Efficacy of endovascular embolization versus microsurgical clamping in the treatment of intracranial aneurysms: a meta-analysis.

Intracranial aneurysms (IA) can induce increased intracranial pressure, headache, and the development of nausea and vomiting if not treated in time, and failure to receive timely diagnosis and treatment can lead to disability or death. However, the efficacy and prognostic value of craniotomy and endovascular embolization in patients with IA remains a controversial topic. This meta-analysis systematically evaluated the efficacy of endovascular coiling versus cranial aneurysm clamping on the immediate postoperative outcome and prognosis of patients with IA. PubMed, EMBASE, and the Cochrane Library databases were searched for retrieval of relevant references. Literature was screened according to pre-defined inclusion and exclusion criteria, and data were extracted and assessed for quality. A total of 10 studies, including 2,654 cases, were included in the analysis. Among them, 1,313 cases underwent craniotomy clipping surgery (clip group), and 1,341 cases underwent endovascular coiling (coil group). The quality of the studies in 8 articles evaluated using the Newcastle-Ottawa Scale (NOS) was ≥6. Meta-analysis was conducted using Rev Man 5.3 and Stata 17 software. The results of meta-analysis showed that no significant difference in complete occlusion rate [OR=1.76, 95% CI (0.78, 3.96), P=0.17] when comparing the clip and coil group. Compared to the clip group, the coil group had a better clinical short-term outcome [OR=1.55, 95% CI (1.05, 2.27), P=0.03], but an increased rate of postoperative residual or recurrence [OR=0.40, 95% CI (0.17, 0.91), P=0.03]. In addition, there were no significance differences identified in terms of complications, including the rates of postoperative rebleeding [OR=1.60, 95% CI (0.97, 2.63), P=0.07], ischemic stroke [OR=1.12, 95% CI (0.45, 2.79), P=0.81], and cerebral vasospasm [OR=0.90, 95% CI (0.13, 6.03), P=0.91]. Subsequently, we conducted experimental sequence analysis for each indicator, and the results were consistent with the results of meta-analysis. According to the recent clinical prognosis, a funnel plot was constructed, showing significant asymmetry on both sides, indicating some publication bias. However, the results of Begg's test with P=0.734 and Egger's test with P=0.633 suggest no significant publication bias. In general, endovascular coiling and microsurgical clipping appear to be equally effective in achieving vascular occlusion. Endovascular coiling may be more effective in improving the short-term clinical outcomes for patients. However, this approach may increase the rate of postoperative residual issue or recurrence.

Comparing extracellular volume fraction with apparent diffusion coefficient for the characterization of breast tumors.

PURPOSE: To investigate the feasibility of dual-energy CT (DECT)-derived extracellular volume (ECV) fraction for characterization of breast tumors, compared to apparent diffusion coefficient (ADC) and validated against histopathological findings. MATERIAL AND METHODS: The ECV fraction and ADC were prospectively assessed in patients with breast tumors using chest DECT and breast MRI. The diagnostic performance of ECV fraction and ADC was accessed in predicting breast histopathological subtypes and pathological complete response (pCR) status. Histopathological sections were analyzed by digital image analysis. Pearson's correlation analysis was used to correlate between DECT and histopathological ECV fractions. RESULTS: This study included 271 patients, with 314 breast lesions (61 benign and 253 malignant). The ECV fraction and ADC showed comparable area under the curve (AUC) for distinguishing benign from malignant lesions (p = 0.123) and invasive carcinoma from ductal carcinoma in situ (p = 0.115). There were significant differences in ECV fraction between different hormone receptors and Ki67 states (p = 0.001 âˆ¼ 0.014), while ADC values only differed among various Ki67 states (p < 0.001). The ECV fraction was lower (p = 0.007), ADC was higher (p = 0.013) in pCR than in non-pCR group, with an AUC of 0.748 and 0.730 (p = 0.887), respectively. There was a positive correlation between DECT and histopathological ECV fractions (r = 0.615, p < 0.01). CONCLUSIONS: Routine chest DECT-derived ECV fraction is a viable quantitative imaging biomarker for predicting histopathological subtypes and pCR in patient with breast tumors, and correlated well with histopathology finding.

Early prediction of pathologic complete response of breast cancer after neoadjuvant chemotherapy using longitudinal ultrafast dynamic contrast-enhanced MRI.

