Low Cubilin/Myeloperoxidase ratio as a promising biomarker for prognosis of high-grade T1 bladder cancer

PURPOSE

T1 bladder cancer is known for its high progression and recurrence rates. Identifying aggressive tumours at the non-muscle-invasive stage is crucial to allow early interventions and subsequently increase patient survival. This study aimed to investigate the potential of the cubilin/myeloperoxidase (CUBN/MPO) ratio as a high-grade T1 bladder cancer biomarker.

METHODS

Urine samples were collected from 30 patients who underwent transurethral resection of the tumour with high-grade T1 bladder cancer (June 2015 to December 2019) before surgery. The urinary proteome was analysed using high-resolution mass spectrometry and the CUBN/MPO ratio was calculated. The primary outcome was the recurrence during the follow-up (around 31.5 months after resection). Univariate Cox regression and Kaplan-Meier curves were used for data analysis.

RESULTS

Patients with a low CUBN/MPO ratio exhibited upregulated MPO and/or downregulated CUBN. This group of patients had a higher incidence of disease recurrence and progression. Low CUBN/MPO ratio was significantly associated with a higher likelihood of recurrence, progression, and death. It is worth noting that this study was exploratory and conducted on a small sample size, so further research is needed to validate these findings in larger cohorts.

CONCLUSION

This study highlights the potential of the CUBN/MPO ratio as a prognostic biomarker for high-grade T1 bladder cancer.

Differences between HbA1c and glucose-related variables in predicting weight loss and glycaemic changes in individuals with overweight and hyperglycaemia - The PREVIEW trial

AIMS

To examine the differences between HbA_1c and glucose related variables in predicting weight loss and glycaemic changes following 8 weeks of low energy diet (LED) in individuals with overweight and hyperglycaemia.

RESEARCH DESIGN AND METHODS

2178 individuals with ADA-defined pre-diabetes - impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) - who started an 8 week LED weight loss diet, were included in this analysis. Participants were enrolled in the PREVIEW (PREVention of diabetes through lifestyle interventions and population studies In Europe and around the World) clinical trial. Multivariable linear mixed effects regression models and generalised additive mixed effect logistic models were used.

RESULTS

Only 1 in 3 participants (33%) had HbA_1c levels defined as pre-diabetes. Neither baseline HbA_1c, IFG or IGT were associated with body weight change at 8 weeks. Higher baseline body weight, baseline fasting insulin and weight loss predicted normalisation of fasting plasma glucose (FPG), whilst higher baseline fasting insulin, C-reactive protein (hsCRP) and older age predicted normalisation of HbA_1c. Additionally, male sex and higher baseline BMI, body fat and energy intake were positively associated with weight loss, whereas greater age and higher HDL-cholesterol predicted less weight loss.

CONCLUSIONS

Whilst neither HbA_1c nor fasting glucose predicts short-term weight loss success, both may impact the metabolic response to rapid weight loss. We propose a role of inflammation versus total body adiposity since these variables are independent predictors of the normalisation of HbA_1c and fasting glucose, respectively.

Prognostic Impact of Baseline Neutrophil-to-Eosinophil Ratio in Patients With Metastatic Renal Cell Carcinoma Treated With Nivolumab Therapy in Second or Later Lines

Background

Inflammation is a crucial component in carcinogenesis. The neutrophil-to-eosinophil ratio (NER) has been studied as a biomarker of prognosis and predictive of response in metastatic renal cell carcinoma (mRCC). In the present study, we evaluated the relevance of baseline NER on the progression-free survival (PFS) and overall survival (OS) outcomes in real-world patients with mRCC treated with nivolumab in second or subsequent lines. We also assessed the association of baseline NER with objective response, as well as with toxicity and histology.

Methods

In this multicenter retrospective analysis of patients with mRCC treated with nivolumab, the last systemic absolute neutrophil and eosinophil count before treatment with nivolumab was used to calculate the NER. An additive Cox proportional hazards model was used to identify the cut-off point for NER considering PFS and the patients were allocated into low and high NER groups. Median OS and median PFS were estimated using the Kaplan-Meier estimator, and survival curves of groups were compared using the log-rank test. Univariable and multivariable Cox regression models were used to study OS and PFS and Fisher’s exact test was performed to evaluate the association of NER with the response, toxicity, and histology.

