Thyroid nodule recurrence following lobo-isthmectomy: incidence, patient's characteristics, and risk factors

PURPOSE

This study was aimed at assessing the incidence and timing of thyroid nodules recurrence, defined as appearance of new benign or malignant nodules in contralateral lobe in patients with benign thyroid nodules or thyroid microcarcinoma treated with lobo-isthmectomy. Patient's characteristics and risk factors associated with this phenomenon were also investigated.

METHODS

A retrospective study was performed by evaluating 413 patients undergoing lobo-isthmectomy with a minimum follow-up of 1 year. Clinical characteristics, surgical interventions and complications, histological diagnosis, and thyroid function at last follow-up were collected.

RESULTS

Single or multiple thyroid nodule recurrence equally occurred in 80 patients (23%) with a median time to relapse of ~ 5 years (range 0.3-34.5 years) after lobo-isthmectomy. Recurrence was significantly associated with younger age (< 46 years) and number of pregnancies in women. Development of hypothyroidism was not rare either (~ 10%) and appeared in 3-19 months; a preoperative TSH level > 2.43 mIU/L was associated with the need of l-thyroxin replacement therapy after surgery. The most frequent surgical complication was transient hypoparathyroidism (4.6%), while the rate of permanent hypoparathyroidism significantly increased in patients submitted to completion thyroidectomy (5.3%).

CONCLUSIONS

Thyroid nodules recurrence following lobo-isthmectomy is not a rare event and occurs within 5 years after surgery, more frequently in younger patients with family history of nodular goiter and in women with multiple pregnancies. Pre-surgical TSH levels may predict the development of post-surgical hypothyroidism, possibly improving the management of patients addressed to surgery.

Thyroid ultrasonography reporting: consensus of Italian Thyroid Association (AIT), Italian Society of Endocrinology (SIE), Italian Society of Ultrasonography in Medicine and Biology (SIUMB) and Ultrasound Chapter of Italian Society of Medical Radiology (SIRM)

Thyroid ultrasonography (US) is the gold standard for thyroid imaging and its widespread use is due to an optimal spatial resolution for superficial anatomic structures, a low cost and the lack of health risks. Thyroid US is a pivotal tool for the diagnosis and follow-up of autoimmune thyroid diseases, for assessing nodule size and echostructure and defining the risk of malignancy in thyroid nodules. The main limitation of US is the poor reproducibility, due to the variable experience of the operators and the different performance and settings of the equipments. Aim of this consensus statement is to standardize the report of thyroid US through the definition of common minimum requirements and a correct terminology. US patterns of autoimmune thyroid diseases are defined. US signs of malignancy in thyroid nodules are classified and scored in each nodule. We also propose a simplified nodule risk stratification, based on the predictive value of each US sign, classified and scored according to the strength of association with malignancy, but also to the estimated reproducibility among different operators.

Italian consensus on diagnosis and treatment of differentiated thyroid cancer: joint statements of six Italian societies

BACKGROUND

Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent.

METHODS

Six scientific Italian societies entitled to cure thyroid cancer patients (the Italian Thyroid Association, the Medical Endocrinology Association, the Italian Society of Endocrinology, the Italian Association of Nuclear Medicine and Molecular Imaging, the Italian Society of Unified Endocrine Surgery and the Italian Society of Anatomic Pathology and Diagnostic Cytology) felt the need to develop a consensus report based on significant scientific advances occurred in the field.

OBJECTIVE

The document includes recommendations regarding initial evaluation of thyroid nodules, clinical and ultrasound criteria for fine-needle aspiration biopsy, initial management of thyroid cancer including staging and risk assessment, surgical management, radioiodine remnant ablation, and levothyroxine therapy, short-term and long-term follow-up strategies, and management of recurrent and metastatic disease. The objective of this consensus is to inform clinicians, patients, researchers, and health policy makers about the best strategies (and their limitations) relating to the diagnosis and treatment of differentiated thyroid cancer.

