Contrast-Enhanced Ultrasonography Features of Breast Malignancies with Different Sizes: Correlation with Prognostic Factors

Mesenchymal stem cells in orthopaedics: A systematic review of applications to practice

Background

Mesenchymal stem cells (MSCs) have alluring interest for clinical use in orthopaedics based on their therapeutic potential through directed pluripotent differentiation. While many studies and reviews have discussed the importance of this approach, few have reduced it to practice using reproducible criteria. This study was designed to systematically review and synthesize current evidence regarding clinical use of clearly defined MSCs in orthopaedics.

Methods

Studies of any level of evidence and sample size, regardless of MSC source, orthopaedic pathology, and patient population, were reviewed. In vitro and animal studies, and articles written in a language other than English, were excluded. Studies were then screened for final inclusion based on documented MSC verification using testing of the therapeutic cellular population for at least one of the following phenotypic markers: CD 73, CD 90, and CD 105. In addition, therapeutic cellular populations could not have higher percentages of CD34, CD45, CD14, HLA-DR, CD11b, or CD19 markers compared to the aforementioned markers. From each studies' results, sample size, procedural methods, radiographic outcomes, clinical outcomes, patient-report outcomes (PROs), and adverse events were tabulated.

Results

Overall, 43 studies were included. Twenty-three studies (53.5 %) derived their MSCs from iliac crest bone marrow while 12 (27.9 %) studied adipose-derived MSCs. Included studies explored MSC use in Osteoarthritis, Cartilage Defects, Osteonecrosis, Bone Defects and Nonunions, Spine, and Other. MSC use in all pathologies led to improvement of studied radiographic, clinical, and patient-reported outcomes.

Conclusions

Mesenchymal stem cells have proven to have successful and safe uses in multiple orthopaedic applications, including treating chondral defects, osteoarthritis, and osteonecrosis. A stringent and reproducible process for evaluating obtained human stem cells using CD markers for clinical use is necessary to both evaluate previous studies and continue to evaluate for future uses.

Level of evidence

Level V.

Dosimetric comparison of free-breathing versus respiratory motion-managed radiotherapy via four-dimensional computed tomography-based volumetric-modulated arctherapy for lung cancer

PURPOSE

The aim of this study is to use respiratory motion-managed radiotherapy (RT) to reduce side effects and to compare dosimetric factors with free-breathing planning in patients with lung cancer.

MATERIALS AND METHODS

Simulation images were obtained in 10 respiratory phases with free breathing using four-dimensional computed tomography (4D-CT) scanner. Planning target volume (PTV) was created with 5mm margins in each direction of the internal target volume delineated using the maximum intensity projection. A volumetric arc treatment (VMAT) plan was created so that the prescribed dose would cover 98% of the PTV. Target volumes for the free-breathing VMAT plan were created according to ICRU Reports 62 and the same prescribed dose was used.

RESULTS

Patients were evaluated during January 2020. Median 63Gy (59.4-64) RT was administered. Median PTV volumes were 173.53 and 494.50cm3 (P=0.008) and dose covering 95% of PTV volume was 62.97 and 60.51Gy (P=0.13) in 4D-CT based and free-breathing VMAT plans, respectively. The mean and V50 heart dose was 6.03Gy (vs. 10.36Gy, P=0.043) and 8.2% (vs. 33.9%, P=0.007), and significantly lower in 4D-CT based VMAT plans and there was also found a non-significant reduction for other risky organ doses.

CONCLUSION

Ten patients treated with respiratory motion-managed RT with 4D-CT based VMAT technique. It was observed that PTV did not increase, the target was covered with 95% accuracy, and with statistical significance in heart doses, all risky organ doses were found to be less.

Multi-parameter ultrasonography-based predictive model for breast cancer diagnosis

OBJECTIVES

To develop, validate, and evaluate a predictive model for breast cancer diagnosis using conventional ultrasonography (US), shear wave elastography (SWE), and contrast-enhanced US (CEUS).

MATERIALS AND METHODS

This retrospective study included 674 patients with 674 breast lesions. The data, a main and an independent datasets, were divided into three cohorts. Cohort 1 (80% of the main dataset; n = 448) was analyzed by logistic regression analysis to identify risk factors and establish the predictive model. The area under the receiver operating characteristic curve (AUC) was analyzed in Cohort 2 (20% of the main dataset; n = 119) to validate and in Cohort 3 (the independent dataset; n = 107) to evaluate the predictive model.

RESULTS

Multivariable regression analysis revealed nine independent breast cancer risk factors, including age > 40 years; ill-defined margin, heterogeneity, rich blood flow, and abnormal axillary lymph nodes on US; enhanced area enlargement, contrast agent retention, and irregular shape on CEUS; mean SWE higher than the cutoff value (P < 0.05 for all). The diagnostic performance of the model was good, with AUC values of 0.847, 0.857, and 0.774 for Cohorts 1, 2, and 3, respectively. The model increased the diagnostic specificity (from 31% to 81.3% and 7.3% to 73.1% in cohorts 2 and 3, respectively) without a significant loss in sensitivity (from 100.0% to 90.1% and 100.0% to 81.8% in cohorts 2 and 3, respectively).

