The Role of Predeployment Retraction in Biopsy Marker Migration During Stereotactic Breast Biopsies: A Randomized Controlled Trial.

OBJECTIVE: Inaccurate breast biopsy marker placement and marker migration during stereotactic biopsy procedures compromise their reliability for lesion localization and precise surgical excision. This trial evaluated the impact of 5-mm predeployment retraction of the marker introducer on marker migration, investigating other potential factors that influence the outcome. METHODS: This parallel, randomized controlled trial enrolled women aged ≥18 years undergoing stereotactic breast biopsy at a single institution from May 2020 through August 2022. The study was approved by the institutional review board at the University of Alabama at Birmingham (UAB). Patients were randomized to intervention (5-mm introducer retraction before marker deployment) or control (standard marker placement) by drawing a labeled paper. The primary outcome was the distance of marker migration on immediate postprocedure mammogram. RESULTS: Of 251 patients enrolled, 223 were analyzed; 104 received the intervention, and 119 received control. Mean (SD) marker migration was 12.1 (14.9) mm in the intervention group vs 9.8 (14.9) mm, with differences between groups estimated at 2.3 mm (SE = 1.9, P = .2312) (d = 0.16; 95% CI, 1.5-6.0). Effects of age, breast density, thickness, and biopsy approach showed no statistical significance. In exploratory models, central lesions exhibited 5.7 mm less migration than proximal lesions (95% CI, 0.7-10.6; P = .025), and each body mass index (BMI) unit increase was associated with 0.3 mm greater migration (95% CI, 0-0.6; P = .044). CONCLUSION: Retracting the marker introducer 5 mm before deployment did not reduce migration. Higher BMI and certain lesion locations were all associated with marker migration, highlighting the need to investigate biomechanical factors and techniques to optimize breast marker placement.Clinical Trials Registration: NCT04398537.

Chromosome-level genome assembly of Korean holoparasitic plants, Orobanche coerulescens.

Orobanche coerulescens is a parasitic plant that cannot complete its life cycle without a host and is incapable of photosynthesis. The habitats of O. coerulescens span the coasts of Korea and its volcanic islands, Ulleungdo and Dokdo. Those on the volcanic islands exhibit morphological differences and have distinct hosts compared to those on the peninsula. The family of Orobanchaceae, encompassing both autotrophic and parasitic species, serves as a model for evolutionary studies of parasitic states. However, there are limited genome assemblies for the Orobanche genus. In our study, we produced approximately 100x ONT long reads to construct a chromosome-level genome of O. coerulescens. The resulting assembly has a total size of 3,648 Mb with an N50 value of 195 Mb, and 82.0% of BUSCO genes were identified as complete. Results of the repeat annotation revealed that 86.3% of the genome consisted of repeat elements, and 29,395 protein-coding genes were annotated. This chromosome-level genome will be an important biological resource for conserving biodiversity and further understanding parasitic plants.

Breast Cancer Genomics: Primary and Most Common Metastases.

Specific genomic alterations have been found in primary breast cancer involving driver mutations that result in tumorigenesis. Metastatic breast cancer, which is uncommon at the time of disease onset, variably impacts patients throughout the course of their disease. Both the molecular profiles and diverse genomic pathways vary in the development and progression of metastatic breast cancer. From the most common metastatic site (bone), to the rare sites such as orbital, gynecologic, or pancreatic metastases, different levels of gene expression indicate the potential involvement of numerous genes in the development and spread of breast cancer. Knowledge of these alterations can, not only help predict future disease, but also lead to advancement in breast cancer treatments. This review discusses the somatic landscape of breast primary and metastatic tumors.

Breast papillomas in the United States: single institution data on underrepresented minorities with a multi-institutional update on incidence.

