Immediate preoperative blood glucose and hemoglobin a1c levels are not predictive of postoperative infections in diabetic men undergoing penile prosthesis placement.

Defining the risks associated with diabetes mellitus in patients undergoing penile prosthesis implantation remains controversial. Our study aims to assess whether preoperative hemoglobin a1c and preoperative blood glucose levels are associated with an increased risk for postoperative infection in diabetic men. We performed a retrospective review of 932 diabetic patients undergoing primary penile prosthesis implantation from 18 high-volume penile prosthesis implantation surgeons throughout the United States, Germany, Belgium, and South Korea. Preoperative hemoglobin a1c and blood glucose levels within 6 h of surgery were collected and assessed in univariate and multivariate models for correlation with postoperative infection, revision, and explantation rates. The primary outcome is postoperative infection and the secondary outcomes are postoperative revision and explantation. In all, 875 patients were included in the final analysis. There were no associations between preoperative blood glucose levels or hemoglobin a1c levels and postoperative infection rates; p = 0.220 and p = 0.598, respectively. On multivariate analysis, a history of diabetes-related complications was a significant predictor of higher revision rates (p = 0.034), but was nonsignificant for infection or explantation rates. We conclude preoperative blood glucose levels and hemoglobin a1c levels are not associated with an increased risk for postoperative infection, revision, or explantation in diabetic men undergoing penile prosthesis implantation.

Validation of "patient-reported outcomes via online questionnaire" as a urinary continence assessment and quality improvement tool following radical prostatectomy.

BACKGROUND: Securing reliable data on functional outcomes following radical prostatectomy (RP) is paramount to patient follow-up and management. OBJECTIVE: To validate an email-based patient-reported outcomes tracking system in assessing pad-free continence rates and time-to continence recovery following RP. PATIENTS AND METHODS: 483 men undergoing RP by a single surgeon from November 2013 to March 2019 were prospectively assigned to 1 of 3 tracking systems: 1) a preaddressed paper packet containing a pad-free card and daily urinary pad log, (N = 249); 2) an automated email questionnaire, (N = 234) or 3) both (N = 51). Patients tracked electronically received electronic Research Electronic Data Capture surveys 30 days after catheter removal, with up to 3 reminders sent automatically if no response was received within 2 days. Response rates and continence rates were compared in group 1 vs. group 2 via student t-tests; time-to pad-free status was assessed for concordance among men in group 3 via linear regression. RESULTS: Thirty-day response rates in group 1 (paper) vs. group 2 (electronic) were 80.7% (201/249) and 94.0% (220/234), (P < 0.0001); pad-free rates were 64.2% (129/201) and 64.1% (141/220), (P = 0.9847), respectively. Similarly, 1-year response rates in group 1 and 2 were 87.6% (218/249) vs. 94.0% (220/234), (P = 0.0146); pad-free rates were 91.7% (200/218) vs. 96.4% (212/220), (P = 0.0411), respectively. In group 3, time to pad-free continence recovery assessed via Patient Reported Outcomes via Online Questionnaire (PROVOQ) was highly concordant in 89.6% (43/48) of patients ± 5 days (Figure 1, R2 = 0.9893). No significant bias was found for subsequent reporting in either group. CONCLUSION: The use of automated email survey questionnaires via PROVOQ for the assessment of patient-reported post-RP continence recovery facilitates increased response rates, timeliness of response, and accuracy. PROVOQ significantly reduce the labor of tracking continence outcomes, improve quality improvement efforts, and enables surgeons to more clearly differentiates risk of long-term incontinence.

Chitosan promotes aquaporin formation and inhibits mucociliary differentiation of nasal epithelial cells through increased TGF-ß1 production.

