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Objective: Chronic low back pain, affecting up to 58% of the population, often stems from intervertebral disc degeneration. Although magnetic resonance imaging (MRI) is commonly used for diagnostics, challenges arise in pinpointing pain sources due to frequent asymptomatic findings. Single-photon emission tomography (SPECT) integrated with computed tomography (CT) offers a promising approach, enhancing sensitivity and specificity., Methods: In this retrospective study, spanning 2016 to 2022, SPECT/CT imaging was performed on 193 patients meeting specific criteria. We correlated SPECT/CT findings with lumbar MRI results, utilizing Pfirrmann and Rajasekaran classifications for disc degeneration and endplate damage assessment. Logistic regression analysis adjusted for age and sex evaluated associations., Results: Of 965 spinal levels assessed, SPECT/CT positivity strongly correlated with higher Pfirrmann grades and Rajasekaran endplate classifications. Notably, Modic changes (MCs) on MRI displayed a nonsignificant relationship with SPECT/CT positivity. Significant associations were observed in older patients with positive MCs, Pfirrmann grades, and Rajasekaran classifications., Conclusions: This comprehensive study, the largest of its kind, establishes a significant link between SPECT/CT positivity and advanced lumbar degenerative changes. Higher Pfirrmann grades and increased Rajasekaran endplate damage demonstrated substantial correlations with SPECT/CT positivity. Notably, MCs did not exhibit such association. Our findings underscore the potential of SPECT/CT in identifying pain generators in degenerative spinal conditions, offering valuable insights for future interventions., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Abstract: A 41-year-old man was admitted to hospital due to sudden loss of consciousness. A regional brain perfusion SPECT/low-dose CT showed abnormal 99m Tc-HMPAO uptake in the right hemisphere frontotemporally without any other supratentorial or infratentorial radiotracer uptake. A neuropathological examination disclosed a middle cerebral artery aneurysm. Presumably, vessel wall fibrosis prevented collapse. Multiple transmural dissections of the fibrotic aneurysmal wall were the source of the subarachnoid hemorrhage. This interesting image shows that radiotracer accumulation in cerebral artery aneurysms can be a diagnostic pitfall in brain death scintigraphy assessment., Competing Interests: Conflicts of interest and sources of funding: none declared. Ethics approval: This article was approved by the hospital’s ethics committee (no. 02/0/2023). No informed consent was required or obtained. Tissues and images of the anonymized subject were investigated with respect to privacy. No treatment, diagnostic intervention, or genetic analysis was performed. The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: AI models have shown promise in performing many medical imaging tasks. However, our ability to explain what signals these models have learned is severely lacking. Explanations are needed in order to increase the trust of doctors in AI-based models, especially in domains where AI prediction capabilities surpass those of humans. Moreover, such explanations could enable novel scientific discovery by uncovering signals in the data that aren't yet known to experts., Methods: In this paper, we present a workflow for generating hypotheses to understand which visual signals in images are correlated with a classification model's predictions for a given task. This approach leverages an automatic visual explanation algorithm followed by interdisciplinary expert review. We propose the following 4 steps: (i) Train a classifier to perform a given task to assess whether the imagery indeed contains signals relevant to the task; (ii) Train a StyleGAN-based image generator with an architecture that enables guidance by the classifier ("StylEx"); (iii) Automatically detect, extract, and visualize the top visual attributes that the classifier is sensitive towards. For visualization, we independently modify each of these attributes to generate counterfactual visualizations for a set of images (i.e., what the image would look like with the attribute increased or decreased); (iv) Formulate hypotheses for the underlying mechanisms, to stimulate future research. Specifically, present the discovered attributes and corresponding counterfactual visualizations to an interdisciplinary panel of experts so that hypotheses can account for social and structural determinants of health (e.g., whether the attributes correspond to known patho-physiological or socio-cultural phenomena, or could be novel discoveries)., Findings: To demonstrate the broad applicability of our approach, we present results on eight prediction tasks across three medical imaging modalities-retinal fundus photographs, external eye photographs, and chest radiographs. We showcase examples where many of the automatically-learned attributes clearly capture clinically known features (e.g., types of cataract, enlarged heart), and demonstrate automatically-learned confounders that arise from factors beyond physiological mechanisms (e.g., chest X-ray underexposure is correlated with the classifier predicting abnormality, and eye makeup is correlated with the classifier predicting low hemoglobin levels). We further show that our method reveals a number of physiologically plausible, previously-unknown attributes based on the literature (e.g., differences in the fundus associated with self-reported sex, which were previously unknown)., Interpretation: Our approach enables hypotheses generation via attribute visualizations and has the potential to enable researchers to better understand, improve their assessment, and extract new knowledge from AI-based models, as well as debug and design better datasets. Though not designed to infer causality, importantly, we highlight that attributes generated by our framework can capture phenomena beyond physiology or pathophysiology, reflecting the real world nature of healthcare delivery and socio-cultural factors, and hence interdisciplinary perspectives are critical in these investigations. Finally, we will release code to help researchers train their own StylEx models and analyze their predictive tasks of interest, and use the methodology presented in this paper for responsible interpretation of the revealed attributes., Funding: Google., Competing Interests: Declaration of interests OL, DYS, HCL, CS, DRW, GSC, AH, YM, YL, NH and BB are current or past Google employees and may own Alphabet stock. IT, CRB, and CL are paid consultants to Google. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

In this paper, we study the well-posedness properties of a stochastic rotating shallow water system. An inviscid version of this model has first been derived in Holm (Proc R Soc A 471:20140963, 2015) and the noise is chosen according to the Stochastic Advection by Lie Transport theory presented in Holm (Proc R Soc A 471:20140963, 2015). The system is perturbed by noise modulated by a function that is not Lipschitz in the norm where the well-posedness is sought. We show that the system admits a unique maximal solution which depends continuously on the initial condition. We also show that the interval of existence is strictly positive and the solution is global with positive probability., Competing Interests: Conflict of interestBoth authors declare no conflict of interest., (© The Author(s) 2023.)

Pancreatic polypeptide cell hyperplasia (PPY-H) is a multiplication of the neuroendocrine cells producing pancreatic polypeptide (PPY). The development and role of PPY-H and its corresponding clinical and imaging findings still need to be fully elucidated. We present 12 cases of PPY-H accompanying pancreatic neuroendocrine neoplasias (NEN). PPY-H was analyzed with the help of immunohistochemistry and confocal microscopy; preoperative clinical data and imaging studies were evaluated retrospectively. We observed PPY-H emerging from pancreatic ducts, and in some cases, we observed simultaneous NKX6.1 positivity in ducts and PPY-H. Additional clinical-pathological correlations suggests that gastrointestinal symptoms (e.g., epigastric pain and cholestasis) could be more related to PPY-H than to NEN hormonal production. In particular cases, SSTR2 expression was strong in PPY-H and correlated with distinguishable accumulation of activity next to NEN on 99 m Tc EDDA/Hynic-TOC SPECT/CT. In another case, 18 F-FDG-PET/CT showed increased metabolic activity in the area of PPY-H surrounding NEN. Our data suggest that PPY-H originates in the lining of pancreatic ducts. Confirmation of SSTR2 in PPY-H, using immunohistochemistry, suggests the utility of 99 m Tc EDDA/Hynic-TOC or 68 Ga-DOTA radiotracers in clinical diagnostics; however, studies with larger cohort are needed., Competing Interests: Declaration of Competing Interest Authors declare no conflicts of interest. Only the named authors contributed to the draft and writing of the manuscript. This work was supported by MH CZ – DRO (Thomayer University Hospital – TUH, 00064190)., (Copyright © 2023 Elsevier GmbH. All rights reserved.)

