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Introduzione. Il D-chiro-inositolo (DCI) è un mediatore dell’azione insulinica e ha dimostrato di migliorare i parametri metabolici delle donne con diabete gestazionale (GDM). L’obiettivo di questo studio è valutare l’impatto della supplementazione di DCI sul controllo metabolico e gli esiti materni e fetali delle donne affette da GDM. Pazienti e metodi. È stata valutata retrospettivamente una coorte di 20 donne affette da GDM, trattate con dieta standard e, in metà dei casi, supplementate con DCI. Sono stati valutati e confrontati nei due gruppi (DCI vs controllo) vari parametri (compenso glicemico, dose insulinica totale, parametri biometrici materni e fetali). Risultati. Il gruppo DCI ha mostrato una tendenza a una minor dose insulinica giornaliera, a glicemie postprandiali più basse e un minor peso al parto, mentre i feti del gruppo DCI avevano una minor circonferenza addominale e un minor peso alla nascita. A causa della bassa numerosità, le differenze riscontrate non sono risultate statisticamente significative. Conclusioni. La supplementazione di DCI nel GDM è sicura e sembra migliorare, in associazione a terapia standard, i parametri metabolici materni, oltre che esercitare un ruolo favorevole sullo sviluppo fetale.

Grazie ai progressi compiuti dall’oncologia negli ultimi decenni, oggi le percentuali di guarigione dei bambini e dei giovani adulti affetti da tumore si attestano intorno all’80%. Tuttavia, anche con i moderni protocolli di terapia oltre il 50% dei giovani pazienti sviluppa nel tempo infertilita, nella maggior parte dei casi dovuta a danno gonadico diretto. La proposta di preservare la fertilita, in un momento cosi critico della vita, diviene quindi essenziale di fronte a trattamenti che possono ledere in modo irreversibile la capacita fecondante dell’individuo. Esistono per entrambi i sessi metodi consolidati e approcci ancora sperimentali per salvaguardare le potenzialita procreative cui si deve ricorrere nel contesto dell’inquadramento oncologico iniziale poiche, tuttora, non esistono parametri per poter prevedere con certezza l’entita dell’effetto gonadotossico dei vari trattamenti oncologici. I problemi attualmente emergenti sono relativi alla preservazione della fertilita nei prepuberi e su tale aspetto si sta soprattutto orientando la ricerca biomedica.

Varicocele is defined as a state of varicosity and tortuosity of the pampiniform plexus around the testis caused by retrograde blood flow through the internal spermatic vein. The prevalence of clinically relevant varicocele ranges from 5 to 20% in the male population and is often associated with infertility and reduction of sperm quality. In this review, the pathophysiology and clinical aspects of varicocele are reviewed along with therapeutic options and treatment effects on sperm parameters and fertility both in adult and in pediatric/adolescent subjects. We conducted a Medline and a PubMed search from 1965 to 2018 to identify publications related to varicocele clinical aspects, treatment procedures and treatment outcomes. Keywords used for the search were: “varicocele”, “varicocelectomy”, “sclerotherapy”, “male infertility”, “subfertility”, and “semen abnormalities”. Data from a large number of studies in adolescent and adult males indicate that varicocele correction improves semen parameters in the majority of patients, reducing oxidative stress and improving sperm nuclear DNA integrity either with surgical or percutaneous approach. Varicocele repair seems to represent a cost-effective therapeutic option for all males (both adolescent and adults) with a clinical varicocele in the presence of testicular hypotrophy, worsening sperm alterations or infertility. On the other hand, some investigators questioned the role of varicocelectomy in the era of assisted reproduction. Thus, a better understanding of the pathophysiology of varicocele-associated male subfertility is of paramount importance to elucidating the deleterious effects of varicocele on spermatogenesis and possibly formulating new treatment strategies.

L’OSAS e una condizione patologica cronica caratterizzata da ipossiemia intermittente, microrisvegli, frammentazione e deprivazione cronica di sonno. L’OSAS e associata all’obesita e ad alterazioni endocrinologiche tra cui la PCOS. L’elevata prevalenza di OSAS nella PCOS e stata considerata una funzione degli elevati livelli di testosterone, dell’obesita e, soprattutto, dell’insulino-resistenza. Le donne affette da PCOS hanno multipli fattori di rischio per patologie cardiovascolari e la compresenza di OSAS comporta un netto incremento di tale rischio.

Ghrelin, a 28 amino-acid octanoylated peptide predominantly produced by the stomach, was discovered to be the natural ligand of the type 1a GH secretagogue receptor (GHS-R1a). It was thus considered as a natural GHS additional to GHRH, although later on ghrelin has mostly been considered a major orexigenic factor. The GH-releasing action of ghrelin takes place both directly on pituitary cells and through modulation of GHRH from the hypothalamus; some functional antisomatostatin action has also been shown. However, ghrelin is much more than a natural GH secretagogue. In fact, it also modulates lactotroph and corticotroph secretion in humans as well as in animals and plays a relevant role in the modulation of the hypothalamic-pituitary-gonadal function. Several studies have indicated that ghrelin plays an inhibitory effect on gonadotropin pulsatility, is involved in the regulation of puberty onset in animals, and may regulate spermatogenesis, follicular development and ovarian cell functions in humans. In this chapter ghrelin actions on the GH/IGF-I and the gonadal axes will be revised. The potential therapeutic role of ghrelin as a treatment of catabolic conditions will also be discussed.

