Association between Hashimoto's Thyroiditis and Thyroid Cancer in 64,628 Patients

BACKGROUND: The incidence of thyroid cancer (TC) is increasing although explanatory causes are lacking. A link between cancer and inflammation is well documented but unclear for autoimmune thyroid diseases and TC. We aimed to systematically review the association between Hashimoto’s thyroiditis (HT) and papillary, follicular, medullary, anaplastic thyroid carcinoma, and thyroid lymphoma (TL). METHODS: PubMed, OVID Medline, Google Scholar, and the Cochrane Library were searched from 1955 to 2016. The inclusion criteria were age >18 years, ≥20 cases of HT or TC. We collectively examined the incidence of HT in TC and of TC in HT. RESULTS: We identified 36 studies (64,628 subjects) published between 1955 and 2016 from 13 countries. We found a relative risk (RR) of HT among papillary thyroid cancer (PTC) of 2.36 [95% confidence intervals (CIs) 1.55–3.29, p < 0.001], an RR of PTC among HT of 1.40 (95% CI 1.07–1.85, p = 0.016), and an RR of TL among HT of 9.74 (95% CI 3.93–24.13, p < 0.001). CONCLUSION: We report an association between HT and PTC and between HT and TL. No association was found between HT and follicular, medullary, or anaplastic thyroid cancer

The roles, resources and competencies of employee lay judges: A cross-national study of Germany, France and Great Britain

This research project analysed and compared the roles, resources and competencies of lay judges in Germany, France and Great Britain, where lay judges take up their role through nationally distinctive routes: nomination essentially by the social partners in Germany, self-nomination in Great Britain and election in France. The primary research consisted of qualitative data collected through interviews, set against contextual information on national institutional arrangements, industrial relations, This research project analysed and compared the roles, resources and competencies of lay judges in Germany, France and Great Britain, where lay judges take up their role through nationally distinctive routes: nomination essentially by the social partners in Germany, self-nomination in Great Britain and election in France. The primary research consisted of qualitative data collected through interviews, set against contextual information on national institutional arrangements, industrial relations, and court procedures. The key findings are as follows: • The dominant influence on lay judge’s reported perception of their role is their experience of the prevailing industrial relations system in each country, mediated by the labour court structure. Routes to nomination not only reflect national systems but may reinforce them and have a bearing on employee lay judges’ sense of organisational allegiance. • While acknowledging distinct employer and employee perspectives, there was an aspiration to be impartial and a commitment to fairness. This was most unambiguously expressed in Germany and Great Britain. In France, deliberations were sometimes reported as resembling a negotiation between employee and employer lay judges, but one that had to culminate in a legally correct judgment. Very few employee lay judge interviewees reported that they experienced enduring dissonance between sitting on the employee side in the court and their role as a lay judge, although this was noted by several at the outset. • Our interview findings from lay and professional judges indicated that lay judges bring distinctive knowledge. Some of this knowledge is explicit and often specific. Lay knowledge is often tacit, however, and acquired through long exposure to workplace events. Such knowledge was valued by many professional judge interviewees as adding an extra dimension to decision-making and was seen by near-ly all our interviewees as the main contribution of lay judges to the judicial process. Crucially tacit knowledge is a form of understanding that needs to be elicited in the process of deliberations, rather than as evidence provided by an expert witness. As well as bringing knowledge to the court, lay judges also reported that they could enhance their representational and personal-professional skills by transferring knowledge and experience acquired in court back to the work-place. • Gender played some role in the motivation to become a lay judge in Great Britain and in how lay judges assessed their contribution in Germany. Some female interviewees in Britain reported that work-place problems they had personally experienced had contributed to their motivation to become a lay judge. In Germany, there were some differences between men and women in their views of the nature of their contribution: whereas men tended to emphasise the specialist knowledge they could bring to bear in deliberations, women highlighted a ‘social perspective’

Safety and efficacy of advanced atrial pacing therapies for atrial tachyarrhythmias in patients with a new implantable dual chamber cardioverter-defibrillator

AbstractObjectivesThis study evaluated the safety and efficacy of atrial pacing therapies for the treatment and prevention of atrial tachycardia (AT) or atrial fibrillation (AF) in a new dual chamber implantable cardioverter defibrillator (ICD).BackgroundPatients with an ICD may also experience AT or AF that is amenable to pace termination.MethodsThe efficacy of atrial antitachycardia pacing (ATP) therapies for atrial tachycardia or atrial fibrillation (AT/AF) was determined in 151 patients after implantation of a GEM III AT ICD (Medtronic Inc., Minneapolis, Minnesota). The percentage of episodes successfully terminated was adjusted for multiple episodes per patient.ResultsA total of 717 of 728 (96%) episodes classified as AT or AF were judged to be appropriate detections. By device classification, atrial ATP terminated 187 of 383 (40% adjusted) episodes classified as AT compared with 65 of 240 episodes classified as AF (26% adjusted, p = 0.013). Atrial Ramp or Burst+ ATP terminated 184 of 378 episodes of AT (39% adjusted), whereas 50-Hz Burst pacing therapy terminated only 12 of 109 episodes of AT (12% adjusted) and 65 of 240 episodes of AF (26% adjusted). If efficacy was defined as termination of AT/AF within 20 s of delivery of the pacing therapy, ATP therapies terminated 139 of 383 (32% adjusted) episodes of AT compared with 34 of 240 episodes of AF (15% adjusted, p = 0.003). Efficacy was dependent on AT cycle length. Frequent transitions between AT and AF predicted inefficacy of atrial ATP (p < 0.001). Ventricular proarrhythmia secondary to atrial ATP was not observed.ConclusionsAtrial ATP therapies terminate many episodes of AT without ventricular proarrhythmia. The addition of 50-Hz Burst pacing has minimal efficacy for AT/AF

