Highly Efficient Room Temperature NO2 Sensor Using Two-Phase TiOx Heterogeneous Nanoparticles.

In this study, we successfully synthesized two-phase titanium oxide (TiOx) heterogeneous nanoparticles (NPs) using an advanced sol-gel method, a significant stride in developing efficient, room temperature (RT) NO2 gas sensors. The prepared two-phase TiOx heterogeneous NPs exhibited exceptional sensitivity to low concentrations of NO2 gas at RT. The heightened gas response was attributed to a significant presence of oxygen vacancies, creating intermediate states within the two-phase heterostructures and thus narrowing the band gap. This facilitated electron transport from the valence band (VB) to the conduction band (CB), resulting in increased current at RT. The XPS analysis confirmed a substantial amount of chemisorbed oxygen O2(ads)- within the two-phase heterostructures, providing more chemisorption sites for nitrogen dioxide gas. This increase in chemisorption sites significantly improved the gas response. Furthermore, the introduction of zinc into the TiOx NPs reduced their band gap, enhancing the background resistance signal-to-noise ratio and increasing the response while maintaining remarkable stability. In summary, our work introduces a promising RT NO2 sensor based on two-phase TiOx heterogeneous NPs, holding great potential for applications in environmental monitoring and gas sensing technology. In future work, we aim to delve deeper into the capabilities of the sensor, exploring broader applications and refining its design for enhanced practicality in environmental monitoring.

Diagnostic Accuracy for Acute Rib Fractures: A Cross-sectional Study Utilizing Automatic Rib Unfolding and 3D Volume-Rendered Reformation.

RATIONALE AND OBJECTIVES: The aim of this study was to compare the use of computed tomography (CT) with automatic rib unfolding and three-dimensional (3D) volume-rendered imaging in the detection and characterization of rib fractures and flail chest. MATERIALS AND METHODS: A total of 130 patients with blunt chest trauma underwent whole-body CT, and five independent readers assessed the presence and characterization of rib fractures using traditional CT images, automatic rib unfolding, and 3D volume-rendered images in separate readout sessions at least 2 weeks apart. A gold standard was established by consensus among the readers based on the combined analysis of conventional and reformatted images. RESULTS: Automatic rib unfolding significantly reduced mean reading time by 47.5%-74.9% (P < 0.0001) while maintaining a comparable diagnostic performance for rib fractures (positive predictive value [PPV] of 82.1%-93.5%, negative predictive value [NPV] of 96.8%-98.2%, and 69.4%-94.2% and 96.9%-99.1% for conventional axial images and 70.4%-85.1% and 95.2%-96.6% for 3D images) and better interobserver agreement (kappa of 0.74-0.87). For flail chest, automatic rib unfolding showed a PPV of 85.7%-100%, NPV of 90.4%-99.0%, and 80.0%-100% and 89.7%-100% for conventional axial images and 76.9%-100% and 89.0%-92.1% for 3D images. CONCLUSION: Automatic rib unfolding demonstrated equivalent diagnostic performance to conventional images in detecting acute rib fractures and flail chest, with good interobserver agreement and time-saving benefits.

Inspiratory Muscle Training Improves Aerobic Fitness in Active Children.

Research on the effect of inspiratory muscle training (IMT) on exercise performance is inconsistent. IMT has not been applied to fit child athletes, who are more likely to develop inspiratory muscle fatigue, and, consequently, to benefit from IMT. Methods: Thirty children (mean age: 10.7 ± 1.2 years) were recruited and randomly assigned to a high-intensity (HG), a low-intensity (LG), or a control group (CG). For both training groups, a double-blind procedure was applied. In the HG, 80% of maximal inspiratory pressure (MIP) was used as the level of training intensity. The LG used 30% MIP. Training groups were trained at 6 breaths a set, 4 sets a day, totaling 24 breaths a day for 6 weeks. Exercise capacity outcomes include maximal and submaximal aerobic capacity, as measured as VO2max and distance from six-minute walk test (6MWD). Results show improvement in MIP, VO2max, and 6MWD only in the HG. MIP in the HG significantly increases from 108.7 (100.8-143.3) to 144.4 (130.0-175.6) cmH2O. VO2max in the HG increases from 43.0 (40.5-45) to 53.0 (46-63) mL·kg-1·min-1. The 6MWD increases from 792.0 (737.5-818.0) to 862.0 (798.5-953.5) m. Data are presented as median (interquartile range). No difference is found in the LG or CG. Conclusion: high-intensity IMT increases MIP, maximal, and submaximal exercise capacity in the HG, but no difference is found in the LG or CG. Therefore, high-intensity type of IMT improves aerobic fitness in fit children by appropriately applying inspiratory muscle strength training.

