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Objetivo: Evaluar, a lo largo de un seguimiento de 79,2 meses, el comportamiento de la densidad mineral ósea (DMO) determinada mediante Densitometría Axial Computarizada (DXA), la densidad mineral ósea volumétrica (DMOvol) y su relación con los datos antropométricos, junto con los parámetros relativos al metabolismo óseo (calcio, fósforo, fosfatasa alcalina, parathormona (PTH) y vitamina D (25-OH-D3)) en una población infantil con Diabetes Mellitus Tipo 1 (DM1) sin complicaciones microvasculares y un grupo control de referencia de similares características. Material y métodos: Inicialmente, se realizó un estudio transversal en 40 niños diabéticos (edad media 9,4±2,8 años) y 108 controles (9,3±1,5 años) para valorar las posibles diferencias entre ambas poblaciones. 26 pacientes del grupo diabético inicial, fueron reevaluados tras 79,2 meses de seguimiento. Resultados: Se observó que, al inicio, la masa ósea fue similar en los diabéticos y controles. Después del seguimiento, la DMO de los niños diabéticos era muy inferior a la esperada en población infantil no diabética. El peso, la altura y el Índice de Masa Corporal (IMC) siguieron el mismo patrón que la DMO. Los valores de calcio, fósforo, fosfatasa alcalina, PTH y vitamina D, aunque en rango de normalidad, fueron más bajos que en los controles. La fosfatasa alcalina no se incrementó en el periodo puberal. Conclusiones: El presente estudio demuestra que los niños y adolescentes con un diagnóstico reciente de DM1 tienen una DMO normal. Sin embargo, con el paso del tiempo, y sobre todo durante la adolescencia, muestran una menor ganancia de masa ósea y alteraciones en los parámetros de recambio óseo.

A growing body of research has implicated the protein hormone leptin in the modulation of vertebrate reproduction. While the results of mammalian studies, both physiological and molecular, has been extensive, leptin research in nonmammalian vertebrates has been less robust. Researchers have presented tissue immunoreactivity, seasonal cyclicity and life-stage related changes in hormone expression, and physiological responsiveness to exogenous leptin treatments in some fish, reptiles, and birds. However, the use of molecular techniques to investigate leptin in these species has been limited to a few avian species. Furthermore, some controversy exists regarding the validity of the proposed genetic sequences. Therefore, we have investigated the possible presence of a leptin-like molecule in another archosaur species, the American alligator (Alligator mississipiensis), using western blotting, radioimmunoassay, and the polymerase chain reaction. We will present initial results addressing tissue specific expression patterns in hatchling, juvenile, and adult animals, adult seasonal cyclicity of plasma leptin immunoreactivity, and sexual dimorphism of hormone and receptor expression.

From September 2017 to June 2020 the University of the Balearic Islands organised a monthly film workshop called Aules Sense Armaris: Cinema LGBTIQ+ a la UIB focused on giving visibility to affective and sexual diversity through film analysis in a university context. Each film was introduced with an interview with a queer activist or cultural expert related to the particular topics the film addressed, and after the screening a cinematographic and critical discussion was held in which the students contributed either with their own reflections or asking questions to the guests. This article exposes the necessity of approaching and celebrating sexual diversity from the university classroom as a form of activism. It also describes the as well as describing the criteria that were followed when choosing the films, how the monthly workshops took place and the most interesting conclusions from the post-film debates between activists, university students and spectators.

Earlier studies have described an antibody that recognized salivary ductal epithelium in sera from 15-50% of patients with primary Sjoögren's syndrome; however, the specific salivary antigen in those studies was not identified. The present study further investigated this unknown salivary antigen. Twenty-nine of 31 patients (94%) with primary Sjoögren's syndrome demonstrated IgG antinuclear antibodies that bound to an epithehial cell line with ductal characteristics derived from a human salivary gland. Seventy-seven percent of these patients had serum antibodies that bound to ductal cells of normal human parotid tissue after formalin fixation. Western blots of cell extracts, immunofluorescence, and adsorption studies indicated that SS-A/Ro and SS-B/La were the antigens recognized in the salivary cell line. The pattern of fluorescence seen when anti-SS-B/La bound to normal parotid tissue was identical to the fluorescence pattern of the anti-salivary ductal antibodies described in earlier literature. [ABSTRACT FROM AUTHOR]

