Posterior capsular opacification and YAG laser capsulotomy in uveitis patients following cataract surgery.

OBJECTIVE: To evaluate the incidence of visually significant posterior capsule opacification (PCO with visual acuity ≤20/50) and the incidence of Nd:YAG laser capsulotomy in the year following cataract surgery for uveitic eyes. METHOD: Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study using a standardized chart review process. RESULTS: Among 1,855 uveitic eyes of 1,370 patients who had undergone cataract surgery, visually significant PCO occurred in 297 eyes (16%), and YAG laser capsulotomy was done in 407 eyes (22%) within the first year following surgery. Higher odds of developing 20/50 visual acuity attributed to PCO were noted in children and young adults compared with adults older than 65 years of age (overall p = 0.03). Poorer preoperative visual acuity (overall p = 0.0069) and postoperative inflammation (odds ratio [OR] = 1.83; 95% CI, 1.37-2.45; p < 0.0001) were associated with PCO incidence. In multivariable analysis, risk factors for YAG laser capsulotomy were younger age groups compared with those older than 65 years of age at the time of surgery (adjusted OR [aOR] = X.XX; 95% CI, 1.90-2.24; overall p = 0.0007), female sex (aOR = 1.37; 95% CI, 1.03-1.82; p = 0.03), postoperative active inflammation (aOR = 165; 95% CI, 1.27-2.16; overall p < 0.0001), extracapsular cataract extraction compared with phacoemulsification (aOR = 1.70; 95% CI, 1.17-2.47; overall p < 0.0001), and insertion of an intraocular lens (aOR = 4.60; 95% CI, -2.29-9.25; p < 0.0001). Black race was associated with lower YAG laser capsulotomy incidence than Whites (aOR = 0.36; 95% CI, 0.24-0.52; overall p < 0.0001). CONCLUSIONS: Vision-reducing (≤20/50) PCO is common, occurring in about one sixth of uveitic eyes within 1 year of cataract surgery; a higher number (22%) of eyes underwent YAG laser capsulotomy within the first year. Age and postoperative inflammation following cataract surgery are the variables most associated with the incidence of visually significant PCO and YAG laser capsulotomy.

Sustainable development of three distinct starch based bio-composites reinforced with the cotton spinning waste collected from fiber preparation stage.

Composites are new materials that combine two or more distinct components with diverse properties to create a new material with improved properties. The goal of this endeavor was to use fiber preparation wastes, or waste from cotton spinning mill blow room and carding, to produce bio composites based on starch. The matrix was prepared using the starches of potatoes, maize, and arrowroot, and any remaining reinforcing material was used. A hand layup technique was used to make the bio-composites. Tensile, bending, density, water absorbency, and SEM testing were among the studies used to illustrate the starch-based biodegradable materials. The maximum tensile strength of 0.49 MPa is displayed by sample AB. The resistive bending force of 3.71 MPa is greatest in Sample AB. The most uniform combination of reinforcing material (wastage cotton) and matrix is seen in PB's SEM picture. Among the samples, AB had the greatest density value, measuring 0.35 g/cm3. The sample PC had the highest absorption findings in both water and the 5 % HCl combination because carding waste had more fiber than blow room and fiber absorbs more water. The resultant bio-composites made of starch had the potential to replace Styrofoam.

Synthesis, characterization, and cytotoxicity studies of nanocellulose extracted from okra (Abelmoschus Esculentus) fiber.

