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

The rationality of rainy day savers: objective and subjective determinants of individual savings in Britain

Using the largest and richest data on savings in Great Britain, six waves of the Wealth and Assets Survey from the Office for National Statistics, we compare standard life cycle models of saving with models using more 'subjective' measures, and the added dimension of longitudinal data. Whilst the life cycle model provides a benchmark, regular criticisms remain, particularly people's propensity to continue saving at older ages. Data on attitudes attenuate that issue, and panel data largely eliminate it. Our results confirm empirically, for Great Britain, the importance of some of the objective determinants of savings included in life cycle theory. When we look at more subjective ones, we show that other factors, including self-rated health and financial pressure, provide an enhanced direct explanation of the propensity to save. Individuals who regard themselves as 'rainy day savers' tended to save more, irrespective of their demographic or financial circumstances. Results are robust to different specifications

Increased 68 Ga-PSMA-11 Bone Marrow and Splenic Uptake in a Case of Erythroid Myelodysplasia

We describe the case of an 82-year-old man who underwent 68&nbsp;Ga-prostate-specific membrane antigen-11 (68&nbsp;Ga-PSMA-11) positron emission tomography/computed tomography (PET/CT) for the restaging of prostate carcinoma. 68&nbsp;Ga-PSMA-11 PET/CT unexpectedly showed increased tracer uptake homogenously involving the axial and appendicular bone marrow and the spleen, not characteristic for metastatic prostate disease. Further investigations revealed that 2&nbsp;months before the patient underwent bone marrow biopsy, which showed the occurrence of monolinear myelodysplasia

Central Nervous System Imaging in Movement Disorders

Movement disorders are a group of neurological diseases (recognizing neurodegenerative and non-neurodegenerative etiologies) whose primary symptomatology is related to the lack of movement or, conversely, to an excessive and/or involuntary movement. Among them, neurodegenerative parkinsonian syndromes include Parkinson's Disease, Dementia with Lewy Bodies, and Atypical Parkinsonisms. The differential diagnosis of the neurodegenerative parkinsonian syndromes includes clinical entities such as essential tremor (ET), drug-induced parkinsonism, vascular parkinsonism, and psychogenic parkinsonism. In the last years, the differential diagnosis between these different etiologies has been increasingly guided by molecular imaging. The present chapter deals with the use of Positron Emission Tomography (PET) biomarkers in patients with movement disorders. In particular, as PET's clinical role in this field is most prevalent in patients with parkinsonian syndromes, a more extended discussion is provided about the use of PET in parkinsonism. As a result, dopaminergic imaging is more extensively discussed. Further topics addressed include the use of 18F-Fluorodeoxyglucose (FDG) PET in patients with movement disorders and patients with movement disorders presenting with mild cognitive impairment and dementia. Other tracers such as tracers for Tau and Amyloid PET imaging and tracers for neuroinflammation imaging are more briefly mentioned. Preliminary data and challenges related to the development of tracers for alpha-synuclein are also reported

Evidence-based PET for neurological diseases

Over the past two decades, one of the major breakthroughs for the approach to neurological diseases both in the clinical and research settings has been represented by the validation of diagnostic biomarkers able to demonstrate the presence of pathological mechanisms, alteration in neurotransmission as well as to predict disease progression [1, 2]. The use of PET with different tracers as well as other imaging biomarkers support the etiological diagnosis of neurological disorders in vivo. This approach is particularly relevant in the field of neurodegenerative diseases. In fact, neurodegenerative diseases are characterized by the progressive degeneration and death of neurons. They represent a heterogeneous group of conditions characterized by different etiologies, different neuropathological and neurochemical alterations leading to different clinical pictures and courses [3]. Indeed, an early accurate diagnosis allows to tackle the disease with available or experimental intervention, lifestyle changes, or logistical arrangements, before disability has developed. Early intervention is expected to have greater clinical impact, extend independent and active life, improve its quality, and decrease the burden and costs of the disease [4]. However, the validation of PET tracers in neurological disease is still ongoing, and evidence on its comparative and combined diagnostic value with respect to other biomarkers is incomplete [4, 5]. As a matter of fact, the increasing pressure for cost-effectiveness requires systematic assessment and validation of all biomarker performance in the clinical settings. Similarly only an evidence-based approach to new PET tracers can allow to select the most promising tracers for PET imaging in the research field both for pathophysiological investigations and for upcoming diagnostic approaches

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

Emerging applications of imaging in glioma: focus on PET/MRI and radiomics

Purpose: In the last years, it has emerged the unmet need for imaging technologies able to accurately describe the biological and clinical heterogeneity of glioma, assess responsiveness to therapy, and predict patient outcomes. The increasing number of additional imaging parameters primarily derived from advanced Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET), the technical developments of hybrid PET/MRI scanners, and the use of artificial intelligence might be able to fill this gap. In the present narrative review, we analyzed the potential of radiomics features extracted from stand-alone PET/MRI or combined PET and MRI scanners in the assessment of glioma. Methods: PubMed, Embase, and Web of Science were searched for articles published up to January 2021 using the following keywords: “PET/MRI AND glioma”, “PET/MRI AND glioblastoma”, “PET/MRI AND radiomics AND glioma”, “PET/MRI AND radiomics AND glioblastoma”. We included only original articles published in English reporting the use of PET/MRI or PET/MRI-derived radiomics features (extracted either from PET or MRI scanner or hybrid PET/MRI device) in patients with glioma. Results: Published data suggest that hybrid PET/MRI may be superior to MRI-alone in differentiating low-grade vs. high-grade glioma, in detecting malignant transformation of LGG, and in the differential diagnosis between true recurrences from post-treatment changes. Moreover, PET/MRI could add helpful information for radiotherapy and surgery planning. Also, the rapid advancement in computer-based image analysis including artificial intelligence and radiomics has extended to PET imaging in the last years, with promising results particularly in the setting of preoperative imaging and in the post-treatment setting. Conclusions: Published literature suggests a high potential for PET/MRI-derived radiomics. However, these results are based on small datasets and need to be further investigated in large prospective studies. Multidisciplinary efforts and multicenter collaborations will be essential to achieve these aims in the next future