PURPOSE: To assess the percentage of papillomas from all biopsies performed, comparing differences in patient age and race at a single institution. To assess trends in biopsied papillomas at institutions throughout the United States (US). METHODS: This is a HIPPA-compliant IRB-approved single-institution (Southern1) retrospective review to assess race and age of all-modality-biopsied non-malignant papillomas as a percentage of all biopsies (percentage papillomas calculated as papilloma biopsies/all biopsies) from January 2012 to December 2019. To assess national variation, several academic or large referral centers were contacted to provide data regarding papilloma percentages, biopsy modalities, and trends in case numbers. Trends were estimated using the method of analysis of variance (ANOVA). Comparisons of differences in trends were assessed. RESULTS: Southern1 institution demonstrated a significant association between race and percentage of papillomas (p < 0.0001). After adjustment for multiple comparisons with Bonferroni correction at 5% type I family error, the percentage of biopsied papillomas in Black and Asian patients remained significantly higher than in White patients (p < 0.0001 and p = 0.0032, respectively) using a Chi-square test. The regional variation in percentage of papillomas was found to be 3-9%. Southern1 institution showed a 7-year significant trend of increase in percentage of papillomas. Other institutions showed a decreasing trend (p < 0.05). CONCLUSION: Black and Asian women had significantly higher papilloma percentages compared to white patients in our single institution review. This institution also showed a statistically significant trend of increasing percentage papillomas from 2012 to 2019. Multi-institutional survey found regional variation in percentage papillomas, ranging from 3% to 9%.

Quantitative analysis of piano performance proficiency focusing on difference between hands.

Quantitative evaluation of piano performance is of interests in many fields, including music education and computational performance rendering. Previous studies utilized features extracted from audio or musical instrument digital interface (MIDI) files but did not address the difference between hands (DBH), which might be an important aspect of high-quality performance. Therefore, we investigated DBH as an important factor determining performance proficiency. To this end, 34 experts and 34 amateurs were recruited to play two excerpts on a Yamaha Disklavier. Each performance was recorded in MIDI, and handcrafted features were extracted separately for the right hand (RH) and left hand (LH). These were conventional MIDI features representing temporal and dynamic attributes of each note and computed as absolute values (e. g., MIDI velocity) or ratios between performance and corresponding scores (e. g., ratio of duration or inter-onset interval (IOI)). These note-based features were rearranged into additional features representing DBH by simple subtraction between features of both hands. Statistical analyses showed that DBH was more significant in experts than in amateurs across features. Regarding temporal features, experts pressed keys longer and faster with the RH than did amateurs. Regarding dynamic features, RH exhibited both greater values and a smoother change along melodic intonations in experts that in amateurs. Further experiments using principal component analysis (PCA) and support vector machine (SVM) verified that hand-difference features can successfully differentiate experts from amateurs according to performance proficiency. Moreover, existing note-based raw feature values (Basic features) and DBH features were tested repeatedly via 10-fold cross-validation, suggesting that adding DBH features to Basic features improved F1 scores to 93.6% (by 3.5%) over Basic features. Our results suggest that differently controlling both hands simultaneously is an important skill for pianists; therefore, DBH features should be considered in the quantitative evaluation of piano performance.

Optimization of Fermentation Medium for Indole Acetic Acid Production by Pseudarthrobacter sp. NIBRBAC000502770.

Indole acetic acid (IAA) has been an important compound for plant growth and is widely known to be produced by plant growth-promoting rhizobacteria (PGPR). The isolate producing the maximum amount of IAA from the Korea shooting range soil was identified as Pseudarthrobacter sp. NIBRBAC000502770, using 16S rRNA gene sequencing. IAA production was determined in Luria-Bertani (LB) broth and optimized using different temperatures, agitation rates, L-tryptophan concentrations, carbon and nitrogen sources, and inorganic salts. The strain NIBRBAC000502770 showed better production of IAA at temperature 30 °C (29.47 mg·L-1) and at an agitation rate of 200 rpm (32.65 mg·L-1). Maltose (0.5%) was found to be the best carbon source for the strain (yielding 36.48 mg·L-1 IAA). IAA yield was 19.17 mg·L-1 and 24.73 mg·L-1 at 1% yeast extract and 1% tryptone as nitrogen sources, respectively. qRT-PCR showed the transcript levels of amiE and aldH genes, which had been predicted to encode indole-3-acetamide hydrolase and indole-3-acetaldehyde dehydrogenase, to be significantly upregulated in response to tryptophan. This study has examined that NIBRBAC000502770 has significant effects as a biological agent such as plant growth promotion, and development of optimal medium could significantly reduce the cost of mass production of microorganisms.

