Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study

Background Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours.Methods In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186.Findings Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78 center dot 6%] female patients and 4922 [21 center dot 4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1 center dot 4 [IQR 0 center dot 6-3 center dot 4]) compared with the prepandemic phase (2 center dot 0 [0 center dot 9-3 center dot 7]; p<0 center dot 0001) and pandemic decrease phase (2 center dot 3 [1 center dot 0-5 center dot 0]; p<0 center dot 0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69 center dot 0%] of 3704 vs 1515 [71 center dot 5%] of 2119; OR 1 center dot 1 [95% CI 1 center dot 0-1 center dot 3]; p=0 center dot 042), lymph node metastases (343 [9 center dot 3%] vs 264 [12 center dot 5%]; OR 1 center dot 4 [1 center dot 2-1 center dot 7]; p=0 center dot 0001), and tumours at high risk of structural disease recurrence (203 [5 center dot 7%] of 3584 vs 155 [7 center dot 7%] of 2006; OR 1 center dot 4 [1 center dot 1-1 center dot 7]; p=0 center dot 0039).Interpretation Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation.Funding None.Copyright (c) 2023 Published by Elsevier Ltd. All rights reserved

Local taxonomy and terminology for some terrestrial arthropods in five different ethnic groups of Papua New Guinea and Central Australia

Volume: 58Start Page: 15End Page: 3

Therapeutic arthropods and other, largely terrestrial, folk-medicinally important invertebrates:a comparative survey and review

Abstract Traditional healing methods involving hundreds of insect and other invertebrate species are reviewed. Some of the uses are based on the tenet of “similia similibus” (let likes be cured by likes), but not all non-conventional health promoting practices should be dismissed as superstition or wishful thinking, for they have stood the test of time. Two questions are addressed: how can totally different organ systems in a human possibly benefit from extracts, potions, powders, secretions, ashes, etc. of a single species and how can different target organs, e.g. bronchi, lungs, the urinary bladder, kidneys, etc. apparently respond to a range of taxonomically not even closely related species? Even though therapeutically used invertebrates are generally small, they nevertheless possess organs for specific functions, e.g. digestion, gas exchange, reproduction. They have a nervous system, endocrine glands, a heart and muscle tissue and they contain a multitude of different molecules like metabolites, enzymes, hormones, neurotransmitters, secretions, etc. that have come under increased scientific scrutiny for pharmacological properties. Bearing that in mind it seems likely that a single species prepared and used in different ways could have a multitude of uses. But how, for example, can there be remedies for breathing and other problems, involving earthworms, molluscs, termites, beetles, cockroaches, bugs, and dragonflies? Since invertebrates themselves can suffer from infections and cancers, common defence reactions are likely to have evolved in all invertebrates, which is why it would be far more surprising to find that each species had evolved its own unique disease fighting system. To obtain a more comprehensive picture, however, we still need information on folk medicinal uses of insects and other invertebrates from a wider range of regions and ethnic groups, but this task is hampered by western-based medicines becoming increasingly dominant and traditional healers being unable and sometimes even unwilling to transmit their knowledge to the younger generation. However, collecting and uncontrolled uses of therapeutic invertebrates can put undue pressure on certain highly sought after species and this is something that has to be borne in mind as well

Electrophysiological and Histological Observations on the Eye of Adult, Female Diastylis rathkei (Crustacea, Malacostraca, Cumacea)

Volume: 175Start Page: 144End Page: 15

Light-induced photoreceptor sensitivity loss and recovery at 4°C and 14°C in

Specimens of Mysis relicta from Pojoviken Bay (Finland) were divided into two groups, one kept at 4°C, the other at 14°C, in total darkness. Immediately following a 1 h exposure to noon sunlight both 4°C and 14°C animals displayed strongly reduced visual sensitivities. In both groups pre-exposure levels were regained in about two days, but apparently along slightly different routes. Slopes of V/log I curves hardly changed throughout the time of observation in the 14°C material, suggesting an adaptation to brighter light levels without undue stress responses. In the 4°C animals, however, there appears to have been not only a longer initial delay before recovery commenced, but slopes of V/log I curves indicated that these animals had reacted with depression to the bright light and needed time to regain their pre-exposure value. The results suggest that recovery is a two-stage process in which biochemical reactions and structural phenomena interact. The results, when compared with similar observations on Lake Pääjärvi specimens, underline the view that different localities may have populations of Mysis relicta which differ from each other in photophysiological characteristics

The eye of Anoplognathus (Coleoptera, Scarabaeidae)

The night flying scarabaeid beetle Anoplognathus provides an example of a dark-adapted clear-zone compound eye in which rays from a distant point source, entering by a large patch of facets, are imperfectly focused upon the receptor layer. The optical system of the eye was investigated by six methods, all of which give similar results: (1) ray tracing through structures of known refractive index, (2) measurement of visual fields of single receptors, (3) measurement of the divergence of eyeshine, and (4) of the optomotor response to stripes of decreasing width, and (5) by direct observation of distribution of light within the eye. Finally (6) anatomically there is no single plane upon which an image could be focused. In each ommatidium, beneath the thick cornea, with its short corneal cone, lies a non-homogeneous crystalline cone (range of r. i. 1.442-1.365) that is significant in partially focusing rays across the wide clear zone (340 μm) in the dark-adapted eye. On the proximal side of the clear zone the rhabdoms form 7-lobed columns, isolated from each other over half their length by a tracheal tapetum. In the light-adapted eye the cone cells extend to form a crystalline tract (70-90 μm long) which is sur­rounded by dense pigment, and the optical path across the clear zone is completed by retinula cell columns that are of higher density than the surrounding cells. Pigment movement upon adaptation takes about 10 min to complete. Dark adaptation can be induced only at night on account of a strong diurnal rhythm. Eyeshine can be seen in the dark-adapted eye so long as the distal pig­ment leaves free the tips of the crystalline cones. Eyeshine falls to 50% at an angle of 12° from the direction of a parallel beam shining on the eye, as is consistent with a partial focus in which the distribution of light on the receptor layer is 18°-24° wide at the 50% contour. This distribution was confirmed by direct examination of the inside of the eye and by measure­ment of receptor fields as follows. The mean acceptance angle for 13 light-adapted units was 12.57° ± 1.97° s. d. and that of 10 dark-adapted ones 20.3° ± 3.36° s. d. The sensi­tivity to a point source on axis is increased at least 1000 fold by dark adaptation. Rays traced through a scale drawing of the eye, with refractive index measured for each component, show how the eye as a whole comes to be partially focused, and predicts an acceptance angle of 12° in the light-adapted and 20°-24° in the dark-adapted eye. In optomotor experiments dark-adapted Anoplognathus does not respond to stripes narrower than 18° repeat period, but light-adapted beetles respond down to 10°. The optomotor experiments also show a 1000 fold increase in sensitivity when dark-adapted at night. The eye has poor acuity that goes with wide visual fields of its recep­tors, and this is surprising when other excellently focused clear zone eyes are known. A possible compensation for the poor acuity is that the aperture of the eye can be larger, so that sensitivity although only to large objects, is that much increased