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The occurrence of post-radioactive iodine thyroid storm among patients with hyperthyroidism is relatively rare and only a few cases have been reported. We conducted a literature review of cases reported from 1951 to 2023 and determined the risk factors and clinical characteristics of patients who developed thyroid storm. A total of 19 cases were documented and reviewed. The mean age was 51.2 ± 20.1 years (range 7.5 to 75). Approximately two-thirds were females. Major etiologies were diffuse toxic goiter (57.9%) and nodular disease (36.8%). Mean dose was 11.3 ± 7.7 mCi (range 3.3 to 35), with 52.6% receiving less than 10 mCi. Mean interval time from administration to development of thyroid storm was 6.6 ± 5.5 days (range 0.5 to 20). The most common preexisting conditions were weight loss, heart failure, atrial fibrillation, hypertension and coronary artery disease. Thyroxine levels were not routinely measured prior to and during storm. Among those with available data, only 26.3% had hormone levels prior to and during storm. Thyroxine levels during storm (range 19.8 to 65 µg/dL) were higher than levels prior to storm (range 9.6 to 45 µg/dL). Pretreatment regimens varied consisting of no intervention, beta blockers, steroids, reserpine, phenobarbital and anti-thyroid drugs. Treatment regimens are more uniform and consistent with American Thyroid Association recommendations. The mortality rate remains high at ~ 26.3%. Statistical analyses did not show any significant differences. Even though the frequency of this condition is quite rare, it is an important and potentially prognostic condition underscoring the value of this review. The inclusion of this severe adverse effect should be part of patient discussion with emphasis on the need to seek early consultation when severe symptoms appear. [ABSTRACT FROM AUTHOR]

This case report describes a mycobacterial infection in an adult Whippet cross dog. The dog was diagnosed with Mycolicibacterium sediminis infection, a species of mycobacteria that is yet to be reported as a causative agent of infection in humans or domestic animals. The dog was presented for specialist opinion of a 6‐month history of severe facial lymphadenopathy that was nonresponsive to antibiotic and immunosuppressive therapy. A necrotic lesion developed on her right antebrachium approximately 10–14 days before presentation. The dog was anaesthetised for computed tomography and nodule and skin biopsies including fresh tissue for mycobacterial polymerase chain reaction (PCR). The nodules contained pyogranulomatous inflammation and perivascular necrosis that are typically found in mycobacterial infections. The mycobacterial PCR isolated Mycolicibacterium sediminis. The dog was prescribed triple antibiotic therapy and tapered off corticosteroids, with noticeable improvement within 4 weeks and resolution of granulomas within 3 months of therapy. Presence of chronic dermal pyogranulomatous inflammation should raise suspicions for mycobacterial disease, and fresh tissue should be submitted for PCR to aid in diagnosis. [ABSTRACT FROM AUTHOR]

ABSTRACT Nodular gill disease (NGD) is a serious proliferative gill condition that affects farmed salmonids, particularly in Europe. While the cause of NGD remains unknown (and maybe multifactorial), various amoebae are often isolated from the gills of affected fish and can in some cases be seen associated with lesions by histopathology. The present study aimed to quantify the abundance of different amoeba species directly from the gills of rainbow trout affected by NGD and healthy controls. An 18S rRNA amplicon metagenomic approach was employed to profile the diversity and abundance of micro‐eukaryotes (including amoebae) while suppressing the amplification of host DNA using a salmonid‐specific C3 spacer blocking primer. The 18S rRNA metagenomics approach identified a diversity of micro‐eukaryotes on the gills of rainbow trout, including the phylum's Amoebozoa, Diatomea, Platyhelminthes and Ciliophora. Rainbow trout clinically affected by NGD had a significantly higher abundance of a specific sequence (zOTU2) classified as Vannella sp. compared to healthy controls. A quantitative PCR assay was then developed and validated which accurately quantified the abundance of this Vannella sp. sequence from a NGD outbreak in a Swiss rainbow trout farm. Additional PCR and Sanger sequencing analysis of the zOTU2 sequence demonstrated that this sequence is most likely derived from Vannella mustalahtiana. Our study highlights the potential role of Vannella mustalahtiana in NGD in Switzerland and further describes a specific and validated diagnostic PCR assay for accurate detection of this Vannella species. [ABSTRACT FROM AUTHOR]

Nodular granulomatous episcleritis (NGE) typically presents as an elevated mass or elevated masses at the limbus and often infiltrates the cornea (episclerokeratitis). In the current report, a granulomatous lesion was observed subretinally in the right eye (OD) of a 5‐year‐old male castrated American Staffordshire Terrier dog. There was concurrent retinal hemorrhage and detachment OD; the right eye was not visual. Due to poor prognosis for vision and potential for a neoplastic etiology of the mass, staging with higher imaging was recommended but declined by the owner. Therefore, an enucleation was performed. Histopathology of the globe identified a subretinal mass, marked histiocytic and lesser lymphoplasmacytic choroiditis, posterior episcleritis, and optic neuritis with retinal detachment. The subretinal mass was composed of densely packed, large, spindle histiocytes mixed with occasional lymphocytes, plasma cells, and only rare neutrophils. Regions of the mass showed lymphocytes aggregate to form nodules. This histological presentation was a type of proliferative histiocytic disease with similarities to nodular granulomatous episcleritis or granulomatous/necrotizing scleritis. This is a novel presentation of NGE‐like progression to subretinal scleral, choroidal, and retinal involvement and provides a new differential possibility for posterior segment masses observed on fundic examination. [ABSTRACT FROM AUTHOR]

Primary pigmented nodular adrenocortical disease (PPNAD) is a rare cause of ACTH-independent Cushing syndrome (CS), presenting diagnostic challenges due to its rarity and its difficult clinical differentiation from other causes of CS. Here, we report the case of a 22-year-old female who developed classical symptoms of hypercortisolism including progressive weight gain, moon facies, and various skin manifestations. Despite biochemical screening confirming ACTH-independent CS, imaging modalities including computed tomography and magnetic resonance imaging showed normal adrenal gland morphology, complicating the localization of cortisol hypersecretion. Subsequent nuclear imaging methods were not indicative of ectopic cortisol production until adrenal vein sampling (AVS) conclusively identified the adrenal glands as the only possible source of cortisol hypersecretion. Eventually, bilateral adrenalectomy led to a significant improvement in symptoms. Pathological examination confirmed the diagnosis of PPNAD, and genetic testing revealed a mutation in the PRKAR1A gene associated with the Carney complex. This case highlights the importance of considering rare etiologies in hypercortisolism diagnosis and describes their challenging diagnostic workup and the utility of AVS in localizing cortisol hypersecretion in PPNAD patients. [ABSTRACT FROM AUTHOR]

Aim: Bethesda System for reporting thyroid cytopathology established in 2009 was updated for the first time in 2017. Since its introduction very few studies have been done on the utility of recently introduced "The 2017 Bethesda System for Reporting Thyroid Cytopathology" (TBSRTC II) and estimation of risk of malignancy in various categories. Material and methods: This was a prospective study done on thyroid lesions in which lesions were evaluated cytologically and classified according to TBSRTC II. Histopathological correlation was done, wherever possible. ROM was calculated for each Bethesda category in both ways as per TBSRTC II i.e. with NIFTP and excluding NIFTP from the malignant category. Results: Using 2017 TBSRTC, 190 cases of thyroid FNACs were classified into 6 diagnostic categories. Cytohistological correlation was available in 60 cases. ROM was calculated which changed only in category III and V as only these two categories showed one case each of NIFTP. However there was an overestimation of ROM in category II and III as there are selection biases and not all thyroid nodules underwent surgical resections. Conclusion: To conclude, the risk of malignancy calculated in two ways in the recent 2017 Bethesda system may have higher clinical relevance as those lesions with high ROM are defined for surgical excision. Thus we recommend that "The 2017 Bethesda system for Reporting Thyroid Cytopathology" should be implemented uniformly in our country as it provides a homogenous and standardised terminology resulting in better management of patients with thyroid nodular disease. [ABSTRACT FROM AUTHOR]

Intra-articular tumours are uncommonly encountered in routine practice and may present diagnostic challenges to pathologists. Challenges unique to this site include distinction from more common reactive synovial conditions, which are far more common; histologic variability; superimposed reactive changes; and often, lack of provided clinicoradiological context. This article reviews the pathology of the synovial tumours and tumour-like lesions, including diagnostic pearls, pitfalls and rare entities. [ABSTRACT FROM AUTHOR]

