Long-term penile morphometric alterations in patients treated with robot-assisted versus open radical prostatectomy

Neglected side effects after radical prostatectomy have been previously reported. In this context, the prevalence of penile morphometric alterations has never been assessed in robot-assisted radical prostatectomy series. We aimed to assess prevalence of and predictors of penile morphometric alterations (i.e. penile shortening or penile morphometric deformation) at long-term follow-up in patients submitted to either robot-assisted (robot-assisted radical prostatectomy) or open radical prostatectomy. Sexually active patients after either robot-assisted radical prostatectomy or open radical prostatectomy prospectively completed a 28-item questionnaire, with sensitive issues regarding sexual function, namely orgasmic functioning, climacturia and changes in morphometric characteristics of the penis. Only patients with a post-operative follow-up ≥ 24 months were included. Patients submitted to either adjuvant or salvage therapies or those who refused to comprehensively complete the questionnaire were excluded from the analyses. A propensity-score matching analysis was implemented to control for baseline differences between groups. Logistic regression models tested potential predictors of penile morphometric alterations at long-term post-operative follow-up. Overall, 67 (50%) and 67 (50%) patients were included after open radical prostatectomy or robot-assisted radical prostatectomy, respectively. Self-rated post-operative penile shortening and penile morphometric deformation were reported by 75 (56%) and 29 (22.8%) patients, respectively. Rates of penile shortening and penile morphometric deformation were not different after open radical prostatectomy and robot-assisted radical prostatectomy [all p > 0.5]. At univariable analysis, self-reported penile morphometric alterations (either penile shortening or penile morphometric deformation) were significantly associated with baseline international index of erectile function-erectile function scores, body mass index, post-operative erectile function recovery, year of surgery and type of surgery (all p < 0.05). At multivariable analysis, robot-assisted radical prostatectomy was independently associated with a lower risk of post-operative penile morphometric alterations (OR: 0.38; 95% CI: 0.16-0.93). Self-perceived penile morphometric alterations were reported in one of two patients after radical prostatectomy at long-term follow-up, with open surgery associated with a potential higher risk of this self-perception.

Sexual functioning mirrors overall men's health status, even irrespective of cardiovascular risk factors

Erectile dysfunction has been described as a sentinel marker of co-existing and undetected cardiovascular disease. Beside cardiovascular diseases, a correlation between erectile dysfunction and other major comorbidities has been also reported. The study was aimed to analyze the association between sexual functioning and overall men's health in sexually active, Caucasian-European men with new-onset sexual dysfunction. Data from the last 881 consecutive patients seeking first medical help for sexual dysfunction were cross-sectionally analyzed. The International Classification of Diseases, 9th revision, Clinical Modification was used to classify health-significant comorbidities, which were scored with the Charlson Comorbidity Index (CCI). A modified CCI score from which all potential cardiovascular risk factors (CCI-CV) were subtracted was then calculated for every patient. Patients were requested to complete the International Index of Erectile Function (IIEF). The main outcome of the study was the association between the IIEF domain scores and CCI, which scored health-significant comorbidities even irrespective of cardiovascular risk factors (CCI-CV). The final sample included 757 patients (85.9%) (Median age: 48 years; IQ range: 37-59). Overall, erectile dysfunction was found in 540 (71.4%) patients. Of these, 164 (21.6%) had a CCI ≥ 1 and 138 (18.2%) had a CCI-CV ≥ 1, respectively. At the analysis of variance, IIEF-Erectile Function (EF) scores significantly decreased as a function of incremental CCI and CCI-CV scores (all p < 0.01). At multivariable logistic regression analysis, both IIEF-EF and IIEF-total score achieved independent predictor status for either CCI ≥ 1 or CCI-CV ≥ 1, after accounting for potential confounders (p < 0.01). We report novel findings of a significant association between erectile dysfunction severity and overall men's health, even irrespective of cardiovascular risk factors. Thereof, erectile dysfunction severity could serve as a proxy for general men's health, thus encouraging physicians to comprehensively assess patients complaining of sexual dysfunction in the real-life everyday clinical practice.

