bluuebunny/crossref_metadata_2025 huggingface dataset:
Tissue-specific plant toxins and adaptation in a specialist root herbivore
Authors: Agrawal Anurag A. , Hastings Amy P.
Published: May 2023

In coevolution between plants and insects, reciprocal selection often leads to phenotype matching between chemical defense and herbivore offense. Nonetheless, it is not well understood whether distinct plant parts are differentially defended and how herbivores adapted to those parts cope with tissue-specific defense. Milkweed plants produce a diversity of cardenolide toxins and specialist herbivores have substitutions in their target enzyme (Na
+
/K
+
–ATPase), each playing a central role in milkweed–insect coevolution. The four-eyed milkweed beetle (
Tetraopes tetrophthalmus
) is an abundant toxin-sequestering herbivore that feeds exclusively on milkweed roots as larvae and less so on milkweed leaves as adults. Accordingly, we tested the tolerance of this beetle’s Na
+
/K
+
–ATPase to cardenolide extracts from roots versus leaves of its main host (
Asclepias syriaca
), along with sequestered cardenolides from beetle tissues. We additionally purified and tested the inhibitory activity of dominant cardenolides from roots (syrioside) and leaves (glycosylated aspecioside).
Tetraopes’
enzyme was threefold more tolerant of root extracts and syrioside than leaf cardenolides. Nonetheless, beetle-sequestered cardenolides were more potent than those in roots, suggesting selective uptake or dependence on compartmentalization of toxins away from the beetle’s enzymatic target. Because
Tetraopes
has two functionally validated amino acid substitutions in its Na
+
/K
+
–ATPase compared to the ancestral form in other insects, we compared its cardenolide tolerance to that of wild-type
Drosophila
and CRISPR-edited
Drosophila
with
Tetraopes
’ Na
+
/K
+
–ATPase genotype. Those two amino acid substitutions accounted for >50% of
Tetraopes’
enhanced enzymatic tolerance of cardenolides. Thus, milkweed’s tissue-specific expression of root toxins is matched by physiological adaptations in its specialist root herbivore.
Dynamics of interacting skyrmions in magnetic nano-track
Authors: Al Saidi W , Sbiaa R , Bhatti S , Piramanayagam S N , Al Risi S
Published: May 2023

Controlling multiple skyrmions in nanowires is important for their implementation in racetrack memory or neuromorphic computing. Here, we report on the dynamical behavior of two interacting skyrmions in confined devices with a comparison to a single skyrmion case. Although the two skyrmions shrink near the edges and follow a helical path, their behavior is different. Because the leading skyrmion is between the edge and the trailing one, its size is reduced further and collapses at a lower current density compared to the single skyrmion case. For higher current density, both skyrmions are annihilated with a core-collapse mechanism for the leading one followed by a bubble-collapse mechanism for the trailing one.
Controlling the charge of dust particles in a plasma afterglow by timed switching of an electrode voltage
Authors: Chaubey Neeraj , Goree J
Published: May 2023

A method is demonstrated for controlling the charge of a dust particle in a plasma afterglow, allowing a wider range of outcomes than an earlier method. As in the earlier method, the dust particles are located near an electrode that has a DC voltage during the afterglow. Here, that DC voltage is switched to a positive value at a specified delay time, instead of maintaining a constant negative voltage as in the earlier method. Adjusting the timing of this switching allows one to control the residual charge gradually over a wide range that includes both negative and positive values of charge. For comparison, only positive residual charges were attained in the earlier method. We were able to adjust the residual charge from about −2000 e to +10 000 e, for our experimental parameters (8.35 µm particles, 8 mTorr argon pressure, and a DC voltage that was switched from −150 V to +125 V within the first two milliseconds of the afterglow). The plasma conditions near the dust particles changed from ion-rich to electron-rich, when the electrode was switched from cathodic to anodic. Making this change at a specified time, as the electrons and ions decay in the afterglow, provides this control capability. These results also give insight into the time development of a dust particle’s charge in the afterglow, on a sub-millisecond time scale.
Charge transport and dielectric characteristics of Sm
x
Bi1−x
FeO3 thin films from the perspective of grain and grain boundary properties
Authors: Minussi F B , Borges F V A , Araújo E B
Published: May 2023

Samarium-substituted bismuth ferrite (Sm
x
Bi1−x
FeO3) compositions comprise a system of important materials due to their combination of multiferroic properties. Several dielectric and charge transport reports in literature can be found in this system. However, as a typical polycrystalline electroceramic, their grains and grain boundaries (GBs) are expected to possess very different properties. To this date, these distinctions have not been determined for this system. In this work, through measurements via impedance spectroscopy on Sm
x
Bi1−x
FeO3 thin films, we show that using a brick layer model allows the separation of the electrical properties of grains and GBs. Results indicate that grains have dielectric permittivity and electrical conductivity much higher than GBs. Their properties mostly control the characteristics observed in the studied thin films. The introduction of samarium reduces the electrical conductivity and increases the activation energies for charge transport in grains and GBs. In turn, dielectric permittivity is reduced in grains and subtly increased in GBs.
Automatic slice thickness measurement on three types of Catphan CT phantoms
Authors: Anam Choirul , Naufal Ariij , Sutanto Heri , Arifin Zaenal , Hidayanto Eko , Tan Li K , Wong Jeannie H D , Ng Kwan H , Shahrudin Sharizan , Zain Azleen M , Ahmad Faizah , Dougherty Geoff
Published: May 2023

