i America's abortion ban will hurt women everywhere By www.chathamhouse.org Published On :: Tue, 09 Aug 2022 09:56:27 +0000 America's abortion ban will hurt women everywhere The World Today mhiggins.drupal 9 August 2022 In the final part of a series on the impact of the Roe v Wade ruling, Nina van der Mark assesses the global impact of America’s reverse on reproductive rights. In overturning the constitutional right to an abortion established by Roe v Wade, the Supreme Court of the United States placed the US alongside Poland, El Salvador and Nicaragua as countries that have restricted access to abortion in recent decades. While the Dobbs ruling is a domestic reversal, the US remains the largest funder of global health, family planning and reproductive health services. There is a lot at stake for women and girls around the world. Here are four potential global impacts to consider. Millions of women will be at greater risk The Guttmacher Institute, a research and policy organization that aims to improve sexual and reproductive health worldwide, calculated that in 2021 American international family planning assistance saw an estimated 27.2 million women and couples receive contraceptive services, some 12 million pregnancies averted, four million unsafe abortions prevented and 19,000 maternal deaths avoided. These outcomes help to improve gender equity as well as increase women’s education and employment opportunities and boost economic growth. This happens despite US funding for international family planning being in decline over the past decade. It peaked during the Obama administration at $715 million in 2010 but since 2017 averaged about $607 million a year. Using US aid to directly fund abortions as a method of family planning is prohibited under the terms of the Helms Amendment of 1973. In America, the Dobbs ruling has so far led 14 Republican-controlled states to enact anti-abortion legislation. This, in turn, has motivated pro-choice campaigners – on August 2, a referendum in the staunchly conservative state of Kansas returned a decisive vote to preserve abortion rights. That result gives hope to abortion-rights groups that the issue will cut across traditional political loyalties and bring swing voters to their cause in the mid-term congressional elections in November. That is important because Congress decides on the level of funding for America’s global health programmes, including family planning and reproductive health. The stakes are high. For instance, Kenya, Nigeria and Ethiopia, with a combined population of more than 370 million, are among the top 10 recipients of US Overseas Development Assistance, most of which goes to health programmes. Nigeria, for instance, received $794 million in such funding from America in 2019-2020. A sudden policy reversal affecting funding for reproductive health would lead to clinic closures, reduced access to help and shortages of essential family planning commodities. The result would be more unintended pregnancies, more unsafe abortions and a potential increase in maternal mortality. Women will have more unsafe abortions The Helms Amendment, which prevents recipients of American aid directly funding abortion services, was passed by Congress in 1973 following the Roe v Wade decision. The Global Gag Rule, first enacted by Ronald Reagan in 1984, goes further, forbidding NGOs abroad in receipt of American aid from promoting or counselling abortion as a form of family planning, even when using their own funds. Since its introduction, Republican administrations have enforced the rule while Democratic administrations have rescinded it, as Biden did in January 2021. Restricting access to safe abortion services increases the number of unsafe abortions, whereas legalizing abortion services reduces them. During the Bush administration, the Global Gag Rule prompted a 12-per-cent increase in pregnancies in rural Ghana, which led to an additional 200,000 abortions. Another study found a substantial increase in abortions, a decline in contraceptive use and an increase in pregnancies in 26 countries in sub-Saharan Africa affected by the rule across three US administrations. It’s estimated that 77 per cent of abortions in the region are unsafe. In 2019 that translated into 6.2 million unsafe abortions. The failure of America to consistently support safe abortion services contributes to the more than 35 million unsafe abortions that take place each year across 132 lower middle-income countries. Under the Trump administration, the Global Gag Rule was extended from family planning funding to cover all US global health assistance, increasing the level of US funding affected from around $600 million to $8.8 billion. Were a Republican administration to be elected in 2024 there is little doubt the rule would be reinstated, possibly in the most restrictive form that Trump enforced. Anti-abortion movements will double their efforts The repeal of Roe v Wade has not occurred in a silo, nor are its effects contained within the US. News of the Dobbs ruling, which overturned Roe v Wade, prompted One of Us, a European anti-abortion platform, to mount an immediate, 20,000-strong anti-abortion demonstration in Spain, including leaders of the conservative Vox party. On Twitter, Sara Larin, an anti-abortion activist from El Salvador, likened the Dobbs ruling to the abolition of slavery in the US, calling it ‘the beginning of the end for abortion [worldwide]’. Countries have based their legal protections for abortion access on Roe v Wade or cited it in their case law, which now opens them up to legal challenge domestically. A Christian anti-abortion group in Kenya is legally challenging a pro-choice ruling based on Roe v Wade. Such challenges may increase: anti-choice groups in Mexico and Peru cited the Dobbs ruling as an encouraging development. An offshoot of the American Center for Law and Justice contributed to the legal case that helped overturn abortion rights in Poland Many American Christian right-wing groups fund anti-abortion activities abroad. OpenDemocracy, an independent global media platform, recently reported that 28 Christian right-wing organizations spent more than $280 million internationally between 2007-2018 on anti-choice activities, targeting Europe primarily, followed by Africa and Asia. The American right is not afraid to take direct legal action abroad either. The European Center for Law and Justice, an offshoot of the Trump-backed American Center for Law and Justice, has made interventions in dozens of court cases on sexual and reproductive health and rights in the European Court, including in the case that overturned abortion rights in Poland. The European parliament in its most recent motion on the topic expressed concern about the potential for the Dobbs ruling to prompt a surge in the flow of money to anti-choice groups around the world. America’s global standing will take a hit The Dobbs ruling immediately attracted criticism from many world leaders. ‘Watching the removal of a woman’s fundamental right to make decisions over their own body is incredibly upsetting,’ said Jacinda Ardern, the New Zealand prime minister. ‘To see that principle now lost in the United States feels like a loss for women everywhere.’ President Emmanuel Macron of France tweeted: ‘I wish to express my solidarity with the women whose liberties are being undermined by the Supreme Court of the United States.’ Javier Milei, a potential candidate in Argentina’s presidential election, welcomed the Dobbs ruling The ruling is in conspicuous opposition to the Biden administration’s more progressive stance on sexual and reproductive health and rights and its advocacy abroad. It sends a clear message from the world’s most powerful democracy that these rights are not guaranteed. While many world leaders reacted to the Dobbs ruling with dismay, other senior figures from the conservative right welcomed it, including the Brazilian President Jair Bolsonaro’s son, Eduardo, and Javier Milei, a potential candidate in Argentina’s presidential election next year. In 2020, the Trump administration co-sponsored the ‘Geneva Consensus Declaration on Promoting Women’s Health and Strengthening the Family,’ declaring that there was ‘no international right to abortion.’ It was signed by more than 30 countries, including autocratic and right-wing governments in Brazil, Poland, Hungary and Saudi Arabia. The Biden administration withdrew from it – but its signatories are the governments who may yet take advantage of America’s self-inflicted erosion of authority on reproductive rights. The Dobbs ruling exposes the limitation of the American executive to act within the US legal system while opening up questions on American support of, and dedication to, fundamental rights. Read the other two articles in this series: ‘Empowering women aids climate resilience’ and ‘Counting the cost of the abortion ban’ Full Article
i Russia's war: How will it shape the region's future? By www.chathamhouse.org Published On :: Wed, 17 Aug 2022 08:27:13 +0000 Russia's war: How will it shape the region's future? 1 December 2022 — 9:00AM TO 6:00PM Anonymous (not verified) 17 August 2022 Chatham House and Online This conference takes a deep-dive into the implications of the war for the wider region. You will receive an email in advance of the conference with further details on accessing the event. The video on this page is of the opening session only. To view all the session videos, please visit the conference playlist on YouTube. How will Russia’s war shape the region’s future? Russia’s latest invasion of Ukraine is on such a scale that it will have a seismic effect on all the countries that once formed the Soviet empire. Vladimir Putin’s decisions have accelerated trends across the region leading to unintended consequences. Now it is more crucial than ever – not only for those concerned with the region’s economic and democratic development, but for all those with a stake in the future security of Europe. For some states, this will mean a faster break from the legacy of the USSR and from Russia’s ‘Geopathological embrace‘ while, for others, maybe even a fresh start at democracy and good governance. In isolated cases, the war will conceivably hasten assimilation with Russia. But the two principal combatants, Ukraine and Russia, will diverge even further. Ukraine, though fighting for its survival now, will at least get the opportunity to ‘build back better’ if it achieves some form of victory. Whatever the course of the war, however, Russia’s aspirations to be a global power again are doomed as it is gradually deglobalized from Western structures. This conference analyses: How Russia’s war will affect the broader regional economy and whether this will hasten Vladimir Putin’s exit What to hope for, what to fear and the key trends that will dominate the region going forward. Unique expertise in an independent forum on what’s at stake for Europe. Full Article
i Gorbachev's complex legacy is beyond the popular belief By www.chathamhouse.org Published On :: Sat, 03 Sep 2022 09:45:59 +0000 Gorbachev's complex legacy is beyond the popular belief Expert comment NCapeling 3 September 2022 The last major figure with a decisive Cold War role, Mikhail Gorbachev was not as bad as Putin’s Russia portrays him, but also not as heroic as the West thinks. Arguably the worst year of the Cold War since the Cuban Missile Crisis was 1983, with three major incidents which escalated East-West tensions – and any one of them could have led to a full-scale war. The first was the Korean Airline KAL007 being shot down by an SU15 fighter aircraft for straying into Soviet airspace, killing all 269 passengers and crew. Then came the identification of signals from Soviet satellites as being incoming US intercontinental ballistic missiles – Colonel Stanislav Petrov, going against all protocols, thankfully decided to report them as a false alarm before he could be sure. The third was perhaps the most dangerous, being the misinterpretation of a live-fire NATO exercise which was believed by some in both East Germany and Russia to be a front for an imminent attack. The greatest disappointment in Gorbachev’s legacy was he completely believed the USSR could be reformed and still survive as an entity while others, such as Boris Yeltsin and Ronald Reagan, understood it had to be dismantled All three incidents occurred in the few months following the infamous March 1983 ‘Star Wars’ speech by US president Ronald Reagan, in which he talked about nuclear arms control and laid out the US case for a ballistic missile defence programme. At that time Mikhail Sergeyevich Gorbachev was the youngest serving member of the USSR Politburo, known to be a favourite of Soviet leader Yuri Andropov, and it is highly likely he had been aware of these close calls and was part of discussions within Kremlin decision-making circles. A changemaker both inside and outside the USSR Following the deaths of Andropov in 1984 and his replacement Konstantin Chernenko in 1985, Gorbachev’s appointment as general secretary of the Communist Party saw him immediately begin to change the Soviet Union from within – and also change relationships with the major Western powers, especially the US, Germany, and the UK. His policies of glasnost (openness) and perestroika (restructuring) were primarily aimed at internal reforms but translated into a major reset of international relations and international security. During his six years as leader, Gorbachev initiated many arms control negotiations which resulted in treaties and increased both the transparency and the confidence between the USSR and the US. These included the 1986 Stockholm Accord which emanated from the Helsinki Process and allowed for the observation and inspection of large-scale military exercises, the 1985 resumption of the Strategic Arms Reduction Talks which lead to START I, and the 1987 INF Treaty in which the USSR ‘out-yessed’ the US – the most open and transparent disarmament treaty in terms of notification and verification measures ever agreed. There was also a reciprocal moratorium on nuclear weapons tests starting from 1985 – which laid the groundwork for the 1996 CTBT – the 1991 Chemical Weapons Convention, and the 1990 Conventional Forces in Europe (CFE) Treaty. The most dramatic moment of all was when Gorbachev and Reagan met at a summit in Reykjavik and came close to deciding to eliminate nuclear weapons – but the initiative failed to reach agreement, mainly because Reagan could not drop his commitment to ballistic missile defences and Gorbachev could not accept the offer of joint development. Nonetheless, all these nuclear arms control treaties led the way for their descendants which have kept nuclear weapons in check ever since and are still in place in the form of the New START agreement. During his six years as leader, Gorbachev initiated many arms control negotiations which resulted in treaties and increased both the transparency and the confidence between the USSR and the US But despite these outstanding achievements, Gorbachev had blind spots – such as enabling rather than destroying the USSR bioweapons programme, unlike the US which had dismantled its own bioweapons offensive capability by 1973. And it is now known that, despite negotiating the Chemical Weapons Convention, Russia withheld information on new chemical weapons agents – Novichoks – which have since been used to lethal effect by Russia in Salisbury and against figures opposing the current regime. His misguided faith in a Soviet future Gorbachev was markedly different to his predecessors as secretary general. He was neither as decrepit nor as hardline, and he understood from the outset that the Soviet Union was, by the 1980s, finally dying. Using the intellectual abilities of Aleksandr Yakovlev, he forced through the reforms which simultaneously captured the imagination of the free world and liberated his countrymen and women. But although he built solid relationships – even friendships – with the world’s major heads of state and improved the USSR’s human rights, releasing dissidents such as Andrei Sakharov, but many – especially Ukrainian dissidents – continued to languish in camps. The greatest disappointment in Gorbachev’s legacy was he completely believed the USSR could be reformed and still survive as an entity while others, such as Boris Yeltsin and Ronald Reagan, understood it had to be dismantled. This shortcoming is especially uncomfortable as today’s Russia continues to insist it has a given right to control other former Soviet states, to the extent it is willing to destroy them if they do not concede. Full Article
