Incidence of malignant lesions in patients with clinically benign thyroid nodules: observational and prospective study in a cohort of 50 patients followed during two years

INTRODUCTION: To study the frequency of malignant lesions in patients with clinically benign thyroid nodules and the value of the repetition of fine needle aspiration biopsy (FNAB). METHODS: Observational and prospective 2-year study in a cohort of 50 patients with clinically benign thyroid nodules. Patients were initially submitted to clinical examination, ultrasound (US) and FNAB1 patients, followed by a second FNAB and US. RESULTS: Palpation is not a good test for diagnosis and follow-up of thyroid nodules. On the other hand, the initial consideration that these patients should harbor benign lesions is a very useful parameter, since 47/50 patients (94%) did not present malignant lesions during the follow-up. FNAB1 and FNAB2 were concordant in 33/39 patients when FNAB1 was negative (85%); 11 patients were operated, 8 by suspicious FNAB and 3 due to nodule growth. We observed 2 patients with non-invasive papillary microcarcinoma and 1 patient with papillary carcinoma outside of the main nodules. CONCLUSION: there was concordance between initial clinical benign diagnosis, FNAB and the follow-up. In one case there was a papillary carcinoma. In addition, ultrasonography should be considered for all patients with suspected thyroid nodules. Finally, we demonstrated that a second cytology usually confirms the result of the first cytology in benign thyroid nodules.OBJETIVOS: Verificar a ocorrência de lesões malignas em pacientes com nódulos tiroidianos clinicamente benignos e o valor da repetição da citologia aspirativa da tiróide (PAAF). MÉTODOS: Estudo observacional prospectivo por 2 anos em coorte de 50 mulheres com nódulos tiroidianos clinicamente benignos, com exame clínico, ultra-sonografia (US) e PAAF inicial, seguidas por acompanhamento clínico, US e repunção dos mesmos nódulos (PAAF2). RESULTADOS: A palpação não é bom método para o seguimento dos nódulos quando comparada ao US. O quadro clínico foi parâmetro de confiança, pois 47/50 pacientes (94%) evoluíram sem malignidade durante o seguimento. PAAF1 e PAAF2 concordaram em 33/39 pacientes quando PAAF1 foi negativa (85%); 11 pacientes foram operadas, 8 por PAAF suspeita e 3 por aumento do volume nodular durante o seguimento. O anátomo-patológico (AP) foi benigno nas lesões suspeitas (8 adenomas e 3 bócios colóides). Houve 2 casos de microcarcinoma papilífero não invasivo em área distante dos nódulos e 1 caso de carcinoma papilífero não invasivo em bócio multi-nodular. CONCLUSÕES: Houve concordância entre características clínicas de benignidade com PAAF, US e acompanhamento clínico ou cirurgia; numa paciente encontramos carcinoma papilífero. O US deve ser considerado em pacientes com suspeita de nódulos de tiróide ao exame clínico; na maioria das vezes quando o resultado da PAAF1 é negativo para malignidade, o segundo exame citológico confirma o primeiro.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoUNIFESP, EPM, Depto. de MedicinaUNIFESP, EPM, Depto. de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoSciEL

Well-posedness of minimal time problems with constant dynamics in Banach spaces

This paper concerns the study of a general minimal time problem with a convex constant dynamics and a closed target set in Banach spaces. We pay the main attention to deriving sufficient conditions for the major well-posedness properties that include the existence and uniqueness of optimal solutions as well as certain regularity of the optimal value function with respect to state variables. Most of the results obtained are new even in finite-dimensional spaces. Our approach is based on advanced tools of variational analysis and generalized differentiation

Transcriptome-based phylogenomic analysis reveals evidence of ancient hybridization events in the Mepraia genus (Hemiptera: Reduviidae: Triatominae)

IntroductionThe Mepraia genus is composed of three endemic species in Chile, namely Mepraia spinolai, Mepraia gajardoi, and Mepraia parapatrica, all capable of transmitting the causative agent of Chagas disease. Although species divergence within this genus is supported by morphological, molecular, and geological evidence, it has never been validated by genome-wide data.MethodsIn this sense, a pioneering phylogenomic study was conducted using transcriptome data of the three species, aiming to infer robust phylogenies and evaluate the impact of interspecific gene flow on the evolution of these insects. Our transcriptomes were used to robustly infer the phylogenetic relationships, employing multi-species coalescent and supermatrix approaches, as well as to investigate the occurrence of introgression.Results and discussionThe inferred phylogenies support the monophyly of the three described taxa and infer divergence times, although gene trees display high levels of discordance. Our results indicate widespread introgression among Mepraia lineages. Thus, our results support that Mepraia diversification occurred in a short period resulting in reticulate phylogenies and low genetic diversity. Additionally, we obtained evidence of introgression suggesting that ancient hybridization has had a major role in the evolution of the three Mepraia species