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Objective: Endourological treatment is assoSummary ciated with a risk of postoperative febrile urinary tract infections and sepsis. The aim of this study was to review the reported rate of infectious complications in relation to the type and modality of the endourologic procedure. Methods: This systematic review was conducted in accordance with the PRISMA guidelines. Two electronic databases (PubMed and EMBASE) were searched. Out of 243 articles retrieved we included 49 studies after full-text evaluation. Results: Random-effects meta-analysis demonstrated that retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) were associated with not significantly different odds of getting fever (OR = 1.54, 95% CI: 0.99 to 2.39; p = 0.06) or sepsis (OR = 1.52, 95% CI: 0.37 to 6.20, p = 0.56). The odds of getting fever were not significantly different for mini PCNL compared to standard PCNL (OR = 1.11, 95% CI: 0.85 to 1.44; p = 0.45) and for tubeless PCNL compared to standard PCNL (OR = 1.34 95% CI: 0.61 to 2.91, p = 0.47). However, the odds for fever after PCNL with suctioning sheath were lower than the corresponding odds for standard PCNL (OR = 0.37, 95% CI: 0.20 to 0.70, p = 0.002). The odds of getting fever after PCNL with perioperative prophylaxis were not different from the corresponding odds after PCNL with perioperative prophylaxis plus a short oral antibiotic course (before or after the procedure) (OR = 1.31, 95% CI: 0.71 to 2.39, p = 0.38). Conclusions: The type of endourological procedure does not appear to be decisive in the onset of infectious complications, although the prevention of high intrarenal pressure during the procedure could be crucial in defining the risk of infectious complications. © 2022 Edizioni Scripta Manent s.n.c.. All rights reserved.

Azithromycin is a macrolide antibiotic which inhibits bacterial protein synthesis, quorum-sensing and reduces the formation of biofilm. Accumulating effectively in cells, particularly phagocytes, it is delivered in high concentrations to sites of infection, as reflected in rapid plasma clearance and extensive tissue distribution. Azithromycin is indicated for respiratory, urogenital, dermal and other bacterial infections, and exerts immunomodulatory effects in chronic inflammatory disorders, including diffuse panbronchiolitis, post-transplant bronchiolitis and rosacea. Modulation of host responses facilitates its long-term therapeutic benefit in cystic fibrosis, non-cystic fibrosis bronchiectasis, exacerbations of chronic obstructive pulmonary disease (COPD) and non-eosinophilic asthma. Initial, stimulatory effects of azithromycin on immune and epithelial cells, involving interactions with phospholipids and Erk1/2, are followed by later modulation of transcription factors AP-1, NFκB, inflammatory cytokine and mucin release. Delayed inhibitory effects on cell function and high lysosomal accumulation accompany disruption of protein and intracellular lipid transport, regulation of surface receptor expression, of macrophage phenotype and autophagy. These later changes underlie many immunomodulatory effects of azithromycin, contributing to resolution of acute infections and reduction of exacerbations in chronic airway diseases. A sub-group of post-transplant bronchiolitis patients appears to be sensitive to azithromycin, as may be patients with severe sepsis. Other promising indications include chronic prostatitis and periodontitis, but weak activity in malaria is unlikely to prove crucial. Long-term administration of azithromycin must be balanced against the potential for increased bacterial resistance. Azithromycin has a very good record of safety, but recent reports indicate rare cases of cardiac torsades des pointes in patients at risk. © 2014 Elsevier Inc.

Toxoneuron nigriceps is an endophagous parasitoid of larval stages of the noctuid moth Heliothis virescens. As all parasitoids, this wasp avoid host immune reaction by a combination of several passive and active mechanisms. Secretions injected by ovipositing females, which contain venom, calyx fluid and polydnaviruses, are the most probably factors actively disrupting Heliothis virescens immune system. This paper describes the main alterations of the host immune response observed shortly after oviposition by T. nigriceps. A transient block of prophenoloxidase activity is registered along with changes in hemocyte number, adhesion and structure, which suggest the occurrence of apoptosis. In contrast, the host plasmatocytes appear structurally unaltered, but unable to produce a capsule in vitro.

Three different prime-boost immunization protocols were tested in rabbits and their immune response was evaluated and compared with the final aim of identifying a-vaccine strategy that might be able to protect non-human primates from infection with the pathogenic chimera simian/human immunodeficiency virus (SHIV)(89.6P). Protocols were based on priming with two fowlpox (FP) recombinant vectors and two expression plasmids, which express either the simian immunodeficiency virus (SIV)mac(239) gag/pol or the human immunodeficiency virus (HlV-1)env(89.6P) genes, followed by boosting with virus-like particles (VLP). All protocols were effective in eliciting homologous neutralizing Ab and highlighted the efficacy of VLP boosting. The FP vector was less efficient than plasmid DNA in inducing Ab against the gag core proteins. Analysis of cytokine expression 5 months after last immunization indicated that priming with pcDNA3gag/pol(SIV) and FPenv(89.6P) followed by VLP boosting generated a T helper (Th0) profile and a good Ab titer, suggesting a potential protocol to be tested in the SHIV-macaque model of HIV-1 infection. (C) 2002 Elsevier Science Ltd. All rights reserved.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a complex condition for which the etiological determinants are still poorly defined. To better characterize the diagnostic and therapeutic profile of patients, an algorithm known as UPOINT was created, addressing six major phenotypic domains of CP/CPPS, specifically the urinary (U), psycho-social (P), organ-specific (O), infection (I), neurological/systemic (N) and muscular tenderness (T) domains. An additional sexual dysfunction domain may be included in the UPOINT(S) system. The impact of the infection domain on the severity of CP/CPPS symptoms is a controversial issue, due to the contradictory results of different trials. The aim of the present retrospective study was to further analyze the extent to which a positive infection domain of UPOINTS may modify the pattern of CP/CPPS symptom scores, assessed with the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI). In a cohort of 935 patients that was divided on the basis of the presence or absence of prostatic infection, more severe clinical symptoms were shown by the patients with infection (median NIH total score: 24 versus 20 points in uninfected patients; P