Bilateral spontaneous massive renal hemorrhage in a peritoneal dialysis patient: A case report.

RATIONALE: Non-traumatic bilateral spontaneous massive renal hemorrhage confined to the subcapsular and perirenal space, also known as Wünderlich syndrome, can occur suddenly and insidiously and cause serious consequences if not properly identified and managed. We report a case of bilateral spontaneous massive renal hemorrhage in a series of devastating episodes. PATIENT CONCERNS: A 38-year-old woman undergoing peritoneal dialysis for 7 years for end-stage renal disease presented with disturbances in consciousness and sudden hypotension. DIAGNOSIS: The patient's laboratory results indicated an abrupt drop in hemoglobin level. Emergent abdominal computed tomography (CT) showed a rupture of the lower pore of the left kidney, with massive hemoretroperitoneum. A second sudden reduction in hemoglobin level occurred 2 months later during the same admission course, with poor response to urgent blood transfusion. Contrast extravasation at the lower pole of the right kidney and posterior pararenal space along with a subcapsular hematoma was revealed on abdominal CT. INTERVENTION: The patient's initial episode was managed with emergent transcatheter arterial embolization (TAE) of the left renal artery and again after the second episode for occlusion of the inferior branches of the right renal artery. OUTCOMES: After the first episode, immediate postprocedural angiography showed total occlusion of the left renal artery without contrast extravasation. Follow-up CT performed 10 days after the first TAE showed a residual left perirenal hematoma that extended to the left retroperitoneal and left upper pelvic region, without active bleeding. No follow-up imaging was done after the second TAE except for immediate postprocedural angiography, which showed no additional contrast extravasation of the right renal artery. LESSONS: Bilateral spontaneous massive renal hemorrhage is rare and generally occurs in patients undergoing dialysis. Known studies appear primarily in case reports. Most patients can be treated successfully with TAE when diagnosed early.

Impact of pre-operative breast magnetic resonance imaging on contralateral synchronous and metachronous breast cancer detection-A case control comparison study with 1468 primary operable breast cancer patients with mean follow-up of 102 months.

BACKGROUND: Women with unilateral breast cancer are at an increased risk for the development of contralateral breast cancers. We hypothesis that combined breast MRI would detect more contralateral synchronous breast cancer than conventional imaging alone, and resulted in less contralateral metachronous breast cancer during follow-up. METHODS: We retrospectively collected two groups of breast cancer patients diagnosed from 2009 to 2013 for evaluating the effectiveness and value of adding pre-operative breast MRI to conventional breast images (mammography and sonography) for detection of contralateral synchronous breast cancer. The new metachronous contralateral breast cancer diagnosed during follow-up was prospectively evaluated and compared. RESULTS: Group A (n = 733) comprised patients who underwent conventional preoperative imaging and group B (n = 735) combined with MRI were enrolled and compared. Seventy (9.5%) of the group B patients were found to have contralateral lesions detected by breast MRI, and 65.7% of these lesions only visible with MRI. The positive predictive value of breast MRI detected contralateral lesions was 48.8%. With the addition of breast MRI to conventional imaging studies, more surgical excisions were performed in contralateral breasts (6% (44/735) versus 1.4% (10/733), P< 0.01), more synchronous contralateral breast cancer detected (2.9% (21/735) versus 1.1% (8/733), P = 0.02), and resulted in numerical less (2.2% (16/714) versus 3% (22/725), p = 0.3) metachronous contralateral breast cancer during a mean follow-up of 102 months. CONCLUSIONS: Our study provides useful estimates of the pre-operative breast MRI for the increased detection of contralateral synchronous breast cancer and less subsequent contralateral metachronous breast cancer.

