68Ga-PSMA PET/CT evaluation in men enrolled in prostate cancer Active Surveillance

Introduction: To evaluate the accuracy of 68Ga-prostate specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in the diagnosis of clinically significant prostate cancer (csPCa: Grade Group ≥ 2) in men enrolled in Active Surveillance (AS) protocol. Materials and methods: From May 2013 to December 2021 200 men aged between 52 and 74 years (median age 63) with very low risk PCa were enrolled in an AS protocol study. During the follow up 48/200 (24%) men were upgraded and 10/200 (5%) decided to leave the AS protocol. After five years from confirmatory biopsy (range: 48-60 months) 40/142 (28.2%) consecutive patients were submitted to mpMRI and 68Ga-PSMA PET/CT imaging examinations before scheduled repeated biopsy. All the mpMRI (PI-RADS ≥ 3) and 68Ga-PET/TC standardized uptake value (SUVmax) ≥ 5 index lesions underwent targeted cores (mpMRI-TPBx and PSMA-TPBx) combined with transperineal saturation prostate biopsy (SPBx: median 20 cores). Results: Multiparametric MRI and 68Ga-PSMA PET/CT showed 18/40 (45%) and 9/40 (22.5%) lesions suspicious for PCa. In 3/40 (7.5%) men a csPCa (GG2) was found; 68Ga-PSMA-TPBx vs. mpMRI-TPBx vs. SPBx diagnosed 2/3 (66.6%) vs. 2/3 (66.6%) vs. 3/3 (100%) csPCa, respectively. In detail, mpMRI and 68Ga-PSMA PET/TC demonstrated 16/40 (40%) vs. 7/40 (17.5%) false positive and 1 (33.3%) vs. 1 (33.3%) false negative results. Conclusion: Although 68PSMA PET/CT did not improve the detection for csPCa of SPBx (1 false negative result equal to 33.3% of the cases), at the same time, would have spared 31/40 (77.5%) scheduled biopsies showing a better diagnostic accuracy in comparison with mpMRI (83.3% vs. 70.2%)

Experimental and numerical investigation of magneto-plasma optical properties toward measurements of opacity relevant for compact binary objects

Electromagnetic transients known as kilonovae (KN), are among the photonic messengers released in the post-merger phase of compact binary objects, for example, binary neutron stars, and they have been recently observed as the electromagnetic counterpart of related gravitational-wave (GW) events. Detection of the KN signal plays a fundamental role in the multi-messenger astronomy entering in a sophisticated GW-detecting network. The KN light curve also delivers precious information on the composition and dynamics of the neutron-rich post-merger plasma ejecta (relying on r-process nucleosynthesis yields). In this sense, studying KN becomes of great relevance for nuclear astrophysics. Because of the highly heterogeneous composition, plasma opacity has a great impact both on radiative transport and spectroscopic observation of KN. Theoretical models attempting in encoding the opacity of this system often fail, due to the complexity of blending plethora of both light- and heavy-r nuclei transition lines, requesting for more complete atomic database. Trapped magneto-plasmas conceived in PANDORA could answer to these requests, allowing experimental in-laboratory measurements of optical properties and opacities, at plasma electron densities and temperatures resembling early-stage plasma ejecta’s conditions, contributing to shed light on r-process metallic species abundance at the blue-KN diffusion time. A numerical study has been recently performed, supporting the choice of first physics cases to be investigated and the design of the experimental setup. In this article, we report on the feasibility of metallic plasmas on the basis of the results from the systematic numerical survey on optical spectra computed under non-local thermodynamic equilibrium (NLTE) for several light-r nuclei. Results show the great impact of the NLTE regime of laboratory magneto-plasmas on the gray opacity contribution contrasted with those under the astrophysical LTE assumption. A first experimental attempt of reproducing ejecta plasma conditions has been performed on the operative Flexible Plasma Trap (FPT) at the INFN-LNS and here presented, together with first plasma characterization of density and temperature, via non-invasive optical emission spectroscopy (OES). The measured plasma parameters have supported numerical simulations to explore optical properties of NLTE gaseous and metallic plasmas, in view of the near-future plasma opacity measurements through spectroscopic techniques. The novel work so far performed on these under-dense and low-temperature magneto-plasmas, opens the route for the first-time to future in-laboratory plasma opacity measurements of metallic plasma species relevant for KN light curve studies

Could 68Ga-PSMA PET/CT Evaluation Reduce the Number of Scheduled Prostate Biopsies in Men Enrolled in Active Surveillance Protocols?

Background: To evaluate the accuracy of 68Ga-prostate specific membrane antigen (PSMA) PET/CT in the diagnosis of clinically significant prostate cancer (csPCa) (Grade Group > 2) in men enrolled in Active Surveillance (AS) protocol. Methods: From May 2013 to May 2021, 173 men with very low-risk PCa were enrolled in an AS protocol study. During the follow-up, 38/173 (22%) men were upgraded and 8/173 (4.6%) decided to leave the AS protocol. After four years from confirmatory biopsy (range: 48–52 months), 30/127 (23.6%) consecutive patients were submitted to mpMRI and 68Ga-PSMA PET/CT scan before scheduled repeated biopsy. All the mpMRI (PI-RADS > 3) and 68Ga-PET/TC standardised uptake value (SUVmax) > 5 g/mL index lesions underwent targeted cores (mpMRI-TPBx and PSMA-TPBx) combined with transperineal saturation prostate biopsy (SPBx: median 20 cores). Results: mpMRI and 68Ga-PSMA PET/CT showed 14/30 (46.6%) and 6/30 (20%) lesions suspicious for PCa. In 2/30 (6.6%) men, a csPCa was found; 68Ga-PSMA-TPBx vs. mpMRI-TPBx vs. SPBx diagnosed 1/2 (50%) vs. 1/2 (50%) vs. 2/2 (100%) csPCa, respectively. In detail, mpMRI and 68Ga-PSMA PET/TC demonstrated 13/30 (43.3%) vs. 5/30 (16.7%) false positive and 1 (50%) vs. 1 (50%) false negative results. Conclusion: 68Ga-PSMA PET/CT did not improve the detection for csPCa of SPBx but would have spared 24/30 (80%) scheduled biopsies showing a lower false positive rate in comparison with mpMRI (20% vs. 43.3%) and a negative predictive value of 85.7% vs. 57.1%, respectively

