Feasibility study for the improvement of microcalcification visualization in different breast thicknesses and tissue components using a dual-energy approach in digital mammography.

OBJECTIVE: The purpose of this study was to improve detectability of microcalcifications using a dual-energy digital mammographic (DEDM) technique. METHODS: Slabs of uniform breast-equivalent plastic and an additional plate were used to mimic various breast thicknesses, from 3 to 7 cm, and to simulate microcalcification with diameters from 0.16 to 0.39 mm. Free-response receiver operating characteristics and area under the curves (Az) were used to evaluate the sensitivity of detecting microcalcifications using the DEDM compared with using the conventional single-energy digital mammography (SEDM). RESULTS: The mean number of false-positives per image was 0.0198 (Az = 0.956 ± 0.027) using DEDM compared with 0.292 (Az = 0.681 ± 0.235) using SEDM. A lower radiation dose could be possibly obtained for the DEDM technique with a thickness of less than 5 cm compared with the SEDM with a thickness larger than 5 cm. CONCLUSIONS: Microcalcifications could be more accurately and efficiently detected using the DEDM, which might bring reliable and promising applications on early computer-aided diagnosis of breast cancer.

Discrimination of breast cancer by measuring prostate-specific antigen levels in women's serum.

Prostate-specific antigen (PSA) has been reported to be a potential biomarker of breast cancer. Serum PSA of normal women is around 1 pg/mL, which is usually undetectable by current assay methods; thus an ultrasensitive measurement of PSA expression in women's serum is necessary to distinguish normal from malignant breast diseases. To enhance the sensitivity of conventional immunoassay technology for the detection of PSA in sera, we adopted a localized surface plasmon coupled fluorescence fiber-optic biosensor, which combines a sandwich immunoassay with the localized surface plasmon technique. The concentration of total PSA (t-PSA) (from 0.1 to 1000 pg/mL) in phosphate-buffered saline solution and the normalized fluorescence signal exhibit a linear relationship where the correlation coefficient is 0.9574. In addition, the concentration of additional t-PSA in 10-fold-diluted healthly women's serum across a similar range was measured. The correlation coefficient for this measurement is 0.9142. In clinical serum samples, moreover, the experimental results of t-PSA detection show that both the mean value and median of normalized fluorescence signals in the breast cancer group (155.2 and 145.7, respectively) are higher than those in the noncancer group (46.6 and 37.1, respectively). We also examined the receiver operating characteristic curve for t-PSA, and the area under the curve (AUC) is estimated to be 0.9063, the AUC being used to measure the performance of a test to correctly identify diseased and nondiseased subjects.

Effect of Transcutaneous Acupoint Electrical Stimulation on Post-Hemorrhoidectomy-Associated Pain, Anxiety, and Heart Rate Variability: A Randomized-Controlled Study.

Hemorrhoidectomy is the current best treatment for severe hemorrhoids, but it causes significant postoperative pain and anxiety, which is associated with heart rate variability (HRV). Transcutaneous acupoint electrical stimulation (TAES) was assumed to alleviate pain and anxiety, and modify the autonomic nervous system. This study aimed to examine the effects of TAES intervention on postoperative pain, anxiety, and HRV in patients who received a hemorrhoidectomy. A randomized-controlled trial with five repeated measures was conducted. The TAES group ( n = 39) received four 20-min sessions of electrical stimulation at chengshan (BL57) and erbai (EX-UE2) after hemorrhoidectomy, whereas the control group ( n = 41) did not. Data were collected using Visual Analogue Scale (VAS), State Anxiety Inventory (STAI), and HRV physiological signal monitor. TAES resulted in a significant group difference in pain scores, anxiety levels, and some HRV parameters. The findings indicate that TAES can help reduce pain and anxiety associated with hemorrhoidectomy. TAES is a noninvasive, simple, and convenient modality for post-hemorrhoidectomy-associated pain control and anxiety reduction.

Differences in time-domain and spectral indexes of skin-surface laser-Doppler signals between controls and breast-cancer subjects.

BACKGROUND: There is an urgent need to improve the early diagnosis of breast cancer. OBJECTIVE: The present study applied spectral and beat-to-beat analyses to laser-Doppler (LDF) data sequences measured on the skin surface on the back of the right hands, with the aim of comparing the different peripheral microcirculatory-blood-flow (MBF) perfusion condition between breast-cancer and control subjects. METHODS: ECG and LDF signals were obtained simultaneously and noninvasively from 23 breast-cancer patients and 23 age-matched control subjects. Time-domain beat-to-beat indexes and their variability parameters were calculated. Spectral indexes were calculated using the Morlet wavelet transform. RESULTS: The beat-to-beat LDF pulse width and its variability were significantly smaller in cancer patients than in the controls. The energy contributions of endothelial-, neural-, and myogenic-related frequency bands were also significantly smaller in cancer patients. CONCLUSIONS: The present study has revealed significant differences in the beat-to-beat and spectral indexes of skin-surface-acquired LDF signals between control subjects and breast-cancer patients. This illustrates that LDF indexes may be useful for monitoring the changes in the MBF perfusion condition induced by breast cancer. Since the breast-cancer patients were at TNM stages 0- 2, the present findings may aid the development of indexes for detecting breast cancer.

Characteristics of spectral indexes of the blood pressure waveform in patients with breast cancer.

