The association of level of practical experience in transrectal ultrasonography guided prostate biopsy with its diagnostic outcome

INTRODUCTION The diagnostic yield of transrectal ultrasonography (TRUS) guided prostate biopsy is influenced by many patient and procedure specific factors. However, the role of operator specific factors remains inadequately defined. This study investigated the association of diagnostic outcome of TRUS guided biopsy with operator skill level. METHODS This study looked at a consecutive cohort of 690 men undergoing their first extended pattern TRUS guided prostate biopsy by 27 operators over a 24-month period in a single institution. Logistic regression was used for statistical analysis. RESULTS Biopsies performed by consultants (odds ratio [OR]: 2.35, p=0.004) and senior trainees (OR: 2.37, p=0.002) in patients with prostate specific antigen levels of <10ng/ml were more likely to be positive than those performed by junior trainees (cancer detection rate 50.0%, 50.3% and 29.9% respectively). Furthermore, biopsies performed by junior trainees yielded a significantly higher proportion of prostate cancers with a Gleason score of ≥3+4 than those performed by senior trainees (OR: 2.11, p=0.031) and consultants (OR: 2.40, p=0.013) (81.4%, 67.5% and 64.6% respectively). No significant differences emerged between operator skill groups for complications, rebiopsy rates or the number of prostate cancers found during the follow-up period (median: 34 months) of patients with a negative biopsy. CONCLUSIONS Level of operator experience is associated with the diagnostic outcome of extended pattern TRUS guided biopsy. The findings of this study imply that case selection, self-audit and expert supervision for the duration of the learning curve should form the basis of biopsy training.

Vitamin D status in children and adolescents with autoimmune thyroiditis

BACKGROUND

Vitamin D deficiency is a global health problem. Its role as an immune modulator has been recently emphasized. There is increasing evidence for the significant role of vitamin D in reducing the incidence of autoimmune diseases. However, little is known about the status of vitamin D in children and adolescents with autoimmune thyroiditis (AIT).

OBJECTIVE

The goal of the present study was to assess vitamin D status in Egyptian children and adolescents with AIT and to explore its relation to biomarkers of autoimmunity and thyroid function.

DESIGN

A prevalence case-control study that included 56 children with AIT and 56 healthy, age- and sex-matched subjects that served as the control group. The following was done for all participants: thorough history, physical examination, thyroid ultrasound, measurement of thyroid-stimulating hormone (TSH), free thyroxin (FT4), anti-thyroid peroxidase antibodies (TPOAb), anti-thyroglobulin antibody (TgAb) and assessment of serum 25-hydroxy vitamin D (25OHD) level.

RESULTS

Overt hypothyroidism was detected in 42/56 while subclinical hypothyroidism was detected in 14/56 of the studied patients. Vitamin D deficiency rate was significantly higher in the AIT group compared to the control subjects (71.4 vs 21.4 %, P < 0.001). In AIT group, the mean level of 25OHD was significantly lower compared to the control group (16.2 ± 8.2 vs 33.9 ± 12.7 nmol/L, P < 0.001). The difference was more evident in patients with overt hypothyroidism than those with subclinical hypothyroidism (P < 0.01). There were significant negative correlations between serum 25OHD and age, duration of the disease, BMI, anti-TPOAb, anti-TGAb and TSH (P < 0.001 each). On the other hand, serum 25OHD correlated positively with FT4 levels. While 25OHD level was an independent risk factor for AIT, it failed to qualify as an independent risk for the progression of AIT to overt hypothyroidism after adjustment for other potential confounding factors; age, sex and BMI.

CONCLUSIONS

Low serum vitamin D is significantly associated with AIT in Egyptian children. However, vitamin D level is not an independent risk for the progression of AIT to overt hypothyroidism. BMI may have an influence on serum 25OHD levels.

Thermoluminescent properties of some phosphor glasses based on aluminum oxide

The transparent thermoluminescent aluminum oxide-based glass of 15Al₂ O₃ -35P₂ O₅ -25CaO-25Na₂ CO₃ , abbreviated as APCN (all in mol%) doped with different concentrations of SiO₂ from 0.0-500 ppm was prepared using a conventional melt-quenching technique. The TL sensitivities of the prepared glasses were investigated at 3 Gy γ-dose using a ⁶⁰ Co source and measured at a heating rate 10 C/sec. The highest TL intensity of the material doped with SiO₂ was found at a concentration of 500 ppm (APCNSi₅ ). Deconvolution of the glow curve from APCNSi₅ resulted in four peaks at about 161, 194, 237 and 293 C with a Figure Of Merit (FOM) of 1.28%. The APCNSi₅ specimen had the best dosimetric properties when compared with the other samples. Reproducibility, repeatability, dose-response curve and fading effect were checked for peak 3, which appeared at about 237 C. The results displayed that the APCNSi₅ glass system was a low-Z material (Z_eff  ≈ 10), and had good reproducibility and good repeatability. Peak 3 showed good linearity over a dose range up to 20 Gy (R²  = 0.999) and sublinearity behaviour was found. The signal from APCNSi₅ faded by about 11% after 2 days post irradiation, therefore it showed almost no significant loss. Such properties make the newly prepared glasses suitable for and highly recommended for use in γ-dosimeters. Copyright © 2016 John Wiley & Sons, Ltd.