Reduction In Nodule Size Research Articles

The safety and efficacy of radiofrequency ablation in benign pediatric thyroid disease in the US: An initial case series.

To evaluate the efficacy and safety of radiofrequency ablation (RFA) for benign nonfunctional thyroid nodules or functional lingual thyroid gland in a pediatric population. Four pediatric patients (four female; mean age 13.50 ± 4.04, range 8-17 years) with either benign thyroid nodules or mildly obstructive lingual thyroid glands were treated with RFA from 2020 to 2021 were evaluated. The inclusion criteria for RFA therapy were (i) age < 18 years; (ii) benign cytopathological results on ultrasound guided fine needle aspiration; (iii) pressure or pain symptoms caused by the thyroid nodules; (iv) dysphagia or obstruction caused by the lingual thyroid tissue; (v) follow up for >6 months with otolaryngology or endocrinology. Two patients had benign non-functioning thyroid nodules and two had mildly obstructive functioning lingual thyroid glands. Mean follow up was 10.75 ± 4.79 months. Each patient underwent one RFA session with no complications. For the patients with thyroid nodules, there was >74% reduction in nodule size at last follow up with improvement in neck swelling and pain. For the patients with lingual thyroid glands, both did not have any other functional thyroid gland identified. Both had visible decrease in size of the gland as visualized transorally with improvement in dysphagia and obstructive symptoms when lying flat. RFA is a safe and effective option for managing benign thyroid nodules and lingual thyroid glands in a pediatric patient population. 4.

A Case of 21-hydroxylase Deficiency with Massive Bilateral Adrenal Masses

Background: Congenital adrenal hyperplasia (CAH) can lead to bilateral adrenal tumors. Excess adrenocorticotropic hormone is thought to play a role in the development of adrenal nodules. Here we present a patient with a simple virilizing form of 21-hydroxylase deficiency, a married man, bilateral adrenal tumors, and 46-XX chromosomes.Case report: 39-year-old man suffered from abdominal pain and tension. Abdominal tomography showed macronodular hyperplasia in both adrenal glands, with the largest nodule reaching 4.2 cm on the left side. The patient's old records showed that CAH had been diagnosed at the age of 11 years, but the patient was not taking any medication. The patient was treated with glucocorticoid. Despite irregular use of the treatment, the size of the nodules remained stable for 3 years, and then a significant reduction in nodule size was observed.&#x0D; Conclusion: In patients with bilateral adrenal masses and incidentaloma, CAH should be considered to avoid unnecessary surgery or biopsy. A 17-hydroxyprogesterone test in a suspicious patient is a useful tool for diagnosis.

Robotic-assisted Bronchoscopy and Cone-beam CT: A Retrospective Series.

Robotic-assisted Bronchoscopy and Cone-beam CT: A Retrospective Series.

Efficacy and Safety of Radiofrequency Ablation for Benign Thyroid Nodules: Initial Mongolian Experience

Objectives: To assess the efficacy and safety of thyroid radiofrequency (RF) ablation for benign thyroid nodules for a 24 months period. Methods: From 2019 to 2021, 485 nodules were from 183 patients (mean age 47.7 ± 11.2) who met eligibility criteria were enrolled from participants. At pre-ablation, the median volume was 0.371 mL (CI 95 %; 0.289 - 0.513). For 1, 3, 6, 12 and 24 months after treatment, 485 lesions, consisting of 258 (27 %) solid, 108 (11.3 %) predominantly solid, 47 (4.9 %) cystic, 25 (2.6 %) predominantly cystic and 47 (4.9 %) sponge were followed. RFA treatment was performed using two standard techniques (trans isthmic and moving-shot) and an RFA V-1000 cooling system. For 24 months, nodule size reduction was assessed. Results: At pre-ablation, the median volume was 0.371 mL (CI 95 % 0.289 - 0.513). For 1, 3, 6, 12 and 24 months after treatment, median volume reduction was 0.263 (CI 95 %; 0.205 - 0.325 p &lt; 0.000), 0.163 (CI 95 %; 0.124 - 0.218 p &lt; 0.000), 0.153 (CI 95 %; 0.074 - 0.194 p &lt; 0.000), 0.148 (CI 95 %; 0.046 - 0.150 p &lt; 0.000), and 0.062 (CI 95 %; 0.006 - 0.111 p &lt; 0.000) respectively. Median volume statistically decreased significantly p = 0.000. Both mean symptom and cosmetic scores showed significant improvements (p &lt; 0.001). All complications were also evaluated during the follow-up. Conclusion: Thyroid RF ablation is an effective and safe treatment modality in patients with benign thyroid nodules. RF ablation may be as effective as surgery if it is performed by experienced physicians in optimally selected patients.

