Navigating a climate of administrative burden: the perspectives of young adult undocumented immigrants in applying for COVID-19 disaster relief assistance for immigrants in California.

Undocumented immigrants experienced high levels of economic insecurity during the COVID-19 pandemic while being excluded from government-based relief and unemployment benefits. In April 2020, California became the first state to offer financial aid to undocumented immigrants through the innovative Disaster Relief Assistance for Immigrants (DRAI) program in collaboration with several community-based organizations (CBOs). However, the process of applying for aid was marked by many implementation challenges, such as intake and language access; however, little data exists on the direct experiences of the undocumented community. This qualitative study examines the experiences of undocumented Asian and Latinx young adults living in California in applying for DRAI through framework of administrative burden. Themes distilled from participant experiences highlight how administrative burden via learning, psychological, and compliance costs shape the ways in which undocumented immigrants navigate policies and programs, such as DRAI. These experiences highlight the need for policymakers to address structural and programmatic administrative burdens in policy development; failure to do so result in detrimental impacts that outweigh financial benefits or cause communities to forgo needed resources.

Evaluation of retrieval accuracy and visual similarity in content-based image retrieval of chest CT for obstructive lung disease.

The aim of our study was to assess the performance of content-based image retrieval (CBIR) for similar chest computed tomography (CT) in obstructive lung disease. This retrospective study included patients with obstructive lung disease who underwent volumetric chest CT scans. The CBIR database included 600 chest CT scans from 541 patients. To assess the system performance, follow-up chest CT scans of 50 patients were evaluated as query cases, which showed the stability of the CT findings between baseline and follow-up chest CT, as confirmed by thoracic radiologists. The CBIR system retrieved the top five similar CT scans for each query case from the database by quantifying and comparing emphysema extent and size, airway wall thickness, and peripheral pulmonary vasculatures in descending order from the database. The rates of retrieval of the same pairs of query CT scans in the top 1-5 retrievals were assessed. Two expert chest radiologists evaluated the visual similarities between the query and retrieved CT scans using a five-point scale grading system. The rates of retrieving the same pairs of query CTs were 60.0% (30/50) and 68.0% (34/50) for top-three and top-five retrievals. Radiologists rated 64.8% (95% confidence interval 58.8-70.4) of the retrieved CT scans with a visual similarity score of four or five and at least one case scored five points in 74% (74/100) of all query cases. The proposed CBIR system for obstructive lung disease integrating quantitative CT measures demonstrated potential for retrieving chest CT scans with similar imaging phenotypes. Further refinement and validation in this field would be valuable.

Breast Pseudoaneurysm in a Woman after Core Biopsy: Intravascular Glue Embolization.

Core needle biopsy of breast masses is a common procedure for tissue diagnosis of breast lesions. The incidence of complications is low, with pseudoaneurysm (PA) after core biopsy has been described in the literature, and the subsequent need for surgical management. Ultrasonography is the most common modality used for not only diagnosis but also treatment of a PA. Color Doppler images show a heterogeneous echoic lesion with whirling flow inside of the lesion. We describe a patient whose breast PA that developed after core needle biopsy was successfully treated with sonographically-guided intravascular glue embolization.

Factors Influencing the Control of Hypertension According to the Gender of Older Adults.

(1) Background: This study aimed to identify factors associated with hypertension control among older adults with hypertension based on their socio-demographic and health characteristics. (2) Methods: The sample consisted of a total of 1824 with hypertension and was obtained from the Eighth Korean National Health and Nutrition Examination Survey (VIII-1, VIII-2). (3) Results: As the factors associated with hypertension control among older men, 65-74 years old (OR = 1.76, CI = 1.04-2.96), a lower education level (OR = 2.23, CI = 1.17-4.28), with obesity (OR = 2.05, CI = 1.13-2.05), and under-treatment of hypertension (OR = 22.07, CI = 6.54-7.45) increased the likelihood of rating hypertension control. As the factors associated with hypertension control among older women, trying to weight maintain (OR = 1.70, CI = 1.01-2.85) and under-treatment of hypertension (OR = 12.16, CI = 3.65-40.46) increased the likelihood of rating hypertension control. (4) Conclusion: The factor affecting the control of hypertension differed between the two genders. To improve the control of hypertension, the guidelines for treatment interventions should be gender-specific for the early elderly. There is a need to increase control of hypertension by having health-related behavioral modifications such as reducing obesity for older men and trying weight maintenance for older women.

