Citrus peel powder alters the rheological properties and 3D printing performance of potato starch gel.

Owing to the growing interest in sustainable resource utilization, the current study explores the potential replacement of pectin with citrus peel powder (CP) in starch-based 3D food printing ink formulations. The effect of different concentrations of pectin (1 %, 2 %, 3 %) and CP (1 %, 2 %, 3 %) on the printing fidelity, microstructure, rheological and textural properties of potato starch gel were investigated. The results showed that the 3D printing performance of CP-added inks was higher than that of pectin-added inks at all tested concentrations. The storage modulus of CP-added ink was higher than that of pectin-added ink proving higher printing fidelity of CP-added inks. Additionally, hardness, gumminess, springiness and chewiness of food ink increased with an increase in the concentration of CP while decreased with an increase in concentration of pectin. Interestingly, pectin and CP-added inks displayed similar in vitro digestibility, suggesting an insignificant effect of replacing pectin with CP on in vitro glucose release. Moreover, the antioxidant activity of CP-added ink was higher than pectin-added ink demonstrating the potential applications of CP-added ink in functional ink development. Therefore, this study claims for effective replacement of pectin with CP in starch-based 3D food printing ink formulations as a promising sustainable additive.

Development of New Diffuse Large B Cell Lymphoma Mouse Models.

Diffuse large B cell lymphoma (DLBCL) is the most diagnosed, aggressive non-Hodgkin lymphoma, with ~40% of patients experiencing refractory or relapsed disease. Given the low response rates to current therapy, alternative treatment strategies are necessary to improve patient outcomes. Here, we sought to develop an easily accessible new xenograft mouse model that better recapitulates the human disease for preclinical studies. We generated two Luciferase (Luc)-EGFP-expressing human DLBCL cell lines representing the different DLBCL cell-of-origin subtypes. After intravenous injection of these cells into humanized NSG mice, we monitored the tumor growth and evaluated the organ-specific engraftment/progression period. Our results showed that human IL6-expressing NSG (NSG-IL6) mice were highly permissive for DLBCL cell growth. In NSG-IL6 mice, systemic engraftments of both U2932 activated B cell-like- and VAL germinal B cell-like-DLBCL (engraftment rate; 75% and 82%, respectively) were detected within 2nd-week post-injection. In the organ-specific ex vivo evaluation, both U2932-Luc and VAL-Luc cells were initially engrafted and expanded in the spleen, liver, and lung and subsequently in the skeleton, ovary, and brain. Consistent with the dual BCL2/MYC translocation association with poor patient outcomes, VAL cells showed heightened proliferation in human IL6-conditioned media and caused rapid tumor expansion and early death in the engrafted mice. We concluded that the U2932 and VAL cell-derived human IL6-expressing mouse models reproduced the clinical features of an aggressive DLBCL with a highly consistent pattern of tumor development. Based on these findings, NSG mice expressing human IL6 have the potential to serve as a new tool to develop DLBCL xenograft models to overcome the limitations of standard subcutaneous DLBCL xenografts.

Suicidality is most centrally situated within network of depression symptom criteria in unipolar depression patients with mood stabilizer in Asia.

Lithium and mood stabilizers are considered effective augmentation agents of antidepressants for treatment-resistant depression. Thus, this study aimed to estimate the network structure of depression symptom criteria among unipolar depression patients with mood stabilizers, using data from the Research on Asian Psychotropic Prescription Patterns for mood stabilizers (REAP-MS). We estimated a network of the 9 depression symptom criteria among 411 unipolar depression patients in Asia. Each of the depression symptom criteria was considered to be a dichotomous categorical variable. Suicidality (suicidal ideation or attempt) was the most centrally situated within the network of depression symptoms, followed by depressed mood, loss of energy, anhedonia and weight loss or gain. Contrastingly, concentration problem was the least interconnected. The depression symptom criteria were organized into 4 clusters by the community detection method. The findings suggest that suicidality may be one of the significant therapeutic target symptoms in unipolar depression patients with mood stabilizers.