Radiofrequency Ablation of Benign Thyroid Nodules: Initial Review with Clinical Experience in Singapore

Introduction: Up to half of the population may have benign thyroid nodules, and currently surgery is still the mainstay for treatment. However, minimally invasive approaches such as radiofrequency ablation (RFA) have been emerging in clinical practice in recent years. The purpose of this study is to investigate the safety and efficacy of RFA in treating benign thyroid nodules in our local population in Singapore. Methods: This retrospective study included a cohort of 22 patients (17 female, 5 male), who underwent RFA for benign thyroid nodules at our institute in Singapore, between March 2016 and May 2018. Initial assessment was carried out by ultrasound scanning, to measure pre-RFA nodule diameters, and fineneedle aspiration cytology, to confirm the nodules are histologically benign. Final nodule diameters and post-procedural complications were recorded at 12-months follow-up for all patients. The primary outcome was to investigate a reduction in nodule size, post RFA. The secondary outcome was to investigate any complications/adverse effects up to 12 months post-RFA.

Conditional sanctioning in a legume–Rhizobium mutualism

Legumes are high in protein and form a valuable part of human diets due to their interaction with symbiotic nitrogen-fixing bacteria known as rhizobia. Plants house rhizobia in specialized root nodules and provide the rhizobia with carbon in return for nitrogen. However, plants usually house multiple rhizobial strains that vary in their fixation ability, so the plant faces an investment dilemma. Plants are known to sanction strains that do not fix nitrogen, but nonfixers are rare in field settings, while intermediate fixers are common. Here, we modeled how plants should respond to an intermediate fixer that was otherwise isogenic and tested model predictions using pea plants. Intermediate fixers were only tolerated when a better strain was not available. In agreement with model predictions, nodules containing the intermediate-fixing strain were large and healthy when the only alternative was a nonfixer, but nodules of the intermediate-fixing strain were small and white when the plant was coinoculated with a more effective strain. The reduction in nodule size was preceded by a lower carbon supply to the nodule even before differences in nodule size could be observed. Sanctioned nodules had reduced rates of nitrogen fixation, and in later developmental stages, sanctioned nodules contained fewer viable bacteria than nonsanctioned nodules. This indicates that legumes can make conditional decisions, most likely by comparing a local nodule-dependent cue of nitrogen output with a global cue, giving them remarkable control over their symbiotic partners.

Case Report of Postpartum Thyroid Nodule Size Reduction

Abstract Introduction: Thyroid nodules are very common. They occur more commonly in women with an increased prevalence of thyroid nodules reported in pregnancy. Most thyroid nodules diagnosed during pregnancy are benign. Pregnancy causes major physiological changes including changes in the levels of thyroid hormones and the elevation of thyroid binding globulin. Thyroid nodules may also occur in people with abnormal thyroid function tests manifesting as hyperthyroidism or hypothyroidism. We present a unique case of a new diagnosis of a large thyroid nodule that has significantly decreased in size after 20 months postpartum. Case description: Patient is a 31 year old female with past medical history of anxiety and white coat hypertension who was diagnosed with a 3.3 x 2.3 x 2.1 cm thyroid nodule a month following delivery. Patient did not have any abnormalities in her thyroid function tests before, during, or after pregnancy. She remained euthyroid throughout the pregnancy and in the postpartum period. Fine needle aspiration biopsy of the nodule showed atypia of undetermined significance (Bethesda Category III). The specimen was further analyzed by afirma testing that confirmed benign pathology. Twenty months postpartum, the thyroid nodule significantly decreased in size to 1.9 x 1.4 x 1.2 cm. Conclusion: Thyroid hormone levels physiologically change during pregnancy and this may affect the growth of thyroid nodules. We just presented a patient who exhibited a significant decrease in the size of her thyroid nodule. Sahin et al. showed that while the size of the thyroid nodule increases during pregnancy the number of nodules remains unaffected. Kung et al. showed that pregnancy is associated with an increase in the size of preexisting thyroid nodules as well as the number of newly developed thyroid nodules. Vanucchi et al. showed that although the thyroid gland becomes larger, particularly in late pregnancy, the sizes of any preexisting thyroid nodules remained unchanged and patients’ thyroid gland size returned to normal after delivery. The current literature provides conflicting data on this topic. The true association between pregnancy and thyroid nodules is unknown. Contemporary literature is ambiguous on this topic and more scientific studies are required to find the true association between pregnancy, the formation of thyroid nodules, and increase in the size or number of thyroid nodules.

