Abstract P4-11-06: Feasibility of a non-hormonal vaginal moisturizer in postmenopausal cancer survivors

Objectives: This is a single-arm prospective longitudinal clinical trial investigating the feasibility of using a non-hormonal hyaluronic acid (HLA) vaginal gel (Hydeal-D) to improve estrogen deprivation vaginal health symptoms in postmenopausal women with a history of hormone receptor-positive cancer.

Methods: Preliminary data from an ongoing clinical trial were examined. Demographics, medical information, and clinical assessment from breast cancer patients enrolled on study at baseline (n=23) and at 4-6 weeks (n=18) are presented. Eligible participants included those with a history of breast cancer receiving treatment with an aromatase inhibitor (AI) at the time of enrollment. Furthermore, participants could not have evidence of disease and had to have completed treatment for at least 3 months and no longer than 5 years (excluding AIs). Study participants were instructed to use HLA daily for 2 weeks, then 3 times per week for 12-14 weeks. Study outcomes include: pelvic exam results as recorded on a clinician evaluation form with the Vaginal Assessment Scale (VAS); patient-reported outcomes (PROs) of the Sexual Activity Questionnaire (SAQ), Sexual Self-Schema Scale, and Female Sexual Function Index (FSFI); PROMIS sexual function items; and exploratory items.

Results: The mean age was 56 years (range, 42-75). Seventy-four percent (17/23) were married or living with a partner. Fifty-seven percent (13/23) reported sexual activity with a partner at baseline, which was 72% (13/18) at 4-6 weeks. On the VAS, 65% (15/23) reported symptoms of severe dryness at baseline and 61% (14/23) reported severe dyspareunia; these reported symptoms decreased to 6% (1/18) and 6% (1/18), respectively, at 4-6 weeks. Vaginal pH scores were greater than 6.5 in 30% (7/23) at baseline; by 4-6 weeks, only 22% (4/18) had a pH in this elevated range. At baseline, 78% (18/23) had minimal moisture and 22% (5/23) had no vaginal moisture seen on exam; by 4-6 weeks, 11% (2/18) had normal moisture and 89% (16/18) had minimal moisture. Pain with pelvic exams declined over time—87% (20/23) had pain at baseline, with 22% (5/23) rating it as severe, and 78% (14/18) had pain at 4-6 weeks, with none of the women rating their pain as severe. Forty-eight percent (11/23) indicated confidence about future sexual activity at baseline, which was 56% (10/18) at 4-6 weeks. Level of concern about sexual/vaginal health was measured on a scale of 0-10, with greatest concern rated as a 9 or 10. Sixty-one percent (14/23) of the women fell into this range at baseline; the percentage decreased to 28% (5/18) at 4-6 weeks.

Conclusions:

Preliminary findings suggest that an HLA vaginal gel may improve vaginal/sexual health issues and concerns of breast cancer survivors both in their perceived symptoms and on clinical exam; however, further study is needed to examine if these promising trends continue over time and to determine the ideal frequency of product administration.

Citation Format: Carter J, Seidel B, Stabile C, Dickler M, Goldfrank D, Baser R, Goldfarb S. Feasibility of a non-hormonal vaginal moisturizer in postmenopausal cancer survivors. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-11-06.

Development and validation of a tool incorporating cervical length and quantitative fetal fibronectin to predict spontaneous preterm birth in asymptomatic high-risk women

OBJECTIVE

To develop a predictive tool for spontaneous preterm birth (sPTB) in asymptomatic high-risk women that includes quantification of fetal fibronectin (fFN) along with cervical length (CL) measurement and other clinical factors.

METHODS

Data were analyzed that had been collected prospectively from 1249 women at high risk for sPTB attending preterm surveillance clinics. Clinicians were blinded to quantitative measurements of fFN (qfFN), although they were aware of qualitative fFN results. Parametric survival models for sPTB, with time-updated covariates, were developed and the best was selected using the Akaike and Bayesian information criteria. The model was developed on the first 624 consecutive women and validated on the subsequent 625. Fractional polynomials were used to accommodate possible non-linear effects of qfFN and CL. The estimated probability of delivery before 30, 34 or 37 weeks' gestation and within 2 or 4 weeks of testing was calculated for each patient and analyzed as a predictive test for the actual occurrence of each event. Predictive statistics were calculated to compare training and validation sets.

