3.0-T MR-guided transgluteal in-bore-targeted prostate biopsy under local anesthesia in patients without rectal access: a single-institute experience and review of literature.

PURPOSE: To describe the technique and evaluate the performance of MRI-guided transgluteal in-bore-targeted biopsy of the prostate gland under local anesthesia in patients without rectal access. METHODS: Ten men (mean age, 69 (range 57-86) years) without rectal access underwent 13 MRI-guided transgluteal in-bore-targeted biopsy of the prostate gland under local anesthesia. All patients underwent mp-MRI at our institute prior to biopsy. Three patients had prior US-guided transperineal biopsy which was unsuccessful in one, negative in one, and yielded GG1 (GS6) PCa in one. Procedure time, complications, histopathology result, and subsequent management were recorded. RESULTS: Median interval between rectal surgery and presentation with elevated PSA was 12.5 years (interquartile range (IQR) 25-75, 8-36.5 years). Mean PSA was 11.9 (range, 4.8 -59.0) ng/ml and PSA density was 0.49 (0.05 -3.2) ng/ml/ml. Distribution of PI-RADS v2.0/2.1 scores of the targeted lesions were PI-RADS 5-3; PI-RADS 4-6; and PI-RADS 3-1. Mean lesion size was 1.5 cm (range, 1.0-3.6 cm). Median interval between MRI and biopsy was 5.5 months (IQR 25-75, 1.5-9 months). Mean procedure time was 47.4 min (range, 29-80 min) and the number of cores varied between 3 and 5. Of the 13 biopsies, 4 yielded clinically significant prostate cancer (csPca), with a Gleason score ≥ 7, 1 yielded insignificant prostate cancer (Gleason score = 6), 7 yielded benign prostatic tissue, and one was technically unsuccessful. 3/13 biopsies were repeat biopsies which detected csPCa in 2 out of the 3 patients. None of the patients had biopsy-related complication. Biopsy result changed management to radiation therapy with ADT in 2 patients with the rest on active surveillance. CONCLUSION: MRI-guided transgluteal in-bore-targeted biopsy of the prostate gland under local anesthesia is feasible in patients without rectal access.

Chronic Pelvic Pain: Role of Imaging in the Diagnosis and Management.

Chronic pelvic pain (CPP) in women is not uncommon, and it may be difficult to identify the exact cause difficult to manage. It is major health problem for women that affects the quality of their daily lives. The etiology of chronic pelvic pain may be of gynecological or non-gynecological origin and associated with several predisposing and precipitating factors. Psychological and social factors also contribute to the syndrome of CPP and must be evaluated before managing these patients. Due to multifactorial etiology, CPP needs a multidisciplinary approach for diagnosis and management. A detailed history and physical examination supported by appropriate laboratory tests and imaging are the keys to diagnosis. In this paper, the role of imaging in diagnosis and management of CPP is reviewed. Imaging findings should be correlated with detailed clinical examination findings as there are imaging findings that may be unrelated and not the cause of CPP in a particular patient, imaging findings should be correlated with the clinical circumstances.

PET/MRI in colorectal and anal cancers: an update.

Positron emission tomography (PET) in the era of personalized medicine has a unique role in the management of oncological patients and offers several advantages over standard anatomical imaging. However, the role of molecular imaging in lower GI malignancies has historically been limited due to suboptimal anatomical evaluation on the accompanying CT, as well as significant physiological 18F-flurodeoxyglucose (FDG) uptake in the bowel. In the last decade, technological advancements have made whole-body FDG-PET/MRI a feasible alternative to PET/CT and MRI for lower GI malignancies. PET/MRI combines the advantages of molecular imaging with excellent soft tissue contrast resolution. Hence, it constitutes a unique opportunity to improve the imaging of these cancers. FDG-PET/MRI has a potential role in initial diagnosis, assessment of local treatment response, and evaluation for metastatic disease. In this article, we review the recent literature on FDG-PET/MRI for colorectal and anal cancers; provide an example whole-body FDG-PET/MRI protocol; highlight potential interpretive pitfalls; and provide recommendations on particular clinical scenarios in which FDG-PET/MRI is likely to be most beneficial for these cancer types.

