Preoperative magnetic resonance imaging in predicting early continence recovery after robotic radical prostatectomy

INTRODUCTION AND AIMS

Urinary incontinence is a common complication after radical prostatectomy. The aim of our study was to describe the preoperative anatomical features using magnetic resonance imaging in order to predict early continence recovery after robotic radical prostatectomy.

MATERIAL AND METHODS

72 patients who underwent robotic radical prostatectomy were prospectively analysed. EPIC questionnaire (1, 6 and 12 mo) and first self-reported continence were used to assess functional outcomes. Membranous urethral length (MUL) and MUL-prostate axis angle (aMULP) were assessed preoperatively on T2 weighted sagittal images.

RESULTS

Continence rate was 67.2%, 92.6% and 95.2% at 1, 6 and 12 months, respectively. Early continence was achieved in patients with the lower aMULP. At 1 month, average aMULP in continent patients was 107.21° (IC 95% 90.3-124.6) vs. 118.5° (IC 95% 117.7-134) in incontinent ones (P=.014). At 6 month differences in aMULP among groups were found: 114.24° (IC 95% 104.6-123.9) in continents vs. 142° (IC 95% 126.5-157.6) in incontinents (P=0.015). At 12 month, continent group showed a significantly higher preoperative aMULP. aMULP was revealed as the only independent predictor of urinary continence at 6 mo in multivariate analysis, OR 0.007 (IC 95% 0.002-0.012), P=0.012.

CONCLUSIONS

Preoperative anatomical parameters assessment prior surgery can help to identified those patients will achieve early continence recovery and it supports therapeutic decisions making.

Abstract P5-13-12: Breast cancer in Colombia: A growing challenge for the health care system

INTRODUCTION

Colombia has a population of roughly 49 million people of predominantly Mestizo ethnicity. Cancer has become a growing public health problem in Colombia with nearly 71,000 newly diagnosed malignant tumors per year. It is expected that by 2035, 150,000 new cases of cancer will be diagnosed, making Colombia an intermediate country with regards to global cancer incidence according to IARC.

METHODS

Epidemiological data on breast cancer is scarce and varied due to multiple sources of information. These numbers are obtained thru population-based cancer registries that represent 4 distinct regions of the country. Other data originate from non-governmental institutions and healthcare providers within Colombia. The Colombian National Cancer Institute publishes a Cancer Mortality Atlas annually.

RESULTS

Local cancer registries have shown increases in breast cancer incidence in Colombia. In 2007, age-standardized incidence rate was 27.8 per 100,000 persons increasing to 49.7 cases per 100,000 persons in 2012. Approximately, 2200 women die every year in Colombia due to breast cancer with rates increasing historically, but now are stabilizing. Advanced breast cancers are most frequently found among women without health insurance, while early breast cancers are usually found among working women and those covered by private health insurance. Early breast cancer screening was made mandatory as public policy in the year 2000. However, only 30% of health care coverage was reported, translating to very low coverage by opportunistic screening programs with only 33% of women having had a mammography. In 2012, a National Cancer Control Plan was planned and implemented. It aims to increase early stage cancer diagnosis, increase biannual screening coverage, and guarantee timely access to diagnosis and treatment. A national health survey in 2015 showed only 48% of women had an annual mammographic screening. Multiple disparities have been found with regards to screening and early diagnosis such as economic strata, health insurance coverage, origin, and accessibility. Specifically, data shows that 23% needed to travel in order to obtain access to mammography. Often it is necessary for some patients to sue healthcare insurance systems to obtain specific health care, causing an increase in time to diagnosis and treatment. In 2016, on average a 90-day period was reported from time of onset of symptoms to suspected diagnosis of breast cancer, while the time to the initiation of treatment was 100 days for chemotherapy and close to 120 days for surgery.

