In humans, cats, and dogs, adrenal gland size appears slightly larger when measured by computed tomography (CT) compared to ultrasonography. However, CT measurement values have only been compared with ultrasound reference values retrospectively. This study aimed to directly compare CT and ultrasonographic measurement values of adrenal glands in dogs performed on the same day, under possible mimetic conditions. Thirty client-owned dogs without suspected adrenal disease scheduled for abdominal CT and ultrasound as part of diagnostic workup were enrolled. The maximum cranial and caudal pole diameter and length of both adrenal glands were measured using both modalities consecutively under the same anesthetic moment. Bland-Altman analysis of agreement between ultrasonographic and CT measurement values was performed. The results were also compared using the student's t-test for normally distributed data and the Mann-Whitney rank sum test for non-normal distribution. For all investigated dimensions, the bias was positive, indicating that CT consistently produced larger measurement values than ultrasound. When stratification into different weight categories was applied, there was a significant difference in the measurement values of both poles of the left adrenal gland in all weight categories (P≤0.05). In contrast, for the cranial and caudal pole measurement values of the right adrenal gland, significant differences were found only in some weight categories. The same imaging modality as originally used should be performed for patient follow-up. In larger dogs, greater discrepancies between ultrasonographic and CT acquired measurement values may be expected. When comparing measurement values acquired by CT and US, the information on the caudal pole size may be expected to be less variable than the cranial pole.
Salivary gland ultrasound (SGUS) plays a vital role in diagnosing and monitoring glandular disease activity, including the risk of lymphomagenesis in Sjogren's disease (SjD). Despite the importance of SGUS, access is often limited as rheumatologists do not always have the resources to perform these exams. Radiology, which specializes in image acquisition and interpretation at volume, has the potential to improve access to SGUS for patients undergoing SjD workup. The goal of this study was to evaluate the feasibility of radiology to perform and report SGUS exams. A retrospective analysis of SGUS exams completed at a large urban academic radiology department was conducted. Evaluation was limited to SGUS examinations performed after the implementation of a standardized imaging protocol and reporting template for OMERACT (Outcome Measures in Rheumatology) scoring, developed through a collaborative initiative with rheumatology. Data were extracted from the ultrasound Digital Imaging and Communications in Medicine (DICOM) header, and a large language model (LLM) was used to evaluate the study reports. Over a 42-month period, a total of 811 SGUS exams specifically requesting OMERACT scoring of the salivary glands were completed by radiology. The radiology sonographers took an average of 17 minutes to acquire the images, and the exams were reported by 53 different radiologists. The majority of reports (64%) adhered to the template, and OMERACT scores and gland volumes were documented in 87% of reports. We describe the implementation of a standardized SGUS protocol at a large urban academic health system that includes a wide range of radiologists with diverse experience, demonstrating the ability of radiologists to efficiently and effectively perform SGUS for OMERACT scoring as part of routine care.
We report a unique case of a 32-year-old woman with a 4-day history of painful right lacrimal gland swelling. MRI demonstrated enhancement and enlargement of the right lacrimal gland. There were nonenhancing, intraglandular foci, with low signal on T2-weighted sequences and marked restricted diffusion. Surgical excision revealed multiple dacryoliths centered on an impacted eyelash. Microbiological evaluation yielded Streptococcus pneumoniae and histopathology confirmed noncalcified ductal dacryoliths with a background of acute inflammation. At 1-month follow-up, symptoms completely resolved with no evidence of recurrence. Lacrimal gland dacryolithiasis is rare and usually presents as refractory conjunctivitis or a chronic lateral conjunctival or canthal mass, rather than acute dacryoadenitis. This case expands the clinicoradiological spectrum of this rare entity and highlights novel MRI patterns that may aid preoperative diagnosis and timely management.
