CT-based radiomics prediction of complete response after stereotactic body radiation therapy for patients with lung metastases.

PURPOSE: Stereotactic body radiotherapy (SBRT) is a key treatment modality for lung cancer patients. This study aims to develop a machine learning-based prediction model of complete response for lung oligometastatic cancer patients undergoing SBRT. MATERIALS AND METHODS: CT images of 80 pulmonary oligometastases from 56 patients treated with SBRT were analyzed. The gross tumor volumes (GTV) were contoured on CT images. Patients that achieved complete response (CR) at 4 months were defined as responders. For each GTV, 107 radiomic features were extracted using the Pyradiomics software. The concordance correlation coefficients (CCC) between the region of interest (ROI)-based radiomics features obtained by the two segmentations were calculated. Pairwise feature interdependencies were evaluated using the Spearman rank correlation coefficient. The association of clinical variables and radiomics features with CR was evaluated with univariate logistic regression. Two supervised machine learning models, the logistic regression (LR) and the classification and regression tree analysis (CART), were trained to predict CR. The models were cross-validated using a five-fold cross-validation. The performance of models was assessed by receiver operating characteristic curve (ROC) and class-specific accuracy, precision, recall, and F1-measure evaluation metrics. RESULTS: Complete response was associated with four radiomics features, namely the surface to volume ratio (SVR; p = 0.003), the skewness (Skew; p = 0.027), the correlation (Corr; p = 0.024), and the grey normalized level uniformity (GNLU; p = 0.015). No significant relationship between clinical parameters and CR was found. In the validation set, the developed LR and CART machine learning models had an accuracy, precision, and recall of 0.644 and 0.750, 0.644 and 0.651, and 0.635 and 0.754, respectively. The area under the curve for CR prediction was 0.707 and 0.753 for the LR and CART models, respectively. CONCLUSION: This analysis demonstrates that radiomics features obtained from pretreatment CT could predict complete response of lung oligometastases following SBRT.

Frustration-aggression hypothesis reconsidered: The role of significance quest.

One of the oldest scientific theories of human aggression is the frustration-aggression hypothesis, advanced in 1939. Although this theory has received considerable empirical support and is alive and well today, its underlying mechanisms have not been adequately explored. In this article, we examine major findings and concepts from extant psychological research on hostile aggression and offer an integrative conception: aggression is a primordial means for establishing one's sense of significance and mattering, thus addressing a fundamental social-psychological need. Our functional portrayal of aggression as a means to significance yields four testable hypotheses: (1) frustration will elicit hostile aggression proportionately to the extent that the frustrated goal serves the individual's need for significance, (2) the impulse to aggress in response to significance loss will be enhanced in conditions that limit the individual's ability to reflect and engage in extensive information processing (that may bring up alternative, socially condoned means to significance), (3) significance-reducing frustration will elicit hostile aggression unless the impulse to aggress is substituted by a nonaggressive means of significance restoration, (4) apart from significance loss, an opportunity for significance gain can increase the impulse to aggress. These hypotheses are supported by extant data as well as novel research findings in real-world contexts. They have important implications for understanding human aggression and the conditions under which it is likely to be manifested and reduced.

Addressing the effect of concern with COVID-19 threat on prejudice towards immigrants: The sequential mediating role of need for cognitive closure and desire for cultural tightness.

The link between threat and anti-immigrant prejudice is well-established. Relatedly, recent research has also shown that situational threats (such as concern with COVID-19 threat) increase anti-immigrant prejudice through the mediating role of desire for cultural tightness. This study aims to further our understanding of the psychological processes underlying the relation between concern with COVID-19 threat and increased negative attitudes towards immigrants by considering the mediational role of an individual epistemic motivation (i.e., the need for cognitive closure). A study was conducted on a large sample of Italian respondents covering all the Italian regions. Findings revealed that high concern with COVID-19 threat led to increased negative attitudes towards immigrants through the sequential mediating role of higher need for cognitive closure, leading in turn to higher desire for cultural tightness. Implications of these findings for a timely contextualized study of anti-immigrant prejudice will be highlighted.

