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ObjectivesStandardization is an important milestone in the validation of DWI-based parameters as imaging biomarkers for renal disease. Here, we propose technical recommendations on three variants of renal DWI, monoexponential DWI, IVIM and DTI, as well as associated MRI biomarkers (ADC, D, D*, f, FA and MD) to aid ongoing international efforts on methodological harmonization.Materials and methodsReported DWI biomarkers from 194 prior renal DWI studies were extracted and Pearson correlations between diffusion biomarkers and protocol parameters were computed. Based on the literature review, surveys were designed for the consensus building. Survey data were collected via Delphi consensus process on renal DWI preparation, acquisition, analysis, and reporting. Consensus was defined as ≥ 75% agreement.ResultsCorrelations were observed between reported diffusion biomarkers and protocol parameters. Out of 87 survey questions, 57 achieved consensus resolution, while many of the remaining questions were resolved by preference (65-74% agreement). Summary of the literature and survey data as well as recommendations for the preparation, acquisition, processing and reporting of renal DWI were provided.DiscussionThe consensus-based technical recommendations for renal DWI aim to facilitate inter-site harmonization and increase clinical impact of the technique on a larger scale by setting a framework for acquisition protocols for future renal DWI studies. We anticipate an iterative process with continuous updating of the recommendations according to progress in the field.

The article Consensus-based technical recommendations for clinical translation of renal diffusion-weighted MRI.

Abstract The differentiation between ameloblastoma (AB) and odontogenic keratocyst (OKC) is essential for the formulation of the surgical plan, especially considering the biological behavior of these two pathological entities. Therefore, developing means to increase the accuracy of the diagnostic process is extremely important for a safe treatment. The aim of this study was to use magnetic resonance imaging (MRI) based on texture analysis (TA) as an aid in differentiating AB from OKC. This study comprised 18 patients; eight patients with AB and ten with OKC. All diagnoses were determined through incisional biopsy and later through histological examination of the surgical specimen. MRI was performed using a 3 T scanner with a neurovascular coil according to a specific protocol. All images were exported to segmentation software in which the volume of interest (VOI) was determined by a radiologist, who was blind to the histopathological results. Next, the textural parameters were computed by using the MATLAB software. Spearman's correlation coefficient was used to assess the correlation between texture parameters and the selected variables. Differences in TA parameters were compared between AB and OKC by using the Mann–Whitney test. Mann–Whitney test showed a statistically significant difference between AB and OKC for the parameters entropy (P = 0.033) and sum average (P = 0.033). MRI texture analysis has the potential to discriminate between AB and OKC as a noninvasive method. MRI texture analysis can be an additional tool to differentiate ameloblastoma from odontogenic keratocyst.

Background: and purpose: Radiation recall dermatitis is an adverse event predominantly due to systemic therapy administration after a previous radiation therapy course. Few case reports describe radiation recall dermatitis in breast cancer patients treated with postoperative radiation therapy following COVID-19 vaccination. In this study we investigated the incidence and severity of radiation recall dermatitis after COVID-19 vaccination in irradiated breast cancer patients. Methods: Patients that received at least one COVID-19 vaccination dose during the year after the end of postoperative breast radiation therapy were included in this observational monocentric study. Local symptoms occurring inside the radiation field after vaccination were patient-reported and scored according to the PRO-CTCAE questionnaire. Descriptive data of radiation recall dermatitis incidence and severity, and potential risk factors were evaluated. Results: A cohort of 361 patients with 756 administered COVID-19 vaccinations was analyzed. Breast symptoms were reported by 7.5% of patients, while radiation recall dermatitis was considered for 5.5%. The incidence of radiation recall dermatitis per single dose of vaccine was 2.6%, with a higher risk for the first dose compared to the second/third (4.4% vs 1%, p = 0.003), especially when administered within the first month after the end of irradiation (12.5% vs 2.2%, p = 0.0004). Local symptoms were generally self-limited and a few cases required anti-inflammatory drugs. Conclusions: Radiation recall dermatitis is an uncommon but not rare phenomenon in breast cancer patients that received COVID-19 vaccination within one year after breast irradiation. However, symptoms severity were generally low/mild and reversible. These findings can be useful for patient counseling.

