BackgroundMultiparametric magnetic resonance imaging (mpMRI) is now recommended pre-biopsy in numerous healthcare regions based on the findings of high-quality studies from expert centres. Concern remains about reproducibility of mpMRI to rule-out clinically significant prostate cancer (csPCa) in real-world settings. ObjectiveTo assess the diagnostic performance of mpMRI for csPCa in a real-world setting. Design, Setting, and ParticipantsA multicentre, retrospective cohort study including men referred with a raised PSA or abnormal digital rectal exam who had undergone mpMRI followed by transrectal or transperineal biopsy. Patients could be biopsy naïve or have had previous negative biopsies. Outcome Measurements and Statistical AnalysisThe primary definition for csPCa was defined as ISUP Grade Group 2 or higher (any Gleason >/=7); the accuracy for other definitions was also evaluated. Results and LimitationsAcross 10 sites 2642 men were included (January/2011-November/2018). Mean age and PSA were 65.3 years (SD 7.8 years) and 7.5ng/ml (SD 3.3ng/ml). 35.9% had a 'negative' MRI' (score 1-2). 51.9% underwent transrectal biopsy and 48.1% had transperineal biopsy; with 43.4% diagnosed with csPCa overall. The sensitivity and negative predictive value (NPV) for 5 ISUP GG >/=2 were 87.3% and 87.5%, respectively. The NPV was 87.4% and 88.1% for men undergoing transrectal and transperineal biopsy, respectively. Specificity and positive predictive value of MRI were 49.8% and 49.2%, respectively. The sensitivity and NPV increased to 96.6% and 90.6% when a PSA-density threshold 0.15ng/ml/ml was used in MRI scores 1-2; these metrics increased to 97.5% and 91.2%, respectively, for PSA density 0.12ng/ml/ml. ISUP GG >/=3 (Gleason >/=4+3) was found in 2.4% (15/617) of men with MRI score 1-2. They key limitation of this study is the heterogeneity and retrospective nature of the data. ConclusionsmpMRI when used in real-world settings is able to accurately rule-out csPCa suggesting that about one-third of men might avoid an immediate biopsy. Men should be counselled about the risk of missing some significant cancers.
The cost of urethral catheterisation injury (UCI) is significant, but the true incidence of patient care error is difficult to establish in the absence of specific hospital codes recording difficult urethral catheterisation (DUC) and UCI. For many years urologists are familiar passing a non-traumatic hydrophilic guidewire blindly into the bladder to aid urethral catheter insertion in difficult circumstances. However, so far, no purpose-built regulated medical device was available on the market and clinicians had to improvise. Urethrotech filled that gap and developed the Urethral Catheterisation Device (UCD ® ), which integrates a standard hydrophilic Nitinol guidewire into a 3-way 16F Silicone urethral catheter design to enable safe second-line urethral catheterisation when first-line catheterisation with a standard urethral catheter is unsuccessful. The safety and efficacy of UCD ® catheterisation were evaluated in consecutive cohorts of men undergoing cardiac surgery and compared to the incidence of DUC and UCI with standard Foley catheterisation. A simple new Male Catheterisation Algorithm is proposed that can deliver a safe male urethral catheterisation treatment protocol for all clinical settings of healthcare services, which is easy to implement and integrate into standard catheterisation training programs to manage DUC and avoid UCI, empowering a frontline workforce to deliver better patient care.
Most colorectal surgeons believe that there is an advantage in performing IORWs. Although, most surgeons would routinely perform IORWs in open resections, they do not routinely perform these in laparoscopic resections.
Intestinal tuberculosis (ITB) involves the ileocaecum in the majority of cases with upper gastrointestinal tract tuberculosis accounting for less than 3% of all cases.1 Gallbladder TB, in particular, is very rare, with few cases reported in the literature. ITB results from haematogenous spread or spread from contiguous lymph nodes or swallowed infected sputum.2 Why ITB preferentially affects the ileocaecum is unclear, but proposed mechanisms include bowel stasis in the terminal ileum, due to the ileocaecal valve, and the high density of lymphoid tissue found in the terminal ileum.Bile acids are the major constituent of bile and the primary bile acids, cholic and chenodeoxycholic acid, and secondary bile acids, lithocholic and deoxycholic acid, make up more than 95% of the bile acid pool. Bile acids have a number of biological effects, including generation of reactive oxygen species, a detergent action on lipidcontaining cell membranes and antimicrobial effects. Enterohepatic circulation of bile acids results in efficient reabsorption of bile acids, resulting in a concentration gradient between proximal small intestine and terminal ileum. Only 10% of bile acids escape reabsorption and studies have shown that the bile acid concentration in the caecum is below the micellisation concentration.3 Could the high concentration of bile acids in the gallbladder and the proximal intestine be protective and explain the anatomical distribution of ITB?We determined the effect of physiological concentrations of bile acids on the in vitro growth of Mycobacterium tuberculosis (MTB). MethodsThe 4 major bile acids, lithocolic acid, cholic acid, deoxycholic acid and chenodeoxycholic acid (all supplied by Sigma Aldrich, SA) were selected for study. Individual bile acids were added to standard Lowenstein-Jensen (LJ) media to achieve physiological concentrations, 4 as shown in Table 1. A fifth LJ-bile acid solution was prepared using all 4 bile acids. Due to difficulties in solubilising the combination of 4 bile acids at physiological concentrations, the concentration of each had to be reduced by 50% in this LJ slope.Each 'physiological' LJ-bile acid solution was subsequently doublediluted 4 times with pure LJ solution, to achieve a decreasing concentration of bile acid in the culture medium. A standard inoculum (0.5 McFarland) of MTB H37Rv was inoculated onto each LJ slope in triplicate, as well as onto LJ slopes with no bile salts added. The slopes were incubated at 37°C for 8 weeks. Mycobacterial growth was measured at 2 and 8 weeks in a semiquantitative fashion using cut-offs of >5, >10, >20, >100 colony-forming units (CFUs) per slope. ResultsThere were >100 CFUs of typical MTB colonies on the control slopes at both 2 and 8 weeks. Similarly, all lithocolic acid cultures showed growth of >100 CFUs at 2 and 8 weeks.Three of the bile acids alone (chenodeoxycholic acid, deoxycholic acid and cholic acid) and the combination of all 4 showed inhibition of growth at 2 and 8 weeks. Chenodeoxycholic acid appeared to be the most active of th...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.