Design of a predictive score to assess the risk of developing hypocalcemia after total thyroidectomy. A retrospective study

Anastasios Papanastasiou,1 Konstantinos Sapalidis,1 Stylianos Mantalobas,1 Stefanos Atmatzidis,1 Nikolaos Michalopoulos,1 Valeriu Surlin,1 Athanasios Katsaounis,1 Aikaterini Amaniti,1 Paul Zarogoulidis,1 Ioannis Passos,1 Charilaos Koulouris,1 Efstathios Pavlidis,1 Dimitrios Giannakidis,1 Stelian Mogoanta,2 Christoforos Kosmidis,1 Isaak Kesisoglou113rd Department of Surgery, “AHEPA” University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece; 2Department of Surgery, Faculty of Dentistry, University of Medicine and Pharmacy of Craiova, Craiova, RomaniaBackground: Temporary hypocalcemia is the most common complication in patients after total thyroidectomy. To date, according to the literature, various predictors of the above complication have been proposed, but none of them seems to be effective enough.Objectives: The aim of this study was to develop a reliable predictive tool for biochemical hypocalcemia in the first 48 hrs after total thyroidectomy without central dissection by analyzing several parameters relevant to this operation and to suggest a new score.Methods: A retrospective study was performed on patients who had undergone total thyroidectomy without central neck dissection from October 2017 until January 2018. Data were collected from 36 patients and studied if there was a statistically significant relationship between the risk of hypocalcemia and 10 preselected prognostic factors.Results: The prognostic score was formed, which included the 6 factors that showed a statistically significant relationship. Moreover, an extensive check of the predictive value of the above score was performed. It was found, therefore, that at a value of 3 and above the sensitivity was 100%, the specificity 79.16%, the positive prognostic value (PPV) 70.58% and the negative predictive value (NPV) 100%.Conclusions: High sensitivity of CaReBe’S TiP score makes it feasible to predict patients with postoperative hypocalcemia. High NPV would allow surgeons to exclude patients with a score less than 3 from supplementary calcium medication and achieve a shorter hospitalization for them.Keywords: design, thyroidectomy, hypocalcemia, prognostic factor

Genes’ interactions: A major contributor to the malignant transformation of endometriosis

The genetic and epigenetic factors that contribute to the malignant transformation of endometriosis are still under investigation. The objective of the present study was to investigate the genetic link between endometriosis and cancer by examining and correlating the latest clinical observations with biological experimental data. We collected updated evidence about the genetic relationship between endometriosis and cancers by conducting a comprehensive search of PubMed and Scopus databases, focusing on the papers published between January 2018 and January 2019. New insights into the mechanism of the malignant transformation of endometriosis have been published recently. The use of state-of-the-art techniques and methods, such as the genome-wide association study analysis and the weighted gene co-expression analysis, have significantly altered our understanding of the association between endometriosis and endometriosis-associated cancer development. Interestingly, the interactions formed between genes seem to play a pivotal role in the phenotypic expression of mutations. Therefore, the effect of single nucleotide polymorphisms and the function of the expression quantitative trait loci on genes’ expression have been the subject of many recent works. In addition, it has been discovered that genes, the mutations of which have been related to the development of endometriosis, play a role as hub genes. This may lead to new areas of research for understanding the mechanism of malignant transformation of the disease. Significant steps forward have been made towards the identification of factors that control the malignant transformation of endometriosis. Still, due to rarity of the event, a better-organized scheme for sampling on a global level should be adopted. © 2019 by the authors. Licensee MDPI, Basel, Switzerland