[Intravesical oxybutynin treatment for neurogenic detrusor overactivity : Efficacy and safety data from clinical practice with the first intravesical oxybutynin treatment authorized in Germany]

Existing therapies for neurogenic detrusor overactivity (NDO), i.e. oral anticholinergics and botulinum toxin injections, can be associated with serious adverse effects or are not always sufficiently effective. Therefore, there is a need for alternative safe and effective treatment options for NDO. Intravesical oxybutynin has been successfully used for several years as a prescription drug in adults and children with spinal cord injury and spina bifida. In 2019, VESOXX® (FARCO-PHARMA, Cologne, Germany) became the first registered intravesical oxybutynin product in Germany, which is indicated for the suppression of neurogenic detrusor overactivity (NDO) in children from 6 years of age and adults, who are managing bladder emptying by clean intermittent catheterisation (CIC), if they cannot be adequately managed by oral anticholinergic treatment due to lack of efficacy and/or intolerable side effects. Overall, there are limited data regarding therapy with intravesical oxybutynin, with the majority of publications being retrospective case series. To date, there are limited data on the efficacy and safety of the newly approved intravesical oxybutynin therapy (VESOXX®) in NDO patients. This noninterventional case series from daily routine treatment which evaluated the physician reports of 38 patients suggests that intravesical oxybutynin effectively improves maximum detrusor pressure (Pdet max) by decreasing it by 59% from 51.94 cm H2O ± 26.12 standard deviation (SD) to 21.07 cm H2O ± 17.32 SD (P < 0.001, n = 34). Maximum bladder pressure (MBC) increased by 34% from 260.45 ml ± 200.26 SD to 348.45 ml ± 175.90 SD. Positive or similar effects compared to previous therapies were seen in bladder morphology, number of incontinence episodes, urinary tract infections and adverse drug effects. This case series demonstrates that intravesical oxybutynin is an important addition to current therapies for the treatment of NDO and it is also efficacious in the rare setting of other underlying diseases beyond spinal cord injury or spina bifida. The approved intravesical oxybutynin preparation VESOXX® may be a useful alternative for patients who do not respond to other therapies or suffered side effects.

Application of a Radiopaque Viscous Hydrogel Spacer for Prostate Cancer Radiotherapy - A Prospective Multi-Institutional Phase II Study

PURPOSE/OBJECTIVE(S)

Rectal dose can be significantly decreased after spacer application. An initially fluid spacer (FS) spreads in a predetermined space, whereas the positioning of a viscous spacer is determined by needle guidance. The aim of this study was to evaluate the application a radiopaque viscous spacer (RVS) for prostate cancer radiotherapy (RT).

MATERIALS/METHODS

In 30 patients including three centers, 10ml (median) of a RVS was injected between the prostate and anterior rectal wall. The resulting distance and distribution were determined in different planes and compared with a control group of 30 patients with a FS. A cone beam computed tomography (CBCT) was performed at least at the end of RT, a magnetic resonance imaging (MRI) 3 months and 12 months after RT. Injection and treatment tolerability were analyzed.

RESULTS

With a median prostate volume of 40cm3, no overlap was found between planning target volume and rectal volume in most cases (median = 0cm3, interquartile range, IQR 0-0.6cm3). The median contoured RVS before, at the end and 3 months after RT was 8.5cm3, 8.7cm3 und 6.4cm3. Signs of hydrogel migration were not found in any case. Hydrogel visibility in CBCT was rated with "4" on a scale between 1 (poor) and 5 (excellent). Small residues were detected in the MRI 12 months after RT in 3 cases (10%). The median distance between prostate and rectum at the base / midplane / apex was 14mm / 12mm / 11mm. The median rectal volume percentage within the 90% and 80% isodoses was 3.0% (IQR 1.5-4.5%) bzw. 5.9% (IQR 3.0-10.6%). On a scale between 1 (difficult) and 5 (very easy), ease of application was rated with "3-4". Procedure- or device related adverse events have not been observed in any case. Acute and late gastrointestinal toxicities were found in 17% and 3%, respectively (all grade 1). The control of gel distribution of RVS relative to FS was rated with "3-5" on a scale between 1 (much worse) and 5 (much better), the ease of application relative to FS with "2-3" on a scale between 1 (much harder) and 5 (much easier). With a median contoured FS volume of 9.9cm3, the prostate-rectum distance at the base / midplane / apex was 12mm / 10mm / 10mm (significantly smaller in comparison to RVS). However, the lateral gel extension of RVS was smaller in all planes, statistically significant for all comparisons (base: 28mm vs. 34mm, midplane: 28mm vs. 32mm, apex: 21mm vs. 26mm). The gel symmetry (right vs. left) was comparable.

