Prediction model for pheochromocytoma/paraganglioma using nCounter assay.

BACKGROUND: World Health Organization defined pheochromocytomas/paragangliomas (PPGL) as malignant tumors in 2017 because the existing classification system could not reflect locally aggressive behavior sufficiently. However, predicting the likelihood of metastasis remains a crucial part of the treatment strategy. METHODS: From one tertiary care hospital and one secondary hospital, 97 PPGL cases were selected. Medical records of PPGL cases with the presence of formalin-fixed and paraffin-embedded (FFPE) tissue of primary lesion were reviewed. For FFPE tissues, a nCounter assay was conducted to determine differently expressed genes between metastatic and non-metastatic PPGL groups. Performances of prediction models for the likelihood of metastasis were calculated. RESULTS: Of a total of 97 PPGL cases, 39, 20, and 38 were classified as benign, malignant, and validation, respectively. In the nCounter assay, CDK1, TYMS, and TOP2A genes showed significant differences in expression. Tumor size was positively correlated with CDK1 expression level. The Lasso regression model showed supreme performance of sensitivity 91.7% and specificity 95.5% when those significant factors were considered. CONCLUSION: Machine learning of multi-modal classifiers can be used to create a prediction model for metastasis of PPGL with high sensitivity and specificity using nCounter assay. Moreover, CDK1 inhibitors could be considered for developing drug treatment.

Feasibility of UTE-MRI-based radiomics model for prediction of histopathologic subtype of lung adenocarcinoma: in comparison with CT-based radiomics model.

OBJECTIVES: To assess the feasibility of the UTE-MRI radiomic model in predicting the micropapillary and/or solid (MP/S) patterns of surgically resected lung adenocarcinoma. MATERIALS AND METHODS: We prospectively enrolled 74 lesions from 71 patients who underwent UTE-MRI and CT before curative surgery for early lung adenocarcinoma. For conventional radiologic analysis, we analyzed the longest lesion diameter and lesion characteristics at both UTE-MRI and CT. Radiomic features were extracted from the volume of interest of the lesions and Rad-scores were generated using the least absolute shrinkage and selection operator with fivefold cross-validation. Six models were constructed by combining the conventional radiologic model, UTE-MRI Rad-score, and CT Rad-score. The areas under the curves (AUCs) of each model were compared using the DeLong method. Early recurrence after curative surgery was analyzed, and Kaplan-Meier survival analysis was performed. RESULTS: Twenty-four lesions were MP/S-positive, and 50 were MP/S-negative. The longitudinal size showed a small systematic difference between UTE-MRI and CT, with fair intermodality agreement of lesion characteristic (kappa = 0.535). The Rad-scores of the UTE-MRI and CT demonstrated AUCs of 0.84 and 0.841, respectively (p = 0.98). Among the six models, mixed conventional, UTE-MRI, and CT Rad-score model showed the highest diagnostic performance (AUC = 0.879). In the survival analysis, the high- and low-risk groups were successfully divided by the Rad-score in UTE-MRI (p = 0.01) and CT (p < 0.01). CONCLUSION: UTE-MRI radiomic model predicting MP/S positivity is feasible compared with the CT radiomic model. Also, it was associated with early recurrence in the survival analysis. CLINICAL RELEVANCE STATEMENT: A radiomic model utilizing UTE-MRI, which does not present a radiation hazard, was able to successfully predict the histopathologic subtype of lung adenocarcinoma, and it was associated with the patient's recurrence-free survival. KEY POINTS: • No studies have reported the ultrashort echo time (UTE)-MRI-based radiomic model for lung adenocarcinoma. • The UTE-MRI Rad-score showed comparable diagnostic performance with CT Rad-score for predicting micropapillary and/or solid histopathologic pattern. • UTE-MRI is feasible not only for conventional radiologic analysis, but also for radiomics analysis.

Fiber support prevents colloid-facilitated contamination induced by dissolution-precipitation of a calcium phosphate adsorbent.

