Sensor Integration in a Forestry Machine

This paper presents the integration of multimodal sensor systems for an autonomous forestry machine. The utilized technology is housed in a single enclosure which consolidates a set of components responsible for executing machine control actions and comprehending its behavior in various scenarios. This sensor box, named Sentry, will subsequently be connected to a forestry machine from MDB, model LV600 PRO. The article outlines previous work in this field and then details the integration and operation of the equipment, integrated into the forest machine, providing descriptions of the adopted architecture at both the hardware and software levels. The gathered data enables the assessment of the forestry machine's orientation and position based on the information collected by the sensors. Finally, practical experiments are presented to demonstrate the system's behavior and to analyze the methods to be employed for autonomous navigation, thereby assessing the performance of the established architecture. The novel aspects of this work include the physical and digital integration of a multimodal sensor system on a forestry machine, its use in a real case scenario, namely, forest vegetation removal, and the strategies adopted to improve the machine localization and navigation performance on unstructured environments.

Multifocal MRI-Directed Simultaneous Integrated Boost (SIB) in the Treatment of Prostate Cancer with Stereotactic Body Radiation Therapy (SBRT)

PURPOSE/OBJECTIVE(S)

Conventionally fractionated MRI-directed radiation boosts in the treatment of prostate cancer have been shown to improve oncologic outcomes in the FLAME trial. Moreover, recent data has demonstrated local recurrences following SBRT predominately occur at the site of the dominant intraprostatic lesion. Modern protocols including HYPO-Flame have demonstrated early safety profiles of a 5-fraction intraprostatic SBRT boost. This study aims to determine if multifocal SIB treatment is associated with additional acute toxicity relative to unifocal boosts.

MATERIALS/METHODS

In this single-center retrospective analysis, we identified all patients who underwent SBRT with a SIB using a robotic radiosurgical platform. Fiducial markers and hydrogel rectal spacers were placed prior to simulation. All patients underwent treatment planning MRI with documented PI-RADS 3-5 lesions targeted for SIB delineation. Patients were treated to a prescription dose of 3500 to 3625 cGy in 5 fractions, or 1800 to 2100 cGy in 3 fractions in concert with pelvic nodal irradiation. The SIB prescription dose ranged from 4000 to 4200 cGy and 2100 to 2300 cGy for the 5- and 3-fraction regimens, respectively. Acute toxicity was defined as that occurring within 60 days of treatment completion using the CTCAE v. 5.0.

RESULTS

A total of 35 patients with a median age of 70 underwent SBRT SIB from 5/2022 to 1/2023 with the following risk distribution: low (3%), intermediate (66%), high (28%), and regional (3%). Most patients received rectal spacers (77%) and neoadjuvant ADT (71%) prior to treatment. The majority of patients underwent 5-fraction SBRT (74%) with the remainder receiving SBRT as a boost. Approximately half (51%) of the cohort was treated with a multifocal SIB to multiple PI-RADS lesions. Mean SIB dose was 4105 and 2377 cGy in 5- and 3-fractions, respectively. With a median follow up of 33 days, we identified no grade 3+ acute toxicities. Crude rate of grade 2 GU and GI toxicity was 51% and 6%, respectively, on par with prior unifocal publications. There was no difference in median SIB volume between uni- and multifocal boosts (1.47 vs. 1.72 cc, p = 0.57), nor was SIB volume associated with an increased risk of grade 2 GU toxicity (p = 0.28). Dominant lesion location was not associated with increased grade 2 GU toxicity (p = 0.29). No grade 2 GI toxicities occurred in the multifocal group. Finally, univariate analysis did not identify multifocal boost as a risk of grade 2 GU toxicity (35%) relative to unifocal (67%) boost (p = 0.09).

CONCLUSION

In the first analysis of its kind in the literature, we demonstrate that multifocal MRI-directed intraprostatic SBRT SIB yields no acute high-grade toxicity and is not associated with a higher risk of low-grade GU and GI toxicity relative to unifocal boost. Longer follow is necessary to determine risk of late toxicity and oncologic efficacy.

Robotic SBRT in Prostate Cancer Patients Younger Than 50 Years Old-Updated Results

PURPOSE/OBJECTIVE(S)

Stereotactic Body Radiation Therapy (SBRT) is a standard therapeutic option for men with prostate adenocarcinoma. The median age of prostate cancer in the US is 66 but patients as young as 35 have been reported. Many younger patients will have surgery rather than SBRT for localized prostate cancer but some will be treated with SBRT. There is a paucity of data on the outcomes of this younger subset. This study reports updated outcomes on patients younger than 50 treated with SBRT at a single institution and compares outcomes to older patients.

MATERIALS/METHODS

Between April 2006 and December 2022, 6,130 patients with prostate cancer were treated with inhomogeneous-dosed SBRT using a robotic linear accelerator. Information was available for 4,143 patients. 3568 (86.12%) of patients were treated with a median dose of 3500cGY (3500-3625) delivered over 5 consecutive fractions prescribed to the 83-85% isodose line, and the remaining 575 (13.88%) other patients receiving a median dose of 4500cGY (4500-5400) to the pelvis in conventional fractionation followed by a 3 fraction SBRT boost of 2100 cGY (1950-2100) over 3 consecutive fractions. Androgen deprivation Therapy (ADT) was prescribed in 1,035 (24.98%) of these cases. The mean age was 67.4 years old. 48 patients were younger than 50 years old (mean age 46.6). 4,095 patients were 50 or older. Patients were divided into prognostic D'Amico risk groups with 43.75%, 50.00%, 6.25% of patients falling in the low, intermediate, and high-risk stratifications in the younger cohort and 23.88%, 57.05%, 19.07% in the older cohort respectively. Pretreatment PSA was 1.72 - 43.2 (median: 5.4) in the younger group and 0.3 - 661 (median: 6.5) in the older group. In the younger group, Gleason scores were 6 in 47.92%, 7 in 47.92%, and 8-10 in 4.16%. 44 younger patients were treated with SBRT alone. 4 patients also received supplemental external beam radiation (median dose 4500cGY) and 5 patients (10.42%) received Androgen Deprivation Therapy (ADT) as part of their treatment regimen. In the older group, Gleason scores were 6 in 29.84%, 7 in 54.14%, and 8-10 in 16.02%. 3522 were treated with SBRT alone. 573 patients also received supplemental external beam radiation (median dose 4500cGY) and 1030 patients (25.15%) received Androgen Deprivation Therapy (ADT) as part of their treatment.

