Search

Objective: The gastrointestinal tract (GIT) is the most commonly affected internal organ in systemic sclerosis (SSc). We sought to determine the prevalence and impact of GIT symptoms on survival and patient-reported outcomes., Methods: A total of 907 consecutive patients from the Australian Scleroderma Cohort Study who had prospectively completed the University of California, Los Angeles, Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 Questionnaire (UCLA GIT) between 2015 and 2021 were included. The associations between UCLA GIT scores and physical function (Scleroderma Health Assessment Questionnaire), quality of life (QoL; Short Form 36), mood (Patient-Reported Outcomes Measurement Information System [PROMIS] anxiety and depression domains), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue score), and employment were investigated using multivariable population-averaged panel models using generalized estimating equations (GEEs). Kaplan-Meier curves and multivariable Cox proportional hazard regression models were used to evaluate survival according to total UCLA GIT scores., Results: GIT symptoms were reported in 87% of participants, with 46% to 52% reporting moderate to very severe symptoms of reflux, distension, diarrhea, and constipation. Higher total UCLA GIT scores were associated with worse QoL, physical function, fatigue, anxiety, and depression (P < 0.001). In the multivariable GEE analysis, moderate and severe to very severe total scores, reflux scores, and distension scores were associated with worse physical function, QoL, fatigue, anxiety, and depression compared to mild scores (P < 0.05). Patients with severe total scores and diarrhea scores were more likely to be unemployed compared to those with mild scores (P < 0.05). UCLA GIT total scores were not independently associated with death in our cohort., Conclusion: GIT manifestations are common in SSc and negatively impact QoL, physical function, and employment but are not directly associated with increased death., (© 2024 The Author(s). Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Objective: The aim of this study was to determine the impact of season, temperature and humidity on the severity of Raynaud phenomenon (RP) in systemic sclerosis., Methods: Data from the Australian Scleroderma Cohort Study were used to assess associations of patient-reported worsened RP in the month preceding each study visit. Mean monthly weather data were obtained from the closest weather station to the patient's address. We evaluated the relationship between worsened RP and health-related quality of life (HRQoL) measured using the Short Form 36 instrument., Results: Among 1,972 patients with systemic sclerosis, RP was a near-universal finding, and worsened RP in the preceding month was reported in 26.7% of 9,175 visits. "Worsened RP" showed significant environmental variability. On multivariable analysis, worsened RP was associated with low mean maximum temperatures (odds ratio [OR] 0.91, 95% confidence interval [95% CI] 0.90-0.92, P < 0.001), high relative humidity (OR 1.05, 95% CI 1.04-1.05, P < 0.001) and lower mean daily evaporation (OR 0.77, 95% CI 0.73-0.81, P < 0.001). Worsened RP was strongly associated with telangiectasia, calcinosis, and digital ulceration, as well as demonstrating an association with anticentromere antibody and gastroesophageal reflux disease and a negative correlation with diffuse disease. Worsened RP was also strongly associated with worse HRQoL., Conclusion: Lower environmental temperature and higher relative humidity had significant associations with worsened RP in this systemic sclerosis cohort, suggesting an important role for dry warmth in managing this condition., (© 2024 American College of Rheumatology.)