During the adsorptive removal of hazardous metal contaminants, dissolution-precipitation of sparingly soluble adsorbents may result in the formation of toxic colloidal suspensions, triggering secondary pollution. Therefore, we studied the prevention of colloid-facilitated contamination in a model adsorption system of dicalcium phosphate dihydrate (DCPD, CaHPO4·2H2O) and Cd2+ as an adsorbent and adsorbate. Upon adding pure DCPD powder into a 500 mg L-1 Cd2+ solution of pH â‰Œ 7.0, aggregates of spheroidal Cd-bearing primary particles, within 0.040-0.95 µm size range, were generated via dissolution-precipitation. The accumulated volume of these submicron particles (10.8%) was greater than that of the submicron particles from the exposure of DCPD to deionized water (4.48%). While the Cd-carrying submicron particles, which are responsible for colloidal recontamination, appeared to form via homogeneous nucleation, their formation was suppressed using polyacrylonitrile fibers (PANFs) as supporting substrates. Thus, heterogeneous nucleation on PANFs formed hexagonal columnar microparticles of a new phase, pentacadmium dihydrogen tetrakis (phosphate) tetrahydrate (Cd5H2(PO4)4·4H2O). Together with dissolution-precipitation on the native DCPD, nucleation and growth on the PANFs accelerated the depletion of the dissolved species, reducing the degree of supersaturation along the DCPD-water interface. Although the PANFs decreased the Cd adsorption capacity to 56.7% of that of DCPD, they prevented the formation of small aggregates of Cd-bearing particles. Other sparingly soluble adsorbents can be compounded with PANF to prevent the generation of toxic colloids.

The Risk of Venous Thromboembolism in Korean Patients with Breast Cancer: A Single-Center Experience.

The relationship between cancer and venous thromboembolism (VTE) has long been described. The risk of VTE in Asian patients with breast cancer remains largely unknown. This study described the incidence and risk factors of VTE in Korean patients with breast cancer. Data were collected from a retrospective database of patients who underwent breast cancer surgery between 2011 and 2020 at a single institution. The Cox proportional-hazards model was used to identify factors associated with VTE occurrences. Among the 2246 patients with breast cancer, 48 (2.1%) developed VTE during a median follow-up period of 53 months. The average incidence of VTE was 459 per 100,000 person-years. Age ≥ 60 years, male sex, chronic kidney disease, reconstructive procedures, and stage II or higher were independent predictive factors for VTE. VTE was associated with poor disease-free survival (hazard ratio (HR), 6.140; 95% confidence interval (CI), 3.480-10.835), and overall survival (HR, 8.842; 95% CI 4.386-17.824). Most VTE events were manageable with anticoagulation; three (6.3%) patients died of VTE, despite intensive care. The incidence of VTE was significantly elevated in Korean patients with breast cancer. Since VTE has a negative effect on oncologic outcomes of breast cancer, clinicians should manage its risk throughout their lifetime.

Leaching of structural Ca2+ ions from a chalcogenide adsorbent by H+ lifts Cs(I) uptake.

Acidic wastewater containing radioactive 137Cs is difficult to treat by selective adsorption. Abundant H+ under acidic conditions damages the structure of adsorbents and competes with Cs+ for adsorption sites. Herein, we designed a novel layered calcium thiostannate (KCaSnS) that contains Ca2+ as a dopant. The dopant Ca2+ ion is metastable and larger than the ions attempted before. The pristine KCaSnS demonstrated a high Cs+ adsorption capacity of 620 mg/g at 8250 mg/L Cs+ solution and pH 2, which is 68% higher than that at pH 5.5 (370 mg/g), a trend opposite to all previous studies. The neutral condition allowed the release of Ca2+ present only in the interlayer (∼20%); whereas the high acidity facilitated the leaching of Ca2+ from the backbone structure (∼80%). The complete structural Ca2+ leaching was made possible only by a synergistic interaction of highly concentrated H+ and Cs+. Doping a large enough ion, such as Ca2+, to accommodate Cs+ into the Sn-S matrix upon its liberation opens a new way of designing high-performance adsorbents.

The Threat of Climate Change on Tick-Borne Infections: Rising Trend of Infections and Geographic Distribution of Climate Risk Factors Associated With Ticks.