Nanocellulose, especially originating from a natural source, has already shown immense potential to be considered in various fields, namely packaging, papermaking, composites, biomedical engineering, flame retardant, and thermal insulating materials, etc. due to its environmental friendliness and novel functionalities. Thus, a thorough characterization of nanocellulose is a hot research topic of research communities in a view to judge its suitability to be used in a specific area. In this work, a kind of green and environment-friendly nanocellulose was successfully prepared from okra fiber through a series of multi-step chemical treatments, specifically, scouring, alkali treatment, sodium chlorite bleaching, and sulfuric acid hydrolysis. Several characterization techniques were adopted to understand the morphology, structure, thermal behavior, crystallinity, and toxicological effects of prepared nanocellulose. Obtained data revealed the formation of rod-shaped nanocellulose and compared to raw okra fiber, their size distributions were significantly smaller. X-ray diffraction (XRD) patterns displayed that compared to the crystalline region, the amorphous region in raw fiber is notably larger, and in obtained nanocellulose, the crystallinity index increased significantly. Moreover, variations in the Fourier transform infrared spectroscopy (FTIR) peaks depicted the successful removal of amorphous regions, namely, lignin and hemicelluloses from the surface of fiber. Thermostability of synthesized nanocellulose was confirmed by both Differential Scanning Calorimetry (DSC) analysis, and thermogravimetric analysis (TGA). Cytotoxicity assessment showed that the okra fiber-derived nanocellulose exhibited lower to moderate cellular toxicity in a dose-dependent manner where the LD50 value was 60.60 µg/ml.

Long-term visual acuity outcomes following cataract surgery in eyes with ocular inflammatory disease.

PURPOSE: To evaluate the long-term visual acuity (VA) outcome of cataract surgery in inflammatory eye disease. SETTING: Tertiary care academic centres. DESIGN: Multicentre retrospective cohort study. METHODS: A total of 1741 patients with non-infectious inflammatory eye disease (2382 eyes) who underwent cataract surgery while under tertiary uveitis management were included. Standardised chart review was used to gather clinical data. Multivariable logistic regression models with adjustment for intereye correlations were performed to evaluate the prognostic factors for VA outcomes. Main outcome measure was VA after cataract surgery. RESULTS: Uveitic eyes independent of anatomical location showed improved VA from baseline (mean 20/200) to within 3 months (mean 20/63) of cataract surgery and maintained through at least 5 years of follow-up (mean 20/63). Eyes that achieved 20/40 or better VA at 1 year were more likely to have scleritis (OR=1.34, p<0.0001) or anterior uveitis (OR=2.2, p<0.0001), VA 20/50 to 20/80 (OR 4.76 as compared with worse than 20/200, p<0.0001) preoperatively, inactive uveitis (OR=1.49, p=0.03), have undergone phacoemulsification (OR=1.45 as compared with extracapsular cataract extraction, p=0.04) or have had intraocular lens placement (OR=2.13, p=0.01). Adults had better VA immediately after surgery, with only 39% (57/146) paediatric eyes at 20/40 or better at 1 year. CONCLUSIONS: Our results suggest that adult and paediatric eyes with uveitis typically have improved VA following cataract surgery and remain stable thereafter for at least 5 years.

An approach to improve the existing ribbon retting of jute fibre using concrete tank and natural catalyst.

The ribbon retting method has been developed as a remedy for the issues associated with the conventional water retting method. But this method has not yet gained popularity among jute growers due to the unavailability of catalyst, inadequate training and lack of interest of farmers. The study deals with the improvement of the existing ribbon retting process by using a concrete tank with or without fermented soybean as a natural catalyst in different proportions. For this purpose, 25 fibre samples were developed using different conditions such as concrete tank without natural catalyst, concrete tank with 2.5%, 5% and 7.5% natural catalyst and a micro pond without natural catalyst for various observational time periods. After that, samples collected under mentioned conditions which were measured to assess the fibre properties. The samples produced in a concrete tank with 7.5% natural catalyst demonstrated better fibre characteristics than the other conditions, including fibre fineness, fibre strength, improved fibre color, open surface structure and smooth surface etc. The best conditions for microbial growth were achieved using a concrete tank with more natural catalysts, which improved bacterial growth, fibre quality and reduced the retting time. The use of more natural catalysts increased microbial activity, which in turn affected total dissolved solids (TDS), Biochemical oxygen demand (BOD), Chemical oxygen demand (COD), and pH value of the retted water. In comparison to the existing ribbon retting method, this improved method is significantly faster and produces fibers with better properties. Farmers will gain more from the successful implementation of an improved ribbon retting method because it shortens retting time, conserves water, and uses a concrete tank during retting that can be used for multiple purposes.

