Purpose Minimally invasive surgical treatment for bladder cancer has gained popularity but standardized data on complications are lacking. Urinary diversion type contributes to complications and to ...our knowledge diversion types after minimally invasive cystectomy have not yet been compared. We evaluated perioperative complications stratified by urinary diversion type in patients treated with robot-assisted radical cystectomy. Materials and Methods We analyzed the records of 209 consecutive patients who underwent robot-assisted radical cystectomy at our institution from 2003 to 2012 with respect to perioperative complications, including severity, time period (early and late) and diversion type. All complications were reviewed by academic urologists. Urinary diversion was also done. As outcome measurements and statistical analysis, univariate and multivariate logistic regression models were used to determine predictors of various complications. Results The American Society of Anesthesiologists® (ASA) score was 3 or greater in 80% of patients and continent diversion was performed in 68%. Median followup was 35 months. Within 90 days 77.5% of patients experienced any complication and 32% experienced a major complication. The 90-day mortality rate was 5.3%. Most complications were gastrointestinal, infectious and hematological. On multivariate analysis patients with ileal conduit diversion had a decreased likelihood of complications compared to patients with Indiana pouch and orthotopic bladder substitute diversion despite the selection of a more comorbid population for conduit diversion. Continent diversion was associated with a higher likelihood of urinary tract infection. Our results are comparable to those of previously reported open and minimally invasive cystectomy series. Conclusions Open or minimally invasive cystectomy is a complex, morbid procedure. Urinary diversion is a significant contributor to complications, as is patient comorbidity. Although patients with an ileal conduit had more comorbidities, they experienced fewer complications than those with an orthotopic bladder substitute or Indiana pouch diversion.
Teacher satisfaction is a key affective reaction to working conditions and an important predictor of teacher attrition. Teacher evaluation as a tool for measuring teacher quality has been one source ...of teacher stress in recent years in the United States. There is a growing body of evidence on how to evaluate teachers in ways which support their growth and development as practitioners. For this study, we inquired: What is the relationship between supportive teacher evaluation experiences and U.S. teachers’ overall job satisfaction? To answer this question, we employed a multilevel regression analysis to multiply-imputed data on U.S. lower-secondary teachers’ experiences from the 2013 Teaching and Learning International Survey (TALIS). We found a small, positive relationship between the perceptions of supportive teacher evaluation experiences and U.S. secondary teachers’ satisfaction after controlling for other important teacher and school characteristics and working conditions. Further, teachers who felt their evaluation led to positive changes in their practice had higher satisfaction. Teachers whose primary evaluator was a fellow teacher as opposed to the principal also had higher satisfaction on average. We discuss the implications of these findings for school leaders as well as future teacher evaluation policy.
For many countries, inequitable access to rigorous content and instruction at the early grades leads to the low academic performance for students with fewer resources at home. One way to assess these ...inequities, and identify possible mediators, is to consider the role of instructional leadership as a means for schools to set educational goals for teachers and students which might direct how learning is accessed. This study examines the extent that instructional leadership influences the mediated relationship between students' home resources and opportunity to learn on math reasoning skills across a set of 53 participating countries. We applied a two-level structural equation model to data from the 2011 Trends in International Mathematics and Science Study (TIMSS). Using a nationally representative sample of schools and nested students for each participating country in TIMSS 2011, we demonstrate the variation in the extent and direction of these relationships by country context. For a few countries, instructional leadership mediated the relationship between home resources and opportunity to learn on math reasoning skills.
Abstract Background The technique of robot-assisted radical cystectomy (RARC) has evolved significantly since its inception >10 yr ago. Several high-volume centers have reported standardized ...techniques with refinements and subsequent outcomes. Objective To review all existing literature on RARC and urinary diversion techniques and summarize key points that may affect oncologic, surgical, and functional outcomes. Design, setting, and participants The Pasadena Consensus Panel on RARC and urinary reconstruction convened May 3–4, 2014, to review the existing peer-reviewed literature and create recommendations for best practice. The panel consisted of experts in open radical cystectomy and RARC. No commercial support was received. Surgical procedure The consensus panel extensively reviewed the surgical technique of RARC in men and women, extended pelvic lymph node dissection, extracorporeal urinary diversion, and intracorporeal urinary diversion. Critical aspects of the technique are described. Outcome measurements and statistical analysis Preoperative, operative, and postoperative parameters from the largest and most contemporary RARC series, stratified by urinary diversion technique, are presented. Results and limitations Preoperative, operative, and postoperative measures of RARC technique adhere closely to the standards established in open surgery. Conclusions Refinement of techniques for RARC and urinary diversion over the past 10 yr has made it safe, reproducible, and oncologically sound. Patient summary We summarize the critical aspects of surgical techniques reviewed at the Pasadena international consensus meeting on RARC and urinary reconstruction. Preoperative, operative, and postoperative measures of RARC technique adhere closely to the standards established in open surgery.
Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous in the environment and some exhibit carcinogenic and mutagenic toxicity. Three methods have been used for identification of PAHs sources in ...soils, including molecular diagnostic ratios, receptor models, and stable C isotopic signatures, with stable C isotopic ratios based on δ
13
C values being underutilized. Isotopic fractionation effects occur after environmental transportation of PAHs such as deposition and burial. This characteristic makes this method useful in source identification. Here, we provided a comprehensive review of tracing sources of soil PAHs using stable C isotopic fingerprinting technique. Fractionation of C isotopes occurs during formation and degradation processes of PAHs, making them useful tools to trace sources of PAHs in soils. The fundamentals of δ
13
C measurement and compound-specific isotopic analysis to trace sources of soil PAHs are summarized. Furthermore, for the first time, the biogeochemical cycle and contamination source evaluation based on δ
13
C signatures for soil PAHs are proposed. In addition, radioactive C isotope and stable H isotope ratios of PAHs are also briefly introduced as supplementary techniques. In short, these methods offer much promise, but still need work to fill in knowledge gaps. Establishing a C isotopic signature database to expand the utilization of this technique for tracing PAHs in soils is needed.
Purpose Neoadjuvant chemotherapy for muscle invasive bladder cancer has been shown to confer a survival advantage in phase III studies. Although cisplatin and gemcitabine are often used in this ...setting, a comprehensive evaluation of this regimen is lacking. In this review we summarize the efficacy of neoadjuvant cisplatin and gemcitabine chemotherapy for muscle invasive bladder cancer based on currently published studies. Materials and Methods A systematic literature review was conducted in April 2012 searching MEDLINE® databases. Articles were selected if they included patients with muscle invasive bladder cancer, evaluated the combination of cisplatin and gemcitabine as neoadjuvant treatment, and reported pathological data after cystectomy. Cisplatin and gemcitabine dosing regimens and clinical data were further summarized using weighted averages. Results Seven studies encompassing 164 patients were published between 2007 and 2012. The majority of patients (79%) received cisplatin and gemcitabine on a 21-day cycle. A weighted average of 19.2 lymph nodes was obtained at cystectomy, and 29.7% of patients were found to have pN1 disease. Pathological down staging to pT0 and less than pT2 occurred in 42 (25.6%) and 67 (46.5%) patients, respectively. Conclusions Neoadjuvant cisplatin and gemcitabine yield appreciable pathological response rates in patients with muscle invasive bladder cancer. Since pathological response has been implicated as a potential surrogate for survival in muscle invasive bladder cancer, these data suggest that neoadjuvant cisplatin and gemcitabine may warrant further prospective assessment.
Abstract
Background
The incidence of patients diagnosed with renal cell carcinoma (RCC) is increasing. There are no approved biofluid biomarkers for routine diagnosis of RCC patients. This ...retrospective study aims to identify cell-free microRNA (cfmiR) signatures in urine samples that can be utilized as biomarkers for early diagnosis of sporadic RCC patients.
Methods
Tissue, plasma, and urine samples (n = 221) from 56 sporadic RCC patients and respective normal healthy donors were profiled for 2083 microRNAs (miRs) using the next-generation sequencing-based HTG EdgeSeq miR Whole Transcriptome Assay. DESeq2 (FC |1.2|, false discovery rate <0.05) was performed to identify differentially expressed miRs. Data from RCC tissue samples of The Cancer Genome Atlas database were used for miR validation.
Results
We found a 10-miR signature that distinguished RCC tissues from remote normal kidney tissue or benign kidney lesion samples. Additionally, we identified subtype-specific miRs (miR-122-5p, miR-210-3p, and miR-21-3p) and miRs specific for all RCC subtypes (miR-106b-3p, miR-629-5p, and miR-885-5p). We observed that miR-155-5p was associated with tumor size. Using The Cancer Genome Atlas data sets, we validated the miRs found in RCC tissue samples. In plasma or urine analysis, we found cfmiRs that were consistently and significantly upregulated in RCC tissue samples. A 15-cfmiR signature was proposed in urine samples of RCC patients, of which miR-1275 was consistently upregulated in tissue, plasma, and urine samples.
Conclusions
This integrative study found diagnostic miRs/cfmiRs for RCC patients, which were validated using The Cancer Genome Atlas data sets. Distinctive cfmiR signatures found in urine may have clinical utility for the diagnosis of RCC.
