Exploring the physiological benefits of carrying a suspended backpack versus a traditional backpack.

This study investigates the differences in metabolic energy cost and physiological adaptations between carrying a suspended backpack and a traditional backpack during exercise. For that, 30 males completed the Bruce test while carrying a loaded backpack. Researchers used a metabolic system to obtain variables, analysed muscle oxygen saturation, and used a 2-way RM ANOVA. As results, a significant fatigue interaction was found, but the interaction between fatigue and backpack was non-significant. Using a suspended backpack resulted in energetic advantages in oxygen consumption, muscle oxygen saturation, and performance compared to a traditional backpack. In conclusion, this study offers insights into the physiological implications of using a suspended backpack, suggesting it may reduce the risk of musculoskeletal issues and improve performance for those carrying heavy loads.Practitioner summary: The suspended-load backpacks have been proposed as an alternative to traditional backpacks. This study highlighted that the use of a suspended backpack provided some energetical advantages adaptation compared to the traditional backpack in terms of oxygen consumption, muscle oxygen saturation and performance during a multistage treadmill test walking-running test.

Mn-porphyrins in a four-helix bundle participate in photo-induced electron transfer with a bacterial reaction center.

Hybrid complexes incorporating synthetic Mn-porphyrins into an artificial four-helix bundle domain of bacterial reaction centers created a system to investigate new electron transfer pathways. The reactions were initiated by illumination of the bacterial reaction centers, whose primary photochemistry involves electron transfer from the bacteriochlorophyll dimer through a series of electron acceptors to the quinone electron acceptors. Porphyrins with diphenyl, dimesityl, or fluorinated substituents were synthesized containing either Mn or Zn. Electrochemical measurements revealed potentials for Mn(III)/Mn(II) transitions that are ~ 0.4 V higher for the fluorinated Mn-porphyrins than the diphenyl and dimesityl Mn-porphyrins. The synthetic porphyrins were introduced into the proteins by binding to a four-helix bundle domain that was genetically fused to the reaction center. Light excitation of the bacteriochlorophyll dimer of the reaction center resulted in new derivative signals, in the 400 to 450 nm region of light-minus-dark spectra, that are consistent with oxidation of the fluorinated Mn(II) porphyrins and reduction of the diphenyl and dimesityl Mn(III) porphyrins. These features recovered in the dark and were not observed in the Zn(II) porphyrins. The amplitudes of the signals were dependent upon the oxidation/reduction midpoint potentials of the bacteriochlorophyll dimer. These results are interpreted as photo-induced charge-separation processes resulting in redox changes of the Mn-porphyrins, demonstrating the utility of the hybrid artificial reaction center system to establish design guidelines for novel electron transfer reactions.

Use of diamond sensors for a high-flux, high-rate X-ray pass-through diagnostic.

X-ray free-electron lasers (XFELs) deliver pulses of coherent X-rays on the femtosecond time scale, with potentially high repetition rates. While XFELs provide high peak intensities, both the intensity and the centroid of the beam fluctuate strongly on a pulse-to-pulse basis, motivating high-rate beam diagnostics that operate over a large dynamic range. The fast drift velocity, low X-ray absorption and high radiation tolerance properties of chemical vapour deposition diamonds make these crystals a promising candidate material for developing a fast (multi-GHz) pass-through diagnostic for the next generation of XFELs. A new approach to the design of a diamond sensor signal path is presented, along with associated characterization studies performed in the XPP endstation of the LINAC Coherent Light Source (LCLS) at SLAC. Qualitative charge collection profiles (collected charge versus time) are presented and compared with those from a commercially available detector. Quantitative results on the charge collection efficiency and signal collection times are presented over a range of approximately four orders of magnitude in the generated electron-hole plasma density.

Cosmic Birefringence from the Planck Data Release 4.