i Central and Eastern Europe become hawkish on China By www.chathamhouse.org Published On :: Fri, 16 Sep 2022 18:14:53 +0000 Central and Eastern Europe become hawkish on China Expert comment LJefferson 16 September 2022 The recent withdrawal of the Baltic countries from the ‘17+1’ format displays changing perceptions of China due to its ambiguity towards the war in Ukraine. While the Russian invasion of Ukraine only confirmed Central and Eastern Europe’s views of Russia, it is also affecting their relations with China. Although the relationship was already complicated due to unfulfilled Chinese economic promises to CEE countries and growing indications of efforts to influence their domestic politics, China’s support for Russia is pushing Central and Eastern Europeans even further away. This shift was highlighted, and formalized, recently by several countries in the region leaving the ‘17+1’ format, through which China cooperates with a group of countries from the region. The shifting attitudes towards China will also influence the relationship between the European Union as a whole and China. A Trojan Horse that never was When the format was launched in 2012 between 16 CEE countries at the time and China, the countries jumping on board expected a wave of Chinese investment and an opportunity to diversify mostly west-bound trade. These hopes never fully materialized as Chinese foreign direct investment (FDI) in CEE has been generally lower compared to the rest of Europe and China never became an important export destination for any of the countries. The growing disillusionment and concern about Chinese security threats has led to some of the countries speaking up about the perceived perils of closer cooperation. The first to withdraw from what had become ‘17+1’ by 2021 was Lithuania, which also took an interest in strengthening ties with Taiwan and allowed it to open a Taiwanese representative office in Vilnius. This triggered a breakdown in the bilateral relations with China. As a retaliatory response, China blocked Lithuanian imports and imports from other EU states containing inputs from Lithuania, leading the EU to launch an official dispute at the WTO. War in Ukraine Since the invasion started, CEE countries have been dealing with large numbers of Ukrainian refugees, organizing shipments of military equipment to Ukraine, and at the same time worrying whether they could be next on Russia’s list. However, the concerns and security environment that these countries face seems to be almost entirely disregarded by China. On the sidelines of the 2022 Winter Olympics in Beijing, Xi and Putin signed the joint communiqué in which China backed Moscow’s demands to reverse NATO borders to the pre-1997 situation, completely disregarding CEE’s security interests. Since the invasion started, CEE countries have been dealing with large numbers of Ukrainian refugees, organizing shipments of military equipment to Ukraine, and at the same time worrying whether they could be next on Russia’s list. China’s implicit support for Russia after the invasion has sowed deep mistrust of its respect for the sovereignty of other nations. The Chinese diplomatic apparatus clearly noticed this changing mood among CEE governments and sent a special envoy to eight capitals in April-May tasked with ‘eliminating misunderstandings regarding Russia-Ukraine conflict’. However, the trip was not particularly successful. The delegation failed to secure high-level meetings, with the most prominent case being the Polish minister of foreign affairs declining to meet Huo Yuzhen, the Chinese Special Councilor for CEEC cooperation. Given that Andrzej Duda, President of Poland, was the only head of an EU state who attended the Beijing Olympics opening ceremony just before the Russian invasion in February, the change in attitudes is clear. Following the envoy’s visit to the Czech Republic, the Czech parliament’s foreign affairs committee unanimously approved a resolution calling for the country to quit the ‘16+1’ format and the government is expected to act upon it in the near future. Meanwhile, Latvia and Estonia recently jointly announced that they would no longer be participating in the cooperation framework, turning it into ‘14+1’. Full Article
i Issues to watch in 2023 By www.chathamhouse.org Published On :: Tue, 29 Nov 2022 16:34:32 +0000 Issues to watch in 2023 The World Today mhiggins.drupal 29 November 2022 From nuclear proliferation to African debt, here are the issues six of our expert contributors expect to make the news in the year ahead. Europe’s energy outlook Mike Bradshaw, Professor of Global Energy, Warwick Business School There is cautious optimism that Europe will endure this winter without an energy crisis. Gas prices have fallen, storage is 95 per cent full, and the autumn was mild. High summer gas prices cut industrial demand but domestic heating demand will be critical over the winter. Already, France’s problematic nuclear fleet and lower hydroelectric output mean Europe is using more gas to generate power. The problem is next winter when ensuring adequate gas storage will be much harder Russian pipeline gas supply to southern Europe has fallen by 55 per cent. While Asian demand has fallen, Europe has still paid record prices to secure additional liquefied natural gas (LNG), largely from America but also Russia. European demand for LNG this winter will push prices up, and these will rise even higher if China relaxes its Zero-Covid policy and demand recovers. However, with luck, Europe will avoid power cuts in early 2023. The problem is next winter. With less Russian pipeline gas and a tight LNG market, 90 per cent winter gas storage levels will be much harder to achieve. NATO’s resurgence Alice Billon-Galland, Research Fellow, Europe Programme, Chatham House and one of 14 NATO Young Leaders In response to Russia’s invasion of Ukraine, NATO adopted a new strategic concept. Member states will reinforce NATO battlegroups and bolster higher readiness forces from 40,000 troops to more than 300,000, while striving to avoid escalation with Russia. Turkey’s attempts to block Sweden and Finland’s NATO membership will preoccupy Jens Stoltenberg, the Secretary-General, until he leaves his post next autumn. Infrastructure vulnerabilities such as the sabotaged Nord Stream pipeline will be a NATO focus Expect arguments on defence spending in the run-up to the July summit in Vilnius. Although only nine of its 30 members are expected to meet the 2 per cent spending target, the debate is moving towards 3 per cent, in part to reduce dependency on American assets and hedge against the uncertainty of the 2024 US presidential election. Infrastructure vulnerabilities, such as the Nord Stream pipeline sabotage in the Baltic, will also be a focus. Otherwise, NATO ’s eyes will be on China: from its relations with Russia to the threat of cyberattacks. Universal health reforms Robert Yates, Executive Director, Centre for Universal Health, Chatham House In response to the perma-crisis experienced by many populations this past year, some leaders are launching or extending universal health reforms. New left-wing leaders in Chile, Colombia and Brazil have promised to rebuild their publicly financed universal health systems. In Brazil, newly elected president Lula da Silva has pledged to increase public health spending and improve access to medicines. It is hoped Malaysia’s new coalition will carry forward its predecessor’s pledge to raise health spending to 5 per cent of GDP by 2027 to provide a universal package of free health services. Might a US presidential candidate propose a publicly financed health system? In September, world leaders will discuss universal health coverage at the UN General Assembly. There, Chatham House will publish its Commission for Universal Health report, identifying countries in which crises may trigger new national health programmes. Might this be when a US presidential candidate announces a platform to create a publicly financed health system? Weapons of mass destruction Patricia Lewis, Director of the International Security Programme, Chatham House Since its illegal invasion of Ukraine, Russia has attacked civil nuclear power stations, falsely accused Ukraine of possessing bioweapons and radiological bombs, and threatened to use nuclear weapons. In contrast, NATO has instead demonstrated that deterrence can be highly effective with conventional weaponry. In the coming year, the Kremlin’s nuclear brinkmanship will still be a focus. Washington will try to restart bilateral nuclear negotiations with Moscow and similarly try to engage Beijing. North Korea’s nuclear weapons programme is a growing threat Following the failure of the nuclear Non-Proliferation Treaty Review Conference to reach consensus in August, the next review cycle will start by looking at strengthening the process. Iran’s nuclear capabilities remain a concern, and North Korea’s nuclear weapons programme is a growing threat. So, we are left with a question: will 2023 be the year of nuclear conflict or the year when states get busy again on non-proliferation and disarmament? Africa’s mounting debt Joseph Asunka, Chief Executive Officer, Afrobarometer Inflation is at historic highs in several African economies. Meanwhile, many African countries including Nigeria, Zimbabwe and Democratic Republic of Congo will hold elections in 2023, driving up public spending, increasing inflationary pressures and exacerbating poverty. According to Afrobarometer data, the proportion of Africans experiencing high levels of poverty has increased from 19 per cent in 2014/2015 to 26 per cent in 2021/2022. Zimbabwe is in debt distress and Nigeria is at risk, which makes their elections in 2023 critical Worse still, many of those countries holding elections are either, like Zimbabwe, in debt distress – that is unable to honour their obligations to creditors – or at high risk of debt distress, like Nigeria. This makes the elections in Zimbabwe and Nigeria critical. The expiration of the World Bank/IMF-backed debt service suspension initiative in 2021 has only amplified this risk. What are viable policy options to tackle this dire economic predicament? A debt service moratorium, debt cancellation and serious attention to fiscal discipline. Feminist foreign policy Daniela Philipson García, Co-founder of Internacional Feminista, and a PhD candidate, Monash University Feminist Foreign Policy (FFP) is under threat. The war in Ukraine led to strengthened military budgets and alliances at odds with FFP’s human security and peace-centred approaches. Sweden’s new right-wing government reversed its FFP. In Mexico, the first Global South country to adopt an FFP, Congress has voted to expand the military’s role to curb cartel-related violence, in contradiction of its FFP. The second anniversary of the US withdrawal from Afghanistan will be a moment to assess how foreign policy, diplomacy and women’s and girls’ rights have been affected globally. Colombia has announced a feminist foreign policy along with a National Action Plan on Women, Peace and Security There is hope. Germany, whose coalition government adopted an FFP in 2021, is to publish more guidelines in the spring. The governments of Colombia and Chile have announced their own FFPs. Colombia’s first National Action Plan on Women, Peace and Security, to be announced at the UN General Assembly in September, is expected to set a standard for a region submerged in violence. Full Article
i Russian imperial mindset must change for real victory By www.chathamhouse.org Published On :: Thu, 08 Dec 2022 09:47:14 +0000 Russian imperial mindset must change for real victory Expert comment NCapeling 8 December 2022 The attitude of Russia’s elite – and wider population – to the states which used to constitute the USSR needs to change in order to solve the Russia challenge. Although the reverberations of Russia’s invasion of Ukraine clearly stretch around the globe, the strongest shocks are – and will continue to be – felt by those countries Moscow used to directly rule. These countries struggle to shrug off a Soviet legacy as, to varying degrees – linguistically, technologically, culturally, and politically – they bear psychological and physical scars of Russia’s colonial past and its present mentality. It does not help that these countries lack an appropriate collective descriptor. Over the years there has been ‘Newly Independent States’ – hardly appropriate after 31 years – the now-defunct ‘Commonwealth of Independent States’, the ‘post-Soviet space’ and ‘Former Soviet Union’ which both reference the past, and simply ‘Eurasia’ which is hardly appropriate for either Ukraine or Turkmenistan. Some of these former ‘colonies’ are as badly governed and as sinister – albeit not as lethal beyond their borders – as Russia itself. Others, most notably the Baltic states, are modern, liberal, affluent societies, but Moscow’s shadow still looms. There is a strong mindset in most of Russia’s citizens that, because that it used to rule these other countries, it either still has privileged rights over them or they are not real countries at all – but instead historical aberrations to be extinguished. What is past is gone As historian Timothy Snyder has noted, whatever the wrongs of Putin’s ‘history-based’ assertions about the ‘return of historic lands’, all historical claims are bunkum anyway. If the past brings validity, almost no land border on earth would be beyond dispute. It is agreements which count, and Russia signed away the other successor states in 1991. There is a strong mindset in most of Russia’s citizens that, because that it used to rule these other countries, it either still has privileged rights over them or they are not real countries at all The Russia and Eurasia programme at Chatham House has, for the last 31 years, always taken as a starting position that these countries are as sovereign as any other. This of course this means they can choose to be in Russia’s embrace if they wish. But none do because Russia is insufficiently attractive. Some have better relationships with Moscow than others – mainly the more autocratic ones – but no former slave goes back to their master willingly. At the recent Chatham House conference Russia’s war: How will it shape the region’s future? (note the avoidance of a specific descriptor), the overwhelming consensus was that Russia must lose, that Ukraine must be reconstructed and planning for that must start now, and that the regional economy is convulsing. But another key view was that, in Russia, rent seeking and buying loyalty are likely to lead to the separation of the Russian people and the regime, especially as the population ages and young men being sent to die at the front. Putin may still be popular in some places in Russia, but not in others – although popularity can rise and fall fast in Russia. However, few at the conference foresaw the disintegration of Russia any time soon. With continued skill, determination, and more weaponry, Ukraine may well vanquish Russia on the battlefield, and this remains a necessary pre-requisite for European security. But even a Ukraine victory will not erase malign intent. Getting Russians to look upon their neighbours as equals requires widescale self-reassessment in a post-Putin Russia The Russian imperial itch is so deeply embedded, it must be excised not just from Russian capability but from the intention and mindset of elites and in the popular imagination. That is hard to achieve when so many believe in it as fervently as a religion – even the Russian Orthodox Church invokes a messianism in Russia’s imperial ‘rights’. The wider region is suffering Getting Russians to look upon their neighbours as equals requires widescale self-reassessment in a post-Putin Russia. But, for now, the wider region will surely be looking to simply neuter Russia’s destructive capacities. Full Article
