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.

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.

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.

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.

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.

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.

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.

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.

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.

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 kg_cell ^-1 and 395 Wh L_cell ^-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.

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.

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.

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.

Analysis of Attitudes About COVID-19 Contact Tracing and Public Health Guidelines Among Undocumented Immigrants in the US

This qualitative study examines the factors associated with undocumented immigrants’ ability and willingness to follow COVID-19 contact tracing and public health guidelines.

Redefining communities: The association between deferred action, online and offline social capital and depressive symptoms among undocumented young adults

An explosion in Internet use, social networking sites, and COVID-19 has promoted a new concept in health - online social capital, defined as linkages to online social networks that promote trust and group norms. Particularly for the 1.3 million undocumented young adult immigrants who "live in the shadows," the Internet may serve as a place of support and information. This study examines the association between documentation status (defined as Deferred Action for Childhood Arrivals (DACA) status), offline social capital, online social capital, and depressive symptoms among foreign-born Latino and Asian and Pacific Islander young adults in California (N = 208) using data from an internet-based survey conducted in 2017. This study found that those without DACA status had higher online social capital (p < 0.001) and increased depressive symptoms (p = 0.01) than those with DACA status. Using linear regression, we found evidence of online social capital potentially mediating the relationship between DACA status and depressive symptoms. This study also found that as offline social capital increases, the association between online social capital on depressive symptoms decreases. This study points to the power of offline communities and the importance of increasing access to community resources, particularly to those without documentation status who may only have online social networks.

Muscle insulin-like growth factor-I modulates murine craniofacial bone growth

Insulin-like growth factor I (IGF-I) is essential for muscle and bone development and a primary mediator of growth hormone (GH) actions. While studies have elucidated the importance of IGF-I specifically in muscle or bone development, few studies to date have evaluated the relationship between muscle and bone modulated by IGF-I in vivo, during post-natal growth. Mice with muscle-specific IGF-I overexpression (mIgf1+/+) were utilised to determine IGF-I- and muscle-mass-dependent effects on craniofacial skeleton development during post-natal growth. mIgf1+/+ mice displayed accelerated craniofacial bone growth when compared to wild-type animals. Virus-mediated expression of IGF-I targeting the masseter was performed to determine if post-natal modulation of IGF-I altered mandibular structures. Increased IGF-I in the masseter affected the mandibular base plane angle in a lateral manner, increasing the width of the mandible. At the cellular level, increased muscle IGF-I also accelerated cartilage thickness in the mandibular condyle. Importantly, mandibular length changes associated with increased IGF-I were not present in mice with genetic inhibition of muscle IGF-I receptor activity. These results demonstrated that muscle IGF-I could indirectly affect craniofacial growth through IGF-I-dependent increases in muscle hypertrophy. These findings have clinical implications when considering IGF-I as a therapeutic strategy for craniofacial disorders.

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.

[Immunoglobulin G4-Related Disease in the Thorax: Imaging Findings and Differential Diagnosis]

Immunoglobulin G4-related disease (IgG4-RD) is a chronic inflammatory condition involving multiple organs, including the salivary or lacrimal glands, orbit, pancreas, bile duct, liver, kidney, retroperitoneum, aorta, lung, and lymph nodes. It is histologically characterized by tissue infiltration with lymphocytes and IgG4-secreting plasma cells, storiform fibrosis, and obliterative phlebitis. In the thoracic involvement of IgG4-RD, mediastinal lymphadenopathy and perilymphangitic interstitial thickening of the lung are the most common findings. Peribronchovascular and septal thickening and paravertebral band-like soft tissue are characteristic findings of IgG4-RD. Other findings include pulmonary nodules or masses, ground-glass opacity, alveolar interstitial thickening, pleural effusion or thickening, mass in the chest wall or mediastinum, and arteritis involving the aorta and coronary artery. Radiologic differential diagnosis of various malignancies, infections, and inflammatory conditions is needed. In this review, we describe the imaging findings of IgG4-RD and the radiologic differential diagnoses in the thorax.

The association between social ties and depression among Asian and Pacific Islander undocumented young adults

BACKGROUND

The mental health of Asian and Pacific Islander (API) undocumented young adults has been understudied, despite an increasingly restrictive immigration climate that would ostensibly raise mental health risks. This study examined the role of social ties and depression among API undocumented young adults. We distinguished between two types of social ties, bonding and bridging, and additionally considered the absence of ties (e.g. isolation).

METHODS

We used primary data collected among 143 API undocumented young adults. We first identified correlates for each type of social tie and then examined the association for each measure with depression.

RESULTS

Higher levels of bonding and bridging ties were associated with lower odds of a positive depression screen. In contrast, isolation was associated with higher odds of a positive depression screen. There were no significant associations between total social ties and depression.

CONCLUSIONS

Our findings suggest that both bonding and bridging ties are important factors in the mental health of API undocumented young adults. Factors that facilitate these types of ties, such as DACA, can be effective interventions for improving mental health among this population.

