bluuebunny/crossref_metadata_2025_split huggingface dataset:
(069) IDENTIFYING PREDICTORS OF BONE DENSITY LOSS IN MEN WITH LOW TESTOSTERONE
Authors: Ljubetic BM , Liso N , Mulhall JP , Flores JM 
Published: December 2024

Abstract

Introduction
Bone density loss (BDL), is associated with low testosterone (T).

Objective
We aimed to identify predictors of BDL in this cohort of patients.

Methods
The sample included (i) men ≥50 years old (ii) with low total T levels (&lt;300 ng/dL using LCMS on 2 early morning blood draws) (iii) who had dual-energy X-ray absorptiometry (DEXA) within 6 months of T measurement. Men with prior T therapy were excluded. On DEXA, osteopenia was defined as a T score -1.1 to -2.5, osteoporosis T score lower than -2.5. Additionally, demographics and comorbidity data, diabetes, sleep apnea, coronary artery disease (CAD), hypertension, dyslipidemia and smoking status were collected. We report rates and attempt to define predictors of any BDL using multivariable analysis (MVA), including age, comorbidities ≥3 (yes), and total T levels ≤100 ng/dL (yes).

Results
512 men were analyzed, mean age of 65 ± 5 years. Median total T was 223 (175, 262) ng/dL, free T 4.5 (2.8, 7.9) ng/dL, and estradiol 17 (13, 23) pg/mL. 6% had a total T ≤ 100 ng/dL. Median number of comorbidities was 2 (1, 3). 57% hypertension, 57% dyslipidemia, 40% reported OSA, 24% had diabetes, and 8% reported CAD. 34% of the men had ≥3 comorbidities. 44% were former or current smokers. BDL was present in 36% of the patients. 91% had osteopenia, and 9% had osteoporosis. On MVA, significant predictors of BDL were older age, presence of ≥3 comorbidities and the presence of total T ≤ 100 ng/dL (Table 1).

Conclusions
In our cohort of men with low T, one third had BDL, and we have identified key predictors of this occurrence, older age, higher number of comorbidities and profoundly low T.

Disclosure
No.
(090) DELAYED STENOSIS RATE POST VASECTOMY REVERSAL: A MULTICENTER COHORT
Authors: Tyler A , Deebel N , Goldstein M , Lipshultz L , Brannigan R , Kavoussi P , Ramasamy R , Terlecki R , Halpern J , Trost L 
Published: December 2024

Abstract

Introduction
Outcomes with vasectomy reversal procedures for infertility have varied widely in the literature, with limited data available on long-term results. The current study objective was to provide data on long-term outcomes, including delayed stenosis rates using a multicenter dataset.

Objective
To evaluate the rate of long-term stenosis of men undergoing vasectomy reversal.

Methods
A retrospective study was performed of men undergoing vasectomy reversal for infertility by 14 surgeons from nine institutions. Each of the participating institutions had fellowship-trained andrologists specializing in male infertility and provided the data in an anonymous manner to optimize accuracy of reporting. Two institutions provided only limited datasets. The primary objective of the study was to evaluate the rate of long-term patency. Secondary objectives were to describe sperm concentration at various time points and by surgical team. For clinical variability, clinics without at least 10 data points were excluded from those analyses.

Results
A combined total of 3589 cases were included in the cohort, with 2838 having at least one test and 893 with at least one semen analysis available beyond 10 months. The percentage of patients with test results &gt;10 months after surgery by clinic ranged from 1.2 to 47.5%, indicating wide discrepancies in follow-up protocols. Overall median sperm concentrations at &lt;2, 2-4, 4-7, 7-10, 10-13, 13-18, and 18-24+ months were 5.8, 6.7, 5.3, 2.5, 1.3, 0, 1.2 million/ml, respectively. All-comer patency (defined as sperm at any point) rates ranged from 60-97%, with median maximal sperm concentration by clinic (any time point) ranging from 2-21 million/ml. Among men with at least two semen analyses, at least one of which was &gt;10 months, 33.4% who initially had sperm went on to experience azoospermia (clinics varying from 2-48%). Overall patency rates at &gt;10 months were 54% for the full cohort (range by clinic 41-93%). When reviewing data by surgeon, statistically significant differences were noted with all variables assessed, including the ratio of VV vs EV, successful completion rates of both sides, sperm concentrations, and short and long-term rates of azoospermia, suggesting notable differences in results based on surgical technique.

