Investigation of Primary Grade Writing Instruction

This study was designed to gather information regarding the writing practices of primary grade teachers across the United States. Surveys were sent to a random sample of 300 first, second, and third grade teachers (100 at each grade level) asking them a variety of questions regarding their writing programs. Of these teachers, 178 responded to the survey (61% response rate). Results showed that 72% of teachers employed a writing approach that combined traditional skill instruction with process writing, and that 65% of respondents utilized a commercial program during writing instruction. Statistically significant differences were found by grade for the types of writing activities students do throughout the year. In addition, parent-teacher communication regarding students' writing was found to be low, and most teachers reported making personal changes to their writing programs due to recent No Child Left Behind legislation. Suggestions for future research and limitations are also addressed

Diagnosi per immagini istologiche, immunoistochimiche e sonografiche di un raro caso di plasmocitoma scarsamente differenziato della tiroide

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Role of Thyroglobulin, Neck Ultrasound, Thyroglobulin Antibodies Trend and Diagnostic Whole Body Scan in the Management of Differentiated Thyroid Cancer Patients with Persistent Thyroglobulin Antibodies

Background: During the follow-up of differentiated thyroid cancer patients, the presence of thyroglobulin antibodies makes thyroglobulin measurements unreliable. For this reason, thyroglobulin antibodies measurement and the evaluation of their titer trend are also recommended. Objective: We aimed to identify the best method among stimulated thyroglobulin, thyroglobulin antibodies titer trend, neck ultrasound and diagnostic whole body scan for detecting the presence of disease in a group of differentiated thyroid cancer patients with thyroglobulin antibodies. Patients and methods: We retrospectively reviewed the data of 212 consecutive differentiated thyroid cancer patients with thyroglobulin antibodies referred to us between 2005 and 2007 for performing a diagnostic whole body scan. All patients were evaluated during the first two years after the initial treatment. Results: Diagnostic whole body scan sensitivity and specificity in detecting persistent diseases were 70% and 72%, respectively. Diagnostic whole body scan alone had the best positive and negative predictive values (93% and 32%, respectively). A low sensitivity and specificity (56% and 10%, respectively) for increasing or stable thyroglobulin antibodies titer trends were also identified. A good compromise between sensitivity and specificity was obtained when diagnostic whole body scan, stimulated thyroglobulin and neck ultrasound were combined without considering thyroglobulin antibodies trend evaluations (82% and 45%, respectively). Conclusions: Diagnostic whole body scan plays an important role in detecting persistent disease in differentiated thyroid cancer patients with thyroglobulin antibodies, both alone and in association with other methods. However, its low negative predictive value suggests that when a suspicious persistent disease is present, the use of other imaging methods, such as computed tomography scan or FDG-positron emission computed tomography, is recommended. Finally, from this study, it appears that the thyroglobulin antibodies titer trend does not add any useful information about the disease status in the first two years after initial treatment

No difference in the outcome of metastatic thyroid cancer patients when using recombinant or endogenous TSH

Objective: At the present, recombinant TSH cannot be used for the treatment of metastatic differentiated thyroid cancer patients. Aim of this study was to evaluate if the type of TSH stimulation, recombinant or endogenous, had an impact on the outcome of these patients. Design and methods: We compared the outcome of two propensity score-matched groups of metastatic patients, stimulated by either only recombinant TSH (n=43) or only endogenous TSH (n=34). Results: As expected from the matching procedure, the clinical-pathological features and the cumulative 131I-activities administered of the two groups were very similar. After 4 years of follow-up 4% of patients were cured, 3% had biochemical disease and 93% had structural disease. However, 91% of patients obtained a clinical benefit from this therapy in terms of stabilization of the disease or complete remission or partial response. When considering the two groups separately we did not find any difference in their outcome. When considering the response to 131-I therapy of the single type of metastases, 8% of lymph node metastases and 8% of lung metastases disappeared but none of bone metastases. The response to 131-I therapy of the single type of metastases was similar when we looked at the two groups separately. Conclusions: this study shows a) an overall clinical benefit of the 131-I therapy since the majority of patients remained affected but with a stable disease b) the preparation with either recombinant or endogenous TSH has no impact on the 131-I therapy efficacy and the outcome of our two groups of patients

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

Active surveillance in differentiated thyroid cancer: a strategy applicable to all treatment categories response

Currently, the differentiated thyroid cancer (DTC) management is shifted toward a tailored approach based on the estimated risks of recurrence and disease-specific mortality. While the current recommendations on the management of metastatic and progressive DTC are clear and unambiguous, the management of slowly progressive or indeterminate disease varies according to different centers and different physicians. In this context, active surveillance (AS) becomes the main tool for clinicians, allowing them to plan a personalized therapeutic strategy, based on the risk of an unfavorable prognosis, and to avoid unnecessary treatment. This review analyzes the main possible scenarios in treated DTC patients who could take advantage of AS

Pros and cons of an aggressive initial treatment with surgery and radioiodine treatment in minimally invasive follicular thyroid carcinoma

Abstract Background Currently, surgery alone is the gold standard treatment for minimally invasive follicular thyroid cancer (mi-FTC). Case presentation A case of a mi-FTC diagnosed in 1994 was treated with total thyroidectomy and radioiodine (RAI) ablation, according to the therapeutic algorithm used at that time. Nevertheless, he had a recurrence with distant metastasis after 24 years from the initial treatment. Conclusion Total thyroidectomy and RAI ablation might have delayed the development of distant metastasis but they were not sufficient to avoid disease recurrence. Certainly, remnant ablation simplified the follow-up and the monitoring of serum thyroglobulin allowed the early detection of the biochemical recurrence, but didn’t change the outcome of the disease. Moreover, because of this early detection the patient was exposed to useless biochemical and imaging examinations. The aim of this report is to discuss the pros and cons of an aggressive treatment of a patient with mi-FTC