PURPOSE: The purpose of this study was to evaluate the temporal trends of ultrafast dynamic contrast-enhanced (DCE)-MRI during neoadjuvant chemotherapy (NAC) and to investigate whether the changes in DCE-MRI parameters could early predict pathologic complete response (pCR) of breast cancer. MATERIALS AND METHODS: This longitudinal study prospectively recruited consecutive participants with breast cancer who underwent ultrafast DCE-MRI examinations before treatment and after two, four, and six NAC cycles between February 2021 and February 2022. Five ultrafast DCE-MRI parameters (maximum slope [MS], time-to-peak [TTP], time-to-enhancement [TTE], peak enhancement intensity [PEI], and initial area under the curve in 60 s [iAUC]) and tumor size were measured at each timepoint. The changes in parameters between each pair of adjacent timepoints were additionally measured and compared between the pCR and non-pCR groups. Longitudinal data were analyzed using generalized estimating equations. The performance for predicting pCR was assessed using area under the receiver operating characteristic curve (AUC). RESULTS: Sixty-seven women (mean age, 50 ± 8 [standard deviation] years; age range: 25-69 years) were included, 19 of whom achieved pCR. MS, PEI, iAUC, and tumor size decreased, while TTP increased during NAC (all P < 0.001). The AUC (0.92; 95% confidence interval [CI]: 0.83-0.97) of the model incorporating ultrafast DCE-MRI parameter change values (from timepoints 1 to 2) and clinicopathologic characteristics was greater than that of the clinical model (AUC, 0.79; 95% CI: 0.68-0.88) and ultrafast DCE-MRI parameter model at timepoint 2 when combined with clinicopathologic characteristics (AUC, 0.82; 95% CI: 0.71-0.90) (P = 0.01 and 0.02). CONCLUSION: Early changes in ultrafast DCE-MRI parameters after NAC combined with clinicopathologic characteristics could serve as predictive markers of pCR of breast cancer.

Multiple parameters from ultrafast dynamic contrast-enhanced magnetic resonance imaging to discriminate between benign and malignant breast lesions: Comparison with apparent diffusion coefficient.

PURPOSE: The purpose of this study was first to assess the diagnostic performance of ultrafast dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters compared to apparent diffusion coefficient (ADC) for distinguishing benign from malignant breast lesions and second to investigate the complementarity of ultrafast DCE-MRI with DWI in that task. MATERIALS AND METHODS: A total of 142 women (mean age, 48.42 ± 11.03 [SD]) years; range: 14-78 years) with 150 breast lesions who underwent breast ultrafast DCE-MRI were prospectively recruited. Ultrafast DCE-MRI semi-quantitative parameters (maximum slope [MS], time to peak [TTP], time to enhancement [TTE], and initial area under curve in 60 s [iAUC]), ultrafast DCE-MRI quantitative parameters (Kep, Ktrans, and Ve), and the ADC were estimated and compared between benign and malignant breast lesions. Classification performances were assessed using area under the receiver operating characteristic curve (AUC) and compared using Delong test. RESULTS: The ultrafast DCE-MRI semi-quantitative multiparameters (AUC, 0.913; 95% CI: 0.856-0.953) showed better classification performance than the quantitative multiparameters (AUC, 0.818; 95% CI: 0.747-0.876) (P = 0.022). No differences in AUC were found between ultrafast DCE-MRI semi-quantitative multiparameters and ADC (AUC, 0.912; 95% CI: 0.855-0.952) (P = 0.990). The combination of ultrafast DCE-MRI semi-quantitative multiparameters and ADC (AUC, 0.960; 95% CI: 0.915-0.985) showed better classification performance than the ultrafast DCE-MRI semi-quantitative multiparameters (P = 0.014) and quantitative multiparameters (P < 0.001). CONCLUSION: Ultrafast DCE-MRI can be used as an accurate method for discriminating benign from malignant breast lesions. The combination of ultrafast DCE-MRI and DWI significantly increases the diagnostic value of ultrafast DCE-MRI.

The Impact of Interactive Control in Budget Management on Innovation Performance of Enterprises: From the Perspective of Manager Role Stress.

This study aimed to study the influence of the interactive budget on enterprise innovation performance from the perspective of managerial psychology, and to examine the mediating effect of managers' stress and the moderating effect of environmental turbulence in this influence. The study collected 228 managers' data in the Yangtze River Delta region of China through online questionnaires; the structural equation model is constructed by IBM SPSS Amos 24.0, and the data is analyzed by Mplus 7.4 and IBM SPSS 23.0. The results showed that: (1) an interactive budget positively affects enterprise innovation performance; (2) the role stress of managers plays a partial mediating role in the relationship between an interactive budget and enterprise innovation performance; (3) environmental turbulence positively moderates the relationship between the interactive budget and enterprise innovation performance; and (4) the positive effect of the interactive budget on enterprise innovation performance is more significant in enterprises with a high proportion of female managers, and the negative effect on the role stress of managers is more significant in high-tech enterprises. In theory, the results enrich the research on the impact of an interactive budget on individual managers' psychology, and further reveals the "black box" of the impact of an interactive budget on enterprise innovation performance; in practice, the results make enterprises attach importance to the influence of control environments on the psychological health of managers, and provides a reference for enterprises to use control methods rationally to promote innovation in budget management.

