ENDOCRINE TUMOURS: Imaging in the follow up of differentiated thyroid cancer: current evidence and future perspectives for a risk-adapted approach

The clinical and epidemiological profiles of differentiated thyroid cancers (DTCs) have changed in the last three decades. Today's DTCs are more likely to be small, localized, asymptomatic papillary forms. Current practice is though moving towards more conservative approaches (e.g. lobectomy instead of total thyroidectomy, selective use of radioiodine). This evolution has been paralleled and partly driven by rapid technological advances in the field of diagnostic imaging. The challenge of contemporary DTCs follow up is to tailor a risk-of-recurrence-based management, taking into account the dynamic nature of these risks, which evolve over time, spontaneously and in response to treatments. This review provides a closer look at the evolving evidence-based views on the use and utility of imaging technology in the post-treatment staging and the short- and long-term surveillance of patients with DTCs. The studies considered range from cervical US with Doppler flow analysis to an expanding palette of increasingly sophisticated second-line studies (cross-sectional, functional, combined-modality approaches), which can be used to detect disease that has spread beyond the neck and, in some cases, shed light on its probable outcome. 

Fiscal Capacity and Decision Making Flexibility and the Title IV-E Waiver

Public managers must reconcile fiscal constraints within a confined decision-making environment. This study was conducted to examine the extent to which policy tools, such as the Title IV-E waiver demonstration, facilitate cost control and increased decision-making flexibility. The central question guiding the study was whether policy tools enable public managers to effectively meet policy goals within inelastic fiscal and regulatory environments. Choice theories provided a theoretical framework to examine the multidimensional aspects of decision making and policy prioritization. An exploratory case study approach was employed to compare the change in fiscal capacity and flexibility of California counties participating in the Title IV-E waiver program with comparable counties not participating in the program. The data used for this study came from county, state, and other public agency resources specific to the scope of Title IV-E funded services; data were organized and analyzed using Atlas.ti is a qualitative software program. The findings of this study indicated that the potential to control costs and gain managerial discretion afforded by the waiver were diminished by other policy prioritization decisions. This study contributes to raising awareness of the complexity of fiscal management within county structures and facilitates increased scholarly interest in the study of county-specific issues. This study contributes to positive social change by raising awareness of the complexity of fiscal management of social service programs within county structures. The study facilitates increased scholarly interest in the study of county-specific issues

Molecular Imaging and Theragnostics of Thyroid Cancers

SIMPLE SUMMARY: According to the American Cancer Society, approximately 53,000 new cases of thyroid cancer were diagnosed and more than 2200 people died from the disease in 2020. New developments in molecular imaging are significantly improving thyroid cancer diagnostics and therapy. Continuous research in molecular imaging techniques additionally contributes to an understanding of a variety of diseases and enables more efficient care of thyroid cancer patients. Molecular imaging-based personalized therapy has been a fascinating concept for individualized therapeutic strategy, which is able to attain the highest efficacy and reduce adverse effects in certain patients. Theragnostics, which integrates diagnostic testing to detect molecular targets for particular therapeutic modalities, is one of the key technologies that contributes to the success of personalized medicine. This review details the inception of molecular imaging and theragnostic applications for thyroid cancer management. ABSTRACT: Molecular imaging plays an important role in the evaluation and management of different thyroid cancer histotypes. The existing risk stratification models can be refined, by incorporation of tumor-specific molecular markers that have theranostic power, to optimize patient-specific (individualized) treatment decisions. Molecular imaging with varying radioisotopes of iodine (i.e., (131)I, (123)I, (124)I) is an indispensable component of dynamic and theragnostic risk stratification of differentiated carcinoma (DTC) while [(18)F]F-fluorodeoxyglucose ([(18)F]FDG) positron emission tomography/computed tomography (PET/CT) helps in addressing disease aggressiveness, detects distant metastases, and risk-stratifies patients with radioiodine-refractory DTC, poorly differentiated and anaplastic thyroid cancers. For medullary thyroid cancer (MTC), a neuroendocrine tumor derived from thyroid C-cells, [(18)F]F-dihydroxyphenylalanine (6-[(18)F]FDOPA) PET/CT and/or [(18)F]FDG PET/CT can be used dependent on serum markers levels and kinetics. In addition to radioiodine therapy for DTC, some theragnostic approaches are promising for metastatic MTC as well. Moreover, new redifferentiation strategies are now available to restore uptake in radioiodine-refractory DTC while new theragnostic approaches showed promising preliminary results for advanced and aggressive forms of follicular-cell derived thyroid cancers (i.e., peptide receptor radiotherapy). In order to help clinicians put the role of molecular imaging into perspective, the appropriate role and emerging opportunities for molecular imaging and theragnostics in thyroid cancer are discussed in our present review

