bluuebunny/crossref_metadata_2025 huggingface dataset:
184 Does Medicaid Cover Artificial Urinary Sphincter Surgeries? A State-by-State Analysis
Authors: Loeb C. , Barnard J. , Yafi F. , Schneider D.
Published: April 2022

Introduction

Artificial urinary sphincter (AUS) placement is the most effective long-term treatment for men with severe stress urinary incontinence (SUI), typically due to post-prostatectomy intrinsic sphincter deficiency. Published success rates range from 59 to 90 percent and the procedure is associated with very high patient satisfaction. Existing literature regarding insurance coverage and physician reimbursement overwhelmingly focuses on Medicare and commercial plans, leaving a knowledge gap with respect to the Medicaid population, which may contribute to inequitable utilization of this treatment modality for SUI.

Objective

To quantify Medicaid coverage for AUS placement and revision for male SUI by state.

Methods

State Medicaid websites were utilized to access publicly available physician fee schedules. Individual search queries were performed for CPT codes 53444, 53445, 53446, and 53447, which represent insertion of tandem cuff, insertion of inflatable urethral/bladder neck sphincter, removal of inflatable urethral/bladder neck sphincter, and removal and replacement inflatable urethral/bladder neck sphincter. Data were recorded for each device, including the coverage status and physician fees.

Results

Medicaid physician fee schedules were accessible for 49 out of 50 US states. All 49 of these states reported coverage for removal with and without revision of the AUS, 48 states reported coverage for insertion of an AUS, and 48 states reported coverage for insertion of a tandem cuff. Means and range of physician reimbursement for each AUS related procedure were $1,007.59 ($181.84-$10,960.90) for insertion of tandem cuff (53444), $1,087.40 ($199.89-$11,949.86) for insertion of AUS (53445), $596.93 ($146.90-$1893.12) for removal of AUS (53446), and $1020.14 ($208.55-$11,586.74) for removal and replacement of AUS (53447).

Conclusions

AUS related surgeries in the Medicaid population are covered by nearly all states as confirmed by publicly available data. Interestingly, removal with and without replacement of AUS was covered by all 49 states with publicly reported data. Knowledge of Medicaid coverage for AUS related surgery may result in improvement in the utilization of this treatment for male SUI and may improve access to care in the Medicaid population.

Disclosure

No
200 Hemoglobin A1c does not Predict Severity of Erectile Dysfunction
Authors: Myers A. , Haehn D. , Ball C. , Shumate A. , Broderick G.
Published: April 2022

Introduction

Erectile dysfunction (ED) is a common consequence of Diabetes Mellitus (DM). The medical literature is inconclusive as to which DM related morbidities improve with better glycemic control. Surgical literature often associates infection outcomes with DM and with glycemic control. There is limited research on the relationship between Hemoglobin A1c and severity of vascular ED.

Objective

To evaluate the relationship between hemoglobin A1c (HbA1c) and severity of vascular ED in men with DM diagnosed with vascular ED by penile color duplex Doppler ultrasound (CDDU).

Methods

We retrospectively analyzed patients with a history of DM who underwent intracavernous injection followed by CDDU at our institution between 2005 and 2019. CDDU findings including peak systolic velocities (PSV), primary diagnosis after CDDU, and resistive indices (RIs) were recorded. Doppler diagnosis was based on post stimulation PSV and RI. Arterial Insufficiency (AI) was classified as PSV < 25 cm/s (severe), or (moderate) PSV 25-34.9 cm/s with RI ≥ 0.90. Corporal veno-occlusive disease (CVOD) was classified as PSV ≥ 35 cm/s with RI < 0.90. Mixed ED was classified as PSV 25-34.9 cm/s with RI < 0.90. HbA1c was recorded at time of assessment. Among our cohort of 1490 men who had CDDU, 520 had DM: 130 with CDDU diagnosis of ED, 270 with CDDU diagnosis of ED + Peyronie's disease (PD), 94 with PD alone and 26 with normal vascular erections on CDDU and no PD. The 130 patients with DM diagnosed with ED without presence of PD were included in our analysis. We used a Kruskal-Wallis rank sum test to evaluate the overall association between HgA1c and CDDU diagnosis (AI, CVOD, and mixed ED). Spearman rank correlation tests were used to explore the relationship of HbA1C with PSV and RI.

Results

Among the 130 men with DM + ED without PD, the median age was 61 y (range 20-79 y), 76 (58%) had hypertension, 37 (28%) had heart disease, median BMI was 30.7 kg/m2 (range 21.2-48.9 kg/m2), and median HgbA1C was 7.0 (range 5.0-11.0). PDE-5 inhibitor use was reported in 119/129 (92.2%) and among those who reported using it 108/119 (90.8%) reported PDE-5 inhibitor failure. CDDU diagnoses were 53 (40.8%) AI, 44 (33.8%) CVOD, and 33 (25.4%) mixed vascular (25%). The median (interquartile range) HbA1c was 7.0 (6.1-7.8) in men with AI, 7.1 (6.3-8.0) in men with CVOD, and 6.7 (6.1-7.0) in men with mixed ED. We did not find evidence of a relationship between HbA1c and severity of vascular ED (Kruskal-Wallis test P = 0.25). We also did not find evidence of a correlation of HbA1c with either post-stimulation PSV (Spearman rank correlation = 0.04, P=0.68) or RI (Spearman rank correlation = -0.03, P = 0.79).

