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Abstract In western countries, men are increasingly using cosmetic surgery. However, despite this trend, there remains a dearth of information on the prevalence, acceptance, and motivations behind men’s use of cosmetic surgery. Furthermore, the potential association between men’s use of cosmetic surgery and in particular male-specific cosmetic surgery procedures such as head hair transplant or penis enlargement and traditional masculinity ideologies (TMI) has not been investigated so far. For this purpose, a cross-sectional anonymous online survey was conducted among 241 self-identifying men aged 18 years or older from the German-speaking part of Europe. Participants responded to questions about cosmetic surgery use and experiences, and completed the Conformity to Masculine Norms Inventory—Short Form (CMNI-SF) and the Male Role Norms Inventory—Short Form (MRNI-SF) questionnaires to assess conformity with and endorsement of TMI. Of the 241 men investigated, 47 (19.5%) had undergone cosmetic surgery. The most common types of cosmetic surgeries reported were wrinkle treatment, eyelid correction, and head-hair transplant. Penis enlargement procedures were reported by three (6.4%) of the 47 men who had undergone cosmetic surgery. The main reasons for undergoing surgery were to feel better (72.3%) and look better (55.3%), while to increase sexual success (17.0%) and to increase manliness (14.9%) were also reported. Logistic regression models showed that higher conformity to TMI (CMNI-SF) was associated with higher odds of having undergone cosmetic surgery. The results highlight the overall increase in men’s cosmetic surgery use and its specific characteristics. The significant positive association between conformity to TMI and men’s use of cosmetic surgery suggests that men increasingly use cosmetic surgery as a means to assert power, success, dominance, and sexual success.

Introduction Humanitarian workers (HWs) face significant challenges while providing aid to those in need, often leading to psychological exhaustion and the risk of primary or secondary trauma. Objectives Our study aimed to validate and adapt the Greek version of the Brief Resilient Coping Scale (BRCS) for HWs in Greece. Methods We conducted a cross-sectional study between September and December 2022. Participants were recruited through a self-administered questionnaire distributed via social media to humanitarian groups. Additionally, the questionnaire was sent via email to these groups’ members, who then forwarded it to their respective networks. The questionnaire included the BRCS, a 4-item measure designed to capture tendencies to cope with stress in a highly adaptive manner. A score of 4-13 points indicates low resilient copers, 14-16 points medium resilient copers and 17-20 points high resilient copers. Cronbach’s alpha was used to assess internal consistency. Confirmatory Factor Analysis (CFA) was employed to evaluate model fit. Adequate or good fit criteria included a χ2 test p-value ≥ 0.05, Root Mean Square Error Approximation (RMSEA) ≤ 0.08, Standardized Root Mean Squared Residual (SRMR) ≤ 0.05, and a Comparative Fit Index (CFI) or Tucker–Lewis Index (TLI) ≤ 0.90. Statistical analyses were performed using STATA and SPSS software. Results A total of 151 humanitarian workers (76% females), with a mean age of 39.3±10.6 years participated in the study. The mean BRCS score was 65.6/100. Participants were categorized as follows: 34.6% as low resilient copers, 38.6% as medium resilient copers, and 26.8% as high resilient copers. Cronbach’s alpha for the BRCS was 0.84, indicating good internal consistency. CFA results supported the one-factor solution proposed by the original researchers, with acceptable global fit indices: Chi-square p-value = 0.303, SRMR = 0.028, RMSEA = 0.036, CFI = 0.991, TLI = 0.974. Conclusions The findings of our study show that the Greek version of BRCS is a valid and reliable tool that can be used to evaluate resilient coping among humanitarian workers in Greece. Disclosure of Interest None Declared

