Factors Impacting Postoperative Opioid Use Among Patients Undergoing Implantation of Inflatable Penile Prosthesis.

BACKGROUND: While there is an increasing burden of chronic postoperative opioid use and opioid abuse in the United States, opioid use following inflatable penile prosthesis (IPP) surgery has not been well described. AIM: Describe postoperative opioid use following IPP surgery. METHODS: Seventy-four consecutive patients undergoing IPP implantation by a single surgeon were enrolled. Self-reported diaries tracked the type and amount of medication taken for 2 weeks following IPP surgery. High opioid consumers were defined as those consuming more than the median amount (10 mg) of opioids during the first 2 weeks postoperatively. Multivariate analyses were performed using stepwise backward elimination. OUTCOMES: Quantification of opioid use postoperatively and factors related to high opioid use. RESULTS: Fifty-six patients were included after 7 were excluded for preoperative opioid use and 11 were excluded for inability to contact. Median age was 67.5. Devices used were Boston Scientific (41, 73%) and Coloplast (15, 27%). All patients received local anesthetic. Most surgeries (44, 79%) were performed as outpatient. Preoperative analgesia with acetaminophen, celecoxib, and pregabalin was administered in 44 (78%), 44 (78%), and 28 (50%) of cases respectively; 32 (57%) of patients received 2 medications, 21 (36%) received three medications. In hospital median morphine equivalents was 7.5 (interquartile range [IQR] 0-7.5). Oxycodone prescribed at discharge was 50 mg (29, 52%), 75 mg (4; 7%), and 100 mg (23; 41%). Median milligrams of oxycodone used was 10 mg (IQR 0-23.5) at 7 days and 10 (IQR 0-37.5) at 14 days postdischarge. On univariate analysis, factors associated with an increased likelihood of high opioid use were morphine equivalents utilized in hospital (odds ratio [OR] 1.13, P < .05) and milligrams oxycodone prescribed at discharge (OR 1.05, P < .001) while patient demographics, procedure characteristics, and analgesic types were not found to be predictive of high opioid use. On multivariate analysis, milligrams oxycodone prescribed at discharge (OR 1.04, P < .005) were associated with an increased likelihood of high opioid use after discharge. CLINICAL IMPLICATIONS: Increased understanding of opioid use after IPP surgery may improve prescribing patterns after discharge. STRENGTHS & LIMITATIONS: This study quantified post discharge opioid use over the first 14 postoperative days. It is limited by single surgeon, small sample size, and retrospective design. CONCLUSION: Provider opioid prescribing patterns were associated with high opioid consumption postoperatively and a substantial amount of opioids prescribed at discharge remain unused by patients, suggesting that we can reduce or replace the amount of opioids that are prescribed. Ehlers ME, Mohan CS, Akerman JP, et al. Factors Impacting Postoperative Opioid Use Among Patients Undergoing Implantation of Inflatable Penile Prosthesis. J Sex Med 2021;18:1915-1920.

Poor allograft outcome in Indian patients with post-transplant C3 glomerulopathy.

BACKGROUND: Complement 3 glomerulopathy (C3G) results from dysfunction of the alternative complement pathway (ACP). No data are available on post-transplant C3G in South Asia. METHODS: In this study, renal allograft biopsies of C3G patients performed from 2012 to 2017 were analysed for ACP functional assay (APFA), serum complement levels, complement factor H (CFH), complement factor B (CFB) and autoantibodies to CFH and CFB. Limited genetic screening for CFH/CFHR5 genes was carried out. All study patients were also followed up. RESULTS: A total of 21 cases of C3G were included, of which 11 had native C3G disease (that is, recurrent C3G). Of these 11 recurrent cases, 7 presented with allograft dysfunction and 4 with proteinuria and renal dysfunction. Early post-transplant recurrence (<1 month) was noted in six patients, whereas recurrence in five patients occurred within 8-17 months of transplant. Biopsies showed mild focal mesangial expansion with or without endocapillary proliferation and thrombotic microangiopathy. Rejection was also noted in six patients. APFA/C3 levels were low in all cases. Serum CFH levels were low [dense deposit disease (DDD), 44%; C3 glomerulonephritis (C3GN), 25%], whereas CFB levels were normal. Autoantibodies to CFH, CFB and C3 nephritic factor were present in 11, 0 and 44% of DDD cases, respectively, and in 17, 17 and 33% of C3GN cases, respectively. Genetic analysis revealed only non-pathogenic CFH gene variants (93%). No novel mutation was found. At follow-up (140 months), stable graft was noted in 28% of cases, progressive renal failure in 19%, graft loss in 34%, and 19% of patients died. CONCLUSION: Post-transplant C3G can present with graft dysfunction and/or proteinuria. Subtle histological findings demand careful interpretation of immunofluorescence results. Autoantibodies to complement pathway regulatory proteins are common, and no novel mutation has been found from limited genetic workup. Clinical outcome is poor.

