bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends in GDP production and carbon emissions in Russia: Spline-analysis of the relationship
Authors: Ilyasov Ruslan , Plotnikov Vladimir , Khuazheva Aminat
Published: June 2024

In recent years, demand for energy, the main source of carbon emissions, has continued to increase against the background of GDP production growth. Ensuring a global transition to a low-carbon economy can be achieved by increasing the consumption of environmentally friendly energy. Crises have a noticeable impact on the development of the global energy system, slowing down economic growth and transforming the structure of consumed energy sources. Russia has been affected by several crises over the past two decades, which have led to disruptions in supply chains, volatility in energy prices, fluctuations in GDP growth and carbon emissions. The classical approach to the study of relationships suggests replacing empirical data with smoothed ones, abstracting from taking into account fluctuations caused by crises. The article examines the changes in the correlation between GDP growth trends and carbon emissions in Russia, which occur under the influence of crises. The article proposes a new method for studying relationships in economics, which refuses regression smoothing of data. Its conceptual basis is the interpolation of data by a cubic spline, which preserves all changes in the dynamics of processes without distortion. Correlations are searched for between trends -fluctuations in the rate of GDP growth and carbon emissions. The method is based on a natural mathematical method of analytical description of velocity – differentiation of spline models of GDP growth dynamics and carbon emissions. Fluctuations in the growth rate reveal the evolution of the parameters of the relationship between trends in the rate of GDP growth and carbon emissions under the influence of crises.
Recycling agricultural waste as a way to sustainable development
Authors: Ivukina Yelena , Skvortsova Irina
Published: June 2024

The paper discusses the importance of agricultural waste recycling as one of the modern green technology categories. The authors describe and analyze the case of using agricultural waste for biodegradable polymers production by applying innovative biomicrogel’s technology. Further, the contribution of these environmentally friendly products to solving the problems of wastewater treatment and water purification is highlighted. Principles of conscious consumption as a significant part of sustainable development are outlined. The vital role of support from the state, scientific research, and business community in the implementation of green technologies is stressed.
The Effect of Breakup on Angular Distribution of Scattering Cross Sections in6He+197Au,6He+209Bi, and8He+208Pb Systems at Energies Close to Coulomb Potential Barrier
Authors: Alwan Haider H. , Hussain Fatima M.
Published: June 2024

Effects of breakup channel on elastic and inelastic scattering have been studied using the nuclear potential Woods-Saxon (WS) for6He+197Au,6He+209Bi, and8He+208Pb systems, which contain weakly bound nuclei (halo nuclei) as projectiles. The Continuum-discretized coupled-channels CDCC method have been used to employed single channel (SC) and coupled channels (CC) calculations. Cross-sections of elastic and inelastic scattering were extracted from the optical potential fits, to achieve the optimum comparability between the theoretical calculations of dstot/dsR and experimental data for the systems reviewed. The breakup process at near Coulomb barrier energies play essential role in the results of cross section as a function of angle in angular distribution.
Assessing climate stability and greenhouse gas emissions in Issyk-Kul basin of Kyrgyzstan: A Focus on the tourist season
Authors: Zhusupkeldiev Sharshenbek , Asanbekova Damira , Tynaliev Urmatbek , Sabitov Baratbek , Ismailova Gulzat
Published: June 2024

The dataset of this study is derived from measurements of greenhouse gases and particulate matter (PM2.5, PM10) collected with portable gas analyzers using the in situ measurement method in the Issyk Kul basin of Kyrgyzstan. Data were collected from July, 2023 to September, 2023 to assess atmospheric conditions and air quality in towns and villages surrounding Lake Issyk-Kul. Various factors contribute to the deterioration of air quality, including increased automobile traffic and fires. In addition, calm air conditions, which can be caused by anticyclones, temperature inversions or low wind speeds, can lead to the accumulation of pollutants. This stagnation leads to increased concentrations of pollutants and facilitates chemical reactions between them, often resulting in smog.
Comparison of Patients Based on Their Self-Selected Discharge Pathway after Total Knee Arthroplasty at an Ambulatory Surgical Center
Authors: Palmsten Allison , Haynes Amy L. , Ryan Jaclyn M. , Pittman Gavin T. , Huang Der-Chen T. , Obermeier Michael , Chmielewski Terese L.
Published: June 2024

Outpatient total knee arthroplasty (TKA) is being performed more frequently in ambulatory surgical centers (ASCs) to decrease the cost of care. Discharge pathways include 23-hour observation (OBSERVATION) or same-day discharge home (HOME), which differ in postoperative medical supervision. Few studies allow patients to self-select their discharge pathway. This study compared patient variables between self-selected OBSERVATION or HOME discharge after TKA at an ASC. We hypothesized that age, sex, and distance lived from the ASC would differ between discharge pathways. Clinical and patient-reported outcomes were explored.

A chart review identified 130 patients with TKA at an ASC between November 2017 and December 2019. Patients self-selected OBSERVATION or HOME during a preoperative physician visit. Patient variables obtained from the electronic medical record were age, sex, race/ethnicity, marital status, body mass index, diabetic status, American Society of Anesthesiologists (ASA) class, distance lived from the ASC, anesthesia type, procedure time, and time in the postanesthesia recovery unit. Clinical outcomes (knee range of motion, infection rate, and reoperation rate) and patient-reported outcomes (Knee Injury and Osteoarthritis Outcome Score, Joint Replacement [KOOS, JR]; Oxford Knee Score [OKS]) were collected at either 6 or 12 weeks postsurgery. Variables were compared between groups.

Pathway selection was n = 70 OBSERVATION and n = 60 HOME, and all patients completed their self-selected discharge pathway. Age and proportion of females were significantly higher in OBSERVATION than in HOME (61.3 ± 3.5 vs. 58.5 ± 5.4 years, 85.7 vs. 65.0%, respectively; p < 0.05). Distance lived from the ASC tended to be greater in OBSERVATION than HOME (22.1 ± 24.6 vs. 15.3 ± 10.1 miles, p = 0.056). Across groups, clinical outcomes were favorable (i.e., >88% met the 6-week knee flexion milestone, 1.9% infection rate, and 3.1% manipulation under anesthesia), and the preoperative to 12-week postoperative change in KOOS, JR and OKS scores met the minimal clinically important difference.

Older age, female sex, and farther distance lived from the ASC may influence patients to select OBSERVATION over HOME discharge following TKA at an ASC. No robust differences were found in early outcomes.
Clinical Characteristics of Different Human Cytomegalovirus Glycoprotein N Genotypes among Child Patients in China
Authors: Li Huamei , He Lin , Wang Bing , Tao Ran , Shang Shiqiang
Published: June 2024

Objective This study aimed to investigate the relationship between clinical characteristics and human cytomegalovirus (HCMV) glycoprotein N (gN) genotypes in children.

Methods HCMV gN gene polymorphisms in 544 patients were analyzed using semi-nested polymerase chain reaction and restriction fragment length polymorphism.

Results The highest proportion was observed for the gN3a genotype (126/544, 23.2%). The proportion of children with mixed infections presenting with the hepatitis phenotype (65/69, 94.2%) was significantly higher than that of each gN genotype, except for gN3b (34/43, 79.1%, all p < 0.0083). Patients infected with 4b genotype (56/56, 100%) had a significantly higher proportion of anemia symptoms than those infected with all other gN genotypes (all p < 0.0083). There were also significant differences in the proportion of patients infected with different gN genotypes who presented with clinical features, such as jaundice, pneumonia, and thrombocytopenic purpura. Patients with the gN2 genotype had significantly higher albumin levels than those with the gN3a genotype (p = 0.042).

Conclusion The clinical phenotypes and laboratory indicators of HCMV infection in children with different gN genotypes are somewhat different, suggesting that precise typing of gN genes has clinical value.
Ptychography provides detailed look at challenging nanoparticles
Authors: Thompson Avery
Published: June 2024

Ptychography can capture signals from light elements in a dose-effective manner in 3D, providing a more complete understanding of upconverting core-shell nanoparticles than conventional methods.
Unraveling the psychological impact of spatial cybertext environments on speech intent
Authors: Rahardi R Kunjana , Rahmat Wahyudi , Tiawati Refa Lina , Setyaningsih Yuliana
Published: June 2024

This cyberpragmatic study investigates the correlation between spatial multimodal cybertext environments and their psychological impact on speech intent. The research delves into speech fragments in diverse cybertextual contexts across social media platforms. The methodology involves data identification, transcription, classification, and typification. Similarly, looking at things, the study shows that the physical settings of cybertexts have a big effect on the everyday meanings of words, acting as background, determinant, emphasis enhancer, reinforcement, illustration, and signal for speech intent. The research explores the distinct role of each category in shaping speech intention within spatial cybertexts, underscoring how these insights can facilitate effective communication and their psychological impact on speech intent, particularly for language learners on social media platforms.
Binary classification of dead detector elements in flat panel detectors using convolutional neural networks
Authors: Box Jon , Schnell Erich , Rutel Isaac
Published: June 2024

Objective. Medical physicists routinely perform quality assurance on digital detection systems, part of which involves the testing of flat panel detectors. Flat panels may degrade over time as an increasing number of individual detector elements begin to malfunction. The pixels that correspond to these elements are corrected for using information elsewhere in the detector system, however these corrected elements still constitute a loss in image quality for the system as a whole. These correction methods, as well as the location and number of dead detector elements, are often only available to the vendor of the digital detection system, but not to the medical physicist responsible for the quality assurance of the system. Approach. We greatly expand upon a previous work by providing a novel technique for classifying dead detector elements at single pixel resolution. We also demonstrate that this technique can be trained on one detector, and then tested and validated on another with moderate success, which demonstrates some ability to generalize to different detectors. The technique requires 3 flat field, or ‘noise’, images to be taken to predict the dead detector element maps for the system. Main results. Models using only for-processing pixel data were unable to successfully generalize from one detector to the other. Models preprocessed using the standard deviation across three for-processing images were able to classify dead detector element maps with an F1 score ranging from 0.4527 to 0.8107 and recall ranging from 0.5420 to 0.9303 with better performance, on average, observed using the low exposure data set. Significance. Many physicists do not have access to the dead detector maps for their diagnostic digital radiography systems. CNNs are capable of predicting the dead detector maps of flat panel detectors with single pixel resolution. Physicists can implement this tool by acquiring three flat field images and then inputting them into the model. Model performance saw a marginal increase when trained on the low exposure set data, as opposed to the high exposure set data, indicating high exposure, low relative noise images may not be necessary for optimal performance. Model performance across detectors manufactured by different vendors requires further investigation.
Toward optimal exponent pairs
Authors: Trudgian Timothy , Yang Andrew
Published: June 2024

We quantify the set of known exponent pairs

(
k
,
ℓ
)

(k, \ell )

and develop a framework to compute the optimal exponent pair for an arbitrary objective function. Applying this methodology, we make progress on several open problems, including bounds of the Riemann zeta-function

