Similar Proportion Of Men Research Articles

Outpatient treatment of decompensated heart failure: A systematic review and study level meta-analysis.

Patients with acutely decompensated heart failure (ADHF) are usually admitted to hospital for management. There is growing interest in delivering intravenous (IV) diuretic therapy at home, in the community or at hospital day-care units; the safety and effectiveness of outpatient-based management (OPM) for ADHF has not been established. We conducted a systematic literature review and meta-analysis to investigate the short-term safety and effectiveness of OPM compared with inpatient management (IPM) of ADHF. Pre-specified endpoints were 30day mortality and 30day hospitalization. The meta-analysis was conducted using RevMan 5.4 software. Twenty-nine studies of OPM were identified, including 7683 patients. Only five studies directly compared OPM (n=1303) with IPM (n=2047), including three observational studies, and two randomized controlled trials (RCTs). The other 24 studies only stated OPM outcomes. For the five studies comparing IPM versus OPM, patients were generally aged >75years and of similar age for each strategy, with a similar proportion of men (56%). In a study-level, aggregate analysis, 30day all-cause mortality was 9.3% (121/1303) for OPM, compared with 15.6% (320/2047) for IPM [OR 0.29 (95% CI 0.09, 0.93) P=0.04]. Four studies reported 30day all-cause hospitalization; 22.0% for IPM versus 16.8% for OPM [OR 0.73 (95% CI 0.61, 0.89), P=0.001]. In the two RCTs, we found no difference in 30day mortality or hospitalization. In observational studies, OPM of ADHF is associated with lower 30day hospitalization and lower 30day mortality; such differences were not observed in two small, single-centre RCTs. A substantial, multicentre RCT is required to confirm the safety and effectiveness of OPM for ADHF.

FREQUENCY OF POST-EXERTIONAL MALAISE AMONG INDIVIDUALS WITH POST ACUTE SEQUELAE OF SARS-COV-2 INFECTION

INTRODUCTION AND AIM Post acute sequelae of SARS-CoV-2 infection (PASC) is a multifaceted disorder with varying symptoms. Fatigue is commonly reported; however, it is unclear if similarities exist between PASC and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). We sought to determine the frequency of post-exertional malaise in individuals with PASC; a hallmark symptom of ME/CFS. METHODS 116 participants (Age: 53.4±8.4, 36% Male) were identified to have PASC through medical screening. The Duke Activity Status Index (DASI) subjectively evaluated functional capacity, and participants achieving <100% of age and sex defined norms were eligible for the study. Participants attended one of three sites across Victoria and Tasmania to complete Cardiopulmonary Exercise Testing (CPET). Two days post CPET they were asked to complete the DePaul Symptom Questionnaire (DSQ) post-exertional malaise (PEM). PEM was defined as a score ≥ 2 for frequency and severity on DSQ-PEM items 1-5. A personalised exercise rehabilitation program is currently underway for participants, with results on responses to training to be available at the time of the conference. RESULTS 106 (91%) of the participants who completed a CPET achieved less than 85% of predicted relative VO2peak (21.79±5.72ml.min-1.kg-1). The DSQ-PEM questionnaire was completed in 75% (n=79) of participants. Among these individuals 78% (n=62) met the threshold for PEM. The PEM group were older (53±8 vs 48±8 years, p=0.04), had higher BMI (30.5±7.6 vs 26.7±3.9kg.m2, p=0.02), lower VO2peak (21.6±5.7 vs 25.6±5.4ml.min-1.kg-1, p=0.01) and six-minute walk distance (491±131 vs 583±112m, p=0.02). There was a similar proportion of men and women between both groups. CONCLUSION Like with ME/CFS, PEM is a common symptom in PASC. Additionally, these individuals are more deconditioned than PASC sufferers without PEM. Thus, practitioners should carefully consider the impact of PEM and deconditioning when developing rehabilitation programs.