RESULTS

At 75 months the 6-year biochemical relapse free survival was 95.83% in younger patients compared to 98.41% in older patients using the Phoenix definition of biochemical failure. The 6-year median post treatment PSA was 0.3 in younger patients and 0.2 in the older patients. There were no significant differences in the risk stratification between the 2 groups.

CONCLUSION

This represents the largest series evaluating outcomes in very young patients treated with definitive SBRT for prostate cancer. With updated 6-year follow up, SBRT remains an effective treatment for this younger subset of patients. Continued follow up will be required to see if these results remain durable.

Dual-Band Infrared Scheimpflug Lidar Reveals Insect Activity in a Tropical Cloud Forest

We describe an entomological dual-band 808 and 980 nm lidar system which has been implemented in a tropical cloud forest (Ecuador). The system was successfully tested at a sample rate of 5 kHz in a cloud forest during challenging foggy conditions (extinction coefficients up to 20 km^-1). At times, the backscattered signal could be retrieved from a distance of 2.929 km. We present insect and bat observations up to 200 m during a single night with an emphasis on fog aspects, potentials, and benefits of such dual-band systems. We demonstrate that the modulation contrast between insects and fog is high in the frequency domain compared to intensity in the time domain, thus allowing for better identification and quantification in misty forests. Oscillatory lidar extinction effects are shown in this work for the first time, caused by the combination of dense fog and large moths partially obstructing the beam. We demonstrate here an interesting case of a moth where left- and right-wing movements induced oscillations in both intensity and pixel spread. In addition, we were able to identify the dorsal and ventral sides of the wings by estimating the corresponding melanization with the dual-band lidar. We demonstrate that the wing beat trajectories in the dual-band parameter space are complementary rather than covarying or redundant, thus a dual-band entomological lidar approach to biodiversity studies is feasible in situ and endows species specificity differentiation. Future improvements are discussed. The introduction of these methodologies opens the door to a wealth of possible experiments to monitor, understand, and safeguard the biological resources of one of the most biodiverse countries on Earth.

Development of solid dispersions based on 3- (2,6-difluorobenzyl) -5- (5-bromo-1H-indol-3-ylmethylene) thiazolidine-2,4-dione for schistosomicidal treatment

Schistosomiasis is an endemic disease in Brazil. It is important to broaden the treatment options to control and containment of the disease. Thiazolidine derivatives appear as important alternatives to treatment. In vitro studies have demonstrated excellent schistosomiasis activity for LPSF/GQ-238. The molecule, however, has poorly water-soluble. This study focused on increasing the aqueous solubility of LPSF/GQ-238 by obtaining solid dispersions. Were prepared by the solvent techniques, using Soluplus®, Polyethylene glycol (PEG), and Polyvinylpyrrolidone (PVP-K30) as carriers. Solubility tests, Scanning Electron Microscopy (SEM), X-ray Diffraction (XRD), Exploratory Differential Calorimetry (DSC), and Raman Spectroscopy characterized these new intermediate products. The solubility tests showed that the higher the proportion of polymer used in the preparation of the dispersion, the greater the solubility presented. The observation of the morphology by SEM analysis, elucidated, that the new chemical entity (NCE) has a characteristic crystalline structure. The folding of this structure by the polymer was observed in all analyzed dispersions, thus demonstrating the amorphous state of the product. The scales observed in the structures of the dispersions demonstrate the successive wrinkles that occurred. The greater the proportion of the polymer, the greater the number of folds that occurred, which may explain the greater solubility observed in these preparations. The X-ray diffraction profile of the NCE reveals the presence of intense peaks, presenting a crystalline pattern. The polymer, on the other hand, shows amorphous nature, evidenced by the absence of peaks. All the analyzed dispersions did not present the characteristic peaks of the NCE, evidencing the amorphous behavior of the products. The thermal degradation profile of the NCE presents a characteristic crystalline structure endothermic peak. This peak was not observed in any of the obtained dispersions, evidencing the obtaining of a new solid state. Raman spectroscopy showed that peaks in the range 200-400 (cm-1) by NCE were lost when compared to all analyzed dispersions, showing a slight change in the structure of the molecule when dispersed, probably due to the formation of hydrogen bonds with the polymer. The in vitro study showed a significant improvement in the activity of the NCE against the adult worm and to the schistosomulae. It was possible to observe that the obtained solid dispersions were physicochemically and biologically viable for schistosomicidal treatment due to the increase of solubility of the molecule.

Predictors of immune-related adverse events and outcomes in patients with NSCLC treated with immune-checkpoint inhibitors

OBJECTIVE

To identify predictors of immune-related adverse events (IRAEs) in patients with non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs). Assess associations between outcomes and the development of IRAEs.

METHODS

Retrospective analysis of patients with NSCLC treated with ICIs between 2016 and 2020 in the Pulmonology Department of our hospital. Patients with and without IRAEs were compared. A logistic regression analysis was performed to determine predictors of IRAEs. Progression-free survival (PFS) and overall survival (OS) curves were calculated using the Kaplan-Meier method, and the long-rank test was used to assess survival differences between groups. Univariate and multivariate Cox proportional-hazards regression models were used to identify factors associated with PFS and OS. The value considered statistically significant was p≤0.05.

RESULTS

A total of 184 patients (77.7% men, mean age 66.9±9.5 years) treated with ICIs were analyzed. During follow-up, 49 (26.6%) patients developed IRAEs and 149 (81.0%) died. According to the multivariate logistic regression analysis, treatment with statins (OR:3.15; p = 0.007), previous systemic corticosteroid therapy (OR:3.99; p = 0.001), disease controlled as response to ICI (OR:5.93; p < 0.001) and higher hemoglobin values (OR:1.28; p = 0.040) were independent predictors for the development of IRAEs. Patients who developed IRAEs had significantly longer medians of PFS (41.0 vs 9.0 weeks, p < 0.001) and OS (89.0 vs 28.0 weeks; p < 0.001).