Risk factors affecting intimate partner violence occurrence in South Korea: Findings from the 2016 Domestic Violence Survey

This study aimed to identify factors affecting the occurrence of intimate partner violence (IPV) in Korean adults aged 19 years and older. Specifically, we identified the factors in women's victimization in and men's perpetration of IPV. This study adopted a cross-sectional and correlational design in conducting secondary data analysis of the 2016 Domestic Violence Survey in Korea. Men (N = 1,272) and women (N = 2,689) with partner were included in the analysis. The ecological model was used as a conceptual framework. Multiple logistic regression analyses were conducted to identify factors affecting women's victimization in and men's perpetration of IPV. The results showed that the prevalence of IPV against female partner was 12.1%. IPV occurrence was higher among women (Odds ratios (OR) = 2.92, Confidence intervals (CI): 1.84-4.63) and men (OR = 2.64, CI: 1.62-4.32) who experienced witnessing inter-parental violence in childhood, and among women (OR = 2.25, CI: 1.40-3.61) and men (OR = 2.68, CI: 1.59-4.52) with a tolerant attitude toward IPV. The occurrence was higher among women who experienced childhood maltreatment by the parents (OR = 1.70, CI: 1.03-2.82) and women whose income was 2 million Korean Won(KRW) to 3 million KRW compared with women whose income was above 4 million KRW (OR = 1.97, CI: 1.10-3.55). The occurrence was lower among women with office jobs compared with other jobs (OR = 0.47, CI: 0.26-0.84). Based on the results of this study, early intervention in abusive families to reduce the negative impact of abuse experiences and witnessing inter-parental violence in childhood, and education and publicity for changing attitudes toward IPV are necessary at the individual and societal levels. The formation of policies for the stable workplace and income of women are required.

Successful Transcatheter Arterial Embolization following Diverticular Bleeding in the Third Portion of the Duodenum: A Case Report

본 증례는 73세 남자 환자가 십이지장 3부에서 발생한 상부위장관 출혈로 인해 경동맥 색전술로 치료한 드문 증례이다. 환자는 혈변을 주소로 내원하여 시행한 초기 상부 및 하부 위장관 내시경과 전산화단층촬영에서 출혈 부위를 발견하지 못하였다. 입원 3일째에 혈색소 수치가 지속적으로 감소하여 테크네슘-적혈구 스캔을 시행하였고 십이지장 3부의 게실 내에 출혈이 의심되어 혈관조영술을 시행하였다. 상장간동맥 혈관조영술에서 십이지장 게실에 혈류를 공급하는 하췌십이지장동맥의 활동성 출혈이 관찰되어 색전술을 시행하였다. 이후 7일 동안 재출혈이나 합병증이 없어 퇴원하였다. 이에 발생빈도가 매우 낮고 초기 진단이 어려웠던 십이지장 게실 출혈의 보고와 관련된 문헌고찰을 하고자 한다.

Diagnostic accuracy of non-contrast abdominopelvic computed tomography scans in follow-up of breast cancer patients

OBJECTIVES

To evaluate the effectiveness of follow-up with non-enhanced CT (NECT) in patients with breast cancer.

METHODS

The present retrospective study included 1396 patients with breast cancer. Group A included patients with no metastasis to evaluate the diagnostic performance of NECT in detecting newly developed metastasis. Group B included patients with known hepatic metastasis to evaluate the accuracy of NECT for the assessment of hepatic metastasis.

RESULTS

Group A included 895 patients (mean age 52.8 years). Among them, 145 patients had 160 metastases. The per-patient sensitivities for diagnosing newly developed metastasis were 68.3 and 53.8% according to the two reviewers, while the per-lesion sensitivities were 89.4 and 85.0%. Sensitivities for bone metastasis were 98.9 and 95.9%, while sensitivities for hepatic metastasis were 73.7 and 68.4%. In group B, the accuracy of hepatic metastasis response evaluation according to the RECIST criteria was 70.8% for reviewer 1 and 63.8% for reviewer 2.

CONCLUSIONS

NECT showed inadequate diagnostic performance in detecting newly developed metastasis and in evaluating the response of hepatic metastasis. However, NECT can be utilized as a follow-up modality in patients with decreased renal function or hypersensitivity to iodinated contrast media.

ADVANCES IN KNOWLEDGE

The risk of side effects of contrast media should be considered as important when NECT can be utilized as a follow-up modality in decreased renal function patients.

Quantitative Vertebral Bone Density Seen on Chest CT in Chronic Obstructive Pulmonary Disease Patients: Association with Mortality in the Korean Obstructive Lung Disease Cohort

Objective

Patients with chronic obstructive pulmonary disease (COPD) are known to be at risk of osteoporosis. The purpose of this study was to evaluate the association between thoracic vertebral bone density measured on chest CT (D_Thorax) and clinical variables, including survival, in patients with COPD.

Materials and Methods

A total of 322 patients with COPD were selected from the Korean Obstructive Lung Disease (KOLD) cohort. D_Thorax was measured by averaging the CT values of three consecutive vertebral bodies at the level of the left main coronary artery with a round region of interest as large as possible within the anterior column of each vertebral body using an in-house software. Associations between D_Thorax and clinical variables, including survival, pulmonary function test (PFT) results, and CT densitometry, were evaluated.