Results

The 49 analyzed patients had a median follow-up of nine months. The NER cut-off was established at 48, locating 29 patients in the low NER group (NER < 48) and 20 in the high NER group (NER ≥ 48). Median PFS and median OS were significantly shorter in patients with high NER versus low NER (3 vs. 30 months (p < 0.001) and 6 vs. 24 months (p = 0.002), respectively). Multivariable analyses showed that NER (HR 3.92 (95% CI: 1.66-9.23), p = 0.002) was an independent factor for PFS and that NER (HR 3.85 (95% CI: 1.33-11.17), p = 0.013) and progressive disease (HR 5.62 (95% CI: 1.88-16.83), p = 0.002) were independent factors for OS. NER was significantly associated with objective response rate (ORR) (NER ≥ 48-12.5% vs. NER < 48-87.5%, p = 0.003), immune-related adverse events (irAEs) (NER ≥ 48-10.0% vs. NER < 48-42.9%, p = 0.014), and tumor’s histology as patients of high NER group had more non-clear cell carcinoma than low NER group (35.0% vs. 7.4%, p = 0.017).

Conclusion

Our real-world data analysis of NER in patients with mRCC confirmed the prognostic value of this biomarker, supporting clinical utility in predicting survival. Results also suggested an association between lower NER and better ORR, and that irAEs occur more frequently in patients with a lower NER. However, further large-scale prospective studies are needed to confirm these findings and to validate this biomarker.

Coronary microvascular dysfunction in hypertrophic cardiomyopathy – impact from tissue characteristics to clinical manifestations

Background

Coronary microvascular dysfunction (CMD) is an important pathophysiological feature in hypertrophic cardiomyopathy (HCM).

Purpose

This study investigated the role of CMD in tissue characteristics, left ventricular (LV) systolic performance and clinical manifestations in HCM.

Methods

This prospective study enrolled patients with HCM without obstructive epicardial coronary artery disease. Each patient underwent cardiovascular magnetic resonance (CMR) including parametric mapping, perfusion imaging during regadenoson-induced hyperemia, late gadolinium enhancement (LGE) and three-dimensional longitudinal, circumferential and radial strains analysis. Electrocardiogram and 24 hours Holter recording were performed to assess arrhythmias.

Results

75P were enrolled, 47 (63%) males, mean age 54.6 (14.8) years; 51 patients (68%) had non obstructive HCM, mean maximum wall thickness (MWT) was 20.2 (4.6)mm, LV ejection fraction 71.6 (8.3)%, ischemic burden 22.5 (16.9)% of LV.

Greater MWT was associated the severity of ischemia (β-estimate: 1.809, 95% CI: 1.073; 2.545; p&lt;0.001).

Ischemic burden was strongly associated with higher values of native T1 (β-estimate: 9.018, 95% CI: 4.721, 13.315; p&lt;0.001).

An association between ischemia and the extent of LGE was found (β-estimate: 2.02, 95% CI: 0.93, 3.10; p&lt;0.001). Ischemia in ≥21% of LV was associated with LGE &gt;15% (AUC 0.766, sensitivity 0.724, specificity 0.659).

In multivariable analysis, in the overall population, MWT and LGE were independently associated with ischemia, however the evidence of association between ischemia and extent of LGE became weaker (β-estimate: 1.070, 95% CI: −0.106; 2.245; p=0.074).

In subgroup analysis, the association between ischemia and LGE remained significant in individuals with MWT 15–20mm, non-obstructive HCM, female and age &lt;40 years.

The severity of ischemia was not associated with markers of LV systolic function, namely LVEF, longitudinal, radial and circumferential strain

A strong evidence of association was found between ischemia and atrial fibrillation/flutter (AF/AFL) (OR: 1.481, 95% CI: 1.020,2.152; p=0.039), but no association was verified with non-sustained ventricular tachycardia.

Conclusion

In HCM, CMD is related to the severity of LV hypertrophy. Ischemia secondary to CMD promotes fibrosis and is associated with an increase in the odds of AF/ALF.

Funding Acknowledgement

Type of funding sources: None.