Introduction and Purpose: With current imaging modalities and diagnostic tests, identifying pain generators in patients with non-specific chronic low back pain (CLBP) is difficult. There is growing evidence of the effectiveness of SPECT/CT examination in diagnosing the source of pain in the spine. The study aims to investigate the effect of posterior interbody fusion on a single-level SPECT/CT positive lumbar degenerative disc disease (DDD)., Material and Methods: This is a prospective study of patients with chronic low back pain (CLBP) operated on for a single-level SPECT/CT positive DDD. Primary outcomes were changes in visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). Secondary outcomes were complications, return to work, satisfaction and willingness to re-undergo surgery., Results: During a 3-year period, 38 patients underwent single-level fusion surgery. The mean preoperative VAS score of 8.4 (± 1.1) decreased to 3.2 (± 2.5, p < 0.001) and the mean preoperative ODI of 51.5 (± 7.3) improved to 20.7 (± 14.68, p < 0.001) at a 2-year follow-up. A minimum clinically important difference (30% reduction in VAS and ODI) was achieved in 84.2% of patients. Some 71% of patients were satisfied with the surgery results and 89.4% would undergo surgery again. There were four complications, and two patients underwent revision surgery. Some 82.9% of patients returned to work., Conclusion: Fusion for one-level SPECT/CT positive lumbar DDD resulted in substantial clinical improvement and satisfaction with surgical treatment. Therefore, SPECT/CT imaging could be useful in assessing patients with CLBP, especially those with unclear MRI findings., Trial Registration: ClinicalTrials.gov Identifier: NCT04876586., (© 2023. The Author(s).)

Confidence in experimental results is critical for discovery. As the scale of data generation in genomics has grown exponentially, experimental error has likely kept pace despite the best efforts of many laboratories. Technical mistakes can and do occur at nearly every stage of a genomics assay (i.e., cell line contamination, reagent swapping, tube mislabelling, etc.) and are often difficult to identify post-execution. However, the DNA sequenced in genomic experiments contains certain markers (e.g., indels) encoded within and can often be ascertained forensically from experimental datasets. We developed the Genotype validation Pipeline (GenoPipe), a suite of heuristic tools that operate together directly on raw and aligned sequencing data from individual high-throughput sequencing experiments to characterize the underlying genome of the source material. We demonstrate how GenoPipe validates and rescues erroneously annotated experiments by identifying unique markers inherent to an organism’s genome (i.e., epitope insertions, gene deletions, and SNPs).

We prove the existence of a unique global strong solution for a stochastic two-dimensional Euler vorticity equation for incompressible flows with noise of transport type. In particular, we show that the initial smoothness of the solution is preserved. The arguments are based on approximating the solution of the Euler equation with a family of viscous solutions which is proved to be relatively compact using a tightness criterion by Kurtz., (© The Author(s) 2022.)

Genome-wide, little is understood about how proteins organize at inducible promoters before and after induction and to what extent inducible and constitutive architectures depend on cofactors. We report that sequence-specific transcription factors and their tethered cofactors (e.g., SAGA [Spt-Ada-Gcn5-acetyltransferase], Mediator, TUP, NuA4, SWI/SNF, and RPD3-L) are generally bound to promoters prior to induction ("poised"), rather than recruited upon induction, whereas induction recruits the preinitiation complex (PIC) to DNA. Through depletion and/or deletion experiments, we show that SAGA does not function at constitutive promoters, although a SAGA-independent Gcn5 acetylates +1 nucleosomes there. When inducible promoters are poised, SAGA catalyzes +1 nucleosome acetylation but not PIC assembly. When induced, SAGA catalyzes acetylation, deubiquitylation, and PIC assembly. Surprisingly, SAGA mediates induction by creating a PIC that allows TFIID (transcription factor II-D) to stably associate, rather than creating a completely TFIID-independent PIC, as generally thought. These findings suggest that inducible systems, where present, are integrated with constitutive systems., (© 2022 Mittal et al.; Published by Cold Spring Harbor Laboratory Press.)

Background: Numerous studies have reported an increase in mental disorders during the COVID-19 pandemic, but the exact reasons for this development are not well understood. In this study we investigate whether pandemic-related occupational and financial changes (e.g., reduced working hours, working from home, financial losses) were associated with increased symptoms of depression and anxiety compared with the situation before the pandemic., Methods: We analyzed data from the German National Cohort (NAKO) Study. Between May and November 2020, 161 849 study participants answered questions on their mental state and social circumstances. Their responses were compared with data from the baseline survey before the pandemic (2014-2019). Linear fixed-effects models were used to determine whether individual changes in the severity of symptoms of depression (PHQ-9) or anxiety (GAD-7) were associated with occupational/ financial changes (controlling for various covariates)., Results: The prevalence of moderate or severe symptoms of depression and anxiety increased by 2.4% and 1.5%, respectively, during the COVID-19 pandemic compared with the preceding years. The mean severity of the symptoms rose slightly. A pronounced increase in symptoms was observed among those who became unemployed during the pandemic (+ 1.16 points on the depression scale, 95% confidence interval [0.91; 1.41], range 0-27). Increases were also seen for reduced working hours with no short-time allowance, increased working hours, working from home, insecurity regarding employment, and financial strain. The deterioration in mental health was largely statistically explained by the occupational and financial changes investigated in the model., Conclusion: Depressive symptoms and anxiety disorders increased slightly in the study population during the first year of the COVID-19 pandemic. Occupational and financial difficulties were an essential contributory factor. These strains should be taken into account both in the care of individual patients and in the planning of targeted prevention measures.