Use of lenvatinib in the treatment of radioiodine-refractory differentiated thyroid cancer: a multidisciplinary perspective for daily practice

Differentiated thyroid cancer; Lenvatinib; ToxicityCáncer diferenciado de tiroides; Lenvatinib; ToxicidadCàncer diferenciat de tiroide; Lenvatinib; ToxicitatBackground Most thyroid cancers of follicular origin have a favorable outcome. Only a small percentage of patients will develop metastatic disease, some of which will become radioiodine refractory (RAI-R). Important challenges to ensure the best therapeutic outcomes include proper, timely, and appropriate diagnosis; decisions on local, systemic treatments; management of side effects of therapies; and a good relationship between the specialist, patients, and caregivers. Methods With the aim of providing suggestions that can be useful in everyday practice, a multidisciplinary group of experts organized the following document, based on their shared clinical experience with patients with RAI-R differentiated thyroid cancer (DTC) undergoing treatment with lenvatinib. The main areas covered are patient selection, initiation of therapy, follow-up, and management of adverse events. Conclusions It is essential to provide guidance for the management of RAI-R DTC patients with systemic therapies, and especially lenvatinib, since compliance and adherence to treatment are fundamental to achieve the best outcomes. While the therapeutic landscape in RAI-R DTC is evolving, with new targeted therapies, immunotherapy, etc., lenvatinib is expected to remain a first-line treatment and mainstay of therapy for several years in the vast majority of patients and settings. The guidance herein covers baseline work-up and initiation of systemic therapy, relevance of symptoms, multidisciplinary assessment, and patient education. Practical information based on expert experience is also given for the starting dose of lenvatinib, follow-up and monitoring, as well as the management of adverse events and discontinuation and reinitiating of therapy. The importance of patient engagement is also stressed.Eisai Europe sponsored the expert panel and editorial assistance providing medical writing support. Eisai Europe had no editorial control over this manuscript and the views expressed are those of the authors. JC, DD, CD, SL, ML, RNM, KN, SS,GS, and LDL received an honorarium from Eisai Europe for time attending the panel and for editorial contribution to the present manuscript. Beate Bartès, as president of Association Vivre sans Thyroïde, received a donation from Eisai Europe. Kate Farnell received, on behalf of Butterfly Thyroid Cancer Trust, a donation from Eisai Europe

Aprendiendo a aprender: una experiencia de taller de estudio de fuentes primarias

El artículo detalla una experiencia con talleres de lectura y estudio de fuentes primarias (Smith, Ricardo, Marx, Keynes, Marshall) en la materia "Economía" del Ciclo Básico Común de la Universidad de Buenos Aires. Estos talleres extracurriculares y optativos ofrecieron a los estudiantes una experiencia de primera lectura de fuentes teóricas primarias, asi como una introducción a los métodos de lectura y estudio en la Universidad. Palabras clave: Metanoia – Aprendizaje significativo – Autonomía - Zona Desarrollo Potencial - Creatividad. Learning how to learn: a Source Readings Workshop Experience This paper describes a Source Readings Workshop at a Freshman Introductory Course of Economics (CBC - Universidad de Buenos Aires). Workshops on specific subjects as extracurricular optative activities offered the students a first approach experience in the study of primary theorical sources, as well as a first approach to University level reading and study methodology. Keywords: Metanoia - Significative learning - Autonomy - Potential Development Zone - Creativit