Results

The median follow-up time was 7.3 years (range: 0.1–12.4 years). Fifty-six patients (17.4%) died. D_Throax differed significantly between the different Global Initiative for Chronic Obstructive Lung Disease stages. D_Throax correlated positively with body mass index (BMI), some PFT results, and the six-minute walk distance, and correlated negatively with the emphysema index (EI) (all p < 0.05). In the univariate Cox analysis, older age (hazard ratio [HR], 3.617; 95% confidence interval [CI], 2.119–6.173, p < 0.001), lower BMI (HR, 3.589; 95% CI, 2.122–6.071, p < 0.001), lower forced expiratory volume in one second (FEV₁) (HR, 2.975; 95% CI, 1.682–5.262, p < 0.001), lower diffusing capacity of the lung for carbon monoxide corrected with hemoglobin (DL_CO) (HR, 4.595; 95% CI, 2.665–7.924, p < 0.001), higher EI (HR, 3.722; 95% CI, 2.192–6.319, p < 0.001), presence of vertebral fractures (HR, 2.062; 95% CI, 1.154–3.683, p = 0.015), and lower D_Thorax (HR, 2.773; 95% CI, 1.620–4.746, p < 0.001) were significantly associated with all-cause mortality and lung-related mortality. In the multivariate Cox analysis, lower D_Thorax (HR, 1.957; 95% CI, 1.075–3.563, p = 0.028) along with older age, lower BMI, lower FEV₁, and lower DL_CO were independent predictors of all-cause mortality.

Conclusion

The thoracic vertebral bone density measured on chest CT demonstrated significant associations with the patients' mortality and clinical variables of disease severity in the COPD patients included in KOLD cohort.

Low pectoralis muscle index, cavitary nodule or mass and segmental to lobar consolidation as predictors of primary multidrug-resistant tuberculosis: A comparison with primary drug sensitive tuberculosis

Background

The loss of muscle mass in primary multidrug-resistant tuberculosis (MDR-TB) has not been examined in previous studies. This study aimed to investigate that low pectoralis muscle index and characteristic CT features can help differentiate patients with primary MDR-TB from those with drug-sensitive tuberculosis (DS-TB).

Material and methods

From 2010 to 2016, we retrospectively enrolled 90 patients with primary MDR-TB and 90 age- and sex-matched patients with primary DS-TB. The pectoralis muscle mass was quantitatively measured on axial CT images using density histogram analysis. The pectoralis muscle index (PMI) was defined as the pectoralis muscle mass divided by body mass index. We compared the PMI and characteristic CT features of pulmonary tuberculosis between the two groups.

Results

Low PMI, segmental to lobar consolidation, cavity in consolidation, cavitary nodule or mass, and bilateral involvement were more frequently observed in patients with MDR-TB than in those with DS-TB. In stepwise multivariate logistic regression analysis, low PMI (odds ratio, 2.776; 95% confidence interval, 1.450–5.314; p = 0.002), segmental or lobar consolidation (odds ratio, 3.123; 95% confidence interval, 1.629–5.987; p = 0.001), and cavitary nodule or mass (odds ratio, 2.790; 95% confidence interval, 1.348–5.176; p = 0.002) were significant factors for MDR-TB.

Conclusion

Low pectoralis muscle index, segmental to lobar consolidation and cavitary nodule or mass can help differentiate primary MDR-TB from DS-TB.

Vertebral fracture is associated with myocardial infarction in incident hemodialysis patients: a Korean nationwide population-based study

Chronic kidney disease (CKD)-mineral and bone disorder suggests that fragile bone and vascular disorder might be connected closely in CKD patients. In this study, fracture event was significantly associated with myocardial infarction (MI) in end-stage renal disease patients on hemodialysis (HD), especially for vertebral fractures.

INTRODUCTION

CKD-mineral and bone disorder is characterized by biochemical abnormalities, bone disorders, and vascular calcification. We aimed to verify the association between fracture and MI in CKD patients.

METHODS

Records for incident CKD stage 3 to 5 patients and patients who initiated HD between July 2014 and June 2018 were retrieved from the Korean Health Insurance Review & Assessment Service Database. Fractures were defined using diagnostic codes and were classified into vertebral, femoral, and other site fractures. MI was defined using a combination of MI diagnostic codes and related procedure codes. Multiple logistic regressions and 1:1 propensity score matching analysis were conducted.

RESULTS

A total of 38,935 patients (HD, 11,379; pre-dialysis CKD, 27,556) were included in this study. A total of 5,057 (13.0%) patients experienced fracture, and 1,431 (3.7%) patients had MI. Multiple logistic regression analysis showed that fracture was significantly associated with MI in the HD group (odds ratio (OR) 1.34, P = 0.024), but not in the pre-dialysis CKD group (OR 1.04, P = 0.701). After propensity score matching for age, gender, and diabetes mellitus between patients with and without fracture, fracture still significantly correlated with MI in HD patients (OR 1.47, P = 0.034) but not in patients with pre-dialysis CKD (OR 1.04, P = 0.751). Subgroup analysis by fracture site found that vertebral fracture was associated with MI in HD patients (OR 2.11, P = 0.024), but femoral or other site fractures were not.

CONCLUSION

In HD patients, fracture was significantly associated with MI, especially for vertebral fractures patients.

