Isolated Liver Metastasis in Hürthle Cell Thyroid Cancer Treated with Microwave Ablation

Hürthle cell thyroid cancer (HCTC) is a less common form of differentiated thyroid cancer. It rarely metastasizes to the liver, and when it does, the metastasis is almost never isolated. Here we report a 62-year-old male with widely invasive Hürthle cell thyroid cancer, who underwent total thyroidectomy and received adjuvant treatment with I-131 with posttreatment scan showing no evidence of metastatic disease. His thyroglobulin however continued to rise after that and eventually an isolated liver metastasis was identified. He underwent laparoscopic microwave ablation of the liver metastasis, with dramatic decline in thyroglobulin and no structural disease identified to date. This case highlights the rare occurrence of isolated liver metastasis from HCTC and also illustrates the utility of thermoablation as an alternative to surgical resection in the treatment of small isolated liver metastases from HCTC

Metastatic Hürthle cell carcinoma presenting with low free thyroxine, severe hypercalcemia and spurious growth hormone production

Objective: Hürthle cell tumors constitute about 5% of thyroid neoplasms. They have malignant potential, behaving very aggressively compared to other differentiated thyroid cancers. The objective of this case report is to describe a case of a Hürthle cell carcinoma with a single large metastasis in the liver presenting almost 17 years after hemithyroidectomy. We highlight the difficulties in making a histologic diagnosis and the unpredictable nature of this cancer. Methods: The patient history and biochemistry were detailed. Thyroid function tests analyzed on multiple platforms (single-photon emission computed tomography, dynamic magnetic resonance imaging, technetium-99m bone scan, and radioactive iodine) were used to aid biochemical and radiologic diagnosis. Results: The patient's thyroid function test showed persistently low free thyroxine concentrations with normal thyroid stimulating hormone and free triiodothyronine, suggesting rapid deiodination in the context of a large liver lesion. Radiologic and morphologic appearances of the liver lesion led to an initial misdiagnosis of primary hepato-cellular carcinoma, revised to metastatic Hürthle cell carcinoma after positive immunochemistry. Nonparathyroid hormone-related intractable hypercalcemia of malignancy with an unusual pattern of elevated 1,25-dihydroxyvitamin D and raised fibroblast growth factor 23 concentrations culminated in his demise. Conclusions: In Hürthle cell carcinomas treated with partial thyroidectomy, subsequent abnormal thyroid functions tests may herald a more sinister underlying diagnosis. The management of Hürthle cell carcinoma relies heavily on the initial histology results. Histologic diagnosis should be sought earlier in abnormal and suspicious distant masses. Malignant hypercalcemia poses a great challenge in delayed presentations and can prove resistant to conventional treatments

Posterior Instrumentation for Occipitocervical Fusion

Since 1995, 29 consecutive patients with craniocervical spine instability due to several pathologies were managed with posterior occipitocervical instrumentation and fusion. Laminectomy was additionally performed in nineteen patients. The patients were divided in two groups: Group A which included patients managed with screw-rod instrumentation, and Group B which included patients managed with hook-and-screw-rod instrumentation. The patients were evaluated clinically and radiographically using the following parameters: spine anatomy and reconstruction, sagittal profile, neurologic status, functional level, pain relief, complications and status of arthrodesis. The follow-up was performed immediately postoperatively and at 2, 6, 12 months after surgery, and thereafter once a year. Fusion was achieved in all but one patient. One case of infection was the only surgery related complication. Neurological improvement and considerable pain relief occurred in the majority of patients postoperatively. There were neither intraoperative complications nor surgery related deaths. However, the overall death rate was 37.5% in group A, and 7.7% in group B. There were no instrument related failures. The reduction level was acceptable and was maintained until the latest follow-up in all of the patients. No statistical difference between the outcomes of screw-rod and hook-and-screw-rod instrumentation was detected. Laminectomy did not influence the outcome in either group. Screw-rod and hook-and-screw-rod occipitocervical fusion instrumentations are both considered as safe and effective methods of treatment of craniocervical instability

