RT-QuIC detection of pathological prion protein in subclinical goats following experimental oral transmission of L-type BSE

Objective

The spread of bovine spongiform encephalopathy (BSE) agent to small ruminants is still a major issue in the surveillance of transmissible spongiform encephalopathies (TSEs). L-type bovine spongiform encephalopathy (L-BSE) is an atypical form of BSE with an unknown zoonotic potential that is transmissible to cattle and small ruminants. Our current knowledge of bovine atypical prion strains in sheep and goat relies only on experimental transmission studies by intracranial inoculation. To assess oral susceptibility of goats to L-BSE, we orally inoculated five goats with cattle L-BSE brain homogenates and investigated pathogenic prion protein (PrP^sc) distribution by an ultrasensitive in vitro conversion assay known as Real-Time Quaking Induced Conversion (RT-QuIC).

Results

Despite a prolonged observation period of 80 months, all these animals and the uninfected controls did not develop clinical signs referable to TSEs and tested negative by standard diagnostics. Otherwise, RT-QuIC analysis showed seeding activity in five out of five examined brain samples. PrP^sc accumulation was also detected in spinal cord and lymphoreticular system. These results indicate that caprine species are susceptible to L-BSE by oral transmission and that ultrasensitive prion tests deserve consideration to improve the potential of current surveillance systems against otherwise undetectable forms of animal prion infections.

Rapid Screening Technique To Identify Sudan Dyes (I to IV) in Adulterated Tomato Sauce, Chilli Powder, and Palm Oil by Innovative High-Resolution Mass Spectrometry

Sudan dyes are synthetic azo dyes used by industry in a variety of applications. Classified as carcinogenic, they are not allowed in foodstuffs; however, their presence as adulterants in food products has been regularly reported. Here, we describe an innovative screening method to detect Sudan I, II, III, and IV in tomato sauce, palm oil, and chilli powder. The method entails minimal sample preparation, completely avoiding the liquid chromatography phase, followed by detection and identification through atmospheric pressure chemical ionization time-of-flight mass spectrometry, in positive ionization mode. Analytes were efficiently identified and detected in samples, fortified both with individual analytes and with their mixture, with an error in mass identification less than 5 ppm. Limits of identification of the analytes in the fortified samples were 0.5 to 1 mg/kg, depending on the dye and matrix. The method had a linear range of 0.05 to 5 mg/kg and good linear relationships (R² > 0.98). Repeatability was satisfactory, with a coefficient of variation lower than 20%. The method was applied to detect the dyes in real adulterated chilli samples, previously found positive by confirmatory high-performance liquid chromatography-mass spectrometry and ELISA, and in commercial products purchased from supermarkets. In all positive samples, analytes were correctly identified with an error in mass identification lower than 5 ppm, while none of the 45 commercial samples analyzed were found to be contaminated. The proposed new assay is sensitive, with a limit of identification, for all the three matrices, complying with the limits defined by the European Union (0.5 to 1 mg/kg) for analytical methods. Compared with conventional methods, the new assay is rapid and inexpensive and characterized by a high throughput; thus, it could be suitable as screening technique to identify Sudan dyes in adulterated food products.

A randomized single-center study to compare the efficacy and tolerability of tadalafil once daily plus lidocaine anesthetic spray on premature ejaculation

OBJECTIVE

The use of topical local anesthetics in the form of creams, gel or spray is the oldest method of retarding ejaculation. However, several studies have suggested that phosphodiesterase type 5 inhibitors (5-PDEiS) show a potential therapeutic use in the treatment of premature ejaculation (PE). The aim of this study was to compare the efficacy and tolerability of tadalafil-only, tadalafil plus local anesthetic spray (lidocaine), and topical lidocaine spray-only before intercourse on the intravaginal ejaculatory latency time (IELT) of patients with lifelong PE.

