Differences in negative predictive value of prostate MRI based in men with suspected or known cancer.

OBJECTIVE: To compare the negative predictive value (NPV) of multiparametric MRI for Gleason score (GS) ≥ 3+4 cancer and evaluate predictors of these tumors in men with suspected disease and under active surveillance (AS). MATERIALS AND METHODS: This retrospective study included 38 men with suspected prostate cancer and 38 under AS with scans assigned PI-RADS v2 scores 1 or 2 between May 2016 and September 2017. Biopsy results were no cancer, GS = 3+3, or GS ≥ 3+4. Pre-MRI PSA, gland volume, and PSA density were recorded. Chi-square, equality of proportions, and logistic regressions were used to analyze the data. RESULTS: Intermediate to high-grade cancer was found in 12.8% (95% CI = 2.3-23.3) and 35.9% (95% CI = 20.8-50.9) of men with suspected cancer, and under AS (p = 0.02), respectively. The NPV for GS ≥ 3+4 were 87.2% (suspected cancer; 76.7-97.7) and 64.1% (AS; 49.0-79.2). In neither group PSA significantly predicted cancer grade (p = 0.75 and 0.63). Although it did not reach conventional statistical significance, PSA density was a good predictor of cancer grade in men with suspected disease (p = 0.06), but not under AS (p = 0.62). CONCLUSION: The NPV of multiparametric MRI for GS ≥ 3+4 is higher in men with suspected prostate cancer than in men under AS. PSA density ≤ 0.15 improved the prediction of intermediate to high-grade disease in patients without known cancer.

OBJETIVO: Comparar o valor preditivo negativo (VPN) da RM multiparamétrica da próstata para o diagnóstico de tumores escore de Gleason (EG) ≥ 3+4 e avaliar os preditores desses tumores em homens com suspeita de doença e nos sob vigilância ativa (VA). MATERIAIS E MÉTODOS: Este estudo retrospectivo incluiu 38 homens com suspeita de câncer de próstata e 38 em VA com RM, aos quais foram atribuídos escores PI-RADS v2 1 ou 2 entre maio de 2016 e setembro de 2017. Os resultados da biópsia foram ausência de câncer, câncer EG = 3+3 ou câncer EG ≥ 3+4. PSA pré-RM, volume da glândula e densidade de PSA foram anotados. Qui-quadrado, igualdade de proporções e regressões logísticas foram utilizados para analisar os dados. RESULTADOS: Câncer de grau intermediário a alto grau foi encontrado em 12,8% (IC 95% = 2,3­23,3) e 35,9% (IC 95% = 20,8­50,9) dos homens com suspeita de câncer e nos sob VA (p = 0,02), respectivamente. O VPN para GS ≥ 3+4 foi 87,2% (suspeita de câncer; IC 95% = 76,7­97,7) e 64,1% (VA; IC 95% = 49,0­79,2). Em nenhum dos grupos o PSA previu significativamente o grau de câncer (p = 0,75 e 0,63. Embora não tenha alcançado o limiar de significância estatística usual, a densidade de PSA foi um bom preditor de grau de câncer em homens com suspeita de doença (p = 0,06), mas não sob VA (p = 0,62). CONCLUSÃO: O VPN da RM multiparamétrica para GS ≥ 3+4 é maior em homens com suspeita de câncer de próstata do que em homens sob VA. Uma densidade de PSA ≤ 0,15 melhorou a previsão de doença de grau intermediário a alto grau em pacientes sem diagnóstico prévio de câncer.

Differences in negative predictive value of prostate MRI based in men with suspected or known cancer / Diferenças no valor preditivo negativo da ressonância magnética da próstata baseada em homens com câncer suspeito ou conhecido

Abstract Objective: To compare the negative predictive value (NPV) of multiparametric MRI for Gleason score (GS) ≥ 3+4 cancer and evaluate predictors of these tumors in men with suspected disease and under active surveillance (AS). Materials and Methods: This retrospective study included 38 men with suspected prostate cancer and 38 under AS with scans assigned PI-RADS v2 scores 1 or 2 between May 2016 and September 2017. Biopsy results were no cancer, GS = 3+3, or GS ≥ 3+4. Pre-MRI PSA, gland volume, and PSA density were recorded. Chi-square, equality of proportions, and logistic regressions were used to analyze the data. Results: Intermediate to high-grade cancer was found in 12.8% (95% CI = 2.3-23.3) and 35.9% (95% CI = 20.8-50.9) of men with suspected cancer, and under AS (p = 0.02), respectively. The NPV for GS ≥ 3+4 were 87.2% (suspected cancer; 76.7-97.7) and 64.1% (AS; 49.0-79.2). In neither group PSA significantly predicted cancer grade (p = 0.75 and 0.63). Although it did not reach conventional statistical significance, PSA density was a good predictor of cancer grade in men with suspected disease (p = 0.06), but not under AS (p = 0.62). Conclusion: The NPV of multiparametric MRI for GS ≥ 3+4 is higher in men with suspected prostate cancer than in men under AS. PSA density ≤ 0.15 improved the prediction of intermediate to high-grade disease in patients without known cancer.

