Computer-aided diagnosis (CAD) and other risk stratification systems may improve ultrasound image interpretation. This prospective study aimed to compare the diagnostic performance of CAD and the European Thyroid Imaging Reporting and Data System (EU-TIRADS) classification applied by physicians with S-Detect 2 software CAD based on Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and combinations of both methods (MODELs 1 to 5). In all, 133 nodules from 88 patients referred to thyroidectomy with available histopathology or with unambiguous results of cytology were included. The S-Detect system, EU-TIRADS, and mixed MODELs 1–5 for the diagnosis of thyroid cancer showed a sensitivity of 89.4%, 90.9%, 84.9%, 95.5%, 93.9%, 78.9% and 93.9%; a specificity of 80.6%, 61.2%, 88.1%, 53.7%, 73.1%, 89.6% and 80.6%; a positive predictive value of 81.9%, 69.8%, 87.5%, 67%, 77.5%, 88.1% and 82.7%; a negative predictive value of 88.5%, 87.2%, 85.5%, 92.3%, 92.5%, 81.1% and 93.1%; and an accuracy of 85%, 75.9%, 86.5%, 74.4%, 83.5%, 84.2%, and 87.2%, respectively. Comparison showed superiority of the similar MODELs 1 and 5 over other mixed models as well as EU-TIRADS and S-Detect used alone (p-value < 0.05). S-Detect software is characterized with high sensitivity and good specificity, whereas EU-TIRADS has high sensitivity, but rather low specificity. The best diagnostic performance in malignant thyroid nodule (TN) risk stratification was obtained for the combined model of S-Detect (“possibly malignant” nodule) and simultaneously obtaining 4 or 5 points (MODEL 1) or exactly 5 points (MODEL 5) on the EU-TIRADS scale.

FIG 2: Metaphase spread with chromosome breaks (arrows), showing (a) a single break in an autosome and (b) three breaks, one in an X chromosome and two in autosomesPOLYMELIA is a rare congenital defect characterised by the presence of a supernumerary limb at different locations on the body. Depending on the body region, polymelia has been classified as notomelia, cephalomelia, thoracomelia and pygomelia (Kim and others 2001). The phenomenon of polymelia is usually associated with other congenital defects such as polydactyly (extra fingers or toes) or the presence of additional and often underdeveloped bones (Murondoti and Busayi 2001). In most cases, the extra limb is shorter and devoid of muscle tissue. The physiological attributes of the affected animal, including temperature, pulse and respiration rate, are usually normal (Hirsbrunner and others 2002). This short communication describes polymelia in a heifer, associated with frequent chromatid/chromosome breaks observed in lymphocytes cultured in vitro.A black-and-white heifer, genetically 62·5 per cent Holstein-Friesian, was born with four normal legs and one extra limb localised in a shoulder girdle between the scapulas. The supernumerary limb was smaller than the normal legs, was bent at the carpal joint and had a terminal hoof. It hung down on the left side of the animal (Fig 1a). The extra limb was attached to an underdeveloped additional scapula, which was connected to the thoracic vertebrae. The animal underwent surgery on two occasions at three and four months of age. During the first operation the additional leg was removed at the shoulder joint. During the second operation, which was performed due to unsuccessful wound healing, only a part of the extra scapula was removed at the neck of the scapula; the whole scapula was not removed due to the risk of injury to the vertebral column.The skeleton of the additional limb, according to anatomical nomenclature (Dyce and others 1987), consisted of the stylopodium (humerus), zeugopodium (radius and ulna) and autopodium, including the basipodium (carpal bones), metapodium (metacarpal bones) and acropodium (proximal, middle and distal phalanges) (Fig 1b). The stylopodium consisted of a single long bone with distinguishable epiphysial cartilage of the proximal epiphysis and three unfused skeletal elements that made up the metaphysis. The diaphysis of the stylopodium, near the epiphysis, was laterally flattened. The appearance of this bone resembled a humerus. The zeugopodium included one long bone with a cleft in the diaphysis; however, the epiphyisis and metaphysis were jointed. It was not possible to conclude whether this bone was an element of a thoracic or pelvic limb. The basipodium consisted of carpal bones that were fused in two blocks not resembling the tarsal bones (there was no talus or calcaneus). The metapodium of the extra limb had features that were not typical of this segment of the autopodium in cattle. Two bones were partially fused together (a massive one and a very thin underdeveloped bone). ...

Acne vulgaris is a very common skin disease being diagnosed in Westernized populations, however, its multifactorial etiopathogenesis still remains unclear. Recent research has demonstrated a possible linkage between acne and insulin resistance (IR), which is the topic of our review. In addition to an inappropriate diet, excessive androgen production or obesity, it is the IR which might be responsible for lack of efficacy of classical treatment strategy in acne. Interestingly, in all such cases an increased activity of mammalian target of rapamycin kinase complex 1 (mTORC1) has been detected. This observation might be considered as the basis of the possible role of metformin as an adjunct therapeutic modality for patients suffering from acne. The aim of our review is to present the possible etiological correlation between acne and insulin resistance, as well as metformin therapy, which might be highly useful in the treatment to resistant forms of acne.

BackgroundThe aim of the study was to evaluate the differences in clinical profile, laboratory parameters, and ophthalmological signs, and symptoms between patients with high IgG4 Graves orbitopathy and patients with normal IgG4 Graves orbitopathy.MethodsThis was a prospective observational study. We recruited adult patients with Graves Orbitopathy(GO) referred to our clinic for further diagnostics and treatment. Eventually, 60 patients with GO were enrolled in the study. All patients underwent ophthalmological assessment, magnetic resonance imaging (MRI) of the orbits, and laboratory tests, including IgG4 serum concentration measurement. High IgG4 GO was diagnosed if the IgG4 concentration exceeded 135 mg/dl. We used both the clinical activity score (CAS) and magnetic resonance imaging (MRI) to assess the activity of GO. Eventually, active GO was defined according to MRI results.ResultsAmong 60 GO patients, 15 (25%) patients had elevated IgG4 levels. Patients in the high IgG4 group had a higher prevalence of active GO by MRI than patients with normal IgG4 (100% vs. 64.44%, P=0.006). They also had a higher eosinophile count in peripheral blood, a lower bilirubin level, a more frequent lower eyelid retraction, and a lower prevalence of glaucoma. There were no statistically significant differences between the groups in CAS. Patients with active GO, had higher median IgG4 level [89.95 (55.48; 171.1) vs 43.45 (32.48; 49.68) mg/dl, P&lt;0.001]. The receiver operating characteristic (ROC) analysis for IgG4 as a marker of active GO revealed the following results: AUC 0.848 for the cut-off value of 54.2 mg/dl, sensitivity 79.5%, specificity 87.5%, positive predictive value 94.6%, negative predictive value 59.1%.ConclusionsWe demonstrated that IgG4 is a marker of GO activity. Certain differences in the clinical profile of patients with high IgG4 GO, and normal IgG4 GO were observed. More data is needed to establish whether patients with high IgG4 GO are GO patients with particularly active disease or actually represent a distinct clinical entity related to IgG4-Related Disease.

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