i Why the UK must deliver on Nordic-Baltic security By www.chathamhouse.org Published On :: Fri, 16 Dec 2022 12:02:39 +0000 Why the UK must deliver on Nordic-Baltic security Expert comment NCapeling 16 December 2022 Hard choices are needed but it is crucial the UK provides security and leadership to its European partners given the wider context of the war in Ukraine. The UK’s role in Nordic-Baltic security has been growing over the past decade. The region is key to core British strategic interest and engagement, and UK threat assessment closely aligns with long-held regional perspectives – the 2021 Integrated Review defines Russia as ‘the most acute threat to our security’. Since Russia’s invasion of Ukraine, the UK’s strong stance towards Moscow and the concrete steps taken to assist Ukraine and strengthen defence and deterrence on NATO’s eastern flank have been widely appreciated in the Nordic-Baltic region. The UK is seen as a reliable partner but, for it to continue to deliver in the region, difficult choices must be made with regards to UK defence spending and military capabilities, and London’s more global ambitions. The UK is a major contributor to NATO’s deterrence posture on the eastern flank, serving as a framework nation for NATO’s Enhanced Forward Presence (EFP) battlegroup in Estonia, and contributing to another battlegroup in Poland. UK remains crucial to regional security Coupled with its contribution to NATO’s Baltic Air Policing mission and maritime forces in the area, the UK is a crucial security partner both in the region and in a broader arch across Europe. The UK offers military capability, strong political will, a long-standing tradition of engagement in the Nordic-Baltic area, and fast decision-making Over the past decade and a half, the UK has been developing a dense network of bilateral and minilateral relations in the region which are major assets in the current security environment. It leads the Joint Expeditionary Force (JEF) which is a military cooperation format highly valued for its flexibility in responding to the needs of the participating nations – including non-NATO Sweden and Finland – and is increasingly focused on the North Atlantic, High North and wider Baltic areas. The UK has also seen increased bilateral defence cooperation with Norway, Denmark, Estonia, and other regional allies and partners. There are reasonable expectations that Germany or France may at some point assume a greater role in this part of Europe, building on France’s participation in the EFP in Estonia, and Germany’s lead of the EFP in Lithuania. However, while Paris remains more focused on NATO’s southern (and south-eastern) flank and building the European Union’s defence role, Berlin often underperforms as a leading or an organizing power of collaborative efforts across Europe. Both also have a credibility problem in the Nordic-Baltic region due to their past policies towards Russia that occasionally reappear when discussing military support to Ukraine or how to treat Russia in the post-war European security order. By contrast, the UK offers military capability, strong political will, a long-standing tradition of engagement in the Nordic-Baltic area, and fast decision-making. The latter is exemplified by the bilateral security guarantees provided to Sweden and Finland during their accession to NATO, and the surge of assets sent to the region in the wake of Russia’s full-scale invasion of Ukraine such as an additional battlegroup and Chinook helicopters to Estonia, as well as forward-deployed elements of the Standing Joint Force Headquarters to Latvia and Lithuania as part of the JEF. Such pragmatic and resolute engagement help substantiate the UK’s post-Brexit claim that although it left the EU, it did not leave Europe. London also understands and facilitates the pivotal role that the US plays in European security – a shared perspective with the Nordic-Baltic partners. Only the US – which has just recently decided to step up its military presence in the Baltics – has a greater appeal than the UK as a major ally. But Washington’s truly global responsibilities make it more difficult for it to play a regional leadership role. With the context of the war in Ukraine, the centre of gravity of European security is moving east. The Nordic-Baltic region is likely to feature more prominently in the upcoming refresh of the UK’s Integrated Review, as the war in Ukraine and NATO’s new forward defence approach will focus UK attention and military capabilities on Europe for the foreseeable future. But the UK still has limited resources and, despite the worsening security environment, there is currently no commitment by the Rishi Sunak government to increase defence spending beyond two per cent of GDP, as set out in the recently-published Autumn Statement. This difficult fiscal reality contrasts UK ambition to also increase its footprint and engagement in the Indo-Pacific, a region highlighted by Rishi Sunak in his first foreign policy speech. London is already confronted with increasing expectations from its Nordic and Baltic partners, which are rattled by Russia’s aggression and seek more engagement and commitments from larger and more resourceful allies, and are insisting on prompt implementation of NATO’s new defence and deterrence plans. This all comes on top of the resources that further assistance to Ukraine will require in the coming months and years. Balancing competing priorities and demands from partners is routine for a major power with global ambition but, in the current context, if the UK government fails to prioritize and increase resources, over-extension is in sight for its armed forces. The war in Ukraine confirms that, beyond the rhetoric around the ‘Indo-Pacific tilt’, the Euro-Atlantic is – and will remain – the priority theatre of engagement for the UK. To keep delivering in the Nordic-Baltic region and remain a reliable partner, UK ambitions should be set clearly, and expectations managed with regional partners. A good example is the recent UK-Estonia joint statement and defence roadmap, which is an attempt to reconcile London’s vision of modern deterrence with Tallinn’s preference for ‘more boots on the ground’. The UK gains many benefits from deepening and widening its engagement in the Nordic-Baltic region, and not only by showcasing its regional leadership at a time of dire need or having more weight in Europe and across the Atlantic The joint statement also clarifies initial misunderstandings regarding the upcoming withdrawal of the second UK battlegroup deployed to Estonia in the wake of Russia’s invasion of Ukraine – support Tallinn expected to continue ‘as long as necessary’ but London saw as temporary. It offsets the poor political ‘optics’ of the withdrawal while providing solid ground for deepening the common agenda in the near future. By the 2023 NATO summit in Vilnius, progress on implementing the roadmap will be a crucial measure of success for the bilateral relationship, and for the UK’s broader regional role. It should serve as an opportunity for the UK to reflect on its force development priorities and balance, with Baltic partners arguing in favour of the UK rebuilding some mass in its armed forces and providing more resources to the land component. Much to gain for the UK The UK gains many benefits from deepening and widening its engagement in the Nordic-Baltic region, and not only by showcasing its regional leadership at a time of dire need or having more weight in Europe and across the Atlantic in strategic debates about future security architecture. Full Article
i Culture notes: Will the EU find its voice at last? By www.chathamhouse.org Published On :: Mon, 30 Jan 2023 13:09:06 +0000 Culture notes: Will the EU find its voice at last? The World Today mhiggins.drupal 30 January 2023 Russia’s invasion of Ukraine has galvanized the bloc, but doubt remains about how it can capitalize on this moment, writes Catherine Fieschi. Despite its reticence to believe that Russia would attack Ukraine, once Vladimir Putin’s tanks rolled across the Donbas, the European Union finally grasped the momentous nature of the events unfolding on its eastern flank. The immediate reaction of Europe’s member states was one of unity, resolve and uncharacteristically rapid decision-making, at least on sanctions and energy policy. That they would need to act in concert across a concatenation of crises that would be either triggered (energy), worsened (inflation) or heightened (geopolitical instability) by Putin’s move was obvious. And so, Europe’s collective narrative of this past year slid into place, and it goes something like this: We gave Russia the benefit of every doubt, including after their invasion of Crimea when we still tried to bring them back to the negotiating table, but Putin has made the fundamental choice of turning away from democracy and the rule of law. Europe had long been in need of an arc to follow Now, the narrative goes on, we have to treat them as enemies and give ourselves the means to become resilient in the face of aggression as Ukraine is all that stands – both symbolically and geographically – between us and the chaos of a Europe-wide war. Like any good narrative, it is anchored in previous trials and exploits. Having learnt from its failure to coordinate action during the eurozone crisis and then the migration crisis, Europe was keen to make the most of its resilience in the face of the Covid pandemic in the form of the joint vaccine purchases and a massive recovery plan. The Russian invasion of Ukraine is an added – albeit dramatic and costly – opportunity to pursue further collective action and discover the next chapter of its shared purpose, as a political and perhaps even a defence alliance. Europe had long been in need of an arc to follow. In the aftermath of the Second World War, peace and prosperity seemed enough. But the new multipolar world that emerged from the ashes of the Cold War and then 9/11 were more difficult to navigate for a largely commercial and regulatory alliance. Could the EU, then, ever find its political voice? David vs Goliath While Brexit and Covid created rallying points, the shock and tragedy of the invasion delivered everything the EU needed in narrative terms: a David and Goliath story, with the opportunity to feature on Team David in European terms while allying with the United States, and a ‘band of brothers’ element to shore up a union bruised by the defection of a key but troubled member. Above all, the appearance of an arch-villain in the form of Vladimir Putin put Europe back into the familiar and mythical territory of the 1940s and then the Cold War. When on May 28, 2016, Putin seated himself on the throne of the Byzantine emperors in Mount Athos’ Protaton Church in Greece in a scene truly worthy of Game of Thrones, the writing should have been on the wall. That day he explicitly laid out his aim to appoint himself as the new Eastern emperor who would fight the decadence of the West. ‘Today,’ Putin told the world, ‘we restore the values of patriotism, historical memory and traditional culture.’ Later, he cited Ukraine as the biggest unfinished mission of his years in power. That Europe – and Germany in particular – had taken so long to decipher Putin’s dark designs only adds to the narrative’s epic quality, positioning Europe as a victim of its own good faith and open heart. Cracks in the narrative But the narrative is not free from cracks. The Baltic states would argue that they had long warned of Putin’s nefarious intentions; and Poland has always been convinced of the threat posed by its neighbour. Full Article
i In conversation with Edi Rama, prime minister of Albania By www.chathamhouse.org Published On :: Mon, 13 Mar 2023 17:22:14 +0000 In conversation with Edi Rama, prime minister of Albania 23 March 2023 — 5:30PM TO 6:30PM Anonymous (not verified) 13 March 2023 Chatham House and Online From migration to Russia and China, how is Albania responding to the geopolitical challenges of today? In late 2022, the UK government made a pointed remark that many of the illegal migrants attempting to get into the country were from Albania. In response, Albania prime minister Edi Rama replied that targeting Albanians as the cause of Britain’s crime and border problems ‘makes for easy rhetoric but ignores hard fact’. This nuanced response demonstrated the challenges and complexities that Albania faces, the same as many other countries. As well as being embroiled in the major challenge of international migration, Albania has suffered from a serious cyber-attack in July 2022 from Iran. Government networks were compromised for a month with Tirana removing the Iranian embassy in the capital. Then there is the ongoing threat from Russia and China. Nestled in the already volatile Balkans, Albania has been at the heart of international affairs in recent months. Prime Minister Rama speaks at Chatham House to discuss: How is Albania responding to Russian aggression and what is its stance on Ukraine? Where does Tirana believe China poses the most serious threat? How can countries in Europe best respond to illegal migration and better control the flow of people? How is the region of the Western Balkans effected by the war in Ukraine and how can it contribute to the security challenges posed by the war? As with all member events, questions from the audience drive the conversation. Full Article
i How Russia’s war affects politics in southeast Europe By www.chathamhouse.org Published On :: Fri, 24 Mar 2023 11:42:13 +0000 How Russia’s war affects politics in southeast Europe 4 April 2023 — 11:00AM TO 12:00PM Anonymous (not verified) 24 March 2023 Online This event will discuss how the war on Ukraine has affected southeastern Europe. This event will discuss how the war on Ukraine has affected southeastern Europe. How have the governments and publics responded to the war? The panel will discuss Russia’s goals and leverage in the region, including the impact of its disinformation campaigns. Are the governments reassessing their foreign policy options? The granting of EU candidate status to Ukraine and Moldova has brought attention to the stalled accession process in the Western Balkans. What lessons from the Western Balkans can be applied in Ukraine and Moldova? Have new linkages emerged between the two regions? Full Article
