Urologic latency time during uroflow stop test with electromyography: an incontinence detector in rehabilitation after robotic radical prostatectomy.

BACKGROUND: Stress urinary incontinence (UI) is the most common presentation following robot-assisted radical prostatectomy (RARP), but a postoperative non-invasive and objective test is still lacking. To assess pelvic floor integrity after RARP, we recently proposed Uroflow Stop Test (UST) with surface electromyography (EMG). AIM: Here we provide two new clinical parameters: the neurologic latency time (NLT) and the urologic latency time (ULT) derived from UST-EMG Test. Principal outcome was to evaluate their variation during one year follow-up and ULT ability to predict post-RARP UI. DESIGN: Observational and longitudinal study. SETTING: Interdivisional Urology Clinic (Perugia-Terni, Italy). POPULATION: Patients with prostate cancer treated with a full nerve-sparing RARP who underwent postoperative pelvic floor muscles training (PFMT): a diurnal functional home program and a weekly hospital program with the use of biofeedback, between 1 and 3 months postoperatively. METHODS: All patients consecutively performed a UST-EMG test at one, three, six, and twelve months after surgery. At each follow-up visit we collected NLT values, ULT values, 5-item 26-Expanded Prostate Cancer Index (EPIC), Incontinence Developed on Incontinence Questionnaire (ICIQ-UI) Short Form and International Prostate Symptom Score (IPSS). We analysed statistically significant differences in NLT and ULT between continent and incontinent patients and we evaluate the diagnostic ability of 1-month post-surgery ULT value to diagnose the presence of postoperative UI. RESULTS: Sixty patients were enrolled. The mean time to PFMT was 31.08 (range: 30-35) days. Overall IPSS, NLT and ULT had similar trends: progressive decrease until the six months after surgery (1-month vs. 3 months vs. 6 months, P<0.05) to plateau thereafter. When considering the two group of patients, IPSS and NLT were significantly higher in the incontinent group only one month after surgery, while ULT became similar between the two groups at 6 months after surgery. The best cut-off of 1-month ULT values that maximized the Youden function at 12-months resulted 3.13 second. CONCLUSIONS: NLT and ULT may respectively account for the nerve and the urethral closure system integrity post-RARP. In the first month after RARP, both NLT and ULT differs between incontinent vs. continent patients. NLT become similar between two group after one month, confirming the recovery from neuropraxia, but ULT remains statistically significant different until 3 months postoperatively. The value of 1-month ULT resulted a valid tool to predict incontinence status at 12 months. CLINICAL REHABILITATION IMPACT: ULT and NLT may be also useful tools to monitor the continence progressive recovery after RARP and they may help rehabilitation specialists to evaluate the ongoing results during postoperative follow-up.

Mixing Improvement in a T-Shaped Micro-Junction through Small Rectangular Cavities.

The T-shaped micro-junction is among the most used geometry in microfluidic applications, and many design modifications of the channel walls have been proposed to enhance mixing. In this work, we investigate through numerical simulations the introduction of one pair of small rectangular cavities in the lateral walls of the mixing channel just downstream of the confluence region. The aim is to preserve the simple geometry that has contributed to spread the practical use of the T-shaped micro-junction while suggesting a modification that should, in principle, work jointly with the vortical structures present in the mixing channel, further enhancing their efficiency in mixing without significant additional pressure drops. The performance is analyzed in the different flow regimes occurring by increasing the Reynolds number. The cavities are effective in the two highly-mixed flow regimes, viz., the steady engulfment and the periodic asymmetric regimes. This presence does not interfere with the formation of the vortical structures that promote mixing by convection in these two regimes, but it further enhances the mixing of the inlet streams in the near-wall region of the mixing channel without any additional cost, leading to better performance than the classical configuration.

Optimized design of obstacle sequences for microfluidic mixing in an inertial regime.

