bluuebunny/crossref_metadata_2025_split huggingface dataset:
(414) Double Distal Fixation Stitch
Authors: Suarez-Sarmiento A , Ghomeshi A , Castillo M P , Levit B , Perito P 
Published: May 2023

Abstract

Introduction
Distal cylinder extrusion is not a common complication of penile prothesis surgery when compared to mechanical device failure but can have very serious complications if not addressed properly. Reported revision surgery for IPP implantation is more commonly required for cosmetic and erosion problems as opposed to mechanical failure. Complications such as distal crossovers, delayed distal crossovers, and impending lateral extrusion can be treated with a double distal fixation stitch. This technique addresses stabilization issues and keeps penile implant secure and in place.

Objective
We demonstrate the Double Distal Fixation Stitch for the meandering distal cylinder

Methods
62 y/o white male Hx of erectile dysfunction and Penile implant No significant past medical history Presents with pending left lateral cylinder extrusion Implant functional Patient underwent a corporoplasty and double distal fixation stich in order to ensure distal aspect of cylinder remains in place

Results
A lateral sub-coronal incision is used on the affected side where cylinder should be positioned. Dissection is carried through the Buck fascia, followed by a transverse incision of the tunica albuginea, where the distal aspect of the affected cylinder is delivered. Two 2-0 Ethibon sutures are threaded through the distal cylinder islet of the implant. A new, properly positioned intracorporal channel is created using a longitudinal capsulotomy and dilation with a 9 Hagar. Two 2-0 Ethibon sutures are passed through the distal islet of the implant cylinder. The first suture is passed through the glans with the cylinder in the native corpora position, a second suture is passed through about .25cm apart from first suture creating a small bridge. A small incision is made connecting the two suture exit sites. Both sutures are then tied down individually leaving one suture on each side to be tied across the bridge. The knots are then buried in the glans by elevating the skin and closing the skin with 3-0 chromic.

Conclusions
This technique ensured that the cylinder remained in the newly created, appropriately positioned channel. The double distal fixation stitch is safe and effective in securing the distal cylinder of an inflatable penile prosthesis and preventing recurrence. This technique is a useful surgical adjunct to treating patients with prosthetic lateral extrusions or crossovers that can be applied in almost all cases and can ensure distal stabilization of a migrating distal cylinder in weak tunica.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: coloplast, boston scientific.
(461) Health Insurance Coverage for Infertility in the United States
Authors: Sandozi A , Khurgin J 
Published: May 2023

Abstract

Introduction
As many as one in five heterosexual couples in the United States experience infertility. Medical advances can help resolve infertility, however access to treatment is often out-of-pocket and can be prohibitively expensive. State benchmark health insurance plans detail minimum coverage standards that all other state offerings must match with some exceptions.

Objective
The objective of this study was to evaluate differences in health insurance coverage for infertility.

Methods
The most recent state benchmark health insurance plans submitted to Centers for Medicare and Medicaid were examined. We identified provisions to cover or exclude treatment of infertility. A literature search was also performed to identify states with legislation relating to health insurance coverage for infertility.

Results
Data was available for all 50 states and the District of Columbia. Fifteen states had legislation requiring coverage of infertility benefits, and two states required employers to offer at least one such plan. In benchmark offerings, 19 states did not provide any minimum coverage for diagnosis or treatment of infertility. Twenty-five states offered some type of treatment, of which 9 covered treatments of underlying cause of infertility only (ie. Fibroids, ductal obstruction). Ten states offered coverage for prescription medications, 10 states offered coverage for artificial insemination, and six states provided coverage for assisted reproductive technologies such as in vitro fertilization. Only two states covered cryopreservation of ova, but only for patients actively undergoing treatment for infertility.

Conclusions
Diagnosis and treatment of infertility is not guaranteed to be covered by health insurance, and nearly half of states do not provide any minimum level of coverage in state benchmark plans. Health insurance coverage for the diagnosis and treatment of infertility is highly variable and continues to be a barrier faced by patients desiring to conceive.

Disclosure
No
(481) Experience with Plaque Excision and Dermal Grafting in the Surgical Treatment of Peyronie's Disease
Authors: Mai Ba Tien D , Dang Guang T 
Published: May 2023

Abstract

Introduction
Plaque incision and grafting (PIG) is indicated for men with complex or severe penile curvature, several surgical options to treat PD have been performed. Surgical treatment use graft, as these procedures aim to maintain penile length.

Objective
To assess outcomes following plaque excision and dermal grafting in the surgical treatment of Peyronie's disease.