RESULTS

The final model that was selected used a log-normal survival curve with CL, √qfFN and previous sPTB/preterm prelabor rupture of membranes as predictors. Predictive statistics were similar for training and validation sets. Areas under the receiver-operating characteristics curves ranged from 0.77 to 0.99, indicating accurate prediction across all five delivery outcomes.

CONCLUSIONS

sPTB in high-risk asymptomatic women can be predicted accurately using a model combining qfFN and CL, which supersedes the single-threshold fFN test, demographic information and obstetric history. This algorithm has been incorporated into an App (QUiPP) for widespread use.

Do cognitive measures and brain circuitry predict outcomes of exercise in Parkinson Disease: a randomized clinical trial

BACKGROUND

There is emerging research detailing the relationship between balance/gait/falls and cognition. Imaging studies also suggest a link between structural and functional changes in the frontal lobe (a region commonly associated with cognitive function) and mobility. People with Parkinson's disease have important changes in cognitive function that may impact rehabilitation efficacy. Our underlying hypothesis is that cognitive function and frontal lobe connections with the basal ganglia and brainstem posture/locomotor centers are responsible for postural deficits in people with Parkinson's disease and play a role in rehabilitation efficacy. The purpose of this study is to 1) determine if people with Parkinson's disease can improve mobility and/or cognition after partaking in a cognitively challenging mobility exercise program and 2) determine if cognition and brain circuitry deficits predict responsiveness to exercise rehabilitation.

METHODS/DESIGN

This study is a randomized cross-over controlled intervention to take place at a University Balance Disorders Laboratory. The study participants will be people with Parkinson's disease who meet inclusion criteria for the study. The intervention will be 6 weeks of group exercise (case) and 6 weeks of group education (control). The exercise is a cognitively challenging program based on the Agility Boot Camp for people with PD. The education program is a 6-week program to teach people how to better live with a chronic disease. The primary outcome measure is the MiniBESTest and the secondary outcomes are measures of mobility, cognition and neural imaging.

DISCUSSION

The results from this study will further our understanding of the relationship between cognition and mobility with a focus on brain circuitry as it relates to rehabilitation potential.

TRIAL REGISTRATION

This trial is registered at clinical trials.gov (NCT02231073).

Nonquenched Isoscalar Spin-M1 Excitations in sd-Shell Nuclei

Differential cross sections of isoscalar and isovector spin-M1 (0(+)→1(+)) transitions are measured using high-energy-resolution proton inelastic scattering at E(p)=295  MeV on (24)Mg, (28)Si, (32)S, and (36)Ar at 0°-14°. The squared spin-M1 nuclear transition matrix elements are deduced from the measured differential cross sections by applying empirically determined unit cross sections based on the assumption of isospin symmetry. The ratios of the squared nuclear matrix elements accumulated up to E(x)=16  MeV compared to a shell-model prediction are 1.01(9) for isoscalar and 0.61(6) for isovector spin-M1 transitions, respectively. Thus, no quenching is observed for isoscalar spin-M1 transitions, while the matrix elements for isovector spin-M1 transitions are quenched by an amount comparable with the analogous Gamow-Teller transitions on those target nuclei.

COMETARY SCIENCE. 67P/Churyumov-Gerasimenko surface properties as derived from CIVA panoramic images

The structure and composition of cometary constituents, down to their microscopic scale, are critical witnesses of the processes and ingredients that drove the formation and evolution of planetary bodies toward their present diversity. On board Rosetta's lander Philae, the Comet Infrared and Visible Analyser (CIVA) experiment took a series of images to characterize the surface materials surrounding the lander on comet 67P/Churyumov-Gerasimenko. Images were collected twice: just after touchdown, and after Philae finally came to rest, where it acquired a full panorama. These images reveal a fractured surface with complex structure and a variety of grain scales and albedos, possibly constituting pristine cometary material.

Cardiac digital angiography: applications in ventriculography and coronary arteriography

Clearly, computer-based digital subtraction offers several advantages over conventional approaches to contrast angiography. Using the newer method, in many situations contrast loads can be beneficially reduced, radiation exposure can be markedly diminished, and right ventricle evaluations can be simplified. In addition, storage of data on magnetic tape is less space consuming, and less costly, than storage on film. Over the 5- to 10-year life expectancy of a digitally equipped laboratory, these advantages probably justify the 30-50% increase in the initial monetary outlay for equipment in excess of that required for a conventionally equipped laboratory. However, the greatest promise of digital angiography is in the area of coronary arteriography. If three-dimensional reconstruction of coronary lesions and determination of regional flow can be effected, important advances in diagnosis and in prognostication theoretically might be expected, leading to more appropriate selection of therapy for individual patients than now can be achieved. However, currently available information does not yet indicate the extent to which such potential advantages will be realized. Thus, it will be several years before we will know whether the exciting potential of digital angiography in this area can be reached.