Parotid and submandibular gland function were evaluated in 12 HIV-1 antibody-positive men at two visits separated by a median interval of 14.5 months (range 6-22 months). Unstimulated and stimulated flow rates, and the concentrations of total protein, lysozyme, albumin and lactoferrin in these secretions, were determined. Parotid and submandibular gland secretions changed in a specific fashion with time. Lysozyme levels in both glandular stimulated secretions showed significant changes (approximately 40% and 70% elevated, between visits, in parotid and submandibular saliva, respectively). In addition, the frequency with which albumin was detected in unstimulated parotid secretions increased with time. These findings support earlier results suggesting the presence of alterations in major salivary gland function following HIV-1 infection. Submandibular gland function appears to manifest these alterations earlier, but with time the parotid secretions show similar changes. [ABSTRACT FROM AUTHOR]

In the work presented here, we explore the upcycling of polyethylene terephthalate (PET) that was derived from water bottles. The material was granulated and extruded into a filament compatible with fused filament fabrication (FFF) additive manufacturing platforms. Three iterations of PET combined with a thermoplastic elastomer, styrene ethylene butylene styrene with a maleic anhydride graft (SEBS-g-MA), were made with 5, 10, and 20% by mass elastomer content. The elastomer and specific mass percentages were chosen based on prior successes involving acrylonitrile butadiene styrene (ABS), in which the maleic anhydride graft enabled compatibility between different materials. The rheological properties of PET and the PET/SEBS blends were characterized by the melt flow index and dynamic mechanical analysis. The addition of SEBS-g-MA did not have a significant impact on mechanical properties, as determined by tensile and impact testing, where all test specimens were manufactured by FFF. Delamination of the tensile specimens convoluted the ability to discern differences in the mechanical properties, particularly % elongation. Annealing of the specimens enabled the observation of the effect of elastomer content on the mechanical properties, particularly in the case of impact testing, where the impact strength increased with the increase in SEBS content. However, annealing led to shrinkage of the specimens, detracting from the realized benefits of the thermal process. Scanning electron microscopy of spent tensile specimens revealed that, in the non-annealed condition, SEBS formed nodules that would detach from the PET matrix during the tensile test, indicating that a robust bond was not present. The addition of SEBS-g-MA did allow for shape memory property characterization, where deformation of tensile specimens occurred at room temperature. Specimens from the 20% by mass elastomer content sample group exhibited a shape fixation ratio on the order of 99% and a shape recovery ratio on the order of 80%. This work demonstrates a potential waste reduction strategy to tackle the problem of polymer waste by upcycling discarded plastic into a feedstock material for additive manufacturing with shape memory properties.

Stereolithography (SLA) 3D printing is a rapid prototyping technique and reproducible manufacturing platform, which makes it a useful tool to develop advanced microfluidic devices for bioanalytical applications. However, limited information exists regarding the physical, chemical, and biological properties of the photocured polymers printed with SLA. This study demonstrates the characterization of a commercially available SLA 3D printed polymer to evaluate the potential presence of any time-dependent changes in material properties that may affect its ability to produce functional, capillary-action microfluidic devices. The printed polymer was analyzed with Fourier transform infrared-attenuated total reflectance, contact angle measurements, tensile test, impact test, scanning electron microscopy, and fluid flow analysis. Polymer biocompatibility was assessed with propidium iodide flow cytometry and an MTT assay for cell viability. The material characterization and biocompatibility results were then implemented to design and fabricate a self-driven capillary action microfluidic device for future use as a bioanalytical assay. This study demonstrates temporally stable mechanical properties and biocompatibility of the SLA polymer. However, surface characterization through contact angle measurements shows the polymer's wettability changes over time which indicates there is a limited postprinting period when the polymer can be used for capillary-based fluid flow. Overall, this study demonstrates the feasibility of implementing SLA as a high-throughput manufacturing method for capillary action microfluidic devices.

