The purpose of this study was to prospectively evaluate the interobserver agreement on lesion characterization and the final assessment of automated whole breast ultrasonography (ABUS) images.
Between March and August 2012, 172 women underwent bilateral ABUS before biopsy guided by handheld ultrasonography (HHUS) and mammography. A total of 206 breast lesions were confirmed histopathologically by biopsy. Three-dimensional volume data from ABUS scans were analyzed by two radiologists without the knowledge of HHUS results or patient clinical information. The two readers described the type, shape, orientation, margin, echogenicity, posterior acoustic features, and categorization of the final assessment of detected breast lesions. Kappa statistics were used to analyze the described characteristics of the breast lesions detected by both of the two readers.
Of the 206 histopathologically confirmed lesions, reader 1 detected 166 lesions and reader 2 detected 150 lesions. A total of 145 lesions were detected by both readers using ABUS images. There was substantial agreement on shape (κ=0.707), and moderate agreement on type, margin, mass orientation, echogenicity, and posterior acoustic features (κ=0.592, 0.438, 0.472, 0.524, and 0.541, respectively). Breast Imaging Reporting and Data System final assessment values yielded a kappa value of 0.3971 when category subdivisions 4A, 4B, and 4C were included. With respect to the C2, C3, C4, and C5 categories, the interobserver agreement was moderate (κ=0.505).
ABUS is a promising diagnostic tool with a good interobserver agreement, comparable to that of HHUS.
Breast; Ultrasonography; Observer variation
The purpose of this study was to compare the image quality of standard single-shot echo-planar imaging (ss-EPI) and that of readout-segmented EPI (rs-EPI) in patients with breast cancer.
Materials and Methods
Seventy-one patients with 74 breast cancers underwent both ss-EPI and rs-EPI. For qualitative comparison of image quality, three readers independently assessed the two sets of diffusion-weighted (DW) images. To evaluate geometric distortion, a comparison was made between lesion lengths derived from contrast enhanced MR (CE-MR) images and those obtained from the corresponding DW images. For assessment of image parameters, signal-to-noise ratio (SNR), lesion contrast, and contrast-to-noise ratio (CNR) were calculated.
The rs-EPI was superior to ss-EPI in most criteria regarding the qualitative image quality. Anatomical structure distinction, delineation of the lesion, ghosting artifact, and overall image quality were significantly better in rs-EPI. Regarding the geometric distortion, lesion length on ss-EPI was significantly different from that of CE-MR, whereas there were no significant differences between CE-MR and rs-EPI. The rs-EPI was superior to ss-EPI in SNR and CNR.
Readout-segmented EPI is superior to ss-EPI in the aspect of image quality in DW MR imaging of the breast.
Breast neoplasm; Magnetic resonance imaging; Diffusion-weighted MRI
To compare the diagnostic performance in evaluating the response of neoadjuvant chemotherapy (NAC), between the response evaluation criteria in solid tumor (RECIST) 1.0 and RECIST 1.1, on magnetic resonance imaging (MRI) for advance breast cancer patients.
Materials and Methods
Breast cancer patients, who underwent NAC between 2005 and 2010, were included. Both prechemotherapy and post-chemotherapy MRIs were performed within 1-4 weeks before and after NAC. Only the patients with subsequent surgery were included. The response to NAC was assessed by using RECIST 1.0 and RECIST 1.1. Patients with a complete or partial response on MRI were considered as responders, and those with stable or progressive disease were considered as non-responders. Tumor necrosis > 50% on pathology was defined as responders and necrosis < 50% was defined as non-responders. The diagnostic accuracy of both RECIST 1.0 and RECIST 1.1 was analyzed and compared by receiver operating characteristic curve analysis.
Seventy-nine females (mean age 51.0 ± 9.3 years) were included. Pathology showed 45 responders and 34 non-responders. There were 49 responders and 30 non-responders on RECIST 1.0, and in 55 patients, RECIST 1.0 results agreed with pathologic results (69.6%). RECIST 1.1 showed 52 responders and 27 non-responders. In 60 patients, RECIST 1.1 results were in accordance with pathology results (75.9%). The area under the ROC curve was 0.809 for RECIST 1.0 and 0.853 for RECIST 1.1.
