Citations

Purpose of review Peyronie's disease characterizes a condition in which there is angular curvature of the penis. We know that the most patients with Peyronie's disease will not have spontaneous resolution of their penile curvature. As such, patients who desire treatment can elect for either surgical or nonsurgical therapy. Herein, we discuss the contemporary nonsurgical management options for Peyronie's disease. Recent findings Nonsurgical management options for Peyronie's disease include oral therapy, intra-lesional injections, and penile traction therapy. At the time of this review, there is essentially no high-level evidence demonstrating any benefit for oral therapy. Penile traction therapy has evolved over the past decade with second-generation devices demonstrating strong efficacy and more convenient treatment regimens. Intra-lesional options include collagenase Clostridium histolyticum (CCH), verapamil, and interferon alpha-2b. The IMPRESS trial garnered the strongest level of evidence (two randomized, double-blind, placebo-controlled trials) to support the safety and efficacy of CCH. Verapamil is an option supported by several urological societies; however, the evidence supporting its efficacy is inconsistent between several notable series and randomized studies. IFN alpha 2b can produce modest improvement in curvature, however, is not available for use in North America. Summary Herein, we will discuss notable advances in nonsurgical management of Peyronie's disease.

Article Title: ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis

Metabolic syndrome (MetS) is associated with low-grade inflammation, which can be exacerbated by renal artery stenosis (RAS) and renovascular hypertension, potentially worsening outcomes through pro-inflammatory cytokines. This study investigated whether mesenchymal stem/stromal cells (MSCs) could reduce fat inflammation in pigs with MetS and RAS. Twenty-four pigs were divided into Lean (control), MetS, MetS + RAS, and MetS + RAS + MSCs. In the MSC-treated group, autologous adipose-derived MSCs (107 cells) were injected into the renal artery six weeks after RAS induction. After four weeks, fat volumes and inflammatory markers were assessed. MSC treatment reduced levels of pro-inflammatory cytokines (MCP-1, TNF-a, IL-6) in the renal vein blood and in perirenal fat. The MSCs also decreased fat fibrosis, restored adipocyte size, and altered adipogenesis-related gene expression, particularly in the perirenal fat. These effects were less pronounced in subcutaneous fat. The MSC therapy attenuated fat inflammation and improved metabolic outcomes in pigs with MetS + RAS, suggesting that adipose-derived MSCs may offer a promising therapeutic approach for metabolic disorders.

Abstract The demands associated with ongoing disease management may overwhelm middle aged and older adults living with two or more chronic conditions. Treatment burden refers to both (a) the numerous demands—such as the time and costs of travel to clinical appointment, administrative burden, and coordinating fragmented care—healthcare makes on patients and (b) the negative impact on the patient’s wellbeing. We evaluated data from respondents of the treatment burden experimental module included in the 2022 Health and Retirement Study data collection wave (N=1,888). We analyzed responses to the 15-item Treatment Burden Questionnaire (TBQ; 15 questions scored 0-10; total sum 0-150; >59 considered unsustainable burden). We compared mean total TBQ score by sociodemographic and multimorbidity combination groups using either a t-test (among 2 groups) or ANOVA (among >2 groups). We compared sustainability across groups using a chi-square test. Respondents (mean 69 years; 62% female, 71% living with 2+ chronic conditions) had a mean TBQ score of 20.3/150 (SD 22.7) with 125 (6.6%) reporting unsustainable burden. Administrative and financial tasks and lifestyle changes were the most burdensome activities. Unsustainable burden was significantly more likely among younger (51-64 vs. older), lower educated (< high school vs. ≥high school), and Black and Latino (vs. non-Latino White) respondents, and in those living with 2+ chronic conditions. In this nationally-representative sample of US adults, participants reported less treatment burden than previously reported in international studies. Certain sociodemographic groups reported high and unsustainable burden of treatment, informing future interventions to reduce treatment burden in mid and late life.

