Thyroid autoimmunity, thyroglobulin autoantibodies and thyroid cancer prognosis

Relevance of thyroid autoimmunity to prognosis of papillary thyroid carcinoma is still unsettled. We decided to investigate the impact of thyroid autoimmunity on prognosis of papillary thyroid carcinoma and the handling of TgAbs. We evaluated the clinical course of a large group of patients according to the presence (PTC-LT) or absence (PTC) of lymphocytic thyroiditis at histology. We studied 194 consecutive patients with a diagnosis of PTC and treated with total thyroidectomy plus ¹³¹I ablation between 2007 and 2009. Median follow-up (with 25th-75th percentiles) was 84·0 (56·4-118·0) months. The remission criteria were: basal Tg <0·2 ng/mL (or stimulated Tg <1), TgAbs <8 IU/mL (otherwise "decreasing TgAb trend", a decline of ≥20% in sequential TgAb measurements) and unremarkable imaging. PTC-LT and PTC patients had comparable treatment.TgAbs were detectable in 72·5% of PTC-LT and 16·5% of PTC patients. Time to remission was longer in the detectable than in the undetectable TgAb cohort (28·5 vs· 7·5 months [median]; HR 0·54, CI 0·35-0·83, p=0·005). When comparing PTC-LT to PTC patients the difference was maintained in the detectable TgAb (29·3 vs 13·0 months; HR 0·38, CI 0·18-0·80; p=0·01), but not in the undetectable TgAb cohort (7·7 vs 7·3 months; HR 0·90, CI 0·55-1·47; p=0·68). Using the decreasing TgAb trend, the influence of detectable TgAbs on time to remission was abolished. Thyroid autoimmunity does not influence the prognosis of papillary thyroid carcinoma. A decreasing TgAb trend seems an appropriate criterion to establish the remission of papillary thyroid carcinoma

Suscetibilidade antimicrobiana de Salmonella spp e Staphylococcus aureus isolados de carnes bovinas comercializadas em Campo Grande, Mato Grosso do Sul, Brasil

As falhas na qualidade higiênico-sanitária da carne podem ser identificadas a partir da avaliação de microrganismos patogênicos que comprometem a qualidade microbiológica do alimento e podem veicular doenças de origem alimentar. O presente estudo objetivou avaliar a qualidade higiênica-sanitária de carnes bovinas comercializadas em supermercados, açougues e mercados públicos da cidade de Campo Grande (Mato Grosso do Sul, Brasil) por meio da pesquisa e caracterização fenotípica e genotípica de Salmonella spp. e Escherichia coli produtora de toxina Shiga (STEC) e pesquisa e contagem de Staphylococcus aureus. Foram avaliadas 71 amostras de carne bovina de 17 estabelecimentos comerciais que foram submetidas a pesquisa de detecção de Salmonella spp., Escherichia coli produtora de toxina Shiga (STEC) e pesquisa e contagem de Staphylococcus aureus. Os isolados obtidos foram submetidos ao perfil de sensibilidade aos antimicrobianos pelo teste de difusão em disco, de acordo com o Clinical & Laboratory Standards Institute (CLSI). Constatou-se a presença de Salmonella em 7,04% das amostras avaliadas, sendo que 70,0% dos isolados foram sensíveis aos antimicrobianos testados. Em relação ao Staphylococcus aureus, 25,35% das amostras foram positivas com contagens variando entre 1,0 x 102 a 4,3 x 104 UFC/g, sendo que os isolados apresentaram resistência para penicilina (62,5%), tetraciclina (18,75%) e cloranfenicol (6,25%). Nenhuma amostra apresentou-se positiva para STEC. A detecção desses patógenos em alimentos representa um perigo a saúde pública, principalmente, devido a presença de isolados resistentes a antimicrobianos. Além disso, ressalta-se a necessidade do emprego das boas práticas de higiene e fabricação nos estabelecimentos varejistas. Palavras-chave: antibiótico; comércio varejista; patógenos alimentares; resistência

ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in adult patients

Central venous access devices are routinely used in clinical practice for administration of fluids and medications, for drawing blood samples and for hemodynamic monitoring. The adoption of ultrasound guided venipuncture has significantly reduced procedure-related complications, as documented by the recommendations of most recent guidelines. Ultrasound has also an important role also in other aspects of central venous catheterization, such as in the pre-procedural evaluation of the venous patrimony and in the detection of early and late non-infective complications. Recently, bedside ultrasound has been regarded as a promising tool also for ensuring an accurate and intraprocedural method of tip navigation and tip location. The aim of this paper is to review all the evidence about the accuracy of ultrasound methods for tip navigation and tip location in adult patients, and to suggest a structured standardized protocol for clinical practice

ECHOTIP-Ped: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in pediatric patients

