Spontaneous and Treatment-Related Changes of Serum Calcitonin in Medullary Thyroid Cancer: Long-Term Experience in a Patient With Multiple Endocrine Neoplasia Type 2B.

PURPOSE: Medullary thyroid carcinoma (MTC) in MEN2B syndrome is associated with germline RET mutation. Patients harboring de novo mutations are usually diagnosed at more advanced disease stages. We present a young woman with Met918Th mutation diagnosed with stage IV MTC at age 10 years. METHODS: The disease progressed despite total thyroidectomy and multiple surgical interventions for cervical lymph node recurrences, leading to distant metastases in the fifth year after the initial diagnosis. Subsequently, she underwent five different types of tyrosine kinase inhibitor (TKI) treatments. The 17-year disease course was divided into periods defined by four surgical interventions and sequential treatment intervals with four multikinase (sunitinib, vandetanib, cabozantinib, and lenvatinib) and one RET-selective TKI (selpercatinib). Tumor growth for different phases of spontaneous development and drug treatment intervals was characterized by changes in serial log-transformed calcitonin measurements (n = 114). RESULTS: Three operations (one for calcitonin-producing adrenal pheochromocytoma) were associated with drops in calcitonin levels. All of the nonselective TKIs were stopped due to adverse effects. As reflected by the negative calcitonin doubling rate, the best treatment response was observed with selpercatinib, which was associated with an initial large drop followed by a decreasing calcitonin trajectory over 514 days without any major side effects. CONCLUSION: This case of MEN2B medullary thyroid cancer with long-term survival presents how the effectiveness of different treatment modalities can be estimated using log-transformed calcitonin levels. Furthermore, our experience supports the view that serial calcitonin measurements may be more sensitive than radiological follow-up in advanced MTC. Our patient also represents a new case of rarely reported calcitonin-producing pheochromocytomas.

The chemokine XCL1 functions as a pregnancy hormone to program offspring innate anxiety.

Elevated levels of cytokines in maternal circulation increase the offspring's risk for neuropsychiatric disease. Because of their low homeostatic levels, circulating maternal cytokines during normal pregnancies have not been considered to play a role in fetal brain development and offspring behavior. Here we report that the T/NK cell chemotactic cytokine XCL1, a local paracrine immune signal, can function as a pregnancy hormone and is required for the proper development of placenta and male offspring approach-avoidance behavior. We found that circulating XCL1 levels were at a low pregestational level throughout pregnancy except for a midgestational rise and fall. Blunted elevation in maternal plasma XCL1 in dams with a genetic 5HT1A receptor deficit or following neutralization by anti-XCL1 antibodies increased the expression of tissue damage associated factors in WT fetal placenta and led to increased innate anxiety and stress reactivity in the WT male offspring. Therefore, chemokines like XCL1 may act as pregnancy hormones to regulate placenta development and offspring emotional behavior.

Multiple bronchial carcinoids associated with Cowden syndrome.

Cowden syndrome (CS) is a rare genetic condition due to the various germline mutations in the phosphatase and tensin homologue on chromosome ten (PTEN) tumour suppressor gene. As a result, CS is characterised by an increased risk of developing various benign and malignant tumours, such as thyroid, breast, endometrial and urogenital neoplasms, as well as gastrointestinal tract tumours. However, the neuroendocrine tumour association with CS is not elucidated yet. We present a case of a 46-year-old male patient diagnosed with testicular seminoma and follicular thyroid cancer in his medical history. Our patient met the clinical diagnostic criteria of Cowden syndrome. Genetic analysis established the clinical diagnosis; a known heterozygous PTEN mutation was detected [PTEN (LRG_311t1)c.388 C > T (p.Arg130Ter)]. Incidentally, he was also seen with multiple pulmonary lesions during his oncological follow-up. A video-assisted thoracoscopic left lingula wedge resection and later resections from the right lung were performed. Histological findings revealed typical pulmonary carcinoid tumours and smaller tumorlets. Somatostatin receptor SPECT-CT, 18F-FDG-PET-CT and 18F-FDOPA-PET-CT scans and endoscopy procedures could not identify any primary tumours in other locations. Our patient is the first published case of Cowden syndrome, associated with multifocal pulmonary carcinoids. Besides multiple endocrine neoplasia type 1, we propose Cowden syndrome as another hereditary condition predisposing to multiple pulmonary tumorlets and carcinoid tumours.

