Nodular Formation Research Articles

Scintigraphy in Thyroid Nodular Pathology

Thyroid scintigraphy is a method that formed more than 60 years ago and retains its importance for the diagnosis and assessment of the risk of nodular malignancy. The review examines the use of the scintigraphic method in functional and metabolic assessment of nodular goiter. Prerequisites for functional thyroid nodes screening with short-lived 99mTc-pertechnetate are outlined. Information is provided on the principles of its preparation and pharmacokinetics, as well as variants of the thyroid nodes functional activity, their possible malignant potential and indications for metabolic screening. The characteristic of metabolic activity allows to assess the risk of functionally “cold” thyroid nodes malignancy. The main stages of the use of nonspecific tumorotropic radiopharmaceuticals, the mechanism of their accumulation and metabolism in the thyroid tumors, the possibilities of the differential diagnosis of various types of nodular formations are presented. Modern views on the diagnostic capabilities of two-phase scintigraphy with 99mTс-methylisobutylisonitrile are reflected taking into account the relationship of radiopharmaceuticals accumulation with factors of proliferative activity and ultrastructural cell types, a variant of oncocytic pathology and multidrug-resistant protein expression.

S3143 Rare Case of Plasma Cell Infiltration-Induced Cirrhosis

Introduction: Multiple myeloma (MM) is a type of malignancy that arises from the unorganized replication of plasma cells within the bone marrow. The overproduction of these cells damages systems throughout the body leading to early asymptomatic symptoms that can rapidly progress to systemic signs of disease. Liver involvement with MM is less common and generally occurs through plasma cell infiltration, light chain/amyloid deposition, and biliary obstruction. Though it can occur, the probability of it presenting near the time of diagnosis of MM is very rare and associated with poorer outcomes. Case Description/Methods: A 59-year-old male presented with generalized weakness, shortness of breath and weight gain. Physical exam showed sign of ascites and hepatomegaly. PMH was significant for esophageal cancer and a recent diagnosis of MM. No history of acute or chronic liver disease or cirrhosis risk factors. CT scan showed cardiomegaly, bilateral pleural effusions, pulmonary edema, and cirrhosis with abdominal ascites. Labs was unremarkable other than normocytic anemia. An echocardiogram showed mild reduced ejection fraction (47%) with speckle tracking suggestive of cardiac amyloidosis. Abdominal ultrasound confirmed appearance of cirrhosis, ascites, and right pleural effusion. Cirrhosis work up revealed negative hepatitis panel, normal alpha-1 antitrypsin, and normal ceruloplasmin. EGD was performed and ruled out extracellular vesicles (EV) but noted type I isolated gastric varices. Liver biopsy confirmed cirrhosis and showed portal tract damage with severe extensive plasma cell infiltration. Additionally, fragments of hepatic parenchymal showed disrupted lobular architecture by septal fibrosis and nodular formation. Immunohistochemistry was positive for CD3, CD20, CD5, BCL2, CD79a, and CD138 as well as increased lambda light chain compared to free kappa light chain. Despite extensive treatment including repeated thoracentesis and paracentesis, patient eventually developed in to decompensating liver cirrhosis (Figure 1). Discussion: In previous studies, plasma cell infiltration of the liver was seen in about 40% of cases of MM, but rarely lead to cirrhosis. This case is unique in that the patient had liver failure caused by cirrhosis and that it was some of the presenting symptoms. Whether due to masked signs or aggressive onset, the outcome for this diagnosis is poor and more specific factors observing liver function could have provided a more favorable outcome.Figure 1.: Cirrhosis secondary to plasma cell infiltration. Table 1. - Total Protein 5.0 g/dL Serum Ascites Albumin Gradient (SAAG) 1.9 g/dL Left Hepatic Vein Pressure 25 Hg Left Portal Vein Pressure 29 Hg Portosystemic Pressure Gradient 5 Hg EUS Guided Shear Wave Elastography of Liver 27 kPa

