Men's Health Boston

Background: Several studies have assessed sex differences in outcomes of patients with pulmonary embolism (PE). However, they have been limited by small sample sizes, lack of a prespecified protocol, or other methodological problems. Aims: The SERIOUS-PE study was designed for rigorous prespecified analyses in patients aged ≥65 years, a group most likely to suffer from PE and its adverse outcomes. Methods: We used data from the RIETE registry (predominantly representing Europe) and a validated algorithm using ICD-10 codes to identify US Medicare Fee-For-Service beneficiaries with PE. To focus on clinically-relevant differences in clinical characteristics, standardized differences (SRD)>10% were considered. Thirty-day outcomes were assessed in unadjusted and adjusted models. Results: The outcomes analysis included 33,462 patients from RIETE (age 77.6 years, 59.5% female) and 666,128 from Medicare (age 73.5 years, 53.9% female). Females were older than males (SRD: 34% [RIETE] and 30% [Medicare]), and more frequently had varicose veins, immobility, depression, or hormonal therapy (SRD>10%). Males more frequently had atherosclerotic diseases and cancer (SRD>10%). Thrombus burden, PE risk stratification, anticoagulant therapy, and advanced therapies did not have clinically-relevant differences between groups (SRD<5%). 30-day mortality occurred in 6.4% of females and 6.8% of males in RIETE (OR 0.91, 95% CI 0.83-1.00) and 15.2% of females and 16.5% of males in Medicare (OR 0.91, 95% CI 0.90-0.92). After adjusting for age and other covariates, females had a higher risk of mortality than males in RIETE (aOR 1.24, 95% CI 1.11-1.39) and in Medicare (aOR 1.10, 95% CI 1.08-1.13). 30-day readmission occurred in 14.7% of females and 15.1% of males in Medicare (OR 0.97, 95% CI 0.96-0.99, and aOR 1.00, 95% CI 0.98-1.01). Conclusions: This is the most comprehensive assessment of sex differences in presentation, treatment strategies, and outcomes of older adults with PE. Sex differences in crude vs adjusted mortality warrant additional investigation.

Infectious diseases remain a significant public health challenge in low- and middle-income countries (LMICs), with HIV, tuberculosis (TB), and malaria contributing significantly to morbidity and mortality. Community Health Workers (CHWs) play a pivotal role in addressing these diseases, yet evidence on the costs and cost-effectiveness of CHW-led interventions remains fragmented. We performed a scoping review, searching ten databases and the grey literature for original studies published between August 2015 and July 2024. Recognized search terms related to "Community Health Workers" and "Economic Evaluation(s)" in LMICs were utilized. Covidence software was employed to screen studies based on inclusion and exclusion criteria. Data on study methodology, costs and cost-related outcomes were then extracted, tabulated in a data-extraction form, and analysed using Microsoft Excel. Thirty-three studies representing 106 scenarios were included, predominantly from sub-Saharan Africa (61%). Over half the scenarios provide evidence about malaria (n = 59), followed by HIV (n = 31) and TB (n = 24). CHWs performed diverse roles, including delivering preventive education, case finding, diagnosis, treatment adherence support, counselling and referrals. The majority demonstrated that CHW programs were cost-effective compared to alternative service delivery models, most commonly facility-based care. These programs were particularly effective in improving treatment adherence and targeting high-priority populations. Costs per beneficiary ranged widely, from $1.20 to $26,556. This review highlights significant heterogeneity in methodologies and reporting, impeding comprehensive comparisons. Future research should emphasize standardized reporting, assess affordability, explore integrated CHW roles across multiple disease groups, and focus on generating evidence that supports priority-setting and resource allocation at the health system level.

Background: Health-related quality of life (HRQL) is reduced in patients with heart failure with preserved ejection fraction (HFpEF). However, the extent to which HRQL outcomes are related to cardiac structure and function in patients with HFpEF is not well understood. Methods: We examined the association between baseline echocardiographic measures and longitudinal Kansas City Cardiomyopathy Questionnaire (KCCQ) measures in patients with HFpEF in the PARAGON-HF trial using longitudinal regression models adjusted for age, sex, baseline KCCQ score, randomization, and other important clinical confounders. Results: Among 1,094 patients with baseline KCCQ data at randomization and a baseline echocardiogram within 6 months of enrollment, the mean age was 74 years and 53% were women. Over 3 years, 78% completed KCCQ measures at baseline, 12, 24, and 36 months. Missing values for non-survivors (n=116) were imputed as zero to avoid survival bias. Posterior wall thickness, septal E/e’, and right ventricular (RV) end diastolic area were negatively associated with the KCCQ Overall Summary Score, and a similar pattern of associations was observed for the KCCQ Clinical Summary Score (Table). Pulmonary artery systolic pressure was additionally negatively associated with the KCCQ Total Symptom Score. Notably, left ventricular (LV) size, septal wall thickness, LV ejection fraction, LV strain, and left atrial size were not significantly associated with longitudinal changes in KCCQ. Conclusion: In patients with HFpEF, increased LV posterior wall thickness, elevated LV filling pressure, elevated pulmonary pressure, and RV enlargement - together suggestive of more advanced diastolic dysfunction - are associated with a decline in KCCQ scores and may influence future worsening of quality of life.