Abstract Background DIALOG+ is a digital psychosocial intervention aimed at making routine meetings between patients and clinicians therapeutically effective. This study aimed to evaluate the cost-effectiveness of implementing DIALOG+ treatment for patients with psychotic disorders in five low- and middle-income countries in Southeast Europe alongside a cluster randomised trial. Methods Resource use and quality of life data were collected alongside the multi-country cluster randomised trial of 468 participants with psychotic disorders. Due to COVID-19 interruptions of the trial’s original 12-month intervention period, adjusted costs and quality-adjusted life years (QALYs) were estimated at the participant level using a mixed-effects model over the first 6 months only. We estimated the incremental cost-effectiveness ratio (ICER) with uncertainty presented using a cost-effectiveness plane and a cost-effectiveness acceptability curve. Seven sensitivity analyses were conducted to check the robustness of the findings. Results The average cost of delivering DIALOG+ was €91.11 per participant. DIALOG+ was associated with an incremental health gain of 0.0032 QALYs (95% CI –0.0015, 0.0079), incremental costs of €84.17 (95% CI –8.18, 176.52), and an estimated ICER of €26,347.61. The probability of DIALOG+ being cost-effective against three times the weighted gross domestic product (GDP) per capita for the five participating countries was 18.9%. Conclusion Evidence from the cost-effectiveness analyses in this study suggested that DIALOG+ involved relatively low costs. However, it is not likely to be cost-effective in the five participating countries compared with standard care against a willingness-to-pay threshold of three times the weighted GDP per capita per QALY gained.

PURPOSE: To compare the effectiveness of a newly designed multi-component cryoprotective medium (15% PEO-1500, 10% DMSO, 5% 1.2-propanediol, 5% sucrose) with three known singleand two-component ones containing DMSO (20 %), PEO-1500 (30 %), and glycerol-mannitol (30 % and 4 %, respectively) in the cryopreservation of human, equine, bovine and rabbit erythrocytes. METHODS: Cryopreservation was achieved plunging the cryotubes with erythrocyte suspensions into liquid nitrogen (-196°C) at an average cooling rate of 200 deg/min. During the three cryopreservation stages; equilibration, freeze-thaw and final removal of cryoprotectants, the survival of erythrocytes was estimated by the level of hemolysis, measured spectrophotometrically. RESULTS: With the erythrocytes of all investigated mammals the designed medium produced a higher level of survival at all cryopreservation stages. CONCLUSION: The tested multi-component cryopreservation medium, combining both penetrating and non-penetrating cryoprotectants, diminished their concentration and accompanying toxic effects and achieved a higher survival of human and mammal erythrocytes at all stages of their cryopreservation.

The relevance of the topic depends on the lack of an integrated approach to assessment of investment risk in infrastructure of Russian public utilities. The authors have developed the proposals for methodology of comprehensive risk assessment for public utilities` investment. This methodology helps to define the organization of this activity. The proposed methodology has developed taking into consideration the logical framework and temporary structure of risk assessment activities for investment projects in Russia’s utility sector and the features ofthese projects. The study determines the composition of activities in the area of comprehensive risk assessment for public utilities` investment, suggested the distribution of responsibilities between the core actors of this work. It also describes means and the methods of comprehensive risk assessment for public utilities` investment, its desired results.

PURPOSE: To study the influence of human placenta extract (HPE) and its individual fractions on the thermal stability of human erythrocyte membrane. METHODS: HPE fractions were isolated by gel chromatography. Thermal hemolysis of erythrocytes, exposed to 55°C was measured spectrophotometrically. Cytosol microvscosity and barrier function of erythrocyte membranes at hyperthermia were investigated by EPR spin probe TEMPON. Thermal denaturation of erythrocyte membrane proteins were studied by differential scanning calorimetry. RESULTS: Pre-treatment of erythrocytes with HPE or its fractions inhibited thermal hemolysis. Low-molecular fractions (below 4 kDa and 12-20 kDa) were the most effective in thermal hemolysis inhibition ((31.7±3.3) % and (31.5±3.2) %, respectively). The latter fractions markedly reduced the hyperthermia (55°C)-induced permeability of erythrocytes for ferricyanide ions and inhibited the thermo-induced structural transitions in erythrocyte membrane between 40 and 50°C, which are associated with cytoskeletal proteins. HPE fractions reversibly increased the denaturation temperatures of erythrocyte membrane proteins, except that of spectrin, and enlarged the enthalpy of denaturation of all membrane proteins. CONCLUSIONS: HPE and its individual fractions increased the thermal stability of erythrocyte membranes and erythrocytes. This effect was attributed to the reversible binding of some low molecular ingredient of HPE to the integral proteins and consequent stabilization of their interaction with under-membrane cytoskeleton.

