Majority Of Nodules Research Articles

Pulmonary nodules and the psychological harm they can cause: A scoping review

More than 1.6 million pulmonary nodules are diagnosed in the United States each year. Although the majority of nodules are found to be benign, nodule detection and the process of ruling out malignancy can cause patients psychological harm to varying degrees. The present study undertakes a scoping review of the literature investigating pulmonary nodule-related psychological harm as a primary or secondary outcome. Online databases were systematically searched to identify papers published through June 30, 2023, from which 19 publications were reviewed. We examined prevalence by type, measurement, associated factors, and behavioral or clinical consequences. Of the 19 studies reviewed, 11 studies investigated distress, anxiety (n = 6), and anxiety and depression (n = 4). Prevalence of distress was 24.0 %-56.7 %; anxiety 9.9 %-42.1 %, and 14.6 %-27.0 % for depression. A wide range of demographic and social characteristics and clinical factors were associated with nodule-related psychological harm. Outcomes of nodule-related harms included experiencing conflict when deciding about treatment or surveillance, decreased adherence to surveillance, adoption of more aggressive treatment, and lower health-related quality of life. Our scoping review demonstrates that nodule-related psychological harm is common. Findings provide evidence that nodule-related psychological harm can influence clinical decisions and adherence to treatment recommendations. Future research should focus on discerning between nodule-related distress and anxiety; identifying patients at risk; ascertaining the extent of psychological harm on patient behavior and clinical decisions; and developing interventions to assist patients in managing psychological harm for better health-related quality of life and treatment outcomes.

Pulmonary Sclerosing Pneumocytoma - A Comprehensive Exploration of Clinical, Radiological, and Surgical Dimensions By IJISRT

Objectives: The study findings have important Clinical implications, especially in the preoperative evaluation of Lung Nodules and aid in the radiological diagnosis based on CT features. Pulmonary Sclerosing pneumocytoma is a Benign, rare tumor of the lung that represents a diagnostic challenge due to the Non-specific CT findings. The Aim of this study was to present a 10-year experience with sclerosing pneumocytoma of a large center of CHINA for the diagnosis and treatment of pulmonary diseases, and to emphasize differential diagnostic dilemmas as a potential source of errors.  Material and Methods: This represents a retrospective study of 31 patients diagnosed and treated with sclerosing pneumocytoma in the 10-year period. The study analyzed various Variables, including Gender, Age, Smoking history, Reason for CT, Nodule location, Nodule shape, Clinical symptoms, Calcifications, and Surgical Resections.  Results: Sclerosing pneumocytoma was more frequently diagnosed in females (93.5%). The patients ranged in age from 28 to 68. Most of the patients (77.4%) were asymptomatic. 30 patients had no history of smoking (96.8%). Mean Nodule size was 14.4mm. Most nodules have Round, oval and smooth margin, with majority of Nodules have location in the lower lobes of both lungs. Most nodules were peripherally situated (54.83%). VATS with lobectomy performed in 25 (80.64%) patients while VATS with wedge resection performed in 6(19.64%) patients, without post-surgical complications and Normal follow up.

Endoscopic Thyroidectomy for Large-Sized Goiters: Merits of the Axillo-Breast Approach with Gas Insufflation.

Several minimal access approaches to the thyroid gland have been widely applied; nevertheless, such approaches are still challenging when dealing with large-sized thyroid nodules or goiters. We hereby evaluated the outcomes and highlighted the merits of endoscopic axillo-breast hemithyroidectomy (EABH) for large-sized unilateral goiters. Patients underwent EABH for unilateral large thyroid nodules ≥6 cm in its greatest dimension or unilateral large goiter (≥60 ml sonographic volume) whatever the size of its contained nodules were identified from a prospectively maintained database. Their demographic data, clinicopathological profiles, and surgical and esthetic outcomes are reported and analyzed. Over a 2-year period, 33 patients matched the selection criteria. Their mean age was 34.75 ± 11.39 years. There were 30 women and 3 men. The majority of nodules were radiologically TIRADS3 and cytologically Bethesda 3. The mean sonographic dominant nodule greatest dimension was 5.29 ± 1.48 cm (range: 3-9.5 cm). The mean sonographic volume of the pathological lobe was 101.86 ± 54.45 ml (range: 60.11-236.88 ml). All cases were completed endoscopically with no conversion to open. The mean operative time was 110.76 ± 18.75 minutes. No significant postoperative complications were reported except for one case with temporary vocal cord paresis. Most (87.9%) of the patients were extremely satisfied with the procedure. EABH with our suggested key steps could be considered an effective valid approach for unilateral large goiters in trained hands and in patients desirous for cosmesis.