Complexity of SMAX1 signaling during seedling establishment.

Karrikins (KARs) are small butenolide compounds identified in the smoke of burning vegetation. Along with the stimulating effects on seed germination, KARs also regulate seedling vigor and adaptive behaviors, such as seedling morphogenesis, root hair development, and stress acclimation. The pivotal KAR signaling repressor, SUPPRESSOR OF MAX2 1 (SMAX1), plays central roles in these developmental and morphogenic processes through an extensive signaling network that governs seedling responses to endogenous and environmental cues. Here, we summarize the versatile roles of SMAX1 reported in recent years and discuss how SMAX1 integrates multiple growth hormone signals into optimizing seedling establishment. We also discuss the evolutionary relevance of the SMAX1-mediated signaling pathways during the colonization of aqueous plants to terrestrial environments.

Lobar emphysema ratio of more than 1% in the lobe with lung cancer as poor predictor for recurrence and overall survival in patients with stage I non-small cell lung cancer.

BACKGROUND: The purpose of this study was to examine the relationship between the lobar emphysema ratio (LER) and tumor recurrence and survival in patients with stage I non-small cell lung cancer (NSCLC). METHODS: We enrolled 258 patients with surgically proven stage I NSCLC. These patients underwent noncontrast chest CT, and pulmonary lobe segmentation and lobar emphysema quantification were performed using commercially available software. We assessed the LER in the lobe with lung cancer. We divided the patients into two groups according to the LER, and the cut-off value was 1. Furthermore, we analyzed the disease-free survival of high LER and other clinical factors after surgical resection. RESULTS: The 258 patients were divided into two groups: low LER (n = 195) and high LER (n = 63). The right upper lobe was the most frequent location in lung cancer and the most severe location in emphysema. In the Kaplan‒Meier curve, high LER showed a significantly lower disease-free survival (8.21 ± 0.27 years vs 6.53 ± 0.60 years, p = 0.005) and overall survival (9.56 ± 0.15 years vs. 8.51 ± 0.49 years, p = 0.011) than low LER. Stage Ib (2.812 [1.661-4.762], p<0.001) and high LER (2.062 [1.191-3.571], p = 0.010) were poor predictors for disease-free survival in multivariate Cox regression analysis. Stage Ib (4.729 [1.674-13.356], p = 0.003) and high LER (3.346 [1.208-9.269], p = 0.020) were significant predictors for overall survival in multivariate Cox regression analysis. CONCLUSION: A LER of more than 1% in the lobe with lung cancer is a poor predictor for cancer recurrence and overall survival in patients with stage I NSCLC.

Image Turing test and its applications on synthetic chest radiographs by using the progressive growing generative adversarial network.

The generative adversarial network (GAN) is a promising deep learning method for generating images. We evaluated the generation of highly realistic and high-resolution chest radiographs (CXRs) using progressive growing GAN (PGGAN). We trained two PGGAN models using normal and abnormal CXRs, solely relying on normal CXRs to demonstrate the quality of synthetic CXRs that were 1000 × 1000 pixels in size. Image Turing tests were evaluated by six radiologists in a binary fashion using two independent validation sets to judge the authenticity of each CXR, with a mean accuracy of 67.42% and 69.92% for the first and second trials, respectively. Inter-reader agreements were poor for the first (κ = 0.10) and second (κ = 0.14) Turing tests. Additionally, a convolutional neural network (CNN) was used to classify normal or abnormal CXR using only real images and/or synthetic images mixed datasets. The accuracy of the CNN model trained using a mixed dataset of synthetic and real data was 93.3%, compared to 91.0% for the model built using only the real data. PGGAN was able to generate CXRs that were identical to real CXRs, and this showed promise to overcome imbalances between classes in CNN training.

