Prospective Assessment Research Articles

Cumulative risk assessment with pesticides in the framework of MRL setting.

This abstract presents a report on the proposed work programme, focus on cumulative risk assessment (CRA) for chemical risks, specifically pesticide residues in food. While not a scientific publication, this technical report aims to provide insights without including the fellow's data to avoid publication restrictions. This report focuses on addressing the question concerning the trigger value to perform a prospective CRA in case of a new maximum residue level (MRL) setting. The 1,000 margin of exposure (MOE) threshold value was tested and compared to preliminary ANSES results. Alternative thresholds were calculated and explored. The EU-FORA fellow selected two cumulative assessment groups (CAGs) related to acute craniofacial alterations and chronic thyroid effects. The fellow performed exposure assessments, integrating effects data, French monitoring data, processing factors, agricultural uses, MRLs and extrapolations into Monte Carlo risk assessment (MCRA). Retrospective cumulative exposures using MCRA were conducted for children, adults and a vulnerable group of childbearing women based on the French survey INCA3, identifying background levels at P99.9. The fellow also performed prospective assessments with MCRA, analysing results at P99.9 to evaluate the adequacy of the 1,000 MOE threshold. Alternative thresholds are discussed and proposed.

Prospective assessment of management of male urethral catheterisation problems in a tertiary centre

Prospective assessment of management of male urethral catheterisation problems in a tertiary centre

Environmental potential of fungal insulation: a prospective life cycle assessment of mycelium-based composites

PurposeBio-based insulation materials are one of the most promising solutions for reducing the environmental impacts of building envelopes. Among these materials, the environmental benefits of mycelium-based materials have merely been investigated, despite their promising technical and thermal properties. In this paper, we perform a first prospective cradle-to-grave life cycle assessment (LCA) of mycelium-based composite blocks.MethodsAn attributional cradle-to-gate LCA of the laboratory production of mycelium-based composites was first performed, including 11 environmental impact indicators. Then, scenarios were defined to scale up the technology to the level of industrial production, including the remaining life cycle modules to perform a cradle-to-grave analysis. Biogenic and metabolic carbon were considered by applying the static −1/+1 approach and following the current LCA standards. Future-oriented energy and transport mixes were also included as an additional scenario, systematically modifying both the foreground and background data. Finally, the industrially scaled-up technology and alternative insulation materials were compared with these future conditions (as applied to both materials).Results and discussionConsidering climate change, the results are encouraging in comparison to those for traditional plastic insulation, but do not necessarily surpass those for other existing materials such as rock wool. However, trade-offs are observed in other indicators, for which mycelium-based composites tend to perform worse than traditional insulation materials. The industrial scale-up reduced impacts for most indicators, but a considerable trade-off was observed with regard to terrestrial ecotoxicity. The main driver for the remaining greenhouse gas (GHG) emissions was found to be the electricity use during the manufacturing phase. We consider the inclusion of the other life cycle stages as relevant, as this increased the GHG emissions by 10%. Limitations of the current LCA standards, however, are noted and discussed, especially regarding the cascading use of biogenic materials, and highlight the relevance of this case study.ConclusionsMycelium-based composites show a potential for future development, but careful attention should be paid to reducing electricity needs in their manufacturing process. Further improvements could also be made by using fast-growing biogenic materials as a substrate. In particular, we encourage researchers to include all of the life cycle stages in future studies, especially if biogenic emissions are considered.

Incorporating climate projections in the environmental risk assessment of pesticides in aquatic ecosystems.

