External validation of nomograms including MRI features for the prediction of side-specific extraprostatic extension

BACKGROUND

Prediction of side-specific extraprostatic extension (EPE) is crucial in selecting patients for nerve-sparing radical prostatectomy (RP). Multiple nomograms, which include magnetic resonance imaging (MRI) information, are available predict side-specific EPE. It is crucial that the accuracy of these nomograms is assessed with external validation to ensure they can be used in clinical practice to support medical decision-making.

METHODS

Data of prostate cancer (PCa) patients that underwent robot-assisted RP (RARP) from 2017 to 2021 at four European tertiary referral centers were collected retrospectively. Four previously developed nomograms for the prediction of side-specific EPE were identified and externally validated. Discrimination (area under the curve [AUC]), calibration and net benefit of four nomograms were assessed. To assess the strongest predictor among the MRI features included in all nomograms, we evaluated their association with side-specific EPE using multivariate regression analysis and Akaike Information Criterion (AIC).

RESULTS

This study involved 773 patients with a total of 1546 prostate lobes. EPE was found in 338 (22%) lobes. The AUCs of the models predicting EPE ranged from 72.2% (95% CI 69.1-72.3%) (Wibmer) to 75.5% (95% CI 72.5-78.5%) (Nyarangi-Dix). The nomogram with the highest AUC varied across the cohorts. The Soeterik, Nyarangi-Dix, and Martini nomograms demonstrated fair to good calibration for clinically most relevant thresholds between 5 and 30%. In contrast, the Wibmer nomogram showed substantial overestimation of EPE risk for thresholds above 25%. The Nyarangi-Dix nomogram demonstrated a higher net benefit for risk thresholds between 20 and 30% when compared to the other three nomograms. Of all MRI features, the European Society of Urogenital Radiology score and tumor capsule contact length showed the highest AUCs and lowest AIC.

CONCLUSION

The Nyarangi-Dix, Martini and Soeterik nomograms resulted in accurate EPE prediction and are therefore suitable to support medical decision-making.

Thresholdless stochastic particle heating by a single wave

Stochastic heating is a well-known mechanism through which magnetized particles may be energized by low-frequency electromagnetic waves. In its simplest version, under spatially homogeneous conditions, it is known to be operative only above a threshold in the normalized wave amplitude, which may be a demanding requisite in actual scenarios, severely restricting its range of applicability. In this paper we show, by numerical simulations supported by inspection of the particle Hamiltonian, that allowing for even a very weak spatial inhomogeneity completely removes the threshold, trading the requirement upon the wave amplitude with a requisite upon the duration of the interaction between the wave and particle. The thresholdless chaotic mechanism considered here is likely to be applicable to other inhomogeneous systems.

Internal Transport Barrier Broadening through Subdominant Mode Stabilization in Reversed Field Pinch Plasmas

The reversed field pinch (RFP) device RFX-mod features strong internal transport barriers when the plasma accesses states with a single dominant helicity. Such transport barriers enclose a hot helical region with high confinement whose amplitude may vary from a tiny one to an amplitude encompassing an appreciable fraction of the available volume. The transition from narrow to wide thermal structures has been ascribed so far to the transport reduction that occurs when the dominant mode separatrix, which is a preferred location for the onset of stochastic field lines, disappears. In this Letter we show instead that the contribution from the separatrix disappearance, by itself, is marginal and the main role is instead played by the progressive stabilization of secondary modes. The position and the width of the stochastic boundary encompassing the thermal structures have been estimated by applying the concept of a 3D quasiseparatrix layer, developed in solar physics to treat reconnection phenomena without true separatrices and novel to toroidal laboratory plasmas. Considering the favorable scaling of secondary modes with the Lundquist number, these results open promising scenarios for RFP plasmas at temperatures higher than the presently achieved ones, where lower secondary modes and, consequently, larger thermal structures are expected. Furthermore, this first application of the quasiseparatrix layer to a toroidal plasma indicates that such a concept is ubiquitous in magnetic reconnection, independent of the system geometry under investigation.

