The utility of in-bore multiparametric magnetic resonance-guided biopsy in men with negative multiparametric magnetic resonance-ultrasound software-based fusion targeted biopsy

ObjectivesTo evaluate the utility of in-bore multiparametric magnetic resonance-guided biopsy of the prostate (IB) in patients with visible lesion/s and previous negative software-based multiparametric magnetic resonance imaging/ultrasonography fusion-targeted biopsy of the prostate (FTB).Patients and methodsWe retrospectively analysed prospectively maintained database including consecutive men undergoing IB from March 2013 to October 2017 in 2 European centres expert in this procedure. We selected men with the following criteria: No previous treatment for prostate cancer (CaP), multiparametric magnetic resonance imaging (mpMRI) lesion(s) PIRADS score ≥ 3, FTB showing no clinically significant cancer (csCaP), and subsequent IB. Patient's characteristics, mpMRI findings, biopsy technique, and histopathological results were extracted. The primary outcome was to determine the detection rate of csCaP, defined as any Gleason pattern ≥ 4. A multivariable analysis was performed to identify predictors of positive findings at IB.ResultsFifty-three men were included. Median age was 68 years (interquartile range [IQR] 64–68), median Prostate-Specific Antigen (PSA) was 7.6 ng/ml (IQR 5.2–10.9), and median prostate volume was 59 ml (IQR 44–84). Fifty-six lesions with PIRADS score 3 in 9 cases (16%), 4 in 30 cases (54%), and 5 in 17 cases (30%) were detected. FTB was performed in all cases using a transrectal approach with 3 different platforms (Toshiba, Koelis, and Artemis). Median time between FTB and IB was 3 months (IQR 1–7). A median of 2 cores per lesion were collected with IB (IQR 2–3). No cancer, clinically insignificant and clinically significant cancer were found in 33 (59%), 9 (16%), and 14 (25%) targeted lesions, respectively. Median maximum cancer core length and maximum positive percentage were 9 mm (3–13) and 55% (21%–80%). The only predictor of csCaP on IB was prostate volume (P = 0.026) with an ideal cut-off at 70 ml.ConclusionOne in 4 patients with previous negative FTB, IB was able to detect csCaP. According to this study, IB would be of particularly useful in patients with large glands.     

High-resolution computed tomographic study of the retrotympanum

Summary The aim of this study was to define the imaging of the retrotympanum precisely by means of high-resolution CT. Based on 66 scans of petrous bones performed in 49 patients observed in an otologic department, several retrotympanic structures were studied: the pyramidal eminence, ponticulus, subiculum, chordal ridge, tympanic sinus of Proctor, sinus tympani and recess of the facial n. The variations in morphology and depth were noted as well as the relationship between the pyramid and the facial canal. In a second phase the same anatomic structures were studied in 24 temporal bones removed from embalmed cadavers and investigated with the same radiologic technique. Anatomic correlations were made for six temporal bones to confirm the general applicability of our radiologic hypotheses. In CT the pyramidal eminence was visualised in 100% of cases, the chordal ridge in 52%, the ponticulus in 63% and the subiculum in 57%. As regards the different recesses, the sinus tympani was visualised in 95% of cases, the posterior tympanic sinus of Proctor in 38%, the fossula of Grivot in 47% and the facial recess in 80%. The mean depth of the sinus tympani was 2.7 mm and that of the tympanic sinus of Proctor was 1.65 mm; the fossula of Grivot was assessed as 2.1 mm and the facial recess as 2.2 mm. A better knowledge of these sinuses and their variations will aid the surgeon, particularly in a posterior tympanotomy or a retro-facial approach.

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Étude tomodensitométrique en haute résolution du rétrotympanum — Confrontations anatomiques

Résumé Le but de ce travail était de définir avec précision en tomodensitométrie haute résolution l'imagerie du rétrotympanum. A partir de 66 TDMs des rochers réalisés chez 49 patients suivis en ORL, plusieurs structures du rétrotympanum ont été étudiées : éminence pyramidale, ponticulus, subiculum, crête cordale, sinus tympanique de proctor, sinus tympani et récessus du facial. Les variations morphologiques et de profondeur ont été notées ainsi que le rapport entre la pyramide et le canal facial. Dans un deuxième temps, à partir de 24 temporaux prélevés sur cadavres embaumés, explorés selon la même technique radiologique, les mêmes structures anatomiques ont été étudiées. Des corrélations anatomiques pour 6 temporaux ont été réalisées pour confirmer l'ensemble de nos hypothèse radiologiques. En tomodensitométrie la visibilité de l'éminence pyramidale était obtenue dans 100% des cas, celle de la crête cordale dans 52% des cas, du ponticulus dans 63% des cas et du subiculum dans 57% des cas. Pour ce qui est des différents récessus, le sinus tympani était visible dans 95% des cas, le sinus tympani de Proctor dans 38% des cas, la fossette de Grivot dans 47% des cas et le recessus du facial dans 80% des cas. La profondeur moyenne du sinus tympani était de 2.7 mm, le sinus tympani de Proctor mesurait 1.65 mm, la fossette de Grivot était évaluée à 2.1 mm et le récessus du facial à 2.2 mm. La meilleure connaissance de ces sinus et de leur variation aidera le chirurgien en particulier pour une tympanotomie postérieure ou un abord rétro-facial.