Objective To investigate the value of magnetic resonance image-diffusion weighted imaging (MRI-DMI) combined with attenuation imaging (ATI) in the diagnosis of focal nodular lesions < 2 cm in the background of fatty liver. Methods The clinical data of 68 patients with fatty liver complicated with focal nodular lesions < 2 cm were retrospectively analyzed from June 2022 to June 2023 in Huaihe Hospital of Henan University. All patients underwent MRI, pathology and ATI examination. According to the degree of fatty liver disease, 68 patients were divided into severe group (n = 24), moderate group (n = 27) and mild group (n = 17). The apparent diffusion coefficient (ADC) and acoustic attenuation coefficient (AC) values of patients with different focal lesions were compared with clinical data, and the ADC values and AC values of patients with different fatty liver lesions were compared with clinical data, and the correlation was analyzed by Pearson. To analyze the value of MRIDWI combined with AC value in the diagnosis of malignant fatty liver disease with focal nodular disease < 2 cm. Results Pathological diagnosis showed that 41 of the 68 patients were benign and 27 were malignant. There were no significant differences in low density lipoprotein cholesterol (LDL-C), age, triglyceride (TG), sex, total cholesterol (TC) and high density lipoprotein cholesterol (HDL-C) between benign nodule group and malignant nodule group (P > 0.05). There was no difference in TG, age, HDL-C, sex, TC and LDL-C among mild, moderate and severe groups (P > 0.05). The ADC value of malignant nodule group was lower than benign nodule group under different b values (P < 0.05), and the AC value of malignant nodule group was higher than that of benign nodule group (P < 0.05). ADC value under different b values in the severe group was lower than mild and moderate groups (P < 0.05), ADC value under different b values in the moderate group was lower than mild group (P < 0.05), AC value in the severe group was higher than mild and moderate groups (P < 0.05), and AC value in the moderate group was higher than mild group (P < 0.05). ADC values at different b values were negatively correlated with the degree of fatty liver disease (P < 0.05), but not with TG, HDL-C, TC and LDL-C (P > 0.05). AC was positively correlated with the degree of fatty liver disease (P < 0.05), negatively correlated with HDL-C (P < 0.05), but not with TG, TC and LDL-C (P > 0.05). The area under the curve (AUC) values of MRI-DWI, AC and their combination in the diagnosis of fatty liver complicated with focal nodule disease < 2 cm into malignancy were 0.775, 0.773 and 0.909, respectively (P < 0.05), and the AUC value of the combination was higher (P < 0.05). Conclusion MRI-DWI and ATI have important value in the differential diagnosis of benign and malignant lesions of focal nodular lesions < 2 cm in the background of fatty liver, and the combination of MRI-DWI and ATI has higher diagnostic value. [ABSTRACT FROM AUTHOR]

Background and Objectives: Thyroid disorders are one of the most common endocrine disorders affecting 4-5% of the general population. The objective of study is to evaluate the predictive value of preoperative serum TSH levels in predicting malignancy in nodular thyroid diseases. Methods: It is a longitudinal study of 28 patients with thyroid swelling admitted to surgery department in a tertiary care referral hospital, during the period of January 2011 to December 2011. Thyroid function tests were done by standard electro chemiluminescent assay and serum TSH levels, age, sex were compared with malignancy. Logistic regression analysis was used to determine which factors were predictive of malignancy. Results: 28 cases were analysed. Mean TSH levels were higher in the malignant group and in the age group of 50-65 yrs. Prevalence of malignancy was studied in the all TSH groups and it was found that the higher quartiles of serum TSH levels were found to be associated with increased risk of malignancy. Logistic regression analysis revealed that TSH levels was the only significant risk factor for malignancy. Conclusion: the serum TSH level may be useful in predicting the probability of cancer and optimizing the extent of thyroidectomy in patients with NTD. [ABSTRACT FROM AUTHOR]

Neurosurgeons often use radiation to visualize blood vessels and implants intraoperatively. However, high exposure to radiation increases one's cancer risk. This study aims to investigate intraoperative ionizing radiation exposure awareness and associated morbidity among neurosurgeons. An anonymized 30-question survey about their intraoperative radiation exposure, protective measures, radiation knowledge, and any conditions that can arise from protracted radiation exposure was disseminated to 3344 American Association of Neurological Surgeons members. A total of 227 (6.8%) neurosurgeons completed the survey. Most neurosurgeons (61, 27%) performed 2–4 surgeries per week necessitating radiation (61, 27%), did not use a dosimeter (134, 59%), and wore a lead apron (89%) and a thyroid shield (75%). Only 7 (3%) of respondents could correctly identify the safety limit for occupational radiation. One hundred and thirty-four (59%) respondents correctly identified the relationship between distance and radiation dose reduction. Two hundred and thirteen (94%) neurosurgeons reported concern about occupational radiation exposure. No significant association was found between occupational radiation exposure and the rate of cataracts, combined cancer, and skin cancer. Multivariate logistic regression adjusting for age and cancer history found that the likelihood of developing leukemia (P = 0.02) and nonmalignant thyroid nodular disease (P = 0.01) is positively associated with increased total occupational radiation exposure. There is a need for improved radiation safety awareness among neurosurgeons, especially in the context of rising usage of minimally invasive surgery. This can allow for a greater understanding of radiation-associated risks among neurosurgeons and guide the implementation of safer practices. [ABSTRACT FROM AUTHOR]

Nodular scabies (NS) is a relatively common variant of classical scabies whose pathogenesis is unclear. It is clinically characterized by pruritic, firm nodules most commonly involving the genitalia followed by axilla and groin region. A clinical diagnosis of NS is often straightforward. NS may persist despite the administration of antiscabicidal drugs such as permethrin and ivermectin. Topical and intralesional corticosteroids form the mainstay of treatment. Postscabietic nodule is a complication that primarily occurs in patients with previous history of scabies that had been successfully treated. [ABSTRACT FROM AUTHOR]

Background: The use of ultrasound aids in the identification of thyroid nodules, but it is still crucial to determine whether or not they are problematic using non-invasive methods. Aim of work: To evaluate validity of TIRADS in diagnosis of nature of thyroid nodules. Patients and methods: A cross sectional study was conducted on 95 nodules derived from thirty patients in radio diagnosis department in Zagazig University hospital from February 2018 to June 2019. All patients underwent complete history taking, full clinical examination, ultrasonographic evaluation of thyroid gland and Fine needle aspiration cytology (FNAC) for solitary nodule or the most suspicious nodules in patients with multinodular goiter and then smears were pathologically assessed. Results: About 73% of patients were females with mean age 46 years. Out of the ninety-five nodules, fifty were assesses using US-guided FNAB. Ten nodules were malignant. Papillary carcinoma was the most common accounting for seven nodules. Thyroid Imaging Reporting and Data System (TIRADS) 3 was the most commonly encountered category accounting (42%) while The different TIRADS categories were confronted with the results of pathology and the risk of malignancy were Compared with benign nodules, significantly higher percentages of malignant nodules wee solid, hypoechoic, with irregular margins, taller-than-wide morphology, with microcalcifications, markedly hypoechoic or associated abnormal cervical lymphadenopathy. Tab and T5 predict malignant nature of nodule with sensitivity 90%, specificity 95%, and 95% accuracy. Conclusions: Russ' modified TIRADS classification is reliable in both stratifying nodular thyroid disease based on the risk of malignancy and predicting thyroid malignancy. [ABSTRACT FROM AUTHOR]

Nodular gill disease (NGD) is an emerging condition associated with amoeba trophozoites in freshwater salmonid farms. However, unambiguous identification of the pathogens still must be achieved. This study aimed to identify the amoeba species involved in periodic NGD outbreaks in two rainbow trout (Oncorhynchus mykiss) farms in Northeastern Italy. During four episodes (February–April 2023), 88 fish were euthanized, and their gills were evaluated by macroscopic, microscopic and histopathological examination. The macroscopic and microscopic severity of the lesions and the degree of amoebae infestation were scored and statistically evaluated. One gill arch from each animal was put on non‐nutrient agar (NNA) Petri dishes for amoeba isolation, cultivation and subsequent identification with SSU rDNA sequencing. Histopathology confirmed moderate to severe lesions consistent with NGD and mild to moderate amoeba infestation. The presence of amoebae was significantly correlated with lesion severity. Light microscopy of cultured amoebae strains and SSU rDNA analysis revealed the presence of a previously characterized amoeba Naegleria sp. strain GERK and several new strains: two strains from Hartmannelidae, three vannelid amoebae from the genus Ripella and cercozoan amoeba Rosculus. Despite the uncertainty in NGD etiopathogenesis and amoebae pathogenic role, identifying known and new amoebae leans towards a possible multi‐aetiological origin. [ABSTRACT FROM AUTHOR]

This article explores the potential of plasma extrachromosomal circular DNA (eccDNA) as a diagnostic biomarker for distinguishing between benign and malignant thyroid nodules, specifically papillary thyroid carcinoma (PTC). The study utilizes Circle-seq technology and machine learning to analyze eccDNA profiles in plasma samples from healthy controls, nodular thyroid goitre patients, and PTC patients. The results show significant differences in eccDNA counts and genomic characteristics between the groups, suggesting the potential of eccDNA as a non-invasive biomarker for diagnosing thyroid cancer. However, the study acknowledges the limitation of a small sample size and the need for further research to validate the findings. [Extracted from the article]