Alfvénic propagation: a key to nonlocal effects in magnetized plasmas

A long-standing puzzle in fusion research comes from experiments where a sudden peripheral electron temperature perturbation is accompanied by an almost simultaneous opposite change in central temperature, in a way incompatible with local transport models. This Letter shows that these experiments and similar ones are fairly well quantitatively reproduced, when induction effects are incorporated in the total plasma response, alongside standard local diffusive transport, as suggested in earlier work [Plasma Phys. Controlled Fusion 54, 124036 (2012).

Experimental observation of microtearing modes in a toroidal fusion plasma

Experimental evidences of short wavelength electromagnetic modes are found in the reversed-field-pinch configuration device RFX-mod by means of in-vessel magnetic probes. The modes are revealed during the helical states of the plasma. Their amplitude is well correlated to the electron temperature gradient strength in the core. On the basis of linear gyrokinetic calculations we interpret these instabilities as microtearing modes.

Calculation of transport coefficient profiles in modulation experiments as an inverse problem

The calculation of transport profiles from experimental measurements belongs in the category of inverse problems which are known to come with issues of ill-conditioning or singularity. A reformulation of the calculation, the matricial approach, is proposed for periodically modulated experiments, within the context of the standard advection-diffusion model where these issues are related to the vanishing of the determinant of a 2×2 matrix. This sheds light on the accuracy of calculations with transport codes, and provides a path for a more precise assessment of the profiles and of the related uncertainty.

Microtearing modes in reversed field pinch plasmas

In the reversed field pinch RFX-mod strong electron temperature gradients develop when the single-helical-axis regime is achieved. Gyrokinetic calculations show that in the region of the strong temperature gradients microtearing instabilities are the dominant turbulent mechanism acting on the ion Larmor radius scale. The quasilinear evaluation of the electron thermal conductivity is in good agreement with the experimental estimates.

When can the Fokker-Planck equation describe anomalous or chaotic transport?

The Fokker-Planck equation, applied to transport processes in fusion plasmas, can model several anomalous features, including uphill transport, scaling of confinement time with system size, and convective propagation of externally induced perturbations. It can be justified for generic particle transport provided that there is enough randomness in the Hamiltonian describing the dynamics. Then, except for 1 degree of freedom, the two transport coefficients are largely independent. Depending on the statistics of interest, the same dynamical system may be found diffusive or dominated by its Lévy flights.

Statistical model for intermittent plasma edge turbulence

The probability distribution function of plasma density fluctuations at the edge of fusion devices is known to be skewed and strongly non-Gaussian. The causes of this peculiar behavior are, up to now, largely unexplored. On the other hand, understanding the origin and the properties of edge turbulence is a key issue in magnetic fusion research. In this paper we show that a stochastic fragmentation model, already successfully applied to fluid turbulence, is able to predict an asymmetric distribution that closely matches experimental data. The asymmetry is found to be a direct consequence of intermittency. A discussion of our results in terms of recently suggested Bramwell-Holdsworth-Pinton universal curve [S. T. Bramwell, P. C. W. Holdsworth, and J.-F. Pinton, Nature (London) 396, 552 (1998)], that should hold for strongly correlated and critical systems, is also proposed.

Experimental and simulated neon spectra in the 10-nm wavelength region from tokamak and reversed field pinch plasmas

Experimental neon spectra (in the 10-nm region), from the tokamak Tore Supra and the reversed field pinch experiment RFX, have been simulated. The spectra include lines from three neon ionization states, namely Ne(7+), Ne(6+), and Ne(5+) ions. Collisional radiative models have been built for these three Ne ions, considering electron collisional excitation and radiative decay as populating processes of the excited states. These models give photon emission coefficients for the emitted lines at electron density and temperature values corresponding to the experimental situations. Impurity modelling is performed using a one-dimensional impurity transport code, calculating the steady-state radial distribution of the Ne ions. The Ne line brightnesses are evaluated in a post-process subroutine and simulated spectra are obtained. The parts of the spectra corresponding to a single ionization state do not depend on the experimental conditions and show good agreement with the simulated single ionization state spectra. On the other hand, the superposition of the three spectra depends on the experimental conditions, as a consequence of the fact that the ion charge distribution depends not only on the radial profiles of the electron density and temperature, but also of the impurity transport coefficients. Simulations of the Ne spectra (including transport) give confidence in the atomic physics calculations; moreover, they allow the determination of the transport coefficients in the plasma region emitting the considered ionization states.