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Objectives: To develop and validate a nomogram for predicting ≥ 3 metastatic axillary lymph nodes (ALNs) in early breast cancer with no palpable axillary adenopathy by clinicopathologic data, contrast-enhanced (CE) lymphatic ultrasound (US), and grayscale findings of sentinel lymph nodes (SLNs). Materials and methods: Women with T1-2N0 invasive breast cancer were consecutively recruited for the CE lymphatic US. Patients from Center 1 were grouped into development and internal validation cohorts at a ratio of 2:1. The external validation cohort was constructed from Center 2. The clinicopathologic data and US findings of SLNs were analyzed. A nomogram was developed to predict women with ≥ 3 metastatic ALNs. Nomogram performance was assessed with the area under the receiver operating characteristic curve (AUC) and calibration curve analysis. Results: One hundred seventy-nine from Center 1 were considered the development cohorts. The remaining 90 participants from Center 1 were internal cohorts and 197 participants from Center 2 were external validation cohorts. The US findings of no enhancement (odds ratio (OR), 15.3; p = 0.01), diffuse (OR, 19.1; p = 0.01) or focal eccentric (OR, 27.7; p = 0.003) cortical thickening, and absent hilum (OR, 169.7; p < 0.001) were independently associated with ≥ 3 metastatic ALNs. Compared to grayscale US or CE lymphatic US alone, the nomogram showed the highest AUC of 0.88 (0.85, 0.91). The nomogram showed a calibration slope of 1.0 (p = 0.80–0.81; Brier = 0.066–0.067) in validation cohorts in predicting ≥ 3 metastatic ALNs. Conclusion: Patients likely to have ≥ 3 metastatic ALNs were identified by combining the lymphatic and grayscale US findings of SLNs. Our nomogram could aid in multidisciplinary treatment decision-making. Trial registration: This trial is registered on www.chictr.org.cn: ChiCTR2000031231. Registered March 25, 2020. Critical relevance statement: A nomogram combining lymphatic CEUS and grayscale US findings of SLNs could identify early breast cancer patients with low or high axillary tumor burden preoperatively, which is more applicable to the Z0011 era. Our nomogram could be useful in aiding multidisciplinary treatment decision-making for patients with early breast cancer. Key points: • CEUS can help identify and diagnose SLN in early breast cancer preoperatively. • Combining lymphatic and grayscale US findings can predict axillary tumor burden. • The nomogram showed a high diagnostic value in validation cohorts. [ABSTRACT FROM AUTHOR]

Under the retailing environment, shelf space-based competition between items with different brands has drawn much attention from practitioners and researchers, the decision for low-temperature stored items on limited shelf spaces are compounding this challenge. This paper discusses the shelf display space partition assignment decision for low-temperature dairy items with two-phase demand in remaining shelf-life to maximize the profit of the shelf. Two-phase demand is assumed for the first time based on the knowledge that consumers' perception on the quality of the dairy item is unequal to its true shelf-life. Moreover, considering shelf partitions in different heights carry different sale gaining potentials, three profit weights are given to the partitions. Herein, a new research model named as SPSPA of shelf profit space partition assignment for the low-temperature stored dairy items is constructed. To effectively solve the proposed SPSPA, a hybrid firefly particle swarm optimization (HFPSO) is developed combing the superiority of particle swarm optimization (PSO) in coarse search and firefly algorithm (FA) in fine search. Numerical experiments have been performed on small- and large-scale cases to verify the performance of the proposed HFPSO algorithm by comparing with genetic algorithm, differential evolution (DE), PSO, and FA based on which management insights are obtained for the shelf space assignment decision. [ABSTRACT FROM AUTHOR]

