Pulmonary Epstein-Barr virus-associated smooth muscle tumor after kidney transplantation: two case reports with review of differential diagnosis.

Pulmonary nodules are a common complication in solid organ transplant recipients, and may have various underlying causes, with Epstein-Barr virus-associated smooth muscle tumor (EBV-SMT) being one of them. Given the rarity of this entity, we describe the diagnosis and therapeutic interventions for post-transplant EBV-SMT in two individuals. Both cases involved female patients who were diagnosed with multiple pulmonary nodules 60 months and 116 months, respectively, after receiving living-related kidney transplantation. Pathological examination revealed a spindle cell tumor, with immunophenotype and EBV in situ hybridization supporting the diagnosis of EBV-SMT. After diagnosis, these two patients underwent intervention by decreasing their intake of immunosuppressants. As of the latest follow-up, the patients' lesion size remained stable, and their overall condition was favorable. We also reviewed literature about the morphological and molecular pathological features of EBV-SMT and highlighted the diagnosis and differential diagnosis of pulmonary spindle cell lesions especially in the setting of immunosuppression.

Reprogramming Metabolic Flux in Escherichia Coli to Enhance Chondroitin Production.

Reprogramming metabolic flux is a promising approach for constructing efficient microbial cell factories (MCFs) to produce chemicals. However, how to boost the transmission efficiency of metabolic flux is still challenging in complex metabolic pathways. In this study, metabolic flux is systematically reprogrammed by regulating flux size, flux direction, and flux rate to build an efficient MCF for chondroitin production. The ammoniation pool for UDP-GalNAc synthesis and the carbonization pool for UDP-GlcA synthesis are first enlarged to increase flux size for providing enough precursors for chondroitin biosynthesis. Then, the ammoniation pool and the carbonization pool are rematched using molecular valves to shift flux direction from cell growth to chondroitin biosynthesis. Next, the adaptability of polymerization pool with the ammoniation and carbonization pools is fine-tuned by dynamic and static valve-based adapters to accelerate flux rate for polymerizing UDP-GalNAc and UDP-GlcA to produce chondroitin. Finally, the engineered strain E. coli F51 is able to produce 9.2 g L-1 chondroitin in a 5-L bioreactor. This strategy shown here provides a systematical approach for regulating metabolic flux in complex metabolic pathways for efficient biosynthesis of chemicals.

Genome-Wide Identification of B-Box Gene Family and Expression Analysis Suggest Its Roles in Responses to Cercospora Leaf Spot in Sugar Beet (Beta Vulgaris L.).

The B-box (BBX) protein, which is a zinc-finger protein containing one or two B-box domains, plays a crucial role in the growth and development of plants. Plant B-box genes are generally involved in morphogenesis, the growth of floral organs, and various life activities in response to stress. In this study, the sugar beet B-box genes (hereafter referred to as BvBBXs) were identified by searching the homologous sequences of the Arabidopsis thaliana B-box gene family. The gene structure, protein physicochemical properties, and phylogenetic analysis of these genes were systematically analyzed. In this study, 17 B-box gene family members were identified from the sugar beet genome. A B-box domain can be found in all sugar beet BBX proteins. BvBBXs encode 135 to 517 amino acids with a theoretical isoelectric point of 4.12 to 6.70. Chromosome localization studies revealed that BvBBXs were dispersed across nine sugar beet chromosomes except chromosomes 5 and 7. The sugar beet BBX gene family was divided into five subfamilies using phylogenetic analysis. The gene architectures of subfamily members on the same evolutionary tree branch are quite similar. Light, hormonal, and stress-related cis-acting elements can be found in the promoter region of BvBBXs. The BvBBX gene family was differently expressed in sugar beet following Cercospora leaf spot infection, according to RT-qPCR data. It is shown that the BvBBX gene family may influence how the plant reacts to a pathogen infection.

Abnormal metabolic connectivity in default mode network of right temporal lobe epilepsy.