We search for the signature of parity-violating physics in the cosmic microwave background, called cosmic birefringence, using the Planck data release 4. We initially find a birefringence angle of ß=0.30°±0.11° (68% C.L.) for nearly full-sky data. The values of ß decrease as we enlarge the Galactic mask, which can be interpreted as the effect of polarized foreground emission. Two independent ways to model this effect are used to mitigate the systematic impact on ß for different sky fractions. We choose not to assign cosmological significance to the measured value of ß until we improve our knowledge of the foreground polarization.

Total removal of amoxicillin from water using magnetic core nanoparticles functionalized with silver.

Framed in the problem of emerging pollutants, in this work we introduce a novel procedure for the total removal of amoxicillin from water samples using magnetic nanoparticles functionalized with nanometric silver (Fe3O4@AgNPs). Experimental conditions such as pH, contact time, temperature, as well as adsorbate and adsorbent doses have been studied to achieve the total adsorption for different concentrations of amoxicillin in water. Particularly, for concentrations 10 and 100 mg L-1, a maximum removal efficiency of 100% was reached at room temperature and pH = 7 after 15 min of contact time between adsorbent and water samples under gentle shaking. The doses of adsorbent employed to remove 10 and 100 mg L-1 of amoxicillin were 100 and 500 µL, respectively. Characterization of the adsorbent surfaces was performed by Scanning and Transmission Electron Microscopy, Energy Dispersive X-ray Spectroscopy, BET analysis and Fourier-transform infrared spectroscopy. Recycling studies were carried out employing 500 µL of NaOH solution 1 M during 15 min in order to explore desorption and reuse of the adsorbent, showing that Fe3O4@AgNPs remains unaltered and can be used for two more additionally adsorption cycles, exhibiting 93% adsorption efficiency after the third regeneration. The characterization of equilibrium isotherms and thermodynamics reveal a Langmuir-type endothermic chemisorption.

CART19-BE-01: A Multicenter Trial of ARI-0001 Cell Therapy in Patients with CD19+ Relapsed/Refractory Malignancies.

We evaluated the administration of ARI-0001 cells (chimeric antigen receptor T cells targeting CD19) in adult and pediatric patients with relapsed/refractory CD19+ malignancies. Patients received cyclophosphamide and fludarabine followed by ARI-0001 cells at a dose of 0.4-5 × 106 ARI-0001 cells/kg, initially as a single dose and later split into 3 fractions (10%, 30%, and 60%) with full administration depending on the absence of cytokine release syndrome (CRS). 58 patients were included, of which 47 received therapy: 38 with acute lymphoblastic leukemia (ALL), 8 with non-Hodgkin's lymphoma, and 1 with chronic lymphocytic leukemia. In patients with ALL, grade ≥3 CRS was observed in 13.2% (26.7% before versus 4.3% after the amendment), grade ≥3 neurotoxicity was observed in 2.6%, and the procedure-related mortality was 7.9% at day +100, with no procedure-related deaths after the amendment. The measurable residual disease-negative complete response rate was 71.1% at day +100. Progression-free survival was 47% (95% IC 27%-67%) at 1 year: 51.3% before versus 39.5% after the amendment. Overall survival was 68.6% (95% IC 49.2%-88%) at 1 year. In conclusion, the administration of ARI-0001 cells provided safety and efficacy results that are comparable with other academic or commercially available products. This trial was registered as ClinicalTrials.gov: NCT03144583.

In vitro ovicidal activity of Brongniartia montalvoana against small ruminant gastrointestinal nematodes.

