Significant up-regulation of lncRNAs in neuromyelitis optica spectrum disorder.

Neuromyelitis optica spectrum disorder (NMOSD) is an immune-related demyelinating defect. Long non-coding RNAs (lncRNAs) might influence the pathobiology and progression of NMOSD. The current study assessed expression level of NEAT1, PANDAR, MEG3 and TUG1 lncRNAs in the peripheral blood of NMOSD patients compared with healthy individuals. All mentioned lncRNAs were shown to be over-expressed in total NMOSD cases, male NMOSD cases and female NMOSD cases compared with the matching control subgroups. MEG3 had the most robust over-expression in patients subgroups compared with normal subjects. There was no noteworthy difference in the expression of any of lncRNAs between female and male patients. MEG3 had an ideal performance in the differentiation of NMOSD cases from healthy persons (Sensitivity and specificity values = 100%). Other lncRNAs could also efficiently separate NMOSD cases from control subjects (AUC values = 0.97, 0.89 and 0.88 for PANDAR, NEAT1 and TUG1, respectively). Cumulatively, NEAT1, PANDAR, MEG3 and TUG1 lncRNAs can be considered as appropriate disease markers for NMOSD.

Multidimensional characterization of inducible promoters and a highly light-sensitive LOV-transcription factor.

The ability to independently control the expression of different genes is important for quantitative biology. Using budding yeast, we characterize GAL1pr, GALL, MET3pr, CUP1pr, PHO5pr, tetOpr, terminator-tetOpr, Z3EV, blue-light inducible optogenetic systems El222-LIP, El222-GLIP, and red-light inducible PhyB-PIF3. We report kinetic parameters, noise scaling, impact on growth, and the fundamental leakiness of each system using an intuitive unit, maxGAL1. We uncover disadvantages of widely used tools, e.g., nonmonotonic activity of MET3pr and GALL, slow off kinetics of the doxycycline- and estradiol-inducible systems tetOpr and Z3EV, and high variability of PHO5pr and red-light activated PhyB-PIF3 system. We introduce two previously uncharacterized systems: strongLOV, a more light-sensitive El222 mutant, and ARG3pr, which is induced in the absence of arginine or presence of methionine. To demonstrate fine control over gene circuits, we experimentally tune the time between cell cycle Start and mitosis, artificially simulating near-wild-type timing. All strains, constructs, code, and data ( https://promoter-benchmark.epfl.ch/ ) are made available.

Quality of Professional Life and Its Association with Emotional Well-Being among COVID-19 Physicians and Nurses.

Background: The present study was to compare the professional quality of life (ProQOL) and its association with the emotional well-being among the physicians and nurses in contact with COVID-19 patients in Iran and France. Materials and Methods: The study was performed on 903 nurses and physicians in contact with COVID-19 patients in Iran and France.he subjects completed their demographics online and then answered questions addressing their job stress and emotion associated with their contact with COVID-19 patients and ProQOL. Finally, the collected data were analyzed using the SPSS software (ver. 25). Results: According to the results of the present study, the degree of contact with COVID-19 patients had a significant role in compassion satisfaction, burnout, and compassion fatigue, with the coefficient effects of 0.459, 0.688, and 0.433, respectively (P < 0.05). The emotional well-being had a significant role in increasing compassion satisfaction (B = 0.505, P < 0.05). Conclusion: According to the results of the present study, factors such as contact with a COVID-19 patient, emotional well-being, gender, and marital status had a significant effect on dimensions of ProQOL in both Iran and France. Considering that the entire focus of the physicians and nurses is on the health of COVID-19 patients and they have no concentration on improving their emotional state, it seems that supporting them in terms of psychological self-care and considering its indirect impact on the quality of professional performance are of particular significance.

The optimal strategy balancing risk and speed predicts DNA damage checkpoint override times.

