The application of computer-aided diagnosis in Breast Imaging Reporting and Data System ultrasound training for residents-a randomized controlled study.

Background: The consistency of Breast Imaging Reporting and Data System (BI-RADS) classification among experienced radiologists is different, which is difficult for inexperienced radiologists to master. This study aims to explore the value of computer-aided diagnosis (CAD) (AI-SONIC breast automatic detection system) in the BI-RADS training for residents. Methods: A total of 12 residents who participated in the first year and the second year of standardized resident training in Ningbo No. 2 Hospital from May 2020 to May 2021 were randomly divided into 3 groups (Group 1, Group 2, Group 3) for BI-RADS training. They were asked to complete 2 tests and questionnaires at the beginning and end of the training. After the first test, the educational materials were given to the residents and reviewed during the breast imaging training month. Group 1 studied independently, Group 2 studied with CAD, and Group 3 was taught face-to-face by experts. The test scores and ultrasonographic descriptors of the residents were evaluated and compared with those of the radiology specialists. The trainees' confidence and recognition degree of CAD were investigated by questionnaire. Results: There was no statistical significance in the scores of residents in the first test among the 3 groups (P=0.637). After training and learning, the scores of all 3 groups of residents were improved in the second test (P=0.006). Group 2 (52±7.30) and Group 3 (54±5.16) scored significantly higher than Group 1 (38±3.65). The consistency of ultrasonographic descriptors and final assessments between the residents and senior radiologists were improved (κ3 > κ2 > κ1), with κ2 and κ3 >0.4 (moderately consistent with experts), and κ1 =0.225 (fairly agreed with experts). The results of the questionnaire showed that the trainees had increased confidence in BI-RADS classification, especially Group 2 (1.5 to 3.5) and Group 3 (1.25 to 3.75). All trainees agreed that CAD was helpful for BI-RADS learning (Likert scale score: 4.75 out of 5) and were willing to use CAD as an aid (4.5, max. 5). Conclusions: The AI-SONIC breast automatic detection system can help residents to quickly master BI-RADS, improve the consistency between residents and experts, and help to improve the confidence of residents in the classification of BI-RADS, which may have potential value in the BI-RADS training for radiology residents. Trial Registration: Chinese Clinical Trial Registry (ChiCTR2400081672).

Intensification of Inclusion Body Processing via Temperature-Based Refolding.

Inclusion bodies (IB) are dense insoluble aggregates of mostly misfolded polypeptides that usually result from recombinant protein overexpression. IB formation has been observed in protein expression systems such as E. coli, yeast, and higher eukaryotes. To recover soluble recombinant proteins in their native state, IB are commonly first solubilized with a high concentration of denaturant. This is followed by concurrent denaturant removal or reduction and a transition into a refolding-favorable chemical environment to facilitate the refolding of solubilized protein to its native state. Due to the high concentration of denaturant used, conventional refolding approaches can result in dilute products and are buffer inefficient. To circumvent the limitations of conventional refolding approaches, a temperature-based refolding approach which combines a low concentration of denaturant (0.5 M guanidine hydrochloride, GdnHCl) with a high temperature (95 °C) during solubilization was proposed. In this chapter, we describe a temperature-based refolding approach for the recovery of core streptavidin (cSAV) from IB. Through the temperature-based approach, intensification was achieved through the elimination of a concentration step which would be required by a dilution approach and through a reduction in buffer volumes required for dilution or denaturant removal. High-temperature treatment during solubilization may have also resulted in the denaturation and aggregation of undesired host-cell proteins, which could then be removed through a centrifugation step resulting in refolded cSAV of high purity without the need for column purification. Refolded cSAV was characterized by biotin-binding assay and SDS-PAGE, while purity was determined by RP-HPLC.

Histiocytoid Sweet Syndrome Presenting in Two Sisters With Deficiency of Deaminase Type 2.

ABSTRACT: Deficiency of adenosine deaminase type 2 (DADA2) is an autosomal recessive monogenic autoinflammatory syndrome that is classically characterised by polyarteritis nodosa, systemic vasculitis and stroke. The spectrum of disease manifestations has broadened to encompass a range of cutaneous, vascular and haematological manifestations. We report a novel association in two sisters with heterozygous p.R169G/p.M309l mutations in ADA2 with low serum ADA2 activity who both presented similarly with clinical and histological features consistent with histiocytoid Sweet syndrome.

Translating new breast ultrasound techniques into clinical practice: evaluating their intended uses and describing other unexpected uses for them.

