Continuity of illicit drug use among Malay patients attending methadone clinics in Kelantan, Malaysia

The study aimed to determine the prevalence of continuity of illicit drug use and its associated factors among Malay opioid users receiving methadone treatment in Kelantan, Malaysia. This cross-sectional study involved a total of 150 respondents. Sociodemographic characteristic of participants, level of religiosity, and quality of life were collected using the self-administered questionnaires. The prevalence of continuity illicit drug use was 38.7% (n = 58) by self-report and 40.7% (n = 61) by positive urine test result for drugs. Positive hepatitis C status and high quality of life in the psychological health domain were associated with low continuity of illicit drug use by self-reported data and urine drug test results. In conclusion, the continuity of illicit drug use among methadone program users is still high, especially among those on methadone therapy for less than 2 years.

Aerosol precautions and airway complications: a national prospective multicentre cohort study

The perceived risk of transmission of aerosolised viral particles from patients to airway practitioners during the COVID-19 pandemic led to the widespread use of aerosol precautions, including personal protective equipment and modifications to anaesthetic technique. The risk of these aerosol precautions on peri-operative airway complications has not been assessed outside of simulation studies. This prospective, national, multicentre cohort study aimed to quantify this risk. Adult patients undergoing general anaesthesia for elective or emergency procedures over a 96-hour period were included. Data collected included use of aerosol precautions by the airway practitioner, airway complications and potential confounding variables. Mixed-effects logistic regression was used to assess the risk of individual aerosol precautions on overall and specific airway complications. Data from 5905 patients from 70 hospital sites were included. The rate of airway complications was 10.0% (95%CI 9.2-10.8%). Use of filtering facepiece class 2 or class 3 respirators was associated with an increased risk of airway complications (odds ratio 1.38, 95%CI 1.04-1.83), predominantly due to an association with difficult facemask ventilation (odds ratio 1.68, 95%CI 1.09-2.61) and desaturation on pulse oximetry (odds ratio 2.39, 95%CI 1.26-4.54). Use of goggles, powered air-purifying respirators, long-sleeved gowns, double gloves and videolaryngoscopy were not associated with any alteration in the risk of airway complications. Overall, the use of filtering facepiece class 2 or class 3 respirators was associated with an increased risk of airway complications, but most aerosol precautions used during the COVID-19 pandemic were not.

Written Asthma Action Plan Improves Asthma Control and the Quality of Life among Pediatric Asthma Patients in Malaysia: A Randomized Control Trial

BACKGROUND

A written asthma action plan (WAAP) is one of the treatment strategies to achieve good asthma control in children.

METHODS

This randomized controlled trial was conducted to observe the effect of WAAP on asthma control and quality of life using the Asthma Control Questionnaire and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) at baseline and after 3 months. A repeated measure analysis of variance was used to analyze the mean score difference between the two groups.

RESULTS

There was no significant difference in mean score for asthma control at baseline between groups (F[degree of freedom (df)]=1.17 [1, 119], P=0.282). However, at 3 months, a significant difference in mean scores between groups was observed (F[df]=7.32 [1, 119], P=0.008). The mean±standard deviation (SD) scores in the intervention and control groups were 0.96±0.53 and 1.21±0.49, respectively. For the analysis of the PAQLQ, no significant difference was observed in the mean score for the quality of life baseline in both groups. There were significant mean score changes for the quality of life (F[df]=10.9 [1, 119], P=0.001) at 3 months follow-up, where those in the intervention group scored a mean±SD score of 6.19±0.45, and those in the control group scored 5.94±0.38. A time-group interaction analysis using repeated-measures analysis of variance showed significant differences in mean score changes (F[df]=5.03 [1, 116], P=0.027) and (F[df]=11.55 [1, 116], P=0.001) where a lower mean score was observed in the intervention group, indicating better asthma control and quality of life, respectively. A significant (P<0.001) negative Pearson correlation between asthma control and quality of life (-0.65) indicated a moderate correlation.

CONCLUSION

WAAP, along with standard asthma treatment, improves asthma care.