The mediating effect of transition shock on the relationship between readiness for practice and turnover intention of new graduate nurses in South Korea: A longitudinal study.

BACKGROUND: Nurses' turnover intention has garnered significant global attention due to the shortage of the nursing workforce. New graduate nurses encounter challenges as they transition from students to professional nurses. Many new graduate nurses have experienced transition shock, which impacts their turnover intention. Researchers show that undergraduate readiness for practice is linked to transition shock and turnover intention, but there is a lack of longitudinal studies investigating their associations and causality. OBJECTIVES: To explore the longitudinal factors affecting turnover intention among new graduate nurses, as well as the mediating role of transition shock in the relationship between readiness for practice and turnover intention. DESIGN: A retrospective longitudinal design. SETTINGS: This study was conducted in 54 nursing schools in South Korea. PARTICIPANTS: A total of 232 new graduate nurses who participated in the New Nurse e-Cohort Panel Study as students and have continued working at the same hospital since graduation were included. METHODS: Surveys were conducted during three periods: two months before graduation (T0), six months after graduation (T1), and one year after graduation (T2). Hayes' PROCESS macro Model 4 was utilized to analyze the mediating effect of transition shock (T1) on the relationship between readiness for practice (T0) and turnover intention (T2) among new graduate nurses. RESULTS: Readiness for practice (ß = -0.140, p = 0.028) and transition shock (ß = 0.259, p < 0.001) were significantly associated with turnover intention. Transition shock acted as a mediator between readiness for practice and turnover intention (ß = -0.165, 95 % confidence interval -0.311 to -0.051) among new graduate nurses after controlling for work experience, working in desired units, and completion of internship before nursing school graduation. CONCLUSIONS: This study explored the causal relationships among readiness for practice, transition shock, and turnover intention of new graduate nurses. The findings suggest that higher readiness for practice decreases transition shock and influences the intention to leave. To retain a valuable nursing workforce, nursing schools should strive to create a supportive learning environment that prepares students with a high level of readiness for practice. Additionally, hospitals' nursing managers and administrators should implement a structured adaptation program for new graduate nurses to facilitate a smooth transition into the profession.

Impact of Electric Field Magnitude in the Left Dorsolateral Prefrontal Cortex on Changes in Intrinsic Functional Connectivity Using Transcranial Direct Current Stimulation: A Randomized Crossover Study.

This study investigated whether the electric field magnitude (E-field) delivered to the left dorsolateral prefrontal cortex (L-DLPFC) changes resting-state brain activity and the L-DLPFC resting-state functional connectivity (rsFC), given the variability in tDCS response and lack of understanding of how rsFC changes. Twenty-one healthy participants received either 2 mA anodal or sham tDCS targeting the L-DLPFC for 10 min. Brain imaging was conducted before and after stimulation. The fractional amplitude of low-frequency fluctuation (fALFF), reflecting resting brain activity, and the L-DLPFC rsFC were analyzed to investigate the main effect of tDCS, main effect of time, and interaction effects. The E-field was estimated by modeling tDCS-induced individual electric fields and correlated with fALFF and L-DLPFC rsFC. Anodal tDCS increased fALFF in the left rostral middle frontal area and decreased fALFF in the midline frontal area (FWE p < 0.050), whereas sham induced no changes. Overall rsFC decreased after sham (positive and negative connectivity, p = 0.001 and 0.020, respectively), with modest and nonsignificant changes after anodal tDCS (p = 0.063 and 0.069, respectively). No significant differences in local rsFC were observed among the conditions. Correlations were observed between the E-field and rsFC changes in the L-DLPFC (r = 0.385, p = 0.115), left inferior parietal area (r = 0.495, p = 0.037), and right lateral visual area (r = 0.683, p = 0.002). Single-session tDCS induced resting brain activity changes and may help maintain overall rsFC. The E-field in the L-DLPFC is associated with rsFC changes in both proximal and distally connected brain regions to the L-DLPFC.

Reference Standard of Median Nerve Conduction Study in Korea.