PD07-12 THE PERIOPERATIVE SAFETY OF MINIMALLY INVASIVE PARTIAL NEPHRECTOMY IN OCTOGENARIANS

You have accessJournal of UrologyCME1 Apr 2023PD07-12 THE PERIOPERATIVE SAFETY OF MINIMALLY INVASIVE PARTIAL NEPHRECTOMY IN OCTOGENARIANS Dhaval Jivanji, Michael West, Katiana Vazquez-Rivera, Marc Lubin, Ervin Teper, David Silver, and Ariel Schulman Dhaval JivanjiDhaval Jivanji More articles by this author , Michael WestMichael West More articles by this author , Katiana Vazquez-RiveraKatiana Vazquez-Rivera More articles by this author , Marc LubinMarc Lubin More articles by this author , Ervin TeperErvin Teper More articles by this author , David SilverDavid Silver More articles by this author , and Ariel SchulmanAriel Schulman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003231.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Octogenarians with renal masses amenable to partial nephrectomy often receive a radical nephrectomy. This stems from concerns that the renorrhaphy may not heal appropriately and that older patients may not tolerate major complications such as bleeding or urine leak. Using a national cohort, we compared complications and 30-day outcomes in octogenarians who received a partial or radical nephrectomy. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify all subjects 80 years or older who received a minimally invasive partial (CPT: 50543) or radical nephrectomy (CPT: 50545, 50546) from 2016 to 2020. Baseline characteristics, comorbidities, and post-operative complications were compared. Emergent cases, subjects with disseminated disease, and subjects with concurrent procedures were excluded. Chi square analysis and student t-tests were used to analyze categorial and continuous variables, respectively. RESULTS: We identified 1,609 nephrectomies of which, 1,226 (76.2%) were radical and 383 (23.8%) were partial. Those who underwent partial nephrectomy were younger (82 years old vs. 83 years old, p < 0.001). A similar proportion of men (58.5% vs. 56.8%, p = 0.34) and women (40.5% vs. 43.2%, p = 0.34) were seen in each group, and there was no difference in BMI (27.7 vs. 27.2, p = 0.08). Operative times were longer (165.5 mins vs. 150.2, p <0.001) but length of stay was shorter (3 days vs. 4 days, p < 0.001) in the partial nephrectomy group. No differences were seen in post-operative complications. Octogenarians who underwent a partial nephrectomy were readmitted at higher rates (11.8% vs. 7.0%, p = 0.003); however, there was no difference in reoperative rates (2.9% vs. 1.9%, p = 0.24) or mortality (1.8% vs. 1.6%, p = 0.79). CONCLUSIONS: Readmission rates in octogenarians who received a partial nephrectomy were higher than those who received a radical nephrectomy; however, no other differences in adverse events were seen. Therefore, we should consider expanding the use of partial nephrectomy in this age cohort. Future studies are needed to explore surgeon parameters and oncological characteristics. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e167 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dhaval Jivanji More articles by this author Michael West More articles by this author Katiana Vazquez-Rivera More articles by this author Marc Lubin More articles by this author Ervin Teper More articles by this author David Silver More articles by this author Ariel Schulman More articles by this author Expand All Advertisement PDF downloadLoading ...

The added influence of genomics and post-MRI confirmatory biopsy results to MRI results alone on medical decision making for men with favorable risk prostate cancer being considered for active surveillance.

We examined how the results of genomic classifier (GC) or post-magnetic resonance imagingconfirmatory biopsy (pMRI-CBx) influenced management strategy for men with an MRI considering active surveillance (AS). We reviewed the Michigan Urological Surgery Improvement Collaborative registry for men with favorable-risk prostate cancer. Among men with an MRI after the diagnostic biopsy (n = 1162) a subset also had GC (n = 126) or pMRI-CBx (n = 309). Results of MRI, GC, and pMRI-CBx were deemed reassuring (RA) or non-reassuring (Non-RA). We assess the association of the combination of test results obtained with the selection of AS. Proportions were compared with the Fisher's exact test. Multivariable logistic regression models were fit for an association of test results with the selection of AS. The results of pMRI-CBx tended to influence management decisions greater than that of GC, especially in situation where testing results were discordant with the MRI result. Fewer men with a RA MRI and non-RA pMRI-CBx where managed with AS compared with RA MRI alone (31% vs. 86%, p < 0.001). non-RA genomics did not seem to have the same influence on management as non-RA pMRI-CBx as a similar proportion of men with RA MRI and non-RA genomics were managed with AS compared with RA MRI alone (85% vs. 86%, p = 0.753). More men with non-RA MRI and RA pMRI-CBx were managed with AS compared with non-RA MRI alone (89% vs. 40%, p < 0.001). Alternatively, a similar proportion of men with non-RA MRI and RA genomics were managed with AS compared with non-RA MRI alone (42% vs. 40%, p > 0.999). In the multivariable models, pMRI-CBx results influenced the decision for AS versus treatment. In men with newly diagnosed prostate cancer and an MRI, the additional information provided by pMRI-CBx influenced the decision of AS versus treatment, while the addition of GC results were less influential.

