US lesion visibility predicts clinically significant upgrade of prostate cancer by systematic biopsy

Purpose To identify predictors of when systematic biopsy leads to a higher overall prostate cancer grade compared to targeted biopsy. Methods and materials 918 consecutive patients who underwent prostate MRI followed by MRI/US fusion biopsy and systematic biopsies from January 2015 to November 2019 at a single academic medical center were retrospectively identified. The outcome was upgrade of PCa by systematic biopsy, defined as cases when systematic biopsy led to a Gleason Grade (GG) ≥ 2 and greater than the maximum GG detected by targeted biopsy. Generalized linear regression and conditional logistic regression were used to analyze predictors of upgrade. Results At the gland level, the presence of an US-visible lesion was associated with decreased upgrade (OR 0.64, 95% CI 0.44–0.93, p = 0.02). At the sextant level, upgrade was more likely to occur through the biopsy of sextants with MRI-visible lesions (OR 2.58, 95% CI 1.87–3.63, p < 0.001), US-visible lesions (OR 1.83, 95% CI 1.14–2.93, p = 0.01), and ipsilateral lesions (OR 3.89, 95% CI 2.36–6.42, p < 0.001). Conclusion Systematic biopsy is less valuable in patients with an US-visible lesion, and more likely to detect upgrades in sextants with imaging abnormalities. An approach that takes additional samples from regions with imaging abnormalities may provide analogous information to systematic biopsy.

Preoperative Localization in Colonic Surgery (PLoCoS Study): a multicentric experience on behalf of the Italian Society of Colorectal Surgery (SICCR)

The aim of this prospective multicentric study was to compare the accurate colonic lesion localization ratio between CT and colonoscopy in comparison with surgery. All consecutive patients from 1st January to 31st December 2019 with a histologically confirmed diagnosis of dysplastic adenoma or adenocarcinoma with planned elective, curative colonic resection who underwent both colonoscopy and CT scans were included. Each patient underwent conventional colonoscopy and CT to stage the tumour, and the localization results of each procedure were registered. CT and colonoscopic localization were compared with surgical localization, adopted as the reference. Our analysis included 745 patients from 23 centres. After comparing the accuracy of colonoscopy and CT (for visible lesions) in localizing colonic lesions, no significant differences were found between the two preoperative tools (510/661 vs 499/661 correctly localized lesions, p = 0.518). Furthermore, after analysing only the patients who underwent complete colonoscopy and had a visible lesion on CT, no significant difference was observed between conventional colonoscopy and CT (331/427 vs 340/427, p = 0.505). Considering the intraoperative localization results as a reference, a comparison between colonoscopy and CT showed that colonoscopy significantly failed to correctly locate the lesions localized in the descending colon (17/32 vs 26/32, p = 0.031). We did not identify an advantage in using CT to localize colonic tumours. In this setting, colonoscopy should be considered the reference to properly localize lesions; however, to better identify lesions in the descending colon, CT could be considered a valuable tool to improve the accuracy of lesion localization.

Cellular and Cytokine Responses in Lymph Node Granulomas of Bacillus Calmette Guérin (BCG)-Vaccinated and Non-vaccinated Cross-Breed Calves Naturally Infected With Mycobacterium bovis

