Automated graded prognostic assessment for patients with hepatocellular carcinoma using machine learning.

BACKGROUND: Accurate mortality risk quantification is crucial for the management of hepatocellular carcinoma (HCC); however, most scoring systems are subjective. PURPOSE: To develop and independently validate a machine learning mortality risk quantification method for HCC patients using standard-of-care clinical data and liver radiomics on baseline magnetic resonance imaging (MRI). METHODS: This retrospective study included all patients with multiphasic contrast-enhanced MRI at the time of diagnosis treated at our institution. Patients were censored at their last date of follow-up, end-of-observation, or liver transplantation date. The data were randomly sampled into independent cohorts, with 85% for development and 15% for independent validation. An automated liver segmentation framework was adopted for radiomic feature extraction. A random survival forest combined clinical and radiomic variables to predict overall survival (OS), and performance was evaluated using Harrell's C-index. RESULTS: A total of 555 treatment-naïve HCC patients (mean age, 63.8 years ± 8.9 [standard deviation]; 118 females) with MRI at the time of diagnosis were included, of which 287 (51.7%) died after a median time of 14.40 (interquartile range, 22.23) months, and had median followed up of 32.47 (interquartile range, 61.5) months. The developed risk prediction framework required 1.11 min on average and yielded C-indices of 0.8503 and 0.8234 in the development and independent validation cohorts, respectively, outperforming conventional clinical staging systems. Predicted risk scores were significantly associated with OS (p < .00001 in both cohorts). CONCLUSIONS: Machine learning reliably, rapidly, and reproducibly predicts mortality risk in patients with hepatocellular carcinoma from data routinely acquired in clinical practice. CLINICAL RELEVANCE STATEMENT: Precision mortality risk prediction using routinely available standard-of-care clinical data and automated MRI radiomic features could enable personalized follow-up strategies, guide management decisions, and improve clinical workflow efficiency in tumor boards. KEY POINTS: • Machine learning enables hepatocellular carcinoma mortality risk prediction using standard-of-care clinical data and automated radiomic features from multiphasic contrast-enhanced MRI. • Automated mortality risk prediction achieved state-of-the-art performances for mortality risk quantification and outperformed conventional clinical staging systems. • Patients were stratified into low, intermediate, and high-risk groups with significantly different survival times, generalizable to an independent evaluation cohort.

Automated MRI liver segmentation for anatomical segmentation, liver volumetry, and the extraction of radiomics.

OBJECTIVES: To develop and evaluate a deep convolutional neural network (DCNN) for automated liver segmentation, volumetry, and radiomic feature extraction on contrast-enhanced portal venous phase magnetic resonance imaging (MRI). MATERIALS AND METHODS: This retrospective study included hepatocellular carcinoma patients from an institutional database with portal venous MRI. After manual segmentation, the data was randomly split into independent training, validation, and internal testing sets. From a collaborating institution, de-identified scans were used for external testing. The public LiverHccSeg dataset was used for further external validation. A 3D DCNN was trained to automatically segment the liver. Segmentation accuracy was quantified by the Dice similarity coefficient (DSC) with respect to manual segmentation. A Mann-Whitney U test was used to compare the internal and external test sets. Agreement of volumetry and radiomic features was assessed using the intraclass correlation coefficient (ICC). RESULTS: In total, 470 patients met the inclusion criteria (63.9±8.2 years; 376 males) and 20 patients were used for external validation (41±12 years; 13 males). DSC segmentation accuracy of the DCNN was similarly high between the internal (0.97±0.01) and external (0.96±0.03) test sets (p=0.28) and demonstrated robust segmentation performance on public testing (0.93±0.03). Agreement of liver volumetry was satisfactory in the internal (ICC, 0.99), external (ICC, 0.97), and public (ICC, 0.85) test sets. Radiomic features demonstrated excellent agreement in the internal (mean ICC, 0.98±0.04), external (mean ICC, 0.94±0.10), and public (mean ICC, 0.91±0.09) datasets. CONCLUSION: Automated liver segmentation yields robust and generalizable segmentation performance on MRI data and can be used for volumetry and radiomic feature extraction. CLINICAL RELEVANCE STATEMENT: Liver volumetry, anatomic localization, and extraction of quantitative imaging biomarkers require accurate segmentation, but manual segmentation is time-consuming. A deep convolutional neural network demonstrates fast and accurate segmentation performance on T1-weighted portal venous MRI. KEY POINTS: • This deep convolutional neural network yields robust and generalizable liver segmentation performance on internal, external, and public testing data. • Automated liver volumetry demonstrated excellent agreement with manual volumetry. • Automated liver segmentations can be used for robust and reproducible radiomic feature extraction.

