Abstract
Objectives
We evaluated telecytology rapid on-site evaluation (ROSE) for thyroid ultrasound-guided fine-needle aspiration. To the best of our knowledge, this study is the first case-control ...clinical trial of thyroid telecytology.
Methods
We introduced on-site ROSE in our institution’s thyroid clinic for 6 months, followed by telecytology for 12 months. Our institution’s ultrasound clinic, where ROSE is not provided, was used as a control group for each period.
Results
Both groups had similar initial unsatisfactory rates (thyroid clinic: 8.8%; ultrasound clinic: 8.0%) before the study began. The thyroid clinic’s unsatisfactory rate was significantly reduced to 1.6% after on-site ROSE (P = .001) and to 3.8% after telecytology ROSE (P = .010), with no significant difference between on-site and telecytology ROSE periods (P > .05). The ultrasound clinic’s unsatisfactory rate was unchanged for both periods. Concordance between telecytology ROSE and final adequacy was 97% (κ = 0.699).
Conclusions
Telecytology ROSE reduces unsatisfactory rates for ultrasound-guided fine-needle aspiration without compromising patient care.
There is lack of evidence-based information on the use and timing of endotracheal intubation (ETI) in children with prehospital status epilepticus (SE).
The aim of this study was to investigate ETI ...use, timing, risk factors, and outcomes in children presenting to a single-center children's emergency (CE) with prehospital SE, over a 5-year period.
A total of 118 events involving children presenting to CE with ongoing prehospital SE were included, and 39% (46/118) of the events required ETI. The most common indication for ETI was respiratory depression. The median time to intubation after arrival at CE was 20.0 minutes (1-155 minutes). Risk factors associated with ETI use include the administration of more than 2 benzodiazepines (26.1% vs 4.2%, P < 0.001) and the use of second- or third-line antiepileptic therapy ( P < 0.001). The use of more than 2 doses of benzodiazepines was found in 12.7% (15/118) of the patients. In patients who received excessive benzodiazepines, 87% (13/15) of them required intubation.
Excessive use of benzodiazepine was found to be a main risk factor for ETI in patients with prehospital SE. Avoidance of the excessive use of benzodiazepines and adhering to clinical management guidelines may reduce the risk for ETI in the CE. The best approach to airway management in children with prehospital SE is lacking and urgently needed.
Objectives: We evaluated telecytology rapid on-site evaluation (ROSE) for thyroid ultrasound-guided fine-needle aspiration. To the best of our knowledge, this study is the first case-control clinical ...trial of thyroid telecytology. Methods: We introduced on-site ROSE in our institution's thyroid clinic for 6 months, followed by telecytology for 12 months. Our institution's ultrasound clinic, where ROSE is not provided, was used as a control group for each period. Results: Both groups had similar initial unsatisfactory rates (thyroid clinic: 8.8%; ultrasound clinic: 8.0%) before the study began. The thyroid clinic's unsatisfactory rate was significantly reduced to 1.6% after on-site ROSE (P = .001) and to 3.8% after telecytology ROSE (P = .010), with no significant difference between on-site and telecytology ROSE periods (P > .05). The ultrasound clinic's unsatisfactory rate was unchanged for both periods. Concordance between telecytology ROSE and final adequacy was 97% (kappa = 0.699). Conclusions: Telecytology ROSE reduces unsatisfactory rates for ultrasound-guided fine-needle aspiration without compromising patient care. Key Words: Telecytology; Thyroid; Adequacy; Rapid on-site evaluation (ROSE); Fine-needle aspiration
To describe the difference in clinical presentation, including race, of ischemic stroke between patients with and without novel coronavirus disease 2019 (COVID-19), and the association of ...inflammatory response with stroke severity.
This is a retrospective, observational, cross-sectional study of patients (n = 60) admitted with ischemic stroke between late March and early May 2020. All patients were tested for COVID-19 during admission. Demographic, clinical, and laboratory data was collected through electronic medical record review. Descriptive statistics was performed to observe the differences between stroke patients with and without COVID-19
60 hospitalized patients with acute ischemic stroke were included in the analysis. Nine were positive for COVID-19. African-Americans comprised of 55.6% of those that had COVID-19 and stroke and 37.7% of those with only stroke. Stroke patients with COVID-19 had a significantly higher NIHSS 18.4 (8.8) and neutrophil-to-lymphocyte ratio (NLR) 7.3 (4.2) vs 3.8 (2.8); P = 0.0137 than those without. Those with COVID-19 also had a significantly higher mortality rate (44.4% vs. 7.6%; p < 0.001).