Several plants of the Fabaceae family have been assessed regarding their high nutritional value and anthelmintic properties. The ovicidal effect of the hydroalcoholic extract (Bm-HAE) and subfractions from the aerial parts of Brongniartia montalvoana (Fabaceae) against a mixed strain of gastrointestinal nematodes (GIN) (Haemonchus spp., Trichostrongylus spp. and Oesophagostomum spp.) resistant to albendazole sulfoxide, ivermectin and levamisole was evaluated by the egg hatch test (EHT). The Bm-HAE was subjected to liquid-liquid chemical separation with ethyl acetate giving two fractions, an aqueous (Bm-Aq) and an organic (Bm-EtOAct). The purification of the bioactive fraction (Bm-EtOAct) through chromatographic separation resulted in four bioactive subfractions (BmR6, BmR7, BmR8 and BmR10). The treatments were designed as follows: Bm-HAE at 800, 1,500, 3,000 and 6,000 µg/mL, and Bm-Aq, Bm-EtOAct and subfractions (BmR6, BmR7, BmR8 and BmR10) at 100, 200, 400 and 800 µg/mL. Two properly negative controls (distilled water and 2% methanol) and thiabendazole (100 µg/mL) as a positive control were used for each bioassay. The chemical identification of the extract, fractions and subfractions was performed through chromatographic processes like open column chromatography, thin-layer chromatography (TLC) and high-performance liquid chromatography (HPLC-PDA). Additionally, the GIN eggs exposed to the bioactive compounds were observed through confocal laser scanning microscopy (CLSM). The Bm-HAE showed 99.5% egg hatching inhibition (EHI) at 6,000 µg/mL with a lethal concentration (LC50) of 1110 µg/mL. The Bm-EtOAc fraction displayed 99.1% EHI at 800 µg/mL with LC50 = 180 µg/mL. The ovicidal activity of the four subfractions was similar at 800 µg/mL: BmR6 (92% EHI); BmR7 (100% EHI); BmR8 (97.8%); and BmR10 (99.1%). The HPLC-PDA analysis of the bioactive subfractions allowed identification of p-coumaric acid, ferulic acid and coumarin derivatives as major compounds. The CLSM analysis allowed observation of morphological alterations in unhatched larvae caused by bioactive compounds present in the Bm-EtOAc and BmR10. In addition, the flavonoids eriodyctiol, luteolin and cynaroside were described for the first time for B. montalvoana.

Biologically synthesized silver nanoparticles as potent antibacterial effective against multidrug-resistant Pseudomonas aeruginosa.

Pseudomonas aeruginosa is one of the most worrisome infectious bacteria due to its intrinsic and acquired resistance against several antibiotics and the recalcitrance of its infections; hence, the development of novel antimicrobials effective against multidrug-resistant P. aeruginosa is mandatory. In this work, silver nanoparticles obtained by green synthesis using a leaf extract and fungi were tested against a battery of clinical strains from cystic fibrosis, pneumonia and burnt patients, some of them with multidrug resistance. Both nanoparticles showed a potent antibacterial effect, causing severe damage to the cell wall, membrane and DNA, and inducing the production of reactive oxygen species. Moreover, the nanoparticles derived from fungi showed synergistic antibacterial effects with the antibiotics meropenem and levofloxacin for some clinical strains and both kinds of nanoparticles were nontoxic for larvae of the moth Galleria mellonella, encouraging further research for their implementation in the treatment of P. aeruginosa infections.

Arterial stiffness in acute COVID-19 and potential associations with clinical outcome.

BACKGROUND: Coronavirus disease 2019 (COVID-19) interferes with the vascular endothelium. It is not known whether COVID-19 additionally affects arterial stiffness. METHODS: This case-control study compared brachial-ankle pulse wave (baPWV) and carotid-femoral pulse wave velocities (cfPWV) of acutely ill patients with and without COVID-19. RESULTS: Twenty-two COVID-19 patients (50% females, 77 [67-84] years) were compared with 22 age- and sex-matched controls. In COVID-19 patients, baPWV (19.9 [18.4-21.0] vs. 16.0 [14.2-20.4], P = 0.02) and cfPWV (14.3 [13.4-16.0] vs. 11.0 [9.5-14.6], P = 0.01) were higher than in the controls. In multiple regression analysis, COVID-19 was independently associated with higher cfPWV (ß = 3.164, P = 0.004) and baPWV (ß = 3.532, P = 0.003). PWV values were higher in nonsurvivors. In survivors, PWV correlated with length of hospital stay. CONCLUSION: COVID-19 appears to be related to an enhanced PWV reflecting an increase in arterial stiffness. Higher PWV might be related to an increased length of hospital stay and mortality.

