bluuebunny/crossref_metadata_2025 huggingface dataset:
Axonal damage in spinal cord is associated with gray matter atrophy in sensorimotor cortex in experimental autoimmune encephalomyelitis
Authors: Meyer Cassandra E , Gao Josephine L , Cheng James Ying-Jie , Oberoi Mandavi R , Johnsonbaugh Hadley , Lepore Stefano , Kurth Florian , Thurston Mackenzie J , Itoh Noriko , Patel Kevin R , Voskuhl Rhonda R , MacKenzie-Graham Allan
Published: March 2019

Background:

Gray matter (GM) atrophy in brain is one of the best predictors of long-term disability in multiple sclerosis (MS), and recent findings have revealed that localized GM atrophy is associated with clinical disabilities. GM atrophy associated with each disability mapped to a distinct brain region, revealing a disability-specific atlas (DSA) of GM loss.

Objective:

To uncover the mechanisms underlying the development of localized GM atrophy.

Methods:

We used voxel-based morphometry (VBM) to evaluate localized GM atrophy and Clear Lipid-exchanged Acrylamide-hybridized Rigid Imaging-compatible Tissue-hYdrogel (CLARITY) to evaluate specific pathologies in mice with experimental autoimmune encephalomyelitis (EAE).

Results:

We observed extensive GM atrophy throughout the cerebral cortex, with additional foci in the thalamus and caudoputamen, in mice with EAE compared to normal controls. Next, we generated pathology-specific atlases (PSAs), voxelwise mappings of the correlation between specific pathologies and localized GM atrophy. Interestingly, axonal damage (end-bulbs and ovoids) in the spinal cord strongly correlated with GM atrophy in the sensorimotor cortex of the brain.

Conclusion:

The combination of VBM with CLARITY in EAE can localize GM atrophy in brain that is associated with a specific pathology in spinal cord, revealing a PSA of GM loss.
Enablers and barriers for hospital pharmacy information systems
Authors: Carroll Noel , Richardson Ita
Published: March 2019

Pharmacy plays a pivotal role in supporting acute clinical care pathways. However, across hospital environments, pharmacies are often stretched by growing service demands and conflicted by increased medication and service costs. Ultimately, such factors contribute towards process inefficiencies that impact on the provision of healthcare services. Following a literature review, we examined clinical pharmacy services by undertaking three acute hospital pharmacy case studies. We adopted an ethnographic approach, observing and interviewing pharmacists, pharmacy staff and nurses. With a view to improving healthcare information systems (ISs), we identified the enablers and barriers in service efficiency, thus identifying opportunities for pharmacy IS implementation across acute hospital environments. The findings also reveal some of the key enablers and barriers towards the introduction of hospital IS innovation. We present recommendations to overcome such barriers.
Faulty ‘tools’? Why social work scholarship needs to take a more critical approach to Michel Foucault
Authors: Garrett Paul Michael
Published: March 2019

Having outlined Foucault’s articulation of power and governmentality, the article critically explores attempts to translate the philosopher’s theorisation into social work.

Findings

After briefly referring to Jacques Donzelot’s work and that of other writers, it is argued that Foucault’s conceptual ‘tools’ are problematic for those seeking to promote critical approaches within the field of social work. Those influenced by Foucault’s complex contributions may amplify a defective understanding of power which unduly emphasises ‘soft’ power and neglects the continuing significance of hierarchical and coercive power. This is reflected in Foucault’s analysis of the state and, at a micro level, his remarks on sexualised interactions involving adults and children. Efforts to ‘apply’ Foucauldian reasoning within social work may also risk promoting politically passive forms of theory and practice.

Applications

Contributing to the discipline’s literature on Foucault, the article maintains the social work scholarship has much to gain by engaging with work, but this engagement might aspire to become more critical.
Bergson contra Bergson: Race and morality in The Two Sources
Authors: Glezos Simon
Published: March 2019

Interest in the work of Bergson has seen a revival in political theory over the past two decades. Initially, this interest focused primarily on Bergson’s earlier writings. However, recently there has been increased attention to Bergson’s controversial last book – The Two Sources of Morality and Religion. This has had the benefit of bringing attention to a book frequently maligned as uneven and disappointing. At the same time, mostly absent from this renewed interest has been the subject of race. One of the great ironies of The Two Sources is that, even as it calls for an open morality, it relies on a series of regressive, racist and Eurocentric assumptions. It is this article’s contention that, if we are going to see a renewed turn to The Two Sources, we must grapple with these assumptions, both to investigate how they limit the effectiveness of Bergson’s argument, and to ensure that they are not smuggled into our own work. The article goes on to argue that Bergson’s philosophy ultimately gives us the tools to challenge these reactionary elements; that his focus on morality as a dynamic and open-ended process provides us with the opportunity for recognizing the contingent limitations of Bergson’s worldview.
From the Editors
Authors: Ray Rashawn , Rojas Fabio
Published: March 2019

Contexts editors Rashawn Ray and Fabio Rojas introduce a special issue on wealth inequality and remember Cedric Herring and Erik Olin Wright.
Accuracy in Ethnography: Narratives, Documents, and Circumstances
Authors: Lubet Steven
Published: March 2019

The author of Interrogating Ethnography explores the ways social scientists have responded to his critiques and offers practices he believes might strengthen the web of evidence.
Finding Culinary Injustice
Authors: Byrd Kaitland M.
Published: March 2019

Kaitland M. Byrd on the Cooking Gene.
Flat Rebels
Authors: Whitaker Julie
Published: March 2019

Julie Whitaker on women reconsidering breast reconstruction.
When is a Dildo Just a Dildo?
Authors: Comella Lynn
Published: March 2019

