Prognostic value of 18F-FDG PET/CT in patients with relapsed multiple myeloma.

This study aimed to assess the prognostic value of 18F-fluorodeoxyglucose positron emission tomography/computer tomography (18F-FDG PET/CT) in patients with relapsed multiple myeloma (MM). Fifty-one consecutive patients with relapsed MM were enrolled in this retrospective study. 18F-FDG parameters based on the Italian Myeloma Criteria for PET Use (IMPeTUs) and clinical data were analyzed for overall survival (OS) and progression-free survival (PFS). The Cox proportional risk model was used for univariate and multivariate analysis, and Kaplan-Meier survival curves were used for survival analysis. The median length of follow-up was 20 months (IQR, 5-29 months), the median PFS for the entire cohort was 8 months (IQR, 3-17 months) and the median OS was 21 months (IQR, 8-49 months). Multivariate survival analysis demonstrated that the Deauville score of BM > 3 [HR 2.900, 95% CI (1.011, 8.319), P = 0.048] and the presence of EMD [HR 3.134, 95% CI (1.245, 7.891), P = 0.015] were independent predictors of poor PFS. The presence of EMD [HR 12.777, 95% CI (1.825, 89.461), P = 0.010] and the reduced platelets count [HR 7.948, 95% CI (1.236, 51.099), P = 0.029] were adversely associated with OS. 18F-FDG PET/CT parameters based on IMPeTUs have prognostic significance in patients with relapsed MM.

Interpretation criteria for FDG PET/CT in multiple myeloma (IMPeTUs): final results. IMPeTUs (Italian myeloma criteria for PET USe).

ᅟ: FDG PET/CT (18F-fluoro-deoxy-glucose positron emission tomography/computed tomography) is a useful tool to image multiple myeloma (MM). However, simple and reproducible reporting criteria are still lacking and there is the need for harmonization. Recently, a group of Italian nuclear medicine experts defined new visual descriptive criteria (Italian Myeloma criteria for Pet Use: IMPeTUs) to standardize FDG PET/CT evaluation in MM patients. The aim of this study was to assess IMPeTUs reproducibility on a large prospective cohort of MM patients. MATERIALS AND METHODS: Patients affected by symptomatic MM who had performed an FDG PET/CT at baseline (PET0), after induction (PET-AI), and the end of treatment (PET-EoT) were prospectively enrolled in a multicenter trial (EMN02)(NCT01910987; MMY3033). After anonymization, PET images were uploaded in the web platform WIDEN® and hence distributed to five expert nuclear medicine reviewers for a blinded independent central review according to the IMPeTUs criteria. Consensus among reviewers was measured by the percentage of agreement and the Krippendorff's alpha. Furthermore, on a patient-based analysis, the concordance among all the reviewers in terms of positivity or negativity of the FDG PET/CT scan was tested for different thresholds of positivity (Deauville score (DS 2, 3, 4, 5) for the main parameters (bone marrow, focal score, extra-medullary disease). RESULTS: Eighty-six patients (211 FDG PET/CT scans) were included in this analysis. Median patient age was 58 years (range, 35-66 years), 45% were male, 15% of them were in stage ISS (International Staging System) III, and 42% had high-risk cytogenetics. The percentage agreement was superior to 75% for all the time points, reaching 100% of agreement in assessing the presence skull lesions after therapy. Comparable results were obtained when the agreement analysis was performed using the Krippendorff's alpha coefficient, either in every single time point of scanning (PET0, PET-AI or PET-EoT) or overall for all the scans together. DS proved highly reproducible with the highest reproducibility for score 4. CONCLUSIONS: IMPeTUs criteria proved highly reproducible and could therefore be considered as a base for harmonizing PET interpretation in multiple myeloma. A prospective clinical validation of IMPeTUs criteria is underway.

Image interpretation criteria for FDG PET/CT in multiple myeloma: a new proposal from an Italian expert panel. IMPeTUs (Italian Myeloma criteria for PET USe).

