The signaling axis of microRNA-31/interleukin-25 regulates Th1/Th17-mediated inflammation response in colitis

Interleukin-25 (IL-25) is an important regulatory cytokine that has a key role on mucosal immune tolerance during inflammation response. However, the molecular mechanism that regulates the colonic IL-25 expression in Crohn's disease (CD) remains unclear. In this study, IL-25 level was proved to decrease in 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitis mice and IL-10 knockout (KO) spontaneous colitis mice. An inverse correlation between IL-25 and miR-31 was discovered in the colons from model mice and CD patients. Furthermore, target validation analysis demonstrated that miR-31 directly regulated IL-25 expression by binding to its messenger RNA 3'-untranslated region. Changing colonic miR-31 level in the colitis mice could affect the mucosal IL-12/23-mediated Th1/Th17 pathway and lead to either amelioration or aggravation of colonic inflammation. In addition, the therapeutic effects of anti-miR-31 in TNBS-induced colitis were abolished by colonic treatment with IL-25 antibody or colonic down-expression of IL-25. Our findings demonstrated that IL-25 could be a crucial anti-inflammatory cytokine in TNBS-induced colitis and the signaling of miR-31 targeting IL-25 might be a possible mechanism that regulates IL-12/23-mediated Th1/Th17 inflammatory responses during colonic inflammation process. Restoring colonic IL-25 expression and blocking Th1/Th17 responses via intracolonic administration of miR-31 inhibitor may represent a promising approach for CD treatment.

[Mediating effect of mental elasticity on occupational stress and depression in female nurses]

Objective: To investigate the interaction between mental elasticityand occupational stress and depressionin female nurses and the mediating effect of mental elasticity, as well as the functioning way of mental elasticity in occupational stress-depression. Methods: From August to October, 2015, cluster sampling was used to select 122 female nurses in a county-level medical institution as study subjects. The Connor-Davidson Resilience Scale (CD-RISC) , Occupational Stress Inventory-Revised Edition (OSI-R) , and Self-Rating Depression Scale (SDS) were used to collect the data on mental elasticity, occupational stress, and depression and analyze their correlation and mediating effect. Results: The 122 female nurses had a mean mental elasticity score of 62.4±15.1, which was significantly lower than the Chinese norm (65.4±13.9) (P<0.05) ; the mean depression score was 41.0±7.7, which was significantly higher than the Chinese norm (33.5±8.6) (P<0.01) , and the incidence rate of depression of 52.5%. Mental elasticity was negatively correlated with occupational stress and depression (r=-0.559 and -0.559, both P<0.01) . Occupational stress and the two subscales mental stress reaction and physical stress reaction were positively correlated with depression (r=0.774, 0.734, and 0.725, all P<0.01) . After adjustment for confounding factors, occupational stress had a positive predictive effect on depression (β=0.744, P<0.01) , and mental elasticity had a negative predictive effect on depression (β=-0.221, P<0.01) . The analysis of mediating effect showed a significant direct effect of occupational stress on depression and a significant mediating effect of mental elasticity (a=-0.527, b=-0.227, c=0.744, c'=0.627; all P<0.01) , and the mediating effect of mental elasticity accounted for 16.08% of the total effect. Conclusion: As a partial mediating variable, mental elasticity has an indirect effect on the relationship between occupational stress and depression and can alleviate the adverse effect of occupational stress and reduce the development of depression.

Identification of a novel Hemoplasma species from pigs in Zhejiang province, China

Hemoplasmas belong to Mycoplasmataceae (Mollicutes: Mycoplasmatales) and are able to infect a broad range of mammalian species. We investigated prevalence of hemotropic mycoplasma species in pig farms in the region of Zhejiang by a PCR scheme using universal primers targeting 16S rRNA and RNase P RNA gene (rnpB). Representative positive samples from different farms were selected for sequencing of 16S rRNA and the 219bp rnpB gene fragments for phylogenetic analysis. Sequencing analysis of PCR products from first samples identified a novel hemoplasma species present in several pig farms in the region with highest nucleotide identity of 92% to Candidatus Mycoplasma turicensis. A duplex PCR assay was then designed for differential detection of the novel hemoplasma from Mycoplasma parvum/M. suis in field samples. Of 324 blood samples from clinically healthy pigs, 26.5% was positive for this novel hemoplasma species and 50% positive for M. suis/M. parvum, indicating that the novel hemotropic mycoplasma species were of considerably high prevalence in Zhejiang province, China.