Thyroid functional state in children with duodenal ulcer

Background. Most experts agree that duodenal ulcers are much more common in children. In recent years, the research interest in the relationship between the thyroid system and duodenal ulcer processes has become evident. The purpose of the study is to investigate the thyroid functional state in children with duodenal ulcer. Materials and methods. The observation group consisted of 56 children aged 7 to 18 years with a verified duodenal ulcer and 15 healthy children. All pediatric patients underwent fibroesophagogastroduodenoscopy with a targeted thyroid biopsy and examination for the presence of the Helicobacter pylori bacterium, intragastric pH-metry, ultrasound examination of the abdominal cavity and thyroid gland; the concentration of thyroid hormones (thyroid-stimulating hormone, T3, T4) was also studied. Reliability was assessed using Student’s t-test. The difference was considered significant at p<0.05. Results. The average age of children with duodenal ulcer was 13.1±3.1 years. In all age categories, duodenal ulcer occurred more often in boys— 58.9%. During an in-depth ultrasound examination, the structure of the thyroid gland in 52 (92.8%) children was homogeneous, in 4 (7.1%) individuals it was heterogeneous, but without nodular formations. Serum concentrations of thyroid-stimulating hormone and T3 in children with duodenal ulcer also did not differ from the average levels in children of the comparison group. At the same time, a decrease in the concentration of T4 was noted, which can be considered as a variant of euthyroid sick syndrome— the syndrome of reduced T4. The average serum level of T4 (32.67±3.84 nmol/l) was significantly lower (p=0.001) in children infected with Helicobacter pylori than in those without infection (39.45±4.23 nmol/l) and healthy individuals (89.12±5.91 nmol/l). Conclusions. Children with a duodenal ulcer have a violation of the thyroid status due to a decrease in the thyroxine concentration. A functional shift in the thyroid status in these patients can be considered as a prognostically unfavorable sign of possible deterioration of the ulcer course.

Post-Covid-19 Immunological Disorder: A Possible Pathological Entity in a 43 Year Old Man

Background: Post-COVID-19 systemic inflammatory syndrome is considered to be an aquired immunological disorder, which may develop in some individuals after the remission of infection with SARS-CoV-2 and defined by inflammatory clinical manifestations (fever, arthralgias, cutaneous and mucosal pallor, physical weakness) and modified biological parametres (normochromic normocytic anaemia, increased serum levels of C reactive protein and rheumatoid factor), with no proof of an infectious process, to which corticotherapy may be a suitable therapeutic strategy. Case Report: A 43 year old male was admited in the Department of Internal Medicine for high fever (39,4°C), moderate polyarthralgias and physical weakness, with a negative test result of SARS-CoV-2 RT-PCR. The patient had been previously diagnosed with a moderate-to-severe form of COVID-19, a month prior to the current admission. The patient also experienced transitory dry cough for a month, with no other relevant clinical abnormalities. Upon physical examination, cutaneous and scleral pallor was observed and lung auscultation revealed hardened vesicular murmur bilaterally. Blood analysis revealed normochromic normocytic anaemia and increased serum levels of rheumatoid factor and of C reactive protein, which suggested a nonspecific inflammatory syndrome. Although blood cultures and other microbiological tests were negative for an infectious process, a chest X-ray was performed, which detected the presence of a nodular formation in the superior left lung lobe. Several differential diagnoses were taken into consideration, including pulmonary sarcoidosis and granulomatosis with polyangiitis, both of which were excluded, clinically and biologically. A thoracic computed tomography (CT) was later performed, which revealed the presence of a tumoral nodule in the left lung, associated with multiple mediastinal and supraclavicular lymphadenopathies, indicative of lung cancer. However, lung cancer was also excluded upon the histopathological examination of paratracheal lymphnodes, which detected multiple areas of parenchymal necrosis surrounded by dense inflammatory infiltrates, formed predominantly by histiocytes. All of these findings resulted in the diagnosis of a post-COVID-19 rheumatoid syndrome, the only therapeutic strategy being the administration of high doses of intravenous and oral methylprednisolone, which improved the patient’s health. Conclusion: Post-COVID-19 immunological disturbances should be taken into consideration in patients who experience repetitive clinical and biological inflammatory manifestations after the remission of the infection with SARS-CoV-2, which may be improved through high dose corticosteroid therapy

Different check sizes pattern-reversal visual evoked potentials study in patients with compensated hepatic cirrhosis

Background: Cirrhosis is a dynamic process starts after sustained inflammation, followed by necrosis of liver cells and fibrosis that occur as a normal wound healing response then nodular formation that eventually lead to hepatic dysfunction. Aim and objectives: Study the effect of hepatic cirrhosis on cerebral cortex and subcortical pathways using VEP, and Comparison between different VEP check sizes in detection of early encephalopathy among cirrhotics. Subjects and methods: This was a case/control study carried out on 45 cirrhotic patients, and 45 matched normal controls. All subjects underwent full opthalmological assesment prio to the conduction of the PVEP, after the approval of the ethical committee. Results: the studied cases had significantly more delayed latency and lower amplitude than the studied controls on both sides at both 1 degree and 15 minutes check sizes (P-value<0.05), however 13 patiebts were detected by the 15 min check size to be abnormal on he contrary of the 1 degree chech size that detected changes only in 6 patients. Conclusion: Vep 15 min is more sensitive in detecting early changes in cirrhotic patients. denoting that most of the hepatic encephalopathy changes are affecting the central visual field.