Objective. To develop an algorithm to measure slice thickness running on three types of Catphan phantoms with the ability to adapt to any misalignment and rotation of the phantoms.Method. Images of Catphan 500, 504, and 604 phantoms were examined. In addition, images with various slice thicknesses ranging from 1.5 to 10.0 mm, distance to the iso-center and phantom rotations were also examined. The automatic slice thickness algorithm was carried out by processing only objects within a circle having a diameter of half the diameter of the phantom. A segmentation was performed within an inner circle with dynamic thresholds to produce binary images with wire and bead objects within it. Region properties were used to distinguish wire ramps and bead objects. At each identified wire ramp, the angle was detected using the Hough transform. Profile lines were then placed on each ramp based on the centroid coordinates and detected angles, and the full-width at half maximum (FWHM) was determined for the average profile. The slice thickness was obtained by multiplying the FWHM by the tangent of the ramp angle (23°).Results. Automatic measurements work well and have only a small difference (<0.5 mm) from manual measurements. For slice thickness variation, automatic measurement successfully performs segmentation and correctly locates the profile line on all wire ramps. The results show measured slice thicknesses that are close (<3 mm) to the nominal thickness at thin slices, but slightly deviated for thicker slices. There is a strong correlation (R2= 0.873) between automatic and manual measurements. Testing the algorithm at various distances from the iso-center and phantom rotation angle also produced accurate results.Conclusion. An automated algorithm for measuring slice thickness on three types of Catphan CT phantom images has been developed. The algorithm works well on various thicknesses, distances from the iso-center, and phantom rotations.
The Development of Fish Stocks and Fisheries in the Baltic Sea Since the Last Glaciation
Authors: Svedäng Henrik
Published: May 2023

The fish fauna of the Baltic Sea reflects its 9 KY history of Arctic and temperate conditions and is a mixture of species that have invaded from the Atlantic and the continental watersheds. In spite of the challenging environmental conditions, such as low salinity in the entire Baltic Sea and varying temperature conditions, limiting the possibilities for successful reproduction, the number of species is comparably high.

Except for the Baltic Ice Lake and certain stages of the cold Yoldia Sea and freshwater Ancylus Lake, the fish fauna of the Baltic Sea, as recorded by archaeological and historical notes, has to a large extent remained unchanged. Some freshwater and cold-water species such as Arctic char may have disappeared while others, such as fourhorned sculpin and eelpout, have adapted and persist as “ice age relicts.” There are few viable introductions of novel species; the round goby may be the most conspicuous invasive species. The extinction rate is still low; the loss of sturgeon and the common skate within the HELCOM (the Helsinki Commission) area is due to fishing, and, for the riverine sturgeon, due to damming.

Since the formation of the Baltic Sea, fishing has played an essential role in supplying coastal settlements and their hinterlands and in trading. The archaeological and historical records have indicated fishing conducted with varying intensity using different methods.

Herring fishing has been a significant economic driver from the Middle Ages onward. Recent archaeological findings indicate that organized fishing was established at the outer archipelagos along the present Swedish east coast on predominately herring and cod archipelagos for self-sufficiency shortly before or during the Viking Age, and later to engage in barter.

The fact that the cod abundance has sometimes been sufficient for letting cod fishing be the most important fishery in the northern Baltic Proper alongside the fishery on herring may indicate that the eastern cod stock had relatively high productivity even when the Baltic Sea was significantly less eutrophic than it has been since the mid-20th century. This preindustrial variability in cod abundance suggests that climatic changes leading to changes in inflows of oceanic water may have affected salinity levels in the Baltic Sea.

Fisheries show substantial variability, especially over the last century. Fish production may have increased due to nutrient enrichment of the Baltic Sea. Higher yields have also been obtained due to higher fishing intensity and technological changes. Fishing has, therefore, become a major driver in shaping fish stocks.

The eutrophication of the Baltic Sea, leading to higher primary productivity and increasing water temperature and reductions in ice cover, may have led to changes in ecosystem structure and productivity. It should be underscored that such changes may also be amplified by the increasing fishing pressure on the cornerstone species such as herring, leading to significant disruptions in the food web.
Genealogies of Intersectionality in International Relations
Authors: Montoya Celeste , Killen Kimberly
Published: May 2023

The term intersectionality was introduced in the late 1980s by Kimberlé Crenshaw, a U.S. legal scholar critiquing single-axis approaches (i.e., race only or gender only) to oppression that often obscure those residing at the intersection of multiple marginalities and preclude them from justice. Since then, intersectionality has become a burgeoning field of study aimed at exploring and addressing the complexity of multiple and intersecting dimensions of power and oppression. While scholars across a range of disciplines have engaged intersectionality and incorporated intersectional analysis into their work, its explicit application and study in international relations (IR) has been somewhat limited. While intersectionality, named as such, may be less common in IR, postcolonial, Third World, transnational, Islamic, and queer feminist scholars and activists have long sought to complicate traditional understandings of power. Identifying and tracing the genealogical strands of their intersectional thinking and interventions help demonstrate the relevance and potential of intersectionality for the study of IR.
Climate and Climate Change in Early America
Authors: Mulcahy Matthew
Published: May 2023