PURPOSE: FDG PET/CT is able to detect active disease in patients with multiple myeloma (MM) and can be helpful for staging and assessing therapy response, but no standard interpretation criteria have been proposed for the evaluation of FDG PET/CT in MM. METHODS: A group of Italian nuclear medicine physicians and haematologists met to propose new visual interpretation criteria to standardize FDG PET/CT evaluation in MM patients (Italian Myeloma criteria for PET USe; IMPeTUs) and the reproducibility of these criteria was tested. This Italian multicentre protocol was set up as a subprotocol of EMN02, an international prospective multicentre trial of the European Myeloma Network. The criteria were agreed at multidisciplinary consensus meetings. They include a description of the metabolic state of the bone marrow (BM), number and site of focal PET-positive lesions, the number of osteolytic lesions, and the presence and site of extramedullary disease, paramedullary disease and fractures. A visual degree of uptake was defined for the target lesion and extramedullary lesions according to modified Deauville criteria. MM patients who had undergone FDG PET/CT at baseline (PET-0), after induction (PET-AI) and at the end of treatment (PET-EoT) were enrolled. The patients had been prospectively enrolled in EMN02 and their PET scans were a posteriori reinterpreted in a blinded independent central review process managed by WIDEN®. Five expert nuclear medicine physicians scored the scans according to the new criteria. A case was considered read when four out of the five reviewers completed the report. Concordance among reviewers on different metrics was calculated using Krippendorff's alpha coefficient. RESULTS: A total of 17 consecutive patients were enrolled. On PET-0, the alpha coefficients for the BM score, the score for the hottest focal lesion, the number of focal lesions and the number of lytic lesions were 0.33 and 0.47, 0.40 and 0.32, respectively. On PET-AI, the alpha coefficients were 0.09 and 0.43, 0.22 and 0.21, respectively, and on PET-EoT, the alpha coefficients were 0.07, 0.28, 0.25 and 0.21, respectively. BM was generally difficult to score since grades 2 and 3 are difficult to discriminate. However, since neither of the two grades is related to BM myelomatous involvement, the difference was not clinically relevant. Agreement on focal lesion scores and on the number of focal lesions was good. CONCLUSION: The new visual criteria for interpreting FDG PET/CT imaging in MM patients, IMPeTUs, were found to be feasible in clinical practice.

Developmental changes in children's understanding of horizontal projectile motion.

This study investigated 5- to 13-year-old children's performance in solving horizontal projectile motion problems, in which they predicted the trajectory of a carried object released from a carrier in three different contexts. The results revealed that 5- and 8-year-olds' trajectory predictions were easily distracted by salient contextual features (e.g. the relative spatial locations between objects), whereas a proportion of 11- and 13-year-olds' performance suggested the engagement of the impetus concept in trajectory prediction. The impetus concept is a typical misconception of inertial motion that assumes that motion is caused by force. Children's performance across ages suggested that their naïve knowledge of projectile motion was neither well-developed and coherent nor completely fragmented. Instead, this study presented the dynamic process in which children with age gradually overcame the influences of contextual features and consistently used the impetus concept across motion problems.

The impact and transmission mechanism of green credit policy on energy efficiency: new evidence from China.

Green credit policy is the primary means for financial institutions to fulfill their environmental responsibilities. It is an issue worthy of attention whether green credit policy can achieve the effect of energy conservation, efficiency improvement, pollution reduction, and carbon reduction. This study uses the difference-in-difference method to test the impact of green credit policy on energy efficiency. The results show that green credit policy led to a significant decrease in energy intensity of green credit-restricted sectors while impeding the advancement of green total factor energy efficiency. The heterogeneity results show that the energy efficiency of large-scale, light textile manufacturing, resource processing industries, and clean industries are more significantly affected. Green credit policy can achieve energy conservation and has a linkage effect on pollution and carbon reduction. Although the constraint effect of green credit policy has effectively suppressed energy intensity, it also leads some industries to face a vicious cycle of "enhanced financing constraints-weakened innovation impetus," which in turn makes it challenging to improve green total factor energy efficiency. The above findings confirm the effectiveness of green credit policy in energy conservation and emission reduction. Also, they indicate the necessity of further improvement of the green financial policy system.

