Quality of Life in Patients Treated with Percutaneous Laser Ablation for Non-Functioning Benign Thyroid Nodules: A Prospective Single-Center Study

Objective: While many studies have reported that laser ablation (LA) for benign non-fuctioning thyroid nodules is efficacious in reducing nodular volume and neck symptoms, none have described changes in quality of life (QoL). The purpose of this study was to report post-LA changes in QoL in our cohort of patients. Materials and Methods: Fourteen patients with benign thyroid nodules were involved in a prospective, single-center study and underwent a single session of LA. We evaluated the following: changes in nodule volume, thyroid function, and autoimmunity; adverse events during and after LA; changes in neck discomfort by means of a visual analogic scale (VAS) at one week and 1, 3, 6, and 12 months; and changes in QoL through the 13-scale Thyroid-specific Patient Reported Outcome (ThyPRO) questionnaire at 1, 3, 6, and 12 months. ThyPRO is a validated questionnaire for thyroid diseases, which consists of 13 scales with multiple-choice answers. They investigate several aspects of life that may be impaired by goiter-related compression symptoms, by esthetic alterations and by hypo- or hyperthyroidism. Results: Nodule volume decrease was -37 \ub1 23%, -55 \ub1 22%, -53 \ub1 25%, -58 \ub1 25% (p < 0.01 vs. baseline) at the first, third, sixth, and twelfth month, respectively. No hypothyroidism or positivization of autoimmunity was observed. There were no major complications during or after LA. After LA, VAS scores improved significantly from 1 week onwards in 100% of patients, while a significant improvement was seen in the goiter symptoms score after one month, and in the general score and mean values of ThyPRO after six months. Scores on the other ThyPRO scales did not change significantly. Conclusion: Laser ablation is safe and effective in reducing nodule volume and neck symptoms; this is confirmed by improvements in the goiter scale, general score, and mean values of ThyPRO and in the VAS score

Collisions of self-bound quantum droplets

We report on the study of binary collisions between quantum droplets formed by an attractive mixture of ultracold atoms. We distinguish two main outcomes of the collision, i.e. merging and separation, depending on the velocity of the colliding pair. The critical velocity $v_c$ that discriminates between the two cases displays a different dependence on the atom number $N$ for small and large droplets. By comparing our experimental results with numerical simulations, we show that the non-monotonic behavior of $v_c(N)$ is due to the crossover from a compressible to an incompressible regime, where the collisional dynamics is governed by different energy scales, i.e. the droplet binding energy and the surface tension. These results also provide the first evidence of the liquid-like nature of quantum droplets in the large $N$ limit, where their behavior closely resembles that of classical liquid droplets

Pierwotna nadczynność przytarczyc o niewielkim nasileniu — porównanie leczenia farmakologicznego i obserwacji klinicznej w ramach trwającego pięć lat badania klinicznego