European colonization of eastern North America and the Caribbean occurred against the backdrop of the Little Ice Age (LIA), a period between roughly 1300 and 1850 ce that witnessed generally colder conditions than in earlier and later centuries. Alone or in combination, shorter growing seasons associated with colder temperatures and periods of intense drought influenced Indigenous societies prior to the arrival of Europeans, interactions and conflicts between Europeans and Native Americans, and the development of colonial societies across the 16th, 17th, and 18th centuries. Farther south in the Caribbean region, climatic threats such as hurricanes and droughts created distinct challenges to colonists as they sought to establish large-scale plantations worked by enslaved Africans. Such threats forced Europeans to alter their expectations and perceptions of the climate in North America and the Caribbean. Following the principle that locations at the same latitude would have the same climate, Europeans had anticipated that places like Virginia would have a climate similar to Spain’s, but that was not the case. As they adjusted to new American climate realities, colonists remained confident they could change the climate for the better. Far from a threat, human-induced climate change seemed to many colonists a desirable goal, one that marked the degree to which they might improve and civilize the “wilderness” of the New World. However, colonists also became aware of some negative consequences associated with their activities.
Arts and Ethics: Questions
Authors: Fenner David
Published: May 2023

The world of art, across the globe and especially in the 20th and 21st centuries, has presented a range of challenges to those who attend to that world. These challenges span various spectra, but one set is ethical in character. How one responds to these ethical challenges will depend on one’s general ethical commitments and perspectives, but it will also depend, first, on one’s view of the relationship between the arts and ethics and, second, on understanding the context in which the challenge is made and the ethical challenge itself. Censoring a work of art, which can itself take many forms, is the result of meeting a particular challenge with the judgment that the work violates in important ways some ethical precept or set of precepts.
Recreation Use Values for Water-Based Recreation
Authors: Loomis John , Bair Lucas
Published: May 2023

Outdoor recreation is an important and growing activity worldwide. Water-based outdoor recreation is a subset that includes various activities such as fishing, boating, and swimming. While a large portion of water-based recreation is either free or provided at administratively set minimal entrance fees, these activities still involve significant economic value in aggregate. Because many water-based recreation activities do not have market prices, economists have developed nonmarket valuation methods to estimate the full scope of economic values to participants associated with these activities.

Estimates of the economic value of water-based recreation are important in water resource management. While water resource infrastructure investment decisions typically include the economic value of recreation, periodic evaluation of infrastructure operations after construction may not. Re-evaluation of operations is particularly important if rapid changes in future conditions such as drought or changes in recreational demand occur. Because developing original site-based estimates of economic value requires significant effort, it is important to understand the general economic value of specific water-based recreational activities and methods used to transfer benefit estimates from existing studies to other sites.
Diagnostic accuracy of the 3-minute diagnostic interview for confusion assessment method-defined delirium in delirium detection: a systematic review and meta-analysis
Authors: Ma Rui , Zhao Jin , Li Cui , Qin Yunlong , Yan Jipeng , Wang Yuwei , Yu Zixian , Zhang Yumeng , Zhao Yueru , Huang Boyong , Sun Shiren , Ning Xiaoxuan
Published: May 2023

Background

Delirium is a common complication clinically and is associated with the poor outcomes, yet it is frequently unrecognised and readily disregarded. Although the 3-minute diagnostic interview for confusion assessment method-defined delirium (3D-CAM) has been used in a variety of care settings, a comprehensive evaluation of its accuracy in all available care settings has not been performed.

Objective

This study aimed to evaluate the diagnostic test accuracy of the 3D-CAM in delirium detection through a systematic review and meta-analysis.

Methods

We systematically searched PubMed, EMBASE, the Cochrane Library, Web of Science, CINAHL (EBSCO) and ClinicalTrials.gov published from inception to 10 July 2022. The quality assessment of the diagnostic accuracy studies-2 tool was applied to evaluate methodological quality. A bivariate random effects model was used to pool sensitivity and specificity.

Results

Seven studies with 1,350 participants and 2,499 assessments were included, which were carried out in general medical wards, intensive care units, internal medical wards, surgical wards, recovery rooms and post-anaesthesia care units. The prevalence of delirium ranged from 9.1% to 25%. The pooled sensitivity and specificity were 0.92 (95% confidence interval [CI] 0.87–0.95) and 0.95 (95% CI 0.92–0.97), respectively. The pooled positive likelihood ratio was 18.6 (95% CI 12.2–28.2), the negative likelihood ratio was 0.09 (95% CI 0.06–0.14) and the diagnostic odds ratio was 211 (95% CI 128–349). Moreover, the area under the curve was 0.97 (95% CI 0.95–0.98).

Conclusions

The 3D-CAM has good diagnostic accuracy for delirium detection in different care settings. Further analyses illustrated that it had comparable diagnostic accuracy in older adults and patients with dementia or known baseline cognitive impairment. In conclusion, the 3D-CAM is recommended for clinical delirium detection.
GIL: a python package for designing custom indexing primers
Authors: Mateyko Nicholas , Tariq Omar , Chen Xinyi E , Cheney Will , Salaudeen Asfar Lathif , Luthra Ishika , Nikpour Najmeh , Rafi Abdul Muntakim , Kamali Dehghan Hadis , Jensen Cassandra , de Boer Carl
Published: May 2023

Generate Indexes for Libraries (GIL) is a software tool for generating primers to be used in the production of multiplexed sequencing libraries. GIL can be customized in numerous ways to meet user specifications, including length, sequencing modality, color balancing, and compatibility with existing primers, and produces ordering and demultiplexing-ready outputs.

