Nodule Growth Research Articles

Mineral and Carbon Metabolic Adjustments in Nodules of Symbiotically Grown Faba Bean (Vicia faba L.) Varieties in Response to Organic Phosphorus Supplementation.

Phosphorus (P) is a major limiting factor for legume and symbiotic nitrogen fixation (SNF). Although overall adaptations of legumes to P supplementation have been extensively studied in connection with inorganic P, little information is currently available regarding nodulation or SNF responses to organic P (Po) in hydroponics. We investigated the mineral and carbon metabolism of Po-induced nodules of two contrasting faba bean varieties grown hydroponically under inorganic P (Pi), viz., in P-deficient (2 µM KH2PO4, -Pi), sufficient-P (200 µM KH2PO4, +Pi), and phytic acid (200 µM, Po) conditions, and were inoculated with Rhizobium leguminosarum bv. viciae 3841 and grown for 30 days. The results consistently reveal similar growth and biomass partitioning patterns between +Pi and Po, with both varying substantially from -Pi. In comparison, +Pi and Po observed equivalent accumulations of overall elemental P concentrations, with both increasing by 114 and 119%, respectively, relative to -Pi. A principal component analysis on metabolites showed a clear separation of the -Pi treatment from the others, with +Pi and Po correlating closely together, highlighting the nonsignificant differences between them. Additionally, the δ15N abundance of shoots, roots, and nodules was not significantly different between treatments and varieties and exhibited negative δ15N signatures for all tissues. Our study provides a novel perspective on mineral and carbon metabolism and their regulation of the growth, functioning, and reprogramming of nodules upon phytate supply.

Tumor blood vessel in 3D reconstruction CT imaging as an risk indicator for growth of pulmonary nodule with ground-glass opacity

ObjectiveDespite the vital role of blood perfusion in tumor progression, in patients with persistent pulmonary nodule with ground-glass opacity (GGO) is still unclear. This study aims to investigate the relationship between tumor blood vessel and the growth of persistent malignant pulmonary nodules with ground-glass opacity (GGO).MethodsWe collected 116 cases with persistent malignant pulmonary nodules, including 62 patients as stable versus 54 patients in the growth group, from 2017 to 2021. Three statistical methods of logistic regression model, Kaplan–Meier analysis regression analysis were used to explore the potential risk factors for growth of malignant pulmonary nodules with GGO.ResultsMultivariate variables logistic regression analysis and Kaplan–Meier analysis identified that tumor blood vessel diameter (p = 0.013) was an significant risk factor in the growth of nodules and Cut-off value of tumor blood vessel diameter was 0.9 mm with its specificity 82.3% and sensitivity 66.7%.While in subgroup analysis, for the GGO CTR < 0.5[C(the maximum diameter of consolidation in tumor)/T(the maximum diameter of the whole tumor including GGO) ratio], tumor blood vessel diameter (p = 0.027) was important during the growing processes of nodules.ConclusionsThe tumor blood vessel diameter of GGO lesion was closely associated with the growth of malignant pulmonary nodules. The results of this study would provide evidence for effective follow-up strategies for pulmonary nodule screening.

Prediction of subsolid pulmonary nodule growth rate using radiomics

BackgroundPulmonary nodule growth rate assessment is critical in the management of subsolid pulmonary nodules (SSNs) during clinical follow-up. The present study aimed to develop a model to predict the growth rate of SSNs.MethodsA total of 273 growing SSNs with clinical information and 857 computed tomography (CT) scans were retrospectively analyzed. The images were randomly divided into training and validation sets. All images were categorized into fast-growth (volume doubling time (VDT) ≤ 400 days) and slow-growth (VDT > 400 days) groups. Models for predicting the growth rate of SSNs were developed using radiomics and clinical features. The models’ performance was evaluated using the area under the curve (AUC) values for the receiver operating characteristic curve.ResultsThe fast- and slow-growth groups included 108 and 749 scans, respectively, and 10 radiomics features and three radiographic features (nodule density, presence of spiculation, and presence of vascular changes) were selected to predict the growth rate of SSNs. The nomogram integrating radiomics and radiographic features (AUC = 0.928 and AUC = 0.905, respectively) performed better than the radiographic (AUC = 0.668 and AUC = 0.689, respectively) and radiomics (AUC = 0.888 and AUC = 0.816, respectively) models alone in both the training and validation sets.ConclusionThe nomogram model developed by combining radiomics with radiographic features can predict the growth rate of SSNs more accurately than traditional radiographic models. It can also optimize clinical treatment decisions for patients with SSNs and improve their long-term management.