DISCUSSION

These data serve to impact the landscape of breast cancer and improve patient outcomes in Colombia. While the National Cancer Plan has led to major changes, a big challenge remains related to the delays between suspicion of breast cancer and diagnosis and treatment. Quality of care provided by private and public insurance administrators is also of concern. General practitioners should receive more detailed training in breast cancer detection and management. The healthcare system should provide quality cancer care with urgent improvement in mammography, especially in more rural areas. Widely, more timely and appropriate follow-up is needed.

Citation Format: Duarte C, Salazar A, Strasser-Weippl K, de Vries E, Wiesner C, Krush L, Goss PE. Breast cancer in Colombia: A growing challenge for the health care system [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-13-12.

Understanding the different relationships between mood and sleep disorders in several groups of non-oncological patients with chronic pain

OBJECTIVE

To compare sleep dimensions in patients suffering from chronic pain of different origins, and with a group of pain-free subjects. To analyze the relationship between depression and/or anxiety and sleep disorders in musculoskeletal, neuropathic, and fibromyalgia patients.

METHODS

This cross-sectional study included patients diagnosed with neuropathic pain (NP) (n = 104), musculoskeletal pain (MSK) (n = 99), or fibromyalgia (FM) (n = 51), and pain free subjects (n = 72). Information about sleep dimensions (MOS-sleep), duration and intensity of pain (Visual Analog Scale), and anxiety and depression (Hospital Anxiety and Depression scale) was collected.

RESULTS

Of the 254 patients with chronic pain (PCP) studied, the mean pain intensity was 6.6 (SD = 1.9), with an average duration of 9 years. The scores in all sleep dimensions of the MOS-sleep were higher in CPP (more disturbances) compared to pain free patients, and differences were observed among the three groups of PCP, with FM most severely affected. Anxiety (β = 1.3), depression (β = 1.1), intensity (β = 1.7), and duration of pain (β = 0.04) were associated with more sleep problems in MSK patients. In contrast, anxiety (β = 2.5) and duration of pain (β = 0.05) were negatively related to sleep in the NP patients, and only depression (β = 1.3) affected FM patients.

CONCLUSIONS

The sleep pattern differs among groups of PCP in the presence or absence of mood disorders. Understanding these disorders in each specific group of PCP is fundamental, and it can contribute to improve the clinical situation of the patients and better orientating therapeutic strategies.

Presence of somatic symptoms (especially pain) in patients with depresive disorder and its impact on quality of life, and possible involvement with anhedonia

Depressive Disorder, according to WHO will be one of the most disabling causes in the world. Depression includes psychological and somatic symptoms, like anhedonia or pain, and both have a bidirectional relationship, so that the presence and severity of one of them directly affects the other one, and both leads to a disruption in quality of life and increase health resources. The relationship between major depression and chronic pain has been widely investigated but few studies have focused on other depressive spectrum disorders, and never the possible relationship between pain and anhedonia in DD. Our aim is to analyse the presence of somatic symptoms (especially pain) in patients with DD and its impact on quality of life, and involvement with anhedonia. We analysed the correlation between the scores of the HADS, SSI-28, SHAPS and SF-36 scales. Results showed a significant correlation between SSI-28 and HADS-A(r = 0.45; P < 0.001), HADS-D(r = 0.35; P < 0.001) and with 7 of the 8 domains of SF-36: Bodily Pain(r = –0.62; P < 0.001), General Health(r = –0.29; P = 0.003), Role Physical(r = –0.45; P < 0.001) Mental Health(r = –0.34; P = 0.003), Vitality(r = –0.403; P < 0.001), Social Functioning(r = –0.37; P < 0.001). In addition, SHAPS correlates with 6 of the 8 domains of SF-36: PF(r = –0.33; P = 0.001), GH(r = –0.27; P = 0.006), Vit (r = –0.41; P < 0.001), SF(r = –0.52; P < 0.001), RE(r = –0.24; P < 0.001) and MH(r = –0.49; P < 0.001). The results demonstrate that both anhedonia and somatic symptoms negatively correlate with HRQoL, and that a bidirectional relationship between depression and somatic symptoms is clearly proven, which means that depression may be related with the presence of somatic symptoms, especially pain, and also somatic symptoms lead to an increase of depressive symptoms. This could impact on the diagnosis and treatment of depressed patients with somatic symptoms and anhedonia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

