Role of Bronchial Artery Embolization as Early Treatment Option in Stable Cystic Fibrosis Patients with Sub-Massive Hemoptysis: Personal Experience and Literature Review.

(1) Background: We describe our experience with cystic fibrosis (CF) patients treated with bronchial artery embolization (BAE) for sub-massive hemoptysis to understand if early treatment of sub-massive hemoptysis can reduce the volume of any subsequent bleedings. (2) Materials: We performed a retrospective study including CF patients who underwent angiographic procedures for BAE following sub-massive hemoptysis, from March 2016 to December 2021. All patients underwent an initial chest angio-CT study. BAE was realized with microspheres or coils. (3) Results: Thirteen patients were included, subjected to at least one BAE after sub-massive hemoptysis, for a total of 19 procedures. Technical success was 94.7%; in a single case, the catheterization of the bronchial arterial feeder was not achievable and the procedure was repeated. Primary clinical success was 92.3%; secondary clinical success was 69.2%. Relative clinical success was 85%. A higher incidence of recurrent hemoptysis following treatment with coils was observed (100% of cases) compared to treatment with microspheres (54.5% of cases) χ2 = 5.43 (p < 0.05). (4) Conclusions: BAE is a safe and effective method for the treatment of hemoptysis in CF patients; it should be practiced not only after massive or recurrent hemoptysis but also in patients with sub-massive bleeding to improve their life expectancy and quality of life.

2D shear wave elastography in evaluation of prognostic factors in breast cancer.

PURPOSE: To evaluate the reproducibility of the 2D shear wave elastography (2D-SWE) method and to identify the prognostic factors of breast lesions. METHODS: In this prospective study, 44 female patients were consecutively included from January 2020 to September 2021. All patients showing visible masses at B-mode ultrasound underwent to clinical evaluation, followed by qualitative and quantitative 2D-SWE by two different operators with over 15-year and 2-year experience, respectively. Subsequently, patients underwent to surgical treatment after core needle biopsy. Reproducibility of qualitative and quantitative 2D-SWE was evaluated by Cohen's kappa and intraclass correlation coefficient (ICC). Clinical, imaging, and histopathological data and 2D-SWE evaluations were analysed with Spearman's rank correlation test. RESULTS: The mean age of the patients was 55 years ± 12. The mean histological and ultrasound tumour size of were 23.1 mm ± 13.2 and 17.2 mm ± 10.2, respectively. The interobserver agreement showed a good reproducibility limited to the qualitative evaluation colour maps (Cohen's kappa = 0.603) and to the quantitative evaluation E ratio (ICC = 0.771). Correlation analysis between the ultrasound and 2D-SWE values and the clinical-pathological parameters showed a significant relationship between E ratio and Elston-Ellis grading (P < 0.030) and between tumour size and Elston-Ellis grading (P < 0.041). CONCLUSION: The 2D-SWE has shown good reproducibility among operators with different experience. It could be a promising tool in the evaluation of some prognostic factors in ultrasound visible breast cancer.

Comparison of point shear wave elastography and transient elastography in the evaluation of patients with NAFLD.