Targeting the vivid facets of apolipoproteins as a cardiovascular risk factor in rheumatoid arthritis.

Mostly, cardiovascular diseases are blamed for casualties in rheumatoid arthritis (RA) patients. Customarily, dyslipidemia is probably the most prevalent underlying cause of untimely demise in people suffering from RA as it hastens the expansion of atherosclerosis. The engagement of inflammatory cytokines like tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6), etc., is crucial in the progression and proliferation of both RA and abnormal lipid parameters. Thus, lipid abnormalities should be monitored frequently in patients with both primary and advanced RA stages. An advanced lipid profile examination, i.e., direct role of apolipoproteins associated with various lipid molecules is a more dependable approach for better understanding of the disease and selecting suitable therapeutic targets. Therefore, studying their apolipoproteins is more relevant than assessing RA patients' altered lipid profile levels. Among the various apolipoprotein classes, Apo A1 and Apo B are primarily being focused. In addition, it also addresses how calculating Apo B:Apo A1 ratio can aid in analyzing the disease's risk. The marketed therapies available to control lipid abnormalities are associated with many other risk factors. Hence, directly targeting Apo A1 and Apo B would provide a better and safer option.

MRI of Benign Prostatic Hyperplasia: Important Pre- and Posttherapeutic Considerations.

New minimally invasive techniques that reduce morbidity while improving lower urinary tract symptoms (LUTS) due to benign prostatic hypertrophy (BPH) have become attractive alternatives for patients, in comparison to traditional techniques such as transurethral resection of the prostate (TURP) and simple prostatectomy. Pre- and postprocedural MRI is not routinely performed for LUTS due to BPH treatments. However, because of the combination of rapidly evolving treatments available for LUTS due to BPH and increasing demand for prebiopsy prostate MRI for detection of clinically significant prostate cancer (PCa), an understanding of procedural techniques and expected changes are important for accurate interpretation of prostate MRI performed after treatment of BPH. The authors discuss the imaging evaluation of LUTS due to BPH and emerging predictors of treatment success. The posttreatment appearance and underlying anatomic changes in the prostate after medical, surgical, and minimally invasive treatments including TURP, simple prostatectomy, laser enucleations and ablations, prostatic urethral lift, water vapor thermal therapy, and prostate artery embolization are detailed. Most procedures reduce prostate volume, notably in the periurethral prostatic tissue. Ablations create areas of necrosis and can distort the normal zonal anatomy between the transition zone and the peripheral zone, and prostate artery embolization creates infarcts in the transition zone. Mechanical prostatic urethral lift devices open the anterior channel at the bladder base but create susceptibility artifacts that can obscure and prevent detection of a lesion in the transition zone. Also discussed are the detection of clinically significant prostate cancer in the postprocedural prostate and imaging of BPH procedure complications such as urethral strictures, abscesses, and hematuria. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material. See the invited commentary by Purysko in this issue.

Pulmonary Fibrosis: Unveiling the Pathogenesis, Exploring Therapeutic Targets, and Advancements in Drug Delivery Strategies.

Idiopathic pulmonary fibrosis (IPF) is an ailment with no cure and a very high rate of progression that ultimately leads to death. The exact reason for this disease is still not acknowledged. Many underlying mechanisms of wound healing and various types of stimuli that trigger the pathogenesis of IPF continue to be intensively explored. The exact therapy for the reversal of this disease is not yet known and is constantly in progress. Existing treatments only slow down the process or mitigate the symptoms to enhance the patient's healthcare system. The only two Food and Drug Administration-approved oral medications include pirfenidone and nintedanib whose high dose and systemic circulation can have side effects to a greater extent. Further research on restorative and extra-curative therapies for IPF is necessary due to the absence of viable therapeutic choices. To assure minimum off-targeted site delivery and longer duration of action, techniques that offer a sustainable release of the drug, better bioavailability, and patient compliance can be used.The work is an overview of the main therapeutic targets and pertinent developing therapies for the management of IPF. This study is an attempt to focus on various drug delivery systems that are responsible for showing effectiveness in defense mechanisms against IPF.