Global climate change will significantly impact the biodiversity of freshwater ecosystems, both directly and indirectly via the exacerbation of impacts from other stressors. Pesticides form a prime example of chemical stressors that are expected to synergize with climate change. Aquatic exposures to pesticides might change in magnitude due to increased runoff from agricultural fields, and in composition, as application patterns will change due to changes in pest pressures and crop types. Any prospective chemical risk assessment that aims to capture the influence of climate change should properly and comprehensively account for the variabilities and uncertainties that are inherent to projections of future climate. This is only feasible if they probabilistically propagate extensive ensembles of climate model projections. However, current prospective risk assessments typically make use of process-based models of chemical fate that do not typically allow for such high-throughput applications. Here, we describe a Bayesian network model that does. It incorporates a two-step univariate regression model based on a 30-day antecedent precipitation index, circumventing the need for computationally laborious mechanistic models. We show its feasibility and application potential in a case study with two pesticides in a Norwegian stream: the fungicide trifloxystrobin and herbicide clopyralid. Our analysis showed that variations in pesticide application rates as well as precipitation intensity lead to variations in in-stream exposures. When relating to aquatic risks, the influence of these processes is reduced and distributions of risk are dominated by effect-related parameters. Predicted risks for clopyralid were negligible, but the probability of unacceptable future environmental risks due to exposure to trifloxystrobin (i.e., a risk quotient >1) was 8%-12%. This percentage further increased to 30%-35% when a more conservative precautionary factor of 100 instead of 30 was used. Integr Environ Assess Manag 2024;20:384-400. © 2023 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Prospective Life Cycle Assessment of Two Supercapacitor Architectures

Prospective Life Cycle Assessment of Two Supercapacitor Architectures

Prospective Life Cycle Assessment of Chemical Electrolyte Recycling for Vanadium Flow Batteries: A Comprehensive Study

Battery storage systems are an important key element for a successful energy transition. Increasingly, the focus is also on the sustainability analysis of the various energy storage technologies. In particular, the vanadium flow battery (VFB) is mentioned as a promising day storage technology. Nevertheless, its high cost and environmental impacts are attributed to its electrolyte. It is assumed that this issue can be addressed through reprocessing and reuse. The aim of this study is to provide, for the first time in the literature, information on the process design and the potential emissions of the treatment of end‐of‐life (EoL) vanadium electrolyte with various critical impurities, in order to be able to validly estimate the total emissions of VFB with recycled electrolyte. Four different scenarios are considered, combining treatment steps for electrolyte with different critical contaminations, revealing detailed mass and energy balances. The life cycle assessment provides valuable results for the sustainability assessment of the EoL vanadium electrolyte and the entire VFB system. The treatment of the electrolyte leads to significantly lower CO2 emissions (−79.2% to −99.8%) compared to the primary electrolyte and must be taken into account in future when assessing the sustainability of the VFB.

Genetic Risk Assessment of Degenerative Eye Disease (GRADE): study protocol of a prospective assessment of polygenic risk scores to predict diagnosis of glaucoma and age-related macular degeneration

BackgroundGlaucoma and age-related macular degeneration (AMD) account for a substantial portion of global blindness. Both conditions are highly heritable, with recognised monogenic and polygenic inheritance patterns. Current screening guidelines lack decisive recommendations. Polygenic risk scores (PRS) allow for cost-effective broad population risk stratification for these conditions. The predictive potential of PRS could facilitate earlier diagnosis and treatment, and prevent unnecessary vision loss.MethodsThe Genetic Risk Assessment of Degenerative Eye disease (GRADE) study is a prospective study designed to generate high-quality evidence about the feasibility of PRS to stratify individuals from the general population, enabling identification of those at highest risk of developing glaucoma or AMD. The targeted recruitment is 1000 individuals aged over 50 years, from which blood or saliva samples will be used for genotyping and an individual PRS for glaucoma and AMD will be derived. Individuals with PRS values in the bottom decile (n = 100), top decile (n = 100) and middle 80% (n = 100) for both glaucoma and AMD will undergo a detailed eye examination for glaucoma and/or AMD.DiscussionThe primary objective will be to compare the prevalence of glaucoma and AMD cases between low, intermediate, and high PRS risk groups. We expect to find a higher prevalence of both diseases in the high PRS risk group, as compared to the middle and low risk groups. This prospective study will assess the clinical validity of a PRS for glaucoma and AMD in the general Australian population. Positive findings will support the implementation of PRS into clinical practice.

Nd:YAG 1064 nm laser treatment for onychomycosis - is it really effective? A prospective assessment for efficiency and factors contributing to response.