Grounding Intuitive Physics in Perceptual Experience.

This review article explores the foundation of laypeople's understanding of the physical world rooted in perceptual experience. Beginning with a concise historical overview of the study of intuitive physics, the article presents the hypothesis that laypeople possess accurate internalized representations of physical laws. A key aspect of this hypothesis is the contention that correct representations of physical laws emerge in ecological experimental conditions, where the scenario being examined resembles everyday life experiences. The article critically examines empirical evidence both supporting and challenging this claim, revealing that despite everyday-life-like conditions, fundamental misconceptions often persist. Many of these misconceptions can be attributed to a domain-general heuristic that arises from the overgeneralization of perceptual-motor experiences with physical objects. To conclude, the article delves into ongoing controversies and highlights promising future avenues in the field of intuitive physics, including action-judgment dissociations, insights from developmental psychology, and computational models integrating artificial intelligence.

Multitracer PET/CT with [18F]Fluorodeoxiglucose and [18F]Fluorocholine in the Initial Staging of Multiple Myeloma Patients Applying the IMPeTus Criteria: A Pilot Study.

Initial staging of patients diagnosed with multiple myeloma (MM) can lead to negative results using conventional diagnostic imaging workup, including [18F]Fluorodesoxiglucose ([18F]FDG) PET/CT. The aim of this prospective pilot study was to evaluate the diagnostic efficacy of [18F]Fluorocholine ([18F]FCH) PET/CT in the initial staging of MM patients who were candidates for autologous bone marrow transplant. Materials and Methods: The inclusion criteria of our study were: (a) patients diagnosed with MM; (b) candidates for autologous bone marrow transplant (AT); and (c) studied with [18F]FCH PET/CT and [18F]FDG PET/CT for initial staging less than 4 weeks apart. Imaging analysis included the presence of: bone marrow infiltration, focal bone lesions, and para-medullary or extra-medullary disease, according to the proposed IMPeTus criteria. The analysis was performed per lesion, per patient, and per location. Results: The study population included ten patients. Globally, [18F]FCH PET/CT showed bone marrow uptake in all the patients and visualised 16 more focal lesions than [18F]FDG PET/CT. One patient presented a plasmacytoma, detected by both tracers. Extra-medullary and para-medullary disease was identified with different degrees of uptake by both tracers. In summary, [18F]FCH PET seemed to be superior to [18F]FDG PET/CT in detecting focal bone lesions. SUVmax values were slightly higher in [18F]FCH PET/CT than in [18F]FDG PET/CT. Conclusions: Taking into account the small study population, according to our results, [18F]FCH PET/CT could be a useful tool for staging MM patients.

The possibility of an impetus heuristic.

Evidence consistent with a belief in impetus is drawn from studies of naïve physics, perception of causality, perception of force, and representational momentum, and the possibility of an impetus heuristic is discussed. An impetus heuristic suggests the motion path of an object that was previously constrained or influenced by an external source (e.g., object, force) appears to exhibit the same constraint or influence even after that constraint or influence is removed. Impetus is not a valid physical principle, but use of an impetus heuristic can in some circumstances provide approximately correct predictions regarding future object motion, and such predictions require less cognitive effort and resources than would predictions based upon objective physical principles. The relationship of an impetus heuristic to naïve impetus theory and to objective physical principles is discussed, and use of an impetus heuristic significantly challenges claims that causality or force can be visually perceived. Alternatives to an impetus heuristic are considered, and potential boundary conditions and falsification of the impetus notion are discussed. Overall, use of an impetus heuristic offers a parsimonious explanation for findings across a wide range of perceptual domains and could potentially be extended to more metaphorical types of motion.

The prognostic significance of [18F]FDG PET/CT in multiple myeloma according to novel interpretation criteria (IMPeTUs).