Resumo Objetivo: Comparar o valor preditivo negativo (VPN) da RM multiparamétrica da próstata para o diagnóstico de tumores escore de Gleason (EG) ≥ 3+4 e avaliar os preditores desses tumores em homens com suspeita de doença e nos sob vigilância ativa (VA). Materiais e Métodos: Este estudo retrospectivo incluiu 38 homens com suspeita de câncer de próstata e 38 em VA com RM, aos quais foram atribuídos escores PI-RADS v2 1 ou 2 entre maio de 2016 e setembro de 2017. Os resultados da biópsia foram ausência de câncer, câncer EG = 3+3 ou câncer EG ≥ 3+4. PSA pré-RM, volume da glândula e densidade de PSA foram anotados. Qui-quadrado, igualdade de proporções e regressões logísticas foram utilizados para analisar os dados. Resultados: Câncer de grau intermediário a alto grau foi encontrado em 12,8% (IC 95% = 2,3-23,3) e 35,9% (IC 95% = 20,8-50,9) dos homens com suspeita de câncer e nos sob VA (p = 0,02), respectivamente. O VPN para GS ≥ 3+4 foi 87,2% (suspeita de câncer; IC 95% = 76,7-97,7) e 64,1% (VA; IC 95% = 49,0-79,2). Em nenhum dos grupos o PSA previu significativamente o grau de câncer (p = 0,75 e 0,63. Embora não tenha alcançado o limiar de significância estatística usual, a densidade de PSA foi um bom preditor de grau de câncer em homens com suspeita de doença (p = 0,06), mas não sob VA (p = 0,62). Conclusão: O VPN da RM multiparamétrica para GS ≥ 3+4 é maior em homens com suspeita de câncer de próstata do que em homens sob VA. Uma densidade de PSA ≤ 0,15 melhorou a previsão de doença de grau intermediário a alto grau em pacientes sem diagnóstico prévio de câncer.

Korean Youth with Comorbid Allergic Disease and Obesity Show Heightened Psychological Distress.

OBJECTIVE: To explore psychological distress in Korean adolescents having allergic disease comorbid with obesity. STUDY DESIGN: A total of 703 869 adolescents who completed the Korean Youth Risk Behavior Web-based Survey between 2007 and 2016 were analyzed. Participants were divided into 4 groups-healthy control, allergic disease only, obesity only, and comorbidity of allergic disease and obesity-and compared them to determine whether they showed differences in mental health. RESULTS: Adolescents with both atopic dermatitis and obesity had significantly greater odds of experiencing unhappiness (OR, 1.17), stress (OR, 1.32), and suicidal ideation (OR, 1.25) than those without both conditions. The same was true of adolescents with obesity and allergic rhinitis (OR, 1.21, 1.37, and 1.27, respectively) or bronchial asthma (OR, 1.37, 1.39, and 1.37). The comorbidity groups also showed significantly greater odds of stress and suicidal ideation than the allergic disease-only (atopic dermatitis with obesity, 1.21 and 1.15, respectively; allergic rhinitis with obesity, 1.11 and 1.09; bronchial asthma with obesity, 1.17 and 1.14) and obesity-only groups (atopic dermatitis with obesity, 1.13 and 1.09; allergic rhinitis with obesity, 1.18 and 1.10; bronchial asthma with obesity, 1.18 and 1.21). CONCLUSIONS: Allergic disease and obesity negatively and additively influence mental health in adolescents.

Clinical Evaluation of Rapid Diagnostic Test Kit Using the Polysaccharide as a Genus-Specific Diagnostic Antigen for Leptospirosis in Korea, Bulgaria, and Argentina.