Mucoepidermoid carcinoma (MEC) is the most common malignant tumor of the parotid gland. High-grade MEC has a high degree of malignancy, strong invasiveness, lacks obvious clinical and imaging features, and is prone to misdiagnosis. Moreover, the literature on the ultrasonic characteristics of MEC is limited. This article retrospectively analyzes the multimodal ultrasound features of a case of MEC. A 68-year-old Asian man noticed a raised mass beneath his right earlobe one year ago. Initially, the mass was painless, leading the patient to delay seeking medical attention. Over time, the mass has increased in size, prompting the patient to seek further evaluation at this hospital. Upon examination, a palpable mass measuring approximately 2.5 cm ×2.0 cm was identified beneath the right earlobe. The mass exhibited distinct borders, fair mobility, no tenderness, normal skin surface, and low skin temperature. The patient denies any significant family history of disease and has no history of infectious diseases or prior radiation therapy. Following comprehensive multimodal ultrasound diagnostic evaluation, the lesion was suspected to be a malignant neoplasm of the parotid gland. Subsequent pathological examination confirmed the diagnosis of MEC of the parotid gland. So the patient underwent surgery to remove the parotid gland mass under general anesthesia. This report provides a detailed description of the multimodal ultrasound imaging features of MEC. It underscores the potential value of this technique in the diagnostic process. The case aims to improve the understanding of this disease and enhance clinicians' ability to achieve an early diagnosis, thereby reducing the risks of misdiagnosis and delayed treatment.
Castleman disease constitutes a rare spectrum of conditions with rheumatologic, hematologic, and oncologic features. Orbital involvement is extremely rare with only several cases involving the lacrimal gland. This report describes Castleman disease in a 15-year-old patient who presented with progressive left eye bulging and intermittent periorbital pain. Neuroimaging demonstrated a well-defined, enhancing, homogeneous left lacrimal gland mass with decreased diffusivity, smooth bone remodeling, and anteromedial globe displacement, and no other systemic findings. The lesion was excised in toto and histopathology revealed features of hyaline vascular-type Castleman disease. This is the first reported case of Castleman disease in a pediatric patient with an isolated lacrimal gland lesion. It emphasizes the importance of considering Castleman disease among other lymphoproliferative diseases in the differential diagnosis for patients presenting with a well-circumscribed, homogeneous orbital mass associated with decreased diffusivity and bone remodeling.
To evaluate and compare the clinical effectiveness of radiofrequency (RF), intense pulsed light (IPL), and combined RF+IPL therapy in patients with dry eye disease (DED) associated with Meibomian Gland Dysfunction (MGD), using real-world data from a high-volume ophthalmic clinic. This retrospective cohort study included 286 adult patients diagnosed with MGD-related DED who received treatment between August 2022 and August 2024. Patients were divided into three groups based on the treatment modality administered: RF alone, IPL alone, or combined RF+IPL. Clinical outcomes were assessed using the Ocular Surface Disease Index (OSDI), the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, tear break-up time (TBUT), and Meibomian gland score (MGS), measured before intervention (baseline), 1 month and 3 months post-treatment. Statistical comparisons were performed within and between groups to assess treatment efficacy. All treatment groups showed statistically significant improvements from baseline to 4 weeks in OSDI, SPEED, TBUT, and MGS scores (p < 0.001). MGS improved within all groups, although the group-by-time interaction did not reach statistical significance. In the combined RF+IPL group, OSDI decreased from 22.70 to 3.61, SPEED from 18.17 to 5.25, TBUT increased from 7.29 to 11.54 seconds, and MGS from 25.00 to 29.63. Improvements were greatest in the combined group across most outcome domains. No serious adverse events occurred. Energy-based therapies represent an effective, non-invasive approach for managing MGD-related DED. The combined RF+IPL treatment demonstrated superior outcomes across most clinical domains compared to monotherapies, including the greatest improvement in gland function. These findings support its integration into routine clinical dry eye care and underscore the value of personalized, technology‑driven treatment approaches in modern ophthalmology.
