NORMAL NUTRITIONAL COMPONENTS AND EFFECTS ON BONE METABOLISM IN PREVENTION OF OSTEOPOROSIS.

Osteoporosis is the most common bone disease, affecting millions of people and causing a high risk of fractures and a loss of quality of life. It is characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. A primary method of prevention, in order to reduce the risk of fractures, is represented by an appropriate lifestyle and a correct diet. There are potentially numerous nutrients and dietary components that can influence bone health, and these range from macronutrients to micronutrients as well as bioactive food ingredients. The purpose of this review is to overview osteoporosis, including its definition, etiology, and incidence, and then provide some information on possible dietary strategies for optimizing bone health and preventing osteoporosis. A correct diet to prevent osteoporosis should contain adequate amounts of calcium, vitamins D and K, protein, and fatty acids. The effects of these elements are briefly discussed, reporting on their correlation with bone benefits.

Parallel conduction of the phase I preventive and therapeutic trials based on the Tat vaccine candidate.

The native HIV-1 Tat protein was chosen as vaccine candidate for phase I clinical trials in both uninfected (ClinicalTrials.gov identifier: NCT00529698) and infected volunteers (ClinicalTrials.gov identifier: NCT00505401). The rationale was based on the role of Tat in the natural infection and AIDS pathogenesis, on the association of Tat-specific immune responses with the asymptomatic stage and slow-progression rate as well as on its sequence conservation among HIV clades (http://www.hiv1tat-vaccines.info/). The parallel conduction in the same clinical centers of randomized, double blind, placebo-controlled phase I studies both in healthy, immunologically competent adults and in HIV-infected, clinically asymptomatic, individuals represents a unique occasion to compare the vaccine-induced immune response in both the preventive and therapeutic setting. In both studies, the same lot of the native Tat protein was administered 5 times, every four weeks, subcute (SC) with alum adjuvant or intradermic (ID), in the absence of adjuvant, at 7.5 microg, 15 microg or 30 microg doses, respectively. The primary and secondary endpoints of these studies were the safety and immunogenicity of the vaccine candidate, respectively. The study lasted 52 weeks and monitoring was conducted for on additional 3 years. The results of both studies indicated that the Tat vaccine is safe and well tolerated both locally and systemically and it is highly immunogenic at all the dosages and by both routes of administration. Vaccination with Tat induced a balanced immune response in uninfected and infected individuals. In particular, therapeutic immunization induced functional antibodies and partially reverted the marked Th1 polarization of anti-Tat immunity seen in natural infection, and elicited a more balanced Th1/Th2 immune response. Further, the number of CD4 T cells correlated positively with anti-Tat antibody titers. Based on these results, a phase II study is ongoing in infected drug-treated individuals (http://www.hiv1tat-vaccines.info/).

[Male Accessory Gland Infections (MAGI): patient questionnaire and additional ultrasonography criteria]. / Male Accessory Gland Infections (MAGI): questionario dedicato e criteri ecografici addizionale.

Male Accessory Gland Infections (MAGI) refers to a syndrome that has generated considerable debate recently in relation to its possible role in causing certain acquired conditions of male fertility. A further characterization of the syndrome based on symptoms and ultrasonographic findings has therefore become necessary. The article examines the practical outcome of the use of a new questionnaire designed specifically for patients with MAGI and that inquires about: 1) the range of associated symptoms (pelvic discomfort, micturition disorders, sexuality, quality of life); 2) the possible relationship between progress of prostate inflammation/infection or retrograde spread of inflammation/infection to the seminal vesicles and/or the epididymis and symptom severity; 3) combined sequential medical therapy based on the quality of the anamnestic changes the patient reports on the questionnaire. The need to improve targeted diagnosis, the requisite for correct diagnostic characterization of this patient category, has drawn increasing attention to non-conventional sonographic aspects, thus permitting the following hypotheses: 1) a possible role of characterization according to non-conventional criteria in terms of diagnostic specificity and sensitivity; 2) a possible role of sonography at initial diagnosis and during follow-up, particularly in relation to the possibility of identifying by ultrasonography the category of patients who test negative at microbiological analysis after treatment, despite continued symptoms with or without abnormal conventional parameters.

[Treatment with non-steroidal anti-inflammatory drugs in patients with amicrobial chronic prostato-vesiculitis: transrectal ultrasound and seminal findings]. / Trattamento con FANS nella prostato-vesciculite cronica amicrobica: effetti su quadro ecografico e spermatico (parametri citologici e chimico-fisici).