CONCLUSION

The multi-parameter US-based model showed good performance in breast cancer diagnosis, improving specificity without a significant loss in sensitivity. Using the model could reduce unnecessary biopsies and guide clinical diagnosis and treatment.

Radiomic Signatures Derived from Hybrid Contrast-Enhanced Ultrasound Images (CEUS) for the Assessment of Histological Characteristics of Breast Cancer: A Pilot Study

The purpose of this study was to evaluate the diagnostic performance of radiomic features extracted from standardized hybrid contrast-enhanced ultrasound (CEUS) data for the assessment of hormone receptor status, human epidermal growth factor receptor 2 (HER2) status, tumor grade and Ki-67 in patients with primary breast cancer.

METHODS

This prospective study included 72 patients with biopsy-proven breast cancer who underwent CEUS examinations between October 2020 and September 2021.

RESULTS

A radiomic analysis found the WavEnHH_s_4 parameter as an independent predictor associated with the HER2+ status with 76.92% sensitivity, and 64.41% specificity and a prediction model that could differentiate between the HER2 entities with 76.92% sensitivity and 84.75% specificity. The RWavEnLH_s-4 parameter was an independent predictor for estrogen receptor (ER) status with 55.93% sensitivity and 84.62% specificity, while a prediction model (RPerc01, RPerc10 and RWavEnLH_s_4) could differentiate between the progesterone receptor (PR) status with 44.74% sensitivity and 88.24% specificity. No texture parameter showed statistically significant results at the univariate analysis when comparing the Nottingham grade and the Ki-67 status.

CONCLUSION

Our preliminary data indicate a potential that hybrid CEUS radiomic features allow the discrimination between breast cancers of different receptor and HER2 statuses with high specificity. Hybrid CEUS radiomic features might have the potential to provide a noninvasive, easily accessible and contrast-agent-safe method to assess tumor biology before and during treatment.

Comparison of Linear and Convex-Array Transducers in Assessing the Enhancement Characteristics of Suspicious Breast Lesions at Contrast-Enhanced Ultrasound (CEUS)

The purpose of this study was to determine the observer agreement in assessing the enhancement pattern of suspicious breast lesions with contrast-enhanced ultrasound (CEUS) using high and low frequency transducers. Methods: This prospective study included 70 patients with suspicious breast lesions detected at mammography and/or ultrasound and classified according to the American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS) in 4A, 4B, 4C, or 5, who underwent CEUS examinations between October 2020 and August 2021. Results: Participants’ ages ranged from 28 to 83 years (48.5 + 6.36, mean age + SD). We obtained a substantial agreement for the first reader (kappa = 0.614, p < 0.001) and a perfect agreement for the second and third reader (kappa = 1, p < 0.001) between the two transducers for the uptake pattern. A moderate agreement for the second and third reader (kappa = 0.517 and 0.538, respectively, p < 0.001) and only a fair agreement (kappa = 0.320, p < 0.001) in the case of the first reader for the perilesional enhancement was observed. We obtained an excellent inter-observer agreement (Cronbach’s Alpha coefficient = 0.960, p < 0.001) for the degree of enhancement, a good inter-observer agreement for the uptake pattern and perilesional enhancement (Cronbach’s Alpha coefficient = 0.831 and 0.853, respectively, p < 0.001), and a good and acceptable inter-observer agreement for internal homogeneity, perfusion defects and margins of the lesions (Cronbach’s Alpha coefficient = 0.703, 0.703 and 0.792, respectively, p < 0.001) concerning the evaluation of breast lesions with the linear-array transducer. Conclusions: The evaluation of suspicious breast lesions by three experts with high-frequency linear-array transducer and low-frequency convex-array transducer was comparable in terms of uptake pattern and perilesional enhancement. The agreement regarding the evaluation of the degree of enhancement, the internal homogeneity, and the perfusion defects varied between fair and substantial. For all CEUS characteristics, the inter-observer agreement was superior for linear-array transducer, which leads to more a homogeneous and reproducible interpretation.

Comparison of combinations of irradiation techniques and jaw conditions in intensity-modulated radiotherapy for lung cancer

Purpose

To assist in the selection of a suitable combination of an irradiation technique and jaw condition in intensity‐modulated radiotherapy (IMRT) and volumetric‐modulated arc radiotherapy (VMAT) for lung cancer treatment plans.

Materials and methods

Thirty patients with lung cancer who underwent radiotherapy were enrolled retrospectively. They were categorized as having central lung cancer, peripheral lung cancer with mediastinal lymph node metastasis (peripheral E lung cancer), and peripheral lung cancer without mediastinal lymph node metastasis (peripheral N lung cancer). Four treatment plans were designed for each patient: fixed jaw and adaptive jaw IMRT technique (FJ‐IMRT and JA‐IMRT), and fixed jaw and jaw tracking VMAT technique (FJ‐VMAT and JT‐VMAT). The dose parameters of the four group plans were compared and analyzed.

