Prospective Multicenter Diagnostic Performance of Technologist-Performed Screening Breast Ultrasound After Tomosynthesis in Women With Dense Breasts (the DBTUST).

PURPOSE: To assess diagnostic performance of digital breast tomosynthesis (DBT) alone or combined with technologist-performed handheld screening ultrasound (US) in women with dense breasts. METHODS: In an institutional review board-approved, Health Insurance Portability and Accountability Act-compliant multicenter protocol in western Pennsylvania, 6,179 women consented to three rounds of annual screening, interpreted by two radiologist observers, and had appropriate follow-up. Primary analysis was based on first observer results. RESULTS: Mean participant age was 54.8 years (range, 40-75 years). Across 17,552 screens, there were 126 cancer events in 125 women (7.2/1,000; 95% CI, 5.9 to 8.4). In year 1, DBT-alone cancer yield was 5.0/1,000, and of DBT+US, 6.3/1,000, difference 1.3/1,000 (95% CI, 0.3 to 2.1; P = .005). In years 2 + 3, DBT cancer yield was 4.9/1,000, and of DBT+US, 5.9/1,000, difference 1.0/1,000 (95% CI, 0.4 to 1.5; P < .001). False-positive rate increased from 7.0% for DBT in year 1 to 11.5% for DBT+US and from 5.9% for DBT in year 2 + 3 to 9.7% for DBT+US (P < .001 for both). Nine cancers were seen only by double reading DBT and one by double reading US. Ten interval cancers (0.6/1,000 [95% CI, 0.2 to 0.9]) were identified. Despite reduction in specificity, addition of US improved receiver operating characteristic curves, with area under receiver operating characteristic curve increasing from 0.83 for DBT alone to 0.92 for DBT+US in year 1 (P = .01), with smaller improvements in subsequent years. Of 6,179 women, across all 3 years, 172/6,179 (2.8%) unique women had a false-positive biopsy because of DBT as did another 230/6,179 (3.7%) women because of US (P < .001). CONCLUSION: Overall added cancer detection rate of US screening after DBT was modest at 19/17,552 (1.1/1,000; CI, 0.5- to 1.6) screens but potentially overcomes substantial increases in false-positive recalls and benign biopsies.

Behavioral and physiological responses to instability in group membership in wild male woolly monkeys (Lagothrix lagotricha poeppigii).

In group-living species, integrating into a new social group after dispersal is an important life history milestone associated with physical and social challenges. Generally, this process seems to be accompanied by heightened glucocorticoid (GC) concentrations; however, most studies of physiological responses to group transfer have been conducted on species with despotic social relationships, where integrating individuals are often targets of frequent aggression. Here we present data on fecal glucocorticoid (fGC) concentrations during periods of unstable group membership for male woolly monkeys (Lagothrix lagotricha poeppigii), a species with extremely low rates of male-male aggression and generally tolerant male-male associations. We collected data on males in four study groups at the Tiputini Biodiversity Station, Ecuador, and observed three attempted transfer events, involving a total of four adult males, in one study group. We observed only three instances of overt aggression (chases) between males across the entire study period, though male display behaviors were more frequent. We tested whether rates of displays were higher during periods of unstable group membership using a generalized linear mixed model (LMM). We also examined whether male status, group stability, and the occurrence of intergroup encounters affected fGC concentrations using LMMs. Contrary to our predictions, rates of display behaviors were not higher during periods of unstable group membership. However, both transient/integrating males and those who were already group members showed elevated fGC concentrations during these unstable periods. Our results suggest that even in species with tolerant male-male relationships, the integration of unfamiliar individuals can provoke an increase in GCs.

Preserving the organ donor pool and suprahepatic vena cava: Case series of transverse hepatectomy for polycystic liver disease.

Management of symptomatic polycystic liver disease (PLD) has remained primarily unchanged since the early 20th century when multiple case reports described management of non-parasitic liver cysts. In 1968, Lin et al. described the fenestration procedure, "aspiration of the cysts, incision, partial excision with or without external drainage, or marsupilization and anastomosis to the gastrointestinal tract". Further surgical options have included cyst sclerotherapy, laparoscopic cyst aspiration, partial hepatectomy, and orthotopic liver transplant (OLT). Recently there has been discussion of medical management with somatostatin analogs to reduce hepatomegaly in PLD with varying success. There is no current consensus on treatment or standard of care for symptomatic PLD, it is largely up to surgeon preference and ability; however, there has been a movement toward early OLT with Model for End-Stage Liver Disease (MELD) score exception points. This case series reviews two female patients with normal renal and hepatic function with symptomatic PLD treated with transverse hepatectomy. We propose that patients suffering from symptomatic PLD, with retained renal and hepatic function, can be treated with transverse hepatectomy conserving limited donor livers for decompensated patients; moreover, transverse hepatectomy does not disrupt the major suprahepatic vena cava preserving potential surgical access for future OLT.

Children's Cognitive and Affective Responses About a Narrative Versus a Non-Narrative Cartoon Designed for an Active Videogame.

OBJECTIVE: This article presents the results of interviews conducted with children regarding their cognitive and affective responses toward a narrative and a non-narrative cartoon. The findings will be used to further explore the role of a narrative in motivating continued active videogame play. MATERIALS AND METHODS: Twenty children (8-11 years old of mixed gender) watched two cartoons (narrative and non-narrative) and were subsequently interviewed. A thematic matrix was used to analyze the interviews. RESULTS: The narrative cartoon (n = 11) was only slightly preferred compared with the non-narrative one (n = 9), with little difference among the participants. The theme categories identified during the analyses were plot, characters, and suggestions. The fight scenes were mentioned by the children as a likeable aspect of the narrative cartoon. In the non-narrative cartoon, the vast majority (n = 17) liked the information about physical activity that was provided. The children enjoyed the appearance and personalities of the characters in both cartoons. A discrepancy in the data about the fight scenes (narrative cartoon) and characters (both cartoons) was found among the female participants (i.e., some girls did not like the fight and thought the characters were too aggressive). However, most of the children wanted to see more action in the story, an increase in the number of fight scenes (narrative cartoon), or more information about exercise and examples of exercises they could do (non-narrative cartoon). They also suggested adding a game to the non-narrative cartoon, including more characters, and improving the animation in both cartoons. CONCLUSIONS: The children preferred the narrative cartoon because of the story and the fight. Some gender differences were found, which further studies should investigate.