Lynn Comella on the social camouflage surrounding Texas sex toy sales.
Bedside Duplex Ultrasonography Identifies Multiple Pseudoaneurysms in a Penetrating Extremity Trauma
Authors: Broussard Bryan M. , Conners Michael S.
Published: March 2019

A 14-year-old boy sustained an accidental self-inflected stab wound to the calf injuring both the posterior and anterior tibial arteries. On physical examination, pedal pulses were palpable and no obvious sign of arterial injury was identified. It was only after noninvasive duplex ultrasonography that multiple pseudoaneurysms were identified. The patient was taken to the operating room where reversed saphenous vein interposition grafts were used to repair both injuries. Therefore, use of bedside vascular duplex ultrasonography has the ability to expedite patient care.
Defeating the Toxic Boss: The Nature of Toxic Leadership and the Role of Followers
Authors: Milosevic Ivana , Maric Stefan , Lončar Dragan
Published: March 2019

Drawing on the findings from a multiple case study, we build a process model of toxic leadership and empirically illustrate the toxic leadership process and its outcomes. In doing so, we make two important contributions to current literature. First, we provide a theoretical model of the toxic leadership process that details the intent and outcomes of toxic leadership relative to other dark leadership styles: destructive, abusive, and ineffective. In doing so, we show that, although the intent of toxic leaders is relatively less harmful, the behaviors these leaders engage may be harmful for the organization. More specifically, we show that the primary intent of toxic leaders is to conceal lack of relevant competence and maintain a position of control, at the exclusion of other organizationally relevant objectives. To achieve their intent, toxic leaders engage in upward and downward directed influence attempts that create ambiguity and confusion, thus increasing the toxicity of the context and interfering with others’ ability to perform their work. Second, our findings suggest that followers are more agentic than previously suggested. We show that followers not only choose to unfollow their leaders but also actively work to neutralize the influence of toxic leaders through workarounds and learning. Followers have largely been neglected by the extant leadership literature, and thus, the agency they often display in leadership processes has been insufficiently examined.
Working for Racial Equity at the Margins: Teacher-Leaders Facilitate a Book Study on Race in a Predominantly White Suburban High School
Authors: Lac Van , Diamond John
Published: March 2019

This case examines a book study focused on racial equity work at Oak Meadows—a suburban high school with shifting student racial demographics. Two teacher-leaders organize a yearlong book study, initially with the tacit support of school administrators. Book study participants approached their work with great enthusiasm. As the content of the book study shifted to heavier topics such as racialized tracking, teacher colleagues started to withdraw their support, question teacher-leaders’ intentions, and undermine their work. This case explores how teacher-leaders work at the margins for social justice with a school leader who lacks the necessary subjectivities and skill sets to adequately address these issues of racial equity at Oak Meadows.
Assessment of the accuracy of different systems for measuring football velocity and spin rate in the field
Authors: Okholm Kryger Katrine , Mitchell Séan , Forrester Steph
Published: March 2019

The aim of this study was to measure the level of agreement of four portable football velocity and spin rate measurement systems (Jugs speed radar gun, 2-D high-speed video, TrackMan and adidas miCoach football) against a Vicon motion analysis system. One skilled male university football player performed 70 shots covering a wide range of ball velocities (12–30 m s−1) and spin rates (94–743 r/min). A Bland–Altman analysis was used to assess the level of agreement. For ball velocity, the 2-D high-speed video had the smallest systematic error, followed by the radar gun, TrackMan and miCoach football at 0.2, 0.4, 0.5 and 4.8 m s−1, respectively. A similar ranking was also observed for the random errors (95% confidence intervals: ±0.4, ±1.5, ±1.9 and ±6.0 m s−1). The first three systems all tracked ball velocity in >90% of shots, while the miCoach football tracked slightly fewer shots (79%). For spin rate, the miCoach football had a much smaller systematic error (4 vs 38 r/min) and random error (95% confidence intervals: ±24 vs ±355 r/min) compared to TrackMan. The miCoach also successfully tracked spin rate in more shots than the TrackMan (79% vs 44%). These results indicate that 2-D high-speed video would be the preferred option for the field assessment of ball velocity; however, radar gun and TrackMan may also be appropriate. A minimum of 10 frames of 2-D high-speed video, captured close to the ball starting position, was demonstrated to be sufficient in providing a reliable measure of ball velocity. The miCoach ball is the preferred option for field assessment of ball spin rate.
Influence of Transvalvar Pressure Gradient on Hinge Washing in Closed Mechanical Prosthetic Cardiac Valves Under Pulmonary Pressure Conditions: A Comparative In Vitro Study
Authors: Pragt Hanna , van Melle Joost P. , Mariani Massimo A. , Verkerke Gijsbertus J. , Ebels Tjark
Published: March 2019

Objective:

Hinge washing is a crucial factor in the prevention of mechanical prosthetic valvar thrombosis, especially in the pulmonary valve position. The aim of this laboratory study was to determine the relationship between pressure difference and the amount of hinge washing in the closed position, using the pressures that are normal for the right ventricle and pulmonary artery.

Methods:

In an in vitro setting, four different bileaflet mechanical valves were tested for hinge washing in closed position. Based on similarity in inner diameter (range: 20.5-21.4 mm), the following valves were tested: Abbott SJM Regent size 23, Cryolife On-X size 23, LivaNova Carbomedics-R size 25, Medtronic Open Pivot (M-OP)-A size 25. Tests were carried out in a range between 3 and 100 mm Hg pressure difference, using water as a test fluid. The amount of leakage per minute through the closed valve was measured.