Results

Compared to FJ‐IMRT, JA‐IMRT significantly reduced the mean dose (D_mean) and volume percentage of 5 Gy (V_5Gy) of the total lung in central and peripheral N lung cancer. Similarly, compared to FJ‐VMAT, JT‐VMAT provided better protection to most organs at risk (OARs), particularly for total lung and heart. In comparison with IMRT, VMAT significantly improved the conformity index (CI) of the planning target volume for the three lung cancer classifications, and it reduced the dose of almost all OARs except V_5Gy and D_mean of the total lung. Moreover, the mean monitor units of the VMAT groups were far lower than the IMRT groups.

Conclusion

Based on the dosimetric findings and considering clinical data published on lung and heart side effects, we propose recommendations on the preferred treatment technique based on tumor location and pulmonary function. For central lung cancer with normal pulmonary function, we advise JT‐VMAT techniques. Conversely, for central lung cancer with poor pulmonary function, we recommend JA‐IMRT techniques. We advocate JA‐IMRT for peripheral E lung cancer. For peripheral N lung cancer, JT‐VMAT techniques are strongly recommended.

ORS-Pred: An optimized reduced scheme-based identifier for antioxidant proteins

Antioxidant proteins can terminate a chain of reactions caused by free radicals and protect cells from damage. To identify antioxidant proteins rapidly, a computational model was proposed based on the optimized recoding scheme, sequence information and machine learning methods. First, over 600 recoding schemes were collected to build a scheme set. Then, the original sequence was recoded as a reduced expression whose g-gap dipeptides (g = 0, 1, 2) were used as the features of proteins. Furthermore, a random forest method was used to evaluate the classification ability of the obtained dipeptide features. After going through all schemes, the best predictive performance scheme was chosen as the optimized reduction scheme. Finally, for the RF method, a grid search strategy was used to select a better parameter combination to identify antioxidant proteins. In the experiment, the present method correctly recognized 90.13-99.87% of the antioxidant samples. Other experimental results also proved that the present method was efficient to identify antioxidant proteins. Finally, we also developed a web server that was freely accessible to researchers.

Dynamic Changes in Plasma Urotensin II and Its Correlation With Plaque Stability

ABSTRACT

Urotensin II (UII) is involved in the formation of atherosclerosis, but its role in the stability of atherosclerotic plaques is unknown. The purpose of this study was to observe the dynamic changes in plasma UII and analyze its relationship to the stability of atherosclerotic plaques. One hundred thirty-five consecutive patients with acute coronary syndrome (ACS) were enrolled. The plasma UII levels were measured immediately after admission and during three-month follow-up. A vulnerable plaque model was established using local transfection of a recombinant P53 adenovirus into plaques in rabbits fed with a high-cholesterol diet and subjected to balloon arterial injury. The levels of plasma UII were measured weekly. The changes in plasma UII during the formation of atherosclerotic plaques and before and after plaque transfection were observed. The morphology of the plaques and the expression, distribution, and quantitative expression of UII in the plaques also were observed. Our results showed that the levels of plasma UII in patients with ACS at admission were lower than levels observed at the three-month follow-up. UII dynamic changes and its correlation with plaque stabilities were further verified in rabbits with atherosclerotic vulnerable plaques. The UII levels in rabbits were significantly decreased immediately after the P53 gene transfection, which led to plaque instability and rupture. These results suggested that UII expression was down-regulated in ACS, which may be related to its ability to modulate mechanisms involved in plaque stability and instability.

Tendon tissue engineering: Cells, growth factors, scaffolds and production techniques

Tendon injuries are a global health problem that affects millions of people annually. The properties of tendons make their natural rehabilitation a very complex and long-lasting process. Thanks to the development of the fields of biomaterials, bioengineering and cell biology, a new discipline has emerged, tissue engineering. Within this discipline, diverse approaches have been proposed. The obtained results turn out to be promising, as increasingly more complex and natural tendon-like structures are obtained. In this review, the nature of the tendon and the conventional treatments that have been applied so far are underlined. Then, a comparison between the different tendon tissue engineering approaches that have been proposed to date is made, focusing on each of the elements necessary to obtain the structures that allow adequate regeneration of the tendon: growth factors, cells, scaffolds and techniques for scaffold development. The analysis of all these aspects allows understanding, in a global way, the effect that each element used in the regeneration of the tendon has and, thus, clarify the possible future approaches by making new combinations of materials, designs, cells and bioactive molecules to achieve a personalized regeneration of a functional tendon.

Clinical utility of ABCB1 and ABCG2 genotyping for assessing the clinical and pathological response to FAC therapy in Mexican breast cancer patients

PURPOSE

Resistance to neoadjuvant chemotherapy with 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC) in some patients with locally advanced breast cancer remains one of the main obstacles to first-line treatment. We investigated clinical and pathological responses to FAC neoadjuvant chemotherapy in Mexican women with breast cancer and their possible association with SNPs present in ABC transporters as predictors of chemoresistance.

MATERIALS

A total of 102 patients undergoing FAC neoadjuvant chemotherapy were included in the study. SNP analysis was performed by RT-PCR from genomic DNA. Two SNPs were analyzed: ABCB1 rs1045642 (3435 C > T) and ABCG2 rs2231142 (421 G > T).

