The association of age at menarche and adult height with mammographic density in the International Consortium of Mammographic Density.

BACKGROUND: Early age at menarche and tall stature are associated with increased breast cancer risk. We examined whether these associations were also positively associated with mammographic density, a strong marker of breast cancer risk. METHODS: Participants were 10,681 breast-cancer-free women from 22 countries in the International Consortium of Mammographic Density, each with centrally assessed mammographic density and a common set of epidemiologic data. Study periods for the 27 studies ranged from 1987 to 2014. Multi-level linear regression models estimated changes in square-root per cent density (√PD) and dense area (√DA) associated with age at menarche and adult height in pooled analyses and population-specific meta-analyses. Models were adjusted for age at mammogram, body mass index, menopausal status, hormone therapy use, mammography view and type, mammographic density assessor, parity and height/age at menarche. RESULTS: In pooled analyses, later age at menarche was associated with higher per cent density (ß√PD = 0.023 SE = 0.008, P = 0.003) and larger dense area (ß√DA = 0.032 SE = 0.010, P = 0.002). Taller women had larger dense area (ß√DA = 0.069 SE = 0.028, P = 0.012) and higher per cent density (ß√PD = 0.044, SE = 0.023, P = 0.054), although the observed effect on per cent density depended upon the adjustment used for body size. Similar overall effect estimates were observed in meta-analyses across population groups. CONCLUSIONS: In one of the largest international studies to date, later age at menarche was positively associated with mammographic density. This is in contrast to its association with breast cancer risk, providing little evidence of mediation. Increased height was also positively associated with mammographic density, particularly dense area. These results suggest a complex relationship between growth and development, mammographic density and breast cancer risk. Future studies should evaluate the potential mediation of the breast cancer effects of taller stature through absolute breast density.

The Relationship between Anthropometric Indices and Breast Cancer in Central Iran.

Background: Anthropometric indices have a debatable relationship with breast cancer (BC) among different ethnicity. In the current study, we have evaluated the relationship between anthropometric indices and BC in Iranian participants. Methods: Between 2012 and 2014, a total of 7,805 women were enrolled from different mammography centers in Isfahan province, Iran. For each participant, a detailed questionnaire was filled out and anthropometric indices were measured by trained technicians. We used logistic regression models to estimate odds ratios (OR) and 95% confidence interval (CI) for BC risk associated with anthropometry measurements, stratified on menopausal status. Results: In the postmenopausal group, weight ≥68 kg compared to weight <61.75 kg was associated with decreased risk of BC (OR = 0.78; 95% CI: 0.63-0.97). Postmenopausal women with Waist-Hip Ratio (WHR) ≥ 0.85 compared to WHR < 0.77 were at increased risk of BC (OR = 1.36; 95% CI: 1.07-1.73). Both premenopausal and postmenopausal women had a decreased risk of BC with higher Obesity Index (OI) and Relative Weight. Conclusion: Ethnicity appears to play an important role in the discrepancies between results of different studies about the correlation of anthropometric features with BC.

Active Surveillance Versus Nephron-Sparing Surgery for a Bosniak IIF or III Renal Cyst: A Cost-Effectiveness Analysis.

