Evaluation of the dual vascular supply patterns in ground-glass nodules with a dynamic volume computed tomography

BACKGROUND In recent years,the detection rate of ground-glass nodules(GGNs)has been improved dramatically due to the popularization of low-dose computed tomography(CT)screening with high-resolution CT technique.This presents challenges for the characterization and management of the GGNs,which depends on a thorough investigation and sufficient diagnostic knowledge of the GGNs.In most diagnostic studies of the GGNs,morphological manifestations are used to differentiate benignancy and malignancy.In contrast,few studies are dedicated to the assessment of the hemodynamics,i.e.,perfusion parameters of the GGNs.AIM To assess the dual vascular supply patterns of GGNs on different histopathology and opacities.METHODS Forty-seven GGNs from 47 patients were prospectively included and underwent the dynamic volume CT.Histopathologic diagnoses were obtained within two weeks after the CT examination.Blood flow from the bronchial artery[bronchial flow(BF)]and pulmonary artery[pulmonary flow(PF)]as well as the perfusion index(PI)=[PF/(PF+BF)]were obtained using first-pass dual-input CT perfusion analysis and compared respectively between different histopathology and lesion types(pure or mixed GGNs)and correlated with the attenuation values of the lesions using one-way ANOVA,student’s t test and Pearson correlation analysis.RESULTS Of the 47 GGNs(mean diameter,8.17 mm;range,5.3-12.7 mm),30(64%)were carcinoma,6(13%)were atypical adenomatous hyperplasia and 11(23%)were organizing pneumonia.All perfusion parameters(BF,PF and PI)demonstrated no significant difference among the three conditions(all P>0.05).The PFs were higher than the BFs in all the three conditions(all P<0.001).Of the 30 GGN carcinomas,14 showed mixed GGNs and 16 pure GGNs with a higher PI in the latter(P<0.01).Of the 17 benign GGNs,4 showed mixed GGNs and 13 pure GGNs with no significant difference of the PI between the GGN types(P=0.21).A negative correlation(r=-0.76,P<0.001)was demonstrated between the CT attenuation values and the PIs in the 30 GGN carcinomas.CONCLUSION The GGNs are perfused dominantly by the PF regardless of its histopathology while the weight of the BF in the GGN carcinomas increases gradually during the progress of its opacification.

Identification of Rhizobia Isolated from Nodules of Mexican Commercial Soybean Varieties

Rhizobia, crucial for nitrogen fixation in leguminous plants, play a vital role in soybean cultivation. This study, conducted in Mexico, a major soybean importer, aimed to identify bacteria from nodules of five soybean varieties in high-production regions. Multilocus sequence analysis (MLSA) was employed for enhanced species resolution. The study identified six Bradyrhizobium species: Bradyrhizobium japonicum USDA 110, Bradyrhizobium japonicum USDA 6, Bradyrhizobium elkanii USDA 76, Bradyrhizobium neotropicale, Bradyrhizobium lablabi, and Bradyrhizobium icense. Bradyrhizobium japonicum USDA 110 predominated in the soils, displaying symbiotic preference for the Huasteca 400 variety. However, phylogenetic analysis didn't reveal a clear association between strains, soil, and soybean variety. This research sheds light on the diversity of rhizobia in Mexican soybean cultivation, contributing to the understanding of symbiotic relationships in soybean production systems.

Advancements in Medication Rule for Pulmonary Nodules: A Review of Current Research Progress

This paper reviewed the literature on medication rule of pulmonary nodules in recent years. It is found that contemporary doctors pay more attention to regulating Qi, clearing heat and detoxifying, eliminating phlegm, dissolving phlegm and dissipating masses. They use mild drugs, cold and warm treatments in parallel, combining the tastes of pungent, bitterness, and sweetness at the same time. The treatment focuses on the five viscera with emphasis on the lung meridian while also considering the spleen and stomach functions as well as soothing liver stagnation. This information aims to provide some reference for clinical treatment of pulmonary nodules.