Although endoscopic sinus surgery is the mainstay surgical treatment for chronic rhinosinusitis, over 15% of patients require a repeat operation wherein postoperative adhesion formation is one of the main causes of failure. Several recently proposed chitosan-based biomaterials promote mucosal healing, reduce postoperative adhesion formation and restore mucociliary function of sinonasal mucosa. However, the effects of chitosan on cellular morphology, re-epithelization, and mucociliary differentiation of nasal epithelial cells (NECs) during the wound healing process have not been thoroughly investigated. The present study investigates the direct effects of chitosan on cellular growth, cellular migration, mucociliary differentiation and aquaporin (AQP) formation of NECs to elucidate the role of chitosan in sinonasal applications. Wound healing assay reveals that proliferation and migration of NECs are inhibited by incubation of chitosan. The NECs become irregular in shape without formation of tight junction and mucociliary differentiation of NECs is inhibited during a culture period with incubation of chitosan. However, AQP3 and AQP5 formation in NECs is significantly higher in chitosan groups than in control groups. Further, expressions of transforming growth factor (TGF)-ß1, Smad2, and Smad3 are significantly higher in the chitosan groups compared with controls. The results of the comparison indicate that chitosan inhibits proliferation, migration and mucociliary differentiation of NECs through increasing production of TGF-ß1. Copyright © 2016 John Wiley & Sons, Ltd.

Increased mucociliary differentiation and aquaporins formation of respiratory epithelial cells on retinoic acid-loaded hyaluronan-derivative membranes.

While playing a major role in maintaining the mucociliary phenotype of respiratory epithelial cells (RECs), retinoids are critical determinants of their normal function. However, despite being a powerful biological agent, retinoic acid (RA) is generally not used in regenerative medicine due to its scarce bioavailability via conventional administration. Therefore, the ability to incorporate RA into biomaterials allows for a combination of the biological effects of RA and biomaterials in influencing cellular behavior. This study attempts to develop RA-loaded hyaluronan-derivative membrane (RA-HAm) and investigates how this membrane affects the mucociliary differentiation and aquaporins (AQP) formation of RECs. In a simulated in vitro culture condition, the RA release from membranes is maintained for 7days. On the seventh day, the cumulative release rate of RA from supportive biomaterials is ~87% under detect limitation. RECs cultured on RA-HAm reveal numerous mature ciliated cells and microvilli compared to aggregated cilia-like structures on hyaluronan-derivative membrane (HAm). Moreover, the expression levels of MUC5AC and AQP on RA-HAm are higher than those on HAm. The proposed model elucidates the release of hydrophobic RA from hyaluronan-derivative biomaterials. We believe that RA-loaded hyaluronan biomaterials are highly promising biomaterials for use in sinonasal surgery and tissue engineering of the respiratory system.

Improved objective outcomes and quality of life after adenotonsillectomy with inferior turbinate reduction in pediatric obstructive sleep apnea with inferior turbinate hypertrophy.

OBJECTIVES/HYPOTHESIS: Whether adenotonsillectomy (AT) is sufficient for pediatric obstructive sleep apnea syndrome (OSAS) with persistent severe allergic rhinitis (PSAR) remains unclear. This study attempts to identify the role of inferior turbinate reduction in treating pediatric OSAS with PSAR. STUDY DESIGN: Case series with planned data collection. METHODS: Fifty-one subjects aged 3 to 12 years with OSAS and PSAR were enrolled. Among them, 23 patients underwent AT concurrent with microdebrider-assisted inferior turbinoplasty (MAIT) (group AT-MAIT) and 28 patients underwent AT alone (group AT). Before surgery and at 1 year after surgery, objective outcomes were assessed using overnight polysomnography and acoustic rhinometry. Subjective outcomes were evaluated using the Obstructive Sleep Apnea (OSA)-18 quality-of-life questionnaire (OSA-18). RESULTS: Following surgery, the median apnea-hypopnea index, minimal oxygen saturation, and snoring index were 0.8 (/h), 94 (%), and 104 (/h) in group AT-MAIT, respectively, compared with 3.5 (/h), 93 (%), and 158 (/h) in group AT, respectively (P < .05). In group AT-MAIT, the median postoperative minimal cross-sectional area recorded by acoustic rhinometry was 0.31 cm(2) , significantly larger than 0.16 cm(2) in group AT (P < .01). Compared with postoperative scores in group AT, those in group AT-MAIT were significantly improved in domains of physical symptoms, emotional symptoms, daytime function, caregiver concerns, and overall OSA-18 scores (P < .05). CONCLUSIONS: Analytical results suggest that AT with concurrent MAIT achieves favorable subjective and objective outcomes in pediatric OSAS with PSAR. We believe that volume reduction of the inferior turbinate plays an important role in treating pediatric OSAS with inferior turbinate hypertrophy.