P–041 Reproductive concerns and sexual health in men with newly diagnosed testicular cancer prior to orchiectomy: preliminary results from an on-going study

Study question

What is the prevalence of reproductive concerns among patients with newly diagnosed testicular cancer (TC), and how do they rate their sexual health (SH).

Summary answer

Of 20 patients, 75% (n = 15) were moderate to highly concerned about decreased reproductive functioning. Twenty-four percent exhibited overall low SH.

What is known already

Currently, only little is known about reproductive concerns among TC patients. Furthermore, these concerns have not been investigated in a TC population prior to orchiectomy. One study among post-surgery TC patients two years after diagnosis, reported that 28% had high degree of reproductive concern. The literature indicates that TC patients’ sexual health is negatively affected due to altered body image and sexual dysfunction. However, studies regarding sexual health have primarily been performed on long term survivors of TC. Thus, little is known about SH in this population prior to treatment.

Study design, size, duration

The present cross-sectional study included patients from the fertility clinic in Horsens, Denmark. Patients were approached at their pre-scheduled appointment for cryopreservation of semen prior to orchiectomy. Enrolment started March, 2019 and is still on-going. Preliminary data is included from 21 enrolled patients.

Participants/materials, setting, methods

Patients newly diagnosed with TC, who were referred to the fertility clinic for semen cryopreservation prior to orchiectomy and other treatment modalities were invited. The patients responded to a questionnaire package of which reproductive concerns were assessed with seven questions with Likert scale response options ranging from 0 (not concerned) to 5 (highly concerned). SH was assessed with the validated 22-item questionnaire European Organization for Research and Treatment of Cancer Sexual health questionnaire (EORTC-SHQ).

Main results and the role of chance

A total of 37 patients met the inclusion criteria and of these 21 were enrolled in the study. Due to technical issues, only 20 out of 21 patients completed the full questionnaire package. Patients were asked about concerns regarding the ability to father children. Nine patients (45%) were moderately concerned, and six patients (30%) were highly concerned. When asked about their concerns of not being able to father children without fertility treatment, the answers were mostly unaffected with eight patients (40%) being moderately concerned, and seven patients (35%) highly concerned.

Four patients (20%) were highly concerned that decreased semen quality would affect future or present relationships. Patients were also asked if they felt sufficiently informed regarding the chance of fathering children without help from a fertility clinic following cancer treatment. Three patients (15%) reported that they were insufficiently informed, while four patients (20%) responded only to a little extend. Five patients (23,8%) scored ≤ 50 on the EORTC SHQ indicating that they had low SH. Eleven patients (52,3%) felt less masculine due to their disease. Furthermore, one patient (4,8%) scored ≤ 50 on the symptomatic scale, indicating that he had symptomatic sexual problems as fatigue and sexual pain.

Limitations, reasons for caution

The relatively low participant number is a limitation, making the results less generalizable. Furthermore, there is a risk of selection bias due to the moderate inclusion rate. Also, the questionnaire examining fertility related concerns were non validated, and focused mainly on the fertility-related aspects of reproductive concerns.

Wider implications of the findings: A considerable number of patients with newly diagnosed TC show substantial reproductive concerns as well as lowered sexual health. These worries could possibly be alleviated by more sufficient information from the health professionals already in the beginning of the treatment phase, reducing further emotional distress during the remaining treatment period.

Trial registration number

ClinicalTrials.gov ID:NCT03880994

3046High levels of MMP-cleaved mimecan is associated to carotid plaque stability and less future cardiovascular events

Introduction

The clinical consequences of atherosclerosis, myocardial infarction and stroke are the most common causes of death globally. Mimecan, a small leucine rich-repeat proteoglycan (SLRP), is cleaved by matrix metalloproteinases (MMPs) and known to be involved in collagen fibrillogenesis and angiogenesis. Circulating levels of MMP-cleaved mimecan (cMIM) has previously been identified as a marker of extracellular matrix remodelling in ApoE−/− knockout mice. The role of mimecan and its degradation in human atherosclerotic plaques has not been explored.

Purpose

We explored whether full-length mimecan and cleaved mimecan (cMIM) are associated to plaque composition and evaluated if they can predict future cardiovascular events.

Methods

Two hundred and eighteen human atherosclerotic plaques were stained for mimecan using immunohistochemistry. cMIM was measured in 202 plaque tissue homogenates using a competitive ELISA assay. Histological components (α-actin, CD68 and glycophorin A) were assessed using immunohistochemistry, neutral lipids were measured using Oil Red O and visible areas of calcium deposits were quantified. Matrix metalloproteinases (MMP-1, -2, -3, -9, -10 and -12), tissue inhibitors of matrix metalloproteinases (TIMP-1 and -2) were analysed in plaque tissue homogenates using ELISA assays and a proximity extension assay. ECM components (glycosaminoglycans, collagen and elastin) were detected with colorimetric assays and the TGF-β1, β2 and β3 were measured by a multiplex assay. Cardiovascular events were registered using national registers, patient records and telephone calls during a follow-up period of 59 months IQR (34–73).

