84 research outputs found
Impact of Perioperative Blood Transfusion on Oncological and Overall Survival after Radical Cystectomy
No full textDer Einfluss der PBT auf das Überleben von Patienten, die sich einer RZE in kurativer Intention unterziehen war bis ca. 2013 kaum untersucht, hiernach bietet sich eine sehr heterogene Datenlage. Diese Tatsache, sowie die in der Vergangenheit geäußerten methodologischen Einschränkungen und ausschließlich in retrospektivem Studiendesign an mitunter nicht zeitgenössischen Patientenkohorten durchgeführten Arbeiten veranlassten uns zur Durchführung der hier vorliegenden Arbeit. In unserer prospektiven, zeitgenössischen und multizentrischen Kohorte konnten wir zeigen, dass die Gabe von PBT einen negativen Einfluss in der unadjustierten Überlebensanalyse hat, sich dieser aber aufhebt, wenn Unterschiede in den Patientencharakteristika von Patienten die eine PBT erhalten versus nicht erhalten mittels IPTW abgeschwächt bzw. ausgeglichen werden. Diese Daten interpretieren wir so, dass in unserem Patientenkollektiv nicht die eigentliche PBT, sondern die Umstände, die diese bedingen, also ein fortgeschrittenes Tumorleiden, ausgeprägte Komorbidität, weibliches Geschlecht, Ursache des verringerten Überlebens von Patienten die eine PBT benötigen, sind.
Obwohl wir durch unser Studiendesign und statistische Methodik eine Minimalisierung möglicher Confounder zu erreichen versuchten, bieten sich weiterhin zahlreiche mögliche Störquellen (s.o.). Da eine abschließende Klärung der Frage mittels idealerweise randomisiert kontrolliertem Studiendesign ethisch nicht vertretbar sein kann, sollten sich zukünftige Studienvorhaben neben einer genauen Erkundung der Ursachen und möglicher Prävention von TRIM insbesondere um eine verbesserte Prävention der PBT richten. Beispiele hierfür sind aktuelle Arbeiten, die über das perioperative Volumenmanagement, bzw. Gabe von Hämostyptika eine signifikante Reduzierung des perioperativen Blutverlusts bzw. der Gabe von PBT bei Patienten die eine RZE unterlaufen, erreichen konnten.The impact of PBT on survival in patients that undergo curatively intended radical cystectomy (RC) had received only limited study up to 2013. Studies published thereafter were inconclusive and partly contradictory. Notably, the majority of these studies relied on retrospective study design, patient cohorts that spanned several decades and possibly methodological inconsistencies. These shortcomings let us to propose the current work. Using a contemporary, multi-institutional cohort of prospectively enrolled patients, we were able to demonstrate that PBT have a significant impact in unadjusted survival analyses. However, after mitigating imbalances in patient characteristics via IPTW, we found that this association no longer held true. Our interpretation of these data is that in our patient cohort, the circumstances necessitating PBT, such as advanced disease stage, comorbidities, or female gender are the cause of inferior survival, regardless of PBT.
Even though we attempted to minimize confounding (i.e. relying on prospective data collection; multicentre, contemporary patient cohort; IPTW and competing-risk regression) our study is subject to multiple sources of remaining bias. However, a conclusive assessment of the question at stake, optimally via randomized controlled study design appears technically and moreover ethically impossible. Therefore, future avenues of research may be exploring the causation leading to TRIM as well as measures to minimize PBT. Examples of such approach are recent works that utilized perioperative hydration volume management, as well as use of hemostatic agents to significantly reduce perioperative blood loss in patients undergoing RC
The Impacts of Insecurity and Instability on FDI Inflow and Business Activities in Afghanistan
No full textAbstract: Despite the existence of plenteous investment opportunities in various sectors such as mining, infrastructure, energy, agriculture, services, construction, and telecommunication, moreover the unprecedented attention of the international community, large-scale financial assistance in the last two decades, the strong support and significant reforms initiated by the government to facilitate a better environment for doing business; unfortunately, Afghanistan remains one of the most unattractive poor economies in the world. Four decades of conflicts, the deterrent security situation, and the political instability significantly caused backwardness and poverty and negatively impacted the overall economic growth in the country.
Therefore, this study investigates the negative impacts of insecurity and instability on the inflow of foreign direct investments (FDI) and business activities in Afghanistan. Meanwhile, it explores the role of FDI and business activities in stimulating economic growth, improving security conditions, and assuring peace and stability in the country.
The research employed a survey questionnaire to collect the primary data from the Afghan business community who have been directly and indirectly affected by the consequences of insecurity and instability. At the same time, the literature of other studies was comprehensively reviewed to discuss the research topic and collect the secondary data. A mixture of qualitative and quantitative approaches was adopted to analyze and describe the research findings.
Keywords: Afghan Economy, Business Activities, Economic Growth, FDI, Insecurity and FDI, Instability.
