Multicenter Experience Using Collagen Fleece for Plaque Incision With Grafting to Correct Residual Curvature at the Time of Inflatable Penile Prosthesis Placement in Patients With Peyronie's Disease.

BACKGROUND: Adjuvant maneuvers are often necessary to correct residual curvature during inflatable penile prosthesis (IPP) placement in patients with Peyronie's disease (PD). AIM: We present our multicenter experience using collagen fleece as graft material for plaque incision and grafting (PIG) during IPP placement in patients with moderate to severe PD. METHODS: We retrospectively reviewed 51 patients with IPP from 3 sites who underwent PIG with Tachosil (Baxter, IL) collagen fleece. Coloplast (Minneapolis, MN) IPP devices were used. Factors associated with residual curvature, revision, and patient satisfaction were performed using chi-squared analysis. OUTCOMES: We evaluated postoperative outcomes including factors associated with residual curvature, revision, and patient satisfaction. RESULTS: The mean compound curvature was 69.6°. The mean follow-up was 10.6 (range 1-38) months. All patients reported erections sufficient for penetrative intercourse at the last follow-up. Residual curvature <15° was noted in 6 of 51 (12%) patients. 3 patients required device revision. 2 patients experienced temporary glanular paresthesia, and no patients experienced device infection. CLINICAL IMPLICATIONS: In our multicenter study, patients experienced substantial curve correction with minimal complications, and in the few patients who had persistent mild curvature, severe preoperative curvature (>60°) was found to be the only risk factor. STRENGTHS & LIMITATIONS: Our study represents the largest series of patients coming from multiple centers undergoing surgical correction of PD with IPP and collagen fleece grafting. Limitations of this study include the retrospective study design, lack of a comparison group, and modest follow-up. CONCLUSION: PIG using collagen fleece is a safe and effective means of correcting residual curvature after IPP placement in patients with moderate to severe PD. Hatzichristodoulou G, Yang DY, Ring JD, et al. Multicenter Experience Using Collagen Fleece for Plaque Incision With Grafting to Correct Residual Curvature at the Time of Inflatable Penile Prosthesis Placement in Patients With Peyronie's Disease. J Sex Med 2020;17:1168-1174.

The Utility of Sex Hormone-Binding Globulin in Hypogonadism and Infertile Males.

PURPOSE: We sought to determine the role of sex hormone-binding globulin in patients with male infertility. MATERIALS AND METHODS: We retrospectively reviewed the records of 168 males seen at a fertility clinic from 2012 to 2014 to investigate the accuracy of total testosterone in the biochemical diagnosis of hypogonadism using calculated bioavailable testosterone as the reference value. We used multivariable analysis to assess sex hormone-binding globulin as an independent predictor of infertility. RESULTS: Computations using calculated bioavailable testosterone as a standard in the measurement of definitive biochemical hypogonadism (less than 156 ng/dl) revealed 81% sensitivity, 83% specificity, 81% positive predictive value and 82% negative predictive value for diagnosing hypogonadism with total testosterone alone. Of the 90 men with total testosterone greater than 300 ng/dl, 20% had low bioavailable testosterone less than 156 ng/dl, 52% had borderline low bioavailable testosterone less than 210 ng/dl and only 48% could be considered biochemically eugonadal according to calculated bioavailable testosterone. Of the 80 patients with total testosterone less than 300 ng/dl, 19% had free testosterone levels greater than 6.5 ng/dl and, thus, could be considered to be eugonadal. By a magnitude similar to that of follicle-stimulating hormone, sex hormone-binding globulin independently predicted decreased sperm concentration (p = 0.0027) and motility (p = 0.0447). After excluding men with azoospermia, only sex hormone-binding globulin levels differed significantly in classically hypogonadal men (group 1-total testosterone less than 300 ng/dl) and those missed but hypogonadal (group 2-calculated bioavailable testosterone less than 210 ng/dl) (p = 0.0001). At a more stringent cutoff of calculated bioavailable testosterone less than 156 ng/dl, sperm motility was significantly different for groups 1 and 2 (p = 0.014). CONCLUSIONS: Adding sex hormone-binding globulin to total testosterone serum testing facilitates more accurate diagnosis with free testosterone and calculated bioavailable testosterone, and clinical implications of decreased semen parameters to a magnitude similar to that of follicle-stimulating hormone. This warrants further study of the role of sex hormone-binding globulin in male infertility.