Checkpoints arrest biological processes allowing time for error correction. The phenomenon of checkpoint override (also known as checkpoint adaptation, slippage, or leakage), during cellular self-replication is biologically critical but currently lacks a quantitative, functional, or system-level understanding. To uncover fundamental laws governing error-correction systems, we derived a general theory of optimal checkpoint strategies, balancing the trade-off between risk and self-replication speed. Mathematically, the problem maps onto the optimization of an absorbing boundary for a random walk. We applied the theory to the DNA damage checkpoint (DDC) in budding yeast, an intensively researched model checkpoint. Using novel reporters for double-strand DNA breaks (DSBs), we first quantified the probability distribution of DSB repair in time including rare events and, secondly, the survival probability after override. With these inputs, the optimal theory predicted remarkably accurately override times as a function of DSB numbers, which we measured precisely for the first time. Thus, a first-principles calculation revealed undiscovered patterns underlying highly noisy override processes. Our multi-DSB measurements revise well-known past results and show that override is more general than previously thought.

Contributing factors to the total fertility rate declining trend in the Middle East and North Africa: a systemic review.

BACKGROUND: The total fertility rate (TFR) in the Middle East and North Africa has experienced a declining trend in recent years. Accordingly, the present study was conducted to provide a clear picture of the most critical factors affecting the TFR decline in this region. METHODS: This study was a systematic review between the years 2000 and 2016. The different databases like Cochrane, PubMed, Scopus, and Science Direct and the Google Scholar search engine were used. At first, 270 articles and then 18 articles were selected and meticulously read for the final analysis. RESULTS: The results indicated a declining trend in the TFR in the Middle East and North Africa, as in other parts of the world. Regarding the causes of this declining trend, several factors were identified and categorized into five main factors of health care-related, cultural, economic, social, and political. CONCLUSIONS: While taking advantage of the experiences, it is necessary to identify the five main factors and their related issues and hence consider them in the population policy-making.

The Impact of 18F-DCFPyL PET-CT Imaging on Initial Staging, Radiation, and Systemic Therapy Treatment Recommendations for Veterans With Aggressive Prostate Cancer.

PURPOSE: Our purpose was to study the effect of 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-DCFPyL) positron emission tomography (PET)-computed tomography (CT) on staging/treatment recommendations of previously untreated prostate cancer. We report here results of a prospective single center single arm imaging trial within Veterans Affairs (Greater Los Angeles): the frequency of patients upstaged to M1 disease (primary endpoint) and the frequency of patients with change in treatment recommendations (secondary endpoint). This is the first report of prostate-specific membrane antigen PET-CT exclusive to U.S. veterans. METHODS AND MATERIALS: Veterans with Gleason ≥4 + 3, clinical stage ≥T2c, or prostate-specific antigen >10 ng/mL were eligible. Patients underwent conventional imaging (99mTc-methyl diphosphonate bone scan or 18F-NaF PET-CT; and pelvic CT or pelvic magnetic resonance imaging) in addition to 18F-DCFPyL PET-CT. The effect of 18F-DCFPyL PET-CT on treatment change was determined by applying prespecified treatment recommendations based on National Comprehensive Cancer Network guidelines and modern clinical practice. RESULTS: One hundred patients underwent 18F-DCFPyL PET-CT. Nineteen out of 84 (23%) patients initially thought to be nonmetastatic were upstaged to M1; 8/16 (50%) patients initially thought to have M1 disease were downstaged to M0. In total, 39/100 (39%) had a change in prespecified treatment recommendations, including change of radiation therapy volume/dose in 39/100 (39%) and starting abiraterone in 22/100 (22%). CONCLUSIONS: Incorporation of 18F-DCFPyL PET-CT into the initial conventional imaging workup for prostate cancer can substantially affect staging/treatment recommendations.

A convolutional neural network segments yeast microscopy images with high accuracy.