Objective: To assess the feasibility, acceptability, and preliminary impact of Kick Vaping among Latino young adults., Methods: Forty Latino young adults (ages 18 to 25) who were currently vaping received Kick Vaping , a vaping cessation text messaging intervention available in English and Spanish. Feasibility was measured by the eligibility, enrollment, and follow-up rates. Acceptability was measured by overall satisfaction with the intervention. Preliminary impact was measured by self-reported 7-day point prevalence abstinence and changes in self-efficacy., Results: Two hundred three individuals were identified, 61 were assessed for eligibility, and 55 were eligible. Forty individuals consented to participate and were enrolled in Kick Vaping . At baseline, most participants used disposable devices (70%), vaped daily (97.5%), had low (37.5%) or medium (35.0%) e-cigarette dependence, and had attempted to quit in the past year (72.5%). At Month 3, the follow-up rate was 90% (36/40). Treating those lost to follow-up as participants who continued vaping, 75% (30/40) of participants self-reported 7-day point prevalence abstinence. Self-efficacy mean scores significantly increased from 30.65 (SD 8.07) at baseline to 50.11 (SD 10.57) at follow-up ( p  < 0.01). Most participants (88.9%, 32/36) reported being satisfied/extremely satisfied with Kick Vaping ., Conclusion: It is feasible to recruit and retain Latino young adults in a vaping cessation text messaging intervention. Kick Vaping generated high satisfaction among Latino young adults, significantly increased self-efficacy, and resulted in a notable vaping cessation rate at Month 3. Additional testing in a randomized controlled trial is warranted to assess the efficacy of the intervention.

Background and Objectives: Women of reproductive age with substance use (SU) disorders have lower rates of contraceptive use and higher rates of unintended pregnancy than women without SU disorders and are less likely to access treatment than men. Integration of SU and sexual and reproductive health (SRH) services, using a model known as Screening, Brief Intervention, and Referral to Treatment (SBIRT), has been proven effective in reducing SU and improving health care equity. The SBIRT model includes screening, brief intervention (a short client-centered conversation providing an opportunity to identify/discuss concerns), and referral to treatment. The purpose of this study was to test whether an established quality improvement (QI) learning collaborative model could be used to support SU and SRH sites in implementing an SBIRT/SBIRT-like model to improve health outcomes for women. Five SRH sites and 4 SU sites across New York State participated in the Partnership to Advance Integrated Referrals (PAIR), an 18-month QI learning collaborative designed and implemented by Public Health Solutions., Methods: Six standardized mixed-methods data collection tools were used over 18 months to gather process and outcome data from over 130 QI team members and site staff and over 5000 clients., Results: By the end of PAIR, QI team members and site staff showed a reduction in bias, increased knowledge and comfort, increased rating of organizational practices related to client-centered care, and increased access to peer learning, information about best practices, and training and technical assistance. SU sites increased SRH screening from 47.9% in the first quarter of data collection to 67.4% in the final quarter and increased brief interventions from 92.5% in the first quarter to 100.0% in the final quarter. Similarly, SRH sites increased SU screening from 51.6% to 75.6% and increased brief interventions from 81.3% to 85.1%. The processes and outcomes were very different for the SU and SRH sites, and their varying successes and challenges are discussed. Making and verifying referrals remained challenging., Conclusions: The results of PAIR demonstrated the feasibility of SU and SRH sites implementing an SBIRT/SBIRT-like model when supported by a QI learning collaborative. Larger community and organizational challenges (COVID-19, staff turnover) still present barriers to improved reproductive health and SU outcomes for women., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Hypoxia-inducible factor pathway genes are linked to adaptation in both human and nonhuman highland species. EPAS1 , a notable target of hypoxia adaptation, is associated with relatively lower hemoglobin concentration in Tibetans. We provide evidence for an association between an adaptive EPAS1 variant (rs570553380) and the same phenotype of relatively low hematocrit in Andean highlanders. This Andean-specific missense variant is present at a modest frequency in Andeans and absent in other human populations and vertebrate species except the coelacanth. CRISPR-base-edited human cells with this variant exhibit shifts in hypoxia-regulated gene expression, while metabolomic analyses reveal both genotype and phenotype associations and validation in a lowland population. Although this genocopy of relatively lower hematocrit in Andean highlanders parallels well-replicated findings in Tibetans, it likely involves distinct pathway responses based on a protein-coding versus noncoding variants, respectively. These findings illuminate how unique variants at EPAS1 contribute to the same phenotype in Tibetans and a subset of Andean highlanders despite distinct evolutionary trajectories.

