Predictors of Health-related Quality of Life and Adjustment to Prostate Cancer During Active Surveillance

Background

Active surveillance (AS) is emerging as an alternative approach to limit the risk of overtreatment and impairment of quality of life (QoL) in patients with low-risk localised prostate cancer. Although most patients report high levels of QoL, some men may be distressed by the idea of living with untreated cancer.

Objective

To identify factors associated with poor QoL during AS.

Design, setting, and participants

Between September 2007 and March 2012, 103 patients participated in the Prostate Cancer Research International Active Surveillance (PRIAS) QoL study. Mental health (Symptom Checklist-90), demographic, clinical, and decisional data were assessed at entrance in AS. Health-related QoL (HRQoL) Functional Assessment of Cancer Therapy-Prostate version and Mini-Mental Adjustment to Cancer outcomes were assessed after 10 mo of AS.

Outcome measurements and statistical analysis

Multivariate logistic regression models were used to identify predictors of low (<25th percentile) HRQoL, adjustment to cancer, and a global QoL index at 10 mo after enrolment.

Results and limitations

The mean age of the study patients was 67 yr (standard deviation: ±7 yr). Lack of partner (odds ratio [OR]: 0.08; p = 0.009) and impaired mental health (OR: 1.2, p = 0.1) were associated with low HRQoL (p = 0.006; area under the curve [AUC]: 0.72). The maladaptive adjustment to cancer (p = 0.047; AUC: 0.60) could be predicted by recent diagnosis (OR: 3.3; p = 0.072). Poor global QoL (overall p = 0.02; AUC: 0.85) was predicted by impaired mental health (OR: 1.16; p = 0.070) and time from diagnosis to enrolment in AS <5 mo (OR: 5.52; p = 0.009). Influence of different physicians on the choice of AS (OR: 0.17; p = 0.044), presence of a partner (OR: 0.22; p = 0.065), and diagnostic biopsy with >18 core specimens (OR: 0.89; p = 0.029) were predictors of better QoL. Limitations of this study were the small sample size and the lack of a control group.

Conclusions

Factors predicting poor QoL were lack of a partner, impaired mental health, recent diagnosis, influence of clinicians and lower number of core samples taken at diagnostic biopsy. Educational support from physicians and emotional/social support should be promoted in some cases to prevent poor QoL.     

Three-dimensional evaluation of bone changes following ridge preservation procedures

Purpose: To evaluate three-dimensionally the bone change following ridge preservation procedures (RPP) using computed tomography (CT). Materials and Methods: Subjects in need of implant therapy were enrolled in the study. The teeth were extracted, and sockets underwent RPP with a bioactive glass (Inion BioRestore, Inion Oy). The patients were scanned with CT within 1 week and 3 months after surgery. Horizontal and vertical radiographic measurements were performed on superimposed CT scans to evaluate bone changes in the alveolar sites during the 3-month period. Results: Thirteen subjects participated, and 32 teeth were extracted and treated with grafting. Alveolar sites treated with RPP demonstrated a preservation of about 77% of the original width dimensions, with a mean loss of 1.8 ± 1.1 mm in width. Moreover, it was observed that the vertical loss of buccal bone was 2.7 ± 1.1 mm, while the loss of lingual bone was 1.9 ± 1.2 mm. Conclusions: The CT evaluation was helpful to assess that the bone loss in width was less than the vertical bone loss of both walls 3 months after RPP.     

Prolonged distal motor latency of median nerve does not improve diagnostic accuracy for CIDP

Journal of Neurology - Compression of the median nerve at the carpal tunnel can give demyelinating features and result in distal motor latency (DML) prolongation fulfilling the EFNS/PNS...     

Difference in safety and humoral response to mRNA SARS-CoV-2 vaccines in patients with autoimmune neurological disorders: the ANCOVAX study

Journal of Neurology - Assessing the safety of SARS-CoV-2 mRNA vaccines and the effect of immunotherapies on the seroconversion rate in patients with autoimmune neurological conditions (ANC) is...     

GOKIO KUMBU/AMADABLAM TREK 2012: stabilometric adaptation in women to exercise training at low and high altitude

Purpose

Balance is the essential ability to maintain posture during physical activity and daily life. Exercise can have acute and chronic effects on postural stability. Individual exercise sessions can decrease postural stability, while long-term training improves balance and postural sway. Consequently, athletes and people undergoing training have better postural sway than more sedentary subjects. Hypobaric hypoxia has also been suggested to cause stress and adaptation of balance abilities. Thus, the aim of this study was to determine the effects of exercise training under normoxia and hypobaric hypoxia on postural sway.

Methods

Seven adult females participated in this study. They underwent assessments of posture before and after 12 days of low-to-moderate exercise training at low altitude, and the same 4 months later, after 12 days of exercise training at high altitude. The data collected included: centre of pressure, average speed oscillation, and Romberg Quotient. This generated a total of 56 posture tests for these seven subjects.

Results and conclusions

The results of this research suggest that comparing the each period of activity (pre-exercise) and after the end of each period (post-exercise), both at low and at high altitudes, did not influence the postural stability.

     

Reference ranges of Doppler parameters of foetal pulmonary artery segments between 19 and 39 weeks of gestation

Objective: To determine reference ranges of Doppler parameters of foetal pulmonary artery segments.

Methods: A prospective cross-sectional study was conducted to evaluate 150 healthy singleton pregnancies between 19 and 39 weeks of gestation. The proximal, middle and distal segments of the foetal pulmonary artery were assessed. The following Doppler parameters were evaluated: pulsatility index (PI) and peak systolic velocity (PSV). The mean, standard deviation (SD) and maximum and minimum values were determined for each Doppler parameter. Pearson’s correlation coefficient (r) was used to assess the correlation between the foetal pulmonary artery segments. Polynomial regression was performed, and adjustments were made using the coefficient of determination (R²).

Results: The mean PI values (mean?±?SD) in the proximal, middle and distal arterial segments were 2.99?±?0.61, 2.25?±?0.96 and 1.31?±?0.58, respectively. The mean PSVs in the proximal, middle and distal segments were 50.68?±?16.63, 24.396?±?11.86 and 12.08?±?3.66?cm/s, respectively. Significant differences were observed between the PI and PSV values from the different segments (p?<?0.0001). A correlation between each Doppler parameter and gestational age was observed, and it was better represented using linear equations.

Conclusion: We successfully determined the reference ranges for Doppler parameters of foetal pulmonary artery segments between 19 and 39 weeks of gestation.