The diagnostic performance of both the single- and dual-phase approaches of portal venous phase split-bolus DECT urography is equally good in patients with hematuria, and single-phase acquisition has the added benefit of radiation reduction.

Proper bone age assessment is crucial for the clinical diagnosis and evaluation of treatment responses. We investigated the applicability of Greulich and Pyle (GP), and Tanner and Whitehouse 3 (TW3) methods for children in modern Taiwan, using computer‐aided diagnosis. Hand and wrist radiographs were obtained from 611 children (3‐17 years) who came to our emergency department due to trauma. Ages 0 to 2 years old were excluded because of a limited number of cases. Skeletal maturation was assessed using the BoneXpert (version 2.5.4.1 automated software), which determines GP and TW3 bone age. The two scoring systems were evaluated for comparing the chronological ages in each subgroup. In boys, mean GP bone age vs mean chronological ages were delayed for ages 3 to 11 and advanced for age 12 to 17. In girls, mean GP bone age vs mean chronological ages was delayed for ages 4 to 8 and 17, and advanced for ages 3 and 9 to 17. In boys, the mean TW3 bone ages vs mean chronological ages were delayed for ages 5 to 10 except age 8, and advanced for ages 3 to 4, 8, and 11 to 15. In girls, the mean TW3 bone ages vs mean chronological ages were delayed for ages 4 to 12, and advanced for ages 3 and 13 to 14. By using the BoneXpert automatic software, we established bone age reference standards for children in Taiwan. Clinical application of GP and TW3 scoring methods can be adjusted according to our results to better assess bone age.

Stereotactic vacuum‐assisted biopsy (SVAB) is an alternative method of breast biopsy for nonpalpable lesions detected by mammography. Considering the diagnostic effectiveness, a direct comparison of SVAB and open surgical biopsy (OSB) is lacking. We performed a retrospective review of 276 (33.8%) SVAB and 541 (66.2%) OSB to compare the diagnostic accuracy and the total number of procedures the patients underwent. The negative predictive values of OSB and SVAB were 99.77% and 99.61%, and their false‐negative rates were 0.96% and 4.76%, respectively. SVAB, as the first‐line biopsy method, obviated 92.3% of operations. All malignancies diagnosed using SVAB could be treated with single therapeutic surgery. By contrast, 48% of malignancies of OSB group received two operations. Breast Imaging Reporting and Data System (BI‐RADS) category used at the study correlated well with the percentage of malignancy and can thus be used to predict biopsy results. Our study concluded that SVAB is reliable for diagnosing nonpalpable breast lesions and is the better biopsy method for categories 3 and 4A lesions, which reduces the benign surgery rate. For lesions with a higher likelihood of malignancy, BI‐RADS 4B, 4C and 5, SVAB has an advantage over OSB, which lowers the total number of operations for malignancy treatment.

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Background: Negatively charged very-low-density lipoprotein (VLDL-χ) in metabolic syndrome (MetS) patients exerts cytotoxic effects on endothelial cells and atrial myocytes. Atrial cardiomyopathy, manifested by atrial remodeling with a dilated diameter, contributes to atrial fibrillation pathogenesis and predicts atrial fibrillation development. The correlation of VLDL-χ with atrial remodeling is unknown. This study investigated the association between VLDL-χ and the remodeling of left atrium.Methods: Consecutively, 87 MetS and 80 non-MetS individuals between 23 and 74 years old (50.6% men) without overt cardiovascular diseases were included in the prospective cohort study. Blood samples were collected while fasting and postprandially (at 0.5, 1, 2, and 4 hours after a unified meal). VLDL was isolated by ultracentrifugation; the percentile concentration of VLDL-χ (%) was determined by ultra-performance liquid chromatography. The correlations of left atrial diameter (LAD) with variables including VLDL-χ, LDL-C, HDL-C, triglycerides, glucose, and blood pressure, were analyzed by multiple linear regression models. A hierarchicallinear model was conducted to test the independencies of each variable’s correlation with LAD.Results: The mean LAD was 3.4 ± 0.5 cm in non-MetS subjects and 3.9 ± 0.5 cm in MetS patients (P< 0.01). None of the fasting lipid profiles were associated with LAD. VLDL-χ, BMI, waist circumference, hip circumference, and blood pressure were positively correlated with LAD (all P<0.05) after adjustment for age and sex. Significant interactions between VLDL-χ and blood pressure, waist circumference, and hipcircumference were observed. When adjusted for obesity- and blood pressure-related variables, 2-hour postprandial VLDL-χ (mean 1.30 ± 0.61%) showed a positive correlation with LAD in MetS patients. Each 1% VLDL-χ increase was estimated to increase LAD by 0.23 cm.Conclusions: Postprandial VLDL-χ is associated with atrial remodeling particularly in the MetS group. VLDL-χ is a novel biomarker and may be a therapeutic target for atrial cardiomyopathy in MetS patients.Trial registration: ISRCTN 69295295. Retrospectively registered 9 June 2020.

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Congenital coronary artery fistulas (CAFs) are an uncommon congenital anomaly. While most patients are asymptomatic, life-threatening events including sudden death, myocardial ischemia, heart failure, infective endocarditis, and rupture of aneurysm may occur. Surgical ligation was once the standard choice of management of CAFs in the past. However, transcatheter closure of CAFs has become an emerging alternative to surgery in patients with suitable anatomy. We reported a 7-month-old infant with a giant and tortuous CAF that originated from the distal right coronary artery and drained into the right ventricle, and was successfully treated by transcatheter closure with an Amplatzer ductus occluder.

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