The mediating role of narcissism in the effects of regulatory mode on positivity.

Positivity (i.e., the individual tendency to positively approach life experiences) has proven to be an effective construct applied in positive psychology. However, individuals' self-regulation may have contrasting effects on positivity. We specifically examined whether positivity could be partially explained through two aspects of motivation concerned with self-regulation: locomotion (i.e., a motivational orientation concerned with movement) and assessment (i.e., a motivational orientation concerned with comparison and evaluation). Furthermore, based on previous literature that found a link between these aspects and narcissism, we examined whether "adaptive" and "maladaptive" dimensions of narcissism could mediate the effects of locomotion and assessment on increased or decreased positivity. Narcissism was defined by previous research as adaptive or maladaptive insofar as it leads or does not lead to increased psychological well-being. We estimated a mediation model with multiple independent variables and multiple mediators in a cross-sectional study with self-reported data from 190 university students. We found that both locomotion and assessment were associated with adaptive narcissism, which in turn was positively associated with positivity. However, assessment was also associated with maladaptive narcissism, which in turn was negatively associated with positivity. Relationships between aspects of self-regulation, narcissism, and positivity can have significant implications which will be discussed.

Neutrophil to lymphocyte ratio predicts permanent pacemaker implantation in TAVR patients.

INTRODUCTION: In this prospective multicenter analysis, we aimed to investigate the predictive role of neutrophil/lymphocyte ratio (NLR) in permanent pacemaker implantation (PPI) in patients undergoing transcatheter aortic valve replacement (TAVR). MATERIALS AND METHODS: One hundred and seventy-nine consecutive patients without previous PPI underwent TAVR from February 2017 to September 2021. Patients were further divided based on presence (n = 48) and absence of conduction abnormalities (CAs) at hospital admission (n = 131). RESULTS: In patients with previous CAs, NLR values did not differ significantly between patients requiring PPI (n = 16, 33%) and those not requiring it. In contrast, in patients with no CAs at hospital admission, NLR values measured at admission and on TAVR day were significantly higher in patients requiring PPI (n = 17, 13%) (4.07 ± 3.22 vs. 3.01 ± 1.47, p = .025, and 10.81 ± 7.81 vs. 5.84 ± 3.78, p = .000, respectively). Multivariable analysis showed that NLR at TAVR day was an independent predictor of PPI in patients without CAs (OR 1.294; 95% CI 1.028-1.630; p = .028), but not in those with previous CAs. ROC curve analysis showed that the cut point was a NLR value of >7.25. Time to PPI was delayed till 21 days in patients without CAs. CONCLUSIONS: In this prospective study, higher NLR values on the day of TAVR day were associated with an increased PPI rate in patients undergoing TAVR with no previous CAs. It is advisable, being inflammation part of the process, to prolong the time of observation for all patients without CAs till at least 21 days not to miss any new CA necessitating PPI.

CT angiography-based radiomics as a tool for carotid plaque characterization: a pilot study.

