Benefits of Using Magnetic Resonance Imaging During Breast Tissue Expansion: Literature Review and Case Series.

Breast cancer results in up to 1.6 million new candidates for yearly breast reconstruction (BR) surgery. Two-stage breast reconstruction surgery with the use of a tissue expander (TE) is a common approach to reconstructing the breast after mastectomy. However, a common disadvantage encountered with the traditional breast TE is the magnetic injection port, which has been reported to cause injuries in patients undergoing magnetic resonance (MR) imaging. Therefore this type of breast TE is labeled "MR unsafe." Recent technological advances have incorporated radio-frequency identification (RFID) technology in the TE to allow for the location of the injection port without magnetic components, resulting in an MR-conditional TE. This paper aims to review the information regarding the safety profile of TEs with magnetic ports and to gather distinct clinical scenarios in which an MR-conditional TE benefits the patient during the BR process. A literature review ranging from 2018 to 2022 was performed with the search terms: "tissue expander" OR "breast tissue expander" AND "magnetic resonance imaging" OR "MRI." Additionally, a case series was collected from each of the authors' practices. The literature search yielded 13 recent peer-reviewed papers, and 6 distinct clinical scenarios were compiled and discussed. Most clinicians find MRI examinations to be the state-of-art diagnostic imaging modality. However, due to the preexisting risks associated with TEs with magnetic ports, the MRI labeling classification should be considered when deciding which TE is the most appropriate for the patient requiring MRI examinations.

Diagnostic value of the stand-alone synthetic image in digital breast tomosynthesis examinations.

OBJECTIVE: To demonstrate the non-inferiority of synthetic image (SI) mammography versus full-field digital mammography (FFDM) in breast tomosynthesis (DBT) examinations. METHODS: An observational, retrospective, single-centre, multireader blinded study was performed, using 2384 images to directly compare SI and FFDM based on Breast Imaging Reporting and Data System (BIRADS) categorisation and visibility of radiological findings. Readers had no access to digital breast tomosynthesis slices. Multiple reader, multiple case (MRMC) receiver operating characteristic (ROC) methodology was used to compare the diagnostic performance of SI and FFDM images. The kappa statistic was used to estimate the inter-reader and intra-reader reliability. RESULTS: The area under the ROC curves (AUC) reveals the non-inferiority of SI versus FFDM based on BIRADS categorisation [difference between AUC (ΔAUC), -0.014] and lesion visibility (ΔAUC, -0.001) but the differences were not statistically significant (p=0.282 for BIRADS; p=0.961 for lesion visibility). On average, 77.4% of malignant lesions were detected with SI versus 76.5% with FFDM. Sensitivity and specificity of SI are superior to FFDM for malignant lesions scored as BIRADS 5 and breasts categorised as BIRADS 1. CONCLUSIONS: SI is not inferior to FFDM when DBT slices are not available during image reading. SI can replace FFDM, reducing the dose by 45%. KEY POINTS: • Stand-alone SI demonstrated performance not inferior for lesion visibility as compared to FFDM. • Stand-alone SI demonstrated performance not inferior for lesion BIRADS categorisation as compared to FFDM. • Synthetic images provide important dose savings in breast tomosynthesis examinations.

Effect of Genetic Polymorphisms and Long-Term Tobacco Exposure on the Risk of Breast Cancer.

INTRODUCTION: Tobacco smoke contains many potentially harmful compounds that may act differently and at different stages in breast cancer development. The focus of this work was to assess the possible role of cigarette smoking (status, dose, duration or age at initiation) and polymorphisms in genes coding for enzymes involved in tobacco carcinogen metabolism (CYP1A1, CYP2A6) or in DNA repair (XRCC1, APEX1, XRCC3 and XPD) in breast cancer development. METHODS: We designed a case control study with 297 patients, 217 histologically verified breast cancers (141 smokers and 76 non-smokers) and 80 healthy smokers in a cohort of Spanish women. RESULTS: We found an association between smoking status and early age at diagnosis of breast cancer. Among smokers, invasive carcinoma subtype incidence increased with intensity and duration of smoking (all Ptrend < 0.05). When smokers were stratified by smoking duration, we only observed differences in long-term smokers, and the CYP1A1 Ile462Ile genotype was associated with increased risk of breast cancer (OR = 7.12 (1.98-25.59)). CONCLUSIONS: Our results support the main effect of CYP1A1 in estrogenic metabolism rather than in tobacco carcinogen activation in breast cancer patients and also confirmed the hypothesis that CYP1A1 Ile462Val, in association with long periods of active smoking, could be a breast cancer risk factor.

