Over 60 years ago, stone tools and remains of megafauna were discovered on the Southeast Asian islands of Flores, Sulawesi and Luzon, and a Middle Pleistocene colonization by Homo erectus was ...initially proposed to have occurred on these islands
. However, until the discovery of Homo floresiensis in 2003, claims of the presence of archaic hominins on Wallacean islands were hypothetical owing to the absence of in situ fossils and/or stone artefacts that were excavated from well-documented stratigraphic contexts, or because secure numerical dating methods of these sites were lacking. As a consequence, these claims were generally treated with scepticism
. Here we describe the results of recent excavations at Kalinga in the Cagayan Valley of northern Luzon in the Philippines that have yielded 57 stone tools associated with an almost-complete disarticulated skeleton of Rhinoceros philippinensis, which shows clear signs of butchery, together with other fossil fauna remains attributed to stegodon, Philippine brown deer, freshwater turtle and monitor lizard. All finds originate from a clay-rich bone bed that was dated to between 777 and 631 thousand years ago using electron-spin resonance methods that were applied to tooth enamel and fluvial quartz. This evidence pushes back the proven period of colonization
of the Philippines by hundreds of thousands of years, and furthermore suggests that early overseas dispersal in Island South East Asia by premodern hominins took place several times during the Early and Middle Pleistocene stages
. The Philippines therefore may have had a central role in southward movements into Wallacea, not only of Pleistocene megafauna
, but also of archaic hominins.
Abstract
The recently described site of Kalinga in the Philippines adds to our understanding of Early-Middle Pleistocene hominin behaviour. Yet, disentangling the natural from the anthropogenic ...modifications that have taken place in such an old archaeological site is challenging. In this paper we use a set of taphonomic tools at hand to rectify the distortion made by natural processes during the formation of the Kalinga site. From the description of the ribs completeness, surface damages and scattering in the excavation, one can reconstruct the butchery, transport and deposition sequence of the rhino carcass and its post-depositional disturbances and diagenetic evolution of the site. We conclude that the rhino and the stone artefacts potentially used to deflesh the carcass were transported by a mudflow from its butchery place over a few meters only and got stuck and mixed with an older faunal assemblage that was transported by a small stream.
•Readout-segmented multi-shot echo-planar imaging (rs-EPI) and parallel transmit (ptx)-EPI showed a significantly higher contrast intensity between prostate cancer (PCa) and benign PZ or TZ compared ...single-shot (ss)-EPI.•Subjective IQ was significantly higher for rs-EPI.•Single PCa lesions could only be recognized and correlated on rs-EPI.
This study evaluates objective and subjective image quality (IQ) of three different diffusion weighted imaging (DWI) sequences in prostate MRI at 3.0 Tesla within the same patients.
Thirty-six consecutive patients (70 ± 8 years) with multi-parametric prostate MRI (mp-MRI; 3 T) and subsequently verified prostate cancer (PCa) by targeted plus systematic MR/US-fusion biopsy from 03/2016 to 12/2017 were included. Readout-segmented (rs) multi shot echo-planar imaging (EPI), parallel transmit (ptx) EPI, and single-shot (ss) EPI with b-values of 0, (500,) 1,000 s/mm² and calculated b1,500 were prospectively acquired of every patient. Signal intensities (SI) of PCa and benign tissue (peripheral and transition zone; PZ and TZ) in ADC, b1,000, and calculated b1,500 images were analyzed. Endpoints were signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and subjective IQ on a 5-point scale by two blinded readers.
For ss-EPI ADC, b-values of 1,000, and calculated 1,500 s/mm² images showed a higher SNR compared to rs-EPI and ptx-EPI (p < 0.01). CNR of PCa and benign tissue was significantly higher for rs-EPI in high b value images compared to ptx-EPI and ss-EPI (p < 0.01). Subjective IQ was significantly higher for rs-EPI (p < 0.01). Significantly higher ADC reduction combined with signal increase on high b value images for PCa compared to the surrounding healthy tissue in PZ and TZ (PCa contrast intensity) was detected for rs-EPI (p < 0.01). Single PCa lesions could only be recognized and correlated on rs-EPI.