LC-HRMS for Characterizing Durum Wheat Pasta Production Variability and Consumer Overall Liking

Semolina pasta represents one of the most important dishes in Italian cuisine worldwide. Italy is the leader in its production and, recently, the worldwide diffusion of its production has begun to grow tremendously. The perceived quality of a food product, such as pasta, is a key feature that allows a company to increase and maintain the competitive advantage of a specific brand. The overall flavor perception of the consumer, therefore, has become as important as other key quality factors such as texture and color; thus, the food industry needs to meet consumer expectations and needs the tools to objectively "measure" the quality of food products. Untargeted fingerprinting by means of coupling LC with high-resolution MS (HRMS) has been well received within the analytical community, and different studies exploiting this approach for the characterization of high-value food products have recently been reported in the literature. In the present work, a tentative application of the sensomics approach to cluster analysis of semolina pasta obtained using different production conditions was developed to objectively define target molecules that correlate with consumer overall liking of an industrial standard product. Principal component analysis of chemical and physical testing, GC-MS, LC-HRMS, and sensory data were performed with the aim of identifying the main parameters to discern similarities and differences among samples and clustering them according to these features. The correlation between analytical data and compounds related to sensory data was further investigated, and lastly, a partial least-squares regression model for the prediction of consumer overall liking was reported.

Real-life management and outcome of thyroid carcinoma-related bone metastases: results from a nationwide multicenter experience

PURPOSE AND PATIENTS

The M.O.S.CA.TI. (Metastases of the Skeleton from CArcinoma of the ThyroId) is a multicenter, retrospective study investigating the real-life outcome and management of bone metastases (BM) in 143 patients (63 M, 80 F; median age 64 years, range 11-87) with differentiated thyroid carcinoma (DTC).

RESULTS

Radio-active iodine (RAI) treatment was performed in 131 patients (91.6%), surgical approach and/or external radiotherapy in 68 patients (47.6%), and anti-resorptive bone-active drugs in 32 patients (22.4%; in 31 zoledronate and in one denosumab). At the start of treatment, 24 patients (75.0%) receiving anti-resorptive bone-active drugs had at least one clinical skeletal-related event (SRE) (p < 0.001). One or more clinical SREs (pathological fractures and/or malignant hypercalcemia and/or spinal cord compression) developed in 53 patients (37.1%). Development of SREs was significantly associated with metachronous BM (hazard ratio (HR) 2.04; p = 0.04), localization of BM to cervical spine (HR 3.89; p = 0.01), and lack of avid RAI uptake (HR 2.66; p = 0.02). Thirty-nine patients (27.3%) died in correlation with development of SREs (HR 6.97; p = 0.006) and localization of BM to the hip (HR 3.86; p = 0.02). Moreover, overall mortality was significantly decreased by RAI therapy (HR 0.10; p = 0.02), whereas no significant effects were induced by bone-active drugs (p = 0.36), external radiotherapy (p = 0.54), and surgery (p = 0.43) of BM.

CONCLUSIONS

SREs are very frequent in BM from DTC and they impact patient survival. In the real life, the use of bone-active drugs is currently limited to zoledronate in patients with pre-existing SREs. In this clinical setting, RAI therapy, but not zoledronate, decreased mortality.

Clinical-grade quality platelet-rich plasma releasate (PRP-R/SRGF) from CaCl2 -activated platelet concentrates promoted expansion of mesenchymal stromal cells

BACKGROUND AND OBJECTIVES

The aim of our study was to test a platelet-rich plasma releasate (PRP-R/SRGF) from CaCl2 -activated platelets as a source of growth factors for the expansion of mesenchymal stromal cells (MSCs). PRP-R/SRGF, obtained with a low-cost procedure, is characterized by a reduced variability of growth factor release.

