Appropriate indications for positron emission tomography/computed tomography: College of Nuclear Physicians of the Colleges of Medicine of South Africa

Individualised patient treatment approaches demand precise determination of initial disease extent combined with early, accurate assessment of response to treatment, which is made possible by positron emission tomography/computed tomography (PET/CT). PET is a non-invasive tool that provides tomographic images and quantitative parameters of perfusion, cell viability, and proliferation and/or metabolic activity of tissues. Fusion of the functional information with the morphological detail provided by CT as PET/CT can provide clinicians with a sensitive and accurate one-step whole-body diagnostic and prognostic tool, which directs and changes patient management. Three large-scale national studies published by the National Oncologic PET Registry in the USA have shown that imaging with PET changes the intended patient management strategy in 36.5% to 49% of cases, with consistent results across all cancer types. The proven clinical effectiveness and growing importance of PET/CT have prompted the College of Nuclear Physicians of South Africa, in collaboration with university hospitals, to develop a list of recommendations on the appropriate use of fluorine-18-fluorodeoxyglucose (18F-FDG) and non-18F-FDG PET/CT in oncology, cardiology, neurology and infection/inflammation. It is expected that other clinical situations will be added to these recommendations, provided that they are based upon solid clinical evidence. These recommendations are intended to offer advice regarding contemporary applications of PET/CT, as well as indicating novel developments and potential future indications. The CNP believes that these recommendations will serve an important and relevant role in advising referring physicians on the appropriate use of 18F-FDG and non-18F-FDG PET/CT. More promising clinical applications will be possible in the future, as newer PET tracers become more readily available

Discovery of Water Maser Emission in Five AGN and a Possible Correlation Between Water Maser and Nuclear 2-10 keV Luminosities

We report the discovery of water maser emission in five active galactic nuclei (AGN) with the 100-m Green Bank Telescope (GBT). The positions of the newly discovered masers, measured with the VLA, are consistent with the optical positions of the host nuclei to within 1 sigma (0.3 arcsec radio and 1.3 arcsec optical) and most likely mark the locations of the embedded central engines. The spectra of three sources, 2MASX J08362280+3327383, NGC 6264, and UGC 09618 NED02, display the characteristic spectral signature of emission from an edge-on accretion disk with maximum orbital velocity of ~700, ~800, and ~1300 km s^-1, respectively. We also present a GBT spectrum of a previously known source MRK 0034 and interpret the narrow Doppler components reported here as indirect evidence that the emission originates in an edge-on accretion disk with orbital velocity of ~500 km s^-1. We obtained a detection rate of 12 percent (5 out of 41) among Seyfert 2 and LINER systems with 10000 km s^-1 < v_sys < 15000 km s^-1. For the 30 nuclear water masers with available hard X-ray data, we report a possible relationship between unabsorbed X-ray luminosity (2-10 keV) and total isotropic water maser luminosity, L_{2-10} proportional to L_{H2O}^{0.5+-0.1}, consistent with the model proposed by Neufeld and Maloney in which X-ray irradiation and heating of molecular accretion disk gas by the central engine excites the maser emission.Comment: 16 pages, 5 tables, 3 figures, to appear in the November 10, 2006, v651n2 issue of the Astrophysical Journa

Appropriate indications for positron emission tomography/computed tomography, 2015

These recommendations are intended to serve an important and relevant role in advising referring physicians on the appropriate use of 18F-fluorodeoxyglucose (18F-FDG) and non-18F-FDG positron emission tomography/computed tomography (PET/CT), which can be a powerful tool in patient management in oncology, cardiology, neurology and infection/inflammation. PET is a non-invasive molecular imaging tool that provides tomographic images and quantitative parameters of perfusion, cell viability, proliferation and/or metabolic activity of tissues. These images result from the use of different substances of biological interest (sugars, amino acids, metabolic precursors, hormones) labelled with positron-emitting radionuclides (PET radiopharmaceuticals). Fusion of the aforementioned important functional information with the morphological detail provided by CT as PET/CT provides clinicians with a sensitive and accurate one-step whole-body diagnostic and prognostic tool, which directs and changes patient management. Hence PET/CT is currently the most widely used molecular imaging technology for a patient-tailored treatment approach. In these recommendations we outline which oncological and non-oncological indications are appropriate for PET/CT. Once each combination of pathology and clinical indication is defined, a recommendation is given as: 1. Recommended; 2. Recommended in select cases; 3. May be considered; or 4. Not recommended