Solitary Pulmonary Nodule: Is It Benign or Malignant?

Solitary pulmonary nodules (SPN) are round-shaped opacities with or without firm borders and ≤3 cm in diameter. 40% of solitary pulmonary nodules in high-risk populations are malignant and &gt;10 mm in diameter. With the high incidence of pulmonary cancer, diagnosing pulmonary nodules is essential for clinicians. This review aims to discuss more solitary pulmonary nodules based on multiple recommendations for diagnosis and management. Malignancy probability assessment is the first step in evaluating each patient with new pulmonary nodules, as it significantly affects the prognosis of the disease. The assessment depends on the risk factors present in the patient, which are cigarettes, age, history of cancer, and family history. Radiological evaluation is the second phase in pulmonary nodule evaluation. Predictors of malignant nodules that should be assessed are nodule size, growth rate, nodule morphology, location, and enhancement. Many guidelines have been published regarding treating solitary pulmonary nodules, including the Fleischner Society, ACCP, and BTS guidelines.

HUNCHEST-II contributes to a shift to earlier-stage lung cancer detection: final results of a nationwide screening program.

The introduction of low-dose CT (LDCT) altered the landscape of lung cancer (LC) screening and contributed to the reduction of mortality rates worldwide. Here we report the final results of HUNCHEST-II, the largest population-based LDCT screening program in Hungary, including the screening and diagnostic outcomes, and the characteristics of the LC cases. A total of 4215 high-risk individuals aged between 50 and 75 years with a smoking history of at least 25 pack-years were assigned to undergo LDCT screening. Screening outcomes were determined based on the volume, growth, and volume doubling time of pulmonary nodules or masses. The clinical stage distribution of screen-detected cancers was compared with two independent practice-based databases consisting of unscreened LC patients. The percentage of negative and indeterminate tests at baseline were 74.2% and 21.7%, respectively, whereas the prevalence of positive LDCT results was 4.1%. Overall, 76 LC patients were diagnosed throughout the screening rounds (1.8% of total participants), out of which 62 (1.5%) patients were already identified in the first screening round. The overall positive predictive value of a positive test was 58%. Most screen-detected malignancies were stage I LCs (60.7%), and only 16.4% of all cases could be classified as stage IV disease. The percentage of early-stage malignancies was significantly higher among HUNCHEST-II screen-detected individuals than among the LC patients in the National Koranyi Institute of Pulmonology's archive or the Hungarian Cancer Registry (p < 0.001). HUNCHEST-II demonstrates that LDCT screening for LC facilitates early diagnosis, thus arguing in favor of introducing systematic LC screening in Hungary. HUNCHEST-II is the so-far largest population-based low-dose CT screening program in Hungary. A positive test's overall positive predictive value was 58%, and most screen-detected malignancies were early-stage lesions. These results pave the way for expansive systematic screening in the region. • Conducted in 18 medical facilities, HUNCHEST-II is the so far largest population-based low-dose CT screening program in Hungary. • The vast majority of screen-detected malignancies were early-stage lung cancers, and the overall positive predictive value of a positive test was 58%. • HUNCHEST-II facilitates early diagnosis, thus arguing in favor of introducing systematic lung cancer screening in Hungary.

Acidification of intracellular pH in MM tumor cells overcomes resistance to hypoxia-mediated apoptosis in vitro and in vivo.