Abstract Background Lesion/tissue segmentation on digital medical images enables biomarker extraction, image-guided therapy delivery, treatment response measurement, and training/validation for developing artificial intelligence algorithms and workflows. To ensure data reproducibility, criteria for standardised segmentation are critical but currently unavailable. Methods A modified Delphi process initiated by the European Imaging Biomarker Alliance (EIBALL) of the European Society of Radiology (ESR) and the European Organisation for Research and Treatment of Cancer (EORTC) Imaging Group was undertaken. Three multidisciplinary task forces addressed modality and image acquisition, segmentation methodology itself, and standards and logistics. Devised survey questions were fed via a facilitator to expert participants. The 58 respondents to Round 1 were invited to participate in Rounds 2–4. Subsequent rounds were informed by responses of previous rounds. Results/conclusions Items with ≥ 75% consensus are considered a recommendation. These include system performance certification, thresholds for image signal-to-noise, contrast-to-noise and tumour-to-background ratios, spatial resolution, and artefact levels. Direct, iterative, and machine or deep learning reconstruction methods, use of a mixture of CE marked and verified research tools were agreed and use of specified reference standards and validation processes considered essential. Operator training and refreshment were considered mandatory for clinical trials and clinical research. Items with a 60–74% agreement require reporting (site-specific accreditation for clinical research, minimal pixel number within lesion segmented, use of post-reconstruction algorithms, operator training refreshment for clinical practice). Items with ≤ 60% agreement are outside current recommendations for segmentation (frequency of system performance tests, use of only CE-marked tools, board certification of operators, frequency of operator refresher training). Recommendations by anatomical area are also specified.

Long-term pulmonary sequelae in COVID-19 patients are currently under investigation worldwide. Potential relationships between blood sampling and functional and radiological findings are crucial to guide the follow-up. In this study, we collected and evaluated clinical status, namely symptoms and patients’ reported outcome, pulmonary function tests (PFT), laboratory tests, and radiological findings at 3- and 12-months post-discharge in patients admitted between 25 February and 2 May 2020, and who survived severe COVID-19 pneumonia. A history of chronic pulmonary disease or COVID-19-unrelated complications were used as exclusion criteria. Unenhanced CTs were analyzed quantitatively (compromising lung volume %) and qualitatively, with main patterns of: ground-glass opacity (GGO), consolidation, and reticular configuration. Patients were subsequently divided into groups based on their radiological trends and according to the evolution in the percentage of compromised lung volume. At 12 months post-discharge, seventy-one patients showed significantly improved laboratory tests and PFT. Among them, 63 patients also underwent CT examination: all patients with negative CT findings at three months (n = 14) had negative CT also at 12 months; among the 49/63 patients presenting CT alterations at three months, 1/49 (2%) normalized, 40/49 (82%) improved, 7/49 (14%) remained stably abnormal, and 1/49 (2%) worsened. D-dimer values were low in patients with normal CT and higher in cases with improved or stably abnormal CT (median values 213 vs. 329 vs. 1000 ng/mL, respectively). The overall compromised lung volume was reduced compared with three months post-discharge (12.3 vs. 14.4%, p < 0.001). In stably abnormal CT, the main pulmonary pattern changed, showing a reduction in GGO and an increase in reticular configuration. To summarize, PFT are normal in most COVID-19 survivors 12 months post-discharge, but CT structural abnormalities persist (although sensibly improved over time) and are associated with higher D-dimer values.

