MEN1 in a Patient With Nonsyndromic Familial Nonmedullary Thyroid Carcinoma.

Clinical syndromes involving multiple endocrine glands have been well recognized for over a century. Multiple reports describing hereditary multiple endocrine neoplasia (MEN) syndromes involving pituitary, parathyroid, and pancreatic neuroendocrine tumors have been published. Differentiated (nonmedullary) thyroid cancer can also present as a hereditary syndrome with or without a specific genetic predisposition. We report the case of a man with nonsyndromic familial nonmedullary thyroid carcinoma, a pituitary adenoma, hyperparathyroidism, an adrenal adenoma, and pancreatic adenocarcinoma. Genetic testing did not reveal mutations in the commonly reported genes associated with MEN syndromes. MEN1 is characterized by endocrine neoplasia in at least 2 of the following glands: pituitary, parathyroid, and the gastro-entero-pancreatic (GEP) tract. Co-occurrence of MEN1 with familial nonmedullary thyroid carcinoma, however, has not been reported in the medical literature. This unique case of MEN1 co-existing in a patient with nonsyndromic familial thyroid carcinoma was not associated with any common MEN syndrome germline mutations.

Anomalous phenology of Ixodes scapularis (Ixodida: Ixodidae) in Mississippi.

The blacklegged tick, Ixodes scapularis Say, is one of the most important vectors of tick-borne disease agents in North America. Accordingly, it is crucial to know this species local composition, abundance, and seasonality (phenology) to help prevent tick-borne illnesses. The phenology of adult I. scapularis is reported in the scientific literature from October through May. Data from previous research in Mississippi have all supported this time frame for adult blacklegged tick activity. However, in this study, we report a collection of 13 I. scapularis from 9 widely separated areas in Mississippi during the summer and early fall of 2022 (June, July, and September). These findings are remarkable, even enigmatic, and should prompt further investigation.

Geographic distribution of the hard ticks (Acari: Ixodida: Ixodidae) of the world by countries and territories.

The hard tick family Ixodidae currently comprises 762 species worldwide, but an analysis of the occurrence of these species in the world´s countries, territories, zoogeographic regions (Afrotropical, Australasian, Nearctic, Neotropical, Oriental, Palearctic) and remote islands has not been attempted since 2009. Here, we present and critically discuss distributional data for all currently accepted ixodid species known from 226 countries and territories in six zoogeographic realms. This summary of ixodid tick biogeography should prove to be a valuable reference for biologists interested in ticks as organisms as well as specialists focusing on tick-borne diseases. Data for all species treated here were derived from a literature search that ended on March 31, 2022.

Persistent or Recurrent Disease in Thyroid Cancer Survivors Who Have Elevated Serum Antithyroglobulin Antibodies.

OBJECTIVE: Detection of residual differentiated thyroid cancer is important but difficult. A variety of imaging modalities and biochemical markers has been used with moderately good success. We hypothesized that elevated perioperative serum antithyroglobulin antibody (TgAb) levels would also be a predictive marker for persistent or recurrent thyroid cancer. METHODS: We performed a retrospective analysis of 277 differentiated thyroid cancer survivors divided into 2 groups: (1) those with low or normal serum TgAb (TgAb-) and (2) those with elevated serum TgAb (TgAb+). All patients were seen at one major academic medical center. Patients were followed for a median of 7.54 years. RESULTS: Patients in the TgAb+ group were more likely to have positive lymph nodes at initial surgery, to be assigned to a higher American Joint Committee on Cancer stage, and to have significantly higher incidence of persistent/recurrent disease. The higher incidence of persistent/recurrent cancer was significant under univariable and multivariable (including TgAb status, age, and sex) Cox proportional hazards model analysis. CONCLUSION: We conclude that individuals with elevated serum TgAb at the outset should be followed with a higher index of suspicion for persistent/recurrent thyroid cancer.

The Genus Haemaphysalis (Acari: Ixodidae) in Laos: An Update of Species Records and a Review of Taxonomic Challenges.

Haemaphysalis Koch, 1844, is the largest genus of ticks in Southeast Asia, but little information is available concerning the species present in Laos. Recent research has yielded records for 10 Haemaphysalis species in Laos, including 5 new records, as well as 3 morphological entities of uncertain status. Further morphological and molecular studies are needed to clarify our taxonomic understanding of this genus in Southeast Asia.

