Integrating MRI for the diagnosis of prostate cancer

Purpose of review We review recent developments in prostate MRI for prostate cancer diagnosis. Recent findings Large series have strengthened the case for the use of MRI prior to subsequent biopsy to maximize the detection of clinically significant disease, and reduce the detection of clinically insignificant disease. This has effectively moved the discussion on from whether MRI is useful in prostate cancer detection to how best to use it, and at which time point. The Prostate Imaging- Reporting And Data System (PIRADS) group have published a second version of the PIRADS criteria for prostate MRI, covering acquisition, interpretation, and reporting both for clinical practice and data collection for research. There is debate about the commonly used and more prescriptive PIRADS system versus the less prescriptive systems based on overall clinical impression of clinically significant disease (e.g. Likert or simplified quantum scoring). Studies suggest that the Likert or simplified quantum scoring approach may outperform PIRADSv2. Published data are conflicting on whether software-assisted fusion of MRI lesions to ultrasound used at biopsy is more effective than visual registration by a trained operator. Summary The use of prostate MRI is increasing worldwide, and the debate now focuses on how best to use it to optimize the detection of clinically significant disease

Pointlike probes of superstring-theoretic superfluids

In analogy with an experimental setup used in liquid helium, we use a pointlike probe to study superfluids which have a gravity dual. In the gravity description, the probe is represented by a hanging string. We demonstrate that there is a critical velocity below which the probe particle feels neither drag nor stochastic forces. Above this critical velocity, there is power-law scaling for the drag force, and the stochastic forces are characterized by a finite, velocity-dependent temperature. This temperature participates in two simple and general relations between the drag force and stochastic forces. The formula we derive for the critical velocity indicates that the low-energy excitations are massless, and they demonstrate the power of stringy methods in describing strongly coupled superfluids.Comment: 17 pages, 2 figures, added a figure, a reference, and moved material to an appendi

Bulk spectral function sum rule in QCD-like theories with a holographic dual

We derive the sum rule for the spectral function of the stress-energy tensor in the bulk (uniform dilatation) channel in a general class of strongly coupled field theories. This class includes theories holographically dual to a theory of gravity coupled to a single scalar field, representing the operator of the scale anomaly. In the limit when the operator becomes marginal, the sum rule coincides with that in QCD. Using the holographic model, we verify explicitly the cancellation between large and small frequency contributions to the spectral integral required to satisfy the sum rule in such QCD-like theories.Comment: 16 pages, 2 figure

Infering Air Quality from Traffic Data using Transferable Neural Network Models

This work presents a neural network based model for inferring air quality from traffic measurements. It is important to obtain information on air quality in urban environments in order to meet legislative and policy requirements. Measurement equipment tends to be expensive to purchase and maintain. Therefore, a model based approach capable of accurate determination of pollution levels is highly beneficial. The objective of this study was to develop a neural network model to accurately infer pollution levels from existing data sources in Leicester, UK. Neural Networks are models made of several highly interconnected processing elements. These elements process information by their dynamic state response to inputs. Problems which were not solvable by traditional algorithmic approaches frequently can be solved using neural networks. This paper shows that using a simple neural network with traffic and meteorological data as inputs, the air quality can be estimated with a good level of generalisation and in near real-time. By applying these models to links rather than nodes, this methodology can directly be used to inform traffic engineers and direct traffic management decisions towards enhancing local air quality and traffic management simultaneously.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

An elementary stringy estimate of transport coefficients of large temperature QCD

Modeling QCD at large temperature with a simple holographic five dimensional theory encoding minimal breaking of conformality, allows for the calculation of all the transport coefficients, up to second order, in terms of a single parameter. In particular, the shear and bulk relaxation times are provided. The result follows by deforming the AdS background with a scalar dual to a marginally relevant operator, at leading order in the deformation parameter.Comment: 11 pages; v2: comments and references adde

A multicentre randomised controlled trial assessing whether MRI-targeted biopsy is non-inferior to standard transrectal ultrasound guided biopsy for the diagnosis of clinically significant prostate cancer in men without prior biopsy: a study protocol

INTRODUCTION: The classical pathway for the diagnosis of prostate cancer is transrectal ultrasound-guided (TRUS) biopsy of the prostate initiated on the basis of a raised prostate-specific antigen (PSA). An alternative pathway is to perform multi-parametricMRI (MPMRI) to localise cancer and to use this information to influence the decision for, and conduct of, a subsequent biopsy, known as an MPMRI-targeted biopsy. An MPMRI pathway has been shown to detect a similar or greater amount of clinically significant cancer as TRUS biopsy but has several advantages, including the potential to biopsy fewer men with fewer cores. METHODS: This is a pragmatic, international, multicentre, parallel group randomised study in which men are allocated in a 1:1 ratio to an MPMRI or TRUS biopsy pathway. This study will assess whether an MPMRI-targeted biopsy approach is non-inferior to a standard TRUS biopsy approach in the diagnosis of clinically significant cancer.Men in the MRI arm will undergo targeted biopsy of suspicious areas only and no biopsy will be carried out if the MRI is non-suspicious. Men in the TRUS biopsy will undergo a standard 10-12-core TRUS biopsy. The main inclusion criteria are a serum PSA ≤20 ng/mL, a digital rectal examination finding of T2 or less and no prior prostate biopsy.The primary outcome is the proportion of men with clinically significant cancer detected. A sample size of at least 470 patients is required. Key secondary outcomes include the proportion of clinically insignificant cancer detected. ETHICS AND DISSEMINATION: Ethical approval was obtained from the National Research Ethics Committee East Midlands, Leicester (15/EM/0188). Results of this study will be disseminated through national and international papers. The participants and relevant patient support groups will be informed about the results of the study. REGISTRATION DETAILS: NCT02380027; Pre-results

Rationing tests for drug-resistant tuberculosis - who are we prepared to miss?

