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Purpose: We aimed to investigate the potential of [ 68 Ga]Ga-FAPI-04 PET/CT as an alternative diagnostic and theranostic tool in well-differentiated NETs refractory to [ 177 Lu]Lu-DOTATATE therapy., Methods: Patients who received at least two cycles of [ 177 Lu]Lu-DOTATATE therapy for metastatic NETs and progressed under treatment were included. All patients had performed [ 68 Ga]Ga-DOTATATE and [ 68 Ga]Ga-FAPI-04 PET/CT within 3 weeks. The number of PET-positive lesions related to NETs and tumor sites was documented. Mann-Whitney U and chi-square tests were used to compare SUVmax levels of tracers and the number of detected metastases., Results: Twelve patients (7 male, 5 female) who met the eligibility criteria were included in the study. Ten patients had grade 1-2 NET of various origins, and two had paraganglioma and pheochromocytoma. One hundred ninety-eight of 230 lesions (86%) were SSTR positive with a median SUVmax of 16.6 (2.2-76.5), and 88 of 230 lesions (38.2%) were [ 68 Ga]Ga-FAPI-04 positive with a median SUVmax of 5.1 (2.3-21). Median SUVmax level and detected number of tumors were significantly higher in [ 68 Ga]Ga-DOTATATE PET/CT (p=<0.001). [ 68 Ga]Ga-FAPI-04 PET/CT was completely (n:2) or almost completely (n:3) negative in 5 (42%) patients. Two (17%) patients had flip-flop SSTR/FAPI uptake in tumors. In four patients (33%), tumor uptake or the number of PET-positive lesions was inferior in [ 68 Ga]Ga-FAPI-04 PET/CT. In only one patient (8%), tumor uptakes were higher in [ 68 Ga]Ga-FAPI-04 PET/CT. Low-dose [ 177 Lu]Lu-FAPI-46 dosimetry was performed on the FAPI-dominant patient; absorbed radiation doses per GBq were 1.26 Gy, 0.36 Gy, 0.32 Gy, and 0.2 Gy for kidneys, liver, spleen, and total body, respectively. The mean absorbed dose per GBq was 0.33 Gy for liver mass and 0.41 Gy for metastatic lymph nodes., Conclusion: Our preliminary results demonstrated that [ 68 Ga]Ga-FAPI-04 PET/CT mainly failed in well-differentiated NETs refractory to [ 177 Lu]Lu-DOTATATE therapy and had a limited role as an alternative diagnostic or theranostic agent. Further investigations with a larger patient population are required to determine the impact of [ 68 Ga]Ga-FAPI-04 PET/CT on NETs., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: We aimed to examine the relationship between tumor marker (Cancer Antigen 15-3 [CA15-3] and Carcinoembryonic Antigen [CEA]) positivity and metabolic (standardized uptake value [SUV]) and volume-based (metabolic tumor volume [MTV] and total lesion glycolysis [TLG]) 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) parameters of the primary tumor and lymph node., Material and Methods: Our study group consisted of 91 female patients, who underwent PET/CT between January 2018 and December 2019 in our clinic with a diagnosis of breast cancer. These patients had no distant metastasis or supraclavicular and internal mammarian lymph node metastasis. MTV, TLG, and SUVmax values were obtained from the primary breast lesion and axillary lymph nodes., Results: The mean age of the patients, who participated in the study, was 52,19±14,57, and the median values of the primary tumor MTV, TLG, and total MTV values were found to be statistically significantly higher in those who were CEA positive compared to those who were CEA negative. The median SUVmax value of the axillary lymph node was found to be statistically significantly higher in those who were CEA positive compared to those who were CEA negative (p: 0.004). There was no statistically significant difference between the other parameters., Conclusion: There was a statistically significant correlation between CEA positivity in preoperative primary breast cancer and primary tumor volume MTV, TLG, and total MTV values, which are volume-based PET parameters. CEA positivity evaluation may indicate increased tumor load in preoperative., Key Words: Breast Cancer, CEA, CA 15-3, MTV, TLG, FDG PET/CT.

