Delayed placement of an inflatable penile prosthesis is associated with a high complication rate in men with a history of ischemic priapism.

BACKGROUND: Corporal fibrosis is known to result from prolonged priapism; however, the impact of the timing of penile prosthesis placement after priapism on complication rates is poorly understood. AIM: We sought to evaluate the impact of timing of inflatable penile prosthesis (IPP) placement on complications in men with a history of ischemic priapism. METHODS: We performed a multicenter, retrospective cohort study of patients with a history of priapism undergoing IPP placement by 10 experienced implantation surgeons. We defined early placement as ≤6 months from priapism to IPP. We identified a 1:1 propensity-matched group of men without a history of priapism and compared complication rates between men who had early placement, late placement, and no history of priapism. OUTCOMES: Our primary outcome was postoperative noninfectious complications, and secondary outcomes included intraoperative complications and postoperative infection. RESULTS: A total of 124 men were included in the study with a mean age of 50.3 ± 12.7 years. A total of 62 had a history of priapism and 62 were matched control subjects. The median duration of priapism was 37 (range, 3-168) hours and the median time from ischemic priapism to IPP placement was 15 months (range, 3 days to 23 years). Fifteen (24%) men underwent early (≤6 months) IPP placement at a median time of 2 months (range, 3 days to 6 months) following the ischemic priapism event. The remaining 47 (76%) underwent placement >6 months following priapism at a median time of 31.5 months (range, 7 months to 23 years). The complication rate in the delayed placement group was 40.5% compared with 0% in the early placement group and control group. Cylinder-related complications such as migration or leak accounted for 8 (57%) of 14 of the postoperative noninfectious complications. Full-sized cylinders were used in all patients who had a cylinder related complication. CLINICAL IMPLICATIONS: Priapism patients should be referred to prosthetic experts early to decrease complication rates in those needing an IPP. STRENGTHS AND LIMITATIONS: This is a multicenter study from experienced prosthetic urologists but is limited by the retrospective nature and small number of patients in the early placement group. CONCLUSION: IPP complication rates are high in men with a history of ischemic priapism, especially when implantation is delayed beyond 6 months.

Emerging concepts in male contraception: a narrative review of novel, hormonal and non-hormonal options.

Access to reliable contraception is a pillar of modern society. The burden of unintended pregnancy has fallen disproportionately on the mother throughout human history; however, recent legal developments surrounding abortion have sparked a renewed interest in male factor contraceptives beyond surgical sterilization and condoms. Modern efforts to develop reversible male birth control date back nearly a century and initially focused on altering the hypothalamic-pituitary-testes axis. These hormonal contraceptives faced multiple barriers, including systemic side effects, challenging dosing regimens, unfavorable routes of delivery, and the public stigma surrounding steroid use. Novel hormonal agents are seeking to overcome these barriers by limiting the side effects and simplifying use. Non-hormonal contraceptives are agents that target various stages of spermatogenesis; such as inhibitors of retinoic acid, Sertoli cell-germ cell interactions, sperm ion channels, and other small molecular targets. The identification of reproductive tract-specific genes associated with male infertility has led to more targeted drug development, made possible by advances in CRISPR and proteolysis targeting chimeras (PROTACs). Despite multiple human trials, no male birth control agents have garnered regulatory approval in the United States or abroad. This narrative review examines current and emerging male contraceptives, including hormonal and non-hormonal agents.

The Impact of Dietary Factors on Indices of Chronic Disease in Older People: A Systematic Review.

