Retrospective cohort study on the bilateral occurrence of invasive lobular breast cancer.

OBJECTIVE: Invasive lobular carcinoma (ILC) is the second most common histological subtype of invasive breast cancer, following the no special type (NST) invasive carcinoma. It has historically been assumed that ILC occurs bilaterally in 20-29 % of cases, which has influenced the inclusion of MRI in the standard workup of ILC according to European guidelines. However, challenging this long-held belief regarding the bilateral occurrence of ILC opens up the possibility of revising the guidelines and using MRI only for more specific indications. This study aims to evaluate whether the previously reported high percentage of bilaterality still holds true and to question the added value of MRI in the standard workup of ILC. STUDY DESIGN: A retrospective cohort study was conducted following approval from the institutional review board (EC 21/18/249) at Antwerp University Hospital (UZA). The cohort comprised female patients of all ages who had been diagnosed with either ILC or NST invasive carcinoma and had sought consultation at the UZA breast clinic. A comprehensive database was established to collect information on patient characteristics, imaging, and pathology. RESULTS: A total of 271 patients with ILC were included in the study, with incidence dates ranging from 01/01/2007 to 01/01/2023. Among these patients, a synchronous bilateral ILC lesion was observed in 1.85 % (5/271) of cases. This proportion is significantly lower than the reported percentage of patients with a bilateral lesion in the literature population, which stands at 4.95 %. The reference group consisted of 809 patients with NST invasive carcinoma, with incidence dates ranging from 01/01/2017 to 01/01/2023. In the control group, a synchronous bilateral NST lesion was observed in 3.96 % (32/809) of cases. There is no significant difference in the bilaterality rates between the group of ILC patients and the group of NST patients. Furthermore, MRI did not detect any histopathologically confirmed contralateral ILC lesion that had not already been detected by mammography or ultrasound. CONCLUSIONS: The study results indicate a lower occurrence of bilateral ILC than previously assumed. Additionally, the incidence of synchronous bilateral lesions in ILC patients is not higher compared to patients with NST invasive carcinoma. Performing an MRI does not provide additional value in detecting bilateral carcinomas in ILC. Consequently, it is recommended that the current European guidelines be reassessed, and the indications for undergoing an MRI should be adjusted accordingly.

Literature review on the bilateral occurrence of invasive lobular breast cancer.

Historically, it has been believed that invasive lobular carcinomas (ILC) occur more frequently bilaterally compared to other invasive subtypes, with estimates ranging between 20% and 29%. This study aims to determine if this historical perspective still holds true. A comprehensive literature review was conducted to examine the bilateral occurrence of lobular carcinoma using various imaging methods. Additionally, the role of magnetic resonance imaging (MRI) in detecting contralateral carcinomas was also investigated. A comprehensive search was conducted in the MedLine database on the PubMed platform, resulting in 307 articles published between January 1, 2014, and January 1, 2023. Various selection criteria were applied to identify articles relevant to the research question. After careful assessment, eight articles remained that met the eligibility criteria, all of which provided level-three evidence and were therefore included in the literature review. A total of 599 patients were included in this review, comprising a total of 602 cases of ILC. Six out of the eight articles reviewed provided information on the bilateral occurrence of ILC based on histopathology. A weighted average calculation yielded a bilaterality percentage of 4.95% (24 out of 485 cases). Four articles reported the number of bilateral cases identified through MRI, resulting in a weighted average of 10.2% (26 out of 255 cases). It is worth noting that 20.4% (100 out of 491) of the performed MRIs were found to be either useless or even harmful. Furthermore, MRI led to a change in the treatment plan in 27.7% (136 out of 491) of cases. Overall, it can be concluded that there is limited available data regarding the bilateral occurrence of ILC. The numbers found in the literature are also inconsistent and tend to vary. The literature review revealed a decrease in the percentage of bilaterality compared to historical beliefs. Based on this study, it can be concluded that a high number of MRI scans were found to be either useless or harmful. As a result of this conclusion and a higher sensitivity of other screening modalities, MRI may no longer be indicated as part of the standard workup for ILC. However, further research is necessary to validate these findings.

Not all apparently gynandromorphic butterflies are gynandrous: The case of Polyommatus icarus and its relatives (Lepidoptera: Lycaenidae).

