects, Still’s disease patients and Behçet’s disease patients. Clinical variables associated with cancer development in FMF patients were searched through binary logistic regression.Results580 FMF patients and 102 fibromyalgia subjects, 1012 Behçet’s disease patients and 497 Still’s disease patients were enrolled. The RR for the occurrence of malignant neoplasms was 0.26 (95% Confidence Interval [CI.] 0.10-0.73, p=0.006) in patients with FMF compared to fibromyalgia subjects; the RR for the occurrence of malignant cancer was 0.51 (95% CI. 0.23-1.16, p=0.10) in FMF compared to Still’s disease and 0.60 (95% CI. 0.29-1.28, p=0.18) in FMF compared to Behçet’s disease. At logistic regression, the risk of occurrence of malignant neoplasms in FMF patients was associated with the age at disease onset (β1 = 0.039, 95% CI. 0.001-0.071, p=0.02), the age at the diagnosis (β1 = 0.048, 95% CI. 0.039-0.085, p=0.006), the age at the enrolment (β1 = 0.05, 95% CI. 0.007-0.068, p=0.01), the number of attacks per year (β1 = 0.011, 95% CI. 0.001- 0.019, p=0.008), the use of biotechnological agents (β1 = 1.77, 95% CI. 0.43-3.19, p=0.009), the use of anti-IL-1 agents (β1 = 2.089, 95% CI. 0.7-3.5, p=0.002).ConclusionsThe risk for cancer is reduced in Caucasic FMF patients; however, when malignant neoplasms occur, this is more frequent in FMF cases suffering from a severe disease phenotype and presenting a colchicine-resistant disease.

Human Embryonic Kidney cells (HEK293) are a popular host for recombinant protein expression and production in the biotechnological industry. This has driven within both, the scientific and the engineering communities, the search for strategies to increase their protein productivity. The present work is inserted into this search exploring the impact of adding sodium acetate (NaAc) into a batch culture of HEK293 cells. We monitored, as a function of time, the cell density, many external metabolites, and the supernatant concentration of the heterologous extra-cellular domain ECD-Her1 protein, a protein used to produce a candidate prostate cancer vaccine. We observed that by adding different concentrations of NaAc (0, 4, 6 and 8 mM), the production of ECD-Her1 protein increases consistently with increasing concentration, whereas the carrying capacity of the medium decreases. To understand these results we exploited a combination of experimental and computational techniques. Metabolic Flux Analysis (MFA) was used to infer intracellular metabolic fluxes from the concentration of external metabolites. Moreover, we measured independently the extracellular acidification rate and oxygen consumption rate of the cells. Both approaches support the idea that the addition of NaAc to the culture has a significant impact on the metabolism of the HEK293 cells and that, if properly tuned, enhances the productivity of the heterologous ECD-Her1 protein.

Introduction Neurofilmology is a young and evolving research field, at the intersection between neuroscience and movie experiences, that explores how the brain processes and responds to visual storytelling. It involves examining the cognitive and emotional effects of movies on viewers, including social cognition and perspective-taking aspects. However, up to date, these studies have focused only on the neurotypical population, hence constituting a considerable gap in the literature with respect to individuals with neuroatypical functioning. Objectives Aim of this study was to investigate the experience of film viewing and its correlates in individuals with a diagnosis of Autism Spectrum Disorders (ASD). Methods 30 neurotypical individuals and 30 individuals with ASD without intellectual disabilities were asked to observe 12 short video clips of 3 seconds length, showing an agent grasping an object from a table, and filmed with three different camera techniques: Still, Steadycam, Zoom; for each clip, they were asked to respond to six question on a Visual Analogue Scale (0-100) designed to investigate participants’ potential feeling of involvement with the observed scene, their comfort with the different filming conditions, and their estimation of the ecological plausibility of the different types of camera movements. Results Participants felt more involved watching videos filmed with a Steadycam, with respect to the Zoom and Still condition. Within the neurotypical group participants felt more comfortable when the camera was in motion (both Steadycam and Zoom condition) compared to the Still condition; no differences were found between conditions in the ASD group, as if they felt equally comfortable in every condition administered, regardless the filming technique. Conclusions First, our results reinforce prior findings regarding the influence of different camera techniques on neurotypical individuals. Second, they add to the existing literature suggesting that individuals with ASD may exhibit differences in their subjective experiences related to empathizing with characters and immersing themselves as actors when the camera replicates naturalistic movements, resulting in a diminished overall fulfillment in the movie-watching process. Disclosure of Interest None Declared

