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Huang KD, Amend L, Gálvez EJC, Lesker TR, de Oliveira R, Bielecka A, Blanco-Míguez A, Valles-Colomer M, Ruf I, Pasolli E, Buer J, Segata N, Esser S, Strowig T, Kehrmann J. Establishment of a non-Westernized gut microbiota in men who have sex with men is associated with sexual practices. Cell Rep Med 2024; 5:101426. [PMID: 38366600 PMCID: PMC10982974 DOI: 10.1016/j.xcrm.2024.101426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/07/2023] [Accepted: 01/22/2024] [Indexed: 02/18/2024]
Abstract
The human gut microbiota is influenced by various factors, including health status and environmental conditions, yet considerable inter-individual differences remain unexplained. Previous studies identified that the gut microbiota of men who have sex with men (MSM) is distinct from that of non-MSM. Here, we reveal through species-level microbiota analysis using shotgun metagenomics that the gut microbiota of many MSM with Western origin resembles gut microbial communities of non-Westernized populations. Specifically, MSM gut microbiomes are frequently dominated by members of the Prevotellaceae family, including co-colonization of species from the Segatella copri complex and unknown Prevotellaceae members. Questionnaire-based analysis exploring inter-individual differences in MSM links specific sexual practices to microbiota composition. Moreover, machine learning identifies microbial features associated with sexual activities in MSM. Together, this study shows associations of sexual activities with gut microbiome alterations in MSM, which may have a large impact on population-based microbiota studies.
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Affiliation(s)
- Kun D Huang
- Department of Microbial Immune Regulation, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Lena Amend
- Department of Microbial Immune Regulation, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Eric J C Gálvez
- Department of Microbial Immune Regulation, Helmholtz Centre for Infection Research, Braunschweig, Germany; Hannover Medical School, Hannover, Germany; Roche Pharma Research and Early Development, Roche Innovation Center, Basel, Switzerland
| | - Till-Robin Lesker
- Department of Microbial Immune Regulation, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Romulo de Oliveira
- Department of Microbial Immune Regulation, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Agata Bielecka
- Department of Microbial Immune Regulation, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | | | - Mireia Valles-Colomer
- Department CIBIO, University of Trento, Trento, Italy; Department of Medicine and Life Sciences, University Pompeu Fabra, Barcelona, Spain
| | - Isabel Ruf
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Edoardo Pasolli
- Department of Agricultural Sciences, University of Naples, Naples, Italy
| | - Jan Buer
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nicola Segata
- Department CIBIO, University of Trento, Trento, Italy
| | - Stefan Esser
- Department of Dermatology and Venerology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Till Strowig
- Department of Microbial Immune Regulation, Helmholtz Centre for Infection Research, Braunschweig, Germany; Hannover Medical School, Hannover, Germany; Centre for Individualized Infection Medicine, Hannover, Germany.
| | - Jan Kehrmann
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
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Zohdy YM, Skandalakis GP, Kassicieh AJ, Rumalla K, Kazim SF, Schmidt MH, Bowers CA. Causes and Predictors of Unplanned Readmission in Patients Undergoing Intracranial Tumor Resection: A Multicenter Analysis of 31,776 Patients. World Neurosurg 2023; 178:e869-e878. [PMID: 37619845 DOI: 10.1016/j.wneu.2023.08.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Although unplanned readmission is a postoperative outcome metric associated with significant morbidity and financial burden, precise assessment tools for its prediction have not yet been developed. The Risk Analysis Index (RAI) could potentially be used to help improve the prediction of unplanned readmissions for patients undergoing intracranial tumor resection (ITR). In the present study, we evaluate the predictive accuracy of frailty on 30-day unplanned readmission after ITR using the RAI. METHODS Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program database. The baseline characteristics, preoperative clinical status, and outcomes were compared between patients with and without unplanned readmission. Frailty was calculated using the RAI. Univariate and multivariate logistic regression analyses were performed to identify independent associations between unplanned readmissions and patient characteristics. RESULTS The unplanned readmission rate for this cohort (n = 31,776) was 10.8% (n = 3420). Of the 3420 readmitted patients, 958 required unplanned reoperation. Multiple characteristics were significantly different between the 2 groups, including age, body mass index, comorbidities, and RAI groups (P < 0.05). The common causes of unplanned readmission included infection (9.4%), seizures (6%), and pulmonary embolism (4%). The patient characteristics identified as reliable predictors of unplanned readmission included age, body mass index, functional status, diabetes, hypertension, hyponatremia, and the patient's RAI score (P < 0.05). Frail status, hyponatremia, leukocytosis, hypertension, and thrombocytosis were significant predictors of unplanned readmissions. CONCLUSIONS The RAI is a reliable preoperative frailty index for predicting unplanned readmissions after ITR. Using the RAI could decrease unplanned readmissions by identifying high-risk patients and enabling future implementation of appropriate management guidelines.
