bluuebunny/crossref_metadata_2025_split huggingface dataset:
(329) GEOGRAPHIC VARIATIONS AND THEIR CORRELATION WITH ERECTILE DYSFUNCTION GOOGLE SEARCHES IN THE UNITED STATES
Authors: Ahmed Z , Hammad MAM , Miller J , Abou Chawareb E , Jenkins L , Yafi FA 
Published: December 2024

Abstract

Introduction
Erectile dysfunction (ED) significantly impacts the well-being and quality of life of millions of men. Understanding geographic patterns and associated factors influencing ED search trends can offer valuable insights for healthcare improvement and advocacy. This study investigates the correlation between Google search trends for ED and various factors across different U.S. states, focusing on healthcare accessibility, demographic characteristics, and socioeconomic status.

Objective
To analyze Google search trends for ED across different states in the United States in correlation with the urologist-to-population ratio, percentage of the population aged 65 and older, median household income, and percentage of state residents with a bachelor's degree or higher.

Methods
Google search trends for ED were collected over a 12-month period between May 2023 and May 2024, with the specific term “erectile dysfunction”. Synonyms such as impotence, sexual dysfunction, erectile difficulty, erection problems, erectile disorder, erection impairment, and erection failure were also included to strengthen the data. The Google search trends provided data for individual states and were ranked on a scale of 1 to 100 to determine ED search popularity. We then analyzed the search volume alongside variables including the urologist-to-population ratio, percentage of the population aged 65 and older, median household income, and percentage of state residents with a bachelor's degree or higher. Pearson correlation coefficients and correlation analyses were conducted to examine the linear relationships between ED search volumes and these factors that create significant geographical variations.

Results
Significant geographic disparities in ED search volumes were identified across U.S. states. Higher ED search volumes were associated with a greater urologist-to-population ratio (r = 0.39, p = 0.0042) and a higher percentage of older adults (r = 0.51, p = 0.0002). No significant correlation was found between median household income and ED search volumes (r = -0.03, p = 0.8704). Similarly, there was no significant correlation between educational attainment and ED search volumes (r = -0.16, p = 0.2581).

Conclusions
The findings highlight the impact of healthcare accessibility and demographic factors on ED search trends. States with better healthcare access and a higher proportion of older adults show increased public interest in ED. These insights can guide targeted healthcare improvements and advocacy efforts. Future research should explore causative factors and potential interventions to address identified disparities.

Disclosure
No.
(331) SOLID ORGAN TRANSPLANTATION IMPROVES SEXUAL DYSFUNCTION IN OLDER MEN AND WOMEN
Authors: Thompson L , Yatsenko T , Riveros C , Muthigi A 
Published: December 2024

Abstract

Introduction
Solid organ transplant recipients experience life-prolonging benefits. While a substantial body of literature addresses the fertility consequences of transplantation, data on the post-transplant sexual function in both male and female recipients is relatively sparse. This study aims to evaluate sexual dysfunction and fertility issues in this patient population and contribute to the existing body of knowledge regarding the long-term quality of life of transplant recipients.

Objective
The primary objective is to assess the prevalence and extent of sexual dysfunction among patients who have undergone solid organ transplantation. This includes various types of sexual dysfunction such as erectile dysfunction, vaginismus, dyspareunia, and other related conditions. Another key objective is to investigate fertility issues in both male and female transplant recipients.

Methods
This study utilized the TriNetX Global Collaborative Network, a federated database containing &gt;140 million anonymized electronic medical records participating healthcare organizations around the world. Using International Classification of Diseases (ICD) codes, adult patients (≥18 years old) who had undergone solid organ (heart, kidney, liver, lung, and pancreas) transplantation were selected. The primary outcome was a composite of sexual dysfunction, including erectile dysfunction, ejaculatory dysfunction, vaginismus, dyspareunia, orgasmic disorder, hypoactive sexual desire disorder, decreased libido, sexual dysfunction not attributable to substance use or a known physiological condition, and vulvar/vaginal atrophy. The secondary outcome was a composite of male/female infertility as defined by ICD codes. Outcomes were defined a priori and reported as absolute risk reduction (ARR), risk ratios (RR) with 95% confidence intervals (CI). The index event was the date of the transplant, and significance was set at P &lt; 0.05.