Beside the more than two thousand normal specimens of Polyommatus icarus (Rottemburg, 1775) yielded by rearing experiments, there was one perfectly bilateral dichromatic individual first considered to be gynandrous. On the basis of analysing genitalia traits, wing surface covering scale micromorphology, and the spectral characteristics of the blue colour generated by the cover scales, the gender of the specimen has been identified as female. This exemplar was investigated in comparison with gynandrous specimens from the collections of the Hungarian Natural History Museum exhibiting various degrees of intermixing of blue and brown coloration. Focus stacking microscopy for detailed scale morphology and UV-visible reflectance spectroscopy was used for the characterization of the optical properties. Inspecting literature references and the Lycaenidae collection of the museum, further examples have been found for female bilateral dichromatism in the closely related polyommatine lycaenid species Lysandra bellargus (Rottemburg, 1775) and Lysandra coridon (Poda, 1761) what suggests that polyommatine female dichromaticity may be displayed by the manner of bilaterality and mosaicism, phenomena hitherto solely connected to gynandromorphy.

Profiling Bilateral Skills in High-Performance Male and Female Gaelic Footballers.

Bilateral skill symmetry in sport refers to an individual's ability to successfully perform sporting actions with both sides of the body. Two scarcely researched areas in relation to bilateral skills are the effects of opposition proximity on skill execution and bilateral skill in high-performance female athletes. In this study, we used Nacsport to code all skill executions (hand pass, kick pass, hop, solo and shot) during 121 games by both male and female participants (76 male, 45 female), classified as Tier 1 (n = 181, 134) and Tier 2 (n = 238, 115) high performance, adult Gaelic Football players. Irrespective of the participants' tier group or gender, these players relied upon their dominant side for most skill executions (Kick Pass Dominant Foot Mdn: MT1 = 90%, MT2 = 98.6%, FT1 = 100%, FT2 = 100%; Solo Dominant Foot: Mdn MT1 = 95%, MT2 = 97.3%, FT1: 100%, FT2: 100%; Hand Pass Dominant Hand Mdn: MT1: 83.7%, MT2: 99%, FT1: 95.5%, FT2: 95.5%; Hop Dominant Hand Mdn: MT1: 91.9%, MT2: 94.7%, FT1: 98.1%, FT2: 98.1%; Play Dominant Foot Mdn: MT1: 74.5%, MT2: 94.5%, FT1: 94.7%, FT2: 88.2%). There were no consistent differences between tier groups or genders in relation to dominant side use, but top tier male players were generally less reliant on the dominant limb than were female players from both tiers. In general, top tier male players performed more successfully than either second tier male players or female players in both tiers. Most skills were executed under conditions of low opponent proximity, limiting the requirement for participants to use their non-dominant limbs. These findings illustrate the demands of Gaelic football in relation to bilateral skills, and we identified new research questions for future investigators.

The Impact of Total Tumor Diameter on Lymph Node Metastasis and Tumor Recurrence in Papillary Thyroid Carcinomas.

(1) Introduction: The impact of multifocality/bilaterality on the prognosis of papillary thyroid carcinoma (PTC) is a matter of debate. In order to clarify this debate, several studies have attempted to identify additional parameters associated with poor prognosis, including total tumor diameter (TTD), in the context of multifocal PTCs. In this context, this study was carried out to investigate the impact of TTD on tumor recurrence and lymph node metastasis (LNM) in PTCs. (2) Materials and Methods: The sample of this single-center retrospective study consisted of 706 patients diagnosed with PTC. TTD was calculated as the sum of the largest diameters of tumor foci in multifocal tumors. The resulting TTDs were grouped into TTDs ≤ 10 mm, TTDs > 10 mm, TTDs ≤ 20 mm, and TTDs > 20 mm, using 10 mm and 20 mm as cutoff values. (3) Results: There was no significant difference between multifocal papillary microcarcinomas (PTMCs) with a TTD of >10 mm and unifocal PTCs with a primary tumor diameter (PTD) of >10 mm except for advanced age and lymphovascular invasion (LVI). In addition, perineural invasion (PNI) and TTD > 10 mm were found to be significant risk factors for LNM, and PNI, TTD > 10 mm, TTD > 20 mm, and bilaterality were found to be significant risk factors for recurrence. LVI, and TTD > 10 mm were found to be independent significant predictors for recurrence, and LVI and extrathyroidal extension (ETE) were found to be independent significant predictors for LNM. (4) Conclusions: Considering TTD > 10 mm in recurrence risk categorization models and adopting a clinical approach that takes into account multifocal PTMCs with TTD > 10 mm along with unifocal PTCs with PTD > 10 mm may be more useful in terms of clinical management of the disease.