Fabrication of strong magnetic micron-sized supraparticles with anisotropic magnetic properties for magnetorheology.

We propose three different techniques to synthesize anisotropic magnetic supraparticles for their incorporation in the formulation of magnetorheological fluids with novel potential applications. The techniques include microtransfer molding, electrodeposition and microfluidic flow-focusing devices. Although the yield of these methods is not large, with their use, it is possible to synthesize supraparticles with anisotropy in both their magnetic content and shape. The magnetorheological characteristics (yield stress) of the resulting field-induced structures were computed using finite element method simulations and demonstrated to be strongly dependent on the microstructural anisotropy of the supraparticles. In anisotropic particles, the simulated yield stress is always larger than that of the isotropic ones consisting of magnetically homogeneous spherical particles.

Doppler changes in umbilical artery, middle cerebral artery, cerebroplacental ratio and ductus venosus during open fetal microneurosurgery for intrauterine open spina bifida repair.

OBJECTIVE: To describe changes in fetal Doppler parameters during a novel technique for open fetal microneurosurgery for open spina bifida (OSB) repair. METHODS: This was a prospective study of 44 fetuses undergoing open fetal surgery for OSB repair using a novel microneurosurgery approach that is characterized by a mini-hysterotomy (diameter of 15 mm), minimal fetal manipulation and maintenance of a constant normal amniotic fluid volume throughout the procedure. Doppler velocimetry of the umbilical artery (UA), fetal middle cerebral artery (MCA) and ductus venosus (DV) was performed before the start of surgery and at prespecified timepoints during fetal surgery. UA pulsatility index (PI) > 95th percentile, DV-PI > 95th percentile, MCA-PI < 5th percentile and cerebroplacental ratio (CPR) < 5th percentile were considered abnormal. RESULTS: Median gestational age at fetal surgery was 25.2 weeks (range, 22.9-27.9 weeks). Doppler recordings were successfully obtained in all cases during all timepoints throughout the surgery. As compared with Doppler values before surgery, there was a significant increase in the proportion of fetuses with MCA-PI < 5th percentile (63.6% vs 13.6%; P < 0.001), CPR < 5th percentile (65.9% vs 15.9%; P < 0.001) and DV-PI > 95th percentile (22.7% vs 0%; P = 0.01) and a non-significant increase in the proportion of fetuses with UA-PI > 95th percentile (11.4% vs 0%; P = 0.12) during fetal surgery. None of the fetuses showed absent or reversed end-diastolic velocity in the UA or absent or reversed DV a-wave at any stage during OSB repair. All abnormal Doppler parameters returned to normal after surgery. CONCLUSIONS: During open fetal surgery for OSB repair, a small hysterotomy, reduced fetal manipulation and maintenance of a normal amniotic fluid volume seem to prevent severe fetal Doppler abnormalities. The mild Doppler changes observed during fetal surgery could be a manifestation of fetal adaptation to the stress of fetal surgery. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Invasive tree cover covaries with environmental factors to explain the functional composition of riparian plant communities.

Invasive species are a major cause of biodiversity loss worldwide, but their impact on communities and the mechanisms driving those impacts are varied and not well understood. This study employs functional diversity metrics and guilds-suites of species with similar traits-to assess the influence of an invasive tree (Tamarix spp.) on riparian plant communities in the southwestern United States. We asked: (1) What traits define riparian plant guilds in this system? (2) How do the abundances of guilds vary along gradients of Tamarix cover and abiotic conditions? (3) How does the functional diversity of the plant community respond to the gradients of Tamarix cover and abiotic conditions? We found nine distinct guilds primarily defined by reproductive strategy, as well as growth form, height, seed weight, specific leaf area, drought and anaerobic tolerance. Guild abundance varied along a covarying gradient of local and regional environmental factors and Tamarix cover. Guilds relying on sexual reproduction, in particular, those producing many light seeds over a long period of time were more strongly associated with drier sites and higher Tamarix cover. Tamarix itself appeared to facilitate more shade-tolerant species with higher specific leaf areas than would be expected in resource-poor environments. Additionally, we found a high degree of specialization (low functional diversity) in the wettest, most flood-prone, lowest Tamarix cover sites as well as in the driest, most stable, highest Tamarix cover sites. These guilds can be used to anticipate plant community response to restoration efforts and in selecting appropriate species for revegetation.