CPNE1-mediated neuronal differentiation can be inhibited by HAX1 expression in HiB5 cells

We previously demonstrated that CPNE1 induces neuronal differentiation and identified two binding proteins of CPNE1 (14-3-3γ and Jab1) as potential regulators of CPNE1-mediated neuronal differentiation in hippocampal progenitor cells. To better understand the cellular processes in which CPNE1 participates in neuronal differentiation, we here carried out a yeast two-hybrid screening to find another CPNE1 binding protein. Among the identified proteins, HCLS1-related protein X-1 (HAX1) directly interacts with CPNE1. Immunostaining experiments showed that a fraction of CPNE1 and HAX1 co-localized in the cytosol, particularly in the plasma membrane. In addition, the physical interaction as well as the specific binding regions between CPNE1 and HAX1 were confirmed in vitro and in vivo. Moreover, AKT phosphorylation, Tuj1 (neuronal marker protein) expression, and neurite outgrowth are all reduced in CPNE1/HAX1 overexpressing cells compared to CPNE1 only overexpressing HiB5 cells. Conversely, the HAX1 mutant that does not bind to CPNE1 was unable to inhibit the CPNE1-mediated neuronal differentiation. Together these results indicate that HAX1 is a binding partner of CPNE1 and CPNE1-mediated neuronal differentiation is negatively affected through the binding of HAX1, especially its N-terminal region, with CPNE1.

A rare case of thyroglossal duct cyst extending to the sublingual space: A case report

RATIONALE

Thyroglossal duct cyst (TGDC) is the most common congenital anomaly of midline neck masses. A thyroglossal duct cyst is especially difficult to diagnose and is treated differently when it appears in the sublingual area. Here, we report a rare case of TGDC extending to the sublingual space.

PATIENT CONCERNS

A 42-year-old female presented with a history of neck swelling in the submental region.

DIAGNOSIS

The final pathologic diagnosis was a TGDC.

INTERVENTIONS

Sistrunk operation was performed.

OUTCOMES

Recurrence of the disease has not been seen for the past year.

LESSION

Clinical awareness of the thyroglossal duct cyst in the sublingual area or on the oral floor area is important for an accurate diagnosis and the appropriated management.

Generation of a NESTIN-EGFP reporter human induced pluripotent stem cell line, KSCBi005-A-1, using CRISPR/Cas9 nuclease

NESTIN, an intermediate filament, is a neuroectodermal marker involved in induced pluripotent stem cell (iPSC) differentiation toward neural lineages. Here, we introduced an EGFP reporter into the C-terminus of NESTIN in KSCBi005-A hiPSCs through homologous recombination using CRISPR/Cas9 nuclease. The successfully edited line was confirmed by sequencing and had a normal karyotype. It expressed EGFP upon induction of neural differentiation and exhibited potential for differentiation into three germ layers. KSCBi005-A-1 cells could be used to monitor the expression of NESTIN in differentiated cell types. This cell line is available at the National Stem Cell Bank, Korea National Institute of Health.

Adverse effect of smoking on cross-sectional area of small pulmonary vessel and arterial stiffness in healthy smokers without COPD

INTRODUCTION

Because it induces systemic inflammation, smoking is a risk factor of atherosclerosis and pulmonary hypertension. The brachial-ankle pulse wave velocity (baPWV) and cross-sectional area (CSA) of small pulmonary vessels can be useful markers to assess early changes of arterial stiffness and pulmonary vascular alteration in smokers.

OBJECTIVES

This study aimed to explore association between the CSA of small pulmonary vessel and arterial stiffness in healthy male smokers.

METHODS

We enrolled 90 male non-smokers and 90 male smokers (age: 51.5 ± 9.7 years and 52.1 ± 7.9 years, respectively). All subjects underwent chest computed tomography (CT), pulmonary function test and baPWV measurement. We evaluated the total CSAs less than 5 mm² using ImageJ software and divided by the total lung area (%CSA<5). We compared the association between baPWV and %CSA<5 in two groups as well as correlations among the amount of smoking, baPWV and %CSA<5. Multiple linear regression analysis using %CSA<5 as the dependent variable was also performed.

RESULTS

The mean baPWV and mean %CSA<5 were significantly different between the smokers and non-smokers. The pack-years was significantly correlated with %CSA<5 (r = -0.631, P < 0.001) and baPWV (r = 0.534, P < 0.001) in smokers. In multiple linear regression analysis, age, pack-years, FEV₁ /FVC and baPWV were associated with %CSA<5, regardless of body mass index, blood pressure and heart rate.

CONCLUSIONS

There is a dose-response relationship between cigarette smoking and the CSA of small pulmonary vessels and arterial stiffness, respectively. Arterial stiffness, age, pack-years and mild airflow impairment are independent predictors of small pulmonary vascular destruction in smokers.

Methotrexate-associated primary hepatic lymphoma and cranial neuropathy in a patient with rheumatoid arthritis: A case report with clinical follow-up over a 7-year period

RATIONALE

Rheumatoid arthritis (RA) shows a variable clinical expression in patients. Articular disease is common manifestation, but patients may rarely present with extra-articular manifestation such as cranial neuropathy. Also, primary hepatic lymphoma (PHL) has rarely been reported in patient treated with immunosuppressive drug such as methotrexate (MTX) for RA. We herein describe a case of cranial neuropathy and MTX-related PHL in a woman receiving MTX for RA.

PATIENT CONCERNS

A 73-year-old women received MTX treatment for more than 5 years, presented with recurrent cranial neuropathies. During therapy of cranial neuropathies, liver enzyme levels were elevated.

DIAGNOSES

The patient was diagnosed as RA by laboratory examination. A series of examinations had been launched to evaluate any possible cause of the extra-articular manifestation of the patient including ultrasound, computed tomography, magnetic resonance image (MRI) and positron emission tomography of the liver and MRI of the brain. Finally, the patient diagnosed as MTX-associated PHL and cranial neuropathy.