Exploring the role of polyphenols in rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic, inflammatory and autoimmune disorder which is mainly characterized by inflammation in joints, bone erosions and cartilaginous destruction that leads to joint dysfunction, deformation, and/or permanent functional impairment. The prevalence of RA is increasing, incurring a considerable burden on healthcare systems globally. The exact etiology of RA is unknown, with various pathways implicated in its pathophysiology. Non-steroidal anti-inflammatory drugs (NSAIDs) including celecoxib, diclofenac and ibuprofen, disease-modifying anti-rheumatic drugs (DMARD) including azathioprine, methotrexate and cyclosporine, biological agents including anakinra, infliximab, and rituximab and immunosuppressants are used for symptomatic relief in patients with RA, but these medications have severe adverse effects such as gastric ulcers, hypertension, hepatotoxicity and renal abnormalities which restrict their use in the treatment of RA; new RA treatments with minimal side-effects are urgently required. There is accumulating evidence that dietary polyphenols may show therapeutic efficacy in RA through their antioxidant, anti-inflammatory, apoptotic, and immunosuppressant activities and modulation of the tumor necrosis factor-α (TNF-α), interleukin (IL)-6, mitogen-activated protein kinase (MAPK), IL-1ß, c-Jun N-terminal kinase (JNK), and nuclear factor κ light-chain-enhancer of activated B cell (NF-κB) pathways. While resveratrol, genistein, carnosol, epigallocatechin gallate, curcumin, kaempferol, and hydroxytyrosol have also been studied for the treatment of RA, the majority of data are derived from animal models. Here, we review the various pathways involved in the development of RA and the preclinical and clinical data supporting polyphenols as potential therapeutic agents in RA patients. Our review highlights that high-quality clinical studies are required to decisively establish the anti-rheumatic efficacy of polyphenolic compounds.

Recent updates on development of protein-tyrosine phosphatase 1B inhibitors for treatment of diabetes, obesity and related disorders.

The aim of this review was to discuss an overview of type 2 diabetes; biology of PTP1B; role of PTP1B in metabolic disorders; and recent updates in the development of PTP1B inhibitors reported in literature since 1994. In this study, extensive literature search was carried out on PTP1B inhibitors of natural as well as synthetic origin in various scientific databases and research articles related to discovery of PTP1B inhibitors were selected for this study. Protein tyrosine phosphatase 1B (PTP1B) is an important therapeutic target for several human diseases including type 2 diabetes, obesity and cancer because of its seminal part as a negative modulator in both insulin and leptin signaling pathways. A large number of molecules of broad chemical diversity were reported as potent and selective PTP1B inhibitors over other protein tyrosine phosphatases. Several of these molecules have shown their potential in the treatment of various human diseases including type 2 diabetes, obesity, inflammation and cancer in various animal models. But only a very limited number of PTP1B inhibitors (including ertiprotafib, trodusquemine and JTT-551) has entered clinical trials and are finally withdrawn owing to their unsatisfactory effectiveness and undesirable adverse effects. Consequently, it is still highly imperative and of great importance to develop potent, highly selective and safe PTP1B inhibitors.

Hemorrhagic dot score as a follow up marker in psoriasis on treatment: A prospective observational study.

CONTEXT: Psoriasis assessment tools in use presently lack reproducibility and are cumbersome to use. An easily reproducible, objective tool with ability to maintain visual records for follow up is hence desirable. We conducted a study with the aim to assess dermoscopic changes in psoriasis while on treatment by recording the number of hemorrhagic dots (Hemorrhagic Dot Score-HDS) in a representative plaque and comparing it to the PASI score. SETTINGS AND DESIGN: A longitudinal prospective study was conducted between October 2018 to March 2020 in a dermatology centre of a tertiary hospital on cases of chronic plaque psoriasis on treatment over 6 months, assessed at baseline and thereafter monthly for 6 months. METHODS: Hundred consenting patients of chronic plaque psoriasis were assessed, clinically, PASI and dermoscopically. HDS and other dermoscopic features were noted at every visit. STATISTICAL ANALYSIS USED: ANOVA and F test of testing of equality of Variance; effect size in terms of Cohen were used to report the strength of an apparent relationship. RESULTS AND INTERPRETATION: Percentage improvement in the mean PASI scores and HDS and percentage improvement of mean was found significant in each month on follow up. Systemic therapy as compared to topical therapy showed higher effect size of 6.1 and 1.7, respectively. CONCLUSION: Hemorrhagic dot score can be used as an objective, definite assessment tool correlating with clinical severity of psoriasis with more accuracy which shows changes early following institution of therapy.