Pathological and Clinical Correlation European Union-Thyroid Imaging Reporting and Data System (EU-TIRADS) Classification of Thyroid Nodules in Two University Hospitals in Cotonou

Introduction: Since its creation in 2017 by the European community, the EU-TIRADS classification has enjoyed an excellent reputation in several countries around the world. Indeed, several studies conducted in these countries testify to the effectiveness of this tool for the management of nodular thyroid pathology. However, in Benin, the contribution of this classification has not yet been evaluated. It is therefore to overcome this inadequacy that we undertook this study. Objective: Participate in improving the diagnostic and therapeutic management of thyroid nodules at the CNHU HKM in Cotonou and at the CHUZ in Suru-Léré. Methods: This is a cross-sectional study with retrospective data collection spread over a period of 3 years 5 months, from January 2019 to May 2022 and carried out jointly in the Endocrinology Metabolism Nutrition and ORL-CCF departments of the CNHU HKM of Cotonou and in the ORL-CCF department of the CHUZ of Suru-Léré. The study population consisted of patients who consulted the University Clinic of Endocrinology Metabolism Nutrition, the University Clinic of ORL-CCF of the CNHU-HKM and the University Clinic of ORL-CCF of the CHUZ of Suru-Léré for thyroid nodule and who have had surgery. The study data was collected from patients hospitalization records using a survey form. Results: On ultrasound, according to the EU-TIRADS classification, 56.8% of nodules presented a low risk of malignancy (EU-TIRADS 3) compared to respectively 19.8%;23% and 2.5% of nodules with zero (EU-TIRADS 2), intermediate (EU-TIRADS 4) and high (EU-TIRADS 5) risk of malignancy. Regarding the performance of this classification, it is sensitive in 37.5% of cases and has a specificity of 78.5% with a PPV (Positive Predictive Value) and a NPV (Negative Predictive Value) respectively of 6.6 % and 91.6%. Furthermore, the bivariate correlations revealed that the size of the nodule was significantly associated with the malignancy of the nodule (p = 0.014) and the calculated value of the Yule’s Q coefficient (0.375) reflects a moderate intensity of the connection between the EU-TIRADS and histology. Conclusion: the EU-TIRADS classification, due to its excellent NPV, is of great interest for the management of thyroid nodules at the CNHU-HKM of Cotonou and at the CHUZ of Suru-Léré. In view of this, particular emphasis must be placed on its regular and rigorous use.

Systemic lupus erythematosus in a 15-year-old female with multiple splenic nodules:A case report

BACKGROUND Systemic lupus erythematosus(SLE)is a chronic inflammatory disease primarily affecting young females.SLE can invade any organ,and various forms of splenic invasion have been reported.Manifestations include splenomegaly and splenic infarction,rupture,and calcification.The study encountered a rare case of splenic involvement,with nodules of various sizes without calcifications or ruptures.CASE SUMMARY A 15-year-old girl presented with arthralgia,weight loss,fever,increased levels of inflammatory markers,and positive antinuclear antibody test results.The patient was diagnosed with SLE.She was asymptomatic while taking steroids and hydroxychloroquine.Ten months after discharge,the patient developed a fever and abdominal pain.Lupus enteritis was suspected,and abdominopelvic computed tomography(AP-CT)was performed.There were no specific findings in the gastrointestinal tract,but multiple splenic nodules were observed.Infection or hemangioma was considered;however,no specific radiological findings were observed.A biopsy of the spleen was performed to determine the possibility of malignancy.The histological findings of the spleen included extensive periarteriolar necrosis with hematoxylin bodies and numerous karyorrhectic debris.Based on the biopsy results,the patient was diagnosed with an SLE flare-up and was maintained on high-dose steroids and immunosuppressants.CONCLUSION As disease activity increased,multiple nodules in the spleen that were previously unseen were observed using AP-CT and histologically confirmed.Spleen invasion by SLE can appear in multiple nodular forms and patterns.Therefore,physicians should consider these findings when differentiating these nodules from infections and malignancies.