The association between patient experience and healthcare outcomes using SEER-CAHPS patient experience and outcomes among cancer survivors.

OBJECTIVE: To understand the relationship between patient experience, as measured by scores on the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey, and clinical and financial outcomes among older cancer survivors. MATERIALS AND METHODS: We analyzed the records of all Fee-for-Service (FFS) Medicare beneficiaries 66 years and older who completed one CAHPS survey from 2001 to 2004 or 2007-2013 with one of the five following cancer types: breast, bladder, colorectal, lung, or prostate; and completed a CAHPS survey within 5 years of cancer diagnosis date. We conducted a multivariate analysis, controlling for clinical and demographic variables, to evaluate the association between excellent CAHPS scores and the following clinical and financial outcomes: mortality, emergency department visits, and total healthcare expenditures. RESULTS: A total of 7395 individuals were present in our cohort, with 57% being male and 85.7% non-Hispanic White. Breakdown of the cohort by cancer site is as follows: prostate (40.4%), breast (28.6%), colorectal (14.0%), lung (9.4%), and bladder (7.6%). When looking at the relationship between CAHPS scores and clinical outcomes, there was no significant difference between excellent and non-excellent CAHPS score respondents in all three of the clinical outcomes studied. Furthermore, there was no association between ED utilization and patient experience scores when stratifying by cancer site and race/ethnicity among this cohort. CONCLUSION: In this cohort, a highly rated patient experience, as measured by responses on the CAHPS survey, is not associated with improved clinical outcomes among older cancer survivors.

Characterization of Aerosol Hygroscopicity Over the Northeast Pacific Ocean: Impacts on Prediction of CCN and Stratocumulus Cloud Droplet Number Concentrations.

During the Marine Aerosol Cloud and Wildfire Study (MACAWS) in June and July of 2018, aerosol composition and cloud condensation nuclei (CCN) properties were measured over the N.E. Pacific to characterize the influence of aerosol hygroscopicity on predictions of ambient CCN and stratocumulus cloud droplet number concentrations (CDNC). Three vertical regions were characterized, corresponding to the marine boundary layer (MBL), an above-cloud organic aerosol layer (AC-OAL), and the free troposphere (FT) above the AC-OAL. The aerosol hygroscopicity parameter (κ) was calculated from CCN measurements (κ CCN) and bulk aerosol mass spectrometer (AMS) measurements (κ AMS). Within the MBL, measured hygroscopicities varied between values typical of both continental environments (~0.2) and remote marine locations (~0.7). For most flights, CCN closure was achieved within 20% in the MBL. For five of the seven flights, assuming a constant aerosol size distribution produced similar or better CCN closure than assuming a constant "marine" hygroscopicity (κ = 0.72). An aerosol-cloud parcel model was used to characterize the sensitivity of predicted stratocumulus CDNC to aerosol hygroscopicity, size distribution properties, and updraft velocity. Average CDNC sensitivity to accumulation mode aerosol hygroscopicity is 39% as large as the sensitivity to the geometric median diameter in this environment. Simulations suggest CDNC sensitivity to hygroscopicity is largest in marine stratocumulus with low updraft velocities (<0.2 m s-1), where accumulation mode particles are most relevant to CDNC, and in marine stratocumulus or cumulus with large updraft velocities (>0.6 m s-1), where hygroscopic properties of the Aitken mode dominate hygroscopicity sensitivity.

Outpatient Panniculectomy and Skin Graft for Adult Buried Penis.

OBJECTIVE: To demonstrate a technique for performing panniculectomy and skin graft for a patient with adult buried penis, highlighting a number of technical modifications that allow for the procedure to be performed as an outpatient. METHODS: Pannus is mobilized with a modified trapezoid incision, leaving superior attachments intact for skin graft harvest. Diseased penile skin is removed, defect is measured, and an appropriately sized split thickness skin graft is harvested from the pannus in 2-inch sections at a depth of 18/1000. The unmeshed graft is applied to the penis and covered with a bolster that is secured to the penis for 5-7 days. Patients are discharged postoperative day 0 or 1. RESULTS: From 2017 to 2019, 19 patients underwent outpatient adult-buried penis repair. Median follow-up was 11.5 months. Median age was 70 years, median body mass index was 43.4, 9 (47%) patients had pathologically confirmed lichen sclerosus. Graft take was ≥95% in all patients. Complications included cellulitis (5, 26%) and minor dehiscence (3, 16%). No patients experienced deep vein thrombosis. CONCLUSION: Outpatient panniculectomy and skin graft is an effective treatment option for patients with adult buried penis.

