Prosthetic Valve Endocarditis

Prosthetic valve infective endocarditis (PVE) is associated with high morbidity and mortality. With the increasing number of prostheses implanted every year, the incidence of PVE is expected to rise. The diagnosis of PVE is challenging as blood cultures are often negative and the sensitivity of echocardiography is suboptimal in the presence of prosthetic valves. In 2015, the European Society of Cardiology introduced 18F-fluorodeoxyglucose–positron emission tomography/computed tomography (FDG-PET/CT) as a major criterion for the diagnosis of PVE, based on its ability to identify valve infection and to detect septic emboli. In addition, FDG-PET/CT can detect PVE portal of entry, which may lead to change in management. This chapter will discuss the epidemiology and clinical presentations of PVE. In addition, the role of FDG-PET/CT in PVE as well as optimal imaging protocols will be reviewed.</p

Fracture toughness and fatigue crack growth rate properties in wire + arc additive manufactured Ti-6Al-4V

This paper presents an experimental investigation of the fracture and fatigue crack growth properties of Ti-6Al-4V produced by the Wire + Arc Additive Manufacture (WAAM) process. First, fracture toughness was measured for two different orientations with respect to the build direction; the effect of wire oxygen content and build strategy were also evaluated in the light of microstructure examination. Second, fatigue crack growth rates were measured for fully additive manufactured samples, as well as for samples containing an interface between WAAM and wrought materials. The latter category covers five different scenarios of crack location and orientation with respect to the interface. Fatigue crack growth rates are compared with that of the wrought or WAAM alone conditions. Crack growth trajectory of these tests is discussed in relation to the microstructure characteristic

Cardiac molecular pathways influenced by doxorubicin treatment in mice

Doxorubicin (DOX) is a potent chemotherapeutic with distinct cardiotoxic properties. Understanding the underlying cardiotoxic mechanisms on a molecular level would enable the early detection of cardiotoxicity and implementation of prophylactic treatment. Our goal was to map the patterns of different radiopharmaceuticals as surrogate markers of specific metabolic pathways induced by chemotherapy. Therefore, cardiac distribution of Tc-99m-sestamibi, Tc-99m-Annexin V, Tc-99m-glucaric acid and [F-18]FDG and cardiac expression of Bcl-2, caspase-3 and -8, TUNEL, HIF-1 alpha, and p53 were assessed in response to DOX exposure in mice. A total of 80 mice (64 treated, 16 controls) were evaluated. All radiopharmaceuticals showed significantly increased uptake compared to controls, with peak cardiac uptake after one (Tc-99m-Annexin V), two (Tc-99m-sestamibi), three ([F-18]FDG), or four (Tc-99m-glucaric acid) cycles of DOX. Strong correlations (p <0.01) were observed between Tc-99m-Annexin V, caspase 3 and 8, and TUNEL, and between [F-18]FDG and HIF-1 alpha. This suggests that the cardiac DOX response starts with apoptosis at low exposure levels, as indicated by Tc-99m-Annexin V and histological apoptosis markers. Late process membrane disintegration can possibly be detected by Tc-99m-sestamibi and Tc-99m-glucaric acid. [F-18]FDG signifies an early adaptive response to DOX, which can be further exploited clinically in the near future

PET imaging in cardiovascular infections

Cardiovascular (CVS) infections are associated with high morbidity and mortality. Early diagnosis is crucial for adequate patient's management, as early treatment improves the prognosis. Hardly they are diagnosed on the basis of a single symptom, sign or diagnostic test, being a multidisciplinary discussion in addition to the integration of clinical signs, microbiology data and imaging data necessary in many cases. The application of multimodality imaging, including molecular imaging techniques has improved the sensitivity to detect infections involving heart valves and vessels and implanted cardiovascular devices while also allowing for early detection of septic emboli and metastatic infections before these become clinically apparent. In this chapter, we describe the role of WBC SPECT/CT and [18F] FDG PET/CT in most clinically relevant CVS infections including dedicated imaging acquisition protocols, specific imaging reading and interpretations criteria, emphasizing the need of a specific reference framework within a Cardiovascular Multidisciplinary Team Approach to select the best test or combination of tests for each specific clinical situation.</p

Artificial intelligence and hybrid imaging: the best match for personalized medicine in oncology

