Valutazione dello stato morfologico ed ecologico di corsi d'acqua alpini: utilizzo e confronto dell'indice di qualità morfologica (IQM) e di un indice basato sugli odonati

This thesis deals with the assesment of morphological and ecological conditions of six Italian alpine rivers. Odonata (dragonflies) were chosen as bioindicators to assess the ecological status of river corridors while the assessment of th morphological status of the study cases was performed by using the Morphological Quality Index (MQI) Dragonflies demonstrated to be an effective bioindicator. The results also indicated a significant correlation between MQI and OQI and demonstrated the importance of river processes as drivers for the maintenance of a high diversity of habitats and species within the river corridor

PSMA PET for the Evaluation of Liver Metastases in Castration-Resistant Prostate Cancer Patients: A Multicenter Retrospective Study

Simple Summary Visceral involvement in prostate cancer (PCa) represents a negative prognostic factor. Liver metastases typically occur in systemic, late-stage, castration-resistant prostate cancer (CRPC). The diagnostic performance of [68Ga]Ga-PSMA-11-PET for visceral metastases of CRPC patients has never been systematically assessed. Our aim was to evaluate the diagnostic performance of PSMA-PET compared to conventional imaging, i.e., CT or MRI, or liver biopsy in the detection of liver metastases in CRPC patients. The secondary aim was to assess the ability of radiomics to predict the presence of liver metastases. Regarding liver metastases assessment in CRPC patients, [68Ga]-PSMA-11-PET demonstrated moderate sensitivity while high specificity, positive predictive value, and reproducibility compared to conventional imaging and liver biopsy. However, nuclear medicine physicians should carefully assess the liver parenchyma on PET images, especially in patients at higher risk for liver metastases and with high PSA values. Moreover, radiomic features may aid in recognizing higher-risk patients to develop them. Background: To evaluate the diagnostic performance of PSMA-PET compared to conventional imaging/liver biopsy in the detection of liver metastases in CRPC patients. Moreover, we evaluated a PSMA-PET/CT-based radiomic model able to identify liver metastases. Methods: Multicenter retrospective study enrolling patients with the following inclusion criteria: (a) proven CRPC patients, (b) PSMA-PET and conventional imaging/liver biopsy performed in a 6 months timeframe, (c) no therapy changes between PSMA-PET and conventional imaging/liver biopsy. PSMA-PET sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for liver metastases were calculated. After the extraction of radiomic features, a prediction model for liver metastases identification was developed. Results: Sixty CRPC patients were enrolled. Within 6 months before or after PSMA-PET, conventional imaging and liver biopsy identified 24/60 (40%) patients with liver metastases. PSMA-PET sensitivity, specificity, PPV, NPV, and accuracy for liver metastases were 0.58, 0.92, 0.82, 0.77, and 0.78, respectively. Either number of liver metastases and the maximum lesion diameter were significantly associated with the presence of a positive PSMA-PET (p < 0.05). On multivariate regression analysis, the radiomic feature-based model combining sphericity, and the moment of inverse difference (Idm), had an AUC of 0.807 (95% CI:0.686-0.920). Conclusion: For liver metastases assessment, [68Ga]Ga-PSMA-11-PET demonstrated moderate sensitivity while high specificity, PPV, and inter-reader agreement compared to conventional imaging/liver biopsy in CRPC patients

Consensus recommendations of three-dimensional visualization for diagnosis and management of liver diseases

Three-dimensional (3D) visualization involves feature extraction and 3D reconstruction of CT images using a computer processing technology. It is a tool for displaying, describing, and interpreting 3D anatomy and morphological features of organs, thus providing intuitive, stereoscopic, and accurate methods for clinical decision-making. It has played an increasingly significant role in the diagnosis and management of liver diseases. Over the last decade, it has been proven safe and effective to use 3D simulation software for pre-hepatectomy assessment, virtual hepatectomy, and measurement of liver volumes in blood flow areas of the portal vein; meanwhile, the use of 3D models in combination with hydrodynamic analysis has become a novel non-invasive method for diagnosis and detection of portal hypertension. We herein describe the progress of research on 3D visualization, its workflow, current situation, challenges, opportunities, and its capacity to improve clinical decision-making, emphasizing its utility for patients with liver diseases. Current advances in modern imaging technologies have promised a further increase in diagnostic efficacy of liver diseases. For example, complex internal anatomy of the liver and detailed morphological features of liver lesions can be reflected from CT-based 3D models. A meta-analysis reported that the application of 3D visualization technology in the diagnosis and management of primary hepatocellular carcinoma has significant or extremely significant differences over the control group in terms of intraoperative blood loss, postoperative complications, recovery of postoperative liver function, operation time, hospitalization time, and tumor recurrence on short-term follow-up. However, the acquisition of high-quality CT images and the use of these images for 3D visualization processing lack a unified standard, quality control system, and homogeneity, which might hinder the evaluation of application efficacy in different clinical centers, causing enormous inconvenience to clinical practice and scientific research. Therefore, rigorous operating guidelines and quality control systems need to be established for 3D visualization of liver to develop it to become a mature technology. Herein, we provide recommendations for the research on diagnosis and management of 3D visualization in liver diseases to meet this urgent need in this research field

