Spatial distribution and influencing factors of CDC health resources in China: a study based on panel data from 2016-2021.

Background: Measuring the development of Chinese centers for disease control and prevention only by analyzing human resources for health seems incomplete. Moreover, previous studies have focused more on the quantitative changes in healthcare resources and ignored its determinants. Therefore, this study aimed to analyze the allocation of healthcare resources in Chinese centers for disease control and prevention from the perspective of population and spatial distribution, and to further explore the characteristics and influencing factors of the spatial distribution of healthcare resources. Methods: Disease control personnel density, disease control and prevention centers density, and health expenditures density were used to represent human, physical, and financial resources for health, respectively. First, health resources were analyzed descriptively. Then, spatial autocorrelation was used to analyze the spatial distribution characteristics of healthcare resources. Finally, we used spatial econometric modeling to explore the influencing factors of healthcare resources. Results: The global Moran index for disease control and prevention centers density decreased from 1.3164 to 0.2662 (p < 0.01), while the global Moran index for disease control personnel density increased from 0.4782 to 0.5067 (p < 0.01), while the global Moran index for health expenditures density was statistically significant only in 2016 (p < 0.1). All three types of healthcare resources showed spatial aggregation. Population density and urbanization have a negative impact on the disease control and prevention centers density. There are direct and indirect effects of disease control personnel density and health expenditures density. Population density and urbanization had significant negative effects on local disease control personnel density. Urbanization has an indirect effect on health expenditures density. Conclusion: There were obvious differences in the spatial distribution of healthcare resources in Chinese centers for disease control and prevention. Social, economic and policy factors can affect healthcare resources. The government should consider the rational allocation of healthcare resources at the macro level.

Prevalence and Determinants of Anxiety and Depression Among Healthcare Workers in Liaoning Province, China.

Purpose: To assess the anxiety and depression and their predictors among healthcare workers in Liaoning Province, China. Methods: In order to explore the influencing factors and prevalence of anxiety and depression among healthcare workers, a cross-sectional research design was used to survey 500 healthcare workers using the 14-item Hospital Anxiety Depression Scale (HADS), the Rosenberg Self-Esteem Scale (RSES), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Survey of Perceived Organizational Support (SPOS). Results: About 47.12% of the healthcare workers suffered from anxiety and 71.63% suffered from depression. In our study, we found that the health status (OR: 0.540, 95% CI: 0.298-0.976), self-esteem (OR: 0.395, 95% CI: 0.251-0.619), PSS (OR: 0.621, 95% CI: 0.388-0.994), organizational support (OR: 0.533, 95% CI. 0.333-0.854) were protective factors for healthcare workers suffering from anxiety, and resistance to COVID-19 (OR: 1.703, 95% CI: 1.082-2.681) was a risk factor for healthcare workers suffering from anxiety, while good quality of life (OR: 0.385, 95% CI: 0.206-0.719) self-esteem (OR: 0.187, 95% CI: 0.110-0.317), and PSS (OR: 0.475, 95% CI: 0.267-0.847) were protective factors for healthcare workers suffering from depression, and at the age of 35-40 years (OR: 2.475, 95% CI: 1.140-5.369) and resistance to COVID-19 (OR: 2.219, 95% CI: 1.313-3.751) were risk factors for healthcare workers suffering from depression. Conclusion: The anxiety and depression status of healthcare workers in China is poor, and hospital administrators should take positive measures to support healthcare workers and give positive expectations to alleviate negative emotions such as anxiety and depression.

Psychometric Characteristics of the Chinese Version of the Tuberculosis Related-Stigma Scale in a Population of Medical Students and Its Correlation with Selected Demographic Characteristics.

