Paolo Casale

Molecular evidence of male-biased dispersal in loggerhead turtle juveniles

Serum testosterone levels and mtDNA haplotypes were obtained from 65 juvenile loggerhead turtles (Caretta caretta, L.) incidentally caught in the central Mediterranean. The group of specimens carrying a haplotype specific for the northwest Atlantic had higher testosterone levels, and so included more males, than the other one. Since primary sex ratios of northwest Atlantic colonies are strongly skewed towards females, results indicate a male bias among Atlantic turtles entering the Mediterranean. This demonstrates for the first time a sex-biased dispersal of specimens in the pelagic phase, an important factor to be considered in conservation programs.

Relationship among symptom score, prostate volume, and urinary flow rates in 543 patients with and without benign prostatic hyperplasia.

Studies on the relationship among symptom score, urinary flow rate, and prostate volume in men with lower urinary tract symptoms (LUTS) continue to be of great interest.

Sea turtle bycatch and consumption in Egypt threatens Mediterranean turtle populations

Turtle trade in the fish markets of Alexandria was reported up to the late 1990s, motivating conservation initiatives and enforcement of legal protection. To assess the current trade and bycatch levels in Alexandria and other ports we carried out an interview survey of 445 people in 2007, mostly fishermen and fishmongers, in 15 coastal cities and fishing ports along the Mediterranean coast of Egypt. The declared catch rates and official fishing fleet statistics suggest that captures of loggerhead Caretta caretta and green turtles Chelonia mydas are in the order of several thousands per year, possibly > 7,000 per year, mainly from trawling, longlining and set nets. Probably several hundred turtles die each year as a consequence of the high mortality rates typical of these fishing gears. In addition, most fishermen from Alexandria and some fishermen from other regions declared that they kill turtles for meat. Regulations and enforcement appear to be ineffective, as turtles are usually killed and consumed on board or only their meat is landed. Some turtles are still traded on the black market in some Alexandria fish markets. The overall mortality probably represents an unsustainable toll on the Mediterranean loggerhead and green turtle populations, and the perception of fishermen is that turtle numbers are declining. Mitigating the identified threats is thus urgent. In particular, intentional killing should be tackled through its cultural drivers, and measures to reduce bycatch mortality need to be tested and implemented.

Relationship among age, prostate‐specific antigen, and prostate volume in men with lower urinary tract symptoms (LUTS) and in different groups of men with and without benign and malignant prostate diseases

In order to enhance prostate‐specific antigen (PSA) as a predictor of prostate cancer, it is necessary to understand the characteristics of this tumor marker in a population of men without evidence of prostate cancer but who are at risk for developing the condition.

Biases and best approaches for assessing debris ingestion in sea turtles, with a case study in the Mediterranean.

In a sample of 567 loggerhead turtles (Caretta caretta) from the central Mediterranean, debris occurrence varied according to methods and turtle source, and was up to 80% in pelagic turtles. Frequencies of plastic types, size and color are also reported. These results and a critical review of 49 studies worldwide indicate that: (i) the detected occurrence of plastic (% turtles) is affected by several factors (e.g., necropsy/feces, ecological zone, type and date of finding, captivity period for feces collection), (ii) mixed dataset and opportunistic approaches provide results which are biased , not comparable, and ultimately of questionable value, (iii) only turtles assumed to have had a normal feeding behaviour at the time of capture or death should be considered, (iv) turtle foraging ecology and possible selectivity may undermine the use of turtles as indicator species for monitoring marine litter, as recently proposed for the Mediterranean.

Barnacles (Cirripedia, Thoracica) and associated epibionts from sea turtles in the central Mediterranean

The association patterns and ecology of sea turtle epibionts, and especially obligate epibionts, are still poorly known. Epibiont communities were investigated in the central Mediterranean Sea in relation to the host habitat and seven species of barnacles, three amphipods, one crab, and one tanaid were found on 117 loggerhead sea turtles, Caretta caretta. Particular attention was given to barnacles, some of them being obligate turtle epibionts, with a total of 3330 individuals examined, among which high intraspecific aggregation was observed. Results indicate that (i) the species composition of barnacles varies among turtles frequenting not only different geographic areas but also different habitats in the same area, (ii) different species have marked preferences for hosts frequenting pelagic vs. benthic habitats, and also (iii) for body parts of the host representing microhabitats with different features and trophic opportunities, (iv) settlement is favoured by the presence of conspecific individuals and possibly also (v) by individuals of related species, notably Chelonibia testudinaria that may act as a pioneer species, and finally (vi) barnacles show rapid turnover on turtles, with relatively short lives, rapid growth, and high juvenile mortality.

Clinical performance of prostate health index in men with tPSA>10ng/ml: Results from a multicentric European study.