ζ
(
s
)

\zeta (s)

in the critical strip, estimates of the moments of

ζ
(
1

/

2
+
i
t
)

\zeta (1/2 + it)

and the generalised Dirichlet divisor problem.
Asymptotic Completeness for a Scalar Quasilinear Wave Equation Satisfying the Weak Null Condition
Authors: Yu Dongxiao
Published: June 2024

In this paper, we prove the first asymptotic completeness result for a scalar quasilinear wave equation satisfying the weak null condition. The main tool we use in the study of this equation is the geometric reduced system introduced in Yu (Modified wave operators for a scalar quasilinear wave equation satisfying the weak null condition, 2021). Starting from a global solution

u
u

to the quasilinear wave equation, we rigorously show that well chosen asymptotic variables solve the same reduced system with small error terms. This allows us to recover the scattering data for our system, as well as to construct a matching exact solution to the reduced system.
Epidemiology and Prognostic Factors Analysis of Electrical Injuries in Shaanxi, China: A Single-Center Observational Study of 385 Cases
Authors: Zhao Huaqiang , Lei Zhanjun , Yang Ming , Li Xueyong , Tang Jiezhang , Dong Yuchen , Feng Jian , Bian Yongqian
Published: June 2024

The objective of this research is to investigate the epidemiological features of electrical injuries in Shaanxi Province, China, examine their prognosis, and ascertain the factors that impact the outcomes. Telephone follow-ups were conducted with patients with electrical injuries at our hospital between 2011 and 2021, yielding the following results: Most electrical injuries occur in males (94.3%) and younger or middle-aged individuals. The most common voltages involved are 220 and 380 V. Since 2016, there has been a 20.1% annual decrease in electrical injuries, with most cases occurring from April to September. Patients typically undergo 1 surgical procedure (0.3), with a 14.8% amputation rate and an average hospital stay of 21 days (9.43). A total of 1.8% of patients with electrical injuries have died, 17.1% have permanent nerve damage, and 10.8% need help with daily tasks; 18.5% have psychological issues, and 9.6% have posttraumatic stress disorder; and 93.7% return-to-work in an average of 6 months (2.12). Amputation risk is influenced by voltage, muscle injury, and current pathway; skin grafting risk is mainly due to voltage. Heart injuries are affected by unconsciousness and current pathways; labor loss risk factors include voltage, falls from heights, and muscle injury; and nerve damage is linked to muscle injury. Cataract development risk is associated with electric shock to the head and neck. It is crucial to address the psychological well-being of patients and provide necessary support. Patient input should be taken into account when deciding on treatment for nonfunctional limbs. Physicians should evaluate prognostic factors and provide appropriate treatment to enhance patient outcomes.
Burn Center Verification and Safety Net Status: Are There Differences in Discharge to Inpatient Rehabilitation?
Authors: Lakhlani Devi , Steeman Samantha , Stanton Eloise W , Sheckter Clifford
Published: June 2024

Discharge to acute rehabilitation following a major burn injury is crucial for patient recovery and quality of life. However, barriers to acute rehabilitation, including race and payor type, impede access. The effect of burn center organizational structure on discharge disparities remains unknown. This study aims to investigate associations between patient demographics, burn center factors, and discharge to acute rehabilitation on a population level. Using the California Healthcare Access and Information Database, 2009-2019, all inpatient encounters at verified and non-verified burn centers were extracted. The primary outcome was the proportion of patients discharged to acute rehabilitation. Key covariates included age, race, burn center safety net status, diagnosis-related group, American Burn Association (ABA) verification status, and American College of Surgeons Level 1 trauma center designation. Logistic regression and mixed-effects modeling were performed, with Bonferroni adjustment for multiple testing. Among 27 496 encounters, 0.8% (228) were discharged to inpatient rehabilitation. By race/ethnicity, the proportion admitted to inpatient rehabilitation was 0.9% for White, 0.6% for Black, 0.7% for Hispanic, and 1% for Asian. After adjusting for burn severity and age, notable predictors for discharge to inpatient rehabilitation included Medicare as payor (OR 0.30-0.88, P = .015) compared to commercial insurance, trauma center status (OR 1.45-3.43, P < .001), ABA verification status (OR 1.16-2.74, P = .008), and safety net facility status (OR 1.09-1.97, P = .013). Discharge to inpatient rehabilitation varies by race, payor status, and individual burn center. Verified and safety net burn centers had more patients discharge to inpatient rehabilitation adjusted for burn severity and demographics.
(333) SEXUAL FUNCTION RECOVERY FOLLOWING OPEN AND ROBOTIC RADICAL PROSTATECTOMY: RESULTS OF AN ACADEMIC PENILE REHABILITATION PROGRAM
Authors: Di Nauta Dr Michele , Falagario Dr Ugo G , Ricapito Dr Anna , Annese Dr Pasquale , Rubino Dr Matteo , Busetto Prof Gian M , Cormio Prof Luigi , Carrieri Prof Giuseppe , Bettocchi Carlo
Published: June 2024

Objectives

Radical prostatectomy (RP) is the gold standard treatment for clinically localized prostate cancer (PCa) in patients with a life expectancy 10 yr. Notwithstanding improvements in surgical techniques, erectile dysfunction (ED) is a common sequela of RP. The aim of the present study was to evaluate the effect of early penile rehabilitation in a dedicated Penile Rehabilitation Program on both assisted and unassisted erectile function (EF) in men who developed ED after open and robotic RP.

