Usefulness of ultrasound-guided core biopsy in thyroid nodules with inconclusive fine-needle aspiration biopsy findings.

OBJECTIVES: To determine the diagnostic performance of ultrasound-guided core-needle biopsy in thyroid nodules after two inconclusive fine-needle aspiration biopsies. To assess the complications of core-needle biopsy. To analyze the reliability of diagnoses obtained with core-needle biopsy. To measure the economic impact of avoiding lobectomies in patients with benign core-needle biopsy findings. MATERIAL AND METHODS: This retrospective study reviewed 195 core-needle biopsies in 178 patients. To determine the reliability of the core-needle biopsy findings, we compared the diagnosis from the core-needle specimen versus the histologic findings in the surgical specimens when core-needle biopsy findings indicated malignancy or follicular proliferation and versus the stability of the nodule on ultrasound follow-up for one year when core-biopsy findings indicated benignity. RESULTS: Core-needle biopsy yielded a diagnosis for 179 (91.7%) nodules, of which 122 (62.5%) were classified as benign, 50 (25.6%) as follicular proliferation, and 7 (3.6%) as malignant. The findings were inconclusive for 16 (8.3%) nodules. Minor complications were observed in 4 (2%) patients; no major complications were observed. The sensitivity of core-needle biopsy for the diagnosis of thyroid cancer was low (42.8%) because the technique was unable to detect capsular or vascular invasion, although the specificity and positive predictive value (PPV) were 100%. However, when we considered histologic findings of malignancy and follicular proliferation positive because both require surgical resection, the sensitivity increased to 97.5% and the PPV decreased to 83.3%. There were 79 nodules with ultrasound follow-up for at least one year; 76 (96.2%) had negative core-needle biopsy findings, and 74 (97.3%) of these remained stable. The negative predictive value (NPV) for malignancy of the benign nodules was 98.6%, although no malignant transformation was observed. Nevertheless, the results of the statistical analysis do not allow us to recommend forgoing ultrasound follow-up in patients with benign core-biopsy findings. The cost savings of avoiding lobectomy in patients with benign nodules and stability of the nodule on ultrasound follow-up for at least one year was about 90%. CONCLUSIONS: Core-needle biopsy of thyroid nodules is effective because it diagnoses more than 90% of nodules with inconclusive findings after fine-needle aspiration biopsy. It is safe if done by experienced professionals. It is reliable because it yields 100% specificity and 100% PPV for malignant nodule, 97.5% sensitivity for the detection of nodules that require surgery, and 98.6% NPV for benign nodules. It is efficient because it reduces the costs of diagnosis compared to lobectomy in benign nodules.

Utilidad de la biopsia con aguja gruesa ecoguiada en nódulos tiroideos con punción aspirativa con aguja fina no diagnóstica / Usefulness of ultrasound-guided core biopsy in thyroid nodules with inconclusive fine-needle aspiration biopsy findings

Objetivos: Conocer el rendimiento diagnóstico de la biopsia con aguja gruesa (BAG) ecoguiada en nódulos tiroideos con dos punciones aspirativas con aguja fina (PAAF) previas no diagnósticas. Evaluar complicaciones de la BAG. Analizar la fiabilidad de los diagnósticos obtenidos mediante BAG. Medir el impacto económico de evitar lobectomía tras BAG con resultado benigno. Material y métodos: Revisión retrospectiva de 195 BAG realizadas en 178 pacientes. Las referencias utilizadas para medir la fiabilidad de los resultados de la BAG fueron el análisis de la pieza quirúrgica tras una biopsia con malignidad o proliferación folicular (PF) y la estabilidad ecográfica superior a 1 año tras una BAG benigna. Se compararon costes directos de BAG más seguimiento ecográfico frente al que hubiera tenido realizar lobectomía sin complicaciones en los pacientes con estabilidad ecográfica superior a 1 año tras BAG benigna. Resultados: De los 195 nódulos sometidos a BAG, el resultado fue diagnóstico en 179 (91,7%), incluyendo 122 benignos (62,5%), 50 PF (25,6%) y 7 malignos (3,6%). No fue diagnóstico en 16 nódulos (8,3%). Hubo complicaciones menores en 4 pacientes (2%) y mayores en ninguno. La sensibilidad de la BAG para el diagnóstico de cáncer de tiroides fue baja (42,8%) por su incapacidad para detectar invasión capsular o vascular, aunque con especificidad y valor predictivo positivo (VPP) del 100%. Al considerar los diagnósticos de malignidad y PF como positivos, pues ambos obligan a resección quirúrgica, la sensibilidad ascendió al 97,5%, con descenso al 83,3% del VPP. Hubo 79 nódulos con seguimiento ecográfico superior a 1 año, 76 con BAG benigna (96,2%), de los cuales mostraron estabilidad 74 (97,3%). El valor predictivo negativo (VPN) para malignidad de los nódulos benignos fue del 98,6%, aunque no se detectó ninguna transformación maligna. Sin embargo, el análisis estadístico no permite recomendar la supresión del seguimiento ecográfico tras BAG benigna.(AU)

