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Performance Monitoring Unit (PMU) is a common hardware module in Intel CPUs. It can be used to record various CPU behaviors therefore it is often used for performance analysis and optimization. Of the 65536 event spaces, Intel has officially published only 200 or so. In this paper, we design a hidden PMU event collection method. And we found a large number of undocumented PMU events in CPUs of Skylake, Kabylake, and Alderlake microarchitectures. We further demonstrate the existence of these events by using them for transient execution attack detection and build-side channel attacks. This also implies that these hidden PMU events have huge exploitation potential and security threats.

The transient execution attack is a type of attack leveraging the vulnerability of modern CPU optimization technologies. New attacks surface rapidly. The side-channel is a key part of transient execution attacks to leak data. In this work, we discover a vulnerability that the change of the EFLAGS register in transient execution may have a side effect on the Jcc (jump on condition code) instruction after it in Intel CPUs. Based on our discovery, we propose a new side-channel attack that leverages the timing of both transient execution and Jcc instructions to deliver data. This attack encodes secret data to the change of register which makes the execution time of context slightly slower, which can be measured by the attacker to decode data. This attack doesn't rely on the cache system and doesn't need to reset the EFLAGS register manually to its initial state before the attack, which may make it more difficult to detect or mitigate. We implemented this side-channel on machines with Intel Core i7-6700, i7-7700, and i9-10980XE CPUs. In the first two processors, we combined it as the side-channel of the Meltdown attack, which could achieve 100\% success leaking rate. We evaluate and discuss potential defenses against the attack. Our contributions include discovering security vulnerabilities in the implementation of Jcc instructions and EFLAGS register and proposing a new side-channel attack that does not rely on the cache system.

High-throughput sequencing, culture-dependent workflows, and microbiome transfer experiments reveal whether potassium phosphite (KP), an environmentally acceptable agricultural chemical, could specifically enrich the antagonistic bacterial community that inhibited the growth of the pathogen Ralstonia solanacearum. The application of KP enriched the potential antagonistic bacteria Paenibacillus and Streptomyces in soil, but depleted most dominant genera belonging to gram negative bacteria, such as Pseudomonas, Massilia, and Flavobacterium on day 7. Moreover, the KP-modulated soil microbiome suppressed R. solanacearum growth in soil. The predicted functions related to the synthesis of antagonistic substances, such as streptomycin, and the predicted functions related to tellurite resistance and nickel transport system were significantly enriched, but the synthesis of lipopolysaccharide (distinct component lipopolysaccharide in gram negative bacteria) were significantly depleted in the KP-treated soils. In addition, the copy numbers of specific sequences for Streptomyces coelicoflavus and Paenibacillus favisporus were significantly increased in the soil amended with KP, inhibited the growth of R. solanacearum, and had a higher tolerance of KP than R. solanacearum. Our study linked the application of fertilizers to the enrichment of antagonistic bacteria, which could support future work that aims to precisely regulate the soil microbiome to protect the host from infection by soil-borne pathogens.

Bacterial wilt caused by Ralstonia solanacearum is a distributed and worldwide soilborne disease. The application of biocontrol microbes or agricultural chemicals has been widely used to manage tomato bacterial wilt. However, whether and how agricultural chemicals affect the antagonistic ability of biocontrol microbes is still unknown. Here, we combined potassium phosphite (K-Phite), an environmentally friendly agricultural chemical, and the biocontrol agent Bacillus amyloliquefaciens QPF8 (strain F8) to manage tomato bacterial wilt disease. First, K-Phite at a concentration of 0.05% (wt/vol) could significantly inhibit the growth of R. solanacearum. Second, 0.05% K-Phite enhanced the antagonistic capability of B. amyloliquefaciens F8. Third, the greenhouse soil experiments showed that the control efficiency for tomato bacterial wilt in the combined treatment was significantly higher than that of the application of B. amyloliquefaciens F8 or K-Phite alone. Overall, our results highlighted a novel strategy for the control of tomato bacterial wilt disease via application and revealed a new integrated pattern depending on the enhancement of the antagonistic capability of biocontrol microbes by K-Phite.