CONCLUSIONS

Patients treated with statins, pre-ICI systemic corticosteroids, higher baseline hemoglobin value and controlled disease as initial response to ICI had a higher risk of developing IRAEs. The development of IRAEs was associated with better outcomes.

Training responsiveness of cardiorespiratory fitness and arterial stiffness following moderate-intensity continuous training and high-intensity interval training in adults with intellectual and developmental disabilities

BACKGROUND

Cardiorespiratory fitness (CRF) prompts antiatherogenic adaptations in vascular function and structure. However, there is an extraordinary interindividual variability in response to a standard dose of exercise, wherein a substantial number of adults with intellectual and developmental disabilities (IDD) do not improve CRF. We (1) evaluated the effects of 12-month of moderate-intensity continuous training (MICT) on CRF and arterial stiffness and (2) tested whether an additional 3-month of high-intensity interval training (HIIT) would add to improvements in CRF responsiveness and arterial stiffness.

METHODS

Fifteen adults with mild-to-moderate IDD (male adults = 9, 30.1 ± 7.5 years old) met 3 days per week for 30 min MICT for 12 months, after which the incidence of CRF responsiveness was calculated (≥5.0% change in absolute peak VO₂ ). Thereafter, responders and non-responders started HIIT for 3 months with identical daily training load/frequency. Peak VO₂ , local and regional indices of arterial stiffness were assessed prior to and after each period.

RESULTS

Sixty per cent of the participants were non-responders following MICT, but the incidence dropped to 20% following HIIT (P = 0.03). Absolute peak VO₂ values reached significant difference from pre-intervention (+0.38 ± 0.08 L min^-1 , P = 0.001) only when HIIT was added. Lower limb pulse wave velocity (PWV) decreased following MICT (-0.8 ± 1.1 m s^-1 , P = 0.049), whereas central PWV only decreased following HIIT (-0.8 ± 0.9 m s^-1 , P = 0.013).

CONCLUSIONS

Cardiorespiratory fitness responsiveness and reductions in PWV to a 12-month MICT period in adults with IDD improved following a period of HIIT programme inducing higher metabolic stress.

A New Prognostic Model in Patients with Advanced Urothelial Carcinoma Treated with First-line Immune Checkpoint Inhibitors

BACKGROUND

While immune checkpoint inhibitors (ICIs) are approved in the first-line (1L) setting for cisplatin-unfit patients with programmed death-ligand 1 (PD-L1)-high tumors or for platinum (cisplatin/carboplatin)-unfit patients, response rates remain modest and outcomes vary with no clinically useful biomarkers (except for PD-L1).

OBJECTIVE

We aimed to develop a prognostic model for overall survival (OS) in patients receiving 1L ICIs for advanced urothelial cancer (aUC) in a multicenter cohort study.

DESIGN, SETTING, AND PARTICIPANTS

Patients treated with 1L ICIs for aUC across 24 institutions and five countries (in the USA and Europe) outside clinical trials were included in this study.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

We used a stepwise, hypothesis-driven approach using clinician-selected covariates to develop a new risk score for patients receiving ICIs in the 1L setting. Demographics, clinicopathologic data, treatment patterns, and OS were collected uniformly. Univariate Cox regression was performed on 18 covariates hypothesized to be associated with OS based on published data. Variables were retained for multivariate analysis (MVA) if they correlated with OS (p < 0.2) and were included in the final model if p < 0.05 on MVA. Retained covariates were assigned points based on the beta coefficient to create a risk score. Stratified median OS and C-statistic were calculated.

RESULTS AND LIMITATIONS

Among 984 patients, 357 with a mean age of 71 yr were included in the analysis, 27% were female, 68% had pure UC, and 13% had upper tract UC. Eastern Cooperative Oncology Group performance status ≥2, albumin <3.5 g/dl, neutrophil:lymphocyte ratio >5, and liver metastases were significant prognostic factors on MVA and were included in the risk score. C index for new 1L risk score was 0.68 (95% confidence interval 0.65-0.71). Limitations include retrospective nature and lack of external validation.

CONCLUSIONS

We developed a new 1L ICI risk score for OS based on data from patients with aUC treated with ICIs in the USA and Europe outside of clinical trials. The score components highlight readily available factors related to tumor biology and treatment response. External validation is being pursued.

PATIENT SUMMARY

With multiple new treatments under development and approved for advanced urothelial carcinoma, it can be difficult to identify the best treatment sequence for each patient. The risk score may help inform treatment discussions and estimate outcomes in patients treated with first-line immune checkpoint inhibitors, while it can also impact clinical trial design and endpoints. TAKE  HOME MESSAGE: A new risk score was developed for advanced urothelial carcinoma treated with first-line immune checkpoint inhibitors. The score assigned Eastern Cooperative Oncology Group performance status ≥2, albumin <3.5 g/dl, neutrophil:lymphocyte ratio >5, and liver metastases each one point, with a higher score being associated with worse overall survival.

Suicidal ideation during the first wave of COVID-19 pandemic in a child and adolescent psychiatry emergency care sample

Introduction

The COVID-19 pandemic forced many countries to apply restrictive measures. During the first wave Portugal went through a lockdown, and all the child and adolescents had to stay home and could only contact with the one’s they lived with for several months.

Objectives

This study aimed to evaluate the impact of those restrictions on suicidal ideation in the pediatric population evaluated in a child and adolescent psychiatry emergency care of a tertiary referral hospital.

Methods

We conducted an exploratory retrospective study. All the data from discharge notes were collected between March 15^th and June 15^th of 2020 (n=59), and in the homologous period of the previous year (n=178). The referral after evaluation (primary care, child and adolescent psychiatry consultation, inpatient unit) was considered a measure of severity.

Results

The demographic variables (sex, age) were homogeneous between the two groups (p ≥ 0,05). 17,4% (n=31) of the sample from 2019, and 16,9% (n=10) of the sample of 2020 had suicidal ideation, which was not statistically different between groups (p=1,000). The referral, after evaluation between groups were also not statistically different (p=0,186).

Conclusions

Even though the proportion of patients with suicidal ideation was homogenous during the two periods, the total number of patients evaluated in the emergency room were lower during the first wave of Covid-19 pandemic. We assume that the population had fear of seeking help in hospital facilities, but we also believe that the pause on school burdens and the reconnection between some families could have function as protective factors.

