4,025 research outputs found
Concomitant CIS on TURBT does not impact oncological outcomes in patients treated with neoadjuvant or induction chemotherapy followed by radical cystectomy
© Springer-Verlag GmbH Germany, part of Springer Nature 2018Background: Cisplatin-based neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer improves all-cause and cancer specific survival. We aimed to evaluate whether the detection of carcinoma in situ (CIS) at the time of initial transurethral resection of bladder tumor (TURBT) has an oncological impact on the response to NAC prior to radical cystectomy. Patients and methods: Patients were identified retrospectively from 19 centers who received at least three cycles of NAC or induction chemotherapy for cT2-T4aN0-3M0 urothelial carcinoma of the bladder followed by radical cystectomy between 2000 and 2013. The primary and secondary outcomes were pathological response and overall survival, respectively. Multivariable analysis was performed to determine the independent predictive value of CIS on these outcomes. Results: Of 1213 patients included in the analysis, 21.8% had concomitant CIS. Baseline clinical and pathologic characteristics of the ‘CIS’ versus ‘no-CIS’ groups were similar. The pathological response did not differ between the two arms when response was defined as pT0N0 (17.9% with CIS vs 21.9% without CIS; p = 0.16) which may indicate that patients with CIS may be less sensitive to NAC or ≤ pT1N0 (42.8% with CIS vs 37.8% without CIS; p = 0.15). On Cox regression model for overall survival for the cN0 cohort, the presence of CIS was not associated with survival (HR 0.86 (95% CI 0.63–1.18; p = 0.35). The presence of LVI (HR 1.41, 95% CI 1.01–1.96; p = 0.04), hydronephrosis (HR 1.63, 95% CI 1.23–2.16; p = 0.001) and use of chemotherapy other than ddMVAC (HR 0.57, 95% CI 0.34–0.94; p = 0.03) were associated with shorter overall survival. For the whole cohort, the presence of CIS was also not associated with survival (HR 1.05 (95% CI 0.82–1.35; p = 0.70). Conclusion: In this multicenter, real-world cohort, CIS status at TURBT did not affect pathologic response to neoadjuvant or induction chemotherapy. This study is limited by its retrospective nature as well as variability in chemotherapy regimens and surveillance regimens.Peer reviewedFinal Accepted Versio
Mitral valve prolapse syndrome and MASS phenotype: stability of aortic dilatation but progression of mitral valve prolapse
AbstractBackgroundMitral valve prolapse syndrome (MVPS) and MASS phenotype (MASS) are Marfan-like syndromes that exhibit aortic dilatation and mitral valve prolapse. Unlike in Marfan syndrome (MFS), the presence of ectopia lentis and aortic aneurysm preclude diagnosis of MVPS and MASS. However, it is unclear whether aortic dilatation and mitral valve prolapse remain stable in MVPS or MASS or whether they progress like in MFS.MethodsThis retrospective longitudinal observational study examines clinical characteristics and long-term prognosis of 44 adults with MVPS or MASS (18 men, 26 women aged 38±17years) as compared with 81 adults with Marfan syndrome (MFS) with similar age and sex distribution. The age at final contact was 42±15years with mean follow-up of 66±49months.ResultsAt baseline, ectopia lentis and aortic sinus aneurysm were absent in MVPS and MASS, and systemic scores defined by the revised Ghent nosology were lower than in MFS (all P<.001). Unlike in MFS, no individual with MVPS and MASS developed aortic complications (P<.001). In contrast, the incidence of endocarditis (P=.292), heart failure (P=.644), and mitral valve surgery (P=.140) was similar in all syndromes. Cox regression analysis identified increased LV end-diastolic (P=.013), moderate MVR (P=.019) and flail MV leaflet (P=.017) as independent predictors of mitral valve surgery.ConclusionsThe study provides evidence that MVPS and MASS are Marfan-like syndromes with stability of aortic dilatation but with progression of mitral valve prolapse. Echocardiographic characteristics of mitral valve disease rather than the type of syndrome, predict clinical progression of mitral valve prolapse
Prospects for progress on health inequalities in England in the post-primary care trust era : professional views on challenges, risks and opportunities
Background - Addressing health inequalities remains a prominent policy objective of the current UK government, but current NHS reforms involve a significant shift in roles and responsibilities. Clinicians are now placed at the heart of healthcare commissioning through which significant inequalities in access, uptake and impact of healthcare services must be addressed. Questions arise as to whether these new arrangements will help or hinder progress on health inequalities. This paper explores the perspectives of experienced healthcare professionals working within the commissioning arena; many of whom are likely to remain key actors in this unfolding scenario.
Methods - Semi-structured interviews were conducted with 42 professionals involved with health and social care commissioning at national and local levels. These included representatives from the Department of Health, Primary Care Trusts, Strategic Health Authorities, Local Authorities, and third sector organisations.
