Michał Kisiel

Thyroid cancer (TC) is the most commonly diagnosed endocrine malignancy, with rising global incidence. Current diagnostic techniques, including ultrasound and fine-needle aspiration biopsy (FNAB), often yield inconclusive results, leading to unnecessary thyroidectomies for benign nodules. Improving preoperative risk stratification using non-invasive methods remains an important clinical challenge. This study aimed to develop machine learning (ML) models to enhance the classification of thyroid nodules (TNs) as malignant or benign based solely on selected ultrasonographic features. Data from 5928 patients who underwent thyroidectomy at Wroclaw Medical University (2008–2023) were retrospectively analyzed. Five ultrasonographic features were included: hypoechogenicity, microcalcifications, shape, irregular margins, and vascularity. Five ML models – Random Forest, Logistic Regression, Multilayer Perceptron (MLP), Gradient Boosting Machines, and Decision Tree – were trained and evaluated. Model performance was assessed using accuracy, precision, recall, F1 score, specificity, and the area under the receiver operating characteristic curve (ROC-AUC). Feature importance was analyzed to determine the contribution of each variable. Among the evaluated models, Random Forest achieved the highest overall performance, with an accuracy of 0.905, specificity of 0.939, ROC-AUC of 0.843, and recall of 0.616. Nodule vascularity was identified as the most influential predictor, followed by microcalcifications, irregular margins, and hypoechogenicity. ML models based on a limited set of ultrasonographic features can effectively support the non-invasive identification of benign TNs, potentially reducing unnecessary surgical interventions. However, the modest recall underscores that the current approach is insufficient for reliable standalone malignancy detection. Incorporation of additional imaging parameters and cytological data would be necessary to enhance sensitivity and improve clinical applicability.

Diabetic neuropathy is a troublesome complication of diabetes mellitus. It affects about 50% of patients with diabetes and may mask symptoms of ischemic conditions. Sudden blockade in blood flow to the limb known as acute limb ischemia (ALI) is a life-threatening disease associated with peripheral artery disease (PAD). Diabetes mellitus predisposes both to ALI and PAD, while also delaying recognition due to diabetic peripheral neuropathy. We report a case of a patient with poorly controlled type 2 diabetes and atrial fibrillation who presented a rare occurrence of painless acute upper limb ischemia. Despite two embolectomies with positive revascularization, ischemia progressed, leading to amputation. In the article we discuss management of the patient and the case’s similarity to diabetic foot disease. Our case report highlights the importance of vigilance against diabetes-related complications, which may manifest unusual symptoms and thus mask other dangerous ailments.

Plants produce an extensive repertoire of secondary metabolites, developed over evolutionary time to support survival. Among these, D-limonene, a monoterpene exuded by citrus fruits, has demonstrated a broad range of pharmacological activities. This review elucidates limonene’s biological versatility, spanning antioxidant, anti-inflammatory, antitumor, antidiabetic, neuroprotective, and gastroprotective domains. Synthesizing data from both preclinical and early-phase clinical research, we explore its molecular mechanisms, ranging from reactive oxygen species mitigation and apoptosis induction to metabolic remodeling and neurotransmitter modulation. Special attention is given to limonene’s emerging role in oncological therapeutics, notably in breast and liver cancers, and its capacity to ameliorate pathophysiological hallmarks of diabetes and neurodegeneration. Its low toxicity and high bioavailability support its potential as a safe adjunct or alternative in phytotherapy. This review advocates for continued investigation into limonene’s translational potential across a spectrum of neoplastic and non-neoplastic diseases.

Several molecular pathways are likely involved in the regulation of cancer stem cells (CSCs) via Ras-associated C3 botulinum toxin substrate 2, RAC2, and pituitary tumor-transforming gene 1 product, PTTG1, given their roles in cellular signaling, survival, proliferation, and metastasis. RAC2 is a member of the Rho GTPase family and plays a crucial role in actin cytoskeleton dynamics, reactive oxygen species production, and cell migration, contributing to epithelial–mesenchymal transition (EMT), immune evasion, and therapy resistance. PTTG1, also known as human securin, regulates key processes such as cell cycle progression, apoptosis suppression, and EMT, promoting metastasis and enhancing cancer cell survival. This article aims to describe the molecular pathways involved in the proliferation, invasiveness, and drug response of cancer cells through RAC2 and PTTG1, aiming to clarify their respective roles in neoplastic process dependencies. Both proteins are involved in critical signaling pathways, including PI3K/AKT, TGF-β, and NF-κB, which facilitate tumor progression by modulating CSC properties, angiogenesis, and immune response. This review highlights the molecular mechanisms by which RAC2 and PTTG1 influence tumorigenesis and describes their potential and efficacy as prognostic biomarkers and therapeutic targets in managing various neoplasms.

Obesity often coexists with thyroid diseases, and the prevalence of these disorders has been on the rise for years. While hypothyroidism can contribute to excess fat tissue, the relationship between Body Mass Index (BMI) and thyroid function hormones is bidirectional. Research confirms that fat tissue reduction can positively impact thyroid function. Thus, delaying the initiation of therapies beyond substitution treatment to achieve optimal weight reduction in individuals with thyroid dysfunction seems unwarranted. The authors summarize current knowledge on this topic in the article.