OBJECTIVE: The objective of our study was to evaluate the cost-effectiveness of active surveillance (AS) versus nephron-sparing surgery (NSS) in patients with a Bosniak IIF or III renal cyst. MATERIALS AND METHODS: Markov models were developed to estimate life expectancy and lifetime costs for 60-year-old patients with a Bosniak IIF or III renal cyst (the reference cases) managed by AS versus NSS. The models incorporated the malignancy rates, reclassification rates during follow-up, treatment effectiveness, complications and costs, and short- and long-term outcomes. An incremental cost-effectiveness analysis was performed to identify management preference under an assumed $75,000 per quality-adjusted life-year (QALY) societal willingness-to-pay threshold, using data from studies in the literature and the 2015 Medicare Physician Fee Schedule. The effects of key parameters were addressed in a multiway sensitivity analysis. RESULTS: The prevalence of malignancy for Bosniak IIF and III renal cysts was 26% (25/96) and 52% (542/1046). Under base case assumptions for Bosniak IIF cysts, the incremental cost-effectiveness ratio of NSS relative to AS was $731,309 per QALY for women, exceeding the assumed societal willingness-to-pay threshold, and AS outperformed NSS for both life expectancy and cost for men. For Bosniak III cysts, AS yielded greater life expectancy (24.8 and 19.4 more days) and lower lifetime costs (cost difference of $12,128 and $11,901) than NSS for men and women, indicating dominance of AS over NSS. Superiority of AS held true in sensitivity analyses for men 46 years old or older and women 57 years old or older even when all parameters were set to favor NSS. CONCLUSION: AS is more cost-effective than NSS for patients with a Bosniak IIF or III renal cyst.

Mammographic density and ageing: A collaborative pooled analysis of cross-sectional data from 22 countries worldwide.

BACKGROUND: Mammographic density (MD) is one of the strongest breast cancer risk factors. Its age-related characteristics have been studied in women in western countries, but whether these associations apply to women worldwide is not known. METHODS AND FINDINGS: We examined cross-sectional differences in MD by age and menopausal status in over 11,000 breast-cancer-free women aged 35-85 years, from 40 ethnicity- and location-specific population groups across 22 countries in the International Consortium on Mammographic Density (ICMD). MD was read centrally using a quantitative method (Cumulus) and its square-root metrics were analysed using meta-analysis of group-level estimates and linear regression models of pooled data, adjusted for body mass index, reproductive factors, mammogram view, image type, and reader. In all, 4,534 women were premenopausal, and 6,481 postmenopausal, at the time of mammography. A large age-adjusted difference in percent MD (PD) between post- and premenopausal women was apparent (-0.46 cm [95% CI: -0.53, -0.39]) and appeared greater in women with lower breast cancer risk profiles; variation across population groups due to heterogeneity (I2) was 16.5%. Among premenopausal women, the √PD difference per 10-year increase in age was -0.24 cm (95% CI: -0.34, -0.14; I2 = 30%), reflecting a compositional change (lower dense area and higher non-dense area, with no difference in breast area). In postmenopausal women, the corresponding difference in √PD (-0.38 cm [95% CI: -0.44, -0.33]; I2 = 30%) was additionally driven by increasing breast area. The study is limited by different mammography systems and its cross-sectional rather than longitudinal nature. CONCLUSIONS: Declines in MD with increasing age are present premenopausally, continue postmenopausally, and are most pronounced over the menopausal transition. These effects were highly consistent across diverse groups of women worldwide, suggesting that they result from an intrinsic biological, likely hormonal, mechanism common to women. If cumulative breast density is a key determinant of breast cancer risk, younger ages may be the more critical periods for lifestyle modifications aimed at breast density and breast cancer risk reduction.

Liver Surface Nodularity Score Allows Prediction of Cirrhosis Decompensation and Death.

