bluuebunny/crossref_metadata_2025_split huggingface dataset:
(323) Mechanistic Insights into a Rare Genetic Cause of COVID Orchitis
Authors: Ramsoomair C , Seetharam D , Moorthy B , Zhang F , Ramasamy R 
Published: May 2023

Abstract

Introduction
To date, biomedical efforts against the SARS-CoV-2 virus have mainly focused on mitigating spread and primary infection mortality. While significant strides have been made in community response and vaccine production, post-acute COVID-19 syndromes (Long COVID) are growing in prevalence and becoming an increasing burden on public health. Current evidence suggests COVID-19 can affect the testis and cases of orchitis (testicular pain) appear to present in up to 20% of men with COVID-19. With an aim of uncovering causal mechanisms of COVID-19 sequela outside of pulmonary symptomology, a recent study from our group has identified a nonsynonymous non-frameshift mutation in the NACAD protein associated with COVID-19 orchitis and decreased ACE2 serum levels. NACAD is thought to prevent inappropriate targeting of non-secreted peptides to the endoplasmic reticulum.

Objective
We hypothesized that a defect in NACAD function/processing will decrease ACE2 serum levels by disrupting extracellular transport and endoplasmic reticulum interaction. We explored whether intracellular levels of ACE2 as well as TMPRSS2 were altered and if cell membrane protein deposition was increased, which may result in more severe effects to SARS-CoV-2 infection.

Methods
We obtained testis biopsies from men undergoing sperm retrieval for infertility. After siRNA NACAD knockdown, we analyzed total ACE2 expression using Western blot and qPCR as well as immunofluorescence/H&E staining for colocalization (with NACAD). Membrane-anchored ACE2 (mACE2) levels were quantified using immunostaining and flowcytometry while secreted ACE2 (sACE2) was analyzed by ELISA and Western blot.

Results
NACAD and ACE2 co-localize in both the Leydig and germ cells. When NACAD is knocked down, primary testes cells show 80% decreased mRNA and 50% total protein levels of ACE2. The secreted ACE2 was also reduced by nearly 50%. However, when we specifically measured the level of mACE2 on the cell surface, we found that the knockdown of NACAD did not lead to reduction.

Conclusions
NACAD likely specifically affects the level of sACE2, which is speculated to act as a protection factor by retaining the virus in serum and reducing cellular entry. While the exact reason for the differential effects of NACAD on mACE2 and sACE2 remain unclear, our data is consistent to other studies, which found a reduction of total ACE2 expression and sACE2 in patients is coupled with worse outcomes in COVID-19. We hope that establishing a relationship between NACAD and ACE2 expression will prove useful not only to elucidate why some men with COVID develop orchitis but, ultimately, why some men develop multiorgan failure with COVID infection whereas most do not.

Disclosure
No
(372) Does Age Predict the Difference in Morning vs Afternoon Testosterone Levels?
Authors: Flores J , Benfante N , Schofield E , Katz D J , Bryson C F , Jamzadeh A E , Nelson C J , Mulhall J P 
Published: May 2023

Abstract

Introduction
It is recommended that serum testosterone (T) level measurement be conducted in the early morning (AM) as T levels decrease in the afternoon (PM) due to the circadian rhythm in T secretion. This rhythm is reported to be blunted in older men.

Objective
This study aimed to define the magnitude and direction of the changes between morning and afternoon T levels across age groups.

Methods
The study population included men who had both AM (before 10 am) and PM (after 2 pm) total T (TT) levels within 3 months of each other. All TT measurements were performed using LCMS. We excluded patients with a prior orchiectomy, with T levels 1000 ng/dL, those with a history of androgen deprivation therapy, and patients on T therapy. Differences in AM and PM TT levels were quantified and stratified by age continuously. We reported the directionality of the changes based on increases or the decreases in T levels between AM vs PM. No difference was defined as a delta T levels between -100 to + 100 ng/dL, changes increasing or decreasing as &gt;100 ng/dL. Correlation of TT difference between AM vs PM levels and age was calculated.

