The collection of normally non-pathogenic microorganisms that mainly inhabit our gut lumen shapes our health in many ways. Structural and functional perturbations in the gut microbial pool, known as “dysbiosis”, have been proven to play a vital role in the pathophysiology of several diseases, including cardiovascular disease (CVD). Although therapeutic regimes are available to treat this group of diseases, they have long been the main cause of mortality and morbidity worldwide. While age, sex, genetics, diet, tobacco use, and alcohol consumption are major contributors (World Health Organization, 2018), they cannot explain all of the consequences of CVD. In addition to the abovementioned traditional risk factors, the constant search for novel preventative and curative tools has shed light on the involvement of gut bacteria and their metabolites in the pathogenesis of CVD. In this narrative review, we will discuss the established interconnections between the gut microbiota and CVD, as well as the plausible therapeutic perspectives.

Background/Objectives: Lung cancer is the leading cause of cancer-related mortality worldwide. Accurate radiotherapy (RT) planning alongside chemotherapy and immunotherapy is critical for improving treatment outcomes for inoperable non-metastatic cases. Conventional computed tomography (CT)-based planning may be inadequate for accurately identifying tumor margins and the location of nodal disease. We investigated whether ¹⁸F-labeled fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET-CT) imaging can assist in target volume delineation for primary, nodal, and metastatic disease in the RT planning and overall therapeutic planning of patients. Methods: In this single-center, prospective study, we recruited 34 patients with histologically confirmed locally advanced non-small-cell lung carcinoma (NSCLC). All patients underwent ¹⁸F-FDG PET-CT-based RT simulation. Two sequential RT plans were created by the same radiation oncologist: one based on CT alone and the other PET-CT. Planning target volumes (PTVs) and PET-CT-guided adjustments were analyzed to assess their impact. Standardized protocols for immobilization, imaging, target delineation, and dose prescription were applied. Results: A total of 34 patients (31 males and 3 females) were recruited in the study. ¹⁸F-FDG PET-CT detected distant metastases in 7/34 (20.6%) patients, altering the overall therapeutic plan in 4/34 (11.8%) and allowing radical RT in 3 of them who had oligometastatic disease (8.8%). It modified RT planning in 26/34 (76.5%) patients and clarified malignancy in atelectatic areas. Nodal involvement was identified in 3/34 patients (8.8%) and excluded in 3/34 cases, avoiding unnecessary nodal irradiation. Additional involved nodes were revealed in 12/34 (35.3%) patients, requiring dose escalation. Overall, changes to the tumor PTV were made in 23/30 (76.6%) and to the nodal PTV in 19/30 (63.3%) cases (p < 0.0001). Primary tumor and nodal PTVs increased in 20/34 (66.7%) and 13/34 (43.3%), respectively. Conclusions: ¹⁸F-FDG PET-CT significantly improves RT planning by more precisely defining tumor and nodal volumes, identifying undetected lesions, and guiding dose adaptation. Larger long-term studies are required to confirm potential locoregional control and survival improvements.

Clinical characteristics and outcomes of patients with transthyretin amyloidosis cardiomyopathy (ATTR-CM) vary by region, necessitating the acquisition of country-specific evidence for proper management. This is an observational study including sequential patients presenting in the Amyloidosis Reference Center of Greece, from 01/2014 to 12/2022. ATTR-CM was diagnosed by positive scintigraphy and exclusion of light-chain amyloidosis or positive biopsy typing. Genetic testing was performed in all cases. One-hundred and nine ATTR-CM patients were included (median age, 81 years) of which 15 carried TTR mutations (27% Val30Met). Most patients (82%) presented with heart failure and 59% with atrial fibrillation, while 10% had aortic stenosis. Importantly, 78 (71.6%) had clinically significant extracardiac manifestations (45% musculoskeletal disorder, 40% peripheral neuropathy and 33% gastrointestinal symptoms). Sixty-five (60%) received disease-specific treatment with tafamidis. Estimated median survival was 48 months; advanced NYHA class, National Amyloidosis Center stage, eGFR5000 pg/mL were associated with worse survival, while tafamidis treatment was associated with improved survival in patients with IVS≥ 12 mm. These are the first data describing the characteristics, management, and outcomes of patients with ATTR-CM in Greece, which could influence local guidelines. Transthyretin cardiomyopathy in Greece.