Objective: Physician global assessments (PhyGAs) are variably applied in systemic sclerosis (SSc) clinical trials. The comparability of different PhyGA results is unknown. We sought to assess the comparability of results from three different PhyGA instruments simultaneously applied in the Australian Scleroderma Cohort Study (ASCS)., Methods: Using data from 1,965 ASCS participants, we assessed the correlation between results of three PhyGA assessments: (1) overall health, (2) activity, and (3) damage. We evaluated the concordance of change in each PhyGA between study visits. Ordered logistic regression analysis was used to evaluate the clinical associations of each PhyGA., Results: The absolute scores of each PhyGA were strongly correlated at individual study visits. Concordant changes of the PhyGA scores occurred between 50% of study visits. Only patient-reported breathlessness was associated with all three PhyGA scores (overall health: odds ratio [OR] 1.67, P < 0.01; activity: OR 1.44, P < 0.01; damage: OR 1.32, P < 0.01). Changes in physician-assessed activity scores were also associated with patient-reported worsening skin disease (OR 1.25, P = 0.03) and fecal incontinence (OR 1.23, P = 0.01), whereas damage scores were associated with respiratory disease (pulmonary arterial hypertension: OR 1.25, P = 0.03; chronic obstructive pulmonary disease: OR 1.37, P = 0.04), as well as skin scores (OR 1.02, P < 0.01) and fecal incontinence (OR 1.21, P = 0.02)., Conclusion: PhyGAs of overall health, activity, and damage are each associated with different SSc features, and changes in different PhyGA scores are discordant 50% of the time. Our findings suggest results of variably worded PhyGAs are not directly interchangeable and support the development of a standardized PhyGA., (© 2024 The Author(s). Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Introduction: Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder that presents with a progressive movement disorder along with cognitive and psychiatric problems. It is caused by a Cytosine-adenin-guanine (CAG) expansion in exon 1 of the huntingtin gene which codes for mutant huntingtin (mHTT) that over time accumulates in cells, causing dysfunction and then death through new toxic gain-of-function mechanisms. Autophagy has been shown to be critical for the degradation of diverse intracytoplasmic aggregate-prone proteins that cause neurodegenerative disease, including mHTT. From a screen of a library enriched in approved drugs, felodipine was selected as the most suitable candidate showing strong autophagy-inducing effects in preclinical models of HD. We are, therefore, conducting a trial to assess the safety and tolerability of felodipine in people with early HD., Methods and Analysis: FELL-HD is a phase II, single-centre, open-label, dose-finding trial in people with early HD. 18 participants with early clinical features of the disease will be treated with felodipine for 58 weeks, with a further 4-week follow-up. The primary outcome measure is the number of adverse events attributable to felodipine. Exploratory outcomes include additional measures of motor and cognitive function, non-motor symptoms and quality of life scales, as well as peripheral and central disease biomarkers assessed through brain MRI. Analysis of blood and cerebrospinal fluid will also be performed through an associated sample study, FELL HD-s., Ethics and Dissemination: The study was approved by the London-Brent Research Ethics Committee (reference 22/LO/0387) and has been accepted by the Medicines and Healthcare products Regulatory Agency for clinical trials authorisation (reference CTA 12854/0256/001-0001). A lay summary of the results of the trial will be uploaded to our research group website which is publicly accessible. A webinar or in-person open day, to present results of the trial to participants and our wider cohort of patients who attend our centre, will be held once the trial is completed. The results of the trial will also be published in scientific journals and presented at national and international conferences., Trial Registration Numbers: EudraCT-2021-000897-27, ISRCTN56240656., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Objective: The study objective was to determine the event-free survival (EFS) of Australian patients with diffuse cutaneous systemic sclerosis (dcSSc) who met eligibility criteria for autologous stem cell transplant (ASCT) in previously published randomized controlled trials but were not treated with ASCT., Methods: Patients who met inclusion criteria for the Autologous Stem Cell Transplantation International Scleroderma (ASTIS) and Scleroderma: Cyclophosphamide Or Transplantation (SCOT) trials were identified from the multicenter Australian Scleroderma Cohort Study (ASCS). EFS (survival without cardiac, renal, or pulmonary failure or death) at 4 years was assessed. ASCS patients who had already undergone transplantation were excluded from analysis., Results: Of the 492 patients with dcSSc in the ASCS, 56 met ASTIS inclusion criteria for ASCT (56 of 492 [11.4%]) and 30 met SCOT inclusion criteria (30 of 492 [6.1%]). An additional 11 patients met ASTIS or SCOT inclusion criteria, but they were excluded due to severe organ manifestations. EFS at 4 years in ASCS patients meeting ASTIS inclusion criteria was 83.3% and in ASCS patients meeting SCOT inclusion criteria was 81.2%. EFS at 4 years in ASCS patients who met ASTIS and SCOT inclusion but also exclusion criteria was 46.7% and 45.7%, respectively., Conclusion: ASCS patients meeting ASTIS and/or SCOT inclusion criteria who were not treated with ASCT have similar EFS at 4 years as patients receiving ASCT and better EFS than those receiving cyclophosphamide in the ASTIS and SCOT trials. This may reflect confounders unable to be controlled for, including survivor bias, but may also reflect improved standard of care for dcSSc over time., (© 2024 The Authors. Arthritis & Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Objective: Patients with pulmonary arterial hypertension (PAH) may be stratified as low, intermediate, or high risk of 1-year mortality. In 2022, the European Society of Cardiology (ESC) updated and simplified its risk stratification tool, based on three variables: World Health Organization functional class, serum N-terminal pro-brain type natriuretic peptide and six-minute walk distance, applied at follow-up visits, intended to guide therapy over time., Methods: We applied the 2022 ESC risk assessment tool at baseline and follow-up (within 2 years) to a multinational incident cohort of systemic sclerosis-associated PAH (SSc-PAH). Kaplan-Meier curves, Cox hazards regression, and accelerated failure time models were used to evaluate survival by risk score., Results: At baseline (n = 260), the majority of SSc-PAH (72.2%) were graded as intermediate risk of death according to the 2022 tool. At follow-up, according to 2022 tool, half (55.5%) of the cohort were classified as low or intermediate-low risk. The 2022 risk model at follow-up was able to differentiate survival between risk strata. All three individual parameters (World Health Organization functional class, N-terminal pro-brain type natriuretic peptide, six-minute walk distance) were significantly associated with mortality at baseline and/or follow-up., Conclusion: The 2022 ESC risk assessment strategy applied at baseline and follow-up predicts survival in SSc-PAH. Treatment decisions for SSc-PAH should include risk assessments, aiming to achieve low-risk status according to the 2022 ESC guidelines., (© 2024 The Authors. Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Background: During the COVID-19 pandemic, three European countries (Austria, Greece, Italy) announced and/or implemented mandatory COVID-19 vaccination for high-risk groups in the general population. Besides the ethical justification for this policy, it is important to assess and quantify the effectiveness of the mandate in raising vaccination rates., Methods: Controlled interrupted time series analysis of first-dose vaccination rates in the targeted age groups (Greece: ≥60 years; Italy: ≥50 years) relative to a control group (Greece: 50-59 years; Italy: 25-49 years) between week 35/2021 and week 50/2022. For Austria an uncontrolled analysis was performed, as the vaccine mandate targeted all adults ≥18 years., Results: Announcement of mandatory vaccination substantially increased vaccination rates in the targeted age groups compared to control in both Greece (RR = 4.36, 95 % CI: 3.57-5.32) and Italy (RR = 2.90, 95 % CI: 2.37-3.56), an effect which persisted throughout the study period. There were 176,428 (95 % CI: 164,097-187,226) mandate-attributable first-dose vaccinations in Greece and 316,192 (95 % CI: 282,467-346,678) in Italy, most of which occurred before the mandate came into effect. In Austria no discernible increase in vaccination rates was observed after the announcement of mandatory vaccination. At the end of the study period, 9.5 % of ≥60 year-olds in Greece, 4.9 % of ≥50 year-olds in Italy and 13.8 % of ≥18 year-olds in Austria remained unvaccinated., Conclusions: In Greece and Italy - though not in Austria - simple announcement of a vaccine mandate rapidly increased COVID-19 vaccination rates in the targeted age groups, without fully closing the vaccination gap. Mandatory vaccination appears to effectively target complacency but not vaccine hesitancy, and its public health benefits need to be weighted against possible detrimental effects on confidence and trust., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: Regular