The role of a mobile hearing application in secondary care ENT (HAppENT).

OBJECTIVE: Sudden hearing loss is a common presentation to ENT. In the authors' practice, patients often wait many weeks for formal hearing testing. This study aimed to assess whether a tablet-based hearing test, hearTest, could aid clinical decision-making within secondary care ENT. METHOD: This was a multi-centre, prospective, non-randomised study to assess the feasibility, usability and accuracy of hearTest. RESULTS: In the sample, hearTest was shown to be an acceptable method of testing for hearing loss by both patients and clinicians. The 0.5-4 kHz range had an average clinical agreement rate of 95.1 per cent when compared with formal pure tone audiometry, deeming it an accurate test to diagnose hearing loss. CONCLUSION: The authors propose that hearTest can be used within ENT as a clinical decision support tool when manual audiometry is not immediately available. Within the authors' practice, hearTest is used to aid diagnosis and management of sudden sensorineural hearing loss.

Elucidating the Effects of Reaction Time on the Physicochemical Characterization of Valorized Synthesized Alumina.

Aluminum waste-can management in Malaysia has recently become a serious environmental and public health issue, particularly in metropolitan areas. This has prompted the need to valorize these waste-cans into value-added products using the most economical and environmentally friendly techniques. In this study, the sol-gel technique was used to synthesize high-quality alumina from the aluminum waste-cans collected. From this method, the observed peaks of the synthesized alumina were identified as diaspore (α-AlO(OH)), boehmite (γ-AlO(OH)), aluminum oxide, or gamma-alumina (γ-Al2O3) crystalline structure and corundum. The morphological configuration, microstructure, and functional group properties of the synthesized alumina were evaluated. All the synthesized alumina exhibited a non-spherical shape and appeared to have hexagonal-like shape particles. Moreover, the XRD patterns of the synthesized alumina AL-6-30 and AL-12-30 exhibited a small angle (1-10°) with no XRD peak, which indicated a mesoporous pore structure with no long-range order. The overall results of γ-alumina synthesized from the aluminum waste-cans showed an optimal condition in producing a highly structured γ-alumina with excellent surface-area characteristics. The synthesized alumina exhibited stronger and highly crystalline functional characteristics almost comparable with the commercially available brands on the market.

Ischemic injury of the upper gastrointestinal tract after out-of-hospital cardiac arrest: a prospective, multicenter study.

BACKGROUND: The consequences of cardiac arrest (CA) on the gastro-intestinal tract are poorly understood. We measured the incidence of ischemic injury in the upper gastro-intestinal tract after Out-of-hospital CA (OHCA) and determined the risk factors for and consequences of gastrointestinal ischemic injury according to its severity. METHODS: Prospective, non-controlled, multicenter study in nine ICUs in France and Belgium conducted from November 1, 2014 to November 30, 2018. Included patients underwent an esophago-gastro-duodenoscopy 2 to 4 d after OHCA if still intubated and the presence of ischemic lesions of the upper gastro-intestinal tract was determined by a gastroenterologist. Lesions were a priori defined as severe if there was ulceration or necrosis and moderate if there was mucosal edema or erythema. We compared clinical and cardiac arrest characteristics of three groups of patients (no, moderate, and severe lesions) and identified variables associated with gastrointestinal ischemic injury using multivariate regression analysis. We also compared the outcomes (organ failure during ICU stay and neurological status at hospital discharge) of the three groups of patients. RESULTS: Among the 214 patients included in the analysis, 121 (57%, 95% CI 50-63%) had an upper gastrointestinal ischemic lesion, most frequently on the fundus. Ischemic lesions were severe in 55/121 (45%) patients. In multivariate regression, higher adrenaline dose during cardiopulmonary resuscitation (OR 1.25 per mg (1.08-1.46)) was independently associated with increased odds of severe upper gastrointestinal ischemic lesions; previous proton pump inhibitor use (OR 0.40 (0.14-1.00)) and serum bicarbonate on day 1 (OR 0.89 (0.81-0.97)) were associated with lower odds of ischemic lesions. Patients with severe lesions had a higher SOFA score during the ICU stay and worse neurological outcome at hospital discharge. CONCLUSIONS: More than half of the patients successfully resuscitated from OHCA had upper gastrointestinal tract ischemic injury. Presence of ischemic lesions was independently associated with the amount of adrenaline used during resuscitation. Patients with severe lesions had higher organ failure scores during the ICU stay and a worse prognosis. Clinical Trial Registration NCT02349074 .