OBJECTIVE: To establish the reference standard of the median nerve conduction study (NCS) in Korea. METHODS: A total of 648 median motor and 602 median sensory NCSs from 349 Korean healthy volunteers were tested and analyzed prospectively. Equipment calibration, assessment of intraand inter-rater reliability, and the NCSs per se were conducted according to a predetermined protocol. A reference standard was established from uncertainty components for the following parameters: the onset and peak latencies; the baseline-to-peak and peak-to-peak amplitudes; the area and duration of the negative wave; and the nerve conduction velocity. The effects of sex, age and stimulation intensity were analyzed. RESULTS: Each measured value of 648 median motor and 602 median sensory nerves were obtained and presented with both mean and expanded uncertainties, as well as mean and standard deviations. The cut-off values with expanded uncertainty were determined for different age and sex groups. After adjusting for anthropometric covariates, all parameters except duration were affected by age, and sex appeared to influence both duration and area. While stimulation intensity significantly affected some parameters including latencies, the effect sizes were negligible. CONCLUSION: We propose the median NCS reference standard using the largest Korean dataset ever available. The use of the traceable and reliable reference standard is anticipated to promote more accurate and dependable diagnosis and appropriate management of median neuropathies in Korea.

Factors for increasing positive predictive value of pneumothorax detection on chest radiographs using artificial intelligence.

This study evaluated the positive predictive value (PPV) of artificial intelligence (AI) in detecting pneumothorax on chest radiographs (CXRs) and its affecting factors. Patients determined to have pneumothorax on CXR by a commercial AI software from March to December 2021 were included retrospectively. The PPV was evaluated according to the true-positive (TP) and false-positive (FP) diagnosis determined by radiologists. To know the factors that might influence the results, logistic regression with generalized estimating equation was used. Among a total of 87,658 CXRs, 308 CXRs with 331 pneumothoraces from 283 patients were finally included. The overall PPV of AI about pneumothorax was 41.1% (TF:FP = 136:195). The PA view (odds ratio [OR], 29.837; 95% confidence interval [CI], 15.062-59.107), high abnormality score (OR, 1.081; 95% CI, 1.066-1.097), large amount of pneumothorax (OR, 1.005; 95% CI, 1.003-1.007), presence of ipsilateral atelectasis (OR, 3.508; 95% CI, 1.509-8.156) and a small amount of ipsilateral pleural effusion (OR, 5.277; 95% CI, 2.55-10.919) had significant effects on the increasing PPV. Therefore, PPV for pneumothorax diagnosis using AI can vary based on patients' factors, image-acquisition protocols, and the presence of concurrent lesions on CXR.

Artificial intelligence-based computer-aided diagnosis abnormality score trends in the serial mammography of patients with breast cancer.

PURPOSE: To explore the abnormality score trends of artificial intelligence-based computer-aided diagnosis (AI-CAD) in the serial mammography of patients until a final diagnosis of breast cancer. METHOD: From 2015 to 2019, 126 breast cancer patients who had at least two previous mammograms obtained from 2008 up to cancer diagnosis were included. AI-CAD was retrospectively applied to 487 previous mammograms and all the abnormality scores calculated by AI-CAD were obtained. The contralateral breast of each affected breast was defined as the control group. We divided all mammograms by 6-month intervals from cancer diagnosis in reverse chronological order. The random coefficient model was used to estimate whether the chronological trend of AI-CAD abnormality scores differed between cancer and normal breasts. Subgroup analyses were performed according to mammographic visibility, invasiveness and molecular subtype of the invasive cancer. RESULTS: Mean period from initial examination to cancer diagnosis was 6.0 years (range 1.7-10.7 years). The abnormality scores of breasts diagnosed with cancer showed a significantly increasing trend during the previous examination period (slope 0.6 per 6 months, p for the slope < 0.001), while the contralateral normal breast showed no trend (slope 0.03, p = 0.776). The difference in slope between the cancerous and contralateral breasts was significant (p < 0.001). For mammography-visible cancers, the abnormality scores in cancerous breasts showed a significant increasing trend (slope 0.8, p < 0.001), while for mammography-occult cancers, the trend was not significant (slope 0.1, p = 0.6). For invasive cancers, the slope of the abnormality scores showed a significant increasing trend (slope 1.4, p = 0.002), unlike ductal carcinoma in situ (DCIS) which showed no significant trend. There was no significant difference in the slope of abnormality scores among the subtypes of invasive cancers (p = 0.418). CONCLUSION: Breasts diagnosed with cancer showed an increase in AI-CAD abnormality scores in previous serial mammograms, suggesting that AI-CAD could be useful for early detection of breast cancer.