The occurrence of adverse events following immunization after first and/or second dose of Covishield or Covaxin vaccine at a tertiary care hospital: An observational study

Background: With the introduction of the COVID-19 vaccine, many cities of India are reporting minor, mild, and severe AEFI cases during half an hour of observation and after that. No vaccine can protect everyone receiving it and is safe too for everyone. Effective vaccines could produce a few unwanted side effects mainly mild and clear up frequently.Methods: After the COVID-19 vaccination, everyone was asked to wait for 30 minutes in the observation room to check for any type of AEFI. While waiting, all second dose beneficiaries were asked to fill a printed case record form with all demographic details, including AEFI events experienced after their first dose of the COVID-19 vaccine. Phone calls were made to all 500 beneficiaries after seven days of vaccination to know about the type of AEFI experienced after the second dose.Results: Safety of product is of paramount importance and in this study, we actively captured adverse events post-vaccination. Fever, headache, weakness, body pain, were the most common adverse events along with pain at the injection site. In our study, the younger age group was associated with minor AEFIs. However, we did not find any supporting evidence for high reactogenicity among women, and this may be due to an almost similar proportion of men and women in our sample.Conclusions: The advantages of immunization in disease prevention have significantly exceeded the risks of immunization-associated adverse events. COVID vaccines have their largest potential to end the COVID-19 pandemic if they are widely accepted and used. As we all want to get rid of the diseases which are not curable easily and spread with very large intensity, now is the time to get vaccinated and control them.

Comparison of the patterns of chlamydia and gonorrhoea at the oropharynx, anorectum and urethra among men who have sex with men

ObjectiveChlamydia and gonorrhoea are common sexually transmitted infections that infect the oropharynx, anorectum and urethra in men who have sex with men (MSM). This study aimed to examine the pattern...

MP62-14 THE INFLUENCE OF MAGNETIC RESONANCE IMAGING, GENOMIC CLASSIFIERS, AND POST-MAGNETIC RESONANCE IMAGING BIOPSY RESULTS ON SHARED-DECISION MAKING IN NEWLY DIAGNOSED FAVORABLE RISK PROSTATE CANCER PATIENTS

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II (MP62)1 Sep 2021MP62-14 THE INFLUENCE OF MAGNETIC RESONANCE IMAGING, GENOMIC CLASSIFIERS, AND POST-MAGNETIC RESONANCE IMAGING BIOPSY RESULTS ON SHARED-DECISION MAKING IN NEWLY DIAGNOSED FAVORABLE RISK PROSTATE CANCER PATIENTS Michael Wang, Ji Qi, Arvin George, James Montie, Michael Cher, Kevin Ginsburg, and for the Michigan Urological Surgery Improvement Collaborative Michael WangMichael Wang More articles by this author , Ji QiJi Qi More articles by this author , Arvin GeorgeArvin George More articles by this author , James MontieJames Montie More articles by this author , Michael CherMichael Cher More articles by this author , Kevin GinsburgKevin Ginsburg More articles by this author , and for the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002102.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Magnetic resonance imaging (MRI), genomic classifiers (GC), and post-MRI biopsy (pMRI-Bx) have become increasingly integrated into the shared-decision making process for men with newly diagnosed prostate cancer deciding between definitive treatment and active surveillance (AS). We aimed to assess how these tests and combination of the results influenced initial management decisions. METHODS: We reviewed the Michigan Urological Surgery Improvement Collaborative registry for men with newly diagnosed favorable risk prostate cancer (FPRC: grade group (GG) 1 or low volume GG 2) from 06/2016 to 12/2019. All men included in this study obtained an MRI, with or without GC or pMRI-Bx. The primary outcome was the proportion of patients who selected AS and remained free of treatment one year after diagnosis. MRI, GC, pMRI Bx results were classified as reassuring (RA) vs non-RA according to predefined and previously published MUSIC criteria. Proportions were compared between groups using the Fisher’s exact test. RESULTS: Of the 1,394 men with FRPC who met inclusion criteria, 914 had an MRI alone, 140 had an MRI and GC, 295 had MRI and pMRI-Bx, and 45 had MRI, GC, and pMRI-Bx. Compared with men with RA MRI alone, more men with RA MRI/RA pMRI-Bx chose AS (95% vs. 84%, p=0.006) and fewer men with RA MRI/non-RA pMRI-Bx chose AS (35% vs. 84%, p<0.001, Figure 1). A similar proportion of men with RA MRI/RA GC and RA MRI/non-RA GC chose AS as men with RA-MRI alone (85% vs. 84, p=1.00 and 84% vs 84%, p=1.00, respectively). Compared with men with non-RA MRI alone, more men with non-RA MRI/RA pMRI-Bx chose AS (89% vs. 58%, p=0.001) and fewer men with non-RA MRI/non-RA pMRI-Bx chose AS (28% vs. 58%, p<0.001). Compared with nonRA MRI alone, a similar proportion of men with non-RA MRI/RA GC chose AS (64% vs. 58%, p=0.593) and fewer men with non-RA MRI/non-RA GC chose AS (28% vs. 58%, p=0.01). CONCLUSIONS: Post-MRI biopsy results strongly influenced the decision for treatment vs. AS compared with MRI results alone. In men with both GC and MRI, treatment decisions were mostly aligned with MRI results. These data suggest MRI and pMRI-Bx results are weighed more heavily by patients and providers compared with GC results. Source of Funding: Blue Cross Blue Shield of Michigan © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1097-e1098 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Wang More articles by this author Ji Qi More articles by this author Arvin George More articles by this author James Montie More articles by this author Michael Cher More articles by this author Kevin Ginsburg More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement Loading ...