AIM: The aim of this paper was to evaluate the efficacy (0= none; 3= fully) of the treatment with nonsteroidal anti-inflammatory (NSAI) drugs on (a) gland post-inflammatory echopattern, by transrectal ultrasound (TRUS); (b) seminal cytologic (WBC concentration and spermiophagies) and (c) >2 physicochemical inflammatory parameters in patients with chronic amicrobial prostato-vesiculitis (PV). METHODS: Thirty-five patients with PV received NSAI drugs in the following intermittently steps (over a 3-month period): 1) Pygeum 100 mg twice a day for 14 consecutive days per month; 2) flavoxate-propyphenazone 400 mg twice a day plus Serratiopeptidase 10 000 U twice a day for the subsequent 14 days per month. All patients underwent semen analysis and TRUS scans in the pre-treatment and after 3 months of therapy. RESULTS: The fully (a+b+c) efficacy rate, through an improvement of TRUS prostatic or vesicular echopattern in 37.1% and 22.8% respectively, was higher than that registered with an improvement of only 1 or 2 endpoints. Altogether, the following TRUS findings showed reductions (range 25-40%): prostate volume and hypochogenicity (51.4%); vesicular antero-posterior diameter (APD) in the 43.5% and 28.6% of the uni- and bilateral PV respectively; vesicular wall tickness (25%); unilateral vesicular honeycomb aspect (36%). No efficacy, mainly related to immodified TRUS prostatic or vesicular echopattern in 51.4% and 65.7% respectively, was observed on: areas of prostatic hyperechogenicity; peri-prostatic venous congestion; vesicular APD <7 mm or >21 mm (with honeycomb aspect). CONCLUSIONS: In PV patients, the treatment with NSAI compounds was effective when it was enable to produce multiple positive effects, mainly through TRUS changes.

BKV infection and hemorrhagic cystitis after allogeneic bone marrow transplant.

Hemorrhagic cystitis (HC) is a well-known complication after allogeneic bone marrow transplant (BMT) and can be related to adenovirus or human polyomavirus BK (BKV) infections. In this study a group of 20 patients after allogeneic BMT has been examined. BMT urine samples were analysed for the presence of Adenovirus and BKV DNAby means of polymerase chain reaction (PCR). 5/20 BMT patients developed HC after BMT. The presence of BKV DNA in urine samples was evident in 3/15 patients without HC and in 5/5 patients with HC. In 2/5 HC-patients the BKV DNA was not found after therapy with Cidofovir and Ribavirin. The search for adenovirus DNA in all samples was negative. The analysis of BKV non-coding control region (NCCR) isolated from urine samples revealed a structure very similar to the archetype in all samples. The RFLP (Restriction Fragment Length Polymorphism assay) showed the presence of BKV subtypes I and IV, with the prevalence of subtype I (4/5). This study supports the hypothesis that HC is mainly related to BKV rather than to adenovirus infection in BMT patients. Moreover, since BKV subtype I was predominant, it is reasonable to hypothesize that a specific BKV subtype could be associated with the development of HC.

Incidence of extragenital vascular disease in patients with erectile dysfunction of arterial origin.

This research was carried out to evaluate the prevalence of carotid and/or lower limb artery abnormalities in patients with arterial erectile dysfunction (ED). To this end, patients with ED (Andrology Unit) or suspected peripheral atherosclerosis (Angiology Unit) underwent an independent and parallel echo-Duplex examination. The Andrology Unit examined 167 patients with ED of different etiologies: 52 of them had penile artery insufficiency and consequently their carotids and lower limb arteries had to be evaluated by means of echo-Doppler. In all, 36 out of the 46 patients with nonarterial organic ED and 22 out of the 69 patients with nonorganic ED underwent the same evaluation and served as controls. The Angiology Unit enrolled 457 ED patients who initially underwent echo-Doppler for suspected carotid and/or arterial leg atherosclerosis and subsequently dynamic echo-Doppler. Isolated penile artery insufficiency was found in 23.1 and 25% of the patients evaluated in the Angiology and Andrology Units, respectively. The remaining patients were shown to have ED associated with an atheroma or marked intima-media thickness of the carotid vessels and/or of leg arteries. The frequency of penile arterial insufficiency and of carotid and/or lower limb artery abnormalities was significantly higher (P < 0.01) compared to that found in patients with ED of nonarterial organic or psychogenic origin. Both Units found that the frequency of penile artery insufficiency and carotid or lower limb artery abnormalities was significantly higher than that of penile artery insufficiency alone or plus both carotid and lower limb artery abnormalities. This study showed that penile artery insufficiency is associated with carotid and/or lower limb artery ultrasound abnormalities in about 75% of the cases. Therefore, arterial ED may be regarded as a sign of a more generalized atherosclerosis.

