Wireless Technologies in Flexible and Wearable Sensing: From Materials Design, System Integration to Applications.

Wireless and wearable sensors attract considerable interest in personalized healthcare by providing a unique approach for remote, noncontact, and continuous monitoring of various health-related signals without interference with daily life. Recent advances in wireless technologies and wearable sensors have promoted practical applications due to their significantly improved characteristics, such as reduction in size and thickness, enhancement in flexibility and stretchability, and improved conformability to the human body. Currently, most researches focus on active materials and structural designs for wearable sensors, with just a few exceptions reflecting on the technologies for wireless data transmission. This review provides a comprehensive overview of the state-of-the-art wireless technologies and related studies on empowering wearable sensors. The emerging functional nanomaterials utilized for designing unique wireless modules are highlighted, which include metals, carbons, and MXenes. Additionally, the review outlines the system-level integration of wireless modules with flexible sensors, spanning from novel design strategies for enhanced conformability to efficient transmitting data wirelessly. Furthermore, the review introduces representative applications for remote and noninvasive monitoring of physiological signals through on-skin and implantable wireless flexible sensing systems. Finally, the challenges, perspectives, and unprecedented opportunities for wireless and wearable sensors are discussed.

Utilization of Biopolymer-Based Lutein Emulsion as an Effective Delivery System to Improve Lutein Bioavailability in Neonatal Rats.

Newborns' eyes and brains are prone to oxidative stress. Lutein has antioxidant properties and is the main component of macular pigment essential for protecting the retina, but has low bioavailability, thereby limiting its potential as a nutritional supplement. Oil-in-water emulsions have been used as lutein delivery systems. In particular, octenylsuccinated (OS) starch is a biopolymer-derived emulsifier safe to use in infant foods, while exhibiting superior emulsifying capacity. This study determined the effects of an OS starch-stabilized lutein emulsion on lutein bioavailability in Sprague-Dawley neonatal rats. In an acute study, 10-day-old pups received a single oral dose of free lutein or lutein emulsion, with subsequent blood sampling over 24 h to analyze pharmacokinetics. The lutein emulsion group had a 2.12- and 1.91-fold higher maximum serum lutein concentration and area under the curve, respectively, compared to the free lutein group. In two daily dosing studies, oral lutein was given from postnatal day 5 to 18. Blood and tissue lutein concentrations were measured. The results indicated that the daily intake of lutein emulsion led to a higher lutein concentration in circulation and key tissues compared to free lutein. The OS starch-stabilized emulsion could be an effective and safe lutein delivery system for newborns.

Coordination Environment Engineering to Regulate the Adsorption Strength of Intermediates in Single Atom Catalysts for High-performance CO2 Reaction Reduction.

The modulation of the coordination environment of single atom catalysts (SACs) plays a vital role in promoting CO2 reduction reaction (CO2 RR). Herein, N or B doped Fe-embedded graphyne (Fe-GY), Fe-nXGYm (n = 1, 2, 3; X = N, B; m = 1, 2, 3), are employed as probes to reveal the effect of the coordination environment engineering on CO2 RR performance via heteroatom doping in SACs. The results show that the doping position and number of N or B in Fe-GY significantly affects catalyst activity and CO2 RR product selectivity. In comparison, Fe-1NGY exhibits high-performance CO2 RR to CH4 with a low limiting potential of -0.17 V, and Fe-2NGY3 is demonstrated as an excellent CO2 RR electrocatalyst for producing HCOOH with a low limiting potential of -0.16 V. With applied potential, Fe-GY, Fe-1NGY, and Fe-2NGY3 exhibit significant advantages in CO2 RR to CH4 while hydrogen evolution reaction is inhibited. The intrinsic essence analysis illustrates that heteroatom doping modulates the electronic structure of active sites and regulates the adsorption strength of the intermediates, thereby rendering a favorable coordination environment for CO2 RR. This work highlights Fe-nXGYm as outstanding SACs for CO2 RR, and provides an in-depth insight into the intrinsic essence of the promotion effect from heteroatom doping.

Welded Carbon Nanotube-Graphene Hybrids with Tunable Strain Sensing Behavior for Wide-Range Bio-Signal Monitoring.