Magnetic resonance cholangiopancreatography: pitfalls in interpretation.

Magnetic resonance cholangiopancreatography (MRCP) has become a widely accepted noninvasive diagnostic tool in the assessment of pancreatic and biliary disease. MRCP essentially exploits extended T2 relaxation times of slow-moving fluid and delineates the outline of biliary and pancreatic ducts on T2-weighted images. In order to maximize the clinical implication of MRCP, it is of utmost importance for radiologists to optimize the acquisition technique, be aware of patient-related factors and physiologic changes than can affect its performance and interpretation. It is critical to understand the most common artifacts and pitfalls encountered during acquisition and interpretation of MRCP. We provide a general overview of the different pitfalls encountered in MRCP and pearls on how to manage them in real-world practice.

Evaluating the Downstream Revenues of a Self-Pay Bi-Parametric Prostate MRI Program.

OBJECTIVE: To quantify downstream healthcare utilization and revenue associated with a self-pay bi-parametric prostate MRI (bpMRI) program. METHODS: Medical records of 592 patients who underwent bpMRI between August 2017 and March 2020 were examined for follow-up clinical activities. These include prostate biopsy, radical prostatectomy, external beam radiation therapy, brachytherapy, androgen deprivation therapy, CT Chest, Abdomen and Pelvis, PET/CT, MRI Pelvis, and Nuclear Medicine Bone Scans. The charges for each clinical activity were derived from the Medicare Physician Fee Schedule to conservatively estimate revenues. This patient population was further divided into four groups: Group A, patients who demonstrated an MRI lesion and underwent prostatectomy; Group B, patients who did not demonstrate lesion but underwent prostatectomy; Group C, patients who demonstrated lesion but did not undergo prostatectomy; and Group D, patients who neither demonstrated lesion nor underwent prostatectomy. Revenues for each group were categorized by Urology, Radiation Oncology and Radiology subspecialties. RESULTS: Conservative estimates yielded $520 of downstream revenue per patient who underwent bpMRI. Group A patients yielded 47% of total revenue ($1974 per patient). Group B patients, the smallest group, yielded $1828 per patient. Group C patients made up the largest group and grossed $398 per patient. Group D demonstrated the lowest per patient revenue of $179. Groups A and B yielded most relative revenue for Urology. Group C yielded most relative revenue for Radiation Oncology, and Group D yielded most relative revenue for Radiology. CONCLUSION: A self-pay bpMRI program has the potential to improve patient access to prostate cancer screening while remaining financial sustainable.

Safety and efficacy of a feed additive consisting of Bifidobacterium longum CNCM I-5642 (PP102I) for cats and dogs (Nestlé Enterprises S.A.).

Following a request from the European Commission, the Panel on Additives and Products or Substances used in Animal Feed (FEEDAP) was asked to deliver a scientific opinion on the safety and efficacy of Bifidobacterium longum CNCM I-5642 (PP102I) when used as a feed additive for cats and dogs. The product under assessment consists of viable cells of a strain of B. longum, a species considered suitable for the qualified presumption of safety (QPS) approach to safety assessment. The strain was unambiguously identified as B. longum and was shown not to harbour antimicrobial resistance determinants for antibiotics of human and veterinary importance, thus meeting the QPS requirements. Following the QPS approach to safety assessment and since no concerns are expected from maltodextrin, the other component of the additive, PP102I was considered safe for the target species and the environment. Owing to the lack of data, no conclusions could be drawn on the skin/eye irritancy potential of PP102I. However, it should be considered a skin and respiratory sensitiser. The Panel was not in the position to conclude on the efficacy of PP102I for the target species.

The protective effect of muscimol against systemic inflammatory response in endotoxemic mice is independent of GABAergic and cholinergic receptors.