A dendritic cell targeted vaccine induces long-term HIV-specific immunity within the gastrointestinal tract

Despite significant therapeutic advances for HIV-1 infected individuals, a preventative HIV-1 vaccine remains elusive. Studies focusing on early transmission events, including the observation that there is a profound loss of gastrointestinal (GI) CD4(+) T cells during acute HIV-1 infection, highlight the importance of inducing HIV-specific immunity within the gut. Here we report on the generation of cellular and humoral immune responses in the intestines by a mucosally administered, dendritic cell (DC) targeted vaccine. Our results show that nasally delivered α-CD205-p24 vaccine in combination with polyICLC, induced polyfunctional immune responses within naso-pulmonary lymphoid sites that disseminated widely to systemic and mucosal (GI tract and the vaginal epithelium) sites. Qualitatively, while α-CD205-p24 prime-boost immunization generated CD4(+) T-cell responses, heterologous prime-boost immunization with α-CD205-p24 and NYVAC gag-p24 generated high levels of HIV-specific CD4(+) and CD8(+) T cells within the GI tract. Finally, DC-targeting enhanced the amplitude and longevity of vaccine-induced immune responses in the GI tract. This is the first report of a nasally delivered, DC-targeted vaccine to generate HIV-specific immune responses in the GI tract and will potentially inform the design of preventative approaches against HIV-1 and other mucosal infections.

Factors related to the evolution of Health Related Quality of Life in coronary patients. A longitudinal approach using Weighted Generalized Estimating Equations with missing data

BACKGROUND

The aim is to know the factors related to the evolution of Health Related Quality of Life (HRQL) in Coronary Patients (CP) from a longitudinal perspective using an appropriate method that handles missing data adequately when the mechanism of missingness is uncertain.

METHODS

Prospective study with repeated measures at baseline, 3 and 6months. 250 patients with acute myocardial infarction or unstable angina were studied. Sociodemographic and clinical data were collected at baseline. Mental health (GHQ-28) and HRQL (SF-36v1) were assessed during the follow-up. The missingness mechanism was tested. Friedman test and partial eta-squared were used to analyse changes in SF-36 scores and WGEE were used to identify the predictors of the evolution of HRQL.

RESULTS

95 dropped out after 3months and 72 after 6months. The missingness was likely to be at random. All the dimensions of the SF-36 improved over time, except PF. The factors related to the evolution of HRQL were: being woman (B=-23.9 in RE; B=-6.9 in MCS), older age (B=-0.5 in BP; B=-0.3 in VT), being single/separated (B=-14.5 in GH; B=-14.1 in SF; B=-23.3 in MH) and widow(er) (B=-23.2 PF; B=-29.8 in SF), hypertensive (B=-19.8 in RP; B=-8.9 in VT), worse mental health (B=-3 in PF; B=-2.8 in RP; B=-3.1 in BP; B=-1.2 in PCS; B=-3.8 in VT; B=-2.6 in SF), previous history of CHD (B=-12.5 in PF; B=-5.2 in PCS), and performing heart-healthy physical activities (B=13.9 in PF).

CONCLUSIONS

HRQL improves over time. A global approach, including age, marital status, performing physical activities or hypertension, is required to improve HRQL in CP.

Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort

BACKGROUND

Although preterm birth <37 weeks' gestation is the leading cause of neonatal morbidity and mortality in the United States, the majority of data regarding preterm neonatal outcomes come from older studies, and many reports have been limited to only very preterm neonates. Delineation of neonatal outcomes by delivery gestational age is needed to further clarify the continuum of mortality and morbidity frequencies among preterm neonates.