Neurocritical care for neurological incapacitated patients.

Admission to ICU for patients with long-term disease is always the result of a reflection for short and long term benefit. When the disease is about functional or cognitive autonomy, we have to think with ethical considerations to allow the patient to find acceptable quality of life after Intensive Care Unit (ICU). ICU complications through the prism of neurological incapacitated patients will be described. As neurodegenerative disorder like Parkinson's disease shares common points with delirium or sepsis associated encephalopathy (SAE), there is a theoretic link to think that ICU could worsen cognitive function among patients with neurodegenerative disorder (ND). However, clinical data are still very poor. Regarding long term sequelae after ICU stay and probable synergy between ICU and incapacitated patients to worsen their handicap, different angles should be considered when those patients are referred to ICU.

Link N suppresses interleukin-1ß-induced biological effects on human osteoarthritic cartilage.

Osteoarthritis (OA) is a disease of diarthrodial joints associated with extracellular matrix proteolytic degradation under inflammatory conditions, pain and disability. Currently, there is no therapy to prevent, reverse or modulate the disease course. The present study aimed at evaluating the regenerative potential of Link N (LN) in human OA cartilage in an inflammatory milieu and determining if LN could affect pain-related behaviour in a knee OA mouse injury model. Osteo-chondro OA explants and OA chondrocytes were treated with LN in the presence of interleukin-1ß (IL-1ß) to simulate an osteoarthritic environment. Quantitative von Frey polymerase chain reaction and Western blotting were performed to determine the effect of LN on matrix protein synthesis, catabolic enzymes, cytokines and nerve growth factor expression. Partial medial meniscectomy (PMM) was performed on the knee of C57BL/6 mice and, 12 weeks post-surgery, mice were given a 5 µg intra-articular injection of LN or phosphate-buffered saline. A von Frey test was conducted over 24 h to measure the mechanical allodynia in the hind paw. LN modulated proteoglycan and collagen synthesis in human OA cartilage through inhibition of IL-1ß-induced biological effects. LN also supressed IL-1ß-induced upregulation of cartilage-degrading enzymes and inflammatory molecules in OA chondrocytes. Upon investigation of the canonical signalling pathways IL-1ß and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), LN resulted to significantly inhibit NF-κB activation in a dose-dependent manner. In addition, LN suppressed mechanical allodynia in an OA PMM mouse model. Results supported the concept that LN administration could provide therapeutic potential in OA.

Self-Reported Parenting Stress and Cortisol Awakening Response Following Mindfulness-Based Stress Reduction Intervention for Parents of Children With Developmental Delays: A Pilot Study.

BACKGROUND: Many parents of children with developmental delays (DDs) experience high levels of parental stress, and young children with DDs are likely to exhibit clinical levels of behavioral problems. The reciprocal relationship between the two issues makes these families vulnerable to stress-related health risks. To address this, the current study aims to investigate the effectiveness of mindfulness-based stress reduction (MBSR) at reducing parent stress, as measured by both psychological self-report and a physiological biomarker. METHOD: A pretest-posttest design with a 6-month follow-up assessment was used to establish effectiveness with analyses of within-subject effects. Parents (N = 47) of children (2.5-5 years of age) with DDs participated in a standard 8-week MBSR intervention. Measures included the Parenting Daily Hassles, a self-report measure of perceived frequency and intensity of parenting stress, and salivary samples for measurement of the cortisol awakening response (CAR), a biological marker of stress response. RESULTS: Both self-reported parenting stress and CAR decreased following MBSR for parents of children with DDs. The greatest difference in means over time was between baseline and follow-up, where changes in effect size were even stronger for biological markers than for self-report measures. CONCLUSION: The MBSR intervention reduced both perceived and physiologic stress. Health-care professionals caring for these families might consider encouraging parents to participate in MBSR as both treatment and prevention of parenting stress.

Diabetic ketoacidosis, a common disease with life-threatening pitfalls.

