Chronic inflammatory disease of the male lower genito-urinary tract

The underlying aetiology and pathophysiology of chronic abacterial prostatitis is poorly understood. The study of patients with chronic prostatitis and normal controls by transrectal ultrasound identified seven signs associated with a diagnosis of chronic prostatitis. A cohort of sixty patients with chronic abacterial prostatitis (CABP), based on standard localisation criteria, was constructed. These patients underwent transrectal ultrasound and subsequent guided biopsy of any parenchymal abnormalities, thereby overcoming the problem of urethral contamination. The tissue so obtained was submitted for microbiological, histological and immunological study. Within the cohort no organism was isolated consistently from either prostatic secretion or tissue. In particular Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum could not be identified. A chronic inflammatory infiltrate was detected in 85% of the cohort, yet no controls, thereby vindicating the biopsy technique. However, no specific histological pattern could be attributed to CABP. Immunological analysis of the prostatic tissue suggested the inflammatory process was stimulated by a persistent antigen and was in keeping with a cell mediated, type IV hypersensitivity reaction. Urinary flow rates were subnormal in 27% of the cohort. In selected cases, intraprostatic urinary reflux was demonstrated, and postulated, as being responsible for the transportation of the inciting antigen, whose nature remains unknown, yet probably is non-organismal. Serum PSA was unhelpful in diagnosis and management of CABP. No evidence of a psychological role in the aetiology of CABP was identified. A possible link between acute epididymitis and inflammatory prostatic disease was noted on transrectal ultrasound; intraprostatic and vasal reflux being a proposed unifying factor. In acute epididymitis the role of Chlamydia trachomatis and Enterobacteriaceae was confirmed, and Ureaplasma urealyticum discovered. Thus CABP* appears to be an active immunological reaction in response to a persistent antigen whose nature, although unknown, is possibly non-organismal and transported into the prostate by urinary reflux

Rethinking Justice in Massachusetts: Public Attitudes Toward Crime and Punishment

Presents results from a public opinion survey about the sharp increase in the incarcerated population in Massachusetts and about current strategies for reintegrating ex-offenders who have been released into the community

Successful conservative management of a colorenal fistula complicating percutaneous cryoablation of renal tumors: a case report.

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.INTRODUCTION: Colorenal fistula is a rare phenomenon and may complicate percutaneous cryoablation of renal cell carcinoma. Treatment remains controversial. CASE PRESENTATION: A 62-year-old Caucasian man presented with pneumaturia and left flank pain six weeks following ultrasound-guided percutaneous cryoablation of two recurrent lesions in the left kidney 14 years after partial left nephrectomy for a left renal cell carcinoma. A computed tomography scan eight weeks after cryoablation revealed a cryoablated mass with adjacent stranding and adherent descending colon as well as bubbles of gas in the area of stranding, the left collecting system, and the bladder. These features were consistent with a colorenal fistula at the site of previous ablation. Successful resolution of the fistula, both clinical and radiological, was achieved following a complete conservative non-interventional out-patient approach. No ureteric stent or surgical intervention was employed. CONCLUSIONS: In the absence of severe symptoms or sepsis, complete conservative management of a colorenal fistula complicating percutaneous cryoablation of renal tumors should be considered prior to interventional stenting or resectional surgery