Tumor Necrosis Factor-Alpha Exacerbates Viral Entry in SARS-CoV2-Infected iPSC-Derived Cardiomyocytes.

The coronavirus disease 2019 (COVID-19) pandemic with high infectivity and mortality has caused severe social and economic impacts worldwide. Growing reports of COVID-19 patients with multi-organ damage indicated that severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) may also disturb the cardiovascular system. Herein, we used human induced pluripotent stem cell (iPSC)-derived cardiomyocytes (iCMs) as the in vitro platform to examine the consequence of SARS-CoV2 infection on iCMs. Differentiated iCMs expressed the primary SARS-CoV2 receptor angiotensin-converting enzyme-II (ACE2) and the transmembrane protease serine type 2 (TMPRSS2) receptor suggesting the susceptibility of iCMs to SARS-CoV2. Following the infection of iCMs with SARS-CoV2, the viral nucleocapsid (N) protein was detected in the host cells, demonstrating the successful infection. Bioinformatics analysis revealed that the SARS-CoV2 infection upregulates several inflammation-related genes, including the proinflammatory cytokine tumor necrosis factor-α (TNF-α). The pretreatment of iCMs with TNF-α for 24 h, significantly increased the expression of ACE2 and TMPRSS2, SASR-CoV2 entry receptors. The TNF-α pretreatment enhanced the entry of GFP-expressing SARS-CoV2 pseudovirus into iCMs, and the neutralization of TNF-α ameliorated the TNF-α-enhanced viral entry. Collectively, SARS-CoV2 elevated TNF-α expression, which in turn enhanced the SARS-CoV2 viral entry. Our findings suggest that, TNF-α may participate in the cytokine storm and aggravate the myocardial damage in COVID-19 patients.

Different Patterns in Ranking of Risk Factors for the Onset Age of Acute Myocardial Infarction between Urban and Rural Areas in Eastern Taiwan.

This cross-sectional study aimed to investigate the difference in ranking of risk factors of onset age of acute myocardial infarction (AMI) between urban and rural areas in Eastern Taiwan. Data from 2013 initial onset of AMI patients living in the urban areas (n = 1060) and rural areas (n = 953) from January 2000 to December 2015, including onset age, and conventional risk factors including sex, smoking, diabetes, hypertension, dyslipidemia, and body mass index (BMI). The results of multiple linear regressions analysis showed smoking, obesity, and dyslipidemia were early-onset reversible risk factors of AMI in both areas. The ranking of impacts of them on the age from high to low was obesity (ß = -6.7), smoking (ß = -6.1), and dyslipidemia (ß = -4.8) in the urban areas, while it was smoking (ß = -8.5), obesity (ß= -7.8), and dyslipidemia (ß = -5.1) in the rural areas. Furthermore, the average onset ages for the patients who smoke, are obese, and have dyslipidemia simultaneously was significantly earlier than for patients with none of these comorbidities in both urban (13.6 years) and rural (14.9 years) areas. The findings of this study suggest that the different prevention strategies for AMI should be implemented in urban and rural areas.

Acute Myocardial Infarction among Young Adult Men in a Region with Warm Climate: Clinical Characteristics and Seasonal Distribution.

The aim of this cross sectional study was to investigate the influence of the seasons on acute myocardial infarction (AMI) among young adult among young adults aged <45 years compared to old adults aged ≥45 years. The seasonal distribution of AMI hospital admissions among young adult men in eastern Taiwan was assessed. Data were extracted from 1413 male AMI patients from January 1994 to December 2015, including onset date, the average temperature (Tave) on the date of AMI hospitalization (AMI-Tave), and conventional risk factors, notably smoking, diabetes, hypertension, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and body mass index (BMI). The 1413 cases were divided into two groups: the young group (n = 138, <45 y/o) and the older group (n = 1275, ≥45 y/o). The differences between groups were examined. Logistic regression analyses were used to evaluate the associations between the seasons and the AMI hospitalization among the young group. The young group showed significantly higher percentage of smokers, BMI, total cholesterol levels, and triglycerides levels but lower percentage of diabetes and hypertension than the older group (p < 0.05). AMI hospitalization in winter was significantly greater compared to the other seasons among the young group (p < 0.05). Winter hospitalization was significantly associated with the young group relative to the older group (adjusted OR 1.750; 95% CI 1.151 to 2.259), while winter AMI-Tave in the young group was similar to that in the older group. Young adult men diagnosed with AMI are more likely than older adult men to be smokers, obese, and show an onset dependent on winter but not low-temperature in a region with a warm climate.

