Thyroxine treatment with softgel capsule formulation. Usefulness in hypothyroid patients without malabsorption

Background: Levothyroxine sodium (LT4) is the therapy of choice for hypothyroidism. In the last decade, new LT4 formulations, such as liquid and softgel capsules, became available. Even if some evidence has been reached in the efficacy of liquid LT4 in patients with suboptimal TSH on tablet LT4, the usefulness of softgel LT4 has been rarely studied. This study aimed at evaluating the effect of switching from tablet to softgel LT4 patients without increased need for LT4. TSH was used as proxy of LT4 bioavailability and effectiveness. Methods: During the period from April to August 2017, 19 patients on tablet LT4 treatment for hypothyroidism, mostly due to autoimmune thyroiditis, were enrolled. Subjects with causes of malabsorption or increased requirement of LT4 were previously excluded. Patients finally included were asked to switch from tablet to softgel LT4 formulation at unchanged dose and ingestion fashion (30 min before breakfast). TSH was measured with chemiluminescence immunoassays. results: According to exclusion and inclusion criteria, 19 patients were finally selected. One of these had headache 4 days later and come back to tablet LT4, and 18 of them (16W/2M; mean age = 55 years; BMI 22.7 kg/m2) completed the study. They were treated with a median LT4 dose of 88 μg/day and showed a median TSH value of 3.33 mIU/L. The rate of cases with TSH ≤ 4.0 mIU/L was 61.1% (11/18 cases). When patients were re-evaluated after 3 months of softgel LT4, we observed that TSH reached levels under 4.0 mIU/L in 16/18 (88.9%) patients, TSH was lower in 11 cases, and in 6 out of 7 patients with pre-switch TSH values over the normal range. Overall, TSH values on softgel LT4 (median 1.90 mIU/L) was significantly lower from that observed during tablet LT4 (p = 0.0039). conclusion: These data show that hypothyroid patients with no proven malabsorption may have an improved TSH following 3 months from the switch from tablet to softgel LT4 preparation at unchanged dose

Galectin-3 performance in histologic and cytologic assessment of thyroid nodules. A systematic review and meta-analysis

The literature on Galectin-3 (Gal-3) was systematically reviewed to achieve more robust information on its histologic reliability in identifying thyroid cancers and on the concordance between Gal-3 test in histologic and cytologic samples. A computer search of the PubMed and Scopus databases was conducted by combinations of the terms thyroid and Gal-3. Initially, 545 articles were found and, after their critical review, 52 original papers were finally included. They reported 8172 nodules with histologic evaluation of Gal-3, of which 358 with also preoperative FNAC Gal-3 assessment. At histology, Gal-3 sensitivity was 87% (95% confidence intervals [CI] from 86% to 88%), and specificity 87% (95% CI from 86% to 88%); in both cases, we found heterogeneity (I285% and 93%, respectively) and significant publication bias (p < 0.001). The pooled rate of positive Gal-3 at fine needle aspiration (FNAC) among cancers with histologically proven Gal-3 positivity was 94% (95% CI from 89% to 97%), with neither heterogeneity (I214.5%) nor bias (p = 0.086). These data show high reliability of Gal-3 for thyroid cancer at histology, while its sensitivity on FNAC samples is lower. The limits of cytologic preparations and interpretation of Gal-3 results have to be solved

An Altered Derivatives Marketplace: Clearing Swaps Under Dodd-Frank

Though over a year has passed, the impact of the Dodd Frank Act remains unclear. This Note examines the provisions of the Act that relate to swap transactions within the context of pre-reform and postreform markets. In order to reduce the uncertainties inherent in unregulated swap transactions, the Act employs a comprehensive framework, which includes mandatory clearing through derivative clearing organizations, extensive reporting requirements, margin requirements, and position limits. This Note argues that, in doing so, the Dodd Frank Act addresses the fundamental failures of pre-reform derivative markets. However, the importance of the role for derivative clearing organizations under this framework creates a risk that these organizations will become systemically significant, mirroring problems with under-capitalized and over-exposed financial institutions in the downturn

Low-Cost and Green Fabrication of Polymer Electronic Devices by Push-Coating of the Polymer Active Layers

