The significance of fluoride uptake and inflammation within the atherosclerotic plaque: a PET/CT analysis

Background and aims: Atherosclerosis is a vessel disease, having a relatively early onset and a slow progression, and is currently the first cause for morbidity and mortality worldwide. Patients with atherosclerosis are usually classified according to their cardiovascular risk; however, tools to characterize the atherosclerotic plaque or to predict its progression are presently missing. In this thesis, we present a novel approach to this issue, by applying multimodal (CT- ad PET-based) imaging, in synergy with segmentation analysis, to the atherosclerotic plaques. Materials and Methods: Patients were recruited from three different databases retrospectively and then assigned to three different study populations. Population A consisted of 51 patients (19 females, mean age 69\uf0b19 years, range 49-82), submitted to 18F-NaF-PET/CT (NaF-PET). Each patient underwent at least 2 Naf-PET, spaced on average 14 months apart. In each patient, a VOI was placed on each visible CT plaque, using a CT-iso-contour approach; mean blood-pool normalized SUV (TBR), mean HU and Agaston-like calcification score (CS) were computed. TBR was compared with the mean percent variation of HU and CS, normalized for elapsed time between NaF-PETs (NDHU% and NDCS%, respectively). Whole-aorta TBR was then compared to whole-aorta NDCS%. Population B included 79 patients (51 women, 70.8 \ub18 years) who underwent NaF-PET. Plaque analysis was performed as described above. An in-house software application was used to identify and segment the trabecular bone semi-automatically. TBR and HU of trabecular bone were compared to the ones of arterial plaques. Population C consisted of twenty-seven patients (12 males, mean age 69.4 \ub1 8, range 56-87), who underwent a 18F-FDG and a 68Ga-DOTATOC PET/CT within a two-weeks period Cardiovascular risk score was estimated in all patients; TBRmax and TBRmean was calculated in a large VOI, placed on the aorta, in FDG and DOTATOC scans. Results: In population A, mean HU and CS significantly increased from the first to the second PET/CT (p<0.001). A tight and direct correlation was noted between TBR in the plaques in the baseline PET and both NDHU% (R=0.67, p<0.01) and NDCS% (R=0,7, p<0.001). Whole-aorta TBR correlated with NDCS% in the entire vessel (R=0,85, p<0.001). In the population B, mean plaque density showed an inverse association with vertebral HU density (R=-0.56, p<0.01). Plaque and trabecular bone TBR were directly and closely correlated (R=0.63 and p<0.001). At univariate analysis, mean HU density of aortic plaque was not predicted by any of the cardiovascular risk factor or by age; conversely, it was related to its own TBR (p=<0.001) as well as by trabecular bone TBR. In population C, the mean of TBRmax was significantly higher in 68Ga-DOTATOC PET, when compared to FDG (5,7\ub13,1 Vs. 2\ub11,2, p<0.01). A tight and direct correlation was noted between FDG TBRmean and CV risk score (R=0.82, p<0.001), as well as between 68Ga-DOTATOC TBRmean and CV risk score (R=0.81, p<0.001). Average TBRmax of 68Ga-DOTATOC was slightly higher in DM patients when compared to the non-diabetic ones (6\ub12.1 Vs. 4,9\ub10,9, p<0.05). Conclusions: PET/CT with NaF can predict subsequent plaque evolution: in particular, plaque displaying a higher uptake have a greater progression of calcification at follow-up. Observing the behavior of skeletal bone might represent a new window for assessing the plaques\ub4 characteristics. Inflammation within the plaque can be detected by 18F-FDG and by 68Ga-DOTATOC, the latter tracer might perform better, especially in diabetic patients. Overall PET techniques could display a great relevance in diverse research fields, such as assessment of therapy effectiveness and identification of vulnerable plaques; further study could allow the possibly enabling a patient-centered treatment and improving therapy outcomes as well as quality of life.application of this methods to larger population

Impact of close and positive margins in transoral laser microsurgery for TIS-T2 glottic cancer

