bluuebunny/crossref_metadata_2025_split huggingface dataset:
Topical steroid withdrawal: a survey of UK dermatologists’ attitudes
Authors: Barlow Richard , Proctor Andrew , Moss Celia 
Published: February 2024

Abstract
The term topical steroid withdrawal (TSW) refers to a condition widely discussed on social media, but rarely mentioned in the medical literature. It typically involves a patient with chronic eczema who abruptly discontinues topical corticosteroids (TCS) believing they are ineffective and damaging. Symptoms include an acute eruption, worse than the previous eczema, of painful erythema followed by oozing, crusting, desquamation and sometimes prolonged systemic weakness. Patients self-diagnose and often avoid healthcare professionals who dismiss the diagnosis and persist in offering TCS, leaving them unsupported. We analysed 121 responses to a survey of UK dermatologists’ attitudes to TSW. Views on aetiology included relapsed eczema, erythroderma and a social construct. A total of 88.4% (107/121) agreed that TSW needs better understanding and more research. Respondents earlier in their careers are more cautious than senior respondents about prescribing TCS long term because of TSW, suggesting a trend that might lead to better understanding, communication and management.
Populismo constituyente, democracia y promesas incumplidas: el caso de la Convención Constitucional Chilena (2021-2022)Constituent populism, democracy, and failed promises: The case of the Chilean Constitutional Convention (2021-2022)
Authors: Issacharoff Samuel , Verdugo Sergio 
Published: February 2024

Abstract
Mechanisms of popular participation, such as constitutional conventions and citizen assemblies, emerge as a near-universal canon of every political discussion on how constitutions should change. This article offers a cautionary approach to the way these participatory mechanisms work in constitution-making. In democratic contexts including populist narratives and representative institutions functioning in flawed ways, constitution-making can fail not simply despite the existence of participatory mechanisms but in part because of them. We identify two types of failures. First, the authoritarian failure, which consists of constitution-making processes that lead to authoritarian outcomes or become part of democratic backsliding or abusive processes. Second, the activation failure, by which constitutions are not passed. We claim that this later failure can likely occur when reforms attempt to bypass established, functioning institutional actors, whatever their flaws, and use a comparative approach to the Chilean Constitutional Convention (2021-2022) as an example.
Efficacy of cefoperazone/sulbactam for ESBL-producing Escherichia coli and Klebsiella pneumoniae bacteraemia and the factors associated with poor outcomes
Authors: Chen Rou-Zhen , Lu Po-Liang , Yang Tsung-Ying , Lin Shang-Yi , Tang Hung-Jen , Chang Feng-Yee , Yang Ya-Sung , Chiang Tsung-Ta , Wang Fu-Der , Wu Ting-Shu , Shie Shian-Sen , Ho Mao-Wang , Liu Jien-Wei , Shi Zhi-Yuan , Chou Chia-Hui , Chuang Yin-Ching 
Published: February 2024

Abstract

Objective
We aimed to assess the efficacy of cefoperazone/sulbactam (CPZ/SUL) in extended-spectrum β-lactamase (ESBL)-producing Enterobacterales infections and identify factors influencing outcomes.

Methods
This retrospective multicentre study was conducted in Taiwan (January 2015 to December 2020) and examined the efficacy of CPZ/SUL treatment in ESBL-producing Enterobacterales bacteraemia. The minimum inhibitory concentrations (MICs) were determined using agar dilution; ESBL/AmpC genes were detected using polymerase chain reaction. The primary outcome was clinical success, whereas the secondary outcome was 30-day mortality. Clinical success was defined as the complete resolution of clinical signs and symptoms of K. pneumoniae or E. coli infection, with no evidence of persistent or recurrent bacteraemia. The factors influencing outcomes were identified using a multivariate analysis.

Results
CPZ/SUL demonstrated a clinical success rate of 82.7% (91/110) in treating ESBL-producing Enterobacterales bacteraemia, with a 30-day mortality rate of 9.1% (10/110). Among 110 ESBL-producing isolates, a high clinical success rate was observed at an MIC of ≤32/32 mg/L. Multivariate analysis revealed that a Charlson comorbidity index (CCI) of ≥6 was associated with lower clinical success [odds ratio (OR): 5.80, 95% confidence interval (CI): 1.15–29.14, P = 0.033]. High Sequential Organ Failure Assessment scores (≥6) were significantly associated with increased 30-day mortality (OR: 14.34, 95% CI: 1.45–141.82, P = 0.023).