Bacterial wilt caused by Ralstonia solanacearum is a distributed and worldwide soil-borne disease. The application of biocontrol microbes or agricultural chemicals has been widely used to manage tomato bacterial wilt. However, whether and how agricultural chemicals affect the antagonistic ability of biocontrol microbes is still unknown. Here, we combined potassium phosphite (K-Phite), an environmentally friendly agricultural chemical, and the biocontrol agent Bacillus amyloliquefaciens QPF8 (strain F8) to manage tomato bacterial wilt disease. First, K-Phite at a concentration of 0.05% (w/v) could significantly inhibit the growth of Ralstonia solanacearum. Second, 0.05% K-Phite enhanced the antagonistic capability of B. amyloliquefaciens F8. Third, the greenhouse soil experiments showed that the control efficiency for tomato bacterial wilt in the combined treatment was significantly higher than that of the application of B. amyloliquefaciens F8 or K-Phite alone. Overall, our results highlighted a novel strategy for the control of tomato bacterial wilt disease via application and revealed a new integrated pattern depending on the enhancement of the antagonistic capability of biocontrol microbes by K-Phite.

High-throughput sequencing, culture-dependent workflows, and microbiome transfer experiments reveal whether potassium phosphite (KP), an environmentally acceptable agricultural chemical, could specifically enrich the antagonistic bacterial community that inhibited the growth of the pathogen Ralstonia solanacearum. The application of KP enriched the potential antagonistic bacteria Paenibacillus and Streptomyces in soil, but depleted most dominant genera belonging to gram negative bacteria, such as Pseudomonas, Massilia, and Flavobacterium on day 7. Moreover, the KP-modulated soil microbiome suppressed R. solanacearum growth in soil. The predicted functions related to the synthesis of antagonistic substances, such as streptomycin, and the predicted functions related to tellurite resistance and nickel transport system were significantly enriched, but the synthesis of lipopolysaccharide (distinct component lipopolysaccharide in gram negative bacteria) were significantly depleted in the KP-treated soils. In addition, the copy numbers of specific sequences for Streptomyces coelicoflavus and Paenibacillus favisporus were significantly increased in the soil amended with KP, inhibited the growth of R. solanacearum, and had a higher tolerance of KP than R. solanacearum. Our study linked the application of fertilizers to the enrichment of antagonistic bacteria, which could support future work that aims to precisely regulate the soil microbiome to protect the host from infection by soil-borne pathogens.

Flexible thermoelectrics provide a different solution for developing portable and sustainable flexiblepower supplies. The discovery of silver sulfide–based ductile semiconductors has driven a shift in thepotential for flexible thermoelectrics, but the lack of good p-type ductile thermoelectric materials hasrestricted the reality of fabricating conventional cross-plane p-shaped flexible devices. We report aseries of high-performance p-type ductile thermoelectric materials based on the composition-performance phase diagram in AgCu(Se,S,Te) pseudoternary solid solutions, with high figure-of-meritvalues (0.45 at 300 kelvin and 0.68 at 340 kelvin) compared with other flexible thermoelectricmaterials. We further demonstrate thin and flexible p-shaped devices with a maximum normalizedpower density that reaches 30 mW cm−2 K−2. This output is promising for the use of flexiblethermoelectrics in wearable electronics.

By virtue of the excellent plasticity and tunable transport properties, Ag2S-based materials demonstrate an intriguing prospect for flexible or hetero-shaped thermoelectric applications. Among them, Ag(2)S1-xTex exhibits rich and interesting variations in crystal structure, mechanical and thermoelectric transport properties. However, Te alloying obviously introduces extremely large order-disorder distributions of cations and anions, leading to quite complicated crystal structures and thermoelectric properties. Detailed composition-structure-performance correlation of Ag2S1-xTex still remains to be established. In this work, we designed and prepared a series of Ag2S1-xTex (x = 0-0.3) materials with low Te content. We discovered that the monoclinic-to-cubic phase transition occurs around x = 0.16 at room temperature. Te alloying plays a similar role as heating in facilitating this monoclinic-to-cubic phase transition, which is analyzed based on the thermodynamic principles. Compared with the monoclinic counterparts, the cubic-structured phases are more ductile and softer in mechanical properties. In addition, the cubic phases show a degenerately semiconducting behavior with higher thermoelectric performance. A maximum zT = 0.8 at 600 K and bending strain larger than 20% at room temperature were obtained in Ag2S0.7Te0.3. This work provides a useful guidance for designing Ag2S-based alloys with enhanced plasticity and high thermoelectric performance.