Abstract This study aimed to evaluate the responsiveness of the Italian version of the Paediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL-MFS) to changes in BMI, fatigue and depressive symptoms in adult inpatients with obesity. 198 adults (81% female, mean age = 44.7 years) with obesity completed the PedsQL-MFS, the Fatigue Severity Scale (FFS) and the Centre for Epidemiologic Studies Depression Scale (CESD) before and after completing a 3-week body weight reduction program. Internal responsiveness was measured via paired t-tests, standardized mean response (SMR) and Glass’s delta (d). Changes in FFS, CESD and BMI were used as anchors to categorize participants as “improved”, “unchanged” or “deteriorated”. External Responsiveness was assessed by comparing mean post-intervention PedsQL-MFS scores across change groups, adjusting for pre-intervention PedsQL-MFS scores and in area-under-curve (AUC) analysis. PedsQL-MFS Total, Sleep/Rest Fatigue and Cognitive Fatigue scores demonstrated significant reductions in response to an established body weight reduction program. Post-intervention PedsQL-MFS scale scores were lower among those who had improved on the CESD and FSS than among those whose CESD and FSS scores had not significantly changed. There was no difference in PedsQL-MFS scale scores according to whether participants had reduced their BMI by at least 5%. AUC analyses indicated that change in PedsQL-MFS scores was somewhat more predictive of improvement in CESD than FSS scores. The Italian version of the PedsQL-MFS demonstrated both internal and external responsiveness. It appeared more sensitive to improvement than deterioration in fatigue symptoms and its sensitivity to deterioration in depressive symptoms and weight loss could not be evaluated in the present study as there was no reliable deterioration in CESD scores and weight loss was modest. Future studies should include a control group to assess the sensitivity of the PedsQL-MFS more thoroughly.

Uncovering key actors within a policy network provides pathways for engagement, consensus-building, partnership development, and understanding the diffusion of knowledge in a given debate. Given the unprecedented scale of the climate emergency, the emerging field of climate security has rapidly gained centrality in academic and policy fora, as well as in the public debate. Yet, a systematic analysis of the main actors engaged in this space is missing. This study draws from digital methods and network analysis techniques to employ a method for identifying relevant actors, focusing on Twitter (now X) from 2014 to 2022, with the objective of systematically spotting the major actors driving and shaping public discussions around climate security. The research also demonstrates how institutions can position themselves within such issue networks through a case study of the CGIAR, the largest publicly funded global research partnership for a food-secure future dedicated to transforming food, land, and water systems in a climate crisis that has recently positioned itself in this community. Results reveal that the climate security debate on social media is predominantly institutional, with research bodies and international organizations from the Global North as central elements. While CGIAR is a relatively new actor, it is already centrally located in the network, maintaining strong connections with other major players, which places it in a strategic position to enhance its influence and reach. Understanding this discursive landscape is crucial for institutions and organizations to identify opportunities for effective engagement, partnership, and positioning in such an increasingly salient field of research and practice. [ABSTRACT FROM AUTHOR]

Background: Glioblastoma (GBM) is a lethal brain tumor characterized by the glioma stem cell (GSC) niche. The V-ATPase proton pump has been described as a crucial factor in sustaining GSC viability and tumorigenicity. Here we studied how patients-derived GSCs rely on V-ATPase activity to sustain mitochondrial bioenergetics and cell growth. Methods: V-ATPase activity in GSC cultures was modulated using Bafilomycin A1 (BafA1) and cell viability and metabolic traits were analyzed using live assays. The GBM patients-derived orthotopic xenografts were used as in vivo models of disease. Cell extracts, proximity-ligation assay and advanced microscopy was used to analyze subcellular presence of proteins. A metabolomic screening was performed using Biocrates p180 kit, whereas transcriptomic analysis was performed using Nanostring panels. Results: Perturbation of V-ATPase activity reduces GSC growth in vitro and in vivo. In GSC there is a pool of V-ATPase that localize in mitochondria. At the functional level, V-ATPase inhibition in GSC induces ROS production, mitochondrial damage, while hindering mitochondrial oxidative phosphorylation and reducing protein synthesis. This metabolic rewiring is accompanied by a higher glycolytic rate and intracellular lactate accumulation, which is not exploited by GSCs for biosynthetic or survival purposes. Conclusions: V-ATPase activity in GSC is critical for mitochondrial metabolism and cell growth. Targeting V-ATPase activity may be a novel potential vulnerability for glioblastoma treatment. [ABSTRACT FROM AUTHOR]

