Follicular nodules (Thy3) of the thyroid: is total thyroidectomy the best option?

BACKGROUND: Identification of the best management strategy for nodules with Thy3 cytology presents particular problems for clinicians. This study investigates the ability of clinical, cytological and sonographic data to predict malignancy in indeterminate nodules with the scope of determining the need for total thyroidectomy in these patients. METHODS: The study population consisted of 249 cases presenting indeterminate nodules (Thy3): 198 females (79.5%) and 51 males (20.5%) with a mean age of 52.43 ± 13.68 years. All patients underwent total thyroidectomy. RESULTS: Malignancy was diagnosed in 87/249 patients (34.9%); thyroiditis co-existed in 119/249 cases (47.79%) and was associated with cancer in 40 cases (40/87; 45.98%). Of the sonographic characteristics, only echogenicity and the presence of irregular margins were identified as being statistically significant predictors of malignancy. 52/162 benign lesions (32.1%) and 54/87 malignant were hypoechoic (62.07%); irregular margins were present in 13/162 benign lesions (8.02%), and in 60/87 malignant lesions (68.97%). None of the clinical or cytological features, on the other hand, including age, gender, nodule size, the presence of microcalcifications or type 3 vascularization, were significantly associated with malignancy. CONCLUSIONS: The rate of malignancy in cytologically indeterminate lesions was high in the present study sample compared to other reported rates, and in a significant number of cases Hashimoto’s thyroiditis was also detected. Thus, considering the fact that clinical and cytological features were found to be inaccurate predictors of malignancy, it is our opinion that surgery should always be recommended. Moreover, total thyroidectomy is advisable, being the most suitable procedure in cases of multiple lesions, hyperplastic nodular goiter, or thyroiditis; the high incidence of malignancy and the unreliability of intraoperative frozen section examination also support this preference for total over hemi-thyroidectomy

Diaphragmatic hernia following oesophagectomy for oesophageal cancer – Are we too radical?

Background: Diaphragmatic herniation (DH) of abdominal contents into the thorax after oesophageal resection is a recognised and serious complication of surgery. While differences in pressure between the abdominal and thoracic cavities are important, the size of the hiatal defect is something that can be influenced surgically. As with all oncological surgery, safe resection margins are essential without adversely affecting necessary anatomical structure and function. However very little has been published looking at the extent of the hiatal resection. We aim to present a case series of patients who developed DH herniation post operatively in order to raise discussion about the ideal extent of surgical resection required. Methods: We present a series of cases of two male and one female who had oesophagectomies for moderately and poorly differentiated adenocarcinomas of the lower oesophagus who developed post-operative DH. We then conducted a detailed literature review using Medline, Pubmed and Google Scholar to identify existing guidance to avoid this complication with particular emphasis on the extent of hiatal resection. Discussion: Extended incision and partial resection of the diaphragm are associated with an increased risk of postoperative DH formation. However, these more extensive excisions can ensure clear surgical margins. Post-operative herniation can be an early or late complication of surgery and despite the clear importance of hiatal resection only one paper has been published on this subject which recommends a more limited resection than was carried out in our cases. Conclusion: This case series investigated the recommended extent of hiatal dissection in oesophageal surgery. Currently there is no clear guidance available on this subject and further studies are needed to ascertain the optimum resection margin that results in the best balance of oncological parameters vs. post operative morbidity

Smart transportation systems (STSs) in critical conditions

In the context of smart transportation systems (STSs) in smart cities, the use of applications that can help in case of critical conditions is a key point. Examples of critical conditions may be natural-disaster events such as earthquakes, hurricanes, floods, and manmade ones such as terrorist attacks and toxic waste spills. Disaster events are often combined with the destruction of the local telecommunication infrastructure, if any, and this implies real problems to the rescue operations.The quick deployment of a telecommunication infrastructure is essential for emergency and safety operations as well as the rapid network reconfigurability, the availability of open source software, the efficient interoperability, and the scalability of the technological solutions. The topic is very hot and many research groups are focusing on these issues. Consequently, the deployment of a smart network is fundamental. It is needed to support both applications that can tolerate delays and applications requiring dedicated resources for real-time services such as traffic alert messages, and public safety messages. The guarantee of quality of service (QoS) for such applications is a key requirement.In this chapter we will analyze the principal issues of the networking aspects and will propose a solution mainly based on software defined networking (SDN). We will evaluate the benefit of such paradigm in the mentioned context focusing on the incremental deployment of such solution in the existing metropolitan networks and we will design a "QoS App" able to manage the quality of service on top of the SDN controller

Follicular thyroid carcinoma: Differences in clinical relevance between minimally invasive and widely invasive tumors

Evidence on the biological behavior and clinical courses of minimally invasive and widely invasive follicular thyroid carcinoma (MI-FTC, WI-FTC) is still debatable. The current study was conducted to identify differences between MI and WI tumors and those prognostic parameters influencing late outcome such as local recurrence and survival