XGBoost-based multiparameters from dual-energy computed tomography for the differentiation of multiple myeloma of the spine from vertebral osteolytic metastases.

OBJECTIVES: To evaluate the performance of extreme gradient boosting (XGBoost) combined with multiparameters from dual-energy computed tomography (mpDECT) to differentiate between multiple myeloma (MM) of the spine and vertebral osteolytic metastases (VOM). METHODS: For this retrospective study, 28 patients (83 lesions) with MM of the spine and 23 patients (54 lesions) with VOM who underwent DECT were included. The mpDECT for each lesion, including normalized effective atomic number, slope of the spectral Hounsfield unit curve, CT attenuation, and virtual noncalcium (VNCa), was obtained. Boruta was used to select the key parameters, and then subsequently merged with XGBoost to yield a prediction model. The lesions were divided into the training and testing group in a 3:1 ratio. The highest performance of the univariate analysis was compared with XGBoost using the Delong test. RESULTS: The mpDECT of MM was significantly lower than that of VOM (all p < 0.05). In univariate analysis, VNCa had the highest area under the receiver operating characteristic curve (AUC) in the training group (0.81) and testing group (0.87). Based on Boruta, 6 parameters of DECT were selected for XGBoost model construction. The XGBoost model achieved an excellent and stable diagnostic performance, as shown in the training group (AUC of 1.0) and testing group (AUC of 0.97), with a sensitivity of 80%, a specificity of 95%, and an accuracy of 88%, which was superior to VNCa (p < 0.05). CONCLUSIONS: XGBoost combined with mpDECT yielded promising performance in differentiating between MM of the spine and VOM. KEY POINTS: • The multiparameters obtained from dual-energy CT of multiple myeloma differed significantly from those of vertebral osteolytic metastases. • The virtual noncalcium offered the highest AUC in the univariate analysis to distinguish multiple myeloma from vertebral osteolytic metastases. • Extreme gradient boosting combined with multiparameters from dual-energy CT had a promising performance to distinguish multiple myeloma from vertebral osteolytic metastases.

N-myc downstream regulated gene 1 inhibition of tumor progression in Caco2 cells.

BACKGROUND: Invasion and migration are the irreversible stages of colorectal cancer (CRC). The key is to find a sensitive, reliable molecular marker that can predict the migration of CRC at an early stage. N-myc downstream regulated gene 1 (NDRG1) is a multifunctional gene that has been tentatively reported to have a strong relationship with tumor invasion and migration, however the current molecular role of NDRG1 in CRC remains unknown. AIM: To explore the role of NDRG1 in the development of CRC. METHODS: NDRG1 stably over-expressed Caco2 cell line was established by lentiviral infection and NDRG1 knock-out Caco2 cell line was established by CRISPR/Cas9. Furthermore, the mRNA and protein levels of NDRG1 in Caco2 cells after NDRG1 over-expression and knockout were detected by real-time polymerase chain reaction and western blot. The cell proliferation rate was measured by the cell counting kit-8 method; cell cycle and apoptosis were detected by flow cytometry; invasion and migration ability were detected by the 24-transwell method. RESULTS: NDRG1 over-expression inhibited Caco2 proliferation and the cell cycle could be arrested at the G1/S phase when NDRG1 was over-expressed, while the number of cells in the G2 phase was significantly increased when NDRG1 was knocked out. This suggests that NDRG1 inhibited the proliferation of Caco2 cells by arresting the cell cycle in the G1/S phase. Our data also demonstrated that NDRG1 promotes early cell apoptosis. Invasion and migration of cells were extensively inhibited when NDRG1 was over-expressed. CONCLUSION: NDRG1 inhibits tumor progression in Caco2 cells which may represent a potential novel therapeutic strategy for the treatment of CRC.

Initial Investigation of Clinical Value of Noise-Optimized Virtual Monoenergetic Images Derived From Dual-Energy Computed Tomography Angiography in Preoperative Perforator Planning of Anterolateral Thigh Flap Transplantation.