PATIENTS AND METHODS

The study included 78 men in stable heterosexual, monogamous relationships (of ≥3 months) who were diagnosed with lifelong PE. The patients were divided into three groups: G1: 25 patients who received lidocaine spray 10 g/100 ml at 5 min before intercourse; G2: 27 patients who received tadalafil 5 mg once daily; G3: 26 patients who treated with tadalafil once daily plus lidocaine spray before planned sexual activity. The treatments were continued for up to three months in all groups. Moreover, the quality of their sexual attempts was rated on a 5-point scale. Follow-up was made at 1-month and 3-month.

RESULTS

Not statistically significant differences emerged between the three groups at baseline. Mean ejaculatory latency time at the 3-month follow-up in G1, G2 and G3 was 3.7±1.3, 3.4±1.5, 5.6±1.7 (p<0.001). Mean satisfaction score was at the 3-month follow-up in G1: 2.8±1.4, in G2: 2.9±1.8, and G3: 3.7±1.5 (p<0.002). None of the patients withdrew from the study because of these adverse events.

CONCLUSIONS

This study demonstrates that tadalafil used daily has a role on treatment in lifelong PE. This action is valid when combined strategically to the synergistic action of lidocaine spray applied before intercourse increasing significantly the mean IELT.

Ten-year experience in the management of distal ureteral stones greater than 10 mm in size

AIM

Extracorporeal shock wave lithotripsy (ESWL) and semirigid ureteroscopy lithotripsy (URSL) have become standards of treatment for ureteral calculi. The aim of this retrospective study was to compare ESWL vs. URSL in terms of safety and efficacy for treatment of large distal ureteral stones ≥ 1cm.

PATIENTS AND METHODS

This investigation assessed 637 patients with distal ureteral stones (10 to 15mm in size). 313 in the ESWL group were treated on an outpatient basis using the LithoDiamond machine without anaesthesia. URSL was performed in 324 patients with a 6-8 Fr semirigid ureterorenoscope and YAG laser under spinal anaesthesia. A successful outcome was defined as the patient being stone free 1 month after treatment. For all patients the parameters, including stone-free rate, operation time, complications, were inserted retrospectively in this study after review of medical records and operating room logs.

RESULTS

The stone-free rate after URSL was 77.5% and 45.4% after ESWL treatment (p<0.001). The mean operative time between two groups was 74.7±9.8 for URSL group and 38.3±7.6 for ESWL group. The average number of office visits was 4.2 and 2.6 in patients treated with ESWL and URSL, respectively. Double j stents were inserted in 28.7% of patients. Twenty-one patients needed rehospitalisations for major complications. However, the differences in the overall complication rate were not statistically significant, with a rate of 16.3% for URSL and 14.4% for ESWL (p=0.246).

CONCLUSION

We have shown that URSL has enough safety and efficacy for the treatment of distal ureteral stones ≥ 1cm. URSL is associated with higher stone clearance rate as compared with ESWL.

The best prostate biopsy scheme is dictated by the gland volume: a monocentric study

OBJECTIVE

Accuracy of biopsy scheme depends on different parameters. Prostate-specific antigen (PSA) level and digital rectal examination (DRE) influenced the detection rate and suggested the biopsy scheme to approach each patient. Another parameter is the prostate volume. Sampling accuracy tends to decrease progressively with an increasing prostate volume. We prospectively observed detection cancer rate in suspicious prostate cancer (PCa) and improved by applying a protocol biopsy according to prostate volume (PV).

PATIENTS AND METHODS

Clinical data and pathological features of these 1356 patients were analysed and included in this study. This protocol is a combined scheme that includes transrectal (TR) 12-core PBx (TR12PBx) for PV ≤ 30 cc, TR 14-core PBx (TR14PBx) for PV > 30 cc but < 60 cc, TR 18-core PBx (TR18PBx) for PV ≥ 60 cc.

