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Lenzi A.,University of Rome La Sapienza | Mirone V.,University of Naples Federico II | Gentile V.,University of Rome La Sapienza | Bartoletti R.,Santa Maria Annunziata Hospital | And 8 more authors.
BMC Public Health | Year: 2013

Background: Human Papillomavirus (HPV) is a very resistant, ubiquitous virus that can survive in the environment without a host. The decision to analyse HPV-related diseases in males was due to the broad dissemination of the virus, and, above all, by the need to stress the importance of primary and secondary prevention measures (currently available for women exclusively). The objective of the Consensus Conference was to make evidence-based recommendations that were designed to facilitate the adoption of a standard approach in clinical practice in Italy. Methods. The Sponsoring Panel put a series of questions to the members of the Scientific Committee who prepared a summary of the currently available information, relevant for each question, after the review and grading of the existing scientific literature. The summaries were presented to a Jury, also called multidisciplinary Consensus Panel, who drafted a series of recommendations. Results: The prevalence of HPV in males ranges between 1.3-72.9%;. The prevalence curve in males is much higher than that in females and does not tend to decline with age. Women appear to have a higher probability of acquiring HPV genotypes associated with a high oncogenic risk, whereas in males the probability of acquiring low- or high-risk genotypes is similar. The HPV-related diseases that affect males are anogenital warts and cancers of the penis, anus and oropharynx. The quadrivalent vaccine against HPV has proved to be effective in preventing external genital lesions in males aged 16-26 years in 90.4%; (95%; CI: 69.2-98.1) of cases. It has also proved to be effective in preventing precancerous anal lesions in 77.5%; (95%; CI: 39.6-93.3) of cases in a per-protocol analysis and in 91.7%; (95%; CI: 44.6-99.8) of cases in a post-hoc analysis. Early ecological studies demonstrate reduction of genital warts in vaccinated females and some herd immunity in males when vaccine coverage is high, although males who have sex with males gained no benefit at all. Males with an immunodeficiency disease are at greater risk of developing disease. Infertility seems to be caused by HPV in some cases. Studies demonstrate vaccination to both genders can be more efficacious and social equity matters are to be taken into consideration. Conclusions: The Jury made Recommendations based on the scientific evidence presented by the Scientific Committee. Accordingly, for prevention purposes and social fairness and equality, as both sexes are affected by the disease, the vaccination of 12-year-old males against HPV should be recommended in order to guaranty protection to everyone. Aspects related to healthcare policy and economic sustainability, are to be discussed by respective public system representatives. More campaigns to raise awareness through all institutional channels are needed, not only regarding anogenital warts, but for HPV-related diseases in general in males in accordance to new scientific evidences. © 2013 Lenzi et al.; licensee BioMed Central Ltd.

Lotti F.,University of Florence | Corona G.,University of Florence | Corona G.,Endocrinology Unit | Mondaini N.,Santa Maria Annunziata Hospital | And 6 more authors.
Andrology | Year: 2014

'Prostatitis-like symptoms' (PLS) are a cluster of bothersome conditions defined as 'perineal and/or ejaculatory pain or discomfort and National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) pain subdomain score ≥4' (Nickel's criteria). PLS may originate from the prostate or from other portions of the male genital tract. Although PLS could be associated with 'prostatitis', they should not be confused. The NIH-CPSI is considered the gold-standard for assessing PLS severity. Although previous studies investigated the impact of prostatitis, vesiculitis or epididymitis on semen parameters, correlations between their related symptoms and seminal or scrotal/transrectal colour-Doppler ultrasound (CDU) characteristics have not been carefully determined. And no previous study evaluated the CDU features of PLS in infertile men. This study was aimed at investigating possible associations among NIH-CPSI (total and subdomain) scores and PLS, with seminal, clinical and scrotal/transrectal CDU parameters in a cohort of males of infertile couples. PLS of 400 men (35.8 ± 7.2 years) with a suspected male factor were assessed by the NIH-CPSI. All patients underwent, during the same day, semen analysis, seminal plasma interleukin 8 (sIL-8, a marker of male genital tract inflammation), biochemical evaluation, urine/seminal cultures, scrotal/transrectal CDU. PLS was detected in 39 (9.8%) subjects. After adjusting for age, waist and total testosterone (TT), no association among NIH-CPSI (total or subdomain) scores or PLS and sperm parameters was observed. However, we found a positive association with current positive urine and/or seminal cultures, sIL-8 levels and CDU features suggestive of inflammation of the epididymis, seminal vesicles, prostate, but not of the testis. The aforementioned significant associations of PLS were further confirmed by comparing PLS patients with age-, waist- and TT-matched PLS-free patients (1 : 3 ratio). In conclusion, NIH-CPSI scores and PLS evaluated in males of infertile couples, are not related to sperm parameters, but mainly to clinical and CDU signs of infection/inflammation. © 2013 American Society of Andrology and European Academy of Andrology.