Results - In general, respondents lamented the lack of progress on health inequalities during the PCT commissioning era, where strong policy had not resulted in measurable improvements. However, there was concern that GP-led commissioning will fare little better, particularly in a time of reduced spending. Specific concerns centred on: reduced commitment to a health inequalities agenda; inadequate skills and loss of expertise; and weakened partnership working and engagement. There were more mixed opinions as to whether GP commissioners would be better able than their predecessors to challenge large provider trusts and shift spend towards prevention and early intervention, and whether GPs’ clinical experience would support commissioning action on inequalities. Though largely pessimistic, respondents highlighted some opportunities, including the potential for greater accountability of healthcare commissioners to the public and more influential needs assessments via emergent Health & Wellbeing Boards.
Conclusions - There is doubt about the ability of GP commissioners to take clearer action on health inequalities than PCTs have historically achieved. Key actors expect the contribution from commissioning to address health inequalities to become even more piecemeal in the new arrangements, as it will be dependent upon the interest and agency of particular individuals within the new commissioning groups to engage and influence a wider range of stakeholders.</p
Acute myocardial infarction, associated with the use of a synthetic adamantyl-cannabinoid: a case report
BACKGROUND: “Legal highs” are novel psychoactive substances that have evaded statutory control. Synthetic cannabinoid compounds with adamantane moieties have recently been identified, which have high potency at target receptors and are undetectable on conventional toxicology testing. However, little is known about any harmful effects, and their potential to cause serious ill health. We describe a case of myocardial infarction following the use of this class of drug. CASE PRESENTATION: We report the case of a 39-year-old man admitted after an out-of-hospital cardiac arrest, in whom ECG and elevated cardiac enzymes confirmed ST-elevation myocardial infarction. Normal coronary perfusion was restored after thrombectomy and coronary artery stenting. In the hours preceding his admission, the patient is known to have consumed the legal high product “Black Mamba”. Subsequent urine testing confirmed the presence of an adamantyl-group synthetic cannabinoid, whilst cannabis, cocaine, amphetamines and other drugs of abuse were not detected. CONCLUSION: The use of legal highs is being increasingly recognised, but the chemical compositions and physiological effects of these drugs are poorly characterised and are continually changing. Synthetic cannabinoids, rarely identified on toxicological testing, can be linked to serious adverse cardiovascular events. This case highlights the importance of testing for novel psychoactive compounds, and recognising their potential to cause life-threatening conditions
Systematics of Inclusive Photon Production in 158 AGeV Pb Induced Reactions on Ni, Nb, and Pb Targets
The multiplicity of inclusive photons has been measured on an event-by-event
basis for 158 AGeV Pb induced reactions on Ni, Nb, and Pb targets. The
systematics of the pseudorapidity densities at midrapidity (rho_max) and the
width of the pseudorapidity distributions have been studied for varying
centralities for these collisions. A power law fit to the photon yield as a
function of the number of participating nucleons gives a value of 1.13+-0.03
for the exponent. The mean transverse momentum, , of photons determined
from the ratio of the measured electromagnetic transverse energy and photon
multiplicity, remains almost constant with increasing rho_max. Results are
compared with model predictions.Comment: 16 pages including 4 figure
Scaling of Particle and Transverse Energy Production in 208Pb+208Pb collisions at 158 A GeV
Transverse energy, charged particle pseudorapidity distributions and photon
transverse momentum spectra have been studied as a function of the number of
participants (N_{part}) and the number of binary nucleon-nucleon collisions
(N_{coll}) in 158 A GeV Pb+Pb collisions over a wide impact parameter range. A
scaling of the transverse energy pseudorapidity density at midrapidity as
N_{part}^{1.08 \pm 0.06} and N_{coll}^{0.83 \pm 0.05} is observed. For the
charged particle pseudorapidity density at midrapidity we find a scaling as
N_{part}^{1.07 \pm 0.04} and N_{coll}^{0.82 \pm 0.03}. This faster than linear
scaling with N_{part} indicates a violation of the naive Wounded Nucleon Model.Comment: 13 pages, 16 figures, submitted to European Physical Journal C
(revised results for scaling exponents
Bose-Einstein Correlations in e+e- to W+W- at 172 and 183 GeV
Bose-Einstein correlations between like-charge pions are studied in hadronic
final states produced by e+e- annihilations at center-of-mass energies of 172
and 183 GeV. Three event samples are studied, each dominated by one of the
processes W+W- to qqlnu, W+W- to qqqq, or (Z/g)* to qq. After demonstrating the