Prenatal and postnatal findings of acrania.

INTRODUCTION: Acrania is a rare congenital anomaly in which the flat bones of the cranial vault are partial or complete absent with complete but abnormal development of the cerebral hemispheres. CASE REPORT: We report two cases, diagnosed prenatally by ultrasound and followed by medical pregnancy termination, one with isolated acrania and one with associated cleft lip and palate and spina bifida. DISCUSSION: The acrania pathogenesis is unknown and differential diagnosis should be made with other conditions like anencephaly and acalvaria. Genetic counselling is not easy because there is no evidence for a specific genetic origin, but the extreme rarity and sporadic nature suggests a low recurrence risk.

Rearrangement patterns of JC virus noncoding control region from different biological samples.

The JC virus (JCV) is generally considered the etiological agent of progressive multifocal leukoencephalopathy (PML), a demyelinating brain illness, often associated with immunosuppression and significantly frequent in acquired immunodeficiency syndrome (AIDS) patients. The primary infection by JCV is usually asymptomatic and the virus can remain in a latent status in the kidney. As a consequence of immunological alterations of the host, the virus can show a genetic variability in the noncoding control region (NCCR) due to deletions, duplications, and insertions as compared with the archetype. The NCCR of the archetype strain can be divided into six regions, named boxes A to F. In this study, the authors evaluated the presence of the JCV genome in different biological samples, such as urine, peripheral blood mononuclear cells (PBMCs) and cerebral spinal fluid (CSF) by means of polymerase chain reaction (PCR). After sequencing of the PCR fragments, the NCCR structure of isolated JCV strains was analyzed in order to verify the presence of different viral variants. An analysis of the homology and of the multiple alignment of the obtained sequences in comparison with the archetype strain has been carried out. The results indicated the presence of different rearrangements among the analyzed samples. Whereas in the urine, the NCCR structure always appeared very similar to that of the archetype, in the PBMCs and CSF, the NCCR sequences showed specific and characteristic rearrangements as compared to the archetype. These different rearrangements could be correlated with the emerging of an NCCR organization more suitable for the development of PML.

Detection and sequence analysis of human polyomaviruses DNA from autoptic samples of HIV-1 positive and negative subjects.

The distribution of DNA of BK and JC human polyomaviruses (BKV and JCV) was investigated in samples from autopsies of different organs in 2 groups of patients: Human Immunodeficiency Virus -1 (HIV) positive and negative. Samples from various organs were analysed by a nested polymerase chain reaction (PCR) for the non-coding control and for the VP1 regions of both viruses. The results obtained showed that BKV DNA was present in both males and females with a higher prevalence in HIV-positive subject samples (spleen: 33%; kidney: 44%; brain: 22%, uterine cervix:100%; prostatic urethra: 50%). In prostatic urethra samples of HIV-positive subjects, the JCV DNA was revealed in a low percentage (33%), while it was not found at all in uterine cervix samples of both groups. The varying presence of BK and JC viral DNA in the different organs seems to reflect the different pathogenetic attitude of these viruses. JCV was mainly present in the brain (55%), confirming its typical neurotropism and its etiological role in neurological disorders found in immunodeficient patients. BKV, on the other hand, was mainly present in the kidney (44%) and in genital organs (uterine cervix: 100%; prostatic urethra: 50%) with the latter finding favouring the hypothesis of a possible sexual transmission of BKV. Furthermore, our results confirm the crucial role of the immune system in the persistence of human polyomaviruses in the host.

A case of reversible azoospermia following withdrawal from alcohol consumption.