The effect of a new coronavirus infection caused by the SARS-CoV-2 virus on microcirculation in the conjunctiva

Introduction. The availability of an objective assessment of the microcirculatory bed is possible when examining the vessels of the conjunctiva. This is especially true in individuals who have had COVID-19 and have diseases associated with endothelial dysfunction.Aim. To study the microcirculation in the conjunctiva after a new coronavirus infection caused by the SARS-CoV-2 virus.Materials and methods. 83 patients with a history of coronavirus infection were examined. Patients were divided into 2 groups depending on the presence or absence of comorbidities. Group 1 patients (n = 42) with post-COVID changes in the conjunctiva (severe injection of the eyeball, chemosis, microhemorrhagia, folliculosis of the tarsal and bulbar conjunctiva, the presence of a nodular formation (conflicts), slight edema of the corneal epithelium) and a history of concomitant diseases: arterial hypertension, diabetes, coronary heart disease, atherosclerosis. Group 2 patients (n = 41) with no history of concomitant diseases and similar post-COVID changes in the conjunctiva. The control group consisted of healthy volunteers without a history of coronavirus infection (n = 30). All subjects underwent laser Doppler flowmetry of the bulbar conjunctiva 3, 6, 12 months after the coronavirus infection.Results and discussion. In comparison with the control group of persons after 3 months, microcirculatory disorders were detected in both groups (group 1 – subcompensated, group 2 – decompensated). In group 1, after 6 months and 12 months, violations persisted in the subcompensation stage, which were accompanied by an increase in the intensity of the functioning of the regulatory systems of the microcirculation: the M index corresponded to normal values, and the values of σ and Kv were above the norm. After 6 months in group 2, compensation of microcirculatory disorders was noted (indicators M, σ, Kv were normal), which persisted even by 12 months of observation.Conclusion. The data obtained indicate that in patients with concomitant endothelial dysfunction, the processes of restoration of the microvasculature are slowed down.

Study on the Mechanical Properties of Silty Clay Sediments with Nodular Hydrate Occurrence

Natural gas hydrates are a strategic energy resource in China. The China Geological Survey has discovered segregated hydrate mass formations under the seepage mechanism in the South China Sea through exploration, and gas hydrates occur in nodular, massive, and vein formations in silty clay sediment. Previous work has focused on the analysis of sediment mechanical properties with respect to the uniform distribution of natural gas hydrates in pore spaces, but the mechanical properties of hydrate-bearing sediments containing segregated hydrate masses are not well understood. Spherical hydrates are used to characterize nodular hydrates, a method is proposed for the preparation of sediment samples containing segregated hydrates masses, and a series of triaxial compression tests are carried out on the samples containing spherical hydrates with two kinds of particle sizes at a certain volume fraction. The paper presents triaxial stress–strain curves for the samples containing spherical hydrates. A model for predicting elastic modulus is established. The results present two distinct stages in the triaxial compression tests of silty clay sediments containing spherical hydrates; they also show that the elastic moduli predicted by the model are in good agreement with the experimental results when the model parameters are set at α = 0.5 and β = −0.21. These results provide fundamental mechanical parameters for the safety evaluation of strata containing segregated gas hydrates.

Evidence of neural crest cell origin of a DICER1 mutant CNS sarcoma in a child with DICER1 syndrome and NRAS-mutant neurocutaneous melanosis.

Evidence of neural crest cell origin of a DICER1 mutant CNS sarcoma in a child with DICER1 syndrome and NRAS-mutant neurocutaneous melanosis.