Background: As future health workers, medical students' attitudes towards tuberculosis (TB) patients can impact TB control. However, in China, there is a lack of well-quantified assessment regarding the stigma among medical students towards TB patients. Therefore, this study aimed to validate the Chinese version of the Tuberculosis related-Stigma Scale (TSS) in medical students and to apply the scale to measure stigma and its determinants. Methods: A total of 1035 eligible medical students participated in the cross-sectional questionnaire. Exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were first conducted to test Chinese version of the TSS construct validity, and then internal consistency was assessed using Cronbach's α. Finally, multiple linear regression analyses were conducted to identify predictors of stigma. Results: EFA extracted two factors ("Social distance" and "Exclusionary sentiments"). The CFA further confirmed the two-factor construct. The internal consistency, convergent and divergent validity of the adapted Chinese version of the TSS was acceptable. Furthermore, Whether one has received TB health education and whether know a person with TB are associated with all dimensions of TB stigma, while differences in sex and place of residence play different roles in influencing the different dimensions of stigma. Conclusion: The adapted Chinese version of the TSS can be used to assess the level of stigma among medical students in China towards tuberculosis patients. When implementing future interventions to reduce stigma associated with TB, special attention should be given to medical students from urban areas, of male gender, who have not received TB health education, and no know a person with TB. However, these two dimensions ("Social distance" and "Exclusionary sentiments") are impacted by different determinants and should therefore be addressed separately when designing, implementing, and evaluating measures to reduce stigma.

Determination of Tumor Marker Screening for Lung Cancer Using ROC Curves.

Introduction: Lung cancer ranks first among malignant tumors worldwide and is a leading cause of cancer-related mortality in both men and women. Combining tumor marker testing is a strategy to screen individuals at high risk of pulmonary cancer and minimize pulmonary cancer mortality. Therefore, tumor marker screening is crucial. In this study, we analyzed combinations of tumor markers for lung cancer screening using receiver operating characteristic (ROC) curve analysis. Methods: A retrospective descriptive study was conducted on patients diagnosed with lung cancer, as well as healthy and benign lung diseases, using data from the China Huludao Central Hospital database between January 2016 and July 2022. The t-test and ROC curve were utilized to assess the effectiveness of individual tumor marker and the combination of multiple tumor markers. Tumor markers are molecular products metabolized and secreted by tumor tissues, characterized by cells or body fluids. They serve as indicators of tumor stage and grading, monitor treatment response, and predict recurrence. Results: In this study, 267 healthy participants, 385 patients with benign lesions, and 296 patients with lung cancer underwent tumor marker screening. The sensitivity of five tumor markers-CEA, CYFRA21-1, NSE, pro-GRP, and CA125-was found to be <55%. This study revealed that a single tumor marker had limited value in lung cancer screening. However, combining two or more markers yielded varying area under the curves (AUC), with no significant impact on screening accuracy. The combination of CEA + CA125 demonstrated the highest accuracy for lung cancer screening in healthy participants. At a cutoff of 0.447 for CEA + CA125, the combination showed a sensitivity of 0.676 and specificity of 0.846 for lung cancer screening. Conversely, for patients with benign lung lesions, the optimal combination was CEA + NSE, with a cutoff of 0.393, yielding a sensitivity of 0.645 and specificity of 0.766 for lung cancer screening. Conclusion: The five tumor markers-CEA, CA125, CY211, NSE, GRP-show promising results in screening healthy individuals and patients with lung cancer. However, only CEA, NSE, and GRP effectively differentiate patients with benign lung lesions from those with lung cancer. A single tumor marker has limited utility in detecting and screening for lung cancer and should be combined with other tumor markers. CEA + CA125 emerges as a superior tumor marker for distinguishing healthy individuals from those with lung cancer, whereas the CEA + NSE combination is more effective in identifying tumor markers in patients with benign lung lesions and lung cancer.

Retinal Thinning as a Marker of Disease Severity in Progressive Supranuclear Palsy.

OBJECTIVE: Progressive supranuclear palsy (PSP) involves a variety of visual symptoms that are thought to be partially caused by structural abnormalities of the retina. However, the relationship between retinal structural changes, disease severity, and intracranial alterations remains unknown. We investigated distinct retinal thinning patterns and their relationship with clinical severity and intracranial alterations in a PSP cohort. METHODS: We enrolled 19 patients with PSP (38 eyes) and 20 age-matched healthy controls (40 eyes). All of the participants underwent peripapillary and macular optical coherence tomography. Brain 11C-2ß-carbomethoxy-3ß-(4-fluorophenyl) tropane (11C-CFT) and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography imaging were also performed in patients with PSP. We investigated the association between retinal thickness changes and clinical features, striatal dopamine transporter availability, and cerebral glucose metabolism. RESULTS: The peripapillary retinal nerve fiber layer (pRNFL) and macula were significantly thinner in patients with PSP than in controls. The thickness of the superior sector of the pRNFL demonstrated a significant negative relationship with the Movement Disorder Society-Unified Parkinson's Disease Rating Scale part III and Hoehn and Yahr staging scale scores. A significant negative correlation was found between outer inferior macular thickness and disease duration. Outer temporal macular thickness was positively correlated with Montreal Cognitive Assessment scores. In PSP, lower outer temporal macular thickness was also positively correlated with decreased dopamine transporter binding in the caudate. CONCLUSION: The pRNFL and macular thinning may be candidate markers for monitoring disease severity. Additionally, macular thinning may be an in vivo indicator of nigrostriatal dopaminergic cell degeneration in PSP patients.

