Usefulness of Impulse Oscillometry in Predicting the Severity of Bronchiectasis.

Background: : Bronchiectasis is a chronic respiratory disease that leads to airway inflammation, destruction, and airflow limitation, which reflects its severity. Impulse oscillometry (IOS) is a non-invasive method that uses sound waves to estimate lung function and airway resistance. The aim of this study was to assess the usefulness of IOS in predicting the severity of bronchiectasis. Methods: : We retrospectively reviewed the IOS parameters and clinical characteristics in 145 patients diagnosed with bronchiectasis between March 2020 and May 2021. Disease severity was evaluated using the FACED score, and patients were divided into mild and moderate/severe groups. Results: : Forty-four patients (30.3%) were in the moderate/severe group, and 101 (69.7%) were in the mild group. Patients with moderate/severe bronchiectasis had a higher airway resistance at 5 Hz (R5), a higher difference between the resistance at 5 and 20 Hz (R5-R20), a higher resonant frequency (Fres), and a higher area of reactance (AX) than patients with mild bronchiectasis. R5 ≥0.43, resistance at 20 Hz (R20) ≥0.234, R5-R20 ≥28.3, AX ≥1.02, reactance at 5 Hz (X5) ≤-0.238, and Fres ≥20.88 revealed significant univariable relationships with bronchiectasis severity (p<0.05). Among these, only X5 ≤-0.238 exhibited a significant multivariable relationship with bronchiectasis severity (p=0.039). The receiver operating characteristic curve for predicting moderate- to-severe bronchiectasis of FACED score based on IOS parameters exhibited an area under the curve of 0.809. Conclusion: : The IOS assessed by the disease severity of FACED score can effectively reflect airway resistance and elasticity in bronchiectasis patients and serve as valuable tools for predicting bronchiectasis severity.

Determination of axillary lymph node status by fine-needle aspiration: preoperative axillary staging vs. postoperative surveillance for breast cancers.

Background: Despite the common use of ultrasound (US)-guided fine-needle aspiration (FNA) for axillary node (AN) in breast cancer patients, only a limited number of studies are available regarding the diagnostic performance of AN-FNA according to the suspicion level based on US findings. This study compares the outcomes of US-guided AN-FNA in breast cancer patients, differentiating between those undergoing staging and surveillance. Methods: A cross-sectional retrospective study with retrospective analysis was conducted on 767 consecutive AN-FNA procedures performed in 2017 at Samsung Medical Center in Seoul, with 654 for staging and 113 for surveillance in breast cancer patients. The radiologists performed axillary US and the specific finding was prospectively classified into the AN-reporting and data system (AN-RADS) category 3-5 before FNA. The malignancy rate of each category was evaluated. The chi-square test, with or without Bonferroni correction, or Fisher's exact test was used to compare the malignancy rates between the staging and surveillance groups for each category. Results: Among the 767 AN-FNAs, 424 (55.3%) were malignant. The malignancy rate was significantly higher in the staging group (59.5%) than in the surveillance group (31.0%, P<0.0001). The distribution of AN-RADS categories differed between the groups (P=0.015), with 4A being the most common. The malignancy rates in categories 3, 4A, 4B, 4C, and 5 were as follows: 5.6%, 36.0%, 77.4%, 87.7%, and 98.4% in the staging group, and 0.0%, 9.7%, 53.3%, 88.9%, and 100% in the surveillance group. The malignancy rate was significantly different between the two groups only in category 4A (P=0.0001). Conclusions: AN-FNA according to AN-RADS category appears to be an appropriate method for determination of axillary nodal status. Overall malignancy rate of AN-FNA in breast cancer patients was higher in the staging group than in the surveillance group. According to the suspicion level, the difference between two groups was significant only in category 4A.

The VP53 protein encoded by RNA2 of a fabavirus, broad bean wilt virus 2, is essential for viral systemic infection.

