Purpose To evaluate the characteristics of breast cancers detected and missed by artificial intelligence-based computer-assisted diagnosis (AI-CAD) during screening mammography. Materials and Methods This retrospective secondary analysis was conducted using data from the Artificial Intelligence for Breast Cancer Screening in Mammography trial (ClinicalTrials.gov: NCT05024591), a prospective, multicenter cohort study performed from 2021 to 2022. AI-CAD results were categorized into nine subgroups based on abnormality scores (in 10% increments). Positive predictive values of recall (PPV1s) were calculated for each subgroup and by breast density, and AI-CAD scores were compared with mammographic and pathologic features. Results A total of 24 543 women (mean age ± SD, 59.8 years ± 11.2), including two with bilateral cancer, were included; 148 cancers were confirmed by pathologic evaluation after 1 year of follow-up. AI-CAD results were negative in 23 010 cases (93.8%) and positive in 1535 (6.2%). The overall PPV1 was 8.7% (133 of 1535), with a sensitivity of 89.9% and specificity of 94.3%; PPV1 increased with higher abnormality scores but remained below 3% in groups 1 and 3 for dense breasts. AI-CAD detected 3.4% (five of 148) of cancers missed by radiologists but missed 8.1% (12 of 148) that were detected at radiologist recall. Abnormality scores were lower in patients presenting with mammographic asymmetry (P = .001) and luminal A subtype (P = .032). Conclusion AI-CAD shows potential to improve breast cancer detection in screening programs and to support radiologists in mammogram interpretation. Understanding the imaging and pathologic features of cancers detected or missed by AI-CAD may enhance its effective clinical application. Keywords: Breast Cancer, Mammography, AI CAD Clinical trial registration no. NCT05024591 © RSNA, 2025 See also commentary by Do and Bahl in this issue.
Background:Arthroscopic repair of bucket-handle meniscal tears (BHMTs) is technically challenging owing to the complexity of the tear patterns. Compared to simpler meniscal tears, BHMTs are associated with a higher failure rate and often require subsequent meniscectomy. This study aimed to assess clinical outcomes, failure rates, and risk factors for failure following primary arthroscopic repair of BHMTs. Methods:Seventy-four patients (mean age, 27.2 ± 11.2 years) who underwent arthroscopic BHMT repair were included (mean follow-up period, 60.2 ± 36.0 months). Analyzed risk factors included age, sex, body mass index, chronicity, laterality, tear zone, and concomitant anterior cruciate ligament reconstruction. Clinical failure was defined as the presence of clinical symptoms consistent with a meniscus tear and the need for subsequent surgery. The Kaplan-Meier method and log-rank test were performed to compare groups classified by postoperative meniscal healing status on magnetic resonance imaging (MRI) at a mean follow-up period of 7.30 ± 1.80 months. Clinical outcomes were assessed using the Tegner activity score, Lysholm knee score, and Hospital for Special Surgery (HSS) knee score. Results:The clinical failure rate was 14.9% (11 / 74). Six patients underwent subtotal meniscectomy, and 5 patients underwent partial meniscectomy. Red-white zone involvement was a significant risk factor for clinical failure (odds ratio, 6.182; 95% CI, 1.093-34.950; p = 0.039). Survival analysis based on postoperative MRI findings revealed a significant difference among 3 groups (p = 0.008): the completely healed group showed a 100% survival rate (20 / 20); the partially healed group, 80% (32 / 40); and the unhealed group, 0% (0 / 5). Patients with lateral BHMTs had a significantly higher rate of complete healing than those with medial BHMTs (46.4% vs. 18.9%; p = 0.014). At the final follow-up, the non-failure group demonstrated significantly higher Tegner activity (5.1 ± 1.2 vs. 4.4 ± 0.5; p = 0.038), Lysholm knee (87.7 ± 6.2 vs. 83.2 ± 3.1; p = 0.029), and HSS knee (93.9 ± 4.7 vs. 89.6 ± 3.0; p = 0.007) scores than the failure group. Conclusions:BHMTs involving the red-white zone or located in the medial meniscus-particularly those showing inferior early postoperative MRI healing-should be closely monitored after surgery.
Herein, we present a novel high-throughput (HT) molecular diagnostic platform that automates nucleic-acid testing from sample extraction to fluorescence detection. A single microfluidic disc accommodates six distinct units, each of which includes the RNA extraction, the gene amplification, and the fluorescence detection, enabling simultaneous analysis of up to 36 targets in one run. For HT diagnostics, the microfluidic disc features a zig-zag aliquoting architecture for rapid and uniform reagent loading. Additionally, we incorporated the Switching-PCR assay, which is a sequentially executed nested PCR, providing higher specificity and sensitivity compared with the conventional PCR. We also constructed a point-of-care testing (POCT) workstation featuring an induction-driven thermal cycler and an automated reagent-injection system. The thermal cycler combines a high-speed spinning motor for on-disc centrifugation with induction heating for precise cycling. Electromagnetic induction provides contactless, rapid, and spatially uniform heating of embedded conductive elements, minimizing contamination risk while improving thermal accuracy on the 36 reaction chambers. Real-time amplification was monitored by a two-channel fluorescence detector (supports FAM and Texas Red probe). For the automatic solution loading, the dual-function injection system was manufactured, and hand-free fluid injection is carried out in an order, thereby eliminating operator intervention. We demonstrated the performance of the Switching-PCR assay incorporated POCT system by detecting seven respiratory virus targets-influenza A, influenza B, respiratory syncytial virus A, respiratory syncytial virus B, adenovirus, metapneumovirus, and SARS-CoV-2 (E and Rdrp gene)-across six samples. These results highlight our proposed platform's potential for rapid, accurate, and fully automated molecular diagnostics as a workstation-style POCT system, enabling near-patient, decentralized testing for screening, outbreak response, and surveillance in clinic-based or mobile-deployment environments with minimal operator training.