Correlation of ACR TI-RADS and Patient Outcomes in a Real-World Cohort Presenting for Thyroid Ultrasonography.

The American College of Radiology Thyroid Image Reporting and Data System (ACR TI-RADS) was developed to predict malignancy risk in thyroid nodules using ultrasound features. TI-RADS was derived from a database of patients already selected for fine-needle aspiration (FNA), raising uncertainty about applicability to unselected patients. We aimed to assess the effect of ACR TI-RADS reporting in unselected patients presenting for thyroid ultrasound in a real-world setting. Records for all patients presenting for thyroid ultrasonography in Canterbury, New Zealand, were reviewed across two 18-month periods, prior to and after implementation of TI-RADS reporting. Patient outcomes were compared between the 2 periods. Malignancy rates were calculated for nodules 10 mm or larger with a definitive FNA or histology result. A total of 1210 nodules were identified in 582 patients prior to implementation of TI-RADS; 1253 nodules were identified in 625 patients after implementation of TI-RADS. TI-RADS category was associated with malignancy rate (0% in TR1 and TR2, 3% in TR3, 5% in TR4, 12% in TR5; P = .02); however, 63% of nodules were graded TR3 or TR4, for which malignancy rate did not meaningfully differ from baseline risk. After implementation of TI-RADS there was a small reduction in the proportion of patients proceeding to FNA (49% vs 60%; P < .01) or surgery (14% vs 18%; P < .05), with no difference in cancer diagnoses (3% vs 4%, not significant). TI-RADS category is associated with malignancy rate and may alter clinical decision-making in a minority of patients; however, it is nondiscriminatory in the majority of nodules. In this study of unselected patients, nodules classified as TR5 and thus considered "highly suspicious" for cancer had only a modest risk of malignancy.

Clinicopathologic Characteristics and Postsurgical Follow-Up of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features in the Postnomenclature Revision Era.

Background: Noninvasive encapsulated follicular variant papillary thyroid carcinoma (EFVPTC) was reclassified as "noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) in 2016. Most existing studies that examined outcomes included patients managed as EFVPTC and only retrospectively reclassified as NIFTP. This is the first study to evaluate the clinicopathologic, molecular, and surveillance characteristics of patients diagnosed with NIFTP at the time of surgery and managed based on this diagnosis. Methods: We performed a retrospective cohort study of consecutive cases diagnosed as NIFTP from June 2016 to October 2021 identified from electronic medical records at a large tertiary care institution. Patients with coexisting low-risk thyroid cancers ≥1.0 cm in size or any size aggressive histology were excluded, and review of demographic, clinical, imaging, cytologic, and molecular genetic data was performed. Initial care was delivered according to existing clinical guidelines, with a consensus institutional plan for five-year follow-up after surgery. Results: Among 79 patients with 84 nodules diagnosed as NIFTP after surgery, 83.5% (66/79) were women and the mean age was 51 years (range, 21-84). Mean NIFTP size was 2.4 cm (range 0.15-8.0). On ultrasound, the majority of nodules were categorized as thyroid imaging, reporting and data system TI-RADS 3 (55.3%, 42/76), and TI-RADS 4 (36.8%, 28/76). On cytology, they were typically diagnosed as Bethesda III (69.1%, 47/68) or Bethesda IV (23.5%, 16/68). Molecular testing was performed on 62 nodules, and molecular alterations were found in 93.5% (58/62). The most common alterations identified in NIFTP were RAS mutation (75.4%, 43/57), THADA fusion (12.3%, 7/57), and BRAFK601E mutation (7.0%, 4/57). Fifty-two (65.8%) patients underwent lobectomy and 27 (34.2%) total thyroidectomy, and no patient received completion thyroidectomy. Twenty-one patients (26.5%) had coexisting papillary or follicular microcarcinoma. None of the patients received radioiodine ablation. On a mean follow-up of 28.5 months (range, 6-69 months), no structural or biochemical recurrences were observed. Conclusions: In this large cohort of patients with NIFTP diagnosed at the time of surgery and managed typically by lobectomy with no radioiodine ablation, no evidence of tumor recurrence was identified on a limited follow-up. This finding supports indolent clinical course of NIFTP.