Diabetic ketoacidosis (DKA) is a common cause for admission in Emergency Department. Its treatment is well defined. Nevertheless, in some cases, type I diabetes combines with auto-immune polyendocrine syndrome, which can carry life-threatening consequences. Here we report the case of a young man with inaugural DKA who exhibited ventricular fibrillation and cardiac arrest due to significant hypokalaemia, following undiagnosed thyrotoxicosis with periodic paralysis.

Polymer complexes. LXXV. Characterization of quinoline polymer complexes as potential bio-active and anti-corrosion agents.

The Cu2+, Co2+, Ni2+ and UO22+ polymer complexes of 5-(2,3-dimethyl-1-phenylpyrazol-5-one azo)-8-hydroxyquinoline (HL) ligand were prepared and characterized. Elemental analyses, IR spectra, X-ray diffraction analysis and thermal analysis studies have been used to confirm the structure of the prepared polymer complexes. The chemical structure of metal chelates commensurate that the ligand acts as a neutral bis(bidentate) by through four sites of coordination (azo dye nitrogen, carbonyl oxygen, phenolic oxygen and hetero nitrogen from pyridine ring). The molecular and electronic structures of the hydrogen bond conformers of HL ligand were optimized theoretically and the quantum chemical parameters were calculated. Elemental analysis data suggested that the polymer complexes have composition of octahedral geometry for all the polymer complexes. Molecular docking of the binding between HL and the receptors of prostate cancer (PDB code 2Q7L Hormone) and the breast cancer (PDB code 1JNX Gene regulation) was studied. The interaction between HL and its polymer complexes with the calf thymus DNA (CT-DNA) was determined by absorption spectra. The antimicrobial activity of HL and its Cu2+, Co2+, Ni2+ and UO22+ polymer complexes were investigated; only Cu(II) polymer complex (1) was specifically active against Aspergillus niger. It inhibited the fungal sporulation and distorted the fungal mycelia, which became squashed at a concentration of 150 µg/ml; transmission electron microscope (TEM) also showed a deactivation of autophagy in the treated A. niger cells via accumulation of autophagic bodies in vacuoles. The inhibition process of the prepared ligand (HL) against the corrosion of carbon steel in 2 M HCl solution was determined by various methods (weight loss, potentiodynamic polarization, electrochemical impedance spectroscopy (EIS) and electrochemical frequency modulation (EFM) techniques) are found to be in reasonable agreement. The mechanism of inhibition in presence of HL in carbon steel corrosion obeys Friendlish adsorption isotherm.

Tactile intervention as a novel technique in improving body stability in healthy elderly and elderly with diabetes.

BACKGROUND: Body sway increases in the elderly because of normal aging and high incidence of disease such as diabetes. Prevalence of sway is greater in the elderly with diabetes because of damage to the central and peripheral nervous systems. Increase in body sway is associated with an elevated risk of falling. Falling is one of the major causes of morbidity and mortality in the elderly. The purpose of this study was to develop a new technique to improve body stability and decrease body sway in the elderly people with or without diabetes. SUBJECTS AND METHODS: Twenty-two subjects--12 elderly (mean age, 75.5±7.3 years) and 10 age-matched elderly with diabetes (mean age, 72.5±5.3 years)--were recruited for this study. Subjects received tactile feedback as a tingling sensation resulting from electrical stimulation triggered by body sway. RESULTS: The results showed a significant reduction in body sway in the elderly while standing on foam with eyes open (1.0±0.31 vs. 1.9±0.8; P=0.006) and eyes closed (1.8±0.7 vs. 3.3±1.5; P=0.001). In the group with diabetes, there was a significant reduction in body sway while standing on foam with eyes closed (1.4±0.5 vs. 2.3±0.8; P=0.045) but not with eyes open. CONCLUSIONS: In this small study, this technique offers a new tool for training people with diabetes and elderly people to improve body stability and balance.

Polymorphism of the merozoite surface protein-1 block 2 region in Plasmodium falciparum isolates from Mauritania.