Simple Summary: In this paper, a three-round nested PCR assay with high specificity and sensitivity (2.62 copies/reaction), employing the Pseudomonas plecoglossicida sctU gene, was established. The detection system was used to detect large yellow croaker samples in the Zhejiang and Fujian areas. It was found that March and April were the peak times of visceral white nodules disease, which was inversely related to temperature. Using this detection method, early detection of visceral white nodules disease in large yellow croakers could be realized. The visceral white nodules disease in the internal organs of Larimichthys crocea has caused significant harm in the aquaculture of this species, with Pseudomonas plecoglossicida considered one of the core pathogens causing this disease. In this study, we designed three pairs of specific nested PCR primers targeting the sctU gene of P. plecoglossicida, a crucial component of the Type III secretion system (T3SS), which is instrumental in bacterial pathogenesis and virulence. Through the optimization of PCR reaction conditions, specificity testing, and sensitivity determination, a method was established for the accurate detection of P. plecoglossicida. This method yielded single amplification products, exhibited a false positive rate of zero for reference bacteria, and achieved a detection sensitivity of a minimum of 2.62 copies/reaction for the target sequence. Using the detection method, we conducted analyses on the diseased populations of L. crocea, involving a total of 64 screened fishes along the southeast coast of China from 2021 to 2023. The results revealed that the infection rate of P. plecoglossicida in diseased L. crocea exceeded over 90% in March and April, while in other months, the maximum recorded infection rate was merely 10%. The detection method developed in this study shows potential for early warning and routine monitoring of visceral white nodules disease in the internal organs of species such as L. crocea. [ABSTRACT FROM AUTHOR]

To evaluate the current incidence of pulmonary hemorrhage and the potential factors contributing to its increased risk after percutaneous CT-guided pulmonary nodule biopsy and to summarize the technical recommendations for its treatment. In this observational study, patient data were collected from ten medical centers from April 2021 to April 2022. The incidence of pulmonary hemorrhage was as follows: grade 0, 36.1% (214/593); grade 1, 36.8% (218/593); grade 2, 18.9% (112/593); grade 3, 3.5% (21/593); and grade 4, 4.7% (28/593). High-grade hemorrhage (HGH) occurred in 27.2% (161/593) of the patients. The use of preoperative breathing exercises (PBE, p =0.000), semiautomatic cutting needles (SCN, p = 0.004), immediate contrast enhancement (ICE, p =0.021), and the coaxial technique (CoT, p = 0.000) were found to be protective factors for HGH. A greater length of puncture (p =0.021), the presence of hilar nodules (p = 0.001), the presence of intermediate nodules (p = 0.026), a main pulmonary artery diameter (mPAD) larger than 29 mm (p = 0.015), and a small nodule size (p = 0.014) were risk factors for high-grade hemorrhage. The area under the curve (AUC) was 0.783. These findings contribute to a deeper understanding of the risks associated with percutaneous CT-guided pulmonary nodule biopsy and provide valuable insights for developing strategies to minimize pulmonary hemorrhage. [ABSTRACT FROM AUTHOR]

Thyroid cancer incidence increased over 200% from 1992 to 2018, whereas mortality rates had not increased proportionately. The increased incidence has been attributed primarily to the detection of subclinical disease, raising important questions related to thyroid cancer control. We developed the Papillary Thyroid Carcinoma Microsimulation model (PATCAM) to answer them, including the impact of overdiagnosis on thyroid cancer incidence. PATCAM simulates individuals from age 15 until death in birth cohorts starting from 1975 using 4 inter-related components, including natural history, detection, post-diagnosis, and other-cause mortality. PATCAM was built using high-quality data and calibrated against observed age-, sex-, and stage-specific incidence in the United States as reported by the Surveillance, Epidemiology, and End Results database. PATCAM was validated against US thyroid cancer mortality and 3 active surveillance studies, including the largest and longest running thyroid cancer active surveillance cohort in the world (from Japan) and 2 from the United States. PATCAM successfully replicated age- and stage-specific papillary thyroid cancers (PTC) incidence and mean tumor size at diagnosis and PTC mortality in the United States between 1975 and 2015. PATCAM accurately predicted the proportion of tumors that grew more than 3 mm and 5 mm in 5 years and 10 years, aligning with the 95% confidence intervals of the reported rates from active surveillance studies in most cases. PATCAM successfully reproduced observed US thyroid cancer incidence and mortality over time and was externally validated. PATCAM can be used to identify factors that influence the detection of subclinical PTCs. • This study used high-quality data sources and rigorous calibration to develop, to our knowledge, the first cross-population microsimulation model to replicate thyroid cancer epidemiology in the United States over time. • This study demonstrated the use of a stakeholder advisory board comprising patients, providers, policymakers, and researchers in building an epidemiologic microsimulation model. • This study successfully explained the drastic increase in the incidence of thyroid cancer since the 1990s through modeling of changing diagnostic pathways over time. [ABSTRACT FROM AUTHOR]

Syphilis is becoming an increasingly concerning sexually transmitted infection in the primary care setting with a precipitous rise in cases in the USA over the past decade according to the CDC surveillance data. This rise in cases is particularly relevant in military medicine as the greatest increase in cases is among adults in their 20s. Nodular syphilis is a rare presentation of the secondary stage of syphilis, and contrary to the well-known maculopapular rash seen with syphilis infection, little is known about effective treatment of nodular manifestations of the disease. We present a case of a 54-year-old HIV-positive man with nodular secondary syphilis effectively treated with an empiric 2-week course of oral doxycycline. Initial differential diagnosis included erythema nodosum, arthropod vector disease, skin infection, and erythema elevatum diutinum. Biopsy demonstrated granulomatous dermatitis, and serology revealed positive Treponema pallidum antibodies with a rapid plasma reagin of 1:256, confirming the diagnosis of secondary syphilis with granulomatous dermatitis. This case indicates that clinicians should consider this unusual cutaneous presentation of secondary syphilis when evaluating patients with nodular skin lesions, especially in high-risk individuals. [ABSTRACT FROM AUTHOR]

Significance: Photoacoustic (PA) imaging is an imaging modality that integrates anatomical, functional, metabolic, and histologic insights. It has been a hot topic of medical research and draws extensive attention. Aim: This review aims to explore the applications of PA clinical imaging in human diseases, highlighting recent advancements. Approach: A systemic survey of the literature concerning the clinical utility of PA imaging was conducted, with a particular focus on its application in tumors, autoimmune diseases, inflammatory conditions, and endocrine disorders. Results: PA imaging is emerging as a valuable tool for human disease investigation. Information provided by PA imaging can be used for diagnosis, grading, and prognosis in multiple types of tumors including breast tumors, ovarian neoplasms, thyroid nodules, and cutaneous malignancies. PA imaging facilitates the monitoring of disease activity in autoimmune and inflammatory diseases such as rheumatoid arthritis, systemic sclerosis, arteritis, and inflammatory bowel disease by capturing dynamic functional alterations. Furthermore, its unique capability of visualizing vascular structure and oxygenation levels aids in assessing diabetes mellitus comorbidities and thyroid function. Conclusions: Despite extant challenges, PA imaging offers a promising noninvasive tool for precision disease diagnosis, long-term evaluation, and prognosis anticipation, making it a potentially significant imaging modality for clinical practice. [ABSTRACT FROM AUTHOR]

Pleomorphic dermal sarcoma (PDS) is a rare dermal-based mesenchymal tumor that shares histologic characteristics with atypical fibroxanthoma (AFX), but demonstrates aggressive features increasing the risk of local recurrence or metastases. We report a unique case of a 62-year-old man with a recent history of left-groin PDS, now with a 2-cm pedunculated left tonsillar mass and two hypermetabolic nodules in the left thyroid. Microscopically, the tonsillar biopsy demonstrated infiltrating spindle cell neoplasm composed of highly pleomorphic tumor cells with abundant mitoses. The left hemithyroidectomy specimen also demonstrated similar pleomorphic spindled tumor cells infiltrating thyroid parenchyma with perineural invasion and focal osseous and chondroid components. Immunohistochemically, both tumors were diffusely positive for smooth muscle actin. Focal nonspecific positive staining with p53, SATB2, and S100 was observed in the thyroid tumor. Additional markers, including p40, CK5, p63, pancytokeratin, CAM5.2, S100, SOX10, Melan-A, HMB45, CD45, CD68, CD163, caldesmon, p16, TTF1, PAX8, and calcitonin, were all negative. INI-1 expression was retained. Molecular analysis showed that the tumor harbored PDGFRA deletion of exon 9 and amplification, PTCH1 A300fs*24, MDM2 amplification, CDKN2A/B loss, and FRS2 amplification. Compared with the patient's groin tumor, the current tumors showed similar morphology. Overall, the histologic and immunohistochemical findings are consistent with metastatic PDS to the tonsil and thyroid. Although PDS is commonly found on the sun-exposed skin in the elderly, this case highlights an unusual primary site as well as peculiar locations for the metastasis of PDS. Treatment and management of the patient are also considered. [ABSTRACT FROM AUTHOR]