BACKGROUND: Early identification of patients with drug-resistant tuberculosis (DR-TB) increases the likelihood of treatment success and interrupts transmission. Resource-constrained settings use risk profiling to ration the use of drug susceptibility testing (DST). Nevertheless, no studies have yet quantified how many patients with DR-TB this strategy will miss. METHODS: A total of 1,545 subjects, who presented to Lima health centres with possible TB symptoms, completed a clinic-epidemiological questionnaire and provided sputum samples for TB culture and DST. The proportion of drug resistance in this population was calculated and the data was analysed to demonstrate the effect of rationing tests to patients with multidrug-resistant TB (MDR-TB) risk factors on the number of tests needed and corresponding proportion of missed patients with DR-TB. RESULTS: Overall, 147/1,545 (9.5%) subjects had culture-positive TB, of which 32 (21.8%) had DR-TB (MDR, 13.6%; isoniazid mono-resistant, 7.5%; rifampicin mono-resistant, 0.7%). A total of 553 subjects (35.8%) reported one or more MDR-TB risk factors; of these, 506 (91.5%; 95% CI, 88.9-93.7%) did not have TB, 32/553 (5.8%; 95% CI, 3.4-8.1%) had drug-susceptible TB, and only 15/553 (2.7%; 95% CI, 1.5-4.4%) had DR-TB. Rationing DST to those with an MDR-TB risk factor would have missed more than half of the DR-TB population (17/32, 53.2%; 95% CI, 34.7-70.9). CONCLUSIONS: Rationing DST based on known MDR-TB risk factors misses an unacceptable proportion of patients with drug-resistance in settings with ongoing DR-TB transmission. Investment in diagnostic services to allow universal DST for people with presumptive TB should be a high priority

Unicellular cyanobacteria are important components of phytoplankton communities in Australia's northern oceanic ecoregions

© 2019 Moore, Huang, Ostrowski, Mazard, Kumar, Gamage, Brown, Messer, Seymour and Paulsen. The tropical marine environments of northern Australia encompasses a diverse range of geomorphological and oceanographic conditions and high levels of productivity and nitrogen fixation. However, efforts to characterize phytoplankton assemblages in these waters have been restricted to studies using microscopic and pigment analyses, leading to the current consensus that this region is dominated by large diatoms, dinoflagellates, and the marine cyanobacterium Trichodesmium. During an oceanographic transect from the Arafura Sea through the Torres Strait to the Coral Sea, we characterized prokaryotic and eukaryotic phytoplankton communities in surface waters using a combination of flow cytometry and Illumina based 16S and 18S ribosomal RNA amplicon sequencing. Similar to observations in other marine regions around Australian, phytoplankton assemblages throughout this entire region were rich in unicellular picocyanobacterial primary producers while picoeukaryotic phytoplankton formed a consistent, though smaller proportion of the photosynthetic biomass. Major taxonomic groups displayed distinct biogeographic patterns linked to oceanographic and nutrient conditions. Unicellular picocyanobacteria dominated in both flow cytometric abundance and carbon biomass, with members of the Synechococcus genus dominating in the shallower Arafura Sea and Torres Strait where chlorophyll a was relatively higher (averaging 0.4 ± 0.2 mg m-3), and Prochlorococcus dominating in the oligotrophic Coral Sea where chlorophyll a averaged 0.13 ± 0.07 mg m-3. Consistent with previous microscopic and pigment-based observations, we found from sequence analysis that a variety of diatoms (Bacillariophyceae) exhibited high relative abundance in the Arafura Sea and Torres Strait, while dinoflagellates (Dinophyceae) and prymnesiophytes (Prymnesiophyceae) were more abundant in the Coral Sea. Ordination analysis identified temperature, nutrient concentrations and water depth as key drivers of the region's assemblage composition. This is the first molecular and flow cytometric survey of the abundance and diversity of both prokaryotic and picoeukaryotic phytoplankton in this region, and points to the need to include the picocyanobacterial populations as an essential oceanic variable for sustained monitoring in order to better understand the health of these important coastal waters as global oceans change

Colour-electric spectral function at next-to-leading order

The spectral function related to the correlator of two colour-electric fields along a Polyakov loop determines the momentum diffusion coefficient of a heavy quark near rest with respect to a heat bath. We compute this spectral function at next-to-leading order, O(alpha_s^2), in the weak-coupling expansion. The high-frequency part of our result (omega >> T), which is shown to be temperature-independent, is accurately determined thanks to asymptotic freedom; the low-frequency part of our result (omega << T), in which Hard Thermal Loop resummation is needed in order to cure infrared divergences, agrees with a previously determined expression. Our result may help to calibrate the overall normalization of a lattice-extracted spectral function in a perturbative frequency domain T << omega << 1/a, paving the way for a non-perturbative estimate of the momentum diffusion coefficient at omega -> 0. We also evaluate the colour-electric Euclidean correlator, which could be directly compared with lattice simulations. As an aside we determine the Euclidean correlator in the lattice strong-coupling expansion, showing that through a limiting procedure it can in principle be defined also in the confined phase of pure Yang-Mills theory, even if a practical measurement could be very noisy there.Comment: 38 page