Search

Introduction Prostate cancer is common and may be treated immediately or managed conservatively by observation. We sought to determine how reliable multiparametric MRI is in the detection of intraprostatic prostate cancer and what role it has in risk stratification. Methods The histology from 38 whole mount prostate specimens was compared with preoperative multiparametric 3T MRI studies with an endorectal receiver coil in place. T1-weighted, T2-weighted, diffusion (b values 50 400 800), perfusion (Ve, Kep, Ktrans, area under the curve) and proton spectroscopic sequences were used. Results For cancers greater than 0.5 cc, the detection rate for combined T2-weighted imaging and diffusion-weighted imaging (DWI) was 85%. For cancers 0.1 cc-0.5 cc, the sensitivity was 52%.Per patient, false positive rate was 50% for combined T2-weighted imaging and DWI. Perfusion imaging had a sensitivity of 70% for tumours greater than 0.5 cc but had a per patient false positive rate of 80% influenced by benign prostatic hypertrophy. In only 15 patients could a satisfactory spectroscopy study be obtained. Weak correlation was found between the Gleason score and tumour size (r = 0.51), apparent diffusion coefficient (ADC) (r = -0.30) and (choline + creatine)/citrate ratio (r = 0.41). Conclusion T2-weighted imaging and DWI in combination were the best strategy for detecting prostate cancer and had a sensitivity of 85% for detecting lesions greater than 0.5 cc. At 3T, an ADC threshold of between 1100-1200.10-6 mm 2/s was optimal for diagnosing prostate cancer. There are significant limitations in the use of perfusion and spectroscopy to detect prostate cancer. Magnetic resonance imaging-targeted or guided biopsy post-MRI imaging is likely to be needed in some patients to assist risk stratification. © 2014 The Royal Australian and New Zealand College of Radiologists.

Background To be eligible to donate blood, potential donors must meet certain eligibility criteria to ensure safety to the donor and to the blood supply. In Australia, there is no reliable estimate of the size of the donor-eligible population. This study uses a refinement to a published method to determine the population prevalence of donor-exclusion factors and subsequently estimates the size of the potential donor pool in Australia.

Objectives: To determine the best photographic surrogate markers for detecting sight-threatening macular oedema (MO) in people with diabetes attending UK national screening programmes. Design: A multicentre, prospective, observational cohort study of 3170 patients with photographic signs of diabetic retinopathy visible within the macular region [exudates within two disc diameters, microaneurysms/dot haemorrhages (M/DHs) and blot haemorrhages (BHs)] who were recruited from seven study centres. Setting: All patients were recruited and imaged at one of seven study centres in Aberdeen, Birmingham, Dundee, Dunfermline, Edinburgh, Liverpool and Oxford. Participants: Subjects with features of diabetic retinopathy visible within the macular region attending one of seven diabetic retinal screening programmes. Interventions: Alternative referral criteria for suspected MO based on photographic surrogate markers; an optical coherence tomographic examination in addition to the standard digital retinal photograph. Main outcome measures: (1) To determine the best method to detect sight-threatening MO in people with diabetes using photographic surrogate markers. (2) Sensitivity and specificity estimates to assess the costs and consequences of using alternative strategies. (3) Modelled long-term costs and quality-adjusted life-years (QALYs). Results: Prevalence of MO was strongly related to the presence of lesions and was roughly five times higher in subjects with exudates or BHs or more than two M/DHs within one disc diameter. Having worse visual acuity was associated with about a fivefold higher prevalence of MO. Current manual screening grading schemes that ignore visual acuity or the presence of M/DHs could be improved by taking these into account. Health service costs increase substantially with more sensitive/less specific strategies. A fully automated strategy, using the automated detection of patterns of photographic surrogate markers, is superior to all current manual gradi