BACKGROUND Evidence regarding the diagnostic accuracy of a [-2]proPSA derivative, namely, the prostate health index (PHI), to predict the presence of prostate cancer (PCa) in individuals with high total prostate-specific antigen (tPSA) levels is lacking. We tested the hypothesis that these markers could assist clinicians in the biopsy decision path of patients with tPSA>10ng/ml. METHODS The primary endpoint was to evaluate the sensitivity, specificity, and diagnostic accuracy of PHI in determining the presence of PCa at biopsy in comparison to tPSA, free PSA, and % of free to total PSA. We calculated the number of prostate biopsies that could have been spared by using this marker to decide whether or not to perform a biopsy. A secondary endpoint was to determine the relationship between PHI and PCa characteristics. RESULTS The PCa was diagnosed in 136 of 262 patients (51.9%). Total PSA and PHI values were significantly higher (P<0.005) and % of free to total PSA values significantly lower (P<0.0001) in patients with PCa relative to those with a negative biopsy. In multivariable logistic regression models, PHI achieved the independent predictor status and significantly increased the accuracy of the base multivariable model by an extent of 8.2% (P = 0.0005). The inclusion of PHI in the biopsy decision path would decrease the number of unnecessary biopsies by an extent of 50.0%, while missing only few cases with clinically significant PCa. Finally, Gleason score was significantly related to PHI levels. CONCLUSIONS The results of our study support the diagnostic effectiveness of PHI even in patients with tPSA >10ng/ml. Further validation studies with larger sample size are needed to corroborate our findings.

Active surveillance for low-risk non-muscle-invasive bladder cancer: Mid-term results from the Bladder cancer Italian Active Surveillance (BIAS) project.

To report the oncological safety and the risk of progression for patients with non‐muscle‐invasive bladder cancer (NMIBC) included in an active surveillance (AS) programme after the diagnosis of recurrence.

Active Surveillance for Low Risk Nonmuscle Invasive Bladder Cancer: A Confirmatory and Resource Consumption Study from the BIAS Project

Purpose: We investigated predictive factors of failure and performed a resource consumption analysis in patients who underwent active surveillance for nonmuscle invasive bladder cancer. Materials and Methods: This prospective observational study monitored patients with a history of pathologically confirmed stage pTa (grade 1‐2) or pT1a (grade 2) nonmuscle invasive bladder cancer, and recurrent small size and number of tumors without hematuria and positive urine cytology. The primary end point was the failure rate of active surveillance. Assessment of failure predictive variables and per year direct hospital resource consumption analysis were secondary outcomes. Descriptive statistical analysis and Cox regression with univariable and multivariable analysis were done. Results: Of 625 patients with nonmuscle invasive bladder cancer 122 with a total of 146 active surveillance events were included in the protocol. Of the events 59 (40.4%) were deemed to require treatment after entering active surveillance. Median time on active surveillance was 11 months (IQR 5–26). Currently 76 patients (62.3%) remain under observation. On univariable analysis only time from the first transurethral resection to the start of active surveillance seemed to be inversely associated with recurrence‐free survival (HR 0.99, 95% CI 0.98–1.00, p = 0.027). Multivariable analysis also revealed an association with age at active surveillance start (HR 0.97, 95% CI 0.94–1.00, p = 0.031) and the size of the lesion at the first transurethral resection (HR 1.55, 95% CI 1.06–2.27, p = 0.025). The average specific annual resource consumption savings for each avoided transurethral bladder tumor resection was &U20AC;1,378 for each intervention avoided. Conclusions: Active surveillance might be a reasonable clinical and cost‐effective strategy in patients who present with small, low grade pTa/pT1a recurrent papillary bladder tumors.

Managing chronic bladder diseases with the administration of exogenous glycosaminoglycans: an update on the evidence

Although the pathophysiology of acute chronic cystitis and other ‘sensory’ disorders, i.e. painful bladder syndrome (PBS) or interstitial cystitis (IC), often remains multifactorial, there is a wide consensus that such clinical conditions may arise from a primary defective urothelium lining or from damaged glycosaminoglycans (GAGs). A ‘cascade’ of events starting from GAG injury, which fails to heal, may lead to chronic bladder epithelial damage and neurogenic inflammation. To restore the GAG layer is becoming the main aim of new therapies for the treatment of chronic cystitis and PBS/IC. Preliminary experiences with GAG replenishment for different pathological conditions involving the lower urinary tract have been reported. There is a range of commercially available intravesical formulations of these components, alone or in combination. Literature evidence shows that exogenous intravesical hyaluronic acid markedly reduces recurrences of urinary tract infections (UTIs). Patients treated with exogenous GAGs have fewer UTI recurrences, a longer time to recurrence and a greater improvement in quality of life. Exogenous intravesical GAGs have been used for the treatment of PBS/IC. Despite the limitations of most of the studies, findings confirmed the role of combination therapy with hyaluronic acid and chondroitin sulfate as a safe and effective option for the treatment of PBS/IC. To prevent and/or treat radiotherapy and chemotherapy induced cystitis, GAG replenishment therapy has been used showing preliminary encouraging results. The safety profile of exogenous GAGs has been reported to be very favourable, without adverse events of particular significance.