The identification of cell borders ('segmentation') in microscopy images constitutes a bottleneck for large-scale experiments. For the model organism Saccharomyces cerevisiae, current segmentation methods face challenges when cells bud, crowd, or exhibit irregular features. We present a convolutional neural network (CNN) named YeaZ, the underlying training set of high-quality segmented yeast images (>10 000 cells) including mutants, stressed cells, and time courses, as well as a graphical user interface and a web application ( www.quantsysbio.com/data-and-software ) to efficiently employ, test, and expand the system. A key feature is a cell-cell boundary test which avoids the need for fluorescent markers. Our CNN is highly accurate, including for buds, and outperforms existing methods on benchmark images, indicating it transfers well to other conditions. To demonstrate how efficient large-scale image processing uncovers new biology, we analyze the geometries of ≈2200 wild-type and cyclin mutant cells and find that morphogenesis control occurs unexpectedly early and gradually.

Effective factors on improving the quality of hospital services in south of Iran.

OBJECTIVE: To determine the quality of service being provided in a hospital in southern Iran and to evaluate it from patients' perspective. METHODS: The cross-sectional study was conducted at a general university hospital in Shiraz, southern Iran, in two phases in 2015. The first phase comprised a survey based on SERVQUAL method-ServQual stands for Service Quality- and collected data from hospitalised patients. In second stage Decision Making Trial and Evaluation (DEMATEL) technique was employed to prioritize quality factors identified in first stage to suggest action. The second phase comprised experts who determined the relationship between 5 quality aspects and 14 criteria in line with DEMATEL matrixes. SPSS 16 was used for data analysis. RESULTS: Of the 208 subjects in the first phase, 103(49.5%) were men and 105(50.5%) were women. The second phase had 12 experts from among the senior nursing staff. In all the five aspects of service quality, the hospital was not able to meet the expectations of the patients (p<0.001). DEMATEL analysis indicated responsiveness as the most important element for improving service quality, followed by reliability, empathy, assurance and tangibility. CONCLUSIONS: The authorities running the hospital needed to eliminate the negative gap and improve service quality by taking necessary measures.

Feasibility of implementing public-private partnership (PPP) in the development of hospital services and optimizing resource allocation in Iran.

BACKGROUND: In recent decades, many countries have utilized public-private partnership (PPP) as a development initiative to reform their healthcare sectors. The present study examines the feasibility of implementing public-private partnerships for development of hospital services in Shiraz, Iran. METHODS: This was a descriptive study of questionnaires carried out on one of Iran's major southern cities (Shiraz) in 2016. Research population comprised of the hospitals affiliated to the Shiraz University of Medical Sciences (SUMS), private hospitals, charities, and healthcare investors. A total of 56 participants were chosen by convenience sampling. Data were collected using a researcher-made questionnaire. The questions` range were defined from 1 to 5. Data analysis was performed in SPSS21 using the Mann-Whitney test, T test, and Chi square test at 0.05 significance level. RESULTS: The participants from the public sector had a significantly higher level of acquaintance with the concept of PPP and significantly more inclination to participate in such projects (P < 0.05). The mean values of the determinants of successful implementation of PPPs for hospital services were presented from the public and private participants` viewpoints as follows: public sector rated the capacity-creating (2.60 ± 0.39) and the social-cultural (2.58 ± 0.40) component as having a better condition than other determinants however, the private sector rated the financial-capital (2.64 ± 0.46) as the best. Analysis of the mean scores of determinants of implementation of PPP from the viewpoint of public and private sectors showed a significant difference in their views in terms of financial-capital and social-cultural dimensions (P < 0.05). CONCLUSIONS: According to the participants, the requirements for implementation of public-private partnerships for hospital services are not properly met. For any progress to be made in this regard, Iranian authorities and policymakers should devise a new platform for attracting private participation and improving hospitals' readiness to engage in PPP projects.

Prostate-only Versus Whole-pelvis Radiation with or Without a Brachytherapy Boost for Gleason Grade Group 5 Prostate Cancer: A Retrospective Analysis.