Because of both its easy processability and compatibility with roll-to-roll processes, polymer electronics is considered to be the most promising technology for the future generation of low-cost electronic devices such as light-emitting diodes and solar cells. However, the state-of-the-art deposition technique for polymer electronics (spin-coating) generates a high volume of chlorinated solution wastes during the active layer fabrication. Here, we demonstrate that devices with similar or higher performances can be manufactured using the push-coating technique in which a poly(dimethylsiloxane) (PDMS) layer is simply laid over a very small amount of solution (less than 1μL/covered cm2), which is then left for drying. Using mm thick PDMS provides a means to control the solvent diffusion kinetics (sorption/retention) and removes the necessity for additional applied pressure to generate the desired active layer thickness. Unlike spin-coating, push-coating is a slow drying process that induces a higher degree of crystallinity in the polymer thin film without the necessity for a post-annealing step. The polymer light-emitting diodes and solar cells prepared by push-coating exhibit slightly higher performances with respect to the reference spin-coated devices, whereas at the same time reduce the amounts of active layer materials and chlorinated solvents by 50 and 20 times, respectively. These increased performances can be correlated to the higher polymer crystallinities obtained without applying a post-annealing treatment. As push-coating is a roll-to-roll compatible method, the results presented here open the path to low-cost and eco-friendly fabrication of a wide range of emerging devices based on conjugated polymer materials

Lymph Node Thyroglobulin Measurement in Diagnosis of Neck Metastases of Differentiated Thyroid Carcinoma

Aim. Enlarged cervical lymph nodes (LNs) in patients with thyroid cancer are usually assessed by fine-needle aspiration cytology (FNAC). Thyroglobulin (Tg) is frequently elevated in malignant FNAC needle wash specimens (FNAC-Tg). The objectives of the study were to (1) determine an appropriate diagnostic cut-off for FNAC-Tg levels (2) compare FNAC and FNAC-Tg results in a group of 108 patients affected by differentiated thyroid carcinoma (DTC). Methods. A total of 126 consecutive FNACs were performed on enlarged LNs and the final diagnosis was confirmed by surgical pathology examination or clinical follow-up. The best FNAC-Tg cut-off level was selected by receiver operating curve analysis, and diagnostic performances of FNAC and FNAC-Tg were compared. Results. The rate of FNAC samples adequate for cytological examination was 77% in contrast FNAC-Tg available in 100% of aspirates (<.01). The sensitivity, specificity, and accuracy of FNAC were 71%, 80%, 74%, 100%, 80%, and 94%, respectively. The most appropriate cut-off value for the diagnosis of thyroid cancer metastatic LN was 1.1 ng/mL (sensitivity 100%, specificity 100%). Conclusions. The diagnostic performance of needle washout FNAC-Tg measurement with a cut-off of 1.1 ng/mL compared favorably with cytology in detecting DTC node metastases

Governança regional: estratégias e disputas para gestão em saúde

OBJECTIVE To analyze the regional governance of the health systemin relation to management strategies and disputes. METHODOLOGICAL PROCEDURES A qualitative study with health managers from 19 municipalities in the health region of Bahia, Northeastern Brazil. Data were drawn from 17 semi-structured interviews of state, regional, and municipal health policymakers and managers; a focus group; observations of the regional interagency committee; and documents in 2012. The political-institutional and the organizational components were analyzed in the light of dialectical hermeneutics. RESULTS The regional interagency committee is the chief regional governance strategy/component and functions as a strategic tool for strengthening governance. It brings together a diversity of members responsible for decision making in the healthcare territories, who need to negotiate the allocation of funding and the distribution of facilities for common use in the region. The high turnover of health secretaries, their lack of autonomy from the local executive decisions, inadequate technical training to exercise their function, and the influence of party politics on decision making stand as obstacles to the regional interagency committee’s permeability to social demands. Funding is insufficient to enable the fulfillment of the officially integrated agreed-upon program or to boost public supply by the system, requiring that public managers procure services from the private market at values higher than the national health service price schedule (Brazilian Unified Health System Table). The study determined that “facilitators” under contract to health departments accelerated access to specialized (diagnostic, therapeutic and/or surgical) services in other municipalities by direct payment to physicians for procedure costs already covered by the Brazilian Unified Health System. CONCLUSIONS The characteristics identified a regionalized system with a conflictive pattern of governance and intermediate institutionalism. The regional interagency committee’s managerial routine needs to incorporate more democratic devices for connecting with educational institutions, devices that are more permeable to social demands relating to regional policy making.OBJETIVO Analisar o sistema de governança regional em saúde quanto a estratégias e disputas de gestão. PROCEDIMENTOS METODOLÓGICOS Pesquisa qualitativa com gestores de saúde de 19 municípios que integram a região de saúde no estado da Bahia. Foram realizadas 17 entrevistas semiestruturadas com gestores/gerentes (estadual, regional e municipal), grupo focal, observações na Comissão Intergestores Regional e documentos institucionais, em 2012. Foram analisados os componentes político-institucional e organizacional e interpretados pela hermenêutica-dialética. RESULTADOS A comissão intergestores regional foi a principal estratégia da governança regional, sendo ferramenta fundamental para fortalecimento da governança por reunir diferentes sujeitos responsáveis pela tomada de decisão nos territórios sanitários e pela negociação da alocação de recursos e distribuição dos estabelecimentos de uso comum na região. A rotatividade de secretários de saúde, baixa autonomia nas decisões executivas, a qualificação técnica insuficiente para exercício da função e o atravessamento das políticas partidárias na tomada de decisão são fatores que obstruem a comissão intergestores regional às demandas sociais. Recursos financeiros insuficientes não viabilizam o cumprimento da programação pactuada integrada nem o aumento da oferta pública na rede e impunham ao gestor a compra de serviços no mercado privado por valores acima da Tabela do Sistema Único de Saúde. Foram relatados atravessadores contratados para agilizar o acesso aos serviços especializados (diagnóstico, terapêutico e/ou cirúrgico) em outros municípios mediante pagamento direto a médicos por procedimentos já custeados pelo Sistema Único de Saúde. CONCLUSÕES A rede regionalizada de saúde apresenta padrão de governança conflitante e com institucionalidade intermediária. A comissão intergestores regional necessita incorporar, à rotina de gestão, dispositivos mais democráticos que logrem articulação com instituições de ensino, permeáveis às demandas sociais, para definição das políticas regionais