Objectives: Chronic bacterial prostatitis (CBP) is a chronic or persistent infection of the prostate in which a pathogen can be demonstrated by a lower urinary tract segmented localization test, but in which systemic symptoms are absent. CBP can be caused by traditional uropathogens - E. coli, P. mirabilis, Kl. pneumoniae, Ps. aeruginosa, unusual ; non-traditional uropathogens - C. trachomatis, U. urealyticum, and is also a biofilm disease. The aim of this study was to investigate the efficacy and tolerability of IV azithromycin and IV/PO ciprofloxacin combination therapy in the treatment of CBP caused by traditional uropathogens. Patients and Methods: The study was conducted at the UHID Department for Urogenital Infections between 2008 and 2010. We examined a total of 30 patients older than 20 years of age with CBP caused by traditional uropathogens. The patients were not consecutively enrolled. Ultrasound examination showed no evidence of anatomical abnormality of the genitourinary tract in these patients. During the first three consecutive days the patients received the following combination therapy: a total dose of 1, 5g azithromycin as a 3-day therapy of 1x500mg IV and a ciprofloxacin 400 mg IV bid. Ciprofloxacin 1x500 mg po bid was administered for additional 25 days. The severity of chronic prostatitis symptoms scored by the Croatian translation of the NIH-CPSI questionnaire was performed. Bacteriological and clinical efficacy, as well as tolerability and possible adverse events of administered drugs were evaluated 4-6 weeks and 6 months after completion of therapy. During the course of the study patients received no medication that would relieve their symptoms. Results: The frequency of detected pathogens in expressed prostatic secretion (EPS) was as follows: Enterococcus (9), E. coli (8), P. mirabilis (3), Kl. pneumoniae (3), Citrobacter (2), Enterobacter (2), Ps. aeruginosa (1), E. coli + Enterococcus (1), Ps. aeruginosa + Enterococcus (1). The eradication and clinical cure rates were 27/30 (90%) and 25/30 (83%), respectively, 4-6 weeks after completion of therapy and 24/30 (80%) and 23/30 (77%), 6 months after completion of therapy. There were no adverse events. Conclusion: The results of this research on the efficacy and tolerability of azithromycin IV and ciprofloxacin IV/PO combination therapy in the treatment of CBP are an additional confirmation that an improvement has been achieved in the clinical use of azithromycin for the treatment of CBP.

Background: We previously demonstrated safety and efficacy of fluoroquinolone-macrolide combination therapy in cat. II (NIH-NIDDK) chronic bacterial prostatitis (CBP). Administration of this combination was characterized by a high safety profile, and was effective in eradicating both traditional uropathogens and unusual pathogens infecting the prostate gland. Moreover, a swift symptom decrease was observed in patients undergoing microbiological eradication. Interestingly, such combination decreased total serum PSA patients, thus markedly enhancing the cancer detection rate upon biopsy in a patient population. As patients found the original 6-week regimen lengthy and rather difficult to comply with, we investigated whether this therapeutic scheme could be modified to administer the same cumulative dose of 21 grams ciprofloxacin at the rate of 750 mg/day for 4 weeks. Objectives This study was aimed at comparing the microbiological, inflammatory, biochemical and clinical findings of two antibacterial treatment schemes for CBP, based on the combination of azithromycin (500 mg, thrice-weekly) with ciprofloxacin, administered at the once-daily doses of 500 mg (Cipro-500 cohort), or 750 mg (Cipro-750 cohort). The effect of combination therapy on sexual dysfunction, frequently observed in chronic prostatitis patients, was analyzed in detail. Findings Administration of the cumulative dose of 21 grams Ciprofloxacin at the rate of 750 mg/day for 4 weeks rather than at the rate of 500 mg/day for 6 weeks increased eradication rates from 62.3% to 77.3%, and the total bacteriological success from 71.8% to 85.6%. Relapse/reinfection rates were very low. A marked decrease of pain and voiding signs/symptoms was sustained throughout a 18-month follow-up period. Combination therapy also induced a significant reduction of inflammatory leukocyte counts and serum PSA, more pronounced in the Cipro-750 group. Ejaculatory pain, hemospermia and premature ejaculation were attenuated at microbiological eradication in both groups, but premature ejaculation symptoms subsided more promptly in the Cipro-750 cohort. Of total 59 Cipro-750 patients showing mild to severe erectile dysfunction (ED) at baseline, 22 had no ED at microbiological eradication and throughout a follow-up period of 18 months. Conclusions The results of this study add up to a growing body of data from our research group and from our Croatian partners, demonstrating that macrolides, in combination with first-line fluoroquinolones, are safe and effective in eradicating causative pathogens and in resolving a complex array of chronic bacterial prostatitis symptoms, including pain, voiding disturbances and sexual dysfunction.

In the Milan area (Northern Italy) we have identified a family characterized by a high prevalence of ovary and breast cancer cases (5 out of 6 subjects over 3 generations, 83, 3%) in the mother lineage of a healthy male proband of 50 years of age. Analysis of BRCA1 and BRCA2 genes revealed the presence of a missense T309C transversion in the codon 64 of BRCA1. The aims of the present investigation were: (i) to characterize the functional consequences of the C64R substitution at the molecular level, and (ii) to study whether additional mutations or polymorphisms may be linked to the peculiar phenotypic features observed in the Italian pedigree.