Background: The accurate preoperative diagnosis of TC plays a very important role in the selection of an appropriate treatment strategy. In addition to the hypoechogenicity of thyroid lesions on ultrasound and the presence of microcalcifications or high cell atypia on FNAB, highlighting the features of laterality and focality and ascertaining their influence (alone or combined) on TC staging and appropriate treatment are crucial. Materials and Methods: A retrospective analysis of the clinical data of 697 patients admitted to the study center between 2008 and 2023 was conducted. Preoperative data (age, sex, type of surgery, ultrasound, and FNAB data) and postoperative histopathological data indicating TC advancement (pTNM, extrathyroidal extension, vascular invasion) were collected and analyzed. Patients presenting well-differentiated TCs (papillary TC and follicular TC) were isolated for better clinical evaluation. Finally, patients were divided into four groups according to their laterality and focality features, and the influences of combinations of these features on TC advancement were analyzed. Results: The largest group included patients with unilateral and solitary TC (n = 461). This group had the lowest rate of negative prognostic features: extrathyroidal extension, lymph node invasion, distant metastases, and vascular invasion (25.81%, 19.96%, 3.69%, and 26.46%, respectively). In contrast, the group with bilateral and multifocal TC (n = 40) presented the highest percentages of the mentioned features (82.50%, 82.50%, 7.50%, and 77.50%, respectively). All the results were statistically significant (p < 0.0001). Conclusions: Laterality and focality features may be important parameters in the management of TC and should be accurately determined. These features should be combined and a more aggressive treatment method should be selected to reduce the reoperation rate.

Obesity often coexists with thyroid diseases, and the prevalence of these disorders has been on the rise for years. While hypothyroidism can contribute to excess fat tissue, the relationship between Body Mass Index (BMI) and thyroid function hormones is bidirectional. Research confirms that fat tissue reduction can positively impact thyroid function. Thus, delaying the initiation of therapies beyond substitution treatment to achieve optimal weight reduction in individuals with thyroid dysfunction seems unwarranted. The authors summarize current knowledge on this topic in the article.

Background/Objectives: Old age and illnesses can limit physical activity (PA). We have assessed the level of PA and its limitations in older people with diabetes (DM). Methods: Cross-sectional study, period: January and June 2024, place: Diabetes Center, subjects: patients (N = 207) > 64 years with DM), Surveying using: IPAQ, Accompanying Survey (AS). The significance was assessed by: Student’s t-test, Mann–Whitney U test, Pearson’s test. The relationships between the IPAQ and the AS results were analyzed based on a meta-analysis model for variable effects, OR with a 95% CI. ROC curve was used to determine the threshold values for age, BMI. Correlations between selected key variables were evaluated using the PCA. Results: The median age: 72 years (65–87), BMI: 28.70 (18.61–49.69). The median PA level: 1837 MET-min/week (0–9.891). The individuals who obtained insufficient (n = 28), sufficient (n = 75), and high levels of PA (n = 53) were 17.95%, 48.08%, and 33.97%, respectively. Diseases were the main factor limiting PA (53.54%) in patient’s opinion, followed by the lack of a companion or motivation. The meta-analysis found no diseases linked to insufficient PA, but those with BMI > 33.3 and over 75 years old more often had insufficient PA. PCA revealed several characteristics that predispose individuals to insufficient PA. Conclusions: People over 75 years of age tend to avoid PA more than younger seniors, leading to its insufficient level, similarly like higher BMI. The individual with DM who has an insufficient level of PA is typically a single, woman, over 75, BMI > 33.

Background: Old age and illnesses can limit physical activity (PA). Objectives: To assess the level of PA and its limitations. Design: Cross-sectional study, January and June 2024. Setting: Diabetes Center. Subjects: Patients (N=207) >64 years with diabetes (DM). Methods: Surveying using: IPAQ, Accompanying Survey (AS). The significance was assessed by: Student’s t-test, Mann-Whitney U test, Pearson’s test. The relationships between the IPAQ and the AS results were analyzed based on a meta-analysis model for variable effects, OR with a 95% CI. ROC curve was used to determine the threshold values for age, BMI. Correlations between selected key variables were evaluated using the PCA. Results: The median age: 72 years (65–87), BMI: 28.70 kg/m2 (18.61–49.69). The median PA level: 1,837 MET-min/week (0–9,891). The individuals who obtained insufficient (n=28), sufficient (n=75), and high levels of PA (n=53) were 17.95%, 48.08%, and 33.97%, respectively. Diseases were the main factor limiting PA (53,54%) in patient’s opinion, followed by the lack of a companion or motivation. The meta-analysis found no diseases linked to insufficient PA, but those with BMI > 33.3 kg/m² and over 75 years old more often had insufficient PA. PCA revealed several characteristics that predispose individuals to insufficient PA. Conclusions: People over 75 years of age tend to avoid PA more than younger seniors, leading to its insufficient level, similarly like higher BMI. The individual with DM who has an insufficient level of PA is typically a single, woman, over 75, BMI>33.

Exosomes and microvesicles bear great potential to broaden therapeutic options in the clinical context. They differ in genesis, size, cargo, and composition despite their similarities. They were identified as participating in various processes such as angiogenesis, cell migration, and intracellular communication. Additionally, they are characterized by their natural biocompatibility. Therefore, researchers concluded that they could serve as a novel curative method capable of achieving unprecedented results. Indeed, in experiments, they proved remarkably efficient in enhancing wound regeneration and mitigating inflammation. Despite immense advancements in research on exosomes and microvesicles, the time for their large-scale application is yet to come. This article aims to gather and analyze current knowledge on those promising particles, their characteristics, and their potential clinical implementations.