Criteria for patient selection and indication for intracorneal ring segments in keratoconus

BACKGROUND

Keratoconus is an ectatic, progressive corneal disorder characterized by alterations in the morphology of the corneal tissue that leads to limitation of visual function of the patient. Intracorneal ring segments (ICRS) are small synthetic devices that are implanted in the corneal stromal in order to regularize the morphology of the tissue therefore improving the visual function and the quality of life of the patients.

MAIN TEXT

The present narrative review summarizes the main scientific articles developed by the authors in relation to the clinical outcomes and long-term results of ICRS in the treatment of keratoconus. It was found that those patients that benefit the most from this surgical intervention are those that have the most severe form of keratoconus. Additionally, patients with good visual function, those with more than 0.9 in the decimal scale are at risk of losing visual acuity after ICRS implantation. In relation to long-term results, scientific investigations published by the authors demonstrate that ICRS is a stable procedure after long period of time in terms of vision, refraction, and topographic variables in those patients with stable keratoconus. However, in patients with keratoconus and signs of progression, ICRS may not have the capability of halting the progression of the disease. Using artificial intelligence to guide ICRS implantation provide better clinical outcomes and improvement in corneal higher-order aberrations in patients with keratoconus in comparison to those treated using the commercial nomogram of implantation.

CONCLUSIONS

ICRS is a safe surgical procedure in the treatment of keratoconus. Patients that benefit most from the surgery are those with a significant visual impairment. ICRS should not be considered in patients with good visual function because of the risk of losing lines of vision. Long-term follow-up demonstrate stability of the clinical outcomes in patients with stable keratoconus although ICRS may not have the ability of halting the progression of the disease. New technologies based artificial intelligence improved the indications and the clinical outcomes of keratoconus patients treated with ICRS.

Structural and electronic changes in the Ni13@Ag42 nanoparticle under surface oxidation: the role of silver coating

Icosahedral Ni13@Ag42 is a stable nanoparticle formed by a magnetic nickel core surrounded by a silver coating that provides physical protection to the 3d metal cluster as well as antibacterial properties. In this work, we report density functional theoretical calculations to delve into a comprehensive analysis of how surface oxidation impacts the structural, electronic, magnetic, and reactivity properties of this interesting nanoparticle. To elucidate the role played by the silver coating, we compare the results with those found for the bare Ni13 cluster also subjected to surface oxidation. When Ni13 is covered by silver, we find a markedly robust behavior of the magnetic moment of the resulting nanoparticle, which remains nearly constant upon oxidation up to the rates explored, and the same holds for its overall reactivity. The obtained trends are rationalized in terms of the complex interplay between Ni-Ag and Ag-O interactions which impact the relative inter-atomic distances, charge transfer effects, spin polarization and magnetic couplings.

Managing RT Schedules of Early-Stage Breast Cancer Patients with a Genetic-Dosimetric Validated Model for Late Fibrosis

PURPOSE/OBJECTIVE(S)

Define a multifactorial risk prediction model for RT-induced fibrosis and investigate the benefit of a personalized approach for breast cancer (BC) patients (pts) treated with whole breast RT.

MATERIALS/METHODS

In a previous study, we confirmed the predictive role of 30 SNPs from the literature and built an interaction aware Polygenic Risk Score (PRS, following the methods from Franco RO 2021) for Late Fibrosis (FG2+) on a cohort of 1500 pts from the REQUITE EU/USA prospective observational study. The PRS weights the radiosensitive (RS) and radioresistant (RR) genetic components and can be included in NTCP models. In a subgroup from the same cohort (390 pts), we have also confirmed an NTCP model based on biologically Equivalent Uniform Dose (BEUD) from PTV DVHs for pts treated at 40-50 Gy and no RT boost. Here, we combine PRS and BEUD into a sigmoid model allowing PRS to modulate BEUD50 (BEUD leading to 50% FG2+), i.e., we permitted a personalized BEUD50. We can also consider this as translating the PRS into a personalized equivalent BEUD, which is added/subtracted to the treatment BEUD. We evaluated model performances through ROC-AUC, calibration plot and Precision-Recall AUC.