In this study, we studied the performance of the 2022 American College of Rheumatology (ACR)/ European Alliance of Associations for Rheumatology (EULAR) classification criteria for Takayasu's arteritis (TAK) as compared to the 1990 ACR classification criteria in a Chinese population. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and the area under the receiver operating characteristics curve (AUC) of the above two criteria were compared. The sensitivity (92.6%), positive predictive value (95.6%), negative predictive value (94.6%), accuracy (95.0%) and AUC (0.981) of the 2022 criteria were superior to those of the 1990 criteria (45.7%, 91.5%, 70.5%, 75.0% and 0.874, respectively), and the difference of AUC was statistically significant (Z = 5.362, P < 0.001). In addition, we included new imaging modalities in the 1990 criteria, whose sensitivity, positive predictive value, negative predictive value, accuracy and AUC were significantly improved, but still lower than those of the 2022 criteria, the difference in AUC was also statistically significant (Z = 2.023, P = 0.043). The 2022 criteria for TAK exhibited superior performance compared with the 1990 criteria and may be more appropriate for the Chinese population. Incorporating additional imaging modalities could enhance the classification performance of the 1990 criteria even further. [ABSTRACT FROM AUTHOR]

Essential trace metals (ETMs) may play important roles in the pathophysiology of benign and malignant breast cancers. Our study aimed to find associations between ETMs and benign and malignant breast cancers. We recruited 146 patients with benign (n = 73) and malignant (n = 73) breast tumors and 95 healthy controls (HCs) from Peking University Third Hospital, Beijing, China. The serum concentrations of seven ETMs (Zn, Mn, Cu, Fe, Co, Ni, and Mo) were evaluated using inductively coupled plasma mass spectrometry (ICP-MS). The serum concentrations of Zn were significantly lower in the malignant group than in the HC group, whereas the concentrations of Cu (p < 0.001) were significantly higher in the malignant group. The concentrations of Fe were significantly lower in both malignant and benign groups than in the HC group (p < 0.05). We observed that the Fe/Cu ratio was lower and the Cu/Ni ratio was higher in the malignant group than in the HCs, as well as in the benign group than in the HCs. The serum concentration of Fe (OR = 0.454; 95% CI, 0.263, 0.784; p = 0.005) was negatively associated with breast tumors after adjusting for potential confounders, including age, BMI, and smoking, drinking and menopause statuses; that of Cu (OR = 2.274; 95% CI, 1.282, 4.031; p = 0.005) was positively associated. Changes in the concentrations of ETMs (Zn, Cu, Fe, and Ni) may be involved in the development of malignant breast cancer. The findings provide foundations for further exploration of ETMs in the prevention and treatment of breast tumors. [ABSTRACT FROM AUTHOR]

Objectives: To assess the efficacy of percutaneous Sonazoid-enhanced ultrasound and in vitro verification for identification sentinel lymph nodes (SLNs) and diagnosis of metastatic SLNs in patients with early breast cancer (BC). Methods: Sixty-eight patients with early BC were enrolled finally. After the induction of general anesthesia, 0.4 ml of Sonazoid (SNZ), a new second-generation tissue-specific ultrasound contrast agent (UCA), mixed with 0.6 ml of methylene blue, was injected intradermally. The lymphatic vessels and connected SLNs were immediately observed and marked. After being resected, these SLNs were soaked in saline water and examined still in the mode of contrast-enhanced ultrasound (CEUS) in vitro. This procedure could ensure that all the enhanced nodes had been removed as much as possible. The numbers of SLNs detected by UCA and blue dye were recorded. The enhancement patterns of SLNs were compared with the final pathological results. Results: SLNs detection rate by SNZ-CEUS was 100%, which was higher than that by blue dye (95.59%). CEUS identified a median of 1.5 nodes, while blue dye identified a median of 1.9 nodes per case (p = 0.0012). When homogeneous high perfusion and complete annular high perfusion were regarded as negative nodes, the sensitivity and negative predictive value were 92.31% and 96.79% respectively, while the specificity was 84.21%. Conclusions: Percutaneous SNZ-enhanced ultrasonography combined with in vitro verification is a feasible and reliable method for SLNs identification intraoperatively. Enhancement patterns can be helpful in determining the status of SLNs. Key Points: • CEUS with percutaneous injection of Sonazoid can successfully identify SLNs with the rate of 100% in early breast cancer patients, higher than 95.59% of blue dye. • Sonazoid, with high affinity with reticuloendothelial cells, increases the imaging time of SLNs and facilitates biopsy intraoperatively better than Sonovue as a lymphatic tracer. • Homogenous high and complete annular high perfusions have a sensitivity of 92.31% and a negative predictive value of 96.79% in the prediction of uninvolved SLNs. [ABSTRACT FROM AUTHOR]