Impact of Implementing a Bendamustine-Based Conditioning Regimen on Outcomes of Autologous Stem Cell Transplantation in Lymphoma while Novel Cellular Therapies Emerge

With the advent of new cellular and targeted therapies, treatment options for relapsed and refractory (r/R) lymphomas have multiplied, and the optimal approach offering the best outcomes remains a matter of passionate debate. High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is still considered a treatment option for patients with chemosensitive lymphoma when cure is the expected goal. The myeloablative conditioning regimen preceding the stem cell infusion is considered the effective component of this approach. Carmustine (BCNU)-based preparative regimens, such as BEAM and BEAC, are considered the standard of care and have shown efficacy and low nonrelapse mortality (NRM). Comparative studies between conditioning regimens have failed to identify a better option. After a BCNU drug shortage in Canada followed by a steep increase in price, we elected to substitute BCNU for bendamustine (benda) in the preparative regimen. The purpose of this substitution was to improve response while preserving safety and controlling costs. From May 2015 to May 2018, a total of 131 consecutive lymphoma patients received benda-EAM conditioning. These patients were compared with 96 consecutive patients who received BCNU-based conditioning from January 2012 to May 2015. Apart from conditioning, supportive care measures were the same in the 2 groups. Patients receiving benda were older (55.7 years versus 51.1 years; P = .002). The development of grade ≥3 mucositis was more frequent with benda conditioning (39.5% versus 7.8%; P < .001) leading to a greater requirement for parenteral nutrition (48.9% versus 21.9%; P < .001). A transient creatinine increase >1.5 times the upper limit of normal (15.3% versus 4.2%; P < .008) and intensive care unit admission (6.9% versus 1.1%; P < .029) were more frequent with benda; however, there were no between-group differences in cardiac, pulmonary, or liver toxicity and NRM. With a median follow-up of 48 months for the benda group and 60 months for the BCNU group, benda was associated with significantly better progression-free survival (71% versus 61%; P = .040; hazard ratio [HR], 1.6; 95% confidence interval [CI], 1.0 to 2.7) and overall survival (86% vs 71%; P = .0066; HR, 2.6; 95% CI, 1.3 to 5.4) compared with BCNU-based conditioning regimens. While novel therapies emerge, our study demonstrates that benda-EAM is safe and effective and should be considered a valid alternative to BCNU conditioning to improve outcomes of patients with chemosensitive r/R lymphomas undergoing ASCT.

The Role of Platelet-Rich Plasma in Reducing Pain, Pruritis, and Improving Wound Healing of Skin Graft Donor Site

Background  Wound healing is a dynamic and complex process. Therefore, no single agent can efficiently mediate all aspects of the wound healing process. Split-thickness graft has become a workhorse of plastic surgery for wound or raw area cover. In this study, we evaluate the effectiveness of autologous platelet-rich plasma (PRP) on the donor site and its effect in pain, purities, and epithelization. Materials and Methods  This is a prospective study. A total of 15 patients were included who underwent split skin grafting for burns, trauma, or post-tumor excision raw area. PRP was prepared using standard described procedure. The donor site raw area after harvesting split-thickness graft was measured and the surface area was divided into two equal halves. One half was dressed using PRP and the other half was dressed using paraffin gauze piece only. The dressings were changed weekly for 3 weeks. Observation  We found significant reduction in severity of pain and pruritis in the PRP group as compared with control group. Epithelization was faster in the PRP group on day 7 and 14, but the overall healing time was nearly the same by day 21. The side-by-side dressing thus show a definite improvement in the post-split-thickness skin graft wound care and PRP as a good dressing alternative. Conclusion  Autologous PRP is very effective adjuvant in management of skin graft donor site. Its role in relieving pain and pruritis over donor site significantly improves patient's discomfort postoperatively. It helps in early and painless wound healing. However, we recommend for larger clinical study for better understanding of the efficacy of this blood product.

Occurrence and Distribution of Heavy Metals in Mining Degraded Soil and Medicinal Plants: A Case Study of Pb/Zn Sulfide Terrain Northern Areas, Pakistan

Mining activities have serious environmental impacts, thus releasing heavy metals (HMs) such as cadmium (Cd), lead (Pb), chromium (Cr), zinc (Zn) and nickel (Ni) into the surrounding environment. The current paper investigated the impacts of mining activities of Pb-Zn sulfide on soil and medicinal plants. Hence, soil samples (n = 36) and medicinal plants (n = 36) samples were collected, acid extracted and were analyzed through Inductively Coupled Plasma Mass Spectrometry (ICP-MS) for HMs quantification. Our results showed that mineralized zones showed high HMs enrichment levels as compared to non-mineralized zones. Various Indices for HMs assessment revealed that the contaminated soil of the study area had low to extreme level. The mean concentrations of HMs in mining degraded soil and medicinal plants were significantly higher (p ≤ 0.01) and were found in order of Zn > Pb > Cr > Ni > Cd and Cr > Zn > Pb > Ni > Cd respectively. Similarly, some widely consumable medicinal plants showed good metal accumulation for Cd, Cr and Pb i.e., 3.57 mg kg¹, 350 mg kg^-1 and 335 mg kg^-1 in C. sativa, while 5.9 mg kg-1, 276.9 mg kg-1 and 188.7 mg kg-1 in R. hestatus respectively. Hence, the present study recommended that medicinal plants grown in mining areas should be analyzed for HMs concentration before consumption.