i Review: Rediscovering Milan Kundera’s European tragedy By www.chathamhouse.org Published On :: Tue, 28 Mar 2023 11:47:01 +0000 Review: Rediscovering Milan Kundera’s European tragedy The World Today mhiggins.drupal 28 March 2023 The Czech writer’s 40-year-old essay on the roots of Russia’s empire-building, ‘A Kidnapped West’, reads all too presciently, writes Stefan Auer. A Kidnapped West: The Tragedy of Central EuropeMilan Kundera, Faber, £10 ‘In November 1956, the director of the Hungarian News Agency, shortly before his office was flattened by artillery fire, sent a telex to the entire world with a desperate message announcing that the Russian attack against Budapest had begun. The dispatch ended with these words: “We are going to die for Hungary and for Europe.”’ Thus, Milan Kundera began his 1983 essay for the French journal Le Débat, reflecting on the 1956 Hungarian Uprising. A seminal essay The Czech author might well have written a near-identical passage about the fraught hours immediately after Russia’s invasion of Ukraine in 2022. In the event, Russian tanks failed to occupy Kyiv, unlike Budapest in 1956. Nevertheless, Faber has chosen this moment, 40 years later, to republish Kundera’s seminal essay on Europe and Russian aggression in its original translation for the New York Review of Books by Edmund White. How salient are its observations today? Thanks to the Cold War, the countries of Central Europe were denied their true destiny, Kundera thought, in the democratic West The essay’s original French title, ‘Un Occident kidnappé ou la tragédie de l’Europe centrale’ (The Kidnapped West, or the Tragedy of Central Europe), described the fate of Hungary, Czechoslovakia in 1968 and, to an extent, Poland in 1980-81 at the hands of the Soviet Union. Owing to the Cold War division of Europe, the countries of Central Europe were denied their true destiny, Kundera thought, to be an integral part of the liberal, democratic West. Kundera himself fled Czechoslovakia for France in 1975. The author of The Unbearable Lightness of Being might no longer be as well-known as he was at the height of his fame in the 1980s, but his novels and essays still deserve attention. So, it is pleasing to see Kundera’s masterpiece republished, even as it is awful to witness the enduring relevance of the questions it raises. What did the Hungarian journalist mean when he declared his willingness to die for Europe, Kundera asked? That ‘Russians, in attacking Hungary, were attacking Europe itself. He was ready to die so that Hungary might remain Hungary and European’. The journalist did indeed die in the uprising. It is a line that President Volodymyr Zelenskyy and his supporters abroad have echoed time and again: that Ukrainian soldiers are not just dying for their country, they are dying for Europe at large. Kundera’s suspicion of Russia has been validated. His frustration about the indifference of the West less so The ‘tragedy’ in Kundera’s essay was that the West didn’t care. ‘Europe hasn’t noticed the disappearance of its cultural home,’ Kundera wrote, ‘because Europe no longer perceives its unity as a cultural unity.’ In other words, as the cultural sphere in Central Europe continued to defy the political restrictions imposed by the Soviet empire, it embodied the western values of freedom and democracy more than the West itself did. The extent to which this analysis remains relevant today will prove decisive for Europe’s future. As timely as ever Kundera’s essay is as timely as ever but in ways that both vindicate and challenge his key arguments. His suspicion of Russia has been validated. His frustration about the indifference of the West less so. But the true tragedy of Ukraine would be if the West has not changed sufficiently. So far, the West appears to be doing enough to enable Ukraine to defend itself, but not enough to defeat the aggressor. [A small nation] is one whose very existence can be put in question at any moment; a small nation can disappear and it knows it Milan Kundera Faber has made an excellent decision in combining The Tragedy of Central Europe with a lesser-known text by Kundera: his 1967 speech to the Czech Writers’ Congress given the year before the ill-fated Prague Spring. In it, Kundera addressed what was to become a lifelong preoccupation: the fate of small nations. ‘For Czechs’, Kundera wrote, ‘nothing has ever constituted an indisputable possession – neither their language nor their belonging to Europe.’ Rather than reflecting the size of its territory or population, a small nation ‘is one whose very existence can be put in question at any moment; a small nation can disappear, and it knows it.’ In this way Ukraine, Europe’s largest country, apart from Russia, is fighting to avoid the fate of Kundera’s ‘small nation’. Historically, the ‘small’ nations of Central Europe were threatened by both Germany and Russia. But after the Second World War, the threat was from the Soviet Union, which for Kundera was indistinguishable from Russia (tacitly including Ukraine). In its expansiveness, Russia was the opposite of Central Europe. While the latter was based on the principle of ‘the greatest variety within the smallest space’, the former represented ‘the smallest variety within the greatest space’. Kundera was criticized for observations that smack of civilizational racism, yet his bleak view of Russia remains prescient In this sense, authoritarian communism was the fulfilment of Russian history, Kundera argued, writing that ‘Russian communism vigorously reawakened Russia’s old anti-western obsessions and turned it brutally against Europe’. Vladimir Putin’s Russia appears to build on these same pernicious impulses. Kundera was widely criticized for observations in his essay that smack of civilizational racism (including by me) describing Russians as fundamentally different from us: ‘Russia knows another (greater) dimension of disaster, another image of space (a space so immense that entire nations are swallowed up in it), another sense of time (slow and patient), another way of laughing, living, and dying’. Full Article
i Eurovision, war and the geopolitics of pop By www.chathamhouse.org Published On :: Tue, 28 Mar 2023 15:46:39 +0000 Eurovision, war and the geopolitics of pop The World Today mhiggins.drupal 28 March 2023 Europe’s great song competition may strive for continental harmony, but bitter conflicts and voting blocs often drag it off key, writes Saskia Postema. In May, the city that spawned the Beatles will add another notch to its cultural belt as Liverpool hosts the Eurovision Song Contest. The pop competition has been celebrating extravagance, dramatic acts and lots of glitter since 1956. It is expressly designed to be non-political, with performers barred from promoting political interests, yet it exists for a specific political purpose – to promote European unity. The organizer, the European Broadcasting Union (EBU), has certainly succeeded in part with its mission. While Europe Day on May 9 comes and goes without much fanfare, Eurovision is an eagerly anticipated fixture on the cultural calendar. Cultural diplomacy While some may dismiss it as simply an extravagant party, there is more to it than that: it is a form of cultural diplomacy. Beyond artistry, acts are expected to bring their cultural identity to the stage as they bid for douze points, Eurovision’s highest score, from national juries. Like any popular forum, it reflects popular opinion. So, when war threatens the European harmony Eurovision is meant to exude, politics inevitably manifests itself. This was evident last year. Following Russia’s invasion of Ukraine in February, Eurovision’s organizers reiterated their apolitical stance stating both countries would be allowed to participate. But when various countries threatened to withdraw if Russia was allowed to compete, the EBU changed its tune and broke off ties with Russian broadcasting agencies indefinitely. As reluctant as it was to act in this capacity, the organization still inadvertently highlighted its role as a political gatekeeper and confirmed Eurovision does function as a political arena. The first ‘nul points’ awarded to the UK in 2003 was seen as a backlash against the Iraq war Unsurprisingly, all eyes were on the Ukrainian entry that year. Kalush Orchestra’s Stefania, presenting a blend of traditional Ukrainian folk music with hip hop beats, went on to win the contest resoundingly. And while the winning nation normally hosts next year’s competition, due to the war this honour passed to the runner-up, the United Kingdom. Britain, coincidentally, has been one of the most visible supporters of Kyiv’s war efforts. Boris Johnson, the former prime minister, was among the first leaders to visit Kyiv after the Russian invasion. Last year’s second place ended a long spate of poor results for the UK in the competition. The first year it scored nul points was 2003 when the UK entry was Cry Baby by the duo Jemini. The result was seen widely as a backlash against Britain’s entry into the Iraq war earlier that year. In the intervening years it has been placed last twice and received nul points again in 2021 when the entry was Embers sung by James Newman. With last year’s second place for Sam Ryder’s Space Man, the UK redeemed itself and will get to host Eurovision in Liverpool, a city twinned with Odesa since 1957. It is not the first time that Russia’s geopolitical relations have led to Eurovision controversy. In 2008, following the Russo-Georgian war, Russia recognized the self-proclaimed independence of South Ossetia and Abkhazia which had broken away from Georgia. Despite Russian objections, Ukraine’s 2016 entry about Stalin’s deportation of Crimean Tatars was permitted – and won As a result, Georgia initially refused to take part in the 2009 Eurovision as it was to be held in Moscow. It changed its mind, however, submitting a song by Stefane and 3G called We Don’t Wanna Put In. The submission was rejected by the EBU, which said it contained obvious references to the Russian leader, something Georgia denied. In 2015, Ukraine withdrew from Eurovision following the Russian annexation of Crimea. The following year the EBU was faced with a similar problem when Ukraine submitted a song, 1944,sung by Jamala, which told the story of her great-grandmother who lived through the mass deportation of Crimean Tatars in the Soviet Union under Josef Stalin. This time the EBU allowed the entry, despite the Russian Duma calling for its rejection. The song went on to win. " class="video-embed-field-lazy"> — A year after Russia annexed Crimea, Ukraine’s triumphant 2016 Eurovision entry, ‘1944’ by Jamala, touched on the mass deportation of Crimean Tatars in the Soviet Union. Country-level voting behaviour, in general, can reveal interesting trends, starting with neighbourly support. Geographical voting blocs are a reality – whether it is Belgium and the Netherlands awarding each other points, the former Soviet Bloc countries showing preference for one another, or the Nordic states exchanging highest scores. In 2004 hosts Turkey refused to screen a map of the Republic of Cyprus Similarly, voting trends might be indicative of large diaspora communities living in a particular country. They can also provide insights into political trends. Amid rising tensions between Armenia and Azerbaijan in 2009, police reportedly questioned all 43 Azerbaijan judges who had voted for Armenia, resulting in a fine from the EBU. On the flipside, when Istanbul hosted the 2004 contest, it marked the first time that Turkey and Cyprus recognized each other through voting despite ongoing tensions, although Turkey still refused to screen a map of the Republic of Cyprus, which it does not recognize, when that country’s votes were announced as is custom. Participation means recognition Indeed, participation means recognition for countries. It shows kinship to the European continent, particularly attractive in the early 2000s during the initial waves of accession to the European Union by Eastern Bloc countries. Participation also offers individual recognition for the acts, whose mere involvement may promote diversity and inclusion. Having achieved a cult following from the LGBT community, Eurovision has become a platform for the promotion of human rights as well, exemplified by Austria’s 2014 winner Rise Like a Phoenix by Conchita Wurst, a moustachioed drag performer in a ball gown. " class="video-embed-field-lazy"> — The drag performer Conchita Wurst won Eurovision for Austria in 2014 with ‘Rise Like a Phoenix’. Eurovision acts as a gauge for cultural trends across the continent. As a result, it simply cannot be apolitical, not when countries such as Hungary withdraw from the competition calling Eurovision ‘too gay’. Interestingly, when China censored Ireland’s 2018 entry because it included two men dancing together, the EBU chose not to break ties. Full Article
i Independent Thinking: Sweden, Finland, and NATO By www.chathamhouse.org Published On :: Fri, 31 Mar 2023 09:24:17 +0000 Independent Thinking: Sweden, Finland, and NATO Audio NCapeling 31 March 2023 Episode 21 of our weekly podcast examines the latest developments relating to Sweden and Finland’s proposed accession to NATO. The Hungarian parliament has finally ratified Finland’s membership to the NATO alliance, two weeks after President Erdogan in Turkey gave his seal of approval following a meeting with the Finnish president. Sweden however remains trapped in limbo, with both Turkey and Hungary delaying Stockholm’s membership and Erdogan in particular asking for more concessions. The panel discusses why Turkey and Hungary took issue with Sweden and Finland, what the strategic situation in the Baltic looks like now with only Finland joining NATO, and the challenges facing Sweden amid its fraught ties with President Erdogan. We also look ahead to Turkey’s presidential election in May as recent opinion polls point to a neck-and-neck race, with some polls even showing President Erdogan falling behind the opposition. The panel examines what the sentiment is like in Turkey ahead of the election, and how the world would respond if there was a change in power in Ankara for the first time in 20 years. Joining Bronwen Maddox on the podcast this week is Henri Vanhanen, research fellow with the Finnish Institute of International Affairs, and Galip Dalay, associate fellow with our Middle East and North Africa programme. About Independent Thinking A weekly podcast hosted by Chatham House director Bronwen Maddox, in conversation with leading policymakers, journalists, and Chatham House experts providing insight on the latest international issues. Full Article
i Africa and Europe: Climate security for the future By www.chathamhouse.org Published On :: Fri, 31 Mar 2023 10:37:14 +0000 Africa and Europe: Climate security for the future 20 April 2023 TO 21 April 2023 — 7:30AM TO 12:00PM Anonymous (not verified) 31 March 2023 Slovenia and Online The 12th Africa Day International Conference hosted in Slovenia offers a platform for interregional exchange and policy cooperation between African and European countries on climate security. The 12th Africa Day International Conference offers a platform for inter-regional exchange and cooperation to further contribute to progress on climate security. The 12th Africa Day International Conference is hosted by the Ministry of Foreign and European Affairs of the Republic of Slovenia, in collaboration with the European Commission and the Chatham House Africa Programme. This high-level annual event seeks to improve policy outcomes for citizens in Europe and Africa on the basis of mutual understanding and cooperation between the two regions, while strengthening bilateral relations between Slovenia and African countries. Climate change poses one of the most serious threats to global security. No individual country or region can face it alone; strong regional and international partnerships are crucial. Analysing risk and taking action can help towards achieving a number of SDGs and a more secure and sustainable future. Addressing climate security is essential for the well-being and future stability of nations and societies around the world, and for the global community as a whole. This conference will offer a platform for interregional exchange and cooperation on the topic of climate security policy. It will bring together decision-makers and experts from Europe, Africa and across the globe to identify the key challenges and policy priorities in addressing climate security. The conference will be broadcast live on the Slovenian Ministry of Foreign Affairs webpage, and on the Africa Programme Facebook page. Full Article