CEA, CYFRA 21-1, NSE, and ProGRP in the diagnosis of lung cancer: a multivariate approach

We retrospectively studied the single and combined diagnostic value of carcinoembryonic antigen (CEA), cytokeratin fragment 19 (CYFRA 21-1), neuron specific enolase (NSE) and pro-gastrin-releasing peptide (ProGRP), which were routinely analysed in patients with lung tumours of unknown origin at the time of admission to hospital. Inclusion criteria were the determination of CEA (AxSYM/Abbott), CYFRA 21-1 (ElecSys/Roche) and NSE (Kryptor/Brahms). We examined 1747 patients, where 1325 suffered from lung cancer (LC; small cell lung cancer, SCLC: n=194; non-small cell lung cancer, NSCLC: n = 1015; others: n = 116), 318 from benign lung diseases and 104 from lung metastases due to another primary malignancy. As ProGRP (ELISA ALSI/IBL) became available only recently, there are less data points of this marker. In total, 99.8% of LC patients released at least one of the four biomarkers (defined as values exceeding the median of healthy controls), and for the discrimination between benign disease (BID) and malignant lung disease each marker reached 100% tumour specificity at high levels (CEA: 20 ng/mL; CYFRA 21-1: 40 ng/mL; NSE: 45 ng/mL; ProGRP: 250 pg/mL). At a specificity of &gt; 99%, ProGRP reached the highest diagnostic efficacy for SCLC with 57% true positive results, CEA had the highest capacity (17%) to detect malignant lung tumours in general and adenocarcinomas of the lung with 29%. CYFRA 21-1 was dominant for squamous cell carcinomas (12%). Combining the four markers leads with the prerequisite of high specificity (&gt; 99%) to 50% true positives for malignant lung tumours, 44% for NSCLC, 36% for squamous cell carcinomas, 53% for adenocarcinomas, and 78% for SCLC, respectively. In cases of lung tumours of unknown origin, the combined use of CEA, CYFRA 21-1, NSE and ProGRP is useful for the differentiation between benign and primary or secondary malignant disease and suggests the assignment to histological subtypes

Reutilização do lodo remanescente do processo de beneficiamento de gemas na fabricação de pisos intertravados de concreto

