Eggshell calcifications at thyroid ultrasound are connected to the challenging field of thyroid nodules and/or malignancy from a multidisciplinary perspective. Calcifications may be found in malignant and benign tumors; typically, micro-calcifications are identified in the papillary type of cancer, being equivalent to psammoma bodies in the pathological report. The risk of macro- calcifications, however, is more nuanced; recent data suggest a potential connection with a differentiated malignancy as well. Eggshell calcifications, a distinct type of macro-calcification, are generally considered benign findings, especially uninterrupted forms. Yet, the real incidence is not clear, which is why the topic remains open. In this narrative review, we analyzed eggshell calcifications in relationship with cytological diagnosis upon fine needle aspiration and post-thyroidectomy histological report. A PubMed-based search of the English-language papers using several
The harmful effects of smoking cigarettes on human health are well documented; thus various smoking cessation methods have been assessed and new options are currently under development to provide a “better’ alternative to the “worse” one, namely smoking. However, no ideal method of ending or replacing conventional smoking has been developed so far, and actually, none of them has been proven entirely effective or safe. The laxity, or rather the absence of regulations in the first decade of existence of electronic nicotine delivery systems (ENDS) allowed their use with prohibited substances instead of nicotine or other substances with detrimental effect, with the emergence of a severe syndrome - e-cigarette and vaping-associated lung injury (EVALI), whose treatment required even lung transplantation in young people without any prior underlying lung disease. This narrative review aims to provide a brief overview of concerns about medical issues associated with e-cigarette use, particularly cardiovascular and respiratory panels. We organized the data in several micro-sections varying from practical aspects of understanding ENDS to clinical issues. To combat tobacco addiction, electronic cigarettes are increasingly widely accepted. A global regulatory framework is required to prevent the emergence of an illicit e-cigarette business with detrimental impacts on health.
We aim to introduce a 2022 update on CHD (carcinoid heart disease) considering a multidisciplinary perspective. This is a narrative mini-review. We searched English, full-length papers (PubMed). Inclusion criteria: original articles regardless of the level of statistical significance. We identified 44 papers and manually selected those with CHD, as follows: 8 original studies, 1 case series (N=9 patients), 16 case reports (N=1 patient/paper), and a total of 1,030 patients on published studies. The most remarkable results are the longest period of enrolment of 3-4 decades; CHD ratio among carcinoid syndrome of 37%; 30-day mortality post-cardiac surgery of 12%; median survival in CHD from 1.3 to 3.9 years (more than 2 years if valve intervention is provided); most useful prognostic markers: 5HIIA, NT-pro-BNP, but, potentially, chromogranin A. The specific protective role of somatostatin analogs against developing CHD is yet to be determined. CHD in the absence of carcinoid syndrome/liver metastasis may be related to ovarian NEN (neuroendocrine neoplasia) with a better outcome if prompt intervention. Remarkably, 3 guidelines are released regarding CHD on behalf of ENETS (European Neuroendocrine Tumor Society), and ESC (European Society of Cardiology). CHD still represents a most challenging entity situated at the crossroads of surgery, cardiology, oncology, endocrinology, and gastroenterology.