Methods
A prospective study, was performed at Binh Dan Hospital (Ho Chi Minh City – VietNam), from 1/2016 – 12/2020. Surgical correction for curvature is indicated when the PD duration is &gt;12 months, and when the stable phase of PD is &gt;6 months, all case use plaque excision and dermal grafting technique.

Results
our study have 52 patients, - History illnes: 42.1% diabetes, 26.3% hypertension, 36.84% hyperlipid. - Age mean: 58.31 ± 8.5 years (min: 48 – max 72). - Chief complaine: penile deformities (36.8%), pain (31.6%), palpable lumps (26.3%). - 52.6% have psychological effects. - Fibrous plaque on corpus: Anterior (5.2%), Mid (47.37%), Posterior (47.37%). - Plaque size: 72.59 ± 75.78mm2 (15.51 mm2 – 207 mm2). + Primary outcome measures - Complications (follow one month): alter sensation (16.7%), edema (21.05%), infection (1.9%), pain (10.53%) - Penile straightening: 89%. - Penile length: no changes (82.7%), shorter (17.3%). + Secondary outcome measures - Recurrent curvature: 3 cases – 01 case need operation second time. - Post-operative erectile dysfunction: 7 cases (13.46%). - Patient satisfaction: 82.3%

Conclusions
Surgical correction of penile curvature is the mainstay for PD treatment. Dermal graft: effectiveness in terms of satisfaction, length change, straightening, economic efficiency and complications. Suitable for patients with underlying medical conditions. Adequate preoperative patient counseling.

Disclosure
No
(488) Pooled Outcomes from over 300 Controlled Subjects Reveal Improvements in Sexual Function and a Majority Shift to Lower IPSS Symptom Severity after Treatment with PUL
Authors: Eure G , Roehrborn C , Gange S , Chin P 
Published: May 2023

Abstract

Introduction
The Prostatic Urethral Lift (PUL) is the most thoroughly studied minimally invasive surgical therapy (MIST) for BPH with over 300 patients studied in a controlled trial setting.

Objective
In this combined analysis from 5 PUL controlled studies we examine the meta-effect of the procedure on outcomes including sexual function and the proportion of subjects who move from higher to lower IPSS symptom severity grades.

Methods
Five PUL controlled studies were utilized for the analysis, including L.I.F.T. (RCT: PUL vs Sham [n = 140]), Crossover (crossover of L.I.F.T. sham subjects [n = 51]), MedLift (single arm, subjects with OML [n = 45]), BPH6 (RCT; PUL vs TURP [n=44]), and LOCAL (Single arm, PUL under local anesthesia in office [n=51]]. Sexual function was evaluated with SHIM and MSHQ-EjD, as well as IPSS, QoL, Qmax at baseline and through 12M post-PUL. Post-op AEs, catheterization, surgical retreatment, BPH medication usage, IPSS severity level shift, and IPSS responder rate (≥3pt improvement from baseline) were examined through 12M.

Results
331 subjects were treated with PUL among the five studies and had largely similar baseline characteristics. 266 subjects were sexually active at baseline, and notable improvements were found in SHIM (13%, p&lt;0.01) and MSHQ-EjD (30%, p&lt;0.01) at 12mo. Post-PUL, mean IPSS improved at 1, 3, 6, and 12M at least 11.1 points from baseline (48.5%, p &lt;0.0001). QoL improved up to 52.8% (p &lt;0.0001) and Qmax was increased by at least 4.3 ml/sec (p &lt;0.0001). Most AEs were mild to moderate and resolved within 2 weeks. 33% (73/121) of void trial-tested subjects required catheterization (mean duration 3.7d). 15 subjects underwent surgical retreatment and 7 needed BPH medication through 12M post-PUL. 79% (261/331) of subjects were IPSS responders and 66% (219/331) moved into a lower IPSS severity grade (Table 1). Subjects who underwent a shift in symptom severity on average had lower baseline QoL (1.8 vs 3.1, p&lt;0.000), higher Qmax (13.3 vs 11.9, p&lt;0.05) and were treated with more implants (median 5 vs 4 implants, p&lt;0.01).

Conclusions
The largest analysis of PUL controlled subjects including over 300 men demonstrates the procedure provides significant improvement in IPSS symptom severity grades. Subjects who were sexually active experienced improvements in sexual function through 12 months.

Disclosure
Yes, this is sponsored by industry/sponsor: Neotract, Inc./Teleflex.

