Trattamento chirurgico delle neoplasie tiroidee nel cane: presentazione clinica e criteri prognostici

RIASSUNTO PAROLE CHIAVE: Cane, Tiroide, Carcinoma, Tiroidectomia, Chirurgia OBIETTIVO: Valutazione della presentazione clinica e dei criteri prognostici per il trattamento chirurgico delle neoplasie tiroidee nel cane. MATERIALI E METODI: In questo studio sono stati inclusi 100 cani di età, razza e sesso diversi. Gli animali sono pervenuti in tre differenti per la presenza di una massa nella regione cervicale di probabile origine tiroidea. Nel periodo preoperatorio sono state effettuate una visita anestesiologica, un esame ematobiochimico completo con misurazione delle concentrazioni sieriche di T4 e TSH e un eventuale esame tomografico. Tutti i pazienti sono stati sottoposti a intervento di tiroidectomia con tecnica extracapsulare modificata e in 27 cani è stato necessario effettuare un’altra procedura chirurgica, data l’invasività del tumore. Le masse rimosse sono state sottoposte a esame istopatologico ed è stato misurato il loro asse maggiore. Per tutti i pazienti è stato effettuato il follow-up fino al momento della morte, che è avvenuta sia per cause imputabili al tumore tiroideo sia per cause a sé stanti la tiroide. Alcuni cani al momento della chiusura dello studio clinico erano ancora vivi o ne era stato perso il follow-up: questi gruppo di cani è indicato con il nome censored. RISULTATI: La media totale di sopravvivenza per tutti i cani è di 730 giorni (24 mesi). Analizzando la prospettiva di sopravvivenza correlata ai differenti criteri prognostici per tutti i pazienti morti sono emerse differenze statisticamente significative soltanto per il parametro riferito alla presenza di metastasi al momento della chirurgia. Dall’analisi statistica con metodo di Kaplan-Meier sulla sopravvivenza per i cani morti per cause attribuibili al tumore tiroideo sono state riscontrate differenze statisticamente significative, in particolare in rapporto a 4 dei criteri prognostici, ovvero il tipo di chirurgia, la dimensione dell’asse maggiore del tumore, la classificazione istologica e la presenza di metastasi al momento della chirurgia. CONCLUSIONI: Sulla base delle informazioni raccolte con questo studio, la sopravvivenza media per cani con tumore tiroideo trattato chirurgicamente è di 730 giorni. I criteri prognostici che influiscono maggiormente sulla prospettiva di sopravvivenza sono la classificazione istologica, la presenza di metastasi al momento della chirurgia, il tipo di chirurgia e la dimensione del tumore stesso. ABSTRACT KEY WORDS: Dog, Thyroid, Carcinoma, Thyroidectomy, Surgery OBJECTIVE: Evaluation of clinical presentation and prognostic factors for surgical treatment of thyroid neoplasms in dog. MATERIALS AND METHODS: In this study 100 dogs of different age, breed and sex were enrolled. The animals have come to three different facilities for the presence of a mass in the cervical region. Prior to surgery dogs underwent to an anesthesiology check-up, a complete ematobiochimic exam with the measurement of T4 and TSH’s serum concentrations and a tomografic exam. All the patients ungergo a thyroidectomy with modified extracapsular technic and 27 dogs needed an other surgery, due to tumor invasivity. After surgery an istopathologic evaluation of all neoplasms were performed. For the dogs that died, death was classified as being attributable to the thyroid tumor or as not attributable. Dogs that not died at the time of the study were classified as censored. RESULTS: Overall censored medium survival time was 730 days (24 months). Analysing the overall survival time for all deceaded dogs, the only statistical significant difference was observed related to the presence of methastasis at the time of surgery. Statistical analyses with Kaplan-Meier method of the survival time for dogs that died of causes attributable to the thyroid tumors revealed statistical significant differences in 4 prognostic factors: kind of surgery, dimension and isthological classification of the tumor and presence of methastasis at the time of the surgery. CONCLUSIONS: On the basis of the information collected in the present study, the overall medium survival time for dogs that underwent thyroidectomy for thyroid neoplasms was 730 days. Prognostic factors more influent on the survival prospective are the isthological classification, the presence of methastasis at the time of the surgery, the kind of the surgery and the dimension of the tumor

Does a multidisciplinary approach have a beneficial effect on the development of a structured patient handover process between acute surgical wards in one of Scotland's largest teaching hospitals?