Plant viruses evolves diverse strategies to overcome the limitations of their genomic capacity and express multiple proteins, despite the constraints imposed by the host translation system. Broad bean wilt virus 2 (BBWV2) is a widespread viral pathogen, causing severe damage to economically important crops. It is hypothesized that BBWV2 RNA2 possesses two alternative in-frame translation initiation codons, resulting in the production of two largely overlapping proteins, VP53 and VP37. In this study, we aim to investigate the expression and function of VP53, an N-terminally 128-amino-acid-extended form of the viral movement protein VP37, during BBWV2 infection. By engineering various recombinant and mutant constructs of BBWV2 RNA2, here we demonstrate that VP53 is indeed expressed during BBWV2 infection. We also provide evidence of the translation of the two overlapping proteins through ribosomal leaky scanning. Furthermore, our study highlights the indispensability of VP53 for successful systemic infection of BBWV2, as its removal results in the loss of virus infectivity. These insights into the translation mechanism and functional role of VP53 during BBWV2 infection significantly contribute to our understanding of the infection mechanisms employed by fabaviruses.

Attitude Toward Virtual Rehabilitation and Active Video Games Among Therapists in Korea: A Nationwide Survey.

In this study, we conducted a survey targeting 191 physical therapists (PTs) and 159 occupational therapists (OTs) in South Korea to explore attitudes toward virtual rehabilitation. Utilizing the Korean version of the ADOPT VR by Glegg et al., OT exhibited significantly more experience with virtual reality (VR) and active video games (AVG) than PT. Therapists with VR/AVG experience scored significantly higher in most categories, and the scores in each category were significantly correlated with the Behavioral Intention category, reflecting the willingness to use VR/AVG. The biggest barriers identified were insufficient funds and setup assistance for the equipment. Differences in responses between the groups with and without VR/AVG experience were most prominent in terms of lack of interest and funding. Therapists' attitudes, perceptions, and intentions toward VR/AVG are crucial factors in the establishment and implementation of VR/AVG; thus, the results of this study provide valuable evidence for future policies related to VR/AVG in rehabilitation medicine.

Selective Avoidance of Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in Human Epidermal Growth Factor 2-Positive/Triple-Negative Breast Cancer Patients With Excellent Response.

PURPOSE: The Avoid Axillary Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy (ASLAN) trial aims to demonstrate the oncologic safety of omitting axillary surgery in patients with excellent response after neoadjuvant chemotherapy (NACT) for early human epidermal growth factor 2 (HER2)-positive (+)/triple-negative breast cancer (TNBC) who have undergone breast-conserving surgery (BCS) and adjuvant radiotherapy. The ASLAN trial will provide crucial information that could change the procedure in highly selected patients undergoing axillary surgery after NACT. METHODS: ASLAN is a prospective, multicenter, and single-arm surgical trial. The recruitment will be conducted among five tertiary care hospitals in the Republic of Korea. The total number of patients to be recruited will be 178, and we plan to complete patient enrollment by December 2023. The enrollment is considered among patients with HER2+ breast cancer (BC) or TNBC at clinical stage T1-3N0-1M0 who are expected to achieve breast pathological complete response (BpCR) based on a combination of radiologic imaging and physical examination after NACT. BCS was performed on eligible patients. After BCS, patients who showed BpCR were enrolled with the omission of sentinel lymph node biopsy (SLNB). The primary study endpoint upon completion of this trial is 5-year recurrence-free survival, and the secondary endpoints include the 5-year ipsilateral breast tumor recurrence interval, 5-year ipsilateral axillary recurrence interval, 5-year distant metastasis-free survival, 5-year BC-specific survival, 5-year overall survival, 5-year contralateral BC-free survival, re-operation rate according to breast biopsy after NACT, adverse events within 5 years, and quality of life. DISCUSSION: Several clinical trials are currently underway to determine whether SLNB can be omitted after NACT in patients with HER2+ BC or TNBC that are expected to achieve pathologic complete response. The ASLAN trial is expected to provide valuable clues regarding the feasibility of omitting axillary surgery in highly selected patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04993625. Registered on August 6, 2021. Clinical Research Information Service Identifier: KCT0006371. Registered on July 22, 2021.

Effect of the sodium-glucose cotransporter-2 inhibitor, DWP16001, as an add-on therapy to insulin for diabetic dogs: A pilot study.

