Clinical significance of prophylactic central compartment neck dissection in the treatment of clinically node-negative papillary thyroid cancer patients

BACKGROUND: Lymph nodal involvement is very common in differentiated thyroid cancer, and in addition, cervical lymph node micrometastases are observed in up to 80 % of papillary thyroid cancers. During the last decades, the role of routine central lymph node dissection (RCLD) in the treatment of papillary thyroid cancer (PTC) has been an object of research, and it is now still controversial. Nevertheless, many scientific societies and referral authors have definitely stated that even if in expert hands, RCLD is not associated to higher morbidity; it should be indicated only in selected cases. MAIN BODY: In order to better analyze the current role of prophylactic neck dissection in the surgical treatment of papillary thyroid cancers, an analysis of the most recent literature data was performed. Prophylactic or therapeutic lymph node dissection, selective, lateral or central lymph node dissection, modified radical neck dissection, and papillary thyroid cancer were used by the authors as keywords performing a PubMed database research. Literature reviews, PTCs large clinical series and the most recent guidelines of different referral endocrine societies, inhering neck dissection for papillary thyroid cancers, were also specifically evaluated. A higher PTC incidence was nowadays reported in differentiated thyroid cancer (DTC) clinical series. In addition, ultrasound guided fine-needle aspiration citology allowed a more precocious diagnosis in the early phases of disease. The role of prophylactic neck dissection in papillary thyroid cancer management remains controversial especially regarding indications, approach, and surgical extension. Even if morbidity rates seem to be similar to those reported after total thyroidectomy alone, RCLD impact on local recurrence and long-term survival is still a matter of research. Nevertheless, only a selective use in high-risk cases is supported by more and more scientific data. CONCLUSIONS: In the last years, higher papillary thyroid cancer incidence and more precocious diagnoses were worldwide reported. Among endocrine and neck surgeons, there is agreement about indications to prophylactic treatment of node-negative “high-risk” patients. A recent trend toward RCLD avoiding radioactive treatment is still debated, but nevertheless, prophylactic dissections in low-risk cases should be avoided. Prospective randomized trials are needed to evaluate the benefits of different approaches and allow to drawn definitive conclusions

A New Orbiting Deployable System for Small Satellite Observations for Ecology and Earth Observation

In this paper, we present several study cases focused on marine, oceanographic, and atmospheric environments, which would greatly benefit from the use of a deployable system for small satellite observations. As opposed to the large standard ones, small satellites have become an effective and affordable alternative access to space, owing to their lower costs, innovative design and technology, and higher revisiting times, when launched in a constellation configuration. One of the biggest challenges is created by the small satellite instrumentation working in the visible (VIS), infrared (IR), and microwave (MW) spectral ranges, for which the resolution of the acquired data depends on the physical dimension of the telescope and the antenna collecting the signal. In this respect, a deployable payload, fitting the limited size and mass imposed by the small satellite architecture, once unfolded in space, can reach performances similar to those of larger satellites. In this study, we show how ecology and Earth Observations can benefit from data acquired by small satellites, and how they can be further improved thanks to deployable payloads. We focus on DORA—Deployable Optics for Remote sensing Applications—in the VIS to TIR spectral range, and on a planned application in the MW spectral range, and we carry out a radiometric analysis to verify its performances for Earth Observation studies

Clinical Features, Cardiovascular Risk Profile, and Therapeutic Trajectories of Patients with Type 2 Diabetes Candidate for Oral Semaglutide Therapy in the Italian Specialist Care

Introduction: This study aimed to address therapeutic inertia in the management of type 2 diabetes (T2D) by investigating the potential of early treatment with oral semaglutide. Methods: A cross-sectional survey was conducted between October 2021 and April 2022 among specialists treating individuals with T2D. A scientific committee designed a data collection form covering demographics, cardiovascular risk, glucose control metrics, ongoing therapies, and physician judgments on treatment appropriateness. Participants completed anonymous patient questionnaires reflecting routine clinical encounters. The preferred therapeutic regimen for each patient was also identified. Results: The analysis was conducted on 4449 patients initiating oral semaglutide. The population had a relatively short disease duration (42%  60% of patients, and more often than sitagliptin or empagliflozin. Conclusion: The study supports the potential of early implementation of oral semaglutide as a strategy to overcome therapeutic inertia and enhance T2D management

Studio Minisevo: Trial randomizzato prospettico su due regimi di precondizionamento anestetico in pazienti sottoposti a chirurgia mininvasiva della valvola mitralica.

