Hashimoto Thyroiditis beyond Cytology: A Correlation between Cytological, Hormonal, Serological, and Radiological Findings

Introduction. Hashimoto thyroiditis is the most common cause of chronic inflammation of the thyroid gland. Ultrasound is the modality for detection, while fine needle aspiration is the gold standard method for diagnosis. Serologic markers, such as antithyroidal peroxidase antibody (TPO) and antithyroglobulin antibody (TG), are usually elevated. Aim. The main objective is to appraise the incidence of neoplasms on a background of Hashimoto thyroiditis. Our second objective is to recognize the different sonographic appearances of Hashimoto thyroiditis, to focus on its nodular and focal patterns, and to measure the sensitivity of the ACR TIRAD system (2017) when interpreted on patients with Hashimoto thyroiditis. Methods. A single-center retrospective cross-sectional study. We studied 137 cases diagnosed cytologically as Hashimoto thyroiditis from January 2013–December 2019. The data collected were analyzed using SPSS (26th edition), and ultrasounds were reviewed by a single board-certified radiologist. The ACR thyroid imaging and Data System 2017 (ACR TI-RADs 2017) and the Bethesda System for reporting thyroid cytology 2017 (BSRTC 2017) were used for reporting ultrasound and cytology, respectively. Results. The mean age was 44.66 years and the female : male was 9 : 1. Serologically, anti-Tg was high in 22 cases (38%), while anti-TPO was positive in all of the 60 cases studied. Histologically, 11 cases were diagnosed with papillary thyroid carcinoma (8%) and a single case with follicular adenoma (0.7%). Ultrasonographically, 50% of the cases showed diffuse pattern, in which 13% of them showed micronodules. 32.2% were macronodular, and 17.7% were a focal nodular pattern. 45 nodules were interpreted with the ACR TIRAD system (2017), in which 22.2% were TR2, 26.6% were TR3, 17.7% were TR4, and 33.3% were TR5. Conclusion. Hashimoto thyroiditis is a risk factor for developing thyroid neoplasms, which necessitate a proper assessment of the cytological material studied and a correlation with the clinical and radiological features. Recognizing the different types of Hashimoto thyroiditis and its variable appearances is significantly important in performing and interpreting thyroid ultrasound imaging. Microcalcification is the most sensitive parameter to discriminate between PTC and nodular type of Hashimoto thyroiditis. The TIRAD system (2017) is a useful tool for risk stratification; however, it might create unnecessary FNA studies in the setting of Hashimoto thyroiditis because of its variable appearances on ultrasound. A modified TIRAD system for patients with Hashimoto thyroiditis is important to alleviate this confusion. Finally, anti-TPO is a sensitive marker for detecting Hashimoto thyroiditis, which could be used for future referencing of newly diagnosed cases

Experimental study on the effects of external strengthening and elevated temperature on the shear behavior of ultra-high-performance fiber-reinforced concrete deep beams

The shear behavior of deep beams, especially of ultra-high-performance fiber-reinforced concrete (UHPFC), is rather intricate, as it depends on several factors, including its depth, concrete strength, amount of flexural and shear reinforcements, the ratio of shear span to depth, and the bearing area under the load and at the support. Moreover, these beams may be exposed to elevated temperatures requiring strengthening, which has not been adequately studied. This study examines experimentally the shear capacity of UHPFC deep beams strengthened using carbon fiber-reinforced polymer (CFRP) sheets for improving the shear strength of deep beams after exposure to an elevated temperature. Eight specimens were cast in four groups of two specimens each. Testing of the beams of the first group was performed at the ambient temperature, whereas the beams of the second group were tested after being exposed to a temperature of 450 °C. For the third group, the deep beams were strengthened by CFRP U-wrap strips and tested at the ambient temperature, whereas the beams of the fourth group were subjected to the elevated temperature of 450 °C, followed by strengthening using CFRP U-wraps and then testing to collapse. The test results indicated that the post-peak behavior was affected significantly by the elevated temperature. Moreover, the experimental results indicated the excellent performance of strengthening schemes in improving the post-cracking behavior of UHPFC deep beams, enhancing shear strength (up to 16 %), energy-based ductility index (39 % to 648 %), and deflection ductility index (68 % to 144 %). An analytical model is developed to predict the load-carrying capacity of UHPFC deep beams strengthened after exposure to elevated temperature

Quantifying the risk-adjusted hospital costs of postoperative complications after lower extremity bypass in patients with claudication