Bilaterality as a Risk Factor for Recurrence in Papillary Thyroid Carcinoma.

Previous studies suggested that the multifocality of papillary thyroid carcinoma (PTC) would increase the risk of recurrence; however, the impact of its bilaterality remains unclear. Between 2011 and 2018, 1258 patients with PTC underwent total thyroidectomy at Ewha University Medical Center. The 5-year recurrence-free survival rate was 95.7% in patients with bilateral PTC, while those with unilateral multifocal PTC and a unifocal tumor showed a 5-year event-free survival rate of 97.0% and 97.8%, respectively (p = 0.004). A multivariable Cox proportional hazards model indicated that bilaterality (HR 2.550, 95% CI 1.354-4.800), male sex (HR 2.010, 95% CI 1.007-4.013), and tumor size (HR 1.748, 95% CI 1.316-2.323) were associated with recurrence, although unilateral multifocality did not increase the risk of recurrence (HR 1.211, 95% CI 0.348-4.213). In conclusion, bilaterality was associated with aggressive features, including tumor size and microscopic ETE. Moreover, bilaterality was an independent predictor of recurrence in patients with PTC. Patients with bilateral PTC might require careful treatment and follow-up approaches.

Analysis of Bilaterality and Symmetry of Posterior Staphyloma in High Myopia.

The purpose of this study was to examine bilaterality and symmetry of posterior staphyloma (PS) in high myopic eyes. Methods: This cross-sectional and non-interventional study assessed 473 high myopic eyes [axial length (AL) ≥ 26 mm] of 259 patients. Patients underwent an ophthalmological examination including multimodal-imaging and myopic maculopathy grading according to Atrophic/Tractional/Neovascular (ATN) system, presence and subtype of PS, and severe pathologic myopia (PM). Bilaterality of PS and subtype's symmetry between eyes of the same patient was assessed. Four groups were analyzed: (1) bilateral vs. unilateral PS's eyes. Within bilateral group, symmetric vs. asymmetric subtypes according to (2) Curtin's classification, (3) Ohno-Matsui's classification, and (4) primary/compound subtypes. Results: Out of the total, 334 myopic eyes of 167 patients were included. The 92.8% (n = 310/334) of the eyes presented PS and was bilateral in 85.6% (n = 143/167) of the patients. Bilateral eyes showed significantly (p < 0.01) greater AL, severe PM, A and N components vs. unilateral PS. AL-difference between both eyes was greater in unilateral PS (p < 0.01). Among bilateral PS, the subtype was symmetric in 79 (55.2%), 84 (58.7%), and 115 (80.4%) patients according to Curtin's classification, Ohno-Matsui's classification, and primary/compound; respectively. The asymmetric group presented worse best-corrected visual acuity (p < 0.01), higher AL (p < 0.01), incidence of PM, and severe PM (p < 0.05). Conclusions: PS was bilateral in most of the patients without clinical differences between both eyes, being symmetrical in more than half of bilateral cases. Patients with bilateral PS showed higher myopic maculopathy, AL, and incidence of severe PM than unilateral PS.

Clinical Implication of Bilateral and Unilateral Multifocality in Papillary Thyroid Carcinoma: A Propensity Score-Matched Study.

Papillary thyroid cancer (PTC) is commonly characterized by multifocality, which is associated with aggressive features and a less favorable prognosis. The current study aimed to compare the clinicopathologic characteristics and long-term oncological outcomes of bilateral and unilateral multifocal PTC. The medical records of 1745 patients with multifocal PTC who underwent thyroid surgery at Seoul St. Mary's Hospital were retrospectively reviewed. The clinicopathological characteristics and recurrence rates were compared based on cancer laterality. Further, 357 patients who underwent total thyroidectomy were matched to investigate the recurrence risk and disease-free survival (DFS). Before propensity score matching (PSM), there was no significant difference in the recurrence rate between the bilateral and unilateral multifocal PTC groups. Cancer laterality was not a predictor of DFS based on the Cox regression analyses. However, after PSM, unilateral multifocality was associated with a significantly high risk of recurrence. Similarly, unilateral multifocality was associated with a significantly poor DFS based on the Kaplan-Meier analysis. Compared with bilateral PTC, unilateral multifocal PTC was associated with a poor DFS. A comprehensive preoperative examination should be performed to detect multifocality before the initial surgical intervention for optimal treatment. Postoperative short-term follow-up is recommended for unilateral multifocal PTC for recurrence surveillance.