Discussion
CPZ/SUL demonstrated a clinical success rate of 82.7% (91/110) in treating ESBL-producing Enterobacterales bacteraemia. Treatment success was evident when the CPZ and SUL MIC was ≤32/32 mg/L. Comorbidities (CCI ≥6) were associated with lower clinical success, while disease severity (Sequential Organ Failure Assessment score ≥6) correlated with higher mortality.
Term Neonate Born With Right Upper Extremity Skin Necrosis at Birth: A Case Report
Authors: Siddappa Ashajyothi M , Shaik Likhita , Slusher Tina , Gayken Jon , Bjorklund Ashley 
Published: February 2024

Abstract
Congenital skin and soft tissue necrosis is a rare condition associated with significant morbidity and mortality in neonates. The authors treated a neonate born with significant skin necrosis of the right forearm. The case report is followed by a literature review and discussion of previously published reports of neonatal skin necrosis. A term female neonate was admitted to our hospital at 24 h of age for skin necrosis of the right forearm with sloughing and edema below the right elbow and contractures of her fingers. Topical treatment with cleansing and antibiotic application was initiated. The LUNA florescent microangiography showed superficial perfusion defects in the arm and dorsum of the hand along with overt ischemia over the dorsal aspect of the forearm. She was treated with intravenous antibiotics following a sepsis evaluation. Subsequently, she developed hypotension treated with fluid boluses, dopamine, and stress dose steroids. Concerns of wound infection and sepsis led to debridement of the necrotic area within the first 24 h post-admission. Wet-to-dry dressing changes using Vashe wound solution were begun postoperatively.; followed by placement of Integra on postoperative day-of-life (DOL) 7; dressing takedown on DOL 12; and autografting of the right hand and forearm with disarticulation of the 4th distal interphalangeal joints and right 5th distal interphalangeal transection on DOL 24. Postoperative dressing care was continued during the remainder of the hospital stay, she remained stable without any further complications and was discharged home on DOL 34 with outpatient clinic follow-up.
An improved pure quasi-P-wave equation for complex anisotropic media
Authors: Zhang Pingmin , Yao Gang , Zheng Qingqing , Fang Xinyu , Wu Di 
Published: February 2024

Abstract
An accurate pure qP-wave equation in transverse isotropic (TI) media and its efficient and stable implementation are valuable for seismic imaging and inversion. Owing to the complexity of the qP-wave phase velocity expression in anisotropic media, it is difficult to construct such a pure qP-wave equation. In this paper, we combine the Taylor expansion and scalar operator methods to formulate an efficient and stable pure qP-wave equation in TI media. First, the Taylor expansion method is used to convert the square-root term into a fractional term in the qP-wave phase velocity expression. We further improve the approximation accuracy of the resulting equation by a correction technique. Then, the scalar operator is applied to scalarize the equivalent form of the fractional term in the approximated dispersion equation, deriving a simple and easy-to-implement pure qP-wave equation. We use the optical flow method to compute the direction of wave propagation, which improves the calculation accuracy of the scalar operators. Numerical experiments with representative models demonstrate that the new method has higher accuracy and better adaptability to models with strong anisotropy, complex structure, and rapid variation of the tilt angle than previous methods.
A rare case of invasive endometriosis causing intestinal obstruction
Authors: Thirumurthy Sathish K , Mohammed Mahsheena 
Published: February 2024

Abstract
A 35-year-old woman presented to the emergency department with severe right iliac fossa pain with features of subacute intestinal obstruction and recurrent episodes of similar pain in the past. CT scan showed a mass with fluid collection with no trace of the appendix in the right iliac fossa. The patient was taken up for a diagnostic laparoscopy and proceeded. Operative findings were that of a mass in the lumen of the terminal ileum just 6 inches from the ileocaecal junction. Normal pelvis with normal uterus and ovaries. The patient underwent a laparoscopic resection of the terminal ileum and limited resection of the ascending colon with an ileo-colic anastomosis. The patient recovered well and was discharged. The biopsy was reported as invasive endometriosis involving the muscularis layer of the terminal ileum with stricture of the terminal ileum with transmural inflammation. The case is being presented for the rarity of invasive endometriosis causing bowel obstruction with a normal pelvis.
(018) Predictors of the Conduct of Nerve Sparing During Radical Prostatectomy
Authors: Thorogood SL , Liso N , Eastham J , Laudone V , Mulhall JP , Flores JM 
Published: February 2024