Ultrasound-Guided Lumbar Intradiscal Injection for Discogenic Pain: Technical Innovation and Presentation of Two Cases.

We described two cases and the techniques for using the ultrasound (US) to guide lumbar intradiscal injection with platelet-rich plasma (PRP). The two cases suffered from chronic low back pain. Magnetic resonance imaging revealed posterior annular tear of the L5/S1 intervertebral disc (IVD) in the first case and L4/5 and L5/S1 IVDs in the second case. For the US-guided lumbar intradiscal injection, the patient was placed in a prone position. By placing the transducer in the axial plane at the interlaminar space, the needle was directed toward the center of the aimed IVD. The needle tip was ensured inside the IVD by using the end-feel of sudden reduction of resistance and the poking technique with the transducer oriented in the paramedian sagittal oblique plane. At the follow-up, both patients had significant improvement after the intradiscal PRP injections (visual analogue scale from 7.5 to 1.5 on average). The report indicated US-guided lumbar intradiscal PRP injection to be a feasible approach for treatments of low back pain. Familiarization of the anatomy and sonoanatomy of the lumbar spine is fundamental to achieve the success of intradiscal injection.

Microtube Array Membrane (MTAM)-Based Encapsulated Cell Therapy for Cancer Treatment.

The treatment of cancer has evolved significantly in recent years with a strong focus on immunotherapy. Encapsulated Cell Therapy (ECT) for immunotherapy-based anti-cancer treatment is a unique niche within this landscape, where molecules such as signaling factors and antibodies produced from cells are encapsulated within a vehicle, with a host amount of benefits in terms of treatment efficacy and reduced side effects. However, traditional ECTs generally lie in two extremes; either a macro scale vehicle is utilized, resulting in a retrievable system but with limited diffusion and surface area, or a micro scale vehicle is utilized, resulting in a system that has excellent diffusion and surface area but is unretrievable in the event of side effects occurring, which greatly compromises the biosafety of patients. In this study we adapted our patented and novel electrospun Polysulfone (PSF) Microtube Array Membranes (MTAMs) as a 'middle' approach to the above dilemma, which possess excellent diffusion and surface area while being retrievable. Hybridoma cells were encapsulated within the PSF MTAMs, where they produced CEACAM6 antibodies to be used in the suppression of cancer cell line A549, MDA-MB-468 and PC 3 (control). In vitro and in vivo studies revealed excellent cell viability of hybridoma cells with continuous secretion of CEACAM6 antibodies which suppressed the MDA-MB-468 throughout the entire 21 days of experiment. Such outcome suggested that the PSF MTAMs were not only an excellent three-dimensional (3D) cell culture substrate but potentially also an excellent vehicle for the application in ECT systems. Future research needs to include a long term in vivo >6 months study before it can be used in clinical applications.

Ultrahigh packing density next generation microtube array membrane: A novel solution for absorption-based extracorporeal endotoxin removal device.

Sepsis is a deadly disease that is widely attributed to endotoxin released by gram-negative bacterial infections often plague emergency care facilities. Conventionally antibiotics and vasopressors are used to treat this disease. Recent treatment protocol shifted to a membrane to remove the offending endotoxin monomer. Despite this shift, membrane-based devices are often extremely costly, hindering accessibility to this life saving medical device. In view of this challenges, we adopted the internally developed polysulfone (PSF) microtube array membrane alternating (MTAM-A) for use in blood sepsis treatment. PSF MTAM-A were with polymyxin B (PMB) molecules immobilized were assembled into an internally developed cartridge housing and subjected to endotoxin removal models with water and blood spiked with 100 EU/ml of endotoxin as the feed solution. Samples were derived at 15, 30, 60, and 120 min and endotoxin levels were determined with limulus amebocyte lysate assay and benchmarked against the commercially available Toraymyxin device. The PSF MTAM-A with 2.3 times the surface area was successfully fabricated and with PMB molecules immobilized, and assembled into a hemoperfusion device. Dynamic endotoxin removal test revealed and overall endotoxin removal capacity of 90% and a superior endotoxin removal efficiency that was significantly higher than that of Toraymyxin (internally conducted and reported). The data suggested that PSF MTAM-A PMB membranes could potentially be applied in future hemoperfusion devices which would be significantly more efficient, compact, and affordable; potentially making such a life-saving medical device widely available to the general public.