Abstract Storage of human retinal pigment epithelium (hRPE) can contribute to the advancement of cell-based RPE replacement therapies. The present study aimed to improve the quality of stored hRPE cultures by identifying storage medium additives that, alone or in combination, contribute to enhancing cell viability while preserving morphology and phenotype. hRPE cells were cultured in the presence of the silk protein sericin until pigmentation. Cells were then stored for 10 days in storage medium plus sericin and either one of 46 different additives. Individual effects of each additive on cell viability were assessed using epifluorescence microscopy. Factorial design identified promising additive combinations by extrapolating their individual effects. Supplementing the storage medium with sericin combined with adenosine, L-ascorbic acid and allopurinol resulted in the highest cell viability (98.6 ± 0.5%) after storage for three days, as measured by epifluorescence microscopy. Flow cytometry validated the findings. Proteomics identified 61 upregulated and 65 downregulated proteins in this storage group compared to the unstored control. Transmission electron microscopy demonstrated the presence of melanosomes after storage in the optimized medium. We conclude that the combination of adenosine, L-ascorbic acid, allopurinol and sericin in minimal essential medium preserves RPE pigmentation while maintaining cell viability during storage.

Abstract Background This case illustrates the importance of prompt assessment and treatment of orbital cellulitis. In fact the ocular signs and symptoms may be associated with systemic complications which should be investigated and identified as soon as possible to avoid a poor prognosis. Case presentation A 46-year-old white woman presented to our emergency room with proptosis, ophthalmoplegia, and conjunctival chemosis of her left eye. An ophthalmologist, having diagnosed orbital cellulitis in her left eye, suspected a cavernous sinus thrombosis. Hematochemical and radiological examinations confirmed the cavernous sinus thrombosis and also showed septic pulmonary embolism. A blood culture indicated Streptococcus constellatus, which is a member of the Peptostreptococcus family, a saprophyte of the oral mucosa that can be pathogenic in immunocompromised persons. The odontogenic origin was then confirmed by dental radiography which showed a maxillary abscess. Her eye signs regressed after antibiotic and anticoagulant therapy. Conclusions This complex case shows the importance of a multidisciplinary approach for the management of orbital cellulitis, for the prompt diagnosis and treatment of eye injuries and possible complications, so as to avoid serious and permanent sequelae.

Since the introduction of in vitro fertilization (IVF) in 1978, over five million babies have been born worldwide using IVF. Contrary to the perception of many, IVF does not guarantee success. Almost 50% of couples that start IVF will remain childless, even if they undergo multiple IVF cycles. The decision to start or pursue with IVF is challenging due to the high cost, the burden of the treatment, and the uncertain outcome. In optimal counseling on chances of a pregnancy with IVF, prediction models may play a role, since doctors are not able to correctly predict pregnancy chances. There are three phases of prediction model development: model derivation, model validation, and impact analysis. This review provides an overview on predictive factors in IVF, the available prediction models in IVF and provides key principles that can be used to critically appraise the literature on prediction models in IVF. We will address these points by the three phases of model development.

The Sharpe-Lotka-Mckendrick-von Foerster one-sex population model and Fredrickson-Hoppensteadt-Staroverov two-sex population one are well known in mathematical biology. But they do not describe dynamics of populations with child care. In recent years some models were proposed to describe dynamics of the wild population with child care. Some of them are based on the notion of the density of offsprings under maternal (or parental) care. However, such models do not ensure the fact that offsprings under maternal (or parental) care move together with their mothers (or both parents). In recent years to solve this problem, some models of a sex-age-structured population, based on the discrete set of newborns, were proposed and examined analytically. Numerical schemes for solving of a one-sex age-structured population model with and without spatial dispersal taking into account a discrete set of offsprings and child care are proposed and results are discussed in this paper. The model consists of partial integrodifferential equations subject to conditions of the integral type. Numerical experiments exhibit the stability of the separable solutions to these models.

We present results of the numerical investigation of the homogenous Dirichlet and Neumann problems to an age-sex-structured population dynamics deterministic model taking into account random mating, female’s pregnancy, and spatial diffusion. We prove the existence of separable solutions to the non-dispersing population model and, by using the numerical experiment, corroborate their local stability.