Objectives: We aimed to study whether or not various dental antiseptic agents affect the viability and proliferation of human periodontal ligament cells (PDLCs)., Materials and Methods: Human PDLCs were isolated from a total of 10 surgically extracted impacted third molars and were.cultured in-vitro . The cells were exposed to commonly used dental antiseptics, including chlorhexidine, cetylpyridinium chloride, triclosan, povidone-iodine and sodium bicarbonate for ultra-short-term (10, 20, 30 sec), short-term (10, 20, 30 min) and long-term (24, 48 h) at various concentrations. Cell morphology was observed with light microscopy. Cell viability was studied with impedimetric real-time xCELLigence and resazurin-based alamarBlue® assays. We used one-way ANOVA with Tukey's and Bonferroni test (p < 0.05) for statistical analysis., Results: Both alamarBlue® and xCELLigence analysis results were in agreement that ultra-short-term contact with cetylpyridinium chloride ≥ 0.01 mg/ml, chlorhexidine ≥ 1 mg/ml, triclosan ≥ 1 mg/ml and povidone-iodine ≥ 1 mg/ml as well as long-term exposure to cetylpyridinium chloride ≥ 0.001 mg/ml, chlorhexidine ≥ 0.01 mg/ml, triclosan ≥ 1 mg/ml, povidone-iodine ≥ 1 mg/ml and sodium bicarbonate ≥ 10 mg/ml was able to reduce the viability of human PDLCs significantly. According to the half-maximal inhibitory concentration (IC50) the rank of cytotoxicity was cetylpyridinium chloride > chlorhexidine > triclosan > povidone-iodine > sodium bicarbonate., Conclusions: Our findings suggest that the tested antiseptic agents were cytotoxic to human PDLCs at lower than practically applied concentrations in dental interventions., (© 2021 The Authors.)

Background: Although platelet-released growth factors (PRGF) can protect cells from inflammation or oxidative stress condition, their therapeutic efficacy for articular cartilage degeneration has been little discussed. The purpose of this study was to investigate the effect of PRGF on human articular chondrocytes under inflammatory conditions., Methods: Human C-28/I2 chondrocytes were treated with PRGF, the production from liquid-preserved platelet concentrates obtained by platelet apheresis from human volunteers. Cell proliferation/viability, and collagen type (COL) II and SOX9 gene expressions for chondrogenesis were evaluated with different PRGF concentrations. Additionally, in vitro inflammatory condition was mimicked by stimulating the cells with tumor necrosis factor (TNF)-α. Under inflammation, cell viability, TNF-α gene expression, and the protein levels of cytokines including TNF-α, interleukin (IL)-1β and -6, and vascular endothelial growth factor (VEGF) angiogenesis marker, were compared with and without PRGF treatment., Results: Cell proliferation/viability, and SOX9 and COL II expressions in chondrocytes stimulated with 10% PRGF were significantly higher than without treatment. Cell viability with 10% PRGF was also statistically higher than without treatment under inflammation. The TNF-α gene expression with 10% PRGF was significantly lower than without treatment under inflammation. The protein levels of endogenous TNF-α with 5% PRGF, IL-1β with 10% PRGF, and IL-6 with 5 and 10% PRGF in chondrocytes were significantly lower than untreated ones under inflammation. The VEGF-protein level in chondrocytes stimulated with 20% PRGF was significantly higher than without treatment under inflammation, while there was no significant difference between with 10% PRGF and without treatment., Conclusions: Our results reveal that optimal PRGF treatment leads to the increase of chondrocyte proliferation/viability and chondrogenic markers, while it increased cell viability but reduced IL-1β and IL-6 expressions under inflammatory condition, suggesting the therapeutic role of PRGF for protection from articular cartilage degeneration through anti-inflammatory effects., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Background and Objective: Periodontal ligament cells (PDLCs) are an important source for periodontal tissue healing and regeneration. Proper cell adhesion is a key for survival of anchorage-dependent cells and also initiates further intracellular signals for essential cellular functions. We aimed to test 3 different synthetic conjugates with integrin-binding RGD sequence (SAK-c[RGDfC], AK-c[RGDfC], and SAK-opn on the adhesion of human PDLCs and subsequent events including proliferation, migration, behavior of cell surface molecules, and osteogenic differentiation., Materials and Methods: Synthetic peptides were synthesized by solid-phase technique and attached to branched chain polymeric polypeptides via thioether linkage. Simple adsorption method was used to coat tissue culture plastic or electric arrays. PDLCs were isolated from 24 surgically extracted human third molars. Cell adhesion and proliferation were measured with real-time impedimetric xCELLigence SP system. Cell migration assay was performed with Ibidi ® Culture inserts. Cell surface antigens were detected using flow cytometry analysis. Osteogenic differentiation was assessed with alkaline phosphatase (ALP) assay and Alizarin Red S staining, and real-time qPCR was performed to analyze the osteoblast-related gene expression. Osteogenic differentiation and adipogenic differentiation of PDLCs were monitored by real-time Electrical Cell-Substrate Impedance Spectroscopy (ECIS)., Results: Primary outcome of this study relies on that all three synthetic RGD peptides improved PDLC adhesion (P < .05). When animal serum is absent in culture medium, SAK-c[RGDfC] and AK-c[RGDfC] elevated cell adhesion (P < .05). Cell migration was enhanced by SAK-c[RGDfC] and AK-c[RGDfC] (P < .05). After 1-week treatment, all synthetic peptides elevated CD105 (1.7- to 2.2-fold) and CD146 (1.3- to 1.5-fold) markers and caused different integrin patterns. ALP activity (1.4-fold) and ARS (1.8- and 2.0-fold) were increased by SAK-c[RGDfC] and AK-c[RGDfC] in absence of osteogenic supplements, and all the peptides supported the mineralization under osteogenic condition (P < .05). RT-qPCR revealed the upregulation of bone sialoprotein (5.0- to 7.8-fold), osteocalcin (2.3- to 2.7-fold), and ALP (1.9- to 2.3-fold) gene expression in osteogenesis-induced PDLCs. ECIS monitoring showed that higher impedance was generated by the osteogenic induction compared with the adipogenic or the non-induced (P < .05)., Conclusions: Our study demonstrates that SAK-c[RGDfC] and AK-c[RGDfC] improved adhesion and migration of PDLCs and supported osteogenic differentiation of PDLCs. These cyclic RGD peptides proved to be applicable biocompatible material in regenerative medicine., (© 2020 The Authors. Journal of Periodontal Research published by John Wiley & Sons Ltd.)