Systemic inflammatory response syndrome plays an important role in the development of sepsis. GABAergic and cholinergic pathways activation are considered important for inflammatory response regulation. Tumor necrosis factor (TNF)-α, interleukin (IL)-1ß, IL-12, IL-10, as well as inducible nitric oxide synthase (iNOS)-derived nitric oxide (NO) are important inflammatory mediators involved in the pathogenesis of sepsis. Muscimol, an active compound from the mushroom Amanita muscaria (L.) Lam., is a potent GABAA agonist, inhibits inflammatory response via activating GABAA receptor and vagus nerve. However, the effect of muscimol on lipopolysaccharide (LPS)-induced systemic inflammatory response is still unclear. Therefore, we studied the effects of muscimol on systemic inflammatory response and survival rate in endotoxemic mice. Mice endotoxemia was induced by LPS. Muscimol was given to mice or RAW264.7 cells 30 min before LPS (10 mg/kg, i.p., or 10 ng/mL, respectively). Mice received GABAergic and cholinergic receptor antagonists 30 min before muscimol and LPS. Muscimol decreased TNF-α, IL-1ß, IL-12, iNOS-derived NO, and increased IL-10 levels and survival rate after LPS treatment. Muscimol significantly decreased nuclear factor kappa B (NF-κB) activity, increased IκB expression, and decreased pIKK expression in LPS-treated RAW264.7 cells. GABAergic and cholinergic antagonists failed to reverse muscimol's protection in LPS-treated mice. In conclusion, muscimol protected against systemic inflammatory response in endotoxemic mice may be partially independent of GABAergic and cholinergic receptors.

Processing of Aluminium-Silicon Alloy with Metal Carbide as Reinforcement through Powder-Based Additive Manufacturing: A Critical Study.

Powder-based additive manufacturing (PAM) is a potential fabrication approach in advancing state-of-the-art research to produce intricate components with high precision and accuracy in near-net form. In PAM, the raw materials are used in powder form, deposited on the surface layer by layer, and fused to produce the final product. PAM composite fabrication for biomedical implants, aircraft structure panels, and automotive brake rotary components is gaining popularity. In PAM composite fabrication, the aluminium cast alloy is widely preferred as a metal matrix for its unique properties, and different reinforcements are employed in the form of oxides, carbides, and nitrides. However, for enhancing the mechanical properties, the carbide form is predominantly considered. This comprehensive study focuses on contemporary research and reveals the effect of metal carbide's (MCs) addition to the aluminium matrix processed through various PAM processes, challenges involved, and potential scopes to advance the research.

Consensus Definitions and Interpretation Templates for Magnetic Resonance Imaging of Defecatory Pelvic Floor Disorders: Proceedings of the Consensus Meeting of the Pelvic Floor Disorders Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdominal Radiology, the International Continence Society, the American Urogynecologic Society, the International Urogynecological Association, and the Society of Gynecologic Surgeons.

The Pelvic Floor Disorders Consortium (PFDC) is a multidisciplinary organization of colorectal surgeons, urogynecologists, urologists, gynecologists, gastroenterologists, radiologists, physiotherapists, and other advanced care practitioners. Specialists from these fields are all dedicated to the diagnosis and management of patients with pelvic floor conditions, but they approach, evaluate, and treat such patients with their own unique perspectives given the differences in their respective training. The PFDC was formed to bridge gaps and enable collaboration between these specialties. The goal of the PFDC is to develop and evaluate educational programs, create clinical guidelines and algorithms, and promote high quality of care in this unique patient population. The recommendations included in this article represent the work of the PFDC Working Group on Magnetic Resonance Imaging of Pelvic Floor Disorders (members listed alphabetically in Table 1). The objective was to generate inclusive, rather than prescriptive, guidance for all practitioners, irrespective of discipline, involved in the evaluation and treatment of patients with pelvic floor disorders.

Bio-Fabrication of Human Amniotic Membrane Zinc Oxide Nanoparticles and the Wet/Dry HAM Dressing Membrane for Wound Healing.