Early Chemistry of Nicotine Degradation in Heat-Not-Burn Smoking Devices and Conventional Cigarettes: Implications for Users and Second- and Third-Hand Smokers.

Nicotine exposure results in health risks not only for smokers but also for second- and third-hand smokers. Unraveling nicotine's degradation mechanism and the harmful chemicals that are produced under different conditions is vital to assess exposure risks. We performed a theoretical study to describe the early chemistry of nicotine degradation by investigating two important reactions that nicotine can undergo: hydrogen abstraction by hydroxyl radicals and unimolecular dissociation. The former contributes to the control of the degradation mechanism below 800 K due to a non-Arrhenius kinetics, which implies an enhancement of reactivity as temperature decreases. The latter becomes important at higher temperatures due to its larger activation energy. This change in the degradation mechanism is expected to affect the composition of vapors inhaled by smokers and room occupants. Conventional cigarettes, which operate at temperatures higher than 1000 K, are more prone to yield harmful pyridinyl radicals via nicotine dissociation, while nicotine in electronic cigarettes and vaporizers, with operating temperatures below 600 K, will be more likely degraded by hydroxyl radicals, resulting in a vapor with a different composition. Although low-temperature nicotine delivery devices have been claimed to be less harmful due to their nonburning operating conditions, the non-Arrhenius kinetics that we observed for the degradation mechanism below 873 K suggests that nicotine degradation may be more rapidly initiated as temperature is reduced, indicating that these devices may be more harmful than it is commonly assumed.

Clinical impact of misinterpretation of dual-energy X-ray absorptiometry during the evaluation of osteoporotic patients.

Osteoporosis is a highly prevalent systemic skeletal disorder leading to decreased bone strength and increased susceptibility to fragility fracture. The global burden of osteoporosis negatively impacts health systems around the world, and the estimation of millions of individuals at high risk for fracture in 2010 will double by the year 2040. There are many techniques to evaluate bone mineral density, but the preferred method in clinical practice is dual-energy X-ray absorptiometry (DXA). This method, despite offering multiple advantages, can lead us to a wrong diagnosis if we do not take into account certain clinical and technical considerations. The objective of this review is to analyze the different aspects that we must consider when, as clinicians, we have to evaluate a densitometric report. These aspects are presented as technical factors influencing DXA results and patients' conditions limiting DXA interpretation.

Does a standard school trolley fit children of different heights?

Although school trolleys are an alternative to traditional backpacks, no studies have determined their suitability for children of different heights. This study aims to analyse the fit of a school trolley (0.89 m height from the top to the bottom of the handle) for children with different heights based on kinematic variables and the rate of perceived effort (RPE). A 3D motion capture system was used to analyse the kinematics of the thorax and hip during walking without load and when pulling a trolley loaded with 15% of the child's body weight (BW). The RPE was recorded at the end of each trial. The height of the subjects was clustered using Ward´s hierarchical cluster, and two groups were identified: Group 1: 120-139.9 cm; and Group 2: 140-160 cm. No differences were found between groups in the kinematics or RPE. In conclusion, a standard school trolley fits well to children with heights from 120 to 160 cm. Practitioner Summary: No studies have determined the suitability of school trolleys for children of different heights. This study aims to analyse the fit of a school trolley for children with different heights based on the kinematics and rate of perceived effort. The major finding is that a standard school trolley fits children with heights from 120 to 160 cm well and that the height of the school trolley was between 59% and 68% of the children's heights. Abbreviations: RPE: rate of perceived exertion; BW: body weight; CAST: calibrated anatomical system technique; GC: gait cycle.