MATERIALS AND METHODS

PRP-R/SRGF is a clinical-grade quality solution obtained from CaCl2 -activated platelets. Its activity was evaluated by measuring the proliferation, the phenotype, the differentiation potential and the immunosuppressive properties of MSCs derived from bone marrow (BM) and adipose tissue (AT).

RESULTS

PRP-R/SRGF was more active than FBS to expand BM- and AT-derived MSCs. PRP-R/SRGF treatment did not affect the expression of typical MSCs surface markers, neither MSCs differentiation potential nor their capability to inhibit activated T-cell proliferation.

CONCLUSIONS

The clinical-grade PRP-R/SRGF may be used in the clinical setting for the expansion of MSCs.

Recommendations for post-surgical thyroid ablation in differentiated thyroid cancer: a 2015 position statement of the Italian Society of Endocrinology

Post-surgical ablation of thyroid remnant with radioactive iodine (RAI) in differentiated thyroid cancer (DTC) is aimed to destroy any thyroid remnant in the thyroid bed (remnant ablation) and any microscopic foci of cancer cells eventually present within the thyroid remnant (adjuvant therapy). The present text is an attempt to offer practice guidelines for the indication of thyroid ablation and the preparation of DTC patients considering the latest achievement in the field and the changing epidemiology of DTC observed in the last 10 years.

METHODOLOGY

The executive committee of the Italian Society of Endocrinology appointed a task force of thyroid cancer expert including Nuclear Medicine Physicians and Endocrinologists to provide a consensus on the post-surgical ablation in thyroid cancer patients. The task force had no conflict of interest and had no commercial support. A number of specific topics were selected and the members selected relevant papers by searching in the Pubmed for articles published from 2000 to January 2015. Selected studies were categorized by level of evidence, and the recommendations were graded according to the level of evidence as high (A), moderate (B), or low (C).

Reduced expression of THRβ in papillary thyroid carcinomas: relationship with BRAF mutation, aggressiveness and miR expression

PURPOSE

Down-regulation of thyroid hormone receptor beta (THRβ) gene has been described in several human malignancies, including thyroid cancer. In this study, we analyzed THRβ mRNA expression in surgical specimens from a series of human papillary thyroid carcinomas (PTCs), characterized by their genotypic and clinical-biological features.

METHODS

Thirty-six PTCs were divided into two groups according to the 2009 American Thyroid Association risk classification (17 low, 19 intermediate), and each group was divided into subgroups based on the presence or absence of the BRAFV600E mutation (21 BRAF mutated, 15 BRAF wild type). Gene expression was analyzed using fluidic cards containing probes and primers specific for the THRβ gene, as well as for genes of thyroperoxidase (TPO), sodium/iodide symporter (NIS), thyroglobulin (Tg) and thyroid stimulating hormone receptor (TSH-R) and for some miRNAs involved in thyroid neoplasia and targeting THRβ. The mRNA levels of each tumor tissue were compared with their correspondent normal counterpart.

RESULTS

THRβ transcript was down-regulated in all PTCs examined. No significant differences were found between intermediate- vs low-risk PTCs patients, and BRAF-mutated vs BRAF wild-type groups. THRβ expression was directly correlated with NIS, TPO, Tg and TSH-R, and inversely correlated to miR-21, -146a, -181a and -221 expression.

CONCLUSIONS

Our results demonstrate that down-regulation of THRβ is a common feature of PTCs. While it is not associated with a more aggressive phenotype of PTC, it correlates with the reduction of all the markers of differentiation and is associated with overexpression of some miRNAs supposed to play a role in thyroid tumorigenesis.