Introduction: Primary hyperparathyroidism (PHPT) is an increasingly common endocrine disorder. Most patients with PHPT do not have disease-specific symptoms. The management of these patients has been widely debated. Recent studies have shown the importance of following up asymptomatic patients in order to reduce co-morbidity. However, there are conflicting opinions as to medical management. The aim of our study was to compare the outcome of PHPT patients on antiresorptive therapy vs. observation only.Material and methods: We longitudinally evaluated 157 PHPT patients (126 females) aged 22–90 years. Patients who did not undergo surgery were divided into two groups: those on anti-resorptive therapy (N = 52), and those without any treatment (N = 37). Patients who were disease-free after surgery (N = 50) served as controls.Results: The values of serum calcium (S-Ca), parathyroid hormone (PTH) and indices of bone metabolism did not differ significantly among the three groups of subjects. No differences in 25(OH)-vitamin D levels were noted. Bone mineral density (BMD) was not significantly different at the spinal level. Finally, we found no evidence of an effect of medical treatment on quality of life (QoL). However, QoL significantly improved in the surgery group after parathyroidectomy (PTX).Conclusions: This study provided up-to-date information in terms of biochemical progression on the natural history of PHPT patients. No significant differences emerged between anti-resorptive therapy and observation only. It is not yet possible to assess the effect of pharmacological treatments on QoL in statistical terms. (Endokrynol Pol 2014; 65 (6): 456–463)Wstęp: Pierwotna nadczynność przytarczyc (PHPT) jest coraz częściej spotykanym zaburzeniem endokrynologicznym. Większość dotkniętych nim pacjentów nie ma szczególnych objawów podmiotowych, a metody leczenia schorzenia pozostają przedmiotem dyskusji. Najnowsze publikacje wskazują na konieczność obserwowania pacjentów bezobjawowych, co ma na celu zmniejszenie zapadalności na schorzenia współistniejące. Opinie na temat leczenia farmakologicznego są jednak podzielone. Celem niniejszego badania było porównanie przebiegu PHPT u pacjentów przyjmujących leki zmniejszające resorpcję kości i u pacjentów poddanych jedynie obserwacji.Materiał i metody: Przeanalizowano dane 157 pacjentów (w tym 126 kobiet) w wieku 22–90 lat chorujących na PHPT. Pacjentów nieleczonych chirurgicznie podzielono na dwie grupy: grupa leczonych preparatami hamującymi resorpcję kości (n = 52) i grupa nieleczona farmakologicznie (n = 37). W grupie kontrolnej znaleźli się pacjenci bez objawów choroby po zabiegu chirurgicznym (n = 50).Wyniki: Stężenia wapnia w surowicy (S-Ca), aktywność parathormonu (PTH) i wskaźniki metabolizmu kostnego nie różniły się istotnie w trzech badanych grupach pacjentów. Nie stwierdzono różnic pod względem stężenia witaminy 25-OH-D (hydroksycholekalcyferolu). Gęstość mineralna kości (BMD) w obrębie kręgosłupa nie różniła się istotnie pomiędzy grupami. Nie stwierdzono też wpływu farmakoterapii na jakość życia (QoL). Odnotowano jednak, że QoL poprawiła się istotnie po zabiegu paratyreoidektomii (PTX) w grupie operowanej.Wnioski: Niniejsze badanie przynosi informacje na temat naturalnego przebiegu i zmian biochemicznych u chorych na PHPT. Nie stwierdzono istotnych różnic pomiędzy grupą pacjentów leczonych preparatami hamującymi resorpcję kości a pacjentami nieleczonymi. Nie można jednak było ocenić statystycznie wpływu leczenia farmakologicznego na QoL. (Endokrynol Pol 2014; 65 (6): 456–463

Gender influence on professional satisfaction and gender issue perception among young oncologists. A survey of the Young Oncologists Working Group of the Italian Association of Medical Oncology (AIOM)

Background: The professional gender gap is increasingly recognised in oncology. We explored gender issues perception and gender influence on professional satisfaction/gratification among young Italian oncologists. Methods: Italian oncologists aged 6440 years and members of the Italian Association of Medical Oncology were invited to participate in an online survey addressing workload/burnout, satisfaction in professional abilities and relations, relevant factors for professional gratification, and gender barriers. \u3c72 test for general association or \u3c72 test for trend was used to analyse the data. Results: 201 young oncologists participated in the survey: 67% female, 71% aged 30-40 years, 41% still in training and 82% without children. Women and men were equally poorly satisfied by the relations with people occupying superior hierarchical positions. There was heterogeneity between women and men in current (p=0.011) and expected future (p=0.007) satisfaction in professional abilities: women were more satisfied by current empathy and relations with colleagues and were more confident in their future managerial and team leader skills. The most important elements for professional gratification indicated by all participants were, in general, work-life balance (36%) and intellectual stimulation/research (32%); specifically for women, work-life balance (48%) and intellectual stimulation/research (20%); and specifically for men, career (29%) and social prestige/recognition (26%). Heterogeneity within the same gender emerged. For example, the elements indicated by men as the most important were intellectual stimulation/research (39%) and work-life balance (21%) in general, versus social prestige/recognition (24%) and career (24%), respectively, specifically for men (p<0.0001). More women versus men perceived gender issue as an actual problem (60% vs 38%, p=0.03); men underestimated gender barriers to women's career (p=0.011). Conclusions: Satisfaction in professional abilities varied by gender. Work-life balance is important for both women and men. Stereotypes about gender issues may be present. Gender issue is an actual problem for young oncologists, mostly perceived by women