OBJECTIVE

We sought to describe the contemporary frequencies of neonatal death, neonatal morbidities, and neonatal length of stay across the spectrum of preterm gestational ages.

STUDY DESIGN

This was a secondary analysis of an obstetric cohort of 115,502 women and their neonates who were born in 25 hospitals nationwide, 2008 through 2011. All liveborn nonanomalous singleton preterm (23.0-36.9 weeks of gestation) neonates were included in this analysis. The frequency of neonatal death, major neonatal morbidity (intraventricular hemorrhage grade III/IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II/III, bronchopulmonary dysplasia, persistent pulmonary hypertension), and minor neonatal morbidity (hypotension requiring treatment, intraventricular hemorrhage grade I/II, necrotizing enterocolitis stage I, respiratory distress syndrome, hyperbilirubinemia requiring treatment) were calculated by delivery gestational age; each neonate was classified once by the worst outcome for which criteria was met.

RESULTS

In all, 8334 deliveries met inclusion criteria. There were 119 (1.4%) neonatal deaths. In all, 657 (7.9%) neonates had major morbidity, 3136 (37.6%) had minor morbidity, and 4422 (53.1%) survived without any of the studied morbidities. Deaths declined rapidly with each advancing week of gestation. This decline in death was accompanied by an increase in major neonatal morbidity, which peaked at 54.8% at 25 weeks of gestation. As frequencies of death and major neonatal morbidity fell, minor neonatal morbidity increased, peaking at 81.7% at 31 weeks of gestation. The frequency of all morbidities fell >32 weeks. After 25 weeks, neonatal length of hospital stay decreased significantly with each additional completed week of pregnancy; among babies delivered from 26-32 weeks of gestation, each additional week in utero reduced the subsequent length of neonatal hospitalization by a minimum of 8 days. The median postmenstrual age at discharge nadired around 36 weeks' postmenstrual age for babies born at 31-35 weeks of gestation.

CONCLUSION

Our data show that there is a continuum of outcomes, with each additional week of gestation conferring survival benefit while reducing the length of initial hospitalization. These contemporary data can be useful for patient counseling regarding preterm outcomes.

Assessing the Construct Validity and Internal Reliability of the Screening Tool Test Your Memory in Patients with Chronic Pain

Patients with chronic pain often complain about cognitive difficulties, and since these symptoms represent an additional source of suffering and distress, evaluating the cognitive status of these patients with valid and reliable tests should be an important part of their overall assessment. Although cognitive impairment is a critical characteristic of pain, there is no specific measure designed to detect these effects in this population. The objective was to analyze the psychometric properties of the “Test Your Memory” (TYM) test in patients with chronic pain of three different origins. A cross-sectional study was carried out on 72 subjects free of pain and 254 patients suffering from different types of chronic pain: neuropathic pain (104), musculoskeletal pain (99) and fibromyalgia (51). The construct validity of the TYM was assessed using the Mini-Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADs), Index-9 from MOS-sleep, SF-12, and through the intensity (Visual Analogical Scale) and duration of pain. An exploratory factor analysis was also performed and internal reliability was assessed using Cronbach’s alpha. After adjusting for potential confounders the TYM could distinguish between pain and pain-free patients, and it was correlated with the: MMSE (0.89, p<0.001); HAD-anxiety (-0.50, p<0.001) and HAD-depression scales (-0.52, p<0.001); MOS-sleep Index-9 (-0.49, p<0.001); and the physical (0.49, p < .001) and mental components (0.55, p < .001) of SF-12. The exploratory structure of the TYM showed an 8-factor solution that explained 53% of the variance, and Cronbach’s alpha was 0.66. The TYM is a valid and reliable screening instrument to assess cognitive function in chronic pain patients that will be of particular value in clinical situations.