INTERVENTIONS

The patient underwent 4-year MTX therapy for RA at first with prednisolone. After that, she had been treated with cyclophosphamide therapy for cranial neuropathy. The liver biopsy was performed for hepatic lesion.

OUTCOMES

MTX was discontinued, but no improvement of PHL and elevated liver enzyme was observed during the 3 weeks. The patient received 6 cycles of chemotherapy for 3 months and achieved complete remission including PHL and cranial neuronal lesion with symptom. No instances of relapse have occurred in 2 years of follow-up.

LESSONS

The present case is the extremely rare case in which MTX-related PHL and cranial neuropathy were involved together in the RA patient. It is necessary to examine long-term follow up hepatic and neurologic examinations that patient had a long history of receiving MTX therapy for RA.

Shear wave elastography for the diagnosis of small (≤2 cm) breast lesions: added value and factors associated with false results

OBJECTIVE

We compared the diagnostic performance of B-mode ultrasound, shear wave elastography (SWE), and combined B-mode ultrasound and SWE in small breast lesions (≤ 2 cm), and evaluated the factors associated with false SWE results.

METHODS

A total of 428 small breast lesions (≤ 2 cm) of 415 consecutive patients between August 2013 and February 2017 were included. The diagnostic performance of each set was evaluated using the area under the receiver operating characteristic curve (AUC) analysis. Histologic diagnosis was used as reference standard. Multivariate logistic regression analyses identified the factors associated with false SWE results.

RESULTS

Of 428 lesions, 142 (33.2%) were malignant and 286 (66.8%) were benign. The AUC of the combined modality was higher than that of B-mode ultrasound (0.792 vs 0.572, p < 0.001) and that of SWE was higher than that of B-mode ultrasound (0.718 vs 0.572, p < 0.001). Multivariate analysis showed that the smaller lesion size and in situ cancer were associated with false negative, and patient's age, high-risk lesion, shorter distance from the skin or chest wall, and deeper breast thickness were associated with false positive (all p < 0.05).

CONCLUSIONS

The addition of SWE to B-mode ultrasound could improve the diagnostic performance in ≤ 2 cm lesions. However, ultrasound lesion size, pathology, and lesion location are likely to affect the SWE value and result in false results.

ADVANCES IN KNOWLEDGE

Despite the diagnostic usefulness of SWE in small breast lesions (≤ 2 cm), ultrasound lesion size, pathology, and lesion location were associated with false results.

Factors Affecting Breast Cancer Detectability on Digital Breast Tomosynthesis and Two-Dimensional Digital Mammography in Patients with Dense Breasts

Objective

To compare digital breast tomosynthesis (DBT) and conventional full-field digital mammography (FFDM) in the detectability of breast cancers in patients with dense breast tissue, and to determine the influencing factors in the detection of breast cancers using the two techniques.

Materials and Methods

Three blinded radiologists independently graded cancer detectability of 300 breast cancers (288 women with dense breasts) on DBT and conventional FFDM images, retrospectively. Hormone status, histologic grade, T stage, and breast cancer subtype were recorded to identify factors affecting cancer detectability. The Wilcoxon signed-rank test was used to compare cancer detectability by DBT and conventional FFDM. Fisher's exact tests were used to determine differences in cancer characteristics between detectability groups. Kruskal-Wallis tests were used to determine whether the detectability score differed according to cancer characteristics.

Results

Forty breast cancers (13.3%) were detectable only with DBT; 191 (63.7%) breast cancers were detected with both FFDM and DBT, and 69 (23%) were not detected with either. Cancer detectability scores were significantly higher for DBT than for conventional FFDM (median score, 6; range, 0–6; p < 0.001). The DBT-only cancer group had more invasive lobular-type breast cancers (22.5%) than the other two groups (i.e., cancer detected on both types of image [both-detected group], 5.2%; cancer not detected on either type of image [both-non-detected group], 7.3%), and less detectability of ductal carcinoma in situ (5% vs. 16.8% [both-detected group] vs. 27.5% [both-non-detected group]). Low-grade cancers were more often detected in the DBT-only group than in the both-detected group (22.5% vs. 10%, p = 0.026). Human epidermal growth factor receptor-2 (HER-2)-negative cancers were more often detected in the DBT-only group than in the both-detected group (92.3% vs. 70.5%, p = 0.004). Cancers surrounded by mostly glandular tissue were detected less often in the DBT only group than in the both-non-detected group (10% vs. 31.9%, p = 0.016). DBT cancer detectability scores were significantly associated with cancer type (p = 0.012), histologic grade (p = 0.013), T and N stage (p = 0.001, p = 0.024), proportion of glandular tissue surrounding lesions (p = 0.013), and lesion type (p < 0.001).

Conclusion

Invasive lobular, low-grade, or HER-2-negative cancer is more detectable with DBT than with conventional FFDM in patients with dense breasts, but cancers surrounded by mostly glandular tissue might be missed with both techniques.

Generation of a human induced pluripotent stem cell line, KSCBi003-A, from human adipose tissue-derived mesenchymal stem cells using a chromosomal integration-free system

We generated a human induced pluripotent stem cell (hiPSC) line, KSCBi003-A, from adipose tissue-derived mesenchymal stem cells (Ad-MSCs) using a Sendai virus-based gene delivery system. We confirmed that the KSCBi003-A has a normal karyotype and short tandem repeat (STR)-based identities that match the parent cells. We also confirmed that the cell line expresses pluripotent stem cell markers such as Nanog, OCT4, SSEA-4, TRA-1-60, and TRA-1-81. We also analyzed that the KSCBi003-A has an ability to differentiate three germ layers (ectoderm, mesoderm, endoderm). This cell line is registered and available at the National Stem Cell Bank, Korea National Institute of Health.