Background: Minimally invasive parathyroidectomy is the treatment of choice in patients with primary hyperparathyroidism (PHP), but it needs a reliable preoperative localization method to detect hyperfunctioning parathyroid tissue. Higher sensitivity and lower radiation exposure was demonstrated for [ 18 F]fluorocholine PET/CT (FCh-PET/CT) in comparison to [ 99m Tc]sestamibi (MIBI) scintigraphy. However, data of its efficiency in resource use and patient outcomes is lacking. The aim of our study was to determine the resource efficiency and patient outcomes of FCh-PET/CT in comparison to conventional MIBI scintigraphy., Patients and Methods: A group of 234 patients who underwent surgery after MIBI scintigraphy was compared to a group of 163 patients who underwent surgery after FCh-PET/CT. The whole working process from the implementation of imaging to the completion of surgical treatment was analyzed. The economic burden was expressed in the time needed for the required procedures., Results: The time needed to perform imaging was reduced by 83% after FCh-PET/CT in comparison to MIBI scintigraphy. The time needed to perform surgery was reduced by 41% when intraoperative parathyroid hormone monitoring was not used. There was no significant difference in the time of surgery between FCh-PET/CT and MIBI scintigraphy., Conclusions: FCh-PET/CT reduces the time of imaging, the time of surgery and potentially reduces the number of reoperations for persistent disease., (© 2024 Sebastijan Rep et al., published by Sciendo.)

Introduction: Dual phase technetium-99mTc-methoxy isobutyl isonitrile (MIBI) single-photon emission computed tomography with computed tomography (SPECT/CT) may be the most accurate conventional imaging approach for localization of enlarged parathyroid gland (EPG). The imaging is based on the radiopharmaceutical (RP) retention in EPG compared to washout from normal thyroid and normal parathyroid glands. This study aimed to estimate and optimize the contribution of computed tomography (CT) scan and scan range to effective dose (ED) in dual-phase MIBI SPECT/CT parathyroid scintigraphy., Methods: The study included seventy-four patients; thirty-seven with reduced and thirty-seven with extended CT scan range. The ED caused by the CT scan was calculated using Dose Length Product (DLP) data and estimated using the Imaging Performance Assessment of CT scanners (ImPACT) calculator., Results: For all patients, the contribution of CT to the ED in a combined SPECT/CT examination was 2.62 ± 0.29 mSv (48%). The contribution of CT to the total ED was 1.8 ± 0.18 mSv (33%) when using reduced and 3.44 ± 0.23 mSv (64%) when using extended scan range. The DLP and ED were statistically significantly different between the reduced and extended CT scan range (p < 0.001) in the first and second phases. The individual organ dose was reduced from 8% to 94%., Conclusion: The hybrid SPECT/CT improves the interpretation of nuclear medicine images and also increases the radiation dose to the patient. An adequately defined CT scan range on SPECT/CT imaging, can significantly reduce a patient's ED., Implications for Practice: The research findings showed that knowledge of anatomy, pathology and technology can provide optimising diagnostic procedures and reduce patient ED after SPECT/CT scans., Competing Interests: Conflict of interest statement None (all authors)., (Copyright © 2024 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Background: In the setting of primary hyperparathyroidism (PHPT), [ 18 F]fluorocholine PET/CT (FCH-PET) has excellent diagnostic performance, with experienced practitioners achieving 97.7% accuracy in localising hyperfunctioning parathyroid tissue (HPTT). Due to the relative triviality of the task for human readers, we explored the performance of deep learning (DL) methods for HPTT detection and localisation on FCH-PET images in the setting of PHPT., Patients and Methods: We used a dataset of 93 subjects with PHPT imaged using FCH-PET, of which 74 subjects had visible HPTT while 19 controls had no visible HPTT on FCH-PET. A conventional Resnet10 as well as a novel mPETResnet10 DL model were trained and tested to detect (present, not present) and localise (upper left, lower left, upper right or lower right) HPTT. Our mPETResnet10 architecture also contained a region-of-interest masking algorithm that we evaluated qualitatively in order to try to explain the model's decision process., Results: The models detected the presence of HPTT with an accuracy of 83% and determined the quadrant of HPTT with an accuracy of 74%. The DL methods performed statistically worse (p < 0.001) in both tasks compared to human readers, who localise HPTT with the accuracy of 97.7%. The produced region-of-interest mask, while not showing a consistent added value in the qualitative evaluation of model's decision process, had correctly identified the foreground PET signal., Conclusions: Our experiment is the first reported use of DL analysis of FCH-PET in PHPT. We have shown that it is possible to utilize DL methods with FCH-PET to detect and localize HPTT. Given our small dataset of 93 subjects, results are nevertheless promising for further research., (© 2022 Leon Jarabek, Jan Jamsek, Anka Cuderman, Sebastijan Rep, Marko Hocevar, Tomaz Kocjan, Mojca Jensterle, Ziga Spiclin, Ziga Macek Lezaic, Filip Cvetko, Luka Lezaic, published by Sciendo.)