i Virtual breakfast: The state of the EU in 2023 By www.chathamhouse.org Published On :: Wed, 05 Apr 2023 10:52:14 +0000 Virtual breakfast: The state of the EU in 2023 3 May 2023 — 8:30AM TO 9:30AM Anonymous (not verified) 5 April 2023 Online In this breakfast discussion, we will explore the current state of play in the EU with one the most prominent experts on European politics. While the European Union has come together in its response to the invasion of Ukraine, significant divisions remain on other issues. East-West tensions remain high and troublesome German-French relations are hampering the bloc’s traditional engine of integration. Furthermore, the EU is pushing through legislation at breakneck speed, including in its attempts to kickstart green industrial policy with its responses to the American Inflation Reduction Act. At the same time, the main players within the EU continue to disagree on what the bloc’s fiscal rules should look like. What are the implications of the recent wave of protests in France against President Macron’s pension reforms? What is the outlook of EU-UK relations following the successful completion of the Windsor Framework? Where are the fiscal rules likely to land and when will they be back in place? Are we seeing the emergence of a new Central and Eastern European power bloc within the EU? In short, despite having avoided an energy crisis over the winter, the EU continues to face significant challenges. In this breakfast event, we will explore the current state of play in the EU with one of the most prominent experts on European politics. Full Article
i [68Ga]Ga-PSMA-11 PET/CT-Positive Hepatic Inflammatory Pseudotumor: Possible PSMA-Avid Pitfall in Nuclear Imaging By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Full Article
i Ultrashort Oncologic Whole-Body [18F]FDG Patlak Imaging Using LAFOV PET By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Methods to shorten [18F]FDG Patlak PET imaging procedures ranging from 65–90 to 20–30 min after injection, using a population-averaged input function (PIF) scaled to patient-specific image-derived input function (IDIF) values, were recently evaluated. The aim of the present study was to explore the feasibility of ultrashort 10-min [18F]FDG Patlak imaging at 55–65 min after injection using a PIF combined with direct Patlak reconstructions to provide reliable quantitative accuracy of lung tumor uptake, compared with a full-duration 65-min acquisition using an IDIF. Methods: Patients underwent a 65-min dynamic PET acquisition on a long-axial-field-of-view (LAFOV) Biograph Vision Quadra PET/CT scanner. Subsequently, direct Patlak reconstructions and image-based (with reconstructed dynamic images) Patlak analyses were performed using both the IDIF (time to relative kinetic equilibrium between blood and tissue concentration (t*) = 30 min) and a scaled PIF at 30–60 min after injection. Next, direct Patlak reconstructions were performed on the system console using only the last 10 min of the acquisition, that is, from 55 to 65 min after injection, and a scaled PIF using maximum crystal ring difference settings of both 85 and 322. Tumor lesion and healthy-tissue uptake was quantified and compared between the differently obtained parametric images to assess quantitative accuracy. Results: Good agreement was obtained between direct- and image-based Patlak analyses using the IDIF (t* = 30 min) and scaled PIF at 30–60 min after injection, performed using the different approaches, with no more than 8.8% deviation in tumor influx rate value (Ki) (mean difference ranging from –0.0022 to 0.0018 mL/[min x g]). When direct Patlak reconstruction was performed on the system console, excellent agreement was found between the use of a scaled PIF at 30–60 min after injection versus 55–65 min after injection, with 2.4% deviation in tumor Ki (median difference, –0.0018 mL/[min x g]; range, –0.0047 to 0.0036 mL/[min x g]). For different maximum crystal ring difference settings using the scan time interval of 55–65 min after injection, only a 0.5% difference (median difference, 0.0000 mL/[min x g]; range, –0.0004 to 0.0013 mL/[min x g]) in tumor Ki was found. Conclusion: Ultrashort whole-body [18F]FDG Patlak imaging is feasible on an LAFOV Biograph Vision Quadra PET/CT system without loss of quantitative accuracy to assess lung tumor uptake compared with a full-duration 65-min acquisition. The ultrashort 10-min direct Patlak reconstruction with PIF allows for its implementation in clinical practice. Full Article
i Improving 18F-FDG PET Quantification Through a Spatial Normalization Method By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Quantification of 18F-FDG PET images is useful for accurate diagnosis and evaluation of various brain diseases, including brain tumors, epilepsy, dementia, and Parkinson disease. However, accurate quantification of 18F-FDG PET images requires matched 3-dimensional T1 MRI scans of the same individuals to provide detailed information on brain anatomy. In this paper, we propose a transfer learning approach to adapt a pretrained deep neural network model from amyloid PET to spatially normalize 18F-FDG PET images without the need for 3-dimensional MRI. Methods: The proposed method is based on a deep learning model for automatic spatial normalization of 18F-FDG brain PET images, which was developed by fine-tuning a pretrained model for amyloid PET using only 103 18F-FDG PET and MR images. After training, the algorithm was tested on 65 internal and 78 external test sets. All T1 MR images with a 1-mm isotropic voxel size were processed with FreeSurfer software to provide cortical segmentation maps used to extract a ground-truth regional SUV ratio using cerebellar gray matter as a reference region. These values were compared with those from spatial normalization-based quantification methods using the proposed method and statistical parametric mapping software. Results: The proposed method showed superior spatial normalization compared with statistical parametric mapping, as evidenced by increased normalized mutual information and better size and shape matching in PET images. Quantitative evaluation revealed a consistently higher SUV ratio correlation and intraclass correlation coefficients for the proposed method across various brain regions in both internal and external datasets. The remarkably good correlation and intraclass correlation coefficient values of the proposed method for the external dataset are noteworthy, considering the dataset’s different ethnic distribution and the use of different PET scanners and image reconstruction algorithms. Conclusion: This study successfully applied transfer learning to a deep neural network for 18F-FDG PET spatial normalization, demonstrating its resource efficiency and improved performance. This highlights the efficacy of transfer learning, which requires a smaller number of datasets than does the original network training, thus increasing the potential for broader use of deep learning–based brain PET spatial normalization techniques for various clinical and research radiotracers. Full Article
i C-X-C Motif Chemokine Receptor 4-Directed Scintigraphy Using [99mTc]Tc-Pentixatec in Primary Aldosteronism: A Proof-of-Concept Study By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 C-X-C motif chemokine receptor 4 (CXCR4)–directed imaging has gained clinical interest in aiding clinical diagnostics in primary aldosteronism (PA). We retrospectively evaluated the feasibility of CXCR4-directed scintigraphy using the novel CXCR-4 ligand [99mTc]Tc-pentixatec in patients with PA. Methods: Six patients (mean age ± SD, 49 ± 15 y) underwent CXCR4-directed scintigraphy (including planar imaging and SPECT/CT) 30, 120, and 240 min after injection of 435 ± 50 MBq of [99mTc]Tc-pentixatec. Adrenal CXCR4 expression was analyzed by calculating lesion-to-contralateral ratios (LCRs). Imaging results were correlated to clinical information. Histopathology and clinical follow-up served as the standard of reference. Results: Three subjects showed lateralization of adrenal tracer accumulation, with a mean maximum lesion-to-contralateral ratio of 1.65 (range, 1.52–1.70), which correlated with morphologic findings on CT. One individual underwent adrenalectomy and presented with complete biochemical and clinical remission at follow-up. Histopathologic workup confirmed unilateral aldosterone-producing adenoma. Conclusion: [99mTc]Tc-pentixatec scintigraphy with SPECT in patients with PA is feasible and might offer a valuable alternative to CXCR4-directed imaging with [68Ga]Ga-pentixafor PET. Full Article
i Design, Synthesis, and Preclinical Evaluation of a High-Affinity 18F-Labeled Radioligand for Myocardial Growth Hormone Secretagogue Receptor Before and After Myocardial Infarction By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 The peptide hormone ghrelin is produced in cardiomyocytes and acts through the myocardial growth hormone secretagogue receptor (GHSR) to promote cardiomyocyte survival. Administration of ghrelin may have therapeutic effects on post–myocardial infarction (MI) outcomes. Therefore, there is a need to develop molecular imaging probes that can track the dynamics of GHSR in health and disease to better predict the effectiveness of ghrelin-based therapeutics. We designed a high-affinity GHSR ligand labeled with 18F for imaging by PET and characterized its in vivo properties in a canine model of MI. Methods: We rationally designed and radiolabeled with 18F a quinazolinone derivative ([18F]LCE470) with subnanomolar binding affinity to GHSR. We determined the sensitivity and in vivo and ex vivo specificity of [18F]LCE470 in a canine model of surgically induced MI using PET/MRI, which allowed for anatomic localization of tracer uptake and simultaneous determination of global cardiac function. Uptake of [18F]LCE470 was determined by time–activity curve and SUV analysis in 3 regions of the left ventricle—area of infarct, territory served by the left circumflex coronary artery, and remote myocardium—over a period of 1.5 y. Changes in cardiac perfusion were tracked by [13N]NH3 PET. Results: The receptor binding affinity of LCE470 was measured at 0.33 nM, the highest known receptor binding affinity for a radiolabeled GHSR ligand. In vivo blocking studies in healthy hounds and ex vivo blocking studies in myocardial tissue showed the specificity of [18F]LCE470, and sensitivity was demonstrated by a positive correlation between tracer uptake and GHSR abundance. Post-MI changes in [18F]LCE470 uptake occurred independently of perfusion tracer distributions and changes in global cardiac function. We found that the regional distribution of [18F]LCE470 within the left ventricle diverged significantly within 1 d after MI and remained that way throughout the 1.5-y duration of the study. Conclusion: [18F]LCE470 is a high-affinity PET tracer that can detect changes in the regional distribution of myocardial GHSR after MI. In vivo PET molecular imaging of the global dynamics of GHSR may lead to improved GHSR-based therapeutics in the treatment of post-MI remodeling. Full Article
i Molecular Imaging of p53 in Mouse Models of Cancer Using a Radiolabeled Antibody TAT Conjugate with SPECT By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Mutations of p53 protein occur in over half of all cancers, with profound effects on tumor biology. We present the first—to our knowledge—method for noninvasive visualization of p53 in tumor tissue in vivo, using SPECT, in 3 different models of cancer. Methods: Anti-p53 monoclonal antibodies were conjugated to the cell-penetrating transactivator of transcription (TAT) peptide and a metal ion chelator and then radiolabeled with 111In to allow SPECT imaging. 111In-anti-p53-TAT conjugates were retained longer in cells overexpressing p53-specific than non–p53-specific 111In-mIgG (mouse IgG from murine plasma)-TAT controls, but not in null p53 cells. Results: In vivo SPECT imaging showed enhanced uptake of 111In-anti-p53-TAT, versus 111In-mIgG-TAT, in high-expression p53R175H and medium-expression wild-type p53 but not in null p53 tumor xenografts. The results were confirmed in mice bearing genetically engineered KPC mouse–derived pancreatic ductal adenocarcinoma tumors. Imaging with 111In-anti-p53-TAT was possible in KPC mice bearing spontaneous p53R172H pancreatic ductal adenocarcinoma tumors. Conclusion: We demonstrate the feasibility of noninvasive in vivo molecular imaging of p53 in tumor tissue using a radiolabeled TAT-modified monoclonal antibody. Full Article
i The Emission of Internal Conversion Electrons Rather Than Auger Electrons Increased the Nucleus-Absorbed Dose for 161Tb Compared with 177Lu with a Higher Dose Response for [161Tb]Tb-DOTA-LM3 Than for [161Tb]Tb-DOTATATE By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Preclinical data have shown that 161Tb-labeled peptides targeting the somatostatin receptor are therapeutically more effective for peptide receptor radionuclide therapy than are their 177Lu-labeled counterparts. To further substantiate this enhanced therapeutic effect, we performed cellular dosimetry to quantify the absorbed dose to the cell nucleus and compared dose–response curves to evaluate differences in relative biological effectiveness in vitro. Methods: CA20948 cell survival was assessed after treatment with [161Tb]Tb- and [177Lu]Lu-DOTATATE (agonist) and with [161Tb]Tb- and [177Lu]Lu-DOTA-LM3 (antagonist) via a clonogenic assay. Cell binding, internalization, and dissociation assays were performed up to 7 d to acquire time-integrated activity coefficients. Separate S values for each type of particle emission (Auger/internal conversion [IC] electrons and β– particles) were computed via Monte Carlo simulations, while considering spheric cells. Once the absorbed dose to the cell nucleus was calculated, survival curves were fitted to the appropriate linear or linear-quadratic model and corresponding relative biological effectiveness was evaluated. Results: Although the radiopeptide uptake was independent of the radionuclide, [161Tb]Tb-DOTATATE and [161Tb]Tb-DOTA-LM3 delivered a 3.6 and 3.8 times higher dose to the nucleus, respectively, than their 177Lu-labeled counterparts on saturated receptor binding. This increased nucleus-absorbed dose was mainly due to the additional emission of IC and not Auger electrons by 161Tb. When activity concentrations were considered, both [161Tb]Tb-DOTATATE and [161Tb]Tb-DOTA-LM3 showed a lower survival fraction than did labeling with 177Lu. When the absorbed dose to the nucleus was considered, no significant difference could be observed between the dose–response curves for [161Tb]Tb- and [177Lu]Lu-DOTATATE. [161Tb]Tb-DOTA-LM3 showed a linear-quadratic dose response, whereas [161Tb]Tb-DOTATATE showed only a linear dose response within the observed dose range, suggesting additional cell membrane damage by Auger electrons. Conclusion: The IC, rather than Auger, electrons emitted by 161Tb resulted in a higher absorbed dose to the cell nucleus and lower clonogenic survival for [161Tb]Tb-DOTATATE and [161Tb]Tb-DOTA-LM3 than for the 177Lu-labeled analogs. In contrast, [161Tb]Tb-DOTATATE showed no higher dose response than [177Lu]Lu-DOTATATE, whereas for [161Tb]Tb-DOTA-LM3 an additional quadratic response was observed. Because of this quadratic response, potentially caused by cell membrane damage, [161Tb]Tb-DOTA-LM3 is a more effective radiopeptide than [161Tb]Tb-DOTATATE for labeling with 161Tb. Full Article
