Breast Cancer Risk Factors among Women with Solid Breast Lesions

BACKGROUND

Breast cancer is the most frequent malignancy in women worldwide and one of the most curable cancers if diagnosed at an early stage. Female patients presenting solid breast lesions are greatly predisposed to breast cancer development, and as such, effective screening of high-risk patients is valuable in early-stage breast cancer detection.

OBJECTIVES

The aim of our study was to identify the most relevant demographic, reproductive and lifestyle risk factors for breast cancer among women with solid breast lesions living in western Romania, namely the urban region consisting of Timisoara and the rural surrounding regions.

METHODS

From January 2017 to December 2021, 1161 patients with solid breast lesions, as detected by sonoelastography, were divided into two groups: patients with benign lesions (1019, 87.77%) and patients with malignant nodules (142, 12.23%). The malignancy group was confirmed by a histopathological result. Variables including age, BMI, menarche, menopause, years of exposure to estrogen, number of births, breastfeeding period, use of oral combined contraceptives, smoker status, family medical history and living area (rural-urban) were recorded.

RESULTS

It was evidenced by our study that the main risk factors for malignancy were elevated age (OR = 1.07, 95% CI 1.05-1.08), BMI (OR = 1.06, 95% CI 1.02-1.10), living area (rural) (OR = 1.86, 95% CI 1.13-2.85) and family medical history (negative) (OR 3.13, 95% CI 1.43-8.29). The other proposed risk factors were not found to be statistically significant.

CONCLUSIONS

Age and BMI were observed to be the most significant factors for breast cancer risk increase, followed by living in a rural area. A family history of breast cancer was shown to be inversely correlated with cancer risk increase.

Multiparametric ultrasound-based assessment of overt hyperthyroid diffuse thyroid disease

Introduction

Hyperthyroidismis a prevalent condition affecting global populations, with an overall prevalence of 1.2%. Our research aimed to establish a systematic diagnostic approach using multiparametric ultrasound (MPUS) to diagnose hyperthyroid diffuse thyroid disease (DTD).

Methods

We conducted a retrospective study from June 2021 to June 2023 at a specialized endocrinology center in Timisoara, Romania, enrolling subjects presenting with clinical hyperthyroidism. Using the Mach 30 Aixplorer ultrasound equipment, evaluations were performed initially in B-mode US, followed by Color Doppler and Spectral Doppler measurements, and finally, 2D Shear wave elastography (SWE).

Results

From the 218 patients analyzed, the diagnosis of DTD with hyperthyroidism was confirmed through biochemical assessment, subgrouping various pathologies such as subacute thyroiditis, Graves' disease, painless thyroiditis, Hashimoto's thyroiditis, iatrogenic, as well as healthy controls. In the first step, B-mode hypoechogenicity had an AUC of 0.951 for DTD detection. In the second step, the peak systolic velocity differentiated Graves' disease with a median of 42.4 cm/s and an AUC of 1. Lastly, the third step consisted of SWE evaluation, revealing a mean elasticity index in the SAT subgroup significantly higher from other subgroups (p<0.001) with an AUC of 1.

Conclusion

Our study offers a step-by-step evaluation algorithm for DTD diagnosis, with a very good overall diagnostic performance (AUC of 0.946).

Connections between serum Trimethylamine N-Oxide (TMAO), a gut-derived metabolite, and vascular biomarkers evaluating arterial stiffness and subclinical atherosclerosis in children with obesity

Introduction

Childhood obesity leads to early subclinical atherosclerosis and arterial stiffness. Studying biomarkers like trimethylamine N-oxide (TMAO), linked to cardio-metabolic disorders in adults, is crucial to prevent long-term cardiovascular issues.

Methods

The study involved 70 children aged 4 to 18 (50 obese, 20 normal-weight). Clinical examination included BMI, waist measurements, puberty stage, the presence of acanthosis nigricans, and irregular menstrual cycles. Subclinical atherosclerosis was assessed by measuring the carotid intima-media thickness (CIMT), and the arterial stiffness was evaluated through surrogate markers like the pulse wave velocity (PWV), augmentation index (AIx), and peripheral and central blood pressures. The blood biomarkers included determining the values of TMAO, HOMA-IR, and other usual biomarkers investigating metabolism.

Results

The study detected significantly elevated levels of TMAO in obese children compared to controls. TMAO presented positive correlations to BMI, waist circumference and waist-to-height ratio and was also observed as an independent predictor of all three parameters. Significant correlations were observed between TMAO and vascular markers such as CIMT, PWV, and peripheral BP levels. TMAO independently predicts CIMT, PWV, peripheral BP, and central SBP levels, even after adding BMI, waist circumference, waist-to-height ratio, puberty development and age in the regression model. Obese children with high HOMA-IR presented a greater weight excess and significantly higher vascular markers, but TMAO levels did not differ significantly from the obese with HOMA-IR

Conclusion

Our study provides compelling evidence supporting the link between serum TMAO, obesity, and vascular damage in children. These findings highlight the importance of further research to unravel the underlying mechanisms of this connection.

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Key Words

• TMAO
• arterial stiffness
• atherosclerosis
• cardiovascular risk
• carotid intima-media thickness
• childhood obesity
• high blood pressure
• pulse wave velocity

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MESH Headings

• Adult
• Female
• Humans
• Child
• Pediatric Obesity/complications
• Carotid Intima-Media Thickness
• Vascular Stiffness/physiology
• Pulse Wave Analysis
• Acanthosis Nigricans
• Atherosclerosis/diagnosis
• Atherosclerosis/etiology
• Biomarkers

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Grants Collapse

Affiliation(s)

Monica Simina Mihuta Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Corina Paul Department of Pediatrics, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Andreea Borlea Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Cristina Mihaela Roi Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Denisa Pescari Department of Doctoral Studies, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Oana-Alexandra Velea-Barta 3rd Department of Odontotherapy and Endodontics, Faculty of Dental Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Ioana Mozos Department of Functional Sciences—Pathophysiology, Center for Translational Research and Systems Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
Dana Stoian Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania 2nd Department of Internal Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania

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Differentiating thyroid nodules parathyroid lesions using 2D-shear-wave elastography: a novel approach for enhanced diagnostic accuracy

Differentiating between thyroid and parathyroid lesions by means of ultrasound can be a challenge in some cases. This study explores the diagnostic efficacy of bidimensional shear wave elastography planewave ultrasound (2D SWE PLUS) as an auxiliary technique in distinguishing these superficial structures. We evaluated 86 cases, presenting with concurrent thyroid nodules and hyperparathyroidism, through conventional ultrasound and 2D SWE PLUS, employing an Aixplorer Supersonic Mach30 with a 5-18 MHz linear probe. Statistically significant differences were observed for the elasticity index (EI) between parathyroid and normal thyroid tissue (p<0.0001, U=291), and between parathyroid lesions and thyroid nodules (p<0.0001, U=248.5). An area under the curve (AUC) of 0.961, with an optimal cut-off value of ≤8.9 kPa, was established to effectively distinguish parathyroid tissue from normal thyroid tissue (sensitivity of 91.9%; specificity of 97.5%). Furthermore, an AUC of 0.963 and an optimal cut-off of 9.24 kPa (sensitivity of 94.2%, specificity of 91.1%) were determined for parathyroid vs thyroid lesions. Elasticity values were significantly elevated in the cancer group compared to benign thyroid nodules (p<0.0001). Our findings suggest that 2D SWE PLUS is an effective tool in differentiating between thyroid nodules and parathyroid lesions, enhancing diagnostic performance in neck ultrasonography.