RESULTS

A total of 381 pts had complete dosimetric/genetic data, prescribed dose 40-50 Gy, and no fibrotic alteration at RT start. We scored FG2+ in 87 pts (23%). PRS ranged from -13 (more RR pts) to 7 (more RS), and a unit in PRS corresponds to 5.3 Gy BEUD or 3 Gy in EQ EUD2 Gy. Table 1 summarizes model performances, with details for subgroups below/above the quartiles I/III of the BEUD distribution. The PRS-only model correctly describes the toxicity rates in the whole population (calibration slope/offset = 0/1). Still, it overestimates/underestimates the absolute risks in the low/high dose ranges. The integrated model improves AUC-ROC and AUC-PRC by 5% and 10% and guarantees a better calibration in pts receiving low/high BEUD to the PTV.

CONCLUSION

We developed a multifactorial model for FG2+ based on two previously validated models and reported the improvement against single-factor models. The BEUD+PRS model is suitable for assisting clinicians in managing early-stage BC pts. The number of fractions or the daily dose could be reduced for RS pts. The integrated model resulted in a possible quantitative tool for driving the planning decision process. Also, it showed a better performance in the high BEUD region, suggesting the potential value of its extension toward RT including boost or ultra hypofractionation. We are testing this extension in the whole REQUITE cohort.

Carbon Nanostructures for Ocular Tissue Reinforcement

Purpose

The purpose of this study was to improve the biomechanical properties of the cornea through the incorporation of carbon nanostructures.

Methods

Healthy Japanese rabbits were used to evaluate the effect of carbon nanostructures’ incorporation in the cornea. Rabbits were divided in two groups A and B. In each of these groups, the corneas were divided in (i) corneas not submitted to any treatment (the control group), (ii) corneas modified either with carbon nanostructures (group A), or with the traditional cross-linking technology (group B). After modification, rabbits were euthanized at different time intervals. The biomechanical properties of the treated corneas were evaluated using the inflation method.

Results

Biomechanical tests based on the inflation method show that the incorporation of carbon nanostructures to the cornea and their proper distribution within it gives rise to a large improvement in the mechanical properties and tangential elastic modulus (up to 155%). These results anticipate that this novel and easy approach based on nanotechnology is able to compete with the actual cross-linking technology applied in clinical ophthalmology using a photosensitive molecule, such as riboflavin and unpleasant UV-A radiation.

Conclusions

The incorporation of carbon nanostructures (single-walled carbon nanotubes and graphene) in corneal stroma is proposed as a promising alternative to improve the mechanical properties in the treated eyes. The proper dispersion of the carbon nanostructures a few days after implementation (down to 60 micrometers depth) explains the successful results achieved.

Translational Relevance

Nanotechnology applied to the eye constitutes a promising approach for ocular tissue reinforcement.

Nanoplastics are bioaccumulated in fish liver and muscle and cause DNA damage after a chronic exposure

The extent of the widespread, planetary contamination by plastic waste is difficult to fully capture. Nanoplastics (NPs) are currently in the center of research concerning plastic litter, both for the analytical challenges they pose and for their potential to provoke hazardous effects in organisms. However, there are still many unanswered questions in this multidisciplinary field, with a crucial missing piece being the quantification of NPs in fish tissues after in vivo exposures. Another relevant question that is still greatly unexplored is how a chronic exposure to NPs will affect fish health. This study aims to provide answers to both of these relevant knowledge gaps. To this end, goldfish (Carassius auratus) were exposed to 44 nm polystyrene (PS)-NPs via water for 30 days. Following the exposure, gastrointestinal tract, liver and muscle were sampled for PS-NPs analysis by means of size exclusion chromatography coupled to high resolution mass spectrometry. PS-NPs were detected in all liver and muscle samples of exposed fish, with higher concentrations in liver than in muscle, whereas no PS-NPs were detected in the gastrointestinal tract. Nevertheless, exposure to PS-NPs did not induce changes in hematology parameters nor in cortisol and glucose levels in plasma. On the other hand, even a relatively low concentration of PS-NPs was able to cause DNA damage, measured by an increase in erythrocyte nuclear abnormalities, suggesting that PS-NPs can reach the cell nucleus and cause genotoxicity. These results show for the first time that PS-NPs find their way to fish muscle after chronic exposure, where they bioaccumulate, but do not alter fish survival nor hematological or physiological stress indicators. The accumulation of PS-NPs in fish muscle can represent a threat to human health as a possible route of exposure to small-sized plastics. The present results in a model fish species open windows for future studies in edible fish species.