Carbon nanotubes (CNTs) and graphene have commonly been applied as the sensitive layer of strain sensors. However, the buckling deformation of CNTs and the crack generation of graphene usually leads to an unsatisfactory strain sensing performance. In this work, we developed a universal strategy to prepare welded CNT-graphene hybrids with tunable compositions and a tunable bonding strength between components by the in situ reduction of CNT-graphene oxide (GO) hybrid by thermal annealing. The stiffness of the hybrid film could be tailored by both initial CNT/GO dosage and annealing temperature, through which its electromechanical behaviors could also be defined. The strain sensor based on the CNT-graphene hybrid could be applied to collect epidermal bio-signals by both capturing the faint skin deformation from wrist pulse and recording the large deformations from joint bending, which has great potential in health monitoring, motion sensing and human-machine interfacing.

Developing biopolymer-stabilized emulsions for improved stability and bioaccessibility of lutein.

Lutein is essential for infant visual and cognitive development but has low stability and solubility. This study aimed to enhance the stability and bioaccessibility of lutein using oil-in-water emulsions stabilized with biopolymers. Commercially available octenylsuccinylated (OS) starches, including capsule TA® (CTA), HI-CAP®100 (HC), and Purity Gum® 2000 (PG), along with gum Arabic (GA) variants Ticaloid acacia Max® (TAM), TICAmulsion® 3020 (TM), and pre-hydrate gum Arabic (PHGA), were chosen as emulsifiers. By screening the effect of biopolymer concentration and oil volume fraction (Φ), emulsions stabilized with CTA, HC, or TM at 20% and 30% (w/v) concentration and 70% Φ exhibited a gel-like structure and were selected for further assessments. After a week at 25 °C, emulsions stabilized by CTA and HC showed no significant change in droplet size, while TM emulsion exhibited a 1.58-fold increase. At 45 °C, all emulsions exhibited increase in droplet size. Lutein retention is higher in CTA emulsions at both storage temperatures than free lutein. In vitro bioaccessibility of all lutein emulsions was higher than that of free lutein. These findings highlight the superior stability and bioaccessibility of the lutein emulsion stabilized by OS starch, positioning it as a promising carrier to broaden lutein applications in infant foods.

Stabilized cyclic peptides as modulators of protein-protein interactions: promising strategies and biological evaluation.

Protein-protein interactions (PPIs) control many essential biological pathways which are often misregulated in disease. As such, selective PPI modulators are desirable to unravel complex functions of PPIs and thus expand the repertoire of therapeutic targets. However, the large size and relative flatness of PPI interfaces make them challenging molecular targets for conventional drug modalities, rendering most PPIs "undruggable". Therefore, there is a growing need to discover innovative molecules that are able to modulate crucial PPIs. Peptides are ideal candidates to deliver such therapeutics attributed to their ability to closely mimic structural features of protein interfaces. However, their inherently poor proteolysis resistance and cell permeability inevitably hamper their biomedical applications. The introduction of a constraint (i.e., peptide cyclization) to stabilize peptides' secondary structure is a promising strategy to address this problem as witnessed by the rapid development of cyclic peptide drugs in the past two decades. Here, we comprehensively review the recent progress on stabilized cyclic peptides in targeting challenging PPIs. Technological advancements and emerging chemical approaches for stabilizing active peptide conformations are categorized in terms of α-helix stapling, ß-hairpin mimetics and macrocyclization. To discover potent and selective ligands, cyclic peptide library technologies were updated based on genetic, biochemical or synthetic methodologies. Moreover, several advances to improve the permeability and oral bioavailability of biologically active cyclic peptides enable the de novo development of cyclic peptide ligands with pharmacological properties. In summary, the development of cyclic peptide-based PPI modulators carries tremendous promise for the next generation of therapeutic agents to target historically "intractable" PPI systems.

Nomogram prediction of the 70-gene signature (MammaPrint) binary and quartile categorized risk using medical history, imaging features and clinicopathological data among Chinese breast cancer patients.