PURPOSE: To compare point shear wave elastography (pSWE, ElastPQ®) and transient elastography (TE) with Liver Biopsy in order to evaluate fibrosis stage in non-alcoholic fatty liver disease (NAFLD). METHODS: Our prospective study from September 2017 to October 2020 included 50 consecutively enrolled patients with NAFLD (52.2 ± 13.0 years, 32 male). All patients underwent clinical evaluation, B-mode ultrasound, pSWE, TE and liver biopsy in a single evaluation. The clinical, laboratory and liver biopsy data were compared with liver stiffness (LS) measurement obtained with pSWE and TE. TE and pSWE diagnostic accuracy for the diagnosis of the different fibrosis stages were evaluated using the area under receiver operating characteristic curve (AUROC). RESULTS: Only fibrosis stage was independently associated with TE and pSWE. The median liver stiffness measurement for fibrosis stages F0, F1, F2, F3, and F4 using TE was 4.8 (4.7-6.1) kPa, 5.5 (4.4-7.3) kPa, 7.7 (6.1-9.1) kPa, 9.9 (8.8-13.8) kPa, and 20.2 kPa, respectively. The corresponding median liver stiffness measurement using pSWE was 4.2 (4.0-4.8) kPa, 4.7 (4.2-5.8) kPa, 5.1 (4.1-6.9) kPa, 8.5 (5.2-13.3), and 15.1 kPa, respectively. The AUROC of TE for diagnosis of fibrosis stage F1, ≥ F2, ≥ F3, and F4 were 0.795, 0.867, 0.927, and 0.990, respectively. The corresponding AUROC of pSWE was 0.717, 0.733, 0.908, and 1.000, respectively. No association was observed with other histological parameters. CONCLUSION: TE was significantly better than pSWE for the diagnosis of fibrosis stage ≥ F2. No statistically significant differences were found between TE and pSWE AUROC of fibrosis stage ≥ F1, ≥ F3, and F4.

Shear wave elastography and transient elastography in HCV patients after direct-acting antivirals.

PURPOSE: To compare the ultrasound (US) and pulse shear wave elastography (pSWE, Elast PQ®) methods with transient elastography (TE), clinical scores and laboratory tests, during the follow-up of HCV patients receiving direct-acting antiviral drugs (DAA). METHODS: Our prospective study from June 2016 to December 2017 included 22 consecutively enrolled HCV-positive patients (59.7 ± 12.3 years, 11 male) which were subjected to antiviral therapy. All patients underwent B-mode ultrasound, color-Doppler, pSWE and TE five times: before therapy (T0), at the end of therapy (post-Tx), and at 12, 24, 48 weeks post-therapy. The liver stiffness (LS) values obtained with pSWE and TE and the data coming from US assessment and clinical evaluation were compared. RESULTS: We obtained a statistically significant reduction of LS values (kPa) measured by pSWE, between T0 (14.3 ± 9.3), post-Tx (11.8 ± 10.5), 12 weeks (7.5 ± 3.3), 24 weeks (8 ± 3.8) and 48 weeks (8.5 ± 4.6) (p = 0.02). The reduction of kPa measured by TE was not significant between T0 (14.7 ± 9.3), post-Tx (12 ± 9.5), 12 weeks (11.6 ± 7.7), 24 weeks (10.3 ± 6) and 48 weeks (10.8 ± 7.5) (p > 0.05). Multivariate baseline analysis showed significant independent association among measurement of TE stiffness with cirrhosis, type of vein hepatic flow and showed significant independent association between delta-pSWE measurement (difference between stiffness measurements at the baseline and 12 months after treatment) with staging of fibrosis (p = 0.006) and sustained virologic response after 12 weeks of treatment (SVR12, p = 0.017). CONCLUSION: The pSWE method has shown better ability than TE to identify a reduction in LS. Therefore, pSWE allow to evaluate stiffness reduction in HCV patient during DAA treatment follow-up, which is related to SVR12.

Sural Nerve Size in Fibromyalgia Syndrome: Study on Variables Associated With Cross-Sectional Area.

Increased cross-sectional area (CSA) of sural nerve, documented by ultrasound (US), has been revealed in small fibers neuropathy, condition present in about half of patients with fibromyalgia (FM). The aims of this study were to evaluate sural nerve CSA and to establish the variables associated with increased CSA in FM patients. A cross-sectional assessment was conducted in consecutive FM patients. Demographic data, clinimetric parameters [Fibromyalgia Impact Questionnaire (FIQR)], the neuropathic pain features [PainDetect Questionnaire (PDQ)], and the sural nerve CSA were recorded. CSA was determined by US, examining the sural nerve at the lateral region of the calf. CSA was compared with demographic and clinical variables. A multiple regression analysis was conducted applying CSA as dependent variable. One hundred and ten FM patients were enrolled. Sural nerve CSA showed a significant association with body mass index (BMI) (r = 0.422; p < 0.0001) and with PDQ (r = 0.361; p = 0.0001). The multiple regression analysis confirmed that BMI (p = 0.0001) and PDQ (p = 0.0028) were the two independent variables associated with CSA. The severity of the disease, measured with FIQR, showed no association. An increase in sural nerve CSA is closely related to BMI and to distinctive neuropathic symptoms. Overweight and obesity appear to be associated with a FM phenotype with documented peripheral nervous system involvement. Ultrasound examination of the sural nerve at calf level may reveal useful information in patients with FM, identifying a cluster of patients with peripheral nervous system alterations. This cluster of patients is generally overweight or obese, and complains of painful symptoms with neuropathic features.

