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An advantage of breast augmentation with injectable fillers is that the desired size can be determined and achieved under local anesthesia with a short recovery time. However, a high complication rate is a critical disadvantage. Some fillers are challenging to remove, resulting in breast deformity and scarring. Five patients who underwent surgery to manage a foreign body in the breasts in 2021 were enrolled in this study. Two had copolyamide filler injections, while the other three had polyacrylamide hydrogel filler injections. A physical examination was performed, and preoperative and intraoperative photographs were obtained. Two patients underwent subcutaneous mastectomy because most of the filler had infiltrated into the normal breast tissue. In contrast, the other patients underwent filler removal and debridement because most of the filler had remained separate from the normal breast tissue. All patients who had a subcutaneous mastectomy and one who underwent only filler removal underwent immediate breast reconstruction with cohesive gel implants. The other patients rejected immediate reconstruction, and only filler removal was performed. All patients recovered without complications. We propose an algorithm for diagnosis and treatment based on our cases, which we hope can help clinicians manage the complications of filler injections for breast augmentation.

We report a case of transient unilateral exotropia, a rare complication that occurred after an infraorbital local anesthetic injection, and present the possible mechanism underlying this adverse effect. A 64-year-old man underwent an excisional biopsy under local anesthesia for bilateral lower eyelid masses. He received a subcutaneous injection of a local anesthetic (a combination of 1:100,000 epinephrine and 2% lidocaine). Intraoperatively, we observed a homogeneous, fat-attenuated mass with thin fibrous septae inside the orbital septum of each eye. Following excision of the masses, the patient developed severe diplopia accompanied by exotropia, impaired adduction, and mydriasis of the right eye. The pupillary light reflex, visual acuity, and visual field test results were within normal ranges. Notably, his symptoms completely resolved 4 hours postoperatively without intervention. To our knowledge, transient unilateral exotropia following infraorbital local anesthetic injection is rare. The exotropia was attributed to diffusion of the epinephrine/lidocaine solution, which may have affected the ciliary ganglion and the medial rectus muscle. Caution is warranted during local anesthetic injections in patients who undergo periorbital surgery.

Wohlfahrtiimonas chitiniclastica are aerobic, non-motile, gram-negative rods, first described by Toth et al. in 2008. A small number of cases of W. chitiniclastica infections have been reported worldwide. These bacteria are transmitted through fly larvae in open wounds of skin and/or mucosal surfaces on the host. W. chitiniclastica is pathogenic to humans and can cause severe diseases like septicemia and osteomyelitis. Herein, we report the identification of W. chitiniclastica in tissue culture from a severely ill, infected patient without myiasis. Diagnoses of W. chitiniclastica without myiasis are often missed; therefore, careful attention is needed. It is reported that W. chitiniclastica infection responds well to antibiotics and general treatment of open wounds in diabetic feet. Hence, early intravenous antibiotic treatment and adequate surgical management are required for efficient management and also to prevent progression to severe disease.

This study was conducted to investigate variations in the stable isotope ratios of carbon (δ13C) and nitrogen (δ15N) of agricultural soils under different land uses (i.e., paddy, upland, and orchard) that subjected to different fertilization management (i.e., 15 N-depleted synthetic fertilizer and 13C- and 15 N-enriched livestock manure and compost application). Soil samples were collected from paddy, upland, and orchard fields in an intensive agricultural area, and forest (pine and oak) soils were additionally included as background soils. The C and N concentrations and isotope ratios of both bulk and water-extractable soil fractions were analyzed. The δ13C and δ15N of agricultural soils were higher than those of forest soils, reflecting repeated manure and compost applications (for both δ13C and δ15N) and higher N loss (for δ15N) in agricultural soils. Among agricultural soils, orchard (− 24.2‰ for δ13C and + 10.6‰ for δ15N) and upland (− 25.4‰ and + 9.6‰, respectively) soils which received higher rates of manure and compost were more enriched with 13C and 15N compared with paddy (− 28.0‰ and + 4.9‰, respectively). Such differences in the isotopic compositions among agricultural soils were also found for water-extractable soil fractions. Our study suggests that δ13C and δ15N of agricultural soils are affected by land use types with different fertilization management, particularly application of 13C- and 15 N-enriched livestock manure and compost. The δ13C and δ15N could be used as chemical indicators to evaluate the effects of the application of manure and compost on soil C and N dynamics.

