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StaStandalone AI for Breast Cancer Detection at Screening Digital Mammography and Digital Breast Tomosynthesis: A Systematic Review and Meta-Analysis
No full textBackground : There is considerable interest in the potential use of artificial intelligence (AI) systems in mammographic screening. However, it is essential to critically evaluate the performance of AI before it can become a modality used for independent mammographic interpretation. Purpose To evaluate the reported standalone performances of AI for interpretation of digital mammography and digital breast tomosynthesis (DBT).
Materials and Methods: A systematic search was conducted in PubMed, Google Scholar, Embase (Ovid), and Web of Science databases for studies published from January 2017 to June 2022. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) values were reviewed. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 and Comparative (QUADAS-2 and QUADAS-C, respectively). A random effects meta-analysis and meta-regression analysis were performed for overall studies and for different study types (reader studies vs historic cohort studies) and imaging techniques (digital mammography vs DBT).
Results: In total, 16 studies that include 1 108 328 examinations in 497 091 women were analyzed (six reader studies, seven historic cohort studies on digital mammography, and four studies on DBT). Pooled AUCs were significantly higher for standalone AI than radiologists in the six reader studies on digital mammography (0.87 vs 0.81, P = .002), but not for historic cohort studies (0.89 vs 0.96, P = .152). Four studies on DBT showed significantly higher AUCs in AI compared with radiologists (0.90 vs 0.79, P < .001). Higher sensitivity and lower specificity were seen for standalone AI compared with radiologists.
Conclusion: Standalone AI for screening digital mammography performed as well as or better than radiologists. Compared with digital mammography, there is an insufficient number of studies to assess the performance of AI systems in the interpretation of DBT screening examinations. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Scaranelo in this issue.restrictio
Comparative studies on the binding site of anesthetics to GABA a receptors using in silico docking methods
Full text linkBackground: Although the GABAA receptor (GABAAR) has been proposed as the main action site for
sevoflurane, isoflurane, halothane, enflurane, propofol, and benzodiazepines (BZDs), binding of these anesthetics with high-resolution structures of the GABAAR have been rarely examined by comparative docking analyses. Moreover, various combinations of ligands on more GABAARs with various subtypes need to be analyzed to understand the elaborate action mechanism of GABAARs better because some GABAA ligands showed specificity toward the distinct subtypes of the GABAAR.
Methods: We performed in silico docking analysis to compare the binding modes of sevoflurane, isoflurane, halothane, enflurane, propofol, and BZDs to the GABAAR based on one of the most recently provided 3D structures. We performed the docking analysis and the affinity-based ranking of the binding sites.
Results: Our docking studies revealed that isoflurane, halothane, and enflurane docked in an extracellular domain (ECD) on GABAARs, in contrast to sevoflurane. Conclusion: Our results supported a multi-site mechanism for the allosteric modulation of propofol. Propofol was bound to the pore or favored various subsites in the transmembrane domain (TMD). Our result confirmed that different chemically related BZD ligands interact via distinct binding modes rather than by using a common binding mode, as previously suggested.ope