Aims: Temporal lobe epilepsy (TLE) is a common neurological disorder associated with the dysfunction of the default mode network (DMN). Metabolic connectivity measured by 18F-fluorodeoxyglucose Positron Emission Computed Tomography (18F-FDG PET) has been widely used to assess cumulative energy consumption and provide valuable insights into the pathophysiology of TLE. However, the metabolic connectivity mechanism of DMN in TLE is far from fully elucidated. The present study investigated the metabolic connectivity mechanism of DMN in TLE using 18F-FDG PET. Method: Participants included 40 TLE patients and 41 health controls (HC) who were age- and gender-matched. A weighted undirected metabolic network of each group was constructed based on 14 primary volumes of interest (VOIs) in the DMN, in which Pearson's correlation coefficients between each pair-wise of the VOIs were calculated in an inter-subject manner. Graph theoretic analysis was then performed to analyze both global (global efficiency and the characteristic path length) and regional (nodal efficiency and degree centrality) network properties. Results: Metabolic connectivity in DMN showed that regionally networks changed in the TLE group, including bilateral posterior cingulate gyrus, right inferior parietal gyrus, right angular gyrus, and left precuneus. Besides, significantly decreased (P < 0.05, FDR corrected) metabolic connections of DMN in the TLE group were revealed, containing bilateral hippocampus, bilateral posterior cingulate gyrus, bilateral angular gyrus, right medial of superior frontal gyrus, and left inferior parietal gyrus. Conclusion: Taken together, the present study demonstrated the abnormal metabolic connectivity in DMN of TLE, which might provide further insights into the understanding the dysfunction mechanism and promote the treatment for TLE patients.

Clinical utility of cryptococcal antigen detection in transthoracic needle aspirate by lateral flow assay for diagnosing non-HIV pulmonary cryptococcosis: A multicenter retrospective study.

Lateral flow immunoassay (LFA) detection of cryptococcal capsular polysaccharide antigen (CrAg) is reported to be the most rapid and convenient laboratory method for diagnosing cryptococcosis. Its clinical diagnostic use, however, is not well studied. We retrospectively analyzed the data from 97 patients with suspected pulmonary cryptococcosis (PC) at 2 tertiary care centers. CrAg in both serum and lung aspirate specimens were examined by LFA. We divided the patients who were diagnosed with PC into group I, patients positive for CrAg in both the serum and lung aspirate, and group II, patients positive for CrAg in the lung aspirate but not in the serum. We analyzed the differences in imaging distribution, morphological characteristics, and concomitant signs between the 2 groups. Of all 97 patients, 47 were diagnosed with PC. Lung aspirates were positive for CrAg in 46/47 patients with PC (sensitivity 97.9%, specificity 100%, positive predictive value = 100%, negative predictive value = 98%). There were no false positive results in the noncryptococcosis patients, revealing a diagnostic accuracy of 99%. Serum CrAg tests were positive in 36/47 patients with PC (sensitivity 76.6%, specificity 100%, accuracy 88.7%, positive predictive value = 100%, negative predictive value = 82%). Chest imaging data showed a statistically significant greater number of single lesions in group II than in group I (P < .05). More lesions accompanied by halo signs were showed in group I (P < .01), whereas more accompanied by pleural stretch signs were found in group II (P < .01). The LFA-positive rate of CrAg in lung aspirate samples was higher than that of the serum samples, especially in patients with single pulmonary lesion or in those accompanied by pleural stretch. The direct measurement of CrAg in lung aspirate is a rapid, useful alternative diagnostic method for PC confirmation.

Residual Spatial and Channel Attention Networks for Single Image Dehazing.