Clinico Pathological Analysis of Nodular Goiter: A Retrospective Study

This retrospective study was conducted to evaluate the clinico-pathological pattern of nodular goiter among patients who underwent thyroidectomy. This study included 50 patients following selection criteria. All patients were properly evaluated by history, clinical examination along with blood chemistry, ultrasonography, nuclear scanning and histopathology [fine needle aspiration cytology (FNAC)]. Out of 50 patients 38 were females and 12 were males, the male to female ratio was 1:3.12. Majority of the patients belonged to the age group of 25-40 years. Most of them were in euthyroid state. Among the study patients; tiredness, palpitation, breathing difficulties, swallowing problem, altered appetite and cold preference were the major presenting features. Solitary nodules (60%) were more frequent than multi-nodular goiter (40%). Among the 20 patients having multi-nodular goiter; 18 were nontoxic goiter and 2 cases were diagnosed as carcinoma. On the other hand in 30 patients with solitary nodule; 27 cases were simple nodule and rest 3 cases were carcinoma. Among total study patients 46 were cold nodules and 4 were warm nodules. Histopathological reports of excised tissues revealed that 45 cases were papillary adenoma, 3 cases were papillary carcinoma and 2 cases were follicular carcinoma. The study concluded that solitary thyroid nodules are frequent at the middle age and predominant among females. Most of the patients of thyroid goiter are in euthyroid state and majority of nodules are benign lesions. Papillary adenoma is the most frequent benign nodular tumor followed by papillary carcinoma and then follicular carcinoma.

THE ART OF WATCHFUL WAITING: PULMONARY NODULES WITH EXTENDED SURVEILLANCE PERIODS IDENTIFIED AS PRIMARY LUNG MALIGNANCY IN VETERANS

TOPIC: Lung Cancer TYPE: Original Investigations PURPOSE: Lung cancer screening has resulted in earlier, more accurate detection of pulmonary nodules, likely as a result of continued surveillance. Organizing care and timely follow up for patients with pulmonary nodules that require “watchful waiting” can be challenging. Comprehensive evaluation in a dedicated pulmonary nodule clinic (PNC) may help streamline further diagnostic workup and clinical care, while providing appropriate nodule risk assessment. In an effort to identify clinical characteristics and pulmonary nodule features that may indicate an increased risk for pre-neoplastic lesions, we reviewed a historical cohort of veterans in our single institution Veteran Health Affairs (VHA) medical center PNC. METHODS: We performed a retrospective cohort study of all patients seen in our PNC with a cancer diagnosis between January 2013 and February 2021. Patients with time to initial diagnosis of greater than 100 days, indicating ongoing surveillance, were included. Patients with metastatic disease, extra-pulmonary malignancy and time to diagnosis less than 100 days were excluded. Data collected included patient demographics, nodule characteristics, and cancer care outcomes including histological subtype, stage, and timeliness as well as method of diagnosis and treatment. RESULTS: We identified 430 patients with a new cancer diagnosis, the majority of which had metastatic disease, extra-pulmonary malignancy or were diagnosed within 100 days of nodule identification. Of those, 79 were enrolled in active surveillance, with an average age of 69 years. The majority of patients were men (94.9%) of which 51.9% were African American. The prevalence of previous smoking exposure was 90.0%, with 46.8% carrying a formal diagnosis of COPD. The pulmonary nodules in our cohort were primarily solid (54.4%) or mixed (22.8%). These were also either solitary (48.1%) or multiple i.e., 2-4 nodules (36.7%). The average longest dimension was around 18 mm. The most common methods of diagnosis were fiberoptic bronchoscopy (41.0%) and surgical resection (37.2%). The most frequent histological subtype was adenocarcinoma (68.4%) in which 91% of cases were treated with curative intent. The average time to diagnosis and treatment was 332 and 354 days, respectively. CONCLUSIONS: Pulmonary nodule risk assessment and surveillance remains paramount to ensure appropriate monitoring in patients with pre-malignant pulmonary nodules, or nodules not immediately actionable at time of identification. In patients enrolled in ongoing surveillance programs, we were able to identify characteristics that reflected an increased risk of malignancy for veterans, including current or previous exposure to smoking as well as previous hx of COPD, solid lesions and nodule size > 1 cm. Consistent with prior literature, the presence of 5+ pulmonary nodules conferred a lower risk of malignancy. In our cohort, the majority of nodules were diagnosed with bronchoscopy and the most frequent histological subtype was adenocarcinoma. CLINICAL IMPLICATIONS: Ongoing follow up in patients with risk factors for lung cancer without initial actionable nodules is imperative, as these nodules may progress to malignancy. Close monitoring may facilitate timely biopsy and earlier stage at diagnosis in this population.“This material is the result of work supported with resources and the use of facilities at the VA Maryland Health Care System, Baltimore, Maryland.” DISCLOSURES: No relevant relationships by Hatoon Abbas, source=Web Response No relevant relationships by Fahid Alghanim, source=Web Response No relevant relationships by Max An, source=Web Response No relevant relationships by Janaki Deepak, source=Web Response No relevant relationships by William Grier, source=Web Response No relevant relationships by Kevin Li, source=Web Response No relevant relationships by Avelino Verceles, source=Web Response

