Association between Hashimoto's thyroiditis and papillary thyroid carcinoma: A retrospective analysis of 305 patients

Background: The association between Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC) is a controversial question that is still under debate, its pathological significance and the eventual clinical implications of this association remaining unclear. Methods: The data regarding 305 patients were retrospectively analyzed. The patients were divided in two different groups. A first group made up of 142 patients undergoing surgery for differentiated thyroid carcinoma was compared to a control group of 142 analogous subjects operated for normofunctioning goiter. A second group was made up of 163 patients who had undergone total thyroidectomy (TT) with pre-operative diagnosis of HT. Results: In the first group of patients an association with HT was found in 28,6% of the patients with final histopathological diagnosis of PTC versus 7,7% of the patients with histopathological diagnosis of multinodular goiter, which was a significant difference (p < 0.001). In the second group, the association with PTC was found in 43 (40,2%) cases of HT nodular variant and in 3 cases (8,1%) of HT diffuse variant (p < 0.001). Conclusions: The relationship between HT and PTC is still far from clear and represents an unresolved issue. Our own study has underlined the frequent coexistence of these two pathologies, an aspect not to be neglected in clinical practice. Patients receiving HT diagnosis should undergo careful follow-up and, especially those with the nodular variant, should undergo a frequent both clinical and cytological evaluation of the nodular lesions, taking always into great consideration the surgical approach of total thyroidectomy

Efeito da solução desinfetante de iodo a 2% sobre a adesão à dentina

INTRODUCTION: Disinfection of dentin surfaces is desirable so long as it does not interfere with subsequent bonding of adhesive resins. OBJECTIVE: To test the null hypothesis that bond strengths to dentin are not affected by previous application of an iodine disinfecting solution. MATERIALS AND METHODS: Twenty-four extracted non-carious molars were selected. Occlusal enamel was removed producing a flat dentin substrate. Test teeth were all treated with 2% Iodine disclosing/disinfecting solution (I2DDS) for 20 sec and rinsed for 20 sec followed by the application of self- or total- etching bonding systems, generating five adhesive groups (n=3): Single Bond; ; Prime & Bond NT; Clearfil SE Bond; Opti-Bond Plus. The control groups (n=3 per adhesive) had no disclosing/disinfectant application prior to adhesive application. A 4-mm thick resin restoration was built up on each tooth for microtensile testing. Statistical analyses between experimental and control groups were performed by student's t-test (alpha= 0.05). RESULTS: In general, experimental groups (previously treated with I2DDS) showed significantly lower bond strength values when compared with their respective controls (p;0.05). CONCLUSION: Acetone-base adhesive systems seem not to be affected by the application of I2DDS prior to etching and bonding procedures.INTRODUÇÃO: A desinfecção das superfícies de dentina é desejada desde que não haja interferência na adesão dos agentes adesivos. OBJETIVO: Testar a hipótese nula de que a resistência adesiva não é afetada pela aplicação prévia de uma solução desinfetante de iodo. MATERIAL AND MÉTODO: Vinte e quatro molares hígidos foram selecionados. O esmalte oclusal destes dentes foi removido, e sobre as superfícies planas de dentina expostas foi aplicada da solução desinfetante de Iodo a 2% (I2DDS), que permaneceu sobre a superfície por 20 s e foi lavada por 20 s com água deionizada. Sobre as superfícies desinfetadas foram aplicados um dos seguintes sistemas adesivos (n=3): Single Bond; Prime & Bond NT; Clearfil SE Bond; Opti-Bond Plus. Os grupos controle (n=3) não tiveram a supeficie de dentina tratada com I2DDS antes dos precedimentos adesivos. Em todos os grupos, após hibridização da dentina, foi construída uma "restauração" de resina composta com cerca de 4 mm de espessura. Após 7 dias de armazenagem em água destilada, os dentes foram secionados de modo a originarem espécimes a serem submetidos ao teste de microtração (palitos). Análise estatística para comparação dos dados foi realizada pelo teste t de student (alfa=0,05). RESULTADOS: De forma geral, os grupos experimentais (tratados com I2DDS) apresentraram resistência adesiva significativamente menor do que os respectivos grupos controle (p;0.05). Assim, a hipótese nula deve ser rejeitada para os adesivos a base de etanol e/ou a base de água, mas aceita para o adesivo a base de acetona. CONCLUSÃO: O uso da solução experimental de iodo previamente à realização dos procedimentos adesivos afetou a efetividade da união à dentina apenas quando do emprego de sistemas adesivos a base de etanol e/ou água