Objectives: To determine the diagnostic performance of ultrasound-guided core-needle biopsy in thyroid nodules after two inconclusive fine-needle aspiration biopsies. To assess the complications of core-needle biopsy. To analyze the reliability of diagnoses obtained with core-needle biopsy. To measure the economic impact of avoiding lobectomies in patients with benign core-needle biopsy findings. Material and methods: This retrospective study reviewed 195 core-needle biopsies in 178 patients. To determine the reliability of the core-needle biopsy findings, we compared the diagnosis from the core-needle specimen versus the histologic findings in the surgical specimens when core-needle biopsy findings indicated malignancy or follicular proliferation and versus the stability of the nodule on ultrasound follow-up for one year when core-biopsy findings indicated benignity. Results: Core-needle biopsy yielded a diagnosis for 179 (91.7%) nodules, of which 122 (62.5%) were classified as benign, 50 (25.6%) as follicular proliferation, and 7 (3.6%) as malignant. The findings were inconclusive for 16 (8.3%) nodules. Minor complications were observed in 4 (2%) patients; no major complications were observed. The sensitivity of core-needle biopsy for the diagnosis of thyroid cancer was low (42.8%) because the technique was unable to detect capsular or vascular invasion, although the specificity and positive predictive value (PPV) were 100%. However, when we considered histologic findings of malignancy and follicular proliferation positive because both require surgical resection, the sensitivity increased to 97.5% and the PPV decreased to 83.3%. There were 79 nodules with ultrasound follow-up for at least one year; 76 (96.2%) had negative core-needle biopsy findings, and 74 (97.3%) of these remained stable. The negative predictive value (NPV) for malignancy of the benign nodules was 98.6%, although no malignant transformation was observed.(AU)

Case study of pipeline failure analysis from two automated vacuum collection system.

Conventional municipal waste management systems based on collecting and storing waste for future management are cost-effective and flexible. These systems present significant problems such as odours, plagues and hygiene problems caused by their storage and greenhouse gas emissions from garbage trucks used for the transport of waste. The Automated Waste Collection System (AWCS) and Automated Vacuum Waste Collection (AVWC) systems, in which waste is transported directly underground to the processing plants, are efficient collection systems and respectful of the environment as alternatives to traditional systems. The pneumatic system reduces the value of the per capita generation of general waste. The present study explains the origin of pipe failure in two different AWCS factories, as well as the identification of the failure phenomena. To carry out the study, a classification of 90 failure cases by primary cause was performed, followed by recommendations to avoid these failures in the future. Moreover, a computational fluid dynamics (CFD) simulation was performed in order to help in the failure determination and the key recommendations to avoid the most common and frequent failures.

Usefulness of ultrasound-guided core biopsy in thyroid nodules with inconclusive fine-needle aspiration biopsy findings. / Utilidad de la biopsia con aguja gruesa ecoguiada en nódulos tiroideos con punción aspirativa con aguja fina no diagnóstica.