Cryoablation of goiter irrespective of thyroid profile

Abstract Background Thyroid nodules are extremely common. By age 60, about one-half of all people have a thyroid nodule. Cryoablation is used in a variety of clinical applications, using hollow needles (cryoprobes). Cryoprobes are inserted into or placed adjacent to diseased tissue which is desired to be ablated. Aim of work To evaluate the effect of Cryoablation on the size &amp; function of thyroid noduleWhich may replace the need for surgery or radiotherapy. Patients &amp; methods This is an interventional therapeutic study, conducted in Ain-Shams University hospitals; endocrinology clinic. Our study sample included 80 subjects, age between 20 &amp; 60, having thyroid nodule diagnosed by ultrasound. Subjects were divided into 2 groups: Group 1 included 40 subjects “control group” who were not subjected to cryoablation. Group 2 included 40 subjects “cases” upon which cryoablation was done. Neck ultrasound was done for subjects &amp; they were sampled for their TSH, free T4 &amp; free T3 levels at start and after 3 &amp; 6 months. Results There was high statistical significant difference between group 1 &amp; group 2 regarding nodule size after 6 months. Group 1 showed mean nodule size (0.89 cm ± 0.25 SD) while group 2 showed (0.62 cm ± 0.35 SD),(p-value&amp;lt;0.001). Non-thyrotoxic cases were 6 times more liable to show nodule size reduction, from 0-6 months, more than thyrotoxiccases, which shows thyrotoxicosis as a factor against nodule size reduction in significant statistical relation. Females were more liable than males, to show nodule size reduction. There was no statistical significant difference between cases &amp; controls regarding TSH, free T4 nor free T3 values, before study, at 3 months nor after 6 months. Conclusions Cryoablation causes nodule size reduction, especially after 2nd session. Cryoablation doesn’t affect thyroid function tests, all through our study.

Non-Surgical and Non-Radioiodine Techniques for Ablation of Benign Thyroid Nodules: Consensus Statement and Recommendation.

Thyroid nodules and cysts are frequently diagnosed in Germany with a prevalence of about 20% in young adults reaching up to 70% in older adults. Surgery is the standard treatment of symptomatic nodules, nodules with suspicion of malignancy and thyroid cancer. Radioiodine treatment is applied for autonomously functioning nodules. During the last years new non-surgical and non-radioiodine techniques have been introduced to treat thyroid nodules. These techniques include ethanol/polidocanol treatment, radiofrequency, microwave, and laser ablation, and high frequency ultrasound ablation. A significant reduction in nodule size could be documented for these techniques in several studies, but long-term outcome data are missing. Until now, there is no general consensus regarding the appropriate indications for these methods. For this reason, the Thyroid Section (German Society for Endocrinology), the Thyroid Working Committee (German Society for Nuclear Medicine), and the German Association of Endocrine Surgeons (CAEK) for the German Society of General and Visceral Surgery (DGAV) reviewed the respective literature, discussed the pro and cons and developed a consensus statement and recommendation to help physicians and patients in their decision making.

Correction: DNA plasmid coding for Phlebotomus sergenti salivary protein PsSP9, a member of the SP15 family of proteins, protects against Leishmania tropica

[This corrects the article DOI: 10.1371/journal.pntd.0007067.].

