Diagnostic Accuracy of Ultrasonography and Radiography in Initial Evaluation of Chest Trauma Patients

Introduction: Application of chest radiography for all multiple trauma patients is associated with a significant increase in total costs, exposure to radiation, and overcrowding of the emergency department. Ultrasound has been introduced as an alternative diagnostic tool in this regard. The aim of the present study is to compare the diagnostic accuracy of chest ultrasonography and radiography in detection of traumatic intrathoracic injuries. Methods: In the present prospective cross-sectional study, patients with traumatic intrathoracic injuries, who were referred to the emergency department from December 2013 to December 2014, were assessed. The patients underwent bedside ultrasound, radiographic and computed tomography (CT) scan examinations based on ATLS recommendations. Screening performance characteristics of ultrasonography and radiography were compared using SPSS 21.0. Chest CT scan was considered as gold standard. Results: 152 chest trauma patients with a mean age of 31.4 ± 13.8 years (range: 4 ‒ 67), were enrolled (77.6% male). Chest CT scan showed pulmonary contusion in 48 (31.6%) patients, hemothorax in 29 (19.1%), and pneumothorax in 55 (36.2%) cases. Area under the ROC curve of ultrasonography in detection of pneumothorax, hemothorax, and pulmonary contusion were 0.91 (95% CI: 0.86‒0.96), 0.86 (95% CI: 0.78‒0.94), and 0.80 (95% CI: 0.736‒0.88), respectively. Area under the ROC curve of radiography was 0.80 (95% CI: 0.736‒0.87) for detection of pneumothorax, 0.77 (95% CI: 0.68‒0.86) for hemothorax, and 0.58 (95% CI: 0.5‒0.67) for pulmonary contusion. Comparison of areas under the ROC curve declared the significant superiority of ultrasonography in detection of pneumothorax (p = 0.02) and pulmonary contusion (p < 0.001). However, the diagnostic value of the two tests was equal in detection of hemothorax (p = 0.08). Conclusion: The results of the present study showed that ultrasonography is preferable to radiography in the initial evaluation of patients with traumatic injuries to the thoracic cavity

On-levothyroxine measurement of thyroglobulin is not a reliable test for the follow-up of patients at high risk for remnant/recurrent differentiated thyroid carcinoma

Wstęp: Obecnie najszerzej akceptowanym narzędziem używanym w badaniach kontrolnych u chorych ze zróżnicowanym rakiem tarczycy jest pomiar osoczowego stężenia tyreoglobuliny (Tg). Nierzadko zdarza się, iż pomiary stężenia Tg odbywają się, gdy chory jednocześnie przyjmuje preparaty hormonów tarczycowych. Celem niniejszego badania była ocena przydatności pomiaru osoczowego stężenia Tg w trakcie stosowania hormonów tarczycy w wykrywaniu choroby resztkowej/nawrotowej lub obecności przerzutów u chorych z wysokim ryzykiem wznowy zróżnicowanego raka tarczycy. Materiały i metody: Retrospektywnej analizie poddano dokumentację medyczną 26 pacjentów obciążonych dużym ryzykiem wystąpienia zróżnicowanego raka tarczycy. Porównano wartości pomiarów osoczowego stężenia Tg odpowiednio w trakcie stosowania hormonów tarczycy oraz po ich odstawieniu. U wszystkich badanych wykluczono obecność przeciwciał przeciwko Tg. Przyjmując pomiary stężenia Tg w okresie odstawienia hormonów tarczycy jako "złoty standard", przeanalizowano (ustalając czułość, specyficzność oraz dodatnią i ujemną wartoœæ predylekcyjną) wyniki oznaczeń stężenia Tg podczas przyjmowania hormonów tarczycy pod kątem diagnostyki resztkowej/nawrotowej choroby. Wyniki: Średnie osoczowe stężenie Tg w warunkach stosowania terapii supresyjnej za pomocą podawanych egzogennych hormonów tarczycy wynosiło 16,5 ng/ml, natomiast po zaprzestaniu stosowania tyroksyny - 95,0 ng/ml (wartość p = 0,001). U 6 chorych (23%) przyjmujących hormony tarczycy stężenie Tg nie potwierdzało wznowy procesu nowotworowego. Przy założeniu, że pomiary stężenia Tg w okresie odstawienia hormonalnych preparatów tarczycy stanowią "złoty standard", czułość, specyficzność dodatnia i ujemna wartość predylekcyjna wynosiły odpowiednio: 72,7%, 100%, 100% i 40%. Wnioski: Monitorowanie stężenia Tg w trakcie terapii tyroksyną nie jest wiarygodną metodą w wykrywaniu wznowy choroby u chorych na zróżnicowanego raka tarczycy.Introduction: At present the most widely accepted tool for follow-up management of differentiated thyroid cancer (DTC) patients is serum thyroglobulin (Tg) measurement. It is not uncommon for the serum Tg level to be measured while the patient is taking thyroid hormones (on-treatment Tg measurement). The purpose of the study was to evaluate the accuracy of on-treatment measurement of serum Tg in detecting remnant/recurrent or metastatic disease in high-risk DTC patients. Material and methods: We retrospectively analysed the medical records of 26 high-risk DTC patients and compared the on-treatment and off-treatment Tg levels of these patients. All patients were anti-Tg negative. Using off-treatment measurement of Tg as the gold standard, the results of on-treatment measurement of Tg in the diagnosis of remnant/recurrent disease were analysed for sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV). Results: The median serum Tg level under thyroid hormone suppressive therapy (on-treatment Tg) was 16.5 ng/ml and after withdrawal of thyroid hormone suppressive therapy (off-treatment Tg) was 95.0 ng/ml (P value = 0.001). In 6 patients (23%) the on-treatment Tg level missed the recurrence of the disease. Regarding the off-treatment Tg as the gold standard, the sensitivity, specificity, PPV and NPV of the on-treatment Tg measurement were 72.7%, 100%, 100%, and 40% respectively. Conclusion: Normal serum Tg level without TSH-stimulation (on-treatment) is not diagnostically reliable in the follow-up of DTC patients with a high probability of residual/recurrent or metastatic disease

