Diagnosis and treatment of thyroid cancer in children in the multicenter analysis in Poland for PPGGL

Introduction: Differentiated thyroid carcinoma (DTC) in children presents different biological behavior in comparison to adults. Authors presents preliminary results of multicenter analysis concerning incidence, diagnostics and treatment of DTC in children. Material and methods: The study is a retrospective analysis of 107 pediatric patients from 14 academic centers based on the data from 2000 to 2005 obtained by questionnaire in hospitals involved in the treatment of DTC in children. Results: Papillary thyroid cancer was diagnosed in 83 children, follicular thyroid cancer in 10 children and medullary thyroid cancer in 14 children. Incidence of DTC in children was estimated between 18 and 23 cases per year. The biggest group of patients consisted of children between 11 and 15 years of age, with girls to boys ratio 3.3 : 1. Clinically DTC in children presented most often as solitary thyroid nodule. Cervical lymphadenopathy was observed in 42% of patients. Intraoperative verification indicated metastatic nodes in 50% of children. Low stage DTC predominated (T1 in 36% and T2 in 26% of children). One step surgery was performed in 65% of children with DTC, two step surgery in 25% of patients. I131 therapy was undertaken in 80% of children. Lung metastases were indicated in post therapeutic studies in 14% of children with DTC. Prophylactic thyroidectomies were performed in 79% of children in the group of patients with MTC and RET gene mutations. Conclusions: The necessity of introduction of unified therapeutic standard in children with DTC in Poland is underlined.Wstęp: Zróżnicowane raki tarczycy (DTC, differentiated thyroid carcinoma) występują u dzieci rzadko. Większość przypadków wykrywanych jest w wieku 11-17 lat. W odróżnieniu od dorosłych DTC u dzieci prezentują odmienne zachowanie biologiczne. Mała liczba przypadków DTC w poszczególnych ośrodkach oraz względnie łagodny ich przebieg utrudniają ocenę występowania i leczenia DTC u dzieci w Polsce, uzależniając ją od wysiłków włożonych w uzyskanie rzetelnych danych. Autorzy przedstawiają wstępne wyniki analizy wieloośrodkowej dotyczące występowania, diagnostyki i leczenia DTC u dzieci. Materiał i metody: Podjęte badania są retrospektywną analizą obejmującą lata 2000-2005, opartą na danych z historii chorób uzyskanych z ankiet rozesłanych do ośrodków dla dzieci i dorosłych podejmujących leczenie DTC. Do analizy zgłoszono 107 pacjentów z 14 ośrodków akademickich w Polsce. Analizie poddano wiek i płeć dzieci z DTC, wielkość i lokalizację zmian w tarczycy, sposoby rozpoznawania DTC, rodzaje i zakres wykonywanych zabiegów operacyjnych oraz leczenie uzupełniające izotopem J131. Wyniki: Raka brodawkowatego stwierdzono u 83 dzieci, pęcherzykowego u 10 dzieci, a rdzeniastego u 14 dzieci. Częstość występowania DTC u dzieci w Polsce wahała się między 18 a 23 przypadkami rocznie. W województwach: mazowieckim i połączonych wielkopolskim i lubuskim wykazano w okresie 2000-2005 wyższą (24 i 25) częstość występowania DTC, w pozostałych województwach wykazywano od 2 do 10 przypadków DTC. Największą grupę pacjentów stanowiły dzieci w wieku 11-15 lat, a stosunek dziewcząt do chłopców wynosił 3,3 : 1. Klinicznie DTC prezentowały się najczęściej jako pojedyncze guzki tarczycy. Limfadenopatię szyjną w badaniu klinicznym stwierdzono u 42% pacjentów, a śródoperacyjnie u 50% dzieci. U większości pacjentów dominowały niższe stopnie zaawansowania DTC (T1 u 36% i T2 u 26% dzieci). Operacje jednoetapowe wykonano u 65% dzieci, operacje dwuetapowe u 25% dzieci, a profilaktyczne tyreoidektomie u 79% dzieci z grupy pacjentów z rakiem rdzeniastym tarczycy (MTC, medullary thyroid cancinoma) i mutacją genu Ret. Leczenie izotopowe J131 podjęto u 80% dzieci. Przerzuty do płuc w scyntygrafii poterapeutycznej wykazano u 14% dzieci z DTC. Wnioski: We wnioskach podkreśla się konieczność wdrożenia na terenie całego kraju ujednoliconego i ocenianego na podstawie obiektywnych przesłanek sposobu postępowania z dziećmi z DTC

The effect of L-theanine supplementation on the immune system of athletes exposed to strenuous physical exercise