Oral lichen planus (OLP) is a chronic inflammatory disorder mediated by cellular immunity. Xerostomia is not a typical feature but has been reported by a subset of patients and may reflect underlying salivary gland alterations. The mechanisms contributing to xerostomia in OLP remain unclear. This study evaluated the levels of autoantibodies against the muscarinic M3 receptor (anti-M3R Ab) in the labial minor salivary glands, saliva, and serum of OLP patients with xerostomia and compared them with those of healthy controls. In this case-control study, unstimulated whole saliva, serum samples, and labial minor salivary gland biopsies were obtained from 35 patients with OLP and xerostomia and 25 healthy controls. Anti-M3R Ab levels were measured using enzyme-linked immunosorbent assay (ELISA). Statistical analyses included Mann-Whitney U test, Spearman correlation coefficients, and multiple logistic regression. Anti-M3R Ab levels were significantly reduced in minor salivary gland tissue of OLP patients compared with controls. Lower anti-M3R Ab levels in minor salivary glands were statistically associated with higher xerostomia scores and lower unstimulated salivary flow rates. Correlation analyses showed a significant inverse relationship between glandular anti-M3R Ab levels and xerostomia severity. The reduction of anti-M3R Ab within minor salivary gland tissue may represent a localized immunological alteration contributing to xerostomia in OLP. These findings underscore the importance of localized, rather than systemic, immune mechanisms in the salivary gland dysfunction observed in OLP.
Mastitis is one of the most prevalent and economically significant diseases in dairy cattle, causing to inflammation of the mammary gland and reduced milk yield. This study investigated the therapeutic efficacy of Vitex pseudo-negundo (VPN) extracts in an experimentally induced rat mastitis model. Sixty female Wistar rats were randomly assigned into six groups of 10. Group I served as the control group. Mastitis was induced by intramammary injection of Staphylococcus aureus (SA) (1.5 × 108 cfu/mL; 10 µL per gland) into the L4, L5, R4 and R5 mammary glands. Group III received intramammary gentamicin (0.25 mg/10 µL/day) for 5 days. Groups IV-VI received VPN extracts-water (0.2603 µg/kg/day), ethanol (0.0803 µg/kg/day) and petroleum ether (0.1042 µg/kg/day), administered at 10 µL per gland for the same duration. Rats were clinically monitored three times daily from the onset of clinical signs until euthanasia. SA infection significantly increased mammary gland weight, total oxidative status (TOS) and bacterial load and induced tissue pathology, while decreasing total antioxidant status (TAS). C-reactive protein levels remained unchanged. VPN significantly improved mammary gland weight, TOS, TAS, bacterial load and histological parameters (p < 0.001). Mammary gland weight, oxidative stress, bacterial load and histopathological lesion severity all decreased markedly following treatment. Histological examination showed near-normal restoration of mammary gland architecture in all treatment groups. Preparations of VPN, particularly the water extract, demonstrated strong potential for restoring altered microbiological, biochemical and histological parameters in this rat mastitis model.
