1,720,996 research outputs found
90-DAY MORTALITY AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER
No full textIntroduction/Aim: Radical cystectomy represents the gold standard treatment in muscle-invasive bladder cancer and is one of the most challenging procedures in urologic surgery. This procedure is associated with significant perioperative morbidity and mortality, ranging from 20 to 64% and from 0.3 to 5.7%, respectively. The considerable inter-individual variability of perioperative mortality has led to the development of several models of individual perioperative mortality prediction for patients undergoing radical cystectomy. The aim of our study was to evaluate the predictive accuracy of the nomograms of Isbarn and Aziz and the identification of perioperative mortality risk factors in a series of patients undergoing radical cystectomy for muscle invasive bladder cancer at our institution. Patients and Methods: We retrospectively reviewed data regarding 145 consecutive patients who underwent radical cystectomy and urinary diversion for urothelial bladder cancer at our Institute between 2002 and 2012. The following pre-operative variables, such as age at intervention, gender, body mass index (BMI), operative volume, Charlson comorbidity index, presence of carcinoma in situ (CIS) to endoscopic resection bladder (TURV), American society of anesthesiologists (ASA) score, clinical stage according to the TNM and 90-day mortality, were collected and analyzed. The Isbarn and Aziz nomograms were, moreover, applied to our cohort. Results: Median age at radical cystectomy was 68 years and 85% of patients were male, with a median BMI of 26 (IQR=25-27). The most represented ASA score was 2, whereas the most frequent Charlson score (62.76%) was 0. Median in-hospital stay was 15 days, with a range between 7 and 35 days. Median follow-up was 26 months (IQR=11-45); five deaths were registered within 90 days (3.4%). Applying the nomograms of Aziz and Isbarn to our patients, we obtained an average mortality risk <10% and of 2.4%, respectively. At multivariate analysis, no variable was independently related to perioperative mortality risk. Evaluating the receiver operating characteristic (ROC) curves, the Aziz nomogram showed the highest predictive accuracy, while ASA score was found to be the single variable with the highest accuracy in predicting 90 days mortality. Results: In our series, at the multivariate analysis, none of the variables resulted as an independent risk factor for 90-day mortality; however, only ASA score seemed to have a trend in this sense. This retrospective study has a small number of participants with few events, thus making the multivariate analysis unreliable. Conclusion: In our series, 90- day mortality after radical cystectomy was 3.4% (5/145 patients). On univariate analysis, only Charlson comorbidity index (ref. 0-2; p= 0.019; 0.013), ASA score ( p= 0.004) and the adjusted ICC age (0.022) were indipendent risk factors of 90- day perioperative mortality, whereas at multivariate analysis, no variable was independently related to mortality risk. The Aziz nomogram presents the highest accuracy in predicting a 90-day mortality of patients undergoing radical cystectomy
OnabotulinumtoxinA detrusor injection improves female sexual function in women with overactive bladder wet syndrome
No full textObjectives: The correlation between changes in sexual function and improvements in LUTD in patients treated with OnabotulinumtoxinA (onaBoNT-A) detrusor injection is unclear and limited only to women with neurogenic OAB. The aim of this study was to evaluate the impact of OnabotulinumtoxinA (onaBoNT-A) injection on sexual function in women undergoing this treatment for idiopathic wet overactive bladder (OAB). Study design: This is a pilot three-center observational study including women affected by idiopathic wet overactive bladder refractory to standard conservative treatments and underwent onaBoNT-A injection. Sexuality was assessed using the Female Sexual Function Index (FSFI). A 3-day voiding diary, OAB screener questionnaire (OAB-S), and the international consultation on incontinence questionnaire short form (ICIQ-sf) were completed before and 3 months after onaBoNT-A injection to evaluate OAB symptoms. Results: All the 32 enrolled patients were included for statistical analysis. These patients received 100U of onaBoNT-A. Significant improvement of many FSFI domains was found. Only desire and pain domains had no significant improvements. The FSFI total score showed a significant improvement (P 0.0008). Clinical efficacy has been documented by voiding diaries, OAB-S scores, and ICIQ-sf scores. Correlation between UUI episodes and FSFI total score was statistically significant (r = −0.73; p = 0.04) while no significant correlation was found between the number of micturition and FSFI total score. Conclusion: Women who underwent successful OnaBoNT-A detrusor injection to treat wet OAB, showed an improvement in sexual function due to the significant correlation between the improvement of urinary urge incontinence and a better gratification of sexuality
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Bilateral lymph node micrometastases and seminal vesicle invasion associated with same clinical predictors in localized prostate cancer