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Affiliation(s)
- Youssef M Zohdy
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Georgios P Skandalakis
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, University of New Mexico Hospital, Albuquerque, New Mexico, USA; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Alexander J Kassicieh
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, University of New Mexico Hospital, Albuquerque, New Mexico, USA; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Kavelin Rumalla
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, University of New Mexico Hospital, Albuquerque, New Mexico, USA; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Syed Faraz Kazim
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, University of New Mexico Hospital, Albuquerque, New Mexico, USA; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Meic H Schmidt
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Christian A Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, University of New Mexico Hospital, Albuquerque, New Mexico, USA; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA.
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Kwon TE, Pasqual E, Kitahara CM, Lee C. Absorbed dose coefficients for adult thyroid cancer patients undergoing radioiodine therapy. J Radiol Prot 2023; 43. [PMID: 37196645 DOI: 10.1088/1361-6498/acd648] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/17/2023] [Indexed: 05/19/2023]
Abstract
Use of radioactive iodine (RAI) for thyroid cancer patients is accompanied by elevated risks of radiation-induced adverse effects due to significant radiation exposure of normal tissues or organs other than the thyroid. The health risk estimation for thyroid cancer patients should thus be preceded by estimating normal tissue doses. Although organ dose estimation for a large cohort often relies on absorbed dose coefficients (i.e., absorbed dose per unit activity administered, mGy/MBq) based on population models, no data are available for thyroid cancer patients. In the current study, we calculated absorbed dose coefficients specific for adult thyroid cancer patients undergoing RAI treatment after recombinant human TSH (rhTSH) administration or thyroid hormone withdrawal (THW). We first adjusted the transfer rates in the biokinetic model previously developed for THW patients for use in rhTSH patients. We then implemented the biokinetic models for thyroid cancer patients coupled with S values from the International Commission on Radiological Protection (ICRP) reference voxel phantoms to calculate absorbed dose coefficients. The biokinetic model for rhTSH patients predicted the extrathyroidal iodine decreasing noticeably faster than in the model for THW patients (calculated half-times of 12 and 15 h for rhTSH administration and THW, respectively). All dose coefficients for rhTSH patients were lower than those for THW patients with the ratio (rhTSH administration/THW) ranging from 0.60 to 0.95 (mean = 0.67). The ratio of the absorbed dose coefficients in the current study to the ICRP dose coefficients, which were derived from models for normal subjects, varied widely from 0.21 to 7.19, stressing the importance of using the dose coefficients for thyroid cancer patients. The results of this study will provide medical physicists and dosimetrists with scientific evidence to protect patients from excess exposure or to assess radiation-induced health risks caused by RAI treatment.