clinical assessment for complications of systemic sclerosis (SSc) such as pulmonary arterial hypertension (PAH) is essential for early institution of therapy and improved outcomes. The objective of this study was to determine the impact of COVID-19 pandemic-related restrictions on health care access of patients with SSc, including screening for PAH., Methods: South Australian and Victorian patients enrolled in the Australian Scleroderma Cohort Study were surveyed about their perceptions of the impact of the pandemic on mental well-being, access to medications, investigations, and management of SSc. Frequency of annual rheumatology assessments, pulmonary function tests (PFT), and transthoracic echocardiography (TTE) to screen for PAH were compared with rates from before the pandemic., Results: A total of 312 of 810 patients with SSc responded (38.5% response); 273 were female (87.5%), the median age was 64.7 years, 77.2% had limited disease, the median illness duration was 15.6 years, 15.7% were immunosuppressed, 32.1% had interstitial lung disease, and 6.4% had PAH. A total of 65.7% of consultations were by telehealth, of which 81.2% were by telephone. Compared with respondents in South Australia (n = 109), Victorian respondents (n = 203) experiencing prolonged lockdown, reported reduced access to their rheumatologist (49.3% vs 27.9%; P = 0.004), greater use of consultation by video (17.3% vs 2.1%; P = 0.008), greater health care disruption (49.0% vs 23.2%; P < 0.001), and worse mental health (P = 0.002). Respondents reported reduced access to PFT and TTE (31.7% and 22.5%, respectively). Annual visits, PFT, TTE, and new diagnoses of PAH were reduced in 2020 to 2022 compared with 2011 to 2019., Conclusion: The COVID-19 pandemic-related disruption to health care for patients with SSc was associated with worse mental health and reduced screening and diagnosis of PAH, which may impact long-term outcomes., (© 2023 The Authors. Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Objectives: This prospective, multicenter, open-label, randomized, crossover trial study was to evaluate the diagnostic performance of 18F-PSMA-1007 (PSMA) vs. 18F-Choline PET/CT (FCH) in prostate cancer (PCa) patients (pts) with biochemical recurrence (BCR)., Methods: One hundred eighty-six pts, who have undergone primary definitive treatment for PCa with BCR, were recruited to this prospective study. All pts underwent one PSMA and one FCH PET/CT examination in randomized order within a time frame of 8 days and were followed up for at least 6 months (182 ± 10 days)., Results: Recurrence of PCa was observed in 176 out of 186 pts. The overall correct detection rate (DR) was 84% (95% CI 0.7967-0.8830) for PSMA and 69% (95% CI 0.6191-0.7489) for FCH, yielding a difference in proportion of 16% ( P  < 0.0001). PSMA had a sensitivity of 0.8464 and FCH 0.6857 with an odds ratio of 2.5259 ( P  < 0.0001), with statistically significant greater sensitivity of PSMA (ORs, 2.7877 and 2.1283 respectively) ( P  < 0.0001). PET/CT imaging led to a more accurate diagnosis in 166 (89.2%) pts, of which PSMA had contributed more than FCH in 91 (54.8%) of them. The DR for cutoff point PSA ≤ 1 ng/ml was higher for PSMA compared to FCH (61.8% vs. 39.5%). DR value of 51.6% for PSMA reached at PSA ≤ 0.3 ng/ml, while FCH reached that DR value with PSA ≤ 2.2 ng/ml., Conclusion: 18F-PSMA-1007 is more efficacious than 18F-Choline for the identification metastatic lesions both in patient and in regional level analysis in PCa patients with BCR., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

We present a case of severe juvenile dermatomyositis with limited response to steroids in an adolescent who developed symptoms within hours after receiving Pfizer BNT162b2 coronavirus disease 2019 vaccine. The patient presented with severe weakness of proximal muscles, dyspnoea, and tachycardia. His muscle enzymes were raised, and he was diagnosed with severe juvenile dermatomyositis following magnetic resonance imaging and muscle biopsy. His management was challenging, requiring multidisciplinary input, and difficult decisions with regard to the appropriate immunomodulatory treatments. The patient had to undergo escalating immunosuppressive treatments before he began to recover clinically and biochemically. To our knowledge, this is the first case in an adolescent although a few cases of similar presentations following coronavirus disease 2019 vaccination have been reported in adults. Elucidating the potential relationship of the vaccine with this severe myopathy in an adolescent is important for global vaccination policies, but avoiding the conflation of association with causation is also crucial in the context of the pandemic., (© Japan College of Rheumatology 2023. Published by Oxford University Press.)