The complete chloroplast genome of Campanula takesimana Nakai from Dokdo Island in Korea (Campanulaceae).

Completed chloroplast genome of Campanula takesimana Nakai isolated from Dokdo island in Korea is 169,719 bp long (GC ratio is 38.8%) and has four subregions: 102,381 bp of large single-copy (37.8%) and 7,750 bp of small single-copy (32.6%) regions are separated by 29,794 bp of inverted repeat (41.3%) regions including 131 genes (87 protein-coding genes, eight rRNAs, and 36 tRNAs). Phylogenetic analyses suggested that C. takesimana from Dokdo Island form a clade with C. takesimana from Ulleungdo Island and that chloroplast genomes of the two accessions are diverged.

Review of Newer Antidiabetic Agents for Diabetes Management in Kidney Transplant Recipients.

OBJECTIVE: This systematic review describes the efficacy, safety, and drug interactions of dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), and sodium-glucose transport protein 2 (SGLT2) inhibitors in kidney transplant recipients (KTRs). DATA SOURCES: Articles were identified by English-language MEDLINE search, published prior to May 2020, using the terms kidney transplant, OR PTDM, OR NODAT, AND metformin, OR DPP4, OR GLP1, OR SGLT2. STUDY SELECTION AND DATA EXTRACTION: All selected studies were included if the study population was composed of adult KTRs who were diagnosed with either impaired glucose tolerance, diabetes mellitus (DM), new-onset diabetes after transplant (NODAT), or posttransplantation diabetes mellitus (PTDM). DATA SYNTHESIS: In KTRs, there is evidence for safety with DPP-4 inhibitors, GLP-1 RAs, and SGLT2 inhibitors. However, urinary tract infections and a slight initial decrease in renal function may limit use of SGLT2 inhibitors. As compared with the nontransplant type 2 DM population, SGLT2 inhibitors are not as efficacious in KTRs. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: This review provides an overview of the current literature on newer antidiabetic agents, addressing efficacy, safety, and drug interactions to help guide clinical decision-making for their use in KTRs. CONCLUSION: Newer antidiabetic agents have been recommended by the American Diabetes Association for potential cardiovascular, renal, and hypoglycemic benefits. Particular agents, such as DPP-4 inhibitors and GLP-1 RAs may play a role in correcting PTDM-related defects. Clinicians need to take into account both patient-specific and drug-specific characteristics when initiating these agents in KTRs.

Double trapezia sign: A new radiologic sign of scaphoid nonunion.

In scaphoid nonunion, pseudarthrosis and sclerotic change occur at the nonunion site. These changes make a distal fragment look like a trapezium on plain radiographs and we called this phenomenon the double trapezia sign. The purpose of this study was to estimate the diagnostic reliability of the double trapezia sign and its clinical and prognostic implications for the scaphoid nonunion.A retrospective review of 124 patients who underwent surgical treatment because of scaphoid nonunion between January 2007 and December 2017 was performed. Two hand surgeons and 1 musculoskeletal radiologist reviewed preoperative plain radiographs independently. Each observer evaluated the plain radiographs in 2 separate sessions at least 3 weeks apart to assess intraobserver and interobserver reliabilities of the double trapezia sign. To assess clinical and prognostic implications of the double trapezia sign, the patients were divided into the positive and nonpositive groups, and several variables such as age, sex, duration of nonunion, size of the distal fragment, avascular necrosis (AVN) of the proximal fragment, type of bone graft, healing time, and failure rate were compared between the 2 groups.The kappa values of intraobserver and interobserver reliabilities were >0.8, corresponding to almost perfect agreement. There were 58 patients in the positive group and 66 patients in the nonpositive group. The mean duration of nonunion was 38.5 months in the positive group and 12.2 months in the nonpositive group (P < .001). The size of distal fragment was 49.6% and 60.9%, respectively (P < .001). The AVN of proximal fragment was 24.1% and 54.5%, respectively (P = .001). The mean healing time was 4.1 and 6.4 months, respectively (P < .001). The failure rate was 13.8% and 27.3%, respectively (P = .066).In conclusion, the double trapezia sign is a valuable radiographic sign of scaphoid nonunion. The double trapezia sign is easily identifiable on plain radiographs and has excellent intra- and interobserver reliabilities. The positive double trapezia sign implies mid-waist nonunion, long duration of nonunion, less possibility of AVN, and favorable postoperative prognosis.

