Panminerva medica
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Review Historical Article
A comprehensive update on urinary tract lithiasis management.
In the past decade, the field of urology has been one of the most rapidly progressing in applied technological advancements at the level of both medical diagnostics and treatment. The introduction of modern robotic laparoscopy has changed the face of minimally invasive surgery. For endourology specialists, stone surgery continues to be in the forefront of daily practice and innovations and new technologies are constantly being developed, aiming towards ever higher stone free rates and earlier recovery for the patient. ⋯ It is more than often that even expert professionals are not totally familiar with the whole range of treatment options and devices that are available in the market, as they commonly bear different names despite being used for the same purpose. Furthermore, a question of integrity might arise when using newly developed equipment directly in the operating theatre, with respect to the efficacy of the device as well as the learning curve required by the operator. In this review, we shall outline the latest advances in interventional lithotripsy technology and also demonstrate the most effective ways to use each particular modality efficiently and safely, with respect to the latest published guidelines and evidence-based recommendations.
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Fertility preservation has become an issue of great importance in female cancer patients due to increasing survival rates and delayed childbearing. It is an emerging challenge for physicians, cause of several related issues (multidisciplinary approach, doctor-patient communication, ethical, religious and legal problems) and many unresolved questions. This review aims to update the latest literature data, summarizing the effects of cancer treatments on female fertility and the various options currently available to offer cancer patients the opportunity of future pregnancies. ⋯ Oocytes donation and gestational surrogacy represent the last options. Thus, the care of these patients is challenging, complex and requires a multidisciplinary approach. A close collaboration between Oncologists, Specialists in Reproductive Medicine, Gynecologic Oncologists and Endocrinologists is crucial for always offering the best possible option.
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Large-scale medical sequencing provides a focal point around which to reorganize health care and health care research. Mobile health (mHealth) is also currently undergoing explosive growth and could be another innovation that will change the face of future health care. We are employing primary ovarian insufficiency (POI) as a model rare condition to explore the intersection of these potentials. ⋯ Too often advances in research are not effectively integrated into community care at the point of service for those with rare diseases. There is a need to connect community health providers in real time with investigators who have the requisite knowledge and expertise to help manage the rare disease and to conduct ongoing research. Here we review the pathophysiology and management of POI and propose the development of an international Clinical Research Integration Special Program (CRISP) for the condition.
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Studies on major depressive disorders (MDD) pathophysiology show decreased blood levels of brain-derived neurotrophic factor (BDNF) that increase after antidepressant treatment. The link between BDNF levels and antidepressants is still controversial. In addiction, there is a relationship between MDD and concurrent cognitive function. Hippocampus is linked to memory and learning and BDNF is abundant in this area. For this reason we investigated the presence of any association between paroxetine treatment, BDNF levels and cognitive performances in depressed patients. ⋯ To our knowledge this is one of the few studies on the effects of paroxetine treatment on plasma BDNF levels. We confirm literature data regarding the link between BDNF plasma levels, depression and antidepressant treatments. In addiction we found a specific cognitive deficit of depressed patients.
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Optimal management of multivessel disease (MVD) is a complex medical decision with significant prognostic implications. Despite the advent of clinical and angiographic scores to aid with treatment delineation, therapy for MVD must be individualized for each patient and his/her clinical presentation. ⋯ Several patient factors including clinical presentation, severity of coronary artery disease, presence of left ventricular dysfunction and other comorbidities, and the patient's personal preferences should guide the decision making process. In this review, we discuss the management of MVD with regards to decisions of revascularization versus GDMT alone, mode of revascularization, extent of revascularization (i.e., complete versus incomplete), the strategy of angiography- versus ischemia-guided revascularization, and MVD management in the setting of an acute coronary syndrome.