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Affiliation(s)
- Tae-Eun Kwon
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, UNITED STATES
| | - Elisa Pasqual
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, UNITED STATES
| | - Cari M Kitahara
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, UNITED STATES
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, UNITED STATES
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Zhang L, Xu S, Cheng X, Wu J, Wang Y, Gao W, Bao J, Yu H. Inflammatory tumor microenvironment of thyroid cancer promotes cellular dedifferentiation and silencing of iodide-handling genes expression. Pathol Res Pract 2023; 246:154495. [PMID: 37172523 DOI: 10.1016/j.prp.2023.154495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/23/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Due to dedifferentiation of tumor cells, manifested by a decreased expression of iodide-handling genes in thyrocytes, some thyroid carcinomas lose their capability for radioiodine concentration and gradually develop radioactive iodine (RAI) resistance. This work aimed to investigate the role of tumor microenvironment (TME) in the process of tumor cell dedifferentiation. MATERIALS AND METHODS Bioinformatic analyses and subsequent immunohistochemistry (IHC) and western blot assays were performed in papillary thyroid carcinoma (PTC) and matched normal tissue. ELISA was used to assess the secretion of cytokines under the stimulation of pharmacological endoplasmic reticulum (ER) stress inducer. RESULTS Higher levels of pro-inflammatory cytokines, interleukin 6 (IL-6) and (C-X-C motif chemokine ligand 8 (CXCL8), were found in thyroid cancer tissues compared with matched normal tissues. ER stress, induced by stressful environmental stimuli, such as nutrient deprivation and hypoxia, occurred in thyroid tumors. Classic ER stress inducers, thapsigargin (Tg) and tunicamycin (Tm), promoted the expression of IL6 and CXCL8 in thyroid cancer cells at mRNA and protein levels. Of note, rIL-6 and rCXCL8 promoted the dedifferentiation of thyroid cancer cells or even non-transformed cells in an autocrine/paracrine manner, weakening radioiodine uptake ability of thyroid cancer cells. Intriguingly, sorafenib, a multiple kinase inhibitor (MKI), could potently suppress not only ER stress-induced but also basal expressions of IL-6 and CXCL8 in thyroid cancer cells. CONCLUSIONS The inflammatory TME could regulate cell dedifferentiation, leading to loss of thyroid-specific gene expressions, through reciprocal interaction between thyroid tumor cells and follicular cells. Our study provides a new perspective on the mechanisms of how inflammatory TME affects DTC dedifferentiation.
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Affiliation(s)
- Li Zhang
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu 214063, China; Department of Radiopharmaceuticals, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China; School of Life science and Technology, Southeast University, Nanjing 210096, China.
| | - Shichen Xu
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu 214063, China
| | - Xian Cheng
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu 214063, China
| | - Jing Wu
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu 214063, China
| | - Yunping Wang
- School of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu, China
| | - Wenjing Gao
- School of Life science and Technology, Southeast University, Nanjing 210096, China
| | - Jiandong Bao
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu 214063, China
| | - Huixin Yu
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu 214063, China
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Aicale R, Maffulli N. Rotational ankle instability: A current concept review. J Orthop Surg (Hong Kong) 2023; 31:10225536231182347. [PMID: 37449793 DOI: 10.1177/10225536231182347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Ankle sprains are extremely common. It is important to have a clear insight of the course of recovery after such injury to evaluate the effective strategies to guide management decisions, and understand the potential risk factors involved in the development of chronic problems and recurrent ankle sprains. When a prompt diagnosis is not formulated, ligament tears can remain untreated, and chronic ankle instability can result after acute lateral or medial ankle sprain. When the medial ligament complex (MLC), in particular the anterior fascicle of the deltoid ligament, is involved, rotational ankle instability (RAI) can develop. Generally, a tear of the anterior fibres of the MCL accompanied by anterior talofibular ligament (ATFL) insufficiency has been associated with RAI, while injury of the intermediate fibres of the MLC has been associated with medial ankle instability (MAI). Conservative management is the first line of treatment, with surgery reserved for special cases or if rehabilitation has failed. Regarding surgery, several options are available, including anatomic repair, anatomic reconstruction, and tenodesis procedures. Ankle arthroscopy is increasingly used to address ligament insufficiency and to identify and treat intra-articular pathologies. Repair of MLC tears by an arthroscopic all-inside procedure is effective in both MAI and RAI.
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Affiliation(s)
- Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Fisciano, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Fisciano, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Italy
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK
- Keele University, Faculty of Medicine, School of Pharmacology and Bioengineering, Guy Hilton Research Centre, Hartshill, Stoke-on-Trent, UK
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Herrmann H. What's next for responsible artificial intelligence: a way forward through responsible innovation. Heliyon 2023; 9:e14379. [PMID: 36967876 PMCID: PMC10036946 DOI: 10.1016/j.heliyon.2023.e14379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/29/2023] Open
Abstract
Industry is adopting artificial intelligence (AI) at a rapid pace and a growing number of countries have declared national AI strategies. However, several spectacular AI failures have led to ethical concerns about responsibility in AI development and use, which gave rise to the emerging field of responsible AI (RAI). The field of responsible innovation (RI) has a longer history and evolved toward a framework for the entire research, development, and innovation life cycle. However, this research demonstrates that the uptake of RI by RAI has been slow. RAI has been developing independently, with three times the number of publications than RI. The objective and knowledge contribution of this research was to understand how RAI has been developing independently from RI and contribute to how RI could be leveraged toward the progression of RAI in a causal loop diagram. It is concluded that stakeholder engagement of citizens from diverse cultures across the Global North and South is a policy leverage point for moving the RI adoption by RAI toward global best practice. A role-specific recommendation for policy makers is made to deploy modes of engaging with the Global South with more urgency to avoid the risk of harming vulnerable populations. As an additional methodological contribution, this study employs a novel method, systematic science mapping, which combines systematic literature reviews with science mapping. This new method enabled the discovery of an emerging 'axis of adoption' of RI by RAI around the thematic areas of ethics, governance, stakeholder engagement, and sustainability. 828 Scopus articles were mapped for RI and 2489 articles were mapped for RAI. The research presented here is by any measure the largest systematic literature review of both fields to date and the only cross-disciplinary review from a methodological perspective.