Purpose To determine whether use of the liver surface nodularity (LSN) score, a quantitative biomarker derived from routine computed tomographic (CT) images, allows prediction of cirrhosis decompensation and death. Materials and Methods For this institutional review board-approved HIPAA-compliant retrospective study, adult patients with cirrhosis and Model for End-Stage Liver Disease (MELD) score within 3 months of initial liver CT imaging between January 3, 2006, and May 30, 2012, were identified from electronic medical records (n = 830). The LSN score was measured by using CT images and quantitative software. Competing risk regression was used to determine the association of the LSN score with hepatic decompensation and overall survival. A risk model combining LSN scores (<3 or ≥3) and MELD scores (<10 or ≥10) was created for predicting liver-related events. Results In patients with compensated cirrhosis, 40% (129 of 326) experienced decompensation during a median follow-up period of 4.22 years. After adjustment for competing risks including MELD score, LSN score (hazard ratio, 1.38; 95% confidence interval: 1.06, 1.79) was found to be independently predictive of hepatic decompensation. Median times to decompensation of patients at high (1.76 years, n = 48), intermediate (3.79 years, n = 126), and low (6.14 years, n = 152) risk of hepatic decompensation were significantly different (P < .001). Among the full cohort with compensated or decompensated cirrhosis, 61% (504 of 830) died during the median follow-up period of 2.26 years. After adjustment for competing risks, LSN score (hazard ratio, 1.22; 95% confidence interval: 1.11, 1.33) and MELD score (hazard ratio, 1.08; 95% confidence interval: 1.06, 1.11) were found to be independent predictors of death. Median times to death of patients at high (0.94 years, n = 315), intermediate (2.79 years, n = 312), and low (4.69 years, n = 203) risk were significantly different (P < .001). Conclusion The LSN score derived from routine CT images allows prediction of cirrhosis decompensation and death. ©RSNA, 2016 Online supplemental material is available for this article.

Mammographic density assessed on paired raw and processed digital images and on paired screen-film and digital images across three mammography systems.

BACKGROUND: Inter-women and intra-women comparisons of mammographic density (MD) are needed in research, clinical and screening applications; however, MD measurements are influenced by mammography modality (screen film/digital) and digital image format (raw/processed). We aimed to examine differences in MD assessed on these image types. METHODS: We obtained 1294 pairs of images saved in both raw and processed formats from Hologic and General Electric (GE) direct digital systems and a Fuji computed radiography (CR) system, and 128 screen-film and processed CR-digital pairs from consecutive screening rounds. Four readers performed Cumulus-based MD measurements (n = 3441), with each image pair read by the same reader. Multi-level models of square-root percent MD were fitted, with a random intercept for woman, to estimate processed-raw MD differences. RESULTS: Breast area did not differ in processed images compared with that in raw images, but the percent MD was higher, due to a larger dense area (median 28.5 and 25.4 cm2 respectively, mean √dense area difference 0.44 cm (95% CI: 0.36, 0.52)). This difference in √dense area was significant for direct digital systems (Hologic 0.50 cm (95% CI: 0.39, 0.61), GE 0.56 cm (95% CI: 0.42, 0.69)) but not for Fuji CR (0.06 cm (95% CI: -0.10, 0.23)). Additionally, within each system, reader-specific differences varied in magnitude and direction (p < 0.001). Conversion equations revealed differences converged to zero with increasing dense area. MD differences between screen-film and processed digital on the subsequent screening round were consistent with expected time-related MD declines. CONCLUSIONS: MD was slightly higher when measured on processed than on raw direct digital mammograms. Comparisons of MD on these image formats should ideally control for this non-constant and reader-specific difference.

Vascular Tumor Burden as a New Quantitative CT Biomarker for Predicting Metastatic RCC Response to Antiangiogenic Therapy.