Introduction: Transoral laser microsurgery (TLM) represents one of the most effective treatment strategies for us 12 glottic squamous cell carcinomas (SCC). The prognostic influence of close/positive margins is still debated, and the role of narrow band imaging (NBI) in their intraoperative definition is still to be validated on large cohort of patients. This study analyzed the influence of margin status on recurrence-free survival (RFS) and disease specific survival (DSS).Methods: We retrospectively studied 507 cases of pTis-Tib (Group A) and 127 cases of pT2 (Group B) glottic SCC. We identified the following margin status: negative (n = 232), close superficial (n = 79), close deep (CD) (n = 35), positive single superficial (n = 146), positive multiple superficial (n = 94), and positive deep (n = 48) and analyzed their impact on RFS and DSS. Close margins were defined by tumor-margin distance &lt;1 mm. PreTLM margins were defined by white light in 323 patients, whereas NBI was employed in 311 patients.Results: In Group A, DSS and RFS were reduced in positive multiple superficial and positive deep margins (DSS = 96.1 and 97%, both p &lt; 0.05; RFS = 72%, p &lt; 0.001 and 75.8%, p &lt; 0.01). In Group B, DSS was reduced in positive multiple superficial margins (82.4%, p &lt; 0.05). RFS was reduced in positive single superficial, positive multiple superficial, and positive deep margins (62.5, 41.2, and 53.3%, p &lt; 0.01). In the entire population, RFS was reduced in CD margins (77.1%, p &lt; 0.05). Use of NBI led to improvement in RFS and DSS.Conclusion: The study indicates that close and positive single superficial margins do not affect DSS. By contrast, all types of margin positivity predict the occurrence of relapses, albeit with different likelihood, depending on stage/margin type. CD margins should be considered as a single risk factor. Use of NBI granted better intraoperative margins definition

Expatriates&apos; Multiple Fears, from Terrorism to Working Conditions: Development of a Model

Companies’ internationalization appears to be fundamental in the current globalized and competitive environment and seems important not only for organizational success, but also for societal development and sustainability. On one hand, global business increases the demand for managers for international assignment. On the other hand, emergent fears, such as terrorism, seem to be developing around the world, enhancing the risk of expatriates’ potential health problems. The purpose of this paper is to examine the relationships between the emergent concept of fear of expatriation with further workplace fears (economic crisis and dangerous working conditions) and with mental health problems. The study uses a quantitative design. Self-reported data were collected from 265 Italian expatriate workers assigned to both Italian and worldwide projects. Structural equation model analyses showed that fear of expatriation mediates the relationship of mental health with fear of economic crisis and with perceived dangerous working conditions. As expected, in addition to fear, worries of expatriation are also related to further fears. Although the study is based on self-reports and the cross-sectional study design limits the possibility of making causal inferences, the new constructs introduced add to previous research

Analysis of Complications in (Crico-) Tracheal Resection Anastomosis in Adults: A Multicenter Study

Objectives The gold standard treatments for advanced laryngotracheal stenosis (LTS) are represented by partial crico-tracheal (PCTRA) or tracheal resection and anastomosis (TRA). These procedures are potentially burdened by high postoperative complication rates. We investigated the impact of the most common stenosis and patient-related characteristics on the onset of complications in a multicentric cohort.Methods We retrospectively analyzed patients who underwent PCTRA or TRA for LTS of different etiologies in three referral centers. We tested the effectiveness of these procedures, the impact of complications on the outcomes, and identified factors causing postoperative complications.Results A total of 267 patients were included in the study (130 females; mean age, 51.46 +/- 17.64 years). The overall decannulation rate was 96.4%. Altogether, 102 (38.2%) patients presented at least one complication, whereas 12 (4.5%) had two or more. The only independent predictor of post-surgical complications was the presence of systemic comorbidities (p = 0.043). Patients experiencing complications needed additional surgery more frequently (70.1% vs. 29.9%, p < 0.001), and had a longer duration of hospitalization (20 +/- 10.9 vs. 11.3 +/- 4.1 days, p < 0.001). Six of 102 (5.9%) patients with complications had restenosis, although this event did not occur among patients without complications.Conclusion PCTRA and TRA have an excellent success rate even when performed for high-grade LTS. However, a significant percentage of patients may experience complications associated with a longer duration of hospitalization or the need for additional surgeries. The presence of medical comorbidities was independently related to an increased risk of complications