Functional limitations in people with multimorbidity and the association with mental health conditions: Baseline data from the Canadian Longitudinal Study on Aging (CLSA).

IntroductionIncreasing multimorbidity is often associated with declining physical functioning, with some studies showing a disproportionate impact on functioning when mental health conditions are present. More research is needed because most multimorbidity studies exclude mental health conditions.ObjectivesThis study aims to improve our understanding of the association between functional limitation and multimorbidity, including a comparison of those with multimorbidity that includes versus excludes mental health conditions.MethodsThis is a population-based, cross-sectional analysis of data from The Canadian Longitudinal Study on Aging. Functional limitation was defined as the presence of any of 14 activities of daily living (ADLs) or instrumental activities of daily living (IADLs). Multimorbidity, measured by the number of chronic conditions, included mood and anxiety disorders. Logistic regression explored the association between multimorbidity (with and without mental health conditions) and functional limitation. Factor analysis identified common condition clusters to help understand clinical complexity in those with mood/anxiety disorders and the potential influences on functional limitation.ResultsThere were 51,338 participants, with a similar proportion of men and women (49% versus 51%) and 42% age 65 years or older. Fifteen percent (15%) had no chronic conditions and 17% had 5+. Ten percent (10%) reported at least one ADL or IADL limitation. Odds ratios (ORs) for functional limitation increased with multimorbidity and were generally higher for those with versus without mental health conditions (e.g., ORs from 1 to 5+ chronic conditions increased 1.9 to 15.8 for those with mood/anxiety disorders versus 1.8 to 10.2 for those without). Factor analysis showed that mood/anxiety conditions clustered with somatic conditions (e.g., migraines, bowel/gastrointestinal disorders).ConclusionThis study found higher odds of functional limitation for those with multimorbidity that included versus excluded mental health conditions, at all levels of multimorbidity. It highlights the need for concurrent management of mental and physical comorbidities to prevent functional limitations and future decline. This approach is aligned with the NICE clinical assessment and management guidelines for people with multimorbidity.

Age of First Exposure to Football Is Not Associated With Later-in-Life Cognitive or Mental Health Problems.

Background: The purpose of this study was to determine if earlier age of first exposure to football is associated with worse brain health in middle-aged and older adult men who played high school football.Methods: Men from the United States, aged 35 and older, who reported playing high school football, completed a customized, online health survey via the Amazon Mechanical Turk (mTurk) platform. Survey items included physical, psychological, and cognitive symptoms over the past week and over the past year, sports participation history (including age of first exposure to football), medical history, and concussion history. Participants also completed the Patient Health Questionnaire-8 (PHQ-8) and the British Columbia Post-Concussion Symptom Inventory (BC-PSI).Results: There were 186 men (age M = 51.78, SD = 10.93) who participated in high school football, and 87 (46.8%) reported football participation starting before the age of 12 and 99 (53.2%) reported football participation at or after the age of 12. Those who started playing football at an earlier age reported a greater number of lifetime concussions (M = 1.95, SD = 1.79) compared to those who started playing at age 12 or later (M = 1.28, SD = 1.52; U = 3,257.5, p = 0.003). A similar proportion of men who played football before vs. after the age of 12 reported a lifetime history of being prescribed medications for depression, anxiety, chronic pain, headaches, or memory problems. When comparing men who played football before vs. after the age of 12, the groups did not differ significantly in their ratings of depression, anger, anxiety, headaches, migraines, neck or back pain, chronic pain, concentration problems, or memory problems over the past week or the past year. The two groups did not differ significantly in their ratings of current symptoms of depression (PHQ-8; U = 4,187.0, p = 0.74) or post-concussion-like symptoms (BC-PSI; U = 3,944.0, p = 0.53). Furthermore, there were no statistically significant correlations between the age of first exposure to football, as a continuous variable, and PHQ-8 or BC-PSI scores.Conclusion: This study adds to a rapidly growing body of literature suggesting that earlier age of first exposure to football is not associated with later-in-life brain health.

