bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment and Counseling Gaps Among Former Smokers Eligible for Lung Cancer Screening in US Adults
Authors: Hood-Medland Eve Angeline , Dove Melanie S. , Tong Elisa K.
Published: April 2022

Background

Lung cancer screening (LCS) for former and current smokers requires that current smokers are counseled on tobacco treatment. In the USA, over 4 million former smokers are estimated to be eligible for LCS based on self-report for “not smoking now.” Tobacco use and exposure can be measured with the biomarker cotinine, a nicotine metabolite reflecting recent exposure.

Objective

To examine predictors of tobacco use and exposure among self-reported former smokers eligible for LCS.

Design

Cross-sectional study using the 2013–2018 National Health and Nutrition Examination Survey.

Participants

Former smokers eligible for LCS (n = 472).

Main Measures

Recent tobacco use was defined as reported tobacco use in the past 5 days or a cotinine level above the race/ethnic cut points for tobacco use. Recent tobacco exposure was measured among former smokers without recent tobacco use and defined as having a cotinine level above 0.05 ng/mL.

Key Results

One in five former smokers eligible for LCS, totaling 1,416,485 adults, had recent tobacco use (21.4%, 95% confidence interval (CI) 15.8%, 27.0%), with about a third each using cigarettes, e-cigarettes, or other tobacco products. Among former smokers without recent tobacco use, over half (53.0%, 95% CI: 44.6%, 61.4%) had cotinine levels indicating recent tobacco exposure. Certain subgroups had higher percentages for tobacco use or exposure, especially those having quit within the past 3 years or living with a household smoker.

Conclusions

Former smokers eligible for LCS should be asked about recent tobacco use and exposure and considered for cotinine testing. Nearly 1.5 million “former smokers” eligible for LCS may be current tobacco users who have been missed for counseling. The high percentage of “passive smokers” is at least double that of the general nonsmoking population. Counseling about the harms of tobacco use and exposure and resources is needed.
Perfluoroalkane acids in human milk under the global monitoring plan of the Stockholm Convention on Persistent Organic Pollutants (2008–2019)
Authors: Fiedler Heidelore , Sadia Mohammad , Krauss Thomas , Baabish Abeer , Yeung Leo W. Y.
Published: April 2022

Within the global monitoring plan (GMP) established by article 16 of the Stockholm Convention on Persistent Organic Pollutants, perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), and perfluorohexane sulfonic acid (PFHxS) are recommended for analysis in core matrices to assess occurrence and changes geographically and with time. In 101 samples consisting of 86 national pools and 15 pools from States in Brazil obtained between 2008 and 2019, PFHxS was detected in 17% of the national pools and none in Brazil. PFOA and PFOS had a detection frequency of 100% and 92%, respectively. Other perfluoroalkane substances (PFAS) had either low detection frequencies and median values of zero (carboxylic acids C4–C11; except PFOA) or could not be quantified in any sample (sulfonic acids, C4–C10, and long-chain carboxylic acids, C12–C14). Correlation between PFOA and PFOS was moderately (r = 0.58). Whereas median values were almost identical (18.9 pg/g f.w. for PFOS; 18.6 pg/g f.w. for PFOA), PFOS showed larger ranges (< 6.2 pg/g f.w.−212 pg/g f.w.) than PFOA (< 6.2 pg/g f.w.−63.4 pg/g f.w.). It was shown that wealthier countries had higher PFOA concentrations than poorer countries. No difference in concentrations was found for samples collected in countries having or not having ratified the Stockholm Convention amendments to list PFOS or PFOA. The goal to achieve 50% decrease in concentrations within ten years was met by Antigua and Barbuda, Kenya, and Nigeria for PFOS and by Antigua and Barbuda for PFOA. In a few cases, increases were observed; one country for PFOS, four countries for PFOA.
Economic Burden of Pancreatic Cancer in Europe: a Literature Review
Authors: Hernandez Diego , Wagner Fabienne , Hernandez-Villafuerte Karla , Schlander Michael
Published: April 2022

Purpose

Pancreatic cancer is characterized by its high mortality, usually attributed to its diagnosis in already advanced stages. This article aims at presenting an overview of the economic burden of pancreatic cancer in Europe.

Methods

A systematic literature review was conducted. It made use of the search engines EconLit, Google Scholar, PubMed and Web of Science, and retrieved articles published after December 31st, 1992, and before April 1st, 2020. Study characteristics and cost information were extracted. Cost per patient and cost per patient per month (PPM) were calculated, and drivers of estimate heterogeneity was analysed. Results were converted into 2019 Euros.

Results

The literature review yielded 26 studies on the economic burden attributable to pancreatic cancer in Europe. Cost per patient was on average 40,357 euros (median 15,991), while figures PPM were on average 3,656 euros (median 1,536). Indirect costs were found to be on average 154,257 euros per patient or 14,568 euros PPM, while direct costs 20,108 euros per patient and 2,004 euros PPM. Nevertheless, variation on cost estimations was large and driven by study methodology, patient sample characteristics, such as type of tumour and cancer stage and cost components included in analyses, such as type of procedure.