Djulis (Chenopodium Formosanum) Prevents Colon Carcinogenesis via Regulating Antioxidative and Apoptotic Pathways in Rats.

Djulis is a cereal crop rich in polyphenols and dietary fiber that may have nutraceutical activity to prevent colon cancer. This study was designed to examine the preventive effect of djulis on colon carcinogenesis in rats treated with 1,2-dimethylhydrazine (DMH). Rats were fed different AIN-93G-based diets: groups N and DMH were fed AIN-93G diet and groups LD, MD, and HD were fed AIN-93G diet containing 5, 10, and 20% djulis, respectively. All rats except for group N were injected with DMH to induce colon carcinogenesis. After 10 weeks, rats were sacrificed and colon and liver tissues were collected for analysis. The results showed that djulis-treated rats had significantly lower numbers of colonic preneoplastic lesions, aberrant crypt foci (ACF), sialomucin-producing (SIM)-ACF, and mucin-depleted foci. Djulis treatment increased superoxide dismutase and catalase activities in colon and liver. Djulis also reduced p53, Bcl-2, and proliferating cell nuclear antigen expressions and increased Bax and caspase-9 expressions. Besides, phenolic compounds and flavonoids were found rich in djulis. These results demonstrate the chemopreventive effect of djulis on carcinogen-induced colon carcinogenesis via regulating antioxidative and apoptotic pathways in rats. Djulis may have the potential to be developed as a valuable cereal product for chemoprevention of colon cancer.

Acute Myocardial Infarction Hospitalizations between Cold and Hot Seasons in an Island across Tropical and Subtropical Climate Zones-A Population-Based Study.

We investigated the effects of cold and hot seasons on hospital admissions for acute myocardial infarction (AMI) at the junction of tropical and subtropical climate zones. The hospitalization data of 6897 AMI patients from January 1997 to December 2011 were obtained from the database of the National Health Insurance, including date of admission, gender, age, and comorbidities of hypertension, diabetes mellitus (DM), and dyslipidemia. A comparison of AMI prevalence between seasons and the association of season-related AMI occurrences with individual variables were assessed. AMI hospitalizations in the cold season (cold-season-AMIs) were significantly greater than those in the hot season (OR 1.15; 95% CI 1.10-1.21). In the subtropical region, cold-season-AMIs were strongly and significantly associated with the ≥65 years group (OR1.28; 95% CI 1.11 to 1.48). In the tropical region, cold-season-AMIs, in association with dyslipidemia relative to non-dyslipidemia, were significantly strong in the non-DM group (OR 1.45; 95% CI 1.01 to 2.09) but weak in the DM group (OR 0.74; 95% CI 0.55 to 0.99). The cold season shows increased risks for AMI, markedly among the ≥65 years cohort in the subtropical region, and among the patients diagnosed with either DM or dyslipidemia but not both in the tropical region. Age and comorbidity of metabolic dysfunction influence the season-related incidences of AMI in different climatic regions.

Synbiotic Combination of Djulis (Chenopodium formosanum) and Lactobacillus acidophilus Inhibits Colon Carcinogenesis in Rats.

