Propensity-matched analysis of patient-reported outcomes for neoadjuvant chemotherapy prior to radical cystectomy

© 2019, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: To evaluate patient-reported outcomes (PROs) for bladder cancer patients undergoing neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) using longitudinal data and propensity-matched scoring analyses. Methods: 155 patients with muscle-invasive bladder cancer scheduled for RC completed the European Organization for Research and Treatment of Cancer questionnaires, EORTC QLQ-C30, EORTC QLQ-BLM30, Fear of Recurrence Scale, Mental Health Inventory and Satisfaction with Life Scale within 4 weeks of surgery. A propensity-matched analysis was performed comparing pre-surgery PROs among 101 patients who completed NAC versus 54 patients who did not receive NAC. We also compared PROs pre- and post-chemotherapy for 16 patients who had data available for both time points. Results: In propensity-matched analysis, NAC-treated patients reported better emotional and sexual function, mental health, urinary function and fewer financial concerns compared to those that did not receive NAC. Longitudinal analysis showed increases in fatigue, nausea and appetite loss following chemotherapy. Conclusion: Propensity-matched analysis did not demonstrate a negative effect of NAC on PRO. Several positive associations of NAC were found in the propensity-matched analysis, possibly due to other confounding differences between the two groups or actual clinical benefit. Longitudinal analysis of a small number of patients found small to modest detrimental effects from NAC similar to toxicities previously reported. Our preliminary findings, along with known survival and toxicity data, should be considered in decision-making for NAC

Isotropization of Bianchi type models and a new FRW solution in Brans-Dicke theory

Using scaled variables we are able to integrate an equation valid for isotropic and anisotropic Bianchi type I, V, IX models in Brans-Dicke (BD) theory. We analyze known and new solutions for these models in relation with the possibility that anisotropic models asymptotically isotropize, and/or possess inflationary properties. In particular, a new solution of curve ($k\neq0$) Friedmann-Robertson-Walker (FRW) cosmologies in Brans-Dicke theory is analyzed.Comment: 15 pages, 4 postscript figures, to appear in Gen. Rel. Grav., special issue dedicated in honour of Prof. H. Dehne

Isotropization of Bianchi-Type Cosmological Solutions in Brans-Dicke Theory

The cosmic, general analitic solutions of the Brans--Dicke Theory for the flat space of homogeneous and isotropic models containing perfect, barotropic, fluids are seen to belong to a wider class of solutions --which includes cosmological models with the open and the closed spaces of the Friedmann--Robertson--Walker metric, as well as solutions for models with homogeneous but anisotropic spaces corresponding to the Bianchi--Type metric clasification-- when all these solutions are expressed in terms of reduced variables. The existence of such a class lies in the fact that the scalar field, $\phi$, times a function of the mean scale factor or ``volume element'', $a^3 = a_1 a_2 a_3$, which depends on time and on the barotropic index of the equation of state used, can be written as a function of a ``cosmic time'' reduced in terms of another function of the mean scale factor depending itself again on the barotropic index but independent of the metrics here employed. This reduction procedure permites one to analyze if explicitly given anisotropic cosmological solutions ``isotropize'' in the course of their time evolution. For if so can happen, it could be claimed that there exists a subclass of solutions that is stable under anisotropic perturbations.Comment: 15 pages, Late

Percutaneous Nephrolithotomy During Uninterrupted Aspirin Therapy in High-cardiovascular Risk Patients: Preliminary Report

OBJECTIVE To determine the feasibility and safety of performing percutaneous nephrolithotomy (PCNL) in high-cardiovascular risk patients remaining on aspirin therapy. METHODS We retrospectively reviewed all PCNLs performed by 3 fellowship-trained endourologists at a single institution between July 2012 and January 2014. All patients remaining on aspirin for imperative indications through the day of surgery were evaluated for surgical outcomes and thromboembolic events. RESULTS Of 281 PCNL procedures performed during the study period, 16 (5.7%) were performed in 14 patients taking aspirin, uninterrupted, through surgery. Mean surgery time was 66 minutes, mean estimated blood loss was 161 mL, and mean length of hospital stay was 2.8 days. All patients were stone free. There were no intraoperative complications. A total of 5 patients experienced a postoperative complication (n = 4, Clavien grade II; n = 1, Clavien grade IIIa). No patient experienced a perioperative thromboembolic or cardiac event. Three patients required a blood transfusion postoperatively, and none experienced delayed renal bleeding. CONCLUSION PCNL can be performed safely and effectively in high-cardiovascular risk patients continuing aspirin perioperatively. Compared with the potential sequelae of a thromboembolic or cardiac event, PCNL is associated with an acceptably low transfusion rate, and should be considered a viable treatment option for large renal stones in this population. (C) 2014 Elsevier Inc