BACKGROUND: Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a novel class of anti-hyperglycaemic agents. OBJECTIVE: This study aimed to evaluate the safety and the adjuvant glycaemic control effect of an SGLT2 inhibitor, DWP16001, in diabetic dogs receiving insulin treatment. METHODS: Nineteen diabetic dogs receiving insulin treatment (NPH, porcine lente and glargine insulin) were divided into two groups according to dosing frequency: DWP TOD group (n = 10) and DWP SID group (n = 9). In the DWP TOD group, 0.025 mg/kg of DWP16001 was administered once every 3 days, whereas, in the DWP SID group, 0.025 mg/kg of DWP16001 was administered once a day. Food intake was maintained during the trial period. Hypoglycaemia, ketoacidosis or unexpected life-threatening reactions were assessed as adverse effects before and after DWP16001 administration. We compared insulin requirement reduction and blood glucose level control between two groups. RESULTS: No specific adverse effects were observed during the clinical trial, and haematological parameter remained unchanged. Moreover, the fasting glucose levels and daily insulin dose in the DWP TOD group were lower than the pre-administration values, but not significantly different for 8 weeks. Systolic blood pressure, fructosamine and insulin dose decreased significantly in the DWP SID group compared to the DWP TOD group at 8 weeks (p < 0.05) without affecting food consumption. Among these patients, 10 patients were monitored while receiving DWP16001 for 12 months (DWP TOD group n = 5, DWP SID group n = 5). The fasting glucose and fructosamine levels and daily insulin dose were reduced in both groups at 12 months compared with those before receiving DWP16001. CONCLUSION: When DWP16001, an SGLT2 inhibitor, was supplied to dogs with type 1 diabetes, no adverse effects were observed, and it was confirmed that the administered insulin dose can be reduced in controlling blood glucose.

Ashwagandha Ethanol Extract Attenuates Sarcopenia-Related Muscle Atrophy in Aged Mice.

The investigation focused on the impact of Withania somnifera (ashwagandha) extract (WSE) on age-related mechanisms affecting skeletal muscle sarcopenia-related muscle atrophy in aged mice. Beyond evaluating muscular aspects, the study explored chronic low-grade inflammation, muscle regeneration, and mitochondrial biogenesis. WSE administration, in comparison to the control group, demonstrated no significant differences in body weight, diet, or water intake, affirming its safety profile. Notably, WSE exhibited a propensity to reduce epidermal and abdominal fat while significantly increasing muscle mass at a dosage of 200 mg/kg. The muscle-to-fat ratio, adjusted for body weight, increased across all treatment groups. WSE administration led to a reduction in the pro-inflammatory cytokines TNF-α and IL-1ß, mitigating inflammation-associated muscle atrophy. In a 12-month-old mouse model equivalent to a 50-year-old human, WSE effectively preserved muscle strength, stabilized grip strength, and increased muscle tissue weight. Positive effects were observed in running performance and endurance. Mechanistically, WSE balanced muscle protein synthesis/degradation, promoted fiber differentiation, and enhanced mitochondrial biogenesis through the IGF-1/Akt/mTOR pathway. This study provides compelling evidence for the anti-sarcopenic effects of WSE, positioning it as a promising candidate for preventing sarcopenia pending further clinical validation.

Nonmass Lesions on Breast US: An International Perspective on Clinical Use and Outcomes.

Nonmass lesions (NMLs) on breast US are defined as discrete areas of altered echotexture compared to surrounding breast tissue and lack the 3-dimensionality of a mass. They are not a component of American College of Radiology BI-RADS, but they are a finding type included in the Japan Association of Breast and Thyroid Sonology lexicon. Use of the NML finding is routine in many Asian practices, including the Samsung Medical Center and Seoul National University Hospital, and their features and outcomes have been investigated in multiple studies. Nonmass lesions are most often observed when US is used to evaluate mammographic asymmetries, suspicious calcifications, and nonmass enhancement on MRI and contrast-enhanced mammography. Nonmass lesions can be described by their echogenicity, distribution, presence or absence of associated calcifications, abnormal duct changes, architectural distortion, posterior shadowing, small cysts, and hypervascularity. Malignant lesions, especially ductal carcinoma in situ, can manifest as NMLs on US. There is considerable overlap between the US features of benign and malignant NMLs, and they also must be distinguished from normal variants. The literature indicates that NMLs with linear or segmental distribution, associated calcifications, abnormal duct changes, posterior shadowing, and hypervascularity are suggestive of malignancy, whereas NMLs with only interspersed small cysts are usually benign fibrocystic changes. In this article, we introduce the concepts of NMLs, illustrate US features suggestive of benign and malignant etiologies, and discuss our institutional approach for evaluating NMLs and an algorithm that we use to guide interpretation in clinical practice.