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Bobanga I, Jin J, Wilhelm S, Sarode A, Alvarado CE, ElSherif A, McHenry CR. Primary hyperparathyroidism after radioactive iodine therapy: Is it a distinct clinical entity? Am J Surg 2023; 225:180-183. [PMID: 35934557 DOI: 10.1016/j.amjsurg.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/12/2022] [Accepted: 07/24/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Radioactive iodine (RAI) treatment is considered a rare cause of primary hyperparathyroidism (pHPT). METHOD A multi-institutional retrospective review of patients with pHPT who underwent parathyroidectomy from 1990 to 2020 was completed to evaluate the prevalence and latency time for development of RAI-associated pHPT and determine clinical differences in pHPT patients with or without prior RAI treatment. RESULTS 1929 patients with sporadic pHPT underwent parathyroidectomy; 48 (2.5%) had prior RAI treatment and 1881 (97.5%) did not. RAI treatment was for thyrotoxicosis in 43 (90%) patients. Average latency was 24 years (3-59 years) and inversely correlated with age. Patients with prior RAI treatment had lower preoperative calcium and PTH levels (p < 0.0001). No significant differences were observed in age, symptoms, pathology, ectopic glands and cure rate. CONCLUSION RAI is a potential causative factor for pHPT, accounting for 2.5% of sporadic pHPT. RAI-associated pHPT may be a less severe form of sporadic pHPT and latency inversely correlates with age.
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Affiliation(s)
- Iuliana Bobanga
- University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA.
| | - Judy Jin
- Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, 44195, USA
| | - Scott Wilhelm
- University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Anuja Sarode
- University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Christine E Alvarado
- University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Ayat ElSherif
- Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, 44195, USA
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Keum J, Ryu KY, Roh J. Radioactive Iodine-induced hypothyroidism interferes with the maturation of reproductive organs during puberty in immature female rats. Toxicol Res 2023; 39:53-60. [PMID: 36726832 PMCID: PMC9839935 DOI: 10.1007/s43188-022-00147-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/27/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023] Open
Abstract
Animal and human studies suggest that thyroid hormone may have critical roles in the development of the ovary. For example, thyroid deficiency disrupts the ovarian microarchitecture and menstrual cycle in neonate and adult women, respectively. Therefore, it is conceivable that thyroid deficiency might disrupt sexual maturation during the peri-pubertal period. To investigate the impact of radioactive iodine-induced thyroid deficiency on reproductive organs throughout puberty, immature female rats were given water containing radioactive iodine (0.37 MBq/g body weight) twice, on postnatal days 22 and 29. Radioactive iodine-induced hypothyroidism was revealed by low free thyroxin levels. Thyroid deficiency delayed the onset of vaginal opening, reduced ovarian weight and the number of medium-sized follicles and led to elongated uteri. However, there was no effect on the estrous cycle or absolute uterus weight. We conclude that radioactive iodine-induced thyroid deficiency delays sexual maturation and alters normal ovarian growth in peri-pubertal rats.