A Comparative Analysis of Strain and 2D Shear Wave Elastography in the Diagnosis of Autoimmune Thyroiditis in Pediatric Patients

This paper aims to assess the usefulness of shear-wave elastography (SWE) and strain elastography (SE) for identifying and monitoring thyroid gland changes in children diagnosed with chronic autoimmune thyroiditis (CAT). Our study included 77 children between the ages of six and eighteen. Of these, 45 were diagnosed with CAT, while 32 had no thyroid pathology. Following a clinical examination and laboratory tests, an ultrasound was carried out, and then a SE (using a Hitachi Preirus machine) and SWE (using an Aixplorer Mach 30, Supersonic imagine, France) were performed in the same session. The median thyroid elastic index (EI) in the CAT group was 13.8 (13.3-17) kPa compared to 10.1 (9.3-11.2) kPa in healthy children (p < 0.0001). We found a median strain ratio (SR) of 1.2 (1.2-1.3) for CAT compared to 0.7 (0.6-0.9) for healthy thyroid tissue (p < 0.0001). The optimal cut-off value for predicting the presence of CAT in children using SR was >1 (Se = 82.2%, Sp = 87.5%, PPV = 90.2%, and NPV = 77.8%, AUROC = 0.850), while using SWE, the optimal cut-off value for predicting the presence of CAT in children was >12 kPa (Se = 88.9%, Sp = 93.7%, PPV = 95.2%, and NPV = 85.5%, AUROC = 0.943). Both techniques are useful for measuring thyroid tissue elasticity, and their diagnostic accuracy and reliability are comparable.

The impact of the COVID-19 pandemic on thyroid nodular disease: a retrospective study in a single center in the western part of Romania

Introduction

The COVID-19 pandemic had a significant impact on the healthcare system, leading to a prioritization of hospital admissions in many countries. Romania was no exception, and it had to restrict patient access to medical services in hospitals with chronic diseases and oncological pathology, including thyroid cancer. This study aimed to compare the clinical and pathological factors of patients with nodular thyroid disease diagnosed and surgically treated during the two years before and after the COVID-19 pandemic, in a single medical institution.

Methods

The retrospective study included 1505 patients who were diagnosed and operated on for nodular thyroid disease between January 2018 and December 2021. The patients were divided into two groups: the "PRECOVID" group (January 2018 to February 2020), and the "POSTCOVID" group (March 2020 to December 2021). The analyzed parameters included patients' gender, age, preoperative diagnosis, type of surgical intervention, and pathological diagnosis.

Results

A significant decrease was observed in the number of surgeries performed for thyroid nodular disease during the COVID-19 pandemic period (450 versus 1055 cases, p<0.00001). There was a significant decrease in the number of surgical reinterventions (0.9% in the POSTCOVID group versus 2.9% in the PRECOVID group, p=0.01) and a significant increase in the number of total thyroidectomies (84.9% in the POSTCOVID group versus 80.1% in the PRECOVID group, p=0.02). We also observed a higher incidence of malignant/borderline tumors in the POSTCOVID group compared to the PRECOVID group (p=0.04) and a significantly higher frequency of aggressive forms of thyroid cancer in the POSTCOVID group (p=0.0006).

Discussion

The COVID-19 pandemic had a significant impact on the surgical management of nodular thyroid disease, resulting in a decrease in surgeries and a change in the type of surgical interventions performed. The higher incidence of malignant/borderline tumors diagnosed during the pandemic highlights the importance of timely diagnosis and treatment of thyroid nodules to prevent cancer progression.

The Paradox of Sexual Dysfunction Observed during Pregnancy

The aim of this study is to analyze the evolution of sexual function throughout pregnancy and highlight the predicting factors of sexual dysfunction in pregnant women. Our study included 144 participants, aged 16 to 45. Patients were evaluated three times during pregnancy by filling out the Female Sexual Function Index (FSFI) and the Body Exposure in Sexual Activities Questionnaire (BESAQ). At the time of the last evaluation, we asked patients to also fill out Beck's Depression Inventory (BDI-II) and a questionnaire regarding their psychological status and relationship satisfaction. We observed that the FSFI lubrication, satisfaction, and pain domains and the FSFI total score significantly decreased from the 1st to the 3rd evaluation. We observed that an increase in BDI score and the presence of abortion in the patient's history increase the risk of developing female sexual dysfunction (FSD). Higher BMIs were found to be a protective factor against FSD, as was being unmarried. The relationship satisfaction score was found to be an independent predictor of FSD. These findings support previous studies that indicate that pregnancy and postpartum sexuality are multifaceted phenomena and that psycho-social factors have a greater impact on sexuality than biological factors.

Unveiling the Silent Danger of Childhood Obesity: Non-Invasive Biomarkers Such as Carotid Intima-Media Thickness, Arterial Stiffness Surrogate Markers, and Blood Pressure Are Useful in Detecting Early Vascular Alterations in Obese Children

Obese children present a higher cardio-metabolic risk. Measuring vascular biomarkers that assess the evolution of arterial stiffness, subclinical atherosclerosis, and hypertension in such patients could be helpful in the long term. We studied 84 children, aged from 6 to 18 years: 50 obese subjects, versus 34 of normal weight. Clinical examination involved: BMI, waist circumference, waist-to-height ratio, and detection of the presence of acanthosis nigricans and irregular menstrual cycles (the latter in adolescent girls). The carotid intima-media thickness (CIMT) was measured with the Aixplorer MACH 30 echography device. The pulse wave velocity (PWV), augmentation index (AIx), and peripheral and central blood pressures (i.e., SBP, DBP, cSBP, cDBP, and cPP) were acquired through a Mobil-O-Graph device. Obese subjects underwent body composition analysis with a Tanita BC-418. Blood tests were: HOMA-IR, lipid panel, uric acid, and 25-OH vitamin D. All vascular biomarkers presented increased values in obese subjects versus controls. The following cut-off values were significant in detecting obesity: for PWV > 4.6 m/s, cSBP > 106 mmHg for the <12-year-olds, PWV > 4.5 m/s and cSBP > 115 mmHg for the 12-15-year-olds, and PWV > 5 m/s, cSBP > 123 mmHg for the >15-year-olds. AIx is higher in obese children, regardless of their insulin resistance status. Waist circumference and waist-to-height ratio correlate to all vascular parameters. HOMA-IR is an independent predictor for all vascular parameters except CIMT. Cut-off values for PWV of >4.8 m/s, SBP > 125 mmHg, and a cSBP > 117 mmHg predicted the presence of acanthosis nigricans. Obese girls with irregular menses displayed significantly higher PWV, SBP, and DPB. Elevated levels of uric acid, LDL-c, non-LDL-c, triglycerides, and transaminases, and low levels of HDL-c and 25-OH vitamin D correlated with higher arterial stiffness and CIMT values. We conclude that CIMT and the markers of arterial stiffness are useful in the early detection of vascular damage in obese children.