Characteristics of Breast Charcoal Granuloma: A Delayed Complication Following Tattoo Localization.

Rationale and Objective: To evaluate the characteristic clinical and imaging findings of charcoal granuloma and suggest features that may differentiate charcoal granuloma from breast cancer. Materials and Methods: This retrospective study included 18 patients with a histologically confirmed breast charcoal granuloma between 2005 and 2021 at a single institution. All patients had a history of breast surgery after ultrasound (US)-guided charcoal marking. Two radiologists analyzed the radiologic findings of charcoal granulomas, including the presence of a mass or calcification; the shape, margin and density of the masses on mammography; and the location, size, shape, margin, orientation, echogenicity, vascularity, presence of an echogenic halo, and posterior acoustic shadowing on US. In cases with available follow-up images, we also investigated whether the size and shape had changed. Results: The median interval between breast surgery and the diagnosis of charcoal granuloma was 2.3 years (range, 0.7-18.3 years). Thirteen lesions (72.2%) were detected on screening images. In 11 (61.1%) cases, the surgical incision was not made in the tattooed skin area. Mammography showed positive findings in 10/15 patients, and most lesions were isodense masses (70%). There were no cases with calcification. On US, all lesions were masses and showed a taller-than-wide orientation (61.1%), round or oval shape (55.6%), and iso- or hyperechogenicity (83.3%). Echogenic halo (27.8%) and posterior acoustic shadowing (16.7%) were uncommon. On Doppler US, only four cases (22.2%) showed increased vascularity. Most were classified as BI-RADS 3 (38.9%) or 4A (50.0%). After biopsy, 12 patients had follow-up mammography and US. The size of the lesion decreased in nine cases and remained unchanged in three cases. A decrease in the lesion size after biopsy showed a negative correlation with the interval between detection on imaging and biopsy (p = 0.04). Conclusion: Charcoal granuloma is most commonly found 2-3 years after surgery and occurs more frequently when the incision site is different from the tattooed skin area. US findings of tall and round or oval masses with iso- or hyperechogenicity without increased vascularity could help to differentiate them from malignancies.

Analysis of Prognoses according to Breast MRI Results in Patients with Axillary Lymph Node Metastases from an Unknown Primary Origin.

PURPOSE: To compare the prognosis of patients with axillary adenocarcinoma from an unknown primary (ACUPax) origin with negative MRI results and those with MRI-detected primary breast cancers. MATERIALS AND METHODS: The breast MRI images of 32 patients with ACUPax without signs of primary breast cancer on mammography and ultrasound (US) were analyzed. Spot compression-magnification mammography and second-look US were performed for the area of MRI abnormality in patients with positive results; any positive findings corresponding to the MRI abnormality were confirmed by biopsy. If suspicious MRI lesions could not be localized on mammography or US, MR-guided biopsy or excision biopsy after MR-guided localization was performed. We compared the prognosis of patients with negative breast MRI with that for patients with MRI-detected primary breast cancers. RESULTS: Primary breast cancers were confirmed in 8 (25%) patients after breast MRI. Primary breast cancers were not detected on MRI in 24 (75%) patients, including five cases of false-positive MRI results. Twenty-three patients underwent axillary lymph node dissection (ALND) followed by whole breast radiation therapy (WBRT) and chemotherapy (n=17) or subsequent chemotherapy only (n=2). Recurrence or distant metastasis did not occur during follow up in 7/8 patients with MRI-detected primary breast cancers and 22/24 patients with negative MRI results. Regional recurrence or distant metastasis did not occur in any MR-negative patient who received adjuvant chemotherapy after ALND and WBRT. CONCLUSION: The prognoses of MR-negative patients with ACUPax who received ALND and WBRT followed by chemotherapy were as good as those of patients with MRI-detected primary breast cancers.

Effect of artificial intelligence-based computer-aided diagnosis on the screening outcomes of digital mammography: a matched cohort study.