Treatment of 198 Cases of Thyroid Nodules with Sanying Capsule Combined with Xiaoying Patch

[Objectives]To observe the clinical efficacy of Sanying capsule combined with Xiaoying Patch in treating thyroid nodule(TN).[Methods]Two groups were treated similarly,with 200 cases in the control group undergoing basic treatment for 12 weeks and 198 cases in the observation group receiving Sanying capsule combined with Xiaoying patches for the same duration.The clinical symptoms,number of nodules,diameter of the largest nodule,and maximum reduction of nodules were observed before and after treatment.A control analysis was performed,and the underlying mechanisms were explored.[Results]The primary symptoms of the observation group exhibited a more favorable improvement than those of the control group.Additionally,the number of nodules decreased,the diameter of the largest nodule decreased,and the maximum reduction of nodules decreased in both groups following treatment.However,the observation group demonstrated a more pronounced improvement than the control group(P<0.05).[Conclusions]The combination of Sanying capsule and Xiaoying patch has been demonstrated to be an effective treatment for TN,with a high degree of reliability in terms of safety.

Primary pulmonary meningioma and minute pulmonary meningothelial-like nodules: Rare pulmonary nodular lesions requiring more awareness in clinical practice

In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute pulmonary meningothelial-like nodules,and metastatic pulmonary meningiomas are rare pulmonary lesions.These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations.Herein,we briefly introduce the clinical,imaging,and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.

Analysis of the Prevalence Characteristics of Lung Nodules and Their Influencing Factors in The Health Check-Up Population

Objective: To study the prevalence characteristics of pulmonary nodules and their influencing factors in the health check-up population. Methods: A total of 500 cases of health checkups were selected for the data study to analyze the detection and prevalence characteristics of pulmonary nodules. The influencing factors between the pulmonary nodules group and the no pulmonary nodules group were analyzed. Results: A total of 209 cases were detected, of which there were more males than females, and for female patients, the detection rate increased with age (P < 0.05). The distribution of gender, age, smoking, respiratory symptoms, and exposure to kitchen fumes between the two groups was compared (P < 0.05). The multifactorial analysis concluded that risk factors include, respiratory symptoms, older age, exposure to kitchen fumes, and smoking. In addition, patients who exercised more had a lower risk of developing lung nodules. Conclusion: The detection rate of pulmonary nodules was high in the health check-up population and the influencing factors analyzed involved the presence of respiratory symptoms, older age, kitchen fume exposure, and smoking, while the positive influencing factor was increased exercise.

Pathological diagnosis and immunohistochemical analysis of minute pulmonary meningothelial-like nodules:A case report

BACKGROUND Minute Pulmonary Meningothelial-like Nodules(MPMNs)are rare benign pulmonary nodules,which are more common in elderly women and have a higher detection rate in lung tissues of patients with lung malignant diseases.Its origin is not yet clear.At present,there are few reports on the diagnostic methods such as imaging and pathological manifestations of MPMNs.This article reports a 70-year-old female patient with pulmonary adenocarcinoma combined with MPMNs and reviews of the relevant literature.CASE SUMMARY A 70-year-old women was admitted to our institution with feeling sour in her back and occasional cough for more than 2 mo.Computerized electronic scanning scan and 3D reconstruction images in our institution showed there were multiple ground-glass nodules in both of her two lungs.The biggest one was in the apicoposterior segment of left upper lobe,about 2.5 mm×9 mm in size.We performed thoracoscopic resection of the left upper lung apicoposterior segment of the patient,and the final pathological report was minimally invasive adenocarcinoma.Re-examination of high resolution computed tomography 21 mo after surgery showed multiple ground-glass nodules in both lungs,and a new groundglass nodule was found in the superior segment of the right lower lobe.We took pathological biopsy of the right upper lung and right lower lung nodules for the patient under thoracoscopy.The histomorphology of the right lower lobe nodule showed multiple lesions in the lung tissue,and the small foci in the alveolar septum were distributed in mild form of the aggregation of short spindle cells.The immunohistochemistry showed that the lesion was epithelial membrane antigen(EMA)(+),somatostatin receptor 2a(SSTR2a)(+),S-100(-),chromogranin A(-),Syn(-),cytokeratin(-)and HMB-45(-).The final diagnosis was minimally invasive adenocarcinoma,accompanied by MPMNs.We recommend that patients continue to receive treatment after surgery and to do regular follow-up observations.CONCLUSION The imaging manifestations of MPMNs are atypical,histomorphology and immunohistochemistry can assist in its diagnosis.This article reviews the relevant literature of MPMNs immunohistochemistry and shows that MPMNs are positive for EMA,SSTR2a,and progesterone receptor.

