bluuebunny/crossref_metadata_2025 huggingface dataset:
Is HbA1c a valid surrogate for mortality in type 2 diabetes? Evidence from a meta-analysis of randomized trials
Authors: Baechle Christina , Scherler Wiebke , Lang Alexander , Filla Tim , Kuss Oliver
Published: May 2022

Aims

Hemoglobin A1c (HbA1c) has been repeatedly questioned as a valid surrogate marker, especially for patient-relevant outcomes. The aim of this study was to validate the HbA1c value as a surrogate for all-cause mortality in people with type 2 diabetes.

Methods

The effect estimates for HbA1c lowering after treatment as well as reductions in all-cause mortality of randomized trials were extracted from a systematic review and updated. For the measurement of actual surrogacy, weighted linear regression models with a random intercept for the study effect were used with the all-cause mortality estimate (risk difference and log relative risk) as the outcome and the estimate for HbA1c difference as the covariate. Surrogacy was assessed according to the criteria of Daniels and Hughes.

Results

A total of 346 HbA1c-mortality-pairs from 205 single randomized trials were included in the analysis. Regarding the risk difference of all-cause mortality, there was no evidence for surrogacy of the HbA1c value. For the log relative risk, a small positive association between HbA1c and the all-cause mortality estimate (slope 0.129 [95% confidence interval −0.043; 0.302]) was observed. However, there was no sign of valid surrogacy.

Conclusions

Based on the results of more than 200 randomized trials, HbA1c is not a valid surrogate marker for all-cause mortality in people with type 2 diabetes.
Prognostic value of stress hyperglycemia ratio on short- and long-term mortality after acute myocardial infarction
Authors: Schmitz T. , Freuer D. , Harmel E. , Heier M. , Peters A. , Linseisen J. , Meisinger C.
Published: May 2022

Aims

Prior studies demonstrated an association between hospital admission blood glucose and mortality in acute myocardial infarction (AMI). Because stress hyperglycemia ratio (SHR) has been suggested as a more reliable marker of stress hyperglycemia this study investigated to what extent SHR in comparison with admission blood glucose is associated with short- and long-term mortality in diabetic and non-diabetic AMI patients.

Methods

The analysis was based on 2,311 AMI patients aged 25–84 years from the population-based Myocardial Infarction Registry Augsburg (median follow-up time 6.5 years [IQR: 4.9–8.1]). The SHR was calculated as admission glucose (mg/dl)/(28.7 × HbA1c (%)—46.7). Using logistic and COX regression analyses the associations between SHR and admission glucose and mortality were investigated.

Result

Higher admission glucose and higher SHR were significantly and nonlinearly associated with higher 28-day mortality in AMI patients with and without diabetes. In patients without diabetes, the AUC for SHR was significantly lower than for admission glucose (SHR: 0.6912 [95%CI 0.6317–0.7496], admission glucose: 0.716 [95%CI 0.6572–0.7736], p-value: 0.0351). In patients with diabetes the AUCs were similar for SHR and admission glucose. Increasing admission glucose and SHR were significantly nonlinearly associated with higher 5-year all-cause mortality in AMI patients with diabetes but not in non-diabetic patients. AUC values indicated a comparable prediction of 5-year mortality for both measures in diabetic and non-diabetic patients.

Conclusions

Stress hyperglycemia in AMI patients plays a significant role mainly with regard to short-term prognosis, but barely so for long-term prognosis, underlining the assumption that it is a transient dynamic disorder that occurs to varying degrees during the acute event, thereby affecting prognosis.
IgG4-related hypophysitis: a retrospective cohort study
Authors: Bhargava R. , Hussein Z. , Dorward N. L. , Grieve J. P. , Jaunmuktane Z. , Marcus H. J. , Proctor I. , Baldeweg S. E.
Published: May 2022

Purpose

IgG4-related hypophysitis (IgG4-RH) is a rare chronic inflammatory condition of the pituitary gland. This study reports the presentation, management and outcomes for patients with histologically proven IgG4-related hypophysitis.

Methods

A prospectively maintained electronic database was searched over a 14-year period from 1 January 2007 to 31 December 2020 at a single academic centre to identify all patients with a histological diagnosis of IgG4-RH. A retrospective case note review from electronic health records was conducted for each case to extract data on their presentation, management and outcomes.

Results

A total of 8 patients (5 male) with a median age of 51 years were identified. The most common presenting symptoms were headache (4/8; 50%), fatigue (3/8; 37.5%) and visual impairment (2/8; 25%). Three patients were initially treated with high-dose steroids aiming for reduction of the pituitary mass. However, ultimately all patients underwent transsphenoidal surgery. Post-operative changes included radiological reduction in pituitary mass in all patients that had imaging (7/7; 100%), improvement in vision (1/2; 50%), residual thick pituitary stalk (5/7; 71.4%), persistent anterior hypopituitarism (4/8; 50%) and panhypopopituitarism including diabetes insipidus (3/8; 37.5%).