RECIST 1.1 showed better diagnostic performance than RECIST 1.0, although there was no statistically significant difference between the two.
Breast neoplasm; Chemotherapy; Magnetic resonance imaging; Response evaluation criteria in solid tumor
Implant-supported overdenture is a reliable treatment option for the patients with edentulous mandible when they have difficulty in using complete dentures. Several options have been used for implant-supported overdenture attachments. Among these, bar attachment system has greater retention and better maintainability than others. SFI-Bar® is prefabricated and can be adjustable at chairside. Therefore, laboratory procedures such as soldering and welding are unnecessary, which leads to fewer errors and lower costs. A 67-year-old female patient presented, complaining of mobility of lower anterior teeth with old denture. She had been wearing complete denture in the maxilla and removable partial denture in the mandible with severe bone loss. After extracting the teeth, two implants were placed in front of mental foramen, and SFI-Bar® was connected. A tube bar was seated to two adapters through large ball joints and fixation screws, connecting each implant. The length of the tube bar was adjusted according to inter-implant distance. Then, a female part was attached to the bar beneath the new denture. This clinical report describes two-implant-supported overdenture using the SFI-Bar® system in a mandibular edentulous patient.
Implant-Supported Denture; Prefabricated Bar; Edentulous Jaws; Overdenture
Leiomyoma of the nipple is a rare, benign, non-epithelial tumor that is thought to arise from smooth muscle fibers in the subareolar tissue of the breast. We report an unusual case of leiomyoma of the nipple in a 32-year-old woman in whom the diagnosis was made by ultrasound-guided core needle biopsy. She came to our hospital complaining of a recently enlarged nipple with discharge and erosion in the region of the left nipple-areolar complex. This mass was evaluated by mammography, ultrasonography, and magnetic resonance imaging (MRI). To the best of our knowledge, this is the first case of a leiomyoma of the nipple examined by MRI. MRI showed an oval mass with circumscribed margins that appeared as an intermediate signal intensity on both T1- and T2-weighted images. A dynamic MRI study showed a rim-enhancing oval mass with delayed persistent enhancement. Ultrasound-guided core needle biopsy revealed spindle cell proliferation consistent with leiomyoma of the nipple.
Breast; nipple; benign neoplasm; leiomyoma; magnetic resonance imaging
Fracture of the veneering material of zirconia restorations frequently occurs in clinical situations. The purpose of this in vitro study was to compare the fracture strengths of zirconia crowns veneered with various ceramic materials by various techniques.
MATERIALS AND METHODS
A 1.2 mm, 360° chamfer preparation and occlusal reduction of 2 mm were performed on a first mandibular molar, and 45 model dies were fabricated in a titanium alloy by CAD/CAM system. Forty-five zirconia copings were fabricated and divided into three groups. In the first group (LT) zirconia copings were veneered with feldspathic porcelain by the layering technique. In the second group (HT) the glass ceramic was heat-pressed on the zirconia coping, and for the third group (ST) a CAD/CAM-fabricated high-strength anatomically shaped veneering cap was sintered onto the zirconia coping. All crowns were cemented onto their titanium dies with Rely X™ Unicem (3M ESPE) and loaded with a universal testing machine (Instron 5583) until failure. The mean fracture values were compared by an one-way ANOVA and a multiple comparison post-hoc test (α=0.05). Scanning electron microscope was used to investigate the fractured interface.
Mean fracture load and standard deviation was 4263.8±1110.8 N for Group LT, 5070.8±1016.4 for Group HT and 6242.0±1759.5 N for Group ST. The values of Group ST were significantly higher than those of the other groups.
Zirconia crowns veneered with CAD/CAM generated glass ceramics by the sintering technique are superior to those veneered with feldspathic porcelain by the layering technique or veneered with glass ceramics by the heat-pressing technique in terms of fracture strength.