Taguchi L16 (44) orthogonal array-based study and thermodynamics analysis for electro-Fenton process treatment of textile industrial dye

Reactive orange 16 (RO16) is the most widely used azo dye in Textile industry. Complex aromatic structures and resistivity to biological decay caused the dye pollutants incompletely treated by the conventional oxidative methods. The current study presents the electro-Fenton-based advanced oxidation treatment of RO16 dye and the process optimization by Taguchi-based design of experiment (DOE). Using a 500 mL volume lab-scale experimental setup, the process was first studied for the principal operational parameters (initial dye concentration (q); [H2O2]/[Fe+2] (R); current density (ρ); and temperature (T)) effect on decolourization (D R ) and COD removal (C R ). Then, by means of the L16 (44) orthogonal array (OA) formation, standard mean and signal-to-noise (S/N) ratio, the process was optimized for the response variables. The result showed the optimized result at q = 100 mg/L, R = 100, ρ = 8 mA/cm2, and T = 32 °C; with D R and C R as 90.023 and 84.344%, respectively. It was found that the current density affects the process most, followed by [H2O2]/[Fe+2] ratio, initial dye concentration, and temperature i.e., ρ > R > q > T. Also, with the analysis of variance (ANOVA), model equations for D R and C R were developed and its accuracy was verified for experimental results. At optimized conditions, the first order removal rate constants (k a ) were found from batch results. Additionally, the thermodynamic constants (ΔH e , ΔS e , and ΔG b ) were also calculated for the nature of heat-energy involved and temperature effect study on dye degradation. The results showed that the process was thermodynamically feasible, endothermic, and non-spontaneous with a lower energy barrier (E A  = 46.7 kJ mol−1).

Association of monomeric C-Reactive Protein (m-CRP) with hypothalamic neurons after CRP hippo-campal administration in a model of dementia

OBJECTIVE

The ensuing ischemia due to the disruption of blood supply to the brain is one of the most common causes of stroke. Evidence suggests a clear association of the ischemic injury with vascular dementia and Alzheimer's disease (AD). In response to the brain ischemia, a cascade reaction starts leading to neuronal damage due to oxidative stress and other inflammatory mediators. A pilot study was done, which showed that following stroke, monomeric-C-reactive protein (mCRP) is expressed in large quantities around the infarcted zone and this CRP is able to induce neurodegeneration and inflammation potentially perpetuating dementia.

MATERIALS AND METHODS

We examined both patient brain samples and excised mouse brain tissue, previously injected with 1.75 mg/mL mCRP into the CA1 area of the hippocampus through the stereotactic surgical procedures and followed them over a period of over 6 months. The distribution of mCRP was examined through immunohistochemistry (mouse anti-human mCRP-specific antibodies 8C10).

RESULTS

We observed a novel finding: those micro vessels close to the injection location were strongly stained with mCRP only in the mice that had been injected with mCRP, indicating that this small blood vessel can spread it throughout the brain.

CONCLUSIONS

mCRP found in the brain after a hemorrhagic stroke promotes damage over a large area via the induction of inflammation and degeneration of perivascular compartments.

The role of restaurant wastewater for producing bioenergy towards a circular bioeconomy: A review on composition, environmental impacts, and sustainable integrated management