Background: PET/CT imaging is widely used in oncology and provides both metabolic and anatomic information. Because of the relatively poor spatial resolution of PET, the detection of small lesions is limited. The low spatial resolution introduces the partial-volume effect (PVE) which negatively affects images both qualitatively and quantitatively. The aim of the study was to investigate the effect of small-voxel (2 mm in-line pixel size) vs. standard-voxel (4 mm in-line pixel size) reconstruction on lesion detection and image quality in a range of activity ratios., Materials and Methods: The National Electrical Manufacturers Association (NEMA) body phantom and the Micro Hollow-Sphere phantom spheres were filled with a solution of [ 18 F]fluorodeoxyglucose ([ 18 F]FDG) in sphere-to-background ratios of 2:1, 3:1, 4:1 and 8:1. In all images reconstructed with 2 mm and 4 mm in-line pixel size the visual lesion delineation, contrast recovery coefficient (CRC) and contrast-to-noise ratio (CNR) were evaluated., Results: For smaller (≤ 13 mm) phantom spheres, significantly higher CRC and CNR using small-voxel reconstructions were found, also improving visual lesion delineation. CRC did not differ significantly for larger (≥ 17 mm) spheres using 2 mm and 4 mm in-line pixel size, but CNR was significantly lower; however, lower CNR did not affect visual lesion delineation., Conclusions: Small-voxel reconstruction consistently improves precise small lesion delineation, lesion contrast and image quality., (© 2022 Sebastijan Rep, Petra Tomse, Luka Jensterle, Leon Jarabek, Katja Zaletel, Luka Lezaic, published by Sciendo.)

Objective: Medullary thyroid cancer (MTC) is a challenging neuroendocrine malignancy where the role of nuclear medicine imaging is currently limited. This paper investigates the potential diagnostic value of [ 18 F]Fluorocholine PET/CT in primary MTC., Methods: We prospectively enrolled 25 patients (10 male, 15 female) with suspicion for primary MTC based on fine-needle aspiration biopsy (FNAB). All patients had a baseline three phase [ 18 F]Fluorocholine PET/CT (2.5 MBq/kg): two regional head and neck and upper mediastinum studies at 5 min (first phase) and 120 min (third phase) and a whole-body PET/CT (from the skull vertex to mid-thighs) at 60 min (second phase). Any non-physiological radiotracer uptake was regarded as MTC positive. All patients referred to surgery had a preoperative neck-US. True lesion status was assessed using either histopathology, FNAB results or follow-up imaging and laboratory (calcitonin, CEA) results. Results with p < 0.05 were considered statistically significant., Results: Nineteen of 25 patients (76%) were surgically treated and histopathology reports were obtained. Patient-based sensitivity and positive predictive value for detection of any MTC lesion using [ 18 F]Fluorocholine PET/CT were both 100%. Neck-US was more specific (100% vs 70%; p = 0.002) and had a higher positive predictive value than [ 18 F]Fluorocholine PET/CT (100% vs 55%; p = 0.018) for N1a and N1b staging. [ 18 F]Fluorocholine PET/CT had a higher sensitivity (100% vs 50%; p = 0.025) and higher negative predictive value (100% vs 81%; p = 0.026) than neck-US for N1b staging. The optimal SUV max cut-off to differentiate malignant from benign neck lesions at 60 and 120 min was 2.56. Patients with M1 stage on PET/CT had higher calcitonin (median of 5,372 vs 496.6 pg/ml; p = 0.005) and CEA concentrations (median of 95.8 vs 18.65 µg/l; p = 0.034) compared to patients with M0 disease., Conclusion: [ 18 F]Fluorocholine PET/CT appears to be a promising radiotracer for primary staging of MTC by increasing diagnostic accuracy for N staging and detecting possible distant metastatic sites at initial presentation of disease.