Several new ultrasound tools have been developed to further evaluate breast lesions detected on B-mode ultrasound. Strain elastography (SRE) was developed to assess the likelihood of malignancy of lesions based on their stiffness. This has been incorporated into the latest edition of the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) lexicon and atlas. However, no agreed cut-off stiffness values have been established to distinguish benign from malignant lesions making the translation into routine clinical practice difficult. Superb microvascular imaging (SMI) was developed to better evaluate the vascularity within sonographic lesions and assess their likelihood of malignancy. However, there is also no agreed cut-off value for vascular index (VI) to distinguish between benign and malignant lesions. MicroPure was developed to better visualize and evaluate calcifications seen on ultrasound. Its effective use in breast screening and evaluating the calcifications detected for likelihood of malignancy have not been established. This article describes the original intended uses of these applications and reviews the studies evaluating them, showing the varying success of the translation of these tools into routine clinical practice. Also described are some other uses of these tools for which they were not originally intended. This illustrates the importance of being perceptive to alternative uses of imaging tools in their translation from bench to bedside.

An unusual penile lesion.

We present an unusual case of an orange-brown penile lesion with a description of the histological findings. Click here for the corresponding questions to this CME article.

The 'twinkle' artifact - A novel method of clip identification to facilitate targeted axillary surgery following neoadjuvant chemotherapy in breast cancer patients.

OBJECTIVES: A targeted surgical approach which accurately determines axillary status after neoadjuvant chemotherapy (NAC) may allow appropriate de-escalation of surgical treatment. It is postulated that the combined use of a particular marker clip, ULTRACOR®TWIRL™ (Bard, Inc.), and specific ultrasound settings for its identification, may overcome the challenges of pre-operative localisation with size diminution of nodes following NAC. Hence, this feasibility study was performed. METHODS: Three patients with locally advanced breast cancer (LABC), who had the Twirl marker clip placed in biopsy-proven metastatic axillary lymph nodes and completed treatment were included in this preliminary study. Preoperative sonographic identification of the clip and associated node was done on the day of surgery, confirmed by eliciting the 'twinkle' artifact, followed by hookwire localisation and resection. The 'twinkle' artifact was demonstrated within each specimen after resection. RESULTS: All three patients who completed treatment for LABC had successful identification and resection of clipped node aided by the 'twinkle artifact'. CONCLUSION: The 'twinkle' artifact is a novel and useful aid in identifying the Twirl™ clip marking a lymph node in the post-NAC setting, with the potential to be used intraoperatively.

BRAF Inhibitor-Associated Granulomatous Dermatitis: A Report of 3 Cases.

Cutaneous toxicities associated with BRAF inhibitor treatment in patients with metastatic melanoma have been well described. We present a rare association of granulomatous dermatitis in association with the BRAF inhibitor vemurafenib. Three patients with metastatic melanoma all presented with asymptomatic papular eruptions 8-21 months into vemurafenib therapy. Skin biopsies confirmed the diagnosis of granulomatous dermatitis. Other causes of granulomatous dermatitis including infectious agents and sarcoid were excluded. Treatment with potent topical and oral steroids improved the eruptions, but only after the cessation of vemurafenib did all 3 cases of granulomatous dermatitis completely resolve within 2 weeks. It is important to recognize that this association, unlike most other BRAF inhibitor-related skin toxicities, can occur many months after commencement of therapy and that vemurafenib treatment can be continued without clinically significant adverse effects.

Dermatoscopic findings of penile intraepithelial neoplasia: Bowenoid papulosis, Bowen disease and erythroplasia of Queyrat.

BACKGROUND/OBJECTIVES: The clinical diagnosis of penile intraepithelial neoplasia is challenging. No specific dermoscopic criteria for penile intraepithelial neoplasia have been described in the literature. This study aimed to describe and evaluate the dermoscopic features of penile intraepithelial neoplasia. METHODS: Clinical and dermoscopic images of 11 patients with histopathologically confirmed penile intraepithelial neoplasia were recorded and evaluated. RESULTS: The most frequent dermoscopic features were the presence of structureless areas (100%, structureless pink 72.7%) and vascular structures (81.8%), particularly dotted vessels (72.7%). Other findings included the absence of a pigment network (100%); scale (45.5%); scar-like areas (45.5%); erosions (27.3%); and pigmentation consisting of brown-grey dots and globules (27.3%). CONCLUSIONS: The dermoscopic features that characterise penile intraepithelial neoplasia are structureless pink areas and a prominent vascular pattern (mainly clustered dotted vessels). Dermoscopy is a useful tool that can aid in the diagnosis and surveillance of penile intraepithelial neoplasia.

Preoperative imaging for breast conservation surgery-do we need more than conventional imaging for local disease assessment?

Breast conservation surgery (BCS) is offered for early breast cancer. Conventional imaging with mammography and ultrasound would have been performed prior to surgery. This article considers other imaging modalities available [such as 3D tomosynthesis, magnetic resonance imaging (MRI), contrast-enhanced spectral mammography, positron emission mammography (PEM), breast-specific gamma imaging (BSGI) and cone beam computed tomography (CBCT)] and discusses the evidence for these in terms of diagnostic accuracy and clinical outcomes.