Background: Thyroid disorders are one of the most common endocrine disorders. Benign thyroid swellings include solitary thyroid nodules and multinodular goiter. Most of the thyroid swellings are asymptomatic. USG neck and FNAC aid each other in differentiating neoplastic from non-neoplastic lesions. The present study was done to understand clinic-pathological findings of multinodular goiter. Materials and Methods: 50 patients diagnosed with multinodular goiter were included in this prospective study, conducted in the Department of ENT, Surabhi Institute of Medical Sciences, Siddipet. Results: Females are most commonly affected. The majority belong to 40-60 yrs of age group. Nonneoplastic lesions were more common than neoplastic lesions. All patients were euthyroid. All patients underwent surgical management. In histopathological examination, nodular goiter was most common. Conclusion: Multinodular goiter most commonly affects females in the middle age group. Most of the patients are asymptomatic. Surgical management is the definitive mode of treatment. [ABSTRACT FROM AUTHOR]

Introduction: Non functional parathyroid carcinoma (PC) is one of the rarest malignant neoplasms. Due to the lack of symptoms and laboratory findings, it is mostly diagnosed in late AQ2 stages, when local invasion and dissemination are already present. However, our case is an exception, because it was detected in early stage, with no local invasion present. We present a case of the smallest non-functional PC yet reported and review of the literature. Case presentation: A 47-year-old woman was admitted to outpatient Clinic where fine-needle aspiration biopsy (FNAB) of bilateral thyroid nodules (slide 1) and central neck mass (slide 2), which was suspected to be an enlarged lymphatic nodule or parathyroid gland was performed. Results came back as Bethesda I-colloid (slide 1), and Bethesda IV (slide 2), stating that it is hard to distinguish thyroid gland oxyphil lesions from parathyroid cells. Total thyroidectomy was performed as well as excision of the left central neck mass, without any involvement of surrounding structures. Pathological examination revealed bilateral thyroid follicular nodular disease, papillary microcarcinoma, and parathyroid carcinoma with vascular and capsular invasion, measuring 10 × 8 × 7 mm. The immunohistochemical profile included positive PTH, Chromogranin A, and negative TTF1. Conclusion: Non-functional PC is usually diagnosed in advanced stages, already involving adjacent structures; however, this case presents a rare example. It is important not to exclude PC as a differential diagnosis in the absence of elevated Ca and PTH serum levels. Follow-up will be difficult, since there are no prognostic parameters to rely on. [ABSTRACT FROM AUTHOR]

Carney complex (CNC) is an ultrarare disorder causing cutaneous and cardiac myxomas, primary pigmented nodular adrenocortical disease, hypophyseal adenoma, and gonadal tumours. Genetic alterations are often missed under routine genetic testing. Pathogenic variants in PRKAR1A are identified in most cases, while large exonic or chromosomal deletions have only been reported in a few cases. Our aim was to identify the causal genetic alteration in our kindred with a clinical diagnosis of CNC and prove its pathogenic role by functional investigation. Targeted testing of PRKAR1A gene, whole exome and whole genome sequencing (WGS) were performed in the proband, one clinically affected and one unaffected relative. WGS identified a novel, large, 10,662 bp (10.6 kbp; LRG_514t1:c.-10403_-7 + 265del; hg19, chr17:g.66498293_66508954del) deletion in the promoter of PRKAR1A in heterozygous form in the affected family members. The exact breakpoints and the increased enzyme activity in deletion carriers compared to wild type carrier were proved. Segregation analysis and functional evaluation of PKA activity confirmed the pathogenic role of this alteration. A novel deletion upstream of the PRKAR1A gene was proved to be the cause of CNC. Our study underlines the need for WGS in molecular genetic testing of patients with monogenic disorders where conventional genetic analysis fails. [ABSTRACT FROM AUTHOR]

Importance: Overt hyperthyroidism, defined as suppressed thyrotropin (previously thyroid-stimulating hormone) and high concentration of triiodothyronine (T3) and/or free thyroxine (FT4), affects approximately 0.2% to 1.4% of people worldwide. Subclinical hyperthyroidism, defined as low concentrations of thyrotropin and normal concentrations of T3 and FT4, affects approximately 0.7% to 1.4% of people worldwide. Untreated hyperthyroidism can cause cardiac arrhythmias, heart failure, osteoporosis, and adverse pregnancy outcomes. It may lead to unintentional weight loss and is associated with increased mortality. Observations: The most common cause of hyperthyroidism is Graves disease, with a global prevalence of 2% in women and 0.5% in men. Other causes of hyperthyroidism and thyrotoxicosis include toxic nodules and the thyrotoxic phase of thyroiditis. Common symptoms of thyrotoxicosis include anxiety, insomnia, palpitations, unintentional weight loss, diarrhea, and heat intolerance. Patients with Graves disease may have a diffusely enlarged thyroid gland, stare, or exophthalmos on examination. Patients with toxic nodules (ie, in which thyroid nodules develop autonomous function) may have symptoms from local compression of structures in the neck by the thyroid gland, such as dysphagia, orthopnea, or voice changes. Etiology can typically be established based on clinical presentation, thyroid function tests, and thyrotropin-receptor antibody status. Thyroid scintigraphy is recommended if thyroid nodules are present or the etiology is unclear. Thyrotoxicosis from thyroiditis may be observed if symptomatic or treated with supportive care. Treatment options for overt hyperthyroidism from autonomous thyroid nodules or Graves disease include antithyroid drugs, radioactive iodine ablation, and surgery. Treatment for subclinical hyperthyroidism is recommended for patients at highest risk of osteoporosis and cardiovascular disease, such as those older than 65 years or with persistent serum thyrotropin level less than 0.1 mIU/L. Conclusions and Relevance: Hyperthyroidism affects 2.5% of adults worldwide and is associated with osteoporosis, heart disease, and increased mortality. First-line treatments are antithyroid drugs, thyroid surgery, and radioactive iodine treatment. Treatment choices should be individualized and patient centered. This review summarizes current evidence regarding the pathophysiology, clinical presentation, and treatment of hyperthyroidism, focusing on the management of Graves disease and toxic nodular disease. [ABSTRACT FROM AUTHOR]

Background: The incidence of thyroid malignancy is increasing globally and this results in the growing number of patients facing increasing wait times for ultrasound (US) guided fine needle aspiration cytology (FNAC) for diagnosis. The objective of this study is to investigate the accuracy of surgeon performed US guided FNAC of thyroid nodules in the outpatient setting. Methods: This was a retrospective cross-sectional study on patients who underwent US guided FNAC followed by thyroidectomy between July 2019 and September 2022. US TI-RADS grade, FNAC Bethesda category and final histology were obtained from medical records and analysed. Result: There were 122 biopsy samples from 103 patients with a female gender preponderance of 89.3% and mean age of 46.5 years old. The majority of nodules biopsied were TI-RADS 4 and 5 (44.3% and 37.7%). Of the FNAC samples, 13.1% were non diagnostic, 27.9% benign, 14.7% atypia, 14.7% follicular neoplasm, 16.4% suspicious of malignancy and 13.1% were malignant. On final histology, adenomatoid nodules with nodular hyperplasia made up 82.5% of benign nodules and 94.9% of malignancies were papillary thyroid carcinomas (PTC). The overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 88.9%, 82.4%, 84.2%, 87.5% and 85.7% with higher accuracy rate (90.1%) when used in TI-RADS 5 nodules. Conclusion: Surgeon performed US guided FNAC for thyroid nodules is feasible and can be done in the outpatient setting thereby reducing time taken to reach a diagnosis. Standardizing techniques and use of additional modalities such as elastography may improve yield and diagnostic rates. [ABSTRACT FROM AUTHOR]

Nodular Gill Disease (NGD) is an emerging pathogenic condition that causes gill damage and mainly affects farmed freshwater fish, rainbow trout (Oncorhynchus mykiss) in particular, and this inevitably generates noticeable economic losses for the industry. The present study aimed to assess the prevalence of NGD in the Autonomous Province of Trento, a highly productive area located in Northeastern Italy, traditionally suited to rainbow trout production, and to identify possible risk factors for the introduction of this disease in trout farms. The necessary data were obtained through a questionnaire and the collection of fish samples. According to the data analysis, 42% of the investigated farms tested positive for NGD. The two possible risk factors identified for its introduction in farms are the presence of other diseases in the same farm (OR = 17.5; 95% CI = 2.7; 111.5) and having farms located 5 km upstream (OR = 24.8; 95% CI = 2.9; 211.1). These results highlight (i) a possible impairment of the immune system caused by other diseases as a predisposing factor to the manifestation of the pathology and (ii) the role of water in spreading pathogens. [ABSTRACT FROM AUTHOR]

