Urologists’ knowledge base and practice patterns in Peyronie’s disease. A national survey of members of the italian andrology society

Peyronie’s disease is a chronic inflammatory disease involving the formation of plaque in the tunica albuginea of the corpora cavernosa, resulting in penis deformity. It is often associated with penile pain, especially in younger patients, but it is not rare for pain to be absent; the disease is also associated with erectile dysfunction and a depressive state in a large percentage of cases. Objective: Aim of our study was to explore the basic knowledge base and diagnostic and therapeutic practice patterns in Peyronie's disease (PD) of a large number of physicians belonging to the Italian Andrology Society (SIA). Methods: Our survey is based on two questionnaires which were e-mailed to the members of the SIA. The first questionnaire explored diagnostic and therapeutic practice patterns of SIA physicians, while the second questionnaire focused on their knowledge of the disease, as well as their training and level of experience in the specific field. We then planned to compare our outcomes with similar PD surveys from other countries. Results: The first questionnaire was answered by 142 SIA physicians. The second questionnaire was answered by 83 SIA physicians. Most respondents (74.6%) chose penile ultrasonography as first-line diagnostic approach and 47.1% prefer to perform a color Doppler ultrasound after pharmaco-induced erection. Concerning the therapeutic practice patterns in active stage of the disease, most respondents (99.29%) prefer conservative medical therapy. Additionally, most respondents (64.78%), when failure of conservative treatment had been established, considered surgical treatment necessary, specifically corporoplasty, which may be associated with other techniques. Conclusions: The results of our survey show that, in comparison to their foreign counterparts, Italian SIA uro-andrologists have a more proactive diagnostic approach right from when patients first present. When PD is still in its active stage, SIA uro-andrologists mostly opt for medical therapy. In advanced disease or if conservative treatment fails, our survey indicates a greater preference for surgical treatment. Answers to the theoretical knowledge questions showed that SIA physicians have a good understanding of the disease’s etiology, epidemiology, and clinical picture, and of the appropriate indications for treatment.

Insect Succession and Decomposition Pattern on Pig Carrion During Warm and Cold Seasons in Kwazulu-Natal Province of South Africa

With the aim of identifying insects with potential value as indicator species in postmortem interval (PMI), the location or season of death of human or monogastric animals, two medium-sized large white pigs were used for the study during cold and warm seasons. Five stages of decomposition and their durations were observed and described in the pig carcasses during both seasons. Carcasses were first colonized by flies from seven taxa during fresh stage. Chrysomya marginalis (Wiedemann) (Diptera: Calliphoridae), Chrysomya albiceps, (Wiedemann) (Diptera: Calliphoridae) and Musca domestica (Walker) (Diptera: Calliphoridae) were recorded as the overall dominant adult flies found on the carcasses in both seasons. Colonization by beetles began during the bloated stage in the warm season and active stage in the cold season. Dermestes maculatus (De Geer) (Coleoptera: Dermestidae) and Necrobia rufipes (De Geer) (Cleridae) were the most abundant beetles in both seasons. Flies and beetles were generally abundant during the warm seasons as compared to the cold season. However, the difference was only significant for beetles. The highest number of flies were recorded in the bloated stage for both seasons, however they were reduced in the active stage which coincided with the introduction of predatory beetles. The arrival time of the different arthropod species and their association with different stages of decomposition during both seasons pointed to their value in estimating the PMI in forensic investigations in the locality of KwaZulu-Natal, South Africa. Consequently, they can potentially be useful in the estimation of PMI and other cases of criminal investigations.

More Severe COVID-19 in Patients With Active Cancer: Results of a Multicenter Cohort Study

