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Background: Parkinson’s disease is a neurodegenerative disease characterized by progressive dopaminergic (DAergic) neuronal loss. Motor deficits experienced by patients with Parkinson’s disease are well documented, but non-motor symptoms, including mood disorders associated with circadian disturbances, are also frequent features. One common phenomenon is “sundowning syndrome,” which is characterized by the occurrence of neuropsychiatric symptoms at a specific time (dusk), causing severe quality of life challenges. This study aimed to elucidate the underlying mechanisms of sundowning syndrome in Parkinson’s disease and their molecular links with the circadian clock.Methods: To induce the Parkinson’s disease mouse model, a single injection of 6-hydroxydopamine (6-OHDA) was administered into the left dorsal striatum. Five weeks post injection, mood-related behavioral tests were performed at the indicated time of day (circadian time 22-01 vs. 10-13). Local injection of a REV-ERBα antagonist, SR8278, into the ventral tegmental area, was performed 3 h before each behavioral test. To determine the molecular mechanism of behavioral deficits, fluorescent in situ hybridization, chromatin immunoprecipitation assay, western blot analysis, and ATAC-sequencing were performed.Results: Our study demonstrated that 6-OHDA-lesioned mice exhibited increased depression- and anxiety-like behaviors only at dawn. SR8278 treatment exerted antidepressant and anxiolytic effects in a circadian time-dependent manner in 6-OHDA-lesioned mice, restoring the circadian rhythm of mood-related behaviors. 6-OHDA-lesion altered DAergic-specific Rev-erbα and Nurr1 transcription, and atypical binding activities of REV-ERBα and NURR1, which are upstream nuclear receptors for the discrete tyrosine hydroxylase promoter region SR8278, restored the binding activities of REV-ERBα and NURR1 to the tyrosine hydroxylase promoter and the induction of enrichment of the R/N motif, recognized by REV-ERBα and NURR1 only at dawn, as revealed by ATAC-sequencing; therefore, tyrosine hydroxylase expression was elevated in the ventral tegmental area of 6-OHDA-injected mice, especially at dawn.Conclusions: These results indicate that REV-ERBα is a potential therapeutic target, and its antagonist, SR8278, is a potential drug for mood disorders related to circadian disturbances, namely sundowning syndrome, in Parkinson’s disease.

To compare the characteristics of the peripapillary choroid (PPC) between the 2 eyes of patients with unilateral treatment-naïve normal-tension glaucoma (NTG).Observational case series.Sixty-nine patients (138 eyes) with treatment-naïve unilateral NTG.The characteristics of PPC vasculature were evaluated by measuring PPC thickness and assessing the presence of parapapillary deep-layer microvasculature dropout (MvD). Peripapillary choroid thickness was measured by enhanced depth imaging OCT. Microvasculature dropout was assessed using OCT angiography. The area and maximum radial width of β-zone parapapillary atrophy (PPA) were measured on infrared images using the built-in caliper tool of the Spectralis OCT (Heidelberg Engineering).Between-eye differences in PPC thickness, MvD frequency, and the area and maximum width of β-zone PPA.Eyes with NTG showed higher intraocular pressure (IOP), longer axial length, thinner PPC, larger area and maximum radial width of the β-zone PPA, and more frequent MvD (P0.01 for each) than contralateral healthy eyes. Multivariate conditional logistic regression analysis revealed that higher IOP, thinner PPC, larger maximum radial width of β-zone PPA, and the presence of MvD were associated independently with the risk of NTG (P0.03 for each). In eyes with NTG, MvD location and retinal nerve fiber layer defect were correlated topographically.Peripapillary choroid vasculature characteristics are significantly more compromised in eyes with NTG than in contralateral healthy eyes of patients with unilateral NTG.

To investigate the added diagnostic value of abbreviated breast magnetic resonance imaging (MRI) for suspicious microcalcifications on screening mammography. This prospective study included 80 patients with suspicious calcifications on screening mammography who underwent abbreviated MRI before undergoing breast biopsy between August 2017 and September 2020. The abbreviated protocol included one pre-contrast and the first post-contrast T1-weighted series. MRI examinations were interpreted as either positive or negative based on the visibility of any significant enhancement. The positive predictive value (PPV) was compared before and after the MRI. Of the 80 suspicious microcalcifications, 33.8% (27/80) were malignant and 66.2% (53/80) were false positives. Abbreviated MRI revealed 33 positive enhancement lesions, and 25 and two lesions showed true-positive and false-negative findings, respectively. Abbreviated MRI increased PPV from 33.8 (27 of 80 cases; 95% CI: 26.2%, 40.8%) to 75.8% (25 of 33 cases; 95% CI: 62.1%, 85.7%). A total of 85% (45 of 53) false-positive diagnoses were reduced after abbreviated MRI assessment. Abbreviated MRI added significant diagnostic value in patients with suspicious microcalcifications on screening mammography, as demonstrated by a significant increase in PPV with a potential reduction in unnecessary biopsy. • Abbreviated breast magnetic resonance imaging increased the positive predictive value of suspicious microcalcifications on screening mammography from 33.8 (27/80 cases) to 75.8% (25/33 cases) (p < .01). • Abbreviated magnetic resonance imaging helped avoid unnecessary benign biopsies in 85% (45/53 cases) of lesions without missing invasive cancer.