Carney complex (CNC) is an ultrarare disorder causing cutaneous and cardiac myxomas, primary pigmented nodular adrenocortical disease, hypophyseal adenoma, and gonadal tumours. Genetic alterations are often missed under routine genetic testing. Pathogenic variants in PRKAR1A are identified in most cases, while large exonic or chromosomal deletions have only been reported in a few cases. Our aim was to identify the causal genetic alteration in our kindred with a clinical diagnosis of CNC and prove its pathogenic role by functional investigation. Targeted testing of PRKAR1A gene, whole exome and whole genome sequencing (WGS) were performed in the proband, one clinically affected and one unaffected relative. WGS identified a novel, large, 10,662 bp (10.6 kbp; LRG_514t1:c.-10403_-7 + 265del; hg19, chr17:g.66498293_66508954del) deletion in the promoter of PRKAR1A in heterozygous form in the affected family members. The exact breakpoints and the increased enzyme activity in deletion carriers compared to wild type carrier were proved. Segregation analysis and functional evaluation of PKA activity confirmed the pathogenic role of this alteration. A novel deletion upstream of the PRKAR1A gene was proved to be the cause of CNC. Our study underlines the need for WGS in molecular genetic testing of patients with monogenic disorders where conventional genetic analysis fails. [ABSTRACT FROM AUTHOR]

Human brucellosis is a common zoonotic disease in certain regions of the world, especially in rural populations, yet it is often neglected. The index patient presented with prolonged fever and headache. Examination revealed hepatosplenomegaly, and investigations revealed transaminitis with bicytopenia with serological evidence positive for Brucella. The radiological picture suggested granulomatous disease with miliary nodules, and a bone marrow examination revealed a noncaseating granuloma. The case was unique and challenging, as the clinical picture was consistent with epidemiologically prevailing tuberculosis, which is also seen in brucellosis-endemic countries. Brucellosis mimicked disseminated tuberculosis, making the case intriguing to diagnose and treat. The case demonstrated that physicians need to have a high index of suspicion for brucellosis, which should be actively investigated in cases with prolonged fever. It also illustrated the fundamental importance of teamwork and the centrality of the multidisciplinary team in the planning and prioritization of treatment. [ABSTRACT FROM AUTHOR]

Carney complex (CNC) is an ultrarare disorder causing cutaneous and cardiac myxomas, primary pigmented nodular adrenocortical disease, hypophyseal adenoma, and gonadal tumours. Genetic alterations are often missed under routine genetic testing. Pathogenic variants in PRKAR1A are identified in most cases, while large exonic or chromosomal deletions have only been reported in a few cases. Our aim was to identify the causal genetic alteration in our kindred with a clinical diagnosis of CNC and prove its pathogenic role by functional investigation. Targeted testing of PRKAR1A gene, whole exome and whole genome sequencing (WGS) were performed in the proband, one clinically affected and one unaffected relative. WGS identified a novel, large, 10,662 bp (10.6 kbp; LRG_514t1:c.-10403_-7 + 265del; hg19, chr17:g.66498293_66508954del) deletion in the promoter of PRKAR1A in heterozygous form in the affected family members. The exact breakpoints and the increased enzyme activity in deletion carriers compared to wild type carrier were proved. Segregation analysis and functional evaluation of PKA activity confirmed the pathogenic role of this alteration. A novel deletion upstream of the PRKAR1A gene was proved to be the cause of CNC. Our study underlines the need for WGS in molecular genetic testing of patients with monogenic disorders where conventional genetic analysis fails. [ABSTRACT FROM AUTHOR]

With the increasing utilization of semi-thyroidectomy and rapid advancements in ultrasound-guided thermal ablation therapy for the management of papillary thyroid carcinoma (PTC) and PTC cervical lymph node metastasis, ultrasound-guided fine-needle aspiration biopsy (FNAB) has emerged as the predominant approach for the pre-treatment cytopathologic diagnosis of PTC. Numerous expert consensuses and practice guidelines have delineated the acquisition of sufficient, high-quality cellular specimens for cytological examination. However, new challenges keep emerging in the real-world practice of thyroid FNAB, primarily stemming from the perceptions and expertise of physicians or technicians who perform FNAB. The aim of this study was to delineate the key deficiencies in specimen collection during FNAB, elucidate principles of systematic thinking, and propose preventive measures for these issues, along with a range of innovative concepts and technical approaches. Effectively addressing these concerns will enhance FNAB implementation and facilitate advancements in novel therapeutic modalities, such as thermal ablation, to ameliorate prognosis. [ABSTRACT FROM AUTHOR]

Nodular gill disease (NGD) is an infectious condition characterized by proliferative gill lesions leading to respiratory problems, oxygen deficiency and mortality in fish. Globally, NGD primarily impacts freshwater salmonids in intensive aquaculture systems. In recent years, numerous outbreaks of severe gill disease have affected more than half of the larger rainbow trout (Oncorhynchus mykiss) farms in Switzerland, mainly during spring and early summer. Mortality has reached up to 50% in cases where no treatment was administered. Freshwater amoeba are the presumed aetiologic agent of NGD. The gross gill score (GS) categorising severity of gill pathology is a valuable first‐line diagnostic tool aiding fish farmers in identifying and quantifying amoebic gill disease (AGD) in farmed marine salmonids. In this study, the GS was adapted to the NGD outbreak in farmed trout in Switzerland. In addition to scoring disease severity, gill swabs from NGD‐affected rainbow trout were sampled and amoeba were cultured from these swabs. Morphologic and molecular methods identified six amoeba strains: Cochliopodium sp., Naegleria sp., Vannella sp., Ripella sp., Saccamoeba sp. and Mycamoeba sp. However, the importance of the different amoeba species for the onset and progression of NGD still has to be evaluated. This paper presents the first description of NGD with associated amoeba infection in farmed rainbow trout in Switzerland. [ABSTRACT FROM AUTHOR]

Background: The solitary node in thyroid is a palpably discrete swelling within an apparently normal thyroid gland. It is usually a benign lesion but from clinical standpoint the possibility of neoplastic disease is of major concern for surgeon and patient. As there is variability in the conclusion of various authors and there is no work about clinicopathology of solitary nodules of thyroid in our region, present study has been designed to evaluate the epidemiology, fine needle aspiration cytology and incidence of malignancy in solitary nodule. Aims: To review data regarding incidence of the solitary nodular goitre, analyse & discuss the various clinical presentation, percentage of malignancy and importance of histopathological examination. Methods: As per exclusion and inclusion criteria 80 patients with solitary nodule of thyroid were included in this study. Various data like age, sex, family history, duration of nodule, site and size of nodule were recorded. Thyroid function test, fine needle aspiration cytology and ultrasonographic finding were recorded from case record. Results: Out of all histopathological finding of nodules follicular adenoma was most common followed by multinodular goitre (25%) and Adenomatous goitre (7.5%). Carcinoma was present in (17.5 %) and thyroiditis is 7.5% patients. Conclusions: Most of the patients were Euthyroid and benign condition was more common than malignancy. Follicular adenoma was most common among benign lesion and papillary carcinoma was more common neoplasm. Most of the patients required hemithyroidectomy. [ABSTRACT FROM AUTHOR]

To elucidate the clinical characteristics of atypical retinal vascular proliferation in patients with von Hippel-Lindau (VHL) disease using OCT angiography (OCTA). Prospective, observational study. Fifty-seven consecutive patients with a diagnosis of VHL disease who visited Kyoto University Hospital between January 2019 and March 2022. Retinal hemangioblastomas (RHs) were assessed using multimodal imaging including OCTA. Retinal hemangioblastomas were classified into 2 phenotypes: nodular and flat. Nodular RHs were defined as typical RHs that were globular, well-circumscribed tumors, often accompanied with dilated feeder arterioles and draining venules. Flat RHs lacked a protruded red or colored mass, had variable and indistinct borders, and were not accompanied with feeder and draining vessels. The prevalence, distribution, and description of atypical flat RHs. Among 57 consecutive patients with VHL disease, 37 patients (64.9%) showed RHs in at least 1 eye. Bilateral RHs were seen in 23 patients (62.2%). Among 58 eyes of 37 patients with RHs, typical nodular RHs were detected in 54 eyes. Nodular RHs were seen mainly in the peripheral retina and occasionally in the peripapillary region, and they showed exudative changes in some cases. Flat RHs were detected in 7 eyes (12.1%). Four eyes showed only flat RHs, and 3 eyes showed both types in the same eye. Most flat RHs appeared as retinal hemorrhages or faint flat abnormal retinal vessels in the inner retina on the fundus examination, often within the macula area or peripapillary. In all eyes with flat RHs, OCTA showed abundant blood flow in the lesions. OCT revealed that flat RHs were seen mainly between the retinal nerve fiber layer and the ganglion cell layer, and occasionally within the inner nuclear layer. During a mean follow-up period of 20.4 ± 15.0 months, no flat RHs accompanied exudative change, tractional retinal detachment, or progression in size. Patients with VHL disease can demonstrate 2 distinct types of RHs: the classic nodular type and an atypical flat type. OCT angiography can be useful in improving the detection of atypical flat RHs, which can be difficult to detect clinically. Proprietary or commercial disclosure may be found after the references. [ABSTRACT FROM AUTHOR]