BackgroundThe aim of the study was to compare coronavirus disease 2019 (COVID-19) severity presentation between oncologic and non-oncologic patients and to evaluate the impact of cancer type and stage on COVID-19 course.MethodsWe performed a multicentre, retrospective study involving 13 COVID-19 Units in Campania region from February to May 2020. We defined as severe COVID-19 presentation the cases that required mechanical ventilation and/or admission to Intensive Care Units (ICU) and/or in case of death.ResultsWe enrolled 371 COVID-19 patients, of whom 34 (9.2%) had a history or a diagnosis of cancer (24 solid, 6 onco-hematological). Oncologic patients were older (p<0.001), had more comorbidities (p<0.001) and showed a higher rate of severe COVID-19 presentation (p=0.001) and of death (p<0.001). Compared to 12 patients with non-active cancer and to 337 without cancer, the 17 patients with active cancer had more comorbidities and showed a higher rate of severe COVID-19 and of mortality (all p values <0.001). Compared to the 281 non-severe patients, the 90 subjects with a severe presentation of COVID-19 were older (p<0.01), with more comorbidities (p<0.001) and with a higher rate of cancer (p=0.001). At multivariate analysis, age (OR 1.08, 95% CI: 1.04-1.11) and suffering from cancer in an active stage (OR 5.33, 95% CI: 1.77-16.53) were independently associated with severe COVID-19.ConclusionsSince the higher risk of severe evolution of COVID-19, cancer patients, especially those with an active malignancy, should be candidates for early evaluation of symptoms and early treatment for COVID-19.

P039 New molecular markers of the development of ulcerative colitis

Background The mechanisms of ulcerative colitis (UC) progression require detailed study. Modern achievements of proteomic methods of analysis are ideal for research that is free from hypotheses and allows us to define molecular characteristics of inflammation in colon mucosa of UC patients. Methods The study was comparative cohort with parallel design and included 88 patients (range from 22 to 35 years, 37 men and 51 women): 53 (60.2%) pancolitis and 35 (39.8%) left-sided UC, mild and moderate activity. The control group included 30 healthy individuals. Biosamples of colon mucosa in patients with UC in the active stage and in healthy persons were received by ileocolonoscopy with colon mucosa biopsy. The separation of individual proteins of colon mucosa was based on technologies of IEF, SDS-PAGE, 2DPAGE, by standard sets (MB-HIC C8 Kit, MB-IMAC Cu, MB-Wax Kit, «Bruker», USA). Automated mass spectrometry imaging was performed by MALDI-TOF-MS/MS, Ultraflex II, «Bruker», USA). The data of the molecular interactions and functional features of proteins were received with STRING 10.0 database. Results We identified following functional groups of peptides and proteins in molecular patterns of colon mucosa in UC patients: SMAD family member 2 (SMAD2) activates the transcription of TFG1β, that leads to specific regulation of the CCN2 gene in cells and the development of fibrosis in colon submucosa in UC patients; the stimulation of the expression of apoС-III in affected colon mucosa in UC is associated with the activation of the FOXO1 signaling pathway that supports inflammatory processes in colon mucosa; the second small heat shock protein (HSP2) controls the apoptosis of colonocytes, is also responsible for the mucosa resistance to therapeutic strategies; caspase 8 protects colonocytes from TNFα-induced cell death through a necroptosis mechanism via the blockade of the RIP3 expression; the expression of prohibitin maintains optimal activity of the electronic transport chain through the activity of transcription factor STAT3 and the decrease in the TNFα expression; significant decrease of the PPARγ expression promotes the activation of STAT and AP-1 signaling pathways, which promotes the activity of immune and inflamation processes in colon mucosa and a significant increase in the NF-kB expression in colon mucosa is associated with the activation of TNFα and IL-1, which promotes the increase of immune processes in colon mucosa. Conclusion Bioinformatics analysis revealed the presence of molecules that are the participants in the universal pathways of UC in the active stage, and the molecular interactions involved. This information may provide new avenues for the development of novel diagnostic tests for UC.

P035 Potential biomarkers for diagnosis through proteomics, in patients with Inflammatory Bowel Disease