BACKGROUND: The 70-gene signature (70-GS, MammaPrint) test has been recommended by the main guidelines to evaluate prognosis and chemotherapy benefit of hormonal receptor positive human epidermal receptor 2 negative (HR + /Her2-) early breast cancer (BC). However, this expensive assay is not always accessible and affordable worldwide. Based on our previous study, we established nomogram models to predict the binary and quartile categorized risk of 70-GS. METHODS: We retrospectively analyzed a consecutive cohort of 150 female patients with HR + /Her2- BC and eligible 70-GS test. Comparison of 40 parameters including the patients' medical history risk factors, imaging features and clinicopathological characteristics was performed between patients with high risk (N = 62) and low risk (N = 88) of 70-GS test, whereas risk calculations from established models including Clinical Treatment Score Post-5 years (CTS5), Immunohistochemistry 3 (IHC3) and Nottingham Prognostic Index (NPI) were also compared between high vs low binary risk of 70-GS and among ultra-high (N = 12), high (N = 50), low (N = 65) and ultra-low (N = 23) quartile categorized risk of 70-GS. The data of 150 patients were randomly split by 4:1 ratio with training set of 120 patients and testing set 30 patients. Univariate analyses and multivariate logistic regression were performed to establish the two nomogram models to predict the the binary and quartile categorized risk of 70-GS. RESULTS: Compared to 70-GS low-risk patients, the high-risk patients had significantly less cardiovascular co-morbidity (p = 0.034), more grade 3 BC (p = 0.006), lower progesterone receptor (PR) positive percentage (p = 0.007), more Ki67 high BC (≥ 20%, p < 0.001) and no significant differences in all the imaging parameters of ultrasound and mammogram. The IHC3 risk and the NPI calculated score significantly correlated with both the binary and quartile categorized 70-GS risk classifications (both p < 0.001). The area under curve (AUC) of receiver-operating curve (ROC) of nomogram for binary risk prediction were 0.826 (C-index 0.903, 0.799-1.000) for training and 0.737 (C-index 0.785, 0.700-0.870) for validation dataset respectively. The AUC of ROC of nomogram for quartile risk prediction was 0.870 (C-index 0.854, 0.746-0.962) for training and 0.592 (C-index 0.769, 0.703-0.835) for testing set. The prediction accuracy of the nomogram for quartile categorized risk groups were 55.0% (likelihood ratio tests, p < 0.001) and 53.3% (p = 0.04) for training and validation, which more than double the baseline probability of 25%. CONCLUSIONS: To our knowledge, we are the first to establish easy-to-use nomograms to predict the individualized binary (high vs low) and the quartile categorized (ultra-high, high, low and ultra-low) risk classification of 70-GS test with fair performance, which might provide information for treatment choice for those who have no access to the 70-GS testing.

Eco-Friendly Cerium-Cobalt Counter-Doped Bi2Se3 Nanoparticulate Semiconductor: Synergistic Doping Effect for Enhanced Thermoelectric Generation.

Metal chalcogenides are primarily used for thermoelectric applications due to their enormous potential to convert waste heat into valuable energy. Several studies focused on single or dual aliovalent doping techniques to enhance thermoelectric properties in semiconductor materials; however, these dopants enhance one property while deteriorating others due to the interdependency of these properties or may render the host material toxic. Therefore, a strategic doping approach is vital to harness the full potential of doping to improve the efficiency of thermoelectric generation while restoring the base material eco-friendly. Here, we report a well-designed counter-doped eco-friendly nanomaterial system (~70 nm) using both isovalent (cerium) and aliovalent (cobalt) in a Bi2Se3 system for enhancing energy conversion efficiency. Substituting cerium for bismuth simultaneously enhances the Seebeck coefficient and electrical conductivity via ionized impurity minimization. The boost in the average electronegativity offered by the self-doped transitional metal cobalt leads to an improvement in the degree of delocalization of the valence electrons. Hence, the new energy state around the Fermi energy serving as electron feed to the conduction band coherently improves the density of the state of conducting electrons. The resulting high power factor and low thermal conductivity contributed to the remarkable improvement in the figure of merit (zT = 0.55) at 473 K for an optimized doping concentration of 0.01 at. %. sample, and a significant nanoparticle size reduction from 400 nm to ~70 nm, making the highly performing materials in this study (Bi2-xCexCo2x3Se3) an excellent thermoelectric generator. The results presented here are higher than several Bi2Se3-based materials already reported.

Starch-ascorbyl palmitate inclusion complex, a type 5 resistant starch, reduced in vitro digestibility and improved in vivo glycemic response in mice.