Methods

All patients undergoing open or robotic RP and early penile rehabilitation were included in the present study. All patients were treated and followed up at a single academic institution in a dedicated Penile Rehabilitation Program. Treatment included phosphodiesterase type 5 inhibitors (PDE5Is), intracavernous injections and vacuum erection devices (VEDs). EF recovery was defined as IIEF>20. Data were prospectively collected and retrospectively reviewed. Kaplan Mayer curves were used to evaluate EF recovery.

Results

A total of 570 patients met the inclusion criteria. 397 patients underwent rehabilitation. 168 (42.3%) underwent robotic RP. Unilateral and bilateral nerve sparing was performed in 38 (9.6%) and 116 (29.2%) patients respectively.

A combination of PDE5I and intracavernous injections was the most frequently used first line treatment (233, 59%). VEDs were used in 52 patients in addition to PDE5I and intracavernous injections (39, 10%) or intracavernous injections (23, 6%). In patients with a preoperative IIEF>21, assisted and unassisted EF recovery rates were 78% and 36% respectively.

In patients with a preoperative IIEF<16, assisted and unassisted EF recovery rates were 46% and 18% respectively. Sub analysis showed a moderate benefit of penile rehabilitation also in patients with a preoperative IIEF<16 undergoing bilateral nerve sparing RP.

Conclusions

Intensive penile rehabilitation programs improves EF recovery in patients undergoing radical prostatectomy. Preservation of Neurovascular bundles should be attempted also in patients with preoperative ED.

Conflicts of Interest

No conflicts of interest.
(405) GONADIS NATIONAL REGISTRY ON GONADAL STATUS IN PITUITARY AND ADRENAL DISORDERS: PREVALENCE AND CHARACTERIZATION OF SEXUAL DYSFUNCTIONS IN MALE PATIENTS WITH HYPERPROLACTINEMIA
Authors: De Fraia Dr Antonio , Maseroli Dr Elisa , Sbardella Dr Emilia , de Angelis Dr Cristina , Minnetti Dr Marianna , Auriemma Prof Renata Simona , Indirli Dr Rita , Golinelli Dr Caterina , Cignarelli Dr Angelo , Aversa Dr Luigi , Vignozzi Prof Linda , Corona Prof Giovanni , Isidori Prof Andrea , Pivonello Prof Rosario
Published: June 2024

Objectives

Hyperprolactinemia is frequently accompanied by sexual dysfunctions, represented by decreased libido, and erectile and ejaculatory disorders. Moreover, cabergoline (CAB), used for the treatment of hyperprolactinemia is known to influence sexual function. Aim of the study was to evaluate sexual function in adult men with hyperprolactinemia under medical therapy, by also addressing the role of disease control.

Methods

Data on sexual function addressed by Structured Interview on Erectile Dysfunction (SIEDY), Androtest, International Index of Erectile Function (IIEF)-15 and Premature Ejaculation Diagnostic Tool (PEDT) and psychological traits by Middlesex Hospital Questionnaire (MHQ) and Beck Depression Inventory (BDI) questionnaires, and on hormonal profile, were retrieved from GONADIS, an Italian registry on gonadal status and reproductive and psycho-sexual function in patients with pituitary and adrenal disorders, promoted by SIAMS-SIE-AME. Twenty-three men with hyperprolactinemia aged 25-76 yrs (median: 49 yrs) under CAB treatment were recruited. Between-group differences were analyzed by Mann–Whitney and Chi-squared test, and correlation of continuous variables by Spearman test, using SPSS-Statistics software.

Results

In the overall cohort, 12/23(52.2%) patients reached disease control; CAB dose negatively correlated with free anxiety (MHQ-A)(p=0.016), obsession (MHQ-O)(p=0.025), somatization (MHQ-S)(p=0.024), depression (MHQ-D)(p=0.046) and hysteria (MHQ-H)(p=0.030). In uncontrolled patients, CAB dose positively correlated with IIEF-15 overall satisfaction domain score (p<0.021) and prolactin negatively correlated with IIEF-15 intercourse satisfaction domain score (p<0.027); in controlled patients, CAB dose negatively correlated with MHQ-S (p<0.028) and MHQ-H (p<0.03). Controlled and uncontrolled patients did not differ for continuous variables of interest nor for the prevalence of psycho-sexual dysfunctions.

Conclusions

In uncontrolled patients, a worse disease control (i.e. higher prolactin) is associated with a worse intercourse satisfaction, and CAB treatment positively impacts on overall satisfaction; a tighter disease control by increasing CAB dose should be encouraged. In controlled patients, CAB dose positively impacts on somatization and hysteria traits, which might contribute to general and sexual health, regardless of prolactin levels, suggesting that it might be due to CAB dopaminergic properties.

Conflicts of Interest

Authors declare no potential conflicts of interest.
(334) THE RELATIONSHIP BETWEEN THE SUCCESS OF PRIMARY/SECONDARY MICRODISSECTION TESTICULAR SPERM EXTRACTION AND TESTICULAR PATHOLOGY IN NON-OBSTRUCTIVE AZOOSPERMIA PATIENTS
Authors: Gultekin Dr Mehmet H , Sahin Dr Kadir C , Ozkara Prof Hamdi , Akkus Prof Emre
Published: June 2024

Objectives

In this study, we aimed to investigate the effect of testicular biopsy on the success rate of microdissection testicular sperm extraction (mTESE) in patients with non-obstructive azoospermia (NOA).