DNA plasmid coding for Phlebotomus sergenti salivary protein PsSP9, a member of the SP15 family of proteins, protects against Leishmania tropica.

BackgroundThe vector-borne disease leishmaniasis is transmitted to humans by infected female sand flies, which transmits Leishmania parasites together with saliva during blood feeding. In Iran, cutaneous leishmaniasis (CL) is caused by Leishmania (L.) major and L. tropica, and their main vectors are Phlebotomus (Ph.) papatasi and Ph. sergenti, respectively. Previous studies have demonstrated that mice immunized with the salivary gland homogenate (SGH) of Ph. papatasi or subjected to bites from uninfected sand flies are protected against L. major infection.Methods and resultsIn this work we tested the immune response in BALB/c mice to 14 different plasmids coding for the most abundant salivary proteins of Ph. sergenti. The plasmid coding for the salivary protein PsSP9 induced a DTH response in the presence of a significant increase of IFN-γ expression in draining lymph nodes (dLN) as compared to control plasmid and no detectable PsSP9 antibody response. Animals immunized with whole Ph. sergenti SGH developed only a saliva-specific antibody response and no DTH response. Mice immunized with whole Ph. sergenti saliva and challenged intradermally with L. tropica plus Ph. sergenti SGH in their ears, exhibited no protective effect. In contrast, PsSP9-immunized mice showed protection against L. tropica infection resulting in a reduction in nodule size, disease burden and parasite burden compared to controls. Two months post infection, protection was associated with a significant increase in the ratio of IFN-γ to IL-5 expression in the dLN compared to controls.ConclusionThis study demonstrates that while immunity to the whole Ph. sergenti saliva does not induce a protective response against cutaneous leishmaniasis in BALB/c mice, PsSP9, a member of the PpSP15 family of Ph. sergenti salivary proteins, provides protection against L. tropica infection. These results suggest that this family of proteins in Ph. sergenti, Ph. duboscqi and Ph. papatasi may have similar immunogenic and protective properties against different Leishmania species. Indeed, this anti-saliva immunity may act as an adjuvant to accelerate the cell-mediated immune response to co-administered Leishmania antigens, or even cause the activation of infected macrophages to remove parasites more efficiently. These findings highlight the idea of applying arthropod saliva components in vaccination approaches for diseases caused by vector-borne pathogens.

Cryoablation of goiter irrespective of thyroid profile

Introduction: Thyroid nodules (TNs) are extremely common and most of them are benign in nature. Cryoablation is used in a variety of clinical applications, and has been applied in focal treatment as a substitute or an adjunct to surgery and other nonoperative modalities. Objectives: The objective is to evaluate the effect of cryoablation on the size and function of TN. Subjects and Methods: This was an interventional therapeutic study, conducted at endocrinology clinic, Ain Shams University Hospitals. Our study sample included 80 participants, aged between 20 and 60 years, having TN diagnosed by ultrasound (US). The participants were divided into two groups: Group 1 (control group) included 40 participants who were not subjected to cryoablation and Group 2 (cases) included 40 participants upon which cryoablation was done. Neck US was done for participants and they were sampled for their thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free tetraiodothyronine (FT4) levels at start and after 3 and 6 months. Results: There was a high statistically significant difference between Group 1 and Group 2 regarding nodule size after 6 months (0.87 ± 0.25 cm vs. 0.67 ± 0.21 cm, respectively, P Conclusions: Cryoablation causes nodule size reduction, while it does not affect thyroid function tests.

Cryoablation of goiter irrespective of thyroid profile

Introduction: Thyroid nodules (TNs) are extremely common and most of them are benign in nature. Cryoablation is used in a variety of clinical applications, and has been applied in focal treatment as a substitute or an adjunct to surgery and other nonoperative modalities. Objectives: The objective is to evaluate the effect of cryoablation on the size and function of TN. Subjects and Methods: This was an interventional therapeutic study, conducted at endocrinology clinic, Ain Shams University Hospitals. Our study sample included 80 participants, aged between 20 and 60 years, having TN diagnosed by ultrasound (US). The participants were divided into two groups: Group 1 (control group) included 40 participants who were not subjected to cryoablation and Group 2 (cases) included 40 participants upon which cryoablation was done. Neck US was done for participants and they were sampled for their thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free tetraiodothyronine (FT4) levels at start and after 3 and 6 months. Results: There was a high statistically significant difference between Group 1 and Group 2 regarding nodule size after 6 months (0.87 ± 0.25 cm vs. 0.67 ± 0.21 cm, respectively, P Conclusions: Cryoablation causes nodule size reduction, while it does not affect thyroid function tests.