A indústria beneficiadora de gemas gera, ao final de sua cadeia produtiva, uma significativa quantidade de resíduo denominado lodo de gemas, proveniente das etapas de corte, torneamento e lixamento dos geodos. Devido ao alto custo e pelo fato do processo ser realizado na sua maior parte por empresas de pequeno e médio porte, geralmente com tecnologia defasada, o lodo remanescente é constantemente acumulado no pátio das empresas. A falta de gerenciamento adequado para este rejeito fomenta a ideia de reutilização por parte do empreendedor moderno, visando assim, aumentar o valor agregado do resíduo e contribuir com a diminuição da exploração de recursos naturais como os rios e as pedreiras. A fim de desenvolver um produto não convencional como uma solução alternativa para o setor da construção civil, este trabalho tem como objetivo principal reutilizar o lodo de gemas na formulação de pisos intertravados de concreto. Inicialmente, o lodo de gemas foi submetido ao ensaio de lixiviação para que se determinasse a concentração de óleos e graxas e a sua classificação como resíduo. As composições química e mineralógica foram determinadas pelas técnicas de Fluorescência de Raios X e Difração de Raios X, respectivamente. A análise granulométrica do lodo e dos agregados (pedrisco e areia) foi feita a fim de formular as dosagens experimentais para a fabricação dos pavers, utilizando o resíduo como mineral adicionado ao traço. Foram produzidas peças substituindo a areia fina pelo lodo de gemas em quantidades de 0%, 2%, 4%, 6%, 8%, e 12% calculadas sobre a porcentagem de areia fina. A verificação das dimensões, a determinação da resistência à compressão e a absorção de água foram realizadas nos corpos de prova com a finalidade de comprovar a qualidade final do produto produzido. Os resultados encontrados para o ensaio de lixiviação apresentaram uma concentração de chumbo presente no resíduo de 28 mg.L-1. As análises de composição do resíduo identificaram sílica como material majoritário numa proporção de 97,45%. As dosagens que apresentaram os melhores resultados para resistência à compressão e absorção de água foram as que se substituíram a areia fina por 2% e 4% de lodo de gemas. O melhor resultado médio para a resistência à compressão foi de 44,02 MPa, obtido na dosagem AF8/LG4, e para a absorção de água o melhor resultado médio foi de 3,01 %, encontrado na dosagem AF10/LG2.The gem processing industry generates, at the end of its productive chain, a significant quantity of waste called gem sludge, which comes from the steps of cutting, turning and sanding the geodes. Due to the high cost and the fact that the process is carried out mostly by small and medium sized companies, usually with lagged technology, the remaining sludge is constantly accumulated in the companies' yard. The lack of adequate management for this waste encourages the idea of reuse by the modern entrepreneur, in order to increase the value added of the waste and contribute to the reduction of the exploitation of natural resources such as rivers and quarries. In order to develop an unconventional product as an alternative solution for the construction industry, this work has as main objective to reuse the sludge of gemstones in the formulation of interlocking concrete floors. Initially, the sludge was subjected to the leaching test to determine the concentration of oils and greases and their classification as residue. The chemical and mineralogical compositions were determined by X-Ray Fluorescence and X-Ray Diffraction techniques, respectively. The granulometric analysis of the sludge and the aggregates (hail and sand) was done in order to formulate the experimental dosages for the manufacture of the pavers, using the residue as mineral added to the trace. Pieces were produced replacing the fine sand by the sludge of gems in amounts of 0%, 2%, 4%, 6%, 8% and 12% calculated on the percentage of fine sand. The verification of the dimensions, the determination of the compressive strength and the water absorption were carried out in the specimens in order to prove the final quality of the product produced. The results found for the leaching test presented a lead concentration in the residue of 28 mg.L-1. Analyzes of the composition of the residue identified silica as the major material in a ratio of 97,45%. The dosages that presented the best results for resistance to compression and water absorption were those that were substituted for fine sand by 2% and 4% of sludge. The best average result for the compressive strength was 44,02 MPa, obtained at the TS8/GS4 dosage, and for the water absorption the best average result was 3,01%, found at the TS10/GS2 dosage.CAPE

Cytological Diagnoses Associated with Noninvasive Follicular Thyroid Neoplasms with Papillary-Like Nuclear Features According to the Bethesda System for Reporting Thyroid Cytopathology: A Systematic Review and Meta-Analysis.

The recent introduction of noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) in the World Health Organization classification of thyroid tumors has significantly modified the risk of malignancy of cytological diagnoses. In fact, while this tumor was previously classified as a carcinoma (the encapsulated, noninvasive form follicular variant of papillary thyroid carcinoma), it is now considered a neoplasm with low malignant potential. Given that the cytological features of NIFTP are not specific and overlap with other pathologic entities, there is no specific cytological diagnostic category for NIFTP. To obtain more robust information about the cytological findings associated with NIFTP, published articles were systematically reviewed, and a meta-analysis of the data was conducted. The review was conducted according to PRISMA guidelines. A comprehensive literature search of the PubMed/MEDLINE and Scopus databases was conducted using a combination of terms "noninvasive," "encapsulated," "follicular variant," "NIFTP," and "thyroid cancer." The search was updated to June 2018, and references of the retrieved articles were also screened. Only original articles reporting the classification of histologically proven NIFTPs with cytological findings according to The Bethesda System for Reporting Thyroid Cytopathology were eligible for inclusion. The literature search revealed 117 articles, of which 15 were included in the study. All studies were retrospective. A total of 915 NIFTP cases were retrieved. The incidence of cases cytologically classified according to the Bethesda system was as follows: non-diagnostic 3%, benign 10%, atypia of undetermined significance or follicular lesion of undetermined significance 30%, follicular neoplasm or suspicious for a follicular neoplasm 21%, suspicious for malignancy 24%, and malignant 8%. Mild heterogeneity between the studies was found. Publication bias was absent. This meta-analysis shows that the cytological diagnoses associated with NIFTP by fine-needle aspiration cytology includes a wide spectrum of findings. The majority of cases are cytologically indeterminate, and the remainder may be read as non-diagnostic, benign, or malignant. In order to develop an accurate presurgical diagnosis of these cases, further cytological and/or molecular characteristics need to be identified