Search Results (144)

Background: Papillary thyroid microcarcinoma (PTMC), a subtype of papillary thyroid carcinoma ≤ 1 cm in diameter, has shown a marked increase in incidence in recent decades, largely due to the widespread use of neck ultrasonography and fine needle aspiration cytology. Despite its generally indolent course, optimal management of PTMC remains controversial, with treatment strategies ranging from active surveillance to total thyroidectomy. Methods: This retrospective study analyzes five years of experience at a single tertiary care center, including 130 patients diagnosed with PTMC following thyroid surgery between July 2018 and December 2023. Clinical, cytological, and pathological data were collected and analyzed to identify factors influencing surgical decision-making and postoperative outcomes. Patients underwent either total thyroidectomy or hemithyroidectomy, with central and lateral lymph node dissection performed as indicated. Follow-up included clinical and biochemical surveillance for a mean duration of 3 years. Results: Total thyroidectomy was performed in 89.3% of patients, while hemithyroidectomy was limited to 10.7%. Multifocality was observed in 26.1% of cases, with bilateral involvement in 17.7%. Occult lymph node metastases were found in 14.6% (central compartment) and 3.8% (lateral neck). Postoperative radioactive iodine therapy was administered in 23.8% of patients. At final follow-up, 90.7% were disease-free. No significant predictors of recurrence or adverse outcomes were identified, though multifocality and lymph node involvement influenced surgical planning. Conclusions: Our findings support a risk-adapted surgical approach to PTMC, favoring total thyroidectomy in patients with suspicious or multifocal disease to avoid reoperation. While active surveillance and minimally invasive techniques are emerging, total thyroidectomy remains a safe and effective strategy in selected cases. Prospective, multicenter studies are needed to further refine management guidelines for this increasingly common thyroid malignancy. Full article

Background and Objectives: The technique of complete mesocolic excision (CME) for colonic cancer is being advocated to improve the local control of the disease and increase the long-term survival. However, even with an open approach, CME is a complex technique and has not yet been adopted as standard care. Laparoscopy has been proven to bring significant advantages to colorectal surgery but performing a laparoscopic CME (Lap-CME) for colonic cancer is even more technically demanding than CME in open surgery. The purpose of this study is to evaluate whether Lap-CME can be offered as a standard procedure for patients with colonic cancer and to compare the results with those obtained after a conventional, open technique. Materials and methods: This study included 100 consecutive patients with colonic cancer, who were operated on by the same surgical team using a standardized medial-to-lateral open or laparoscopic complete mesocolic excision technique. The perioperative data was prospectively recorded in a database and retrospectively analyzed with the aim of identifying the proportion of patients that received Lap-CME, to evaluate the success rate of the procedure and to identify whether there are differences in the oncological quality of CME between the laparoscopic and open surgery groups. Results: Most of the patients enrolled in this study were in the advanced stages of the disease, with the incidence of pT3 tumors being 67% and the mean tumor size averaging 4.5 cm. Laparoscopic CME was performed in 39% of cases overall, with 41.4% being right colectomies, 42.5% being left colectomies and 16.1% being transverse colectomies. All of the parameters relevant to the oncological quality of resection, namely total lymph node count, resection margins, or the completeness of resection, were similar between the open and laparoscopic groups both when analyzed for the entire cohort or when analyzed for specific subgroups according to the tumor location (right, transverse, or left colon) or stage of the disease (pT3 or stage III). Conclusions: Laparoscopic complete mesocolic excision for colonic cancer can be offered as a standard procedure by experienced surgical teams in carefully selected patients and provides oncological results similar to those obtained with open surgery. Full article