Tomosíntesis de mama: mamografía sintetizada versus mamografía digital. Impacto en la dosis / Breast tomosynthesis: synthesized versus digital mammography. Impact on dose

Objetivo. Comparar la detectabilidad y la visibilidad de las lesiones en la imagen sintetizada y en la mamografía digital. Estimar el ahorro de dosis que supondría utilizar la imagen sintetizada en los exámenes de tomosíntesis. Pacientes y métodos. Siete observadores evaluaron la detectabilidad y la visibilidad de objetos similares a microcalcificaciones sobre las imágenes sintetizadas y mamografías digitales de un maniquí. Cuatro observadores evaluaron retrospectivamente las imágenes de 20 pacientes con lesiones histológicamente corroboradas. Se estimaron retrospectivamente los valores de dosis glandular promedio en una muestra de 50 pacientes. Resultados. La detectabilidad y la visibilidad de las microcalcificaciones sobre el fondo estructural de las imágenes del maniquí fue del 50 y del 100%, respectivamente, superior en la imagen sintetizada. La visibilidad de los hallazgos en las imágenes clínicas fue similar en ambos tipos de imagen, exceptuando las distorsiones, mejor visualizadas en la imagen sintetizada (p = 10−5). Un 16% de hallazgos malignos no se detectaron en las imágenes de mamografía digital y un 7% en las imágenes sintetizadas. La dosis glandular promedio por mama para un examen de 2 proyecciones (mama promedio) fue de 3,2 mGy (mamografía digital), 4,1 mGy (tomosíntesis) y 7,3 mGy (mamografía digital + tomosíntesis). Conclusiones. La detectabilidad y la visibilidad de la imagen sintetizada es equiparable a la mamografía digital. La sustitución de la mamografía digital por la imagen sintetizada supondría un ahorro de dosis del 44% (mama promedio) (AU)

Objective. To compare the detectability and visibility of lesions in synthesized and digital mammography. To estimate the dose saving due to the use of synthesized images in tomosynthesis examinations. Patients and methods. Seven observers scored the detectability and visibility of objects simulating microcalcifications in digital and synthesized images of a phantom. Four observers retrospectively assessed the images from a sample of 20 patients with histologically confirmed lesions. Mean glandular dose values were retrospectively estimated in a sample of 50 patients. Results. The detectability and visibility of microcalcifications in the structural background of phantom images were 50% and 100% higher, respectively, for synthesized images. The visibility of the findings in the clinical images was similar for both types of images, except for distortions, which were better visualized on synthesized images (p = 10−5). Sixteen percent of malignant findings were not detected in digital images and 7% were undetected in synthesized images. The mean glandular dose per breast for a two-view examination (average breast) was 3.2 mGy (digital mammography), 4.1 mGy (tomosynthesis) and 7.3 mGy (digital mammography + tomosynthesis). Conclusions. The detectability and visibility of synthesized images was comparable to that of digital mammography. Replacing digital mammography with synthesized imaging would result in a dose saving of 44% (average breast) (AU)

Melatonin treatment protects liver of Zucker rats after ischemia/reperfusion by diminishing oxidative stress and apoptosis.

Fatty livers occur in up to 20% of potential liver donors and increase cellular injury during the ischemia/reperfusion phase, so any intervention that could enable a better outcome of grafts for liver transplantation would be very useful. The effect of melatonin on liver ischemia/reperfusion injury in a rat model of obesity and hepatic steatosis has been investigated. Forty fa/fa Zucker rats were divided in 4 groups. 3 groups were subjected to 35 min of warm hepatic ischemia and 36 h of reperfusion. One experimental group remained untreated and 2 were given 10mg/kg melatonin intraperitoneally or orally. Another group was sham-operated. Plasma ALT, AST and hepatic content of ATP, MDA, hydroxyalkenals, NOx metabolites, antioxidant enzyme activity, caspase-9 and DNA fragmentation were determined in the liver. The expression of iNOS, eNOS, Bcl2, Bax, Bad and AIF were determined by RT-PCR Melatonin was effective at decreasing liver injury by both ways as assessed by liver transaminases, markers of apoptosis, of oxidative stress and improved liver ATP content. Melatonin administration decreased the activities or levels of most of the parameters measured in a beneficial way, and our study identified also some of the mechanisms of protection. We conclude that administration of melatonin improved liver function, as well as markers of pro/antioxidant status and apoptosis following ischemia/reperfusion in obese rats with fatty liver. These data suggest that this substance could improve outcome in patients undergoing liver transplantation who receive a fatty liver implant and suggest the need of clinical trials with it in liver transplantation.

El Cultivo del Maní

Consideraciones generales. Características agroecológicas: Suelos, temperatura, requerimiento híbrido, fotoperiodo. Variedades de maní. Zonificación. Sistemas de cultivo: Manual, mecanizado, semimecanizado. Protección del cultivo del maní: Malezas y su control, plagas insectiles y su control, enfermedades y su control. Cosecha de maní: Arrancado, secado, despicado, descascarado o trillado, almacenaje. Otros