Effects of Hormonal Profile, Weight, and Body Image on Sexual Function in Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a hyperandrogenic endocrinological disorder associated with chronic oligo-anovulation and polycystic ovarian morphology. Compared to women without PCOS, women with PCOS have a risk of sexual dysfunction that is more than 30% higher. Although alterations in sex hormones and psychosocial wellbeing have been proposed, the precise mechanisms of FSD in PCOS remain unclear. The aim of our study was to analyze how the hormonal, clinical and psychometric parameters of PCOS patients are involved in the development of sexual dysfunction. The study group consisted of 54 women, aged between 21 and 32 years, diagnosed with PCOS. We collected the following parameters: age, body mass index (BMI), the Ferriman-Gallwey score (FG), maximum duration of oligomenorrhea, abdominal circumference (AC), free testosterone value (FT), luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio value, serum cortisol value and ovarian ultrasound appearance. At the time of the examination, patients were asked to fill in the Female Sexual Function Index (FSFI) and the Body Exposure during Sexual Activities Questionnaire (BESAQ). Statistically significant differences were observed between normal weight and overweight women regarding BESAQ (p-value = 0.02) and FSFI total (p-value <0.001). Elevated BMI, AC or BESAQ scores correlated with a lower FSFI score. The most involved domains of the scale were orgasm, arousal, and desire. Elevated BESAQ scores increase the risk of female sexual dysfunction (FSD) by 4.24 times. FT, BESAQ score, BMI, and LH/FSH ratio were found to independently predict FSD. The cutoff point for the BESAQ score in detecting FSD was found to be 1.97. Weight, body image and anxiety related to sexual activities seem to be significant components in the development of sexual dysfunction in PCOS patients, beyond the effect due to hyperandrogenism. FT value has a U-shape effect in sexual dysfunction, because both in the case of deficit and in the case of excess, sexual function is impaired. BESAQ is a strong predictor for sexual dysfunction in women with PCOS, along with FT value, LH/FSH ratio and BMI.

Assessment of Thyroid Stiffness and Viscosity in Autoimmune Thyroiditis Using Novel Ultrasound-Based Techniques

The estimation of viscosity by measuring the shear-wave dispersion (SWD) using ultrasound 2D shear-wave elastography (SWE) is becoming more and more popular. Recent research suggests that SWD can be used in addition to 2D-SWE (shear-wave speed) to diagnose diffuse liver disease. Viscosity was studied for the assessment of normal thyroid tissue. This study aims to evaluate the use of viscosity measurements in patients with chronic autoimmune thyroiditis using the SuperSonic MACH^®30 ultrasound machine (Hologic SuperSonic Imagine, Aix-en-Provence, France) which provides the Vi PLUS mode for viscosity and the 2D SWE PLUS mode for shear-wave speed measurements. Valid measurements were obtained in 308 cases, 153 with chronic autoimmune thyroiditis (CAT) and 155 with no thyroid pathology (95.95% feasibility of the methods). The differences between the healthy group and the CAT group were statistically significant both for Vi PLUS (2.5 ± 0.4 vs. 2.8 ± 0.5, p < 0.0001) and for 2D-SWE PLUS (13.5 ± 3.3 vs. 23.1 ± 8.3, p < 0.0001). The diagnostic performance was poor for Vi PLUS alone (AUC = 0.69; cut-off > 2.5 Pa·s, se = 68.6%; sp = 64.52%) and good for 2D-SWE PLUS alone (AUC = 0.861; cut-off > 18.4 kPa, se = 69.9%; sp = 92.2%). Vi PLUS correlated with 2D-SWE PLUS, with the presence of CAT, the thyroid volume, levothyroxine replacement therapy and age. Statistically significant differences were found between the CAT subgroup receiving thyroid replacement therapy and the subgroup without therapy: 24.74 ± 8.33 vs. 21.93 ± 8.12 kPa for 2D-SWE (p = 0.0380) and 3 ± 0.5 vs. 2.7 ± 0.4 Pa·s for Vi PLUS (p = 0.0193). Elastography-based methods improve the classic ultrasound evaluation: 2D-SWE PLUS performed somewhat better in distinguishing CAT from normal thyroid tissue, while Vi PLUS made a slightly better assessment regarding the functional status.

The Impact of the Blood Lipids Levels on Arterial Stiffness

Arterial stiffness is a recognized predictor of cardiovascular morbidity and death. It is an early indicator of arteriosclerosis and is influenced by numerous risk factors and biological processes. The lipid metabolism is crucial and standard blood lipids, non-conventional lipid markers and lipid ratios are associated with arterial stiffness. The objective of this review was to determine which lipid metabolism marker has a greater correlation with vascular aging and arterial stiffness. Triglycerides (TG) are the standard blood lipids that have the strongest associations with arterial stiffness, and are often linked to the early stages of cardiovascular diseases, particularly in patients with low LDL-C levels. Studies often show that lipid ratios perform better overall than any of the individual variables used alone. The relation between arterial stiffness and TG/HDL-C has the strongest evidence. It is the lipid profile of atherogenic dyslipidemia that is found in several chronic cardio-metabolic disorders, and is considered one of the main causes of lipid-dependent residual risk, regardless of LDL-C concentration. Recently, the use of alternative lipid parameters has also been increasing. Both non-HDL and ApoB are very well correlated with arterial stiffness. Remnant cholesterol is also a promising alternative lipid parameter. The findings of this review suggest that the main focus should be on blood lipids and arterial stiffness, especially in individuals with cardio-metabolic disorders and residual cardiovascular risk.

Evaluating the Arterial Stiffness as a Useful Tool in the Management of Obese Children

Childhood obesity speeds up the development of arterial stiffness and progressively increases the values of arterial pressure. The purpose of this study is to investigate the value of using pulse wave analysis (PWA) to measure arterial stiffness as a sign of vascular wall impairment in obese children. The research was focused on 60 subjects: 33 obese and 27 normal-weight. Ages ranged from 6 to 18 years old. PWA includes parameters such as pulse wave velocity (PWV), augmentation index (AIx), peripheral and central blood pressure (SBP, DBP, cSBP, cDBP), heart rate, and central pulse pressure (cPP). The device used was a Mobil-O-Graph. Blood parameters were taken from the subject's medical history, not older than 6 months. A high BMI and a large waist circumference are linked to a high PWV. The levels of LDL-c, triglycerides (TG), non-HDL-c, TG/HDL-c ratio, and total cholesterol-HDL-c ratio significantly correlate to PWV, SBP, and cSBP. Alanine aminotransferase is a reliable predictor of PWV, AIx, SBP, DBP, and cDBP, while aspartate aminotransferase is a significant predictor of AIx, mean arterial pressure (MAP), cSBP, and cPP. 25-OH-Vitamin D negatively correlates with PWV, SBP, and MAP and significantly predicts the MAP. Cortisol and TSH levels are not significant to arterial stiffness in obese children without specific comorbidities and neither is fasting glucose in obese children without impaired glucose tolerance. We conclude that PWA contributes valuable data regarding patients' vascular health and should be considered a reliable tool in the management of obese children.