Chronic alcohol intake is associated with male reproductive function impairment. However, no longitudinal studies have been carried out to determine the recovery of alcohol-related spermatogenetic failure subsequent to moderate periods of abstinence. The present report describes the achievement of a pregnancy 3 months after withdrawal from alcohol consumption in the partner of a patient with azoospermia secondary to heavy alcoholic intake (mean daily alcohol consumption: 90 g). Alcoholism was the putative cause of the infertile condition of this patient because, during alcohol consumption, he first had teratozoospermia characterized by a never reported high percentage of spermatozoa with large heads (associated with a nonmegaloblastic macrocytic anaemia in the blood smear), and subsequently azoospermia.

[Antioxidant therapeutic efficiency after the use of carnitine in infertile patients with bacterial or non bacterial prostato-vesiculo-epididymitis]. / Vantaggi terapeutici antiossidanti dopo carnitine in pazienti infertili con prostato-vesciculo-epididimite batterica o abatterica.

OBJECTIVE: In the male genital tract, reactive oxygen species (ROS) overproduction generated by infiltrating WBC or spermatozoa is one of the major causes of defective sperm function. Recently, we demonstrated that prostato-vesiculo-epididymitis (PVE) is the male accessory gland infection more crucial for the establishment of this cellular (sperm and/or WBC oxidative) response. This biochemical stress is due to an imbalance of pro and antioxidants factors and persists even after treatment with antimicrobials. Thus, the antioxidative properties of Carnitines (in terms of combined "Carnitine-Acetil-Carnitine" system) have currently found more attention as part of antimicrobial therapies. In this study, we compared which antioxidative strategy was more beneficial for the treatment of PVE. MATERIALS AND METHODS: We selected two groups of infertile patients. One group consisted of 55 abacterial PVE patients (mean age 34 yrs, range 27-40) (group A); the other included other 35 bacterial PVE patients (mean age 35 yrs, range 28-38) (group B). Each group was randomly subdivided into the following treatment subsets: 1) A1 (n = 14) and B1 (n = 23) subsets received respectively a combined antibiotic and/or antiphlogistic regimen (x 14 days/ monthly x 3 months) (first step) followed by L-Carnitine 1 g x 2 day + acetyl-Carnitine 0.5 g x 2/day x other 3 months (second step) and finally no drug x other 3 months (third step). 2) A2 (n = 8) and B2 (n = 16) subsets received, for a 3 month period, in the meantime the combined antibiotic and/or antiphlogistic regimen (x 14 days/monthly) and L-Carnitine 1 g x 2/day + acetyl-Carnitine 0.5 g x 2/day (first step) and finally no drug x other 3 months (second step). 3) A3 (n = 8) and B3 (n = 12) subsets received for a 3-month period L-Carnitine 1 g x 2/day + acetyl-Carnitine 0.5 g x 2 day (first step) and finally no drug x other 3 months (second step). Before and after each step of the therapeutical design, all patients underwent semen and quantitative bacteriological analyses and 60/90 semen specimens were also investigated about ROS production analysis by chemiluminescence in their 45% and 90% Percoll-generated fractions. RESULTS: The antioxidative response either in terms of significant decrease in the ROS production and increase in some semen parameters (sperm motility and viability) were highest in the patients of A1/B1 subsets, followed by A2/B2 subsets and lowest in the A3/B3 subsets. CONCLUSION: These results indicate that in PVE patients antimicrobials and/or antiphlogistic drugs get a full positive antimicrobial response but a partial antioxidative response, which seems to be potentiated by the addition of antioxidative agents (Carnitines). Furthermore, it is important to underline that the antioxidative treatment with Carnitines administered in the meantime with antiinfectious agents is less effective, and finally this treatment is unsuccessful without the eradication of the pro-oxidant (germs and WBC) agents.

[Clinical and sperm follow-up after subinguinal varicocelectomy]. / Follow-up clinico e spermatico dopo varicocelectomia subinguinale.

