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The effect of radical cystectomy (RC) on cancer-specific mortality (CSM) is unclear in non-metastatic sarcomatoid bladder cancer (SBC) patients. We aimed to test the benefit of RC in SBC, and to perform a direct comparison vs urothelial bladder cancer (UCB).Within the Surveillance, Epidemiology, and End Results database (SEER 2001-2018) all non-metastatic SBC and UBC patients were identified. Endpoint of interest was CSM. Propensity score matching (PSM), cumulative incidence plots, competing risks regression (CRR) analyses, three-months landmark analyses, and sensitivity analyses were performed. All results were stratified according to organ-confined (OC: TOf 554 SBC patients, 49 vs 51% harbored OC vs NOC stages. Of 47,741 UBC patients, 62 vs 38% harbored OC vs NOC stages. RC rates were 33 vs 67% in OC vs NOC-SBC patients, and 40 vs 60% in OC vs NOC-UBC patients. After 1:1 PSM, comparison between RC vs no-RC was performed in OC-SBC (67 patients per group), OC-UBC (7611 patients per group), NOC-SBC (63 patients per group), and NOC-UBC patients (4644 patients per group). CRR hazard ratios associated with RC vs no-RC were 0.37 (p 0.001) in OC-SBC vs 0.45 (p 0.001) in OC-UBC, and 0.56 (p = 0.01) in NOC-SBC vs 0.68 (p 0.001) in NOC-UBC. These results were replicated in sensitivity and landmark analyses.The protective effect of RC vs no-RC is stronger in SBC than UBC patients, regardless of OC vs NOC stages.

To investigate the association between Barthel Index (BI), which measures level of patients independence during daily living activities (ADL), and perioperative outcomes in a large cohort of consecutive bladder cancer (BCa) patients, who underwent radical cystectomy (RC) at a tertiary referral center.We retrospectively evaluated data from clinically nonmetastatic BCa patients treated with RC between 2015 and 2022. For each patient, BI was assessed preoperatively. According to BI score, patients were divided into three groups: ≤60 (total/severe dependency) vs. 65-90 (moderate dependency) vs. 95-100 (slight dependency/independency). Regression analyses tested the association between BI score and major postoperative complications (Clavien-Dindo2), length of in-hospital stay (LOHS), 90-days readmission, and total costs.Overall, 288 patients were included. According to BI score, the patient cohort was distributed as follows: 4% (n = 11) BI ≤60 vs. 15% (n = 42) BI 65-90 vs. 81% (n = 235) BI 95-100. Patients with BI ≤60 had more frequent ureterocutaneostomy performed, shorter operative time, higher rates of postoperative complications, longer LOHS, higher rates of readmission, and were associated with higher total costs, compared to patients with BI 65-90 and 95-100. In multivariable regression models, BI ≤60 remained an independent predictor of increased risk of major postoperative complications (odds ratio: 6.62, p = 0.006), longer LOHS (rate ratio: 1.25, p 0.001), and higher costs (β: 2.617, p = 0.038).Total/severe dependency in ADL assessed by BI was associated with higher rates of major postoperative complications, longer hospitalization, and higher costs in BCa patients treated with RC. BI assessment should be considered during patients selection process and counseling before surgery.

To test the hypothesis of an association between the American Society of Anesthesiologists (ASA) physical status classification system and the risk of 90-days postoperative complications after robot-assisted radical prostatectomy (RARP), graded using the Clavien-Dindo classification system (CDS). In a period ranging from January 2013 to October 2020, 1143 patients were evaluated. ASA classification was computed by trained anesthesiologists. Postoperative complications at 90 days after RARP were grouped as greater than one (CDS between 2 and 4a) versus up to one (CDS between 0 and 1). The risk association was computed using logistic regression models. According to ASA physical status classification system, patients were distributed as follows: 102 (8.9%) ASA 1, 934 (81.7%) ASA 2, and 107 (9.4%) ASA 3. Overall, 90-days postoperative complications occurred in 277 (24.2%) cases, of which 137 (12%) were graded as CDS 1 vs. 105 (9.2%) CDS 2 vs. 17 (1.5%) CDS 3a vs. 15 (1.3%) CDS 3b vs. 3 (0.3%) CDS 4a. ASA 2 and 3 patient categories were more likely to have 90-days postoperative complications CDS 1 (12.5% and 16.8%, respectively) compared to ASA 1 patients (4.9%). The risk association was stronger for ASA 3 (odds ratio, [OR]: 4.085; 95%CI: 1.457-11.455; p = 0.007) than for ASA 2 (OR: 2.907; 95%CI: 1.106-7.285; p = 0.023) patient categories. After adjustment for clinical, pathological, and perioperative covariates, including pelvic lymph node dissection (performed vs. not performed), either ASA 2 or 3 categories remained independent predictors of 90-days postoperative complications CDS 1. The risk of 90-days postoperative complications CDS 1 after RARP increased as the ASA physical status deteriorated independently by performing or not an extended pelvic lymph node dissection. In the ASA 3 patients category, RARP should be performed at tertiary referral centers to safely manage the risk of postoperative complications.