Childhood asthma, often linked with atopic conditions, poses a challenge when classified as severe and uncontrolled. The 2023 GINA guidelines define severe asthma in children as asthma that remains uncontrolled despite optimized treatment with high-dose ICS-LABA or requires high-dose ICS-LABA to prevent it from becoming uncontrolled. This category encompasses about 5% of pediatric asthma cases, emphasizing the need for innovative therapeutic exploration. Advances in understanding asthma phenotypes and endotypes enable personalized treatment based on biomarkers. Monoclonal antibodies offer targeted solutions, reducing exacerbations, improving lung function, and minimizing corticosteroid use in pediatric patients. Integrating these therapies requires a personalized approach by healthcare providers, enhancing outcomes in severe and refractory cases.

Background We evaluated the diagnostic performance of height-, age- and body surface area (BSA)-based kidney length (KL) percentiles in the identification of at least one small kidney (KL < 3.sup.rd) and in the prediction of reduced estimated glomerular filtration rate (eGFR) and/or elevated blood pressure (BP) in children with and without overweight (OW)/obesity(OB). Methods In this cross-sectional study, 744 apparently healthy children (mean age 8.3 years) were recruited in a primary care setting. Clinical data were collected, and serum creatinine and KL were measured. Height-, age- and BSA-based percentiles of KL were calculated and the association of at least one small kidney per subject with reduced eGFR and/or elevated BP was explored by logistic regression. Results Two hundred fifty-seven out of seven hundred forty-four (34.5%) subjects were OW/OB and 127 (17.1%) had reduced eGFR or elevated BP. In separate analyses in children with OW/OB, the KL percentiles calculated on the basis of BSA were lower compared with height- and age-based KL percentiles. Consequently, the prevalence of a small kidney was significantly higher when evaluating percentiles of KL based on BSA compared with other percentiles. In logistic regression analysis, a small kidney was significantly associated with reduced eGFR and/or elevated BP only when using height-based KL percentiles. The KL percentiles according to BSA for the ideal weight (iBSA) showed similar performance compared with height-based percentiles. No differences in the diagnostic performance of different percentiles were found in children with normal weight. Conclusions BSA-based percentiles underestimate KL in children with OW/OB. In these subjects, the use of height-based or iBSA-based percentiles should be preferred. Graphical abstract, Author(s): Pierluigi Marzuillo [sup.1] , Gemma Carreras-Badosa [sup.2] , José-María Martínez-Calcerrada [sup.3] , Stefano Guarino [sup.1] , Pier Luigi Palma [sup.1] , Delfina Petrone [sup.1] , Emanuele Miraglia del Giudice [...]

Children with type 1 diabetes mellitus (T1DM) have an increased risk of developing kidney involvement. Part of the risk establishes at the beginning of T1DM. In fact, up to 65% of children during T1DM onset may experience an acute kidney injury (AKI) which predisposes to the development of a later chronic kidney disease (CKD). The other part of the risk establishes during the following course of T1DM and could be related to a poor glycemic control and the subsequent development of diabetic kidney disease. In this review, we discuss the acute and chronic effects of T1DM on the kidneys, and the implications of these events on the long-term prognosis of kidney function., Author(s): Giulio Rivetti [sup.1] , Brenden E. Hursh [sup.2] , Emanuele Miraglia del Giudice [sup.1] , Pierluigi Marzuillo [sup.1] Author Affiliations: (1) grid.9841.4, 0000 0001 2200 8888, Department of Woman, [...]