During the scent secretion period, adult male muskrats (Ondatra zibethicus) produce a musk-like fragrance similar to that of the forest musk deers (Moschus berezovskii). However, the underlying mechanism of scent secretion in muskrats were not well understood. Scent glands and testicular tissues from 2-year-old muskrats during non-scenting and scenting periods were analyzed using transcriptomics and metabolomics to identify key genes, metabolites, and pathways involved in scent secretion. Key findings include: (1) Significant differences were observed in the tissue structure of scent glands and testes between the two phases. (2) In the scent glands, fifteen candidate genes were identified that primarily regulate the formation of major musk components through steroid biosynthesis, unsaturated fatty acid (UFA) synthesis, glyceride metabolism, cholesterol metabolism, and aldosterone-regulated sodium reabsorption pathways. (3) In the testes, seven key genes were identified that regulate muskrat sex hormone synthesis and action, thereby controlling musk secretion via steroid hormone biosynthesis, GnRH signaling, estrogen signaling, prolactin signaling, cholesterol metabolism, and aldosterone synthesis and secretion pathways. (4) Transcriptomic and metabolomic association analysis revealed that cholesterol metabolism, UFA biosynthesis, and fatty acid metabolism pathways played key roles in regulating scent secretion activity. Meanwhile, during the scent-secreting period, the testes increase the level of phosphatidylethanol through genes Itpr1, Plcb2, and Prkca, influencing the transport and biosynthesis processes of fatty acids and cholesterol in the scent glands via GnRH signaling transduction and prolactin signaling transduction pathways. In addition, the testes regulate the expression of Hsd17b3 and Cyp3a in the scent glands through genes Cyp11a and Hsd11b2 via the steroid hormone biosynthesis pathway, promoting the synthesis of sterols and steroids from cholesterol in the scent glands. This study discovered that the testes regulate the synthesis and transport of key components in muskrat musk within the scent glands through genes (Itpr1, Plcb2, and Prkca, Hsd11b2, and Cyp11a) via GnRH signaling transduction, prolactin signaling transduction, and steroid hormone biosynthesis pathways.
Pleomorphic adenoma (PA) of the salivary gland, particularly of the parotid gland, is generally considered benign but exhibits heterogeneous biological behavior, including recurrence and malignant transformation. While benign pleomorphic adenoma (BPA) and carcinoma ex pleomorphic adenoma (CXPA) are well defined, lesions with borderline or atypical features represent a clinically challenging gray zone with unclear surgical implications. This study aimed to characterize the clinicopathological features of borderline/atypical PA (BaPA) within the PA spectrum and to evaluate its recurrence parttern and malignant transformation risk. We conducted a single-center retrospective cohort study of surgically treated PAs diagnosed between 2008 and 2023. Cases were categorized as BPA, BaPA, and CXPA based on standardized histopathological re-review. BaPA and CXPA were considered higher-risk lesions within the PA spectrum. Preoperative fine-needle aspiration (FNA) concordance, Ki-67 proliferation index, surgical approach, and recurrence were analyzed, with follow-up focused on pathology-confirmed recurrence. A total of 1,306 cases were included, of which 87.9% arose in the parotid gland. FNA concordance with final diagnosis was high in BPA (84.0%) but substantially lower in BaPA (54.4%) and CXPA (32.1%). Ki-67 increased stepwise across tumor categories and showed good discriminative ability for malignant transformation (area under the curve =0.841), with an optimal cutoff value of 10%. During follow-up, recurrence occurred in 15.5% of BaPA and 27.0% of CXPA cases. In BaPA, recurrence was associated with surgical approach; in sensitivity analysis excluding enucleation cases, recurrence remained significantly lower after total parotidectomy than after superficial parotidectomy (7.0% vs. 19.2%, P=0.01). Among recurrent BaPA cases, malignant transformation occurred in 41.7% and was associated with longer tumor duration. In CXPA, recurrence was primarily associated with advanced T category and stage. These findings support PA as a clinicopathological continuum and suggest that BaPA may represent an intermediate-risk subgroup within this spectrum. Adequate local surgical control, awareness of the limitations of FNA, and incorporation of Ki-67 (≥10%) may aid individualized risk stratification and postoperative surveillance, while further validation of this category is warranted.