Availability and implementation

GIL is written in Python and is freely available on GitHub under the MIT license: https://github.com/de-Boer-Lab/GIL and can be accessed as a web-application implemented in Streamlit at https://dbl-gil.streamlitapp.com.
Sudden cardiac death after heart transplantation: a population-based study
Authors: Bonnet Guillaume , Coutance Guillaume , Aubert Olivier , Waldmann Victor , Raynaud Marc , Asselin Anouk , Bories Marie-Cécile , Guillemain Romain , Bruneval Patrick , Varnous Shaida , Leprince Pascal , Achouch Paul , Marijon Eloi , Loupy Alexandre , Jouven Xavier
Published: May 2023

Aims

The epidemiology of sudden cardiac death (SCD) after heart transplantation (HTx) remains imprecisely described. We aimed to assess the incidence and determinants of SCD in a large cohort of HTx recipients, compared with the general population.

Methods and results

Consecutive HTx recipients (n = 1246, 2 centres) transplanted between 2004 and 2016 were included. We prospectively assessed clinical, biological, pathologic, and functional parameters. SCD was centrally adjudicated. We compared the SCD incidence beyond the first year post-transplant in this cohort with that observed in the general population of the same geographic area (registry carried out by the same group of investigators; n = 19 706 SCD). We performed a competing risk multivariate Cox model to identify variables associated with SCD. The annual incidence of SCD was 12.5 per 1,000 person-years [95% confidence interval (CI), 9.7–15.9] in the HTx recipients cohort compared with 0.54 per 1,000 person-years (95% CI, 0.53–0.55) in the general population (P < 0.001). The risk of SCD was markedly elevated among the youngest HTx recipients with standardized mortality ratios for SCD up to 837 for recipients ≤30 years. Beyond the first year, SCD was the leading cause of death. Five variables were independently associated with SCD: older donor age (P = 0.003), younger recipient age (P = 0.001) and ethnicity (P = 0.034), pre-existing donor-specific antibodies (P = 0.009), and last left ventricular ejection fraction (P = 0.048).

Conclusion

HTx recipients, particularly the youngest, were at very high risk of SCD compared with the general population. The consideration of specific risk factors may help identify high-risk subgroups.
Anelastic response of the Earth's crust underneath the Canary Islands revealed from ocean tide loading observations
Authors: Arnoso Jose , Bos Machiel S , Benavent Maite , Penna Nigel T , Sainz-Maza Sergio
Published: May 2023

We report on the analysis of M2 ocean tide loading (OTL) kinematic GPS vertical displacement and tidal gravity measurements using 26 GPS and four gravimetric sites across the Canary Islands archipelago. In this region, the standard deviation among recent ocean tide models is lower than 0.4 cm in amplitude and 0.3° in phase, which are suitably accurate for displacement modelling. However, for gravity we need to model regional ocean tides to achieve enough accuracy in the loading calculations. Particularly, this study improves the predicted OTL gravity variations when global ocean models are replaced with the regional model CIAM2 which assimilates local tide gauge data. These small ocean tide model errors allow us to use the differences between observed and predicted OTL values to study the elastic and anelastic properties of the solid Earth around the Canary Islands. In the prediction of OTL, we first used the recent elastic STW105 and S362ANI seismic models, obtaining average observed minus predicted residuals of 1.2–1.3 mm for vertical displacement and 3 nm s−2 for gravity. After the STW105 and S362ANI models were adjusted for anelasticity, by considering a constant quality factor Q at periods ranging from 1 s to 12.42 hr, the average misfit between observations and predicted OTL values reduced to 0.7–0.8 mm for vertical displacement and to 1 nm s−2 for gravity. However, the average vertical displacement misfit is made up from site misfits less than 0.5 mm in western islands but for the easternmost islands of Lanzarote and Fuerteventura, they still reach up to nearly 2 mm at some sites, which still exceeds the uncertainty in the GPS observations. It is hypothesized that mantle upwelling underneath the Canary Islands, creating spatial variations in the elastic properties, causes the large residuals observed in the eastern islands. We reduced the shear modulus by up to 35 per cent in the upper mantle layer of 24.4–220 km depth. This produced residual observed minus model differences of about 0.7 mm for the sites on Lanzarote and Fuerteventura, comparable to the results obtained for the GPS sites across the rest of the archipelago, whose residuals in turn were also slightly reduced through the VS velocity and shear modulus reductions (by 0.2 mm on average).
Role of fluorine-18-fluorodeoxyglucose positron emission tomography in selecting candidates for a minimally invasive approach for thymic epithelial tumour resection
Authors: Akamine Takaki , Nakagawa Kazuo , Ito Kimiteru , Watanabe Hirokazu , Yotsukura Masaya , Yoshida Yukihiro , Yatabe Yasushi , Kusumoto Masahiko , Watanabe Shun-Ichi
Published: May 2023

OBJECTIVES

We evaluated the potential of preoperative fluorine-18-fluorodeoxyglucose positron emission tomography to predict invasive thymic epithelial tumours in patients with computed tomography-defined clinical stage I thymic epithelial tumours ≤5 cm in size who are generally considered to be candidates for minimally invasive approaches.

