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Histotype and grade of endometrial cancer (EC) are prognostic factors of nodal involvement and thus of survival. Preoperative biopsy (PB) and intraoperative frozen section (FS) are usually used to guide surgical staging on which the choice of adjuvant therapy will be based successively.
The aim of this study was to assess the agreement rate between PB and FS with final diagnosis (FD) in a series of surgically resected EC.
All patients submitted to hysterectomy for EC or atypical endometrial hyperplasia in the Reggio Emilia Province hospitals from 2007 to 2018 were included. Concordance rate differences in histotype, grading, myoinvasion, risk of recurrence between PB, FS and FD were assessed with Fisher's exact test and Mc Nemar contingency test.
A total of 352 patients were identified. For 345 patients it was possible to compare PB and FD results. FS examination was performed in 201/352 (57%) cases, while for 21/352 (6%) patients only an intraoperative macroscopic evaluation was done; in the remaininnefit from adjuvant therapy.
FS remains a useful tool to tailor surgery in EC-patients, avoiding secondary surgery to complete staging particularly in patients with AH + AHBA, low and intermediate risk ECs that could benefit from adjuvant therapy.
OSNA is a molecular technique for sentinel lymph node (SN) analysis in breast cancer. Compared to histology, OSNA may yield more (micro)metastases and thereby result in more axillary lymph node dissections or radiotherapy. We investigated whether axillary treatments increase when using OSNA, applying current guidelines for de-escalating axillary management.
All patients treated for cT1-3N0 breast cancer in our hospital between December 2013 and February 2016 were included. Retinoic acid datasheet In 148 prospectively included patients (January 2015-February 2016), SN's were examined with OSNA. In a retrospective cohort of 123 patients (December 2013-December 2014), SN's were examined with conventional histology. Outcomes were number of macro and micrometastases, amount of patients receiving axillary dissection or irradiation, number of patients receiving adjuvant systemic therapy. Data were analyzed using Mann-Whitney and Pearson Chi-square test. P<0.05 was considered statistically significant.
230 SN's from 123 patients wedard histology. When applying current guidelines, OSNA analysis does not lead to overtreatment with more axillary dissections or irradiation.
We utilized a national administrative database to investigate drivers of immediate adverse economic and hospital outcomes, including non-routine discharge, prolonged length of stay (LOS), and admission costs among patients undergoing surgery for idiopathic normal pressure hydrocephalus (iNPH).
The National Inpatient Sample (NIS) was queried from 2007 to 2017 for patients aged ≥60 with a diagnosis code for iNPH undergoing surgery. Multivariable logistic-regression models and Wald χ2 were used to identify drivers of non-routine discharge, prolonged length of stay (LOS) (>75th percentile) and higher admission costs (>90th percentile).
A total of 13,363 patients with iNPH undergoing surgical management were identified. The most common comorbidity reported in the cohort was a cardiovascular pathology (56.9 %, n = 7,787), followed by urinary pathology (37.2 %, n = 5,084), osteoarthritis (7.8 %, n = 1,071), Alzheimer's disease (4.6 %, n = 626) and cerebrovascular pathology (4.2 %, n = 569). The most freqncluded emergent-admission (OR 11.34), ETV (OR 10.92), VA/VPleural shunt (OR 7.79) and open VP shunt (OR 8.24). For increased admission costs, some of the highly associated factors included VA/VPleural shunt (OR 18.48), laparoscopic VP shunt (OR 9.92), open VP shunt (OR 12.72) and ETV (OR 9.34). Predictor importance analysis revealed emergent admission, number of diagnosis codes (comorbidities) open VP shunt, hospital region, age] and revision or removal of shunt to be the most important drivers of these outcomes.
Analyses from a national database indicate that among patients with iNPH, an emergent-admission may be the most significant risk-factor of adverse economic outcomes and higher costs.
Analyses from a national database indicate that among patients with iNPH, an emergent-admission may be the most significant risk-factor of adverse economic outcomes and higher costs.
Although Complementary and Alternative Therapies (CATs) are currently incorporated into psychotherapy, scepticism remains among professional and practicing psychologists about integration of CATs into professional practice. This research explored perceived benefits and barriers to integrating CATs into psychology practice with individual clients.
We used a qualitative framework informed by Transpersonal Psychology to explore benefits and barriers to integrative psychology practice. We conducted semi-structured interviews with six practitioners trained or training in psychology and CATs and analysed verbatim transcripts using thematic analysis.
Participants reported personal, career-based, and epistemological benefits and barriers to integrative psychology practice. Benefits were improved therapeutic relationships, specialisation options, and a time reflective psychology. Barriers included stigma and bias, regulations, and dominance of the scientist-practitioner model. Superordinate themes were holism, connectedness, and governance.
Results activate conversation about the importance of a transpersonally oriented integrative psychological practice for the 21st century.
Results activate conversation about the importance of a transpersonally oriented integrative psychological practice for the 21st century.Influenza D is the only type of influenza virus that mainly affects cattle with frequent spillover to other species. Since the initial description of influenza D virus (IDV) in 2011, the virus has been found to circulate among cattle and swine populations worldwide. Research conducted during the past several years has led to an increased understanding of this novel influenza virus with bovines as a reservoir. In this review, we describe the current knowledge of epidemiology and host range of IDV followed by discussion of infection biology and animal model development for IDV. Finally, we review progress towards understanding of the pathogenesis and host response of IDV as well as developing preventive vaccines for IDV.
Read More: https://www.selleckchem.com/products/Tretinoin(Aberela).html
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