i Theranostic GPA33-Pretargeted Radioimmunotherapy of Human Colorectal Carcinoma with a Bivalent 177Lu-Labeled Radiohapten By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Radiolabeled small-molecule DOTA-haptens can be combined with antitumor/anti-DOTA bispecific antibodies (BsAbs) for pretargeted radioimmunotherapy (PRIT). For optimized delivery of the theranostic - and β-emitting isotope 177Lu with DOTA-based PRIT (DOTA-PRIT), bivalent Gemini (DOTA-Bn-thiourea-PEG4-thiourea-Bn-DOTA, aka (3,6,9,12-tetraoxatetradecane-1,14-diyl)bis(DOTA-benzyl thiourea)) was developed. Methods: Gemini was synthesized by linking 2 S-2-(4-isothiocyanatobenzyl)-DOTA molecules together via a 1,14-diamino-PEG4 linker. [177Lu]Lu-Gemini was prepared with no-carrier-added 177LuCl3 to a molar-specific activity of 123 GBq/μmol and radiochemical purity of more than 99%. The specificity of BsAb-177Lu-Gemini was verified in vitro. Subsequently, we evaluated biodistribution and whole-body clearance for [177Lu]Lu-Gemini and, for comparison, our gold-standard monovalent [177Lu]Lu-S-2-(4-aminobenzyl)-DOTA ([177Lu]Lu-DOTA-Bn) in naïve (tumor-free) athymic nude mice. For our proof-of-concept system, a 3-step pretargeting approach was performed with an established DOTA-PRIT regimen (anti-GPA33/anti-DOTA IgG-scFv BsAb, a clearing agent, and [177Lu]Lu-Gemini) in mouse models. Results: Initial in vivo studies showed that [177Lu]Lu-Gemini behaved similarly to [177Lu]Lu-DOTA-Bn, with almost identical blood and whole-body clearance kinetics, as well as biodistribution and mouse kidney dosimetry. Pretargeting [177Lu]Lu-Gemini to GPA33-expressing SW1222 human colorectal xenografts was highly effective, leading to absorbed doses of [177Lu]Lu-Gemini for blood, tumor, liver, spleen, and kidneys of 3.99, 455, 6.93, 5.36, and 14.0 cGy/MBq, respectively. Tumor–to–normal tissue absorbed-dose ratios (i.e., therapeutic indices [TIs]) for the blood and kidneys were 114 and 33, respectively. In addition, we demonstrate that the use of bivalent [177Lu]Lu-Gemini in DOTA-PRIT leads to improved TIs and augmented [177Lu]Lu-Gemini tumor uptake and retention in comparison to monovalent [177Lu]Lu-DOTA-Bn. Finally, we established efficacy in SW1222 tumor-bearing mice, demonstrating that a single injection of anti-GPA33 DOTA-PRIT with 44 MBq (1.2 mCi) of [177Lu]Lu-Gemini (estimated tumor-absorbed dose, 200 Gy) induced complete responses in 5 of 5 animals and a histologic cure in 2 of 5 (40%) animals. Moreover, a significant increase in survival compared with nontreated controls was noted (maximum tolerated dose not reached). Conclusion: We have developed a bivalent DOTA-radiohapten, [177Lu]Lu-Gemini, that showed improved radiopharmacology for DOTA-PRIT application. The use of bivalent [177Lu]Lu-Gemini in DOTA-PRIT, as opposed to monovalent [177Lu]Lu-DOTA-Bn, allows curative treatments with considerably less administered 177Lu activity while still achieving high TIs for both the blood (>100) and the kidneys (>30). Full Article
i Preclinical Evaluation of 177Lu-OncoFAP-23, a Multivalent FAP-Targeted Radiopharmaceutical Therapeutic for Solid Tumors By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Fibroblast activation protein (FAP) is abundantly expressed in the stroma of most human solid tumors. Clinical-stage radiolabeled FAP ligands are increasingly used as tools for the detection of various cancer lesions. To unleash the full therapeutic potential of FAP-targeting agents, ligands need to remain at the tumor site for several days after administration. We recently described the discovery of OncoFAP, a high-affinity small organic ligand of FAP with a rapid accumulation in tumors and low uptake in healthy tissues in cancer patients. Trimerization of OncoFAP provided a derivative (named TriOncoFAP, or OncoFAP-23) with improved FAP affinity. In this work, we evaluated the tissue biodistribution profile and the therapeutic performance of OncoFAP-23 in tumor-bearing mice. Methods: OncoFAP-23 was radiolabeled with the theranostic radionuclide 177Lu. Preclinical experiments were conducted on mice bearing SK-RC-52.hFAP (BALB/c nude mice) or CT-26.hFAP (BALB/c mice) tumors. 177Lu-OncoFAP and 177Lu-FAP-2286 were included in the biodistribution study as controls. Toxicologic evaluation was performed on Wistar rats and CD1 mice by injecting high doses of OncoFAP-23 or its cold-labeled counterpart, respectively. Results: 177Lu-OncoFAP-23 emerged for its best-in-class biodistribution profile, high and prolonged tumor uptake (i.e., ~16 percentage injected dose/g at 96 h), and low accumulation in healthy organs, which correlates well with its potent single-agent anticancer activity at low levels of administered radioactivity. Combination treatment with the tumor-targeted interleukin 2 (L19-IL2, a clinical-stage immunocytokine) further expands the therapeutic window of 177Lu-OncoFAP-23 by potentiating its in vivo antitumor activity. Proteomics studies revealed a potent tumor-directed immune response on treatment with the combination. OncoFAP-23 and natLu-OncoFAP-23 exhibited a favorable toxicologic profile, without showing any side effects or signs of toxicity. Conclusion: OncoFAP-23 presents enhanced tumor uptake and tumor retention and low accumulation in healthy organs, findings that correspond to a strongly improved in vivo antitumor efficacy. The data presented in this work support the clinical development of 177Lu-OncoFAP-23 for the treatment of FAP-positive solid tumors. Full Article
i [68Ga]Ga-RAYZ-8009: A Glypican-3-Targeted Diagnostic Radiopharmaceutical for Hepatocellular Carcinoma Molecular Imaging--A First-in-Human Case Series By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 To date, the imaging and diagnosis of hepatocellular carcinoma (HCC) rely on CT/MRI, which have well-known limitations. Glypican-3 (GPC3) is a cell surface receptor highly expressed by HCC but not by normal or cirrhotic liver tissue. Here we report initial clinical results of GPC3-targeted PET imaging with [68Ga]Ga-DOTA-RYZ-GPC3 (RAYZ-8009), a peptide-based GPC3 ligand in patients with known or suspected HCC. Methods: [68Ga]Ga-RAYZ-8009 was obtained after labeling the peptide precursor with 68Ga from a 68Ge/68Ga generator and heating at 90°C for 10 min followed by sterile filtration. After administration of [68Ga]Ga-RAYZ-8009, a dynamic or static PET/CT scan was acquired between 45 min and 4 h after administration. Radiotracer uptake was measured by SUVs for the following tissues: suspected or actual HCC or hepatoblastoma lesions, non–tumor-bearing liver, renal cortex, blood pool in the left ventricle, and gastric fundus. Additionally, tumor–to–healthy-liver ratios (TLRs) were calculated. Results: Twenty-four patients (5 patients in the dynamic protocol; 19 patients in the static protocol) were scanned. No adverse events occurred. Two patients had no lesion detected and did not have HCC during follow-up. In total, 50 lesions were detected and analyzed. The mean SUVmax of these lesions was 19.6 (range, 2.7–95.3), and the mean SUVmean was 10.1 (range, 1.0–49.2) at approximately 60 min after administration. Uptake in non–tumor-bearing liver and blood pool rapidly decreased over time and became negligible 45 min after administration (mean SUVmean, <1.6), with a continuous decline to 4 h after administration (mean SUVmean, 1.0). The opposite was observed for HCC lesions, for which SUVs and TLRs continuously increased for up to 4 h after administration. In individual lesion analysis, TLR was the highest between 60 and 120 min after administration. Uptake in the gastric fundus gradually increased for up to 45 min (to an SUVmax of 31.3) and decreased gradually afterward. Conclusion: [68Ga]Ga-RAYZ-8009 is safe and allows for high-contrast imaging of GPC3-positive HCC, with rapid clearance from most normal organs. Thereby, [68Ga]Ga-RAYZ-8009 is promising for HCC diagnosis and staging. Further research is warranted. Full Article
i Dual Somatostatin Receptor/18F-FDG PET/CT Imaging in Patients with Well-Differentiated, Grade 2 and 3 Gastroenteropancreatic Neuroendocrine Tumors By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Our purpose was to prospectively assess the distribution of NETPET scores in well-differentiated (WD) grade 2 and 3 gastroenteropancreatic (GEP) neuroendocrine tumors (NETs) and to determine the impact of the NETPET score on clinical management. Methods: This single-arm, institutional ethics review board–approved prospective study included 40 patients with histologically proven WD GEP NETs. 68Ga-DOTATATE PET and 18F-FDG PET were performed within 21 d of each other. NETPET scores were evaluated qualitatively by 2 reviewers, with up to 10 marker lesions selected for each patient. The quantitative parameters that were evaluated included marker lesion SUVmax for each tracer; 18F-FDG/68Ga-DOTATATE SUVmax ratios; functional tumor volume (FTV) and metabolic tumor volume (MTV) on 68Ga-DOTATATE and 18F-FDG PET, respectively; and FTV/MTV ratios. The treatment plan before and after 18F-FDG PET was recorded. Results: There were 22 men and 18 women (mean age, 60.8 y) with grade 2 (n = 24) or grade 3 (n = 16) tumors and a mean Ki-67 index of 16.1%. NETPET scores of P0, P1, P2A, P2B, P3B, P4B, and P5 were documented in 2 (5%), 5 (12.5%), 5 (12.5%) 20 (50%), 2 (5%), 4 (10%), and 2 (5%) patients, respectively. No association was found between the SUVmax of target lesions on 68Ga-DOTATATE and the SUVmax of target lesions on 18F-FDG PET (P = 0.505). 18F-FDG/68Ga-DOTATATE SUVmax ratios were significantly lower for patients with low (P1–P2) primary NETPET scores than for those with high (P3–P5) primary NETPET scores (mean ± SD, 0.20 ± 0.13 and 1.68 ± 1.44, respectively; P < 0.001). MTV on 18F-FDG PET was significantly lower for low primary NETPET scores than for high ones (mean ± SD, 464 ± 601 cm3 and 66 ± 114 cm3, respectively; P = 0.005). A change in the type of management was observed in 42.5% of patients after 18F-FDG PET, with the most common being a change from systemic therapy to peptide receptor radionuclide therapy and from debulking surgery to systemic therapy. Conclusion: There was a heterogeneous distribution of NETPET scores in patients with WD grade 2 and 3 GEP NETs, with more than 1 in 5 patients having a high NETPET score and a frequent change in management after 18F-FDG PET. Quantitative parameters including 18F-FDG/68Ga-DOTATATE SUVmax ratios in target lesions and FTV/MTV ratios can discriminate between patients with high and low NETPET scores. Full Article
i Quantitative SPECT/CT Metrics in Early Prediction of [177Lu]Lu-DOTATATE Treatment Response in Gastroenteropancreatic Neuroendocrine Tumor Patients By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Our objective is to explore quantitative imaging markers for early prediction of treatment response in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) undergoing [177Lu]Lu-DOTATATE therapy. By doing so, we aim to enable timely switching to more effective therapies in order to prevent time-resource waste and minimize toxicities. Methods: Patients diagnosed with unresectable or metastatic, progressive, well-differentiated, receptor-positive GEP-NETs who received 4 sessions of [177Lu]Lu-DOTATATE were retrospectively selected. Using SPECT/CT images taken at the end of treatment sessions, we counted all visible tumors and measured their largest diameters to calculate the tumor burden score (TBS). Up to 4 target lesions were selected and semiautomatically segmented. Target lesion peak counts and spleen peak counts were measured, and normalized peak counts were calculated. Changes in TBS (TBS) and changes in normalized peak count (nPC) throughout treatment sessions in relation to the first treatment session were calculated. Treatment responses were evaluated using third-month CT and were binarized as progressive disease (PD) or non-PD. Results: Twenty-seven patients were included (7 PD, 20 non-PD). Significant differences were observed in TBSsecond-first, TBSthird-first, and TBSfourth-first (where second-first, third-first, and fourth-first denote scan number between the second and first, third and first, and fourth and first [177Lu]Lu-DOTATATE treatment cycles), respectively) between the PD and non-PD groups (median, 0.043 vs. –0.049, 0.08 vs. –0.116, and 0.109 vs. –0.123 [P = 0.023, P = 0.002, and P < 0.001], respectively). nPCsecond-first showed significant group differences (mean, –0.107 vs. –0.282; P = 0.033); nPCthird-first and nPCfourth-first did not reach statistical significance (mean, –0.122 vs. –0.312 and –0.183 vs. –0.405 [P = 0.117 and 0.067], respectively). At the optimal threshold, TBSfourth-first exhibited an area under the curve (AUC) of 0.957, achieving 100% sensitivity and 80% specificity. TBSsecond-first and TBSthird-first reached AUCs of 0.793 and 0.893, sensitivities of 71.4%, and specificities of 85% and 95%, respectively. nPCsecond-first, nPCthird-first, and nPCfourth-first showed AUCs of 0.764, 0.693, and 0.679; sensitivities of 71.4%, 71.4%, and 100%; and specificities of 75%, 70%, and 35%, respectively. Conclusion: TBS and nPC can predict [177Lu]Lu-DOTATATE response by the second treatment session. Full Article
i Composite Prediction Score to Interpret Bone Focal Uptake in Hormone-Sensitive Prostate Cancer Patients Imaged with [18F]PSMA-1007 PET/CT By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Unspecific bone uptake (UBU) related to [18F]PSMA-1007 PET/CT imaging represents a clinical challenge. We aimed to assess whether a combination of clinical, biochemical, and imaging parameters could predict skeletal metastases in patients with [18F]PSMA-1007 bone focal uptake, aiding in result interpretation. Methods: We retrospectively analyzed [18F]PSMA-1007 PET/CT performed in hormone-sensitive prostate cancer (PCa) patients at 3 tertiary-level cancer centers. A fourth center was involved in performing an external validation. For each, a volume of interest was drawn using a threshold method to extract SUVmax, SUVmean, PSMA tumor volume, and total lesion PSMA. The same volume of interest was applied to CT images to calculate the mean Hounsfield units (HUmean) and maximum Hounsfield units. Clinical and laboratory data were collected from electronic medical records. A composite reference standard, including follow-up histopathology, biochemistry, and imaging data, was used to distinguish between PCa bone metastases and UBU. PET readers with less (n = 2) or more (n = 2) experience, masked to the reference standard, were asked to visually rate a subset of focal bone uptake (n = 178) as PCa metastases or not. Results: In total, 448 bone [18F]PSMA-1007 focal uptake specimens were identified in 267 PCa patients. Of the 448 uptake samples, 188 (41.9%) corresponded to PCa metastases. Ongoing androgen deprivation therapy at PET/CT (P < 0.001) with determination of SUVmax (P < 0.001) and HUmean (P < 0.001) independently predicted bone metastases. A composite prediction score, the bone uptake metastatic probability (BUMP) score, achieving an area under the receiver-operating-characteristic curve (AUC) of 0.87, was validated through a 10-fold internal and external validation (n = 89 bone uptake, 51% metastatic; AUC, 0.92). The BUMP score’s AUC was significantly higher than that of HUmean (AUC, 0.62) and remained high among lesions with HUmean in the first tertile (AUC, 0.80). A decision-curve analysis showed a higher net benefit with the score. Compared with the visual assessment, the BUMP score provided added value in terms of specificity in less-experienced PET readers (88% vs. 54%, P < 0.001). Conclusion: The BUMP score accurately distinguished UBU from bone metastases in PCa patients with [18F]PSMA-1007 focal bone uptake at PET imaging, offering additional value compared with the simple assessment of the osteoblastic CT correlate. Its use could help clinicians interpret imaging results, particularly those with less experience, potentially reducing the risk of patient overstaging. Full Article