Eye-Hand Span is not an Indicator of but a Strategy for Proficient Sight-Reading in Piano Performance.

Eye-hand span, i.e., the distance between a performer's fixation and execution of a note, has been regarded as a decisive indicator of performers' competence in sight-reading. However, integrated perspectives regarding the relationship between eye-hand span and sight-reading variables have been less discussed. The present study explored the process of sight-reading in terms of three domains and their interrelations. The domain indicators included musical complexity and playing tempo (musical domain), eye-hand span (cognitive domain), and performance accuracy (behavioural domain). Thirty professional pianists sight-read four musical pieces with two different complexities and playing tempi. We measured the participants' eye-hand span, evaluated their performance accuracy, and divided the participants into three groups according to their performance accuracy values. Interestingly, we found that the eye-hand span did not change solely based on the performance accuracy. In contrast, the relationship between the eye-hand span and performance accuracy changed according to the difficulty of the sight-reading task. Our results demonstrate that the eye-hand span is not a decisive indicator of sight-reading proficiency but is a strategy that can vary according to the difficulty of sight-reading tasks. Thus, proficient sight-readers are performers who are skilled at adjusting their eye-hand span instead of always maintaining an extended span.

Survey Result of the Counting Efficiency of Gamma Counter by Certified Reference Materials.

PURPOSE: In radioimmunoassay (RIA), the gamma counter is the important instrument for the accurate measurement. To manage quality assurance of RIA, the counting efficiency of gamma counter is one of the important parameters. The aim of this study was to evaluate the counting efficiency of gamma counters in multiple institutes on the base of traceability by using the certified reference materials (CRMs). METHODS: Twenty-three institutes that perform RIA were enrolled in this study. I-125 CRMs that were certified by National Institute of Standards and Technology (NIST) were used. Each institute was asked to count the activity of I-125 CRMs at most twice on all gamma counters in use. The counting efficiency of each well of counter was calculated on the base of NIST-certified information, corrected for I-125 decay for date of testing. RESULTS: From 23 institutes, 44 gamma counters were evaluated. The average counting efficiency of all wells was 85.9% and the standard deviation was 13.5%. As a mean value of each gamma counter, three gamma counters showed poor counting efficiency (less than 70%). The poorest counting efficiency was 7%. The counting efficiency of seven gamma counters was between 70 and 75%. Eight counters had the counting efficiency between 75 and 90%. More than half of counter (26 gamma counters) showed excellent counting efficiency (more than 90%). The standard deviation variation range of inter-well efficiency was from 0 to 11.2. CONCLUSION: The first survey on the counting efficiency of gamma counter was performed in South Korea. Most of the RIA laboratories have well managed the quality assurance of gamma counter.

Musical Expectations Enhance Auditory Cortical Processing in Musicians: A Magnetoencephalography Study.

The present study investigated the influence of musical expectations on auditory representations in musicians and non-musicians using magnetoencephalography (MEG). Neuroscientific studies have demonstrated that musical syntax is processed in the inferior frontal gyri, eliciting an early right anterior negativity (ERAN), and anatomical evidence has shown that interconnections occur between the frontal cortex and the belt and parabelt regions in the auditory cortex (AC). Therefore, we anticipated that musical expectations would mediate neural activities in the AC via an efferent pathway. To test this hypothesis, we measured the auditory-evoked fields (AEFs) of seven musicians and seven non-musicians while they were listening to a five-chord progression in which the expectancy of the third chord was manipulated (highly expected, less expected, and unexpected). The results revealed that highly expected chords elicited shorter N1m (negative AEF at approximately 100 ms) and P2m (positive AEF at approximately 200 ms) latencies and larger P2m amplitudes in the AC than less-expected and unexpected chords. The relations between P2m amplitudes/latencies and harmonic expectations were similar between the groups; however, musicians' results were more remarkable than those of non-musicians. These findings suggest that auditory cortical processing is enhanced by musical knowledge and long-term training in a top-down manner, which is reflected in shortened N1m and P2m latencies and enhanced P2m amplitudes in the AC.