Should multifocality be an indication for prophylactic central neck dissection in papillary thyroid cancer?

Although multifocality is common in patients with papillary thyroid cancer, its effects on lymphatic metastasis and the necessity of central dissection in the presence of multifocality are still controversial. In our clinic, 258 patients who underwent thyroidectomy between 2015 and 2020 and were found to have papillary thyroid cancer in postoperative pathology reports were analyzed. The tumor characteristics contributing to central lymph node metastasis positivity were evaluated. Lymph node metastases were not significantly increased in the presence of multifocality. In cases with bilateral multifocal tumors, compared to cases with unilateral multifocal tumors, capsular invasion (p = 0.02), vascular invasion (p = 0.01) and cervical lymphatic metastasis (p = 0.004) were observed to increase. Bilateral multifocal tumors have more aggressive clinicopathological features than unilateral tumors. We found that the risk of central lymph node metastasis increased significantly in bilateral multifocal tumors in our study. Prophylactic central lymph node dissection may be considered in patients with no preoperative or intraoperative lymph node metastasis but thought to have a multifocal tumor.

[Recognition and endodontic management of maxillary first premolars with two roots and three canals. bilaterality case report]. / Reconocimiento y manejo endodóntico de primeros premolares maxilares con dos raíces y tres conductos. reporte de caso de bilateralidad.

The ability to recognize the anatomical variations of the root canal system is crucial before starting endodontic treatment, no less important is being able to carry out these treatments based on current scientific evidence. The premolars are the dental pieces with the greatest complexity in their internal anatomy and the ones that appear in the highest percentage compared to other teeth, if a piece presents accessory anatomy, it is highly probable that the contralateral piece presents the same internal anatomy, to this it is known as symmetrical bilaterality, therefore the radiographic images must be executed with proximal and orthoradial projections in order to approximate the 3D shape that these anatomies present and minimize procedural errors. The use of magnification is essential to be able to address the entire root canal system and perform an adequate endodontic treatment. This case report presents the approach to 2 maxillary first premolars from the same patient with 3-canal anatomy, presenting bilateral symmetry.

Risks of central lymph node metastasis in papillary thyroid carcinoma with or without multifocality in at least one lobe: A multi-center analysis.

PURPOSES: To quantitatively predict central lymph node metastasis (CLNM) risks by comparing the clinicopathological features of different multifocal manifestations in papillary thyroid carcinomas (PTC) patients. METHODS: A total of 998 PTC patients from three medical centers were retrospectively analyzed. RESULTS: PTC patients with multifocal lesions in at least one thyroid lobe (MF group) yielded significantly higher CLNM rates than those with unifocal lesions in one or both lobes (UF group). Multifocality in at least one lobe rather than bilateral presence was confirmed to be an independent risk factor of CLNM for PTC patients. Four (age, gender, maximum tumor diameter, and thyroid capsular invasion (TCI)) and three (age, gender, and TCI) factors were proven to be independent risk factors of CLNM for patients within UF and MF groups, respectively. Predictive nomograms were established for these patients based on their respective high-risk factors. The accuracy and validity of these newly-created models were verified using C-index and calibration curves. Patients within UF and MF groups possessing significantly different CLNM risks based on individualized nomogram risk scores were further classified into different subgroups. A detailed CLNM risk stratification flow chart covering all PTC patients was then established. CONCLUSION: A meticulous evaluating system that quantifiesCLNM risk for PTC patients with unifocal lesions in one or both lobes and multifocal lesions in at least one lobe was established.

Predictive Factors for Bilateral Disease in Papillary Microcarcinoma: A Retrospective Cohort Study.

Background: Based on risk stratification, the therapeutic options in papillary microcarcinoma (PTMC) can be active surveillance or surgery. Multifocal tumor occurrence can be decisive in determining the treatment strategy. The objective of this study was to identify risk factors for bilateral tumor occurrence in PTMC to enable individual therapy planning. Methods: A total of 545 PTMC patients who underwent thyroidectomy from 2008 to 2020 were retrieved. Univariate and multivariate analyses were performed to evaluate risk factors for bilateral PTMC. Results: 25.1% (n = 137) of all patients had multifocal PTMC, and 13.2% (n = 72) bilateral PTMC, respectively. In contrast to the maximum tumor size, the total tumor size significantly influenced a bilateral tumor manifestation (median total tumor size 5 mm versus 8.5 mm for bilateral PTMC, p < 0.001). A cut-off level for the total tumor size of >10 mm resulted in a sensitivity and specificity of 29.2% and 94.7%, respectively, in predicting a bilateral tumor manifestation, AUC 0.680 (95% CI, 0.611−0.748, p < 0.001). A cut-off of >4 tumors showed a sensitivity of 99.4% and a specificity of 97.5%, AUC 0.897 (95% CI, 0.870−0.924, p < 0.001) in predicting bilaterality. Conclusion: We could demonstrate for the first time that a total tumor size of >10 mm and more than four tumors significantly increased the risk of bilateral PTMC tumor involvement. These findings enable a risk-adjusted patient treatment.