Multiple myeloma (MM) is an incurable cancer of malignant plasma cells that engraft in the bone marrow (BM). It is more than likely that the poorly investigated physical parameters of hypoxia and pH in the tumor microenvironment (TME) is critical for MM survival. Here, we explore the effects of a hypoxic environment on pH regulation and its role in MM survival. We used in vitro models of MM, in which the culturing medium was modified to specific pH and pO2 levels and then measured the effects on cell survival that was correlated with changes in intracellular (pHi) and extracellular pH (pHe). In a MM xenograft model, we used PET/CT to study hypoxia-mediated effects on tumor growth. Hypoxia-mediated apoptosis of MM cells is correlated with acidic intracellular pHi (less than < 6.6) that is dependent on HIF activity. Using a polyamide HIF responsive element binding compound, a carbonic anhydrase inhibitor (acetazolamide), and an NHE-1 inhibitor (amiloride) acidified the pHi and lead to cell death. In contrast, treatment of cells with an alkalization agent, Na-lactate, rescued these cells by increasing the pHi (pH > 6.6). Finally, treatment of mice with acetazolamide decreased cell growth in the tumor nodules. Targeting hypoxia and HIF have been proposed as an anti-tumor therapy but the clinical efficacy of such strategies are modest. We propose that targeting the pHi may be more effective at treating cancers within a hypoxic TME.

Precipitation pattern alters the effects of nitrogen deposition on the growth of alien species Robinia pseudoacacia

AimsNitrogen (N) supply and precipitation pattern (amount and frequency) both affect plant growth. However, N deposition is increasing and precipitation regimes are changing in the context of global change. An experiment was conducted to access how the growth of Robinia pseudoacacia, a widely distributed and cultivated N2-fixing alien species, is affected by both the pattern of precipitation and N supplies. MethodsSeedlings were grown in a glasshouse at four different N levels combined with different precipitation regimes, including three precipitation amounts, and two precipitation frequencies. After treatment for 75 days, plant height, biomass allocation, leaf and soil nutrient concentrations were measured. ResultsPlants under high precipitation frequency had greater biomass compared with plants lower precipitation frequency, despite receiving the same amount of precipitation. Higher N supply reduced biomass allocation to nodules. Under low precipitation level, nodule growth and N2 fixation of R. pseudoacacia was more inhibited by high N deposition compared with plants under higher precipitation level. Even slightly N deposition under higher precipitation inhibited N2 fixation but it was insufficient to meet the N needs of the plants. ConclusionsEven at low levels, N deposition might inhibit N2 fixation of plants but low N in soil cannot meet the N requirements of plants, and caused N2 fixation limitation in plants during seedling stage. There was likely a transition from N2 fixation to acquisition of N from soil directly with root when N supply was increased.

A spatio-temporal image analysis for growth of indeterminate pulmonary nodules detected by CT scan.

The objective is to evaluate the performance of computational image classification for indeterminate pulmonary nodules (IPN) chronologically detected by CT scan. Total 483 patients with 670 abnormal pulmonary nodules, who were taken chest thin-section CT (TSCT) images at least twice and resected as suspicious nodules in our hospital, were enrolled in this study. Nodular regions from the initial and the latest TSCT images were cut manually for each case, and approached by Python development environment, using the open-source cv2 library, to measure the nodular change rate (NCR). These NCRs were statistically compared with clinico-pathological factors, and then, this discriminator was evaluated for clinical performance. NCR showed significant differences among the nodular consistencies. In terms of histological subtypes, NCR of invasive adenocarcinoma (ADC) were significantly distinguishable from other lesions, but not from minimally invasive ADC. Only for cancers, NCR was significantly associated with loco-regional invasivity, p53-immunoreactivity, and Ki67-immunoreactivity. Regarding Epidermal Growth Factor Receptor gene mutation of ADC-related nodules, NCR showed a significant negative correlation. On staging of lung cancer cases, NCR was significantly increased with progression from pTis-stage 0 up to pT1b-stage IA2. For clinical shared decision-making (SDM) whether urgent resection or watchful-waiting, receiver operating characteristic (ROC) analysis showed that area under the ROC curve was 0.686. For small-sized IPN detected by CT scan, this approach shows promise as a potential navigator to improve work-up for life-threatening cancer screening and assist SDM before surgery.

