Surgical approach to medullary thyroid carcinoma associated with multiple endocrine neoplasia type 2

We briefly review the surgical approaches to medullary thyroid carcinoma associated with multiple endocrine neoplasia type 2 (medullary thyroid carcinoma/multiple endocrine neoplasia type 2). The recommended surgical approaches are usually based on the age of the affected carrier/patient, tumor staging and the specific rearranged during transfection codon mutation. We have focused mainly on young children with no apparent disease who are carrying a germline rearranged during transfection mutation. Successful management of medullary thyroid carcinoma in these cases depends on early diagnosis and treatment. Total thyroidectomy should be performed before 6 months of age in infants carrying the rearranged during transfection 918 codon mutation, by the age of 3 years in rearranged during transfection 634 mutation carriers, at 5 years of age in carriers with level 3 risk rearranged during transfection mutations, and by the age of 10 years in level 4 risk rearranged during transfection mutations. Patients with thyroid tumor >5 mm detected by ultrasound, and basal calcitonin levels >40 pg/ml, frequently have cervical and upper mediastinal lymph node metastasis. In the latter patients, total thyroidectomy should be complemented by extensive lymph node dissection. Also, we briefly review our data from a large familial medullary thyroid carcinoma genealogy harboring a germline rearranged during transfection Cys620Arg mutation. All 14 screened carriers of the rearranged during transfection Cys620Arg mutation who underwent total thyroidectomy before the age of 12 years presented persistently undetectable serum levels of calcitonin (<2 pg/ml) during the follow-up period of 2–6 years. Although it is recommended that preventive total thyroidectomy in rearranged during transfection codon 620 mutation carriers is performed before the age of 5 years, in this particular family the surgical intervention performed before the age of 12 years led to an apparent biochemical cure

Avaliação de parâmetros hidráulicos e manejo da irrigação por microaspersão em área de assentamento Hydraulic parameters evaluation and management of microsprinkler irrigation in settlement area

Este trabalho foi desenvolvido em solo aluvial do semi-árido de Pernambuco, suscetível à salinização, visando a orientar agricultores de assentamento para instalar, avaliar e manejar racionalmente sistemas de irrigação por microaspersão, para atender ao plantio da cultivar de repolho Midori. Adotando-se percentagem de área molhada igual a 100%, foram avaliados nos setores da unidade operacional a variação de vazão e pressão, os coeficientes de uniformidade (CU) e a eficiência de aplicação (EA). A uniformidade da irrigação apresentou valores elevados, superiores a 93%. A eficiência de aplicação foi boa, com valores maiores que 80%. O sistema foi então utilizado na irrigação, utilizando como controle o tanque "Classe A", durante um período de 75 dias, e conduzido por um agricultor local. Considerando os riscos de salinização na área, promoveu-se lavagem contínua do solo. Foi adotado um coeficiente de lixiviação médio de 1,21, com desvio-padrão de 0,45, para o período sem precipitação. Praticamente em todo o experimento, o sentido do gradiente de potencial total da água do solo foi ascendente, com média de 1,14 e 0,21 de desvio-padrão. Preveniu-se com isso a ocorrência de ascensões capilares, estabelecendo-se um perfil drenante, bem como se manteve a condutividade elétrica da zona saturada em equilíbrio. Não foi observada a saturação do solo na zona radicular.<br>This study has been carried out in alluvial area in the semi-arid zone of Pernambuco State, Brazil, subject to salinisation, aiming to guide local farmers to install, evaluate and to manage micro sprinkler irrigation systems, raising Midori cabbage cultivar. Adopting the area percentage of wetted soli 100% the sub units have been evaluated regarding the discharge and pressure variation, and also coefficients of uniformity (CU) and efficiency of application coefficient (EA). The irrigation uniformity was high, greater than 93%. The efficiency of application coefficient could be classified as good, exhibiting values greater than 80%. The system was then used to local scale irrigation, adopting a "Class A" tank as a management control, during a 75 days period and conducted by a local farmer. Continuous leaching has been implemented throughout the study, for salinity control. Average leaching coefficient equal to 1,21 with standard deviation of 0,45 has been adopted, for the period with no rainfall. Upward gradients have prevailed, with average of 1,14 and 0,21 standard deviation, preventing capillary flow to occur. A stable electrical conductivity in the saturated zone has been observed. Soil saturation has not been recorded in the root zone

Correlation of biological serum markers with the degree of hepatic fibrosis and necroinflammatory activity in hepatitis C and schistosomiasis patients

Liver biopsy is the gold-standard method to stage fibrosis; however, it is an invasive procedure and is potentially dangerous. The main objective of this study was to evaluate biological markers, such as cytokines IL-13, IFN-&#947;, TNF-&#945; and TGF-&#946;, platelets, bilirubins (Bil), alanine aminotransferase (ALT) and aspartate aminotransferase (AST), total proteins, &#947;-glutamil transferase (&#947;-GT) and alkaline phosphatase (AP), that could be used to predict the severity of hepatic fibrosis in schistosomiasis and hepatitis C (HC) as isolated diseases or co-infections. The following patient groups were selected: HC (n = 39), HC/hepatosplenic schistosomiasis (HSS) (n = 19), HSS (n = 22) and a control group (n = 13). ANOVA and ROC curves were used for statistical analysis. P < 0.05 was considered significant. With HC patients we showed that TNF-&#945; (p = 0.020) and AP (p = 0.005) could differentiate mild and severe fibrosis. With regard to necroinflammatory activity, AST (p = 0.002), &#947;-GT (p = 0.034) and AP (p = 0.001) were the best markers to differentiate mild and severe activity. In HC + HSS patients, total Bil (p = 0.008) was capable of differentiating between mild and severe fibrosis. In conclusion, our study was able to suggest biological markers that are non-invasive candidates to evaluate fibrosis and necroinflammatory activity in HC and HC + HSS

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology