ED Treatment Research Articles

(045) Comparing Bacterial Presence with the Usage of 0.05% Chlorhexidine Gluconate (CHG) Lavage During Urologic Prosthesis Revision Surgery: Update on Results

Abstract Introduction An Inflatable Penile Prosthesis (IPP) is third line surgical therapy for refractory ED. An IPP uses a fluid-filled reservoir with a pump and valve system to activate inflation and deflation. Although penile implants achieve the highest success rates in ED treatment, the possible presence of bacteria on the device itself or bacteria exposure accumulated during the surgery increases the risk of progression into biofilm or infection. Biofilm complicates the bacteria eradication effort and can ultimately jeopardize the implant. Often, the only way to treat the post-op infection is with implant removal. Currently, many preventative measures, such as different perioperative irrigations, are being studied to reduce the number of penile implant infections. Research has shown that irrigation at the time of both infectious and noninfectious surgery lowers subsequent infection rates. Different solutions like saline, antibiotic, betadine, and hydrogen peroxide solutions have been considered. Recently, orthopedic literature has shown that 0.05% Chlorhexidine Gluconate (CHG) lavage has effectively reduced biofilm in artificial joint procedures. Objective The purpose of this study is to determine the effectiveness of CHG lavage on bacterial presence in IPP implant spaces. We hypothesize that CHG will lower bacterial presence after washing out implant spaces at time of replacement for infections and mechanical failure. Methods We aimed to investigate a series of patients who underwent revision IPP surgery while utilizing FDA-approved CHG lavage for irrigation and compared the bacterial presence before and after CHG washout. Additionally, Next Generation Sequencing (NGS), a DNA sequencing technology, was used to further identify the pathogens involved. Results Between 2021 to 2023, 48 patients underwent IPP revision surgery for either infectious or noninfectious reasons. During the operation, a section of the capsule tissue surrounding the implanted IPP pump was first taken and sent for cultures. NGS studies were also sent out. After the implant removal, all implant spaces were irrigated and washed out with CHG (two 450-mL bottles). A second tissue culture was then obtained post washout. Of the 48 patients, there were 4 positive bacterial cultures before washout and 13 positive NGS results. Results of the post CHG washout cultures were all negative. Conclusions It appears that irrigation with 0.05% Chlorhexidine Gluconate solution is an effective antiseptic that can decrease bacterial presence, and hopefully reduce IPP infections. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Microgen Dx, Irrisept.

(285) Evaluation of Penile Prosthesis Implantation in Older Adults with Bladder Cancer After Radical Cystectomy

Abstract Introduction Erectile dysfunction (ED) is common after radical cystectomy (RC), but ED treatment in this setting remain understudied. Many such patients will be unresponsive to oral pharmacotherapy, often requiring penile prosthesis (PP) implantation. Objective The objective of this study was to evaluate PP implantation in a contemporary, national cohort of older adults with bladder cancer following RC. Methods We used the SEER-Medicare database to identify male patients 66 years and older diagnosed with Tany Nany M0 bladder cancer from 2000 to 2017 and treated with RC. We estimated time to PP implantation using the Kaplan-Meier method, and evaluated the associations of baseline characteristics with PP implantation using Cox proportional hazard regression. Results The study cohort included 4,468 men who underwent RC, including 75% who were married or had a domestic partner. A total of 334 (7%) patients had baseline ED. Median follow-up after RC was 38.0 (IQR 16.0-84.0) months. After RC, only 71 (2%) patients underwent PP implantation, with a median time to PP implantation of 12 (IQR 5-32) months. In univariable analysis, younger age, black race, and undergoing RC at small bed size hospitals, comprehensive NCI Cancer Centers, higher RC volume hospitals, and hospitals in the West and South/Southeast regions were associated with higher rates of implantation (Table 1). Disease characteristics were not related to PP implantation. Conclusions Despite the expected prevalence of ED following RC, contemporary, real-world rates of PP implantation are very low. Univariable analyses suggest that both patient characteristics and features of the hospital performing RC are associated with treatment for post-RC ED with PP implantation. Disclosure No.

(156) Morphometrix Tissue Segmentation Technology as a Diagnostic Aid in the Evaluation of Vasculogenic Causes of Erectile Dysfunction

Abstract Introduction Morphometrix Imaging Technologies Inc. (MPX) Tissue Segmentation Technology (TST) isolates and processes the component of ultrasound reflective signals associated with coherent specular reflection at the liquid spaces in living tissue. The software identifies and quantifies the hypoechoic structures in B-Mode Ultrasound Scans produced by these reflections and thereby profiles liquid spaces in the tissue created by blood and lymphatic vessels as a proxy for vascular intensity. It then derives tissue segment counts (TSC) as a final quantification step. Unlike SHIM Scores, TST provides a quantitative assessment of the vascular health of the erectile tissue. Objective The goal of the study was to determine whether TSC can predict a response to regenerative treatments for ED. We retrospectively studied the efficacy of MPX TST in assessing the vascularity of the corpus cavernosa (CC) and compared the findings to SHIM scores before and after Shockwave therapy (SWT). MPX can assess penile vascularity in the flaccid state using TSC and can calculate cross-sectional area and volume. Methods Retrospective study of 57 men, average age 54.9 with ED. B-mode Ultrasound video scans were performed on the penis in the flaccid state before and after treatment completion and processed through MPX to obtain the TSC which were compared to IIEF-5 SHIM scores. A typical treatment involved multiple sessions of SWT and PRP penile injection. Subjects were divided into three groups based on response to treatment and correlation with SHIM Scores: Group 1 – Good Responders & Good Correlation with SHIMs, Group 2 – Poor & Non-Responders & Good Correlation with SHIMs, Group 3 – Good & Poor Responders & Non-Correlation with SHIMs. Results Overall we had an 80.7% correlation between TSC and the SHIM Score results. The average SHIM score increased to 15.9 from 10.6, (p<0.006). The average TSC in the left CC increased to 25 from 17.3, (p<0.002). The average TSC in the right CC increased to 24.7 from 17.9, (p<0.002). 54.9% (34 patients) were good responders and the SHIM scores correlated well with TSC. The average SHIM score increased to 17.5 from 10.8, (p<0.001). The average TSC in the left CC increased to 28.1 from 15.3, (p<0.001). The average TSC in the right CC increased to 31.2 from 17.1, (p<0.003). 21.1% (12 patients) were poor responders and the SHIM scores correlated well with TSC. The average SHIM score increased 10.3 from 9.4, (p<0.554). The average TSC in the left CC declined to 13.5 from 15.5, (p<0.559). The average TSC in the right CC declined slightly to 14.9 from 12.5, (p<0.268). 19.3% (11 patients) were a mixture of good and poor responders and the SHIM scores did not correlate well with TSC. The average SHIM score increased to 15.1 from 11.3, (p<0.103). The average TSC in the left CC declined to 25.5 from 26.8, (p<0.919). The average TSC in the right CC declined to 25.5 from 25.7, (p<0.975). Conclusions MPX tissue segmentation software can provide quantitative information about the vascularity of the corpus cavernosa and can differentiate responders to treatment from non-responders. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Morphometrix.

(232) The Use of Restorative Therapies for Erectile Dysfunction: A Review of the Current Canadian Landscape

Abstract Introduction Erectile dysfunction (ED) is the inability to achieve or maintain an erection that is sufficient for sexual performance. Restorative therapies are heralded as options to restore one’s natural, spontaneous erection without the need for pharmacologic therapy. There is a growing interest in these therapies including low-intensity shockwave therapy (Li-EST), platelet-rich plasma (PRP) and stem cells for the treatment of ED. However, limited data exists to support their routine clinical use. With direct-to-consumer marketing, numerous clinics across Canada now offer this therapy. We sought to investigate the landscape of restorative therapies for ED across Canada. Objective The objective is to evaluate how restorative therapies for ED are being marketed and administered to patients. Our study hopes to analyze cost, indications for treatment, equipment utilized, treatment protocol, clinic ownership, level of training for staff, and whether a urologic consult is required prior to treatment. Methods Searches were made on a private Google browser with queries that include phrases “Shockwave therapy for erectile dysfunction in Province/Territory”, “PRP therapy for erectile dysfunction in Province/Territory”, among others. Searches were also made to include any stem cell regenerative therapies for ED. Clinics advertising their services online had their public website analysed for preliminary data collection. Our team captured data on costs, treatment duration, success rates, adjuvant therapies administered and more. Data obtained was then compared against existing literature to assess the accuracy of marketing towards patients. Results To date, we have obtained preliminary results from 107 clinics across Canada offering a form of restorative therapy for ED. We hope to contact every clinic offering these services in Canada by the end of the study period in August of 2023. Out of the identified clinics thus far, 72.9% are offering SWT and 49.5% are offering PRP treatment for ED, with 27.1% of clinics offering both. Our team was unable to identify any clinics providing stem cell therapy for ED. The average cost of SWT from the data we have collected thus far is $1701.92, ranging from $500 to $3500 for a six-treatment protocol that a majority of clinics opt for. Similarly, the average cost of PRP is $1458.22, ranging from $875 to $2000 per treatment. 15% of clinics reported a success rate for SWT, with a mean of 76.81% (ranges 50-100%). A singular clinic has quoted the success rate of PRP at 75% currently. Out of the 107 clinics contacted, 74 of them listed their ownership and staff. 12.2% of the clinics that listed their staff had a urologist present, 56.8% of them had a non-urologist MD employed on staff, and 31.1% did not have an MD present at the clinic. Conclusions Our study has so far found that Li-SWT and PRP for restorative therapies are being largely marketed directly-to-consumer with very little urologic intervention prior to treatment throughout Canada. The study highlights similar trends found in the US, taking advantage of the psychosocial burden faced by patients that suffer from ED, tacking on substantial financial costs for restorative therapies. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

(242) Medicare Beneficiaries with Erectile Dysfunction Who Receive Inflatable Penile Prosthesis: A Real-World, Downstream Revenue Analysis

Abstract Introduction Erectile dysfunction (ED) has a significant negative impact on the quality of life of patients, while also presenting challenges due to the limited access to effective treatment options. Given ED is recognized as a precursor for other chronic health conditions, increasing patient access to ED treatment through men’s health programs may provide economic benefits to a healthcare system through revenue generated from subsequent patient care for other comorbidities. Objective This study quantified the incremental downstream revenue generated from treating men with ED with an inflatable penile prosthesis (IPP) compared to men without ED. Methods This retrospective study used the 100% Medicare Standard Analytical Files to identify men aged 65 years or older with ED who underwent IPP implantation (Current Procedural Terminology 54405) in a hospital outpatient setting between January 1, 2016 and December 31, 2021. To capture 5-year downstream revenue, patients were required to have continuous Medicare Parts A and B enrollment for 12 months pre-index IPP and five years post-index IPP discharge date. Propensity score matching (PSM) was used to match men with ED who received an IPP to men without ED based on demographic and clinical characteristics. Revenue was defined as the sum of the payment for patient services received by hospitals from Medicare, other payor paid amounts, and patient deductibles, copayment, and coinsurance. The total revenue generated was estimated as follows: 1-year pre-IPP, 1-year post-IPP, and 5-year cumulative post-IPP. The 1-year and 5-year downstream revenue was captured post-IPP discharge date and excluded the revenue generated from the index IPP encounter. Revenue was inflated to 2022 US dollars. The mean values and their corresponding standard deviations (SD) were reported. Results Before PSM, the study identified 3,367 men with ED who received IPP and 10,609 men without ED or IPP (mean age: 70; White: 77% vs 79%; Southern region: 53% vs 45%; and Elixhauser comorbidity index score ≥3: 21% vs 20%). Among men undergoing IPP, the average revenue generated was $6,152 (SD: $12,934) at 1-year pre-IPP and $7,898 (SD: $17,794) at 1-year post-IPP. After PSM, the men with ED who received IPP showed a significantly higher 5-year cumulative revenue (n=2,905; mean=$34,571 [SD=$50,234]) compared to the men without ED (n=7,462; mean=$3,189 [SD=$11,527]), respectively. The 5-year cumulative average revenue varied by type of diagnosis: circulatory disease (n=1,597; cost difference=$10,258), urology (n=1,358; cost difference=$2,013), diabetes diagnosis (n=562; cost difference=$2,646), and prostate cancer diagnosis (n=551; cost difference=-$1,043). All statistical analysis results post-PSM are significant at p-value less than 0.05. Conclusions Men with ED who received IPP generated substantially higher revenue for the healthcare system over a 5-year period, nearly ten times as much, compared to men without ED, excluding the initial cost of the IPP procedure. These findings emphasize the financial implications of implementing an advanced ED program aimed at improving access to necessary care for these patients. Healthcare facilities can leverage these insights to effectively allocate resources to deliver critical healthcare to men with ED. Disclosure Yes, this is sponsored by industry/sponsor: Boston Scientific. Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: This study was funded by Boston Scientific. Abimbola O. Williams, Sirikan Rojanasarot, Gregory Moore, Alysha M. McGovern, Liesl M. Hargens, and Erin Turner are employees of Boston Scientific. Paurush Babbar is a practicing urologist at The Urology Group in Cincinnati, Ohio and discloses no financial interests. Andrew Sun is a practicing urologist at Urology Partners of North Texas and serves as a consultant for Boston Scientific, Endo Pharmaceuticals, and Marius Pharmaceuticals. Paurush Babbar and Andrew Sun were not compensated for their participation in this study.

Inhibition of YAP1 Rescues Erectile Dysfunction by Inhibiting Phenotypic Modulation through Myocardin in Diabetic Rats

Background. Phenotypic modulation was shown to be related to the pathological mechanism of diabetes mellitus erectile dysfunction (DMED), and excessive expression of YAP1 was measured in the cavernous tissues of rats with DMED. Objectives. This investigation was performed to explore the efficiency and mechanism of gene therapy through the knockdown of YAP1 in the field of ED treatment. Materials and Methods. Corpus cavernosum smooth muscle cells were obtained and cultivated in vitro employing the explant technique. EdU, CCK-8, and collagen gel lattice contraction assays were subsequently performed to assess cell proliferation and contractility, which indicate smooth muscle phenotypes. Results. Initially, overexpression of YAP1 enhanced the proliferation and expression of YAP1 and osteopontin (OPN) while reducing cell contractility and the expression of myocardin, α-SMA, and calpontin, which is consistent with phenotypic modulation. Moreover, knocking down YAP1 resulted in the opposite effects, and the blockade of myocardin attenuated the reversal of phenotypic transformation. Then, 45 screened DMED rats were randomly divided into three equal groups, named streptozotocin (STZ)-induced DMED with intracavernosal injection of Ad-myocardin (DMED + myocardin), DMED with lenti-shYAP1 (DMED + shYAP1) and DMED with PBS (DMED + PBS), and 10 rats were in the negative control group. Staining with H&E and Masson’s trichrome, immunochemistry, and determination of the ratio of the intracavernosal pressure/mean arterial pressure were performed to evaluate penile erection and histological changes. Western blotting was conducted to determine the molecular protein expression levels. In vivo, similar to myocardin overexpression, YAP1 inhibition rescued erectile function, repaired morphology, and maintained the contractile phenotype of smooth muscle tissues 14 days after treatment. Discussion and Conclusion. In conclusion, our study demonstrated the validity of gene therapy by downregulating excessive YAP1 expression to ameliorate ED in diabetic rats, and the ability of YAP1 inhibition to reverse phenotypic modulation was mediated through interaction with myocardin.

(230) Investigating the Efficacy, Satisfaction, and Predictors of Response to Low-Intensity Shockwave Therapy for Erectile Dysfunction

Abstract Introduction Erectile dysfunction (ED) affects 52% of men in the US, with treatment modalities varying significantly in their degree of invasiveness. Low-intensity shockwave therapy (LI-SWT) is an emerging non-invasive therapy that uses acoustic waves to improve cavernosal arterial flow by inducing microtrauma and subsequent angiogenesis, in addition to enhancing tissue regeneration and reducing local inflammation. Objective Our objective is to investigate the efficacy of LI-SWT, identify factors predictive of response, and explore patient satisfaction and attitudes towards the therapy. Methods An IRB-approved retrospective chart review and survey study was conducted, examining 102 men who underwent LI-SWT for ED between 2009-2022 at a single tertiary referral center. Univariate and multivariate analyses were performed in JMP. Results Out of 102 men, 50 (49.0%) subjects responded to the survey. 22 (44.0%) men reported clinical responses to LI-SWT, with an average improvement of 1.46 on the validated Erection Hardness Score (EHS; scale 0-5). Clinical responders noticed their first response after a mean of 3.53 treatments. 48 of the respondents (96.0%) had previously trialed PDE5 inhibitors, while 18 (36.0%) men previously trialed intracavernosal injections (ICI). On univariate analysis, alcohol use (OR 0.23, 95% CI 0.07-0.77, p =0.015) and prior ICI (OR 0.23, 95% CI 0.05-0.95, p=0.036) use were both associated with lower odds of response to LI-SWT. Interestingly, history of radical prostatectomy (RP) did not correlate with LI-SWT response (p=0.117). These results were redemonstrated on multivariate logistic regression, with alcohol use (OR 0.23, p=0.039) and prior ICI use (OR 0.17, p=0.047) again predicting lower odds of LI-SWT response. Of 28 men who did not benefit from LI-SWT, 5 (18%) progressed to ICI, and 3 (11%) progressed to inflatable penile prosthesis (IPP). Out of all respondents, only 2 men (4%) experienced side effects, which consisted of mild transient pain/paresthesia. No hematomas or bruising were reported, including 8 men on anticoagulants. Clinical responders demonstrated a higher mean satisfaction score of 7.1 on the 10-point Likert scale (somewhat satisfied) compared to non-responders who scored an average satisfaction score of 2.3 (somewhat dissatisfied). Surprisingly, the majority (66%) of the survey respondents were willing to try LI-SWT again, including 54% of first time non-responders. Conclusions Patients with a history of alcohol use and/or prior ICI use were associated with a lower likelihood of response to LI-SWT. LI-SWT demonstrated promising results as a non-invasive option for ED treatment, including treatment refractory ED as well as post-prostatectomy ED, with minimal adverse events. Responders viewed LI-SWT favorably as a modality for treating ED, and the majority of patients who had undergone LI-SWT were willing to try it again. These findings support the use of LI-SWT before resorting to more invasive ED therapies, including surgery. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Mohit Khera - consultant for Endo, Petros, AbbVie, Tolmar, Marius, Halozyme, Boston Scientific.

(288) Trends in Penile Prosthesis Placement in Men with Erectile Dysfunction

Abstract Introduction Erectile Dysfunction (ED) is a common problem impacting 20% of all men. Current treatment options include oral medications, vacuum erection devices, intraurethral suppositories, intracavernosal injections, and penile prosthesis placement (PPP). A shared decision-making framework is increasingly utilized for treatment decisions where an appropriate treatment is selected from all options based on the values and priorities of the patient and their partner. Objective Our objective is to identify trends in PPP, including the proportion of patients who pursue PPP as an initial treatment as well as the time from ED diagnosis to PPP. Methods We retrospectively reviewed all men with an ED diagnosis based on ICD9/ICD10 codes using the IBM MarketScan insurance claims database. The initial treatment option processed through an insurance claim following an ED diagnosis was identified and categorized using ICD, HCPCS, NDC, J, and CPT codes. Time from ED diagnosis to PPP was also recorded. Only patients with at least one year of enrollment pre-ED diagnosis and with at least one year of follow-up were included. Linear regressions were performed to investigate the trends of each year based on the time of initial ED diagnosis. Results We identified a total of 670,096 patients diagnosed with ED between 2012-2019. The mean age was 56 years (47-62). Of those patients, 11% were smokers, 29% had diabetes, 24% had cardiovascular disease, 65% had hypertension, and 29% were obese. Among those who received treatment, the most common initial treatment was oral medications in 26% of patients. PPP was an initial treatment in <1% of patients. The proportion of patients who underwent this surgical intervention as an initial treatment significantly decreased from 2012-2019 (P<0.001) as patients utilized other initial treatment modalities more commonly. Over the same period, the time from ED diagnosis to PPP significantly decreased from approximately 500 days in 2012 to <200 days in 2019 (P=0.001). Conclusions Although the proportion of patients who utilize other ED treatment options prior to PPP is higher, patients diagnosed with ED more recently undergo PPP in a significantly shorter timeframe. Utilization of other treatment modalities as an initial treatment option may stem from changes in insurance coverage. Patients moving more quickly from an ED diagnosis to PPP is likely due to several factors, including improvements in the device leading to less mechanical and infectious complications, familiarity with the device due to marketing, and an earlier discussion with the physician about the device based on a shared decision-making model. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Inherent bio, Paterna bio, Firmtech, Turtle health, Maximus, Carrot.

Protocol for a scoping review to identify research reporting on eating disorders in minority ethnic populations in the UK, Canada, Australia and New Zealand

IntroductionEating disorders (EDs) are common, severe and often life-threatening psychiatric conditions. Notwithstanding stereotypes, EDs affect individuals from all racial and ethnic backgrounds. However, despite similar and in some cases increased...

Effect of BIS-guided anesthesia on emergence delirium following general anesthesia in children: A prospective randomized controlled trial

ObjectiveEmergence delirium (ED) is a postoperative complication in pediatric anesthesia characterized by a perception and psychomotor disorder, with a negative impact on postoperative recovery. As the use of inhalation anesthesia is associated with a higher incidence of ED, we investigated whether titrating the depth of general anesthesia with BIS monitor can reduce the incidence of ED. DesignRandomized, prospective, and double-blind. SettingPatients undergoing endoscopic adenoidectomy under general anesthesia according to a uniform protocol. PatientsA total of 163 patients of both sexes aged 3–8 years were enrolled over 18 months. InterventionsImmediately after the induction of general anesthesia, a bispectral index (BIS) electrode was placed on the patient’s forehead. In the study group, the depth of general anesthesia was monitored with the aim of achieving BIS values of 40–60. In the control group, the dose of sevoflurane was determined by the anaesthesiologist based on MAC (minimum alveolar concentration) and the end-tidal concentration. MeasurementsThe primary objective was to compare the occurrence of ED during the PACU (post-anesthesia care unit) stay in both arms of the study. The secondary objective was to determine the PAED score at 10 and 30 min in the PACU and the need for rescue treatment of ED. Main results86 children were randomized in the intervention group and 77 children in the control group. During the entire PACU stay, 23.3% (38/163) of patients developed ED with PAED score >10: 35.1% (27/77) in the control group and 12.8% (11/86) in the intervention group (p = 0.001). Lower PAED scores were also found in the intervention group at 10 (p < 0.001) and 30 (p < 0.001) minutes compared to the control group. The need for rescue treatment did not differ between groups (p = 0.067). ConclusionIndividualization of the depth of general anesthesia with BIS monitoring is an effective method of preventing ED in children. Clinical trial registrationNCT04466579.

Racial disparities in emergency department utilization among patients with newly diagnosed depression

ObjectiveTo test the hypothesis that racial and ethnic minorities have increased emergency department visit rates, despite being established with a primary care provider. MethodsIn this retrospective cohort study, ED visits without hospital admission in a 12-month period among patients with a new primary care provider-issued diagnosis of depression were assessed. Electronic medical record (EMR) data was obtained from 47 family medicine clinics in a large Michigan-based healthcare system. General linear regression models with Poisson distribution were used to predict frequency of ED visits. ResultsA total of 4159 patients were included in the analyses. In multivariable analyses, Black / African American race was associated with an additional 0.90 (95% CI 0.64, 1.16) ED visits and American Indian or Alaska Native race was associated with an additional 1.39 (95% CI 0.92, 1.87) ED visits compared to White or Caucasians (null value 0). These risks were only exceeded by patients who received a prescription for a typical antipsychotic drug agent. ConclusionDespite being established patients at primary care providers and having follow-up encounters, Black / African American and American Indian or Alaska Native patients with depression were considerably more likely to seek ED treatment compared to White/Caucasian patients with depression.

Unified Protocol for the transdiagnostic treatment of emotional disorders in people with post COVID-19 condition: study protocol for a multiple baseline n-of-1 trial.

Post COVID-19 syndrome, defined as the persistence of COVID-19 symptoms beyond 3 months, is associated with a high emotional burden. Post COVID-19 patients frequently present comorbid anxiety, depressive and related disorders (emotional disorders, EDs) which have an important impact on their quality of life. Unfortunately, psychological interventions to manage these EDs are rarely provided to post COVID-19 patients. Also importantly, most psychological interventions do not address comorbidity, namely simultaneous EDs present in COVID-19 patients. This study will explore the clinical utility and acceptability of a protocol-based cognitive-behavioral therapy called the Unified Protocol for the transdiagnostic treatment of EDs in patients suffering post COVID-19 condition. A multiple baseline n-of-1 trial will be used, as it allows participants to be their own comparison control. Sample will be composed of 60 patients diagnosed with post COVID-19 conditions and comorbid EDs from three Spanish hospitals. After meeting the eligibility criteria, participants will answer the pre-assessment protocol and then they will be randomly assigned to three different baseline conditions (6, 8, or 10 days of assessments before the intervention). Participants and professionals will be unblinded to participants' allocation. Once the baseline assessment has been completed, participants will receive the online psychological individual intervention through video-calls. The Unified Protocol intervention will comprise 8 sessions of a 1 h duration each. After the intervention, participants will answer the post-assessment protocol. Additional follow-up assessments will be conducted at one, three, six, and twelve months after the intervention. Primary outcomes will be anxiety and depressive symptoms. Secondary outcomes include quality of life, emotion dysregulation, distress tolerance, and satisfaction with the programme. Data analyses will include between-group and within-group differences and visual analysis of patients' progress. Results from this study will be disseminated in scientific journals. These findings may help to provide valuable information in the implementation of psychological interventions for patients suffering post COVID-19 conditions. https://clinicaltrials.gov, identifier (NCT05581277).

Effect of Preharvest Ethephon Application on Selected Biochemical Components and Polyphenol Oxidase Activity in Macadamia Nuts

Ethephon is a plant growth regulator that triggers diverse responses in plants, such as fruit ripening, leaf senescence, hull senescence, stem elongation, and nut abscission. This study examined how the preharvest application of ethephon 480 SL® affects selected biochemical components and polyphenol oxidase (PPO) activity in two macadamia nut cultivars: ‘788’ and ‘Beaumont’. Ethephon was applied to the trees via a Cima mist blower at rates of 13.33 mL/L per hectare for the ‘788’ cultivar and 16.67 mL/L per hectare for the ‘Beaumont’. Following harvest, the nuts were stored at 25 °C for 72 days, and samples were taken at 18-day intervals. Standard procedures were used to assess the following: total phenolics, total flavonoids, 2,2,-diphenyl-1-picrylhydrazyl (DPPH) assay, Ferric reducing ability power (FRAP) assay, sucrose, total protein, and PPO activities. This evaluation was carried out across a total of four treatments: ethephon-treated nuts from the orchard floor (ED), ethephon-treated nuts from the tree (ET), untreated nuts from the orchard floor (CD), and untreated nuts from the tree (CT). The evaluation’s outcomes were analyzed using a principal component analysis (PCA), a correlation matrix heat map (CMHM), and a graphical assessment. The results unveiled significant correlations and associations among the assessed parameters. The correlation matrix heat map analysis highlighted a strong positive correlation (0.97) between the sucrose and the PPO activity in the ‘Beaumont’ cultivar, supported by the PCA analysis identifying the ED treatment as the most influential. At the storage period’s conclusion, the ED treatment had the highest sucrose content (18.63 mg/g) and polyphenol oxidase activity (1.06 U g−1). In the ‘788’ cultivar, a close relationship emerged between the phenolic content, the PPO activity, and the Ferric reducing antioxidant power (FRAP)’s antioxidant activity. Consistently, the CT treatment (untreated nuts) demonstrated positive correlations with several key parameters in both cultivars, displaying heightened phenolic content and antioxidant activities. Consequently, our findings indicate that the CT treatment, involving tree-harvested nuts without ethephon application, could be the preferred option for sustaining macadamia nuts’ quality and shelf life compared to other methods. Moreover, our study underscores the significance of proper storage conditions for maintaining the desired biochemical parameters of macadamia nuts. By comprehending the effects of distinct treatments and harvesting techniques, producers and processors can devise strategies to optimize storage conditions and uphold macadamia nut quality.

Finding Voices: a survey of young people’s experiences of the ED

BackgroundMental health presentations in young people are increasing. Recurrence of self-harm (SH) presentations is common and of great concern since self-harm is known to be a risk factor for suicide....

A Case Report of Food Impaction Relieved by Warm Water Drinking Therapy

BackgroundEmergency department (ED) management of esophageal food impaction without high-grade obstruction is highly variable, without definitive and validated interventions being supported in medical literature. Case ReportWe discuss a 34-year-old male patient with diagnosis of eosinophilic esophagitis and history of multiple food impactions presenting to the ED with a food impaction. Based on a known esophageal history with repeated failure of pharmacologic interventions, the patient was submitted to a new conservative treatment of warm water drinking. Why Should an Emergency Physician Be Aware of This?This case report suggests warm water ingestion as a novel, safe, and successful treatment method in the management of esophageal food bolus impaction. As a conservative treatment not deviating greatly from current ED treatment options, it can reduce patient length of stay and decrease exposure to potential morbidity via invasive endoscopic or surgical intervention. It should be further investigated and validated with a large cohort study.

Removal of heat stable salts from degraded amine solvent by “BMED+ED” two-stage electrodialysis unit

Due to the degradation reaction and the presence of acidic impurities (HCl, SO2, etc.) in the flue gas, heat stable salts (HSS) are widely present in the aqueous amine solvent for post-combustion CO2 capture. Accumulation of HSS in the solvent can lead to decreased absorption capacity and even corrosion of equipment in post-combustion capture (PCC) pilot plants. This study presents a novel “BMED+ED” two-stage electrodialysis unit for the efficient removal of HSS, including glycolate, formate, Cl−, and SO42−, from degraded amine solvent with an initial loading of approximately 0.38 mol/mol taken from the solvent loop of a PCC pilot plant after over 1000 hours of operation at real conditions. Experimental results showed that 94.93% of HSSs were removed with an initial HSS concentration of approximately 1920 ppm. The amine loss rate in the two-stage electrodialysis unit was much lower than that in a conventional ED unit, as protonated amine is further converted to organic amines by bipolar membrane electrodialysis. The energy consumption of the two-stage electrodialysis unit was 0.1643 kWh/L amine solvent, and the total cost for amine reclaiming was 1.8145 $/kg amine. This method effectively addressed the challenges of high amine loss rate in the traditional ED treatment process and hazardous wastewater disposal.

Attachment-Based Family Therapy to Improve Family Functioning in Adolescent Binge-Spectrum Eating Disorders: An Initial Evaluation Via Case Series Design.

Binge-spectrum eating disorders (EDs; bulimia nervosa, binge eating disorder) often develop during adolescence and are associated with serious psychological and physical consequences. Current treatments for adolescents are highly behavioral in nature and while efficacious, many patients do not reach remission indicating that current treatments fail to target a key maintenance factor for EDs. One potential maintenance factor is poor family functioning (FF). In particular, high family conflict (e.g., arguing, critical comments) and low family cohesion (e.g., warmth, support) are known to maintain ED behaviors. Poor FF can (1) cause or exacerbate an adolescent's use of ED behaviors to cope with life stress and/or (2) inhibit parents from being a resource to adolescents during ED treatment. Attachment-Based Family Therapy (ABFT) is specifically designed to improve FF, and thus may be a promising adjunct to behavioral ED intervention strategies. ABFT, however, has not been tested in adolescents with binge-spectrum EDs. Thus, the current study is the first to evaluate a 16-week adapted ABFT treatment for adolescents with EDs (N = 8, Mage = 16.00, 71.43% female, 71.43% White) fusing together behavioral treatment for EDs with ABFT for highest possible impact. Eight families were treated in an open pilot trial to examine treatment feasibility, acceptability, and preliminary efficacy on FF and eating pathology. Overall, findings were promising. ABFT + B treatment was feasible and acceptable and showed preliminary evidence that it could improve FF and ED behaviors. Future research will test this intervention in a larger sample and further examine the role of FF in maintaining ED symptoms.

1842-PUB: Ischemic Stroke in Patients with Diabetes Mellitus during COVID-19 Pandemic in South Korea, Using National Emergency Department Information System

Background: Coronavirus disease 2019 (COVID-19) put strain on patients using health care services, which results in suboptimal care for diseases requiring prompt management, such as ischemic stroke. Patients with diabetes mellitus (DM), high risk group of stroke, were compromised with routine diabetic care during pandemic. Until now, the influence of this outbreak on the management of ischemic stroke has not been clarified both in total and DM subjects. Methods: This nationwide population-based study analyzed 11,734 patients diagnosed of acute ischemic stroke and underwent intravenous thrombolysis (IVT) or endovascular thrombectomy (EVT) during January 2019 (reference year) to December 2020 (pandemic year). The changes in the frequency of ED visit, treatment modality and outcomes by ischemic stroke were compared between pandemic and reference period. Subgroup analysis in DM patients was also performed. Results: During COVID-19 pandemic, incidence of ischemic stroke available requiring for urgent procedures increased by 7.57% in South Korea (5,653 in 2019 vs 6,081 in 2020). In total subjects, time for symptom onset to ED visit and for ED visit to admission was significantly delayed. As a treatment modality, the rate of IVT increased, while that of patients applied mechanical ventilation decreased. Especially, DM patients aged more than seventies exhibited a significant higher chance to ICU admission rate during pandemic (p-value &amp;lt; 0.01). Nevertheless, there was no significant difference in hospital-stay days and in-hospital mortality both in total and DM subjects. Conclusion: During COVID-19 pandemic, the incidence of ischemic stroke necessary for emergency care was increased and elderly DM patient showed a higher ICU admission rate. However, overall treatment outcome of ischemic stroke was preserved during this outbreak period in South Korea. Disclosure M.Park: None. S.Jang: None. K.Choi: None. S.Baik: None. H.Yoo: None.

Digital communication and virtual reality for extending the behavioural treatment of obesity – the patients’ perspective: results of an online survey in Germany

BackgroundCBT has been found effective for the treatment of EDs and obesity. However not all patients achieve clinically significant weight loss and weight regain is common. In this context, technology-based interventions can be used to enhance traditional CBT but are not yet widespread. This survey therefore explores the status quo of pathways of communication between patients and therapists, the use of digital applications for therapy as well as attitudes towards VR from the perspective of patients with obesity in Germany.MethodsThis cross-sectional online survey was conducted in October 2020. Participants were recruited digitally through social media, obesity associations and self-help groups. The standardized questionnaire included items concerning current treatment, paths of communication with their therapists, and attitudes toward VR. The descriptive analyses were performed with Stata.ResultsThe 152 participants were mostly female (90%), had a mean age of 46.5 years (SD = 9.2) and an average BMI of 43.0 kg/m² (SD = 8.4). Face-to-face communication with their therapist was considered of high importance in current treatment (M = 4.30; SD = 0.86) and messenger apps were the most frequently used digital application for communication. Participants were mostly neutral regarding the inclusion of VR methods in obesity treatment (M = 3.27; SD = 1.19). Only one participant had already used VR glasses as part of treatment. Participants considered VR suitable for exercises promoting body image change (M = 3.40; SD = 1.02).DiscussionTechnological approaches in obesity therapy are not widespread. Face-to-face communication remains the most important setting for treatment. Participants had low familiarity with VR but a neutral to positive attitude toward the technology. Further studies are needed to provide a clearer picture of potential treatment barriers or educational needs and to facilitate the transfer of developed VR systems into clinical practice.

(379) The Effectiveness of Low-intensity Shock Wave Therapy as an Emerging Non-invasive Management of Erectile Dysfunction Among Adult Males: A Systematic Review and Meta-analysis

Abstract Introduction Erectile dysfunction (ED) is the penile inability to sustain erection necessary for sexual function due to physiological, psychological, or emotional factors. While the WHO promotes sexual health for all individuals, ED remains a major influence in attaining satisfying sexual performance among the aging population of men. The effective management and treatment of ED has been primarily pharmacologic and the research to support other non-invasive management such as low-intensity shock wave therapy (Li-ESWT) is apparently limited. Objective This systematic review and meta-analysis of available randomized controlled studies investigates the effectiveness of Li-ESWT for ED among adult males based on the International Index of Erectile Dysfunction (IIEF) score. Methods The literature search was conducted using the PubMed database. The search was limited to randomized controlled trials on the effectiveness of Li-ESWT on ED, written in English from Medline and Nursing journals, and are publicly accessible without monetary cost published from 2012 to 2020. PRISMA guidelines were used as framework for literature search and review. The RevMan software was utilized for data collection and analysis. A fixed effect model was used in the meta-analysis. Results A total of 19 randomized controlled trials were reviewed of which three were included in this meta-analysis. There were total of 120 participants with overall mean age ranges from 41 to 61 years, 61 were enrolled in Li-ESWT group and 59 in the sham group. The heterogeneity of the data shows □2 = 7.70, df= 2, (p= &amp;lt;0.05); I2 = 74%, the overall effect is Z= 3.35, p = &amp;lt;0.05. This meta-analysis demonstrates that the control group (sham) was favored over the experimental group (Li-ESWT) (SMD= 0.64, 95% CI, [0.27, 1.02]) based on the mean IIEF score at the end of the studies. Conclusions The use of shock wave therapy in addition to pharmacologic and non-invasive modalities in the treatment and management of ED is promising. However, while the dearth of randomized clinical trials using Li-ESWT for ED management is evident, the decision to proceed with treatment is based on the informed and collaborative decision between the urologist and the patient. This review highlights that sham therapy is not inferior to Li-ESWT treatment. The urologists may consider the cost, adverse effects, time, and effort of using Li-ESWT provided that there is no significant difference in the effectiveness of Li-ESWT compared with sham treatment. Further research is needed to support effectiveness and safety of Li-ESWT in managing ED compared to current pharmacologic regimen. Disclosure No