Lung Nodule Evaluation Using Robotic-Assisted Bronchoscopy at a Veteran's Affairs Hospital.

The incidence of lung nodules has increased with improved diagnostic imaging and screening protocols. Despite improvements for diagnosing pulmonary nodules with technologies such as electromagnetic navigational bronchoscopy (ENB), several limitations still exist including adequate visualization, localization, and diagnostic yield. Robotic-assisted bronchoscopy with ENB has been introduced as a method to overcome these shortcomings. We describe our initial experience in evaluating lung nodules with robotic assisted bronchoscopy. We retrospectively reviewed data on the first 25 patients that underwent robotic-assisted bronchoscopy and biopsy. We analyzed success with localization, diagnostic yield, and post procedural morbidity. Diagnostic yield was 96% (24/25) with no periprocedural morbidity. The majority of nodules were malignant or atypical (76%) and were located in the right upper lobe. Diameter ranged between 0.8–6.9 cm (median size 1–2 cm). Seventy-five percent of patients underwent subsequent treatment for cancer based on these results, with 25% having continued surveillance. Robotic assisted bronchoscopy is safe and accurate. Studies with larger numbers will allow better understanding of the diagnostic yield and clinical utility of this approach in comparison to other diagnostic tools for lung nodules.

Hospital-Based Ultra-Sonographic Prevalence and Spectrum of Thyroid Incidentalomas in Pakistani Population.

Introduction: Thyroid incidentalomas (TIs) are clinically asymptomatic nodules found accidentally during imaging studies ordered for some other reasons. Being easily accessible, non-invasive, and inexpensive, thyroid ultrasound (US) is a key investigation in the management of thyroid nodules.Methods: This ultrasound-based cross-sectional study was performed in the radiology department of a major tertiary care hospital. Every second patient visiting the emergency department was a potential candidate for a thyroid ultrasound. Patients having ages greater than 20 years were included in the study.Results: A total of 250 patients were included in the study. Out of these, 175 were female and 75 were male. The majority (54.80%) were in the age group 21-30 years. Nodules were found in 65 (26%) patients and in the majority of cases (67.7%) they were multiple in number. Associated lymphadenopathy was seen in only one patient. Thyroid nodules were more common in females as compared to males (75.38% versus 24.62%). According to Thyroid Imaging and Reporting Data System (TI-RADS) classification, the majority of the nodules were falling in TI-RADS 1 (74%) followed by TI-RADS 3 (9.60%) and 4A (8.80%).Conclusion: The thyroid nodules are more commonly seen in females as compared to males. A significant association is seen between the frequency of thyroid nodules and increasing age. The majority of thyroid nodules fall in TI-RADS 1 category followed by TI-RADS 3 and 4A.