BACKGROUND: The genetic diversity of Plasmodium falciparum has been extensively studied in various parts of the world. However, limited data are available from Mauritania. The present study examined and compared the genetic diversity of P. falciparum isolates in Mauritania. METHODS: Plasmodium falciparum isolates blood samples were collected from 113 patients attending health facilities in Nouakchott and Hodh El Gharbi regions. K1, Mad20 and RO33 allelic family of msp-1 gene were determined by nested PCR amplification. RESULTS: K1 family was the predominant allelic type carried alone or in association with Ro33 and Mad20 types (90%; 102/113). Out of the 113 P. falciparum samples, 93(82.3%) harboured more than one parasite genotype. The overall multiplicity of infection was 3.2 genotypes per infection. There was no significant correlation between multiplicity of infection and age of patients. A significant increase of multiplicity of infection was correlated with parasite densities. CONCLUSIONS: The polymorphism of P. falciparum populations from Mauritania was high. Infection with multiple P. falciparum clones was observed, as well as a high multiplicity of infection reflecting both the high endemicity level and malaria transmission in Mauritania.

Characterization of anopheline (Diptera: Culicidae) larval habitats in Nouakchott, Mauritania.

BACKGROUND & OBJECTIVES: Despite the increasing number of reported autochthonous malaria cases in Nouakchott and the identification of Anopheles arabiensis as the major malaria vector in this Saharan city, anopheline larval habitats have never been identified so far. The objective of this study was to identify and characterize anopheline larval habitats in Nouakchott. METHODS: During September and October 2012, samples from pools of rainwater, water discharged from standpipes and household drinking water tanks in the districts of Dar Naim, Teyarett and Arafat were analyzed for the presence/absence of anopheline larvae and physicochemical characterization of breeding habitats. RESULTS: Of the 51 prospected water bodies, eight consisting of seven water discharged from standpipes and one household drinking water tank were productive for Anopheles sp. All emerged anopheline mosquitoes from the positive dipping were morphologically identified as members of the An. gambiae complex. Multivariate regression analyses showed that a salinity up to 0.1 g/l and a shaded situation were respectively protective factors against high larval density in breeding sites (adjusted odds ratio = 0.62, 95% CI [0.44-0.87], p = 0.0052 and adjusted odds ratio = 0.56, 95% CI [0.44-0.71, p <0.0001] and a pH up to 7.61 was a risk factor for high larval density in breeding sites (adjusted odds ratio = 1.56, 95% CI [1.25-1.95], p = 0.0001). INTERPRETATION & CONCLUSION: The study demonstrated in Nouakchott that despite an arid and dry climate, human practices have contributed to the establishment of favourable environmental conditions for the development of anopheline mosquitoes and, therefore, maintaining malaria transmission in this Saharan city. The core malaria vector control intervention as the use of long-lasting insecicidal nets (LLINs) could be complemented in Nouakchott by larval source control. In this area, appropriate larval control measures may be recommended in line with an integrated vector management (IVM) approach.

Malaria prevalence and morbidity among children reporting at health facilities in Nouakchott, Mauritania.

Although malaria has become a serious public health problem in Mauritania since the late 1990s, few documented data on its epidemiology exist. The objective of this study was to assess the morbidity of clinical malaria among children in Nouakchott. Three hundred and one febrile children, consulting at three health facilities of Nouakchott, were screened for malaria in 2009 (n=216) and 2010 (n=85). Plasmodium species identification and parasite density were determined by microscopic examination of Giemsa-stained thin and thick films and confirmed by rapid diagnostic test and nested PCR. Of 301 febrile children, 105 (34.9%) were malaria-positive by nested PCR and 87 (28.9%) by microscopy. Plasmodium vivax represented 97.1% (102/105) and P. falciparum accounted for 2.9% (3/105) of positive cases. All positive children under five years old were infected with P. vivax. The highest numbers of malaria positives were found during or shortly after the rainy season and the lowest during the dry season. Fifty-four of 105 (51.4%) malaria cases, all with P. vivax, had never travelled outside Nouakchott. Individuals belonging to the Moors ethnic group represented 97.0% of P. vivax cases. Results of the present study indicate that malaria is endemic in Nouakchott and that P. vivax is the principal causative agent. Regular surveillance is required to monitor malaria prevalence and incidence, and further measures are needed to counter the possible spread of malaria in the country.

D.C. electrical conductivity and conduction mechanism of some azo sulfonyl quinoline ligands and uranyl complexes.