Results
A total of 81,341 solid organ transplant recipients were identified. The mean age at transplant was 52 ± 14.2 years, 39% of patients were female, 20% were Black, 11% were Hispanic, and 4% were Asian. Mean follow up was 6 years. Most common comorbidities included hypertension (59%), diabetes mellitus (38%), obesity (21%), and depression (21%). Following solid organ transplant, the ARR of sexual dysfunction was 12.5%, with a RR of 0.83, 95% CI 0.79-0.86, P &lt; 0.001. The ARR for infertility after solid organ transplantation was 0.048%, with a RR of 0.86, 95% CI 0.73-1.02, P = 0.09.

Conclusions
This large-scale study highlights significant improvements in sexual health for solid organ transplant recipients, with a significant ARR in sexual dysfunction. Although a reduction in infertility risk was observed, it was not statistically significant. These findings emphasize the importance of considering sexual health in post-transplant care and suggest a need for further research to better understand and address fertility issues in this population.

Disclosure
No.
(333) TRENDS IN PHOSPHODIESTERASE TYPE 5 INHIBITOR PRESCRIPTIONS AND COST: MEDICARE ANALYSIS 2017-2021
Authors: Cahill E , Reddy S , Rotker K , Honig S 
Published: December 2024

Abstract

Introduction
Phosphodiesterase Type 5 (PDE5) inhibitors are the first line treatment for erectile dysfunction. While urologists commonly prescribe these medications, patients may also receive them from their primary care providers. Cost of medication also highly varies depending on insurance, location, and pharmacy type, which may impact prescribing behavior.

Objective
We aimed to examine prescribing patterns and cost of PDE5 inhibitors in the United States over time, specifically comparing urologists to non-urologists.

Methods
The 2017-2021 Medicare Part D Public Use File was used to identify prescribers of PDE5 inhibitor medications including sildenafil, tadalafil, and vardenafil. The number of claims and total annual expenditure for each medication for all prescribers, non-urologists, and urologists were analyzed from 2017 to 2021.

Results
Sildenafil was the most commonly prescribed PDE5 inhibitor each year, comprising 70.6% of claims in 2021 (Table 1). From 2017 to 2021, sildenafil claims increased from 282,809 to 456,709. Tadalafil prescriptions decreased each year, with 278,773 claims in 2017 and 189,303 claims In 2021. Vardenafil was the least prescribed medication each year. Urologists consistently prescribed more tadalafil than sildenafil each year, however there was a trend towards decreased tadalafil and increased sildenafil prescriptions (Fig. 1). Total annual expenditures for all medications steadily decreased from $444 million in 2017 to $143 million in 2021 (Table 2).

Conclusions
There was a rise in overall claims accompanied by a drastic drop in cost for PDE5 inhibitors over the 5 year period in the Medicare Part D database. Specifically, claims for sildenafil increased, while claims for tadalafil decreased. Additionally, claims from non-urologists increased each year, while claims from urologists remained relatively stable. Urologists most commonly prescribed tadalafil while non-urologists most commonly prescribed sildenafil. Vardenafil prescriptions remained low over time. We suspect that usage of these medications increased as a result of decreasing costs. However, online access options, direct to consumer advertising, and patient comfortability with seeking treatment may play a role as well.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Endo Pharma, Fellow, Posterity Health, HIMS, WIN fertility, Haleon.
(335) VENTRAL CORPORAL REINFORCEMENT USING PERICARDIUM ALLOGRAFT (TUTOPLAST®) IN PATIENT UNDERGOING URETHRECTOMY PROCEDURE WITH INFLATABLE PENILE PROSTHESIS IN PLACE
Authors: Leung S , Mahdi M , Wang R 
Published: December 2024

Abstract

Introduction
Radical cystectomy (RC) is the standard treatment for non-metastatic muscle-invasive or high-grade/intravesical therapy refractory bladder cancer. Erectile dysfunction (ED) is a common consequence of RC, with inflatable penile prosthesis (IPP) placement considered as the gold standard for refractory cases. Urethral recurrence post-RC necessitates urethrectomy, which poses challenges for patients with existing IPP.

