RNA Therapeutics Investigation as well as Specialized medical Improvements

T of children with acute ischemic stroke seems safe and feasible. However, these findings should be interpreted with caution as more and larger studies are needed to clarify the trade-off between risks and benefits of this treatment.The author explores the idea of sovereignty as an illusion that is and will continue to have deleterious effects on cooperative efforts to slow or stop climate change and the extinction of millions of species. To make this case, the notion of sovereignty is defined and its attributes described. This lays the foundation for arguing, from a psychoanalytic perspective, that sovereignty is a tightly held illusion (and practice). The last section of the article identifies the negative present and future impact of sovereignty with regard to the Anthropocene Age, as well as briefly identifying other possibilities for ordering societies.The author describes the evolution of theory and practice at the New York Psychoanalytic Society and Institute. The core concepts at the Institute have included the importance of unconscious fantasy, conflict and compromise theory, transference and countertransference, and defense analysis. In recent years, a variety of contemporary analytic theories have been incorporated into the theory and practice of the Institute. The importance of systematized research to theory development and practice is stressed.The authors share their observations on the implications of concepts originated in object relations theory in art therapy students' and clinicians' identity development. Through the lens of object relations theory, students considered how the personal informs the professional, as reflected in assemblage and artwork inspired by personal or found objects. Through their own creative expression, students learned how to apply object relations theory beyond its original formulation, and how their artwork acts as a transitional object between their personal history and professional individuation. read more The authors explore how creative expression may serve as a bridge between these two aspects of the self, thus facilitating an educated and creatively informed personal/professional integration in the process of clinical training and practice.In psychoanalytic discourse, the question of meaning or lack thereof should be relegated only to the domain of the interlocutor's perception. Not every slip of the tongue or bungled action is necessarily precipitated by some unconscious motivation, although one may construct meaning for it après coup (Nachträglichkeit). What is a message versus a noise depends on the perceptual experience of the analytic couple, and a cigar, if not just a cigar, depends on the context-specific fantasy of the perceiver. The author's aim is to show the difficulty of distinguishing the noise from the message in the interactive matrix of the analytic situation. Yet what at first may seem to be a banal error such as double-booking may at times enliven a stultified course of the analytic process; it may even drag a stillborn transference out of its embalmed closet.The author explores the idea that psychoanalysis is a process that facilitates, for some patients, the emergence of an ungovernable self. To make this case, Agamben's notion of the ungovernable self and its relation to potentiality-actuality, excess, and inoperativity are explained in light of psychosocial development. It is argued that the seeds of the ungovernable self lie within the parent-infant space of speaking and acting together, wherein good-enough parents' personalizing attunements to infants' assertions facilitate children's sense of singularity that is not contingent on social-political apparatuses. link2 This space of suchness provides a secure base for children's transition to political spaces. From here, the argument shifts to the psychoanalytic process, which (1) affirms the singularity of the individual while engaging in inquiry into and exploration of the patient's life; (2) possesses a key premise of the excess of the "unconscious"; and (3) fosters the exercise of ungovernable selves.
Restriction spectrum imaging-magnetic resonance imaging is a short duration enhanced diffusion-weighted technique that seeks to standardize sequences and predict upgrading. We test this technology for active surveillance biopsies. Our objective is to investigate the utility of restriction spectrum imaging-magnetic resonance imaging to improve upgrading detection in a prostate cancer active surveillance cohort.
We prospectively enrolled men on active surveillance undergoing repeat biopsy from January 2016 to June 2019. Subjects underwent prostate multiparametric magnetic resonance imaging and restriction spectrum imaging-magnetic resonance imaging reviewed by a urological radiologist for PI-RADS® scored lesions, followed by magnetic resonance imaging-guided prostate biopsy by a urologist. Restriction spectrum imaging-magnetic resonance imaging analysis with proprietary research software (CorTechs Labs, San Diego, California) generated a restricted signal map. link3 We compared the restricted signal map and appar PI-RADS system by providing a noninvasive radiological biomarker to predict upgrading in active surveillance.
Restriction spectrum imaging-magnetic resonance imaging enhances the standard PI-RADS system by providing a noninvasive radiological biomarker to predict upgrading in active surveillance.
Holmium laser enucleation of the prostate has proven to be efficacious and safe for the treatment of benign prostatic hyperplasia. New laser technologies, such as the MOSES™ pulse laser system, improve energy delivery and may improve operative times. We sought to prospectively evaluate holmium laser enucleation of the prostate using MOSES technology in a double-blind randomized controlled trial.
This is a single-center, prospective, double-blind, randomized controlled trial comparing holmium laser enucleation of the prostate using MOSES technology to holmium laser enucleation of the prostate. Patients were randomized in a 11 fashion. The study was powered to evaluate for a difference in operative time. Secondary end points included enucleation, morcellation, and hemostasis times, as well as blood loss, functional outcomes and complications 6 weeks postoperatively.