Despite the facile fabrication of geometry-controlled vertical silicon nanocolumn arrays (vSNAs), metal-assisted chemical etching (MACE) showed critical limitations for producing vSNAs, particularl...

To determine whether texture analysis for magnetic resonance imaging (MRI) can predict recurrence in patients with breast cancer treated with neoadjuvant chemotherapy (NAC). This retrospective study included 130 women who received NAC and underwent subsequent surgery for breast cancer between January 2012 and August 2017. We assessed common features, including standard morphologic MRI features and clinicopathologic features. We used a commercial software and analyzed texture features from pretreatment and midtreatment MRI. A random forest (RF) method was performed to build a model for predicting recurrence. The diagnostic performance of this model for predicting recurrence was assessed and compared with those of five other machine learning classifiers using the Wald test. Of the 130 women, 21 (16.2%) developed recurrence at a median follow-up of 35.4 months. The RF classifier with common features including clinicopathologic and morphologic MRI features showed the lowest diagnostic performance (area under the receiver operating characteristic curve [AUC], 0.83). The texture analysis with the RF method showed the highest diagnostic performances for pretreatment T2-weighted images and midtreatment DWI and ADC maps showed better diagnostic performance than that of an analysis of common features (AUC, 0.94 vs. 0.83, p < 0.05). The RF model based on all sequences showed a better diagnostic performance for predicting recurrence than did the five other machine learning classifiers. Texture analysis using an RF model for pretreatment and midtreatment MRI may provide valuable prognostic information for predicting recurrence in patients with breast cancer treated with NAC and surgery. • RF model-based texture analysis showed a superior diagnostic performance than traditional MRI and clinicopathologic features (AUC, 0.94 vs.0.83, p < 0.05) for predicting recurrence in breast cancer after NAC. • Texture analysis using RF classifier showed the highest diagnostic performances (AUC, 0.94) for pretreatment T2-weighted images and midtreatment DWI and ADC maps. • RF model showed a better diagnostic performance for predicting recurrence than did the five other machine learning classifiers.

Background Since the 5th edition of BI-RADS was released, prior studies have compared BI-RADS and quantitative fully automated volumetric assessment, but with software packages that were not recalibrated according to the 5th edition. Purpose To investigate mammographic density assessment of automated volumetric measurements recalibrated according to the BI-RADS 5th edition compared with visual assessment. Material and Methods A total of 4000 full-field digital mammographic examinations were reviewed by three radiologists for the BI-RADS 5th edition density category by consensus after individual assessments. Volumetric density data obtained using Quantra and Volpara software were collected. The comparison of visual and volumetric density assessments was performed in total and according to the presence of cancer. Results Among 4000 examinations, 129 were mammograms of breast cancer. Compared to visual assessment, volumetric measurements showed higher category B (40.6% vs. 19.8%) in Quantra, and higher category D (40.4% vs. 14.7%) and lower category A (0.2% vs. 5.0%) in Volpara ( P Conclusion Automated volumetric measurements adapted for the BI-RADS 5th edition showed different but correlated results with visual assessment and each other. Recalibration of volumetric measurement has not completely reflected the visual assessment.

Background: Research into patient safety has largely focused on healthcare organisations bureaucratic routines, with little research available regarding the impact of patient perceptions on clinical practice. Acknowledging and openly discussing patient perceptions of medical errors may result in improved quality of healthcare. The research study aimed to gain a better understanding of the public's perception of medical errors to drive a structured approach to improve healthcare outcomes. Methods: In this study, we examined the public experiences of medical errors using an anonymous on-line survey to collect empirical data from April to December 2018. A total of 407 responses were obtained with 303 participants meeting the criteria for inclusion in the study. Results: The majority (74.9%) of these participants identified that they had experienced a medical error during receiving healthcare in Australia and 73% of these confirmed that they were harmed as a result of these errors. Conclusion: Findings from this study indicate that many participants have experienced medical errors when accessing healthcare in Australia. These findings provide information and a deeper understanding of patient experiences and perceptions of healthcare service delivery which can be used by healthcare organisations to improve healthcare services and promote patient participation in their care.

As the coronavirus disease 2019 (COVID-19) pandemic continues, reinfection is likely to become increasingly common. However, confirming COVID-19 reinfection is difficult because it requires whole-genome sequencing of both infections to identify the degrees of genetic differences. Since the first reported case of reinfection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the Republic of Korea in April 2020, four additional cases were classified as suspected reinfection cases. We performed whole-genome sequencing of viral RNA extracted from swabs obtained at the initial infection and reinfection stages of these four suspected cases. The interval between initial infection and reinfection of all four suspected cases was more than 3 months. All four patients were young (10-29 years), and they displayed mild symptoms or were asymptomatic during the initial infection and reinfection episodes. The analysis of genome sequences combined with the epidemiological results revealed that only two of the four cases were confirmed as reinfection, and both were reinfected with the Epsilon variant. Due to the prolonged COVID-19 pandemic, the possibility of reinfections with SARS-CoV-2 variants is increasing, as reported in our study. Therefore, continuous monitoring of cases is necessary.