Primary, secondary and compensated hypogonadism: a novel risk stratification for infertile men

Recently, the cohort of men from the European Male Ageing Study has been stratified into different categories distinguishing primary, secondary and compensated hypogonadism. A similar classification has not yet been applied to the infertile population. We performed a cross-sectional study enrolling 786 consecutive Caucasian-European infertile men segregated into eugonadal [normal serum total testosterone (≥3.03 ng/mL) and normal luteinizing hormone (≤9.4 mU/mL)], secondary (low total testosterone, low/normal luteinizing hormone), primary (low total testosterone, elevated luteinizing hormone) and compensated hypogonadism (normal total testosterone; elevated luteinizing hormone). In this cross-sectional study, logistic regression models tested the association between semen parameters, clinical characteristics and the defined gonadal status. Eugonadism, secondary, primary and compensated hypogonadism were found in 80, 15, 2, and 3% of men respectively. Secondary hypogonadal men were at highest risk for obesity [OR (95% CI): 3.48 (1.98-6.01)]. Primary hypogonadal men were those at highest risk for azoospermia [24.54 (6.39-161.39)] and testicular volume <15 mL [12.80 (3.40-83.26)]. Compensated had a similar profile to primary hypogonadal men, while their risk of azoospermia [5.31 (2.25-13.10)] and small testicular volume [8.04 (3.17-24.66)] was lower. The risk of small testicular volume [1.52 (1.01-2.33)] and azoospermia [1.76 (1.09-2.82)] was increased, although in a milder fashion, in secondary hypogonadal men as well. Overall, primary and compensated hypogonadism depicted the worst clinical picture in terms of impaired fertility. Although not specifically designed for infertile men, European Male Ageing Study categories might serve as a clinical stratification tool even in this setting.

Efficacy and safety of dapoxetine in treatment of premature ejaculation: an evidence-based review

BACKGROUND

Premature ejaculation (PE) is a major issue in male sexual health, with a global prevalence estimated to be between 20% and 40%, making it the most common sexual dysfunction in men. PE causes distress and reduced quality of life for patients and has a negative impact on interpersonal relationships. Historically, it has been treated with cognitive therapy, behavioural methods and off-label use of selective serotonin reuptake inhibitors (SSRIs) usually used to treat depression and other psychological disorders. Dapoxetine is the only SSRI specifically designed to treat PE.

MECHANISM OF ACTION

Dapoxetine hydrochloride is a potent inhibitor of serotonin reuptake transporters. Dapoxetine is suited for 'on-demand' treatment of PE because of its rapid absorption and short initial half-life.

EFFICACY

Evidence from published studies showed that dapoxetine 30 mg or 60 mg taken 'on-demand' results in a significant increase in intravaginal ejaculatory latency time (IELT) when compared with placebo. Most patient-reported outcomes are clearly improved relative to placebo following dapoxetine therapy, indicating greater control over ejaculation, more satisfaction with intercourse, less ejaculation-related distress and significantly reduced interpersonal difficulties.

SAFETY

The most common adverse events with dapoxetine are nausea, dizziness, somnolence, headache, diarrhoea and insomnia. Usually they do not lead to drug discontinuation.

CONCLUSION

Dapoxetine is the only effective and safe available on-label oral treatment for PE, and its use can result in better quality of life for the patient and their sexual partner.

A disorder-enhanced quasi-one-dimensional superconductor

A powerful approach to analysing quantum systems with dimensionality d>1 involves adding a weak coupling to an array of one-dimensional (1D) chains. The resultant quasi-1D (q1D) systems can exhibit long-range order at low temperature, but are heavily influenced by interactions and disorder due to their large anisotropies. Real q1D materials are therefore ideal candidates not only to provoke, test and refine theories of strongly correlated matter, but also to search for unusual emergent electronic phases. Here we report the unprecedented enhancement of a superconducting instability by disorder in single crystals of Na_2−δMo₆Se₆, a q1D superconductor comprising MoSe chains weakly coupled by Na atoms. We argue that disorder-enhanced Coulomb pair-breaking (which usually destroys superconductivity) may be averted due to a screened long-range Coulomb repulsion intrinsic to disordered q1D materials. Our results illustrate the capability of disorder to tune and induce new correlated electron physics in low-dimensional materials.