Percutaneous nephrostomy for complex renal stones: Percutaneous renal access behind the stone versus renal calyx dilation.

OBJECTIVE: To evaluate the technical success rate and complications associated with percutaneous nephrostomy (PCN) via percutaneous renal access behind the stone and renal calyx dilation in patients with complex renal stones. MATERIALS AND METHODS: From January 2010 to February 2021, we identified 69 patients with 70 complex renal stones who underwent PCN. Complex renal stones were classified as simple (renal pelvis only) (27.1%, 19/70), borderline staghorn (8.6%, 6/70), partial staghorn (51.4%, 36/70), or complete staghorn (12.9%, 9/70). All PCNs were performed under ultrasound and fluoroscopic guidance using one of two renal-entry techniques: puncture behind the stone (56%, 39/70) or renal calyx dilation (44%, 31/70). Then, we retrospectively evaluated the technical success rates and complications associated with each renal entry access technique. RESULTS: The overall technical success rate was 100%, and the complication rate was 20.0% (14/70). For those who underwent renal access behind the stone, the complication rate was 15.4% (6/39), and six patients (six PCNs) had transient gross hematuria. For those who underwent dilated renal calyx entry, the complication rate was 25.8% (8/31), and one patient had significant bleeding complications requiring transfusion. Furthermore, seven patients (seven PCNs) had transient gross hematuria. Overall, the complication rates did not differ between the technique groups (p = 0.279). CONCLUSION: PCN for complex renal stones has a high technical success rate and an acceptable complication rate regardless of the specific technique. Renal entry behind the stone is as safe and feasible as approaching via a dilated renal calyx.

Factors Associated with Poor Self-Rated Health among Older Women Living Alone.

BACKGROUND: The study aimed to identify the differences in self-rated health (SRH) and the factors associated with poor SRH among older women who live alone, based on their sociodemographic and health characteristics. METHODS: The sample consisted of 812 older women living alone and was obtained from the Seventh Korean National Health and Nutrition Examination Survey (Ⅶ-1, Ⅶ-2, Ⅶ-3). Complex sample analysis was performed using the independent t-test, the Chi-square test, and multiple logistic regression in SPSS/WIN 24.0 program. RESULTS: The study found that SRH status in older women living alone differed according to age, education level, income, occupation, walking practices, sleeping hours, perceived stress, experiencing depression, diabetes, arthritis, and restrictions in daily functions. As the factors associated with poor SRH among older women living alone, a lower education level (OR = 1.89, CI = 1.19-3.02), higher perceived stress (OR = 4.92, CI = 1.84-13.16), experiencing arthritis (OR = 1.52, CI = 1.07-2.16), and higher restrictions in functioning (OR = 6.20, CI = 4.01-9.59) increased the likelihood of rating the poor SRH. CONCLUSION: SRH is an indicator of overall health status, and physical, psychological, and economic factors affect each other. Therefore, it is necessary to develop effective health education and intervention programs for vulnerable groups, including older women living alone with poor SRH.

Association between immigration enforcement encounters and COVID-19 testing and delays in care: a cross-sectional study of undocumented young adult immigrants in california.