Detection and Clinical Significance of Sternal Lesions on Breast MRI.

The purpose of this study is to characterize sternal lesions detected on breast magnetic resonance imaging (MRI), compare MRI detection of sternal lesions with other imaging modalities (bone scan, positron emission tomography/computed tomography (PET/CT) and chest CT), and ascertain how often patient management is altered by discovery of sternal lesions. Retrospective review of 1143 breast MRIs between 2007 and 2012 identified 17 patients with sternal lesions including 15 patients with newly diagnosed breast cancer and two patients with remote history of breast cancer. Tumor size, histopathology, receptor status, nodal and distant metastasis, and images of breast MRI, and other modalities were reviewed. Sternal lesions in 9 of the 17 patients were determined to be malignant (metastasis) either by biopsy or presence of widespread metastases. Sternal lesions in 8 of the 17 were benign, confirmed by biopsy or presumed benign as not detected by other modalities. The malignant group had statistically significant larger breast cancer size (malignant: 6.4 cm; benign: 2.3 cm), a higher percentage of diffuse sternal lesions (malignant: 56%; benign: 0%), and more frequently showed rapid initial enhancing (malignant: 100%; benign: 63%) and delayed washout curves (malignant: 67%; benign: 13%). Although not statistically significant, the malignant group had a higher frequency of invasive lobular carcinoma (malignant: 44%; benign: 13%) and more lymph node involvement (malignant: 78%; benign: 50%). Breast MRI detected more sternal lesions than did bone scan, PET/CT and chest CT. Four of the 17 (24%) patients were upgraded to stage 4 due to unsuspected metastatic sternal lesions on breast MRI. In conclusion, breast MRI is more sensitive than other modalities in detecting sternal lesions. Sternal metastases occur more frequently in aggressive breast cancer and exhibit malignant-type dynamics on breast MRI. Detection of unsuspected sternal metastasis alters staging and improves patient management with more appropriate treatment.

MR findings of the osteofibrous dysplasia.

OBJECTIVE: The aim of this study was to describe MR findings of osteofibrous dysplasia. MATERIALS AND METHODS: MR images of 24 pathologically proven osteofibrous dysplasia cases were retrospectively analyzed for a signal intensity of the lesion, presence of intralesional fat signal, internal hypointense band, multilocular appearance, cortical expansion, intramedullary extension, cystic area, cortical breakage and extraosseous extension, abnormal signal from the adjacent bone marrow and soft tissue and patterns of contrast enhancement. RESULTS: All cases of osteofibrous dysplasia exhibited intermediate signal intensity on T1-weighted images. On T2-weighted images, 20 and 4 cases exhibited heterogeneously intermediate and high signal intensity, respectively. Intralesional fat was identified in 12% of the cases. Internal low-signal bands and multilocular appearance were observed in 91%. Cortical expansion was present in 58%. Intramedullary extension was present in all cases, and an entire intramedullary replacement was observed in 33%. Cortical breakage (n = 3) and extraosseous mass formation (n = 1) were observed in cases with pathologic fractures only. A cystic area was observed in one case. Among 21 cases without a pathologic fracture, abnormal signal intensity in the surrounding bone marrow and adjacent soft tissue was observed in 43% and 48%, respectively. All cases exhibited diffuse contrast enhancement. CONCLUSION: Osteofibrous dysplasia exhibited diverse imaging features ranging from lesions confined to the cortex to more aggressive lesions with complete intramedullary involvement or perilesional marrow edema.