A total of 60 patients were analyzed without difference in preoperative characteristics in either group (holmium laser enucleation of the pro laser enucleation of the prostate. MOSES technology resulted in an improvement in operative time and a reduction in blood loss with comparable functional outcomes and complications compared to traditional holmium laser enucleation of the prostate.
We report the results of a prospective, double-blind, randomized controlled trial comparing holmium laser enucleation of the prostate using MOSES technology to traditional holmium laser enucleation of the prostate. MOSES technology resulted in an improvement in operative time and a reduction in blood loss with comparable functional outcomes and complications compared to traditional holmium laser enucleation of the prostate.
Noninvasive tests that can accurately detect prostate cancer are urgently needed for prostate cancer diagnosis, surveillance and prognosis. Exfoliated prostate cells captured in urine represent a promising resource for noninvasive detection of prostate cancer. We investigated performance of a novel cell-based urine test for detection of clinically significant prostate cancer.
We previously developed a multiplex RNA in situ hybridization assay targeting NKX3-1, PRAC1 and PCA3 that enables identification and quantification of malignant and benign prostate cells released into urine. We investigated application of the assay for prostate cancer detection in a cohort of 98 patients suspected of harboring prostate cancer. Urine was collected following digital rectal examination, and the sediment was isolated and evaluated by RNA in situ hybridization. Samples were scored based on cellular expression of RNA in situ hybridization targets. Cells of prostate origin were defined by positivity for NKX3-1 and/or PRAC1, and prostate cancer cells by positivity for PCA3.
Prostate cells (NKX3-1/PRAC1+ cells) were detected in 69 samples, among which 20 were positive for PCA3 (ie positive for prostate cancer cells). Comparison of RNA in situ hybridization results with biopsy outcome and clinical variables revealed that positivity for cancer by RNA in situ hybridization significantly correlated with intermediate/high risk cancer (p=0.003), PSA density (p=0.022), significant disease (p <0.0001) and Gleason score (p=0.003). The test was 95% specific and 51% sensitive for detection of clinically significant prostate cancer.
Identification of exfoliated prostate cancer cells in urine by RNA in situ hybridization provides a novel tool for highly specific and noninvasive detection of prostate cancer.
Identification of exfoliated prostate cancer cells in urine by RNA in situ hybridization provides a novel tool for highly specific and noninvasive detection of prostate cancer.
We sought to determine the optimal cystoscopic interval for intermediate risk, nonmuscle invasive bladder cancer.
A retrospective analysis of patients with intermediate risk, nonmuscle invasive bladder cancer (2010-2017) was performed and 3 hypothetical models of surveillance intensity were applied model 1 high (3 months), model 2 moderate (6 months) and model 3 low intensity (12 months) over a 2-year period. We compared timing of actual detection of recurrence and progression to proposed cystoscopy timing between each model. We calculated number of avoidable cystoscopies and associated costs.
Of 107 patients with median followup of 37 months, 66/107 (77.6%) developed recurrence and 12/107(14.1%) had progression. Relative to model 1, there were 33 (50%) delayed detection of recurrences in model 2 and 41 (62%) in model 3. There was a 1.7-month mean delay in detection of recurrence for model 1 vs 3.2, and a 7.6-month delay for models 2 and 3 (p <0.001 model 1 vs 2; p <0.001 model 2 vs 3). Relative ttection without oncologic compromise and is less costly with fewer cystoscopies.
We sought to identify and validate known predictors of disease reclassification at 1 or 4 years to support risk-based selection of patients suitable for active surveillance.
An individual participant data meta-analysis using data from 25 established cohorts within the Movember Foundations GAP3 Consortium. In total 5,530 men were included. Disease reclassification was defined as any increase in Gleason grade group at biopsy at 1 and 4 years. Associations were estimated using random effect logistic regression models. The discriminative ability of combinations of predictors was assessed in an internal-external validation procedure using the AUC curve.
Among the 5,570 men evaluated at 1 year, we found 815 reclassifications to higher Gleason grade group at biopsy (pooled reclassification rate 13%, range 0% to 31%). Important predictors were age, prostate specific antigen, prostate volume, T-stage and number of biopsy cores with prostate cancer. Among the 1,515 men evaluated at 4 years, we found 205 reclassifveillance.
Men with nonseminomatous germ cell tumors of the testicle without evidence of residual disease after radical orchiectomy (clinical stage I) are increasingly managed with active surveillance. The guideline-recommended cornerstones of surveillance are conventional serum tumor markers and computerized tomography. The reliability of serum tumor markers as a tool to diagnose early recurrence of clinical stage I nonseminomatous germ cell tumors is unclear. The study objective was to conduct a systematic review of the currently available evidence assessing the reliability of serum tumor markers as a test to diagnose recurrence in patients with clinical stage I nonseminomatous germ cell tumors under active surveillance.
A systematic review was conducted in accordance with PRISMA guidelines, with no language or date restrictions. Studies were included that readily identified the tumor marker status of patients with clinical stage I nonseminomatous germ cell tumors who had a recurrence on active surveillance. The primary outcome was marker positivity at the time of recurrence.