Ticks transmit a wide range of pathogens. The spread of tick-borne infections is an emerging, yet often overlooked, threat in the context of climate change. The infections have rapidly increased over the past few years in South Korea despite no significant changes in socioeconomic circumstances. We investigated the impact of climate change on the surge of tick-borne infections and identified potential disease hot spots at a resolution of 5 km by 5 km. A composite index was constructed based on multiple climate and environmental indicators and compared with the observed tick-borne infections. The surge of tick-borne episodes corresponded to the rising trend of the index over time. High-risk areas identified by the index can be used to prioritize locations for disease prevention activities. Monitoring climate risk factors may provide an opportunity to predict the spread of the infections in advance.

Complete Surgical Excision Is Necessary following Vacuum-Assisted Biopsy for Breast Cancer.

Vacuum-assisted breast biopsy (VABB) has been replacing excisional biopsy in the treatment of benign breast lesions. Complete surgical excision is still needed for the lesions occasionally diagnosed with breast cancer after VABB. We aimed to characterize residual tumors after VABB and define a subset of patients who do not need surgical excision after VABB. From a retrospective database, we identified patients diagnosed with breast cancer after VABB guided with ultrasonography. Patients who underwent stereotactic biopsies were excluded. We reviewed clinicopathologic data and radiologic findings of the sample. We identified 48 patients with 49 lesions. After surgical excision, the residual tumors were identified in 40 (81.6%) lesions, and there was no residual tumor in nine (18.3%) patients. Imaging studies could not accurately locate residual tumors after VABB. A small tumor size on a VABB specimen was associated with no residual tumor on final pathology. However, residual tumors were identified in four (40%) of 10 lesions with a pathologic tumor size less than 0.5 cm. In conclusion, complete surgical excision remains the primary option for most of the patients diagnosed with breast cancer after VABB. Imaging surveillance without surgery should be carefully applied for selected low-risk patients.

Organ-Specific Differentiation of Human Adipose-Derived Stem Cells in Various Organs of Xenotransplanted Rats: A Pilot Study.

Adipose-derived stem cells (ADSCs) are potential therapeutics considering their self-renewal capacity and ability to differentiate into all somatic cell types in vitro. The ideal ADSC-based therapy is a direct injection into the relevant organs. The objective of this study was to investigate the viability and safety of intra-organ human ADSC (h-ADSC) xenotransplants in vivo. Subcutaneous adipose tissue from the abdominal area of 10 patients was sampled. h-ADSCs were isolated from adipose tissue samples and identified using immunofluorescence antibodies. Multi-differentiation potential assays for adipocytes, osteocytes, and chondrocytes were performed. Cultured h-ADSCs at passage 4 were transplanted into multiple organs of 17 rats, including the skin, subcutaneous layer, liver, kidney, pancreas, and spleen. The h-ADSC-injected organs excised after 100 days were examined, and the survival of h-ADSCs was measured by quantitative real-time polymerase chain reaction (qRT-PCR) using specific human and rat target genes. h-ADSCs confirmed by stem cell phenotyping were induced to differentiate into adipogenic, osteogenic, and chondrogenic lineages in vitro. All rats were healthy and exhibited no side effects during the study; the transplanted h-ADSCs did not cause inflammation and were indiscernible from the native organ cells. The presence of transplanted h-ADSCs was confirmed using qRT-PCR. However, the engrafted survival rates varied as follows: subcutaneous fat (70.6%), followed by the liver (52.9%), pancreas (50.0%), kidney (29.4%), skin (29.4%), and spleen (12.5%). h-ADSCs were successfully transplanted into a rat model, with different survival rates depending on the organ.

PIK3CA Mutation as Potential Poor Prognostic Marker in Asian Female Breast Cancer Patients Who Received Adjuvant Chemotherapy.