Il precondizionamento miocardico è quel fenomeno per il quale un intervento o un trigger, applicati prima di un prolungato insulto ischemico al miocardico, possono ridurre l’area infartuata. Esso garantisce sia una protezione immediata che si verifica dopo 1-2 ore dallo stimolo precondizionante sia una protezione tardiva, seppur meno potente, che persiste per 2-3 giorni. Inoltre, il miocardio, può anche essere protetto da uno stimolo applicato dopo il danno da ischemia-riperfusione: questo fenomeno è chiamato postcondizionamento. Infine, se lo stimolo ischemico per la protezione miocardica è applicato ad un organo o tessuto distante come per esempio un arto, si parla di precondizionamento remoto. Dal punto di vista clinico, la possibilità di indurre un precondizionamento farmacologico, dovrebbe aiutarci a raggiungere gli stessi benefici ottenuti con lo stimolo ischemico, ma senza il rischio rappresentato dall’esposizione transitoria ad un’ostruzione del flusso coronarico miocardico. Diversi farmaci sono stati studiati per determinare se possiedano o meno proprietà precondizionanti per il cuore, inclusi gli anestetici alogenati. Tutti gli studi in merito hanno quantificato il danno miocardico in base ai livelli di troponina I. I loro risultati hanno mostrato che l’utilizzo di ipnotici alogenati determinano un minore danno cellulare e una migliore performance miocardica. Le conseguenze di questi effetti protettivi sono una riduzione dei giorni di degenza in terapia intensiva associata ad una ridotta morbidità e mortalità. Sulla scorta di questi dati, a fronte di risultati talvolta controversi e non chiari, diventa palese la necessità di effettuare ulteriori studi. Oggetto della tesi è proprio lo studio degli effetti precondizionanti del sevoflurane in pazienti che si sottopongono ad intervento cardiochirurgico di sostituzione/plastica della valvola mitralica in minitoracotomia destra: abbiamo condotto un trial monocentrico, randomizzato, in singolo cieco, per comparare l’effetto cardioprotettivo della somministrazione continua di sevoflurane rispetto all’ anestesia intravenosa con propofol. L’outcome primario era il rilascio della troponina I nelle prime 72 ore del postoperatorio. L'analisi dei risultati ha evidenziato che l’ anestesia con propofol e con sevoflurane sono associate ad un simile danno miocardico, direttamente correlato alla durata di clampaggio, in pazienti che si sottopongono a chirurgia della valvola mitralica con approccio mininvasivo

Novel association between the nonsynonymous A803G polymorphism of the N-acetyltransferase 2 gene and impaired glucose homeostasis in obese children and adolescents

Background: The N-acetyltransferase 2 ( NAT2 ) A803G polymorphism has been associated with decreased insulin sensitivity in a large adult population with the A allele associated with insulin-resistance-related traits. Objective: Evaluate the association of this polymorphism with anthropometric and metabolic parameters in obese children and adolescents. Subjects: A total of 748 obese children and adolescents were enrolled. Methods: Anthropometric and laboratory data were collected. During oral glucose tolerance test, the presence of a possible exaggerated plasma glucose excursion at 1h (1HPG) or impaired glucose tolerance (IGT) was considered. Homeostasis model assessment, oral disposition index (oDI) and insulinogenic index (IDI) were calculated. Patients were genotyped for the NAT2 A803G polymorphism. Results: The prevalence of both IGT and elevated-1HPG was higher in children carrying the A803 allele (P=.02 and P=.03). Moreover, this allele was associated with both oDI and IGI reduction (P=.01). No differences among the NAT2 A803G genotypes for the other parameters were shown. Children homozygous for the A allele presented an odds ratio (OR), to show IGT of 4.9 (P=.01). Children both homozygous and heterozygous for the A allele had higher risk to show elevated-1HPG (OR of 2.7, P=.005; and OR=2.3, P=.005) compared with patients homozygous for the NAT2 803G allele. Conclusions: NAT2 A803 allele seems to play a role in worsening the destiny of obese children carrying it, predisposing them to elevated-1HPG and IGT and then to a possible future type 2 diabetes mellitus throughout an impairment of pancreatic β-cellular insulin secretion as suggested by oDI and IGI reduction

Acute kidney injury in children hospitalized for community acquired pneumonia

Background: Acute kidney injury (AKI) enhances the risk of later chronic kidney disease. Significant prevalence of AKI is reported in adults with community acquired pneumonia (CAP). We investigated prevalence of and prognostic factors for AKI in children hospitalized for CAP. Methods: We retrospectively collected clinical and biochemical data of 186 children (48.4% male; mean age 2.6±2.4 years) hospitalized for X-ray-confirmed CAP. AKI was defined according to Kidney Disease/Improving Global Outcomes creatinine criteria. We considered as basal serum creatinine the value estimated with Hoste (age) equation assuming basal eGFR were median age-based eGFR normative values for children ≤ 2 years of age and eGFR= 120 mL/min/1.73m2 for children > 2 years. Univariate and multivariate logistic regression models were used to explore associations with AKI. Results: AKI was found in 38/186 (20.4%) patients. No patient required hemodialysis nor reached AKI stage 3, 5 (2.7%) reached AKI stage 2, and 33 (17.7%) AKI stage 1. Mean length of stay was 6.0±1.7, 6.9±2.3, and 12.2±1.5 days, for patients without AKI, stage 1 AKI, and stage 2 AKI (p < 0.001), respectively. Duration of symptoms before hospitalization (OR 1.2; 95%CI 1.09-1.43; p = 0.001), severe pneumonia (OR 11.9; 95%CI 4.3-33.3; p < 0.001), and serum C-reactive protein levels (OR 1.1; 95%CI 1.04-1.23; p = 0.004) were independent AKI predictors. Conclusions: About 1/5 of children hospitalized for CAP present a generally mild AKI with a longer stay for those with more severe AKI. Attention should be paid to kidney health of children with CAP especially in presence of higher duration of symptoms before hospitalization, severe pneumonia and higher serum CRP levels