Purpose To quantify initial changes in the vascular tumor burden (VTB), a measure of the area of vascularized tumor on computed tomographic (CT) images, and predict tumor response to antiangiogenic therapy in patients with metastatic renal cell carcinoma (RCC). Materials and Methods For this institutional review board-approved HIPAA-compliant secondary analysis of a prospective phase III trial, adult patients with digital CT images and metastatic clear-cell RCC treated with sunitinib were included (n = 275). Target lesions were selected by using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 guidelines, and the CT images obtained after one cycle of sunitinib therapy were evaluated in comparison with baseline images. Tumor-response software was created to quantify tumor metrics (length, area, VTB, and mean attenuation) and automate response assessment. Progression-free survival (PFS) in responders and nonresponders according to VTB criteria was compared by using the Cox proportional hazard ratio (HR). The intraclass correlation coefficient (ICC) was used to assess interobserver agreement among three readers evaluating 28 randomly selected patients. Results VTB criteria nonresponders (n = 120) according to the initial posttherapy CT study were 5.7 times more likely to experience progression of disease (HR = 5.70; 95% confidence interval [CI]: 4.07, 7.97; P < .001) than responders (n = 155). There was not a statistically significant difference in PFS between RECIST nonresponders (n = 255) and responders (n = 20; HR = 1.54; 95% CI: 0.85, 2.77; P = .148). In a patient-level analysis, interobserver agreement was very good for assessing percentage change in length, area, and VTB (ICC = 0.82 [95% CI: 0.67, 0.91], 0.89 [95% CI: 0.79, 0.94], and 0.88 [95% CI: 0.79, 0.94], respectively) but was very poor for assessing percentage change in mean attenuation (ICC = 0.17 [95% CI: -0.05, 0.45]). Conclusion A quantitative CT imaging biomarker designed to measure initial changes in the VTB separated patients into responders and nonresponders, each with significantly different PFS, and showed very good interobserver agreement in patients with metastatic RCC treated with sunitinib. © RSNA, 2016 Online supplemental material is available for this article.

The transtheoretical model, health belief model, and breast cancer screening among Iranian women with a family history of breast cancer.

BACKGROUND: Participation of Iranian women with a family history of breast cancer in breast cancer screening programs is low. This study evaluates the compliance of women having a family history of breast cancer with clinical breast exam (CBE) according to the stage of transtheoretical model (TTM) and health belief model (HBM). MATERIALS AND METHODS: In this cross-sectional study, we used Persian version of champion's HBM scale to collect factors associated with TTM stages applied to screening from women over 20 years and older. The obtained data were analyzed by SPSS, using descriptive statistics, Chi-square test, independent t-test, and analysis of covariance. RESULTS: Final sample size was 162 women. Thirty-three percent were in action/maintenance stage. Older women, family history of breast cancer in first-degree relatives, personal history of breast disease, insurance coverage, and a history of breast self-examination were associated with action/maintenance stage. Furthermore, women in action/maintenance stages had significantly fewer perceived barriers in terms of CBE in comparison to women in other stages (P < 0.05). There was no significant difference in other HBM subscales scores between various stages of CBE screening behavior (P > 0.05). CONCLUSION: The finding indicates that the rate of women in action/maintenance stage of CBE is low. Moreover, results show a strong association between perceived barriers and having a regular CBE. These clarify the necessity of promoting national target programs for breast cancer screening, which should be considered as the first preference for reducing CBE barriers.

Evaluation of different aspects of power Doppler sonography in differentiating and prognostication of breast masses.

BACKGROUND: We conducted our study on 1110 patients with breast masses in order to investigate different aspects of power Doppler sonography (PDS) for differentiating between benign and malignant breast lesions and their prognostication. MATERIALS AND METHODS: This study was conducted on the women who were referred to the sonography units of University Hospitals for breast sonography and had a BIRADS-3 mass or higher in gray scale sonography. Then, PDS was performed for all the patients. Vascularization, number of vessels, resistance index (RI), pulsatility index (PI), and vascularization patterns were evaluated for all the lesions. We compared our radiologic findings concerning different histopathologic and hormonal aspects of the lesions. RESULTS: The differences between mean vascular density in malignant lesions concerning size of the tumor, histological grade, stage, and hormone receptor status were statistically significant. Although, there was an overlap between benign and malignant values. A resistive index (RI) value higher than 0.83 as a sign for malignancy had sensitivity equal to 75% and specificity equal to 97% (P = 0.04 and 0.03, respectively). A PI value higher than 1.6 has a sensitivity and specificity value of 70% and 98%, respectively, as a malignancy sign (P = 0.02 and 0.04, respectively). CONCLUSION: It seems that while malignant tumors have significantly higher number of vessels in comparison to benign one, since the number of vessels overlap between benign and malignant tumors, this aspect has little clinical usefulness in distinguishing or prognostication of breast masses. In contrast RI, PI, and vascularization pattern have an ability to differentiate and predict the prognosis of breast lesions.