Results
506 men were analyzed. Mean age = 63 ± 12 years. Mean of AM and PM TT levels were 425 ± 164 ng/dL and 397 ± 155 ng/dL, respectively (p &lt; 0.001). While 63% of men had no significant difference (-100 to +100) between AM and PM levels, 24% had a &gt; 100 ng/dl decrease, 13% &gt; 100 ng/dl increase. Overall, 13% had higher PM and 24% lower PM TT levels. Neither AM nor PM TT levels were significantly associated with age. Age was weakly negatively correlated with the change between AM and PM levels (r = 0.10, p = 0.03). That is, the mean difference between AM and PM levels was more pronounced for lower ages and approached zero as age increased.

Conclusions
While age was not associated with mean AM or PM total T levels, this study did find differences in the magnitude of the difference by age.

Disclosure
No
(375) Can Tamoxifen and a PDE5 inhibitor slow the progression of Peyronie’s Disease?
Authors: Megson M , Merrett C , Cellek S , Ralph D 
Published: May 2023

Abstract

Introduction
The available treatments for Peyronie’s Disease as recommended by international guidelines are either surgery or intralesional injection therapy. In recently cell and rat studies it has been shown that using a phosophdiesterase type 5 inhibitor (PDE5i) and a selective oestrogen receptor modulator (Tamoxifen) inhibited myofibroblast transformation and extracellular matrix production.

Objective
The aim of this study is to compare the combination of tamoxifen and a PDE5i versus no treatment or other oral medications in the progression of early Peyronie’s Disease.

Methods
This is a retrospective study of all patients with early Peyronie’s Disease, defined as less than 6 months duration or persistent pain presenting over a 3-year period. Patients were given Tamoxifen 20mg twice daily + Tadalafil 5mg daily for 2 months. The control group either received no treatment or simple oral medication such as Vitamin E. Data retrieved included demographics, duration of disease, change in curvature and pain, as well as further treatment modalities. Assessment of curvature was with photos or an artificial erection test. Data was analysed using the Mann-Whitney Test.

Results
A total of 147 patients were recruited with early Peyronie’s Disease, 102 patients given the active drug combination (median age 49, range 24-71) and 45 controls (median age 55, range 27-76). The results in each group are presented in Table 1. Overall, the patients on Tamoxifen and Tadalafil showed more improvement and less deterioration which was statistically significant (p=0.009)

Conclusions
The combination of Tamoxifen and Tadalafil has been shown to prevent the progression of Peyronie’s Disease in vitro and in this study in patients with early disease. Future prospective studies are warranted to confirm this finding.

Disclosure
No
(380) “Setting the Mood: Improving the Experience for Male Patients during Penile Assessment”
Authors: Tentis E , Ziegelmann M , Kohler T , Helo S , Nelson K , Carlson S 
Published: May 2023

Abstract

Introduction
Penile duplex Doppler ultrasound (PDDU) is an important test to diagnose and guide treatment recommendations for peyronie’s Disease and erectile dysfunction. When patients do not achieve optimal rigidity during their evaluation we may be underestimating their degree of curvature and erection response which can impact treatment recommendations.

Objective
To evaluate specific examination conditions that may negatively impact the patient experience in men undergoing PDDU.

Methods
We developed a survey to evaluate patient experience during PDDU. Specific questions addressed preferences regarding the type of clinician performing the examination (physician versus advanced practice provider), provider gender, and specific modifiable conditions about the examination room. The survey was administered to thirty-five consecutive patients at a single academic practice. Patients were asked to complete portions of the survey before and after the examination to limit bias.

Results
113 patients completed the survey. Prior to starting the testing, 48% of patients (n=54) had no provider preference, whereas 43% (n=49) preferred a physician as the performing clinician. 70% of patients (n=79) had no provider gender preference. All patients received at least a single dose of intracavernosal erectogenic medication at the start of their assessment. After completing PDDU, 40% of patients (n=45) reported that room conditions negatively impacted their ability achieve an adequate erectile response in the clinic. As shown in Figure 1, bright fluorescent overhead lighting (29%) and hallway noise (21%) were the most frequent contributing factors. When asked about opportunities to improve future patient experience, 38% (n=43) recommended dimming the room lights, 31% (n=35) would enjoy a warm blanket, and 36% (n=41) would favor gentle music or background sounds. 32% (n=36) felt that using call button, as opposed to routine staff checks to verify erectile response, would be desirable. Despite these preferences, the mean overall patient experience on a scale of 0-10 (0=poor, 10=excellent) was high at 9.3 (SD 1.2).