Risk of diabetes in viral hepatitis B or C patients compared to that in noninfected individuals in Korea, 2002-2013: A population-based cohort study

While the association between hepatitis C virus (HCV) infection and diabetes has been established, the relationship between hepatitis B virus (HBV) infection and diabetes remains unclear. Therefore, we compared the association between diabetes development in HBV, HCV and co-infected (HBV/HCV) patients to that in noninfected participants using population-based cohort data. We used the National Health Insurance Service-National Sample Cohort, which consists of 514 791 randomly selected persons among those who underwent health check-ups from 2002 to 2003 aged 40-79 years. Adults found to have HBV or HCV infection from 2002 to 2003, without a prior history of diabetes, were selected as subjects. Competing risk regression models were used to estimate cumulative incidence and hazards ratios (HRs) of diabetes development. The cumulative incidences, incidence densities and HRs of diabetes were highest in the co-infected group, followed by those in the HCV-, HBV- and noninfected groups. The 12-year cumulative incidences were as follows: 42.0% in HBV/HCV-, 32.9% in HCV-, 23.9% in HBV- and 18.3% in the noninfected groups. The incidence density per 1000 person-years was 55.0, 51.5, 38.2 and 28.2 for the HBV/HCV-, HCV-, HBV- and noninfected groups, respectively. The adjusted HRs for diabetes were 1.90, 1.68 and 1.41 for the HBV/HCV-, HCV- and HBV-infected groups, respectively. Our findings suggest that both HCV and HBV infections are associated with the development of diabetes; therefore, prevention of, screening for, and treatment of both may reduce the risk of diabetes in these patients.

Effect of zolpidem on functional recovery in a rat model of ischemic stroke

Objective

To evaluate the effects of zolpidem on functional recovery in a rat model of acute ischemic stroke.

Methods

Following ischemic stroke procedures, 42 rats (six in each group) were randomly assigned to receive zolpidem (0.1, 0.25, 0.5, 1.0, 2.0 or 4.0 mg/kg) or normal saline administer intraperitoneally once daily for two weeks. Motor behavioural index (MBI) scores, radial 8-arm maze (RAM) test times and brain MRI scans were obtained 24 hours (Day 1) and two weeks (Day 14) post-procedure. Immunohistochemistry was performed on Day 14.

Results

By comparison with the normal saline group, the 0.5 and 1.0 mg/kg zolpidem groups showed statistically significant improvements in MBI scores and increased numbers of brain-derived neurotrophic factor (BDNF) stained cells over the two week dosing period. By contrast, the 4.0 mg/kg zolpidem group had statistically significantly impaired MBI scores compared with the control group. No differences among groups were found in RAM times or infarction volumes.

Conclusions

This study in a rat model showed that 0.5–1.0 mg/kg of zolpidem had beneficial effects on behavioural recovery by enhancing neural plasticity without causing any memory impairment in acute ischemic stroke.

Evaluation of Screening US-detected Breast Masses by Combined Use of Elastography and Color Doppler US with B-Mode US in Women with Dense Breasts: A Multicenter Prospective Study

Purpose To investigate the value of the combined use of elastography and color Doppler ultrasonography (US) with B-mode US for evaluation of screening US-detected breast masses in women with dense breasts. Materials and Methods This prospective, multicenter study included asymptomatic women with dense breasts who were referred for screening US between November 2013 and December 2014. Eligible women had a newly detected breast mass at conventional B-mode US screening, for which elastography and color Doppler US were performed. The following outcome measures were compared between B-mode US and the combination of B-mode US, elastography, and color Doppler US: area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), and the number of false-positive findings at screening US. Results Among 1021 breast masses (mean size, 1.0 cm; range, 0.3-3.0 cm) in 1021 women (median age, 45 years), 68 were malignant (56 invasive). Addition of elastography and color Doppler US to B-mode US increased the AUC from 0.87 (95% confidence interval [CI]: 0.82, 0.91) to 0.96 (95% CI: 0.95, 0.98; P < .001); specificity from 27.0% (95% CI: 24.2%, 29.9%) to 76.4% (95% CI: 73.6%, 79.1%; P < .001) without loss in sensitivity (95% CI: -1.5%, 1.5%; P > .999); and PPV from 8.9% (95% CI: 7.0%, 11.2%) to 23.2% (95% CI: 18.5%, 28.5%; P < .001), while avoiding 67.7% (471 of 696) of unnecessary biopsies for nonmalignant lesions. Conclusion Addition of elastography and color Doppler US to B-mode US can increase the PPV of screening US in women with dense breasts while reducing the number of false-positive findings without missing cancers. ^© RSNA, 2017 Online supplemental material is available for this article.

