(18)F-FDG PET-CT simulation for non-small-cell lung cancer: effect in patients already staged by PET-CT.

Purpose: Positron emission tomography (PET), in addition to computed tomography (CT), has an effect in target volume definition for radical radiotherapy (RT) for non–small-cell lung cancer (NSCLC). In previously PET-CT staged patients with NSCLC, we assessed the effect of using an additional planning PET-CT scan for gross tumor volume (GTV) definition. Methods and Materials: A total of 28 patients with Stage IA-IIIB NSCLC were enrolled. All patients had undergone staging PET-CT to ensure suitability for radical RT. Of the 28 patients, 14 received induction chemotherapy. In place of a RT planning CT scan, patients underwent scanning on a PET-CT scanner. In a virtual planning study, four oncologists independently delineated the GTVon the CT scan alone and then on the PET-CTscan. Intraobserver and interobserver variability were assessed using the concordance index (CI), and the results were compared using the Wilcoxon signed ranks test. Results: PET-CT improved the CI between observers when defining the GTVusing the PET-CT images compared with using CTalone for matched cases (median CI, 0.57 for CTand 0.64 for PET-CT, p = .032). The median of the mean percentage of volume change from GTVCT to GTVFUSED was 5.21% for the induction chemotherapy group and 18.88% for the RT-alone group. Using the Mann-Whitney U test, this was significantly different (p = .001). Conclusion: PET-CT RT planning scan, in addition to a staging PET-CT scan, reduces interobserver variability in GTV definition for NSCLC. The GTV size with PET-CT compared with CT in the RT-alone group increased and was reduced in the induction chemotherapy group.

Comparison of weight in middle age, weight at 18 years, and weight change between, in predicting subsequent 14 year mortality and coronary events: Caerphilly Prospective Study

Objective-The prevalence of obesity is increasing in many European countries and in the United States. This report examines the mortality and morbidity associated with being overweight and obese in the Caerphilly Prospective Study and the relative effects of weight in middle age and self reported weight at 18 years.

Mid- to late-Holocene climate variability and anthropogenic impacts: multi-proxy evidence from Lake Bliden, Denmark

We conducted multi-proxy geochemical analyses (including measurements of organic carbon, nitrogen and sulphur stable isotope composition, and carbonate carbon and oxygen isotope composition) on a 13.5 m sediment core from Lake Bliden, Denmark, which provide a record of shifting hydrological conditions for the past 6,700 years. The early part of the stratigraphic record (6,700-5,740 cal year BP) was wet, based on delta O-18(carb) and lithology, and corresponds to the Holocene Thermal Maximum. Shifts in primarily delta O-18(carb) indicate dry conditions prevailed from 5,740 to 2,800 cal year BP, although this was interrupted by very wet conditions from 5,300 to 5,150, 4,300 to 4,050 and 3,700 to 3,450 cal year BP. The timing of the latter two moist intervals is consistent with other Scandinavian paleoclimatic records. Dry conditions at Lake Bliden between 3,450 and 2,800 cal year BP is consistent with other paleolimnological records from southern Sweden but contrasts with records in central Sweden, possibly suggesting a more northerly trajectory of prevailing westerlies carrying moisture from the North Atlantic at this time. Overall, fluctuating moisture conditions at Lake Bliden appear to be strongly linked to changing sea surface temperatures in the Greenland, Iceland and Norwegian seas. After 2,800 cal year BP, sedimentology, magnetic susceptibility, delta C-13(ORG), delta C-13(carb) and delta O-18(carb) indicate a major reduction on water level, which caused the depositional setting at the coring site to shift from the profundal to littoral zone. The Roman Warm Period (2,200-1,500 cal year BP) appears dry based on enriched delta O-18(carb) values. Possible effects of human disturbance in the watershed after 820 cal year BP complicate attempts to interpret the stratigraphic record although tentative interpretation of the delta O-18(carb), magnetic susceptibility, delta C-13(ORG), delta C-13(carb) and delta O-18(carb) records suggest that the Medieval Warm Period was dry and the Little Ice Age was wet.

Does pre-operative estimation of oesophageal tumour metabolic length using F-18-fluorodeoxyglucose PET/CT images compare with surgical pathology length?

PURPOSE:
The aim of the study was to compare the pre-operative metabolic tumour length on FDG PET/CT with the resected pathological specimen in patients with oesophageal cancer.

METHODS:
All patients diagnosed with oesophageal carcinoma who had undergone staging PET/CT imaging between the period of June 2002 and May 2008 who were then suitable for curative surgery, either with or without neo-adjuvant chemotherapy, were included in this study. Metabolic tumour length was assessed using both visual analysis and a maximum standardised uptake value (SUV(max)) cutoff of 2.5.

RESULTS:
Thirty-nine patients proceeded directly to curative surgical resection, whereas 48 patients received neo-adjuvant chemotherapy, followed by curative surgery. The 95% limits of agreement in the surgical arm were more accurate when the metabolic tumour length was visually assessed with a mean difference of -0.05 cm (SD 2.16 cm) compared to a mean difference of +2.42 cm (SD 3.46 cm) when assessed with an SUV(max) cutoff of 2.5. In the neo-adjuvant group, the 95% limits of agreement were once again more accurate when assessed visually with a mean difference of -0.6 cm (SD 1.84 cm) compared to a mean difference of +1.58 cm (SD 3.1 cm) when assessed with an SUV(max) cutoff of 2.5.

CONCLUSION:
This study confirms the high accuracy of PET/CT in measuring gross target volume (GTV) length. A visual method for GTV length measurement was demonstrated to be superior and more accurate than when using an SUV(max) cutoff of 2.5. This has the potential of reducing the planning target volume with dose escalation to the tumour with a corresponding reduction in normal tissue complication probability.

Lack of Predictability at Work and Risk of Acute Myocardial Infarction: An 18-Year Prospective Study of Industrial Employees

Objectives. We examined whether the distinctive components of job control-decision authority, skill discretion, and predictability-were related to subsequent acute myocardial infarction (MI) events in a large population of initially heart disease-free industrial employees.