Single cell transcriptomic representation of social dominance in prefrontal cortex and the influence of preweaning maternal and postweaning social environment.

Social dominance encompasses winning dyadic contests and gaining priority access to resources and reproduction. Dominance is influenced by environmental factors, particularly during early postnatal life and adolescence. A disinhibitory medial prefrontal cortex (mPFC) microcircuit has been implicated in the expression of dominance in the "tube test" social competition paradigm in mice, but the neuroplasticity underlying dominance is not known. We previously reported that male pups raised by physically active (wheel-running, as opposed to sedentary) dams exhibit tube test dominance and increased reproductive fitness, and here we show that social isolation from weaning also increases dominance. By using single cell transcriptomics, we tested if increased dominance in these models is associated with a specific transcriptional profile in one or more cell-types in the mPFC. The preweaning maternal effect, but not postweaning social isolation, caused gene expression changes in pyramidal neurons. However, both the effect of maternal exercise and social isolation induced the coordinated downregulation of synaptic channel, receptor, and adhesion genes in parvalbumin positive (PV) interneurons, suggesting that development of dominance is accompanied by impaired PV interneuron-mediated inhibition of pyramidal cells. This study may help understand environmentally induced transcriptional plasticity in the PFC and its relationship to tube test dominance.

High prevalence of venous thrombotic events in Cushing's syndrome: data from ERCUSYN and details in relation to surgery.

OBJECTIVE: The aim of this study was to evaluate the prevalence of venous thromboembolism (VTE) in patients included in the European Registry on Cushing's syndrome (ERCUSYN), compare their clinical characteristics with those who did not develop VTE and identify risk factors for VTE. DESIGN: A retrospective observational cohort study. METHODS: Data extraction from the registry was taken on February, 7, 2022. At the time there were 2174 patients diagnosed with Cushing's syndrome (CS) and 95 VTEs were reported in the database. RESULTS: Of 95 VTE events 70 (74%) were in pituitary-dependent CS patients, 12 (12.5%) in adrenal-dependant CS, 10 (10.5%) in ectopic CS, and 3 (3%) in CS due to other causes. Sex, 24-hour urinary free cortisol (UFC) value at diagnosis, as well as the number of operations remained statistically significant predictors of VTE. Of patients who were treated with at least one surgery, 12 (13%) VTE occurred before and 80 (87%) after the surgery. Nearly half of these VTEs occurred within six months since the operation (36; 45%). Over half of the centers that reported VTE did not routinely anticoagulate CS patients. Anticoagulation schemes varied widely. CONCLUSION: Patients with CS have an elevated risk of developing VTE for an extended period of time. From ERCUSYN cohort patients have higher risk for VTE if they need multiple surgeries to treat CS, are males and have high UFC values at the diagnosis of CS. Since there is no agreement on thromboprohpylaxis, a protocol for VTE prevention that is widely adopted appears to be necessary for patients with CS.

The Optimal Choice of Trap Type for the Recently Spreading Jewel Beetle Pests Lamprodila festiva and Agrilus sinuatus (Coleoptera, Buprestidae).