Partial frequency of radiation pneumonitis and its association with the energy and treatment technique in patients with breast cancer, Isfahan, Iran.

BACKGROUND: Breast cancer is the most common type of cancer among women, and the second cause of cancer mortality after pulmonary cancer in this gender. Radiotherapy is one of the major treatments, which locally controls the disease and prohibits in recurrency. Radiation pneumonitis is one of the radiotherapy complications, which usually occurs within 1.5-3 months after radiotherapy. As there is no precise estimation concerning this complication in Isfahan, partial frequency of radiation pneumonitis and its association with the energy and treatment technique in patients with breast cancer were evaluated. MATERIALS AND METHODS: This was an analytic cross-sectional study performed in 2010 in university referral center. A total of 382 patients with breast cancer, undergone surgery and referred for radiotherapy entered the study. A posterior and anterior and lateral X-Rays were taken as control images before starting radiotherapy and all X-Rays were repeated after 3-4 months post radiotherapy. The occurrence of radiotherapy pneumonitis was evaluated by the same radiologist. Data were analyzed through SPSS version 20. RESULTS: Out of 382 patients undergone breast conservative surgery (BCS) or modified radical mastectomy (MRM), and radiotherapy, 60 patients had pneumonitis of whom 6 patients underwent BCS and were treated by tangential field (three cases by Co 60 and three cases by PH 9). The rest of radiotherapy pneumonitis patients (n = 54) underwent MRM of whom, 42 cases were treated by one-field and 12 by two-field treatment techniques. CONCLUSION: Incidence of radiotherapy pneumonitis was different with respect to the adopted technique (one-field, two-field and tangential) (P = 0.023), with the highest association with two-field radiotherapy.

The Intersection of Radiology With Blockchain and Smart Contracts: A Perspective.

INTRODUCTION: Although blockchain technology and smart contracts are garnering attention in various sectors, their applications and familiarity within the realm of radiology remain largely unexplored. Blockchain, a decentralized digital ledger technology, offers secure, transparent, and resilient data management by distributing the verification process across a network of independent entities. This decentralized technology presents a possible solution for a range of healthcare challenges, from secure data transfer to automated verification processes. To address such challenges in the context of medical imaging, blockchain could provide different approaches, including smart contracts, machine learning algorithms, and the secure dissemination of large files among key stakeholders such as patients, healthcare providers, and institutions. This manuscript aims to explore the current attitudes and perspectives of trainees and radiologists to the utilization of blockchain technology and smart contracts in clinical radiology. Additionally, the study provides an in-depth analysis of the potential applications for incorporating blockchain into radiology. METHODS: After obtaining The George Washington University Committee on Human Research Institutional Review Board (IRB) approval, we conducted a 10-question survey among radiologists and trainees at several institutions and private practices. Surveys were created via the Google Forms application and were emailed to potential participants. Participants were asked about their current academic level (medical student, resident/fellow, academic radiologist, private practice radiologist, others), their knowledge level about the field of imaging informatics and blockchain and smart contract technologies, their level of interest in learning more about blockchain and smart contracts, and their opinion about possible applications of blockchain and smart contract in the future of medical imaging. RESULTS: A total of 118 survey requests were distributed; 83 were returned, reflecting a 70.3% overall response rate. Of these, 19 were sent to private practices with a 15.8% response rate (3/19), and 99 to academic centers, yielding an 80.8% response rate (80/99). The survey respondents demonstrated a strong interest and need to further understand these technologies among radiologists and trainees. This study focuses on key components of this technology as it relates to healthcare and the practice of radiology, including data storage, patient care, secure communication, and automation, as well as strengths, weaknesses, opportunities, and threats (SWOT) analysis. DISCUSSION: To our knowledge, this is the first study to investigate and establish a baseline for the current perspectives on the application of blockchain technology and smart contracts in clinical radiology amongst trainees and radiologists across academic and private settings. Incorporating blockchain and smart contracts technologies into the field of radiology has the potential to achieve greater efficiency, security, and patient empowerment. However, the adoption of this technology comes with challenges, such as infrastructure, interoperability, scalability, and regulatory compliance. Collaboration between radiologists, hospital administration, policymakers, technology developers, and patient advocacy organizations will help guide and advance our understanding of the potential applications of blockchain and smart contracts in radiology and healthcare.

