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Purpose of Review: This article explores the cardiovascular effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with type 2 diabetes mellitus (T2DM), with a particular focus on their impact on lipid profiles. As evidence grows of the cardiovascular benefits of SGLT2i beyond glucose control, it is essential to better understand their effects on lipoproteins and their impact on cardiovascular disease., Recent Findings: SGLT2i have shown significant cardiovascular benefits in patients with type 2 diabetes mellitus, beyond their role in lowering blood glucose. Studies indicate that SGLT2i reduce major adverse cardiovascular events by impacting factors such as blood pressure, body weight, and arterial stiffness. However, their effects on lipid profile remain complex and somewhat inconsistent. Some research points to modest increases in LDL cholesterol, while others report shifts toward less atherogenic lipid profile, including reductions in triglycerides and small, dense LDL particles, and increases in HDL-C. SGLT2i represent a significant advancement in managing diabetes and associated cardiovascular risks, with benefits such as triglyceride reduction and HDL-C increase. While their impact on LDL-C remains controversial and varies across studies, the reduction of small, dense LDL particles may mitigate negative effects. This article highlights the need for future research to better understand the specific mechanisms behind lipid modulation., Competing Interests: Declarations. Conflict of Interest: The authors declare no conflicts of interest related to this work. Human and Animal Rights and Informed Consent: This article does not contain any studies with human or animal subjects performed by any of the authors., (© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: There are many surgical techniques for ventral hernias and diastasis recti, both conventional or video-endoscopic, with or without mesh placement, detailed in the literature. Using some details of the techniques proposed by Wolfgang Reinpold (Mini- or Less Open Sublay Operation, MILOS) and Federico Fiori (Totally Endoscopic Sublay Anterior Repair, TESAR) we found modifications that allowed repairing and reinforcement of the posterior fascia with a retro-muscular mesh and achieve primary fascial closure by minimally umbilical access and searching for the best anatomical, functional, and aesthetic results., Method: Describe the surgical technique step by step and analyze 629 surgical treatments. The cohort comprises the period January 2018 to January 2023. Our Database registered 318 men and 311 women who underwent video endoscopicassisted Rives-Stoppa techniques to treat umbilical and epigastric hernias with diastasis RESULTS: All patients were treated on an outpatient basis and discharged home on the same day. The most frequent complications were seromas with conservative management. Other complications recorded were omphalitis in 6 patients, and three patients presented hematomas, one of whom performed surgical evacuation. There were ten patients with recurrences., Conclusion: These hybrid approaches provide the advantages of mini-invasive techniques with a lower rate of complications and a high standard of quality of life, providing anatomical, functional, and aesthetic benefits., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Introduction: While sexual minority people have been widely considered at risk for developing a range of body image concerns, evidence of body dissatisfaction and shame amongst LGB (lesbian, gay, and bisexual) individuals is mixed. This study investigated differences in body uneasiness, body dissatisfaction, and self-blaming/attacking attitudes between LGB and heterosexual individuals, as well as within LGB groups, while also examining the predictive role of body mass index (BMI)., Methods: A sample of cisgender lesbian women ( n  = 163), gay men ( n  = 277), bisexual women ( n  = 135), bisexual men ( n  = 39), heterosexual women ( n  = 398), and heterosexual men ( n  = 219) completed an online survey assessing different aspects of body image between May and July 2020., Results: Gay and bisexual men reported greater body image disturbance and self-blaming attitudes relative to heterosexual men. In contrast, lesbian women reported lower body uneasiness than their bisexual and heterosexual counterparts, but greater self-hate. Moreover, lesbian and bisexual women showed more body dissatisfaction than gay men, and bisexual individuals reported more body uneasiness than individuals in other sexual minority subgroups. Higher BMI emerged as a significant predictor of body image concerns and dissatisfaction., Conclusions: Body image dimensions showed sexual identity-based differences. Determining the specific nuances of body image in LGB individuals can provide important information on potential risk factors that may impact mental health outcomes., Policy Implications: In-depth knowledge of body dissatisfaction and uneasiness in individuals with LGB identities may have critical implications for the development of personalized prevention and treatment strategies., Competing Interests: Conflicts of Interest/Competing InterestsThe authors have no relevant financial or non-financial interests to disclose., (© The Author(s) 2023.)

