A strategy was described to design antimicrobial peptides (AMPs) with enhanced salt resistance and antiendotoxin activities by linking two helical AMPs with the Ala-Gly-Pro (AGP) hinge. Among the designed peptides, KR12AGPWR6 demonstrated the best antimicrobial activities even in high salt conditions (NaCl ~300 mM) and possessed the strongest antiendotoxin activities. These activities may be related to hydrophobicity, membrane-permeability, and α-helical content of the peptide. Amino acids of the C-terminal helices were found to affect the peptide-induced permeabilization of LUVs, the α-helicity of the designed peptides under various LUVs, and the LPS aggregation and size alternation. A possible model was proposed to explain the mechanism of LPS neutralization by the designed peptides. These findings could provide a new approach for designing AMPs with enhanced salt resistance and antiendotoxin activities for potential therapeutic applications.

Context: Cervical lymph node metastases are common in papillary thyroid carcinoma (PTC), causing recurrence and poor regional control, highlighting the need for accurate diagnostics. Although fine-needle aspiration with thyroglobulin washout (FNA-Tg) shows promise, its diagnostic performance and association with serum biomarkers across settings remain unclear. Objective: To assess the diagnostic performance of FNA-Tg for cervical lymph node metastases in PTC and its correlation with serum thyroglobin (s-Tg) and s-Tg antibody (s-Tg-Ab) levels. Data Sources: PubMed, Embase, Web of Science, Scopus, Cochrane Library, and Ovid Medline were searched for relevant studies. Study Selection: Studies enrolling PTC patients with cervical lymphadenopathy who underwent FNA-Tg pre- or postthyroidectomy were included. Studies involving non-PTC populations or lacking sufficient data for 2 × 2 diagnostic table construction were excluded. Data Extraction: Data were independently extracted by 3 researchers, and study quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Data Synthesis: FNA-Tg showed pooled sensitivity of 0.94 [95% confidence interval (CI), 0.91-0.96], specificity of 0.92 (95% CI: 0.88-0.94), and diagnostic odds ratio (DOR) of 174.20 (95% CI: 87.05-348.61), with an area under curve (AUC) of 0.98 (95% CI: 0.96-0.99). Postthyroidectomy, sensitivity increased to 0.96 (95% CI: 0.94-0.98), specificity to 0.93 (95% CI: 0.86-0.96), and DOR to 305.87 (95% CI: 127.99-730.93), with an AUC of 0.98 (95% CI: 0.97-0.99). In the group without thyroid gland present, sensitivity was 0.96 (95% CI: 0.93-0.97), specificity 0.93 (95% CI: 0.87-0.97), and DOR 300.27 (95% CI: 118.47-761.05), with an AUC of 0.98 (95% CI: 0.97-0.99). Likelihood ratio scattergrams and Fagan plots supported its discriminatory ability. FNA-Tg correlated weakly with s-Tg but not with s-Tg-Ab. Conclusion: FNA-Tg showed high diagnostic accuracy, especially after thyroidectomy, with minimal s-Tg-Ab interference, supporting its role in PTC surveillance.

Background: Nontuberculous mycobacteria (NTM), an extremely rare pathogen causing cervicofacial infections, may result in permanent hearing impairment or intracranial complications. Due to the lack of specific manifestations during the initial onset of NTM otomastoiditis, physicians may misdiagnose it as cholesteatoma or other common bacterial infections. Patient concerns: A 44-year-old male who complained of left-sided aural fullness, otalgia, and dizziness for 2 months. Diagnosis: The initial diagnosis was hypothesized to be cholesteatoma based on a whitish mass with mucoid discharge filling the entire outer ear canal on otoscopy and left-sided mixed hearing loss. However, NTM was identified by microbial culture at the 2-month follow-up after surgery. Interventions: The patient underwent a left-sided exploratory tympanotomy. Because NTM otomastoiditis was diagnosed, 3 weeks of starting therapies were administered with azithromycin (500 mg/day, oral administration), cefoxitin (3 g/day, intravenous drip), and amikacin (750 mg/day, intravenous drip). The maintenance therapies were azithromycin (500 mg/day, oral administration) and doxycycline (200 mg/day, oral administration) for 7 months. Outcomes: The patient’s clinical condition improved initially after surgery, but the otomastoiditis gradually worsened, combined with subtle meningitis, 2 months after surgery. The external auditory canal became swollen and obstructed, making it difficult to monitor the treatment efficacy through otoscopy. Thus, we used regular vestibular function tests, including static posturography, cervical vestibular evoked myogenic potentials, and video Head Impulse Test, to assess recovery outcomes. After antibiotic treatment, the infectious symptoms subsided significantly, and there was no evidence of infection recurrence 7 months after treatment. Improvements in static posturography and cervical vestibular evoked myogenic potentials were compatible with the clinical manifestations, but video Head Impulse Test showed an unremarkable correlation. Lessons: The clinical condition of NTM otomastoiditis may be evaluated using vestibular tests if patients have symptoms of dizziness.

Background: Paraneoplastic pemphigus (PNP) is a rare, life-threatening autoimmune bullous disease. Among the ≈500 reported cases of PNP, only 1 case has been associated with tonsillar cancer, specifically, human papillomavirus (HPV)–positive squamous carcinoma. However, the occurrence of PNP in non-HPV–related tonsillar cancer is exceptionally rare and has not been reported to date. Methods: We present a 58-year-old male with a history of smoking, who experienced recurrent oral ulcers, right neck swelling, and hoarseness for 5 months. Diagnosis of right tonsillar squamous cell carcinoma (cT1N3bM0) was confirmed through computed tomography/magnetic resonance imaging and pathology, not associated with HPV. Histological and immunohistochemical findings indicated PNP. Results: The patient underwent primary tumor resection and ipsilateral neck dissection. Topical steroids and antifungal agents were administered to manage oral lesions and prevent secondary infections. Adjuvant concurrent chemoradiotherapy with cisplatin proceeded smoothly. Postconcurrent chemoradiotherapy follow-up at 3, 6, and 9 months, utilizing computed tomography/magnetic resonance imaging and nasopharyngoscopy, revealed no signs of recurrent cancer or PNP. Conclusion: Early indicators, such as oral mucosal ulcers and skin blisters, prompt consideration of underlying oral cancer in PNP. Comprehensive examination is crucial for diagnosing PNP and identifying concurrent internal neoplasms. Effective management includes occult malignancy treatment, postoperative steroid therapy, and infection prevention.