RESULTS

In clinical response evaluation, significant associations were found between the ABCB1 C3435T genotype and breast cancer chemoresistant and chemosensitive patients (p < 0.05). In the early clinical response, patients with genotype C/C or C/T were more likely to be chemosensitive to neoadjuvant therapy than patients with genotype T/T (OR = 4.055; p = 0.0064). Association analysis between the ABCB1 gene polymorphism and the pathologic response to FAC chemotherapy showed that the C/C + C/T genotype was a protective factor against chemoresistance (OR = 3.714; p = 0.0104). Polymorphisms in ABCG2 indicated a lack of association with resistance to chemotherapy (p = 0.2586) evaluating the clinical or pathological response rate to FAC neoadjuvant chemotherapy.

CONCLUSION

The early clinical response and its association with SNPs in the ABCB1 transporter are preserved until the pathological response to neoadjuvant chemotherapy; therefore, it could be used as a predictor of chemoresistance in locally advanced breast cancer patients of the Mexican population.

Contrast-Enhanced Ultrasonography in the Diagnosis and Treatment Modulation of Breast Cancer

The aim of this paper is to highlight the role of contrast-enhanced ultrasound in breast cancer in terms of diagnosis, staging and follow-up of the post-treatment response. Contrast-enhanced ultrasound (CEUS) is successfully used to diagnose multiple pathologies and has also clinical relevance in breast cancer. CEUS has high accuracy in differentiating benign from malignant lesions by analyzing the enhancement characteristics and calculating the time-intensity curve’s quantitative parameters. It also has a significant role in axillary staging, especially when the lymph nodes are not suspicious on clinical examination and have a normal appearance on gray-scale ultrasound. The most significant clinical impact consists of predicting the response to neoadjuvant chemotherapy, which offers the possibility of adjusting the therapy by dynamically evaluating the patient. CEUS is a high-performance, feasible, non-irradiating, accessible, easy-to-implement imaging method and has proven to be a valuable addition to breast ultrasound.

Utility of quantitative contrast-enhanced ultrasound for the prediction of lymph node metastasis in patients with papillary thyroid carcinoma

OBJECTIVES

The aim of this study was to find the optimal parameters and cutoffs to differentiate metastatic lymph nodes (LNs) from benign LNs in the patients with papillary thyroid carcinoma (PTC) on the quantitative contrast-enhanced ultrasound (CEUS) features.

METHODS

A total of 134 LNs in 105 patients with PTCs were retrospectively enrolled. All LNs were evaluated by conventional ultrasound (US) and CEUS before biopsy or surgery. The diagnostic efficacy of CEUS parameters was analyzed.

RESULTS

Univariate analysis indicated that metastatic LNs more often manifested centripetal or asynchronous perfusion, hyper-enhancement, heterogeneous enhancement, ring-enhancing margins, higher PI, larger AUC, longer TTP and DT/2 than benign LNs at pre-operative CEUS (p <  0.001, for all). Multivariate analysis showed that centripetal or asynchronous perfusion (OR = 3.163; 95% CI, 1.721-5.812), hyper-enhancement(OR = 0.371; 95% CI, 0.150-0.917), DT/2 (OR = 7.408; 95% confidence interval CI, 1.496-36.673), and AUC (OR = 8.340; 95% CI, 2.677-25.984) were predictive for the presence of metastatic LNs. The sensitivity and accuracy of the quantitative CEUS were higher than qualitative CEUS (75% vs 55 % and 83.6% vs 76.1 % , respectively).

CONCLUSIONS

Quantitative CEUS parameters can provide more information to distinguish metastatic from benign LNs in PTC patients; In particular, DT/2 and AUC have a higher sensitivity and accuracy in predicting the presence of metastatic LNs and reduce unnecessary sampling of benign LNs.

The clinical value of Arrival-time Parametric Imaging using contrast-enhanced ultrasonography in differentiating benign and malignant breast lesions

OBJECTIVES

To evaluate the clinical value of Arrival-time Parametric Imaging (At-PI) in the differentiation of benign and malignant breast lesions.

METHODS

For this ethics committee-approved retrospective study, a total of 184 breast lesions in 176 women were included and gray-scale ultrasound, contrast-enhanced ultrasound (CEUS) and At-PI were performed. In CEUS and At-PI, perfusion patterns, perfusion uniformity and color spatial distribution for lesions were analyzed qualitatively and the maximal diameter ratio of the lesion in accumulated parametric images and that in gray-scale images (MDRAI/GI) and area ratio of the lesion in accumuated parametric images and that in gray-scale images (ARAI/GI) were calculated quantitatively. Kappa and Intraclass Correlation Coefficient were used to evaluate the interobserver reproducibility for CEUS and At-PI and the intraobserver reproducibility for At-PI, respectively. The area under receiver operating characteristic (AUC), sensitivity, specificity, accuracy and positive and negative likelihood ratios (PPV, NPV) were calculated for MDRAI/GI and ARAI/GI.