Transgenic Eimeria magna Pérard, 1925 Displays Similar Parasitological Properties to the Wild-type Strain and Induces an Exogenous Protein-Specific Immune Response in Rabbits (Oryctolagus cuniculus L.)

Rabbit coccidiosis causes great economic losses to world rabbitries. Little work has been done considering genetic manipulation on the etiological agents, rabbit Eimeria spp. In this study, we constructed a transgenic line of Eimeria magna (EmagER) expressing enhanced yellow fluorescent protein (EYFP) and red fluorescent protein (RFP) using regulatory sequences of Eimeria tenella and Toxoplasma gondii. We observed the life cycle of EmagER and confirmed that the transgenic parasites express exogenous proteins targeted to different cellular compartments throughout the entire life cycle. EYFP was expressed mainly in the nucleus and RFP both in the nucleus and cytoplasm. Then, coccidia-free, laboratory-reared 40-day-old rabbits were primarily infected with either EmagER or wild-type strain oocysts and challenged with the wild-type strain. EmagER showed similar reproductivity and immunogenicity to the wild-type strain. Finally, we examined the foreign protein-specific immune response elicited by EmagER. Rabbits were immunized with either transgenic or wild-type oocysts. Immune response against parasite-soluble antigen, EYFP and RFP in spleen, and mesenteric lymph nodes were detected by quantitative real-time PCR. The relative expression level of IFN-γ, IL-2, and TNF-α were higher in EmagER-immunized rabbits than wild-type parasites-immunized rabbits after stimulation with EYFP and RFP. Our study confirmed that a specific immune response was induced by the exogenous protein expressed by EmagER and favored future studies on application of transgenic rabbit coccidia as recombinant vaccine vectors.

Nonlinear Transition from Mitigation to Suppression of the Edge Localized Mode with Resonant Magnetic Perturbations in the EAST Tokamak

Evidence of a nonlinear transition from mitigation to suppression of the edge localized mode (ELM) by using resonant magnetic perturbations (RMPs) in the EAST tokamak is presented. This is the first demonstration of ELM suppression with RMPs in slowly rotating plasmas with dominant radio-frequency wave heating. Changes of edge magnetic topology after the transition are indicated by a gradual phase shift in the plasma response field from a linear magneto hydro dynamics modeling result to a vacuum one and a sudden increase of three-dimensional particle flux to the divertor. The transition threshold depends on the spectrum of RMPs and plasma rotation as well as perturbation amplitude. This means that edge topological changes resulting from nonlinear plasma response plays a key role in the suppression of ELM with RMPs.

Active fiber-based retroreflector providing phase-retracing anti-parallel laser beams for precision spectroscopy

We present an active fiber-based retroreflector providing high quality phase-retracing anti-parallel Gaussian laser beams for precision spectroscopy of Doppler sensitive transitions. Our design is well-suited for a number of applications where implementing optical cavities is technically challenging and corner cubes fail to match the demanded requirements, most importantly retracing wavefronts and preservation of the laser polarization. To illustrate the performance of the system, we use it for spectroscopy of the 2S-4P transition in atomic hydrogen and demonstrate an average suppression of the first order Doppler shift to 4 parts in 10⁶ of the full collinear shift. This high degree of cancellation combined with our cryogenic source of hydrogen atoms in the metastable 2S state is sufficient to enable determinations of the Rydberg constant and the proton charge radius with competitive uncertainties. Advantages over the usual Doppler cancellation based on corner cube type retroreflectors are discussed as well as an alternative method using a high finesse cavity.

Stable Transfection of Eimeria intestinalis and Investigation of Its Life Cycle, Reproduction and Immunogenicity

Rabbit coccidiosis, caused by infection of Eimeria spp. is one of the most severe parasitic diseases in rabbits. Eimeria intestinalis is one of the most immunogenic species in rabbit coccidia. Due to the lack of genomic information and unsuccessful in vitro cultivation, genetic manipulation of rabbit coccidia lagged behind other apicomplexan parasites. Using regulatory sequences from E. tenella, we obtained a transgenic line of E. intestinalis expressing yellow fluorescent protein (YFP). YFP was continuously expressed throughout the whole life cycle. Morphological features of E. intestinalis in different developmental stages were dynamically observed with the transgenic line. Some important features in the endogenous development stages were observed. Trophozoites were found as early as 4 h post inoculation. Two types of schizonts and merozoites were observed in first three of the four schizogonies. Beside jejunum and ileum, gametogony stage and oocysts were also found in the duodenum and vermiform appendix. In addition, the transgenic strain was highly immunogenic but less pathogenic than the wild type. Considering the high immunogenicity of E. intestinalis and amenability to transfection with foreign genes, transgenic E. intestinalis could be a promising oral eukaryotic vaccine vector.