CONCLUSION

The application of a radiopaque viscous hydrogel spacer is harder in comparison to the initially fluid spacer. However, it can be better controlled and is achievable without any complications. Visibility in CBCT is good. The resulting prostate-rectum distance is >10mm in most cases and slightly larger at the base in comparison to FS. The resulting rectum volume within the high dose region and radiotherapy toxicity are very low.

ECG changes in psychiatric patients on psychotropic medications

Funding Acknowledgements

Type of funding sources: None.

Background

Suicide and euthanasia accounts for 14.3% of deaths in those with psychiatric conditions. The rest are attributed to preventable causes such as cardiovascular disease, respiratory disease, and infections. Several psychotropic medications have been associated with sudden death due to their effect on prolonging QT interval, resulting in the development of a polymorphic ventricular arrhythmia, Torsades de Pointes (TdP). TdP may be self-limiting or lead to sudden cardiac arrest and death.

Purpose

This study aims to evaluate the cardiotoxic effects of psychotropic medications.

Method

This is a descriptive retrospective study of patients submitted to the local psychiatric wards within one year. Patients with psychotropic drug prescriptions were included while patients below 18 years old, pregnant, or did not have ECG performed were excluded. The control group consisted of sex- and age- matched patients with ECG conducted for occupational health purposes. Multiple regression models were conducted to investigate the predictors of significant ECG differences.

Result

Of the 154 psychiatric inpatients admitted, exclusions were 44 patients due to exclusion criteria and 19 patients due to difficulty in physical file access. The study population (n = 91) had a mean age of 36.7 years old with 40.7% female and 59.3% male. The predominant diagnoses were schizophrenia and delusional disorders (58.2%). 86 psychiatric patients (94.5%) were prescribed antipsychotic drugs (APD).

A significantly higher proportion of psychiatric patients has a history of smoking (p &lt; 0.001), alcohol consumption (p = 0.001), and illicit drug use (p &lt; 0.001). They also exhibited significantly more co-morbid illnesses including hypertension (p = 0.022), hyperlipidaemia (p = 0.013), diabetes (p = 0.026) and thyroid disease (p = 0.023) than the control population.

Psychiatric patients had a significantly higher mean heart rate (79.9 vs 69.6 ms; p &lt; 0.001) and QTc interval (452.2 vs 418.6ms; p &lt; 0.001). Mean QTc interval was significantly longer for psychiatric patients in both male (454.2 vs 414.5ms; p &lt; 0.001) and female (449.3 vs 425.6 ms; p = 0.029) gender. Psychotropic drug use is a significant predictor for both prolonged heart rate (p &lt; 0.001) and prolonged QTc interval (p &lt; 0.001). Electrolyte imbalance is a significant predictor of prolonged QTc interval only (p = 0.036). One year follow of both groups detected only 1 psychiatric patient with palpitation.

Conclusion

Psychiatric patients on psychotropic medications have a longer baseline heart rate and QTc interval, which was not associated with MACE at 1 year. None of the underlying comorbidities and lifestyle choices were significant predictors of this. Electrolyte abnormalities and psychotropic drug use significantly predicted QTc prolongation. However, these findings were largely driven by APD use. A follow-up study of a longer period is recommended to investigate whether patients with prolonged QTc interval are of higher risk of MACE occurrence.

A systematic review of behaviour analytic interventions for young children with intellectual disabilities

BACKGROUND

According to several comprehensive systematic and narrative reviews, interventions based on applied behaviour analysis principles, or behaviour analytic interventions, are considered evidence based for children with autism spectrum disorder (ASD). However, no comprehensive review of the literature related to behaviour analytic interventions for children with intellectual disability (ID) currently exists.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration ID: CRD42018099317), the purpose of this study was to conduct a systematic review of the relevant published literature on the use of behaviour analytic interventions to develop skills in young children (0-8 years) with ID (and without ASD). A preliminary search of the literature identified 1209 potential studies published between January 2000 and April 2020. The review process resulted in 48 articles consisting of 49 studies (i.e. one paper contained two studies) that met the inclusion criteria. Most used single-case research designs. Studies were evaluated on five dimensions of methodological quality based on the Scientific Merit Rating Scale developed by the National Autism Center (NAC). The NAC definitions were also used for the quantity and quality of research evidence required for interventions to be considered established or emerging.