Neuroscientists postulate 3D representations in the brain in a variety of different coordinate frames (e.g. 'head-centred', 'hand-centred' and 'world-based'). Recent advances in reinforcement learning demonstrate a quite different approach that may provide a more promising model for biological representations underlying spatial perception and navigation. In this paper, we focus on reinforcement learning methods that reward an agent for arriving at a target image without any attempt to build up a 3D 'map'. We test the ability of this type of representation to support geometrically consistent spatial tasks such as interpolating between learned locations using decoding of feature vectors. We introduce a hand-crafted representation that has, by design, a high degree of geometric consistency and demonstrate that, in this case, information about the persistence of features as the camera translates (e.g. distant features persist) can improve performance on the geometric tasks. These examples avoid Cartesian (in this case, 2D) representations of space. Non-Cartesian, learned representations provide an important stimulus in neuroscience to the search for alternatives to a 'cognitive map'., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Several studies have highlighted the relationship between internalized sexual stigma (ISS) and dissociation. The aim of the present study was to empirically investigate this relationship through a quantitative study. The Measure of Internalized Sexual Stigma for Lesbians and Gay Men (MISS-LG) and the Dissociation Scale (DIS) of the Trauma Symptom Inventory (TSI) were administered to 120 Caucasian participants who self-identified as gay men. Findings suggested that dissociative symptomatology, as measured by DIS-an estimation of the use of dissociation as a defense mechanism-was positively associated with MISS general index and all dimensions of MISS, especially the sexuality dimension (ISS-S). Moreover, the effect of the ISS-S on DIS was amplified in Catholic participants, suggesting a moderating role of religiosity. Implications for future research and clinical practice are discussed.

This article describes two interrelated studies that investigated beliefs and stereotypes on two-father parenting and two-mother parenting through the development and validation of the Beliefs on Same-Sex Parenting (BOSSP) scale. The BOSSP captures two beliefs: (1) prejudices toward same-sex couples' inherent inability to parent and (2) concerns about same-sex parenting that are not necessarily related to homonegativity. In Study 1 (301 heterosexual participants), exploratory factor analysis (EFA) suggested an 11-item scale for attitudes toward both two-father families and two-mother families, with two factors: parenting skills, which evaluates beliefs on same-sex couples' ability to take care of their children; and parental adjustment, which assesses beliefs on the impact of challenges related to same-sex parenting on children's well-being. Support for convergent validity between BOSSP factor scores and those of theoretically related measures were provided. In Study 2 (346 heterosexual participants surveyed in two time points), CFA indicated that the two-factor model provided the best fit. Test-retest reliability and longitudinal invariance were documented. Finally, results revealed that more negative attitudes toward same-sex parenting were held by men than by women and were associated with negative opinions on reproductive techniques. The innovative characteristics of the BOSSP and implications for future practice are discussed.

Purpose: Chronic pain of the inguino-crural region or "pubalgia" explains the 0.5-6.2% of the consultations by athletes. Recently, areas of weakness in the posterior wall called "sports hernias," have been identified in some of these patients, capable of producing long-standing pain. Several authors use different image methods (CT, MRI, ultrasound) to identify the lesion and various techniques of repair, by open or laparoscopic approaches, have been proposed but there is no evidence about the superiority of one over others due to the difficulty for randomizing these patients. In our experience, diagnosis was based on clinical and ultrasound findings followed by laparoscopic exploration to confirm and repair the injury. The present study aims to assess the performance of our diagnostic and therapeutic management in a series of athletes affected by "pubalgia"., Methods: 1450 athletes coming from the orthopedic office of a sport medicine center were evaluated. In 590 of them (414 amateur and 176 professionals) sports hernias were diagnosed through physical examination and ultrasound. We performed laparoscopic "TAPP" repair and, thirty days after, an assessment was performed to determine the evolution of pain and the degree of physical activity as a sign of the functional outcome. We used the U Mann-Whitney test for continuous scale variables and the chi-square test for dichotomous variables with p < 0.05 as a level of significance., Results: In 573 patients ultrasound examination detected some protrusion of the posterior wall with normal or minimally dilated inguinal rings, which in 498 of them coincided with areas affected by pain. These findings were confirmed by laparoscopic exploration that also diagnosed associated contralateral (30.1%) and ipsilateral defects, resulting in a total of 1006 hernias. We found 84 "sport hernias" in 769 patients with previous diagnosis of adductor muscle strain (10.92%); on the other hand, in 127 (21.52%) of our patients with "sport hernias" US detected concomitant injuries of the adductor longus tendon, 7 of which merited additional surgical maneuvers (partial tenotomy). Compared with the findings of laparoscopy, ultrasound had a sensitivity of 95.42% and a specificity of 100%; the positive and negative predictive values were 100 and 99.4% respectively. No postoperative complications were reported. Only seven patients suffered recurrence of pain (successful rate: 98.81%); the ultrasound ruled out hernia recurrence, but in three cases it diagnosed tendinitis of the rectus abdominis muscle., Conclusions: Our series reflects the multidisciplinary approach performed in a sports medicine center in which patients are initially evaluated by orthopedic surgeons in order to discard the most common causes of "pubalgia". "Sports hernias" are often associated with adductor muscle strains and other injuries of the groin allowing speculate that these respond to a common mechanism of production. We believe that, considering the difficulty to design randomized trials, only a high coincidence among the diagnostic and therapeutic instances can ensure a rational health care.