To describe the epidemiology, organ involvement, histopathological patterns, and clinical management of immunoglobulin G4-related disease (IgG4-RD) in Stockholm County, Sweden. Patients with an International Classification of Diseases, 10th revision, Swedish Edition (ICD-10-SE) diagnosis of IgG4-RD recorded between 2019 and 2023 were identified from the Swedish National Patient Register, encompassing all diagnoses recorded in inpatient and specialist outpatient care. Clinical data, laboratory results, histopathology reports, and treatment information were obtained through systematic medical record review. In total, 112 patients with a registered IgG4-RD diagnosis were identified, of which 95 diagnoses were confirmed after medical record review. The cohort was predominantly male (68%), and 60% had disease involvement of two or more organs. Elevated serum IgG4 was present in 71% of patients. The pancreas, hepatobiliary system, and kidneys were the most frequently affected organs, while salivary gland involvement was comparatively uncommon. Among patients who underwent biopsy (76%), a majority showed histopathological features supportive of IgG4-RD, although only a minority fulfilled multiple histopathological criteria. Comorbidities at the time of diagnosis were similar to those observed in the general older population, although an elevated prevalence of nasal polyposis and asthma was observed. Most patients received systemic glucocorticoids, either alone or in combination with rituximab. Overall, the prognosis was favourable, with high remission rates. IgG4-RD in Stockholm County shows a pancreatohepatobiliary-renal dominant pattern, with relatively few glandular cases compared to Asian and US cohorts. Histopathological confirmation was supportive in most biopsied patients, although many affected organs were not biopsied.
Hypercalcemic crisis from a functioning parathyroid adenoma (PA) is exceptionally rare in prepubertal children and typically presents with a non-specific complaint such as polyuria or lethargy. We report a 7-year-old girl who was urgently referred for acute, colicky abdominal pain and repeated vomiting, which clinically mimicked acute appendicitis. During the work-up, extensive metabolic tests incidentally revealed severe hypercalcemia and elevated intact parathyroid hormone (PTH), which led to the diagnosis of PA-induced hypercalcemic crisis.Her initial manifestation was an acute abdomen rather than renal or neuropsychiatric symptoms. The case underscores that functioning PA should be included in the differential diagnosis of children presenting with unexplained gastrointestinal distress, and illustrates that timely diagnosis and focused parathyroidectomy can effectively reverse biochemical abnormalities, alleviate skeletal symptoms, and mitigate the risk of serious long-term complications. We report the case of a seven-year-old female patient who was hospitalized due to complaints of abdominal discomfort accompanied by episodes of recurrent vomiting.Subsequent analysis revealed that these symptoms may represent acute gastrointestinal syndrome in the context of a hypercalcemic crisis.We describe her clinical course, diagnostic workup, and treatment. Laboratory tests revealed severe hypercalcemia (4.67 mmol/L; reference range: 2.1-2.7mmol/L), along with hypophosphatemia, hypomagnesemia, and markedly elevated PTH (268.1 pg/mL).Thyroid ultrasound revealed a nodule in the inferior aspect of the right lobe of the thyroid gland, which was subsequently confirmed by contrast-enhanced CT.After urgent management of hypercalcemia-including intravenous fluids, furosemide, salmon calcitonin, and pamidronate-the patient underwent surgical excision of the right inferior parathyroid gland.Histopathological examination confirmed the diagnosis of a benign PA. Serum calcium and PTH levels normalized within 24 hours postoperatively, with complete resolution of clinical symptoms. Marked hypocalcemia developed within several days postoperatively and was corrected. During follow-up to date, serum calcium,PTH levels, and ultrasound examination of the parathyroid have been normal. PA represents an uncommon yet manageable cause of hypercalcemic crisis in pediatric patients. Timely assessment of serum calcium and PTH levels in individuals presenting with unexplained gastrointestinal symptoms-such as nausea, vomiting, or abdominal pain-facilitates swift diagnosis, thereby reducing the need for unnecessary diagnostic procedures like extensive imaging or invasive tests.Surgical resection of the PA is the first-line treatment. Postoperatively, prevention of hungry bone syndrome and long-term follow-up are required.