Leptospirosis, a zoonotic disease that is caused by many serovars which are more than 200 in the world, is an emerging worldwide disease. Accurate and rapid diagnostic tests for leptospirosis are a critical step to diagnose the disease. There are some commercial kits available for diagnosis of leptospirosis, but the obscurity of a species- or genus-specific antigen of pathogenic Leptospira interrogans causes the reduced sensitivity and specificity. In this study, the polysaccharide derived from lipopolysaccharide (LPS) of nonpathogenic Leptospira biflexa serovar patoc was prepared, and the antigenicity was confirmed by immunoblot and enzyme linked immunosorbent assay (ELISA). The performance of the rapid diagnostic test (RDT) kit using the polysaccharide as a diagnostic antigen was evaluated in Korea, Bulgaria and Argentina. The sensitivity was 93.9%, 100%, and 81.0% and the specificity was 97.9%, 100%, and 95.4% in Korea (which is a rare region occurring with 2 serovars mostly), Bulgaria (epidemic region with 3 serovars chiefly) and Argentina (endemic region with 19 serovars mainly) respectively. These results indicate that this RDT is applicable for global diagnosis of leptospirosis. This rapid and effective diagnosis will be helpful for diagnosis and manage of leptospirosis to use and the polysaccharide of Leptospira may be called as genus specific antigen for diagnosis.

Serum Tumor Markers Provide Refined Prognostication in Selecting Liver Transplantation Candidate for Hepatocellular Carcinoma Patients Beyond the Milan Criteria.

OBJECTIVE: To develop and validate a model to predict tumor recurrence after living donor liver transplantation (LDLT) (MoRAL) for hepatocellular carcinoma (HCC) beyond the Milan criteria (MC). BACKGROUND: Some subgroups of HCC exceeding the MC experience substantial benefit from LDLT. METHODS: This multicenter study included a total of 566 consecutive patients who underwent LDLT in Korea: the beyond-MC cohort (n = 205, the derivation [n = 92] and validation [n = 113] sets) and the within-MC cohort (n = 361). The primary endpoint was time-to-recurrence. RESULTS: Using multivariate Cox proportional hazard model, we derived the MoRAL score using serum levels of protein induced by vitamin K absence-II and alpha-fetoprotein, which provided a good discriminant function on time-to-recurrence (concordance index = 0.88). Concordance index was maintained similarly on both internal and external validations (mean 0.87 and 0.84, respectively). At cut off of 314.8 (75th percentile value), a low MoRAL score (≤314.8) was associated with significantly longer recurrence-free (versus > 314.8, HR = 5.29, P < 0.001) and overall survivals (HR = 2.59, P = 0.001) in the beyond-MC cohort. The 5-year recurrence-free and overall survival rates of beyond-MC patients with a low MoRAL score were as high as 66.3% and 82.6%, respectively. The within-MC patients with a high MoRAL score showed a higher risk of recurrence than beyond-MC patients with a low MoRAL score (HR = 2.56, P = 0.035). The MoRAL score was significantly correlated with explant histology. CONCLUSIONS: This new model using protein induced by vitamin K absence-II and alpha-fetoprotein provides refined prognostication. Among beyond-MC HCC patients, those with a MoRAL score ≤314.8 and without extrahepatic metastasis might be potential candidates for LDLT.

Ashea megacephala Kim & Ahn (Coleoptera, Staphylinidae, Aleocharinae), a new gyrophaenine genus and species from Peru.

Ashea megacephala, a new Peruvian genus and species is described. The specimens were collected on mushrooms and mushroom-associated trees. This genus can be readily distinguished from the other genera of the subtribe Gyrophaenina by the large head and the three indistinctly articulated labial palpomeres. A key to the known genera of Gyrophaenina is provided. A habitus photograph and illustrations of diagnostic characters are also presented.

Sinuplastia con balón / Balloon sinuplasty

The balloon sinuplasty or sinus ostia balloon dilation is a surgical therapeutic instrument used in patients with refractory chronic rhinosinusitis, which can be performed as an isolated procedure or simultaneously with the functional endoscopic surgery (hybrid technique). Although there is a lack of prospective randomized controlled studies and only few studies in pediatric population, it seems to be an efficient and safe tool. It stands out because of its less invasiveness, therefore, especially useful in frontal sinus, in revision surgery, and making possible office setting sinus treatment.