Cai T.,University of Florence | Nesi G.,University of Florence | Dal Canto M.,University of Florence | Tinacci G.,Santa Maria Annunziata Hospital | And 4 more authors.
Journal of Urology | Year: 2010

Purpose: We evaluated the role of loss of heterozygosity on the interferon-α locus to predict the response to bacillus Calmette-Guerin therapy in patients with nonmuscle invasive bladder cancer. Materials and Methods: A total of 117 consecutive patients were selected, including 77 with nonmuscle invasive bladder cancer and 40 controls. Loss of heterozygosity on the interferon-α locus (chromosome 9p21) was assessed in blood and urine samples before transurethral resection. All patients underwent transurethral resection and then 6 weekly bacillus Calmette-Guerin instillations. Those with nonmuscle invasive bladder cancer were assigned to groups 1 and 2 with and without loss of heterozygosity on the interferon-α locus, respectively. Results: Of the 77 patients with nonmuscle invasive bladder cancer 39 (50.6%) had loss of heterozygosity on the interferon-α locus (group 1) and 38 (49.4%) had no alteration (group 2). Only 1 of 40 controls showed loss of heterozygosity on the interferon-α locus. At the end of followup 13 patients in group 1 and 27 in group 2 were alive without recurrence. We noted a significant difference between loss of heterozygosity on interferon-α and followup status (dF 01, LR 11.252, p = 0.003). Kaplan-Meier analysis revealed a significant difference in recurrence probability (response to bacillus Calmette-Guerin) and loss of heterozygosity on interferon-α (p <0.0001). On multivariate analysis loss of heterozygosity (HR 4.09, 95% CI 2.59-6.28, p = 0.002), grade (grade 3 HR 3.31, 95% CI 1.38-3.35, p = 0.03) and the number of lesions (3 or greater HR 2.31, 95% CI 1.38-3.25, p = 0.03) were independent predictors of the bacillus Calmette-Guerin response. Conclusions: This study highlights the predictive value of loss of heterozygosity analysis on interferon-α in patients with nonmuscle invasive bladder cancer treated with bacillus Calmette-Guerin. © 2010 American Urological Association Education and Research, Inc.

D'Arminio Monforte A.,University of Milan | Cozzi-Lepri A.,University College London | Cozzi-Lepri A.,University of Minnesota | Girardi E.,National Institute For Infectious Diseases L Spallanzani | And 9 more authors.
Antiviral Therapy | Year: 2011

Background: To study the prevalence, predictors and outcome of late HIV diagnosis in the Icona cohort, according to the new European consensus definition of late diagnosis. Methods: In this observational cohort study we investigated patients diagnosed with HIV over 3 months preceding enrolment who were defined as diagnosed late if they presented with AIDS or a CD4 + T-cell count ≤350/ mm3 (European consensus definition). We estimated the prevalence of late diagnosis, identified factors associated with being diagnosed late and looked at the prognostic value of the European consensus definition of late presentation to predict subsequent clinical progression (new AIDS events or death). Results: In total, 1,438/2,276 patients (63%) were defined as diagnosed late using the new European Consensus definition. Of these, 387 (16%) were AIDS-presenters. Predictors of being diagnosed late were older age, non- Italian origin, high HIV RNA and unemployment (versus retirement). A total of 293 patients showed clinical progression (3 events/100 person-years of follow-up, 95% CI: 2.7-3.4). Presenting late was strongly associated with a >5-fold increased risk of disease progression. Conclusions: In our observational setting with free access to care, more than 60% of new HIV diagnoses occurred below the recommended threshold for initiating antiretroviral treatment. Presenting late for care was associated with a high risk of clinical progression. ©2011 International Medical Press.

Bartoletti R.,Urology Unit | Cai T.,Urology Unit | Tosoratti N.,RandD Unit | Amabile C.,RandD Unit | And 6 more authors.
BJU International | Year: 2010

OBJECTIVE To test the in vivo effects (toxicity, completeness of necrosis, dimensions of the lesion) of microwave thermoablation on porcine kidneys, using the Amica Probe v3 (Hospital Service SpA, Aprilia, Italy), in a refrigerated 17-G microwave applicator, that can be used to induce a spherical necrotic area. PATIENTS AND METHODS Six pigs were used; each kidney was treated, with no kidney pedicle clamping, by microwave thermoablation at least in three different zones with different exposure times and power, during open surgery. Twelve kidneys had 32 microwave thermoablations overall. The kidneys were then surgically removed, and necrotic lesions measured and evaluated microscopically. The sphericity index (SI) was also calculated to evaluate lesion reproducibility. Areas of renal tissue that were missed were then microscopically evaluated by NADH in vivo staining. RESULTS In all, 32 thermoablations were applied; the mean (sd) lesion diameter ranged from 1.2 (0.3) to 4.2 (0.1) cm and changed in relation to both power and time of exposure. The 50-W power particularly induced necrotic renal lesions ranging from 1.9 (0.2) to 4.2 (0.1) cm as a function of the time of exposure and the optimal SI (1.04). Pathological evaluation showed no skipped areas in the context of the lesion, or healthy kidney tissue damage close to necrotic lesions. CONCLUSIONS Thermoablation with the Amica probe is safe and showed excellent in vivo effects in this porcine model. Increasing the exposure time at 50 W power could be a useful percutaneous minimally invasive treatment for small solid masses (<4.2 cm), avoiding the risk of missing tumour areas or kidney parenchymal damage from microwave treatment. © 2010 BJU International.

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