Results:

All four valves showed an increase in leakage with increasing transvalvar gradient, and the relationship between pressure and leakage behaves in logarithmic fashion. Leakage under normal pulmonary diastolic pressure conditions (10 mm Hg) was between 23.3% and 29.3% of the leakage under aortic diastolic pressure conditions (80 mm Hg). The Cryolife On-X valve showed the highest closed leakage volume under pulmonary conditions (10 mm Hg) 0.254 ± 0.01 (L/min), where the Medtronic M-OP showed the lowest leakage volume with 0.125 ± 0.014 (mL/min).

Conclusion:

Hinge washing is related to transvalvar pressure difference in closed position. Valve brands differed significantly from each other in the amount of hinge washing.
Determining Evidence-Based Outcomes in School-Aged Youth: Free-Access Instruments for School Counselor Use
Authors: Bardhoshi Gerta , Cobb Nicole , Erford Bradley T.
Published: March 2019

School counselors must demonstrate effectiveness of counseling services in a cost-effective manner. This article reviews and applies commonly used, free-access assessment instruments for use with school-aged youth to provide evidence of effective individual, small-group, and large-group interventions. We present instruments assessing depression, anxiety, disruptive behavior, and trauma, so that school counselors can learn basic administration, scoring, interpretation procedures, and psychometric utility to allow immediate use with diverse students.
Enhancing Evidence-Based Practice Through University–Practitioner Partnerships
Authors: Martin Ian , Zyromski Brett , Gigliotti Edward W.
Published: March 2019

This article proposes a three-step model for implementing successful university and practitioner partnerships to advance the use of evidence-based practices (EBP) in school counseling. Although an ethical mandate exists to use EBP, many school counselor educators and school counselors struggle to implement EBP in their coursework or at their schools. The university–practitioner partnership model proposed here emphasizes that EBP be taught in coursework, that students reinforce those practices through observation of practitioners using them in their schools, and that students experiment with EBP in their fieldwork. We provide suggestions to support successful implementation of the model.
Connect the Dots: Using a Logic Model to Connect Goals With Interventions, Evaluation Strategies, and Outcomes
Authors: Zyromski Brett , Mariani Melissa
Published: March 2019

The evidence-based school counseling model calls for school counselors to (a) make data-driven decisions to determine needs, (b) identify research-supported interventions to address the previously determined needs, and (c) evaluate the effectiveness of the implemented interventions. This article offers both a process model and logic model that school counselors can apply to visually represent data-driven school counseling interventions that are designed to meet the needs of students as reflected in school counseling program goals. Further, the logic model assists school counselors in creating a plan to evaluate immediate, proximal, and distal outcomes.
Thermomechanical and in vitro biological characterization of injection-molded PLGA craniofacial plates
Authors: Pimenta de Melo Liliane , Contessi Negrini Nicola , Farè Silvia , de Mello Roesler Carlos Rodrigo , de Mello Gindri Izabelle , Salmoria Gean Vitor
Published: March 2019

Purpose:

To evaluate the thermomechanical and in vitro biological response of poly(lactic-co-glycolic acid) (PLGA) plates for craniofacial reconstructive surgery.

Methods:

PLGA 85/15 craniofacial plates were produced by injection molding by testing two different temperatures (i.e., 240°C, PLGA_lowT, and 280°C, PLGA_highT). The mechanical properties of the produced plates were characterized by three-point bending tests, dynamic mechanical analysis, and residual stress. Crystallinity and thermal transitions were investigated by differential scanning calorimetry. Finally, in vitro cell interaction was evaluated by using SAOS-2 as cell model. Indirect cytotoxicity tests (ISO 10-993) were performed to prove the absence of cytotoxic release. Cells were then directly seeded on the plates and their viability, morphology, and functionality (ALP) checked up to 21 days of culture.

Results:

A similar performance of PLGA_lowT and PLGA_highT plates was verified in the three-point bending test and dynamic mechanical analyses. Also, the two processing temperatures did not influence the in vitro cell interaction. Cytotoxicity and ALP activity were similar for the PLGA plates and control. Cell results demonstrated that the PLGA plates supported cell attachment and proliferation. Furthermore, energy-dispersive X-ray spectroscopy revealed the presence of sub-micron particles, which were identified as inorganic mineral deposits resulting from osteoblast activity.

Conclusion:

The present work demonstrated that the selected processing temperatures did not affect the material performance. PLGA plates showed good mechanical properties for application in craniofacial reconstructive surgery and adequate biological properties.
Return to Play and Performance Perceptions of Baseball Players After Isolated SLAP Tear Repair
Authors: Douglas Lonnie , Whitaker John , Nyland John , Smith Patrick , Chillemi Filippo , Ostrander Roger , Andrews James
Published: March 2019

Background:

Variable return-to-play (RTP) rates have been reported after surgical repair of superior labral anterior-posterior (SLAP) tears in baseball players. Many studies, however, have not controlled for concomitant shoulder injuries.

Purpose/Hypothesis:

The purpose of this study was to evaluate rates of RTP and return to previous or higher performance level (RTPP) and long-term outcomes after isolated SLAP tear repair. The hypothesis was that improved outcomes would be identified compared with previous reports.

Study Design:

Case series; Level of evidence, 4.

Methods:

The records of 232 players who underwent isolated SLAP tear repair from 2004 to 2014 were reviewed. A total of 98 players who were at least 12 months out from surgery were identified. Through telephone interviews, participants completed the Western Ontario Shoulder Instability Index (WOSI) and Veterans RAND 12-Item Health Survey (VR-12) and answered scripted questions about RTP, RTPP, and current symptoms.