BACKGROUND: The role of elective whole-pelvis radiotherapy (WPRT) remains controversial. Few studies have investigated it in Gleason grade group (GG) 5 prostate cancer (PCa), known to have a high risk of nodal metastases. OBJECTIVE: To assess the impact of WPRT on patients with GG 5 PCa treated with external-beam radiotherapy (EBRT) or EBRT with a brachytherapy boost (EBRT+BT). DESIGN, SETTING, AND PARTICIPANTS: We identified 1170 patients with biopsy-proven GG 5 PCa from 11 centers in the United States and one in Norway treated between 2000 and 2013 (734 with EBRT and 436 with EBRT+BT). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Biochemical recurrence-free survival (bRFS), distant metastasis-free survival (DMFS), and prostate cancer-specific survival (PCSS) were compared using Cox proportional hazards models with propensity score adjustment. RESULTS AND LIMITATIONS: A total of 299 EBRT patients (41%) and 320 EBRT+BT patients (73%) received WPRT. The adjusted 5-yr bRFS rates with WPRT in the EBRT and EBRT+BT groups were 66% and 88%, respectively. Without WPRT, these rates for the EBRT and EBRT+BT groups were 58% and 78%, respectively. The median follow-up was 5.6yr. WPRT was associated with improved bRFS among patients treated with EBRT+BT (hazard ratio [HR] 0.5, 95% confidence interval [CI] 0.2-0.9, p=0.02), but no evidence for improvement was found in those treated with EBRT (HR 0.8, 95% CI 0.6-1.2, p=0.4). WPRT was not significantly associated with improved DMFS or PCSS in the EBRT group (HR 1.1, 95% CI 0.7-1.7, p=0.8 for DMFS and HR 0.7, 95% CI 0.4-1.1, p=0.1 for PCSS), or in the EBRT+BT group (HR 0.6, 95% CI 0.3-1.4, p=0.2 for DMFS and HR 0.5 95% CI 0.2-1.2, p=0.1 for PCSS). CONCLUSIONS: WPRT was not associated with improved PCSS or DMFS in patients with GG 5 PCa who received either EBRT or EBRT+BT. However, WPRT was associated with a significant improvement in bRFS among patients receiving EBRT+BT. Strategies to optimize WPRT, potentially with the use of advanced imaging techniques to identify occult nodal disease, are warranted. PATIENT SUMMARY: When men with a high Gleason grade prostate cancer receive radiation with external radiation and brachytherapy, the addition of radiation to the pelvis results in a longer duration of prostate-specific antigen control. However, we did not find a difference in their survival from prostate cancer or in their survival without metastatic disease. We also did not find a benefit for radiation to the pelvis in men who received radiation without brachytherapy.

Albumin Usage in Iran.

BACKGROUND: Human albumin is an expensive therapy with inappropriate use in many clinical conditions. Inappropriate use of albumin imposes a substantial economic burden on the healthcare system and society. Drug use evaluation (DUE) is one method of assessing the appropriateness of drug use which has been powered by increasing concern about the cost-effectiveness of drugs. The objective of this study is to systematically review the appropriateness of albumin utilization in Iranian hospitals. METHODS: We searched the PubMed, MEDLINE, EMBASE, SCOPUS, and Google Scholar for articles in English and SID, Magiran, Medlib, and Irandoc for articles in Persian from 1997 to 2018. Studies on the DUE of albumin in Iranian hospitals were included in this study. Articles conducted outside Iran, editorials, letters and review articles were excluded. RESULTS: In total, eight studies were selected for the final review. The majority of the papers were conducted in Tehran. In most studies, the highest albumin consumption was related to the intensive care unit. The most frequent reasons for prescribing albumin were edema, hypoalbuminemia, volume expansion after heart surgery, ascites, cardiac surgery and cirrhosis. Of the studies included, five studies evaluated the costs of drug use. CONCLUSION: Our findings show that inappropriate use of albumin imposes a relatively high additional cost on the society. The included studies show that the percentage of inappropriate use of albumin is relatively high in Iran and this abuse is an essential problem in Iranian hospitals. Prescription based on standard guidelines could improve rational use of albumin and lead to savings in treatment costs.

The Prevalence of Nonalcoholic Fatty Pancreas by Endoscopic Ultrasonography.