Single-Cell Transcriptome Analysis Reveals Inter-Tumor Heterogeneity in Bilateral Papillary Thyroid Carcinoma.

Background: The tumor microenvironment (TME) plays a pivotal role in cancer progression in papillary thyroid carcinoma (PTC), yet the composition and the phenotype of cells within the TME in bilateral PTC are poorly understood. Methods: We performed unbiased transcriptome-wide single-cell RNA sequencing (scRNA-seq) analysis on 29,561 cells from 3 pairs of bilateral PTC and 1 non-tumor thyroid sample. The results of the analysis were validated by a large-scale bulk transcriptomic dataset deposited in The Cancer Genome Atlas (TCGA) database. Results: Our integrative analysis of thyroid follicular cells revealed 42 signaling pathways enriched in malignant follicular cells, including cytokine-cytokine receptor interaction, PI3K/Akt signaling pathway, mitogen-activated protein kinase (MAPK) signaling pathway, and tumor necrosis factor (TNF) signaling pathway. A 6-gene signature (CXCL3, CXCL1, IL1A, CCL5, TNFRSF12A, and IL18) in the cytokine-cytokine receptor interaction pathway was constructed to predict the prognosis of patients with PTC, with high risk scores being associated with decreased overall survival [hazard ratio (HR) = 3.863, 95% CI = 2.233-6.682, p < 0.001]. Gene set variation analysis (GSVA) indicated that the pathways enriched in bilateral PTC were significantly different, indicating great heterogeneity in bilateral PTC, even with the same BRAF V600E mutation. Comprehensive analysis of T cells revealed that the proportion of CD8+ tissue-resident memory T cells expressing IFNG decreased in tumor samples with advanced N stage. Within the myeloid compartment, the ratio of suppressive M2-like to pro-inflammatory M1-like macrophages increased with advanced disease stage, which was confirmed in the bulk dataset using transcriptomic profiles. In addition, we also identified numerous biologically critical interactions among myeloid cells, T cells, and follicular cells, which were related to T-cell recruitment, M2-like macrophage polarization, malignant follicular cell progression, and T-cell inhibitory signaling. Conclusion: Our integrative analyses revealed great inter-tumor heterogeneity within the TME in bilateral PTC, which will offer assistance for precise diagnosis and treatment.

Evaluation of functional outcome of bilateral kidney tumors after sequential surgery.

BACKGROUND: There are limited data concerning patients treated with sequential bilateral kidney surgery. Current guidelines still lack an optimal surgical sequencing approach. We evaluated renal functional outcomes after sequential partial nephrectomy (PN) and radical nephrectomy (RN) in patients with bilateral renal cell carcinoma (RCC). METHODS: A propensity score matched cohort of 267 patients (synchronous bilateral RCCs, N = 44 [88 lesions]; metachronous bilateral, N = 45 [90 lesions]; unilateral, N = 178) from two tertiary institutions were retrospectively analyzed. Synchronous bilateral RCCs were defined as diagnosis concomitantly or within 3 months of former tumor. Renal functional outcomes were defined as estimated glomerular filtration rate (eGFR) changes and de novo chronic kidney disease (CKD, stage ≥3) after surgery. Renal functional outcomes and clinical factors predicting de novo CKD were assessed using descriptive statistics and Cox regression analysis. RESULTS: In subgroup of bilateral RCCs, patients underwent sequential PN (N = 48), PN followed by RN (N = 8), or RN followed by PN (N = 25). Final postoperative estimated glomerular filtration rates (eGFRs) were 79.4, 41.4, and 61.2 ml/minute/1.73 m2, respectively (p = 0.003). There were significant differences in eGFR decline from baseline and de novo chronic kidney disease (CKD stage ≥ III) among groups, with PN followed by RN group showing the worst functional outcomes (all p <  0.05). Moreover, sequential PN subgroup in bilateral RCC showed significantly higher rate of de novo CKD than unilateral RCC group (13.8% vs. 6.9%, p = 0.016). On multivariate analysis, hypertension (p = 0.010) and surgery sequence (PN followed by RN, p <  0.001) were significant predictors of de novo CKD. CONCLUSIONS: The surgery sequence should be prudently determined in bilateral renal tumors. PN followed by RN showed a negative impact on renal functional preservation. Nephron-sparing surgery should be considered for all amenable bilateral RCCs.