Prostate cancer (PCa) nodal staging does not account for lymph node (LN) tumor burden. The LN anatomical compartment involved with the tumor or the quantified extent of extranodal extension (ENE) ...have not yet been studied in relation to biochemical recurrence-free survival (BRFS).
Histopathological slides of 66 pN1 PCa patients who underwent extended pelvic lymph node dissection were reviewed. We recorded metrics to quantify LN tumor burden. We also characterized the LN anatomical compartments involved and quantified the extent of ENE.
The median follow-up time was 38 months. The median number of total LNs obtained per patient was 30 (IQR 23-37). In the risk-adjusted cox regression model, the following variables were associated with BRFS: mean size of the largest LN deposit per patient (log2: adjusted hazard ratio (aHR) = 1.91,
< 0.001), the mean total span of all LN deposits per patient (2.07,
< 0.001), and the mean percent surface area of the LN involved with the tumor (1.58,
< 0.001). There was no significant BRFS association for the LN anatomical compartment or the quantified extent of ENE.
LN tumor burden is associated with BRFS. The LN anatomical compartments and the quantified extent of ENE did not show significant association with BRFS.
Objectives: This study tested the mediating effect of resilience on the relationship between life stress and health-related quality of life (HRQoL) in older people, 50 years of age and older, living ...with HIV/AIDS (OPLWHA).
Method: Data from 299 OPLWHA were analyzed using structural equation modeling (SEM) to define a novel resilience construct (represented by coping self-efficacy, active coping, hope/optimism, and social support) and to assess mediating effects of resilience on the association between life stress and HRQoL (physical, emotional, and functional/global well-being).
Results: SEM analyses showed satisfactory model fit for both resilience and mediational models, with resilience mediating the associations between life stress and physical, emotional, and functional/global well-being.
Conclusion: Resilience may reduce the negative influence of life stress on physical, emotional, and functional/global well-being in OPLWHA. Interventions that build personal capacity, coping skills, and social support may contribute to better management of HIV/AIDS and increase HRQoL.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
What's known on the subject? and What does the study add?
Extended pelvic lymphadenectomy is the present standard of care according to European Association of Urology guidelines. Extended dissection ...improves staging, removes more metastatic lymph nodes, and potentially has therapeutic benefits. Previous reports have examined the morbidity of extended dissection compared with a more limited dissection in the open and laparoscopic setting. While some have suggested an increased complication rate with extended node dissection, others have not.
This represents the first study focused on comparing the complications associated with the extent of node dissection using the modified Clavien system and Martin criteria in the literature on robot‐assisted surgery. In a single surgeon series, we found no statistically significant differences in complications. With careful anatomic dissection, robot‐assisted extended lymph node dissection can be performed safely and effectively, although operating time and length of hospital of stay are slightly increased.
Objectives
To compare the perioperative course of patients undergoing robot‐assisted limited lymph node dissection (LLND) or extended lymph node dissection (ELND) for prostate cancer.
To examine the differential lymph node counts and rates of detection of lymph node metastases.
Patients and Methods
Between 2008 and 2012, 406 consecutive patients with D'Amico intermediate‐ or high‐risk prostate cancer underwent either bilateral LLND (n = 204) or ELND (n = 202) and robot‐assisted laparoscopic radical prostatectomy by a single surgeon.
The region of dissection was the obturator fossa for LLND, while ELND included, in addition, the common iliac, external iliac and internal iliac lymph nodes.
All complications within 90 days of surgery were recorded according to a modified Clavien system.
Clinical variables were summarized and compared. Logistic regression was used to identify predictors of complications.
Results
There were no differences in demographics when comparing patients who underwent ELND with those who underwent LLND.
The median operating time was 3.0 h for the ELND cohort and 2.8 h in the LLND cohort (P < 0.001). Intraoperative blood loss was 200 mL in both cohorts. Hospital stay was longer for a small percentage of patients in the ELND cohort, with 75% of ELND patients and 85% of LLND patients staying 1 day (P = 0.004).
No significant difference was found in the overall or major complication rates between LLND (21.6% overall; 6.9% major) and ELND (22.8% overall; 4.5% major). No difference was seen in the symptomatic lymphocele rate between LLND and ELND, 2.9 vs 2.5%, respectively.
Overall, the lymph‐node‐positive rate was 12% compared with 4% for the ELND and LLND groups, respectively (P = 0.002).
A higher Charlson comorbidity index score was associated with the development of major complications.
Conclusions
ELND at the time of robot‐assisted radical prostatectomy can be performed safely with minimal additional morbidity.
Long‐term oncological and functional outcomes require further study.
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