ЭНДЕМИЧЕСКИЙ ЗОБ В РЕСПУБЛИКЕ САХА (ЯКУТИЯ)

The authors conducted a study of the prevalence and features of the course of endemic goiter in the Republic of Sakha (Yakutia). According to the classification, the area is considered endemic for goiter if a goiter-altered gland is observed in more than 10 % of the population. There are light, medium and severe goiter endemias. It was revealed that, on average, the prevalence of endemic goiter in the republic is 28 %, which corresponds to the average severity of endemia, but the level of endemia is heterogeneous: there are areas of Yakutia with a severe degree. The peculiarities of endemic goiter in the Republic of Sakha (Yakutia) should also include the predominance of euthyroid forms (92.8 %) and a high (up to 57.3 %) proportion of thyroid nodules in areas with severe endemia. An important feature is the significant frequency of histologically confirmed thyroid malignancies: 8.2 % of the number of operated. In addition to the lack of iodine and a number of other trace elements in the environment, the body as a whole and, in particular, the thyroid is affected by a number of specific features of Yakutia: extreme temperature and light conditions, pronounced seasonality of climate, anomalies of geomagnetic fields. The predominance of nodular formations of the thyroid gland in endemic areas, especially polynodose (up to 86.9 %), is one of the prerequisites for the more frequent development of cervical-thoracic goiter. Cervical-thoracic goiter requires surgical intervention due to manifestations of compression of the mediastinal organs or the threat of their development. Unlike cervical goiter, with cervical-thoracic goiter, there is a problem of differential diagnosis with other intra-thoracic formations.

IL-17RA receptor signaling contributes to lung inflammation and parasite burden during Toxocara canis infection in mice.

IL-17 is a cytokine produced by innate and acquired immunity cells that have an action against fungi and bacteria. However, its action in helminth infections is unclear, including in Toxocara canis infection. Toxocariasis is a neglected zoonosis representing a significant public health problem with an estimated seroprevalence of 19% worldwide. In the present study, we describe the immunopathological action of IL-17RA in acute T. canis infection. C57BL/6j (WT) and IL-17RA receptor knockout (IL-17RA-/-) mice were infected with 1000 T. canis eggs. Mice were evaluated 3 days post-infection for parasite load and white blood cell count. Lung tissue was harvested for histopathology and cytokine expression. In addition, we performed multiparametric flow cytometry in the BAL and peripheral blood, evaluating phenotypic and functional changes in myeloid and lymphoid populations. We showed that IL-17RA is essential to control larvae load in the lung; however, IL-17RA contributed to pulmonary inflammation, inducing inflammatory nodular aggregates formation and presented higher pulmonary IL-6 levels. The absence of IL-17RA was associated with a higher frequency of neutrophils as a source of IL-4 in BAL, while in the presence of IL-17RA, mice display a higher frequency of alveolar macrophages expressing the same cytokine. Taken together, this study indicates that neutrophils may be an important source of IL-4 in the lungs during T. canis infection. Furthermore, IL-17/IL-17RA axis is important to control parasite load, however, its presence triggers lung inflammation that can lead to tissue damage.

The Effectiveness of the Device for Vacuum Fine-Needle Aspiration Biopsy in Focal Thyroid Pathology

Purpose: Determination of the effectiveness of using vacuum fine-needle aspiration biopsy under ultrasound control in patients with focal thyroid pathology. Material and methods: The modified original experimental sample for vacuum fine-needle aspiration biopsy (patent RU No. 2757525) was developed with the help of which 48 vacuum fine-needle aspiration biopsy were performed under the control of ultrasound navigation in patients with focal thyroid pathology. The device is a full-fledged vacuum compressor that creates a negative pressure in the range from –0.1 to –0.8 bar, which is connected to a syringe using a metal container, foot switches, electromagnetic valves, high-strength hoses and an adapter, where a high discharge power is created and fragmentation and aspiration of cellular material occurs. The degree of discharge depended on the assumed morphological structure of thyroid nodes, which were determined using multiparametric ultrasound. The average vacuum level was selected in the range from –0.3 to –0.5 bar, which is significantly higher than the level of discharge created by a 10 ml syringe (–0.2 bar). Results: During the vacuum fine-needle aspiration biopsy, no complications were detected during and after the manipulation. In the group of patients, 72.1 % (n = 32) women prevailed, the average age was 59.0±5.5 years. The collection of cytological material was carried out much easier, since when using v-TAB, the discharge in the syringe is formed using an apparatus that is kept at a constant level, which eliminated the need for translational movements of the syringe piston and needle in the focus for greater collection of cytological material, this indicates a low level of uninformative cytological conclusion (Bethesda I), n = 5 (11.2 %). Conclusions: 1. The implementation of vacuum fine-needle aspiration biopsy allows to improve the quality of sampling of cellular material, which affects the informativeness of cytological examination of nodular formations of the thyroid gland. 2. The vacuum fine-needle aspiration biopsy allows you to individualize the procedure depending on the ultrasound semiotics of the nodular formation of the thyroid gland. 3. The vacuum fine-needle aspiration biopsy minimizes the number of uncontrolled needle movements during a biopsy, which reduces the risk of complications.