Quantification of Thyroid Viscosity in Healthy Subjects Using Ultrasound Shear Wave Dispersion (Viscosity PLUS)

Shear-wave elastography (SWE) is widely used in thyroid evaluation, but multiple factors influence thyroid stiffness. Estimating tissue viscosity may enhance the ultrasound diagnosis of thyroid diseases, along with the ultrasound (US) and the SWE assessment. In order to be able to detect diffuse thyroid disease by viscosity measurements, it is essential to firstly define the normal values of thyroid viscosity in healthy subjects. Currently there are no published data on thyroid viscosity measurements. This first prospective study aimed to determine the normal range of thyroid viscosity values in a cohort of healthy thyroids, as well as to determine the factors that may influence them. One hundred and twenty-one consecutive subjects without thyroid pathology were evaluated in the study by means of conventional ultrasound, two-dimensional SWE (2D SWE PLUS) and viscosity plane-wave ultrasound (ViPLUS) embedded in the Supersonic MACH^® 30 ultrasound system. Five valid tissue viscosity measurements were obtained for each thyroid lobe in every patient and the median values were analyzed and correlated with the biological and demographic parameters of each patient. Our results reveal that ViPLUS is a highly feasible and reproducible technique for thyroid evaluation. Thyroid stiffness, age, gender, BMI and depth of measurements did not influence the thyroid viscosity values. The mean thyroid viscosity by ViPLUS for normal thyroid tissue was of 2.42 ± 0.41 Pa·s. Viscosity assessment by Supersonic ViPLUS is an innovative, non-invasive technique that has proven to be useful for thyroid US evaluation and remains to demonstrate its effectiveness in identifying patients with thyroid disease.

The Oscillometric Pulse Wave Analysis Is Useful in Evaluating the Arterial Stiffness of Obese Children with Relevant Cardiometabolic Risks

Early detection of all complications of childhood obesity is imperative in order to minimize effects. Obesity causes vascular disruptions, including early increased arterial stiffness and high blood pressure. This study’s aim is to assess the reliability of pulse wave analysis (PWA) in obese children and how additional risk factors influence the evaluated parameters. We analyzed 55 children aged 6–18 years old by measuring their pulse wave velocity (PWV), augmentation index (AIx), peripheral blood pressure (SBP, DBP), heart rate, central blood pressure (cSBP, cDBP) and central pulse pressure (cPP). We used the oscillometric IEM Mobil-O-Graph and performed a single-point brachial measurement. The subjects were divided into two groups: obese (n = 30) and normal-weight (n = 25) and were clinically and anamnestically assessed. BMI and waist circumference are significantly correlated to higher values for PWV, SBP, DBP, cSBP, and cDBP. Weight significantly predicts PWV, SBP, DBP and cPP. The risk factors that significantly influence the PWA and BP values are: a cardiometabolically risky pregnancy (higher PWV, AIx, SBP), active and passive smoking (higher PWV, SBP, cSBP, cDBP), sleep deprivation (higher PWV, SBP, cSBP) and sedentariness (higher PWV, AIx, peripheral and central BP). We conclude that obese children with specific additional cardiometabolic risk factors present increased arterial stiffness and higher blood pressure values.

The Relationship Between Dietary Choices and Health and Premature Vascular Ageing

The paper aims to review the available data about the main mechanisms enabling improvement or accelerating vascular ageing due to food choices, considering recent experimental and clinical data, and emphasising potential implications for clinical practice and therapy. The main food choices which will be discussed are diets rich in fruits and vegetables, the Mediterranean diet, polyunsaturated fatty acids, cocoa, caffeine, tea, meat, dairy products, sodium, and potassium intake.

Plasma ghrelin, adiponectin and leptin levels in obese rats with type 2 diabetes mellitus after sleeve gastrectomy and gastric plication

The prevalence of obesity has increased in recent decades and has become a public health problem. In obesity patients the metabolism of almost all adipokines is markedly dysregulated. Studies regarding levels of ghrelin, leptin, and adiponectin after bariatric surgery reveal contradictory results. The purpose of the present study was to analyze modification of body weight and plasma levels of fasting glucose, ghrelin, adiponectin and leptin, in obese rats with T2DM after sleeve gastrectomy (SG), gastric plication (GP) and sham-operated (SO). Eighteen specimens where randomized to three weight-matched groups: Group SG underwent sleeve gastrectomy (n=6), group GP underwent gastric plication (n=6) and the control group SO underwent sham surgery (n=6). Upon surgery a normal rat chow diet (Bio-Serv^® product no. F4031) was fed to the rats until the end of the experiment. Additional blood samples were harvested after 4 weeks. The results revealed that body mass decreased in the SG (783.17±101.39 vs. 658.33±86.57 g; P<0.0001) and the GP (781.33±103.12 vs. 702.33±84.06 g; P=0.004) rats after surgery. There were significant lower fasting glucose levels at 4 weeks postoperative in the SG group compared to the SO group (83.1±12.81 vs. 104.5±9.81 mg/dl; P=0.016). The same trend was observed in the GP group vs. the SO group (86.7±11.43 vs. 104.5±9.81 mg/dl; P=0.026). There was no difference regarding mean glucose levels between the SG group compared to the GP group (P>0.05). Plasma acylated ghrelin and leptin levels decreased four weeks after surgery compared to preoperative levels, while adiponectin levels increased four weeks after surgery in the SG and GP groups, respectively. The present study revealed that plasma glucose levels, ghrelin and leptin levels decreased after SG and GP, while adiponectin levels improved. This suggests that there may be hormonal contribution in weight loss.

Thyroid Autoimmune Disease-Impact on Sexual Function in Young Women

The important prevalence of autoimmune thyroid disease (AITD) in the general population was the main motivation for conducting the present study. The present paper aims to estimate the possible comorbidities related to female sexual dysfunction (FSD) and depression related to AITD. The study group consisted of 320 patients: 250 cases known with untreated AITD, divided into subgroups (euthyroid subgroup, subclinical hypothyroidism subgroup and clinical hypothyroidism subgroup); respectively 70 healthy females in the control group. Patients underwent thyroid evaluation, ovarian evaluation and laboratory assays. At the time of the diagnosis of autoimmune thyroid disease, psychometric scales were filled in by the patients: the Female Sexual Function Index 6 (FSFI-6) and the Beck’s Depression Inventory-II (BDI-II). It was observed that healthy patients had significantly higher FSFI scores than patients with AITD (28 vs. 27; p = 0.006). In the AITD group, the risk of FSD increases with the severity of thyroid disease. The most affected areas were: sexual desire (p < 0.001), lubrication (p = 0.001) and orgasm (p = 0.008), followed by excitability and sexual satisfaction. The severity of hypothyroidism influences the degree of decrease in libido, central and peripheral excitability. Sexual satisfaction and orgasm were less influenced. The field related to pain seems uninfluenced by the presence of thyroid disease. The concomitant presence of depression and the value of thyroid-stimulating hormone (TSH) are risk factors in the development of FSD. Higher TSH value and BDI-II score increase the risk of female sexual dysfunction by 1.083 and 1.295 times, respectively. Our findings are significant and promising; they may help professionals dealing with sexual and reproductive health. Despite the importance of female sexual dysfunction and its prevalence, clinicians and patients often ignore it. In fact, only a small percentage of patients consult their doctors about sexual health, and their doctors do not often ask them questions related to this aspect.