RESULTS

There were a number of limitations to the quality of the body of research. Nevertheless, various behaviour analytic interventions met criteria for being established interventions when used for targeting communication, adaptive and pre-academic skills in young children with ID. Behaviour analytic interventions targeting academic skills met criteria for emerging interventions.

CONCLUSIONS

Although the current literature is limited, results indicate that behaviour analytic interventions may be effectively used to support skill development in children with ID.

Computational modelling for the spiral flow in umbilical arteries with different systole/diastole flow velocity ratios

The systole/diastole (S/D) flow velocity ratios in umbilical arteries (UAs) have been used to assess the health status of the feto-placental circulation, yet its connection to the morphology of UAs, specifically its coiling pattern remains unclear. Spiral flow induces unbalanced wall shear stress (WSS) distribution in UAs, and may contribute to the uneven arterial wall thickness, and the chirality. In this paper, we use a 3D computational fluid dynamics (CFD) technique to quantify the wall shear stress (WSS) in UA models of two configurations, i.e. at 0.17 and 0.50 spirals per centimeter, to represent normo- and hyper-coiling, respectively. For CFD simulations we use two different S/D ratios (3.02 and 5.70) revealed from the ultrasonography waveforms of a normal and an intrauterine growth restriction (IUGR) case. We found that more coils in the UA model enhanced WSS throughout a cardiac cycle (up to 24%) with the same inflow condition. In addition, time-averaged WSS are generally increased and more uneven in the hyper-coiling model. We suggest that the large WSS difference between the peak systole and end diastole (62% higher in the IURG case than the normal case) may induce uneven stenosis distribution at UAs, and contribute to UA chirality.

Extrapolation for a pharmacokinetic model for acetaminophen from adults to neonates: A Latin Hypercube Sampling analysis

Physiological and drug-specific parameters need to be adjusted when extrapolating a pharmacokinetic (PK) model from adults to neonates, so as to reproduce the time profiles of the studied drug(s) consistent with clinical, in vivo data or in vitro cell line measurements. In this paper we present a parameter analysis method, i.e. the Latin Hypercube Sampling (LHS) method for an acetaminophen (APAP) PK model. The original model consists of two compartments (the blood and the urine) with Michaelis-Menten kinetic parameters determined for APAP and its metabolites. The physiological parameters are scaled through allometric laws from adults to neonates, and APAP-specific parameters are adjusted for enzymatic maturational changes. The LHS method is used to statistically investigate the interplay between these parameters. The results for the extrapolated APAP model are consistent with published APAP PK data in neonates. We found the sulphation clearance parameter played a crucial role in the neonatal PK model, but its influence was weakened if the volume of distribution parameters were included. We suggest that this kind of in silico experiment could be valuable as the first step in PK model extrapolation between different ages.

Vertebral Fractures Following Stereotactic Body Radiotherapy for Spine Oligometastases: A Multi-institutional Analysis of Patient Outcomes

AIMS

Stereotactic body radiotherapy (SBRT) is a locally ablative therapy used for the treatment of patients with spine metastases. However, it is associated with higher rates of vertebral compression fractures (VCF) than conventionally fractionated palliative radiotherapy. The purpose of this study was to determine the rate of VCF following spine SBRT and to identify the risk factors associated with this outcome.

MATERIALS AND METHODS

We retrospectively reviewed patients treated at two Australian institutions from January 2015 to March 2019. Descriptive statistics were used to assess patient, tumour and treatment factors. The Log-rank test and Cox proportional hazards model were applied in univariate and multivariable analyses to identify factors associated with VCF, local control and overall survival.