Evaluation of vocal changes after vestibular rehabilitation in patients with balance disorders

BACKGROUND:

Although there are articles and studies that associate postural changes with changes in vocal quality, to the best of our knowledge, this was the first study investigating the association between balance disorders and voice.

OBJECTIVE:

This study aimed to determine whether patients with balance disorders present any clinical, acoustic, or endoscopic vocal changes, and if the correction of balance impairments, such as through vestibular rehabilitation, lead to improvement in vocal quality.

METHODS:

This was a prospective cohort study that analyzed vocal differences (clinical, videoendostroboscopic, audio-perceptual, and acoustic vocal parameters) in a sample of 43 patients with vestibular dysfunction at three different time points (pre-treatment, post-treatment, and 3 months’ post-treatment) diagnosed by videonystagmography with changes in computerized dynamic posturography who were treated with vestibular rehabilitation.

RESULTS:

In pre-treatment, all of the patients presented supraglottic hyperfunction during videoendoscopic examination and abnormal values in the audio-perceptual scale. After treatment for balance disorders, there was a statistically significant improvement in some parameters of the videoendoscopic and audio-perceptual measures. These improvements were detected immediately after treatment and remained present until at least three months after treatment.

CONCLUSIONS:

The results suggested that the treatment for balance disorders results in changes in posture and consequently in voice quality.

Evaluation of Postural Changes Using Dynamic Posturography after Speech Rehabilitation in Patients with Voice Disorders: A Longitudinal Study

BACKGROUND

The association between voice and body posture is consensual across the scientific literature and seems to be established both ways. Any changes in normal posture can influence the mechanisms of vocal production; on the other hand, vocal rehabilitation can influence posture.

OBJECTIVES

This study aimed to evaluate the postural pattern in subjects with organic voice disorders before and after speech rehabilitation, using computerised dynamic posturography (CDP).

METHODS

In this prospective cohort study, 21 patients affected by dysphonia caused by benign vocal fold lesions, never treated with speech therapy/vocal training, were submitted to a posturographic analysis using CDP before and after vocal rehabilitation/therapy. Each patient underwent an accurate voice and ear, nose, and throat (ENT) anamnesis, a general ENT examination, a rigid and flexible laryngoscopy, a videolaryngostroboscopy, an acoustic voice analysis including aerodynamic evaluation, and a perceptual evaluation of voice using the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale and the Voice Handicap Index (VHI) questionnaire, before and after vocal therapy. Fifteen healthy age- and sex-matched volunteers were also submitted to a posturographic analysis on the day of recruitment and 4 weeks later.

RESULTS

All patients showed an improvement in voice quality after vocal training. The VHI decreased in all subjects, and the GRBAS scale showed a decrease in all parameters in each vowel (/a/, /i/, /e/) and in spontaneous speech (p < 0.001 for all). Posturographic results showed an improvement in equilibrium score, in conditions 2-6 and composite score. Strategic analysis results showed an improvement in conditions 1-6.

CONCLUSIONS

The posturographic analysis showed a significant difference in the visual, vestibular, and proprioceptive component of posture after voice therapy. These results showed that dysphonic patients changed their postural patterns after an effective voice treatment, with an improvement in postural performance. It seems like modifications of breathing pattern and voice production techniques led to objective and measurable postural changes.

Biomarkers of Peripheral Nonperfusion in Retinal Venous Occlusions Using Optical Coherence Tomography Angiography

Purpose

To study the association between the assessment of central macular vascular layers by optical coherence tomography angiography (OCT-A) and peripheral nonperfusion evaluated by fluorescein angiography (FA) in patients with retinal venous occlusion (RVO).

Methods

Retrospective review of RVO patients without macular edema. Patients underwent a comprehensive ophthalmic examination including FA, spectral-domain OCT, and OCT-A. Significant ischemia was defined as nonperfusion areas superior or equal to the equivalent of one retinal quadrant on FA. Vascular density (VD) and foveal avascular zone were measured using AngioAnalytics software. Fractal dimension (FD) and lacunarity (LAC) were computed using an algorithm designed by MATLAB (MathWorks, Natick, MA). These variables were used to build a model that translates their association with OCT-A parameters.