Tracing mercury pathways in Augusta Bay (southern Italy) by total concentration and isotope determination

The mercury (Hg) pollution of sediments is the main carrier of Hg for the biota and, subsequently, for the local fish consumers in Augusta Bay area (SE Sicily, Italy), a coastal marine system affected by relevant sewage from an important chlor-alkali factory. This relationship was revealed by the determination of Mass Dependent (MDF) and Mass Independent Fractionation (MIF) of Hg isotopes in sediment, fish and human hair samples. Sediments showed MDF but no MIF, while fish showed MIF, possibly due to photochemical reduction in the water column and depending on the feeding habitat of the species. Benthic and demersal fish exhibited MDF similar to that of sediments in which anthropogenic Hg was deposited, while pelagic organisms evidenced higher MDF and MIF due to photoreduction. Human hair showed high values of δ(202)Hg (offset of +2.2‰ with respect to the consumed fish) and Δ(199)Hg, both associated to fish consumption.

Growth factor release from platelet concentrates: analytic quantification and characterization for clinical applications

BACKGROUND AND OBJECTIVES

Clinical use of plasma rich in growth factors requires biochemical product control. We aimed to measure and modulate concentrations of growth factors in solutions deriving from platelet apheresis or whole blood.

MATERIALS AND METHODS

Growth factor concentrations were measured 5', 10', 20', 30', 60' after CaCl2 was added at 40°C to platelet-apheresis products (n = 39) or after 60' in platelet concentrates from whole blood (n = 13). Growth factor release was also obtained in platelet apheresis a) by incubation at 22°C or 40°C for 10' or 30' (n = 4); b) by repeated freeze-thaw (n = 9).

RESULTS

Fibroblast growth factor (FGF), platelet-derived growth factor (PDGF) isoforms AA and AB and transforming growth factor beta (TGF-β) concentrations (pg/10(9 ) plt) were 25-60% higher in growth factors solutions from whole blood compared to platelet apheresis. Vascular endothelial growth factor (VEGF), TGF-β and PDGF isoforms were released early (5-10') during incubation: TGF-β concentration increased also at 30'. FGF and epidermal growth factor (EGF) were released only after 30'. Incubation at 40°C/10' increased VEGF (+70%) and decreased EGF (-30%) and PDGF-BB (-50%) versus 22°C/30'. Shock significantly increased TGF-β (1.6-fold), EGF (1.5-fold), FGF (4.5-fold) and lowered PDGF isoforms (0.2- to 0.5-fold) versus prolonged incubation at 40°C.

CONCLUSION

Platelets from platelet apheresis and whole-blood release all investigated growth factors. The release can be regulated controlling incubation time and/or temperature and performing cell lysis.

Application of one- and two-dimensional NMR spectroscopy for the characterization of Protected Designation of Origin Lambrusco wines of Modena

Lambrusco is a Protected Designation of Origin (PDO) red wine of Modena (Italy) produced according to the production regulation (Decreto Ministeriale (DM) July 27, 2009; GU no. 184-187-188, 13/08/2009). Here the use of (1)H NMR spectroscopy as molecular fingerprints of several PDO Lambrusco wines was proposed to serve as indicators of authenticity and quality control. Application of partial least squares discriminant analysis (PLS-DA) revealed a good varietal discrimination by analyzing the low-frequency spectral region. This model explains 68.8% of the variance for the Y vector (classification factor: varietal source). In particular, the signals of 2,3-butanediol, lactic, succinic and malic acids, and threonine were found to be the most statistically significant variables in the model. These findings seem to be very promising in the attempt to extend the study to geographical discrimination.

Growth and optical properties of silver nanostructures obtained on connected anodic aluminum oxide templates

Ag nanostructures are grown by AC electrodeposition on anodic alumina oxide (AAO) connected membranes acting as templates. Depending on the thickness of the template and on the voltage applied during the growth process, different Ag nanostructures with different optical properties are obtained. When AAO membranes about 1 μm thick are used, the Ag nanostructures consist in Ag nanorods, at the bottom of the pores, and Ag nanotubes departing from the nanorods and filling the pores almost for the whole length. When AAO membranes about 3 μm thick are used, the nanostructures are Ag spheroids, at the bottom of the pores, and Ag nanowires that do not reach the upper part of the alumina pores. The samples are characterized by angle resolved x-ray photoelectron spectroscopy, scanning electron microscopy and UV-vis and Raman spectroscopies. A simple NaOH etching procedure, followed by sonication in ethanol, allows one to obtain an exposed ordered array of Ag nanorods, suitable for surface-enhanced Raman spectroscopy, while in the other case (3 μm thick AAO membranes) the sample can be used in localized surface plasmon resonance sensing.