Conclusion

Pancreatic cancer direct costs PPM are in the upper bound relative to other cancer types; however, direct per patient costs are likely to be lower because of shorter survival. Indirect costs are substantial, mainly attributed to high mortality.
The organizational side of a disruption mitigation process: exploring a case study during the COVID-19 pandemic
Authors: Molinaro Margherita , Romano Pietro , Sperone Gianluca
Published: April 2022

This paper deals with the mitigation process of the COVID-19 pandemic. Scholars propose and discuss several mitigation strategies to face the COVID-19 disruptions, mainly focusing on technology and supply chain redesign related aspects. Less attention has been paid to the organizational aspects of the mitigation process. We address this gap through an in-depth analysis of the reactive organizational practices implemented by an Italian company during the COVID-19 pandemic. We further compare these practices with those proposed in the disruption management literature to identify common traits and differences. The results show that the overall management of a pandemic’s mitigation process does not significantly differ from that of conventional disruptions, since both contexts require the same basic organizational practices. However, some peculiarities on how these practices should be implemented in a pandemic setting do emerge, such as the implementation of a cyclic rather than linear problem-solving process, the adoption of a learning-by-doing approach, the need of a risk-taker mindset and the importance of creativity and improvisation. Besides complementing the literature, these findings allow to provide indications to managers on how to organize and coordinate the activities during the mitigation process, as well as on what capabilities and competencies should be leveraged to face the pandemic’s disruptions.
Appraisal self-respect: Scale validation and construct implications
Authors: Clucas Claudine , Corr Philip , Wilkinson Heather , Schepman Astrid
Published: April 2022

Despite the widely accepted recognition of the notion of self-respect and its importance for emotional well-being, it has received scant attention in the psychological literature. We report on the development and validation of a scale to measure trait (character-based) appraisal self-respect (ASR), conceptualised as a disposition to perceive or appraise oneself as being a respectworthy honourable person. We tested the factor structure, reliability, convergent, discriminant and criterion validity of the ASR scale in samples of adult individuals (combined N = 1910 across samples). The resulting ASR scale was found to be essentially unidimensional and showed good internal and acceptable test-retest reliability. Trait ASR was correlated with (yet distinct from) theoretically related measures of global self-esteem, moral self and principledness, and was distinct from other self-esteem facets not based on honourable character traits. Importantly, it related to well-being and prosocial behaviour over-and-above self-esteem. The validation work served to consolidate the theoretical boundaries and utility of this important concept.
Isoflurane and Sevoflurane Induce Cognitive Impairment in Neonatal Rats by Inhibiting Neural Stem Cell Development Through Microglial Activation, Neuroinflammation, and Suppression of VEGFR2 Signaling Pathway
Authors: Zuo Chunlong , Ma Junmei , Pan Yizhao , Zheng Dongxu , Chen Chunjiang , Ruan Naqi , Su Ying , Nan Haihan , Lian Qingquan , Lin Han
Published: April 2022

Inhaled anesthetics are known to induce neurotoxicity in the developing brains of rodents, although the mechanisms are not well understood. The aim of this study was to elucidate the molecular mechanisms underlying anesthetics-induced neurodevelopmental toxicity by VEGF receptor 2 (VEGFR2) through the interaction between microglia and neural stem cells (NSCs) in postnatal day 7 (P7) rats. Cognitive function of P7 rats exposed to isoflurane and sevoflurane were assessed using Morris Water Maze and T maze tests. We also evaluated the expression levels of NSC biomarkers (Nestin and Sox2), microglia biomarker (CD11b or or IBA1), pro-inflammatory cytokines (IL-6 and TNF-α), and VEGFR2 using western blotting and immunohistochemistry in the brains of control and anesthesia-treated rats. We found spatial learning and working memory was impaired 2 weeks after anesthetics exposure in rats. Isoflurane induced stronger and more prolonged neurotoxicity than sevoflurane. However, cognitive functions were recovered 6 weeks after anesthesia. Isoflurane and sevoflurane decreased the levels of Nestin, Sox2, and p-VEGFR2, activated microglia, decreased the number of NSCs and reduced neurogenesis and the proliferation of NSCs, and increased the levels of IL-6, TNF-α, and CD11b. Our results suggested that isoflurane and sevoflurane induced cognitive impairment in rats by inhibiting NSC development and neurogenesis via microglial activation, neuroinflammation, and suppression of VEGFR2 signaling pathway.
Deep convolutional forest: a dynamic deep ensemble approach for spam detection in text
Authors: Shaaban Mai A. , Hassan Yasser F. , Guirguis Shawkat K.
Published: April 2022

The increase in people’s use of mobile messaging services has led to the spread of social engineering attacks like phishing, considering that spam text is one of the main factors in the dissemination of phishing attacks to steal sensitive data such as credit cards and passwords. In addition, rumors and incorrect medical information regarding the COVID-19 pandemic are widely shared on social media leading to people’s fear and confusion. Thus, filtering spam content is vital to reduce risks and threats. Previous studies relied on machine learning and deep learning approaches for spam classification, but these approaches have two limitations. Machine learning models require manual feature engineering, whereas deep neural networks require a high computational cost. This paper introduces a dynamic deep ensemble model for spam detection that adjusts its complexity and extracts features automatically. The proposed model utilizes convolutional and pooling layers for feature extraction along with base classifiers such as random forests and extremely randomized trees for classifying texts into spam or legitimate ones. Moreover, the model employs ensemble learning procedures like boosting and bagging. As a result, the model achieved high precision, recall, f1-score and accuracy of 98.38%.
Synthesis of Parallel Software from Heterogeneous Dataflow Models
Authors: Rafique Omair , Schneider Klaus
Published: April 2022