Zirconia; Fracture strength; CAD/CAM
Paratyphoid fever is considered an emerging systemic intracellular infection caused by Salmonella enterica serotypes Paratyphi A, B, and C. We performed in vitro time-kill studies on three clinical isolates of nalidixic acid-resistant Salmonella serotype Paratyphi (NARSP) with different concentrations of ciprofloxacin and cefotaxime to identify combinations of antibiotics with synergistic activity against paratyphoid fever. Furthermore, we identify the frequency of mutations to ciprofloxacin, cefotaxime, and rifampin resistance and also sequenced the gyrA, gyrB, parC, and parE genes to identify the cause of resistance in NARSP. When the activity of ciprofloxacin at 0.75× MIC (0.012 to 0.38 μg/ml) with cefotaxime at the MIC (0.125 to 0.25 μg/ml) against all three NARSP isolates was investigated, synergy was observed at 24 h, and the bacterial counts were reduced by >3 log10 CFU/ml. This synergy was elongated for up to 72 h in two out of three isolates. When ciprofloxacin at 0.75× MIC (0.012 to 0.38 μg/ml) was combined with cefotaxime at 2× MIC (0.25 to 0.50 μg/ml), synergy was prolonged for up to 72 h in all three isolates. Both Salmonella serotype Paratyphi A isolates carried single mutations in codon 83 of the gyrA gene and codon 84 of the parC gene that were responsible for their reduced susceptibility to ciprofloxacin, while no mutations were found in the gyrB or parE gene. The ciprofloxacin-plus-cefotaxime regimen was very effective in reducing the bacterial counts at 24 h for all three isolates, and this combination therapy may be helpful in reducing the chance of the emergence of fluoroquinolone-resistant mutants in patients with severe paratyphoid fever.
The purpose of this paper is to show the clinical and radiologic features of a variety of diffuse, infiltrative breast lesions, as well to review the relevant literature. Radiologists must be familiar with the various conditions that can diffusely involve the breast, including normal physiologic changes, benign disease and malignant neoplasm.
Breast; Breast ultrasonography or mammography; Magnetic resonance imaging
The purpose of this study was to evaluate the ultrasonographic features of benign adenomyoepithelioma of the breast.
Materials and Methods
Between 2005 and 2009, five patients had histologically confirmed adenomyoepithelioma of the breast. We retrospectively evaluated the ultrasonographic findings of the tumors in correlation with the pathology, and reviewed medical records.
The clinical manifestations included a palpable mass in three patients, while mammographic screening helped detect abnormalities in two patients. Ultrasonograms showed masses with an oval (n = 3) or irregular (n = 2) shape, with uncircumscribed (n = 4) or relatively well-circumscribed (n = 1) margins, as well as with a hypoechoic (n = 3) or a complex echoic (n = 2) internal echo texture. Three patients had focal ductectasia adjacent to the mass. The ultrasonographic assessments were classified as Breast Imaging Reporting and Data System (BI-RADS) category 4A, with low suspicion of malignancy in two cases, and as category 4B, with intermediate suspicion of malignancy in three cases. The pathology revealed benign adenomyoepithelioma in all patients.
Benign adenomyoepitheliomas appear as solid or complex echoic masses with suspicious malignant ultrasonographic features, which may be associated with adjacent ductectasia. Although adenomyoepithelioma is a rare breast tumor, awareness of its sonographic features will be helpful for the differential diagnosis from other tumors.
Adenomyoepithelioma; Breast; Ultrasonography
The purpose of this study was to investigate the diametral tensile strength of polymer-based temporary crown and fixed partial denture (FPD) materials, and the change of the diametral tensile strength with time.
MATERIAL AND METHODS
One monomethacrylate-based temporary crown and FPD material (Trim) and three dimethacrylate-based ones (Protemp 3 Garant, Temphase, Luxtemp) were investigated. 20 specimens (ø 4 mm × 6 mm) were fabricated and randomly divided into two groups (Group I: Immediately, Group II: 1 hour) according to the measurement time after completion of mixing. Universal Testing Machine was used to load the specimens at a cross-head speed of 0.5 mm/min. The data were analyzed using one-way ANOVA, the multiple comparison Scheffe test and independent sample t test (α = 0.05).
Trim showed severe permanent deformation without an obvious fracture during loading at both times. There were statistically significant differences among the dimethacrylate-based materials. The dimethacrylate-based materials presented an increase in strength from 5 minutes to 1 hour and were as follows: Protemp 3 Garant (23.16 - 37.6 MPa), Temphase (22.27 - 28.08 MPa), Luxatemp (14.46 - 20.59 MPa). Protemp 3 Garant showed the highest value.