Somatic Symptoms As Measured By Ssi-26 (somatic Symptom Inventory) Correlate With Social And Physical Functioning (sf36) In Depressed Patients. The Relative Contribution Of Anhedonia

According to the DSM5, Somatic Symptom Disorder (SSD) is characterized by somatic symptoms that are either very distressing or result in significant disruption of functioning. These criteria are significantly different compared with previous editions of DSM. For example, the DSM-IV diagnosis of somatization disorder required a specific number of complaints from among four symptom groups, however the SSD criteria no longer have such a requirement. Nevertheless somatic symptoms must be significantly distressing or disruptive to daily life. Very few studies have focussed on the influence of suffering anhedonia on the perception of somatic symptoms and how this impact on Health Related Quality of Life (HRQoL), particularly physical functioning. We studied the relative impact of somatic symptoms on the social and physical functioning in depressed patients. Moreover we have explored the influence of anhedonia as measured by the Snaith-Hamilton Anhedonia Pleasure Scale (SHAPS). We analysed the correlations between the scores of the 8 dimensions of the SF-36, the SSI-26 and the SHAPS questionnaires. The results show a significant correlation between SSI-26 score and physical functioning (r = –0.565; P < 0.001), role physical (r = –0.551; P < 0.001), bodily pain (r = –0.659; P < 0.001), general health (r = –0.534; P < 0.001), vitality (r = –0.481; P = 0.001), social functioning (r = –0.302; P = 0.044) and mental health (r = –0.461; P = 0.001). Additionally, SHAPS score correlates with vitality (r = –0.371; P = 0.012), social functioning (r = –0.574; P < 0.001) and mental health (r = –0.445; P = 0.002). The results demonstrated that both somatic symptoms and level of anhedonia negatively correlate with HRQoL, suggesting a potential relationship between level of anhedonia and some somatic symptoms. This could impact on the diagnosis and treatment of depressed patients with somatic symptoms and anhedonia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Characterization of rectangular vertical cracks using burst vibrothermography

We use burst vibrothermography to characterize, i.e., to determine the dimensions and location of buried vertical cracks of rectangular shape. Surface breaking as well as buried cracks are investigated. We calculate the surface temperature distribution generated by a rectangular vertical crack when excited by an ultrasound burst of constant power. By fitting synthetic data with added white noise, we analyze the effect of the burst duration on the accuracy of the retrieved dimensions and depth of the crack. We take data on samples containing artificial calibrated vertical cracks. The results of the fittings performed on these experimental data show that it is possible to characterize rectangular vertical cracks from burst vibrothermography experiments.

3D-XY critical behavior of CsMnF₃ from static and dynamic thermal properties

Static and dynamic critical behavior of the easy-plane antiferromagnet CsMnF3 have been studied by means of a high-resolution ac photopyroelectric calorimeter. Thermal diffusivity, thermal conductivity and specific heat have been carefully measured in the near vicinity of the antiferromagnetic to paramagnetic transition (51.1 K). Specific heat and thermal diffusivity show singularities at the Néel temperature while thermal conductivity does not. Both the static and dynamic critical parameters agree with the standard 3D-XY universality class (α = -0.014, A⁺/A⁻ = 1.06): for specific heat α = -0.016, A⁺/A⁻ = 1.09 and for thermal diffusivity b = -0.010, U⁺/U⁻ = 1.09. As the dynamic critical behavior of thermal diffusivity has not yet been theoretically established for the 3D-XY universality class, an approximate equation relating static and dynamic critical parameters has been obtained for it, leading to b ≈ α and A⁺/A⁻ ≈ U⁺/U⁻ by studying the asymptotic behavior of the functions. This equation has also been experimentally verified for another XY antiferromagnet (SmMnO₃). As an easy-plane antiferromagnet with a hexagonal structure, CsMnF₃ could have been expected to comply with the 3D-XY chiral class (α = +0.34, A⁺/A⁻ = 0.36) (as is the case of CsMnBr₃), but the experimental results rule out that possibility. This is attributed to the presence of a small in-plane anisotropy of the spins in CsMnF₃, which breaks the chiral degeneracy of the 120° spin structure.