Which needle in the treatment of thyroid nodules?

Thyroid nodules are a common finding in general population, with a prevalence of 20% to 70% at ultrasound (US) examination. Many of them are benign but treatment can be necessary to relief compressive symptoms. In the last years, percutaneous ablations have achieved amazing development in the treatment of thyroid nodules as they provide a minimally invasive but effective approach. We aimed to summarize the main aspects related to treatment of thyroid nodules with radiofrequency ablation (RFA), focusing on the use of different types of needles. A narrative review was performed and all papers analyzed reported good results in terms of nodule's size reduction and symptoms relief. No major complications have been reported, even though needles of bigger size seemed related with major risks of post-procedural local edema. Thus, thinner internally cooled multi tined needles [18-19 Gauge (G)] rather than larger needles (14 G) seem to have better results and less complications.

Early Results of Radiation Therapy for Palmar Fibromatosis

To investigate clinical outcomes and patient satisfaction following radiotherapy (RT) for early stage palmar fibromatosis (Dupuytren’s Contracture). Thirteen patients (22 hands) were treated at our institution from 2015 to 2016 for early stage, progressive palmar fibromatosis (PF). Initial assessment included time course and severity of disease, previous interventions, and pertinent risk factors. Measurements were obtained for nodules, cords, and flexion deformities noted on physical exam. Patients were clinically reassessed 3 months following RT, and standardized patient satisfaction surveys were completed at that time. The treatment field included the palpable disease sites with a margin of 1.5 - 2.0 cm. Patients were treated with 6 MeV en-face electrons with 0.5 cm bolus. All patients received a split course of radiation therapy, consisting of 30 Gy in 10 fractions with a break of 6-12 weeks after 15 Gy. Acute and chronic toxicities were evaluated per the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. All 13 patients completed treatment according to protocol without delay, and all patients were assessed 3 months following RT. At that time, 95% of patients experienced either a reduction in nodule size or stability in nodule size, and all patients experienced reduced cord size or halted progression of cord growth. All patients reported an improvement in quality of life and all patients would recommend the treatment to another. Patients’ reported improvement in symptoms and ability to function averaged 8.9 out of 10. No CTCAE Grade 2 or higher toxicities were noted in any patient. In our analysis of patients treated at this institution, we achieved excellent early local control rates comparable to published data with minimal adverse effects. Long-term follow-up should be maintained to assess rates of long-term disease control, and additional patient accrual will be considered to expand the cohort.

High-Intensity Focused Ultrasound for Treatment of Symptomatic Benign Thyroid Nodules: A Prospective Study.

Purpose To evaluate first-year efficacy and changes in pressure symptoms and health-related quality of life (HRQOL) after ultrasonographically (US) guided high-intensity focused ultrasound (HIFU) ablation of symptomatic benign thyroid nodules. Materials and Methods After ethics approval and informed consent were obtained, a prospective trial was conducted. Patients with a symptomatic benign thyroid nodule were given a choice of HIFU treatment or active surveillance. Clinical and US examinations, pressure symptom scores (visual analog scale), and HRQOL questionnaires (short form-12 survey) were evaluated at baseline and at 3, 6, and 12 months. The primary outcome was change in nodule volume after 12 months. The percentage of change in nodule volume was defined as the baseline volume minus the volume at 12 months divided by the baseline volume times 100. Ablation success was defined as a reduction in volume of greater than 50%. Nodule volume was compared by using the paired t test. Continuous variables were compared by using the Mann-Whitney U test, and categorical variables were compared by using χ2 tests. Results Twenty-two patients underwent HIFU and 22 underwent active surveillance. Mean age was 53.11 years (range, 28-76 years) and 55.19 years (range, 41-70 years), respectively. The ratio of men to women was 2:20 and 1:21, respectively. The 12-month mean volume reduction ± standard deviation in the HIFU group was significant (68.87% ± 15.27 [range, 47.35%-94.89%], P < .001) but not in the surveillance group (-2.11% ± 6.29 [range, -15.64% to 12.70%], P > .05). Preablation nodule volume was the only determinant of ablation success (odds ratio, 1.877; 95% confidence interval [CI]: 1.085, 3.249; P = .024). At 12 months, patients in the HIFU group had less swelling (P < .001), lower pressure symptom scores (P < .001), and higher physical composite scores (P = .006). Physical composite scores significantly correlated with 6-month reduction in nodule size (r = 0.768; 95% CI: 0.660, 0.930; P < .001) and 12-month reduction in nodule size (r = 0.704; 95% CI: 0.680, 940; P < .001). Conclusion HIFU ablation of symptomatic benign thyroid nodules not only induced significant shrinkage but also improved pressure symptom scores and HRQOL throughout a 12-month period. © RSNA, 2017.