Prosthetic versus native artery inflow for infrainguinal bypass

BackgroundInfrainguinal bypass performed after previous prosthetic inflow reconstruction offers a choice of where to perform the proximal anastomosis. The hood of a previous inflow bypass might be technically easier to isolate during reoperative surgery. However, the more distal native artery might offer better patency to the outflow revascularization. The purpose of the present study was to compare the outcomes of infrainguinal bypass using the hood of a previous inflow bypass vs the native artery as the inflow source. MethodsA single vascular group's database was queried for all cases of infrainguinal bypass performed after previous prosthetic inflow bypass to a femoral artery from January 2006 to December 2016. The demographics, indications, operative details, and long-term results were recorded and analyzed. Two groups were compared stratified by the location of the proximal anastomosis for the distal bypass. In one group, the inflow source for the distal bypass was from the hood of a previous inflow graft (prosthetic). In the second group, the distal native arterial tree was used as the inflow source. A subset analysis of the patency of the distal bypass was also performed between the two groups for those in which the previous inflow reconstruction had become occluded. Patency was calculated using the Kaplan-Meier method. ResultsA total of 197 patients had undergone infrainguinal bypass after previous inflow bypass from 2006 to 2016. Of the 197 procedures, 59 (30%) had used the hood of the previous bypass as the inflow source (prosthetic group) and 138 (70%) had used the native artery distal to the hood of the inflow bypass as the inflow source (native group). The indications were similar between the two groups. The two groups had a similar proportion of men and a similar incidence of hypertension, hyperlipidemia, coronary artery disease, tobacco use, and renal disease. The previous inflow procedures were also similar between the two groups. The native artery used for the inflow source in the native group was the profunda femoris in 80 (58%), common femoral artery in 51 (37%), and superficial femoral artery in 7 (5.1%). Patency was significantly greater for the native group at 1 year (91% vs 75%; P = .0221). Also, the patency after inflow bypass occlusion significantly favored the native group at 1 year (87% vs 40%; P = .0035). ConclusionsInfrainguinal bypass performed after previous ipsilateral inflow bypass offers the option of using the hood of the bypass or a native artery as the inflow source. The present study demonstrated greater patency rates when using the distal native artery as the inflow source. The native artery option also offered continued patency when the inflow bypass occluded.

Association between prior radical surgery (RS) and outcomes with immune checkpoint inhibitor (ICI) therapy for advanced urothelial carcinoma (aUC).

444 Background: It is unclear whether prior RS of primary tumor is associated with response and outcomes with ICI in aUC. We hypothesized that such response and outcomes would not differ based on prior RS. Methods: We performed a retrospective cohort study including patients (pts) with aUC who received ICI. We compared overall response rate (ORR), progression-free survival (PFS), and overall survival (OS) between pts with vs without RS [cystectomy or (nephro)-ureterectomy]. Analysis was stratified based on ICI therapy line (first-line vs salvage). A separate comparison between pts with prior RS or radiation (RT) only or none was also pursued. ORR was compared between groups using logistic regression, as well OS and PFS using cox regression analysis; a multivariable model was built adjusting for calculated Bellmunt score. P&lt;0.05 was significant. Results: We identified 984 pts from 24 institutions; 682, 704 and 673 were included in OS, PFS and ORR analyses, respectively; 54% of pts had prior RS with median age 68 at ICI initiation with RS vs 71 without RS with similar proportion of men (73-74%) and ever smokers (70-71%). The RS group had higher proportion (%) of white pts (77% vs 71%), lower % of pts with Hb&lt;10g/dL at ICI initiation (23% vs 32%) but not significantly higher % of liver metastasis at ICI initiation (23% vs 17%). Bellmunt score with vs without RS was 16% vs 11%, 50% vs 48%, 27% vs 37%, 7% vs 4% for 0, 1, 2, and 3, respectively. ORR and PFS were not significantly different between groups, while prior RS was associated with longer OS (unadjusted HR 0.8, p=0.03). However, after adjustment for Bellmunt score, this association was not significant (table). Upon stratification based on treatment line, OS was longer with prior RS (0.7, p=0.03) for those treated with salvage ICI but this was not significant after adjusting for Bellmunt score. ORR, PFS and OS were not significantly different between pts receiving prior RT only vs RS vs none. Conclusions: Prior RS was not significantly associated with longer OS in pts with aUC receiving ICI after adjusting for Bellmunt score. Further work is needed to interrogate tumor-host immune interactions and identify biomarkers that can be prognostic and/or predictive of ICI response. [Table: see text]

Sex, Permanent Drug Discontinuation, and Study Retention in Clinical Trials: Insights From the TIMI trials.