Purpose: The purpose of this study was to evaluate renal parenchymal trauma of two-step dilation compared to the conventional Amplatz gradual dilation during percutaneous nephrolithotomy on a porcine model., Materials and Methods: A nonpapillary percutaneous access tract was established under fluoroscopic guidance in both kidneys of four female pigs. On the right kidney of each pig, gradual dilation was performed using an Amplatz dilator set with a gradual dilation to 30 Fr, whereas on the left, a two-step dilation was utilized using only 16 Fr and 30 Fr dilators. Two of the animals were euthanized immediately after the procedure and the remaining two 1 month later. The pigs that were kept alive underwent a contrast-enhanced computed tomography immediately, 15, and 30 days postoperatively. A dimercaptosuccinic acid (DMSA) scintigraphy and single-photon emission computed tomography-computed tomography (CT) were also performed after the last CT and afterward, the pigs were sacrificed. All kidneys were harvested for pathohistological examination., Results: The follow-up radiologic imaging showed similar parenchymal damage caused by the compared dilation techniques and an expected reduction in scar size in the later scans. No scar was identified by DMSA in any kidney. Gross and microscopic examinations conducted both on the kidneys that were harvested immediately after the procedure and the ones from the animals that were left to heal, revealed no significant differences in tissue damage, grade of fibrosis, or inflammation depending on the dilation method., Conclusions: Our study showed no inferior outcomes caused by two-step dilation compared to gradual dilation regarding renal parenchymal damage following a nonpapillary puncture. In fact, postoperative imaging findings suggested a trend toward better healing and less scar tissue when the two-step method was used., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Urology Annals.)

Introduction: The diagnostic and therapeutic approach to axillary lymph nodes is considered indispensable in the treatment of breast cancer patients., Aim: To investigate the effectiveness of 3D freehand SPECT (fhSPECT) in sentinel lymph node (SLN) mapping in breast cancer, compared with the use of a conventional gamma probe., Material and Methods: We retrospectively compared the fhSPECT lymph node mapping modality, with gamma probe detection in early-stage, clinically node-negative breast cancer patients, with biopsy-confirmed malignancy. The two techniques were compared based on the average number of LNs excised per axilla. The duration of SLN mapping was also compared between the two groups. The performance of the two methods on obese and post-systemic therapy patients was evaluated. FhSPECT was used in 150 cases, while the gamma probe was employed in 50 cases., Results: FhSPECT detected at least 3 nodes in 83.3% of the patients vs. 72.0% with the γ -probe (p = 0.107). The mean number of SLNs excised per axilla was 3.66 using the γ -probe and 4.18 with fhSPECT (p = 0.03). The average surgical time was 39 ±7 min with the γ -probe and 37.54 ±17 min with fhSPECT (p = 0.228). Sentinel lymph node biopsy (SLNB) mean surgical time evolved from 40.2 ±20.77 min to 32.35 ±10.46 min (p = 0.033). In obese patients, a reduction in surgical times was noted from 45.5 ±3.09 min to 44.04 ±20.9 (p = 0.27), in addition to a significant increase in average LN detection in the fhSPECT group (4.26 ±1.44) compared to the γ -probe group (3.2 ±1.65) (p = 0.043)., Conclusions: The use of the fhSPECT modality is effective and safe, and, when compared to the γ -probe, has significant advantages in SLN mapping., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2022 Fundacja Videochirurgii.)