Adjunctive use of saturated solution of potassium iodide (SSKI) with liposomal amphotericin B (L-AMB) in mucormycosis achieves favorable response, shortened dose and duration of amphotericin: A retrospective study from a COVID-19 tertiary care center.

PURPOSE: Second wave of COVID-19 pandemic was associated with an unprecedented rise in cases of mucormycosis, treatment of which has been challenging owing to the availability and side effects associated with amphotericin. METHODS: All patients presenting with rhino-orbital cerebral mucormycosis (ROCM) following COVID-19 infection between April 2021 to June 2021 were included in this retrospective interventional study. Primary objective was to assess the clinical response with combination of intravenous liposomal amphotericin B (4-5 mg/kg/day) and saturated solution of potassium iodide (SSKI) given orally along with surgical debridement. RESULTS: Twenty-five patients of ROCM were treated with the regimen. Mean age and fasting blood sugar levels were 53.48 years and 239.64 mg/dL respectively. All patients had history of intake of steroids with a mean daily dose of 86.39 mg of prednisolone equivalent. 88% of patients had a "proven" diagnosis of mucormycosis. Cultures were positive in 52% of patients with Rhizopus arrhizus as the predominant species. The mean daily dose of amphotericin received was 268 mg/day with a mean duration of 9.52 days. Mean daily dose of SSKI was 2.57 g. 21 patients (84%) had stabilization of disease at week 8 and achieved cure at the end of treatment whereas the mortality rate was 16%. Factors that significantly affected outcome were eye and central nervous system (CNS) involvement on presentation. CONCLUSION: SSKI, with its remarkably low cost and safety profile, makes it a potential adjuvant drug that may help achieve the twin benefits of shortened duration and dose of LAMB.

Magnetic Resonance Imaging-Guided Transurethral Ultrasound Ablation of Prostate Cancer.

PURPOSE: Magnetic resonance imaging-guided transurethral ultrasound ablation uses directional thermal ultrasound under magnetic resonance imaging thermometry feedback control for prostatic ablation. We report 12-month outcomes from a prospective multicenter trial (TACT). MATERIALS AND METHODS: A total of 115 men with favorable to intermediate risk prostate cancer across 13 centers were treated with whole gland ablation sparing the urethra and apical sphincter. The co-primary 12-month endpoints were safety and efficacy. RESULTS: In all, 72 (63%) had grade group 2 and 77 (67%) had NCCN® intermediate risk disease. Median treatment delivery time was 51 minutes with 98% (IQR 95-99) thermal coverage of target volume and spatial ablation precision of ±1.4 mm on magnetic resonance imaging thermometry. Grade 3 adverse events occurred in 9 (8%) men. The primary endpoint (U.S. Food and Drug Administration mandated) of prostate specific antigen reduction ≥75% was achieved in 110 of 115 (96%) with median prostate specific antigen reduction of 95% and nadir of 0.34 ng/ml. Median prostate volume decreased from 37 to 3 cc. Among 68 men with pretreatment grade group 2 disease, 52 (79%) were free of grade group 2 disease on 12-month biopsy. Of 111 men with 12-month biopsy data, 72 (65%) had no evidence of cancer. Erections (International Index of Erectile Function question 2 score 2 or greater) were maintained/regained in 69 of 92 (75%). Multivariate predictors of persistent grade group 2 at 12 months included intraprostatic calcifications at screening, suboptimal magnetic resonance imaging thermal coverage of target volume and a PI-RADS™ 3 or greater lesion at 12-month magnetic resonance imaging (p <0.05). CONCLUSIONS: The TACT study of magnetic resonance imaging-guided transurethral ultrasound whole gland ablation in men with localized prostate cancer demonstrated effective tissue ablation and prostate specific antigen reduction with low rates of toxicity and residual disease.