Abstract

Introduction
The association between nerve-sparing (NS) status at the time of radical prostatectomy (RP) and functional outcomes is well described; however, our profession lacks insight as to whether patient factors such as age and baseline erectile function influence surgeon behavior when it comes to nerve-sparing during RP.

Objective
We analyzed predictors associated with bilateral nerve damage/resection at the time of RP.

Methods
The study included patients who underwent RP with surgeon-reported NS scoring. The NS outcome of the right and left sides were independently scored between 1-4: 1 = completely preserved, 2 = partially preserved, 3 = partially damaged, and 4 = completely resected; scores of 1 or 2 indicate nerve-sparing and scores of 3 or 4 indicate non-nerve-sparing. We classified overall NS status as bilateral, unilateral, or not-spared. Demographics, ED-related comorbidities, pre-RP digital rectal exam (DRE), most recent prostate biopsy (bx) results, and pre-RP IIEF Erectile Function Domain (EFD) were analyzed. Pre-RP prostate MRI was used to define prostate volume (PV). EFD score &lt; 24 defined non-functional erections. We created a multivariable (MV) model to define predictors of poorer NS status. The model included patient age, pre-RP EFD, PV, PSA, DRE, noted possible extracapsular extension (ECE) on pre-RP MRI, number of positive bx cores, and predominant Gleason (G) score on bx.

Results
3805 men met inclusion criteria. Median age was 64 (57, 67) years. Median pre-RP EFD score was 26 (15, 30); 41% had a pre-RP EFD score &lt; 24. Median PV and PSA were 35 (27, 47) mL and 5.7 (4.2, 8.4) ng/dL, respectively. 64% had a normal pre-RP DRE. Median total bx cores 12 (9, 14). Median positive bx cores 4 (2, 7). Distribution of bx pathology: 17% G6, 64% G7, 10% G8, 8% G9, &lt;1% G10. 65% had predominant G3 and 34% G4 pathology. 26% of MRI reports noted some degree of suspicion for ECE. NS status at RP: bilateral (69%), unilateral (20%), non-spared (11%). Median NS score was 3 (2, 4). On MV analysis, abnormal DRE, number of positive bx cores, and predominance of G4 were predictive of non-NS surgery. Most notably, the non-oncological factors – older patient age and a pre-RP EFD &lt; 24 – were also predictive of non-NS surgery (Table).

Conclusions
While patient age and baseline erectile function (EF) are not necessarily predictors of a patient’s interest in preserving EF, these non-oncologic factors were identified as predictors of non-NS surgery in this analysis. Surgeons should define the individual patient’s sexual function goals prior to RP.

Disclosure
No.
(028) The Emerging Role of Telehealth in Sexual Medicine: A Survey of Patient Attitudes
Authors: Naeem T , Saffati G , Kassab J , Lipshultz LI , Khera M 
Published: February 2024

Abstract

Introduction
The COVID-19 pandemic brought with it an increase of healthcare interactions on an electronic interface, but a return to in-person interactions has left many questions open regarding the future utility and viability thereof. Urologic care, and particularly sexual health, frequently involves sensitive issues and understanding patients’ attitudes is imperative to determine how to incorporate telemedicine in the future.

Objective
This study seeks to characterize patients’ overall perspective on telehealth services in a sexual medicine setting to identify patient preferences and satisfaction with the use of telehealth services.

Methods
An electronic survey was sent through REDCap to patients who had at least one telehealth visit with a provider in our tertiary referral center since the start of the COVID-19 pandemic. The accrued patient cohort was sent a 15-question four-pronged survey assessing the purpose of the visit, the patient-provider relationship and communication, the perceived quality of care, and the patient’s overall satisfaction on a 5-point Likert scale. Descriptive statistical analysis was done using REDCap.