Background/Objectives: Abnormal muscle tone and impaired motor control commonly limit gait recovery after stroke. Robot-assisted gait training has been introduced to augment conventional rehabilitation; however, its effects on stage-based motor recovery, functional ambulation, and muscle tone during the subacute phase remain unclear. Methods: This prospective, single-center, randomized controlled trial enrolled 30 patients with subacute stroke who received robot-assisted gait training plus conventional rehabilitation (R-BoT Plus group, n = 15) or conventional rehabilitation alone (control group, n = 15) over 4 weeks. The primary outcome was the change in Brunnstrom recovery stage of the lower extremities (BRS-LE). Secondary outcomes included Functional Ambulation Category (FAC), Fugl-Meyer Assessment for the Lower Extremity (FMA-LE), clinical spasticity measures (Modified Ashworth Scale and Modified Tardieu Scale), and muscle mechanical properties (MyotonPRO). Exploratory analyses were conducted to examine the associations between changes in stage-based motor recovery (ΔBRS-LE), functional ambulation (ΔFAC), and MyotonPRO parameters. Within-group changes were assessed using the Wilcoxon signed-rank test. Between-group effects were primarily evaluated using baseline-adjusted ANCOVA with HC3 robust standard errors, with Wilcoxon rank-sum tests on change scores as sensitivity analyses. Associations between changes in clinical outcomes and MyotonPRO parameters were evaluated using Spearman's rank correlation coefficient (ρ). Results: BRS-LE (p = 0.014) and functional ambulation (p = 0.041) were significantly improved in the R-BoT Plus group. Changes in FMA-LE and clinical spasticity measures did not differ significantly between groups. Quantitative myotonometry revealed selective muscle- and parameter-specific changes. No robust correlations were observed between MyotonPRO parameters and changes in BRS-LE. Conclusions: The addition of robot-assisted gait training to conventional rehabilitation was associated with greater improvements in stage-based lower-limb motor recovery and functional ambulation in patients with subacute stroke. In contrast, cumulative impairment scores and conventional clinical spasticity measures demonstrated limited changes between groups. Quantitative muscle mechanical assessment revealed selective muscle-specific adaptations, supporting its role as a complementary tool for mechanistic characterization rather than as a surrogate marker of motor recovery. Future studies incorporating dose-matched designs and longer follow-up periods are warranted to clarify the independent and long-term effects of robot-assisted gait training.
BACKGROUND:Although low-dose triple single-pill combination therapies show promising efficacy and safety, studies comparing them to standard-dose monotherapies remain limited. This phase III, randomized, double-blind trial evaluated the efficacy and safety of a low-dose single-pill combination of telmisartan, amlodipine, and chlorthalidone versus standard-dose telmisartan monotherapy in patients with essential hypertension. METHODS:After a 4-week placebo run-in period, 314 eligible subjects were randomized to either receive telmisartan/amlodipine/chlorthalidone 20/2.5/6.25 mg or telmisartan 40 mg for 8 weeks. The primary efficacy end point was the change in mean sitting systolic blood pressure from baseline to week 8, with noninferiority assessed in the per-protocol set (PPS), followed by superiority testing in the full analysis set using a gatekeeping approach to control for type I error. RESULTS:At week 8, the combination group demonstrated significant mean sitting systolic blood pressure reduction compared with monotherapy in the per-protocol set analysis (least squares mean difference, -3.8 mm Hg [95% CI: -6.7 to -0.9]; P=0.01), establishing its noninferiority. Furthermore, the superiority of the combination therapy was confirmed in the full analysis set (LS mean difference, -4.0 mm Hg [95% CI, -6.8 to -1.3]; P<0.01). Mean sitting diastolic BP, BP normalization rates, and response rates also favored the combination group at weeks 4 and 8 (all P<0.01). Subgroup analyses showed consistent efficacy across clinical strata, including age and prior antihypertensive treatment. The incidence of adverse events was comparable between groups, with no serious drug-related events reported. CONCLUSIONS:Low-dose triple single-pill combination of telmisartan/amlodipine/chlorthalidone demonstrated superior BP-lowering efficacy with well-tolerated and comparable safety to standard-dose telmisartan monotherapy. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT06348576.
