Utility of immunohistochemical markers in differentiating benign from malignant follicular-derived thyroid nodules

<p>Abstract</p> <p>Background</p> <p>Thyroid nodules are common among adults though only a small percentage is malignant, which can histologically mimic benign nodules. Accurate diagnosis of these thyroid nodules is critical for the proper clinical management.</p> <p>Methods</p> <p>We investigated immunoexpression in 98 surgically removed benign thyroid nodules including 52 hyperplastic nodules (HN) and 46 follicular/Hurthle cell adenomas (FA), and 54 malignant tumors including 22 follicular carcinoma (FC), 20 classic papillary carcinoma (PTC), and 12 follicular variant papillary carcinoma (FVPC).</p> <p>Results</p> <p>The staining results showed that malignant tumors express galectin-3, HBME-1, CK19 and Ret oncoprotein significantly more than benign nodules. The sensitivity of these markers for the distinction between benign and malignant lesions ranged from 83.3% to 87%. The sensitivity of two-marker panels was not significantly different. Immunoexpression was usually diffuse and strong in malignant tumors, and focal and weak in the benign lesions.</p> <p>Conclusion</p> <p>Our findings indicate that these immunomarkers are significantly more expressed in malignant tumors compared to benign lesions and may be of additional diagnostic value when combined with routine histology.</p

Do angiotensin converting enzyme inhibitors or angiotensin receptor blockers prevent diabetes mellitus? A meta-analysis

Background: The prevalence of diabetes mellitus (DM) has increased exponentially in recent years, with 100 million people expected to develop diabetes in the coming 15 years. The impact of medical therapy on the incidence of new onset DM is not clear. We performed a systematic review and meta-analysis to study the impact of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) on the incidence of new onset DM. Methods: MEDLINE, EMBASE, BIOSIS, Cochrane databases from inception until February 2009 for randomized controlled trials (RCT) that reported new incident DM with ACEI or ARB therapy. A total of 18 RCT are included in this meta-analysis. A random-effect model was used and between-studies heterogeneity was estimated with I2. Results: There were 50,451 patients randomized to ACEI or ARB and 50,397 patients randomized to other therapies. ACEI/ARB use was associated with a decrease in new onset DM (RR 0.78, 95% CI 0.70-0.88, p = 0.003 for ACEI and RR 0.8, 95% CI 0.75-0.86, p < 0.0001 for ARB). Treating 100 patients with ACEI or 50 patients with ARB prevents one case of new onset DM. Conclusions: The cumulative evidence suggests that the use of ACEI/ARB prevents diabetes mellitus. This finding may be of special clinical benefit in patients with hypertension and prediabetes or metabolic syndrome. (Cardiol J 2010; 17, 5: 448-456

Czy inhibitory konwertazy angiotensyny lub blokery receptora dla angiotensyny zapobiegają wystąpieniu cukrzycy? Metaanaliza

Wstęp: Zapadalność na cukrzycę w ciągu ostatnich lat gwałtownie wzrosła, przy czym szacuje się, że w ciągu kolejnych 15 lat choroba ta rozwinie się u 100 milionów osób. Wpływ leczenia na rozwój cukrzycy de novo nie jest jasny. Autorzy badania przeprowadzili systematyczny przegląd i metaanalizę w celu zbadania wpływu inhibitorów konwertazy angiotensyny (ACEI) i blokerów receptora dla angiotensyny (ARB) na wystąpienie cukrzycy de novo. Materiał i metody: Przeszukano bazy danych MEDLINE, EMBASE, BIOSIS, Cochrane od dnia ich powstania aż do lutego 2009 roku. Poszukiwano badań z randomizacją dotyczących świeżych zachorowań na cukrzycę w grupie pacjentów leczonych ACEI lub ARB. Do metaanalizy włączono 18 badań. Zastosowano model efektów losowych i różnice między badaniami oszacowano za pomocą I2. Wyniki: Losowo wybrano 50 451 pacjentów leczonych ACEI lub ARB i 50 397 osób poddanych terapii innymi preparatami. Stosowanie ACEI lub ARB wiązało się ze zmniejszeniem liczby nowych przypadków cukrzycy (RR 0,78, 95% CI 0,70-0,88, p = 0,003 dla ACEI i RR 0,8, 95% CI 0,75-0,86, p < 0,0001 dla ARB). Liczba osób, które należało leczyć, aby zapobiec jednemu nowemu przypadkowi cukrzycy, wyniosła 100 w przypadku ACEI i 50 w przypadku ARB. Wnioski: Zgromadzone dowody wskazują, że stosowanie ACEI/ARB zapobiega rozwojowi cukrzycy. Może to przynieść szczególne korzyści kliniczne pacjentom z nadciśnieniem tętniczym i stanem przedcukrzycowym lub zespołem metabolicznym. (Folia Cardiologica Excerpta 2010; 5, 5: 247-256

Rationale, design, and baseline characteristics in Evaluation of LIXisenatide in Acute Coronary Syndrome, a long-term cardiovascular end point trial of lixisenatide versus placebo

BACKGROUND: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Furthermore, patients with T2DM and acute coronary syndrome (ACS) have a particularly high risk of CV events. The glucagon-like peptide 1 receptor agonist, lixisenatide, improves glycemia, but its effects on CV events have not been thoroughly evaluated. METHODS: ELIXA (www.clinicaltrials.gov no. NCT01147250) is a randomized, double-blind, placebo-controlled, parallel-group, multicenter study of lixisenatide in patients with T2DM and a recent ACS event. The primary aim is to evaluate the effects of lixisenatide on CV morbidity and mortality in a population at high CV risk. The primary efficacy end point is a composite of time to CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. Data are systematically collected for safety outcomes, including hypoglycemia, pancreatitis, and malignancy. RESULTS: Enrollment began in July 2010 and ended in August 2013; 6,068 patients from 49 countries were randomized. Of these, 69% are men and 75% are white; at baseline, the mean ± SD age was 60.3 ± 9.7 years, body mass index was 30.2 ± 5.7 kg/m(2), and duration of T2DM was 9.3 ± 8.2 years. The qualifying ACS was a myocardial infarction in 83% and unstable angina in 17%. The study will continue until the positive adjudication of the protocol-specified number of primary CV events. CONCLUSION: ELIXA will be the first trial to report the safety and efficacy of a glucagon-like peptide 1 receptor agonist in people with T2DM and high CV event risk