Conclusions

Median HbA1c did not vary with the vascular diagnosis of men with DM + ED (AI vs. CVOD vs. Mixed Vascular). DM is a significant risk factor for ED and HbA1c is used to monitor and advise patients. We found no predictive relationship between HbA1c and type of vascular ED as defined by CDDU.

Disclosure

No
214 Reconstruction of AUS Cuff Erosion: Defect Size Predicts Prognosis
Authors: Chertack N , Nealon S , Joice G , Caldwell K , Kavoussi M , Dropkin B , Ortiz N , Baumgarten A , Shakir N , Sanders S , Hudak S , Morey A
Published: April 2022

Introduction

In-situ urethroplasty (ISU) has been proposed in conjunction with device explant as an acute management strategy after artificial urinary sphincter (AUS) cuff erosion. Previous studies have not shown a clear relationship between extent of erosion and long-term prognosis.

Objective

We hypothesize that more extensive erosions are associated with higher rates of lower urinary tract complications (LUTC) and increased need for urinary diversion (UD).

Methods

We performed a retrospective study of patients who underwent ISU for AUS cuff erosion from June 2007 to December 2020 with a minimum of 90-day follow up. Patients were stratified into two groups based on the degree of urethral erosion determined endoscopically at the time of device explant - mild erosions (<33% circumferential defect) and major erosions (> 33%). Outcomes included LUTC, AUS reimplantation, and UD. LUTC was defined as urethral strictures, diverticulum, fistulas, and erosions of a secondary AUS. UD was defined as suprapubic tube placement with or without urethral ligation or ileal conduit creation. Kaplan-Meier curves were created to compare outcomes between groups.

Results

A total of 40 patients underwent ISU for urethral cuff erosion and met the follow-up criteria. Median patient age was 76 years old with median erosion defect size of 46% (IQR: 20-50%); 15 men (37.5%) had mild erosions and 25 (62.5%) had major erosions. The overall LUTC rate was 53.5% with significantly fewer complications noted with mild erosions (28.6% vs 65.4%, p = 0.002) (Figure 1). Ultimately, 35.0% of patients required permanent UD with decreased rates in the case of mild erosions (13.3% vs 48.0%, p = 0.04) (Figure 2). On Kaplan-Meier analysis, mild erosion was associated with improved LUTC-free and UD-free survival but not associated with AUS reimplantation.

Conclusions

Prognosis after AUS cuff erosion is associated with size of the urethral defect. Patients with extensive cuff erosion are at high risk for LUTCs and permanent UD.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast
220 Time to presentation of Peyronie's Disease in the era of injections and information
Authors: Ly L , Morales-Lopez R , Metro M
Published: April 2022

Introduction

Characterized by acquired fibrosis of the tunica albuginea, Peyronie's disease (PD) can cause penile curvature, pain, and plaque, as well as erectile dysfunction and difficulty with penetration. Using online surveys in 2007-2008, Dibenedetti et al found that the prevalence of PD in adult men in the US was 0.5% based on PD diagnosis; 0.8% based on PD diagnosis or treatment of PD; and 13.1% based on diagnosis, treatment, or any symptom of PD. They found that 68% of patients saw a doctor when they first noticed symptoms, at a mean time to see a doctor of 16.8 (SD = 5.5) months. The other third, or 32%, of patients who sought treatment later in the disease course, had a mean time of 46.2 (SD = 8.4) months. Only 5% of patients presented with current pain, thus in the active phase.

Objective

Our study investigated how patient presentation for PD changed after two sentinel events: 1) the FDA approval of intralesional injections of collagenase clostridium histolyticum (CCH) in 2013, and 2) the national publicity surge for PD in 2016-2017. We then aimed to compare this data to a prior study by Dibenedetti et al conducted for patients in 2007-2008.

Methods

Our retrospective, single institution study was conducted as a chart review of patients presenting from 2014 to 2020 with penile curvature, pain, or plaque. Descriptive statistics were used to compile data at the time of initial evaluation by the reconstructive urologist, including patient demographics, pre-treatment assessments, and time to evaluation.

Results

Our study included 152 adult men, and mean age was 57.9 years old (SD = 8.1) (Table 1). Initial symptoms included penile curvature (87%), pain (30%), and plaque (8%). 38% of patients were in the active phase of PD at time of evaluation. The mean time from onset of symptoms to evaluation by the specialized urologist was 27.5 months (SD = 53.2, range 1 to 360 months) (Figure 1). For the 2/3 of patients, or 68%, who had the shortest time to evaluation, the mean duration of PD symptoms prior to evaluation by a specialized urologist was 10.0 months (SD = 4.6) (Figure 2). For the 1/3 of patients, or 32%, who had the longest time to evaluation, the mean duration of PD symptoms prior to evaluation was 69.7 months (SD = 80.6).

Conclusions

Over the years, the majority of PD patients are presenting sooner in their PD course. The outlier patients, or those who have suffered from PD for a relatively long time, are also presenting for evaluation and treatment. These trends are likely influenced by the FDA approval of intralesional injections of CCH and by the national media efforts to raise awareness of the underdiagnosed and undertreated disease.

Disclosure

No
223 Women in Medicine: Career vs Family. Can we have both?
Authors: Parikh N , Ahmed M , Robinson M , Mcgriff S , Olive E , Helo S
Published: April 2022

Introduction

Women in healthcare are faced with unique challenges that may increase their risk of infertility including irregular work hours, occupational hazards due to radiation or chemicals, and advanced maternal age.