Conclusions

IgG4-RH is an increasingly recognised entity presenting with a variety of symptoms and signs. Clinical presentation is similar to other forms of hypophysitis. It is therefore important to consider IgG4-RH as a differential and to have a low threshold for pituitary biopsy, the diagnostic gold standard. The diagnosis of IgG4-RH will guide decisions for additional workup for IgG4-related disease, multi-disciplinary team involvement and follow-up.
On Simple Rules for the Social Cost of Carbon
Authors: Withagen Cees
Published: May 2022

The objective of this paper is to assess the use of simple rules for the social cost of carbon. It is shown that several interrelated objections may apply. The main issues are the following. First, the underlying theoretical models typically assume that the economy finds itself on a balanced growth path, implying that addressing the issue of designing policies for the short run, which play a role in the actual policy debate, are neglected. Second, for some cases the assumptions made regarding the marginal damages of high temperature or of arge atmospheric$$CO_{2}$$CO2stocks are shown to be incompatible with other assumptions made. Third, typically the rules follow from an optimal growth model and associate the social cost for a particular year with GDP for that year, but it is not always acknowledged that it should be optimal rather than actual GDP for that year. I also go into the performance of simple rules as compared to first-best.
The inner frontier. Images of the USA in recent Western cinema (2000–2020)
Authors: Stiglegger Marcus
Published: May 2022

At the heart of the American western cinema lies the myth. And the western myth is closely linked to the frontier, that boundary between civilization and wilderness that is constantly being negotiated. The frontier mythology is an integral part of scholarly writing on the western, and especially works well with the classical western of the studio era, where the dichotomy of wilderness and civilization had been considered the key to the genre. The following study will go back to the original term frontier, Frederick Jackson Turner’s concept of frontier mythology and Matthias Waechter’s re-reading of this mythology, and will seek for a new angle to discuss recent westerns in the light of current events. This is necessary as most of the exemples may look like westerns, but most of them are only told in the mode of a western or use the classical form and iconography to aim for something different than in earlier decades. Genre cinema has become more of a discourse today which is not created according to a classical formula any more. This article takes this fact into account and will furthermore show that the outer boundary between civilization and wilderness is turned inward in films of the last decade: This means that the ‘stranger’ is part of the self, the abject lurks in one’s own forests and mountains–or in one’s own micro-society, even if films are only told in Western mode, such as the crime thriller ‘Wind River’ (2017) by Taylor Sheridan.
Effects of an ad valorem Web Tax in a Cournot-Nash market for digital advertising
Authors: d’Andria Diego
Published: May 2022

I extend the theory of tax incidence under Cournot-Nash oligopolistic competition to study the effects of an ad valorem sales tax on Web services that are provided free of charge to users, and produce advertising space sold to businesses. Ads are more valuable to advertisers the more users are served by a Web service. Users have ads-neutral preferences and Web companies compete in a Cournot-Nash fashion on the advertising market but enjoy monopolistic power in the service market they serve. I demonstrate that the equilibrium market price may be reduced by such tax, while ads sold increase. The conditions for such a tax-induced change depend upon the functional form and the elasticity assumed for ads demand.
The effects of a tax deduction for lifelong learning expenditures
Authors: van den Berge Wiljan , Jongen Egbert , van der Wiel Karen
Published: May 2022

We study the effects of a tax deduction for lifelong learning, exploiting exogenous variation in the effective costs of lifelong learning due to jumps in tax bracket rates. We use a regression kink design and tax return data on the universe of Dutch taxpayers. Low-income individuals show no response, but high-income individuals are more likely to report lifelong learning expenditures (though not a higher amount) when net costs are lower. Furthermore, for high-income individuals the effect peaks at the age interval 40–45 years of age.
Tight compact extended relaxations for nonconvex quadratic programming problems with box constraints
Authors: Vries Sven de , Perscheid Bernd
Published: May 2022

Cutting planes from the Boolean Quadric Polytope can be used to reduce the optimality gap of the $$\mathcal {NP}$$
NP
-hard nonconvex quadratic program with box constraints (BoxQP). It is known that all cuts of the Chvátal–Gomory closure of the Boolean Quadric Polytope are A-odd cycle inequalities. We obtain a compact extended relaxation of allA-odd cycle inequalities, which allows to optimize over the Chvátal–Gomory closure without repeated calls to separation algorithms and has less inequalities than the formulation provided by Boros et al. (SIAM J Discrete Math 5(2):163–177, 1992) for sparse matrices. In a computational study, we confirm the strength of this relaxation and show that we can provide very strong bounds for the BoxQP, even with a plain linear program. The resulting bounds are significantly stronger than these from Bonami et al. (Math Program Comput 10(3):333–382, 2018), which arise from separating A-odd cycle inequalities heuristically.
Adsorption of 60Co and 154+152Eu Using Graft Copolymer of Starch-Polyacrylic Acid-Polyvinylsulfonic Acid
Authors: Ghamry Mohamed Abdelhamid , Abdelmonem Islam Mohamed
Published: May 2022

Starch-polyacrylic acid-polyvinylsulfonic acid (St-g-PAA-PVSA) graft copoymer was synthesized by gamma radiation as an initiator. The chemical structure, morphology, and thermal stability of the graft copolymer were investigated using FTIR, SEM, and TGA. The St-g-PAA-PVSA graft copolymer was employed as an adsorbent for the removal of Co(II) and Eu(III) radionuclides from their aqueous solutions by batch adsorption method. Several experimental factors such as pH, contact time, initial concentration of adsorbate, and temperature were used to find the best conditions for the removal of Co(II) and Eu(III) radionuclides. The pseudo-second order kinetic model better fits the adsorption kinetic data of radionuclides. Langmuir models had the ability to well describe the equilibrium data of adsorption of radionuclides. Thermodynamic parameters were calculated and suggested the adsorption process of Co(II) was endothermic while exothermic in the case of Eu(III) adsorption and both adsorption systems were spontaneous in nature. Among the examined desorbing agents, both AlCl3 and HCl were succeeded to desorb most of the radionuclides.
Explore with Me: Peer Observation Decreases Risk-Taking but Increases Exploration Tendencies across Adolescence
Authors: Lorenz Corinna , Kray Jutta
Published: May 2022