Increased Prevalence of Thyroid Nodules Across Nearly 10 Years in Shanghai,China

Objective This study aimed to determine whether the prevalence of thyroid nodules(TNs)increased due to modern lifestyles or other factors,despite the advances in screening and diagnostic tools.Methods This study included 3474 pairs of participants,who were matched by gender and age(±3 years)from two cross-sectional sampling surveys:(1)the program on the iodine nutritional status and related health status of residents in Shanghai in 2009;(2)the thyroid disease screening program for adults in Shanghai between 2017 and 2018.The prevalence of TNs and thyroid diseases in 2009 and 2017–2018 were compared,and the potential risk factors of TNs were detected.Results The prevalence of TNs in 2009 was 28.9%:22.5%in males and 34.5%in females.In 2017,this increased to 43.8%:37.9%in males and 49.1%in females.The prevalence of TNs significantly increased from 2009 to 2017(odds ratio,1.486;95%confidence interval,1.238–1.786).In addition,female gender,thyroid disease history,and age were the main risk factors for TNs after adjusting for confounders in the logistic regression across the time period.Conclusion The prevalence of TNs significantly increased across nearly 10 years in Shanghai.

CTCs Detection and Whole-exome Sequencing Might Be Used to Differentiate Benign and Malignant Pulmonary Nodules

Background and objective Low-density computed tomography(LDCT)improved early lung cancer diagnosis but introduces an excess of false-positive pulmonary nodules data.Hence,accurate diagnosis of early-stage lung cancer remains challenging.The purpose of the study was to assess the feasibility of using circulating tumour cells(CTCs)to differentiate malignant from benign pulmonary nodules.Materials and methods 122 patients with suspected malignant pulmonary nodules detected on chest CT in preparation for surgery were prospectively recruited.Peripheral blood samples were collected before surgery,and CTCs were identified upon isolation by size of epithelial tumour cells and morphological analysis.Laser capture microdissection,MALBAC amplification,and whole-exome sequencing were performed on 8 samples.The diagnostic efficacy of CTCs counting,and the genomic variation profile of benign and malignant CTCs samples were analysed.Results Using 2.5 cells/5 m L as the cut-off value,the area under the receiver operating characteristic curve was of 0.651(95%confidence interval:0.538-0.764),with a sensitivity and specificity of 0.526 and 0.800,respectively,and positive and negative predictive values of 91.1%and 30.3%,respectively.Distinct sequence variations differences in DNA damage repair-related and driver genes were observed in benign and malignant samples.TP53 mutations were identified in CTCs of four malignant cases;in particular,g.7578115T>C,g.7578645C>T,and g.7579472G>C were exclusively detected in all four malignant samples.Conclusion CTCs play an ancillary role in the diagnosis of pulmonary nodules.TP53 mutations in CTCs might be used to identify benign and malignant pulmonary nodules.

Clinical and Pathological Research Status of Multiple Pulmonary Nodules

With the changes in disease spectrum and the popularization of screening of low-dose spiral CT (CT) in the chest, more and more pulmonary nodules have been detected, most of which are bipulmonary multiple nodules. The existence of multiple pulmonary nodules means that it may be a pathological state of benign and malignant co-existence. The origin and evolution of pulmonary nodules in different histopathological states have a great impact on the choice of treatment methods. In recent years, the rise of immunotherapy has brought a breakthrough in the treatment of refractory lung cancer. However, some patients are still ineffective in immunotherapy, which may be related to the immune microenvironment where nodules are proportioned in different components in different pathological states. This review article mainly predicts the development process of nodules by analyzing the origin of multiple pulmonary nodules and the immune microenvironment of nodules in different pathological conditions, so as to provide guidance for clinical treatment.

