Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator cuff tears management is lacking. This work is divided into two main sessions: in the first, we set questions about hot topics involved in the rotator cuff tears, from the etiopathogenesis to the surgical treatment. In the second, we answered these questions by mentioning Evidence Based Medicine. The aim of the present work is to provide easily accessible guidelines: they could be considered as recommendations for a good clinical practice developed through a process of sys- © C I C E d i z i o n i I n t e r n a z i o n a l i tematic review of the literature and expert opinion, in order to improve the quality of care and rationalize the use of resources. KEY WORDS: rotator cuff tears, Guidelines. IntroductionThe pathologies of the rotator cuff are common and they can be considered as a natural decline of the muscletendon unit in aging with statistically significant increase in frequency after 50 years. The painful shoulder is related in 30-70% of cases to disorders of the rotator cuff. The incidence of rotator cuff tears varies between 5 and 40%, although it is very difficult to establish the real incidence of these lesions, which are often asymptomatic. Currently, the pathology of the rotator cuff is considered to be multifactorial, because extrinsic and intrinsic factors play important roles, although it remains unclear the specific weight of each of these factors (Tab. 1). and often increased in number. staining eosinophilic There is a loss of orientation of homogeneous preparation the cores in relation to the bundles with hematoxylin/eosin. of collagen fibers. Chromatin has a dark color. Muscles, Ligaments and Tendons Grade 4 SevereComplete loss of orientation of The cores are reduced in number, Hyalinization with a homogeneous degeneration the collagen fiber bundles.small, dark and round. appearance. I.S.Mu.L.T -Rotator Cuff Tears Guidelines Grade 1The nuclei become more Colorable mucin between Decreased polarization Occasional clusters oval or round in shape fiber bundles but still fibers: separation of the of capillaries, less than without large cytoplasm. discrete number. individual fibers with one per 10 fields at high maintenance of the magnification. demarcation of the beams. Grade 2The nuclei are circular, Colorable mucin between Separation of the fibers 1-2 cluster of capillaries slightly widened and the fibers with loss with loss of demarcation for 10 fields at high a small amount of demarcation and a clear loss of normal magnification. of cytoplasm becomes of the beams. polarization. visible. Grade 3The nuclei are round, Abundant mucin among Demarcated separation More than two clusters wide with abundant poor colorable collagen. of fibers with complete to 10 fields at high cytoplasm and loss of architecture. magnification. the formation of a gap (chondroid change). © C I C E d i z i o n i I n t e r n a z i o n a l i MethodologyThe Authors were divided into four groups: -Coordinator: he conce...

Two transglutaminase-mediated modifications of the rat epididymal spermatozoon surface were demonstrated in vitro. Transglutaminase was effective in promoting the binding of spermidine to the sperm. Moreover, the enzyme, by reacting with one of the major proteins secreted by the rat seminal vesicle epithelium, produced a modified form of the protein with a higher molecular weight and the capability of binding to the sperm cells. A specific physiological role for the enzyme, bringing about modifications of the rat sperm surface in the seminal fluid environment, is suggested.

The ␤3-adrenoreceptor plays a major role in lipolysis but the role and distribution of ␤3-receptors in other specific sites have not been extensively studied. ␤3-adrenergic receptors are present not only in adipose tissue but also in human gall bladder, colon, prostate, and skeletal muscle. Recently, ␤3-adrenergic receptor stimulation was shown to elicit vasorelaxation of rat aorta through the NO-cGMP signal transduction pathway. Here we show that ␤3-receptors are present in human corpus cavernosum and are localized mainly in smooth muscle cells. After activation by a selective ␤3-adrenergic receptor agonist, BRL 37344, there was a cGMP-dependent but NOindependent vasorelaxation that was selectively blocked by a specific ␤3-receptor antagonist. In addition, we report that the human corpus cavernosum exhibits basal ␤3-receptor-mediated vasorelaxant tone and that ␤3-receptor activity is linked to inhibition of the RhoA͞ Rho-kinase pathway. These observations indicate that ␤3-receptors may play a physiological role in mediating penile erection and, therefore, could represent a therapeutic target for treatment of erectile dysfunction.erectile dysfunction ͉ Rho kinase ͉ endothelin E rectile dysfunction (ED) is defined as the inability to achieve and maintain an erection sufficient to permit satisfactory sexual intercourse. ED is the result of psychological, neurologic, hormonal, arterial, or cavernosal impairment or a combination of two or more of these factors. After sexual stimulation, nerve impulses cause the release of neurotransmitters, including nitric oxide (NO), from the cavernous nerve terminal, resulting in the relaxation of arteries and arterioles with a consequent increase in penile blood flow. NO is also generated by vascular endothelial cells in the corpus cavernosum in response to increased penile blood flow. This process, together with relaxation of the trabecular smooth muscle leading to an increase in the compliance of sinusoids, results in the filling and expansion of the sinusoidal system (1).NO seems to be the principal mediator released both by nerves and endothelial cells after sexual stimulation. The vascular smooth muscle relaxant effect of NO is mediated by cGMP, and the tissue levels of cGMP in the corpus cavernosum are regulated by phosphodiesterase-5 (2, 3). The pathophysiology of ED was not well understood until the discovery was made that NO is the principal neurotransmitter of the nonadrenergic͞noncholinergic nerves that innervate the corpus cavernosum, and that the NO-cGMP signal transduction pathway is the main effector of penile erection (4-6). These findings were followed by the availability of sildenafil for the oral treatment of ED. Despite the clinical success of sildenafil, the physiology of the corpus cavernosum and the pathophysiology of ED are still incompletely understood (3).The ␤ 3 -adrenergic receptor subtype of sympathetic nervous system has been extensively characterized at the structural level (7, 8). Humans, other large mammalian species, and rodents possess ␤ 3 -rec...

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