Post-exposure prophylaxis for HIV infection in sexual assault victims.

OBJECTIVES: Sexual assault (SA) is recognized as a public health problem of epidemic proportions. Guidelines recommend the administration of post-exposure prophylaxis (PEP) after an SA. However, few data are available about the feasibility of this strategy, and this study was conducted to assess this. METHODS: We conducted a retrospective, longitudinal, observational study in SA victims attending the Hospital Clinic in Barcelona from 2006 to 2015. A total of 1695 SA victims attended the emergency room (ER), of whom 883 met the PEP criteria. Five follow-up visits were scheduled at days 1, 10, 28, 90 and 180 in the out-patient clinic. The primary endpoint was PEP completion rate at day 28. Secondary endpoints were loss to follow-up, treatment discontinuation, occurrence of adverse events (AEs) and rate of seroconversion. RESULTS: The median age of participants was 25 years [interquartile range (IQR) 21-33 years] and 93% were female. The median interval between exposure and presentation at the ER was 13 h (IQR 6-24 h). The level of risk was appreciable in 47% (n = 466) of individuals. Of 883 patients receiving PEP, 631 lived in Catalonia. In this group, the PEP completion rate at day 28 was 29% (n = 183). The follow-up rate was 63% (n = 400) and 38% (n = 241) at days 1 and 28, respectively. Treatment discontinuation was present in 58 (15%) of 400 patients who attended at least the day 1 visit, the main reason being AEs (n = 35; 60%). AEs were reported in 226 (56%) patients, and were mainly gastrointestinal (n = 196; 49%). Only 211 (33%) patients returned for HIV testing at day 90. A single seroconversion was observed in a men who have sex with men (MSM) patient at day 120. CONCLUSIONS: Follow-up and compliance rates in SA victims were poor. In addition, > 50% of the patients experienced AEs, which were the main reason for PEP interruption. Strategies to increase follow-up testing and new better tolerated drug regimens must be investigated to address these issues.

Collision Efficiency Parameter Influence on Pressure-Dependent Rate Constant Calculations Using the SS-QRRK Theory.

The system-specific quantum Rice-Ramsperger-Kassel (SS-QRRK) theory (J. Am. Chem. Soc. 2016, 138, 2690) is suitable to determine rate constants below the high-pressure limit. Its current implementation allows incorporating variational effects, multidimensional tunneling, and multistructural torsional anharmonicity in rate constant calculations. Master equation solvers offer a more rigorous approach to compute pressure-dependent rate constants, but several implementations available in the literature do not incorporate the aforementioned effects. However, the SS-QRRK theory coupled with a formulation of the modified strong collision model underestimates the value of unimolecular pressure-dependent rate constants in the high-temperature regime for reactions involving large molecules. This underestimation is a consequence of the definition for collision efficiency, which is part of the energy transfer model. Selection of the energy transfer model and its parameters constitutes a common issue in pressure-dependent calculations. To overcome this underestimation problem, we evaluated and implemented in a bespoke Python code two alternative definitions for the collision efficiency using the SS-QRRK theory and tested their performance by comparing the pressure-dependent rate constants with the Rice-Ramsperger-Kassel-Marcus/Master Equation (RRKM/ME) results. The modeled systems were the tautomerization of propen-2-ol and the decomposition of 1-propyl, 1-butyl, and 1-pentyl radicals. One of the tested definitions, which Dean et al. explicitly derived (Z. Phys. Chem. 2000, 214, 1533), corrected the underestimation of the pressure-dependent rate constants and, in addition, qualitatively reproduced the trend of RRKM/ME data. Therefore, the used SS-QRRK theory with accurate definitions for the collision efficiency can yield results that are in agreement with those from more sophisticated methodologies such as RRKM/ME.

Quality of life in patients with resectable rectal cancer during the first 24 months following diagnosis.