Results:

Of the 98 players who met the inclusion criteria, 73 (74.5%) participated. The mean age at the time of surgery was 19.8 ± 2.9 years. The mean follow-up time was 86.2 ± 25.1 months overall; it was 84.4 ± 24.4 months for pitchers and 90.3 ± 26.7 months for other position players, ( P = .40). There were 10 professional, 36 collegiate, and 27 high school players. Most players perceived successful RTP (83.6%), including 80.0% of pitchers and 91.3% of other position players ( P = .23). However, RTPP rates were lower, at 52.3% (n = 26) and 78.3% (n = 18) for pitchers and other position players, respectively ( P = .03). Pitchers were younger at the time of surgery (19.3 ± 3.0 vs 20.8 ± 3.0 years, respectively; P = .03) and had greater perceived shoulder and general health impairments compared with other position players ( P ≤ .02). Players who perceived successful RTPP had better WOSI of the healthy shoulder and individual physical, sports, lifestyle, and emotion scores compared with players who did not perceive successful RTPP.

Conclusion:

After the surgical repair of isolated type II or greater SLAP tears, other position players displayed superior RTP (91.3% vs 80.0%, respectively) and RTPP (78.3% vs 52.3%, respectively) rates than pitchers. Long-term follow-up suggests that pitchers may perceive greater long-term impairments than other position players and are less likely to return to their previous or higher performance level.
Evaluation of preoperative prostate magnetic resonance imaging for cancer control and neurovascular tissue preservation during robotic radical prostatectomy.
Authors: Gold Samuel A , Lebastchi Amir H , Bloom Jonathan , Mehralivand Sherif , Gomella Patrick H , Sanford Thomas , Hale Graham , Valera Vladimir , Ball Mark Wayne , Merino Maria J , Choyke Peter L. , Turkbey Baris , Pinto Peter A.
Published: March 2019

101

Background: Prostate multi-parametric magnetic resonance imaging (mpMRI) can precisely depict prostate cancer (PCa) location and adverse pathologic features. Surgeons can utilize this information to maximize sparing of the neurovascular bundles (NVBs) during radical prostatectomy (RP) while avoiding a positive surgical margin (PSM). We detail the technique of using preoperative mpMRI to quantify its effect regarding nerve-sparing and rates of PSMs. Methods: A prospectively maintained database was queried for robotic-assisted RPs (RARPs) with preoperative mpMRI between 2007-2017. Imaging margin risk factors (iMRF) were defined on mpMRI as frank extraprostatic extension (EPE), possible EPE, and capsular irregularity (capsular bulge, lesion-capsule contact, or lesion adjacency to the neurovascular bundles). Surgical adjustments to nerve-sparing technique (full sparing, partial sparing, and wide excision) were made based on these findings. Results: Five hundred thirty-two patients comprising 1041 prostate sides were included for analysis. Overall, PSM rate was found in 80/1041 (7.7%) sides of the prostate. iMRF were seen in 313/1041 (30.1%) prostate sides, for which adjustments were made in 244/313 (78.0%) of these. In the 69/244 (22.0%) cases where full nerve-sparing was performed despite iMRF, PSM rate was 20/69 (29%) compared to 33/244 (13.5%), p = 0.002. MRI-guided surgical adjustments decreased PSM risk by 68% and 15% in pT3 and pT2 cases, respectively. On multivariable analysis, logPSA (odds ratio [OR] 4.06, [95% CI 2.40-12.3], p < 0.001) and iMRF (OR 1.78, [95% CI 1.01-3.16], p = 0.047) were significantly associated with PSM while nerve-sparing adjustment was significantly associated with decreased risk of PSM (OR 0.38 [95% CI 0.22-0.66], p = 0.001). Conclusions: MRI effectively detects risks for PSM and guides surgical adjustments to decrease PSM rates. As prostate MRI is more frequently acquired for PCa screening and biopsy, we show its additional value for RP planning and potentially improved outcomes.
Efficacy and toxicity from phase II study of dose escalation to intraprostatic tumor nodule in localized prostate cancer.
Authors: Murray Julia , Alexander Emma , Tree Alison , McNair Helen , Hansen Vibeke , Gao Annie , Thomas Karen , DeSouza Nandita M , Dearnaley David P.
Published: March 2019

102

Background: Intra-prostatic boost to dominant nodule is an attractive method for biological dose augmentation. Aim of study was to assess clinical feasibility of radiation boost to mp-MRI visible tumour using external beam radiotherapy. We report a planned analysis of toxicity and efficacy in the first two dose cohorts in this study. Methods: DELINEATE (ISRCTN04483921) was a single centre prospective phase 2 multi-cohort study including standard (Cohort A (A): 74Gy/37F) and moderately hypofractionated (Cohort B (B): 60Gy/20F) prostate image-guided IMRT regimens. Patients treated in A and B received integrated boost of 82Gy and 67Gy to mp-MRI-visible lesions. 55 patients were recruited to A and 158 patients recruited to B; the first 50 sequentially treated patients in B were included in analysis. Duration of androgen deprivation therapy was at clinician discretion. Primary endpoint was RTOG late toxicity at 1 year. Secondary endpoints included acute and late toxicity timepoints and biochemical relapse (BCR) free survival, using Phoenix definition. Treatment related toxicity was measured by RTOG, CTCAE v4 scales, IPSS and EPIC-26. Results: Between July 2011 and January 2015, 105 patients were treated within A&B. Median follow up for A was 74.5 months and 52 months for B. Median age was 71 years (range 57-80). In A and B, there were 27% and 40% of patients respectively classified with NCCN high risk disease. Cumulative RTOG toxicity in Table. 6 patients had BCR (5 patients: A and 1 patient: B). Within A, 1 patient had pelvic nodal progression and 1 local progression; patient in B had local progression. Conclusions: Delivery of intra-prostatic boost to dominant nodule is feasible with acceptable toxicity and good efficacy. Intra-prostatic boost is now part of the randomised phase 3 PIVOTALboost trial (ISRCTN80146950). Clinical trial information: 04483921. [Table: see text]
“Management Migration” in United States patients diagnosed with localized prostate cancer from 2010-2015.
Authors: Butler Santino , Franco Idalid Ivy , Mahal Amandeep R , Sanford Nina Niu , Trinh Quoc-Dien , Rebbeck Timothy , Nguyen Paul L. , D'Amico Anthony Victor , Mahal Brandon Arvin Virgil
Published: March 2019

