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A spectroscopic study of the binary Wolf–Rayet (WR)+O system WR 145 is performed, in order to determine the radial velocity orbits of the individual stars, the angle of orbital inclination and the stellar masses. The emission and absorption components are separated from the original spectra, allowing us to confirm the spectral classification WN 7o/CE of the hybrid WR component and to derive a spectral classification O7V((f)) for the O star. A study of the wind-collision properties is performed. Fitting the radial velocity and full width at half-maximum of the excess emission with Lührs’ model results in an inclination angle of , leading to estimates of the stellar masses: and . Both of these masses are compatible with those of other stars of similar types. [ABSTRACT FROM AUTHOR]

Introduction. In our department the standard surgical procedure for multinodular goiter used to be subtotal resection. Over the years, total thyroidectomy has progressively replaced subtotal resections and is performed in most of our patients at present. Patients and Methods. In a prospective cohort, observational study, we assessed the immediate surgical outcome in 742 consecutive patients with multinodular goiter (MNG), admitted for surgery and operated in our hospital. Of all patients, 664 were women (89.5%) and 78 men (11.5%), aged 15 to 85 years, mean (±SD) of 48 ±13.8 years. Pathology was done on frozen and permanent sections. The complications directly related to surgery in subtotal thyroidectomy (STT) were compared to total thyroidectomy (TT) or near-total thyroidectomy (NTT) patients: temporary hypoparathyroidism, temporary RLN injury, permanent hypoparathyroidism and permanent RLN injury. The χ² test (95% confidence interval) was used and values of p<0.05 were considered significant. Results. There were no significant differences among the patients with SST for MNG, NTT or TT , and TT for recurrent MNG or completion thyroidectomy, with respect to temporary and permanent RLN injury. Significant differences were found for temporary hypoparathyroidism in STT for MNG (9 out of 361 patients, 2.45%) and NTT or TT for MNG (21 out of 266 cases, 7.89%) (p<0.01) and between STT for MNG (9 out of 361 cases, 2.45%) and TT for recurrent MNG for completion thyroidectomy (8 out of 45 cases, 17.77%) (p<0.01) and no difference between NTT or TT for MNG (21 out of 266 cases, 7.89%) and TT for recurrent MNG or completion thyroidectomy (8 out of 45 cases, 17.77%) (p=0.11). We registered no permanent hypoparathyroidism in our patients. Conclusions. Total thyroidectomy is now the preferred option for the management of patients with bilateral benign MNG. However, TT is associated with a considerable rate of complications, higher than of STT. In patients with bilateral MNG and no malignancy, STT remains in our opinion, a valuable option. [ABSTRACT FROM AUTHOR]

Anorchia is a syndrome characterized by unilateral or bilateral absence of testicular tissue. At puberty, growth and development are normal but secondary sexual development fails to occur if anorchia is bilateral. We present the case of a 21 year-old male with a late diagnosis of bilateral anorchia. The diagnosis was suggested by a bilateral empty scrotum, in a patient with male phenotype and poor secondary sexual development and established by karyotype analysis, hormonal profile and surgical exploration. The lack of testosterone response to hCG stimulation is the hormonal hallmark of bilateral congenital anorchia. In the absence of any information about germinal cell presence, bilateral excision of the testicular nubbins, implantation of testicular prostheses and hormonal replacement therapy were indicated. [ABSTRACT FROM AUTHOR]

Introduction. Subtypes of nonfunctioning pituitary adenomas which may differentiate into functioning adenomas are silent corticotroph adenomas (SCA). These are pituitary tumors positive on immunohistochemical staining for ACTH, but without clinical evidence of Cushing's disease. Case report. FG, a 50 years old man was twice operated for compressive non secreting pituitary macroadenoma (NFPA). After the first surgery he developed hypopituitarism and needed replacement therapy for all the hormonal lines. After the second surgery he rapidly developed the clinical features of Cushing's syndrome. Hormonal dosages showed: the absence of the circadian rhythm of cortisol, high ACTH level and the lack of suppression at 1 mg overnight and high dose Dexamethasone suppression tests. The immunohistochemistry of the previously resected pieces confirmed the diagnosis of a silent corticotroph adenoma. The patient was referred for conventional antitumoral radiotherapy associated with Cabergoline, then with Ketoconazole treatment. As the high levels of cortisol recurred, he was subjected to bilateral adrenalectomy. Conclusions. We present the rare case of a silent corticotroph macroadenoma which became hypersecreting after two pituitary adenomectomies. SCA may represent another entity in the spectrum of Cushing's syndrome that must be evoked in the cases of pituitary macroadenomas thought to be non-functional. [ABSTRACT FROM AUTHOR]