Aim: In this study, we aimed to investigate the roles of volume based 18F-FDG PET/CT parameters, CA19-9 levels, and complete blood count parameters in predicting survival in patients with unresectable and/or metastatic pancreatic ductal adenocarcinoma., Materials and Method: Fifty-seven pancreatic cancer patients who were followed in University of Health Sciences Gazi Yasargil Training and Research Hospital between January 2017 and June 2020, declined surgical treatment and/or radiation therapy or had medically inoperable, unresectable, or metastatic disease, and received chemotherapy were included in the study. 18F-FDG PET/CT images of patients were evaluated and calculated metabolic tumor volume (MTV) and total lesion glycolysis (TLG) parameters were compared with CA19-9 levels and complete blood count parameters. Patients were assessed in two groups as survivors and non-survivors., Results: Total MTV and total TLG on 18F-FDG PET/CT were significantly higher among non-survivors than survivors (p: 0.023 and 0.034, respectively). Multivariate Cox regression analysis revealed that TLG higher than 46 g/ml.cm3, MTV higher than 11.02 cm3 (OR 0.987, 95%CI 0.976-0.999, p:0.029 and OR 0.246, 95%CI 0.089- 0.685, p: 0.007, respectively) and elevated MPV (OR:0.785, 95% CI 0,574-0.976, p:0.042) were independent prognostic factors for predicting mortality., Conclusion: TLG >46 g/ml.cm3 and MTV >11.02 cm3 in 18F-FDG PET/CT and elevated MPV in complete blood count are independent prognostic factors for predicting mortality in patients with unresectable or metastatic pancreatic cancer who are treated with chemotherapy., Key Words: Pancreatic cancer, Metabolic tumor volume, Total lesion glycolysis, Mean platelet volume.

To evaluate ICIs related dry eye and dry mouth in nivolumab therapy, 24 patients receiving nivolumab (group 1), 30 patients in remission without treatment for 6 months (group 2), 30 healthy participants (group 3) were cross-sectionally examined. Schirmer's 1, 2, TSH blood tests, serological analysis, salivary flow scintigraphy and minor-salivary gland biopsy were performed. Schirmer's tests were performed with anesthetic (1) and without anesthetic (2). Schirmer's scores were lower in group 1 with more frequent reduced tear production ( p  < 0.001). TSH levels negatively correlated with Schirmer's scores. Functional insufficiency was detected by salivary flow scintigraphy in 7 out of 10 patients with Schirmer's test positivity. In Schirmer's positive patients, lymphocytic sialadenitis was confirmed in 4 patients (focus score > 1) and CD4 T lymphocyte precipitation was observed in 6 patients. Nivolumab therapy may be associated with ICIs related immune sicca.

At present a large number of the renal transplantations are being performed from the deceased donors. The success of these transplantations depends on the viability of the deceased donor kidneys. The aim of this study was to investigate the reliability of scintigraphic estimation of function of deceased donor kidneys by comparing the histopathologic and scintigraphic findings. Ten rats were included in the study (2-3 months old, 250-300 g, all male). Control scintigraphy was performed to all the rats by injection of 37 MBq Tc-99m DTPA from the tail vein in a dynamic manner. Brain death of the rats was achieved by inflation of a Fogartys catheter in the cranial cavity. Immediately, after brain death confirmation, dynamic renal scintigraphy was performed with the same parameters of control scintigraphy. In the comparison of scintigraphies obtained in the before and just after brain death period, there was impairment of tubular functions, concentration and excretion functions in the postbrain death period. In the immediate postbrain death period, there was a significant elevation in the glomerular filtration rate and time to maximum concentration values. In the histopathological evaluation of the kidney samples in the postbrain death period, there were definitive findings of tubular impairment. Dynamic renal scintigraphy also demonstrated definite impairment of tubular system and tubular functions in the deceased donor kidneys. This could explain the reason of the increased frequency of acute tubular necrosis seen among deceased donor kidneys.

Purpose . This study was designed to investigate the effects of peripheral nerve block methods, applied through unilateral spinal anaesthesia on elderly patients to undergo total knee arthroplasty, on perioperative hemodynamic parameters and postoperative analgesia period. Materials and Method . 60 patients were randomly divided into two groups in the study. In group USA spinal anaesthesia was performed. In group PCS it was applied on psoas compartment block and sciatic nerve block. Results . Significantly higher intraoperative 60th and 90th minute mean arterial pressure values were ascertained in the PCS group compared to the USA group. The decrease observed in the 5th, 10th, and 20th minute MAP values in the USA group was statistically significant according to the control MAP value. Concerning within group comparisons, the decrease in 5th, 10th, and 20th minute heart rate values in the USA group was statistically significant compared with the control measurement value. The mean beginning time of sensory and motor blocks in the PCS group was found to be at a significantly advanced level compared with that in the USA group. Conclusions . The PCS block technique using bupivacaine hydrochloride ensured a higher haemodynamic efficiency in the perioperative period in high-risk elderly patients undergoing total knee arthroplasty. This trial is registered with ClinicalTrials.gov Identifier: NCT03021421., Competing Interests: The authors declare that they have no competing interests.