Results

There were 48 eyes (48 patients) of which 19 had significant peripheral nonperfusion. Deep capillary plexus FD, VD, and LAC were associated with significant ischemia. In fact, regarding the association with this outcome, LAC alone had the highest area under the curve (AUC = 0.88) followed by FD (AUC = 0.85) and VD (AUC = 0.73). The multivariable model that included LAC and VD, adjusted by best-corrected visual acuity (BCVA) achieved the best performance for the identification of severe nonperfusion on wide-field FA (AUC = 0.93).

Conclusions

The characteristics of the central macular deep capillary plexus on OCT-A may be associated with peripheral nonperfusion on FA, particularly the combination of LAC and vessel density after adjusting by BCVA.

Translational Relevance

Fractal-based metrics applied to OCT-A may become a valuable marker of ischemia in RVO and help guide the clinical decision to perform invasive angiography.

Quantitative optical coherence tomography angiography biomarkers for neovascular age-related macular degeneration in remission

Purpose

To characterize quantitative optical coherence tomography angiography (OCT-A) parameters in active neovascular age-related macular degeneration (nAMD) patients under treatment and remission nAMD patients.

Design

Retrospective, cross-sectional study.

Participants

One hundred and four patients of whom 72 were in Group 1 (active nAMD) and 32 in Group 2 (remission nAMD) based on SD-OCT (Spectral Domain OCT) qualitative morphology.

Methods

This study was conducted at the Centre Ophtalmologique de l’Odeon between June 2016 and December 2017. Eyes were analyzed using SD-OCT and high-speed (100 000 A-scans/second) 1050-nm wavelength swept-source OCT-A. Speckle noise removal and choroidal neovascularization (CNV) blood flow delineation were automatically performed. Quantitative parameters analyzed included blood flow area (Area), vessel density, fractal dimension (FD) and lacunarity. OCT-A image algorithms and graphical user interfaces were built as a unified tool in Matlab coding language. Generalized Additive Models were used to study the association between OCT-A parameters and nAMD remission on structural OCT. The models’ performance was assessed by the Akaike Information Criterion (AIC), Brier Score and by the area under the receiver operating characteristic curve (AUC). A p value of ≤ 0.05 was considered as statistically significant.

Results

Area, vessel density and FD were different (p<0.001) in the two groups. Regarding the association with CNV activity, Area alone had the highest AUC (AUC = 0.85; 95%CI: 0.77–0.93) followed by FD (AUC = 0.80; 95%CI: 0.71–0.88). Again, Area obtained the best values followed by FD in the AIC and Brier Score evaluations. The multivariate model that included both these variables attained the best performance considering all assessment criteria.

Conclusions

Blood flow characteristics on OCT-A may be associated with exudative signs on structural OCT. In the future, analyses of OCT-A quantitative parameters could potentially help evaluate CNV activity status and to develop personalized treatment and follow-up cycles.

Respiratory infections in elderly people: Viral role in a resident population of elderly care centers in Lisbon, winter 2013-2014

OBJECTIVE

The aim of this study was to analyze the etiology and clinical consequences of viral respiratory infections in 18 elderly care centers (ECC) in Lisbon, which housed a total of 1022 residents.

METHODS

Nasopharyngeal swabs were collected whenever an elderly had symptoms of acute respiratory infections (ARI). PCR and RT-PCR were performed for influenza A/B, human parainfluenza virus 1-4, adenovirus, human metapneumovirus (HMPV), respiratory syncytial virus (RSV), rhinovirus, enterovirus, human coronavirus and human Bocavirus (HBoV). Array cards for atypical bacteria were also used in severe cases.

RESULTS

In total, 188 episodes of ARI were reported, being rhinovirus the most frequently detected (n=53), followed by influenza A(H3) (n=19) and HBoV (n=14). Severe infections were reported in 19 patients, 11 of which were fatal, Legionela pneumophila, rhinovirus, HMPV and RSV associated with these fatalities. Nine influenza strains were analyzed, all antigenically dissimilar from vaccine strain 2013/14. "Age", "HMPV" and "Respiratory disease" showed an association with severe infection.

CONCLUSIONS

In this study an etiologic agent could be found in 60% of the acute respiratory episodes. These data provides information about the circulating viruses in ECC and highlights the importance of searching both viruses and atypical bacteria in severe ARI.