The preparation of unique wet and dry wound dressing products derived from unprocessed human amniotic membrane (UP-HAM) is described. The UP-HAM was decellularized, and the constituent proteins were cross-linked and stabilized before being trimmed and packed in sterile Nucril-coated laminated aluminium foil pouches with isopropyl alcohol to manufacture processed wet human amniotic membrane (PW-HAM). The dry type of PD-HAM was prepared by decellularizing the membrane, UV irradiating it, lyophilizing/freeze-drying it, sterilizing it, and storing it at room temperature. The UP-HAM consists of a translucent yellowish mass of flexible membranes with an average thickness of 42 µm. PW-HAM wound dressings that had been processed, decellularized, and dehydrated had a thinner average thickness of 30 µm and lacked nuclear-cellular structures. Following successful decellularization, discrete bundle of fibrous components in the stromal spongy layers, microvilli and reticular ridges were still evident on the surface of the processed HAM, possibly representing the location of the cells that had been removed by the decellularization process. Both wet and dry HAM wound dressings are durable, portable, have a shelf life of 3-5 years, and are available all year. A slice of HAM dressing costs 1.0 US$/cm2. Automation and large-scale HAM membrane preparation, as well as storage and transportation of the dressings, can all help to establish advanced technologies, improve the efficiency of membrane production, and reduce costs. Successful treatment of wounds to the cornea of the eye was achieved with the application of the HAM wound dressings. The HAM protein analysis revealed 360 µg proteins per gram of tissue, divided into three main fractions with MWs of 100 kDa, 70 kDa, and 14 kDa, as well as seven minor proteins, with the 14 kDa protein displaying antibacterial properties against human pathogenic bacteria. A wide range of antibacterial activity was observed after treatment with 75 µg/ml zinc oxide nanoparticles derived from human amniotic membrane proteins (HAMP-ZnO NP), including dose-dependent biofilm inhibition and inhibition of Gram-positive (S. aureus, S. mutans, E. faecalis, and L. fusiformis) and Gram-negative bacteria (S. sonnei, P. aeruginosa, P. vulgaris, and C. freundii).

Physical and psychological stress along with candle fumes induced-cardiopulmonary injury mimicking restaurant kitchen workers.

Restaurant kitchens are work areas where involve strict and hierarchal environments that promote opportunity for bullying and workplace aggression and violence. These physical and psychological stress and fumes ultimately trigger severe occupational stress by disrupting the body's homeostasis that might induce cardiopulmonary injury. The study aimed to investigate the physical and psychological stress and candle fumes on cardiopulmonary injury in an animal model mimicking a restaurant kitchen worker. Social disruption stress (SDR) mice were exposed to scented candle fumes (4.5 h/d, 5 d/wk) in an exposure chamber for 8 weeks. Exposure to burning scented candles failed to reduce serum corticosterone level and increased proinflammatory cytokines levels and NF-ƙB activity in the lung. In addition, burning scented candle fumes synergistically increased SDR-induced serum LDH, CPK, CKMB levels, proinflammatory cytokines production as well as NF-ƙB activation in the lung and heart. Further, cardiac HIF-1α and BNP levels were also increased. We conclude that the physical and psychological stress along with candle fumes might induce cardiopulmonary injury in mice. These results could be extrapolated to restaurant kitchen workers.

Pancreatic cystic neoplasms: a review of current recommendations for surveillance and management.