The cytotoxicity of glass ionomer cements (GICs) was investigated using a novel, cost-effective, easy-to-perform and standardized test. GIC rings were made using in-house designed, custom-made moulds under sterile conditions; 10 with Fuji Equia and 10 with Fuji Triage capsules, placed in direct contact with primary human gingival fibroblasts (HGF) and immortalized human fibroblasts (HFF1). On day 1, 4, 14 and 21, an AlamarBlue® (resazurin) assay was completed towards determining the effects of the GICs on metabolic activities of the cells, whilst cell morphology was examined by light microscopy. The influence of the compounds released from the GIC rings on cell physiological effects (viability, proliferation and adhesion) during 24 h incubation was further investigated by impedimetry. Result trends obtained from this battery of techniques were complementary. At 100 v/v% concentration, the released compounds from Equia were strongly cytotoxic, while at lower concentration (0, 4, 20 v/v%) they were not cytotoxic. In contrast, Triage elicited only slightly transient cytotoxicity. The method proposed has been proved as being efficient, reliable and reproducible and may be useful in quick testing of the cytotoxicity of similar biomaterials by using an immortalized cell line., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Spinal cord stimulation (SCS) reduces sympathetic activity in animal models of heart failure with reduced ejection fraction (HF) but limited data exist of SCS in patients with HF. The aim of the present study was to test the primary hypothesis that SCS reduces cardiac sympathetic nerve activity in HF patients. Secondary hypotheses were that SCS improves left ventricular function and dimension, exercise capacity, and clinical variables relevant to HF., Methods: HF patients with a SCS device previously participating in the DEFEAT-HF trial were included in this crossover study with 6-week intervention periods (SCS-ON and SCS-OFF). SCS (50 Hz, 210-μs pulse duration, aiming at T2-T4 segments) was delivered for 12 hours daily. Indices of myocardial sympathetic neuronal function (heart-to-mediastinum ratio, HMR) and activity (washout rate, WR) were assessed using 123 I-metaiodobenzylguanidine (MIBG) scintigraphy. Echocardiography, exercise testing, and clinical data collection were also performed., Results: We included 13 patients (65.3 ± 8.0 years, nine males) and MIBG scintigraphy data were available in 10. HMR was not different comparing SCS-ON (1.37 ± 0.16) and SCS-OFF (1.41 ± 0.21, P = 0.46). WR was also unchanged comparing SCS-ON (41.5 ± 5.3) and SCS-OFF (39.1 ± 5.8, P = 0.30). Similarly, average New York Heart Association class (2.4 ± 0.5 vs 2.3 ± 0.6, P = 0.34), quality of life score (24 ± 16 vs 24 ± 16, P = 0.94), and left ventricular dimension and function as well as exercise capacity were all unchanged comparing SCS-ON and SCS-OFF., Conclusion: In patients with HF, SCS (12 hours daily, targeting the T2-T4 segments of the spinal cord) does not appear to influence cardiac sympathetic neuronal activity or function as assessed by MIBG scintigraphy., (© 2017 Wiley Periodicals, Inc.)

Study Objective: To compare parameters of diastolic function as assessed by radionuclide ventriculography (RNVG) and Doppler echocardiography (ECHO) in the patients with chronic heart failure and reduced ejection fraction (HF REF)., Patients and Methods: RNVG and ECHO were performed on the same day in 40 patients with systolic chronic HF, NYHA II and III, with LV EF < 50 % and sinus rhythm, followed at tertiary HF clinic. Diastolic function was assessed by RNVG using parameters: PFR (peak filling rate [% SV/sec]), TFR - time to peak filling rate (ms), and by ECHO using pulse Doppler parameters: the peak Doppler velocities of early (E) and late diastolic flow (A), the E/A ratio, the calculated mean of the early (E´) diastolic velocity of septal and lateral mitral annulus measured by tissue Doppler imaging, and the E/E´ ratio., Results: The mean PFR was 421.7 (median 371.0) % SV/sec and TPF was 198.7 ms (median 169.5), the mean E/A ratio was 1.21 (median 0.85) and the E/E´ ratio was 9.0 (median 8.40). TPF correlated significantly (inverse correlation) with the E/A ratio (r = -0.34, p = 0.030), and not significantly with E´ (r = -0.27, p = 0.082), the PFR/age ratio correlated with the E/E´ ratio (r = -0.31, p = 0.05)., Conclusion: Significant correlations of parame-ters of diastolic function as assessed by radionuclide and Doppler studies were identified in the HF REF patients.

Background: The objective of the KORA-Age research consortium is to assess the determinants and consequences of multimorbidity in the elderly and to look into reasons for successful aging in the general public., Patients and Methods: In the KORA-Age cohort study 9,197 persons were included who where born in the year 1943 or before and participants of previous KORA cohort studies conducted between 1984 and 2001 (KORA: Cooperative Health Research in the Region of Augsburg). The randomized intervention study KORINNA (Coronary infarct follow-up treatment in the elderly) tested a nurse-based case management program with 338 patients with myocardial infarct and included an evaluation in health economics., Results: A total of 2,734 deaths were registered, 4,565 participants submitted a postal health status questionnaire and 4,127 participants were interviewed by telephone (response 76.2% and 68.9% respectively). A gender and age-stratified random sample of the cohort consisting of 1,079 persons took part in a physical examination (response 53.8%)., Conclusion: The KORA-Age consortium was able to collect data in a large population-based sample and is contributing to the understanding of multimorbidity and successful aging.

Purpose: Proper identification of the cardiac cycle is essential for gated SPECT myocardial perfusion imaging. We have developed an alternate method of ECG for gating, that is, using the peripheral pulse wave (PW) as the triggering signal for gated SPECT acquisition. The aim of this study is to compare the use of this method of gating with the standard ECG trigger., Methods: We tested the PW triggering by comparing it with the ECG trigger. We evaluated 33 patients (25 males, 8 females), average age of 61 years (39-80) referred for stress myocardial perfusion imaging. Data from all patients were acquired twice and were processed by CEqual and QGS software. We compared the left ventricular ejection fraction (LVEF), end-diastolic and end-systolic volumes (EDV, ESV). Paired t test and Pearson correlation coefficient were used for comparison., Results: The mean LVEF, EDV, and ESV calculated with the ECG trigger were 0.52, 120, and 64, respectively, those with the pulse-wave trigger were 0.48, 126, and 71, respectively. Mean paired difference for LVEF was -0.034 (P<0.001), for EDV 5.9 (P=0.012), and for ESV 7.9 (P<0.001). Pearson correlation coefficient for LVEF was 0.955, for EDV 0.987, and for ESV 0.991 (P<0.001 for all correlations)., Conclusion: Triggering of gated-data acquisition by the PW is feasible. Quantitative parameters of cardiac function correlate highly with those obtained from the ECG trigger and the absolute differences are not clinically significant across a wide range of values.

Histamine, produced by dendritic cells (DCs) or by other cells of the immune system, may have significant impact on DC activities. We investigated the influence of histamine and histamine H4 receptor (H4R) on some relevant functions of DCs. Histamine significantly decreased the antigen presentation capacity of splenic DCs, and this effect was reversed by a H4R antagonist. Furthermore, enhanced antigen presentation was detected in H4R-/- DCs. Prolonged histamine treatment during DC differentiation stimulated migration, albeit the increase was not significant. H4R-deficient DCs possessed significantly lower migration capacity than their wild-type counterparts. Monitoring in vivo and in vitro DC cytokine production revealed that a H4R agonist in combination with LPS, increased IL-1 beta mRNA expression, and a H4R antagonist reversed this effect. In H4R-deficient mice we detected decreased mRNA expression of some DC-derived cytokines including IFN-gamma and IL-10. Upon CFA stimulation, genotype-dependent differences were found in the expression of IL-6 and IFN-gamma. Our data suggest that H4R plays a crucial role in variety of functions of murine DCs.

