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Radiation therapy is used to treat breast malignancies. Old external radiotherapy protocols included high-dose schedules and were associated with late complications. We describe the case of a 72-year-old woman who was admitted with recurrent bleeding from chest wall. Arteriovenous fistulae were diagnosed. Embolization therapy was initially successful, even though the bleeding episodes became recurrent. Arteriovenous fistulae should be included among differential diagnosis of thoracic bleeding in patients with history of local radiation therapy. The prognosis is poor and endovascular treatment may be considered a first-line treatment.

Purpose of Review: There is a critical need for timely and accurate decisions in breast cancer management. This narrative review aims to clarify the potential role of novel PET tracers in optimizing treatment strategies for different breast cancer subtypes., Recent Findings: 2-deoxy-2-[18F]-fluoro-D-glucose PET/computed tomography (FDG PET/CT) has a pivotal role in response assessment in metastatic breast cancer, despite its limitations in certain histological and molecular subtypes. Further PET radiopharmaceuticals have been proposed to address these clinical needing., Summary: FES PET/CT demonstrates its usefulness in assessing ER expression and predicting response to therapy in luminal breast cancer, with implications for treatment optimization and monitoring. In HER2-positive and HER2-low breast cancer, HER2-targeted PET tracers show potential in assessing HER2 status, while their accuracy in predicting response to targeted therapies is still debated. PARP-targeted PET imaging holds potential for selecting patients for PARP inhibitors treatments, particularly in triple-negative breast cancer (TNBC), where imaging tools are crucial due to the absence of specific targets. Immunotherapy and antibody-drug conjugates (ADCs) are emerging treatment options for TNBC, and PET imaging targeting immune checkpoints could aid in treatment selection and response monitoring. The dynamic role of PET/CT imaging in tailoring breast cancer treatments requires further multidisciplinary research to validate the clinical utility of targeted tracers., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Metabolic alterations in cancers can be exploited for diagnostic, prognostic, and therapeutic purposes. This is exemplified by 18F-fluorodeoxyglucose (FDG)-positron emission tomography (FDG-PET), an imaging tool that relies on enhanced glucose uptake by tumors for diagnosis and staging. By performing transcriptomic analysis of breast cancer (BC) samples from patients stratified by FDG-PET, a 54-gene signature (PETsign) is identified that recapitulates FDG uptake. PETsign is independently prognostic of clinical outcome in luminal BCs, the most common and heterogeneous BC molecular subtype, which requires improved stratification criteria to guide therapeutic decision-making. The prognostic power of PETsign is stable across independent BC cohorts and disease stages including the earliest BC stage, arguing that PETsign is an ab initio metabolic signature. Transcriptomic and metabolomic analysis of BC cells reveals that PETsign predicts enhanced glycolytic dependence and reduced reliance on fatty acid oxidation. Moreover, coamplification of PETsign genes occurs frequently in BC arguing for their causal role in pathogenesis. CXCL8 and EGFR signaling pathways feature strongly in PETsign, and their activation in BC cells causes a shift toward a glycolytic phenotype. Thus, PETsign serves as a molecular surrogate for FDG-PET that could inform clinical management strategies for BC patients., (© 2024 The Authors. Advanced Science published by Wiley‐VCH GmbH.)

When analyzing health data in relation to environmental stressors, it is crucial to identify which variables to include in the statistical model to exclude dependencies among the variables. Four meteorological parameters: temperature, ultraviolet radiation, precipitation, and vapor pressure and four outdoor air pollution parameters: ozone ( O 3 ), nitrogen dioxide ( NO 2 ), particulate matter ( P M 2.5 , P M 10 ) were studied on a daily basis for Baden-Württemberg (Germany). This federal state covers urban and rural compartments including mountainous and river areas. A temporal and spatial analysis of the internal relationships was performed among the variables using (a) cross-correlations, both on the grand ensemble of data as well as within subsets, and (b) the Local Indications of Spatial Association (LISA) method. Meteorological and air pollution variables were strongly correlated within and among themselves in time and space. We found a strong interaction between nitrogen dioxide and ozone, with correlation coefficients varying over time. The coefficients ranged from negative correlations in January (-0.84), April (-0.47), and October (-0.54) to a positive correlation in July (0.45). The cross-correlation plot showed a noticeable change in the correlation direction for O 3 and NO 2 . Spatially, NO 2 , P M 2.5 , and P M 10 concentrations were significantly higher in urban than rural regions. For O 3 , this effect was reversed. A LISA analysis confirmed distinct hot and cold spots of environmental stressors. This work examined and quantified the spatio-temporal relationship between air pollution and meteorological conditions and recommended which variables to prioritize for future health impact analyses. The results found are in line with the underlying physico-chemical atmospheric processes. It also identified postal code areas with dominant environmental stressors for further studies., (© 2024. The Author(s).)