Djulis is a functional grain containing prebiotic dietary fiber, which has an anti-cancer potential. This study examined the preventive effect of djulis alone or in combination with Lactobacillus acidophilus on colon carcinogenesis induced by 1,2-dimethylhydrazine (DMH) and dextran sulfate sodium (DSS). Rats were divided into five groups and fed B (AIN-93G, blank), C (AIN-93G, control), D (10% djulis), DLA (10% djulis plus 5 × 106 cfu L. acidophilus/g), and DHA (10% djulis plus 5 × 107 cfu L. acidophilus/g) diets, respectively. All rats except for those in group B received three doses of DMH (40 mg/kg) by intraperitoneal injection and 3% DSS in drinking water. After 10 weeks of feeding, the colon was analyzed for precancerous lesions and biomarkers. DMH and DSS treatment induced aberrant crypt foci (ACF), especially in the distal colon. D, DLA, and DHA significantly reduced the numbers of total ACF, sialomucin-producing ACF (SIM-ACF), and mucin-depleted foci (MDF) in the distal colon compared to C. Additionally, DLA and DHA further downregulated the expressions of proliferating cell nuclear antigen (PCNA) and cyclooxygenase-2 (COX-2) and regulated apoptosis-related proteins. These results suggest that synbiotic combination of djulis and L. acidophilus shows the best inhibitory effect on colon carcinogenesis via regulation of proliferative, inflammatory, and apoptotic pathways.

Clinicopathologic factors related to surgical margin involvement, reoperation, and residual cancer in primary operable breast cancer - An analysis of 2050 patients.

BACKGROUND: To evaluate whether clinicopathologic factors are related to surgical margin involvement, reoperation, and residual cancer in primary operable breast cancer. METHODS: Identification of patients at increased risk for positive surgical margins may enhance clinical preoperative decision-making and lower the reoperation rate. In this retrospective study, we analyzed the factors associated with positive surgical margins, the need for re-excision, and residual cancer detection in re-excised specimens in a cohort of 2050 women who underwent either breast-conserving surgery (BCS) or mastectomy for primary operable breast cancer. RESULTS: Positive surgical margins were detected in 151 (7.4%) of the 2050 patients. The incidence of positive surgical margins was 11.3% (118/1042) in the BCS group and 3.3% (33/1008) in the mastectomy group (P < 0.001). In multivariate analysis, lower body mass index (BMI), larger tumor size, and pathologic evidence of multifocal disease were associated with positive surgical margin involvement in the BCS group. Younger age and ductal carcinoma in situ (DCIS) histologic subtypes (Odds ratio (OR) = 2.165, 95% CI = 1.253-4.323) were associated with higher risk of re-operations. Preoperative MRI examination was associated with decreased risk for margin involvement in the BCS group (OR = 0.530, 95% CI = 0.332-0.842) and reoperation (OR = 0.302, 95% CI = 0.119-0.728). DCIS histologic subtypes were associated with higher residual tumor incidence than other types of breast cancer. CONCLUSIONS: Lower BMI, larger tumor size, pathologic evidence of multifocal disease, and no preoperative MRI evaluation were associated with increased risk for positive surgical margin involvement. DCIS with positive surgical margins was associated with increased risk for reoperation and residual cancer detection at re-excision.

Early diagnosis of spinal tuberculosis.

Spinal tuberculosis (STB) is a common manifestation of extrapulmonary tuberculosis (TB). STB accounts for around 2% of all cases of TB and around 15% of extrapulmonary TB cases. The World Health Organization has proposed a global strategy and targets for TB prevention, care, and control after 2015. Under this strategy, patients will receive standard care according to the recommendations and guidelines after confirmation of STB diagnosis. However, current recommendations and guidelines focus on disease and medication therapy management, and recommendations for early detection or decision-making algorithms regarding STB are lacking. In this review, we identified five key components for early diagnosis: (1) risk factors for STB; (2) common symptoms/signs of STB; (3) significant neuroradiological findings of STB; (4) significant laboratory findings of STB, including positive interferon-γ release assays and nonpyogenic evidence in initial laboratory data; and (5) significant clinical findings of STB. Individualized consideration for each patient with STB is essential, and we hope that the algorithm established in this review will provide a valuable tool for physicians who encounter cases of STB.

A cross sectional study in patients with confirmed spinal tuberculosis in central Taiwan: Analysis of preliminary clinical presentation and neuroradiological findings.