Background: Thromboprophylaxis with rivaroxaban 10 mg once daily has been shown to reduce the risk of major thrombotic events in patients with COVID-19 both in-hospital and after discharge. The potential role of thromboprophylaxis with rivaroxaban in high-risk outpatients with COVID-19 was examined in 2 randomized, controlled trials; pooled analyses of these studies will enable evaluation of consistency of findings. Methods: PREVENT-HD (NCT04508023) and the Bill and Melinda Gates Medical Research Institute (Gates MRI) study (NCT04504032) are both virtually conducted, pragmatic trials which randomized patients with acute COVID-19 to rivaroxaban 10 mg daily or placebo (PREVENT-HD)/placebo equivalent (Gates MRI) on top of standard care (Figure). Both studies collected clinical outcomes including all-cause hospitalization, death, thrombotic and bleeding events. A patient-level meta-analysis was prespecified prior to PREVENT-HD database lock. Results: The 2 trials randomized a total of 1,781 patients. PREVENT-HD closeout is ongoing with anticipated unblinding in July 2022 and submission to AHA as an LBCT. Gates MRI study results have been reported; among the 497 randomized patients, clinical events were infrequent overall, with hospitalizations in 3 (1.4%) patients receiving rivaroxaban and 7 (3.2%) in the placebo group (RR 0.43, 95% CI 0.11, 1.65; p=0.21). A planned pooled analysis will occur after PREVENT-HD database lock enabling presentation at AHA 2022 if selected. Conclusions: A patient-level meta-analysis of 2 randomized, controlled trials of similar design evaluating rivaroxaban 10 mg daily for pre-hospital prevention of thrombotic complications, hospitalization, and death in outpatients with COVID-19 will be conducted. We hope to present the results at the AHA Scientific Sessions.

Introduction: The role of endothelial shear stress (ESS) in the development of coronary plaque erosion is unknown. High ESS gradient (ESSG) has been hypothesized to promote plaque erosion, but no studies have included matched control stable plaques with the same minimal and reference lumen area (MLA, RLA, respectively). No studies examined the location of plaque erosion (proximal vs distal to MLA of the culprit plaque) related to the max magnitude of upslope vs downslope of the lumen obstruction. Aims: (1) to compare ESSG between plaques with erosion and similar control plaques that remained stable; (2) among erosion plaques, to study the effect of max slope steepness (Δ lumen area/frame) up- and down-stream from the culprit plaque MLA on thrombus location. Methods: We studied 46 patients from TOTAL and COMPLETE trials who underwent angiography and OCT imaging: 46 arteries: 27 LAD, 6 LCX, 13 RCA. Plaques were divided into Plaque Erosion (n=24) with OCT features of erosion before PCI (17 definite, 7 probable erosion) and matched coronary plaques from separate control patients (n=22) without plaque disruption. Orthogonal angiographic views were used to generate a 3-D arterial reconstruction, and angio centerline was combined with OCT centerline. Local ESS distribution was assessed by computational fluid dynamics and reported in consecutive 3-mm segments. Among the plaque erosions, we calculated the up- and down-slope (Δ lumen area/frame) of lumen obstruction for each culprit plaque. Results: See Table Conclusion: In plaques with similarly severe obstruction, plaque erosion is associated with higher max ESS and max ESSG vs plaques that remain stable. Proximal plaque erosion/thrombus is associated with steeper plaque upslope vs downslope, and distal plaque erosion/thrombus is associated with steeper plaque downslope vs upslope. Absolute ESSG is higher in downslope vs upslope erosions. These features may help prognosticate individual plaques at risk for future erosion.