Disorder localizes electrons, which is usually detrimental to the onset of superconductivity. Here, Petrović et al. report a disorder-enhanced superconducting instability in quasi-one dimensional Na_2-dMo₆Se₆ and suggest that this effect may originate from an intrinsically screened Coulomb repulsion.

Metabolic syndrome in white European men presenting for primary couple's infertility: investigation of the clinical and reproductive burden

Despite complex interactions between obesity, dyslipidemia, hyperinsulinaemia, and the reproductive axis, the impact of metabolic syndrome on human male reproductive function has not been analysed comprehensively. Complete demographic, clinical, and laboratory data from 1337 consecutive primary infertile men were analysed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (categorised 0 vs. 1 vs. 2 or higher). NCEP-ATPIII criteria were used to define metabolic syndrome. Semen analysis values were assessed based on the 2010 World Health Organisation (WHO) reference criteria. Descriptive statistics and logistic regression models tested the association between semen parameters and clinical characteristics and metabolic syndrome. Metabolic syndrome was found in 128 (9.6%) of 1337 men. Patients with metabolic syndrome were older (p < 0.001) and had a greater Charlson Comorbidity Index of 1 or higher (chi-square: 15.6; p < 0.001) compared with those without metabolic syndrome. Metabolic syndrome patients had lower levels of total testosterone (p < 0.001), sex hormone-binding globulin (p = 0.004), inhibin B (p = 0.03), and anti-Müllerian hormone (p = 0.009), and they were hypogonadal at a higher rate (chi-square: 32.0; p < 0.001) than patients without metabolic syndrome. Conversely, the two groups did not differ significantly in further hormonal levels, semen parameters, and rate of either obstructive or non-obstructive azoospermia. At multivariate logistic regression analysis, testicular volume (OR: 0.90; p = 0.002) achieved independent predictor status for WHO pathological semen concentration; conversely, age, Charlson Comorbidity Index scores, metabolic syndrome, and inhibin B values did not. No parameters predicted normal sperm morphology and total progressive motility. Metabolic syndrome accounts for roughly 9% of men presenting for primary couple's infertility. Although metabolic syndrome patients have a lower general male health status, semen analysis values seem independent of the presence of metabolic syndrome.

Lower urinary tract symptoms among Caucasian-European men who have sex with men: findings from a real-life survey

BACKGROUND

Prevalence of and severity of lower urinary tract symptoms (LUTS) according to male sexual orientation have been scantly analysed. We aimed to assess the prevalence and severity of LUTS in a cohort of Caucasian-European men who have sex with men seeking medical help for uroandrologic reasons other than LUTS.

METHODS

Data from 949 consecutive individuals in an outpatient setting were analysed. Severity of LUTS was measured with the International Prostate Symptom Score (IPSS). Men with storage symptoms scored 1-3 and ⩾ 4 (of 15), and voiding symptoms scored 1-4 and ⩾ 5 (of 20) were considered as having mild and moderate-to-severe symptoms, respectively. For individual symptoms, patients with scores ⩾ 1 were deemed symptomatic (according to Apostolidis et al.(15)). Descriptive statistics and logistic regression models tested the association between LUTS and sexual orientation.