Local immunological responses at the site of infections, such as at the lymph nodes and lungs, do play a role in containing infection caused by Mycobacterium bovis (M. bovis). This bovine tuberculosis (bTB) study was conducted to evaluate cellular and cytokine responses in the lymph nodes and lungs of BCG-vaccinated and non-vaccinated calves that were naturally infected with M. bovis. Immunohistochemical assays were used for examination of the responses of macrophages, T cells, cytokines and chemical mediators of 40 (22 vaccinated and 18 non-vaccinated) Holstein-Friesian-zebu crossbred calves that were naturally exposed for 1 year to a known bTB positive cattle herd. The incidence rates of bTB visible lesion were 68.2% (15/22) and 89% (16/18) in vaccinated and non-vaccinated calves, respectively. The local responses of CD4+ and CD8+ T cells, and those of IFN-γ and TNF-α within the lesions, were stronger (P &lt; 0.05) in BCG-vaccinated calves than in non-vaccinated calves. However, there was no statistically significant difference between the two groups (P &gt; 0.05) in the response of CD68+ cells. Thus, the findings of this study indicated stronger responses of a set of immunological cells and markers at the local granulomas of BCG-vaccinated calves than in non-vaccinated calves. Furthermore, BCG vaccination may also play a role in reducing the severity of the gross pathology at the primary site of infection.

Haematological and histopathological examinations of African mud catfish (Clarias gariepinus) exposed to petroleum wastewater

Effects of petroleum refinery wastewater on Clarias gariepinus juvenile were investigated. Commercially obtained C. gariepinus fingerlings were acclimatized in a plastic tank (100 L capacity) of de-chlorinated tap water at 25±2°C for 14 days and fed with commercial feed pellet at 2% body weight of the fingerlings. Bioassay tests were carried out in four transparent plastics tank with nominal concentrations of 100 ml, 200 ml, 300 ml of the wastewater added to 40L of de-chlorinated tap water and only de-chlorinated tap water as control. Each tank contains twenty fish samples, while the assay was replicated three times concurrently. Following standard procedures, behavioural response, growth changes, haematological and histopathological tests were carried out on the samples. Significant reduction in the weight was observed in the fingerlings cultured with the wastewaters, while no significant difference occurred in the control fish. Highest values of Packed Cell Volume (PCV) (22), Haemoglobin (HB) (7.0), Red Blood Cell (RBC) (1.62) and endocochlear potential (EP) (5) were recorded for the control fish than exposed fish. On the other hand, Haptoglobin (HP), Mean Corpuscular Volume (MCV) and Mean Corpuscular Haemoglobin (MCH) were higher in the blood of exposed fish than in control. Histopathologically, exposed fishes showed no visible lesion in gills except from the thickening of the lamellae as the concentration of wastewater increases, indicating an increase in tissue disintegration. Similarly, gross tissue disintegration was observed in those fish exposed to 200ml wastewater as evidenced by the presence of large open spaces (hepatocytes) in the liver.

Endobronchial Metastasis of Renal Carcinoma: A Case Report and Review of Previous Literature

The definition of endobronchial metastasis (EBM) lacks clarity because it is currently based on the judgments of surgeons; it is rare in patients with nonpulmonary malignancies. Although EBM represents an advanced stage of malignancy, it does not necessarily indicate a poorer prognosis than that for its primary tumors. The present study defines EBM as bronchoscopy-visible lesions with histologically confirmed primary extrapulmonary tumors, excluding those primary lung tumors with involvement of the bronchial lumen. A bronchoscopy and biopsy provide strong proof for diagnosis. Complete surgical resection is the best choice for patients with EBM. This study analyzed the case of a 69-year-old male patient who had undergone a radical left nephrectomy several years previously after the identification of a bronchoscopy-visible lesion in the left main bronchus. The lesion was initially diagnosed as an angiogenic tumor but was eventually confirmed by surgical biopsy as EBM from the left kidney. After diagnosis, the patient underwent a left pneumonectomy. The analysis of this case focused on diagnosis, symptoms, radiographic findings, treatment, and prognosis. A review of the previous literature relating to EBM was also conducted.