The prevalence of type 2 diabetes (T2D) has become a major public health concern worldwide. Slowly digested or indigestible carbohydrates such as resistant starch (RS) are associated with a low glycemic index (GI) and the decreased risk of developing T2D. Recently, starch inclusion complexes (ICs) have raised attention due to their thermally stable structure and high RS content. In this study, starch-ascorbyl palmitate (AP) ICs were produced using two different methods with hydrothermal treatments performed, and their in vitro digestion kinetics and in vivo glycemic response in C57BL/6J mice were investigated to determine their potential as a new type of RS, i.e., RS5. After treatments of annealing followed by acid hydrolysis (ANN-ACH), IC samples produced by both methods retained V-type crystalline structure. Either in their raw or treated conditions, V6h-AP ICs prepared using the "empty" V-type method exhibited a more favorable hydrolysis pattern as compared to its counterpart produced by the DMSO method in terms of a lower hydrolysis rate and equilibrium concentration (C∞) (p < 0.05). From the in vitro results, the ANN-ACH treated V6h-AP IC exhibited an estimated GI (eGI) value of 54.83, falling within the range of low GI foods and was the lowest among all tested samples (p < 0.05). Consistent with the in vitro digestion kinetics, the in vivo results showed that mice fed with ANN-ACH V6h-AP IC exhibited a modest glycemic response as evidenced by the lowest increase in postprandial blood glucose and AUC blood glucose (p < 0.05). In addition, the in vivo GI of the ANN-ACH V6h-AP IC (39.53) was the lowest among all the sample treatments and was even lower than that of the RS2 comparison (56, p < 0.05), indicating its more pronounced effect in modulating the postprandial glycemic response in mice and great potential as a new RS5.

Polyvinyl alcohol flame retardant film based on halloysite nanotubes, chitosan and phytic acid with strong mechanical and anti-ultraviolet properties.

The research of additive biomass flame retardants is becoming more and more popular. In this work, amino modified halloysite nanotubes (A-HNTs), chitosan (CS) and phytic acid (PA) were introduced into polyvinyl alcohol (PVA) matrix to construct PA/A-HNT/CS/PVA organic-inorganic composite film with hydrogen bond and covalent bond cross-linking network structure. Adding PA/A-HNT/CS can remarkably improve the mechanical strength, UV resistance and thermal stability of PVA film. Compared with control PVA film, the transmittance of composite film in ultraviolet region decreases from 90 % to <15 %, and the tensile strength raises from 19.8 MPa to 31.0 MPa. The thermal decomposition temperature of the composite film increases, the weight loss rate decreases obviously, and the carbon residue can reach 26 wt% at 700 °C. The limiting oxygen index increases from 18.5 % to 32.2 %. Furthermore, the addition of this flame-retardant system can obviously reduce the combustion intensity of PVA, and its flame-retardant grade can reach V-0. It is of great significance to expand the application of PVA and the development of biomass flame retardant.

Is Breast Magnetic Resonance Imaging Superior to Sonography in Gynecomastia Evaluation and Surgery Planning.

BACKGROUND: Data on the value of magnetic resonance imaging (MRI) in the preoperative evaluation and surgery planning of gynecomastia are limited. The purpose of this study is to reveal MRI features and categories of gynecomastia and compare surgical outcomes following MRI and sonography as well as their diagnostic accuracy. METHODS: The area of the gland and the whole breast on the transverse plane via nipple of MRI were measured to calculate the ratio between them. Areola, mass and branch patterns were categorized to represent three different gynecomastia type on MRI. 183 patients were included, with 38 in MRI group and 145 in sonography group. Diagnostic accuracy was assessed by the level of agreement between preoperative imaging findings and intraoperative observations. Surgical data, patients' satisfaction and complications were compared between the two groups. RESULTS: MRI in 75 gynecomastic breasts demonstrated the average ratio of the gland to the whole breast was 10.6%±13.3%. The most common MRI categories were branch patterns (45.3%). The diagnostic concordance rate of MRI was higher than sonography (100% vs. 86.8%, p = 0.001). Among those junior surgeons, the length of surgery was reduced in MRI group (100 min vs. 115 min, p = 0.048). There was no difference in terms of patient's satisfaction and complication rate between MRI and sonography. CONCLUSION: MRI was superior to sonography in diagnostic accuracy to assess the tissue components of gynecomastia and provided informative guidance especially for junior surgeons. Surgical outcomes were comparable regardless of the use of MRI or sonography for evaluation. LEVEL OF EVIDENCE IV: IThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

bHLH transcription factor family identification, phylogeny, and its response to abiotic stress in Chenopodium quinoa.