Yersinia pestis uses the Ail outer membrane protein to recruit vitronectin.

Yersinia pestis, the agent of plague, requires the Ail (attachment invasion locus) outer membrane protein to survive in the blood and tissues of its mammalian hosts. Ail is important for both attachment to host cells and for resistance to complement-dependent bacteriolysis. Previous studies have shown that Ail interacts with components of the extracellular matrix, including fibronectin, laminin and heparan sulfate proteoglycans, and with the complement inhibitor C4b-binding protein. Here, we demonstrate that Ail-expressing Y. pestis strains bind vitronectin - a host protein with functions in cell attachment, fibrinolysis and inhibition of the complement system. The Ail-dependent recruitment of vitronectin resulted in efficient cleavage of vitronectin by the outer membrane Pla (plasminogen activator protease). Escherichia coli DH5α expressing Y. pestis Ail bound vitronectin, but not heat-treated vitronectin. The ability of Ail to directly bind vitronectin was demonstrated by ELISA using purified refolded Ail in nanodiscs.

Improving the inhibitory activity of arylidenaminoguanidine compounds at the N-methyl-D-aspartate receptor complex from a recursive computational-experimental structure-activity relationship study.

Using a combination of both the partial least squares (PLS) and back-propagation artificial neural network (ANN) pattern recognition methods, several models have been developed to predict the activity of a series of arylidenaminoguanidine analogs as inhibitory modulators of the N-methyl-D-aspartate receptor complex. This was done by correlating structural and physicochemical descriptors obtained from computation software with the experimentally observed [(3)H]MK-801 displacement ability of a small library of synthesized and in vitro screened arylidenaminoguanidines. Results for the generated PLS model were r(2)=0.814, rmsd=0.208, rCV(2)=0.714, loormsd=0.261. The ANN model was created utilizing the eleven descriptors from the PLS model for comparison. The quality of the ANN model (r(2)=0.828, rmsd=0.200, rCV(2)=0.721, loormsd=0.257) is similar to the PLS model, and indicates that the feature between the inputs and the output is majorly linear. These computational models were able to predict inhibition of the NMDA receptor complex by this series of compounds in silico, affording a predictive structure-based 'pre-screening' paradigm for the arylideneaminoguanidine analogs.

Complete primary repair of bladder exstrophy: a systematic review.

OBJECTIVES: Complete primary repair of exstrophy (CPRE) was established as a method to reduce numbers of procedures for the reconstruction of bladder exstrophy (BE). Performed since 1989, some suggest it as a replacement for the staged reconstructive procedure, the gold standard. Does CPRE reduce the numbers of procedures for reconstruction of BE? METHODS: Literature was reviewed from 1989 to 2016, and articles evaluating outcomes of patients undergoing CPRE, extracted. Effort was made to obtain final data from each reporting institution/group. Eleven articles meeting criteria were evaluated for qualitative systematic review. Age at initial closure, complications, additional procedures, and outcomes were evaluated to provide an overview of CPRE. RESULTS: Ten groups reported BE management using the CPRE technique. 236 patients (153 boys; 72 girls; 11 unknown sex) had primary closure ranging from birth to 5.6 years. Osteotomy was favored by most in infants closed beyond the first 72 h of life along with spica cast immobilization. Three groups recommended concomitant augmentation for infants with small bladder capacities. Ureteral reimplantation was required in 58 patients with recurrent urinary tract infections resistant to prophylaxis. Hypospadias repair was required for most boys having complete penile disassembly, and most children eventually required bladder neck reconstruction (BNR) for continence. Overall, voiding without BNR was noted in 16-37% of children in the reported series. CONCLUSIONS: Complete primary repair of exstrophy has been suggested as a single procedure for the management of BE. Literature review suggests most patients require multiple procedures to complete reconstruction and attain continence.

Depression and Functional Outcomes in Patients Presenting to the Emergency Department With Low Back Pain.