Pancreatic cystic neoplasms (PCN) comprise of a diverse array of pancreatic cysts, including intraductal papillary mucinous neoplasms (IPMN), mucinous cystic neoplasms (MCN), serous cystic neoplasms (SCN), cystic neuroendocrine tumors (cNET), and many others. Increasing use of cross-sectional imaging has resulted in greater numbers of PCNs discovered incidentally. The overall risk of malignancy is low, but can vary considerably between different classes of PCNs. Furthermore, many pancreatic cysts are indeterminate on imaging, and the inability to reliably predict the course of disease remains a challenge for radiologists. Due to the variability in disease course and a lack of high-quality studies on PCNs, there is no universal consensus when it comes to balancing optimal surveillance while avoiding the risk for overtreatment. Currently, there are three widely accepted international guidelines outlining guidelines for surveillance and management of PCNs: the American Gastroenterological Association (AGA) in 2015, the International Association of Pancreatology (IAP) last revised in 2017, and the European Study Group on Cystic Tumours of the Pancreas (European) last revised in 2018. In 2017, the American College of Radiology released its own comprehensive set of recommendations for managing indeterminate pancreatic cysts that are detected incidentally on CT or MRI. The purpose of this paper is to describe the key differences between the ACR recommendations and the aforementioned three sets of guidelines regarding cyst management, imaging surveillance, performance, and cost-effectiveness.

Fluorometric detection of bisphenol A using ß-cyclodextrin-functionalized ZnO QDs.

The estrogenic property of bisphenol A (BPA) leads to potential adverse health and ecological effects. A simple, selective, and cost-effective sensor capable of detecting BPA would have a noteworthy relevance for the environmental system. The present work illustrates the synthesis and characterization of ß-cyclodextrin (ß-CD) functionalized zinc oxide (ZnO) quantum dots (QDs) for the selective detection of BPA. BPA has a fluorescence quenching effect on functionalized ZnO QDs, and the decrease in fluorescence intensity is associated with the BPA concentration between 2 and 10 µM. Under the optimum reaction condition, a good linear correlation was obtained between relative fluorescence-quenching intensity of ß-cyclodextrin-functionalized ZnO QDs and BPA concentration (R2 = 0.9891). The lower detection limit of functionalized QDs for BPA was estimated to be 0.19 µM, which is lower than the toxic limits in aquatic biota. The fluorescence-based detection of BPA may be ascribed to the electron transfer mechanism, which is elucidated with scientific details from the literature.

Removal of methylene blue dye using nano zerovalent iron, nanoclay and iron impregnated nanoclay - a comparative study.

There has been an increasing challenge from the emission of methylene blue (MB) dye-containing wastewater and its management methods in industry. The sorption process is one conventionally used method. In this study, nanoclay, nano zero valent iron (nZVI), and iron impregnated nanoclay were prepared and studied for the removal of MB dye in batch mode. The effects of operating parameters like pH, dye concentration, sorbent dosage, and contact time were investigated and optimized. The nZVI, nanoclay, and iron impregnated nanoclay sorbents showed zeta potentials of -32.1, -53.4, and -40.7 mV, respectively. All the nano adsorbents were crystalline. The nanoclay was characterized by an average surface area, pore volume and pore diameter of 43.49 m2 g-1, 0.104 cm3 g-1 and 2.806 nm, respectively. nZVI showed a surface area of 47.125 m2 g-1, pore volume of 0.119 cm3 g-1, and pore diameter of 3.291 nm. And iron impregnated nanoclay showed a surface area of 73.110 m2 g-1 with a pore volume of 15 cm3 g-1 and a pore diameter size of 3.83 nm. A Langmuir EXT nitrogen gas adsorption isotherm (R 2 ∼ 0.99) was the best fit. The thermodynamics parameters, such as ΔG° (-12.64 to -0.63 kJ mol-1), ΔH° (+0.1 to +62.15 kJ mol-1) and ΔS° (+0.10 to +0.22 kJ mol-1), confirmed that a spontaneous and endothermic adsorption process took place at a high rate of disorder. Iron impregnated nanoclay showed higher negative Gibbs free energy (-12.64 kJ mol-1), higher enthalpy change (+62.5 kJ mol-1) and entropy (+0.22 kJ mol-1) and gave a better MB removal performance. In addition, the lower negative heat of enthalpy for all adsorptions proved the dominance of physisorption. The methylene blue adsorption isotherm on nZVI and nanoclay showed the best fit with the Freundlich isotherm model with correlation coefficients (R 2) ∼0.98 and 0.99, respectively. Whereas the Langmuir adsorption isotherm was the best fit for iron impregnated nanoclay (R 2 ∼ 0.98). The adsorption activities of nZVI, nanoclay and iron impregnated nanoclay were fitted to a pseudo-second-order kinetic model with correlation coefficients (R 2) of 0.999, 0.997 and 0.983, respectively. The optimal pH 7.0 (RE: 99.1 ± 0.73%), initial MB concentration 40 ppm (RE: 99.9 ± 0.03%), contact time 120 min (RE: 99.9 ± 0.9%), and adsorbent dose 80 (99.9 ± 0.03%) were obtained for iron impregnated nanoclay. The optimal operational parameters of nanoclay and nZVI, respectively, were pH 11.0 and 13.0, initial MB concentration 20 and 20 ppm, adsorbent dose 100 and 140 mg, and contact time 120 and 140 min. In general, iron impregnated nanoclay has shown promising cationic dye adsorbance for industrial applications; but a recyclability test is suggested before scale-up.

