Molecular Markers In The Diagnosis Of Thyroid Nodules.

An indeterminate thyroid nodule cytology result occurs about every sixth fine-needle aspiration. These indeterminate nodules harbor a 24% risk of malignancy (ROM); too high to ignore, but driving surgery where most nodules are benign. Molecular diagnostics have emerged to ideally avoid surgery when appropriate, and to trigger the correct therapeutic surgery when indicated, as opposed to an incomplete diagnostic surgery. No current molecular test offers both high sensitivity and high specificity. A molecular diagnostic test with high sensitivity (e.g. Afirma Gene Expression Classifier sensitivity 90%) offers a high Negative Predictive Value when the ROM is relatively low, such as < 30%. Only such tests can rule-out cancer. In this setting, a molecularly benign result suggests the same ROM as that of operated cytologically benign nodules (~6%). Thus, clinical observation can replace diagnostic surgery; increasing quality of life and decreasing medical costs. However, its low specificity cannot rule-in cancer as a suspicious result has a Positive Predictive Value (PPV) of ~40%, perhaps too low to routinely reflex to definitive cancer surgery. Conversely, high specificity tests (BRAF, RAS, PPAR/PAX-8, RET/PTC, PTEN) offer high PPV results, and only these tests can rule-in cancer. Here a positive molecular result warrants definitive therapeutic surgery. However, their low sensitivity cannot rule-out cancer and a negative molecular result cannot dissuade diagnostic surgery; limiting their cost-effectiveness. Whether or not there is a useful and cost-effective role to sequentially combine these approaches, or to modify existing approaches, is under investigation.5789-9

O paciente difícil: interação entre drogas e influência de doenças concomitantes no tratamento do hipotiroidismo

Although most hypothyroid patients do well with one single tablet of thyroxine daily, approximately 10% are dissatisfied and another important group of patients is difficult to control. We reviewed the most common causes for frequent-dose adjustment or high-dose requirement, including poor compliance with therapy and inadequate medication. Since these two causes have been ruled out, drug interaction and other concomitant diseases need to be investigated. Requirements of thyroxine increase in all conditions characterized by impaired gastric acid secretion. Proton-pump inhibitors, antacids and a long list of drugs may decrease thyroxine absorption. In addition, a series of diseases including celiac disease and chronic inflammatory intestinal diseases, as well as nutritional habits may be important in patient control. Finally, we mention the effects of a growing list of drugs and thyroid disruptors that may also affect thyroid hormone metabolism at many levels.Embora a maior parte dos pacientes com hipotiroidismo fique bem com um único comprimido diário de tiroxina, aproximadamente 10% não ficam satisfeitos e outro importante grupo de pacientes apresenta controle difícil. Foram revistas as causas mais comuns para necessidades frequentes de ajuste de dose ou uso de dose elevadas, incluindo falta de adesão à terapia e medicação inadequada. Descartando-se essas duas causas, é necessário investigar o uso de drogas e a presença de doenças concomitantes. Existe necessidade maior de tiroxina quando diminui a secreção ácida do estômago. Inibidores de bomba de prótons, antiácidos e uma longa lista de drogas podem dificultar a absorção da tiroxina. Várias doenças, incluindo a doença celíaca e as doenças intestinais inflamatórias crônicas, além dos hábitos alimentares, são importantes no controle do paciente hipotiroideo. Finalmente, foram mencionados os efeitos de uma lista crescente de drogas e disruptores que podem afetar o metabolismo tiroidiano em diferentes níveis.43544

Characteristics associated with US Walk to School programs

Participation in Walk to School (WTS) programs has grown substantially in the US since its inception; however, no attempt has been made to systematically describe program use or factors associated with implementation of environment/policy changes

[thyroid Cancer: Prognostic Factors And Treatment].

Because most differentiated thyroid carcinomas have an excellent prognosis, some authors have claimed that these patients are suffering from over treatment. Grouping patient- and tumor-specific factors have been proposed for prognostic stratification, but no clinicopathologic staging was demonstrated to be useful at the present time. More recently, molecular genetic tools have been used to identify and understand how the primary tumor progresses and many molecular markers have been proposed in order to distinguish the subset of patients at risk of developing metastasis. Here we analyzed some of them, with emphasis on the expression of NIS, a determinant of prognosis since the functional integrity of the iodine transport is essential to assure an uptake of radioiodine high enough to detect and destroy any tumoral thyroid tissue. More recent observations on how some relevant molecular genetics aspects of thyroid cancer impact new potential therapeutic approaches are also discussed.48126-3

Impact on the Population of the Triplet Excited State

Publisher Copyright: © 2022 American Chemical Society. All rights reserved.Two series of dinuclear gold(I) complexes that contain two Au-chromophore units (chromophore = dibenzofurane or dimethylfluorene) connected through a diphosphane bridge that differs in the flexibility and length (diphosphane = dppb for 1,4-bis(diphenylphosphino)butane, DPEphos for bis[(2-diphenylphosphino)phenyl]ether, xanthphos for 4,5-bis(diphenylphosphino)-9,9-dimethylxanthene, and BiPheP for 2,2′-bis(diphenylphosphino)-1,1′-biphenyl) have been synthesized and structurally characterized. Their photophysical properties have been carefully investigated, paying attention to the role of the presence, or absence, of aurophilic contacts and their nature (intra- or intermolecular character). This analysis was permitted due to the X-ray crystallographic determination of all of the structures of the compounds discussed herein. The quantum yields of the triplet population, φT, have been calculated by nanosecond-laser flash photolysis measurements, and we could determine the main role of the character of the aurophilic contacts in the resulting φT, being especially favored in the presence of intermolecular contacts. Time-dependent density functional theory (TD-DFT) calculations support the absorption and emission assignments and the shorter distance between S1and the closest triplet excited state energy in the case of the compounds with a higher triplet-state population.publishersversionpublishe