Background Effective handover is key in preventing harm.1 In the Acute Surgical Receiving Unit of Ninewells Hospital, Dundee, large numbers of patients are transferred daily. However, lack of medical handover during transfer means important tasks are missed. Our aim was to understand and reflect on the current system and test changes to improve medical handover.Aim Our aim was to ensure that 95% of patients being transferred from the Acute Surgical Receiving Unit receive a basic medical handover within 2 months.Methods Initially, we collated issues that were missed when patients were transferred. These data coupled with questionnaire data from members of the team fed into the creation of a handover tool. We proposed to link our tool with the nursing handover, hence creating one unified handover tool. We completed six full Plan-Do-Study-Act (PDSA) cycles (two on communication to aide handover and four on the tool itself) to assess and develop our tool.Results By our final PDSA cycle, 84% (33/39) of the patients had a handover, meaning no tasks were missed during transfer. After 4 months, 9 out of 10 staff felt that the introduction of the handover sheet made the handover process smoother and 8 out of 10 felt that the handover sheet improved patient safety and quality of care.Conclusions Improving handover can be challenging. However, we have shown that a relatively simple intervention can help promote better practice. Challenges are still present as uptake was only 84%, so work still has to be done to improve this. A wider cultural change involving communication and education would be required to implement this tool more widely

Do men with bladder stones benefit from treatment of benign prostatic obstruction (BPO)?

Peer reviewedPublisher PD

Tissue Factor/Factor FVII Complex Inhibitors in Cardiovascular Disease. Are Things Going Well?

Blood coagulation is a complex biological mechanism aimed to avoid bleeding in which a highly regulated and coordinated interplay of specific proteins and cellular components respond quickly to a vascular injury. However, when this mechanisms occurs in the coronary circulation, it has not a “protective” effect, but rather, it plays a pivotal role in determining acute coronary syndromes. Coagulation recognizes Tissue Factor (TF), the main physiological initiator of the extrinsic coagulation pathway, as its starter

Obesity and ischemic heart disease. Is there a link between wellness’ diseases?

Obesity, the most common nutritional disorder in Western countries, is usually associated to cardiovascular diseases. However, the precise molecular pathways underlying this close association remain poorly understood. Nowadays, the adipose tissue is considered as an endocrine organ able to produce substances called adipo(cyto)kines that have different effects on lipid metabolism, closely involved in metabolic syndrome, and cardiovascular risk. The increased cardiovascular risk can be related also to peculiar dysfunction in the endocrine activity of adipose tissue observed in obesity responsible of vascular impairment (including endothelial dysfunction), prothrombotic tendency, and low-grade chronic inflammation. The present review aims at providing an up-dated overview on the adipocytederived molecules potentially involved in cardiovascular pathophysiology

Clinical Characterization of Patients Diagnosed with Prostate Cancer and Undergoing Conservative Management : a PIONEER Analysis Based on Big Data

Funding statement PIONEER is funded through the IMI2 Joint Undertaking and is listed under grant agreement No. 777492. This joint undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and European Federation of Pharmaceutical Industries and Associations EFPIA. The European Health Data & Evidence Network has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement no. 806968. The Joint Undertaking is supported by the European Union’s Horizon 2020 research and innovation programme and EFPIA, a large association which represents the biopharmaceutical industry in Europe. The views communicated within are those of PIONEER. Neither the IMI nor the European Union, EFPIA, or any Associated Partners are responsible for any use that may be made of the information contained hereinPeer reviewe

Clinical Characterization of Patients Diagnosed with Prostate Cancer and Undergoing Conservative Management:A PIONEER Analysis Based on Big Data

Background: Conservative management is an option for prostate cancer (PCa) patients either with the objective of delaying or even avoiding curative therapy, or to wait until palliative treatment is needed. PIONEER, funded by the European Commission Innovative Medicines Initiative, aims at improving PCa care across Europe through the application of big data analytics. Objective: To describe the clinical characteristics and long-term outcomes of PCa patients on conservative management by using an international large network of real-world data. Design, setting, and participants: From an initial cohort of &gt;100 000 000 adult individuals included in eight databases evaluated during a virtual study-a-thon hosted by PIONEER, we identified newly diagnosed PCa cases (n = 527 311). Among those, we selected patients who did not receive curative or palliative treatment within 6 mo from diagnosis (n = 123 146). Outcome measurements and statistical analysis: Patient and disease characteristics were reported. The number of patients who experienced the main study outcomes was quantified for each stratum and the overall cohort. Kaplan-Meier analyses were used to estimate the distribution of time to event data. Results and limitations: The most common comorbidities were hypertension (35–73%), obesity (9.2–54%), and type 2 diabetes (11–28%). The rate of PCa-related symptomatic progression ranged between 2.6% and 6.2%. Hospitalization (12–25%) and emergency department visits (10–14%) were common events during the 1st year of follow-up. The probability of being free from both palliative and curative treatments decreased during follow-up. Limitations include a lack of information on patients and disease characteristics and on treatment intent. Conclusions: Our results allow us to better understand the current landscape of patients with PCa managed with conservative treatment. PIONEER offers a unique opportunity to characterize the baseline features and outcomes of PCa patients managed conservatively using real-world data. Patient summary: Up to 25% of men with prostate cancer (PCa) managed conservatively experienced hospitalization and emergency department visits within the 1st year after diagnosis; 6% experienced PCa-related symptoms. The probability of receiving therapies for PCa decreased according to time elapsed after the diagnosis.</p