The Value of Strain Elastography in Predicting Autoimmune Thyroiditis

Chronic autoimmune thyroiditis (CAT) defines a diffuse intrathyroidal lymphocytic infiltration associating a destructive process of the thyroid follicles, most commonly in evolution developing hypothyroidism. Typical ultrasound changes may suggest the presence of the disease. This study aims to evaluate the performance of strain elastography in detecting autoimmune thyroiditis as an additional tool to the conventional ultrasound examination. A total of 250 patients were enrolled in the study; 180 had biochemical confirmation of CAT, the other 70 healthy subjects represented the control group. All patients were examined clinically and by means of conventional thyroid ultrasound (US) and real-time elastography using a Hitachi Preirus machine (5–15 MHz linear probe). Five valid measurements for the parenchyma/muscle strain ratios (SR) were taken for each subject, considering the mean value for analysis. A mean SR value above 1.64 was found to predict the presence of CAT with sensitivity (Sen) 69%, specificity p92%, positive predictive value (PPV) 95.4%, negative predictive value (NPV) 54% and area under receiver operating characteristic (AUROC) 0.87. Moreover, when comparing the mean values for SR, significantly higher values were found in CAT patients compared with the controls (2.81 ± 2.11 vs. 1.03 ± 0.51; p < 0.0001). Of the 180 CAT subjects, 92 were on thyroid hormone replacement therapy; significantly higher values were detected for patients under therapy compared with asymptomatic cases (3.45 ± 2.53 vs. 2.15 ± 1.27, p < 0.0001). A cut-off value of 2.94 was established for identifying CAT patients who needed hormonal treatment (Sen 52.3%, Sp 83.7%, PPV 75.4%, NPV 64.7% and AUROC 0.66). No correlation was found between stiffness and antibody titers nor for functional status. Elastography does add valuable information to the US evaluation of cases with autoimmune thyroiditis.

Associations between Intrinsic Heart Rate, P Wave and QT Interval Durations and Pulse Wave Analysis in Patients with Hypertension and High Normal Blood Pressure

The present study aimed to explore the relationship between electrocardiographic (ECG) and pulse wave analysis variables in patients with hypertension (HT) and high normal blood pressure (HNBP). A total of 56 consecutive, middle-aged hypertensive and HNBP patients underwent pulse wave analysis and standard 12-lead ECG. Pulse wave velocity (PWV), heart rate, intrinsic heart rate (IHR), P wave and QT interval durations were as follows: 7.26 ± 0.69 m/s, 69 ± 11 beats/minute, 91 ± 3 beats/minute, 105 ± 22 mm and 409 ± 64 mm, respectively. Significant correlations were obtained between PWV and IHR and P wave duration, respectively, between early vascular aging (EVA) and P wave and QT interval durations, respectively. Linear regression analysis revealed significant associations between ECG and pulse wave analysis variables but multiple regression analysis revealed only IHR as an independent predictor of PWV, even after adjusting for blood pressure variables and therapy. Receiver-operating characteristic (ROC) curve analysis revealed P wave duration (area under curve (AUC) = 0.731; 95% CI: 0.569-0.893) as a predictor of pathological PWV, and P wave and QT interval durations were found as sensitive and specific predictors of EVA. ECG provides information about PWV and EVA in patients with HT and HNBP. IHR and P wave durations are independent predictors of PWV, and P wave and QT interval may predict EVA.

Characterization and in vitro Evaluation of a New Levonorgestrel Silver Liposomes

Levonorgestrel is the most widely used synthetic hormone due in particular to strong progestin and anti-ovulatory effects, without estrogenic effects, being also used in hormone supportive therapy and found in preclinical studies for the prevention / occurrence of malignant processes. In order to be able to eliminate the adverse effects but to benefit at the same time from the beneficial biological effects, the posibility of obtaining effective and safe biocompatible formulations is studied. In the present research silver nanoparticles loaded with lenorgestrel were obtained and were subsequently included in a liposomal transporter system. Physico-chemical characterizations showed good stability of the liposomal systems obtained and dimensions compatible with the biological environment. In vitro data conducted on breast cells (MCF 10A and MCF7) revealed a dose-dependent influence in terms of cell viability with no significant changes at low concentration of samples (0.1 μM), while higher concentration was associated with a decrease of the viable breast adenocarcinoma cells especially in the case of silver nanoparticles.

IgG anti-(Fab�)2 Antibodies in Early Pregnancy Sera of Women with Anti-thyroid Antibodies and Normal Outcome or Spontaneous Abortions

Anti-thyroid antibodies (atbs) (anti-TPO, anti-TG, anti-TRH receptor) are autoatbs that recognize specific antigens that belong to thyroid structures. Several mechanisms were proposed to explain the breaking of immunotolerance to thyroid antigens. Our previous studies showed that IgG-anti-F(ab�)2 atbs exert immunosuppresives effect in vitro and inverse correlate with autoatbs in certain autoimmune diseases. Relying on sera from pregnant women with and without anti-thyroid atbs, respectively with or without spontaneous pregnancy loss we intended to analyze the IgG-anti-F(ab)2 atbs titers in sera of these categories of patients. The lot of patients consists of 126 pregnant women out of which 47 had a normal course of pregnancy and 79 experienced spontaneous abortion. Anti-TPO, anti-TG, and IgG-anti-F(ab�)2 atbs titers were measured in sera of these women. Although a difference was found between IgG-anti-F(ab�)2 atbs titer in pregnant women with positive versus negative anti-thyroid atbs, this was not statistically significant. IgG-anti-F(ab)2 atbs titer is higher in women with a normal course of pregnancy compared to women spontaneous pregnancy loss. Differently from other autoimmune diseases, our data show that IgG-anti-F(ab�)2 atbs are not inversely correlated to anti-thyroid atbs titers. Higher IgG-anti-(Fab�)2 atbs titers were found in pregnant women with normal course of pregnancy compared with those with pregnancy loss.

Shear Wave Elastography versus Strain Elastography in Diagnosing Parathyroid Adenomas

OBJECTIVES

The aim of the study was to compare elastographic means in parathyroid adenomas, using shear wave elastography and strain elastography.

METHODS

This prospective study examined 20 consecutive patients diagnosed with primary hyperparathyroidism and parathyroid adenoma, confirmed by biochemical assay, technetium-99 sestamibi scintigraphy, and pathology report, after parathyroid surgery. All patients were examined on conventional 2B ultrasound, 2D shear wave elastography, and strain elastography. We determined using 2D shear wave elastography (SWE) the elasticity index (EI) in parathyroid adenoma, thyroid parenchyma, and surrounding muscle and examined using strain elastography the parathyroid adenoma, and determined the strain ratio with the thyroid tissue and muscle tissue.