Background: The prognostic relevance of the PIK3CA mutation together with PD-L1, c-Met, and mismatch repair deficiency (dMMR) have not been fully investigated in Asian women with breast cancer (BC) who have undergone postoperative adjuvant chemotherapy. Methods: We analyzed PIK3CA mutations via peptide nucleic acid (PNA)-mediated real-time PCR assay, PD-L1/c-Met expression via immunohistochemistry (IHC), and microsatellite instability (MSI) status using PCR and IHC, in 191 resected BCs from 2008 to 2011. The Cancer Genome Atlas (TCGA) dataset for the involvement of the PIK3CA mutation with PD-L1/c-Met/MMR was explored. Results: The PNA clamp-mediated assay was able to detect the PIK3CA mutation in 1% of the mutant population in the cell line validation. Using this method, the PIK3CA mutation was found in 78 (49.4%) of 158 samples. c-Met and PD-L1 positivity were identified in 31.4 and 21.8% of samples, respectively, which commonly correlated with high histologic grade and triple-negative subtype. MSI/dMMR was observed in 8.4% of patients, with inconsistency between MMR IHC and the MSI PCR. The PIK3CA mutation exhibited a poor prognostic association regarding recurrence-free survival (RFS) in both overall and triple-negative BCs. In subgroup analyses, the PIK3CA-mutated tumors showed poorer RFS than the PIK3CA-wildtype within the c-Met-positive, MSS, triple-negative, or age onset <50 years subgroups, which showed a similar trend of association in TCGA data. Conclusions: PIK3CA mutation together with c-Met or dMMR/MSI status might be relevant to poor prognosis in BC subsets, especially in Asian women.

Highly selective cesium removal under acidic and alkaline conditions using a novel potassium aluminum thiostannate.

The pH values of nuclear wastewater are extremely low or high, which make the efficient removal of 137Cs a major concern among the issues for safety management and environmental remediation. Existing metal sulfides for Cs+ adsorption have shown poor performance at acidic and alkaline conditions, and the reason has not been revealed yet. Herein, a novel potassium aluminum thiostannate (KAlSnS-3) adsorbent was designed and its Cs+ adsorption mechanism over a wide pH range was investigated. We hypothesized that Al3+ dopant on Sn4+ sites would allow stable adsorption for Cs+ upon its partial release at acidic and alkaline conditions. As a result, KAlSnS-3 demonstrated excellent adsorption performance across a broad pH range (1-13), and high selectivity toward Cs+, even under high salinity conditions (in tap water Kd = 3.12 × 104 mL/g; and in artificial seawater Kd = 3.42 × 103 mL/g). KAlSnS-3 also exhibited rapid adsorption kinetics (R = 97.6% in the first minute), a remarkable adsorption capacity (259.31 mg/g), and a high distribution coefficient (2.09 × 105 mL/g) toward Cs+. In addition, the high reusability of KAlSnS-3 was observed, suggesting its potential for real-world applications. The mechanism for enhancing performance at low and high pH values was discussed with the evidence of crystallinity, elemental concentrations, and binding energy of electrons based on the concept of electrostatic interactions and chemical affinity. In summary, this work provides insights into the mechanism of Cs+ removal under a wide pH range, and the impressive Cs+ adsorption performance indicates the application potential of KAlSnS-3 in wastewater treatment.

Association of Family History with the Development of Breast Cancer: A Cohort Study of 129,374 Women in KoGES Data.

BACKGROUND: Breast cancer is the most common cancer among women. The Korean Genome and Epidemiology Study (KoGES) is a large cohort study that is available to the public. Using this large cohort study, we aimed to unravel the relationship between breast cancer development and a family history of breast cancer in Korea. METHODS: This cohort study relied on data from the KoGES from 2001 through 2013. A total of 211,725 participants were screened. Of these, 129,374 women were evaluated. They were divided into two groups, including participants with and without breast cancer. A logistic regression model was used to retrospectively analyze the odds ratio of breast cancer history in families of women with and without breast cancer. RESULTS: Of 129,374 women, 981 had breast cancer. The breast cancer group had more mothers and siblings with histories of breast cancer (p < 0.001). A history of breast cancer in the participant's mother resulted in an odds ratio of 3.12 (1.75-5.59), and a history of breast cancer in the participant's sibling resulted in an odds ratio of 2.63 (1.85-3.74). There was no interaction between the history of maternal breast cancer and the history of sibling breast cancer. Based on the subgroup analysis, family history was a stronger factor in premenopausal women than in menopausal and postmenopausal women. CONCLUSIONS: A family history of breast cancer is a significant risk factor for breast cancer in Korea. Premenopausal women with a maternal history of breast cancer are of particular concern. Intensive screening and risk-reducing strategies should be considered for this vulnerable subpopulation.