Objectives To determine the best photographic surrogate markers for detecting sight-threatening macular oedema (MO) in people with diabetes attending UK national screening programmes. Design A multicentre, prospective, observational cohort study of 3170 patients with photographic signs of diabetic retinopathy visible within the macular region [exudates within two disc diameters, microaneurysms/dot haemorrhages (M/DHs) and blot haemorrhages (BHs)] who were recruited from seven study centres. Setting All patients were recruited and imaged at one of seven study centres in Aberdeen, Birmingham, Dundee, Dunfermline, Edinburgh, Liverpool and Oxford. Participants Subjects with features of diabetic retinopathy visible within the macular region attending one of seven diabetic retinal screening programmes. Interventions Alternative referral criteria for suspected MO based on photographic surrogate markers; an optical coherence tomographic examination in addition to the standard digital retinal photograph. Main outcome measures (1) To determine the best method to detect sight-threatening MO in people with diabetes using photographic surrogate markers. (2) Sensitivity and specificity estimates to assess the costs and consequences of using alternative strategies. (3) Modelled long-term costs and quality-adjusted life-years (QALYs). Results Prevalence of MO was strongly related to the presence of lesions and was roughly five times higher in subjects with exudates or BHs or more than two M/DHs within one disc diameter. Having worse visual acuity was associated with about a fivefold higher prevalence of MO. Current manual screening grading schemes that ignore visual acuity or the presence of M/DHs could be improved by taking these into account. Health service costs increase substantially with more sensitive/less specific strategies. A fully automated strategy, using the automated detection of patterns of photographic surrogate markers, is superior to all current manual grading sche

BACKGROUND: It is more common for women in both high- and low-income countries giving birth in health facilities, to labour in bed. There is no evidence that this is associated with any advantage for women or babies, although it may be more convenient for staff. Observational studies have suggested that if women lie on their backs during labour this may have adverse effects on uterine contractions and impede progress in labour, and in some women reduce placental blood flow.OBJECTIVES: To assess the effects of encouraging women to assume different upright positions (including walking, sitting, standing and kneeling) versus recumbent positions (supine, semi-recumbent and lateral) for women in the first stage of labour on duration of labour, type of birth and other important outcomes for mothers and babies.SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2013).SELECTION CRITERIA: Randomised and quasi-randomised trials comparing women randomised to upright versus recumbent positions in the first stage of labour.DATA COLLECTION AND ANALYSIS: We used methods described in the Cochrane Handbook for Systematic Reviews of Interventions for carrying out data collection, assessing study quality and analysing results. Two review authors independently evaluated methodological quality and extracted data for each study. We sought additional information from trial authors as required. We used random-effects analysis for comparisons in which high heterogeneity was present. We reported results using the average risk ratio (RR) for categorical data and mean difference (MD) for continuous data.MAIN RESULTS: Results should be interpreted with caution as the methodological quality of the 25 included trials (5218 women) was variable.For Comparison 1: Upright and ambulant positions versus recumbent positions and bed care, the first stage of labour was approximately one hour and 22 minutes shorter for women randomised to upright as opposed

Background: It is more common for women in the developed world, and those in low-income countries giving birth in health facilities, to labour in bed. There is no evidence that this is associated with any advantage for women or babies, although it may be more convenient for staff. Observational studies have suggested that if women lie on their backs during labour this may have adverse effects on uterine contractions and impede progress in labour. Objectives: The purpose of the review is to assess the effects of encouraging women to assume different upright positions (including walking, sitting, standing and kneeling) versus recumbent positions (supine, semi-recumbent and lateral) for women in the first stage of labour on length of labour, type of delivery and other important outcomes for mothers and babies.Search methods: We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (November 2008).Selection criteria: Randomised and quasi-randomised trials comparing women randomised to upright versus recumbent positions in the first stage of labour. Data collection and analysis: We used methods described in the Cochrane Handbook for Systematic Reviews of Interventions for carrying out data collection, assessing study quality and analysing results. A minimum of two review authors independently assessed each study.Main results: The review includes 21 studies with a total of 3706 women. Overall, the first stage of labour was approximately one hour shorter for women randomised to upright as opposed to recumbent positions (MD -0.99, 95% CI -1.60 to -0.39). Women randomised to upright positions were less likely to have epidural analgesia (RR 0.83 95% CI 0.72 to 0.96).There were no differences between groups for other outcomes including length of the second stage of labour, mode of delivery, or other outcomes related to the wellbeing of mothers and babies. For women who had epidural analgesia there were no differences between those randomised to upright versus