Objective: To evaluate whether reducing tract dilation diameter in PCNL (percutaneous nephrolithotomy) procedures results in minimizing of renal trauma of the percutaneous tract., Methods: A percutaneous renal access tract was established bilaterally to 11 pigs. Two pigs were euthanized immediately after the experiment, while nine pigs were sacrificed 1 month later. The percutaneous accesses were dilated up to 30Fr, 22Fr or 12Fr. The animals underwent a contrast-enhanced computer tomography immediately after the procedure and 30 days later. DMSA-scintigraphy with SPECT-CT was also performed. The kidneys of all animals were harvested for histological evaluation. The volume of scar tissue and the percentage of renal volume replaced by scar tissue were calculated., Results: Immediate post-procedural CT-scans revealed a significant difference in defect diameter among the three modalities. However, the scar volume calculated on CT-images and histopathology showed a significant difference only when 30Fr dilation was compared to 12Fr dilation. The percentage of scar volume was negligible in all cases, but there was still a statistical difference between 30 and 12Fr dilation. Dilation up to 22Fr revealed no statistical differences compared to the other two modalities. DMSA-scintigraphy showed no scar tissue in any case., Conclusion: Dilation up to 30Fr may cause a significantly larger scar tissue on renal parenchyma compared to 12Fr dilation as it was shown on CT-images and microscopic evaluation, but based on the DMSA/SPECT-CT this difference seems to be insignificant to the renal function. The scar tissue caused by 22Fr dilation seemed to have no significant difference from the other modalities., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The impact of a non-dominant right coronary artery (NDRCA), on single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI)has not been clarified., Methods and Results: We compared SPECT-MPI results of consecutive patients without significant (diameter stenosis ≥50%)coronary artery disease (CAD) and a NDRCA (Group-1), with those of patients from our database without CAD and a dominant RCA (Group-2). All patients were subjected to SPECT-MPI with I.V. infusion of adenosine, and TC 99 -tetrofosmin. Group-1 included 69 patients (55 men, 79.7%), mean age 66.8 ± 9.8 years. Group-2 consisted of 79 patients (56 men, 70.9%), mean age 62.7 ± 11.5. There was no difference in demographics and CAD risk factors between the two groups. The SPECT-MPI revealed inferior wall ischemia, in 35 patients (50.7%), in Group-1 and 27 patients (34.1%), in Group-2 (P = 0.041)., Conclusions: A relatively high rate of reversible SPECT-MPI perfusion defects may be anticipated in patients with an unobstructed NDRCA compared to patients with a dominant RCA., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: The purpose of this study was to develop a rapid, reliable, and efficient tool for three-dimensional (3D) dosimetry treatment planning and post-treatment evaluation of liver radioembolization with 90 Y microspheres, using tissue-specific dose voxel kernels (DVKs) that can be used in everyday clinical practice. Materials and Methods: Two tissue-specific DVKs for 90 Y were calculated through Monte Carlo (MC) simulations. DVKs for the liver and lungs were generated, and the dose distribution was compared with direct MC simulations. A method was developed to produce a 3D dose map by convolving the calculated DVKs with the activity biodistribution derived from clinical single-photon emission computed tomography (SPECT) or positron emission tomography (PET) images. Image registration for the SPECT or PET images with the corresponding computed tomography scans was performed before dosimetry calculation. The authors first compared the DVK convolution dosimetry with a direct full MC simulation on an XCAT anthropomorphic phantom. They then tested it in 25 individual clinical cases of patients who underwent 90 Y therapy. All MC simulations were carried out using the GATE MC toolkit. Results: Comparison of the measured absorbed dose using tissue-specific DVKs and direct MC simulation on 25 patients revealed a mean difference of 1.07% ± 1.43% for the liver and 1.03% ± 1.21% for the tumor tissue, respectively. The largest difference between DVK convolution and full MC dosimetry was observed for the lung tissue (10.16% ± 1.20%). The DVK statistical uncertainty was <0.75% for both media. Conclusions: This semiautomatic algorithm is capable of performing rapid, accurate, and efficient 3D dosimetry. The proposed method considers tissue and activity heterogeneity using tissue-specific DVKs. Furthermore, this method provides results in <1 min, making it suitable for everyday clinical practice.

