Category: Nevin Manimala

Eur J Nucl Med Mol Imaging. 2023 Dec 12. doi: 10.1007/s00259-023-06547-z. Online ahead of print.

ABSTRACT

BACKGROUND: C-X-C motif chemokine receptor 4 (CXCR4) is overexpressed in various solid cancers and can be targeted by CXCR4-directed molecular imaging. We aimed to characterize the in-vivo CXCR4 expression in patients affected with solid tumors, along with a comparison to ex-vivo findings.

METHODS: A total 142 patients with 23 different histologically proven solid tumors were imaged with CXCR4-directed PET/CT using [⁶⁸ Ga]Ga-pentixafor (total number of scans, 152). A semi-quantitative analysis of the CXCR4-positive tumor burden including maximum standardized uptake values (SUV_max) and target-to-background ratios (TBR) using blood pool was conducted. In addition, we performed histopathological staining to determine the immuno-reactive score (IRS) from patients’ tumor tissue and investigated possible correlations with SUV_max (by providing Spearman’s rho ρ). Based on imaging, we also assessed the eligibility for CXCR4-targeted radioligand therapy or non-radioactive CXCR4 inhibitory treatment (defined as more than five CXCR4-avid target lesions [TL] with SUV_max above 10).

RESULTS: One hundred three of 152 (67.8%) scans showed discernible uptake above blood pool (TBR > 1) in 462 lesions (52 primary tumors and 410 metastases). Median TBR was 4.4 (1.05-24.98), thereby indicating high image contrast. The highest SUV_max was observed in ovarian cancer, followed by small cell lung cancer, desmoplastic small round cell tumor, and adrenocortical carcinoma. When comparing radiotracer accumulation between primary tumors and metastases for the entire cohort, comparable SUV_max was recorded (P > 0.999), except for pulmonal findings (P = 0.013), indicative for uniform CXCR4 expression among TL. For higher IRS, a weak, but statistically significant correlation with increased SUV_max was observed (ρ = 0.328; P = 0.018). In 42/103 (40.8%) scans, more than five TL were recorded, with 12/42 (28.6%) exhibiting SUV_max above 10, suggesting eligibility for CXCR4-targeted treatment in this subcohort.

CONCLUSIONS: In a whole-body tumor read-out, a substantial portion of prevalent solid tumors demonstrated increased and uniform [⁶⁸ Ga]Ga-pentixafor uptake, along with high image contrast. We also observed a respective link between in- and ex-vivo CXCR4 expression, suggesting high specificity of the PET agent. Last, a fraction of patients with [⁶⁸ Ga]Ga-pentixafor-positive tumor burden were rendered potentially suitable for CXCR4-directed therapy.

PMID:38082196 | DOI:10.1007/s00259-023-06547-z

Radiol Med. 2023 Dec 11. doi: 10.1007/s11547-023-01751-1. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the diagnostic role of a dedicated AI software in detecting anomalous breast findings on mammography and tomosynthesis images in the clinical setting, stand-alone and as aid of four readers.

METHODS: A total of 210 patients with complete clinical and radiologic records were retrospectively analyzed. Pathology was used as the reference standard for patients undergoing surgery or biopsy, and a 1-year follow-up was used to confirm no change in the remaining patients. The image evaluation was performed by four readers with different levels of experience (a junior and three senior breast radiologists) using a 5-point Likert scale moving from 1 (definitively no cancer) to 5 (definitively cancer). The positivity of mammograms was assessed on the presence of any breast lesion (masses, architectural distortions, asymmetries, calcifications), including malignant and benign ones. A multi-reader multi-case analysis was performed. A p value < 0.05 was considered statistically significant.

RESULTS: The stand-alone AI system achieved an accuracy of 71% (69% sensitivity and 73% specificity), which is overall lower than the value achieved by readers without AI. However, with the aid of AI, a significant increase of accuracy (p value = 0.004) and specificity (p value = 0.04) was achieved for the less experienced radiologist and a senior one.

CONCLUSION: The use of AI software as a second reader for breast lesions assessment could play a crucial role in the clinical setting, by increasing sensitivity and specificity, especially for less experienced radiologists.

PMID:38082194 | DOI:10.1007/s11547-023-01751-1

J Ultrasound. 2023 Dec 12. doi: 10.1007/s40477-023-00836-x. Online ahead of print.

ABSTRACT

AIMS: To identify and highlight pertinent US features that could serve as imaging biomarkers to describe different patient phenotypes, within Great Trochanteric Pain Syndrome (GTPS) clinical diagnosis.

MATERIALS AND METHODS: Using ultrasound we evaluated eighty-eight clinically diagnosed patients with GTPS, for tendon matrix changes and calcium deposits in the gluteus medius (superoposterior and lateral aspects) and in the gluteus minimus. Peritrochanteric examination included fascia lata, trochanteric bursa, cortical irregularities and the presence of enthesophytes. The association of pathological changes with pain and functionality was evaluated using multivariate regression models.

RESULTS: Out of the 88 patients, 86 examinations (97.7%) detected gluteus medius tendinopathy, and 54 patients (61.4%) had gluteus minimus tendinopathy in addition. Calcium deposits were present in 97.7% of patients, associated with tenderness (p = 0.009), and most often located in the gluteus medius rather than in the gluteus minimus (p = 0.014); calcifications were associated with tendon thickness (p = 0.042), hypoechogenicity (p = 0.005) and the presence of partial tears (p = 0.030). Bursa swelling occurred in 36 patients (40.9%); multivariate regression models predicted less pain in patients with bursa distension (p = 0.008) and dysfunction in patients with gluteal muscle atrophy (p = 0.001) and loss of fibrillar pattern in the gluteus medius (p = 0.002).

