What's to come in PSMA therapies and diagnostics: A summary of clinical trials involving PSMA radioligand-based therapeutic and/or diagnostic approaches with active recruitment.

INTRODUCTION: Prostate-Specific Membrane Antigen (PSMA)-based diagnostics and therapeutics are proving highly valuable in identifying disease sites and providing targeted radioligand therapy (RLT) for disseminated disease in prostate cancer (PC). With successful integration of these tools in limited PC presentations, there is a real need and excitement for trials testing PSMA-based approaches more broadly. AREAS COVERED: We review the ongoing trials registered on ClinicalTrials.gov which aim to evaluate PSMA-PET or PSMA-RLT applications. We outline clinical contexts which have significant ongoing study and therefore may see imminent change, as well as contexts which are lacking in study in the hopes of guiding future research. EXPERT OPINION: Trials examining intensification strategies through targeted radiotherapy, combination systemic therapies, and RLTs have the potential to demonstrate improved clinical outcomes using PSMA-PET CT for guidance. We expect that PSMA-PET will become fundamental in the work-up of patients before targeted radiotherapy or surgery. The results of ongoing trials will likely clarify the benefits of PSMA-RLT in metastatic PC including in oligometastatic and hormone-sensitive disease; however, there is a sparsity of trials evaluating PSMA-RLT outside of metastatic PC. Clinical trials with PSMA PET/CT as an endpoint for disease control are emerging and standardized reporting and metrics for PSMA staging and response will facilitate the inclusion of PSMA PET endpoints into therapeutic trials.

Performance of machine learning methods in diagnosing Parkinson's disease based on dysphonia measures.

Parkinson's disease (PD) is a widespread degenerative syndrome that affects the nervous system. Its early appearing symptoms include tremor, rigidity, and vocal impairment (dysphonia). Consequently, speech indicators are important in the identification of PD based on dysphonic signs. In this regard, computer-aided-diagnosis systems based on machine learning can be useful in assisting clinicians in identifying PD patients. In this work, we evaluate the performance of machine learning based techniques for PD diagnosis based on dysphonia symptoms. Several machine learning techniques were considered and trained with a set of twenty-two voice disorder measurements to classify healthy and PD patients. These machine learning methods included linear discriminant analysis (LDA), k nearest-neighbors (k-NN), naïve Bayes (NB), regression trees (RT), radial basis function neural networks (RBFNN), support vector machine (SVM), and Mahalanobis distance classifier. We evaluated the performance of these methods by means of a tenfold cross validation protocol. Experimental results show that the SVM classifier achieved higher average performance than all other classifiers in terms of overall accuracy, G-mean, and area under the curve of the receiver operating characteristic plot. The SVM classifier achieved higher performance measures than the majority of the other classifiers also in terms of sensitivity, specificity, and F-measure statistics. The LDA, k-NN and RT achieved the highest average precision. The RBFNN method yielded the highest F-measure.; however, it performed poorly in terms of other performance metrics. Finally, t tests were performed to evaluate statistical significance of the results, confirming that the SVM outperformed most of the other classifiers on the majority of performance measures. SVM is a promising method for identifying PD patients based on classification of dysphonia measurements.

Partial Correlation-Based Retinotopically Organized Resting-State Functional Connectivity Within and Between Areas of the Visual Cortex Reflects More Than Cortical Distance.