Diagnostic accuracy and recall rates for digital mammography and digital mammography combined with one-view and two-view tomosynthesis: results of an enriched reader study.

OBJECTIVE: The purpose of this study was to compare two methods of combining tomosynthesis with digital mammography by assessing diagnostic accuracy and recall rates for digital mammography alone and digital mammography combined with one-view tomosynthesis and two-view tomosynthesis. SUBJECTS AND METHODS: Three hundred ten cases including biopsy-proven malignancies (51), biopsy-proven benign findings (47), recalled screening cases (138), and negative screening cases (74) were reviewed by 15 radiologists sequentially using digital mammography, adding one-view tomosynthesis, and then two-view tomosynthesis. Cases were assessed for recall and assigned a BI-RADS score and probability of malignancy for each imaging method. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) analysis. Screening recall rates were compared using pooled logistical regression analysis. A p value of < 0.0167 was considered significant. RESULTS: The area under the ROC curve (AUC) for digital mammography (DM), DM plus one-view tomosynthesis, and DM plus two-view tomosynthesis was 0.828, 0.864, and 0.895, respectively. Both one-view and two-view tomosynthesis plus DM were significantly better than DM alone (Δ AUCs 0.036 [p = 0.009] and 0.068 [p < 0.001]). Average noncancer recall rates for digital mammography, DM plus one-view tomosynthesis, and DM plus two-view tomosynthesis were 44.2%, 27.2%, and 24.0%, respectively. Combined with DM, one-view and two-view tomosynthesis both showed significantly lower noncancer recall rates than digital mammography alone (p < 0.001). Digital mammography with two-view tomosynthesis showed a significantly lower recall rate than digital mammography with one-view tomosynthesis (p < 0.001). Diagnostic accuracy for dense (Δ AUC, 0.091%; p < 0.001) and nondense (Δ AUC, 0.035%; p = 0.001) breasts improved with DM plus two-view tomosynthesis compared with digital mammography alone. Compared with digital mammography, diagnostic sensitivity for invasive cancers increased with the addition of both one-view (Δ12.0%, p < 0.001) and two-view (Δ21.7%, p < 0.001) tomosynthesis. CONCLUSION: The addition of one-view tomosynthesis to conventional digital mammography improved diagnostic accuracy and reduced the recall rate; however, the addition of two-view tomosynthesis provided twice the performance gain in diagnostic accuracy while further reducing the recall rate.

The selection of the appropriate computer interface device for patients with high cervical cord injury.

In order to determine the most suitable computer interfaces for patients with high cervical cord injury, we report three cases of applications of special input devices. The first was a 49-year-old patient with neurological level of injury (NLI) C4, American Spinal Injury Association Impairment Scale (ASIA)-A. He could move the cursor by using a webcam-based Camera Mouse. Moreover, clicking the mouse could only be performed by pronation of the forearm on the modified Micro Light Switch. The second case was a 41-year-old patient with NLI C3, ASIA-A. The SmartNav 4AT which responds according to head movements could provide stable performance in clicking and dragging. The third was a 13-year-old patient with NLI C1, ASIA-B. The IntegraMouse enabling clicking and dragging with fine movements of the lips. Selecting the appropriate interface device for patients with high cervical cord injury could be considered an important part of rehabilitation. We expect the standard proposed in this study will be helpful.

The clinical significance of the mini-nutritional assessment and the scored patient-generated subjective global assessment in elderly patients with stroke.