Exploring relationships between the distribution of giant red shrimp Aristaeomorpha foliacea (Risso, 1827) and environmental factors in the Central-Western Mediterranean Sea

Mediterranean giant red shrimp Aristaeomorpha foliacea (Risso, 1827) is one of the dominant species in deep-sea megafaunal assemblages, plays a key role in deep-sea communities and it is considered one of the most important targets of deep-water trawl fishing. Although a large number of studies have analysed the spatial distribution of epibenthic crustaceans in bathyal habitats with respect to environmental, geomorphological and hydrological factors, as well as fishing pressure, the manner in which these variables synergistically affect the spatio-temporal changes of giant red shrimp is unclear. To analyse the possible effects of abiotic predictors on the spatio-temporal distribution of giant red shrimp, Generalized Additived Models (GAMs) and Regression Trees were produced. Biological data were collected during the MEDITS trawl surveys carried out in the Sea of Sardinia (2009-2014), during which environmental data were obtained with a multiparametric probe. A longitudinal (west-east) trend was found, with higher abundances at depths of 400-600 m, corresponding to salinity values of 38.1-38.5 psu and temperatures of 13.6-13.8°C. Our results confirm the existence of a tight linkage between the distribution of the Levantine Intermediate Water (LIW) from the eastern Mediterranean Sea and the preferential habitat characteristics of the giant red shrimp. We suggest that a deeper knowledge of the relationships between abiotic (hydrological) factors in the water column and the distribution of Mediterranean resources, such as the giant red shrimp, can provide valuable support for their better management, at the local scale (Sardinia) and across the whole Mediterranean Sea. al use only

The vascular flora of the Marine Protected Area of "Capo Carbonara" (SE-Sardinia)

This study aims at presenting an updated inventory of the vascular flora of the Capo Carbonara Marine Protected Area, including the Sites of Community Importance “Isola dei Cavoli, Serpentara, Punta Molentis e Campulongu” and partially of “Costa di Cagliari”, in Sardinia (Italy). A total of 653 taxa are reported, 84% of which are native (5% endemics) and 16% non-native (10% neophytes, 6% archaeophytes). The native component includes 406 species, 135 subspecies, two variety and one hybrid, belonging to 75 families and 313 genera. The non-native taxa are 94 species, 13 subspecies, one variety and one hybrid, belonging to 40 families and 81 genera. Life-form analysis of native species revealed a prevalence of therophytes (49%) followed by hemicryptophytes (21%), geophytes (14%) and chamaephytes (7%). Therophytes (33%) fol lowed by phanerophytes (32%) are prevalent among the non-native taxa. Biogeographically, among native species, the Mediterranean element is largely prevailing (81%), mainly consisting of Circum-Mediterranean (39%) and Euro-Mediterranean (27%) taxa, while the American ele ment (35%) prevails over the Mediterranean species (29%) among the non-native taxa. Among endemics, the Sardo-Corsican taxa are dominant (55%), followed by Sardo-Corsican-Tuscan Archipelago (14%) and Sardinian (10%) taxa

A two-step pH control method to remove divalent metals from near-neutral mining and metallurgical waste drainages by inducing the formation of layered double hydroxide

A neutral M2+-rich and M3+-poor (M = metal) metallurgical waste drainage was used to test a metal removal method based on the precipitation of layered double hydroxide (LDH). The LDH precipitation was induced by adding a salt of Al3+ (trivalent metal missing in the drainage) and maintaining or restoring the pH to a circum-neutral value. The precipitates were characterized by chemical analysis, XRD, ESEM, HRTEM and XAS. The main parameter controlling the removal of metals and the type of precipitate appeared to be the pH. As a function of pH variation during the experiments, analyses of precipitates and solutions showed either the formation of poor crystalline LDH combined with very high removal of Zn, Ni and Pb (92–100%), more variable removal of Mn (46–98%) and less Cd (33–40%), or the formation of more crystalline LDH combined with lower removal of Zn (62%), Mn (43%), Ni (88%), Pb (64%) and especially Cd (1%). The different metal removal efficiency in the two cases is only indirectly due to the different LDH crystallinity, and it is clearly affected by the following factors: 1) the two pH steps of the method; 2) the direction of pH variation within each step. In particular, the highest removal of metals is obtained when the first pH step goes towards acidic conditions, as a consequence of Al salt addition, and precipitation of a quasi-amorphous hydrated hydroxysulfate of Al (probably a precursor of felsӧbányaite Al4(SO4)(OH)10 · 4H2O) occurs. This first acidic pH step removes little or no metals (just 0–3%) but it is essential so that the second pH step towards slightly alkaline conditions, as a consequence of NaOH addition, can be highly efficient in removing divalent metals as the quasi-amorphous hydrated hydroxysulfate of Al gradually turns into an LDH incorporating Zn, Mg and other metals. On the contrary, when both pH steps remain in the neutral-alkaline range, only LDH precipitation occurs and a lower metal removal is observed. These results encourage further investigations on the removal of metals by inducing LDH precipitation as a simple and effective method for the treatment of circum-neutral polluted drainages