Purpose: The diagnosis of osteomyelitis is a challenge for diagnostic imaging. Nuclear medicine procedures including white blood cell imaging have been successfully used for the identification of bone infections. This multinational, phase III clinical study in 22 European centres was undertaken to compare anti-granulocyte imaging using the murine IgG antibody besilesomab (Scintimun) with (99m)Tc-labelled white blood cells in patients with peripheral osteomyelitis., Methods: A total of 119 patients with suspected osteomyelitis of the peripheral skeleton received (99m)Tc-besilesomab and (99m)Tc-hexamethylpropyleneamine oxime (HMPAO)-labelled white blood cells (WBCs) in random order 2-4 days apart. Planar images were acquired at 4 and 24 h after injection. All scintigraphic images were interpreted in an off-site blinded read by three experienced physicians specialized in nuclear medicine, followed by a fourth blinded reader for adjudication. In addition, clinical follow-up information was collected and a final diagnosis was provided by the investigators and an independent truth panel. Safety data including levels of human anti-mouse antibodies (HAMA) and vital signs were recorded., Results: The agreement in diagnosis across all three readers between Scintimun and (99m)Tc-HMPAO-labelled WBCs was 0.83 (lower limit of the 95% confidence interval 0.8). Using the final diagnosis of the local investigator as a reference, Scintimun had higher sensitivity than (99m)Tc-HMPAO-labelled WBCs (74.8 vs 59.0%) at slightly lower specificity (71.8 vs 79.5%, respectively). All parameters related to patient safety (laboratory data, vital signs) did not provide evidence of an elevated risk associated with the use of Scintimun except for two cases of transient hypotension. HAMA were detected in 16 of 116 patients after scan (13.8%)., Conclusion: Scintimun imaging is accurate, efficacious and safe in the diagnosis of peripheral bone infections and provides comparable information to (99m)Tc-HMPAO-labelled WBCs.

Background: The persistence of moderate ischemic mitral regurgitation (IMR) after isolated coronary artery bypass graft surgery is an important independent predictor of long-term mortality. The aim of the present study was to identify predictors of postoperative improvement in moderate IMR in patients with ischemic heart disease undergoing elective isolated coronary artery bypass graft surgery., Methods and Results: The study population consisted of 135 patients with ischemic heart disease (age, 65+/-9 years; 81% male) and moderate IMR undergoing isolated coronary artery bypass graft surgery. Fourteen patients died before the 12-month follow-up echocardiography and were excluded. At the 12-month follow-up, 57 patients showed no or mild IMR (improvement group), whereas 64 patients failed to improve (failure group). Before coronary artery bypass graft surgery, the improvement group had significantly more viable myocardium and less dyssynchrony between papillary muscles than the failure group (P<0.001). All other preoperative parameters were similar in both groups. Large extent (> or =5 segments) of viable myocardium (odds ratio, 1.45; 95% confidence interval, 1.22 to 1.89; P<0.001) and absence (<60 ms) of dyssynchrony (odds ratio, 1.49; 95% confidence interval, 1.29 to 1.72; P<0.001) were independently associated with improvement in IMR. The majority (93%) of patients with viable myocardium and an absence of dyssynchrony showed an improvement in IMR. In contrast, only 34% and 18% of patients with dyssynchrony and nonviable myocardium, respectively, showed an improvement in IMR, whereas 32% and 49%, respectively, of these patients showed worsening of IMR (P<0.001)., Conclusions: Reliable improvement in moderate IMR by isolated coronary artery bypass graft surgery was observed only in patients with concomitant presence of viable myocardium and absence of dyssynchrony between papillary muscles.

Objectives: The objective of the present study was to assess the relationship between the presence of left ventricular (LV) dyssynchrony and clinical outcome in patients with moderate systolic heart failure undergoing coronary artery bypass graft (CABG) surgery., Background: The presence of LV dyssynchrony is associated with poor prognosis in patients with LV dysfunction., Methods: The study consisted of 215 consecutive patients with ischemic cardiomyopathy and dyspnea (age 65 +/- 9 years, 81% male) undergoing CABG. Dyssynchrony was calculated by tissue Doppler imaging from regional time intervals in basal LV segments before and 1 month after CABG. Myocardial viability was assessed using single-photon emission computed tomography (SPECT) before CABG., Results: Twenty-five patients (11.6%) died within 30 days (in-hospital mortality) of CABG. The presence of pre-CABG dyssynchrony > or =119 ms had the highest predictive accuracy for in-hospital mortality, with a sensitivity of 84% and a specificity of 71%. During the median follow-up period of 359 days (interquartile range 219 to 561), an additional 19 patients (10.3%) died and 34 patients (18.5%) were hospitalized for worsening heart failure. At Cox regression analysis, post-CABG dyssynchrony > or =72 ms and > or =5 viable segments were identified as independent predictors of clinical events, with a hazard ratio (HR) of 5.02, 95% confidence interval (CI) 2.57 to 10.02 (p < 0.001), and an HR of 0.63, 95% CI 0.55 to 0.75 (p < 0.001), respectively. Patients without post-CABG dyssynchrony and with viable myocardium had excellent prognosis compared with patients with severe post-CABG dyssynchrony and nonviable myocardium (event rate 3% vs. 64%; p < 0.001)., Conclusions: The presence of severe LV dyssynchrony is associated with poor clinical outcomes despite revascularization. These results advocate a routine assessment of both LV dyssynchrony and viability to predict outcome in systolic heart failure patients undergoing CABG surgery.

Unlabelled: Use of beta-blockers is associated with a reduced risk of fractures in middle-aged and older subjects from the general population., Introduction: The present prospective population-based study investigated the association between use of beta-blockers and incidence of any fracture., Methods: The study was based on 1,793 persons 55 to 74 years of age who participated in one of the three MONICA Augsburg surveys between 1984 and 1995. Subjects were without any fracture at baseline. Incident fractures were assessed using a health questionnaire. Hazard ratios (HRs) were estimated from Cox proportional hazard models., Results: During a mean follow-up of 10.7 years, there occurred 263 incident fractures. beta-blocker users were older, were significantly more likely to be obese, to drink no alcohol, to have hypertension or diabetes, to use thiazides and statins, and to be physically inactive. The use of beta-blockers was associated with a lower risk of any fracture (HR 0.57; 95% CI = 0.36-0.90) after adjustment for age, sex and survey. Further adjustment for body mass index and education years only slightly attenuated the relationship (HR 0.60; 95% CI = 0.38-0.95) and additional adjustment for a variety of further risk factors did not attenuate the association (HR 0.60; 95% CI = 0.37-0.96)., Conclusion: Use of beta-blockers was associated with a reduced risk of fractures in middle-aged and older subjects from the general population.