Objective

We sought to investigate live birth rates of female healthcare workers presenting with infertility compared to their non-healthcare counterparts.

Methods

After obtaining IRB approval, a retrospective review of all hospital employees (and their partners) presenting for a fertility evaluation between 2013-2019 was conducted. Patient age, BMI, history of previous live birth, occupation, use of assisted reproductive technology and female fertility factor were recorded. Couples with at least 12 months of follow up from initial presentation as well as a documented semen analysis were included in the study. Normal semen parameters were defined by the World Health Organization 2010 criteria. Logistic regression analysis was conducted to identify factors associated with increased likelihood of live birth.

Results

Of the 934 female partners identified, 445 were healthcare workers and 489 non-healthcare workers. Female age, female BMI, smoking status, and history of previous live birth were not statistically significant between groups. No differences in male partner age, male BMI, semen parameters and presence of male factor were noted. Live birth rate was greater in female health care workers compared to non-healthcare workers, 76.1 vs. 69.6%, respectively, p=0.042.

Conclusions

In this cohort of hospital employees, female healthcare workers had a higher live birth rate despite no differences in age, BMI, rate of female factor infertility, use of assisted reproductive technology, or male partner factors. While no differences in fertility were noted for female health care workers in this study, further research is needed to identify subgroups within the healthcare population that may be at greater risk for infertility.

Disclosure

No
240 Cylinder Realignment for Impending Inflatable Penile Prosthesis Erosion
Authors: Osmonov D , Ragheb A , Junemann K , Wilson S
Published: April 2022

Introduction

Due the low incidence of impending inflatable penile prosthesis (IPP) erosion, low volume implanters may be challenged by these cases. In many situations, capsule formation around the implant may suffice to hinder cylinder migration. Nevertheless, severe cases may require prompt recognition and repair otherwise will transform into infected implantations once the implant exits the skin.

Objective

In this step-by-step video we demonstrate the Mulcahy technique for distal corporoplasty and cylinder realignment performed on a case of impending left side IPP erosion. We hope this video serves as an instructive resource for treating these particular cases.

Methods

Our case was a male patient who had a previously challenging implant revision with difficult corporal dilation into severely scarred corporal bodies. This may have been the potential cause for this complication. Through a conventional penoscrotal access, we began by utilizing the cutting current to access and explant all components of the old implant. Due to the difficulty in reservoir removal, we opted to drain it and leave it in place (“Drain and retain”). In addition to the conventional instruments required for IPP implantation, the special instruments we utilized were the Wilson's backward cutting scissors as well as the Uramix cavernotomes (http://www.uramix.com/category/og/). A second small incision was performed localized at the site of presumed distal corporal perforation for access and repair of the problem. After creating the correct corporal pathway and obliterating the false track, hence concluding distal corporoplasty, a new IPP was implanted. The new reservoir was implanted ectopically, contralateral to the retained one. Although the original technique does not include device exchange and wash out, we preferred the latter to avoid the increased risk of infection associated with same device revision implantations.

Results

A new IPP was successfully implanted into the newly realigned distal corporal pathway. The patient demonstrated an eventless postoperative follow-up period. After 7 months of implant usage, the patient had a normal looking erect penis and was highly satisfied with his implant.

Conclusions

We consider the Mulcahy distal corporoplasty to be a safe and feasible approach to address the daunting complication of impending IPP cylinder erosion, excluding the need for total corporal exposure.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast
122 Increasing Utilization of Outpatient Surgery for Inflatable Penile Prosthesis Placement: Contemporary Data from the National Surgical Quality Improvement Program Database
Authors: Shelton TM , Fustok J , Pandit A , Machado B , Payakachat N , Davis R , Benson C , Raheem O
Published: April 2022

Introduction

The inflatable penile prosthesis (IPP) is the gold-standard surgical treatment for medically refractory erectile dysfunction.

Objective

The aim of this study is to characterize the differences between inpatient (IP) and outpatient (OP) practice patterns for IPP placement while utilizing the National Surgical Quality Improvement Program (NSQIP) database to identify and compare factors and outcomes associated with each approach.

Methods

NSQIP database was queried for men undergoing IPP placement between 2009-2019. Patients were classified as either IP (>24 hours) or OP (<24 hours). Baseline demographics, operating time, and complications were compared between the two groups. Multivariate logistic regression evaluated factors associated with discharge timing and 30-day complications.

Results

A total of 456 patients were identified and classified: 185 as IP and 271 as OP. Statistically significant differences were noted in co-morbidities favoring inpatient surgery between the groups including chronic steroid use, chronic obstructive pulmonary disease, congestive heart failure, acute renal failure, end-stage renal disease, and bleeding disorders. Year of surgery was also significant, with a notable increase in outpatient surgery beginning in 2015 (p<0.001). The 30-day complication rates between both groups differed notably for any complication (20.5 IP, 3.3% OP, p< 0.001), any readmission (9.7% IP, 2.2% OP, p <0.001), intraoperative or post-operative transfusion (8.1% IP, 0% OP, p< 0.001), and sepsis (4.1% IP, 0% OP, p<0.001). Operative time was shorter in the OP group (159.10 minutes IP, 133.50 minutes OP, p <.001).

Conclusions

IPP placement is increasingly utilized as an OP procedure. OP surgery favors patients with few medical co-morbidities and shorter operative times. Beginning in 2015, trends began to shift toward OP procedures. In the era of increasing hospital costs, a shift toward outpatient prosthetic surgery has increased.