Introduction: The survival benefit of inguinal lymph node dissection (ILND) vs no ILND in patients with squamous cell carcinoma of the penis (SCCP) and the absence of lymph node invasion is unclear. We addressed this uncertainty within the Surveillance, Epidemiology and End Results (SEER 2000-2018) database. Material and methods: We identified lymph node negative SCCP patients who either underwent ILND (pN0) or clinical examination only (cN0). We tested for the effect of ILND vs no ILND on cancer-specific mortality (CSM) in Kaplan-Meier plots, univariable and multivariable Cox regression analyses, in a pT stage-specific fashion, before and after 1:3 propensity score matching (PSM). Sensitivity analyses were conducted according to historical and contemporary treatment periods as well as geographic regions. Results: Of 2520 SCCP patients, 369 (15%) underwent ILND (pN0) vs 2151 (85%) did not (cN0). The pN0 vs cN0 distribution according to pT stages was as follows: 80 (7%) vs 1092 (93%) in pT1b, and 289 (21%) vs 1059 (79%) in pT2-3. At 36 months, CSM-free survival in pT2-3 stage was 89% in ILND vs 74% in no ILND patients (multivariable hazard ratio: 0.42, CI 0.30-0.60, p < 0.001). This result was confirmed in sensitivity analyses, and after 1:3 PSM. The same analyses could not be completed in pT1b stage due to insufficient number of observations and events. Conclusions: In pT2-3 stage SCCP, a significantly lower CSM was recorded in lymph node negative patients treated with ILND than in their clinical lymph node negative counterparts who did not undergo ILND.

In this paper, we assess the capabilities of the Arbitrary Lagrangian–Eulerian (ALE) method implemented in the open-source code TrioCFD to tackle down two fluid–structure interaction problems involving moving boundaries. To test the code, we first consider the bi-dimensional case of two coaxial cylinders moving in a viscous fluid. We show that the two fluid forces acting on the cylinders are in phase opposition, with amplitude and phase that only depend on the Stokes number, the dimensionless separation distance and the Keulegan–Carpenter number. Throughout a detailed parametric study, we show that the self (resp. cross) added mass and damping coefficients decrease (resp. increase) with the Stokes number and the separation distance. Our numerical results are in perfect agreement with the theoretical predictions of the literature, thereby validating the robustness of the ALE method implemented in TrioCFD. Then, we challenge the code by considering the case of a vibrating cylinder located in the central position of a square tube bundle. In parallel to the numerical investigations, we also present a new experimental setup for the measurement of the added coefficient, using the direct method introduced by Tanaka. The numerical predictions for the self-added coefficients are shown to be in very good agreement with a theoretical estimation used as a reference by engineers. A good agreement with the experimental results is also obtained for moderate and large Stokes numbers, whereas an important deviation due to parasitic frequencies in the experimental setup appears for low Stokes number. Still, this study clearly confirms that the ALE method implemented in TrioCFD is particularly efficient in solving fluid–structure interaction problems. As an open-source code, and given its ease of use and its flexibility, we believe that TrioCFD is thus perfectly adapted to engineers who need simple numerical tools to tackle down complex industrial problems.