11

Background: National guidelines have increasingly supported active surveillance/watchful waiting (AS/WW) in low- and favorable intermediate-risk prostate cancer (PCa). It is unknown how these changes have influenced national management patterns across localized PCa. Therefore, we sought to define the U.S. trends in management of localized PCa across National Comprehensive Cancer Network (NCCN) risk groups. Methods: Using the novel and non-public Surveillance, Epidemiology, and End Results Program Prostate with AS/WW Database, we identified 164,760 men diagnosed with localized PCa and actively treated with either AS/WW, radical prostatectomy [RP], or radiation therapy [RT] from 2010-2015. Rates of initial management type over time, stratified by NCCN risk-category, were determined. Multivariable logistic regression defined adjusted odds ratios (AORs) and 95% confidence intervals (CI) for receipt of each initial management type, with year of diagnosis (2010-2015) as the independent variable of interest (Year 2010 = referent). Results: AS/WW utilization increased from 14.5% to 42.1% from 2010-2015 in low-risk disease (AOR 4.50 [95% CI 4.17–4.86, P < 0.001]); conversely, RT and RP decreased from 38.0% to 26.6% (AOR 0.55 [0.51–0.59, P < 0.001]), and from 47.4% to 31.3% (AOR 0.50, [0.47-0.54, P < 0.001]), respectively (all Ptrends< 0.001). AS/WW increased in intermediate-risk disease from 5.78% to 9.60% (AOR 1.83 [1.67–2.00, P < 0.001]) and RT also decreased from 42.4% to 39.8% (AOR 0.81 [0.77–0.85], P < 0.001; Ptrends< 0.001)—Yet, there was no change in RP (51.8% vs. 50.6%; AOR 1.03 [0.98–1.09, P = 0.254]). Notably, while RP for high-risk disease increased from 38.0% to 42.8% (AOR 1.41 [1.30–1.53, P < 0.001]), RT decreased from 60.1% to 55.0% (AOR 0.71 [0.65–0.77, P < 0.001]; Ptrends< 0.001). Conclusions: These findings capture the rapidly shifting landscape of management for localized PCa and are suggestive of “management migration”—where down-trending RP utilization in low-risk disease (in the setting of up-trending AS/WW) may drive non-evidence based management bias toward RP over RT in higher risk disease. These national patterns serve as a targetable trend that should be addressed.
Outcomes in a cohort of patients with a Gleason score 6 on radical prostatectomy specimen.
Authors: Le Bihan Elodie , Lebacle Cedric Michel , Bessede Thomas , de la TAILLE Alexandre , Salomon Laurent , Irani Jacques
Published: March 2019

112

Background: This retrospective study evaluates the outcome of a cohort of patients who had a radical prostatectomy with GS 6 on the prostatic specimen. Methods: Consecutive cases were extracted from prostatectomy database of 2 teaching hospitals between 2000 and 2006 for a prostate cancer and were scored GS 6 on the specimen. Overall, specific, metastasis and PSA progression-free survivals were analyzed. Cox model was used to evaluate predictive factors. PSA progression was defined by a level of 0.2 ng/mL or above. Results: Mean age of the 616 analyzed patients was 62.8 yrs (SD 6.4). Mean initial PSA was 8.2 ng/mL (SD 8.0). In 46 cases (7.5%) grade 4 was described on pre-operative prostatic biopsies. Median total tumor length (TTL) was 3 mm (IQ 7.7). Pelvic lymphadenectomy was performed in 213 cases and no positive lymph node was diagnosed. Positive margin (R1) was diagnosed in 79 patients (12.8%). pT3a and pT3b stages were described in 65 and 11 cases (10.5% and 1.8%) respectively. Mean follow-up (FU) was 57.2 months (SD 48). None of the 4 deaths were attributed to prostate cancer. PSA progression was observed in 73 patients (11.8%) of whom 48 had a secondary treatment. One patient developed metastasis. Independent predictive factors of PSA progression were TTL on prostatic biopsy (p = 0.007), R1 status (p = 0.005) and seminal vesicles invasion (p = 0.005). Center, initial PSA, number of positive cores and GS on prostatic biopsy were not associated with outcome. Conclusions: No specific mortality was observed in this cohort of prostatectomy GS 6 prostate cancer patients with the limitation of an insufficient FU. The number of positive cores on pre-operative prostatic biopsies was not predictive of outcome which calls into question its use as criterion for active surveillance.
Hospitalization after prostate biopsy in Iceland: Results from a nationwide study.
Authors: Ã“lafsdÃ³ttir Birgitta , Hilmarsson Rafn , Fridriksson Jon Orn , Gudmundsson Sigurdur , Gudjonsson Sigurdur
Published: March 2019