OBJECTIVES: Low back pain (LBP) is a common reason for patients to present to emergency departments (EDs). Our objective was to describe the associations between depressive symptoms, pain severity, and functional impairment up to 3 months after initial ED presentation for LBP. METHODS: We performed a secondary analysis on an observational cohort of adult patients from a high-volume, urban ED. Initial depressive symptoms (Patient Health Questionnaire-9) and disability (Roland Morris Disability Questionnaire) were collected in person at the time of initial ED visit and by telephone at 1-week and 3-month follow-ups. Pain intensity (Numeric Rating Scale) was collected at 1-week and 3-month follow-ups. Our primary goal was to determine the associations between initial depressive symptoms and pain intensity and disability scores at 3 months. We also investigated the associations of initial and 3-month change in depressive symptoms with change in disability score from initial presentation to 3 months and change in pain score from 1 week to 3 months. RESULTS: Of the 674 patients initially enrolled, 362 patients had complete depressive symptom, pain, and disability data and were included in the final analysis. Those with higher levels of intake depressive symptoms had worse pain intensity (B = 0.14, 95% confidence interval [CI] = 0.08 to 0.21) and disability (0.46, 95% CI = 0.30 to 0.62) severity at 3 months, with less improvement in disability over the 3 months (B = 0.22, 95% CI = 0.05 to 0.40). Furthermore, those with worsening depressive symptoms over the 3-month study period experienced less improvement in pain intensity (B = 0.10, 95% CI = 0.05 to 0.17) and disability (B = 0.84, 95% CI = 0.66 to 1.02) over the same time frame. Except for a slight strengthening of the association between initial depressive symptom severity and 3-month pain score among patients with no prior LBP episodes, history of prior LBP episodes did not moderate these relationships. CONCLUSIONS: Significant positive temporal associations exist between initial severity and 3-month progression of depressive symptoms and 3-month pain intensity and disability outcomes for ED patients with LBP. Future work is needed to investigate whether behavioral interventions initiated from the ED may mitigate the incidence and severity of LBP-related chronic pain and functional impairments.

Current medical management of endocrine-related male infertility.

Male factor contributes to 50%-60% of overall infertility but is solely responsible in only 20% of couples. Although most male factor infertility is ascertained from an abnormal semen analysis, other male factors can be contributory especially if the sample returns normal. Male infertility can be due to identifiable hormonal or anatomical etiologies that may be reversible or irreversible. This manuscript will highlight existing guidelines and our recommendations for hormone evaluation for male infertility and empiric therapies including multivitamins, estrogen receptor modulators (clomiphene), estrogen conversion blockers (anastrozole), and hormone replacement.

Bladder stones after bladder augmentation are not what they seem.

INTRODUCTION: Bladder and renal calculi after bladder augmentation are thought to be primarily infectious, yet few studies have reported stone composition. OBJECTIVE: The primary aim was to assess bladder stone composition after augmentation, and renal stone composition in those with subsequent nephrolithiasis. The exploratory secondary aim was to screen for possible risk factors for developing infectious stones. STUDY DESIGN: Patients treated for bladder stones after bladder augmentation at the present institution between 1981 and 2012 were retrospectively reviewed. Data were collected on demographics, surgeries and stone composition. Patients without stone analysis were excluded. Stones containing struvite, carbonate apatite or ammonium acid ureate were classified as infectious. The following variables were analyzed for a possible association with infectious bladder stone composition: gender, history of cloacal exstrophy, ambulatory status, nephrolithiasis, recurrent urea-splitting urinary tract infections, first vs recurrent stones, timing of presentation with a calculus, history of bladder neck procedures, catheterizable channel and vesicoureteral reflux. Fisher's exact test was used for analysis. RESULTS: Of the 107 patients with bladder stones after bladder augmentation, 85 met inclusion criteria. Median age at augmentation was 8.0 years (follow-up 10.8 years). Forty-four patients (51.8%) recurred (14 multiple recurrences, 143 bladder stones). Renal calculi developed in 19 (22.4%) patients with a bladder stone, and 10 (52.6%) recurred (30 renal stones). Overall, 30.8% of bladder stones were non-infectious (Table). Among patients recurring after an infectious bladder stone, 30.4% recurred with a non-infectious one. Among patients recurring after a non-infectious stone, 84.6% recurred with a non-infectious one (P = 0.005). Compared with bladder stones, renal stones were more likely to be non-infectious (60.0%, P = 0.003). Of patients with recurrent renal calculi after an infectious stone, 40.0% recurred with a non-infectious one. No clinical variables were significantly associated with infectious stone composition on univariate (≥0.28) or bivariate analysis (≥0.36). DISCUSSION: This study had several limitations: it was not possible to accurately assess adherence with bladder irrigations, and routine metabolic evaluations were not performed. The findings may not apply to patients in all clinical settings. While stone analysis was available for 3/4 of the stones, similar rates of incomplete stone analyses have been reported in other series. CONCLUSIONS: In patients with bladder augmentation, 1/3 of bladder stones and >1/2 of renal stones were non-infectious. Furthermore, an infectious stone does not imply an infectious recurrent stone and no known clinical variables appear to be associated with stone composition, suggesting that there is a possible metabolic component in stone formation after bladder augmentation.