i Clinical Factors That Influence Repeat 68Ga-PSMA-11 PET/CT Scan Positivity in Patients with Recurrent Prostate Cancer Under Observation After a Negative 68Ga-PSMA-11 PET/CT Scan: A Single-Center Retrospective Study By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 This analysis aimed to identify clinical factors associated with positivity on repeat 68Ga-PSMA-11 PET/CT after a negative scan in patients with recurrent prostate cancer (PCa) under observation. Methods: This single-center, retrospective analysis included patients who underwent at least 2 68Ga-PSMA-11 PET/CT scans (PET1 and PET2) at UCLA between October 2016 and June 2021 for recurrent PCa with negative PET1 and no PCa-related treatments between the 2 scans. Using Prostate Cancer Molecular Imaging Standardized Evaluation criteria to define negative and positive scans, the final cohort was divided into PET2-negative (PET2-Neg) and PET2-positive (PET2-Pos). The same PET1 was used twice in the more than 2 PET cases with inclusion criteria fulfilled. Patient characteristics and clinical parameters were compared between the 2 cohorts using Mann–Whitney U test and Fisher exact test. Areas under the curve (AUCs) of the receiver operating characteristic and the Youden index were computed to determine the discrimination ability of statistically significant factors and specific cut points that maximized sensitivity and specificity, respectively. Results: The final analysis included 83 sets of 2 PET/CT scans from 70 patients. Thirty-nine of 83 (47%) sets were PET2-Neg, and 44 of 83 (53%) sets were PET2-Pos. Prostate-specific antigen (PSA) increased from PET1 to PET2 for all 83 (100%) sets of scans. Median PSA at PET1 was 0.4 ng/mL (interquartile range, 0.2–1.0) and at PET2 was 1.6 ng/mL (interquartile range, 0.9–3.8). We found higher serum PSA at PET2 (median, 1.8 vs. 1.1 ng/mL; P = 0.015), absolute PSA difference (median, 1.4 vs. 0.7 ng/mL; P = 0.006), percentage of PSA change (median, +270.4% vs. +150.0%: P = 0.031), and median PSA velocity (0.044 vs. 0.017 ng/mL/wk, P = 0.002) and shorter PSA doubling time (DT; median, 5.1 vs. 8.3 mo; P = 0.006) in the PET2-Pos cohort than in the PET2-Neg cohort. Receiver operating characteristic curves showed cutoffs for PSA at PET2 of 4.80 ng/mL (sensitivity, 34%; specificity, 92%; AUC, 0.66), absolute PSA difference of 0.95 ng/mL (sensitivity, 62%; specificity, 71%; AUC, 0.68), percentage of PSA change of a positive 289.50% (sensitivity, 48%; specificity, 82%; AUC, 0.64), PSA velocity of 0.033 ng/mL/wk (sensitivity, 57%; specificity, 80%; AUC, 0.70), and PSA DT of 7.91 mo (sensitivity, 71%; specificity, 62%; AUC, 0.67). Conclusion: Patients with recurrent PCa under observation after a negative 68Ga-PSMA-11 PET/CT scan with markedly elevated serum PSA levels and shorter PSA DT are more likely to have positive findings on repeat 68Ga-PSMA-11 PET/CT. Full Article
i Optimizing the Therapeutic Index of sdAb-Based Radiopharmaceuticals Using Pretargeting By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Single-domain antibodies (sdAbs) demonstrate favorable pharmacokinetic profiles for molecular imaging applications. However, their renal excretion and retention are obstacles for applications in targeted radionuclide therapy (TRT). Methods: Using a click-chemistry–based pretargeting approach, we aimed to reduce kidney retention of a fibroblast activation protein α (FAP)–targeted sdAb, 4AH29, for 177Lu-TRT. Key pretargeting parameters (sdAb-injected mass and lag time) were optimized in healthy mice and U87MG (FAP+) xenografts. A TRT study in a pancreatic ductal adenocarcinoma (PDAC) patient-derived xenograft (PDX) model was performed as a pilot study for sdAb-based pretargeting applications. Results: Modification of 4AH29 with trans-cyclooctene (TCO) moieties did not modify the sdAb pharmacokinetic profile. A 200-µg injected mass of 4AH29-TCO and an 8-h lag time for the injection of [177Lu]Lu-DOTA-PEG7-tetrazine resulted in the highest kidney therapeutic index (2.0 ± 0.4), which was 5-fold higher than that of [177Lu]Lu-DOTA-4AH29 (0.4 ± 0.1). FAP expression in the tumor microenvironment was validated in a PDAC PDX model with both immunohistochemistry and PET/CT imaging. Mice treated with the pretargeting high-activity approach (4AH29-TCO + [177Lu]Lu-DOTA-PEG7-tetrazine; 3 x 88 MBq, 1 injection per week for 3 wk) demonstrated prolonged survival compared with the vehicle control and conventionally treated ([177Lu]Lu-DOTA-4AH29; 3 x 37 MBq, 1 injection per week for 3 wk) mice. Mesangial expansion was reported in 7 of 10 mice in the conventional cohort, suggesting treatment-related kidney morphologic changes, but was not observed in the pretargeting cohort. Conclusion: This study validates pretargeting to mitigate sdAbs’ kidney retention with no observation of morphologic changes on therapy regimen at early time points. Clinical translation of click-chemistry–based pre-TRT is warranted on the basis of its ability to alleviate toxicities related to biovectors’ intrinsic pharmacokinetic profiles. The absence of representative animal models with extensive stroma and high FAP expression on cancer-associated fibroblasts led to a low mean tumor-absorbed dose even with high injected activity and consequently to modest survival benefit in this PDAC PDX. Full Article
i Evaluating the Utility of 18F-FDG PET/CT in Cancer of Unknown Primary By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Cancer of unknown primary (CUP) represents a heterogeneous group of metastatic tumors for which standardized diagnostic work-up fails to identify the primary site. We aimed to describe the Peter MacCallum Cancer Centre experience with 18F-FDG PET/CT in extracervical CUP with respect to detection of a primary site and its impact on management. A secondary aim was to compare overall survival (OS) in patients with and without a detected primary site. Methods: CUP patients treated between 2014 and 2020 were identified from medical oncology clinics and 18F-FDG PET/CT records. Information collated from electronic medical records included the suspected primary site and treatment details before and after 18F-FDG PET/CT. Clinicopathologic details and genomic analysis were used to determine the clinically suspected primary site and compared against 2 independent masked reads of 18F-FDG PET/CT images by nuclear medicine specialists to determine sensitivity, specificity, accuracy, and the rate of detection of the primary site. Results: We identified 147 patients, 65% of whom had undergone molecular profiling. The median age at diagnosis was 61 y (range, 20–84 y), and the median follow-up time was 74 mo (range, 26–83 mo). Eighty-two percent were classified as having an unfavorable CUP subtype as per international guidelines.18F-FDG PET/CT demonstrated a primary site detection rate of 41%, resulted in a change in management in 22%, and identified previously occult disease sites in 37%. Median OS was 16.8 mo for all patients and 104.7 and 12.1 mo for favorable and unfavorable CUP subtypes, respectively (P < 0.0001). Median OS in CUP patients when using 18F-FDG PET/CT, clinicopathologic, and genomic information was 19.8 and 8.5 mo when a primary site was detected and not detected, respectively (P = 0.016). Multivariable analysis of survival adjusted for age and sex remained significant for identification of a potential primary site (P < 0.001), a favorable CUP (P < 0.001), and an Eastern Cooperative Oncology Group status of 1 or less (P < 0.001). Conclusion: 18F-FDG PET/CT plays a complementary role in CUP diagnostic work-up and was able to determine the likely primary site in 41% of cases. OS is improved with primary site identification, demonstrating the value of access to diagnostic 18F-FDG PET/CT for CUP patients. Full Article
i Predicting Pathologic Complete Response in Locally Advanced Rectal Cancer with [68Ga]Ga-FAPI-04 PET, [18F]FDG PET, and Contrast-Enhanced MRI: Lesion-to-Lesion Comparison with Pathology By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Neoadjuvant therapy in patients with locally advanced rectal cancer (LARC) has achieved good pathologic complete response (pCR) rates, potentially eliminating the need for surgical intervention. This study investigated preoperative methods for predicting pCR after neoadjuvant short-course radiotherapy (SCRT) combined with immunochemotherapy. Methods: Treatment-naïve patients with histologically confirmed LARC were enrolled from February 2023 to July 2023. Before surgery, the patients received neoadjuvant SCRT followed by 2 cycles of capecitabine and oxaliplatin plus camrelizumab. 68Ga-labeled fibroblast activation protein inhibitor ([68Ga]Ga-FAPI-04) PET/MRI, [18F]FDG PET/CT, and contrast-enhanced MRI were performed before treatment initiation and before surgery in each patient. PET and MRI features and the size and number of lesions were also collected from each scan. Each parameter’s sensitivity, specificity, and diagnostic cutoff were derived via receiver-operating-characteristic curve analysis. Results: Twenty eligible patients (13 men, 7 women; mean age, 60.2 y) were enrolled and completed the entire trial, and all patients had proficient mismatch repair or microsatellite-stable LARC. A postoperative pCR was achieved in 9 patients (45.0%). In the visual evaluation, both [68Ga]Ga-FAPI-04 PET/MRI and [18F]FDG PET/CT were limited to forecasting pCR. Contrast-enhanced MRI had a low sensitivity of 55.56% to predict pCR. In the quantitative evaluation, [68Ga]Ga-FAPI-04 change in SULpeak percentage, where SULpeak is SUVpeak standardized by lean body mass, had the largest area under the curve (0.929) with high specificity (sensitivity, 77.78%; specificity, 100.0%; cutoff, 63.92%). Conclusion: [68Ga]Ga-FAPI-04 PET/MRI is a promising imaging modality for predicting pCR after SCRT combined with immunochemotherapy. The SULpeak decrease exceeding 63.92% may provide valuable guidance in selecting patients who can forgo surgery after neoadjuvant therapy. Full Article
i Whole-Body HER2 Heterogeneity Identified on HER2 PET in HER2-Negative, -Low, and -Positive Metastatic Breast Cancer By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Understanding which patients with human epidermal growth factor receptor 2 (HER2)–negative or –low metastatic breast cancer (MBC) benefit from HER2-targeted strategies is urgently needed. We assessed the whole-body heterogeneity of HER2 expression on 89Zr-trastuzumab PET (HER2 PET) and the diagnostic performance of HER2 PET in a large series of patients, including HER2-negative and -low MBC. Methods: In the IMPACT-MBC study, patients with newly diagnosed and nonrapidly progressive MBC of all subtypes were included. Metastasis HER2 status was determined by immunohistochemistry and in situ hybridization.89Zr-trastuzumab uptake was quantified as SUVmax and SUVmean. HER2 immunohistochemistry was related to the quantitative 89Zr-trastuzumab uptake of all metastases and corresponding biopsied metastasis, uptake heterogeneity, and qualitative scan evaluation. A prediction algorithm for HER2 immunohistochemistry positivity based on uptake was developed. Results: In 200 patients, 89Zr-trastuzumab uptake was quantified in 5,163 metastases, including 186 biopsied metastases. With increasing HER2 immunohistochemistry status, uptake was higher (geometric mean SUVmax of 7.0, 7.6, 7.3, and 17.4 for a HER2 immunohistochemistry score of 0, 1, 2, or 3+, respectively; P < 0.001). High uptake exceeding 14.6 (90th percentile) was observed in one third of patients with a HER2-negative or -low metastasis biopsy. The algorithm performed best when lesion site and size were incorporated (area under the curve, 0.86; 95% CI, 0.79–0.93). Conclusion: HER2 PET had good diagnostic performance in MBC, showing considerable whole-body HER2 heterogeneity and uptake above background in HER2-negative and -low MBC. This provides novel insights into HER2-negative and -low MBC compared with standard HER2 immunohistochemistry on a single biopsy. Full Article
i Diagnostic Accuracy of [18F]FDG PET/MRI in Head and Neck Squamous Cell Carcinoma: A Systematic Review and Metaanalysis By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 This study evaluates the diagnostic utility of PET/MRI for primary, locoregional, and nodal head and neck squamous cell carcinoma (HNSCC) through systematic review and metaanalysis. Methods: A systematic search was conducted using PubMed and Scopus to identify studies on the diagnostic accuracy of PET/MRI for HNSCC. The search included specific terms and excluded nonhybrid PET/MRI studies, and those with a sample size of fewer than 10 patients were excluded. Results: In total, 15 studies encompassing 638 patients were found addressing the diagnostic test accuracy for PET/MRI within the chosen subject domain. Squamous cell carcinoma of the nasopharynx was the most observed HNSCC subtype (n = 198). The metaanalysis included 12 studies, with pooled sensitivity and specificity values of 93% and 95% per patient for primary disease evaluation, 93% and 96% for locoregional evaluation, and 89% and 98% per lesion for nodal disease detection, respectively. An examination of a subset of studies comparing PET/MRI against PET/CT or MRI alone for evaluating nodal and locoregional HNSCC found that PET/MRI may offer slightly higher accuracy than other modalities. However, this difference was not statistically significant. Conclusion: PET/MRI has excellent potential for identifying primary, locoregional, and nodal HNSCC. Full Article
i Development of 18F-Fluoromisonidazole Hypoxia PET/CT Diagnostic Interpretation Criteria and Validation of Interreader Reliability, Reproducibility, and Performance By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Tumor hypoxia, an integral biomarker to guide radiotherapy, can be imaged with 18F-fluoromisonidazole (18F-FMISO) hypoxia PET. One major obstacle to its broader application is the lack of standardized interpretation criteria. We sought to develop and validate practical interpretation criteria and a dedicated training protocol for nuclear medicine physicians to interpret 18F-FMISO hypoxia PET. Methods: We randomly selected 123 patients with human papillomavirus–positive oropharyngeal cancer enrolled in a phase II trial who underwent 123 18F-FDG PET/CT and 134 18F-FMISO PET/CT scans. Four independent nuclear medicine physicians with no 18F-FMISO experience read the scans. Interpretation by a fifth nuclear medicine physician with over 2 decades of 18F-FMISO experience was the reference standard. Performance was evaluated after initial instruction and subsequent dedicated training. Scans were considered positive for hypoxia by visual assessment if 18F-FMISO uptake was greater than floor-of-mouth uptake. Additionally, SUVmax was determined to evaluate whether quantitative assessment using tumor-to-background ratios could be helpful to define hypoxia positivity. Results: Visual assessment produced a mean sensitivity and specificity of 77.3% and 80.9%, with fair interreader agreement ( = 0.34), after initial instruction. After dedicated training, mean sensitivity and specificity improved to 97.6% and 86.9%, with almost perfect agreement ( = 0.86). Quantitative assessment with an estimated best SUVmax ratio threshold of more than 1.2 to define hypoxia positivity produced a mean sensitivity and specificity of 56.8% and 95.9%, respectively, with substantial interreader agreement ( = 0.66), after initial instruction. After dedicated training, mean sensitivity improved to 89.6% whereas mean specificity remained high at 95.3%, with near-perfect interreader agreement ( = 0.86). Conclusion: Nuclear medicine physicians without 18F-FMISO hypoxia PET reading experience demonstrate much improved interreader agreement with dedicated training using specific interpretation criteria. Full Article
