MRI-targeted or standard biopsy for prostate-cancer diagnosis

Background Multiparametric magnetic resonance imaging (MRI), with or without targeted biopsy, is an alternative to standard transrectal ultrasonography-guided biopsy for prostate-cancer detection in men with a raised prostate-specific antigen level who have not undergone biopsy. However, comparative evidence is limited. Methods In a multicenter, randomized, noninferiority trial, we assigned men with a clinical suspicion of prostate cancer who had not undergone biopsy previously to undergo MRI, with or without targeted biopsy, or standard transrectal ultrasonography-guided biopsy. Men in the MRI-targeted biopsy group underwent a targeted biopsy (without standard biopsy cores) if the MRI was suggestive of prostate cancer; men whose MRI results were not suggestive of prostate cancer were not offered biopsy. Standard biopsy was a 10-to-12-core, transrectal ultrasonography-guided biopsy. The primary outcome was the proportion of men who received a diagnosis of clinically significant cancer. Secondary outcomes included the proportion of men who received a diagnosis of clinically insignificant cancer. Results A total of 500 men underwent randomization. In the MRI-targeted biopsy group, 71 of 252 men (28%) had MRI results that were not suggestive of prostate cancer, so they did not undergo biopsy. Clinically significant cancer was detected in 95 men (38%) in the MRI-targeted biopsy group, as compared with 64 of 248 (26%) in the standard-biopsy group (adjusted difference, 12 percentage points; 95% confidence interval [CI], 4 to 20; P=0.005). MRI, with or without targeted biopsy, was noninferior to standard biopsy, and the 95% confidence interval indicated the superiority of this strategy over standard biopsy. Fewer men in the MRI-targeted biopsy group than in the standard-biopsy group received a diagnosis of clinically insignificant cancer (adjusted difference, -13 percentage points; 95% CI, -19 to -7; P<0.001). Conclusions The use of risk assessment with MRI before biopsy and MRI-targeted biopsy was superior to standard transrectal ultrasonography-guided biopsy in men at clinical risk for prostate cancer who had not undergone biopsy previously. (Funded by the National Institute for Health Research and the European Association of Urology Research Foundation; PRECISION ClinicalTrials.gov number, NCT02380027 .)

Mount of Things : An Expedition in Object-Oriented Ontology Architecture

The research behind this thesis engages notions of philosophy and architecture through the realm of ontology and materialism. Understanding the potential residing in phenomenology and applying it to innate objects such as works of architecture opens a world of speculative possibilities. I argue for entities to have no ontological privilege over one another, but rather that all things and beings exist equally. As the contemporary discourse positions our center around human concern as precluding all entity’s perception of the world, I posit that we could perceive buildings or objects as finite things in it of themselves rather than filtering our perception of things through human experience. In the acknowledgment of elevated importance to things, new materialism, re-inscribes humanist values by merely extending agency, vitality, and social phenomena to nonhuman material. The partial construction of the Mont Analogue and its surroundings serves as an attempt at creating architecture in a space where the reality of anything outside of the thought-and-being correlation is unknowable but imaginable. This thesis is a knowledge seeking expedition to a symbolic mountain where human comprehension and architectural realization are partial. The Mountain is the bond between Earth and Sky. Its solitary summit reaches the spheres of eternity, and its base spreads out in manifolds foothills into the world of mortals. It is the way by which man can raise himself to the divine, and by which the divine reveals itself to man.Applied Science, Faculty ofArchitecture and Landscape Architecture (SALA), School ofUnreviewedGraduat

Intérêt de la radioembolisation dans le carcinome Hépatocellulaire avec thrombose vasculaire (comparaison rétrospective avec le Sorafenib)

Introduction: La thrombose vasculaire est un facteur de mauvais pronostic majeur dans le Carcinome Hépatocellulaire (CHC). L'efficacité du sorafenib est limitée. La radioembolisation semble une option intéressante. Patients et Méthodes: Nous avons comparé rétrospectivement les patients traités à Rennes, Bordeaux et Marseille pour un CHC avec thrombose vasculaire macroscopique. Nous avons comparé les patients traités par radioembolisation ou sorafenib. Résultats: 201 patients ont été traités: 20 par radioembolisation seule, 14 par radioembolisation et sorafenib et 167 par sorafenib seul. Les réponses mRECIST et de la thrombose étaient meilleures dans le groupe radioembolisation. La survie globale médiane était de 18,3 mois dans le groupe radioembolisation contre 5,9 mois pour le sorafenib (p<0,001). La différence persistait en analyse multivariée. Les temps jusqu'à progression médians était respectivement de 6,9 mois contre 4,1 mois (p=0,031). Conclusion: La radioembolisation semble une option plus intéressante que le sorafenib chez les patients présentant un CHC avec thrombose vasculaire.RENNES1-BU Santé (352382103) / SudocSudocFranceF

Gestion globale de la qualité sanitaire des grandes cultures

National audienc