The combination of ACR-Thyroid Imaging Reporting and Data system and The Bethesda System for Reporting Thyroid Cytopathology in the evaluation of thyroid nodules-An institutional experience.

BACKGROUND: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is widely utilised by cytopathologists. The American College of Radiology (ACR) has also proposed a thyroid imaging reporting and data system (TIRADS) to classify thyroid nodules and guide their selection for fine needle aspiration (FNA). The current study aimed to analyse the usefulness of TBSRTC in thyroid cytology reporting, to examine its histological correlation with TIRADS, and to compare the management of lesions in each cytological category in our institute to the TBSRTC recommendations. MATERIALS AND METHODS: A retrospective study was performed on all thyroid FNAs from a 2-year period at a tertiary care centre. Histological correlations of TBSRTC and ACR TIRADS were examined for cases with surgical follow-up, and the risk of malignancy in each TBSRTC category, and sensitivity and specificity of FNA and TIRADS, were calculated. RESULTS: A total of 337 thyroid FNAs were examined, with histological follow-up in 99 cases. Risk of malignancy in categories I-VI was 9.5%, 2.3%, 0.0, 8%, 87.5% and 100.0%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of FNA were 60.0%, 99.0%, 85.7%, and 97.5%, respectively, while those values for thyroid ultrasound were 90.3%, 72.2%, 92.9% and 65%, respectively. CONCLUSION: The study substantiates the usefulness of TBSRTC in arriving at a more precise diagnosis. Hurthle cell lesions with atypia were the common cause of misdiagnosis. The combination of TIRADS and TBSRTC aids in better stratification of thyroid nodules and in decision making for management of lesions.

Nanocomposite-Coated Silk-Based Artificial Conduits: The Influence of Structures on Regeneration of the Peripheral Nerve.

In this study, silk filaments are coated with different concentrations (5, 7.5, and 10% w/w) of carbon nanofibers (CNFs) dispersed in poly-ε-caprolactone. The nanocomposite-coated silk filaments are subjected to knitting, braiding, and twisting. The tubular structures are covered with a silk fibroin/polyvinyl film for the nerve conduit application. Physical characterization of the developed nerve conduits demonstrates suitable mechanical properties comparable to native nerve tissue. Cell proliferation is confirmed through in vitro cell culture studies using Neuro 2a and rat primary cortical neural progenitor cells, which show that the proliferation happens along the interconnected macrochannels of the internal structure of the nerve conduit. The knitted structure presents better biological properties than the nerve conduits with other internal structures. The in vivo sciatic nerve implantation is performed in a rabbit model using the best conduit, i.e., 10% CNF-based nanocomposite-coated silk with a knitted inner structure without any biomolecules or tube filling gels. Regeneration of a 2 cm gap excised sciatic nerve is investigated by immunohistochemistry and histology of implanted nerve conduits removed after 30 days. Results suggest that the CNF-based conducting nanocomposite coating in this well-defined architecture of the conduit helps in signal transmission and neural growth during the regeneration of the transected nerve.

Carbon nanofiber amalgamated 3D poly-ε-caprolactone scaffold functionalized porous-nanoarchitectures for human meniscal tissue engineering: In vitro and in vivo biocompatibility studies.

We developed customizable biomolecule functionalized 3D poly-ε-caprolactone (PCL) scaffolds reinforced with carbon nanofibers (CNF) for human meniscal tissue engineering. 3D nanocomposite scaffolds exhibited commendable mechanical integrity and electrical properties with augmented cytocompatibility. Especially, the functionalized 3D (10wt% CNF) scaffolds showed ~363% increase in compressive moduli compared to the pristine PCL. In dynamic mechanical analysis, these scaffolds achieved highest value (~42 MPa at 10 Hz) among all tested scaffolds including pristine PCL and human menisci (33, 41, 56 years). In vitro results were well supported by the outcomes of cell proliferation analysis, microscopic images, Hoechst staining and extracellular-matrix estimation. Further, in vivo rabbit bio toxicity studies revealed scaffold's non-toxicity and its future potential as a meniscus scaffold. This study also indicates that the incorporation of CNF in polymer matrix may be optimized based on mechanical properties of patient meniscus and it may help in developing the customized patient specific 3D constructs with improved multifunctional properties.

Tissue engineering of human knee meniscus using functionalized and reinforced silk-polyvinyl alcohol composite three-dimensional scaffolds: Understanding the in vitro and in vivo behavior.

Tissue engineered constructs with rapid restoration of mechanical and biological properties remain a challenge, emphasizing the need to develop novel scaffolds. Here, we present a multicomponent composite three-dimensional scaffold structure with biomimetic reinforcement and biomolecule functionalization for meniscus tissue engineering. The scaffold structure was developed using 3:1 silk fibroin (SF) and polyvinyl alcohol (PVA). Autoclaved eggshell membrane (AESM) powder (1-3%w/v) was used as reinforcement to enhance biomechanical properties. Further to improve cell attachment and proliferation, these scaffolds were functionalized using an optimized unique combination of biomolecules. Comprehensive analysis of scaffolds was carried out on morphological, structural, mechanical and biological functionalities. Their mechanical properties were compared with different native human menisci. The results indicated that, functionalized SF-PVA with 3%AESM has shown similar order of magnitude of compressive and dynamic mechanical properties as in human meniscus. Moreover, 3% AESM based scaffolds were found to support better primary human meniscal cellular proliferation and extracellular matrix secretion. Immunohistochemical analysis revealed angiogenesis and biocompatibility with minimal inflammatory response for subcutaneously implanted scaffolds in New Zealand white rabbits. The developed reinforced and functionalized SF-PVA scaffolds can uniquely combine the potential for load-bearing properties with improved in vitro and in vivo support for meniscus tissue regeneration. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 1722-1731, 2018.

Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster-randomised trial.

BACKGROUND: Cervical cancer is the most common cancer among women in developing countries. We assessed the effect of screening using visual inspection with 4% acetic acid (VIA) on cervical cancer incidence and mortality in a cluster randomised controlled trial in India. METHODS: Of the 114 study clusters in Dindigul district, India, 57 were randomised to one round of VIA by trained nurses, and 57 to a control group. Healthy women aged 30 to 59 years were eligible for the study. Screen-positive women had colposcopy, directed biopsies, and, where appropriate, cryotherapy by nurses during the screening visit. Those with larger precancerous lesions or invasive cancers were referred for appropriate investigations and treatment. Cervical cancer incidence and mortality in the study groups were analysed and compared using Cox regression taking the cluster design into account, and analysis was by intention to treat. The primary outcome measures were cervical cancer incidence and mortality. RESULTS: Of the 49,311 eligible women in the intervention group, 31,343 (63.6%) were screened during 2000-03; 30,958 control women received the standard care. Of the 3088 (9.9%) screened positive, 3052 had colposcopy, and 2539 directed biopsy. Of the 1874 women with precancerous lesions in the intervention group, 72% received treatment. In the intervention group, 274,430 person years, 167 cervical cancer cases, and 83 cervical cancer deaths were accrued compared with 178,781 person-years, 158 cases, and 92 deaths and in the control group during 2000-06 (incidence hazard ratio 0.75 [95% CI 0.55-0.95] and mortality hazard ratio 0.65 [0.47-0.89]). INTERPRETATION: VIA screening, in the presence of good training and sustained quality assurance, is an effective method to prevent cervical cancer in developing countries.