It has been assumed that adolescents increase risk-taking tendencies when peers are present but findings on experimental decision-making have been inconclusive. Most studies focus on risk-taking tendencies, ignoring the effects peer presence can exert over other cognitive processes involved in decision-making, as well as any other underlying developmental and individual differences. In the present study, the trial-by-trial choice behavior was analyzed in a task in which adolescents adjust to dynamically changing risk probabilities. Using Bayesian modeling, the study aimed to infer about peer presence effects on risk-taking tendencies but also on reactions to, exploration of, and learning from positive and negative outcomes of risk-taking. 184 pre- to late adolescents (M= 14.09 years, min = 8.59, max = 18.97,SD= 2.95, 47% female) conducted the Balloon Analog Risk Task under two conditions: Once alone and once in the presence of a (non-existent) peer observing them virtually. Findings revealed that (a) peer observation reduced risk-taking but increased exploration tendencies and (b) that individual differences modulated this effect. Especially female pre-adolescents increased their openness to explore different choice outcomes when a peer observed their behavior. These results support the assumption that the occurrence and direction of peer influences on risk-taking depend on a person-environment interaction, emphasizing the dynamic role peers play in adolescent risk-taking.
Lerneffekte aus dem Distance Schooling: Strategien zur Vermeidung wachsender Ungleichheit an Wiener Mittelschulen und AHS aus Perspektive der Lehrpersonen
Authors: Köpping Maria , Leitner Andrea
Published: May 2022

Pandemiebedingte Phasen des Distance Schooling stellen eine Ausnahmesituation dar, in der die Lernleistungen der Schüler:innen noch stärker als im Regelunterricht von der Ressourcenausstattung und privaten Unterstützung abhängen, wodurch das Risiko der sozialen Selektivität steigt. Im Beitrag werden pädagogische Strategien zur Vermeidung von Kompetenzverlusten und Benachteiligungen während der Schulschließungen reflektiert. Damit wird analysiert, wie sich diese in der Abgrenzung der Zuständigkeiten von Schule und Eltern wie auch in der wahrgenommenen Kompetenzentwicklung der Schüler:innen niederschlagen. Der Fokus liegt auf den Erfahrungen von Lehrpersonen der Sekundarstufe 1 in Wien, die im Rahmen von qualitativen Interviews erhoben wurden. Dabei zeigt sich, dass sich mit den umfassenden inhaltlichen und methodischen Adaptierungen im Distance Schooling auch das Rollenverständnis der Lehrenden und deren Beziehung zu den Lernenden verändern.
Fungal Infections in Lung Transplantation
Authors: Ramirez-Sanchez Claudia , Nguyen Vi N. , Law Nancy
Published: May 2022

Purpose of Review

We aim to understand the most common fungal infections associated with the post-lung transplant period, how to diagnose, treat, and prevent them based on the current guidelines published and our center’s experience.

Recent Findings

Different fungi inhabit specific locations. Diagnosis of invasive fungal infections (IFIs) depends on symptoms, radiologic changes, and a positive microbiological or pathology data. There are several molecular tests that have been used for diagnosis. Exposure to fungal prophylaxis can predispose lung transplant recipients to these emerging molds. Understanding and managing medication interactions and drug monitoring are essential in successfully treating IFIs.

With the increasing rate of lung transplantations being performed, and the challenges posed by the immunosuppressive regimen, understanding the risk and managing the treatment of fungal infections are imperative to the success of a lung transplant recipient. There are many ongoing clinical trials being conducted in hopes of developing novel antifungals.
Hall effect on MHD Jeffrey fluid flow with Cattaneo–Christov heat flux model: an application of stochastic neural computing
Authors: Awais Muhammad , Rehman Huma , Raja Muhammad Asif Zahoor , Awan Saeed Ehsan , Ali Aamir , Shoaib Muhammad , Malik Muhammad Yousaf
Published: May 2022

Exploration and exploitation of intelligent computing infrastructures are becoming of great interest for the research community to investigate different fields of science and engineering offering new improved versions of problem-solving soft computing-based methodologies. The current investigation presents a novel artificial neural network-based solution methodology for the presented problem addressing the properties of Hall current on magneto hydrodynamics (MHD) flow with Jeffery fluid towards a nonlinear stretchable sheet with thickness variation. Generalized heat flux characteristics employing Cattaneo–Christov heat flux model (CCHFM) along with modified Ohms law have been studied. The modelled PDEs are reduced into a dimensionless set of ODEs by introducing appropriate transformations. The temperature and velocity profiles of the fluid are examined numerically with the help of the Adam Bashforth method for different values of physical parameters to study the Hall current with Jeffrey fluid and CCHFM. The examination of the nonlinear input–output with neural network for numerical results is also conducted for the obtained dataset of the system by using Levenberg Marquardt backpropagated networks. The value of Skin friction coefficient, Reynold number, Deborah number, Nusselt number, local wall friction factors and local heat flux are calculated and interpreted for different parameters to have better insight into flow dynamics. The precision level is examined exhaustively by mean square error, error histograms, training states information, regression and fitting plots. Moreover, the performance of the designed solver is certified by mean square error-based learning curves, regression metrics and error histogram analysis. Several significant results for Deborah number, Hall parameters and magnetic field parameters have been presented in graphical and tabular form.
Identification of Characteristic Values in Impulse-Based Processes Using Small Specimens
Authors: Valentino Tobias , Radel Tim
Published: May 2022

