Search

Background: To determine whether multiple fine-needle passes to the same thyroid nodule in the fine-needle aspiration (FNA) biopsy session affect sufficient and/or atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) cytological result. Methods: Ultrasonography(US) and cyto-histopathology results of the nodules of patients were retrospectively analyzed. The nodules were divided into 2 groups according to the number of needle passes performed in the same FNA session as those with 1 pass (1-pass group) and those with 2 or 3 passes (multiple-pass group). Results: Totally, 1409 (93.9%) nodules were performed 1 pass, and 91 (6.1%) were performed multiple pass(n=91).The rates of cystic/mixed nodule, macrocalcification, and Thyroid Imaging Reporting and Data System 3 score were higher in the multiple-pass group (P=.001, P=.039, P=.006, respectively). Adequacy and AUS/FLUS rates were similar between the 2 groups. When nodules with macrocalcifications and cystic/ mixed structures were evaluated as 2 separate subgroups, the rates of the adequacy and AUS/FLUS were similar between 1-pass and multiplepass groups within each subgroup.The number of passes showed no univariate or multivariate significant effect on sufficient and/or AUS/FLUS cytology results (P > .05). Conclusion: Although more passes are performed in cystic/mixed and macrocalcified nodules estimating that the material would be insufficient with macroscopic on-site evaluation, needle insertion of 2 or 3 times does not affect obtaining sufficient and/or AUS/FLUS cytology compared to 1 pass.

SUMMARY Euglycemic diabetic ketoacidosis (DKA) is a rare complication of diabetes mellitus (DM) characterized by metabolic acidosis, ketosis, and blood glucose levels < 250 mg/dL. The prevalence of euglycemic DKA is increasing with the popularity of ketogenic (low-carbohydrate) diets. We present herein the case of a patient with newly diagnosed type 1 DM who developed euglycemic DKA following a ketogenic diet. A 22-year-old woman presented to the emergency department with malaise, fatigue, nausea, and vomiting. She had no family history of DM. She had consulted her primary care physician 2 weeks before due to hair loss, numbness, and tingling sensation in her fingertips. Her fasting blood glucose was 205 mg/dL at that time. Reluctant to use medication to control her blood glucose levels, she started a ketogenic diet. On admission, she was conscious, oriented, cooperative, and tachycardic. Her body mass index was 17.6 kg/m2. Laboratory tests showed fasting blood glucose of 86 mg/dL, glycated hemoglobin of 10.3%, and elevated insulin levels. Ketone levels in urine and blood were high, indicating ketosis. High anion-gap metabolic acidosis was detected, with a pH of 7.10 and serum bicarbonate level of 12 mEq/L. A diagnosis of new-onset DM and euglycemic DKA was established. She was treated with a modified DKA protocol that included intravenous dextrose-containing serum as fluid therapy, and intravenous insulin infusion was delayed until blood glucose levels increased above 250 mg/dL. The development of euglycemic DKA in our patient was attributed to severe carbohydrate restriction. This case underscores the importance of considering dietary risk factors, particularly ketogenic diets, in the management of DM.

Abstract Recently, chemically synthesized minimal mRNA (CmRNA) has emerged as a promising alternative to in vitro transcribed mRNA (IVT-mRNA) for cancer therapy and immunotherapy. CmRNA lacking the untranslated regions and polyadenylation exhibits enhanced stability and efficiency. Encapsulation of CmRNA within lipid-polymer hybrid nanoparticles (LPPs) offers an effective approach for personalized neoantigen mRNA vaccines with improved control over tumor growth. LPP-based delivery systems provide superior pharmacokinetics, stability, and lower toxicity compared to viral vectors, naked mRNA, or lipid nanoparticles that are commonly used for mRNA delivery. Precise customization of LPPs in terms of size, surface charge, and composition allows for optimized cellular uptake, target specificity, and immune stimulation. CmRNA-encoded neo-antigens demonstrate high translational efficiency, enabling immune recognition by CD8+ T cells upon processing and presentation. This perspective highlights the potential benefits, challenges, and future directions of CmRNA neoantigen vaccines in cancer therapy compared to Circular RNAs and IVT-mRNA. Further research is needed to optimize vaccine design, delivery, and safety assessment in clinical trials. Nevertheless, personalized LPP-CmRNA vaccines hold great potential for advancing cancer immunotherapy, paving the way for personalized medicine.