RESULTS

Good interobserver and intraobserver reproducibility for At-PI were identified. In At-PI, there were statistically significant differences in perfusion patterns, color spatial distribution, MDRAI/GI and ARAI/GI between benign and malignant breast lesions (P < 0.05). The AUCs of MDRAI/GI and ARAI/GI were 0.895 and 0.954, respectively, with no significant difference between them (Z = 1.84, P > 0.05). By using the thresholds of 1.125 for MDRAI/GI and 1.21 for ARAI/GI, the sensitivity, specificity, accuracy, PPV and NPV of At-PI were 84.48%, 88.24%, 85.57%, 92.45% and 76.92%, respectively, for MDRAI/GI and 93.10%, 91.18%, 92.39%, 94.74% and 88.57%, respectively, for ARAI/GI.

CONCLUSIONS

At-PI is helpful to distinguish benign from malignant breast lesions. And MDRAI/GI and ARAI/GI are useful and efficient features for differential diagnosis.

Incorporation of contrast-enhanced ultrasound in the differential diagnosis for breast lesions with inconsistent results on mammography and conventional ultrasound

OBJECTIVE

To identify the efficacy of contrast-enhanced ultrasound (CEUS) in re-evaluating masses with inconsistent Breast Imaging Reporting and Data System (BI-RADS) on mammography (MG) and conventional ultrasound (US).

MATERIALS AND METHODS

A total of 637 breast lesions were evaluated with MG, US, and CEUS within 6 months and assessed as BI-RADS MG and US. CEUS was used as an additional screening to rerate BI-RADS US according to a five-point system. Lesions were divided into consistent or inconsistent group on the basis of BI-RADS MG and US assessment. The performance of MG, US, and CEUS in the overall and inconsistent group as well as the clinicopathological differences between consistent and inconsistent group were compared using Z test, Mann-Whitney U test, and t-test.

RESULTS

The respective AUCs of MG and US were 0.742, 0.843 for overall group and 0.412, 0.789 for inconsistent group. The corresponding values of rerated CEUS BI-RADS were 0.958 and 0.950, which were significantly prior to those of MG and US (p < 0.001). Younger age, negative lymph node status, and dense breast were significantly associated with inconsistent group.

CONCLUSION

Incorporation of CEUS to re-evaluate lesions can improve the diagnostic efficacy comparing to MG or US alone especially when disagreement occurred.

Outcome of tantalum rod insertion in the treatment of osteonecrosis of the femoral head with minimum follow-up of 1 year: a meta-analysis and systematic review

Osteonecrosis of the femoral head (ONFH) is a debilitating disease that can cause deformity and collapse of the femoral head, thus leading to the development of degenerative joint disease that can incapacitate the patient with pain and reduction in hip mobility. This study aims to determine the safety and efficacy of tantalum rod insertion in the treatment of ONFH with a minimum follow-up period of 1 year. A multi-database search was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Data from studies assessing the clinical and radiological outcomes as well as complications of tantalum rod insertion in the treatment of ONFH with a minimum follow-up period of 1 year were extracted and analyzed. Ten studies were included in this meta-analysis, consisting of 550 hips. There was a statistically significant increase in HHS (MD = 30.35, 95% CI: 20.60-40.10, P < 0.001) at final follow-up versus pre-operative scores. The weighted pooled proportion (PP) of radiographic progression of ONFH was 0.221 (95% CI: 0.148-0.316), while that of progression into femoral head collapse was 0.102 (95% CI: 0.062-0.162). Conversion to total hip arthroplasty (THA) had a PP of 0.158 (95% CI: 0.107-0.227) with a mean weighted period of 32.4 months (95% CI: 24.9-39.9 months). Subgroup analysis of conversion to THA when tantalum rods were used in conjunction with bone grafting (PP = 0.150, 95% CI: 0.092-0.235) showed a marginal risk reduction than when compared with subgroup analysis of tantalum rods being used alone (PP = 0.154, 95% CI: 0.078-0.282). Tantalum rod is a safe alternative option to the current joint-preserving procedures available in the treatment of ONFH. However, more studies are needed to investigate and identify the most appropriate patients who would benefit most and the synergistic effect brought on by the use of complementary biological augmentation of bone grafting or stem cells with tantalum rods.

Diagnostic efficacy of contrast-enhanced ultrasound for breast lesions of different sizes: a comparative study with magnetic resonance imaging

OBJECTIVE

This study aimed to compare the diagnostic performance of contrast-enhanced ultrasound (CEUS), MRI, and the combined use of the two modalities for differentiating breast lesions of different sizes.

METHODS

A total of 406 patients with 406 solid breast masses detected by conventional ultrasound underwent both CEUS and MRI scans. Histological results were used as reference standards. The lesions were categorized into three groups according to size (Group 1, ≤ 20 mm; Group 2, > 20 mm, Group 3: total lesions). Sensitivity, specificity, accuracy, and receiver operating characteristic (ROC) curve analysis were used to assess the diagnostic performance of these imaging methods for breast lesions.

RESULTS

There were 194 benign and 212 malignant breast lesions according to the histological diagnosis. Compared with MRI, CEUS demonstrated similar sensitivity in detecting breast cancer (p = 1.0000 for all) in all the three groups. With regard to specificity, accuracy, and the area under the ROC curve (Az) values, MRI showed a better performance than that shown by CEUS (p ＜0.05 for all), and the combination of the two modalities improved the diagnostic performance of CEUS alone significantly (p ＜0.05 for all) in all the three groups. However, the diagnostic specificity and accuracy of the combined method was not superior to that of MRI alone except for Group 2.