Mechanistic and physiological approaches of fecal microbiota transplantation in the management of NAFLD.

Non-alcoholic fatty liver disease (NAFLD) is a multifaceted disease allied with various metabolic disorders, obesity and dysbiosis. Gut microbiota plays an influential role in the pathogenesis of NAFLD and other metabolic disorders. However, recent scientific upsurge emphasizes on the utility of beneficial gut microbiota and bacteriotherapy in the management of NAFLD. Fecal microbiota transplantation (FMT) is the contemporary therapeutic approach with state-of-the-art methods for the treatment of NAFLD. Other potential therapies include probiotics and prebiotics supplements which are based on alteration of gut microbes to treat NAFLD. In this review, our major focus is on the pathological association of gut microbiota with progression of NAFLD, historical aspects and recent advances in FMT with possible intervention to combat NAFLD and its associated metabolic dysfunctions.

Understanding the possible role of endocannabinoid system in obesity.

BACKGROUND: Maintenance of weight is essential for sustenance, well-being and to endorse prolonged life. The prevalence of obesity is increasing at an alarming rate globally, due to modern lifestyle and dietary habits. Endocannabinoids are fatty acid derivatives and numerous studies are carried out which focuses and targets their relationship with obesity, via multiple signals which have been recently known for exerting crucial role in regulating energy balance. PURPOSE: This article aims at examining the prospects of endocannabinoids in obesity via directing the role of ECs in stimulating hunger. RESULT: In last few years, irregular stimulation of endocannabinoid system has been suggested as a chief element in the progression of obesity-associated metabolic complications. Certainly, this cascade system comprises of cannabinoid type1 and 2 receptors (CB1R and CB2R) along with their endogenous lipid ligands which are responsible for enhanced feeding behavior as well as lipid metabolism. Significantly, inhibiting CB1R activity might reduce metabolic abnormality linked with obesity. CONCLUSION: Conclusion withdrawn on the basis of supporting scientific data and evidences report that the blockade of cannabinoids can serve as a therapeutic potential for treatment of obesity. Future prospective aims at assessing molecular pathways which contributes towards ECS, elicited weight control and to evaluate how these mechanisms are presently relocated into the production of novel cannabinoid drugs exhibiting enriched care.

Imaging Features at the Periphery: Hemodynamics, Pathophysiology, and Effect on LI-RADS Categorization.

Liver lesions have different enhancement patterns at dynamic contrast-enhanced imaging. The Liver Imaging Reporting and Data System (LI-RADS) applies the enhancement kinetic of liver observations in its algorithms for imaging-based diagnosis of hepatocellular carcinoma (HCC) in at-risk populations. Therefore, careful analysis of the spatial and temporal features of these enhancement patterns is necessary to increase the accuracy of liver mass characterization. The authors focus on enhancement patterns that are found at or around the margins of liver observations-many of which are recognized and defined by LI-RADS, such as targetoid appearance, rim arterial phase hyperenhancement, peripheral washout, peripheral discontinuous nodular enhancement, enhancing capsule appearance, nonenhancing capsule appearance, corona enhancement, and periobservational arterioportal shunts-as well as peripheral and periobservational enhancement in the setting of posttreatment changes. Many of these are considered major or ancillary features of HCC, ancillary features of malignancy in general, features of non-HCC malignancy, features associated with benign entities, or features related to treatment response. Distinction between these different patterns of enhancement can help with achieving a more specific diagnosis of HCC and better assessment of response to local-regional therapy. ©RSNA, 2021.

Platelet-rich plasma-Where do we stand today? A critical narrative review and analysis.

"Sometimes you have to travel a long way to find what is near." This quote by Paulo Coelho stands true for platelet-rich plasma (PRP) as we know of it today. Large strides have been made to understand this "youth" in blood, but there still seems a long way to go in our understanding of it. Despite advances, clarity in its preparation, biology, and the properties of the final product still remains elusive. The concepts of an ideal number or concentration of platelets in the final enriched plasma, best devices to prepare PRP, an ideal hardware, standard parameters for its preparation, the need for its activation or buffering of the final preparation or whether anticoagulants should be used or not, have evolved, since it was first described. The authors present an analysis of PRP present day status and its usefulness in field of medicine with a review of published literature from "Medline" (via "PubMed"), "Cochrane," the Virtual Health Library, and Google Scholar related to PRP, its biology, types, and classifications, preparation, and use.