This article argues against the claim that the dispositional middle construction is always subject-oriented, by discussing dispositional constructions in Japanese and impersonal middle constructions formed with the causative verb lassen ‘let’ in German. In Japanese, the disposition is ascribed not to the nominative subject, but to an object. In German, nominative subjects are not required. This suggests that subject orientedness is not inherent but arises from the properties of independently existing constructions that are interpeted as dispositional. In English and German, an intransitive or a reflexive construction derived from its transitive variant is employed as a canonical middle construction. In these cases, the accusative argument becomes a nominative subject by applying specific grammatical operations; thus, the expression of a subject becomes obligatory. In contrast, a potential construction is interpreted as dispositional in Japanese in which case the disposition is typically ascribed to the object with nominative case, which is almost obligatory in Japanese. It follows that the target of the disposition in middle constructions is a grammatically “highlighted” event participant, as in the case of root modals.

INTRODUCTION: Simple renal cysts are lesions that are epithelial in origin, with a prevalence changing between 5 to 15% in the normal population. In animal studies, it was shown that PTH might stimulate cyst formation via intracellular signaling systems triggering epithelial cell proliferation. Our primary aim was to detect the simple cyst prevalence in a large cohort of PHPT and compare it with sex and age-matched health individuals. The secondary aim was to detect determinants of cyst formation in PHPT. METHODS: A total of 307 PHPT patients and 112 healthy controls were enrolled in our study. PHPT group was compared with the control group regarding the biochemical parameters and presence, size and bilaterality of renal cysts in the US performed by a single experienced radiologist. RESULTS: Prevalence (43.65% vs 25%, p=0.020) and size [28.40 mm (min-max: 4-82) vs 12.20 mm (min-max: 3-94) (p=0.013)] of simple renal cysts were higher in the PHPT group compared to controls. The presence of renal cysts was correlated with age but not sex and positively correlated with the serum PTH level in regression analysis. Serum Ca, P, and 24-hour urinary Ca excretion were not found to be associated with cyst formation. DISCUSSION AND CONCLUSION: Simple renal cysts are a benign renal complication of PHPT that does not alter renal function significantly, and their presence is directly correlated with the hypersecretion of PTH.

Simple geometric assumptions for dikes and faults are often used for interpreting the parameters of these structures from magnetic anomalies. The magnetic anomaly of a 2D dike or a vertical fault consists of two components; one with even and the other with odd symmetries. The function resulting from the ratio of the even and odd components is independent from the amplitude coefficient. The abscissa of the half-maximum of the even component and the maximum of the odd component of a dike or a vertical fault is related to its depth and its half-width. Incorporating this relation into the corresponding equations for dikes and vertical faults, the half-width value can be eliminated from the equations. Thus, the resulting ratio can be used for determining the model parameters. Using the ratio of the even component to the odd component for given distances, curves can be obtained for different depth-index parameter pairs, and from the graph of these curves, parameters of 2D dikes and vertical faults can be determined. The validity of the method is tested using synthetic models for dike and vertical fault cases. The method is also implemented on two different field data, and the results obtained are compared to previous studies.

Objectives:To investigate the intraocular pressure (IOP)-lowering efficacy, safety, and treatment tolerability of brinzolamide/ brimonidine fixed combination (BBFC) in maximum medical therapy.Materials and Methods:The medical records of 92 patients with glaucoma or ocular hypertension who had previously been treated with a different antiglaucomatous regimen and were switched to a treatment regimen that included BBFC were retrospectively analyzed. Patients were divided into 4 groups including 22, 20, 27, and 23 patients based on previous glaucoma treatment. All patients received maximum medical treatment regimen by adding a combination of beta blocker-prostaglandin analogue therapy along with BBFC. IOP values at baseline and month 1, month 3 and month 6 after starting BBFC and ocular adverse effects at follow-up visits were evaluated.Results:The mean age of all patients was 62.7±16.6 years (range: 18-90). Fifty-two patients (56.5%) were women and 40 (43.5%) were men. Forty-eight (52.2%) patients had primary open-angle glaucoma, 35 (38.0%) had pseudoexfoliation glaucoma, and 9 (9.8%) had ocular hypertension. The IOP of the all eyes was 21.1±4.8 mmHg (range: 17-25) before and 17.6±3.7 mmHg, 17.3±3.4, and 17.0±3.5 mmHg at month 1, 3, and 6 after the introduction of BBFC, respectively (p

