Diagnostic values of shear wave elastography and strain elastography for breast lesions

ABSTRACT Background: Strain elastography (SE) and shear wave elastography (SWE) have high diagnostic yield for breast lesions, but the optimal parameters remain elusive. Aim: To evaluate the diagnostic yield of SWE and SE for breast lesions by multivariate logistic regression analysis. Material and Methods: A total of 132 patients with 164 breast tumors were enrolled. Breast lesions were classified with the breast imaging reporting and data system (BI-RADS). Maximum (Emax), mean (Emean) and standard deviation (Esd) of elastic modulus, lesion/fat elasticity ratio and elastographic classification were obtained by SWE. Strain ratio (SR) and elastographic score were obtained by SE. A multivariate logistic regression analysis was performed. The diagnostic efficiencies of BI-RADS classification, SWE, SE and their combination were compared plotting ROC curves. Results: There were 110 benign and 54 malignant lesions which had significantly different SWE and SE parameters. The parameters included in the logistic regression were Esd and elastographic classification obtained by SWE and the elastographic score obtained by SE. When combining SWE with SE, Esd, SR and SWE classification were included in the equation. The areas under ROC curves for BI-RADS classification, SWE, SE and their combination were 0.75, 0.88, 0.79 and 0.89, respectively. Conclusions: The diagnostic value of SWE in combination with SE for breast lesions exceeded that of SE or SWE alone. Esd showed a good diagnostic yield when SWE was used alone or combined with SE.

Antecedentes: La elastografía de deformación (SE) y de onda cortante (SWE) son útiles para el diagnóstico de lesiones mamarias, pero falta definir los parámetros óptimos. Objetivo: Evaluar el valor diagnóstico de SE y SWE en lesiones mamarias usando una regresión logística multivariable. Material y Métodos: Ciento treinta y dos pacientes con 164 tumores mamarios fueron evaluados, los que se clasificaron usando el sistema BI-RADS (breast imaging reporting and data system). El módulo elástico máximo, promedio y su desviación estándar (Esd), la razón entre la elasticidad de la lesión y de la grasa y la clasificación elastográfica se obtuvieron con SWE. La razón de deformación (SR) y el puntaje elastográfico se obtuvieron con SE. Se efectuó una regresión logística y las eficiencias diagnósticas de la clasificación BI-RADS, SWE and SE y su combinación se compararon usando curvas ROC (receiver operating characteristic curves). Resultados: Ciento diez lesiones fueron benignas y 54 malignas. Estas tenían parámetros SWE y SE significativamente diferentes. En la ecuación de regresión logística, se incluyeron la clasificación elastográfica y el Esd obtenidos por SWE y el puntaje elastográfico obtenido por SE. Cuando se combinó SWE y SE, se incluyeron en la ecuación el Esd, SR y la clasificación por SWE. Las áreas bajo la curva ROC para la clasificación BI-RADS, SWE y SE y la combinación de ambas fueron 0.75, 0.88, 079 y 0.89 respectivamente. Conclusiones: La combinación de SWE y SE tuvo un mejor rendimiento diagnóstico para lesiones mamarias que cada parámetro por separado. Esd tuvo un buen rendimiento diagnóstico cuando se utilizó SWE sola o combinada con SE.

Relationship between the after-school schedule and bone mineral density in middle-school students in Shanghai / 中国学校卫生

Objective@#To investigate the relationship between after-school schedule and bone mineral density in middle-school students in Shanghai, to provide a reference for taking targeted measures.@*Methods@#From November 2017 to April 2018，eighteen classes of six middle schools in Shanghai (from urban districts, urban-suburb combined districts and suburban districts, respectively) were selected based on cluster random sampling. In each school, 2-4 classes were further randomly chosen in the 6th grade. Questionnaires were completed by 518 students and their parents, as well as physical examination and bone mineral density assessment.@*Results@#The average time spent on after-school academic learning during weekends was 4.0 (IQR: 2.0, 6.0) h. The Z-score of bone density was 0.3 (IQR: -0.7, 1.0). The smooth curve fit model showed a non-linear relationship between after-school academic learning time during weekends and the Z-scores of bone mineral densities. A two-stage multiple linear regression analysis was further applied according to the fit results, and the results showed that when total afterschool academic learning time <4.5 hours during weekends, the learning time was inversely correlated with the bone density Z-scores (β=-0.11,P=0.01), and when the learning time ≥4.5 hours, there was no significant correlation between the learning time and bone density Z-scores (β=0.02, P=0.65). Parent and student questionnaires showed that there was a non-linear relationship between students’ daily time spent on outdoor sports-related activities and bone density Z-scores. When time spent on the outdoor activities ≥45 minutes per day, outdoor activities were positively correlated with bone density Z-scores (P<0.05). However, when the time spent on outdoor activities <45 minutes per day, there was no significant relationship between outdoor activities and bone density Z-scores (P>0.05).@*Conclusion@#Too much time on after-school academic learning during weekends or limited time on outdoor activities are both related to impaired bone mineral densities. Therefore, a reasonable after-school schedule for middle-school students is important for physical development, especially during weekends.