간호사의 윤리적 역량에 영향을 미치는 요인
Full text link간호사는 임상현장에서 간호대상자의 옹호자로서의 역할을 감당할 책임이 있다. 따라서 임상현장에 서 직면하는 윤리적 문제에 대해 윤리적 성찰에 기반한 결정을 도출하고 이를 수행할 수 있는 윤리적 역량을 함양하는 일이 매우 중요하다. 본 연구는 임상 간호사의 윤리적 영향에 영향을 미치는 요인을 기술함으로써 추후 임상윤리지원서비스 개발에 기초자료를 제공하고자 시도되었다. 연구방법으로는 서 술적 조사연구로 설계되었고, 연구윤리심의위원회 동의를 받은 후 일 종합병원의 경력 2년 이상인 간호 사 100명을 대상으로 윤리적 역량, 임상윤리 서비스 요구도, 윤리교육 요구도, 윤리적 자신감, 도덕적 민감성 등을 자가보고식 설문지로 측정하였다. 자료분석에는 기술 통계, 상관관계 분석, 및 다중회귀분 석 등을 사용하였다. 연구결과로 다음의 내용을 확인하였다. 간호사의 윤리적 역량과 임상윤리 서비스 요구도, 윤리적 자신감, 도덕적 민감성은 유의한 상관관계를 보였고, 간호사의 윤리적 역량에 영향을 미 치는 요인은 윤리적 자신감이었으며, 이에 대한 설명력은 39%로 나타났다. 결론적으로, 간호사의 윤리 적 역량을 증진시키기 위하여 윤리적 요구도가 높은 동시에 윤리적 역량이 낮게 보고된 주제를 바탕으로 한 윤리교육을 실시하여 윤리적 자신감을 높이는 전략과 더불어 지속적인 연구가 요구된다고 하겠다.ope
HIF-1α Overexpression Using a Protein Transduction Domain to Increase the Osteogenic Potential of SHED
Full text linkBackground: Hypoxia-Inducible Factor 1 (HIF-1) alpha (HIF-1α) is known to be expressed in
hypoxia and affects stemness and bone differentiation. Protein Transduction Domains (PTDs) safely
and effectively deliver proteins into cells. This study combined HIF-1α delta Oxygen-Dependent
Degradation Domain–Transcription Modulation Domain (ntHIF-1α-ΔODD-TMD) with the PTD
and then used it to treat Stem cells from Human Exfoliated Deciduous teeth (SHED) to determine
its effect on stemness and bone differentiation.
Methods: The SHED were treated using PDT-conjugated ntHIF-1α-ΔODD-TMD, and its effects on
STRO-1 expression, cytotoxicity, stemness-related gene expression, and osteogenic differentiation
were confirmed. These were also transferred to 5-week-old mice in order to confirm the effects in
vivo after recellularization of SHED treated using ntHIF-1α-ΔODD-TMD on decellularized tooth
specimens. After 9 weeks, they were sacrificed to confirm the expression of genes related to bone
differentiation and angiogenesis.
Results: ntHIF-1α-ΔODD-TMD increased the expression levels of STRO-1, HIF-1α-related genes,
and stemness-related genes in SHED. Osteogenic differentiation was also increased both in vitro
and in vivo.
Conclusion: These results suggest that ntHIF-1α-ΔODD-TMD maintains or increases the stemness
of SHED and also increases the osteogenic potential. SHED have previously been found to have
excellent proliferative but low differentiation capacities compared with other cells. However,
properly using ntHIF-1α-ΔODD-TMD increases the osteogenic potential of SHED, indicating the
potential of using SHED as a useful source for hard-tissue regeneration.ope
Botulinum neurotoxin injection in the deltoid muscle: application to cosmetic shoulder contouring
No full textBackground and objectives: This study describes the intramuscular nerve branching of the deltoid muscle in relation to shoulder surface anatomy, with the aim of providing essential information regarding the most appropriate sites for botulinum neurotoxin injection during shoulder line contouring.
Methods: The modified Sihler's method was used to stain the deltoid muscles (16 specimens). The intramuscular arborization areas of the specimens were demarcated using the marginal line of the muscle origin and the line connecting the anterior and posterior upper edges of the axillary region.
Results: The intramuscular neural distribution of the deltoid muscle had the greatest arborization patterns in the area between the horizontal 1/3 and 2/3 lines of the anterior and posterior deltoid bellies, and 2/3 to axillary line in middle deltoid bellies. The greatest part of the posterior circumflex artery and axillary nerve ran below the areas with the highest aborizations.