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Affiliation(s)
- Jihyun Keum
- Department of Obstetrics and Gynecology, College of Medicine, Hanyang University, Seoul, 04763 Republic of Korea
| | - Ki-Young Ryu
- Department of Obstetrics and Gynecology, College of Medicine, Hanyang University, Guri, 11923 Republic of Korea
| | - Jaesook Roh
- Laboratory of Reproductive Endocrinology, Department of Anatomy and Cell Biology, College of Medicine, Hanyang University, Seoul, 04763 Republic of Korea
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Egan C, Stefanova D, Thiesmeyer JW, Lee YJ, Greenberg J, Beninato T, Zarnegar R, Christos PJ, Klein IL, Fahey TJ, Finnerty BM. Proposed Risk Stratification and Patterns of Radioactive Iodine Therapy in Malignant Struma Ovarii. Thyroid 2022; 32:1101-1108. [PMID: 35765923 DOI: 10.1089/thy.2022.0145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Introduction: Malignant struma ovarii (MSO) is a rare thyroid cancer arising within an ovarian teratoma. While surgical excision of the primary tumor is widely accepted as standard of care, recommendations for adjuvant treatment of MSO-whether or not to administer radioactive iodine (RAI)-are based largely on case reports and remain debated. In this study, we aimed to propose a risk stratification and analyze RAI utilization patterns in MSO cases. Methods: The National Cancer Database (NCDB) was queried for patients with MSO between 2004 and 2016. Demographic, oncological, and clinicopathologic data were compared between groups using Fisher's exact test. Kaplan-Meier curves were used to estimate overall survival (OS), and variables associated with OS were assessed via univariate Cox regression. We adapted the 2015 American Thyroid Association risk guidelines for MSO patients. We stratified patients into low-, intermediate-, and high-risk groups using metastasis, extraovarian extension, lymphovascular invasion, lymph node status, surgical margins, tumor size, and grade. Risk stratification, demographic, oncological, and clinicopathologic data were compared between the groups receiving and not receiving RAI therapy. We then queried the Surveillance, Epidemiology, and End Results (SEER) 18 registry for patients with MSO between 2000 and 2018 to confirm our risk stratification analysis. Results: In the NCDB analysis, a total of 158 patients were identified, and 19 received RAI. RAI therapy was associated with distant metastasis (p = 0.005) and lymph node status (p = 0.012). Twenty-one NCDB patients were stratified as high risk, and 30% of high-risk patients received RAI. High-risk stratification was associated with decreased OS via univariate Cox regression (hazard ratio = 4.0 [95% confidence interval 1.11-14.26], p = 0.034). In our subsequent analysis using the SEER registry, there were 95 MSO patients, and 18 received RAI. Again, the majority of high-risk patients did not receive RAI, with only 41% of high-risk patients receiving RAI. Conclusions: MSO is a rare malignancy with apparently variable and inconsistent patterns of postoperative RAI administration. The risk stratification described here provides a framework to identify patients potentially at risk for mortality, and utilization of RAI in this group should be studied further.
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Affiliation(s)
- Caitlin Egan
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Dessislava Stefanova
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Jessica W Thiesmeyer
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Yeon Joo Lee
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Jacques Greenberg
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Toni Beninato
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Rasa Zarnegar
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Paul J Christos
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Irwin L Klein
- Department of Medicine, NYU School of Medicine, Melville, New York, USA
| | - Thomas J Fahey
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Brendan M Finnerty
- Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
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Watanabe S, Okamoto S, Akikawa K, Miyamoto N, Okamura-Kawasaki M, Uchiyama Y, Takenaka J, Toyonaga T, Hirata K, Kudo K. Identification of patients with Graves' disease who benefit from high-dose radioactive iodine therapy. Ann Nucl Med 2022; 36:923-930. [PMID: 35972673 DOI: 10.1007/s12149-022-01781-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Radioactive iodine (RAI) therapy is a useful treatment for Graves' disease (GD). Most RAI sessions administer ≤ 500 MBq of iodine (I)-131. Sometimes patients require repeated RAI, often for longer periods of remission. We investigated the characteristics of patients for whom high dose (mostly 1110 MBq of I-131) RAI was effective as RAI therapy for GD. METHODS We retrospectively analyzed the cases of 79 patients who underwent RAI for GD in a multicenter setting. We divided the patients into two groups based on the I-131 dose administered: the low dose (LD) group who received ≤ 500 MBq (n = 44) and the high dose (HD) group who received > 500 MBq (n = 35). The therapeutic effect was defined as achieving remission and reaching the point of participating in thyroid hormone replacement therapy within 1 year after RAI. We compared the LD and HD groups' remission rates and conducted a multivariate logistic regression analysis of predictive factors for remission. In a simulation, using the formula for predicting the probability of remission obtained from the analysis results, we estimated how much the remission rate would change if the I-131 dose is increased from 500 to 1110 MBq. RESULTS The mean ± standard deviation I-131 dose administered in the LD group was 480 ± 6 MBq, and that of the HD group was 1054 ± 265 MBq. Thirty-five patients (80%) in the LD group and 26 patients (74%) in the HD group achieved remission; this difference in the remission rate was not significant. The multivariate analysis results demonstrated that the absorbed dose and thyroid-stimulating antibody (TSAb) were independent predictors of remission. Seven patients (8.9%) showed an increased probability of remission from < 50% to > 50% when the higher RAI dose was applied (1110 MBq instead of 500 MBq). The thyroid volume and TSAb values in these patients were relatively large at 54.7 ± 34.2 mL and 1378.4 ± 586.3%, respectively. CONCLUSION Although the overall remission rate was not significantly different between the patients who received high- or low-dose I-131, treatment with high-dose RAI may improve the probability of remission in patients with a massive thyroid volume and/or high-TSAb Graves' disease.
