Citations

Importance Multiparametric magnetic resonance imaging (MRI), with or without prostate biopsy, has become the standard of care for diagnosing clinically significant prostate cancer. Resource capacity limits widespread adoption. Biparametric MRI, which omits the gadolinium contrast sequence, is a shorter and cheaper alternative offering time-saving capacity gains for health systems globally. Objective To assess whether biparametric MRI is noninferior to multiparametric MRI for diagnosis of clinically significant prostate cancer. Design, Setting, and Participants A prospective, multicenter, within-patient, noninferiority trial of biopsy-naive men from 22 centers (12 countries) with clinical suspicion of prostate cancer (elevated prostate-specific antigen [PSA] level and/or abnormal digital rectal examination findings) from April 2022 to September 2023, with the last follow-up conducted on December 3, 2024. Interventions Participants underwent multiparametric MRI, comprising T2-weighted, diffusion-weighted, and dynamic contrast–enhanced (DCE) sequences. Radiologists reported abbreviated biparametric MRI first (T2-weighted and diffusion-weighted), blinded to the DCE sequence. After unblinding, radiologists reported the full multiparametric MRI. Patients underwent a targeted biopsy with or without systematic biopsy if either biparametric MRI or multiparametric MRI was suggestive of clinically significant prostate cancer. Main outcomes and measures The primary outcome was the proportion of men with clinically significant prostate cancer. Secondary outcomes included the proportion of men with clinically insignificant cancer. The noninferiority margin was 5%. Results Of 555 men recruited, 490 were included for primary outcome analysis. Median age was 65 (IQR, 59-70) years and median PSA level was 5.6 (IQR, 4.4-8.0) ng/mL. The proportion of patients with abnormal digital rectal examination findings was 12.7%. Biparametric MRI was noninferior to multiparametric MRI, detecting clinically significant prostate cancer in 143 of 490 men (29.2%), compared with 145 of 490 men (29.6%) (difference, −0.4 [95% CI, −1.2 to 0.4] percentage points; P = .50). Biparametric MRI detected clinically insignificant cancer in 45 of 490 men (9.2%), compared with 47 of 490 men (9.6%) with the use of multiparametric MRI (difference, −0.4 [95% CI, −1.2 to 0.4] percentage points). Central quality control demonstrated that 99% of scans were of adequate diagnostic quality. Conclusion and relevance In men with suspected prostate cancer, provided image quality is adequate, an abbreviated biparametric MRI scan, with or without targeted biopsy, could become the new standard of care for prostate cancer diagnosis. With approximately 4 million prostate MRIs performed globally annually, adopting biparametric MRI could substantially increase scanner throughput and reduce costs worldwide. Trial registration ClinicalTrials.gov Identifier: NCT04571840

Abstract Objectives The aim of this study was to compare the measured physiological factors that limit running performance with real marathon results from world-class distance runners, evaluating the compatibility between measured data and predicted results based on the previously suggested model. Methods Four world-class East African marathon runners (three male, one female) underwent physiological running assessments to predict marathon performance times using a model based on V ˙ $\dot {\mathrm{V}}$ O 2 peak, percentage of V ˙ $\dot {\mathrm{V}}$ O 2 peak at the second ventilatory threshold, and running economy. Predictions were then compared to participants’ best marathon times. Results The measured V ˙ $\dot {\mathrm{V}}$ O 2 peak of the world-class runners was 75.1 ± 2.7 mL/kg/min. The second ventilatory threshold occurred at 85 ± 3 % of the peak, with a running economy of 63.7 ± 2.4 mL/kg/min at 19.6 ± 0.9 km/h. The predicted marathon performance time was 2:06:51 ± 0:03:17 h:min:s for the males and 2:17:36 h:min:s for the female. Comparing these predictions to their personal best times, the average difference was 00:55 ± 00:51 min:s (range: 00:20-02:08). Conclusions This research provides laboratory data on world-class road running athletes, reinforcing the link between marathon performance and V ˙ $\dot {\mathrm{V}}$ O 2 peak, the percentage of V ˙ $\dot {\mathrm{V}}$ O 2 peak at the second ventilatory threshold, and running economy. The examined athletes had lower V ˙ $\dot {\mathrm{V}}$ O 2 peak compared to predicted values, highlighting the importance of running economy and fractional utilization of V ˙ $\dot {\mathrm{V}}$ O 2 peak in achieving such performances. Future studies should continue to advance the field by including additional bioenergetic parameters measured during race conditions and expanding the participant cohort of elite marathoners, encompassing both sexes.

We report the case of a healthcare worker who presented with a large vessel acute ischemic stroke in setting of a mild SARS-CoV-2 infection and provide a review of the emerging literature on COVID-related stroke. A 43-year-old female presented with right-sided hemiparesis, aphasia and dysarthria. She had a nonproductive of cough for 1 week without fever, fatigue or dyspnea. A CT Head, CT angiography and CT perfusion imaging revealed a M1 segment occlusion of the left middle cerebral artery requiring transfer from a primary to a comprehensive stroke center. A nasopharyngeal swab confirmed SARS-CoV-2 infection prior to arrival at the accepting center. During the thrombectomy a 3 cm thrombus was removed. Thrombus was also evident in the 8 French short sheath during closure device placement so a hypercoagulable state was suspected. Stroke work-up revealed a glycosylated hemoglobin of 8.7%, elevation of inflammatory markers and an indeterminate level of lupus anticoagulant IgM. On discharge home, she had near complete neurological recovery. This case highlights suspected mechanisms of hypercoagulability in SARS-CoV-2 infection and the importance of optimizing stroke care systems during the COVID-19 pandemic.