Workplace bullying in a sample of italian and spanish employees and its relationship with job satisfaction, and psychological well-being

Purpose – The purpose of this study is to examine the prevalence rate of workplace bullying in a sample of Italian and Spanish employees, and its differential consequences on employees’ job satisfaction and psychological well-being. The effects of workplace bullying on job satisfaction and psychological well-being were explored taking into account a contextualized approach. Design/Methodology/approach – Cross-sectional study was adopted, in which a sample of 1,151 employees in Italy and 705 in Spain completed a questionnaire. We hypothesized that the relationship between exposure to bullying behaviors and psychological well-being is mediated by job satisfaction, and that this simple mediation model is moderated by the country (moderated mediation). Findings – Results suggest that no particular differences exist in bullying prevalence among Spanish and Italian employees. However, we found scientific confirmation of our hypothesized moderated mediation model. Research limitations/implications – Despite the limitations of the sample studied, findings capture contextual differences in the bullying phenomenon, which may have several implications for further research in this domain, as well as for designing interventions to deal with workplace bullying. Originality/value – Although this study explores bullying in different cultural contexts without investigating specific cultural values, it establishes the roots to assess workplace bullying from a contextualized perspective

Comparative diagnostic accuracy of 18F-FDG PET/CT for breast cancer recurrence

In the last decades, in addition to conventional imaging techniques and magnetic resonance imaging (MRI), 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) has been shown to be relevant in the detection and management of breast cancer recurrence in doubtful cases in selected groups of patients. While there are no conclusive data indicating that imaging tests, including FDG PET/CT, produce a survival benefit in asymptomatic patients, FDG PET/CT can be useful for identifying the site of relapse when traditional imaging methods are equivocal or conflicting and for identifying or confirming isolated loco-regional relapse or isolated metastatic lesions. The present narrative review deals with the potential role of FDG PET in these clinical settings by comparing its accuracy and impact with conventional imaging modalities such as CT, ultrasound, bone scan, 18F-sodium fluoride PET/CT (18F-NaF PET/CT) as well as MRI. Patient-focused perspectives in terms of patients\ue2\u80\u99 satisfaction and acceptability are also discussed

Radiomic Gradient in Peritumoural Tissue of Liver Metastases: A Biomarker for Clinical Practice? Analysing Density, Entropy, and Uniformity Variations with Distance from the Tumour

The radiomic analysis of the tissue surrounding colorectal liver metastases (CRLM) enhances the prediction accuracy of pathology data and survival. We explored the variation of the textural features in the peritumoural tissue as the distance from CRLM increases. We considered patients with hypodense CRLMs &gt;10 mm and high-quality computed tomography (CT). In the portal phase, we segmented (1) the tumour, (2) a series of concentric rims at a progressively increasing distance from CRLM (from one to ten millimetres), and (3) a cylinder of normal parenchyma (Liver-VOI). Sixty-three CRLMs in 51 patients were analysed. Median peritumoural HU values were similar to Liver-VOI, except for the first millimetre around the CRLM. Entropy progressively decreased (from 3.11 of CRLM to 2.54 of Liver-VOI), while uniformity increased (from 0.135 to 0.199, p &lt; 0.001). At 10 mm from CRLM, entropy was similar to the Liver-VOI in 62% of cases and uniformity in 46%. In small CRLMs (≤30 mm) and responders to chemotherapy, normalisation of entropy and uniformity values occurred in a higher proportion of cases and at a shorter distance. The radiomic analysis of the parenchyma surrounding CRLMs unveiled a wide halo of progressively decreasing entropy and increasing uniformity despite a normal radiological aspect. Underlying pathology data should be investigated