Multimodale Bronchoskopie in der Rundherddiagnostik: Gewinnbringende Kombinationen ausloten

There are cases of peripheral lung nodules that are difficult to approach despite using ancillary diagnostic devices during multimodal bronchoscopy. The use of ultrathin bronchoscopes has shown superiority over standard thin bronchoscopes. We retrospectively evaluated whether substitution of the thin-bronchoscope by the ultrathin device during multimodal bronchoscopy improves lesion ultrasound visualization and diagnostic yield in patients with difficult-to-approach pulmonary lesions. The study comprised 44 out of 338 patients that underwent multimodal bronchoscopy at Matsusaka Municipal Hospital. The thin-bronchoscope with an external diameter of 4 mm was substituted by the ultrathin-bronchoscope with an external diameter of 3 mm when the radial endobronchial ultrasound showed that the probe position was not within the target lesion. The median diameter of the pulmonary tumors was 17.5 mm (range: 6.0–5.2.0 mm). The endobronchial ultrasound showed the probe’s position adjacent to the lesion in 12 cases and no visible lesion in 32 cases using a thin-bronchoscope. However, the endobronchial ultrasound views changed from adjacent to the lesion to within the lesion in nine cases, from no visible lesion to within the lesion in 17 cases, and from no visible lesion to adjacent to the lesion in nine cases after bronchoscope substitution. After substitution, the diagnostic yield was 80.8% in cases with the radial probe within the target lesion, 72.7% in cases with the probe adjacent to the target lesion, and 0% in cases with no visible lesion. The overall diagnostic yield was 65.9% after bronchoscope substitution. The substitution of the thin bronchoscope by the ultrathin device on a need basis improves the position of the radial endobronchial ultrasound probe and diagnostic yield of pulmonary lesions during multimodal diagnostic bronchoscopy.

Hypermetabolism and impaired cerebrovascular reactivity beyond the standard MRI-identified tumor border indicate diffuse glioma extended tissue infiltration

Background Diffuse gliomas exhibit diffuse infiltrative growth, often beyond the MRI-detectable tumor lesion. Within this lesion, hypermetabolism and impaired cerebrovascular reactivity are found, but its exact distribution pattern into the peritumoral environment is unknown. Our aim was to better characterize the extent of diffuse glioma tissue infiltration, beyond the visible lesion (i.e. beyond the T1-contrast-enhancing lesion and/or T2/FLAIR defined tumor border), with metabolic PET, and fMRI cerebrovascular reactivity (BOLD-CVR) mapping. Methods From a prospective glioma database 18 subjects (19 datasets) with diffuse glioma (n=2 with anaplastic astrocytoma, n=10 with anaplastic oligodendroglioma, n=7 with glioblastoma) underwent a BOLD-CVR and metabolic PET study between February 2016 and September 2019, 7 of them at primary diagnosis and 12 at tumor recurrence. In addition, 19 matched healthy controls underwent an identical BOLD-CVR study. The tumor lesion was defined using high-resolution anatomical MRI. Volumes of interest (VOIs) starting from the tumor lesion outwards up to 30 mm were created for a detailed peritumoral PET and BOLD-CVR tissue analysis. Student’s t test were used for statistical analysis. Results Patients with diffuse glioma exhibit impaired BOLD-CVR 12 mm beyond the tumor lesion (p=0.02) with normalization of BOLD-CVR values after 24 mm. Metabolic PET shows a difference between the affected and contralateral hemisphere of 6 mm (p=0.05) with PET values normalization after 12 mm. Conclusion We demonstrate hypermetabolism and impaired cerebrovascular reactivity beyond the standard MRI-defined tumor border, suggesting active tumor infiltration in the peritumoral environment.

Comparative Anatomical Responses of Tolerant and Susceptible European Plum Varieties to Black Knot Disease

Plums are affected by a cancerous disease called “Black Knot disease” caused by the fungus Apiosporina morbosa. It affects both Japanese (Prunus salicina) and European plums (Prunus domestica) equally. In order to understand the spread of the disease, histological analysis was performed in two different European plum cultivars (susceptible and tolerant). Light and Scanning Electron Microscope (SEM) analyses confirmed the presence of the growing hyphae in the internal tissues of the susceptible trees. By using stereoscopic analysis with a fluorescence filter, we were able to detect the hyphae in the visible lesion area. At about 2 inches from above and below the knots, no spore or hypha was visible with the light microscope. However, SEM images showed strong evidence that the fungus is capable of migrating to adjacent vessels in the susceptible plum genotype. In fact, at that distance below and above the knots, conidia were detected inside xylem vessels suggesting a systemic movement of the fungus that has not been shown so far. No symptoms were observed in the resistant genotype. Starch granules, vessel occlusions and lipid droplets were the main distinguishable characteristics between susceptible and tolerant varieties.