Onychomycosis is a highly prevalent and persistent nail disorder primarily caused by dermatophytes. The effectiveness of current topical and systemic antifungals is limited by the extent and severity of the infection, patient demographics and health status, hepatic toxicity, drug interactions and low compliance. Laser therapy is a promising modality for safe and cost-effective removal of mycotic nail. This prospective study assessed the performance of a multi-series long-pulsed Nd:YAG 1064 nm regimen (30-40 J/cm2 , 1 Hz) in the treatment of 213 mycotic nails in 31 patients. Pain and discomfort were scored at each treatment session and mycological and clinical cure rates were determined 3 months after the last treatment session. Patients presented with mostly severe (mean SCIO score: 21.9 ± 8.9), T. rubrum-positive (87.1%) infections. Most (61%) had a family history of onychomycosis and a significant proportion had comorbidities, including hypertension (38.7%), hyperlipidemia (35.5%) and/or diabetes (12.9%). Treatment was well tolerated and there were no reports of nail deformity or burns. By 3 months post-treatment, mycological cure was achieved by 4 (12.9%) and visual improvements were noted for 10 (32.3%) patients, including 3 (9.7%) with moderate to significant improvements. Clinical response correlated with baseline SCIO ≤ 20 (OR: 0.9 [0.13-6.52]), family history of onychomycosis (OR: 0.27 [0.04-1.50]) and comorbidities (OR: 0.44 [0.05-3.74]). In conclusion, Nd:YAG 1064 nm laser is safe and effective for the management of mild-to-moderate onychomycosis in diverse populations. Further studies will be necessary to adjust treatment parameters to patient and nail profiles and to determine the impact of combined laser and topical therapies.

Regional Tau Deposition Reflects Different Pathways of Subsequent Neurodegeneration and Memory Decline in Cognitively Normal Older Adults.

Tau pathology is recognized as a primary contributor to neurodegeneration and clinical symptoms in Alzheimer's disease (AD). This study aims to localize the early tau pathology in cognitively normal older people that is predictive of subsequent neurodegeneration and memory decline, and delineate factors underlying tau-related memory decline in individuals with and without β-amyloid (Aβ). A total of 138 cognitively normal older individuals from the Berkeley Aging Cohort Study underwent 11 C-Pittsburgh Compound-B (PiB) positron emission tomography (PET) to determine Aβ positivity and 18 F-Flortaucipir (FTP) PET to measure tau deposition, with prospective cognitive assessments and structural magnetic resonance imaging. Voxel-wise FTP analyses examined associations between baseline tau deposition and longitudinal memory decline, longitudinal hippocampal atrophy, and longitudinal cortical thinning in AD signature regions. We also examined whether hippocampal atrophy and cortical thinning mediate tau effects on future memory decline. We found Aβ-dependent tau associations with memory decline in the entorhinal and temporoparietal regions, Aβ-independent tau associations with hippocampal atrophy within the medial temporal lobe (MTL), and that widespread tau was associated with mean cortical thinning in AD signature regions. Tau-related memory decline was mediated by hippocampal atrophy in Aβ- individuals and by mean cortical thinning in Aβ+ individuals. Our results suggest that tau may affect memory through different mechanisms in normal aging and AD. Early tau deposition independent of Aβ predicts subsequent hippocampal atrophy that may lead to memory deficits in normal older individuals, whereas elevated cortical tau deposition is associated with cortical thinning that may lead to more severe memory decline in AD. ANN NEUROL 2024;95:249-259.

Prospective assessment of corneal biomechanical properties and intraocular pressure after scleral lens wear: A 12-month follow-up study