INTRODUCTION: Primary hyperparathyroidism (PHPT) is associated with an increased risk of nephrolithiasis and osteoporosis, and predicting the development of these diseases will reduce PHP-related morbidities. METHODS: A total of 311 patients with PHPT due to parathyroid adenoma were evaluated retrospectively. The patients were divided into groups, as patients with and without nephrolithiasis and those with and without osteoporosis. Demographic and biochemical variables that could predict the development of nephrolithiasis and osteoporosis in these groups were examined. RESULTS: Nephrolithiasis was observed in 24.44% of 311 PHPT patients. Serum creatinine (Cr), serum calcium (Ca), adjusted Ca (adj Ca), albumin and 24-hour urinary phosphorus (24h uP) levels were higher, and serum P-value was significantly lower in patients with nephrolithiasis than those without nephrolithiasis. In the Receiver Operating Characteristic (ROC) analysis, serum Cr ≥0.66 mg/dl, adj Ca ≥10.72 mg/dl, serum P ≤2.71 mg/dl and 24h uP ≥635 mg/day cut-off values were found to have high sensitivity and low specificity values on the risk of developing nephrolithiasis. Of all patients, 43.09% had osteoporosis, and it was determined that only ≥50.50 years (sensitivity 81.34%, specificity 49.51%) and intact parathyroid hormone ≥ 201.50 pg/mL (sensitivity 75.14%, specificity 41.04%) values could predict osteoporosis (Area Under the ROC curve ranged from 0.57 to 0.67). DISCUSSION AND CONCLUSION: While biochemical parameters are useful in predicting nephrolithiasis in patients with PHPT, the development of osteoporosis seems to be less related to biochemical parameters.

INTRODUCTION: Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome. Coronavirus 2 (SARS-CoV-2) is spreading rapidly around the world. Asymptomatic infection is highly contagious, potentially leading to viral spread. We aimed to determine the rate of patients positive for COVID-19 PCR performed for safety measures before thyroid fine-needle aspiration biopsy (FNAB). METHODS: The patients applied to Ankara City Hospital, Endocrinology and Metabolism Clinics between 15.03.2020 and 15.08.2020 and underwent routine COVID-19 PCR test before FNAB were evaluated retrospectively. Age, gender, history of hypertension and Type 2 Diabetes Mellitus (T2DM), use of levothyroxine (LT4) or antithyroid drug, 25-hydroxyvitamin D3 [25(OH)D3], TSH, freeT3 (fT3), free (fT4) levels, FNAB results were obtained from the records. RESULTS: Asymptomatic COVID-19 infection was detected in 29 (2.43%) of 1195 patients who underwent FNAB. There was no statistically significant difference between patients with COVID-19 PCR test positive asymptomatic and negative patients in terms of age, gender, median values of 25(OH)D3, TSH, fT3, fT4, the ratio of hypertension and T2DM. DISCUSSION AND CONCLUSION: The healthcare professionals work devotedly against COVID-19 infection, demonstrating a great example of struggle worldwide. FNAB is an invasive procedure requiring close contact. It should be known by the clinician that COVID-19 infection is associated with a high risk of transmission in asymptomatic patients. The rate of 2.43% in the population can not be underestimated and indicates the importance of the use of personal protective equipment and taking infection prevention measures.