Abstract Aging is associated with intestinal dysbiosis, a condition characterized by diminished microbial biodiversity and inflammation. This leads to increased vulnerability to extraintestinal manifestations such as autoimmune, metabolic, and neurodegenerative conditions and accelerates mortality. As such, modulation of the gut microbiome is a promising way to extend healthspan. In this study, we explore the effects of fecal microbiota transplant (FMT) from long-living Ames dwarf donors to their normal littermates, and vice versa, on the recipient gut microbiota and liver transcriptome. Importantly, our previous studies highlight differences between the microbiomes of Ames dwarf relative to their normal siblings, potentially contributing to their extended lifespan and healthspan. Our findings demonstrate that FMT from Ames dwarf mice to normal mice significantly alters the recipient’s gut microbiota, reprograms bacterial metabolic functions related to healthy aging, and changes the liver transcriptome, indicating improved metabolic health. Our liver mRNA sequencing and RT-PCR validation reveals that FMT in normal recipient animals administered dwarf donor stool may contribute to the significant downregulation of p21, Elovl3, and Insig2, genes involved with cellular senescence and liver metabolic pathways. Our data suggest a regulatory axis exists between the gut and liver, highlighting the potential of microbiome-targeted therapies in promoting healthy aging. Future research should validate these findings and study the underlying mechanisms that confer geroprotection.

Abstract Muscle wasting is a significant hurdle in patients due to immobilization, prolonged bed rest, and injury. In particular, the older population develops sarcopenia, characterized by progressive loss of muscle strength due to natural aging. However, there are no FDA-approved drugs for sarcopenia, and it is critical to explore novel therapeutics. Myostatin inhibition is one such strategy that has had varying degrees of success previously, yet the desired levels of muscle strength have not been achieved. Here, we employed a novel vaccine (V13) that generates anti-myostatin antibodies and another (V07) that generates anti-activin A; myostatin and activin A regulate muscle growth negatively. We administered seven doses of V13, V07, and V35 (generates both anti-myostatin and anti-activin A) to long-living, GH-deficient Ames dwarf mice (df/df) and their normal littermate controls (N/df). By week 24 post-first dose, we saw increased forelimb grip strength in V13, V07, and V35 vaccinated df/df mice and V07 and V35 vaccinated N/df mice. Additionally, almost 40% of the vaccinated df/df mice completed the accelerating rotarod trials, compared to the 20% of placebo-treated counterparts. We observed increased lean body mass and reduced fat mass in vaccinated N/df mice, yet surprisingly there were no changes in lean and fat mass in df/df mice. In summary, our results indicate that while myostatin and activin A inhibition play an intimate role in fat metabolism in the presence of GH/IGF-1, this immunization strategy improves muscle motor performance in GH/IGF-1 deficient mice providing promising treatments in older animals regardless age-associated suppression of GH/IGF-1 axis.

Abstract Few studies have reliable estimates on costs of informal care following hospitalization, including health care use and out-of-pocket costs for family caregivers (FCGs) and their care recipients (CR). This presentation discusses results from a Transitional Palliative Care (TPC) intervention on healthcare use and out-of-pocket spending for both FCGs and CRs. The study used data from the Technology-Enhanced TPC study, a trial comparing the TPC intervention to support FCGs of seriously ill CRs to an attention control condition. TPC FCGs received teaching, guidance, and counseling via video calls for 8 weeks following CR hospital discharge. After discharge, a research assistant called FCGs once a month for up to 6 months or CR death to collect healthcare utilization (e.g. outpatient, emergency department, and hospital), out-of-pocket healthcare spending (e.g. deductibles and coinsurance), and health-related travel costs (e.g., transportation, lodging, food) for FCGs and CRs. Incidence rate ratios (IRR) were estimated using negative binomial regressions. The study included 282 FCG-CR dyads across 3 US states. TPC reduced nights in the hospital for CR (IRR = 0.75; 95% CI = 0.56 – 0. 99). Total out-of-pocket spending was not significantly different for TPC versus control; however, TPC dyads reported lower lodging costs (IRR = 0.71; 95% CI = 0.56-0.89). Across groups, mean out-of-pocket spending for dyads was $1401.85, with healthcare payments contributing $1048.58 and transportation expenses contributing $136.79. This study contributes to evidence that palliative care interventions reduce unnecessary hospitalization for seriously ill patients, yet the financial costs to caregivers remain high.

Abstract Recruiting family caregivers to participate in research, especially caregivers of people with severe or life limiting illnesses transitioning from hospital to home, is challenging. Traditional approaches for recruitment, including recruitment done on site at clinics or hospitals, became impracticable during the COVID-19 pandemic, leading to shifts toward virtual or remote recruitment and consent. In this presentation, Dr. Gustavson will compare the success of these two methodological approaches, in-person and remote recruitment and consent, used in the Technology-Enhanced Transitional Palliative Care (TPC) study. She found that the rate of recruitment and consent done in-person was 28% and the rate of remote recruitment and consent was 23%. Those recruited and consented remotely were more likely to be younger, white, have greater than high school education, and were children of or had another non-spousal relationship to the care recipient. She discusses the limitations and benefits of each recruitment modality, including the impact on representativeness of the study sample.