Osteoarthritis (OA) is an incurable joint disease affecting 240 million elderly population, and major unmet medical needs exist for better therapeutic options for OA. During skeletal development, Nkx3.2 has been shown to promote chondrocyte differentiation and survival, but to suppress cartilage hypertrophy and blood vessel invasion. Here we show that Nkx3.2 plays a key role in osteoarthritis (OA) pathogenesis. Marked reduction of Nkx3.2 expression was observed in three different murine OA models. Consistent with these findings, analyses of surgery-induced and age-driven OA models revealed that cartilage-specific post-natal induction of Nkx3.2 can suppress OA progression in mice. These results suggest that Nkx3.2 may serve as a promising target for OA drug development.

OBJECTIVE To develop a scoring system stratifying the malignancy risk of mammographic microcalcifications using the 5th edition of the Breast Imaging Reporting and Data System (BI-RADS). MATERIALS AND METHODS One hundred ninety-four lesions with microcalcifications for which surgical excision was performed were independently reviewed by two radiologists according to the 5th edition of BI-RADS. Each category's positive predictive value (PPV) was calculated and a scoring system was developed using multivariate logistic regression. The scores for benign and malignant lesions or BI-RADS categories were compared using an independent t test or by ANOVA. The area under the receiver operating characteristic curve (AUROC) was assessed to determine the discriminatory ability of the scoring system. Our scoring system was validated using an external dataset. RESULTS After excision, 69 lesions were malignant (36%). The PPV of BI-RADS descriptors and categories for calcification showed significant differences. Using the developed scoring system, mean scores for benign and malignant lesions or BI-RADS categories were significantly different (p < 0.001). The AUROC of our scoring system was 0.874 (95% confidence interval, 0.840-0.909) and the PPV of each BI-RADS category determined by the scoring system was as follows: category 3 (0%), 4A (6.8%), 4B (19.0%), 4C (68.2%), and 5 (100%). The validation set showed an AUROC of 0.905 and PPVs of 0%, 8.3%, 11.9%, 68.3%, and 94.7% for categories 3, 4A, 4B, 4C, and 5, respectively. CONCLUSION A scoring system based on BI-RADS morphology and distribution descriptors could be used to stratify the malignancy risk of mammographic microcalcifications.

In order to evaluate the level of knowledge acquired by students, this study presents the contents of the students’ knowledge using a proposed novel method to monitor a knowledge map and to diagnose them. To do so, we propose a method to improve the accuracy of diagnoses by comparing the level of the surrounding knowledge related to the knowledge, rather than the level of the knowledge itself, to correct the evaluation value. Moreover, in visualizing the relationship between knowledge objects based on knowledge evaluation data using an ontological structure, the Deep Sparse Neural Network model of deep learning is applied, and the map is regarded as one neural network and is proposed to express the quantitative value using the weight instead of the qualitative concept of ontology. The proposed knowledge map visualization can monitor the relationship and relevance (weight) of the related knowledge level at a glance, so that it is possible to intuitively grasp the result with the quantitative knowledge diagnosis and to improve the efficiency of knowledge evaluation and the accurate evaluation of knowledge diagnoses.

Background Endemic outbreaks of hantaviruses pose a critical public health threat worldwide. Hantaan orthohantavirus (HTNV) causes hemorrhagic fever with renal syndrome (HFRS) in humans. Using comparative genomic analyses of partial and nearly complete sequences of HTNV from humans and rodents, we were able to localize, with limitations, the putative infection locations for HFRS patients. Partial sequences might not reflect precise phylogenetic positions over the whole-genome sequences; finer granularity of rodent sampling reflects more precisely the circulation of strains. Methods Five HFRS specimens were collected. Epidemiological surveys were conducted with the patients during hospitalization. We conducted active surveillance at suspected HFRS outbreak areas. We performed multiplex polymerase chain reaction–based next-generation sequencing to obtain the genomic sequence of HTNV from patients and rodents. The phylogeny of human- and rodent-derived HTNV was generated using the maximum likelihood method. For phylogeographic analyses, the tracing of HTNV genomes from HFRS patients was defined on the bases of epidemiological interviews, phylogenetic patterns of the viruses, and geographic locations of HTNV-positive rodents. Results The phylogeographic analyses demonstrated genetic clusters of HTNV strains from clinical specimens, with HTNV circulating in rodents at suspected sites of patient infections. Conclusions This study demonstrates a major shift in molecular epidemiological surveillance of HTNV. Active targeted surveillance was performed at sites of suspected infections, allowing the high-resolution phylogeographic analysis to reveal the site of emergence of HTNV. We posit that this novel approach will make it possible to identify infectious sources, perform disease risk assessment, and implement preparedness against vector-borne viruses.

