Injection Therapy Research Articles

Cellular Enhancement of Frozen Meniscus Allograft Combining Native Meniscus and Mesenchymal Stromal Cell Injections.

This proof-of-concept study investigated an improved cell-based injection therapy combining mesenchymal stem cells (MSCs) and meniscus cells (MCs) to support superior meniscus allograft repopulation and early revival compared to injecting MSCs alone. In this controlled laboratory study, frozen meniscus allograft samples were injected vertically with a cell suspension containing different ratios of MSCs and MCs or control (lactated ringers) and cultured for 28 days. Samples were analyzed weekly for cell viability, migration, and metabolism using histological and biochemical assays. Tissue medium was analyzed for matrix metalloproteinase (MMP) expression using zymography. Cellular repopulation of frozen allografts injected with different cell suspensions was validated by immunohistochemistry. Significant higher DNA content was evidenced in grafts treated with suspensions of MCs or MC:MSC (1:4 ratio). Cell metabolic activity was significantly different between all treated groups and control group after 1 week. Allografts injected with MCs showed significantly more cell proliferation than injections with MSCs. MMP2 activity was detected in medium of all grafts cellularized with MCs with or without MSCs. Scanning electron microscopy (SEM) analysis showed resolution of the needle puncture, but not in the control group. Cell labeling of MCs upon injection of mixed MC:MSC suspensions revealed a gradual increase in the cell ratio. The findings of this study establish that injection of MCs with or without MSCs enhances the cellularity of meniscus allograft to support early graft revival and remodeling.

Опыт лечения энтезопатий методикой локальной инъекционной терапии

Введение. Особенность энтезопатий, или периартропатий, заключается в том, что, являясь участком постоянного биомеханического напряжения и оказывая влияние на соседние твердые и мягкие ткани, энтезис формирует воспалительный импульс, приводящий к развитию воспаления в синовиальной оболочке, прилегающей к энтезису. Одним из патогенетически обоснованных шагов в лечении энтезопатий является метод периартикулярного введения хондропротектора. Этот метод позволяет воздействовать на различные звенья воспалительного процесса, влиять на клеточное дыхание. Цель работы. Изучить влияние локальной инъекционной терапии метаболическим специфичным стимулятором репарации соединительной ткани на течение периартропатий. Материалы и методы. 10 пациентам (6 женщин и 4 мужчины в возрасте 54,3 ± 0,4 года) проведено лечение явлений энтезопатий инъекционным методом с использованием метаболического специфичного стимулятора репарации соединительной ткани. 8 пациентам был выставлен и инструментально подтвержден диагноз «трохантерит односторонний», двум пациентам – «двусторонний эпикондилит». Инъекции проводились периартикулярно по 2 мл каждые 3 дня, всего выполнено 5 уколов. Для оценки результатов использовали шкалу оценки интенсивности боли ВАШ, а также сравнивали объем движений в тазобедренном и локтевом суставах до и после лечения. Всего было три контрольных точки – до начала лечения, в момент окончания лечения и через 14 дней после последнего введения препарата. Заключение. Показано, что при локальном введении препарата начинает преобладать репаративная стадия и исход воспаления в сухожильной части мышц. Клинически это наблюдается в виде улучшения функции и ликвидации боли. Background. The peculiarity of enthesopathies, or periarthropathies, is that, being an area of constant biomechanical stress and influencing adjacent hard and soft tissues, the enthesis forms an inflammatory impulse, leading to the development of inflammation in the synovial membrane adjacent to the enthesis. One of the pathogenetically substantiated steps in the treatment of enthesopathies is the method of periarticular administration of a chondroprotector. This method allows you to influence various parts of the inflammatory process and influence cellular respiration. Objective. To study the effect of local injection therapy with a metabolic specific stimulator of connective tissue repair on the course of periarthropathies. Materials and methods. 10 patients (6 women and 4 men aged 54.3 ± 0.4 years) were treated for enthesopathies by injection using a metabolically specific stimulator of connective tissue repair. Eight patients were diagnosed with "unilateral trochanteritis" and instrumentally confirmed, and two patients were diagnosed with "bilateral epicondylitis." Injections were performed periarticularly, 2 ml every 3 days, for a total of 5 injections. To evaluate the results, we used the VAS pain intensity scale, and also compared the range of motion in the hip and elbow joint before and after treatment. There were three control points in total before the start of treatment, at the end of treatment and 14 days after the last administration of the drug. Conclusion. It has been shown that when the drug is administered locally, the reparative stage and the outcome of inflammation in the tendon part of the muscles begin to predominate. Clinically, this is observed in the form of improved function and elimination of pain.