Background and Clinical Significance: Kaposi sarcoma (KS) is a rare angio-proliferative mesenchymal tumor that predominantly affects the skin and mucous membranes but may involve lymph nodes and visceral organs. Clinically, it manifests as red-purple-brown papules, nodules, or plaques, either painless or painful, often with disfiguring potential. The diagnosis is traditionally based on clinical and histopathological evaluation, although non-invasive imaging techniques are increasingly used to support diagnosis and treatment monitoring. We report a case of HHV-8-negative Kaposi sarcoma evaluated with multiple non-invasive imaging modalities to highlight their diagnostic utility. Case Presentation: An 83-year-old man presented with multiple painful, violaceous papulo-nodular lesions, some ulcerated, on the lateral aspect of his left foot. Dermoscopy revealed the characteristic rainbow pattern. Dynamic Optical Coherence Tomography (D-OCT) allowed real-time visualization of microvascular abnormalities, identifying large serpentine and branching vessels with clearly delineated capsules. Line-field Optical Coherence Tomography (LC-OCT) showed irregular dermal collagen, vascular lacunae, and the presence of spindle cells and slit-like vessels. Histological analysis confirmed the diagnosis of Kaposi sarcoma, revealing a proliferation of spindle-shaped endothelial cells forming angulated vascular spaces, with red blood cell extravasation and a mixed inflammatory infiltrate. Conclusions: Non-invasive imaging tools, including dermoscopy, D-OCT, and LC-OCT, have emerged as valuable adjuncts in the diagnosis and monitoring of KS. These techniques enable in vivo assessment of vascular architecture and tissue morphology, enhancing clinical decision-making while reducing the need for immediate biopsy. Dermoscopy reveals polychromatic vascular features, such as the rainbow pattern, while D-OCT and LC-OCT provide high-resolution insights into vascular proliferation, tissue heterogeneity, and cellular morphology. Dermoscopy, dynamic OCT, and LC-OCT represent promising non-invasive diagnostic tools for the assessment of Kaposi sarcoma. These technologies provide detailed morphological and vascular information, enabling earlier diagnosis and more personalized management. While histopathology remains the gold standard, non-invasive imaging offers a valuable complementary approach for diagnosis and follow-up, particularly in complex or atypical presentations. Ongoing research and technological refinement are essential to improve accessibility and clinical applicability. Full article

We present a case with unusual findings on nuclear imaging after mild SARS-CoV-2 infection. During evaluation for an incidentaloma, 18F-Fluorodeoxyglucose Positron Emission Tomography–Computed Tomography imaging showed activity in the thyroid gland, in the lower thoracic spinal column, in portal lymph nodes, and in the terminal ileum and surrounding lymph nodes, all suspicious for metastatic cancer. The patient underwent extensive invasive and non-invasive diagnostic procedures, including biopsies of all the suspicious foci, only showing a small low-grade thyroid cancer that would often be followed and not immediately operated on. Three months later, the findings had either disappeared or were considered reactive. The patient later recalled having had mild COVID-19 seven days prior to the PET/CT. Full article

Background and Objectives: After introducing the single-port robotic surgical system (da-Vinci SP), thyroid surgeries using da-Vinci SP are becoming more popular. Although many methods have been designed for thyroidectomy using the da-Vinci SP, there are very few reports on methods that can perform not only thyroidectomy but also lateral cervical lymph node dissection. In this study, we want to report the first clinical experience with SPRA-MRND (Single Port Robotic Areolar-Modified Radical Neck dissection), using right breast access. Materials and Methods: From April 2024 to January 2025, a total of 24 robotic MRNDs were performed, of which 11 were SPRA-MRNDs. The remaining 13 were performed using conventional BABA surgery. The two data sets were compared through retrospective medical record analysis. Results: There were no significant differences regarding patient characteristics, pathologic variables and oncologic outcomes between the two groups. However, SPRA group showed significantly shorter operation time (182.1 ± 27.5 vs. 213.1 ± 31.5 min, p = 0.017), higher immediate postoperative calcium level (calcium: 8.7 ± 0.5 vs. 8.0 ± 0.8 mg/dL, p = 0.014) and lower drainage amount (98.1 ± 33.2 vs. 146.4 ± 43.2 mL, p = 0.005). Conclusions: Our initial experience has shown that SPRA-MRND is performed safely. We propose SPRA-MRND as a good method for minimally invasive robotic surgery. Full article