Free-Breathing Myocardial T1 Mapping using Inversion-Recovery Radial FLASH and Motion-Resolved Model-Based Reconstruction

Purpose: To develop a free-breathing myocardial T1 mapping technique using inversion-recovery (IR) radial fast low-angle shot (FLASH) and calibrationless motion-resolved model-based reconstruction. Methods: Free-running (free-breathing, retrospective cardiac gating) IR radial FLASH is used for data acquisition at 3T. First, to reduce the waiting time between inversions, an analytical formula is derived that takes the incomplete T1 recovery into account for an accurate T1 calculation. Second, the respiratory motion signal is estimated from the k-space center of the contrast varying acquisition using an adapted singular spectrum analysis (SSA-FARY) technique. Third, a motion-resolved model-based reconstruction is used to estimate both parameter and coil sensitivity maps directly from the sorted k-space data. Thus, spatio-temporal total variation, in addition to the spatial sparsity constraints, can be directly applied to the parameter maps. Validations are performed on an experimental phantom, eleven human subjects, and a young landrace pig with myocardial infarction. Results: In comparison to an IR spin-echo reference, phantom results confirm good T1 accuracy, when reducing the waiting time from five seconds to one second using the new correction. The motion-resolved model-based reconstruction further improves T1 precision compared to the spatial regularization-only reconstruction. Aside from showing that a reliable respiratory motion signal can be estimated using modified SSA-FARY, in vivo studies demonstrate that dynamic myocardial T1 maps can be obtained within two minutes with good precision and repeatability. Conclusion: Motion-resolved myocardial T1 mapping during free-breathing with good accuracy, precision and repeatability can be achieved by combining inversion-recovery radial FLASH, self-gating and a calibrationless motion-resolved model-based reconstruction.Comment: Part of this work has been presented at the ISMRM Annual Conference 2021 (Virtual), submitted to Magnetic Resonance in Medicin

Quantification of left atrial strain and strain rate using Cardiovascular Magnetic Resonance myocardial feature tracking: a feasibility study.

BACKGROUND: Cardiovascular Magnetic Resonance myocardial feature tracking (CMR-FT) is a quantitative technique tracking tissue voxel motion on standard steady-state free precession (SSFP) cine images to assess ventricular myocardial deformation. The importance of left atrial (LA) deformation assessment is increasingly recognized and can be assessed with echocardiographic speckle tracking. However atrial deformation quantification has never previously been demonstrated with CMR. We sought to determine the feasibility and reproducibility of CMR-FT for quantitative derivation of LA strain and strain rate (SR) myocardial mechanics. METHODS: 10 healthy volunteers, 10 patients with hypertrophic cardiomyopathy (HCM) and 10 patients with heart failure and preserved ejection fraction (HFpEF) were studied at 1.5 Tesla. LA longitudinal strain and SR parameters were derived from SSFP cine images using dedicated CMR-FT software (2D CPA MR, TomTec, Germany). LA performance was analyzed using 4- and 2-chamber views including LA reservoir function (total strain [εs], peak positive SR [SRs]), LA conduit function (passive strain [εe], peak early negative SR [SRe]) and LA booster pump function (active strain [εa], late peak negative SR [SRa]). RESULTS: In all subjects LA strain and SR parameters could be derived from SSFP images. There was impaired LA reservoir function in HCM and HFpEF (εs [%]: HCM 22.1 ± 5.5, HFpEF 16.3 ± 5.8, Controls 29.1 ± 5.3, p \u3c 0.01; SRs [s⁻¹]: HCM 0.9 ± 0.2, HFpEF 0.8 ± 0.3, Controls 1.1 ± 0.2, p \u3c 0.05) and impaired LA conduit function as compared to healthy controls (εe [%]: HCM 10.4 ± 3.9, HFpEF 11.9 ± 4.0, Controls 21.3 ± 5.1, p \u3c 0.001; SRe [s]⁻¹: HCM -0.5 ± 0.2, HFpEF -0.6 ± 0.1, Controls -1.0 ± 0.3, p \u3c 0.01). LA booster pump function was increased in HCM while decreased in HFpEF (εa [%]: HCM 11.7 ± 4.0, HFpEF 4.5 ± 2.9, Controls 7.8 ± 2.5, p \u3c 0.01; SRa [s⁻¹]: HCM -1.2 ± 0.4, HFpEF -0.5 ± 0.2, Controls -0.9 ± 0.3, p \u3c 0.01). Observer variability was excellent for all strain and SR parameters on an intra- and inter-observer level as determined by Bland-Altman, coefficient of variation and intraclass correlation coefficient analyses. CONCLUSIONS: CMR-FT based atrial performance analysis reliably quantifies LA longitudinal strain and SR from standard SSFP cine images and discriminates between patients with impaired left ventricular relaxation and healthy controls. CMR-FT derived atrial deformation quantification seems a promising novel approach for the study of atrial performance and physiology in health and disease states