Differentiated search for disease in a patient with hyperthyroisis with a prevailing syndrome of cardiovascular disorders. Clinical case

Background. Elderly patients in the presence of iodine deficiency most often develop functional autonomy of the thyroid gland, accompanied by dysfunction— hyperthyroidism. Due to an excess of thyroid hormones, thyrotoxic cardiomyopathy is formed, in which in most cases there is a syndrome of heart rhythm disturbances— atrial fibrillation. The aim of the study: to find out the algorithm for the differential search for a disease in the presence of hyperthyroidism with severe cardiovascular disorders using the example of a specific elderly patient from real clinical practice. Clinical case. A 61-year-old patient was hospitalized in the intensive care unit for arrhythmogenic shock against the background of an attack of atrial fibrillation. The absence of myocardial infarction, pulmonary embolism, acute adrenal insufficiency was stated. The examination revealed a significant decrease in the level of TSH along with an increase in the levels of thyroid hormones without the phenomena of autoaggression, hyperglycemia, hypocholesterolemia, a tendency to hypoproteinemia, leukopenia. An increase in the thyroid gland, heterogeneity of the structure with hypovascularization, the presence of small multiple nodular formations that require clarification were determined. The patient has atrial fibrillation with variability in blood pressure, impaired repolarization processes, hyperkinetic type of hemodynamics, reflecting cardiomyopathy. In this case, there are all prerequisites for the development of functional autonomy of the thyroid gland: age, endemic region, absence of autoimmune changes, dermopathy, ophthalmopathy. Attention is drawn to the severity of manifestations of thyrotoxic heart with dyshormonal and catabolic syndromes, superimposed on comorbid coronary heart disease, hypertension. Conclusions. Hyperthyroidism in the elderly is manifested primarily by cardiovascular disorders, most often with the presence of an arrhythmia syndrome in the form of atrial fibrillation, which can provoke arrhythmogenic shock. Functional autonomy of the thyroid gland with the formation of thyrotoxic cardiomyopathy has specific clinical course, especially in comorbid conditions, which significantly impairs the quality of life.

P223 THYROTOXIC DILATED CARDIOMYOPATHY

Abstract Hyperthyroidism can strongly impact cardiac function. Thyrotoxicosis enhances myocardiocytes metabolism and it can be responsible for hyperdynamic circulation state leading to heart failure with preserved ejection fraction, but also left ventricle dilatation and severe contractile function impairment. It can furthermore provoke arrhythmias, mostly atrial fibrillation, but, as we are going to discuss in this case, even ventricular arrhythmias. A 40–year–old woman came to our emergency department for chest pain. ECG showed reduced R waves voltage in precordial leads and troponin I values were normal. The echocardiogram showed severe left ventricle disfunction with global hypokinesia (EF 35%) and enlarged left ventricle (LVEDD 65 mm). Blood tests revealed severe hyperthyroidism with extremely low level of TSH, FT3 13,45 pg/ml, FT4 3,4 ng/ml and thyroid echography documented multiple solid nodular formations with hypo–isoechogenic signal. She underwent a coronary angiography that showed patent coronary arteries, and a cardiac magnetic resonance confirming severe contractile impairment and hypertrabeculation of the apex and lateral wall. On the assumption of a dilated cardiomyopathy secondary to hyperthyroidism, we started treatment with methimazole, ACE inhibitors and propranolol. During hospitalization, continuous ECG monitoring recorded several episodes of non–sustained ventricular tachycardia, the longest lasting 22 seconds, so the patient was discharged with a wearable cardioverter–defibrillator. It did not record any arrhythmias and it was dismissed a month later. After almost two months of therapy, the echocardiogram showed mild left ventricular contractility improvement (EF 45%), and blood tests documented partial reduction of hyperthyroidism. A 24–hour ECG Holter did not record any arrhythmias and the patient remained asymptomatic during all the period after discharge. Even if rare, scientific literature confirms that dilated cardiomyopathy with reduced ejection fraction can occur as a complication of hyperthyroidism. After the exclusion of an ischemic cause, we underline the need for adequate initiation of treatments for thyrotoxicosis and heart failure, in order to improve chance of left ventricular function recovery. In the case discussed, after two months of therapy, EF was still not completely restored but improved from 35% to 45%, and concurrently arrhythmic risk did clearly decrease.

