OBJECTIVE: Image-guided targeted biopsy techniques have been proposed to address problems ofsystematic transrectal ultrasound guided prostate biopsies that lead to the suboptimal cancer detectionrate as well as inaccurate grading of the disease. This study aims to provide local data on the diagnosticaccuracy of multiparametric MRI (MP-MRI) and MP-MRI ultrasound cognitive fusion biopsy inidentifying areas of clinically significant malignancy of the prostate. MATERIALS AND METHODS: This is a validity study involving patients who underwent MP-MRI and MP-MRI ultrasound cognitive fusion biopsy, who eventually underwent robot-assisted laparoscopic radicalprostatectomy (RALRP). Outcome measures included sensitivity, specificity, positive and negativepredictive values of MP-MRI and MP-MRI ultrasound cognitive fusion biopsy. Reference standardused was the final histopathologic report obtained after RALRP. RESULTS: MP-MRI has a sensitivity of 35.5%, specificity of 95.2%, positive predictive value of 97.1%,and negative predictive value of 25%. MP-MRI ultrasound fusion biopsy had similar results, withsensitivity of 34.4%, specificity of 81.0%, positive predictive value of 88.9%, and negative predictivevalue of 21.8%. CONCLUSION The high specificity and positive predictive value of MP-MRI (95.2% and 97.1%respectively) indicates the necessity for a prostate biopsy and supports the utility of a targeted MP-MRI guided ultrasound cognitive fusion biopsy. However, the low sensitivity and negative predictivevalue (25% and 35% respectively) of 35.5% indicates that MP-MRI guidance does not limit thenumber of biopsy samples only to visible MP-MRI lesions, since negative areas on MP-MRI stillcontains tumors in 75% of cases.

Human ; Adult ; GLAUCOMA-OPEN-ANGLE ; GLAUCOMA,SIMPLEX ; GLAUCOMA, COMPENSATED ; IRIDOCORNEAL ENDOTHELIAL SYNDROME ; FILTERING SURGERY ; GLAUCOMA ; SCLEROSTOMY ; TRABECULECTOMY

PURPOSE:To determine the cup and disc areas using computer-aided imaging. METHODOLOGY:Case-control study using the computer-aided imaging as a screening test in a given population. RESULTS:There is a wide variability in cup and disc areas among glaucoma suspects and normal. CONCLUSION:C:D alone has a poor predictive value for diagnosing glaucoma.Optic disc size with C:D is just as sensitive and specific in screening for glaucoma.Cup and disc areas are positively correlated for normal and glaucoma suspects.
Human ; Aged ; Middle Aged ; Adult ; GLAUCOMA

Purpose: This study aimed to compare the proinsulin to C-peptide (PI:C) ratio in those with recent-onset type 1 diabetes versus those with no diabetes and to explore the effect of age on PI:C ratio. Methods: Nineteen participants (n=9 with type 1 diabetes and n=10 with no diabetes) between 10 and 19 years of age were enrolled in a single-visit cross-sectional study and underwent blood collection after 10 hours fasting to measure proinsulin and C-peptide levels as well as other glycemic parameters. Results: The median PI:C ratio was significantly different between type 1 diabetes and nondiabetes groups (6.24% vs. 1.46%, P<0.01). A significant negative correlation was seen between PI:C ratio and patient age after adjustment for duration of diabetes (r2=0.61, P=0.02) in the type 1 diabetes group. Conclusion Even in this narrow age window, a higher degree of β-cell dysfunction indicated by a higher PI:C ratio was seen in younger children.

PURPOSE: To investigate the hypothesis that resuscitation with hypertonic saline (HTS) in hemorrhagic shock (HS) will improve the pulmonary function and inflammatory changes in post-hemorrhage induced acute lung injury. METHODS: HS was induced in anesthetized Swiss-Webster mice by removing 0.025cc blood/g. body weight via the carotid artery while under blood pressure monitoring. Mice were divided into 5 groups: Group I (n=12) were cannulated but not bled (sham); Group II (n=12) were bled and received 4mL/kg 7.5% HTS; Group III (n=10) were bled and received 3 times their shed blood (SB) volume of normal saline (NS); Group IV (n=11) were bled and received SB and 4mL/kg 7.5% HTS; Group V (n=9) were bled and received SB and two times their SB volume of NS after 30 minutes shock. Serum lactates (LA) were evaluated at the end of the shock period and after resuscitation. Pulmonary function was measured by whole-body plethysmography prior to any instrumentation and again 24hr, 48hr and 72hr after resuscitation. Pulmonary inflammation was assessed by quantifying bronchoalveolar lavage neutrophil infiltration (BALN) and myeloperoxidase (MPO) activity after 72hr of observation. RESULTS: There were no differences in baseline BP, shock BP, shock LA and LA after resuscitation in each shock group. The survival rates were as follows: Group I, 75.0%; Group II, 33.3%; Group III, 60%; Group IV, 81.8%; and Group V, 88.8% (p=0.046). There were no significant differences in the changes of airway resistance after resuscitation in each group. BALN and MPO activity in Group III were increased. CONCILUSION: HTS resuscitation alone was associated with higher mortality. HTS was decreased pulmonary inflammation but it did not alter respiratory function.
Acute Lung Injury* ; Airway Resistance ; Animals ; Blood Pressure Monitors ; Body Weight ; Bronchoalveolar Lavage ; Carotid Arteries ; Lactates ; Mice ; Mortality ; Neutrophil Infiltration ; Peroxidase ; Plethysmography ; Pneumonia ; Resuscitation* ; Shock ; Shock, Hemorrhagic* ; Survival Rate