The dimethacrylate-based temporary materials tested were stronger in diametral tensile strength than the monomethacrylate-based one. The diametral tensile strength of the materials investigated increased with time.
Polymer-based temporary crown and fixed partial denture materials; Diametral tensile strength
Breast plasmacytoma (BP) is an extremely rare extramedullary manifestation of multiple myeloma (MM). We report the imaging findings of an unusual case in which BP was the initial presentation of MM. A 53-year-old woman with no contributory medical history underwent chest computed tomography to evaluate intermittent nocturnal anterior chest pain, and bilateral multiple breast masses were found. Following an ultrasound-guided core needle biopsy, these lesions were confirmed to be BP.
Breast neoplasms; multiple myeloma; plasmacytoma; multidetector computed tomography; mammography; ultrasonography
Background and Purpose
The time of hospital arrival may have an effect on prognosis of various vascular diseases. We examined whether off-hour admission would affect the 3-month functional outcome in acute ischemic stroke patients admitted to tertiary hospitals.
We analyzed the ‘off-hour effect’ in consecutive patients with acute ischemic stroke using multi-center prospective stroke registry. Work-hour admission was defined as when the patient arrived at the emergency department between 8 AM and 6 PM from Monday to Friday and between 8 AM and 1 PM on Saturday. Off-hour admission was defined as the rest of the work-hours and statutory holidays. Multivariable logistic regression was used to analyze the association between off-hour admission and 3-month unfavorable functional outcome defined as modified Rankin Scale (mRS) 3–6. Multivariable model included age, sex, risk factors, prehospital delay time, intravenous thrombolysis, stroke subtypes and severity as covariates.
A total of 7075 patients with acute ischemic stroke were included in this analysis: mean age, 67.5 (±13.0) years; male, 58.6%. In multivariable analysis, off-hour admission was not associated with unfavorable functional outcome (OR, 0.89; 95% CI, 0.72–1.09) and mortality (OR, 1.09; 95% CI, 0.77–1.54) at 3 months. Moreover, off-hour admission did not affect a statistically significant shift of 3-month mRS distributions (OR, 0.90; 95% CI, 0.78–1.05).
‘Off-hour’ admission is not associated with an unfavorable 3-month functional outcome in acute ischemic stroke patients admitted to tertiary hospitals in Korea. This finding indicates that the off-hour effects could be overcome with well-organized stroke management strategies.
The purpose of this study was to develop a dental image processing system using a three-dimensional (3D) camera and stereovision technology. The reliability of the system for measuring axial wall convergence angles was evaluated.
MATERIALS AND METHODS
The new system predicted 3D coordinate points from 2D images and calculated distances and angles between points. Two examiners measured axial wall convergence angles for seven artificial abutments using a traditional tracing-based method (TBM) and the stereovision-based method (SVBM). Five wax abutment models of simplified abutment forms were made and axial wall convergence angles of wax models were measured by both methods. The data were statistically analyzed at the level of significance, 0.05.
Intraclass correlation coefficients showed excellent intra-examiner and inter-examiner reliabilities for both methods. Bland-Altman plots and paired t-tests showed significant differences between measurements and true values using TBM; differences were not significant with SVBM.
This study found that the SVBM reflected true angle values more accurately than a TMB and illustrated an example of 3D computer science applied to clinical dentistry.
Three-dimensional; Tracing; abutment; Axial wall convergence angle; Stereovision dental image system
The purpose of this study was to evaluate the intra-rater reliability and inter-rater reliability of three different methods using a drawing protractor, a digital protractor after tracing, and a CAD system.
MATERIALS AND METHODS
Twenty-four artificial abutments that had been prepared by dental students were used in this study. Three dental students measured the convergence angles by each method three times. Bland-Altman plots were applied to examine the overall reliability by comparing the traditional tracing method with a new method using the CAD system. Intraclass Correlation Coefficients (ICC) evaluated intra-rater reliability and inter-rater reliability.
All three methods exhibited high intra-rater and inter-rater reliability (ICC>0.80, P<.05). Measurements with the CAD system showed the highest intra-rater reliability. In addition, it showed improved inter-rater reliability compared with the traditional tracing methods.