Violence against parents perpetrated by adolescent siblings of individuals with intellectual disability in South Korea.

BACKGROUND: Few studies have focused on the daily hassles among adolescent siblings living with individuals with intellectual disability (IwID) and the resulting conflicts between family members. The pathway from stress (hassles) to adolescents' violent acts has been largely ignored. OBJECTIVE: This study examined the link between hassles (independent variable) and violence against parents (dependent variable), with aggression as a mediator and social support as a moderator. PARTICIPANTS: Data were collected from November 2018 to February 2019 in Seoul, Gyeonggi Province, and Incheon City. Participants were 303 adolescent siblings of IwID (male: 47.2 %; female: 52.1 %). METHODS: Descriptive analysis was conducted using SPSS 24.0 and mediating pathways were determined using SPSS Macro 25.0. To verify the moderating role of social support, the entire sample was divided into two groups based on the mean value of social support and the mediating model was analyzed. RESULTS: In the low social support group (n = 140), the direct effect was not significant (ß = 0.0111, 95 % CI = -0.0044 to 0.0266), but the indirect effect was maintained (ß = 0.0096, 95 % CI = 0.0005 to 0.0234). However, in the high support group (n = 118), neither the direct effect (ß = 0.0106, 95 % CI = -0.0162 to 0.0373) nor the indirect effect (ß = 0.0126, 95 % CI = -0.0013 to 0.0301) was significant. Social support as a moderator was statistically significant compared with different paths in the two-group analysis. CONCLUSIONS: Counselling interventions are needed to alleviate the link between hassles and adolescent violence against parents through aggression.

Development of a new prognostic model to predict pneumonia outcome using artificial intelligence-based chest radiograph results.

This study aimed to develop a new simple and effective prognostic model using artificial intelligence (AI)-based chest radiograph (CXR) results to predict the outcomes of pneumonia. Patients aged > 18 years, admitted the treatment of pneumonia between March 2020 and August 2021 were included. We developed prognostic models, including an AI-based consolidation score in addition to the conventional CURB-65 (confusion, urea, respiratory rate, blood pressure, and age ≥ 65) and pneumonia severity index (PSI) for predicting pneumonia outcomes, defined as 30-day mortality during admission. A total of 489 patients, including 310 and 179 patients in training and test sets, were included. In the training set, the AI-based consolidation score on CXR was a significant variable for predicting the outcome (hazard ratio 1.016, 95% confidence interval [CI] 1.001-1.031). The model that combined CURB-65, initial O2 requirement, intubation, and the AI-based consolidation score showed a significantly high C-index of 0.692 (95% CI 0.628-0.757) compared to other models. In the test set, this model also demonstrated a significantly high C-index of 0.726 (95% CI 0.644-0.809) compared to the conventional CURB-65 and PSI (p < 0.001 and 0.017, respectively). Therefore, a new prognostic model incorporating AI-based CXR results along with traditional pneumonia severity score could be a simple and useful tool for predicting pneumonia outcomes in clinical practice.

Bioelectrical impedance parameters add incremental value to waist-to-hip ratio for prediction of metabolic dysfunction associated steatotic liver disease in youth with overweight and obesity.