PURPOSES: Radiomics is a quantitative method able to analyze a high-throughput extraction of minable imaging features. Herein, we aim to develop a CT angiography-based radiomics analysis and machine learning model for carotid plaques to discriminate vulnerable from no vulnerable plaques. MATERIALS AND METHODS: Thirty consecutive patients with carotid atherosclerosis were enrolled in this pilot study. At surgery, a binary classification of plaques was adopted ("hard" vs "soft"). Feature extraction was performed using the R software package Moddicom. Pairwise feature interdependencies were evaluated using the Spearman rank correlation coefficient. A univariate analysis was performed to assess the association between each feature and the plaque classification and chose top-ranked features. The feature predictive value was investigated using binary logistic regression. A stepwise backward elimination procedure was performed to minimize the Akaike information criterion (AIC). The final significant features were used to build the models for binary classification of carotid plaques, including logistic regression (LR), support vector machine (SVM), and classification and regression tree analysis (CART). All models were cross-validated using fivefold cross validation. Class-specific accuracy, precision, recall and F-measure evaluation metrics were used to quantify classifier output quality. RESULTS: A total of 230 radiomics features were extracted from each plaque. Pairwise Spearman correlation between features reported a high level of correlations, with more than 80% correlating with at least one other feature at |ρ|> 0.8. After a stepwise backward elimination procedure, the entropy and volume features were found to be the most significantly associated with the two plaque groups (p < 0.001), with AUCs of 0.92 and 0.96, respectively. The best performance was registered by the SVM classifier with the RBF kernel, with accuracy, precision, recall and F-score equal to 86.7, 92.9, 81.3 and 86.7%, respectively. The CART classification tree model for the entropy and volume features model achieved 86.7% well-classified plaques and an AUC of 0.987. CONCLUSION: This pilot study highlighted the potential of CTA-based radiomics and machine learning to discriminate plaque composition. This new approach has the potential to provide a reliable method to improve risk stratification in patients with carotid atherosclerosis.

Automated treatment planning as a dose escalation strategy for stereotactic radiation therapy in pancreatic cancer.

PURPOSE: To assess the feasibility of automated stereotactic volumetric modulated arc therapy (SBRT-VMAT) planning using a simultaneous integrated boost (SIB) approach as a dose escalation strategy for SBRT in pancreatic cancer. METHODS: Twelve patients with pancreatic cancer were retrospectively replanned. Dose prescription was 30 Gy to the planning target volume (PTV) and was escalated up to 50 Gy to the boost target volume (BTV) using a SIB technique in 5 fractions. All plans were generated by Pinnacle3 Autoplanning using 6MV dual-arc VMAT technique for flattened (FF) and flattening filter-free beams (FFF). An overlap volume (OLV) between the PRV duodenum and the PTV was defined to correlate with the ability to boost the BTV. Dosimetric metrics for BTV and PTV coverage, maximal doses for serial OARs, integral dose, conformation numbers, and dose contrast indexes were used to analyze the dosimetric results. Dose accuracy was validated using the PTW Octavius-4D phantom together with the 1500 2D-array. Differences between FF and FFF plans were quantified using the Wilcoxon matched-pair signed rank. RESULTS: Full prescription doses to the 95% of PTV and BTV can be delivered to patients with no OLV. BTV mean dose was >90% of the prescribed doses for all patients at all dose levels. Compared to FF plans, FFF plans showed significant reduced integral doses, larger number of MUs, and reduced beam-on-times up to 51% for the highest dose level. Despite plan complexity, pre-treatment verification reported a gamma pass-rate greater than the acceptance threshold of 95% for all FF and FFF plans for 3%-2 mm criteria. CONCLUSIONS: The SIB-SBRT strategy with Autoplanning was dosimetrically feasible. Ablative doses up to 50 Gy in 5 fractions can be delivered to the BTV for almost all patients respecting all the normal tissue constraints. A prospective clinical trial based on SBRT strategy using SIB-VMAT technique with FFF beams seems to be justified.

Does inconsistency always lead to negative affect? The influence of need for closure on affective reactions to cognitive inconsistency.

We present an experiment showing that need for closure (NFC)-defined as the epistemic desire for certainty-can moderate individuals' affective reactions to cognitive inconsistency. Informed by Kruglanski and colleagues' new theory, that cognitive inconsistency elicits negative affect particularly under certain circumstances, we find that NFC (i.e. the desire for certain, stable and unambiguous knowledge) influences the strength of consistency effects and resulting negative affect. More specifically, we find that individuals who are high on NFC experience more negative affect upon encountering an inconsistent (vs. consistent) cognition. However, when individuals are low on NFC, inconsistency is irrelevant, and their affect depends on whether the ultimate outcome of the cognition is positive or negative. We discuss the theoretical and practical implications of this research.

"Keeping in mind the gender stereotype": the role of need for closure in the retrieval-induced forgetting of female managers' qualities.