Positron Emission Tomography (PET) is a powerful medical imaging technique widely used for detection and monitoring of disease. However, PET imaging can be adversely affected by patient motion, leading to degraded image quality and diagnostic capability. Hence, motion gating schemes have been developed to monitor various motion sources including head motion, respiratory motion, and cardiac motion. The approaches for these techniques have commonly come in the form of hardware-driven gating and data-driven gating, where the distinguishing aspect is the use of external hardware to make motion measurements vs. deriving these measures from the data itself. The implementation of these techniques helps correct for motion artifacts and improves tracer uptake measurements. With the great impact that these methods have on the diagnostic and quantitative quality of PET images, much research has been performed in this area, and this paper outlines the various approaches that have been developed as applied to whole-body PET imaging., Competing Interests: Conflict of interest AM is a consultant for Weinberg Medical Physics. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Nanoscale particles described by Mie resonance in the UV-vis-NIR region are in high demand for optical applications. Controlling the shape and size of these particles is essential, as it results in the ability to control the wavelength of the Mie resonance peak. In this work, we study the extensive scattering properties of gadolinium niobate particles with complex bar- and cube-like shapes in the UV-vis-NIR region. We perform our experimental analysis by characterizing the morphology and extinction spectra, and our theoretical study by implementing a Mie scattering model for a distribution of spherical particles. We can accurately model the size distribution and extinction spectra of complex shaped particles and isolate the contribution of aggregates to the extinction spectra. We can separate the contributions of dipoles, quadrupoles, and octupoles to the Mie resonances for their respective electric and magnetic parts. Our results show that we can tune the broad Mie resonance peak in the extinction spectra by the nanoscale properties of our system. This behavior can aid in the design of lasing and luminescence-enhanced systems. These dielectric gadolinium niobate submicron particles are excellent candidates for light manipulation on the nanoscale., (Creative Commons Attribution license.)

We present the complete chloroplast genome sequence of an endophytic Ostreobium sp. isolated from a 19th-century coralline red algal specimen from St. Croix, U.S. Virgin Islands. The chloroplast genome is 84,848 bp in length, contains 114 genes, and has a high level of gene synteny to other Ostreobiaceae., Competing Interests: The authors declare no conflict of interest.

Introduction: The rapid advances in technology, market pressures, globalization, and, recently, the COVID-19 pandemic show the need to find educational models that respond to these realities while improving the employability levels of young people and promoting economic growth. This research analyzes how the professional formation model, where two learning spaces, the academy, and the company, are combined, promotes the closing of gaps and economic growth, through the development of intellectual capital that arises from this relationship, in an emerging economy such as Colombia., Methods: The methodology used corresponds to a qualitative approach, where the vision of the actors involved in the training process at the undergraduate level in Colombia is analyzed through semi-structured interviews, focus groups, and documentary analysis., Results and Discussion: The results show five major elements to consider for the formation of the intellectual capital required for the success of the relationship and the reduction in the gaps between academia and business: decision-making mechanisms, inter-organizational coordination, knowledge., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Vélez-Rolón, Pulido López, Méndez-Pinzón and Neira-Bermudez.)

High-altitude (HA) hypoxia may alter the structural-functional integrity of the neurovascular unit (NVU). Herein, we compared male lowlanders (n = 9) at sea level (SL) and after 14 days acclimatization to 4300 m (chronic HA) in Cerro de Pasco (CdP), Péru (HA), against sex-, age- and body mass index-matched healthy highlanders (n = 9) native to CdP (lifelong HA). Venous blood was assayed for serum proteins reflecting NVU integrity, in addition to free radicals and nitric oxide (NO). Regional cerebral blood flow (CBF) was examined in conjunction with cerebral substrate delivery, dynamic cerebral autoregulation (dCA), cerebrovascular reactivity to carbon dioxide (CVR CO2 ) and neurovascular coupling (NVC). Psychomotor tests were employed to examine cognitive function. Compared to lowlanders at SL, highlanders exhibited elevated basal plasma and red blood cell NO bioavailability, improved anterior and posterior dCA, elevated anterior CVR CO2 and preserved cerebral substrate delivery, NVC and cognition. In highlanders, S100B, neurofilament light-chain (NF-L) and T-tau were consistently lower and cognition comparable to lowlanders following chronic-HA. These findings highlight novel integrated adaptations towards regulation of the NVU in highlanders that may represent a neuroprotective phenotype underpinning successful adaptation to the lifelong stress of HA hypoxia. KEY POINTS: High-altitude (HA) hypoxia has the potential to alter the structural-functional integrity of the neurovascular unit (NVU) in humans. For the first time, we examined to what extent chronic and lifelong hypoxia impacts multimodal biomarkers reflecting NVU structure and function in lowlanders and native Andean highlanders. Despite lowlanders presenting with a reduction in systemic oxidative-nitrosative stress and maintained cerebral bioenergetics and cerebrovascular function during chronic hypoxia, there was evidence for increased axonal injury and cognitive impairment. Compared to lowlanders at sea level, highlanders exhibited elevated vascular NO bioavailability, improved dynamic regulatory capacity and cerebrovascular reactivity, comparable cerebral substrate delivery and neurovascular coupling, and maintained cognition. Unlike lowlanders following chronic HA, highlanders presented with lower concentrations of S100B, neurofilament light chain and total tau. These findings highlight novel integrated adaptations towards the regulation of the NVU in highlanders that may represent a neuroprotective phenotype underpinning successful adaptation to the lifelong stress of HA hypoxia., (© 2023 The Authors. The Journal of Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society.)