The use of hybrid systems is increasingly growing in Europe and this is progressively important for the final result of diagnostic tests. As an integral part of the hybrid imaging system, computed tomography (CT) plays a crucial role in myocardial perfusion imaging diagnostics. Throughout Europe, a variety of equipment is available and also different university curricula of the nuclear medicine technologist are observed. Hence, the Technologist Committee of the European Association of Nuclear Medicine proposes to identify, through a bibliographic review, the recommendations for best practice in computed tomography applied to attenuation correction and calcium score in myocardial perfusion imaging, which courses in the set of knowledge, skills, and competencies for nuclear medicine technologists. This document aims at providing recommendations for CT acquisition protocols and CT image optimization in nuclear cardiology.

Primary hyperparathyroidism (PHPT) is a common endocrine disorder, definitive treatment usually requiring surgical removal of the offending parathyroid glands. To perform focused surgical approaches, it is necessary to localize all hyperfunctioning glands. The aim of the study was to compare the efficiency of established conventional scintigraphic imaging modalities with emerging 18 F-fluorocholine PET/CT imaging in preoperative localization of hyperfunctioning parathyroid glands in a larger series of PHPT patients. Methods: In total, 103 patients with PHPT were imaged preoperatively with 18 F-fluorocholine PET/CT and conventional scintigraphic imaging methods, consisting of 99m Tc-sestamibi SPECT/CT, 99m Tc-sestamibi/pertechnetate subtraction imaging, and 99m Tc-sestamibi dual-phase imaging. The results of histologic analysis, as well as intact parathyroid hormone and serum calcium values obtained 1 d after surgery and on follow-up, served as the standard of truth for evaluation of imaging results. Results: Diagnostic performance of 18 F-fluorocholine PET/CT surpassed conventional scintigraphic methods (separately or combined), with calculated sensitivity of 92% for PET/CT and 39%-56% for conventional imaging (65% for conventional methods combined) in the entire patient group. Subgroup analysis, differentiating single and multiple hyperfunctioning parathyroid glands, showed PET/CT to be most valuable in the group with multiple hyperfunctioning glands, with sensitivity of 88%, whereas conventional imaging was significantly inferior, with sensitivity of 22%-34% (44% combined). Conclusion: 18 F-fluorocholine PET/CT is a diagnostic modality superior to conventional imaging methods in patients with PHPT, allowing for accurate preoperative localization., (© 2020 by the Society of Nuclear Medicine and Molecular Imaging.)

Background: Parathyroid subtraction scintigraphy (PSS) is the most commonly used imaging method for localisation of hyperfunctioning parathyroid glands (HPGs) in primary hyperparathyroidism (PHP), a common endocrine disorder. Hybrid (SPECT/CT) imaging with 99m Tc-sestaMIBI (MIBI) at an early and delayed phase (dual-phase imaging) may be the most accurate conventional imaging approach, but includes additional radiation exposure due to added CT imaging. Recently, 18 F-choline (FCH) PET/CT was introduced for HPG imaging, which can also be performed using the dual-phase approach. To date, no studies have compared organ doses and the effective dose (ED) from conventional subtraction scintigraphy, dual-phase MIBI SPECT/CT, and FCH PET/CT in the localisation of HPGs., Aim: In addition to the comparison of the diagnostic performance of FCH PET/CT and conventional scintigraphic imaging methods, the aim of the study was to measure the organ doses and the ED for conventional subtraction parathyroid imaging protocols, using dual-phase MIBI SPECT/CT as a potential conventional imaging method of choice and FCH dual-phase PET/CT as a potential future imaging method of choice for the localisation of HPGs. Materials, methods. Thirty-six patients referred for parathyroid imaging with a clinical indication of PHP underwent preoperative PSS and dual-phase SPECT/CT imaging with the addition of FCH PET/CT. The diagnostic performance of the imaging modalities was assessed by using histology results as a gold standard. Radiation exposure was calculated for the administered activities of radiopharmaceuticals using ICRP80 weighting factors and for CT exposure at hybrid imaging using dose-length products and the ImPACT CT Patient Dosimetry Calculator., Results: The diagnostic performance of FCH PET/CT was significantly better than that of conventional imaging modalities (sensitivity of 97% vs 64% and 46% for MIBI SPECT/CT and PSS, respectively, with comparable specificity of over 95% for all modalities). The highest radiation exposure was caused by conventional PSS (7.4 mSv), followed by dual-phase MIBI SPECT/CT (6.8 mSv). The radiation exposure was the lowest for dual-phase FCH PET/CT imaging (2.8 mSv). The added CT imaging for both hybrid approaches did not cause significant additional radiation exposure (1.4 mSv for MIBI SPECT/CT, additional 26.4% to overall exposure; 0.8 mSv for FCH PET/CT, additional 42.4% to overall exposure)., Conclusion: In comparison to conventional scintigraphic imaging of HPGs, emerging hybrid (SPECT/CT, PET/CT) imaging techniques combine superior diagnostic performance with lower radiation exposure to patients.