Objective: To investigate the kinetics of myocardial engraftment of bone marrow-derived mononuclear cells (BMNCs) after intracoronary injection using 99mTc-d,l-hexamethylpropylene amine oxime (99mTc-HMPAO) nuclear imaging in patients with acute and chronic anterior myocardial infarction., Design: Nuclear imaging-derived tracking of BMNCs at 2 and 20 h after injection in the left anterior descending (LAD) coronary artery., Setting: Academical cardiocentre., Patients: Five patients with acute (mean (SD) age 58 (11) years; ejection fraction range 33-45%) and five patients with chronic (mean (SD) age 50 (6) years; ejection fraction range 28-34%) anterior myocardial infarction., Interventions: A total of 24.2 x 10(8)-57.0 x 10(8) BMNCs (20% labelled with 700-1000 MBq 99mTc-HMPAO) were injected in the LAD coronary artery., Results: At 2 h after BMNC injection, myocardial activity was observed in all patients with acute (range 1.31-5.10%) and in all but one patient with chronic infarction (range 1.10-3.0%). At 20 h, myocardial engraftment was noted only in three patients with acute myocardial infarction, whereas no myocardial activity was noted in any patient with chronic infarction., Conclusions: Engraftment of BMNCs shows dynamic changes within the first 20 h after intracoronary injection. Persistent myocardial engraftment was noted only in a subset of patients with acute myocardial infarction.

Aims: To assess the accuracy of tissue Doppler imaging-derived myocardial positive pre-ejection velocity (+Vic) in detecting myocardial viability defined by dobutamine stress echocardiography (DSE), fluorine-18 fluorodeoxyglucose positron emission tomography (PET), and contrast-enhanced magnetic resonance imaging (MRI), and in predicting recovery of left ventricular (LV) function after coronary artery bypass grafting (CABG) in patients with chronic ischaemic LV dysfunction., Methods and Results: +Vic in dysfunctional segments was recorded in 54 patients treated medically and 65 patients undergoing CABG [age 67 +/- 9 year; LV ejection fraction (EF) 30 +/- 6%]. A good agreement was observed between +Vic and detection of viable myocardium at DSE, PET, and MRI (kappa = 0.76). The presence of +Vic in greater than or equal to five dysfunctional segments had the highest sensitivity (93%) and specificity (60%) to identify patients (n = 28) with > or =10% increase in LV EF between baseline and 6-month echocardiogram. During follow-up (median 333 days, interquartile range 209-490 days), 13 cardiac events (6 deaths, 7 hospitalizations) occurred in 24 patients with small extent of viable myocardium (< 5 + Vic), whereas only four hospitalizations in 39 patients with > or =5 + Vic (54% vs. 10%; P < 0.001)., Conclusion: The extent of +Vic in dysfunctional segments accurately predicts extent of viable myocardium and bears a clinical prognostic value in patients with ischaemic LV dysfunction considered for CABG.

In November 2005, the authors used the lung resection method in combination with peroperative brachytherapy125 for a non-small cell carcinoma, for the first time. The patient had an adenocarcinoma of the right lung T2N2M0, stage IIIA. During the procedure, the team diagnosed advanced stage of the process, the tumor originated in the hilus region of the middle lobe with a metastatic spread into the superior and inferior lobe. Distant unilateral lymphonodes were infiltrated simultaneously. The histological examination confirmed the diagnosis of T2N2M1, however, the original classification was re-assessed and changed to stage IV. Pneumonectomy with lymphadenectomy of all of the macroscopically detectable lymphonodes was completed. The lymphatic drainage sites in the upper and lower mediastinum were covered by seeds of a permanent gama emitter 125I with a total dose of 100 Gy. The patient recovered with no complications and was discharged on the day 8. He was included in the study and will be followed on a regular basis. On the authors' opinion, the method of the lung resection with peroperative permanent brachytherapy has a potential for decreasing the tumor relaps rates, eventually, for improving the patients survival rates and their quality of life. The authors will continue their applied research of this serious problematics, aiming to confirm or refuse the stated hypothesis.

Background: The second survey of nuclear cardiology in the Czech Republic was conducted to ascertain whether the activity had increased since the first survey in 2001; we also intended to identify new trends in clinical practice., Materials and Methods: All 46 departments of nuclear medicine in the Czech Republic completed a questionnaire concerning nuclear cardiology activity in 2002-2003 and current clinical and technical practices., Results: There were 66 SPET cameras in 2003 in comparison with 54 SPET cameras in 2001. Of the 46 centres, 39 (85%) provided nuclear cardiology service. The total number of cardiac studies was 19,261 in 2003 (i.e. 1.9 studies/1,000 population; myocardial perfusion imaging (MPI) studies accounted for 91.3% of total nuclear cardiology. In 2001-2003, the utilization rate of MPI increased annually by 10%, 13% and 21% respectively. Twenty-six departments (67%) reported that the number of MPI had increased. The utilization of gated SPET method showed a very positive trend; as only 39% of all MPI studies were acquired using ECG-gating in 2001, but in 2003, there was an increase to 61%. We observed no increase in utilization of attenuation correction (3 centres in 2003 in comparison with 5 centres in 2001). Despite new PET capacity in the Czech Republic, the total number of FDG cardiology studies was somewhat lower in 2003 than in 2001 (155 compared with 163 studies)., Conclusions: Our data documented substantial growth in the number of MPI examinations in 2001-2003. However, Czech Republic nuclear cardiology activity still remained below the European average (2.2 studies/1,000 population in 1994); a further increase in MPI activity is necessary to adequately support the needs of cardiac patients.

Radionuclide myocardial perfusion imaging (MPI) has been on the rise in Europe and the USA. Details on nuclear cardiology in the Czech Republic are not available as yet, as it is impossible to obtain comprehensive data from official registers owing to different methods of reporting and data evaluation. A questionnaire concerning nuclear cardiology activity and practice in 2001 was sent to all nuclear medicine departments in the Czech Republic. All 48 departments completed the questionnaire. In 2001, 50 planar and 54 tomographic (SPET) scintillation cameras were used. The average age of the SPET cameras was 5 years (13% of SPET cameras were >8 years old). Out of the 48 centres, 39 (81%) provided a nuclear cardiology service; the total number of cardiological studies was 15,740 in 2001 (1.5 studies/1,000 population/year). The most frequently employed method was MPI (81.7%), the frequency of which had increased by 10% compared with 2000; 26 of the 39 (67%) departments reported that MPI activity was increasing. Nevertheless, the Czech Republic nuclear cardiology activity remained below the European average (2.2/1,000 population in 1994) and, particularly, below activity in the USA (15/1,000 in 1997). The activity was rather unevenly spread. Whereas two centres with >1,000 studies/year accounted for 20% of the total MPI studies, 16 of 39 (41%) departments exhibited low activity (<200 studies/year) and accounted for only 15% of the total MPI studies. The use of SPET increased from 91% in 2000 to 94% in 2001 (only three institutes performed planar examinations). The most widely used tracer was (99m)Tc-MIBI (60% of total MPI), followed by (201)Tl (21%) and (99m)Tc-tetrofosmin (19%). ECG-gated SPET was employed by 20/39 (51%) centres, of which 11 (28%) performed it as a standard examination; 39% of the total MPI studies included this technique. Thirteen percent (5/39) of the departments used attenuation correction, and 69% (27/39) of the departments used a prone projection. Equilibrium radionuclide ventriculography, with 2,317 examinations (14.7%), ranked second among all nuclear cardiology methods, followed by first-pass angiocardiography (406 studies, 2.6%) and (18)F-FDG (163 studies, 1%).