CONCLUSION

CEUS demonstrated good sensitivity in detecting breast cancer, and the combined use with MRI can optimize the diagnostic specificity and accuracy in breast cancer prediction.

ADVANCES IN KNOWLEDGE

Few studies have compared the diagnostic efficacy of CEUS and MRI, and this study is the first attempt to seek out the diagnostic values for breast lesions of variable sizes (lesions with ≤20 mm and >20 mm).

Peripheral Blood Stem Cell Therapy Does Not Improve Outcomes of Femoral Head Osteonecrosis With Cap-Shaped Separated Cartilage Defect

A combination treatment with porous tantalum rod implantation and intra-arterial infusion of peripheral blood stem cells (PBSCs) provides a promise for treating early and intermediate stages of osteonecrosis of the femoral head (ONFH). However, its clinical indications and application restrictions remain unclear. This study aims to determine the clinical, histological, and radiological outcomes of a combination treatment using mechanical support and a targeted intra-arterial infusion of PBSCs for painful ONFH with a cap-shaped separation (CSS) cartilage defect. Compared with the standard pain management (control group), this combination treatment did not improve the Harris Hip Score (HHS) at 36 months. Micro-CT and histologic analyses showed severe focal destruction in all CSS-ONFH femoral heads in both the combination and control groups. Femoral heads showed a higher percentage of bone lesions in the combination treatment group than in the control group. There was no significant difference in osteoclast number in the subchondral bone areas between the two groups. A high level of expression of inflammatory cytokines, including tumor necrosis factor-α and interleukin-1β, was detected in blood vessels around the subchondral bone in both groups. The RANKL/OPG (receptor activator of the nuclear factor-kB ligand/osteoprotegerin) ratio was also similar between the control and combination treatment groups. Our results indicate that this combination treatment is not an effective method for the treatment of patients with painful CSS-ONFH. Moreover, this combination treatment did not inhibit inflammatory osteoclastogenesis in patients with more advanced disease. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:269-276, 2020.

Electrosprayed naringin-loaded microsphere/SAIB hybrid depots enhance bone formation in a mouse calvarial defect model

The burst release of active osteogenic factors, which is not beneficial to osteogenesis, is commonly encountered in bone tissue engineering. The aims of this study were to prepare naringin-loaded microsphere/sucrose acetate isobutyrate (Ng-m-SAIB) hybrid depots, reduce the burst release of naringin (Ng), and improve osteogenesis. The morphology and size distributions of electrosprayed Ng-microspheres were characterized by scanning electron microscopy (SEM). The Ng-microspheres and Ng-m-SAIB depots were characterized by Fourier transform infrared spectroscopy (FTIR) and in vitro release studies. In vitro osteoblast-microsphere interactions and in vivo osteogenesis were assessed after implantation of Ng-m-SAIB depots. The addition of sucrose acetate isobutyrate (SAIB) to monodisperse Ng-microspheres did not cause a change in the chemical structure. The performances of the microspheres in osteoblast-microsphere interactions were better when the naringin content was 4% than when it was at 2% and 6%. On the first day following the loading of Ng-microspheres (2%, 4%, and 6%) into SAIB depots, the burst release was reduced dramatically from 70.9% to 6.3%, 73.1% to 7.2%, and 73.9% to 9.9%, respectively. In addition, after 8 weeks, the new bone formation rate in the calvarial defects of SD rats receiving Ng-m-SAIB was 53.1% compared to 21.2% for the control group and 16.1% for the microsphere-SAIB group. These results demonstrated that Ng-m-SAIB hybrid depots may have promise in bone regeneration applications.

Vascular index measured by smart 3-D superb microvascular imaging can help to differentiate malignant and benign breast lesion

Purpose: The purpose of our study was to prospectively evaluate the diagnostic performance of the vascular index (VI, defined as the ratio of Doppler signal pixels to pixels in the total lesion) measured via Smart 3-D superb microvascular imaging (SMI) for breast lesions.

Patients and methods: Two hundred and thirty-two consecutive patients with 236 breast lesions referred for biopsy at Peking Union Medical College Hospital were enrolled in the study from December 2016 to November 2017. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of VI were calculated with histopathologic results as the reference standard.

Results: Of the 236 breast lesions, 121 were malignant and 115 were benign. The mean VI was significantly higher in malignant lesions (9.7±8.2) than that in benign ones (3.4±3.3) (P<0.0001). Sensitivity, specificity, PPV, NPV and accuracy of VI (4.0 as the threshold) were respectively: 76.0%, 66.1%, 70.2%, 72.4% and 71.2% (P<0.05).

Conclusion: Smart three-dimensional (3-D) SMI is a noninvasive tool using two-dimensional (2-D) scanning to generate 3-D vascular architecture with a high-resolution image of micro-vessels. This can be used as a qualitative guide to identify the optimal 2-D SMI plane with the most abundant vasculature to guide VI quantitative measurements of breast lesions. Smart 3-D SMI may potentially serve as a noninvasive tool to accurately characterize benign versus malignant breast lesions.