Methods

The data of patients who underwent mTESE between 1999 and 2019 in our clinic were retrospectively analyzed. Sperm retrieval rate (SRR), demographic and clinical data of the patients with pathology reports were compiled. Using SPSS v.25 (Armonk, NY: IBM Corp.), pathology data and SRR of the patients who underwent mTESE were analyzed comparatively.

Results

A total of 377 patients who underwent mTESE operation between the specified dates in our clinic and satisfied the exclusion and inclusion criteria were included in the study. Of the patients, 321 had primary, and 56 had secondary mTESE. Of the primary mTESE patients, the pathology reports revealed as hypospermatogenesis, maturation arrest, Sertoli cell-only (SCO) syndrome, Leydig cell hyperplasia, and normal testicular tissue were 66 (20.5%), 88 (27.4%), 127 (39.5%), 23 (7.1%), 17 (5.3%), respectively. SRR was %51 in primary mTESE. In subgroup analysis, the lowest SRR was found in SCO pathology at 21.3%. In the pathology data of patients who underwent secondary mTESE, the rates of hypospermatogenesis, maturation arrest, SCO, Leydig cell hyperplasia, and normal testicular tissue were recorded as 11 (19.6%), 16 (28.5%), 1 (1.8%), and 3 (5.4%), respectively. The SRR of all secondary mTESE patients was 38%. In the subgroup analysis, the lowest SRRs were found in SCO and Leydig cell hyperplasia groups (6.3% and 0%, respectively) (Table).

Conclusions

According to our results, Leydig cell hyperplasia, hypospermatogenesis, and maturation arrest pathologies showed higher SRR than the general average in patients who underwent primary mTESE. The SCO group appears to have the least favorable outcomes, as indicated by the lowest observed SRR. Patients should be informed prior to the secondary mTESE based on the pathologic data, and further treatments that improve outcomes might be suggested.

Conflicts of Interest

All authors declare that they have no conflicts of interest.
(430) DEFINITION OF RISK CATEGORIES FOR URETHRAL STRICTURE RECURRENCE AFTER FREE GRAFT BULBAR URETHROPLASTY USING CLASSIFICATION AND REGRESSION TREE ANALYSIS
Authors: Palminteri Dr Enzo , Toso Dr Stefano , Ferrari Dr Giovanni , Nava Dr Luciano , Buffi Dr Nicolò M , Pane Dr Manuela , Preto Dr Mirko , Gobbo Dr Andrea
Published: June 2024

Objectives

This study aims to stratify patients undergoing buccal mucosa bulbar urethroplasty (BMU) for urethral stricture into risk groups (RGs) for stricture recurrence at 5y, providing clinicians with an easy-to-use tool useful in practice.

Methods

To define the RGs for stricture recurrence we used classification and regression tree (CART) analysis. In the CART we included the variables age, stricture length, previous dilatation/urethrotomy, and stricture etiology, that were further selected and split by the program to produce the optimal tree. The final leaves were used to define three RGs for stricture recurrence. To test the predictive accuracy of the RGs, we compared the accuracy in the logistic regression model with the RGs against the model with all the variables used to generate the CART. We repeated the same process in a second CART, also including the first postoperative uroflowmetry Qmax performed within two months after surgery.

Results

The analysis included 855 BMU, of those 93 experienced stricture recurrence. At logistic regression, the first CART-generated RGs were significant predictors of treatment failure (p<.001) and performed equally well when compared to the standard model with all variables, with an accuracy of 62%. The second CART-generated RGs were also significant predictors of failure (p<.001) and performed as the standard model with all variables, with an accuracy of 77%. The prediction accuracy was significantly higher in the RGs from the second CART (p<.001), which included the Qmax.

Conclusions

CART analysis assisted in creating three RGs with an increasing recurrence risk at 5y. At logistic regression, RGs performed equally well when compared to the relative standard models. Using RGs has the significant advantage of being easy to interpret and implement into clinical practice, and the stratification of patients can be used to tailor follow-up. Our analysis proved that the first postoperative uroflowmetry can significantly improve patient classification.

Conflicts of Interest

No conflict of interest to disclose.
(323) ZSI-375 ARTIFICIAL URINARY SPHINCTER: EFFICACY, SAFETY AND LONG-TERM OUTCOMES
Authors: Ricapito Dr Anna , Falagario Dr Ugo G , Selvaggio Dr Oscar , Annese Dr Pasquale , Mancini Dr Vito , Busetto Dr GianMaria , Cormio Dr Luigi , Carrieri Dr Giuseppe , Bettocchi Dr Carlo
Published: June 2024

Objectives

To evaluate efficacy and long-term outcomes of ZSI-375 artificial urinary sphincter for the treatment of male urinary incontinence in male patients at the Urological Clinic, University Hospital of Foggia, Italy.

Methods

Male patients with iatrogenic urinary incontinence, who underwent ZSI-375 artificial urinary sphincter (AUS) implantation in the Urological Clinic at the University Hospital of Foggia, Italy from 2013 to 2019, were retrospectively evaluated. Daily pads number, ICIQ-SF, IIEF-5 and complication rate were evaluated and assessed. Postoperative follow-up of patients was performed at 3, 6, 12, and 24 months after ZSI-375 activation.

Results

Thirty-eight patients with iatrogenic urinary incontinence were included with a median follow-up of 36.8 months (24.6-48). 34/38 (89.4%) had developed incontinence following radical prostatectomy, while 4/38 (10.5%) after TURP. Twenty-seven patients (71%) reported severe preoperative incontinence, while moderate incontinence was observed in the remaining cohort. Median preoperative IIEF-5 was 22 (18-25).