Workshop-based learning and networking: a scalable model for research capacity strengthening in low- and middle-income countries.

Science education and research have the potential to drive profound change in low- and middle-income countries (LMICs) through encouraging innovation, attracting industry, and creating job opportunities. However, in LMICs, research capacity is often limited, and acquisition of funding and access to state-of-the-art technologies is challenging. The Alliance for Global Health and Science (the Alliance) was founded as a partnership between the University of California, Berkeley (USA) and Makerere University (Uganda), with the goal of strengthening Makerere University's capacity for bioscience research. The flagship program of the Alliance partnership is the MU/UCB Biosciences Training Program, an in-country, hands-on workshop model that trains a large number of students from Makerere University in infectious disease and molecular biology research. This approach nucleates training of larger and more diverse groups of students, development of mentoring and bi-directional research partnerships, and support of the local economy. Here, we describe the project, its conception, implementation, challenges, and outcomes of bioscience research workshops. We aim to provide a blueprint for workshop implementation, and create a valuable resource for bioscience research capacity strengthening in LMICs.

Myxedema Coma Associated with Macroprolactinoma: Case Report and Review of the Literature.

Myxedema coma is a rare life-threatening presentation of severe hypothyroidism associated with a high mortality rate. Although most cases are due to primary thyroid failure, a minority have central hypothyroidism as the underlying cause. We report the case of a 69-year-old man who presented with obtundation, hypoglycemia, and hyponatremia. The patient's initial thyroid-stimulating hormone (TSH) was within normal limits. Subsequent evaluation revealed critical anterior pituitary insufficiency due to a macroprolactinoma and a diagnosis of myxedema coma after appropriate workup The finding of a normal serum TSH should not eliminate the possibility of myxedema coma.

First Report of the Bat Tick Carios kelleyi (Acari: Ixodida: Argasidae) From Vermont, United States.

The soft tick Carios kelleyi (Cooley and Kohls, 1941) is an ectoparasite of bats that can harbor bacteria known to cause disease in humans, such as Rickettsia spp., Bartonella spp., and relapsing fever Borrelia spp. Human-tick encounters may occur when bats occupy attics or similar dwellings with access points to human-inhabited areas. During May 2021, a partially engorged adult female C. kelleyi was collected from a Vermont home with an attic that was being used as a roost by big brown bats, Eptesicus fuscus (Chiroptera: Vespertilionidae). The source of the blood in the tick was the domestic dog, Canis lupus familiaris. Subsequently, eight C. kelleyi larvae were collected from a rescued E. fuscus adult. This is the first report of a soft tick species from Vermont and it is unknown how long C. kelleyi has been present in this state. Reports of C. kelleyi are on the rise across the northeastern United States but the implications for the health of humans, domestic animals, and bats in northern New England remain unclear. Bat management plans should consider the importance of bat exclusion in preventing tick encounters with members of the household and should include a tick monitoring component if bats are evicted.

Ixodes scapularis (Ixodida: Ixodidae) Parasitizing an Unlikely Host: Big Brown Bats, Eptesicus fuscus (Chiroptera: Vespertilionidae), in New York State, USA.

Ixodes scapularis Say is a three-host tick that has been recorded feeding on over 150 different species of terrestrial vertebrates (mammals, birds, and reptiles). This tick is found throughout the northeastern, coastal southeastern, and upper midwestern United States and is considered the most significant vector of tick-borne pathogens to humans in North America. Despite its ubiquity and broad host range, I. scapularis previously has not been reported feeding on bats (Chiroptera). However, during 2019 and 2020, larvae and nymphs of I. scapularis were recovered from big brown bats, Eptesicus fuscus (Palisot de Beauvois), at four locations in rural New York State, USA. All Ixodes infested bats were injured and found on the ground; therefore, parasitism by I. scapularis was likely opportunistic. Nonetheless, the large number of pathogens known to be associated with bats and the frequency with which I. scapularis bites people suggest that this host-tick relationship is of at least potential epidemiological significance.