Femtomolar Detection of Spermidine Using Au Decorated SiO2 Nanohybrid on Plasmon-Coupled Extended Cavity Nanointerface: A Smartphone-Based Fluorescence Dequenching Approach.

Coupling of photons with molecular emitters in different nanocavities have resulted in transformative plasmonic applications. The rapidly expanding field of surface plasmon-coupled emission (SPCE) has synergistically employed subwavelength optical properties of localized surface plasmon resonance (LSPR) supported by nanoparticles (NPs) and propagating surface plasmon polaritons assisted by metal thin films for diagnostic and point-of-care analysis. Gold nanoparticles (AuNPs) significantly quench the molecular emission from fluorescent molecules (at close distances <5 nm). More often, complex strategies are employed for providing a spacer layer around the AuNPs to avoid direct contact with fluorescent molecules, thereby preventing quenching. In this study we demonstrate a rapid and facile strategy with the use of Au-decorated SiO2 NPs (AuSil), a metal (Au)-dielectric (SiO2) hybrid material for dequenching the otherwise quenched fluorescence emission from radiating dipoles and to realize 88-fold enhancement using the SPCE platform. Different loading of AuNPs were studied to tailor fluorescence emission enhancements in spacer, cavity, and extended (ext.) cavity nanointerfaces. We also present femtomolar detection of spermidine using this nanohybrid in a highly desirable ext. cavity interface. This interface serves as an efficient coupling configuration with dual benefits of spacer and cavity architectures that has been widely explored hitherto. The multifold hot-spots rendered by the AuSil nanohybrids assist in augmented electromagnetic (EM)-field intensity that can be captured using a smartphone-based SPCE platform presenting excellent reliability and reproducibility in spermidine detection.

Comparative analysis of midgut bacterial communities in three aedine mosquito species from dengue-endemic and non-endemic areas of Rajasthan, India.

Dengue viruses are transmitted to humans through the bites of infected female aedine mosquitoes. Differences in the composition and structure of bacterial communities in the midguts of mosquitoes may affect the vector's ability to transmit the disease. To investigate and analyse the role of midgut bacterial communities in viral transmission, midgut bacteria from three species, namely Stegomyia aegypti (= Aedes aegypti), Fredwardsius vittatus (= Aedes vittatus) and Stegomyia albopicta (= Aedes albopictus) (all: Diptera: Culicidae), from dengue-endemic and non-endemic areas of Rajasthan, India were compared. Construction and analyses of six 16S rRNA gene libraries indicated that Serratia spp.-related phylotypes dominated all clone libraries of the three mosquito species from areas in which dengue is not endemic. In dengue-endemic areas, phylotypes related to Aeromonas, Enhydrobacter spp. and uncultivated bacterium dominated the clone libraries of S. aegypti, F. vittatus and S. albopicta, respectively. Diversity indices analysis and real-time TaqMan polymerase chain reaction assays showed bacterial diversity and abundance in the midguts of S. aegypti to be higher than in the other two species. Significant differences observed among midgut bacterial communities of the three mosquito species from areas in which dengue is and is not endemic, respectively, may be related to the vectorial capacity of mosquitoes to carry dengue viruses and, hence, to the prevalence of disease in some areas.

Translocation and toxicity of docetaxel multi-walled carbon nanotube conjugates in mammalian breast cancer cells.

Multi-walled-carbon nanotubes (MWNTs) are widely explored as carriers for drug delivery due to their facile transport through cellular membranes and are reportedly found to be effective against cancer. In the present study, we have evaluated cellular uptake of Docetaxel (DTX) conjugated MWNTs from human breast cancer cells (MCF-7 and MDA-mb-231) and have provided primary results on cytotoxicity of the same. Efficient internalization of the drug conjugate (DTX-MWNTs) inside the cell was corroborated with the help of confocal microscopy, transmission electron microscopy and flow cytometry. The comparison of cytotoxicity of the conjugate and DTX was done by MTT assay. Results of the study indicated increased efficacy of the conjugates over the drug in terms of their cytotoxicity. It was observed that such conjugation of drug to MWNTs can be explored as a strategy to improve therapeutic index of cytotoxic drugs such as DTX and thereby enriching cancer therapies of coming time.

Virus enhancement following infection with antibody-coated infectious bursal disease virus (IBDV) in chickens.

