Objective Extensive bone defects remain a therapeutic challenge necessitating alternative surgical approaches with better outcomes. Can increase the effectiveness of PRP or EGF treatment in surgical treatment of large bone defects with Masquelet technique? Aim of this study examined potential therapeutic benefits of the Masquelet technique with induced membranes in combination with platelet-rich plasma (PRP) or epidermal growth factor (EGF) in a rat model of segmental femur defect. Methods Three groups each consisting of 20 Sprague-Dawley rats were defined as follows: EGF group, PRP group, and control group. A femoral bone defect was created and filled with antibiotic embedded polymethyl methacrylate. Half of the animals in each group were sacrificed at week 6 and the pseudo-membranes formed were analyzed. In the remaining half, the cement was removed and the space was filled with autograft. After another 6 weeks, the structures formed were examined radiologically, histologically, and biochemically. Results At week 6, both PRP and EGF groups had significantly higher membrane CD31, TGF-beta, and VEGF levels than controls. At week 12, when compared to controls, PRP and EGF groups had significantly higher membrane CD31 levels and the PRP group had significantly higher membrane TGF levels. Regarding bone tissue levels, PRP and EGF groups had significantly higher VEGF levels and the EGF group had significantly higher BMP levels. In addition, PRP and EGF groups had higher radiological scores than controls. However, the two experimental groups did not differ with respect to any parameter tested in this study. Conclusion Both PRP and EGF seem to be associated with histological, biochemical, and radiological improvements in experimental rat model of Masquelet technique, warranting in further clinical studies. Level of evidence Level 5

Background. Thyroid cancer is one of the most common cancers and is especially common in young patients. Therefore, effective recognition and treatment of thyroid cancer are essential for patient survival. Objectives.To compare the effectiveness of standard guidelines for predicting thyroid malignancy. To do so, thyroid nodules were classified according to the categories of the American Thyroid Association (ATA) and Thyroid Imaging Reporting and Data System (TI-RADS) guidelines, and compared with fine-needle aspiration biopsy (FNAB) results. Materials and methods.The study included 1741 thyroid nodules with a final diagnosis in 1121 consecutive patients. The FNAB was recommended for all patients according to ATA guidelines and subsequently performed. The nodules were reclassified according to TI-RADS guidelines. Results.Comparing nodules classified according to ATA and TI-RADS in terms of ultrasonography (US) features with the Bethesda cytological diagnosis classification System for Reporting Thyroid Cytopathology, 37.6% of the nodules classified in the high-risk category according to the ATA classification were found to be malignant cytology, 10.4% suspicious for malignancy, 4% non-diagnostic, 9.6% indeterminant cytology, and 38.4% benign. According to the TI-RADS risk category, 50% of those with high suspicion were malignant, 13.3% suspicious for malignancy cytology and 36.7% were benign. For the TI-RADS guidelines, the best cutoff value for differentiating benign and malignant nodules was found to be 4.5 (area under the curve (AUC) = 0.962, 95% CI = 0.943-0.981, p < 0.001). For the ATA guidelines, the best cutoff value for separating benign and malignant nodules was 4.5 (AUC = 0.917, 95% CI = 0.875-0.959, p < 0.001). The diagnostic performances of the TI-RADS and ATA score systems were evaluated using highly suspicious nodules. The sensitivity and specificity of highly suspicious nodules, according to both TI-RADS and ATA guidelines, were both high. Sensitivity and specificity of ATA classification were 80% and 96.3%, respectively. Sensitivity and specificity of TI-RADS classification were 76% and 97.5%, respectively, but positive predictive value was low (63.3% compared to 55.5%).Conclusions. Both, the ATA and TI-RADS classifications can effectively predict malignancy risk of thyroid nodules and may thus decrease unnecessary FNAB.

Pulmonary alveolar microlithiasis is a rare infiltrative pulmonary disease, in which intraalveolar accumulation of small stones (microliths) consisting of calcium phosphatite occurs. It is an autosomal recessive disorder. The disease occurs as a result of the disruption of type IIb sodium phosphate cotransporter in type II alveolar cells after the mutation of SLC34A2. Majority of patients are diagnosed between age 20 and 40. Here, we present a case of alveolar microlithiasis that was diagnosed with transbronchial biopsy.

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