The present research addressed the question of whether need for closure (NFC; Kruglanski in The psychology of closed mindedness, Psychology Press, New York, 2004) biases individuals' memory of female leaders. Merging research on role congruity theory of leadership (Koenig et al. in Psychol Bull 4:616-642, 2011. https://doi.org/10.1037/a0023557 ) and research on retrieval-induced forgetting (RIF, Anderson et al. in J Exp Psychol Learn Mem Cognit 20:1063-1087, 1994. https://doi.org/10.1037/0022-3514.65.5.861 ), we hypothesized and found that high-NFC participants show (1) a higher RIF of dimensions commonly associated with the leadership prototype (agentic/masculine) ascribed to female manager targets, when selectively retrieved dimensions commonly associated with the female prototype (communal/feminine) were ascribed to the same target; and (2) a lessened RIF of female stereotypical dimensions ascribed to female manager targets, when selectively retrieved prototypical leadership dimensions were ascribed to the same target. Overall, the present findings suggest that when faced with women leaders, high NfC enhances the accessibility of gender stereotype-congruent memories and reduces the accessibility of prototypical leadership ones, thus reducing the RIF of communal/feminine memories.

Experience of Time by People on the Go: A Theory of the Locomotion-Temporality Interface.

We explore the psychological interface of time and motion.Locomotion, the proclivity toward movement and change, constitutes a significant determinant of persons' orientation toward time, both as a valuable resource and as a flow advancing from past to future. High locomotors act quickly, multitask and refrain from procrastination, thus conserving time as are source Their preoccupation with movement, moreover, affects their relation to the flow of time High locomotors are future oriented and eschew preoccupation with the past. They are optimistic, experience little regret, generate few counterfactuals, feel little guilt about past wrongdoings, and leave behind past friends. Evidence accumulates that locomotors' "fast forward" orientation pervades diverse aspects of their behavior and has significant consequences for individuals and societies.

The relationship between thought suppression and retrieval-induced forgetting: an analysis of witness memories.

The aim of the present research was to examine the relationship between individual differences in thought suppression and retrieval-induced forgetting (RIF) in witness-like situations. We predicted that people who are more prone to suppress undesired thoughts and memories would demonstrate a stronger RIF effect. Consistent with findings obtained in a US sample (Blumberg in Personal Individ Differ 29:943-950, 2000), results of a preliminary study (Study 1) confirmed the three-factor structure of the white bear suppression inventory (WBSI): the tendency to rely on thought suppression (suppression dimension), the frequency of experiencing intrusive thoughts (intrusion dimension), and the frequency of using self-distraction to avoid undesired thoughts (self-distraction dimension). Consistent with our hypotheses, Study 2 found that only the suppression sub-dimension of the WBSI was positively and significantly related to RIF. Theoretical expectations of these findings and implications for witness research are discussed.

On the cutting edge of intensity modulated radiotherapy and simultaneous integrated boost (IMRT-SIB): The case of a patient with 8 brain metastases.

BACKGROUND: Patients with multiple brain metastases, especially those with more than 3 lesions, usually undergo to palliative whole brain (WB) radiotherapy (RT). METHODS: A breast cancer patient with 8 brain metastases was treated on the brain by a radical RT regimen. Prescription doses were according to the simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) technique with all lesions as well brain irradiated simultaneously in 20 daily fractions. Doses of 40.0 Gy (2.0 Gy/fraction) and 50.0 Gy (2.5 Gy/fraction) were prescribed to the whole brain and to eight individual metastases, respectively. RESULTS: Mean volume of the eight metastases was 8.1 cc (range: 3.8-10.1 cc). For all lesions, the volume receiving 95% of prescribed dose was 100% and dose homogeneity was within 3%. Moreover, maximum doses were less than 105% of prescribed dose, while average mean dose to lesions was 50.6 Gy (range: 49.7-51.5 Gy). Whole brain mean dose was 45.2 Gy. Maximum doses to brainstem and optic chiasma were limited to 44.5 Gy and 42.9 Gy, respectively, while maximum doses to eyes, lens and optic nerves were limited to 9.2 Gy, 4.9 Gy and 41.0 Gy, respectively. From a clinical point of view, subsequent MRI brain controls showed a complete clinical response. Forty months after treatment the patient is disease free and shows no late brain and skin toxicities. CONCLUSION: This case demonstrates the technical feasibility of a SIB-IMRT treatment in patients with more than 3 brain metastases.

