Performance of Wide-Angle Tomosynthesis with Synthetic Mammography in Comparison to Full Field Digital Mammography.

RATIONALE AND OBJECTIVES: The purpose of this study was to test for superiority of wide-angle digital breast tomosynthesis plus synthetic mammography (Insight 2D) in comparison to full-field digital mammography (FFDM). MATERIALS AND METHODS: In this study, twenty readers interpreted 350 screening and diagnostic cases of wide-angle digital breast tomosynthesis (DBT) plus Insight 2D and FFDM in two separate reading sessions separated by at least a 6-week washout period. Breast-level estimates of the area under the curve and sensitivity along with subject-level recall rate were measured and compared between wide-angle DBT plus Insight 2D and FFDM. The same measures were also assessed for dense breasts. A hierarchical analysis plan was used to control the study's type I error rate at 0.05. RESULTS: The mean breast-level area under the curve for distinguishing breasts with cancer from non-cancer breasts was 0.893 with DBT plus Insight 2D versus 0.837 with FFDM, showing superiority of DBT plus Insight 2D (p < 0.001). Breast-level sensitivity was significantly superior for DBT plus Insight 2D in comparison to FFDM (0.852 vs. 0.805, p = 0.043). Subject-level recall rate for DBT plus Insight 2D was significantly lower in comparison to FFDM (0.344 vs. 0.473, p < 0.001). For dense breasts, the readers' accuracy with DBT plus Insight 2D was superior to their accuracy with FFDM (0.875 vs. 0.830, p = 0.026), and their recall rate was significantly lower for DBT plus Insight 2D in comparison to FFDM (0.338 vs. 0.441, p = 0.003). CONCLUSION: Reader performance with wide-angle DBT plus Insight 2D is superior to that with FFDM, showing significantly higher breast-level accuracy and sensitivity and significantly lower recall rates.

Utilization of lacrimal urea assay in the monitoring of hemodialysis: conditions, limitations and lacrimal arginase characterization.

The lacrimal urea content was found to be proportional to that of blood, which suggested its possible utilization in the monitoring of hemodialysis as a less invasive method. On the other hand, however, arginase activity was detected in tears, which may influence the urea content independently of blood urea concentration. The feasibility of using lacrimal urea measurement to replace blood urea measurement in the monitoring hemodialysis was also investigated. Blood and tear samples of 35 healthy persons and 43 renal patients undergoing hemodialysis were tested. Tear samples were collected on Schirmer paper strips. After elution the lacrimal urea content was measured by a colorimetric method. The determination of arginase activity was based on the release of urea and ornithine. The correlation between blood and lacrimal urea and arginase was studied by multivariate regression analysis. The lacrimal arginase isoenzyme pattern was investigated by native polyacrylamide gel electrophoresis and Western blotting. The effect of partially isoform-specific inhibitors was also studied. Blood urea levels in blood were significantly higher in the renal patients before dialysis than in the control patients (12.86 +/- 0.59 vs. 6.45 +/- 0.41 mM, p < 0.0001). Blood sera arginase activity was very low. Lacrimal arginase activity was significantly higher in tears than in sera (p < 0.0001 for each group). The tear/serum ratio of urea content was significantly different between controls and renal patients, particularly in postdialytic samples (1.89 +/- 0.07 vs. 3.49 +/- 0.31, p < 0.0001). The correlation between lacrimal and blood sera urea was best in controls (r = 0.89) and was better in predialytic (r = 0.75) than in postdialytic (r = 0.52) samples, depending on the level of arginase activity. In postdialytic samples a stronger correlation (r = 0.77) between tear urea and arginase was observed. Both arginase isoforms were detected in tears, but the extrahepatic (arginase II) isoenzyme was present in higher concentration. In conclusion, the determination of lacrimal urea level as a possible less invasive replacement for blood urea determination could only be utilized in the monitoring of hemodialysis if lacrimal arginase is also measured. Blood urea levels can be correctly determined by using equations, which take into account arginase activity. The accuracy of these equations was checked on a new patient population. Both arginase isoenzymes were observed in lacrimal samples.

Enhanced utilization and altered metabolism of arginine in inflammatory macrophages caused by raised nitric oxide synthesis.

Nitric oxide (NO) production was increased in macrophages during inflammation. Casein-elicitation of rodents causing a peritoneal inflammation offered a good model to study alterations in the metabolism of L-arginine, the precursor of NO synthesis. The utilization of L-arginine for NO production, arginase pathway and protein synthesis were studied by radioactive labeling and chromatographic separation. The expression of NO synthase and arginase was studied by Western blotting.Rat macrophages utilized more arginine than mouse macrophages (228+/-27 versus 71+/-12.8pmol per 10(6) macrophages). Arginine incorporation into proteins was low in both species (<15% of labeling). When NO synthesis was blocked, arginine was utilized at a lower general rate, but L-ornithine formation did not increase. The expression of enzymes utilizing arginine increased. NO production was raised mainly in rats (1162+/-84pmol citrulline per 10(6) cells) while in mice both arginase and NO synthase were active in elicited macrophages (677+/-85pmol ornithine and 456+/-48pmol citrulline per 10(6) cells). We concluded, that inflammation induced enhanced L-arginine utilization in rodent macrophages. The expressions and the activities of arginase and NO synthase as well as NO formation were increased in elicited macrophages. Specific blocking of NO synthesis did not result in the enhanced effectivity of the arginase pathway, rather was manifested in a general lower rate of arginine utilization. Different rodent species reacted differently to inflammation: in rats, high NO increase was found exclusively, while in mice the activation of the arginase pathway was also important.