Use of X-ray diffraction technique and chemometrics to aid soil sampling strategies in traceability studies

Aim of this work is to assess the potentialities of the X-ray powder diffraction technique as fingerprinting technique, i.e. as a preliminary tool to assess soil samples variability, in terms of geochemical features, in the context of food geographical traceability. A correct approach to sampling procedure is always a critical issue in scientific investigation. In particular, in food geographical traceability studies, where the cause-effect relations between the soil of origin and the final foodstuff is sought, a representative sampling of the territory under investigation is certainly an imperative. This research concerns a pilot study to investigate the field homogeneity with respect to both field extension and sampling depth, taking also into account the seasonal variability. Four Lambrusco production sites of the Modena district were considered. The X-Ray diffraction spectra, collected on the powder of each soil sample, were treated as fingerprint profiles to be deciphered by multivariate and multi-way data analysis, namely PCA and PARAFAC. The differentiation pattern observed in soil samples, as obtained by this fast and non-destructive analytical approach, well matches with the results obtained by characterization with other costly analytical techniques, such as ICP/MS, GFAAS, FAAS, etc. Thus, the proposed approach furnishes a rational basis to reduce the number of soil samples to be collected for further analytical characterization, i.e. metals content, isotopic ratio of radiogenic element, etc., while maintaining an exhaustive description of the investigated production areas.

Evaluation of the behaviour of fluorine-containing bioactive glasses: reactivity in a simulated body fluid solution assisted by multivariate data analysis

Potentially bioactive fluorine-containing glasses of formula 46.2SiO(2)·24.3Na(2)O·(26.9-x)CaO·2.6P(2)O(5)·xCaF(2) [x = (0), 5, 10, 15] have been studied: the study was carried out as a function of fluorine percentage, dimensions and time of soaking in SBF. The results are compared to those obtained in the same conditions for Bioglass(®) 45S5. Due to the high number and different kind of variables/conditions explored by this set of data, the results are rationalized for the first time by means of multivariate data analysis (MDA); in this way it is possible to classify the behaviour of bioglasses toward bioactivity. The presence of fluorine does not inhibit the formation of HA; in particular, for a fast bioactivity (in term of HA crystallization) it will be better to have large particle size or slabs, while for a fast dissolution fine particle sizes should be preferred.

Optimization of a Dynamic Headspace-Thermal Desorption-Gas Chromatography/Mass Spectrometry procedure for the determination of furfurals in vinegars

The use of a Dynamic Headspace System (DHS) device combined with a Thermal Desorption Unit (TDU) interfaced to a Gas Chromatography/Mass Spectrometry (GC/MS) system is proposed for the determination of furfurals in oenological products. An experimental design protocol has been employed for the optimization of the instrumental settings concerning DHS and TDU extraction and desorption steps. It has been possible to individuate the following optimized conditions: incubation temperature 40°C, purge volume 800 mL, dry volume 1500 mL, TDU hold time 5 min and incubation time 10 min. The performance of two different SPE sorbents, namely Tenax TA and Tenax GR used for the furfurals trapping, was investigated too. The developed DHS sampling procedure showed good reproducibility values with a RSD% lower than 10% for all the monitored species. The optimized experimental settings have been used to determine furfurals in several vinegar samples obtained by traditional procedure starting from cooked grape musts, i.e. in Aceto Balsamico Tradizionale di Modena (ABTM). In fact, the control of these species is extremely important for quality and safety issues.