BACKGROUND: Undocumented immigrants are expected to face increased risks related to COVID-19 due to marginalizing restrictive immigration policies. However, few studies have assessed the prevalence of direct encounters with the immigration enforcement system among the undocumented and its impacts on their COVID-related health behaviors and outcomes. In this study, we quantify undocumented immigrants' lifetime exposure to various immigration enforcement tactics and their association with delays in COVID-19 testing and healthcare behaviors. METHODS: This cross-sectional study included a non-random sample of 326 Asian and Latinx undocumented immigrants in California from September 2020 to February 2021. The primary exposure was immigration enforcement encounter scores ranging from 0-9, assessed through self-reports of direct experiences with the immigration system, immigration officials, and law enforcement. The main outcomes were positive test for COVID-19, had or suspected having COVID-19, and delayed or avoided testing and/or treatment for COVID-19 due to immigration status. We used multivariable logistic regression models to examine the association between the primary exposure and outcomes of interest. RESULTS: Among 326 participants, 7% had received a positive COVID-19 test result, while 43% reported having or suspected having COVID-19. Almost 13% delayed or avoided COVID-19 testing and/or treatment because of their immigration status. Overall, an increase in immigration enforcement encounters was associated with higher odds of suspecting having had COVID-19 (aOR = 1.13; 95% CI: 1.01,1.26). Reporting an additional enforcement encounter was associated with higher odds of delaying or avoiding testing and/or treatment because of immigration status (aOR = 1.53, 95% CI: 1.26,1.86). Compared to their Latino counterparts, Asian respondents were more likely to report higher odds of delaying or avoiding testing and/or treatment (aOR = 3.13, 95% CI: 1.17,8.42). There were no significant associations between the enforcement score and testing positive for COVID-19. Additionally, while Latinxs were more likely to report immigration enforcement encounters than Asians, there were no differences in the effects of race on COVID-19 testing and healthcare behaviors in models with race as an interaction term (p < 0.05). CONCLUSIONS: Immigration enforcement encounters compound barriers to COVID-19 testing and treatment for undocumented immigrants.

Up-regulation of CPNE1 Appears to Enhance Cancer Progression in HER2-positive and Luminal A Breast Cancer Cells.

BACKGROUND/AIM: Copine 1 (CPNE1) is a calciumdependent phospholipid protein that has been shown to regulate the AKT serine/threonine kinase 1 (AKT) signaling pathway to mediate its function in various cell types. However, little is known about the physiological function of this protein in breast cancer cells. We aimed to investigate the prognostic and therapeutic value of CPNE1 in erb-b2 receptor tyrosine kinase 2 [human epidermal growth factor receptor 2 (HER2)]-positive and luminal A subtypes of breast cancer. MATERIALS AND METHODS: Western blotting, cell viability, wound-healing and invasion assays were performed on SK-BR3 and MCF-7 breast cancer cells with forced overexpression of CPNE1. CPNE1 immunohistochemical (IHC) staining and bioinformatics analysis were performed on specimens from patients with breast cancer and compared to normal breast samples. RESULTS: CPNE1 overexpression promoted AKT activation, and increased cell viability and cell motility in SK-BR3 and MCF-7 breast cancer cells. In addition, invasive capabilities of SK-BR3 cells were increased by the overexpression of CPNE1. The expression levels of CPNE1 were higher in HER2-positive and luminal A subtypes of human breast cancer tissues compared with those in adjacent normal tissues. Furthermore, CPNE1 expression was increased in RNA microarray analysis of samples from patients with breast cancer compared to normal breast samples. CONCLUSION: CPNE1 may play a key role in the pathophysiology of HER2-positive and luminal A subtypes of breast cancer.

Mucoepidermoid carcinoma of the breast: A case report and literature review focused on radiological findings.

RATIONALE: Mucoepidermoid carcinoma (MEC) of the breast is a rare entity, with an estimated incidence of only 0.2% to 0.3% of all primary breast tumors. The radiological features of breast MEC have scarcely been investigated mainly because of its rarity. In this article, we present a case of breast MEC diagnosed at our hospital and review the literature, focusing on radiological findings and radiologic-pathologic correlations that could improve clinical management of this entity. To the best of our knowledge, our study is the first review of the literature that focuses on the radiological features of breast MEC. PATIENT CONCERNS: A 47-year-old premenopausal woman presented with a painless palpable mass in the right breast. DIAGNOSIS: Mammography and ultrasonography revealed a mass with suspicious malignant features, which was categorized as Breast Imaging Reporting and Data System category 4c. A 14-gauge core-needle biopsy revealed an intermediate-grade MEC of the breast. The patient underwent breast magnetic resonance imaging and chest computed tomography for preoperative evaluation. Postoperative histopathological examination confirmed a diagnosis of intermediate-grade MEC. The clinical staging was T2N0M0. INTERVENTIONS: The patient underwent breast-conserving surgery, adjuvant chemotherapy, radiotherapy, and hormonal therapy. OUTCOMES: No evidence of recurrence has been reported over 37 months. LESSONS: The imaging characteristics of breast MEC were variable, and there were no specific radiological features for diagnosis. The presence of cystic components on radiological imaging is likely to be an indicator of a low-grade tumor and better prognosis, although the number of reported cases is limited.