Disclosure

No significant relationships.

Not guilty by reason of insanity and dangerousness: A demographic, clinical and forensics description of the patients in the forensic inpatinent service of Coimbra

Introduction

Despite being essential for the service quality improvement, empirical research on the characteristics of people hospitalized in forensic psychiatry units and the psychopharmacological treatment instituted in this care context is scarce in Portugal.

Objectives

To describe the sociodemographic, clinical and criminological characteristics of the patients admitted to a forensic psychiatric unit in Portugal, as well as, the psychiatric drugs prescription pattern in this care context.

Methods

A retrospective observational study was carried out, through the data analysis of patients admitted to the Sobral Cid Forensic Psychiatry unit of the Coimbra Hospital and University over the past 12 years.

Results

The sample had 194 inpatients, 153(78.9%) male and 41(21.1%) females. The mean age was 43.3 years and 74.7% had no professional, school or occupational activity. The most frequent psychiatric diagnoses were psychotic disorders (56.7%) and neurodevelopmental disorders(33.5%). 24.2% had at least two psychiatric diagnoses and 38.7% had concomitant medical conditions. 77.8% had history of psychiatric hospitalizations and 21.6% had history of self-injurious behaviors. 37.1% of the sample had a criminal record. Crimes against people were the most frequent. The use of injectable antipsychotic formulations was frequent and 18.6% of the patients were medicated with Clozapine. The prescribed daily doses were above the defined daily dose. Psychotic disorders and addictive disorders were less frequent in women. Statistically significant differences were found in the frequency of homicide between females(41.5%) and males(22.2%).

Conclusions

Tailored solutions are crucial to accomplish the purpose of security measures, mostly by addressing the identified needs and rethinking the approach on this specific context.

Disclosure

No significant relationships.

Keyword

Forensic Psychiatry Units

Late diagnosis of idiopathic esophageal achalasia in patient with recurrent pneumonias

Esophageal achalasia is the most prevalent esophageal motility disease; however, it is rare in pediatrics. The principal cause is secondary to the loss of function in inhibitory neurons of myenteric plexus, due inflammatory process of unknown origin. The most prevalent symptoms in children are vomit, loss of weight and aspiration pneumonia; those are more commonly related to gastroesophageal reflux disease (GERD), making it more difficult the diagnosis of achalasia. Complementary exams are crucial to diagnoses, such as upper digestive endoscopy, radiography (barium swallow) and esophageal manometry. The treatment aims to relieve the symptoms and improve the esophageal emptying. Three years old female child, presenting persistent vomit, pulmonary auscultation reduced at right lung and condensation in the right pulmonary base suggestive of pneumonia, regarding an antecedent of five episodes of pneumonia. The symptoms started at nine months old, and the initial treatment was for GERD, without improvement. The propaedeutic confirmed the diagnoses of achalasia, though etiology was not conclusive. The chosen treatment was pneumatic dilatation with an additional surgical injection of botulinum toxin at the lower esophageal sphincter. The patient received hospital discharge to outpatient follow-up.

Process modelling of organized screening programs – breast cancer

Breast cancer is the most frequent cancer among women and one of the principal causes of cancer related death in women worldwide, being a public health problem. Oncology screenings allow its early detection and reduce its mortality. Business process management (BPM) is a management field that leads an organization into continuously improvement with increase of efficiency. The processes of the healthcare system are complex what makes the application of BPM techniques harder, however their usage has been increasing in this sector.

The main objective of this study is the identification and modelling of BPM processes for the Portuguese breast cancer screening.

The current processes and the entities (actors, systems and documents) involved in the Breast Cancer Organized Screening performed by the Portuguese League Against Cancer were identified through interviews to the employees. With the information retrieved and using Bizagi the related As-Is diagrams were developed.

In this work 5 processes within the Breast Cancer Organized Screening were identified: Process “Patients' invitation”; Process “Screening”; Process “Reading of the exam”; Process “Check-up Consultation” and Process “Sending Results”. Through the analysis of the As-Is diagrams and of the available information, a critical analysis was made. As for example, in the process “Patients' invitation” an invitation letter is sent 15 days earlier to the patient but no telephone contact is done before the screening. An improvement could be sending a message in the day before the screening, remembering the appointment, avoiding forgetfulness absences.

With this work the mainly processes of the breast cancer organized screening were modelled as “As-Is” diagrams and, in a macroscopic way, some of the problems were identified and improvement suggestions were made in order to achieve the main objective of the process, the early detection of breast cancer, while optimizing the process.

Key messages

This work represents an important contribution to the Breast Cancer Organized Screening since, through the use of BPM, a set of actions is proposed with an impact on its effectiveness and efficiency. This work represents an example of what the BPM techniques can do to help in the optimization of all the processes of the healthcare sector, from screening to diagnosis and treatment.

Small for gestational age very preterm infants present a higher risk of developing bronchopulmonary dysplasia

INTRODUCTION

Several studies assessed the influence of a low birth weight on bronchopulmonary dysplasia (BPD), but not all could find a significant association. Our aim was to assess the association between low birth weight and BPD in preterm infants, prospectively recruited at 11 level III Portuguese neonatal centers.

METHODS

Obstetrical and neonatal data on mothers and preterm infants with gestational ages between 24 and 30 weeks, born during 2015 and 2016 after a surveilled pregnancy, were analyzed. Neonates were considered small for gestational age (SGA) when their birthweight was below the 10th centile of Fenton's growth chats and BPD was defined as the dependency for oxygen therapy until 36 weeks of corrected age. Statistical analysis was performed using IBM SPSS® statistics 23 and a p-value <0.05 was considered statistically significant.

RESULTS

Out of 614, a total of 494 preterm infants delivered from 410 women were enrolled in the study; 40 (8.0%) infants with SGA criteria. SGA were more often associated with a single pregnancy, had greater use of antenatal corticosteroids, increased prevalence of gestational hypertensive disorders, C-section, rupture of membranes below 18 hours, rate of intubation in the delivery room, use of surfactant treatment, oxygen therapy, mechanical ventilation need, BPD, cystic periventricular leukomalacia, nosocomial sepsis and pneumonia; had lower prevalence of chorioamnionitis, and lower Apgar scores. The multivariate analysis by logistic regression, adjusted for BPD risk factors revealed a significant association between SGA and BPD: OR = 5.2 [CI: 1.46-18.58]; p = 0.01.