OBJECTIVES: Pancreatic steatosis or fatty pancreas refers to the fat accumulation in the pancreas, which can lead to inflammation and fibrosis, ß-cell dysfunction, fibrosis, and, possibly, pancreatic cancer. This study aimed to study the prevalence of fatty pancreas and its risk factors in patients referred to an endosonography center. METHODS: During 18 months, 228 patients who were referred to our endosonography center for various reasons were evaluated for fatty pancreas. Fatty pancreas was defined as hyperechoic pancreas echotexture compared with spleen echotexture. Demographic characteristics, past medical history, and laboratory measurements were compared between groups with and without fatty pancreas to determine the risk factors for fatty pancreas. RESULTS: The prevalence of fatty pancreas was 25.9%. Patients with fatty pancreas had a significantly higher mean level of uric acid (P = 0.04), frequency of ischemic heart disease (P = 0.03), hyperlipidemia (P = 0.04), frequency of fatty liver (P < 0.001), and aortic intima thickness (P = 0.01). There was no significant difference in age, sex, body mass index, smoking status, substance abuse, and use of oral contraceptives in the 2 groups. CONCLUSIONS: Fatty pancreas is a common disorder. There are meaningful relationships between coronary artery disease, nonalcoholic fatty liver, and atherosclerosis with fatty pancreas.

Can public-private partnership (PPP) improve hospitals' performance indicators?

Background: This study was conducted to compare the main performance indicators of Hasheminejad hospital before and after implementing PPP model. Methods: This cross sectional study was conducted in Iran in 2015. Performance indicators of Hasheminejad hospital, the only Iranian unit that implemented PPP model, were applied. Data were collected based on a researcher-designed checklist after ensuring its validity and reliability. Data were analyzed applying SPSS21, and the Shapiro-Wilk test was used to examine the relevant data normalization. After confirming the normality of the data, descriptive statistics and paired t test were used to analyze the data at a significant level of 0.05. Results: Dramatic variations were observed in the status of the studied indicators after the implementation of PPP in Hasheminejad hospital, and the changes were statistically significant in all these indicators (p<0.05). Conclusion: It seems that implementing PPP in Hasheminejad hospital can be considered as a successful experience in Iran's health sector. The significant improvement in this hospital's performance indicators can emphasize the effective role of PPP in administration of this hospital. However, service quality and patient satisfaction should be considered as qualitative indicators, along with the present quantitative indicators because better judgment about the changes was achieved in this hospital after implementing PPP.

Systemic and tumor-directed therapy for oligometastatic prostate cancer: study protocol for a phase II trial for veterans with de novo oligometastatic disease.

BACKGROUND: The treatment paradigm for metastatic hormone-sensitive prostate cancer (mHSPC) patients is evolving. PET/CT now offers improved sensitivity and accuracy in staging. Recent randomized trial data supports escalated hormone therapy, local primary tumor therapy, and metastasis-directed therapy. The impact of combining such therapies into a multimodal approach is unknown. This Phase II single-arm clinical trial sponsored and funded by Veterans Affairs combines local, metastasis-directed, and systemic therapies to durably render patients free of detectable disease off active therapy. METHODS: Patients with newly-diagnosed M1a/b prostate cancer (PSMA PET/CT staging is permitted) and 1-5 radiographically visible metastases (excluding pelvic lymph nodes) are undergoing local treatment with radical prostatectomy, limited duration systemic therapy for a total of six months (leuprolide, abiraterone acetate with prednisone, and apalutamide), metastasis-directed stereotactic body radiotherapy (SBRT), and post-operative fractionated radiotherapy if pT ≥ 3a, N1, or positive margins are present. The primary endpoint is the percent of patients achieving a serum PSA of < 0.05 ng/mL six months after recovery of serum testosterone ≥150 ng/dL. Secondary endpoints include time to biochemical progression, time to radiographic progression, time to initiation of alternative antineoplastic therapy, prostate cancer specific survival, health related quality-of-life, safety and tolerability. DISCUSSION: To our knowledge, this is the first trial that tests a comprehensive systemic and tumor directed therapeutic strategy for patients with newly diagnosed oligometastatic prostate cancer. This trial, and others like it, represent the critical first step towards curative intent therapy for a patient population where palliation has been the norm. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03298087 (registration date: September 29, 2017).