Extraction and characterization of a newly developed cellulose enriched sustainable natural fiber from the epidermis of Mikania micrantha.

Riding on the journey of a sustainable world it is very crucial to extend the usage of natural cellulosic fiber from renewable sources. Due to their numerous applications and eco-friendly behavior, natural cellulosic fibers are in greater demand every day. In this article a new natural fiber extracted from the creepers of Mikania micrantha with the help of 5% NaOH retting process. Previously no research work have been done with this fiber. The fiber was characterized by following ASTM D1909, ASTM D 2654, ASTM D1445, TAPPI standard for determination of moisture regain and content, bundle fiber strength and chemical composition respectively. XRD, SEM, FTIR and TGA analysis were also done for the identification of crystallinity, fiber morphology, functional group and thermal behavior. The tests results showed that it is a cellulose enriched textile fiber having 56.42% cellulose. The average moisture regain and content % were 9.17% and 8.4% respectively analyzed from the five samples. The average tenacity was determined 38.6 gm/tex with 1.8% elongation and the crystallinity of the tested fiber was 72%. The maximum degradation temperature for this fiber was 477 °C. The application of this noble fiber can be for making fiber reinforced composites, cellulose nanomaterials, biomaterials etc.

Effect of fibre loading on mechanical properties of jute fibre bundle reinforced gypsum composites.

Gypsum plasterboards are widely used in interior decoration like false ceilings, wall partitioning etc. The main component of this plasterboard is gypsum, which is a mineral material. These boards contain poor mechanical strength with lower durability. The addition of natural fibres in these plasterboards can be useful to achieve better mechanical properties. Since Jute fibre is abundant in Bangladesh and its usability in reinforced composites is well established, for this reason, jute fibre was selected to do the research. The aim of this study was to evaluate the impact of jute fibre on the mechanical properties of the gypsum plasterboard. To make this board, Plaster of Paris and water were thoroughly mixed to make a suspension first. Different fibre loadings of 2, 4, 6, and 8% were incorporated into gypsum composites. Reinforcement of 6% fibre provided the highest tensile properties, but 8% fibre loading showed inferior tensile and flexural properties. Impact test results showed a gradually improving nature with fibre loading, and hardness values showed a decreasing trend in hardness with higher fibre loading. FTIR results and SEM images confirmed that no significant chemical bonding took place in the composites, instead, the composite depended mainly on the mechanical bonding among the reins crystals and between the fibre and gypsum matrix.

Use of Immunosuppression and the Risk of Subsequent Overall or Cancer Mortality.