Spinal tuberculosis (STB) can cause significant functional impairment. The purpose of the present study was to analyze the factors at preliminary presentation and the neuroradiological findings in STB patients. We performed a retrospective cross-sectional analysis of cases with a definitive diagnosis of STB. Four patients with confirmed mycobacterial infection and histopathological findings confirming TB were identified. We noted two key clinical indicators. We also identified seven key neuroradiological findings associated with STB lesions. A high degree of clinical suspicion along with nine neuroradiological findings described in this study are important for STB diagnosis and for starting treatment with antituberculosis agents.

Preoperative clinicopathologic factors and breast magnetic resonance imaging features can predict ductal carcinoma in situ with invasive components.

PURPOSE: Ductal carcinoma in situ (DCIS) is a non-invasive cancerous breast lesion; however, from 10% to 50% of patients with DCIS diagnosed by core needle biopsy (CNB) or vacuum-assisted core biopsy (VACB) are shown to have invasive carcinoma after surgical excision. In this study, we evaluated whether preoperative clinicopathologic factors and breast magnetic resonance image (MRI) features are predictive of DCIS with invasive components before surgery. MATERIALS AND METHODS: Patients comprised 128 adult women with a diagnosis of DCIS as determined by pathological analysis of CNB or VACB specimens and positive MRI findings who underwent breast surgery during the period January 2011 to December 2013 at the Changhua Christian Hospital. Clinicopathologic and breast MRI factors were compared between patients with postoperative pathology indicative of true DCIS and those with postoperative pathology showing DCIS with invasive components. RESULTS: Of the 128 patients with a preoperative diagnosis of DCIS, 73 (57.0%) had postoperative histopathologic evidence of true DCIS and 55 (43.0%) showed evidence of DCIS with invasive components. Results of statistical analyses revealed that MRI evidence of a mass-like lesion (P=0.025), nipple-areolar complex (NAC) invasion (P=0.029), larger tumor volume (P=0.010), larger maximum measurable apparent diffusion coefficient (ADC) area (P=0.039), heterogenous or rim enhancement pattern (P=0.010), as well as immunohistochemical evidence of human epidermal growth factor receptor 2 (HER-2) overexpression (P=0.010) were predictive of DCIS with an invasive component in postoperative surgical specimens. CONCLUSION: Invasive component should be considered in biopsy proven DCIS patients with preoperative MRI evidence of a mass-like lesion, nipple-areolar complex invasion, large tumor volume, a larger maximum measurable ADC area, or a rim or heterogenous enhancement pattern, as well as in patients with immunohistochemical evidence of HER-2 overexpression.

Non-Invasive Evaluation of Hepatic Fibrosis: The Diagnostic Performance of Magnetic Resonance Elastography in Patients with Viral Hepatitis B or C.

PURPOSE: To compare the accuracy of magnetic resonance elastography (MRE) with that of aspartate aminotransferase-to-platelet ratio index (APRI) for estimating the stage of hepatic fibrosis in patients with chronic hepatitis B virus (HBV) or chronic hepatitis C virus (HCV) infection. MATERIALS AND METHODS: We retrospectively enrolled 160 patients with chronic hepatitis and 25 healthy living liver donors. Fibrosis stage (METAVIR, F0 to F4) was determined histopathologically for all patients. APRI was recorded at the time of histopathologic examination and liver stiffness values were measured on MRE quantitative stiffness maps. The cutoff values, sensitivity, and specificity of MRE and APRI for each fibrosis stage were determined using receiver operating characteristic (ROC) analysis. RESULTS: MRE had a significantly greater area under the ROC curve than APRI score for discriminating among METAVIR stages F2-F4. Using a cutoff value of 2.80 kPa, MRE had a sensitivity of 94.4% and a specificity of 97.8% for detecting significant fibrosis (≥F2). There were no significant differences in fibrosis stage between patients with HBV and those with HCV infection. For ≥F2, the cutoffs were 2.47 kPa (100% sensitivity), 2.80 kP (maximum sum of sensitivity and specificity), and 3.70 kPa (100% specificity). CONCLUSIONS: MRE is a more accurate modality than APRI for detecting significant fibrosis in patients with chronic HBV or HCV infection. Antiviral treatment should be considered in patients with liver stiffness values ≥ 2.8 kPa.