AIM: An increasing number of patients survive rectal cancer, resulting in more patients living with the side-effects of the treatment. Exploring quality of life before and after treatment enables follow-up and additional treatment to be adjusted to the patient's needs. The aim of the study was to describe the quality of life during the 24 months following diagnosis and to identify risk factors for poor quality of life. METHOD: This is a prospective cohort study of patients with rectal cancer followed up by extensive questionnaires. Patients from 16 surgical departments in Denmark and Sweden from 2012 to 2015 were included. The self-assessed quality of life was measured with a seven-point Likert scale. RESULTS: A total of 1110 patients treated with curative intent were included, and the response rate at the 24-month follow-up was 71%. Patients with rectal cancer assessed their quality of life before start of treatment as poorer than that of a reference population. At the 12- and 24-month follow-up, the quality of life on group level had recovered to the same level as for the reference population. Risk factors for poor quality of life included bother with urinary, bowel and stoma function. A reference population was used for comparison. CONCLUSION: The quality of life of patients with resectable rectal cancer recovered to levels comparable to a reference population 12 and 24 months after diagnosis. Our results indicate that the urinary, bowel and stoma function has an impact on quality of life.

Self-reported sexual dysfunction in patients with rectal cancer.

AIM: Patients with rectal cancer often experience sexual dysfunction after treatment. The aim of this study was to evaluate sexual function in a prospective cohort of patients regardless of treatment and tumour stage and explore what factors might affect sexual activity 1 year after diagnosis. METHOD: The QoLiRECT study (Quality of Life in RECTal cancer) is a prospective study on the health-related quality of life in patients with rectal cancer in Denmark and Sweden. Questionnaires were completed at diagnosis and 1 year. Clinical data were retrieved from national quality registries. RESULTS: Questionnaire data were available from 1085 patients at diagnosis and 920 patients at 1 year. Median age was 69 years (range 25-100). At diagnosis, 29% of the women and 41% of the men were sexually active, which was lower than an age-matched reference population. This was further reduced to 25% and 34% at 1 year. Risk factors for sexual inactivity were absence of sexual activity prior to the diagnosis and the presence of a stoma. Women experienced reduced lubrication and more dyspareunia at 1 year compared with the time of diagnosis. In men, erectile dysfunction increased from 46% to 55% at 1 year. CONCLUSION: Sexual activity in patients with rectal cancer is lower at diagnosis compared with the population norm and is further reduced at 1 year. The presence of a stoma contributed to reduced sexual activity after operation. Sexual dysfunction was difficult to evaluate due to low sexual activity in the cohort. In men, erectile dysfunction is common.

Low anterior resection syndrome in a Scandinavian population of patients with rectal cancer: a longitudinal follow-up within the QoLiRECT study.

AIM: Low anterior resection syndrome (LARS) is common after low anterior resection. Our aim was to evaluate the prevalence and 'bother' (subjective, symptom-associated distress) of major LARS after 1 and 2 years, identify possible risk factors and relate the bowel function to a reference population. METHOD: The QoLiRECT (Quality of Life in RECTal cancer) study is a Scandinavian prospective multicentre study including 1248 patients with rectal cancer, of whom 552 had an anterior resection. Patient questionnaires were distributed at diagnosis and after 1, 2 and 5 years. Data from the baseline and at 1- and 2-year follow-up were included in this study. RESULTS: The LARS score was calculated for 309 patients at 1 year and 334 patients at 2 years. Prevalence was assessed by a generalized linear mixed effects model. Major LARS was found in 63% at 1 year and 56% at 2 years. Bother was evident in 55% at 1 year, decreasing to 46% at 2 years. Major LARS was most common among younger women (69%). Among younger patients, only marginal improvement was seen over time (63-59%), for older patients there was more improvement (62-52%). In the reference population, the highest prevalence of major LARS-like symptoms was noted in older women (12%). Preoperative radiotherapy, defunctioning stoma and tumour height were found to be associated with major LARS. CONCLUSION: Major LARS is common and possibly persistent over time. Younger patients, especially women, are more affected, and perhaps these patients should be prioritized for early stoma closure to improve the chance of a more normal bowel function.