Women are underrepresented across cardiovascular clinical trials. Whether women are more likely than men to prematurely discontinue study drug or withdraw consent once enrolled in a clinical trial is unknown. Eleven phase 3/4 TIMI (Thrombolysis in Myocardial Infarction) trials were included (135 879 men and 51 812 women [28%]). The association between sex and premature study drug discontinuation and withdrawal of consent were examined by multivariable logistic regression after adjusting for potential confounders in each individual trial and combining the individual point estimates in random effects models. After adjusting for baseline differences, women had 22% higher odds of premature drug discontinuation (adjusted odds ratio [ORadj], 1.22 [95% CI, 1.16-1.28]; P<0.001) compared with men. Qualitatively consistent results were observed for women versus men in the placebo arms (ORadj, 1.20 [95% CI, 1.13-1.27]) and active therapy arms (ORadj, 1.23 [95% CI, 1.17-1.30)]; there was some evidence for regional heterogeneity (P interaction <0.001). Of those who stopped study drug prematurely, a similar proportion of men and women in the active arm stopped because of an adverse event (36% for both; P=0.60). Women were also more likely to withdraw consent compared with men (ORadj, 1.26 [95% CI, 1.17-1.36]; P<0.001). Women were more likely than men to prematurely discontinue study drug and withdraw consent across cardiovascular outcome trials. Premature study drug discontinuation was not explained by baseline differences by sex or a higher proportion of adverse events. Future trials should better capture reasons for drug discontinuation and withdrawal of consent to understand barriers to continued study drug use and clinical trial participation, particularly among women.

Outcomes of acute hepatitis B virus (HBV) in HIV infection with and without HBV-active antiretroviral therapy.

Men with acute hepatitis B virus (HBV) infection in the Multicenter AIDS Cohort Study from 1985 to 2013 had serological testing to determine proportions with HBV recovery or chronic hepatitis B (CHB). A similar proportion of men without human immunodeficiency virus (HIV) and men with HIV receiving HBV-active antiretroviral therapy (ART) developed CHB [8.2%, 95% confidence interval (CI) 3.8-15.0% vs. 7.7%, 95% CI 2.00-36.0%]. In contrast, 17.5% (95% CI 8.7-29.9%) of men living with HIV, not on HBV-active ART developed CHB. HBV-active ART protects against developing CHB.

Complicaciones cerebrovasculares luego de angiografía coronaria en contexto de infarto agudo de miocardio. Estudio de cohorte

Introduction: cerebrovascular events are serious but infrequent complications of invasive percutaneous coronary procedure.Coronary angioplasty increases the risk 17 times. Patients suffering this complication have higher morbidity and mortality rates.Objective: to determine the clinical and evolutionary characteristics of the patients who developed a cerebrovascular event after an emergency coronary angiography in the context of an acute myocardial infarction. Secondly, analyze thetemporal relationship between both events and identify previous factors associated with the development of neurological complications.Method: demographic, characteristics of the angiographic procedure, and cerebrovascular features of a population of patients with stroke occurring within 30 days after of invasive percutaneous coronary procedure for myocardial infarctions are described. Data was retrospectively collected from the Cardiovascular University Center (Hospital de Clinicas, Montevideo, Uruguay) between 2008-2017.Results: 24 patients, 54.2% were men; 1/3 had prior stroke; 66.7% presented non ST segment elevation myocardial infarction.All of the cerebrovascular events were ischemic, most were from the anterior circulation. 62% occurred in the first 48 hours after invasive percutaneous coronary procedure, having this group a higher percentage of percutaneous coronary angioplasty and longer procedures. In three patients recombinant tissue plasminogen activator was used for stroke treatment. NIHSS median was 4 points (IQ 2-8) in patients without ST-segment elevation myocardial infarction and 8 points (IQ 3-20) in patients with ST-segment elevation myocardial infarction (p=0.20). 79% of patients had complications during the hospitalization, and 5 died.Conclusions: there was a similar proportion of men and women, and a high percentage of patients with a history of stroke. The presentation of the cardiovascular events was predominantly non ST myocardial infarction. All the cerebrovascular events were ischemic, it occurred for most patients in the first 48 hours after invasive percutaneous coronary procedure, and the anterior brain circulation was most commonly affected. Stroke/transient ischemic attack after invasive percutaneous coronary procedure could be associated with longer hospital stays and death.