Distinguishing between nontuberculous mycobacterial pulmonary disease (NTM-PD) and pulmonary tuberculosis (TB) is difficult. We aimed to evaluate the usefulness of gastric aspirate examination for NTM-PD diagnosis and for differentiating NTM-PD from other diseases, including pulmonary TB. We retrospectively collected data for 491 patients with negative sputum smears or a lack of sputum production at Fukujuji Hospital. We compared 31 patients with NTM-PD to 218 patients with other diseases (excluding 203 with pulmonary TB). Additionally, we compared 81 patients with NTM cultured from at least one sputum or bronchoscopy sample to the other 410 patients. Gastric aspirate examination for NTM-PD diagnosis showed 74.2% sensitivity and 99.0% specificity for culture positivity. There was no significant difference between the nodular bronchiectatic disease and cavitary disease types for culture positivity (p = 0.515). The significance of NTM isolation from gastric aspirate showed 64.2% sensitivity and 99.8% specificity for culture positivity. Gastric aspirate examination revealed NTM in one TB patient, allowing TB to be ruled out in 98.1% of patients with NTM cultured from gastric aspirates. Gastric aspirate examination is helpful for early-stage NTM diagnosis and ruling out pulmonary TB. This could lead to more accurate and timely treatment. [ABSTRACT FROM AUTHOR]

Management options for benign, autonomously functioning, and malignant thyroid nodules were limited to surgery or targeting by radioactive iodine before the availability of radiofrequency ablation (RFA). Despite being a relatively new technique, RFA may be favored for patients of high surgical risk, and for those who wish to avoid hypothyroidism. Although insurance coverage for the procedure can be a significant barrier, several groups of investigators have shown improved quality of life for RFA compared to surgery, due to the less invasive nature and favorable risk profile. Hyperthyroidism due to transient thyroiditis is a known risk of RFA, secondary to direct trauma and subsequent thyroid hormone release. Here we present a case of an adult with large, symptomatic, multinodular goiter, with no prior history of thyroid autoimmunity, who underwent RFA with successful volume reduction of two nodules, but who developed acute hyperthyroidism due to Graves disease eight weeks after RFA. Larger studies evaluating the risks of RFA should evaluate for incident hyperthyroidism, specifically for Graves disease/thyroid autoimmunity, as this could represent an additional risk of the procedure. [ABSTRACT FROM AUTHOR]

This article discusses a study that used predictive metagenomic analysis to identify specific bacterial metabolic pathways in hidradenitis suppurativa (HS) tunnels. HS is a chronic inflammatory skin disease characterized by nodules, abscesses, tunnels, and scarring. Previous studies have identified metabolic pathways associated with inflamed nodules and follicular samples in HS patients, but no studies have investigated the metabolic pathways in HS tunnels. The study found that certain taxa, including Prevotella and Porphyromonas, were associated with HS tunnels and correlated with specific metabolic pathways, such as amino acid metabolism and glycosaminoglycan metabolism. These findings provide new insights into the potential therapeutic targets for HS treatment. [Extracted from the article]

Introduction Prurigo nodularis (PN), a chronic inflammatory and pruritic skin condition with severely itchy skin nodules, substantially affects quality of life. Patients with PN are affected by highly pruritic lesions that can feature other sensations, such as stinging, burning, tingling, heat, and cold. These lesions can range in severity from a few nodules to several hundred, and in sizes from 10 millimeters to 2–3 cm. Objective To report the effect of dupilumab on pruritus and skin lesions in patients with PN according to the severity of their lesions at baseline, in a post hoc analysis of pooled data from two phase 3 trials. Materials & Methods In the two randomized, double-blind, placebo-controlled, 24-week studies LIBERTY-PN PRIME (NCT04183335) and PRIME2 (NCT04202679), adults with PN inadequately controlled by topical prescription therapies, or for whom those therapies are inadvisable, were randomized 1:1 to dupilumab 300 mg every 2 weeks or matched placebo. Efficacy was assessed from baseline to Week 24 through the Worst Itch Numerical Rating Scale (WI-NRS; scored 0–10; high scores represent a poorer outcome), and the Investigator's Global Assessment for PN-Stage score (IGA PN-S; scored 0–4; high scores represent more severe nodular disease). The PRIME and PRIME2 studies enrolled only patients with an IGA PN-S of 3 (moderate; 20−100 nodules) or 4 (severe; >100 nodules) at baseline. Results 311 patients were randomized (dupilumab/placebo n = 153/158), including 205 patients with moderate PN (IGA PN-S = 3) at baseline (dupilumab/placebo N = 103/102) and 104 patients with severe PN (IGA PN-S = 4) at baseline (dupilumab/placebo N = 50/54). Baseline demographics and disease characteristics were well balanced in both subgroups. At Week 24, significantly more dupilumab-treated patients achieved an IGA PN-S of 0 (no nodules) or 1 (almost clear; 1−5 nodules), whether they had moderate (52.4% vs 24.5%; nominal P = 0.0008) or severe (40.0% vs 7.4%; nominal P = 0.0014) PN at baseline, with a similar treatment effect (TE) vs placebo in both the moderate (27.9%) and severe (32.6%) subgroups. The proportion of patients with ≥3-point and ≥4-point improvement in WI-NRS, was also significantly greater in the dupilumab group than in the placebo group, whether their PN was moderate (68.9%/62.1% vs 34.3%/22.6%; nominal P = 0.0002/ P < 0.0001, respectively) or severe (72.0%/66.0% vs 31.5%/25.9%; nominal P = 0.0064/ P = 0.0046, resp.) at baseline. Treatment-emergent adverse events (TEAEs) occurred with higher rates in dupilumab-treated patients with moderate PN at baseline (71.6%) compared with placebo (57.8%). Patients with severe PN at baseline had similar rates of TEAEs in the dupilumab (48.0%) and placebo (55.6%) groups. Nevertheless, dupilumab-treated patients with moderate PN at baseline, and those with severe PN at baseline, had overall similar or lower rates vs placebo of serious TEAEs (3.9%/6.0% vs 8.8%/5.6%, resp.), severe TEAEs (4.9%/0.0% vs 5.9%/5.6%, resp.), and frequent TEAEs such as headache (6.9%/2.0% vs 5.9%/5.6%, resp.) and neurodermatitis (2.9%/2.0% vs 2.9%/14.8%, resp.). The incidence of conjunctivitis in dupilumab-treated patients was consistent with the known safety profile vs placebo in both the moderate and severe groups (4.9%/2.0% vs 2.0%/0.0%, resp.). Conclusion Dupilumab treatment for 24 weeks improves itch and skin lesions in patients with PN regardless of lesion severity at baseline, with an acceptable safety profile. [ABSTRACT FROM AUTHOR]

Single-cell transcriptomic (scRNA-seq) and proteomic [cytometry time of flight (CyTOF) mass spectrometry] approaches have recently been applied to cells isolated from Dupuytren's nodules and have enabled us to comprehensively profile the complex cellular ecosystem within Dupuytren's nodules. This has highlighted the high degree of heterogeneity of both fibroblast and myofibroblast cell states. In silico trajectory analysis has facilitated the identification of myofibroblast precursors such as pericytes and resident fibroblasts. Differential gene analysis along the differentiation trajectory identified novel markers of pathogenic myofibroblasts, including CD82, podoplanin, TNFSF12A, and the transcription factors SCX and DMRT2. Interleukin 13 (IL-13) has recently been shown to have a role in Dupuytren's disease, where it is expressed by mast cells, and enhances the expression of profibrotic gene expression, which was sensitive to inhibition by the JAK inhibitor, tofacitinib. Tumour necrosis factor (TNF) has also been shown to be produced by both M2 macrophages and mast cells in DD, and chronic expression was maintained by a positive feedback loop of IL-33. TNF signals through TNFR2 to upregulate the expression of α-smooth muscle actin (α-SMA) and collagen. These findings led to the assessment of local injection of anti-TNF (adalimumab) into the nodules in a Phase 2b clinical trial, which met the primary endpoint of reduction in nodule hardness and the secondary endpoint of nodule size, suggesting the potential to control the progression of early-stage Dupuytren's disease. We review the biology of Dupuytren's disease (DD), a common localised fibrotic disorder of the hand. The disease develops through a complex interplay of genetic and environmental factors, and epigenetic signalling. The early-stage disease nodules comprise a complex milieu of stromal and immune cells which interact to promote disease development. Recently, inhibition of tumour necrosis factor (TNF) locally resulted in softening and a decrease in nodule size, potentially controlling disease progression. Unlike fibrotic disorders of the visceral organs, the easy access to tissue in DD patients enables dissection of the cellular landscape and molecular signalling pathways. In addition, the study of DD may have wider benefits in enhancing our understanding of less-accessible fibrotic tissues. [ABSTRACT FROM AUTHOR]