Introduction. McCune-Albright syndrome (MAS) is a noninherited, genetic condition defined by the clinical triad: polyostotic fibrous dysplasia (FD), café-aulait skin spots and different hyper functioning endocrinopathies. Case presentation. The patient, a 39-year-old female previously diagnosed with MAS, presented with severe, left-sided skeletal pain and accentuated asymmetrical facial features. Although there were no clinical signs (except type II diabetes) the hormonal dosages revealed GH hypersecretion and ACTH-independent hypercortisolism. CT revealed a pituitary microadenoma, severe craniofacial hyperostosis and left-side macronodular adrenal hyperplasia. The modified bone anatomy rendered the surgical adenomectomy impossible, whereas radiotherapy was not an option due to the increased risk of sarcomatous transformation of FD; therefore somatostatin analogues were used. Cushing syndrome was cured by left adrenalectomy. For the facial dysmorphism, surgical cure was proposed. Conclusion. We report the case of an adult female with MAS associating both acromegaly and Cushing syndrome, the MAS-Cushing syndrome association having been identified only in children up to present. The setting of a therapeutic strategy in these cases is difficult determined by the multiple concomitant tissue damage and by the limited number of therapeutic options available, not only for acromegaly, but also for pain management and the cure of bone deformities. [ABSTRACT FROM AUTHOR]

Liver failure due to acetaminophen intoxication is the cause to many deaths and life threatening conditions every year, due to the fact that it is still an over the counter drug. There are plants that contain the necessary principles to counteract the toxic effect of acetaminophen and one of these are known in traditional medicine to be the gentian (Gentiana asclepiadea). The objective of this study was to demonstrate the hepatoprotective and antimicrobial effects of this gentian. For this we extracted the active principles in ethanol and analyzed it using a gas spectrometer coupled with a mass spectrometer, administered the extracts to mice, and conducted liver transaminases analysis, histology and ultrastructural analyses of the liver, GC-MS analysis of the extracts, and microbiology tests against a number of pathological strains. Our results show that the ethanolic extract of G. asclepiadea has a slight hepatoprotective effect, seen on both the enzyme analysis where it reduced the ALT and AST in comparison to the intoxicated group, and the histology and ultrastructure analyses both show a decrease in cellular degradation comparing to the intoxicated mice. The microbiology analysis shows that it produces a sensibility for Ps. aeruginosa, E. faecalis B. subtilis and C. albicans. [ABSTRACT FROM AUTHOR]

Background/Objectives : Pyoderma gangrenosum (PG) is a rare, autoimmune skin condition characterized by painful, rapidly progressing ulcers, often associated with autoimmune dysregulation. Managing PG following breast surgery presents unique challenges due to its pathergy phenomenon, which complicates surgical interventions. This article outlines the case of PG in a 48-year-old female post-breast surgery and reviews management strategies through a systematic analysis of the literature. Methods: A systematic literature review from 2018 to 2023 identified 24 relevant articles on PG management post-breast surgery. The studies were analyzed to compare the efficacy and complications of conservative versus combined (conservative and surgical) treatment strategies. Results: Results indicate that while conservative management, primarily with corticosteroids, remains preferred, combined strategies, including systemic therapies, vacuum-assisted closure, and surgery, offer significant benefits in select cases. Conclusions: Our findings suggest that a personalized, multifaceted treatment plan is crucial for managing PG effectively, emphasizing the need for early detection, meticulous planning, and comprehensive care to optimize patient outcomes.