CONCLUSION

The results of this study increase the scientific evidence that SGA is an independent risk factor for BPD.

Impact of performance status on treatment outcomes: A real-world study of advanced urothelial cancer treated with immune checkpoint inhibitors

BACKGROUND

Immune checkpoint inhibitors (ICIs) represent an appealing treatment for patients with advanced urothelial cancer (aUC) and a poor performance status (PS). However, the benefit of ICIs for patients with a poor PS remains unknown. It was hypothesized that a poor Eastern Cooperative Oncology Group (ECOG) PS (≥2 vs 0-1) would correlate with shorter overall survival (OS) in patients receiving ICIs.

METHODS

In this retrospective cohort study, clinicopathologic, treatment, and outcome data were collected for patients with aUC who were treated with ICIs at 18 institutions (2013-2019). The overall response rate (ORR) and OS were compared for patients with an ECOG PS of 0 to 1 and patients with an ECOG PS ≥ 2 at ICI initiation. The association between a new ICI in the last 30 and 90 days of life (DOL) and death location was also tested.

RESULTS

Of the 519 patients treated with ICIs, 395 and 384 were included in OS and ORR analyses, respectively, with 26% and 24% having a PS ≥ 2. OS was higher in those with a PS of 0 to 1 than those with a PS ≥ 2 who were treated in the first line (median, 15.2 vs 7.2 months; hazard ratio [HR], 0.62; P = .01) but not in subsequent lines (median, 9.8 vs 8.2 months; HR, 0.78; P = .27). ORRs were similar for patients with a PS of 0 to 1 and patients with a PS ≥ 2 in both lines. Of the 288 patients who died, 10% and 32% started ICIs in the last 30 and 90 DOL, respectively. ICI initiation in the last 30 DOL was associated with increased odds of death in a hospital (odds ratio, 2.89; P = .04).

CONCLUSIONS

Despite comparable ORRs, ICIs may not overcome the negative prognostic role of a poor PS, particularly in the first-line setting, and the initiation of ICIs in the last 30 DOL was associated with hospital death location.

Mitochondria, endoplasmic reticulum and innate immune dysfunction in mood disorders: Do Mitochondria-Associated Membranes (MAMs) play a role?

Mood disorders like major depression and bipolar disorder (BD) are among the most prevalent forms of mental illness. Current knowledge of the neurobiology and pathophysiology of these disorders is still modest and clear biological markers are still missing. Thus, a better understanding of the underlying pathophysiological mechanisms to identify potential therapeutic targets is a prerequisite for the design of new drugs as well as to develop biomarkers that help in a more accurate and earlier diagnosis. Multiple pieces of evidence including genetic and neuro-imaging studies suggest that mood disorders are associated with abnormalities in endoplasmic-reticulum (ER)-related stress responses, mitochondrial function and calcium signalling. Furthermore, deregulation of the innate immune response has been described in patients diagnosed with mood disorders, including depression and BD. These disease-related events are associated with functions localized to a subdomain of the ER, known as Mitochondria-Associated Membranes (MAMs), which are lipid rafts-like domains that connect mitochondria and ER, both physically and biochemically. This review will outline the current understanding of the role of mitochondria and ER dysfunction under pathological brain conditions, particularly in major depressive disorder (MDD) and BD, that support the hypothesis that MAMs can act in these mood disorders as the link connecting ER-related stress response and mitochondrial impairment, as well as a mechanisms behind sterile inflammation arising from deregulation of innate immune responses. The role of MAMs in the pathophysiology of these pathologies and its potential relevance as a potential therapeutic target will be discussed.

Intravaginal administration of gelatine capsules containing freeze-dried autochthonous lactobacilli: a double-blind, randomised clinical trial of safety

Vaginal lactobacilli (LAB) in probiotic formulas constitute a promising alternative for microbiome reconstitution and for the prevention and treatment of urogenital infections. A double-blind, randomised clinical trial was conducted to assess the safety of LAB-gelatine capsules vaginally administered to healthy sexually active women. Participants were randomised into three groups: intervention A: Lactobacillus reuteri CRL1324, Lactobacillus gasseri CRL1263 and CRL1307; intervention B: Lactobacillus rhamnosus CRL1332, L. gasseri CRL1256 and CRL1320; and intervention C: placebo. In a survey and clinical evaluation, participants received a blister with 7 capsules to be administered 1 per day. A second sampling and a new survey were conducted 3-10 days after completing application. Colposcopy was performed to assess adverse effects on vaginal-cervical mucosa. Vaginal swabs were taken for Gram staining to determine the Nugent score, and obtainment of viable-cell cultures to quantify cultivable lactic acid bacteria and pathogens. The main outcomes evaluated were overall satisfaction and secondary effects, including discomfort, urogenital infection, inflammatory response or other symptoms. No significant differences were found in Nugent score or in leukocyte numbers in vaginal samples either before or after the three interventions. However, a tendency to decrease in both the Nugent score and in leukocyte numbers was observed after interventions A and B, though not after C. A significant increase in cultivable lactobacilli was determined after LAB interventions. No severe adverse events were detected. LAB-containing capsules were well tolerated by subjects, so they could be proposed as an adequate alternative to restore vaginal lactobacilli in sexually active women.

Riddling: Chimera's dilemma

We investigate the basin of attraction properties and its boundaries for chimera states in a circulant network of Hénon maps. It is known that coexisting basins of attraction lead to a hysteretic behaviour in the diagrams of the density of states as a function of a varying parameter. Chimera states, for which coherent and incoherent domains occur simultaneously, emerge as a consequence of the coexistence of basin of attractions for each state. Consequently, the distribution of chimera states can remain invariant by a parameter change, and it can also suffer subtle changes when one of the basins ceases to exist. A similar phenomenon is observed when perturbations are applied in the initial conditions. By means of the uncertainty exponent, we characterise the basin boundaries between the coherent and chimera states, and between the incoherent and chimera states. This way, we show that the density of chimera states can be not only moderately sensitive but also highly sensitive to initial conditions. This chimera's dilemma is a consequence of the fractal and riddled nature of the basin boundaries.