Based on the results of this study, the CAD system may be an easy and reliable tool for measuring the abutment convergence angle.
Computer-aided design; Convergence angle; Prosthodontic tooth preparation; Validation studies; Dental abutments
The computer-aided detection (CAD) system on mammography has the potential to assist radiologists in breast cancer screening. The purpose of this study is to evaluate the diagnostic performance of the CAD system in full-field digital mammography for detecting breast cancer when used by dedicated breast radiologist (BR) and radiology resident (RR), and to reveal who could benefit the most from a CAD application.
We retrospectively chose 100 image sets from mammographies performed with CAD between June 2008 and June 2010. Thirty masses (15 benign and 15 malignant), 30 microcalcifications (15 benign and 15 malignant), and 40 normal mammography images were included. The participating radiologists consisted of 7 BRs and 13 RRs. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for total, normal plus microcalcification and normal plus mass both with and without CAD use for each reader. We compared the diagnostic performance values obtained with and without CAD use for the BR and RR groups, respectively. The reading time reviewing one set of 100 images and time reduction with CAD use for the BR and RR groups were also evaluated.
The diagnostic performance was generally higher in the BR group than in the RR group. Sensitivity improved with CAD use in the BR and RR groups (from 81.10 to 84.29% for BR; 75.38 to 77.95% for RR). A tendency for improvement in all diagnostic performance values was observed in the BR group, whereas in the RR group, sensitivity improved but specificity, PPV, and NPV did not. None of the diagnostic performance parameters were significantly different. The mean reading time was shortened with CAD use in both the BR and RR groups (111.6 minutes to 94.3 minutes for BR; 135.5 minutes to 109.8 minutes for RR). The mean time reduction was higher for the RR than that in the BR group.
CAD was helpful for dedicated BRs to improve their diagnostic performance and for RRs to improve the sensitivity in a screening setting. CAD could be essential for radiologists by decreasing reading time without decreasing diagnostic performance.
Computer-aided detection (CAD); Mammography; Screening
The purpose of this study was to evaluate the imaging features of complex sclerosing lesions of the breast and to assess the rate of upgrade to breast cancer.
From March 2008 to May 2012, seven lesions were confirmed as complex sclerosing lesions by ultrasonography-guided core needle biopsy. Final results by either surgical excision or follow-up imaging studies were reviewed to assess the rate of upgrade to breast cancer. Two radiologists retrospectively analyzed the imaging findings according to the Breast Imaging Reporting and Data System classification.
Five lesions underwent subsequent surgical excision and two of them revealed ductal carcinoma in situ (n=1) and invasive ductal carcinoma (n=1). Our study showed a breast cancer upgrade rate of 28.6% (2 of 7 lesions). Two lesions were stable on imaging follow-up beyond 1 year. The mammographic features included masses (n=4, 57.1%), architectural distortion (n=2, 28.6%), and focal asymmetry (n=1, 14.3%). Common B-mode ultrasonographic features were irregular shape (n=6, 85.7%), spiculated margin (n=5, 71.4 %), and hypoechogenicity (n=7, 100%). The final assessment categories were category 4 (n=6, 85.7%) and category 5 (n=1, 14.3%).
The complex sclerosing lesions were commonly mass-like on mammography and showed the suspicious ultrasonographic features of category 4. Due to a high underestimation rate, all complex sclerosing lesions by core needle biopsy should be excised.
Breast; Ultrasonography; Mammography; Breast diseases
Baicalein (BA), a plant-derived active flavonoid present in the root of Scutellaria baicalensis, has been widely used for the treatment of stress-related neuropsychiatric disorders including depression. Previous studies have demonstrated that repeated restraint stress disrupts the activity of the hypothalamic-pituitary-adrenal (HPA) axis, resulting in depression. The behavioral and neurochemical basis of the BA effect on depression remain unclear. The present study used the forced swimming test (FST) and changes in brain neurotransmitter levels to confirm the impact of BA on repeated restraint stress-induced behavioral and neurochemical changes in rats. Male rats received 10, 20, or 40 mg/kg BA (i.p.) 30 min prior to daily exposure to repeated restraint stress (2 h/day) for 14 days. Activation of the HPA axis in response to repeated restraint stress was confirmed by measuring serum corticosterone levels and the expression of corticotrophin-releasing factor in the hypothalamus. Daily BA administration significantly decreased the duration of immobility in the FST, increased sucrose consumption, and restored the stress-related decreases in dopamine concentrations in the hippocampus to near normal levels. BA significantly inhibited the stress-induced decrease in neuronal tyrosine hydroxylase immunoreactivity in the ventral tegmental area and the expression of brain-derived neurotrophic factor (BDNF) mRNA in the hippocampus. Taken together, these findings indicate that administration of BA prior to the repeated restraint stress significantly improves helpless behaviors and depressive symptoms, possibly by preventing the decrease in dopamine and BDNF expression. Thus, BA may be a useful agent for the treatment or alleviation of the complex symptoms associated with depression.
