Introduction Treating indeterminate thyroid nodules (ITNs) without validated molecular testing (MT) has been challenging. However, adding specific clinical and radiological parameters helps us to decide on treatment for a few individuals. The risk of malignancy in ITN after eliminating the obvious risk parameters needs to be studied. Methods This prospective single‐centre analysis included patients who underwent fine needle aspiration cytology (FNAC) of thyroid between March 2022 and October 2023. The study included patients with thyroid nodules classified as Bethesda III/IV who subsequently underwent surgery. Different clinicopathological and FNAC‐related parameters were statistically analysed to predict malignancy, after excluding those factors that would strongly suggest malignancy. Results Among 1501 patients who underwent FNAC, 207 met the inclusion criteria. The mean age of the study population was 39 ± 12.1 years, and the majority were women (80.2%). Among the ITNs, 86% were Bethesda III, and 14% were Bethesda IV nodules. The risk of malignancy in Bethesda III and IV nodules was 67.4% and 69%, respectively. On multivariate analysis, it was noted that hypothyroidism was the single independent factor that predicted malignancy associated with a significant odds of 0.309 (95%CI:0.127–0.784, p = 0.013). The most common malignancy among ITNs was the follicular variant of papillary thyroid carcinoma. Conclusion Women less than 40 years of age, in this cohort, had a higher risk of malignancy compared to the Western population. More than half of the patients diagnosed with ITN underwent surgery. Hypothyroidism is an independent factor that may predict the risk of malignancy in ITNs, and this needs external validation. Rule‐in MT might be important in categorizing patients with ITN in the Indian population.
Background: Traditional first-trimester screening for chromosomal abnormalities using nuchal translucency (NT), serum biomarkers, and cell-free DNA-based screening still has limitations, particularly for morphology-based early risk enrichment and for abnormalities outside the main autosomal trisomies. This study evaluated a novel 3D ultrasound marker-the choroid plexus-to-lateral ventricle volume ratio (CLVVR)-for detecting fetal autosomal aneuploidies at 11-13(+6) gestational weeks. Methods: In this prospective, case-enriched cohort study, 142 singleton pregnancies (100 euploid and 42 aneuploid) underwent 3D volumetry using Virtual Organ Computer-Aided Analysis (VOCAL). CLVVR was calculated from choroid plexus volume and lateral ventricle volume. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis and compared with a baseline Fetal Medicine Foundation (FMF)-style screening model and an updated model incorporating CLVVR. Results: CLVVR was significantly lower in trisomy 21 (0.317) and trisomy 18 (0.270) than in euploid fetuses (0.458; P < 0.001), whereas no significant differences were observed in sex chromosome or structural chromosomal abnormalities. CLVVR showed good discriminatory performance for autosomal aneuploidies (AUC = 0.928, sensitivity = 91.0%, specificity = 77.5%) and outperformed choroid plexus volume alone. In the external validation analysis, incorporation of CLVVR improved the AUC of the baseline FMFstyle model from 0.927 to 0.959. Intra-and interobserver reproducibility was high (ICC > 0.90). Conclusion: CLVVR appears to be a reproducible, non-invasive morphometric marker for trisomy 21 and trisomy 18 in the first trimester. Its integration into an established screening framework improved discrimination in an external validation analysis, although broader validation is still needed before routine implementation. Plain Language Summary: What is already known about this topic? First-trimester screening combines NT, serum biomarkers, and increasingly cell-free DNA-based screening, but no single approach provides complete early phenotyping of all chromosomal abnormalities and confirmatory invasive testing is still required in screen-positive cases. What does this study add? In this prospective, case-enriched cohort, a 3D ultrasound-derived CLVVR was significantly lower in trisomy 21 and trisomy 18 than in euploid fetuses, outperformed choroid plexus volume alone, and improved discrimination when added to a baseline FMF-style screening model. These findings support CLVVR as a complementary early morphometric marker, while also underscoring the need for cautious interpretation because specificity was moderate and the study was exploratory.