Background and Aims: To evaluate the performance of magnetic resonance imaging (MRI) in restaging locally advanced rectal cancers (LARC) after neoadjuvant chemoradiotherapy (nCRT), with pathologic correlation., Methods: 80 patients with LARC treated with neoadjuvant therapy, with restaging MRI and surgery, were enrolled and prospectively reviewed. The diagnostic accuracy of the restaging MRI was assessed for tumor (ymrT), nodal status (ymrN), circumferential resection margin (ymrCRM), extramural vascular invasion (ymrEMVI) and tumoral deposits (ymrN1c) by calculating the sensitivity (Se), specificity (Sp), negative predictive values (NPV) and positive predictive values (PPV). Response to treatment was classified as good response (complete/near complete) vs. poor response (poor/partial response). The agreement between the tumor regression grade at MRI (mrTRG) and pathology (pTRG) was reported, as well the performance of mrTRG to identify good responders. The correlation between restaging MRI and histopathology was assessed by Spearman correlation coefficient., Results: The MRI accuracy ranged between 63.8% and 92.5% for T stage and was 81.3% for N stage. All MRI parameters evaluated at restaging were statistically significant correlated with histopathology evaluation, but EMVI. There was moderate correlation for N and N1c and a positive strong correlation for T, CRM and TRG (Spearman correlation coefficient of 0.390 for mrN1c-pN1c, 0.428 for mrN-pN, 0.522 for mrCRM-pCRM, 0.550 for mrT-pT and 0.731 for mrTRG-pTRG). Diagnostic accuracy of anal sphincter invasion was 91.3%, with a negative predictive value (NPV) of 100%. Accuracy rate varied between 70% for partial response to 93.75% for complete response after nCRT., Conclusions: MR imaging had good accuracy in restaging LARCs after nCRT. Our results showed high MRI accuracy in detecting anal sphincter involvement for low rectal tumors, with high NPV to exclude tumoral invasion. Restaging MRI predicted well the tumor regression grade, with good diagnostic performance in differentiating good responders from poor/partial responders. The accuracy was high for detecting complete response.

Residency training in medicine lays the foundation for future medical doctors. In real-world settings, training centers face challenges in trying to create balanced residency programs, with cases encountered by residents not always being fairly distributed among them. In recent years, there has been a tremendous advancement in developing artificial intelligence (AI)-based algorithms with human expert guidance for medical imaging segmentation, classification, and prediction. In this paper, we turned our attention from training machines to letting them train us and developed an AI framework for personalised case-based ophthalmology residency training. The framework is built on two components: (1) a deep learning (DL) model and (2) an expert-system-powered case allocation algorithm. The DL model is trained on publicly available datasets by means of contrastive learning and can classify retinal diseases from color fundus photographs (CFPs). Patients visiting the retina clinic will have a CFP performed and afterward, the image will be interpreted by the DL model, which will give a presumptive diagnosis. This diagnosis is then passed to a case allocation algorithm which selects the resident who would most benefit from the specific case, based on their case history and performance. At the end of each case, the attending expert physician assesses the resident's performance based on standardised examination files, and the results are immediately updated in their portfolio. Our approach provides a structure for future precision medical education in ophthalmology.

Aim: Parathyroid carcinoma (PC) is a rare endocrine malignancy that represents 0.005% of all malignant tumors. Associated PC and differentiated thyroid carcinoma (DTC) is an exceptionally rare condition, and the preoperative diagnostics and proper treatment are challenging. Almost all PCs and the majority of DTCs are diagnosed postoperatively, making correct surgical treatment questionable. Specific guidelines for parathyroid and thyroid carcinomas association treatment are lacking. The purposes of our study were to identify the association between parathyroid and thyroid carcinomas, to analyze the available published data, and to evaluate the possible relationship between preoperative diagnostic and surgical decision-making, and outcome-related issues. Material and methods: We performed a literature review of several databases from the earliest records to March 2022, using controlled vocabulary and keywords to search for records on the topic of PC and WDTC pathological association. The reference lists from the initially identified articles were analyzed to obtain more references. Results: We identified 25 cases of PC and DTC association, 14 more than the latest review from 2021. The mean age of patients was 55, with a female to male ratio of about 3:1. Exposure to external radiation was identified in only one patient, although it is considered a risk factor the development of both PC and DTC. The preoperative suspicion of PC was stated by the authors in only 25% of cases, but suspicion based on clinical, laboratory, ultrasound (US), and fine needle aspiration (FNA) criteria could have been justified in more than 50% of them. With neck ultrasound, 40% of patients presented suspicious features both for PC and thyroid carcinoma. Intra-operatory descriptions of the lesions revealed the highest suspicion (83.3%) of PC, but en bloc resection was recommended and probably performed in only about 50% of the cases. Histopathological examinations of the thyroid revealed different forms of papillary thyroid carcinoma (PTC) in most cases. Postoperative normocalcemia was achieved in 72% of patients, but follow-up data was missing in about 25% of cases. Conclusion: Associated PC and DTC is an exceptionally rare condition, and the preoperative diagnostic and treatment of the patients is a challenge. However, in most cases pre- and intraoperative suspicious features are present for identification by a highly specialized multidisciplinary endocrine team, who can thus perform the optimal treatment to achieve curability.