Clinical Outcomes for Patients With Gleason Score 10 Prostate Adenocarcinoma: Results From a Multi-institutional Consortium Study.

PURPOSE: Gleason score (GS) 10 disease is the most aggressive form of clinically localized prostate adenocarcinoma (PCa). The long-term clinical outcomes and overall prognosis of patients presenting with GS 10 PCa are largely unknown because of its rarity. METHODS AND MATERIALS: The study included 112 patients with biopsy-determined GS 10 PCa who received treatment with radical prostatectomy (RP, n = 26), external beam radiation therapy (EBRT, n = 48), or EBRT with a brachytherapy boost (EBRT-BT, n = 38) between 2000 and 2013. Propensity scores were included as covariates for comparative analysis. Overall survival, prostate cancer-specific survival, and distant metastasis-free survival (DMFS) were estimated by the Kaplan-Meier method with inverse probability of treatment weighting to control for confounding. RESULTS: The median follow-up period was 4.9 years overall (3.9 years for RP, 4.8 years for EBRT, and 5.7 years for EBRT-BT). Significantly more EBRT patients than EBRT-BT patients received upfront androgen deprivation therapy (98% vs 79%, P < .01 by χ2 test), though the durations were similar (median, 24 months vs 22.5 months). Of the RP patients, 34% received postoperative EBRT, and 35% received neoadjuvant systemic therapy. The propensity score-adjusted 5-year overall survival rate was 80% for the RP group, 73% for the EBRT group, and 83% for the EBRT-BT group. The corresponding adjusted 5-year prostate cancer-specific survival rates were 87%, 75%, and 94%, respectively. The EBRT-BT group trended toward superior DMFS when compared with the RP group (hazard ratio, 0.3; 95% confidence interval 0.1-1.06; P = .06) and had superior DMFS when compared with the EBRT group (hazard ratio, 0.4; 95% confidence interval 0.1-0.99; P = .048). CONCLUSIONS: To our knowledge, this is the largest series ever reported on the clinical outcomes of patients with biopsy-determined GS 10 PCa. These data provide useful prognostic benchmark information for physicians and patients. Aggressive therapy with curative intent is warranted, as >50% of patients remain free of systemic disease 5 years after treatment.

Psychological factors of healthful diet promotion among diabetics: an application of health action process approach.

BACKGROUND AND AIM: Worldwide, type 2 diabetes mellitus (T2DM) prevalence has increased. Non-healthful diet is one of the main reasons to T2DM growth. This study aims to determine the efficacy of the health action process approach (HAPA) in explaining healthful diet (HD) in T2DM patients. METHODS: This cross-sectional study was conducted based on HAPA in Isfahan, Iran between July and December 2015. Participants were recruited by convenience sampling method. HAPA inventory was administered to 203 Isfahan diabetics. Intentions, outcome expectancies, risk perception, action self-efficacy, action and coping planning, maintenance and recovery self-efficacy, and dietary style were the constructs measured. Structural equation modeling (SEM) in AMOS 21 was used to test the hypothesis. RESULTS: The results based on the common fit indices revealed that the HAPA fitted the data acceptably well among the T2DM patients and within dietary behavior (p<0.001), RMSEA=0.082, CFI=0.903, NFI=0.899). Action self-efficacy was the best predictor of intention (ß=2.49, p<0.001). Result revealed action and coping planning (ß=5.36, p=0.027) and recovery self-efficacy (ß=5.67, p=0.021) significantly predicted behavior. CONCLUSIONS: Our findings provide preliminary support for the practical usage of the HAPA model for predicting HD intention and behavior among T2DM patients. Randomized controlled trials should be performed in the future in order to involve causality.

Radical Prostatectomy, External Beam Radiotherapy, or External Beam Radiotherapy With Brachytherapy Boost and Disease Progression and Mortality in Patients With Gleason Score 9-10 Prostate Cancer.