BI-RADS 4 breast lesions: could multi-mode ultrasound be helpful for their diagnosis?

Background

The malignant probability of Breast Imaging Reporting and Data System (BI-RADS) 4 breast lesions is 3-94%, which is a very large span, and thus leads to a high rate of unnecessary biopsy. Therefore, the differential diagnosis of benign and malignant BI-RADS 4 breast lesions has become extremely important. Thus, in this paper, we investigated the diagnostic value of conventional ultrasonography (US), contrast-enhanced ultrasound (CEUS) and shear wave elastography (SWE) for BI-RADS 4 breast lesions, and tried to figure out a multi-mode ultrasonic method for them.

Methods

From March 2016 to May 2017, 118 breast lesions that were categorized as BI-RADS 4 lesions by US were studied with CEUS and SWE. All the lesions were confirmed by pathology via surgery or vacuum-assisted biopsy. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of US, CEUS and SWE were analyzed. Then the diagnostic efficacies of US, CEUS, SWE and the combination of these modalities were compared. Logistic regression analysis was performed to identify the independent risk factors. A multi-mode method to evaluate BI-RADS 4 lesions based on the logistic regression was developed.

Results

Of the 118 BI-RADS 4 lesions, 74 lesions (62.7%) were benign and 44 lesions (37.3%) were malignant. The diagnostic sensitivity and specificity for US, US + CEUS, US + SWE, US + CEUS + SWE were 88.6% and 75.7%, 86.4% and 94.6%, 88.6% and 90.5%, 97.7% and 93.2%, respectively. The area under the ROC curve (AUC) of US + SWE + CEUS was significantly higher than that of US (P<0.0001), US + CEUS (P=0.020), but there was no significant difference between the AUC of US + SWE + CEUS and the AUC of US + SWE.

Conclusions

US + CEUS + SWE and US + SWE could significantly improve the diagnostic efficiency and accuracy of US in the diagnosis of BI-RADS 4 breast lesions.

Fathoming Aspergillus oryzae metabolomes in formulated growth matrices

The stochasticity of Aspergillus oryzae (Trivially: the koji mold) pan-metabolomes commensurate with its ubiquitously distributed landscapes, i.e. growth matrices have been seemed uncharted since its food fermentative systems are mostly being investigated. In this review, we explicitly have discussed the likely tendencies of A. oryzae metabolomes pertaining to its growth milieu formulated with substrate matrices of varying nature, composition, texture, and associated physicochemical parameters. We envisaged typical food matrices, namely, meju, koji, and moromi as the semi-natural cultivation models toward delineating the metabolomic patterns of the koji mold, which synergistically influences the organoleptic and functional properties of the end products. Further, we highlighted how tailored conditions in sub-natural growth matrices, i.e. synthetic cultivation media blends, inducers, and growth surfaces, may influence A. oryzae metabolomes and targeted phenotypes. In general, the sequential or synchronous growth of A. oryzae on formulated matrices results in a number of metabolic tradeoffs with its immediate microenvironment influencing its adaptive and regulatory metabolomes. In broader context, evaluating the metabolic plasticity of A. oryzae relative to the tractable variables in formulated growth matrices might help approximate its growth and metabolism in the more complex natural matrices and environs. These approaches may considerably help in the design and manipulation of hybrid cultivation systems towards the efficient harnessing of commercial molds.

Correlation Between Contrast-enhanced Ultrasound Characteristics (Qualitative and Quantitative) and Pathological Prognostic Factors in Breast Cancer

BACKGROUND/AIM

Little is known about the correlation between contrast-enhanced ultrasound (CEUS) characteristics and pathological prognostic factors in breast cancer. The aim of this study was to explore the correlation between CEUS characteristics and pathological prognostic factors.

PATIENTS AND METHODS

A retrospective study with 34 malignant breast lesions was conducted. CEUS characteristics included qualitative characteristics (e.g. lesion's enhancement degree and order, internal lesion homogeneity etc.) and quantitative characteristics (e.g. peak intensity, time to peak etc.). Also, pathological prognostic factors were included (e.g. tumor grade, estrogen receptor status etc.).

RESULTS

Blurred lesion margins were observed more often in tumors of high histological grade (p=0.01) and in estrogen receptor-negative tumors (p=0.049). Furthermore, perilesional enhancement was associated with positive Ki-67 expression (p=0.049), while heterogeneous internal sentinel lymph node enhancement was associated with malignant infiltration of the node (p=0.002).

CONCLUSION

CEUS has the potential to provide a prevision of pathological prognostic factors in malignant breast lesions, helping in the better early patient management.

Correlation Between Contrast-enhanced Ultrasound Characteristics (Qualitative and Quantitative) and Pathological Prognostic Factors in Breast Cancer

BACKGROUND/AIM

Little is known about the correlation between contrast-enhanced ultrasound (CEUS) characteristics and pathological prognostic factors in breast cancer. The aim of this study was to explore the correlation between CEUS characteristics and pathological prognostic factors.