PurposeTo investigate the long-term influence of scleral lens (SL) wear on corneal biomechanical properties and intraocular pressure (IOP) in irregular and regular corneas. Secondary goal comprised evaluate the fluid reservoir (FR) thickness overtime and correlate it with the changes in corneal biomechanical parameters and IOP. MethodsSeventy (70) eyes with irregular corneas (IC Group) and 21 eyes with regular corneas (RC Group) were fitted with 16.4 mm SL and wore the lenses for 12 months. Corrected IOP (IOPcc), Goldmann equivalent IOP (IOPg) and corneal biomechanical parameters (Corneal Hysteresis (CH) and Corneal Resistance Factor (CRF)) were measured with Ocular Response Analyzer. Slit lamp images were analyzed with ImageJ software to assess FR thickness overtime. Measurements were taken at lens dispensing visit prior lens wear (LDV1) and after 60 min of lens wear (LDV2) and at 1, 6 and 12-month follow-up visits. Measurements were done immediately after lens removal. ResultsThere were no statistically significant differences on IOPcc, IOPg, CRF and CH over the follow-up visits in both groups. Mean IOPcc and IOPg fluctuations overtime were clinically insignificant and below 1 mmHg in both groups. IOPg, CH and CRF were significantly lower on IC Group (p < 0.001), although no statistically significant differences were found between groups for IOPcc. Regarding FR thickness, statistically significant differences were found over the follow-up on both groups, with a mean decrease of 186.29 µm on IC Group and 175.32 µm on RC Group (p < 0.001). Statistically significant moderate to high negative correlations between FR and IOPg, CRF and CH were found only in the RC Group. ConclusionsLong-term SL wear was not associated to changes in corneal biomechanical parameters neither on IOP as measured after lens removal. Besides IOP measurement without SL removal, more studies are needed to investigate the potential relationship with SL fitting characteristics (namely FR thickness).

Assessing growth potential of careers with occupational mobility network and ensemble framework

The growth potential of a career reflects its future prospects and is an important consideration for individuals and organizations when career planning. There is still a lack of quantitative assessment tools for growth potential of careers. In this study, considering the key role of human capital in human resource management, as well as the excellent performance of complex network and machine learning in big data analysis and prediction, a career growth potential assessment model with human capital ensemble is proposed through human capital-based occupational mobility network and ensemble learning. First, an occupational mobility network is constructed based on online professional dataset to associate occupations with each other. Then, five dimensions of human capital measurements are designed to quantify human capital in terms of education, experience, social capital, occupational size, and concentration. These are then combined with the occupational mobility network to create a new network that depicts human capital flows among occupations. Finally, an ensemble framework for assessing career growth potential is constructed to integrate multidimensional human capital information in the network and obtain quantitative scores of growth potential. This study is the original attempt to adopt a data-driven idea and an intelligent approach to understand career growth potential. The experimental results show that it also makes a useful exploration for modeling human capital flows and intelligent assessment of career prospects.

Empowering Family Glaucoma Risk Communication Using QR-Code-Mediated Online Intervention

Attempts at engaging relatives of glaucoma patients in education and screening have had limited success. This study explores the feasibility of an electronic intervention to facilitate direct yet reliable glaucoma risk communication between open-angle glaucoma patients (probands) and their first-degree relatives (FDRs). Prospective survey and assessment of intervention. Fifty adult probands, engaging 140 FDRs. Phase I was an iterative process involving creating a customized website and Quick Response (QR)-code-based intervention designed with input from probands, FDRs of patients, community members, and researchers. In phase II, the intervention was deployed in a clinical setting; this involved recruiting probands who had a smartphone and were willing to use the QR-code to message their FDRs a standard message, including a website link about glaucoma risk in FDRs and the importance of getting examined. Follow-up interviews were conducted with probands 1 to 2 weeks after their clinic visit to assess the impact of the intervention. Demographic data, website analytics, and participant feedback were collected and analyzed. Increased awareness of glaucoma risk among FDRs and enhanced discussions. At the time of the first interview, probands reported that 70% of the FDRs were aware of the probands' glaucoma diagnosis, but only 26% had undergone glaucoma screening. Ninety percent of probands had no issues using the QR-codes. Website analytics recorded 73 visits from 51 distinct internet protocol addresses (IPs). After receiving the standard message, 95% of FDRs followed up with the probands, actively discussing glaucoma. Of the probands, 84% completed the follow-up interview 1 to 2 weeks after enrollment. Fifty-nine percent of the FDRs were reported to have scheduled screening appointments. The collected feedback revealed that 96% of probands found the intervention helpful, fostering glaucoma discussions with their FDRs and improving probands' comfort level in discussing health issues with FDRs from baseline (very comfortable: 88%, comfortable: 8%, neutral: 2%, and very uncomfortable: 2%) to the follow-up interview (very comfortable: 98% and comfortable: 2%). This innovative online method of communicating the risk of glaucoma to FDRs of probands prompted and increased the comfort level of familial discussions of glaucoma. More than half of FDRs reported making an appointment to get screened for glaucoma. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Prospective Assessment of Bone Metabolism Biomarkers and Survival in Metastatic Castration-resistant Prostate Cancer Patients Treated with Radium-223: The PRORADIUM Study