Intra- vs Intermolecular Aurophilic Contacts in Dinuclear Gold(I) Compounds: Impact on the Population of the Triplet Excited State

Two series of dinuclear gold(I) complexes that contain two Au–chromophore units (chromophore = dibenzofurane or dimethylfluorene) connected through a diphosphane bridge that differs in the flexibility and length (diphosphane = dppb for 1,4-bis(diphenylphosphino)butane, DPEphos for bis[(2-diphenylphosphino)phenyl]ether, xanthphos for 4,5-bis(diphenylphosphino)-9,9-dimethylxanthene, and BiPheP for 2,2′-bis(diphenylphosphino)-1,1′-biphenyl) have been synthesized and structurally characterized. Their photophysical properties have been carefully investigated, paying attention to the role of the presence, or absence, of aurophilic contacts and their nature (intra- or intermolecular character). This analysis was permitted due to the X-ray crystallographic determination of all of the structures of the compounds discussed herein. The quantum yields of the triplet population, ϕT, have been calculated by nanosecond-laser flash photolysis measurements, and we could determine the main role of the character of the aurophilic contacts in the resulting ϕT, being especially favored in the presence of intermolecular contacts. Time-dependent density functional theory (TD-DFT) calculations support the absorption and emission assignments and the shorter distance between S1 and the closest triplet excited state energy in the case of the compounds with a higher triplet-state population

Crow Deaths Caused by West Nile Virus during Winter

In New York, an epizootic of American crow (Corvus brachyrhynchos) deaths from West Nile virus (WNV) infection occurred during winter 2004–2005, a cold season when mosquitoes are not active. Detection of WNV in feces collected at the roost suggests lateral transmission through contact or fecal contamination

Estudo de adesão ao tratamento do hipotiroidismo

In order to assess the impact of adherence in the treatment of hypothyroidism, we examined 100 outpatients, 80 women and 20 men from HC-UNICAMP and HUCFF-UFRJ. All had a poor control (Mo TSH: 12U/L). After an initial medical exam and orientation, they randomly received either one of the 4 commercially available preparations of levothyroxine in the same dose previously prescribed, composing 4 groups of 25 patients each. Groups were similar regarding clinic, socioeconomic and cultural profiles, with a monthly income around US$100.00 per capita (X²: NS). During a 3 month follow-up they were examined by the same physician and requested to bring all remaining pills and empty packs. Pills were counted and TSH and fT4 were measured monthly. We found 82$ 100,00 (X²: NS). Mensalmente os doentes eram examinados por um mesmo médico. Realizávamos um controle do número de comprimidos restantes e embalagens vazias, dosagens de TSH e de T4 livre. Nossos resultados mostram que 82% dos pacientes não aderiam ao tratamento proposto, faltando aos retornos (36% dos casos) e/ou não seguindo corretamente a prescrição médica (66% dos casos). Os níveis de TSH foram controlados em 77 pacientes ao término do estudo, independente da formulação de tiroxina prescrita (X² de pacientes controlados/grupo: NS). Dezesseis pacientes apresentaram níveis de TSH diminuídos no 1o retorno, sugerindo que usavam doses inferiores às prescritas antes do medicamento ser-lhes fornecido. Concluímos que podemos controlar portadores de hipotiroidismo adequadamente com qualquer uma das apresentações disponíveis no mercado nacional quando o paciente adere ao esquema terapêutico proposto.48348

Subject preferences of fifth-grade children.

Thesis (Ed.M.)--Boston University N.B.:Pages 155 and 309 are missing from original thesis

Is Thyroid Stunning Clinically Relevant? A Retrospective Analysis Of 208 Patients.

Current guidelines have advised against the performance of (131)I-iodide diagnostic whole body scintigraphy (dxWBS) to minimize the occurrence of stunning, and to guarantee the efficiency of radioiodine therapy (RIT). The aim of the study was to evaluate the impact of stunning on the efficacy of RIT and disease outcome. This retrospective analysis included 208 patients with differentiated thyroid cancer managed according to a same protocol and followed up for 12-159 months (mean 30 ± 69 months). Patients received RIT in doses ranging from 3,700 to 11,100 MBq (100 mCi to 300 mCi). Post-RIT-whole body scintigraphy images were performed 10 days after RIT in all patients. In addition, images were also performed 24-48 hours after therapy in 22 patients. Outcome was classified as no evidence of disease (NED), stable disease (SD) and progressive disease (PD). Thyroid stunning occurred in 40 patients (19.2%), including 26 patients with NED and 14 patients with SD. A multivariate analysis showed no association between disease outcome and the occurrence of stunning (p = 0.3476). The efficacy of RIT and disease outcome do not seem to be related to thyroid stunning.58292-30