Automated Definition of Skeletal Disease Burden in Metastatic Prostate Carcinoma: A 3D Analysis of SPECT/CT Images

To meet the current need for skeletal tumor-load estimation in castration-resistant prostate cancer (CRPC), we developed a novel approach based on adaptive bone segmentation. In this study, we compared the program output with existing estimates and with the radiological outcome. Seventy-six whole-body single-photon emission computed tomographies/x-ray computed tomography with 3,3-diphosphono-1,2-propanedicarboxylic acid from mCRPC patients were analyzed. The software identified the whole skeletal volume (SVol) and classified the voxels metastases (MVol) or normal bone (BVol). SVol was compared with the estimation of a commercial software. MVol was compared with manual assessment and with prostate specific antigen (PSA) levels. Counts/voxel were extracted from MVol and BVol. After six cycles of 223RaCl2-therapy every patient was re-evaluated as having progressive disease (PD), stable disease (SD), or a partial response (PR). SVol correlated with that of the commercial software (R = 0.99, p &lt; 0.001). MVol correlated with the manually-counted lesions (R = 0.61, p &lt; 0.001) and PSA (R = 0.46, p &lt; 0.01). PD had a lower counts/voxel in MVol than PR/SD (715 \ub1 190 vs. 975 \ub1 215 and 1058 \ub1 255, p &lt; 0.05 and p &lt; 0.01) and BVol (PD 275 \ub1 60, PR 515 \ub1 188 and SD 528 \ub1 162 counts/voxel, p &lt; 0.001). Segmentation-based tumor load correlated with radiological/laboratory indices. Uptake was linked with the clinical outcome, suggesting that metastases in PD patients have a lower affinity for bone-seeking radionuclides and might benefit less from bone-targeted radioisotope therapies

Personalised PET imaging in oncology:an umbrella review of meta-analyses to guide the appropriate radiopharmaceutical choice and indication

PurposeFor several years, oncological positron emission tomography (PET) has developed beyond 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG). This umbrella review of meta-analyses aims to provide up-to-date, comprehensive, high-level evidence to support appropriate referral for a specific radiopharmaceutical PET/computed tomography (CT) or PET/magnetic resonance (MR) in the diagnosis and staging of solid cancers other than brain malignancies.MethodsWe performed a systematic literature search on the PubMed/MEDLINE and EMBASE databases for meta-analyses assessing the accuracy of PET/CT and/or PET/MRI with [18F]FDG, somatostatin- receptor-targeting 68Ga-DOTA-peptides, 18F-labelled dihydroxyphenylalanine ([18F]DOPA), prostate-specific membrane antigen (PSMA)-targeted radioligands, and fibroblast activation protein inhibitors (FAPI) in the diagnosis/disease characterisation and staging of solid cancers other than brain tumours.ResultsThe literature search yielded 449 scientific articles. After screening titles and abstracts and applying inclusion and exclusion criteria, we selected 173 meta-analyses to assess the strength of evidence. One article was selected from references. Sixty-four meta-analyses were finally considered. The current evidence corroborates the role of [18F]FDG as the main player in molecular imaging; PSMA tracers are useful in staging and re-staging prostate cancer; somatostatin-targeting peptides (e.g. [68Ga]Ga- DOTA-TOC and -TATE) or [18F]DOPA are valuable in neuroendocrine tumours (NETs). FAPI has emerged in gastric cancer assessment. According to search and selection criteria, no satisfactory meta-analysis was selected for the diagnosis/detection of oesophageal cancer, the diagnosis/detection and N staging of small cell lung cancer and hepatic cell carcinoma, the diagnosis/detection and M staging of melanoma and Merkel cell carcinoma, cervical, vulvar and penis cancers, the N and M staging of lung and gastroenteropancreatic NET, testicular cancer, and chondrosarcoma, and the M staging of differentiated thyroid, bladder and anal cancers.ConclusionThe comprehensive high-level evidence synthesised in the present umbrella review serves as a guiding compass for clinicians and imagers, aiding them in navigating the increasingly intricate seascape of PET examinations