Efectos de exposición aguda a cadmio en la acción de estrógenos en útero de rata impúber / Effects of acute exposure to cadmiun on response to estrogen in the prepuberal rat uterus

Background: Few information is available about uterine effects of Cadmium (Cd) exposure, where toxic agents affecting the female genital tract interact with estrogen (E) receptors, modifiying myometrial activity and the menstrual cycle, causing dysmenorrhea, infertility and spontaneous abortion. No information exists whether prenatal or early postnatal exposure may cause any gynecologic persistent adverse effect. Our finding of a second mechanism of E interaction and differences between E receptors in the various uterine cell types suggests that Cd may affect differently E interaction in each cell-type. Objective: Evaluate a possible selective effect of acute Cd exposure on E action in the uterus during prepuber age. Method: Female prepuber rats exposed to Cd 4 mg/kg and 2 hours later, treated with Estradiol-17² 0,3 mg/kg. A myometrial sample was obtained under anaesthesia 24 hours after E treatment and histologically processed for the quantification of E responses on different uterine cell-types. Results: Cd exposure potentiates E-induced uterine eosinophilia and endometrial edema and inhibits E-induced cell hypertrophy in circular myometrium and cell proliferation in luminal myometrium. Cd, in the absence of hormone stimulation, causes a slight cell hypertrophy in circular myometrium. Conclusions: Acute exposure to Cd affects differently various responses to E in the different uterine cell-types. Future studies should verify whether this effect explains Cd-induced infertility, postpubertal sex organ development and whether prenatal or early postnatal exposure to Cd induces delayed persistent effects.

Antecedentes: Existe poca información sobre efectos del cadmio (Cd) en el útero. En mujeres altera la actividad miometrial, el ciclo menstrual y causa dismenorrea, abortos espontáneos, infertilidad y mortinatos. No existe información si la exposición prenatal o postnatal temprana causa efectos ginecológicos diferidos persistentes. Los tóxicos que afectan el útero suelen interactuar con receptores de estrógeno (E). Nuestro hallazgo de un segundo mecanismo de acción de E y de diferencias entre receptores de E de los diversos tipos celulares uterinos hacen posible que el Cd interactúe con los E en forma diferente en cada tipo celular. Objetivos: Buscar un posible efecto selectivo de la exposición aguda a Cd con algunas respuestas a E en útero de rata durante la edad prepuberal. Métodos: Ratas hembra impúberes recibieron 4 mg Cd/kg p.c. y 2 h después se trataron con 0,3 mg estradiol-17(3/kg p.c; los úteros fueron obtenidos bajo anestesia a las 24 h del tratamiento con E. Los úteros se procesaron para la cuantificación de respuestas a E en cada tipo celular por separado. Resultados: La exposición a Cd incrementa la eosinofilia uterina y edema endometrial inducidos por E; inhibe las siguientes respuestas a E: hipertrofia celular en miometrio circular, proliferación celular en epitelio luminal y miometrio. En ausencia de hormona, el cadmio causa una leve hipertrofia celular en miometrio circular. Conclusiones: La exposición aguda a Cd afecta de manera diferente las respuestas a E en los diversos tipos celulares uterinos de rata prepuberal. Futuros estudios deberán verificar si este efecto explica la infertilidad causada por exposición a Cd, afecta el desarrollo postpuberal de los órganos sexuales, e investigar si la exposición prenatal o postnatal temprana induce efectos diferidos persistentes, como puede ocurrir en población infantil prenatalmente expuesta a Cd.

The micromorphology and protein characterization of rubber particles in Ficus carica, Ficus benghalensis and Hevea brasiliensis.

Rubber biosynthesis takes place on the surface of rubber particles. These particles are surrounded by a monolayer membrane in which the rubber transferase is anchored. In order to gain better insight into whether rubber particles from different plant species share common structural characteristics, the micromorphology of rubber particles from Ficus carica, Ficus benghalensis, and Hevea brasiliensis was examined by electron microscopy. Rubber particles of all three species were spherical in shape, and the size of rubber particles of H. brasiliensis was much smaller than those of F. carica and F. benghalensis. In addition, investigations were undertaken to compare the cross-reactivity of the antibody raised against either the H. brasiliensis small rubber particle protein (SRPP) which is suggested to be involved in rubber biosynthesis, or the cis-prenyltransferase (CPT) which has an activity similar to rubber transferase. Both western analysis and TEM-immunogold labelling studies showed that rubber particles of F. carica and F. benghalensis do not contain the SRPP. None of the rubber particles in F. carica, F. benghalensis and H. brasiliensis contained the CPT, suggesting that the CPT itself could not catalyse the formation of high molecular weight rubber. These results indicate that rubber particles in the three different plant species investigated share some degree of similarity in architecture, and that the SRPP and CPT themselves are not the core proteins necessary for rubber biosynthesis.