关键词： cystectomy   neoadjuvant therapy   drug therapy   urinary bladder neoplasms  

摘要： Purpose: Patients with muscle invasive bladder cancer (MIBC) of variant histology have a poor prognosis. It is unclear if neoadjuvant chemotherapy prior to radical cystectomy is associated with pathological downstaging or improved overall survival (OS) for patients with variant histology. Our objective was to assess for associations between receipt of neoadjuvant chemotherapy, pathological downstaging and OS for patients with variant histology MIBC. Materials and Methods: Patients were identified in the National Cancer Database from 2004 to 2017 with MIBC, without metastases, who underwent radical cystectomy. Patients were stratified by histological subgroup, and receipt or nonreceipt of neoadjuvant chemotherapy. Pathological downstaging was defined as pT0N0 or pT <= 1N0, and OS from the time of diagnosis to date of death or censoring at last followup. Multivariable logistic regression analysis determined associations between neoadjuvant chemotherapy and pathological downstaging. Multivariable Cox regression analysis determined associations between neoadjuvant chemotherapy and OS. Results: A total of 31,218 patients were included in the final study population (urothelial carcinoma [UC]: 27,779;sarcomatoid UC: 501;micropapillary UC: 418;squamous cell carcinoma: 1,141;neuroendocrine carcinoma: 629;adenocarcinoma: 750). Neoadjuvant chemotherapy was associated with pathological downstaging to pT0N0 in all histological subgroups (UC: OR 5.1 [4.6-5.6];sarcomatoid UC: OR 13.8 [5.5-39.0];micropapillary UC: OR 9.7 [2.8-46.8];squamous cell carcinoma: OR 7.4 [2.1-24.5];neuroendocrine: OR 4.7 [2.6-9.2];adenocarcinoma: OR 23.3 [8.0-74.2]). Neoadjuvant chemotherapy was associated with improved OS for UC (HR 0.8 [0.77-0.84]), sarcomatoid UC (HR 0.64 [0.44-0.91]) and neuroendocrine carcinoma (HR 0.55 [0.43-0.70]). Conclusions: Neoadjuvant chemotherapy was associated with pathological downstaging for all MIBC histological variants, with improved OS for patients with UC, sarcomatoid

关键词： Comprehensive income   Net income   Performance reporting   Value relevance  

摘要： Under Accounting Standards Update 2011-05, firms can present comprehensive income (CI), defined as the sum of net income (NI) and other comprehensive income (OCI), in a single continuous statement or two separate, consecutive statements. We identify whether firms use the one- or two-statement approach for the years 2012-2015 and assess the value relevance of CI, NI, and OCI under the alternative approaches. We find that NI is less value relevant under the one-statement approach relative to the two-statement approach, while the value relevance OCI is marginally enhanced. We also find that the decrease (increase) in value relevance of NI (OCI) under the one-statement approach is driven by a decrease (an increase) in the value relevance of operating income (unrealized gains/losses on securitized assets). Additional analyses demonstrate that the reduced value relevance of NI under the one-statement approach persists only in subsamples that report positive OCI. Our findings suggest that, consistent with arguments put forth in comment letters in support of the one-statement approach, increasing the prominence of OCI may result in investors incorporating this information to a greater extent in their valuation decisions. However, consistent with comment letters in opposition to the one-statement approach, we also present evidence that suggests presenting OCI in the same statement as NI may also draw attention away from the portion of NI that reflects the core operations of the firm.

关键词： hospital staffing   nurse staffing legislation   nurse staffing mandate   staffing committee   public reporting  