Splenial Lesions of the Corpus Callosum: Disease Spectrum and MRI Findings

The corpus callosum (CC) is the largest white matter structure in the brain, consisting of more than 200–250 million axons that provide a large connection mainly between homologous cerebral cortical areas in mirror image sites. The posterior end of the CC is the thickest part, which is called the splenium. Various diseases including congenital to acquired lesions including congenital anomalies, traumatic lesions, ischemic diseases, tumors, metabolic, toxic, degenerative, and demyelinating diseases, can involve the splenium of the CC and their clinical symptoms and signs are also variable. Therefore, knowledge of the disease entities and the imaging findings of lesions involving the splenium is valuable in clinical practice. MR imaging is useful for the detection and differential diagnosis of splenial lesions of the CC. In this study, we classify the disease entities and describe imaging findings of lesions involving the splenium of the CC based on our experiences and a review of the literature.

Comparison of 3D and 2D shear-wave elastography for differentiating benign and malignant breast masses: focus on the diagnostic performance

AIM

To evaluate the diagnostic performance of three-dimensional (3D) image shear-wave elastography (SWE) for differentiating benign from malignant breast masses compared to two-dimensional (2D) SWE and B-mode ultrasound (US).

MATERIALS AND METHODS

This study consisted of 205 breast lesions from 199 patients who underwent B-mode US and SWE before biopsy from January 2014 to March 2016. Quantitative elasticity values (maximum and mean elasticity, Emax and Emean) obtained from 2D and 3D SWE (axial, sagittal, and coronal images) were reviewed retrospectively, in addition to the histopathological findings including immunohistochemistry profiles (luminal A, luminal B, human epidermal growth factor receptor 2 (HER2)-enriched, and triple-negative breast cancer) in cases of malignancy. Histopathological findings were regarded as the reference standard. The diagnostic performance of each data set was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC) analysis to compare sensitivity and specificity.

RESULTS

Among 205 lesions, 105 (51.22%) were malignant and 100 (48.78%) were benign. Compared to benign masses, malignant masses had higher values of Emax and Emean on both 2D and 3D SWE, the differences of which were statistically significant (p<0.001). The AUCs of 2D, 3D axial, and sagittal SWE were significantly higher than that of 3D coronal SWE (p<0.05). In addition, the sensitivities of axial, sagittal, and coronal 3D SWE were all higher than that of 2D SWE for Emean (81.9%, 87.6%, and 89.5% versus 70.5%, respectively, p<0.05). Conversely, the specificity of 2D and 3D axial SWE was higher than that of 3D sagittal and coronal SWE (Emax, 84%, 83% versus 76%, 73%; Emean, 85%, 81% versus 68%, 50%, respectively, p<0.05). We also assessed changes in Breast Imaging-Reporting and Data System (BI-RADS) category 3 and category 4a lesions by adding each of the parameters for 2D and 3D SWE in B-mode US. The specificity, PPV, and accuracy of combined 2D or combined 3D SWE with B-mode US was statistically higher than that of B-mode US alone for differentiating benign and malignant lesions (p<0.05).

CONCLUSIONS

Among SWE images, 2D SWE, and 3D SWE axial and sagittal images exhibited superior diagnostic performance compared to 3D coronal images. Addition of 3D SWE images to B-mode US improved the diagnostic performance for distinguishing benign from malignant masses.

Cordycepin-enriched WIB-801C from Cordyceps militaris improves functional recovery by attenuating blood-spinal cord barrier disruption after spinal cord injury

ETHNOPHARMACOLOGICAL RELEVANCE

Cordyceps militaris is an ingredient of traditional Chinese medicine and have been widely used for inflammatory diseases and cancer. Cordycepin is one of the major bioactive components of Cordyceps militaris, and has been known to have anti-inflammatory and anti-oxidant effects.

AIM OF THIS STUDY

In the present study, we examined whether WIB-801C, a standardized and cordycepin-enriched extract of caterpillar fungus (Cordyceps militaris), would attenuate blood-spinal cord barrier (BSCB) disruption by inhibiting matrix metalloprotease (MMP)-9 activity, leading to improvement of functional outcomes after spinal cord injury (SCI).

MATERIALS AND METHODS

Male Sprague-Dawley rats were subjected to contusive SCI using a New York University (NYU) impactor, and WIB-801C (50mg/kg) was administered at 2h and 8h after injury orally and further treated once a day for indicated time points. BSCB disruption, MMP-9 activity, blood infiltration, inflammation, neuronal apoptosis, axonal loss, demyelination, and neurological deficit were evaluated.

RESULTS

We found that WIB-801C significantly attenuated BSCB disruption by inhibiting MMP-9 expression and activation after injury. The infiltration of neutrophils at 1 d and macrophage at 5 d after SCI was also ameliorated by WIB-801C as compared with vehicle control. In addition, the expression of inflammatory cytokines and mediators such as Tnf-α, IL-1β, IL-6, Cox-2, and inos as well as chemokines such as Gro-α and Mip-2α was significantly inhibited by WIB-801C. Furthermore, WIB-801C inhibits p38MAPK activation and proNGF production in microglia after injury. These events eventually led to the inhibition of apoptotic cell death of neurons and oligodendrocytes, improved functional recovery and attenuated demyelination and axon loss after SCI.

CONCLUSION

Our results suggest that WIB-801C can be used as a therapeutic agent after SCI by attenuating BSCB disruption followed inflammation.

Generation of human induced pluripotent stem cells from urinary cells of a healthy donor using a non-integration system

Urinary cells can be an ideal source for generating hiPSCs and progenitors, as they are easily accessible, non-invasive, and universally available. We generated human induced pluripotent stem cells (hiPSCs) from the urinary cells of a healthy donor using a Sendai virus-based gene delivery method. The generated hiPSC line, KSCBi001-A, has a normal karyotype (46,XY). The pluripotency and capacity of multilineage differentiation were characterized by comparison with those of a human embryonic stem cell line. This cell line is registered and available from National Stem Cell Bank, Korea National Institute of Health.