Purpose: To evaluate the reproducibility of the expression of Parkinson's Disease Related Pattern (PDRP) across multiple sets of 18F-FDG-PET brain images reconstructed with different reconstruction algorithms., Methods: 18F-FDG-PET brain imaging was performed in two independent cohorts of Parkinson's disease (PD) patients and normal controls (NC). Slovenian cohort (20 PD patients, 20 NC) was scanned with Siemens Biograph mCT camera and reconstructed using FBP, FBP+TOF, OSEM, OSEM+TOF, OSEM+PSF and OSEM+PSF+TOF. American Cohort (20 PD patients, 7 NC) was scanned with GE Advance camera and reconstructed using 3DRP, FORE-FBP and FORE-Iterative. Expressions of two previously-validated PDRP patterns (PDRP-Slovenia and PDRP-USA) were calculated. We compared the ability of PDRP to discriminate PD patients from NC, differences and correlation between the corresponding subject scores and ROC analysis results across the different reconstruction algorithms., Results: The expression of PDRP-Slovenia and PDRP-USA networks was significantly elevated in PD patients compared to NC (p<0.0001), regardless of reconstruction algorithms. PDRP expression strongly correlated between all studied algorithms and the reference algorithm (r⩾0.993, p<0.0001). Average differences in the PDRP expression among different algorithms varied within 0.73 and 0.08 of the reference value for PDRP-Slovenia and PDRP-USA, respectively. ROC analysis confirmed high similarity in sensitivity, specificity and AUC among all studied reconstruction algorithms., Conclusions: These results show that the expression of PDRP is reproducible across a variety of reconstruction algorithms of 18F-FDG-PET brain images. PDRP is capable of providing a robust metabolic biomarker of PD for multicenter 18F-FDG-PET images acquired in the context of differential diagnosis or clinical trials., (Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.)

A focused surgical approach based on pre-operative localization replaced the classical four-gland exploration in patients with primary hyperparathyroidism (PHP). Sestamibi scanning and ultrasound are most often used localization modalities with reported sensitivity of 54-100% for identification of single gland disease. The aim of this study was to analyze the results of pre-operative localization with 18 F-Fluorocholine PET/CT (FCh-PET) in patients with PHP. A retrospective review of 151 patients with PHP who underwent surgery after pre-operative localization with FCh-PET was performed. Only a focused parathyroidectomy without ioPTH testing had been done in patients with single adenoma on FCh-PET. Primary outcome was operative failure, defined as persistent PHP. According to pre-operative FCh-PET 126 (83,4%) patients had single adenoma, 22 (14,5%) multiglandular disease and the test was negative in only two patients. Intraoperative failure experienced 4/126 patients (3,3%) with single adenoma. Removed parathyroid glands were normal in three and hyperplastic in one patient with intraoperative failure. A limited bilateral neck exploration with ioPTH testing was used in 14/22 patients with double adenoma and a classical four-gland exploration without ioPTH testing was used in 8/22 patients with more than two pathological glands according to pre-operative FCh-PET. Intraoperative failure experienced 2/22 patients (9,1%). In two patients with negative FCh-PET a classical four-gland exploration without ioPTH testing was used and one experienced intraoperative failure. A preoperative localization with FCh-PET is a reliable test in patients with PHP. Patients with a single adenoma on FCh-PET can safely undergo a focused parathyroidectomy without ioPTH testing., (Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Background: Parathyroid adenomas, the most common cause of primary hyperparathyroidism, are benign tumours which autonomously produce and secrete parathyroid hormone. [(18)F]-fluorocholine (FCH), PET marker of cellular proliferation, was recently demonstrated to accumulate in lesions representing enlarged parathyroid tissue; however, the optimal time to perform FCH PET/CT after FCH administration is not known. The aim of this study was to determine the optimal scan time of FCH PET/CT in patients with primary hyperparathyroidism., Patients and Methods: 43 patients with primary hyperparathyroidism were enrolled in this study. A triple-phase PET/CT imaging was performed five minutes, one and two hours after the administration of FCH. Regions of interest (ROI) were placed in lesions representing enlarged parathyroid tissue and thyroid tissue. Standardized uptake value (SUVmean), retention index and lesion contrast for parathyroid and thyroid tissue were calculated., Results: Accumulation of FCH was higher in lesions representing enlarged parathyroid tissue in comparison to the thyroid tissue with significantly higher SUVmean in the second and in the third phase (p < 0.0001). Average retention index decreased significantly between the first and the second phase and increased significantly between the second and the third phase in lesions representing enlarged parathyroid tissue and decreased significantly over all three phases in thyroid tissue (p< 0.0001). The lesion contrast of lesions representing enlarged parathyroid tissue and thyroid tissue was significantly better in the second and the third phase compared to the first phase (p < 0.05)., Conclusions: According to the results the optimal scan time of FCH PET/CT for localization of lesions representing enlarged parathyroid tissue is one hour after administration of the FCH.