By virtue of the excellent plasticity and tunable transport properties, Ag2S-based materials demonstrate an intriguing prospect for flexible or hetero-shaped thermoelectric applications. Among them, Ag(2)S1-xTex exhibits rich and interesting variations in crystal structure, mechanical and thermoelectric transport properties. However, Te alloying obviously introduces extremely large order-disorder distributions of cations and anions, leading to quite complicated crystal structures and thermoelectric properties. Detailed composition-structure-performance correlation of Ag2S1-xTex still remains to be established. In this work, we designed and prepared a series of Ag2S1-xTex (x = 0-0.3) materials with low Te content. We discovered that the monoclinic-to-cubic phase transition occurs around x = 0.16 at room temperature. Te alloying plays a similar role as heating in facilitating this monoclinic-to-cubic phase transition, which is analyzed based on the thermodynamic principles. Compared with the monoclinic counterparts, the cubic-structured phases are more ductile and softer in mechanical properties. In addition, the cubic phases show a degenerately semiconducting behavior with higher thermoelectric performance. A maximum zT = 0.8 at 600 K and bending strain larger than 20% at room temperature were obtained in Ag2S0.7Te0.3. This work provides a useful guidance for designing Ag2S-based alloys with enhanced plasticity and high thermoelectric performance.

By virtue of the excellent plasticity and tunable transport properties, Ag2S-based materials demonstrate an intriguing prospect for flexible or hetero-shaped thermoelectric applications. Among them, Ag(2)S1-xTex exhibits rich and interesting variations in crystal structure, mechanical and thermoelectric transport properties. However, Te alloying obviously introduces extremely large order-disorder distributions of cations and anions, leading to quite complicated crystal structures and thermoelectric properties. Detailed composition-structure-performance correlation of Ag2S1-xTex still remains to be established. In this work, we designed and prepared a series of Ag2S1-xTex (x = 0-0.3) materials with low Te content. We discovered that the monoclinic-to-cubic phase transition occurs around x = 0.16 at room temperature. Te alloying plays a similar role as heating in facilitating this monoclinic-to-cubic phase transition, which is analyzed based on the thermodynamic principles. Compared with the monoclinic counterparts, the cubic-structured phases are more ductile and softer in mechanical properties. In addition, the cubic phases show a degenerately semiconducting behavior with higher thermoelectric performance. A maximum zT = 0.8 at 600 K and bending strain larger than 20% at room temperature were obtained in Ag2S0.7Te0.3. This work provides a useful guidance for designing Ag2S-based alloys with enhanced plasticity and high thermoelectric performance.

By virtue of the excellent plasticity and tunable transport properties, Ag2S-based materials demonstrate an intriguing prospect for flexible or hetero-shaped thermoelectric applications. Among them, Ag(2)S1-xTex exhibits rich and interesting variations in crystal structure, mechanical and thermoelectric transport properties. However, Te alloying obviously introduces extremely large order-disorder distributions of cations and anions, leading to quite complicated crystal structures and thermoelectric properties. Detailed composition-structure-performance correlation of Ag2S1-xTex still remains to be established. In this work, we designed and prepared a series of Ag2S1-xTex (x = 0-0.3) materials with low Te content. We discovered that the monoclinic-to-cubic phase transition occurs around x = 0.16 at room temperature. Te alloying plays a similar role as heating in facilitating this monoclinic-to-cubic phase transition, which is analyzed based on the thermodynamic principles. Compared with the monoclinic counterparts, the cubic-structured phases are more ductile and softer in mechanical properties. In addition, the cubic phases show a degenerately semiconducting behavior with higher thermoelectric performance. A maximum zT = 0.8 at 600 K and bending strain larger than 20% at room temperature were obtained in Ag2S0.7Te0.3. This work provides a useful guidance for designing Ag2S-based alloys with enhanced plasticity and high thermoelectric performance.