Genetic susceptibility loci of lung cancer are associated with malignant risk of pulmonary nodules and improve malignancy diagnosis based on CEA levels

Objective:The heightened prevalence of pulmonary nodules(PN)has escalated its significance as a public health concern.While the precise identification of high-risk PN carriers for malignancy remains an ongoing challenge,genetic variants hold potentials as determinants of disease susceptibility that can aid in diagnosis.Yet,current understanding of the genetic loci associated with malignant PN(MPN)risk is limited.Methods:A frequency-matched case-control study was performed,comprising 247 MPN cases and 412 benign NP(BNP)controls.We genotyped 11 established susceptibility loci for lung cancer in a Chinese cohort.Loci associated with MPN risk were utilized to compute a polygenic risk score(PRS).This PRS was subsequently incorporated into the diagnostic evaluation of MPNs,with emphasis on serum tumor biomarkers.Results:Loci rs10429489G>A,rs17038564A>G,and rs12265047A>G were identified as being associated with an increased risk of MPNs.The PRS,formulated from the cumulative risk effects of these loci,correlated with the malignant risk of PNs in a dose-dependent fashion.A high PRS was found to amplify the MPN risk by 156%in comparison to a low PRS[odds ratio(OR)=2.56,95%confidence interval(95%CI),1.40−4.67].Notably,the PRS was observed to enhance the diagnostic accuracy of serum carcinoembryonic antigen(CEA)in distinguishing MPNs from BPNs,with diagnostic values rising from 0.716 to 0.861 across low-to high-PRS categories.Further bioinformatics investigations pinpointed rs10429489G>A as an expression quantitative trait locus.Conclusions:Loci rs10429489G>A,rs17038564A>G,and rs12265047A>G contribute to MPN risk and augment the diagnostic precision for MPNs based on serum CEA concentrations.

Formation of FeNi metal nodules in the Jilin H5 chondrite,the largest stone meteorite in the world

The Jilin H5 chondrite, the largest known stony meteorite in the world, with its No.1 fragment weighing1770 kg. It contains submillimeter-to centimeter-sized FeNi metal particles/nodules. Our optical microscopic and electron microprobe analyses revealed that the formation of metal nodules in this meteorite is a complex and long-term process, The early stage is the thermal diffusion-caused migration and concentration of dispersed metallic material along fractures to form root-hair shaped metal grains during thermal metamorphism of this meteorite. The later two collision events experienced by this meteorite led to the further migration and aggregation of metallic material into the shock-produced cracks and openings to form largersized metal grains. The shock-produced shear movement and frictional heating occurred in this meteorite greatly enhanced the migration and aggregation of metallic material to form the large-sized nodules. It was revealed that the metal nodule formation process in the Jilin H5 chondrite might perform in the solid or subsolidus state, and neither melting of chondritic metal grains nor shock-induced vaporization of bulk chondrite material are related with this process.

Nodule Detection Using Local Binary Pattern Features to Enhance Diagnostic Decisions

Pulmonary nodules are small, round, or oval-shaped growths on the lungs. They can be benign (noncancerous) or malignant (cancerous). The size of a nodule can range from a few millimeters to a few centimeters in diameter. Nodules may be found during a chest X-ray or other imaging test for an unrelated health problem. In the proposed methodology pulmonary nodules can be classified into three stages. Firstly, a 2D histogram thresholding technique is used to identify volume segmentation. An ant colony optimization algorithm is used to determine the optimal threshold value. Secondly, geometrical features such as lines, arcs, extended arcs, and ellipses are used to detect oval shapes. Thirdly, Histogram Oriented Surface Normal Vector (HOSNV) feature descriptors can be used to identify nodules of different sizes and shapes by using a scaled and rotation-invariant texture description. Smart nodule classification was performed with the XGBoost classifier. The results are tested and validated using the Lung Image Consortium Database (LICD). The proposed method has a sensitivity of 98.49% for nodules sized 3–30 mm.