Textbook Outcome After Trans-arterial Chemoembolization for Hepatocellular Carcinoma

PurposeTextbook Outcome (TO) is inclusive of quality indicators and it not been provided for trans-arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).Materials and methodsData on treatment-naïve HCC patients receiving TACE from 10 centers were reviewed. TO was defined as "no post-TACE grade 3-4 complications, no prolonged hospital stay (defined as a post-procedure stay ≤ 75th percentile of the median values from the total cohort), no 30-day mortality/readmission and the achievement of an objective response (OR) at post-TACE imaging." Grade of adverse event was classified according to the Common Terminology Criteria for Adverse Events and short-term efficacy was assessed by response. Pooled estimates were calculated to account for hospital's effect and risk-adjustment was applied to allow for diversity of patients in each center.ResultsA total of 1124 patients (2014-2018) fulfilling specific inclusion criteria were included. Baseline clinical features showed considerable heterogeneity (I2 > 0.75) across centers. TACE-related mortality was absent in 97.6%, readmission was not required after 94.9% of procedures, 91.5% of patients had no complication graded 3-4, 71.8% of patients did not require prolonged hospitalization, OR of the target lesion was achieved in 68.5%. Risk-adjustment showed that all indicators were achieved in 43.1% of patients, and this figure was similar across centers. The median overall survival for patients who achieved all indicators was 33.1 months, 11.9 months longer than for patients who did not.ConclusionsA useful benchmark for TACE in HCC patients has been developed, which provides an indication of survival and allows for a comparison of treatment quality across different hospitals

Reliability of human retina organoid generation from hiPSC-derived neuroepithelial cysts

The possible applications for human retinal organoids (HROs) derived from human induced pluripotent stem cells (hiPSC) rely on the robustness and transferability of the methodology for their generation. Standardized strategies and parameters to effectively assess, compare, and optimize organoid protocols are starting to be established, but are not yet complete. To advance this, we explored the efficiency and reliability of a differentiation method, called CYST protocol, that facilitates retina generation by forming neuroepithelial cysts from hiPSC clusters. Here, we tested seven different hiPSC lines which reproducibly generated HROs. Histological and ultrastructural analyses indicate that HRO differentiation and maturation are regulated. The different hiPSC lines appeared to be a larger source of variance than experimental rounds. Although previous reports have shown that HROs in several other protocols contain a rather low number of cones, HROs from the CYST protocol are consistently richer in cones and with a comparable ratio of cones, rods, and Müller glia. To provide further insight into HRO cell composition, we studied single cell RNA sequencing data and applied CaSTLe, a transfer learning approach. Additionally, we devised a potential strategy to systematically evaluate different organoid protocols side-by-side through parallel differentiation from the same hiPSC batches: In an explorative study, the CYST protocol was compared to a conceptually different protocol based on the formation of cell aggregates from single hiPSCs. Comparing four hiPSC lines showed that both protocols reproduced key characteristics of retinal epithelial structure and cell composition, but the CYST protocol provided a higher HRO yield. So far, our data suggest that CYST-derived HROs remained stable up to at least day 200, while single hiPSC-derived HROs showed spontaneous pathologic changes by day 200. Overall, our data provide insights into the efficiency, reproducibility, and stability of the CYST protocol for generating HROs, which will be useful for further optimizing organoid systems, as well as for basic and translational research applications

Challenges to water quality assessment in Europe – Is there scope for improvement of the current Water Framework Directive bioassessment scheme in rivers?

The EU Water Framework Directive (WFD) assessment scheme has been putting in force the evaluation of freshwater ecosystems in Europe, including a new paradigm of ecological status. After almost 20 years since the WFD implementation, it is imperative to evaluate the efficiency of its standard assessment scheme and to explore the possibility of learning how to improve its effectiveness. That is the spirit of this review, aiming (i) to explore the existing literature on the WFD bioassessment scheme for assessing freshwater ecosystem health, particularly in lotic ecosystems (where the WFD scheme is most consolidated); (ii) to document which paths are suggested by the scientific community to improve the efficiency of the bioassessment in tackling current challenges. In the specific arena of bioassessment, we first identify the major constraints to the WFD full implementation in rivers. Second, we analyse retrospective Ecological Risk Assessment (ERA) as an evaluation approach supporting management actions that could inspire improvements in the WFD bioassessment scheme. Third, we review the advances and debate on complementary metrics to improve WFD evaluation protocols and/or the feasibility of the evaluation outcome. Fourth, a conceptual scheme for an improved evaluation strategy is presented. Our proposal essentially merges the WFD bioassessment scheme with the ERA philosophy, proposing a tiered approach of increasing complexity and spatial resolution, where expert judgement is included surgically at all decision stages. This scheme requires true integration of chemical, ecological and ecotoxicological LoE for a quantitative estimation of risks, and provides a comprehensive framework that accommodates tools and perspectives already suggested by other authors. Besides providing a literature review on the strengths and weaknesses of the current WFD bioassessment scheme, we wish to open way for the scientific discussion towards an improved conceptual scheme for the evaluation of ecosystem health.CESAM - Centro de Estudos Ambientais e Marinhos, Universidade de Aveiro(UIDP/50017/2020 + UIDB/50017/2020

