Radical Cystectomy vs. Radiotherapy in Urothelial Bladder Cancer in Elderly and Very Elderly Patients

Introduction: Controversy regarding cancer-specific mortality (CSM) of elderly and very elderly patients with muscle-invasive, non-metastatic, urothelial carcinoma of the urinary bladder (UCUB) undergoing radical cystectomy (RC) vs radiotherapy (RT) still exists. Materials and Methods: In the 2004-2016 Surveillance, Epidemiology and End Results (SEER) database, we identified 2663 UCUB patients aged 75-79 (1808 RC vs 855 RT) and 3569 UCUB patients aged 80-89 (1551 RC vs 2018 RT). After stratification for concomitant chemotherapy, propensity score matching (PSM) between RC and RT was applied and competing-risks regression models addressed CSM and OCM. Results: In the cohort aged 75-79, five-year CSM rates were 22.0 vs 49.0% for RC only vs RT only and yielded a HR of 0.41 (95% confidence interval (CI) 0.30-0.57, p<0.001) favoring RC only. Five-year CSM rates were 28.3 vs 44.3% for RC with chemotherapy vs trimodal therapy (TMT) and yielded a HR of 0.48 (95% CI 0.35-0.65, p<0.001) favoring RC with chemotherapy. In the cohort aged 80-89, five-year CSM rates were 24.2 vs 48.9% for RC only vs RT only and yielded a HR of 0.42 (95% CI 0.33-0.52, p<0.001) favoring RC only. Five-year CSM rates were 19.6 vs 43.2% for RC with chemotherapy vs TMT and yielded a HR of 0.43 (95% CI 0.28-0.67, p<0.001) favoring RC with chemotherapy. Conclusions: In elderly and very elderly patients, radical cystectomy is associated with virtually half the CSM rate than radiotherapy, regardless of concomitant chemotherapy administration

Tratamento cirúrgico da endocardite em prótese valvular cardíaca Surgical treatment of endocarditis in prosthetic valves

No período de janeiro de 1983 a março de 1988, 1.512 pacientes foram submetidos a substituição valvar, no Instituto do Coração, sendo 28 (1,85%) deles por endocardite em prótese valvular. Dezessete doentes eram do sexo masculino e a idade variou de 18 a 67 anbs, com média e desvio padrão de 36,7 ± 12,9. A avaliação da classe funcional (CF.) revelou 11 pacientes em CF. IV, 12 em C. F. III e 5 em CF . II. Oito (28,5%) pacientes foram operados em condições de emergência. Um paciente era portador e válvula mecânica e 27, de válvula biológica. As hemoculturas foram positivas em 14 (50%) pacientes; o agente mais encontrado foi o Streptococcus viridans em 5 casos. O ecocardiograma realizado no pré-operatório em 27 pacientes mostrou correlação com os achados cirúrgicos em 26 (96,2%). Na cirurgia, 17 doentes apresentavam vegetação na prótese e 11, abscesso no anel. Na retroca, foram utilizadas biopróteses em 27 (96,4%) pacientes. A mortalidade imediata foi de 28,5% (8 doentes), ocorrendo 1 óbito tardio. A análise da associação óbito e tempo de aparecimento da endocardite, condição cirúrgica e resultado da cultura foi feita pelo teste de Qui-Quadrado (χ2). Podemos concluir que as condições clínicas pré-operatórias interferem, decisivamente, no resultado cirúrgico; a cirurgia de emergência tem resultados piores, devido às condições mais críticas dos doentes; as endocardites mais precoces são mais graves; a manipulação de focos infecciosos em pacientes com prótese valvular deve ser cuidadosa e precedida de antibioticoterapia e, nos doentes sobreviventes à operação, a evolução a longo prazo apresenta melhora significativa da classe funcional.From January/1983 to March/1988, 1512 patients were submitted to valve replacement in the Instituto do Coração, Of these, 28 (1.8%) presented endocarditis in a valvular prosthesis. Seventeen patients were males, their ages varying from 18 to 67 years, with an average and standard deviation of 36.7 ± 12.9. The evolution of the functional class (F. C.) revealed 11 patients in (F. C.) IV, 12 in F. C. III and 5 in F. C. II (NYHA). Eight (28.5%) patients were operated on under emergency conditions. One patient had a mechanical valve and 27 had biological valves. The blood cultures were positive in 14 (50%) patients, the agent most commonly found being Streptococcus viridans (5 cases). Preoperative echocardiogram in 27 patients showed good correlation with the surgical findings in 26 (96.2%). At surgery, 17 patients presented vegetations in the prosthesis and 11 had an abscess in the valvular ring. Bioprosthesis were used as valvular replacement in 27 patients (96,4%). Immediate mortality was 28,5% (8 patients), one death occurring later. An analysis of the association between death, time from onset of the endocarditis, surgical conditions and result of the cultures was carried out by the Chi-Squared (χ2) test. We conclude that the clinical preoperative conditions influence decisively the surgical results. Surgery under emergency conditions has the poorest results because of the patient's more critical condition: the more premature cases of endocarditis are also the more severe. Manipulation of infectious foci in patients with a valvular prosthesis should be careful and preceded by antibiotic administration. The longterm evolution of the surviving patients demonstrated significant functional class improvement

Mu2e Conceptual Design Report

Mu2e at Fermilab will search for charged lepton flavor violation via the coherent conversion process mu- N --> e- N with a sensitivity approximately four orders of magnitude better than the current world's best limits for this process. The experiment's sensitivity offers discovery potential over a wide array of new physics models and probes mass scales well beyond the reach of the LHC. We describe herein the conceptual design of the proposed Mu2e experiment. This document was created in partial fulfillment of the requirements necessary to obtain DOE CD-1 approval, which was granted July 11, 2012