Clarification
Industry initiated, executed and funded study.
Any of the authors act as a consultant, employee or shareholder of an industry for: Neotract, Inc./Teleflex.
(493) Utilization of Intracavernosal Injection and Penile Ultrasound in the Evaluation of Erectile Dysfunction and Peyronie’s Disease
Authors: Ebbott D , Prebay Z , Li M , Chung P 
Published: May 2023

Abstract

Introduction
Intracavernosal injections (ICI) and penile duplex Doppler ultrasound (DDUS) play a diagnostic role for patients with erectile dysfunction (ED) and Peyronie’s disease (PD). They can help to identify vascular and anatomical changes that may guide medical and surgical management; however, contemporary utilization rates of ICI and penile DDUS have not recently been described. Here we use a multicenter database to determine utilization of ICI and penile DDUS in patients with ED and PD.

Objective
To evaluate the rates of ICI and penile DDUS in patients with ED and PD using a global database.

Methods
TriNetX is a research network of real-time data from 58 Healthcare Organizations globally. Using the International Classification of Diseases Tenth Edition (ICD-10) codes, we queried the network for adult men with ED (N52) being medically treated with phosphodiesterase (PDE)-5 inhibitors from 2002 - 2022. This included sildenafil, tadalafil, vardenafil, and avanafil. Current Procedural Technology (CPT) codes were utilized to identify patients who received penile DDUS (93980, 93981) and penile prosthesis (54400, 54401, 54405). ICD-10 codes were utilized to query the network for those with PD (N48.6) from 2002 – 2022. We then used CPT codes to search within this cohort for those who had ICI (54235) excluding patients that also had penile DDUS (93980, 93981). We separately queried for patients that had penile DDUS (93980, 93981). Finally, we queried for patient who received either evaluation method and had injection therapy (54200), penile plication (54360), or plaque excision +/− grafting (PEG) (54110, 54111, 54112). The analysis was run on June 30, 2022.

Results
The cohort with ED on a PDE-5 inhibitor in the TriNetX database included 613,323 patients. The cohort had a mean age of 63 +/− 13 years and racial demographics of 18% black and 70% white. 8,540 patients (1.4%) had a penile DDUS and 868 (0.1%) went on to penile prosthesis (Figure 1A). A second study cohort included 46,743 patients with Peyronie’s disease with a mean age of 62 +/− 13 years and racial demographics of 8% black and 73% white. ICI was performed in 2,960 (6.3%) PD patients: 568 (1.2%) then underwent injection therapy, 1,128 (2.4%) penile plication, and 142 (0.3%) PEG (Figure 1B). Penile DDUS was performed in 4,972 (10.7%) patients with PD: 955 (2.0%) then underwent injection treatment, 474 (1.0%) penile plication, and 255 (0.5%) PEG (Figure 1B).

Conclusions
For ED, penile DDUS is used in a low percentage of evaluations. For PD, penile DDUS is used more commonly than ICI only. After evaluation with penile DDUS, the most common therapy is injection. After an evaluation with ICI only, the most common therapy is penile plication.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast.
(523) Changes in Testosterone Levels in Patients with Erectile Function
Authors: Corredor H , Benites J , Sandoval C , Laborda E 
Published: May 2023

Abstract

Introduction
Erectile dysfunction (ED) is a disease that affects approximately 20% of adult men. Androgen deficiency is one of the organic etiologies described for this sexual dysfunction.

Objective
To estimate the frequency of alterations in the sex hormone binding globuline (SHBG), total testosterone (TT), calculated free (FT) and bioavailable testosterone (BT) in Spanish men with a clinical diagnosis of erectile dysfunction in Madrid, Spain.

Patients and methods
Cross-sectional study. Men over 18 years of age with a clinical diagnosis of erectile dysfunction and a score in the international index of erectile function (IIEF-EF) &lt; 26 were included. Serum levels of SHBG, TT, TL and TB were evaluated and the proportion of men was estimated. with hormonal alterations defined as: a) serum levels &lt;2.49 ng/mL of TT in men under 50 years and &lt;1.93 ng/mL in men of 50 years or older; b) TL for calculated value &lt;2% of total testosterone; c) TB for calculated value &lt;40% of total testosterone; d) serum SHBG levels &gt;54.1 nmol/L in men younger than 50 years and &gt;76.7 nmol/L in men 50 years and older.