Disclosure

No
128 Perioperative Morbidity of Penile Prosthesis Placement with Concurrent Surgery: Analysis of the National Surgical Quality Improvement Program Database
Authors: Khalil M , Acharya M , Kamel M , Davis R , Machado B , Raheem O
Published: April 2022

Introduction

There is always a concern whether performing concurrent surgery along with penile prosthesis (PP) placement may increase the risk of complications, specifically postoperative infection. Contemporary reports on perioperative morbidity of PP placement with concurrent surgery are scarce.

Objective

To assess the 30-day postoperative morbidity in patients undergoing insertion of PP with concurrent surgery utilizing the National Surgical Quality Improvement Program (NSQIP).

Methods

From 2005-2016, the NSQIP database was queried to identify males who underwent placement of PP combined with other procedure. Patient demographics, postoperative morbidity including complications, readmission and re-operation rates were recorded and compared between the two groups. Student t test and Chi-square or Fischer's exact test were used as appropriate.

Results

142 patients were identified and included in the study. The most prevalent concurrent procedures were surgical correction of Peyronie's disease (n=54, 38%), insertion of artificial urinary sphincter (n=27, 19%), and repair of inguinal or abdominal hernia (n=25, 17.6%). A majority of patients were white (65.5%), aged 60-69 (42.9%) and received the combined procedure in 2016 (30.3%). Fifty percent of patients were ASA class I/II and 50% were class III-V. Mean body mass index (±SD) was 30.1±4.8. Mean operating time (±SD) and length of stay (±SD) were 139.4±62.7 minutes and 2.0±1.0 days, respectively. Overall, postoperative complications occurred in 7 patients (4.9%) only. Specifically, there were urinary tract infection (n=4, 2.8%), superficial surgical site infection (n=2, 1.4%) and unplanned intubation (n=1, 0.7%). Similarly, reoperation and readmission rates were low (0.7% and 2.8%, respectively).

Conclusions

Overall the 30-day postoperative morbidity, reoperation and readmission rates of PP insertion with concurrent surgery were low. The majority of the reported complications were minor. Concurrent surgery with PP insertion does not seem to significantly increase the risk of postoperative morbidity.

Disclosure

No
133 Pelvic Floor HIFEM in Men Improves Ejaculation
Authors: Brandeis J , Lu S
Published: April 2022

Introduction

High-Intensity Focused Electromagnetic (HIFEM) field technology utilizes rapidly changing magnetic fields that generate electrical currents in the underlying tissue where it depolarizes motor neurons and causes muscle contractions. BTL Emsella provides non-invasive electromagnetic stimulation of pelvic floor musculature for the purpose of rehabilitation of weak pelvic muscles and restoration of neuromuscular control for the treatment of male and female incontinence. Novel protocol U2 is intended for men and uses a field intensity max of 2.5 T and a 10 cm depth of penetration for 28 minutes.

Objective

Determine the effects of High-Intensity Focused Electromagnetic (HIFEM) field technology on the intensity and duration of ejaculation in men, with additional observations on erectile function using the IIEF-15 and urination using the IPSS.

Methods

We looked at the effects of HIFEM on ejaculation, erectile function, and urination. Our IRB-approved protocol was one 28 minutes pelvic floor treatment per week for 4 weeks. At baseline, end of treatment, and one month post-treatment, the patient completed the IIEF-15, IPSS, and the LuBE Score, a four-question 5 point Likert style questionnaire created specifically for this study to investigate patient-reported aspects of orgasm, including volume, force, duration, and intensity of ejaculation. 0 is no change, 1 is increased, 2 is dramatically increased, -1 is decreased, -2 is dramatically decreased. Men participated with their sexual partners who also received four weekly treatments.

Results

12 men, average age of 57, completed the protocol. The range of the LuBE score is -8 to 8. The LuBE Score increased from baseline 0 up to 2.1 (median is 3 with a range of -1 to 5) to 2.7 (median of 3 with a range of 0 to 4) one month after the completion of treatment. The IIEF-15 increased from 54 at baseline to 60.3 at the completion of treatment and 60.4 one month after the completion of treatment. The IPSS declined from 7.1 to 4.6 at the completion of treatment and down to 3.3 one month after th

Conclusions

We conclude that the U2 protocol for HIFEM boosts the strength of the bulbocavernosus and ischiocavernosus muscle and the pelvic floor resulting in an increase in volume, force, duration and intensity of ejaculation. In addition, there was a six-point increase in IIEF-15 score. There was a 3 to 4 point drop in IPSS score. We were surprised to see improvements in IIEF-15 and IPSS, and this should be investigated further. COVID limited patient recruitment, but the results indicate that pelvic HIFEM potentially improves ejaculation. Based on patient communications, I believe that more treatments than the four provided will add to the benefits. I plan on studies with more participants and extended treatment sessions.

Disclosure

Yes, this is sponsored by industry/sponsor: BTL

Clarification: No industry support in study design or execution

Any of the authors act as a consultant, employee or shareholder of an industry for: AFFIRM Science
148 Racial Disparities in Sexual Health Care Received by Kidney Transplant Recipients in a Metropolitan Area
Authors: Santamaria A , Yoffe DA , Modiri N , Shahinyan R , Jayadevan R , Islam M , Eleswarapu S , Mills J
Published: April 2022

Introduction

Issues regarding disparities in urologic health care delivery and access among different racial and ethnic groups in the United States is well described in oncologic care. Such issues also exist in male sexual health care and kidney transplantation, but are less studied when these areas overlap. As a result of improved outcomes with kidney transplants (KT), quality of life (QOL) metrics become increasingly important to address. Sexual function is one such QOL domain in which KT recipients are particularly affected.