Analyses of the association between breast cancer and osteoporosis/fracture history: a cross-sectional study using KoGES HEXA data.

We performed a nationwide, population-based cohort study to evaluate the risk of osteoporosis and osteoporotic fracture in patients with breast cancer using the data from Korean Genome and Epidemiology Study (KoGES) and concluded that Korean women with breast cancer had a higher risk of osteoporosis than healthy women, regardless of age. PURPOSE: This study aimed to evaluate the association between breast cancer and the occurrence of osteoporosis and osteoporotic fracture using data from the Korean Genome and Epidemiology Study (KoGES). METHODS: Using the national KoGES health examinee (HEXA) data consisting of data from urban resident participants ≥ 40 years old, we extracted data for patients with breast cancer (n = 1080) and for control participants (n = 106,993); we then analyzed the occurrence of osteoporosis and osteoporotic fracture at baseline from 2004 to 2013 and during follow-up from 2012 to 2016. A logistic regression model was used to analyze the odds ratios (ORs) and the 95% confidence intervals (CIs). Subgroup analysis was performed based on age (younger group aged ≤ 51 years old; older group aged ≥ 52 years old). RESULTS: The ORs (95% CIs) for osteoporosis and osteoporotic fracture were 1.54 (95% CI = 1.28-1.84, P < 0.001) and 1.01 (95% CI = 0.82-1.23, P = 0.949), respectively, in the breast cancer group. In the subgroup analysis based on age, the ORs (95% CIs) for osteoporosis were 2.41 (95% CI = 1.70-3.43, P < 0.001) in the younger group and 1.33 (95% CI = 1.08-1.64, P = 0.007) in the older group of breast cancer patients. The ORs (95% CIs) for osteoporotic fracture were 1.15 (95% CI = 0.81-1.63, P = 0.441) in the younger group and 0.95 (95% CI = 0.74-1.21, P = 0.661) in the older group of breast cancer patients. CONCLUSION: We concluded that Korean women with breast cancer had a higher risk of osteoporosis than healthy women, but the same finding was not observed for osteoporotic fracture, regardless of age.

Clinicopathological Characteristics and Recurrence-Free Survival of Rare Variants of Papillary Thyroid Carcinomas in Korea: A Retrospective Study.

BACKGROUND: We aimed to evaluate the clinicopathological features and biological behaviors of Korean thyroid cancer patients with rare variants of papillary thyroid carcinoma (PTC) to address the ambiguity regarding the prognostic consequences of these variants. METHODS: We retrospectively reviewed the medical records of 5,496 patients who underwent thyroid surgery for PTC, between January and December 2012, in nine tertiary hospitals. Rare PTC variants included tall cell (TCV), columnar cell (CCV), diffuse sclerosing (DSV), cribriform-morular (CMV), solid (SV), hobnail, and Warthin-like variants. Recurrence-free survival (RFS) was defined as the time from the date of thyroidectomy until recurrence. RESULTS: Rare variants accounted for 1.1% (n=63) of the PTC patients; with 0.9% TCV, 0.02% CCV, 0.1% DSV, 0.1% CMV, and 0.1% SV. The mean age of patients and primary tumor size were 42.1±13.1 years and 1.3±0.9 cm, respectively. Extrathyroidal extension and cervical lymph node metastasis were observed in 38 (60.3%) and 37 (58.7%) patients, respectively. Ultrasonographic findings revealed typical malignant features in most cases. During a median follow-up of 7 years, 6.3% of patients experienced a locoregional recurrence. The 5-year RFS rates were 71.4% in patients with DSV or SV, 95.9% for TCV, or CCV, and 100% for other variants. DSV emerged an independent risk factor associated with shorter RFS. CONCLUSION: In this multicenter Korean cohort, rare variants accounted for 1.1% of all PTC cases, with TCV being the most frequent subtype. DSV emerged as a significant prognostic factor for RFS.