Renal cancer (RC) represents 3% of all cancers, with a 2% annual increase in incidence worldwide, opening the discussion about the need for screening. However, no established screening tool currently exists for RC. To tackle this issue, we assessed surface-enhanced Raman scattering (SERS) profiling of serum as a liquid biopsy strategy to detect renal cell carcinoma (RCC), the most prevalent histologic subtype of RC. Thus, serum samples were collected from 23 patients with RCC and 27 controls (CTRL) presenting with a benign urological pathology such as lithiasis or benign prostatic hypertrophy. SERS profiling of deproteinized serum yielded SERS band spectra attributed mainly to purine metabolites, which exhibited higher intensities in the RCC group, and Raman bands of carotenoids, which exhibited lower intensities in the RCC group. Principal component analysis (PCA) of the SERS spectra showed a tendency for the unsupervised clustering of the two groups. Next, three machine learning algorithms (random forest, kNN, naïve Bayes) were implemented as supervised classification algorithms for achieving discrimination between the RCC and CTRL groups, yielding an AUC of 0.78 for random forest, 0.78 for kNN, and 0.76 for naïve Bayes (average AUC 0.77 ± 0.01). The present study highlights the potential of SERS liquid biopsy as a diagnostic and screening strategy for RCC. Further studies involving large cohorts and other urologic malignancies as controls are needed to validate the proposed SERS approach.

In this study we aimed to compare the mineralogical, thermal, physicochemical, and biological characteristics of recent organic carbon-rich sediments ('sapropels') from three geographically distant Romanian lakes (Tekirghiol and Amara, SE Romania, and Ursu, Central Romania) with distinct hydrogeochemical origins, presently used for pelotherapy. The investigated lakes were classified as inland brackish Na-Cl-sulfated type (Amara), coastal moderately saline and inland hypersaline Na-Cl types (Tekirghiol and Ursu, respectively). The settled organic matter is largely composed of photosynthetic pigments derived from autochthonous phytoplankton. Kerogen was identified in the sapropel of coastal Tekirghiol Lake suggesting its incipient maturation stage. The mineral composition was fairly similar in all sapropels and mainly consisted of quartz, calcite, and aragonite. Smectite, illite, mixed layer smectite/illite appeared as major clay components. Potentially toxic elements were found in low concentrations. The physical properties (i.e., specific heat, thermal conductivity and retentivity) and cation exchange capacity are comparable to other peloids used for therapy. This study is the first comprehensive multi-approached investigation of the geochemical nature of recent sapropels in Romanian saline lakes and thus contributes to expanding our knowledge on the origin and physicochemical qualities of organic matter-rich peloids with therapeutic uses., (© 2021. The Author(s).)

Ursu Lake is located in the Middle Miocene salt deposit of Central Romania. It is stratified, and the water column has three distinct water masses: an upper freshwater-to-moderately saline stratum (0-3 m), an intermediate stratum exhibiting a steep halocline (3-3.5 m), and a lower hypersaline stratum (4 m and below) that is euxinic (i.e. anoxic and sulphidic). Recent studies have characterized the lake's microbial taxonomy and given rise to intriguing ecological questions. Here, we explore whether the communities are dynamic or stable in relation to taxonomic composition, geochemistry, biophysics, and ecophysiological functions during the annual cycle. We found: (i) seasonally fluctuating, light-dependent communities in the upper layer (≥0.987-0.990 water-activity), a stable but phylogenetically diverse population of heterotrophs in the hypersaline stratum (water activities down to 0.762) and a persistent plate of green sulphur bacteria that connects these two (0.958-0.956 water activity) at 3-3.5 to 4 m; (ii) communities that might be involved in carbon- and sulphur-cycling between and within the lake's three main water masses; (iii) uncultured lineages including Acetothermia (OP1), Cloacimonetes (WWE1), Marinimicrobia (SAR406), Omnitrophicaeota (OP3), Parcubacteria (OD1) and other Candidate Phyla Radiation bacteria, and SR1 in the hypersaline stratum (likely involved in the anaerobic steps of carbon- and sulphur-cycling); and (iv) that species richness and habitat stability are associated with high redox-potentials. Ursu Lake has a unique and complex ecology, at the same time exhibiting dynamic fluctuations and stability, and can be used as a modern analogue for ancient euxinic water bodies and comparator system for other stratified hypersaline systems., (© 2019 The Authors. Environmental Microbiology published by Society for Applied Microbiology and John Wiley & Sons Ltd.)