ACR Lung-RADS v2022: Assessment Categories and Management Recommendations

The ACR created the Lung CT Screening Reporting and Data System (Lung-RADS) in 2014 to standardize the reporting and management of screen-detected pulmonary nodules. Lung-RADS was updated to version 1.1 in 2019 and revised size thresholds for nonsolid nodules, added classification criteria for perifissural nodules, and allowed for short-interval follow-up of rapidly enlarging nodules that may be infectious in etiology. Lung-RADS v2022, released in November 2022, provides several updates including guidance on the classification and management of atypical pulmonary cysts, juxtapleural nodules, airway-centered nodules, and potentially infectious findings. This new release also provides clarification for determining nodule growth and introduces stepped management for nodules that are stable or decreasing in size. This article summarizes the current evidence and expert consensus supporting Lung-RADS v2022.

SAT511 High Intensity Focused Ultrasound (HIFU) Ablation for Benign Thyroid Nodules: A Single-Center Cohort

Abstract Disclosure: M. Mavromati: None. P. Meyer: None. F. Vermeulen: None. M. Demarchi: None. E. Saiji: None. C. De Vito: None. F. Jornayvaz: None. S. Leboulleux: None. A. Wolff: None. F. Triponez: None. Introduction:Benign thyroid nodules may increase in size over time and cause local compressive symptoms. Current guidelines suggest surgery for benign symptomatic nodules, however, complications such as hypothyroidism, bleeding, infection and recurrent laryngeal nerve injury are of concern for a growing number of patients. Minimally invasive techniques may therefore be an alternative to surgical resection. The objective of our study was to evaluate the efficacy and safety of high intensity focused ultrasound (HIFU) ablation in a single-center cohort of benign symptomatic thyroid nodules.Materials and methods:Between February 2021 and May 2022, 13 patients were treated by HIFU for a single benign solid symptomatic thyroid nodule. Benign nature of thyroid nodules was confirmed by a Bethesda II result in fine-needle aspiration, before HIFU. Treatment was performed under hypnosis, carried out by an experienced anesthesiologist. Patients were evaluated by clinical examination and ultrasound at 6 and 12 months after treatment. Results: A total of 13 patients (12 female and 1 male) were treated with HIFU for a single solid symptomatic benign thyroid nodule. Mean age was 57 years (range: 48-67 years). Thyroid nodules had an mean maximum diameter of 48 mm (range: 31-66 mm) and a meanvolume of 28.4 mL (range: 8.5-53 mL). At 12 months after HIFU, 4 patients underwent surgical ablation (31%) because of nodule growth (n=2, 15.4%) or persistent local compression (n=2, 15.4%). Those nodules were benign on final histology. Among non-operated nodules, mean decrease of volume at 6 months was 35% (range: 20-46%) and smaller nodules showed a better response to treatment. Altogether, 8 patients (61.5%) reported a clinical improvement 6 months after treatment, while 4 patients (31%) underwent surgery. Treatment was well tolerated in the majority of patients and had to be stopped because of pain in only one case (7.7%). There were no treatment-related local complications. Conclusion:High-intensity focused ultrasound (HIFU) ablation for benign symptomatic thyroid nodules is a safe minimally invasive technique but volume reduction was only 20-46% at 6 months, while 31% of patients required surgery after all. This could be attributed to the large initial volume of nodules included in our cohort. Clinical hypnosis is a useful alterative for pain management. Presentation Date: Saturday, June 17, 2023

Natural history of endometriosis in pregnancy: ultrasound study of morphology of deep endometriosis and ovarian endometrioma.

