Opportunistic skeletal muscle metrics as prognostic tools in metastatic castration-resistant prostate cancer patients candidates to receive Radium-223

Objective: Androgen deprivation therapy alters body composition promoting a significant loss in skeletal muscle (SM) mass through inflammation and oxidative damage. We verified whether SM anthropometric composition and metabolism are associated with unfavourable overall survival (OS) in a retrospective cohort of metastatic castration-resistant prostate cancer (mCRPC) patients submitted to 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG PET/CT) imaging before receiving Radium-223. Patients and methods: Low-dose CT were opportunistically analysed using a cross-sectional approach to calculate SM and adipose tissue areas at the third lumbar vertebra level. Moreover, a 3D computational method was used to extract psoas muscles to evaluate their volume, Hounsfield Units (HU) and FDG retention estimated by the standardized uptake value (SUV). Baseline established clinical, lab and imaging prognosticators were also recorded. Results: SM area predicted OS at univariate analysis. However, this capability was not additive to the power of mean HU and maximum SUV of psoas muscles volume. These factors were thus combined in the Attenuation Metabolic Index (AMI) whose power was tested in a novel uni- and multivariable model. While Prostate-Specific Antigen (PSA), Alkaline Phosphatase (ALP), Lactate Dehydrogenase and Hemoglobin, Metabolic Tumor Volume, Total Lesion Glycolysis and AMI were associated with long-term OS at the univariate analyses, only PSA, ALP and AMI resulted in independent prognosticator at the multivariate analysis. Conclusion: The present data suggest that assessing individual 'patients' SM metrics through an opportunistic operator-independent computational analysis of FDG PET/CT imaging provides prognostic insights in mCRPC patients candidates to receive Radium-223. Graphical abstract: [Figure not available: see fulltext.

Spinal cord hypermetabolism extends to skeletal muscle in amyotrophic lateral sclerosis: a computational approach to [18F]-fluorodeoxyglucose PET/CT images

Purpose: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease leading to neuromuscular palsy and death. We propose a computational approach to [18F]-fluorodeoxyglucose (FDG) PET/CT images to analyze the structure and metabolic pattern of skeletal muscle in ALS and its relationship with disease aggressiveness. Materials and methods: A computational 3D method was used to extract whole psoas muscle\u2019s volumes and average attenuation coefficient (AAC) from CT images obtained by FDG PET/CT performed in 62 ALS patients and healthy controls. Psoas average standardized uptake value (normalized on the liver, N-SUV) and its distribution heterogeneity (defined as N-SUV variation coefficient, VC-SUV) were also extracted. Spinal cord and brain motor cortex FDG uptake were also estimated. Results: As previously described, FDG uptake was significantly higher in the spinal cord and lower in the brain motor cortex, in ALS compared to controls. While psoas AAC was similar in patients and controls, in ALS a significant reduction in psoas volume (3.6 \ub1 1.02 vs 4.12 \ub1 1.33 mL/kg; p < 0.01) and increase in psoas N-SUV (0.45 \ub1 0.19 vs 0.29 \ub1 0.09; p < 0.001) were observed. Higher heterogeneity of psoas FDG uptake was also documented in ALS (VC-SUV 8 \ub1 4%, vs 5 \ub1 2%, respectively, p < 0.001) and significantly predicted overall survival at Kaplan\u2013Meier analysis. VC-SUV prognostic power was confirmed by univariate analysis, while the multivariate Cox regression model identified the spinal cord metabolic activation as the only independent prognostic biomarker. Conclusion: The present data suggest the existence of a common mechanism contributing to disease progression through the metabolic impairment of both second motor neuron and its effector

Is there a subjective well-being premium in voluntary sector employment?

Previous studies have found that employment in the voluntary sector offers a so-called ‘job satisfaction premium’: despite lower salaries, voluntary sector employees are more satisfied with their jobs than workers in other sectors. This paper examines whether voluntary sector employees also experience a subjective well-being premium. Using data from the UK Annual Population Survey 2012/2013, we find that voluntary sector employees do have higher levels of subjective well-being but this subjective well-being premium is not evenly distributed between men and women. Men score higher on happiness and life satisfaction. However, women in the voluntary sector have lower levels of life satisfaction compared with their counterparts in the public sector. We discuss the implications of our findings for policy and practice in the voluntary sector in the UK

Integration between primary care and mental health care in Bologna

Introduction: Integration between primary care and mental health care is critical for health-care systems. Some years ago, the Emilia-Romagna Region undertook a project (the "Leggieri Project") aimed at rationalizing pathways to care and improving the quality of treatments for common psychiatric disorders. The aim of this study was to monitor and assess local implementation of the stepped care model outlined by the regional project. Materials and methods: We examined all new cases referred to Bologna Mental Health Centers (MHCs) from 2007 through 2009 (N = 15,534). Data on patients, referrals and treatments were collected from Department of Mental Health's Adult Psychiatry database. Standardized incidence rates, rates of referrals from general practitioners (GPs), and stepped care levels were investigated. We compared patient characteristics and treatments of cases referred by GPs and all other cases. A similar analysis was carried out for groups defined by stepped care level. Results: The annual incidence of MHC referral ranged from 64.7 to 65.8 per 10,000 adult inhabitants. On the whole, 52% of the new cases were referred to the MHCs by GPs: this rate increased over time from 48% to 54%. As for stepped care, MHC care was planned for 55% of the patients referred by GPs, 14% were managed with joint GP and MHC care, and 31% of the new cases were back-referred after a psychiatric consultation. The differences between these levels of care narrowed over the three-year period: cases managed with psychiatric consultations or joint GP-MHC care increased, while those managed exclusively by the MHC decreased. Almost 50% of all cases involving non-Italian immigrants were referred by GPs, although this rate was lower than that observed among Italian patients. These trends were evident in each departmental area. Patients referred by GPs were more likely to be elderly women with common psychiatric disorders. Among these, the cases managed in MHCs had the most severe diagnoses and received the most intensive and long-lasting treatments. Conclusions: Integration of primary care and mental health care is increasing and seems to be appropriate. In accordance with the recommendations of the regional project, integrated care is used above all for patients with common psychiatric disorders. Collaborative care for severe disorders requires further investigation. For these disorders, which often affect young patients and are frequently associated with comorbidity and a high risk of chronicity evolution, early detection and integrated care are crucial goals for the immediate future