PURPOSE: [18F]FDG PET/CT is the elective imaging modality for treatment monitoring in multiple myeloma (MM). However, MM is a heterogeneous disease from an imaging point of view, raising challenges in interpretation of PET/CT. We herein investigated the prognostic role of the novel Italian Myeloma criteria for PET Use (IMPeTUs) in MM patients undergoing high-dose chemotherapy (HDT) followed by autologous stem cell transplantation (ASCT). METHODS: Forty-seven patients with newly diagnosed MM underwent [18F]FDG PET/CT before commencement of treatment (baseline PET/CT). Thirty-four of them (72.3%) were also examined after completion of ASCT (follow-up PET/CT). PET/CT analysis was based on the IMPeTUs criteria, which take into consideration-among others-the metabolic state of the bone marrow based on the 5-point Deauville score (DS), the number and metabolic state of focal [18F]FDG-avid lesions, as well as the presence of paramedullary disease (PMD) and extramedullary disease (EMD). We analyzed whether parameters from IMPeTUs correlate with clinically relevant parameters and patients' outcome, as assessed by progression-free survival (PFS). RESULTS: Median follow-up from baseline and follow-up PET/CT were 85.1 months and 76.7 months, respectively. The number of focal, [18F]FDG-avid lesions significantly correlated with the bone marrow infiltration rate and the R-ISS stage, while the presence of PMD was associated with LDH. After univariate survival analysis, the number of focal, [18F]FDG-avid lesions both before and after therapy as well as the presence of PMD and EMD before therapy adversely affected PFS. Multivariate survival analysis for baseline parameters confirmed that the number of focal, [18F]FDG-avid lesions and the presence of EMD are associated with adverse prognosis, irrespective of the ISS stage and/or the presence of high-risk cytogenetic abnormalities. The 5-point DS of [18F]FDG uptake in reference bone marrow and focal lesions showed a significant decrease as response to treatment, but it did not affect PFS. CONCLUSION: Several parameters utilized in IMPeTUs predict PFS in MM patients, suggesting the potentially significant role of the new criteria in patient stratification and response assessment. Additional studies are warranted for the further evaluation of IMPeTUs in the direction of establishment of robust cut-off values with a prognostic significance in the disease.

PET-FDG: Impetus.

The International Myeloma Working Group (IMWG)recommends FDG PET/CT (Fluoro-Deoxy-glucose Positron Emission Tomography/Computed Tomography) as the gold standard imaging modality for initial evaluation and response to therapy assessment in multiple myeloma. In fact, FDG PET/CT, provides multiple useful indexes to risk-stratify patients and has significant prognostic value. However, multiple myeloma remains a complex disease to interpret on imaging. The Italian myeloma criteria for PET use (IMPeTUs) were proposed to standardize FDG PET/CT reading in multiple myeloma. In this communication an overview on IMPeTUs is provided as well as some examples of application.

Causal reports: Context-dependent contributions of intuitive physics and visual impressions of launching.

Everyday causal reports appear to be based on a blend of perceptual and cognitive processes. Causality can sometimes be perceived automatically through low-level visual processing of stimuli, but it can also be inferred on the basis of an intuitive understanding of the physical mechanism that underlies an observable event. We investigated how visual impressions of launching and the intuitive physics of collisions contribute to the formation of explicit causal responses. In Experiment 1, participants observed collisions between realistic objects differing in apparent material and hence implied mass, whereas in Experiment 2, participants observed collisions between abstract, non-material objects. The results of Experiment 1 showed that ratings of causality were mainly driven by the intuitive physics of collisions, whereas the results of Experiment 2 provide some support to the hypothesis that ratings of causality were mainly driven by visual impressions of launching. These results suggest that stimulus factors and experimental design factors - such as the realism of the stimuli and the variation in the implied mass of the colliding objects - may determine the relative contributions of perceptual and post-perceptual cognitive processes to explicit causal responses. A revised version of the impetus transmission heuristic provides a satisfactory explanation for these results, whereas the hypothesis that causal responses and intuitive physics are based on the internalization of physical laws does not.

Political Impetus: Towards a Successful Agenda-Setting for Inclusive Health Policies in Low- and Middle-Income Countries Comment on "Shaping the Health Policy Agenda: The Case of Safe Motherhood Policy in Vietnam".