INTRODUCTION: We aimed to determine the awareness of obese, overweight and normal-weight patients about the complications, causes and prevention of obesity. METHODS: Patients who were admitted to our clinic during a four months period were included. Demographical features, familial histories of obesity, smoking, alcohol use, chronic diseases, medications, medical nutrition therapy and exercise habits were questioned. Patients were divided into groups as normal, overweight and obese according to the WHO criteria. RESULTS: The median age of 352 patients was 45 (18-88), Of all, 282 (80.11%) were female, and 70 (19.89%) were male. Fifty-one patients (14.49%) were normal weight, 72 (20.45%) were overweight, and 229 (65.06%) were obese. The level of education was lower in obese patients, and the family history of obesity was higher (p

Objectives: To investigate the effect of vestibular rehabilitation exercises supported with virtual reality containing real-life environments on dizziness, static and dynamic balance, functional mobility, fear of falling, anxiety, and depression in elderly patients with dizziness. Methods: In this prospective randomized controlled study, 32-patients aged 65-years and older who applied to the otorhinolaryngology clinic with dizziness complaint randomly assigned to 2 groups. In Group 1 (n = 16), vestibular rehabilitation program, supported with virtual reality, and in Group 2 (n = 16), conventional vestibular rehabilitation program was applied 30-min a day, 5 sessions per week, 15 sessions in total for 3 weeks. Subjects were evaluated with The Vertigo Symptom Scale (VSS), Dizziness Handicap Inventory (DHI), Berg Balance Test (BBT) and Timed Up & Go Test (TUG), Falls Efficacy Scale-International (FES-I), Postural Stability Test (PST), Geriatric Depression Scale (GDS), Hamilton Anxiety Scale (HAS) at baseline, at the end of the treatment and 6-months after the treatment. Results: Statistically significant improvements were seen in the DHI emotional subscale and TUG in Group 1 compared to Group 2 at the end of the treatment in elderly with dizziness (p

INTRODUCTION: We aimed to evaluate adherence and determine the factors that are related to adherence in patients on levothyroxine therapy. METHODS: Patients older than 18 years old and using levothyroxine for primary hypothyroidism were recruited. Demographical and clinical features, practices of using levothyroxine, and compliance were evaluated through a questionnaire. Those who answered the frequency of not using/skipping the drug as never/rarely, sometimes, and frequently/often were grouped as high, medium, and low adherence, respectively. RESULTS: Data of 335 patients -282(84.18%) female and 53(15.82%)- male, with a mean age of 47.36+-12.50 were analyzed. 330 (98.50%) patients were taking levothyroxine in the morning, and 332 (99.10%) were taking fast. 8(%2.41) patients were taking the drug just before the meal, and 66(19.88%) were taking it in 15 minutes. 66.66% of 145 patients using a medication that interferes with the absorption of levothyroxine were using it less than 2 hours of levothyroxine. There were 218 (65.08%) high, 98 (29.25%) medium and 19 (5.67%) low adherence patients. Drug adherence was not associated with demographical features, the cause and duration of hypothyroidism, the presence of comorbid disease, and thyroid hormones. Higher education level and familial thyroid disease were associated with high adherence (p=0.008 and p=0.013, respectively). DISCUSSION AND CONCLUSION: Drug adherence was medium/ low in 34.92% of hypothyroid patients. A considerable amount of patients did not leave enough time between levothyroxine and meal or other medications. For effective treatment of hypothyroidism, it is important to inform patients about hypothyroidism and levothyroxine use and increase drug compliance.