Obesity and Overweight Are Associated with Minimal Extrathyroidal Extension, Multifocality and Bilaterality of Papillary Thyroid Cancer.

Epidemiological studies have shown a strong association between high body mass index (BMI) and papillary thyroid cancer (PTC). We assessed the clinical and histopathological features of PTC in patients with a higher BMI and compared them to analogous parameters in PTC patients with a normal BMI. We retrospectively analyzed 5021 medical records of patients admitted and surgically treated for thyroid tumors in one center between 2008 and 2018. Finally, we extracted data from 523 adult patients with PTC and stratified patients into two groups according to BMI: Group 1 with BMI < 25 kg/m2 and Group 2 with BMI ≥ 25 kg/m2. Data stratification was performed to estimate the association of overweight and obesity with clinical and histopathological features of PTC in both univariable and multivariable binary logistic regression analyses. Overall, compared to patients with a normal BMI, overweight and obese patients had a greater risk of minimal extrathyroidal extension (minimal ETE), multifocality and bilaterality of PTC (p < 0.001 for all). Analysis did not show that BMI was significantly associated with the more advanced tumor-node-metastasis (TNM) stage (p = 0.894). Obesity and overweight were significantly associated with higher aggressiveness of PTC. When considering various management options for PTC patients, these findings regarding overweight and obesity should be taken into consideration during the decision-making process.

Bilaterality and symmetry of c-shaped mandibular second molars in a Mexican Maya and non-Maya population: a CBCT in vivo study / Bilateralidad y simetría de los segundos molares mandibulares en forma de c en una población mexicana Maya y no Maya: estudio in vivo mediante CBCT

SUMMARY: The objective of this study was to evaluate the bilaterality and symmetry in C-shaped mandibular second molars in Mexican Maya and non-Maya populations using cone-beam computed tomography (CBCT). Five-hundred-twenty-five CBCT scans of patients with left and right mandibular second molars were analyzed to determine the prevalence and bilaterality. The teeth were assessed for the presence of C-shaped root canals, according to Fan et al. (2004) criteria. The sample was subdivided by ethnicity, sex, unilateral/bilateral presence, side of the longitudinal groove, and the C-shaped root canal configuration and symmetry, at the cervical, middle, and apical cross- sections of the root. C-shaped mandibular second molars were present in 24.95% of the individuals. Most (60.30%) of those showing this trait had it bilaterally. When comparing by ethnicity, sex, and side, we detected no significant differences. The vast majority (97.33%) presented the groove along the lingual side. The C3 was the most prevalent configuration in the overall sample, while in the Maya group, the C1 was the most common configuration. When analyzed by sex and ethnic group, the non-Maya females tended to deviate from the other groups in terms of bilaterality. Overall, 55.70% of bilateral C-shaped mandibular second molars were also symmetric in the three radicular thirds. The prevalence of C-shaped mandibular second molars was similar to that reported for northernAsian populations, which is consistent with the evolutionary origins of Native American populations. Most of the sample showed bilaterality and half were symmetric. Clinicians must be aware of the ethnic background of their patients and consider the possible variations to do more predictable root canal treatments.