Levantamento epidemiológico do hiv/aids no município de parnaíba-pi, brasil, 1990-2018 / Epidemiological survey of HIV/AIDS in the municipality of Parnaíba-PI, Brazil, 1990-2018 / Encuestaepidemiológica del VIH/SIDA en el municipio de Parnaíba-PI, Brasil, 1990-2018

Introdução:Aepidemia do HIV/AIDS é um desafio para saúde pública mundial e leva ao óbito milhares de pessoas todos os anos. Hoje éconsiderada uma condição crônica, com mudanças epidemiológicas importantes que necessitam ser conhecidas para que intervenções no combate a novas infecções possam ser implementadas. Objetivo:Realizar um levantamento epidemiológico de HIV/AIDS no município deParnaíba-PI, no período de 1990-2018. Métodos:Estudo descritivo, transversal e quantitativo, realizado a partir de dados disponibilizados pelo Departamento de Informática do Sistema Único de Saúde (DATASUS) e peloDepartamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis, da Secretaria de Vigilância em Saúde, do Ministério da Saúde (DCCI/SVC/MS). Resultados:Foram registrados 372casos de HIV/AIDS comas maioresprevalênciasobservadasnosexo masculino (65,9%), raça/cor parda (36,8%), nível fundamental incompleto (44,9%), categoria de exposição heterossexual (34,9%) e faixa etária entre 20-49 anos (85,2%). A taxa média de detecção de infecçãopelo HIV foi de 9,2/100.000 hab. Outro fator relevante,diz respeito ao número de gestantes com cerca de 12,6%do total de mulheres infectadas. Foram registrados o total de 114óbitospor AIDS,com taxa média de mortalidade de 2,8/100.000hab. eletalidadede 30,6%. Conclusão:O estudopermitiudiscutirsobre as variáveis epidemiológicase a necessidade de avanços empolíticas públicasespecíficas, a exemplo das mulheres gestantese dos homens,além do incentivo aodiagnóstico e ao trabalho permanente em educação e prevenção, para que haja redução da morbimortalidade por esse agravo (AU).

Introduction: The HIV/AIDSepidemicis a challenge to global public health and leads to death thousands of people every year. Today it is considereda chronic condition, with important epidemiological changes that need to be known so that interventions to fight new infections can be implemented.Objective:To perform an epidemiological survey of HIV/AIDS in the municipality of Parnaíba-PI, in the period 1990-2018.Methods:Descriptive, cross-sectional and quantitative study, based on data provided by the Department of Informatics of the Unified Health System (DATASUS) and by the Department of Diseases of Chronic Conditions and Sexually Transmitted Infections, of the Secretary of Health Surveillance, of the Ministry of Health(DCCI/SVC/MS).Results:372 cases of HIV/AIDS were registered with the highest prevalences observed in males (65.9%), brown race/color (36.8%), incomplete fundamental level (44.9%), heterosexual exposure category (34.9%) and age group between 20-49 years (85.2%). The average HIV infection detection rate was 9.2/100,000 inhabitants. Another relevant factor concerns the number of pregnant women with about 12.6% of the total number of infected women. A total of 114 deaths from AIDS were recorded, with an average mortality rate of 2.8/100,000 inhabitants and lethality of 30.6%.Conclusion: The study allowed to discussthe epidemiological variables and the need for progress on specific public policies, like the pregnant women and men, in addition to encouraging the diagnosis and permanentwork on education and prevention, so that there is reduction in morbidity and mortality from this injury (AU).