Background/Objectives: Precise staging and tumor delineation are essential for optimizing treatment and enhancing outcomes of radiotherapy (RT). While computed tomography (CT)-based RT remains standard, fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) offers improved detection of primary and nodal disease. This study investigates the role of PET/CT in RT planning of HNSCC. Methods: Fifty-one HNSCC patients underwent radical volumetric modulated arc RT with concurrent cisplatin chemotherapy in a prospective study. Two RT plans per patient were sequentially created by a single oncologist using CT-only and PET/CT data, respectively. Planning target volumes (PTVs) for primary and nodal regions were independently defined, and dose–volume histograms were analyzed and compared. Results: PET/CT significantly affected TNM staging, increasing the T-stage in 11.8% of patients and the N-stage in 33.3%. Distant metastases were found in 9.8% of patients, leading to a redefinition of the overall treatment policy. PET/CT-based planning improved primary tumor PTV coverage (PTV4) in 37.2% (19/51) of cases. The tumor areas excluded from the CT-based planning received an average of 85.6% of the prescribed PTV4 dose (range 18–93%), while in PET/CT planning, they received 95.4% (range 93–99%) (p < 0.0001). Nodal PTV areas requiring a booster dose (PTV2) were adjusted in 33.3% (17/51) of patients during PET-CT planning. These nodal areas received an average of 85.6% of the prescribed dose for PTV2 (range 18–93%) during CT planning, compared to 95.4% (range 93–99%) during PET/CT planning. There was no statistically significant difference in the dose received by organs at risk between CT- and PET/CT-RT planning. Conclusions: PET/CT improves target delineation for primary tumors and lymph nodes, also allowing for dose escalation in metabolically highly active lesions in patients with HNSCC. The method also reveals occult distant metastases in a subset of patients, enabling personalized treatment strategies.

Objective: This study proposes a novel deep learning approach for enhancing low-dose bone scintigraphy images using an Enhanced Convolutional Autoencoder (ECAE), aiming to reduce patient radiation exposure while preserving diagnostic quality, as assessed by both expert-based quantitative image metrics and qualitative evaluation. Methods: A supervised learning framework was developed using real-world paired low- and full-dose images from 105 patients. Data were acquired using standard clinical gamma cameras at the Nuclear Medicine Department of the University General Hospital of Alexandroupolis. The ECAE architecture integrates multiscale feature extraction, channel attention mechanisms, and efficient residual blocks to reconstruct high-quality images from low-dose inputs. The model was trained and validated using quantitative metrics—Peak Signal-to-Noise Ratio (PSNR) and Structural Similarity Index (SSIM)—alongside qualitative assessments by nuclear medicine experts. Results: The model achieved significant improvements in both PSNR and SSIM across all tested dose levels, particularly between 30% and 70% of the full dose. Expert evaluation confirmed enhanced visibility of anatomical structures, noise reduction, and preservation of diagnostic detail in denoised images. In blinded evaluations, denoised images were preferred over the original full-dose scans in 66% of all cases, and in 61% of cases within the 30–70% dose range. Conclusion: The proposed ECAE model effectively reconstructs high-quality bone scintigraphy images from substantially reduced-dose acquisitions. This approach supports dose reduction in nuclear medicine imaging while maintaining—or even enhancing—diagnostic confidence, offering practical benefits in patient safety, workflow efficiency, and environmental impact.

This case report highlights a rare occurrence of osteomalacia induced by hypophosphatemia secondary to ferric carboxymaltose (FCM) therapy in a patient with hereditary hemorrhagic telangiectasia (HHT, or Rendu‐Osler‐Weber syndrome). A 21‐year‐old man presented with left tibial pain without prior trauma, accompanied by severe hypophosphatemia, vitamin D deficiency, and elevated fibroblast growth factor 23 (FGF23) levels. Upon the full diagnostic imaging work‐up, F‐18‐FDG PET/CT majorly contributed to the differential diagnosis by excluding potential malignancy and verifying a stress fracture. Treatment included vitamin D supplementation and oral phosphorus replacement, along with discontinuation of ferric carboxymaltose (FCM) therapy. This case demonstrates the importance of vigilance for metabolic bone disease in patients undergoing FCM treatment, particularly those with predisposing conditions such as HHT, to prevent misdiagnosis and mitigate complications.