ABSTRACT Objectives: Thyroid nodules located in isthmus were found less prevalent, although papillary thyroid cancer in this location was reported to be more aggressive behaviour in some studies. Our aim was to evaluate hormonal,ultrasonographic, and cytopathologic features of nodules located in isthmus (isthmic nodules). Subjects and methods: Patients who underwent thyroidectomy between 2006-2014 reviewed retrospectively. Hormonal, ultrasonographic, and cytopathologic features compared between patients with isthmic (Group-1) and with lober (non-isthmic, Group-2) nodules. Results: Group-1 and Group-2 consisted of 251 and 2076 patients, respectively. 260 isthmic (5.5%) and 4433 non-isthmic (94.5%) nodules were compared.However,most ultrasonographical features such as presence of microcalcification and halo, diameters, echogenicity, texture, margin, and vascularity were similar between groups, macrocalcification rate was lower in isthmic nodules (18.8%, 25.9%; p = 0.012). Cytologic results were also similar.Although malignancy rate was lower in isthmic nodules (6.2%, 12.5%; p = 0.002), type of thyroid cancer was similar in isthmic and non-isthmic nodules.When malignant isthmic (n = 16,2.8%) and malignant non-isthmic nodules (n = 553, 97.2%) were compared, diameter and type of tumor, lymphovascular and capsular invasions, extrathyroidal extension and multifocality rates were not statistically significant.Malignant isthmic nodules (n = 16, 6.2%) had smaller size [10.1 (7.5-34.5) mm, 19.95 (8.4-74.1) mm; p = 0.002], and higher hypoechogenicity rate (31.3%, 5.7%, p = 0.003) compared to benign isthmic nodules (n = 244, 93.8%). Negative predictive value was higher and positive predictive value was lower in isthmic nodules compared to non-isthmic nodules (p = 0.033, p = 0.047, respectively). Conclusion: Isthmic nodules appear to be indolent because of having lower malignancy rate. FNAB might be required in isthmic nodules even if it has relatively small size.The surgery with limited extent or follow-up might seem to be reliable in the management of patients having isthmic nodules especially with indeterminate cytology.

INTRODUCTION: The overdiagnostic analyses can be performed for evaluation of thyroid nodules which are commonly seen pathology in the population. Diagnostic tests in the evaluation of thyroid nodules, commonly-seen pathology in the population, mostly cause overdiagnosis. In fact, serum calcitonin(SC) measurement is a sensitive and specific method in the diagnosis of medullary thyroid cancer(MTC). If the patients with Bethesda Category III(atypia of undetermined significance -AUS) cytologies have also high risk clinical and ultrasonographical features, they can be evaluated for thyroidectomy. In this study, we aimed to evaluate the value of screening with serum calcitonin in patients with cytologies of Bethesda I and III categories. METHODS: The medical records of patients who had thyroidectomy between 2007-2018 were screened retrospectively. The patients with preoperative calcitonin, cytology results and postoperative histopathology reports were included in the study. RESULTS: Of the 6905 thyroidectomized patients, 881 had SC values. SC levels were evaluated as 10pg/mL and classified as Group 1, 2, and 3; respectively. 217 patients(24.6%) had nondiagnostic(ND) and 275(31.2%) had AUS cytologies. The gender distribution was similar between ND and AUS groups(p=0.7). However, SC levels of group 1, 2, and 3 were found in 84.8%, 14.3%, and 0.9% of patients with ND, it was found in 82.9%, 15.6%, and 1.5% in patients with AUS cytologies, respectively(p=0.786). In histopathology, malignancy was detected in 30% of patients with AUS and 11.6% patients with ND(p=0.006). Calcitonin levels of patients with malignant histopathology were evaluated in 82.9%, 15.4%, and 1.7% of patients as Group 1, 2, and 3, respectively. This was similar compared to patients with benign histopathology (p=0.16). In the present study, 2 female patients had high calcitonin levels(144pg/mL and 655pg/mL). Both patients had preoperative AUS cytologies and final malignant histopathologies. DISCUSSION AND CONCLUSION: We think that preoperative assessment of serum calcitonin levels can be useful in treatment decision of patients especially with Bethesda Category III thyroid nodules such as in follow-up and extent of surgery for cases planning surgery.

ABSTRACT Objective: We aimed to evaluate the patients diagnosed with papillary thyroid carcinoma (PTC) and papillary thyroid microcarcinoma (PTMC) in terms of clinical, ultrasonographical (US) and histopathological features and their relationships with tumor size. Subjects and methods: We retrospectively evaluated 881 patients who underwent thyroid surgery in our clinic and diagnosed with PTC histopathologically were enrolled the study. Demographic characteristics, US findings and histopathological features were evaluated. Results: In total, 1264 nodules were identified in the 881 patients. The incidentality rates were higher in the PTMC group and also in the ≤ 5 mm group. In total multifocality rate was 32.9%, and was significantly higher in PTMC group than the PTC group. PTC and > 5 mm PTMC groups compared to PTMC and ≤ 5 mm groups respectively, were more aggresive histopathological features. Conclusions: Since the incidentality rates were found significantly more common in our patients with PTMC and those with ≤ 5 mm, ultrasonographic features of the nodules should be evaluated carefully and for cases which are suspicious with US, US-guided fine needle aspiration biopsy (FNAB) should be considered in order to make the correct treatment strategy. Also our study revealed that PTC and > 5 mm PTMC groups compared to PTMC and ≤ 5 mm groups respectively, have more aggresive histopathological features.