Hypofractionated Radiotherapy in Localized, Low–Intermediate-Risk Prostate Cancer: Current and Future Prospectives

At the time of diagnosis, the vast majority of prostate carcinoma patients have a clinically localized form of the disease, with most of them presenting with low- or intermediate-risk prostate cancer. In this setting, various curative-intent alternatives are available, including surgery, external beam radiotherapy and brachytherapy. Randomized clinical trials have demonstrated that moderate hypofractionated radiotherapy can be considered as a valid alternative strategy for localized prostate cancer. High-dose-rate brachytherapy can be administered according to different schedules. Proton beam radiotherapy represents a promising strategy, but further studies are needed to make it more affordable and accessible. At the moment, new technologies such as MRI-guided radiotherapy remain in early stages, but their potential abilities are very promising

Atlas of PD-L1 for Pathologists: Indications, Scores, Diagnostic Platforms and Reporting Systems

Innovative drugs targeting the PD1/PD-L1 axis have opened promising scenarios in modern cancer therapy. Plenty of assays and scoring systems have been developed for the evaluation of PD-L1 immunohistochemical expression, so far considered the most reliable therapeutic predictive marker

Professione infermieristica: stati dell’identità e soddisfazione lavorativa

Assumendo la prospettiva della teoria degli stati d’identità di Marcia, l’obiettivo del presente studio è di analizzare i processi di ridefinizione dell’identità professionale di un gruppo di infermieri della Regione Emilia Romagna esaminandone la connessione da un lato con alcune variabili organizzative (percezione del cambiamento normativo), dall’altro con la motivazione e con la soddisfazione lavorativa. Attraverso uno studio correlazionale su un campione di 838 infermieri reclutati da 5 ospedali della Regione Emilia Romagna e realizzato mediante un questionario, sono stati misurati: 1) gli stati d’identità professionale, 2) le motivazioni alla professione, 3) il grado di soddisfazione lavorativa, 4) la percezione dell’importanza del cambiamento normativo. I risultati mostrano che sono gli infermieri in stato di identità acquisita a mostrare maggior soddisfazione lavorativa, maggiore motivazione e a considerare più importanti i cambiamenti normativi. Dai risultati si evince che le organizzazioni sanitarie dovrebbero promuovere azioni formative orientate non solo alle conoscenze (knowing) e al "saper fare" (doing), ma anche al miglioramento della pratica professionale intesa come "saper essere" (being)

Value of Artificial Intelligence in Evaluating Lymph Node Metastases

One of the most relevant prognostic factors in cancer staging is the presence of lymph node (LN) metastasis. Evaluating lymph nodes for the presence of metastatic cancerous cells can be a lengthy, monotonous, and error-prone process. Owing to digital pathology, artificial intelligence (AI) applied to whole slide images (WSIs) of lymph nodes can be exploited for the automatic detection of metastatic tissue. The aim of this study was to review the literature regarding the implementation of AI as a tool for the detection of metastases in LNs in WSIs. A systematic literature search was conducted in PubMed and Embase databases. Studies involving the application of AI techniques to automatically analyze LN status were included. Of 4584 retrieved articles, 23 were included. Relevant articles were labeled into three categories based upon the accuracy of AI in evaluating LNs. Published data overall indicate that the application of AI in detecting LN metastases is promising and can be proficiently employed in daily pathology practice

Advantages of Using a Web-based Digital Platform for Kidney Preimplantation Biopsies

Background: In the setting of kidney transplantation, histopathology of kidney biopsies is a key element in the organ assessment and allocation. Despite the broad diffusion of the Remuzzi-Karpinski score on preimplantation kidney biopsies, scientific evidence of its correlation to the transplantation outcome is controversial. The main issues affecting the prognostic value of histopathology are the referral to general on-call pathologists and the semiquantitative feature of the score, which can raise issues of interpretation. Digital pathology has shown very reliable and effective in the oncological diagnosis and treatment; however, the spread of such technologies is lagging behind in the field of transplantation. The aim of our study was to create a digital online platform where whole-slide images (WSI) of preimplantation kidney biopsies could be uploaded and stored. Methods: We included 210 kidney biopsies collected between January 2015 and December 2019 from the joint collaboration of the transplantation centers of Padua and Verona. The selected slides, stained with hematoxylin and eosin, were digitized and uploaded on a shared web platform. For each case, the on-call pathologists' Remuzzi grades were obtained from the original report, together with the clinical data and the posttransplantation follow-up. Results: The storage of WSI of preimplantation kidney biopsies would have several clinical, scientific, and educational advantages. The clinical utility relies on the possibility to consult online expert pathologists and real-time quality checks of diagnosis. From the perspective of follow-up, the archived digitized biopsies can offer a useful comparison to posttransplantation biopsies. In addition, the digital online platform is a precious tool for multidisciplinary meetings aimed both at the clinical discussion and at the design of research projects. Furthermore, this archive of readily available WSI is an important educational resource for the training of professionals. Conclusions: Finally, the web platform lays the foundation for the introduction of artificial intelligence in the field of transplantation that would help create new diagnostic algorithms and tools with the final aim of increasing the precision of organ assessment and its predictive value for transplant outcome