CONCLUSION: GTPS involves both degenerative calcifying gluteal tendinopathy and alterations in the peritrochanteric space associated with physical function and pain. The severity of GTPS can be assessed using ultrasound imaging biomarkers.

PMID:38082193 | DOI:10.1007/s40477-023-00836-x

J Environ Manage. 2023 Dec 10;351:119606. doi: 10.1016/j.jenvman.2023.119606. Online ahead of print.

ABSTRACT

Cyanobacterial harmful algal blooms (CHABs) have become a persistent seasonal problem in the upper San Francisco Estuary, California also known as the Sacramento-San Joaquin Delta (Delta). The Delta is comprised of a complex network of open water bodies, channels, and sloughs. The terminus of the Stockton Channel is an area identified as a CHAB “hotspot.” As CHABs increase in severity, there is an urgent need to better understand CHAB drivers to identify and implement mitigation measures that can be used in an estuarine complex like the Delta. We investigated water quality conditions and nutrient dynamics in the Stockton Channel by measuring nutrients in the water column, sediments, and pore waters. In situ nutrient addition bioassay experiments were used to assess the effects of nutrient enrichment on total algal/cyanobacterial growth and pigment concentrations. In both June and September, relative to unamended controls, total chlorophyll and cyanobacterial pigment concentrations were unaffected by nutrient additions; hence, the study area showed signs of classical hypereutrophication, with ambient nitrogen and phosphorus present in excess of algal growth requirements. A cyanobacterial bloom, dominated by Microcystis spp. was present throughout the study area but was most severe and persistent at the shallowest site at the channel terminus. At this site, Microcystis spp. created water quality conditions that allowed for a prolonged bloom from June through September. While targeted nutrient reductions are recommended for long term mitigation, on a shorter timescale, our findings suggest that physical/mechanical controls are the more promising alternative approaches to reduce the severity of CHABs in the terminus of the Stockton Channel.

PMID:38081090 | DOI:10.1016/j.jenvman.2023.119606

Aust Health Rev. 2023 Dec 12. doi: 10.1071/AH23160. Online ahead of print.

ABSTRACT

ObjectiveThere is limited evidence about how legal frameworks that underpin end-of-life decisions are applied in practice. This study aimed to identify how end-of-life decisions are made and documented in emergency departments and intensive care units. The secondary aim was to explore the extent to which the legal processes featured in these decisions.MethodsA retrospective chart audit of 85 adult patients who died in the emergency departments and intensive care units of a Queensland health service was undertaken. Quantitative data were analysed and reported using descriptive statistics. Qualitative textual data were analysed using inductive content analysis.ResultsNearly all admissions were unplanned (97.6%), and most patients (74.1%) were admitted from home. Only one patient had an advance health directive, although all had an eligible substitute decision-maker. The qualitative analysis revealed two main concepts – ‘healthcare professionals choreograph the end of life’ and ‘patients and families are carried on an unplanned journey’.ConclusionsThere was limited documentation related to the application of the legal framework in these decisions. Healthcare professionals relied on their clinical judgment about what was in the best interest of the patient. It was common for there to be a substantial effort to achieve consensus in decision-making which coincidently complied with the law.

PMID:38081044 | DOI:10.1071/AH23160

J Perinat Med. 2023 Dec 13. doi: 10.1515/jpm-2023-0211. Online ahead of print.

ABSTRACT

OBJECTIVES: To use saline infusion sonohysterography (SIS) to evaluate the effect of uterine closure technique on niche formation after multiple cesarean deliveries (CDs).

METHODS: Patients with at least one prior CD were evaluated for niche via SIS. Subgroups of any number repeat CD (>1 prior), lower-order CD (<4 prior), and higher-order CD (≥4 prior) were analyzed, stratifying by hysterotomy closure technique at last cesarean preceding imaging; techniques included Technique A (endometrium-free double-layer closure) and Technique B (single- or double-layer routine endo-myometrial closure). Niche defects were quantified (depth, length, width, and residual myometrial thickness). The primary outcome was clinically significant niche, defined as depth >2 mm. Statistical analysis was performed using chi-square, ANOVA, t-test, Kruskal-Wallis, and multiple logistic regression, with p-values of <0.05 were statistically significant.

RESULTS: A total of 172 post-cesarean SIS studies were reviewed: 105 after repeat CDs, 131 after lower-order CDs, and 41 after higher-order CDs. Technique A was associated with a shorter interval to imaging and more double-layer closures. Technique B was associated with more clinically significant niches across all subgroups, and these niches were significantly longer and deeper when present. Multiple logistic regression demonstrated a 5.6, 8.1, and 11-fold increased adjusted odds of clinically significant niche following Technique B closure in the repeat CD (p<0.01), lower-order CD (p<0.001), and higher-order CD (p=0.04) groups, respectively.

CONCLUSIONS: While multiple CDs are known to increase risk for niche defects and their sequelae, hysterotomy closure technique may help to reduce niche development and severity.

PMID:38081042 | DOI:10.1515/jpm-2023-0211

West J Med Phys Sci. 1838 Apr-Jun;6(1):149-150.

NO ABSTRACT

PMID:38080888 | PMC:PMC10470978

West J Med Phys Sci. 1833 Jul-Sep;1(2):161-181.

NO ABSTRACT

PMID:38080776 | PMC:PMC10467859

N Am Medchir Rev. 1858 Mar;2(2):334-340.

NO ABSTRACT

PMID:38080312 | PMC:PMC10348215

N Am Medchir Rev. 1861 Sep;5(5):927-937.

NO ABSTRACT

PMID:38080064 | PMC:PMC10344228