Faculty Bibliography

OBJECTIVES/OBJECTIVE:To evaluate mail-in semen collection services for cryopreservation, focusing on costs, transparency, and efficacy due to the advancements of direct access to fertility testing and treatment. METHODS:Using Google, we identified eight prominent companies offering mail-in sperm cryopreservation services. We analyzed their costs, storage practices, marketing strategies, and prescription requirements. For comparison, we examined academic institutions offering similar services, exploring differences in pricing, processes, and accessibility. RESULTS:The average upfront cost to process and freeze sperm was $730 (range $329 to $1575) with 10-year storage costs of $3117, on average (range $1450 to $5500), which may or may not be guaranteed to remain level. Not all services disclosed future costs such as transport, thawing, and disposal fees, with some firms being less transparent. Two firms offered client depositor storage on-site and the remainder outsourced to partner labs scattered around the country. One facility offered storage of tissue samples for men with azoospermia; none of the companies required men to have an order from their doctor to use the service. CONCLUSIONS:Mail-in cryopreservation services provide convenience but present challenges, including varying costs, transparency issues, and potential limitations in medical oversight. Integrating these services into traditional healthcare settings could optimize patient outcomes and satisfaction.

BACKGROUND:to date, no standardized, evidence-based follow-up schemes exist for the monitoring of patients who underwent focal therapy (FT) and expert centers rely mainly on their own experience and/or institutional protocols. We aimed to perform a comprehensive review of the most advantageous follow-up strategies and their rationale after FT for prostate cancer (PCa). METHODS:a narrative review of the literature was conducted to investigate different follow-up protocols of FT for PCa. Outcomes of interest were post-ablation oncological and functional outcomes and complications. RESULTS:Oncological success after FT was generally defined as the biopsy-confirmed absence of clinically significant PCa in the treated zone. De novo PCa in the untreated area usually reflects an inaccurate patient selection and should be treated as primary PCa. During follow-up, oncological outcomes should be evaluated with periodic PSA, multiparametric MRI and prostate biopsy. The use of PSA derivatives and new biomarkers is still controversial and therefore not recommended. The first MRI after FT should be performed between 6-12 months to avoid ablation-related artifacts and diagnostic delay in case of FT failure. Other imaging modalities, such as PSMA PET/CT scan, are promising but still need to be validated in the post-FT setting. A 12-month "for-protocol" prostate biopsy, including targeted and systematic biopsy, was generally considered the preferred biopsy method to rule out tumor persistence/recurrence. Subsequent mpMRIs and biopsies should follow a risk-adapted approach depending on the clinical scenario. Functional outcomes should be periodically assessed using validated questionnaires within the first year, when typically recover to a new baseline. Complications, despite uncommon, should be strictly monitored mainly in the first month. CONCLUSIONS:FT follow-up is a multifaceted process involving clinical, radiological, and histological assessment. Studies evaluating the impact of different follow-up strategies and ideal timings are needed to produce standardized protocols following FT.