Dataflow process networks (DPNs) are intrinsically data-driven, i.e., node actions are not synchronized among each other and may fire whenever sufficient input operands arrived at a node. While the general model of computation (MoC) of DPNs does not impose further restrictions, many different subclasses of DPNs representing different dataflow MoCs have been considered over time. These classes mainly differ in the kinds of behaviors of the processes. A DPN may be heterogeneous in that different processes in the network belong to different classes of DPNs. A heterogeneous DPN can therefore be effectively used to model and to implement different components of a system with different kinds of processes and, therefore, different dataflow MoCs. This paper presents a model-based design based on different dataflow MoCs including their heterogeneous combinations. In particular, it covers the automatic software synthesis of systems from DPN models. The main objective is to validate, evaluate and compare the artifacts exhibited by different dataflow MoCs at the implementation level of systems under the supervision of a common design tool. Moreover, this work also offers an efficient synthesis method that targets and exploits heterogeneity in DPNs by generating implementations based on the kinds of behaviors of the processes. The proposed synthesis method provides a tool chain including different specialized code generators for specific dataflow MoCs, and a runtime system that finally maps models using a combination of different dataflow MoCs on cross-vendor target hardware.
Liver paranchyma orignated accessory cystic artery: Case report and review article
Authors: alharbi mohammad bukhetan
Published: April 2022

ABSTRACT

Introduction:

The cystic artery continues to be a significant structure visualized during laparoscopic cholecystectomy. Despite numerous reports on the variable anatomy of the cystic artery, only a few discuss the liver parenchyma that developed as an accessory to the cystic artery.

Case presentation:

I present a middle-aged patient who had an elective laparoscopic cholecystectomy by blunt dissection to separate tissues in the surgical field surrounding her gallbladder. The inferolateral liver parenchyma segment 5 accessory cystic artery was visualized and clipped safely.

Conclusion:

Blunt, careful dissection of the inferolateral aspect of the gallbladder may reduce the chance of bleeding due to aberrant dissection with abnormal blood supply to the gallbladder.

Highlights
4 The Effect of Route of Testosterone on Changes in Hematocrit: A Systematic Review and Bayesian Network Meta-Analysis of Randomized Trials
Authors: Nackeeran S , Ory J , Gonzalez D , Kohn T , White J , Ramasamy R
Published: April 2022

Introduction

Testosterone therapy (TT) is known to be associated with secondary erythrocytosis. Previous studies have shown that method of administration and formulation may result in variances in hematocrit (Hct) increases. Given the increasing demand for TT and newer formulations becoming available, an updated review and meta-analysis of relative increases in hematocrit is warranted. As head-to-head trials are rare, network meta-analysis of the contemporary studies is the only way to compare hematocrit changes by testosterone type, including topical gels and patches, injectables (both short-acting and long-acting) and oral tablets.

Objective

We aimed to characterize hematocrit changes by testosterone type, including gel, patch, oral testosterone undecanoate (TU), intramuscular (IM) TU, and IM testosterone enanthate/cypionate (TE/C) through a review and meta-analysis of randomized control trials (RCTs) on this topic.

Methods

We conducted a thorough search of listed publications in Scopus, PubMed, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov. Twenty-nine placebo-controlled randomized trials (3,393 men) met inclusion criteria for analysis of mean hematocrit change after testosterone therapy. Randomized controlled trial data for the following formulations of testosterone were pooled via network meta-analysis: gel, patch, oral testosterone undecanoate, intramuscular testosterone undecanoate, and intramuscular testosterone enanthate/cypionate.

Results

All types of testosterone therapies result in statistically significant increases in mean hematocrit when compared with placebo. Meta-analysis revealed all formulations, including gel (3.0%, 95% CI 1.8-4.3%), oral testosterone undecanoate (4.3%, 0.7-8.0%), patch (1.4%, 0.2-2.6%), intramuscular testosterone enanthate/cypionate (4.0%, 2.9-5.1%), and intramuscular testosterone undecanoate (1.6%, 0.3-3.0%) result in statistically significant increases in mean hematocrit when compared with placebo. When comparing all formulations against one another, intramuscular testosterone cypionate/enanthate were associated with a significantly higher increase in mean hematocrit compared to patch, but no differences in hematocrit between other formulations were detected.

Conclusions

All types of testosterone are associated with increased hematocrit; however, the clinical concern of this increase remains questionable, warranting future studies. This is the first network meta-analysis to quantify mean hematocrit change and compare formulations, given the absence of head-to-head trials.

Disclosure

No
5 Continuous Testosterone Therapy with Recombinant FSH & HCG Improves Semen Parameters: A Pilot Study
Authors: Hakky T , Shirazi H , Christensen M , Pastuszak A
Published: April 2022

Introduction

Male hypogonadism is characterized by inadequate production of Testosterone (T) and a deficiency in spermatogenesis. The main treatment of male hypogonadism is T therapy (TTh), which can disrupt normal hypothalamic-pituitary-gonadal axis function and cause oligospermia and/or azoospermia with testicular atrophy.

Objective

We evaluated the safety and efficacy of continuous intramuscular testosterone administration in combination with low doses of human chorionic gonadotropin (HCG) and recombinant follicle stimulating hormone (FSH) on semen parameters.

Methods

A total of 10 hypogonadal men on TTh, HCG, and FSH who had achieved pregnancy with their partners or had successful sperm retrievals were retrospectively identified. All of the men were maintained on continuous intramuscular testosterone therapy, HCG at 750 IU subcutaneously twice weekly and recombinant FSH 75 IU every other day. A semen analysis was performed in men who had not had vasectomy prior to or after starting therapy, and serum testosterone, estrogen, FSH, LH, hemoglobin and hematocrit levels, as well as a scrotal ultrasound for testicle size determination, were obtained.