Діагностика, клінічне значення та лікування вузлів щитоподібної залози

Огляд літератури присвячений питанням діагностики та лікування вузлів щитоподібної залози (ЩЗ). Вузли ЩЗ виявили у 68% випадково відібраних осіб, яким проводилося ультразвукове дослідження (УЗД) високої роздільної здатності. При цьому більшість вузлів мала доброякісний характер. Вузли ЩЗ є клінічним проявом багатьох патологічних процесів. Застосування УЗД дозволило різко зменшити число оперативних втручань на ЩЗ з приводу вузлового зоба. Розроблено декілька систем оцінки ризику, спрямованих на поліпшення діагностики вузлового зоба, з подальшою можливістю клініцистів приймати рішення щодо подальшого спостереження за хворими на вузловий зоб. Найкориснішою з них є класифікаційна система TIRADS. Шестирівнева система бальних оцінок Bethesda також надає цінну інформацію клініцистам щодо менеджменту вузлів ЩЗ. При цьому встановлена кореляція між цитологічними та гістопатологічними результатами. Однак частка пацієнтів потрапляє до так званої невизначеної категорії. Американська тиреоїдна асоціація використовує систему, що ґрунтується на оціночному ризику малігнізації вузлів ЩЗ. Наявність молекулярних маркерів вдосконаленої технології найновішого покоління з класифікацією експресії належить до сучасних додаткових діагностичних методів, що можуть сприяти успішному менеджменту тиреоїдних вузлів. Водночас ці методи є недоступними в багатьох країнах. Прагматичний підхід до діагностики таких вузлів містить використання комплексного підходу клініцистів, фахівців з УЗД, цитологів. При використанні цього підходу пацієнтів з високим ризиком можна належним чином відібрати для подальшого хірургічного лікування, а за пацієнтами з меншим ризиком здійснювати динамічне спостереження.

CT features of thyroid nodules with isolated macrocalcifications detected by ultrasonography.

PurposeA thyroid nodule with an isolated macrocalcification is visualized as a calcified nodule with complete posterior shadowing on ultrasonography (US). This study aimed to determine the computed tomography (CT) features of isolated macrocalcifications detected using US.MethodsThis study included 20 patients who had thyroid nodules with isolated macroalcifications and underwent neck CT or chest CT. The patients were enrolled from a sample of 82 patients with isolated macrocalcifications detected by US drawn from 7,142 consecutive patients who underwent thyroid biopsy at two institutions. We evaluated the CT features of nodules with isolated macrocalcifications and categorized them as central or rim calcifications. We assessed the nodule size and the frequency of nondiagnostic fine-needle aspiration (FNA) results and malignant tumors according to the CT features of isolated macrocalcifications.ResultsCT scans showed central calcifications in 18 (90.0%) and rim calcifications in two (10.0%) of the 20 nodules with isolated macrocalcifications. Among the 18 nodules with central isolated macrocalcifications, complete compact calcification was found in six nodules and partial coarse calcification in 12 nodules. In 18 nodules with central isolated macrocalcifications, the nondiagnostic FNA rate and frequency of malignant tumors were not significantly different between complete and partial central calcifications (P=0.620 and P=0.999, respectively). Malignant tumors were only found in nodules with central isolated macrocalcifications.ConclusionThe majority of nodules with isolated macrocalcifications showed central calcifications on CT. Thyroid nodules with isolated macrocalcifications detected by US should not be classified as having a type of rim or peripheral calcification.