Conclusions
Despite high patient-reported satisfaction, we found that patients undergoing PDDU for PD and ED reported a preference towards (i) softer/dimmer lights, (ii) sound machine to drown out hallway noise, (iii) aa warm blanket, (iv) a call system to alert staff of a satisfactory erectile response. Further investigations are necessary to determine whether these simple modifications can improve the patient experience and exam efficiency.

Disclosure
No
(387) Evaluating Bias Against Prostate Cancer Survivors in Clinical Trials for Erectile Dysfunction
Authors: Gu C , Berk B , Ernandez J , Kathrins M 
Published: May 2023

Abstract

Introduction
Approximately 250,000 men are diagnosed with prostate cancer every year in the United States with 90,000 radical prostatectomies (RP) performed yearly. Erectile dysfunction (ED) is a common side effect following prostate cancer therapies. The estimated incidence of erectile dysfunction (ED) varies in the literature after RP, however some studies have reported percentages as high as 75%. It is unclear whether there is exclusion bias among clinical trials evaluating erectile dysfunction therapies against prostate cancer survivors. We were interested to determine if clinical trials for ED had specific criteria that would exclude prostate cancer survivors.

Objective
To investigate how previous and current clinical trials evaluating ED interventions exclude prostate cancer survivors from enrollment.

Methods
We reviewed all registered trials under the category of “Erectile Dysfunction” on the website “clinicaltrials.gov”. Studies were excluded if an intervention for ED was not tested or if evaluation of ED was not a primary outcome. Exclusion criteria were examined for radical prostatectomy, androgen deprivation, pelvic radiotherapy for prostate cancer, or a history of prostate cancer whether treated or not.

Results
A total of n = 545 trials were reviewed. 169 trials were excluded because the primary end point did not assess ED outcomes. Thus, 376 trials were analyzed further for relevant exclusion criteria. Of the 376 trials, 48 (12.8%) were specifically for patients undergoing or status post radical prostatectomy, 8 (2.1%) for post-radiation prostate cancer survivors, 1 (0.3%) for after any intervention for prostate cancer including radical prostatectomy, radiation, and hormonal therapy, and 1 (0.3%) was for men with prostate cancer more generally. Among the 317 studies not specifically for prostate cancer survivors, 126 (39.7%) studies specifically excluded patients who had undergone RP and 167 trials (52.7%) had at least one exclusion criteria pertaining to prostate cancer history or treatment. 150 trials (47.3%) had no exclusions regarding prostate cancer interventions. A chi-square test of independence was performed to examine the relationship between exclusion criteria for prostate cancer history/therapies and intervention type. The relation between these variable was significant, χ2(7, N=317)=37.33, p=0.00. Prostate cancer related exclusions were more likely to be present than no-prostate cancer related exclusions among the examined trials not specifically designed for prostate survivors.

Conclusions
While erectile dysfunction is a common problem for prostate cancer survivors, over half of registered general erectile dysfunction intervention trials exclude patients with prostate cancer or who have had a therapeutic intervention for prostate cancer. Almost half of these clinical trials specifically exclude patients who have had a radical prostatectomy.

Disclosure
No
(416) Clinical Characteristics of Men with Sexual Dysfunction Visiting an Andrology Clinic: A Single-Center Study in Saudi Arabia
Authors: Assaggaf H , Muawad R , Qasem A , Koujan M , Alsaif B , Aldairi A F , Minshawi F , Alwafi H 
Published: May 2023

Abstract

Introduction
Previous studies that investigated the clinical characteristics of sexual dysfunction in men in Saudi Arabia are limited. This study aimed to explore the clinical characteristics of sexual dysfunction in men visiting an andrology clinic in Saudi Arabia.

Objective
This study aimed to explore the clinical characteristics of sexual dysfunction in men visiting an andrology clinic in Saudi Arabia.