Hansen's disease in the era of COVID-19: An observation on a series of six patients with co-infection.

Since the onset of the present pandemic, effect of the novel corona virus on other infectious conditions continues to be investigated. Although the immunological responses to SARS-Cov-2 infection have been elaborated extensively, they fail to explain, variations in its clinical manifestations and its interaction with other diseases. Hansen's disease is known to present as a complex immunological response to the lepra bacilli, resulting in its varied spectral manifestations. An interaction between these two infectious agents, hence, may affect Hansen's disease. We came across six cases of Hansen's disease who developed COVID19 co-infection. This series presents their clinical course and outcome, during the period of co-infection. All cases were followed up for a minimum eight-week period thereafter. In all these cases the active phase of coronavirus infection had no effect on Hansen's disease and those on prednisolone for their lepra reaction had a more favorable outcome, with two cases manifesting exacerbation of their lepra reactions in the follow period.

MR-Guided High-Intensity Directional Ultrasound Ablation of Prostate Cancer.

PURPOSE OF REVIEW: The goal of this paper was to review the novel treatment modality of high-intensity transurethral directional ultrasound for prostate cancer. RECENT FINDINGS: Prostate cancer is a heterogeneous disease with some patients electing for active surveillance and focal therapies instead of definitive treatment with radical prostatectomy or radiation therapy. Prostate MRI has become a cornerstone of prostate cancer diagnosis, targeted biopsy, and treatment planning. Transurethral high-intensity directional ultrasound allows for MRI-guided ablation of the prostate gland with the ability to contour boundaries and spare critical structures, such as the neurovascular bundle and urinary sphincter. Although results are still emerging, this may offer patients a new option for focal therapy with a favorable side-effect profile. High-intensity transurethral directional ultrasound is an emerging treatment modality for both whole-gland and focal ablation with promising early results. Further research is needed to establish safety, tolerability, and long-term oncologic outcomes.

Nailfold capillaroscopy in psoriasis.

BACKGROUND: Psoriasis a chronic inflammatory skin disease manifests with microcirculatory changes within skin which may precede skin manifestations, correlate with their severity, joint involvement and resolve with treatment. Nailfold capillaroscopy (NFC) is used in rheumatology for connective tissue disorder assessment and is assuming significance in psoriasis. The aim was to study the nailfold capillaroscopic findings in patients with psoriasis. METHODS: A cross-sectional observational study was carried out at a skin center of a tertiary care hospital from January 2016 to June 2017. Selected cases underwent NFC using a portable color capillaroscope with an attached computer with software to analyze the nailfold capillaries for morphological parameters and abnormalities. Independent-samples t test and chi-square test was used to analyze the relationships between variables. RESULTS: Mean capillary loop density in 96% of study population was subnormal (<9 capillaries/mm), mean arterial limb diameter 11.37 ± 2.434µ; mean venous limb diameter 15.89 ± 3.131µ, top of the loop diameter 14.41 ± 4.373µ and length of the loop was 152.51 ± 57.21µ. Only 3 had length of loop >300µ. Bizarre morphology was seen in 15.5% of capillaries (p value < 0.001). Crossed loops/tortuous capillaries were seen in 17.3% of patients (p value < 0.001). Ramified capillaries were seen in 9.1% of patients with psoriasis (p value < 0.001). Other abnormalities observed were hemorrhage, avascular areas and subpapillary plexus. Widespread disease and psoriatic arthritis (18.2%) had irregular and haphazard distribution of capillaries (p value < 0.001). Analysis of Psoriasis Area Severity Index score, age of the patient and NFC did not reveal any statistically significant relationship. CONCLUSIONS: Nailfold capillaroscopy (NFC), a non invasive imaging technique for microcirculation evaluation can serve to prognosticate and follow up patirents with psoriasis as a simple and highly reproducible tool. Nailfold capillaroscopy is a simple and an easy method to study the microvascular abnormalities in psoriasis. Findings correlate with disease severity. It can be used for follow-up as a predictor of disease worsening or response to treatment.