Silk is a highly versatile natural protein fiber with a wide range of uses, yet its diversity in composition and function remains poorly understood across the tree-of-life. This study investigates the silk of the Luna moth, Actias luna (Saturniidae), known to produce high-density cocoons with distinct fiber characteristics. Despite the broad recognition of A. luna as an important species for research and education, its silk production, silk fiber composition, and properties remain under characterized, particularly in comparison to other Saturniidae and model species such as Bombyx mori. Building from the recently assembled A. luna genome, this study examines key repeat motifs and amino acid composition of the silk fibroin heavy chain (FibH) protein in relation to silk fiber properties across species. We assessed the physical properties of native and degummed A. luna silk fibers, evaluating the effects of degumming time and treatment on fiber morphology and mechanical properties. Actias luna silk fibers have similar properties to other saturniid silks, aligning with established trends that link fiber characteristics to structural protein composition. Silk gland architecture and regional composition shifts in A. luna were analyzed, highlighting differences that correlate to differential protein expression. Analyses of fiber characteristics were further expanded to silk fibers produced by A. luna at different developmental stages. Variation in larval characteristics, fiber morphology, and silk fiber composition across larval instars suggests that life stage-specific silk fiber function may stem from differences in protein expression and silk fiber use. These findings advance understanding of how evolutionary and developmental shifts influence silk fiber properties, providing a foundation for rational design of protein-based biomaterials with tunable mechanical and structural characteristics for biomedical applications.
Pleomorphic adenoma (PA) and Warthin tumor (WT) are the two most common benign parotid tumors, and their distinct management strategies necessitate accurate preoperative discrimination. Therefore, this study aimed to investigate the value of ultrasound texture analysis in differentiating between them. This retrospective study analyzed ultrasound images from patients with pathologically confirmed PA or WT. Following lesion segmentation, texture features were extracted from the regions of interest (ROI). Feature selection was subsequently performed to identify the most discriminative feature subset. Machine learning (ML) models were constructed based on the selected features and evaluated on an independent test set using metrics including accuracy, sensitivity, specificity, and the area under the curve (AUC). Finally, SHapley Additive exPlanations (SHAP) was employed to interpret the model's predictions and quantify the contribution of key features, thereby linking them to sonographic characteristics of the tumors. In addition, the cut-off value of each feature was calculated. Eight key texture features were identified. PA showed more homogeneous and regular patterns, whereas WT appeared more heterogeneous and random. A discriminative model using these features achieved good performance on the test set: AUC 0.958 [95% confidence interval (CI): 0.899-0.996], sensitivity 90.5% (95% CI: 76.9-100.0%), specificity 83.3% (95% CI: 66.7-96.3%). On the independent external validation cohort, the model achieved accuracy 85.4% (95% CI: 73.2-95.1%), sensitivity 72.2% (95% CI: 50.0-92.9%), specificity 95.7% (95% CI: 86.4-100.0%), and AUC 82.4% (95% CI: 67.7-95.7%). This study identified and validated eight texture features that may help distinguish PA from WT in the parotid gland. Integrated into an ML model, these features showed discriminative potential, offering a useful adjunct for preoperative assessment of parotid masses.
Previous studies have reported that indocyanine green (ICG) near-infrared fluorescence imaging facilitates laparoscopic adrenalectomy. This study aimed to evaluate the feasibility of ICG imaging in cortical-sparing adrenalectomy and to explore its utility in distinguishing adrenal tumors from normal tissue using quantitative image analysis. This institutional review board-approved, single-center retrospective cohort study included 80 patients who underwent unilateral laparoscopic cortical-sparing adrenalectomy between June 2024 and June 2025. Patients were divided into two groups: the non-ICG group (n = 40), comprising patients operated without ICG between June and December 2024; and the ICG group (n = 40), comprising patients operated with ICG between January and June 2025. Postoperative image analysis was performed using ImageJ software to calculate the adrenal-to-background fluorescence ratio (ABR) and the contrast-to-noise ratio (CNR). Statistical analysis compared CNR values between ICG and conventional views. A total of 80 patients underwent unilateral cortical-sparing adrenalectomy. The median operative time was significantly shorter in the ICG group compared to the non-ICG group (63 min vs. 90 min, P < 0.001). In the ICG group, 28 cases (70%) exhibited hyper-fluorescence intensity (ABR > 1), while 12 cases (30%) showed hypo-fluorescence (ABR < 1). On multivariate analysis, tumor size/volume was the only independent predictor of fluorescence intensity (P = 0.019). The CNR values were significantly higher in the ICG view than in the conventional view (P < 0.001), indicating the ICG view has superior contrast for differentiating adrenal tumors from normal tissue. ICG fluorescence imaging effectively enhances intraoperative identification of the adrenal gland and delineates tumor boundaries, potentially reducing operative time. By integrating ICG imaging with quantitative analysis using ImageJ software, visual contrast differences can be objectively measured. This study introduces quantitative metrics, notably CNR, providing a novel and objective method for evaluating the utility of ICG in cortical-sparing surgery.