Integrating anatomy, radiology, pathology, and surgery: An alternative approach in resecting multifocal and multicentric breast carcinoma.

The sick lobe hypothesis provides the basis for a lobar approach in radiology, pathology, and surgical treatment of breast cancer. This approach aims to remove the tumor together with the surrounding field of genetic aberrations. Detailed preoperative lobar imaging that properly maps the disease and assesses its extent guides the parenchymal resection. Integration of our knowledge of breast anatomy and pathology with the results of preoperative radiological mapping is critical in assessing the eligibility of patients with multifocal and/or multicentric breast cancer for breast conservation treatment. Through an appropriately selected incision, a multisegment resection of the diseased lobe(s) is performed, which leaves the residual parenchyma in a formation that allows dovetailing of one part into the other, like the way pieces of a jigsaw puzzle fit together. Detailed pathologic analysis of the surgical specimen provides valuable feedback to the radiologist, establishes the completeness of surgical intervention, and generates predictive information for therapeutic decisions. Our approach is a step in continuous search for ideal tailored therapy to avoid under or over-treatment of breast cancer patients.

The role of surgical excision for the Krukenberg tumour: A case report.

INTRODUCTION: Krukenberg tumour (KT), which represents carcinoma in the ovary, is an uncommon manifestation of metastatic colorectal cancer. It is associated with poor prognosis and a high incidence of peritoneal metastatic disease. PRESENTATION OF CASE: The authors present a case of a 51-year-old female who had a symptomatic, metachronous right ovarian KT diagnosed 12 months after her initial resection. Surgery was performed to excise the 23cm tumour as well as the contralateral ovary and isolated peritoneal disease, with an R0 resection achieved. DISCUSSION: KT from colorectal origin behave differently to non-ovarian colorectal metastases, with features suggestive of transcoloemic dissemination. Surgical removal of isolated ovarian metastasis without peritoneal involvement is associated with improved outcomes. Treatment with cytoreductive surgery and heated intraperitoneal chemotherapy offers promise for patients with KT and concominant peritoneal involvement. CONCLUSION: This case is illustrative of the clinical features of KT including its chemo-resistance and concomitant carcinomatosis peritoneii. Cytoreductive surgery for KT provides symptom control and confers survival benefit in selected patients.

Creation of chimeric human/rabbit APOBEC1 with HIV-1 restriction and DNA mutation activities.

APOBEC1 (A1) proteins from lagomorphs and rodents have deaminase-dependent restriction activity against HIV-1, whereas human A1 exerts a negligible effect. To investigate these differences in the restriction of HIV-1 by A1 proteins, a series of chimeric proteins combining rabbit and human A1s was constructed. Homology models of the A1s indicated that their activities derive from functional domains that likely act in tandem through a dimeric interface. The C-terminal region containing the leucine-rich motif and the dimerization domains of rabbit A1 is important for its anti-HIV-1 activity. The A1 chimeras with strong anti-HIV-1 activity were incorporated into virions more efficiently than those without anti-HIV-1 activity, and exhibited potent DNA-mutator activity. Therefore, the C-terminal region of rabbit A1 is involved in both its packaging into the HIV-1 virion and its deamination activity against both viral cDNA and genomic RNA. This study identifies the novel molecular mechanism underlying the target specificity of A1.

Differential risks of cancer types in people with Parkinson's disease: a national record-linkage study.

BACKGROUND: There is evidence that people with Parkinson's disease (PD) have a decreased risk of developing cancer. PD has also variably been shown to be associated with an increased risk of cancers like melanoma and breast. We investigated this relationship in a very large cohort of PD patients. METHODS: We constructed two cohorts of people from an all-England record-linked hospital and mortality dataset spanning 1999-2011. One cohort comprised people with a record of PD; the other comprised people without a record of PD. We 'followed up' these two cohorts to determine observed and expected numbers of people with subsequent primary cancers in each, based on person-years at risk, and calculated standardised rate ratios (RRs). RESULTS: In 219,194 people with PD, the RR for all subsequent primary malignant cancers combined was 0.92 (95% confidence interval (CI) 0.91-0.93). Increased RRs (p<0.05) were found for six out of the 31 cancer types investigated, including breast, melanoma, uterus, kidney, and neurological malignancies. Decreased RRs were found for 11 cancer sites, including lung and colon cancer. CONCLUSIONS: We corroborate the findings of a reduced risk for the development of cancers in PD patients shown in smaller studies, including cancers associated and not known to be associated with smoking; and of an increased risk of melanoma and breast cancer. To the best of our knowledge, this is the first study to report an association between PD and elevated rates of uterine and renal cancer. Further work is warranted to understand the mechanisms behind these findings.