OBJECTIVES: There has been little evaluation of the evidence relating dietary factors to functional capacity in older adults. The aims were to i) conduct a systematic review of studies assessing dietary factors in relation to six key functional indicators which impact on quality of life in adults ≥65 yrs: non-fatal cardiovascular events, cognition, mental health, falls and fractures, physical health (muscle mass, strength) and frailty; and ii) assess if there was sufficient evidence to devise food-based dietary recommendations. DESIGN: Systematic review. PARTICIPANTS: Cross-sectional and prospective cohort studies were included together with intervention studies that evaluated food/drink interventions (excluding supplements). Evidence base statements were determined according to the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) levels of evidence criteria (Grades (A-excellent; B-good; C-satisfactory; D-poor). RESULTS: There was good evidence that the Mediterranean type diet (MD) reduced the risk of non-fatal cardiovascular events (Grade B) and reduced cognitive decline (Grade B). There was some evidence indicating that a MD decreases the likelihood of frailty (Grade C), consistent but weaker evidence that ≥3 servings/d of vegetables is associated with reduced cognitive decline (Grade D), a modest increase in protein may be associated with improved cognition (Grade C) and decreased frailty (Grade C), and that protein plus resistance exercise training in frail elderly may enhance physical strength (Grade C). CONCLUSION: It is recommended that older adults adopt the characteristics of a Mediterranean type diet such as including olive oil and eating ≥3 servings/d of vegetables to reduce their risk of chronic disease, impaired cognition and frailty. Consumption of dietary protein above the current dietary requirements would be recommended to reduce risk of frailty and impaired cognition. A modest increase in dietary protein when combined with resistance exercise would be recommended to help maintain muscle mass and strength and to enhance functional capacity.

Vaginal Cuff Dehiscence Presenting with Free Air 60 Days after Robotic-Assisted Hysterectomy.

INTRODUCTION: The vast majority of patients presenting with pneumoperitoneum have visceral organ perforation and require urgent diagnostic laparoscopy. Nonsurgical causes are relatively rare and may be attributed to multiple etiologies. CASE PRESENTATION: Here we describe the case of a 38-year-old Caucasian female who presented to the emergency department with three days of cramping, epigastric abdominal pain. Her physical exam was notable for tenderness to palpation in the epigastric area and abdominal and chest X-rays showed free air under the diaphragm. Free air around the porta hepatis was verified on CT scan. Approximately 90% of pneumoperitoneum cases are due to perforation of visceral organs and therefore require operative management. An urgent exploratory laparoscopy revealed no clear source of free air, but postoperatively the patient developed a large volume of watery discharge from her vagina. Subsequent workup revealed a 1 cm vaginal cuff dehiscence which was later repaired with no postoperative complications. CONCLUSION: Although the majority of patients with pneumoperitoneum require urgent exploratory laparoscopy, a careful diagnostic workup may reveal sources of free air that are not related to hollow viscous perforation. Vaginal cuff dehiscence represents a rare yet nonurgent source of pneumoperitoneum. This differential should be considered in light of the possible intra- and postoperative complications of surgery.

Heterogeneous incidence and propagation of spreading depolarizations.

Spreading depolarizations are implicated in a diverse set of neurologic diseases. They are unusual forms of nervous system activity in that they propagate very slowly and approximately concentrically, apparently not respecting the anatomic, synaptic, functional, or vascular architecture of the brain. However, there is evidence that spreading depolarizations are not truly concentric, isotropic, or homogeneous, either in space or in time. Here we present evidence from KCl-induced spreading depolarizations, in mouse and rat, in vivo and in vitro, showing the great variability that these depolarizations can exhibit. This variability can help inform the mechanistic understanding of spreading depolarizations, and it has implications for their phenomenology in neurologic disease.

Genetic characterization of spoilage pseudomonads isolated from retail-displayed beef.

AIM: This study genetically characterized Pseudomonas isolated from beef using the random amplification of polymorphic DNA (RAPD) method and correlate predominant genotypes with spoilage changes. METHODS AND RESULTS: Pseudomonads were recovered from beef loins and steaks on days 0, 2, 4, 6, 8 and 10. A total of 309 pseudomonads were grouped into 50 RAPD types (>85% similarity). One major RAPD type contained 45% of the isolates comprising 71%, 45%, 31%, 35%, 50% and 37% of isolates from days 0, 2, 4, 6, 8 and 10, respectively, from steaks and 48% of the isolates recovered from beef loins. Nineteen RAPD types consisted of isolates that were shared between more than two sampling times, whereas the remaining 31 types were unique to one particular time. CONCLUSIONS: A genetically diverse Pseudomonas population was present on the loins and steaks at each sampling time. Although pseudomonads associated with beef loins were transferred to the steaks prepared from it, a genetically diverse Pseudomonas population emerged during the retail display. SIGNIFICANCE AND IMPACT OF THE STUDY: Information about the heterogeneous nature of Pseudomonas recovered from meat would help understanding the spoilage owing to predominant strains. The meat industry can use the knowledge to develop control strategies for prevalent spoilage strains.