A Multicenter, Randomized, Controlled Trial for Assessing the Usefulness of Suppressing Thyroid Stimulating Hormone Target Levels after Thyroid Lobectomy in Low to Intermediate Risk Thyroid Cancer Patients (MASTER): A Study Protocol.

BACKGROUND: Postoperative thyroid stimulating hormone (TSH) suppression therapy is recommended for patients with intermediate- and high-risk differentiated thyroid cancer to prevent the recurrence of thyroid cancer. With the recent increase in small thyroid cancer cases, the extent of resection during surgery has generally decreased. Therefore, questions have been raised about the efficacy and long-term side effects of TSH suppression therapy in patients who have undergone a lobectomy. METHODS: This is a multicenter, prospective, randomized, controlled clinical trial in which 2,986 patients with papillary thyroid cancer are randomized into a high-TSH group (intervention) and a low-TSH group (control) after having undergone a lobectomy. The principle of treatment includes a TSH-lowering regimen aimed at TSH levels between 0.3 and 1.99 µIU/mL in the low-TSH group. The high-TSH group targets TSH levels between 2.0 and 7.99 µIU/mL. The dose of levothyroxine will be adjusted at each visit to maintain the target TSH level. The primary outcome is recurrence-free survival, as assessed by neck ultrasound every 6 to 12 months. Secondary endpoints include disease-free survival, overall survival, success rate in reaching the TSH target range, the proportion of patients with major cardiovascular diseases or bone metabolic disease, the quality of life, and medical costs. The follow-up period is 5 years. CONCLUSION: The results of this trial will contribute to establishing the optimal indication for TSH suppression therapy in low-risk papillary thyroid cancer patients by evaluating the benefit and harm of lowering TSH levels in terms of recurrence, metabolic complications, costs, and quality of life.

Limited Clinical and Diagnostic Utility of Circulating Tumor DNA Detection in Patients with Early-Stage Well-Differentiated Thyroid Cancer: Comparison with Benign Thyroid Nodules and Healthy Individuals.

Limited data are available on the diagnostic utility of circulating tumor DNA (ctDNA) in early-stage thyroid cancers for BRAF, KRAS, NRAS, and TERT promoter mutations, which are known detectable markers for thyroid cancers. Here, we analyzed the above driver mutations in ctDNA and matched neoplastic tissues from patients with early-stage thyroid cancers in order to investigate diagnostic utility of circulating markers in distinguishing from other mimicking thyroid lesions and healthy individuals. In total, 73 matched neoplastic tissue and plasma samples [thyroid cancers (n = 62), benign thyroid disorders (n = 8), and parathyroid lesions (n = 3)] and 54 plasma samples from healthy individuals (as controls) were analyzed for BRAF, KRAS, NRAS, and TERT promoter mutations using peptide nucleic acid clamp real-time PCR. Although only one patient with an indeterminate lesion on thyroid cytology showed KRAS mutation (codon 146) in the preoperative plasma, that KRAS mutation was not identified in the stage I papillary thyroid carcinoma tissue. In the remaining 72 plasma samples, no other mutations were identified in BRAF, NRAS, and TERT promoter genes. The concordance rates of mutational results between the plasma and tumor tissue or metastatic lymph node were very low. One (1.9%) of the 54 healthy individuals harbored a KRAS mutation in the plasma samples. The ctDNA results did not represent the mutational profile of primary or metastatic thyroid cancers, warranting a caution for interpretation. The clinical utility of BRAF, KRAS, NRAS, and TERT promoter mutation analysis on ctDNA appears to be limited to early-stage thyroid cancers.

Does Thyroidectomy Impact Quality of Life: Retrospective Case-Control Study of Post-Thyroidectomy Patients and Matched Individuals from the General Population.

Background and objectives: The study assesses quality of life (QoL) in patients who underwent thyroidectomy compared to the general population. Materials and Methods: QoL data from post-thyroidectomy patients and individuals with no subjective health concerns, who had attended a routine health screening visit, were evaluated. QoL was assessed using the modified version of Korean Short Form 12 questionnaire (SF-12). Patients and controls were matched using the propensity score approach and a ratio of 1:4. Results: Data from a total of 105 patients and 420 controls were analyzed. For five SF-12 items, lower QoL was found in patients (p < 0.05). Multivariate analysis revealed that a follow-up duration of <1-year, female sex, and an age of >50 years were independent risk factors. No significant difference was found between controls and patients who were >1-year post-surgery. Conclusions: For specific SF-12 items, QoL was lower in post-thyroidectomy patients than in controls. No intergroup difference in QoL was found >1-year post-surgery.