Results

Mimecan was expressed in human atherosclerotic plaques. The expression correlated positively with neutral lipids and intraplaque hemorrhage and inversely with α-actin. In contrast cMIM correlated with α-actin and inversely with neutral lipids. cMIM correlated also with stabilizing extracellular matrix proteins elastin, collagen as well as TGF-β1, β2 and β3. Mimecan correlated to MMP-9 and cMIM correlated to MMP-2 and TIMP-2. Patient with high levels of cMIM had a lower risk of future cardiovascular events which remained significant after adjusting for risk factors (age, gender, diabetes and symptoms) in a multivariate Cox regression

Conclusion(s)

Mimecan was associated with vulnerable plaque features, whereas cMIM was related to stable plaque features. Low levels of cMIM predicted future cardiovascular events, independently of known risk factors. Taken together this suggests a possible role for mimecan and its cleavage in atherosclerosis that needs to be further explored.

Acknowledgement/Funding

Danish Research Foundation, Swedish Research Council, Swedish Heart and Lung Foundation, Skåne University Hospital and more.

The good and the bad collagens of fibrosis - Their role in signaling and organ function

Usually the dense extracellular structure in fibrotic tissues is described as extracellular matrix (ECM) or simply as collagen. However, fibrosis is not just fibrosis, which is already exemplified by the variant morphological characteristics of fibrosis due to viral versus cholestatic, autoimmune or toxic liver injury, with reticular, chicken wire and bridging fibrosis. Importantly, the overall composition of the ECM, especially the relative amounts of the many types of collagens, which represent the most abundant ECM molecules and which centrally modulate cellular functions and physiological processes, changes dramatically during fibrosis progression. We hypothesize that there are good and bad collagens in fibrosis and that a change of location alone may change the function from good to bad. Whereas basement membrane collagen type IV anchors epithelial and other cells in a polarized manner, the interstitial fibroblast collagens type I and III do not provide directional information. In addition, feedback loops from biologically active degradation products of some collagens are examples of the importance of having the right collagen at the right place and at the right time controlling cell function, proliferation, matrix production and fate. Examples are the interstitial collagen type VI and basement membrane collagen type XVIII. Their carboxyterminal propeptides serve as an adipose tissue hormone, endotrophin, and as a regulator of angiogenesis, endostatin, respectively. We provide an overview of the 28 known collagen types and propose that the molecular composition of the ECM in fibrosis needs careful attention to assess its impact on organ function and its potential to progress or reverse. Consequently, to adequately assess fibrosis and to design optimal antifibrotic therapies, we need to dissect the molecular entity of fibrosis for the molecular composition and spatial distribution of collagens and the associated ECM.

Resting-state connectivity predicts levodopa-induced dyskinesias in Parkinson's disease

Background

Levodopa‐induced dyskinesias are a common side effect of dopaminergic therapy in PD, but their neural correlates remain poorly understood.

Objectives

This study examines whether dyskinesias are associated with abnormal dopaminergic modulation of resting‐state cortico‐striatal connectivity.

Methods

Twelve PD patients with peak‐of‐dose dyskinesias and 12 patients without dyskinesias were withdrawn from dopaminergic medication. All patients received a single dose of fast‐acting soluble levodopa and then underwent resting‐state functional magnetic resonance imaging before any dyskinesias emerged. Levodopa‐induced modulation of cortico‐striatal resting‐state connectivity was assessed between the putamen and the following 3 cortical regions of interest: supplementary motor area, primary sensorimotor cortex, and right inferior frontal gyrus. These functional connectivity measures were entered into a linear support vector classifier to predict whether an individual patient would develop dyskinesias after levodopa intake. Linear regression analysis was applied to test which connectivity measures would predict dyskinesia severity.

Results

Dopaminergic modulation of resting‐state connectivity between the putamen and primary sensorimotor cortex in the most affected hemisphere predicted whether patients would develop dyskinesias with a specificity of 100% and a sensitivity of 91% (P < .0001). Modulation of resting‐state connectivity between the supplementary motor area and putamen predicted interindividual differences in dyskinesia severity (R² = 0.627, P = .004). Resting‐state connectivity between the right inferior frontal gyrus and putamen neither predicted dyskinesia status nor dyskinesia severity.