Influence of clay mineral structure and polyamide polarity on the structural and morphological properties of clay polypropylene/polyamide nanocomposites

The influence of the clay mineral structure and of the polyamide dispersed phase polarity on the structure and morphology of polypropylene/polyamide blends filled with clay mineral nanoparticles was investigated. Two polyamides (PA) were used: a polar PA6 and a less polar PA12. The clay mineral nanofillers used were either organically modified montmorillonite (Mt) or synthetic talc (ST), having preferential affinity towards PA dispersed phase. For all clay polymer nanocomposites (CPN), a decrease of PA nodule size was observed. However, the mechanisms governing the morphology establishment were shown to depend mainly on the clay structure, and also on the polyamide polarity. Mt nanoparticles were shown to be mostly located at the interface, forming a nanocomposite interphase. The decrease of PA nodule size induced by Mt nanoparticles was attributed to coalescence inhibition by steric repulsions, mediated by the interphase, which is more developed in the case of PA6. Besides, the interphase was shown to play a key role in the change from a nodular to a non-nodular morphology, even at low Mt fractions. ST particles were shown to be exclusively dispersed within PA nodules. In this case, nodule size reduction was attributed to the presence of some larger ST particles, exhibiting numerous structural defects, which favor the nodule break-up, especially in the case of PA12.

Radiofrequency ablation for thyroid nodules: which indications? The first Italian opinion statement.

Nodular thyroid disease is a very common finding in clinical practice, discovered by ultrasound (US) in about 50 % of the general population, with higher prevalence in women and in the elderly [1–4]. Whereas therapeutic flowchart is quite established and shared for malignant lesions, multiple options are now available for patients presenting with benign thyroid nodules, ranging from simple clinical and US follow-up to thyroid surgery. The majority of thyroid nodules, benign by fine-needle aspiration, are asymptomatic, stable, or slow-growing over time and require no treatment. Nevertheless, large thyroid nodules may become responsible for pressure symptoms, resulting in neck discomfort, cosmetic complaints, and decreased quality of life. Partial/total thyroid surgery has so far constituted the only therapeutic approach for these. Although surgery is widely available, highly effective, and safe in skilled centers, complications (both temporary and permanent) still occur in 2–10 % of cases [5, 6]. Hypothyroidism is an unavoidable effect after total thyroidectomy, requiring lifelong l-thyroxine replacement therapy. Besides, surgery is expensive and may be not recommended for high-risk patients or refused by others. Radioiodine (131I) therapy has been proven to be effective to treat toxic multinodular goiters and autonomously functioning thyroid nodules (AFTN) [7], although they are usually more radioresistant than toxic diffuse goiters [8]. Radioiodine therapy normalizes thyroid function and significantly reduces thyroid volume. However, hypothyroidism often occurs, in up to 60 % of patients, several years after treatment [9]. Otherwise, radioiodine therapy shows only incomplete, weak effects in nonfunctioning cold thyroid nodules. Pretreatment with recombinant human TSH may improve goiter volume reduction by causing a more homogeneous distribution of radioiodine within the gland, especially increasing the uptake of 131I in scintigraphically relatively cold areas [10]. TSH-suppression therapy withl-thyroxine was widely used to achieve nodule shrinkage and to prevent nodule growth and formation, producing, however, controversial results and exposing patients to heart and bone side effects. Therefore, current guidelines do not recommend its routine use in clinical practice, suggesting its usefulness in some cases only [3, 4]. Over the last two decades, nonsurgical, minimally invasive, US-guided techniques have been proposed for the treatment of thyroid nodules [11–16]. Percutaneous ethanol injection (PEI) is recommended for the treatment of relapsing cysts and dominantly cystic thyroid nodules [17]. Because of the limitations of PEI in the management of solid thyroid nodules, hyperthermic methods (laser ablation and radiofrequency ablation) have been introduced afterward for the treatment of solid, benign thyroid lesions [18], achieving marked nodule size reduction and clinical improvement in nodule-related symptoms, in several series from skilled centers, especially in Korea and Italy. Other nonsurgical therapies, such as high-intensity focused-ultrasound (HIFU), microwaves, cryotherapy, and electroporation, are presently under investigation.