OBJECTIVE: To investigate whether artificial intelligence-based computer-aided diagnosis (AI-CAD) can improve radiologists' performance when used to support radiologists' interpretation of digital mammography (DM) in breast cancer screening. METHODS: A retrospective database search identified 3158 asymptomatic Korean women who consecutively underwent screening DM between January and December 2019 without AI-CAD support, and screening DM between February and July 2020 with image interpretation aided by AI-CAD in a tertiary referral hospital using single reading. Propensity score matching was used to match the DM with AI-CAD group in a 1:1 ratio with the DM without AI-CAD group according to age, breast density, experience level of the interpreting radiologist, and screening round. Performance measures were compared with the McNemar test and generalized estimating equations. RESULTS: A total of 1579 women who underwent DM with AI-CAD were matched with 1579 women who underwent DM without AI-CAD. Radiologists showed higher specificity (96% [1500 of 1563] vs 91.6% [1430 of 1561]; p < 0.001) and lower abnormal interpretation rates (AIR) (4.9% [77 of 1579] vs 9.2% [145 of 1579]; p < 0.001) with AI-CAD than without. There was no significant difference in the cancer detection rate (CDR) (AI-CAD vs no AI-CAD, 8.9 vs 8.9 per 1000 examinations; p = 0.999), sensitivity (87.5% vs 77.8%; p = 0.999), and positive predictive value for biopsy (PPV3) (35.0% vs 35.0%; p = 0.999) according to AI-CAD support. CONCLUSIONS: AI-CAD increases the specificity for radiologists without decreasing sensitivity as a supportive tool in the single reading of DM for breast cancer screening. CLINICAL RELEVANCE STATEMENT: This study shows that AI-CAD could improve the specificity of radiologists' DM interpretation in the single reading system without decreasing sensitivity, suggesting that it can benefit patients by reducing false positive and recall rates. KEY POINTS: • In this retrospective-matched cohort study (DM without AI-CAD vs DM with AI-CAD), radiologists showed higher specificity and lower AIR when AI-CAD was used to support decision-making in DM screening. • CDR, sensitivity, and PPV for biopsy did not differ with and without AI-CAD support.

Correction: Kim et al. Assessment of Enhancement Kinetics Improves the Specificity of Abbreviated Breast MRI: Performance in an Enriched Cohort. Diagnostics 2023, 13, 136.

There were errors in the original publication [...].

Benign Adenomyoepithelioma of the Breast: Imaging Characteristics.

Purpose: This study aimed to evaluate the radiological and clinical characteristics of benign adenomyoepitheliomas of the breast. Materials and Methods: Over the last 20 years, 120 patients were histologically diagnosed with breast adenomyoepithelioma (AME) at our institution. We excluded 43 patients who were incidentally diagnosed during mastectomy for breast cancer, 28 who underwent percutaneous biopsy without further excision, and 8 who had biopsy-confirmed benign AME and were found to have another pathology after complete excision. We retrospectively reviewed the clinical records and radiological findings of the remaining 41 patients with histologically diagnosed benign breast AMEs after complete excision. Results: All 41 patients underwent US; 38 underwent mammography (MG) and US; and 18 underwent MG, US, and MRI. MG detected 38 cases with a round or oval shape (56%), and mass (89%), were non-circumscribed (62%), hyperdense (53%), and without microcalcifications (95%). Breast US revealed suspicious masses (98%) with a non-circumscribed margin (66%), hypoechogenicity (43%), and intratumoral vascularity (63%). All lesions on breast MRI showed suspicious masses (100%) with ill-defined margins (61%), and 84% showed wash-out kinetics. Benign AMEs showed suspicious features of Breast Imaging Reporting and Data System (BI-RADS) category 4 or 5 in 83%-95% of the MG, US, and MRI. Sixteen of the 41 cases were misdiagnosed on the initial core needle biopsy and two were diagnosed as malignancy. Conclusion: Benign breast AME often shows suspicious radiological features mimicking a malignant mass on MG, US, and MRI. Differentiating benign AME from other pathologies might be difficult on core needle biopsy, and complete excision is needed for a correct diagnosis.

Screening Outcomes of Supplemental Automated Breast US in Asian Women with Dense and Nondense Breasts.