Results

Of the 10 men with a mean(SD) age of 39.5(6.4) years) who underwent treatment, 7 achieved pregnancy naturally and 3 underwent sperm retrieval due to prior vasectomy, with successful sperm retrieval in all 3. Mean(SD) pretreatment T levels were 745(614) ng/dl, Estradiol 38.7(42.8) pg/ml, LH 0.18(0.24) IU/L, FSH 0.47(0.46) IU/L. Mean(SD) total motile sperm count (TMSC) was 1.43(2.99) million total motile sperm. Mean(SD) pretreatment testicular volume was 11.1(3.3)cc and post-treatment was 11(5.5) cc. Mean(SD) post-treatment T levels were 1185(482) ng/dl, Estradiol 26.0(16.9) pg/ml, LH 0.43(0.23) IU/L, FSH 1.78(0.91) IU/L, with TMSC 102.8(89.4) million.

Conclusions

Across a cohort of 10 men, TTh in combination with HCG and FSH resulted in resumption or increase in TMSC during treatment, resulting in either natural pregnancy or successful sperm retrieval and supporting the conclusion that TTh does not require cessation in men desiring fertility during TTh. Further prospective studies are required to validate these findings.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Vault Health
12 Early Experience with Subcutaneous Injection of Non-Proprietary Testosterone as an Alternative Approach for Testosterone Replacement
Authors: Alter K , Roadman D , Amarasekera C , Levine L
Published: April 2022

Introduction

Testosterone replacement therapy (TRT) has been demonstrated to benefit men with a diagnosis of hypogonadism. We elected to offer a non-proprietary subcutaneous injection (subQ) using a ½ inch 27g needle for TRT as an alternative treatment for hypogonadism.

Objective

To investigate the effect of subQ TRT in hypogonadal men, in order to compare satisfaction, HCT, and PSA levels to other forms of TRT.

Methods

The study period was defined as the most recent follow-up appointment after beginning subQ TRT with a mean follow-up of 4.2 months (range 1-6 months). Variables were obtained prior to beginning subQ TRT and at last follow-up visit. Patients either began subQ TRT primarily or switched from another method. Additionally, patients completed a satisfaction survey. Statistical analysis was performed with SPSS 24. Associations between testosterone levels and clinical variables were analyzed by a univariate analysis.

Results

32 total patients received subQ TRT. Pre and post-subQ TRT testosterone levels (increased 299.7 +/- 61.5), HCT levels (increased 0.8 +/- 1.0%), PSA levels (increased 0.87 +/- 0.3 ng/mL), AUASS (decreased 3.7 +/- 1.7), and SHIM scores (increased 2.1 +/- 2.4) were recorded (Table 1). 21 patients received other forms of TRT prior to beginning subQ TRT and variables were collected and analyzed (Table 2). Overall, 21 patients completed the follow-up satisfaction survey. 19 (90.5%) were satisfied with subQ TRT and 2 (9.5%) patients attributed their dissatisfaction to greater symptom improvement on previous therapies (Testopel, Jatenzo). 11 (84.6%) patients reported better or same satisfaction on subQ TRT than with prior therapy. Furthermore, 8 (88.9%) patients said subQ TRT was easier to use than prior TRT injection (Intramuscular and Testopel), while 1 (11.1%) patient preferred fewer treatments with Testopel. Lastly, all patients reported subQ TRT as less painful during administration.

Conclusions

SubQ TRT led to higher testosterone levels, positive satisfaction scores, and improved AUASS and SHIM scores at most recent follow-up. There was also no significant change to HCT or PSA levels. Ongoing monitoring focusing on longer duration of follow-up, erythrocytosis, satisfaction, and side effects are being conducted and will be reported.

Disclosure

No
29 Temporal Effects of Clomiphene Citrate on Testosterone and Semen Parameters
Authors: Jiang T , Sigalos J , Santamaria A , Modiri N , Zheng M , Osadchiy V , Jayadevan R , Islam M , Mills J , Eleswarapu S
Published: April 2022

Introduction

In men with secondary hypogonadism or impaired sperm concentrations, clomiphene citrate (CC) is often prescribed off-label to improve testosterone levels and fertility parameters. Prior studies have largely focused on outcomes in the short term (∼3 months). Longer-term efficacy of CC use is less clear, particularly if and when improvement may reach a plateau.

Objective

We sought to determine the magnitude of improvement in total testosterone and sperm concentration in men taking CC for fertility optimization 3, 6, 9, and 12-month interval follow-up.

Methods

With IRB approval, we retrospectively evaluated men presenting to an academic andrology clinic for fertility evaluation who were prescribed CC from January 2016 through May 2021. We identified men with 3, 6, 9, and 12-month follow-up data for total testosterone (TT) and 3, 6, and 9-month follow-up semen analyses. Mean absolute change in TT and sperm concentration are reported, along with 95% confidence intervals. Men with previous genitourinary procedures or hormone therapy were excluded. Paired t-tests were used to compare change in TT and sperm concentration at each time point to baseline, and statistical significance was set at p<0.05.