Results
We surveyed 4071 patients and received 771 (18.9%) responses. Of those who replied, 470 (61%) were seen for hypogonadism, 216 (28%) for erectile dysfunction, 50 (6.5%) for infertility, and 35 (4.5%) for Peyronie’s. A majority of patients (78.4%) ‘moderately’ or ‘strongly’ agreed that they are able to maintain a physician-patient relationship, are comfortable with telehealth use for new and follow-up visits alike and perceive a comparable quality of care when averaged across all questions in these sections. 613 (79.5%) of patients reported being ‘somewhat’ or ‘very’ satisfied with their telehealth visits and 513 (66.6%) patients would prefer a telehealth visit over an in-person in the future.

Conclusions
The results of this study indicate that patients are generally satisfied with telehealth visits, and it would likely be in the best interest for physicians and their patients to increasingly adopt telehealth solutions. The data further suggests that patients with certain diagnoses are less likely to prefer telehealth than others, though a more rigorous statistical analysis is needed once additional patient responses are received.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.
(061) Analysis of BMP4 and GREM1 as Targets of SHH Signaling and Downstream Regulators of the Collagen Axis in the Penis
Authors: Deng J , Martin S , Ohlander S , Harrington D , Stupp S , Mcvary K , Podlasek C 
Published: February 2024

Abstract

Introduction
Cavernous nerve (CN) injury caused by prostatectomy and diabetes, initiates a remodeling process (smooth muscle apoptosis and increased collagen) in the corpora cavernosa of the penis of patients and animal models that is an underlying cause of erectile dysfunction (ED). The Sonic hedgehog (SHH) pathway plays an essential role in the response of the penis to denervation, as collagen increases with SHH inhibition and decreases with SHH treatment. Part of the mechanism of how SHH impacts collagen may involve bone morphogenetic protein four (BMP4) and GREMLIN (GREM1). Microarray analysis identified increased GREM1 (BMP4 antagonist) in corpora cavernosa of ED patients and SHH is a regulator of GREM1 in the limb bud.

Objective
We will examine the relationship between SHH, BMP4, GREM1 and collagen in penis of ED patients and rat models of CN injury, SHH inhibition, and SHH, BMP4 and GREM1 treatment.

Methods
Corpora cavernosa of Peyronie’s (control), prostatectomy and diabetic ED patients was obtained (n=26). Adult Sprague Dawley rats (n=90) underwent either: 1. CN crush (1-7 days) or sham control, 2. CN injury and BMP4, GREM1 or MSA (control) protein treatment via Affi-Gel beads or peptide amphiphile (PA) for 14 days, 3. 5E1 SHH inhibitor, IgG and PBS (controls), or SHH protein treatment for 2-4 days. Immunohistochemical and western analysis for BMP-4 and GREM1, and collagen analysis by hydroxyproline and trichrome stain were performed.

Results
BMP4 and GREM1 proteins were identified in corpora cavernosal smooth muscle of prostatectomy, diabetic and Peyronie’s patients, and in rat penis, sympathetic nerve fibers, perineurium, blood vessels, and urethra. Collagen decreased 25.4% in rats with CN injury and BMP4 PA treatment (p=0.02) and increased 61.3% with CN injury and GREM1 treatment (p=0.005). Trichrome showed increased collagen in rats treated with GREM1. BMP4 increased smooth muscle. Western identified increased BMP4 and GREM1 in corpora cavernosa of prostatectomy and diabetic patients, and after CN injury (1-2 days) in our rat model. Localization of BMP4 and GREM1 changed with SHH inhibition. SHH treatment increased BMP4 and GREM1. Aging did not impact BMP4 and GREM1 localization.

Conclusions
BMP4 and GREM1 are downstream targets of SHH that impact collagen and may be useful in collaboration with SHH to prevent penile remodeling and ED. Better understanding of penile remodeling and how fibrosis occurs is essential for development of novel therapies for ED.

