The association between patient and disease characteristics, and the risk of disease progression in patients with prostate cancer on active surveillance.

PURPOSE: The objective of this study was to identify and assess patient and disease characteristics associated with an increased risk of disease progression in men with prostate cancer on active surveillance. METHODS: We studied patients with low-risk (ISUP GG1) or favorable intermediate-risk (ISUP GG2) PCa. All patients had at least one repeat biopsy. Disease progression was the primary outcome of this study, based on pathological upgrading. Univariate and multivariate Cox proportional hazard analyses were used to evaluate the association between covariates and disease progression. RESULTS: In total, 240 men were included, of whom 198 (82.5%) were diagnosed with low-risk PCa and 42 (17.5%) with favorable intermediate-risk PCa. Disease progression was observed in 42.9% (103/240) of men. Index lesion > 10 mm (HR = 2.85; 95% CI 1.74-4.68; p < 0.001), MRI (m)T-stage 2b/2c (HR = 2.52; 95% CI 1.16-5.50; p = 0.02), highest PI-RADS score of 5 (HR 3.05; 95% CI 1.48-6.28; p = 0.002) and a higher PSA level (HR 1.06; 95% CI 1.01-1.11; p = 0.014) at baseline were associated with disease progression on univariate analysis. Multivariate analysis showed no significant baseline predictors of disease progression. CONCLUSION: In AS patients with low-risk or favorable intermediate-risk PCa, diameter of index lesion, MRI (m)T-stage, height of the PI-RADS score and the PSA level at baseline are significant predictors of disease progression to first repeat biopsy.

Left ventricular ejection fraction calculated from gated technetium-99-sestamibi SPECT.

BACKGROUND: The accuracy of the left ventricular ejection fraction (LVEF) calculated from gated single photon emission computed tomography (GSPECT) studies is dependent on the accuracy of the determination of the end-diastolic volume (EDV) and end-systolic volume (ESV) of the left ventricle (LV). In this study we evaluated the feasibility of calculating the EDV, ESV and LVEF from the area under the polar graph (APC) of the edges of the LV image determined by a first derivative edge-detection method. METHODS AND RESULTS: Technetium-99m ((99m)Tc) sestamibi GSPECT studies and planar equilibrium radionuclide ventriculography (ERNV) were performed on 15 male subjects in whom the LVEF ranged from 19% to 75%. Images were reconstructed to obtain short axis slices of the LV spanning the cardiac cycle. On each slice the LV edge points were determined at 10 degrees intervals using the APC method. The area of each short axis slice was determined by conversion to polar co-ordinates, interpolation and numerical integration of the graphs and multiplication by a pre-determined conversion factor. RESULTS: Edges were successfully determined in all 15 patients using the APC method. The LVEF results correlate well with conventional planar ERNV studies (r = 0.96, LVEF(GSPECT) = 8.80 + 0.66 LVEF( ERNV)). The absolute difference between the LVEF for ERNV and for the APC method was 6.1% with a standard deviation of 7.6%. The reproducibility of SPECT LVEF using the APC method was good (intra-observer r = 0.99, inter-observer r = 0.99). CONCLUSIONS: The APC method provides for easy and accurate ejection fraction determination with limited underlying mathematical assumptions. The ability to interpolate the edge points provides for stable edge detection even in hypoperfused myocardium.

Effects of oral and intravenous midazolam, triazolam and flunitrazepam on the sleep-wakefulness cycle of rabbits.

The effect of the new, short-acting benzodiazepine, midazolam as well as that of triazolam and flunitrazepam on the sleep of rabbits was recorded for 6 h. Midazolam at 1 mg kg-1 i.v. augmented both rapid eye movement sleep (REMS) and non-REM sleep (NREMS) only in the first half of the observation period. At 10 mg kg-1 i.v., NREMS was further increased in the first and, to a lesser degree, in the second 3-h period, while REMS was suppressed. Both doses were less effective orally than intravenously. Qualitatively, the effect of triazolam 0.01 and 0.1 mg kg-1 i.v. was very similar to that of the corresponding low and high intravenous doses of midazolam, except that the high dose of triazolam had a prolonged effect on total sleep time. Like midazolam, triazolam was substantially less effective orally than intravenously. Flunitrazepam at 0.1 and 1 mg kg-1 i.v. produced almost the same effects as midazolam and triazolam at the respective low and high intravenous doses, but had a longer duration of action. In contrast to midazolam and triazolam, flunitrazepam was almost as active orally as intravenously.