Results
30 subjects participated in the study. The mean age was 50.6 years (+/− 13.2), the median scores for IIEF-EF, Erection Hardness Score (EHS) and Aging Male Symptoms Score (AMS) were 15 (range 1-24), 2 (range 1-3) and 29.5 (range 11-62) respectively. 6 patients (20%) had severe erectile dysfunction, 13 (43.3%) moderate, 8 (26.7%) mild to moderate, and 3 (10%) mild erectile dysfunction. The mean TT was 4.94 ng/mL (+/− 1.91), FT 1.94% (+/− 0.605), BT 45.6% (+/− 14.2), and SHBG 33.3 nmol/L ( +/− 14.5). Only 6.7% of the patients (n=2) presented alterations of the TT, while in 60% (n=18) an alteration of the FT was found, in 36.7% (n=11) an alteration of the BT and in 3.3% (n=1) SHBG alterations, alterations being more frequent in men with moderate ED.

Conclusions
Our study found alterations in total testosterone in a small percentage of patients with ED, however the alterations in Free Testosterone calculated turned out to be much higher. This study suggests that future research should be carried out to identify a relationship between changes in calculated free testosterone levels and the presence of erectile dysfunction.

Disclosure
No
(532) An Innovative Combination of Penile Corporeal Girth Enhancement and Erection Restoration
Authors: Hsu G 
Published: May 2023

Abstract

Introduction
It has been controversial in penile venous surgery for erection restoration and penile enhancement across three centuries thus far.

Objective
Based on the De Novo penile fibro-vascular assembly, we report an anatomy-physiology-based combination of a physiological penile corporeal diameter expansion and erection restoration surgery in recent decades.

Methods
From 2012 to 2022, intractable impotence and subjective micropenis prompted 23 men to seek penile venous stripping (PVS) and factual penile enhancement (TPE). All patients received dual cavernosography demonstrating penile venous anatomy and veno-occlusive dysfunction. PVS entailed the venous stripping of one deep dorsal vein and two cavernosal veins after every emissary's vein was double ligated 0.3 cm apart closest to the outer tunica with a 6-0 nylon suture. In addition, the para-arterial veins were just segmentally ligated. In TPE, a longitudinal incision was performed bilaterally over 3 and 9 O'clock positions along the pendulous penis. Every tunic defect was then water-tight sutures with a 7x3 cm rectangle venous stripe as an inner tunica bilaterally, subsequently covered with a piece of 7x3 venous wall, fascia tense lata, or a controlled tissue integration material sheet for surrogating the outer layer bilaterally. On penile girth and glans penis, the diameter was measured preoperatively and postoperatively in six months when a cavernosography was conducted, if available. Radio-opacity was used to compare the femoral cortex and the penile crus on preoperative and postoperative cavernosography. Additionally, the abridged 5-item version of the International Index of Erectile Function (IIEF-5) score system and the erection hardness scale (EHS) was used to confirm improvement preoperatively and postoperative follow-up yearly either by telephone or INTERNET.

Results
The average follow-up period was 5.3±0.8 years. The operation time was 7.2±1.8 hours. The material of outer patches was fascia tense lata (n=3), Surgifrom (n=6), penile vein (n=8), internal spermatic vein (n=3), and cephalic vein (n=3). The radiopacity was unexceptionally enhanced postoperatively. It was a significant difference between the preoperative and postoperative IIEF-5scores (9.7±2.8 vs. 20.8±2.3; P&lt;0.01). The EHS improved at least one scale. The diameter of the glans and distal penile shaft is increased from 2.78±0.33 cm and 3.41±0.41 cm (n=18) to 2.98±0.32 cm and 3.49±0.31 cm, respectively. Although the satisfaction rate is only 70.0% (16/23), the intracorporeal retention and erection quality improvement were unexceptional.

Conclusions
This novel combination strategy of factorial penile enhancement and erection restoration is feasible. However, it requires a more significant sample size and longer-term follow; the surgery technology is conspicuously challenging.

Disclosure
No
(535) A Novel Approach for Penile Venous Stripping Surgery and Bilateral Varicocelectomy on an Ambulatory Basis
Authors: Hsu G , Chang Y , Chang C 
Published: May 2023

Abstract

Introduction
There are varied approaches for conducting varicocelectomy and penile venous surgery, which are not unified or conspicuously, being not above controversy in the later type either in methodology or routes for accessibility thus far.

Objective
We sought to present this innovative method in a novel combination of a physiological penile venous stripping and bilateral varicocelectomy via a single longitudinal pubic wound on an ambulatory basis.