OBJECTIVE: To objectively and subjectively assess the image characteristics of noise-optimized virtual monoenergetic images [MEI (+)] and polyenergetic images (PEIs) from dual-energy computed tomography angiography and then to explore the clinical value of the optimal MEI (+) in preoperative perforator planning of anterolateral thigh (ALT) flap transplantation. METHODS: Sixteen patients (32 thighs) who underwent lower extremity run-off dual-energy computed tomography angiography for planning ALT flap transplantation were enrolled. One standard PEI and 5 MEI (+) in 10-keV intervals (range, 40-80 keV) were reconstructed. First, we compared the image quality subjectively (branch order, image quality, and vascular network continuity) and objectively (vascular attenuation, image noise, signal-to-noise ratio, and the contrast-to-noise ratio). Then, we compared the clinical value (number, type, source artery, pedicle length, caliber, and location of all sizable perforators) between the optimal MEI (+) and PEI groups. RESULTS: The 40-keV MEI (+) was rated superior subjective and objective image quality metrics to PEI (all P < 0.001). Compared with PEI, 40 keV MEI (+) increased the number of visible perforators, the percentage of perforators with identifiable types, and the measurable length of perforator pedicle (all P < 0.001). CONCLUSIONS: We recommend 40 keV MEI (+) for the visualization of perforators and their contribution to the selection and location of suitable perforators in preoperative planning for ALT flaps.

Low-dose CT with tin filter combined with iterative metal artefact reduction for guiding lung biopsy.

BACKGROUND: Computed tomography (CT) is currently the imaging modality of choice for guiding pulmonary percutaneous procedures. The use of a tin filter allows low-energy photons to be absorbed which contribute little to image quality but increases the radiation dose that a patient receives. Iterative metal artefact reduction (iMAR) was developed to diminish metal artefacts. This study investigated the impact of using tin filtration combined with an iMAR algorithm on dose reduction and image quality in CT-guided lung biopsy. METHODS: Ninety-nine consecutive patients undergoing CT-guided lung biopsy were randomly assigned to routine-dose CT protocols (groups A and B; without and with iMAR, respectively) or tin filter CT protocols (groups C and D; without or with iMAR, respectively). Subjective image quality was analysed using a 5-point Likert scale. Objective image quality was assessed, and the noise, contrast-to-noise ratio, and figure of merit were compared among the four groups. Metal artefacts were quantified using CT number reduction and metal diameter blurring. The radiation doses, diagnostic performance, and complication rates were also estimated. RESULTS: The subjective image quality of the two scan types was compared. Images with iMAR reconstruction were superior to those without iMAR reconstruction (group A: 3.49±0.65 vs. group B: 4.63±0.57; P<0.001, and group C: 3.88±0.66 vs. group D: 4.82±0.39; P<0.001). Images taken with a tin filter were found to have a significantly higher figure-of-merit than those taken without a tin filter (group A: 14,041±7,230 vs. group C: 21,866±10,656; P=0.001, and group B: 13,836±6,849 vs. group D: 21,639±9,964; P=0.001). In terms of metal artefact reduction, tin filtration combined with iMAR showed the lowest CT number reduction (116.62±103.48 HU) and metal diameter blurring (0.85±0.30) among the protocols. The effective radiation dose in the tin filter groups was 73.2% lower than that in the routine-dose groups. The complication rate and diagnostic performance (sensitivity, specificity, and overall accuracy) did not differ significantly between the tin filter and routine-dose groups (all P>0.05). CONCLUSIONS: Tin filtration combined with an iMAR algorithm may reduce the radiation dose compared to the routine-dose CT protocol, while maintaining comparable diagnostic accuracy and image quality and producing fewer metal artefacts.

Electrolytic manganese residue disposal based on basic burning raw material: Heavy metals solidification/stabilization and long-term stability.

Solidification/stabilization (S/S) is an option for the treatment of electrolytic manganese residue (EMR). Basic burning raw material (BRM) could successfully solidify/stabilize EMR, though heavy metals S/S mechanism and long-term stability remain unclear. Herein, Mn2+ and NH4+ S/S behavior, hydrated BRM and S/S EMR characterization, Mn2+ long-term leaching behavior, phase and morphology changes for long-term leaching were discussed in detail to clarify these mechanisms. Mn2+ and NH4+ leaching concentrations as well as pH value in S/S EMR were respectively 0.02 mg/L, 0.68 mg/L and 8.75, meeting the regulations of Chinese standard GB 8978-1996. Long-term stability of EMR was significantly enhanced after S/S. Mn2+ leaching concentration, Mn2+ migration, Mn2+ cumulative release, Mn2+ apparent diffusion coefficient and conductivity of EMR reduced to 0.05 mg/L, 5.5 × 10-6 mg/(m2·s), ~ 9 mg/m2, 6.30 × 10-15 m2/s and 435 µs/cm. Mechanism studies showed that the hydration of BRM forms OH-, calcium silicate hydrate gels (C-S-H) and ettringite. Therefore, during S/S process, NH4+ was escaped as NH3, Mn2+ was solidified/stabilized as tephroite (Mn2SiO4), johannsenite (CaMnSi2O6) and davreuxite (MnAl6Si4O17(OH)2), and Pb2+, Cu2+, Ni2+, Zn2+ were solidified/stabilized by C-S-H and ettringite via substitution and encapsulation. This study provides a good choice for EMR long-term stable storage.