PURPOSE: To determine the incidence of all-cause and cancer mortality (CM) in association with immunosuppression. DESIGN: Retrospective cohort study at ocular inflammatory disease (OID) subspecialty centers. We harvested exposure and covariate data retrospectively from clinic inception (earliest in 1979) through 2010 inclusive. Then we ascertained overall and cancer-specific mortalities by National Death Index linkage. We constructed separate Cox models to evaluate overall and CM for each class of immunosuppressant and for each individual immunosuppressant compared with person-time unexposed to any immunosuppression. PARTICIPANTS: Patients with noninfectious OID, excluding those with human immunodeficiency infection or preexisting cancer. METHODS: Tumor necrosis factor (TNF) inhibitors (mostly infliximab, adalimumab, and etanercept); antimetabolites (methotrexate, mycophenolate mofetil, azathioprine); calcineurin inhibitors (cyclosporine); and alkylating agents (cyclophosphamide) were given when clinically indicated in this noninterventional cohort study. MAIN OUTCOME MEASURES: Overall mortality and CM. RESULTS: Over 187 151 person-years (median follow-up 10.0 years), during which 15 938 patients were at risk for mortality, we observed 1970 deaths, 435 due to cancer. Both patients unexposed to immunosuppressants (standardized mortality ratio [SMR] = 0.95, 95% confidence interval [CI], 0.90-1.01) and those exposed to immunosuppressants but free of systemic inflammatory diseases (SIDs) (SMR = 1.04, 95% CI, 0.95-1.14) had similar mortality risk to the US population. Comparing patients exposed to TNF inhibitors, antimetabolites, calcineurin inhibitors, and alkylating agents with patients not exposed to any of these, we found that overall mortality (adjusted hazard ratio [aHR] = 0.88, 0.89, 0.90, 1.11) and CM (aHR = 1.25, 0.89, 0.86, 1.23) were not significantly increased. These results were stable in sensitivity analyses whether excluding or including patients with SID, across 0-, 3-, or 5-year lags and across quartiles of immunosuppressant dose and duration. CONCLUSIONS: Our results, in a cohort where the indication for treatment was proven unassociated with mortality risk, found that commonly used immunosuppressants-especially the antimetabolites methotrexate, mycophenolate mofetil, and azathioprine; the TNF inhibitors adalimumab and infliximab, and cyclosporine-were not associated with increased overall and CM over a median cohort follow-up of 10.0 years. These results suggest the safety of these agents with respect to overall and CM for patients treated with immunosuppression for a wide range of inflammatory diseases. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Preparation of lignin-based hydrogels, their properties and applications.

Polymers obtained from biomass are a concerning alternative to petro-based polymers because of their low cost of manufacturing, biocompatibility, ecofriendly and biodegradability. Lignin as the second richest and the only polyaromatics bio-polymer in plant which has been most studied for the numerous applications in different fields. But, in the past decade, the exploitation of lignin for the preparation of new smart materials with improved properties has been broadly sought, because lignin valorization plays one of the primary challenging issues of the pulp and paper industry and lignocellulosic biorefinery. Although, well suited chemical structure of lignin comprises of many functional hydrophilic and active groups, such as phenolic hydroxyls, carboxyls and methoxyls, which provides a great potential to be applied in the preparation of biodegradable hydrogels. In this review, lignin hydrogel is covered with preparation strategies, properties and applications. This review reports some important properties, such as mechanical, adhesive, self-healing, conductive, antibacterial and antifreezing properties were then discussed. Furthermore, herein also reviewed the current applications of lignin hydrogel, including dye adsorption, smart materials for stimuli sensitive, wearable electronics for biomedical applications and flexible supercapacitors. Overall, this review covers recent progresses regarding lignin-based hydrogel and constitutes a timely review of this promising material.

Potentiality of sustainable corn starch-based biocomposites reinforced with cotton filter waste of spinning mill.

The textile sector is among the leading industries globally in terms of releasing pollutants and producing waste. Despite being reusable, many wastes are squandered by disposing to landfills or incineration, creating a serious environmental threat. Because the cost of raw materials makes up a significant portion of the total product cost, manufacturers can obtain significant profits by exploiting waste generated during the manufacturing process. Herein, an attempt has been taken to utilize cotton filter waste (CFW) (collected from the humidification plant of the spinning mill) as reinforcement in manufacturing biocomposites with the corn starch (CS) matrix. Starch was considered to be the most suitable matrix as it is sustainable, abundant, natural, biodegradable, and, more importantly, capable of showing thermoplastic behavior under high temperatures. Sheets of corn starch composites reinforced with different wt% of cleaned cotton filter waste were fabricated using hand layup and compression molding techniques. The 50 wt% cotton waste was found to be optimum loading in terms of tensile strength, Young's modulus, bending strength, toughness, impact strength, and thermal Conductivity of the biocomposites. SEM micrographs revealed good interfacial adhesion (bonding) in matrix and filler interfaces, with the most substantial bonding for composites containing 50% fibers that concomitantly enhanced the mechanical properties of composites. The obtained biocomposites are deemed to be a sustainable alternative to non-degradable synthetic polymeric materials like Styrofoam for packaging and insulation applications.

Corneal Endothelial Transplantation in Uveitis: Incidence and Risk Factors.