Objective

This study aims to elucidate the racial composition of male KT recipients with and without a sexual health issue, how that compares to the racial breakdown of the metropolitan area, and whether a particular racial group is more likely to be diagnosed with sexual dysfunction before versus after their transplant surgery.

Methods

After obtaining IRB approval we retrospectively reviewed the charts of men age 18 and older who received a KT at a single institution in a metropolitan city between January 2016 and February 2020. We sought to identify those with a diagnosis of ED, low or decreased libido, hypogonadism, ejaculatory dysfunction, Peyronie's disease (PD), or male factor subfertility. Demographic information, time of initial diagnosis of ED, and treatment profile were documented. The causes of end stage renal disease (ESRD) were obtained, but not controlled for.

Results

A total of 833 men received KT's during this time, 43% of which identified as Hispanic or Latino, 26% white (non-Hispanic or Latino), 13% Asian, and 12% Black. Of the men with a sexual dysfunction diagnosis, 26% identified as Hispanic or Latino, 31% white (non-Hispanic or Latino), 14% Asian, and 23% Black (Figure 1). No men were found to have a diagnosis of ejaculatory dysfunction, PD, or male factor subfertility. Latino men were more likely to have a diagnosis of sexual dysfunction after receiving a KT when compared to their non-Latino counterparts (OR: 2.91, 95% CI: [0.41 to 20.90]). Finally, there was no statistically significant difference in treatment patterns for ED between racial groups.

Conclusions

In this study we show that the overall racial composition of men age 18 and over who received a KT is representative of the demographics in its corresponding metropolitan city. However, we do note that Latino men are underdiagnosed for sexual dysfunction issues when compared to their non-Latino counterparts. Latino men are also more likely to have a diagnosis of sexual dysfunction after their transplant, likely implying they suffer from these conditions longer than men of other races. These findings highlight the need for continued research to reduce and eliminate health care disparities in the sexual health arena, specifically for patients with ESRD.

Disclosure

No
150 When to Suspect Artificial Urinary Sphincter Cuff Erosion: An Analysis of Presenting Signs and Symptoms
Authors: Diao L , Nealon S , Wolfe A , Dropkin B , Joice G , Sanders S , Hudak S , Morey A
Published: April 2022

Introduction

Presenting signs and symptoms of artificial urinary sphincter (AUS) cuff erosion are not well established in the urological literature.

Objective

We sought to characterize the most common presentation and clinical risk factors for erosion to distinguish the relative frequency of symptoms that should trigger further evaluation in these unfortunate patients.

Methods

We retrospectively reviewed our large tertiary center database to identify men who presented with cuff erosion between 2007 and 2020. A similar cohort of men who underwent AUS placement without erosion were randomly selected from the same database for comparison. Risk factors for cuff erosion – pelvic radiation, androgen deprivation therapy (ADT), high-grade prostate cancer (Gleason score ≥ 8) – were recorded for each patient. Presenting signs and symptoms of erosion were grouped into three categories: obstructive symptoms, worsening incontinence, and localized scrotal inflammation (“pump-itis”).

Results

Of 893 men who underwent AUS placement during the study interval, 61 (6.8%) suffered cuff erosion. The vast majority of erosion patients (66%) presented with scrotal inflammatory changes including tenderness, erythema, and swelling (Figure). Fewer men reported obstructive symptoms (26/61, 43%) and worsening incontinence (21/61, 34%). Men with worsening incontinence presented significantly later than those with pump-itis or obstructive symptoms (37 ± 48 vs. 14 ± 18 vs. 15 ± 16 months after AUS insertion, p<0.01). Relative to the non-erosion control group (n=95), men who suffered erosion had a higher prevalence of pelvic radiation (71 vs. 53%, p=0.03). Rates of ADT (41 vs. 40 %, p = 0.96) and high-grade prostate cancer (39 vs. 38 %, p = 0.91) were similar. There was no difference in age at AUS placement (73 ± 7 vs 68 ± 7 years, p=0.70).

Conclusions

AUS cuff erosion most commonly presents as scrotal inflammatory symptoms. Obstructive voiding symptoms and worsening incontinence are also common. Any of these symptoms should prompt further investigation of cuff erosion.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast
The Pleasure Problem and the Spriggean Solution
Authors: PALLIES DANIEL
Published: April 2022

Some experiences—like the experience of eating cheesecake—are good experiences to have. But when we try to explain why they are good, we encounter a clash of intuitions. First, we have an objectivist intuition: plausibly, the experiences are good because they feel the way that they do. Second, we have a subjectivist intuition: if a person were indifferent to that kind of experience, then it might fail to be good for that person. Third, we have a possibility intuition: for any kind of experience, possibly there is a subject who is indifferent to that kind of experience. The pleasure problem is the problem we face in reconciling these three claims. I explain the problem and argue for a solution. I argue that we ought to reject the most common solutions: rejecting the objectivist or subjectivist intuitions. Instead, we ought to follow Timothy Sprigge in rejecting the possibility claim. We should embrace the view that experiences bear necessary connections to our attitudes.
Risk factors and outcomes associated with external ventricular drain infections
Authors: Walek Konrad W. , Leary Owen P. , Sastry Rahul , Asaad Wael F. , Walsh Joan M. , Horoho Jean , Mermel Leonard A.
Published: April 2022

Background:

Insertion of an external ventricular drain (EVD) is a common neurosurgical procedure which may lead to serious complications including infection. Some risk factors associated with EVD infection are well established. Others remain less certain, including specific indications for placement, prior neurosurgery, and prior EVD placement.