Application of machine learning with multiparametric dual-energy computed tomography of the breast to differentiate between benign and malignant lesions.

BACKGROUND: Multiparametric dual-energy computed tomography (mpDECT) is widely used to differentiate various kinds of tumors; however, the data regarding its diagnostic performance with machine learning to diagnose breast tumors is limited. We evaluated univariate analysis and machine learning performance with mpDECT to distinguish between benign and malignant breast lesions. METHODS: In total, 172 patients with 214 breast lesions (55 benign and 159 malignant) who underwent preoperative dual-phase contrast-enhanced DECT were included in this retrospective study. Twelve quantitative features were extracted for each lesion, including CT attenuation (precontrast, arterial, and venous phases), the arterial-venous phase difference in normalized effective atomic number (nZeff), normalized iodine concentration (NIC), and slope of the spectral Hounsfield unit (HU) curve (λHu). Predictive models were developed using univariate analysis and eight machine learning methods [logistic regression, extreme gradient boosting (XGBoost), stochastic gradient descent (SGD), linear discriminant analysis (LDA), adaptive boosting (AdaBoost), random forest (RF), decision tree, and linear support vector machine (SVM)]. Classification performances were assessed based on the area under the receiver operating characteristic curve (AUROC). The best performances of the conventional univariate analysis and machine learning methods were compared using the Delong test. RESULTS: The univariate analysis showed that the venous phase λHu had the highest AUROC (0.88). Machine learning with mpDECT achieved an excellent and stable diagnostic performance, as shown by the mean classification performances in the training dataset (AUROC, 0.88-0.99) and testing (AUROC, 0.83-0.96) datasets. The performance of the AdaBoost model based on mpDECT was more stable than the other machine learning models and superior to the univariate analysis (AUROC, 0.96 vs. 0.88; P<0.001). CONCLUSIONS: The performance of the AdaBoost classifier based on mpDECT data achieved the highest mean accuracy compared to the other machine learning models and univariate analysis in differentiating between benign and malignant breast lesions.

Synergistic solidification/stabilization of electrolytic manganese residue and carbide slag.

Electrolytic manganese residue (EMR) contains high concentrations of NH4+ and heavy metals, such as Mn2+, Zn2+, Cu2+, Pb2+, Ni2+ and Co2+, while carbide slag (CS) contains high amount of OH- and CO32-, both posing a serious threat to the ecosystem. In this study, EMR and CS synergistic stabilization/solidification (S/S) was discussed science CS could stabilize or solidify EMR and simultaneously reduce its corrosive. The results showed that after the synergistic S/S for 24 h when liquid-solid ratio was 17.5% and CS dosage was 7%, Mn2+ and NH4+ leaching concentrations of the S/S EMR were below the detection limits (0.02 mg/L and 0.10 mg/L) with a pH value of 8.8, meeting the requirements of the Chinese integrated wastewater discharge standard (GB 8978-1996). Mn2+ was stabilized as MnFe2O4, Mn2SiO4, CaMnSi2O6, and NH4+ escaped as NH3. Zn2+, Cu2+, Pb2+, Ni2+ and Co2+ in EMR can also be stabilized/solidified because of the react with OH- and CO32- in CS. Chemical cost was only $ 0.54 for per ton of EMR synergistic harmless treatment with CS. This study provided a new idea for EMR cost-effective and environment-friendly harmless treatment.

Clinical and genomic analyses of neuroendocrine neoplasms of the breast.