113

Background: The best method to confirm prostate cancer diagnosis is by performing a transrectal ultrasound guided biopsy. This procedure does not come without risks as international reports suggest that frequency of hospitalization after biopsy are increasing. This study aimed to estimate incidence and risk factors for hospitalization after prostate biopsy in Iceland. Methods: Every patient in Iceland who had undergone a prostate biopsy during the years 2013-2017 was included in the study. Primary outcome measure was hospitalization within fifteen days from the biopsy. We also studied the type of infectious agents and resistance to ciprofloxacin or trimethoprim. Multivariable logistic regression model was used to identify risk factors for hospitalization. Results: Of 2076 men who had prostate biopsies 59 (2.8%) were hospitalized within fifteen days. Of these men 45 (76.3%) were hospitalized because of infection, 6 (10.2%) were hospitalized because of bleeding and 8 (13.5%) were hospitalized for other reasons. Risk factor for hospitalization was higher age (OR 1.06 p < 0.001). An antibiotic prescription within 6 months of biopsy was a protecting factor (OR 0.57 p = 0.04). E.coli was the most common infectious agent (73.3%). Pseudomonas, Staphylococcus and Streptococcus dysgalactiae where other agents. Of those admitted to hospital with infection 57.1% of the agents were resistant to ciprofloxacin and 54% to trimethoprim. 31.4% of the infectious agents were resistant to both antibiotics. Conclusions: Despite the invasive nature of the procedure and increasing bacterial antibiotic resistance the rate of hospitalization was relatively low (2.8%). Antibiotic resistance to ciprofloxacin or trimethoprim might prompt a change in common prophylactic practice and a need for new clinical practice guidelines in Iceland.
The impact of Charlson Comorbidity Index on survival outcomes in men with prostate cancer who underwent definitive prostate radiotherapy.
Authors: Ghanem Ahmed I. , Khalil Remonda M , Khedr Gehan Abd Elatti , Tang Amy , Elsaid Amr A. , Chetty Indrin , Movsas Benjamin , Elshaikh Mohamed A.
Published: March 2019

114

Background: Life expectancy is very essential in deciding treatment options in men with prostate cancer (PCa); however, the impact of comorbidities on outcomes is not well-established. We investigated the influence of Charlson Comorbidity Index (CCI) on survival endpoints in men with localized PCa who were treated with prostate radiotherapy (RT). Methods: Men with intermediate and high risk PCa who were treated with definitive RT between 1/2007 and 12/2012 were included. Groups were created according to their baseline CCI score at diagnosis into no, mild and severe comorbidity (CCI 0, 1 or 2+). The groups were then compared based on patients’ characteristics and prognostic factors. Kaplan-Meier curves and Uni/multivariate analyses (MVA) were used to examine the impact of CCI groups on overall (OS), disease specific (DSS), and biochemical relapse free (BRFS) survival. Results: 257 patients were identified after excluding low risk, metastatic cases and those with inadequate follow up. Median follow-up was 92 months (range: 2-135) and median age was 73 years (range: 48-85). 53% of the cases were black and 67% were of intermediate risk. Median RT dose was 76 Gy and 47% received androgen deprivation therapy. CCI groups 0, 1 and 2+ encompassed 76 (30%), 54 (21%) and 127 (49%) patients, respectively. Groups were generally well-balanced. 10 and 15 years OS was significantly different across CCI groups (76% & 53%, 46% & 31% and 55% & 14%, for CCI-0, 1 and 2+ respectively; p < 0.001). CCI-0 had better DSS than CCI-2+ ( p = 0.03) with no difference for CCI-0 vs 1 ( p = 0.1). BRFS was non-different among CCI groups ( p = 0.99). On MVA, increased CCI was deterministic for OS ( p < 0.001) after adjusting for age, Gleason’s score and T-stage. For DSS, only age and T3 vs T1/2 were independently prognostic ( p < 0.001); whereas CCI-1 vs 0 was only marginal ( p = 0.05). Conclusions: Higher CCI was a significant predictor of shorter OS in intermediate and high-risk PCa. Baseline comorbidities should be taken into consideration during patient counselling for treatment options and in designing prospective trials for men with localized prostate cancer.
Feasibility of robot-assisted radical prostatectomy in high elderly patients: Comparative analysis of the perisurgical/oncological outcomes with younger patients.
Authors: Miura Noriyoshi , Noda Terutaka , Nishimura Kenichi , Fukumoto Tetsuya , Yanagihara Yutaka , Miyauchi Yuki , Kikugawa Tadahiko , Oka Akihiro , Ninomiya Iku , Hashine Katsuyoshi , Saika Takashi
Published: March 2019

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Background: Robot-assisted radical prostatectomy (RARP) has become one of standard treatments for localized prostate cancer. However, a feasibility of RARP in high elderly patients has not been clear yet. We performed a comparative analysis of peri-surgical / oncological outcomes for younger and elder patients underwent RARP. Methods: We reviewed and compared our 553 consecutive patients who underwent RARP in 3 institutes from 6/2013 to 2/2018 for peri-surgical outcomes, including surgical times, blood loss, complications, pathological findings, continence recovery, and oncological outcomes stratified by age less than 75 and over 75 years. Results: In our cohort, 477 men were age less than 75 and 76 men were ≥75. Preoperative parameters (PSA, T factor) were similar in both younger and high elder groups. But Gleason score was higher in elder group than younger group ( p=0.009). Operative time (median: 232 vs. 212 minutes) and estimated blood loss (median 100 ml vs 100 ml) were similar in both groups. Two of elder patients (3.8%) needed transfusion. Peri/post-operative all grade complications were 1.4%/6.5% in younger group and 3.8%/9.6% in elder group. No case needed intra-operative open conversion. Surgical positive margin rates were also similar (29.5%, younger vs. 23.7%, elder). Both younger patients (93.6%) and elder patients (90.3%) recovered their continence at 12 months. After a median follow-up of 33.0 months, the 3-year PSA-free survival rates were 86.0% for elder patients and 88.9% for younger patients (p>0.05). Conclusions: In our study, RARP in high elderly patients was relatively safe surgical procedure with a limited complication rate, excellent oncologic and continence outcomes. RARP is feasible even in elderly patients.
Predictors of prostate bed nodule on MRI in patients with rising PSA after radical prostatectomy.
Authors: Nasser Nicola Joseph , Chernyak Victoria , Kalnicki Shalom , Klein Jonathan
Published: March 2019