Atmospheric composition and climate impacts of a future hydrogen economy

Hydrogen is expected to play a key role in the global energy transition to net zero emissions in many scenarios. However, fugitive emissions of hydrogen into the atmosphere during its production, storage, distribution and use could reduce the climate benefit and also have implications for air quality. Here we explore the atmospheric composition and climate impacts of increases in atmospheric hydrogen abundance using the UKESM1 chemistry-climate model. We find that increases in hydrogen result in increases in methane, tropospheric ozone and stratospheric water vapour, resulting in a positive radiative forcing. However, some of the impacts of hydrogen leakage are partially offset by potential reductions in emissions of methane, carbon monoxide, nitrogen oxides and volatile organic compounds from the consumption of fossil fuels. We derive a new methodology for determining indirect Global Warming Potentials from steady-state simulations which is applicable to both shorter-lived species and those with intermediate and longer lifetimes, such as hydrogen. Using this methodology, we determine a 100-year Global Warming Potential for hydrogen of 12 &plusmn; 6. To maximise the benefit of hydrogen as an energy source, emissions associated with hydrogen leakage and emissions of the ozone precursor gases need to be minimised.</p

A phase II study of weekly neoadjuvant chemotherapy followed by radical chemoradiation for locally advanced cervical cancer

Background: We investigated the feasibility of dose-dense neoadjuvant chemotherapy (NACT) with paclitaxel and carboplatin before radical chemoradiation (CRT) and assessed the response rate to such a regimen. Methods: CxII is a single-arm phase II trial of 46 patients, with locally advanced cervical cancer (stage Ib2-IVa). Patients received dose-dense carboplatin (AUC2) and paclitaxel (80 mg m−2) weekly for six cycles followed by CRT (40 mg m−2 of weekly cisplatin, 50.4 Gy, 28 fractions plus brachytherapy). The primary end point was response rate 12 weeks post-CRT. Results: Baseline characteristics were: median age at diagnosis 43 years; 72% squamous, 22% adenocarcinoma and 7% adenosquamous histologies; FIGO stage IB2 (11%), II (50%), III (33%), IV (7%). Complete or partial response rate was 70% (95% CI: 54–82) post-NACT and 85% (95% CI: 71–94) post-CRT. The median follow-up was 39.1 months. Overall and progression-free survivals at 3 years were 67% (95% CI: 51–79) and 68% (95% CI: 51–79), respectively. Grade 3/4 toxicities were 20% during NACT (11% haematological, 9% non-haematological) and 52% during CRT (haematological: 41%, non-haematological: 22%). Conclusion: A good response rate is achieved by dose-dense weekly NACT with carboplatin and paclitaxel followed by radical CRT. This treatment regimen is feasible as evidenced by the acceptable toxicity of NACT and by the high compliance to radiotherapy (98%)

Multitrophic enemy escape of invasive Phragmites australis and its introduced herbivores in North America

© 2015, Springer International Publishing Switzerland. One explanation for why invasive species are successful is that they escape natural enemies from their native range or experience lower attack from natural enemies in the introduced range relative to native species (i.e., the enemy-release hypothesis). However, little is known about how invasive plants interact with co-introduced herbivores or natural enemies of the introduced herbivores. We focus on Phragmites australis, a wetland grass native to Europe (EU) and North America (NA). Within the past 100–150 years, invasive European genotypes of P. australis and several species of specialist Lipara gall flies have spread within NA. On both continents we surveyed P. australis patches for Lipara infestation (proportion of stems infested) and Lipara mortality from natural enemies. Our objectives were to assess evidence for enemy-release in the invaded (NA) versus native (EU) range and whether Lipara infestation or mortality differed between invasive and native P. australis genotypes in NA. Enemy-release varied regionally; Lipara were absent throughout most of NA, supporting enemy-release of Phragmites. However, where Lipara were present, the proportion of invasive P. australis stems infested with Lipara was higher in the introduced (11 %) than native range (\u3c1 \u3e%). This difference may be explained by the absence of Lipara parasitoids in our NA survey, strongly supporting enemy-release of Lipara. In NA, native P. australis genotypes exhibited higher Lipara infestation (32 %) than invasive genotypes (11 %), largely driven by L. rufitarsis. We attribute genotypic differences in infestation to a combination of Lipara exhibiting 34 % greater performance (gall diameter) and suffering four times less vertebrate predation on native than invasive genotypes. Our study suggests that complex interactions can result from the co-introduction of plants and their herbivores, and that a multitrophic perspective is required for investigating how biotic interactions influence invasion success