Agenda-setting is a crucial step for inclusive health policies in the low- and middle-income countries (LMICs). Enlightened by Ha et al manuscript, this commentary paper argues that 'political impetus' is the key to the successful agenda-setting of health policies in LMICs, though other determinants may also play the role during the process. This Vietnamese case study presents a good example for policy-makers of other LMICs; it offers insights for contexts where there are limited health resources and poor health performance. Further research which compares various stages of the health policy process across countries, is much needed.

Tempo, Sofrimento e Ímpeto Vital: Investigações Fenomenológicas em Minkowski / Time, Suffering and Vital Impetus: Phenomenological Investigations in Minkowski

Resumo O objetivo do presente trabalho é apresentar como se relacionam os conceitos de tempo, sofrimento e ímpeto vital em Minkowski, a partir de seu modo de aparição no trabalho Estudo psicológico e análise fenomenológica de um caso de melancolia esquizofrênica. Tal escolha se deu pela importância histórica da obra que introduziu seu pensamento nas Américas. A seguir, apresenta-se esta íntima ligação conceitual em textos do psiquiatra, datados posteriormente a este primeiro, em que tais temas são desenvolvidos e aprofundados. Conclui-se que mesmo que tal relação temática não tenha sido realizada de modo explícito, ao recorrer ao estudo de um destes três conceitos, os outros dois aparecem como indispensáveis no escopo teórico de seus estudos, a partir de suas relações intrínsecas, constitutivas da existência humana.

Abstract The aim of this paper is to present the way Minkowski relates the concepts of time, suffering and vital impetus since its appearance in the text Findings in a case of schizophrenic depression. This choice was made due to the historical importance of this work that introduced Minkowski´s ideas in the Americas. It is, then, presented how the intimate connection of these three concepts appears in later texts in which such themes are developed and deepened. In conclusion, when Minkowski reflects theoretically on one of these three concepts, even when such a thematic relationship is not explained, the other two concepts appear as essential in its theoretical scope, due to their intrinsic and constitutive relations in human existence.

Response of biodegradation characteristics of unacclimated activated sludge to moderate pressure in a batch reactor.

This study was aimed to investigate the effect of moderate pressure on unacclimated activated sludge. Process of organic degradation, variation of carbon dioxide (CO2) concentration of off-gas and characteristics of extracellular polymeric substances (EPS) of activated sludge were analyzed using pressure-atmospheric comparative experiments in bench-scale batch reactors. It was found that moderate pressure increased the degradation rate more dramatically when the biological process ran under a higher organic load with much more oxygen demand, which illuminated that applications of the pressurized method to high concentration organic wastewaters would be more reasonable and practicable. High oxygen transfer impetus increased utilization of oxygen which not only promoted the biodegradation of organics in wastewater, but also led to more EPS consumption in activated sludge. CO2 concentration of off-gas was lower in the earlier stage due to CO2 being pressed into the liquid phase and converted into inorganic carbon (IC). More CO2 emission was observed during the pressurized aerobic process 160 min later. EPS in pressurized reactor was much lower, which may be an important way of sludge reduction by pressurized technology.

Neurocognitive mechanisms of perception-action coordination: a review and theoretical integration.

The present analysis aims at a theoretical integration of, and a systems-neuroscience perspective on, a variety of historical and contemporary views on perception-action coordination (PAC). We set out to determine the common principles or lawful linkages between sensory and motor systems that explain how perception is action-oriented and how action is perceptually guided. To this end, we analyze the key ingredients to such an integrated framework, examine the architecture of dual-system conjectures of PAC, and endeavor in an historical analysis of the key characteristics, mechanisms, and phenomena of PACs. This analysis will reveal that dual-systems views are in need of fundamental re-thinking, and its elements will be amalgamated with current views on action-oriented predictive processing into a novel integrative theoretical framework (IMPPACT: Impetus, Motivation, and Prediction in Perception-Action Coordination theory). From this framework and its neurocognitive architecture we derive a number of non-trivial predictions regarding conative, motive-driven PAC. We end by presenting a brief outlook on how IMPPACT might present novel insights into certain pathologies and into action expertise.