Supramolecular coordination of dioxouranium(VI) heterochelates 5-sulphono-7-(4'-X phenylazo)-8-hydroxyquinoline HL(n) (n=1, X=CH(3); n=2, X=H; n=3, X=Cl; n=4, X=NO(2)) have been prepared and characterized with various physico-chemical techniques. The infrared spectral studies showed a monobasic bidentate behavior with the oxygen and azonitrogen donor system. The temperature dependence of the D.C. electrical conductivity of HL(n) ligands and their uranyl complexes has been studied in the temperature range 305-415 K. The thermal activation energies E(a) for HL(n) compounds were found to be in the range 0.44-0.9 eV depending on the nature of the substituent X. The complexation process decreased E(a) values to the range 0.043-045 eV. The electrical conduction mechanism has been investigated for all samples under investigation. It was found to obey the variable range hopping mechanism (VRH).

A mini-bag technique for evaluation of fungicide effects on Trichoderma spp in mushroom compost.

An in vivo technique was developed to observe colonisation of mushroom compost by Trichoderma spp. Isolates of T. harzianum (Th2), T. harzianum (Th1), T. koningii (Tk) and T. viride (Tv) were artificially introduced into compost using a mini-bag system. Wheat grains, colonised by Trichoderma spp, were placed centrally on a layer of compost at the bottom of 1-litre polythene bags which were then filled with 350 g of spawned or un-spawned compost, and partially sealed. After 14 and 21 days incubation at 27 degrees C, the bags were assessed for recovery of Trichoderma from middle and top zones using a needle stab re-isolation technique and a visual colonisation scoring system. Visible green mould contamination, similar to that observed in practice, developed within 21 days. The visual colonisation scoring was reliably related to the re-isolation success. In this evaluation, Trichoderma spp showed considerable differences in their relative abilities to colonise spawned and un-spawned compost, with Th2 isolates being consistently superior to the other isolates of Th1, Tk and Tv in colonising spawned compost. This technique was employed to evaluate the effects of fungicides on the colonisation of mushroom compost by three Trichoderma spp: Th2, Th1 and Tk, using 1-litre and 5-litre mini-bag systems. Aqueous suspensions of benomyl, carbendazim, thiabendazole, prochloraz and prochloraz+carbendazim incorporated into the compost at 50 mg litre(-1), or applied to spawn at 50 mg kg(-1), reduced the colonisation by Trichoderma spp. Prochloraz and prochloraz+carbendazim were superior to benomyl, carbendazim or thiabendazole in reducing compost colonisation by Th2, Th1 and Tk, with Th2 being the most persistent type, capable of colonising treated compost in the presence of all five fungicides. The prochloraz+carbendazim mixture, not normally used in mushroom production, was equal to or better than prochloraz alone. The incidence of green mould colonisation by Th2 was as extensive in the 5-litre compost bags as in the 1-litre bags, but colonisation by Th1 and Tk was more apparent in the 5-litre bags. The in vivo mini-bag evaluations using wheat grain Trichoderma inoculum and needle stab re-isolation procedures proved an efficient method for studying colonisation and screening for effectiveness of fungicides applied to mushroom compost or spawn.

Variceal bleeding and portal hypertension: has there been any progress in the last 12 months?

A review of the literature on the management of esophagogastric varices published in the last 12 months shows that the data are still quite conflicting. In the primary and secondary prophylaxis of variceal bleeding, beta-blockers are still the mainstay of pharmacotherapy. Measurement of the hepatic portal venous pressure gradient is considered to be a reliable parameter for successful reduction of portal pressure using medical therapy. However, intolerance of propranolol requiring discontinuation of therapy has been observed in approximately 30 % of patients. Patients' compliance with medication may represent another drawback of medical therapy. The role of endoscopic band ligation in secondary prophylaxis is now indisputable, especially in comparison with sclerotherapy. In the primary prevention of variceal bleeding, band ligation is beginning to have a competitive edge over pharmacological therapy. Acute variceal bleeding is no longer a frequent morbid emergency. Most cases of bleeding can now be managed successfully with band ligation and N-butyl-2-cyanoacrylate obliteration. N-butyl-2-cyanoacrylate has come into increasingly widespread use in the treatment of bleeding gastric fundal varices in which surgery or transjugular intrahepatic portosystemic shunting were previously regarded as the preferred therapies.

FNAB thyroid gland: comparison study between pre- and post-operative histological diagnosis.