Endovascular treatment of persistent sciatic artery aneurysm with the multilayer stent.

PURPOSE: To describe the successful management of a symptomatic persistent sciatic artery (PSA) aneurysm using the Multilayer Aneurysm Repair System (MARS). CASE REPORT: A 50-year-old man with history of smoking, hypertension, and hypercholesterolemia suddenly developed pain in the buttock radiating to the left lower limb, mimicking sciatica. The ∼57×54-mm incomplete type PSA aneurysm was treated with two 14×80- and 14×60-mm MARS devices through a surgical left axillary artery access. There were no periprocedural complications. Thirty-day imaging documented patency of the stents and a minor reduction (∼47×55 mm) in the aneurysm, with slightly hyperdense content and no signs of perfusion. At 6 months, duplex and computed tomographic angiography showed complete thrombosis of the sac, patency of the multilayer stents, and further aneurysm shrinkage (40×37 mm). CONCLUSION: The multilayer stent can alter the hemodynamics inside a peripheral aneurysm to promote sac thrombosis and redirect flow to collaterals originating from the sac.

Effect of circadian rhythms on retrieval-induced forgetting.

This study investigated the effects of natural circadian rhythms on retrieval-induced forgetting (RIF; Anderson et al. in J Exp Psychol Learn Mem Cogn 20:1063-1087, 1994). Individuals tested at optimal times (i.e., morning persons tested in the morning and evening persons tested in the evening) showed a significantly greater RIF effect than individuals tested at non-optimal times (i.e., morning persons tested in the evening and evening persons tested in the morning). Thus, the limited quantity of resources available to allocate in the inhibitory activity during non-optimal times produced a significant decrement in RIF. These findings are compatible with the inhibitory account of RIF and with the notion of a resource-demanding process underlying this memory phenomenon.

Self-regulation predicts risk-taking through people's time horizon.

In the context of decision-making research, people's regulatory orientation mode (i.e., assessment and locomotion modes) has been included among the most prominent individual difference variables, which may potentially account for choice behaviour. Thus, the main objective of our experiment was to investigate the relations between habitual use of regulatory mode and risk-taking through people's time horizon. Risk-taking was appraised using a behavioural measure (i.e., BART) 1 month following evaluation of habitual use of regulatory mode. The findings revealed a significant negative association between the assessment mode and risk-taking through individual differences in time horizon.

Regulatory modes and time management: how locomotors and assessors plan and perceive time.

This research investigated the relationship between regulatory mode orientations (locomotion and assessment), time management behaviours and the perceived control of time. "Locomotion" refers to the aspect of self-regulation involving the movement from state to state, whereas "assessment" is the comparative aspect of self-regulation that refers to the critical evaluation of alternative goals and the means for achieving them. The Italian versions of the Time Management Behavior Scale and the Perceived Control of Time Scale, as well as the Locomotion and Assessment Regulatory Modes Scales were administered to 339 Italian participants (249 students and 90 employees). The results supported the notion that locomotors and assessors differ in the ways they perceive the control of time. Locomotion was found to be positively related to perceived control of time. In contrast, assessment was negatively related to perceived control of time. Furthermore, the two time management dimensions of setting goals and priorities and preference for organisation were shown to mediate the relationship between locomotion and perceived control of time, whereas assessment proved to be unrelated to all time management behaviours. These findings highlight the importance of regulatory modes for human behaviour regarding time management and perceived control of time.

The Impact of the Need for Cognitive Closure on Attitudes toward Women as Managers and the Sequential Mediating Role of Belief in a Just World and Gender Essentialism.