Neuroprotective effects of Cubebin and Hinokinin lignan fractions of Piper cubeba fruit in Alzheimer’s disease in vitro model

The current research examines the protective effects of the Piper cubeba ethanolic extract and its isolated lignans; Cubebin and Hinokinin fractions against Alzheimer’s Disease (AD) in vitro model

A comprehensive evaluation of the immune system response and type-I Interferon signaling pathway in hospitalized COVID-19 patients

Abstract Background The COVID-19 pandemic has become the world’s main life-threatening challenge in the third decade of the twenty-first century. Numerous studies have been conducted on SARS-CoV2 virus structure and pathogenesis to find reliable treatments and vaccines. The present study aimed to evaluate the immune-phenotype and IFN-I signaling pathways of COVID-19 patients with mild and severe conditions. Material and methods A total of 100 COVID-19 patients (50 with mild and 50 with severe conditions) were enrolled in this study. The frequency of CD4 + T, CD8 + T, Th17, Treg, and B lymphocytes beside NK cells was evaluated using flow cytometry. IFN-I downstream signaling molecules, including JAK-1, TYK-2, STAT-1, and STAT-2, and Interferon regulatory factors (IRF) 3 and 7 expressions at RNA and protein status were investigated using real-time PCR and western blotting techniques, respectively. Immune levels of cytokines (e.g., IL-1β, IL-6, IL-17, TNF-α, IL-2R, IL-10, IFN-α, and IFN-β) and the existence of anti-IFN-α autoantibodies were evaluated via enzyme-linked immunosorbent assay (ELISA). Results Immune-phenotyping results showed a significant decrease in the absolute count of NK cells, CD4 + T, CD8 + T, and B lymphocytes in COVID-19 patients. The frequency of Th17 and Treg cells showed a remarkable increase and decrease, respectively. All signaling molecules of the IFN-I downstream pathway and IRFs (i.e., JAK-1, TYK-2, STAT-1, STAT-2, IRF-3, and IRF-7) showed very reduced expression levels in COVID-19 patients with the severe condition compared to healthy individuals at both RNA and protein levels. Of 50 patients with severe conditions, 14 had anti-IFN-α autoantibodies in sera. Meanwhile, this result was 2 and 0 for patients with mild symptoms and healthy controls, respectively. Conclusion Our results indicate a positive association of the existence of anti-IFN-α autoantibodies and immune cells dysregulation with the severity of illness in COVID-19 patients. However, comprehensive studies are necessary to find out more about this context. Video abstrac