This study aims to describe the clinical spectrum, imaging localization, surgical approaches, and histopathology of orbital space-occupying lesions treated at a tertiary center. A retrospective review was conducted on 59 consecutive patients with orbital masses who were treated at the Central Hospital of Wuhan, from July 2018 to January 2025. Demographics, laterality, compartmental localization using the new 5-compartment model (intraconal, extraconal, eyeball zone, optic nerve sheath, subperiosteal), management, and pathology were summarized descriptively. We found that among the 59 lesions, 48 were benign (81.36%) and 11 were malignant (18.64%). The most frequent benign lesions were cavernous venous malformation (10/59, 16.95%), dermoid cyst (8/59, 13.56%), inflammatory pseudotumor (6/59, 10.17%), and pleomorphic adenoma of the lacrimal gland (5/59, 8.47%). Lymphoma was the most common malignant lesion (8/59, 13.56%). Fifty patients underwent surgery (lateral, anterior, or medial orbitotomy, or endoscopic transnasal approach), and 9 were managed conservatively. Benign tumors rarely recur after surgical resection and have a favorable prognosis. Malignant tumors such as lymphoma are difficult to be radically resected through surgery, requiring postoperative adjuvant radiotherapy and chemotherapy, with a high risk of recurrence and metastasis. In this single-center series, benign orbital masses were predominant, with cavernous venous malformation being the most common benign entity and lymphoma the leading malignancy. Compartment-based imaging analysis is beneficial for differential diagnosis and surgical planning; infiltrative patterns in lymphoma often preclude complete resection and necessitate adjuvant therapy.
Rhipicephalus microplus, also known as the "cattle tick", presents worldwide distribution in tropical and subtropical regions and causes significant economic losses in livestock activity. At the present work, an immunogenic cysteine-rich protein produced in salivary glands was identified through an association of phage display and third generation sequencing (TGS) high-throughput techniques. This protein presenting a trypsin inhibitor-like (TIL) domain from R. microplus, named here as RmTIL, was expressed as a recombinant protein and submitted to a functional characterization as a serine protease inhibitor. The recombinant protein corresponding to its TIL domain portion (rRmTIL-D) inhibited human neutrophil elastase, cathepsin G, and subtilisin A, displaying inhibition constant (Ki) values of 7.0, 32.7 and 182.5 nM, respectively. RNA interference (RNAi) was employed to evaluate the effect of RmTIL-gene expression over reproductive parameters in engorged female ticks, revealing that eggs viability was significantly affected after gene silencing. Moreover, RmTIL gene silencing led to upregulation of 16S bacterial rRNA levels in ovary and eggs, while experimental infection of ticks with Gram-positive bacteria resulted in upregulated RmTIL transcripts. Following the increased bacterial burden, genes encoding proteins related to embryo development, lipid, redox, and energy metabolism pathways were modulated in eggs laid by RNAi-silenced females. Data presented here indicate that RmTIL is an immunogenic protein playing the two important roles of inhibiting host proteases and regulating tick microbiota, both crucial to the R. microplus life cycle.