Portable electronic flight progress strip system

Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Aeronautics and Astronautics, 2003.Includes bibliographical references (p. 119-120).This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.There has been growing interest in using electronic alternatives to the paper Flight Progress Strip (FPS) for air traffic control. However, most research has been centered on radar-based control environments, and has not considered the unique operational needs of the airport air traffic control tower. Based on an analysis of the human factors issues for control tower Decision Support Tool (DST) interfaces, a requirement has been identified for an interaction mechanism which replicates the advantages of the paper FPS (e.g., minimal head-down time, portability) but also enables input and output with DSTs. An approach has been developed which uses a Portable Electronic FPS that has attributes of both a paper flight strip and an electronic flight strip. The prototype Portable Electronic Flight Progress Strip system uses handheld computers to replace individual paper strips in addition to a central management interface which is displayed on a desktop computer. Each electronic FPS is connected to the management interface via a wireless local area network. The Portable Electronic FPSs replicate the core functionality of paper flight strips and have additional features which provide an interface to a DST. A departure DST is used as a motivating example. This thesis presents the rationale for a Portable Electronic FPS system and discusses the formatting and functionalities of the prototype displays. A usability study has been conducted to determine the utility of the Portable Electronic FPS in comparison to paper flight strips. This study consisted of a human-in-the-loop experiment which simulated the tasks of an air traffic controller in an airport control tower environment. Specific issues explored during the experiment include the appropriateness of displaying departure advisories on the Portable Electronic FPS, the importance of FPS portability, and the advantages of interaction mechanisms enabled by an electronic interface. Experimental results are presented which show that test subjects preferred the Portable Electronic FPS to a paper FPS. However, results for performance-based measures were partially confounded by a dominance of practice effects, experimental limitations, and characteristics of the prototype hardware itself. The implications of the experimental results are discussed with the aim of directing further research toward the goal of creating an operationally-deployable Portable Electronic FPS system. Future research should explore emergent display technologies which better emulate the physical characteristics of the paper FPS. Once this is accomplished, higher-fidelity performance-based analyses may be conducted, engaging air traffic controllers on design and implementation issues.by Nathan Andrew Doble.S.M

Development and validation of risk score for predicting positive repeat prostate biopsy in patients with a previous negative biopsy in a UK population.

BACKGROUND: Little evidence is available to determine which patients should undergo repeat biopsy after initial benign extended core biopsy (ECB). Attempts have been made to reduce the frequency of negative repeat biopsies using PSA kinetics, density, free-to-total ratios and Kattan's nomogram, to identify men more likely to harbour cancer but no single tool accurately predicts biopsy outcome. The objective of this study was to develop a predictive nomogram to identify men more likely to have a cancer diagnosed on repeat prostate biopsy. METHODS: Patients with previous benign ECB undergoing repeat biopsy were identified from a database. Association between age, volume, stage, previous histology, PSA kinetics and positive repeat biopsy was analysed. Variables were entered stepwise into logistic regression models. A risk score giving the probability of positive repeat biopsy was estimated. The performance of this score was assessed using receiver characteristic (ROC) analysis. RESULTS: 110 repeat biopsies were performed in this period. Cancer was detected in 31% of repeat biopsies at Hospital (1) and 30% at Hospital (2). The most accurate predictive model combined age, PSA, PSA velocity, free-to-total PSA ratio, prostate volume and digital rectal examination (DRE) findings. The risk model performed well in an independent sample, area under the curve (AUCROC) was 0.818 (95% CI 0.707 to 0.929) for the risk model and 0.696 (95% CI 0.472 to 0.921) for the validation model. It was calculated that using a threshold risk score of > 0.2 to identify high risk individuals would reduce repeat biopsies by 39% while identifying 90% of the men with prostate cancer. CONCLUSION: An accurate multi-variable predictive tool to determine the risk of positive repeat prostate biopsy is presented. This can be used by urologists in an outpatient setting to aid decision-making for men with prior benign histology for whom a repeat biopsy is being considered.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Multiparametric Prostate Magnetic Resonance Imaging and Cognitively Targeted Transperineal Biopsy in Patients With Previous Abdominoperineal Resection and Suspicion of Prostate Cancer.