FDG-PET Imaging of Doxorubicin-Induced Cardiotoxicity: a New Window on an Old Problem

Purpose of Review The present review focus on the published literature about the use of 18F-fluorodeoxyglucose (FDG) PET/CT imaging in the early recognition of anthracyclines-related cardiotoxicity. Recent Findings The application of PET/CT may represent an early predictor of subsequent cardiotoxicity in cancer patients treated with doxorubicin (DXR). However, the application of PET/CT may also extend beyond mere cardiotoxicity identification and monitoring to provide mechanistic delineation of the cardiotoxic pathophysiology. Indeed, this tool further enriched the current knowledge on energy metabolism impairment in the DXR-induced cardiotoxic cascade. The capability of FDG to selectively track the early endoplasmic reticulum pentose phosphate pathway (PPP) response to oxidative stress rather than the later occurring contractile dysfunction might imply the abrupt occurrence of metabolic abnormality during the course of chemotherapy, possibly identifying the ongoing myocardial damage in time to change the chemotherapy scheme or to initiate targeted cardioprotective treatments. Future prospective studies encompassing a specific dietary or pharmacologic preparation before FDG injection, as already performed in infectious and inflammatory heart diseases, are needed to move the obtained preclinical findings supporting the role of FDG imaging in DXR cardiotoxicity from bench to bedside

The provision of mental health services to immigrants and refugees in Italy: The barriers and facilitating factors experienced by mental health workers

Objective: To explore the barriers and facilitating factors to the provision of mental health services to immigrants and refugees by exploring the experiences of mental health workers (MHWs.) Method: A qualitative study was performed in May 2013 in a city in the Emilia Romagna region. Participants were recruited using purposive sampling and 14 semi-structured interviews were performed with MHWs. Framework Analysis was used to interpret the data. Results: Five facilitating factors were identified: language skill of patients, involvement of patients' family, specialist cultural psychiatric services, voluntary services and organisation of the mental health system. Five barriers were identified: patients' perceptions, lack of family support, cultural knowledge of MHWs, language skill of MHWs and funding of the mental health system. Conclusions: The barriers and facilitating factors identified reflect findings from research in both European and non-European countries. Nevertheless, the results of this study highlight the fact that a national mental health policy for immigrants and refugees needs to be implemented alongside cultural competence training programmes and specialist cultural psychiatric services

Striatal dopamine transporter SPECT quantification: head-to-head comparison between two three-dimensional automatic tools

Purpose: Our aim was to compare a widely distributed commercial tool with an older free software (i) one another, (ii) with a clinical motor score, (iii) versus reading by experts. Procedures: We analyzed consecutive scans from one-hundred and fifty-one outpatients submitted to brain DAT SPECT for a suspected parkinsonism. Images were post-processed using a commercial (Datquant\uae) and a free (BasGanV2) software. Reading by expert was the gold standard. A subset of patients with pathological or borderline scan was evaluated with the clinical Unified Parkinson\u2019s Disease Rating Scale, motor part (MDS-UPDRS-III). Results: SBR, putamen-to-caudate (P/C) ratio, and both P and C asymmetries were highly correlated between the two software with Pearson\u2019s \u2018r\u2019 correlation coefficients ranging from.706 to.887. Correlation coefficients with the MDS-UPDRS III score were higher with caudate than with putamen SBR values with both software, and in general higher with BasGanV2 than with Datquant\uae. Datquant\uae correspondence with expert reading was 84.1% (94.0% by additionally considering the P/C ratio as a further index). BasGanV2 correspondence with expert reading was 80.8% (86.1% by additionally considering the P/C ratio). Conclusions: Both Datquant\uae and BasGanV2 work reasonably well and similarly one another in semi-quantification of DAT SPECT. Both tools have their own strength and pitfalls that must be known in detail by users in order to obtain the best help in visual reading and reporting of DAT SPECT

Brain metabolic correlates of persistent olfactory dysfunction after sars-cov2 infection

We aimed to evaluate the brain hypometabolic signature of persistent isolated olfactory dysfunction after SARS-CoV-2 infection. Twenty-two patients underwent whole-body [18F]-FDG PET, including a dedicated brain acquisition at our institution between May and December 2020 following their recovery after SARS-Cov2 infection. Fourteen of these patients presented isolated persistent hyposmia (smell diskettes olfaction test was used). A voxel-wise analysis (using Statistical Parametric Mapping software version 8 (SPM8)) was performed to identify brain regions of relative hypometabolism in patients with hyposmia with respect to controls. Structural connectivity of these regions was assessed (BCB toolkit). Relative hypometabolism was demonstrated in bilateral parahippocampal and fusiform gyri and in left insula in patients with respect to controls. Structural connectivity maps highlighted the involvement of bilateral longitudinal fasciculi. This study provides evidence of cortical hypometabolism in patients with isolated persistent hyposmia after SARS-Cov2 infection. [18F]-FDG PET may play a role in the identification of long-term brain functional sequelae of COVID-19