Advanced techniques to improve the performance of OFDM Wireless LAN

OFDM systems have experienced increased attention in recent years and have found applications in a number of diverse areas including telephone-line based ADSL links, digital audio and video broadcasting systems, and wireless local area networks (WLAN). Orthogonal frequency-division multiplexing (OFDM) is a powerful technique for high data-rate transmission over fading channels. However, to deploy OFDM in a WLAN environment, precise frequency synchronization must be maintained and tricky frequency offsets must be handled. In this thesis, various techniques to improve the data throughput of OFDM WLAN are investigated. A simulation tool was developed in Matlab to evaluate the performance of the IEEE 802.11a physical layer. We proposed a rapid time and frequency synchronization algorithm using only the short training sequence of the IEEE 802.11a standard, thus reducing the training overhead to 50%. Particular attention was paid to channel coding, block interleaving and antenna diversity. Computer simulation showed that drastic improvement in error rate performance is achievable when these techniques are deployed.http://archive.org/details/advancedtechniqu109451514Lieutenant, Hellenic NavyApproved for public release; distribution is unlimited

A Disposable Inkjet-Printed Humidity and Temperature Sensor Fabricated on Paper

In this work we present the development of a low-cost humidity and temperature sensing platform on paper by inkjet printing, using a commercial AgNPs conductive ink. The humidity sensing module was capable of measuring relative humidity in the range of 0–90%rH, exhibiting linear response with minimal memory effect when returning to 0%rH baseline signal while the temperature sensor performed linearly as well in the range of 25–75°C. Process repeatability has been verified by electrical and optical characterization. Mechanical bending results highlight the platform’s capability to serve as an easy to install, flexible multi-parametric sensing platform

Rotating Triboelectric Nanogenerators for Energy Harvesting and Their Applications

Addressing the increasing development of IoT networks and the associated energy requirements, rotating triboelectric nanogenerators (R-TENGs) are proving to be strong candidates in the field of energy harvesting, as well as to that of self-powered devices and autonomous sensors. In this work, we review the theoretical framework surrounding the operating principles and key design parameters of R-TENGs, while also associating them with their output characteristics. Furthermore, we present an overview of the core designs used by the research community in energy harvesting applications, as well as variations of these designs along with explicit solutions for the engineering and optimization of the electrical output of R-TENGs. Last but not least, a comprehensive survey of the potential applications of R-TENGs outside the energy harvesting scope is provided, showcasing the working principles of the various designs and the benefits they confer for each specific scenario

Synthesis of carbon dots and utilization in the development of micro- and nanodevices