i Association Between CA 15-3 and 18F-FDG PET/CT Findings in Recurrent Breast Cancer Patients at a Tertiary Referral Hospital in Kenya By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 The tumor marker cancer antigen 15-3 (CA 15-3) is that most commonly used to monitor metastatic breast cancer during active therapy and surveillance for disease recurrence after treatment. The association of CA 15-3 and 18F-FDG PET/CT findings can be considered complementary, since any significant rise may indicate the presence of disease and imaging is able to map the tumor sites. Although current guidelines do not recommend the routine performance of CA 15-3 in asymptomatic patients being followed up after definitive breast cancer treatment, most oncologists perform serial assessment of the tumor markers as part of routine follow-up of patients. The aim of this study was to evaluate the correlation between CA 15-3 levels and 18F-FDG PET/CT scan findings in patients with recurrent breast cancer. Methods: This was a cross-sectional study with data collected retrospectively. Patients being evaluated for breast cancer recurrence with 18F-FDG PET/CT imaging and CA 15-3 level were included. Evaluation of the association between CA 15-3 levels and 18F-FDG PET/CT scan findings was then done. Results: In total, 154 cases were included in this study; 62 patients had recurrence (positive) on the 18F-FDG PET/CT scans, whereas 92 patients had normal (negative) findings on follow-up 18F-FDG PET/CT scans. There was an association between CA 15-3 levels and the presence or absence of recurrence on 18F-FDG PET/CT scans, with 84.4% (27/32) of patients who had elevated CA 15-3 levels having disease recurrence on 18F-FDG PET/CT and 84.4% (27/32) of patients who had elevated CA 15-3 levels having disease recurrence on 18F-FDG PET/CT as well as a correlation with the burden of metastases. Most patients with disease recurrence on 18F-FDG PET/CT, however, had normal CA 15-3 levels. Conclusion: Higher CA 15-3 levels correlate with breast cancer recurrence on 18F-FDG PET/CT as well as with burden of metastasis. Notably, CA 15-3 levels within the reference range do not exclude breast cancer disease recurrence since more than half of patients with recurrence had normal CA 15-3 levels. 18F-FDG PET/CT should therefore be considered in patients with suspected breast cancer recurrence but normal CA 15-3 levels. Full Article
i 1,090 Publications and 5 Years Later: Is FAP-Targeted Theranostics Really Happening? By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Full Article
i Nuclear Imaging of Bispecific Antibodies on the Rise By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Bispecific antibodies (bsAbs) are engineered to target 2 different epitopes simultaneously. About 75% of the 16 clinically approved bsAbs have entered the clinic internationally since 2022. Hence, research on biomedical imaging of various radiolabeled bsAb scaffolds may serve to improve patient selection for bsAb therapy. Here, we provide a comprehensive overview of recent advances in radiolabeled bsAbs for imaging via PET or SPECT. We compare direct targeting and pretargeting approaches in preclinical and clinical studies in oncologic research. Furthermore, we show preclinical applications of imaging bsAbs in neurodegenerative diseases. Finally, we offer perspectives on the future directions of imaging bsAbs based on their challenges and opportunities. Full Article
i The Rise of Molecular Image-Guided Robotic Surgery By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Following early acceptance by urologists, the use of surgical robotic platforms is rapidly spreading to other surgical fields. This empowerment of surgical perception via robotic advances occurs in parallel to developments in intraoperative molecular imaging. Convergence of these efforts creates a logical incentive to advance the decades-old image-guided robotics paradigm. This yields new radioguided surgery strategies set to optimally exploit the symbiosis between the growing clinical translation of robotics and molecular imaging. These strategies intend to advance surgical precision by increasing dexterity and optimizing surgical decision-making. In this state-of-the-art review, topic-related developments in chemistry (tracer development) and engineering (medical device development) are discussed, and future scientific robotic growth markets for molecular imaging are presented. Full Article
i Navigating the Future of Prostate Cancer Care: AI-Driven Imaging and Theranostics Through the Lens of RELAINCE By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Full Article
i Is ChatGPT a Reliable Ghostwriter? By jnm.snmjournals.org Published On :: 2024-10-01T04:08:08-07:00 Full Article
i EU-Turkey Customs Union: Lessons for Brexit By www.chathamhouse.org Published On :: Mon, 05 Mar 2018 12:30:00 +0000 EU-Turkey Customs Union: Lessons for Brexit 15 March 2018 — 11:00AM TO 12:00PM Anonymous (not verified) 5 March 2018 Chatham House, London Turkey and the EU are preparing to open negotiations to modernize their 22 year old customs union and expand its scope beyond goods to include services, public procurement and a more liberal regime for agriculture. At the same time, the UK is debating whether to seek a customs union with the EU to facilitate a frictionless flow of goods and to prevent a hard border with Ireland. The speaker will discuss Turkey’s customs union modernization agenda and share his insights on the lessons for the UK’s future relationship with the EU.Attendance at this event is by invitation only. Full Article
i How to Explain Turkey's Early Elections By www.chathamhouse.org Published On :: Tue, 29 May 2018 09:30:00 +0000 How to Explain Turkey's Early Elections 14 June 2018 — 12:30PM TO 1:30PM Anonymous (not verified) 29 May 2018 Chatham House | 10 St James's Square | London | SW1Y 4LE On 24 June 2018 Turkey will go to the polls to vote in early presidential and parliamentary elections. Following a constitutional referendum last spring and against the backdrop of Turkey’s continued intervention in Syria and rising economic problems, President Erdogan has argued that an early election would help reduce uncertainty and set the country on a course to greater prosperity. The elections, likely to be held under the state of emergency in place since the attempted coup in July 2016, will also mark the country’s transformation from a parliamentary democracy to one with a powerful executive presidency.In this session, the speaker will discuss what other factors led President Erdogan to call for an early election, what the state of the opposition is and what we can expect from Turkey should Erdogan win another term.Attendance at this event is by invitation only. Full Article
i Can Cyprus Be Reunified? By www.chathamhouse.org Published On :: Fri, 29 Jun 2018 10:55:02 +0000 Can Cyprus Be Reunified? 18 July 2018 — 12:30PM TO 1:30PM Anonymous (not verified) 29 June 2018 Chatham House | 10 St James's Square | London | SW1Y 4LE The latest round of Cyprus peace negotiations to resolve the Cypriot issue broke down in Crans-Montana, Switzerland in July 2017. The speaker will offer the Turkish Cypriot perspective on future developments to reunifying the divided island.THIS EVENT IS NOW FULL AND REGISTRATION HAS CLOSED. Full Article
i Turkey Is on the Road to a Severe Economic Crisis By www.chathamhouse.org Published On :: Thu, 12 Jul 2018 08:07:30 +0000 Turkey Is on the Road to a Severe Economic Crisis Expert comment sysadmin 12 July 2018 The deteriorating state of the economy is President Erdoğan’s Achilles’ heel and the biggest threat to his currently unrivalled leadership. — A special one lira coin minted for the presidential inauguration of Recep Tayyip Erdogan. Photo: Getty Images. Fifteen days after Turkey’s parliamentary and presidential elections, Turkish President Recep Tayyip Erdoğan appointed a new government under radically enhanced executive powers granted by the constitution. He chose 16 loyalists and partisan figures to ensure that he remains front and centre in decision-making and policy formation.Most notably, Erdoğan sacrificed the former deputy prime minister and ex-Merrill Lynch chief economist Mehmet Şimşek in favour of his inexperienced son-in-law Berat Albayrak as finance and treasury minister to manage the fragile economy. Whether he has the competence to placate jittery financial markets and foreign investors is debatable.Erdoğan will prioritize short-term growth at all costs to the detriment of macroeconomic and financial stability. That entails foregoing interest rate hikes needed to contain runaway double-digit inflation and to support a plummeting lira that depreciated nearly 20 per cent this year. It also means loosening the purse strings, flooding the markets with cheap credit and sponsoring rampant construction and mega-infrastructure projects.True to his promise, he has appropriated to himself, by presidential decree, the right to hire the central bank governor, deputies and monetary policy committee members for a four-year term. This completes the politicization of the once-respected and independent central bank and is in line with his unorthodox monetary views that higher interest rates equates with higher inflation.Erdoğan associates progress with gleaming high-rise buildings, gargantuan infrastructure show-pieces and elevated growth rates. He is spiking the fuel to boost the speed of the sputtering mid-sized Audi-style Turkish economy to achieve superior Ferrari growth rates. As any mechanic knows, these tactics are unsustainable in the long term. Eventually, the engine will burn out.He does not seem to appreciate that Turkey’s growth model requires an overhaul to join the league of rich economies. It is too reliant on consumer spending and government-sponsored infrastructure and construction projects funded by speculative financial flows rather than on sustained private investment and exports.Net result: the corporate sector’s foreign-exchange liabilities have climbed to a record $328 billion as of the end of 2017. When netted against foreign-exchange assets, it is still a worrying $214 billion. Its US dollar and euro debt pile has more than doubled since 2008, 80 per cent of which is held by domestic banks. Given these acute balance-of-payments conditions, it is not farfetched that Turkey may impose capital controls in the short-to-medium term to restrict the outflow of foreign assets. At $50 billion, the current account deficit – defined as the sum of the trade balance and financial flows – is not even covered by the central bank’s net international reserves at nearly $45 billion.Unsurprisingly, some major Turkish companies are negotiating with their bondholders to restructure their sizeable foreign loan obligations as lira devaluation increases the financial burden. Should a significant number of Turkish corporates default on their foreign obligations, this would reverberate across the Turkish economy, cause mass consumer panic, shake the confidence of international financial markets and potentially lead to a crisis within the Turkish financial system and to a deep and prolonged economic recession. Revealingly, Erdoğan’s nationalist allies, the Nationalist Movement Party (MHP), refused to join his government. Perhaps Devlet Bahçeli, the MHP leader, learned the lessons of the 2001 financial crisis as a member of a three-party government. So he is opting to project influence from the outside, rather than risk being tainted with responsibility for an economic downturn.Turkey’s president is doubling down on his singular approach to governance irrespective of the fallout. Notwithstanding his current political dominance, the deteriorating state of the economy is his Achilles’ heel and the biggest threat to his currently unrivalled leadership. Full Article
i Taking Stock of Turkey's Trade Policy By www.chathamhouse.org Published On :: Thu, 23 Aug 2018 15:50:01 +0000 Taking Stock of Turkey's Trade Policy 11 September 2018 — 5:00PM TO 6:15PM Anonymous (not verified) 23 August 2018 Chatham House | 10 St James's Square | London | SW1Y 4LE As the only large economy outside of the EU with a customs union agreement, Turkey has a unique trade policy. Amid domestic economic challenges, Turkey’s trade minister, Ruhsar Pekcan, will discuss prospects for upgrading the EU-Turkey customs union. She will also discuss relations between the UK and Turkey and outline strategies for post-Brexit trade.Attendance at this event is by invitation only. Full Article
i EU-Turkey Customs Union: Prospects for Modernization and Lessons for Brexit By www.chathamhouse.org Published On :: Mon, 26 Nov 2018 15:20:01 +0000 EU-Turkey Customs Union: Prospects for Modernization and Lessons for Brexit 12 December 2018 — 12:30PM TO 1:30PM Anonymous (not verified) 26 November 2018 Chatham House | 10 St James's Square | London | SW1Y 4LE Turkey and the EU have been in a customs union since 1995. Both sides recognize that the current agreement is in need of modernization and have agreed to open negotiations to expand its scope to include services, public procurement, agriculture and other elements that would help bring it into the 21st century.At the same time, the UK Parliament is debating whether to approve the agreement on the UK’s withdrawal from the EU. It includes a backstop which – if triggered – would keep the UK and the EU in a single customs territory which would limit the disruption of withdrawal but hamper Britain’s ability to pursue an independent trade policy. The political declaration proposes building on this customs arrangement as the basis for the future relationship.In this context, the speaker will discuss the current EU-Turkey customs union arrangement and its shortcomings, examine the prospects for its modernization and share his insights on the lessons for the UK’s future trading relationship with the EU.The event will launch the briefing paper ‘EU-Turkey Customs Union: Prospects for Modernization and Lessons for Brexit’.Attendance at this event is by invitation only. Full Article
i Turkey's Foreign Policy in the Middle East By www.chathamhouse.org Published On :: Mon, 29 Apr 2019 09:50:01 +0000 Turkey's Foreign Policy in the Middle East 14 May 2019 — 12:30PM TO 1:30PM Anonymous (not verified) 29 April 2019 Chatham House | 10 St James's Square | London | SW1Y 4LE Turkey is cooperating closely with Russia to secure its border with Syria and to encourage a long-term political resolution to the Syrian conflict. Its efforts have staved off a humanitarian catastrophe in the northern Syrian province of Idlib and initiated the trilateral ‘Astana Process’ with Russia and Iran as the primary framework to settle the future of Syria.By contrast, Turkey and the US disagree on a range of important issues including Turkey’s purchase of the Russian-made S-400 air missile defence systems and American support for the PKK-affiliated Peoples’ Protection Units (YPG) in Syria.In this session, the speaker will outline Turkey’s foreign policy priorities in the Middle East and share his country’s perspectives on the US and Russian policies in that region.Attendance at this event is by invitation only. Full Article
i Turkey in 2020 and Beyond: What Lies Ahead for Turkish Politics? By www.chathamhouse.org Published On :: Wed, 06 Nov 2019 11:10:01 +0000 Turkey in 2020 and Beyond: What Lies Ahead for Turkish Politics? 25 November 2019 — 12:30PM TO 1:30PM Anonymous (not verified) 6 November 2019 Chatham House | 10 St James's Square | London | SW1Y 4LE Turkey witnessed some major developments over the last year. In August 2018, the dramatic Lira devaluation caused the Turkish economy to go into recession. In the 2019 local elections, which took place during the economic downturn, the Republican Peoples’ Party (CHP) mayoral candidates took control of Ankara and Istanbul after 25 years of dominance by the ruling Justice and Development Party (AKP).The election results might lead to a rethink of the AKP leadership and consequences on Turkish politics will depend on Erdoğan’s interpretation of this reversal of his political fortune.Will this affect the long-standing alliance between AKP and MHP that has characterised Turkish foreign policy for the past few years? What impact will this have on both the domestic and international level? Finally, will Turkey’s recent incursion into Syria have lasting effect on the country’s alliances with other powers and its standing?In this context, the speaker will analyse the significance of these changes and the future trajectory of Turkish politics, economics and foreign policy. Full Article