Background: Radioembolization with 90 Y microspheres is a treatment approach for liver cancer. Currently, employed dosimetric calculations exhibit low accuracy, lacking consideration of individual patient, and tissue characteristics., Purpose: The purpose of the present study was to employ deep learning (DL) algorithms to differentiate patterns of pretreatment distribution of 99m Tc-macroaggregated albumin on SPECT/CT and post-treatment distribution of 90 Y microspheres on PET/CT and to accurately predict how the 90 Y-microspheres will be distributed in the liver tissue by radioembolization therapy., Methods: Data for 19 patients with liver cancer (10 with hepatocellular carcinoma, 5 with intrahepatic cholangiocarcinoma, 4 with liver metastases) who underwent radioembolization with 90 Y microspheres were used for the DL training. We developed a 3D voxel-based variation of the Pix2Pix model, which is a special type of conditional GANs designed to perform image-to-image translation. SPECT and CT scans along with the clinical target volume for each patient were used as inputs, as were their corresponding post-treatment PET scans. The real and predicted absorbed PET doses for the tumor and the whole liver area were compared. Our model was evaluated using the leave-one-out method, and the dose calculations were measured using a tissue-specific dose voxel kernel., Results: The comparison of the real and predicted PET/CT scans showed an average absorbed dose difference of 5.42% ± 19.31% and 0.44% ± 1.64% for the tumor and the liver area, respectively. The average absorbed dose differences were 7.98 ± 31.39 Gy and 0.03 ± 0.25 Gy for the tumor and the non-tumor liver parenchyma, respectively. Our model had a general tendency to underpredict the dosimetric results; the largest differences were noticed in one case, where the model underestimated the dose to the tumor area by 56.75% or 72.82 Gy., Conclusions: The proposed deep-learning-based pretreatment planning method for liver radioembolization accurately predicted 90 Y microsphere biodistribution. Its combination with a rapid and accurate 3D dosimetry method will render it clinically suitable and could improve patient-specific pretreatment planning., (© 2021 American Association of Physicists in Medicine.)

Background: The Coronavirus Disease (COVID-19) pandemic has greatly impacted people's mental health. Youth with disabilities are at particular risk for the psychological implications of the pandemic. Although much attention has been given to pandemic-related mental health challenges that youth have encountered, little is known about the facilitators for coping with the stresses of the pandemic and how this varies for youth with and without disabilities., Objective: The purpose of this study was to understand facilitators for helping youth and young adults with and without disabilities to cope and maintain mental health during the COVID-19 pandemic., Methods: This qualitative study involved in-depth interviews with 34 youth and young adults (17 with a disability; 17 without), aged 16-29 (mean age 23.2). A narrative, thematic analysis of the transcripts was performed., Results: Our findings revealed several similarities and some differences between youth and young adults with and without disabilities regarding facilitators for maintaining mental health during the pandemic. Enablers of coping included: (1) social support; (2) financial support, (3) keeping busy (i.e., having a daily routine, working to keep the mind occupied, volunteering to boost mental health, focusing on school work), and (4) work-life balance (i.e., reduced commute, more time for exercising, going outdoors, cooking, sleeping better, and reflection on life's purpose)., Conclusions: Our findings highlight how having coping strategies could help to youth and young adults deal with pandemic-related stress. Youth with disabilities may need some additional support in accessing resources, exercising and going outdoors to help enhance their coping strategies., Competing Interests: Conflicts of interest None declared., (Copyright © 2021 Elsevier Inc. All rights reserved.)