Baicalein; Chronic stress; Depression; Dopamine; Hypothalamus-pituitary-adrenal axis
The purpose of this study was to examine whether ginsenoside Rg3 (GRg3) could improve learning and memory impairments and inflammatory reactions induced by injecting lipopolysaccharide (LPS) into the brains of rats. The effects of GRg3 on proinflammatory mediators in the hippocampus and the underlying mechanisms of these effects were also investigated. Injection of LPS into the lateral ventricle caused chronic inflammation and produced deficits in learning in a memory-impairment animal model. Daily administration of GRg3 (10, 20, and 50 mg/kg, i.p.) for 21 consecutive days markedly improved the LPS-induced learning and memory disabilities demonstrated on the step-through passive avoidance test and Morris water maze test. GRg3 administration significantly decreased expression of pro-inflammatory mediators such as tumor necrosis factor-α, interleukin-1β, and cyclooxygenase-2 in the hippocampus, as assessed by reverse transcription-polymerase chain reaction analysis and immunohistochemistry. Together, these findings suggest that GRg3 significantly attenuated LPS-induced cognitive impairment by inhibiting the expression of pro-inflammatory mediators in the rat brain. These results suggest that GRg3 may be effective for preventing or slowing the development of neurological disorders, including Alzheimer’s disease, by improving cognitive and memory functions due to its anti-inflammatory activity in the brain.
Lipopolysaccharide; Memory; Inflammation; Ginsenoside Rg3; Morris water maze; Cyclooxygenase-2
The aim of this study is to evaluate the clinical characteristics and ultrasonographic findings of band-like interposing fat as well as to identify additional approaches for its diagnosis.
Materials and Methods
This study included 26 confirmed cases of band-like interposing fat from June 2008 to June 2010. A retrospective analysis was performed to evaluate the clinical characteristics and ultrasonographic findings in these cases. Five radiologists analyzed the ultrasonographic findings, which correlated with the mammographic and MRI findings when available, according to Breast Imaging Reporting and Data System classification.
None of the 26 patients had any symptoms. In 92.3% of the patients, the lesion was located in the upper outer quadrant of the breast. The mean distance of the lesion from the nipple was 2.4 ± 0.7 cm (1.1-4.5). The mean depth of the lesion from the skin was 1.3 ± 0.3 cm (0.8-2.1). The mean maximal length of the lesion was 0.8 ± 0.4 cm (0.3-1.8). The following were the most frequent ultrasonographic findings of lesions: irregular shape, not parallel orientation, indistinct margins, abrupt interface, hypoechogenicity, no posterior feature, no calcification, and presence of vascularity. The most frequent BI-RADS category was 4a. There were no suspicious findings on the mammography or MRI.
Ultrasonographic findings may lead to misclassification of band-like interposing fat as a malignancy. A better understanding of the clinical and ultrasonographic characteristics of band-like interposing fat would facilitate its differentiation from a true mass.
Breast mass; Ultrasonography; Fatty tissue
Magnetic resonance imaging (MRI)-guided vacuum-assisted biopsy is the technique of choice for lesions that are visible only with breast MRI. The purpose of this study was to report our clinical experience with MRI-guided vacuum-assisted biopsy in Korean women.
A total of 13 patients with 15 lesions for MRI-guided vacuum-assisted biopsy were prospectively entered into this study between September 2009 and November 2011. Biopsy samples were obtained in a 3-T magnet using a 9-guage MRI-compatible vacuum-assisted biopsy device. We evaluated clinical indications for biopsy, lesion characteristics on prebiopsy MRI, pathologic results, and postbiopsy complication status.