BACKGROUND: Two jewel beetle species native to Europe, the cypress jewel beetle, Lamprodila (Palmar, Ovalisia) festiva L. (Buprestidae, Coleoptera), and the sinuate pear tree borer, Agrilus sinuatus Olivier (Buprestidae, Coleoptera), are key pests of ornamental thuja and junipers and of orchard and ornamental rosaceous trees, respectively. Although chemical control measures are available, due to the beetles' small size, agility, and cryptic lifestyle at the larval stage, efficient tools for their detection and monitoring are missing. Consequently, by the time emerging jewel beetle adults are noticed, the trees are typically significantly damaged. METHODS: Thus, the aim of this study was to initiate the development of monitoring traps. Transparent, light green, and purple sticky sheets and multifunnel traps were compared in field experiments in Hungary. RESULTS: Light green and transparent sticky traps caught more L. festiva and A. sinuatus jewel beetles than non-sticky multifunnel traps, regardless of the larger size of the colored surface of the funnel traps. CONCLUSIONS: Although light green sticky sheets turned out to be optimal for both species, using transparent sheets can reduce catches of non-target insects. The key to the effectiveness of sticky traps, despite their reduced suitability for quantitative comparisons, may lie in the behavioral responses of the beetles to the optical features of the traps.

Microsome Mediated in Vitro Metabolism: A Convenient Method for the Preparation of the PET Radioligand Metabolite [18F]FE-PE2I-OH for Translational Dopamine Transporter Imaging.

Undesired radiometabolites can be detrimental to the development of positron emission tomography (PET) radioligands. Methods for quantifying radioligand metabolites in brain tissue include ex vivo studies in small animals or labeling and imaging of the radiometabolite(s) of interest. The latter is a time- and resource-demanding process, which often includes multistep organic synthesis. We hypothesized that this process could be replaced by making use of liver microsomes, an in vitro system that mimics metabolism. In this study, rat liver microsomes were used to prepare radiometabolites of the dopamine transporter radioligand [18F]FE-PE2I for in vitro imaging using autoradiography and in vivo imaging using PET in rats and nonhuman primates. The primary investigated hydroxy-metabolite [18F]FE-PE2I-OH ([18F]2) was obtained in a 2% radiochemical yield and >99% radiochemical purity. In vitro and in vivo imaging demonstrated that [18F]2 readily crossed the blood-brain barrier and bound specifically and reversibly to the dopamine transporter. In conclusions, the current study demonstrates the potential of liver microsomes in the production of radiometabolites for translational imaging studies and radioligand discovery.

Wide Range of Brachyceran Fly Taxa Attracted to Synthetic and Semi-Synthetic Generic Noctuid Lures and the Description of New Attractants for Sciomyzidae and Heleomyzidae Families.

During field tests implemented in Transcarpathia (West Ukraine) in 2015, 6501 specimens belonging to 26 Brachyceran fly families were collected with traps baited with generic lures (originally developed for noctuid moths) based on fermenting liquid and floral compounds. Isoamyl alcohol-based baits generally attracted more flies than phenylacetaldehyde-based baits and unbaited controls; however, the phenylacetaldehyde-based traps were the most attractive to the Empididae and Milichiidae families. The isoamyl alcohol-based semisynthetic lure showed significant attractivity to the families of Muscidae, Ulidiidae, Sarcophagidae, Calliphoridae, Sciomyzidae, Heleomyzidae, Drosophilidae, Phoridae and Platystomatidae. Additionally, isoamyl alcohol-based semisynthetic lure is the first reported attractant of the Sciomyzidae family. Since our phenylacetaldehyde-based floral lure was also attractive to Heleomyzidae flies, both types of lures can be seen as the first known attractants of this family.

Substrate specificity of human chymotrypsin-like protease (CTRL) characterized by phage display-selected small-protein inhibitors.

Chymotrypsin-like protease (CTRL) is one of the four chymotrypsin isoforms expressed in the human exocrine pancreas. Human genetic and experimental evidence indicate that chymotrypsins B1, B2, and C (CTRB1, CTRB2 and CTRC) are important not only for protein digestion but also for protecting the pancreas against pancreatitis by degrading potentially harmful trypsinogen. CTRL has not been reported to play a similar role, possibly due to its low abundance and/or different substrate specificity. To address this problem, we investigated the specificity of the substrate-binding groove of CTRL by evolving the substrate-like canonical loop of the Schistocerca gregaria proteinase inhibitor 2 (SGPI-2), a small-protein reversible chymotrypsin inhibitor to bind CTRL. We found that phage-associated SGPI-2 variants with strong affinity to CTRL were similar to those evolved previously against CTRB1, CTRB2 or bovine chymotrypsin A (bCTRA), indicating comparable substrate specificity. When tested as recombinant proteins, SGPI-2 variants inhibited CTRL with similar or slightly weaker affinity than bCTRA, confirming that CTRL is a typical chymotrypsin. Interestingly, an SGPI-2 variant selected with a Thr29His mutation in its reactive loop was found to inhibit CTRL strongly, but it was digested rapidly by bCTRA. Finally, CTRL was shown to degrade human anionic trypsinogen, however, at a much slower rate than CTRB2, suggesting that CTRL may not have a significant role in the pancreatic defense mechanisms against inappropriate trypsinogen activation and pancreatitis.