Background Automated breast (AB) US effectively depicts mammographically occult breast cancers in Western women. However, few studies have focused on the outcome of supplemental AB US in Asian women who have denser breasts than Western women. Purpose To evaluate the performance of supplemental AB US on mammography-based breast cancer screening in Asian women with dense breasts and those with nondense breasts. Materials and Methods A retrospective database search identified asymptomatic Korean women who underwent digital mammography (DM) and supplemental AB US screening for breast cancer between January 2018 and December 2019. We excluded women without sufficient follow-up, established final diagnosis, or histopathologic results. Performance measures of DM alone and AB US combined with DM (hereafter AB US plus DM) were compared. The primary outcome was cancer detection rate (CDR), and the secondary outcomes were sensitivity and specificity. Subgroup analyses were performed based on mammography density. Results From 2785 screening examinations in 2301 women (mean age, 52 years ± 9 [SD]), 28 cancers were diagnosed (26 screening-detected cancers, two interval cancers). When compared with DM alone, AB US plus DM resulted in a higher CDR of 9.3 per 1000 examinations (95% CI: 7.7, 10.3) versus 6.5 per 1000 examinations (95% CI: 5.2, 7.2; P < .001) and a higher sensitivity of 90.9% (95% CI: 77.3, 100.0) versus 63.6% (95% CI: 40.9, 81.8; P < .001) but a lower specificity of 86.8% (95% CI: 85.2, 88.2) versus 94.6% (95% CI: 93.6, 95.5; P < .001) in women with dense breasts. In women with nondense breasts, AB US plus DM resulted in a higher CDR of 9.5 per 1000 examinations (95% CI: 7.1, 10.6) versus 6.3 per 1000 examinations (95% CI: 3.5, 7.1; P < .001), whereas specificity was lower at 95.2% (95% CI: 93.4, 96.8) versus 97.1% (95% CI: 95.8, 98.4; P < .001). Conclusion In Asian women, the addition of automated breast US to digital mammography showed higher cancer detection rates but lower specificities in both dense and nondense breasts. © RSNA, 2023 Supplemental material is available for this article.

Physiologically Based Pharmacokinetic Modelling to Predict Pharmacokinetics of Enavogliflozin, a Sodium-Dependent Glucose Transporter 2 Inhibitor, in Humans.

Enavogliflozin is a sodium-dependent glucose cotransporter 2 (SGLT2) inhibitor approved for clinical use in South Korea. As SGLT2 inhibitors are a treatment option for patients with diabetes, enavogliflozin is expected to be prescribed in various populations. Physiologically based pharmacokinetic (PBPK) modelling can rationally predict the concentration-time profiles under altered physiological conditions. In previous studies, one of the metabolites (M1) appeared to have a metabolic ratio between 0.20 and 0.25. In this study, PBPK models for enavogliflozin and M1 were developed using published clinical trial data. The PBPK model for enavogliflozin incorporated a non-linear urinary excretion in a mechanistically arranged kidney model and a non-linear formation of M1 in the liver. The PBPK model was evaluated, and the simulated pharmacokinetic characteristics were in a two-fold range from those of the observations. The pharmacokinetic parameters of enavogliflozin were predicted using the PBPK model under pathophysiological conditions. PBPK models for enavogliflozin and M1 were developed and validated, and they seemed useful for logical prediction.

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Breast Imaging Reporting and Data System (BI-RADS) is a communication and data tracking system that standardizes and controls the quality of reporting by presenting lexicon descriptors, assessment categories, and recommendations for managing breast lesions. Using standardized terminology recommended by BI-RADS, radiologists can concisely and reproducibly communicate breast imaging results to clinicians. They can also provide the estimated malignant probability of the lesions found and guide management for them by determining the final assessment category. The limitations of BI-RADS 5th edition currently in use are that there are some areas for which standardized terminologies still need to be established, and that the diagnostic criteria of MRI assessment categories 3 and 4 are ambiguous compared to those for mammography or ultrasound. The next revision of BI-RADS is expected to include solutions for overcoming current limitations.

Feasibility of Ultrasound-Guided Localization for Clipped Metastatic Axillary Lymph Nodes After Neoadjuvant Chemotherapy in Breast Cancer Patients: A Pilot Study.

We present our initial experience of ultrasound (US)-guided localization of clipped metastatic axillary lymph nodes (LNs) following neoadjuvant chemotherapy (NAC). We evaluated US visibility and the successful excision rate of clipped LN after NAC in 29 consecutive patients with breast cancer. US-guided localization of clipped nodes was performed in 22 patients on the day of surgery, while seven patients underwent surgery without localization. The clips were identified in all patients with residual metastatic LNs and 6 of 12 (50%) patients without residual metastatic LNs on US. Six patients without visible clips underwent US-guided localization at the presumed previous clip insertion site. The successful excision rate of 22 LNs with localization was 100% (even though 3 of them were non-sentinel LNs) and 57% (4/7) without localization. Regardless of the presence of visible residual metastatic LNs on US after NAC, successful excision of the clipped LN with US-guided localization is feasible.

