Identifying Neurobiological Markers in Obsessive–Compulsive Disorder: A Study Protocol for a Cross-Sectional Study in Subgroups of Differing Phenotype

Obsessive–compulsive disorder (OCD) represents a frequent and highly disabling mental disorder. Past attempts to characterize different disease subgroups focused on the time of onset (late vs. early onset), presence of insight (poor insight), and post-infectious forms (pediatric acuteonset neuropsychiatric syndrome, PANS). Each subgroup may be associated with a differing impact on cognition, functioning, sleep quality, and treatment response profile. Certain lines of evidence suggest brain-derived neurotrophic factor (BDNF) levels may differ between individuals living with OCD as compared with controls, but there is a lack of evidence on the variation of BDNF levels in OCD subgroups. Lastly, the potential of assessing inflammatory states, electroencephalogram, and polysomnography to characterize these subtypes has been hardly explored. Estimates of drugresistance rates indicate that 20% and up to 65% of affected adults and up to 35% of the pediatric population may not benefit from pharmacological treatments. At least part of the variability in treatment response could depend on the underlying biological heterogeneity. In the present project, we aim to increase the accuracy in characterizing the phenotypical and biological signature for the different OCD subtypes through clinical, cognitive, and sleep markers, along with other possible markers that may be biologically plausible

Thyroid imaging reporting and data system score: evaluation of risk stratification in thyroid nodules with Hashimoto’s Thyroiditis and thyroid nodules without Hashimoto’s thyroiditis underwent fine-needle aspiration cytology: results from a prospective study.

BACKGROUND: Thyroid imaging reporting and data system (TI-RADS) was designed to better select thyroid nodules (TN) to fine needle aspiration cytology (FNAC) with high sensitivity and accuracy. However, the comparison of TI-RADS scores in TN with Hashimoto’s thyroiditis (HT) (HTN+) versus TN without HT (HTN-) has not been examined so far. The aim of this study was to compare the diagnostic performance of TI-RADS score in TN associated or not associated to HT. METHODS: 308 unselected TN consecutively submitted to FNAC from June 2014 to March 2015 were included to compare the diagnostic performance of TI-RADS score in HTN+ and in HTN–; individual TI-RADS score was correlated to FNAC categories in all cases. All suspicious ultrasound features (hypoechogenicity, microcalcifications, irregular margins, taller-thanwide shape, central vascularization) of TN were classified according French TI-RADS categories using a risk score of malignancy. RESULTS: HTN+ had higher prevalence of suspicious/malignant cytology (Tir 4-5) (HTN+ 48/121 = 40%) compared to HTN– (40/163 = 29%, p < 0.05). The distribution of all TI-RADS categories (from 2 to 5) in HTN+ was not significantly different from that found in HTN– (Table). At difference with TI-RADS, the individual features of hypoechogenicity and irregular margins had higher prevalence in HTN+ (77/121 64%) than in HTN– (58/157 37%, p < 0.001), and were more present in suspicious/malignant cytology (TIR 4-5) (69/88 78%) than in benign (Tir 2) cytology (25/196 13%, p < 0.0001). CONCLUSIONS: This study confirms our previous observation of higher prevalence of malignant FNAC in nodules associated to HT. TI-RADS score appears not significantly influenced by presence of HT, in spite of the higher prevalence in HTN+ of individual suspicious ultrasound features such as hypoechogenicity and irregular margins and may be proposed as an useful diagnostic tool to select nodules for FNA independently from associated HT

Score ecografico del rischio di malignità dei noduli tiroidei (TI-RADS): risultati citologici di uno studio prospettico di noduli con tiroidite di Hashimoto vs noduli senza tiroidite di Hashimoto.

RAZIONALE Recentemente, è stato introdotto un sistema di score ecografico per la valutazione del rischio di malignità dei noduli tiroidei (NT) (TI-RADS) per selezionare meglio i NT da sottoporre ad esame citologico su ago-aspirato (FNAC). Non sono tuttavia al momento presenti in letteratura studi che abbiano confrontato prospetticamente questo score in NT con tiroidite di Hashimoto (TH) (THN+) vs NT senza TH (THN-). Lo scopo del nostro studio è stato quello di valutare il ruolo diagnostico dello score TI-RADS in questi 2 gruppi di NT. MATERIALI E METODI Un totale di 417 NT non selezionati è stato sottoposto in maniera consecutiva a FNAC da Marzo 2014 ad Aprile 2016; lo score TI-RADS è stato correlato con le categorie FNAC per tutti i noduli. Tutte le caratteristiche ecografiche di sospetto (ipoecogenicità, microcalcificazioni, margini irregolari, diametro nodulare più lungo che largo, vascolarizzazione interna) venivano raggruppate secondo i criteri TI-RADS francesi, dando un preciso score di rischio di malignità, indeterminato o benignità per ogni singola categoria. RISULTATI Nel gruppo THN+ si evidenziava una più alta prevalenza di citologia maligna e/o sospetta (Tir 4-5) (HTN+ 43/131= 32.8%) rispetto al gruppo dei THN- (58/262= 22%, p<0.05). La distribuzione delle differenti categorie TI-RADS (da 2 a 5) nei THN+ inoltre non differiva in maniera statisticamente significativa rispetto al gruppo THN- (vedi tabella). TI-RADS 2 TI-RADS 3 TI-RADS 4 TI-RADS 5 THN+ 55 (41,9%) 30 (23%) 35 (26,7%) 11 (8,3%) THN- 140 (53,4%) 55 (21%) 53 (20,2%) 14 (5,3%) p = 0.14 (NS) A differenza dello score TI-RADS, solo 2 caratteristiche ecografiche di sospetto per malignità (ipoecogenicità e margini irregolari) presentavano una più alta prevalenza nel gruppo dei THN+ (96/131 73,2%) rispetto al gruppo THN- (58/262 22,1%, p<0.01); esse inoltre differivano in maniera statisticamente significativa nelle citologie sospette e/o maligne (TIR 4-5) (72/101 71,3%) rispetto a quelle benigne (Tir 2) (35/228 15,3%, p<0.0001). CONCLUSIONI I risultati del nostro studio confermano una maggiore prevalenza dei TIR 4-5 nel gruppo HTN+. Lo score TI-RADS non è significativamente correlato con la presenza di TH, nonostante si evidenzi una più alta prevalenza delle singole caratteristiche ecografiche quali ipoeocogenicità e margini irregolari nel gruppo THN+. In conclusione, esso risulta uno strumento valido per selezionare i NT da sottoporre a FNAC ma in maniera indipendente dalla presenza o meno di TH