Allergic rhinitis severity can be assessed using a visual analogue scale in mild, moderate and severe

BACKGROUND

Allergic rhinitis is a global healthcare problem due to its high prevalence, impact on individuals and socioeconomic burden for the nations. Allergic rhinitis severity evaluation is the key to a correct treatment, prevention of comorbidities and improving the quality of life of patients. This evaluation should be made with a simple, easy, fast but accurate and reliable methodology, both in a primary care and specialist setting. The visual analogue scale (VAS) meets all requirements to be the ideal tool to assess allergic rhinitis severity and has already been validated by using a single cut-off point, but this classification in two degrees of severity suffer from not allocating the patients uniformly and from giving a blind interval to classify the patients when the score is between 5 to 6 cm.

METHODOLOGY

The main objective of our study is to describe the optimal cut-off points by using a VAS to discriminate between three degrees of allergic rhinitis severity (mild, moderate, and severe) following the ARIA modified severity criteria that has been previously validated. Sensitivity, specificity, positive and negative predictive values just like receiver operating characteristic curves were used to select the best cut-off values.

RESULTS

In a cross-sectional multicentre study with 3,572 patients included we have found that VAS has a significant correlation with nasal symptom score and quality of life and that the best cut-off points to differentiate between mild, moderate an severe allergic rhinitis are a VAS score of 4 and 7, respectively.

CONCLUSIONS

Allergic rhinitis severity could be assessed in three degrees by using VAS in a simple, easy, and accurate method.

Relationship Between Self-reported and Clinician-rated Psychopathology in Youth Psychiatric Outpatients

Introduction

Psychopathology rating scales have been widely used. Studies evaluating the congruence between self and observer-reported ratings show inconsistent results.

Objectives or aims

Determine whether there was consistency between psychopathology as assessed by patients and clinicians’ assessment in outpatients observed in the Young Adult Unit of our Psychiatry Department (Coimbra Hospital and University Centre-Portugal).

Methods

Socio-demographic characterization was undertaken with young adult outpatients observed during nineteen months (1st January 2015–31st July 2016). Brief Symptom Inventory–53 items (BSI-53) and Brief Psychiatric Rating Scale (BPRS) were applied at the first clinical evaluation. Spearman correlation coefficient between General Severity Index (GSI) of BSI-53 and BPRS total score was calculated.

Results

During the mentioned interval 255 outpatients were observed: 64.3% females and 35.7% males; aged between 17 and 39 years old (average: 20.56; median: 20). Fifty percent were diagnosed with neurotic, stress-related and somatoform disorders (ICD-10 F40-48) and 14.1% with mood disorders (ICD-10 F30-39). BPRS and BSI-53 rating scales were administered to 55 patients: 72.5% females and 27.5% males; average age 21.2. A statistical significant correlation was found between BPRS total and GSI score.

Conclusions

Several factors can determine the accuracy of psychopathology self-assessment, including diagnosis and severity of illness. In fact, studies show strong correlation between self and observer assessment of depressive and anxious psychopathology, but no correlation in psychotic psychopathological dimensions. Therefore, the correlation found in this population can be explained by the fact that the majority of patients were diagnosed with neurotic, stress-related and somatoform and mood disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Socio-demographic and clinic characterization in youth psychiatric outpatients: An observational study

Introduction

Most mental disorders begin during adolescence and early adulthood (18–24-years-old), highlighting the importance of understanding the onset and progression of mental disorders among youths. Although progress has been made, namely by creating youth mental health transition services, gaps continue to exist. Locally, our recently constituted young adults unit aimed to minimize discontinuities in care.

Objectives/aims

To characterize a population of young adult psychiatric outpatients, regarding socio-demographic and clinic variables.

Methods

Socio-demographic and clinic characterization of young adult psychiatric outpatients observed during 1st January 2015–30th July 2016.

Results

Two hundred and fifty-five outpatients were observed: 64.3% females and 35.7% males, average age 20.56-years-old (median 20). Most lived in urban areas (59.4%), with their parents (27.8%), were students (80.4%), attending secondary school (36.1%). A total of, 27.5% were referenced by an emergency department, and adjustment disorders (ICD-10 F43.2) were the most frequent diagnosis (21.6%). Regarding suicidal behaviours and self-harm, 9.8% did self-cutting. A vast majority did not have previous psychiatric hospitalizations–only 5.9% outpatients had at least one. In total, 39.8% were medicated with antidepressants (1/3 of which in association with other drugs), and about 38.8% received cognitive-behavioural interventions. About 2/3 of patients (66.3%) remained in care and only about 1/6 (15.7%) were discharged.

Conclusions

Our typical youth psychiatric outpatient was of female gender, student, living with its parents. Adjustment disorders were the most frequent diagnosis, and antidepressants were the main psychopharmacologic option, often combined with other psychotropic drugs. In the future, psychotherapy interventions should be more widely available, namely group psychotherapy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Patients with schizophrenia assessing psychiatrists’ communication skills

The doctor-patient relationship constitutes the matrix of the entire medical practice. One way in which doctors develop a positive rapport with their patients is through appropriate communication. Evidence suggests that doctors do not communicate with their patients as they should. Important gaps are observed in doctors’ communication with patients with schizophrenia.

Aim

Examine psychiatrists’ communication skills as assessed by their patients with schizophrenia and through external observation, considering patients’ socio-demographic and clinical variables and analyse the importance that aspects of communication have for patients.

Methodology

This cross-sectional study involved a sample of 30 patients and 11 doctors. An adapted and culturally validated version of the Communication Assessment Tool was used for data collection. Data were analysed in IBM SPSS Statistics®, version 24.

Results

Male patients constituted 86.7% of the sample and mean age was 46.7 ± 13.3. The overall mean percentage of items rated as excellent by patients was 57.4%. On the other hand, external observer percentage of excellent scores was much lower when compared with patients’ scores. Single, divorced or widower/widow patients, patients with higher educational level and patients with shorter number of years in medical treatment gave significantly higher scores to psychiatrists’ communication. Patients’ sex, age, occupation residence and family type did not yield statistically significant effects on patients’ ratings.

