Confirmatory validation analysis of the PROFFIT questionnaire to assess financial toxicity in cancer patients

BACKGROUND

The Patient Reported Outcome for Fighting FInancial Toxicity (PROFFIT) questionnaire was developed to measure financial toxicity (FT) and identify its determinants. The aim of the present study was to confirm its validity in a prospective cohort of patients receiving anticancer treatment.

PATIENTS AND METHODS

From March 2021 to July 2022, 221 patients were enrolled at 10 Italian centres. Selected items of the EORTC-QLQ-C30 questionnaire represented the anchors, specifically, question 28 (Q-28) on financial difficulties, and questions 29-30 measuring global health status/quality of life (HR-QOL). The study had 80% power to detect a 0.20 correlation coefficient (r) between anchors and PROFFIT-score (items 1-7, range 0-100, 100 indicating maximum FT) with bilateral alpha 0.05 and 80% power. Confirmatory factor analysis was conducted. FT determinants (items 8-16) were described.

RESULTS

Median age of patients was 65 years, 116 (52.5%) were females, 96 (43.4%) had low education level. Confirmatory factor analysis confirmed goodness of fit of the PROFFIT-score. Significant partial correlation of PROFFIT-score was found with Q-28 (r = 0.51) and HR-QOL (r = -0.23). Mean (SD) PROFFIT-score at baseline was 36.5 (24.9); it was statistically significantly higher for patients living in South Italy, those with lower education level, those who were freelancer/unemployed at diagnosis and those who reported significant economic impact from the COVID-19 pandemic. Mean (SD) scores of determinants ranged from 17.6 (27.1) for item 14 (support from medical staff) to 49.0 (36.3) for item 10 (expenses for medicines or supplements). PROFFIT-score significantly increased with worsening response to determinants.

CONCLUSIONS

External validation of PROFFIT-score in an independent sample of patients was successful. The instrument is now being used in clinical studies.

Role of structural disorder in the vibrational spectra of sol-gel γ and δ-Al2O3 nanoparticles

Alumina nanopowders belonging to the γ and δ transition phases have been characterized by infrared and Raman spectroscopies. A quantitative interpretation of their vibrational spectra has been provided and related to their crystal structure, with particular emphasis on structural disorder and features not predicted by group-theoretical considerations. Both phases show very similar infrared dielectric functions, but with clear instances of mode-splitting in the δ phase, which are related to ordering in the tetrahedral Al positions. Raman spectroscopy was unable to resolve any modes in the sample identified as γ phase, but the full lattice vibrational region could be measured for the δ sample under UV and red excitation lines. Raman spectra are more complex than those obtained by infrared spectroscopy and cannot be completely explained by factor group analysis, in the absence of dedicated theoretical studies. Finally, the luminescent properties of these materials have been qualitatively explored and linked to disorder and substitutional impurities. In general, the results contained in this work prove that vibrational spectroscopies are powerful tools for quantitative analyses of these disordered nanomaterials and suggest the need for more theoretical work to understand their vibrational properties.

Improving Keyword-Based Topic Classification in Cancer Patient Forums with Multilingual Transformers

Online forums play an important role in connecting people who have crossed paths with cancer. These communities create networks of mutual support that cover different cancer-related topics, containing an extensive amount of heterogeneous information that can be mined to get useful insights. This work presents a case study where users' posts from an Italian cancer patient community have been classified combining both count-based and prediction-based representations to identify discussion topics, with the aim of improving message reviewing and filtering. We demonstrate that pairing simple bag-of-words representations based on keywords matching with pre-trained contextual embeddings significantly improves the overall quality of the predictions and allows the model to handle ambiguities and misspellings. By using non-English real-world data, we also investigated the reusability of pretrained multilingual models like BERT in lower data regimes like many local medical institutions.

Sepsis Code: dodging mortality in a tertiary hospital

Introducción

En el hospital de La Princesa comienza el “Código Sepsis” (CSP) en el año 2015, como un grupo multidisciplinar que dota al personal sanitario de herramientas clínicas, analíticas y organizativas, con el objetivo de la detección y el tratamiento precoz del paciente con sepsis. El objetivo de este estudio es evaluar el impacto de la implantación de CSP en la mortalidad y determinar las variables asociadas con un aumento de la misma.