Abstract Background Inactive human cathelicidin antimicrobial peptide is present in neutrophils, and proteinase 3 activates this peptide by producing active LL-37 peptide. LL-37 acts as a defensive peptide in the oral tissues. In the present study, the aim was to evaluate LL-37 and proteinase 3 levels in peri-implant sulcus fluid (PISF) in implants with and without peri-implantitis. Methods Patients who simultaneously had dental implants with peri-implantitis and without peri-implantitis were included in the study. Forty-four samples with peri-implantitis and 34 samples without peri-implantitis from 16 patients were obtained. Intraoral evaluations such as pocket depth, modified sulcus bleeding index, and modified plaque index were noted. Enzyme-linked immunosorbent assay was used for the evaluation of PISF LL-37 and proteinase 3 levels. Results PISF volume was significantly increased in the implants with peri-implantitis than those without peri-implantitis (p < 0.05). No difference was present between PISF LL-37 and proteinase 3 total amounts between the implants with and without peri-implantitis (p > 0.05). Pocket depths and PISF LL-37 and proteinase 3 levels were not correlated in the groups (p > 0.05). Conclusions PISF volume might be increased in response to peri-implant bone destruction. However, peri-implant tissue destruction caused by peri-implantitis does not seem to affect PISF LL-37 and proteinase 3 levels.

AIM: To evaluate and compare the peripapillary and retinal vasculature changes in primary open angle glaucoma (POAG), pseudoexfoliation glaucoma (PXG), ocular hypertension (OHT) and normal eyes using optical coherence tomography angiography (OCTA). METHODS: A total of 114 POAG, PXG and OHT eyes of 60 patients and 46 eyes of 23 healthy control participants with good quality OCTA images were included. The PXG, POAG, OHT, and control groups (aged 68.17±6.30y, 61.11±10.26y, 58.1±8.9y, and 56.9±4.6y, respectively) contained of 46, 36, 32, and 46 eyes, respectively. Measurements of vessel density (VD) in the peripapillary region and macula, average retinal inner thickness, and retinal nerve fiber layer thickness (RNFLT) were compared among groups. In order to test the accuracy of differentiation between eyes with and without glaucoma, the area was calculated under the receiver operating characteristic (ROC) curves. RESULTS: The VD in glaucomatous eyes was significantly lower than the control group in all peripapillary sectors (44.35%±6.78% vs 50.47%±1.83%, P

Summary: Endogenous extracellular Galectins constitute a novel mechanism of membrane protein organization at the cell surface. Although Galectins are also highly expressed intracellularly, their cytosolic functions are poorly understood. Here, we investigated the role of Galectin-9 in dendritic cell (DC) surface organization and function. By combining functional, super-resolution and atomic force microscopy experiments to analyze membrane stiffness, we identified intracellular Galectin-9 to be indispensable for plasma membrane integrity and structure in DCs. Galectin-9 knockdown studies revealed intracellular Galectin-9 to directly control cortical membrane structure by modulating Rac1 activity, providing the underlying mechanism of Galectin-9-dependent actin cytoskeleton organization. Consequent to its role in maintaining plasma membrane structure, phagocytosis studies revealed that Galectin-9 was essential for C-type-lectin receptor-mediated pathogen uptake by DCs. This was confirmed by the impaired phagocytic capacity of Galectin-9-null murine DCs. Together, this study demonstrates a novel role for intracellular Galectin-9 in modulating DC function, which may be evolutionarily conserved. : Biological Sciences; Molecular Biology; Cell Biology Subject Areas: Biological Sciences, Molecular Biology, Cell Biology