Underutilization of primary medical care among men presenting for fertility evaluation

A growing body of evidence demonstrates an association between male infertility and significant medical comorbidities including cardiovascular disease, cancer, and even mortality. As such, it is essential that men with subfertility establish and maintain a relationship with a primary care physician (PCP). We sought to determine the proportion of young men presenting for fertility evaluation who reported an established relationship with a PCP. Retrospective, cross-sectional study. We retrospectively examined all men presenting for initial male infertility consultation at a tertiary care center with a single reproductive urologist between 2000 and 2018. All men were asked to provide the name of their PCP at the time of initial visit. Descriptive statistics and multivariable regression were utilized to characterize the proportion of men with a PCP at the time of evaluation and associations between PCP status, patient age, and comorbidity. Among 4,127 men presenting for initial fertility consultation, 1,324 had PCP data recorded. Of these, 480 (36.3%) did not have an established PCP at the time of evaluation. Men with a PCP were older than those without - median age 35 years (interquartile range [IQR] 23-40) versus 34 years (IQR 31-38), p<0.001. A smaller proportion of men with a PCP had elevated blood pressure (46.2% versus 56.8%, p=0.03), however a similar proportion of men in both groups were obese (21.7% versus 24.6%, p=0.31). Among 513 men who had a documented visit with an internal medicine physician within our tertiary care network prior to initial fertility consultation, 184 (35.9%) had not seen an internal medicine physician in over a year. Over one-third of men presenting for fertility evaluation did not have an established PCP, and among those who did, a sizable proportion had not seen their PCP in the previous year. Given the strong link between male infertility and medical comorbidities, reproductive urologists are uniquely positioned to encourage and facilitate the critical relationship between men with subfertility and primary care physicians.

Prosthetic Versus Native Artery Inflow for Infrainguinal Bypass

Abstract Background Infrainguinal bypass performed after previous prosthetic inflow reconstruction offers a choice of where to perform the proximal anastomosis. The hood of a previous inflow bypass might be technically easier to isolate during reoperative surgery. However, the more distal native artery might offer better patency to the outflow revascularization. The purpose of the present study was to compare the outcomes of infrainguinal bypass using the hood of a previous inflow bypass vs the native artery as the inflow source. Methods A single vascular group's database was queried for all cases of infrainguinal bypass performed after previous prosthetic inflow bypass to a femoral artery from January 2006 to December 2016. The demographics, indications, operative details, and long-term results were recorded and analyzed. Two groups were compared stratified by the location of the proximal anastomosis for the distal bypass. In one group, the inflow source for the distal bypass was from the hood of a previous inflow graft (prosthetic). In the second group, the distal native arterial tree was used as the inflow source. A subset analysis of the patency of the distal bypass was also performed between the two groups for those in which the previous inflow reconstruction had become occluded. Patency was calculated using the Kaplan-Meier method. Results A total of 197 patients had undergone infrainguinal bypass after previous inflow bypass from 2006 to 2016. Of the 197 procedures, 59 (30%) had used the hood of the previous bypass as the inflow source (prosthetic group) and 138 (70%) had used the native artery distal to the hood of the inflow bypass as the inflow source (native group). The indications were similar between the two groups. The two groups had a similar proportion of men and a similar incidence of hypertension, hyperlipidemia, coronary artery disease, tobacco use, and renal disease. The previous inflow procedures were also similar between the two groups. The native artery used for the inflow source in the native group was the profunda femoris in 80 (58%), common femoral artery in 51 (37%), and superficial femoral artery in 7 (5.1%). Patency was significantly greater for the native group at 1 year (91% vs 75%; P = .0221). Also, the patency after inflow bypass occlusion significantly favored the native group at 1 year (87% vs 40%; P = .0035). Conclusion Infrainguinal bypass performed after previous ipsilateral inflow bypass offers the option of using the hood of the bypass or a native artery as the inflow source. The present study demonstrated greater patency rates when using the distal native artery as the inflow source. The native artery option also offered continued patency when the inflow bypass occluded.

Is there a gender bias in the advancement to SAGES leadership?