Material y métodos

Se realizó un estudio analítico retrospectivo de los pacientes con activación de la alerta CSP de 2015 a 2018. Se recogieron variables clínico-epidemiológicas, parámetros analíticos y factores de gravedad como el ingreso en Unidades de Cuidados Críticos (UCC) y la necesidad de aminas. La significación estadística se estableció en una p < 0,05.

Resultados

Se incluyeron 1.121 pacientes. La estancia media fue de 16 días y un 32% requirieron ingreso en UCC. La mortalidad mostró una tendencia lineal descendente estadísticamente significativa del 24% en 2015 hasta el 15% en 2018. Las variables predictivas de mortalidad con asociación estadísticamente significativa fueron el lactato > 2 mmol/L, la creatinina > 1,6 mg/dL y la necesidad de aminas.

Conclusiones

La implementación de Código Sepsis disminuye la mortalidad de los pacientes con sepsis y shock séptico. La presencia de una cifra de lactato > 2 mmol/L, los niveles de creatinina > 1,6 mg/dL y/o la necesidad de administrar aminas en las primeras 24 horas, se asocian con un aumento de la mortalidad en el paciente con sepsis.

Enhanced thermal conduction by surface phonon-polaritons

Improving heat dissipation in increasingly miniature microelectronic devices is a serious challenge, as the thermal conduction in nanostructures is markedly reduced by increasingly frequent scattering of phonons on the surface. However, the surface could become an additional heat dissipation channel if phonons couple with photons forming hybrid surface quasiparticles called surface phonon-polaritons (SPhPs). Here, we experimentally demonstrate the formation of SPhPs on the surface of SiN nanomembranes and subsequent enhancement of heat conduction. Our measurements show that the in-plane thermal conductivity of membranes thinner than 50 nm doubles up as the temperature rises from 300 to 800 kelvin, while thicker membranes show a monotonic decrease. Our theoretical analysis shows that these thickness and temperature dependencies are fingerprints of SPhP contribution to heat conduction. The demonstrated thermal transport by SPhPs can be useful as a previously unidentified channel of heat dissipation in a variety of fields including microelectronics and silicon photonics.

Orchidectomy increases beta-adrenoceptor activation-mediated neuronal nitric oxide and noradrenaline release in rat mesenteric artery

BACKGROUND/AIMS

A previous study has demonstrated that endogenous male sex hormones do not alter neuronal nitric oxide (NO) release in rat mesenteric artery. However, the regulatory role of endogenous male sex hormones on noradrenaline (NA) release in rat mesenteric artery is not known. The present study was designed to analyze whether endogenous male sex hormones influence the NA release induced by electrical field stimulation (EFS), as well as the possible modification in NA and neuronal NO release by presynaptic beta-adrenoceptor activation.

METHODS

For this purpose, mesenteric arteries from control and orchidectomized male Sprague-Dawley rats were used. Basal and EFS-induced neuronal NO and NA release, as well as the contractile effect induced by EFS, was measured.

RESULTS

Basal and EFS-induced neuronal NO and NA release were similar in arteries from control and orchidectomized rats. The beta-adrenoceptor agonist clenbuterol did not modify EFS-induced neuronal NO and NA release in arteries from control rats. In contrast, in arteries from orchidectomized animals, clenbuterol increased both neuronal NO and NA release; this increase was prevented by incubation with the beta-adrenoceptor antagonist propranolol. However, the contractile response elicited by EFS was not modified by clenbuterol in either group of rats.

CONCLUSIONS

These results show that orchidectomy does not alter the EFS-induced NA release. What is more, activation of presynaptic beta-adrenoceptors does not modify EFS-induced NA and neuronal NO release in arteries from control rats although it increases the release of both neurotransmitters in arteries from orchidectomized rats. Despite these modifications, the EFS-induced contractile response is preserved in arteries from orchidectomized rats.