Massive Synovial Osteochondriomatosis of The Shoulder: A Case Report and Review of The Literature

Synovial chondromatosis is a generally monoarticular disorder characterized by multiple benign nodular cartilaginous formations, arising as a result of metaplasia of synovial tissue. Other names by which this entity is known are synovial osteochondromatosis, primary synovial chondromatosis, synovial chondrometaplasia. The most frequent location is the knee, hip, shoulder, shoulder, elbow, wrist and temporomandibular joint. It can be primary or secondary to a pre-existing chondromatosis. 1-8 It is an uncommon entity with a worldwide incidence of 1:100,000 with greater involvement of males up to 3 times higher. It usually affects people between 30 and 50 years of age, and although its etiology is unknown, it has been associated with chromosomal effects. In studies published between 1996 and 2002, structural alterations were found, which showed a rearrangement of bands 1p13-p22. 1, 2, 3, 9, 10, 11

Corynebacterium pseudotuberculosis goat lymphadenitis and mastitis

In a goat farm, 16 goats showed an increase in the superficial cervical, patellar and superficial inguinal lymph nodes, as well as nodular formations in the udder. After slaughter, these animals were diagnosed with caseous inflammation of the lymph nodes and nodular mastitis. In bacteriological examination, the bacterium Corynebacterium pseudotuberculosis was isolated from the foci of inflammation. The object of the study was 16 goats at the age of two to three years. Samples of organs of three goats (out of 16) served as material for histological and bacteriological research: samples of lymph nodes, lungs and mammary glands, fixed in 10% formalin solution. Histological sections were stained with hematoxylin and eosin. Lymph nodes and abscesses in the udder were used for bacteriological examination. On clinical examination, all 16 goats showed a strong increase in the superficial cervical, patellar and superficial inguinal lymph nodes. The lymph nodes were spherical, 4‐6 cm in diameter, dense, painless. The udder was enlarged and tuberous. During milking, curd particles were found in the milk. In general, the condition of the goats has not changed, the appetite has been preserved. Post‐mortem examination revealed changes in the lymph nodes, mammary gland and lungs. The tissue of the lymph nodes is mostly replaced by soft, cheesy contents of a gray‐white color, enclosed in a thick, dense capsule. The udder contains numerous encapsulated lesions with a diameter of 0.5 to 3.0 cm, containing a thick, white, homogeneous mass. Single dense yellow‐white lesions up to 1 cm in diameter were found in the lungs. In histological sections of the lymph nodes, eosinophilic detritus and dark purple, hematoxylin‐stained fragments of cell nuclei, as well as neutrophils and macrophages were found. In histological sections of the mammary gland, in the alveoli, numerous neutrophils, macrophages and fragments of destroyed cells were found. In the histological sections of the lungs, foci of inflammation with accumulations of leukocytes with a large proportion of macrophages were found, as well as necrotic detritus. Bacteriological examination isolated the bacterium Corynebacterium pseudotuberculosis. It is known that C. pseudotuberculosis, as the causative agent of caseous lymphadenitis, is dangerous both for animals of many species and for humans, causing granulomatous inflammation of the lymph nodes and other organs. Moreover, there have been cases of C. pseudotuberculosis infection in humans through the consumption of raw goat's milk and cheese. These circumstances make the diagnosis of caseous lymphadenitis an important measure in the care of goats, especially during lactation.

Histopathology and Immunohistochemistry of tumors in animals attending veterinary teaching hospital