Conclusions
Using data from a combined cohort of 14 surgeons, approximately 54% of men who undergo vasectomy reversal for infertility experience durable patency at 10+ months with results varying significantly by surgeon.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: PathRight Medical.
(092) TESTICULAR CORE EXTRACTION REDUCES NEED FOR MICROSCOPIC TESTICULAR SPERM EXTRACTION BY 75% IN MEN WITH NON-OBSTRUCTIVE AZOOSPERMIA
Authors: Oppenheimer A , Huang J , Stocks B , Lipshultz L 
Published: December 2024

Abstract

Introduction
Current AUA guidelines recommend proceeding to microTESE (mTESE) for patients with non-obstructive azoospermia (NOA). Herein, we propose that that conventional Testicular Sperm Extraction (cTESE) is an effective and preferred first-line technique for sperm retrieval in men with NOA who first undergo a diagnostic testicular core extraction (TCE).

Objective
To comprehensively characterize TCE and cTESE as important diagnostic and therapeutic tools, respectively, we present a large cohort study to confirm our proposed algorithm.

Methods
We identified 187 patients presenting with NOA in our clinic from January 1, 2019 – March 25, 2024. All patients underwent diagnostic TCE that if positive for sperm was followed by cTESE. Chart review was performed, and summary statistics were calculated for tested variables, using chi squared analysis for categorical variables and Kruskal Wallis analysis for non-parametric continuous variables. P &lt; 0.05 deemed significance.

Results
Under current guidelines, all 66 patients who underwent cTESE for NOA would have undergone mTESE. Of these patients, 97.8% had sperm on cTESE sufficient for IVF/ICSI. Those patients who did not have sperm on TCE were offered mTESE. 16 elected to proceed, of which 4 (25%) were found to have sufficient sperm at the time of egg retrieval. In patients with NOA, the only significant predictor of cTESE success was TCE. Other covariates that significantly differed between patients with sperm and those without on TCE included lower FSH (p = 0.001) and LH (p = 0.005). However, these variables were not significant in predicting TCE efficacy for NOA patients.

Conclusions
TCE was the only tested variable statistically associated with cTESE outcome. By pretesting NOA patients with TCE as a method of selection we achieved a 97.8% sensitivity of predicting a positive cTESE outcome in NOA patients and spared 75% of those patients from mTESE. This algorithm for NOA patient management costs significantly less while maintaining efficacy.

Disclosure
No.
(094) PREDICTORS OF ABNORMAL DNA FRAGMENTATION INDEX AND SUCCESSFUL PREGNANCY
Authors: Nguyen V , Li M , Fan A , Patel D , Hsieh T 
Published: December 2024

Abstract

Introduction
Semen analysis is primarily used in initial evaluation of male factor infertility but does not provide insight into sperm DNA quality. DNA fragmentation index (DFI) and high DNA stainability (HDS) reflect the percentage of damage to sperm DNA and sperm with immature chromatin.

Objective
We sought to identify clinical predictors of DFI/HDS, and subsequent success of pregnancy.

Methods
This was a retrospective study of all men who underwent DFI/HDS testing for male infertility at a single academic institution between July 2016 and July 2023.

Results
We identified 199 men with median age of 39 years (range: 25-62). 23% of men had a diagnosis of a varicocele. Median partner age was 36 years (range: 20-46). 45%, 36%, and 26% of couples had a history of failed intrauterine insemination (IUI), in vitro fertilization (IVF), and miscarriage. Median sperm DFI and HDS were 19% (range: 4-72) and 11% (range: 2-40). 65% and 32% of the cohort had abnormal DFI and HDS &gt;15%. Increasing age was a significant predictor of abnormal DFI (37.8 vs 40.1 years, p = 0.01). Men with abnormal HDS were significantly more likely to have a varicocele (18% vs 33%, p = 0.016). Decreased semen morphology was a predictor of abnormal DFI and HDS, though this did not reach statistical significance (4.2% vs 2.4%, p = 0.132 and 3.7% vs 1.7%, p = 0.094; Table 1). 18% of men underwent a testicular sperm retrieval procedure after DFI testing for planned IVF. Of these couples, 31% resulted in successful pregnancy. Among this subset, increased DFI thresholds were correlated to lower success rate of pregnancy (Table 2).