Objective
The thinning of the ventral tunica albuginea during urethrectomy may increase the risk of corporal disruption and IPP cylinder aneurysm, affecting long-term device functionality. This case introduces a novel surgical technique using Tutoplast graft, a human-derived pericardium allograft, for corporal reinforcement during urethrectomy in the presence of in situ IPP.

Methods
74-year-old male, with history of robotic-assisted RC for bladder cancer in 2015 and IPP placement for refractory ED in 2017, presented for recurrent blood per urethra in 2023. Imaging revealed masses on the penile urethra and bulbar urethra. The patient underwent total urethrectomy and was noted intra-operatively to have significant thinning of the ventral tunica albuginea. To prevent device aneurysm or mechanical failure, Tutoplast graft was used to reinforce the thinned tunica albuginea. Tutoplast was secured to the lateral, superior, and inferior aspects of both corpora. Patient was followed up to 6 months post-operatively.

Results
Final pathology of the urethra showed high-grade papillary urothelial carcinoma with invasion of the corpus spongiosum. The patient recovered well post-operatively, with normal IPP functionality up to the 6 months follow-up period. This case introduces Tutoplast graft as a simple and cost-effective technique to support the ventral tunica albuginea and protect the IPP cylinders during urethrectomy. While Tutoplast has been used in other settings, its application in preventing IPP malfunction post-urethrectomy is a unique contribution.

Conclusions
Corporal reinforcement using Tutoplast graft during urethrectomy in patients with existing IPP is a promising and innovative technique. It presents a viable solution to mitigate the risks of corporal disruption and IPP cylinder aneurysms during urethrectomy. The positive outcome demonstrated in this case report warrants further studies with larger patient populations and longer follow-up periods to assess the long-term outcomes and potential risks associated with this procedure.

Disclosure
No.
(337) PRACTICE PATTERNS AND IMPACT OF PRE-OPERATIVE IMAGING IN PENILE FRACTURE: A RETROSPECTIVE ANALYSIS
Authors: Bahaee J , Bajic P , Parekh N , Lundy S , Vallabhaneni S 
Published: December 2024

Abstract

Introduction
Penile fracture is an uncommon, but potentially devastating urogenital injury characterized by rupture of the tunica albuginea induced by trauma to the erect penis. Immediate repair is associated with a significantly improved prognosis for long-term sexual health. Due to the importance of early surgical intervention, the role of imaging techniques such as ultrasound (US) and magnetic resonance imaging (MRI) in diagnosis is controversial. Typically, the diagnosis of penile fracture is made based on history and physical exam. AUA guidelines recommend imaging as an adjunct study to assist with the diagnosis in equivocal cases. However, there is no clear protocol for the use of supplemental imaging in the literature.

Objective
To report our review of patients who presented to the emergency department with possible penile fracture to 1) examine practice patterns in the use of pre-operative imaging and 2) assess if pre-operative imaging was associated with prolonged time to the operating room (OR).

Methods
Electronic medical record data from a single multi-hospital health system from 2011 to 2022 was reviewed. IRB approval was obtained. The retrospective chart review assessed clinical presentation, physical exam findings, subsequent management, operative details (site of injury), imaging modality and erectile function prior to injury.

Results
A total of 96 patients presented to the emergency department with concern for penile fracture. Three were excluded due to incomplete records. Mean patient age was 47 years. Ten patients (10.8%) underwent MRI and 9 patients (9.7%) underwent penile ultrasound. 71% ultimately underwent surgical intervention. 60% of patients who underwent MRI had findings suggesting penile fracture. 67% of patients who underwent penile ultrasound had findings suggesting penile fracture. Mean time to complete an MRI after it was ordered was 3.85 hours. When comparing the time it took for patients to undergo incision after their initial consultation, we found a notable difference between those who underwent MRI and those who did not (p &lt; .001). On average, patients who had an MRI waited significantly longer-25.09 hours compared to those who did not have imaging, who waited an average of 7.29 hours.