We aim in the current study to investigate the pathology and incidence of tumors that are excised surgically in Veterinary Teaching Hospital. This study collected the tissue samples from animals from 1 October 2020 until 1 April 2021. These samples were collected from animals that undergo surgical procedures to remove neoplastic growths in their body. After tissue grossing, samples were collected from tumor mass, then fixed in neutral buffered 10% formalin for 72 hours, then processed to embedded in paraffin wax. A routine Harris’s hematoxylin and eosin stain were also used, histochemical stains such as Masson’s trichrome and PAS techniques were used as needed. In exceptional cases, IHC protocol was used for diagnostic steps to some types of tumors included in the current study. The antibodies that were used are Vimentin for canine osteosarcoma, P53 for squamous cell carcinoma, Mdm2 for ovine pulmonary adenocarcinoma, and CD10 for neoplastic lymphocytes. The result of the current study showed that the prevalence of tumor recorded was Marek’s diseases 22.8%, squamous cell carcinoma 22.8%, ovine pulmonary adenocarcinoma 15.4%, third eyelid adenoma 15.4%, canine osteosarcomas 7.4%, venereal transmitting tumors 7.4%, and feline mammary gland tumor 7.4%. Histological examination of feline mammary gland tumor composed from server infiltration of neoplastic cells, these neoplastic cells identified as lymphocytes in a fibrous stroma. Third eyelid adenomas in cats and dogs were composed of well-demarcated nodules containing neoplastic sebaceous cells present in glandular form and combined by hyperplasia of epidermis extended inside the neoplastic mass. Venereal transmitting tumor in cat composed from cells with a round to oval shape and the cytoplasm is poorly defined by routine stain, with dense fibrous tissue. Osteosarcoma in a dog has a pleomorphic nature with an anaplastic form composed of islands of osteoid materials, and the tumor is composed of three types of osteoblast, chondroblast, and fibroblast. Pulmonary adenocarcinoma in sheep composed of a nodular formation containing dense collagen fiber deposition with transformation of cells lining alveoli into cuboidal or columnar cells can also be observed in other air passages. Squamous cell carcinomas are primarily found in skin lesions associated with the formation of pathognomic lesions known as keratin pearls. This lesion is composed of the acentric layer of keratin produced by neoplastic keratinocytes. Marek’s disease was observed in visceral organs such as liver, lung, kidney, intestines, and spleen composed from pleomorphic lymphocytes, diffusely proliferating small-to-medium-size lymphoblast. In conclusion, the incidence of tumor in animals that attending Veterinary Teaching Hospital belong to the College of Veterinary Medicine, the University of Mosul was in general high in comparison to other studies in Iraq and other countries, this high incidence should pay attention to the causes of these cancerous conditions and their relation to environmental etiology.

Constructive Improvements in the In-Ladle Treatments

Nodular gray cast iron having properties superior to conventional gray cast iron can be produced by treating the molten iron so that, when cast, the graphite will be compacted rather than in flake form. One such treatment involves the introduction of magnesium (Mg) into a molten iron bath of such composition. It is the principal object of the present industrial experiments to provide an improved process for the ductile cast iron production. Another object is to provide a process which permits the efficient use of the nodulizing agents, which results in the efficient production of an improved homogeneous nodular cast iron. Essentially such treatments result in the retention by the cast iron of small amounts of nodulizing agents, for example magnesium (Mg). Conventionally these agents are added to cast iron, usually in the form of pre-alloys and the efficiency of the process is illustrated by the high assimilation of the added nodulizer’s constituents. Another object of this technological practice is to provide an improved method for introducing the nodulizing agents, using constructive improvements to the in-ladle equipment. Finding magnesium (Mg) using novel techniques is the first step to advance the understanding of the role of magnesium (Mg) in the formation of the nodular graphite, the mechanism behind nodular graphite formation due to the addition of Magnesium (Mg) being still relative unclear at present time. Moreover, this may advance new methods to improve the nodulizing treatment process. This study take into account the flexibility of the used technique, which describes the elasticity of the treatment process, by improvement or alternative to the existing one. As nodulizing agents magnesium-ferrosilicon (Fe-Si-Mg type) and cerium-magnesium-ferrosilicon (Nodulin type) are examples of materials containing nodulizing agents that have given excellent results in the mixture. This experiments relates to a process for the production of ductile iron (nodular gray cast iron) and particularly to a process for adding magnesium (Mg) to the melted iron.

Post-Covid-19 Immunological Disorder: A Possible Pathological Entity in a 43 Year Old Man

Abstract Background. Post-COVID-19 systemic inflammatory syndrome is considered to be an aquired immunological disorder, which may develop in some individuals after the remission of infection with SARS-CoV-2 and defined by inflammatory clinical manifestations (fever, arthralgias, cutaneous and mucosal pallor, physical weakness) and modified biological parametres (normochromic normocytic anaemia, increased serum levels of C reactive protein and rheumatoid factor), with no proof of an infectious process, to which corticotherapy may be a suitable therapeutic strategy. Case report. A 43 year old male was admited in the Department of Internal Medicine for high fever (39,4°C), moderate polyarthralgias and physical weakness, with a negative test result of SARS-CoV-2 RT-PCR. The patient had been previously diagnosed with a moderate-to-severe form of COVID-19, a month prior to the current admission. The patient also experienced transitory dry cough for a month, with no other relevant clinical abnormalities. Upon physical examination, cutaneous and scleral pallor was observed and lung auscultation revealed hardened vesicular murmur bilaterally. Blood analysis revealed normochromic normocytic anaemia and increased serum levels of rheumatoid factor and of C reactive protein, which suggested a nonspecific inflammatory syndrome. Although blood cultures and other microbiological tests were negative for an infectious process, a chest X-ray was performed, which detected the presence of a nodular formation in the superior left lung lobe. Several differential diagnoses were taken into consideration, including pulmonary sarcoidosis and granulomatosis with polyangiitis, both of which were excluded, clinically and biologically. A thoracic computed tomography (CT) was later performed, which revealed the presence of a tumoral nodule in the left lung, associated with multiple mediastinal and supraclavicular lymphadenopathies, indicative of lung cancer. However, lung cancer was also excluded upon the histopathological examination of paratracheal lymphnodes, which detected multiple areas of parenchymal necrosis surrounded by dense inflammatory infiltrates, formed predominantly by histiocytes. All of these findings resulted in the diagnosis of a post-COVID-19 rheumatoid syndrome, the only therapeutic strategy being the administration of high doses of intravenous and oral methylprednisolone, which improved the patient’s health. Conclusion. Post-COVID-19 immunological disturbances should be taken into consideration in patients who experience repetitive clinical and biological inflammatory manifestations after the remission of the infection with SARS-CoV-2, which may be improved through high dose corticosteroid therapy.