Collision tumors, rare neoplasms underlying two distinct histological types of carcinomas (with different origins) separated by normal tissue, are described in many organs including the thyroid gland, but to a lesser extent. We aim to overview the current published data concerning collision tumors of the thyroid (CTT). This is a narrative review considering papers published on PubMed through a search starting from the terms “collision” and “thyroid”. Inclusion criteria are full-length articles, the English language, the timeline from inception to December 2022, and original studies with different levels of statistical evidence. We followed the main types of thyroid carcinomas: differentiated thyroid carcinoma of papillary and follicular type, anaplastic/ undifferentiated/poorly differentiated carcinoma, respectively medullary thyroid carcinoma. We identified 92 papers based on the mentioned
Melanoma outcome seems different between females and males, with a potential protective role of estrogen (E) through estrogen receptors (ER) expression into the tumor. In the study of ERs, both alfa (ERα) and beta (ERβ) is a well-known endocrine elements in non-melanoma tumors, like mammary and endometrial cancer. Immunohistochemistry (IHC) assessment of melanoma concerning ERs represents a path to explore the tumor profile to provide useful information concerning the prognostic and potential adjuvant treatment. Currently, this is not a routine practice, nor a mandatory step for deciding the medical therapy. Typically, IHCs are based on usual kits for mammary tumors regarding ERs configuration. Prior/concomitant use of oral contraceptives and hormonal replacement therapy is not correlated with a better prognostic in melanoma; neither have they represented a contraindication for survivors of melanoma; a subset of tumors might present a higher ER expression which is potentially targeted by the hormone-based treatment as SERMs (Selective Estrogen Receptors Modulator), for instance, tamoxifen. Experimental studies on melanoma cell lines confirmed the anti-tumor activity of ERβ which might function as a prognostic marker. G-protein-coupled estrogen receptors in melanocytes and keratinocytes might be involved, too. Additional crosstalk of TGF-β (Transforming Growth Factor β), respective IGF1 (Insulin-like Growth Factor), and ERα expression are involved in tumorigenic pathways. Recent preclinical studies showed the potential benefits of diarylpropionitrile, a selective agonist of ERβ; pyrazole derivates 21-23 can block ERs. Murine melanoma models showed the interference of anti-estrogenic medication (like molecule fulvestrant) to enhance immune checkpoint blockade, a modern approach to solid cancers. The proliferation of melanoma might be partially explained by ERs; whether this is generally applicable or there is a subgroup of tumors particularly related to E status is still debatable. The subject of E status in melanoma is far from clear at this point and further studies are necessary concerning this particular issue to implement it as a practical approach in the daily management of a disease that still has a very severe prognostic nowadays.
During COVID-19 era, a special attention was considered for autoimmune disorders (AD), including at thyroid, which are regarded at higher risk knowing that stress and infections might aggravate the pattern of anti-thyroid antibodies as well as thyroid dysfunction. In this study, we aim to analyse how COVID-19 infection influenced the evolution of HT parameters versus patients with HT who did not go through infection. Study design: an observational, bi-centric study in Romania during first 14 months of pandemic. By the end of April 2022, Romania registered 1,047,520 total cases of COVID- 19 infection (a morbidity rate calculated for entire Romanian population of 5.23%) with 27,267 total deaths (a lethality rate of 2.6%) and around 2000 new patients a day. From our database of 2210 HT patients, a number of 386 HT subjects were assessed (14 months). Among them, 33/386 patients had a different form of COVID-19 infection. The prevalence of COVID- 19 infection among HT patients was 9.35% which is statistically significant higher when compare with official ratio for entire Romanian population (a morbidity rate of 5.23%, z = 3.162, p = 0.00033). A feminine prevalence was identified (89.37%, N=31/33), while age was not different between subgroups (average age over 50 y). At the moment of diagnostic, thyroid levels at the diagnostic time was 650 UI/mL in group 1 versus 840 UI/mL in group 2 (both groups had very high ATPO values, normal cut-offs below 34 UI/mL) with not statistical significance difference - of ATPO evolution was undulatory in 74.07% of patients, decreasing - 3.7%, increasing - 11.11%, unmodified (stationary) - 11.11%, similarly with group 2, meaning that ATPOs had the same profile, regardless the fact that some subjects went through COVID-19 infection. The rate of associated AD was 28.24% (N=2210), COVID-group of 42.42%, non-COVID group of 38.53% (z = 0.44, p = 0.66). In our COVID cohort of 33 patients with HT, we registered the following clinical stages of coronavirus infection: 4/33 patients who were asymptomatic; all women, average age: 65.65 years; 2/33 patients with lack of smell and taste; women, over 65 years old; 14/33 patients with mild form; from 31 years old to 70.5 years old (only one man); 10 patients with a moderate form; all women, from 34 to 71 years old; one 87-year-old male with a severe form; one 50-year old female with a very severe form in addition to a hematologic disease and a history of severe allergic reactions; and a single patient (a 68-year-old, obese female with a severe allergic background) died of COVID-19 infection (thus generating a lethality rate of 3.03%). Conclusion. Our study showed a higher prevalence of COVID-19 infection among HT patients. These individuals do not associate increased levels of ATPO or a elevated prevalence of AD when compare with non- COVID – HT group, and have similar age and sex ratio. Whether HT exposes the subjects to coronavirus infection is an open issue.