Methods
This study is a retrospective single-center cross-sectional study. A random sampling method was used to recruit participants between March and September 2019. Descriptive statistics were used to describe patients’ characteristics. Continuous data were reported as mean ± SD. Chi-squared and multiple logistic regression were used to find the associations between patient's age (older and younger than 50 years) and clinical characteristics of the participants.

Results
In total, 21.3% participants had diabetes and 9.5% had hypertension. More younger males suffered from sexual problems (69.8%) compared to older males (30.2%). Also, 37.5% participants were overweight, while 25.3% had class I obesity. Most participants had normal follicle stimulating hormone, prolactin, testosterone, luteinizing hormone, and prostate specific antigen levels. Approximately 69.5% had vitamin D insufficiency. Among those older than 50 years, 80.2% had diabetes (P &lt; 0.05). Younger smokers accounted for 79% of the population, with a significant association between patient's age and smoking status (P &lt; 0.05). Patients younger than 50 years with normal A1C levels had a 2.5 times higher risk of having sexual problems (P &lt; 0.00, confidence interval 1.63–3.91).

Conclusions
MSD may be considered to be caused by other nonorganic problems. There is a significant need to increase Saudi men's awareness of sexual medicine.

Disclosure
No
(422) Sexual Function of 18-50 Year Old Women With Normal Weight, Overweight and Obese
Authors: Castiglione M , Silva Cardoso E , De Avila V A , Maas Soldi N , Marques Nicastro D , Moura Rodrigues S , Benetti F , Da Silva Paiva L , Glina S 
Published: May 2023

Abstract

Introduction
Female sexual dysfunctions (FSD) can influence mental and physical health, causing limitations in the ability to respond to or enjoy sexual pleasure. Obesity is related to diseases such as type II diabetes, heart disease and some types of cancer, for example, but investigations into its relationship with problems related to sexuality have not yet been well defined. of FSD, but the evidence found, including in this study, is still contradictory

Objective
To investigate and compare the sexual function of, obese, overweight and normal weight 18 to 50 year old women.

Materials and methods
This study was carried out between June 2020 and October 2021, it is observational and comparative. A questionnaire link was sent via social networks, social networks like facebook, whatsapp and also email, to women between 18 and 50 years old, sexually active in the last four weeks before answering the questionnaire, after having agreed to participate in the study and signed the consent form, they filled out a form with demographic data and the questionnaire Female Sexual Function Index (FSFI), postmenopausal women were excluded from the survey. This study was approved by the ethics and research committee under opinion number: 4.229.411.

Results
325 women participated in the study, with a mean age of 28 years, where 186 (49.60%) were classified according to the body mass index (BMI) with normal weight, 109 with overweight (29.07%) and 80 as obese (21.33% most were married or in a stable relationship (50.13%) or single (42.93%). In the total score of the FSFI questionnaire (median), non-obese participants obtained 16.4 points, overweight women scored 16.4 points and obese women scored 17.1 points, it was not statistically significant when comparing the FSD according to the BMI classification (p=0.887).

Conclusions
There was no difference in the assessment of sexual function between normal weight, overweight and obese women aged 18 and 50 years.

Disclosure
No
(447) Use of Audio Recordings in the Consultation of Patients Seeking Gender-Affirming Surgery
Authors: Smith S , Stelmar J , Lee G , Garcia M 
Published: May 2023

Abstract

Introduction
It has been demonstrated that patient memory for medical information is often poor and inaccurate. Providing patients with an audio recording of their consultation has been shown to increase patient recall of information, improves confidence in their treatment decisions, and decreases decision regret. Patients have also reported increased satisfaction with their treatment, felt more involved in their decision making, and reported an improved relationship with the health professional.

Objective
The use of audio recordings has primarily been investigated in the setting of oncologic consultation and has been described in other patient settings as well; however, to our knowledge this is the first reported use of audio recordings in consultation for gender-affirming surgery.

Methods
We conducted a pilot study and began offering all new patients the opportunity to have their consultations recorded. 100% of the patients who were given the option to have the consultation recorded chose to do so. At the end of the consultation the recording was uploaded to a USB, which was either given to the patient to take home immediately or was mailed to their home address within a few days of their consultation. A copy of each consultation was retained by the providers as a record. We then sent out a survey to all patients who had received a copy of their audio consultation to query the utility of having access to an audio recording of their consultation.