Comparison of Diagnostic Performance and Confidence between Contrast-Enhanced Computed Tomography Scan and Non-Contrast-Enhanced Computed Tomography Plus Abdomen Ultrasound for Hepatic Metastasis in Patients with Breast Cancer.

Background: The purpose of this study was to compare the performance between noncontrast-enhanced computed tomography (NECT) plus abdominal ultrasound (US) (NECT + US) with contrast-enhanced computed tomography (CECT) for the detection of hepatic metastasis in breast cancer patient with postsurgical follow-up. Methods: A total of 1470 patients without already diagnosed hepatic metastasis were included. All patients underwent US and multiphase CECT including the NECT. Independent reviewers analyzed images obtained in four settings, namely, abdominal US, NECT, NECT + US, and CECT and recorded liver metastases using a 5-grade scale of diagnostic confidence. Sensitivity, specificity (diagnostic performance), and area under the receiver operating characteristic curve (AUC, diagnostic confidence) were calculated. Interoperator agreement was calculated using the kappa test. Results: Reference standards revealed no metastases in 1108/1470 patients, and metastasis was detected in 362/1470 patients. Abdominal US (P < 0.01) and NECT (P = 0.01) significantly differed from CECT, but NECT + US did not significantly differ from CECT in terms of sensitivity (P = 0.09), specificity (P = 0.5), and AUC (P = 0.43). After an additional review of abdominal US, readers changed the diagnostic confidence scores of 106 metastatic lesions diagnosed using NECT. Interobserver agreements were good or very good in all four settings. Additional review of abdominal US with NECT allowed a change in the therapeutic plan of 108 patients. Conclusion: Abdominal US + NECT showed better diagnostic performance for the detection of hepatic metastases than did NECT alone; its diagnostic performance and confidence were similar to those of CECT.

Contraceptive use and consistency and the role of deferred action for childhood arrivals: A cross-sectional survey of undocumented young adults.

OBJECTIVE: The Deferred Action for Childhood Arrivals (DACA) program grants young, undocumented immigrants work authorization and protections from deportation, with about 1.3 million eligible for the program. This exploratory study examines the association between DACA status and contraceptive use among undocumented young adults. STUDY DESIGN: We conducted an internet-based survey between June 2017 and August 2017 among Asian and Latinx undocumented immigrants (N = 204) aged 18-31 years in California. Bivariate and multivariate logistic regressions were conducted to examine the associations between DACA status and contraceptive use and consistency. RESULTS: Among undocumented participants who were sexually active, about 60% reported having unprotected sex (52% DACA vs. 63% non-DACA) and about 80% reported that documentation status affects how they access care for sexual/reproductive health at least a little. Overall, Asians were 81% less likely to have unprotected sex compared to Latinx individuals (aOR = 0.19, 95%CI: 0.06, 0.56). DACA recipients were more likely to report using contraception every time compared to non-recipients (42.9% vs. 30.5%, p = 0.04). DACA recipients were 63% less likely to report having unprotected sex in the past 12 months compared to those without DACA (aOR = 0.37, 95%CI: 0.14, 0.99). DACA recipients were more than three times as likely to use contraception during sex every time compared to those without DACA (aOR = 3.19, 95%CI: 1.19, 8.54). CONCLUSIONS: This study demonstrates that undocumented young adults have low rates of contraceptive use; however, DACA is associated with improved reproductive health for certain undocumented immigrants. IMPLICATIONS AND CONTRIBUTION: State and federal policies that extend protections and promote immigrant integration are needed to fully achieve reproductive justice for all.