Introducción:La epidemia de VIH / SIDA es un desafío para la salud pública en todo el mundo y provoca la muerte de miles de personas cada año. Hoy se considera una condición crónica, conimportantes cambios epidemiológicos que deben conocerse para que se puedan implementar intervenciones para combatir nuevas infeccionesObjetivo:Realizar una encuesta epidemiológica del VIH/SIDA en la ciudad de Parnaíba-PI, en el período 1990-2018. Métodos:Estudio descriptivo, transversal y cuantitativo, basado en datos proporcionados por el Departamento de Informática del Sistema Único de Salud (DATASUS) y por el Departamentode Enfermedades de CondicionesCrónicas e Infecciones de Transmisión Sexual, del Departamento de Vigilancia Sanitaria, del Ministerio de Salud (DCCI/SVC/MS).Resultados:Se registraron 372 casos de VIH/SIDA con las prevalencias más altas observadas en hombres (65.9%), raza/color marrón (36.8%), nivel fundamental incompleto (44.9%), categoría de exposición heterosexual (34.9%) y grupo de edad entre 20-49 años (85.2%). La tasa promedio de detección de infección por VIH fue de 9.2/100,000 habitantes. Outro factor relevante se refiere al número de mujeres embarazadas con aproximadamente el 12.6% del número total de mujeres infectadas. Se registraron un total de 114 muertes por SIDA, con una tasa de mortalidad promedio de 2.8/100,000habitantes y letalidad del 30.6%.Conclusión:El estudio permitió discutir las variables epidemiológicas y la necesidad de avances en políticas públicas específicas, como mujeresembarazadasy hombres, además de alentar el diagnóstico y el trabajo permanente en educación y prevención, a fin de reducir la morbilidad y la mortalidad debido a este agravio (AU).

Conhecimento de Estudantes da Área da Saúde Sobre o Controle e Prevenção de Infecções Hospitalares / The Knowledge of Health Students regarding the Control and Prevention of Nosocomial Infections

Introdução: Apesar dos avanços científicos e tecnológicos na área de cuidados de saúde, a infecção hospitalar (IH) ainda é considerada como um grave problema de saúde pública. A IH pode ser definida como uma infecção adquirida após a admissão hospitalar do paciente e que se manifesta durante a internação ou após a sua alta. Objetivos: O estudo apresentou como objetivo avaliar o conhecimento dos estudantes técnicos e universitários em saúde sobre as IHs, suas formas de divulgação e prevenção, para promover, assim, a consciência dos riscos relacionados com a má conduta na atividade profissional. Material e Métodos: A coleta de dados foi realizada através de um questionário com questões sobre o assunto, seguido pela apresentação de palestras. Um total de 34 estudantes do ensino superior e 100 estudantes de ensino técnico foi incluído no estudo. Resultados: A definição correta de IH foi observada no primeiro questionário de 33 (97,1%) estudantes do ensino superior e em 86 (86,0%) alunos do ensino técnico, alcançando 100% nos dois casos, após a palestra. Foi observado uma melhora na compreensão dos alunos sobre a importância da diminuição do uso indiscriminado de antibióticos e da contribuição da higienização das mãos para a prevenção da IH, após a palestra, em 85,3% e 87,0% dos estudantes de ensino superior e técnico, respectivamente. Conclusão: Houve um aumento significativo na melhora do conhecimento dos alunos sobre o conceito e causas das IHs após as palestras.(AU)