Although homosexuality was depathologized in the last century and the majority of mental health professionals consider it to be a normal variant of human sexuality, some psychologists and psychiatrists still have negative attitudes toward lesbian, gay and bisexual (LGB) clients. Sometimes they provide interventions aimed at changing sexual orientation through 'reparative' or 'conversion' therapies. At other times their interventions are influenced by anti-gay prejudices or simply by lack of knowledge about sexual minorities. This paper argues for the need for appropriate treatment guidelines aimed at providing bias-free, respectful, and effective interventions given that Italian health associations have delayed providing them. Some of the main guidelines recently approved by the Consiglio Nazionale dell'Ordine degli Psicologi (National Council of the Italian Association of Psychologists) are presented. Issues addressed include differences between gender and sexual orientation, minority stress, including perceived stigma and internalized stigma, homophobic bullying, coming out, and resilience. Respectful listening to LGB and questioning clients, affirming their identities and fostering a sense of resilience are essential requirements for all mental health professionals wishing to provide effective interventions in a society where sexual minorities are subjected to discrimination throughout their entire life cycle.

The goal of this study is to propose a new Measure of Internalized Sexual Stigma for Lesbians and Gay Men (MISS-LG) that assesses three dimensions of internalized homonegativity: identity, social discomfort, and sexuality. A convenience sample of 735 Italian lesbians and gay male participants was used to demonstrate the psychometric validity of the scale. Results of confirmatory factor analysis supported three identifiable factors reflecting theoretically based constructs of the MISS-LG. The correlations with other instruments demonstrate the convergent validity: lesbian and gay participants with high internalized sexual stigma describe lower levels of self-disclosure and wellbeing. Implications for research and practice are discussed.

The purpose of the study was to test measurement methods in an inpatient setting for future use in a multisite study about bowel cleansing before colonoscopy. Because the multisite study used data collectors at distant geographic points who might have limited time to devote to data collection, the forms needed to be tested for practicality and efficiency. The data collection procedures worked well, but we experienced unexpected difficulties recruiting inpatients. We also found that we need to direct more efforts toward building the staff nurses' enthusiasm for the study because they help with data collection.

Previous studies that have evaluated fish oil preparations in patients with IgA nephropathy (IgAN) have produced a wide range of conclusions. Proposed explanations for these discordant results have not provided a unifying hypothesis. Results from two clinical trials were analyzed to examine whether there is a dosage-dependent effect of Omacor, a purified preparation of omega-3 fatty acids, in patients with IgAN. Whether changes in the level of proteinuria and plasma phospholipid fatty acid profiles were dependent on the dose of Omacor factored by body size was determined. In a post hoc analysis of the first trial results, correlations were found between (1) phospholipid eicosapentaenoic acid (EPA)/arachidonic acid (AA) and docosahexaenoic acid (DHA)/AA ratios and the dosage of Omacor, expressed as milligrams per kilogram of body weight (r = 0.78, P < 0.001 for EPA/AA; r = 0.86, P < 0.001 for DHA/AA), (2) phospholipid EPA/AA and DHA/AA levels and percentage change in urine protein/creatinine ratio after 21 to 24 mo of therapy (r = -0.50, P = 0.02 for EPA/AA; r = -0.52, P = 0.01 for DHA/AA), and (3) dosage of Omacor per kilogram of body weight and change in proteinuria after 21 to 24 mo (r = -0.50, P = 0.02). A similar relationship was observed between urine protein/creatinine ratio and dosage of Omacor per kilogram of body weight in trial 2 (r = -0.38, P < 0.001). It is concluded from these data that the effect of Omacor on proteinuria in patients with IgAN is dosage dependent and is associated with a dosage-dependent effect of Omacor on plasma phospholipid EPA and DHA levels.