No full textAim: To determine clinical factors associated with multiple bilateral lymph node micrometastases and seminal vesicle invasion (pT3b) in organ-confined prostate cancer (PCa).Methods: The study excluded patients under androgen deprivation, with lymph node involvement (cN1 status), and having undergone unilateral pelvic lymph node dissection (PLND) during radical prostatectomy (RP). Lymph node micrometastases were classified as unilateral (pN1m) and bilateral (pN1b). Analysis considered multivariate multinomial logistic regression models.Results: Between January 2013 and March 2015, 140 patients underwent PLND during RP. Lymph node micrometastases were detected in 28 cases (20%) including pN1m in 19 (13.6%) and pN1b in 9 (6.4%). Independent clinical predictors of pN1b included prostate-specific antigen (PSA, mu g/L) >12.5 (odds ratio [ OR] = 43.0), proportion of positive biopsy cores (PBC) >0.57 (OR = 6.7), and biopsy Gleason grade (bGG) >3 (OR = 7.5). Independent pT3b predictors included PSA>12.5 (OR = 3.8), PBC>0.57 (OR = 4.1), and bGG>3 (OR = 3.8).Conclusions: In cN0 patients with localized PCa undergoing PLND, a nonnegligible rate of multiple lymph node micrometastases was detected (32.2%). In the natural history of PCa, there is a close association between pT3b and pN1b disease. Prostate cancer patients who are at high risk of extraglandular extension need selective pelvic staging by multiparametric magnetic resonance imaging to assess seminal vesicle invasion. Operated patients with pT3b and pNx status need close PSA monitoring because of the high probability of occult multiple bilateral lymph node micrometastases
Association between Basal Total Testosterone Levels and Prostate Cancer D'Amico Risk Classes
No full textTo test the hypothesis that basal total testosterone (TT) serum levels are associated with the D'Amico risk classification at diagnosis of prostate cancer (PCA)
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
High body mass index predicts multiple prostate cancer lymph node metastases after radical prostatectomy and extended pelvic lymph node dissection
No full textOur aim is to evaluate the association between body mass index (BMI) and preoperative total testosterone (TT) levels with the risk of single and multiple metastatic lymph node invasion (LNI) in prostate cancer patients undergoing radical prostatectomy and extended pelvic lymph node dissection. Preoperative BMI, basal levels of TT, and prostate-specific antigen (PSA) were evaluated in 361 consecutive patients undergoing radical prostatectomy with extended pelvic lymph node dissection between 2014 and 2017. Patients were grouped into either nonmetastatic, one, or more than one metastatic lymph node invasion groups. The association among clinical factors and LNI was evaluated. LNI was detected in 52 (14.4%) patients: 28 (7.8%) cases had one metastatic node and 24 (6.6%) had more than one metastatic node. In the overall study population, BMI correlated inversely with TT (r = -0.256; P < 0.0001). In patients without metastases, BMI inversely correlated with TT (r = -0.282; P < 0.0001). In patients with metastasis, this correlation was lost. In the overall study population, BMI (odds ratio [OR] = 1.268; P = 0.005) was the only independent clinical factor associated with the risk of multiple metastatic LNI compared to cases with one metastatic node. In the nonmetastatic group, TT was lower in patients with BMI >28 kg m-2 (P < 0.0001). In patients with any LNI, this association was lost (P = 0.232). The median number of positive nodes was higher in patients with BMI >28 kg m-2 (P = 0.048). In our study, overweight and obese patients had a higher risk of harboring multiple prostate cancer lymph node metastases and lower TT levels when compared to patients with normal BMI
Total testosterone density predicts high tumor load and disease reclassification of prostate cancer: results in 144 low-risk patients who underwent radical prostatectomy
No full textObjectives: The aim of this study is to evaluate the association between total testosterone density (TTD), defined as the ratio of serum TT to prostate volume (PV), and high tumor load (HTL) in low-risk prostate cancer (PCA) patients who underwent radical prostatectomy. Materials and methods: Tumor load was defined as the percentage of prostate volume invaded by cancer (PPI-PCA) in the surgical specimen. Pathologic features including tumor upgrading, upstaging or positive surgical margins in the specimen defined unfavorable disease (UD). PSA, TT, PSA density (PSAD), TTD, percentage of biopsy positive cores (BPC), PV and body mass index (BMI). The association of factors with the risk UD and HTL was evaluated by statistical methods. Results: The cohort included 144 consecutive low-risk PCA patients. Overall, 104 patients (72.2%) had at least one feature indicating UD. TTD was associated with BMI, TT, PSA, PV and PPI-PCA ≥ 20% defined as HTL. A higher PPI-PCA was associated with an increased risk of UD with a fair discriminant power (area under the curve, AUC = 0.775; p 20% were considered the study group versus patients with a PPI-PCA < 20% (control group). BPC, PSAD and TTD were independently associated with the risk of HTL (PPI-PCA ≥ 20%) with receiver-operating characteristics (ROC) curves indicating the same discriminant power for BPC (AUC = 0.628; p = 0.013), PSAD (AUC = 0.611; p = 0.032) and TTD (AUC = 0.610; p = 0.032). Conclusions: Among low-risk PCA patients, TTD is associated with the risk of HTL, which is an independent predictor of UD and should be evaluated in the management of these patients
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