At 6 months after surgery, urinary incontinence rate dropped to 7.9% but then it raised again at two years to 31.6% and up to 47 % at 48 months. Complications after surgery affected 22 patients (57.9%): 36.8% (14/38) patients experienced malfunctioning of the device; 10.5% (4/38) infection, while 10.5% (4/38) erosion. Concerning potency rates, IIEF decreased to a median value of 10 points at six months after surgery and median postoperative IIEF-5 at 24 months was 15.7 (5-20).

Conclusions

In our experienceZSI 375 artificial urinary sphincter did not improve urinary incontinence in long term observation and led to further surgical procedure due to several complications. Further literature is needed to a better and proper critical analysis.

Conflicts of Interest

None.
(133) PECULIARITIES OF SOCIO-CULTURUL CLINICAL COURSE AND RESULTS OF TREATMENT OF FEMALE GENITAL-PELVIC PAIN/PENETRATION DISORDER (VAGINISMUS) AND RESULTS OF TREATMENT
Authors: Nodia Nino , Marshania Prof Zurab , Khomasuridze Prof Archil
Published: June 2024

Objectives

Vaginismus is defined as a recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina, as well as the pain and fear that interferes with vaginal penetration, which causes personal distress. It is remarkable that reflexive involuntary contraction of the pelvic muscles as well as thigh adduction, contraction of the abdominal muscles, and muscles in the back and limbs, associated with varying degrees of fear of pain and of the unknown, typically precludes full entry, not only of a male genital organ but tampon, speculum, or finger. The purpose of our research is to determine the characteristics of the socio-cultural clinical course of the treatment of female genital-pelvic pain/penetration disorder- vaginismus and to reveal the results of the treatment.

Methods

Our study is prospective, we will observe 150 Georgian women with vaginismus. Patients will be consulted by a sexologist and gynecologist. They will fill out a psychometric questionnaire. Treatment includes three stages: I- conservative therapy; II- sex therapy training; III – woman will have sex therapy (in vivo) with her partner to prepare for successful sexual intercourse and set the exist date of the first penetration.

Results

Through our research, we will see if there is a connection between traditions, the type of family education and the development of vaginismus, treatment methods and it’s results.

Conclusions

Our study will help doctors to understand vaginismus and it’s treatment, to make differential diagnosis between vaginismus and dyspareunia. We will eveluate it's treatment methods and results.

Conflicts of Interest

No conflict of interest.
(363) ETHICAL ASPECTS IN HEALTHCARE FOR TRANSGENDER PEOPLE. ANALYSIS AND IMPROVEMENT PROPOSALS
Authors: Poyato Galán J M , García Millán V
Published: June 2024

Objectives

Transgender healthcare is an exponentially growing field nowadays.

In this study we analyze the main ethical conflicts detected in our area and the improvement proposals that we have formulated in this regard.

Methods

Apart from the social inequities that they usually suffer due to their condition, transgender people still today must face numerous prejudices and a huge disparity in their healthcare. This discrimination results in healthcare avoidance, increased substance use, risk of suicide, and poor general-behavioral-mental health.

Through a telephone survey carried out among professionals (doctors+nurses) in both primary/specialized care, possible ethical conflicts related to the management of transgender people occurred in the last year (January '22 to January '23) were consulted; cases were not only related to processes of affirmation of their gender identities, but regarding any health problem.

Results

50 professionals were surveyed, counting 19 conflicts in the field of study.

The aspects that generated the most controversy were:

Conclusions

1. Clinicians are responsible for identifying the ways that commonly perpetuate negative stereotypes in the treatment of transgender patients and avoiding stigmatization+discrimination of these people, promoting their comprehensive well-being.

2. Applying basic ethical principles (Autonomy, Beneficence, Non-Maleficence and Justice) or asking for help from experienced professionals are key in resolving all conflicts.

3. Main proposals to health professionals in order to diminish stigmatization and promote a normalization of transgender persons healthcare: make a more inclusive practice, acquire skills in this field, use appropriate language, develop communication skills, show sensitivity and respect.

Conflicts of Interest

Authors declare no conflicts of interest.
(402) EFFECTS OF PUDENDAL AND ILIOINGUINAL NERVE BLOCKS ON POSTOPERATIVE PAIN CONTROL IN VAGINOPLASTY FOR GENDER AFFIRMATION SURGERY
Authors: Etcheverry Dr Begoña , Fabregas Dr Maya , De Fuentes Dr Nuria , García Javier , Beato Dr Sergi , Alabat Dr Andreu , de la Torre Dr Silvia , Lozano Dr Victor , Cros Anna , Cabrera Dr Anna , López Dr Ana , Castells Dr Manel , Vigués Dr Francesc
Published: June 2024

Objectives

Postoperative pain control in vaginoplasty for gender affirmation surgery significantly affects the patient's experience. Other pelvic surgeries use nerve block along with general analgesia to improve pain management. The aim of this study is to evaluate the effects of preoperative pudendal and ilioinguinal nerve block on pain management in patients undergoing vaginoplasty.

Methods

A comparative cohort study with a historical cohort was conducted. All patients undergoing vaginoplasty at HUB from 2019 to 2023 were included. Those who underwent surgery without nerve block (n=38) were compared to those who did (n=21). The main study variable is pain measured with visual analog scale (VAS) on the 1st day. Secondary variables to be studied include VAS on the 5th day and at discharge, the presence of nausea/vomiting during hospitalization, and the use of rescue analgesia in the postoperative period. Comparative analysis were performed.

