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Association of prostate specific antigen (PSA) doubling time (DT) and prostate specific membrane antigen (PSMA) findings in biochemically recurrent prostate cancer (BCR)
No full text33Background: Historically, PSA DT can be prognostic for metastasis free survival in BCR (as defined on computed tomography (CT) and bone scan). PSA DT is also an important tool in risk stratification in BCR to identify which patients (pts) require therapy (e.g. pts with a PSA DT>6 months). The emerging use of PSMA imaging creates another tool to assess BCR pts, but there is no data on the association of PSA DT and PSMA findings. Methods: NCT05588128 enrolls BCR pts after definitive +/- salvage therapies. Pts must have a PSA>0.5 ng/ml, testosterone >100 ng/dL, and negative CT/bone scans. Lymph nodes (LNs) up to 1.5 cm and prior therapies are permitted. All patients undergo a baseline PSMA PET scan, along with measurement of PSA and PSA DT. Here we describe the relationship between baseline PSA metrics and baseline PSMA imaging findings in patients with BCR. Results: 130 patients are currently evaluable with a median age= 71 years, baseline PSA of 1.95 ng/dL (range: 0.5 to 71) and PSA DT of 10.6 months (range 1.2 to 132) off therapy. Of all participants, 16.9% (n=22) had findings limited to the prostate bed and 34.6% (n=45) had PSMA+ avidity in the prostate bed with other findings. 42.3% (n=55) had PSMA + LNs, and 13.8% (n=18) had PSMA+ bone lesions. Four patients had serosal deposits with PSMA avidity, and one patient had a PSMA+ lung nodule. Conclusions: These data are the first to compare PSMA imaging results with corresponding PSA levels and PSA DT in a large cohort of patients with BCR. Results show that pts with historically favorable/long PSA DT may have high volume/bone+ findings on PSMA. There is no data to suggest treatment escalation is required in BCR pts with high volume PSMA findings, but long/favorable PSA DT. These results highlight the caveats of using PSMA imaging alone to drive treatment decisions in BCR without further data for how baseline PSMA imaging corresponds with long-term outcomes. Clinical trial information: NCT05588128
Preconception Cardiometabolic Markers and Odds of Developing Adverse Pregnancy Outcomes: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
No full textAdverse pregnancy outcomes (APO) are associated with increased cardiovascular disease (CVD) risk. However, studies evaluating preconception cardiometabolic risk factors and the development of APO are lacking in high-risk, understudied groups including the Hispanic/Latina population.We examined the odds of APO associated with preconception cardiometabolic markers in the prospective cohort of Hispanic Community Health Study/Study of Latinos (HCHS/SOL). APO was defined as self-reported hypertensive disorders of pregnancy (HDP) or gestational diabetes (GDM). Metabolic syndrome was defined per NCEP-ATP III criteria. Women reporting at least 1 pregnancy between baseline (2008-2011) and visit 2 (2014-2017) were included. Multivariate logistic regressions were used to determine the odds of APO.Among 529 participants, 111 (21%) reported an APO. In adjusted models, higher preconception systolic blood pressure (SBP), body mass index, waist circumference, HbA1c, and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) were associated with increased odds of APO. A dose-response relationship in metabolic syndrome components, with two and three or more components significantly increasing the odds of developing an APO (adjusted OR 2.50 (1.07, 5.84) and 3.39 (1.37, 8.42)).High-risk preconception cardiometabolic abnormalities increase the odds of developing an APO in Hispanic/Latina women, with a dose-response relationship by the number of metabolic syndrome components. Early identification and intervention are crucial to reduce APOs and their long-term cardiovascular consequences in this population
Phase 3 study of 68 Ga-PSMA-11 PET combined with MRI for the detection of prostate cancer (BIPASS)
No full textTPS406 Background: Prostate cancer (PC) is diagnosed through directed & template/anatomical biopsy based on clinical and radiographic suspicion. In patients with high risk of PC, directed biopsies are performed to identify occult disease, which can lead to anxiety, complications, financial burden, & logistical challenges. PSMA PET combined with MRI for targeted biopsy may improve the detection of clinically significant PC (csPC) & treatment management, minimize cost and procedural risk, de-escalate the number of biopsies, & potentially eliminate the need for biopsies in select populations. In a study of 56 patients with PI-RADS 3 lesions, csPC was detected in only 8 patients (14.3%) by biopsy. When a PRIMARY score of ≥4 was used to make a biopsy decision in men with PI-RADS 3 lesions, 40/48 (83.3%) patients could have avoided unnecessary biopsies. Biopsy of the Prostate Avoidance Stratification Study (BIPASS) is evaluating the diagnostic performance of combining 68 Ga-PSMA-11 PET & MRI targeted biopsy for detection of PC, using histopathological confirmation as standard of truth (SOT). Methods: This Phase 3, single-arm, multicenter, prospective, open-label, longitudinal study (NCT07052214) will enroll 204 patients ≥18 years with clinical suspicion of PC are prostate biopsy naïve & scheduled to undergo template biopsy based on initial MRI within 3 months before enrollment (PI-RADS 1-4). Key exclusion criteria include prior treatment of PC, diagnosis of PC, or obvious metastatic disease on prior conventional imaging. Patients will undergo 68 Ga-PSMA-11 & MRI scans, followed by standard template biopsy. PSMA & MRI scans will be independently interpreted by 3 blinded readers. MRI- & PSMA-targeted biopsies will be