Generation of human induced pluripotent stem cell lines from human dermal fibroblasts using a non-integration system

We generated human induced pluripotent stem cells (hiPSCs) from dermal fibroblasts using a Sendai virus (SeV)-based gene delivery method. The generated hiPSC line, KSCBi002-A, has a normal karyotype (46,XY). The pluripotency and differentiation capacity were characterized by comparison with those of a human embryonic stem cell line. This cell line is registered and available from the National Stem Cell Bank, Korea National Institute of Health.

A Study on CYP2C19 and CYP2D6 Polymorphic Effects on Pharmacokinetics and Pharmacodynamics of Amitriptyline in Healthy Koreans

We performed a double-blinded, genotype-based stratification study to explore the pharmacokinetics and pharmacodynamics of amitriptyline according to CYP2C19 and CYP2D6 genotype in Korean subjects. Twenty-four healthy adults were grouped by genotype of CYP2C19 and CYP2D6. After a single dose of 25 mg of amitriptyline, blood samples were collected and anticholinergic effects were measured. The extent of N-demethylation of amitriptyline significantly decreased in subjects carrying two nonfunctional alleles of CYP2C19. The extent of hydroxylation of amitriptyline or nortriptyline was significantly reduced in subjects carrying two CYP2D6 decreased functional alleles compared with those with no or one decreased functional allele. The overall metabolic pathway of amitriptyline was more likely to be dominated by CYP2C19 than CYP2D6. The gene variations of CYP2C19 and CYP2D6 did not change the pharmacodynamic effect. The findings of this study will provide useful information on individualized drug treatment with amitriptyline considering both CYP2D6 and CYP2C19 gene variations.

Generation of human induced pluripotent stem cell lines from human dermal fibroblasts using a modified RNA system

We generated human induced pluripotent stem cells (KSCBi002-B and KSCBi002-B-1) from the dermal fibroblasts of a donor using a modified RNA-based gene delivery method. According to GTG-banding analysis, the generated KSCBi002-B line has a cytogenetic abnormality (46,XY, t(1;4)(q21;q25)) that is distinct from that of the donor, whereas KSCBi002-B-1 has a normal karyotype (46,XY). These cell lines can be useful as a model for characterizing the hiPSCs generated by a non-viral and non-integrative system, or as a chromosomal balanced translocation model. These two cell lines are registered and available from the National Stem Cell Bank, Korea National Institute of Health.

Compensatory structural and functional adaptation after radical nephrectomy for renal cell carcinoma according to preoperative stage of chronic kidney disease. Choi DK, Jung SB, Park BH, Jeong BC, Seo SI, Jeon SS, Lee HM, Choi HY, Jeon HG.J Urol. 2015 Oct;194(4):910-5. [Epub 2015 Apr 28]. doi: 10.1016/j.juro.2015.04.093

PURPOSE

We investigated structural hypertrophy and functional hyperfiltration as compensatory adaptations after radical nephrectomy in patients with renal cell carcinoma according to the preoperative chronic kidney disease stage.

MATERIALS AND METHODS

We retrospectively identified 543 patients who underwent radical nephrectomy for renal cell carcinoma between 1997 and 2012. Patients were classified according to preoperative glomerular filtration rate as no chronic kidney disease-glomerular filtration rate 90ml/min/1.73m² or greater (230, 42.4%), chronic kidney disease stage II-glomerular filtration rate 60 to less than 90ml/min/1.73m² (227, 41.8%), and chronic kidney disease stage III-glomerular filtration rate 30 to less than 60ml/min/1.73m² (86, 15.8%). Computerized tomography performed within 2 months before surgery and 1 year after surgery was used to assess functional renal volume for measuring the degree of hypertrophy of the remnant kidney, and the preoperative and postoperative glomerular filtration rate per unit volume of functional renal volume was used to calculate the degree of hyperfiltration.

RESULTS

Among all patients (mean age = 56.0y) mean preoperative glomerular filtration rate, functional renal volume, and glomerular filtration rate/functional renal volume were 83.2ml/min/1.73m², 340.6cm³, and 0.25ml/min/1.73m²/cm³, respectively. The percent reduction in glomerular filtration rate was statistically significant according to chronic kidney disease stage (no chronic kidney disease 31.2% vs. stage II 26.5% vs. stage III 12.8%, P<0.001). However, the degree of hypertrophic functional renal volume in the remnant kidney was not statistically significant (no chronic kidney disease 18.5% vs. stage II 17.3% vs. stage III 16.5%, P = 0.250). The change in glomerular filtration rate/functional renal volume was statistically significant (no chronic kidney disease 18.5% vs. stage II 20.1% vs. stage III 45.9%, P<0.001). Factors that increased glomerular filtration rate/functional renal volume above the mean value were body mass index (P = 0.012), diabetes mellitus (P = 0.023), hypertension (P = 0.015), and chronic kidney disease stage (P<0.001).

CONCLUSIONS

Patients with a lower preoperative glomerular filtration rate had a smaller reduction in postoperative renal function than those with a higher preoperative glomerular filtration rate due to greater degrees of functional hyperfiltration.