Suitable approaches are needed for rapid and cost-efficient materials development. High-throughput experimentation reduces the identification time of suitable material compositions. One approach is to use small specimen geometries to save additional production costs. Hence, research is continuously being conducted on a new hardness test based on laser-induced shock waves. Thus far, characteristic values from the induced indentations have been extracted, which correlate with hardness and tensile strength. However, the indentation result varies in dependence of the specimen size and mass. This condition hinders the correlation between characteristic values and material properties. Thus, the goal was to induce similar indentation results to minimum specimen size. Herein, different mounting materials and methods were investigated. The created indentations were compared with those induced in large specimens. Essential mounting parameters were derived from the findings. Consequently, small specimens can be used for material characterization by considering these mounting parameters.
Safety and Efficiency of Prostatic Abscess Transgluteal Drainage: A Case Report and Review of the Literature
Authors: Abdallah Mikael Abi , Kosseifi Fares , Noujeim Jean Paul , Nasnas Roy , Raad Nehme , Tawk Sammy , Noujeim Antoine
Published: May 2022

Prostatic abscess (PA) is an uncommon disorder that mainly affects diabetic and immunocompromised patients. It requires a high index of suspicion for diagnosis since it can clinically mimic acute prostatitis. Historically, transurethral drainage along with antimicrobial therapy has been the gold standard therapy. However, advances in imaging modalities have shifted the management of PA to less invasive approaches. Here, we present a case of a large PA drained by the percutaneous transgluteal approach. This access route is a safe, effective, and well tolerated alternative for PA drainage, done under local anesthesia and providing a relatively cleaner approach than transrectal or transperineal drainage, allowing easier and better catheter fixation as well. This article illustrates the different steps of the procedure and reviews the literature on PA management.
087 Initial Validation of the Radical Prostatectomy Questionnaire (RPQ): A New Patient Reported Outcome (PRO) to Assess Sexual Function Following Radical Prostatectomy (RP)
Authors: Nelson CJ , Flaherty K , Joshi N , Schofield E , Mulhall JP
Published: May 2022

Introduction

The only PRO validated for men after RP is Extended Prostate Cancer Index (EPIC). However, EPIC has weaknesses, including the lack of assessment of function in response to ED medication use, inclusion of ejaculation and absence of penile morphology assessment. We developed the RPQ to address these weaknesses.

Methods

RPQ is a 41-item scale assessing 5 domains: erectile function (EF), sexual desire (SD), orgasm (O), sexual satisfaction (SS), and penile morphology (PM). The EF domain assesses erections in response to no medication, PDE5i, intracavernosal injections (ICI). We used a multi-step process to develop the RPQ including: extensive literature review; development of primary domains; item generation and winnowing; feedback from 8 sexual medicine experts; and cognitive interviewing with 10 patients to verify content, wording, and response format. For validation, post-RP men completed the RPQ and the following PROs: IIEF, EPIC, SEAR, and the PROMISE measures. Participants completed the RPQ again within two weeks. Analyses include internal consistency (Cronbach's alpha), test-retest reliability, and convergent/discriminant validity. Cronbach's alpha and test-retest reliability ≥0.7 were considered acceptable.

Results

Mean age of the 311 men was 62±7. All domains of the RPQ demonstrated strong internal consistency (Cronbach's alpha=0.70-0.98) and test-retest reliability (ICC= 0.82-0.99). There was sound convergent validity for the RPQ EF domains with/without medication demonstrate by correlations with the IIEF Erectile Function Domain (EFD) (r=0.31 to 0.70, p<.05). Discriminate validity was demonstrated for RPQ EF domains with/without medication with moderate correlations with the SEAR and PROMIS scales (r=0.23 to r=0.59, p<.01). There was also sound convergent validity for RPQ SD, O, and SS domains with strong correlations with the PROMIS desire, orgasm, and satisfaction scales (r=0.66 to r=0.77, p<.01), with discriminant validity demonstrating moderate correlations with SEAR Self-Esteem (r=0.38 to r=0.46, p<.01) and Sexual Bother (r=-0.43 to 0.66, p<.01). The RPQ PM domain demonstrated convergent validity with moderate correlations with the IIEF EFD and Orgasm domain (r=-0.20; r=0.33, p<.01, respectively) and discriminant validity with low, non-significant correlation with EPIC Urinary function.

Conclusion

Initial validation of the RPQ supports the reliability and validity of the scale.

Disclosure

Work supported by industry: no.
098 Hyperestrogenism is Associated with Sexual Function Impairment in Men – Findings from a Cross-Sectional, Real-Life Study
Authors: Boeri L , Capogrosso P , Cazzaniga W , Candela L , Fallara G , Pozzi E , Belladelli F , Schifano N , Cignoli D , Colandrea G , Abbate C , Montorsi F , Salonia A
Published: May 2022

Introduction

High serum estrogens levels have been associated with higher rates of heart attacks, strokes, and prostate cancer. Moreover, hyperestrogenism is believed to be harmful to male sexuality.

Objectives

We aimed to investigate the prevalence of and the impact of hyperestrogenism on sexual functioning in a cohort of men seeking medical attention for new onset erectile dysfunction (ED) in the real-life setting.