DIAGNOSTIC ACCURACY OF IXIP INDEX AND PROSTATE MRI IN THE DIAGNOSIS OF PROSTATE CANCER: PRELIMINARY RESULTS ON A COMBINED APPROACH

The purpose of this study was to assess whether Immune CompleX Predictive Index (iXip) improves diagnostic accuracy of multiparametric prostate MRI (mpMRI) for clinically significant prostate cancer. This study included 72 patients (mean age: 68±8 years) with suspicion of prostate cancer and available iXip score. mpMRI images were evaluated by two radiologists according to the PI-RADS v2.1. Reference standard was based on fusion biopsy and standard transperineal 12-point biopsy. Diagnostic accuracy of iXip, mpMRI and their combination were calculated. Optimal cutoff of iXip with sensitivity and specificity was identified using the Youden index. Patients with clinically significant prostate cancers had significantly higher iXip values compared to patients without clinically significant prostate cancers (median 0.411 vs 0.273; p=0.026). The AUROC for iXip was 0.795 (95% CI 0.579-1.000, p=0.026). Sensitivity and specificity were 75% and 100% respectively for mpMRI alone, and 100% and 80% respectively for mpMRI combined with iXip > 0.375. The combination of mpMRI with a cutoff value of iXip > 0.375 has a very high sensitivity for the diagnosis of prostate cancer and a moderately high specificity

Definition of remission and relapse in polymyalgia rheumatica: data from a literature search compared with a Delphi-based expert consensus

OBJECTIVE: To compare current definitions of remission and relapse in polymyalgia rheumatica (PMR) with items resulting from a Delphi-based expert consensus. METHODS: Relevant studies including definitions of PMR remission and relapse were identified by literature search in PubMed. The questionnaire used for the Delphi survey included clinical (n=33), laboratory (n=54) and imaging (n=7) parameters retrieved from a literature search. Each item was assessed for importance and availability/practicability, and limits were considered for metric parameters. Consensus was defined by an agreement rate of ≥80%. RESULTS: Out of 6031 articles screened, definitions of PMR remission and relapse were available in 18 and 34 studies, respectively. Parameters used to define remission and/or relapse included history and clinical assessment of pain and synovitis, constitutional symptoms, morning stiffness (MS), physician's global assessment, headache, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), blood count, fibrinogen and/or corticosteroid therapy. In the Delphi exercise a consensus was obtained on the following parameters deemed essential for definitions of remission and relapse: patient's pain assessment, MS, ESR, CRP, shoulder and hip pain on clinical examination, limitation of upper limb elevation, and assessment of corticosteroid dose required to control symptoms. CONCLUSIONS: Assessment of patient's pain, MS, ESR, CRP, shoulder pain/limitation on clinical examination and corticosteroid dose are considered to be important in current available definitions of PMR remission and relapse and the present expert consensus. The high relevance of clinical assessment of hips was unique to this study and may improve specificity and sensitivity of definitions for remission and relapse in PMR

Hsp90β inhibition modulates nitric oxide production and nitric oxide-induced apoptosis in human chondrocytes