We observed a cohort of patients, including a large proportion of African-Americans, who developed ischemic stroke with or without COVID-19. An exaggerated inflammatory response, as indicated by NLR, likely plays a role in stroke severity among COVID-19 patients that concurrently develop ischemic stroke.
•Stroke patients with COVID-19 had higher NLR, indicating an inflammatory response to the virus.•NLR was also associated with stroke severity.•Stroke patients with COVID-19 had a higher PT and PTT.
Background:
Head and neck paraganglioma is a rare neoplasm of the paraganglia. It accounts for <1% of all head and neck tumors. It usually has benign clinical course; however, malignant paraganglioma ...can only be diagnosed by showing metastatic disease. We undertook a retrospective study to assess the clinical significance of regional lymph nodes metastases in head and neck paragangliomas.
Design:
From 1993 to 2016, primary head and neck paragangliomas are identified. The patient clinical and histopathologic materials were reviewed.
Results:
Sixty-five specimens from 62 patients (3 patients with more than 1 specimens) with head and neck paragangliomas were recorded (49 female and 13 males) with mean age of 54 (24-78 years). The locations of the tumors were as follows: carotid body: 30, glomus tympanicum: 11, glomus jugulare: 14, parapharyngeal space: 3, and 1 case each of larynx, skull base, paraglottic area, infratemporal fossa, mastoid, cerebellopontine (CP) angle, and pyriform sinus. On histopathology, we found 5 cases of sclerosing variant. Thirty-two (52%) of the 62 patients had regional lymph node biopsy. Four (12%) of the 32 show metastatic paraganglioma (3 females and 1 male with mean age = 35). Two of the 5 cases of sclerosing variant had positive lymph nodes. No evidence of local recurrence or distant metastasis in the patients with positive lymph nodes with a 6 to 11 years follow-up. One of the 28 patients with negative lymph nodes developed metastatic disease to lumbar spine in 5 years.
Conclusion:
Metastatic paraganglioma to regional lymph nodes may have indolent clinical behavior, with disease-free survival of up to 11 years. The incidence of metastatic disease in lymph nodes was 4 (12%) of 32. Forty percent (2/5) of the cases with sclerosing variant of paraganglioma had lymph node metastases indicating that this tumor may have a more aggressive histological behavior.
Objective:
In stroke patients, extensive interventions for incidental thyroid nodules can be burdensome and costly. It appears that the risk of malignancy has not been reported in angiographically ...detected nodules and outcomes have not yet been described in patients, receiving acute stroke work-up.
Materials and Methods:
Incidental thyroid nodules were found on neck computerized tomography angiography or magnetic resonance angiography performed during inpatient stroke workup (January 2017 to September 2019). These patient cases were reviewed based on sonography reports, diagnosis, and follow-up care.
Results:
Of the 13 563 patients, 192 had incidental thyroid nodules (prevalence 1.4%). Twenty-six died from comorbidities and 22 received thyroid sonography. Twelve nodules from 10 patients had sonographic characteristics for biopsy: 10 benign, 1 indeterminate, and 1 papillary thyroid cancer (risk of malignancy: 8%). The cancer patient underwent hemithyroidectomy and is disease-free. Follow-up of the remaining patients showed no worsening or suspicious nodules. The American College of Radiology (ACR) guidelines would have prevented 8 unnecessary sonograms and 1 biopsy without missing malignancy.
Conclusion:
Although a small risk of malignancy was noted, 95% of patients undergoing additional diagnostic thyroid testing had clinically insignificant results. The ACR guidelines can prevent unnecessary interventions. Given the 14% mortality rate in the study cohort, it is proposed that a clinical evaluation of patients is important before undergoing further diagnostics, as comorbidities may be worse than a thyroid cancer.