Sonographically Estimated Thyroid Nodule Malignancy Risk: Strengths and Limitations in Clinical Practice

In recent years, the clinical relevance of thyroid ultra-sound has increased. Due to the development of risk-stratification systems that use a systematic assessment of thyroid nodule sonographic characteristics and tiered categories, such as the Thyroid Imaging Reporting and Data System (TI-RADS), a pattern of morphologic features is easily translated into a specific class, with an associated estimate of malignancy risk and suggestions for clinical management. Currently, scientific societies ( 1. Gharib H. Papini E. Garber J.R. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules – 2016 update. Endocr Pract. 2016; 22 (et al): 622-639 Abstract Full Text Full Text PDF PubMed Scopus (802) Google Scholar ) recommend using sonographic risk evaluation to guide clinical decisions regarding the need for fine-needle aspiration cytology and the timing of subsequent follow-up evaluations ( 5. Durante C. Grani G. Lamartina L. The diagnosis and management of thyroid nodules: a review. JAMA. 2018; 319 (et al): 914-924 Crossref PubMed Scopus (318) Google Scholar ). The main aim of these systems is to reduce the burden of diagnostic tests performed on thyroid nodules, namely the number of fine-needle aspirations ( 6. Grani G. Lamartina L. Ascoli V. Reducing the number of unnecessary thyroid biopsies while improving diagnostic accuracy: toward the “right” TIRADS. J Clin Endocrinol Metab. 2019; 104 (et al): 95-102 Crossref PubMed Scopus (157) Google Scholar ), since the majority of nodules (>90%) are benign, and others are small, indolent neoplasms. As a consequence, risk-stratification systems are expected to reduce overdiagnosis and overtreatment.

Response of dry bean (Phaseolus vulgaris L.) to inoculation with indigenous and commercial Rhizobium strains under organic farming systems in Minnesota

Organic farmers recognize the importance of using Rhizobium to meet crop N fertility needs and to reduce use of chemical fertilizers. Field experiments were conducted during the 2015 and 2016 seasons at different organic fields to assess the effect of indigenous Rhizobium leguminosarum bv. phaseoli (OrgK9) and commercial R. tropici (CIAT899) strains on symbiotic performance and grain yield of bean varieties, Eclipse and Redhawk. Averaged for both varieties, nodule numbers on plants inoculated with CIAT899 (35.2 ± 3.7 and 26.3 ± 2.6 /plant) and OrgK9 (29.6 ± 2.5 and 26.8 ± 2.1 /plant) were significantly greater (P < 0.0001) than the control (18.9 ± 2.2 and 10.5 ± 3.1) in 2015 and 2016, respectively. Bean genotype Eclipse cultivated at Lamberton and inoculated with OrgK9 had (P < 0.0001) greater number of nodules compared with CIAT899-inoculated or non-inoculated plants. The N-content (3.3 ± 0.04%) of plants inoculated with CIAT899 was greater (P < 0.0001) compared with plants inoculated with OrgK9. Strain CIAT899 increased nodule occupancy by 29 and 62% and 4 and 26% on Red Hawk cultivated in the Lamberton and Farmington fields compared with the control in season 2015 and 2016, respectively. The majority of nodules formed on Red Hawk (76%) and Eclipse (64%) at Farmington were occupied by CIAT899 and OrgK9 in 2015 and 2016, respectively. Eclipse inoculated with OrgK9 had a significantly greater seed yields (2683 ± 402 and 2546 ± 247 kg/ha) compared with control (2265 ± 996 and 2058 ± 51 kg/ha) in both years, respectively. These results clearly indicate that symbiotic performance and grain yield of dry bean can be significantly increased by using Rhizobium inoculation under organic farming systems.

Structure and Cytoarchitectonics of Lymphoid Tissue in Appendiсes of Elderly and Senile People

The phenomenon of population aging has been observed in many countries in recent years due to the increase in human life expectancy. Therefore, studies of lymphoid tissue, which supports the immune processes in the human body, are now of particular importance. The lymphoid tissue of appendices from humans of age groups of 54–81 years and 26–35 years was histologically studied, and the results were statistically treated. The lymphoid tissue belonging to senile age groups showed reductions and rearrangements with partial integrity of the modified lymphoid nodules. The majority of nodules were without lighter-stained germinal centers, and the processes of blast transformation were preserved therein. Mitoses were observed in the central zones of nodules with lighter centers. Lymphocytes actively migrate to lymphatic capillaries. The condition of lymphoid tissue in the appendix depends on the individual body parameters. In some cases, the lymphoid tissue is completely reduced, and the organ’s lumen is closed.