The importance of clinical examination in the diagnosis of laterocervical lymphadenopathy – case presentation

Cervical lymph nodes represent a common site of meta­s­ta­­ses for malignancies of the head and neck and, in the absence of a known primary site, the treatment options can be challenging. In patients with a nodular formation with laterocervical localization, the differential diagnosis should always consider the potential metastasis of squamous cell carcinoma of the ENT sphere. This paper emphasizes the importance of a complete physical and imaging exa­mi­na­tion, as well as histopathological diagnosis, which led to a diag­nosis of squamous cell carcinoma originating in the larynx, in an otherwise nonspecific clinical setting.

Adoption of Biomedical Ceramic iRoot BP in the Treatment of Localized Pulpitis in Children

To explore the clinical efficacy of biomedical ceramic iRoot BP in the treatment of localized acute pulpitis in children, and the effect of iRoot BP on proliferation and osteogenic differentiation of human dental pulp stem cells (hDPSCs), 72 localized acute pulpitis children admitted to our hospital from September 2018 to September 2019 were selected and divided into group A (treated with MTA pulp capping material) and group B (treated with iRoot BP material), and the clinical effect, pain degree, and adverse reactions (ADR) rate were compared. The effects of iRoot BP on hDPSCs proliferation and osteogenic differentiation were analyzed; the proliferative activity of cells in iRoot BP group, MTA group, and control group (C group) were measured by cholecystokinin-8 (CCK-8) assay, the ability of cell mineralized nodular formation was observed via alizarin red staining; and quantitative reverse transcription PCR (qRT-PCR) andWestern blot were adopted to determine the expression of osteogenic related genes of hDPSCs and key proteins of mitogen-activated protein kinase (MAPK) signaling pathway. After 1 week of treatment, the clinical efficacy of group B was more favorable in contrast with group A (P < 0.05); the pain of children in group B was notably better in contrast with group A, and incidence of ADR was notably lower in contrast with group A (P < 0.05). 5.0 mg/mL, 10.0 mg/mL, and 30 mg/mL iRoot BP or MTA could improve cell proliferation activity (P < 0.01); the effect of iRoot BP on proliferation of hDPSCs was greater in contrast with MTA (P < 0.05); and the integral optical density (IOD) value of iRoot BP group was notably higher in contrast with MTA group (P < 0.01). The mRNA expression levels of collagen-I (COL-I), bone sialoprotein (BSP), and osteocalcin (OC) in MTA group and iRoot BP group were notably higher in contrast with C group (P < 0.01); the COL-I mRNA expression level of iRoot BP group was notably higher in contrast with MTA group (P < 0.01); the mRNA expression level of BSP in MTA group was notably higher in contrast with iRoot BP group (P < 0.01); the relative protein expression levels of phosphorylated ERK (p-ERK) and phospho-Jun N-terminal kinase (p-JNK) in MTA group and iRoot BP group were notably higher in contrast with C group (P < 0.01); and the relative expression level of p-ERK protein in iRoot BP group was higher in contrast with MTA group (P < 0.05). These results indicated that the clinical efficacy of biomedical ceramic iRoot BP was better than MTA in the preservation of live pulpitis in children, and the patients treated with iRoot BP had better pain recovery effect and lower risk of ADR. The effect of iRoot BP on the proliferation and mineralization of hDPSCs was better than that of MTA, and it may promote the osteogenic differentiation of hDPSCs by activating MAPK signaling pathway and regulating gene expression of COL-I, BSP, and OC.