US Fine-Needle Aspiration Biopsy for Thyroid Malignancy: Diagnostic Performance of Seven Society Guidelines Applied to 2000 Thyroid Nodules.

Purpose To compare the diagnostic performance of ultrasonography (US)-based fine-needle aspiration biopsy (FNAB) criteria from seven international societies in the detection of thyroid malignancy. Materials and Methods This study included a total of 2000 consecutive thyroid nodules (≥1 cm) in 1802 patients with final diagnoses from January 2010 to May 2011. US features of the thyroid nodules were retrospectively reviewed and were classified according to the categories defined by the seven international society guidelines. The diagnostic performance of US-based FNAB criteria in the detection of thyroid malignancy and unnecessary FNAB rates were calculated and compared by using a generalized estimating equation method. Results Of the 2000 thyroid nodules, 1546 (78.3%) were benign and 454 (22.7%) were malignant, with papillary carcinoma comprising 85.5% of all malignancies. The Korean Thyroid Association/Korean Society of Thyroid Radiology (KTA/KSThR) (94.5%), National Comprehensive Cancer Network (NCCN) (92.5%), and American Thyroid Association (ATA) (89.6%) guidelines were more sensitive than those of the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi (AACE/ACE/AME) (80.4%), American College of Radiology (ACR) (74.7%), French Society of Endocrinology (FSE) (72.7%), and Society of Radiology in Ultrasound (SRU) (70.9%) (P < .001), while the latter guidelines had higher specificity (P < .001). The rate of unnecessary FNAB was lowest with the ACR guidelines (25.3%), followed by the FSE (29.1%), AACE/ACE/AME (32.5%), SRU (45.2%), ATA (51.7%), NCCN (54.0%), and KTA/KSThR (56.9%) guidelines. Conclusion Because the diagnostic performance of US-based FNAB criteria varies according to the individual international society guidelines, clinicians should be aware of the strengths and weaknesses of US-based FNAB criteria in the management of thyroid nodules. © RSNA, 2018 Online supplemental material is available for this article.

The effectiveness of anti-biofilm and anti-virulence properties of dihydrocelastrol and dihydrocelastryl diacetate in fighting against methicillin-resistant Staphylococcus aureus.

Human pathogens have readily been converted into multidrug-resistant pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA), because of the long-term use of conventional antibiotics. In addition, the biofilms formed by S. aureus cells are especially problematic and are related to the persistence of chronic infections because they constitute a major mechanism of promoting tolerance to diverse antimicrobial agents. Hence, the inhibitions of biofilm formation and/or toxin production are accepted as alternative means of controlling S. aureus infections. The present study was aimed at identifying novel anti-biofilm and/or anti-virulence compounds in friedelane-based pentacyclic triterpenoids present in many edible and medicinal plants-and investigating them against MRSA strains. As a result, dihydrocelastrol and dihydrocelastryl diacetate were found to both inhibit the biofilm formation of, and to disrupt the preformed biofilms of, MRSA strains to an increasingly greater degree with increasing concentrations of each compound. Furthermore, these two triterpenoids also clearly inhibited the hemolytic activity of MRSA-and in-line with their anti-biofilm activities, rendered the cell more hydrophilic. Additionally, corroborating phenotypic results, transcriptional analyses showed that both dihydrocelastrol and dihydrocelastryl diacetate disturbed the expression of gene related to α-hemolysin (hla) and down-regulated the expressions of the crucial biofilm-associated genes (agrA, sarA, ica, RNAIII, and rbf) in MRSA. The findings of this study suggest that friedelane-based pentacyclic triterpenoids-especially dihydrocelastrol and dihydrocelastryl diacetate-have the potential to be candidates both for use in controlling biofilm-related infections and for use as important components of anti-virulence strategies for fighting against MRSA infection.