METHODS

From January 2012 to July 2022, we retrospectively analysed patients who exhibited tumour-node-metastasis (TNM) clinical stage I thymic epithelial tumours with lesion sizes ≤5 cm as determined by computed tomography. All patients underwent fluorine-18-fluorodeoxyglucose positron emission tomography preoperatively. We analysed the association of maximum standardized uptake values with both the World Health Organization histological classification and the TNM staging classification.

RESULTS

A total of 107 patients with thymic epithelial tumours (thymomas, 91; thymic carcinomas, 14; carcinoids, 2) were evaluated. Nine patients (8.4%) were pathologically upstaged: TNM pathological stage II in 3 (2.8%), III in 4 (3.7%) and IV in 2 (1.9%). Among these 9 upstaged patients, 5 had thymic carcinoma with stage III/IV, 3 had type B2/B3 thymoma with stage II/III and 1 had type B1 thymoma with stage II. Maximum standardized uptake values were a predictive factor that distinguished pathological stage >I thymic epithelial tumours from pathological stage I [best cut-off value, 4.2; area under the curve = 0.820] and thymic carcinomas from other thymic tumours (best cut-off value, 4.5; area under the curve = 0.882).

CONCLUSIONS

Thoracic surgeons should carefully determine the surgical approach for high fluorodeoxyglucose-uptake thymic epithelial tumours and keep in mind the issues associated with thymic carcinoma and potential combined resections of neighbouring structures.
Mitral repair versus replacement: 20-year outcome trends in the UK (2000–2019)
Authors: Al-Zubaidi Fadi , Pufulete Maria , Sinha Shubhra , Kendall Simon , Moorjani Narain , Caputo Massimo , Angelini Gianni D , Vohra Hunaid A
Published: May 2023

OBJECTIVES

Using a large national database, we sought to describe outcome trends in mitral valve surgery between 2000 and 2019.

METHODS

The study cohort was split into mitral valve repair (MVr) or replacement, including all patients regardless of concomitant procedures. Patients were grouped by four-year admission periods into groups (A to E). The primary outcome was in hospital mortality and secondary outcomes were return to theatre, postoperative stroke and postoperative length of stay. We investigated trends over time in patient demographics, comorbidities, intraoperative characteristics and postoperative outcomes. We used a multivariable binary logistic regression model to assess the relationship between mortality and time. Cohorts were further stratified by sex and aetiology.

RESULTS

Of the 63 000 patients in the study cohort, 31 644 had an MVr and 31 356 had a replacement. Significant demographic shifts were observed. Aetiology has shifted towards degenerative disease; endocarditis rates in MVr dropped initially but are now rising (period A = 6%, period C = 4%, period E = 6%; P < 0.001). The burden of comorbidities has increased over time. In the latest time period, women had lower repair rates (49% vs 67%, P < 0.001) and higher mortality rates when undergoing repair (3% vs 2%, P = 0.001) than men. Unadjusted postoperative mortality dropped in MVr (5% vs 2%, P < 0.001) and replacement (9% vs 7%, P = 0.015). Secondary outcomes have improved. Time period was an independent predictor for reduced mortality in both repair (odds ratio: 0.41, 95% confidence interval: 0.28–0.61, P < 0.001) and replacement (odds ratio: 0.50, 95% confidence interval: 0.41–0.61, P < 0.001).

CONCLUSIONS

In-hospital mortality has dropped significantly over time for mitral valve surgery in the UK. MVr has become the more common procedure. Sex-based discrepancies in repair rates and mortality require further investigation. Endocarditis rates in MVS are rising.
On the Center Conjecture for the Cyclotomic KLR Algebras
Authors: Hu Jun , Lin Huang
Published: May 2023

The center conjecture for the cyclotomic KLR algebras $\mathscr{R}_{\beta }^{\Lambda }$ asserts that the center of $\mathscr{R}_{\beta }^{\Lambda }$ consists of symmetric elements in its KLR $x$ and $e(\nu )$ generators. In this paper, we show that this conjecture is equivalent to the injectivity of some natural map $\overline{\iota }_{\beta }^{\Lambda ,i}$ from the cocenter of $\mathscr{R}_{\beta }^{\Lambda }$ to the cocenter of $\mathscr{R}_{\beta }^{\Lambda +\Lambda _{i}}$ for all $i\in I$ and $\Lambda \in P^{+}$. We prove that the map $\overline{\iota }_{\beta }^{\Lambda ,i}$ is given by multiplication with a center element $z(i,\beta )\in \mathscr{R}_{\beta }^{\Lambda +\Lambda _{i}}$ and we explicitly calculate the element $z(i,\beta )$ in terms of the KLR $x$ and $e(\nu )$ generators. We present explicit monomial bases for certain bi-weight spaces of the defining ideal of $\mathscr{R}_{\beta }^{\Lambda }$. For $\beta =\sum _{j=1}^{n}\alpha _{i_{j}}$ with $\alpha _{i_{1}},\cdots , \alpha _{i_{n}}$ pairwise distinct, we construct an explicit monomial basis of $\mathscr{R}_{\beta }^{\Lambda }$, prove the map $\overline{\iota }_{\beta }^{\Lambda ,i}$ is injective, and thus verify the center conjecture for these $\mathscr{R}_{\beta }^{\Lambda }$.
(002) The Effects of Vaginal Testosterone versus Placebo on Female Sexual Function: Interim Analysis of the PIVoT Trial (Prevention of Recurrent Urinary Tract Infection using Vaginal Testosterone)
Authors: Martinez M , Sandozi A , Vafina L , Kaplan-marans E , Lee J , Khurgin J , Lee A , Polland A
Published: May 2023