Results
15/27 patients who had their consultation recorded responded to our survey (6 transfeminine and 9 transmasculine). Mean age was 30.4. One patient reported they did not receive their recording in the mail, leaving 14 respondents to answer questions about the audio. Survey responses are shown in Table 1.

Conclusions
In our series, patients reported that having access to an audio recording of their consultation was beneficial and was viewed overwhelmingly positively. To our knowledge, this is the first study examining the use of audio recordings in the surgical consultation process for patients seeking genital gender-affirming surgery.

Disclosure
No
(456) Development of Erectile Dysfunction in Men Treated for Major Depressive Disorder with Selective Serotonin Reuptake Inhibitors: A Systematic Review
Authors: Alhuwaydi A 
Published: May 2023

Abstract

Introduction
Sexual dysfunction (SD) is known to be associated with selective serotonin reuptake inhibitors (SSRIs).

Objective
To determine the effect of different SSRIs on SD development in males, particularly erectile dysfunction (ED), a systematic review was conducted according to PRISMA guidelines.

Methods
Literature, in English language, published between January 2009 and September 2019 was searched using two electronic databases, PubMed and EMBASE. Studies were screened according to the predefined inclusion-exclusion criteria. The bibliographies of the included articles were screened to identify any relevant articles.

Results
A total of ten articles were included (8/811 articles searched; two from bibliographies of eight included articles). Treatment-emergent SD, particularly ED was observed in male participants, although the ED incidence was low, less than 2%. SSRIs – fluoxetine, escitalopram, and citalopram – showed a higher risk of ED than other SSRIs.

Conclusions
The findings indicated a positive association between SSRIs and SD. However, evidence supporting a strong link between SSRIs and ED was insufficient.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: jouf university, Saudi arabia.
(460) A Case Series on Vulvovaginal Obliteration
Authors: Dominguez-Bali A , Bailey N , Callihan K , Dominguez-Bali C , Nani J 
Published: May 2023

Abstract

Introduction
Between Dec. 2018 & June 2020, 5 cases of Vulvovaginal Obliteration, also known as Labial Adhesion were diagnosed, evaluated and treated. All of the presenting cases had a history which shared certain features, including more than 2 decades without sexual activity, no history of masturbation, no use of hormone replacement therapy and chronic urinary tract symptoms. The most severe case had the longest period without vaginal penetration (&gt;30years). In 3 of the 5 cases the patients didn't have a partner, while the other 2 patients were not sexually active with their partner in any way.

Objective
To add new cases to the literature about this rarely described disorder. To show this condition is one of the most extreme consequences of Genitourinary Syndrome of Menopause. To demonstrate the importance of vaginal penetration and hormone replacement therapy (HRT) to prevent postmenopausal labial adhesion.

Methods
This is a case series reviewing the effective management of labial adhesion in post-menopausal women.

Results
In 2 of the cases the patients main complaint was their inability to urinate due to obstruction of the urethral outlet by the fused labia. This obstruction caused urocolpos, extremely distended urinary bladder, megaloureters, & bilateral hydronephrosis. Leakage of urine also occurred at the posterior fourchette. All of these urinary symptoms disappeared after an urgent introital incision was performed in the OR. In both cases the exclusive use of local estrogens postoperatively failed to prevent recurrent closure. Only the combined use of local estrogens and the regular use of dilators (3-4 times/day/2 weeks, then 1-2 times /day/2 weeks, then PRN) prevented recurrence. In 3 of the 5 cases, regular use of the dilators caused them to reach orgasm for the first time in their lives. The ages of these women were between 76 & 92 years old. The last 2, and more mild cases had 50% labial fusion, without urinary retention. The use of progressively increasing sizes of dilators and estrogen cream resolved the problem without surgical interventions.

Conclusions
Labial adhesion is one of the worst consequences of GSM, due to progression towards urinary retention. It is caused by insufficient maintenance of sexual activity after menopause, combined with lack of prevention with HRT, and is successfully managed with surgery, dilators and topical estrogens.

Disclosure
No