Background/Objectives: With evolving guidelines favoring de-escalation in the management of papillary thyroid microcarcinoma (PTMC), options such as active surveillance and minimally invasive procedures are now considered for patients with low-risk disease. However, a subset of PTMCs—particularly non-incidental cases—may exhibit aggressive behavior. This study compares disease characteristics and outcomes between incidental and non-incidental PTMCs over a 10-year period. Methods: This is a single-center retrospective comparative analysis utilizing a prospectively collected database of patients referred for thyroid surgery. Results: Papillary thyroid carcinoma accounted for 86.7% of thyroid malignancies, with PTMC comprising 36.2% (137 patients). Incidental PTMC represented 109 out of 1012 patients undergoing surgery for benign thyroid disease (10.8%). Non-incidental PTMC (NIPTMC), diagnosed preoperatively and presenting clinically without coexisting thyroid disease, was identified in 28 patients (20.4%). NIPTMCs were more frequently associated with high-risk features (75% vs. 10.1%, p = 0.004), including extrathyroidal extension (21.43% vs. 7.3% p = 0.0015), positive central lymph nodes (21.43% vs. 2.8%, p = 0.0291), positive lateral lymph nodes (28.6% vs. 0% p = 0.012), and lymphovascular invasion (3.6% vs. 0%). Multifocal PTMC was seen in 37 patients (27%), of which 27 had bilobar disease. Multifocal tumors had a higher likelihood of high-risk features (48.6% vs. 14%, p = 0.007). NIPTMC was a significant predictor of multifocality (p = 0.0098). All patients underwent surgery, none opted for active surveillance. Conclusions: NIPTMC is more often associated with high-risk features and multifocality, necessitating more extensive surgery. These findings emphasize the need for careful preoperative risk stratification to guide individualized management. Full article

Background/Objectives: Papillary thyroid carcinoma (PTC) accounts for the majority of thyroid cancers, with lymph node metastasis, including skip metastasis (SM), playing a crucial role in guiding prognosis and therapeutic planning. SM, characterized by lateral lymph node spread in the absence of central compartment involvement, has been observed in PTC with a wide range of reported frequencies. The identification of risk factors for SM is crucial for preoperative evaluation and surgical planning. This research aims to explore the clinicopathological features and potential risk factors linked to SM in patients with PTC, while also offering valuable insights for preoperative risk evaluation. Methods: A retrospective cohort study was conducted on 81 PTC patients who underwent central and lateral cervical lymph node dissection (LND) in our center. Clinical, demographic, and pathological data, including age, sex, tumor size, location, subtype, extrathyroidal extension, lymphovascular invasion, and the number of lymph node metastases were analyzed. Clinicopathological characteristics were analyzed between SM-positive and SM-negative patient groups using suitable statistical methods. Additionally, a regression analysis was performed to identify the risk factors for SM. Results: Of the 81 patients, 17.3% (n = 14) were diagnosed with skip metastasis (SM). The SM-positive group had a significantly higher age (p = 0.006), smaller tumor size (p < 0.001), and higher rates of extrathyroidal extension (p = 0.006). The proportion of female patients was elevated in the SM-positive group, but this observation did not achieve statistical significance (p = 0.128). Tumors located in the upper pole were more common in the SM-positive group (p = 0.016). Multivariate analysis revealed that female sex, older age, and tumor location in the upper pole were significant risk factors for SM (p = 0.031, p = 0.004, and p = 0.017, respectively), while a lower number of lateral lymph node metastases was significantly associated with SM (p = 0.010). Additionally, an age over 43.5 years predicted SM with a sensitivity of 78.6% and a specificity of 72.7%. Conclusions: Skip metastasis is not uncommon in PTC and may be associated with older age, female sex, upper pole tumor location, and fewer lateral lymph node metastases. Recognizing these factors during preoperative assessment may aid in anticipating atypical lymphatic spread patterns and optimizing surgical strategies. Full article