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) presents a growing health concern in pediatric populations due to its association with obesity and metabolic syndrome. Bioelectrical impedance analysis (BIA) offers a non-invasive and potentially effective alternative for identifying MASLD risk in youth with overweight or obesity. Therefore, this study aimed to assess the utility of BIA for screening for MASLD in the youth. Method: This retrospective, cross-sectional study included 206 children and adolescents aged <20 years who were overweight and obese. The correlations between anthropometric measurements and BIA parameters and alanine aminotransferase (ALT) levels were assessed using Pearson's correlation analysis. Logistic regression analysis was performed to examine the associations between these parameters and ALT level elevation and MASLD score. Receiver operating characteristic (ROC) curves were generated to assess the predictive ability of the parameters for MASLD. Results: Pearson's correlation analysis revealed that waist-to-hip ratio (WHR), percentage body fat (PBF), and BIA parameters combined with anthropometric measurements were correlated with ALT level. Logistic regression revealed that WHR, skeletal muscle mass/WHR, PBF-WHR, fat-free mass/WHR, and appendicular skeletal muscle mass/WHR were correlated with ALT level elevation after adjusting for age, sex, and puberty. WHR, PBF-WHR, and visceral fat area (VFA)-WHR were positively correlated with the MASLD score in the total population after adjusting for age, sex, and puberty. PBF-WHR and VFA-WHR were correlated with the MASLD score even in youth with a normal ALT level. The cutoff points and area under the ROC curves were 34.6 and 0.69 for PBF-WHR, respectively, and 86.6 and 0.79 for VFA-WHR, respectively. Discussion: This study highlights the utility of combining BIA parameters and WHR in identifying the risk of MASLD in overweight and obese youth, even in those with a normal ALT level. BIA-based screening offers a less burdensome and more efficient alternative to conventional MASLD screening methods, facilitating early detection and intervention in youth at risk of MASLD.

Validity of the Korean Version of the Brief Irritability Test in Psychiatric Patients.

OBJECTIVE: This study aimed to investigate the validity and reliability of the Korean version of the Brief Irritability Test (BITe) and adapt it for Korean patients with psychiatric disorders. METHODS: A total of 296 patients at the Department of Psychiatry of Hanyang University Guri Hospital completed the BITe, Korean Beck Depression Inventory-II, Korean Beck Anxiety Inventory, the Korean version of the State-Trait Anger Expression Inventory, and Barratt Impulsiveness Scale-11. Construct validity was confirmed through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Reliability testing included assessments of internal consistency (Cronbach's α) and item-total correlations. Convergent validity was examined through correlational analyses with variables such as anxiety, depression, anger, and impulsivity. RESULTS: First, the scale had good internal consistency with a Cronbach's α of 0.88. Second, EFA indicated a single dimensionality of the BITe, and CFA demonstrated a reasonable fit for the single-factor model (comparative fit index=0.97, Tucker-Lewis Index=0.95, normed fit index=0.97, goodness-of-fit index=0.96, root mean square error of approximation=0.12, standardized root mean residual=0.03). Finally, the convergent validity analysis revealed a significant positive correlation with depression, anxiety, and anger, except for anger control, which is a sub-variable of anger. CONCLUSION: The results showed that the Korean version of the BITe had good psychometric properties, and might serve as a valuable tool for assessing irritability in Korean patients with psychiatric disorders.

Analysis of Acute Phase Response Using Acute Phase Proteins Following Simultaneous Vaccination of Lumpy Skin Disease and Foot-and-Mouth Disease.

Since 2011, South Korea has implemented biannual vaccinations against foot-and-mouth disease (FMD) and recently, lumpy skin disease (LSD), to mitigate the spread of transboundary animal diseases. However, due to past adverse reactions, potentially linked to acute phase responses from FMD vaccinations, there is hesitancy among Korean livestock farmers regarding new strategies for simultaneous vaccinations against both FMD and LSD. This study was conducted to assess possible adverse reactions to the LSD vaccination by analyzing acute phase proteins (APPs) in three groups: cows vaccinated against FMD (G1-FMDV), LSD (G2-LSDV), and both (G3-FMDV/LSDV). In G1-FMDV, APP levels peaked on day 3 post-vaccination (p < 0.001) and returned to baseline. In G2-LSDV, APP levels increased gradually, peaking on day 10 post-vaccination. In G3-FMDV/LSDV, APP levels peaked on day 3 post-vaccination and remained high until day 10 (p < 0.001). These results indicate that LSD vaccines trigger a later immune response compared to FMD vaccines, possibly due to different adjuvants. Therefore, a longer follow-up period for monitoring adverse reactions to LSD vaccinations may be required to understand and mitigate potential risks.