Performance Monitor Unit (PMU) is a significant hardware module on the current processors, which counts the events launched by processor into a set of PMU counters. Ideally, the events triggered by instructions that are executed but the results are not successfully committed (transient execution) should not be recorded. However, in this study, we discover that some PMU events triggered by the transient execution instructions will actually be recorded by PMU. Based on this, we propose the PMUSpill attack, which enables attackers to maliciously leak the secret data that are loaded during transient executions. The biggest challenge is how to encode the secret data into PMU events. We construct an instruction gadget to solve this challenge, whose execution path that can be identified by PMU counters represents what values the secret data are. We successfully implement the PMUSpill attack to leak the secret data stored in Intel Software Guard Extensions (SGX) (a Trusted Execution Environment (TEE) in the Intel's processors) through real experiments. Besides, we locate the vulnerable PMU counters and their trigger instructions by iterating all the valid PMU counters and instructions. The experiment results demonstrate that there are up to 20 PMU counters available to implement the PMUSpill attack. We also provide some possible hardware and software-based countermeasures for addressing the PMUSpill attack, which can be utilized to enhance the security of processors in future.

High-throughput sequencing, culture-dependent workflows, and microbiome transfer experiments reveal whether potassium phosphite (KP), an environmentally acceptable agricultural chemical, could specifically enrich the antagonistic bacterial community that inhibited the growth of the pathogen Ralstonia solanacearum. The application of KP enriched the potential antagonistic bacteria Paenibacillus and Streptomyces in soil, but depleted most dominant genera belonging to gram negative bacteria, such as Pseudomonas, Massilia, and Flavobacterium on day 7. Moreover, the KP-modulated soil microbiome suppressed R. solanacearum growth in soil. The predicted functions related to the synthesis of antagonistic substances, such as streptomycin, and the predicted functions related to tellurite resistance and nickel transport system were significantly enriched, but the synthesis of lipopolysaccharide (distinct component lipopolysaccharide in gram negative bacteria) were significantly depleted in the KP-treated soils. In addition, the copy numbers of specific sequences for Streptomyces coelicoflavus and Paenibacillus favisporus were significantly increased in the soil amended with KP, inhibited the growth of R. solanacearum, and had a higher tolerance of KP than R. solanacearum. Our study linked the application of fertilizers to the enrichment of antagonistic bacteria, which could support future work that aims to precisely regulate the soil microbiome to protect the host from infection by soil-borne pathogens.

Bacterial wilt caused by Ralstonia solanacearum is a distributed and worldwide soil-borne disease. The application of biocontrol microbes or agricultural chemicals has been widely used to manage tomato bacterial wilt. However, whether and how agricultural chemicals affect the antagonistic ability of biocontrol microbes is still unknown. Here, we combined potassium phosphite (K-Phite), an environmentally friendly agricultural chemical, and the biocontrol agent Bacillus amyloliquefaciens QPF8 (strain F8) to manage tomato bacterial wilt disease. First, K-Phite at a concentration of 0.05% (w/v) could significantly inhibit the growth of Ralstonia solanacearum. Second, 0.05% K-Phite enhanced the antagonistic capability of B. amyloliquefaciens F8. Third, the greenhouse soil experiments showed that the control efficiency for tomato bacterial wilt in the combined treatment was significantly higher than that of the application of B. amyloliquefaciens F8 or K-Phite alone. Overall, our results highlighted a novel strategy for the control of tomato bacterial wilt disease via application and revealed a new integrated pattern depending on the enhancement of the antagonistic capability of biocontrol microbes by K-Phite.

By virtue of the excellent plasticity and tunable transport properties, Ag2S-based materials demonstrate an intriguing prospect for flexible or hetero-shaped thermoelectric applications. Among them, Ag(2)S1-xTex exhibits rich and interesting variations in crystal structure, mechanical and thermoelectric transport properties. However, Te alloying obviously introduces extremely large order-disorder distributions of cations and anions, leading to quite complicated crystal structures and thermoelectric properties. Detailed composition-structure-performance correlation of Ag2S1-xTex still remains to be established. In this work, we designed and prepared a series of Ag2S1-xTex (x = 0-0.3) materials with low Te content. We discovered that the monoclinic-to-cubic phase transition occurs around x = 0.16 at room temperature. Te alloying plays a similar role as heating in facilitating this monoclinic-to-cubic phase transition, which is analyzed based on the thermodynamic principles. Compared with the monoclinic counterparts, the cubic-structured phases are more ductile and softer in mechanical properties. In addition, the cubic phases show a degenerately semiconducting behavior with higher thermoelectric performance. A maximum zT = 0.8 at 600 K and bending strain larger than 20% at room temperature were obtained in Ag2S0.7Te0.3. This work provides a useful guidance for designing Ag2S-based alloys with enhanced plasticity and high thermoelectric performance.