Conclusions
Increased age is a significant predictor of abnormal DFI, whereas concomitant varicocele predicts abnormal HDS. There is also a trend towards increased DFI and lower success rate of pregnancy.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.
(114) WITH “STANDARD” VAGINOPLASTY TECHNIQUE, ARE SURGEONS POSITIONING THE NEOCLITORIS IN THE SAME LOCATION IN THE VULVA AS IN A CIS-GENDER WOMAN? RESULTS OF ANATOMIC AND MRI-BASED STUDIES AND, A NOVEL SURGICAL TECHNIQUE FOR ORTHOTOPIC PLACEMENT
Authors: Sandhu S , Dadashian E , Mallavarapu S , Stelmar J , Smith S , Saouaf R , Siedhoff M , Garcia M 
Published: December 2024

Abstract

Introduction
The clitoris is a “defining” element of the vulva. It is a primary source of female sexual pleasure. Its location close to the vaginal opening allows for stimulation during vaginal-receptive intercourse. To date, the only described vaginoplasty techniques anchor the newly constructed neoclitoris to the anterior aspect of the penile-corporal stump. We questioned whether this location is orthotopic relative to cis-gender women.

Objective
1. To measure the location of the glans clitoris, relative to boney landmarks. 2. Describe our technique for orthotopic positioning of the neoclitoris during vaginoplasty.

Methods
I. Magnetic Resonance Imaging (MRI) scans of 25 cis-gender women’s pelvises (all with otherwise normal genital anatomy; women positioned flat) were reviewed in A/P and sagittal planes. 12/25 were in cis-women age &lt; 40; 13/25 in women age &gt; 40. The clitoris-shaft and glans, urethra all elements of the pubic symphysis, were identified by a specialized MRI-radiologist. II. We describe our technique for anchoring the neoclitoris in transgender women undergoing vaginoplasty in the correct anatomic position.

Results
In the flat/supine position during the MRI scans, the glans clitoris was identified superficial to (overlying) the pubic symphysis, at midline. The average distance between the center of glans-clitoris to the inferior edge of the pubic symphysis was 19.6 ± 3.1 mm (range: 13.5-25 mm). (Figure 1) This distance did not differ statistically across age groups (p = 0.91) Our technique (Fig. 2): We now anchor the constructed neoclitoris glans at midline, 20 mm anterior to the inferior-edge of the pubic symphysis. To do this, we bluntly-dissect a 1.5 cm 2 midline-window in the dorsal neurovascular bundle (DNVB), to anchor the neoclitoris-glans to periosteum.

Conclusions
To date, no publication has described positioning the neoclitoris glans anywhere but to the corporal stump. This location is not orthotopic relative to cis-women, because, anatomically, the penile corporal stump is located posterior to the inferior edge of pubic symphysis. The approach we describe is orthotopic, and, we believe, improves vaginoplasty cosmesis and female sexual pleasure.

Disclosure
No.
(128) CORRELATION BETWEEN BIOPSY FREQUENCY AND REDUCED SEXUAL FUNCTION IN PROSTATE CANCER PATIENTS UNDER ACTIVE SURVEILLANCE: A PROSPECTIVE COHORT STUDY
Authors: Cortizas EM , Angulo-Llanos L , Szczotka ZO , Williams AD , Guerard T , Punnen S , Masterson TA 
Published: December 2024

Abstract

Introduction
Prostate cancer patients under active surveillance (AS) frequently undergo repeated biopsies to monitor disease progression. While this approach aims to delay or avoid radical treatments, the cumulative effects of multiple biopsies on erectile function and overall patient-reported outcomes (PROs) remains unexplored.

Objective
This study aims to determine a correlation between biopsy frequency and reduced sexual function, as well as deteriorated PROs in patients on AS for low-grade prostate cancer.

Methods
We conducted an analysis on results obtained from two separate prospective, single-institution, single-arm, non-treatment trials: MAST (NCT02242773) and MDSelect (NCT04240327). Both studies involved patients newly or previously diagnosed with low-grade prostate cancer (Gleason grade 2 or less) who were monitored via active surveillance. Participants completed the Expanded Prostate Cancer Index Composite (EPIC) survey before their initial diagnostic or baseline biopsy. Patients were followed for a maximum of 2 years, with repeated surveys conducted at 1-year intervals prior to each repeat biopsy. Statistical analysis was performed to assess the correlation between the number of biopsies and changes in mean EPIC sexual and hormonal domain scores using the ANOVA test, with significance set at a p-value of &lt;0.05.

Results
To date, 226 participants enrolled in the studies have followed or are currently following an active surveillance regimen. These participants were categorized based on the number of biopsies they underwent into three groups: Group A with 1 biopsy (n = 20), Group B with 2 biopsies (n = 98), and Group C with 3 biopsies (n = 108). Participants in Group C exhibited a significant reduction in EPIC sexual and hormonal domain scores compared to those in Groups A and B. Regression analysis confirmed that a higher number of biopsies is an independent predictor of worsening sexual function and PROs.