International consensus on clinical use of presynaptic dopaminergic positron emission tomography imaging in parkinsonism.

PURPOSE: Presynaptic dopaminergic positron emission tomography (PET) imaging serves as an essential tool in diagnosing and differentiating patients with suspected parkinsonism, including idiopathic Parkinson's disease (PD) and other neurodegenerative and non-neurodegenerative diseases. The PET tracers most commonly used at the present time mainly target dopamine transporters (DAT), aromatic amino acid decarboxylase (AADC), and vesicular monoamine type 2 (VMAT2). However, established standards for the imaging procedure and interpretation of presynaptic dopaminergic PET imaging are still lacking. The goal of this international consensus is to help nuclear medicine practitioners procedurally perform presynaptic dopaminergic PET imaging. METHOD: A multidisciplinary task group formed by experts from various countries discussed and approved the consensus for presynaptic dopaminergic PET imaging in parkinsonism, focusing on standardized recommendations, procedures, interpretation, and reporting. CONCLUSION: This international consensus and practice guideline will help to promote the standardized use of presynaptic dopaminergic PET imaging in parkinsonism. It will become an international standard for this purpose in clinical practice.

In vivo cerebral metabolic and dopaminergic characteristics in multiple system atrophy with orthostatic hypotension.

PURPOSE: Multiple system atrophy (MSA) is a rare neurodegenerative disease, often presented with orthostatic hypotension (OH), which is a disabling symptom but has not been very explored. Here, we investigated MSA patients with OH by using positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) and 11C-N-2-carbomethoxy-3-(4-fluorophenyl)-tropane (11C-CFT) for in vivo evaluation of the glucose metabolism and dopaminergic function of the brain. METHODS: Totally, 51 patients with MSA and 20 healthy controls (HC) who underwent 18F-FDG PET/CT were retrospectively enrolled, among which 24 patients also underwent 11C-CFT PET/CT. All patients were divided into MSA-OH(+) and MSA-OH(-) groups. Then, statistical parametric mapping (SPM) method was used to reveal the regional metabolic and dopaminergic characteristics of MSA-OH(+) compared with MSA-OH(-). Moreover, the metabolic networks of MSA-OH(+), MSA-OH(-) and HC groups were also constructed and analyzed based on graph theory to find possible network-level changes in MSA patients with OH. RESULTS: The SPM results showed significant hypometabolism in the pons and right cerebellar tonsil, as well as hypermetabolism in the left parahippocampal gyrus and left superior temporal gyrus in MSA-OH(+) compared with MSA-OH(-). A reduced 11C-CFT uptake in the left caudate was also shown in MSA-OH(+) compared with MSA-OH(-). In the network analysis, significantly reduced local efficiency and clustering coefficient were shown in MSA-OH(+) compared with HC, and decreased nodal centrality in the frontal gyrus was found in MSA-OH(+) compared with MSA-OH(-). CONCLUSION: In this study, the changes in glucose metabolism in the pons, right cerebellar tonsil, left parahippocampal gyrus and left superior temporal gyrus were found closely related to OH in MSA patients. And the decreased presynaptic dopaminergic function in the left caudate may contribute to OH in MSA. Taken together, this study provided in vivo pathophysiologic information on MSA with OH from neuroimaging approach, which is essential for a better understanding of MSA with OH.

Moderating effects of perceived social support on self-efficacy and psychological well-being of Chinese nurses: a cross-sectional study.