Thyroid nodules are very common all over the world, and China is no exception. Ultrasound plays an important role in determining the risk stratification of thyroid nodules, which is critical for clinical management of thyroid nodules. For the past few years, many versions of TIRADS (Thyroid Imaging Reporting and Data System) have been put forward by several institutions with the aim to identify whether nodules require fine-needle biopsy or ultrasound follow-up. However, no version of TIRADS has been widely adopted worldwide till date. In China, as many as ten versions of TIRADS have been used in different hospitals nationwide, causing a lot of confusion. With the support of the Superficial Organ and Vascular Ultrasound Group of the Society of Ultrasound in Medicine of the Chinese Medical Association, the Chinese-TIRADS that is in line with China's national conditions and medical status was established based on literature review, expert consensus, and multicenter data provided by the Chinese Artificial Intelligence Alliance for Thyroid and Breast Ultrasound. [ABSTRACT FROM AUTHOR]

Skeletal muscles are always embedded in sheets of connective tissues, which influences muscle biomechanics by shaping the fascicle geometry and encapsulating muscular mass flow. However, existing Hill-type muscle models typically take surrounding tissues into account as a nonlinear spring, without consideration of the muscle geometry and inertia. In this paper, a new muscle model is proposed to simultaneously account for soft tissue constraints on the muscle's shape together with mass flow during stretch. To accomplish this, a mass-variable cable element of the muscle–tendon unit, with parameterization of its geometrical influence on the force-producing capability, is newly formulated based on an arbitrary Lagrangian–Eulerian description. Also, sliding joints are presented to further constrain possible mass flow of the elements via epimuscular soft tissue connections between adjacent muscle bellies. Available experimental data from cat soleus and rat gastrocnemius medialis muscles validates the proposed method. For further verification, a planar model of the triceps surae is developed by integration of this modeling framework, and subject-specific simulations of the passive ankle dynamometry tests are performed and correlated with sonoelastographic evaluations of two male participants. The results confirm that the flow of the muscle mass can alternate its force-generating behaviors, and the established model provides an accurate prediction of muscle behavior under transverse loading. The proposed muscle element could be integrated with larger musculoskeletal models to better investigate biomechanical functions of muscles during locomotion, such as heel impact or vibration responses of the spine, when dynamic effects are substantial. [ABSTRACT FROM AUTHOR]

Purpose: B-mode ultrasound (B-US) and strain elastography ultrasound (SE-US) images have a potential to distinguish thyroid tumor with different lymph node (LN) status. The purpose of our study is to investigate whether the application of multi-modality images including B-US and SE-US can improve the discriminability of thyroid tumor with LN metastasis based on a radiomics approach.Methods: Ultrasound (US) images including B-US and SE-US images of 75 papillary thyroid carcinoma (PTC) cases were retrospectively collected. A radiomics approach was developed in this study to estimate LNs status of PTC patients. The approach included image segmentation, quantitative feature extraction, feature selection and classification. Three feature sets were extracted from B-US, SE-US, and multi-modality containing B-US and SE-US. They were used to evaluate the contribution of different modalities. A total of 684 radiomics features have been extracted in our study. We used sparse representation coefficient-based feature selection method with 10-bootstrap to reduce the dimension of feature sets. Support vector machine with leave-one-out cross-validation was used to build the model for estimating LN status.Results: Using features extracted from both B-US and SE-US, the radiomics-based model produced an area under the receiver operating characteristic curve (AUC) = 0.90, accuracy (ACC) = 0.85, sensitivity (SENS) = 0.77 and specificity (SPEC) = 0.88, which was better than using features extracted from B-US or SE-US separately.Conclusions: Multi-modality images provided more information in radiomics study. Combining use of B-US and SE-US could improve the LN metastasis estimation accuracy for PTC patients. [ABSTRACT FROM AUTHOR]