The Lights And The Shadows Of Controlled Sting Challenge With Hymenoptera

Hymenoptera venom immunotherapy (VIT) is a treatment which has been shown to be effective in the protection of individuals with systemic allergic reactions caused by Hymenoptera stings. The need for a tool which shows the degree of protection afforded by VIT and the lack of useful biomarkers, has converted the Sting Challenge Test (SCT) into the gold standard for this disorder although its use has both lights and shadows. SCT with Hymenoptera is a test consisting of causing a real sting in a patient diagnosed with an allergy to the venom of the stinging insect and who normally is undergoing treatment with specific immunotherapy. In Spain, SCT is included in the list of services offered by some hospitals and forms part of their habitual clinical practice. This review aims to analyze the strengths and weaknesses of this test and describe the standardized procedure and necessary resources, based on the experience of a group of Spanish experts and a review of the literature.

Techno-economic assessment of decentralized polishing schemes for municipal water reclamation and reuse in the industrial sector in costal semiarid regions: The case of Barcelona (Spain)

This study demonstrates the techno-economic reliability of an innovative fit-for-use treatment train to boost municipal reclaimed water reuse fore industrial uses in the Barcelona Metropolitan Area (BMA). The relatively high conductivity (2090 μS/cm) and hardness (454 mg/L) of reclaimed water in the BMA (e.g. Water Reclamation Plant (WRP) of El Baix Llobregat, Barcelona, Spain), together with the restrictive water quality demands in industrial uses, claims for the implementation of advanced reclamation schemes based on desalination technologies such as reverse osmosis (RO). The study assesses the benefits of two potential pre-treatments of the RO stage: (i) ultrafiltration (UF) or (ii) an innovative high-performance nano-structured polymeric adsorbent (CNM); in which a permeability decline of 5% was observed when CNM was used as a pre-treatment, while a stable permeability of RO was found when was fed by the UF effluent. On the other hand, generic cost curves have been calculated for the technologies evaluated and were applied to estimate capital and operational expenditures (CAPEX and OPEX) for the scale-up in three different industrial sites (e.g., chemical, waste management and electro-coating industries). The economic assessment indicates that the use of municipal reclaimed water is economically competitive in front of the use of tap water in the BMA, providing savings between 0.13 and 0.52 €/m³ for the waste management industry and between 0.49 and 0.98 €/m³ for the electrocoating industry. On the other hand, the use of groundwater in one of the industrial sites and its relatively low cost implied that, although it is necessary a RO, the current cost of water is significantly lower.

Why are Zn-rich Zn-Mg nanoalloys optimal protective coatings against corrosion? A first-principles study of the initial stages of the oxidation process

ZnMg alloys of certain compositions in the Zn-rich side of the phase diagram are particularly efficient, and widely used, as anticorrosive coatings, but a sound understanding of the physico-chemical properties behind such quality is still far from being achieved. The present work focuses on the first stage of the corrosion process, namely the initial growth of a sacrificial surface oxide layer, whose characteristics will condition the next stages of the corrosion. A comprehensive ab initio study, based on density functional theory, is carried out on ZnMg nanoalloys with 20 atoms and different compositions, which serve as model systems to simulate the complex processes that occur in extended granular surfaces. The structural and electronic properties, when progressive oxidation of the nanoalloys takes place, are analyzed in detail with the help of structural descriptors, energetic descriptors such as the oxygen adsorption energies and excess adsorption energies, as well as with electronic ones based on the topological analysis of the electron density and the electron localization function, from which a detailed analysis of the bonding patterns is extracted. We explain why small amounts of Mg create a very positive synergy between Zn and Mg that increases the reactivity to oxygen while reducing, at the same time, the stress induced on the cluster substrate, both facts working in favor of promoting the growth of the oxide crust whilst protecting the core. Moreover, we also show that stoichiometries close to the Mg₂Zn₁₁ and MgZn₂ compositions are the best candidates to optimize the protection against corrosion in Zn-Mg alloys, in agreement with the experimental observations.