Objective: This article aims to analyze the elements of the narrative which, applied to investigations of accidents at work, transform them into stories, making the dynamics of accidents clearer, more complete and emotionally engaging and also capable of being transferred to a non-experts audience., Method: The theoretical reference identified for the analysis of the accident histories is the work of the Lithuanian semiologist Algirdas Julien Greimas. The title, the dimensions of space and time, the characters (according to the actantial model), the point of view, the structure of the story (following the canonical narrative scheme), and the moral of the tale are the elements of the narration analyzed in this article., Results: This article illustrates how the dynamics of accidents can lend themselves to being told according to the typical categories of narration and textual organization, resulting in them being enriched with important elements for the communication of prevention and the learning of safe behaviour. The accident investigation that becomes history takes on important characteristics also in terms of communication: the contents become clearer, more accessible and more engaging. Unlike traditional surveys, injury stories, through the elements of the narrative and in particular with the addition of indications for prevention, become an efficient learning and sharing tool valid in training contexts, and the contents effectively usable in practice of prevention workers., Conclusions: The narration applied to accidents at work, allowing for greater attention to the elements of the context, relationships and the emotional sphere of the various actors involved, is able to bring out more clearly the important and various factors that can contribute to causing an accident, becoming thus an effective tool for the transfer of indications for prevention.

Background: The negative effect of air pollution on human health is widely reported in recent literature. It typically involves urbanized areas where the population is concentrated and where most primary air pollutants are produced. A comprehensive health risk assessment is therefore of strategic importance for health authorities., Methods: In this study we propose a methodology to perform an indirect and retrospective health risk assessment of all-cause mortality associated with long-term exposure to particulate matter less than 2.5 microns (PM 2.5 ), nitrogen dioxide (NO 2 ) and ozone (O 3 ) in a typical Monday to Friday working week. A combination of satellite-based settlement data, model-based air pollution data, land use, demographics and regional scale mobility, allowed to examine the effect of population mobility and pollutants daily variations on the health risk. A Health Risk Increase (HRI) metric was derived on the basis of three components: hazard, exposure and vulnerability, utilizing the relative risk values from the World Health Organization. An additional metric, the Health Burden (HB) was formulated, which accounts for the total number of people exposed to a certain risk level., Results: The effect of regional mobility patterns on the HRI metric was assessed, resulting in an increased HRI associated with all three stressors when considering a dynamic population compared to a static one. The effect of diurnal variation of pollutants was only observed for NO 2 and O 3 . For both, the HRI metric resulted in significantly higher values during night. Concerning the HB parameter, we identified the commuting flows of the population as the main driver in the resulting metric., Conclusions: This indirect exposure assessment methodology provides tools to support policy makers and health authorities in planning intervention and mitigation measures. The study was carried out in Lombardy, Italy, one of the most polluted regions in Europe, but the incorporation of satellite data makes our approach valuable for studying global health., (© 2023. The Author(s).)

Invasive lobular cancer (ILC) is the second most frequent histological type of breast cancer (BC) and includes a heterogeneous spectrum of diseases with unique characteristics, especially the infiltrative growth pattern and metastatic spread. [ 18 F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) is extensively used in oncology and BC patient evaluation. Its role in ILCs is considered suboptimal due to its low FDG avidity. Therefore, ILCs could benefit from molecular imaging with non-FDG tracers that target other specific pathways, contributing to precision medicine. This narrative review aims to summarize the current literature on the use of FDG-PET/CT in ILC and to discuss future opportunities given by the development of innovative non-FDG radiotracers.

Background: Image-guided vacuum-assisted breast biopsy (VABB) of the tumour bed, performed after neoadjuvant therapy, is increasingly being used to assess residual cancer and to potentially identify to identify pathological complete response (pCR). In this study, the accuracy of preoperative VABB specimens was assessed and compared with surgical specimens in patients with triple-negative or human epidermal growth factor receptor 2 (HER2)-positive invasive ductal breast cancer after neoadjuvant therapy. As a secondary endpoint, the performance of contrast-enhanced MRI of the breast and PET-CT for response prediction was assessed., Methods: This single-institution prospective pilot study enrolled patients from April 2018 to April 2021 with a complete response on imaging (iCR) who subsequently underwent VABB before surgery. Those with a pCR at VABB were included in the primary analysis of the accuracy of VABB. The performance of imaging (MRI and PET-CT) was analysed for prediction of a pCR considering both patients with an iCR and those with residual disease at postneoadjuvant therapy imaging., Results: Twenty patients were included in the primary analysis. The median age was 44 (range 35-51) years. At surgery, 18 of 20 patients showed a complete response (accuracy 90 (95 per cent exact c.i. 68 to 99) per cent). Only two patients showed residual ductal intraepithelial neoplasia of grade 2 and 3 respectively. In the secondary analysis, accuracy was similar for MRI and PET-CT (77 versus 78 per cent; P = 0.76)., Conclusion: VABB in patients with an iCR might be a promising method to select patients for de-escalation of surgical treatment in triple-negative or HER2-positive breast cancer. The present results support such an approach and should inform the design of future trials on de-escalation of surgery., (© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.)