This mini-review takes into consideration the physiology, synthesis and mechanisms of action of the nitric oxide (NO) and, subsequently, the causes and effects of the NO bioavailability impairment. In diabetes mellitus the reduced NO bioavailability is caused by the increased free radicals production, secondary to hyperglycemia. The reactive oxygen species oxidize the cofactors of the nitric oxide synthase, diminishing their active forms and consequently leading to a decreased NO production. Furthermore the decreased concentration of reduced glutathione results in a diminished production of nitrosoglutathione. These molecules are important intermediates of the NO pathway and physiologically activate the soluble guanylate cyclase. Their decrease in oxidative states of the cell, therefore, leads to a reduced cGMP production which represents the principal molecule that carries out NO's major effects. Finally we considered the eventual therapeutic strategies to improve NO bioavailability by acting on the causes of its decrease. Therefore the treatments proposed are based on the possibility to counteract the oxidation and, in this context, the physiopathological mechanisms strongly support the treatment with thiols.

The aim of the study was to investigate the uniformity of the muscle motor point location for lower limb muscles in healthy subjects. Fifty-three subjects of both genders (age range: 18–50 years) were recruited. The muscle motor points were identified for the following ten muscles of the lower limb (dominant side): vastus medialis, rectus femoris, and vastus lateralis of the quadriceps femoris, biceps femoris, semitendinosus, and semimembranosus of the hamstring muscles, tibialis anterior, peroneus longus, lateral and medial gastrocnemius. The muscle motor point was identified by scanning the skin surface with a stimulation pen electrode and corresponded to the location of the skin area above the muscle in which an electrical pulse evoked a muscle twitch with the least injected current. For each investigated muscle, 0.15 ms square pulses were delivered through the pen electrode at low current amplitude (

Acylated ghrelin (AG) is a 28 amino acid gastric peptide a natural ligand for the growth hormone secretagogue (GHS) receptor type 1a (GHS-R1a), endowed with GH-secreting and orexigenic properties. Besides, ghrelin exerts several peripheral metabolic actions, including modulation of glucose homeostasis and stimulation of adipogenesis. Notably, AG administration causes hyperglycemia in rodents as in humans. Ghrelin pleiotropy is supported by a widespread expression of the ghrelin gene, of GHS-R1a and other unknown ghrelin binding sites. The existence of alternative receptors for AG, of several natural ligands for GHS-R1a and of acylation-independent ghrelin non-neuroendocrine activities, suggests that there might be a complex 'ghrelin system' not yet completely explored. Moreover, the patho-physiological implications of unacylated ghrelin (UAG), and obestatin (Ob), the other two ghrelin gene-derived peptides, need to be clarified. Within the next few years, we may better understand the 'ghrelin system', where we might envisage clinical applications.

L’iperparatiroidismo primario normocalcemico (NPHPT) e una condizione patologica riconosciuta di recente, contraddistinta da un’abnorme secrezione autonoma di PTH a fronte di valori di calcemia totale nella norma. La diagnosi e biochimica e impone l’esclusione delle forme secondarie a insufficienza renale cronica o a deficit di vitamina D. Mentre e ben noto che l’iperparatiroidismo primario ipercalcemico comporta un incremento del rischio cardiovascolare, le informazioni riguardanti la relazione tra NPHPT e rischio cardiovascolare sono piuttosto scarse. Questo studio retrospettivo ha voluto valutare l’associazione tra NPHPT e ipertensione arteriosa. A tale scopo, gli autori del lavoro hanno analizzato i livelli sierici di PTH e calcio di 940 soggetti ricoverati presso l’Ospedale Universitario di Fujian (Cina) tra il settembre 2010 e il dicembre 2013. I valori di PTH e calcio sono stati correlati con la pressione arteriosa registrata durante le prime 72 ore di ospedalizzazione e con parametri metabolici e antropometrici. Tra i 940 campioni ematici analizzati, 296 mostravano valori di PTH e calcemia—corretta per i livelli di albumina—nella norma (gruppo di controllo). In 69 pazienti venivano riscontrati livelli elevati di PTH con calcemia nella norma, ma soltanto in 11 venivano rispettati i criteri diagno

Steroid myopathy is a non-inflammatory toxic myopathy that occurs as side effect of exogenous and endogenous glucocorticoid excess. The purpose of this review is to examine issues that limit our understanding of this myopathy with respect to nosology, etiopathogenesis, conditioning factors, and muscle fiber selectivity. We suggest that if more data were available on these issues, the understanding of steroid myopathy would be enhanced substantially, thus allowing an early detection of its occurrence (before the appearance of clinical or laboratory signs) and a proper treatment of the patients.