Achieving benchmarks for national quality indicators reduces recurrence and progression in non-muscle-invasive bladder cancer

Background Noncompliance with evidence-based interventions and guidelines contributes to significant and variable recurrence and progression in patients with non–muscle-invasive bladder cancer (NMIBC). The implementation of a quality performance indicator (QPI) programme in Scotland’s National Health Service (NHS) aimed to improve cancer outcomes and reduce nationwide variance. Objective To evaluate the effect of hospitals achieving benchmarks for two specific QPIs on time to recurrence and progression in NMIBC. Design, setting, and participants QPIs for bladder cancer (BC) were enforced nationally in April 2014. NHS health boards collected prospective data on all new BC patients. Prospectively recorded surveillance data were pooled from 12 collaborating centres. Intervention QPIs of interest were (1) hospitals achieving detrusor muscle (DM) sampling target at initial transurethral resection of bladder tumour (TURBT) and (2) use of single instillation of mitomycin C after TURBT (SI-MMC). Outcome measurements and statistical analysis The primary and secondary endpoints were time to recurrence and progression, respectively. Kaplan-Meier and Cox multivariable regression analyses were performed. Key findings and limitations Between April 1, 2014 and March 31, 2017, we diagnosed 3899 patients with new BC, of which 2688 were NMIBC . With a median follow up of 60.3 mo, hospitals achieving the DM sampling target had a 5.4% lower recurrence rate at 5 yr than hospitals not achieving this target (442/1136 [38.9%] vs 677/1528 [44.3%], 95% confidence interval [CI] = 1.6–9.2, p = 0.005). SI-MMC was associated with a 20.4% lower recurrence rate (634/1791 [35.4%] vs 469/840 [55.8%], 95% CI = 16.4–24.5, p &lt; 0.001). On Cox multivariable regression, meeting the DM target and SI-MMC were associated with significant improvement in recurrence (hazard ratio [HR] 0.81, 95% CI = 0.73–0.91, p = 0.0002 and HR 0.66, 95% CI = 0.59–0.74, p &lt; 0.004, respectively) as well as progression-free survival (HR 0.62, 95% CI = 0.45–0.84, p = 0.002 and HR 0.65, 95% CI = 0.49–0.87, p = 0.004, respectively). We did not have a national multicentre pre-QPI control. Conclusions Within a national QPI programme, meeting targets for sampling DM and SI-MMC in the real world were independently associated with delays to recurrence and progression in NMIBC patients. Patient summary Following the first 3 yr of implementing a novel quality performance indicator programme in Scotland, we evaluated compliance and outcomes in non–muscle-invasive bladder cancer. In 2688 patients followed up for 5 yr, we found that achieving targets for sampling detrusor muscle and the single instillation of mitomycin C during and after transurethral resection of bladder tumour, respectively, were associated with delays in cancer recurrence and progression

Complement component C4 structural variation and quantitative traits contribute to sex-biased vulnerability in systemic sclerosis

Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER), "A way of making Europe".Copy number (CN) polymorphisms of complement C4 play distinct roles in many conditions, including immune-mediated diseases. We investigated the association of C4 CN with systemic sclerosis (SSc) risk. Imputed total C4, C4A, C4B, and HERV-K CN were analyzed in 26,633 individuals and validated in an independent cohort. Our results showed that higher C4 CN confers protection to SSc, and deviations from CN parity of C4A and C4B augmented risk. The protection contributed per copy of C4A and C4B differed by sex. Stronger protection was afforded by C4A in men and by C4B in women. C4 CN correlated well with its gene expression and serum protein levels, and less C4 was detected for both in SSc patients. Conditioned analysis suggests that C4 genetics strongly contributes to the SSc association within the major histocompatibility complex locus and highlights classical alleles and amino acid variants of HLA-DRB1 and HLA-DPB1 as C4-independent signals