Evidence of a Down Syndrome Keratopathy: A Three-Dimensional (3-D) Morphogeometric and Volumetric Analysis

The aim of this study was to investigate whether a different and abnormal corneal profile is present in Down syndrome (DS) by personalized three-dimensional (3D) modelling. This single-centre cross-sectional study included 43 patients with DS (43 eyes) and 58 age-sex-matched control subjects (58 eyes) with normal karyotype and topography. Refraction, central corneal thickness (CCT), aberrations (high-order, coma and spherical), asphericity and morphogeometric/volumetric parameters based on a 3D corneal model that was generated from raw topographical data were evaluated. Deviation of anterior/posterior apex (D_apexant/D_apexpost) and thinnest point (D_mctant/D_mctpost) from corneal vertex, anterior/posterior surface area (A_ant/A_post), sagittal area passing through the anterior/posterior apex (A_apexant/A_apexpost) and thinnest point (A_mctpost), total corneal volume (V_total) and volumetric progression for each 0.05 mm step of the radius value centred to the thinnest point (VOL_MCT) and anterior/posterior apex (VOL_AAP/VOL_PAP) comprised the morphogeometric/volumetric parameters. In the DS group, 58.1% of the eyes presented abnormal topography. High-order and coma aberrations, asphericity, D_apexant, A_ant, A_post and A_apexant were significantly higher, whereas CCT, A_apexpost, A_mctpost, V_total, VOL_AAP, VOL_PAP and VOL_MCT were lower in the DS group than in the control group (p < 0.05). D_apexpost did not differ between the groups (p > 0.05). This study demonstrates that corneas of the subjects with DS are different and more aberrated than those of normal age- and sex-matched non-DS controls. Anterior corneal apex appears to be displaced in DS even with normal topography, while posterior apex seems stable although topography is abnormal. These findings may help to modify our approach in the diagnosis of keratopathy in subjects with DS.

Relation between structural patterns and magnetism in small iron oxide clusters: reentrance of the magnetic moment at high oxidation ratios

Due to quantum confinement effects, the understanding of iron oxide nanoparticles is a challenge that opens the possibility of designing nanomaterials with new capacities. In this work, we report a theoretical density functional theory study of the structural, electronic, and magnetic properties of neutral and charged iron oxide clusters FenOm0/± (n = 1-6), with m values until oxygen saturation is achieved. We determine the putative ground state configuration and low-energy structural and spin isomers. Based on the total energy differences between the obtained global minimum structure of the parent clusters and their possible fragments, we explore the fragmentation channels for cationic oxides, comparing with experiments. Our results provide fundamental insight on how the structural pattern develops upon oxidation and its connection with the magnetic couplings and net total moment. Upon addition of oxygen, electronic charge transfer from iron to oxygen is found which weakens the iron-iron bond and consequently the direct exchange coupling in Fe. The binding energy increases as the oxygen ratio increases, rising faster at low oxidation rates. When molecular oxygen adsorption starts to take place, the binding energy increases more slowly. The oxygen environment is a crucial factor related to the stabilities and to the magnetic character of iron oxides. We identified certain iron oxide clusters of special relevance in the context of magnetism due to their high stability, expected abundance and parallel magnetic couplings that cause large total magnetic moments even at high oxidation ratios.