Background: Amyloid deposition is a primary predictor of Alzheimer's disease (AD) and related neurodegenerative disorders. Retinal changes involving the structure and function of the ganglion cell layer are increasingly documented in both established and prodromal AD. Visual event-related potentials (vERP) are sensitive to dysfunction in the magno- and parvocellular visual systems, which originate within the retinal ganglion cell layer. The present study evaluates vERP as a function of amyloid deposition in aging, and in mild cognitive impairment (MCI)., Methods: vERP to stimulus-onset, motion-onset, and alpha-frequency steady-state (ssVEP) stimuli were obtained from 16 amyloid-positive and 41 amyloid-negative healthy elders and 15 MCI individuals and analyzed using time-frequency approaches. Social cognition was assessed in a subset of individuals using The Awareness of Social Inference Test (TASIT)., Results: Neurocognitively intact but amyloid-positive participants and MCI individuals showed significant deficits in stimulus-onset (theta) and motion-onset (delta) vERP generation relative to amyloid-negative participants (all p < .01). Across healthy elders, a composite index of these measures correlated highly (r =  - .52, p < .001) with amyloid standardized uptake value ratios (SUVR) and TASIT performance. A composite index composed of vERP measures significant differentiated amyloid-positive and amyloid-negative groups with an overall classification accuracy of > 70%., Discussion: vERP may assist in the early detection of amyloid deposition among older individuals without observable neurocognitive impairments and in linking previously documented retinal deficits in both prodromal AD and MCI to behavioral impairments in social cognition., (© 2023. The Author(s).)

Erythrocytosis, or increased production of red blood cells, is one of the most well-documented physiological traits that varies within and among in high-altitude populations. Although a modest increase in blood O 2 -carrying capacity may be beneficial for life in highland environments, erythrocytosis can also become excessive and lead to maladaptive syndromes such as chronic mountain sickness (CMS).

The purpose of this study was to assesses the effectiveness of proactive and reactive methods in the recruitment of Black and Latino adolescents into a vaping-prevention randomized controlled trial (RCT). This study also assessed the characteristics of study participants by recruitment method. Proactive recruitment strategies included study presentations at community-based events (e.g., festivals, health fairs), school-based events (e.g., back-to-school events, after-school programs), and recreational centers (e.g., fitness centers, malls). Reactive recruitment strategies included study advertisements via social media (e.g., Facebook posts shared by local community-based organizations), word of mouth, and an academic-based research hub. Using proactive and reactive methods, in a 4-month period, 362 Black and Latino adolescents were successfully enrolled into the RCT. Compared to the proactive method, adolescents screened reactively were equally likely to be eligible but significantly more likely to enroll in the study. However, both proactive and reactive strategies made notable contributions to the overall recruitment effort. Moreover, proactive and reactive methods attracted adolescents with different characteristics (e.g., age, gender, sexual orientation, etc.). These findings suggest that both proactive and reactive recruitment strategies should be implemented for studies interested in recruiting a diverse sample of Black and Latino adolescents.

