Should we perform multiparametric magnetic resonance imaging of the bladder before transurethral resection of bladder? Time to reconsider the rules

We would like to congratulate Ueno and colleagues [1] on their paper on diagnostic accuracy and interobserver agreement for the new Vesical Imaging-Reporting and Data System (VI-RADS) [2] for muscle-invasive bladder cancer (MIBC) in this issue of European Urology. Their report on 74 patients who underwent multiparametric magnetic resonance imaging (mpMRI) before transurethral resection of bladder tumor (TURBT) raises great interest in the RADS (Reporting and Data Systems) era. They address the questions of reproducibility and diagnostic performance of mpMRI in the setting of bladder ca (BC), in which potential applications of this imaging technique have seen constant growth in the past decades without a definitive role having been identified

High-m Kink/Tearing Modes in Cylindrical Geometry

The global ideal kink equation, for cylindrical geometry and zero beta, is simplified in the high poloidal mode number limit and used to determine the tearing stability parameter, $\Delta^\prime$. In the presence of a steep monotonic current gradient, $\Delta^\prime$ becomes a function of a parameter, $\sigma_0$, characterising the ratio of the maximum current gradient to magnetic shear, and $x_s$, characterising the separation of the resonant surface from the maximum of the current gradient. In equilibria containing a current "spike", so that there is a non-monotonic current profile, $\Delta^\prime$ also depends on two parameters: $\kappa$, related to the ratio of the curvature of the current density at its maximum to the magnetic shear, and $x_s$, which now represents the separation of the resonance from the point of maximum current density. The relation of our results to earlier studies of tearing modes and to recent gyro-kinetic calculations of current driven instabilities, is discussed, together with potential implications for the stability of the tokamak pedestal.Comment: To appear in Plasma Physics and Controlled Fusio

Atualização sobre o controle estratégico do carrapato-do-boi.

Detecção da resistência. Classe dos carrapaticidas. Ciclo biológico do carrapato R. microplus. Controle estratégico. Cuidados no controle.bitstream/CNPGC-2010/13274/1/COT123.pd

Continental accretion and incremental deformation in the thermochronologic evolution of the Lesser Caucasus

Apatite fission-track analysis and thermochronologic statistical modeling of Precambrian\u2013Oligocene plutonic and metamorphic rocks from the Lesser Caucasus resolve two discrete cooling episodes. Cooling occurred during incremental crustal shortening due to obduction and continental accretion along the margins of the northern branch of the Neotethys. (1) The thermochronometric record of a Late Cretaceous (Turonian\u2013Maastrichtian) cooling/exhumation event, coeval to widespread ophiolite obduction, is still present only in a relatively small area of the upper plate of the Amasia-Sevan-Akera (ASA) suture zone, i.e. the suture marking the final closure of the northern Neotethys during the Paleogene. Such area has not been affected by significant later exhumation. (2) Rapid cooling/exhumation occurred in the Early-Middle Miocene in both the lower and upper plates of the ASA suture zone, obscuring previous thermochronologic signatures over most of the study area. Miocene contractional reactivation of the ASA suture zone occurred contemporaneously with the main phase of shortening and exhumation along the Bitlis suture zone marking the closure of the southern branch of the Neotethys and the ensuing Arabia-Eurasia collision. Miocene collisional stress from the Bitlis suture zone was transmitted northward across the Anatolian hinterland, which was left relatively undeformed, and focused along preexisting structural discontinuities such as the eastern Pontides and the ASA suture zone

Robotic intracorporeal urinary diversion: practical review of current surgical techniques

In this practical review, we discuss current surgical techniques reported in the literature to perform Intracorporeal Urinary Diversion (ICUD) after Robotic Radical Cystectomy (RARC), emphasizing criticisms of single approaches and making comparisons with Extracorporeal Urinary Diversion (ECUD). Although almost 97% of all RARCs use an ECUD, ICUD is gaining in popularity, in view of its potential benefits (i.e., decreased bowel exposure, etc.), although there are a few studies comparing ICUD and ECUD. Analysing single experiences and the data from recent metanalyses, we emphasize the current critiques to ICUD, stressing particular technical details which could reduce operative time, lowering the postoperative complications rate, and improving functional outcomes. Only analysis of long-term follow-up data from large-scale homogeneous series can ascertain whether robotic intracorporeal urinary diversion is superior to other approaches

