Precision in prostate cancer detection: integrating prostate-specific antigen density (PSAD) and the Prostate Imaging Reporting and Data System (PI-RADS) to provide additional risk stratification for a more accurate diagnostic decision.

PURPOSE: This study focuses on integrating prostate-specific antigen density (PSAD) and Prostate Imaging Reporting and Data System (PI-RADS) for enhanced risk stratification in biopsy-naïve patients. METHODS: A prospective study was conducted on 339 patients with suspected prostate cancer, utilizing PSAD and PI-RADS in combination. Logistic regression models were employed, and receiver operating characteristic (ROC) analysis performed to evaluate predictive performance. The patient cohort underwent multiparametric MRI, targeted biopsy, and systematic biopsy. RESULTS: When patients were stratified into four PSAD risk groups, the rate of clinically significant prostate cancer (csPCa) increased significantly with higher PSAD levels. Logistic regression confirmed the independent contribution of PI-RADS and PSAD, highlighting their role in the prediction of csPCa. Combined models showed superior performance, as evidenced by the area under the curve (AUC) for PI-RADS category and PSAD (0.756), which exceeded that of the individual predictors (PSA AUC, 0.627, PI-RADS AUC 0.689, PSAD AUC 0.708). CONCLUSION: This study concludes that combining PSAD and PI-RADS improves diagnostic accuracy and predictive value for csPCa in biopsy-naïve men, resulting in a promising strategy to provide additional risk stratification for more accurate diagnostic decision in biopsy-naïve patients, especially in the PI-RADS 3 group.

Risk, uncertainty and ambiguity amid Covid-19: A multi-national analysis of international travel intentions.

This study analyses how Covid-19 shapes individuals' international tourism intentions in context of bounded rationality. It provides a novel analysis of risk which is disaggregated into tolerance/aversion of and competence to manage risks across three different aspects: general, domain (tourism) and situational (Covid-19). The impacts of risk are also differentiated from uncertainty and ambiguity. The empirical study is based on large samples (total = 8962) collected from the world's top five tourism source markets: China, USA, Germany, UK and France. Various risk factors show significant predictive powers of individual's intentions to defer international tourism plans amid Covid-19. Uncertainty and ambiguity intolerance is shown to lead to intentions to take holidays relatively sooner rather than delaying the holiday plans.

Gut Microbiota Diversity in Lean Athletes Is Associated with Positive Energy Balance.

INTRODUCTION: In contrast to obesity, little is known about the human lean phenotype associated with gut microbiota composition. OBJECTIVE: We aimed to investigate whether the bacterial composition of lean athletes with a positive energy balance differs from the equal-calorie food group. METHODS: Twenty-four male participants were included in this cross-sectional study: lean athletes with a positive energy balance (LA, n 12) and control group athletes (CTRLs, n 12). Nutritional data, resting and total energy expenditure, and body composition were determined. DNA was extracted from stool samples and subjected to 16S rRNA gene analysis. RESULTS: We found 7 differentially abundant bacterial taxa between the LA and CTRL groups. Of those, 5 were significantly less abundant and 2 were enriched in the LA group. The following categories significantly associated with the community structure were identified: body fat parameters, BMI, energy intake and expenditure, oxygen consumption, and respiratory exchange ratio. CONCLUSIONS: Although we are far from a detailed interpretation of lean human body maintenance, the primary findings of our study suggest that gut microbial composition may be a factor influencing the regulation of weight gain in lean athletes with a positive energy balance.

Advanced Reconstruction of Vesicourethral Support (ARVUS) during robot-assisted radical prostatectomy: first independent evaluation and review of other factors influencing 1 year continence outcomes.

PURPOSE: Anterior and posterior reconstructions of pelvic structures are used during a robot-assisted radical prostatectomy to obtain better continence outcomes. This study was conducted to evaluate the Advanced Reconstruction of Vesicourethral Support (ARVUS), a novel postprostatectomy reconstruction technique. METHODS: The study was designed as a prospective, controlled, partially randomized and blinded experiment. The statistical analysis was based on the generalized linear modeling (GLM) framework with random effects: the logit link was used to model the probability of achieving continence and the logarithmic link was used to evaluate the overall score of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The significance of the fixed effects and all possible two-way interactions was tested using the critical level of 0.05. RESULTS: The probability of achieving the continence significantly depends on the neurovascular bundle sparing (p < 0.001) and the time after the surgery (p < 0.001). Analogously, the expected ICIQ-SF score significantly depends on the nerve-sparing status (p = 0.035) and the time after the surgery (p < 0.001). No statistically significant difference between the unilateral or bilateral nerve sparing was found. The ARVUS technique seems to perform slightly worse with respect to the expected continence, but this difference is within the margins of random fluctuations (p = 0.715). CONCLUSIONS: The study demonstrates a significant positive association between the nerve-sparing approach and the patient's continence, however, regardless of the unilateral or bilateral approach. In terms of the continence rate, no statistically significant benefits of ARVUS were observed.

Prostate cancer - the role of magnetic resonance imaging.

BACKGROUND: This article reviews the potential of magnetic resonance imaging (MRI) in prostate cancer diagnosis. METHODS: Systematic scan of Pubmed, Ovid, Medline, Elsevier search engines was used, additional information was found through bibliographic review of relevant articles. Results. Substantial progress has been made in the imaging of prostate cancer in MR imaging, as well as in advanced MR spectroscopy. CONCLUSIONS: MRI is a non-invasive and direct imaging modality useful for cancer staging, therapy response, detection of recurrence and guided biopsy in previous negative biopsies. MRI with 3.0T system, whole-body MRI, dynamic contrast enhanced MRI, diffusion-weighted imaging (DWI) and MR spectroscopy (MRS) have improved tumor staging, assessment of tumor volume, aggressiveness or recurrence. Implementation of endorectal/phased array superficial MRI findings on 1.5 or 3.0T systems into nomograms for prostate pretreatment prediction is warranted. Surface phasedarray coil MRI accurately defines prostate cancer with elevated risk of extraprostatic disease.

International return mobility, learning and knowledge transfer: a case study of Slovak doctors.

International mobility provides opportunities for learning and knowledge transfer by health care workers, with significant potential benefits for countries of destination and, in the case of returned migration, countries of origin. This is examined using a typology that recognizes four types of tacit knowledge: embrained, embodied, embedded, and encultured. There are, however, constraints to learning and knowledge transfer in the form of professional and social recognition as well as language barriers and power relationships. These theoretical ideas are explored through a case study of internationally mobile Slovak doctors after their return to Slovakia. Individual learning and knowledge sharing with colleagues, both abroad and after return, are analysed through in-depth interviews.

Hyperacute rejection of living related kidney graft caused by IgG endothelial specific antibodies with a negative monocyte cross-match.

We present a case report of a 30-year-old man, who hyperacutely rejected a blood group identical, HLA-haploidentical living related kidney graft in spite of the fact that he had never been immunized. Anti-endothelial IgG antibodies that did not react with monocytes were detected with flow cytometry, on a panel of human umbilical cord cells in his serum retrospectively. On the basis of this experience we put for consideration the possibility of regular examination of non-HLA antibodies in potential living graft recipients.