Fansidar drug induces cytotoxicity in some vital tissues in a rat model: combination defensive effect of selenium and zinc capsules

Aim: Fansidar (FAN) is widely used as an antimalarial drug, but it may cause hepatoxicity, nephrotoxicity, and neurotoxicity. Hence, the study examines the cytoprotection of selenium (Se) and zinc (Zn) tablets against FAN induced toxicity. Method: Group I was given distilled water. Groups II, III, IV, and V received 50 mg/kg FAN by gavage. Group III was co-treated with a 50 mg/kg Se tablet. Group IV was co-treated with a 50 mg/kg Zn tablet. Group V was co-treated with a 50 mg/kg Se tablet + 50 mg/kg Zn tablet. The exposure lasted for 7 days (sub-acute exposure). Result: FAN causes cytotoxicity through significant ( p < 0.05) alteration of antioxidant molecules and hepatic enzymes. It also significantly ( p < 0.05) induces renal, hepatocyte, and purkinje cell damage, but no visible lesion on testicular cells. The FAN induced cytotoxicity was significantly ( p < 0.05) reversed on treatment with both single and combined antioxidant tablets. Conclusion: Our study supports the view that antioxidant micronutrient (Se and Zn) tablets may be a useful modulator in alleviating FAN induced oxidative stress and cytotoxicity in male rats. Plain language summary Combined selenium and zinc capsules: better therapy against cytotoxicity Fansidar was approved by United States’ Food and Drug Administration as an anti-malarial drug to treat acute and complicated malaria fever among patients in West Africa; however, its usage elicits toxicity to several organs of the body. It was elucidated that the combination of selenium and zinc capsules promotes organ wellness on co-treatment with Fansidar.

Endoscopic resection is more effective than biopsy or EUS to detect residual rectal neuroendocrine tumor

Background and study aims Rectal neuroendocrine tumors (NETs) are often discovered incidentally and may be misidentified as adenomatous polyps. This can result in a partial resection at the index procedure, and lesions are often referred for staging or evaluation for residual disease at the resection site. The aim of this study was to identify the ideal method to confirm complete excision of small rectal NETs. Patients and methods Data from patients with a previously resected rectal NET referred for follow-up endoscopy or endoscopic ultrasound (EUS) were retrospectively reviewed. Univariate analysis was performed on categorical data using the Chi-squared test. Results Forty-nine patients with rectal NETs were identified by pathology specimens. Of those, 39 underwent follow-up endoscopy or EUS and were included. Baseline characteristics included gender (71 % F, 29 % M), age (57.2 ± 13.4 yrs) lesion size (7.3 ± 4.2 mm) and location. The prior resection site was identified in 37/39 patients who underwent tissue sampling. Residual NET was found histologically in 14/37 lesions. All residual disease was found during salvage endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) and 43 % had a normal-appearing scar. Every patient undergoing EUS had an unremarkable exam. Initial cold biopsy polypectomy (P = 0.006), visible lesions (P = 0.001) and EMR/ESD of the prior resection site (P = 0.01) correlated with residual NET. Conclusions Localized rectal NETs may be incompletely removed with standard polypectomy. If an advanced resection is not performed initially, repeat endoscopy with salvage EMR or ESD of the scar should be considered. For small rectal NETs, biopsy may miss residual disease when there is no visible lesion and EUS appears to have no benefit.