[Macronodular adrenal hyperplasia causing Cushing's syndrome due to ARMC5 gene mutation.] / Cushing-szindrómát okozó macronodularis mellékvese-hyperplasia ARMC5-génmutáció következtében.

Our 69-year-old female patient was investigated for a 20 kg weight gain over 2 years. The patient's medical history included hypertension, hyperuricemia, bilateral cataract surgery and musculosceletal complaints. Diabetes mellitus was not found. Physical examination revealed abdominal obesity, proximal myopathy and atrophic, vulnerable skin. The "overnight", low-dose and long, low-dose dexamethasone suppression tests indicated autonomous cortisol overproduction (plasma cortisol level: 172.6 and 153.2 nmol/L, cut-off: 50 nmol/L). The suppressed ACTH (<1.11 pmol/L, normal value: 1.12-10.75 pmol/L) suggested ACTH-independent hypercortisolism. Abdominal CT described macronodular enlargement of both adrenals. The size of the largest nodule was 23 × 20 mm in the right, and 24 × 30 mm on the left side (with -33 ± 37 HU density values on native scans). The 131I-cholesterol adrenal scintigraphy and SPECT/CT showed almost equally intensive radiopharmacon uptake on both sides. Based on the clinical results, bilateral macronodular adrenal hyperplasia associated with ACTH-independent hypercortisolism was diagnosed. Genomic DNA was obtained from the peripheral blood leukocytes. Targeted sequencing of 25 genes potentially involved in adrenal tumorigenesis revealed a new disease-causing armadillo repeat-containing 5 (ARMC5) gene mutation (c.1724del28 bp, g.31,476,067-31,476,094). Because of the autosomal dominant inheritance of this genetic alteration, the patient's two children underwent genetic screening for the ARMC5 mutation. The same mutation was found in the younger child of our patient. To the best of our knowledge, this is the first published Hungarian case of ARMC5 mutation with bilateral macronodular adrenal hyperplasia and ACTH-independent Cushing's syndrome. The genetic alteration is present in two generations of the family of the index patient. Orv Hetil. 2023; 164(32): 1271-1277.

[Aggressive pituitary adenoma and pituitary carcinoma]. / Agresszív hypophysisadenoma és hypophysiscarcinoma.

Anterior pituitary tumours, once considered benign neoplasms, may rarely have aggressive behaviour and can even metastasize. The current guideline of the European Society of Endocrinology defines aggressive pituitary adenomas as radiologically invasive tumours with an unusually rapid growth rate and frequent relapses despite the optimal use of standard therapies. Currently, there is not any single, well-defined pathological marker of malignancy. Pituitary carcinomas are thus clinically defined by the presence of craniospinal or distant metastases, typically developing several years after the first presentation. Histopathology may predict aggressive behaviour if the Ki67 index and mitotic rate are elevated and in case of positive p53 staining. These patients' short- and long-term therapy should be individualized and regularly discussed by a multidisciplinary pituitary team. Besides standard medical treatment administered in maximally tolerated doses, current recommendations suggest repeated surgery and radiotherapy. If this approach fails, the next choice of treatment is chemotherapy with temozolomide. After that, immune checkpoint inhibitors, bevacizumab, and peptide receptor radiotherapy are emerging therapies that should be used on a case-by-case basis. Orv Hetil. 2023; 164(30): 1167-1175.