Two-year efficacy of single-session high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules.

Assessing the efficacy of single high-intensity focused ultrasound (HIFU) ablation in benign thyroid nodules beyond 12 months. One hundred and eight patients underwent single HIFU treatment. Extent of nodule shrinkage [by volume reduction ratio (VRR)] and obstructive symptom score [by 0-10 visual analogue scale (VAS)] were evaluated for 24 months after treatment. VRR (%) was calculated based on the formula: [baseline volume - volume at visit] / [baseline volume] × 100. Binary logistic regression was performed to evaluate factors associated with 24-month treatment success (VRR ≥ 50%). After treatment, the mean (± SD) VRR at 3, 6, 12 ,18 and 24 months were 51.32 ± 20.71%, 62.99 ± 22.05%, 68.66 ± 18.48%, 69.76 ± 17.88% and 70.41 ± 17.39%, respectively, while the median (IQR) VAS at baseline, 6, 12 and 24 months was gradually lowered from 4.0 (2.0), 2.0 (1.0), 2.0 (1.0) to 1.0 (2.0), respectively. Sixty-three (58.3%) nodules had a further volume reduction (i.e. > 4.5%) from 12 to 24 months, while 22 (20.4%) nodules had a volume increase of > 4.5% from 12 to 24 months. Small pre-ablation nodule volume was a significant determinant for treatment success at 24 months (OR=1.045, 95% CI=1.021-1.092, p = 0.038). A majority of nodules had further volume reduction beyond 12 months after single HIFU ablation, but since one-fifth of nodules had a notable volume increase beyond 12 months, a longer period of surveillance would be necessary. Small pre-ablation nodule volume was a significant factor determining 24-month treatment success. • Small but significant nodule shrinkage continues beyond 12 months after single treatment. • Obstructive symptom continues to improve beyond 12 months after single treatment • Smaller-sized nodules have a greater chance of treatment success at 24 months.

Competition between introduced Bradyrhizobium japonicum strains and indigenous bradyrhizobia in Minnesota organic farming systems

Organic farmers recognize the importance of rhizobial associations with legume plants to help meet N fertility and plant productivity needs. A field experiment was done at three organic fields in Minnesota to assess the effect of indigenous Bradyrhizobium japonicum ORGS3 and ORGS5 and reference USDA 110 strains on the growth and yield performance of soybean. Soybean genotypes MN1505SP and Lambert inoculated with B. japonicum ORGS3 had significantly greater (P < 0.01) nodule numbers (42.1 ± 2.5), herbage N-contents (4.02 ± 0.01%), dry biomass (12.60 ± 1.45 g), and plant populations (117,890 ± 288.13 plant/acre) compared with the un-inoculated control. Grain yields were not affected by inoculation. Most nodules formed on non-inoculated Lambert (70%) and MN1505SP (53%) were occupied by strain ORGS5. The inoculant strains USDA110 and ORGS5 increased nodule occupancy by 10% on MN1505SP and Lambert. In contrast, strain ORGS3, and the combination of strains ORGS5 plus ORGS3, increased nodules occupancy on Lambert by 23 and 20%, respectively, compared with the control. The majority of nodules on Lambert (59%) and MN1505SP (52%) in the Farmington and Lamberton fields, respectively, were occupied by ORGS5. In contrast, 41 and 45% of nodules formed on Lambert and MN1505SP at Rosemount, respectively, were occupied by strain ORGS3. The lowest percentage of nodules formed on Lambert (4%) and MN1505SP (5%), in the Farmington field, were occupied by USDA110. These results showed that Bradyrhizobium strains ORGS3 and ORGS5 can be used to enhance N fixation and productivity of organically-grown soybeans grown in Minnesota fields.

Ferromanganese nodules from the East Siberian Sea near Bennett Island

Ferromanganese nodules recovered from the bottom of the East Siberian Sea near Bennett Island are studied by coupled ultramicroscopic and ICP-MS methods. The majority of nodules are flattened dense formations 2.5 to 10 cm in cross section and circled by a thick rim, which is common in nodules from other Arctic basins. The major components of nodules are iron and manganese oxides in the form of ferruginous vernadite and magnetite, as well as accessory minerals, including apatite and titanomagnetite. The major and trace element compositions of nodules are comparable to Arctic nodules from other Arctic seas, but somewhat different compared to those from the Mendeleev Rise. A specific feature of these nodules is that they contain high amounts of mercury in all samples and a positive europium anomaly in one sample, along with gold; this may be related to the influence of endogenous gas-and-vapor exhalations.