Introduction

Post-menopasual women experience changes in vaginal flora and vaginal atrophy that have been associated with declining estrogen levels. These changes to the vaginal microenvironment often lead to significant genital pain and discomfort during sexual intercourse. Vaginal estrogen treats atrophy thereby restoring flora, which prevents UTIs and improves sexual function in post-menopausal women. While estrogen is effective, some patients have contraindications or are unwilling to use it. Vaginal testosterone cream (VT) has been shown to improve vaginal atrophy, however, its effects on overall vaginal health and sexual function have not been fully described.

Objective

The purpose of this study was to determine if VT is more effective than placebo cream in restoring the vaginal flora, improving the vaginal health index (VHI), and the sexual function of postmenopausal women with recurrent UTIs.

Methods

This is an interim analysis of a randomized, double- blind placebo-controlled pilot study enrolling postmenopausal women with recurrent UTIs. Vaginal health index (VHI) and swab to assess flora via DNA sequencing were collected. Patients were randomized to VT or placebo. Female sexual function index (FSFI) questionnaires were administered at baseline, one month, and nine months post treatment.

Results

A total of 44 women have been enrolled. Average VHI at enrollment was 13.66 +/− 0.4. There was no difference in baseline characteristics among the groups. Results show an improvement in female sexual function index scores in both groups from baseline. In the VT arm, improvements were seen in the desire (2.18 to 2.85), lubrication (1.74 to 2.175), orgasm (1.64 to 2.5) and pain (0.91 to 1.3) domains of the FSFI. Interestingly, improvements in all domains were seen in the placebo group, however, more patients in this group reported being sexually active. In terms of VHI, there was a statistically significant increase in VHI scores at 9 months post-treatment with VT (14.65 +/−4.20 to 17.50 +/− 4.43, p = 0.04). This increase in vaginal health index was not observed in the placebo arm.

Conclusions

Initial data demonstrates improvement in vaginal pH and VHI after 9 months of treatment with VT. Improvement in sexual function scores were also seen in both the treatment and the placebo groups. Higher patient enrollment and longer treatment follow up will be valuable in understanding the effects of VT versus placebo on sexual function among postmenopausal women.

Disclosure

No
(012) Cannamoms' & the "Postpotum" Stage: Assessment of Cannabis Use and Potential Benefits for Mental Health, Sexual Function & Pleasure, and Parenting Among Postpartum Mothers
Authors: Simpson-Baker D
Published: May 2023

Introduction

Public opinion on cannabis continues to shift as more people emerge from the “green closet” in support of both recreational and medicinal use. ‘Cannamoms,’ a subgroup of cannabis users, represent moms who use cannabis to manage both physical and mental postpartum changes; these moms are attempting to diminish the stigma surrounding cannabis while making the case for how it can be beneficial for postpartum mental health, sex and parenting. For centuries, cannabis has been cited for its multiple benefits, including its anti-depressant and anti-anxiety properties (Zaske, 2018; Stoner, 2017) and its potential to improve sexual health, functioning and pleasure (Kasman et al., 2020; Wiebe & Just, 2019; Testa et al., 2019; Lynn et al., 2019; Sun & Eisenberg, 2017); though multiple studies exist on these topics alone, few have been carried out to investigate how cannabis has the potential to benefit postpartum moms specifically in these areas.

Objective

The purpose of this study is to investigate how cannabis has the potential to be beneficial for moms during the postpartum stage, specifically as it relates to improving mental health, sex and parenting.

Methods

Postpartum moms (participants) were invited to participate in two uncompensated Instagram surveys on May 8, 2021 and May 8, 2022. The survey included 3 poll questions, 4 question & answer sections (Q&A’s) and 1 personal interview. The survey assessed baseline demographics, cannabis use habits and the ways in which participants use cannabis to benefit their mental health, sex lives, and approaches to parenting. A meta-analysis of existing research was also performed to support study findings.

Results

A total of 107 participants between the ages of 18 and 45 were surveyed via Instagram polling, Q&As and personal interviews. Participants reside in the United States and represent multiple racial & ethnic groups (33% Caucasian, 24% Hispanic/Latinx, 25% Black/African American, 1% Native/American Indian, 1% Asian American/Pacific Islander, & 13% Two or more races). 61% of participants endorsed regular use of cannabis, mostly through smoking cannabis flower (46%) or consuming cannabis edibles (36%). Of those participants, 75% agreed that cannabis improves their mental health (including symptoms of depression and anxiety); 89% agreed that cannabis improves their sex lives; and 89% agreed that cannabis improves their approach to parenting.

Conclusions

Cannabis use among postpartum mothers is associated with improved mental health, better sex and better parenting. These results suggest a need for more research on the potential benefits of safe & responsible cannabis use during the postpartum stage.