This randomized, placebo-controlled, double-blind trial evaluated the role of prednisone and omega 3 fatty acids (O3FA) in patients with IgA nephropathy. Entry criteria were (1) biopsy-proven IgA nephropathy, (2) estimated GFR > or = 50 ml/min per 1.73 m2, and (3) moderate to severe proteinuria. Thirty-three patients were randomly assigned to receive prednisone 60 mg/m2 every other day for 3 mo, then 40 mg/m2 every other day for 9 mo, then 30 mg/m2 every other day for 12 mo (prednisone group); 32 were randomly assigned to receive O3FA 4 g/d for 2 yr (1.88 g eicosapentaenoic acid, 1.48 g docosahexaenoic acid; O3FA group); and 31 were randomly assigned to receive placebo (placebo group). Most (73%) patients completed 2 yr of treatment. Randomly assigned patients who were hypertensive were given enalapril 2.5 to 40 mg/d. The primary end point was time to failure, defined as estimated GFR <60% of baseline. An overall significance level of 0.10 was used. The three groups were comparable at baseline except that the O3FA group had higher urine protein to creatinine (UP/C) ratios than the placebo group (P = 0.003). Neither treatment group showed benefit over the placebo group with respect to time to failure, with 14 patient failures overall (two in the prednisone group, eight in the O3FA group, and four in the placebo group). The primary factor associated with time to failure was higher baseline UP/C ratios (P = 0.009). Superiority of prednisone or O3FA over placebo in slowing progression of renal disease was not demonstrated in this study. However, the relatively short follow-up period, inequality of baseline UP/C ratios, and small numbers of patients precludes definitive conclusions.

Purpose: Internal anal sphincterotomy for treating chronic anal fissure can irreversibly damage anal continence. Reversible chemical sphincterotomy may be achieved by anal application of glyceryl trinitrate ointment (nitric oxide donor), which has been reported to heal the majority of patients with anal fissure by inducing sphincter relaxation and improving anodermal blood flow. This trial aimed to further clarify the role of glyceryl trinitrate in the treatment of chronic anal fissure., Methods: A total of 132 consecutive patients from nine centers were randomly assigned to receive 0.2 percent glyceryl trinitrate ointment or placebo twice daily for at least four weeks. The severity of pain and maximum anal resting pressure were measured before and after one week of treatment. Anodermal blood flow was measured before and after application of glyceryl trinitrate or placebo in ten patients., Results: The study was completed by 119 patients (59 glyceryl trinitrate and 60 placebo), matched for gender, age, duration of symptoms, duration of treatment, site of fissure, previous attempts to treat, pain score, and maximum anal resting pressure. Twenty-nine patients (49.2 percent) healed after glyceryl trinitrate and 31 patients (51.7 percent) healed after placebo (P = not significant). Pain score fell significantly in both groups, in addition to maximum anal resting pressure. Anodermal blood flow improved significantly in seven patients receiving glyceryl trinitrate, but not in the three receiving placebo. Twenty-three patients (33.8 percent) experienced headache and 4 (5.9 percent), orthostatic hypotension after glyceryl trinitrate., Conclusion: This trial fails to demonstrate any superiority of topical 0.2 percent glyceryl trinitrate treatment vs. a placebo, although the effects of glyceryl trinitrate on anodermal blood flow and sphincter pressure are confirmed. This finding, together with the high incidence of side-effects, should discourage the use of this treatment as a substitute for surgery in chronic anal fissure.

Having defined the terms of the problem of treating large incisional hernias with regard to the state of the patient and the anatomical conditions of the abdominal wall, the paper outlines the criteria for the execution of radical surgery which, while taking into account the numerous variables, simplify the overall surgical treatment. The efficacy of the prosthesis used, which ranges from a wide intra-abdominal polypropylene net, a well tolerated material, to the simplest plastic prosthesis for the muscle-aponeurotic wall, is confirmed by the excellent results achieved in the first difficult cases operated.