BACKGROUND:Studies of type 1 diabetes in sub-Saharan Africa have suggested that the clinical phenotype might differ from phenotypes reported elsewhere. We aimed to establish whether type 1 diabetes diagnosed in children and young adults in three countries across sub-Saharan Africa is of autoimmune origin. METHODS:In this observational, cross-sectional study, we identified participants without obesity from outpatient clinics in government and private hospitals in Cameroon, Uganda, and South Africa who were of self-reported Black African ethnicity with young-onset (age <30 years), insulin-treated, clinically diagnosed type 1 diabetes. We measured islet autoantibodies to GADA, IA-2A, and ZnT8A, and calculated a genetic risk score (GRS) for type 1 diabetes, which we compared with control populations without diabetes derived from the Uganda Genome Resource databank and other studies. Endogenous insulin secretion was assessed using plasma C-peptide. We compared findings with those for participants with self-reported Black (n=429) and White (n=2602) ancestry with type 1 diabetes from the SEARCH for Diabetes in Youth (SEARCH) study in the USA. FINDINGS/RESULTS:(19·5-24·1). Only 312 (34·9%) of 894 participants were positive for islet autoantibodies; these participants had classic features of type 1 diabetes, including 225 (82·7%) of 272 with plasma C-peptide <200 pmol/L, and high type 1 diabetes GRS. Those without islet autoantibodies (582 [65·1%] of 894) had significantly lower median type 1 diabetes GRS than those with autoantibodies (9·66 [IQR 7·77-11·33] vs 11·76 [10·49-12·91]; p<0·0001), suggesting a subgroup with a non-autoimmune diabetes subtype, with clinical features and C-peptide concentrations not consistent with type 2 diabetes. Among participants diagnosed younger than 20 years, autoantibody-negative diabetes was also observed in 65 (15·1%) of 429 participants with Black ancestry in SEARCH (although less frequently than in sub-Saharan Africa [59 (55·1%) of 107]), and these participants also had a low type 1 diabetes GRS (median 10·41 [IQR 8·65-12·22] in autoantibody-negative subgroup). No such pattern was observed in White participants in SEARCH: 241 (9·3%) of 2602 were autoantibody negative and median GRS for type 1 diabetes was similar in autoantibody-negative and autoantibody-positive participants (median 13·42 [IQR 11·80-14·61] vs 13·49 [12·29-14·58]). INTERPRETATION/CONCLUSIONS:In sub-Saharan Africa, clinically diagnosed type 1 diabetes is heterogeneous, comprising classic autoimmune type 1 diabetes and a novel, non-autoimmune, insulin-deficient diabetes subtype. There is evidence of this subtype in Black but not White individuals in the USA. Therefore, alternative causes must be considered in this group of individuals, and understanding the drivers of this subtype might offer new insights into prevention and treatment. FUNDING/BACKGROUND:UK National Institute of Health and Care Research. TRANSLATION/UNASSIGNED:For the French translation of the abstract see Supplementary Materials section.

INTRODUCTION/BACKGROUND:GLP-1 receptor agonists (GLP1-RAs) are increasingly prescribed as an alternative to bariatric surgery for weight loss, and may pose as an alternative to conversion Roux-En-Y Gastric Bypass (cRYGB) in patients with insufficient weight loss or weight recurrence after sleeve gastrectomy [A C, N C, A I. Postoperative morbidity and weight loss after revisional bariatric surgery for primary failed restrictive procedure: a systematic review and network meta-analysis. International Journal of Surgery; 2022;Jensen et al. in Obes Surg 33:1017-1025, 2023; Jamal et al. in Obes Surg 34:1324-1332, 2024; Lautenbach A, Wernecke M, Stoll FD, Meyhöfer SM, Meyhöfer S, Aberel J. 1422-P: The potential of semaglutide once-weekly in patients without Type 2 Diabetes with weight regain or insufficient weight loss after bariatric surgery. Diabetes 2022; 71(Supplement_1);]. METHODS AND PROCEDURES/METHODS:Adult patients ≥ 18 years old, who previously underwent a sleeve gastrectomy and were subsequently treated with weekly injectable Semaglutide or Tirzepatide, or treated with conversion from sleeve gastrectomy were included for analysis. Patients converted for GERD, GLP1-RA use with BMI ≤ 35, or pre operative GLP1-RA use were excluded. Post operative weights and Hgb A1C were assessed from 3 months to 3 years post intervention (start of GLP1-RA or surgery). T-test, ANOVA, and chi-squared analysis were used to compare groups, while multivariable linear regression analysis was used to evaluate the effect of bariatric surgery on %TBWL at 3 years post intervention when adjusting for baseline characteristics. RESULTS:4901 patients were included for analysis (3004 cRYGB, 1897 GLP1-RA). There was no difference in pre-intervention weight (242.8 ± 44.4 GLP1-RA vs 242.3 ± 57.8 cRYGB, p = .993). cRYGB patients had a higher baseline Hgba1c (6.19 ± 1.4 vs 5.85 ± 1.2, p < 0.001). cRYGB was associated with significantly greater weight loss at all post operative time points up to 3 years post intervention, (26.1 vs 13.7%, p < 0.001). There was no significant difference in Hgba1c control between treatments at all post intervention time points (all p > 0.05). In the multivariate linear regression analysis, when adjusting for sex, baseline BMI, baseline age, and non-white race, cRYGB was associated with an 11% greater %TBWL compared to those who were treated with a GLP1-RA. CONCLUSIONS:For patients who have had insufficient weight loss or weight recurrence following sleeve gastrectomy, conversion to RYGB offers greater, long-term weight loss compared to GLP1-RAs.