Conclusion: We propose that botulinum neurotoxin injections should be administered in the area between the 1/3 and 2/3 lines of the anterior and posterior deltoid bellies, and 2/3 to axillary line on middle deltoid bellies. Accordingly, clinicians will ensure minimal dose injections and fewer adverse effects of the botulinum neurotoxin injection. Deltoid intramuscular injections, such as vaccines and trigger point injections, should ideally be adapted according to our results.restrictio
Platelet-rich fibrin combined with a particulate bone substitute versus guided bone regeneration in the damaged extraction socket: An in vivo study
No full textAim: It has been proposed that platelet-rich fibrin (PRF) can be used to support bone regeneration during alveolar ridge augmentation. The aim of this study was to determine whether an approach utilizing PRF provides similar performance to the established guided bone regeneration (GBR) procedure. Materials and Methods: Two-wall defects were surgically created in beagle dogs and treated in three experimental groups: (i) a sticky bone (SB) substitute prepared using liquid PRF and deproteinized porcine bone mineral (DPBM); (ii) SB covered with solid PRF compressed into a membrane; and (iii) GBR performed using DPBM covered by a collagen membrane. Quantitative reverse-transcription polymerase chain reaction was applied to the specimen after 1 week of healing, and microcomputed tomography (micro-CT) and histological outcomes were analysed after 8 weeks of healing. Results: Compared with GBR, PRF resulted in a moderate increase in the expression levels of osteoblast and osteoclast markers, osteocalcin, and calcitonin receptor. Moreover, PRF modestly increased angiogenesis and the inflammation markers vascular endothelial growth factor (VEGF) and IL-6. Micro-CT and histological analyses confirmed the expected increased alveolar ridge area, with no significant differences between the three groups. Consistently, graft consolidation, as indicated by new bone formation at the defect site, did not differ significantly between groups. Conclusions: The present results demonstrate that PRF-based approaches perform comparably to the established GBR procedure in terms of the consolidation of DPBM in two-wall alveolar defects.restrictio
Combination Lipid-Lowering Therapy in Patients Undergoing Percutaneous Coronary Intervention
No full textBackground: The RACING (randomized comparison of efficacy and safety of lipid-lowering with statin monotherapy versus statin/ezetimibe combination for high-risk cardiovascular diseases) trial examined the effects of combination therapy with moderate-intensity statin and ezetimibe in patients with atherosclerotic cardiovascular disease compared with high-intensity statin monotherapy. Objectives: This observational study was conducted to evaluate the impact of 2 treatment strategies used in the RACING trial in clinical practice. Methods: After stabilized inverse probability of treatment weighting, a total of 72,050 patients who were prescribed rosuvastatin after drug-eluting stent implantation were identified from a nationwide cohort database: 10,794 patients with rosuvastatin 10 mg plus ezetimibe 10 mg (combination lipid-lowering therapy) and 61,256 patients with rosuvastatin 20 mg monotherapy. The primary endpoint was the 3-year composite event of cardiovascular death, myocardial infarction, coronary artery revascularization, hospitalization for heart failure treatment, or nonfatal stroke in accordance with the RACING trial. Results: Combination lipid-lowering therapy was associated with a lower occurrence of the primary endpoint (11.6% vs 15.2% for those with high-intensity statin monotherapy; HR: 0.75; 95% CI: 0.70-0.79; P < 0.001). Compared with high-intensity statin monotherapy, combination lipid-lowering therapy was associated with fewer discontinuations of statin (6.5% vs 7.6%; HR: 0.85; 95% CI: 0.78-0.94: P < 0.001) and a lower occurrence of new-onset diabetes requiring medication (7.7% vs 9.6%; HR: 0.80; 95% CI: 0.72-0.88; P < 0.001). Conclusions: In clinical practice, combination lipid-lowering therapy with ezetimibe and moderate-intensity statin was associated with favorable clinical outcomes and drug compliance in patients treated with drug-eluting stent implantation. (CONNECT DES Registry; NCT04715594) © 2023 American College of Cardiology Foundationrestrictio
Acute Brain Infarction in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Korean Single-Center Study
No full textObjectives: This study investigated the clinical and radiological features of antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV) patients with acute brain infarction, using a cohort of Korean patients with AAV.
Methods: This study included 263 patientswith AAV. Acute brain infarction was defined as infarction that occurred within 7 days or less. The brain territories affected by acute brain infarction were investigated. Active AAV was arbitrarily defined as the highest tertile of Birmingham Vasculitis Activity Score (BVAS).