Introduction: Despite the scientific and technological advances in the field of healthcare, nosocomial infections (NI) remain a serious public health issue. NI can be defined as an infection acquired after hospital admission and manifested during patient hospitalization or after discharge. Objective: To evaluate the knowledge of higher and technical education health students about NI, as well as about dissemination and prevention strategies. Ultimately, it is aimed to promote the awareness of risks related to misconduct in professional practice. Material and Methods: The data were collected using a questionnaire, followed by a lecture. A total of 34 students of higher education and 100 students of technical education were included. Results: A correct definition of NI was reported based on the first questionnaire by 33 (97.1%) students of higher education and 86 (86%) students of technical education. After the lecture, 100% of participants from both groups reported the correct definition of NI. After the lecture, 85.3% and 87% of higher and technical education students, respectively, showed an improved understanding of the importance of decreasing the indiscriminate use of antibiotics as well as of hand hygiene for NI prevention. Conclusion: There was a significant increase in the improvement of students' knowledge about the concept and causes of NI after the lectures. (AU)

Decrease of Pericytes is Associated With Liver Disease Caused by Ligature-Induced Periodontitis in Rats.

BACKGROUND: Damage caused by periodontitis not only affects periodontal tissues, but also increases the severity of various illnesses such as rheumatoid arthritis, diabetes, and liver diseases. The aim of this study is to investigate the association between induced periodontitis and damage caused through its systemic effects on the liver. METHODS: Twenty rats were divided into two groups: control and periodontitis. The following parameters were evaluated: gingival bleeding index (GBI), probing depth (PD), myeloperoxidase (MPO) activity, alveolar bone loss (ABL) for periodontal tissues; histopathologic examination of gingival and liver tissues; immunohistochemistry to cells positive for neural/glial antigen 2 (NG2) expressed in hepatic pericytes, glutathione (GSH), and malondialdehyde (MDA) concentrations in liver; and serum levels of alanine aminotransferase and aspartate aminotransferase. RESULTS: GBI, PD, MPO, ABL, and histopathologic examinations demonstrated the development of periodontitis. There was a significant increase in microvesicular steatosis accompanied by a marked reduction in NG2+ pericytes in the periodontitis group compared with the control group. The periodontitis group had significantly lower GSH and higher MDA concentration in the liver compared with the control group. CONCLUSIONS: The present study results link the systemic effects of induced periodontitis with changes in hepatic tissues such as microvesicular steatosis, likely caused by an increase in oxidative stress and lipid peroxidation. The findings from the present study implicate an association between a decrease of pericytes and liver disease caused by ligature-induced periodontitis in rats.

Soroprevalência de toxoplasmose humana na cidade de Teresina no período de 2010 a 2014 / Serum prevalence of human toxoplasmosis in Teresina, Brazil, bet ween 2010 and 2014

A toxoplasmose é uma zoonose cosmopolita causada pelo Toxoplasma gondii. A enfermidade constitui um importante problema de saúde pública em todo o mundo, especialmente na sua forma congênita, onde o risco de comprometimento fetal e sequelas são iminentes. Objetivou-se estabelecer o perfil epidemiológico da toxoplasmose na cidade de Teresina-PI, por meio da caracterização de sua prevalência em humanos, durante o período de 2010 a 2014. Fora realizado um estudo descritivo e retrospectivo de caráter quantitativo. Observou-se que 69% dos indivíduos do sexo feminino apresentam soropositividade em relação a anticorpos IgG contra toxoplasmose, enquanto que 67% dos indivíduos do sexo masculino apresentam soropositividade. De acordo com as análises estatísticas, a prevalência de toxoplasmose na cidade de Teresina é de 89,4% em relação a anticorpos IgG, e 4,3% para anticorpos IgM. Fica evidente que estudos adicionais são necessários antes da completa compreensão da prevalência de toxoplasmose em Teresina. Diante do exposto, percebe-se a importância da caracterização epidemiologia da toxoplasmose, visto que o aumento na incidência de AIDS no estado do Piauí vem aumentando gradativamente. Conclui-se que é necessário maiores estudos sobre incidência e prevalência no Estado do Piauí, bem como o estudo sobre incidências das variações clínicas da toxoplasmose.