The proportion of women in surgery has risen significantly yet there remains gender discrepancies in upper leadership positions in academia. Specialty societies play an important role in academic advancement but the progression of women in surgical societies has not been studied. The purpose of this study was to determine if there are gender differences in advancement within the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) leadership. A retrospective audit of all SAGES committee members (CM) from 1992 to 2018 was performed. The overall membership gender distribution was available from 2010 to 2018. Leadership positions included Committee Chair/Co-chair, Board of Governors, and Executive Committee. Three phenomena were investigated: "pipeline," by determining the change in women CMs compared to overall membership over time; "sticky floors," by comparing advancement beyond CM by gender; "glass-ceiling," by analyzing the promotion trajectory and time to leadership positions between genders. Statistical analysis comparing trends over time was performed using Kendall-tau. There were 1546 surgeons who served on at least one committee during the study period. Women represented 21% of CMs, 18% of chairs/co-chairs, 16% of board members and 14% of executives, with one woman President. The proportion of women CMs has significantly increased over time from 3% in 1992 to 27% in 2018 (p-trend < 0.001). A similar proportion of women and men advanced beyond CM (17% vs. 14%, p = 0.194), with no difference in time to advancement. From 2010 to 2018, the increase in the proportion of women CMs and board members outpaced that of overall women members (p < 0.05). Women executives surpassed overall women members in 2018 (29% vs. 19%). A similar proportion of men and women "skipped ranks" to reach the Board/Executive (37% vs. 25%, p = 0.307). The proportion of women in leadership positions within SAGES is higher than in the overall membership. There were no gender differences in the advancement of CMs to leadership positions. While these data are encouraging, SAGES should continue to foster the advancement of women surgeons.

Occupational segregation and wage differences: the case of Poland

PurposeThe purpose of this paper is to analyse the relation between occupational segregation and the gender wage differences using data on three-digit occupational level of classification. The authors examine whether a statistically significant relation between the share of men in employment and the size of the unexplained part of the gender wage gap exists.Design/methodology/approachTraditional Oaxaca (1973) – Blinder (1973) decomposition is performed to examine the differences in the gender wage gaps among minor occupational groups. Two types of reweighted decomposition – based on the parametric estimate of the propensity score and non-parametric proposition presented by Barsky et al. (2002) – are used as the robustness check. The analysis is based on individual data available from Poland.FindingsThe results indicate no strong relation between occupational segregation and the size of unexplained differences in wages. The unexplained wage differences are the smallest in strongly female-dominated and mixed occupations; the highest are observed in male-dominated occupations. However, they are probably to a large extent the result of other, difficult to include in the econometric model, factors rather than the effects of wage discrimination: differences in the psychophysical conditions of men and women, cultural background, tradition or habits. The failure to take them into account may result in over-interpreting the unexplained parts as gender discrimination.Research limitations/implicationsThe highest accuracy of the estimated gender wage gap is obtained for the occupational groups with a similar proportion of men and women in employment. In other male- or female-dominated groups, the size of the estimated gender wage gaps depends on the estimation method used.Practical implicationsThe results suggest that decreasing the degree of segregation of men and women in different occupations could reduce the wage differences between them, as the wage discrimination in gender balanced occupations is the smallest.Originality/valueTo the best of the authors’ knowledge, this study is one of the few conducted at such a disaggregated level of occupations, and one of few studies focused on Central and Eastern European countries and the first one for Poland.

Persistence of Trichomonas vaginalis serostatus in men over time

Previous epidemiologic studies have observed positive associations between Trichomonas vaginalis (Tv) serostatus and both prostate cancer (PCa) risk and mortality. However, only a few small older studies have examined Tv antibody persistence over time, all of which were composed mainly of female patients. Therefore, we examined Tv antibody persistence over time, as well as intra-individual variability, among middle- to older-aged men in the Southern Community Cohort Study (SCCS). We tested baseline and repeat plasma specimens (collected 1-3 years later) from 248 male participants for Tv antibodies. We used the same enzyme-linked immunosorbent assay as in previous studies of Tv serostatus and PCa. At baseline, 46 (18.5 %) participants were seropositive for Tv infection. Seventy-six percent of these men were still seropositive 1-3 years later. A similar proportion of men "seroconverted" (4.0 %) as "seroreverted" (4.4 %), all of whom had absorbance values near the cutoff point for seropositivity. Overall, substantial agreement was observed between baseline and repeat serostatus (κ = 0.72, 95 % confidence interval 0.60-0.83). Tv seropositivity was largely persistent between plasma specimens collected 1-3 years apart from middle- to older-aged men. These high levels of persistence are similar to those observed for other sexually transmitted infections frequently investigated in relation to PCa.

P270 Motor neurone disease (MND); a survey of deaths in the era of non-invasive ventilation

BackgroundThe care of patients with MND has changed radically with greater uptake of non-invasive ventilation (NIV) and tube feeding (TF). Community colleagues in our region have expressed anxiety about how...