Conclusions
Preliminary findings suggest that an increased number of biopsies in prostate cancer patients on AS are associated with a reduction in sexual function and a decline in PROs. Future research should explore strategies to minimize biopsy-related effects to quality of life while maintaining effective disease surveillance. Further analysis will be conducted as additional patients reach their follow-up milestones.

Disclosure
Yes, this is sponsored by industry/sponsor: NIH.
Clarification: Industry funding only - investigator initiated and executed study.
Any of the authors act as a consultant, employee or shareholder of an industry for: Bio-Reference Laboratories.
(134) AM I NORMAL? EJACULATE VOLUME NOMOGRAMS FROM &gt; 60 000 INDIVIDUALS
Authors: Fernandez A , Balakrishnan AS , Belarmino A , Li KD , Bowman M , Lindsey J , Kentfield SA , Civello D , Breyer BN , Smith JF 
Published: December 2024

Abstract

Introduction
Male enhancement supplement companies have marketed ejaculate volume as a measure of virility and self-worth. Current reference values for semen volume are based on the World Health Organization’s assessment of 3586 semen samples (Laboratory Manual for the Examination and Processing of Human Semen, 6th edition). The current study seeks to define parameters for “normal” ejaculate volume through the analysis of semen samples from over 60 000 individuals.

Objective
To characterize the distribution of ejaculated seminal volume in adults of varying age and abstinence time.

Methods
This IRB-approved study included patients obtaining a CLIA-accredited semen analysis (SA) using a mail-in test system developed by Fellow Health, Inc. (San Leandro, California). Age and abstinence time were assessed by self-report on surveys administered at the time of semen sample collection. Samples from individuals &lt;18 years of age and duplicate SAs from one individual were excluded. Mean ejaculate volumes were compared between age groups or abstinence-time groups using Welch’s t-test. Given the high number of samples, a p value of &lt;0.01 was considered significant.

Results
Of 60 823 individuals, the mean ejaculated seminal volume was 3.4 ml, with median volume 3.1 ml, interquartile range 2.2, 4.3 ml, max 14.5 ml, and standard deviation 1.7 ml (Fig. 1A). The ejaculate volume distribution is skewed right, with some individuals demonstrating very high volumes. Older age was associated with lower volume ejaculates, with mean ejaculate volume 3.6 ml in individuals aged 18-30 versus mean 2.6 ml in those aged &gt; = 51 (p = 1.0E-132) (Fig. 1B). Increased abstinence time was associated with increased seminal volume, with abstinence of 12-24 and 36-48 hours resulting in mean volumes of 2.6 versus 3.4 ml, respectively (p = 1.0E-46) (Fig. 1C). Average ejaculate volumes were not significantly different among groups abstaining for &gt;84 hours.

Conclusions
We define “normal” seminal volume distribution based on over 60 000 men stratified by age and abstinence. Ejaculate volume decreases with older age and increases with abstinence time, plateauing in the 84-96 hour abstinence timeframe.

Disclosure
Yes, this is sponsored by industry/sponsor: Fellow Health, Inc.
Clarification: Industry funding only - investigator initiated and executed study.
Any of the authors act as a consultant, employee or shareholder of an industry for: Fellow Health, Inc.
Comparison of organism recovery and staining properties for 3 methods of Gram stain preparation
Authors: Pisahl Audrey , Timmons Martha , Criswell Sheila 
Published: December 2024

Abstract

Background
One possible way to improve accuracy of blood culture Gram stain analyses is increasing the concentration of organisms on the slide prepared from the blood culture broth.

Methods
From each positive blood culture bottle, 1 direct smear, a 1-drop concentrated preparation, and 1 cytospin/cytofuge preparation were Gram stained and evaluated. There were 2 evaluators who ranked the 3 preparations from most to fewest organisms seen. Each preparation was also scored as acceptable or unacceptable for both organism and background stain quality.

Results
The 1-drop slide exhibited the highest concentration of organisms compared with both the cytospin and direct smear but presented frequent difficulties with interpretation of Gram staining acceptability with both the background and the organisms. Although cytospin preparations are known to concentrate liquid specimens, the current study found no enrichment of microorganisms over the direct smear preparation. The cytospin was, however, advantageous for enhancing organism morphology by creating a monolayer of elements and reducing background artifacts.