Conclusions

The results corroborate the notion that altered dopaminergic modulation of cortico‐striatal connectivity plays a key role in the pathophysiology of dyskinesias in PD. © 2016 International Parkinson and Movement Disorder Society

Testing the near field/far field model performance for prediction of particulate matter emissions in a paint factory

A Near Field/Far Field (NF/FF) model is a well-accepted tool for precautionary exposure assessment but its capability to estimate particulate matter (PM) concentrations is not well studied. The main concern is related to emission source characterization which is not as well defined for PM emitters compared to e.g. for solvents. One way to characterize PM emission source strength is by using the material dustiness index which is scaled to correspond to industrial use by using modifying factors, such as handling energy factors. In this study we investigate how well the NF/FF model predicts PM concentration levels in a paint factory. PM concentration levels were measured during big bag and small bag powder pouring. Rotating drum dustiness indices were determined for the specific powders used and applied in the NF/FF model to predict mass concentrations. Modeled process specific concentration levels were adjusted to be similar to the measured concentration levels by adjusting the handling energy factor. The handling energy factors were found to vary considerably depending on the material and process even-though they have the same values as modifying factors in the exposure models. This suggests that the PM source characteristics and process-specific handling energies should be studied in more detail to improve the model-based exposure assessment.

Exposure to dust and endotoxin of employees in cucumber and tomato nurseries

Exposure to bioaerosols in occupational settings is associated with a range of adverse health effects. The aim of this study was to investigate the exposure levels to dust and endotoxin of people working in two cucumber nurseries and two tomato nurseries. Exposure was measured for greenhouse workers (n = 70) mainly working on harvesting cucumbers and tomatoes and clearing the plants after the harvest season. The people were exposed to between 0.2 and 15 mg inhalable dust m(-3) (median = 1.6 mg m(-3)) and between 0.5 and 400 ng inhalable endotoxin m(-3) (median = 32 ng m(-3)). The exposure to 'total dust' and endotoxin measured by stationary samplers (n = 30) in the greenhouses was low. Endotoxin was present in relatively high concentrations on cucumber leaves compared with leaves on pot plants. The Danish occupational exposure limit (OEL) for total organic dust is 3 mg m(-3) and 36% and 17% of the cucumber and tomato workers, respectively, were exposed to >3.0 mg inhalable dust m(-3). There is no OEL for endotoxin, but 'no effect levels' at approximately 15 ng m(-3) have been found. The majority of subjects (65%) were exposed to >15 ng m(-3). Significantly higher exposure was found for employees in cucumber nurseries than for employees in tomato nurseries. Clearing tomato plants after the harvest season caused a higher exposure to endotoxin than tomato harvesting. In conclusion, people working in cucumber and tomato nurseries were often exposed to high levels of inhalable dust and endotoxin. Cucumber harvest workers were exposed to significantly more dust and endotoxin than tomato harvest workers. The dust and endotoxin aerosolized during the working processes were only transported to other areas in the greenhouses to a very low degree. Cucumber and tomato leaves were identified as endotoxin reservoirs.

Albuminuria in ischemic heart disease

Proteinuria associated with acute heart disease was studied prospectively in 160 patients admitted to the coronary care unit with suspected AMI. Series 1 comprised 150 patients, divided into the following groups: AMI, 27 UAP, 43 AP, 22 NIP and 18 excluded. Albumin and creatinine were measured in the first urine passed after admission (sample 1) and the first morning urine the following 2 days (samples 2 and 3). The ACR was significantly higher in the AMI and UAP groups than in the other patient groups (p < 0.0001). There was no significant difference of ACR between the AMI and UAP in sample 1 (p = 0.31). In the AMI, UAP and AP groups ACR was significantly higher in sample 1 than in samples 2 and 3 (p < 0.005). In the NIP group there were no significant differences between sample 1 versus samples 2 and 3 (p = 0.06). Series 2 comprised 10 patients: 8 AMI, 1 UAP and 1 AMYO. ACR were measured in all specimens voided during the period of observation. ACR can oscillate within hours between normal concentrations and concentrations well into or above the microalbuminuric range. We propose the term episodic albuminuria for this reversible, switch-like change in renal function. The albuminuric episodes lasted 90-600 minutes. Maximum values for ACR were between 133-790 mumol/mol or 78-466 mg/g. In healthy, resting individuals ACR is < 50 mumol/mol (< 30 mg/g). The rapid changes in glomerular permeability may reflect systemic changes in endothelial permeability in the affected individuals. We speculate that atrial natriuretic peptide (ANP) may be a mediator of this type of albuminuria.

Renal function after myocardial infarction and cardiac arrest in rats: role of ANP-induced albuminuria?