Assessing the readmitted diseases and survivors in patients hospitalized with pulmonary tuberculosis (TB) is crucial for healthcare strategies tailored to TB survivors. This study aims to compare readmissions and survival of hospitalized pulmonary TB patients with those of their matched controls in Thailand. We retrieved inpatient drug-sensitive pulmonary TB cases from the Thai Health Information Portal database (2017-2022), which included all hospitalized admissions in Thai hospitals. Non-TB controls were selected using 1∶1 propensity score matching by admission date, location, sex, age, and comorbidities. Time to readmission and to death event were the outcome variables. Cox regression with a robust variance sandwich estimator was used and then the E-value was computed. E-values indicate the strength of possible unexplained confounders. From the propensity score matching, a total of 59,027 patients newly admitted for TB could be matched with 59,027 non-TB inpatient controls. Hazard ratios (HR) with 95% confidence intervals (CI) and E-values for causes of readmission among TB patients were 5.4 (2.1-14.3) and 10.2 for pericarditis, 5.4 (4.1-7.2) and 10.2 for pneumothorax, 3.8 (2.9-4.9) and 7.1 for bronchiectasis, 3.1 (2.4-4.2) and 5.6 for hyperfunction of the pituitary gland, and 2.4 (2.1-2.8) and 4.2 for inflammatory liver diseases. The TB cohort also had a higher risk of death [HR = 1.5 (95% CI: 1.4-1.6) and E-value = 2.3]. Hospitalized TB patients in Thailand are at higher risk than their non-TB controls in getting readmissions for thoracic problems and death. These problems call for improvement of TB care.
Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) is increasingly used in prostate cancer imaging because of its high sensitivity for detecting metastatic disease, even at low prostate-specific antigen (PSA) levels. However, false-positive uptake may occur in benign or inflammatory conditions, creating important diagnostic pitfalls. We report the case of a patient with oligometastatic low-volume prostate adenocarcinoma who presented with biochemical progression and a PSA level of 10.85 ng/mL. Histopathology confirmed a high-grade adenocarcinoma (International Society of Urological Pathology {ISUP} grade 5, Gleason score 9 {5+4}). PSMA PET/CT demonstrated intense uptake within the prostate gland and an additional focal uptake in the vocal cords, initially suspicious for atypical metastatic disease. Subsequent otorhinolaryngological evaluation with fiberoptic laryngoscopy was normal, supporting the diagnosis of false-positive PSMA uptake. This case highlights the limitations of PSMA PET specificity and emphasizes the importance of correlating imaging findings with clinical, anatomical, and endoscopic evaluations to avoid misdiagnosis, overstaging, and inappropriate therapeutic decisions.
This single-center prospective cohort study evaluated the clinical outcomes of thick acellular dermal matrix (ADM) for partial volume correction in breast reconstruction. Small-to-moderate volume deficits commonly occur after partial or total mastectomy in Asian women with relatively small breasts and may not justify additional major flap surgery. This study aimed to evaluate the safety and efficacy of thick ADM (≤5 mm) for intraoperative partial volume correction across oncoplastic and reconstructive settings. Between July 2022 and June 2023, thick ADM was applied as a deep onlay beneath glandular reshaping flaps, rotation flaps, or latissimus dorsi (LD) flaps in 20 prospectively enrolled cases, while 124 cases without thick ADM (67 partial mastectomy, 57 total mastectomy) served as a reference cohort; clinical variables, complications up to 6 months, and patient-reported satisfaction using a modified KNU Breast-Q were analyzed using appropriate statistical tests. The thick ADM group more frequently underwent oncoplastic volume displacement or replacement and received postoperative radiotherapy. However, rates of seroma, hematoma, dehiscence, fat necrosis-like firmness, infection, and reoperation were comparable between groups. No reconstruction failures or implant removals occurred in the thick ADM cohort. Both groups reported high satisfaction across all domains. Thick ADM is a safe, practical option for targeted partial volume correction following partial or total mastectomy, enabling restoration of contour and symmetry without increased short-term complications.