Lung damage caused by non-tuberculous mycobacteria (NTM) infections can be devastating to individuals that are predisposed to chronic respiratory colonization. Cystic fibrosis patients are at increased risk for diminished lung function and increased mortality from NTM pulmonary infections. Treatment regimens are often intense and prolonged. The case described in this report is of a 16-year-old male with cystic fibrosis infected with Mycobacterium abscessus who showed evidence of severe nodular pulmonary disease on chest computerized tomography. His intensive treatment phase was complicated by neutropenia and drug resistance, leading to the use of omadacycline. Because of rapid improvement clinically and on computed tomography, he was successfully treated with a modified, less intense continuation phase that included azithromycin, omadacycline, and inhaled amikacin. The patient also was switched from tezacaftor/ivacaftor to elexacaftor/tezacaftor/ivacaftor during the course of NTM treatment. [ABSTRACT FROM AUTHOR]

Thyroid disease and hyperparathyroidism (HPT) are among the most common endocrine disorders. Thyroid hormones play an important role in bone and calcium metabolism. The rate of HPT is greater in patients with thyroid disease than in the general medical population. Simultaneous occurrence of hyperthyroidism and hyperparathyroidism in the same patient is a rare combination. The clinical manifestations of hyperthyroidism may overshadow the more subtle and varied symptoms and signs of primary hyperparathyroidism. It poses difficult diagnostic and therapeutic problems. Both diseases, however, may have a profound influence on calcium metabolism. The resulting disturbances in thyrotoxicosis may simulate hyperparathyroidism. Contrariwise, the diagnosis of an associated parathyroid adenoma may be missed, or unnecessarily delayed because hypercalcemia is known to occur in hyperthyroidism. The coexistence of thyroiditis and thyroid nodules with parathyroid disorders is also known. Graves' disease (GD) and primary hyperparathyroidism (PHPT) are two common endocrine disorders. However the co- occurrence of hyperthyroidism and primary hyperparathyroidism (PHPT) is rare. However, the link between the two disorders remains unclarified. Hypercalcemia in Graves' hyperthyroidism should warrant a thorough investigation for concomitant primary hyperparathyroidism. Concomitant thyroid nodular disease and hyperparathyroidism (PHPT) disease has been also documented. PHPT is also reported in patients with thyroid malignancy. We hereby report a rare case of a patient who presented with coexistence of Hyperparathyroidism and Multinodular Goiter with Hashimotos Thyroiditis and Hyperthyroidism. [ABSTRACT FROM AUTHOR]

Half-smooth tongue sole (Cynoglossus semilaevis) is an economic flatfish in seawater factory farming along the coastal areas of China. However, the farming of C. semilaevis is plagued by visceral nodular disease (VND) infections caused by Mycobacterium marinum , resulting in substantial economic losses for the industry. Therefore, it is crucial to understand the molecular mechanisms of VND tolerance in C. semilaevis. To achieve this, we employed a combination of genome-wide association studies (GWAS) and RNA sequencing (RNA-seq) to identify single nucleotide polymorphisms (SNPs) and to elucidate their roles in regulating tolerance to VND in C. semilaevis. Initially, we genotyped 300 individual C. semilaevis using whole genome resequencing (WGS), identifying 4,773,887 high-quality SNPs. Seven significantly associated SNPs were found on chromosomes 1 and 12. Subsequent RNA-seq analysis of liver tissues from both disease sensitive (DS) and disease tolerance (DT) groups during M. marinum infection revealed a total of 2576 differentially expressed genes (DEGs). Potential candidate genes identified from GWAS and DEGs were further integrated. From that, genes involved in transcription factor activity, innate immune response and protein kinase activity, such as rela , jun , ccl36.1 , nfkbiab , pik3r3b and map2k1 , were found to be important for VND tolerance in C. semilaevis. In addition, the expression pattern of candidate genes and genotypes of SNPs associated with disease tolerance traits were validated. These findings provide novel insights into the molecular mechanisms governing disease tolerance and lay the groundwork for genomic selection and molecular breeding strategies enhance VND tolerance in fish. • Reveal the genetic basis and potential regulatory mechanisms of visceral nodular disease in half-smooth tongue sole. • Three significant associated and four suggestive associated SNPs were observed on chromosomes 1 and 12. • Potential candidate genes involved in transcription factor activity, innate immune response and protein kinase activity [ABSTRACT FROM AUTHOR]

• INTERNEO collaboration of neoadjuvant SRS for brain metastases. • Individual patient data pooled analysis from 9 institutions in 5 countries. • 1-year incidence of local recurrence, any grade radionecrosis and nodular LMD < 5 % • Longest median follow-up for neoadjuvant stereotactic radiosurgery. • Largest cohort of multi-fraction neoadjuvant stereotactic radiosurgery. Neoadjuvant stereotactic radiosurgery (NaSRS) is an emerging treatment option for brain metastases (BrM) planned for resection. The aim of this study was to report on the efficacy and safety of NaSRS in an individual patient data pooled analysis. Patients undergoing single- and multi-fraction NaSRS for BrM at nine institutions in five countries (Australia, Canada, South Korea, Switzerland and USA) were included. Eligibility criteria included BrM from any primary malignancy and no prior local therapy. The primary endpoint was a composite of local recurrence (LR), any grade radionecrosis (RN), and/or nodular leptomeningeal disease (nLMD). Secondary endpoints included these endpoints and Grade ≥ 2 RN. Endpoints were evaluated using cumulative incidence functions. NaSRS was delivered to 179 patients with 189 BrM. Median follow-up was 28.4 months. Primary malignancies included non-small cell lung carcinoma (44 %) and melanoma (17 %). The median BrM diameter was 29 mm (IQR 21–36 mm). Single- and multi-fraction NaSRS was utilised in 100 (53 %) and 89 BrM (47 %) respectively. The median single-fraction dose was 18 Gy (IQR 16–20 Gy). Multi-fraction doses included 24 Gy in three fractions (55 %) and 27 Gy in three fractions (25 %). The 12-month incidence for the composite endpoint was 8.0 %. The 12-month incidence of LR was 4.6 %, any grade RN was 3.6 %, Grade ≥ 2 RN was 1.8 % and nLMD was 1.2 %. Neoadjuvant SRS results in favourable rates of LR, RN and nLMD. We provide a global experience of this treatment approach with long-term data and the largest cohort of patients undergoing multi-fraction SRS. [ABSTRACT FROM AUTHOR]

Visceral white nodules disease (VWND), caused by Pseudomonas plecoglossicida, is a common disease among cage-farmed large yellow croaker (Larimichthys crocea) in China. However, comprehensive investigations of the molecular defensive mechanisms used by L. crocea in response to P. plecoglossicida infection remain relatively rare. Here, we constructed transcriptomes of the L. crocea spleen at 12 h and 24 h after P. plecoglossicida challenge. We identified 518 novel miRNAs and 823 known miRNAs in the spleen of L. crocea. Between the challenge and control groups, 32 differentially expressed miRNAs (DEmiRNAs), predicted to target 356 genes, and 1152 differentially expressed mRNAs (DEmRNAs) were identified at 12 h post-infection, while 33 DEmiRNAs, predicted to target 278 genes, and 1067 DEmRNAs were identified at 24 h post-infection. Gene ontology (GO) analysis showed that 146 and 126 GO terms were significantly enriched in the target genes at 12 h and 24 h, respectively. Twenty-eight and four immune-associated Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were significantly enriched in the target genes at 12 h and 24 h, respectively. Three immune-associated pathways were among those most enriched in the target genes: Toll-like receptor signaling, endocytosis, and C-type lectin receptor signaling. Network analysis identified 47 DEmRNA-DEmiRNA pairs. In particular, the immune-related genes TLR5S and PIGR were targeted by the miRNAs lcr-miR-7132c and dre-miR-183-5p, respectively. Dual-luciferase assays verified that lcr-miR-7132c downregulated TLR5S, suggesting that this miRNA may participate in regulating the immune response of L. crocea to P. plecoglossicida infection through the TLR5S-mediated signaling pathway. Our results help to clarify the miRNA-mediated immune response of L. crocea to P. plecoglossicida infection. [ABSTRACT FROM AUTHOR]