The clinical indications for MRI-guided vacuum-assisted biopsy were as follows: abnormalities in patients with interstitial mammoplasty on screening MRI (n = 10); preoperative evaluation of patients with a recently diagnosed cancer (n = 3); and suspicious recurrence on follow-up MRI after cancer surgery (n = 1) or chemotherapy (n = 1). All lesions have morphologic features suspicious or highly suggestive of malignancy by the American College of Radiology Breast Imaging Reporting and Data System category of MRI (C4a = 12, C4b = 2, C5 = 1). In two of the 15 lesions (13.3%, <6 mm), MRI-guided 9-gauge vacuum-assisted breast biopsy was deferred due to nonvisualization of the MRI findings that led to biopsy and the lesions were stable or disappeared on follow up so were considered benign. Of 13 biopsied lesions, pathology revealed four malignancies (4/13, 30.8%; mean size 15.5 mm) and nine benign lesions (9/13, 69.2%; size 14.2 mm). Immediate postprocedural hematoma (mean size 23.5 mm) was observed in eight out of 13 patients (61.5%) and was controlled conservatively.
Our initial experience of MRI-guided vacuum-assisted biopsy showed a success rate of 86.7% and a cancer diagnosis rate of 30.8%, which was quite satisfactory. MRI-guided vacuum-assisted breast biopsy is a safe and effective tool for the workup of suspicious lesions seen on breast MRI alone without major complication. This biopsy may contribute to the early diagnosis of breast cancer in interstitial mammoplasty patients in Korea.
Longitudinal bone growth is the results of chondrocyte proliferation and hypertrophy and subsequent endochondral ossification in the growth plate. Recently, laser acupuncture (LA), an intervention to stimulate acupoint with low-level laser irradiation, has been suggested as an intervention to improve the longitudinal bone growth. This study investigated the effects of laser acupuncture on growth, particularly longitudinal bone growth in adolescent male rats. Laser acupuncture was performed once every other day for a total of 9 treatments over 18 days to adolescent male rats. Morphometry of the growth plate, longitudinal bone growth rate, and the protein expression of BMP-2 and IGF-1 in growth plate were observed. The bone growth rate and the heights of growth plates were significantly increased by laser acupuncture. BMP-2 but not IGF-1 immunostaining in growth plate was increased as well. In conclusion, LA promotes longitudinal bone growth in adolescent rats, suggesting that laser acupuncture may be a promising intervention for improving the growth potential for children and adolescents.
Few studies have investigated the marginal accuracy of 3-unit zirconia fixed partial dentures (FPDs) fabricated by computer-aided design/computer-aided manufacturing (CAD/CAM) system. The purpose of this study was to compare the marginal fit of zirconia FPDs made using two CAD/CAM systems with that of metal-ceramic FPDs.
MATERIALS AND METHODS
Artificial resin maxillary central and lateral incisors were prepared for 3-unit FPDs and fixed in yellow stone. This model was duplicated to epoxy resin die. On the resin die, 15 three-unit FPDs were fabricated per group (45 in total): Group A, zirconia 3-unit FPDs made with the Everest system; Group B, zirconia 3-unit FPDs made with the Lava system; and Group C, metal-ceramic 3-unit FPDs. They were cemented to resin dies with resin cement. After removal of pontic, each retainer was separated and observed under a microscope (Presize 440C). Marginal gaps of experimental groups were analyzed using one-way ANOVA and Duncan test.
Mean marginal gaps of 3-unit FPDs were 60.46 µm for the Everest group, 78.71 µm for the Lava group, and 81.32 µm for the metal-ceramic group. The Everest group demonstrated significantly smaller marginal gap than the Lava and the metal-ceramic groups (P<.05). The marginal gap did not significantly differ between the Lava and the metal-ceramic groups (P>.05).
The marginal gaps of anterior 3-unit zirconia FPD differed according to CAD/CAM systems, but still fell within clinically acceptable ranges compared with conventional metal-ceramic restoration.
Marginal fit; CAD/CAM; Zirconia FPD
The aim of this study was to evaluate the effect of polishing and glazing on the color and spectral distribution of monolithic zirconia.