COVID-19-associated encephalopathy with fulminant cerebral vasoconstriction: CT and MRI findings.

Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) can cause various mild to severe neurologic symptoms, leading to significant morbidity and mortality. We hereby present a fatal case of a 50-year-old male health care provider, admitted due to altered mental status due to encephalopathy, cerebral edema, and fulminant cerebral vasoconstriction caused by SARS-Cov-2. Our case highlights the importance of considering SARS-Cov-2 infection in the differential diagnosis for patients with unexplained central nervous system dysfunction and cerebral edema to prevent delayed diagnosis and render rapid treatment.

Pre-treatment partial-volume-corrected TLG is the best predictor of overall survival in patients with relapsing/refractory non-hodgkin lymphoma following radioimmunotherapy.

The role of fluorodeoxyglucose-positron emission tomography (FDG-PET) has been well established in assessment of lymphoma, including non-Hodgkin lymphoma (NHL). The aim of this study was to compare changes and survival predictive values of various quantification parameters of FDG-PET/CT in patients with relapsing/refractory lymphoma before and after radioimmunotherapy (RIT). Data from 17 patients with relapsing/refractory NHL, treated with targeted RIT after chemotherapy/radiotherapy, were retrospectively collected. FDG-PET/CT scans were performed approximately three months before and six months after RIT. An adaptive contrast-oriented thresholding algorithm was used to segment lesions on the FDG-PET images. Wilcoxon signed-rank tests were used to assess changes in SUVmax, SUVmean, partial volume-corrected SUVmean (pvcSUVmean), total lesion glycolysis (TLG), and pvcTLG before and after treatment. The patients were followed up after completing RIT for up to 10 years. Kaplan-Meier and Cox regression analyses evaluated the association between the quantification parameters and survival data. In the survived group, the decrease in mean percentage of change for TLG and pvcTLG was greater than SUVmax, SUVmean and pvcSUVmean [TLG: 253.9 to 106.9, -81.4%; P = 0.052 and pvcTLG: 368.9 to 153.3, -58.4%; P = 0.04]. In addition, overall survival (OS) was shorter in patients with pre-RIT pvcTLG more than 644 compared to those below this value (log-rank P < 0.01). In univariate Cox regression for OS, a higher baseline pvcTLG was a significant prognostic factor (HR: 6.8, P = 0.02). Our results showed that pre-treatment pvcTLG was the best predictor of OS in patients with relapsing/refractory NHL following RIT.

Precision analysis of a quantitative CT liver surface nodularity score.