Conclusions
While obtaining imaging can prolong time to OR, imaging did not prevent early repair of penile fracture, which has superior outcomes. Future studies should explore long term outcomes in patients who did vs did not receive pre-operative imaging.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Halozyme, Endo pharmaceuticals, Coloplast.
(338) DISPARITIES IN PRIAPISM CARE: INSIGHTS FROM NSQIP DATABASE
Authors: Langston D , Das R , Horns J , Hotaling J 
Published: December 2024

Abstract

Introduction
Priapism, marked by prolonged penile erection unrelated to sexual arousal, carries risks of tissue damage and permanent erectile dysfunction, mainly in its ischemic subtype. Despite guidelines stressing prompt intervention, disparities in management remain largely unexplored, urging further investigation to enhance patient outcomes and quality of life, driving our objective to analyze Priapism data from the National Surgical Quality Improvement Program (NSQIP) database.

Objective
To examine potential disparities in priapism care using the NSQIP database.

Methods
We conducted a retrospective analysis of priapism cases from 2007-2021 using the NSQIP database, focusing on ischemic and non-ischemic cases identified through ICD-9 and -10 and CPT codes. We assessed how reported race/ethnicity (Black, Hispanic, White) correlated with 30-day complication rates, surgical interventions (shunting), immediate penile prosthesis (PP) placement, and procedural management (penile injection and irrigation), analyzing p-values with Chi-squared tests.

Results
Our cohort of 474 priapism patients, were predominately Whites (43%) and the median age was 44 years. Emergent cases accounted for 51.3%, with corporospongiosal shunt being the most common intervention (57.4%). Patient race did not significantly influence the choice of shunting procedure. For those who underwent procedural intervention, 10.6% underwent irrigation of corpora cavernosa and 3.8% underwent injection of corpora cavernosa. Interestingly, Hispanic males trended lower rates in both categories: irrigation (Hispanic 5.6%, Black 10.8%, White 12.9%, p = 0.235) and injection (Hispanic 0%, Black 4.2%, White 5.0%, p = 0.045).Post-operative complications were observed in 6.7% of cases, with blood transfusion being the most common (4.01%). Reoperation rate was 13.7%, primarily for repeat priapism, leading to a 30-day readmission rate of 7.0%.

Conclusions
Priapism demands swift evaluation and treatment to mitigate discomfort and preserve erectile tissue integrity. Our research suggests a potential link between race and the procedural and surgical approaches to managing priapism, with varying initial management and transfusion rates among racial groups. Future investigations should delve deeper into these racial disparities and investigate potential variations in initial treatment upon presentation to the Emergency Department.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: StreamDx, Inherent Bioscience, Turtle Health, Maimus, Carrot Fertility.
RD21-like proteases: key effector hubs in plant–pathogen interactions
Authors: Huang Jie , van der Hoorn Renier A L 
Published: December 2024

Abstract
Over the past decades, numerous studies have demonstrated that proteases serve as a crucial regulatory mechanism in controlling plant immunity. In this review, we specifically focus on the role of one subfamily of RD21-like papain-like cysteine proteases that carry a C-terminal granulin domain. These proteases share high homology but have been described under very different names in different plant species. We provide a comprehensive overview of the background, endogenous regulation, and subcellular localization of RD21-like proteases in plants. Notably, RD21-like proteases act in immunity against various pathogens and they are targeted by many unrelated pathogen-secreted effectors that inactivate, mislocalize, or degrade RD21-like proteases. We highlight open questions and strategies to use this knowledge to develop innovative approaches for crop protection.
Unlocking the promise of UK health data: considering the case for a charitable GP data trust
Authors: Redhead Caroline A B , Bowden Catherine , Ainsworth John , Burns Nigel , Cunningham James , Holm Søren , Devaney Sarah 
Published: December 2024