Introduction: Rural and remote populations experience the greatest burden of chronic obstructive pulmonary disease (COPD), the fifth leading cause of death in Australia. Currently there is a need to prioritise health services to improve health outcomes among those at higher risk of COPD. Objectives: To investigate the differences in COPD hospitalisation between rural and urban populations and determine predictive factors contributing to COPD hospitalisation. Methods: Statewide hospitalisation data from 2010 to 2015 were obtained through the Victorian Admitted Episodes Dataset and other key data sets. The rates of hospitalisation were analysed using hierarchical multiple regression to examine the association between COPD hospitalisations and a number of predictor variables. Results: The highest COPD incidence occurred in metropolitan males aged 85 years of age and older (35.092 hospitalisations per 1000 population). Among metropolitan residents, smoking, population density and household income had a significant association with COPD hospitalisations for both sexes. Among rural males, smoking rates, household income and rural land use (farming) were significant predictors of COPD hospitalisations. There was an overall stability in statewide COPD hospitalisation over the 5 years to 2015, P = 0.420. Conclusion: This investigation highlights many rural and regional areas have much lower COPD hospitalisation rates than metropolitan areas. Between males and females, there are heterogenetic factors that contribute to the significant variation associated with COPD hospitalisation in metropolitan and rural areas, such as rural land use among rural males. This indicates that risk factor assessments, beyond smoking alone, need to be individualised and prioritised in practice to optimise care.

This paper studies a method to recognize vehicle types based on deep learning model. Faster-RCNN, YOLO, and SSD, which can be processed in real-time and have relatively high accuracy, are presented in this paper. We trained each algorithm through an automobile training dataset and analyzed the performance to determine what is the optimized model for vehicle type recognition. The Yolov4 model outperforms other methods, showing 93% accuracy in recognizing the vehicle model.

The issue of medical errors, or adverse events caused within a health care context or by a health care provider, is largely under-researched. While the experience and perspective of health care professionals regarding medical errors have been explored, little attention is paid to the health care consumers regarding their perceptions and experiences. Therefore, there is a need to better understand the public’s views on medical errors to enhance patient safety and quality care. The current study sought to examine Australian public perceptions and experiences, especially concerning what errors had occurred, the perceived sources of the errors, and if the errors had been reported. This paper reports the qualitative findings of an online survey for Australian residents who have accessed or received medical services at any time in Australia. Responses from 304 surveys were analyzed and discussed, including demographic information and key themes about medical errors, which were categorized into engagement and patients’ voices being heard, the quality of care being provided, and the system’s accountability. Based on the findings, the study highlights the importance of effective health professional–patient communication, enhanced capacity to deliver high quality care, and improved mechanism for error reporting and resolution where patients feel safe and confident about positive changes being made.

Aim To investigate whether magnetic resonance imaging (MRI) can improve the positive predictive value (PPV) for Breast Imaging-Reporting and Data System (BI-RADS) category 4B mammographic microcalcification. Materials and methods One hundred and eight consecutive patients with BI-RADS category 4B microcalcification without mass on mammography underwent breast MRI and subsequent histopathological confirmation between January 2009 and December 2015. Mammography and MRI findings were reviewed retrospectively, and imaging features were analysed according to the 5th edition of BI-RADS. The PPV of each descriptor was analysed to identify subgroups in which PPV could be improved by the addition of MRI. Results When the criteria of presence of enhancement on MRI was applied to category 4B microcalcification, PPV increased from 0.38 (41 of 108) to 0.82 (37 of 45) and reduced benign biopsy results by 88% (59 of 67). Four ductal carcinoma in situ lesions were missed. For amorphous microcalcification with regional or grouped distribution, MRI images increased PPV without missing malignancy. Conclusion Breast MRI has the potential to improve PPV for category 4B mammographic microcalcification by reducing false-positive findings. If amorphous microcalcification with regional or grouped distribution on mammography shows no enhancement on MRI, follow-up could be considered rather than immediate biopsy. In addition, breast MRI might have the potential to guide the best site to biopsy in category 4B microcalcification.

Glycogen-rich clear cell carcinoma (GRCC) of the breast is a rare malignant tumor. Most previous reports focused on clinicopathologic findings of GRCC and imaging findings were not precisely described. Here, we report imaging findings of three cases of GRCC along with a literature review. GRCC of the breast was depicted as a mass with irregular or oval shape on mammography and complex cystic and solid composition or focal cystic change on ultrasound. GRCC showed internal high signal intensity on T2-weighted MRI with rim enhancement after contrast injection. These might suggest the possibility of GRCC in differentiating breast tumors.

