Recent Publications by CFE Educators

AIMS

Treatment for urinary incontinence (UI) includes pelvic floor muscle training (PFMT). There is limited data appraising the characteristics of PFMT devices. We aimed to ascertain the primary use, strengths and weaknesses of PFMT devices available online, through evaluation of consumer reviews.

METHODS

We performed an analysis of PFMT devices on Amazon.com. Four key device categories were recognized. Reviews from the five most frequently-reviewed products per category were analyzed (n = 20). W characterized device use, strengths and weaknesses using thematic analysis.

RESULTS

We evaluated 2574 PFMT device reviews including 1168 vibrating Kegel balls, 750 non-vibrating Kegel balls, 411 pelvic floor or thigh exercisers, and 245 electric probes. Non-vibrating Kegel balls were rated highest (4.6/5 stars), followed by vibrating Kegel balls, electric probes and pelvic floor or thigh exercisers (4.4/5, 4.1/5, and 3.8/5 stars, respectively). Most reviews were positive (77%) or negative (16%) with few neutral (7%). While all were marketed to treat UI, most reviews did not mention the intended use. Vibrating and non-vibrating Kegel balls and electric probes were most likely to be used for UI, and pelvic floor or thigh exercisers for toning. Some used non-vibrating and vibrating Kegel balls for sexual function. Electric probes were the most beneficial device for incontinence control (27%, 67/245). Twenty-five percent of all product reviews praised device ease of use and good quality or design. A minority of reviewers found products difficult to use, of poor quality or design and uncomfortable.

CONCLUSION

Consumers utilized online PFMT devices for multiple purposes, including UI, toning and sexual function. Reviewers generally praised PFMT products, particularly electric probes for UI.

Importance

Erectile dysfunction, especially in younger men, is an early sign of cardiovascular disease and may decrease quality of life. Men may be motivated to adopt a healthy dietary pattern if it lowers their risk of erectile dysfunction.

Objective

To assess the association between adherence to a diet quality index based on healthy dietary patterns and erectile dysfunction in men.

Design, Setting, and Participants

This population-based prospective cohort study included men from the Health Professionals Follow-up Study with follow-up from January 1, 1998, through January 1, 2014. Participants included US male health professionals aged 40 to 75 years at enrollment. Men with erectile dysfunction or a diagnosis of myocardial infarction, diabetes, stroke, or genitourinary cancer at baseline were excluded. Analyses were completed in February 2020.

Exposures

A food frequency questionnaire was used to determine nutrient and food intake every 4 years.

Main Outcomes and Measures

Diet quality was assessed by Mediterranean Diet score and the Alternative Healthy Eating Index 2010 score, with higher scores indicating healthier diet. Dietary index scores were cumulatively updated from 1986 until men developed erectile dysfunction, cardiovascular disease, died, or were lost to follow-up. Incident erectile dysfunction was assessed with questionnaires in 2000, 2004, 2008, and 2012. Hazard ratios (HRs) by prespecified categories or quintiles of dietary index scores were estimated using Cox proportional hazards regression analyses stratified by age.

Results

Among 21 469 men included in analysis, mean (SD) age at baseline was 62 (8.4) years. During a mean (SD) follow-up of 10.8 (5.4) years and 232 522 person-years, there were 968 incident erectile dysfunction cases among men younger than 60 years, 3703 cases among men aged 60 to less than 70 years, and 4793 cases among men aged 70 years or older. Men younger than 60 years and in the highest category of the Mediterranean Diet score had the lowest relative risk of incident erectile dysfunction compared with men in the lowest category (HR, 0.78; 95% CI, 0.66-0.92). Higher Mediterranean diet scores were also inversely associated with incident erectile dysfunction among older men (age 60 to 70 years: HR, 0.82; 95% CI, 0.76-0.89; age ≥70 years: HR, 0.93; 95% CI, 0.86-1.00). Men scoring in the highest quintile of the Alternative Healthy Eating Index 2010 also had a lower risk of incident erectile dysfunction, particularly among men age younger than 60 years (quintile 5 vs quintile 1: HR, 0.78; 95% CI, 0.63-0.97).

Conclusions and Relevance

This cohort study found that adherence to healthy dietary patterns was associated with a lower risk for erectile dysfunction, suggesting that a healthy dietary pattern may play a role in maintaining erectile health.

OBJECTIVE

Nonsteroidal antiinflammatory drugs (NSAIDs) increase blood pressure and potentially cardiovascular burden, which may limit their use in ankylosing spondylitis (AS). Our objective was to determine the association of NSAID use with incident hypertension in a longitudinal AS cohort.

METHODS

Adults with AS were enrolled in a prospective cohort study of patient outcomes and examined every 4-6 months. Hypertension was defined by patient-reported hypertension; antihypertensive medication use; or, on 2 consecutive visits, systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg. Continuous NSAID use was dichotomized based on the validated NSAID index. We assessed the association of NSAID use as a time-varying exposure with the incidence of hypertension using Cox proportional hazards models.