Spiral CT findings in active and remission phases in patients with Crohn disease

PURPOSE

The purpose of this study was to evaluate the radiologic findings in helical CT (HCT) that can be useful to differentiate patients with active Crohn disease (CD) from those in the remission phase.

METHOD

Fifty patients diagnosed with cases of CD were classified into active or remission phases (n = 37 and n = 13, respectively) according to clinical criteria and laboratory data. All of them underwent an abdominal HCT exploration. The following radiologic findings were evaluated: thickness, density and enhancement of the bowel wall, presence of "target" or "double halo," mesenteric involvement, and possible complications.

RESULTS

All patients in the active phase had pathologic findings on HCT. The wall thickness was 8.5 (SD 3.2) and 6.5 mm (SD 4 mm) in active and remission phases, respectively (p = 0.06). Target was present in seven patients (19%) with active disease and in five patients (38.5%) in the remission phase (p = 0.15). Density of the wall in the active phase was 95 HU and in the remission phase 65 HU (p < 0.002). Mesentery was involved in 89.2% of patients in the active phase and 38% of patients in the remission phase (p < 0.001). The complications observed in patients with active-phase disease were abscesses in nine (24%), phlegmons in two, fistulas in three, intestinal obstruction in two, and pancreatitis in one.

CONCLUSION

A normal HCT rules out that a patient with CD is in the active phase of disease. The presence of significant bowel wall enhancement and mesentery involvement assists in the differentiation of patients in the active phase from those in remission. HCT is also effective to assess the presence of complications, which are indicative of the active phase.

"Oesophageal angina" in patients with angina pectoris: a possible side effect of chronic therapy with nitroderivates and Ca-antagonists

The study was carried out on 18 patients with angina pectoris in whom the usual treatment with nitroderivatives and/or Ca-antagonists did not improve or prevent the angina-like chest pain in the absence of unstable angina. The patients underwent the following oesophageal examinations: X-ray, endoscopy-biopsy, manometry, acid perfusion test and 24-hour oesophageal pH ambulatory monitoring, the latter two being made in association with dynamic ECG. The presence of coronary insufficiency had been previously determined by means of ECG and scintigraphic stress tests and, when necessary, coronary arteriography was performed. In 10/18 patients severe oesophageal motor disorders were observed, the most frequent being diffuse oesophageal spasm. In the entire group the lower oesophageal sphincter basal tone was significantly lower than normal. In 14/18 patients a pathologic gastroesophageal reflux was detected: in 2 of these patients a temporal correlation between pain attacks and episodes of gastroesophageal reflux were observed in the absence of ECG modifications. Acid perfusion test induced the angina-like chest pain in another 2 patients without ECG modifications. In conclusion, the angina-like chest pain of these patients is not due to a failure of the antianginal therapy in relieving the coronary insufficiency, but is most probably related to gastroesophageal reflux. This oesophageal disorder may be considered a side effect caused by prolonged therapy with nitroderivatives and Ca-antagonists. In fact, these drugs decrease the lower oesophageal sphincter tone which is the main barrier against the reflux of gastric contents into the oesophagus so favoring gastroesophageal reflux and related disorders, including oesophageal pain.

Interdigestive gastroduodenal motility in patients with ulcer-like dyspepsia: effect of ranitidine

Interdigestive gastroduodenal motility was studied manometrically in 16 patients with ulcer-like dyspepsia due to hypersecretory gastroduodenitis (group A) and in a control group of 6 healthy subjects (group B). After a basal recording period sufficient to record at least two activity fronts (AF) of the migrating motor complex (MMC) of the gastroduodenal tract, we administered 100 mg of ranitidine intravenously to 8 patients of group A (group A1), and the same dose of ranitidine to the remaining 8 patients of group A (group A2) after pretreatment with cimetidine 200 mg i.v. to block the acid secretion. The interdigestive motility of patients with hypersecretory gastroduodenitis is characterized by a decrease in frequency and duration of the activity fronts of MMC, which may play a role in the pathogenesis of mucosal lesions. Ranitidine induced premature and prolonged activity fronts in all patients without antisecretory pretreatment, and in the majority of patients in whom the acid secretion was previously blocked.