Results

CC (25 mg qd or 50 mg qod) was prescribed to 235 men seeking fertility optimization during the 5-year period. Mean age was 37.7 (SD 6.7, range 24-52). Of these 235, data for TT at 3, 6, 9, and 12 months were available for 25 men, and semen analyses at 3, 6, and 9 months were available for 26 men. Baseline TT at time of prescription was 358±145 ng/dL, and baseline sperm concentration was 13±17.2 M/mL. In the subset of 25 men with long-term follow-up data, a statistically significant improvement in TT was identified at 3 months (+62.7 ng/dL, 95% CI: 0.49-125.0 ng/dL, p=0.048), and additional benefit was seen at 6 months (+181.8 ng/dL, 95% CI: 114.1-249.5 ng/dL, p<0.01) followed by plateau at 9 and 12 months (Figure A). Improvement in sperm concentration was first noted at 9 months of treatment with CC (+20.7 M/mL, 95% CI: 10.2-31.2 M/mL, p<0.01) (Figure B). At no point were there improvements of semen volume and % motility at any follow-up.

Conclusions

In men prescribed CC for fertility optimization, we observed a maximal improvement in TT at 6 months, followed by plateau. Sperm concentrations showed a statistically significant improvement at 9 months. Our results suggest that longer duration of CC therapy may be needed to fully appreciate a benefit from CC treatment. Our study is limited by retrospective analysis, absence of controls, and small sample size. Work is under way to examine long-term follow-up data of CC in men seeking treatment for hypogonadism rather than optimization of fertility.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: JNM: Antares Pharma, Boston Scientific, and Endo Pharmaceuticals
32 Testosterone Replacement Therapy (TRT) is not Associated with a Higher Risk of DVT: Retrospective Analysis of US Claims Data
Authors: Hernandez-Vegas E , Hotaling J , Son L , Horns J , Paudel N , Gross K , Pastuszak A , Patel D
Published: April 2022

Introduction

As the prevalence of male hypogonadism (HG) has increased, more patients are prescribed TRT. TRT may be associated with an increased risk of deep venous thrombosis (DVT). Although in recent years there have been more studies dedicated to adverse effects of TRT, the literature is mixed on whether TRT increases the risk of DVT.

Objective

This study evaluates the risk of developing DVT in men with hypogonadism based on which types of treatments trends they receive using the MarketScan insurance claims database.

Methods

We performed a retrospective analysis of the IBM MarketScan™ Commercial Claims and Encounters database between 2008-2017. We identified all men with an HG diagnosis using the International Classification of Disease 9th edition (ICD-9) or 10th edition (ICD-10). We recorded how often they received TRT (including formulations as oral, topical/transdermal gels/creams/patches, intranasal, injections, and pellet implants). We followed men to see how many were diagnosed with DVT or pulmonary embolism. We excluded men who had a record of thromboembolic events before their first HG diagnosis. We performed univariate tests of variation across different demographics in three separate stratifications: 1) In all patients stratified by whether they suffered DVT; 2) In patients with DVT stratified by whether they received any kind of treatment at any time; 3) In patients with DVT and any treatment stratified by the type of treatment. Hazard Ratios from Cox Models were calculated for the effects of TRT in the previous 6 months on DVT controlling for the following confounding variables: age and comorbidities such as smoking, drug abuse, obesity, heart disease, cardiovascular problems and surgery/immobilization. Age and TRT in the previous 6 months were included as time-varying covariates.

Results

We identified 1,853,889 total men with HG, of which 21,414 (1.16%) were diagnosed with DVT. Among men who suffered DVT, 7,487 (34.96%) received TRT at some point compared to 605,534 (33.04%) of the men who did not suffer DVT. Results from time-varying Cox models suggest that receipt of TRT in the previous 6 months does not significantly increase the risk of developing a DVT (hazard ratio (HR) 1.049; 95% CI: 0.85, 1.29) among men with HG.

Conclusions

Our study suggests that TRT is not associated with a higher risk of developing DVT. DVT has evidence that the association was more pronounced among patients of later middle age and with chronic disease, whether with or without TRT. Further investigation is warranted to assess the risk effect of TRT on DVT development, which may allow for a more proactive approach in management.

Disclosure

No
60 Improved Peyronie's Disease Curvature Outcomes Using a More Aggressive Collagenase Technique
Authors: Tyler A , Green B , Savage J , Brearton K , Burgon H , Trost L
Published: April 2022

Introduction

Since the FDA approval of Collagenase Clostridium Histolyticum (CCH) for the treatment of Peyronie's Disease (PD), several investigators have reported outcomes of CCH, with improvements ranging from approximately 15-30%. More recently, we reported improved results (49% mean improvement) when CCH was combined with RestoreX penile traction therapy (RxPTT). Since then, we have made additional modifications to create a more aggressive injection / traction protocol to further optimize outcomes.

Objective

To report outcomes of a more aggressive CCH injection / traction protocol in men with PD.

Methods

A prospective database has been maintained of all individuals undergoing CCH injections since 2014. Our CCH injection protocol has evolved from the one described in the IMPRESS trials to a more aggressive use of injections and manual and mechanical traction. Currently, the protocol consists of injecting 0.9 mg of CCH in 0.7 ml of saline into approximately 15-20 sites around the point of maximal curvature (pharmacologically-induced erection performed with the first injection of each series). Injections are only performed on subsequent days (not 2-3 days apart), and very aggressive (i.e. 10-15 lbs of force) modeling is performed with the 2nd injection. Patients are counseled to begin RestoreX traction at 24-48 hours after the 2nd injection for 30-60 minutes daily, and to continue aggressive manual modeling for at least the first week post injection. Penile wraps are applied for 5 days post injection. A descriptive analysis was subsequently performed to review outcomes.