Calibration of a novel, laparoscopic, 12-mm, ultrasound, image-guided, high-intensity focused ultrasound probe for ablation of renal neoplasms.

OBJECTIVE: To calibrate a 12-mm high-intensity focused ultrasound (HIFU) probe to produce histologically verifiable complete tissue necrosis through thermal energy delivery while maintaining safety in ablation of porcine renal tissue. METHODS: The study was approved by the animal research committee at our institution. A HIFU probe on a fixed arm was introduced, and ablation was subsequently carried out robotically (under computer control) at 2 planned locations within each kidney at varying energy levels. After 4 days of survival, kidneys were retrieved and pathologic analysis of the lesions was carried out for necrotic volume. Planned volume was compared with pathologic necrotic volume. RESULTS: A series of optimizations were carried out as the experiment progressed. Near optimal ablation zone dimensions with complete cell death were achieved when the energy density was between 400 and 460 calories/cm(3). Pathologic analysis demonstrated the average ratio of necrotic zone volume to planned zone volume was 1.0 (standard deviation, 0.18) in the 7 lesions with energy density between 400 and 460 calories/cm(3). All animals survived the surgeries, and no device-related complications were identified during the study. No acute renal failure was identified in analysis of the blood work. CONCLUSION: A novel 12-mm laparoscopic HIFU probe was successfully calibrated for the ablation of porcine renal tissue. The safety profile of the Sonatherm probe was found to be excellent with no complications identified.

Novel antiepileptic and anticonvulsive therapeutic agents.

Epilepsy is a broad-reaching central nervous system condition and the underlying pathology suggests a number of pharmacological pathways that can be targeted for drug therapy. These include ion channel modulation, historically the most investigated therapeutic approach, as well as regulation of excitatory and inhibitory neurotransmission. A broad range of drugs that act at each of these targets has been marketed, and promising new drug candidates are being developed constantly. In addition, new drug candidates with novel mechanisms of action are beginning to emerge. This review covers patent literature with the indication for epilepsy between January 2001 and March 2002, and includes brief overviews and backgrounds on currently used anti-epileptic and anticonvulsive drugs.

Computer-aided analysis of 64-slice coronary computed tomography angiography: a comparison with manual interpretation.

Coronary computed tomography angiography (CCTA) is increasingly used for the assessment of coronary heart disease (CHD) in symptomatic patients. Software applications have recently been developed to facilitate efficient and accurate analysis of CCTA. This study aims to evaluate the clinical application of computer-aided diagnosis (CAD) software for the detection of significant coronary stenosis on CCTA in populations with low (8%), moderate (13%), and high (27%) CHD prevalence. A total of 341 consecutive patients underwent 64-slice CCTA at 3 clinical sites in the United States. CAD software performed automatic detection of significant coronary lesions (>50% stenosis). CAD results were then compared to the consensus manual interpretation of 2 imaging experts. Data analysis was conducted for each patient and segment. The CAD had 100% sensitivity per patient across all 3 clinical sites. Specificity in the low, moderate, and high CHD prevalence populations was 64%, 41%, and 38%, respectively. The negative predictive value at the 3 clinical sites was 100%. The positive predictive value was 22%, 21%, and 38% for the low, moderate, and high CHD prevalence populations, respectively. This study demonstrates the utility of CAD software in 3 distinct clinical settings. In a low-prevalence population, such as seen in the emergency department, CAD can be used as a Computer-Aided Simple Triage tool to assist in diagnostic delineation of acute chest pain. In a higher prevalence population, CAD software is useful as an adjunct for both the experienced and inexperienced reader.

(4-Methoxy-3-nitrobenzylideneamino)guanidinium chloride.

In the title compound, C(9)H(12)N(5)O(3)(+) x Cl(-), the cation is almost entirely planar. The imine double bond is exclusively in the E geometry.