Fine-needle aspiration biopsy is recommended as the first and most important step in the management of nodular thyroid disease. A retrospective study of 520 patients with nodular thyroid disease was done in the north of Jordan, between January 1998 and August 2001. We compared the results of fine-needle aspiration biopsy (FNAB) of thyroid gland with postoperative histological findings. The results are classified into three groups A)-benign, B)-malignant, and C)-suspicious as shown in table II. The results of the FNAB were benign in 96.4% of the cases which include benign colloid nodules (325 cases), multi-nodular goitre (70 cases), diffuse goitre (40 cases), thyroiditis (23 cases) and thyroid cysts (43 cases). A total of 52 patients underwent surgical management, 49 patients found to be accurate with the FNAB. The accuracy of FNAB was 94% (49 patients out of 52), with a specificity of 99% and a sensitivity of 93%. Ultrasound findings showed that 65% (338 patients) had solid nodules, 15% (78 patients) had cystic lesions and 20% (104 patients) had mixed echogenicity lesions. Histological confirmation of malignancy was 10 out of 11 patients with a 91% accuracy rate. FNAB was found to be a highly effective procedure, which can obviate a lot of unnecessary surgery in case of thyroid lesions, and avoid over treatment of benign disease. Surgery was recommended in all suspicious cases. FNAB under ultrasound guidance increases the sensitivity rate which can reach 100%. FNAB accuracy seems to be similar in cold and in hot nodules. Clinically, most of the patients with benign colloid nodules were having goitres suggesting the role played by iodine deficiency is which a prominent feature in that area in Jordan.

A protocol for evaluation of the role of disinfectants in limiting pathogens and weed moulds in commercial mushroom production.

In vitro and in vivo evaluations of the effects of three commercial disinfectants on isolates of Trichoderma harzianum Rifai and Cladobotryum dendroides (Bull) W Gams & Hoozemans were combined in the development of methodologies for realistic assessment of disinfectant performance. 'Environ' and 'Purogene' incorporated into agar media at 50 mg AI litre-1 were effective in totally preventing the mycelial growth of T harzianum and C dendroides isolates, whereas with 'Sudol' a concentration of 500 mg AI litre-1 was required. Evaluation of a model in vivo system was combined with observations on the fungicidal effects of disinfectants. Spore suspensions of T harzianum (Th1), T harzianum (Th2) and C dendroides prepared from culture washings with sterilised distilled water were used as contaminating inoculum. Environ, Sudol and Purogene in aqueous solutions at 1000 mg AI litre-1 were sprayed onto these building structure surfaces before or after artificial contamination with spore suspensions. Re-isolation from surfaces was carried out using agar swabs, which were prepared in visking tubing, applied to treated surfaces and incubated at 25 degrees C for 24, 48, 72 or 96 h. Environ and Purogene were more effective than Sudol in limiting the recovery of Trichoderma spp and C dendroides. All three disinfectants applied 12 h after artificial contamination onto wood, concrete or glazed surfaces were able to reduce the recovery of these isolates more effectively than when they were applied 12 h before artificial contamination. Greater persistence of contamination was noted on the rougher surfaces (wood and concrete) than on the smoother glazed surface. It was concluded in this in vivo evaluation that, in many cases, the protection achieved by the physical nature of the smooth glazed tile surfaces was equivalent to that available from the application of disinfectants, thus highlighting the attention needed to the nature of building surfaces in the structures used in the mushroom industry. The artificial contamination and re-isolation techniques allowed significant comparison between disinfectant materials, timings and surface types. In the in vivo experiments using a single standardised test concentration, the relative fungicidal effects of the disinfectants, which varied in the complexity of their active ingredients, were better discriminated than the effects observed in vitro, although the general trend was similar.

Fine needle aspiration biopsy (FNAB) of breast lumps: comparison study between pre- and post-operative histological diagnosis.

Fine-needle aspiration biopsy is recommended as first and most important step in the management of breast cancer. A retrospective study was realized on 420 patients that underwent fine-needle aspiration (FNAB) in comparison to 140 patients that underwent surgical management. The results of FNAB showed that 81% of the cases were benign with an accuracy of 93%, a specificity of 97% and a sensitivity of 92% compared to operative findings. The accuracy of FNAB depends on the expertise and experience of the cyto pathologist as well as the technical skills of the physician performing the biopsy. FNAB is showing to be a highly effective procedure which can obviate unnecessary surgery in breast suspected lumps, save time and money and patient anxiety. It is the effective method for distinguishing benign from malign breast lesions.