     

Monitoring Health Care for Children with Chronic Conditions in a Managed Care Environment

Objective: Children with chronic health conditions face special issues in their interactions with managed care. These children often require additional and more varied services than do other children. Managed care plans increasingly include these children, especially with the growth of Medicaid managed care. This article examines the special issues facing children with chronic conditions and develops strategies for monitoring their care in managed care settings. Methods: The project staff conducted an extensive review of the research and policy literature related to managed care and the special needs of families with children with chronic conditions. The project also reviewed current and proposed plans of federal, state, and private groups for monitoring and, working with parents and other outside groups, identified key issues to consider in developing monitoring plans. Results: The relative rarity of many childhood conditions and the complex interactions among child, family, and community over time make assessment of their care difficult. We describe these child and family characteristics, outline essential features and domains for monitoring systems, and describe population-based and plan-based monitoring systems to assess managed care for these children and their families. Conclusions: Monitoring for children with chronic conditions in managed care arrangements will require public health agencies and health providers to define populations systematically, assess across a variety of conditions, and monitor several domains central to the health of these families.     

Intertester reliability of assessing postural sway using the chattecx balance system

In this study, we examined intertester reliability of dynamic and static balance using the Chattecx Dynamic Balance System. Ten female and two male subjects were randomly assigned to two testers and completed ten, 10-second preprogrammed double- and single-leg test conditions. Balance was measured as postural sway in centimeters by the Chattecx Dynamic Balance System. Static balance consisted of the platform remaining stable, whereas dynamic balance consisted of the platform tilting in an anterior and posterior direction during testing. The protocols and average postural sway values were:1. Double-Leg Static Eyes Open ([unk] = .28 cm)2. Double-Leg Static Eyes Closed ([unk] = .37 cm)3. Double-Leg Dynamic Eyes Open ([unk] = .86 cm)4. Double-Leg Dynamic Eyes Closed ([unk] = 1.72 cm)5. Single-Leg Static Dominant Eyes Open ([unk] = .99 cm)6. Single-Leg Static Dominant Eyes Closed ([unk] = 1.70 cm)7. Single-Leg Static Nondominant Eyes Open ([unk] = .65 cm)8. Single-Leg Static Nondominant Eyes Closed ([unk] = 1.48 cm)9. Single-Leg Dynamic Dominant Eyes Open ([unk] = .99cm)10. Single-Leg Dynamic Nondominant Eyes Open ([unk] = .91 cm).The mean values of postural sway ranged from .28 cm to 1.72 cm for double-leg stance measures and from .65 cm to 1.70 cm for the single-leg stance measures. The intraclass correlations (ICCs)(2,1) ranged from poor to excellent (ICCs = .06 to .90) and the standard error of measurement (SEM) ranged from .06 to .34 for the 10 trials. We feel that variability exists between subjects and/or testers between trials. The wide range of reliability values suggests that further research should determine both intratester and intertester reliability using a variety of protocols for assessment of static and dynamic balance.     

Therapeutic Agents of Assertive Community Treatment

The goal of this study was to learn how assertive community treatment (ACT) contributes to the improvement of those with serious mental illness in order to contribute to the growing clinical literature regarding the therapeutic agents of ACT teams. Methods included reviewing the case records of three ACT clients who have improved significantly, as well as interviewing the clients themselves and their clinicians. The results indicated that there was significant agreement among the case records, the clients, and their clinicians in identifying the most useful aspects of assertive community treatment. Primary among these factors were the persistence demonstrated by ACT clinicians in engaging their clients, the trust that clients developed in their clinicians, and as a result, the process by which their clinicians became guides to the world of psychiatric and social services that further facilitated their clients' community adjustment. In closing, we consider implications from these findings both for staff development for ACT team members, and for suggestions toward the development of a model of recovery from serious mental illness.     

Vinflunine (20′,20′-difluoro- 3′,4′-dihydrovinorelbine), a novel Vinca alkaloid, which participates in P-glycoprotein (Pgp)-mediated multidrug resistance in vivo and in vitro

Vinflunine (VFL) is a novel derivative of vinorelbine (NVB, Navelbine®), which has shown markedly superior antitumor activity to NVB, in various experimental animal models. To establish whether this new Vinca alkaloid participates in P-glycoprotein (Pgp)-mediated multidrug resistance (MDR), VFL-resistant murine P388 cells (P388/VFL) were established in vivo and used in conjunction with the well established MDR P388/ADR subline, to define the in vivo resistance profile for VFL. P388/VFL cells proved cross-resistant to drugs implicated in MDR (other Vinca alkaloids, doxorubicin, etoposide), but not to campothecin or cisplatin and showed an increased expression of Pgp, without any detectable alterations in topoisomerase II or in glutathione metabolism. The P388/ADR cells proved cross-resistant to VFL both in vivo and in vitro, and this VFL resistance was efficiently modulated by verapamil in vitro. Cellular transport experiments with tritiated-VFL revealed differential uptake by P388 sensitive and P388/ADR resistant cells, comparable with data obtained using tritiated-NVB. In various in vitro models of human MDR tumor cells, whilst full sensitivity was retained in cells expressing alternative non-Pgp-mediated MDR mechanisms, cross resistance was identified in Pgp-overexpressing cells. Differences were, however, noted in terms of the drug resistance profiles relative to the other Vincas, with tumor cell lines proving generally least cross-resistant to VFL. Overall, these results suggest that VFL, like other Vinca alkaloids, participates in Pgp-mediated MDR, with tumor cells selected for resistance to VFL overexpressing Pgp, yet MDR tumor cell lines proved generally less cross resistant to VFL relative to the other Vinca alkaloids.