Maternal and child health after assisted vaginal delivery: five-year follow up of a randomised controlled study comparing forceps and ventouse

OBJECTIVE

To undertake a five year follow up of a cohort of women and children delivered by forceps or vacuum extractor in a randomised controlled study.

DESIGN

Follow up of a randomised controlled trial.

SETTING

District general hospital in the West Midlands.

POPULATION

Follow up questionnaires were sent to 306 of the 313 women originally recruited at the North Staffordshire Hospital to a randomised controlled study comparing forceps and vacuum extractor for assisted delivery. Two hundred and twenty-eight women responded (74.5%) and all were included in the study; forceps (n = 115) and vacuum extractor (n = 113).

MAIN OUTCOME MEASURES

Bowel and urinary dysfunction, child vision assessment, and child development.

RESULTS

Maternal adverse symptoms at long term follow up were relatively common. Urinary incontinence of various severity was reported by 47%, bowel habit urgency was reported by 44% (98/225), and loss of bowel control 'sometimes' or 'frequently' by 20% of women (46/226). No significant differences between instruments were found in terms of either bowel or urinary dysfunction. Overall, 13% (20/158) of children were noted to have visual problems. There was no significant difference in visual function between the two groups: ventouse 11/86 (12.8%), compared with forceps 9/72 (12.5%); odds ratio 0.97, 95% CI 0.38-2.50. Of the 20 children with visual problems, a family history was known in 18, and 17/18 (94%) had a positive family history for visual problems. No significant differences in child development were found between the two groups.

CONCLUSIONS

There is no evidence to suggest that at five years after delivery use of the ventouse or forceps has specific maternal or child benefits or side effects.

Patients' satisfaction with fast-track surgery in gynaecological oncology

This study investigates the experience and satisfaction with care of fast-tracked gynaecological patients. The Sydney Gynaecological Oncology Group, New South Wales, Australia, has previously shown the benefits of a fast-track surgery programme for gynaecology patients with both complex benign gynaecological pathology and gynaecological malignancy. The question of whether these benefits translate into a positive experience for fast-tracked patients, in the context of their hospital stay and healthcare team care, has not been previously explored in detail. A self-administered satisfaction questionnaire incorporating the European Organisation for Research and Treatment of Cancer (EORTC) cancer in-patient satisfaction with care measure (INPATSAT-32) questionnaire with additional questions was administered to 106 gynaecology participants at Royal Prince Alfred Hospital. Participants reported high levels of satisfaction with patient care and support received from doctors, ward nurses and the hospital as a service and care organisation, within the context of a fast-track surgical programme. Early hospital discharge after gynaecological surgery results in both enhanced recovery after surgery (ERAS) and high levels of patient satisfaction.

Superiority of chlorhexidine 2%/alcohol 70% wipes in decontaminating ultrasound equipment

Ultrasound equipment is known to act as a reservoir for potentially pathogenic organisms. The aims of these studies were to establish current cleaning practices, to review the extent of bacterial contamination of ultrasound equipment in our hospital, to establish an effective cleaning regimen and to ensure that cleaning does not cause damage. A questionnaire was sent to all acute NHS hospitals in England to establish current cleaning practices. A review of our current practice was performed to establish the extent of bacterial contamination of ultrasound equipment currently in use. Laboratory studies compared cleaning the probes with soap and water with decontaminating with a chlorhexidine 2% and alcohol 70% wipe, including quantifying the residual effect. Accelerated aging was performed on the probe and staff surveyed to establish potential problems with using the wipes on the probe. The survey revealed that a variety of cleaning methods were used to decontaminate ultrasound probes; 57% of our ultrasound machines were contaminated with bacteria. The laboratory studies showed superiority of the chlorhexidine and alcohol wipes over soap and water due to a residual effect, both immediately after cleaning and after 24 hours. The staff survey demonstrated no apparent change in function of the probe after cleaning with the chlorhexidine wipes. Cleaning ultrasound probes with chlorhexidine and alcohol wipes is effective and provides additional protection against bacterial contamination due to its residual effect, and appears in the short term to have no detrimental effect on the probe.