Toxoplasmosis is a world-wide zoonosis caused by Toxoplasma gondii. It is an important public health problem especially in its congenital form where risk to the fetus and its sequences are imminent. The epidemiological profile of toxoplasmosis in Teresina PI,Brazil is described by characterizing its prevalence in humans between 2010 and 2014. The descriptive and retrospective analysis showed that 69% of females were serum positive with regard to antibodies IgG against toxoplasmosis, whereas 67% of males were serum positive. Statistical analyses revealed that the prevalence of toxoplasmosis in Teresina reached 89.4% with regard to antibodies IgG and 4.3% for antibodies IgM. Further studies are required to understand fully the prevalence of toxoplasmosis in the city. The epidemiological characterization of toxoplasmosis is highly relevant due to a gradual increase in AIDS rates in the state of Piauí. Further studies on its occurrence and prevalence in the state of Piauí are required, coupled to studies on the clinical variations of toxoplasmosis.

Ultrasound features of medullary thyroid carcinoma correlate with cancer aggressiveness: a retrospective multicenter study.

BACKGROUND: Poor prognosis of medullary thyroid cancer (MTC) with suspicious ultrasound (US) features has been reported. The aim of the study was to investigate the association between preoperative US presentation and aggressiveness features of MTC. Also, US features of MTC were compared with those previously reported. METHODS: Study group comprised 134 MTC from nine different centers. Based on US presentation the nodules were stratified in "at risk for malignancy" (m-MTC) or "probably benign" (b-MTC) lesions. RESULTS: Eighty nine (66.4%) m-MTC and 45 (33.6%) b-MTC were found. Metastatic lymph nodes (p = 0.0001) and extrathyroid invasiveness (p < 0.0001) were more frequent in m-MTC. There was statistically significant correlation (p = 0.0002) between advanced TNM stage and m-MTC with an Odds Ratio 5.5 (95% CI 2.1-14.4). Mean postsurgical calcitonin values were 224 ± 64 pg/ml in m-MTC and 51 ± 21 in b-MTC (p = 0.003). CONCLUSIONS: This study showed that sonographically suspicious MTC is frequently associated with features of aggressiveness, suggesting that careful preoperative US of MTC patients may better plan their surgical approach.

Patient's comfort with and tolerability of thyroid core needle biopsy.

Recently, the core needle biopsy (CNB) has been proposed as a complementary test for thyroid nodules with inconclusive cytology by fine-needle aspiration (FNA). However, there have been no reports regarding patient comfort during and after CNB or tolerability of this procedure. Here we aimed to investigate and compare comfort with and tolerability of the CNB and FNA procedures. A 21 gauge needle was used for collection in CNB procedures, and a 23 gauge needle was used for collection in FNA procedures. Sixty-one consecutive patients underwent both biopsies and were asked to evaluate their comfort during and after these procedures by a structured questionnaire. A total of 58 (95 %) patients reported local pain during both biopsies. Two patients reported pain only during CNB, and one reported no pain. Mild pain was reported in 87 % of CNB cases. Local pain after biopsy was reported in 29 % of FNA and 45 % of CNB. The occurrence of pain in the first minutes following CNB was significantly higher than FNA (p = 0.008), while there was not a significant difference in pain at later time points after the procedures. Finally, patients were asked to evaluate the degree of tolerability of the two sampling techniques, and FNA and CNB were reported as tolerable in 82 and 83 %, respectively. The results from a questionnaire evaluating patients' comfort level showed no significant difference between the tolerability of CNB and FNA. This finding suggests that CNB may be performed with a reasonable level of patient comfort.

Calcitonin measurement in aspiration needle washout fluids has higher sensitivity than cytology in detecting medullary thyroid cancer: a retrospective multicentre study.