Artificial intelligence (AI) refers to a field of computer science aimed to perform tasks typically requiring human intelligence. Currently, AI is recognized in the broader technology radar within the five key technologies which emerge for their wide-ranging applications and impact in communities, companies, business, and value chain framework alike. However, AI in medical imaging is at an early phase of development, and there are still hurdles to take related to reliability, user confidence, and adoption. The present narrative review aimed to provide an overview on AI-based approaches (distributed learning, statistical learning, computer-aided diagnosis and detection systems, fully automated image analysis tool, natural language processing) in oncological hybrid medical imaging with respect to clinical tasks (detection, contouring and segmentation, prediction of histology and tumor stage, prediction of mutational status and molecular therapies targets, prediction of treatment response, and outcome). Particularly, AI-based approaches have been briefly described according to their purpose and, finally lung cancer—being one of the most extensively malignancy studied by hybrid medical imaging—has been used as illustrative scenario. Finally, we discussed clinical challenges and open issues including ethics, validation strategies, effective data-sharing methods, regulatory hurdles, educational resources, and strategy to facilitate the interaction among different stakeholders. Some of the major changes in medical imaging will come from the application of AI to workflow and protocols, eventually resulting in improved patient management and quality of life. Overall, several time-consuming tasks could be automatized. Machine learning algorithms and neural networks will permit sophisticated analysis resulting not only in major improvements in disease characterization through imaging, but also in the integration of multiple-omics data (i.e., derived from pathology, genomic, proteomics, and demographics) for multi-dimensional disease featuring. Nevertheless, to accelerate the transition of the theory to practice a sustainable development plan considering the multi-dimensional interactions between professionals, technology, industry, markets, policy, culture, and civil society directed by a mindset which will allow talents to thrive is necessary.</p

PET/MRI in Infection and Inflammation

Hybrid positron emission tomography/magnetic resonance imaging (PET/MR) systems are now more and more available for clinical use. PET/MR combines the unique features of MR including excellent soft tissue contrast, diffusion-weighted imaging, dynamic contrast-enhanced imaging, fMRI and other specialized sequences as well as MR spectroscopy with the quantitative physiologic information that is provided by PET. Most of the evidence of the potential clinical utility of PET/MRI is available for neuroimaging. Other areas, where PET/MR can play a larger role include head and neck, upper abdominal, and pelvic tumours. Although the role of PET/MR in infection and inflammation of the cardiovascular system and in musculoskeletal applications are promising, these areas of clinical investigation are still in the early phase and it may be a little longer before these areas reach their full potential in clinical practice. In this review, we outline the potential of hybrid PET/MR for imaging infection and inflammation. A background to the main radiopharmaceuticals and some technical considerations are also included. (C) 2018 Published by Elsevier Inc

The "3M" Approach to Cardiovascular Infections: Multimodality, Multitracers, and Multidisciplinary

Cardiovascular infections are associated with high morbidity and mortality. Early diagnosis is crucial for adequate patient management, as early treatment improves the prognosis. The diagnosis cannot be made on the basis of a single symptom, sign, or diagnostic test. Rather, the diagnosis requires a multidisciplinary discussion in addition to the integration of clinical signs, microbiology data, and imaging data. The application of multimodality imaging, including molecular imaging techniques, has improved the sensitivity to detect infections involving heart valves and vessels and implanted cardiovascular devices while also allowing for early detection of septic emboli and metastatic infections before these become clinically apparent. In this review, we describe data supporting the use of a Multimodality, Multitracer, and Multidisciplinary approach (the 3M approach) to cardiovascular infections. In particular, the role of white blood cell SPECT/CT and [18F]FDG PET/CT in most prevalent and clinically relevant cardiovascular infections will be discussed. In addition, the needs of advanced hybrid equipment, dedicated imaging acquisition protocols, specific expertise for image reading, and interpretation in this field are discussed, emphasizing the need for a specific reference framework within a Cardiovascular Multidisciplinary Team Approach to select the best test or combination of tests for each specific clinical situation. © 2018 Elsevier Inc

Factors influencing European consumer uptake of personalised nutrition: results of a qualitative analysis

The aim of this research was to explore consumer perceptions of personalised nutrition and to compare these across three different levels of ‘‘medicalization’’: lifestyle assessment (no blood sampling); phenotypic assessment (blood sampling); genomic assessment (blood and buccal sampling). The protocol was developed from two pilot focus groups conducted in the UK. Two focus groups (one comprising only ‘‘older’’ individuals between 30 and 60 years old, the other of adults 18–65 yrs of age) were run in the UK, Spain, the Netherlands, Poland, Portugal, Ireland, Greece and Germany (N = 16). The analysis (guided using grounded theory) suggested that personalised nutrition was perceived in terms of benefit to health and fitness and that convenience was an important driver of uptake. Negative attitudes were associated with internet delivery but not with personalised nutrition per se. Barriers to uptake were linked to broader technological issues associated with data protection, trust in regulator and service providers. Services that required a fee were expected to be of better quality and more secure. An efficacious, transparent and trustworthy regulatory framework for personalised nutrition is required to alleviate consumer concern. In addition, developing trust in service providers is important if such services to be successful