Background/Objectives: Prader–Willi syndrome (PWS) is a rare, genetically determined neurodevelopmental disorder. Individuals with PWS face numerous challenges that significantly impact their psychological well-being and quality of life, ultimately limiting their personal and social functioning. This study aimed to evaluate the quality of life and psychological well-being in a sample of Italian adult patients with PWS compared to an age-matched control group of normal-weight Italian individuals. Methods: Thirty patients with PWS (11 men and 19 women; mean age ± SD: 36.4 ± 10.31 years; mean Body Mass Index (BMI: 35.7 ± 8.92 kg/m2) and thirty Italian adult individuals from the general population (5 men and 25 women; mean age ± SD: 32.1 ± 6.86 years; mean Body Mass Index (BMI: 21.8 ± 2.90 kg/m2) were studied. Quality of life and well-being were assessed using the Italian versions of the 36-item Health Survey Short Form and the Psychological General Well-Being Index. Results: Normal-weight subjects scored significantly higher than PWS patients on the physical health (p < 0.001) and social functioning (p = 0.047) subscales of the SF-36. Conversely, PWS patients scored higher on the vitality subscale (p < 0.001). Similarly, the vitality subscale of the PGWBI was significantly higher in PWS patients than in controls (p = 0.010), whereas the Self-Control subscale of the PGWBI was higher in controls compared to PWS patients, albeit not statistically significant (p = 0.057). Discussion: Patients with PWS exhibited impairments in various aspects of quality of life and psychological well-being, including physical, behavioral, and social domains. However, the higher vitality scores observed in PWS patients suggest a preserved dimension of their psychological well-being. Conclusions: These findings enhance the understanding of the psychological condition of patients with PWS and provide valuable insights for improving multidisciplinary psychological treatment approaches for these individuals. [ABSTRACT FROM AUTHOR]

Simple Summary: A study conducted across 19 Italian Radiation Oncology centers examined 41,039 cancer patients undergoing or scheduled for anticancer treatment between February 2020 and May 2021. The study aimed to assess the impact of COVID-19 on treatment schedules and patient outcomes. Among the cohort, 123 patients were diagnosed with COVID-19 during treatment (group A), and 99 were diagnosed before treatment initiation (group B). The overall COVID-19 incidence was 0.54%, including 0.30% in group A. Severe COVID-19 developed in 60 patients, and 45 died due to the infection (incidence of 0.15% and 0.11%, respectively). Treatment delays or suspensions were common, with 37.4% of group A requiring temporary suspension, 32.5% definitive suspension and 37 patients continuing treatment while positive. In group B, 53.5% faced delays, and 20.2% had definitive suspensions. Most of the patients with a COVID-19 diagnosis in our cohort recovered and completed their treatment; nonetheless, the attributable death rate after confirmed infection was 20.27%. With adequate preventive measures, radiation oncology could continue safely during the pandemic, resulting in a low incidence of severe outcomes and mortality. Methods and materials: Patients with ongoing or planned anticancer treatment at 19 Italian Radiation Oncology centers were included in the study retrospectively from 3 February 2020 to 31 December 2020 and prospectively from 1 January 2021 to 31 May 2021. Anonymized data were processed through a specific website and database. Antineoplastic treatment characteristics and timing and outcomes of COVID-19 and its impact on radiotherapy or systemic therapy were described. Results: The retrieved cohort included 41,039 patients that received treatment or were planned for therapy in the study period. Overall, 123 patients had a confirmed COVID-19 diagnosis during antineoplastic treatment (group A) and 99 patients before treatment start (group B). The incidence of COVID-19 across the whole cohort in the index period was 0.54% (groups A + B) and 0.30% considering only group A. A total of 60 patients developed severe COVID-19, and a total of 45 patients died as a consequence of the infection (incidence of 0.15% and 0.11%, respectively). Nonetheless, mortality among COVID-19 patients was high, with an attributable death rate after confirmed infection of 20.27%. Among the 123 patients in group A, 37.4% required temporary treatment suspension, 32.5% definitive suspension and 37 patients continued treatment while positive. As for the 99 patients in group B, 53.5% experienced temporary delay, 20.2% experienced definitive treatment suspension and 26.3% had no delay. Conclusions: Most of the patients with a COVID-19 diagnosis in our cohort recovered and completed their treatment; nonetheless, the attributable death rate after confirmed infection was 20.27%, and mortality was high among cancer patients with severe COVID-19 presentation. The global incidence of death due to COVID-19 or severe COVID-19 was low and decreased over time. Radiation oncology activity could be safely continued during the COVID-19 pandemic with the adoption of adequate preventive measures. [ABSTRACT FROM AUTHOR]

