Vegetation-environment relationship in conifer dominating forests of the mountainous range of Indus Kohistan in northern Pakistan

Environmental variables play a crucial role in shaping vegetation structure,mainly in mountainous ecosystems.Different studies have attempted to identify the environment-vegetation relationship of Conifer Dominating Forests(CDF)worldwide.However,due to differences in local climate and soil composition,different environmental drivers can be found.By applying multivariate analysis techniques,this study investigated the vegetation-environment relationship of CDF of Indus Kohistan in northern Pakistan.Our results showed that CDF of Indus Kohistan are distributed in five distinct ecological groups,which are dominated by different trees and understory species.A total of 7 trees and 71 understory species were recorded from the sampling sites.Cedrus deodara was the leading species among four groups,having the highest importance value(IV),density and basal area.Group I was dominated by Pinus wallichiana with the second highest importance value,density and basal area.In addition,elevation,slope,maximum water holding capacity(MWHC),soil moisture(SM),total organic matter(TOM),sodium,phosphorus and nickel showed highly significant influence on composition and distribution pattern of Indus Kohistan vegetation.Therefore,this study shows a new evidence of vegetation-environment relationship,pointing out specific drivers of vegetation structure in CDF of Indus Kohistan region in northern Pakistan.

Role of multi-parametric MRI of the prostate for screening and staging:Experience with over 1500 cases

Objective:Contemporary prostate cancer(PCa)screening modalities such as prostate specific antigen(PSA)and digital rectal examination(DRE)are limited in their ability to predict the detection of clinically significant disease.Multi-parametric magnetic resonance imaging(mpMRI)of the prostate has been explored as a staging modality for PCa.Less is known regarding its utility as a primary screening modality.We examined our experience with mpMRI as both a screening and staging instrument.Methods:mpMRI studies performed between 2012 and 2014 in patients without PCa were cross-referenced with transrectal ultrasonography(TRUS)biopsy findings.Statistical analyses were performed to determine association of mpMRI findings with overall cancer diagnoses and clinically significant(Gleason score≥7)disease.Subgroup analyses were then performed on patients with a history of prior negative biopsy and those without a history of TRUS biopsy.mpMRI studies were also cross-referenced with RP specimens.Statistical analyses determined predictive ability of extracapsular extension(ECE),seminal vesicle involvement(SVI),and pathologic evidence of clinically significant disease(Gleason score
7).Results:Four hundred biopsy naive or prior negative biopsy patients had positive mpMRI studies.Overall sensitivity,specificity,positive and negative predictive values were 94%,37%,58%,and 87%,respectively and 95%,31%,42%,and 93%,respectively for overall cancer detection and Gleason score≥7 disease.In patients with no prior biopsy history,mpMRI sensitivity,specificity,positive and negative predictive values were 94%,36%,65%,and 82%,for all cancers,and 95%,30%,50%,and 89%for Gleason score
7 lesions,respectively.In those with prior negative biopsy sensitivity,specificity,positive and negative predictive values were 94%,37%,52%,and 90% for all cancers,and 96%,32%,36%,and 96% for Gleason score
7 lesions,respectively.Seventy-four patients underwent radical prostatectomy(RP)after mpMRI.Lesion size on mpMRI correlated with the presence of Gleason score
7 cancers(p Z 0.005).mpMRI sensitivity,specificity,positive and negative predictive values were 84%,39%,81%,and 44% respectively,for Gleason
7 cancer.For ECE and SVI,sensitivity and specificity were 58% and 98% and 44% and 97%,respectively.Conclusion:mpMRI is an accurate predictor of TRUS biopsy and RP outcomes.mpMRI has significant potential to change PCa management,particularly in the screening population,in whom a significant proportion may avoid TRUS biopsy.Further studies are necessary to determine how mpMRI should be incorporated into the current PCa screening and staging paradigms.

Multi-parametric MRI of the prostate:Factors predicting extracapsular extension at the time of radical prostatectomy

Objective:Extracapsular extension(ECE)of prostate cancer is a poor prognostic factor associated with progression,recurrence after treatment,and increased prostate cancer-related mortality.Accurate staging prior to radical prostatectomy is crucial in avoidance of positive margins and when planning nerve-sparing procedures.Multi-parametric magnetic resonance imaging(mpMRI)of the prostate has shown promise in this regard,but is hampered by poor sensitivity.We sought to identify additional clinical variables associated with pathologic ECE and determine our institutional accuracy in the detection of ECE amongst patients who went on to radical prostatectomy.Methods:mpMRI studies performed between the years 2012 and 2014 were cross-referenced with radical prostatectomy specimens.Predictive properties of ECE as well as additional clinical and biochemical variables to identify pathology-proven prostate cancer ECE were analyzed.Results:The prevalence of ECE was 32.4%,and the overall accuracy of mpMRI for ECE was 84.1%.Overall mpMRI sensitivity,specificity,positive predictive value,and negative predictive value for detection of ECE were 58.3%,97.8%,93.3%,and 81.5%,respectively.Specific mpMRI characteristics predictive of pathologic ECE included primary lesion size((20.73±9.09)mm,mean±SD,p<0.001),T2 PIRADS score(p=0.009),overall primary lesion score(p<0.001),overall study suspicion score(p=0.003),and MRI evidence of seminal vesicle invasion(SVI)(p=0.001).