RESUMEN: El objetivo de este estudio fue evaluar la bilateralidad y simetría de los segundos molares mandibulares en forma de C en una población Mexicana Maya y no-Maya mediante tomografía computarizada de haz cónico (CBCT). Material and Métodos: Se analizaron quinientos veinticinco tomografías de pacientes con segundos molares mandibularesderecho e izquierdo para determinar la prevalencia y bilateralidad. Los dientes fueron evaluados según la presencia de conductos en forma de C de acuerdo a los criterios de Fan et al. La muestra fue subdividida por etnicidad, sexo, presencia bilateral/unilateral, lado del surco y configuración y simetría de los conductos en los cortes transversales cervical, medio y apical. Los segundos molares mandibulares en forma de C estuvieron presentes en el 24.95 % de los individuos. La mayoría (60.30%) de los que mostraron este rasgo lo hicieron de forma bilateral. El comparar por etnicidad, sexo y lado, no se encontraron diferencias estadísticamente significativas. La gran mayoría (97.33%) presentó el surco por lingual. C3 fue la configuración más prevalente en la muestra general, mientras que en el grupo Maya el C1 fue la más común. El análisis por sexo y grupo étnico arrojó que las mujeres no Mayas tendieron a desviarse de los otros grupos en términos de bilateralidad. El 55.70% de los segundos molares mandibulares bilaterales fueron simétricos en sus tres tercios radiculares. La prevalencia de los segundos molars mandibulares en forma de C fue similar a la reportada para las poblaciones del norte de Asia, lo cual es consistente con los orígenes evolutivos de las poblaciones nativas americanas. La mayor parte de la muestra presentó el rasgo de forma bilateral y la mitad de éstos fueron simétricos. Los odontólogos deben tomar en cuenta el origen étnico de sus pacientes y considerar las posibles variaciones para realizar tratamientos endodónticos más predecibles.

Bilateral multifocality, a marker for aggressive disease, is not an independent prognostic factor for papillary thyroid microcarcinoma: A propensity score matching analysis.

CONTEXT: Multifocality and bilaterality are common in patients with papillary thyroid microcarcinoma (PTMC). However, their clinical behaviours and prognostic implications remain controversial. OBJECTIVE: To investigate the relationship between multifocality and classically aggressive characteristics and outcomes in patients with PTMC. METHODS: Clinical data of 3005 patients with PTMC were retrospectively reviewed at a tertiary medical centre. The role of unilateral and bilateral multifocality in aggressive characteristics and clinical outcomes of PTMC was evaluated using propensity score matching (PSM). RESULTS: A total of 573 patients had bilateral multifocal disease (B-MFD), 272 had unilateral multifocal disease (U-MFD), and 2160 had unifocal disease (UFD). Univariate analysis showed that patients in the multifocal disease (MFD) groups showed significantly different characteristics compared to patients in the UFD group in terms of age, chronic lymphocytic thyroiditis (CLT), follicular variant PTMC, tumour diameter, aggressive growth, including extrathyroidal extension (ETE), central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM), and TNM stage, and underwent radioactive iodine (RAI) therapy. Further stratified analysis revealed that patients in the B-MFD group reflected the differences between the MFD and UFD groups. However, those in the U-MFD group showed slight differences only in sex, CLT and cell subtypes, compared to the UFD group. In addition, PSM indicated differences in ETE, CLNM and LLNM between the B-MFD and UFD groups (p < .001), while only ETE differed between the U-MFD and UFD groups (p < .001). After a median follow-up period of 60 months, no difference was observed in recurrence-free survival between the UFD and B-MFD (p = .294) or U-MFD (p = .603) groups using PSM. CONCLUSION: This propensity score matching analysis provides strong evidence that bilateral multifocality, rather than unilateral multifocality, should be considered as an aggressive marker at presentation, and neither is an independent prognostic factor for clinical outcome in PTMC.

Locomotion and righting behavior of sea stars: a study case on the bat star Asterina stellifera (Asterinidae) / Comportamiento de locomoción y enderezamiento en estrellas de mar: un caso de estudio sobre la estrella Asterina stellifera (Asterinidae)

Introduction: The locomotion behavior of an organism involves the integration of aspects like body symmetry, sensory and locomotor systems. Furthermore, various ecological factors seem to be related to locomotion characteristics, such as foraging strategy, migration trends, response to predators and competitors, and environmental stress. Objective: To analyze locomotion and the influence of body symmetry in the crawling and righting movements of the sea star Asterina stellifera. Methods: We carried out laboratory experiments in aquariums in the presence/absence of water current and on a horizontal and vertical surface. Results: The speed is similar to speed in other species of similar size. Both the speed and linearity of displacement were independent of individual body size. A water current leads to faster crawling and straight paths, but there is no rheotaxis: streams do not affect locomotion. Speed and linearity of displacement were independent of individual body size. The displacement pattern described here may be an adaptation of organisms that present dense populations in communities with high prey abundance, as is the case of A. stellifera. Conclusions: Like other asteroids, this species did not show an Anterior/Posterior plane of symmetry during locomotion, or righting movement: it does not tend to bilaterality.