Background Previous studies have suggested that texture analysis is a promising tool in the diagnosis, characterization, and assessment of treatment response in various cancer types. Therefore, application of texture analysis may be helpful for early prediction of pathologic response in breast cancer. Purpose To investigate whether texture analysis of features from MRI is associated with pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) in breast cancer. Materials and Methods This retrospective study included 136 women (mean age, 47.9 years; range, 31-70 years) who underwent NAC and subsequent surgery for breast cancer between January 2012 and August 2017. Patients were monitored with 3.0-T MRI before (pretreatment) and after (midtreatment) three or four cycles of NAC. Texture analysis was performed at pre- and midtreatment T2-weighted MRI, contrast material-enhanced T1-weighted MRI, diffusion-weighted MRI, and apparent diffusion coefficient (ADC) mapping by using commercial software. A random forest method was applied to build a predictive model for classifying those with pCR with use of texture parameters. Diagnostic performance for predicting pCR was assessed and compared with that of six other machine learning classifiers (adaptive boosting, decision tree, k-nearest neighbor, linear support vector machine, naive Bayes, and linear discriminant analysis) by using the Wald test and DeLong method. Results Forty of the 136 patients (29%) achieved pCR after NAC. In the prediction of pCR, the random forest classifier showed the lowest diagnostic performance with pretreatment ADC (area under the receiver operating characteristic curve [AUC], 0.53; 95% confidence interval: 0.44, 0.61) and the highest diagnostic performance with midtreatment contrast-enhanced T1-weighted MRI (AUC, 0.82; 95% confidence interval: 0.74, 0.88) among pre- and midtreatment T2-weighted MRI, contrast-enhanced T1-weighted MRI, diffusion-weighted MRI, and ADC mapping. Conclusion Texture parameters using a random forest method of contrast-enhanced T1-weighted MRI at midtreatment of neoadjuvant chemotherapy were valuable and associated with pathologic complete response in breast cancer. © RSNA, 2019 Online supplemental material is available for this article.

Prostate cancer is the fifth leading cause of cancer-related deaths among males worldwide. However, the biomarker for diagnosing prostate cancer that is used currently has limitations that must be overcome. Recently, several studies have demonstrated that the cancer liquid biopsy can be implemented by using exosome miRNAs. However, the current methods for the detection of exosome miRNAs are time-consuming, expensive, and laborious. Thus, we investigated a novel method for diagnosing prostate cancer that involves the use of molecular beacons for the in situ detection of miRNAs in exosomes from prostate cancer cells. We chose miRNA-375 and miRNA-574-3p as the target miRNAs for prostate cancer, and these markers in exosomes produced by prostate cancer cells including DU145 and PC-3 were successfully detected using molecular beacons. High fluorescent signals were obtained from MB and miRNA hybridization in exosomes in a concentration-dependent manner. In addition, exosome miRNAs can be detected even in the presence of human urine, so this method can be applied directly using human urine to perform liquid biopsies for prostate cancer. Overall, the in situ detection of exosome miRNAs using molecular beacons can be developed as a simple, cost effective, and non-invasive liquid biopsy for diagnosing prostate cancer.

Purpose The purpose of this paper is to explore an identified medication error using a root cause analysis and a clinical case study. Design/methodology/approach In this paper the authors explore a medication error through the completion of a root cause analysis and case study in an aged care facility. Findings Research indicates that medication errors are highly prevalent in aged care and 40 per cent of nursing home patients are regularly receiving at least one potentially inappropriate medicine (Hamilton, 2009; Raban et al., 2014; Shehab et al., 2016). Insufficient patient information, delays in continuing medications, poor communication, the absence of an up-to-date medication chart and missed or significantly delayed doses are all linked to medication errors (Dwyer et al., 2014). Strategies to improve medication management across hospitalisation to medication administration include utilisation of a computerised medication prescription and management system, pharmacist review, direct communication of discharge medication documentation to community pharmacists and staff education and support (Dolanski et al., 2013). Originality/value Discussion of the factors impacting on medication errors within aged care facilities may explain why they are prevalent and serve as a basis for strategies to improve medication management and facilitate further research on this topic.

Ephedrae Herba (EH) has been used in Asian traditional herbal medicine to cure bronchial asthma, cold, flu, chills, fever, headache, nasal congestion, and cough. In this study, we evaluated the subchronic toxicity of an Ephedrae Herba aqueous extract (EHAE) in male and female F344 rats. The EHAE was administered orally daily at doses of 0, 125, 250, 500, and 1000 mg/kg bw/day for 13 weeks. Toxicological assessment was performed to determine mortality, clinical signs, and changes in body weight, food consumption, ophthalmological, urinary, hematological, and serum biochemical parameters, macroscopic and microscopic evaluations, and organ weights. We found that oral administration of EHAE to F344 rats for 13 weeks resulted in histopathological changes in the kidneys and salivary glands. In the kidneys, increased incidence and severity of tubular basophilia were observed in females administered 1000 mg/kg bw/day of the extract. In the salivary glands, acinar cell hypertrophy was observed in males administered 500 mg/kg bw/day and in both sexes administered 1000 mg/kg bw/day of the extract. All test article-treated groups of males and females administered ≥250 mg/kg bw/day showed increased absolute and relative salivary gland weights. Therefore, the NOAEL (No Observed Adverse Effect Level) was determined as 125 mg/kg bw/day for both sexes of rats under the present experimental conditions.