RESULTS

We evaluated 113 spinal segments from 84 patients, with a median follow-up time of 11.9 months. The median dose and fractionation utilised was 30 Gy in three fractions (67.3%), with a single-fraction rate of 0.9%. The median Spinal Instability Neoplastic Score (SINS) of the lesions was 4/18, with most (84.1%) being SINS stable, scoring between 0 and 6. Five VCFs were observed (three progression of pre-existing fractures and two de novo), a cumulative VCF risk of 4.4%. Four of five fractures occurred within the first year after treatment, with a median time to VCF of 9.2 months. A pre-existing VCF (P = 0.011) was associated with subsequent fracture on multivariable analysis, whereas all VCF segments displayed lytic disease appearance. All fractures were managed conservatively with analgesia, without requirement for subsequent surgical intervention.

CONCLUSION

SBRT to spine metastases is safe with respect to VCF, with rates around the lower limit observed in similar studies. Knowledge of factors that predispose to post-treatment fracture, such as pre-existing compression, lytic vertebral disease and SINS >6 will aid in the counselling and selection of patients for this therapy.

Identifying barriers to healthcare delivery and access in the Circumpolar North: important insights for health professionals

Lack of access to healthcare services for people living in the Circumpolar North may have important consequences for their health and well-being, both in terms of the actual treatment and other possible health-related consequences intertwined with their life situation. The aim of the present study was to identify the specific challenges to healthcare service delivery and access for populations in the Circumpolar North that are addressed in contemporary literature. A scoping review of literature published between 2005 and 2016 was conducted and 43 articles were selected for inclusion into the review. The review findings address 4 main themes identified in the literature: (1) the influence of physical geography, (2) healthcare provider-related barriers, (3) the importance of culture and language and (4) the impact of systemic factors. The review of the literature enabled us to identify existing gaps in both health service access and issues discussed in the available literature, particularly for informing healthcare services in the Circumpolar North, as well as point towards opportunities for future research. The thematic findings drawn from interdisciplinary and international literature inform understandings of the impact of health system barriers on healthcare services and the opportunities for Northern residents to support their own health.

A twin study of body mass index and dental caries in childhood

Sub-optimal nutrition and dental caries are both common with significant short and long-term implications for child health and development. We applied twin statistical methods to explore the relationship between body mass index (BMI) and dental caries. We measured BMI at 18 months and six years of age and cumulative dental caries experience at six years in 344 twin children. Dental caries in primary teeth was categorised into ‘any’ or ‘advanced’ and BMI was analysed as both a continuous and categorical variable. Statistical analyses included multiple logistic regression using generalized estimating equations and within/between-pair analyses. There was no association between BMI and ‘any’ dental caries experience at either time-point, neither overall nor in within/between pair analyses. However, ‘advanced’ dental caries at six years was associated with a within-pair difference in BMI of −0.55 kg/m² (95% CI −1.00, −0.11, p = 0.015). A within-pair increase of 1 kg/m² in BMI was associated with a lower within-pair risk of advanced dental caries (OR 0.68, 95% CI 0.52, 0.90, p = 0.007). These findings reveal a possible causal relationship between lower BMI and dental caries. As dental outcomes were only measured at one time point, the direction of this potentially causal relationship is unclear.

An in silico pipeline for subject-specific hemodynamics analysis in liver surgery planning

The progresses in fast simulations of the hepatic flow in subject-specific vascular tree have created new toolkits for pre-surgical planning. The aim of this short communication is to introduce a computational pipeline that integrates several recently developed in silico liver models and algorithms. Firstly, a semi-automatic segmentation pipeline is used to digitise hepatic vessels. Then, a constructive constraint optimisation (CCO) algorithm is used to extend the digitised vascular tree, and also to compute the blood pressure and flow velocity in the tree. Couinaud segments are simulated from the diffusion zones of the portal venous tree. The constructed surgical planning model is then deployed cross-platform for use in various scenarios.

Antimicrobial resistance and virulence genes of Streptococcus isolated from dairy cows with mastitis in China

