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Abstract Objectives To compare overall agreement between magnetic resonance imaging (MRI)–ultrasound (US) fusion biopsy (FB) and MRI cognitive fusion biopsy (CB) of the prostate and determine which factors affect agreement for prostate cancer (PCa) who underwent both modalities in a prospective within‐patient protocol. Patients and Methods From August 2017 to January 2021, patients with at least one Prostate Imaging Reporting & Data System (PI‐RADS) 3 or higher lesion on multiparametric MRI underwent transrectal FB and CB in a prospective within‐patient protocol. CB was performed for each region of interest (ROI), followed by FB, followed by standard 12 core biopsy. Patients who were not on active surveillance were analysed. The primary endpoint was agreement for any PCa detection. McNemar's test and kappa statistic were used to analyse agreement. Chi‐square test, Fisher's exact test and Wilcoxon rank sum test were used to analyse disagreement across clinical and MRI spatial variables. A multivariable generalized mixed‐effect model was used to compare the interaction between select variables and fusion modality. Statistics were performed using SAS and R. Results Ninety patients and 98 lesions were included in the analysis. There was moderate agreement between FB and CB (k = 0.715). McNemar's test was insignificant (p = 0.285). Anterior location was the only variable associated with a significant variation in agreement, which was 70% for anterior lesions versus 89.7% for non‐anterior lesions (p = 0.035). Discordance did not vary significantly across other variables. In a mixed‐effect model, the interaction between anterior location and use of FB was insignificant (p = 0.411). Conclusion In a within‐patient protocol of patients not on active surveillance, FB and CB performed similarly for PCa detection and with moderate agreement. Anterior location was associated with significantly higher disagreement, whereas other patient and lesion characteristics were not. Additional studies are needed to determine optimal biopsy technique for sampling anterior ROI.

What does the visual culture of early modern England, and the ways in which that culture articulated specific notions of corporeality, tell us about the actor’s body on Shakespeare’s stage? This article locates one answer to that question in the popular emblem books and the somewhat more rarefied cosmographical treatises of the day. Digging in these sources reveals an understanding of the body that is grounded first and foremost in corporeality – the body, before it was anything else, was matter. As such, I argue that the actor’s body on the early modern stage served as an instance of irrefutable and irreducible materiality, ‘lending’ its materiality to the abstractions and absences that Shakespeare’s theatre so readily ‘bodied forth.’ However, as a wealth of scholarship on the body has suggested over the past few decades, things are not this simple. The body appears in these arenas as a very specific kind of matter, and matter itself is shown to have a complex relationship to ‘form’, or the immaterial realities of life. I argue here that the nature of the body-as-matter, and indeed of matter itself, is fruitfully understood in terms of two related early modern concepts: prima materia, and man as microcosm. These ideas were most in circulation in the distinct but kindred fields of alchemy and cosmography, and their visual manifestations offer a perspective on the theatrical body that does not reduce the body to simplematter, but still acknowledges its profound materiality, and the effect that the body-as-matter has on stage-work as a whole.

BackgroundThe optimal surgical approach for management of acute type A aortic dissection remains controversial. This study aimed to assess outcomes of reoperation after acute type A dissection repair to help guide decision making around index operative strategy. Methods and ResultsAll aortic reoperations (n=129) at a single referral institution from August 2005 to April 2016 after prior acute type A dissection repair were reviewed. The primary outcome was 30‐day or in‐hospital mortality. Secondary outcomes included organ‐specific morbidity and 1‐ and 5‐year outcomes as estimated using the Kaplan–Meier method. The majority of initial reoperations were proximal aortic (aortic valve, aortic root, or ascending) or aortic arch procedures (62.5%, n=55); most initial reoperations were performed in the elective setting (83.1%, n=74). Additional nonstaged second or more reoperations were required in 21 patients (23.6%) after the initial reoperation, during a median follow‐up of 2.5 years after the initial reoperation. Thirty‐day or in‐hospital mortality for all reoperations was 7.0% (elective: 6.3%; nonelective: 11.1%) with acceptable rates of organ‐specific morbidity, given the procedural complexity. One‐ and 5‐year overall survival after initial reoperation was 85.9% and 64.9%, respectively, with aorta‐specific survival of 88% at 5 years. ConclusionsReoperation after acute type A aortic dissection repair is associated with low rates of mortality and morbidity. These data support more limited index repair for acute type A dissection, especially for patients undergoing index repair in lower volume centers without expertise in extensive repair, because reoperations, if needed, can be performed safely in referral aortic centers.

Objective: To present the case of recurrent rhabdomyolysis in an active female Background: A healthy 21 year old female developed severe fatigue and peripheral edema in the upper extremities after an extreme exercise workout session. 4 ½ months later she participated in a similar exercise session with a personal trainer and experienced the same symptoms. Differential Diagnosis: In the initial case, upon physical examination and review of blood work a diagnosis of rhabdomyolysis was made. After the second exercise session athlete was diagnosed with recurrent rhabdomyolysis and was advised to seek treatment at the local emergency room. Treatment: In the initial case the athlete was told by medical personnel to increase fluid intake and rest. In the second case athlete was treated at the emergency room with IV fluids. Uniqueness: The athlete was female, and most cases of rhabdomyolysis occur in males. Athlete was treated for rhabdomyolysis and recurrent rhabdomyolysis, however these diagnosis were made 4 ½ months apart. Also, both cases appear to be the result of the same type of exercise session. Conclusion: There does not appear to be a definitive protocol for an accurate diagnosis of rhabdomyolysis. Guidelines for return to activity should be evaluated on a case by case basis, and a conservative increase in intensity of exercise is warranted to prevent a case of recurrent rhabdomyolysis.