Valutazione dello stato morfologico ed ecologico di corsi d'acqua alpini: utilizzo e confronto dell'indice di qualità morfologica (IQM) e di un indice basato sugli odonati

This thesis deals with the assesment of morphological and ecological conditions of six Italian alpine rivers. Odonata (dragonflies) were chosen as bioindicators to assess the ecological status of river corridors while the assessment of th morphological status of the study cases was performed by using the Morphological Quality Index (MQI) Dragonflies demonstrated to be an effective bioindicator. The results also indicated a significant correlation between MQI and OQI and demonstrated the importance of river processes as drivers for the maintenance of a high diversity of habitats and species within the river corridor.Questa ricerca ha come tematica la valutazione delle condizioni morfoogiche ed ecologiche di sei fiumi alpini italiani. Gli Odonati (Libellule) sono stati scelti, dopo una fase di ricerca bibliografica, come bioindicatore per valutare lo stato ecologico del corridoio fluviale. mentre la valutazione delle stato morfologico è stata effettuata utilizzando l'Indice di Qualità Morfologica (IQM). Gli Odonati hanno dimostrato di essere un valido bioindicatore. I risultati ottenuti indicano una correlazione significativa tra i valori degli indici IQM ed IQO, a dimostrazione dell'importanza dei processi geomorfologici quali driver fondamentali per il mantenimento di un'elevata diversità di habitat e di specie all'interno del corridoio fluviale

Odonates as indicators of the ecological integrity of the river corridor: Development and application of the Odonate River Index (ORI) in northern Italy

none4noThe assessment of the ecological conditions of rivers is crucial for their appropriate management andrestoration. Bioindicators commonly used to evaluate the river status (i.e. diatoms, aquatic macrophytes,benthic macroinvertebrates and fish) detect alterations of water quality, but are not particularly sensitiveto hydromorphological degradation, which is another relevant pressure in river systems. Furthermore,those bioindicators are usually applied only to flowing channels. We developed a new multimetric index,the Odonate River Index (ORI), to assess the conditions of the whole corridor in alluvial rivers. The ORIis a development of an evaluation system proposed in Austria, and based on the Odonate Habitat Index(OHI). Odonates were chosen as bioindicators for the ecological integrity of the river corridor, since thistaxon provides information on the conditions of their aquatic breeding sites, as well as on the surroundingterrestrial areas, due to its amphibiotic life cycle. We used a case study of 18 reaches from six Italian Alpinerivers, characterized by different morphological conditions and level of human impact. Within each studyreach, we selected four sites, both lotic and lentic sites. Dragonfly surveys consisted in field observationof adults, and collection of larvae and exuviae. To define the best sampling strategy, we compared theresults of the ORI metrics obtained varying the input data by combining different sampling methods: thebest compromise between effort and exhaustiveness was obtained coupling the observation of adultswith the collection of exuviae. We found the ORI to be a robust and reliable tool to assess the status ofthe river corridor in a wide range of environmental conditions and river morphology, being particularlysuitable to detect hydromorphological degradation and alterations of the structure of aquatic and riparianvegetation. We identified two limiting factors for the applicability of this index: low water temperaturesof the main channel (i.e. mean annual value below 10◦C) and river reaches with no or scarce aquatic andriparian vegetation. In addition to the assessment of river conditions, the ORI could also be applied formonitoring the effects of river restoration actions.noneGolfieri, Bruno; Hardersen, Sönke; Maiolini, Bruno; Surian, NicolaGolfieri, Bruno; Hardersen, Sönke; Maiolini, Bruno; Surian, Nicol

Towards a more comprehensive assessment of river corridor conditions: A comparison between the Morphological Quality Index and three biotic indices

River management and planning of restoration actions require a detailed analysis of stream conditions. However, most biotic and hydromorphological indices that have been developed for implementing the European Water Framework Directive (WFD) are characterized by limited spatial and temporal scales of application. In addition, the indices based on the biological quality elements defined by the WFD are sensitive to water quality but not to hydromorphological alterations. To overcome these limitations, alternative hydromorphological and biotic indices have recently been developed. In this study we compared the results obtained with the Morphological Quality Index (MQI) to those of three biotic indices, the Odonate River Index (ORI) and two BQE-based indices, in seven rivers of northern Italy. MQI and ORI resulted highly and significantly correlated, and alterations of river functionality and continuity were the most relevant impacts affecting dragonfly assemblages. Conversely, no significant relationships were found between the MQI and both BQE-based indices and assemblages. The significant correlation between MQI and ORI can be explained by the correspondence of the spatial scale of application (i.e. the whole river corridor). In contrast, the lack of correlation between the BQE-based indices and MQI can probably be attributed to the different spatial scales at which the indices work. The results of this study underline the importance of evaluating the lateral dimension of the river corridor and the need to apply reach-scale indices to achieve a comprehensive evaluation of river corridor conditions and to define appropriate management actions