Nontarget catches of traps with chemical lures may refer to the flower-visitation, probable pollination, and feeding of bush crickets (Ensifera: Tettigoniidae).

The diurnal bees, lepidopterans, and other pollinators are among the most studied flower-visiting insect taxa. They mostly play distinct functions in temperate grasslands and ecotones of grassland-forest mosaics (such as in forest steppes). Although orthopterans are widely distributed in these habitats, however, their flower visitation is nearly unknown, especially in the temperate zone. During the development of traps with chemical lures to catch Lepidoptera pests, large numbers of Orthoptera were caught that provide a chance for studying the flower visitation and odor and indirectly the host plant preference of seven temperate zone Tettigoniidae species. Data on the attractivity of isoamyl alcohol-based semisynthetic lures for Meconema thalassinum and efficiency of phenylacetaldehyde-based lures on Leptophyes albovittata and Phaneroptera falcata were reported for the first time. Additionally, analysis of nature photos collected from internet sources, as part of a passive citizen science also supports the revealed preference of these species. Based on photos, the studied orthopterans mainly visit Asteraceae species including the most preferred Tanacetum vulgare, Pulicaria dysenterica, Achillea millefolium, Solidago canadensis, and Centaurea scabiosa. Based on catches of volatile traps, the first data were recorded on the attractivity of phenylacetaldehyde- and isoamyl alcohol-based lures on three temperate zone Orthoptera species. Results of a passive citizen science study strengthen these results that may increase the knowledge on the host plant and habitat preference of Orthoptera species.

Field attraction of Eurydema ornata (Hemiptera: Pentatomidae) to allyl isothiocyanate.

Several Eurydema species (Hemiptera: Pentatomidae) are considered as pests, however, reports on their chemical ecology are scarce. In the current study we focused on Eurydema ornata (Linnaeus) a pentatomid pest of several brassicaceous crops. Since the species is known to feed preferably on generative parts of plants, a series of floral and green leaf volatiles were tested by electroantennography and compounds eliciting remarkable responses were also tested in the field. Three compounds elicited the most outstanding responses from antennae of E. ornata: allyl isothiocyanate, phenylacetaldehyde and ± linalool. Field experiments were conducted in Hungary between 2017 and 2021 to test the potential attractive effects of the compounds. Three Eurydema species were caught in the experiments E. ornata, E. oleracea (Linnaeus) and E. ventralis Kolenati. In the experiments combinations containing allyl isothiocyanate attracted both males and females of E. ornata. The compound was also attractive on its own, in a positive, dose-dependent manner. When presented alone, neither phenylacetaldehyde nor ± linalool was attractive to the species, furthermore, addition of these compounds to allyl isothiocyanate did not affect attraction considerably. To our knowledge this is the first demonstration of field attration of an Eurydema species to a semiochemical and one of the few reports on trapping of a pentatomid species with a synthetic plant volatile in the field. Perspectives regarding research and potential practical applications are discussed in the paper.

Ultrasound examination of the teat parameters of mastitis and healed udder quarters.

A healthy udder is important for economical and hygienic milk production. In this study we determined the teat parameters, measured during milking, in the presence of mastitis and after its recovery. The length of the streak canal, the area of the teat end and the area of the pars papillaris of 52 Holstein-Friesian cows were examined by ultrasound before, immediately after, and two hours after milking. Pars papillaris size before milking was higher in the presence of disease (P = 0.011), but was larger before and two hours after milking (P = 0.047 and P = 0.024) with more severe mastitis. During mastitis and recovery, the dimensions of the streak canal (P=0.056-0.934) and teat end (P=0.156-0.420) did not differ from each other. The obtained results show that during mastitis, coagulated milk dilates the pars papillaris better (P=0.011) than the higher milk production of the cured cow. After more severe mastitis, regeneration of the pars papillaris as well as post-milking regeneration also takes place more slowly. The size and size changes of the streak canal and teat end are not affected by the presence or healing of the udder inflammation.