PURPOSE: To estimate the incidence of corneal endothelial transplantation (CET) and identify risk factors among patients with noninfectious ocular inflammation. DESIGN: Retrospective cohort study. METHODS: Adult patients attending United States tertiary uveitis care facilities diagnosed with noninfectious ocular inflammation were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Time-to-event analysis was used to estimate the incidence of CET, including penetrating keratoplasty, Descemet stripping endothelial keratoplasty, or Descemet membrane endothelial keratoplasty procedures. The incidence of CET was calculated. Potential risk factors for CET were also evaluated using Cox regression, accounting for correlation between eyes of the same patient. RESULTS: Overall, 14,264 eyes met eligibility criteria for this analysis, with a median follow-up of 1.8 eye-years. The Kaplan-Meier estimated incidence of CET within 10 years was 1.10% (95% CI, 0.68%-1.53%). Risk factors for CET included age >60 years vs <40 years (adjusted hazard ratio [aHR], 16.5; 95% CI, 4.70-57.9), anterior uveitis and scleritis vs other types (aHR, 2.97; 95% CI, 1.46-6.05; and aHR, 4.14; 95% CI,1.28-13.4, respectively), topical corticosteroid treatment (aHR, 2.84; 95% CI, 1.32-6.13), cataract surgery (aHR, 4.44; 95% CI, 1.73-11.4), tube shunt surgery (aHR, 11.9; 95% CI, 5.30-26.8), band keratopathy (aHR, 5.12; 95% CI, 2.34-11.2), and hypotony (aHR, 7.38; 95% CI, 3.14-17.4). Duration of uveitis, trabeculectomy, peripheral anterior synechia, and ocular hypertension had no significant association after multivariate adjustment. CONCLUSIONS: In patients with ocular inflammation, CET occurred infrequently. Tube shunt surgery, hypotony, band keratopathy, cataract surgery, and anterior segment inflammation were associated with increased risk of undergoing CET; these factors likely are associated with endothelial cell damage.

Risk of Cataract in Intermediate Uveitis.

PURPOSE: To determine the incidence of and predictive factors for cataract in intermediate uveitis. DESIGN: Retrospective cohort study. METHODS: Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study, in which medical records were reviewed to determine demographic and clinical data of every eye/patient at every visit at 5 participating US tertiary care uveitis centers. The primary outcome was development of vision-compromising cataract as defined by a decrease in visual acuity to 20/40 or less, or requiring cataract surgery. Survival analysis assessed visually defined cataract to avoid bias due to timing of surgery vis-à-vis inflammatory status. RESULTS: Among 2,190 eyes of 1,302 patients with intermediate uveitis, the cumulative incidence of cataract formation was 7.6% by 1 year (95% confidence interval [CI] = 6.2%-9.1%), increasing to 36.6% by 10 years (95% CI = 31.2%-41.6%). Increased cataract risk was observed in eyes with concurrent anterior uveitis causing posterior synechiae (hazard ratio = 2.68, 95% CI = 2.00-3.59, P < .001), and in eyes with epiretinal membrane formation (hazard ratio = 1.54, 95% CI = 1.15-2.07, P = .004). Higher dose corticosteroid therapy was associated with significantly higher incidence of cataract, especially time-updated use of topical corticosteroids ≥2 times/d or ≥4 periocular corticosteroid injections. Low-dose corticosteroid medications (oral prednisone 7.5 mg daily or less, or topical corticosteroid drops <2 times/d) were not associated with increased cataract risk. CONCLUSIONS: Our study found that the incidence of clinically important cataract in intermediate uveitis is moderate. The risk is higher with markers of severity and with higher doses of corticosteroid medications, the latter being potentially modifiable.

Contemporaneous Risk Factors for Visual Acuity in Non-Infectious Uveitis.