Results

A total of 320 men underwent at least 1 series of CCH and had baseline and follow-up curve assessment data available. Mean age was 55.8 (SD 10.4), with a mean PD duration of 27.8 months (SD 53) and a median baseline composite curvature of 64 degrees (IQR 45-80). Curvature improvements (most recent minus baseline) improved over time, correlating with increased injection experience and implementation of more aggressive traction protocols: 2014-2020 (20 degrees, 29% improvement) vs 2020-mid 2021 (27.8 degrees, 50%, p<0.001). When men were stratified by those who either completed 8 injections or indicated that they were satisfied with outcomes (n=147), median results were more pronounced: 2014-2017 (29% improvement), 2018 (38%), 2019 (47%), 2020-mid 2021 (59%), p<0.01.

Conclusions

Progressive implementation of a more aggressive CCH injection protocol has resulted in improved curvature outcomes. Given the specialized nature of technique modifications described, these results would argue for a center-of-excellence model for CCH administration to achieve optimal outcomes.

Disclosure

No
75 Peyronie's Disease: Identification of Patients Requiring Additional Therapy
Authors: Parikh N , Ahmed M , Jimbo M , Bole R , Britton C , Helo S , Kohler T , Ziegelmann M
Published: April 2022

Introduction

Peyronie's disease (PD) is a connective tissue disorder of the penile tunica albuginea, that can often cause penile deformity, pain, sexual dysfunction, and shortening. Therapies available include penile traction, oral medications, intralesional therapy, and surgical management. Many patients undergo multiple therapies for this disease due to poor satisfaction or lack of subjective improvement.

Objective

We thus sought out to delineate which patients were more likely to undergo a second therapy.

Methods

A cohort of 385 men who underwent therapy for Peyronie's disease from 2014-2018 were analyzed. A univariate analysis of patient demographics, subjective complaints, IIEF score parameters, primary treatments, and secondary treatment approaches was conducted.

Results

Of the 385 men identified, 29 patients ultimately decided to undergo a secondary treatment approach with 14 patients undergoing penile traction therapy, 7 intralesional therapy (Xiaflex) and 9 surgical therapy (5 penile plication, 2 insertion of inflatable penile prosthesis, and 2 grafting). 17 patients initially underwent surgery for PD with 23.53% of these patients undergoing a second line therapy (p<0.0469). 148 patients initially underwent Xiaflex injections with 12.16% of these patients undergoing a second line therapy (p<0.0227). Patients with poor orgasmic function as determined by IIEF questionnaire (median scores 8 vs 2, p<0.0420), men with greater objective curvature (median curvature 45 vs 35, p<0.0220), and men with greater stretched penile length (13.5 cm vs 12 cm, p=0.0284) were also more likely to undergo secondary therapy. Table 1 shows all factors associated with increased likelihood for secondary therapy.

Conclusions

Peyronie's disease is often a complex condition to treat due to the mental, emotional, and physical toll this disease takes on patients. It is helpful to determine which patients could likely require secondary therapy as this may help guide patient counseling and further management.

Disclosure

No
82 Utility of Ceramide Testing in Men with Erectile Dysfunction
Authors: Alom M , Yang D , Collins S , Ziegelmann M , Helo S , Kopecky S , Kohler T
Published: April 2022

Introduction

Erectile dysfunction (ED) is a known precursor and sequelae to diagnosed cardiovascular disease (CVD). ED AUA guidelines recommend evaluating standard CV risk factors including serum lipids and penile doppler to help stratify CV risk, but few patients are referred for further evaluation. Plasma ceramides are metabolic byproducts that are novel predictors of adverse cardiovascular events resulting from unstable atherosclerotic plaque. CVD risk conferred by ceramide levels has been shown to be independent of conventional risk factors such as LDL and hsCRP levels. Thus, Plasma MI-Heart Ceramide is a new test that useful for evaluating shorter term major adverse cardiovascular events (MACE) in the next 1 to 5 years.

Objective

We sought to evaluate the utility of ceramide levels in ED patients

Methods

We initiated ceramide testing in all patients with ED in late 2019 (in addition to lipids and Hgba1c). We queried our electronic medical record for ceramide levels and men with a diagnosis of ED. Ceramide levels stratified patients in normal, moderate, high, and very high risk. Twenty eight patients additionally had penile duplex ultrasound (DUS). Left and right peak systolic velocity values were averaged and a value of <25 cm/s was defined as penile arterial insufficiency.

Results

245 men with ED and ceramide levels were analyzed. 44% (n=107) were normal, 42% (n=103) were moderate risk, 12% (n=29) were high risk and 2% (n=6) were very high risk. As result of their ceramide and office evaluation, 42% (15/35) of high/very high risk patients were referred for cardiac evaluation. Comparing ceramide scores in men with penile arterial insufficiency (16.7 cm/sec) vs patients without (43.2 cm/sec), we found no significant difference (p=1). Similarly, when comparing DUS results between ceramide risk categories, we found no significant differences (p=1).

Conclusions

One in 7 men presenting to an ED clinic had a high or very high ceramide risk. DUS results did not correlate with ceramide risk. Patients undergoing DUS (even without arterial insufficiency) may benefit from additional ceramide testing and possible cardiac referral. Further study is warranted to optimize utility of ceramide in men with ED and potentially decrease peri-procedural IPP cardiac morbidity.

Disclosure

No
84 Evaluating the Impact of Time Between Radical Prostatectomy (RP) and Adjuvant Radiation Therapy (RT) on Erectile Function Recovery (EFR)
Authors: Flores Martinez J , Benfante N , Schofield E , Mulhall JP
Published: April 2022

Introduction

RT post-RP in men with PSA recurrence improves survival. It is also associated with a higher rate of urinary incontinence and erectile dysfunction (ED).