Self-powered wearable electronics require thermoelectric materials simultaneously with a high dimensionless figure of merit (zT) and good flexibility to convert the heat discharged by the human body into electricity. Ag-2(S,Se)-based semiconducting materials can well satisfy these requirements, and thus, they are attracting great attention in thermoelectric society recently. Ag-2(S,Se) crystalizes in an orthorhombic structure or monoclinic structure, depending on the detailed S/Se atomic ratio, but the relationship between its crystalline structure and mechanical/thermoelectric performance is still unclear to date. In this study, a series of Ag2Se1-xSx (x = 0, 0.1, 0.2, 0.3, 0.4, and 0.45) samples were prepared and their mechanical and thermoelectric performance dependence on the crystalline structure was systematically investigated. x = 0.3 in the Ag2Se1-xSx system was found to be the transition boundary between orthorhombic and monoclinic structures. Mechanical property measurement shows that the orthorhombic Ag2Se1-xSx samples are brittle while the monoclinic Ag2Se1-xSx samples are ductile and flexible. In addition, the orthorhombic Ag2Se1-xSx samples show better electrical transport performance and higher zT than the monoclinic samples under a comparable carrier concentration, most likely due to their weaker electron-phonon interactions. This study sheds light on the further development of flexible inorganic TE materials.

Self-powered wearable electronics require thermoelectric materials simultaneously with a high dimensionless figure of merit (zT) and good flexibility to convert the heat discharged by the human body into electricity. Ag-2(S,Se)-based semiconducting materials can well satisfy these requirements, and thus, they are attracting great attention in thermoelectric society recently. Ag-2(S,Se) crystalizes in an orthorhombic structure or monoclinic structure, depending on the detailed S/Se atomic ratio, but the relationship between its crystalline structure and mechanical/thermoelectric performance is still unclear to date. In this study, a series of Ag2Se1-xSx (x = 0, 0.1, 0.2, 0.3, 0.4, and 0.45) samples were prepared and their mechanical and thermoelectric performance dependence on the crystalline structure was systematically investigated. x = 0.3 in the Ag2Se1-xSx system was found to be the transition boundary between orthorhombic and monoclinic structures. Mechanical property measurement shows that the orthorhombic Ag2Se1-xSx samples are brittle while the monoclinic Ag2Se1-xSx samples are ductile and flexible. In addition, the orthorhombic Ag2Se1-xSx samples show better electrical transport performance and higher zT than the monoclinic samples under a comparable carrier concentration, most likely due to their weaker electron-phonon interactions. This study sheds light on the further development of flexible inorganic TE materials.

Self-powered wearable electronics require thermoelectric materials simultaneously with a high dimensionless figure of merit (zT) and good flexibility to convert the heat discharged by the human body into electricity. Ag-2(S,Se)-based semiconducting materials can well satisfy these requirements, and thus, they are attracting great attention in thermoelectric society recently. Ag-2(S,Se) crystalizes in an orthorhombic structure or monoclinic structure, depending on the detailed S/Se atomic ratio, but the relationship between its crystalline structure and mechanical/thermoelectric performance is still unclear to date. In this study, a series of Ag2Se1-xSx (x = 0, 0.1, 0.2, 0.3, 0.4, and 0.45) samples were prepared and their mechanical and thermoelectric performance dependence on the crystalline structure was systematically investigated. x = 0.3 in the Ag2Se1-xSx system was found to be the transition boundary between orthorhombic and monoclinic structures. Mechanical property measurement shows that the orthorhombic Ag2Se1-xSx samples are brittle while the monoclinic Ag2Se1-xSx samples are ductile and flexible. In addition, the orthorhombic Ag2Se1-xSx samples show better electrical transport performance and higher zT than the monoclinic samples under a comparable carrier concentration, most likely due to their weaker electron-phonon interactions. This study sheds light on the further development of flexible inorganic TE materials.