Variability of the Positive Predictive Value of PI-RADS for Prostate MRI across 26 Centers: Experience of the Society of Abdominal Radiology Prostate Cancer Disease-focused Panel.

Background Prostate MRI is used widely in clinical care for guiding tissue sampling, active surveillance, and staging. The Prostate Imaging Reporting and Data System (PI-RADS) helps provide a standardized probabilistic approach for identifying clinically significant prostate cancer. Despite widespread use, the variability in performance of prostate MRI across practices remains unknown. Purpose To estimate the positive predictive value (PPV) of PI-RADS for the detection of high-grade prostate cancer across imaging centers. Materials and Methods This retrospective cross-sectional study was compliant with the HIPAA. Twenty-six centers with members in the Society of Abdominal Radiology Prostate Cancer Disease-focused Panel submitted data from men with suspected or biopsy-proven untreated prostate cancer. MRI scans were obtained between January 2015 and April 2018. This was followed with targeted biopsy. Only men with at least one MRI lesion assigned a PI-RADS score of 2-5 were included. Outcome was prostate cancer with Gleason score (GS) greater than or equal to 3+4 (International Society of Urological Pathology grade group ≥2). A mixed-model logistic regression with institution and individuals as random effects was used to estimate overall PPVs. The variability of observed PPV of PI-RADS across imaging centers was described by using the median and interquartile range. Results The authors evaluated 3449 men (mean age, 65 years ± 8 [standard deviation]) with 5082 lesions. Biopsy results showed 1698 cancers with GS greater than or equal to 3+4 (International Society of Urological Pathology grade group ≥2) in 2082 men. Across all centers, the estimated PPV was 35% (95% confidence interval [CI]: 27%, 43%) for a PI-RADS score greater than or equal to 3 and 49% (95% CI: 40%, 58%) for a PI-RADS score greater than or equal to 4. The interquartile ranges of PPV at these same PI-RADS score thresholds were 27%-44% and 27%-48%, respectively. Conclusion The positive predictive value of the Prostate Imaging and Reporting Data System was low and varied widely across centers. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Milot in this issue.

MR Imaging-Guided Transurethral Ultrasound Ablation of Localized Prostate Cancer: Preliminary Experience from a Single Center in a Prospective, Multi-Center, Single-Arm Clinical Trial.

This report details a single-center experience of using magnetic resonance imaging-guided transurethral ultrasound ablation (TULSA) for whole-gland prostate treatment. Nine men with organ-confined low-to-intermediate-risk prostate cancer underwent the TULSA procedure. The primary endpoint of reduction of more than 75% was achieved in 8 of 9 patients, and all patients demonstrated a histologic benefit at 12-month biopsy. No major urinary or gastrointestinal side effects were observed, and there were no postprocedural changes in erectile firmness. These findings suggest that TULSA is potentially safe and efficacious for patients with low-to-intermediate-risk disease.

Molecular insights into therapeutic promise of targeting of Wnt/ß-catenin signaling pathway in obesity.

Obesity is a curable disorder which is a global health concern, linked to an excess amount of fat. It is caused by inherited and environmental factors and can be grim to maintain through dieting only. The importance of peculiar Wnt/ß-catenin signaling has directed considerable efforts in the future production of therapeutic approaches in metabolic complications, including obesity. The article aims to examine the prospects of Wnt/ß-catenin signaling cascade in obesity via directing effects of Wnt/ß-catenin cascade in regulating appetite. A deep research on the literature available to date, for Wnt/ß-catenin cascade in obesity is conducted using various medical databases like PubMed, MEDLINE from the internet. The articles published in English language were mainly preferred. Obesity has developed endemic worldwide, which initiates various obesity-related comorbidities. Obesity is implied by excessive deposition of fat primarily in the adipose tissue. Numerous studies have shown the vital impact of the Wnt/ß-catenin signaling pathway in the growth of body part and biological homeostasis, while latent data illustrate the inherited variations in the Wnt/ß-catenin cascade, correlating to several complications. The current article enlightens the stimulation of the Wnt/ß-catenin cascade in obesity, mainly depot-explicit impact among adipose tissue during high caloric intake regulation and WAT browning event. Taken all together these data illustrate Wnt/ß-catenin signaling cascade subsidizes to obesity promoted insulin resistance independent proliferation of adipose tissue.