Methods

Data from 481 men seeking first medical help for new-onset ED at a single andrology centre were analyzed. Patients were assessed with a thorough medical and sexual history. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All patients completed the International Index of Erectile Function (IIEF) and the IIEF-Erectile function (IIEF-EF) domain was categorized according to Cappelleri's criteria. Circulating hormones were measured in every patient. Hyperestrogenism was defined as estrogen (E2) levels >42.6 pg/mL (Tan RS et al. 2015). Descriptive statistics and logistic/linear regression models tested the association between hyperestrogenism and IIEF scores.

Results

Overall, 88 (18.3%) patients had serum estrogen levels suggestive for hyperestrogenism. Men with hyperestrogenism were older [median (IQR) 46 (34-58) vs. 44 (32-55) years; p<0.001], had more comorbidities [CCI≥2: 18 (20.5%) vs. 28 (7.1%); p<0.001] and higher serum testosterone (TT) levels [5.4 (4.2-7.3) vs. 4.3 (3.1-5.7); p=0.02] than those with normal E2 values. A higher rate of severe ED was found in men with elevated E2 levels (48.9% vs. 30%; p=0.02). Moreover, the IIEF-orgasmic function (IIEF-OF) domain was lower in ED men with hyperestrogenism than those with normal E2 values [6 (3-10) vs. 9 (6-10), p=0.03]. Serum E2 levels were positively correlated with TT levels (rho 0.25, p<0.001), but negatively correlated with IIEF-OF scores (rho -0.17, p=0.005) and IIEF-EF scores (rho -0.32, p<0.001) (Figure 1). At multivariable logistic regression analysis, hyperestrogenism (OR 2.37, p=0.03) was associated with severe ED after accounting for age, BMI, CCI and serum T values.

Conclusions

One out of five men seeking first medical help for ED showed elevated serum E2 values in the real-life setting. Hyperestrogenism was associated with health significant comorbidities, orgasmic function impairment and higher severity of ED.

Disclosure

Work supported by industry: no.
136 Clinical Outcomes of Testosterone Replacement Therapy in Japanese Patients with Late Onset Hypogonadism (LOH) Syndrome
Authors: Kuratsukuri K , Minami A , Naganuma T , Uchida J
Published: May 2022

Objectives

The Japanese late-onset hypogonadism (LOH) guideline is using serum free testosterone (FT) level for diagnosis of LOH syndrome. On the other hand, the European and American guidelines are using total testosterone level (TT) for diagnosis of LOH syndrome. Serum total testosterone levels below 8 nmol/L (231 ng/dL) require substitution of testosterone in the E.A.U. recommendations. In this study, we compared serum free testosterone level and total testosterone level in patients who visited our LOH syndrome out-patient department. We also investigate clinical outcomes of testosterone replacement therapy (TRT) in patients with LOH syndrome.

Material and Methods

Two hundred thirty male patients who visited our LOH syndrome out-patient department from January, 2008 to September, 2017 were targeted at this study. The patient's average age was 55.1 years old. Average of AMS score in patients was 51.7 points.

Results

Only 20 patients (8.7%) were low value (less than 2.31ng/ml) and 86 (37.4%) patients were low and borderline value (less than 3.46ng/ml) in serum total testosterone (TT) level. On the other hand, 99 patients (43.1%) were low values (less than 8.5pg/ml), and also 175 examples (76.1%) were low and borderline value (less than 11.8pg/ml) in serum free testosterone (FT) level. Testosterone replacement therapy (TRT) was carried out for 3 months in 84 patients with patient with LOH syndrome. Sixty nine patients (82.1%) were effective for ART. Only four patients dropped out TRT because of dysuria and plethora. Fifty four patients (83%) with patients who were low value (l less than 8.5pg/ml) in serum free testosterone (FT) were effective for ART in 53 patients. Also 25 patients (80.6༅) who was borderline value (less than 11.8pg/ml) in serum free testosterone (FT) level were effective for TRT in 31 patients.

Conclusions

Including borderline case, high frequency patient is suited at the diagnostic criteria of LOH syndrome using serum FT value compared to TT value. It might be necessary to also consider measurement of the auxiliary total testosterone, and compensation of the isolation testosterone by age. Testosterone replacement therapy (TRT) was also effective in patients with LOH syndrome not only low value but also borderline value in serum free testosterone (FT).

Disclosure

Work supported by industry: no.
143 Selecting Patients for Penile Doppler Ultrasound in Clinical Practice
Authors: Capogrosso P. , Candela L. , Costa A. , Cazzaniga W. , Fallara G. , Cignoli D. , Boeri L. , Colandrea G. , Schifano N. , Cornelius J. , Abbate C. , Dehò F. , Mattei A. , Montorsi F. , Salonia A.
Published: May 2022

Introduction

The routine use of dynamic duplex ultrasound of the penis (DDUP) to detect vasculogenic erectile dysfunction (V-ED) has been questioned because of a related patient’ discomfort and costs issues.

Objective

to investigate clinical factors which could guide the physician in selecting candidates for DDUP in routine practice.

Methods

Data were collected for 119 patients with ED who underwent DDUP regardless of their clinical history, to rule out V-ED at a single centre. Baseline data included: age, comorbidities (as scored with the Charlson Comorbidity Index (CCI)), BMI, recreational habits and the International Index of Erectile Function–6 (IIEF-6). DDUP was performed after intracavernous injection of alprostadil 20 ug and self sexual stimulation. V-ED was defined as a peak systolic velocity (PSV)<30 cm/s ± end diastolic velocity (EDV) of >3 cm/s and a resistance index (RI)<0.8. Logistic regression analysis tested clinical predictors of V-ED. The accuracy of the predictive model was assessed and decision curve analyses (DCA) tested their clinical benefit.