Comparison of Absolute and Relative Grip Strength to Predict Incidence of Diabetes Mellitus in Korea: A Prospective Cohort Study.

Background: This study aimed to investigate the association between absolute grip strength (AGS), relative grip strength (RGS) levels, and the risk of developing diabetes in middle-aged adults, utilizing longitudinal data. Methods: A total of 1935 participants, 51-81 years of age, were engaged in surveys both in 2017-2018 and during the subsequent follow-up survey in 2019-2020. Diabetes diagnosis and treatment were the criteria for categorizing individuals as "diabetic." Grip strength was measured using the JAMA-5030J1 equipment (SAEHAN, Korea), and AGS and RGS were also categorized into tertiles by gender. A proportional hazards Cox regression model was used to evaluate the relationship among AGS, RGS, and the risk of developing diabetes. Subsequently, we computed the hazard ratio (HR) and 95% confidence interval (95% CI) for the risk of developing diabetes. Results: After adjusting for various confounding variables, a significant reduction in diabetes risk was observed in the high grip strength group, adjusted for body mass index (RGS1) and body weight (RGS2), compared with the low RGS1 and RGS2 groups (RGS1 HR = 0.54, 95% CI = 0.36-0.80; RGS2 HR = 0.50, 95% CI = 0.34-0.73). However, there were no significant associations between AGS and diabetes risk. Furthermore, significant differences in the relationship among AGS, RGS levels, and the risk of developing diabetes were found across gender and insulin resistance levels. Conclusion: This study underscores the importance of RGS levels in predicting the incidence of diabetes, with AGS, RGS1, and RGS2 emerging as significant predictive indicators for assessing diabetes risk.

How are new nurses satisfied with their jobs? From the work value perspective of Generations Y and Z nurses.

BACKGROUND: Job satisfaction has garnered significant interest across multiple disciplines as it plays a vital role in shaping human resource strategies. In the field of nursing, enhancing job satisfaction can help prevent workforce shortages. Work values and job-related characteristics are significant predictors of job satisfaction. However, the influence of factors may change as younger generations join the nursing workforce. Although research on generational commonalities and differences in work values is increasing, there is insufficient information on generational differences in the interplay between work values and job satisfaction. This study investigated the factors associated with job satisfaction of new nurses in each generational group based on a work value perspective. METHODS: A total of 280 new nurses (151 from Generation Y and 129 from Generation Z) were selected from the Graduates Occupational Mobility Survey. Multiple linear regression analyses were performed to determine the factors associated with job satisfaction in both groups. RESULTS: Most participants graduated with a diploma (61.1%), were paid less than the average salary of each group (60.4%), and conducted shift (72.9%) and overtime work (64.3%). Work values and job satisfaction levels were not significantly different between the two groups. Multiple linear regression analyses showed that career growth and task work values were associated with job satisfaction for Generation Z, while task, reputation, and environment work values were associated with job satisfaction for Generation Y. Among the job-related characteristics, nurses' job tenure was associated with job satisfaction in both groups; salary and overtime had varying relationships with job satisfaction between the two generations. CONCLUSIONS: Understanding generational differences is crucial for improving the effective management of new generational nurses. Our study findings support that different work value dimensions and job-related characteristics were associated with job satisfaction in each generation. Accordingly, it is essential to develop distinct initiatives, such as a well-structured program, to support the continued career growth of the new Generation Z nurses, thereby enhancing their job satisfaction. Furthermore, providing a conducive working environment that helps new-generation nurses overcome challenges and ensures personal lives should be considered.

Impact of AI for Digital Breast Tomosynthesis on Breast Cancer Detection and Interpretation Time.