OBJECTIVE: Only few studies analysed the capability of cytology in detecting medullary thyroid cancer (MTC), and they reported a low accuracy of this diagnostic technique. Recently, calcitonin (CT) measurement in aspiration needle washout (FNA-CT) of thyroid and neck lesions has been reported as a sensitive tool for MTC. The aim of this study is to compare the sensitivity of FNA-CT and cytology in detecting MTC and to assess a cut-off value of FNA-CT for clinical practice. PATIENTS: Thirty-eight MTC lesions from 36 patients were retrospectively studied, diagnosed and treated in four different centres. Furthermore, 52 nonmedullary lesions from subjects undergone biopsy following increased serum CT were collected as a control group. RESULTS: Cytology detected MTC in 21/37 lesions with 56·8% sensitivity. The median FNA-CT value was 2000 pg/ml (range 58-10 000 pg/ml) in MTC and 2·7 pg/ml (range <2-13 pg/ml) in controls (P < 0·001). Using a cut-off of 39·6 pg/ml, MTC lesions could be identified with 100% sensitivity and specificity. As the most important finding, 14 histologically proved MTC lesions could be detected by FNA-CT, despite they were cytologically diagnosed as benign or nonconclusive. CONCLUSIONS: This study shows, as the first in a multicentre series, that FNA-CT sensitivity is higher than that of cytology in diagnosing MTC. To avoid false-negative MTC by cytology, CT measurement in aspiration needle washout is to be performed in all patients undergoing biopsy following high serum CT.

Thin core biopsy should help to discriminate thyroid nodules cytologically classified as indeterminate. A new sampling technique.

Indeterminate neoplasms (IN) represent the gray zone of thyroid cytology in which malignant and benign tumors cannot be discriminated. Recently, the approach by thin core needle biopsy has been proposed. Here we report a new thin core needle biopsy approach in 40 consecutive patients with thyroid IN at cytology. In this study, a 21-G needle was inserted into the nodule, advanced within the lesion, and moved ahead reaching extranodular tissue. The resulting sample allowed to evaluate the cytomorphology of nodular tissue, its relationship with extranodular parenchyma, and the nodule's capsule when present. All biopsies were adequate for diagnosis but one. Of the 39 adequate samples, 5 cases were papillary cancer as confirmed at histology, while 14 nodules avoided surgery because of Hürthle cell hyperplasia in thyroiditis (n = 6) and microfollicular adenomatous hyperplasia (n = 8). The remaining 20 cases were assessed as follicular neoplasms because of encapsulation and were evaluated by immunohistochemistry. Of these, 6 had positive markers in different degree and 1/6 has follicular cancer at histology, while the other 14 were benign after surgery. Overall, this approach by thin core needle biopsy identified benignancy in 14/40 (35 %) IN avoiding surgery. As a conclusion, thin core biopsy should help to discern the nature of thyroid lesions cytologically classified as indeterminate, and it should be used as a complementary test in thyroid nodule assessment.

Should we use ultrasound features associated with papillary thyroid cancer in diagnosing medullary thyroid cancer?

In thyroid nodule management, ultrasound (US) features, such as hypoechogenicity of the lesion, irregular margins, microcalcifications, and intralesional vascular signal, alone or combined, have to be considered as suggestive for malignancy. Because of the low prevalence of medullary thyroid cancer (MTC), a few papers analyzed US characteristics associated with this cancer in small series, with controversial results. Aim of this study was to evaluate in MTC the US risk factors of thyroid nodule. In this order, a series of nodules histologically proven as MTC and a group of nodules with histology of papillary cancer (PTC) were retrospectively compared with a control group of benign nodule. Fifty percent MTC were solid hypoechoic and 16% showed microcalcifications with significant difference with respect to the benign group (p<0.05 for both parameters), while no significant difference was recorded regarding margins nor nodular vascularization. The presence of at least one US risk feature was almost equal in MTC (58.3%) and controls (55.5%). On the contrary, at least one US risk factor was significantly (p<0.001) more frequent in PTC than in benign group or MTC series. This study showed low frequency of ultrasound features associated to PTC when analyzed in medullary cancer. Because of the poor literature focusing on this topic, and the herein used design, these data contribute to the knowledge about presentation of MTC at US. We advice for further prospective studies on larger series to define the US presentation of this cancer type.

One in five subjects with normal thyroid ultrasonography has altered thyroid tests.