Results

Median (IQR) age was 54(43-60) years and IIEF-6 was 15(8-21). Of 119, 44 (37%) patients had comorbidities (CCI≥1), with cardiovascular disease (CVDs) and diabetes in 13(11%) and 16(14%) patients. Of all, 18(15%) patients were current smokers and 58(49%) had no regular physical activity. At DDUP, median right and left PSV were 36.7(25.7-43.9) and 36.1(25.3-44.9) cm/s. V-ED was detected in 50(42%) patients. Age (OR:1.05;95%CI 1.01–1.08; p=0.004) and smoking history (OR:3.33; 95%CI 1.13–9.8; p=0.02) were associated with a higher risk of V-ED, while physical activity was a protective factor (OR:0.43; 95%CI:0.20-091; p=0.03). Conversely, BMI, IIEF-6, CVDs, diabetes and CCI were not associated with V-ED. The model including age, smoking and physical activity had a fine accuracy to predict V-ED (AUC:0.70;95%CI:0.60- 0.79). At DCA (fig 1), the use of those clinical factors to select candidates for DDUP would result in the best clinical strategy if a threshold risk of V-ED≥35% is considered as a reasonable value to trigger the investigation.

Conclusions

Clinical factors including age and lifestyle habits could be used in the everyday clinical practice to better select patients for DDUP, if the use of this test is considered clinically reasonable for patients with ≥35% risk of V-ED.

Disclosure

Work supported by industry: no.
146 Does the Risk of Obstructive Sleep Apnea (OSA) Affect Erectile Function Recovery (EFR) After Radical Prostatectomy (RP)?
Authors: Martinez J. Flores , Salter C.A. , Ruiz K. , Benfante N. , Schofield E. , Tan M. , Laudone V. , Mulhall J.P.
Published: May 2022

Introduction

Obstructive sleep apnea (OSA) affects as many as 7% of adult men in the general population, higher in men with obesity and large neck sizes. OSA is associated with ED. No data to date has assessed EFR after RP in men with OSA.

Objective

The objective of this study was to define EFR rates 2 years post-RP.

Methods

Records of men who underwent RP with 24-month post-RP follow-up were reviewed. ADT and radiation therapy were exclusions. Men completed the OSA screening questionnaire, STOP-BANG (SB) pre-RP. Men were divided into OSA risk groups: high, intermediate, and low. EFR was recorded using IIEF-EFD score, with a score of at least 24 indicating recovery. Univariable and multivariable logistic regression analyses assessed predictors of EFR.

Results

454 men were analyzed. Mean age 62 ± 7 years. Of the studied population,12% had a history of OSA,10% had diabetes,12% were current smokers, and 37% were former smokers. The median STOP-BANG (SB) score was 2. High, intermediate, and low risk of OSA scores were 8%, 41% and 51% respectively. Mean baseline testosterone (T) was 495 ng/dL, PSA 7.4 ng/mL, and EFD score 22. Most men had a Gleason sum of 7 (87%). 73% of patients had bilateral or unilateral neurovascular bundle preservation. At the 2-year follow up, median EFD score in high, intermediate and low OSA risk groups: were 9, 16, and 18 respectively. The low OSA risk group was significantly more likely to recover (OR = 1.6, 1.1 – 2.4) than the moderate/high group. Younger age (OR = 0.92, 0.89 – 0.95), absence of diabetes (OR = 0.31, 0.14 – 0.72), higher baseline T (OR per 100 units = 1.40, 1.04 – 1.89), higher baseline EFD score (OR = 1.16, 1.11 – 1.22), and lower Gleason score (OR = 0.53, 0.34 – 0.82) were also associated with recovery at 2 years.

Conclusions

In our cohort, at 2 years post-RP, increasing OSA risk is associated with poorer EFR in men post-RP.

Disclosure

Work supported by industry: no.
150 Lipid Abnormality, Current Diabetes and Age Affect Erectile Hardness ∼ An Analysis of Data from Complete Medical Checkups Performed at a Single Hospital in Japan
Authors: Ishikawa K. , Sasaki H. , Ogushi Y. , Niikura A. , Ota T. , Ichimura Y. , Hashimoto Y. , Kurokawa I. , Sugishita H. , Tanifuji S. , Yamagishi M. , Shimoyama H. , Ota M. , Oshinomi K. , Hayashi K. , Morita J. , Shichijo T. , Fukagai T. , Sugawara S.
Published: May 2022

Objectives

The Erection Hardness Score (EHS) can assess erectile hardness with a single question and is readily used in routine clinical practice. We investigated the correlation between EHS and both erectile function and metabolic risk, lifestyle, and other factors.

Methods

This study included 548 men who underwent a complete standard medical checkup at our hospital between July 1, 2016, and August 31, 2018, and answered the question about erectile hardness. The following variables were evaluated: age, erectile hardness on the EHS, erectile function on the Sexual Health Inventory for Men (SHIM), current medical history (diabetes, hypertension, dyslipidemia, heart disease, stroke), metabolic risk factors (abdominal circumference, hyperglycemia, high blood pressure, lipid abnormality), and lifestyle factors. First, to examine the correlation between erectile hardness and erectile function, the mean SHIM score by EHS grade was determined for each age group. Then, an analyses was performed to examine the association between erectile hardness and age, current medical history, metabolic risk factors, and lifestyle factors.