Rs-EPI and ptx-EPI were superior to ss-EPI regarding contrast intensity of PCA, but inferior regarding SNR. Subjective imaging parameters were superior for rs-EPI. Especially rs-EPI, but also ptx-EPI might improve and faciliate prostate cancer detection, rs-EPI at the expense of a longer acquisition time.
To evaluate if follow-up mpMRI scans of patients in PI-RADS category 3 are safe enough to omit or delay prostate biopsy in the future and to determine an optimal control interval. This retrospective ...single center study includes consecutive PI-RADS category 3 patients with one or more follow-up mpMRI (T2WI, DWI, DCE) and subsequent MRI-targeted and systematic TRUS-guided biopsy between 2012 and 2018. Primary study objective was the verification of a significant PI-RADS category upgrade in follow-up mpMRI in patients with subsequent PCA positive biopsy versus patients with negative biopsy. Further objectives were development of the PI-RADS category and clinical parameters between initial and follow-up mpMRI in the context of histopathologic results and time interval. Eighty-nine patients (median PSA 6.6 ng/ml; PSAD 0.13 ng/ml/ml) were finally included (follow-up period 31 ± 18 months). 19 cases had PCA (median PSA 7.8 ng/ml; PSAD 0.14 ng/ml/ml). 4 cases had csPCA (median PSA 5.4 ng/ml; PSAD 0.13 ng/ml/ml) for which there was a significant PI-RADS upgrade after 12-24 months (mean 3.75; p = 0.01) compared to patients without PCA (mean 2.74). Without PCA the mean PI-RADS category decreased after 25-36 months (mean 2.74; p = 0.02). Clinical parameters did not change significantly except a PSAD increase for PCA patients after 24 months. Patients within PI-RADS category 3 may not need prompt biopsy since those with PCA reliably demonstrate a PI-RADS category upgrade in follow-up mpMRI after 12-24 months. PI-RADS 3 patients with negative biopsy do not benefit from follow-up mpMRI earlier than 24 months.
Residual tumor resection (RTR) Lusch, A.; Albers, P.
World journal of urology,
08/2017, Letnik:
35, Številka:
8
Journal Article
Recenzirano
Residual tumor resection in patients with advanced testicular tumor plays a vital role in the multimodal treatment. Treatment indications for residual tumor resection have changed over the last two ...decades. While patients with advanced seminoma after chemotherapy or radiotherapy rarely need surgery, it is mandatory for most non-seminomatous tumor patients to undergo post-chemotherapy tumor resection. Due to adjunctive surgical procedures, the operation is surgically demanding and should be performed only in specialized high-volume referral centers. Additional surgical procedures such as nephrectomy, partial colectomy or vascular interventions including caval and aortic resection with grafting might be required. Consequently, several complications can be seen in the peri- and postoperative course. We aim to describe indications for residual tumor resection, operative technique, including adjunctive surgeries and the most common peri- and postoperative complications.
Objectives
T o evaluate the value of multiparametric MRI (mpMRI) for the prediction of prostate cancer (PCA) aggressiveness.
Methods
In this single center cohort study, consecutive patients with ...histologically confirmed PCA were retrospectively enrolled. Four different ISUP grade groups (1, 2, 3, 4–5) were defined and fifty patients per group were included. Several clinical (age, PSA, PSAD, percentage of PCA infiltration) and mpMRI parameters (ADC value, signal increase on high b-value images, diameter, extraprostatic extension EPE, cross-zonal growth) were evaluated and correlated within the four groups. Based on combined descriptors, MRI grading groups (mG1–mG3) were defined to predict PCA aggressiveness.
Results
In total, 200 patients (mean age 68 years, median PSA value 8.1 ng/ml) were analyzed. Between the four groups, statistically significant differences could be shown for age, PSA, PSAD, and for MRI parameters cross-zonal growth, high b-value signal increase, EPE, and ADC (
p
< 0.01). All examined parameters revealed a significant correlation with the histopathologic biopsy ISUP grade groups (
p
< 0.01), except PCA diameter (
p
= 0.09). A mixed linear model demonstrated the strongest prediction of the respective ISUP grade group for the MRI grading system (
p
< 0.01) compared to single parameters.