Disclosure

No
(036) Outcomes of Penile Prosthesis Implantation after Transgender Phalloplasty: A Single Center Study
Authors: Persily J , Mishra K , Lee Y S , Blasdel G , Bluebond-Langner R , Zhao L
Published: May 2023

Introduction

Many transmen chose to pursue penile prosthesis (PP) implantation as a stage of genital gender affirming surgery. The prosthesis facilitates penetrative intercourse, as the neophallus lacks rigid erectile tissue. While PP placement is a well-established and relatively low-risk surgical treatment option for erectile dysfunction is the cis-male population, published series of post-phalloplasty prosthesis placement have demonstrated a higher rate of complications and subsequent explant.

Objective

To demonstrate that an integrated surgical team that participates in all stages of phalloplasty creation can improve penile prosthesis outcomes in transmen.

Methods

We performed a retrospective review of all transmen who underwent PP implantation at our institution from January 2015 through October 2021, yielding a cohort of 44 men. Men who underwent phalloplasty for another reason (trauma, infection, priapism) were excluded. Both malleable (MPP) and inflatable (IPP) prostheses were included in the cohort. Home phalloplasty refers to phalloplasty performed at our institution, and outside phalloplasty at another institution. The surgical technique emphasizes exclusion of urinary flora from the operative field and avoiding excess anchor material to minimize niduses for infection. We analyzed preoperative, operative, and post-operative characteristics, stratified by whether the phalloplasty was performed at our institution. We also performed logistic regression for predictors of explant in the cohort.

Results

Cohort characteristics and outcomes are represented in Table 1. 44 PPs were implanted 28 at our institution, 16 at an outside institution. Average age was 32 and 33 in the cohorts, respectively. IPPs were more commonly implanted than MPP. Notably, operative time was significantly lower if the phalloplasty had been constructed at our institution (p=0.014). 16 men total required explant, 7/28 (25%) in the home phalloplasty group and 9/16 (56.3%) in the outside phalloplasty group. Predictors of explantation are shown in Table 2. Significant predictors included age (p=0.013), smoking (p=0.030), operative time (p=0.007), whether the phalloplasty was performed at our institution (p=0.043), and the number of pre-PP revision surgeries (p=0.047). On multivariate logistic regression including all variables significant on univariate analysis, only age (p=0.032) and operative time (p=0.010) remained significant predictors.

Conclusions

We present a large post-phalloplasty penile prosthesis cohort, demonstrating exceedingly low infection rate and improved explant rate in a cohort of men who all underwent both phalloplasty and prosthesis placement with the same surgical team. Our analysis suggests that phalloplasty characteristics, patient characteristics, and operative time can influence penile prosthesis outcomes.

Disclosure

No
(037) Contemporary Surgical and Functional Outcomes of Anterolateral Thigh Flap for Penile Reconstruction
Authors: Lee W G , Adasonla K , Ralph D , Christopher N
Published: May 2023

Introduction

The radial forearm free flap phalloplasty is the most commonly used flap for penile reconstruction. The anterolateral thigh (ALT) free flap was proposed in 2006 as an alternative due to the twin advantages of a more easily hidden scar and improved flexibility in the length of the flap. A pedicled variant of the ALT flap was proposed the same year thus offering greater security of vascular supply for suitable patients. Previous reports have highlighted higher rates of flap loss and low rates of integrated urethra.

Objective

The aim of the study is to report the contemporary surgical outcomes of ALT phalloplasty. In addition, the functional outcomes of the ALT flap phalloplasty are reported for the first time.

Methods

All patients undergoing ALT flap phalloplasty were included in the study between 2009 and 2021. Data were extracted from a comprehensive prospective database and the medical records. Functional outcomes were assessed by non-validated questionnaire.

Results

Seventy-six patients underwent ALT flap phalloplasty with a mean follow-up of 34 months (SEM ± 3.05). Median age of the patients was 32 (IQR 26 – 46) and body mass index was 24 (SEM ± 0.61). A significant minority had a previous phalloplasty (22%). In addition, 7% of patients had other co-morbidities including diabetes and peripheral vascular disease. Over half of all flaps (n=41) were designed with an integrated urethra and 6.6% (n=5) required free flap transfer. The average length of stay was seven days (SEM ±0.47). Post-surgery, five (6.6%) patients experienced total flap loss, with a further three (3.9%) experiencing partial loss. Urethral complications were common with eleven (26.8%) patients developing fistulae and three (7.3%) developing strictures. Fifty-three (69%) patients completed the functional outcomes questionnaire. Forty-three (81%) were generally satisfied with their phalloplasty, while thirty-four (65%) felt they had a good cosmetic outcome. Twenty-eight (53%) had sensation in at least half of their phallus. Eight (17%) experienced troublesome post-micturition dribbling.

Conclusions

Presented is one of the largest cohort of patients following genital gender affirmation surgery using the ALT flap phalloplasty. Over half of all patients successfully had an integrated urethra (gold standard for urethral reconstruction). Functional outcomes (an important determinant for the choice of a flap) are reported for the first time showing 81% of patients are satisfied despite a challenging cohort with almost a quarter of patients undergoing salvage following previous failed phalloplasty.