The second-largest transcription factor superfamily in plants is that of the basic helix-loop-helix (bHLH) family, which plays an important complex physiological role in plant growth, tissue development, and environmental adaptation. Systematic research on the Chenopodium quinoa bHLH family will enable a better understanding of this species. Herein, authors used a variety of bioinformatics methods and quantitative Real-Time Polymerase Chain Reaction (qRT-PCR) to explore the evolution and function of the 218 CqbHLH genes identified. A total of 218 CqbHLH transcription factor genes were identified in the whole genome, located on 18 chromosomes. A phylogenetic tree was constructed using the CqbHLH and AtbHLH proteins to determine their homology, and the members were divided into 20 subgroups and one unclustered gene. Authors also analyzed 218 CqbHLH genes, conservative motifs, chromosome diffusion, and gene replication. The author constructed one Neighbor-Joining (NJ) tree and a collinearity analysis map of the bHLH family in C. quinoa and six other plant species to study the evolutionary relationship and homology among multiple species. In addition, the expression levels of 20 CqbHLH members from different subgroups in various tissues, different fruit developmental stages, and six abiotic stresses were analyzed. Authors identified 218 CqbHLH genes and studied their biological functions, providing a basis for better understanding and further studying the bHLH family in quinoa.

Electrospun single-phase spinel magnetic high entropy oxide nanoparticles via low-temperature ambient annealing.

High entropy oxide nanoparticles (HEO NPs) with multiple component elements possess improved stability and multiple uses for functional applications, including catalysis, data memory, and energy storage. However, the synthesis of homogenous HEO NPs containing five or more immiscible elements with a single-phase structure is still a great challenge due to the strict synthetic conditions. In particular, several synthesis methods of HEO NPs require extremely high temperatures. In this study, we demonstrate a low cost, facile, and effective method to synthesize three- to eight-element HEO nanoparticles by a combination of electrospinning and low-temperature ambient annealing. HEO NPs were generated by annealing nanofibers at 330 °C for 30 minutes under air conditions. The average size of the HEO nanoparticles was ∼30 nm and homogenous element distribution was obtained from post-electrospinning thermal decomposition. The synthesized HEO NPs exhibited magnetic properties with the highest saturation magnetization at 9.588 emu g-1 and the highest coercivity at 147.175 Oe for HEO NPs with four magnetic elements while integrating more nonmagnetic elements will suppress the magnetic response. This electrospun and low-temperature annealing method provides an easy and flexible design for nanoparticle composition and economic processing pathway, which offers a cost- and energy-effective, and high throughput entropy nanoparticle synthesis on a large scale.

Role of transition metal d-orbitals in single-atom catalysts for nitric oxide electroreduction to ammonia.

Recently, surging interests exist in direct electrochemical ammonia (NH3) synthesis from nitric oxide (NO) due to the dual benefit of NH3 synthesis and NO removal. However, designing highly efficient catalysts is still challenging. Based on density functional theory, the best ten candidates of transition-metal atoms (TMs) embedded in phosphorus carbide (PC) monolayer is screened out as highly active catalysts for direct NO-to-NH3 electroreduction. The employment of machine learning-aided theoretical calculations helps to identify the critical role of TM-d orbitals in regulating NO activation. A V-shape tuning rule of TM-d orbitals for the Gibbs free energy change of NO or limiting potentials is further revealed as the design principle of TM embedded PC (TM-PC) for NO-to-NH3 electroreduction. Moreover, after employing effective screening strategies including surface stability, selectivity, the kinetic barrier of potential-determining step, and thermal stability comprehensively studied for the ten TM-PC candidates, only Pt embedded PC monolayer has been identified as the most promising direct NO-to-NH3 electroreduction with high feasibility and catalytic performance. This work not only offers a promising catalyst but also sheds light on the active origin and design principle of PC-based single-atom catalysts for NO-to-NH3 conversion.