A RCT of a staff training intervention to promote quality of care in long-term residential facilities–the PromQual study

Introduction

The shift of hospital-based to community-based mental health care, introduced the need to assess and promote quality of residential services.

Objectives

This RCT aimed at assessing the effectiveness of a staff training intervention to improve quality of care in residential facilities.

Methods

Twenty-three units with at least 12-hour on-site staff support per day in Portugal were assessed with the quality instrument for rehabilitative care (QuIRC) filled online by the manager. A random sample of service users were interviewed using standardised measures of autonomy, experiences of care, quality of life, and the time user diary (TUD) for level of activity. The intervention group units (n = 12) received workshops and a four-week hands-on training of the staff versus TAU in the control group (n = 11). All units and users were reassessed at 8-months. The staff knowledge gained during the workshops was assessed using pre- post-test. Generalized linear mixed effects models were used.

Results

The residential units were mainly in the community (n = 17, 73.9%), and had QuIRC mean scores above 50% in the following dimensions : living environment, self-management and autonomy, social inclusion, and human rights. Service users’ level of activity (TUD) at 8-months did not differ between intervention and control groups. At 8 months, all QuIRC dimensions scored higher in the Intervention group, without reaching statistical significance. Pre- post-tests comparison showed a significant increase in the knowledge acquired by the staff.

Conclusions

The intervention had impact on the staff's knowledge without reaching significant change of users’ activity and quality of care of the units.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Spreader grafts: functional or just aesthetical?

OBJECTIVE

Spreader grafts are commonly used in rhinoplasty to achieve an aesthetic improvement of the nose or a functional improvement of the nasal airway. Currently, the aesthetic role of spreader grafts is well established. The functional effect of these grafts, however, has been controversial due to the lack of studies clearly demonstrating an increase on nasal airflow assigned to spreader grafts. The purpose of this study is to evaluate the effect of spreader grafts on nasal breathing.

METHODS

Nasal breathing of 72 consecutive patients undergoing rhinoplasty was evaluated by measuring peak nasal inspiratory flow (PNIF) before surgery and six months after surgery.

RESULTS

The mean preoperative PNIF of the 72 patients included in this study was 79.44 l/min and the mean postoperative PNIF was 110.42 l/min (p < 0.001). In 37 patients of this study no spreader grafts were used. In this group of patients the mean PNIF values changed from 73.24 l/min before surgery to 99.46 l/min after surgery. In the group of 35 patients in whom spreader grafts were used the mean PNIF values changed from 86.00 l/min before surgery to 122.00 l/min after surgery. The increase in the mean PNIF value after rhinoplasty was slightly higher in the group of patients with spreader grafts than in the group of patients without spreader grafts. The difference in the postoperative increase of PNIF between these two groups of patients, however, is not statistically significant.

CONCLUSIONS

This study suggests that patients undergoing rhinoplasty have a statistically significant improvement in nasal breathing after surgery. However, patients receiving spreader grafts in a non-randomized way do not have statistically significant greater benefit than those who do not.

Living conditions and quality of care in residential units for people with long-term mental illness in Portugal--a cross-sectional study

BACKGROUND

As in most European countries, mental health care has shifted from large hospitals to smaller community based settings in Portugal. Our study objectives were to determine: a) the characteristics of users of mental health residential facilities in Portugal; b) the quality of care provided comparing community and hospital units; and c) to investigate associations between quality of care, service and service users' characteristics and experiences of care.

METHODS

All longer term mental health units in Portugal providing on-site staffed support for at least 12 h per day were assessed with the Quality Indicator for Rehabilitative Care (QuIRC), a standardised tool completed by the unit manager. The QuIRC rates seven domains of care (Living Environment, Therapeutic Environment, Treatments and Interventions, Self/Management and Autonomy, Recovery Based Practice, Social Inclusion, and Human Rights). A random sample of service users were interviewed using standardised measures of autonomy, experiences of care and quality of life.