Single image dehazing is a highly challenging ill-posed problem. Existing methods including both prior-based and learning-based heavily rely on the conceptual simplified atmospheric scattering model by estimating the so-called medium transmission map and atmospheric light. However, the formation of haze in the real world is much more complicated and inaccurate estimations further degrade the dehazing performance with color distortion, artifacts and insufficient haze removal. Moreover, most dehazing networks treat spatial-wise and channel-wise features equally, but haze is practically unevenly distributed across an image, thus regions with different haze concentrations require different attentions. To solve these problems, we propose an end-to-end trainable densely connected residual spatial and channel attention network based on the conditional generative adversarial framework to directly restore a haze-free image from an input hazy image, without explicitly estimation of any atmospheric scattering parameters. Specifically, a novel residual attention module is proposed by combining spatial attention and channel attention mechanism, which could adaptively recalibrate spatial-wise and channel-wise feature weights by considering interdependencies among spatial and channel information. Such a mechanism allows the network to concentrate on more useful pixels and channels. Meanwhile, the dense network can maximize the information flow along features from different levels to encourage feature reuse and strengthen feature propagation. In addition, the network is trained with a multi-loss function, in which contrastive loss and registration loss are novel refined to restore sharper structures and ensure better visual quality. Experimental results demonstrate that the proposed method achieves the state-of-the-art performance on both public synthetic datasets and real-world images with more visually pleasing dehazed results.

Preliminary Study on the Relationship of BRAF Mutations with the Outcome of the First 131I Radiotherapy and Malignant Biological Characteristics in Papillary Thyroid Carcinoma.

OBJECTIVE: To investigate the relationship of BRAF mutation with the outcome of the first postoperative 131I treatment and malignant biological characteristics in papillary thyroid carcinoma (PTC). METHODS: Thirty-three patients with PTC who underwent their first 131I treatment after total thyroidectomy were enrolled in this study. BRAF mutation in postoperative tumor tissue and circulating tumor DNA (ctDNA) in peripheral blood at the time of 131I treatment were detected. According to the status of BRAF mutation, all patients were divided into 2 groups in each category of tumor tissues and ctDNA, respectively: 1) BRAF mutation, 2) BRAF wild-type. The Fisher's exact test was performed to analyze the relationship of BRAF mutation in either tumor tissue or ctDNA with the outcome of the first 131I treatment and malignant characteristics of PTC. RESULTS: BRAF mutation was detected in tumor tissues in 25 patients (25/33,75.8%), and all the patients had single mutation site. In ctDNA, BRAF mutation was detected in 5 patients (5/33, 15.2%), and all the patients had single mutation site. In both tumor tissues and ctDNA, BRAF mutation showed no relationship with the outcome of first 131I treatment and the malignant biological characteristics (P>0.05). CONCLUSION: The value of BRAF mutation alone might be limited in predicting therapeutic outcome of the first 131I treatment in PTC. No definitive relevance was found between BRAF mutation and malignant biological features in PTC.

I-125 seed-loaded versus normal stent insertion for obstructive esophageal cancer: a meta-analysis.

INTRODUCTION: Malignant esophageal obstruction is usually caused by esophageal and other chest cancers. More than 80% of cases of obstructive esophageal cancer (OEC) have lost the chance of curative resection. Stent insertion is a first-line palliative approach used to treat incurable OEC. AIM: To gauge the relative clinical efficacy of I-125 seed-loaded stent (ISS) versus normal stent (NS) insertion as a treatment for OEC. MATERIAL AND METHODS: Querying of the PubMed, Embase, and Cochrane Library databases was conducted to find all relevant studies published up to November 2020. The meta-analysis was undertaken using RevMan v5.3. RESULTS: We identified 158 studies initially, eight (4 randomized controlled trials and 4 retrospective studies) of which were used in this meta-analysis. We found that the two groups exhibited the comparable pooled Δdysphagia scores (MD = 0.02; p = 0.80), stent restenosis rates (OR = 0.97; p = 0.89), stent migration rates (OR = 0.81; p = 0.63), severe chest pain rates (OR = 1.05; p = 0.81), hemorrhage rates (OR = 1.53; p = 0.16), aspiration pneumonia rates (OR = 0.72; p = 0.38), and fistula formation rates (OR = 1.47; p = 0.44). The pooled time-to-restenosis and survival were both significantly longer in the ISS group (p = 0.04 and < 0.0001, respectively). Significant heterogeneity was detected in the endpoints of Δdysphagia scores and survival (I2 = 73% and 86%, respectively). Funnel plot analysis indicated an absence of publication bias related to the selected study endpoints. CONCLUSIONS: For patients with OEC, our meta-analysis indicated that ISS insertion could provide longer stent patency and survival than NS insertion.