BackgroundRadium-223 is an active therapy option for bone metastatic castration-resistant prostate cancer (mCRPC). The lack of adequate biomarkers for patient selection and response assessment are major drawbacks for its use. ObjectiveTo assess the prognostic value of bone metabolism biomarkers (BMBs) in ra-223–treated mCRPC patients. Design, setting, and participantsA prospective cohort study of mCRPC patients treated with Ra-223 (PRORADIUM study: NCT02925702) was conducted. Outcome measurements and statistical analysisThe main objective of the study was to evaluate the association between high (≥median) baseline values in at least three bone formation (bone alkaline phosphatase [BAP] and C-terminal type-I collagen propeptide) and bone resorption (N-terminal telopeptide and pyridinoline) biomarkers, and survival. The independent prognostic value of each BMB was also assessed. The association with time to radiographic, clinical, and prostate-specific antigen (PSA) progression; time to skeletal-related events; and PSA response were secondary objectives. Multivariable (MV) Cox-regression models were evaluated. Results and limitationsA total of 169 patients were included. Of the patients, 70.4% received Ra-223 in second/third line; 144 (85.2%) were Eastern Cooperative Oncology Group 0–1, 126 (74.6%) were in pain, and 80 (47.5%) had more than ten bone metastases. Sixty-seven (39.6%) patients had elevation in at least three BMBs. The median overall survival was 12.1 mo (95% confidence interval [CI]: 10–14.7). No association was observed with other treatment-related secondary outcome parameters. Patients with high values in three or more BMBs had significantly worse survival (9.9 vs 15.2 mo; hazard ratio [HR]: 1.8 [95% CI: 1.3–2.5]; p < 0.001) in the univariate analysis, but not independent in the MV analysis (HR: 1.33; 95% CI: 0.89–2; p = 0.181). High baseline BAP was the only biomarker associated with survival in the MV model (HR: 1.89; 95% CI: 1.28–2.79; p = 0.001). Addition of BAP to the MV clinical model increased the area under the receiver operating characteristic curve 2-yr value from 0.667 to 0.755 (p = 0.003). ConclusionsBiomarkers of bone formation, especially BAP, have prognostic value in mCRPC patients treated with radium-223. Its predictive value remains to be assessed, ideally in prospective, adequately powered, randomised clinical trials. Patient summaryIn this study, we evaluate the role of bone metabolism biomarkers to help improve the use of radium-223 as therapy for advanced prostate cancer. We found that bone alkaline phosphatase may be a suitable tool.

Prospective life cycle assessment of CO2 conversion by photocatalytic reaction

CO2 conversion is gradually seen as a better way for society to effectively use carbon sources and avoid climate crisis associated with fossil CO2 emissions. And the decision to deploy CO2 technology scale should be relied on its environmental impact. In this work, life cycle assessment model evaluates the environmental performance of CO2 conversion by photocatalytic reaction process with two different catalysts (NiAl-LDH and Co-ZIF-9). Six impact categories considered in this analysis, including climate change, acidification potential, depletion of abiotic resources, eutrophication potential, ozone layer depletion potential, and photochemical oxidation potential. Results indicated that CO2 conversion with Co-ZIF-9 photocatalyst has a better environmental impact than the NiAl-LDH photocatalyst route. Moreover, the Co-ZIF-9 catalyst scenario also has a lower total environmental burden than the conventional CO production route. Sensitivity analysis shows that recycle performance of the catalyst is highly sensitive to the production process in two scenarios. This study could provide a framework for robust decisions in CO2 conversion by photocatalytic reaction, which is useful for policymakers to decide the feasibility of industrialization.