In order to evaluate the sperm output and the adverse-side-effects after subinguinal varicoceloctomy, a follow-up study of 16 months was performed on 196 selected patients (aged from 22 to 43 years) affected by left varicocele (VR). In the pre-treatment, both Doppler ultrasonography and didymo-epididymal ultrasonography allowed to distinguish two homogeneous patient groups: group A (no. = 136), including patients affected by VR alone and, group B (n. = 60), including patients with VR combined to coincidental didymo-epididymal morphological abnormalities, DEMA). These DEMA lesions (testis size < 12 ml, epididymides abnormalities: increased head- > or = 12 mm- and/or tail- > or = 6 mm-diameter, multiple microcysts, large idrocele) were omolaterally to VR in 30/60 (50%), eterolaterally in 19/60 (31.7%) or bilaterally in 11/60 (18.3%). During sperm follow-up, group A patients showed both a significant temporal change (p < 0.01 ANOVA) of all sperm parameters studied (sperm density, total sperm count, motility and morphology) from month 8 onward and sperm values significantly higher than found in group B patients. On the contrary, the sperm parameters of group B patients did not change significantly during the follow-up observations. As far as the varicocelectomy-mediated clinical symptoms, some patients complained early and transiently (on 1-2-4 weeks following varicocelectomy) the following symptoms: didymal pain (1.5%), didymo-epididymal pain (4.1%) and parasthesiaes on the anterior-medial side of the left thigh (4.1%) or scrotal (3.1%); only four patients (2%) complained permanent paresthesiaes on the anterior-medial side of the left thigh. Furthermore, the clinical follow-up also revealed a low rate of complications: persistent VR (3.6%), hydrocele (1.5%), intrascrotal venous ecstasies (6.1%), epididymitis (0.5%). Some morpho-structural abnormalities at US scans were transient (1-2 weeks): scrotal oedema (6.1%), orchitis (2%), orchi-epididymitis (1%). Subinguinal varicocelectomy performed on large population demonstrated a significant improvement of the sperm output from month 8th onward in patients with VR alone, while sperm parameters did not show any significant change in patients with VR plus coincidental DEMA. This surgical technique also demonstrated safety since both low rates of symptoms and (transient) complications were registered.

[Male urogenital amicrobial phlogosis: effects of the treatment with amtolmetin guacyl on some sperm parameters]. / Flogosi uro-genitali amicrobiche maschili: efficacia del trattamento con amtolmetina guacil su alcuni parametri spermatici.

To examine if some inflammation-related sperm abnormalities were influenced by leucocytospermia (sWBC) alone, WBC-specific Radical oxygen species (WBC-ROS) over-production, and/or by different infected sexual gland sites and if these abnormalities were possibly reversible following treatment with an antiphlogistic drug, a total of 43 infertile male patients with amicrobial male accessory gland infections (MAGI) associated with prostatitis (P, n = 16), prostato-vesiculitis (PV, n = 14) or prostato-vesiculo-epididymitis (PVE, n = 13) as confirmed by ultrasound, were studied. The patients were then further subdivided into two subsets: one of the subsets (P, n = 10; PV, n = 8; PVE, n = 7) was administered amtolmetina guacyl (Eufans) 600 mg once daily for 14 consecutive days per month, for a 2-months period. The second subset (six patients for each category) received no treatment (matched-control). Mean outcome measures included a follow-up of sperm analysis with assessment of sperm forward motility (M), sperm viability (V). In addition, sWBC as well as basal and maximal fMLP-mediated WBC-ROS production were also carried out by conventional immunocytochemistry staining and chemiluminescence analysis respectively. In the pre-treatment, in all patients (treated and not treated subsets) median values of the sperm M and V were significantly different among categories (P > PV > PVE), and necrozoospermia (sperm viability < 25%) were present in the 70% out of group P patients and in all (100%) patients from groups PV and PVE. Median sWBC concentrations, elevated (values > 1 mil/ml) in all groups, in the PV and PVE groups were significantly higher compared to those found in the group P. Furthermore, PVE group generated baseline and fMLP-stimulated ROS productions from low density 45% Percoll fraction (Pc45), significantly higher than those found in P or PV groups. Sperm outcome measures were significantly different compared with the matched-controls (exhibiting 0% case-responders), in a time- and infected gland site-dependent manner. Thus, either in terms of median values and percentages of responders (defined as parameters ensued within the conventional normal range) sperm M and V percentages, as well as sWBC improved after the first (T1) antiphlogistic course in the group P only, but after the second (T2) antiphlogistic course in the other groups (PV or PVE). Moreover, treated patients of each group had amounts of generated basal and fMLP-stimulated ROS signals significantly reduced, with values ensued within a fertile control range at T2, in 80, 62.5 and 42.8% out of the P, PV and PVE groups respectively. We concluded that long-term amtolmetina-guacyl administration demonstrated efficacy and safety in the treatment of amicrobial MAGI, exhibiting a positive impact on all sperm parameters studied and no side-effects.