Conclusions
MpMRI yields relevant pre-biopsy information about PCA aggressiveness. A combination of quantitative and qualitative parameters (MRI grading groups) provided the best prediction of the biopsy ISUP grade group and may improve clinical pathway and treatment planning, adding useful information beyond PI-RADS assessment category. Due to the high prevalence of higher grade PCA in patients within mG3, an early re-biopsy seems indicated in cases of negative or post-biopsy low-grade PCA.
Key Points
•
MpMRI yields relevant pre-biopsy information about prostate cancer aggressiveness.
•
MRI grading in addition to PI-RADS classification seems to be helpful for a size independent early prediction of clinically significant PCA.
•
MRI grading groups may help urologists in clinical pathway and treatment planning, especially when to consider an early re-biopsy.
Incontinence is an important health problem. Effectively treating incontinence could lead to important health gains in patients and caregivers. Management of incontinence is currently suboptimal, ...especially in elderly patients. To optimise the provision of incontinence care a global optimum continence service specification (OCSS) was developed. The current study evaluates the costs and effects of implementing this OCSS for community-dwelling patients older than 65 years with four or more chronic diseases in the Netherlands.
A decision analytic model was developed comparing the current care pathway for urinary incontinence in the Netherlands with the pathway as described in the OCSS. The new care strategy was operationalised as the appointment of a continence nurse specialist (NS) located with the general practitioner (GP). This was assumed to increase case detection and to include initial assessment and treatment by the NS. The analysis used a societal perspective, including medical costs, containment products (out-of-pocket and paid by insurer), home care, informal care, and implementation costs.
With the new care strategy a QALY gain of 0.005 per patient is achieved while saving €402 per patient over a 3 year period from a societal perspective. In interpreting these findings it is important to realise that many patients are undetected, even in the new care situation (36%), or receive care for containment only. In both of these groups no health gains were achieved.
Implementing the OCSS in the Netherlands by locating a NS in the GP practice is likely to reduce incontinence, improve quality of life, and reduce costs. Furthermore, the study also highlighted that various areas of the continence care process lack data, which would be valuable to collect through the introduction of the NS in a study setting.
Background. Hookah pipe (HP) smoking has become popular globally, especially among young adults and adolescents. There are misperceptions regarding the safety of HP smoking, relative to ...cigarettes.Objectives. To assess the prevalence of HP use in grade 8 and 12 students and the factors associated with use in the different age groups.Methods. A cross-sectional study was conducted in grade 8 and 12 high-school students from six randomly selected public schools in Johannesburg, South Africa. A self-administered structured questionnaire was completed by students after consent had been obtained from parents and students. The questionnaire focused on knowledge and awareness of HP smoking. Data were analysed using Stata/SE version 15. A p-value Results. A total of 347 grade 8 and 232 grade 12 students participated in the study. Of the sample, 26% in grade 8 and 70% in grade 12 had ever smoked an HP. In both grades a higher proportion of males smoked. Eleven percent of students in grade 8 and 37% in grade 12 were currently smoking the HP. Approximately 47% and 51% of grade 8 and grade 12 students, respectively, first started smoking at parties. The mean age of initiation was 8 and 12 years in grade 8 and 12, respectively. Grade 12 students had greater awareness of the risks of HP smoking. Having a family member who smoked an HP was significantly related to HP use in grade 8 students. Overall, factors associated with increased odds of smoking the HP were being in grade 12, not being aware of health effects, and seeing the health warnings on hookah tobacco package labels.Conclusions. HP smoking increased significantly between grades 8 and 12. Increasing knowledge and awareness of the risks involved in HP smoking in children at an early age is recommended. One of the factors influencing uptake of HP smoking in young students was having a family member smoking it; adult anti-smoking and anti-HP campaigns are therefore also important.
Highlights • Objective IQ for T2WI was at 1.5T under optimized parameters comparable to 3T. • SNR and CNR of DWI were significantly higher at 3T. • Subjective IQ on was significantly better at 3T. • ...PI-RADS v2 scores were similar at 3T and 1.5T.
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