Self-powered wearable electronics require thermoelectric materials simultaneously with a high dimensionless figure of merit (zT) and good flexibility to convert the heat discharged by the human body into electricity. Ag-2(S,Se)-based semiconducting materials can well satisfy these requirements, and thus, they are attracting great attention in thermoelectric society recently. Ag-2(S,Se) crystalizes in an orthorhombic structure or monoclinic structure, depending on the detailed S/Se atomic ratio, but the relationship between its crystalline structure and mechanical/thermoelectric performance is still unclear to date. In this study, a series of Ag2Se1-xSx (x = 0, 0.1, 0.2, 0.3, 0.4, and 0.45) samples were prepared and their mechanical and thermoelectric performance dependence on the crystalline structure was systematically investigated. x = 0.3 in the Ag2Se1-xSx system was found to be the transition boundary between orthorhombic and monoclinic structures. Mechanical property measurement shows that the orthorhombic Ag2Se1-xSx samples are brittle while the monoclinic Ag2Se1-xSx samples are ductile and flexible. In addition, the orthorhombic Ag2Se1-xSx samples show better electrical transport performance and higher zT than the monoclinic samples under a comparable carrier concentration, most likely due to their weaker electron-phonon interactions. This study sheds light on the further development of flexible inorganic TE materials.

Self-powered wearable electronics require thermoelectric materials simultaneously with a high dimensionless figure of merit (zT) and good flexibility to convert the heat discharged by the human body into electricity. Ag-2(S,Se)-based semiconducting materials can well satisfy these requirements, and thus, they are attracting great attention in thermoelectric society recently. Ag-2(S,Se) crystalizes in an orthorhombic structure or monoclinic structure, depending on the detailed S/Se atomic ratio, but the relationship between its crystalline structure and mechanical/thermoelectric performance is still unclear to date. In this study, a series of Ag2Se1-xSx (x = 0, 0.1, 0.2, 0.3, 0.4, and 0.45) samples were prepared and their mechanical and thermoelectric performance dependence on the crystalline structure was systematically investigated. x = 0.3 in the Ag2Se1-xSx system was found to be the transition boundary between orthorhombic and monoclinic structures. Mechanical property measurement shows that the orthorhombic Ag2Se1-xSx samples are brittle while the monoclinic Ag2Se1-xSx samples are ductile and flexible. In addition, the orthorhombic Ag2Se1-xSx samples show better electrical transport performance and higher zT than the monoclinic samples under a comparable carrier concentration, most likely due to their weaker electron-phonon interactions. This study sheds light on the further development of flexible inorganic TE materials.

Self-powered wearable electronics require thermoelectric materials simultaneously with a high dimensionless figure of merit (zT) and good flexibility to convert the heat discharged by the human body into electricity. Ag-2(S,Se)-based semiconducting materials can well satisfy these requirements, and thus, they are attracting great attention in thermoelectric society recently. Ag-2(S,Se) crystalizes in an orthorhombic structure or monoclinic structure, depending on the detailed S/Se atomic ratio, but the relationship between its crystalline structure and mechanical/thermoelectric performance is still unclear to date. In this study, a series of Ag2Se1-xSx (x = 0, 0.1, 0.2, 0.3, 0.4, and 0.45) samples were prepared and their mechanical and thermoelectric performance dependence on the crystalline structure was systematically investigated. x = 0.3 in the Ag2Se1-xSx system was found to be the transition boundary between orthorhombic and monoclinic structures. Mechanical property measurement shows that the orthorhombic Ag2Se1-xSx samples are brittle while the monoclinic Ag2Se1-xSx samples are ductile and flexible. In addition, the orthorhombic Ag2Se1-xSx samples show better electrical transport performance and higher zT than the monoclinic samples under a comparable carrier concentration, most likely due to their weaker electron-phonon interactions. This study sheds light on the further development of flexible inorganic TE materials.