Safety and Efficacy of Three Modifications of Canaloplasty to Treat Open-Angle Glaucoma: 3-Year Outcomes.

This is a report of 3-year results of a prospective assessment of three modifications of canaloplasty (C): ab externo (ABeC), mini-canaloplasty (miniABeC), and ab interno (ABiC) performed concomitantly with cataract removal in subjects suffering from primary open-angle glaucoma (POAG). Forty-eight individuals were randomized for one of the surgeries: ABeC, miniABeC, or ABiC and cataract removal-16 eyes for each group. Follow-up examinations were carried out on the day of the surgery, on days 1 and 7, after 1, 3, 6 months, and at 1, 2, and 3 years. Complete and qualified success was an IOP ≤ 15 mmHg without or with antiglaucoma eye drops, respectively. The IOP reduction of 20% or more was considered an additional success criterion. Within three years the probability of qualified success was ABiC and miniABeC-94%, ABeC-100%, and of complete success ABiC-75%, miniABeC-100%. At the 3-year follow-up, the median IOP decreased from 22 to 15 mmHg in the ABeC group (p = 0.001), from 22 to 15 mmHg in the miniABeC group 15 (p < 0.001), and from 21 to 15 mmHg in the ABiC group (p = 0.001) compared to the post-washout stage. The IOP dropped by 20% or more without medications in 56.2% of patients post ABiC, 68.8% post miniABeC and 75% post ABeC. The median number of antiglaucoma medications dropped in all three groups; at the 3-year follow-up, only one patient following ABeC and four subjects following miniABeC required treatment. One patient required reoperation and further intensification of topical treatment-post miniABeC. The levels of IOP, CDVA, and success probability at the 36-month follow-up showed no significant difference for individual groups. ABeC, miniABeC, and ABiC have significant IOP-lowering potential in individuals diagnosed with POAG at a mild to moderate stage and no history of IOP ≥ 30 mmHg with a good safety profile.

Prospective consequential life cycle assessment: Identifying the future marginal suppliers using integrated assessment models

Previous research efforts have focused on developing prospective life cycle inventory databases that build upon projections from integrated assessment models but were limited to attributional system models. A novel approach is required to construct consequential LCI databases that can be applied consistently on a large scale. To this end, the heuristic approach from Bo Weidema was selected as a basis for this study. This approach has been validated with historical data and was adapted in this study to identify the marginal suppliers in a prospective context. The different steps within the approach were analyzed, and alternative techniques for each step within the heuristic method were proposed. The techniques were tested on the future electricity sector using projections from two integrated assessment models (IMAGE and REMIND). Results show the sensitivity of results on the modelling technique selected in each step. The most sensitive step is the selection of the time interval, with even small changes resulting in a noticeable difference. In addition, the results also showed a substantial difference between the projections of the two models. The relevance and goals of the alternative techniques for each step were discussed to guide users in forming the heuristic method for their study.

1065P Prospective assessment of nutritional status in patients with advanced non-small cell lung cancer and renal cell carcinoma treated with immune checkpoint inhibitors

1065P Prospective assessment of nutritional status in patients with advanced non-small cell lung cancer and renal cell carcinoma treated with immune checkpoint inhibitors

PB0086 Prospective Assessment of Thrombomodulin Resistance in Oncological Patients and Healthy Subjects Following Vaccination Against Sars-Cov-2 with the mRNAVaccine. The Roadmap-COVID-19-Vaccin Study

PB0086 Prospective Assessment of Thrombomodulin Resistance in Oncological Patients and Healthy Subjects Following Vaccination Against Sars-Cov-2 with the mRNAVaccine. The Roadmap-COVID-19-Vaccin Study

Prospective assessment of the incidence and associations of postvoid dribbling after urethroplasty Impact of surgical technique.