To assess the morphological appearance of deep endometriosis and ovarian endometrioma in pregnancy using pelvic ultrasound examination. This was a prospective observational cohort study conducted over 3 years at University College London Hospital, which is a tertiary level referral unit for early pregnancy complications and an accredited endometriosis center. All women who participated provided written consent and were invited for surveillance ultrasound examination at the time of their routine scans in pregnancy. All scans were performed by a single operator to eliminate interobserver variability. The change in size of ovarian endometrioma and nodules was reported as change in their mean diameter. Ovarian endometrioma with irregular thick inner walls, hyperechoic papillary projections and/or high vascularity and hyperechoic nodules with moderate to high vascularity were reported as decidualized. Sixty-five women with a live, normally sited pregnancy and concomitant ultrasound features of deep and/or ovarian endometriosis were included in the study. The median age of the study population was 34 (range, 23-44) years, and the median gestational age at presentation was 7 + 6 (range, 3 + 6 to 18 + 0) weeks. From the cohort, 47/65 (72%) were nulliparous, 48/65 (74%) had a previous diagnosis of endometriosis and 19/65 (29%) conceived via in-vitro fertilization. There were 10/65 (15% (95% CI, 7-24%)) women with ovarian endometrioma alone, 28/65 (43% (95% CI, 31-55%)) with endometriotic nodules alone and the remaining 27/65 (42% (95% CI, 30-54%)) had both. Of the women with ovarian endometrioma who underwent follow-up, 29/34 (85% (95% CI, 73-97%)) experienced cyst regression, 2/34 (6% (95% CI, 0-14%)) experienced cyst growth, and in 3/34 (9% (95% CI, 0.0-18%)) women, cyst size was unchanged. In 10/34 (29% (95% CI, 14-45%)), there was complete resolution of all cysts. Of the women with nodules who underwent follow-up, 43/51 (84% (95% CI, 74-94%)) experienced nodule regression, 2/51 (4% (95% CI, 0-9%)) experienced nodule growth and, in 6/51 (12% (95% CI, 3-21%)) women, nodule size was unchanged. In 4/51 (8% (95% CI, 0-15%)) women, there was complete resolution of all nodules. In 5/37(14% (95% CI, 3-25%)) women who attended postnatal follow-up, complete resolution of all endometriotic lesions occurred during pregnancy. In 10/34 (29% (95% CI, 14-45%)) women with ovarian endometrioma and 27/51 (53% (95% CI, 39-67%)) women with nodules, a pattern of growth was observed in the first and second trimesters, followed by regression later in pregnancy. Features of decidualization were observed in 17/34 (50% (95% CI, 33-67%)) women with ovarian endometrioma, most commonly in the first trimester, and in 25/51 (49% (95% CI, 35-63%)) women with nodules, most commonly in the second trimester. For the majority of women, despite features of decidualization being common in the first and second trimesters, ovarian endometrioma and deep nodules regress during pregnancy. Morphological changes of endometriosis in pregnancy are difficult to differentiate from characteristics of malignant lesions. Better understanding of the appearance of endometriosis in pregnancy is vital to minimize intervention and help counsel women regarding their condition. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Contralateral Low-to-Intermediate Suspicion Nodule Is Not a Contraindication for Lobectomy in Patients with Papillary Thyroid Carcinoma.

Background: The optimal extent of surgery for unilateral papillary thyroid carcinoma (PTC) with contralateral nodules remains unclear. This study evaluated the long-term outcomes in a large cohort of patients with unilateral PTC and contralateral low-to-intermediate suspicious nodules who underwent lobectomy. Methods: This retrospective cohort study included patients with unilateral PTC who underwent lobectomy between January 2016 and December 2017 at Asan Medical Center in Korea. Patients were divided into two groups, those with and without contralateral nodules at the time of lobectomy: the Present group and the Absent group. All contralateral nodules observed at the time of surgery and during follow-up were evaluated. Results: The study cohort consisted of 1761 patients (1879 nodules), including 700 (39.8%) with and 1061 (60.2%) without contralateral nodules. The median size of the contralateral nodules was 0.5 cm. After a median follow-up of 59 months, the median growth of the contralateral nodules in the Present group was 0.1 cm (range, -3.4 to 4.7 cm). Of the contralateral nodules present at the time of lobectomy, 54.7% remained unchanged, decreased in size, or disappeared; whereas 14.8% increased ≥0.3 cm. Of the 700 patients with contralateral nodules, 20 (2.9%) were diagnosed with contralateral PTC. The 5-year contralateral PTC disease-free survival rates in patients with and without contralateral nodules were 98.2% and 99.3% (p = 0.003), respectively, whereas the 5-year recurrence-free survival rates did not differ significantly in these two groups. Of the 39 patients who underwent completion thyroidectomy, 2 (5.1%) experienced permanent hypocalcemia. Conclusions: Lobectomy may be a safe and feasible initial treatment option for patients with unilateral low-risk PTC and contralateral low-to-intermediate suspicious nodules.

Strigolactones repress nodule development and senescence in pea.