In intensive agricultural watersheds, riverine particulate organic matter (POM) may be transported from many sources such as rice paddies, crop uplands, forests, and livestock farming areas during rainy seasons. However, the impacts of land-use and rainfall changes on the POM sources are not well understood. In this study, changes in the sources of riverine POM were investigated in an agricultural area of Korea between 2014 and 2020/21. During this period, land-use and rainfall patterns changed dramatically. The δ

Background The role of preoperative MRI in women 35 years of age or younger with breast cancer remains controversial. Purpose To determine the association between preoperative MRI and surgical outcomes in women aged 35 years or younger with breast cancer by using propensity score (PS) analysis to investigate the impact of preoperative MRI. Materials and Methods Women 35 years of age or younger diagnosed with breast cancer between 2007 and 2017 who had or had not undergone preoperative breast MRI were retrospectively identified. The MRI detection rate of additional suspicious lesions was analyzed, and changes in surgical management were recorded. Inverse probability weighting (IPW) and PS matching were used to adjust 19 variables and to create a balance between the two groups. Surgical outcomes were compared by using univariable logistic regression. Results Among 964 women (mean age ± standard deviation, 32 years ± 3), 665 (69%) had undergone preoperative MRI (MRI group; mean age, 32 years ± 3) and 299 (31%) had not (no-MRI group; mean age, 32 years ± 3). In the MRI group, additional suspicious lesions were found in 178 of the 665 women (27%), with 88 of those 178 women (49%) having malignant lesions. The surgical management was changed in 99 of the 665 women (15%) due to MRI findings, which was appropriate for 62 of those 99 women (63%). In the IPW analysis, the MRI group showed lower odds of repeat surgery (odds ratio [OR], 0.13; 95% CI: 0.07, 0.21; P < .001) and higher odds of initial mastectomy (OR, 1.62; 95% CI: 1.17, 2.25; P = .004). However, there was no difference in the overall mastectomy rate (OR, 1.24; 95% CI: 0.91, 1.68; P = .17) compared with the no-MRI group. These results were consistent when using the PS matching method. Conclusion Preoperative MRI in young women with breast cancer is useful for detecting additional malignancy and improving surgical outcomes by reducing the repeat surgery rate, with a similar likelihood of overall mastectomy. © RSNA, 2021 Online supplemental material is available for this article.

Oncotype DX is a multigene assay used in breast cancer, and the result provided as a 'recurrence score (RS)' corresponds to the risk of a cancer recurrence and the chemotherapeutic benefit in estrogen receptor (ER)-positive human epidermal growth factor receptor (HER)2-negative invasive breast cancer. However, its accessibility is limited.To evaluate whether magnetic resonance imaging (MRI) could be used to predict Oncotype DX RS in patients with ER-positive HER2-negative invasive breast cancer.We enrolled 473 patients with ER-positive HER2-negative invasive breast cancer who underwent a preoperative MRI and Oncotype DX assay between January 2015 and December 2018. The MRI was reviewed and associations between Oncotype DX RS values were evaluated. Logistic regression analysis was used to identify independent predictors of high and low RS.Of the 485 cancers, 288 (59.4%) had low (18), 155 (31.9%) had intermediate (18-30), and 42 (8.7%) had high (≥31) RS. Multiple logistic regression analysis revealed that a round shape (odds ratio [OR] = 2.554, P = 0.089) and low proportion of washout component (OR = 1.011, P = 0.014) were associated with low RS and that heterogeneously dense (OR = 3.205, P = 0.007) or scattered fibroglandular (OR = 3.776, P = 0.005) breast tissue, a non-spiculated margin (OR = 5.435, P = 0.007), and low proportion of persistent component (OR = 1.012, P = 0.036) were associated with high RS.MRI features showed the potential for the discrimination of Oncotype DX RS in patients with ER-positive HER2-negative invasive breast cancer.