Conclusions

Communication is at the heart of psychiatrists’ daily practice. Many communication styles might be needed, depending on the nature of clinical encounters and patient expectations. Specific training is required to optimise psychiatrists’ communication skills on everyday practice.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Gender Difference Among Admitted Patients with Bipolar Disorder in a Psychiatric Service During a Three-year Period

Introduction

Gender differences in bipolar disorder are becoming apparent, but have been less studied compared with major depression. The presentation, clinical features, course and evolution of bipolar disorder differ between men and women. Research data on these differences will help determine whether gender is important in influencing illness variables.

Objectives

Determine whether men and women with bipolar disorder have statistical significant differences in socio-demographic and clinical data.

Methods

Charts of all patients with a diagnosis of bipolar disorder admitted in the Coimbra Hospital and Universitary Center over a three-year period (between 2013 and 2015) were reviewed to gather data on socio-demographic, clinical and psychopathological variables to assess differences across genders. Statistical analysis of data with “SPSS21”.

Results

During a three-year period, 189 patients were admitted with bipolar disorder, the majority were female patients, with ages between 21 and 84 years old. The authors will analyse if there is any statistical significant difference between gender in the rate of bipolar I or II diagnoses, age at onset, symptom presentation, delay in diagnoses, number of depressive, or manic episodes, hospitalisations, involuntarily admissions, number of suicide attempts, co-morbidity rates, negative life events, family history and treatment options. Sociodemograpic characteristics will also be analysed.

Conclusion

Gender differences in bipolar disorder is a controversial issue in the literature. The importance of gender on the course and outcome in bipolar disorder has been widely acknowledged. The limited data suggest that the prevalence is similar between sexes but that the course of illness may be different.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Substance use among youth psychiatric outpatients

Introduction

Portuguese young adults (15–34 years old) were more frequent engaged in substance abuse (1.2%) than the general population, according to the Portuguese substance use annual report (2014). Alcohol was the most frequent substance use on youth adults. Cannabis was the most frequent illicit substance used (23.9% of users were considered dependent), with higher prevalence than previously reported. LSD (0.4%) use was also higher among young adults than in previous studies. Cocaine (0.4%), heroine/opiates (0.4%), ecstasy (0.3%), and hallucinogenic mushrooms (1.1%) had their consumption lowered among young adults.

Objectives/aims

To characterize a population of young adult psychiatric outpatients, regarding substance use and associated risk.

Methods

Socio-demographic characterization of our young adult unit outpatient users between 1st January 2015–31st July 2016. Substance use was assessed with the Portuguese version of Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).

Results

A total of 255 outpatients were observed during the timeframe; 58 outpatients were assessed with ASSIST: 44 females (75.9%) and 14 males (24.1%), aged between 16–33 years old (average: 20.95; median: 19.50). For tobacco, 3.5% had high risk, 37.9% moderate risk and 58.6% low risk; 22.4% had moderate risk of alcohol, 13.8% moderate risk of cannabis, and 20.7% moderate risk of tranquilizers. For others substances (cocaine, stimulants, inhalants, hallucinogens, and opiates) the risk was low.

Conclusions

In our sample, alcohol and cannabis use had the highest risk, as reported in the National Annual Report; however, we observed a moderate risk for tranquilizers use. In future care planning, youth mental health should address tobacco and alcohol abstinence, and preventive measures regarding anxiolytics should be undertaken, such as banning sale without medical prescription.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Cystic fibrosis - Comparison between patients in paediatric and adult age

Cystic fibrosis (CF) is the most common autosomal recessive disease in Caucasians. Although most cases are diagnosed in childhood, diagnosis in adults is apparently increasing.

OBJECTIVE

Evaluate the adult population with CF, comparing patients who were diagnosed before and after 18 years of age.

METHODS

Retrospective analysis of patients followed in three main medical centres in Portugal in 2012. Comparison of two groups: G1 - patients diagnosed at <18 years and G2 - patients diagnosed at ≥18 years.

RESULTS

89 adults were identified: 61.8% in G1, 38.2% in G2. Gender distribution was similar in both groups. Average age in G2 was higher (38.3±8.4 vs. 26.8±6.1 years, p<0.001). Respiratory symptoms most frequently led to CF diagnosis in all patients, mainly in adulthood. There was a greater percentage of patients homozygous for the mutation delF508 in G1 (43.6 vs. 8.8%, p=0.02). Respiratory and pancreatic function, and body mass index (BMI) showed a higher severity in G1 (G1 vs. G2: FEV1: 54.6±27.3 vs. 29.9±64.6%, p=0.177; pancreatic insufficiency 72.7 vs. 26.5%, p<0.001; BMI 20.2±3.4 vs. 22.2±4.8, p=0.018). Pseudomonas aeruginosa and methicillin-sensitive Staphylococcus aureus were the most frequently isolated microorganisms. Lung transplantation rate was higher in G2 (20.6 vs. 10.9%, p=0.231) while mortality rate was higher in G1 (0 vs. 3.6%, p=0.261). Hospital admission rate was higher in G1 as well as mortality rate.

CONCLUSION

The results suggest that patients with CF diagnosed in childhood have characteristics that distinguish them from those diagnosed in adulthood, and these differences may have implications for diagnosis, prognosis and life expectancy.