Purpose To develop an artificial intelligence (AI) model for the diagnosis of breast cancer on digital breast tomosynthesis (DBT) images and to investigate whether it could improve diagnostic accuracy and reduce radiologist reading time. Materials and Methods A deep learning AI algorithm was developed and validated for DBT with retrospectively collected examinations (January 2010 to December 2021) from 14 institutions in the United States and South Korea. A multicenter reader study was performed to compare the performance of 15 radiologists (seven breast specialists, eight general radiologists) in interpreting DBT examinations in 258 women (mean age, 56 years ± 13.41 [SD]), including 65 cancer cases, with and without the use of AI. Area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and reading time were evaluated. Results The AUC for stand-alone AI performance was 0.93 (95% CI: 0.92, 0.94). With AI, radiologists' AUC improved from 0.90 (95% CI: 0.86, 0.93) to 0.92 (95% CI: 0.88, 0.96) (P = .003) in the reader study. AI showed higher specificity (89.64% [95% CI: 85.34%, 93.94%]) than radiologists (77.34% [95% CI: 75.82%, 78.87%]) (P < .001). When reading with AI, radiologists' sensitivity increased from 85.44% (95% CI: 83.22%, 87.65%) to 87.69% (95% CI: 85.63%, 89.75%) (P = .04), with no evidence of a difference in specificity. Reading time decreased from 54.41 seconds (95% CI: 52.56, 56.27) without AI to 48.52 seconds (95% CI: 46.79, 50.25) with AI (P < .001). Interreader agreement measured by Fleiss κ increased from 0.59 to 0.62. Conclusion The AI model showed better diagnostic accuracy than radiologists in breast cancer detection, as well as reduced reading times. The concurrent use of AI in DBT interpretation could improve both accuracy and efficiency. Keywords: Breast, Computer-Aided Diagnosis (CAD), Tomosynthesis, Artificial Intelligence, Digital Breast Tomosynthesis, Breast Cancer, Computer-Aided Detection, Screening Supplemental material is available for this article. © RSNA, 2024 See also the commentary by Bae in this issue.

Positive Predictive Values of Abnormality Scores From a Commercial Artificial Intelligence-Based Computer-Aided Diagnosis for Mammography.

OBJECTIVE: Artificial intelligence-based computer-aided diagnosis (AI-CAD) is increasingly used in mammography. While the continuous scores of AI-CAD have been related to malignancy risk, the understanding of how to interpret and apply these scores remains limited. We investigated the positive predictive values (PPVs) of the abnormality scores generated by a deep learning-based commercial AI-CAD system and analyzed them in relation to clinical and radiological findings. MATERIALS AND METHODS: From March 2020 to May 2022, 656 breasts from 599 women (mean age 52.6 ± 11.5 years, including 0.6% [4/599] high-risk women) who underwent mammography and received positive AI-CAD results (Lunit Insight MMG, abnormality score ≥ 10) were retrospectively included in this study. Univariable and multivariable analyses were performed to evaluate the associations between the AI-CAD abnormality scores and clinical and radiological factors. The breasts were subdivided according to the abnormality scores into groups 1 (10-49), 2 (50-69), 3 (70-89), and 4 (90-100) using the optimal binning method. The PPVs were calculated for all breasts and subgroups. RESULTS: Diagnostic indications and positive imaging findings by radiologists were associated with higher abnormality scores in the multivariable regression analysis. The overall PPV of AI-CAD was 32.5% (213/656) for all breasts, including 213 breast cancers, 129 breasts with benign biopsy results, and 314 breasts with benign outcomes in the follow-up or diagnostic studies. In the screening mammography subgroup, the PPVs were 18.6% (58/312) overall and 5.1% (12/235), 29.0% (9/31), 57.9% (11/19), and 96.3% (26/27) for score groups 1, 2, 3, and 4, respectively. The PPVs were significantly higher in women with diagnostic indications (45.1% [155/344]), palpability (51.9% [149/287]), fatty breasts (61.2% [60/98]), and certain imaging findings (masses with or without calcifications and distortion). CONCLUSION: PPV increased with increasing AI-CAD abnormality scores. The PPVs of AI-CAD satisfied the acceptable PPV range according to Breast Imaging-Reporting and Data System for screening mammography and were higher for diagnostic mammography.