Disclosure
No.
(070) Androgen Status in Men and Risk Of COVID-19 Complications: An Analysis of United States Claims Data
Authors: Dolendo I , Patel D , Horns J , Nguyen V , Hsieh T , Pastuszak A , Hotaling J 
Published: February 2024

Abstract

Introduction
Biological males have had worse COVID-19 outcomes compared to females. Yet, the impact of hypogonadism (HG) on COVID complications remains unclear.

Objective
We sought to compare COVID complications in males with various androgen status (eugonadal, treated HG, untreated HG) to females to evaluate the effect of testosterone levels on COVID outcomes.

Methods
We used the IBM MarketScan database of commercial claims encounters to identify patients ages 18+ with a COVID diagnosis (n=756,855). We compared eugonadal males (no HG diagnosis), untreated HG males (HG diagnosis without therapy), treated HG males (HG diagnosis and testosterone prescription within 180 days before COVID diagnosis) to females. Rates of intensive care unit (ICU) admission co-occurring with initial COVID diagnosis were modeled using logistic regression. Acute respiratory distress syndrome (ARDS), acute respiratory failure (ARF), and use of critical care services (CCS) were modeled using Cox proportional hazards models. Outcomes were regressed against group, age, rurality, and Charlson Comorbidity Index.

Results
Eugonadal males (n=315,050) were at higher odds of ICU admission (OR: 1.611, 95% CI: 1.549-1.676), having ARDS (HR 1.766, CI: 1.670-1.868), having ARF (HR 1.609, CI: 1.575-1.644), and needing CCS (HR 1.696, CI: 1.652-1.742) compared to females. Treated HG males (n=2,343) and untreated HG males (n=22,614) were also more likely to experience all adverse outcomes compared to females. For untreated HG males the effect was less pronounced compared to eugonadal males and treated HG males for all outcomes (Figure 1). There were no differences in odds of all outcomes for castrate males (n=89) compared to females due to small sample size.

Conclusions
Eugonadal males, treated HG males, and untreated HG males were more likely to have adverse COVID outcomes compared to females. This effect was most pronounced for eugonadal and treated HG males compared to untreated HG males, suggesting normal androgen status is detrimental to COVID-19 outcomes. This is one of the largest studies to show a complex relationship between testosterone and COVID outcomes.

Disclosure
No.
(085) Long-Term Outcomes of Testosterone Replacement Therapy Delaying Biochemical Recurrence Post-RARP: Frequency-Matched Case-Control Study
Authors: Hammad MAM , Tran J , Nguyen MX , Gevorkyan R , Fung C , Yafi FA , Huynh LM , Ahlering T 
Published: February 2024

Abstract

Introduction
Testosterone Replacement Therapy (TRT) is known to improve functional and sexual outcomes in hypogonadal men. TRT historically has been contraindicated for the management of hypogonadism in men with prostate cancer (PC).

Objective
In 2020, we demonstrated in a cohort of 850 men that TRT reduced biochemical recurrence (BCR) by 50% (median follow-up 3.5 yrs.). The present study extends the follow up to 5.25 years

Methods
A retrospective review of prospectively collected data between December 2009 and June 2018 undergoing robotic radical prostatectomy by a single surgeon was conducted. 152 patients were administered TRT post-RP with a calculated free testosterone (cFT; below the 25%) and were frequency matched to 420 patients not receiving TRT with respect to pathological stage (p-stage) and Gleason Grade Group (GGG). Biochemical recurrence (BCR) was defined as two consecutive prostate specific antigen (PSA) blood tests &gt;0.2 ng/mL. An adjusted Kaplan-Meier (KM) graph was used to analyze rate and time to BCR.

Results
Baseline differences in demographics were observed in BMI (p = 0.006) and follow up time (p = 0.0023), and cFT (p = 0.0156). While overall BCR was not significantly different between the two groups, a difference was observed in time to recurrence. In adjusted KM analysis, patients with a higher calculated free testosterone were less likely to have a BCR (p = 0.05). In the same analysis, patients with a higher GGG, p-stage, and preoperative PSA (p &lt;0.01) were more likely to have a BCR. Patients receiving TRT had similar rates of BCR (p = 0.676). However, if they recurred, there was an average delay of 1.4 years.

Conclusions
TRT was observed to have a continuing protective effect in preventing and delaying BCR in patients post-RARP when compared to patients who did not receive TRT.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.