The 1H and 13C NMR spectra of the N‐(3,5‐dichloro‐4‐hydroxyphenyl)‐ 2,4,6‐triphenylpyridinium perchlorate and of its deprotonated betaine 4‐(2,4,6‐triphenylpyridinio)‐2,6‐dichlorophenolate (Wolfbeis's ET(33) dye) were recorded in various solvents and analyzed in search of solvent‐dependent shifts that characterize their solvatomagnetism, which was compared with the well‐known UV–vis spectral behavior of this important solvatochromic dye. Although the NMR spectra of ET(33) and its phenolic precursor in different solvents correlated only poorly with their UV–vis spectral responses, they provided valuable information on specific structural features and solute–solvent interactions that are not available from their UV–vis spectra. [ABSTRACT FROM AUTHOR]

Medication‐related osteonecrosis of the jaw (MRONJ) is a progressive condition that can cause significant bone loss and its diagnosis can be challenging. A 68‐year‐old man with a diagnosis of hepatocellular carcinoma, undergoing treatment with atezolizumab, bevacizumab and zoledronic acid, complained of spontaneous pain in the right lower second premolar. Oral examination revealed no dental changes and implants in the right jaw. A patient history and thorough clinical and radiographic examinations mimic endodontic disease. The implant crowns were removed, bleeding on probing, and peri‐implant pockets were observed. The main hypothesis was MRONJ Stage 2, and the surgical treatment was performed. The pain ceased and signs of MRONJ were not observed within 3 months. MRONJ should be considered as a hypothesis in the case of odontalgia and a patient's history of antiresorptive and antiangiogenic therapies. Furthermore, monitoring patients with dental implants in the mandible through detailed clinical and imaging evaluation is required. [ABSTRACT FROM AUTHOR]

Pomegranate (Punica granatum L.) has long been recognised for its rich antioxidant profile and potential health benefits. Recent research has expanded its therapeutic potential to include antiangiogenic properties, which are crucial for inhibiting the growth of tumours and other pathological conditions involving aberrant blood vessel formation. This review consolidates current findings on the antiangiogenic effects of pomegranate extracts. We explore the impact of pomegranate polyphenols, including ellagic acid, punicalagin, anthocyanins, punicic acid and bioactive polysaccharides on key angiogenesis-related pathways and endothelial cell function. Emphasis is placed on the effects of these extracts as phytocomplexes rather than isolated compounds. Additionally, we discuss the use of pomegranate by-products, such as peels and seeds, in the preparation of extracts within a green chemistry and circular economy framework, highlighting their value in enhancing extract efficacy and sustainability. By primarily reviewing in vitro and in vivo preclinical studies, we assess how these extracts modulate angiogenesis across various disease models and explore their potential as adjunctive therapies for cancer and other angiogenesis-driven disorders. This review also identifies existing knowledge gaps and proposes future research directions to fully elucidate the clinical utility of pomegranate extracts in therapeutic applications. [ABSTRACT FROM AUTHOR]

Purpose: to assess the utility of response monitoring to enzalutamide by using [68Ga]Ga-PSMA PET in mCRPC patients treated with enzalutamide as first-line therapy. Methods: patients underwent [68Ga]Ga-PSMA PET less than 8 weeks before and 3 months after starting enzalutamide. On the basis of EAU/EANM criteria, patients were categorized as PSMA responders (PET-R) or PSMA non-responders (PET-NR), whilst, based on PSA, they were classified as biochemical responders (PSA-R) or non-responders (PSA-NR). Survival analysis was performed using the Cox regression hazard model and the Kaplan-Meier method. Results: 69 patients were considered fully evaluable. We observed 47.8% of concordance between [68Ga]Ga-PSMA PET and PSA monitoring at 3 months after starting enzalutamide. For discordant cases, the PSA reduction has a weak impact on PFS and a significant impact on OS in PET-NR patients, whilst this change has no impact either for PFS and OS in PET-R ones. Conclusions: [68Ga]Ga-PSMA PET could be a useful imaging tool for monitoring response to enzalutamide in mCRPC patients, being more informative than PSA in this setting, and possibly better guiding clinicians in therapeutic decisions. [ABSTRACT FROM AUTHOR]