RESULTS

All patients had positive sestamibi scintigraphy and underwent surgery, with confirmation of parathyroid adenoma in all cases. The mean parathormone (PTH) value before surgery was 153.29 pg/ml (36.5, 464.8) and serum calcium concentration was 10.5 mg/dl (9, 11.5). We compared using 2D-SWE and strain elastography parathyroid adenoma with thyroid tissue and with surrounding muscle. The mean EI measured by SWE in parathyroid adenoma was 4.74 ± 2.74 kPa and in thyroid parenchyma was 11.718 ± 4.206 kPa (mean difference = 6.978 kPa, p < 0.001), and the mean EI value in muscle tissue was 16.362 ± 3.829 kPa (mean difference = 11.622, p < 0.001). Using ROC analysis, we found that an EI below 7 kPa correctly identifies parathyroid tissue. We evaluated parathyroid adenomas using strain elastography by color mapping and strain ratio as a semiquantitative measurement; however, we could not find any statistical correlation comparing the strain ratio obtained from the parathyroid adenoma with the thyroid tissue (p=0.485).

CONCLUSION

Ultrasound elastography is a helpful tool in identifying parathyroid adenomas. A cutoff value below 7 kPa can be used in 2D-SWE. Color maps in strain elastography without adding strain ratio can be used, parathyroid adenoma being identified as score 1 in the Rago criteria.

Rare splicing mutation in COL1A1 gene identified by whole exomes sequencing in a patient with osteogenesis imperfecta type I followed by prenatal diagnosis: A case report and review of the literature

BACKGROUND

Osteogenesis imperfecta (OI) is a rare disease characterized by increased bone fragility and predisposition to fractures, bone deformities and other major signs such as dentinogenesis imperfecta, blue sclera and deafness. Over 90% of OI cases are caused by mutations in the COL1A1 and COL1A2 genes and the inheritance is autosomal dominant.

METHODS

We present a case of a couple requesting genetic counseling, because the man was diagnosed with OI on a clinical and radiological basis and the woman was pregnant. Whole exomes sequencing (WES) was performed in order to identify the mutation (s), followed by prenatal diagnosis.

RESULTS

WES identified a rare splicing mutation c.1155 + 1G > C in the COL1A1 gene recognized to be pathogenic and subsequently confirmed by next generation sequencing. The carrier state of the mutation was excluded for the fetus, so the pregnancy was further pursued and a healthy baby was born at term.

CONCLUSIONS

WES is a new and effective technique for detecting pathogenic variants in monogenic diseases and it is preferable to use such a technique in diseases with genetic heterogeneity especially when time does not allow another time-consuming diagnostic technique such classical Sanger sequencing. WES offers possibility to expand the global spectrum of OI pathogenic variants enabling the diagnosis of the disease.

Advanced Ultrasound Application - Impact on Presurgical Risk Stratification of the Thyroid Nodules

Aim

Current major guidelines recommend risk stratification of the thyroid nodules, after each diagnostic evaluation, in order to focus attention on potentially risky nodules. The main aim of our study was to evaluate the performance of combined advanced ultrasound techniques in this process, compared with conventional stratification models, in order to reduce unnecessary fine-needle biopsies, respectively, surgery.

Material and Methods

We evaluated 261 cases (261 nodules) using conventional ultrasound (2B), real-time Doppler evaluation (4D) respectively, real-time elastography, using a linear multifrequency probe and a linear volumetric probe (Hitachi Prerius Machine, Hitachi Inc, Japan). All the nodules were classified using a risk stratification model comprising seven conventional US characteristics, two 4 D characteristics and a color map RTE aspect. The results were compared with the pathology results, considered the golden standard diagnosis.

Results

The prevalence of malignant nodules was 21.83% (57 cases). Conventional risk classification generated: 106 low-risk cases, 113 intermediate-risk and 42 high-risk cases. Our proposed risk classification changes the conventional risk classification with a risk upgrade in 27 cases and with a risk downgrade in 69 cases. The diagnostic quality of the combined risk stratification model was better, considering a low-risk category predictive for benignancy and a high category predictive for malignancy: Sensitivity: 80.88% versus 49.01%, respectively, Specificity: 91.22% versus 54.38. The diagnostic power differences were observed regardless of the nodule size.

Conclusion

Advanced ultrasound techniques did add diagnostic value in the presurgical risk assessment of the thyroid nodules.

Nicotine Activity on Healthy Oral Cells and Pharyngeal Tumor Cells

A number of studies highlight the harmful effects of smoking and the extremely serious consequences of the majority of compounds found in cigarettes and cigarette smoke. Of these, nicotine has attracted attention due to the suspicion of a carcinogen compound. The present study investigated the effect of nicotine on primary gingival keratinocytes but also on pharyngeal tumor cells, by evaluating viability and apoptotic processes.

RAS Inhibition in Haemodyalisis Patients. Impact on mortality

Patients with chronic kidney disease (CKD) represent a special category of risk. As part of the renal and cardiovascular continuum from risk factors to end stage diseases, they develop clinical syndromes with potentially severe prognosis. Patients on dialysis have severe cardiac risk, have a peculiar hyperlipemic profile with intense atherogenic effect, phosphocalcic metabolic alterations and thus a higher rate of development of atheroma and degenerative valve diseases. They have higher cardiovascular mortality and morbidity being potential candidates for aggressive reduction of risk factors. Dialysate patients are exposed to higher risk of ischemic and arrhythmic events. Echocardiographic assessment of these patients is extremely important in risk stratification and treatment strategy in order to improve prognosis. Drugs proved to improve cardiac remodeling, reduce hypertrophy and LV mass and enhance ejection fraction, improved prognosis.

Lycopene and Vascular Health

Lycopene is a lipophilic, unsaturated carotenoid, found in red-colored fruits and vegetables, including tomatoes, watermelon, papaya, red grapefruits, and guava. The present work provides an up to date overview of mechanisms linking lycopene in the human diet and vascular changes, considering epidemiological data, clinical studies, and experimental data. Lycopene may improve vascular function and contributes to the primary and secondary prevention of cardiovascular disorders. The main activity profile of lycopene includes antiatherosclerotic, antioxidant, anti-inflammatory, antihypertensive, antiplatelet, anti-apoptotic, and protective endothelial effects, the ability to improve the metabolic profile, and reduce arterial stiffness. In this context, lycopene has been shown in numerous studies to exert a favorable effect in patients with subclinical atherosclerosis, metabolic syndrome, hypertension, peripheral vascular disease, stroke and several other cardiovascular disorders, although the obtained results are sometimes inconsistent, which warrants further studies focusing on its bioactivity.