This study aims to analyze the 25-hydroxyvitamin D (25OHD) corelations with TRab (anti-TSH receptor Antibodies) at baseline and after corections of 25OHD deficit. Method: Prospective, interventional, controled, single-centre, clinical study on 62 patients with active Basedow disease (BD), admitted at C.I. Parhon National Institute of Endocrinology, Bucharest, Romania, between 2013 and 2020. Patients were divided into two groups: one group (N=37) received 2000 IU of daily cholecalciferol and a second one (N=25) without vitamin D supplementation, all subjects being under anti-thyroid drugs (standard guideline therapy). 25OHD and TRab levels were assessed at start and after 6, respective 12 months. Results: Initial evaluation confirmed vitamin D deficiency (mean 25OHD of 18.33±6.45 ng/mL). At start, TRab negatively correlates with 25OHD (N=62, r= -0.22, p=0.08). The decrease in TRab was statistically significant higher in group 1 versus group 2 after 6 months (35.84% versus 3.53%, p=0.03). After 12 months, TRab decreased with 56.28% in group 1, respective 27.16% in group 2 (p=0.03). In group 1, inverse correlation between 25OHD and TRab was consistent at 6 and 12 months. Conclusion: In patients with active BD, TRab values were negatively correlated with 25OHD at baseline and during follow-up. Correction of vitamin D deficiency is correlated with the decrease of TRab levels.
Obesity correlates with a higher risk of fractures in some sites as vertebras, upper arm, and legs. This is a narrative mini-review focused on several key points that link obesity with osteoporosis. Waist circumference may a better predictor of fractures than body mass index (BMI) in obese females. Even obese menopausal women have an extra source of estrogens in fat tissue this actually is not enough to offer a complete protection against osteoporotic fractures. Low levels of testosterone in males induce a higher risk of fall dependent or independent of sarcopenia (which is more evident in elderly). High BMI is correlated with vitamin D deficiency. Obesity is a contributor to muscle damage and decline due to fat accumulation and inefficient fuel utilisation by the muscle, namely sarcopenic obesity, regardless the age. Associated type 2 diabetes mellitus involves bone damage and fracture risk due to glycated proteins of the matrix, the changes of adipokines, increased cortical porosity, high risk of fall because of blood pressure and glycaemia anomalies, visual disturbances, renal and peripheral nerves diabetes-associated conditions etc. The fracture risk is also augmented via fat derived cytokines and chronic inflammation. Even it seems logical that the weight correction though bariatric surgery reduces the fracture risk in obesity, actually data from longitudinal studies pointed that, despite the procedure is life saving, it does not actually protect against osteoporosis which is regarded as a potential long-term complication. A high fracture burden in obesity should increase the level of awareness for practitioners of different medical areas due to multiple levels of complications and to the epidemiological impact of obesity.
Objective. In this pilot study, we aimed to analyze the blood irisin levels in relation to glucose and mineral metabolism assays in menopausal women with non-diabetic altered glucose regulation: impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Methods. This was a prospective, transversal, non-interventional, bi-centric (bi-country) study, between December 2024 and October 2025. Results. The patients (N=47) with IGT (N=21) or IFG (N=26) had a similar age (63±9.24 versus 63.46±8.16years, p=0.856), menopause duration (14.05±9.37 versus 16.76±8.07years, p=0.297), and body mass index with mean values within the obesity range (34.84±5.07 versus 31.34±6.46kg/sqm, p=0.765). Average 25-hydroxyvitamin D showed an insufficiency (28.62±8.09 versus 28.06± 6.99ng/mL). The IGT versus IFG group were found with statistically significantly higher 1-hour glycaemia in the oral glucose tolerance test (207.04±34.72 versus 179.40±33.91mg/dL, p=0.009), 2-hour insulin (101.44±67.26 versus 48.97±34.35 µUI/mL, p=001), fasting insulin (13.00±7.38 versus 8.36±3.96µUI/mL, p=0.008); HOMA-IR (3.53±2.32 versus 2.27±1.17; p=0.21) with mean levels sustaining insulin resistance. Conclusion. Circulating irisin was marginally elevated in the IGT versus the IFG group and positively correlated with body mass index in both. We found no correlation with the glucose profile, but with selective mineral metabolism assays. This pilot study requires an expansion of the sample size to pinpoint the potential practical utility of irisin as a biomarker.