Methods
From July 2012 to December 2021, 63 consecutive patients underwent this combined surgery. Primary diagnosis tools are dual cavernosography and doppler sonography. A 4-5cm longitudinal pubic incision is two-thirds above the penile pubic fold. A blunt dissection maneuver using a hemostat or finger creates a space between the Colles' and Buck's fascia. The entire penis is then released with an inside-out maneuver resulting in Buck's fascia being exposed exclusively, followed by firmed ligation of every emissary vein of the corpora cavernosa via 6-7 open-to-open schemes on Buck's fascia, subsequently stripping of the deep dorsal vein (DDV) and paired cavernosal veins (CVs). In contrast, the para-arterial veins are just ligated segmentally. Reduction of the penis is made after Buck's openings are repaired with not too tight square knots with 6-0 nylon. The stripping of the DDV and CVs is completed after 125-137 ligatures until the infra-pubic angle. Finally, the spermatic cord is hooked below the inguinal canal outlet level. On each side of the varicocele, ligation of 8-11 spermatic veins is macroscopically performed at no expense of ruining all other tissues, even the fragile lymphatic vessel. Then meticulous repair is obtained layer by layer. This novel approach is likely the most appropriate method for making a milking maneuver which is helpful in vascular differentiation on both corpora cavernosa and pampiniform plexus during the entire procedure to prevent residual veins from offensive.

Results
The average follow-up period is 5.3±0.5 years. There is a significant (9.6±2.7 vs. 20.9±2.3; P&lt;0.01) between the preoperative and postoperative IIEF-5 scores. So does the EHS scale (1.6±0.3 vs. 2.9±0.3; P&lt;0.01) between the preoperative and postoperative status. The radiopacity was unexceptionally enhanced postoperatively. Although the intracorporeal retention and erection quality improvement were unexceptional, the satisfaction rate is just 71.4% (45/63). Penile length resumed 3.5 months postoperatively, although two patients initially complained about 1-2 cm postoperative shortage.

Conclusions
From the physiology viewpoint, we would like to recommend this promising method with which the shortcut to express.

Disclosure
No
SEPPA-mAb: spatial epitope prediction of protein antigens for mAbs
Authors: Qiu Tianyi , Zhang Lu , Chen Zikun , Wang Yuan , Mao Tiantian , Wang Caicui , Cun Yewei , Zheng Genhui , Yan Deyu , Zhou Mengdi , Tang Kailin , Cao Zhiwei 
Published: May 2023

Abstract
Identifying the exact epitope positions for a monoclonal antibody (mAb) is of critical importance yet highly challenging to the Ab design of biomedical research. Based on previous versions of SEPPA 3.0, we present SEPPA-mAb for the above purpose with high accuracy and low false positive rate (FPR), suitable for both experimental and modelled structures. In practice, SEPPA-mAb appended a fingerprints-based patch model to SEPPA 3.0, considering the structural and physic-chemical complementarity between a possible epitope patch and the complementarity-determining region of mAb and trained on 860 representative antigen-antibody complexes. On independent testing of 193 antigen-antibody pairs, SEPPA-mAb achieved an accuracy of 0.873 with an FPR of 0.097 in classifying epitope and non-epitope residues under the default threshold, while docking-based methods gave the best AUC of 0.691, and the top epitope prediction tool gave AUC of 0.730 with balanced accuracy of 0.635. A study on 36 independent HIV glycoproteins displayed a high accuracy of 0.918 and a low FPR of 0.058. Further testing illustrated outstanding robustness on new antigens and modelled antibodies. Being the first online tool predicting mAb-specific epitopes, SEPPA-mAb may help to discover new epitopes and design better mAbs for therapeutic and diagnostic purposes. SEPPA-mAb can be accessed at http://www.badd-cao.net/seppa-mab/.
Faith, Migration, and Trauma
Authors: Lynch Gordon 
Published: May 2023

Abstract
This chapter reviews religious involvement in UK child migration programs—particularly in the post-war period—with particular attention to how this work harmed children in their care. The UK child migration programs can also be understood as part of wider nation-building projects in Commonwealth countries that also included native assimilationist policies, including the removal of children from Indigenous communities in Australia and Canada. It is helpful to reflect on what this case study suggests about how religion and migration can intersect in ways that can harm vulnerable people. Such harm can arise not only through the ideas, assumptions, and practices of individual religious actors or organizations, but as a consequence of wider organizational and policy contexts as well. In a number of important respects, British child migrants were harmed because of an over-complex and fragmented system of governance, in which children were insufficiently protected from the competing interests of government departments and voluntary societies. The chapter then illustrates how the internal cultures of religious organizations also contribute to these harms. For those religious organizations involved in the UK child migration programs, their work was always underpinned with a sense of spiritual and moral legitimacy that proved resistant to critiques made of it at the time.