Structure-digestibility relationship of starch inclusion complex with salicylic acid.

Amylose, the linear component of starch, can complex with small molecules to form single helical inclusion complexes of 6, 7, or 8 glucosyl units per helical turn, known as V6, V7, and V8. In this study, starch-salicylic acid (SA) inclusion complexes with different amounts of residual SA were obtained. Their structural characteristics and digestibility profiles were obtained with complementary techniques and an in vitro digestion assay. Upon complexation with excess SA, V8 type starch inclusion complex was formed. When excess SA crystals were removed, the V8 polymorphic structure could remain, while further removing intra-helical SA converted the V8 conformation to V7. Furthermore, the digestion rate of the resulted V7 was lowered as indicated by increased resistant starch (RS) content, which could be due to its tight helical structure, whereas the two V8 complexes were highly digestible. Such findings could have practical implications for novel food product development and nanoencapsulation technology.

Encapsulation in Amylose Inclusion Complex Enhances the Stability and Release of Vitamin D.

Vitamin D plays a significant role in the physiological functions of the human body. However, the application of vitamin D in functional foods is limited due to its sensitivity to light and oxygen. Therefore, in this study, we developed an effective method to protect vitamin D by encapsulating it in amylose. In detail, vitamin D was encapsulated by amylose inclusion complex, followed by structural characterization and evaluation of its stability and release properties. The results of X-ray diffraction, differential scanning calorimetry, and Fourier transform infrared spectroscopy showed that vitamin D was successfully encapsulated in the amylose inclusion complex, and the loading capacity was 1.96% ± 0.02%. The photostability and thermal stability of vitamin D after encapsulation was increased by 59% and 28%, respectively. In addition, in vitro simulated digestion showed that vitamin D was protected through the simulated gastric environment and can be released gradually in the simulated intestinal fluid, implying its improved bioaccessibility. Our findings provide a practical strategy for the development of functional foods based on vitamin D.

Microwave imaging for watermelon maturity determination.

Microwave imaging technology is a useful method often applied in medical diagnosis and can be used by the food industry to ensure food safety and quality. For fruit, ripeness is the primary characteristic which determines quality for the consumer. This paper proposes a novel microwave imaging system to determine the ripeness of watermelon as a proof of concept. The design employs a circular array with 10 Coplanar Vivaldi antennas offering wide bandwidth, high gain, and high efficiency. S-parameters between antennas are collected quickly via automated channel switching for fast image generation. Eight different watermelon samples of varying ripeness, type, dimensions, and origin are scanned and imaged. Comparisons with sample cross-sections show distinct differences in image characteristics based on watermelon maturity. Sugar concentration of unripe and ripe watermelon is also measured and plotted for further validation of the imaging technique.

A Modified Vancomycin Molecule Confers Potent Inhibitory Efficacy against Resistant Bacteria Mediated by Metallo-ß-Lactamases.

Multidrug-resistant bacterial infections mediated by metallo-ß-lactamases (MßLs) have grown into an emergent health threat, and development of novel antimicrobials is an ideal strategy to combat the infections. Herein, a novel vancomycin derivative Vb was constructed by conjugation of triazolylthioacetamide and vancomycin molecules, characterized by reverse-phase high performance liquid chromatography (HPLC) and confirmed by matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS). The biological assays revealed that Vb effectively inhibited S. aureus and methicillin-resistant S. aureus (MRSA), gradually increased the antimicrobial effect of ß-lactam antibiotics (cefazolin, meropenem and penicillin G) and exhibited a dose-dependent synergistic antibacterial effect against eight resistant strains tested, which was confirmed by the time-kill curves determination. Most importantly, Vb increased the antimicrobial effect of meropenem against the clinical isolates EC08 and EC10 and E. coli producing ImiS and CcrA, resulting in a 4- and 8-fold reduction in MIC values, respectively, at a dose up to 32 µg/mL. This work offers a promising scaffold for the development of MßLs inhibitors, specifically antimicrobials for clinically drug-resistant isolates.

Long-term survival of screen-detected synchronous and metachronous bilateral non-palpable breast cancer among Chinese women: a hospital-based study (2003-2017).

