Digital Medicine in Men with Advanced Prostate Cancer – A Feasibility Study of Electronic Patient-reported Outcomes in Patients on Systemic Treatment

AIMS: Electronic patient-reported outcome (ePRO) measures have the potential to improve patient care, both at an individual level by detecting symptoms and at an organisational level to rationalise follow-up. The introduction of ePROs has many challenges, including funding, institutional rigidity and acceptability for both patients and clinicians. There are multiple examples of successful ePRO programmes but no specific feasibility studies in those who are less digitally engaged. Prostate cancer is predominantly a disease of older men and digital exclusion is associated with increased age. We assessed the feasibility of ePRO completion in older men receiving treatment for advanced prostate cancer both within the clinic and from home. MATERIALS AND METHODS: Men receiving palliative systemic treatment were asked to complete ePROs on a tablet computer in the outpatient department at 0 and 3 months. Participants were also offered optional completion from home. Feasibility was assessed via a mixed methods approach. RESULTS: On-site ePRO completion was acceptable to most patients, with 90% finding it easy or straightforward and 80% preferring electronic over paper. Remote completion was more challenging, even for those who accessed e-mail daily and owned a tablet, with only 20% of participants successfully completing ePROs. Barriers to electronic completion can be categorised as technical, attitudinal and medical. Quality of life and symptom ePRO results were comparable with published data. CONCLUSIONS: On-site completion is achievable in this population with limited staff support. However, remote completion requires further work to improve systems and acceptability for patients. Remote completion is critical to add significantly to current clinical care by detecting symptoms or stratifying follow-up

No association of breast cancer risk with integrin beta3 (ITGB3) Leu33Pro genotype

To pursue a borderline increased risk of breast cancer for carriers of two integrin beta3 (ITGB3) 33Pro alleles found in a recent prospective study, we conducted a case–control study of 1088 women with breast cancer and 4815 female controls. Leu33Pro heterozygotes, homozygotes and heterozygotes+homozygotes vs noncarriers had odds ratios for breast cancer of 1.0 (95% confidence interval: 0.8–1.1), 0.8 (0.5–1.2) and 1.0 (0.8–1.1), respectively. After stratification for conventional risk factors, odds ratio for breast cancer in heterozygotes, homozygotes and heterozygotes+homozygotes vs noncarriers were not increased above 1.0 in any of the 14 strata examined. This was also true after stratification for tumour histological subtype and cancer stage at the time of diagnosis

Assessment of the immediate effects of cardiopulmonary bypass on left ventricular performance by on-line pressure-area relations

Background: Pressure-volume relations have been established as useful measures of left ventricular (LV) performance. Application of these methods to the intraoperative setting have been limited because of difficulties acquiring LV volume data. Transesophageal echocardiographic automated border detection can measure LV cross-sectional area as an index of volume, which can be coupled with pressure data to construct pressure-area loops on-line. The purpose of this study was to evaluate intraoperative LV performance in patients undergoing coronary bypass surgery before and immediately after cardiopulmonary bypass using on-line pressure-area relations. Methods and Results: Studies were attempted in 13 consecutive patients. Simultaneous measures of LV cross-sectional area, LV pressure, and electromagnetic flow probe-derived aortic flow recorded on a computer work station interfaced with the ultrasound system. Pressure-area loops were compared with simultaneous pressure-volume loops constructed from pressure and flow data during inferior vena caval occlusions before and after bypass. Pressure-volume calculations (end-systolic elastance, maximal elastance, and preload-recruitable stroke work) were then applied to pressure-area loops with area substituted for volume data. Changes in stroke force from pressure-area loops were closely correlated with changes in estimates of stroke work from pressure-volume loops for individual patients before bypass (r=.99±.03, SEE=5±2%, n=10) and after bypass (r=.96±.05, SEE=5±2%, n=9). Pressure-area estimates of end- systolic elastance, maximal elastance, and preload-recruitable stroke force decreased significantly from before to after cardiopulmonary bypass in the 7 patients with paired data sets. Load-dependent measures of LV function (stroke volume, cardiac output, and fractional area change) were unchanged after surgery in these same patients. Conclusions: Intraoperative pressure- area loops may be acquired and displayed on-line using transesophageal echocardiographic automated border detection and readily analyzed in a manner similar to pressure-volume loops. LV performance was depressed immediately after cardiopulmonary bypass compared with before. On-line pressure-area relations may be clinically useful to assess LV performance in patients undergoing cardiac surgery in whom load and contractility may be expected to vary rapidly

Optofluidic fabrication for 3D-shaped particles

Complex three-dimensional (3D)-shaped particles could play unique roles in biotechnology, structural mechanics and self-assembly. Current methods of fabricating 3D-shaped particles such as 3D printing, injection moulding or photolithography are limited because of low-resolution, low-throughput or complicated/expensive procedures. Here, we present a novel method called optofluidic fabrication for the generation of complex 3D-shaped polymer particles based on two coupled processes: inertial flow shaping and ultraviolet (UV) light polymerization. Pillars within fluidic platforms are used to deterministically deform photosensitive precursor fluid streams. The channels are then illuminated with patterned UV light to polymerize the photosensitive fluid, creating particles with multi-scale 3D geometries. The fundamental advantages of optofluidic fabrication include high-resolution, multi-scalability, dynamic tunability, simple operation and great potential for bulk fabrication with full automation. Through different combinations of pillar configurations, flow rates and UV light patterns, an infinite set of 3D-shaped particles is available, and a variety are demonstrated