Reprogramming Escherichia coli Metabolism for Bioplastics Synthesis from Waste Cooking Oil.

The recycle and reutilization of food wastes is a promising alternative for supporting and facilitating circular economy. However, engineering industrially relevant model organisms to use food wastes as their sole carbon source has remained an outstanding challenge so far. Here, we reprogrammed Escherichia coli metabolism using modular pathway engineering followed by laboratory adaptive evolution to establish a strain that can efficiently utilize waste cooking oil (WCO) as the sole carbon source to produce monomers of bioplastics, namely, medium-chain α,ω-dicarboxylic acids (MCDCAs). First, the biosynthetic pathway of MCDCAs was designed and rewired by modifying the ß-oxidation pathway and introducing an ω-oxidation pathway. Then, metabolic engineering and laboratory adaptive evolution were applied for improving the pathway efficiency of fatty acids utilization. Finally, the engineered strain E. coli AA0306 was able to produce 15.26 g/L MCDCAs with WCO as the sole carbon source. This study provides an economically attractive strategy for biomanufacturing bioplastics from food wastes, which has a great potentiality to be developed as a wide range of enabling biotechnologies for achieving green revolution.

T Cell Factor 4 Is Involved in Papillary Thyroid Carcinoma via Regulating Long Non-Coding RNA HCP5.

The annual incidence of papillary thyroid carcinoma has increased dramatically. T cell factor 4 (TCF4) is an important component of Wnt signaling pathway.However, the role of TCF4 in PTC remains unknown. In this study, TCF4 was observed to overexpress in PTC patients and cells by qRT-PCR assay. The colony formation assay, Edu staining and transwell assay indicated thatoverexpression of TCF4 promoted cell proliferation and invasion of TCP-1 cells, whereas knockdown of TCF4 inhibited cell proliferation and invasion of IHH-4 cells. To investigate the mechanism of TCF4 in PTC cells, the luciferase assay demonstrated that TCF4 could modulate HCP5 expression. Besides, GLuc-ON promoter reporter assayproved that TCF4 could bind to HCP5 promoter. Further, knockdown of HCP5 could significantly up-regulated miR-15a, miR-216a-5p, miR-22-3p, miR-139-5p, miR-203, miR-27a-3p and miR-320, and down-regulated miR-186-5p in IHH-4 cells, which might be potential downstream of TFC4/HCP5 axis. In conclusion, up-regulation TCF4 can promote HCP5 expression via binding to HCP5 promoter. It may be the first time to prove that TCF4 regulates HCP5 in PTC, which provides a novel sight for treatment of PTC.

Mechanism of Remediation of Cadmium-Contaminated Soil With Low-Energy Plant Snapdragon.

In the process of remediation of contaminated soil, we should give full play to the role of low-energy plants and fully display the concept of modern energy-saving and environmental protection. Phytoremediation is an effective method to remediate cadmium-contaminated soil, and root exudates play an important part in this process. Here, the response of snapdragon in a pot-culture experiment under two concentrations of Cd (1.0 and 2.5 mg/kg) was evaluated. Snapdragon is a medicinal plant with low energy consumption, which has low requirements on environmental factors and strong resistance. The results showed that both Cd concentrations interfere with the uptake of B, P, Cu, Mn, Mo, and Zn by the soil. The results also showed that plant type and Cd stress can significantly change the concentrations and species of root exudates. The metabolic changes of root exudates revealed the active defense mechanism of plants to Cd stress: up-regulating of amino acids to sequester/exclude Cd, regulation of citric acid on chelation/complexation, and precipitation of cadmium ions. The application of snapdragon can effectively reduce energy consumption and gradually improve the utilization rate of vegetation, which promotes the degradation of cadmium pollutants in soil.

Permanent dry soil layer a critical control on soil desiccation on China's Loess Plateau.