Population inflation has led to the unprecedented increase in urbanization, thus causing negative impacts on environmental sustainability. Recently, there is an upsurge in the number of restaurants due to the changing lifestyles of the people round the globe. For instance, there were 167,490 food and beverage establishments in 2015, representing an annual growth rate of 5.1% since 2010 in Malaysia. The rapid growth of restaurants has implicated a negative impact due to the generation of highly polluted restaurant wastewater (RWW). RWW is mainly generated during the cooking, washing, and cleaning operations. RWW typically contain fat, oil, and grease (FOG) resulting from residues of meat, deep-fried food, baked items and butter, and has caused serious blockages of sewer due to clogging and eventually sewage backup. This has increased the required frequency of cleaning and sanitary sewer overflows (SSOs). Results from the previous studies have shown that FOG can be treated using physical, chemical, and biological processes. Different technologies have been applied for the treatment of FOG and other pollutants (COD, BOD, SS and NH₄-N) present in RWW. Therefore, this review aims to provide an in-depth understanding of the characteristics of RWW, chemical and physical characteristics of FOG with the mechanism of its formation and utilization for biocomposites, biogas and biodiesel productions for circular bioeconomy. Besides, this review has discussed the potential treatment technologies comprehensively for RWW which is currently remain understudied. Integrated sustainable management of FOG with technoeconomic analysis of bioproducts, sustainable management with international initiatives and previous studies are also summarized. Hence, this review aims towards providing better alternatives in managing RWW at sources, including its treatment and potential of its biorefinery, therefore eventually contributing towards environmental sustainability.

Multi-geostatistical analyses of the spatial distribution and source apportionment of potentially toxic elements in urban children's park soils in Pakistan: A risk assessment study

In the past few decades, contamination of urban children's parks (UCPs) with potentially toxic elements (PTEs) has been attracting more and more interest; however, assessment of eco-environmental and child exposure risks particularly in developing countries remains limited. The current study investigated PTE (Cr, Ni, Zn, As, Cd, and Pb) concentrations, potential sources, and their health risk assessment in UCP soils of 12 major cities in Pakistan. The results showed that the mean concentration of Ni exceeded the SEPA-permissible limit in all UCP sites, while other PTEs were found to be within acceptable limits. The soil properties such as pH, electrical conductivity, organic matter, and soil particles size were determined in UCPs soils. The contamination factor and pollution load index results indicated low to moderate pollution levels (CF < 3) and (PLI<1) for all PTEs except Ni in some of the selected cities. Quantile-quantile (Q-Q) plotting determined the normal distribution line for all PTEs in the UCPs. Principal component analysis showed the mixed sources of contamination from industrial emissions, fossil fuel combustion, vehicular emissions, wastewater irrigation, as well as solid waste disposal and natural sources of soil parent materials in all park sites. ANOVA results showed that all the PTEs except Cd had moderate to higher contamination values than the reference site. The risk assessment study revealed that children had high exposure to the selected PTEs via all exposure pathways. The hazard index (HI) mean value (1.82E+00) of Ni for all exposure pathways was greater than 1, while total risk value of Cr (1.00E-03) had exceeded USEPA limit, indicating cancer risk. Consequently, the study of UCPs soils revealed PTEs contamination that could pose a potential health risk to the local population in the studied UCPs regions of Pakistan. Thus, the present study recommends that the influx of PTEs originating from natural and anthropogenic sources should be mitigated and government should implement strict enforcement of environmental regulations and proper management, as well as air quality monitoring guidelines for public health should be strictly adopted to reduce traffic- and industrial emission-related to PTEs in metropolitan areas.

Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft with Fixation Using Endobutton at Femoral End and Bioabsorbable Screw at Tibial End

Anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee. It can be repaired and reconstructed by open and endoscopic method, the gold standard is, however, endoscopic reconstruction. It is usually reconstructed using bone patellar tendon bone (BPTB) or Hamstring autograft. The graft is supported using endobutton at the femoral end while bioabsorbable interference screw at the tibial end. This study aimed to determine how a certain fixation procedure for quadrupled hamstring autografts worked out. This prospective observational study duration period was 1 year in which 40 patients with ACL injury were treated with arthroscopic reconstruction using hamstring autograft from January 2020 to December 2020 with 6 months follow up after surgery. On the femoral side, an endobutton was used to secure the graft, while the tibial end was secured using a bioabsorbable screw. The International Knee Documentation Committee (IKDC) scoring system was used for prospective evaluation. According to subjective IKDC scoring, 20(50.0%) results were very good, 14(35.0%) were good, 4(10.0%) were satisfactory and 2(5.0%) were bad. In 95.0% patients the state of knee joint is very good compared to preoperative state. Of all the 40 patients underwent ACL reconstruction, 38(95.0%) patients are satisfied with the results of the operation.

Escobar Syndrome with Monodactyly: A Rare Case Report

Escobar syndrome (nonlethal type of multiple pterygium syndrome) is a very rare genetic disorder. The central manifestations of Escobar syndrome are the presence of multiple pterygia, fixed joint contractures, and characteristic facies. Here, we report a case of Escobar syndrome with additional features such as monodactyly and hypoplastic pectoralis muscle.