Results

The mean VAS score on the first postoperative day was lower in patients who received nerve block compared to those who did not (VAS 2 vs. 3; p<0.05). There were no significant differences for the secondary variables studied.

Conclusions

Preliminary data suggest that adjunctive pudendal and ilioinguinal nerve blocks are effective in improving pain control on the 1st day after gender reassignment surgery. To accurately conclude the results, a randomized controlled study would be necessary.

Conflicts of Interest

None.
Comorbid Chronic Pain and Post-traumatic Stress Disorder: Current Rates and Psychiatric Comorbidities Among U.S. Military Veterans
Authors: Hadlandsmyth Katherine , Zhuang Caywin , Driscoll Mary A , Lund Brian C
Published: June 2024

Introduction

This study reports rates of comorbid chronic pain and post-traumatic stress disorder (PTSD) among U.S. military veterans and rates of psychiatric comorbidities among those with both chronic pain and PTSD.

Materials and Methods

This study utilized National Veterans Affairs (VA) administrative data to identify all veterans treated for chronic pain or PTSD in 2023. Multivariable logistic regression models determined the likelihood of each psychiatric comorbidity for those with chronic pain and PTSD relative to those with chronic pain only and separately to those with PTSD only, after adjusting for demographic variables and all other psychiatric comorbidities.

Results

Of the 5,846,453 service users of the VA in 2023, a total of 2,091,391 (35.8%) met the criteria for chronic pain and 850,191 (14.5%) met the criteria for PTSD. Furthermore, 21.6% of those with chronic pain also had PTSD and over half (53.2%) of those with PTSD also met the criteria for chronic pain (n = 452,113). Veterans with chronic pain and PTSD were significantly more likely to be women, Black or African American, Hispanic or Latina, and urban dwelling. Veterans with chronic pain and PTSD had significantly higher rates of all selected comorbidities relative to veterans with chronic pain only.

Conclusions

Patients with comorbid chronic pain and PTSD may benefit from tailored treatments to address the additive impact of these conditions.
Structural Antibiotic-Coated Hindfoot Nail Preparation: A Technique Guide
Authors: Wireman Garrett , Hale Taylor , Poynter Thomas , Seligson David , Laco Nicholas
Published: June 2024

The current guide describes a technique that has been in place at the University of Louisville for several years and has been utilized to create structural antibiotic hindfoot nails. This has the intention of creating a stable construct that can be utilized in the setting of previous osteomyelitis, or that is at high risk of developing infections in the postoperative state. This technique guide provides a reproducible way to apply an antibiotic delivery system to a tibiotalocalcaneal nail at the time of definitive surgical intervention. It described our method at rural state level one trauma hospital of utilizing antibiotic-impregnated polymethylmethacrylate around a nail for both antibiotic properties as well as structural properties. Antibiotic delivery systems are a well-researched surgical tool, combining this with a hindfoot nail offers definitive surgical management of otherwise complicated surgical cases. Although this technique has been in use at the University of Louisville for many years, additional research should be done to determine long-term outcomes.

Level of Evidence:

Diagnostic Level VII. See Instructions for Authors for a complete description of levels of evidence.
The Road to Precision Medicine for Acute Kidney Injury
Authors: Birkelo Bethany C. , Koyner Jay L. , Ostermann Marlies , Bhatraju Pavan K.
Published: June 2024

OBJECTIVES:

Acute kidney injury (AKI) is a common form of organ dysfunction in the ICU. AKI is associated with adverse short- and long-term outcomes, including high mortality rates, which have not measurably improved over the past decade. This review summarizes the available literature examining the evidence of the need for precision medicine in AKI in critical illness, highlights the current evidence for heterogeneity in the field of AKI, discusses the progress made in advancing precision in AKI, and provides a roadmap for studying precision-guided care in AKI.

DATA SOURCES:

Medical literature regarding topics relevant to precision medicine in AKI, including AKI definitions, epidemiology, and outcomes, novel AKI biomarkers, studies of electronic health records (EHRs), clinical trial design, and observational studies of kidney biopsies in patients with AKI.

STUDY SELECTION:

English language observational studies, randomized clinical trials, reviews, professional society recommendations, and guidelines on areas related to precision medicine in AKI.

DATA EXTRACTION:

Relevant study results, statements, and guidelines were qualitatively assessed and narratively synthesized.

DATA SYNTHESIS:

We synthesized relevant study results, professional society recommendations, and guidelines in this discussion.

CONCLUSIONS:

AKI is a syndrome that encompasses a wide range of underlying pathologies, and this heterogeneity has hindered the development of novel therapeutics for AKI. Wide-ranging efforts to improve precision in AKI have included the validation of novel biomarkers of AKI, leveraging EHRs for disease classification, and phenotyping of tubular secretory clearance. Ongoing efforts such as the Kidney Precision Medicine Project, identifying subphenotypes in AKI, and optimizing clinical trials and endpoints all have great promise in advancing precision medicine in AKI.
Incidence of Influenza-associated Neurologic and Psychiatric Complications Requiring Hospitalization in Children Ages 5–17 Years
Authors: Quertermous Brooke P. , Williams Derek J. , Bruce Jean , Sekmen Mert , Zhu Yuwei , Grijalva Carlos G. , Antoon James W.
Published: June 2024

Background:

The spectrum and incidence of influenza-associated neuropsychiatric complications are not well-characterized. The objective of this study was to define the incidence of specific neurologic and psychiatric complications associated with influenza in children and adolescents.