<p>Abstract</p> <p>Background</p> <p>Hsp90β is a member of the Hsp90 family of protein chaperones. This family plays essential roles in the folding, maturation and activity of many proteins that are involved in signal transduction and transcriptional regulation. The role of this protein in chondrocytes is not well understood, although its increase in osteoarthritic cells has been reported. The present study aimed to explore the role of Hsp90β in key aspects of OA pathogenesis.</p> <p>Methods</p> <p>Human OA chondrocytes were isolated from cartilage obtained from patients undergoing joint replacement surgery, and primary cultured. Cells were stimulated with proinflammatory cytokines (IL-1β or TNF-α) and nitric oxide donors (NOC-12 or SNP). For Hsp90β inhibition, two different chemical inhibitors (Geldanamycin and Novobiocin) were employed, or siRNA transfection procedures were carried out. Gene expression was determined by real-time PCR, apoptosis was quantified by flow cytometry and ELISA, and nitric oxide (NO) production was evaluated by the Griess method. Indirect immunofluorescence assays were performed to evaluate the presence of Hsp90β in stimulated cells.</p> <p>Results</p> <p>Hsp90β was found to be increased by proinflammatory cytokines. Inhibition of Hsp90β by the chemicals Geldanamycin (GA) and Novobiocin (NB) caused a dose-dependent decrease of the NO production induced by IL-1β in chondrocytes, up to basal levels. Immunofluorescence analyses demonstrate that the NO donors NOC-12 and SNP also increased Hsp90β. Chemical inhibition or specific gene silencing of this chaperone reduced the DNA condensation and fragmentation, typical of death by apoptosis, that is induced by NO donors in chondrocytes.</p> <p>Conclusions</p> <p>The present results show how Hsp90β modulates NO production and NO-mediated cellular death in human OA chondrocytes.</p

Diagnostic delay for giant cell arteritis – a systematic review and meta-analysis

Background Giant cell arteritis (GCA), if untreated, can lead to blindness and stroke. The study’s objectives were to (1) determine a new evidence-based benchmark of the extent of diagnostic delay for GCA and (2) examine the role of GCA-specific characteristics on diagnostic delay. Methods Medical literature databases were searched from inception to November 2015. Articles were included if reporting a time-period of diagnostic delay between onset of GCA symptoms and diagnosis. Two reviewers assessed the quality of the final articles and extracted data from these. Random-effects meta-analysis was used to pool the mean time-period (95% confidence interval (CI)) between GCA symptom onset and diagnosis, and the delay observed for GCA-specific characteristics. Heterogeneity was assessed by I 2 and by 95% prediction interval (PI). Results Of 4128 articles initially identified, 16 provided data for meta-analysis. Mean diagnostic delay was 9.0 weeks (95% CI, 6.5 to 11.4) between symptom onset and GCA diagnosis (I 2 = 96.0%; P < 0.001; 95% PI, 0 to 19.2 weeks). Patients with a cranial presentation of GCA received a diagnosis after 7.7 (95% CI, 2.7 to 12.8) weeks (I 2 = 98.4%; P < 0.001; 95% PI, 0 to 27.6 weeks) and those with non-cranial GCA after 17.6 (95% CI, 9.7 to 25.5) weeks (I 2 = 96.6%; P < 0.001; 95% PI, 0 to 46.1 weeks). Conclusions The mean delay from symptom onset to GCA diagnosis was 9 weeks, or longer when cranial symptoms were absent. Our research provides an evidence-based benchmark for diagnostic delay of GCA and supports the need for improved public awareness and fast-track diagnostic pathways

Thrombosis in vasculitis: from pathogenesis to treatment

In recent years, the relationship between inflammation and thrombosis has been deeply investigated and it is now clear that immune and coagulation systems are functionally interconnected. Inflammation-induced thrombosis is by now considered a feature not only of autoimmune rheumatic diseases, but also of systemic vasculitides such as Behçet’s syndrome, ANCA-associated vasculitis or giant cells arteritis, especially during active disease. These findings have important consequences in terms of management and treatment. Indeed, Behçet’syndrome requires immunosuppressive agents for vascular involvement rather than anticoagulation or antiplatelet therapy, and it is conceivable that also in ANCA-associated vasculitis or large vessel-vasculitis an aggressive anti-inflammatory treatment during active disease could reduce the risk of thrombotic events in early stages. In this review we discuss thrombosis in vasculitides, especially in Behçet’s syndrome, ANCA-associated vasculitis and large-vessel vasculitis, and provide pathogenetic and clinical clues for the different specialists involved in the care of these patients