Bioequivalence of a hybrid pegylated liposomal doxorubicin hydrochloride injection and Caelyx®: A single-dose, randomized, multicenter, open-label, two-period crossover study in patients with advanced ovarian cancer

OBJECTIVE

To evaluate the bioequivalence of a hybrid pegylated liposomal doxorubicin (PLD) hydrochloride injection with reference product Caelyx®.

METHODS

This multicenter, open-label, balanced, randomized, two-treatment, two-period, two-sequence, single-dose, crossover, bioequivalence study was conducted in female patients aged ≥18 years and ≤75 years with ovarian cancer, whose disease progressed or recurred after platinum-based chemotherapy, and who were scheduled to start PLD therapy. Patients were intravenously infused drugs over 1 h at 50 mg/m² dose two hours after breakfast on the first day of the chemotherapy cycle in period-I and crossed over to the other arm in period-II (day 29). Pharmacokinetic (PK) analyses were performed using two separate, validated liquid chromatography-mass spectrometry methods for encapsulated and unencapsulated doxorubicin.

RESULTS

Both the test and reference formulations were well-tolerated and safe. The pharmacokinetic analysis for both encapsulated and unencapsulated doxorubicin was conducted in 50 patients and PK parameters were found to be comparable between test and reference products. The geometric mean ratios (90% confidence interval) of hybrid PLD/Caelyx® were; maximum measured plasma concentration (C_max): 91.94-97.28%, area under the plasma concentration versus time from time 0 to t (AUC_0-t): 95.19-103.67%_, AUC from time 0 to ∞ (AUC_0-∞): 95.13-103.66% for encapsulated doxorubicin and for unencapsulated doxorubicin C_max: 92.08-116.46%_, AUC_0-t: 91.91-108.28%_, AUC_0-∞: 93.45-110.05%.

CONCLUSION

The PLD formulation was found to be bioequivalent to Caelyx®.

Apportionment of heavy metals in a soil-water-plant system via brick kiln emissions in heavily industrialized city of Pakistan

One of the major environmental problems is the fast accumulation of brick kiln emissions near the peripheries of almost all urban centers. An enormous quantity of substandard coal, wood, rubber tires, or saw wood is used as fuel in these brick kilns, creating environmental pollution through carbon and heavy metals present in the emissions. The present study was designed to determine the distribution pattern of heavy metals in a soil-water-plant system under the influence of brick kiln emissions. Ash, soil (0-15 cm), water, and plant samples were collected from the adjacent areas of the brick kilns. Geo-accumulation index and contamination factors were used to assess the toxicity of metals to soil and plants. It was found that the concentrations of Cd in water, soil, coal, and plant samples were found in the range of 0.004-0.024 mg L^-1, 0.02-0.66, 0.002-0.042, and 0.06 to 0.07 mg kg^-1, respectively, while Pb concentration was found within the range of 0-0.08 mg L^-1, 0.30-8.60, 0.011-0, and 0.01-0.08 mg kg^-1 in water, soil, and plant samples, respectively. The concentration of Cd in brick kilns ash was in the range of 0-0.04 mg kg^-1 while Pb was found within the range of 0.01-0.05 mg kg^-1 for ash. Geo-accumulation index and contamination factor values for Cd were found higher suggesting proper pollution prevention measures to be implemented. Based on the results, it was concluded that Cd concentrations in soil, plants, and water samples were higher in the subject area due to brick kiln emissions and higher Cd concentrations in the fuel material.

Effect of season and housing system on hematochemical attributes in rabbits of Southern Punjab, Pakistan

ABSTRACT The present study was conducted to investigate the effect of season and housing system on hematochemical attributes of rabbits in Southern Punjab, Pakistan. Adult healthy rabbits (n=30) were divided into two groups of equal size (n=15). Group I was housed in a modern cage system and group II in traditional colony system for a period of one year. Blood samples of rabbits from both groups were collected in the summer and the winter seasons and analyzed for various hematochemical attributes. Hematochemical attributes including red blood cell (RBC) count, hematocrit (HCT), mean corpuscular volume (MCV), total white blood cell (WBC) count, mixed cells (MID), granulocytes (GRA), glucose and alanine aminotransferase (ALT) were lowered significantly (P<0.05) in the summer in relation to the winter, while mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), creatinine, and cholesterol level were significantly (P<0.05) higher during the summer season. Biochemical attributes as cholesterol, triglycerides and globulin were significantly (P<0.05) lower in the caged rabbits. In conclusion, the summer season caused a significant decrease in most of the hematochemical attributes whereas housing system did not affect most of the hematochemical attributes of the rabbits under the climatic conditions of Southern Punjab, Pakistan.