INTRODUCTION: We evaluated the associations of clinical and demographic characteristics with visual acuity (VA) with over 5 years in a subspecialty noninfectious uveitis population. METHODS: Retrospective data from 5,530 noninfectious uveitis patients were abstracted by expert reviewers, and contemporaneous associations of VA with demographic and clinical factors were modeled. RESULTS: Patients were a median of 41 years old, 65% female, and 73% white. Eyes diagnosed ≥5 years prior to cohort entry had worse VA (-1.2 lines) than those diagnosed <6 months prior, and eyes with cataract surgery performed prior to entry had worse VA (-5.9 lines) than those performed during follow-up. Vitreous haze (-4.2 lines for 3+ vs quiet), hypotony (-2.5 lines for ≤5 mm Hg vs 6-23 mm Hg), and CNV (-1.8 lines) all were strongly associated with reduced VA. CONCLUSION: Factors associated with reduced VA included well-known structural complications, and lack of subspecialty care during cataract surgery.

Remission of Non-Infectious Anterior Scleritis: Incidence and Predictive Factors.

PURPOSE: To assess how often non-infectious anterior scleritis remits and identify predictive factors. METHODS: Our retrospective cohort study at four ocular inflammation subspecialty centers collected data for each affected eye/patient at every visit from center inception (1978, 1978, 1984, 2005) until 2010. Remission was defined as inactivity of disease off all suppressive medications at all visits spanning at least three consecutive months or at all visits up to the last visit (to avoid censoring patients stopping follow-up after remission). Factors potentially predictive of remission were assessed using Cox regression models. RESULTS: During 1,906 years' aggregate follow-up of 832 affected eyes, remission occurred in 214 (170 of 584 patients). Median time-to-remission of scleritis = 7.8 years (95% confidence interval [CI]: 5.7, 9.5). More remissions occurred earlier than later during follow-up. Factors predictive of less scleritis remission included scleritis bilaterality (adjusted hazard ratio [aHR] = 0.46, 95% CI: 0.32-0.65); and diagnosis with any systemic inflammatory disease (aHR = 0.36, 95% CI: 0.23-0.58), or specifically with Rheumatoid Arthritis (aHR = 0.22), or Granulomatosis with Polyangiitis (aHR = 0.08). Statin treatment (aHR = 1.53, 95% CI: 1.03-2.26) within ≤90 days was associated with more remission incidence. CONCLUSIONS: Our results suggest scleritis remission occurs more slowly in anterior scleritis than in newly diagnosed anterior uveitis or chronic anterior uveitis, suggesting that attempts at tapering suppressive medications is warranted after long intervals of suppression. Remission is less frequently achieved when systemic inflammatory diseases are present. Confirmatory studies of whether adjunctive statin treatment truly can enhance scleritis remission (as suggested here) are needed.

Visual Acuity Outcome over Time in Non-Infectious Uveitis.

Introduction: We evaluated visual acuity (VA) over 5 years in a subspecialty noninfectious uveitis population.Methods: Retrospective data from 5,530 noninfectious uveitis patients with anterior, intermediate, posterior or panuveitis were abstracted by expert reviewers. Mean VA was calculated using inverse probability of censoring weighting to account for losses to follow-up.Results: Patients were a median of 41 years old, 65% female, and 73% white. Initial mean VA was worse among panuveitis (20/84) than posterior (20/64), intermediate (20/47), and anterior (20/37) uveitides. On average, mean VA improved by 0.62, 0.51, 0.37, and 0.26 logMAR-equivalent lines over 2 years, respectively (each P < .001), then remained stable, except posterior uveitis mean VA worsened to initial levels.Conclusion: Mean VA of uveitic eyes improved and, typically, improvement was sustained under uveitis subspecialty care. Because VA tends to improve under tertiary care, mean VA change appears a better outcome for clinical studies than time-to-loss of VA.

Comparison Between Methotrexate and Mycophenolate Mofetil Monotherapy for the Control of Noninfectious Ocular Inflammatory Diseases.