Introducción: El comportamiento de locomoción de un organismo implica la integración de aspectos como la simetría corporal, los sistemas sensorial y locomotor. Además, varios factores ecológicos parecen estar relacionados con las características de la locomoción, como la estrategia de alimentación, las tendencias migratorias, la respuesta a los depredadores y competidores y el estrés ambiental. Objetivo: Analizar el patrón general de locomoción y la influencia de la simetría corporal en la locomoción y enderezamiento de la estrella de mar Asterina stellifera. Métodos: Realizamos experimentos de laboratorio en acuarios en presencia / ausencia de corriente de agua y en superficie horizontal y vertical. Resultados: La velocidad es similar a la velocidad en otras especies de tamaño similar. Tanto la velocidad como la linealidad del desplazamiento fueron independientes del tamaño corporal individual. Una corriente de agua conduce a una velocidad de desplazamiento mayor y a trayectorias más rectas, pero no hay reotaxis: una corriente de agua no afecta el patrón de locomoción. La velocidad y la linealidad del desplazamiento fueron independientes del tamaño corporal individual. El patrón de desplazamiento aquí descrito puede ser una adaptación de organismos que presentan densas poblaciones en comunidades con alta abundancia de presas, como es el caso de A. stellifera. Conclusiones: Al igual que otros asteroides, esta especie no mostró un plano de simetría Anterior / Posterior durante la locomoción o el movimiento de enderezamiento: no tiende a la bilateralidad.

Lymphoscintigraphic Bilateral Disease in Patients with Clinically Unilateral Primary Lower Limb Lymphedemas.

Background: Primary lower limb lymphedemas (LLLEs; not present at birth) are classified as early- and late-onset. In both groups, distal lymphangiopathy distal dermal backflow (DDB) may be observed and, in clinically unilateral edema, abnormalities may be present at the level of contralateral limb. The aim of this study is to report the frequency of heterolateral lesions in these patients based on lymphoscintigraphic investigations (LySc). Methods and Results: Retrospective review (CE2048) among our database of patients who were referred for LySc of clinically unilateral LLLE and for whose LySc showed DDB. Fifty-six patients could be classified as early-onset ("praecox": group 1: 8 men and 48 women: median age at investigation = 32.5 years: edema was right sided in 26 and left sided in 30) and 47 (8 men and 39 women: edema was right sided in 25 and left sided in 22) as late-onset ("tarda": group 2). DDB at the level of the opposite nonedematous limb was found in 38.8% of the whole series but more frequently (p < 0.001) in group 2 (70%) than in group 1 (15%). In group 1, bilateral disease were seen as frequently (in 4 cases) among the (33) patients <35 years old than in other patients (4 out of 23). Conclusions: These differences between these two clinical groups could support the following hypothesis: we are facing, either two different lymphatic diseases, or, a single disease but affecting two populations of different susceptibility.

Impact of endometrioma and bilaterality on IVF / ICSI cycles in patients with endometriosis.

AIM: Endometriosis, one of the most common gynecological disorder, is a challenging disease observed in 20 %-40 % of subfertile women. Endometriomas affect 17-44 % of women with endometriosis. Because endometrioma has detrimental effects on fertility, many of these women need Assisted Reproductive Technology (ART) to conceive. In this study, we aimed to investigate the effects of endometrioma presence and impact of bilaterality over In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI) outcomes. METHOD: The study was designed retrospectively. A total of 159 women enrolled in IVF / ICSI cycles were included. Patients were divided into two groups as Endometrioma group (n: 73) and control group (n:86). In Endometrioma group, subgroup analysis was performed according to whether endometrioma was unilateral or bilateral. Demographic characters, clinical and laboratory parameters were recorded. SPSS was used for analysis. RESULTS: In endometrioma group, although basal FSH levels was higher than control group, it was within normal limits, while estradiol levels was lower (p < 0.001, p 0.042, respectively). Antral follicle count (AFC), dominant follicle number, total oocyte count, MII oocyte numbers were found to be significantly lower, whereas numbers of embryos achieved, clinical pregnancy rates (PR) and live birth rates (LBR) were found to be similar.There were no statistically significant differences in terms of Antimullerian Hormon (AMH) levels, oocyte and embryo quality, the numbers of embryos achieved, PR and LBR between unilateral and bilateral endometrioma groups. CONCLUSION: This study shows that presence of endometrioma negatively effects fertility parameters albeit no significant effect over embryo quality, PR and LBR whereas bilaterality doesn't have any influence over any fertility parameters and PR.