Objective

We attempted to evaluate if the time period between RP and adjuvant RT predicts EFR outcomes.

Methods

Men who received RT post-RP with ≥2 years post-RT follow-up were analyzed. ADT and RT pre-RP were exclusions. Demographics, comorbidities and pathological parameters and IIEF erectile function domain (EFD) scores were recorded. We report median EFD scores and factors correlated with EFR ≥24 months post-RT. Factors included: patient age, comorbidities, smoking status, baseline pre-RP and pre-RT Testosterone (T), prostate specific antigen (PSA), baseline EFD score, Nerve-Vascular bundle (NVB) status, and time between RP and RT.

Results

126 men were included. Mean age at RP was 63 ± 7 years. Mean pre-RP T was 390 ± 222 ng/dL, PSA, 10.2 ± 10.4 ng/mL and median EFD score were 27 (IQR = 20-30). Median pre-RT T was 376.9 ± 187 ng/dL, PSA 0.25 ± 0.33 ng/mL, and median EFD score was 9 (IQR = 3-20). 54% of patients had bilateral NVB preservation, and 29.5% unilateral. 71% received ADT with their RT, the median duration of ADT exposure was 4.5 (IQR = 3-8.5) months. Median time between RP and RT was 14.9 months (IQR = 8.5-28.6) months; 41% had ≤1 year between RP and RT. 2 years post RT, median EFD was 9.5 (IQR = 3-22). 22% had a score ≥24. EFD score at follow-up was correlated with age at RP (r=-0.32, p<.001), and pre-RT EFD score (r=0.56, p<.001). Time between RP and RT did not correlate with EFD score at follow up (r=0.08, p=0.39).

Conclusions

In our prostate cancer patients cohort post-RP/RT, EFR is lower; almost 4 of 5 patients will have some ED degree at two years post-RT. The period time between RP and RT is not correlated with EFR post-RT.

Disclosure

No
156 Where to Draw the Line: Understanding Preferences in Mucosal Collar Length After Circumcision
Authors: Callegari M. , Muncey W. , Kim T. , Rhodes S. , Woo L. , Hannick J.
Published: April 2022

Introduction

Male circumcision is a polarizing and omni prevalent procedure within the United States (U.S.). Little understanding exists regarding patient preferences for circumcision appearance.

Objective

To illicit how mucosal collar length may be perceived in terms of overall cosmesis and desirability amongst adults.

Methods

A questionnaire using REDCap was created and distributed through Amazon Mechanical Turk. Respondents provided demographic information and circumcision status before being challenged with artistic representations of circumcised penises with increasing lengths of mucosal collar. Participants were asked to select the most and least aesthetically pleasing image as well as rate the “importance of appearance” from 0 to 100. Responses were analyzed with ordinal regression models.

Results

Preference for shorter mucosal collars were seen in respondents with a postgraduate education (P = 0.013) and no religious affiliation (P = 0.034). In contrast, participants reporting a religious affiliation preferred longer mucosal collars (P = 0.034). Circumcised males rated appearance as being more important (P = 0.001) in contrast to uncircumcised males who did not (P = 0.001). Women were neutral (P = 0.199). Black or African American participants valued circumcision appearance more (P = 0.020) than Caucasian participants (P = 0.021).

Conclusions

Preferences regarding mucosal collar length appear to be influenced by education and religion. Overall, our study did not observe a predominant preference for mucosal collar length following circumcision. With this in mind, surgeons should engage patients preoperatively in discussions regarding preferences and desired cosmetic outcomes.

Disclosure

No
158 Artificial Urinary Sphincter Reverses Weight Gain Associated with Post-Prostatectomy Incontinence
Authors: Bhanvadia R. , Dropkin B. , Wolfe A. , Diao L. , Sanders S. , Joice G. , Roehrborn C. , Hudak S. , Morey A.
Published: April 2022

Introduction

Post-prostatectomy stress urinary incontinence (PPI) is associated with decreased physical activity, a known risk factor for weight gain and negative health outcomes. The relationships of PPI severity and its surgical correction to body mass index (BMI) are unknown.

Objective

We sought to examine the association between urinary incontinence severity and BMI changes before and after artificial urinary sphincter (AUS) insertion.

Methods

We performed a single-institution, retrospective review of 1513 AUS and inflatable penile prosthesis (IPP) insertion cases performed between 2008 and 2020. Inclusion criteria included a history of radical prostatectomy (RP) and complete data on PPI and BMI. The IPP cohort served as a surgical control. PPI severity was assessed by pads per day (PPD). BMI data were reviewed at the following three time points: (a) at RP, (b) at urologic prosthetic surgery (UPS), and (c) 12 months post-UPS. Multivariable linear regression assessed the associations between (a) PPI severity and BMI change from RP to UPS and (b) AUS insertion and BMI change 12 months post-UPS.

Results

We identified 250 men (187 AUS and 63 IPP) who met selection criteria. Men in the AUS group had a mean BMI increase between RP and UPS of + 1.0 kg/m2 versus - 0.6 kg/m2 in the IPP group (p < 0.01, duration 26.0 ± 21.8 months). Higher PPD use was associated with greater BMI gain after RP (Figure 1A, p = 0.03). On multivariable analysis, higher PPD use at the time of UPS was positively associated with BMI gain (Rho coeff. 0.50 kg/m2, p < 0.01), independent of RT and ADT. AUS insertion was independently associated with a decrease in BMI of -2.83 kg/m2 12 months post-UPS (p = 0.02) on multivariable analysis. Magnitude of incontinence improvement after AUS insertion was associated with greater BMI reduction at 12 months (Figure 1B, p = 0.04).