Importance: The optimal treatment for Gleason score 9-10 prostate cancer is unknown. Objective: To compare clinical outcomes of patients with Gleason score 9-10 prostate cancer after definitive treatment. Design, Setting, and Participants: Retrospective cohort study in 12 tertiary centers (11 in the United States, 1 in Norway), with 1809 patients treated between 2000 and 2013. Exposures: Radical prostatectomy (RP), external beam radiotherapy (EBRT) with androgen deprivation therapy, or EBRT plus brachytherapy boost (EBRT+BT) with androgen deprivation therapy. Main Outcomes and Measures: The primary outcome was prostate cancer-specific mortality; distant metastasis-free survival and overall survival were secondary outcomes. Results: Of 1809 men, 639 underwent RP, 734 EBRT, and 436 EBRT+BT. Median ages were 61, 67.7, and 67.5 years; median follow-up was 4.2, 5.1, and 6.3 years, respectively. By 10 years, 91 RP, 186 EBRT, and 90 EBRT+BT patients had died. Adjusted 5-year prostate cancer-specific mortality rates were RP, 12% (95% CI, 8%-17%); EBRT, 13% (95% CI, 8%-19%); and EBRT+BT, 3% (95% CI, 1%-5%). EBRT+BT was associated with significantly lower prostate cancer-specific mortality than either RP or EBRT (cause-specific HRs of 0.38 [95% CI, 0.21-0.68] and 0.41 [95% CI, 0.24-0.71]). Adjusted 5-year incidence rates of distant metastasis were RP, 24% (95% CI, 19%-30%); EBRT, 24% (95% CI, 20%-28%); and EBRT+BT, 8% (95% CI, 5%-11%). EBRT+BT was associated with a significantly lower rate of distant metastasis (propensity-score-adjusted cause-specific HRs of 0.27 [95% CI, 0.17-0.43] for RP and 0.30 [95% CI, 0.19-0.47] for EBRT). Adjusted 7.5-year all-cause mortality rates were RP, 17% (95% CI, 11%-23%); EBRT, 18% (95% CI, 14%-24%); and EBRT+BT, 10% (95% CI, 7%-13%). Within the first 7.5 years of follow-up, EBRT+BT was associated with significantly lower all-cause mortality (cause-specific HRs of 0.66 [95% CI, 0.46-0.96] for RP and 0.61 [95% CI, 0.45-0.84] for EBRT). After the first 7.5 years, the corresponding HRs were 1.16 (95% CI, 0.70-1.92) and 0.87 (95% CI, 0.57-1.32). No significant differences in prostate cancer-specific mortality, distant metastasis, or all-cause mortality (≤7.5 and >7.5 years) were found between men treated with EBRT or RP (cause-specific HRs of 0.92 [95% CI, 0.67-1.26], 0.90 [95% CI, 0.70-1.14], 1.07 [95% CI, 0.80-1.44], and 1.34 [95% CI, 0.85-2.11]). Conclusions and Relevance: Among patients with Gleason score 9-10 prostate cancer, treatment with EBRT+BT with androgen deprivation therapy was associated with significantly better prostate cancer-specific mortality and longer time to distant metastasis compared with EBRT with androgen deprivation therapy or with RP.

Clinical Outcomes for Patients with Gleason Score 9-10 Prostate Adenocarcinoma Treated With Radiotherapy or Radical Prostatectomy: A Multi-institutional Comparative Analysis.