AIM: A tumor can induce abnormalities in vessel properties and the blood flow distribution. The aim of the present study was to determine if blood-pressure-waveform (BPW) harmonic indexes can be used to discriminate hemodynamic differences between healthy control subjects and patients with breast cancer. METHODS: Ten-minute bilateral radial BPW signals were obtained noninvasively in 23 breast-cancer patients and 23 healthy subjects. The amplitude proportion (Cn), phase angle (Pn), and harmonic variability (CVn) were calculated for harmonics 1 to 10 of the BPW. RESULTS: C1, C2, and P1 were significantly smaller and P7, P9, CV2, and CV3 were significantly larger in the control group than in the cancer group. CONCLUSION: The differences identified between the breast-cancer and control groups illustrate significant hemodynamic changes induced by breast cancer at stages 0-2. The BPW harmonic indexes investigated in this study may be useful for detecting these hemodynamic changes and thus improving the sensitivity of discriminating between healthy controls and patients with early-stage breast cancer.

Pharmacokinetics of quercetin-loaded nanodroplets with ultrasound activation and their use for bioimaging.

Bubble formulations have both diagnostic and therapeutic applications. However, research on nanobubbles/nanodroplets remains in the initial stages. In this study, a nanodroplet formulation was prepared and loaded with a novel class of chemotherapeutic drug, ie, quercetin, to observe its pharmacokinetic properties and ultrasonic bioimaging of specific sites, namely the abdominal vein and bladder. Four parallel groups were designed to investigate the effects of ultrasound and nanodroplets on the pharmacokinetics of quercetin. These groups were quercetin alone, quercetin triggered with ultrasound, quercetin-encapsulated in nanodroplets, and quercetin encapsulated in nanodroplets triggered with ultrasound. Spherical vesicles with a mean diameter of 280 nm were formed, and quercetin was completely encapsulated within. In vivo ultrasonic imaging confirmed that the nanodroplets could be treated by ultrasound. The results indicate that the initial 5-minute serum concentration, area under the concentration-time curve, elimination half-life, and clearance of quercetin were significantly enhanced by nanodroplets with or without ultrasound.

Evaluation of the harmonic scalpel in breast conserving and axillary staging surgery.

BACKGROUND: The ultrasonically activated scalpel has been introduced as an alternative to conventional methods of hemostasis in surgical procedures. The present study investigated the benefits of using the Harmonic FOCUS (HF) scalpel in breast-conserving surgery (BCS) and in axillary staging surgery. METHODS: All early-stage breast cancer patients who underwent BCS and axillary staging surgery between January 2009 and December 2010 were retrospectively identified. Those patients treated with the HF scalpel were defined as the HF group, while patients whose surgery involved the electrocautery and the clamp-and-tie technique were designated as the conventional method (CM) group. Both groups were subsequently divided into the axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) subgroups, respectively. RESULTS: A total of 89 patients were included in the study, with 41 patients in the HF group and 48 in the CM group. There were 13 patients in the SLNB subgroup and 28 were in the ALND subgroup of the HF group, and 21 patients were in the SLNB subgroup and 27 in the ALND subgroup of the CM group. Multiple linear regression analysis revealed that the length of surgery was significantly reduced in the ALND subgroup of the HF group (ß = -16.70, p < 0.001). The incidence of axillary numbness was significantly decreased in the ALND subgroup of the HF group, with the results measured by multiple logistic regression analysis (OR = 0.27, p = 0.044). No statistically significant differences were identified concerning intraoperative blood loss, postoperative drainage, and seroma between the HF and CM groups. CONCLUSION: Using the Harmonic FOCUS scalpel in breast conserving surgery and axillary lymph mode dissection significantly reduced the length of surgery and decreased the axillary numbness rate as compared to conventional methods.

A simple method for quantifying ultrasound-triggered microbubble destruction.

Ultrasound-triggered microbubble destruction (UTMD) is essential for targeted drug delivery but currently there is no agreed gold standard for its real-time monitoring. This study used a clinical diagnostic ultrasound scanner to quantify the destruction effects of different values of mechanical index (MI) on microbubble. This was achieved by measuring the signal intensity of peripheral vessels, which is representative of systemic microbubble concentration. Twenty-four male Sprague-Dawley rats and SonoVue contrast agent were used for this study, six for the determination of signal saturation and 18 for the study of microbubble destruction. In the first part of the experiment, four different SonoVue doses (200, 400, 600 and 800 µL/kg) were injected into each of six rats and the signal intensity in their right femoral arteries were recorded using a diagnostic ultrasound scanner. This data was used to plot time-intensity curves (TIC) to determine at which concentration the signal reaches saturation. Then UTMD studies were performed using the 400 µL/kg dose as its peak signal intensity (PSI) was safely within the linear portion of the intensity-concentration curve. The remaining 18 rats were divided into three MI groups (0.2, 0.6 and 1.0) and for each rat, the following was performed: TIC recording of a sham exposure without sonication was performed first using the same scanner from signal saturation study. Simultaneously, another ultrasound scanner was applied to the adductor muscles of left hind limb for sonication later. Then, a sonication TIC recording was performed, with both ultrasound scanners activated. A TIC recording of second sonication was also obtained for comparison. The TICs showed that the area under the curve and the enhancement duration were reduced after sonication in the groups MI = 0.6 and MI = 1.0 but not for the group MI = 0.2. The PSI in the groups with MI of 0.6 and 1.0 were slightly lowered after sonication, although it is not statistically significant. No significant difference of TIC exists between the first and the second sonication for each group. Pharmacokinetic analysis was performed with estimated concentration-time curve derived from TIC curve and found that SonoVue had faster clearance and decreased half-life in the groups MI = 0.6 and MI = 1.0. In conclusion, this study shows that sonographic signal measured from peripheral vessels is a feasible indicator of systemic microbubble concentration and may be used to quantify ultrasound-triggered microbubble destruction at target site.