Purpose: To evaluate the tibiotalar joint capacity and the localisation, frequency and amount of extravasation in patients with extraarticular contrast material leakage into adjacent synovial compartments on ankle magnetic resonance (MR) arthrography., Materials and Methods: Sites of extravasation were determined in the ankle MR arthrograms of 69 patients. Thirty-four patients without extraarticular contrast material leakage into locations unrelated to the injection path were included as a control group. Volumetric measurements of extraarticular contrast material leakage and the tibiotalar joint capacity were performed on a three dimensional (3D) volume measurement workstation., Results: Extravasation of contrast material occurred through the anterior, posterior, and anterolateral recesses of the tibiotalar joint. The most common site of extravasation was along the flexor hallucis longus tendon synovium (24.6%). The amount of extravasation was significantly higher in patients with ankle osteochondritis dissecans (OCD) than in patients with a different diagnosis (p=0.039). Loose bodies were detected in all OCD's patients with insufficient tibiotalar joint distention., Conclusions: Connections between the ankle joint and neighboring synovial compartments can decrease the diagnostic value of ankle MR arthrography examinations due to inadequate joint distention. Large injection volumes should be used for ankle MR arthrography of patients with OCD (especially OCD's patients with loose body) and impingement syndrome., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

A retrospective evaluation was performed of 36 patients (25 males and 11 females; average age, 44 years) with displaced acetabular fractures who were treated with a modified Stoppa approach. Fractures included 18 anterior columns, 2 both columns, 8 anterior columns with posterior hemitransverse, 6 transverse, and 2 T-type, according to the Judet and Letournel classification. Range of motion, Harris Hip Scores, and Merle d'Aubigné scores were evaluated. Pre- and postoperative measurements taken included displacements and gaps on axial, coronal, and sagittal computed tomography (CT) images and postreduction quality assessed radiologically. Mean follow-up was 14.7 months. Mean perioperative bleeding was 970 cc (range, 800-1250 cc). Mean Harris Hip Score was 77.9, mean Merle d'Aubigné score was 16.4, mean flexion was 105.2°, and mean extension was 16.9°. Anatomical reduction of the acetabular fracture was achieved in 29 (80.5%) patients; it was satisfactory in 5 (13.8%) and poor in 2 (5%). Mean preoperative displacements on axial, coronal, and sagittal sections were 4.1, 3.6, and 3.1 mm, respectively, and mean postoperative displacements were 0.2, 0.3, and 0.2 mm, respectively. Mean preoperative gap distance was 14.5 mm, and mean postoperative gap distance was 1.1 mm. Postoperative foot drop was observed in 2 patients, obturator nerve damage in 1, partial iliac vein damage in 1, and avascular necrosis of the femoral head in 1. Despite a steep learning curve, the modified Stoppa approach is a good alternative to the ilioinguinal approach. It can be used to treat many complex acetabular fractures., (Copyright 2016, SLACK Incorporated.)

Purpose: Platelet-rich plasma (PRP) includes growth factors and proteins that accelerate and stimulate bone regeneration and tissue recovery. The aim of this study was to evaluate the effects of PRP on fracture healing in terms of biomechanics and histology., Methods: Seventy female rats were included in this experimental study. They were divided into three groups: Group I (no PRP, n = 30), Group II (PRP added, n = 30) and Group III (control, n = 10). The left femurs of the rats in Groups I and II were osteotomized and fixed by K-wires. Although no additional intervention was performed on Group I rats, PRP was applied to the fracture sites of Group II rats. The remaining ten rats were used as the control group of the biomechanical test (Group III). In the fourth week, nine femurs from Group I and ten femurs from Group II, and in the ninth week, nine femurs from each group were removed, and bone recovery was assessed histologically according to Modified Lane-Sandhu histological scoring criteria. Three-point bending test was applied to femurs for biomechanical evaluation in the ninth week., Results: Histological healing was found to be significantly higher in Group II than in Group I (p < 0.05). Furthermore, biomechanical test results showed that healing quantity and bone strength were significantly better in Group II than in Group I (p < 0.05)., Conclusion: PRP is a widely studied material in the physiology of fracture healing. The results of this study demonstrated the ameliorative biomechanical effects of PRP on fracture healing, in addition to accelerating the histological union of fractures. In the light of these results, PRP could be a viable alternative to accelerate the healing of fractures, late unions or non-unions., Level of Evidence: Prospective comparative study, Level II.