Title: The Impacts of Insecurity and Instability on FDI Inflow and Business Activities in Afghanistan
Author: Atiqullah Nusrat
International Journal of Recent Research in Thesis and Dissertation (IJRRTD)
Vol. 3, Issue 1, January 2022 - June 2022
Page No: 54-64
Paper Publications
Website: www.paperpublications.org
Published Date: 13-May-2022
DOI: https://doi.org/10.5281/zenodo.6546658
Paper Download Link (Source):
https://www.paperpublications.org/upload/book/The%20Impacts%20of%20Insecurity-13052022-3.pdfInternational Journal of Recent Research in Thesis and Dissertation (IJRRTD), Paper Publications, Website: www.paperpublications.or
Reply to Vladimir Novotny, Manfred P. Wirth, Michael Froehner's Letter to the Editor re: Atiqullah Aziz, Matthias May, Maximilian Burger, et al. PROMETRICS 2011 research group. Prediction of 90-day Mortality After Radical Cystectomy for Bladder Cancer in a Prospective European Multicenter Cohort. Eur Urol 2014;66:156–163
No full text
Predictive and Prognostic Value of Preoperative Thrombocytosis in Upper Tract Urothelial Carcinoma
No full textMicro-Abstract We evaluated the predictive and prognostic role of preoperative thrombocytosis (TC) in upper tract urothelial carcinoma. Records of 2492 patients undergoing radical nephroureterectomy between 1990 and 2008 were retrospectively analyzed. Preoperative TC predicts nonâorgan-confined disease (P 400 à 109/L, irrespective of gender type. Logistic regression analyses were performed to evaluate its association with pathologic features. Cox proportional hazards regression was used for estimation of recurrence-free survival, cancer-specific survival, and overall survival. Results Preoperative TC was found in 309 (12.4%) patients and was associated with advanced tumor stage and grade, lymph node metastasis, lymphovascular invasion, tumor architecture, necrosis, and concomitant carcinoma in situ (P-values â¤.027). Preoperative TC independently predicted ⥠pT2 (P <.001), nonâorgan-confined (P <.001), and lymph node-positive (P <.001) disease in a preoperative model that adjusted for the effects of age, gender, location, multifocality, and tumor architecture. Within a median follow-up of 45 months, recurrence occurred in 663 (26.6%) patients with 545 (21.9%) dying of UTUC. In univariable Cox proportional hazard regression analysis, TC was significantly associated with recurrence-free survival (hazard ratio [HR], 1.32; P =.015) and overall survival (HR, 1.4; P <.001), but not cancer-specific survival (HR, 1.17; P =.2). In both pre- and postoperative multivariable models, when adjusted for the effects of standard clinicopathologic features, TC did not retain its association with survival outcomes. Conclusions Preoperative TC is associated with adverse clinicopathologic features and predicts worse pathology at RNU. Among other serum biomarkers, TC could benefit preoperative risk stratification and help guide treatment decisions
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Parallel processing in optimal structural design using simulated annealing
No full textIn this work the basics of parallel computer architectures and some popular parallelization strategies are described. Simulated annealing (SA), a stochastic, discrete optimization technique, is chosen for its global capability, robustness, and suitability for parallel processing. The concept of 'shakeup' in SA, which simulates reannealing, is introduced. The beneficial effects of shakeup for escaping local optima is demonstrated by solving a 2D multimodal optimization problem. A pin-jointed 10-storied multibay plane truss structure is considered as an example optimization problem and has been solved using both serial as well as parallel versions of the SA algorithm. The parallel result, achieved with a relatively small parallel configuration of the computer, indicates that very large structural designs can be optimized in much shorter times along with high probability of achieving global solutions even on moderately sized parallel computers. (Author
Perioperative chemotherapy in upper tract urothelial carcinoma: a comprehensive review.
No full textPURPOSE
To evaluate the role of neoadjuvant (NAC) and adjuvant chemotherapy (AC) in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU).
METHODS
A comprehensive review of the current literature was performed searching for all studies investigating NAC and AC in UTUC in MEDLINE and https://clinicaltrials.gov , prior to April 2016. The following keywords were used: "ureteral neoplasms," "urothelium," "ureter," "upper tract urothelial," "chemotherapy," "adjuvant," "neoadjuvant" and relevant variants.
RESULTS
No randomized trials investigated the role of AC or NAC for UTUC. There was one prospective study with n = 36 patients investigating AC with carboplatin-paclitaxel. We included 14 retrospective studies (four in the NAC and ten in the AC setting), with a total of 694 patients receiving cisplatin-based or non-cisplatin-based AC after RNU and 1437 patients undergoing RNU alone. We found that the current literature, mainly based on retrospective studies, suggests significant overall and cancer-specific survival benefits for AC in UTUC. NAC appears promising, with favorable pathologic response rates up to 14%.
CONCLUSIONS
Evidence is scarce for both NAC and AC use in UTUC. This comprehensive review suggests promising response rates for NAC and a survival benefit for patients treated with AC. Prospective randomized trials are needed to establish the role of AC and NAC in UTUC
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