RESULTS

Of the 1,282 patients in the cohort, 628 patients without baseline hypertension had at least 1 year of follow-up and were included in the analysis. Of these, 72% were male, the mean age at baseline was 39 ± 13 years, and 200 patients used NSAIDs continuously. On follow-up, 129 developed incident hypertension. After controlling for other variables, continuous NSAID use was associated with a hazard ratio of 1.12 for incident hypertension (95% confidence interval 1.04-1.20), compared to noncontinuous or no use. The association did not differ in subgroups defined by age, body mass index, biologic use, or disease activity.

CONCLUSION

In our prospective, longitudinal AS cohort, continuous NSAID use was associated with a 12% increased risk for the development of incident hypertension, as compared to noncontinuous or no NSAID use.

BACKGROUND/PURPOSE

First-degree relatives (FDRs) of patients with ankylosing spondylitis (AS) may be at high risk of spondyloarthritis. We examined the frequency, characteristics of chronic back pain (CBP), associated features, persistence of symptoms, and HLA-B27 allele frequency in FDRs of AS patients, also comparing those FDRs with participants in NHANES 2009-2010 with CBP.

METHODS

399 FDRs of AS probands were divided into: (1) No CBP (subjects >40 years old at study visit without CBP) (n=162); (2) NICBP (non-inflammatory CBP) (n=82), and (3) CIBP (inflammatory CBP) (n=155). White FDRs with CBP were compared with 772 participants in NHANES 2009-2010 with CBP. FDRs were invited to return for reassessment.

RESULTS

FDRs with CIBP had earlier onset of CBP than those with NICBP (p0.001) and had higher frequency of heel pain than those without CBP (p=0.002). HLA-B27 occurred in 57% of FDRs with CIBP vs 39.6% of those without CBP (p=0.005, OR=1.9). Of 23 patients with CIBP at baseline re-evaluated 67.04±31.02 months later, 16 (73%) still had CIBP, whereas 4 (31%) of 13 NICBP patients seen 61.23±31.84 months later remained symptomatic.

CONCLUSION

CIBP in FDRs of AS patients is HLA-B27-associated, has earlier onset and tends to persist compared to NICBP.

Idiopathic pulmonary fibrosis is a fatal interstitial lung disease characterized by the TGF-β (transforming growth factor-β)-dependent differentiation of lung fibroblasts into myofibroblasts, which leads to excessive deposition of collagen proteins and progressive scarring. We have previously shown that synthesis of collagen by myofibroblasts requires synthesis of glycine, the most abundant amino acid found in collagen protein. TGF-β upregulates the expression of the enzymes of the serine-glycine synthesis pathway in lung fibroblasts; however, the transcriptional and signaling regulators of this pathway remain incompletely understood. Here, we demonstrate that TGF-β promotes accumulation of ATF4 (activating transcription factor 4), which is required for increased expression of the serine-glycine synthesis pathway enzymes in response to TGF-β. We found that induction of the integrated stress response (ISR) contributes to TGF-β-induced ATF4 activity; however, the primary driver of ATF4 downstream of TGF-β is activation of mTORC1 (mTOR Complex 1). TGF-β activates the PI3K-Akt-mTOR pathway, and inhibition of PI3K prevents activation of downstream signaling and induction of ATF4. Using a panel of mTOR inhibitors, we found that ATF4 activation is dependent on mTORC1, independent of mTORC2. Rapamycin, which incompletely and allosterically inhibits mTORC1, had no effect on TGF-β-mediated induction of ATF4; however, Rapalink-1, which specifically targets the kinase domain of mTORC1, completely inhibited ATF4 induction and metabolic reprogramming downstream of TGF-β. Our results provide insight into the mechanisms of metabolic reprogramming in myofibroblasts and clarify contradictory published findings on the role of mTOR inhibition in myofibroblast differentiation.

BACKGROUND

The novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) disease has transformed innumerable aspects of medical practice, particularly in the field of transplantation.

MAIN BODY

Here we describe a single-center approach to creating a generalizable, comprehensive, and graduated set of recommendations to respond in stepwise fashion to the challenges posed by these conditions, and the underlying principles guiding such decisions.

CONCLUSIONS

Creation of a stepwise plan will allow transplant centers to respond in a dynamic fashion to the ongoing challenges posed by the COVID-19 pandemic.

While the association between psoriasis and various comorbidities is well documented in adults, questions remain as to whether the same relationships exist in the pediatric population. However, psoriasis develops in childhood or adolescence in approximately 40% of patients, suggesting that the risk of comorbidities may also begin early in life. This presents an opportunity for prevention, early detection and intervention for children who may suffer from, or be at risk of, comorbidities. The pediatric psoriasis Comorbidity Screening Initiative, a multidisciplinary panel, devised and published consensus-based screening recommendations for pediatric psoriasis patients in 2017. As these guidelines closely align with the routine age-related screening recommendations for healthy children set forth by the American Academy of Pediatrics, in the absence of signs and symptoms of comorbidities prompting additional evaluation, dermatologists should partner with patients' primary care physicians to ensure up-to-date, routine, and age-based screening.