Streptococcus is a major mastitis-causing pathogen in dairy cows. To investigate the prevalence, antimicrobial resistance and virulence gene of Streptococcus in mastitic milk, a total of 735 mastitic raw milk samples from dairy cows in 11 provinces of China were collected and tested. Antimicrobial resistance of Streptococcus isolates was determined by disc diffusion against 8 classes 29 antimicrobial agents, and Streptococcus resistant genes and virulence genes were determined by PCR and agarose gel electrophoresis. A total of 64 (8.71%) isolates of Streptococcus were isolated and identified using biochemical profiling, including 22 isolates of Streptococcus agalactiae, 13 isolates of Streptococcus dysgalactiae, and 29 isolates of Streptococcus uberis. Out of 64 resistant Streptococcus isolates, all isolates (100%) were resistant to 3 or more antimicrobials. The most frequency (n = 18, 28.12%) of the isolates were multi-resistant to 5-7 antimicrobials and the highest multi-resistant number was 29 (n = 1, 1.56%). Streptococcus isolates had the highest resistance rate to tetracycline (98.44%) and oxacillin (98.44%), followed by penicillin G (96.88%) and doxycycline (96.88%), and the lowest resistance was observed with respect to ciprofloxacin (1.56%). A total of 16 antimicrobials resistance genes with 25 combination patterns were detected in the isolates. The gene combination of Sul1/Sul2/Sul3 + gyrA/parC + cat1/cat2 was the most common pattern (12.5%). The correlation between resistant phenotypes and resistance genes in Streptococcs was 35.87%. A total of 7 virulence genes were detected and 59 (92.19%) isolates harbored at least one gene. Twenty-four classes of gene patterns were found in the isolates and the patterns of bca (9.38%) and cfb (9.38%) were the most prevalent form. In conclusion, the issue of drug resistance of Streptococcus is still a great concern in cattle health in China.

Novel methods for segment-specific blood flow simulation for the liver

One challenge for hepatic flow simulation is to divide the hepatic vasculature into individual Couinaud segments, and to simulate flow at both segmental and organ levels. We propose to integrate a segment simulation algorithm with the flow solver in a Constructive Constraint Optimisation (CCO) algorithm to address this problem. In this way blood flow simulations can be conducted for large segment-specific vasculatures as relevant to surgical procedures. In this short communication we outline the methods and present some preliminary results.

A CT-image based pig atlas model and its potential applications in the meat industry

In this communication we present a novel pig atlas model which is represented by a parametric linear Lagrange or cubic Hermite mesh. The model is developed from data points digitized from a 3D pig CT image. In total 84 muscles and 121 bones are included in the atlas, representing the tissue structures most relevant to the industry. We discuss its potential applications in virtual meat cuts and statistical shape analysis for pig breeding and genetics companies.

Chromosomal microarray provides enhanced targetable gene aberration detection when paired with next generation sequencing panel in profiling lung and colorectal tumors

The development of targeted therapies based on specific genomic alterations has altered the treatment and management of lung and colorectal cancers. Chromosomal microarray (CMA) has allowed identification of copy number variations (CNVs) in lung and colorectal cancers in great detail, and next-generation sequencing (NGS) is used extensively to analyze the genome of cancers for molecular subtyping and use of molecularly guided therapies. The main objective of this study was to evaluate the utility of combining CMA and NGS for a comprehensive genomic assessment of lung and colorectal adenocarcinomas, especially for detecting drug targets. We compared the results from NGS and CMA data from 60 lung and 51 colorectal tumors. From CMA analysis, 33% were amplified, 89% showed gains, 75% showed losses and 41% demonstrated loss of heterozygosity; pathogenic variants were identified in 81% of colon and 67% lung specimens through NGS. KRAS mutations commonly occurred with loss in TP53 and there was significant loss of BRCA1 and NF1 among male patients with lung cancer. For clinically actionable targets, 23% had targetable CNVs when no pathogenic variants were detected by NGS. The data thus indicate that combining the two approaches provides significant benefit in a routine clinical setting not available by NGS alone.

Post-mortem prediction of primal and selected retail cut weights of New Zealand lamb from carcass and animal characteristics

Post-mortem measurements (cold weight, grade and external carcass linear dimensions) as well as live animal data (age, breed, sex) were used to predict ovine primal and retail cut weights for 792 lamb carcases. Significant levels of variance could be explained using these predictors. The predictive power of those measurements on primal and retail cut weights was studied by using the results from principal component analysis and the absolute value of the t-statistics of the linear regression model. High prediction accuracy for primal cut weight was achieved (adjusted R(2) up to 0.95), as well as moderate accuracy for key retail cut weight: tenderloins (adj-R(2)=0.60), loin (adj-R(2)=0.62), French rack (adj-R(2)=0.76) and rump (adj-R(2)=0.75). The carcass cold weight had the best predictive power, with the accuracy increasing by around 10% after including the next three most significant variables.