Weight of Pregnant Women and their Influence on Second Trimester Biochemical Markers

Fetal aneuploidies screening was based for a long time on ultrasonographic and biochemical markers measurement. The risk calculated in accordance with second trimester biochemical markers (STBM) values relies on calculation of corrected MoM values. MoM (multiple of Medians) signify the deviation of a measured value from the expected value (Median). The Median is measured at the same gestational age in pregnancies which involve healthy fetuses. The correction of MoM includes an adjustment for certain parameters that influence the STBM value: demographical (ethnicity), behavioral (smoking status, weight), and others (mode of conceiving, etc.). In our article we aim to analyze: (1) the accuracy of software to calculate STBM corrected MoM values, (2) the effect of weight of pregnant women on STBM and (3) the capability of software to counterbalance this influence. Pregnant women (n=1242) were screened for aneuploidies based on an integrated test: first trimester ultrasound and STBM (AFP, hCG and uE3). The absolute value, multiple of median (MoM) and corrected multiple of median (MoMc) values were 33.94�0.45, 1.04�0.12 and 0.98�0.01 for AFP, 22530�477, 0.87�0.01 and 0.85�0.01 for hCG, respectively 0.97�0.03, 0.99�0.01 and 0.98�0.01 for uE3. The weight of pregnant women inversely correlates with absolute and MoM AFP, hCG and uE3 values. No correlation was found with AFP and hCG MoMc values. A very weak inverse correlation was found between weight and uE3 corrected MoM values. Our study confirms that there is a difference between provider and own calculated hCG MoMc values. The weight of pregnant women inversely correlates with STBM values. The software used for aneuploidies risk evaluation corrects the influence of weight of pregnant women, but a minimal influence on uE3 corrected MoM values is still present.

Influence of Weight of Pregnant Women on First Trimester Biochemical Markers Values

Values of first trimester biochemical markers (PAPP-A and free b-hCG) concentration are included in aneuploidies risk evaluation algorithm. Since both markers are produced by the fetus and placenta their concentration depends on the volume in which they are dissolved, respectively the weight of the pregnant women. Our study aimed to analyze the influence of maternal weight on first trimester biochemical markers concentration and the ability of the risk calculation software to correct this influence. Pregnancy-associated protein A (PAPP-A) and free � chorionic gonadotropin hormone (free � hCG) first trimester sera concentration respectively weight were measured in 1629 pregnant women. First trimester PAPP-A and free beta hCG concentrations inverse correlate with weight of pregnant women rho=-0.33, p[0.0001, respectively rho=-0.18, p[0.0001. Weight of pregnant women inversely correlates with multiple of median (MoM) values of first trimester markers too: rho=-0.38, p[0.0001 (PAPP-A), respectively rho=-0.17, p[0.0001 (free-b-hCG). The software counterbalances the influence of weight on biochemical markers values. PAPP-A corrected MoM (MoMc) values don�t inversely correlate with the weight (rho=-0.03, p=0.12), whereas free � hCG MoMc values showed an extremely weak inverse correlation (rho=-0.08, p=0.0008). The software counterbalances the influence of weight on PAPP-A values, whereas an extremely weak but insignificant inverse correlation between weight and free-beta hCG values persists after correction.

Inflammatory Markers for Arterial Stiffness in Cardiovascular Diseases

Arterial stiffness predicts an increased risk of cardiovascular events. Inflammation plays a major role in large arteries stiffening, related to atherosclerosis, arteriosclerosis, endothelial dysfunction, smooth muscle cell migration, vascular calcification, increased activity of metalloproteinases, extracellular matrix degradation, oxidative stress, elastolysis, and degradation of collagen. The present paper reviews main mechanisms explaining the crosstalk between inflammation and arterial stiffness and the most common inflammatory markers associated with increased arterial stiffness, considering the most recent clinical and experimental studies. Diverse studies revealed significant correlations between the severity of arterial stiffness and inflammatory markers, such as white blood cell count, neutrophil/lymphocyte ratio, adhesion molecules, fibrinogen, C-reactive protein, cytokines, microRNAs, and cyclooxygenase-2, in patients with a broad variety of diseases, such as metabolic syndrome, diabetes, coronary heart disease, peripheral arterial disease, malignant and rheumatic disorders, polycystic kidney disease, renal transplant, familial Mediterranean fever, and oral infections, and in women with preeclampsia or after menopause. There is strong evidence that inflammation plays an important and, at least, partly reversible role in the development of arterial stiffness, and inflammatory markers may be useful additional tools in the assessment of the cardiovascular risk in clinical practice. Combined assessment of arterial stiffness and inflammatory markers may improve non-invasive assessment of cardiovascular risk, enabling selection of high-risk patients for prophylactic treatment or more regular medical examination. Development of future destiffening therapies may target pro-inflammatory mechanisms.

Qualitative strain elastography - strain ratio evaluation - an important tool in breast cancer diagnostic

AIMS

To assess the quality of real time elastography as a differential diagnosis tool for breast nodules and to compare it with standard ultrasonography.

MATERIAL AND METHODS

In this prospective study we enrolled 174 patients in which 174 dominant breast nodules were considered for the final diagnosis. The results of ultrasonography and real time elastography, both qualitative and quantitative, were compared with pathology findings from the biopsy specimens.

RESULTS

Pathology examinations determined 102 nodules were benign and 72 malignant. Qualitative elastography had a better diagnostic performance (82.4% sensitivity and 81.9% specificity) than ultrasonography plus Doppler evaluation (70.3% sensitivity and 73.5% specificity). Quantitative elastography, assessed using the fat-to-lesion ratio, was a good discriminant for malignancy (AUROC = 0.93, p < 0.001). Our results pointed to an optimal threshold for malignancy of > 4.88; by using this threshold, the diagnostic reliability of the fat-to-lesion ratio was better than both ultrasonography and qualitative elastography (86.5% sensitivity and 90.4% specificity).

CONCLUSION

Real time elastography is superior to ultrasonography in diagnosing malignant breast nodules. The evaluation of nodules using a fat-to-lesion ratio was a better discriminant for malignancy than qualitative elastography.

The Survival of Roma Minority Patients on Chronic Hemodialysis Therapy - A Romanian Multicenter Survey

Objective

The Roma minority represents the largest ethnic group in Central and South-East European countries. Data regarding the mortality in Roma hemodialysis subjects are limited. We evaluated the 3 year mortality of ESRD Roma patients treated with hemodialysis (HD).

Study Design and Setting

Our prospective cohort study included 600 ESRD patients on HD therapy recruited from 7 HD centers, from the main geographical regions of Romania. The median age of the patients was 56 (19) years, 332 (55.3%) being males, 51 (8.5%) having Roma ethnicity.

Results

Roma ESRD patients initiate dialysis at a younger age, 47.8 years vs. 52.3 years (P = 0.017), present higher serum albumin (P = 0.013) and higher serum phosphate levels (P = 0.021). In the Roma group, the overall 3 year mortality was higher when compared to Caucasians (33.3% vs. 24.8%). The multivariate survival analysis revealed that being of Roma ethnicity is an independent risk factor for mortality (HR = 1.74; 95% CI = 1.04–2.91; P = 0.035).

Conclusions

Roma patients with ESRD initiate HD therapy at a younger age as compared to Caucasians. They have a higher 3 year mortality rate and are dying at a younger age. Roma ethnicity represents an independent risk factor for mortality in our cohort.