(011) Implementing Virtual Intracavernosal/ Penile Injection Therapy (ICI) Training in a Prostate Cancer (PC) Supportive Care Program

Abstract Introduction The Sexual Health Clinic (SHC) offered by our prostate cancer (PC) supportive care program delivers sexual health care for PC patients and their partners. Over a two-year period, patients receive seven appointments in which different options for sexual satisfaction are explored, including intracavernosal/penile injection therapy (ICI). Since April 2020, sexual health clinicians have provided virtual and in-person ICI training appointments. Before each appointment, patients are instructed to review educational material, including an educational video, an ICI instruction booklet, and ICI dosing handout. Objective To evaluate the effectiveness of ICI training presented virtually compared to in-person by comparing clinical and patient-reported outcomes (PROs) in each group. Methods All patients who received ICI training between January 2019 and April 2023 were included in this retrospective chart review. PROs from the SHC were obtained prospectively during service as part of usual clinical care. Results Over 4.3 years, 74 patients received ICI training, 54 virtually and 24 in-person. All patients were in heterosexual relationships and rated their pre-treatment erectile function as a median of 9 on a scale of 0-10, with 10 being the highest level of erectile function. In contrast, the median erectile function for all patients was 0 after PC treatment. At the time of attending the SHC, most patients expressed ‘resume intercourse’ as their goal of treatment. Table 1 shows that the demographics of each group are similar with respect to age, education level, ethnicity, and partner information. The use of erectile aids after PC therapy is shown in Table 2. Most patients had not attempted ICI before enrollment in the SHC and were not satisfied with other options offered by the SHC. Details of ICI treatments and response to therapy are shown in Table 3. Overall outcomes and satisfaction rates were similar between groups. Conclusions Overall, clinical outcomes with ICI training in the virtual format do not appear to differ from that done in person. Patient satisfaction with ICI is better than other erectile aid options in each group but is still low. In the future, we will prospectively assess ICI usage and outcomes at 3, 6, and 12 months after ICI training to determine treatment adherence, complications, and long-term patient satisfaction with ICI training across the different delivery methods. Disclosure No.

(176) Prior Intracavernosal Injection Therapy and Prostate Cancer Treatment are Both Independently Associated with Increased Risks of Complications in Men Undergoing Inflatable Penile Prosthesis Placement

Abstract Introduction Intracavernosal injection (ICI) therapy for erectile dysfunction (ED) carries a risk of corporal fibrosis, potentially making placement of an inflatable penile prosthesis more difficult. Prostate cancer treatment may also induce corporal fibrosis. Objective To assess whether a history of ICI or prostate cancer treatment is associated with complications following IPP placement. Methods A retrospective cohort study of primary IPP cases from 2016-2021 across 16 institutions. Patients were stratified by history of ICI and between-group differences in risk factors were assessed. Multivariable logistic regression was used to assess for predictors of intraoperative complications, postoperative non-infectious complications and postoperative infection. Results A total of 2540 patients met inclusion criteria of which 781 (30.8%) had a history of ICI. Patients with a history of ICI tended to be older (mean 63 vs 64 years, p=0.002) and were more likely to have history of radical prostatectomy (21.0% vs. 32.1%, p<0.001) and/or radiation (5.51% vs 10.9%, p<0.001). On multivariable regression, a history of ICI, prostatectomy, and radiation were all significant predictors of intraoperative complications (OR 2.11, p=0.03; OR 2.27, p=0.03; OR 2.40, p=0.04, respectively). A history of ICI and patient age were predictors of non-infectious postoperative complications (OR 1.44, p=0.02, OR 1.02, p=0.004 respectively)). None of the variables were significant predictors of infection. Conclusions In men undergoing IPP placement, a history of ICI is associated with an increased risk of both intraoperative and postoperative, non-infectious complications. Prostate cancer treatment with radiation or surgery is independently associated with increased risk of intraoperative complications. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: D.O. has served as a consultant for Coloplast, Intuitive Surgical, and Fidelis. P.P. has served as a consultant for Coloplast, Boston Scientific, and Urofill. M.S. has served as a consultant for Boston Scientific and Coloplast. J.S. has served as a consultant for Boston Scientific and Coloplast. F.A.Y. has served as a consultant for Coloplast, Cynosure, Antares Pharma, Clarus Pharmaceuticals, and Acerus Pharma. M.S.G. has served as a consultant for Coloplast. The other authors disclose no conflicts.

(287) A Patient's Journey with Erectile Dysfunction: Prediction Progression to Penile Implant

Abstract Introduction Inflatable penile prosthesis (IPP) is seen as the gold standard for surgical treatment for ED, specifically for patients that are not amenable to lifestyle changes or oral medications. Objective This study aims to explore which patients progress to seeking treatment with an IPP along their journey with erectile dysfunction. Methods This retrospective study identified patients with ED as a chief complaint during the primary visit or follow-up from 2009-2022. If patients eventually progressed to treatment with IPP, data was collected to find common features and analyzed. Results Of our cohort of 361 men presenting with erectile dysfunction (ED), 21 men progressed to the placement of an inflatable penile prosthesis (IPP). 20 men classified as non-Hispanic, with 13 white, 6 African American/black, and 1 Asian males. Only 1 man was Hispanic. 5 men had either hypertension (n = 11), hyperlipidemia (n = 10), or DM (n = 3), with 6 having both hypertension and hyperlipemia, 1 with hypertension and diabetes, and 1 with hypertension, hyperlipidemia, and diabetes. Median age of the group at surgery was 76 years (IQR: 71 – 82), with median time from initial presentation to surgery of 12 (IQR = 11.5-27.5) months. N = 10 men had trialed oral phosphodiesterase inhibitor type 5 (PDE-5i) therapy, and 7 men failed intracavernosal injection (ICI) therapy. 8 men had been treated for hypogonadal symptoms with testosterone replacement therapy (TRT). Of patients who had data available on their reason for IPP placement, indications included were Peyronie’s disease inhibiting intercourse (8/21), longstanding ED refractory to medical therapy (4/21), post-prostatectomy ED (4/21), history of priapism requiring surgical intervention (1/21), and history of spinal cord tumor (1/21). Among those treated with IPP, the median patient waited almost 1 year from initial presentation following failure with PDE5i, ICI, and TRT. 17/21 men reported satisfaction after IPP treatment. In those who progressed to IPP, the majority of indications were organic forms of ED (Peyronie’s disease, neurogenic, surgery). Conclusions Only 5.8% of men in this cohort went on to proceed with an IPP. In summary, our results indicate that IPP is best suited for those presenting with organic ED who have failed more conservative management techniques. Further studies are needed to assess why so few men go on to proceed with an IPP and wait an average of 2 years. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.

(051) Safety of Novel Hyaluronic Acid Dermal Filler Injections for Penile Girth Enhancement

Abstract Introduction Limited data exist regarding safety of penile girth enhancement treatments. Reported options for girth enhancement include injections of autologous fat, liquid silicone, hyaluronic acid (HA), or polymethyl-methacrylate, grafting with dermal fat, porcine dermal acellular matrix, or acellular collagen matrix, and surgical placement of a silicone implant. Objective The purpose of our study was to retrospectively evaluate safety in a cohort of men undergoing penile girth enhancement with HA dermal filler at a single site by reporting on post-procedure complications. Methods We performed a retrospective review of men who underwent penile girth enhancement with HA dermal filler from August 2020 through April 2023. Results 471 men underwent penile girth enhancement with HA dermal filler. Two patients experienced injection site infections related to non-compliance post treatment with infection resolution after completing a course of oral antibiotic. One patient reported urinary tract infection symptoms shortly after HA dermal filler procedure and subsequently underwent additional filler injections without recurrence of urinary symptoms. One patient underwent reversal with hyaluronidase after his initial treatment. Three patients developed granulomas which were completely resolved with a single treatment of hyaluronidase. All three of these patients underwent additional HA injections without granuloma formation. Three patients experienced priapism treated without long term sequelae when intracavernosal injection (ICI) therapy was used for tumescence at time of filler injection. Once ICI was no longer used, no patients reported priapism. No patients reported erectile dysfunction or loss of sensitivity. Conclusions Our study suggests that injection of HA dermal filler may be a safe option for men interested in penile girth enhancement. While rare complications may occur, our research suggests they are easily treatable in the outpatient setting without long term sequelae. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: PhalloFill.

(081) Fertility Trends in Men with Prior History of Anabolic Steroid Use: Results from a Standardized Treatment Regimen

Abstract Introduction The management of infertility in men who have previously used anabolic steroids poses a complicated clinical challenge. Addressing the infertility issues in this specific population requires a comprehensive approach that considers the underlying physiological alterations caused by anabolic steroid use and tailors treatment interventions accordingly to restore and optimize reproductive function. In this study, we report an analysis of sperm parameter recovery and fertility outcomes in men who had azoospermia or severe oligospermia caused by anabolic steroid use and underwent a standardized treatment regimen for recovery of spermatogenesis. Objective The study aims to assess the longitudinal trends in sperm concentrations, determine the proportion of men achieving normozoospermia, and evaluate subsequent pregnancy rates in this specific population. Additionally, the study seeks to identify potential predictors for improved semen parameters and successful pregnancy outcomes. Methods A retrospective analysis of the period spanning from 2018 to 2022 was conducted on a cohort of men with a prior history of anabolic steroid use who complained of infertility. The standardized treatment approach involved the cessation of testosterone replacement therapy (TRT) and the administration of a combination regimen comprising clomiphene citrate and human chorionic gonadotropin (hCG) for a minimum of 3 to 6 months. Following adequate treatment, men were contacted in March 2023 to determine the most up-to-date pregnancy outcomes. Statistical analysis was performed utilizing SPSS, employing univariate logistic regression analysis to establish a predictive mathematical model. The level of statistical significance was defined as p < 0.05. Results A total of 45 men (median age 37 years, IQR 32-45) met inclusion criteria for this analysis. Median duration of prior T use was 4 years (IQR 1.3-10), with the two most common modalities consisting of injection therapy (43.5%) and oral therapy (34.8%). Median initial sperm concentration was 0 million/cc (IQR 0-1.15), and 23 (51.1%) men initially presented with azoospermia. The median duration of combination hCG/clomid therapy was 5 months (IQR 3-12). In initially azoospermic men (N:23), 5 were lost to follow-up, 6 (33.3%) progressed to severe oligospermia (<5 million/cc), 6 (33.3%) to oligospermia (<15 million/cc), 1 (5.6%) to normozoospermia (>15 million/cc), and 5 (27.8%) remained azoospermic following medical treatment for 6 months. Among the 24 couples who responded to the follow-up call, a total of 9 (37.5%) achieved a successful subsequent pregnancy. Of these, 33.3% (3 couples) used assisted reproductive technology (ART), while 66.7% (6 couples) conceived naturally. On logistic regression analysis, no significant predictors for improved sperm parameters or successful pregnancy were identified. Conclusions Despite the implementation of appropriate treatment regimens, a significant proportion of men with a prior history of anabolic steroid use continue to exhibit severe oligospermia, with more than half failing to demonstrate substantial improvement in their semen parameters even after undergoing a six-month medical treatment protocol. Moreover, only a fraction of men, estimated to be 1 in 6, achieve normozoospermia following medical treatment after anabolic steroid use. Future work should continue to explore predictors for improved sperm parameters on follow-up as well as subsequent successful pregnancy in men with prior history of anabolic steroid use. Disclosure No.

(119) Impact of Ethnicity on Clinical Outcomes of Intralesional CCH in Peyronie's Disease Patients Across Kaiser Permanente Southern California Database

Abstract Introduction Intralesional CCH injection is an effective treatment for Peyronie’s disease (PD) that utilizes collagenolytic enzymes to break down collagen plaque, thus reducing the penile deformity. The IMPRESS I and II clinical trials demonstrated efficacy of CCH in a predominant Caucasian population of men (95.8%). Little is known about treatment efficacy in the non-Caucasian population. Objective Using Kaiser Permanente’s ethnically diverse database, we sought to study the impact of race on CCH treatment outcomes. Methods This study examined the efficacy of intralesional CCH injection in a large healthcare system over 15 years. We defined treatment efficacy as percent change in penile curvature abnormality from baseline after a maximum of 4 treatment cycles. Impact of comorbidities on CCH efficacy was also examined. Patients with ventral curvature or initial curvature <30 ̊ or >90 ̊ were excluded from analysis. Standard statistical analysis was performed. Results 112 patients underwent CCH therapy and were included in this analysis. 46.4% of men completed all 4 cycles. Among men who received CCH, 66.1% were Caucasian, 22.3% Hispanic, and 9.8% African American. For co-morbidities, 87.5.% of men were not diabetic, while 22.3% of men had erectile dysfunction. The mean baseline pre-injection penile curvature was 51.63 degrees (range was 32-87 degrees). Caucasian men had the largest treatment response to CCH (45.6% decrease in penile curvature) compared to African American men (43.7%) and Hispanic men (40.5%), p = 0.9554. Non-diabetic men had a larger treatment response to CCH (44.9% decrease in curvature versus 39.3% in diabetics, p = 0.4726). Younger Men (age 18-44) also experienced a greater treatment response compared to other age groups (57.9% reduction in curvature, p = 0.171). There was a significant difference in number of cycles completed across different ethnicities (p = 0.0220). Hispanic men were significantly less likely to complete all 4 cycles of CCH compared to Caucasian and African American men (p=0.0004). Only 28.2% of Hispanic men completed all 4 treatment cycles. 48% of Hispanic patients report the need of language interpretation services during health appointments. Conclusions This is the largest post-market analysis of CCH treatment outcomes in a racially diverse PD population. Caucasian men had a greater treatment response after CCH injection possibly due to higher rate of completing all 4 treatment cycles. Nondiabetic men and younger men (aged 18 to 44) also had a greater treatment response after CCH injection. Hispanic men were significantly less likely to complete 4 cycles of injection therapy; possible explanations include language barriers. Future study is needed to determine if patient resources prepared in Spanish can improve treatment outcomes in Hispanic men with PD, and reduce these health care disparities observed in our study. Disclosure No.

(272) Botulinum Toxin Injection in Vulva and Vagina: Evidence from a Literature Systematic Review

Abstract Introduction Vaginismus, vulvodynia and chronic pelvic pain are a group of pain syndromes that may have, in addition to pain, other types of symptoms. Often no specific etiology can be identified, and the choice of treatment is complicated. Although several treatment methods have been proposed, evidence-based therapies are limited. Therapies can be classified in medical, surgical and interventional treatment. Interventional therapy contemplates injection therapy with botulinum toxin, proposed in 1997 Objective To evaluate the BoNT injection in the comprehensive care of vaginismus, vulvodynia and chronic pelvic pain and to enhance the impact on the sexual arousal. Methods 1108 patients, Randomized Controlled Trials (RCT) were 7. The Retrospective Studies Without a control group were 4, With a control group: 1. Besides, the Prospective Studies Without a control group were, . 2 patients were With a control group. The BoNT Dosage Range was: Minimum: 12 UI Maximum: 500 UI Types of BoNT Products: Botox® (onabotulinumtoxinA): 14 Xeomin® (incobotulinumtoxinA): 3 Dysport® (abobotulinumtoxinA): 3 Unspecified BoNT Product: 1 EMG-Guided Injection: 5 I used as BoNT Administration Techniques, the Digital Palpation: 12, the unspecified Injection Procedure: 4. My methods were 17 patients in Intramuscular Injection, 3 patients with Vaginal Submucosal Plane, and one patient with Subcutaneous Injection. Results For Vaginismus, Significant improvement in sexual and orgasmic dysfunction Successful intercourse Reduction of vaginal muscle resistance Improved sexual function (evaluated by Female Sexual Function Index) Pain reduction and improved quality of life (Short-Form Health Survey) BoNT reduced muscular hyperactivity. Both BoNT and placebo improved sexual pain, function, and distress for patients with vulvodynia, Significant improvement in pain 4, improved quality of life 2 and increase of sexual activity due to the reduced pelvic hypertonicity. Other Study Results: Significant improvement in pelvic pain [22, 23, 31, 32] Reduction of vaginal pressure [32] Improvement in quality of life, sexual activity, and reduced pelvic floor muscles myoelectrical activity [31] Conclusions Different endpoints and different methods of analysis. Different types of participants. Various techniques and timing. Adverse events. For this reason, even though BoNT seems a promising treatment, a clear standardization in clinical guidelines is still lacking. A clear standardization is needed for practical guidelines. Future perspectives should address reproducible protocols for BoNT administration. Disclosure No.

(390) A Preliminary Analysis of Outcomes and Complication Rates for Patients Undergoing Inflatable Penile Prosthesis Implantation following Intracavernosal Injection Therapy With or Without Concurrent Anticoagulation

Abstract Introduction Medications, namely antiplatelets (AP) and anticoagulation (AC), are effective at avoiding fatal vascular complications and prolonging the lives of our patients. As such, more and more men seeking treatment for erectile dysfunction (ED) also take blood thinners. This is an interaction we must better understand to provide safe, individualized care to our patients and minimize peri-operative morbidity. Currently, there is no published information on whether differences exist in the escalation of treatment for patients with erectile dysfunction and on AC. A previous study has demonstrated no statistically significant difference in complications between AC and non-AC groups while on ICI, despite there being a higher rate of absolute bleeding events for AC patients. Objective To compare outcomes and complication rates in patients undergoing IPP implantation following ICI therapy with or without concurrent anticoagulation. Methods A retrospective observational study was undertaken. Electronic patient records from January to September 2021 were reviewed. Included patients were those who had either currently or previously utilized ICI therapy for ED treatment. ICI therapy surveys and Erectile Dysfunction Inventory for Treatment Satisfaction (EDITS) questionnaire were obtained. 85 patients met the inclusion criteria; 43 concurrently using AC during ICI therapy and 42 with no AC use. Patients who were unable to completely stop their AC medications a week before surgery due to cardiovascular concerns or recommendations, underwent bridging with a shorter half life and reversible AC. Extra measures taken during the IPP for such patients, including meticulous hemostasis, compression dressing and drain insertion. Additional data regarding IPP implantation as well as any complications or infections experienced following IPP surgery which were compared between the AC and no AC groups. Results Patient demographics, IPP implantation information and subsequent complication rates are listed below in Table 1. There was no statistically significant difference in the rate of patients who underwent IPP placement between the AC and no AC cohorts. Moreover, there was also no statistically significant difference in median time from date of initial ICI usage to time of IPP placement as well as median time from IPP placement to last follow-up. Among the 12 total patients who underwent IPP placement, none experienced any complications, including infection, mechanical failure, device removal or revision at any time point up to last follow-up (longest was 18 months). No statistically significant differences in EDITS score between both groups was observed. Conclusions These preliminary findings, while requiring large-scale follow up, show that there is no statistically significant difference in rate of patients opting for IPP surgery following initiation of ICI therapy regardless of concomitant AC usage as well as the rate of complications following IPP implantation. Lastly, there is no drawbacks in performing such procedure in this specific cohort of patients, provided that all necessary measures are taken into consideration to minimize bleeding complications. Disclosure No.

(318) Factors Influencing Compliance with Trimix, an Intracavernosal Injection for Erectile Dysfunction: A Retrospective Analysis

Abstract Introduction Trimix, an intracavernosal injection therapy, is an effective treatment for erectile dysfunction. However, patient compliance with Trimix use is crucial for treatment success, and factors influencing compliance are not well understood. Objective This retrospective analysis aimed to identify factors that influence compliance with Trimix therapy among patients with erectile dysfunction. Additionally, the study aimed to investigate the impact of comorbidities, specifically diabetes and prostate cancer, on the duration of Trimix treatment. Methods Patient data from pharmacy records between 2017 and 2022 was analyzed. Custom Python code was used to calculate the duration of Trimix use based on the first and last prescription refill events. A comprehensive chart review was conducted to collect additional patient-related data, including demographics and comorbidities. Cox Proportional Hazards Regression models were employed to assess the effects of predictor variables on the duration of Trimix use. Simple linear regression was used to compare the presence of diabetes, prostate cancer, or both on time spent on Trimix treatment. Results The analysis included a total of 4,072 patients. Age was identified as a significant predictor of Trimix therapy discontinuation, with every additional year of age associated with an increased hazard ratio of 1.007 (p < 0.001). Preferred language also emerged as a significant predictor, with patients preferring Spanish exhibiting a higher hazard ratio of 1.163 compared to patients preferring English (p = 0.004). In terms of comorbidities, the presence of prostate cancer significantly differed from other organic causes of erectile dysfunction on time spent on Trimix treatment (p = 0.002), resulting in 80 fewer days of Trimix treatment. Conclusions This retrospective analysis revealed that age and preferred language are important factors influencing compliance with Trimix therapy. Older patients and those preferring Spanish were more likely to discontinue Trimix treatment. Additionally, the presence of prostate cancer significantly impacted the duration of Trimix treatment. These findings emphasize the need for age-specific counseling, language-concordant interventions, and tailored approaches to address comorbidities such as prostate cancer. Understanding these factors is vital for optimizing treatment adherence and efficacy in patients with erectile dysfunction. Disclosure No.

Historical and contemporary management of infantile hemangiomas: a single-center experience.

Objective: This study explores the 22-year evolution of Infantile Hemangiomas (IHs) treatment strategies at a single-center hospital, aiming to establish an individualized IHs management protocol. Methods: Retrospective review of IHs infants 2000-2022 at the Department of Plastic Surgery, Jiangxi Provincial Children's Hospital. Results: In our study of 27,513 IHs cases, 72.2% were female, with the median age at first hospital visit being 25 days. The majority of cases had localized and superficial lesions primarily on the head, face, and neck (67.5%). Ulceration rates fell from 21.1% to 12.6% with the introduction of propranolol. Management strategies have shifted over time, with the proportion of cases undergoing expectant management dropping from 32.9% to 12.4%. Since 2008, 26.1% of patients were treated with oral propranolol, largely replacing corticosteroids. Topical β-blockers have been used in 12.1% of cases, leading to a reduction in local injection therapy from 20.8% to 13.2%. Laser therapy, introduced in 2016, has been used in 13.8% of cases, while surgical excision has dropped from 25.0% to 8.5% due to alternative treatment options. Combination therapy was used in 8.8% of cases post-2015, indicating a rising trend. Drawing from the evolution of IHs management strategies, an individualized protocol for the management of IHs was successfully established. Conclusion: Treatment for IHs has evolved over recent decades, with less invasive medical interventions increasingly replacing more invasive methods. Furthermore, a personalized treatment protocol established in this study could boost the cure rate of IHs while minimizing potential side effects and complications.

Long-Acting Injectable Antiretrovirals for HIV Treatment: A Multi-Site Qualitative Study of Clinic-Level Barriers to Implementation in the United States.

Long-acting injectable antiretroviral therapy (LAI ART) has the potential to address adherence obstacles associated with daily oral ART, leading to enhanced treatment uptake, adherence, and viral suppression among people living with HIV (PLWH). Yet, its potential may be limited due to ongoing disparities in availability and accessibility. We need a better understanding of the organizational context surrounding the implementation of LAI ART, and to inform its widespread rollout, we conducted 38 in-depth interviews with medical and social service providers who offer HIV care at private and hospital-based clinics across six US cities. Our findings highlight real-world implementation barriers outside of clinical trial settings. Providers described ongoing and anticipated barriers across three stages of LAI ART implementation: (1) Patient enrollment (challenges registering patients and limited insurance coverage), (2) medication delivery (insufficient personnel and resources), and (3) leadership and management (lack of interprofessional coordination and a lack of programming guidelines). Providers described how these barriers would have a disproportionate impact on under-resourced clinics, potentially exacerbating existing disparities in LAI ART access and adherence. Our findings suggest strategies that clinic leadership, policymakers, and other stakeholders can pursue to promote rapid and equitable LAI ART implementation in clinics across the United States. Resource and staffing investments could support clinics to begin, sustain, and scale up LAI ART delivery; additionally, the establishment of guidelines and tools could facilitate wider adoption of LAI ART across clinical settings. These efforts are crucial to promote resourced, standardized, and equitable implementation of LAI ART and maximize its potential to help end the HIV epidemic.

Platelet-rich Plasma as Effectiveness in the Treatment of Osteoarthrosis of the Knee in a Tertiary Care Center

ABSTRACT Introduction: Osteoarthrosis (OA) is a condition that develops slowly but eventually causes considerable morbidity. Many medical specialties have employed platelet-rich plasma (PRP) since it is the best autologous biological blood-derived product, can be exogenously supplied to tissues, and releases high concentrations of platelet-derived growth factors to promote tendon, bone, and wound healing. This prospective research aims to clinically assess the effectiveness of PRP injection therapy for treating knee osteoarthrosis. Materials and Methods: A clinical prospective study was conducted at a tertiary care center for a period of a year. Subjects older than 50 years were selected for both genders who had a symptomatic primary knee OA. PRP is administered to and evaluated in 80 patients with knee osteoarthrosis. Using the VAS and WOMAC questionnaire tools, primary data was collected. The observations were compared using the appropriate statistical tools while considering significance at 95%. Results: Eighty-four subjects participated in the study till the end of the study period of 3 months. All study participants filled out questionnaires before injection, eight weeks after injection, and 12 weeks after. The obtained scores for the WOMAC and the VAS were compared, and it was observed that after 12 weeks, the WOMAC scores lowered from 77 to 33 (P < 0.001) and the VAS scores lowered to 6 to 1.5 (P < 0.001) and these alterations were significant. Conclusion: According to the most recent research, PRP therapy is a less expensive and more straightforward therapeutic option for the management of knee pain in patients who have OA, and it has also improved patients’ ability to participate in everyday activities.

Efficacy of trigger point injection therapy in noncardiac chest pain: A randomized controlled trial.

This study aimed to compare the effects of trigger point injections and stretching exercises in patients with noncardiac chest pain (NCCP) associated with myofascial pain syndrome. This prospective randomized controlled trial included 50 patients with noncardiac chest pain and trigger points in the pectoralis muscles between October 2019 and June 2020. The patients were randomly assigned to receive trigger point injections into the pectoralis muscles and exercise (n=25; 15 males, 10 females; mean age: 42.8±9.2 years; range, 25 to 57 years) or only perform exercise (n=25; 11 males, 14 females; mean age: 41.8±11.2 years; range, 18 to 60 years). The primary outcome was pain intensity at the first month and three months after the first treatment session, measured using the Visual Analog Scale from 0 to 100. The secondary outcome was the Nottingham Health Profile score. Treatment with stretching exercises and trigger point injection resulted in significant pain reduction compared to stretching exercises alone, and the reduction was persistent at the three-month follow-up (p<0.001). A between-group comparison showed no significant difference in the Nottingham Health Profile (p=0.522). Complications related to the procedure or severe adverse events attributable to treatment were not reported. Trigger point injection combined with stretching exercises is an efficient treatment for noncardiac chest pain related to myofascial pain syndrome compared to exercise treatment alone.

Genetically inspired organoids prevent joint degeneration and alleviate chondrocyte senescence via Col11a1-HIF1α-mediated glycolysis-OXPHOS metabolism shift.

Developmental dysplasia of hip (DDH) is a hip joint disorder leading to subsequent osteoarthritis. Previous studies suggested collagen XI alpha 1 (COL11A1) as a potential gene in hip dysplasia and chondrocyte degeneration. However, no genetic association has reported COL11A1-related cellular therapy as treatment of DDH and joint degeneration. We report identified genetic association between COL11A1 locus and DDH with genome-wide association study (GWAS). Further exome sequencing for familial DDH patients was conducted in different populations to identify potential pathogenic Col11A1 variants for familiar DDH. Further studies demonstrated involvement of COL11A1 expression was down-regulated in femoral head cartilage of DDH patients and Col11a1-KO mice with induced DDH. Col11a1-KO mice demonstrated aggravated joint degeneration and severe OA phenotype. To explore the underlying mechanism of Col11a1 in cartilage and DDH development, we generated scRNA-seq profiles for DDH and Col11a1-KO cartilage, demonstrating disrupted chondrocyte homeostasis and cellular senescence caused by Col11a1-HIF1α-mediated glycolysis-OXPHOS shift in chondrocytes. Genetically and biologically inspired, we further fabricated an intra-articular injection therapy to preventing cartilage degeneration by generating a Col11a1-over-expressed (OE) SMSC mini-organoids. Col11a1-OE organoids demonstrated superior chondrogenesis and ameliorated cartilage degeneration in DDH mice via regulating cellular senescence by up-regulated Col11a1/HIF1α-mediated glycolysis in chondrocytes. We reported association between COL11A1 loci and DDH with GWAS and exome sequencing. Further studies demonstrated involvement of COL11A1 in DDH patients and Col11a1-KO mice. ScRNA-seq for DDH and Col11a1-KO cartilage demonstrated disrupted chondrocyte homeostasis and cellular senescence caused by Col11a1-HIF1α-mediated glycolysis-OXPHOS shift in chondrocytes. Genetically and biologically inspired, an intra-articular injection therapy was fabricated to prevent cartilage degeneration with Col11a1-OE SMSC organoids. Col11a1-OE organoids ameliorated cartilage degeneration in DDH mice via regulating cellular senescence by up-regulated Col11a1/HIF1α-mediated glycolysis in chondrocytes.

Fresh Versus Frozen Meniscal Allograft Transplant: Revisit or Redundant? A Systematic Review

Background: Fresh-frozen allografts are the current standard in meniscal allograft transplant (MAT) surgery, due to their availability, ease of preservation, and affordability. However, fresh-frozen grafts are associated with several clinical challenges such as graft shrinkage and extrusion, among many others. Purpose: To present the current knowledge on the use of fresh meniscal allografts, presenting whether benefits associated with fresh grafts provide sufficient evidence to support their use in clinical practice. Study Design: Systematic review; Level of evidence, 5. Methods: A comprehensive search was conducted with keywords listed below. After an initial screening on title and abstract, full-text articles were assessed with the inclusion criteria. Results: A total of 78 studies matched the inclusion criteria. Literature and preclinical studies indicated that fresh meniscal allografts are beneficial for maintaining mechanical properties, graft ultrastructure, and matrix metabolism due to the presence of viable cells. Therefore, fresh allografts may address common complications associated with fresh-frozen MAT. To overcome challenges associated with both fresh-frozen and fresh allografts, a group has studied treating fresh-frozen allografts with a cell-based injection therapy. Conclusion: Fresh meniscal allografts pose several challenges including limited availability, demanding preservation procedures, and high costs. Although the role of viable cells within meniscal allografts remains controversial, these cells may be vital for maintaining tissue properties.

Nursing of acupoint injection therapy combined with intravenous administration of antiemetics in the treatment of nausea and vomiting in a patient with paclitaxel liposome chemotherapy

Nursing of acupoint injection therapy combined with intravenous administration of antiemetics in the treatment of nausea and vomiting in a patient with paclitaxel liposome chemotherapy

Comparison of Treatment Efficacy of Different Number of Botulinum Toxin Type A Injection Sites for Crow’s Feet Lines: A Single-Center Retrospective Clinical Study in Vietnam

Objective: Botulinum toxin type A is frequently used to treat crow’s feet lines. However, the optimal dose and injection sites are still controversial. The objective of this study was to compare the efficacy of different botulinum toxin type A injection patterns for the treatment of crow’s feet. Methods: This single-center, retrospective, clinical study was conducted at the National Hospital of Dermatology and Venereology from July 2020 to December 2020. Data on 60 patients with crow’s feet were collected and divided into 2 groups (3- or 4-point intramuscular injection) according to the intramuscular injection technique the patients received. The treatment efficacy was assessed based on the changes in the Crow’s Feet Grading Scale score at 1, 4, and 16 weeks after treatment. Repeated measures analysis of variance was used for the assessment of changes in scores over time between the two groups. Results: After treatment, the average Crow’s Feet Grading Scale score was significantly decreased compared with the pretreatment score at all timepoints (1, 4, and 16 weeks) in both states (dynamic: For 3-point intramuscular injection technique, 1 week: 1.90 ± 0.71 vs. 2.97 ± 0.56; 4 weeks: 1.87 ± 0.68 vs. 2.97 ± 0.56; 16 weeks: 2.60 ± 0.67 vs. 2.97 ± 0.56. For 4-point intramuscular injection technique, 1 week: 1.73 ± 0.83 vs. 3.03 ± 0.49; 4 weeks: 1.73 ± 0.74 vs. 3.03 ± 0.49; 16 weeks: 2.57 ± 0.68 vs. 3.03 ± 0.49, all P &lt; 0.001. and static: For 3-point intramuscular injection technique, 1 week: 1.20 ± 0.89 vs. 2.20 ± 0.85; 4 weeks:1.20 ± 0.89 vs. 2.20 ± 0.85; 16 weeks: 1.87 ± 0.97 vs. 2.20 ± 0.85; For 4-point intramuscular injection technique, 1 week: 1.50 ± 0.86 vs. 2.30 ± 0.84; 4 weeks: 1.33 ± 0.84 vs. 2.30 ± 0.84; 16 weeks: 1.87 ± 0.97 vs. 2.30 ± 0.84. All P &lt; 0.001). The average subjective patient-rated satisfaction scores after treatment were significantly higher in the 4-point injection group than in the 3-point injection group (P = 0.028). The adverse events were post-injection bruising in 3 patients and a feeling of eyelid tightness in 3 patients. Conclusion: Botulinum toxin type A injection is an effective treatment for crow’s feet. Adding a fourth injection maintains the same therapeutic effect and does not increase adverse effects. Patients with lower-fan crow’s feet patterns may benefit more from 4-point injection therapy. However, the present findings require confirmation in studies with larger sample sizes, longer follow-up times, and different botulinum toxin type A doses.

Diagnosis and treatment of dorsalgia in outpatient practice

Dorsalgia − nonspecific back pain is the leader in the number of requests for medical help. Nonspecific musculoskeletal pain accounts for up to 80–90% of all pain syndromes. Back pain can be provoked by professional static-dynamic overloads, violations of the statics of the musculoskeletal system, exposure to cold and/or vibration, overweight, hereditary factors, etc. In outpatient practice, doctors often have to deal with various forms and clinical manifestations of dorsalgia. The leading role in the diagnosis is given to the physical examination of the patient. With the active collection of complaints and anamnesis, the doctor has the opportunity to identify the leading problem that prompted the patient to seek medical help, clarify the localization of the process, the time of occurrence and the sequence of symptoms, which allows you to fully imagine the picture of the disease and differentiate between simultaneously occurring nosologies. The identification of the affected structure, which is the root cause of musculoskeletal pain, does not affect the appointment of basic drug therapy, but it is absolutely necessary when conducting local injection therapy, as well as a number of non-drug treatment methods. Among the pharmacological drugs used to treat musculoskeletal pain, the priority remains for NSAIDs, the choice of which, first of all, is dictated by its safety. The favorable safety profile of Nimesil® (nimesulide) has been confirmed by numerous domestic and foreign studies. Nimesulide is registered in 50 countries for the treatment of pain syndromes, and is also used as an antipyretic and anti-inflammatory drug. According to the results of a study in the Russian Federation, Nimesil® (nimesulide) turned out to be the most frequently prescribed drug, which is due to its high effectiveness and ability to accumulate in therapeutic concentration in the focus of inflammation. In addition to pharmacotherapy, the treatment regimen for musculoskeletal pain should include, on a parity basis, non-drug treatment methods that allow correction of pathobiomechanical changes. If ignored, in many cases, drug anesthesia does not lead to the desired effect, which can contribute to the chronization of pain. The described clinical case illustrates the simultaneous course of two variants of dorsalgia in the patient, different in localization, clinical manifestations, severity and duration of the course.