RESULTS

Complete data were available for 213 (22.4%) men who have sex with men (MSM) and 736 (77.6%) heterosexuals (mean age (s.d.): 41.0 (12.2) vs 39.9 (12.1) years). Compared with heterosexuals, MSM reported higher rates of total IPSS scores suggestive of moderate (21.6% vs 20%) and severe LUTS (3.8% vs 2.4%) (P=0.004). Similarly, MSM showed higher rates of mild (48.8% vs 45.2%) and moderate-to-severe (39.4% vs 30.4%) storage symptoms (all P<0.001), and of mild (45.1% vs 34.8%) and moderate-to-severe (20.2% vs 19.2%) voiding symptoms (all P<0.01). MSM status was an independent predictor of mild voiding symptoms (odds ratio (OR): 1.40; P=0.004), moderate-to-severe storage symptoms (OR: 1.40; P=0.04) and severe total IPSS (OR: 1.49; P=0.03), after adjusting for other variables.

CONCLUSIONS

These findings suggest a higher prevalence and severity of LUTS in MSM compared with heterosexual men seeking medical help for uroandrologic reasons other than LUTS.

Structural origin of the anomalous temperature dependence of the local magnetic moments in the CaFe2As2 family of materials

We report a combination of Fe Kβ x-ray emission spectroscopy and density functional reduced Stoner theory calculations to investigate the correlation between structural and magnetic degrees of freedom in CaFe2(As1-xPx)2. The puzzling temperature behavior of the local moment found in rare earth-doped CaFe2As2 [H. Gretarsson et al., Phys. Rev. Lett. 110, 047003 (2013)] is also observed in CaFe2(As1-xPx)2. We explain this phenomenon based on first-principles calculations with scaled magnetic interaction. One scaling parameter is sufficient to describe quantitatively the magnetic moments in both CaFe2(As1-xPx)2 (x=0.055) and Ca0.78La0.22Fe2As2 at all temperatures. The anomalous growth of the local moments with increasing temperature can be understood from the observed large thermal expansion of the c-axis lattice parameter combined with strong magnetoelastic coupling. These effects originate from the strong tendency to form As-As dimers across the Ca layer in the CaFe2As2 family of materials. Our results emphasize the dual local-itinerant character of magnetism in Fe pnictides.

Vibrational spectrum of solid picene (C22H14)

Recently, Mitsuhashi et al observed superconductivity with a transition temperature up to 18 K in potassium doped picene (C(22)H(14)), a polycyclic aromatic hydrocarbon compound (Mitsuhashi et al 2010 Nature 464 76). Theoretical analysis indicates the importance of electron-phonon coupling in the superconducting mechanisms of these systems, with different emphasis on inter- and intra-molecular vibrations, depending on the approximations used. Here we present a combined experimental and ab initio study of the Raman and infrared spectrum of undoped solid picene, which allows us to unambiguously assign the vibrational modes. This combined study enables the identification of the modes which couple strongly to electrons and hence can play an important role in the superconducting properties of the doped samples.

Breast cancer and genetics

Familiar aggregation of breast cancer has been known since Roman times, but it has been discussed in practical terms only from the 19th century. Most of the studies dealing with this issue suggest that the risk is higher in relatives of patients with early onset and that the risk also increases as a function of the bilaterality of the disease or the simultaneous presence of breast cancer and ovarian cancer.A series of epidemiological studies consistently suggest hereditary autosomal dominant transmission with reduced penetrance. Previous epidemiological research and collection of data from families has been used only from the 1990s in order to identify disease genes. The BRCA1 gene was identified as the first gene responsible for hereditary forms of breast cancer and subsequently BRCA2. In 1995 both genes were identified and cloned, and they demonstrated to have only minimal homology. The conclusions deal with genetic counseling and the evaluation of the risk of developing cancer.

Is LaFeAsO1-xFx an electron-phonon superconductor?

In this Letter, we calculate the electron-phonon coupling of the newly discovered superconductor LaFeAsO1-xFx using linear response. For pure LaFeAsO, the calculated electron-phonon coupling constant lambda=0.21 and logarithmic-averaged frequency omegaln=206 K give a maximum Tc of 0.8 K, using the standard Migdal-Eliashberg theory. For the F-doped compounds, we predict even smaller coupling constants. To reproduce the experimental Tc, a 5-6 times larger coupling constant would be needed. Our results indicate that electron-phonon coupling is not sufficient to explain superconductivity in the whole family of Fe-As-based superconductors, probably due to the importance of strong-correlation effects.