Background Various size and shape of region of interest (ROI) can be applied for shear-wave elastography (SWE). Purpose To investigate the diagnostic performance of SWE according to ROI settings for breast masses. Material and Methods To measure elasticity for 142 lesions, ROIs were set as follows: circular ROIs 1 mm (ROI-1), 2 mm (ROI-2), and 3 mm (ROI-3) in diameter placed over the stiffest part of the mass; freehand ROIs drawn by tracing the border of mass (ROI-M) and the area of peritumoral increased stiffness (ROI-MR); and circular ROIs placed within the mass (ROI-C) and to encompass the area of peritumoral increased stiffness (ROI-CR). Mean (Emean), maximum (Emax), and standard deviation (ESD) of elasticity values and their areas under the receiver operating characteristic (ROC) curve (AUCs) for diagnostic performance were compared. Results Means of Emean and ESD significantly differed between ROI-1, ROI-2, and ROI-3 ( P max did not ( P = 0.50). For ESD, ROI-1 (0.874) showed a lower AUC than ROI-2 (0.964) and ROI-3 (0.975) ( P SD was significantly different between ROI-M and ROI-MR and between ROI-C and ROI-CR ( P SD in ROI-M and ROI-C were significantly lower than in ROI-MR ( P = 0.041 and 0.015) and ROI-CR ( P = 0.007 and 0.004). Conclusion Shear-wave elasticity values and their diagnostic performance vary based on ROI settings and elasticity indices. Emax is recommended for the ROIs over the stiffest part of mass and an ROI encompassing the peritumoral area of increased stiffness is recommended for elastic heterogeneity of mass.

This study was designed to assess the outcomes of subcentimeter thyroid nodules with highly suspicious ultrasonography (US) features and to investigate the predictive factors associated with malignancy and aggressive biological behavior to determine appropriate candidate factors for active surveillance. Between June 2011 and December 2013, 1866 subcentimeter thyroid nodules with highly suspicious US features that were subjected to US-guided fine needle aspiration and subsequent surgery or US follow-up of at least 2 years were evaluated. A multivariate logistic regression analysis was performed to identify independent clinical characteristics and US features associated with the malignancy rate and aggressive biological behavior. Of the 1866 subcentimeter thyroid nodules, 821 (44.0%) were benign and 1045 (56.0%) were malignant. Age younger than 45 years, presence of microcalcification, and a taller than wide shape on US were associated independently with malignancy in the subcentimeter thyroid nodules (P

The proprietary DA-5512 formulation comprises six herbal extracts from traditional oriental plants historically associated with therapeutic and other applications related to hair. Here, we investigated the effects of DA-5512 on the proliferation of human dermal papilla cells (hDPCs) in vitro and on hair growth in C57BL/6 mice and conducted a clinical study to evaluate the efficacy and safety of DA-5512. DA-5512 significantly enhanced the viability of hDPCs in a dose-dependent manner (p<0.05), and 100 ppm of DA-5512 and 1 μM minoxidil (MXD) significantly increased the number of Ki-67-positive cells, compared with the control group (p<0.05). MXD (3%) and DA-5512 (1%, 5%) significantly stimulated hair growth and increased the number and length of hair follicles (HFs) versus the controls (each p<0.05). The groups treated with DA-5512 exhibited hair growth comparable to that induced by MXD. In clinical study, we detected a statistically significant increase in the efficacy of DA-5512 after 16 weeks compared with the groups treated with placebo or 3% MXD (p<0.05). In conclusion, DA-5512 might promote hair growth and enhance hair health and can therefore be considered an effective option for treating hair loss.

To Software product line (SPL) engineering process be efficient, integrated environment supporting SPL is necessary. So far, domain engineering process supporting tools or specific purpose tools such as variability management, feature modeling have been suggested. In this paper, we suggested SW Visualization tools as application engineering supporting tools and VULCAN workbench as domain engineering supporting tools. And we suggested integration mechanism between well-defined open source software tools.

It is not easy to define the well-defined process for software research project but it is important to keep the tracking the progress of the projects. Without the process, it is not easy to measure the progress since we cannot define the unit of measure. In this paper we suggested RD(research descriptor) concept to define the unit of measure. Also we suggested RD relation to trace the progress the research workflow. With suggested mechanism, we can monitor the research project process and visualization the progress.

Harmful materials in the blood are prevented from entering the healthy brain by a highly selective blood–brain barrier (BBB), and impairment of barrier function has been associated with a variety of neurological diseases. In Alzheimer's disease (AD), BBB breakdown has been shown to occur even before cognitive decline and brain pathology. To investigate the role of the cerebral vasculature in AD, a physiologically relevant 3D human neural cell culture microfluidic model is developed having a brain endothelial cell monolayer with a BBB‐like phenotype. This model is shown to recapitulate several key aspects of BBB dysfunction observed in AD patients: increased BBB permeability, decreased expression of claudin‐1, claudin‐5, and VE‐cadherin, increased expression of matrix‐metalloproteinase‐2 and reactive oxygen species, and deposition of β‐amyloid (Aβ) peptides at the vascular endothelium. Thus, it provides a well‐controlled platform for investigating BBB function as well as for screening of new drugs that need to pass the BBB to gain access to neural tissues., An increase in permeability of the blood–brain barrier (BBB) has long been considered a key factor in the cause and consequences of Alzheimer's disease (AD). In this study, a physiologically relevant 3D model is developed and used to investigate several key aspects of BBB dysfunction in AD and to provide a standardized platform for screening of new drugs.