Strigolactones are a class of phytohormones that are involved in many different plant developmental processes, including the rhizobium-legume nodule symbiosis. Although both positive and negative effects of strigolactones on the number of nodules have been reported, the influence of strigolactones on nodule development is still unknown. Here, by means of the ramosus (rms) mutants of Pisum sativum (pea) cv Terese, we investigated the impact of strigolactone biosynthesis (rms1 and rms5) and signaling (rms3 and rms4) mutants on nodule growth. The rms mutants had more red, that is, functional, and larger nodules than the wild-type plants. Additionally, the increased nitrogen fixation and senescence zones with consequently reduced meristematic and infection zones indicated that the rms nodules developed faster than the wild-type nodules. An enhanced expression of the nodule zone-specific molecular markers for meristem activity and senescence supported the enlarged, fast maturing nodules. Interestingly, the master nodulation regulator, NODULE INCEPTION, NIN, was strongly induced in nodules of all rms mutants but not prior to inoculation. Determination of sugar levels with both bulk and spatial metabolomics in roots and nodules, respectively, hints at slightly increased malic acid levels early during nodule primordia formation and reduced sugar levels at later stages, possibly the consequence of an increased carbon usage of the enlarged nodules, contributing to the enhanced senescence. Taken together, these results suggest that strigolactones regulate the development of nodules, which is probably mediated through NIN, and available plant sugars.

Susceptibility of Zr-2.5 (wt. %) Nb alloy to undergo nodular corrosion in water and steam environments: Effect of surface, cold work, temperature

Nodular corrosion can severely affect the service life of zirconium alloys in water cooled nuclear reactors. In this study, the susceptibility of pressure tube alloy to undergo nodular corrosion in water-steam with air surroundings at 250°C and 300°C is investigated. Accelerated corrosion has been studied in single phase steam at 500°C. The effect of specimen surface condition and cold work on nodular corrosion susceptibility has been studied in detail. The results indicate that surface condition of the specimen plays primary role in determining the propensity of the alloy to undergo nodular corrosion. Cold work has negligible effect on the initiation as well as growth of oxide nodules in Zr-2.5 (wt. %)Nb alloy. The effect of temperature is highly localized and is visible on the size of the nodules. Presence of non-uniform or discontinuous autoclave layer increases the susceptibility of pressure tube alloy to undergo nodular corrosion.

Modeling the interactions between inter-correlated variables of plant and soil micro-ecology responses under simultaneous cadmium stress and drought

Cadmium and water stress are considered two important prevalent abiotic stresses which may occur simultaneously in many parts of the world. The occurrence of different stress factors in nature is often simultaneous and the effect of multiple stress factors on living organisms cannot be investigated separately. Although it is essential to evaluate plant and microbial community responses to the combination of different abiotic stresses simultaneously, many scientists have used a single evaluative approach to study the effect of cadmium and/or water stress on the response of plant and/or soil microorganisms. The purpose of this study is to assess the effects of water stress and cadmium together on the development and growth of Medicago scutellata L. and soil biological activity. To investigate potential relationships among inter-correlated variables and comprehend potential mechanisms, predictive regression modeling, principal component analysis, and path analysis were implemented. Considering the outcomes, cadmium at low concentrations stimulates nodule growth and the fungi population. Moderate water stress (50%) decreased the bacteria population while it did not affect the fungi population. The obtained results of this study suggest that soil microsymbiont such as fungi might have a significant role in maintaining (as well as increasing) the nitrogen fixation ability of Medicago under low cadmium stress. Except for the removal rate (0.683), all predictive equation models showed strong linear fitness of the regression models, with adjusted R2 values ranging from 0.838 to 0.987. Based on the path analysis, urease has a significant positive direct effect on phosphatase activity. Due to the high removal rate and bioconcentration factor, M. scutellata can be considered as a potential cadmium hyperaccumulator.

