Role of T2 Textural Analysis of Prostate Lesion: A Retrospective Study

Introduction: Prostate cancer is diagnosed in two-thirds of instances in the world's more developed regions. Prostate cancer was detected in 180,890 new cases in the United States in 2016, according to the American Cancer Society. One out of every six men is projected to develop prostate cancer at some point in their lives. The study's major purpose was to develop a textural analysis-based classifier to differentiate between benign and malignant prostate tumors using MRI-T2WI. Materials and method: The retrospective study was conducted in the department of radiology in KKUH. Total 93 lesions from prostate cases were performed in KKUH from 2015 to 2017. About 75 lesions of 48 patients were included in this study. Eleven haralick features from region of intrests (ROIs) were extracted. After matching them with traces done by consultants in Profuse software, which was utilized for image-guided biopsy, digital rectal examination (DRE), prior biopsy (Prior bx) lesions were traced using ImageJ (MRI-ultrasound fusion). Weka software used this to create a classifier that distinguishes between malignant and benign tumors. Result: The age of total 48 patients was in the interquartile range of 59.0-70.0, with an average of 64.4 years. The PSA was observed an average of 22.5 with an SD of 50.5 and an interquartile of 10.0. The mean size of the prostrate was 3.2 cm with SD 1.9. Among 48 patients Digital rectal examination (DRE) 8 (16.7%) and 40 (83.3%), Prior biopsy (PRIOR BX) 2 (4.2%) and 46 (95.8%), PI-RADS 22 (45.8%) and 26 (54.2%) were observed positive and negative respectively. In DRE, 88% sensitivity 55% specificity with PSA 9.75 (p-value 0.008) were observed. 100% of sensitivity, 41% specificity with PSA 8.19 (p-value 0.897) were found in PRIOR BX, but in MRI, 55% of sensitivity 69% specificity with PSA 10.70 (p-value 0.107) were observed. Conclusion: T2 texture analysis is good in classifying prostate lesions with acceptable sensitivity and specificity. T2W MRI-based textural analysis agreed with pathological findings from many institutions and was sensitive to underlying pathological differences between low- and intermediate/high-grade prostate cancers. Actors in the diagnostic performance, such as DWI/ADC and perfusion, histogram parameters, and other features with distinct orientations and lengths, could help doctors discriminate benign and malignant prostate nodules, allowing for more efficient and precise clinical decisions. Keywords: Prostrate lesion, MRI, textural analysis, cancer</jats:p

Constraints on Language Teacher Autonomy in a University Setting in Saudi Arabia

Compared to ‘teacher autonomy’, the concept of ‘learner autonomy’ has been researched extensively. Even the literature relating to teacher autonomy, often considers it in relation to learner autonomy (Little, 1995; Smith, 2003; Huang and Benson, 2007, 2013; Trebbi, 2008; Cakir, 2012). Although the two concepts are no doubt related, the attention in this study is on teacher autonomy. In addition, the need for understanding teacher autonomy has highlighted another important aspect of this study, which is to recognise and be acquainted with the constraints that teachers face (Anderson, 1987; Lamb, 2008; Han, 2017), including the different types or forms they may take, their effects on autonomy, and ways in which teachers can deal with them. Therefore, this phenomenon was investigated in the context of the higher education sector in Saudi Arabia by conducting a case study at a selected institution where English language teachers face constraints on their teaching that limit their scope for autonomy. The method involved interviewing teachers of English as a foreign language, and the data were complemented by observations and document analysis. The research identified a number of constraints, examined how the teachers dealt with them to create spaces for autonomy, and ascertained what drives those teachers to deal with the constraints. A sharp distinction was found for institutionally imposed constraints, such as administration, exams and textbooks, which teachers were either compelled to comply with or for which they were only able to exercise little autonomy. This situation is in contrast with classroom-related constraints for which teachers demonstrated their autonomy, which also shows evidence of capacity and willingness to deal with the constraints. The investigation revealed an empirical evidence of a potential relationship between teacher autonomy and Identity. It indicated that the spaces that the teachers created were related to their identities that were shaped largely by their own learning, previous teaching experiences, and beliefs. It influenced teachers’ willingness and capacity to create spaces within the constraints. This implies a crucial role of teacher identity in understanding more the phenomena of teacher autonomy and constraints. Implications are also drawn in light of the findings of this study for educational policies, Saudi higher education institutions, teacher education programmes, and English language teachers