Conclusion
The 1-drop preparation is simple, inexpensive, and effective at increasing organism concentration for analysis, making it a good option when processing culture bottles with low organism loads, but more investigation into methods of improving stain quality is necessary.
Harassment and Public Music Theory
Authors: Lavengood Megan L 
Published: December 2024

Abstract
A sense of community, such as the community of a small academic field, encourages collegial behavior in conversations with one another. Individuals without a connection to their addressee may more easily speak and act without empathy; they may feel there is little consequence for simply letting loose. Public music theory in online spaces will attract more harassment than traditional academic scholarship. The degree of the harassment will vary, and can be mild enough for authors to brush off, but sustained or egregious harassment can lead to self-censorship, wherein individuals choose not to engage in public forums so that they can avoid these antagonistic encounters. But with the right kind of preparation and support, music theorists can ensure the reward outweighs the risk.
Financial challenges of being on long-term, high-cost medications
Authors: Elshiekh Cleopatra , Rudà Roberta , Cliff Edward R Scheffer , Gany Francesca , Budhu Joshua A 
Published: December 2024

Abstract
The isocitrate dehydrogenase (IDH) inhibitor, vorasidenib, may offer a promising new treatment option for patients with IDH-mutant gliomas. However, the indefinite nature of this targeted therapy raises significant financial concerns. High costs of targeted cancer therapies, often exceeding $150 000 annually, contribute to financial toxicity, characterized by medical debt, income loss, and psychological stress, and place stress on health systems. This review analyzes the drug approval and pricing mechanisms in various countries and their impact on healthcare costs and patient access, focusing specifically on the impacts in neuro-oncology. The United States employs a market-driven approach resulting in higher drug prices, while most countries, such as the United Kingdom, Germany, France, Italy, Japan, South Africa, and Brazil, use negotiated pricing and health technology assessment to manage costs. The financial burden of expensive medications affects patient adherence and quality of life, with many cancer patients facing substantial out-of-pocket expenses and potential treatment abandonment, and many more unable to access these drugs altogether. Vorasidenib’s introduction, while potentially improving patient outcomes, may exacerbate financial toxicity unless mitigated by patient access programs and cost-management strategies. As neuro-oncology treatment paradigms evolve, understanding the economic implications of new therapies is essential to ensure equitable access and optimize patient care.
Measuring Cigarette and E-Cigarette Use Over Time Among LGBT+ Youth and Young Adults Using a Repeat Cross-Sectional Survey, 2022–2024
Authors: Kierstead Elexis C , Dimaya Brenda , Palmerini Maureen , Bayacal Gabrielle C , Hair Elizabeth C 
Published: December 2024

Abstract

Introduction
Lesbian, gay, bisexual, transgender, and other minority sexual orientation and gender minority (LGBT+) individuals in the United States use tobacco products more than their heterosexual and cisgender peers. Although existing literature identifies this relationship, more research using recent, national data from a large sample is needed to better examine trends over time.

Aims and Methods
A repeat cross-sectional survey of approximately n = 300 youth and young adults aged 15–24 was fielded weekly from October 2022 to June 2024, resulting in a total sample of N = 25 675. This sample was used to examine cigarette and e-cigarette use over time among LGBT+ and non-LGBT+ youth and young adults. Cigarette and e-cigarette use was also examined by specific sexual orientation and gender identity, using the aggregated sample.

Results
From October 2022 to June 2024, cigarette and e-cigarette use were consistently higher among LGBT+ youth and young adults, compared to their cisgender and heterosexual peers. Compared to heterosexual young people, gay/lesbian and bisexual young people reported higher cigarette and e-cigarette use. Male-identifying individuals reported the highest cigarette use, while female young people reported the highest e-cigarette use. Transgender and gender-diverse individuals reported lower cigarette and e-cigarette use than cisgender young people.

Conclusions
Tobacco use disparities persist among LGBT+ youth and young adults. Sexual minority respondents saw elevated risk of tobacco use, while gender minority youth saw lower rates of tobacco use, although prevalence remains high. Future research should continue to investigate LGBT+ tobacco use using national surveillance methods. Effective programs for tobacco prevention and cessation are necessary to advance health equity among LGBT+ youth and young adults.

Implications
This study finds persistently elevated tobacco use among LGBT+ youth and young adults over a 2-year period, highlighting the importance of continued tobacco use surveillance, as well as the development of programmatic interventions to reduce LGBT+ tobacco use. These analyses also inform future work further investigating differences in tobacco use by sexual orientation and gender identity among young people. This work provides a call to action to focus efforts on reducing tobacco use among LGBT+ youth, improving the long-term health of this population, and increasing health equity.