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Background: Radical prostatectomy (RP) is a common treatment modality for localized prostate cancer. Biochemical failure after RP is usually evaluated with whole body imaging to rule out metastatic disease and pelvic MRI to detect local recurrence in the prostate bed. We analyzed disease characteristics and demographic data of patients with rising PSA after RP to determine correlation with MRI-detected cancer recurrence. Methods: Using Clinical Looking Glass, an institutional data registry query tool, we identified all MRI scans performed at our institution between January 2013 and January 2018 to evaluate for the presence of prostate cancer after RP due to rising prostate specific antigen (PSA) levels. Using Chi-square testing, we analyzed PSA levels, pathologic disease characteristics, time from surgery to biochemical failure, and patient demographic characteristics as predictors of local recurrence detected by pelvic MRI. Results: We identified 64 patients who underwent MRI for rising PSA and had complete clinical and pathological data available. A prostate bed nodule compatible with local recurrence was found in 17 patients (27%). Thirty-six patients (56%) had no evidence of tumor in the prostate bed or pelvis. Eleven patients (17%) had a suspicious lesion which could represent scarring, retained seminal vesicle or recurrent cancer. Patient race was associated with likelihood of detecting a prostate nodule on MRI (p = 0.04) with African-American patients having 82% lower chance of MRI-detected tumor recurrence compared with White patients (p = 0.045). No other characteristic was significantly associated with MRI-detected recurrence including prostate cancer risk group, Gleason score, extra-capsular extension, positive surgical margin, seminal vesicle involvement, perineural invasion, lymphovascular invasion, and PSA level before MRI. Conclusions: African-American patients with biochemical failure after RP are less likely to have MRI-detectable recurrence in the prostate bed compared with white patients. This data may support a higher propensity toward microscopic metastatic disease at the time of biochemical failure in this population.
Intraductal carcinoma of the prostate in prostate biopsy samples: Correlation with pathological features after radical prostatectomy and prognostic value in high-risk prostate cancer patients.
Authors: Zhu Sha
Published: March 2019

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Background: Intraductal carcinoma of the prostate (IDC-P) is a biologically aggressive form of prostate cancer. We investigated the correlation between IDC-P in prostate biopsy samples (Pbx) and several pathological features after radical prostatectomy (RP), also its prognostic value in high-risk prostate cancer patients. Methods: Totally, 455 patients diagnosed with PCa during 2010 to 2017 in West China Hospital were included in this study. Chi-squared test and binary logistic regression were used in discovering the correlation between IDC-P and post-RP pathological features. Kaplan Meier curve, log-rank test, Cox’s proportional hazards model and C-index were applied in the investigation of the prognostic value of IDC-P on 418 high-risk patients. Results: The detection rate of IDC-P in Pbx is 7.91%. IDC-P was an independent predictor of SVI ( p= 0.014), EPE ( p< 0.001), cT stage ( p= 0.001), PSM of urethra end ( p= 0.042). Patients with IDC-P in PBx specimens manifested poorer BFS than those without IDC-P ( p< 0.001), and IDC-P pattern 2 (HR: 4.429, p= 0.020) was associated with worse prognosis than IDC-P pattern 1 (HR: 3.225, p= 0.047). Further analyses also demonstrated that the addition of IDC-P in several nomograms could improve their C-index. Conclusions: IDC-P is associated with several post-RP pathological features after radical prostatectomy. Also, IDC-P can effectively predict the patients’ BFS, and the addition of it can increase the C-index of several nomograms.
Risk of recurrence in patients with positive surgical margin at apex only versus other locations after radical prostatectomy.
Authors: Kato Masashi , Yamamoto Akiyuki , Ishida Ryo , Kimura Tohru , Sano Tomoyasu , Owaki Takayuki , Sassa Naoto , Gotoh Momokazu , Tsuzuki Toyonori
Published: March 2019