OBJECTIVE: To report our experience with a combination of prostate magnetic resonance imaging (MRI) and transperineal ultrasound biopsy for evaluating the prostate in patients with elevated prostate-specific antigen (PSA) who have previously undergone abdominoperineal resection (APR). PATIENTS AND METHODS: We reviewed the records of 11 patients with a history of APR and clinical suspicion of prostate cancer due to elevated PSA levels over a 5-year period. All patients underwent multiparametric MRI at our institution prior to biopsy. MR diagnoses were validated either by transperineal ultrasound biopsy (Likert 3-5) guided by visual registration or clinical follow-up >6 months (Likert 1-2). RESULTS: All 7 cases with highly suspicious lesions (Likert 4-5) on MRI demonstrated cancer-1 case of Gleason 3 + 3 and 6 cases of Gleason ≥3 + 4 disease. Two cases with Likert 3 MR lesions revealed benign tissue upon biopsy. Two patients with no suspicious lesions on MRI were followed-up clinically, with PSA levels remaining stable over a mean period of 17.5 months (range 7-28 months). CONCLUSION: The use of prebiopsy multiparametric prostate MRI and subsequent cognitively targeted transperineal biopsy guided by visual registration can aid in the diagnostic pathway of patients with APR and a suspicion of prostate cancer.Author 1 has received a research grant from RWTH Aachen University Hospital (Aachen, Germany). Author 6 acknowledges support from Cancer Research UK, National Institute of Health Research Cambridge Biomedical Research Centre, Cancer Research UK and the Engineering and Physical Sciences Research Council Imaging Centre in Cambridge and Manchester and the Cambridge Experimental Cancer Medicine Centre.This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.urology.2016.04.03

Repeat prostate biopsy strategies after initial negative biopsy: meta-regression comparing cancer detection of transperineal, transrectal saturation and MRI guided biopsy.

INTRODUCTION: There is no consensus on how to investigate men with negative transrectal ultrasound guided prostate biopsy (TRUS-B) but ongoing suspicion of cancer. Three strategies used are transperineal (TP-B), transrectal saturation (TS-B) and MRI-guided biopsy (MRI-B). We compared cancer yields of these strategies. METHODS: Papers were identified by search of Pubmed, Embase and Ovid Medline. Included studies investigated biopsy diagnostic yield in men with at least one negative TRUS-B and ongoing suspicion of prostate cancer. Data including age, PSA, number of previous biopsy episodes, number of cores at re-biopsy, cancer yield, and Gleason score of detected cancers were extracted. Meta-regression analyses were used to analyse the data. RESULTS: Forty-six studies were included; 12 of TS-B, 14 of TP-B, and 20 of MRI-B, representing 4,657 patients. Mean patient age, PSA and number of previous biopsy episodes were similar between the strategies. The mean number of biopsy cores obtained by TP-B and TS-B were greater than MRI-B. Cancer detection rates were 30·0%, 36·8%, and 37·6% for TS-B, TP-B, and MRI-B respectively. Meta-regression analysis showed that MRI-B had significantly higher cancer detection than TS-B. There were no significant differences however between MRI-B and TP-B, or TP-B and TS-B. In a sensitivity analysis incorporating number of previous biopsy episodes (36 studies) the difference between MRI-B and TP-B was not maintained resulting in no significant difference in cancer detection between the groups. There were no significant differences in median Gleason scores detected comparing the three strategies. CONCLUSIONS: In the re-biopsy setting, it is unclear which strategy offers the highest cancer detection rate. MRI-B may potentially detect more prostate cancers than other modalities and can achieve this with fewer biopsy cores. However, well-designed prospective studies with standardised outcome measures are needed to accurately compare modalities and define an optimum re-biopsy approach

Targeted transperineal biopsy of the prostate has limited additional benefit over background cores for larger MRI-identified tumors.

PURPOSE: To compare histological outcomes in patients undergoing MRI-transrectal ultrasound fusion transperineal (MTTP) prostate biopsy and determine the incremental benefit of targeted cores. METHODS: Seventy-six consecutive patients with 89 MRI-identified targets underwent MTTP biopsy. Separate targeted biopsies and background cores were obtained according to a standardized protocol. Target biopsies were considered of added diagnostic value if these cores showed a higher Gleason grade than non-targeted cores taken from the same sector (Group 1, n = 41). Conversely, where background cores demonstrated an equal or higher Gleason grade, target cores were considered to be non-beneficial (Group 2, n = 48). RESULTS: There was no significant difference in age, PSA, prostate volume, time-to-biopsy, and number of cores obtained between the groups. A greater proportion of target cores were positive for cancer (158/228; 69.3 %) compared to background (344/1881; 18.38 %). The median target volume was 0.54 cm(3) for Group 1 (range 0.09-2.79 cm(3)) and 1.65 cm(3) for Group 2 (0.3-9.07 cm(3)), p 1.0 cm.The authors acknowledge research support from Cancer Research UK, National Institute of Health Research Cambridge Biomedical Research Centre, Cancer Research UK and the Engineering and Physical Sciences Research Council Imaging Centre in Cambridge and Manchester and the Cambridge Experimental Cancer Medicine Centre.This is the final version of the article. It first appeared from Springer via http://dx.doi.org/10.1007/s00345-015-1650-

Comparison of initial and tertiary centre second opinion reads of multiparametric magnetic resonance imaging of the prostate prior to repeat biopsy.