Annotated world checklist of the Trombiculidae and Leeuwenhoekiidae (17582021) (Acari: Trombiculoidea), with notes on nomenclature, taxonomy, and distribution.

The superfamily Trombiculoidea is a large and diverse group of acarines that comprises six families; of these, the families Trombiculidae and Leeuwenhoekiidae are characterized by larvae commonly known as chiggers that are parasites of terrestrial vertebrates, including humans, and some species are of medical importance as vectors of chigger-borne rickettsiosis (scrub typhus), caused by the rickettsia Orientia tsutsugamushi. This paper presents an annotated checklist of 3,013 generally accepted chigger species, together with their distribution by zoogeographic region, and a non-comprehensive list of synonyms. A total of 58 new combinations are proposed by transferring species to different genera, treating some subgenera as genera, or updating current generic names. The checklist updates earlier catalogs of the world chigger fauna, but because the literature on chigger taxonomy is voluminous and scattered, similar, regional monographs were utilized in constructing the classificatory foundation. This list may not contain every species, synonym or taxonomic rearrangement that has been published, but it reflects the most recent arrangement of chigger taxa. Distribution records are primarily drawn from collection sites listed in the original species descriptions, together with subsequently published geographical records.

Carios kelleyi (Acari: Ixodida: Argasidae) Infected With Rickettsial Agents Documented Infesting Housing in Kansas, United States.

During September-December 2018, 25 live ticks were collected on-post at Fort Leavenworth, Kansas, in a home with a history of bat occupancy. Nine ticks were sent to the Army Public Health Center Tick-Borne Disease Laboratory and were identified as Carios kelleyi (Cooley and Kohls, 1941), a species that seldom bites humans but that may search for other sources of blood meals, including humans, when bats are removed from human dwellings. The ticks were tested for numerous agents of human disease. Rickettsia lusitaniae was identified by multilocus sequence typing to be present in two ticks, marking the first detection of this Rickettsia agent in the United States and in this species of tick. Two other Rickettsia spp. were also detected, including an endosymbiont previously associated with C. kelleyi and a possible novel Rickettsia species. The potential roles of C. kelleyi and bats in peridomestic Rickettsia transmission cycles warrant further investigation.

Focus Stacking Images of Morphological Character States for Differentiating the Adults of Ixodes affinis and Ixodes scapularis (Acari: Ixodidae) in Areas of Sympatry.

Adult females and males of Ixodes affinis and Ixodes scapularis are illustrated by focus stacking image photography, and morphological character states are described that reliably differentiate the two species. In conjunction with other environmental cues, such as the questing phenology of adults, these characteristics will enable the rapid identification of adults of either sex along the southern Coastal Plain of the United States, where these species are sympatric.

First Record of Carios kelleyi (Acari: Ixodida: Argasidae) in New Jersey, United States and Implications for Public Health.

The soft tick Carios kelleyi (Cooley and Kohls), a parasite of bats known to occur in at least 29 of the 48 conterminous U.S. states, is here reported from New Jersey for the first time, based on larvae collected from big brown bats, Eptesicus fuscus. Although thought to be widespread in North America, the ecology of C. kelleyi is not well understood, despite reports of this species feeding on humans and its consequent potential as a disease vector. The association of C. kelleyi with bat species that regularly roost in human-made structures, such as attics and barns, and recent isolations from this tick of pathogens capable of infecting humans, companion animals, and livestock underscore the need for further studies of these bat ectoparasites.

Ixodidae (Acari: Ixodoidea): descriptions and redescriptions of all known species from 1758 to December 31, 2019.

References to the descriptions and redescriptions of the 742 species of Ixodidae published from 1758 to December 31, 2019 are compiled, with the goal of enabling tick taxonomists to readily access this diffuse and often confusing literature. Additionally, data resulting from this effort are critically analyzed to demonstrate the problems attending correct identification of several tick species that are of medical, veterinary and/or evolutionary importance, and to highlight the need for new or enhanced diagnostic techniques. Recent morphological and molecular studies indicate that some ixodid species names represent more than one taxon; therefore, it is expected that new species will be described in the near future, based partly on material already deposited in museums around the world.

The Evolving Role of the Orthopaedic Surgeon in Combat Zones and Austere Deployed Locations Since the 2012 Troop Drawdown.