Peng-Fei Qiu, Yan-Bing Liu, Yong-Sheng Wang Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, People’s Republic of China Abstract: Although the 2009 American Joint Committee on Cancer incorporated the internal mammary sentinel lymph node biopsy (IM-SLNB) concept, there has been little change in surgical practice patterns due to the low visualization rate of internal mammary sentinel lymph nodes with the traditional injection technique. Meanwhile, as internal mammary lymph nodes (IMLN) metastases are mostly found concomitantly with axillary lymph nodes (ALN) metastases, previous IM-SLNB clinical trials fail to evaluate the status of IMLN in patients who are really in need (only in clinically ALN negative patients). Our modified injection technique (periareolar intraparenchymal, high volume, and ultrasonographic guidance) significantly improved the visualization rate of internal mammary sentinel lymph nodes, making the routine IM-SLNB possible in daily practice. IM-SLNB could provide individual minimally invasive staging, prognosis, and decision-making for breast cancer patients, especially for patients with clinically positive ALN. Moreover, IMLN radiotherapy should be tailored and balanced between the potential benefit and toxicity, and IM-SLNB-guided IMLN radiotherapy could achieve this goal. In the era of effective adjuvant therapy, within the changing treatment approach – more systemic therapy, less loco-regional therapy – clinicians should deliberate the application of regional IMLN therapy. Keywords: breast cancer, internal mammary lymph node, axillary lymph node, sentinel lymph node biopsy A Letter to the Editor has been received and published for this article.&nbsp

Xiaoshan Cao,1,2 Chunjian Wang,1 Yanbing Liu,1 Pengfei Qiu,1 Binbin Cong,1,2 Yongsheng Wang1 1Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, People’s Republic of China; 2School of Medicine and Life Sciences, Jinan University-Shandong Academy of Medical Sciences, Jinan, Shandong, People’s Republic of China Abstract: Male breast cancer (MBC) is considered as a rare disease that accounts for less than 1% of all breast cancers, and its treatment has been based on the evidence available from female breast cancer. Axillary sentinel lymph node biopsy (SLNB) is now regarded as the standard of care for both female and male patients without clinical and imaging evidence of axillary lymph node metastases, while internal mammary SLNB has rarely been performed. Internal mammary chain metastasis is an independent prognostic predictor. Internal mammary SLNB should be performed to complete nodal staging and guide adjuvant therapy in MBC patients with preoperative lymphoscintigraphic internal mammary chain drainage. We report both axillary and internal mammary SLNB in two cases with MBC. Internal mammary sentinel lymph node did contain metastasis in one case. Keywords: male breast cancer, internal mammary lymph node, sentinel lymph node biopsy, case report

Xiang Bi,1,* Yongsheng Wang,2 Minmin Li,1,* Peng Chen,2 Zhengbo Zhou,2 Yanbing Liu,2 Tong Zhao,2 Zhaopeng Zhang,2 Chunjian Wang,2 Xiao Sun,2 Pengfei Qiu2 1School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Cancer Hospital, 2Breast Cancer Center, Shandong Cancer Hospital, Jinan, People’s Republic of China *These authors contributed equally to this study Background: The main purpose of the study reported here was to validate the clinical value of the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram that predicts non-sentinel lymph node (SLN) metastasis in SLN-positive patients with breast cancer. Methods: Data on 1,576 patients who received sentinel lymph node biopsy (SLNB) at the Shandong Cancer Hospital from December 2001 to March 2014 were collected in this study, and data on 509 patients with positive SLN were analyzed to evaluate the risk factors for non-SLN metastasis. The MSKCC nomogram was used to estimate the probability of non-SLN metastasis and was compared with actual probability after grouping into deciles. A receiver-operating characteristic (ROC) curve was drawn and predictive accuracy was assessed by calculating the area under the ROC curve. Results: Tumor size, histological grade, lymphovascular invasion, multifocality, number of positive SLNs, and number of negative SLNs were correlated with non-SLN metastasis (P<0.05) by univariate analysis. However, multivariate analysis showed that tumor size (P=0.039), histological grade (P=0.043), lymphovascular invasion (P=0.001), number of positive SLNs (P=0.001), and number of negative SLNs (P=0.000) were identified as independent predictors for non-SLN metastasis. The trend of actual probability in various decile groups was comparable to the predicted probability. The area under the ROC curve was 0.722. Patients with predictive values lower than 10% (97/492, 19.7%) had a frequency of non-SLN metastasis of 17.5% (17/97). Co