PURPOSE: Screen-detected unilateral non-palpable breast cancer (NPBC) shows favorable prognosis, whereas bilateral breast cancer (BBC), especially synchronous BBC (SBBC) manifests worse survival than unilateral breast cancer (BC). It remains unclear whether screen-detected bilateral NPBC has compromised survival and requires intensified treatment or favorable prognosis and needs de-escalating therapy. METHODS: From 2003 to 2017, 1,075 consecutive NPBC patients were retrospectively reviewed. There were 988 patients with unilateral NPBC (UniNPBC), and 87 patients with ipsilateral NPBC + any contralateral BC [(N + AnyContra) PBC], including 32 patients with bilateral NPBC (BiNPBC) and 55 patients with ipsilateral NPBC + contralateral palpable cancer [(N + Contra) PBC]. Median follow-up time was 91 (48-227) months. Clinicopathological characteristics were compared between UniNPBC and BBC, whereas relapse-free survival (RFS) and overall survival (OS) among BBC subgroups. RFS and OS factors of BBC were identified. RESULTS: Compared to UniNPBC, patients with screen-detected bilateral BC had more invasive (85.1%, 74.8%), ER negative (26.4%, 17.1%), PR negative (36.8%, 23.5%), triple-negative (21.6%, 8.5%) BC as well as less breast conserving surgery (17.2%, 32.4%), radiotherapy (13.8%, 32.0%) and endocrine therapy (71.3%, 83.9%). 10 year RFS and OS rates of (N + AnyContra) PBC (72.8%, 81.5%), (N + Contra) PBC (60.6%, 73.9%), and synchronous (N + Contra) PBC (58.1%, 70.1%) were significantly compromised compared to UniNPBC (91.0%, 97.2%). RFS factors of BBC included pN3 (p = 0.048), lymphovascular invasion (p = 0.008) and existence of contralateral palpable interval BC (p = 0.008), while the OS relevant factor was pN3 (p = 0.018). CONCLUSION: Screen-detected bilateral NPBC including SynBiNPBC and MetaBiNPBC showed good prognosis as UniNPBC so that the therapy of BiNPBC could be de-escalated and optimized according to UniNPBC. Contrarily, screen-detected ipsilateral NPBC with contralateral palpable BC [(N + Contra) PBC] manifested unfavorable survival worse than UniNPBC and synchronous (N + Contra) PBC had the worst survival among all subgroups, implying that these were actually bilateral interval BC and required intensified treatment.

Can Pre-biopsy Second-Look Breast Ultrasound Affect Clinical Management? Experience From a Single Tertiary Hospital.

Objectives: Interpretation discrepancy is a major disadvantage of breast imaging. This study aimed to determine the clinical benefit of the pre-biopsy second-look breast ultrasound (US). Methods: Patients with suspicious breast masses referred to our tertiary hospital for US-guided breast biopsy were retrospectively reviewed between August 2017 and November 2019. Here, second-look assessments were performed by experienced specialized breast radiologists via performing a bilateral breast US scan plus reviewing former imaging studies, and results were compared with the initial assessment. Interpretation changes in terms of biopsy recommendation and surgical management (i.e., lumpectomy to mastectomy) were analyzed. Results: A total of 537 patients were enrolled in this study. Interpretation discrepancies occurred in 109 patients (20%; 95% CI, 17%-24%). Among them, there were 84 patients (16%; 95% CI, 13%-19%) whose masses were re-classified as BI-RADS 3 by the second-look US and underwent 2-year follow-up, showing 82 benign, 1 malignant, and 1 high-risk lesions. On the other hand, 16 patients (3%; 95% CI, 2%-5%) undertook biopsy at an additional site, identifying 10 new malignant lesions, 3 high-risk lesions, and 3 benign lesions, resulting in surgical management changes in 12 patients. In addition, nine (2%; 95% CI, 1%-3%) patients received discrepant disease ranges, which also altered surgical management. Overall, 21 patients (4%; 95% CI, 3%-6%) got their surgical management altered by the second-look US. Conclusion: Pre-biopsy second-look assessment of breast US can reduce unnecessary biopsies in 16% of patients and alter surgical management in 4% of patients, suggesting it is a practical and valuable method for patient care improvement.