Objective:

To identify risk factors for EVD infections.

Methods:

We reviewed all EVD insertions at our institution from March 2015 through May 2019 following implementation of a standardized infection control protocol for EVD insertion and maintenance. Cox regression was used to identify risk factors for EVD infections.

Results:

479 EVDs placed in 409 patients met inclusion criteria, and 9 culture-positive infections were observed during the study period. The risk of infection within 30 days of EVD placement was 2.2% (2.3 infections/1,000 EVD days). Coagulase-negative staphylococci were identified in 6 of the 9 EVD infections). EVD infection led to prolonged length of stay post–EVD-placement (23 days vs 16 days; P = .045). Cox regression demonstrated increased infection risk in patients with prior brain surgery associated with cerebrospinal fluid (CSF) diversion (HR, 8.08; 95% CI, 1.7–39.4; P = .010), CSF leak around the catheter (HR, 21.0; 95% CI, 7.0–145.1; P = .0007), and insertion site dehiscence (HR, 7.53; 95% CI, 1.04–37.1; P = .0407). Duration of EVD use >7 days was not associated with infection risk (HR, 0.62; 95% CI, 0.07–5.45; P = .669).

Conclusion:

Risk factors associated with EVD infection include prior brain surgery, CSF leak, and insertion site dehiscence. We found no significant association between infection risk and duration of EVD placement.
Campus Fiction and Critical University Studies from Below: Disgrace, Welcome to Our Hillbrow, and the Postcolonial University at the Millennium
Authors: Gulick Anne W.
Published: April 2022

Two of South African literature’s best-known titles from the turn of the twenty-first century are works of campus fiction that rarely get recognized as such. In this article I read J. M. Coetzee’s Disgrace (1999) and Phaswane Mpe’s Welcome to Our Hillbrow (2001) as novels whose figuration of the university is far more central to their treatment of the contradictions and ambiguities that characterize postapartheid South Africa than is generally acknowledged. In the course of narratives that seem largely focused on other things, these texts offer up a distinctly South African but also distinctly postcolonial variety of campus fiction, and a critical engagement with the neoliberal university and the conditions under which upward mobility and intellectual inquiry take shape in the twenty-first-century global south. Coetzee and Mpe suggest capacious and transformative, if also deeply ambivalent, ways of imagining an as-yet unrealized decolonial future for universities.
TRACING INTERACTION ON SAMOS ISLAND: POTTERY TRADITIONS AND CONNECTIVITY AT KASTRO-TIGANI AND THE HERAION DURING THE AEGEAN LATE–FINAL NEOLITHIC/WESTERN ANATOLIAN MIDDLE–LATE CHALCOLITHIC
Authors: Menelaou Sergios , Kouka Ourania
Published: April 2022

This paper presents the results from the pilot analytical study of the Aegean Late–Final Neolithic/Anatolian Middle–Late Chalcolithic (c. 5500–3200/3000 BC) pottery from the Kastro-Tigani settlement, located in south-east Samos (east Aegean). In addition to Crete, the region of the insular eastern Aegean has produced the earliest evidence for Neolithic habitation. The archaeological traces at Kastro-Tigani are so far the earliest known on Samos, being partly contemporary with the recently discovered Middle–Late Chalcolithic layers at the Heraion, lying in close proximity to the former site, and at the Agriomernos cave (Megalo Seitani) in the north-west part of the island. The re-evaluation of the ceramic assemblage from Kastro-Tigani has led to the laboratory analysis of 34 samples, using a combination of thin-section petrography and Wavelength Dispersive X-Ray Fluorescence Spectroscopy, in order to determine provenance and establish reference groups for the earliest local production on Samos. This first compositional characterisation of the pottery contributes new data in a relatively under-studied region and provides grounds for comparison with analytical results from the Heraion, with the aim to investigate possible relations between the sites. Hence, the identification of different strategies in pottery production, reflected in the overall distinct fabric and chemical groups, further indicates the practice of several production units and the exploitation of various raw material sources at the Pythagoreion/Chora plain. Isolated examples of possible imported ceramic vessels, as well as exotica (e.g. obsidian, acrolithic and Kilia figurines, ring-shaped features, marble vessels,kratiriskoi) are highlighted as markers of macro-scale interaction in the context of Aegean early maritime connectivity.
Relationship between subjective report and objective assessment of neurocognitive functioning in persons with multiple sclerosis
Authors: Thomas Garrett A. , Riegler Kaitlin E. , Bradson Megan L. , O’Shea Dede U. , Arnett Peter A.
Published: April 2022

Objective:

Persons with multiple sclerosis (PwMS) are at increased risk for cognitive dysfunction. Considering the impact and potential ramifications of cognitive dysfunction, it is important that cognition is routinely assessed in PwMS. Thus, it is also important to identify a screener that is accurate and sensitive to MS-related cognitive difficulties, which can inform decisions for more resource-intensive neuropsychological testing. However, research focused on available self-report screeners has been mixed, such as with the Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ). This study aims to clarify the relationship between subjective and objective assessment of cognitive functioning in MS by examining domain-specific performance and intraindividual variability (IIV).