To investigate whether monitoring with ultrasound and MR imaging before, during and after neoadjuvant chemotherapy (NAC) can predict axillary response in breast cancer patients. A total of 131 breast cancer patients with clinically positive axillary lymph node (LN) who underwent NAC and subsequent surgery were enrolled. They had ultrasound and 3.0 T-MR examinations before, during and after NAC. After reviewing ultrasound and MR images, axillary LN features and tumour size (T size) were noted. According to LN status after surgery, imaging features and their diagnostic performances were analysed. Of the 131 patients, 60 (45.8%) had positive LNs after surgery. Pre-NAC T size at ultrasound and MR was different in positive LN status after surgery (p

Purpose To evaluate the long-term incidence and risk of glaucoma after bilateral congenital cataract surgery in microphthalmic eyes. Design Retrospective, observational case series. Methods Subjects : Children with microphthalmic eyes who had undergone surgery for bilateral congenital cataract within 6 months of birth and been followed up for at least 5 years. Procedures : Review of medical records at our institution. Main Outcome Measures : Probability of an eye's developing glaucoma after bilateral congenital cataract surgery and associated risk factors. Results Thirty-eight eyes of 19 children with bilateral congenital cataract were included. The mean age at surgery was 3.2 ± 1.7 months, and the mean follow-up duration was 7.79 ± 2.61 years. After cataract surgery, 11 eyes (29.0%) developed glaucoma at the age of 4.0 ± 1.4 years. Three of these eyes underwent Ahmed glaucoma valve implantation surgery. The probability of an eye's developing glaucoma was estimated to be 32.0% by 10 years after surgery. In a multivariate analysis, axial length was significantly associated with glaucoma development (odds ratio = 0.364, P = .025). Age at the time of cataract surgery, corneal diameter, and aphakia did not affect the risk of glaucoma (P > .10). Eyes without glaucoma had a better final visual outcome than those with glaucoma (0.75 ± 0.60 and 1.47 ± 1.10 logMAR, respectively, P = .049). Conclusions The long-term cumulative risk of postoperative glaucoma development was 32.0% by 10 years after bilateral congenital cataract surgery. Because the risk of developing glaucoma persists for several years after surgery, careful monitoring and control of intraocular pressure is needed to preserve vision in such patients.

The area of mobile healthcare (mHealth) is expected to expand from disease treatment to various areas, such as disease prevention, telemedicine, and universal health promotion. Under such vertical and horizontal medical industry expansion, the mHealth concept for the improvement of the quality of medical services, such as telemedicine and medical record automation, will become the keyword of the industry while mobile devices and networks will be advanced. In this paper, architecture of mHealth is suggested for multi-product, small-quantity production and a majority constitution by small manufacturers.

Product Line Architecture design is a key activity for developing successful Software Product Line projects. But it is difficult and complex task since architecture of software product line should be considered with variability. In this research, we addressed detail guidelines for identifying the component of architecture from the feature model and defining the variability of component in concerns of feature.

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Software development companies are trying to produce their software products by development processes. However, software development companies have a difficulty on applying a development process to various software development domains. The difficulty like this happens because process tailoring is not a simple work. Process tailoring needs various experiences and involves an intimate knowledge of several aspects of software engineering, but there is a limit in improving the quality of software development processes which a process engineer defines with heuristic way by relying on experience or knowledge of the individual. To ameliorate these problems, we proposed a variability analysis method with cases applying domain analysis technique on software product line to make it possible to reduce the dependency on knowledge or experience of a process engineer in the software development company for process tailoring. If a process engineer tries to apply a suggested method for process tailoring in the software development company, a process engineer can obtain reusable process assets through identifying variabilities in existing process assets.

As automotive manufacturing business has transited from mechanical engineering to software engineering, standardization with architecture framework and process improvement with process maturity model has been required. It means the software quality and productivity is getting important. Software product line is very successful engineering methodology since automotive software is very huge and high complex system but there are so many suppliers which supplies specific component to upper level of tier. It is possible and necessary to develop the software product line for each specific components. So far, it is not enough example or guidelines for software product line in automotive domain. In this paper, we explore the process and techniques for software product line development in state-based control embedded air conditioning control system.

This study aimed to investigate whether the elasticity index of shear-wave elastography (SWE) can predict cervical lymph node (LN) metastasis of papillary thyroid carcinoma (PTC). This retrospective study included 363 patients with a surgical diagnosis of PTC who underwent preoperative SWE evaluation. The elasticity indices of PTC (E mean, E max, E min, E ratio-p, and E ratio-m) and gray-scale ultrasound (US) parameters (extrathyroidal extension, multifocality, and cervical LN metastasis) were correlated with the pathologic staging parameters. The optimal cutoff values for the elasticity indices were determined for the prediction of cervical LN metastasis, and diagnostic performance was compared between gray-scale US and the combined application of gray-scale US and SWE. The findings showed E mean and E max to be associated with central LN metastasis (P = 0.037) and E min to be associated with lateral LN metastasis (P = 0.015). An E mean value higher than 124 kPa or an E max value higher than 138 kPa with suspicious gray-scale US findings improved the sensitivity and area under the curve (AUC) for predicting central LN metastasis (sensitivity, 45.4 and 44.6 % vs. 28 %, P