Numerous studies have demonstrated functional magnetic resonance imaging (fMRI)-based resting-state functional connectivity (RSFC) between cortical areas. Recent evidence suggests that synchronous fluctuations in blood oxygenation level-dependent fMRI reflect functional organization at a scale finer than that of visual areas. In this study, we investigated whether RSFCs within and between lower visual areas are retinotopically organized and whether retinotopically organized RSFC merely reflects cortical distance. Subjects underwent retinotopic mapping and separately resting-state fMRI. Visual areas V1, V2, and V3, were subdivided into regions of interest (ROIs) according to quadrants and visual field eccentricity. Functional connectivity (FC) was computed based on Pearson's linear correlation (correlation), and Pearson's linear partial correlation (correlation between two time courses after the time courses from all other regions in the network are regressed out). Within a quadrant, within visual areas, all correlation and nearly all partial correlation FC measures showed statistical significance. Consistently in V1, V2, and to a lesser extent in V3, correlation decreased with increasing eccentricity separation. Consistent with previously reported monkey anatomical connectivity, correlation/partial correlation values between regions from adjacent areas (V1-V2 and V2-V3) were higher than those between nonadjacent areas (V1-V3). Within a quadrant, partial correlation showed consistent significance between regions from two different areas with the same or adjacent eccentricities. Pairs of ROIs with similar eccentricity showed higher correlation/partial correlation than pairs distant in eccentricity. Between dorsal and ventral quadrants, partial correlation between common and adjacent eccentricity regions within a visual area showed statistical significance; this extended to more distant eccentricity regions in V1. Within and between quadrants, correlation decreased approximately linearly with increasing distances separating the tested ROIs. Partial correlation showed a more complex dependence on cortical distance: it decreased exponentially with increasing distance within a quadrant, but was best fit by a quadratic function between quadrants. We conclude that RSFCs within and between lower visual areas are retinotopically organized. Correlation-based FC is nonselectively high across lower visual areas, even between regions that do not share direct anatomical connections. The mechanisms likely involve network effects caused by the dense anatomical connectivity within this network and projections from higher visual areas. FC based on partial correlation, which minimizes network effects, follows expectations based on direct anatomical connections in the monkey visual cortex better than correlation. Last, partial correlation-based retinotopically organized RSFC reflects more than cortical distance effects.

Evaluation and calibration of functional network modeling methods based on known anatomical connections.

Recent studies have identified large scale brain networks based on the spatio-temporal structure of spontaneous fluctuations in resting-state fMRI data. It is expected that functional connectivity based on resting-state data is reflective of - but not identical to - the underlying anatomical connectivity. However, which functional connectivity analysis methods reliably predict the network structure remains unclear. Here we tested and compared network connectivity analysis methods by applying them to fMRI resting-state time-series obtained from the human visual cortex. The methods evaluated here are those previously tested against simulated data in Smith et al. (Neuroimage, 2011). To this end, we defined regions within retinotopic visual areas V1, V2, and V3 according to their eccentricity in the visual field, delineating central, intermediate, and peripheral eccentricity regions of interest (ROIs). These ROIs served as nodes in the models we study. We based our evaluation on the "ground-truth", thoroughly studied retinotopically-organized anatomical connectivity in the monkey visual cortex. For each evaluated method, we computed the fractional rate of detecting connections known to exist ("c-sensitivity"), while using a threshold of the 95th percentile of the distribution of interaction magnitudes of those connections not expected to exist. Under optimal conditions - including session duration of 68min, a relatively small network consisting of 9 nodes and artifact-free regression of the global effect - each of the top methods predicted the expected connections with 67-85% c-sensitivity. Correlation methods, including Correlation (Corr; 85%), Regularized Inverse Covariance (ICOV; 84%) and Partial Correlation (PCorr; 81%) performed best, followed by Patel's Kappa (80%), Bayesian Network method PC (BayesNet; 77%), General Synchronization measures (67-77%), and Coherence (CohB; 74%). With decreased session duration, these top methods saw decreases in c-sensitivities, achieving 59-76% for 17min sessions. With a short resting-state fMRI scan of 8.5min, none of the methods predicted the real network well, with Corr (65%) performing best. With increased complexity of the network from 9 to 36 nodes, multivariate methods including PCorr and BayesNet saw a decrease in performance. Artifact-free regression of the global effect increased the c-sensitivity of the top-performing methods. In an overall evaluation across all tests we performed, correlation methods (Corr, ICOV, and PCorr), Patel's Kappa, and BayesNet method PC set themselves somewhat above all other methods. We propose that data-based calibration based on known anatomical connections be integrated into future network studies, in order to maximize sensitivity and reduce false positives.