Methods:

87 PwMS (F = 65, M = 22) completed a comprehensive neuropsychological battery which included self- and informant-report measures of neurocognitive functioning. Scores were examined in relation to mean performance on five domains of cognitive functioning and two measures of IIV.

Results:

The MSNQ-Self was inversely associated with executive function, verbal memory, and visual memory; it was not associated with IIV. The MSNQ-Informant was inversely associated with executive function and verbal memory, and positively associated with one measure of IIV. The MSNQ-Self showed a correlation of moderate effect size with depression (r = .39) while the MSNQ-Informant did not.

Conclusions:

Results suggest that the MSNQ-Self and MSNQ-Informant show similar utility. Our findings also suggest that domains of executive function and memory may be most salient, thus more reflected in subjective reports of cognitive functioning. Future work should further examine the impact of mood disturbance with cognitive performance and IIV.
Misshandlungserfahrungen in der Kindheit, Einschränkungen der Mentalisierungsfähigkeit und Wohlbefinden im Erwachsenenalter
Authors: Schwarzer Nicola-Hans , Kirsch Holger , Nolte Tobias , Gingelmaier Stephan
Published: April 2022

Zusammenfassung. Misshandlungserfahrungen in Kindheit und Jugend sind ein umfassendes und weitverbreitetes Problem, das mit massivem Leidensdruck der Betroffenen einhergeht und gravierenden Einfluss auf deren psychosoziale Entwicklung verübt. Mentalisieren – die Fähigkeit, Verhalten auf Basis intentionaler mentaler Zustände wahrnehmen zu können – wird in jüngerer Zeit als schützende Fähigkeit beschrieben, die diesen Zusammenhang vermitteln könnte, so zum Erhalt von Wohlbefinden beiträgt und durch mentalisierungsfördernde Interventionen adressierbar ist. Im Rahmen der vorliegenden Studie zeigt sich auf Basis der Daten von 259 Proband_innen (Querschnitt) in einem Strukurgleichungsmodell, dass retrospektiv erfasste Misshandlungserfahrungen einen negativen Einfluss auf das gegenwärtige Wohlbefinden im Erwachsenenalter verüben. Weiterhin wurde der Zusammenhang über die Mentalisierungsfähigkeit vermittelt. Die Daten erhärten die Annahme, dass die Mentalisierungsfähigkeit an der intrapsychischen Verarbeitungung aversiver Stimuli beteiligt ist, und untermauern die Notwendigkeit, mentalisierungsfördernde Interventionen verstärkt als präventive und niederschwellige Maßnahmen in früh-‍, sozial-‍, schul- und sonderpädagogischen Settings zu nutzen.
Identifying the wide diversity of extraterrestrial purine and pyrimidine nucleobases in carbonaceous meteorites
Authors: Oba Yasuhiro , Takano Yoshinori , Furukawa Yoshihiro , Koga Toshiki , Glavin Daniel P. , Dworkin Jason P. , Naraoka Hiroshi
Published: April 2022

The lack of pyrimidine diversity in meteorites remains a mystery since prebiotic chemical models and laboratory experiments have predicted that these compounds can also be produced from chemical precursors found in meteorites. Here we report the detection of nucleobases in three carbonaceous meteorites using state-of-the-art analytical techniques optimized for small-scale quantification of nucleobases down to the range of parts per trillion (ppt). In addition to previously detected purine nucleobases in meteorites such as guanine and adenine, we identify various pyrimidine nucleobases such as cytosine, uracil, and thymine, and their structural isomers such as isocytosine, imidazole-4-carboxylic acid, and 6-methyluracil, respectively. Given the similarity in the molecular distribution of pyrimidines in meteorites and those in photon-processed interstellar ice analogues, some of these derivatives could have been generated by photochemical reactions prevailing in the interstellar medium and later incorporated into asteroids during solar system formation. This study demonstrates that a diversity of meteoritic nucleobases could serve as building blocks of DNA and RNA on the early Earth.
Investigating the upper bound of high-frequency electromagnetic waves on unshielded twisted copper pairs
Authors: Dinc Ergin , Bukhari Syed Sheheryar , Rawi Anas Al , de Lera Acedo Eloy
Published: April 2022

This paper explores the behaviour of the ubiquitous twisted pairs at high frequencies and wideband excitation of twisted pairs up to 12 GHz. Higher carrier frequencies on twisted pairs can enable the data rates required by the future communication networks; hence, the existing copper infrastructure can be utilised on the last mile complementing the fibre networks. In this paper, we show a fundamental limit on the operating frequency of twisted pairs beyond which twisted pairs start to radiate and behave like an antenna. To validate our theoretical derivations through measurements, we designed a microstrip balun to excite the differential mode on the twisted pairs. At the end, we demonstrate that the standard twisted pairs used in the UK can be used up to 5 GHz carrier frequency without any radiation effect and this upper-bound can be moved to higher frequencies by decreasing the twist lengths.
Automated exploitation of the big configuration space of large adsorbates on transition metals reveals chemistry feasibility
Authors: Gu Geun Ho , Lee Miriam , Jung Yousung , Vlachos Dionisios G.
Published: April 2022