Purpose: The authors wanted to identify those patients assessed by exercise SPECT in whom the quantification of lung Tl-201 uptake helps to evaluate disease prognosis., Methods: One hundred forty-nine patients (114 men, 35 women; 74 after myocardial infarction [MI]; mean age, 54 +/- 9 years) underwent exercise Tl-201 SPECT. The SPECT patterns were divided into normal (n = 45), fixed defects (n = 29), and inducible ischemia (n = 75). Anterior planar imaging was performed before SPECT acquisition to calculate the lung-to-heart ratio (L:H)., Results: During an average follow-up of 20 +/- 9 months, eight patients had died of cardiac causes and 13 patients experienced nonfatal MIs. Among the 45 patients with normal perfusion, no cardiac event was observed and the L:H ratio was not helpful for risk stratification. In 29 patients with fixed defects, four cardiac deaths occurred (all in patients with L:H ratios >0.5; annual event rate, 21.1% for L:H ratios >0.5 compared with 0% for L:H ratios <0.5; chi-square = 4.07, P < 0.05). Among the 75 patients with ischemia, 4 died and 13 had nonfatal MIs (annual event rate, 15.4% for L:H ratios >0.5 compared with 13% for L:H ratios <0.5; P = NS)., Conclusions: These findings suggest a benign prognosis in patients with normal SPECT (regardless of the L:H ratio). Conversely, all patients with ischemia are at high risk for future cardiac events. Quantification of the Tl-201 lung uptake seems to be valuable in evaluations of disease prognosis, especially in patients with fixed defects.

The aims of this study were to establish the percentage of metastatic renal cell carcinoma (RCC) lesions detected by radioimmunoscintigraphy (RIS) with the chimeric monoclonal antibody 131I-cG250 versus positron emission tomography (PET) with 18F-labelled deoxyglucose ([18F]FDG), and to evaluate the use of these radionuclide imaging modalities compared with routinely used imaging techniques. Twenty patients with metastatic RCC disease were examined with [18F]FDG-PET and 131I-cG250 RIS within 1 week. Total body gamma camera images were obtained up to 120h after injection of 232MBq 131I-cG250. Total body PET scanning was performed 45-60 min after intravenous injection of 370MBq [18F]FDG. Nuclear medicine techniques were compared to routine imaging procedures. Routine imaging modalities revealed a total of 79 metastases. [18F]FDG-PET and 131I-cG250 RIS detected 33 previously unknown metastases, of which 32 were [18F]FDG positive and seven were 131I-cG250 positive. Of the 112 tumour lesions that were documented, [18F]FDG-PET detected 69% (77 out of 112), whereas 131I-cG250 RIS detected only 30% (34 out of 112). In conclusion, [18F]FDG-PET is superior to 131I-cG250 RIS in detecting metastases in patients with metastatic RCC, and therefore seems a promising tool for (re)staging patients with RCC. The usefulness of RIS with a diagnostic dose of 131I-cG250 seems to be restricted to selecting patients for radioimmunotherapy with 131I-cG250.

Objective: To assess the prognostic value of SPECT in patients with diabetes (DM) and without DM., Method: A total of 366 patients (104 women, 262 men) were examined by T1 +/- 201 or Tc-99m-MIBI SPECT of the myocardium. DM was recorded in 149 patients, 217 patients did not suffer from DM. The SPECT findings were classified as normal and abnormal perfusion (fixed or reversible perfusion defect). A serious cardiac event was defined as sudden cardiac death or non-fatal myocardial infarction. Also angina pectoris requiring revascularization was recorded., Results: During the average investigation period of 24 +/- 7 months we recorded in 147 patients with a normal load perfusion only one non-fatal myocardial infarction and the risk of a serious cardiac event was low: 0.3% per annum in the whole group. A significantly higher incidence of a severe cardiac event, 5.9% per year, was recorded in 219 patients with an abnormal finding on SPECT (10 deaths and 16 non-fatal myocardial infarctions, P < 0.01). On comparison of the frequency of serious cardiac events in groups of patients with and without DM no significant difference was found as regards normal load perfusion of the heart muscle (1.1% vs. 0%, P = NS) even in patients with an abnormal SPECT finding (5.8% vs. 6.1, P = NS)., Conclusion: SPECT myocardial perfusion makes it possible to stratify the risk in patients with DM similarly as proved previously in non-selected groups. Similarly as in patients without DM normal perfusion in diabetic patients predicts a benign prognosis.

Previous studies have demonstrated that experimentally altering the accessibility and availability of food can have profound impact on behavior and adrenocortical activity in nonhuman primate species. In this study, groups of mother-infant squirrel monkey dyads were housed in either high demand (HFD: 120% normal daily food intake provided), low demand (LFD: 600% normal daily food intake provided) or variable demand (VFD: alternating two-week blocks of low demand and high demand) conditions for 12 weeks. During the 12-week experimental foraging phase, animals in the HFD group exhibited prolonged and consistent cortisol elevations. The cortisol levels in the VFD group reflected the ambient demand condition, with higher levels exhibited during the high demand phases of the study, and lower values when the low demand condition was in effect. Overall, mothers were more affected by the experimental manipulation than were infants. The experimental condition did not affect the infants' response to a 24-h separation from their mothers. A suppression of cortisol levels, particularly in the HFD group, was observed upon resumption of ad-libitum feeding.

Background: In Hodgkin's disease accurate restaging is important to assess treatment results and may eventually provide a basis for further therapeutic strategies. A typical dilemma after treatment of Hodgkin's disease with radiographically persistent lymphoma is the differentiation between sterilized residual mass and viable tumor. Positron emission tomography (PET) has been described as a reliable tool to identify active lymphoma. Aim of the present study was to assess the accuracy and clinical relevance of PET for treatment control and in the situation of a suspected relapse of Hodgkin's disease., Patients and Methods: 63 patients (32 men, 31 women, mean age 41.5 years) with Hodgkin's disease were investigated with FDG-PET. In 51 patients 63 PET studies were performed as a treatment control (group 1) after primary therapy. 17 patients (5 of whom preexamined in group 1) underwent 18 PET scans for confirmation of suspected relapse (group 2). PET was performed with a dedicated whole-body ring scanner. In a retrospective analysis, all FDG-PET scans were compared with conventional imaging methods and related to the final diagnosis obtained by histology and/or clinical follow-up (mean 22.4 months)., Results: Group 1: FDG-PET showed an accuracy of 91%, whereas the accuracy of conventional imaging was 62%. Group 2: The accuracy for PET was 83% and 56% for conventional imaging., Conclusion: The present data suggest that PET is a sensitive and reliable tool for detection of involved areas of active Hodgkin's disease. The accuracy of PET for restaging purpose seems to be superior than conventional imaging.