MATERIALS AND METHODS
Forty-five monolithic zirconia specimens (16.3 mm × 16.4 mm × 2.0 mm) were fabricated and divided into 5 groups according to the number of A2-coloring liquid applications (Group I to V). Each group was divided into 3 subgroups according to the method of surface treatments (n=3): N: no treatment; P: polishing; G: glazing. Color and spectral distribution of five different areas of each specimen were measured according to CIELAB color space in the reflectance mode relative to the standard illuminant D65 on a reflection spectrophotometer. Data were analyzed using one-way ANOVA followed by Tukey's HSD test, Pearson correlation and regression analysis (α=.05).
There was a significant difference in CIE L* between Subgroup N and P, and in CIE b* between Subgroup P and G in each group. Spectral reflectance generally decreased in Subgroup P and G in comparison with Subgroup N. Color differences between Subgroup P and G were within the perceptibility threshold (ΔE*ab< 3.7) in most groups. Highly significant correlation was found between CIE b*and each subgroups as the number of coloring liquid applications increased (R2>0.88, P<.001).
A perceptible color difference can be detected after polishing of monolithic zirconia. Polishing decreases the lightness, and glazing also decreases the lightness, but increases the yellowness of monolithic zirconia.
Zirconia-based ceramic; Color; Dental polishing; Surface properties
The purpose of this study is to evaluate the clinical utility of adding lateral approach to conventional vertical approach for prone stereotactic vacuum-assisted breast biopsies.
Materials and Methods
From April 2010 to May 2012, 130 vacuum-assisted stereotactic biopsies were attempted in 127 patients. While a vertical approach was preferred, a lateral approach was used if the vertical approach failed. The success rate of biopsies utilizing only a vertical approach was compared with that using both vertical and lateral approaches and the breast thickness for both procedures was measured and compared with that for vertical approach. In addition, pathology results were evaluated and the causes of the failed biopsies were analyzed.
Of the 130 cases, 127 biopsies were performed and 3 biopsies failed. The success rate of the vertical approach was 83.8% (109/130); however, when the lateral approach was also used, the success rate increased to 97.7% (127/130) (p = 0.0004). The mean breast thickness was 2.7 ± 1 cm for the lateral approach and 4 ± 1.2 cm for the vertical approach (p < 0.0001). The histopathologic results in 76 (59.8%) of the biopsies were benign, 23 (18.1%) were high-risk lesions, and 28 (22.0%) were malignant. The causes of biopsy failure were thin breasts (n = 2) and undetected difficult lesion location (n = 1).
The addition of lateral approach to conventional vertical approach in prone stereotactic vacuum-assisted breast biopsy improved the success rate of stereotactic biopsy, especially in patients with thin breasts.
Biopsy; Breast neoplasm; Stereotactic technique; Calcification; Success rate
The purpose of this study was to evaluate various core designs on stress distribution within zirconia crowns.
MATERIALS AND METHODS
Three-dimensional finite element models, representing mandibular molars, comprising a prepared tooth, cement layer, zirconia core, and veneer porcelain were designed by computer software. The shoulder (1 mm in width) variations in core were incremental increases of 1 mm, 2 mm and 3 mm in proximal and lingual height, and buccal height respectively. To simulate masticatory force, loads of 280 N were applied from three directions (vertical, at a 45° angle, and horizontal). To simulate maximum bite force, a load of 700 N was applied vertically to the crowns. Maximum principal stress (MPS) was determined for each model, loading condition, and position.
In the maximum bite force simulation test, the MPSs on all crowns observed around the shoulder region and loading points. The compressive stresses were located in the shoulder region of the veneer-zirconia interface and at the occlusal region. In the test simulating masticatory force, the MPS was concentrated around the loading points, and the compressive stresses were located at the 3 mm height lingual shoulder region, when the load was applied horizontally. MPS increased in the shoulder region as the shoulder height increased.
This study suggested that reinforced shoulder play an essential role in the success of the zirconia restoration, and veneer fracture due to occlusal loading can be prevented by proper core design, such as shoulder.
Zirconia; Dental crowns; Dental prosthesis designs; Finite element analyses; Dental stress analyses