PURPOSE: To evaluate precision of a software-based liver surface nodularity (LSN) score derived from CT images. METHODS: An anthropomorphic CT phantom was constructed with simulated liver containing smooth and nodular segments at the surface and simulated visceral and subcutaneous fat components. The phantom was scanned multiple times on a single CT scanner with adjustment of image acquisition and reconstruction parameters (N = 34) and on 22 different CT scanners from 4 manufacturers at 12 imaging centers. LSN scores were obtained using a software-based method. Repeatability and reproducibility were evaluated by intraclass correlation (ICC) and coefficient of variation. Using abdominal CT images from 68 patients with various stages of chronic liver disease, inter-observer agreement and test-retest repeatability among 12 readers assessing LSN by software- vs. visual-based scoring methods were evaluated by ICC. RESULTS: There was excellent repeatability of LSN scores (ICC:0.79-0.99) using the CT phantom and routine image acquisition and reconstruction parameters (kVp 100-140, mA 200-400, and auto-mA, section thickness 1.25-5.0 mm, field of view 35-50 cm, and smooth or standard kernels). There was excellent reproducibility (smooth ICC: 0.97; 95% CI 0.95, 0.99; CV: 7%; nodular ICC: 0.94; 95% CI 0.89, 0.97; CV: 8%) for LSN scores derived from CT images from 22 different scanners. Inter-observer agreement for the software-based LSN scoring method was excellent (ICC: 0.84; 95% CI 0.79, 0.88; CV: 28%) vs. good for the visual-based method (ICC: 0.61; 95% CI 0.51, 0.69; CV: 43%). Test-retest repeatability for the software-based LSN scoring method was excellent (ICC: 0.82; 95% CI 0.79, 0.84; CV: 12%). CONCLUSION: The software-based LSN score is a quantitative CT imaging biomarker with excellent repeatability, reproducibility, inter-observer agreement, and test-retest repeatability.

Disparities in HIV Clinical Outcomes among a Cohort of HIV-Infected Persons Receiving Care-Mississippi.

Increasing patients' cluster of differentiation 4 (CD4) count and achieving viral suppression are the ultimate goals of the human immunodeficiency virus (HIV) care and treatment, yet disparities in these HIV clinical outcomes exist among subpopulations of HIV-infected persons. We aimed to assess potential disparities in viral suppression and normal CD4 count among HIV-infected persons receiving care in Mississippi using Mississippi Medical Monitoring Project (MMP) data from 2009 to 2014 (N = 1233) in this study. Outcome variables in this study were suppressed, recent and durable viral load, and normal CD4 count. Patients' characteristics in this study were race, gender, age, annual income, education, insurance, and length of diagnosis. Descriptive statistics, Chi square tests, and logistic regression analyses were conducted using the SAS 9.4 Proc Survey procedure. Our findings indicate that those aged 50 years or older were more likely to have suppressed recent viral load (adjusted Odds Ratio (aOR) = 2.4) and durable viral loads (aOR = 2.9), compared to those aged 18-24 years. In addition, women were more likely to have a normal CD4 count than men (aOR = 1.4). In conclusion, we found that age and gender disparities in HIV clinical outcomes may be used to develop and implement multifaceted interventions to improve health equity among all HIV-infected patients.

Otitis Media with Effusion in Children and the Impact of Risk Factors on Serum Cytokine Levels.

INTRODUCTION: To evaluate the role of allergic-type and infectious-type cytokines in children with chronic otitis media with effusion (OME). MATERIALS AND METHODS: We investigated serum levels of interleukins (IL)-4, IL-5, and IL-13, along with interferon-gamma (IFN-γ) and tumor necrosis factor-alpha (TNF-α), by enzyme-linked immunosorbent assay (ELISA) in 35 children with OME and 28 healthy controls. RESULTS: Children with OME had significantly higher levels of IL-5 in comparison with the control group, ranging from 1 pg/ml in cases to 0.04 pg/ml in controls (P=0.009). However, after adjusting for confounding variables, there was no significant difference in serum levels of IL-13, IL-4, IFN-γ, or TNF-α between the two groups (P=0.287, P=0.627, P=0.793, and P=0.217, respectively). CONCLUSIONS: The findings of this study suggest that in comparison with the control group, serum IL-5 levels were elevated in OME cases.

Comparative Effectiveness of Tumor Response Assessment Methods: Standard of Care Versus Computer-Assisted Response Evaluation.