Background: Despite significant improvement in imaging quality and advanced scientific knowledge, it may still sometimes be difficult to distinguish diff erent parathyroid lesions. The aims of this prospective study were to evaluate parathyroid lesions with ultrasound elastography and to determine whether strain index c an help to differentiate parathyroid lesions. Methods: Patients with biochemically confirmed hyperparathyroidism and l ocalised parathyroid lesions in ultrasonography were included. All patients underwent B-mode US and USE examination. Ultrasound elastography scores and strain index of lesions were determined. Strain index was defined as the ratio of strain of t he thyroid parenchyma to the strain of the parathyroid lesion. Results: Data of 245 lesions of 230 patients were analysed. Histopathologically, there were 202 (82.45%) parathyroid adenomas, 26 (10.61%) atypical parathyroid adenomas, and 17 (6.94%) cases of parathyroid hyperplasia. Median serum C a was significantly higher in atypical parathyroid adenoma patients than parathyroid hyperplasia patients (P = 0.019) and median PTH was significantly higher in APA compared to PA patients (P < 0.001). In 221 (90.2%) of the parathyroid lesions, USE score was 1 or 2. The median SI of atypical parathyroid adenomas was significantly hig her than parathyroid adenomas and hyperplasia lesions (1.5 (0.56–4.86), 1.01 (0.21–8.43) and 0.91 (0.26–2.02), respectively, P = 0.003). Conclusion: Our study revealed that SI of parathyroid lesions as well as s erum calcium, parathyroid hormone levels, and B-mode US features may help to predict the atypical parathyroid adenoma. Ultrasound elastography can be used to diff erentiate among parathyroid lesions and guide a surgical approach.

The mechanism of force production by invadopodia is unclear. Here, the authors show that cell surface MT1-MMP when in contact with collagen, induces Arp2/3 branched actin polymerisation on the concave side of invadopodia, which generates a pushing force along with collagen cleavage by MT1-MMP to invade.

Objectives:To evaluate the frequency of glaucoma in patients with obstructive sleep apnea syndrome (OSAS) using and not using continuous positive airway pressure treatment.Materials and Methods:This prospective study included 59 patients diagnosed with OSAS based on the Apnea-Hypopnea Index (AHI). OSAS patients were divided into 3 groups according to their AHI scores: 5-15 was considered mild (19 patients), 16-30 was considered moderate (16 patients), and >30 (24 patients) was considered severe. Twenty-eight (47.5%) of the OSAS patients had been using continuous positive airway pressure treatment. The control group included 19 healthy subjects. Retinal nerve fiber layer and ganglion cell complex (GCC) thickness analyses were performed.Results:Average GCC thickness in left eyes was significantly lower in the mild OSAS group than in the control group (p=0.013). The GCC was significantly thinner in the inferior and inferonasal sectors of both eyes in the mild OSAS group compared to the control group (p=0.029, p=0.022, p=0.037, and p=0.019 respectively). Minimum GCC thickness in the left eyes of all OSAS groups was significantly lower than in the control group (p

Although common in biology, controlled stiffening of hydrogels in vitro is difficult to achieve. Here the authors show how a biomimetic hybrid hydrogel can be stiffened instantaneously and reversibly up to 50 times.

Poly(lactic-co-glycolic acid) (PLGA) nanoparticle-based drug delivery systems are known to offer a plethora of potential therapeutic benefits. However, challenges related to large-scale manufacturing, such as the difficulty of reproducing complex formulations and high manufacturing costs, hinder their clinical and commercial development. In this context, a reliable manufacturing technique suitable for the scale-up production of nanoformulations without altering efficacy and safety profiles is highly needed. In this paper, we develop an inline sonication process and adapt it to the industrial scale production of immunomodulating PLGA nanovaccines developed using a batch sonication method at the laboratory scale. The investigated formulations contain three distinct synthetic peptides derived from the carcinogenic antigen New York Esophageal Squamous Cell Carcinoma-1 (NY-ESO-1) together with an invariant natural killer T-cell (iNKT) activator, threitolceramide-6 (IMM60). Process parameters were optimized to obtain polymeric nanovaccine formulations with a mean diameter of 150 ± 50 nm and a polydispersity index