Role of Early Enteral Glutamine Supplementation in Reducing Infectious Morbidity in Burn Patients: A Case-Control Study

Severe burn injury is more challenging to sustain life than a preburn status. The situation changes drastically in terms of energy demands/ expenditure and the great degree of susceptibility to infections due to the loss of amino acids. Glutamine stimulates the immune system and prevents catabolism. The bacterial translocation from the gut can be decreased by glutamine supplementation, thereby suppressing the inflammatory response. In acute burn injury, plasma and muscle glutamine depletion is observed to contribute to muscle wasting, weight loss, and infection. Patients with 20%–50% TBSA burns presenting within 24 hours of injury to the emergency department or outpatient department were included in the study. The patients were divided into two groups randomly. In group 1 (Cases), all patients were given enteral glutamine supplementation at the dose of 0.5 mg/kg/day either orally or through a nasogastric tube started within 24 hours of injury. Group 2 (Control) had all the patients in whom enteral glutamine supplementation was not given. In both groups, blood analysis for total leucocyte count (TLC) and total serum proteins (TSP) was done upon admission. On Day 4, followed by analysis every fourth day, after that, till healing occurred or the patient was taken up for grafting. Blood and wound swab cultures were done on the third day of admission, then the first week, followed by weekly cultures for 4 weeks or till healing occurred or the patient was taken up for grafting. A total of 123 patients were studied. There was a decreasing trend in the mean values of the TLC and an increasing trend in TSP in both groups. The difference became statistically significant from Day 20 onwards. The pattern of wound cultures was found to be statistically significant in Week 3 and Week 4, whereas the difference in blood culture positivity among the groups was statistically significant in Week 3. We noted, in our study, that the glutamine supplementation to the early enteral nutrition increased the TSP levels and decreased the TLC, wound, and blood culture positivity rates in the study group. Glutamine supplementation can contribute to improved immunity and reduce burn wound sepsis and bacteremia. All these combined can lead to decreased morbidity, improved wound healing, and better outcomes with lesser costs.

NeuroSAFE PROOF: study protocol for a single-blinded, IDEAL stage 3, multi-centre, randomised controlled trial of NeuroSAFE robotic-assisted radical prostatectomy versus standard robotic-assisted radical prostatectomy in men with localized prostate cancer

BACKGROUND

Robotic radical prostatectomy (RARP) is a first-line curative treatment option for localized prostate cancer. Postoperative erectile dysfunction and urinary incontinence are common associated adverse side effects that can negatively impact patients' quality of life. Preserving the lateral neurovascular bundles (NS) during RARP improves functional outcomes. However, selecting men for NS may be difficult when there is concern about incurring in positive surgical margin (PSM) which in turn risks adverse oncological outcomes. The NeuroSAFE technique (intra-operative frozen section examination of the neurovascular structure adjacent prostate margin) can provide real-time pathological consult to promote optimal NS whilst avoiding PSM.

METHODS

NeuroSAFE PROOF is a single-blinded, multi-centre, randomised controlled trial (RCT) in which men are randomly allocated 1:1 to either NeuroSAFE RARP or standard RARP. Men electing for RARP as primary treatment, who are continent and have good baseline erectile function (EF), defined by International Index of Erectile Function (IIEF-5) score > 21, are eligible. NS in the intervention arm is guided by the NeuroSAFE technique. NS in the standard arm is based on standard of care, i.e. a pre-operative image-based planning meeting, patient-specific clinical information, and digital rectal examination. The primary outcome is assessment of EF at 12 months. The primary endpoint is the proportion of men who achieve IIEF-5 score ≥ 21. A sample size of 404 was calculated to give a power of 90% to detect a difference of 14% between groups based on a feasibility study. Oncological outcomes are continuously monitored by an independent Data Monitoring Committee. Key secondary outcomes include urinary continence at 3 months assessed by the international consultation on incontinence questionnaire, rate of biochemical recurrence, EF recovery at 24 months, and difference in quality of life.

DISCUSSION

NeuroSAFE PROOF is the first RCT of intra-operative frozen section during radical prostatectomy in the world. It is properly powered to evaluate a difference in the recovery of EF for men undergoing RARP assessed by patient-reported outcome measures. It will provide evidence to guide the use of the NeuroSAFE technique around the world.

TRIAL REGISTRATION

NCT03317990 (23 October 2017). Regional Ethics Committee; reference 17/LO/1978.