High sensitivity troponin I in hypertrophic cardiomyopathy

Background

ESC guidelines recommend measurement of troponin T in patients with hypertrophic cardiomyopathy (HCM) because high concentrations are associated with cardiovascular events, heart failure and death. The cardiac Troponin I subunit is not expressed in skeletal muscle making it a cardio-specific isoform. The use of troponin biomarkers in management of patients HCM is limited because concentrations only weakly correlate with clinical parameters. Most studies are small, and few have examined their relation with genotype and mortality.

Purpose

To assess the relationship between high-sensitive troponin I (hsTnI) and characteristics of adults with HCM.

Methods

Patients included were adults with an established diagnosis of HCM referred to a single centre for genetic testing. Demographic, clinical and imaging data were recorded at baseline. Echocardiography and cardiac magnetic resonance (CMR) were performed according to EACVI standards. Quantification of late gadolinium enhancement (LGE) was performed using the 5 SD quantitative threshold. Genotype was evaluated using a 16 gene panel in an accredited UK laboratory. Pathogenic and likely pathogenic variants were considered as a positive genotype. Serum hsTnI was measured by a two-site electrochemiluminescence immunoassay on a Roche E170 analyser. Normal values for the assay 0–34 ng/L for males and 0–16 ng/L for females.

Results

313 patients (n=200, 64% male) median age 57 (IQR 47–68) years were included. hsTnI concentration was abnormal in 69 (22%) patients. An abnormal hsTnI was more common in females (n=36, 32%) compared to males (n=33, 17%, c2 9.9, p&lt;0.05). A pathogenic variant in a sarcomere gene was identified in 95 (30%) individuals. An abnormal hsTnI concentration was associated with higher left ventricular (LV) wall thickness (20mm v 18mm, p&lt;0.05) and LV outflow tract (LVOT) gradient (34 v 22 mmHg) on echocardiography (n=313). Of the patients (n=204) who had a CMR, an abnormal hsTnI concentration was associated with higher LV mass (183 v 156g, p&lt;0.05) and greater % LGE (30 v 16%, p&lt;0.01, n=129). There was no difference in hsTnI between those with a positive or negative genotype. During follow-up, 18 patients died. Of the 9 patients that died with a normal hsTnI, two died suddenly.

Conclusions

In HCM, patients with abnormal hsTnI concentration have higher LV mass and LVOT gradient and more fibrosis. Whilst mortality is higher in those with abnormal hsTnI, sudden cardiac death may occur with a normal hsTnI. It may not be appropriate to extrapolate hsTnI sex-specific thresholds used in the diagnosis of myocardial infarction to HCM.

Funding Acknowledgement

Type of funding source: None

Clinical outcomes with a new design in multifocal intraocular lens: a pilot study

Purpose

To evaluate the clinical and visual outcomes, quality of near vision and the influence of photic phenomena in patients bilaterally implanted with a new Precizon Presbyopic multifocal intraocular lens (IOL).

Methods

In this prospective consecutive case series, 20 eyes of 10 patients were included (mean age 63.80 ± 12.55 years). Uncorrected and corrected visual acuity (far, intermediate and near), subjective refraction, binocular defocus curve, contrast sensitivity (CSV-1000) and quality of vision and satisfaction questionnaires were measured. The follow-up was 12 months after surgery.

Results

At 12 months after surgery, uncorrected distance visual acuity (UDVA) improved with surgery (p = 0.001) with a value of 0.08 ± 0.08 logMAR. Uncorrected near visual acuity (UNVA) was 0.22 ± 0.12 logMAR and distance corrected near visual acuity (DCNVA) was 0.16 ± 0.13 logMAR. Intermediate distance visual acuity (UIVA) was 0.22 ± 0.10 logMAR. Contrast sensitivity outcomes were similar to normal population in photopic conditions and slightly reduced in mesopic conditions of lighting. Defocus curve showed that this multifocal IOL was able to provide a visual acuity (VA) equal or better to 0.16 logMAR between defocus levels of + 1.00 to − 2.50 D. Good patient satisfaction was obtained in quality of vision and satisfaction questionnaires outcomes.