RESULTS

Out of a total of 1356 patients, in 111 (8.2%) PCa was identified through TR12PBx scheme, in 198 (14.6%) through TR14PBx scheme and in 253 (18.6%) through TR18PBx scheme. The PCa detection rate was increased by 44% by adding two TZ cores (TR14PBx scheme). The TR18PBx scheme increased this rate by 21.7% vs. TR14PBx scheme. The diagnostic yield offered by TR18PBx was statistically significant compared to the detection rate offered by the TR14PBx scheme (p < 0.003). The biopsy Gleason score and the percentage of core involvement were comparable between PCa detected by the TR14PBx scheme diagnostic yield and those detected by the TR18PBx scheme (p = 0.362).

CONCLUSIONS

The only PV parameter, in our opinion, can be significant in choosing the best biopsy scheme to approach in a first setting of biopsies increasing PCa detection rate.

Efficacy of Tadalafil once daily versus Fesoterodine in the treatment of overactive bladder in older patients

OBJECTIVE

Several studies have suggested that phosphodiesterase type 5 inhibitors (5-PDEi) show a potential therapeutic use in the treatment of overactive bladder (OAB) and male lower urinary tract symptoms (LUTS). The aim of this study was to evaluating the efficacy on OAB symptoms, impact on quality of life and sexual function of tadalafil 5mg once daily in older patients versus fesoterodine 8 mg.

PATIENTS AND METHODS

108 consecutive patients diagnosed with OAB were divided into 2 groups: Group A: 56 patients treated with tadalafil 5 mg once daily; Group B: 52 patients treated with fesoterodine 8 mg, both groups treated for a period of 12 weeks. Eligible patients were men aged ≥ 65 years with OAB symptoms, including urgency and increased frequency during a period of ≥ 1 year and urgency urinary incontinence during a period of ≥ 6 months before enrolment. Patients were asked to complete the 3-day voiding diary prior each scheduled visit at weeks 0, 4 and 12. During these visits, they were administered: Overactive Bladder Symptom Score (OABSS), International Prostate Symptoms Score (IPSS), International Index of Erectile Function (IIEF-5) and Quality of life (QoL).

RESULTS

Not statistically significant differences emerged between the two groups at baseline, both patient groups had similar age and BMI; in each treatment group, the proportion of men ≥ 75 years was approximately 65%. From the results of our study, we can say that a treatment once a day with tadalafil improves not only significantly: micturition/24 hours (p < 0.001), urgency episodes/24 hours (p < 0.003), and urge incontinence episodes (p < 0.001) compared to fesoterodine treatment, but also the quality of life (p < 0.001) and sexual function (p < 0.001) in older patients.

CONCLUSIONS

These analyses demonstrate that tadalafil 5 mg once daily vs. fesoterodine 8 mg is efficacious in the treatment of the symptoms of OAB in older adults, improving also the quality of life and sexual and social life.

Detectable serum PSA after radical prostatectomy. Clinical and pathological relevance of perianastomotic biopsies

BACKGROUND

Few reports have detailed the histopathological results of biopsies of the vesicourethral anastomosis or prostatic bed in patients with a detectable postoperative PSA.

PATIENTS AND METHODS

Among a series of 153 patients who underwent radical retropubic prostatectomies, we analyzed the results of 64 perianastomotic biopsies performed in 17 men with a detectable PSA and no evidence of local recurrence or distant metastases.

RESULTS

Fourteen of the 17 patients had a relapse of prostatic carcinoma; the results of histology in the three pT2bN0M0 patients revealed the presence of benign prostatic hyperplasia in 2 patients and atypical cribriform proliferation in 1 patient. The first two patients are free from prostatic cancer recurrence 36 months after perianastomotic biopsies; a further biopsy performed 6 months after in the third patient showed the presence of prostatic carcinoma.

CONCLUSION

The present study raises the possibility that residual benign tissue, resulting from unintentional disruption of the prostatic capsule during surgery, may be responsible for a detectable postoperative PSA. These cases comprise a histopathological classification described as "intraprostatic surgical margin".