: Central venous access devices are routinely used in pediatric care for administration of fluids and medications and for drawing blood samples. The adoption of ultrasound guided venipuncture, the availability of bedside ultrasound devices and the use of intraprocedural methods for tip location have been shown to reduce procedure-related complications, as documented by the recommendations of most recent guidelines. In pediatric patients, bedside ultrasound is a promising tool not only for optimizing the choice of the vein and guiding the venipuncture, but also for ensuring an accurate and intraprocedural method of tip navigation and tip location. The aim of this paper is to review all the evidence about the accuracy of ultrasound methods for tip navigation and tip location in pediatric patients, and to suggest a structured protocol for clinical practice

Neo-ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in neonates

Central venous access devices are often needed in neonates admitted to Neonatal Intensive Care Unit. The location of the tip of the central catheter is usually assessed by post-procedural X-ray. However, this strategy is inaccurate and time consuming. Recent guidelines strongly recommend intra-procedural methods of tip location, to increase the cost-effectiveness of the maneuver and to shorten the time between device placement and utilization. In this regard, real-time ultrasound represents the most promising tool for tip navigation and location in neonates. The aim of this paper is (a) to review all the evidence available about ultrasound-based tip navigation and tip location of central catheters in the neonatal population (b) to propose a novel protocol for tip navigation and location (Neo-ECHOTIP) based on such evidence

Synchrotron-based X-ray fluorescence imaging of human cells labeled with CdSe quantum dots.

International audienceSynchrotron-based X-ray fluorescence (S-XRF) is a powerful technique for imaging the distribution of many biologically relevant elements, as well as of "artificial" elements deliberately introduced into tissues and cells, for example through functionalized nanoparticles. In this study we explored the potential of S-XRF for chemical nanoimaging (100 nm spatial resolution, nanoXRF) of human cells, through the use of functionalized CdSe/ZnS quantum dots (QDs). We used a commercially available QD -- secondary antibody conjugate to label the cancer marker HER2 (Human Epidermal growth factor Receptor 2) on the surface of SKOV3 cancer cells, and beta-tubulin, a protein associated with cytoskeleton microtubules. We set up samples with epoxy inclusion and intracellular labeling, and samples without epoxy inclusion and with surface labeling. Epoxy inclusion, also used in electron microscopy, has the advantage to preserve cell morphology, and to guarantee long term stability. QDs proved to be suitable probes for nanoXRF, due to the Se emission band which is not in close proximity to any other emission band, and the signal specificity which is preserved in both types of labeling. Therefore, nanoXRF using QD-based markers can be very effective to colocalize specific intracellular targets with elements naturally present in the cell, and may complement confocal fluorescence microscopy in a synergistic fashion

Significance of Thyroglobulin Autoantibodies in Patients With Thyroid Cancer Treated With Lenvatinib

Context Serum thyroglobulin (Tg) is a highly sensitive and specific tumor marker, employed in post-operative management of patients with differentiated thyroid carcinomas. Tumor shrinkage of radioiodine-refractory thyroid cancer (RAIR-DTC) treated with multitarget kinase inhibitors as lenvatinib, expressed according to the Response Evaluation Criteria in Solid Tumors (RECIST), is also associated with a drastic reduction of Tg levels. However, interference caused by circulating thyroglobulin autoantibodies (TgAb) represents the main limitation in the clinical use of Tg. Objective To evaluate if in RAIR-DTC TgAb could be considered a surrogate marker of Tg in monitoring response to treatment with lenvatinib. Design We retrospectively evaluated patients who had started lenvatinib and correlated serum Tg and TgAb with the radiological response across visits. Setting University of Pisa, Italy. Patients We selected 9/97 RAIR-DTC patients with detectable TgAb. Intervention None. Main Outcome Measure(s) None. Results Tg values correlated neither with TgAb title nor with radiological response across visits. Greater decreases in TgAb titer correlated with favorable radiological response to lenvatinib after 1 month (Spearman's correlation = 0.74, P = .021) and 6 months (correlation = 0.61, P = .079). According to RECIST, patients with partial response showed a ∼10-fold greater decrease in TgAb compared to those with stable disease at 1 month (median TgAb decrease: −142 vs −14 IU/mL, P = .01) and those with progressive disease at 6 months (median TgAb decrease: −264 vs−24 IU/mL, P = .04). Conclusion TgAb evaluation may represent a reliable surrogate marker for Tg trend in evaluating response of RAIR-DTC to treatment with lenvatinib. A multicentric study would be useful to confirm our results

Influence of Lymphocytic Thyroiditis at Histology and Serum Thyroglobulin Autoantibodies on the Course of Papillary Thyroid Carcinoma

