Performance of multiparametric MRI in men at risk of prostate cancer before the first biopsy: a paired validating cohort study using template prostate mapping biopsies as the reference standard.

BACKGROUND: Multiparametric magnetic resonance imaging (mpMRI) has the potential to serve as a non-invasive triage test for men at risk of prostate cancer. Our objective was to determine the performance characteristics of mpMRI in men at risk before the first biopsy using 5 mm template prostate mapping (TPM) as the reference standard. METHODS: One hundred and twenty-nine consecutive men with clinical suspicion of prostate cancer, who had no prior biopsy, underwent mpMRI (T1/T2-weighted, diffusion-weighting, dynamic contrast enhancement) followed by TPM. The primary analysis used were as follows: (a) radiological scores of suspicion of ≥3 attributed from a five-point ordinal scale, (b) a target condition on TPM of any Gleason pattern ≥4 and/or a maximum cancer core length of ≥4 mm and (c) two sectors of analysis per prostate (right and left prostate halves). Secondary analyses evaluated the impact of changing the mpMRI score threshold to ≥4 and varying the target definition for clinical significance. RESULTS: One hundred and forty-one out of 258 (55%) sectors of analysis showed 'any cancer' and 77/258 (30%) had the target histological condition for the purpose of deriving the primary outcome. Median (with range) for age, PSA, gland volume and number of biopsies taken were 62 years (41-82), 5.8 ng ml(-1) (1.2-20), 40 ml (16-137) and 41 cores (20-93), respectively. For the primary outcome sensitivity, specificity, positive and negative predictive values and area under the receiver-operating curve (with 95% confidence intervals) were 94% (88-99%), 23% (17-29%), 34% (28-40%), 89% (79-98%) and 0.72 (0.65-0.79), respectively. CONCLUSIONS: MpMRI demonstrated encouraging diagnostic performance characteristics in detecting and ruling out clinically significant prostate cancer in men at risk, who were biopsy naive.

The effect of environmental conditions on the ability of a constructed wetland to disinfect municipal wastewaters.

Constructed wetlands are widely used all over the world for the treatment of municipal wastewaters, which are characterized by high concentrations of pathogens. The objectives of this study were (1) to study the effect of solar radiation and temperature on the ability of a constructed wetland to reduce the concentration of total coliforms (TC), and (2) to evaluate the relationship between the presence of Salmonella spp. in the outflow and the concentration of TC. The results of this study showed that under Mediterranean environmental conditions, the percentage reduction in coliforms was lower during winter compared to all other seasons. Maximum removal of coliforms was achieved under conditions of high solar radiation and temperature. In addition, solar radiation was found to play a greater role in coliform die-off at low temperatures than at high temperatures. Finally, it was found that the probability of Salmonella spp. appearance in the outflow of the wetland was related to the concentration of TC. The increase in coliform bacteria in the effluents also increased the chances of Salmonella appearance. The risk of Salmonella spp. appearance in the outflow is minimized when the concentration of TC is below 10(2)/100 mL.