This research investigated the relation between the need for cognitive closure (i.e., a desire for epistemic certainty) and attitudes toward women as managers among men and women. In a cross-sectional study (total N = 241) collected in Italy, we found that need for cognitive closure, controlling for participants' gender, was related to having more prejudice toward women leaders. Furthermore, the results revealed that the positive relation between the need for cognitive closure and negative attitudes toward women as managers was sequentially mediated by belief in a just world (i.e., the belief that people get what they deserve and deserve what they get and other people do not) and gender essentialism (i.e., the belief that women and men are distinctly, immutably, and naturally different, and thus have complementary skills to bring to the workplace). We suggest that men and women who are characterized by a need for cognitive closure are more sensitive to stereotypes of women as being incompatible with leadership roles. Either priming a low need for cognitive closure or providing contrary stereotypes could obviate the effect on beliefs in a just world and in gender essentialism that impedes progress towards greater gender equality in the workplace.

Prevention regulatory focus, desired cultural tightness, civic moral disengagement, and emotional reactions to normative daily transgressions: a serial mediation model among adults in Italy.

Why do people have positive or indifferent reactions to norm violations? The present research hypothesized that individuals who focus on the avoidance of negative outcomes, for example punishments for rule violations, (i.e., a prevention focus) are hypothesized to also have a desire for rigid and clear norms (i.e., desired cultural tightness) as well as punishments for norm violations. Such norms and punishments narrow accepted behavior and, if clearly communicated, can limit rule violations. Consequently, individuals who desire higher levels of cultural tightness should be less likely to justify poor citizenship behavior (i.e., civic moral disengagement) as this behavior is antithetical to desired cultural tightness. Finally, such individuals should also be more likely to react negatively to norm violations. Data for the present study was conducted in Italy. A total of 1,181 participants were included in the analysis; participation requirements were that they be adults who were residents of Italy. Participants completed self-report measures of the prevention focus, desired cultural tightness, civic moral disengagement, and reactions to general norm violations (e.g., exceeding the speed limit, vandalism). The hypothesized serial mediation model was supported. This model can help explain why individuals can fail to react to "everyday" norm violations, as well societal-level violations (e.g., failing to respect hygienic standards during the COVID pandemic). It also calls on the need to develop mass communication approaches that can influence individuals' prevention focus on a large scale, as this can have downstream effects of reactions to such violations.

Significance loss brings to extreme self-care related behaviors: the role of interpersonal influence and obsessive (vs. harmonious) passion.

Building on Significance Quest Theory we hypothesized that significance loss feelings can bring people to extreme self-care related behaviors via (a) the susceptibility to interpersonal influence, and (b) the development of a predominance of obsessive (vs. harmonious) passion toward the self-care. To test these hypotheses, we ran one cross-sectional study among voluntary participants (N = 401). Results confirmed our hypotheses, suggesting that physical appearance is perceived as a fruitful and useful route to maintain or even restoring ones' personal sense of significance. Notably, these results shed light on another scope that can be exploited to achieve social significance (i.e., physical appearance) through extremism, and could represent a starting point to design practical intervention to reduce the examined extreme behaviors.

Motivation to Avoid Uncertainty, Implicit Person Theories about the Malleability of Human Attributes and Attitudes toward Women as Leaders vs. Followers: A Mediational Analysis.

This research investigated the relation between motivation to avoid uncertainty, as reflected in the need for cognitive closure, implicit theories about the malleability of human attributes, and attitudes toward women as leaders vs. followers. In a cross-sectional study (N = 470) conducted in Italy, we hypothesized and found that the need for cognitive closure directly enhanced the belief that women are compatible with followership roles rather than leadership roles. Furthermore, the results from a mediational analysis revealed that the relation between the need for cognitive closure and the belief that women are compatible with followership roles rather than leadership was mediated by implicit person theories (i.e., the conviction that people features are malleable vs. unchangeable). Notably, we obtained these results while controlling for participants' gender, educational level, and age. The theoretical and practical implications are discussed.