Study on JNK/AP-1 signaling pathway of airway mucus hypersecretion of severe pneumonia under RSV infection

OBJECTIVE

To investigate the JNK/AP-1 signaling pathway of airway mucus hypersecretion of severe pneumonia under respiratory virus (RSV) infection.

PATIENTS AND METHODS

Total of 56 severe pneumonia children under RSV infection were selected. Reverse transcription polymerase chain reaction (RT-PCR) was performed to measure the expression quantity of MUC5B mRNA and MUC5AC mRNA, and ELISA was used to measure the expression quantity of MUC5AC and MUC5B proteins. Following that, the children were divided into airway mucus hypersecretion group (n = 37) and non-hypersecretion group (n = 19). Western blotting was performed to detect the expression levels of JNK1/2, p-JNK1/2 and AP-1 proteins.

RESULTS

Expression of MUC5AC and MUC5B proteins, and MUC5AC mRNA and MUC5B mRNA in the airway mucus hypersecretion group were significantly higher than those in the non-hypersecretion group (p < 0.05). The expression levels of JNK1/2, p-JNK1/2 and AP-1 proteins in airway mucus hypersecretion group were higher than those in the non-hypersecretion group (p < 0.05).

CONCLUSIONS

MUC5AC and MUC5B can be used as marker molecules of airway mucus hypersecretion. Airway mucus hypersecretion of severe pneumonia induced by RSV might be related to the activation of JNK/AP-1 signaling pathway.

Clinical significance of group B streptococcus testing in late pregnancy

PURPOSE

This study aimed to detect the maternal group B streptococcus (GBS) by real-time PCR method, aiming to understand its germ-carrying situations and clinical significance.

MATERIALS AND METHODS

The secretions of one-third inferior segment of maternal vagina of 1,540 pregnant and postnatal women were collected for GBS detection by real-time PCR method, and the impacts of positive results on the fetus were observed.

RESULTS

The detection rate of GBS was 5.6% (86/1540); the premature birth rate of GBS-positive pregnant women was 29.1% (25/86), the miscarriage rate was 19.8% (17/86), the premature rupture rate was 26.7% (23/86), and the fetal distress rate was 24.4% (21/86).

CONCLUSIONS

The GBS germ-carriers showed increased rates of premature birth, miscarriage, premature rupture, and fetal distress, thus forming adverse effects towards the maternal and infant outcomes.

Efficacy and safety of extended dosing schedules of CC-486 (oral azacitidine) in patients with lower-risk myelodysplastic syndromes

CC-486, the oral formulation of azacitidine (AZA), is an epigenetic modifier and DNA methyltransferase inhibitor in clinical development for treatment of hematologic malignancies. CC-486 administered for 7 days per 28-day treatment cycle was evaluated in a phase 1 dose-finding study. AZA has a short plasma half-life and DNA incorporation is S-phase-restricted; extending CC-486 exposure may increase the number of AZA-affected diseased target cells and maximize therapeutic effects. Patients with lower-risk myelodysplastic syndromes (MDS) received 300 mg CC-486 once daily for 14 days (n=28) or 21 days (n=27) of repeated 28-day cycles. Median patient age was 72 years (range 31–87) and 75% of patients had International Prognostic Scoring System Intermediate-1 risk MDS. Median number of CC-486 treatment cycles was 7 (range 2–24) for the 14-day dosing schedule and 6 (1–24) for the 21-day schedule. Overall response (complete or partial remission, red blood cell (RBC) or platelet transfusion independence (TI), or hematologic improvement) (International Working Group 2006) was attained by 36% of patients receiving 14-day dosing and 41% receiving 21-day dosing. RBC TI rates were similar with both dosing schedules (31% and 38%, respectively). CC-486 was generally well-tolerated. Extended dosing schedules of oral CC-486 may provide effective long-term treatment for patients with lower-risk MDS.