Conclusions

PPI is associated with weight gain, and its correction via AUS insertion is associated with weight loss. Because severe PPI is a potential risk factor for weight gain and subsequent negative health outcomes, timely anti-incontinence surgery is prudent for prostate cancer survivorship care.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast
167 New Bipolar Radiofrequency Sealing Tool for Transdermal Vasectomy in the Rabbit Model: A Paradigm Shift in Vasectomy Technique?
Authors: Henry G. , Griggs R. , Hakky T.
Published: April 2022

Introduction

Bipolar Radiofrequency (RF) sealing tools have been shown to be successful in the treatment of many areas in the human body. RF has been utilized in the sealing of larger blood vessels and in nerve pain ablation in humans, showing good results for years. Urology has used RF ablation percutaneously for treating renal tumors for years.

Objective

We evaluate the utilization of a new bipolar RF sealing tool for transdermal vasectomy in the rabbit model.

Methods

Two groups of 5 male New Zealand white rabbits were given IV sedation and local anesthetic and subsequent transdermal bilateral vasectomy using a high lateral scrotal approach. We isolated the vas with a novel insulated clamp, fitting the U-shaped electrode of the sealing tool (Figure 1) around the clamp. In Group 1 (n=5), the device was set at 60 watts for 20 seconds. In the second group (n=5), the size of the U-shaped tool jaw was reduced and the device was set at 40 and 60 watts using impedance sensing to automatically shut off energy at a predetermined level. Wound healing, complications, survival, postmortem biopsies, and histology were evaluated. A doe rabbit was used with semen collections & semen analyses preformed on all male rabbits.

Results

We sacrificed 4 of the 5 (80%) of Group 1 rabbits due to poor wound healing due to excessive thermal damage. All 5/5 (100%) of Group 2 rabbits had good tissue healing and survived the procedure. At about 5 seconds of sealing, the impedance sensing automatically shut off power to the device in all Group 2 procedures. All rabbits had a negative semen analysis and on histology had occluded vas deferens. In bench top testing, we found that a 5 second interval is optimal for vas ligation. (Figure 1) Bench top testing revealed that thin short jaws created lower nearby tissue temperature (50 degree Celsius) than wide long jaws (77 degree Celsius).

Conclusions

Transdermal bipolar radiofrequency sealing successfully occludes the vas deferens in rabbit vasectomy. The jaw size and sealing time using an impedance alarm system appear to be important for wound healing. This novel technique may decrease vasectomy time and morbidity. Further studies are needed before its application in humans.

Disclosure

Yes, this is sponsored by industry/sponsor: Signati

Clarification: Industry initiated, executed and funded study

Any of the authors act as a consultant, employee or shareholder of an industry for: Signati
172 Racial Trends in Peyronie's Disease Treatments: Analysis of the Veterans Health Administration
Authors: Nackeeran S. , Masterson T.
Published: April 2022

Introduction

Racial disparities are known to affect urologic care. Settings such as the Veterans Affairs (VA) health system, where access to care is more equitable, have noted reductions in racial disparities for certain diseases. Previous studies of Peyronie's Disease (PD) have investigated responses to treatment by race, but not treatment rates themselves. Frequently, racial disparities in healthcare are attributed to differences in income or decreased insurance rates among people of color. For this reason, we aimed to investigate racial disparities in PD treatments by evaluating the VA Informatics and Computing Infrastructure (VINCI), which contains data from the VA. As veterans are insured and able to obtain treatment for PD through the VHA, this population allows us to study the effects of race on treatment rates when insurance does not serve as a barrier.

Objective

To evaluate the treatment rates for Peyronie's Disease within the VA by race in order to determine whether racial disparities exist when insurance access is equitable.

Methods

We queried VINCI to obtain data for a cohort of men that have a recorded diagnosis of PD by ICD-9 or ICD-10 code between 2015-2020. We then used the following CPT codes to identify which patients had procedures known to be therapeutic for PD: plaque injection (CPT 54200), penile prosthesis (54400, 54405), penile reconstruction to correct penis angle (54360), or plaque excision (54110, 54111, 54112). We evaluated treatment rates among patients with race/ethnicity information recorded. We reported results as frequencies and used the chi-square test to evaluate significant differences in treatment rates when comparing racial groups to Whites, with statistical significance reported at p<.05.

Results

We obtained data for 17,022 patients with diagnoses of PD. Within the total population of patients diagnosed with PD, 71.4% were White (Non-Hispanic), 25.4% were Black, 5.8% were Hispanic or Latino, 0.3% were Asian or Pacific Islander (API), and 1.6% were Native American (NA), and 5.4% were unknown. Among this cohort, 13.6% of all patients, 13.6% of Whites, 14.3% of Blacks (p=0.2985), 13.5% of Hispanics (p=0.9205), 9.1% of API (p=0.3319), 16.7% of NA (p=0.1406), and 9.6% of unknown (p=0.0041) were treated.

Conclusions

Within the VHA population, which is not limited by access to health insurance, all patients with recorded race information were treated at similar rates for PD to Whites. Only those without racial information recorded were treated at a significantly lower rate. This study demonstrates the potential for equitable insurance and access to healthcare to reduce racial disparities. Further investigation is required to evaluate whether these treatment patterns are similar within the general population.

Disclosure

No