OBJECTIVE:To increase the rate of low dose aspirin (LDA) counseling and treatment in patients with 2 or more moderate risk factors of preeclampsia(PMRF) from 9% to 50% within a four-month period after implementation of interventions. STUDY DESIGN/METHODS:A single-institution quality improvement initiative aimed at LDA screening and counseling of those with PMRF. Two groups were evaluated: pre-intervention (January - April 2022) and post-intervention (January - April 2023). This initiative focused on identifying PMRF and monitoring rates of LDA counseling and treatment. Rates were assessed at two-week intervals and presented on a run chart to visualize trends and measure progress over time. Providers underwent education utilizing preeclampsia (PEC) screening flowsheets and integrated a clinical decision-making (CDM) tool in initial prenatal visit documentation using a smart-tool. Patients were provided with educational flyers. RESULTS:In the pre-intervention group (n=126), 8.7% of patients received counseling on PMRF risk factors and LDA use, 7.9% were treated with LDA. In the post-intervention group (n=112) 52.7% of patients received counseling on PMRF risk factors and LDA use, and 35.7% were treated with LDA. There was an 83.5% increase in the percentage of patients counseled following intervention implementation. A progressive increase was noted in counseling rates within the 18 weeks post-intervention. CONCLUSION/CONCLUSIONS:Integrating PEC screening flowsheets, clinical decision-making tools, and patient education flyers effectively enhances LDA counseling for patients with ≥2 PMRF with additional benefits seen in high-risk patients. These interventions offer a replicable model to enhance guideline adherence and reduce preeclampsia risk in vulnerable populations.

BACKGROUND AND AIMS/OBJECTIVE:The TRISCEND II trial demonstrated superior clinical benefits for patients with ≥severe tricuspid regurgitation (TR) treated with the EVOQUE transcatheter tricuspid valve replacement (TTVR) system plus medical therapy versus medical therapy alone. This work reports 1-year and 18-month outcomes in patients stratified by baseline TR severity. METHODS:The multicentre, prospective TRISCEND II trial enrolled 400 patients with symptomatic, ≥severe TR and randomised 2:1 to TTVR (n=267) or control (n=133). In a post-hoc analysis, patients were stratified into severe TR (n=172) and massive/torrential TR (n=220) cohorts. Clinical and quality-of-life outcomes were reported at 1 year, with Kaplan-Meier estimates for all-cause mortality and heart failure (HF) hospitalisation assessed at 18 months. Study oversight included an independent echocardiographic core laboratory, clinical events committee, and data safety monitoring board. RESULTS:One year after TTVR, TR was ≤mild in 95.2% of severe TR and 95.3% of massive/torrential TR patients. The primary safety and effectiveness endpoint (win ratio) favoured TTVR over control regardless of baseline TR severity: severe (1.64 [95% CI: 1.11, 2.43]) and massive/torrential (2.20 [1.55, 3.14]). At 18 months, TTVR patients had similar mortality to controls (rate difference: severe 0.2% [-11.6, 11.9], massive/torrential -5.8% [-17.6, 6.0], whereas HF hospitalisation rates favoured TTVR in the massive/torrential cohort (vs. control, severe 9.8% [-3.0, 22.7], massive/torrential -15.2% [-28.9, -1.5]). CONCLUSIONS:Patients with ≥severe TR benefit from TTVR, experiencing improvements in TR severity, functional capacity, and quality of life regardless of baseline TR severity, with a signal for greater benefit in patients with more advanced disease.