BACKGROUND: The long natural history of prostate cancer (CaP) limits comparisons of efficacy between radical prostatectomy (RP) and external beam radiotherapy (EBRT), since patients treated years ago received treatments considered suboptimal by modern standards (particularly with regards to androgen deprivation therapy [ADT] and radiotherapy dose-escalation]. Gleason score (GS) 9-10 CaP is particularly aggressive, and clinically-relevant endpoints occur early, facilitating meaningful comparisons. OBJECTIVE: To compare outcomes of patients with GS 9-10 CaP following EBRT, extremely-dose escalated radiotherapy (as exemplified by EBRT+brachytherapy [EBRT+BT]), and RP. DESIGN, SETTING, PARTICIPANTS: Retrospective analysis of 487 patients with biopsy GS 9-10 CaP treated between 2000 and 2013 (230 with EBRT, 87 with EBRT+BT, and 170 with RP). Most radiotherapy patients received ADT and dose-escalated radiotherapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Kaplan-Meier analysis and multivariate Cox regression estimated and compared 5-yr and 10-yr rates of distant metastasis-free survival, cancer-specific survival (CSS), and overall survival (OS). RESULTS AND LIMITATIONS: The median follow-up was 4.6 yr. Local salvage and systemic salvage were performed more frequently in RP patients (49.0% and 30.1%) when compared with either EBRT patients (0.9% and 19.7%) or EBRT+BT patients (1.2% and 16.1%, p<0.0001). Five-yr and 10-yr distant metastasis-free survival rates were significantly higher with EBRT+BT (94.6% and 89.8%) than with EBRT (78.7% and 66.7%, p=0.0005) or RP (79.1% and 61.5%, p<0.0001). The 5-yr and 10-yr CSS and OS rates were similar across all three cohorts. CONCLUSIONS: Radiotherapy and RP provide equivalent CSS and OS. Extremely dose-escalated radiotherapy with ADT in particular offers improved systemic control when compared with either EBRT or RP. These data suggest that extremely dose-escalated radiotherapy with ADT might be the optimal upfront treatment for patients with biopsy GS 9-10 CaP. PATIENT SUMMARY: While some prostate cancers are slow-growing requiring many years, sometimes decades, of follow-up in order to compare between radiation and surgery, high-risk and very aggressive cancers follow a much shorter time course allowing such comparisons to be made and updated as treatments, especially radiation, rapidly evolve. We showed that radiation-based treatments and surgery, with contemporary standards, offer equivalent survival for patients with very aggressive cancers (defined as Gleason score 9-10). Extremely-dose escalated radiotherapy with short-course androgen deprivation therapy offered the least risk of developing metastases, and equivalent long term survival.

Experiences of selected countries in the use of public-private partnership in hospital services provision.

OBJECTIVE: To review the experiences of selected countries in the use of public-private partnership in the provision of hospital services. METHODS: This comparative study was conducted in 2015 in Iran. To collect data, valid databases as well as articles, theses, reports and related books in the field of private-sector partnership in hospital services were employed. Using purposive sampling, countries such as the United Kingdom, Spain, Canada, Turkey, Australia and Lesotho, which had successful experiences in the field of application of the public-private partnership in hospital services, were included. Likewise, the only experience in Iran in this field was also reviewed. Studies done between 1980 and 2015 were examined. The results obtained from each country were compared. RESULTS: Implementing public-private partnership had great and valuable outcomes and achievements for governmental hospitals. Moreover, clinical and nonclinical service delivery, hospital utilisation and management along with building, repairing and supportive operations through public-private partnership contracts can be differently divided among the partners. Furthermore, duration of the projects ranged from 12 to 40 years in different countries, depending on the type of the model used. CONCLUSIONS: A successful experience in the use of the public-private partnership in the provision of hospital services was observed.

Equity analysis of hospital beds distribution in Shiraz, Iran 2014.

BACKGROUND: One of the important aspects of equity in health is equality in the distribution of resources in this sector. The present study aimed to assess the distribution of hospital beds in Shiraz in 2014. METHODS: In this retrospective cross-sectional study, the population density index and fair distribution of beds were analyzed by Lorenz curve and Gini coefficient, respectively. Descriptive data were analyzed using Excel software. We used Distributive Analysis Stata Package (DASP) in STATA software, version 12, for computing Gini coefficient and drawing Lorenz curve. RESULTS: The Gini coefficient was 0.68 in the population. Besides, Gini coefficient of hospital beds' distribution based on population density was 0.70, which represented inequality in the distribution of hospital bedsamong the nine regions of Shiraz. CONCLUSION: Although the total number of hospital beds was reasonable in Shiraz, distribution of these resources was not fair, and inequality was observed in their distribution among the nine regions of Shiraz.