The influence of inspiratory effort and emphysema on pulmonary nodule volumetry reproducibility

To evaluate the impact of inspiratory effort and emphysema on reproducibility of pulmonary nodule volumetry. Eighty-eight nodules in 24 patients with emphysema were studied retrospectively. All patients had undergone volumetric inspiratory and end-expiratory thoracic computed tomography (CT) for consideration of bronchoscopic lung volume reduction. Inspiratory and expiratory nodule volumes were measured using commercially available software. Local emphysema extent was established by analysing a segmentation area extended circumferentially around each nodule (quantified as percent of lung with density of -950 HU or less). Lung volumes were established using the same software. Differences in inspiratory and expiratory nodule volumes were illustrated using the Bland-Altman test. The influences of percentage reduction in lung volume at expiration, local emphysema extent, and nodule size on nodule volume variability were tested with multiple linear regression. The majority of nodules (59/88 [67%]) showed an increased volume at expiration. Mean difference in nodule volume between expiration and inspiration was +7.5% (95% confidence interval: -24.1, 39.1%). No relationships were demonstrated between nodule volume variability and emphysema extent, degree of expiration, or nodule size. Expiration causes a modest increase in volumetry-derived nodule volumes; however, the effect is unpredictable. Local emphysema extent had no significant effect on volume variability in the present cohort.

A Pragmatic Approach to the Indeterminate Thyroid Nodule.

Thyroid nodules are prevalent in upto 68% of randomly selected individuals in whom high resolution ultrasound is performed. The majority of nodules are benign. The use of ultrasound coupled with FNAC has dramatically reduced the number of patients who undergo surgery for nodules. The six tier Bethesda scoring system has reduced variability and increased the ability to clinicians to guide patients with thyroid nodules. There is good correlation between cytology and histopathologic outcomes. A significant proportion of patients will however fall into an indeterminate category. The availability of molecular markers enhanced with next generation sequencing technology and the expression classifier are added diagnostic aids that can help in management. However these are not available in many countries and in resource limited settings. A pragmatic approach to the diagnosis of indeterminate nodules includes utilising pre and post test probability, clinical acumen, correlation of ultrasound findings and expert opinion in some settings. Using this approach high risk patients can be appropriately chosen for surgery while relegating patients with lower risk to watchful followup.

Clinical significance of noncalcified lung nodules in patients with breast cancer.

Patients with breast cancer are increasingly likely to have chest computed tomography (CT) performed. In many cases, small lung nodules will be detected, raising concern for metastases and causing considerable patient anxiety. The majority of these nodules, however, are benign, though the specific probability of malignancy is uncertain in any given case. Therefore, we analyzed the results of chest CT scans of a large number of patients with breast cancer, to determine characteristics and clinical significance of noncalcified lung nodules. 3313 patients were investigated, and 4889 CT scans from 1325 patients were retrospectively reviewed. Among the 1325 patients, 812 (59%) had at least one noncalcified lung nodule, of which 330 (41%) had malignant nodules, 197 (24%) had large (≥10mm) nodules, and 586 (72%) had multiple nodules. Large nodules were more often malignant than benign (P<0.001). In patients with multiple large nodules, the rate of malignancy rate was 83%, and most of these were metastases. In the case of very small (2-4mm) nodules, the malignancy rates for solitary and multiple nodules were 8 and 20%, respectively. Lung metastases were more likely with breast cancer cell grade 3 (22%) than grade 1-2 (10%) (P<0.001) and when patients were clinical stage 2-3 (14%) than stage 0-1 (7.9%) (P=0.03). Lung metastases are highly likely in patients with multiple nodules greater than 10mm. Higher cancer cell grades and clinical stage are also related to an increased likelihood of lung metastases. The great majority of small lung nodules in breast cancer patients are benign.