Introduction and objective Although advanced age doesn’t seem to impair oncological outcomes after robot-assisted radical prostatectomy (RARP), elderly patients have increased rates of prostate cancer (PCa) related deaths due to a higher incidence of high-risk disease. The potential unfavorable impact of advanced age on oncological outcomes following RARP remains an unsettled issue. We aimed to evaluate the oncological outcome of PCa patients > 69 years old in a single tertiary center. Materials and methods 1143 patients with clinically localized PCa underwent RARP from January 2013 to October 2020. Analysis was performed on 901 patients with available follow-up. Patients ≥ 70 years old were considered elderly. Unfavorable pathology included ISUP grade group > 2, seminal vesicle, and pelvic lymph node invasion. Disease progression was defined as biochemical and/or local recurrence and/or distant metastases. Results 243 cases (27%) were classified as elderly patients (median age 72 years). Median (IQR) follow-up was 40.4 (38.7–42.2) months. Disease progression occurred in 159 cases (17.6%). Elderly patients were more likely to belong to EAU high-risk class, have unfavorable pathology, and experience disease progression after surgery (HR = 5.300; 95% CI 1.844–15.237; p = 0.002) compared to the younger patients. Conclusions Elderly patients eligible for RARP are more likely to belong to the EAU high-risk category and to have unfavorable pathology that are independent predictors of disease progression. Advanced age adversely impacts on oncological outcomes when evaluated inside these unfavorable categories. Accordingly, elderly patients belonging to the EAU high-risk should be counseled about the increased risk of disease progression after surgery.

Con el objeto de determinar la prevalencia del síndrome de burnout en el personal de enfermería de un hospital general. Se realizó estudio observacional descriptivo de corte transversal cuyo censo poblacional estuvo conformado por un total 124 profesionales de enfermería de género femenino el instrumento de recolección de datos utilizado para medir el Síndrome de burnout fue el de Maslach Burnout Inventory (1986), el cual consta de 22 ítems que se evalúan con una escala de tipo Likert. Los resultados de este estudio denotan que la mayoría de los profesionales de enfermería que participaron en esta investigación se encuentran en un nivel medio en la dimensión cansancio emocional y despersonalización, lo cual se constituye en una de las primeras claves para la aparición del síndrome de burnout, el rango de edad principalmente susceptible fue el de (25 a 35 años) con Sperman Bilateral de p y emergencia. Se concluye que la mayoría de los profesionales de enfermería que participaron en esta investigación se encuentran en un nivel medio de burnout en la dimensión cansancio emocional y despersonalización por lo que se se sugiere realizar una propuesta de intervención del síndrome de burnout en el referido personal que coadyuve a prevenir los efectos deletéreos de este síndrome.

In some primaries African American race/ethnicity predisposes to higher stage and worse survival. We tested for differences in cancer specific mortality (CSM) and other-cause mortality (OCM) in patients with adrenocortical carcinoma (ACC) according to African American vs. Caucasian race/ethnicity. We hypothesized that African Americans present with higher tumor stage and grade, do not receive the same treatment and benefit of lower survival than Caucasians. Within Surveillance, Epidemiology, and End Results database, we identified 1016 ACC patients: 123 (12.1%) African Americans vs. 893 (87.9%) Caucasians. Propensity score matching (age, sex, marital status, grade, T, N and M stages, treatment type), cumulative incidence plots Poisson-smoothing and competing risk regression (CRR) were used. Compared to Caucasians, African Americans were more frequently unmarried (56.9% vs. 35.5%, p < 0.001). No clinically meaningful or statistically significant differences were observed for age, grade, T, N, and M stages, as well as for treatment type (all p > 0.05). After propensity score matching (1:4), 123 African Americans and 492 Caucasians remained and were included in CRR analysis. In multivariable CRR models, CSM and OCM rates were not different between the two race/ethnicities (hazard ratio: 0.84, p = 0.3). In African Americans five-year CSM rates were 31.2% and 75.3% in respectively European Network for the Study of Adrenal Tumors (ENSAT) stages I-II and III-IV vs. 32.9% and 75.4% in Caucasians. Overall five-year OCM rates were 11.0% vs. 10.1% in respectively African Americans and Caucasians. Unlike other primaries, in ACC African American race/ethnicity is not associated with higher disease stage at initial diagnosis or worse survival.