Mogu li lekovi da smanje tiroidne noduse?

Although the good effects of applying thyroid gland extracts in treating goiters were noticed more than a century ago, the justification of TSH suppressive therapy in treating benign thyroid nodules is still controversial. Because of the lack of evidence of its beneficial therapeutical efficiency, it is possibile to apply L-thyroxine in only selected cases. This attitude is supported by the fact that, up to now, only the patients with the diffuse, diffuse-nodular and multinodular goiters, from the areas with various iodine intake, were included into studies. The achieved size regression, defined as a successful curing, was in the ratio up to ~50%, the better results being achieved in curing diffuse multinodular goiters. On the other hand, the reports from several randomized trials lead to the conclusion that a short-term application of L-thyroxine in solitary nontoxic thyroid nodules does not have an advantage over the placebo. The aplication of iodine is equally efficient as the suppression by L-thyroxine, but it was practically abandoned because of the side effects. If treating by L-thyroxine is the choice, the dose of the given drug should be the one necessary to supress the level of TSH from 0,1 to 0,3 mU/L. The treating period should be from 6 to 12 months. A long-term therapy is reserved only for the cases where the nodule size reduction has been confirmed by echotomography. But note that there is a possibility of osteoporosis in postmenopausal women, as well as of cardiac complications in elderly. Percutaneous ethanol injection into benign solitary cold nodules, as well as iodine therapy following the applicacion of a recombinat humane TSH in benign nontoxic multinodular goiters, are the ways of curing that promise, but a more solid evidence is necessary for their broader therapeutical application.

Knockdown of LjALD1, AGD2‐like defense response protein 1, influences plant growth and nodulation in Lotus japonicus

The discovery of the enzyme L,L-diaminopimelate aminotransferase (LL-DAP-AT, EC 2.6.1.83) uncovered a unique step in the L-lysine biosynthesis pathway in plants. In Arabidopsis thaliana, LL-DAP-AT has been shown to play a key role in plant-pathogen interactions by regulation of the salicylic acid (SA) signaling pathway. Here, a full-length cDNA of LL-DAP-AT named as LjALD1 from Lotus japonicus (Regel) Larsen was isolated. The deduced amino acid sequence shares 67% identity with the Arabidopsis aminotransferase AGD2-LIKE DEFENSE RESPONSE PROTEIN1 (AtALD1) and is predicted to contain the same key elements: a conserved aminotransferase domain and a pyridoxal-5'-phosphate cofactor binding site. Quantitative real-time PCR analysis showed that LjALD1 was expressed in all L. japonicus tissues tested, being strongest in nodules. Expression was induced in roots that had been infected with the symbiotic rhizobium Mesorhizobium loti or treated with SA agonist benzo-(1, 2, 3)-thiadiazole-7-carbothioic acid. LjALD1 Knockdown exhibited a lower SA content, an increased number of infection threads and nodules, and a slight reduction in nodule size. In addition, compared with wild-type, root growth was increased and shoot growth was suppressed in LjALD1 RNAi plant lines. These results indicate that LjALD1 may play important roles in plant development and nodulation via SA signaling in L. japonicus.