Conclusions

The Precizon Presbyopic NVA IOL (OPHTEC BV) provides good visual outcomes. This multifocal IOL provides a high percentage of spectacle independence due to good VA at far, intermediate and near distances and satisfactory contrast sensitivity. High patient satisfaction was observed in quality of vision and satisfaction questionnaires with a low percentage of patients manifesting photic phenomena.

Techno-economic evaluation and comparison of PAC-MBR and ozonation-UV revamping for organic micro-pollutants removal from urban reclaimed wastewater

The presence of sewage-borne Organic Micro-Pollutants (OMP) in Wastewater Treatment Plants (WWTP) effluents represents an increasing concern when water is reclaimed for irrigation or even indirect potable reuse. During eighteen months, an innovative hybrid water reclamation scheme based on a Membrane Biological Reactor (MBR) enhanced with Powder Activated Carbon (PAC) was operated at pilot-scale (70 m³/d) in order to compare it with state-of-the art Wastewater Reclamation System (WWRS) also revamped with a final step of ozonation-UV. Removal of persistent OMP, water quality and treatment costs were evaluated and compared for the different treatment schemes. OMP removal efficiency results for the different schemes concluded that established technologies, such as physico-chemical and filtration systems as well as MBR, do not remove significantly (>15%) the most recalcitrant compounds. The upgrading of these two systems through the addition of ozonation-UV step and PAC dosing allowed improving average recalcitrant OMP removal to 85 ± 2 and 75 ± 5%, respectively. In term of costs, PAC-MBR represents an increase of 37% of costs regarding conventional systems but presents improvements of 50% reduction in space and water quality. On the other hand, ozonation requires up to a 15% increase of foot-print; nevertheless, represents lower costs and lower carbon footprint. Ozonation-UV seems to be the best option for upgrading existing facilities, while PAC-MBR should be considered when space represents a critical limitation and produced water is reused for high water quality purposes.

Tunable gap in stable arsenene nanoribbons opens the door to electronic applications

Arsenic has been predicted to present significantly more diverse 2D phases than other elemental compounds like graphene. While practical applications must be based on finite arsenene samples, like nanoribbons, theory has so far focused on the infinite sheet. Our ab initio simulations show the clear contrast between the properties of arsenene nanoribbons and those of the monolayer, ranging from phase stability to electronic structure. We include nanoribbons derived from the buckled, puckered and square/octagon structures of bulk arsenene. The flexibility afforded by different parent structures, widths and edge passivations leads to a rich variety of semiconducting structures with tunable gaps.

Our study of arsenene nanorribons uncovers their structural diversity and, more crucially, the tunability of their electronic structure.

Heterometallic CuII/LnIII polymers active in the catalytic aerobic oxidation of cycloalkenes under solvent-free conditions

Heterometallic 3d-4f inorganic polymers were prepared using 3,5 pyridinedicarboxylic acid (H2PDC), {[CuLn2(PDC)2(SO4)2(H2O)6]·H2O}n (Ln: SmIII, CuSmPDC, EuIII, CuEuPDC, GdIII, and CuGdPDC). These catalysts are active in the aerobic oxidation of cycloalkenes under solvent-free conditions, with a conversion for the oxidation of cyclohexene of 71% after one hour of the reaction, and a TOF value of 1438 h-1 for CuSmPDC. On the other hand, the oxidation of cycloheptene and cyclooctene exhibited slightly lower conversions of 52% and 47%, and TOF values of 1053 and 159 h-1 after 1 and 6 hours of the reaction, respectively. The radical mechanism for the oxidation reaction of cyclohexene was assessed by Raman and EPR spectroscopy. The first evidenced the formation of Cu-O2 adducts and the second permitted is to observe the presence of the oxygen centered radical species, which act as initiators of the reaction chain to generate the products. An increase in the temperature of the reaction correlates with the adduct formation, and with the enhancement of the oxidation reaction.

What will freestanding borophene nanoribbons look like? An analysis of their possible structures, magnetism and transport properties

The geometry, magnetism and electronic transport properties of nanoribbons made of the boron-based analogue of graphene are studied.