Renal function was measured by clearance technique before and after acute myocardial infarction (MI) induced by left coronary artery ligation in male Sprague-Dawley rats. The animals were anaesthetized with halothane-nitrous oxide, paralysed with pancuronium and artificially ventilated. All parameters were stable throughout the experiment in sham-operated time control animals (n = 8). After MI, rats developed left ventricular dysfunction with increased left ventricular end-diastolic pressure and decreased mean arterial pressure. MI produced antidiuresis and antinatriuresis without changes in glomerular filtration rate (GFR), lithium clearance or renal albumin excretion (n = 8). The antidiuretic and antinatriuretic responses to MI were similar in rats with chronic bilateral renal denervation (n = 5). Three additional rats with chronic bilateral renal denervation had cardiac arrest and were resuscitated with cardiac massage, i.v. lidocaine and intracardiac adrenaline administration. These animals showed a transient increase in urine flow rate, sodium and albumin excretion with maximum 30-60 min after resuscitation, while GFR and lithium clearance were normal. Since cardiac ischaemia and sympathetic stimulation are strong stimuli for the release of atrial natriuretic peptide (ANP), we examined if ANP (0.25, 0.50, and 1.00 microg kg(-1) min(-1), n = 8 per dose) affects urinary albumin excretion. ANP increased dose-dependently the urine/plasma concentration ratio of albumin relative to inulin, which suggests that ANP increases the glomerular permeability for albumin. We conclude that MI causes stimulation of renal tubular sodium and water reabsorption by a mechanism which is independent of intact renal innervation. MI does not produce any change in renal albumin excretion in rats, but transient albuminuria may be observed in rats following cardiac arrest and/or manoeuvres used in cardiac resuscitation. Since ANP produces albuminuria, we speculate that ANP may be an important mediator of albuminuria in states with elevated plasma concentrations of ANP.

The MICRAL test for diabetic microalbuminuria: predictive values as a function of prevalence

The MICRAL test is an immunospecific dipstick for detection of low concentrations of albumin in urine (microalbuminuria). The test is intended to be used for screening in an ambulatory setting. The utility of the test depends on its ability to accurately predict which patients will be classified as either microalbuminuric or normoalbuminuric by means of a standard laboratory method for determination of albumin in urine. We have analysed data from studies with a total of 2904 samples of urine from diabetic patients. The data are from our own study (190 samples) and from a selected set of 10 publications. The results from standard laboratory measurements of albumin in urine were used as " gold standards". The sensitivity and specificity as calculated from the pooled data were 83.2 and 92.3%, respectively. The predictive values were calculated using simulated changes in the prevalence of microalbuminuria (MAU). At a prevalence of MAU of 1% the predictive value of a negative test is 99.9% but that of a positive test only 9.8%. At a prevalence of MAU of 80% the positive predictive value is 97.7% and the negative predictive value 57.9%. In general, any change in the prevalence will lead to a change in the predictive values. Thus the prevalence of MAU in the given clinical setting is a decisive factor in determining the utility of the MICRAL test.

Regulation of motilin release from isolated perfused pig duodenum

The release of motilin from an isolated preparation of pig duodenum has been studied. There different types of stimuli were applied: electrical nerve stimulation, intraarterially administered peptides, and instillation of test solutions into the lumen of the duodenum. Furthermore extracts of 20 different regions of the pig digestive system have been analyzed for motilin content. Analysis of the extracts only detected significant presence of motilin in the pig duodenum and jejunum (79 +/- 15 and 60 +/- 19 pmol/g). The stimulation experiments showed: (1) a significant noncholinergic depression of motilin release during electrical stimulation of the vagus nerve (nadir at 74 +/- 5% of baseline level; (2) a significant elevation of motilin release in response to intraarterially administered vasoactive intestinal peptide (VIP) (peak at 330 +/- 35% of baseline level), and (3) a significantly elevated motilin release in response to instillation of autologuous bile (peak at 170 +/- 16% of baseline level) and hydrochloric acid (peak at 196 +/- 42% of baseline level) into the duodenal lumen. In conclusion, luminal acidification and bile are important factors in stimulation of motilin release, whereas the vagally stimulated VIP release was insufficient to overcome the general inhibitory effect of vagus stimulation.

[Metabolic disorders in the treatment of malignant hematologic diseases--the acute tumor lysis syndrome]

The acute tumor-lysis syndrome is a potentially fatal complication which characteristically arises during initial chemotherapy of malignant hematological diseases with large tumor burdens. The syndrome is characterized by hyperphosphatemia, hypocalcemia, hyperuricemia and often acute renal failure. Prior to chemotherapy the patient should be treated for 12-24 hour with intensified diuresis to ensure optimal renal function. The treatment of the fully developed syndrome is hemodialysis. Three cases of TLS which developed during initial chemotherapy of patients with acute lymnphoblastic leukemia and non-Hodgkin lymphoma are presented.