Objective. In this retrospective study, we aimed to analyse bone profile in menopausal women who suffered a low-trauma fall and were found to have an osteoporotic fracture. Methods. This real-life setting included individuals with a fall within the last year before DXA scan [providing bone mineral density (BMD)/T-score], and excluded traumatic falls, prior anti-osteoporosis therapy, diagnosis of osteoporosis, cancers, and bone metabolic diseases. Results. 5-year age-group analysis was statistically significantly different (N=48, p=0.017): in the 70-74 year interval, 75% were in group F (fracture +ve), in the 50-54 year interval, 83.33% were in group nonF (fracture-free). Mineral metabolism assays and bone turnover markers pinpointed a similar profile, except for DXA: femoral neck T-score was lower in group F versus nonF (-1.75±0.72 versus -1.17±0.91, p=0.029). Receiver operating characteristic curve of femoral neck T-score for predicting a fracture showed an area under the curve of 0.691 (p=0.031). Conclusion. Menopausal women with a 1-year fall history with fractures were older, had a longer menopause duration, and had lower femoral neck BMD than fracture-free women. Type 2 diabetes and hypertension had similar prevalence, as did the vitamin D profile and bone turnover markers. Individuals with vertebral fractures (most common types) showed a lower lumbar BMD versus those with non-vertebral fractures.
Background. A novel framework to assess obesity and its complications involves the evaluation of fat-derived factors as potential biomarkers of the cardio-metabolic outcome and long-term management. In this exploratory study, we aimed to evaluate microarray-based circulating levels of adiponectin, adipsin, and AgRP in menopausal women with obesity. Methods. This is a pilot, bi-centric study according to a protocol based on Quantibody® Human Obesity Array 3 (RayBiotech, Norcross, GA, USA). Patients with obesity-associated complications (hypertension, diabetes, dyslipidaemia) were excluded. Results. In the study population (N = 24, median age of 60 years) adiponectin correlated with lipocalin-2 (r = 0.943, p = 0.0048) and plasminogen activation inhibitor-1 (r = 0.829, p = 0.0416). Adipsin correlated with inteleukin-8 (r = 0.786, p = 0.0362), and leptin (r = 0.832, p = 0.0008). Conclusion. Apparently healthy obese menopausal individuals present a landscape of circulating adipokines that might be placed in relationship with the inflammatory and coagulation panel, across a complex inter-play. In addition, agouti-related peptide, despite being a well- known central orexigenic factor, might serve as circulating biomarker, too, noting its correlations with interleukin-6 and glycaemia at 120 minute during oral glucose tolerance test.
Objective: Currently, the global epidemiologic impact of obesity requires continuous seeking of practical biomarkers; hence, this current study aimed to address the gap of chemerin assays in obese versus non-obese females and to analyze its circulating levels in relationship with the glucose profile and other circulating adipokines. Methods: This is an exploratory, prospective, cross-sectional analysis in females aged between 50 and 80 years. We excluded individuals with diabetes, cancers, endocrine, kidney, cardiovascular, and bone conditions. Enzyme-linked immunosorbent assay-based circulating adipokines testing was performed. The final analysis was focused on circulating chemerin (ng/mL) in the obese [body mass index (BMI) ≥ 30 kg/sqm] versus non-obese (BMI < 30 kg/sqm) group. Results: The obesity (N=12) versus the non-obesity (N=12) group showed a statistically significantly higher HOMA-IR (p=0.04), fasting insulin (p=0.01), but similar circulating chemerin. Chemerin positively correlated with BMI only in the obesity group (r=0.881, p=0.0039), but not with patients’ age and glucose profile-based features in any group. Chemerin showed a statistically significant positive, strong correlation with VEGF-A level (r=0.857, p=0.0065) and an inverse statistically significant strong association with circulating leptin (r= -0.713, p=0.0092) and circulating IL-12 p40 (r= -0.829, p=0.0416) in the obesity group. Conclusion: As a potential hypothesis-generating analysis, this pilot study showed different statistical results in BMI-based groups, despite the fact that direct comparison of circulating chemerin and even leptin, VEGF-A, and IL-12 p40 did not reach between-group statistical significance. A larger sample size and a multimodal integration of the adipokines panel might serve for practical points in addressing obesity. Citation: Schipor SV, Manda D, Ciobica ML, Sima OC, Preda EM, Ciuche A, et al. Exploratory results of circulating chemerin testing in humans. R. J. Mil. Med. 2026, CXXIX(4): 404-412 https://doi.org/10.55453/rjmm.2026.129.4.6 Academic Editor: Raluca Mititelu