The relation between thyroid ultrasonography and laboratory, and the relationship of thyroid volume with clinical and anthropometric parameters, are not well clarified. Aim of the study was to investigate normal and hypoechoic-inhomogeneous not nodular thyroid gland in predicting thyroid tests, and to assess the correlation of thyroid volume with several clinical parameters. The series included 434 subjects (244 with normal thyroid ultrasonography, and 190 with hypoechoic-inhomogeneous thyroid) at their first evaluation. Subjects with normal ultrasonography and skewed tests were re-evaluated after one year. All subjects with normal ultrasound showed normal free-T4, while TSH was elevated in 9.8% of cases and thyroid antibodies were positive in another 9.8%. In patients with hypoechoic-inhomogeneous thyroid, free-T4 was low in 33.2%, TSH was elevated in 78.4% and thyroid antibodies were positive in 76.3%. Normal ultrasonography matched with normal tests in 81.1% of cases while hypoechoic-inhomogeneous thyroid in 9.5% (p<0.001). The re-evaluation of tests showed no significant difference. In subjects with both normal ultrasonography and tests, thyroid volume was correlated with age (p=0.001), weight (p=0.003), BMI (p=0.04), body surface area (p=0.002). Thyroid laboratory assessment was different between subjects with ultrasonographically normal or hypoechoic-inhomogeneous thyroid. Thyroid volume of thyroid diseases-free subjects was correlated with age, weight, BMI and body surface area, and this should be of interest to investigate the references of normality of thyroid size.

Pouterin, a novel potential cytotoxic lectin-like protein with apoptosis-inducing activity in tumorigenic mammalian cells.

In this study, the cytotoxicity of pouterin in tumorigenic and non-tumorigenic mammalian cell lines was investigated. We found that HeLa, Hep-2 and HT-29 tumor cells were highly sensitive to pouterin cytotoxicity in a dose-dependent manner, whereas non-tumorigenic Vero cells and human lymphocytes were relatively resistant to the protein. Among the tumor cell lines, HeLa cells showed the highest susceptibility to pouterin cytotoxicity, exhibiting a time-dependent increase in LDH leakage and an IC(50) value of 5mug/mL. Morphological alterations such as rounding, cell shrinkage and chromatin condensation, consistent with apoptotic cell death were observed. Apoptosis induction was demonstrated by DNA fragmentation as detected by terminal dUTP nick-end labeling (TUNEL). Furthermore, HeLa cells incubated with pouterin showed disruption of the actin cytoskeleton. Western blot analysis revealed that pouterin caused increased expression of p21, thus indicating cell cycle arrest. Subsequent studies provided evidence that apoptosis may be partially explained in the activation of the tumor necrosis factor receptor 1 (TNFR1) signaling. Interestingly, a time-dependent decrease of the expression of p65 nuclear factor kappa B (NFkappaB) subunit, concomitant with a downregulation of the inhibitor of apoptosis protein 1 (IAP1) was observed, suggesting that TNFR-mediated apoptosis is the predominant pathway induced by pouterin in HeLa cells.

Morphological and growth alterations in Vero cells transformed by cisplatin.

Cisplatin is an antineoplastic agent used to treat solid tumours, such as ovarian, testicular and bladder tumours. However, studies in vitro and in vivo have shown that cisplatin is mutagenic, genotoxic and tumorigenic in other tissues and organs. In this work, we examined the effect of cisplatin on Vero cells, a fibroblast-like cell line. The morphological characteristics were investigated using phase contrast microscopy, scanning electron microscopy and the actin cytoskeleton was labelled with fluorescein isothiocyanate-phalloidin. Cell proliferation was assessed based on the growth curve. Cultured Vero cells treated with cisplatin showed behavioural and morphological alterations associated with cellular transformation. The transformed cells grew in multilayers and formed cellular aggregates. The proliferation and morphological characteristics of the transformed cells were very different from those of control ones. Since transformed Vero cells showed several characteristics related to neoplastic growth, these cells could be a useful model for studying tumour cells in vitro.