Ectopic thyroid tissue is rare and controversial. Some experts consider it to always be metastatic thyroid carcinoma, whereas others consider it benign as long as it is restricted to few follicles ...without cytoarchitectural features of papillary thyroid carcinoma. Immunohistochemistry (IHC) and molecular studies have not yet been performed to further characterize this entity. We retrospectively searched our pathology files for all ectopic thyroid inclusions and reviewed clinicopathologic characteristics and concurrent thyroid pathologic findings. We identified 8 cases from 7 patients. Ectopic thyroid tissue was present in the following locations: neck soft tissue: 3, thymus: 2, neck lymph nodes: 2, perihilar soft tissue: 1. All patients had histologically benign thyroid specimens. BRAFV600E (VE1) IHC, HBME-1 IHC, galectin-3 IHC, BRAFV600E allele-specific polymerase chain reaction (PCR) and NRAS/KRAS pyrosequencing were performed. To assess the sensitivity and specificity of BRAFV600E IHC compared with PCR; we tested 13 cases of primary and metastatic papillary and follicular thyroid carcinomas. All the ectopic cases were HBME-1, galectin-3, BRAFV600E (IHC, PCR), and NRAS/KRAS mutation negative (specificity=100%). Compared with PCR, BRAF IHC had 89% sensitivity and 100% specificity. Lack of common carcinoma-associated mutations supports benign nature of this entity. BRAF, HBME-1, and galectin-3 IHC are accurate and helpful when not enough tissue is available for molecular studies. IHC and molecular studies are more helpful than morphology alone in identifying benign thyroid rests.
Peking University, founded in 1898, was at the center of the major intellectual movements of twentieth-century China. In this institutional and intellectual history, author Xiaoqing Diana Lin shows ...how the university reflected and shaped Chinese intellectual culture in an era of great change, one that saw both a surge of nationalism and an interest in Western concepts such as democracy, science, and Marxism. Lin discusses Peking University’s spirit of openness and how the school both encouraged the synthesis of Chinese and Western knowledge and promoted Western learning for the national good. The work covers the introduction of modern academic disciplines, the shift from integrative learning to specialized learning, and the reinterpretation of Confucianism for contemporary times.
The aim of this study was to develop a toolset that can be used by site managers to assess and monitor natural attenuation processes in sediments contaminated with legacy hydrophobic organic ...contaminants. The toolset is composed of sediment traps to measure quality and deposition rate of incoming sediment under different hydrodynamic conditions, sediment cores to show trends in sediment bed concentrations over time, and passive samplers attached to a porewater probe frame to assess the mobility of buried contaminants and possible contaminant flux from sediment. These three tools were used together for the first time to assess the mobility of dichlorodiphenyltrichloroethane (DDT) contaminants in sediment in Pallanza Bay, Lake Maggiore, Italy. Depositing sediment and sediment cores were consistent in showing that DDT-contaminated sediment is undergoing burial by cleaner sediment. Elevated DDT concentrations from historical contamination seemed to be effectively buried and immobilized by ongoing deposition by cleaner sediment, because the positive flux from the elevated DDT concentration in the sediment porewater should not advance towards the sediment surface. The monitoring toolset introduced in this study enabled us to more effectively assess ongoing natural attenuation processes and provide more risk relevant data than traditional methods used in monitored natural recovery projects, such as bulk sediment concentrations from sediment cores. Our field assessment results suggest that incoming sediment from the Toce River have reduced DDT concentrations in the sediment compared to historic levels, and will continue to do so in locations where higher DDT concentrations are found within the bioactive layer.
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•Toolset demonstrates natural attenuation processes for contaminated sediments.•Natural recovery occurring faster in areas with higher deposition rates.•Buried DDT contaminants are effectively immobilized by clean sediment deposition.
Our results from quantitative RT-PCR, Western blotting, immunohistochemistry, and the tissue microarray of medullary thyroid cancer (MTC) cell lines and patient specimens confirm that VGSC subtype ...NaV1.7 is uniquely expressed in aggressive MTC and not expressed in normal thyroid cells and tissues. We establish the druggability of NaV1.7 in MTC by identifying a novel inhibitor (SV188) and investigate its mode of binding and ability to inhibit INa current in NaV1.7. The whole-cell patch-clamp studies of the SV188 in the NaV1.7 channels expressed in HEK-293 cells show that SV188 inhibited the INa current in NaV1.7 with an IC50 value of 3.6 µM by a voltage- and use-dependent blockade mechanism, and the maximum inhibitory effect is observed when the channel is open. SV188 inhibited the viability of MTC cell lines, MZ-CRC-1 and TT, with IC50 values of 8.47 μM and 9.32 μM, respectively, and significantly inhibited the invasion of MZ-CRC-1 cells by 35% and 52% at 3 μM and 6 μM, respectively. In contrast, SV188 had no effect on the invasion of TT cells derived from primary tumor, which have lower basal expression of NaV1.7. In addition, SV188 at 3 μM significantly inhibited the migration of MZ-CRC-1 and TT cells by 27% and 57%, respectively.
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