Background: COVID-19 has caused a pandemic and is associated with significant mortality. The pathophysiology of COVID-19, affecting many organs and systems, is still being investigated. The hypothalamus, pituitary gland, and possibly adrenal glands are the targets of SARS-CoV-2 because of its angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) receptors expression. Hypocortisolemia can be seen in the postinfection period. COVID-19 infection tends to be severe in diabetic patients due to immune dysfunction. In this study, our aim was to investigate the relationship between basal cortisol levels and the course of COVID-19 infection in diabetic and non-diabetic patients. Methods: Our retrospective study included 311 PCR-positive COVID-19 patients over the age of 18 who were hospitalized in Ankara City Hospital Infectious Diseases Department or Intensive Care Unit (ICU) between 15 March 2020 and 15 May 2020. Serum basal cortisol, fasting plasma glucose (FPG), HbA1c values, and diabetes history were recorded within the first 24 h of hospitalization. The presence of pulmonary involvement was noted from the patients’ imaging records. Pregnant and breastfeeding women, patients with chronic liver disease or chronic kidney disease, and patients who were already using steroids or had started COVID-19 infection treatment within the 72 h before blood collection were excluded from the study. Results: Of the 311 patients, 100 had Type 2 Diabetes Mellitus (T2D), while 211 did not. The age, serum basal cortisol, and glucose levels of the patients with T2D (64.51 ± 12.29, 19.5 ± 13.12, and 143.5 (77–345)) were higher than those of the patients without T2D (46.67 ± 16.38, 15.26 ± 8.75, and 96 (65–202)), and the differences were statistically significant (p = 0.004, p = 0.004, and p < 0.001, respectively). The basal cortisol values of the ICU patients (27.89 (13.91–75)) were significantly higher than those of the ward patients (13.68 (1.48–51.93)) and patients who were transferred to the ICU from the ward due to worsening conditions (19.28 (7.74–55.21)) (p < 0.001 and p = 0.007, respectively). The factors affecting ICU admission were determined to be age, T2D history, basal cortisol, and elevation in FPG using univariate logistic regression analysis. In the multiple logistic regression analysis, age, basal cortisol level, and infiltrative involvement in thorax CT were determined to be the risk factors affecting intensive care admission. Conclusion: High basal cortisol levels in patients with T2D may predict the severity of COVID-19 infection or mortality. Although high basal cortisol levels are among the risk factors affecting ICU admission, patients with COVID-19 should also be evaluated in terms of clinical and laboratory findings and relative adrenal insufficiency.

Insulin degludec/insulin aspart (IDegAsp) is a fixed-ratio co-formulation of insulin degludec (IDeg), which provides long-lasting basal insulin coverage, and insulin aspart (IAsp), which targets post-prandial glucose. This expert panel aimed to provide a practical and implementable guidance document to assist clinicians in prescribing IDegAsp in the diabetes management with respect to different patient populations including children and adults with type 1 diabetes (T1D) or type 2 diabetes (T2D) as well as pregnant, elderly and hospitalized patients and varying practice patterns (insulin-naive, insulin-treated, switching from basal, basal bolus and premix regimens). The experts recommended that IDegAsp can be used in insulin-naive T2D patients with poor glycemic control (HbA1c >8.5%) despite optimal oral antidiabetic drugs (OADs) as well as in insulin-treated T2D patients by switching from basal insulin, basal-bolus therapy or premixed insulins in relation to lower risk of nocturnal hypoglycemia, fewer injections and lower intraday glycemic variability, respectively. The experts considered the use of IDegAsp in children with T2D as a basal bolus alternative rather than as an alternative to basal insulin after metformin failure, use of IDegAsp in adult T1D patients as a simplified basal bolus regimen with lesser nocturnal hypoglycemia, fewer injections and better fasting plasma glucose control and in children with T1D as an alternative insulin regimen with fewer injection to increase treatment adherence. The proposed expert opinion provides practical information on use of IDegAsp in different patient populations and practice patterns to assist clinicians, which seems to compensate the need for easily implementable guidance on this novel insulin regimen.