RESULTS

Most (60 %) of the 42 units were in Lisbon and surrounding districts with 50 % based in the community and 50 % in hospital settings. They had a mean of 11.5 beds. Service users (n = 278) were mainly men (66.2 %), with a diagnosis of schizophrenia (72.7 %), and a mean age of 49.4 years. Community units scored higher than hospital units on the Living Environment, Treatments and Interventions, and Self-Management and Autonomy domains of the QuIRC. Increased service user age was negatively associated with all but one domain. All QuIRC domains were positively associated with service users' autonomy and experiences of care.

CONCLUSIONS

Investing in better quality, community based mental health facilities is associated with better outcomes for service users who require longer term support.

Improving influenza surveillance in Portuguese preschool children by parents' report

Influenza surveillance is usually based on nationally organized sentinel networks of physicians and on hospital reports. This study aimed to test a different report system, based on parents' phone contact to the research team and in home collection of samples by a dedicated team. The identification of influenza and other respiratory viruses in children who attended a Hospital Emergency Department was also recorded. Real-time PCR and reverse transcription PCR were performed for influenza A and B, parainfluenza 1-4, adenovirus, human metapneumovirus, respiratory syncytial virus A and B, rhinovirus, enterovirus, group 1 coronaviruses, group 2 coronaviruses, and human bocavirus. One hundred children were included, 64 from the day care centers and 36 from the Hospital. Overall, 79 samples were positive for at least one respiratory virus. Influenza A (H3) was the virus most frequently detected: 25 cases, 20 of these in children under 5 years of age (ten from day care centers and ten who went to the hospital) which was higher than those reported by the National Influenza Surveillance Programme for this age.

CONCLUSION

The results obtained in this study suggest that a surveillance system based on parents' reports could complement the implanted system of the National Influenza Surveillance Programme.

Empathy as related to motivations for medicine in a sample of first-year medical students

Professionalism and empathy are crucial in clinical settings. An association would be expected between empathic attitudes and altruistic motivations for a medical education. However, data is scarce in first-year students, and a previous small-scale study did not fully confirm the hypothesis that person-oriented motives would have a strong relationship to empathy. The present study tested this association in a larger sample. 202 first-year medical students (M age = 19.0 yr., SD = 2.7; 67.3% women) were assessed cross-sectionally, using the Vaglum and colleagues' indexes on motives for choosing medicine (security/status, person-orientation, and interest in the natural sciences) and the Jefferson Scale of Physician Empathy for students. There was a weak association between empathy and person-orientation, but the evidence regarding links between empathy and the three motivation scores was low overall. In this Portuguese sample there was not a clear-cut association between empathy and motivations for medical school.

Impact of donor and recipient cytokine genotypes on renal allograft outcome

Allelic differences in gene promoter or codifying regions have been described to affect regulation of gene expression, consequently increasing or decreasing cytokine production and signal transduction responses to a given stimulus. This observation has been reported for interleukin (IL)-10 (-1082 A/G; -819/-592 CT/CA), transforming growth factor (TGF)-beta (codon 10 C/T, codon 25 G/C), tumor necrosis factor (TNF)-alpha (-308 G/A), TNF-beta (+252 A/G), interferon (IFN)-gamma (+874 T/A), IL-6 (-174 G/C), and IL-4R alpha (+1902 G/A). To evaluate the influence of these cytokine genotypes on the development of acute or chronic rejection, we correlated the genotypes of both kidney graft recipients and cadaver donors with the clinical outcome. Kidney recipients had 5 years follow-up, at least 2 HLA-DRB compatibilities, and a maximum of 25% anti-HLA pretransplantation sensitization. The clinical outcomes were grouped as follows: stable functioning graft (NR, n = 35); acute rejection episodes (AR, n = 31); and chronic rejection (CR, n = 31). The cytokine genotype polymorphisms were defined using PCR-SSP typing. A statistical analysis showed a significant prevalence of recipient IL-10 -819/-592 genotype among CR individuals; whereas among donors, the TGF-beta codon 10 CT genotype was significantly associated with the AR cohort and the IL-6 -174 CC genotype with CR. Other albeit not significant observations included a strong predisposition of recipient TGF-beta codon 10 CT genotype with CR, and TNF-beta 252 AA with AR. A low frequency of TNF-alpha -308 AA genotype also was observed among recipients and donors who showed poor allograft outcomes.