The Physiological and Molecular Characterization of a Small Colony Variant of Escherichia coli and Its Phenotypic Rescue

Small colony variants (SCVs) can be defined as a naturally occurring sub-population of bacteria characterized by their reduced colony size and distinct biochemical properties. SCVs of Staphylococcus aureus have been studied extensively over the past two decades due to their role in recurrent human infections. However, little work has been done on SCVs of Escherichia coli, and this work has focused on the physiology and morphology that define these colonies of E. coli, such as small size and slow growth. E. coli strain JW0623, has a null lipA mutation in the lipoic acid synthase gene (lipA), and is a lipoic acid auxotroph. When the mutant was grown in LB medium to log phase, it showed remarkable resistance to acid (pH 3), hydrogen peroxide, heat and osmotic stress compared to its parent BW25113. Using RT-PCR and real time RT-PCR, the expression of certain genes was compared in the two strains in an attempt to create a molecular profile of Escherichia coli SCVs. These include genes involved in glycolysis, TCA cycle, electron transport, iron acquisition, biofilm formation and cyclopropane fatty acid synthesis. It was also demonstrated that the addition of 5 μg/ml of lipoic acid to LB medium allows for the phenotypic rescue of the mutant; reversing its slow growth, its resistance characteristics, and elevated gene expression. These results indicate that the mutation in lipA leads to an E. coli SCV that resembles an electron transport defective SCV of S. aureus These strains are typically auxotrophs, and are phenotypically rescued by adding the missing metabolite to rich medium. There are global shifts in gene expression which are reversible and depend on whether the auxotrophic molecule is absent or present. Looking at the E. coli SCV from an evolutionary point of view, it becomes evident that its path to survival is to express genes that confer stress resistance.

Control of attention in bipolar disorder: Effects of perceptual load in processing task-irrelevant facial expressions

Bipolar disorder (BD), along with schizophrenia, is one of the most severe psychiatric conditions and is correlated with attentional deficits and emotion dysregulation. Bipolar patients appear to be highly sensitive to the presence of emotional distractors. Yet, no study has investigated whether perceptual load modulates the interference of emotionally distracting information. Our main goal was to test whether bipolar patients are more sensitive to task-irrelevant emotional stimulus, even when the task demands a high amount of attentional resources.

Fourteen participants with BD I or BD II and 14 controls, age- and gender-matched, performed a target-letter discrimination task with emotional task-irrelevant stimulus (angry, happy and neutral facial expressions). Target-letters were presented among five distractor-letters, which could be the same (low perceptual load) or different (high perceptual load). Participants should discriminate the target-letter and ignore the facial expression. Response time and accuracy rate were analyzed.

Results

showed a greater interference of facial stimuli at high load than low load, confirming the effectiveness of perceptual load manipulation. More importantly, patients tarried significantly longer at high load. This is consistent with deficits in control of attention, showing that bipolar patients are more prone to distraction by task-irrelevant stimulus only when the task is more demanding. Moreover, for bipolar patients neutral and angry faces resulted in a higher interference with the task (longer response time), compared to controls, suggesting an attentional bias for neutral and threating social cues. Nevertheless, a more detailed investigation regarding the attentional impairments in social context in BD is needed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

PTSD And Quality of Life Among Firefighters and Municipal Police Forces

Research has shown that PTSD is prevalent among firefighters and police forces and that Quality of Life (QoL) is seriously compromised in individuals suffering from PTSD. However, QoL studies with these professionals are scarce. This study results from a screening program held by the Portuguese Red Cross (PRC) aiming to analyze predictors of QoL. Participants were 95 firefighters and municipal police officers. They answered the Posttraumatic Stress Disorder Checklist (PCL-5) in order to evaluate the prevalence of PTSD symptoms, as well as measures of social support (3-Item Oslo Social Support Scale) and QoL (EUROHIS-QOL-8). From the results, there were no group differences regarding total PTSD, social support or QoL and 10% of participants reported enough symptoms to PTSD diagnostic. Social Support and PTSD explained 25% of QoL variance, PTSD symptoms explaining 10% (negative beta) and, in the second step, social support explained 15%. The results suggest that it would be important to include QoL as an outcome measure in clinical and research work in these populations, with special attention to PTSD and social support.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

A randomized controlled trial on the effects of combined aerobic-resistance exercise on muscle strength and fatigue, glycemic control and health-related quality of life of type 2 diabetes patients

AIM

to evaluate the effects of a 12--weeks combined aerobic--resistance exercise therapy on fatigue and isokinetic muscle strength, glycemic control and health--related quality of life (HRQoL) in moderately affected type 2 diabetes (T2DM) patients.

METHODS

a randomized controlled trial design was employed. Forty--three T2DM patients were assigned to an exercise group (n = 22), performing 3 weekly sessions of 60 minutes of combined aerobic--resistance exercise for 12--weeks; or a no exercise control group (n = 21). Both groups were evaluated at a baseline and after 12--weeks of exercise therapy for: 1) muscle strength and fatigue by isokinetic dynamometry; 2) plasma glycated hemoglobin A1C (HbA1C); and 3) HRQoL utilizing the SF--36 questionnaire.

RESULTS

the exercise therapy led to improvements in muscle fatigue in knee extensors (--55%) and increased muscle strength in knee flexors and extensors (+15 to +30%), while HbA1C decreased (--18%). In addition, the exercising patients showed sizeable improvements in HRQoL: physical function (+53%), vitality (+21%) and mental health (+40%).

CONCLUSION

12--weeks of combined aerobic--resistance exercise was highly effective to improve muscle strength and fatigue, glycemic control and several aspects of HRQoL in T2DM patients. These data encourage the use of aerobic and resistance exercise in the good clinical care of T2DM.

Lysyl oxidase-like 2 (LOXL2) and E47 EMT factor: novel partners in E-cadherin repression and early metastasis colonization

Epithelial-mesenchymal transition (EMT) has been associated with increased aggressiveness and acquisition of migratory properties providing tumor cells with the ability to invade into adjacent tissues. Downregulation of E-cadherin, a hallmark of EMT, is mediated by several transcription factors (EMT-TFs) that act also as EMT inducers, among them, Snail1 and the bHLH transcription factor E47. We previously described lysyl oxidase-like 2 (LOXL2), a member of the lysyl oxidase family, as a Snail1 regulator and EMT inducer. Here we show that LOXL2 is also an E47-interacting partner and functionally collaborates in the repression of E-cadherin promoter. Loss and gain of function analyses combined with in vivo studies in syngeneic breast cancer models demonstrate the participation of LOXL2 and E47 in tumor growth and their requirement for lung metastasis. Furthermore, LOXL2 and E47 contribute to early steps of metastatic colonization by cell and noncell autonomous functions regulating the recruitment of bone marrow progenitor cells to the lungs and by direct transcriptional regulation of fibronectin and cytokines TNFα, ANG-1 and GM-CSF. Moreover, fibronectin and GM-CSF proved to be necessary for LOXL2/E47-mediated modulation of tumor growth and lung metastasis.