Introduction: Nurses experience significant physical and psychological stress that negatively influences their psychological well-being. The objective of this study was to explore the association between self-efficacy and psychological well-being among Chinese nurses and to assess the moderating effects of perceived social support (PSS). Methods: In 2020, a hospital-based cross-sectional study using a multistage random sampling approach was performed in five regions of Liaoning, China. Of the 1,200 surveyed nurses, 1,010 completed questionnaires that evaluated the demographic information, 14-item Hospital Anxiety and Depression Scale, General Self-Efficacy Scale, and Multidimensional Scale of Perceived Social Support. To examine the factors associated with mental health parameters, hierarchical multiple regression analysis was performed. The interactions were visualized using a simple slope analysis. Results: The mean depression and anxiety scores for Chinese nurses were 8.74 ± 3.50 and 6.18 ± 3.26, respectively. The association between self-efficacy and depression differed between the low perceived social support (PSS) group (1 SD below the mean, ß = -0.169, p < 0.01) and high PSS group (1 SD above the mean, ß = -0.077, p < 0.01). Similarly, the association between self-efficacy and anxiety differed between the low PSS group (1 SD below the mean, ß = -0.155, p < 0.01) and high PSS group (1 SD above the mean, ß = -0.044, p < 0.01). Conclusion: We found that Chinese nurses experienced high levels of anxiety and depression. Furthermore, PSS moderates the relationship between self-efficacy and psychological well-being. Therefore, interventions targeting self-efficacy and PSS should be implemented to improve the psychological well-being of nurses.

The mediating role of self-efficacy between workplace violence and PTSD among nurses in Liaoning Province, China: A cross-sectional study.

Purpose: Nurses are at high risk for workplace violence, which can lead to psychological problems. The purpose of this study was to determine the relationship between workplace violence, self-efficacy, and PTSD, and to further explore whether self-efficacy mediates the relationship between workplace violence and PTSD among Chinese nurses. Materials and methods: This cross-sectional study was conducted in Liaoning Province, China in 2020. A total of 1,017 valid questionnaires were returned. Each questionnaire included the Workplace Violence Scale, the General Self-Efficacy Scale, the Post-traumatic Stress Disorder Scale (PTSS-10), and demographics information. A hierarchical multiple regression approach was used to explore the mediating role of self-efficacy in the relationship between workplace violence and PTSD. The mediation model was then tested by the PROCESS macro in SPSS. Results: A total of 1,017 nurses were included in this study, and the average score of PTSD among Chinese nurses was 26.85 ± 13.13 (mean ± SD). After further adjustment for control variables, workplace violence was positively associated with PTSD, explaining 13% of the variance. High self-efficacy was associated with low PTSD, explaining 18% of the variance. Self-efficacy partially mediated the role of workplace violence and PTSD. Conclusion: The high scores of PTSD among Chinese nurses demand widespread attention. Workplace violence is an important predictor of PTSD in nurses. Self-efficacy is a significant factor in improving PTSD in nurses and mediates the relationship between workplace violence and PTSD. Measures and strategies to improve self-efficacy may mitigate the effects of workplace violence on PTSD in nurses.

The differences in drug resistance between drug-resistant tuberculosis patients with and without diabetes mellitus in northeast China: a retrospective study.

BACKGROUND: Diabetes mellitus (DM) and drug-resistant tuberculosis (DR-TB) are serious global public health problems. This study aimed to explore the differences in drug resistance between DR-TB patients with and without DM. Risk factors for developing multidrug-resistant tuberculosis (MDR-TB) were also investigated among DR-TB patients. METHODS: The patient's basic demographic,　clinical characteristics, and drug susceptibility testing (DST) data were collected from the Chinese Disease Control Information System. Descriptive statistics were used to estimate the frequency and proportion of included variables. Categorical variables were compared using the Chi-square test or Fisher's exact test. Chi-square tests for trends were used to determine changes and trends in MDR-TB and pre-extensively drug-resistantTB (pre-XDR-TB) patterns over time. Univariate and multivariate logistic regression analysis was used to explore the risk factors of MDR-TB. RESULTS: Compared with DR-TB patients with DM, DR-TB patients without DM had significantly higher rates of mono-resistant streptomycin (SM) and any resistance to kanamycin (KM), but significantly lower rates of any resistance to protionamide (PTO) and mono-resistance to levofloxacin (LFX), and pre-XDR-TB (P<0.05). The proportion of resistance to other anti-TB drugs was not statistically different between the DR-TB with and without DM. Among DR-TB patients without and with DM, the proportion of patients with MDR-TB and pre-XDR-TB patterns showed a significant downward trend from 2016 to 2021 (P<0.05). Among DR-TB patients without DM, male, previously treated DR-TB cases, and immigration were risk factors for MDR-TB (P<0.05). In DR-TB patients with DM, a negative sputum smear is a risk factor for MDR-TB (P<0.05). CONCLUSION: There was no statistical difference in resistance patterns between DR-TB with and without DM, except in arbitrary resistance to PTO and KM, mono-resistant SM and LFX, and pre-XDR-TB. Great progress has been made in the prevention and control of MDR-TB and pre-XDR-TB. However, DR-TB patients with and without DM differ in their risk factors for developing MDR-TB.