Background Currently, the BREAST-Q can effectively measure patient's satisfaction on the quality of life from the patient's perspective in relation to different type of breast reconstruction. However, evaluation of patient satisfaction and cosmetic outcomes in breast reconstruction may have potential to led bias. Methods To maximize the benefits of using BREAST-Q to evaluate clinical outcome, we performed comparative study focused on the correlation between postoperative BREAST-Q and cosmetic outcomes assessed by medical professionals. For the current analysis, we used three postoperative BREAST-Q scales (satisfaction with breast, psychosocial well-being, and sexual well-being). The Ten-Point Scale by Visser et al was applied to provide reproducible grading of the postoperative cosmetic outcomes of the breast. The system includes six subscales that measured overall aesthetic outcome, volume, shape, symmetry, scarring, and nipple-areolar complex. The photographic assessments were made by five medical professionals who were shown photographs on a computer screen in a random order. Obtained data were stored in Excel and evaluated by Spearman's correlations using SPSS Statistics. Results We enrolled 92 women in this study, 10 did not respond to all scales of postoperative BREAST-Q, the remaining 82 women had undergone breast reconstruction. The correlation between BREAST-Q score and aesthetic score measured by Ten-Point Scale for the three BREAST-Q scales all show positive values in Spearman's correlation coefficient. Conclusion A significant correlation without any bias observed was found between the patient's satisfaction measured by BREAST-Q after breast reconstruction and the medical expert's aesthetic evaluation.

This pilot study evaluated the effect of the tablet-based cognitive behavioral intervention ("Tab-CBI") on daily steps, fatigue, and self-efficacy. Tab-CBI combined simple walking and a cognitive behavioral approach. An experimental pretest-posttest repeated measures design was used with 24 older adults. RM-ANOVA results showed a significant group difference (Tab-CBI vs. Comparison), F (1, 22) = 2.25, p =0.048 and time difference (baseline vs. week 4 vs. week 6), F (2, 44) =5.04, p =0.01 in daily steps. There was no significant group difference, F (1, 22) = 2.99, p =0.09, but significant time difference existed, F (2, 44) =2.65, p =0.04 in the PROMIS Fatigue scores. In the PROMIS Self-efficacy scores, no significant group difference, F (1, 22) = 0.02, p =0.90) was found, but significant time difference existed, F (2, 44) =3.27, p = 0.04. The findings provide preliminary evidence for the positive impact of Tab-CBI, but should be interpreted cautiously.

Objectives Nursing has embraced online education to increase its workforce while providing flexible advanced education to nurse professionals. Faculty use virtual simulation and other adaptive learning technologies to enhance learning efficiency and student outcomes in online courses. The purpose of this study was to assess the impact of simulated Electronic Health Records (EHRs) on informatics competency in a graduate online informatics course. Methods A two-group independent measures study design was adopted to assess students' perception of a simulated EHR while comparing differences in informatics competencies between an intervention group and a control group. A simulated EHR assignment was provided to students in the intervention group, and a paper assignment was provided to those in the control group. The informatics competency of the students was measured using the Self-Assessment of Informatics Competency Scale for Health Professionals (SICS). Results Students who were enrolled in a family nurse practitioner program in fall of 2019 participated in this study (n = 39). The students expressed positive perceptions of a simulated EHR experience. The SICS results indicated that students in the intervention (simulated EHR) group showed higher informatics competency than those in the control group. Conclusions The positive results of this study support incorporating simulated EHR exercises in online courses. Higher informatics competency in the intervention group implies that the use of simulated EHR facilitated learning of complicated informatics concepts.

The chloride ion (Cl−) can adversely affect an aquatic ecosystem, but it is not clear how Cl− moves with runoff and how its transport processes are related to land uses and land cover. This study investigated how the loading characteristics of Cl− vary depending on storm events and land cover in a temperate region. We monitored Cl− concentrations in three study watersheds that have different compositions of urban and agricultural land uses. In addition, a Mass First Flush ratio (MFFn) was determined to quantify the effect of first flush on Cl− loading. Overall, the observed concentrations and loadings in this study were found to be less than those reported in cold northern regions. The monitoring data showed that Cl− concentrations and loads observed in an urban watershed were significantly larger than those of a rural watershed. The results suggest water management plans should focus on urbanized areas and their storm water to efficiently reduce chloride loading to downstream waterbodies. However, a further study is recommended to identify the sources and pathways of Cl− loaded to waterbodies. HIGHLIGHTS Cl− loading varies depending on storm events and land cover.; The first flush effect on Cl− loading was strong in urban storm runoff.; The urban watersheds had significantly larger Cl− loads than the rural watershed.