The numbers needed to image to identify pelvic lymph node and/or distant metastases in newly diagnosed prostate cancer (PCa) patients according to risk level are unknown.Relying on Surveillance, Epidemiology, and End Results (2010-2016), we tabulated rates and proportions of patients with (a) lymph node or (b) distant metastases according to National Comprehensive Cancer Network (NCCN) risk level and calculated the number needed to image (NNI) for both endpoints. Multivariable logistic regression analyses were performed.Of 145,939 newly diagnosed PCa patients assessable for analyses of pelvic lymph node metastases (cN1), 4559 (3.1%) harbored cN1 stage: 13 (0.02%), 18 (0.08%), 63 (0.3%), 512 (2.8%), and 3954 (14.9%) in low, intermediate favorable, intermediate unfavorable, high, and very high-risk levels. These resulted in NNI of 4619, 1182, 319, 35, and 7, respectively. Of 181,109 newly diagnosed PCa patients assessable for analyses of distant metastases (M1Our observations perfectly validated the NCCN recommendations for imaging in newly diagnosed high and very high-risk PCa patients. However, in unfavorable intermediate-risk PCa patients, in whom bone and soft tissue imaging is recommended, the NNI might be somewhat elevated to support routine imaging in clinical practice.

Introducción: Dentro del proceso del laboratorio clínico, la fase preanalítica es la fuente más frecuente de errores que pueden impactar en la fiabilidad de los resultados y su utilidad en la práctica clínica. Los indicadores de calidad son herramientas útiles para monitorear y mejorar todos los pasos del proceso de análisis. Objetivo: Evaluar el nivel de desempeño de indicadores preanalíticos en las áreas de química y hematología para identificar errores en el proceso de preanálisis. Métodos: Investigación de tipo descriptiva, de corte transversal, se desarrolló en 11 laboratorios clínicos utilizando seis indicadores preanalíticos del modelo de la International Federation of Clinical Chemistry and Laboratory medicine (IFCC). Resultados: La prevalencia de errores en solicitudes para el área de hematología fue 42,88% y en el área de química 36,37%, observándose que el indicador con mayor registro fue solicitudes con identificación incompleta del paciente 1920 (20,86%) en hematología y en el área de química 1600 (16,09%) (p

En la actualidad el laboratorio clínico evoluciona adaptándose a cambios científicos tecnológicos, organizativos y de gestión, inducidos por los avances en el campo de la medicina, nuevas pruebas y metodologías analíticas, así como la creciente sensibilización y expectativas de los usuarios por disponer de servicios y productos de mayor calidad; en toda esta perspectiva el éxito ante los nuevos desafíos para mejorar su eficacia, dependerá de su desempeño a la vanguardia de la gestión de la calidad, asegurando el logro de los mayores beneficios posibles para la salud del paciente y procurando el óptimo uso de los recursos disponibles en todo su proceso. Sobre esta base, resulta indispensable un sistema de gestión de calidad eficaz, que incluya evaluación interna y programas de evaluación externa de la calidad, lo que proporciona información sobre el nivel de rendimiento del laboratorio en comparación con otros, para promover la armonización de criterios, procedimientos, evaluación de intervenciones, además de ser una estrategia para proporcionar educación y capacitación del recurso humano. Dichos fines requieren que los programas de evaluación externa de la calidad incluyan el proceso total de análisis, no solo enfoque en la fase analítica, sino también la preanalítica y postanalítica, para la obtención de las mejores evidencias que llevan a identificar fuentes de variación, errores en el proceso y oportunidades de mejora de la gestión de la calidad de estos servicios de atención del sector salud en el contexto demandante de los tiempos de hoy. Palabras clave: aseguramiento de la calidad, fase preanalítica, indicadores, seguridad del paciente, laboratorios Abstract Currently, the clinical laboratory get moving adapting to technological, organizational and management changes, induced by advances in the field of medicine, new tests and analytical methodologies, technological innovation, as well as the growing sensitivity and expectations of users to have higher quality services and products; in all this perspective, success in the face of new challenges to improve its effectiveness resulted from its performance at the forefront of quality management, ensuring the achievement of the greatest possible benefits for the patient's health and seeking the optimal use of resources, available throughout your process. On this basis, an effective quality management system, including an internal assessment system and external quality assessment programs, providing information on the level of performance of the laboratory compared to others, is essential to promote harmonization criteria, procedures, exposure assessment, in addition to being a strategy to provide education and training of human resources. These purposes require that external quality assessment programs include the total analysis process, not only focusing on the analytical phase, but also the pre-analytical and post-analytical phases, in order to obtain the best evidence that leads to identifying sources of variation, errors in the process and opportunities to improve the quality management of these health care services in the demanding context of today's times. Key words: Clinical laboratory, quality assurance, extra-analytical phase, indicators, Patient Safety