Prejudice and determinants regarding tuberculosis patients among medical students in Dalian, Northeast China: a cross-sectional study.

Background: Health workers play a central role in global tuberculosis (TB) elimination efforts. If medical students have prejudiced attitudes toward TB patients, this may make it difficult for them to provide effective health care to TB patients in their future roles as health workers. There is currently no research on prejudice toward TB patients among medical students in China. This study aimed to explore the current status of medical students' prejudice against patients with TB and its associated predictors. Methods: We conducted a cross-sectional questionnaire survey among medical students at a medical university in Dalian, Liaoning Province, Northeast China. Multiple logistic regression analysis was employed to determine the predictive factors of medical students' prejudice against patients with TB. Results: More than half (57.23%) of the medical students held prejudices against individuals with TB. Multivariate logistic regression analysis revealed that not receiving TB health education (OR: 2.12, 95% CI: 1.35-3.32), not knowing a person with TB (OR: 2.52, 95% CI: 1.39-4.56), and fear of TB/TB patients (OR: 6.79, 95% CI: 4.36-10.56) were identified as risk factors for medical students' prejudice against TB patients. Conversely, residing in rural areas (OR: 0.60, 95% CI: 0.38-0.95), agreeableness (OR: 0.82, 95% CI: 0.73-0.92) and emotional stability (OR: 0.90, 95% CI: 0.81-1.00) in the Big Five personality traits, and a better understanding of TB knowledge (OR: 0.58, 95% CI: 0.38-0.89) were identified as protective factors. Conclusion: In China, a considerable number of medical students still exhibit prejudice against patients with TB. Targeted interventions, such as incorporating TB health education into the core curriculum of medical students, and enhance their agreeableness and emotional stability, are still needed. Furthermore, greater focus should be placed on medical students from urban backgrounds or those who harbor fear or do not know a person with TB.

Drug Resistance Patterns and Trends in Patients with Suspected Drug-Resistant Tuberculosis in Dalian, China: A Retrospective Study.

Purpose: The emergence of drug-resistant tuberculosis (DR-TB) represents a threat to the control of tuberculosis. This study aimed to estimate the patterns and trends of DR-TB in patients with suspected DR-TB. In addition, risk factors for multidrug-resistant tuberculosis (MDR-TB) were identified among suspected DR-TB patients in Dalian, China. Patients and Methods: A total of 5661 patients with suspected DR-TB from Jan 1, 2013 to Dec 31, 2020 were included in the final analysis. The resistance pattern of all resistant strains was determined by drug susceptibility testing (DST) using the conventional Lowenstein-Jensen Proportion Method (LJ). DR-TB trends were estimated from 2013 to 2020. During the research period, the chi-square test was employed to analyze the significance of linear drug-resistance trends across time. Bivariate and multivariate logistic regression were performed to assess factors associated with MDR-TB. Results: From 2013 to 2020, the resistance rates of rifampicin (RFP) and isoniazid (INH) decreased significantly, whereas the resistance rates of ethambutol (EMB) and streptomycin (SM) increased in patients with suspected DR-TB. From 2013 to 2020, the prevalence of DR-TB decreased in all patients from 34.71% to 28.01% with an average annual decrease of 3.02%. Among new cases, from 2013 to 2020, the prevalence of DR-TB (from 26.67% to 24.75%), RFP-resistant TB (RR-TB) (from 15.09% to 3.00%) and MDR-TB (from 6.08% to 2.62%) showed a significant downward trend. Among patients with a previous treatment history, DR-TB (from 54.70% to 37.50%), RR-TB (from 44.16% to 11.49%) and MDR-TB (from 26.90% to 10.34%) showed a significant downward trend from 2013 to 2020. Males (AOR 1.28, 95% CI 1.035-1.585), patients 45 to 64 years of age (AOR 1.75, 95% CI 1.342-2.284), patients 65 years and older (AOR 1.65, 95% CI 1.293-2.104), rural residents (AOR 1.24, 95% CI 1.014-1.519) and a previous treatment history (AOR 3.94, 95% CI 3.275-4.741) were risk factors for MDR-TB. Conclusion: The prevalence of DR-TB, RR-TB and MDR-TB was significantly reduced from 2013 to 2020. Considerable progress has been made in the prevention and treatment of DR-TB during this period. However, the increasing rate of drug resistance in EMB and SM should be taken seriously. Suspected DR-TB patients who are male, older than 45 years of age, live in rural areas, and have a history of TB treatment should be given priority by health care providers.