Energy gaps and Kohn anomalies in elemental superconductors

The momentum and temperature dependence of the lifetimes of acoustic phonons in the elemental superconductors lead and niobium were determined by resonant spin-echo spectroscopy with neutrons. In both elements, the superconducting energy gap extracted from these measurements was found to converge with sharp anomalies originating from Fermi-surface nesting (Kohn anomalies) at low temperatures. The results indicate electron many-body correlations beyond the standard theoretical framework for conventional superconductivity. A possible mechanism is the interplay between superconductivity and spin- or charge-density-wave fluctuations, which may induce dynamical nesting of the Fermi surface.

Superconductivity in heavy alkaline-Earth intercalated graphites

We report the discovery of superconductivity below 1.65(6) K in Sr-intercalated graphite SrC(6), by susceptibility and specific heat (C(p)) measurements. In comparison with CaC(6), we found that the anisotropy of the upper critical fields for SrC(6) is much reduced. The C(p) anomaly at T(c) is smaller than the BCS prediction, indicating an anisotropic superconducting gap for SrC6 similar to CaC6. The significantly lower T(c) of SrC(6) as compared to CaC(6) can be understood in terms of "negative" pressure effects, which decreases the electron-phonon coupling for both in-plane intercalant and the out-of-plane C phonon modes. We observed no superconductivity for BaC(6) down to 0.3 K.

Momentum-resolved electron-phonon interaction in lead determined by neutron resonance spin-echo spectroscopy

Neutron resonance spin-echo spectroscopy was used to monitor the temperature evolution of the linewidths of transverse acoustic phonons in lead across the superconducting transition temperature over an extended range of the Brillouin zone. For phonons with energies below the superconducting energy gap, a linewidth reduction of maximum amplitude was observed below . The electron-phonon contribution to the phonon lifetime extracted from these data is in satisfactory overall agreement with ab initio lattice-dynamical calculations, but significant deviations are found.

Specific heat of the Ca-intercalated graphite superconductor CaC6

The superconducting state of Ca-intercalated graphite CaC6 has been investigated by specific heat measurements. The characteristic anomaly at the superconducting transition (Tc = 11.4 K) indicates clearly the bulk nature of the superconductivity. The temperature and magnetic field dependence of the electronic specific heat are consistent with a fully gapped superconducting order parameter. The estimated electron-phonon coupling constant is lambda = 0.70 +/- 0.04, suggesting that the relatively high Tc of CaC6 can be explained within the intermediate coupling BCS approach.

[Psychomotor treatment of cranial injuries in childhood. Two cases of apallic syndrome]

In this paper the authors aim to assess the results of psychomotor treatment of 5 patients with cranial injuries admitted to the Division of Infantile Neuropsychiatry at Gaslini Hospital from 1983 to 1985 and to evaluate the role of this treatment in a pathology with multiple, complex functional disorders. Evolution was excellent in 3 out of 5 patients who presented level 1-3 coma with limited post-traumatic sequelae (epilepsy and dysfunction of the left side in A.D., epilepsy and learning disorders in C.F., motor impairment and learning disorders in V.D.) Effective control was achieved in epileptic patients together with a good recovery in those with learning handicaps. Only slight fine motor disorders remained in the case (A.D.) with left hemiparesis. The two cases with level 5 coma that developed into apallic syndrome both attained full postural and motor autonomy, although a slight paretic deficit remained in the left side in one case (V.A.) and vague cerebellar signs in the other (G.D.). Moreover, despite continuing residual difficulties involving concentration and instability of attention, together with slight affective and emotional problems, both girls acquired satisfactory knowledge and responsibility regarding their own psychomotor status and achieved good personal autonomy and a stable ego structure. These results appear to confirm the hypothesis that psychomotor treatment is an effective method of achieving an adequate recomposition of the psychophysical and functional unit of body, damaged by injury.