The purpose of this study was to evaluate the operative experience of orthopaedic surgeons in the various deployment locations since 2012. We also evaluated the implications of humanitarian surgical care and the impact of deployment on an orthopaedic practice. An emailed survey was sent to orthopaedic surgeons deployed after 2012. The survey was 48 questions. Most cases in Iraq, Afghanistan and Syria were emergent traumas. In other locations, however, most cases were elective/non-emergent cases. Of surgeons surveyed, 44% performed less than 10 cases during their deployment, and 50% considered humanitarian surgery part of their mission. Six weeks was needed to prepare for deployment, and 4.4 weeks to re-build a practice. Disparity exists in surgical case volume and types of cases performed by orthopaedic surgeons that is dependent on deployed location. This dichotomy in operative experience places surgeons deployed to such locations at risk of losing surgical skills. (Journal of Surgical Orthopaedic Advances 29(3):182-186, 2020).

A BRAF V600E Mutation in RET-Negative Medullary Thyroid Cancer.

We report the case of a woman with a sporadic medullary thyroid carcinoma. Genomic analysis found that her tumor did not contain any common RET mutations but did harbor a BRAF V600E mutation. Only one other well-confirmed example of the BRAF V600E mutation has been reported in an MTC patient. We conclude that this common BRAF mutation may independently drive neoplastic transformation of human parafollicular C cells.

Features of Multiple Endocrine Neoplasia Type 1 and 2A in a Patient with Both RET and MEN1 Germline Mutations.

The coexistence of multiple endocrine neoplasia type 1 (MEN1) and type 2A (MEN2A) is a rare occurrence and has been reported only twice in the literature. We present a patient with primary hyperparathyroidism and medullary thyroid cancer with strong family history of both MEN1- and MEN2A-associated conditions. Genetic testing showed the patient had a novel MEN1 loss-of-function mutation, c0.525_526insTT (p.Ala176Leufs*10), and an uncommon Cys630Tyr RET mutation. This case highlights the importance of obtaining a detailed family history when heritable endocrine disorders are suspected.

Clinical Features in Differentiated Thyroid Carcinoma Stratified By Lymph Node Status.

OBJECTIVE: Cervical lymph node (CLN) metastases (mets) often occur in differentiated thyroid cancer (DTC), especially in the central compartment, and are a major predictor of local recurrence. We examined clinical endpoints in three groups of patients based on status of lymph node involvement: those with definite lymph node involvement (N1), negative lymph nodes (N0), and no lymph nodes resected (Nx). We correlated these endpoints with clinical and pathologic features of these patients. METHODS: Medical records of 261 patients with DTC who underwent thyroidectomy between 2006 and 2018 at our center were reviewed. Lymph node status of patients was categorized based on American Joint Committee on Cancer (AJCC) 8th edition criteria as N1, N0, and Nx. We performed statistical analysis to assess the differences among these groups, using one-way analysis of variance. When significant differences were found, pairwise comparisons were conducted among the three groups. Statistical significance was defined as 2-tailed P<.05 for all tests. RESULTS: There were significant differences among the groups in tumor multicentricity, tumor category/size, AJCC stage, and the presence of thyroglobulin auto-antibodies (TgAbs). There were no difference in age, gender, or histopathology. N1 patients had a higher incidence of multicentricity, larger tumor sizes, and were more likely to have elevated TgAbs. There were no significant differences between the N0 and Nx groups. CONCLUSION: This study shows that larger and multi-centric tumors are associated with increased likelihood of CLN mets in DTC. We suggest increased vigilance for CLN mets in tumors >2 cm, multicentric tumors, and patients with elevated TgAbs. ABBREVIATIONS: AJCC = American Joint Committee on Cancer; CLN = cervical lymph node; DTC = differentiated thyroid cancer; FTC = follicular thyroid cancer; mets = metastases; N0 = no cancer in any lymph nodes; N1 = cancer in a lymph node; N1a = cancer in a central compartment lymph node; N1b = cancer in a lateral neck lymph node; Nx = lymph nodes not resected or examined; PTC = papillary thyroid cancer; TgAb = thyroglobulin auto-antibody.