OBJECTIVES: To investigate the value of second-opinion evaluation of multiparametric prostate magnetic resonance imaging (MRI) by subspecialised uroradiologists at a tertiary centre for the detection of significant cancer in transperineal fusion prostate biopsy. METHODS: Evaluation of prospectively acquired initial and second-opinion radiology reports of 158 patients who underwent MRI at regional hospitals prior to transperineal MR/untrasound fusion biopsy at a tertiary referral centre over a 3-year period. Gleason score (GS) 7-10 cancer, positive predictive value (PPV) and negative (NPV) predictive value (±95 % confidence intervals) were calculated and compared by Fisher's exact test. RESULTS: Disagreement between initial and tertiary centre second-opinion reports was observed in 54 % of cases (86/158). MRIs had a higher NPV for GS 7-10 in tertiary centre reads compared to initial reports (0.89 ± 0.08 vs 0.72 ± 0.16; p = 0.04), and a higher PPV in the target area for all cancer (0.61 ± 0.12 vs 0.28 ± 0.10; p = 0.01) and GS 7-10 cancer (0.43 ± 0.12 vs 0.2 3 ± 0.09; p = 0.02). For equivocal suspicion, the PPV for GS 7-10 was 0.12 ± 0.11 for tertiary centre and 0.11 ± 0.09 for initial reads; p = 1.00. CONCLUSIONS: Second readings of prostate MRI by subspecialised uroradiologists at a tertiary centre significantly improved both NPV and PPV. Reporter experience may help to reduce overcalling and avoid overtargeting of lesions. KEY POINTS: • Multiparametric MRIs were more often called negative in subspecialist reads (41 % vs 20 %). • Second readings of prostate mpMRIs by subspecialist uroradiologists significantly improved NPV and PPV. • Reporter experience may reduce overcalling and avoid overtargeting of lesions. • Greater education and training of radiologists in prostate MRI interpretation is advised.RWTH Aachen University Hospital (Aachen, Germany), National Institute for Health Research Cambridge Biomedical Research Centre, Cancer Research UK, Engineering and Physical Sciences Research Council Imaging Centre in Cambridge and Manchester, Cambridge Experimental Cancer Medicine Centr

Robust wavebuoys for the marginal ice zone: Experiences from a large persistent array in the Beaufort Sea

An array of novel directional wavebuoys was designed and deployed into the Beaufort Sea ice cover in March 2014, as part of the Office of Naval Research Marginal Ice Zone experiment. The buoys were designed to drift with the ice throughout the year and monitor the expected breakup and retreat of the ice cover, forced by waves travelling into the ice from open water. Buoys were deployed from fast-and-light air-supported ice camps, based out of Sachs Harbour on Canada’s Banks Island, and drifted westwards with the sea ice over the course of spring, summer and autumn, as the ice melted, broke up and finally re-froze. The buoys transmitted heave, roll and pitch timeseries at 1 Hz sample frequency over the course of up to eight months, surviving both convergent ice dynamics and significant waves-in-ice events. Twelve of the 19 buoys survived until their batteries were finally exhausted during freeze-up in late October/November. Ice impact was found to have contaminated a significant proportion of the Kalman-filter-derived heave records, and these bad records were removed with reference to raw x/y/z accelerations. The quality of magnetometer-derived buoy headings at the very high magnetic field inclinations close to the magnetic pole was found to be generally acceptable, except in the case of four buoys which had probably suffered rough handling during transport to the ice. In general, these new buoys performed as expected, though vigilance as to the veracity of the output is required