Mechanistic understanding of large molecule conversion and the discovery of suitable heterogeneous catalysts have been lagging due to the combinatorial inventory of intermediates and the inability of humans to enumerate all structures. Here, we introduce an automated framework to predict stable configurations on transition metal surfaces and demonstrate its validity for adsorbates with up to 6 carbon and oxygen atoms on 11 metals, enabling the exploration of ~108 potential configurations. It combines a graph enumeration platform, force field, multi-fidelity DFT calculations, and first-principles trained machine learning. Clusters in the data reveal groups of catalysts stabilizing different structures and expose selective catalysts for showcase transformations, such as the ethylene epoxidation on Ag and Cu and the lack of C-C scission chemistry on Au. Deviations from the commonly assumed atom valency rule of small adsorbates are also manifested. This library can be leveraged to identify catalysts for converting large molecules computationally.
Knockdown of GABAA alpha3 subunits on thalamic reticular neurons enhances deep sleep in mice
Authors: Uygun David S. , Yang Chun , Tilli Elena R. , Katsuki Fumi , Hodges Erik L. , McKenna James T. , McNally James M. , Brown Ritchie E. , Basheer Radhika
Published: April 2022

Identification of mechanisms which increase deep sleep could lead to novel treatments which promote the restorative effects of sleep. Here, we show that knockdown of the α3 GABAA-receptor subunit from parvalbumin neurons in the thalamic reticular nucleus using CRISPR-Cas9 gene editing increased the thalamocortical delta (1.5–4 Hz) oscillations which are implicated in many health-promoting effects of sleep. Inhibitory synaptic currents in thalamic reticular parvalbumin neurons were strongly reduced in vitro. Further analysis revealed that delta power in long NREM bouts prior to NREM-REM transitions was preferentially affected by deletion of α3 subunits. Our results identify a role for GABAA receptors on thalamic reticular nucleus neurons and suggest antagonism of α3 subunits as a strategy to enhance delta activity during sleep.
Two DNA vaccines protect against severe disease and pathology due to SARS-CoV-2 in Syrian hamsters
Authors: Babuadze George Giorgi , Fausther-Bovendo Hugues , deLaVega Marc-Antoine , Lillie Brandon , Naghibosadat Maedeh , Shahhosseini Nariman , Joyce Michael A. , Saffran Holly A. , Lorne Tyrrell D. , Falzarano Darryl , Senthilkumaran Chandrika , Christie-Holmes Natasha , Ahn Steven , Gray-Owen Scott D. , Banerjee Arinjay , Mubareka Samira , Mossman Karen , Dupont Chanel , Pedersen Jannie , Lafrance Mark-Alexandre , Kobinger Gary P. , Kozak Robert
Published: April 2022

The SARS-CoV-2 pandemic is an ongoing threat to global health, and wide-scale vaccination is an efficient method to reduce morbidity and mortality. We designed and evaluated two DNA plasmid vaccines, based on the pIDV-II system, expressing the SARS-CoV-2 spike gene, with or without an immunogenic peptide, in mice, and in a Syrian hamster model of infection. Both vaccines demonstrated robust immunogenicity in BALB/c and C57BL/6 mice. Additionally, the shedding of infectious virus and the viral burden in the lungs was reduced in immunized hamsters. Moreover, high-titers of neutralizing antibodies with activity against multiple SARS-CoV-2 variants were generated in immunized animals. Vaccination also protected animals from weight loss during infection. Additionally, both vaccines were effective at reducing both pulmonary and extrapulmonary pathology in vaccinated animals. These data show the potential of a DNA vaccine for SARS-CoV-2 and suggest further investigation in large animal and human studies could be pursued.
Influence of roundness errors of bearing components on rotational accuracy of cylindrical roller bearings
Authors: Yu Yongjian , Li Jishun , Xue Yujun
Published: April 2022

Understanding the influence of bearing component roundness errors and roller number on the rotational accuracy of rolling bearings is crucial in the design of high precision bearings. The rotational accuracy of an assembled bearing is dependent upon roller number and roundness errors of the bearing components. We propose a model for calculating the rotational accuracy of a cylindrical roller bearing; we experimentally verified the effectiveness of the model in predicting the radial run-out of the inner ring proposed in the previous paper in this series. We sought to define the key contributing factors to the rotational accuracy by studying both the influence of the coupling effect of the roller number and the influence of the roundness errors in the inner raceway, outer raceway, and rollers on the motion error. The model and results will help engineers choose reasonable manufacturing tolerances for bearing components to achieve the required rotational accuracy.
Integrative analysis of TCGA data identifies miRNAs as drug-specific survival biomarkers
Authors: Lin Shuting , Zhou Jie , Xiao Yiqiong , Neary Bridget , Teng Yong , Qiu Peng
Published: April 2022

Biomarkers predictive of drug-specific outcomes are important tools for personalized medicine. In this study, we present an integrative analysis to identify miRNAs that are predictive of drug-specific survival outcome in cancer. Using the clinical data from TCGA, we defined subsets of cancer patients who suffered from the same cancer and received the same drug treatment, which we call cancer-drug groups. We then used the miRNA expression data in TCGA to evaluate each miRNA’s ability to predict the survival outcome of patients in each cancer-drug group. As a result, the identified miRNAs are predictive of survival outcomes in a cancer-specific and drug-specific manner. Notably, most of the drug-specific miRNA survival markers and their target genes showed consistency in terms of correlations in their expression and their correlations with survival. Some of the identified miRNAs were supported by published literature in contexts of various cancers. We explored several additional breast cancer datasets that provided miRNA expression and survival data, and showed that our drug-specific miRNA survival markers for breast cancer were able to effectively stratify the prognosis of patients in those additional datasets. Together, this analysis revealed drug-specific miRNA markers for cancer survival, which can be promising tools toward personalized medicine.