Dynamics and consequences of DNA looping by the FokI restriction endonuclease

Genetic events often require proteins to be activated by interacting with two DNA sites, trapping the intervening DNA in a loop. While much is known about looping equilibria, only a few studies have examined DNA-looping dynamics experimentally. The restriction enzymes that cut DNA after interacting with two recognition sites, such as FokI, can be used to exemplify looping reactions. The reaction pathway for FokI on a supercoiled DNA with two sites was dissected by fast kinetics to reveal, in turn: the initial binding of a protein monomer to each site; the protein–protein association to form the dimer, trapping the loop; the subsequent phosphodiester hydrolysis step. The DNA motion that juxtaposes the sites ought on the basis of Brownian dynamics to take ∼2 ms, but loop capture by FokI took 230 ms. Hence, DNA looping by FokI is rate limited by protein association rather than DNA dynamics. The FokI endonuclease also illustrated activation by looping: it cut looped DNA 400 times faster than unlooped DNA

Multiparametric MRI of the bladder: inter-observer agreement and accuracy with the Vesical Imaging-Reporting and Data System (VI-RADS) at a single reference center

Objectives: To evaluate accuracy and inter-observer variability using Vesical Imaging-Reporting and Data System (VI-RADS) for discrimination between non-muscle invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC). Methods: Between September 2017 and July 2018, 78 patients referred for suspected bladder cancer underwent multiparametric MRI of the bladder (mpMRI) prior to transurethral resection of bladder tumor (TURBT). All mpMRI were reviewed by two radiologists, who scored each lesion according to VI-RADS. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each VI-RADS cutoff. Receiver operating characteristics curves were used to evaluate the performance of mpMRI. The Ƙ statistics was used to estimate inter-reader agreement. Results: Seventy-five patients were included in the final analysis, 53 with NMIBC and 22 with MIBC. Sensitivity and specificity were 91% and 89% for reader 1 and 82% and 85% for reader 2 respectively when the cutoff VI-RADS > 2 was used to define MIBC. At the same cutoff, PPV and NPV were 77% and 96% for reader 1 and 69% and 92% for reader 2. When the cutoff VI-RADS > 3 was used, sensitivity and specificity were 82% and 94% for reader 1 and 77% and 89% for reader 2. Corresponding PPV and NPV were 86% and 93% for reader 1 and 74% and 91% for reader 2. Area under curve was 0.926 and 0.873 for reader 1 and 2 respectively. Inter-reader agreement was good for the overall score (Ƙ = 0.731). Conclusions: VI-RADS is accurate in differentiating MIBC from NMIBC. Inter-reader agreement is overall good. Key Points: • Traditionally, the local staging of bladder cancer relies on transurethral resection of bladder tumor. • However, transurethral resection of bladder tumor carries a significant risk of understaging a cancer; therefore, more accurate, faster, and non-invasive staging techniques are needed to improve outcomes. • Multiparametric MRI has proved to be the best imaging modality for local staging; therefore, its use in suitable patients has the potential to expedite radical treatment when necessary and non-invasive diagnosis in patients with poor fitness

An evaluation of urinary microRNA reveals a high sensitivity for bladder cancer

Background: Urinary biomarkers are needed to improve the care and reduce the cost of managing bladder cancer. Current biomarkers struggle to identify both high and low-grade cancers due to differing molecular pathways. Changes in microRNA (miR) expression are seen in urothelial carcinogenesis in a phenotype-specific manner. We hypothesised that urinary miRs reflecting low- and high-grade pathways could detect bladder cancers and overcome differences in genetic events seen within the disease. Methods: We investigated urinary samples (n ¼ 121) from patients with bladder cancer (n ¼ 68) and age-matched controls (n ¼ 53). Fifteen miRs were quantified using real-time PCR. Results: We found that miR is stable within urinary cells despite adverse handling and detected differential expression of 10 miRs from patients with cancer and controls (miRs 15a/15b/24-1/27b/100/135b/203/212/328/1224, ANOVA Po0.05). Individually, miR-1224-3p had the best individual performance with specificity, positive and negative predictive values and concordance of 83%, 83%, 75% and 77%, respectively. The combination of miRs-135b/15b/1224-3p detected bladder cancer with a high sensitivity (94.1%), sufficient specificity (51%) and was correct in 86% of patients (concordance). Conclusion: The use of this panel in patients with haematuria would have found 94% of urothelial cell carcinoma, while reducing cystoscopy rates by 26%. However, two invasive cancers (3%) would have been missed

Volume elements of spacetime and a quartet of scalar fields

Starting with a `bare' 4-dimensional differential manifold as a model of spacetime, we discuss the options one has for defining a volume element which can be used for physical theories. We show that one has to prescribe a scalar density \sigma. Whereas conventionally \sqrt{|\det g_{ij}|} is used for that purpose, with g_{ij} as the components of the metric, we point out other possibilities, namely \sigma as a `dilaton' field or as a derived quantity from either a linear connection or a quartet of scalar fields, as suggested by Guendelman and Kaganovich.Comment: 7 pages RevTEX, submitted to Phys. Rev.