Aim: Stress-induced gastric ulcer (SGU) is an acute gastrointestinal mucosal disorder triggered by psychological or physical stress, featuring mucosal erosion followed by ulceration. Acupuncture-particularly at ST36-demonstrates robust therapeutic efficacy in SGU, establishing this acupoint as the most clinically validated and mechanistically supported target. Purpose: This study directly compares left-sided unilateral versus bilateral electroacupuncture at ST36 in a rat model of stress-induced gastric ulcer, evaluating effects on gastric motility and autonomic nervous system balance (assessed via heart rate variability). Methods: The SGU rat model was established using a modified water-immersion restraint stress protocol. To comprehensively assess the differential therapeutic effects and underlying neurogastrointestinal mechanisms of electroacupuncture (EA), we conducted heart rate variability (HRV) analysis, gastric electrophysiological recordings, and quantitative evaluation of gastric mucosal injury. Results: Unilateral and bilateral electroacupuncture at ST36 similarly improved gastric motility, reduced mucosal injury severity, restored autonomic balance (as quantified by heart rate variability), and normalized gastric slow-wave rhythm and cardiac electrophysiological parameters in SGU rats; the inter-group difference did not reach statistical significance (P > 0.05). Conclusion: Bilateral electroacupuncture at ST36 conferred no significant therapeutic advantage over unilateral electroacupuncture in rats with stress-induced gastric ulcers-despite equivalent improvements in gastric motility, mucosal integrity, and autonomic balance. These findings demonstrate no measurable superiority of bilateral electroacupuncture over unilateral electroacupuncture at ST36 under the current experimental conditions. To formally establish therapeutic comparability-and thereby support clinical translation-future studies must be explicitly designed as equivalence or non-inferiority trials.
Background and Objective: Malnutrition significantly contributes to the adverse prognosis of patients with chronic kidney disease (CKD). The Global Leadership Initiative on Malnutrition (GLIM) criteria were introduced to standardize malnutrition diagnosis globally. This study evaluates the diagnostic performance and agreement of the GLIM criteria compared with the Subjective Global Assessment (SGA) in non-dialysis CKD patients. Methods: In this cross-sectional study, 248 non-dialysis CKD patients (stages G1-G5) were screened using the Nutritional Risk Screening 2002 (NRS-2002). Patients with a score < 3 were classified as well-nourished. Those with a score >= 3 underwent GLIM assessment incorporating phenotypic and etiologic parameters. CKD was operationalized as fulfilling the GLIM disease-burden/inflammation etiologic criterion; therefore, GLIM-based prevalence was interpreted in light of this assumption. Concurrently, all patients were assessed using SGA (the reference standard). Diagnostic agreement was evaluated using Cohen's Kappa, sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC). Multivariable logistic regression identified factors independently associated with GLIM-diagnosed malnutrition. Results: The prevalence of malnutrition was 46.8% by SGA and 49.2% by GLIM. The GLIM framework demonstrated substantial agreement with SGA (Kappa = 0.812, P < 0.001). The GLIM criteria exhibited a sensitivity of 87.9%, a specificity of 84.8%, and an AUC of 0.864 (95% CI: 0.818- 0.910). Malnutrition prevalence increased progressively with advanced CKD stages (P < 0.001). Multivariable analysis revealed that advanced CKD stage, older age, and lower serum albumin were factors independently associated with GLIM-diagnosed malnutrition. Conclusion: The GLIM criteria demonstrate good diagnostic agreement with the SGA in assessing malnutrition among non-dialysis CKD patients. While GLIM provides a standardized and structured framework, longitudinal studies are required to validate its predictive value for clinical outcomes.
Background: Patients with unstable angina (UA) and type 2 diabetes mellitus (T2DM) face a high risk of myocardial infarction (MI) driven by systemic inflammation, immune dyshomeostasis, and metabolic derangements. This study evaluated the prognostic value of the global immune-nutrition-inflammation (GINI) index for predicting MI in this high-risk cohort. Methods: This retrospective, single-center observational study included 212 patients with unstable angina (UA) and type 2 diabetes mellitus (T2DM), stratified into MI (n=58) and non-MI (n=154) groups based on clinical progression. Biochemical assays were conducted to determine serum albumin, C-reactive protein, glycated hemoglobin, and serum lipid parameters. Hematological indices, including absolute neutrophil, lymphocyte, monocyte, and platelet counts, were also quantified. Baseline GINI, systemic immune-inflammation index (SII), pan-immune-inflammation value (PIy), and prognostic nutritional index (PNI) were calculated. Predictive performance was assessed using multivariate logistic regression, receiver operating characteristic (ROC) curve analysis, and tertilebased risk stratification. Results: GINI was significantly elevated in the MI group compared to the non-MI group (1245.7 +/- 315.6 vs 820.5 +/- 210.3, P<0.001) and correlated positively with hs-CRP, fasting glucose, and HbA1c (all P<0.001). Multivariate analysis identified GINI as an independent predictor of MI (OR=1.003, P<0.001). GINI demonstrated superior diagnostic accuracy (AUC=0.842) compared to SII, PIy, and PNI, with an optimal cutoff of 1025.4 yielding 81.0% sensitivity and 76.6% specificity. Furthermore, MI incidence escalated significantly across low, middle, and high GINI tertiles (11.4%, 25.0%, and 45.7%, respectively; P<0.001). Conclusion: GINI is a robust, cost-effective biomarker that integrates inflammatory, immunological, and nutritional statuses. It offers superior prognostic value for the early identification of MI risk in patients with UA and T2DM, facilitating personalized risk stratification and targeted therapeutic interventions.