Mixing is a basic but challenging step to achieve in high throughput microfluidic applications such as organic synthesis or production of particles. A common approach to improve micromixer performance is to devise a single component that enhances mixing through optimal convection, and then sequence multiple such units back-to-back to enhance overall mixing at the end of the sequence. However, the mixing units are often optimized only for the initial non-mixed fluid composition, which is no longer the input condition for each subsequent unit. Thus, there is no guarantee that simply repeating a single mixing unit will achieve optimally mixed fluid flow at the end of the sequence. In this work, we analyzed sequences of 20 cylindrical obstacles, or pillars, to optimize the mixing in the inertial regime (where mixing is more difficult due to higher Péclet number) by managing their interdependent convection operations on the composition of the fluid. Exploiting a software for microfluidic design optimization called FlowSculpt, we predicted and optimized the interfacial stretching of two co-flowing fluids, neglecting diffusive effects. We were able to quickly design three different optimal pillar sequences through a space of 3220 possible combinations of pillars. As proof of concept, we tested the new passive mixer designs using confocal microscopy and full 3D CFD simulations for high Péclet numbers (Pe ≈ O(105-6)), observing fluid flow shape and mixing index at several cross-sections, reaching mixing efficiencies around 80%. Furthermore, we investigated the effect of the inter-pillar spacing on the most optimal design, quantifying the tradeoff between mixing performance and hydraulic resistance. These micromixer designs and the framework for the design in inertial regimes can be used for various applications, such as lipid nanoparticle fabrication which has been of great importance in vaccine scale up during the pandemic.

A Study on the Effect of Flow Unsteadiness on the Yield of a Chemical Reaction in a T Micro-Reactor.

Despite the very simple geometry and the laminar flow, T-shaped microreactors have been found to be characterized by different and complex steady and unsteady flow regimes, depending on the Reynolds number. In particular, flow unsteadiness modifies strongly the mixing process; however, little is known on how this change may affect the yield of a chemical reaction. In the present work, experiments and 3-dimensional numerical simulations are carried out jointly to analyze mixing and reaction in a T-shaped microreactor with the ultimate goal to investigate how flow unsteadiness affects the reaction yield. The onset of the unsteady asymmetric regime enhances the reaction yield by more than 30%; however, a strong decrease of the yield back to values typical of the vortex regime is observed when the flow undergoes a transition to the unsteady symmetric regime.

Predictors of Client Satisfaction with Outpatient Mental Health Clinic Services in Italy and New York.

The aim of this cross-sectional study was to assess factors associated with client satisfaction in two mental health outpatient settings in Italy and the US. Sociodemographic and clinical variables, hope, and personality characteristics were evaluated in 18-65-year-old patients who had been receiving services for at least 2 months in one of two outpatient clinics, in Italy and the US. Patients were administered: the Healthy Days Core Module, the Kessler Screening Scale for Psychological Distress, the Verona Service Satisfaction Survey, the Client Satisfaction Inventory, the Health Service OutPatient Experience questionnaire, the Herth Hope Index, and the NEO Five-Factor Inventory-3. Bivariate tests for differences between the two samples were conducted, a Satisfaction Composite z-score was computed, and a stepwise, backward elimination, multiple linear regression model-including the variables that were significantly associated with Satisfaction Composite Score in bivariate tests-was built. From July 1, 2015 to April 30, 2016, 184 patients (121 in Foligno, 63 in New York City) were enrolled in the study. Predictors of client satisfaction included: receiving services in New York City, being older, having lower educational attainment, having inner positive readiness and expectancy as well as interconnectedness with self and others, and high scores on the agreeableness personality domain. Interestingly, diagnosis and treatment characteristics did not influence satisfaction. Client satisfaction with outpatient mental health services is mainly influenced by sociodemographic characteristics and personality factors more than clinical variables or patterns of care. These findings could have implications regarding trends toward value-based payment models.

Auditory and non-auditory hallucinations in first-episode psychosis: Differential associations with diverse clinical features.

Data from 247 first-episode psychosis patients were used to explore associations between types of hallucinations and nine diverse clinical characteristics. Psychopathology was rated using the Scale for the Assessment of Positive Symptoms and Scale for the Assessment of Negative Symptoms (SANS). Childhood adversity was assessed with seven instruments; family history with an adapted version of the Family Interview for Genetic Studies; age at onset of psychosis and duration of untreated psychosis (DUP) with the Symptom Onset in Schizophrenia inventory; and insight with the Birchwood Insight Scale. Both principal component analysis-derived Auditory and Non-Auditory Hallucinations were similarly associated with delusions of influence, negative affect delusions (jealousy and sin/guilt), interpersonal childhood abuse, DUP, and insight. However, the two hallucination domains had different associations with grandiose/religious, paranoid, and somatic delusions; SANS score; childhood violence exposure; cannabis use disorders; and cocaine/other drug use disorders. Neither Auditory nor Non-Auditory Hallucinations were associated with childhood neglect, age at onset, alcohol use disorders, family history, or mode of onset of psychosis. Findings support considering hallucinations not as a unitary psychopathological construct. They represent at least two domains and are correlated in different ways with diverse clinical variables.