18F-FP-CIT PET/CT in a case of probable sporadic Creutzfeldt-Jakob disease with parkinsonism as initial symptom.

Creutzfeldt-Jakob disease (CJD) is a low-prevalence, fatal neurodegenerative disease. Parkinsonism as first symptom of CJD is rare. We present a case manifesting difficulty falling asleep as unspecific prodromal symptom and parkinsonism as initial symptom. The patient received positron emission tomography/computed tomography (PET/CT) of dopamine transporter (DAT) using 18 F-FP-CIT. The DAT-scan demonstrated presynaptic dopaminergic deficit in bilateral posterior putamen, which supports the hypothesis of nigrostriatal pathway dysfunction in CJD.

The factors influencing the psychological distress of transgender women in Shandong, China: a cross-sectional study.

BACKGROUND: As a group at high-risk for acquired immune deficiency syndrome (AIDS) infection, the psychological distress of transgender women cannot be ignored while preventing and controlling AIDS risks. Transgender women are a vulnerable group, and their psychological distress deserves attention. The purpose of this study was to evaluate the psychological distress of transgender women and further determine the influences of factors on the psychological distress of transgender women. METHODS: From March 2021 to August 2021, a cross-sectional survey was conducted in Shandong province, China. Data were collected by a questionnaire designed for transgender women, and the GHQ-12 scale was used to measure their psychological distress. The questionnaire combined sociodemographic characteristics, HIV/AIDS cognition, related behaviors, substance abuse, social support, gender identity and other factors. Univariate logistic regression and multivariate logistic regression models were used to explore the psychological factors of transgender women. RESULTS: In this study, the rate of transgender women with psychological distress was 20.08%. Earned monthly income between 10,000-15,000 yuan (OR:0.16, 95% CI:0.06-0.45) and a monthly income greater than 15,000 yuan (OR:0.07, 95% CI:0.01-0.43) were protective factors in the psychology of transgender women. Transgender women who never disclosed sexual orientation and identity (OR: 0.19, 95% CI: 0.06-0.58), who only disclosed their sexual orientation and identity to families or friends (OR: 0.41, 95% CI: 0.18-0.93) were also less likely to have psychological distress. Additionally, transgender women who did not desire to be identified with their sexual orientation and identity (OR: 3.31, 95%CI: 1.08-10.16) and who reported that the Internet did not play an essential role in helping determine sexual orientation (OR: 5.96, 95% CI: 2.91-12.20) were more likely to have psychological distress. CONCLUSION: Transgender women were at risk of psychological distress. Earning more money can help transgender women's psychological health. When formulating measures for transgender women, we should pay attention to enhance social inclusion and social acceptance of their gender identity and sexual orientation. Strengthening the role of the internet in transgender women's confirmation of sexual orientation and improving the social acceptance of transgender women will have a positive impact on the psychological status of transgender women.

International consensus on the use of tau PET imaging agent 18F-flortaucipir in Alzheimer's disease.

PURPOSE: Positron emission tomography (PET) with the first and only tau targeting radiotracer of 18F-flortaucipir approved by FDA has been increasingly used in depicting tau pathology deposition and distribution in patients with cognitive impairment. The goal of this international consensus is to help nuclear medicine practitioners procedurally perform 18F-flortaucipir PET imaging. METHOD: A multidisciplinary task group formed by experts from various countries discussed and approved the consensus for 18F-flortaucipir PET imaging in Alzheimer's disease (AD), focusing on clinical scenarios, patient preparation, and administered activities, as well as image acquisition, processing, interpretation, and reporting. CONCLUSION: This international consensus and practice guideline will help to promote the standardized use of 18F-flortaucipir PET in patients with AD. It will become an international standard for this purpose in clinical practice.