Breast neuroendocrine neoplasms (NENs) constitute a rare histologic subtype that includes both neuroendocrine tumors (NETs) and neuroendocrine carcinomas (NECs). In this study, we aimed to gain insight into the clinical and molecular characteristics of NENs of the breast. NEN and paired distant normal fresh tissues and clinicopathological data were obtained from 17 patients with NENs, and clinicopathological data were collected from 755 patients with invasive breast carcinomas of no special type (IBCs-NST). We compared the clinicopathological characteristics of NENs and IBCs-NST and performed whole-exome sequencing (WES) of both NEN and paired normal tissues. Compared with the IBC-NST patients, the NEN patients had a higher mean age, lower clinical stage, and lower pathological nodal (pN) stage (P < 0.001, P < 0.001, and P = 0.017, respectively). The most frequently mutated gene in NENs was KMT2C (3/17, 17.6%). NENs had copy number variations (CNVs) of 8q, 11q, and 17q amplification and 17q and 11q deletion and harbored the following specific genes related to tumorigenesis: (i) suppressor genes with loss of heterozygosity (LOH) such as ACE (2/17, 11.8%); (ii) tumor driver genes such as GATA3 (2/17, 11.8%); and (iii) susceptibility genes such as MAP3K4 (17/17, 100%) and PDE4DIP (17/17, 100%). The oncogenic/likely oncogenic mutations of NETs in PI3K pathway genes (50.0%, 18.2%; P < 0.001) and MAPK signaling pathway genes (83.3%, 18.2%; P = 0.035) affected higher proportions than those of NECs. In conclusion, this study provides certain clinical and molecular evidence supporting NENs as a distinct subtype of breast cancer and provides some potential molecular features for distinguishing NETs from NECs.

Dual-energy CT quantitative parameters for the differentiation of benign from malignant lesions and the prediction of histopathological and molecular subtypes in breast cancer.

BACKGROUND: Dual-energy computed tomography (DECT) is widely used to characterize and differentiate tumors. However, data regarding its diagnostic performance for the characterization of breast tumors are limited. In this study, we assessed the diagnostic performance of quantitative parameters derived from DECT in differentiating benign from malignant lesions and predicting histopathological and molecular subtypes in patients with breast cancer. METHODS: Dual-phase contrast-enhanced DECT of the thorax was performed on participants with breast tumors. Conventional CT attenuation and DECT quantitative parameters, including normalized iodine concentration (NIC), the slope of the spectral Hounsfield unit curve (λHu), and normalized effective atomic number (nZeff), were obtained and compared between benign and malignant lesions, invasive non-special carcinoma, and ductal carcinoma in situ (DCIS), and among the four molecular subtypes of breast cancer. The diagnostic performance of the quantitative parameters was analyzed using receiver operating characteristic (ROC) curves. RESULTS: This study included 130 participants with 161 breast lesions (44 benign and 117 malignant). In the arterial and venous phase, NICs, λHu, nZeff, and attenuation were higher in malignant lesions than benign lesions (all P<0.001). The venous phase λHu had the best differential diagnostic capability, with an area under the curve (AUC) of 0.90, a sensitivity of 84.1% (37 of 44), a specificity of 86.3% (101 of 117), and an accuracy of 85.7% (138 of 161). The NICs in the arterial and venous phases were higher in invasive non-special carcinoma than DCIS (both P<0.001). In terms of diagnostic performance, NIC in the venous phase had an AUC of 0.77, a sensitivity of 75.0% (12 of 16), a specificity of 81.2% (82 of 101), and an accuracy of 80.3% (94 of 117). The luminal A subtype produced a lower venous phase NIC, and arterial and venous phase nZeff than the non-luminal A subtype (AUC of 0.91 for the combination of these three parameters). CONCLUSIONS: Dual-energy CT quantitative parameters are a feasible and valuable noninvasive means of differentiating between benign and malignant lesions, and predicting histopathological and molecular subtypes in patients with breast cancer.

Subjective and Objective Assessment of Monoenergetic and Polyenergetic Images Acquired by Dual-Energy CT in Breast Cancer.