Photocatalytic degradation of p-nitrophenol using biologically synthesized ZnO nanoparticles.

The present work deals with the photocatalytic degradation of p-nitrophenol as it is a United States Environmental Protection Agency-listed priority pollutant and has adverse environmental and health effects. To eradicate the detrimental environmental impact of p-nitrophenol, the biologically synthesized ZnO nanoparticles were used as a photocatalyst. The degradation of p-nitrophenol was confirmed by decreasing the absorbance value at a characteristic wavelength of 317 nm using the UV-vis spectrophotometer. Reaction parameters such as ZnO photocatalyst concentration of 0.1 g/L at pH 11 in the presence of H2O2 (5 mM) were found to be optimum conditions for p-nitrophenol degradation. The photocatalytic degradation was slowly enhanced in the presence of H2O2 as an electron acceptor. The kinetics of nitrophenol degradation was studied, which follows the pseudo-first-order reaction. The photocatalytic degradation of p-nitrophenol was characterized by using total organic carbon, chemical oxygen demand, and high-performance liquid chromatography analyses. This method is found to be effective as it is environmentally friendly, free of toxic chemicals.

Prediction of recurrence based on the patellofemoral morphological profile and demographic factors in first-time and recurrent dislocators.

INTRODUCTION: Prediction of recurrence in first-time patellar dislocation is an unsolved mystery. The purpose of our study is to compare patellar instability patients and normal control groups with anatomical risk factors and validation of newer parameters patello-trochlear index (PTI) and tibial tuberosity-posterior cruciate ligament (TT-PCL) and also to find the significant risk factors that help to predict the recurrence of dislocation in first-time dislocators. METHODS: This is a comparison study between 50 normal individuals as a control population (group-1) and 94 patients with patellar instability done between 2013 and 2017. Further, 94 patients (group-2) were divided into first-time dislocators (group-2A) and recurrent dislocators (group-2B) which include 39 and 55 patients, respectively. Demographic factors like age, sex, the age of the first dislocation, mechanism of injury, and laterality and MRI risk factors like trochlear dysplasia, patellar height, patellar malalignment, and lateralization of tibial tuberosity were statistically analyzed. RESULTS: All parameters used to measure each MRI factors showed significant difference with p value < 0.0001 between group 1 and group 2 except PTI (0.035) and TT-PCL (0.036). While comparing demographic factors between first-time dislocators and recurrent dislocator groups, patients with first-time dislocation < 16 years of age (OR-3.6) and bilateral involvement are associated with recurrence and among MRI factors, trochlear dysplasia (odds ratio OR-12), patellar tilt (OR-0.2), and patella alta (OR-4.9) were known to be associated with higher chance of recurrence. CONCLUSION: There is a significant difference in anatomic risk factors between normal and patellar instability knees. PTI and TT-PCL are less significant than the previous parameters. Age < 16 years, the presence of trochlear dysplasia, patella alta, and bilateral involvement have a significant role as prediction factors in a recurrent dislocation in both adolescents and adults.