Introduction: Testosterone (T) deficiency has been reported to be associated with Peyronie's disease (PD). This study investigated response rates to intralesional injections of collagenase clostridium histolyticum (Xiaflex™) (CCx) for penile curvature in men who simultaneously received T therapy (TTh) and in men who received CCx without TTh. Methods: Search of electronic records identified all men treated with CCx from 2013 to 2018, and whether they also received TTh during that time. Laboratory results for baseline serum T, free T, and luteinizing hormone were available for all men. Response to CCx was categorized as no change, mild change, substantial change, or complete resolution based on subjective reports by patients. Results: A total of 117 men received treatment with CCx. Of these, 72 received CCx alone (henceforth referred to as XA group) and 45 received CCx plus TTh (referred to as XT group). Mean baseline serum T was 458 ng/dL for the XA group and 384 ng/dL for the XT group (p = 0.10). Mean age was 60.4 years for the XT group and 56.5 years for the XA group (p = 0.028). Baseline mean curvature was 46° for the XA group and 45° for the XT group. Mean number of treatment cycles (two injections per cycle) was 2.7 for both groups. Overall, 67.5% reported some improvement in curve with CCx. Reports of any improvement were 84.4% for the XT group and 56.9% for the XA group (p < 0.001). Conversely, rates of no improvement were 15.6% for the XT group and 43.1% for the XA group. Substantial improvement or complete resolution of curve was noted by 48.8% of the XT group and 20.8% of the XA group (p = 0.001). Conclusions: These pilot observational results suggest that TTh may improve the response to intralesional CCx treatment of PD. A prospective study is warranted to investigate this further.

Erectile dysfunction (ED) is a common, burdensome, and costly urologic condition strongly related to all aspects of general health, from physical to mental. ED has profound consequences as it may interfere physical well-being, quality of life (QoL), self-esteem, relationships, self-worth, and productivity. It is therefore important to ensure that all types of effective ED treatments are consistently accessible to patients. While federal and state mandates ensure access to treatment for women’s breast health, female-factor infertility, and gender affirmation to ensure that these individuals do not experience a diminished QoL, there are no comparable mandates for men’s sexual and reproductive health. The burden of ED necessitates a call to action to improve the accessibility of ED treatments. The call to action steps include: (a) coverage for pharmacological, surgical, and other ED treatments should be viewed in the same way as coverage for other health issues, whether male or female and regardless of the stages of treatment, physical dysfunction, or physical changes; (b) American Urological Association (AUA) guidelines for the management of ED should be followed, including implementation of templates in electronic medical records (EMRs) to support adherence to the guidelines; and (c) coverage criteria should explicitly state that the criteria are intended to support gender equity for sexual and reproductive health care and should not be used to prevent men from receiving medically necessary ED treatments. This call to action offers a pathway to support every man who seeks treatment for ED as a medically necessary intervention by removing systemic health-care barriers.

The role of testosterone in the pathophysiology of inflammation is of critical clinical importance; however, no universal mechanism(s) has been advanced to explain the complex and interwoven pathways of androgens in the attenuation of the inflammatory processes. PubMed and EMBASE searches were performed, including the following key words: “testosterone”, “androgens”, “inflammatory cytokines”, “inflammatory biomarkers” with focus on clinical studies as well as basic scientific studies in human and animal models. Significant benefits of testosterone therapy in ameliorating or attenuating the symptoms of several chronic inflammatory diseases were reported. Because anti–tumor necrosis factor therapy is the mainstay for the treatment of moderate-to-severe inflammatory bowel disease; including Crohn’s disease and ulcerative colitis, and because testosterone therapy in hypogonadal men with chronic inflammatory conditions reduce tumor necrosis factor-alpha (TNF-α), IL-1β, and IL-6, we suggest that testosterone therapy attenuates the inflammatory process and reduces the burden of disease by mechanisms inhibiting inflammatory cytokine expression and function. Mechanistically, androgens regulate the expression and function of inflammatory cytokines, including TNF-α, IL-1β, IL-6, and CRP (C-reactive protein). Here, we suggest that testosterone regulates multiple and overlapping cellular and molecular pathways involving a host of immune cells and biochemical factors that converge to contribute to attenuation of the inflammatory process.

The contact of subcellular organelles serves as molecular signaling hubs to maintain cellular homeostasis. Endoplasmic Reticulum‐Mitochondria Contacts (ERMC) are one of these signaling hubs. They regulate diverse cellular activities such as Ca2+ or lipid exchange, and mitochondria dynamics including metabolism, apoptosis and autophagy. The significance of ERMCs has recently been highlighted its dysregulation is linked to metabolic disease and neurodegenerative diseases. We previously identified multiple physical components of ERMCs using engineered ascorbate peroxidase (APEX) to map the ERMCs proteome. The identified 405 proteins with a 2.0‐fold cut‐off ratio (log base 2) in culture (SILAC)‐LC/MS‐MS quantification are classified by gene set enrichment analysis (GSEA). The analysis shows protein biosynthesis‐related proteins are enriched along with several Rho/kinase proteins. To investigate ERMC regulatory network, we screened 1126 compounds and ORFs identified in the proteomic analysis with a Split‐Rluc8 complementation assay; a biosensor that measures ERMCs. We found several modulators of adrenergic signaling associated with increased ERMC. These results may be useful to elucidate the regulation of ERMCs, understand ERMC physiology and unravel the disease mechanism.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.