摘要： Objective: The objective of this study was to addresses the basic question of whether alternative legislative approaches are effective in encouraging hospitals to increase nurse staffing. Methods: Using 16 years of nationally representative hospital-level data from the American Hospital Association (AHA) annual survey, we employed a difference-in-difference design to compare changes in productive hours per patient day for registered nurses (RNs), licensed practical/vocational nurses (LPNs), and nursing assistive personnel (NAP) in the state that mandated staffing ratios, states that legislated staffing committees, and states that legislated public reporting, to changes in states that did not implement any nurse staffing legislation before and after the legislation was implemented. We constructed multivariate linear regression models to assess the effects with hospital and year fixed effects, controlling for hospital-level characteristics and state-level factors. Results: Compared with states with no legislation, the state that legislated minimum staffing ratios had an 0.996 (P<0.01) increase in RN hours per patient day and 0.224 (P<0.01) increase in NAP hours after the legislation was implemented, but no statistically significant changes in RN or NAP hours were found in states that legislated a staffing committee or public reporting. The staffing committee approach had a negative effect on LPN hours (difference-in-difference=-0.076, P<0.01), while the public reporting approach had a positive effect on LPN hours (difference-in-difference=0.115, P<0.01). There was no statistically significant effect of staffing mandate on LPN hours. Conclusions: When we included California in the comparison, our model suggests that neither the staffing committee nor the public reporting approach alone are effective in increasing hospital RN staffing, although the public reporting approach appeared to have a positive effect on LPN staffing. When we excluded California form the model, p

关键词： microwave irradiation   organic synthesis   heterocyclic compounds   (E/Z)-3-styrylchromones   (E)-1-[3-(2-hydroxyphenyl)-4-styryl-1H-pyrazol-1-yl]ethan-1-ones   (E)-2-(4-arylbut-1-en-3-yn-1-yl)chromone  

摘要： Microwave irradiation has become a popular heating technique in organic synthesis, mainly due to its short reaction times, solventless reactions, and, sometimes, higher yields. Additionally, microwave irradiation lowers energy consumption and, consequently, is ideal for optimization processes. Moreover, there is evidence that microwave irradiation can improve the regioselectivity and stereoselectivity aspects of vital importance in synthesizing bioactive compounds. These crucial features of microwave irradiation contribute to its inclusion in green chemistry procedures. Since 2003, the use of microwave-assisted organic synthesis has become common in our laboratory, making our group one of the first Portuguese research groups to implement this heating source in organic synthesis. Our achievements in the transformation of heterocyclic compounds, such as (E/Z)-3-styryl-4H-chromen-4-ones, (E)-3-(2-hydroxyphenyl)-4-styryl-1H-pyrazole, (E)-2-(4-arylbut-1-en-3-yn-1-yl)-4H-chromen-4-ones, or (E)-2-[2-(5-aryl-2-methyl-2H-1,2,3-triazol-4-yl)vinyl]-4H-chromen-4-ones, will be discussed in this review, highlighting the benefits of microwave irradiation use in organic synthesis.

关键词： watchful waiting   treatment switching   progression-free survival   observational study  

摘要： Purpose: The purpose of this study was to describe the uptake, discontinuation and variation of active surveillance (AS) by provider and patient level characteristics. Materials and Methods: This observational, population-based study used linked administrative databases and pathology reports to identify all men diagnosed with Gleason score <= 6 prostate cancer (PC) between January 1, 2008 and December 31, 2014 in Ontario, Canada. The Cochran-Armitage test was used for AS trend over time. Treatment-free survival was estimated using cumulative incidence function. Factors associated with discontinuation of AS were evaluated using Cox proportional hazard models. Results: Active surveillance was the initial management strategy for 8,541 cases (51%). Use of AS significantly increased from 38% in 2008 to 69% in 2014 (p=0.001). Men on AS were significantly older (64 years, SD 8.0) than those on initial treatment (62 years, SD 7.7;p=0.001). After a median followup of 48 months, 4,337 (51%) patients had discontinued AS. Treatment-free survival for AS patients at 1, 3, and 5 years were 85%, 58% and 52%, respectively. Median time to definitive treatment after initial AS was 16 months (IQR 11-25 months). Factors associated with AS discontinuation were younger age at diagnosis, year of diagnosis, higher comorbidities, treatment at academic center, treatment by physician and institution in the highest volume tertile, and adverse cancer-specific characteristics (higher prostate specific antigen [PSA], higher number of positive cores and higher percentage of core involvement at diagnosis). Conclusions: Although the uptake of AS significantly increased over time, there has been a relatively high rate of discontinuation over 5 years. Factors associated with transition to definitive treatment were younger age, care provided by higher volume physicians and institutions, higher PSA and greater PC volume at diagnosis. These results may help guide policy making, developing quality indicato