Methods:

We assembled a retrospective cohort of children 5–17 years of age with an outpatient or emergency department International Classification of Diseases, 10th revision influenza diagnosis and enrolled in Tennessee Medicaid from 2016 to 2020. Serious neurologic or psychiatric complications requiring hospitalization were identified using a validated algorithm. Incidence rates of complications were expressed per 100,000 person-weeks of influenza and 95% confidence intervals (CIs) were reported.

Results:

A total of 156,661 influenza encounters (median age of 9.3 years) were included. The overall incidence of neurologic complications was 30.5 (95% CI: 24.0–38.6) per 100,000 person-weeks of influenza and 1880.9 (95% CI: 971.9–3285.5) among children with an underlying neurologic comorbidity. The distribution of antiviral treatment was similar among those with and without neurologic or psychiatric complications. The overall incidence of psychiatric complications was 20.2 (95% CI: 15.1–27.0) per 100,000 person-weeks of influenza and 111.8 (95% CI: 77.9–155.5) among children with an underlying psychiatric comorbidity. Seizures (17.5, 95% CI: 12.8–23.9) were the most common neurologic complications whereas encephalitis (0.5, 95% CI: 0.02–2.5) was rare. Mood disorders (17.5, 95% CI: 12.8–23.9) were the most frequent psychiatric complications and self-harm events (0.9, 95% CI: 0.3–3.3) were the least common.

Discussion:

Our findings reveal that the incidence of neuropsychiatric complications of influenza is overall low; however, the incidence among children with underlying neurologic or psychiatric condition is significantly higher than among children without these conditions.
Immunologic Benefits of 0-antigen Mismatched Transplants: No Added Boost for Racial and Ethnic Minorities
Authors: Caldwell Jillian S. , Parvathinathan Gomathy , Stedman Margaret R. , Ahearn Patrick , Tan Jane C. , Cheng Xingxing S.
Published: June 2024

Background.

Systemic barriers to posttransplant care, including access to immunosuppressant medications, contribute to higher rates of kidney transplant failure in racial minorities. Matching donor and recipient HLA alleles reduce allorecognition, easing reliance on immunosuppression. We hypothesize that 0-antigen mismatch transplants may provide stronger protection against graft loss in racial minorities.

Methods.

We compared adult, single-organ, deceased-donor kidney transplants in the United States from 2007 to 2016 by degree of HLA mismatch (0- versus ≥1-antigen mismatch). We examined time-to-allograft failure, with death as a competing event, using multivariable Weibull models, stratified by recipient race (White versus non-White), and evaluated the interaction between mismatch and recipient race. We used Kaplan-Meier imputation to account for competing risk of death.

Results.

We analyzed 102 114 transplants (median follow-up, 5.6 y; 16 862 graft losses, 18 994 deaths). Zero-antigen mismatch was associated with improved allograft survival (adjusted subdistribution hazard ratio [sHR] 0.80; 95% confidence interval [CI], 0.75-0.85). When stratified by recipient race, the effect of 0-antigen mismatch was more pronounced in White (unadjusted sHR 0.78; 95% CI, 0.72-0.83) versus non-White recipients (sHR 0.88; 95% CI, 0.79-0.99; interaction P = 0.04). The differential effect was attenuated after adjusting for covariates (sHR 0.78; 95% CI, 0.73-0.84 versus sHR 0.87; 95% CI, 0.77-0.98; interaction P = 0.10).

Conclusions.

Zero-antigen mismatch transplants conferred a 20% risk reduction in allograft loss, which was similar between non-White and White recipients. This may reflect an increased degree of mismatch at other HLA alleles and non-HLA alleles in non-White recipients or because of the extent of systemic barriers to healthcare borne by minority recipients.
Exploring Preservation Modalities in a Split Human Pancreas Model to Investigate the Effect on the Islet Isolation Outcomes
Authors: Buemi Antoine , Mourad Nizar I. , Bouzin Caroline , Devresse Arnaud , Hoton Delphine , Daumerie Aurelie , Zech Francis , Darius Tom , Kanaan Nada , Gianello Pierre , Mourad Michel
Published: June 2024

Background.

In islet transplantation, the use of dynamic hypothermic preservation techniques is a current challenge. This study compares the efficacy of 3 pancreas preservation methods: static cold storage, hypothermic machine perfusion (HMP), and oxygenated HMP.

Methods.

A standardized human pancreas split model was employed using discarded organs from both donation after brain death (n = 15) and donation after circulatory death (DCD) (n = 9) donors. The pancreas head was preserved using static cold storage (control group), whereas the tail was preserved using the 3 different methods (study group). Data on donor characteristics, pancreas histology, isolation outcomes, and functional tests of isolated islets were collected.

Results.

Insulin secretory function evaluated by calculating stimulation indices and total amount of secreted insulin during high glucose stimulation (area under the curve) through dynamic perifusion experiments was similar across all paired groups from both DCD and donation after brain death donors. In our hands, islet yield (IEQ/g) from the pancreas tails used as study groups was higher than that of the pancreas heads as expected although this difference did not always reach statistical significance because of great variability probably due to suboptimal quality of organs released for research purposes. Moreover, islets from DCD organs had greater purity than controls (P ≤ 0.01) in the HMP study group. Furthermore, our investigation revealed no significant differences in pancreas histology, oxidative stress markers, and apoptosis indicators.

Conclusions.

For the first time, a comparative analysis was conducted, using a split model, to assess the effects of various preservation methods on islets derived from pancreas donors. Nevertheless, no discernible variances were observed in terms of islet functionality, histological attributes, or isolation efficacy. Further investigations are needed to validate these findings for clinical application.