ObjectiveIncreasing evidence has shown that the risks associated with surgical revascularization for intermittent claudication outweigh the benefits. The aim of our study was to quantify the cost of care associated with perioperative complications after elective lower extremity bypass (LEB) in patients presenting with intermittent claudication.MethodsAll patients undergoing first-time LEB for claudication in the Healthcare Database (2009-2015) were included. The primary outcome was in-hospital postoperative complications, including major adverse limb events (MALE), major adverse cardiac events (MACE), acute kidney injury, and wound complications. The overall crude hospital costs are reported, and a generalized linear model with log link and inverse Gaussian distribution was used to calculate the predicted hospital costs for specific complications.ResultsOverall, 7154 patients had undergone elective LEB for claudication during the study period. The median age was 66 years (interquartile range, 59-73 years), 67.5% were male, and 75.3% were white. Two thirds of patients (61.2%) had Medicare insurance, followed by private insurance (26.9%), Medicaid (7.7%), and other insurance (4.2%). In-hospital complications occurred in 8.5% of patients, including acute kidney injury in 3.0%, MALE in 2.8%, wound complications in 2.3%, and MACE in 1.0%. The overall median crude hospital cost was $11,783 (interquartile range,$8911-$15,767) per patient. The incremental increase in cost associated with a postoperative complication was significant, ranging from$6183 (95% confidence interval, $4604-$7762) for MALE to $10,485 (95$6529-$14,441) for MACE after risk adjustment.ConclusionsPostoperative complications after elective LEB for claudication are not uncommon and increase the in-hospital costs by 46% to 78% depending on the complication. Surgical revascularization for claudication should be used sparingly in carefully selected patients

Halo effect in trauma centers: Does it extend to emergent colectomy?

Background: Trauma centers (TCs) have been demonstrated to improve outcomes for some nontrauma surgical conditions, such as appendicitis, but it remains unclear if this extends to all emergency general surgery procedures. Using emergent colectomy in patients with diverticulitis as index condition, this study compared outcomes between TCs and nontrauma centers (NTCs).Materials and methods: The Nationwide Emergency Department Sample (2006-2011) was queried for patients ≥16 y with diverticulitis who underwent emergency surgical intervention. Outcomes included mortality, total charges, and length of stay (LOS). Mortality in TC and NTC was compared using logistic regression, controlling for patient, procedure, and hospital-level characteristics. Adjusted total charges and LOS were analyzed using generalized linear models with gamma and Poisson distributions, respectively.Results: A total of 25,396 patients were included, 5189 (20.4%) were treated at TC and 20,207 (79.6%) at NTC. Median age and sex distribution were similar. Unadjusted proportional in-hospital mortality did not differ between TC and NTC; median charges and LOS were greater in TC. After adjusting, the odds of mortality were significantly higher in TC (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.02-1.51; P = 0.003) as were mean charges and LOS (P \u3c 0.001).Conclusions: The improved outcomes reported for other nontrauma conditions in TC were not observed for patients undergoing an emergent colectomy for diverticulitis after accounting for patient, procedure, and hospital-level characteristics. Future research is needed to assess differences in case mix between TC versus NTC and possible case-mix effects on outcomes to elucidate potential benefit of surgical care in a TC across the breadth of emergency general surgery conditions

Rethinking priorities: Cost of complications after elective colectomy

Objective: To compare incremental costs associated with complications of elective colectomy using nationally representative data among patients undergoing laparoscopic/open resections for the 4 most frequent diagnoses.Summary background data: Rising healthcare costs have led to increasing focus on the need to achieve a better understanding of the association between costs and quality. Among elective colectomies, a focus of surgical quality-improvement initiatives, interpretable evidence to support existing approaches is lacking.Methods: The 2009 to 2011 Nationwide Inpatient Sample (NIS) data were queried for adult (≥18 years) patients undergoing elective colectomy. Patients with primary diagnoses for colon cancer, diverticular disease, benign colonic neoplasm, and ulcerative colitis/regional enteritis were included. Based on system-based complications considered relevant to long-term treatment of elective colectomy, stratified differences in risk-adjusted incremental hospital costs and complications probabilities were compared.Results: A total of 68,462 patients were included, weighted to represent 337,887 patients nationwide. A total of 16.4% experienced complications. Annual risk-adjusted incremental costs amounted to \u3e$150 million. Magnitudes of complication prevalences/costs varied by primary diagnosis, operative technique, and complication group. Infectious complications contributed the most ($55 million), followed by gastrointestinal ($53 million), pulmonary ($22 million), and cardiovascular ($11 million) complications. Total annual costs for elective colectomies amounted to \u3e$1.7 billion: 11.3% was due to complications [1.9% due to current Centers for Medicare and Medicaid Services (CMS) complications].Conclusions: The results highlight a need to consider the varied/broad impact of complications, offering a stratified paradigm for priority setting in surgery. As we move forward in the development of novel/adaptation of existing interventions, it will be essential to weigh the cost of complications in an evidence-based way