High-resolution pediatric age-specific 18F-FDG PET template: a pilot study in epileptogenic focus localization.

BACKGROUND: PET imaging has been widely used in diagnosis of neurological disorders; however, its application to pediatric population is limited due to lacking pediatric age-specific PET template. This study aims to develop a pediatric age-specific PET template (PAPT) and conduct a pilot study of epileptogenic focus localization in pediatric epilepsy. METHODS: We recruited 130 pediatric patients with epilepsy and 102 age-matched controls who underwent 18F-FDG PET examination. High-resolution PAPT was developed by an iterative nonlinear registration-averaging optimization approach for two age ranges: 6-10 years (n = 17) and 11-18 years (n = 50), respectively. Spatial normalization to the PAPT was evaluated by registration similarities of 35 validation controls, followed by estimation of potential registration biases. In a pilot study, epileptogenic focus was localized by PAPT-based voxel-wise statistical analysis, compared with multi-disciplinary team (MDT) diagnosis, and validated by follow-up of patients who underwent epilepsy surgery. Furthermore, epileptogenic focus localization results were compared among three templates (PAPT, conventional adult template, and a previously reported pediatric linear template). RESULTS: Spatial normalization to the PAPT significantly improved registration similarities (P < 0.001), and nearly eliminated regions of potential biases (< 2% of whole brain volume). The PAPT-based epileptogenic focus localization achieved a substantial agreement with MDT diagnosis (Kappa = 0.757), significantly outperforming localization based on the adult template (Kappa = 0.496) and linear template (Kappa = 0.569) (P < 0.05). The PAPT-based localization achieved the highest detection rate (89.2%) and accuracy (80.0%). In postsurgical seizure-free patients (n = 40), the PAPT-based localization also achieved a substantial agreement with resection areas (Kappa = 0.743), and the highest detection rate (95%) and accuracy (80.0%). CONCLUSION: The PAPT can significantly improve spatial normalization and epileptogenic focus localization in pediatric epilepsy. Future pediatric neuroimaging studies can also benefit from the unbiased spatial normalization by PAPT. TRIAL REGISTRATION: NCT04725162: https://clinicaltrials.gov/ct2/show/NCT04725162.

A deep learning framework for 18F-FDG PET imaging diagnosis in pediatric patients with temporal lobe epilepsy.

PURPOSE: Epilepsy is one of the most disabling neurological disorders, which affects all age groups and often results in severe consequences. Since misdiagnoses are common, many pediatric patients fail to receive the correct treatment. Recently, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) imaging has been used for the evaluation of pediatric epilepsy. However, the epileptic focus is very difficult to be identified by visual assessment since it may present either hypo- or hyper-metabolic abnormality with unclear boundary. This study aimed to develop a novel symmetricity-driven deep learning framework of PET imaging for the identification of epileptic foci in pediatric patients with temporal lobe epilepsy (TLE). METHODS: We retrospectively included 201 pediatric patients with TLE and 24 age-matched controls who underwent 18F-FDG PET-CT studies. 18F-FDG PET images were quantitatively investigated using 386 symmetricity features, and a pair-of-cube (PoC)-based Siamese convolutional neural network (CNN) was proposed for precise localization of epileptic focus, and then metabolic abnormality level of the predicted focus was calculated automatically by asymmetric index (AI). Performances of the proposed framework were compared with visual assessment, statistical parametric mapping (SPM) software, and Jensen-Shannon divergence-based logistic regression (JS-LR) analysis. RESULTS: The proposed deep learning framework could detect the epileptic foci accurately with the dice coefficient of 0.51, which was significantly higher than that of SPM (0.24, P < 0.01) and significantly (or marginally) higher than that of visual assessment (0.31-0.44, P = 0.005-0.27). The area under the curve (AUC) of the PoC classification was higher than that of the JS-LR (0.93 vs. 0.72). The metabolic level detection accuracy of the proposed method was significantly higher than that of visual assessment blinded or unblinded to clinical information (90% vs. 56% or 68%, P < 0.01). CONCLUSION: The proposed deep learning framework for 18F-FDG PET imaging could identify epileptic foci accurately and efficiently, which might be applied as a computer-assisted approach for the future diagnosis of epilepsy patients. TRIAL REGISTRATION: NCT04169581. Registered November 13, 2019 Public site: https://clinicaltrials.gov/ct2/show/NCT04169581.