Immigration enforcement exposures and COVID-19 vaccine intentions among undocumented immigrants in California.

COVID-19 vaccines are effective in preventing COVID-19 infection, disease, and death. However, there is no data about vaccine intentions among the 10.7 million undocumented immigrants in the US. This study examined the associations between immigration enforcement exposure and vaccine intentions among undocumented immigrants in California. This community-engaged study partnered with immigrant organizations across California during the COVID-19 pandemic to recruit 366 study participants to an online survey regarding their attitudes about the COVID-19 vaccine and past exposure with the immigration enforcement system. Data collection occurred from September 2020 - February 2021 before the vaccine became available. Overall, 65% of study participants indicated that they would definitely get the vaccine were it to become available. In multivariable logistic regressions, an increase in immigration enforcement scores were associated with a 12% decrease in vaccine acceptance (aOR = 0.88, CI: 0.78-0.99). Additionally, undocumented women were 3.09 times more likely to report vaccine acceptance compared to undocumented men (CI: 1.79-5.35) and undocumented Asians were 57% less likely to report vaccine acceptance compared to undocumented Latinx immigrants (aOR = 0.43, CI: 0.21-0.88). Exposure to the immigration enforcement system may undermine public health efforts to prevent further transmission of COVID-19 by reducing acceptability of vaccines among immigrant populations.

Improving the Performance of Radiologists Using Artificial Intelligence-Based Detection Support Software for Mammography: A Multi-Reader Study.

OBJECTIVE: To evaluate whether artificial intelligence (AI) for detecting breast cancer on mammography can improve the performance and time efficiency of radiologists reading mammograms. MATERIALS AND METHODS: A commercial deep learning-based software for mammography was validated using external data collected from 200 patients, 100 each with and without breast cancer (40 with benign lesions and 60 without lesions) from one hospital. Ten readers, including five breast specialist radiologists (BSRs) and five general radiologists (GRs), assessed all mammography images using a seven-point scale to rate the likelihood of malignancy in two sessions, with and without the aid of the AI-based software, and the reading time was automatically recorded using a web-based reporting system. Two reading sessions were conducted with a two-month washout period in between. Differences in the area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and reading time between reading with and without AI were analyzed, accounting for data clustering by readers when indicated. RESULTS: The AUROC of the AI alone, BSR (average across five readers), and GR (average across five readers) groups was 0.915 (95% confidence interval, 0.876-0.954), 0.813 (0.756-0.870), and 0.684 (0.616-0.752), respectively. With AI assistance, the AUROC significantly increased to 0.884 (0.840-0.928) and 0.833 (0.779-0.887) in the BSR and GR groups, respectively (p = 0.007 and p < 0.001, respectively). Sensitivity was improved by AI assistance in both groups (74.6% vs. 88.6% in BSR, p < 0.001; 52.1% vs. 79.4% in GR, p < 0.001), but the specificity did not differ significantly (66.6% vs. 66.4% in BSR, p = 0.238; 70.8% vs. 70.0% in GR, p = 0.689). The average reading time pooled across readers was significantly decreased by AI assistance for BSRs (82.73 vs. 73.04 seconds, p < 0.001) but increased in GRs (35.44 vs. 42.52 seconds, p < 0.001). CONCLUSION: AI-based software improved the performance of radiologists regardless of their experience and affected the reading time.

Multimodal Capturing of Polysulfides by Phosphorus-Doped Carbon Composites for Flexible High-Energy-Density Lithium-Sulfur Batteries.