PURPOSE Papillary thyroid carcinoma (PTC) is frequently associated with diffuse lymphocytic thyoiditis (LT) at histology and serum autoantibodies to thyroglobulin (TgAb) and to thyroperoxidase (TPOAb). The influence of LT and thyroid autoantibodies on the prognosis of PTC is debated. We evaluated the clinical course of a large group of PTC patients according to the presence or absence of LT (LT+ and LT-) and thyroid autoantibodies. METHODS We evaluated 194 consecutive and non-selected PTC patients treated with total thyroidectomy plus ¹³¹I ablation between 2007 and 2009, followed for 7.2 years (mean). 72 patients had follicular variant of PTC, 97 classic, 16 tall cells and the remaining 9 others variants (solid or oxyphilic cells). LT was diagnosed in presence of >10 lymphocytes/field (40x). At the time of ablation, all patients underwent measurement of Tg, TgAb and TPOAb, neck ultrasound and whole body scan. After ablation, patients underwent Tg (Beckman Coulter), TgAb and TPOAb (Tosoh) measurement and neck ultrasound (associated with other imaging if required) every 6-12 months. PTC was considered in remission according to the following criteria: un-stimulated Tg <0.2 ng/mL or stimulated Tg <1 ng/mL with TgAb <8 IU/mL and no evidence of structural disease. PTC was considered as persistent when un-stimulated Tg was ≥0.2 ng/mL or stimulated Tg was ≥1 ng/mL, or when TgAb were ≥8 IU/mL, or there was evidence of structural disease. RESULTS LT was found in 47% of patients, with a F/M ratio of 6.6/1, and was associated with a hypoechoic pattern at thyroid ultrasound (p = 0.05). At the end of follow-up 44/194 (22.7%) had persistent disease. Among them, 17/72 (23.6%) were follicular, 19/97 (19.6%) classic, 6/16 (37.5%) tall cells and 2/9 (22.2%) other variants. The time to remission was longer in the LT+ compared to the LT- patients (19.5 vs 7.5 months) (median) (p <0.001), in TgAb positive compared to TgAb negative patients (28.5 vs 7.5 months) (p <0.001) and in TPOAb positive compared to TPOAb negative patients (28.0 vs 8.0 months) (p = 0.005). At multivariate analysis TgAb were the only independent factor influencing the time to remission (0.54; 0.35-0.83; HR and confidence interval) (p = 0.001). However, evaluating only the 111 TgAb negative patients, the time to remission (undetectable un-stimulated or stimulated Tg and no evidence of structural disease) was similar in the LT+ and LT- groups (8.0 months for both). At variance, in 83 TgAb positive patients the time to remission was longer in LT+ than in LT- patients (29.3 vs 13.0 months) (p=0.01). CONCLUSIONS The time to remission is longer in LT+ compared to LT- PTC patients treated with total thyroidectomy plus ¹³¹I ablation. This is due to the frequent association of LT with TgAb, because undetectable TgAb is required to define the remission of PTC. Indeed, coexistent LT does not influence the time to remission when the analysis is restricted to TgAb negative patients

Cytological and Ultrasound Features of Thyroid Nodules Correlate with Histotypes and Variants of Thyroid Carcinoma

Context: Prognosis is excellent for the papillary thyroid carcinoma (PTC), noninvasive follicular thyroid neoplasia with papillary-like nuclear features (NIFT-P) and the follicular thyroid carcinoma (FTC) while is poor for the poorly differentiated thyroid carcinoma (PDTC) and the anaplastic thyroid carcinoma (ATC). Among PTC, the prognosis is more favorable for the follicular (FV-PTC) and the classic (CV-PTC) than for the tall cell (TCV-PTC) and the solid (SV-PTC) variants. Objectives: To associate histotypes and variants of thyroid carcinoma with ultrasound and cytological features. Design: Histology of 1018 benign tumors and 514 PTC (249 CV, 167 FV, 49 TC, 34 SV and 15 other variants), 52 NIFT-P, 50 FTC, 11 PDTC and 3 ATC was correlated to fine-needle aspiration biopsy categories (Italian classification: TIR1, TIR2, TIR3A, TIR3B, TIR4 and TIR5) and ultrasound features. Setting: Endocrinology Unit, University Hospital of Pisa. Patients: 1117 patients with thyroid nodule(s) who underwent thyroidectomy. Intervention: None. Main outcome measure(s): None. Results: Of PTC, 36.3% had an indeterminate cytology (TIR3A or TIR3B), 56.6% suspicious for malignancy or malignant (TIR4 or TIR5); 84.0% FTC and 69.3% NIFT-P were TIR3A or TIR3B. 72.5% FV-PTC and 73.6% SV-PTC were TIR3A or TIR3B, 79.9% CV-PTC and 95.9% TCV-PTC were TIR4 or TIR5. The association of a hypoechoic pattern, irregular margins and no microcalcifications was more frequent in TCV-PTC than in CV-PTC (p=0.02, PPV=38.9%; NPV=85.5%). Conclusions: At cytology, most FTC, NIFT-P, FV-PTC and SV-PTC were indeterminate, most CV-PTC and TCV-PTC were suspicious for malignancy or malignant. Ultrasound can be helpful in ruling out TCV-PTC