Results: The median age at diagnosis was 59.0 years, and 35.4% were male. Fourteen cases of acute brain infarction occurred in 12 patients (4.6%), which was calculated as 1332.2 per 100,000 patient-years and 10 times higher than the incidence rate in the Korean general population. Patients with AAV with acute brain infarction exhibited significantly older age, increased BVAS at diagnosis, and a more frequent history of prior brain infarction compared with those without. The brain territories affected in AAV patients were middle cerebral artery (50.0%), multiple territories (35.7%), and posterior cerebral artery (14.3%). Lacunar infarction and microhemorrhage were observed in 42.9% and 71.4% of cases, respectively. Prior brain infarction and BVAS at diagnosis were independently associated with acute brain infarction (hazard ratios, 7.037 and 1.089). Patients with AAV with prior brain infarction or BVAS for active AAV exhibited significantly lower cumulative acute brain infarction–free survival
rates than those without.
Conclusion: Acute brain infarction was observed in 4.6% of AAV patients, and both prior brain infarction and BVAS at diagnosiswere independently associated with acute brain infarction.restrictio
Repeat uterine artery embolization (UAE) for recurrent postpartum hemorrhage in patients who underwent UAE after a previous delivery: a multicenter study
No full textObjectiveTo evaluate angiographic findings and outcomes of repeat uterine artery embolization (UAE) for recurrent postpartum hemorrhage (PPH) in patients who previously underwent UAE for PPH after a previous delivery.Materials and methodsAmong 1805 patients who underwent UAE for PPH from 2007 to 2020 at four participating hospitals, the data of 21 (1.16%) patients who underwent UAE for PPH after subsequent delivery were collected and analyzed retrospectively. The rate of placental abnormalities, causes of PPH, angiographic findings, and clinical success rate were evaluated.ResultsThe technical success rates were 100% and 95.2%, and clinical success rates were 85.7% and 95.2% in association with first and second UAEs, respectively. The time intervals between first and second UAEs ranged from 15.6 to 103.3 months (46.5 +/- 25.0 months). The rate of placental abnormalities was significantly higher in association with second UAEs than with first UAEs (71.4% vs. 42.8%, p = 0.034). The causes of PPH were different between first and second UAEs with borderline significance (p = 0.049); uterine atony (81.0%) and placenta accreta spectrum (57.1%) were most common in association with first and second UAEs, respectively. During second UAEs, obliterated arteries were observed in 27 uterine arteries (27/42, 64.3%) of 16 patients (16/21, 76.2%), with partial obliteration predominating over total obliteration. Collateral arteries were observed in 15 patients during second UAEs.ConclusionRepeat UAE is safe and effective for recurrent PPH after subsequent delivery in patients with prior UAE. Obliteration of UAs and formation of collateral arteries are common at the second UAEs.restrictio
Contributing Factors to the Burden on Primary Family Caregivers of Stroke Survivors in South Korea
Full text linkThe purpose of this study is to identify the factors associated with the burden on primary family caregivers of stroke patients at home without care services. For this study, the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) data were used. Of the total 8010 caregivers, 1133 family caregiver burden was assessed with the shortened Caregiver Burden Inventory (CBI) 3 months after stroke. Patient and caregiver-related factors affecting the heavier burden of caregivers were identified by comparing the heavier caregiver burden group and the lighter caregiver burden group, which divided according to the CBI scores. The 719 (63.5%) family caregiver cared for patients at home without care services. Logistic regression analysis showed that four or more comorbidities (p = 0.002), neurological impairment at early onset (p < 0.001), dependence on daily life (p < 0.001), aphasia (p = 0.024), and depression(p < 0.001) were associated with a heavier burden of care. According to the shortened CBI, caregivers tended to be concerned more about psychological stress than physical strain. The findings suggest the importance of proactively guiding the emotional support services to caregivers who are at high risk of the heavier burden of patient care. © 2023 by the authors.ope