Abstract Background The aim of this study was to analyze the response of selected components of the immune system in rowers to maximal physical exercise, and to verify if this response could be modulated by supplementation with L-theanine. Method The double-blind study included 20 members of the Polish Rowing Team. The subjects were randomly assigned to the supplemented group (n = 10), receiving 150 mg of L-theanine extract for 6 weeks, or to the placebo group (n = 10). The participants performed a 2000-m test on a rowing ergometer at the beginning (1st examination) and at the end of the supplementation period (2nd examination). Blood samples were obtained from the antecubital vein before each exercise test, 1 min after completing the test, and after a 24-h recovery. Subpopulations of T regulatory lymphocytes (Tregs) (CD4+/CD25+/CD127-), cytotoxic lymphocytes (CTLs) (CD8+/TCRαβ+), natural killer (NK) cells (CD3-/CD16+/CD56+) and TCRδγ-positive (Tδγ) cells were determined by means of flow cytometry. The levels of interleukin 2 (IL-2), interleukin 4 (IL-4), interleukin 10 (IL-10), interferon gamma (INF-ɤ) and total antioxidant capacity (TAC) were determined with commercially available diagnostic kits. Results Supplementation with L-theanine contributed to a significant post-exercise decrease in IL-10 concentration, which was reflected by higher values of IL-2 to IL-10 and IFN-γ to IL-10 ratios. Moreover, a significant post-recovery decrease in CTL count, Treg to NK and Treg to CTL ratios was observed in the supplemented group. Conclusion Despite the decrease in the number of some cytotoxic cells (CTLs) and an increase in the proportion of Tregs to CTLs, supplementation with LTE seems to exert a beneficial effect on a disrupted Th1/Th2 balance in elite athletes, as shown by the decrease in IL-10 concentration

An attempt to induce an immunomodulatory effect in rowers with spirulina extract

Abstract Background The aim of this study was to analyze the response of selected components of the immune system in rowers to maximal physical exercise, and to verify if this response can be modulated by supplementation with spirulina (cyanobacterium Spirulina platensis). Method The double-blind study included 19 members of the Polish Rowing Team. The subjects were randomly assigned to the supplemented group (n = 10), receiving 1500 mg of spirulina extract for 6 weeks, or to the placebo group (n = 9). The participants performed a 2000-m test on a rowing ergometer at the beginning (1st examination) and at the end of the supplementation period (2nd examination). Blood samples were obtained from the antecubital vein prior to each exercise test, 1 min after completing the test, and after a 24-h recovery period. Subpopulations of T regulatory lymphocytes (Tregs) [CD4+/CD25+/CD127-], cytotoxic lymphocytes (CTLs) [CD8+/TCRαβ+], natural killer (NK) cells [CD3-/CD16+/CD56+] and TCRδγ-positive (Tδγ) cells were determined by means of flow cytometry. Results On the 2nd examination, athletes from the supplemented group showed neither a post-exercise increase in Treg count nor a post-recovery decrease in Tδγ cell count (both observed in the placebo group), and presented with significantly lower values of Treg/CTL prior to and after the exercise. During the same examination, rowers from the placebo group showed a significant post-recovery increase in Treg/(NK + Tδγ + CTL) ratio, which was absent in the supplemented group. Conclusion The results of this study imply that supplementation with spirulina extract may protect athletes against a deficit in immune function (especially, anti-infectious function) associated with strenuous exercise, and may cause a beneficial shift in “overtraining threshold” preventing a radical deterioration of immunity

Gastrointestinal symptoms and complications in patients hospitalized due to COVID-19, an international multicentre prospective cohort study (TIVURON project).

Retrospective studies suggest that coronavirus disease (COVID-19) commonly involves gastrointestinal (GI) symptoms and complications. Our aim was to prospectively evaluate GI manifestations in patients hospitalized for COVID-19. This international multicentre prospective cohort study recruited COVID-19 patients hospitalized at 31 centres in Spain, Mexico, Chile, and Poland, between May and September 2020. Patients were followed-up until 15 days post-discharge and completed comprehensive questionnaires assessing GI symptoms and complications. A descriptive analysis as well as a bivariate and multivariate analysis were performer using binary logistic regression. p Eight hundred twenty-nine patients were enrolled; 129 (15.6%) had severe COVID-19, 113 (13.7%) required ICU admission, and 43 (5.2%) died. Upon admission, the most prevalent GI symptoms were anorexia (n=413; 49.8%), diarrhoea (n=327; 39.4%), nausea/vomiting (n=227; 27.4%), and abdominal pain (n=172; 20.7%), which were mild/moderate throughout the disease and resolved during follow-up. One-third of patients exhibited liver injury. Non-severe COVID-19 was associated with ≥2 GI symptoms upon admission (OR 0.679; 95% CI 0.464-0.995; p=0.046) or diarrhoea during hospitalization (OR 0.531; 95% CI 0.328-0.860; p=0.009). Multivariate analysis revealed that worse hospital outcomes were not independently associated with liver injury or GI symptoms. GI symptoms were more common than previously documented, and were mild, rapidly resolved, and not independently associated with COVID-19 severity. Liver injury was a frequent complication in hospitalized patients not independently associated with COVID-19 severity