Automated Breast Cancer Detection in Digital Mammograms of Various Densities via Deep Learning.

Mammography plays an important role in screening breast cancer among females, and artificial intelligence has enabled the automated detection of diseases on medical images. This study aimed to develop a deep learning model detecting breast cancer in digital mammograms of various densities and to evaluate the model performance compared to previous studies. From 1501 subjects who underwent digital mammography between February 2007 and May 2015, craniocaudal and mediolateral view mammograms were included and concatenated for each breast, ultimately producing 3002 merged images. Two convolutional neural networks were trained to detect any malignant lesion on the merged images. The performances were tested using 301 merged images from 284 subjects and compared to a meta-analysis including 12 previous deep learning studies. The mean area under the receiver-operating characteristic curve (AUC) for detecting breast cancer in each merged mammogram was 0.952 ± 0.005 by DenseNet-169 and 0.954 ± 0.020 by EfficientNet-B5, respectively. The performance for malignancy detection decreased as breast density increased (density A, mean AUC = 0.984 vs. density D, mean AUC = 0.902 by DenseNet-169). When patients' age was used as a covariate for malignancy detection, the performance showed little change (mean AUC, 0.953 ± 0.005). The mean sensitivity and specificity of the DenseNet-169 (87 and 88%, respectively) surpassed the mean values (81 and 82%, respectively) obtained in a meta-analysis. Deep learning would work efficiently in screening breast cancer in digital mammograms of various densities, which could be maximized in breasts with lower parenchyma density.

3D Printing and NIR Fluorescence Imaging Techniques for the Fabrication of Implants.

Three-dimensional (3D) printing technology holds great potential to fabricate complex constructs in the field of regenerative medicine. Researchers in the surgical fields have used 3D printing techniques and their associated biomaterials for education, training, consultation, organ transplantation, plastic surgery, surgical planning, dentures, and more. In addition, the universal utilization of 3D printing techniques enables researchers to exploit different types of hardware and software in, for example, the surgical fields. To realize the 3D-printed structures to implant them in the body and tissue regeneration, it is important to understand 3D printing technology and its enabling technologies. This paper concisely reviews 3D printing techniques in terms of hardware, software, and materials with a focus on surgery. In addition, it reviews bioprinting technology and a non-invasive monitoring method using near-infrared (NIR) fluorescence, with special attention to the 3D-bioprinted tissue constructs. NIR fluorescence imaging applied to 3D printing technology can play a significant role in monitoring the therapeutic efficacy of 3D structures for clinical implants. Consequently, these techniques can provide individually customized products and improve the treatment outcome of surgeries.

Machine learning improves the prediction of febrile neutropenia in Korean inpatients undergoing chemotherapy for breast cancer.

Febrile neutropenia (FN) is one of the most concerning complications of chemotherapy, and its prediction remains difficult. This study aimed to reveal the risk factors for and build the prediction models of FN using machine learning algorithms. Medical records of hospitalized patients who underwent chemotherapy after surgery for breast cancer between May 2002 and September 2018 were selectively reviewed for development of models. Demographic, clinical, pathological, and therapeutic data were analyzed to identify risk factors for FN. Using machine learning algorithms, prediction models were developed and evaluated for performance. Of 933 selected inpatients with a mean age of 51.8 ± 10.7 years, FN developed in 409 (43.8%) patients. There was a significant difference in FN incidence according to age, staging, taxane-based regimen, and blood count 5 days after chemotherapy. The area under the curve (AUC) built based on these findings was 0.870 on the basis of logistic regression. The AUC improved by machine learning was 0.908. Machine learning improves the prediction of FN in patients undergoing chemotherapy for breast cancer compared to the conventional statistical model. In these high-risk patients, primary prophylaxis with granulocyte colony-stimulating factor could be considered.