Diagnosis of early invasive breast cancer relies on radiology and clinical evaluation, supplemented by biopsy confirmation. At least three issues burden this approach: a) suboptimal sensitivity and ...suboptimal positive predictive power of radiology screening and diagnostic approaches, respectively; b) invasiveness of biopsy with discomfort for women undergoing diagnostic tests; c) long turnaround time for recall tests. In the screening setting, radiology sensitivity is suboptimal, and when a suspicious lesion is detected and a biopsy is recommended, the positive predictive value of radiology is modest. Recent technological advances in medical imaging, especially in the field of artificial intelligence applied to image analysis, hold promise in addressing clinical challenges in cancer detection, assessment of treatment response, and monitoring disease progression. Radiomics include feature extraction from clinical images; these features are related to tumor size, shape, intensity, and texture, collectively providing comprehensive tumor characterization, the so-called radiomics signature of the tumor. Radiomics is based on the hypothesis that extracted quantitative data derives from mechanisms occurring at genetic and molecular levels. In this article we focus on the role and potential of radiomics in breast cancer diagnosis and prognostication.
•In the screening setting, radiology sensitivity is suboptimal.•Artificial intelligence hold promise in cancer diagnosis and prognostication.•Radiomics include feature extraction from clinical images.
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
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’s 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 ± 1.02 vs 4.12 ± 1.33 mL/kg;
p
< 0.01) and increase in psoas N-SUV (0.45 ± 0.19 vs 0.29 ± 0.09;
p
< 0.001) were observed. Higher heterogeneity of psoas FDG uptake was also documented in ALS (VC-SUV 8 ± 4%, vs 5 ± 2%, respectively,
p
< 0.001) and significantly predicted overall survival at Kaplan–Meier 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.
Genome sharing between cancer and normal tissues might imply a similar susceptibility to chemotherapy toxicity. The present study aimed to investigate whether curative potential of doxorubicin, ...bleomycin, vinblastine, and dacarbazine (ABVD) is predicted by the metabolic response of normal tissues in patients with Hodgkin lymphoma (HL). METHODS: According to current guidelines, 86 patients with advanced-stage (IIB-IVB) HL, prospectively enrolled in the HD0607 trial (NCT00795613), underwent 18 F-fluorodeoyglucose PET/CT imaging at diagnosis and, at interim, after two ABVD courses, to decide regimen maintenance or its escalation. In both scans, myocardial FDG uptake was binarized according to its median value. Death and disease relapse were recorded to estimate progression-free survival (PFS) during a follow-up with median duration of 43.8 months (range 6.97–60). RESULTS: Four patients (4.6%) died, while six experienced disease relapse (7%). Complete switch-off of cancer lesions and cardiac lighting predicted a favorable outcome at Kaplan–Mayer analyses. The independent nature and additive predictive value of their risk prediction were confirmed by the multivariate Cox regression analysis. CONCLUSION: Susceptibility of HL lesions to chemotherapy is at least partially determined by factors featuring the host who developed it.
The thesis is an investigation of how medium of instruction (MOI) as a factor interacts with relevant socio-cultural contextual factors to create impacts on the attitudes, motivation and academic ...performance of secondary school children studying in two branches of the same school, one with Chinese as MOI and one with English as MOI, called MOI bifurcation. It attempts to use both quantitative and qualitative data collection techniques to investigate the impacts of the streaming of students to learn either in their first language or the second language on the attitudinal, motivational as well as behavioural development of students of the two respective MOI streams. The setting for the thesis was the secondary sector of Hong Kong, a city of People's Republic of China with the unique presence of two dominant languages, namely, Chinese, the first language of the majority of the population, and English, the socially and economically powerful second language. Subjects were 213 male and 188 female students from three secondary schools with Chinese as the medium of instruction (CMI), who were allocated to either the Chinese stream or the English stream (EMI) upon transition to Secondary 4 being the penultimate year of the 5 year secondary system. The subjects shared similar cultural and educational backgrounds, all with at least 12 years of education learning through the Chinese medium. Results revealed that differences were consistently identified between the students of the two MOI groups, both immediately upon and some time after the transition to the bifurcation settings, in their attitudinal as well as behavioural development, and in their self-reported academic performance. It was also found that the differences identified were found to either continue or grow in strength in the course of time, though some of the differences only emerged at a later stage. Findings also indicated that in a context where the differences between the two learning media are substantial in terms of status and educational values, the MOI streaming had a unique and more positive impact on students studying through the high power second language (i.e. English), e.g. more favourable attitudes towards English, higher level of L2 motivation, better self-concept and an inclination to a higher level of internality. On the other hand, those studying in their native but low status mother-tongue were found to be more susceptible to less favourable development in the above aspects, in comparison with their EMI counterparts.
Multiple Myeloma (MM) is a blood cancer implying bone marrow involvement, renal damages and osteolytic lesions. The skeleton involvement of MM is at the core of the present paper, exploiting ...radiomics and artificial intelligence to identify image-based biomarkers for MM. Preliminary results show that MM is associated to an extension of the intrabone volume for the whole body and that machine learning can identify CT image features mostly correlating with the disease evolution. This computational approach allows an automatic stratification of MM patients relying of these biomarkers and the formulation of a prognostic procedure for determining the disease follow-up.
To assess Arizona pharmacists' attitudes and knowledge regarding HIV infection and AIDS.
Mailing of a 7-page survey, which included demographic and attitudinal items, as well as preparedness, ...comfort, and knowledge scales.
Randomly selected pharmacists registered and residing in Arizona.
Of the 479 pharmacists surveyed, 41 were removed from the sample because they had moved with no forwarding address, were retired or not practicing, or had died. The response rate was 46% for the remaining 438 pharmacists. A final sample size of 199 was obtained.
The respondents had a high level of preparedness and comfort in addition to positive attitudes. Overall, their knowledge level was low. Inpatient pharmacists had a higher level of therapeutic knowledge (p < 0.0001) and were more willing to work with a person infected with HIV than were outpatient pharmacists (p = 0.05). Pharmacists who had attended at least 1 HIV/AIDS-related continuing education (CE) program had higher levels of preparedness (p < 0.0001), comfort (p = 0.01), and knowledge (p < 0.0001) than those who had not. The majority of respondents believed that an HIV/AIDS CE program should be mandatory.
Although Arizona pharmacists feel prepared, are comfortable, and have positive attitudes regarding patients with HIV/AIDS, their level of knowledge is low. The results of this study may be used by CE providers to design programs to meet the educational needs of pharmacists.
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