OBJECTIVE: To evaluate the clinical usefulness of the subjective assessments of nutritional status (Mini-Nutritional Assessment [MNA] and scored patient-generated subjective global assessment [PG-SGA]), compared with the objective (hematological, biochemical, and anthropometric) assessments, and to identify the correlation between the MNA and the scored PG-SGA in elderly patients with stroke. METHODS: Thirty-five stroke patients, aged 60 to 89 years old, participated in our study. The MNA, the scored PG-SGA and objective factors were evaluated. The objective malnutrition state was defined based on laboratory outcomes. According to the MNA and the scored PG-SGA classifications, total patients were respectively divided into three groups; well-nourished (W), at risk of malnutrition (R), and malnourished (M), and into four groups; normally nourished (A), suspected or mildly malnourished (B), moderately malnourished (C), and severely malnourished (D). RESULTS: Mean age and body mass index of subjects were 70.6 years and 22.2 kg/m(2), respectively. Twenty-six (74.3%) patients were identified to be at an objectively malnourished state. In MNA, 3 (8.6%) patients were classified as group W, 13 (37.1%) as R, and 19 (54.3%) as M. Total MNA scores and three categorization had mild correlation with objective grouping (r=0.383, r=0.350, p<0.05, respectively). Restructuring into two groups by combining group R and M made strong correlation (r=0.520, p<0.01). On the basis of scored PG-SGA, 6 (17.1%) patients were sorted as group A, 10 (28.6%) as B, 15 (42.9%) as C, and 4 (11.4%) as D, respectively. Total scores and the grouping into four indicated meaningful correlation with the objective distinction (r=-0.403, p<0.05, r=0.449, p<0.01, respectively). There was a significant correlation between the MNA scores and the PG-SGA scores (r=-0.651, p<0.01). CONCLUSION: It is proposed that the MNA and the scored PG-SGA would be useful in screening malnourished elderly patients with stroke.

Assessing radiologist performance using combined digital mammography and breast tomosynthesis compared with digital mammography alone: results of a multicenter, multireader trial.

PURPOSE: To compare radiologists' diagnostic accuracy and recall rates for breast tomosynthesis combined with digital mammography versus digital mammography alone. MATERIALS AND METHODS: Institutional review board approval was obtained at each accruing institution. Participating women gave written informed consent. Mediolateral oblique and craniocaudal digital mammographic and tomosynthesis images of both breasts were obtained from 1192 subjects. Two enriched reader studies were performed to compare digital mammography with tomosynthesis against digital mammography alone. Study 1 comprised 312 cases (48 cancer cases) with images read by 12 radiologists; study 2, 312 cases (51 cancer cases) with 15 radiologists. Study 1 readers recorded only that an abnormality requiring recall was present; study 2 readers had additional training and recorded both lesion type and location. Diagnostic accuracy was compared with receiver operating characteristic analysis. Recall rates of noncancer cases, sensitivity, specificity, and positive and negative predictive values determined by analyzing Breast Imaging Reporting and Data System scores were compared for the two methods. RESULTS: Diagnostic accuracy for combined tomosynthesis and digital mammography was superior to that of digital mammography alone. Average difference in area under the curve in study 1 was 7.2% (95% confidence interval [CI]: 3.7%, 10.8%; P < .001) and in study 2 was 6.8% (95% CI: 4.1%, 9.5%; P < .001). All 27 radiologists increased diagnostic accuracy with addition of tomosynthesis. Recall rates for noncancer cases for all readers significantly decreased with addition of tomosynthesis (range, 6%-67%; P < .001 for 25 readers, P < .03 for all readers). Increased sensitivity was largest for invasive cancers: 15% and 22% in studies 1 and 2 versus 3% for in situ cancers in both studies. CONCLUSION: Addition of tomosynthesis to digital mammography offers the dual benefit of significantly increased diagnostic accuracy and significantly reduced recall rates for noncancer cases. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120674/-/DC1.

A Learning Set Up for Detecting Minimally Conscious State (MCS).

Detecting signs of learning in persons diagnosed to be in a post-coma vegetative state and minimally conscious state (MCS) may modify their diagnosis. We report the case of a 65-year-old female in a vegetative state. We used microswitch-based technology that is based on patient response to eye-blinking. We followed an ABABCB design, in which A represented baseline periods, B intervention periods with stimuli contingent on the responses, and C a control condition with stimuli presented non-contingently. We observed the level of response during the B phases was higher than the level of A and C phases. This indicated the patient showed signs of learning. This state was confirmed by an evaluation through the Coma Recovery Scale-Revised (CRSR) score, and after completion of this study her CRSR score changed from 4 to 10. We believe microswitch technology may be useful to make a diagnosis of MCS and offer new opportunities for education to MCS patients.