A novel concept of vaccination, employing virus-antibody complex has been reported for the control of infectious bursal disease in chickens. A comparison of virus replication, serum neutralizing antibody response and pathogenicity in chickens inoculated with the antibody coated virus, prepared by mixing virus and antibody in different ratios (1:1, 1:0.1, 1: 0.01) and virus alone without antibody, has been made. Antibody coated virus (when mixed in certain crucial ratios) replicated to a higher magnitude in the target organ, caused more severe pathogenesis but induced a primary serum neutralizing antibody response almost comparable. The results may have important implications in understanding of pathogenesis and development of control strategies against infectious bursal disease virus, specially employing immune complex vaccine.

T-Cell suppression by cyclosporin-A enhances infectious bursal disease virus infection in experimentally infected chickens.

In this study, the role of T lymphocytes was investigated in chickens experimentally infected with infectious bursal disease virus (IBDV). Chickens were treated with cyclosporin-A (CS-A), a selective T-cell suppressant drug, by the intramuscular route, starting 3 days before virus infection and every third day thereafter,and infectious bursal disease pathogenesis was compared in such T-cell suppressed and intact chickens using a vaccine strain; namely, Georgia and a field isolate of IBDV. Treatment of chickens with CS-A caused a significant suppression of phytohaemagglutinin-A specific proliferative responses of peripheral blood mononuclear cells. The virus neutralizing antibody titres in such CS-A treated chickens were not suppressed. T-Cell suppression resulted in an increase in the severity of gross lesions caused by IBDV and extensive muscular haemorrhages were observed in such chickens between 15 and 21 days post-inoculation. Similarly, there was a marked increase in the severity of infectious bursal disease-specific microscopic lesions in the bursa of T-cell suppressed chickens. Consistently higher titres of virus were observed in bursa of CS-A treated chickens. Virus titres were 1 to 2 log(10) higher in the T-cell suppressed chickens as compared with the intact ones. These studies suggest that T cells play a role in limiting the IBDV infection.

Transforming growth factor-beta induced by live or ultraviolet-inactivated equid herpes virus type-1 mediates immunosuppression in the horse.

Up to 21 days after exposure to live or ultraviolet-inactivated equid herpesvirus type-1 (EHV-1) autologous serum from ponies caused an immunosuppressive effect if incorporated into T-cell proliferation assays to EHV-1. The suppressive factor in the sera of ponies also inhibited T-cell response to phytohaemagglutinin. Increased levels of circulating activated transforming growth factor-beta 1 (TGF-beta 1) were detected, and the suppressive activity of the serum could be reversed by antibody to TGF-beta 1. In a challenge experiment the ponies which exhibited circulating TGF-beta 1 activity succumbed to infection while the ones with similar magnitudes of T-cell responses, but no TGF-beta 1 activity, were protected. A definition of this immunosuppressive mechanism and its mode of induction must be central to the design of vaccines and to an understanding of the pathogenesis of EHV-1.

A dot immunobinding assay in comparison with the gel diffusion test for the detection of equine herpesvirus-1 antigen from field samples.

The authors describe a rapid and simple dot immunobinding assay (DIA) for detection and identification of equine herpesvirus-1 antigen in field samples from cases of abortion, stillbirth, perinatal foal mortality and paralysis. The assay employs a nitrocellulose membrane to which antigen is adsorbed as a dot. Antigen is identified as a coloured dot using a procedure based on the principle of enzyme-linked immunosorbent assay (ELISA). In all, 61 samples were tested by DIA and the test was compared with conventional agar gel immunodiffusion (AGID). With DIA, 44 (72%) samples gave positive results, while only 22 of 61 (36%) samples tested positive by AGID. DIA was observed to be rapid, more sensitive and more specific than AGID, in addition to the obvious advantage of being reagent-conservative, inexpensive and simple to perform.

Immunokinetics of equine herpesvirus 1 in donkey mares: suppression of secondary cell-mediated response.

To study the immunokinetics of equine herpesvirus 1 (EHV1), donkey mares were immunised with a laboratory strain of EHV1, or with recommended doses of Pneumabort-K vaccine (EHV1 Army 183 strain, formalin-inactivated, with an oil adjuvant) and a booster was given after three months. Humoral immune responses were studied by employing a virus neutralisation (VN) test. A leucocyte migration inhibition test (LMIT) was employed for the assay of cellular immune responses. The VN antibody titre reached 1:64 or 1:128 after primary immunisation and showed a marginal increase (1:256) after secondary immunisation with either of the immunogens. After the primary dose of immunogen, there was a gradual increase in host cellular response which persisted for up to three months. However, on secondary immunisation, cell-mediated immune response was short-lived and weak compared to the primary response with both immunogens. This could be one possible explanation for breakdown of anti-EHV1 immunity leading to abortion in immunised mares.