Limited Value of Bladder Wash Cytology During Follow-Up of Patients With Non-muscle Invasive Bladder Cancer

Aims We aimed to assess the performance of bladder wash cytology (BWC) in daily clinical practice in a pure follow-up cohort of patients previously diagnosed with non-muscle invasive bladder cancer (NMIBC). Materials and methods We analyzed 2064 BWCs derived from 314 patients followed for NMIBC (2003-2016). Follow-up investigations were performed using cystoscopy (CS) in combination with BWC. Patients with suspicious CS and/or positive BWC underwent bladder biopsy or transurethral resection. BWC was considered positive if malignant or suspicious cells were reported. Sensitivity (Sn) and specificity (Sp) were calculated for the entire cohort and separately for low-grade (LG) and high-grade (HG) tumors, and carcinoma in situ (CIS) subgroups. Results A total of 95 recurrences were detected, of which only three were detected by BWC alone. Overall, Sn and Sp of BWC were 17.9% and 99.5%, respectively. For LG disease, these numbers were 14.0% and 100%, and for HG disease, these were 22.2% and 99.1%, respectively. For patients with CIS at initial diagnosis, Sn and Sp were 11.0% and 71.4%, respectively. For isolated primary CIS, Sn was 50.0%, and Sp was 98.2%. Conclusion Routine use of BWC in the follow-up for NMIBC is of limited value even in HG tumors. In the presence of isolated primary CIS, adjunct BWC might be justified

Differences in the educational paths of entrepreneurs and employees

This paper examines whether individuals who become either entrepreneurs or employees follow systematically different educational paths to a given educational level. Following Lazear\u27s jack-of-all-trades theory, we expect that entrepreneurs aim at a balanced set of different skills - that is, they combine academic and vocational skills - while employees specialize in one skill. This means that entrepreneurs follow educational paths that combine different types of education, while employees follow same-type paths while climbing up the educational ladder. We use the Swiss Labor Force Survey to test our hypothesis. Our empirical findings are in line with Lazear\u27s theory and indicate that individuals who change between different types of education and acquire a more balanced set of skills are more likely to become entrepreneurs. Thus, the permeability of a country-specific educational system is one crucial determinant of entrepreneurship. (DIPF/Orig.

Natural estrogen emissions to subsurface tile drains from experimental grassland fields in Switzerland after application of livestock slurries and free compounds

Natural estrogens are present in high concentrations in livestock slurries, which are often applied to agricultural fields in large quantities. As such, the export of slurry-derived natural estrogens from tile-drained fields is a potential source for estrogenic pollution in surface waters. Yet despite the abundance of tile-drained fields in Central Europe, export of natural estrogens from agricultural fields receiving livestock slurries is rarely studied in this region. In an effort to fill this knowledge gap, here we applied natural estrogens to Swiss experimental fields in the form of cattle slurry, pig slurry or dissolved in water, and quantified them in flow-proportionally collected drainage water over 18 months. After pig and cattle slurry applications, concentration maxima in drainage water of 73, 8, 37, and 60 ng L−1 for 17α-estradiol (E2α), 17β-estradiol (E2β), estrone (E1), and estriol (E3), respectively, were observed shortly after rain events. The exported fractions of individual natural estrogens to tile drains were on average 0.26% (ranging from 0.08 to 0.41%) after cattle, and 0.18% (0.03–0.40%) after pig slurry applications. Such numbers were higher than expected from the leaching potential based on substance properties, and comparable to those of more mobile micropollutants previously studied on the same fields. Natural estrogens were mainly exported to tile drains through preferential flow. Exported fractions were lower when applied in aqueous solution than when applied in slurry, pointing to particle-facilitated transport to tile drains when applied in slurry. In Switzerland, the estimated 6.3, 0.6, 7.4, and 7.7 g of E2α, E2β, E1, and E3, respectively, exported through the tile-drained agricultural area per year contribute little to the total natural estrogen load received by surface waters. However, after slurry applications in highly drained catchments, natural estrogen emissions to tile drains can cause short term (i.e. less than 1 week) estrogenic exposure in nearby streams.ISSN:0048-9697ISSN:1879-102

Effects of an alveolar recruitment maneuver on cardiovascular and respiratory parameters during total intravenous anesthesia in ponies

OBJECTIVE: To evaluate pulmonary and cardiovascular effects of a recruitment maneuver (RM) combined with positive end-expiratory pressure (PEEP) during total intravenous anesthesia in ponies. ANIMALS: 6 healthy adult Shetland ponies. PROCEDURE: After premedication with detomidine (10 microg/kg, IV), anesthesia was induced with climazolam (0.06 mg/kg, IV) and ketamine (2.2 mg/kg, IV) and maintained with a constant rate infusion of detomidine (0.024 mg/kg/h), climazolam (0.036 mg/kg/h), and ketamine (2.4 mg/kg/h). The RM was preceded by an incremental PEEP titration and followed by a decremental PEEP titration, both at a constant airway pressure difference (deltaP) of 20 cm H2O. The RM consisted of a stepwise increase in deltaP by 25, 30, and 35 cm H2O obtained by increasing peak inspiratory pressure (PIP) to 45, 50, and 55 cm H2O, while maintaining PEEP at 20 cm H2O. Hemodynamic and pulmonary variables were analyzed at every step of the PEEP titration-RM. RESULTS: During the PEEP titration-RM, there was a significant increase in PaO 2 (+12%), dynamic compliance (+ 62%), and heart rate (+17%) and a decrease in shunt (-19%) and mean arterial blood pressure (-21%) was recorded. Cardiac output remained stable. CONCLUSIONS AND CLINICAL RELEVANCE: Although baseline oxygenation was high, Pa(O2) and dynamic compliance further increased during the RM. Despite the use of high PIP and PEEP and a high tidal volume, limited cardiovascular compromise was detected. A PEEP titration-RM may be used to improve oxygenation in anesthetized ponies. During stable hemodynamic conditions, PEEP titration-RM can be performed with acceptable adverse cardiovascular effects