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Background: Some reported that positive surgical margin at radical prostatectomy (RP) was a prognostic factor of clinical recurrence and prostate cancer death, and others showed that was not necessarily true. The prostatic apex is most popular location of positive surgical margin at RP and the frequency of apex is reported to be about 20-40% of all positive cases. Prostatic apex is also reported to lack a well-defined capsule and to be hardly retracted during operation. In this study, we evaluated the effect of positive surgical margin at apex-only on prognosis after RP in a large cohort. Methods: We retrospectively evaluated 1019 patients with prostate cancer who underwent radical prostatectomy without neoadjuvant or adjuvant therapy at the hospitals that the authors were affiliated with between 2005 and 2013. The operative approach (open, laparoscopic, or robotic) was decided by each institution. All prostatectomy specimen slides were reviewed by a single genitourinary pathologist according to ISUP 2014 criteria. Recurrence following RP was defined according to AUA guidelines. Results: The median patient age was 67 (range, 45–80) years. The median initial PSA was 6.8 ng/ml (range, 0.4–82 ng/ml). The median follow-up period was 69 (range, 0.7–135) months. Pathological T stage was in 72.5% of pT2 (n = 739), 23.4% of pT3a (n = 238), and 4.1% of pT3b (n = 42). There were 163 Grade Group (GG) 1 cases, 502 GG 2, 217 GG 3, 39 GG 4, and 98 GG 5 cases. 372 cases had positive surgical margin. Details were 201 (54%) apex only, 57 (15%) anterior, 43 (12%) posterior, 76 (20%) lateral, 40 (11%) bladder. Some patients showed multiple positive surgical margin. The patients with positive surgical margin at apex-only showed significantly better prognosis than other locations (P = 0.0001). This result was confirmed in each operative approach (open; P = 0.008, laparoscopic; P = 0.001, robotic; P = 0.01). Conclusions: Among surgical margin positive patients after RP, those at prostatic apex-only showed lower biochemical recurrence than other locations regardless of operative approach. Physician should follow such a patient carefully without adjuvant therapy.
Increasing utilization of multi-parametric magnetic resonance imaging in prostate cancer active surveillance.
Authors: Maganty Avinash , Yu Michelle , Macleod Liam C , Yabes Jonathan G , Fam Mina M , Bandari Jathin , Turner Robert , Furlan Alessandro , Filson Christopher Paul , Davies Benjamin John , Jacobs Bruce Lee
Published: March 2019

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Background: Multi-parametric resonance imaging (mpMRI) has emerged as a tool that may improve risk-stratification and decrease repeated biopsies in men electing active surveillance. However, the extent to which mpMRI has been implemented in active surveillance has not been established. Therefore, we sought to characterize the use of multiparametric magnetic resonance imaging (mpMRI) in Medicare beneficiaries electing active surveillance for prostate cancer. Methods: SEER-Medicare claims data, we identified men with localized prostate cancer diagnosed between 2008-2013 and managed with active surveillance. We classified men into two treatment groups: active surveillance without mpMRI and active surveillance with mpMRI. We then fit a multivariable logistic regression models to examine changing mpMRI utilization over time, and factors associated with the receipt of mpMRI. Results: We identified 9,467 men on active surveillance. Of these, 8,178 (86%) did not receive mpMRI and 1,289 (14%) received mpMRI. The likelihood of receiving mpMRI over the entire study period increased by 3.7% (p = 0.004). On multivariable logistic regression, patients who were younger, white, had lower comorbidity burden, lived in the northeast and west, had higher incomes and lived in more urban areas had greater odds of receiving mpMRI (all p < 0.05). Conclusions: From 2008-2013, use of mpMRI in active surveillance increased gradually but significantly. Receipt of mpMRI among men on surveillance for prostate cancer varied significantly across demographic, geographic and socioeconomic strata. Going forward, studies should investigate causes for this variation and define ideal strategies for equitable, cost-effective dissemination of mpMRI technology.
Radiogenomic characterization of multifocal prostate cancer.
Authors: Salami Simpa Samuel , Kaplan Jeremy B , Nallandhighal Srinivas , Takhar Mandeep , Tosoian Jeffrey J. , Lee Matthew , Yoon Junhee , Hovelson Daniel H , Plouffe Komal R. , Kaffenberger Samuel D. , George Arvin Koruthu , Montgomery Jeffrey Scott , Davenport Matthew , You Sungyong , Tomlins Scott A. , Curci Nicole E , Kim Hyung Lae , Spratt Daniel Eidelberg , Udager Aaron M. , Palapattu Ganesh S.
Published: March 2019

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Background: Up to 20% of patients with negative multiparametric magnetic resonance imaging (MRI) harbor Gleason score ≥7 prostate cancer (PCa). We sought to elucidate the molecular basis of and determine the prognostic significance of PCa visibility on MRI. Methods: We identified a retrospective cohort of patients who underwent MRI prior to prostatectomy with both MRI visible (PIRADS 3 – 5) and invisible PCa. MRI for each patient was re-reviewed and co-registered with whole-mount histopathology. DNA and RNA were co-isolated from all tumor foci pre-identified on FFPE specimens. High depth, targeted DNA and RNA next generation sequencing was performed to characterize the molecular profile of each tumor focus using the Oncomine Comprehensive Panel (DNA) and a custom targeted RNAseq panel assessing PCa relevant alterations. A multigene RNAseq model was developed and validated in two independent cohorts to predict MRI visible PCa and to determine the prognostic significance of MRI visibility. Results: A total of 26 primary tumor foci from 10 patients were analyzed. Of the 14 (54%) invisible lesions on MRI, 5 (36%) were Gleason 3+4 = 7 and the remainder were Gleason 6. We detected high-confidence prioritized PCa relevant mutations in 54% (14/26) of tumor foci, 43% (6/14) of which were in MRI invisible lesions. Notable point mutations were in APC, AR, ARID1B, ATM, ATRX, BRCA2, FAT1, MAP3K1, NF1, SPEN, SPOP, and TP53. A 9-gene RNA signature, the majority of which were under-expressed cellular organization and structure genes, was developed to predict MRI visibility with an AUC of 0.89. Validation of this signature in an independent data set (n = 16) yielded an AUC of 0.88 with a specificity of 100% for predicting MRI visible tumors. Using this signature in a cohort of 375 patients with clinical follow up, we found that predicted MRI visibility status was not an independent predictor of biochemical recurrence, metastasis-free survival, or PCa specific mortality (all p > 0.05). Conclusions: We observed under-expression of cellular organization and structural genes in MRI visible tumors compared to MRI invisible cancer foci. Using our validated signature to predict MRI visibility status, we found that MRI visibility is not a significant predictor of oncological outcomes.