Role of Strain Elastography and Shear-Wave Elastography in a Multiparametric Clinical Approach to Indeterminate Cytology Thyroid Nodules

BACKGROUND In thyroid nodules with indeterminate cytology, further clinical assessment aimed at ruling out malignancy is often mandatory. Ancillary imaging techniques and genetic mutation analysis can improve the risk stratification of such lesions, thereby facilitating the clinician's decision to undertaken surgery or simple follow-up. The aim of this study was to evaluate the diagnostic performance of shear-wave elastography (SW), strain elastography (ELX 2/1), conventional ultrasound (US), contrast-enhanced ultrasound (CEUS), and BRAF V600E mutation analysis in the aforementioned lesions. MATERIAL AND METHODS We enrolled 81 patients, each with 1 indeterminate-cytology thyroid nodule. Thyroid function, thyroperoxidase antibodies and calcitonin were known in each case. SW, ELX 2/1, US, CEUS, and BRAF mutation analysis were subsequently performed, followed by a second FNAB. If the lesion was not downgraded to benign, surgery was recommended and histological reports collected. RESULTS There were 28 nodules (34%) that proved benign on the second FNAB; 38 nodules (47%) underwent surgery (17 benign, 21 malignant), and 15 nodules (19%) refused surgery. The only techniques related to histological outcome were US (AUC=0,766), ELX 2/1 (AUC=0.701), and BRAF analysis (AUC=0.762). ELX 2/1 and SW reports were not correlated with each other (P=0.45). A scoring system taking into account all the variables considered performed better than the single variables alone (AUC=0.831). CONCLUSIONS In indeterminate-cytology thyroid lesions, repeating FNAB can avoid unnecessary surgery. ELX 2/1 seems to perform better than SW in distinguishing malignancy; these techniques could, however, be complementary in describing such lesions. A multiparametric approach appears the most accurate in predicting nodule histology

Integrated GIS data set and 3d analysis for environmental impact assessment in the Castelfranco Emilia area (Modena Province, Northern Italy).

In this work is presented a database sets in order in order to analyse an Environmental Impact Assessment (EIA), Geographical Information System (GIS), Geomorphology, Castelfranco Emilia, Modena Provinc

Detection of Polyethylene Glycol Thyrotropin (TSH) Precipitable Percentage (Macro-TSH) in Patients with a History of Thyroid Cancer

Background: Owing to its large molecular size, polyethylene glycol (PEG)-precipitable thyrotropin (TSH) can accumulate in the circulation, elevating TSH levels. PEG-precipitable TSH can be used to detect macro-TSH (mTSH) in serum. Our aim was to evaluate the prevalence of mTSH in patients who had undergone thyroidectomy for thyroid cancer.Methods: Seventy-three thyroid cancer patients and 24 control subjects on levothyroxine (LT4) TSH-suppressive or replacement therapy were evaluated. Screening for mTSH was performed by adding PEG to serum in order to precipitate.-globulin. A percentage of PEG-precipitable TSH &gt;= 80% was considered suggestive of mTSH.Results: No correlation between free-T4 (fT4) and TSH levels was found. PEG-precipitable TSH was 39.3%+/- 1.9% in thyroid cancer patients and 44.1%+/- 3.9% in controls. Macro-TSH was deemed to be present in one thyroid cancer patient and in two control subjects. Only in the thyroid cancer group was PEG-precipitable TSH found to be negatively correlated with fT4 concentration. No correlation was found between PEG-precipitable TSH and other clinical conditions in any patients.Conclusion: The presence of mTSH seems to be a rare phenomenon in thyroid cancer. In some patients with low PEG-precipitable TSH, a reduction in LT4 dosage could be suggested. LT4 dosage adjusted to body weight is the main factor in maintaining TSH in a semi-suppressed or normal range. Evaluation of mTSH could be necessary in patients in whom a balance is required between adequate TSH suppression and the avoidance of unnecessary exogenous hyperthyroxinemia