The aim of this doctoral thesis is the synthesis and characterization of Carbon Dots and their use for the development of micro- and nano- devices. Carbon Dots were first discovered in 2004 and are the newest member in the family of carbon nanomaterials. They have drawn scientific interest due to the facile and low-cost synthetic processes available and their low cytotoxicity, but mainly due to their photoluminescence when excited by visible and ultraviolet light. Although to date most of the mechanisms that govern their physicochemical properties have not been yet uncovered, these novel nanomaterials could be excellent candidates for a series of applications.The scientific methodology of this thesis is divided into three separate axes; at first, the synthesis of Carbon Dots by microwave-assisted hydrothermal methods is studied and the materials are characterized for their chemical and structural properties. This characterization takes place in both solutions and the solid state. Secondly, the research focuses on the fluorescent response of the synthesized Carbon Dots. Their photoluminescence is studied in solutions as well as in the solid state and the mechanisms governing it are discussed in association with the results of their chemical and structural characterization.Lastly, methodologies are developed which allow the fabrication of devices based on Carbon Dots. Two different approaches are discussed along with their respective process characterization and the resulting devices are also characterized for their functional properties.Studies of Carbon Dots are still in an early stage, with their structure and optical properties being a topic of intense discussion. To date, research regarding these novel nanomaterials has focused on their properties and applications in the form of solutions.The results of this doctoral thesis contribute to further understanding the chemical and structural properties of Carbon Dots and their association with their fluorescent properties. In addition, the conclusions derived extend to the properties of the materials in solid state, which is an important prerequisite for their utilization in device design and fabrication applications.Το αντικείμενο της παρούσας διδακτορικής διατριβής είναι η σύνθεση και ο χαρακτηρισμός Τελειών Άνθρακα με στόχο την αξιοποίησή τους σε μίκρο- και νανοσυσκευές και διατάξεις. Οι Τελείες Άνθρακα, οι οποίες ανακαλύφθηκαν το 2004 και αποτελούν τη νεότερη προσθήκη στην οικογένεια των νανοϋλικών με βάση τον άνθρακα, έχουν προσελκύσει το ερευνητικό ενδιαφέρον λόγω των εύκολων και χαμηλού κόστους μεθόδων σύνθεσής τους, της χαμηλής τοξικότητας που παρουσιάζουν αλλά κυριότερα λόγω του φθορισμού που επιδεικνύουν κατά τη διέγερσή τους στο εγγύς υπεριώδες και ορατό φάσμα. Παρόλο που μέχρι σήμερα το μεγαλύτερο μέρος των ιδιοτήτων τους και των μηχανισμών που τις διέπουν δεν έχουν αποσαφηνιστεί πλήρως, τα υλικά αυτά θα μπορούσαν να χρησιμοποιηθούν για μια σειρά από δυνητικές εφαρμογές.Η μεθοδολογία που ακολουθήθηκε σε ερευνητικό επίπεδο χωρίζεται σε τρεις διακριτούς άξονες. Αρχικά αναπτύσσονται Τελείες Άνθρακα μέσω υδροθερμικής σύνθεσης με τη βοήθεια μικροκυματικής ακτινοβολίας, οι οποίες έπειτα χαρακτηρίζονται ως προς τις χημικές και δομικές τους ιδιότητες στην υγρή και στερεά κατάσταση. Στη συνέχεια γίνεται ανάλυση της ιδιότητας φθορισμού τους και ερευνώνται οι μηχανισμοί που διέπουν τη φωτοφωταύγεια των νανοϋλικών, ενώ επίσης γίνεται σύνδεση αυτών με τα δομικά χαρακτηριστικά τους. Τέλος, ερευνώνται τεχνικές για την αξιοποίηση των Τελειών Άνθρακα στο σχεδιασμό και την ανάπτυξη μίκρο- και νανοσυσκευών, οι οποίες στη συνέχεια μελετώνται ως προς τα χαρακτηριστικά λειτουργίας τους.Η μελέτη των Τελειών Άνθρακα βρίσκεται ακόμα σε πρώιμο στάδιο με τη δομή και τις οπτικές τους ιδιότητες να αποτελούν πεδίο συζήτησης. Μέχρι στιγμής, η έρευνα των νέων αυτών υλικών έχει επικεντρωθεί κυρίως στις ιδιότητές τους στην υγρή φάση, ενώ αντίστοιχα οι περισσότερες εφαρμογές που έχουν διερευνηθεί αφορούν διαλύματά τους.Τα συμπεράσματα της παρούσας διδακτορικής διατριβής συμβάλουν στην περαιτέρω κατανόηση των χημικών χαρακτηριστικών και της δομής των Τελειών Άνθρακα και επιτυγχάνουν τη σύνδεσή τους με τους μηχανισμούς φθορισμού. Παράλληλα τα αποτελέσματα διευρύνονται και στις ιδιότητες των υλικών στη στερεά κατάσταση, που αποτελεί σημαντικό προαπαιτούμενο για την αξιοποίησή τους σε εφαρμογές σχεδιασμού και ανάπτυξης διατάξεων.Τέλος, οι μεθοδολογίες που αναπτύχθηκαν για πρώτη φορά στο πλαίσιο της παρούσας διατριβής επιτρέπουν την εναπόθεση, επεξεργασία και μορφοποίηση των Τελειών Άνθρακα υπό την μορφή λεπτών υμενίων με κλασικά εργαλεία της μικροηλεκτρονικής, όπως για παράδειγμα η οπτική λιθογραφία, προσφέροντας τη δυνατότητα για αξιοποίηση τους ως δομικά ενεργά στοιχεία στην κατασκευή μίκρο- και νανοσυσκευών και διατάξεων