Purpose: Primary hyperparathyroidism is a common endocrine disorder which is diagnosed biochemically and for which therapy is surgical. A prerequisite for minimally invasive surgery, which minimizes morbidity and cost, is accurate localization of the involved gland(s). The aim of this study was to evaluate the usefulness of (18)F-fluorocholine PET/CT for preoperative localization of hyperfunctioning parathyroid tissue., Methods: (18)F-Fluorocholine PET/CT and conventional parathyroid scintigraphic imaging consisting of (99m)Tc-sestaMIBI SPECT/CT, (99m)Tc-sestaMIBI dual-phase imaging and (99m)Tc-sestaMIBI/pertechnetate subtraction imaging were performed in 24 patients. The diagnostic performance of the imaging methods was compared against histology as the gold standard and postoperative serum Ca(2+) and iPTH values., Results: The sensitivity and specificity of (18)F-fluorocholine PET/CT were 92% and 100%, respectively, in contrast to 49% and 100%, 46% and 100%, and 44% and 100% for (99m)Tc-sestaMIBI SPECT/CT, (99m)Tc-sestaMIBI/pertechnetate subtraction imaging and (99m)Tc-sestaMIBI dual-phase imaging, respectively. Combined conventional scintigraphic imaging had a sensitivity and specificity of 64% and 100%, respectively. The performance of (18)F-fluorocholine PET/CT was superior particularly in patients with multiple lesions or hyperplasia., Conclusion: (18)F-Fluorocholine PET/CT appears to be a promising, effective imaging method for localization of hyperfunctioning parathyroid tissue.

Objectives: To analyze the predictive power of Ki67 area% (Ki67), mitotic activity index (MAI), p53 area% (p53), and the mean area of the 10 largest nuclei (MNA10) for progression of stage in 195 primary consecutive TaT1 urothelial cell carcinomas of the urinary bladder., Methods: Ki67- and p53-positive versus negative nuclei, MAI, and MNA10 using motorized systematic random sampling morphometry were determined. Kaplan-Meier curves and multivariate survival analysis (Cox model) were used to assess the prognostic value of the quantitative and classic clinicopathologic risk factors (age, sex, stage, grade, carcinoma in situ, multicentricity)., Results: Thirteen (6.7%) of the 195 patients had progression (0 [0%] of 36 low-risk, 1 [1.1%] of 85 intermediate-risk, and 12 [16.2%] of 74 high-risk patients). In univariate analysis (all variables), the strongest predictors with the highest hazard ratios were Ki67 (threshold 25.0%), MAI (threshold 30), and MNA10 (threshold 170 microm2). In multivariate analysis, the strongest independent combinations for progression--MNA10 (170 microm2) plus MAI (threshold 30) and MNA10 (threshold 170 microm2) plus Ki67 (threshold 25.0%)--overshadowed all other features. p53 was weaker but, combined with Ki67, still predicted progression fairly well. In the total group, the sensitivity, specificity, and positive and negative predictive values of MNA10-MAI and MNA10-Ki67 at the thresholds mentioned were 100%, 89%, 38%, and 100%, respectively. These feature combinations were also strongest prognostically in the high-risk treatment group., Conclusions: The combined biomarkers MNA10-MAI or MNA10-Ki67 are accurate, well reproducible, and easy to assess progression predictors in all patients with TaT1 urothelial cell carcinomas, as well as in high-risk (bacille Calmette-Guérin-treated) patients.