Results

In each age group, a lower EHS grade was associated with a lower mean SHIM score. Lipid abnormality, diabetes, and age were independent risk factors for decreased erectile hardness.

Conclusion

The EHS as a measure of erectile hardness was correlated with erectile functional as assessed using the SHIM, and current diabetes and lipid abnormality were independent risk factors for decreased erectile hardness. However, neither dyslipidemia nor lipid abnormality is listed as a risk factor in the ED guidelines. Traditionally, lipid abnormality was assessed based mainly on the presence or absence of current hyper-lipidemia and serum total cholesterol level. Today, the diagnostic criteria for metabolic syndrome proposed by the World Health Organization, International Diabetes Federation, and Japanese Society of Internal Medicine also recommend the use of serum triglyceride and HDL cholesterol levels, instead of total cholesterol level, for evaluating lipid abnormality. I think the assessment of lipid abnormality should be used triglyceride and HDL cholesterol levels, instead of total cholesterol level.

Disclosure

Work supported by industry: no.
152 Sexual Dysfunction in Patients with End-Stage Renal Disease: A Systematic Review and Meta-Analysis
Authors: Pyrgidis N. , Mykoniatis I. , Sokolakis I. , Tishukov M. , Kalyvianakis D. , Sountoulides P. , Hatzichristodoulou G. , Hatzichristou D.
Published: May 2022

Introduction

Sexual dysfunction (SD) is an under-recognized clinical entity in both men and women with end-stage renal disease (ESRD). Studies on renal transplant recipients and dialysis patients report different prevalence rates and severity of SD among these groups. Moreover, the effect of renal transplantation on sexual function remains unknown.

Objectives

To explore the prevalence, severity, correlates, diagnostic approach and treatment modalities of sexual symptoms in patients with ESRD.

Methods

We performed a systematic review and meta-analysis assessing the prevalence of SD in ESRD individuals and evaluating the effect of renal transplantation on sexual function. Records were identified by searching PubMed, EMBASE, Scopus, and CENTRAL databases, as well as sources of grey literature. We conducted a random-effects meta-analysis of proportions (double arcsine transformation) to estimate the prevalence of SD in patients with ESRD. Multiple subgroup and sensitivity analyses, cumulative meta-analyses and univariate meta-regression analyses of important correlates were also performed.

Results

We included 94 studies with 10,320 ESRD male individuals and 47 studies with 3,490 ESRD female individuals. Overall, 7,253 males experienced erectile dysfunction (71%, 95% CI: 67% to 74%, I2= 92%). The pooled prevalence of erectile dysfunction was 59% (95% CI: 53% to 64%, I2= 92%) among renal transplant recipients, 79% (95% CI: 75% to 82%, I2= 86%) in hemodialysis patients and 71% (95% CI: 58% to 83%, I2= 86%) in peritoneal dialysis patients. On the contrary, 1,797 females experienced SD (74%, 95%CI: 67%-80%, I2=92%). The pooled prevalence of female SD was 63% (95%CI: 43%-81%, I2=92%) in renal transplant recipients, 80% (95%CI: 72%-87%, I2=91%) in hemodialysis patients and 67% (95%CI: 46%-84%, I2=90%) in peritoneal dialysis patients. In studies comparing erectile function before and after renal transplantation, renal transplant recipients reported an improvement in EF (RR: 2.53, 95%CI: 1.44 to 4.44, I2= 90%). The latter was also observed in women.

Conclusions

Sexual symptoms negatively affect the quality of life and warrant appropriate clinical attention, as they are an underdetermined and undertreated clinical entity in patients with ESRD. Renal transplantation seems to improve sexual function both in men and in women. Still, further studies on the field are mandatory.

Disclosure

Work supported by industry: no.
179 Assessment of Erectile and Ejaculatory Functions after Bladder-Sparing Therapy Against Muscle-Invasive Bladder Cancer
Authors: Uchida Y. , Yokoyama M. , Nakamura Y. , Fukuda S. , Uehara S. , Tanaka H. , Yoshida S. , Matsuoka Y. , Fujii Y.
Published: May 2022

Introduction

Radical cystectomy (RC) is still gold standard for muscle invasive bladder cancer (MIBC). Whereas, bladder-sparing therapy with transurethral resection of bladder tumor (TUR) and chemoradiation therapy (CRT) has been recognized as an alternative treatment to RC for selected patients with MIBC. We have developed and implemented tetra-modality bladder-sparing therapy (TeMT) incorporating partial cystectomy (PC) in addition to maximal TUR and induction CRT to overcome local recurrence after bladder-sparing therapy (Kageyama et al. Am J Clin Oncol 2003, Koga et al. BJU Int 2012, Kijima et al. BJU Int 2019). There are few studies on erectile and ejaculatory functions after bladder-sparing therapy.

Objective

To cross-sectionally survey erectile and ejaculatory functions after TeMT in patients with MIBC.

Methods

Of the total 117 male patients with MIBC who completed TeMT between 2006 and 2019, 70 patients were set as the target to distribute the questionnaires after excluding patients lost to follow up as of February 2020, patients with local recurrence of MIBC or additional prostate cancer treatment. Erectile function was assessed using the International Index of Erectile Function short form (IIEF-5), and ejaculatory function using Male Sexual Health Questionnaire Ejaculatory Dysfunction short form (MSHQ-EjD-SF). Attending physicians handed the questionnaires to the patients at the first regular outpatient visit after February 2020 and had the patients complete them outside the office.