Isolated Liver Metastasis in Hürthle Cell Thyroid Cancer Treated with Microwave Ablation

Hürthle cell thyroid cancer (HCTC) is a less common form of differentiated thyroid cancer. It rarely metastasizes to the liver, and when it does, the metastasis is almost never isolated. Here we report a 62-year-old male with widely invasive Hürthle cell thyroid cancer, who underwent total thyroidectomy and received adjuvant treatment with I-131 with posttreatment scan showing no evidence of metastatic disease. His thyroglobulin however continued to rise after that and eventually an isolated liver metastasis was identified. He underwent laparoscopic microwave ablation of the liver metastasis, with dramatic decline in thyroglobulin and no structural disease identified to date. This case highlights the rare occurrence of isolated liver metastasis from HCTC and also illustrates the utility of thermoablation as an alternative to surgical resection in the treatment of small isolated liver metastases from HCTC

SUN-LB85 Short-Term Outcomes of Radiofrequency Ablation of a Toxic and a Non-Toxic Benign Thyroid Nodule

Abstract Background: Radiofrequency ablation (RFA) of benign thyroid nodules has been shown to be a safe and effective minimally invasive treatment for benign thyroid nodules, based on many years of international experience. Thyroid specific devices have recently become available in the US. Here, we present representative examples of our early experience with RFA for both non-toxic and toxic thyroid nodules in our outpatient center. Clinical Cases: Case 1: A 39 year-old woman presented with subclinical hyperthyroidism, with a TSH of 0.013 uIU/mL (0.45-4.5 uIU/mL). Evaluation showed bilateral autonomously functioning thyroid nodules. Both nodules were predominantly solid with no suspicious features and grade 3 Doppler flow, and were benign (Bethesda II) on UG-FNA. She declined treatment with total thyroidectomy, radioactive iodine, or long-term thionamides, and decided to proceed with RFA, after pre-treatment with methimazole. We decided to target the right lobe nodule first, as it was larger, with a volume of 2.63 ml. The danger triange and vagus nerve were identified, and then we injected local anesthetic using the pericapsular lidocaine technique. We then performed ultrasound-guided RFA of this nodule, using an RF generator with an internally cooled 18-gauge electrode, with a length of 7 cm and an active tip of 7 mm. Power was set at 25 Watts. The trans-isthmic approach and moving shot technique were used. Total energy delivery was 3078 WS. At the end of the procedure, we visualized a transient hyperechoic zone and there was absence of Doppler flow throughout the nodule. She tolerated the procedure well without complications. Methimazole was stopped after the procedure. At the 3-month follow-up, the nodule had decreased in volume by 72.5% and had no internal Doppler flow; TSH normalized (1.37 uIU/mL), so we decided not to proceed with RFA of the left superior toxic adenoma. Case 2: A 49 year-old woman presented with a large right lobe thyroid nodule with a volume of 6.13 ml, which was causing dysphagia and dysphonia. It was predominantly solid with no suspicious features and grade 3 Doppler flow. TSH was normal. It was benign (Bethesda II) on UG-FNA on 2 occasions. She declined surgical therapy, and decided to proceed with RFA. We performed local anesthesia and then RFA in a similar fashion to case 1, with a power of 20-40 Watts. Total energy delivery was 11,491 WS. There were no complications. At the 3-month follow-up, TSH remained normal, and the volume of the ablated nodule had decreased by 59.9%. There was no intranodular Doppler flow. Her compressive symptoms completely resolved. Conclusion: These cases are representative of our early experience with thyroid RFA in the USA, and showcase its safety, efficacy and feasibility in the outpatient setting, for patients with toxic or non-toxic symptomatic thyroid nodules.</jats:p