OBJECTIVE: To objectively and subjectively assess and compare the characteristics of monoenergetic images [MEI (+)] and polyenergetic images (PEI) acquired by dual-energy CT (DECT) of patients with breast cancer. MATERIALS AND METHODS: This retrospective study evaluated the images and data of 42 patients with breast cancer who had undergone dual-phase contrast-enhanced DECT from June to September 2019. One standard PEI, five MEI (+) in 10-kiloelectron volt (keV) intervals (range, 40-80 keV), iodine density (ID) maps, iodine overlay images, and Z effective (Zeff) maps were reconstructed. The contrast-to-noise ratio (CNR) and the signal-to-noise ratio (SNR) were calculated. Multiple quantitative parameters of the malignant breast lesions were compared between the arterial and the venous phase images. Two readers independently assessed lesion conspicuity and performed a morphology analysis. RESULTS: Low keV MEI (+) at 40-50 keV showed increased CNR and SNRbreast lesion compared with PEI, especially in the venous phase ([CNR: 40 keV, 20.10; 50 keV, 14.45; vs. PEI, 7.27; p < 0.001], [SNRbreast lesion: 40 keV, 21.01; 50 keV, 16.28; vs. PEI, 10.77; p < 0.001]). Multiple quantitative DECT parameters of malignant breast lesions were higher in the venous phase images than in the arterial phase images (p < 0.001). MEI (+) at 40 keV, ID, and Zeff reconstructions yielded the highest Likert scores for lesion conspicuity. The conspicuity of the mass margin and the visual enhancement were significantly better in 40-keV MEI (+) than in the PEI (p = 0.022, p = 0.033, respectively). CONCLUSION: Compared with PEI, MEI (+) reconstructions at low keV in the venous phase acquired by DECT improved the objective and subjective assessment of lesion conspicuity in patients with malignant breast lesions. MEI (+) reconstruction acquired by DECT may be helpful for the preoperative evaluation of breast cancer.

Dual-energy CT quantitative parameters for evaluating Immunohistochemical biomarkers of invasive breast cancer.

BACKGROUND: Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and Ki67 are the most useful immunohistochemical biomarkers of invasive breast cancer. The purpose of this study is to investigate the possibility of quantitative parameters derived from dual-energy CT (DECT) to discriminate immunohistochemical biomarkers of invasive breast cancer. METHODS: This prospective study enrolled 120 patients with invasive breast cancer who underwent preoperative contrast-enhanced DECT for staging purposes from June 2019 to January 2020. DECT quantitative parameters, including normalized iodine concentration (NIC), the slope of the spectral Hounsfield unit curve (λHu), and the normalized effective atomic number (nZeff), were obtained from reconstructed images. DECT quantitative parameters were compared with the expression status, and the correlations with the value of immunohistochemical biomarkers were evaluated. Inter-observer reproducibility analysis was performed to assess the measurement reproducibility of quantitative parameters. The diagnostic performance of the quantitative parameters was analyzed by receiver operating characteristic curve. RESULTS: The ER-negative group tended to display higher venous phase NIC and nZeff compared with the ER-positive group (individually, p = 0.003, 0.011; area under the curve [AUC] of 0.65, 0.60). The PR-negative group demonstrated higher arterial and venous phase NIC compared with the PR-positive group (individually, p = 0.022, 0.005; AUC of 0.63, 0.65). NIC was correlated negatively with the value of ER and PR expression (r = - 0.175 ~ - 0.265, p = 0.002 ~ 0.042). The HER2-positive group tended to display higher venous phase nZeff than the HER2-negative group (p = 0.022; AUC of 0.59). The Ki67 high-proliferation group demonstrated higher arterial phase, venous phase NIC and nZeff than the Ki67 low-proliferation group (p < 0.001 ~ 0.005; AUC of 0.67 ~ 0.75). Both the NIC and nZeff were correlated positively with the value of Ki67 (r = 0.240 ~ 0.490, p < 0.001 ~ 0.014). CONCLUSIONS: NIC and nZeff derived from DECT could be used to discriminate expression status and may associate with the value of immunohistochemical biomarkers of invasive breast cancer.

Enhanced leaching of manganese from low-grade pyrolusite using ball milling and electric field.

In this study, electric field and ball milling were used to leach Mn2+ from low-grade pyrolusite (LGP). The effects of current density, reaction time, reaction temperature, ball-to-powder weight ratio, and ball milling time on the leaching efficiency of Mn2+ from LGP as well as the leaching mechanism were systematically studied. The results showed that the combined use of electric field and ball milling enhanced the leaching of Mn2+ from LGP. The leaching efficiency of Mn2+ reached 97.79% under the optimum conditions of LGP-to-pyrite mass ratio of 1:0.18, current density of 30 mA/cm2, LGP-to-H2SO4 mass ratio of 1:0.4, liquid-to-solid ratio of 5:1, ball-to-powder weight ratio of 1:1, ball milling time of 2 h, temperature of 80 °C, and leaching duration of 120 min. This value was 25.95% higher than that attained without ball milling and 41.45% higher than that attained when neither ball milling nor electric field was employed. Pyrite was fully oxidized to generate additional SO42- and Fe3+, and was further hydrolyzed to form jarosite (KFe3(SO4)2(OH)6) and hydronium jarosite (Fe3(SO4)2(OH)5·2H2O) via ball milling and electric field application. Moreover, the electric field changed the surface charge distribution of the mineral particles and promoted collisions between them as well as the collapse of the crystal lattice, further improving the leaching efficiency of Mn2+ from LGP. This study provided a new method for leaching Mn from LGP.