The widespread adoption of Li-ion batteries is currently limited by their unstable electrochemical performance and high flammability under mechanical deformation conditions and a relatively low energy density. Herein, high-energy-density lithium-sulfur (Li-S) batteries are developed for applications in next-generation flexible electronics and electric vehicles with long cruising distances. Freestanding high-S-loading carbon nanotubes cathodes are assembled with a phosphorus (P)-doped carbon interlayer coated on commercial separators. Strategies for the active materials and structural design of both the electrodes and separators are highly efficient for immobilizing the lithium polysulfides via multimodal capturing effects; they significantly improve the electrochemical performance in terms of the redox kinetics and cycling stability. The foldable Li-S cells show stable specific capacities of 850 mAh g-1 over 100 cycles, achieving high gravimetric and volumetric energy densities of 387 Wh kgcell -1 and 395 Wh Lcell -1 , respectively. The Li-S cells show highly durable mechanical flexibilities under severe deformation conditions without short circuit or failure. Finally, the Li-S battery is explored as a light-weight and flexible energy storage device aboard airplane drones to ensure at least fivefold longer flight times than traditional Li-ion batteries. Nanocarbon-based S cathodes and P-doped carbon interlayers offer a promising solution for commercializing rechargeable Li-S batteries.

Quantification of liver extracellular volume using dual-energy CT for ruling out high-risk varices in cirrhosis.

PURPOSE: To determine the performance of quantification of liver extracellular volume fraction (fECV) using dual-energy CT (DECT) compared with CT imaging for ruling out high-riskesophageal varices(HRV) in cirrhotic patients. METHODS: We retrospectively analyzed 229 cirrhotic patients (training [n = 159] and internal validation cohorts [n = 70]) who underwent dual-source DECT, serum marker assessment, and esophagogastroduodenoscopy (EGD) from 2017 to 2020. The fECV score was measured using iodine maps from 3-minute delayed, equilibrium-phase images at 100/140 Sn kVp. The association of CT parameters and serum markers with HRV was investigated. Criteria combining the fECV score (≤ 25.1%) or CT imaging with platelet count (> 150,000/mm3) were created and compared to rule out HRV. RESULTS: In the training cohort, the fECV score (odds ratio (OR), 1.20; 95% confidence interval (CI), 1.09, 1.32) and CT imaging (OR, 28.21; 95% CI, 9.31, 85.93) were independent predictors of HRV, along with platelet count (OR, 0.85 and 0.78). Criteria combining the fECV score with platelet count showed significantly better performance than those combining CT imaging with platelet count in ruling out HRV (p < 0.001). Applying the criteria could have safely avoided an additional 10.7% and 8.6% of EGDs in the training and validation cohorts, respectively, achieving a final value of 36.5% and 35.7% spared EGDs (0 HRV missed) compared to CT imaging with platelet count. CONCLUSIONS: The combined DECT-based fECV score with platelet count is useful for ruling out HRV and can safely avoid more EGDs than CT imaging with platelet count.

A critical review of abdominopelvic computed tomography for the detection of asymptomatic metastasis in new and recurrent breast cancers.

AIM: Abdominopelvic computed tomography (APCT) is a commonly used staging investigation to detect asymptomatic metastasis in breast cancer including early breast cancer (EBC). This study aimed to assess the usefulness of APCT in breast cancers at each clinical stage. METHODS: Patients with new or recurrent invasive breast cancer between January 2009 and December 2014 were included in the study. All staging APCT results were reviewed to evaluate its yield and false positive rate (FPR) and how many investigations are needed to confirm indeterminate results. Odds ratios (ORs) for positive APCT results were calculated for possible risk factors for asymptomatic metastasis. RESULTS: Sixty-five asymptomatic metastases were detected from 1002 APCTs, giving an overall yield of 6.5%. The overall false-positive rate was 14.9 % due to 149 indeterminate findings that were found not to be metastases after further investigations or observation. Whereas the APCTs have a low yield of 3.1% in EBC, but advanced breast cancer and recurrent breast cancer have a high incidence of asymptomatic metastases (13.8% and 16.3%, respectively). The most common cause of indeterminate findings was small liver nodules, including liver cysts and liver hemangiomas. Human epidermal growth factor receptor2 (HER2) status and tumor stage are most significant predictors for positive results of staging APCT scans with high ORs (3.9 and 3.7, respectively). CONCLUSION: Staging APCT is associated with a high incidence of FPRs and low yield, especially among EBCs. It is desirable to choose this investigation more selectively according to HER2 status and tumor stage.