At high altitude Andean region, hypoxia-induced excessive erythrocytosis (EE) is the defining feature of Monge's disease or chronic mountain sickness (CMS). At the same altitude, resides a population that has developed adaptive mechanism(s) to constrain this hypoxic response (non-CMS). In this study, we utilized an in vitro induced pluripotent stem cell model system to study both populations using genomic and molecular approaches. Our whole genome analysis of the two groups identified differential SNPs between the CMS and non-CMS subjects in the ARID1B region. Under hypoxia, the expression levels of ARID1B significantly increased in the non-CMS cells but decreased in the CMS cells. At the molecular level, ARID1B knockdown (KD) in non-CMS cells increased the levels of the transcriptional regulator GATA1 by 3-fold and RBC levels by 100-fold under hypoxia. ARID1B KD in non-CMS cells led to increased proliferation and EPO sensitivity by lowering p53 levels and decreasing apoptosis through GATA1 mediation. Interestingly, under hypoxia ARID1B showed an epigenetic role, altering the chromatin states of erythroid genes. Indeed, combined Real-time PCR and ATAC-Seq results showed that ARID1B modulates the expression of GATA1 and p53 and chromatin accessibility at GATA1/p53 target genes. We conclude that ARID1B is a novel erythroid regulator under hypoxia that controls various aspects of erythropoiesis in high-altitude dwellers., (© 2022. The Author(s).)

We experimentally observe the stimulated analogue of Hawking radiation produced in a photonic-crystal fiber, with a pulsed pump and a continuous-wave probe. In particular, we propose and demonstrate an innovative method to boost the efficiency and probe the coherence characteristics of the analogue Hawking effect relying on a double pump pulse with a controlled temporal delay. We show that the emitted analogue Hawking radiation corresponds to the coherently-added, interfering Hawking signals resulting from the probe interacting with each pump pulse. We introduce a simple effective Michelson interference model, and demonstrate excellent agreement between our experimental data and the predictions derived from this model. Importantly, while naively increasing the pump power in an attempt to boost the Hawking-radiation generation efficiency results in the distortion of the output signal, we show that at the maxima of the observed Hawking-signal interference pattern, the signal can be increased by a factor of >3 (up to 4 under ideal experimental conditions). This approach could be extended to the use of sequences of m pulses, resulting in a Hawking-signal enhancement of m 2 .

Purpose: Second opinion consultation for patients with suspicious findings on breast imaging and patients with known breast cancer is not uncommon. We sought to determine the frequency of second opinion breast and axillary ultrasound imaging review and the subsequent impact on clinical management., Materials and Methods: An IRB-approved retrospective chart review was conducted on 400 consecutive patients with second opinion radiology interpretations performed by subspecialized breast radiologists at a designated cancer center, including mammogram and ultrasound review. The outside institution imaging reports were compared with second opinion reports to categorize ultrasound review discrepancies which were defined as any BI-RADS category change. The discrepancy frequency, relevant alterations in patient management, and added cancer detection were measured., Results: The second opinion imaging review resulted in discrepant findings in 108/400 patients (27%). Patients with heterogeneously or extremely dense breasts had higher discrepancy frequency (36% discrepancy, 68/187) than those with almost entirely fatty or scattered fibroglandular breast tissue (19% discrepancy, 40/213) with P  = 0.0001. Discrepancies resulted in the following changes in impression/recommendations: 70 repeat ultrasounds for better characterization of a breast lesion, 11 repeat ultrasounds of a negative region, 20 repeat ultrasounds for benign axillary lymph nodes, 5 downgrades from probably benign to benign, and 2 upgrades from benign to suspicious. Repeat ultrasounds of the axilla in 19 patients resulted in 13 biopsy recommendations, and 4 were metastatic (PPV3 31%). In the breast, repeat ultrasounds in 81 patients resulted in 14 upgrades to suspicious. Of these, 5 yielded malignancy. In addition, one patient was upgraded from benign to suspicious based on the outside image, with pathology revealing malignancy (breast PPV3 40%). Breast lesion BI-RADS category downgrades in 27 patients resulted in 10 avoided biopsies. Ultimately, second opinion ultrasound review resulted in altered management in 12% of patients (47/400). This included discovery of additional breast malignancies in 6 patients, metastatic lymph nodes in 4 patients, excisional biopsy for atypia in 1 patient, 4 patients proceeding to mastectomy, 10 patients who avoided biopsies, and 22 patients who avoided follow-up of benign findings., Conclusions: In this study, subspecialized second opinion ultrasound review had an impact on preventing unnecessary procedures and follow-up exams in 8% of patients while detecting additional cancer in 2.5%., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 R. Jared Weinfurtner et al.)