Background/Objectives: Abbreviated breast MRI protocols have been proposed as a faster and more cost-effective alternative to standard full protocols for breast cancer detection. This study aimed to compare the diagnostic accuracy of an abbreviated protocol with that of a full protocol in identifying lobular breast carcinoma using Breast Imaging Reporting and Data System (BI-RADS) classification. The diagnostic performance was evaluated against a gold standard comprising biopsy-proven lobular carcinoma or negative follow-up imaging, using Receiver Operating Characteristic (ROC) analysis and performance metrics such as sensitivity and specificity. Methods: A retrospective analysis was conducted on 35 breast MRI examinations performed between January 2019 and December 2021. Of these, 20 cases had biopsy-confirmed lobular carcinoma, and 15 were determined to be normal based on at least 12 months of negative follow-up imaging. Two radiologists independently reviewed the images using only the abbreviated protocol, blinded to the original reports. Their findings were then compared with the initial full-protocol MRI reports. BI-RADS categories 1 and 2 were considered negative for malignancy, while BI-RADS categories 3, 4, and 5 were considered positive. Results: The area under the ROC curve (AUC) was 1.0 for the full protocol and 0.920 and 0.922 for Radiologists A and B, respectively, using the abbreviated protocol. All malignant lesions were correctly identified by both radiologists across both protocols, resulting in a sensitivity of 100%. However, the abbreviated protocol demonstrated significantly lower specificity (73.3% for Radiologist A and 53.5% for Radiologist B) compared to 100% specificity with the full protocol (p < 0.05). Lymph node involvement was correctly identified in 6–7 of 7 cases, though Radiologist A reported four false positives. Lesion laterality and count matched histopathology in 75–90% of cancer cases depending on protocol. Lesion localization was accurate in 60–80% of cases using the abbreviated protocol, though size comparisons were limited due to the incomplete radiological documentation of dimensions. Conclusions: While the abbreviated MRI protocol achieved diagnostic accuracy and sensitivity comparably to the full protocol, it demonstrated reduced specificity. These findings suggest that abbreviated MRI breast protocol may be a viable screening tool, although the higher false-positive rate should be considered in clinical decision-making. Full article

In this article, we present a case of a 49-year-old woman presenting with a recurrent metastatic neuroendocrine tumor. Background: Insulinomas are neuroendocrine tumors derived from beta cells of the pancreas that secrete insulin. Usually, they are benign tumors; however, metastatic insulinomas are an extremely rare malignant form of these tumors, carrying a significantly worse prognosis. Case Presentation: A 49-year-old woman, a patient in the University Hospital in Wroclaw in the Department of Endocrinology, Diabetes and Isotope Therapy, first presented with abdominal pain in 2009, when ultrasound and further examination led to the diagnosis of a tumor in the pancreas (a solid pseudopapillary tumor of the pancreas—meta NET G2), and the patient underwent distal pancreatectomy with splenectomy. For ten years, she was under observation, and her symptoms, such as abdominal pain, nausea, weight loss, and general weakness, reappeared in 2019. Then, magnetic resonance imaging (MRI) showed a lesion in the liver, and further histopathology revealed neuroendocrine tumor (NET) metastasis to the liver. In 2022, the patient presented with loss of consciousness and convulsion, loss of weight, and hypoglycemia after meals. In April 2022, the daily glycemic profile was recorded and a 72 h fasting test was performed; however, their results excluded insulinoma. Positron emission tomography–computed tomography (PET-CT) with 18F-fluorodeoxyglucose (18F-FDG) and PET with gallium-68-DOTA-(Tyr3)-octreotate (68Ga-DOTA-TATE) showed a metastatic proliferative process in the liver. Persistent hypoglycemia led to another hospitalization in May 2022, and repeated tests allowed for the diagnosis of insulinoma. Treatment with somatostatin analogs and diazoxide was started. A CT scan in November 2022 and a PET scan in January 2023 showed new metastases to the liver, bones, and cervical lymph nodes, and it was decided to intensify the treatment. In May 2023, the patient was qualified for Lutathera treatment for insulinoma at the University Clinical Hospital in Poznań. In June 2023, another disturbing symptom was reported by the patient, a painful lump in the breast. During diagnostics, metastases with high proliferation markers were found in both breasts. Two months later, in August 2023, the patient received another dose of Lutathera. In October 2023, significant progression of liver lesions, metastases to bones of the spine, ribs, and pelvis, and periaortic and pelvic lymphadenopathy were found as well as elevated values of neuron-specific enolase and calcitonin. The patient was also referred to the Palliative Medicine Home Hospice. In consultation with the Lower Silesian Cancer Center, the decision was made to forgo further treatment with PRRT and initiate systemic chemotherapy. Despite the chosen treatment, the patient died on 27/DEC/2023. Conclusions: This case report can serve clinicians, as it presents a case of an extremely rare and insidious tumor, metastatic insulinoma. Full article