Background: In Hodgkin disease (HD), accurate assessment of the extent of disease is essential because it provides the basis for different treatment strategies. In addition to conventional imaging methods (CIM), positron emission tomography with fluorine-18-fluorodeoxyglucose (FDG-PET) may permit reliable differentiation between lymphoma and nonmalignant tissue and thus improve determination of the stage of the disease. The aim of the current study was to assess the clinical value of FDG-PET for primary staging, treatment monitoring, and assessment in a suspected case of recurrent HD., Methods: Eighty-one patients with HD underwent 106 FDG-PET studies using a dedicated whole body PET ring scanner. In 25 patients PET was part of the primary staging, 63 PET studies were undertaken for treatment monitoring after the completion of treatment, and in 18 patients PET was performed in cases of suspected recurrence of HD. PET scans were compared with CIM and verified histologically and/or by follow-up evaluation (mean follow-up duration, 20.4 months)., Results: With regard to primary staging, in a patient to patient analysis, both PET scans and CIM were positive (i.e., showed pathologic foci indicative of HD) in 24 of 25 cases. In a staging-relevant lesion to lesion analysis, accuracy in the determination of the stage of disease was 96% for PET versus 56% for CIM. PET led to a lower stage classification in 28% and a higher stage classification in 12% of cases, compared with the stage assumed with CIM. With regard to treatment monitoring, PET showed an accuracy of 91% compared with 62% for CIM. The negative predictive value of PET was 96%. With regard to suspected recurrence, PET findings were true-positive in 10 of 12 PET scans and true-negative in 5 of 6 PET scans, resulting in accuracy of 83%, which compares favorably with the accuracy rate of 56% for CIM., Conclusions: It may be concluded that FDG-PET is capable of determining the stage of HD with great accuracy and is capable of correctly detecting manifestations of HD in treatment monitoring and cases of suspected recurrence, in which CIM occasionally result in equivocal findings. The results of the current study suggest that FDG-PET should become a routine tool in the staging/restaging of HD.

Background: The purpose of this study is to compare sensitivity, specificity and accuracy of myocardial perfusion SPECT for the detection of coronary artery disease (CAD) in women and men., Material and Methods: 588 patients (455 males and 133 females, 273 after a previous myocardial infarction) underwent stress myocardial perfusion SPECT. The accuracy of myocardial perfusion SPECT was proved by coronary angiography (stenosis > 50% was considered as a CAD)., Results: The sensitivity of SPECT was slightly higher, but statistically not significant, in men than in women (94% versus 91%, p > 0.05). The specificity was higher in women than in men (93% versus 82%), but this difference was not statistically significant either (p > 0.05). The accuracy of SPECT was the same for both sexes (92%). In angiographically verified group of patients the selection bias was obvious--patients with CAD dominated (74%) and the fraction of patients with CAD in men's group (83%) was significantly higher than in women's group (50%), p < 0.05., Conclusions: No significant difference was revealed in the accuracy of myocardial perfusion SPECT in men and women. Our results are in accordance with the prevailing opinion in literature that discovered differences in sensitivity, specificity and diagnostic accuracy are usually not statistically significant or that they can be explained by the selection bias of patients in angiographically verified groups (significantly higher fraction of patients with CAD in men's group).

Purpose: The authors assessed the prognostic value of stress myocardial perfusion tomographic imaging (SPECT) in patients with recurrent angina or inconclusive results of exercise electrocardiographic tests after successful percutaneous transluminal coronary angioplasty (PTCA)., Materials and Methods: After PTCA, 70 patients (54 men, 16 women; 41 after myocardial infarction; mean age, 56 +/- 9 years) underwent TI-201 or Tc-99m sestamibi SPECT studies. SPECT patterns were divided into normal (n = 25), fixed defects (n = 15), and reversible or combined fixed plus reversible defects (n = 30). A cardiac event was defined as either cardiac death, nonfatal myocardial infarction, or unstable angina requiring further revascularization., Results: During an average follow-up of 25 +/- 10 months, two patients had severe outcomes (one cardiac death and one nonfatal myocardial infarction), and revascularization was required in 13 patients. In patients with normal SPECT or fixed defects, the annual event rate was low (1.2%), with only one revascularization. In patients with reversible or combined defects, the annual event rate was significantly greater (22.4%; chi square = 17.32, P = 0.00003)., Conclusions: Normal perfusion or fixed defects predict a benign prognosis in patients after successful PTCA. The presence of stress-induced reversible defects appears to be the best predictor of future cardiac events.

The authors compared retrospectively the diagnostic accuracy of three protocols--201Tl stress-redistribution, 2-day 99mTc-tetrofosmin and the dual-isotope protocol (rest 201Tl/stress99m Tc-tetrofosmin)--for the detection of ischaemic heart disease (IHD) in a total of 115 patients without previous myocardial infarction (IM). 201Tl protocol (group A) was used to examine 43 patients, incl. 15 women, mean age 51 years (38-69 years). The 2-day 99m Tc-tetrofosmin protocol was used to examine 39 patients incl. 12 women, mean age 49 years (30-71 years). The dual-isotope protocol was used in 33 patients, incl. 8 women, mean age 52 years (31-69 years). In all patients coronarography was performed, stenosis of the artery >50% was considered significant for IHD. The sensitivity of the dual-isotope protocol was 95% and 96% resp. and 92% in the 2-day tetrofosmin and 201Tl protocol, (p>0.05). The specificity of the dual-isotope protocol was 82% and 89% resp. and 88% in the 201Tl and 2-day tetrofosmin protocol, (p >0.05). The diagnostic accuracy was 91% in the dualisotope and 201Tl protocol and 92% in the 2-day protocol (p>0.05). No significant difference was revealed in the sensitivity, specificity and diagnostic accuracy for the detection of IHD between different protocols in patients without previous IM.

Purpose: With regard to the poor prognosis of patients with glioblastoma multiforme, the aspect of life quality with a minimal treatment time becomes essential. The purpose of the present study is to evaluate whether the results of a radiotherapy schedule using increased single fractions applied over a shortened treatment time is feasible without compromising treatment efficiency or providing more side effects than a conventionally fractionated treatment., Patients and Methods: A total of 38 patients (f = 21, m = 17, mean age 58 years) with histologically proven glioblastoma multiforme were irradiated after (partial) resection (n = 29) or stereotactic surgery (n = 9) with single doses of 3.5 Gy (ICRU) 5 fractions a week up to a total dose of 42 Gy following individual treatment planning., Results: Median survival was 45.7 weeks, survival rate after 6 months was 80.9% and decreased to 34.2% after 12 months. Radiotherapy was tolerated without any important acute toxicity or any late side effects during the follow-up period., Conclusions: The increase of the dose per fraction using a fraction size of 3.5 Gy enhanced neither acute nor late toxicity. The survival rate compared well to those described in the literature. Thus the shortened treatment schedule seems as efficient as conventional radiotherapy. Moreover, it seems preferable with regard to quality of life.