existence of Bose-Einstein correlations in W decays, an attempt is made to
determine Bose-Einstein correlations for pions originating from the same W
boson and from different W bosons, as well as for pions from (Z/g)* to qq
events. The following results are obtained for the individual chaoticity
parameters lambda assuming a common source radius R: lambda_same = 0.63 +- 0.19
+- 0.14, lambda_diff = 0.22 +- 0.53 +- 0.14, lambda_Z = 0.47 +- 0.11 +- 0.08, R
= 0.92 +- 0.09 +- 0.09. In each case, the first error is statistical and the
second is systematic. At the current level of statistical precision it is not
established whether Bose-Einstein correlations, between pions from different W
bosons exist or not.Comment: 24 pages, LaTeX, including 6 eps figures, submitted to European
Physical Journal
W+W- production and triple gauge boson couplings at LEP energies up to 183 GeV
A study of W-pair production in e+e- annihilations at Lep2 is presented,
based on 877 W+W- candidates corresponding to an integrated luminosity of 57
pb-1 at sqrt(s) = 183 GeV. Assuming that the angular distributions of the
W-pair production and decay, as well as their branching fractions, are
described by the Standard Model, the W-pair production cross-section is
measured to be 15.43 +- 0.61 (stat.) +- 0.26 (syst.) pb. Assuming lepton
universality and combining with our results from lower centre-of-mass energies,
the W branching fraction to hadrons is determined to be 67.9 +- 1.2 (stat.) +-
0.5 (syst.)%. The number of W-pair candidates and the angular distributions for
each final state (qqlnu,qqqq,lnulnu) are used to determine the triple gauge
boson couplings. After combining these values with our results from lower
centre-of-mass energies we obtain D(kappa_g)=0.11+0.52-0.37,
D(g^z_1)=0.01+0.13-0.12 and lambda=-0.10+0.13-0.12, where the errors include
both statistical and systematic uncertainties and each coupling is determined
setting the other two couplings to the Standard Model value. The fraction of W
bosons produced with a longitudinal polarisation is measured to be
0.242+-0.091(stat.)+-0.023(syst.). All these measurements are consistent with
the Standard Model expectations.Comment: 48 pages, LaTeX, including 13 eps or ps figures, submitted to
European Physical Journal
Measurements of Flavour Dependent Fragmentation Functions in Z^0 -> qq(bar) Events
Fragmentation functions for charged particles in Z -> qq(bar) events have
been measured for bottom (b), charm (c) and light (uds) quarks as well as for
all flavours together. The results are based on data recorded between 1990 and
1995 using the OPAL detector at LEP. Event samples with different flavour
compositions were formed using reconstructed D* mesons and secondary vertices.
The \xi_p = ln(1/x_E) distributions and the position of their maxima \xi_max
are also presented separately for uds, c and b quark events. The fragmentation
function for b quarks is significantly softer than for uds quarks.Comment: 29 pages, LaTeX, 5 eps figures (and colour figs) included, submitted
to Eur. Phys. J.
a controlled multicenter study with assessment of echocardiographic reference values, and the frequency of dilatation and aneurysm in Marfan syndrome
Background Echocardiographic upper normal limits of both main pulmonary artery
(MPA) diameters (MPA-d) and ratio of MPA to aortic root diameter (MPA-r) are
not defined in healthy adults. Accordingly, frequency of MPA dilatation based
on echocardiography remains to be assessed in adults with Marfan syndrome
(MFS). Methods We enrolled 123 normal adults (72 men, 52 women aged 42 ± 14
years) and 98 patients with MFS (42 men, 56 women aged 39 ± 14 years) in a
retrospective cross-sectional observational controlled study in four tertiary
care centers. We defined outcome measures including upper normal limits of
MPA-d and MPA-r as 95 quantile of normal persons, MPA dilatation as diameters
> upper normal limits, MPA aneurysm as diameters >4 cm, and indication for
surgery as MPA diameters >6 cm. Results MPA diameters revealed normal
distribution without correlation to age, sex, body weight, body height, body
mass index and body surface area. The upper normal limit was 2.6 cm (95%
confidence interval (CI) =2.44-2.76 cm) for MPA-d, and 1.05 (95% CI =
.86–1.24) for MPA-r. MPA dilatation presented in 6 normal persons (4.9%) and
in 68 MFS patients (69.4%; P < .001), MPA aneurysm presented only in MFS (15
patients; 15.3%; P < .001), and no patient required surgery. Mean MPA-r were
increased in MFS (P 1.05 were equally frequent in 7
normal persons (5%) and in 8 MFS patients (10.5%; P = .161). MPA-r related to
aortic root diameters (P = .042), reduced left ventricular ejection fraction
(P = .006), and increased pulmonary artery systolic pressures (P = .040). No
clinical manifestations of MFS and no FBN1 mutation characteristics related to
MPA diameters. Conclusions We established 2.6 cm for MPA-d and 1.05 for MPA-r
as upper normal limits. MFS exhibits a high prevalence of MPA dilatation and
aneurysm. However, patients may require MPA surgery only in scarce
circumstances, most likely because formation of marked MPA aneurysm may
require LV dysfunction and increased PASP
- …