O-031 The natural history of endometriosis in pregnancy: An ultrasound study of the morphological features of deep endometriosis (DE) and ovarian endometrioma

Abstract Study question What is the impact of pregnancy on the morphological features and behaviour of ovarian endometrioma and deep endometriotic nodules? Summary answer For the majority of women, despite features of decidualization being common in the first and second trimesters, endometrioma and deep nodules will regress during pregnancy. What is known already Deep endometriosis and endometrioma subtypes are thought to affect approximately 5% of women in pregnancy, with about 50% being unaware of their condition. Pregnancy has a major effect on the size and morphological features of endometrioma, with published studies reporting a tendency for cyst regression. Decidualization, a hormonally induced pregnancy-related phenomenon, effects endometriomas and may raise suspicion of an ovarian malignancy. The behaviour of deep endometriosis in pregnancy is poorly understood and there is limited available literature on the subject. Study design, size, duration This was a prospective observational cohort study conducted over three years at a single centre. We included 65 women with a viable eutopic pregnancy and concomitant ultrasound features of deep and/or ovarian endometriosis. The study was conducted at University College London Hospital, which is a tertiary level referral unit for early pregnancy complications and an accredited Endometriosis Centre. Participants/materials, setting, methods All women who participated provided written consent and were invited for surveillance ultrasound examinations at the time of their routine scans in pregnancy. All scans were performed by a single operator to minimise interobserver error. The change in size of endometrioma and nodules were reported as change in their mean diameter. Endometrioma with irregular thick inner walls, hyperechoic papillary projections and/or high vascularity and hyperechoic nodules with moderate to high vascularity were reported as decidualized. Main results and the role of chance Sixty five women were included in the study. Their median age was 34 years (23-44), and the gestation at presentation was 7 + 6 weeks (3 + 6 to 18 + 0). 47/65(72%) were nulliparous, 48/65(74%) had a background of endometriosis and 19/65(29%) conceived following IVF. There were 10/65(15%, 95%CI 7-24) women with endometrioma alone, 28/65(43%, 95%CI 31-55) with nodules alone and the remaining 27/65(42%, 95%CI 30-54) had both. 29/34(85%, 95%CI 73-97) women with endometrioma experienced cyst regression, 2/34(6%, 95%CI 0-14) experienced cyst growth and in 10/34(29%, 95%CI 14-45) there was complete resolution of all cysts. 43/51(84%, 95%CI 74-94) women with nodules experienced nodule regression, 2/51(4%, 95%CI 0-9) experienced nodule growth and in 4/51(8%, 95%CI 0-15) there was complete resolution of all nodules. 5/37(14%, 95%CI 3-25) women who attended postnatal follow-up, experienced complete resolution of all endometriotic lesions during pregnancy . In 10/34(29%, 95%CI 14-45) women with endometrioma and 27/51(53%, 95%CI 39-67) with nodules, a pattern of growth was observed in the first and second trimesters, which preceded regression in later pregnancy. Features of decidualization were observed in 17/34(50%, 95%CI 33-67) women with endometrioma, most commonly in the 1st trimester, and 25/51(49%, 95%CI 35-63) women with nodules, most commonly observed in the 2nd trimester. Limitations, reasons for caution The lack of extended follow-up fails to establish the long-term impact of pregnancy, lactation and postnatal contraception on the behaviour of endometriosis. This study relies on ultrasound alone for the detection of moderate/severe disease with no correlation with laparoscopy. Wider implications of the findings Sonographic changes of endometriosis in pregnancy are difficult to differentiate from characteristics of malignant lesions. Better understanding of the appearance of endometriosis in pregnancy is vital to reduce unnecessary surgical procedures, associated morbidity to mothers and babies and will help clinicians to counsel women regarding the significance of their condition. Trial registration number The study was registered on Research Registry (Unique identifying number: researchregistry4569).

The Thoracic Research Evaluation and Treatment 2.0 Model: A Lung Cancer Prediction Model for Indeterminate Nodules Referred for Specialist Evaluation