Purpose: To examine the accuracy of multiparametric 3T MRI in detecting the presence and distribution of prostate cancer within the gland. Methods and materials: 25 patients with biopsy-proven prostate cancer, average age 61, who had MRI as part of pre-prostatectomy work-up. A Siemens 3T Trio system performed triplanar T2, transverse T1, and diffusion-weighted sequences (b values 50, 40, 800), as well as a perfusionstudy of the whole prostate (5.4-s increments, for approximately 9 min; post-processed for maps of AUC, Ktrans, Ve, Kep) and 3D proton spectroscopy. 2 other patients declined the endorectal coil. The excised prostate gland was fixed and sectioned, the apical and basal portions transected and sectioned para-sagitally, the remainder sectioned axially. Prostate cancer was scored according to the Gleason scale, and the presence of prostate cancer marked on the whole mount slides to allow correlation with MR images. Result(s): Within the 25 prostatic specimens, 29 cancers measured 0.5 cc or more, there were 21 cancers between 0.5 cc and 0.1 cc, and 0.28 cancers were less than 0.1 cc, considered below the detection threshold. Most tumours were Gleason score (3 + 4) or (4 + 3). Tumour detection Lesion >0.5 cc 0.5 cc > Lesion > 0.1 cc False positive DWI (ADC < 1100) 26/29 sites 6/21 15 sites in 9 patients T2 23/29 4/21 7 sites in 7 patients In the perfusion study, the AUC (area under curve) best discriminated tumour (mean 7.3 +/- 5.0, arbitrary units) from a contralateral control site (4.7 +/- 3.7), but group overlap existed, influenced by BPH. Spectroscopy was compromised by lack of sensitivity in deeper portions of the prostate, and artefacts; it did not prove reliable in the detection of prostate cancer in this group. Conclusion(s): The combination of T2 and DWI imaging (ADC <1100) was the most reliable in the detection of prostate tumours greater than 0.5 cc. Tumour delineation was best performed with the ADC map, but was occasionally incomplete. Further hist

Background: It is more common for women in both high- and low-income countries giving birth in health facilities, to labour in bed. There is no evidence that this is associated with any advantage for women or babies, although it may be more convenient for staff. Observational studies have suggested that if women lie on their backs during labour this may have adverse effects on uterine contractions and impede progress in labour, and in some women reduce placental blood flow. Objectives: To assess the effects of encouraging women to assume different upright positions (including walking, sitting, standing and kneeling) versus recumbent positions (supine, semi-recumbent and lateral) for women in the first stage of labour on duration of labour, type of birth and other important outcomes for mothers and babies. Search methods: We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (31 January 2013). Selection criteria Randomised and quasi-randomised trials comparing women randomised to upright versus recumbent positions in the first stage of labour. Data collection and analysis: We used methods described in the Cochrane Handbook for Systematic Reviews of Interventions for carrying out data collection, assessing study quality and analysing results. Two review authors independently evaluated methodological quality and extracted data for each study. We sought additional information from trial authors as required. We used random-effects analysis for comparisons in which high heterogeneity was present. We reported results using the average risk ratio (RR) for categorical data and mean difference (MD) for continuous data. Main results: Results should be interpreted with caution as the methodological quality of the 25 included trials (5218 women) was variable. For Comparison 1: Upright and recumbent positions versus recumbent positions and bed care, the first stage of labour was approximately one hour and 22 minutes shorter for women randomised to upright as o