Abstract
The UK National Health Service general practice (GP) patient data constitute a rich research resource, but collecting, managing, and sharing patient data present challenges. In May 2021, to address these challenges, substantial changes to the system for processing pseudonymized GP patient data in England were announced. As part of an opt-out process, patient consent to sharing GP data was deemed to have been given. However, when over a million people quickly acted to opt out of the new system, the process was paused, and an engagement exercise commenced, whose aim was to inform a re-designed programme addressing patient concerns. In this article, we present and discuss the findings of the General Practice Data Trust pilot study, which has investigated people’s reasons for opting out of sharing their data, and, looking for practical solutions to their concerns, has discussed with participants the concept of a ‘data trust’ to manage the sharing of patient data. Making a conceptual argument for the use of the (relatively new) charitable incorporated organization as a governance model for a GP data trust, we demonstrate how this could address patients’ concerns and represent a more attractive means of stewarding GP data for research and service planning purposes.
The Unity of Reason
Authors: Zapero David 
Published: December 2024

Abstract
On one possible view of practical reason, that capacity is subject to a standard of correctness determined by independently obtaining facts. This view has recently come under attack, notably in Jeremy Fix’s ‘Intellectual Isolation’. The relevant view, he claims, treats practical reason as a species of theoretical reason and is unable to account for the role that practical reason plays in rational agency. His case relies, however, on a certain conception of theoretical reason: a contemplative conception according to which theoretical reason is practically inert. By embracing that conception, he is led to suppose that exercises of a capacity with an external standard of correctness could not, by themselves, move a subject to act. But the contemplative conception is hardly compulsory. A view according to which practical reason is subject to an external standard need not take the shape, nor involve the corollaries, that Fix, and others, assume it must. Or so I argue.
Tuning and functionalization of logic gates for time resolved programming of bacterial populations
Authors: Bäcker Leonard E , Broux Kevin , Weckx Louise , Khanal Sadhana , Aertsen Abram 
Published: December 2024

Abstract
In order to increase our command over genetically engineered bacterial populations in bioprocessing and therapy, synthetic regulatory circuitry needs to enable the temporal programming of a number of consecutive functional tasks without external interventions. In this context, we have engineered a genetic circuit encoding an autonomous but chemically tunable timer in Escherichia coli, based on the concept of a transcription factor cascade mediated by the cytoplasmic dilution of repressors. As proof-of-concept, we used this circuit to impose a time-resolved two-staged synthetic pathway composed of a production-followed-by-lysis program, via a single input. Moreover, via a recombinase step, this synchronous timer was further engineered into an asynchronous timer in which the generational distance of differentiating daughter cells spawning off from a stem-cell like mother cell becomes a predictable driver and proxy for timer dynamics. Using this asynchronous timer circuit, a temporally defined population heterogeneity can be programmed in bacterial populations.
Structural and kinetic insights into tRNA promoter engagement by yeast general transcription factor TFIIIC
Authors: Seifert-Dávila Wolfram , Chaban Anastasiia , Baudin Florence , Girbig Mathias , Hauptmann Luis , Hoffmann Thomas , Duss Olivier , Eustermann Sebastian , Müller Christoph W 
Published: December 2024

Abstract
Transcription of transfer RNA (tRNA) genes by RNA polymerase (Pol) III requires the general transcription factor IIIC (TFIIIC), which recognizes intragenic A-box and B-box DNA motifs of type II gene promoters. However, the underlying mechanism has remained elusive, in part due to missing structural information for A-box recognition. In this study, we use single-particle cryogenic electron microscopy (cryo-EM) and single-molecule fluorescence resonance energy transfer (smFRET) to reveal structural and real-time kinetic insights into how the 520-kDa yeast TFIIIC complex engages A-box and B-box DNA motifs in the context of a tRNA gene promoter. Cryo-EM structures of τA and τB subcomplexes bound to the A-box and B-box were obtained at 3.7 and 2.5 Å resolution, respectively, while cryo-EM single-particle mapping determined the specific distance and relative orientation of the τA and τB subcomplexes revealing a fully engaged state of TFIIIC. smFRET experiments show that overall recruitment and residence times of TFIIIC on a tRNA gene are primarily governed by B-box recognition, while footprinting experiments suggest a key role of τA and the A-box in TFIIIB and Pol III recruitment following TFIIIC recognition of type II promoters.