First Report of Rubber Tree Stem Rot Caused by Fusarium oxysporum in China

Rubber tree (Hevea brasiliensis) is an important crop in tropical regions of China. In October 2013, a new stem rot disease was found on cv. Yunyan77-4 at a rubber tree plantation in Hekou, Yunnan Province. There were about 100 plants, and diseased rubber trees accounted for 30% or less. Initially, brown-punctuate secretion appeared on the stem, which was 5 to 6 cm above the ground. Eventually, the secretion became black and no latex produced from the rubber tree bark. After removing the secretion, the diseased bark was brown putrescence, but the circumambient bark was normal. Upon peeling the surface bark, the inner bark and xylem had brown rot and was musty. The junction between health and disease was undulate. On the two most serious plants, parts of leaves on the crown were yellow, and the root near the diseased stem was dry and puce. The pathogen was isolated and designated HbFO01; the pathogenicity was established by following Koch's postulates. The pathogen was cultivated on a potato dextrose agar (PDA) plate at 28°C for 4 days. Ten plants of rubber tree cv. Yunyan77-4 were selected from a disease-free plantation in Haikou, Hainan Province, and the stem diameter was about 7 cm. The bark of five plants was peeled, and one mycelium disk with a diameter of 1 cm was inserted into the cut and covered again with the bark. The other five plants were treated with agar disks as controls. The inoculation site was kept moist for 2 days, and then the mycelium and agar disk were removed. On eighth day, symptoms similar to the original stem lesions were observed on stems of inoculated plants, while only scars formed on stems of control plants. The pathogen was re-isolated from the lesions of inoculated plants. On PDA plates, the pathogen colony was circular and white with tidy edges and rich aerial hyphae. Microscopic examination showed microconidia and chlamydospores were produced abundantly on PDA medium. The falciform macroconidia were only produced on lesions and were slightly curved, with a curved apical cell and foot shaped to pointed basal cell, usually 3-septate, 16.2 to 24.2 × 3.2 to 4.0 μm. Microconidia were produced in false heads, oval, 0-septate, 6.2 to 8.2 × 3.3 to 3.8 μm, and the phialide was cylindrical. Chlamydospores were oval, 6.4 to 7.2 × 3.1 to 3.8 μm, alone produced in hypha. Morphological characteristics of the specimen were similar to the descriptions for Fusarium oxysporum (2). Genomic DNA of this isolate was extracted with a CTAB protocol (4) from mycelium and used as a template for amplification of the internal transcribed spacer (ITS) region of rDNA with primer pair ITS1/ITS4 (1). The full length of this sequence is 503 nt (GenBank Accession No. KJ009335), which exactly matched several sequences (e.g., JF807394.1, JX897002.1, and HQ451888.1) of F. oxysporum. Williams and Liu had listed F. oxysporum as the economically important pathogen of Hevea in Asia (3), while this is, to our knowledge, the first report of stem rot caused by F. oxysporum on rubber tree in China. References: (1) D. E. L. Cooke et al. Fungal Genet. Biol. 30:17, 2000. (2) J. F. Leslie and B. A. Summerell. The Fusarium Laboratory Manual, 2006. (3) T. H. Williams and P. S. W. Liu. A host list of plant diseases in Sabah, Malaysia, 1976. (4) J. R. Xu et al. Genetics 143:175, 1996.

Similar blood-borne DNA methylation alterations in cancer and inflammatory diseases determined by subpopulation shifts in peripheral leukocytes

BACKGROUND

Although many DNA methylation (DNAm) alterations observed in peripheral whole blood/leukocytes and serum have been considered as potential diagnostic markers for cancer, their origin and their specificity for cancer (e.g., vs inflammatory diseases) remain unclear.

METHODS

From publicly available datasets, we identified changes in the methylation of blood-borne DNA for multiple cancers and inflammatory diseases. We compared the identified changes with DNAm difference between myeloid and lymphoid cells extracted from two datasets.

