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Objectives: To compare the ability of 68Ga -PSMA PET/CT (PSMA PET/CT) and multiparametric MRI (mpMRI) to exclude lymph node invasion (LNI) in patients who undergo radical prostatectomy (RP). Materials and methods: A multicenter cohort of patients who underwent PSMA PET/CT and pelvic mpMRI prior to RP with pelvic lymph node dissection (PLND) was analyzed. Increased Ga68-PSMA uptake on PET/CT and enlarged (> 10 mm) or abnormal lymph nodes on mpMRI were considered positive findings. The final surgical pathology served as the standard of reference. The negative predictive value (NPV) was calculated for each modality separately, as well as the combined value. Results: Included were 89 patients with D'Amico intermediate (45%) or high-risk (55%) prostate cancer. The median number of extracted LN was 9 (IQR 6-14). LNI was found in 12 (13.5%) patients. The NPV of mpMRI, PSMA PET/CT, and the two tests combined were 87%, 89%, and 90%, in the entire cohort, 95%, 97%, and 97% in patients with intermediate-risk disease, and 80%, 82%, and 83% in patients with high-risk disease, respectively. The median diameter of LN missed by both imaging and the median intranodal tumor diameter was 5.5 (IQR 3–10) mm and 1 (IQR 1–3) mm, respectively. Conclusions: PSMA PET/CT and mpMRI demonstrated similar performance in excluding pelvic LNI with NPV of approximately 90%. The combination of both tests does not improve NPV significantly. Therefore, even in the era of advanced imaging, PLND is still recommended for accurate staging, especially in the high-risk population. [ABSTRACT FROM AUTHOR]

Objective: To determine whether application of a gum-elastic bougie (GEB), a visual stylet used to improve success rates of difficult intubations, reduces the time, and number of attempts to achieve successful intubation while wearing personal protective equipment (PPE)., Design: A randomized cross-over study comparing orotracheal intubations performed on an AirMan® Mannequin, using either a semirigid stylet or a GEB, while wearing an active hood with a charcoal impregnated suit and butyl rubber gloves., Setting: Simulation training field of the Israel Defense Force Medical Corps., Participants: 27 military physicians and 23 paramedics (PMs)., Interventions: Comparing intubation with and without using the GEB while wearing PPE., Main Outcome Measure(s): Airway (AW) control was considered successful if the "lungs" of the mannequin ex-panded during bag ventilation. Three unsuccessful attempts or a procedure exceeding 60 seconds were regarded as a failure. Correlations between parameters of self-assessment of skills and successful intubation were also determined., Results: With the GEB, success rate was lower (82 percent versus 100 percent, p = 0.002), more attempts were needed (1.4 ± 0.7 versus 1.0 ± 0.2, p = 0.005) and time-to-achieve AW control was longer (43.6 ± 14.6 sec-onds versus 23.1 ± 10.5 seconds, P < 0.001) than without it. Participants with high self-assessment of GEB-assisted AW management skills needed less attempts to perform successful intubation with GEB than participants with low self-assessment (1.0 ± 0.0 versus 1.4 ± 0.8, p = 0.001), but not less time to achieve it., Conclusions: While donning PPE, the use of GEB (versus semirigid stylets) did not reduce the time or the number of attempts necessary to achieve successful intubation.

Introduction: Breast cancer (BC) is the most common cancer in women in Western countries, showing a bimodal age distribution with peaks at 50 and 70 years. Multiple factors are encountered in the etiology of BC, including hereditary and hormonal causes. A few viruses, including MMTV, EBV and HPV have been reported to be associated with BC. This group previously described the presence of the measles virus (MV) in biopsies of patients with Hodgkin's lymphoma. The present study explored MV antigens in BC patients., Patients and Methods: A total of 131 patients with invasive BC diagnosed during the years 1998-2005 were studied using immunohistochemistry (IHC) for the presence of MV antigens, hemagglutinin and nucleoprotein. Clinicopathological parameters included age, stage, histological grade and the expression of estrogen and progesterone receptors, HER2/neu, p53, and Ki67., Results: Hormone receptors and HER2/neu were positive in 54% and 18% of the tumors, respectively. Both MV antigens were detected in 64% of the tumors. All biopsies containing a DCIS component showed MV in DCIS in addition to invasive BC. In univariate analysis, MV correlated with estrogen receptor (p=0.018), low Ki67 index (<40%, p=0.029), low or intermediate grade (p=0.037), age under 50 years (p=0.039), progesterone receptor (p=0.043) and overexpression of p53 (p=0.049). In multivariate analysis, only grade (p=0.011), p53 (p=0.03) and age (p=0.041) remained associated with MV., Conclusion: This study provides evidence for the presence of MV antigens in a relatively large proportion of BC patients. MV was associated with younger age, lower histological grade and overexpression of p53, suggesting that it may play a role in the development of BC.