BACKGROUND: Currently there is no noninvasive imaging modality used to risk stratify patients requiring lead extractions. We report the novel use of superior vena cava (SVC) echocardiography to identify lead fibrosis and complex cardiac implantable electronic device (CIED) lead extraction. With an aging population and expanding indications for cardiac device implantation, the ability to deal with the complications associated with chronically implanted device has also increased. METHODS: This was a retrospective analysis of Doppler echocardiography recorded in our outpatient Electrophysiology/Device Clinic office over 6 months. Images from 109 consecutive patients were reviewed. RESULTS: 62% (68/109) did not have a CIED and 38% (41/109) had a CIED. In patients without a CIED, 6% (4/68) displayed turbulent color flow by Doppler in the SVC, while 22% (9/41) of patients with a CIED displayed turbulent flow. Fisher's exact test found a statistically significant difference between the two groups (p value < 0.05). The CIED group was subdivided into 2 groups based on device implant duration (< 2 years vs. > or = 2 years). Of the CIED implanted for > or = 2 years, 27% (9/33) had turbulent flow in the SVC by Doppler, while no patients (0/8) with implant durations < 2 years demonstrated turbulent flow. Nine patients underwent subsequent lead extraction. A turbulent color pattern successfully identified all 3 patients that had significant fibrosis in the SVC found during extraction. CONCLUSION: Our data suggests that assessing turbulent flow using color Doppler in the SVC may be a valuable noninvasive screening tool prior to lead extraction in predicting complex procedures.
Aging ; Echocardiography* ; Echocardiography, Doppler ; Fibrosis* ; Humans ; Mass Screening* ; Outpatients ; Retrospective Studies ; Vena Cava, Superior*

Body mass is a major factor in determining blood pressure levels in children. We compared associations of body mass with blood pressure in 121 white and 91 black children in Bogalusa, Louisiana with that of 370 children in Kangwha, Korea. All children were seven years old at entry into the study and were followed for three years. Korean children were shorter (p< 0.001) thinner (p<0.0001), and had a lower body mass index (p< 0.01) than white or black children. At age seven, systolic blood pressure levels were 2 approximately 5 mm Hg lower, but at age 10, they were 2 approximately 5 mm Hg higher in Korean than white or black children. The increases in blood pressure levels from age seven to ten years were much greater in Korean than black or white children, while changes in height, weight, and body mass index were generally less. Change in blood pressure level was positively associated with change in body mass index for systolic (but not diastolic) levels; however, the association was no stronger for Korean than for U.S. children, except for Korean males vs Bogalusa black males. Cross-cultural studies of other factors, such as diet and physical activity, may explain these differences.
Analysis of Variance ; *Blood Pressure ; *Body Mass Index ; Caucasoid Race ; Child ; Female ; Human ; Korea ; Longitudinal Studies ; Male ; Negroid Race ; Regression Analysis ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. ; United States

Objective: As the prevalence of neuroendovascular interventions increases, it is critical to mitigate unnecessary radiation for patients, providers, and health care staff. Our group previously demonstrated reduced radiation dose and exposure during diagnostic angiography by reducing the default pulse and frame rates. We applied the same technique for basic neuroendovascular interventions. Methods: We performed a retrospective review of prospectively acquired data after implementing a quality improvement protocol in which pulse rate and frame rate were reduced from 15 p/s to 7.5 p/s and 7.5 f/s to 4.0 f/s respectively. We studied consecutive, unilateral middle meningeal artery embolizations treated with particles. Total radiation dose, radiation per angiographic run, total radiation exposure, and exposure per run were calculated. Multivariable log-linear regression was performed to account for patient body mass index (BMI), number of angiographic runs, and number of vessels catheterized. Results: A total of 20 consecutive, unilateral middle meningeal artery embolizations were retrospectively analyzed. The radiation reduction protocol was associated with a 39.2% decrease in the total radiation dose and a 37.1% decrease in radiation dose per run. The protocol was associated with a 41.6% decrease in the total radiation exposure and a 39.5% decrease in exposure per run. Conclusions Radiation reduction protocols can be readily applied to neuroendovascular interventions without increasing overall fluoroscopy time and reduce radiation dose and exposure by 39.2% and 41.6% respectively. We strongly encourage all interventionalists to be cognizant of pulse rate and frame rate when performing routine interventions.

Objective: As the prevalence of neuroendovascular interventions increases, it is critical to mitigate unnecessary radiation for patients, providers, and health care staff. Our group previously demonstrated reduced radiation dose and exposure during diagnostic angiography by reducing the default pulse and frame rates. We applied the same technique for basic neuroendovascular interventions. Methods: We performed a retrospective review of prospectively acquired data after implementing a quality improvement protocol in which pulse rate and frame rate were reduced from 15 p/s to 7.5 p/s and 7.5 f/s to 4.0 f/s respectively. We studied consecutive, unilateral middle meningeal artery embolizations treated with particles. Total radiation dose, radiation per angiographic run, total radiation exposure, and exposure per run were calculated. Multivariable log-linear regression was performed to account for patient body mass index (BMI), number of angiographic runs, and number of vessels catheterized. Results: A total of 20 consecutive, unilateral middle meningeal artery embolizations were retrospectively analyzed. The radiation reduction protocol was associated with a 39.2% decrease in the total radiation dose and a 37.1% decrease in radiation dose per run. The protocol was associated with a 41.6% decrease in the total radiation exposure and a 39.5% decrease in exposure per run. Conclusions Radiation reduction protocols can be readily applied to neuroendovascular interventions without increasing overall fluoroscopy time and reduce radiation dose and exposure by 39.2% and 41.6% respectively. We strongly encourage all interventionalists to be cognizant of pulse rate and frame rate when performing routine interventions.