The wide spread of dry soil layers (DSL) in China's Loess Plateau region has negative effects on the ecosystem, including soil degradation and vegetation failure. To understand the temporal persistence of DSL, a ca. 860 km south-north transect was established and soil water content of the 0-5 m depth soil layer repeatedly measured for a period of four years. The results indicated that DSL varied with time and had a distribution area over 21.5-47.0% in the 860 km transect during the study period. The DSL could be divided into temporary and permanent types based on the length of period for which the soil remains dry. While temporary DSL is recoverable, permanent DSL (which existed in 47 out of 86 sites) was apparently unrecoverable as it persisted throughout the observation period. Permanent DSL was characterized by high temporal persistence, severe soil desiccation and thick dry layers; all of which suggested severe negative effect on the ecosystem. Non-climatic factors, rather than climate factors, contributed more to the formation of permanent DSL in the study area. Thus, it was suggested that policies and measures should be enacted to control especially permanent DSL formation in the region.

Impact factors for the outcome of the first 131I radiotherapy in patients with papillary thyroid carcinoma after total thyroidectomy.

OBJECTIVE: To investigate the impact factors of the outcome of the first 131I treatment in patients with papillary thyroid carcinoma (PTC) after total thyroidectomy. METHODS: Three hundred and fifty-three patients [256 females, 97 males, average age (43.58 ± 12.33 years)] with PTC after total thyroidectomy who underwent 131I treatment from July 2014 to August 2017 were retrospectively analyzed. Curative efficacy of 131I treatment was assessed 6 months afterward. Therapeutic outcome was determined according to thyrotropin (TSH)-stimulated thyroglobulin (sTg) level, 131I diagnostic whole-body scan (Dx-WBS) after 131I treatment and other imaging modalities. Twelve possible factors affecting the therapeutic outcome of 131I treatment including patients' gender, age, interval between surgery and 131I treatment, primary tumor size and extrathyroidal extension (ETE), number and range of primary tumor lesions, result of 99mTcO4- thyroid scan, number of metastatic lymph nodes (LN), pre-treatment laboratory measurements [TSH, sTg and Tg antibody (TgAb)], therapeutic dose of 131I and result of 131I post-treatment whole-body scan (Rx-WBS) were analyzed using univariate and multivariate logistic regression. The receiver operator characteristic (ROC) curve and diagnostic cutoff value were analyzed to evaluate the predictive value of the significant quantitative impact factors for the outcome of 131I treatment. RESULTS: The curative rate of the first 131I treatment in patients with PTC after total thyroidectomy was 62.32% (220/353). Univariate analysis indicated that gender, age, number and range of primary tumor lesions, number of metastatic LN, pre-treatment sTg and TgAb, therapeutic dose of 131I and result of 131I Rx-WBS (all P < 0.05) were significant factors affecting the outcome of 131I treatment. Multivariate analysis revealed that the numbers of metastatic LN (regression coefficient = 1.170) and sTg (regression coefficient = 0.280) were significant impact factors (all P < 0.001). The regression equation was: Logit P = - 3.997 + 1.170 × number of metastatic LN + 0.280 × sTg (χ2 = 210.68, P < 0.001). Taking sTg as a predictive factor for the outcome of the first 131I treatment, the area under the curve (AUC) of ROC for sTg was 0.917 (95% CI 0.890-0.944). The cutoff value of sTg was 2.69 ng/mL with a sensitivity of 92.48% (123/133) and specificity of 74.09% (163/220). CONCLUSION: Patients with PTC after total thyroidectomy with low pre-treatment sTg level and few lymph node metastases are more likely to be cured by the first 131I treatment.

Correlation of ADRB1 rs1801253 Polymorphism with Analgesic Effect of Fentanyl After Cancer Surgeries.