Aim. Primary hyperparathyroidism (PHPT) often coexists with thyroid diseases. Current guidelines advise preoperative ultrasound (US) examination of the thyroid gland for thyroid nodular disease or concomitant malignancy but not evaluation for autoimmune thyroiditis (AIT). The impact of autoimmune thyroiditis on the clinical presentation and intraoperative course of PHPT is not clear. Material and methods. We retrospectively assessed the medical records of 21 patients with PHPT who underwent parathyroidectomy. Clinical, biochemical, ultrasonographic and intraoperative data were evaluated. Results. There was a longer duration of parathyroidectomy in patients with AIT than in those without (113.3 min vs. 93.9 min, P = 0.03). A lower rate of kidney stones was noted in patients with autoimmune thyroiditis (44.4% vs. 0%, P = 0.03). Patients with AIT were more symptomatic, but this was not significant. There was no difference between the two groups in the prevalence of osteoporosis or thyroid nodular disease. Conclusions. A significantly longer duration of parathyroidectomy was seen in PHPT patients with AIT. Patients with PHPT undergoing surgery should be investigated for autoimmune thyroiditis, as this may affect surgical planning. [ABSTRACT FROM AUTHOR]

Differentiated thyroid carcinoma is one of the commonest malignancies in head and neck region. Among differentiated thyroid carcinoma, papillary carcinoma is the commonest. Encapsulated follicular variant of papillary thyroid carcinoma tumors are very indolent tumors which behave like benign tumors. Many tumors have been over diagnosed and over treated in spite of their indolent nature. We aimed to find out if total thyroidectomy is really required for very low grade tumors like encapsulated FVPTC. We operated 672 patients of thyroid disease during 2012 to 2020 in SMS Medical College, Jaipur. Out of 256 patients, 199 patients (78%) had papillary carcinoma of thyroid. Classical variant was present in 40% and follicular variant was present in 35% (N—69). Out of 69 patients with follicular variant of PTC, 59 patients had well encapsulated type of follicular variant of PTC while 10 patients had invasive type of follicular variant of PTC. Encapsulated FVPTC are less aggressive and indolent tumors. They should be treated more conservatively. Hemithyroidectomy is sufficient treatment for its complete cure. Out of 69 patients with Follicular variant of PTC, 59 patients had encapsulated disease. Out of 59 patients, 14 (24%) had bilateral nodular disease. 45 (77%) patients had unilateral disease; multicentric in one lobe in 9 (15%) patients and unicentric in 36 (61%) patients. However, encapsulated FVPTC was only found in predominant lobe and the non dominant lobe had benign disease. [ABSTRACT FROM AUTHOR]

Amiodarone hydrochloride is an antiarrhythmic drug, with proven efficacy in prevention and treatment of numerous arrhythmias, atrial fibrillation especially, or ventricular arrhythmias, with a long half-life (55–60 days). The increased risk of developing amiodarone-induced pulmonary fibrosis is directly related to the dose and the duration of the intake. Amiodarone-induced pulmonary toxicity is conditioned by dose, patient's age, and pre-existent pulmonary pathologies. The pattern for drug-induced lung injury may vary in many forms, but the amiodarone can cause polymorphous injuries such as diffuse alveolar damage, chronical interstitial pneumonia, organizing pneumonia, pulmonary hemorrhage, lung nodules or pleural disease. The pathological mechanism of pulmonary injury induced by amiodarone consists of the accumulation of phospholipid complexes in histocytes and type II pneumocytes. Differential diagnosis of pulmonary fibrosis induced by amiodarone is made mainly with idiopathic pulmonary fibrosis, left ventricular failure or infectious disease. Before starting treatment with amiodarone, patients should be informed of potential adverse effects and any new respiratory symptoms should promptly be reported to their family physician or attending physician. The assessment carried out at the initiation of amiodarone treatment should include at least chest X-ray and respiratory function tests and extrapulmonary evaluation. [ABSTRACT FROM AUTHOR]

Primary pigmented nodular adrenocortical disease (PPNAD) is a rare cause of adrenocorticotropin hormone (ACTH)-independent Cushing's syndrome (CS), which mainly occurs in children and young adults. Treatment options with proven clinical efficacy for PPNAD include adrenalectomy (bilateral or unilateral adrenalectomy) and drug treatment to control hypercortisolemia. Previously, the main treatment of PPNAD is bilateral adrenal resection and long-term hormone replacement after surgery. In recent years, cases reports suggest that unilateral or subtotal adrenal resection can also lead to long-term remission in some patients without the need for long-term hormone replacement therapy. Medications for hypercortisolemia, such as Ketoconazole, Metyrapone and Mitotane et.al, have been reported as a preoperative transition for in some patients with severe hypercortisolism. In addition, tryptophan hydroxylase inhibitor, COX2 inhibitor Celecoxib, somatostatin and other drugs targeting the possible pathogenic mechanisms of the disease are under study, which are expected to be applied to the clinical treatment of PPNAD in the future. In this review, we summarize the recent progress on treatment of PPNAD, in which options of surgical methods, research results of drugs acting on possible pathogenic mechanisms, and the management during gestation are described in order to provide new ideas for clinical treatment. [ABSTRACT FROM AUTHOR]

Objective: To investigate the long‐term outcomes and prognosis of thyrotoxicosis in a large number of patients in a single UK county (Leicestershire). Design: Retrospective cohort analysis of 56,741 thyroid function test (TFT) results, treatment modalities and outcomes in a well‐established virtual thyrotoxicosis clinic database. Patients: One thousand four hundred and eighty‐nine patients were included with a median length of follow‐up of 10.9 years. The aetiology of thyrotoxicosis was autoimmune (85.9%), nodular (9.1%) and mixed (5.0%). Treatment modalities included antithyroid drugs (ATDs), radioiodine (RAI; 555 MBq fixed dose) and thyroidectomy. Methods: We analysed both individual TFTs and groups of sequential TFTs on or after the same thyroid treatment(s), which we describe as 'phase of thyroid care' (POTC). Patients studied entered the virtual clinic between 1 January 1995 and 1 January 2010; we exported data on every TFT sample up to April 2020. Results: ATD had been used in 99.2% (median 2, maximum seven courses) with long‐term ATD (>2 years) in 48%. RAI and thyroidectomy were used more commonly with nodular and mixed aetiology. Overall, T4 was more often controlled than thyroid‐stimulating hormone (TSH), and at the latest follow‐up, T4 was normal in >96%, TSH in >79% and both in >76% of different aetiologies. The mean percentage control of T4 was 85% and TSH 50%; in long‐term ATD courses, this improved to 89% and 62%, respectively. In the latest POTC, control of T4 and TSH was best in cases off treatment (95%/87%) and on T4 without ablative therapy (94%/72%), but was broadly similar in patients on long‐term ATD (90%/68%), after RAI (92%/60%) or after thyroidectomy (91%/58%). After the first course of ATD, remission or hypothyroidism was seen in 47.3% autoimmune, 20.9% nodular and 32.5% mixed, with 90% relapses seen within 4 years. Relapse was more common in patients with ophthalmopathy, but there was no difference between the sexes. Conclusions: Thyrotoxicosis can be well controlled with minimal specialist clinic attendance using a software‐supported virtual shared‐care scheme. Long‐term ATD appears to be a valid patient choice achieving TFT control comparable to that seen after RAI or surgery. In patients with autoimmune disease, relapse is more common in patients with ophthalmopathy, and hypothyroidism is common after RAI. In nodular disease, we found that spontaneous remission may occur. [ABSTRACT FROM AUTHOR]

A retrospective study published in the International Journal of Dermatology examined the prevalence of malignancy and associated risk factors in patients with prurigo nodularis (PN), a debilitating skin disease characterized by itchy nodules. The study found that 27% of PN patients were diagnosed with concomitant malignancy, including non-melanoma skin cancer (NMSC) and other types of cancer such as melanoma, ovarian, breast, lung, uterine, cervical, and colon cancer, as well as cutaneous T-cell lymphoma and non-Hodgkin's lymphoma. The study also identified increased age at PN diagnosis and the presence of pain as significant risk factors for malignancy development. However, the study had limitations due to its retrospective nature and sample size. [Extracted from the article]

This article discusses a case of nodular lichen myxedematosus (LM), a rare skin disease with unknown causes. The patient, a 48-year-old Afro-Caribbean woman, presented with multiple asymptomatic nodules on her trunk and limbs. Various tests were conducted, including a skin biopsy, which confirmed the diagnosis of nodular LM. Treatment options for localized LM are not well-established, and in this case, the patient chose not to undergo any treatment. Nodular LM is generally self-limiting and benign. [Extracted from the article]