bluuebunny/crossref_metadata_2025_split huggingface dataset:
(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

Abstract

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&lt;0.021) and prolactin negatively correlated with IIEF-15 intercourse satisfaction domain score (p&lt;0.027); in controlled patients, CAB dose negatively correlated with MHQ-S (p&lt;0.028) and MHQ-H (p&lt;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

Abstract

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

Abstract

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&lt;.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&lt;.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&lt;.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

Abstract

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

Abstract

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

Abstract

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

Abstract

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&lt;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

ABSTRACT

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.