Results

Of 44 patients received the questionnaires between February and August 2020, 35 completed the questionnaires. The median age (range) of the eligible patients was 70 (50-87) years old, and the median time from the date of PC to the date of response was 5.2 (0.35-14) years. The results of IIEF-5 showed that 3 (9%) had no erectile dysfunction (ED) (22-25 points), 9 (26%) had mild ED (17-21 points), 4 (11%) had mild to moderate ED (12-16 points), 4 (11%) had moderate ED (8-11 points), and 15 (43%) had severe ED (5-7 points). Based on the results of MSHQ-EjD-SF, 23 patients (66%) responded that they could ejaculate. Of those, 5 patients (14%) scored 4 or higher on all questions 1-3 of MSHQ-EjD-SF, suggesting that they did not have ejaculatory dysfunction.

Conclusions

Preservation of erectile and ejaculatory functions was observed in MIBC patients treated with bladder-sparing therapy. Along with that of lower urinary tract function, preservation of male sexual function in bladder-sparing therapy, especially ejaculatory function which is inevitably lost by RC, is considered to be an advantage over RC.

Disclosure

Work supported by industry: no.
183 Evaluation of Ejaculation Function Using a Simple Questionnaire
Authors: Kimura M. , Yoshimura I. , Yanagida K. , Yoshida T. , Hagiwara K. , Kaneko T. , Yamada Y. , Nakagawa T.
Published: May 2022

Introduction

There is a wide range of problems associated with ejaculation, including decreased semen volume, vaginal ejaculation problems, premature ejaculation, delayed ejaculation, hematospermia, and pain associated with ejaculation. However, there is no simple questionnaire that can comprehensively evaluate these ejaculatory functions.

Objective

In this study, we evaluated the overall ejaculation function of the patients in question using an originally developed ejaculation function score (Kimura and Shoji's Ejaculation Function Score).

Methods

We examined 20 patients who visited our sexual function outpatient clinic with a chief complaint of ejaculation. As a control group, we also examined 20 patients who had undergone vasectomy using the same score. The questionnaire consisted of the following five items (1) Awareness of sufficient momentum, (2) Pleasant sensation during ejaculation, (3) Presence of pain associated with ejaculation, (4) Presence of blood in semen, and (5) Perception of decreased semen volume. The total score was also evaluated. In addition, satisfaction with the current ejaculation was assessed.

Results

The mean age of the ejaculation disorder group was 43.5±15.1 years. The main complaints were decreased semen volume in 7 cases (35%), vaginal ejaculation disorder in 6 cases (30%), delayed ejaculation in 2 cases (10%), premature ejaculation in 2 cases (10%), lack of orgasm in 1 case (5%), and pain associated with ejaculation in 1 case (5%). The mean scores for each item were 1.5 for item 1, 1.8 for item 2, 3.0 for item 3, 3.0 for item 4, and 2.0 for item 5, resulting in a mean total score of 11.2. On the other hand, the mean age of the vasectomy group was 42.0±9.4 years, item 1 was 2.8, item 2 was 2.9, item 3 was 3.0, item 4 was 3.0, item 5 was 2.9, and the mean total score was 14.6. When the two groups were compared, significant differences were found except for items 3 and 4. There was also a significant difference in satisfaction of present ejaculation with mean scores of 1.3 and 2.9. As a result of examining the clinical severity and the total score, the total score of 5-6 was considered severe, 7-9 moderate, 10-13 mild ejaculation disorder, and 14-15 within the normal range.

Conclusion

Although our ejaculation function score is still in the developmental stage, we believe that it can be a screening tool for ejaculation function in practical medical care and self-assessment.

Disclosure

Work supported by industry: no.
192 Association Between Vascular Lesion and Penile Erection Hardness in Japanese Patients With Erectile Dysfunction
Authors: Hayashi K. , Sasaki H. , Mugita T. , Tomiyama T. , Koizumi S. , Kurokawa I. , Saito K. , Fuji K. , Ishikawa K. , Fukagai T.
Published: May 2022

Introduction

It is generally recognized that erectile dysfunction (ED) is largely attributable to vascular endothelial dysfunction which develops secondary to atherosclerotic changes and blood flow disorder. It is suggested that many patients with ED usually have advanced atherosclerosis because both ED and atherosclerosis share common risk factors.

Objective

Many erectile dysfunction(ED) cases are attributed to vascular endothelial dysfunction and impaired blood flow due to arteriosclerotic changes. In this study, we examined the association among the erection hardness score (EHS), Pulse Wave Velocity(PWV), and the presence of carotid artery plaques.

Materials and Methods

The study was enrolled 67 patients who visited our hospital with the chief complaint of ED. Based on the history at the first visit, 28 of the 67 patients were categorized into the EHS 3-4 group and the remaining 39 into the EHS 0-2 group. The two groups were retrospectively analyzed.

Results

The PWV points were significantly higher in the EHS 0-2 group than in the EHS 3-4 group (P = 0.047). In consideration for error in age, the modified points (PWV at the first visit - reference PWV by age) were significantly higher in the EHS 0-2 group than in the EHS 3-4 group (P = 0.026). This group also showed a higher detection rate of plaques by carotid ultrasound (66.7%).

Conclusions

This study showed that patients with lower points of EHS had higher PWV and were more likely to have carotid artery plaques. While ED has occasionally been considered as an early risk marker for the onset of cardiovascular events, this study suggests that the hardness of the penis can be an easier-to-measure and more sensitive index.

Disclosure

Work supported by industry: no.