Individualized Follow-up of Pregnant Women with Asymptomatic Autoimmune Thyroid Disease

Maternal hormones are essential for the normal fetal development during pregnancy. Autoimmune thyroid disease is a frequent pathology in our iodine replete region. The aim of this study is to evaluate the occurrence of subclinical hypothyroidism (SCH) in cases with known autoimmune thyroid disease, which were in a euthyroid state prior to pregnancy, and to assess the association between supplemental treatments administered and the outcome of the pregnancy. The study is a prospective interventional controlled study. The two cohorts comprise the interventional group, consisting of 109 pregnant women with known autoimmune asymptomatic thyroid disease, without any levothyroxine (LT4) treatment and an aged-matched control group, with an unknown thyroid disease. After the pregnancy, a monthly evaluation of TSH, FT3, and FT4 was performed. Offspring evaluation was made at birth time. 88.8% of the women developed SCH in the first four weeks of pregnancy. Average LT4 doses increased as the pregnancy progressed. The monthly adjustment was 12.5 or 25 μg. All SCH cases developed in the first trimester of pregnancy. There was no significant difference regarding the gestational week, weight, or length at birth between the interventional group and controls, when TSH values were in the optimal range, during the whole pregnancy. Premature birth was described in one case in the interventional group.

Thyroid Imaging Reporting and Data System (TI-RADS): the impact of Quantitative Strain Elastography for better stratification of cancer risks

AIMS

Due to the elevated prevalence of the solid thyroid nodules in a general population, an appropriate selection of cases referred to surgery is of paramount importance. The main aim of our study was to evaluate the performance of the Thyroid Imaging Reporting and Data System (TI-RADS) as a differential diagnosis tool for thyroid nodules.

MATERIAL AND METHODS

We evaluated 174 nodules using TI-RADS risk stratification model, using conventional ultrasound and real time elastography parameters and linear multifrequency probe (Hitachi Preirus Machine, Hitachi Inc., Japan). All the nodules were classified using the TI-RADS system according to echogenicity, margins, shapes, calcification, lymph nodes, and increased strain ration. The results were compared with the pathology exam, which was considered the golden standard diagnosis.

RESULTS

The prevalence of malignant nodules was 16.7% (29 cases). The differential diagnosis performance regarding the malignant tumor for TI-RADS is appropriate for clinical use, obtaining an area under ROC curve of 0.95761 [0.8424-0.989] 95% confidence interval. Combining TI-RADS 2, 3 and 4A as probably benign and TI-RADS 4B and 5 as probably malignant, the sensitivity, specificity, positive predictive value, and negative predictive value were 97.93%, 86.20%, 97.26% and 89.28% respectively. The overall accuracy of the method was 95.97%.According to the American Association of Clinical Endocrinologists Guidelines, 169 cases required FNAB examination; by applying the TI-RADS scoring system, the necessity for FNAB would decrease to 74 cases.

CONCLUSION

Quantitative strain elastography, as the 6th parameter of TI-RADS system, adds diagnostic power to the risk stratification model.

Predictors for pregnancy outcomes in Romanian women with Type 1 Diabetes Mellitus: a prospective study

BACKGROUND

Type 1 diabetes mellitus in pregnant women is associated with an increased risk of congenital malformations, obstetric complications, neonatal morbidity, and mortality. Our aim was to evaluate which factors from the first trimester of pregnancy have a significant impact on the pregnancy outcomes of women with type 1 diabetes.

METHODS

We included 94 pregnant women with type 1 diabetes in this study. In these patients, we analyzed the influence of several diabetes-related parameters on the pregnancy outcome. We compared the parameters between two cohorts: those with successful pregnancies and those with adverse pregnancy outcomes, defined as spontaneous abortion or congenital malformations. The influence of several factors on the pregnancy outcome was assessed using multivariate and univariate logistic regressions.

RESULTS

The prevalence of adverse pregnancy outcomes was 28.7%, and was associated with poorer glycemic control (p <0.001), lower frequency of daily self-monitoring tests (p <0.001), smoking status (p <0.001), alcohol consumption (p <0.001), increased prevalence of chronic complications of diabetes, and the presence of ketosis. However, the adverse outcomes were not significantly associated with age, duration of diabetes, presence of thyroid disease, or body mass index. Furthermore, planned pregnancy was found to be a significant protective factor (odds ratio, 0.15; p <0.001).

CONCLUSION

These results indicate that by carefully planning the pregnancy, ensuring optimal glycemic control, and eliminating habitual risk factors, the fetal risk in pregnancies among women with type 1 diabetes may decrease to a value similar to that noted in women without diabetes.

Metabolic syndrome: its features in overweight women with polycystic ovary syndrome as compared with obese women without ovarian dysfunction?

OVARIAN DYSFUNCTIOBJECTIVE: The study assesses the frequency of metabolic changes in overweight patients with or without polycystic ovary syndrome.

MATERIAL AND METHODS

The study group was made up by 148 patients of whom 99 patients without polycystic ovary syndrome (group A, control group) and 49 with polycystic ovary syndrome (group B), that came in our endocrine unit for a weight loss program, in the September 2008 March 2009 period. Morphometric parameters (height, weight, body mass index), biological parameters (cholesterol, triglycerides, blood glucose, glycated hemoglobin) and body composition analysis by measuring the electrical bioimpedance, were evaluated.

RESULTS

Patients with polycystic ovary syndrome have a higher percentage of total fat (38.22+/-7.2) than patients without polycystic ovary syndrome (36.316+/-5.65) (p<0.05), for the same characteristics. Glycated hemoglobin, blood glucose and triglycerides were found higher in group B patients. Furthermore, the amount of free testosterone is higher in group B patients compared to those in group A. The prevalence of metabolic syndrome was higher in polycystic ovary syndrome cases (26.13%) comparative with overweight cases (16.16%, p<0.01).

CONCLUSIONS

In the group of overweight patients, the group of patients with polycystic ovary syndrome is a particular group showing more severe metabolic changes.

Nodular thyroid cancer. Diagnostic value of real time elastography

BACKGROUND

The most important aspect in the diagnostic approach of thyroid nodule is identifying the malignancy Elastography is a newly technique that measures the elasticity of tissue, after applying a external force, standardized control. US elastography is currently used in differentiation of malignant from benign lesions.

PATIENTS

This prospective study included 69 patients, mean age 50.08 +/- 12.43 years, 67 females and 2 men, with thyroid nodules on conventional US, with a volume higher than 0.20 ml. All patients underwent surgery after complete evaluation. Extemporaneous and postsurgical histopathological exam was performed in all cases. Tissue stiffness was scored from one (greatest elasticity) to 5 (no strain), according to the UENO scale.

RESULTS

In the 69 cases we diagnosed 107 nodules, which we analyzed. 27 nodules had score 1 on US elastography and 37 nodules had score 2. All nodules were benign on histopathological exam. Score 3 was found in 33 cases, 32 benign and one papillary carcinoma. Score 4 as found in 10 cases, all carcinomas. ES score of 4 is highly predictive for malignancy (sensitivity of 90.9%, specificity of 98.96%, positive predictive value of 100%, negative predictive value if 98.60%). The diagnostic quality of elastography was independent of the nodule volume.

CONCLUSION

US elastography has a good potential in diagnosing thyroid malignancy, independent of nodule volume, allowing the study of small nodules, less than 0.5 ml.