Appropriate risk stratification of indeterminate pulmonary nodules (IPNs) is necessary to direct diagnostic evaluation. Currently available models were developed in populations with lower cancer prevalence than that seen in thoracic surgery and pulmonology clinics and usually do not allow for missing data. We updated and expanded the Thoracic Research Evaluation and Treatment (TREAT) model into a more generalized, robust approach for lung cancer prediction in patients referred for specialty evaluation. Can clinic-level differences in nodule evaluation be incorporated to improve lung cancer prediction accuracy in patients seeking immediate specialty evaluation compared with currently available models? Clinical and radiographic data on patients with IPNs from six sites (N= 1,401) were collected retrospectively and divided into groups by clinical setting: pulmonary nodule clinic (n= 374; cancer prevalence, 42%), outpatient thoracic surgery clinic (n= 553; cancer prevalence, 73%), or inpatient surgical resection (n= 474; cancer prevalence, 90%). A new prediction model was developed using a missing data-driven pattern submodel approach. Discrimination and calibration were estimated with cross-validation and were compared with the original TREAT, Mayo Clinic, Herder, and Brock models. Reclassification was assessed with bias-corrected clinical net reclassification index and reclassification plots. Two-thirds of patients had missing data; nodule growth and fluorodeoxyglucose-PET scan avidity were missing most frequently. The TREAT version 2.0 mean area under the receiver operating characteristic curve across missingness patterns was 0.85 compared with that of the original TREAT (0.80), Herder (0.73), Mayo Clinic (0.72), and Brock (0.68) models with improved calibration. The bias-corrected clinical net reclassification index was 0.23. The TREAT 2.0 model is more accurate and better calibrated for predicting lung cancer in high-risk IPNs than the Mayo, Herder, or Brock models. Nodule calculators such as TREAT 2.0 that account for varied lung cancer prevalence and that consider missing data may provide more accurate risk stratification for patients seeking evaluation at specialty nodule evaluation clinics.

A single case study on Benign Prostatic Hyperplasia with Dashamoola siddha Taila Uttarbasti

BPH is major giriatric problem of obstructive uropathic disorders described in ayurveda as one type of Mutraghata.BPH is a non-malignant enlargement of the prostate gland caused by excess growth of prostatic nodules. Histo-pathologically the prevalence of BPH is age dependent, initiate usually after 40 years of age.The age-specific prevalence of benign prostatic hyperplasia has been estimated from autopsy studies to be 8% in the fourth decade of life, 50% in the sixth decade of life, and 80% in the ninth decade of life. BPH is a progressive disease and In Ayurveda, Mutraghata either upper or it is commonly associated with lower urinary tract symptoms such as retension, incomplete voiding, dribbling, hesitancy, incontinence of urine etc. In morden medicine the management of BPH is either by conservative treatment using chemotherapy, hormonal therapy and surgical approach. In this case study, a patient diagnosed with Benign Prostatic Hyperplasia was treated with a Dashamoola siddha TailaUttarbasti 20 ml once daily for three days and then 3 days gap given between two cycles for 21 days. Assessment of patient was done by IPSS (International Prostate Symptom Score) and weight of the prostate and post void residual urine volume. After completion of Uttarbasti treatment significant relief was observed in symptoms.&#x0D;

Legume plant yields using biopreparation and plant growth regulators

The effect of the biopreparation Rizotorfin and growth regulators Albit, Kornevin, Epin-Extra on symbiotic activity and yield of the bean plant varieties Geliada and Shokoladnitsa was studied under field conditions. The nitrogenase activity was increased in Heliada bean plants after treatment of seeds with Epin-Extra against the increase of bacteroides area, amount and area of volutin and decrease of area and amount of poly-ß-oxybutyric acid (POM). The protective effect of Rizotorfin was evident in the variety Shokoladnitsa. The relationship between symbiotic nitrogen fixation and yield of bean plants of varieties Heliada and Shokoladnitsa was detected. The varietal responses of these plants to the use of Risotorfin and growth regulators have been identified. To increase the efficiency of legume-rhizobium symbiosis and plant productivity, the pre-sowing treatment of seeds with a biopreparation based on nodule bacteria and growth regulators is recommended.

Invasive histiocytosis in the ear of a dog: case report

The present work aimed at reporting the case of a seven-year-old canine patient of the Jack Russel breed presenting an ulcerated nodule in the ear, diagnosed by histopathology and immunohistochemistry as cutaneous histiocytoma. A surgical conchectomy was performed, and later on the patient evolved with an increase in volume in the cervical region. The patient underwent a tomography scan, which showed that the nodule was unique and had no vascular involvement. Because of this, a new surgical approach was required, in which the nodule was sent for histopathology, which confirmed Histiocytoma invasion in the lymph node. Approximately four months after the last surgical procedure, patient presented growth of several nodules throughout the body, exhibiting a different clinical manifestation in this second moment, compatible with Langerhans Histiocytosis, being the prognosis more unfavorable.