Breast Density Should Play a Greater Role in MRI Screening Guidelines.

Guidelines for breast cancer screening with MRI were first proposed in 2007, only a few years after its clinical introduction. Those initial guidelines, which were generated by a committee sponsored by the American Cancer Society (ACS), have served as the template for similar recommendations by several organizations, with a singular goal regarding patient candidacy for MRI screening, a qualifying threshold based on risk stratification. Higher risk in those patients recommended for MRI screening translates to higher cancer detection rates, which in turn impacts cost-effectiveness. But there is another variable that should be as important as risk stratification in selecting patients for MRI screening: the probability that screening mammography will fail to detect developing cancer. That failure rate is a function of breast density, included in the MRI screening guidelines as a traditional risk factor but neglected when one considers its role as the primary cause of false-negative mammograms. The two implications of dense mammograms are essentially independent: (1) refining risk stratification and (2) predicting the "miss rate" of mammography. In the 2007 guidelines, indications for annual screening MRI, in addition to mammography, were based on patients having a calculated probability of "greater than 20-25% lifetime risk" for developing breast cancer. Other categorical risks, such as BRCA positivity, are listed in the ACS guidelines, but in effect, the threshold for adding MRI to the screening regimen has been a 20% lifetime risk for the development of breast cancer. While risk stratification in the original MRI screening guidelines had a number of inconsistencies, the focus herein is the questionable placement of high-density patients into the category described as "no policy for or against MRI, more research needed," a category where lifetime risks were grouped as 15-19%. Thus, mammographic density was relegated to its role as a traditional risk factor, while its potentially more significant impact, predicting the "miss rate" of mammography, had no role in patient selection for screening MRI. The 2007 ACS guideline committee was limited by the lack of available data, and since there was no evidence for mortality reduction at the time, the decision was made to follow the patient selection criteria that had been used in the six international MRI screening trials, even though there was little consistency among those trials. Since then, the number of screening MRI trials has more than doubled, and new trials are being designed and implemented with a focus on both features of density: risk and cancer camouflage. Enough evidence has accumulated during the 16 years subsequent to the original ACS high-risk screening guidelines to consider a complete revision that accounts for both numerical risk levels and density levels, much like what was used in the ACRIN 6666 trial. In establishing a new set of guidelines, our first question should be: What is the "miss rate" of mammography in this patient? If the chance of a false-negative mammogram is as high as we see with Level D density, then the decision to include MRI becomes straightforward. The traditional risk assessment would then be used to help determine the optimal interval between MRI screens while maintaining cost-effective cancer detection rates.

Social Network Influence on Syphilis Testing for Black Sexual Minority Men in Baltimore, Maryland: A Cross-sectional Social Network Analysis.

ABSTRACT: Black sexual minority men (BSMM), including those with HIV, have disproportionate rates of syphilis infection. This study examines the associations of social network characteristics on syphilis testing, given that social network approaches are well established as effective methods to establish health-promoting social norms. We analyzed baseline data from a sexual health behavioral intervention. Using multivariable logistic regression, we modeled individual and social network characteristics on syphilis testing. Of the 256 participants, 37% tested for syphilis in the past year. In the adjusted model controlling for individual factors, odds of syphilis testing increased 89% for each increase in network member participants being encouraged to get a syphilis test (95% confidence interval [1.19-3.00]). Feeling comfortable accompanying a friend for HIV/sexually transmitted infection testing was associated with 2.47 increased odds of syphilis testing. Encouraging and training individuals to discuss sexual health topics with their network members may lead to the establishment of testing in social networks of Black sexual minority men.

Healing transgender women of color in Los Angeles: A transgender-centric delivery of Seeking Safety.

Background: Transgender women of Color experience disproportionate rates of HIV, depression, and anxiety, and high rates of substance use, attempted suicide, and interpersonal verbal, physical, and sexual violence and assault. However, there are few interventions targeting transgender women of Color that address overlapping health and mental health challenges. Aims: There are two aims/research questions: (1) what are the elements of a transgender-centric model for delivering evidence based interventions and practices?, and (2) does Seeking Safety improve substance use and mental health outcomes for transgender women of Color? Methods: We present a case study of the delivery process of Seeking Safety by Special Service for Groups/Asian Pacific AIDS Intervention Team (SSG/APAIT), and analyze baseline and three month post program participant data (n = 81). Results: The transgender-centric model of intervention delivery consisted of multiple steps, also integrating the structural disadvantages experienced by transgender women of Color. Comparing baseline and three months after completion showed significant decrease in reported alcohol use, depression, and severe anxiety. Discussion: Transgender-centric approaches may lead to programs that significantly improve co-occurring substance use and mental health for transgender women of Color. We recommend that organizations aiming to existing programs include feedback from members of the communities that the adapted programs aim to help, and in addition, train community members to deliver the programs. The statistical results indicate that Seeking Safety, a trauma-based program with a short program delivery timeline, may show longer term effects on substance use and mental health. We recommend that programs targeting substance use and mental health for transgender women of Color should be combined with services that address disadvantage (i.e., lack of access to housing, income/employment, health care).

