RESUMO
ABSTRACT: We describe early ex vivo proof-of-concept testing of a novel system composed of a disposable endorectal coil and converging multichannel needle guide with a reusable clamp stand, embedded electronics, and baseplate to allow for endorectal magnetic resonance (MR) imaging and in-bore MRI-targeted biopsy of the prostate as a single integrated procedure. Using prostate phantoms imaged with standard T 2 -weighted sequences in a Siemens 3T Prisma MR scanner, we measured the signal-to-noise ratio in successive 1-cm distances from the novel coil and from a commercially available inflatable balloon coil and measured the lateral and longitudinal deviation of the tip of a deployed MR compatible needle from the intended target point. Signal-to-noise ratio obtained with the novel system was significantly better than the inflatable balloon coil at each of five 1-cm intervals, with a mean improvement of 78% ( P < 0.05). In a representative sampling of 15 guidance channels, the mean lateral deviation for MR imaging-guided needle positioning was 1.7 mm and the mean longitudinal deviation was 2.0 mm. Our ex vivo results suggest that our novel system provides significantly improved signal-to-noise ratio when compared with an inflatable balloon coil and is capable of accurate MRI-guided needle deployment.
Assuntos
Desenho de Equipamento , Biópsia Guiada por Imagem , Imagens de Fantasmas , Próstata , Masculino , Humanos , Próstata/diagnóstico por imagem , Próstata/patologia , Biópsia Guiada por Imagem/métodos , Biópsia Guiada por Imagem/instrumentação , Imagem por Ressonância Magnética Intervencionista/métodos , Imagem por Ressonância Magnética Intervencionista/instrumentação , Razão Sinal-Ruído , Imageamento por Ressonância Magnética/métodos , Reto/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologiaRESUMO
We report that fluoroquinolone-resistant Escherichia coli are found in feces of 8.8% of healthy women, with most bacteria belonging to pandemic multidrug-resistant ST131-H30R or ST1193 clonal groups. Moreover, these highly uropathogenic clonal groups demonstrate an especially prolonged gut persistence and high rate of bacteriuria without documented urinary tract infection.
Assuntos
Bacteriúria , Infecções por Escherichia coli , Microbioma Gastrointestinal , Infecções Urinárias , Escherichia coli Uropatogênica , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriúria/tratamento farmacológico , Bacteriúria/epidemiologia , Farmacorresistência Bacteriana Múltipla , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/epidemiologia , Feminino , Fluoroquinolonas/farmacologia , Humanos , Pandemias , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologiaRESUMO
We describe the rapid and ongoing emergence across multiple US cities of a new multidrug-resistant Escherichia coli clone-sequence type (ST) 1193-resistant to fluoroquinolones (100%), trimethoprim-sulfamethoxazole (55%), and tetracycline (53%). ST1193 is associated with younger adults (age <40 years) and currently comprises a quarter of fluoroquinolone-resistant clinical E. coli urine isolates.
Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/microbiologia , Farmacorresistência Bacteriana Múltipla , Infecções por Escherichia coli/microbiologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/genética , Infecções por Escherichia coli/epidemiologia , Humanos , Vigilância da População , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologiaRESUMO
Diagnostic multiparametric MRI of the prostate has steadily evolved over the last three decades and can now reliably depict the dominant tumor in most men with prostate cancer. In response, several methods of targeted biopsy to direct tissue sampling of suspected tumor foci seen at multiparametric MRI have been developed and successfully tested in recent years, including software-assisted MRI-ultrasound (US) fusion biopsy and direct MRI-guided in-bore biopsy. These advances are leading to a sea change in the approach to prostate cancer diagnosis, with the traditional approach of blind systematic biopsy increasingly being replaced by MRI directed targeted biopsy. This review aims to describe the current status of targeted biopsy, with an emphasis on the relative accuracy of different techniques. The results of several critical large multicenter trials are presented, while unanswered questions that require more research are highlighted.
RESUMO
Concerns about reduced strength, fatigue resistance, and oxidative stability of highly cross-linked and remelted ultrahigh-molecular-weight polyethylene (UHMWPE) have limited its clinical acceptance for total knee arthroplasty. We hypothesized that a highly cross-linked UHMWPE stabilized with vitamin E would have less oxidation and loss of mechanical properties. We compared the oxidation, in vitro strength, fatigue-crack propagation resistance, and wear of highly cross-linked UHMWPE doped with vitamin E to γ-inert-sterilized direct compression-molded UHMWPE (control). After accelerated aging, the control material showed elevated oxidation, loss of small-punch mechanical properties, and loss of fatigue-crack propagation resistance. In contrast, the vitamin E-stabilized material had minimal changes and exhibited 73% to 86% reduction in wear for both cruciate-retaining and posterior-stabilized total knee arthroplasty designs. Highly cross-linked vitamin E-stabilized UHMWPE performed well in vitro.