Structure, fragmentation patterns, and magnetic properties of small nickel oxide clusters

We report a comprehensive theoretical study of the structural and electronic properties of neutral and charged nickel oxide clusters, Ni_nO_m^0/± (n = 3–8 and m = 1–10), in the context of recent experiments of photodissociation and Ion Mobility Mass Spectrometry.

Radial Scar and Tubular Carcinoma

Clinical, mammographic, sonographic and pathologic examinations in 17 patients with nonpalpable stellate lesions showed radiographic findings suggestive of radial scars, with the exception of 2 cases which showed a dense central region. These findings were not sufficiently consistent to differentiate radial scar from carcinoma so that wire localization biopsy was necessary. Four patients had 7 radial scars associated with 6 tubular carcinomas, 2 of them having 3 and 2 radial scars with 2 tubular carcinomas, respectively. No characteristic radiographic findings were made in these cases. Four patients showed radial scar with punctate microcalcifications in the surrounding breast parenchyma as part of benign and premalignant conditions. Ultrasonography in 7 patients showed a hypoechoic area on 4 with acoustic shadow similar to that of carcinoma. Our study suggested that radial scar has a relationship with tubular carcinoma and surgical excision of these stellate lesions is, therefore, required.

Nonpalpable Breast Lesion

One hundred and fifty-six patients with suspect nonpalpable breast lesion underwent stereotaxic core needle aspiration biopsy (SCNAB) with a single pass in an upright “add-on” stereotaxic device using a manual 1.6-mm needle (16 G), to determine whether the results were comparable to results of SCNAB with a multiple-pass technique. Of the 69 carcinomas, 51 (74%) were correctly diagnosed and definitive surgical therapy, without surgical biopsy, was performed in 42 of the 50 invasive carcinomas (84%) and in 9 of the 19 noninvasive carcinomas (47%). Ten noninvasive carcinomas and 4 invasive carcinomas, discovered by microcalcifications or distortion on the mammograms, form 78% of the false-negative results. There were no false-positive results. Vasovagal reactions occurred in 11% of the procedures. Although the results were acceptable in patients with invasive carcinoma, more than one needle pass is necessary for greater diagnostic accuracy of SCNAB, especially in patients with only microcalcifications or distortion on the mammogram.

Implementing Algorithm-Guided Warfarin Dosing in an Ethnically Diverse Patient Population Using Electronic Health Records and Preemptive CYP2C9 and VKORC1 Genetic Testing

Implementation of pharmacogenetic-guided warfarin dosing has been hindered by inconsistent results from reported clinical trials and a lack of available algorithms that include alleles prevalent in non-white populations. However, current evidence indicates that algorithm-guided dosing is more accurate than empirical dosing. To facilitate multiethnic algorithm-guided warfarin dosing using preemptive genetic testing, we developed a strategy that accounts for the complexity of race and leverages electronic health records for algorithm variables and deploying point-of-care dose recommendations.

Spin-polarized transport in hydrogen-passivated graphene and silicene nanoribbons with magnetic transition-metal substituents

We present a systematic theoretical study of the electronic transport in hydrogen passivated zigzag graphene and silicene nanoribbons with between zero and four neighboring H atoms on one edge replaced by magnetic transition metals (Fe, Co, and Ni). The calculations were performed using equilibrium transport and density-functional theory with the generalized gradient approximation to exchange and correlation. We considered the magnetic moments of the two edges aligned both ferromagnetically (Ferro-F form) and antiferromagnetically (Ferro-A form). The Ferro-A graphene-based ribbons were all semiconducting and would support moderate spin-polarized currents of either sign by applying positive or negative gate voltages. The Ferro-F graphene-based ribbons were all metallic; the most interesting for possible spintronic applications being that with a single Ni atom, in which strong spin-filtering at low bias resulted from a deep trough in the transmission of one spin component around the Fermi level. By contrast, in the Si-based analog this trough was split, partially eliminating the polarization of the current. This splitting was found to be related to the buckled structure of the Si-based nanoribbon, which has its origin in its preference for sp(3)-like hybridization.