PURPOSE: To compare the effectiveness of metastatic tumor response evaluation with computed tomography using computer-assisted versus manual methods. MATERIALS AND METHODS: In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study, 11 readers from 10 different institutions independently categorized tumor response according to three different therapeutic response criteria by using paired baseline and initial post-therapy computed tomography studies from 20 randomly selected patients with metastatic renal cell carcinoma who were treated with sunitinib as part of a completed phase III multi-institutional study. Images were evaluated with a manual tumor response evaluation method (standard of care) and with computer-assisted response evaluation (CARE) that included stepwise guidance, interactive error identification and correction methods, automated tumor metric extraction, calculations, response categorization, and data and image archiving. A crossover design, patient randomization, and 2-week washout period were used to reduce recall bias. Comparative effectiveness metrics included error rate and mean patient evaluation time. RESULTS: The standard-of-care method, on average, was associated with one or more errors in 30.5% (6.1 of 20) of patients, whereas CARE had a 0.0% (0.0 of 20) error rate ( P < .001). The most common errors were related to data transfer and arithmetic calculation. In patients with errors, the median number of error types was 1 (range, 1 to 3). Mean patient evaluation time with CARE was twice as fast as the standard-of-care method (6.4 minutes v 13.1 minutes; P < .001). CONCLUSION: CARE reduced errors and time of evaluation, which indicated better overall effectiveness than manual tumor response evaluation methods that are the current standard of care.

Metastatic renal cell carcinoma imaging evaluation in the era of anti-angiogenic therapies.

During the last decade, the arsenal of anti-angiogenic (AAG) agents used to treat metastatic renal cell carcinoma (RCC) has grown and revolutionized the treatment of metastatic RCC, leading to improved overall survival compared to conventional chemotherapy and traditional immunotherapy agents. AAG agents include inhibitors of vascular endothelial growth factor receptor signaling pathways and mammalian target of rapamycin inhibitors. Both of these classes of targeted agents are considered cytostatic rather than cytotoxic, inducing tumor stabilization rather than marked tumor shrinkage. As a result, decreases in tumor size alone are often minimal and/or occur late in the course of successful AAG therapy, while tumor devascularization is a distinct feature of AAG therapy. In successful AAG therapy, tumor devascularization manifests on computed tomography images as a composite of a decrease in tumor size, a decrease in tumor attenuation, and the development of tumor necrosis. In this article, we review Response Evaluation Criteria in Solid Tumors (RECIST)-the current standard of care for tumor treatment response assessment which is based merely on changes in tumor length-and its assessment of metastatic RCC tumor response in the era of AAG therapies. We then review the features of an ideal tumor imaging biomarker for predicting metastatic RCC response to a particular AAG agent and serving as a longitudinal tumor response assessment tool. Finally, a discussion of the more recently proposed imaging response criteria and new imaging trends in metastatic RCC response assessment will be reviewed.

International Consortium on Mammographic Density: Methodology and population diversity captured across 22 countries.

Mammographic density (MD) is a quantitative trait, measurable in all women, and is among the strongest markers of breast cancer risk. The population-based epidemiology of MD has revealed genetic, lifestyle and societal/environmental determinants, but studies have largely been conducted in women with similar westernized lifestyles living in countries with high breast cancer incidence rates. To benefit from the heterogeneity in risk factors and their combinations worldwide, we created an International Consortium on Mammographic Density (ICMD) to pool individual-level epidemiological and MD data from general population studies worldwide. ICMD aims to characterize determinants of MD more precisely, and to evaluate whether they are consistent across populations worldwide. We included 11755 women, from 27 studies in 22 countries, on whom individual-level risk factor data were pooled and original mammographic images were re-read for ICMD to obtain standardized comparable MD data. In the present article, we present (i) the rationale for this consortium; (ii) characteristics of the studies and women included; and (iii) study methodology to obtain comparable MD data from original re-read films. We also highlight the risk factor heterogeneity captured by such an effort and, thus, the unique insight the pooled study promises to offer through wider exposure ranges, different confounding structures and enhanced power for sub-group analyses.