INTRODUCTION/BACKGROUND:Papillary thyroid cancer (PTC) often follows an indolent course with a favorable prognosis. This has led to evolving guideline-based, low-intensity treatment options for low-risk patients. Recently, the purported benefit of total thyroidectomy (TT) over unilateral lobectomy for PTC with clinical lateral neck nodal metastasis (cN1b) has come into question. MATERIALS AND METHODS/METHODS:A retrospective analysis of the National Cancer Institute's Surveillance, Epidemiology, and End Results database was performed to study patients with PTC with ipsilateral cN1b disease from 1975 to 2020. Kaplan-Meier curves and log-rank tests were used to compare disease-specific survival (DSS) difference between lobectomy and TT at 10 y. Multivariable Cox proportional hazards analysis was performed to determine the independent association of lobectomy versus TT with DSS, correcting for age and lymph node ratio, defined as the ratio of pathologically positive lymph nodes to total number examined. RESULTS:Among 2943 patients (median [interquartile range] age, 45 [26] y), 42 underwent lobectomy and 2901 underwent TT. Unadjusted DSS at 10 y in the lobectomy and TT groups were 51.0% (95% confidence interval, 31.4%-82.8%) and 86.8% (95% confidence interval, 84.8%-88.9%), respectively. On multivariable analysis of all patients, older age (hazard ratio [HR], 1.08; P < 0.001) and male gender (HR, 1.74; P < 0.001) were associated with lower adjusted DSS, whereas treatment with TT (HR, 0.387; P = 0.005) and receipt of radioactive iodine (RAI) (HR, 0.604; P < 0.001) were associated with improved adjusted DSS. In addition, we observed that the magnitude of survival benefit conferred by RAI and TT were reduced with decreasing age (P < 0.001). CONCLUSIONS:This longitudinal cohort study suggests that, while TT is associated with a DSS benefit in most patients with PTC and ipsilateral cN1b disease, this association may not exist in a smaller cohort of younger patients. These findings raise the possibility that unilateral surgical clearance without RAI could offer adequate oncologic outcomes in selected younger individuals; however, further investigation is warranted to confirm these observations and inform clinical decision-making.

BACKGROUND:Fixed-dose combination (FDC) antihypertensives combine two or more agents. Compared with non-FDC antihypertensives of multiple classes (multi-pill therapy), combination-pill therapy using FDC antihypertensives may improve hypertension control. However, combination-pill therapy remains low. OBJECTIVES/OBJECTIVE:This study aims to assess: 1) the association between combination-pill therapy and medication adherence, health care utilization, and costs; and 2) the potential to mitigate racial and ethnic differences in medication adherence. METHODS:A retrospective cohort analysis was conducted using the 2017-2021 Merative MarketScan Medicaid database. The study sample included adults aged 18 to 64 years with hypertension, continuously enrolled 1 year before and after a random index date of prescription. The propensity score overlap weighting method was used to balance characteristics between individuals using combination- and multi-pill therapy. Logistic models were used for medication adherence (defined as medication possession ratio [MPR] ≥80%), linear models for continuous MPRs, negative binomial models for health care utilization, and generalized linear models for costs. RESULTS:Compared with multi-pill therapy, combination-pill therapy was associated with higher medication adherence (3.17 in MPR; 95% CI: 2.79-3.55), fewer hypertension-related emergency department visits (220 per 1,000 individuals; 95% CI: -235 to -204), fewer hospitalizations (153 per 1,000 individuals, 95% CI: -160 to -146), and lower costs ($2,862 per person, 95% CI: -$3,035 to -$2,689). However, differences in medication adherence persisted, with non-Hispanic Black adults demonstrating lower adherence than non-Hispanic White adults. CONCLUSIONS:Combination-pill therapy could improve hypertension management and save costs for the Medicaid program and beneficiaries. However, persistent racial and ethnic differences in adherence highlight the need for tailored interventions.