Purpose: The goal of this study was to assess the clinicopathologic and ultrasonographic features of thyroid nodules with nondiagnostic results on repeat ultrasonography (US)-guided fineneedle aspiration biopsy (FNAB) according to size and the number of suspicious findings and to determine the proper management of nodules with consecutive nondiagnostic results. Methods: This retrospective study included 297 nodules with nondiagnostic results on repeat FNAB that were evaluated by US over the course of at least 12 months of follow-up, a follow-up biopsy, or an operation. We compared clinical and US variables between benign and malignant nodules in thyroid nodules with repeat nondiagnostic results. Results: The comparison of benign and malignant nodules with repeat nondiagnostic results revealed that age, marked hypoechogenicity, irregular or microlobulated margins, microcalcifications, and nonparallel shape were significantly associated with malignancy. Multivariate logistic regression analysis in malignant nodules revealed that microcalcifications and irregular or microlobulated margins were independently associated with malignancy. Among them, only irregular or microlobulated margins were independently significant as a predictor of malignancy in repeatedly nondiagnostic nodules measuring >10 mm. Using receiver operating characteristic analysis, the best cutoff value for the “number of suspicious findings” between benign and malignant nodules was three in nodules of all sizes, three in nodules measuring ≤10 mm, and two in nodules measuring >10 mm. Conclusion: Irregular or microlobulated margins may be the most frequent US features in repeatedly nondiagnostic nodules >10 mm. The presence of “two or more suspicious findings” can be used as the cutoff for distinguishing benign and malignant nodules.

Background The purpose of this study was to investigate the role of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) as a prognostic marker in conventional papillary thyroid carcinoma (PTC). Methods A total of 397 patients who underwent ultrasound-guided fine-needle aspiration biopsy (FNAB) and surgery for conventional PTCs were enrolled. The association between the Bethesda category and histopathologic result was evaluated. Results Among the Bethesda categories, a significant difference was found in the presence of extrathyroidal extension (Bethesda category III, 3.2% [7 of 220]; category V, 19.1% [42 of 220]; and category VI, 77.7% [171 of 220]; p < .001) and lymph node metastasis (Bethesda category III, 3.8% [6 of 156]; category V, 16.7% [26 of 156]; and category VI, 79.5% [124 of 156]; p < .001). Multivariate analysis showed that the Bethesda category was independently predictive of extrathyroidal extension (p = .013) and lymph node metastasis (p = .035). Conclusion Conventional PTC with a higher Bethesda category at the time of cytology diagnosis would be poor prognosis. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

Objectives To determine whether lesion stiffness measured by shear-wave elastography (SWE) can be used to predict the histologic underestimation of ultrasound (US)-guided 14-gauge core needle biopsy (CNB) for breast masses. Methods This retrospective study enrolled 99 breast masses from 93 patients, including 40 high-risk lesions and 59 ductal carcinoma in situ (DCIS), which were diagnosed by US-guided 14-gauge CNB. SWE was performed for all breast masses to measure quantitative elasticity values before US-guided CNB. To identify the preoperative factors associated with histologic underestimation, patients' age, symptoms, lesion size, B-mode US findings, and quantitative SWE parameters were compared according to the histologic upgrade after surgery using the chi-square test, Fisher’s exact test, or independent t-test. The independent factors for predicting histologic upgrade were evaluated using multivariate logistic regression analysis. Results The underestimation rate was 28.3% (28/99) in total, 25.0% (10/40) in high-risk lesions, and 30.5% (18/59) in DCIS. All elasticity values of the upgrade group were significantly higher than those of the non-upgrade group (P

Background: Patient safety remains a priority for healthcare organisations globally. There remains little consensus regarding the extent of this issue and the resultant impact on both individuals and communities. Aim: Our study aims to provide healthcare organisations and decision makers with increased information regarding predictive risk factors to enhance patient safety, and develop an organisational culture of safety. Methods: This paper reviews current literature regarding patient safety and presents predictive risk factors and recommendations for healthcare organisations globally to measure and monitor patient safety. Results: Three categories of organisational factors promoting safety culture were identified – Focusing on system/culture, management support and team work and event reporting. Conclusions: This review strove to identify and discuss the predictive risk factors for patient safety and support the importance of a positive organisational culture and strong leadership in monitoring and reducing patient care errors and improving patient care in healthcare setting.

To analyze the processes applied to the existing R&D projects and standardize the analytical results into the RD concept, we defined a framework based on SPEM, which further defines method class, method component, and process component as framework components. Based on these definitions, we established a model that can create a delivery process. We further constructed an environment that can be monitored while executing the delivery process.

This paper presents a result of feature analysis for building blockchain platforms based on software product line engineering. The result includes a feature model describing major features and constraints among them, and discuss which blockchain platform enables each feature. The result contributes to a developer or an organization who wants to build their own blockchain platform by suggesting commonality and variability of features of the blockchain platform domain, and diverse alternatives to implement the platform.