Metal mobility and toxicity of reclaimed copper smelting fly ash and smelting slag.

Copper is a nonferrous metal closely connected to humans. Approximately 40% of copper is produced by reclaimed copper smelting (RCS). Reclaimed copper smelting fly ash and smelting slag are generated during the RCS process, posing a serious threat to the ecosystem and environment as they contain many heavy metals, such as Cu and Zn. In this study, the metal mobility and toxicity of RCS fly ash and smelting slag were analyzed using standard leaching toxicity procedures, sequential extraction procedures, and bioavailability tests. The results showed that the main phases of RCS fly ash were Cu2(OH)3Cl, FeCl2·2H2O, CuS2, C, CuO, Cu, Ca2SiO4, ZnClO42, Zn(OH)2·0.5H2O, and KFeCl3, and those for smelting slag were SiO2, CaCO3, SiS2, CaAl2Si2O8·4H2O, Cu4O3, CuO, ZnO, NiSO4·6H2O, AlPO4, and Na3Mn(PO4)(CO)3. These two slags contain high contents of Cu, Zn and Fe and trace amounts of heavy metals, such as Ba, Be, Cd, Cr, Ni, As, Pb, Au, Se and Sb. RCS fly ash is classified as hazardous waste in both China and the USA as the toxic leaching concentrations of Pb and Cd exceed the thresholds of 5 and 1 mg L-1. Cu and Zn contained in these two slags can easily be released into the environment, although the residual fraction of Cu and Zn was found to be higher than 65%. Additionally, RCS fly ash and smelting slag also show significant biohazardous potential as the EDTA- and DTPA-extractable Zn, Cu and Se of these two residues are considerably high. The results described above could provide reclaimed copper smelting companies and governments with a better understanding of the risk of RCS fly ash and smelting slag, urging them to stop the slag from harming ecosystems and humans.

Evaluating the Image Quality of Monoenergetic Images From Dual-Energy Computed Tomography With Low-Concentration and Low-Flow-Rate Contrast Media for the Arterials Supply to the Nipple-Areola Complex in Breast Cancer Compared With Conventional Computed Tomography Angiography.

OBJECTIVE: The objective of this study was to evaluate the image quality of monoenergetic images (MEIs (+)) acquired from dual-energy computed tomography with low-concentration and low-flow-rate contrast media for the arterial supply to the nipple-areola complex (NAC) in breast cancer compared with conventional computed tomography angiography (CTA). METHODS: We enrolled 25 patients (MEI (+)300 group, 300 mg/mL and 2.5 mL/s of contrast media) and 23 patients (CTA370 group, 370 mg/mL and 3.5 mL/s of contrast media) for assessing NAC blood supply angiography. The image quality of the 2 groups was evaluated objectively and subjectively. RESULTS: The 40 keV MEI (+)300 demonstrated higher attenuation and contrast-to-noise ratio than CTA370 group (P < 0.001). The subjective image quality and visualization of the arteries were comparable between 2 groups. CONCLUSIONS: The 40 keV MEI (+)300 acquired from dual-energy computed tomography can achieve comparable image quality of arterial supply to NAC with low-concentration and low-flow-rate contrast media in breast cancer compared with CTA370.

Research on energy efficiency improvement in a supply chain with discontinuous market demand.

In many countries, products are divided into several grades according to their energy efficiencies by the government. It leads to the discontinuous market demand for the products with different governmental energy efficiency certifications and further influences the relevant strategies of firms. Considering both increasing consumer environmental awareness and strict governmental grading standard, this paper develops a Stackelberg differential game between a manufacturer and a retailer. The optimal pricing strategies and the energy efficiency efforts are studied, and the influences of discontinuous market demand on those optimal strategies are discussed. The results show that the governmental grading standard has an important boosting impact on the energy efficiency level of products. When the product's energy efficiency level is lower than the governmental standard, the manufacturer will make great efforts on energy efficiency improvement. It would be beneficial for both the manufacturer and the retailer to use penetration pricing strategy during this period. Once the governmental standard is met, the manufacturer will reduce his effort significantly. At this time, taking the skimming pricing strategy is beneficial for both the manufacturer and the retailer. Moreover, a higher governmental standard and a larger consumers' preference difference can motivate the manufacturer to work harder to improve energy efficiency. They also lead to a higher price after the product is certified as the high energy efficiency product by the government.