Effects of the digital divide on the prevention of food risk in Taiwan.

Given the frequent occurrence of various food incidents, food safety is a significant public health concern worldwide. Health information plays an important role in risk prevention. As its reach continues to broaden, the Internet is emerging as a major source of health information for the public, although some social groups continue to have limited access. This study investigates the relation between the digital divide and practices for preventing food incidents in Taiwan. Using a nationally representative survey of 2098 adults, the results of our multinomial logistic regression and bootstrapped mediation analysis indicate the existence of second- and third-level digital divides. The association between socioeconomic status and Internet use time and digital skills results in disparities in food risk prevention behaviors and is partially mediated by online food safety information acquisition. Our findings reveal that the digital divide exacerbates health inequalities in food risk prevention. In addition to providing useful food safety information online, communication interventions should address the digital inequality by delivering food safety information through alternative networks for disadvantaged members of the public.

Feasibility of Breast MRI as the Primary Imaging Modality in a Large Asian Cohort.

Purpose Contrast-enhanced MRI has repeatedly demonstrated significantly enhanced sensitivity compared to mammography and ultrasound in breast cancer detection. The purpose of this study was to evaluate the feasibility and outcomes of using breast MRI as the initial imaging study for screening and diagnosis.  Materials and methods In this retrospective review of a cohort of 10,374 breast MRI scans in 7967 patients in Taitung County, Taiwan, a total of 5619 participants met inclusion criteria and were included in our analysis. We reviewed all biopsies that were performed subsequent to MRI studies in women (screening vs. diagnostic). The primary outcomes were false-positive (FP) biopsy rates and positive predictive value (PPV) of MRI - parameters that have historically been associated with performance that restricts more widespread use of MRI. False-positive rate based on benign biopsies (FPR-3) and the positive predictive value (PPV-3) were calculated. Results Without complementary imaging or follow-up to identify false negatives, the study of performance characteristics was limited to false positives and PPV. There were 351 benign biopsies generated by MRI out of the cohort of 5555 participants (5619 minus the malignant biopsies), generating a false-positive rate of 6.3%. Sixty-four patients out of 415 biopsies were malignant, generating a PPV-3 of 15.4%. Conclusion In this Asian cohort, utilizing breast MRI as the initial study for screening and/or diagnosis appears to be limited more by practical considerations such as cost and patient flow efficiency than by feasibility based on performance characteristics. With well-established superior sensitivity, coupled with improved interpretive skills and techniques that allow for low false-positive rates, MRI should be further studied for its role as the primary imaging modality in breast screening and diagnosis.

Study on effective extraction of chicken feather keratins and their films for controlling drug release.

We report the fabrication of keratin films with porosity using keratin, for controlled drug delivery systems. Feathers are currently an important waste product from the poultry industry, however abandoned down products cause an environmentally difficult disposal problem as they are not efficiently extracted and applied. In this paper, feather keratin was extracted using a high-efficiency method. The yield of pure keratin was up to 90%. Its molecular weight was 20 kDa with low dispersity. The films, based on the extracted keratin, were prepared using a simple method, and showed good mechanical properties. Furthermore, the feather keratin films were used to load and release drugs. The resultant feather keratin biopolymer films were pH-responsive and showed controllable drug-release behavior. In summary, we achieved a simple method to reutilize disused feathers. It could be an attractive candidate for applications in the biomedical field.

Utilization of high-resolution melting analysis to screen patients with neonatal intrahepatic cholestasis caused by citrin deficiency / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To assess the feasibility of high-resolution melting (HRM) analysis for screening patients with neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD).</p><p><b>METHODS</b>Based on previous studies on SLC25A13 gene in Chinese patients with NICCD, four hotspot mutations (851del4, 1638ins23, IVS6+5G>A and IVS16ins3kb) were selected. Results of the HRM analysis was validated using 50 negative controls and 20 patients with NICCD whose genotypes were confirmed previously by direct sequencing. With the established protocol, 171 suspected patients were enrolled. Samples with abnormal melting curves were further validated by DNA sequencing.</p><p><b>RESULTS</b>HRM analysis can accurately determine the genotypes of all negative controls and patients. The sensitivity and specificity of the technique reached 100% (70/70). The melting curves of samples with the same genotype were highly reproducible. In 171 suspected patients, seven NICCD patients were detected by HRM. Identified mutations have included one case of 851del4 homozygote, one case of IVS6+5G>A heterozygote, 3 cases of 851del4 heterozygotes, one case of [IVS6+5G>A]+[ 851del4] and one case of [1638ins23+IVS16ins3kb]+[1638ins23]. All mutations were subsequently confirmed by DNA sequencing.</p><p><b>CONCLUSION</b>HRM analysis is a convenient, high-throughput and rapid technique for the screening of NICCD patients.</p>