Selection and dissemination of resistant bacteria and antibiotic resistance genes (ARGs) require a deeper understanding since antibiotics are permanently released to the environment. The objective of this paper was to evaluate the phenotypic resistance of 499 isolates of Pseudomonas spp. from urban water sources, and the prevalence of 20 ARGs within those isolates. Resistance to penicillins, cephalosporins, carbapenems, quinolones, macrolides, and tetracyclines was mainly observed in the hospital effluent, municipal wastewater and river water downstream the city. Resistant strains were frequently identified as P. aeruginosa and P. putida. P. aeruginosa isolates were mostly resistant to cefepime, ceftazidime, imipenem, and gentamycin, while P. putida strains were especially resistant to piperacillin-tazobactam. ARGs such as bla TEM-1 , bla SHV-1 , bla PER-1 , bla AmpC , bla VIM-1 , PstS, qnrA, qnrB, ermB, tetA, tetB and tetC have been detected. The bla AmpC gene was found in P. aeruginosa, while bla TEM-1 and bla PER-1 genes were found in P. putida. Class 1 integron integrase gene was found in 6.81% of the Pseudomonas isolates.

Background and Purpose: To determine the diagnostic value of bright spotty lesions (BSLs) for aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (NMOSD AQP4+ ), the predictive value of axial-BSLs for AQP4-IgG seropositivity, and the radio-clinical differences in NMOSD AQP4+ patients with and without axial-BSLs., Materials and Methods: Retrospective study that included patients aged≥16 years, with a first acute spinal cord syndrome between 2005 and 2018 and abnormal spinal cord MRI with axial and sagittal T2 sequences. Patients with MRI findings consistent with compressive myelopathy were excluded. All spinal cord MRI were retrospectively evaluated for the presence of BSLs by 2 radiologists blinded to the diagnosis of acute myelopathy., Results: A total of 82 patients were included; 15 aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder patients (NMOSD AQP4+ ), and 67 other patients, considered as the other causes of myelopathy (OM) group. The specificity of axial-BSLs for NMOSD AQP4+ patients was 94.0% (95% CI [85.6 to 97.7]). The sensitivity was 40.0% (95% CI [19.8 to 64.3]). In the multivariable analysis, the only MRI characteristic associated with AQP4-IgG positivity was the presence of axial-BSLs (OR: 9.2, 95% CI [1.2 to 72.9]; P=0.022). In NMOSD AQP4+ patients, the median of cord expansion ratio was higher with axial-BSL (1.2, IQR [1.1-1.3]) than without axial-BSL (1.1, IQR [1.0-1.2]; P=0.046)., Conclusion: After a first acute spinal cord syndrome, the presence of axial-BSLs on spinal cord MRI seems very specific for NMOSD AQP4+ and seems to be a predictor radiological marker of AQP4-IgG positivity., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Purpose: The purpose of this study was to evaluate the accuracy of virtual planning using customized surgical devices (VP3D) in fibula free flap mandibular reconstruction., Methods: Fourteen patients received VP3D and 16 patients underwent conventional surgery (CS). Virtual planning was compared to postoperative scans using cephalometric and three-dimensional (3D) measurements. Operative times of both VP3D and CS groups were compared., Results: Comparisons of cephalometric measurements revealed no significant difference between virtual planning and postoperative scans. 3D analysis demonstrated a high level of virtual planning accuracy. In the VP3D group, total operative time gain was 88 min (p < 0.001) and total ischemia time gain was 36 min (p = 0.04)., Conclusion: Virtual surgical planning using customized devices enables 'tailored' surgery that is accurate and reliable and results in operative and ischemia time gain., Clinical Trial: NCT03869723.