It is unknown whether intestinal ultrasonographic measurements differ between lymphoplasmacytic enteritis (LPE) and low-grade intestinal T-cell lymphoma (LGITL) in cats if the diagnosis is based either on histology/immunohistochemistry (IHC) or on clonality assay results. The effects of treatment on intestinal ultrasonographic measurements are also unknown. Therefore, we prospectively compared small intestinal wall layering between cats with LPE and LGITL and investigated whether there were differences between the groups when the diagnostic gold standard was either histology/IHC or clonality testing. We evaluated the effects of standardized treatment in a subset of cats. The thicknesses of the total wall, mucosa, muscularis, and submucosa were measured in the duodenum, jejunum, and ileum, and ratios (muscularis to submucosa, muscularis to total wall thickness) were calculated. The thickness of the largest mesenteric lymph nodes was also determined. Ultrasonographic measurements from duodenal and jejunal segments were grouped together, and ileal segments were assessed separately. Sixteen cats with standardized full-thickness biopsies from the stomach, duodenum, jejunum, and ileum were included. Samples for clonality testing were fresh-frozen and analyzed later, and the standardized treatment was based on histologic/IHC diagnoses. Ultrasonographic measurements were compared between LPE and LGITL when diagnoses were either based on histology/IHC or clonality testing using a linear mixed model. Repeated ultrasonographic measurements of segments were available for seven cats after 12 weeks (five LPE, two LGITL) and five cats after 24 weeks (three LPE, two LGITL) of standardized treatment. We found that none of the ultrasonographic measurements differed between LPE and LGITL regardless of the diagnostic gold standard used. During treatment, only the ratio of lamina muscularis thickness to total wall thickness decreased significantly in LPE cats after 12 and 24 weeks compared to baseline. In conclusion, the herein evaluated ultrasonographic variables did not differ between LPE and LGITL and the diagnostic gold standard used had no influence on the results. The detected change over time during treatment in LPE cats requires further study. Full article

Background/Objectives: To investigate the association between MRI features of primary breast cancers with axillary status, aiming to identify possible imaging biomarkers. Methods: Patients diagnosed with breast cancer between 2021 and 2023 in our clinic were retrospectively evaluated, and those that presented as mass lesions on preoperative MRI examinations (n: 123) were included in the study. Patients with and without metastatic axillary lymph nodes (mALN) were compared in terms of breast density, background parenchymal enhancement, tumor size, location in the breast, distance from the skin, patient age, presence of edema, multiple foci, histopathological type and molecular subtype of tumors. In multifocal/multicentric cases, the largest lesion was taken into consideration. Prepectoral and subcutaneous edema were considered diffuse edema, while perilesional edema was considered focal edema. MannWhitney U/Student-t test, Chi- square/Fischer Exact tests and logistic regression analysis were used for statistical analyses as appropriate. Results: Axilla was positive in 88 patients. There was a statistically significant difference in terms of edema, age, molecular subtype, Ki-67 index, number of lesions, tumor size, and laterality between the two groups (p < 0.05). Univariate logistic regression analysis showed that all included variables were statistically significant (p < 0.05). Multivariate logistic regression analysis revealed that presence of edema (OR: 2.46 CI; 1.11–5.48, p = 0.027) and multiple lesions (OR: 1.86 CI; 1.01–3.43, p = 0.046) were significantly associated with mALN. There was no significant difference between peritumoral edema and diffuse edema. Conclusions: Our study showed a statistically significant relationship between the axillary status and the presence of edema and multiple tumoral lesions on MRI. These findings have a potential to serve as prognostic imaging biomarkers for predicting the presence of mALN. Further studies with larger case series are needed to support our findings. Full article

Objective: Therapeutic lateral neck dissection is recommended for papillary thyroid cancer with metastatic lymph nodes detected on palpation or on preoperative imaging. Current guidelines recommend systematic dissection of levels IIA, III, IV and VB in these patients. Despite this recommendation, management of level V remains controversial due to a varying degree of clinical and occult lymph node involvement reported in published retrospective studies, but also due to the functional risk involved in level V dissection in which the spinal accessory nerve may be temporarily or permanently injured. The aim of this review was to address the issues involved in level VB dissection and to provide our view of surgical management of level VB. Method: Narrrative review. Result: We propose a new concept of a partial or “super-superselective” level VB dissection in patients with clinical disease in levels IIA, III and IV. Full article