RESULTS

At least 94.7% of the differentially methylated DNA loci (DM loci) observed in peripheral whole blood/leukocytes and serum of cancer patients overlapped with DM loci that distinguish between myeloid and lymphoid cells and >99.9% of the overlapped DM loci had consistent alteration states (hyper- or hypomethylation) in cancer samples compared to normal controls with those in myeloid cells compared to lymphoid cells (binomial test, P-value <2.2 × 10(-16)). Similar results were observed for DM loci in peripheral whole blood/leukocytes in patients with rheumatoid arthritis or inflammatory bowel diseases. The direct comparison between DM loci observed in the peripheral whole blood/leukocytes of patients with inflammatory diseases and DM loci observed in the peripheral whole blood of patients with cancer showed that DM loci detected from cancer and inflammatory diseases also had significantly consistent alteration states (binomial test, P-value <2.2 × 10(-16)).

CONCLUSIONS

DNAm changes observed in the peripheral whole blood/leukocytes and serum of cancer patients and in the peripheral whole blood/leukocytes of inflammatory disease patients are predominantly determined by the increase of myeloid cells and the decrease of lymphoid cells under the disease conditions, in the sense that their alteration states in disease samples compared to normal controls mainly reflect the DNAm difference between myeloid and lymphoid cells. These analyses highlight the importance of comparing cancer and inflammatory disease directly for the identification of cancer-specific diagnostic biomarkers.

Transvaginal sonographic features of perineal masses in the female lower urogenital tract: a retrospective study of 71 patients

OBJECTIVES

To assess the transvaginal ultrasonographic features of perineal masses in the lower urogenital tract in a cohort of 71 women.

METHODS

Seventy-one women with perineal masses were referred consecutively for transvaginal ultrasonography. Two-dimensional (2D) ultrasound was used to scan the pelvic floor, including the urethra, vagina and rectum, and identify any possible areas of interest. A static three-dimensional (3D) sonographic reconstruction of the pelvic anatomy was created to further delineate the relation of the lesions with their neighboring structures. Ultrasound results were compared retrospectively with surgical pathology outcome when possible.

RESULTS

Seventy-nine cystic, cystic-solid or solid masses were detected on transvaginal 2D ultrasonography in the 71 women: in 44 patients, 47 anechoic cystic masses were identified and diagnosed as vaginal wall cysts; in 19 patients, 23 hyperechoic cystic masses were diagnosed as vaginal epidermoid cysts; in each of two patients, a hypoechoic cystic-solid mass showing blood-flow signals on color Doppler imaging was diagnosed as urogenital angiomyofibroblastoma; in each of three patients, a hypoechoic cyst was diagnosed as urethral diverticulum; and in three patients with a known history of gynecological malignancy, solid heterogeneous masses with blood flow signals on color Doppler imaging were diagnosed as metastatic cancer. In all patients, 3D ultrasonography delineated the anatomical relationship of these masses to the vagina, urethra and rectum.

CONCLUSIONS

Transvaginal 2D and 3D ultrasonography is an accurate, non-invasive, cost-effective diagnostic modality for the delineation of congenital, septic and neoplastic lower urogenital tract perineal masses in women.

Distribution and pathogen identification of cassava brown leaf spot in China

Cassava brown leaf spot surveys were conducted in the main cassava plantation areas of China between 2007 and 2012 in order to understand the distribution of the disease. Cassava plants were damaged by the disease to different degrees in most of the survey sites. Samples were collected and seven strains were isolated from lesions. The mycelium-breaking plus black light induction method was applied for sporulation. Microconidia were formed by means of fragmentation on artificial medium plates. When the leaf was stabbed and inoculated with conidia solution, similar symptoms were formed 14 days later. Morphological characteristics of the specimens and conidia were similar to descriptions of Passalora henningsii infection. The internal transcribed spacer (ITS) regions of rDNA were obtained with primer pair ITS1/ITS4 and deposited in GenBank, which differed by three base pairs from that of the P. henningsii isolate (AF284389). The ITS sequences of related species were downloaded from the NCBI database, and phylogenetic analysis showed that the sequences originating from our strains clustered in the same clade as the AF284389 isolate. Biological characteristics were evaluated in two strains from different sites, which indicated that the optimum conditions for mycelia growth were a temperature of 26° to 28°C, carrot agar medium, pH 6, and continuous dark; cassava leaf juice added to malt extract and cassava leaf juice added to potato dextrose agar were the best media for conidia production. The optimal and lethal temperatures for macroconidia germination were 26° to 28°C, and 60°C for 10 min, respectively.