The incidence and associations of postvoid dribbling (PVD) after urethroplasty remains unclear. The purpose of this study was to examine the impact of urethroplasty on PVD and factors associated with de novo PVD. From 2011-2018, patients were offered enrollment in a prospective study assessing PVD after urethroplasty. PVD was assessed preoperatively and six months post-surgery with the question, "After urinating, do you have post-urination dribbling or leakage of urine?" Choices included, "Never" (1), "Occasionally" (2), "Sometimes" (3), "Most of the time" (4), or "All of the time" (5). A response of 3-5 was considered clinically significant. Wilcoxon signed-rank test was used to compare pre- and postoperative PVD, while logistic regression was used to determine the association between new-onset PVD and clinical variables. A total of 384 patients completed the study, with 46.9% (180) reporting PVD preoperatively compared to 39.8% (153) postoperatively (p=0.01); 18.0% (67) of patients experienced de novo PVD, 57.0% (219) no change, and 25.0% (96) reported improvement. On multivariable logistic regression, patients undergoing anastomotic urethroplasty were less likely to report de novo PVD (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.13-0.83, p=0.02). No other factor was associated with de novo PVD, including age (p=0.59), stricture length (p=0.71), location (p=0.50), etiology (p=0.59), failed endoscopic treatment (p=0.18), previous urethroplasty (p=0.55), or recurrence (p=0.78). De novo PVD was not associated with patient dissatisfaction (10.1% vs. 7.6%, p=0.49). PVD is common in patients with urethral stricture. While there is an overall improvement after urethroplasty, 18.0% of patients will experience de novo PVD, with a reduced incidence in those undergoing anastomotic urethroplasty.

Prospective Longitudinal Assessment of Quality of Life after Stereotactic Ablative Radiotherapy for Oligometastases: Analysis of the Population-Based SABR-5 Phase II Trial

To evaluate longitudinal patient-reported quality of life (QoL) in patients treated with stereotactic ablative radiotherapy (SABR) for oligometastases. The SABR-5 trial was a population-based single-arm phase II study of SABR to up to 5 sites of oligometastases, conducted in 6 regional cancer centers in British Columbia from 2016 to 2020. Prospective QoL was measured using treatment site-specific QoL questionnaires at pre-treatment baseline and 3, 6, 9, 12, 15, 18, 21, 24, 30, and 36 months after treatment. Patients with bone metastases were assessed with the Brief Pain Inventory (BPI). Patients with liver, adrenal, and abdominopelvic lymph node metastases were assessed with the Functional Assessment of Chronic Illness Therapy-Abdominal Discomfort (FACIT-AD). Patients with lung and intrathoracic lymph node metastases were assessed with the Prospective Outcomes and Support Initiative (POSI) lung questionnaire. The two one-sided test procedure was used to assess equivalence between the worst QoL score and baseline score of individual patients. Mean QoL at all time points was used to determine the trajectory of QoL response after SABR. The proportion of patients with "stable," "improved," or "worsened" QoL was determined for all time points based on standard minimal clinically important differences (MCID; BPI worst pain = 2, BPI Functional Interference Score [FIS] = 0.5, FACIT-AD Trial Outcome Index [TOI] = 8, POSI = 3). All enrolled patients with baseline QoL assessment and at least 1 follow-up assessment were analyzed (n = 135). On equivalence testing, patients' worst QoL scores were clinically different from baseline scores and met MCID (BPI worst pain mean difference: 1.8, 90% CI [1.19 to 2.42]; BPI FIS mean difference: 1.68, 90% CI [1.15 to 2.21]; FACIT-AD TOI mean difference: -8.76, 90% CI [-11.29 to -6.24]; POSI mean difference: -4.61, 90% CI [-6.09 to -3.14]). However, the mean FIS transiently worsened at 9, 18 and 21 months but eventually returned to stable levels. The mean FACIT and POSI scores also worsened at 36 months, albeit with a limited number of responses (n = 4 and 8, respectively). The majority of patients reported stable QoL at all time points (range: BPI worst pain 71-82%, BPI FIS 45-78%, FACIT-AD TOI 50-100%, POSI 25-73%). Clinically significant stability, worsening, and improvement were seen in 70%/13%/18% of patients at 3 months, 53%/28%/19% at 18 months and 63%/25%/13% at 36 months. SABR in the oligometastatic setting can lead to transient decreases in QoL. However, most patients experienced stable QoL relative to pre-treatment levels on long-term follow-up. Further studies are needed to characterize patients at greatest risk for decreased QoL.