Pyruvate Kinase M2: A New Biomarker for the Early Detection of Diabetes-Induced Nephropathy.

Diabetic nephropathy (DN) is a common complication of diabetes. DN progresses to end-stage renal disease, which has a high mortality rate. Current research is focused on identifying non-invasive potential biomarkers in the early stage of DN. We previously indicated that pyruvate kinase M2 (PKM2) is excreted in the urine of rats after cisplatin-induced acute kidney injury (AKI). However, it has not been reported whether PKM2 can be used as a biomarker to diagnose DN. Therefore, we try to compare whether the protein PKM2 can be detected in the urine samples from diabetic patients as shown in the results of DN models. In this study, high-fat diet (HFD)-induced Zucker diabetic fatty (ZDF) rats were used for DN phenotyping. After 19 weeks of receiving a HFD, the DN model's blood glucose, blood urea nitrogen, and serum creatinine levels were significantly increased; severe tubular and glomerular damages were also noted. The following protein-based biomarkers were increased in the urine of these models: kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and PKM2. PKM2 had the earliest detection rate. In the urine samples of patients, PKM2 protein was highly detected in the urine of diabetic patients but was not excreted in the urine of normal subjects. Therefore, PKM2 was selected as the new biomarker for the early diagnosis of DN. Our results reflect current knowledge on the role of PKM2 in DN.

Appropriate screening mammography method for patients with breast implants.

In this study, we aimed to evaluate the benefits and losses of mammography with and without implant displacement (ID) and propose an appropriate imaging protocol for the screening of breasts with implants. We evaluated mammograms of 162 breasts in 96 patients including 71 breasts with biopsy-proven cancers. Mammography of each breast included standard MLO and ID MLO images. We reviewed the mammograms using clinical image quality criteria, which consist of parameters that evaluate the proper positioning of the breast and the image resolution. Standard MLO images showed significantly higher scores for proper positioning but showed significantly lower scores for image resolution than the ID MLO images. Moreover, standard MLO images showed significantly higher kVp, mAs, and compressed breast thickness than the ID MLO images. The organ dose was also higher in the standard MLO images than in the ID MLO images, but the difference was not statistically significant. In mammography with proven cancer, ID MLO images showed significantly higher degree of cancer visibility than standard MLO images. For screening mammography in patients with breast implants, ID MLO view alone is sufficient for MLO projection with reducing the patient's radiation dose without compromising the breast cancer detection capability, especially in dense breasts with subpectoral implants.

Protective effect of dendropanoxide against cadmium-induced hepatotoxicity via anti-inflammatory activities in Sprague-Dawley rats.

Cadmium (Cd) accumulates in the body through contaminated foods or water and causes pathological damage to the liver via oxidative stress and inflammatory reactions. This study was conducted to explore the effects of dendropanoxide (DPx) on Cd-induced hepatotoxicity in rats. Sprague-Dawley (SD) rats were injected with CdCl2 (7 mg/kg body weight) intraperitoneally for 14 days for the induction of liver dysfunction. The CdCl2-exposed rats were subjected to DPx (10 mg/kg) or silymarin (50 mg/kg). The animals were euthanized after 24 h of the last CdCl2 injection and the serum biochemical parameters, lipid content, pro-inflammatory cytokine levels, apoptotic cell death and histopathology of the tissues were analyzed. Additionally, the activity of antioxidant enzymes, including superoxide dismutase (SOD) and catalase (CAT), was measured. Compared to controls, Cd-injected rats showed significantly elevated serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), triglycerides (TG), total cholesterol, and pro-inflammatory cytokines, and a remarkable decrease in SOD and CAT activities. Importantly, Cd-induced liver damage was drastically ameliorated by treatment with DPx or silymarin. Treatment with DPx protected the Cd-induced histopathological hepatic injury, as confirmed by the evaluation of TUNEL assay. DPx treatment significantly reduced Bax and caspase-3 expression in Cd-injected rats. Additionally, HO-1 and NRF2 expressions were significantly increased after DPx administration in the liver of Cd-injected rats. Our data indicate that DPx successfully prevents Cd-induced hepatotoxicity by emphasizing the antioxidant and anti-inflammatory effect.