Coordinated responses of leaf and nodule traits contribute to the accumulation of N in relay intercropped soybean

Maize(Zea mays L.)-soybean(Glycine max L.Merr.)relay intercropping provides a way to enhance land productivity.However,the late-planted soybean suffers from shading by the maize.After maize harvest,how the recovery growth influences the leaf and nodule traits remains unclear.A three-year field experiment was conducted to evaluate the effects of genotypes,i.e.,supernodulating(nts1007),Nandou 12(ND12),and Guixia 3(GX3),and crop configurations,i.e.,the interspecific row spacing of 45(I45),60(I60),75 cm(I75),and sole soybean(SS),on soybean recovery growth and N fixation.The results showed that intercropping reduced the soybean total leaf area(LA)by reducing both the leaf number(LN)and unit leaflet area(LUA),and it reduced the nodule dry weight(NW)by reducing both the nodule number(NN)and nodule diameter(ND)compared with the SS.The correlation and principal component analysis(PCA)indicated a co-variability of the leaf and nodule traits in response to the genotype and crop configuration interactions.During the recovery growth stages,the compensatory growth promoted soybean growth to reduce the gaps of leaf and nodule traits between intercropping and SS.The relative growth rates of ureide(RGR_U)and nitrogen(RGR_N)accumulation were higher in intercropping than in SS.Intercropping achieved more significant sucrose and starch contents compared with SS.ND12 and GX3 showed more robust compensatory growth than nts1007 in intercropping.Although the recovery growth of relay intercropping soybean improved biomass and nitrogen accumulation,ND12 gained a more significant partial land equivalent ratio(pLER)than GX3.The I60 treatment achieved more robust compensation effects on biomass and N accumulation than the other configurations.Meanwhile,I60 showed a higher nodule sucrose content and greater shoot ureide and N accumulation than SS.Finally,intercropping ND12 with maize using an interspecific row spacing of 60 cm was optimal for both yield advantage and N accumulation.

The MtRGF6 Peptide Differentially Regulates Root Development and Symbiotic Nodulation of Medicago truncatula and Lotus japonicus

Rhizobia induces nitrogen-fixing nodules in legumes used in agricultural production,providing a direct source of combined nitrogen to leguminous crops.Small peptides,such as CLAVATA3/EMBRYO SURROUNDING REGION peptides(CLE),are known to regulate the formation and development of nitrogen-fixing nodules in legumes.Root meristem growth factor(RGF)peptides from Medicago truncatula not only regulate root develop-ment but also modulate nodulation symbiosis with Sinorhizobium meliloti.However,the impact of RGF peptides from one leguminous species on the others remains unclear.In this study,we investigate the effects of the RGF family peptide MtRGF6p from M.truncatula on nodulation symbiosis and root development in Lotus japonicus.The MtRGF6 gene is predominantly expressed in the root nodules of M.truncatula and shows low identity with RGF homologous genes from L.japonicus.The gene promoter is active in the primordia of root nodules and lat-eral roots,as well as in young nodules and roots,and the meristem,infection,and nitrogen-fixing regions of the mature nodule.Chemically synthesized MtRGF6p promoted primary root growth in M.truncatula but sup-pressed the growth of L.japonicus primary roots.The peptide negatively affected the initiation of nodule primor-dia,the formation of infection threads,and nodulation in both legumes,with a low dosage showing effects on L.japonicus compared to M.truncatula.These results suggest that the MtRGF6 peptide from M.truncatula may serve as an inter-species signal affecting the root organ development of L.japonicus.