BACKGROUND Our study aimed to explore the association between ß1-adrenoceptor (ADRB1) rs1801253 polymorphism and analgesic effect of fentanyl after cancer surgeries in Chinese Han populations. MATERIAL AND METHODS Postoperative fentanyl consumption of 120 patients for analgesia was recorded. Genotype distributions were detected by allele specific amplification-polymerase chain reaction (ASA-PCR) method. Postoperative pain was measured by visual analogue scale (VAS) method. Differences in postoperative VAS score and postoperative fentanyl consumption for analgesia in different genotype groups were compared by analysis of variance (ANOVA). Preoperative cold pressor-induced pain test was also performed to test the analgesic effect of fentanyl. RESULTS Frequencies of Gly/Gly, Gly/Arg, Arg/Arg genotypes were 45.0%, 38.3%, and 16.7%, respectively, and passed the Hardy-Weinberg Equilibrium (HWE) test. The mean arterial pressure (MAP) and the heart rate (HR) had no significant differences at different times. After surgery, the VAS score and fentanyl consumption in Arg/Arg group were significantly higher than in other groups at the postoperative 2nd hour, but the differences were not obvious at the 4th hour, 24th hour, and the 48th hour. The results suggest that the Arg/Arg homozygote increased susceptibility to postoperative pain. The preoperative cold pressor-induced pain test suggested that individuals with Arg/Arg genotype showed worse analgesic effect of fentanyl compared to other genotypes. CONCLUSIONS In Chinese Han populations, ADRB1 rs1801253 polymorphism might be associated with the analgesic effect of fentanyl after cancer surgery.

Vasopressin-induced stimulation of the Na(+)-activated K(+) channels is responsible for maintaining the basolateral K(+) conductance of the thick ascending limb (TAL) in EAST/SeSAME syndrome.

The renal phenotype of EAST syndrome, a disease caused by the loss-of-function-mutations of Kcnj10 (Kir4.1), is a reminiscence of Gitelman's syndrome characterized by the defective function in the distal convoluted tubule (DCT). The aim of the present study is to test whether antidiuretic hormone (vasopressin)-induced stimulation of the Na(+)-activated 80-150pS K(+) channel is responsible for compensating the lost function of Kcnj10 in the thick ascending limb (TAL) of subjects with EAST syndrome. Immunostaining and western blot showed that the expression of aquaporin 2 (AQP2) was significantly higher in Kcnj10(-/-) mice than those of WT littermates, suggesting that the disruption of Kcnj10 stimulates vasopressin response in the kidney. The role of vasopressin in stimulating the basolateral K(+) conductance of the TAL was strongly indicated by the finding that the application of arginine-vasopressin (AVP) hyperpolarized the membrane in the TAL of Kcnj10(-/-) mice. Application of AVP significantly stimulated the 80-150pS K(+) channel in the TAL and this effect was blocked by tolvaptan (V2 receptor antagonist) or by inhibiting PKA. Moreover, the water restriction for 24h significantly increased the probability of finding the 80-150pS K(+) channel and the K(+) channel open probability in the TAL. The application of a membrane permeable cAMP analog also mimicked the effect of AVP and activated this K(+) channel, suggesting that cAMP-PKA pathway stimulates the 80-150pS K(+) channels. The role of the basolateral K(+) conductance in maintaining transcellular Cl(-) transport is further suggested by the finding that the inhibition of basolateral K(+) channels significantly diminished the AVP-induced stimulation of the basolateral 10pS Cl(-) channels. We conclude that vasopressin stimulates the 80-150pS K(+) channel in the TAL via a cAMP-dependent mechanism. The vasopressin-induced stimulation of K(+) channels is responsible for compensating lost function of Kcnj10 thereby rescuing the basolateral K(+) conductance which is essential for the transport function in the TAL.

Primary Productivity and Precipitation-Use Efficiency in Temperate Grassland in the Loess Plateau of China.