Disclosure

No
(077) Testosterone Therapy in Men on Active Surveillance for Prostate Cancer
Authors: Flores J , Salter C A , Benfante N , Jenkins L , Ehdaie B , Laudone V , Eastham J , Mulhall J P
Published: May 2023

Introduction

The role of testosterone therapy (TTH) in men with prostate cancer (PC) is debated, especially in men on active surveillance (AS).

Objective

This study aimed to review our data on TTH in this population.

Methods

The study population consisted of (i) men with PC on active surveillance (ii) with two total T (TT) levels <300 ng/dL (iii) associated with symptoms (iii) performed using LCMS (v) conducted in an early morning fashion who (vi) pursued T therapy (TTH). TTH included exogenous (transdermal, intramuscular) and clomiphene citrate (CC) in the setting of low/low-normal LH levels. T lab work including PSA levels, were checked within 4 weeks of TTH initiation, every three months in the first year and every six months after that. Target TT level was the middle tertile of the normal reference range at our institution. We report on T and PSA levels in this group.

Results

82 patients are included. Mean age = 64 ± 9 years. Median pre-TTH PSA levels were 4.6 [3.4, 6.7] ng/mL. Mean baseline TT levels were 305 ± 145 ng/dL. 19% of these men had a TT level <200 ng/dL. Median Gleason score (GS) was 6 with 90% 3+3, 9% 3+4 and 1% 4+3. Median duration on AS before TTH was 14 [1, 43] months. 45% received transdermal T, 19% intramuscular T and 36% CC. Post-TTH TT = 553 ± 268 ng/dL, PSA = 4.9 [3.2, 9.2] Median duration of TTH at last follow-up was 14 [1, 39] months. Median PSA change per patient was 0.3 [-0.9, 2.6] ng/mL, representing a median of 14 (-24, 70) % change in PSA per patient (p= 0.045). 42% had a decrease in PSA, 58% an increase. In 88% of men who experienced a rise in PSA, the PSA rose ≥10%. 50% of men on TTH who had a PSA level below 4 ng/dL rose above 4. 28% of men experienced a PSA level increase ≥1 ng/mL per year. In 18% of these men, TTH was stopped and definitive PC treatment was instituted. In men with ≤1 ng/mL per year increase in PSA, another 18% opted for definitive PC treatment. The most common reason for this was PSA anxiety.

Conclusions

In men with PC on AS treated with TTH, minimal changes in PSA were seen, with equal numbers of men experiencing a rise and a drop in PSA. About fifth of men ceased AS and proceeded to definitive therapy for their PC.

Disclosure

No
(110) Evaluation of Men Under 35 Who Underwent Penile Implant Surgery
Authors: Suarez-Sarmiento A , Perito P , Ghomeshi A , Mendez L , Suarez-Sarmiento M , Levit B
Published: May 2023

Introduction

Erectile Dysfunction (ED) has become an increasingly common disorder in young adult males. There are multiple etiologies of ED ranging from vascular, neurogenic, and structural causes. Often times, ED presenting in young men is psychiatric in nature as opposed to the other causes that typically present in older patients. ED found in young, healthy men with no history of systemic disease or traumatic injury, can be challenging. Past research has shown that men ages 18-35 typically have normal lab results and are treated with PDE-5 inhibitors. However, our data suggests that patients whose symptoms do not improve following the use of PDE-5 inhibitors may have a vascular etiology of ED.

Objective

Our objective is to determine the prevalence of venous leaks in young adult males who present with ED, but do not respond well to PDE-5 inhibitors.

Methods

Patients who underwent inflatable penile prosthesis (IPP) surgery for the treatment of ED over a 36-month period under the age of 35 who had failed PDE-5 inhibitors were identified from our database retrospectively. All patients completed an IIEF-5 questionnaire and had a penile doppler ultrasound (PDUS) performed preoperatively. PDUS was used to identify and record cavernous arterial flow signals before and after stimulation. Veno-occlusive ED was described as persistent End Diastolic Velocity (EDV) over 5 cm/sec during all phases of erection. The relationships, according to Doppler diagnosis, IIEF-5 score, SHIM scale, and erection score were evaluated as well as surgical outcomes and patient comorbidities.

Results

1,558 patients were evaluated in this series, of whom 32 met inclusion criteria. Patients ages ranged from 18 to 35, with a mean age of 28.4. PDUS determined that 27 (84%) suffered from veno-occlusive disease, while 3 (9%) had arterial insufficiency due to DMI and 2 (7%) had neuropraxia. Of those veno-occlusive disease patients, EDV values ranged from 7.4 to 21.2, with a mean of 13.4, with peak systolic velocity values ranging from 45 to 122cm, with a mean of 97. All patients in this cohort had successful penile prosthesis implantation without complications or need for revision.

Conclusions

Doppler examination does indeed suggest that patients with cavernous venous occlusive dysfunction have moderate to severe leaks. We strongly recommend a baseline PDUS following PDE-5 inhibitor failure due to the significant prevalence of veno-ccclusive disease in this rare patient population. Furthermore, if veno-occlusive disease is identified during PDUS, we encourage frank discussion of penile prosthesis placement with the patient as well as the severity of veno-occlusive disease and its resultant effect of worsening ED.

Disclosure

Any of the authors act as a consultant, employee or shareholder of an industry for: coloplast, boston scientific