Diagnostic Value and Misdiagnosis Analysis of Conventional Ultrasonography Combined with Contrast-Enhanced Ultrasonography in Thyroid Nodules

Objective:To explore the diagnostic value of conventional ultrasonography combined with contrast-enhanced ultrasonography in thyroid nodules.Methods:From June 2021 to July 2022,163 patients with thyroid nodules enrolled in our hospital were selected as research subjects.After pathological diagnosis,24 cases were malignant thyroid nodules,and 139 cases were benign thyroid nodules.The diagnosis rate of malignant and benign thyroid nodules was observed and analyzed,with 95%CI.Results:Among them,the malignant and benign detection rates of routine ultrasound were 88.63%and 75.00%,respectively,and the malignant and benign detection rates of contrast-enhanced ultrasound were 81.82%and 81.25%,respectively.The malignant and benign detection rates of conventional ultrasound combined with contrast-enhanced ultrasound were 93.18%and 87.50%,respectively,and the 95%CI was greater than 0.7.Conclusion:Conventional ultrasound combined with contrast-enhanced ultrasound can help improve the diagnostic accuracy of benign and malignant thyroid nodules and reduce the misdiagnosis rate.

Recurrent cyclops lesion after primary resection of fibroreactive nodule following anterior cruciate ligament reconstruction

In this case report featured in World Journal of Orthopedics,Kelmer et al describe a rare finding of a 28-year-old female patient who presented with a recurrent fibroreactive nodule 7 months following the resection of a primary cyclops lesion,suggesting recurrent cyclops syndrome.The patient had undergone an initial anterior cruciate ligament reconstruction for a non-contact right knee injury and reported successful recovery.Two years later,the patient sustained a repeat right knee injury followed by a positive McMurray test and acute pain with terminal extension.Arthroscopic synovectomy confirmed magnetic resonance imaging(MRI)finding of a cyclops lesion,which was surgically removed.Seven months postoperatively,the patient reported stiffness and difficulty with terminal extension.Repeat MRI indicated a recurrent cyclops lesion,which was surgically resected.Following resection of the second lesion,the patient underwent physical therapy and achieved full range of motion,maintaining complete recovery 19 months postoperatively.Recurrent cyclops lesions have rarely been reported in the literature,and this article is novel in its report of recurrent cyclops syndrome following a bone-patellar tendon-bone allograft.The presentation of this unusual finding exposes a need for further investigation of cyclops lesion pathology,which will aid its prevention and treatment.

Prevalence of Thyroid Nodules and Its Relationship with Iodine Status in Shanghai:a Population-based Study

Objective This study was designed to evaluate the prevalence of thyroid nodules（TNs） and its relationship with urine iodine concentrations（UICs） after the regional rapid economic growth and lifestyle changes. Methods A cross-sectional survey was conducted in the general population aged 15-69 years. A questionnaire regarding general and personal characteristics and relevant information was administered. Ultrasonography of the thyroid was performed, and serum triiodothyronine（T3）, tetraiodothyronine（T4）, serum thyroid stimulating hormone（TSH）, free triiodothyronine（FT3）, free tetraiodothyronine（FT4）, thyroglobulin antibody（Tg Ab）, thyroid peroxidase antibody（TPOAb）, and TSH receptor antibody（TRAb） levels were measured for each individual subject. Results The prevalence rates of TNs in the whole population, females and males were 27.76%, 34.04%, and 21.60%, respectively. The prevalence of multiple nodules increased with age, whereas the prevalence peaks differed between males and females. The median UICs in the whole population and females with non-TNs were higher than those of subjects with TNs（P=0.0035, P=0.0068）. The median UICs in subjects with a single TN were higher than those in subjects with multiple TNs（P=0.0164, P=0.0127）. The result showed a U-shaped curve relationship between UIC and prevalence of TNs. The prevalence of TNs was the lowest when the UIC was 140-400 μg/L. Conclusion The prevalence of TNs was nearly 30% and increased with age. The relationship between UIC and prevalence of TNs is U-shaped, with an increase in risk when the UIC was 〈140 μg/L and 〉400 μg/L. Very low or high UIC levels need attention and correction.