Monitoring provides data and information necessary for water quality assessment, but often it is prohibitive, especially when frequent sampling is required. In this study, we explored feasible sampling intervals for improved efficiency of nonpoint source (NPS) pollution assessment. We compared NPS pollutant loads calculated with concentration samples collected at 1, 2, 3, 4, and 6-hour intervals for the first 24 hours of 13 storm events and investigated the effect of different sampling intervals on load estimation for three watersheds that have different land uses. When compared to load estimates made from concentrations sampled at the reference (1-hour) interval, differences in load estimates were less than 10% in the cases of the 2-hour and 3-hour intervals in the urbanized and agricultural watersheds, respectively, except in the case of suspended solids (SS). When it comes to the total load estimation, up to 3-hour interval sampling provided load estimates with acceptable accuracy, except for SS. Thus, the 3-hour sampling interval was considered feasible for long-term pollutant load assessment, while the 2-hour sampling interval was suggested for SS. Such findings are expected to facilitate NPS pollution assessment by providing information required to improve monitoring efficiency. HIGHLIGHTS The efficiency and accuracy of different water sampling intervals were assessed for improved feasibility of nonpoint source pollutant monitoring.; The sampling intervals of equal to or less than 3 hours could provide accurate and efficient pollutant load estimates in agricultural areas.; Urbanized areas required relatively frequent water sampling to satisfy the required accuracy.

OBJECTIVES To evaluate the value of the vascular index (VI) on Superb Microvascular Imaging (SMI; Canon Medical Systems Corporation, Tokyo, Japan) in comparison with grayscale ultrasound (US) alone for assessing breast masses. METHODS We evaluated a total of 70 breast masses (36 malignant and 34 benign lesions) in 70 consecutive patients using grayscale US and SMI. Two breast radiologists analyzed grayscale US alone and the combination of grayscale US and SMI. They also measured the VI based on SMI. The diagnostic performance of grayscale US alone and the combination of grayscale US and SMI was compared. The VI was compared between benign and malignant masses, and the optimal cutoff value was determined. In addition, the interobserver agreement in imaging analyses and the VI was assessed. RESULTS The interobserver agreements in imaging analyses and the VI were almost perfect. The VI of malignant breast masses was significantly higher than that of benign lesions (P

Summary Objective The purpose of this study was to evaluate the feasibility of image fusion between US and supine MRI in breast cancer patients, and to evaluate differences in tumor location between prone and supine positions. Methods This prospective study included 88 patients who underwent an additional supine MRI (MRsup) sequence following routine prone MRI (MRpro) for breast cancer between May 2016 and December 2017. The location of the tumor and discrepancies in the distances from nipple to lesion (NLD), skin to lesion (SLD), and chest wall to lesion (CLD) were evaluated between MRpro and MRsup (MRpro-sup), MRpro and MRsup-navigated US (MRpro-USnav), and MRsup and USnav (MRsup-USnav). Associations between breast thickness and measurement discrepancies were analyzed. Results Total 91 index lesions were evaluated. The intraclass correlation coefficients (ICCs) for the location of MRpro and MRsup compared with USnav were 0.994 (range: 0.990–0.996) and 0.998 (range: 0.996–0.999), respectively. The mean MRpro-sup and MRpro-USnav measurement discrepancies were greater than those of MRsup-USnav, significantly. Most outer locations showed greater mean measurement discrepancies than inner locations, and each NLD, SLD, and CLD mean measurement discrepancy showed different tendencies according to location (upper or lower) and lesion depth (superficial, middle, or deep). High breast thickness showed significantly greater mean measurement discrepancies than low breast thickness. Conclusion Image fusion between US and supine MRI is feasible in breast cancer patients, although there is a considerable difference in tumor location measurements between prone and supine positions, especially with thicker breasts.