performed with 2 cores per lesion. If PC is histopathologically identified, lesion linking with imaging will be performed with no further follow-up required. Follow-up data will be collected for up to 6m for patients with no baseline imaging or histopathological evidence of PC. Additional imaging & biopsies may be performed during the follow-up period at discretion of the investigator. Any additional biopsy, imaging, clinical, histological, genetic, & intervention data will contribute to the determination of SOT. Follow-up will provide longitudinal surveillance to ensure that patients initially evaluated as negative for PC on both imaging & histopathology are reliably negative. The co-primary endpoints are sensitivity & specificity of combining PSMA PET- and MRI- targeted biopsy for the detection of PC, calculated by comparing diagnostic findings to histopathological or composite SOT. Key secondary endpoints include detection performance (sensitivity, specificity, PPV, NPV, accuracy, & misclassification rate) of PSMA PET- & MRI- targeted biopsy for detection of PC and interobserver variability of PSMA PET interpretation. This study is open for enrollment & is sponsored by Telix Pharmaceuticals. Clinical trial information: NCT07052214
Adjuvant Imatinib or Observation in Patients With Gastrointestinal Stromal Tumors With KIT Exon 9 Mutations
No full textThis cohort study evaluates the association between adjuvant imatinib and recurrence-free survival and overall survival in patients with resected high-risk gastrointestinal stromal tumors (GISTs) with KIT exon 9 mutations
Detection of fragmentation while dusting during retrograde intrarenal laser lithotripsy: a novel computer vision and perception pipeline
No full textDusting during ureteroscopy with laser lithotripsy is popular because it minimizes the need for basketing of fragments. However, one of the challenges with dusting is adjusting power settings to be efficient and to limit the inadvertent generation of fragments. Detection of fragment production in real time using computer vision could help facilitate energy adjustments to optimize dusting. With IRB approval, we recorded eight consecutive ureteroscopy with laser lithotripsy procedures performed for intrarenal stones with a single-use flexible ureteroscope. We used a Dornier Thulio laser to dust the stones, with power settings at the discretion of the surgeon. We included all patients with stones between 7 mm and 15 mm. Time and duration of clips showing fragmentation were labeled. We then developed a fragmentation during dusting detection pipeline based on contemporary AI technologies, including semantic segmentation and video point tracking, and qualitatively demonstrated the detection performance on paradigmatic video segments. Successful extraction was performed in all 8 surgical videos, but only 5 had sufficient fragmentation events and adequate visualization for inclusion. We evaluated our pipeline’s performance on frame-level fragmentation detection, achieving an F1 score of 0.568, driven by a recall (sensitivity) of 0.516 and a precision (positive predictive value) of 0.632. Segment-level fragmentation detection performance was substantially lower, with an F1 score of 0.124 due to low precision (0.072) despite a recall of 0.438. We also qualitatively analyzed our pipeline on representative segments and provide insight into the task-specific challenges. Recent advancements in video point tracking enable more accurate capture of object motion patterns, which could be used to track the fracture of fragments from the kidney stone. With refinement, the proposed pipeline for the detection of fragmentation may be utilized to provide feedback to the surgeon and/or laser to adjust power settings in real time
Saccharomyces cerevisiae isolated in a degloving baker's machine injury, a contamination or infection - a case report
No full textDeep tissue and bloodstream yeast infections are associated with poor outcomes due to rapid progression, antifungal resistance, and immune evasion. Differentiating between wound contamination and true fungal infection remains a clinical challenge, with limited guidance on the use of prophylactic antifungal therapy in this setting. This article presents a rare case of an immunocompetent patient who sustained a degloving hand injury and radius fracture from a bread kneading machine, with subsequent deep tissue cultures growing Saccharomyces cerevisiae. The case underscores the potential risk of fungal infection in occupational injuries involving dough and emphasizes the importance of early identification and consideration of prophylactic antifungal treatment in similar scenarios
Comparative analysis of placental transmission mechanisms for Dengue and Zika viruses: outcomes and future directions
No full textZika and Dengue viruses are arboviral pathogens capable of crossing the placental barrier, representing major global health risks for maternal and fetal outcomes. In this narrative review, we compare their epidemiology, clinical consequences in pregnancy, and underlying mechanisms of vertical transmission. Emerging molecular insights are highlighted, including disruptions to placental signaling pathways such as JAK/STAT and mTOR, and strategies to evade Hofbauer cells and the immune system. A comparative analysis of these processes underscores a critical need for improved understanding of placental pathophysiology, immune regulation, and molecular pathways of transmission. Identifying such mechanisms may promote vaccine development, improved diagnostics, and therapies to reduce adverse outcomes in the mother-infant dyad during maternal infection
High-Thrust Stationary Cylindrical Wind Sails Enabled by CoFlow Jet with Enhanced Tip Treatment
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