Clarifying spatial variations in aboveground net primary productivity (ANPP) and precipitation-use efficiency (PUE) of grasslands is critical for effective prediction of the response of terrestrial ecosystem carbon and water cycle to future climate change. Though the combination use of remote sensing products and in situ ANPP measurements, we quantified the effects of climatic [mean annual precipitation (MAP) and precipitation seasonal distribution (PSD)], biotic [leaf area index (LAI)] and abiotic [slope gradient, aspect, soil water storage (SWS) and other soil physical properties] factors on the spatial variations in ANPP and PUE across different grassland types (i.e., meadow steppe, typical steppe and desert steppe) in the Loess Plateau. Based on the study, ANPP increased exponentially with MAP for the entire temperate grassland; suggesting that PUE increased with increasing MAP. Also PSD had a significant effect on ANPP and PUE; where more even PSD favored higher ANPP and PUE. Then MAP, more than PSD, explained spatial variations in typical steppe and desert steppe. However, PSD was the dominant driving factor of spatial variations in ANPP of meadow steppe. This suggested that in terms of spatial variations in ANPP of meadow steppe, change in PSD due to climate change was more important than that in total annual precipitation. LAI explained 78% of spatial PUE in the entire Loess Plateau temperate grassland. As such, LAI was the primary driving factor of spatial variations in PUE. Although the effect of SWS on ANPP and PUE was significant, it was nonetheless less than that of precipitation and vegetation. We therefore concluded that changes in vegetation structure and consequently in LAI and/or altered pattern of seasonal distribution of rainfall due to global climate change could significantly influence ecosystem carbon and water cycle in temperate grasslands.

[Nasopharyngeal teratomas (a case report and review of the literature)].

OBJECTIVE: To investigate the clinical characteristics of nasopharyngeal teratomas (NPT), improve the diagnosis and treatment of the disease. METHOD: We reported a 14 years old girl with NPT, and reviewed the literatures. RESULT: NPT was transorally expected under nasal endoscope, no recurrence was found over a 5 year follow-up. CONCLUSION: NPT is rare,the diagnosis of the disease relies on clinical manifestations, imaging and pathological examination. Transoral endoscopic surgery is an effective method of treatment.

Sustained and diffuse 131I avid bone metastases with low thyroglobulin levels in a patient with papillary thyroid carcinoma.

A 63-year-old man with papillary thyroid carcinoma (PTC) and bone metastases was treated with 131I residual thyroid ablation (RTA) and 2 repeated post-ablation 131I therapies after total thyroidectomy. 131I whole-body scans (WBS) demonstrated sustained and diffuse 131I avid bone metastases, accompanied by persistent very low thyroglobulin (Tg) levels and negative antithyroglobulin antibody (TgAb) in post-ablation 131I therapies in hypothyroid state after levothyroxine withdrawal. The spread of bone metastases were found on the last therapeutical 131I WBS. The benefit of 131I therapy after levothyroxine withdrawal should be weighed even if the metastases are 131I avid in poorly differentiated thyroid carcinoma.

Posterior nutcracker syndrome associated with interrupted left inferior vena cava with azygos continuation and retroaortic right renal vein.

Various anatomic anomalies have been considered the causes of nutcracker syndrome (NCS). Posterior NCS refers to the condition, in which vascular narrowing was secondary to the compression of the retroaortic left renal vein while it is crossing between the aorta and the vertebral column. Here, we report an unusual case of posterior NCS associated with a complicated malformation of the interrupted left inferior vena cava with azygos continuation and retroaortic right renal vein, diagnosed by both color Doppler ultrasonography and CT angiography.

Multiple metastasis-like bone lesions in scintigraphic imaging.

Multiple benign osteolytic lesions are very hard to differentiate from disseminated bone metastasis. Whole-body bone scintigraphy (WBBS) with technetium-99m methylene diphosphonate (Tc-99m MDP) demonstrates multiple lesions with increased uptake in any bone involved. Even combined with medical history and multiple imaging results, such as MRI and CT, the clinical diagnosis of metastasis lesion remains as a challenge. These clinical characteristics are similar to multiple malignant bone metastases and therefore affect the following treatment procedures. In this paper, we analyzed multiple benign osteolytic lesions, like eosinophilic granuloma (EG), multiple myeloma (MM), disseminated tuberculosis, fibrous dysplasia, or enchondroma, occurring in our daily clinical work and concluded that additional attention should be paid before giving the diagnosis of multiple bone metastases.