Background Currently,endoscopy,an invasive medical procedure, is the gold standard for diagnosis of inflammatory bowel disease (IBD) and to determine mucosal activity.Our main goal was to identify biomarkers in saliva samples that can be used as a screening tool for the diagnosis of ulcerative colitis(UC) and Crohn`s disease(CD). Methods 100 saliva samples were collected from: healthy individuals(20), UC-active stage(10),UC-remission stage(31),CD-active stage(7) and CD-remission stage(32) patients. The samples were thawed on ice and centrifugated at 10,000g for 15 min at 4ºC.The supernatants were aliquoted and stored at -80ºC. The protein extracts were digested with trypsin and peptides resulting from digestion were loaded onto a nano Acquity UPLC chromatograph and analysed in a nano Elute coupled on-line to a timsTOF Pro(Bruker).The data obtained was then processed and loaded onto the Progenesis LC-MS software (Nonlinear Dynamics) for Orbitrap data and PEAKS(Bioinformatics Solutions Inc.) for timsTOF Pro data. Finally, this information was converted to deregulation patterns at protein level and relative quantification was done. Saliva protein levels were compared between healthy (always as control) and CD remission,UC remission,UC active and CD active stages respectively.The identification of potential biomarkers was carried out with classical statistic methods(p value<0,05 and ratio> 1,5) and data Mining mathematical model(p-value<0,05, balanced accuracy ≥ 70, sensitivity ≥ 60 and specificity ≥ 60). Results We have chosen the most relevant classifiers according to statistical and biological criteria, based on their biological function and the pathogenesis of UC or CD(figure 1). We have identified 152 classifiers(biomarkers),118 single and 34 dual, defined by one or two proteins of a list of 135 proteins(table 1).The classifiers are shown for each cohort compared to healthy control:42 biomarkers were found in Active UC,16 in Remission UC, 99 in Active CD and 13 in Remission CD,all of them compared to healthy controls. Conclusion Multiple potential biomarkers have been identified in saliva in relation to IBD. Biomarkers with significant value have been found for identifying and classifying UC as well as CD, compared to controls.The number of biomarkers found in CD has been higher than in UC. The simple biomarker option(versus dual) is recommended,since its application involves fewer errors.

Comparative study regarding effect of pH on Misoprostol in induction of labor in full term primigravida pregnant women, a double blind randomized controlled trial

ObjectivesTo evaluate the effect of altering vaginal pH on induction of labor in full-term pregnancies using Misoprostol.MethodsThis randomized controlled trial was conducted at Kasralainy Hospital, Cairo University, Egypt and Algezeera Hospital, Egypt. A total of 218 healthy term primigravida pregnant women who were scheduled for pregnancy termination were recruited in the study. The included patients were divided into three groups; Group A: Those who received normal saline vaginal wash (0.9% NaCl), Group B: those who received alkaline vaginal wash (5% sodium bicarbonate) and Group C: those who received acidic vaginal wash (5% acetic acid). Patients received 25 μg of Misoprostol E1 (Vagiprost® Adwia Pharmaceuticals, Egypt) every 6 h for a maximum of 24 h (total of four potential doses).ResultsThe ‘acid’ group participants took a mean time of 20.46 h to reach active stage of labor, followed by the ‘normal saline’ group with 21.45 h and the ‘alkaline’ group with 22.59 h. The difference between the groups was statistically significant, with a p-value of 0.013.ConclusionsDouching the vagina with acidic solution seems to supplement the effect of Misoprostol on inducing labor in full-term pregnancies, as evidenced by having the shortest mean time needed to reach active stage of labor.

Changes in Chemical Composition and Accumulation of Cryoprotectants as the Adaptation of Anholocyclic Aphid Cinara tujafilina to Overwintering

One of the consequences of climate change is the expansion of insects’ ranges. Colonization of new habitats forces insects to adapt to new conditions, such as low temperatures in winter. Cinara tujafilina is a thermophilic anholocyclic aphid species, which reproduce exclusively parthenogenetic throughout the year, including winter. On the areas where the populations of C. tujafilina had expanded, it demonstrated its adaptation for surviving colder winters. Based on analyses of changes in body chemical composition using Fourier transform infrared (FTIR) and changes in cryoprotectant content using high performance liquid chromatography (HPLC), we showed how aphid C. tujafilina adapted to overwintering as an active stage. In the FTIR spectrum of the winter type of C. tujafilina, higher peak values originating from the carbohydrates, proteins and lipids, were observed. Glucose, trehalose, mannitol, myo-inositol and glycerol were identified in the aphid body in winter as main putative cryoprotectants to increase the insects’ tolerance to cold. The complex sugar-polyol cryoprotectant system facilitates aphids’ survival in unfavorable low temperatures.