Small intrapulmonary artery lung prototypes: design, construction, and in vitro water testing.

Blind-ended, hollow fibers mounted on a pulmonary artery catheter may allow O2 and CO2 transfer in the vena cava, right ventricle, and pulmonary artery. The effects of fiber length, manifold number, and gas oscillation on mass and momentum transfer with water perfusate using mass spectrometry and mass flow controllers were studied. Manifolds with 112-196 microporous polypropylene fibers were mounted on 8 Fr multiple lumen, commercially available pulmonary artery catheters. Fiber lengths varied from 0.5 to 16 cm and surface areas from 7 to 220 cm2. Prototypes with 2 cm long fibers were constructed with 1-15 manifolds. A two manifold prototype with 8 cm long fibers and a surface area of 378 cm2 was also studied. The transfer failed to scale with manifold number because the steady gas flow was maldistributed to the manifolds. Oscillating gas pressures from 780 to 76 mmHg absolute at a rate of 40 cycles/min increased CO2 transfer up to 15-fold and O2 transfer up to 2.5-fold. Oscillation also corrected the maldistribution. Optimal fiber lengths of 3 and 1 cm for O2 and CO2, respectively, were seen with steady gas flow, and 8 cm for both with oscillatory gas flow.

Drug-use patterns among black and nonblack community-dwelling elderly.

OBJECTIVE: To describe and compare drug-use patterns among black and nonblack community-dwelling elderly. DESIGN: Survey. SETTING: Five-county urban and rural region in Piedmont, NC. PARTICIPANTS: Stratified probability household sample of 4164 community residents aged 65 or older from the Piedmont Health Survey of the Elderly (65 percent women, 54 percent black, mean age 73.56 +/- 6.74 y). MAIN OUTCOME MEASURES: Prevalence of medication use and mean drug use; therapeutic medication category use. RESULTS: Data were weighted to represent the population in this geographic area. Fewer blacks reported the use of over-the-counter (OTC) medications and total medications than did nonblacks (66 vs. 76 percent and 88 vs. 92 percent, respectively; p less than 0.001). Compared with nonblacks, blacks reported using a lower mean number of prescription (2.02 vs. 2.35; p less than 0.001), OTC (1.12 vs. 1.42; p less than 0.001), and total (3.14 vs. 3.77; p less than 0.001) drugs. The therapeutic medication categories varied by race for prescription cardiovascular, analgesic, and central nervous system (CNS) drugs and OTC nutritional supplements. More nonblacks than blacks reported the use of analgesics (62.5 vs. 55.6 percent, respectively; p less than 0.001), CNS drugs (26.1 vs. 14.2 percent, respectively; p less than 0.001), nutritional supplements (27.5 vs. 16.9 percent, respectively; p less than 0.001), and gastrointestinal agents (29.0 vs. 23.5 percent, respectively; p less than 0.001). Blacks were more likely to report problems in managing their medications than were nonblacks (9.0 vs. 6.1 percent, respectively; p = 0.001). CONCLUSIONS: Our data suggest that there are distinct racial differences in medication-use patterns among the elderly.

The association of age and depression among the elderly: an epidemiologic exploration.

Advanced age among the elderly has been hypothesized to be a risk factor for depression, yet extant data do not uniformly support this hypothesis. The paucity of sufficiently large and representative samples of both the young-old and old-old and the failure to control for critical variables known to confound the association between advanced age and depression have prevented testing this hypothesis. The Duke EPESE (Establishment of a Population for Epidemiologic Studies of the Elderly) assessed 3,998 community-dwelling elders (65+) for depressive symptoms using a modified version of the CES-D and relevant control variables. Depressive symptoms were associated in bivariate analysis with increased age, being female, lower income, physical disability, cognitive impairment, and social support. In a multiple regression analysis, the association of age and depressive symptoms reversed when the above confounding variables were simultaneously controlled. The oldest old suffered fewer depressive symptoms when factors associated with both increased age and depressive symptoms were taken into account. Because many of these factors can be prevented (such as decreased income, physical disability, and social support), the uncontrolled association between age and depressive symptoms can potentially be modified.