OBJECTIVES: To determine the diagnostic performance of ultrasound-guided core-needle biopsy in thyroid nodules after two inconclusive fine-needle aspiration biopsies. To assess the complications of core-needle biopsy. To analyze the reliability of diagnoses obtained with core-needle biopsy. To measure the economic impact of avoiding lobectomies in patients with benign core-needle biopsy findings. MATERIAL AND METHODS: This retrospective study reviewed 195 core-needle biopsies in 178 patients. To determine the reliability of the core-needle biopsy findings, we compared the diagnosis from the core-needle specimen versus the histologic findings in the surgical specimens when core-needle biopsy findings indicated malignancy or follicular proliferation and versus the stability of the nodule on ultrasound follow-up for one year when core-biopsy findings indicated benignity. RESULTS: Core-needle biopsy yielded a diagnosis for 179 (91.7%) nodules, of which 122 (62.5%) were classified as benign, 50 (25.6%) as follicular proliferation, and 7 (3.6%) as malignant. The findings were inconclusive for 16 (8.3%) nodules. Minor complications were observed in 4 (2%) patients; no major complications were observed. The sensitivity of core-needle biopsy for the diagnosis of thyroid cancer was low (42.8%) because the technique was unable to detect capsular or vascular invasion, although the specificity and positive predictive value (PPV) were 100%. However, when we considered histologic findings of malignancy and follicular proliferation positive because both require surgical resection, the sensitivity increased to 97.5% and the PPV decreased to 83.3%. There were 79 nodules with ultrasound follow-up for at least one year; 76 (96.2%) had negative core-needle biopsy findings, and 74 (97.3%) of these remained stable. The negative predictive value (NPV) for malignancy of the benign nodules was 98.6%, although no malignant transformation was observed. Nevertheless, the results of the statistical analysis do not allow us to recommend forgoing ultrasound follow-up in patients with benign core-biopsy findings. The cost savings of avoiding lobectomy in patients with benign nodules and stability of the nodule on ultrasound follow-up for at least one year was about 90%. CONCLUSIONS: Core-needle biopsy of thyroid nodules is effective because it diagnoses more than 90% of nodules with inconclusive findings after fine-needle aspiration biopsy. It is safe if done by experienced professionals. It is reliable because it yields 100% specificity and 100% PPV for malignant nodule, 97.5% sensitivity for the detection of nodules that require surgery, and 98.6% NPV for benign nodules. It is efficient because it reduces the costs of diagnosis compared to lobectomy in benign nodules.

Evaluación de las técnicas de fisioterapia mediante tomografía de impedancia / Evaluation of physiotherapy techniques using impedance tomography

No disponible

Adopción y alteraciones de conducta en la adolescencia. Estudio en población hospitalaria / Adoption and behavioural disturbances in adolescence. A hospital patient sample

INTRODUCCIÓN: En las últimas décadas se han incrementado las adopciones en el mundo occidental. Se ha descrito que los adolescentes adoptados están sobrerrepresentados en los servicios de salud mental y que consultan con mayor frecuencia por trastornos de externalización. Planteamos un estudio para valorar la proporción de adolescentes adoptivos y la presencia de conductas externalizantes en una muestra hospitalaria. MÉTODOS: Se recogen prospectivamente los datos de todos los ingresos de adolescentes (12-17 años) hospitalizados en la Unidad de Hospitalización Infanto-Juvenil, que atiende a todo el territorio de Bizkaia, durante 56 meses (n = 431). Dividimos la muestra en adoptados (2,6%) y no adoptados (97,4%), y comparamos las siguientes variables: edad media al ingreso, sexo, motivo de ingreso, ingresos previos, diagnóstico al alta, consumo de tóxicos y resultados de la Overt Aggression Scale al ingreso. RESULTADOS: Los adolescentes adoptados están sobrerrepresentados en nuestra muestra (2,84% vs. 0,6% en la población general; p < 0,001). Comparándolos con el subgrupo de no adoptivos, ingresan significativamente más jóvenes (14,09 vs. 15,21 años; p = 0,017) y tienden a hacerlo más frecuentemente por alteraciones de conducta (63,6% vs. 38,1%; p = 0,086). CONCLUSIONES: Los adolescentes adoptados presentan más ingresos y lo hacen a una edad más temprana, datos que indican una mayor gravedad de la afección de estos adolescentes o una menor capacidad de contención de las familias adoptivas. Además, observamos que tienden a ingresar más por alteraciones conductuales, sin existir diferencias significativas en los diagnósticos al alta, lo que sugiere una tendencia a expresar la sintomatología de forma más externalizadora