PURPOSE: To compare mycophenolate mofetil (MMF) to methotrexate (MTX) as corticosteroid-sparing therapy for ocular inflammatory diseases. DESIGN: Retrospective analysis of cohort study data. METHODS: Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics were obtained via medical record review. The study included 352 patients who were taking single-agent immunosuppression with MTX or MMF at 4 tertiary uveitis clinics. Marginal structural models (MSM)-derived statistical weighting created a virtual population with covariates and censoring patterns balanced across alternative treatments. With this methodological approach, the results estimate what would have happened had none of the patients stopped their treatment. Survival analysis with stabilized MSM-derived weights simulated a clinical trial comparing MMF vs MTX for noninfectious inflammatory eye disorders. The primary outcome was complete control of inflammation on prednisone ≤10 mg/day, sustained for ≥30 days. RESULTS: The time to success was shorter (more favorable) for MMF than MTX (hazard ratio = 0.68, 95% confidence interval: 0.46-0.99). Adjusting for covariates, the proportion achieving success was higher at every point in time for MMF than MTX from 2 to 8 months, then converges at 9 months. The onset of corticosteroid-sparing success took more than 3 months for most patients in both groups. Outcomes of treatment (MMF vs MTX) were similar across all anatomic sites of inflammation. The incidence of stopping therapy for toxicity was similar in both groups. CONCLUSIONS: Our results suggest that, on average, MMF may be faster than MTX in achieving corticosteroid-sparing success in ocular inflammatory diseases.

Multiparametric magnetic resonance imaging findings in men with low-risk prostate cancer followed using active surveillance.

UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Up to 35% of men on active surveillance (AS) for clinically localized prostate cancer will experience biopsy reclassification during follow-up. Currently, annual prostate biopsy is recommended in AS programmes. Multiparametric MRI has shown promise in identifying men at risk for immediate reclassification at the time of entry into AS; however, the MRI characteristics of men already enrolled in AS who may be at low risk for disease reclassification have not been fully described. In the present study, we describe the MRI findings of a cohort of men enrolled within AS, with extended follow-up. Among these men, multiparametric MRI demonstrated excellent specificity (0.974) and negative predictive value (0.897) for the detection of pathological index lesions (determined on serial biopsies). These results suggest that men enrolled in AS with a non-suspicious MRI are unlikely to harbour an index cancerous lesion. OBJECTIVE: To assess the performance of multiparametric magnetic resonance imaging (MRI) in identifying pathological-index (path-index) lesions, defined as cancer present in the same prostate sextant in two separate surveillance biopsies, in men followed within an active surveillance (AS) programme for low-risk prostate cancer (CaP) with extended follow-up. MATERIALS AND METHODS: A total of 50 men, representing >215 person-years of follow-up in an AS programme, who were referred for prostate MRI were randomly chosen to have their images reviewed by a radiologist with expertise in prostate MRI, who was blinded to biopsy results. Index lesions on MRI were defined as a single suspicious lesion ≥10 mm or >2 lesions in a given prostate sextant. Lesions on MRI were considered suspicious if ≥2 abnormal parameters co-registered anatomically. Path-index lesions were defined as cancer present in a given prostate sextant on two separate biopsy sessions. Sensitivity and specificity were calculated to test the performance of MRI for identifying path-index lesions. Clinical and pathological features were compared between men with and without a MRI-index lesion. RESULTS: A total of 31 path-index and 13 MRI-index lesions were detected in 22 and 10 patients, respectively. Multiparametric MRI demonstrated excellent specificity and negative predictive value (0.974 and 0.897, respectively) for the detection of path-index lesions. Sensitivity (0.19) and positive predictive value (0.46) were considerably lower. Patients with an index lesion on MRI were younger and less likely to have met the 'Epstein' criteria for very low-risk CaP. Compared with men without an MRI lesion, a significant increase in biopsy reclassification was noted for men with a MRI lesion (40 vs 12.5%, P = 0.04). CONCLUSIONS: A non-suspicious MRI was highly correlated with a lack of path-index lesions in an AS population. Multiparametric MRI may be useful in both the selection and monitoring of patients undergoing AS.