The priority during an emergency, regardless of the type, is to rescue as many lives as possible. Field hospitals are usually installed to provide the primary relief to the affected population when hospitals are compromised or absent. There are several sanitary units worldwide ready to be transported to disaster areas. An average field hospital is equipped with an operating room, laboratory, and radiological equipment, but it does not include a unit for the infectious hospital solid waste treatment, which results in improper management with high infection risks and emissions due to incorrect operations (e.g., open incineration). Therefore, the present study identified two market-available solutions (an incinerator and a sterilizer) designed to be transported even under the challenging conditions typical of disasters and are suitable for treating infectious waste. The systems were assessed by a life cycle assessment (LCA), proving an emission savings >90% (considering all impact categories) using the sterilization system. The avoided combustion allows to halve the effect on climate change due to a portable incinerator. This study supplies interesting food for thought for the emergency managers, proving the possibility of integrating the sustainability also in the planning of the response to catastrophic events. [ABSTRACT FROM AUTHOR]

Multimodal image registration is an important component of medical image processing, allowing the integration of complementary information from various imaging modalities to improve clinical applications like diagnosis and treatment planning. We proposed a novel multistage neural network for three-dimensional multimodal medical image registration, which addresses the challenge of larger rigid deformations commonly present in medical images due to variations in patient positioning in different scanners and rigid anatomical structures. This multistage network combines rigid, affine and deformable transformations in three stages. The network was trained unsupervised with Mutual Information and Gradient L2 loss. We compared the results of our proposed multistage network with a rigid-affine-deformable registration with the classical registration method NiftyReg as a baseline and a multistage network, which combines affine and deformable transformation, as a benchmark. To evaluate the performance of the proposed multistage network, we used four three-dimensional multimodal in vivo datasets: three renal MR datasets consisting of T1-weighted and T2-weighted MR scans and one liver dataset containing CT and T1-weighted MR scans. Experimental results showed that combining rigid, affine and deformable transformations in a multistage network leads to registration results with a high structural similarity, overlap of the corresponding structures (Dice: 76.7 ± 12.5, 61.1 ± 14.0, 64.8 ± 16.2, 68.1 ± 24.6 for the four datasets) and a low level of image folding (|J| ≤ 0: less than or equal to 1.1%), resulting in a medical plausible registration result.

Development of probes specific for human β-cells could aid in delivery of therapeutics and monitoring β-cells mass during diabetes progression or islet transplantation. Here the authors identify two RNA aptamers specific for β-cells that allow efficient transfection of human islets and β-cell quantification of human islet grafts in immunodeficient mice.

Abstract Prader–Willi syndrome (PWS), a multisystemic disorder caused by lack of expression of genes on the paternally inherited chromosome 15q11.2-q13 region, is characterized by hyperphagia and childhood-onset morbid obesity, A retrospective cohort study of 60 PWS patients, 38 females and 22 males, undergoing a 6-year rehabilitation program was analysed. Mean age at the time of first admission was 27 ± 7 years, body weight (BW) was 97 kg ± 29 kg and height was 1.53 ± 0.09 m. Twenty-four patients (40%) showed BW loss after 6 years of follow-up, seventeen (28%) remained stable and nineteen (32%) gained BW. Responsiveness in term of BW reduction was less frequent in patients with the UPD karyotype, karyotype del15 being more frequent among responsive patients. Furthermore, responsive PWS subjects had a higher BMI (47 vs. 36 kg/m2), waist (123 vs. 106 cm) and hip (136 vs. 118 cm) circumferences than non-responsive at the time of first hospitalization. Baseline body composition and metabolic parameters did not differentiate between responsive and non-responsive patients. Given the rarity of PWS and relative lack of studies, these results can be considered relevant because based on a relatively large number of PWS patients followed up for a long term period.

The OPEN Hackathon of the Technical University of Munich (TUM) 2020 set out to address challenges and potential solutions for medical education at the School of Medicine to kick off the 2020/21 winter semester. The event lasted 36 hours, during which medical students, teachers and staff members had the opportunity to tackle current problems in education and to develop co-created, customized solutions through creative teamwork for the School of Medicine at the TUM. The resulting solutions are now being realized and implemented in teaching. This paper describes the process and organization of the hackathon. Furthermore, the result of the evaluation of the event are described. In this paper, we aim to present the project as a valuable pioneer in the field of developing medical-educational topics within the framework of innovative methodological formats.