Purpose: Medicinal and recreational cannabis use has grown exponentially, however, its effect on testicular function and spermatogenesis remains uncertain. The aim of this study was to evaluate the association between cannabis use and semen parameters in a cohort of Asian-American men with unknown fertility. Materials and Methods: Asian men were recruited to complete an online survey and submit a semen sample. Semen analysis, demographic data, lifestyle factors, and cannabis use habits were collected. Linear and logistic regression analyses were used to determine. Results: Among the 112 men included in this study, 51 used cannabis at least once in their lifetime, 30 men used cannabis at least once in the last 12 months, and 26 men used cannabis at least once in the last 30 days. Adjusted linear regression analyses identified an association between cannabis use in the previous 30 days and worse sperm morphology (β: -0.45, p=0.025) and sperm motility (β: -1.64, p=0.016). However, when stratifying by subfertile semen quality (i.e., WHO criteria), no association was identified between semen quality and cannabis use. Lower sperm morphology and motility are partially associated with recent cannabis use, while all other semen parameters are not. Conclusions: We did not observe any consistent associations between cannabis use on any semen parameters in Asian- American men. Further studies within the field are needed to explore racial and ethnic differences in semen quality and lifestyle factors.

Abstract This Position Statement updates the different components of the therapy of obesity (lifestyle intervention, drugs, and surgery) in children and adolescents, previously reported in the consensus position statement on pediatric obesity of the Italian Society of Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Lifestyle intervention is the first step of treatment. In children older than 12 years, pharmacotherapy is the second step, and bariatric surgery is the third one, in selected cases. Novelties are available in the field of the medical treatment of obesity. In particular, new drugs demonstrated their efficacy and safety and have been approved in adolescents. Moreover, several randomized control trials with other drugs are in process and it is likely that some of them will become available in the future. The increase of the portfolio of treatment options for obesity in children and adolescents is promising for a more effective treatment of this disorder.

The historic designation of individual properties and entire neighborhoods has experienced an evolution in its meaning in recent decades. The original passive approach to managing historical buildings, which primarily regarded them as “values” to be defended and preserved for future generations, has been supplemented by strategies aimed at their valorization, derived from an awareness of the potential of such resources for the community, as a means of promoting the economic and social conditions of local populations. This paper proposes a review of all the main research carried out in the literature over the last thirty years concerning the impact of the historical–architectural significance of property values, both from an intrinsic point of view by evaluating the weight that the examined variable assumes in relation to the market value of the individual property and an extrinsic point of view by addressing the issue of the evaluation of “spatial spillovers”, positive and/or negative externalities that neighborhoods with historical–architectural significance—understood as historical districts—produce on the values of the properties falling within them. The analysis conducted shows that, according to the studies carried out, historic-architectural value can have both a positive and negative impact on property values. This output is related to the type of historic designation (local rather than national), the architectural style, the building typology, and the conservation and enhancement activities envisaged for the property.

Prostate-specific antigen (PSA) testing as the sole indication for prostate biopsy lacks specificity, resulting in overdiagnosis of indolent prostate cancer (PCa) and missing clinically significant PCa (csPCa). SelectMDx is a biomarker-based risk score to assess urinary HOXC6 and DLX1 mRNA expression combined with traditional clinical risk factors. The aim of this prospective multi-institutional study was to evaluate the diagnostic accuracy of SelectMDx and its association with multiparametric magnetic resonance (mpMRI) when predicting PCa in prostate biopsies. Overall, 310 consecutive subjects were included. All patients underwent mpMRI and SelectMDx prior to prostate biopsy. SelectMDx and mpMRI showed sensitivity and specificity of 86.5% vs. 51.9%, and 73.8% vs. 88.3%, respectively, in predicting PCa at biopsy, and 87.1% vs. 61.3%, and 63.7% vs. 83.9%, respectively, in predicting csPCa at biopsy. SelectMDx was revealed to be a good predictor of PCa, while with regards to csPCa detection, it was demonstrated to be less effective, showing results similar to mpMRI. With analysis of strategies assessed to define the best diagnostic strategy to avoid unnecessary biopsy, SelectMDx appeared to be a reliable pathway after an initial negative mpMRI. Thus, biopsy could be proposed for all cases of mpMRI PI-RADS 4-5 score, and to those with Prostate Imaging-Reporting and Data System (PI-RADS) 1-3 score followed by a positive SelectMDx.