Association between variation in the genes DDAH1 and DDAH2 and hypertension among Uygur, Kazakh and Han ethnic groups in China / Associação entre variação de genes DDAH1 e DDAH2 com hipertensão nos grupos étnicos uygur, kazakh e han na China

CONTEXT AND OBJECTIVE: Dimethylarginine dimethylaminohydrolase enzymes (DDAH), which are encoded by the genes DDAH1 and DDAH2, play a fundamental role in maintaining endothelial function. We conducted a case-control study on a Chinese population that included three ethnic groups (Han, Kazakh and Uygur), to systemically investigate associations between variations in the genes DDAH1 and DDAH2 and hypertension. DESIGN AND SETTING: Experimental study at the Department of Internal Medicine and Genetic Diagnosis, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. METHODS: This case-control study included 1,224 patients with hypertension and 967 healthy unrelated individuals as controls. DDAH1 -396 4N (GCGT) del>ins, rs3087894, rs805304 and rs9267551 were genotyped using the TaqMan 5' nuclease assay. RESULTS: The G/C genotype of rs3087894 in DDAH1 was a risk factor for hypertension in the Kazakh group in the co-dominant model (G/C versus G/G) (OR 1.39; 95% CI: 1.02-1.88; P < 0.05), with the same result in the dominant model (G/C + C/C versus G/G) (OR 1.38; 95% CI: 1.03-1.84; P < 0.05). In contrast, the C/C genotype of rs3087894 seemed to be a protective factor against hypertension in the Uygur group in the recessive model (C/C versus G/G + G/C) (OR 0.62; 95% CI: 0.39- 0.97; P < 0.05). Similar findings for rs3087894 were also observed after adjusting the variable for the age covariate. CONCLUSION: Our results indicated that the C-allele of rs3087894 in DDAH1 was a risk factor for hypertension in the Kazakh group but a protective factor in the Uygur group.

RESUMO CONTEXTO E OBJETIVO: Enzimas dimetilarginina dimetilaminohidrolase (DDAH), codificadas por genes DDAH1 e DDAH2, desempenham papel fundamental na manutenção da função endotelial. Realizamos estudo tipo caso-controle na população chinesa, com três grupos étnicos (han, kazakh e uygur) para investigar sistematicamente a associação entre a variação de genes DDAH1 e DDAH2 e a hipertensão. DESENHO E LOCAL: Estudo tipo caso-controle no Departamento de Medicina Interna e Diagnóstico Genético, Hospital de Tongji, Tongji Medical College, Universidade de Ciência e Tecnologia de Huazhong. MÉTODOS: Este estudo incluiu 1.224 pacientes com hipertensão e 967 indivíduos saudáveis, sem parentesco, como controles. DDAH1 -396 4 N (GCGT) del > ins, rs3087894, rs805304 and rs9267551 foram genotipados usando o ensaio nuclease TaqMan 5'. RESULTADOS: O genótipo G/C de rs3087894 no DDAH1 foi um fator de risco para a hipertensão arterial no grupo kazakh em modelo codominante (G/C versus G/G; OR 1,39; IC 95%: 1,02-1,88; P < 0,05), com o mesmo resultado no modelo dominante (G/C + C/C versus G/G; OR 1,38; IC 95%: 1,03-1,84; P < 0,05). Em contraste, o genótipo C/C de rs3087894 parecia ser um fator de proteção para a hipertensão no grupo uygur no modelo recessivo (C/C versus G/G + G/C; OR 0,62; IC 95%: 0,39-0,97; P < 0,05). Achado semelhante para rs3087894 também foi observado depois de se ajustar a variante à covariante idade. CONCLUSÃO: Os nossos resultados indicaram que o C-alelo de rs3087894 no DDAH1 foi fator de risco para a hipertensão no grupo de kazakh, mas fator de proteção no grupo de uygur.

Clinicopathological features and prognostic factors of 22 cases of primary squamous cell carcinoma of the breast / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological features and prognosis of primary squamous cell carcinoma of the breast and to improve the diagnosis, treatment and prognosis of this disease.</p><p><b>METHODS</b>The clinicopathological data of 22 patients with primary squamous cell carcinoma of the breast treated in our hospital between January 1985 and January 2011 were retrospectively reviewed. The correlation between age, tumor size, axillary node status, treatment modality and prognosis was statistically analyzed.</p><p><b>RESULTS</b>All the 22 patients were female and their median age was 56 years.The average tumor diameter was 3.6 cm.The diagnosis was confirmed by histopathology. The positive rates of expression of ER, PR and HER-2 of the breast cancers were 9. 1%, 9. 1% and 33. 3%, respectively. In follow-up visits, recurrence or metastasis was found in 5 patients and they all died of it. The median overall survival of the 22 patients was 60 months and their overall 5-year survival rate was 73.6%. Univariate analysis showed that the tumor maximum diameter (P = 0.024) and axillary lymph node status (P = 0.022) were impact factors, while menopause, chemotherapy and radiotherapy were not. Cox multivariate analysis showed that the tumor size (P = 0.021) and axillary lymph node status (P = 0.037) were independent prognostic factors for primary squamous cell carcinoma of the breast.</p><p><b>CONCLUSIONS</b>Primary squamous cell carcinoma of the breast is a rare entity and lack of specific clinical features. Axillary node status is an independent prognostic factor.</p>