PATIENTS AND METHODS

A retrospective study with 34 malignant breast lesions was conducted. CEUS characteristics included qualitative characteristics (e.g. lesion's enhancement degree and order, internal lesion homogeneity etc.) and quantitative characteristics (e.g. peak intensity, time to peak etc.). Also, pathological prognostic factors were included (e.g. tumor grade, estrogen receptor status etc.).

RESULTS

Blurred lesion margins were observed more often in tumors of high histological grade (p=0.01) and in estrogen receptor-negative tumors (p=0.049). Furthermore, perilesional enhancement was associated with positive Ki-67 expression (p=0.049), while heterogeneous internal sentinel lymph node enhancement was associated with malignant infiltration of the node (p=0.002).

CONCLUSION

CEUS has the potential to provide a prevision of pathological prognostic factors in malignant breast lesions, helping in the better early patient management.

Dosimetric evaluation of VMAT for palliative radiotherapy for non-small cell lung carcinoma

OBJECTIVE:

To compare the dosimetric consequences of volumetric modulated arc therapy (VMAT) for high-dose palliative thoracic radiotherapy through comparison with conventionally used isocentric parallel opposed pair (POP) of fields.

METHODS:

20 consecutive patients with non-small cell lung cancer who received 36 Gy in 12 fractions using a POP technique were re-planned using a single VMAT arc. Salient dosimetric parameters were compared between the plans using a paired t-test.

RESULTS:

VMAT demonstrated dosimetric superiority; all PTV dose parameters were significantly improved and importantly the volume of normal lung receiving a high dose was also significantly reduced (mean volume of normal lung receiving 36 Gy was 12.9% in POP vs 1.8% in VMAT, p < 0.005).

CONCLUSION:

The standard POP technique does not take into account tissue densities which results in higher doses to the normal tissue outside the target volume and reduced conformity to the PTV.

ADVANCES IN KNOWLEDGE:

With the help of modern VMAT techniques, it is possible to effectively achieve highly conformal dose delivery which may provide an opportunity to escalate the dose to the tumour in this group of patients.

Diagnostic and prognostic values of contrast-enhanced ultrasound in breast cancer: a retrospective study

This study aimed to explore the diagnostic and prognostic values of contrast-enhanced ultrasound (CEUS) in breast cancer. Between September 2009 and October 2011, a total of 143 breast cancer patients and 161 healthy people were selected as case group and control group, respectively. After the identification of lesions by conventional ultrasound, all patients underwent CEUS. The CEUS images were analyzed, and time-intensity curves (TICs) were obtained. Hematoxylin-eosin and immunohistochemistry staining was performed on tissue specimens, according to which the expressions of estrogen receptor (ER), c-erb-B2, p53, and Ki-67 were measured. Multivariate logistic regression analysis was used to compare CEUS and TIC parameters between the two groups. Compared with the control group, cancer patients showed high enhancement, heterogeneous enhancement or defects in the central region, expansion of lesion diameter after enhancement and crab-like blur lesion edges. The peak intensity (PI), relative start time of enhancement, relative PI, and relative area under the curve in the case group were significantly higher than those in the control group. Logistic analysis showed that the uniformity of enhancement, expansion of lesion diameter, and relative PI were significant diagnostic parameters of breast cancer, with area under the curve being 0.798, 0.776, and 0.919, respectively. There were strong associations between CEUS characteristics and expressions of prognostic factors in breast cancer: the heterogeneous enhancement was common in c-erb-B2-positive tumors; the centripetal enhancement occurred more in ER-negative tumors; perforator vessels were often seen in tumors at high histological grade; perfusion defects were common in ER-negative, c-erb-B2-positive, and Ki-67-positive tumors. CEUS is a useful tool for the early diagnosis and prognosis of breast cancer.

Analysis of SCN5A Gene Variants in East Slovak Patients with Cardiomyopathy

OBJECTIVE

Mutations in ion channels genes are potential cause of cardiomyopathy. The SCN5A gene (sodium channel, voltage gated, type V alpha subunit gene; 3p21) belongs to the family of cardiac sodium channel genes. Mutations in SCN5A gene lead to decreased Na+ current and ion unbalance. The SCN5A gene mutations are found in approximately 2% of patients with dilated cardiomyopathy (DCM), and they may be potential phenotype modifiers in hypertrophic cardiomyopathy (HCM). The role of SCN5A gene mutations in cardiomyopathy is not fully elucidated.

METHODS

Three selected exons (12, 20, and 21) of the SCN5A gene in the cohort of 58 East Slovak patients with dilated and HCM were analyzed by the Sanger sequencing method in order to detect etiopathogenic mutations associated with dilated and HCM.

RESULTS

The mutation screening of three selected exons of SCN5A gene in the cohort of 27 DCM, 12 HCM patients, and 16 controls identified 10 missense genetic variants. Three of them (T1247I, A1260D, and G1262S), all in exon 21 of the SCN5A gene, were potentially damaging and disease-causing variants.

CONCLUSION

Data from this study demonstrate that SCN5A gene variants have important role in the etiopathogenesis of dilated and HCM.