Elastography: A New Ultrasound Technique in Nodular Thyroid Pathology

Elastography is a new technique for evaluating the stiffness of nodules. It is generally recognised that malignant thyroid lesions are harder than benign lesions. Different elastographic techniques are presented, with characteristics, advantages and limitations. Qualitative and semiquantitative methods are described. Comparison of the main existing techniques, static and dynamic elastographies, is presented in this chapter. Strain elastography seems to have a better diagnostic quality than shear wave elastography in the diagnosis of thyroid cancer disease. A positive elastogram, suggestive for malignancy is more useful in diagnosis than a positive grey-scale ultrasound evaluation. Elastography increases the specificity of grey scale ultrasound (US), it should be always integrated with its information and should be considered as a complement of conventional US

Improvement Of Graves' Ophthalmopathy After Administration Of The Cyclooxygenase-2 Selective Inhibitor Celecoxib: A Case-Report

Graves' ophthalmopathy (GO) is a disabling complication of GravesBasedow disease, which in severe cases can progress toward blindness. Its treatment consists of the administration of corticosteroids, radiotherapy, as well as surgical treatment. The present report brings to your attention a case of moderate GO found in a patient recently diagnosed with Graves' disease that was resistant to the administration of Prednisone, stabilized under treatment with Celecoxib. A 45-year-old Caucasian woman presented in an outpatient facility with the following complaints: gritty feeling in both eyes, tachycardia, insomnia, anxiety, sweating, and weight loss. After the clinical European Scientific Journal, ESJ ISSN: 1857-7881 (Print) e - ISSN 1857-7431 January 2021 edition Vol.17, No.3 www.eujournal.org 2 examination and laboratory investigations, the patient has been diagnosed with Graves-Basedow disease and Graves' ophthalmopathy. Consecutively, treatment with Methimazole for Graves' disease and corticotherapy for Graves' ophthalmopathy were initiated. Due to the lack of response to Prednisone, other treatment methods were used, namely, Celecoxib 100 mg treatment, twice per day for 8 weeks. Under treatment with Celecoxib, GO was stabilized and remained stable even after discontinuation, respectively at six months and one year after discontinuation. Celecoxib can be an alternative treatment for mild and moderate ophthalmopathy in newly diagnosed Graves’ disease

The proinsulin-to-adiponectin ratio could be the best practical indicator of the early type 2 diabetes

In 1974, the "Ariadne's thread" (from Greek Mythology, pick one's way through the Labyrinth) of autoimmunity leading to the immunogenetic theory of type 1 diabetes mellitus made it possible to conclude that in this phenotype there exists an unsolved conflict between β-cells and the body's autoreactive immune system. In type 2 diabetes mellitus (T2DM), the "Ariadne's thread" links obesity to pancreatic β-cell biology. Unfortunately, beginning from a wrong interpretation of the relationship between plasma glucose and plasma insulin, the insulin resistance hypothesis was born and claimed as the main defect of T2DM. Overlooking obesity, the understanding of T2DM pathogenesis was delayed by almost half a century. Fortunately, the adipobiology, particularly adipocytes was able to reach the "drawing board" of researchers, and has all the chances these cells to become the "cell of the century", just as the pancreatic β-cell was last the cell of century. The association of diabetes and obesity has motivated us to put pancreatic β-cells and adipocytes head-to-head, that is, we moved from the T2DM-obesity couple to the β-cell-adipocyte couple, appreciating their main secretory products, insulin/proinsulin, C-peptide, amylin (for β-cells), and adiponectin, as well as other numerous adipokines (for adipocytes). We thus propose that the proinsulin-to-adiponectin ratio could become the earliest predictor of dysfunction of these two cell types.Adipobiology 2012; 4: 41-50

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie