Wallshayes8142

5 months. A nonsignificant postoperative eGFR decrease of 3.0 ml/min/1.73m2 was found overall (P = 0.094), with nonsignificant difference between the 2 groups (P = 0.735). A comparable 5-year OS was calculated for RNU and SU patients (P = 0.99). CONCLUSIONS The type of surgery (SU vs. RNU) has a low impact on postoperative renal function and OS in patients with ureteral cancer and preoperative eGFR less then 90 ml/min/1.73m2. The indications for kidney sparing surgery for UTUC should be based on the surgical and oncological risks in these patients. selleck compound PURPOSE Some excised specimens of upper tract urothelial carcinoma (UTUC) are concomitant carcinoma in situ (CIS). However, whether concomitant CIS affects the prognosis of UTUC is controversial. The objective of this study was to provide a comprehensive association between CIS and the prognosis of UTUC. MATERIALS AND METHODS Web of Science, PubMed, and Embase were searched to identify clinical studies about CIS and UTUC before July 2019. Newcastle Ottawa Scale was used to evaluate the quality of the literature. We calculated hazard ratios (HRs) and 95% CIs to evaluate the relationship between concomitant CIS and survival outcomes. Z test was used to pooled HRs, if P 0.05). CONCLUSIONS Our meta-analysis shows that concomitant CIS is associated with worse survival outcomes in UTUC after radical nephroureterectomy. CIS is an independent prognostic risk factor in UTUC. PURPOSE Valproic acid has been proposed as an alternative agent for treatment of agitation and delirium in the intensive care unit (ICU). Clinical data to support the use of valproic acid for this indication are limited. The objective of this analysis was to assess the efficacy and safety associated with the use of valproic acid for the management of agitation and delirium in the ICU. METHODS This retrospective descriptive analysis included patients who were prescribed valproic acid for a minimum of 3 days for the treatment of agitation and/or delirium in the cardiac, surgical, or medical ICU from May 31, 2015 to December 31, 2017. The prevalence of agitation and delirium was assessed during valproic acid therapy for up to 7 days. Additional data analyzed included opioid, sedative, and antipsychotic requirements and safety outcomes. FINDINGS A total of 47 patients met the inclusion criteria. There was an observed downward trend in the prevalence of agitation (47.8% vs 16.7%) and delirium (84.8% vs. 63.3%) throughout valproic acid therapy. In addition, the proportion of patients who required dexmedetomidine, benzodiazepines, antipsychotics, and opioids decreased while patients were taking valproic acid. No adverse effects attributed to valproic acid occurred in this patient population. IMPLICATIONS Valproic acid may be an alternative option to assist in the management of agitation and delirium in the ICU. Additional prospective data are needed to validate the use of this agent for the treatment of agitation and delirium in critically ill patients. In a two-country (home and foreign) model in which the home producer of a branded pharmaceutical product faces generic competition in each market, we analyze home's optimal policy choices regarding two major types of price regulations external reference pricing (ERP) and direct price controls. Home's nationally optimal ERP policy lowers domestic price while maintaining the firm's export incentive. This ERP policy results in a negative international price spillover that the foreign country can (partly) offset via a local price control. Generic competition in either market reduces home's welfare gain from instituting an ERP policy. Weaker competition abroad or a greater weight on firm profits relative to consumer surplus in home's welfare function makes it more likely that home prefers an ERP policy to a price control. While international integration of national generic markets can improve welfare, such is not the case if it causes home to relax its ERP policy. BACKGROUND There is paucity of information on clinical characteristics and outcome of patients with familial atrial fibrillation (AF). The present study was aimed to compare clinical profile and outcome of familial AF with those of non-familial AF. METHODS Between February 2017 and February 2018, we enrolled 738 participants (60% men, median age, 51 years in familial AF vs. 61 years in non-familial AF) from Iranian Registry of AF. All patients were followed for 12 months. Clinical characteristics and main outcome measures for AF patients were obtained from patient's medical records. RESULTS A positive history of AF in first-degree relative was reported in 15.3% of our AF population. Familial AF group were significantly younger than non-familial group (p = 0.001). Concomitant sinus node dysfunction and cardiomyopathies were more common in familial AF group (p = 0.02, p = 0.004, respectively). Patients with familial AF were also likely to receive cardiac devices and AF catheter ablation (all p  0.05). CONCLUSIONS Familial AF patients were more likely to have associated rhythm disorders and dilated cardiomyopathies. Cardiac interventions were also more common in familial patients. However, they did not differ significantly in their long-term outcome. OBJECTIVE The central bouquet (CB) of the fovea comprises a dense array of cone photoreceptors intertwined with Müller cells. The aim of this investigation was to study visual outcomes and structural alterations in the foveal CB associated with cystoid macular edema (CME) of different etiologies. DESIGN Retrospective case series. PARTICIPANTS AND METHODS This study analyzed eyes with various etiologies of CME, including diabetic macular edema, central retinal vein occlusion (CRVO), pseudophakic or Irvine-Gass (IG) syndrome, uveitis, and retinitis pigmentosa using spectral-domain optical coherence tomography (SD-OCT). SD-OCT was used to classify the CB alterations as either (1) thickened hyper-reflectivity associated with indistinct ellipsoid zone (EZ), or (2) subretinal fluid with intact EZ. Comparisons were made using the Students t test and Fisher's exact test. RESULTS The total cohort consisted of 61 eyes from 61 patients with various etiologies of CME. CB alterations were observed in 91% of uveitis eyes, 82% of CRVO eyes and 50% of IG eyes.