关键词： kidney   kidney transplant   morbid obesity   robotic surgery   surgical-site infection  

摘要： Background Many centres deny obese patients with a body mass index (BMI) >35 access to kidney transplantation due to increased intraoperative and postoperative complications. Methods From August 2017 to December 2019, 73 consecutive cases of kidney transplantation in morbidly obese patients were enrolled at a single university at the initiation of a robotic transplant surgery program. Outcomes of patients who underwent robotic assisted kidney transplant (RAKT) were compared to frequency-matched patients undergoing open kidney transplant (OKT). Results A total of 24 morbidly obese patients successfully underwent RAKT, and 49 obese patients received an OKT. The RAKT group developed fewer surgical site infections (SSI) than the OKT group. Graft function, creatinine, and glomerular filtration rate (GFR) were similar between groups 1 year after surgery. Graft and patient survival were 100% for both groups. Conclusions RAKT offers a safe alternative for morbidly obese patients, who may otherwise be denied access to OKT.

关键词： Between-group inequality   Conventional measure   Alternative measure   Ways of grouping   India   Scheduled Castes   Scheduled Tribes  

摘要： Conventionally the ratio of observed between-group inequality to the overall inequality is used to examine the contribution of between-group inequality to total inequality. It is also widely used for defining the relative importance of alternative types of grouping. This conventional statistic is criticized by some scholars on the ground of comparability and extreme benchmark. They have proposed an alternative measure and suggest using this measure as a complementary instrument to the former for examining the relative importance of different types of grouping in any country setting. However, they have not suggested any specific method to use these measures. The major objectives of this study are-to review the conventional and alternative measures for assessing the relative importance of alternative ways of grouping, and to specify the method of the use of these measures for this purpose. Furthermore, we apply these measures on Indian data and analyze the state of between-group inequality for some meaningful ways of grouping in India, and develop a discussion on the relative importance of these ways of groupings. This will enable planners and policymakers to design effective policies for reducing between-group inequality.

关键词： cystitis   interstitial   pregnancy outcome   pregnancy complications  

摘要： Purpose: Our objective was to evaluate the associations with interstitial cystitis during pregnancy using a United States inpatient database. Materials and Methods: We conducted a retrospective cohort study utilizing the Nationwide Inpatient Sample database from the Healthcare Cost and Utilization Project. ICD-9 code number 595.1 was used to extract cases of chronic interstitial cystitis and these pregnancies were compared to pregnancies without chronic interstitial cystitis, using the Chi-squared test to evaluate nominal variables. A multivariate logistic regression model was subsequently used to adjust for statistically significant confounders (p value <0.05). Results: There were 9,095,995 deliveries during the study period;793 pregnant women were found to have chronic interstitial cystitis. When controlling for confounding effects in terms of pregnancy outcomes, the diagnosed group had a greater risk of developing pregnancy-induced hypertension (adjusted OR 1.57, 95% CI 1.21-2.05), preeclampsia (adjusted OR 2.06, 95% CI 1.47-2.87), preterm delivery (adjusted OR 1.63, 95% CI 1.23-2.17), preterm premature rupture of membranes (adjusted OR 2.18, 95% CI 1.25-3.79), chorioamnionitis (adjusted OR 2.05, 95% CI 1.24-3.37), delivery via cesarean section (adjusted OR 1.57, 95% CI 1.32-1.88), maternal infection (adjusted OR 2.19, 95% CI 1.40-3.43), and deep venous thromboembolism (adjusted OR 10.56, 95% CI 3.37-33.09). Conclusions: Interstitial cystitis diagnosis is associated with an increased risk of preeclampsia, preterm birth, and other adverse pregnancy outcomes in this database study. Prospective studies are required to confirm the findings of the correlation between interstitial cystitis and adverse pregnancy outcomes.