[Preparation and immunogenicity of silk fibroin/chitosan microspheres for DNA vaccine delivery against infectious bursal disease virus]

To evaluate the immunities of biodegradable microsphere as a release delivery system for DNA vaccine against Infectious Bursal Disease Virus, in our study, silk fibroin/chitosan microsphere adjuvant was prepared with a precipitation/coacervation method. Both glutaraldehyde and Na2SO4 solution were used in cross-linking. No immune chicken were intramuscularly inoculated at 14 day-old and boosted 2 weeks later. The results show that glutaraldehyde destroyed the DNA activity of the vaccine whereas Na2SO4 solution did not. Factors of the chitosan concentration 0.5% (pH 5.0), silk fibroin concentration 0.6%, plasmid DNA (500 microg/mL) dissolved in 2% Na2SO4 solution were optimized to produce microsphere, with a loading capacity of 89.14%. The average particle size of SF-CS/pCI-VP2/4/3 microsphere is 1.98 microm, and it can protect the loading DNA vaccine from DNase I digestion. Data from anti IBDV ELISA antibodies in the serum show that immunization activity of the microsphere groups were generally higher than plasmid vaccine group (P < 0.05), and the SF/CS compound microspheres group was better than that of sole CS microsphere group. The developed SF/CS microspheres are a very promising vaccine delivery system.

A low-virulence Eimeria intestinalis isolate from rabbit (Oryctolagus cuniculus) in China: molecular identification, pathogenicity, and immunogenicity

An Eimeria intestinalis isolated from a rabbit in China was first identified by amplifying the 18S small subunit (SSU) ribosomal RNA gene. The size of the amplified fragment was 1521 bp. The 18S SSU RNA gene of the E. intestinalis isolate shared 99% sequence identity with E. intestinalis isolates from France and the Czech Republic, with 100 and 96% coverage, respectively. Then, the pathogenicity and immunogenicity of the E. intestinalis isolate were evaluated in specific pathogen free (SPF) rabbits. In the pathogenicity assay, SPF rabbits in four groups were infected with 5 × 10(3), 5 × 10(4), 5 × 10(5), and 0 sporulated oocysts, respectively. Clinical signs including diarrhoea, constipation, loss of appetite, and reduction of body weight gain were observed in rabbits inoculated with 5 × 10(4) and 5 × 10(5) oocysts. And one rabbit (25 %) inoculated with 5 × 10(5) oocysts died 15 days after the inoculation. In the immunogenicity assay, SPF rabbits in five groups (named B1, B2, B3, B4, and B5) were immunised with 5 × 10(1), 5 × 10(2), 5 × 10(3), 0, and 0 sporulated oocysts, respectively. All rabbits but the B5 group were challenged with 1 × 10(6) oocysts. After the challenge, no or slight clinical signs were seen in rabbits of the B2 and B3 groups. Compared with the control, a 69.6 and 84.5% reduction of oocyst output was observed in the B2 and B3 groups, respectively. The body weight gain of the two groups was obviously higher than that of the challenge control group. All the results show that the E. intestinalis isolate has low virulence but immunogenicity in rabbit.

Relapse of hyperthyroidism after hemithyroidectomy in concurrent medullary thyroid cancer and Graves' disease

We present a rare case of concurrent medullary thyroid cancer (MTC) and relapse of Graves' disease (GD). A 26-year-old Chinese female suffered from GD for 1 year. Physical examination demonstrated mildly diffuse goiter with a palpable 1.0 cm nodule in the right thyroid lobe and exophthalmos. Before hemithyroidectomy, calcitonin was elevated and thyroglobulin was normal. After surgery, histopathological findings proved coexistence of MTC and GD. 16 months later, GD relapsed and radioactive iodine 131 therapy was given. Meanwhile, postoperative monitoring showed well controlled calcitonin and carcinoembryonic antigen. Our lesson demonstrates although concomitant of MTC and GD is very rare, yet after hemithyroidectomy for the single nodular MTC lesion, remnant thyroid lobe could be the source of GD relapse very soon. More importantly, the relapse of GD and the following radioiodine therapy and radiation exposure could have been prevented if a better therapy plan of total thyroidectomy was adopted in the first place, instead of hemithyroidectomy (Tab. 1, Fig. 2, Ref. 11).