Sorafenib Combined with Chemoembolization for Locally Advanced Hepatocellular Carcinoma with Macroscopic Vascular Invasion: A Propensity Score Analysis

The purpose of this study was to compare the efficacy and safety of transarterial chemoembolization (TACE) plus sorafenib with those of TACE alone in patients with locally advanced hepatocellular carcinoma (HCC). Treatment-naive patients with preserved hepatic reserve (Child?Pugh score ≤ 7) who received TACE plus sorafenib (n = 91) or TACE alone (n = 109) for locally advanced HCC with macrovascular invasion were retrospectively evaluated. Propensity score matching (PSM) was used to correct selection bias, and 63 pairs were created. In the entire study population, the median progression-free survival (PFS) and overall survival (OS) with TACE plus sorafenib were better than those with TACE alone. After PSM, the median PFS (7.0 vs. 4.3 months; p = 0.017) and OS (17.5 vs. 12.8 months; p = 0.049) were again significantly longer with TACE plus sorafenib than with TACE alone. Stratified Cox regression analysis and doubly robust estimation revealed that treatment type was significantly associated with both PFS and OS. In the subgroup analysis, TACE plus sorafenib did not show a significant survival benefit for patients with main portal vein or inferior vena cava invasion. Major complications were similar in both groups (p = 0.330). In conclusion, TACE plus sorafenib showed better survival outcomes than TACE alone in patients with locally advanced HCC

Facilitated Retrograde Access the Facial Vein for Transvenous Embolization of the Cavernous Sinus Dural Arteriovenous Fistula with Isolated Ophthalmic Venous Drainage

Management of cavernous sinus dural arteriovenous fistula (CSDAVF) continues to present significant challenges, particularly when the inferior petrosal sinus is thrombosed, collapsed, or angiographically invisible. In this study, we introduce facilitated retrograde access via the facial vein, which is employed in the transvenous embolization of CSDAVF with isolated superior ophthalmic venous drainage. We also present illustrative cases and technical points

Comparison of transradial and transfemoral access for transcatheter arterial embolization of iatrogenic renal hemorrhage

Background There are few reports of renal artery embolization (RAE) via transradial access (TRA) for renal hemorrhage, and none have compared outcomes of RAE via TRA and transfemoral access (TFA). The objective was to compare technical and clinical outcomes in patients undergoing RAE via TRA or TFA for iatrogenic renal hemorrhage. Materials and methods This study included 45 RAE procedures (16 TRA and 29 TFA) for iatrogenic renal hemorrhage in 43 patients performed at a tertiary referral center between October 2018 and December 2020. Information regarding underlying diseases, coagulation status, angiographic and embolization procedure details, technical and clinical successes, and complications were retrospectively evaluated. Results There were no differences in demographics, underlying diseases, updated Charlson comorbidity scores, angiographic findings, and volume of contrast material between the TRA and TFA groups. By contrast, prothrombin time and international normalized ratio were significantly lower in the TRA than in the TFA group. Embolic materials differed significantly in the two groups. Procedure duration, fluoroscopy time, digital subtraction angiography number, and dose area product were slightly lower in the TRA than in the TFA group, but the differences were not statistically significant. Technical and clinical success rates in the TRA and TFA groups were 100% and 96.6%, and 100% and 96.6%, respectively. No patient in either group experienced procedure-related complications during a 4 week follow-up period. Conclusion RAE via TRA in the management of iatrogenic renal hemorrhage was safe and feasible, with similar procedure duration and radiation exposure to RAE via TFA. TRA may be an acceptable alternative to TFA in these patients

Lipiodol Lymphangiography and Glue Embolization for Vulvar and Vaginal Lymphorrhea

AbstractA 26-year-old woman patient had an 18-year long history of vulvar and vaginal lymphorrhea and multiple millet-like lesions on her vulva. On magnetic resonance image, multiple T2 high signal intensities were noted at the bilateral vulvar areas and pelvic cavity. Conventional lipiodol lymphangiography showed lymphatic reflux to the vulvar areas, possibly originating from prominent tubular lymphatics in the right lower abdominal wall. After percutaneous puncture of this tubular lymphatic structure, its distal portion was embolized using microcoils to prevent upward glue propagation; this was followed by glue embolization of the tubular lymphatic structure. The patient was without skin lesions or symptoms at follow-up of 1 year after the procedure.</jats:p

Sorafenib Combined with Chemoembolization for Locally Advanced Hepatocellular Carcinoma with Macroscopic Vascular Invasion: A Propensity Score Analysis

The purpose of this study was to compare the efficacy and safety of transarterial chemoembolization (TACE) plus sorafenib with those of TACE alone in patients with locally advanced hepatocellular carcinoma (HCC). Treatment-naïve patients with preserved hepatic reserve (Child–Pugh score ≤ 7) who received TACE plus sorafenib (n = 91) or TACE alone (n = 109) for locally advanced HCC with macrovascular invasion were retrospectively evaluated. Propensity score matching (PSM) was used to correct selection bias, and 63 pairs were created. In the entire study population, the median progression-free survival (PFS) and overall survival (OS) with TACE plus sorafenib were better than those with TACE alone. After PSM, the median PFS (7.0 vs. 4.3 months; p = 0.017) and OS (17.5 vs. 12.8 months; p = 0.049) were again significantly longer with TACE plus sorafenib than with TACE alone. Stratified Cox regression analysis and doubly robust estimation revealed that treatment type was significantly associated with both PFS and OS. In the subgroup analysis, TACE plus sorafenib did not show a significant survival benefit for patients with main portal vein or inferior vena cava invasion. Major complications were similar in both groups (p = 0.330). In conclusion, TACE plus sorafenib showed better survival outcomes than TACE alone in patients with locally advanced HCC.</jats:p

Sorafenib Combined with Chemoembolization for Locally Advanced Hepatocellular Carcinoma with Macroscopic Vascular Invasion: A Propensity Score Analysis

The purpose of this study was to compare the efficacy and safety of transarterial chemoembolization (TACE) plus sorafenib with those of TACE alone in patients with locally advanced hepatocellular carcinoma (HCC). Treatment-naïve patients with preserved hepatic reserve (Child–Pugh score ≤ 7) who received TACE plus sorafenib (n = 91) or TACE alone (n = 109) for locally advanced HCC with macrovascular invasion were retrospectively evaluated. Propensity score matching (PSM) was used to correct selection bias, and 63 pairs were created. In the entire study population, the median progression-free survival (PFS) and overall survival (OS) with TACE plus sorafenib were better than those with TACE alone. After PSM, the median PFS (7.0 vs. 4.3 months; p = 0.017) and OS (17.5 vs. 12.8 months; p = 0.049) were again significantly longer with TACE plus sorafenib than with TACE alone. Stratified Cox regression analysis and doubly robust estimation revealed that treatment type was significantly associated with both PFS and OS. In the subgroup analysis, TACE plus sorafenib did not show a significant survival benefit for patients with main portal vein or inferior vena cava invasion. Major complications were similar in both groups (p = 0.330). In conclusion, TACE plus sorafenib showed better survival outcomes than TACE alone in patients with locally advanced HCC