INTRODUCTION: The number of adoptions has increased in the Western world in recent decades. An over-representation in mental health services and an increased risk of displaying behavioural disorders has been reported among adopted adolescents. In this study, we aim to assess the proportions of adopted and non-adopted adolescents and the presence of externalizing disorders in an inpatient setting. METHODS: Prospective data were collected over 56 months (n = 431) from all adolescent admissions (12-17 years of age) to the Child and Adolescent's Inpatient Psychiatric Unit, which serves the Biscay province (Basque Country, Spain). The sample was divided into adopted (2.6%) and non-adopted adolescents (97.4%), and the following variables were compared: age, gender, cause of admission, prior admissions, main diagnosis, drug use and Overt Aggression Scale score at admission. RESULTS: Adopted adolescents were over-represented in our sample (2.84% vs. 0.6% in the general population of Biscay, P<0.001). Compared to the non-adopted, age at admission was significantly lower (14.09 vs. 15.21 years old, P=.017) and they showed a statistical tendency to be admitted more frequently for behavioural disorders (63.6% vs. 38.1%, P=0.086). CONCLUSIONS: The over-representation and the earlier age at admission suggest that the conditions of adopted adolescents are more serious and-or adoptive families are less able to manage them. The data also show that they tend to be admitted more for behavioural disorders, whilst no significant differences in the diagnosis on discharge were found, which suggests that they tend to externalise their symptoms more

[Adoption and behavioural disturbances in adolescence. A hospital patient sample]. / Adopción y alteraciones de conducta en la adolescencia. Estudio en población hospitalaria.

INTRODUCTION: The number of adoptions has increased in the Western world in recent decades. An over-representation in mental health services and an increased risk of displaying behavioural disorders has been reported among adopted adolescents. In this study, we aim to assess the proportions of adopted and non-adopted adolescents and the presence of externalizing disorders in an inpatient setting. METHODS: Prospective data were collected over 56 months (n=431) from all adolescent admissions (12-17 years of age) to the Child and Adolescent's Inpatient Psychiatric Unit, which serves the Biscay province (Basque Country, Spain). The sample was divided into adopted (2.6%) and non-adopted adolescents (97.4%), and the following variables were compared: age, gender, cause of admission, prior admissions, main diagnosis, drug use and Overt Aggression Scale score at admission. RESULTS: Adopted adolescents were over-represented in our sample (2.84% vs. 0.6% in the general population of Biscay, P<.001). Compared to the non-adopted, age at admission was significantly lower (14.09 vs. 15.21 years old, P=.017) and they showed a statistical tendency to be admitted more frequently for behavioural disorders (63.6% vs. 38.1%, P=.086). CONCLUSIONS: The over-representation and the earlier age at admission suggest that the conditions of adopted adolescents are more serious and-or adoptive families are less able to manage them. The data also show that they tend to be admitted more for behavioural disorders, whilst no significant differences in the diagnosis on discharge were found, which suggests that they tend to externalise their symptoms more.

Colon cancer therapy: recent developments in nanomedicine to improve the efficacy of conventional chemotherapeutic drugs.

The number of patients with colorectal cancer, the third most frequently diagnosed malignancy in the world, has increased markedly over the past 20 years and will continue to increase in the future. Despite recent advances in chemotherapy, currently used anticancer molecules are unable to improve the prognosis of advanced or recurrent colorectal cancer, which remains incurable. The transport of classical drugs by nanoparticles has shown great promise in terms of improving drug distribution and bioavailability, increasing tissue half-life and concentrating anticancer molecules in the tumor mass, providing optimal drug delivery to tumor tissue, and minimizing drug toxicity, including those effects associated with pharmaceutical excipients. In addition, colon cancer targeting may be improved by incorporating ligands for tumor-specific surface receptors. Similarly, nanoparticles may interact with key drug-resistance molecules to prevent a reduction in intracellular drug levels drug. Recently published data have provided convincing pre-clinical evidence regarding the potential of active-targeted nanotherapeutics in colon cancer therapy, although, unfortunately, only a few of these therapies have been translated into early-phase clinical trials. As nanotechnology promises to be a new strategy for improving the prognosis of colon cancer patients, it would be very useful to analyze recent progress in this field of research. This review discusses the current status of nanoparticle-mediated cancer-drug delivery, the challenges restricting its application, and the potential implications of its use in colon cancer therapy.