A Nationwide Study on HER2-low Breast Cancer in South Korea: Its Incidence of 2022 Real World Data and the Importance of Immunohistochemical Staining Protocols.

Purpose: Notable effectiveness of trastuzumab deruxtecan (T-DXd) in patients with HER2-low advanced breast cancer (BC) has focused pathologists' attention. We studied the incidence and clinicopathologic characteristics of HER2-low BC, and the effects of immunohistochemistry (IHC) associated factors on HER2 IHC results. Materials and Methods: The Breast Pathology Study Group of the Korean Society of Pathologists conducted a nationwide study using real-world data on HER2 status generated between January 2022 and December 2022. Information on HER2 IHC protocols at each participating institution was also collected. Results: Total 11,416 patients from twenty-five institutions included in this study. Of these patients, 40.7% (range: 6.0%-76.3%) were classified as HER2-zero, 41.7% (range: 10.5%-69.1%) as HER2-low, and 17.5% (range: 6.7%-34.0%) as HER2-positive. HER2-low tumors were associated with positive ER and PR statuses (p<0.001 and p<0.001, respectively). Antigen retrieval times (≥ 36 min vs. < 36 min) and antibody incubation times (≥ 12 min vs. < 12 min) affected on the frequency of HER2 IHC 1+ BC at institutions using the PATHWAY HER2 (4B5) IHC assay and BenchMark XT or Ultra staining instruments. Furthermore, discordant results between core needle biopsy (CNB) and subsequent resection specimen HER2 statuses were observed in 24.1% (787/3259) of the patients. Conclusion: The overall incidence of HER2-low BC in South Korea concurs with those reported in previously published studies. Significant inter-institutional differences in HER2 IHC protocols were observed, and it may have impact on HER2-low status. Thus, we recommend standardizing HER2 IHC conditions to ensure precise patient selection for targeted therapy.

Digital Literacy and Associated Factors in Older Adults Living in Urban South Korea: A Qualitative Study.

This study aimed to explore digital literacy among community-dwelling older adults in urban South Korea. A semistructured interview guide was developed using the Digital Competence ( 2.0 framework, which emphasizes the competencies for full digital participation in five categories: information and data literacy, communication and collaboration, content creation, safety, and problem-solving. The data were analyzed using combined inductive and deductive content analysis. Inductive analysis identified three main categories: perceived ability to use digital technology, responses to digital technology, and contextual factors. In the results of deductive analysis, participants reported varying abilities in using digital technologies for information and data literacy, communication or collaboration, and problem-solving. However, their abilities were limited in handling the safety or security of digital technology and lacked in creating digital content. Responses to digital technology contain subcategories of perception (positive or negative) and behavior (trying or avoidance). Regarding contextual factors, aging-related physical and cognitive changes were identified as barriers to digital literacy. The influence of families or peers was viewed as both a facilitator and a barrier. Our participants recognized the importance of using digital devices to keep up with the trend of digitalization, but their digital literacy was mostly limited to relatively simple levels.

Different particle sizes of Momordica charantia leaf powder modify the rheological and textural properties of corn starch-based 3D food printing ink.

The study determined the effect of incorporating Momordica charantia leaf powder (MCLP) into corn-starch 3D food-printing ink as a functional ingredient. The effects of the particle size (75, 131, and 200 µm) and quantity of MCLP on 3D printing performance, structural, textural, and rheological properties of corn starch gel were evaluated with different concentrations (5, 10, and 15 % (w/w)) of corn starch. The viscoelastic properties of food inks were determined considering their behavior during extrusion and self-recovery after printing. Scanning electron microscope was used to characterize the microstructure. Based on the results, a high starch content (15 %) with 5 % MCLP was more favorable for 3D food printing. In addition, 3D printing performance, textural and rheological properties of formulated ink was mainly governed by the particle size of MCLP. The food ink with a 5 % mass fraction of 200 µm MCLP had the highest printing precision and the best masticatory properties.