Mycoplasma hyopneumoniae (Mhyo) and porcine circovirus type 2 (PCV2) are critical pathogens in the swine industry, both contributing significantly to the porcine respiratory disease complex (PRDC). Given their impact, it is logical to control these pathogens simultaneously. Consequently, combined vaccinations against Mhyo and PCV2 are gaining popularity in swine health management. We present the efficacy of the first commercial combined vaccine prepared of a genotype PCV2d strain and Mhyo and tested against experimental challenge infections with target pathogens in comparative trials with other commercial products. In these studies, three-week-old piglets were vaccinated according to the manufacturers’ instructions. Five weeks later, they were challenged with two Mhyo strains over three consecutive days or with a PCV2d strain once. Positive controls included challenged pigs without prior vaccination, while non-vaccinated/non-challenged pigs served as negative controls. The key parameters measured were lung lesion scores and seroconversion for Mhyo, and viraemia, rectal shedding, lymph node and lung viral content, and seroconversion for PCV2. Findings and conclusion: The results showed no compromising effects between the vaccine components and highlighted significant differences in efficacy among the various products tested. Additionally, oral fluid sampling demonstrated a strong correlation with the viraemia and fecal shedding of PCV2, underscoring the diagnostic and animal welfare benefits of this sampling method. Full article

Background/Objectives: Immunotherapy has shown promising results in some cancers, but its efficacy remains limited in pancreatic ductal adenocarcinoma (PDAC). Vaccines in nanoparticle form (nanovaccines) can incorporate immunostimulating components to induce a potent immune response. As mesothelin (MSLN) is a tumor-associated antigen overexpressed in PDAC, we evaluated the effect of MSLN nanovaccine in a syngeneic orthotopic KPC-PDAC mouse model. Methods: An MSLN peptide combining three MSLN epitopes and two adjuvants, poly I:C and R848, was encapsulated in PLGA–chitosan nanoparticles to generate the nanovaccine. Results: The MSLN nanovaccine was successfully taken up by dendritic cells in vitro and was found in inguinal lymph nodes 24 h after subcutaneous injection into C57BL/6 mice. Nanovaccine re-stimulation of splenocytes from vaccinated mice led to increased levels of interferon-γ in vitro compared to unstimulated splenocytes. Higher levels of MSLN-specific IgM and IgG antibodies were detected in the serum of vaccinated mice compared to that of control mice. Three vaccination regimens were tested: a prophylactic scheme that included vaccination before tumor induction and two therapeutic schemes involving early and late vaccination after tumor cell inoculation. MSLN nanovaccination inhibited KPC tumor progression and metastasis and induced higher CD8⁺ T cell infiltration in the tumor that developed in response to prophylactic and early therapeutic schedules but not in response to a later vaccination approach. Although the nanovaccine treatment elicited higher humoral and cellular antigen-specific responses in tumor-bearing mice for both vaccination strategies, the therapeutic vaccination also increased the expression of exhaustion markers in CD8⁺ T cells. Conclusions: Our results support the relevance of an MSLN-based nanovaccine as a new immunotherapy treatment for PDAC and propose an innovative method of vaccine delivery using NPs. Full article

A sublingual vaccine comprising the Poly(I:C) adjuvant and influenza HA antigen was evaluated for safety in both mice and macaque monkeys relative to its intranasal counterpart. Safety was assessed in terms of harmful effects corresponding to the upregulation of the inflammation-associated genes Saa3, Tnf, IL6, IL1b, Ccl2, Timp1, C2, Ifi47, Aif1, Omp, Nos2, and/or Gzmb in mice and SAA2, TNF, IL6, IL1B, CCL2, TIMP, C2, AIF1, and GZMB in macaques. Quantitative gene expression analyses were performed using RT-qPCR with RNA samples from four tissue types, the olfactory bulb, pons, lung, tongue, and lymph node, from both mice and macaques. In mice, the intranasally delivered vaccine markedly upregulated the inflammation-related genes in the olfactory bulb 1 day and 7 days after vaccination. The adverse effects of intranasal vaccination were also observed in macaques, albeit to a lesser extent than in mice. The intranasal vaccination also upregulated these genes in the pons of both mice and macaques. In contrast, the sublingual vaccine did not adversely affect the olfactory bulb or pons in either mice or macaques. The intranasally administered vaccine significantly upregulated these genes in the lungs only 1 day after vaccination, but not 7 days later, in both mice and macaques. We conclude that intranasal vaccination results in unfavorable side effects corresponding to upregulated inflammatory genes in the brain (olfactory bulb and pons). Sublingual vaccination, however, did not induce these side effects in either mice or macaques and was hence evaluated as safe. Full article