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Affiliation(s)
- Shiro Watanabe
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
- Department of Nuclear Medicine, Hokkaido University Hospital, Kita 14 Nishi 5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan.
| | - Shozo Okamoto
- Department of Radiology, Obihiro Kosei Hospital, Minami 10-1, Nishi 14, Obihiro City, Hokkaido, 080-0024, Japan
| | - Kazumasa Akikawa
- Department of Internal Medicine, Hokkaido Medical Center of Rheumatic Diseases, 1-1-45, Kotoni 1-jo 3-chome, Nishi-ku, Sapporo, Hokkaido, 063-0811, Japan
| | - Noriyuki Miyamoto
- Department of Radiology, Obihiro Kosei Hospital, Minami 10-1, Nishi 14, Obihiro City, Hokkaido, 080-0024, Japan
| | - Miyuki Okamura-Kawasaki
- Department of Radiology, Tomakomai City Hospital, 1-5-20 Shimizu-cho, Tomakomai, 053-8567, Japan
| | - Yuko Uchiyama
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Nuclear Medicine, Hokkaido University Hospital, Kita 14 Nishi 5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Junki Takenaka
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Nuclear Medicine, Hokkaido University Hospital, Kita 14 Nishi 5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Takuya Toyonaga
- Positron Emission Tomography (PET) Center, Radiology and Biomedical Imaging, Yale School of Medicine, 801 Howard Ave., P.O. Box 208048, New Haven, CT, 06520, USA
| | - Kenji Hirata
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Nuclear Medicine, Hokkaido University Hospital, Kita 14 Nishi 5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Kohsuke Kudo
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Global Station for Quantum Medical Science and Engineering, Global Institution for Collaborative Research and Education, Hokkaido University, Kita-14, Nishi-5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
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Dittman JM, Lavingia KS, Larson RA. Elevated Risk Analysis Index ( RAI) Frailty Scores Are Independently Associated with Adverse Outcomes in Lower Extremity Surgical Revascularizations Similarly Across Genders. Ann Vasc Surg 2022:S0890-5096(22)00188-1. [PMID: 35460856 DOI: 10.1016/j.avsg.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The Risk Analysis Index (RAI) frailty scoring system, developed in a predominantly male Veteran sample, has recently undergone revision and external validation to become the RAI-rev using a general surgical sample from the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database. We set forth to evaluate the application of RAI-rev scoring to lower extremity surgical revascularization outcomes in the NSQIP database while verifying that similar associations with outcomes persist in this subset across genders. METHODS All elective cases in the NSQIP Targeted Lower Extremity Open (LEO) database recorded from 2015-2019 were paired with the NSQIP Participant User File using Case IDs. Groups were defined by EMR-recorded gender. Extended length of stay was defined as top quartile postoperative stays. Aggregate demographics, perioperative factors, and 30-day outcomes were compared between groups using unpaired t-test and Fisher's exact test. Adjusted odds-ratios (aOR) for each outcome were generated by applying a multivariate binary logistic regression model in IBM SPSSTM for five-point RAI-rev score increments from 25-45 and a most-frail group with scores >45. Covariates included surgical indication, prior ipsilateral surgical revascularization versus percutaneous intervention, graft utilization, presence of dirty/infected wound, smoking, hypertension, diabetes, and steroid use. A non-frail group with RAI-rev scores <25 was utilized as the reference for generating adjusted odds ratios. RESULTS 8,155 cases were recorded in the NSQIP LEO database from 2015-2019, including 2,498 (31%) performed in women who had slightly lower RAI-rev scores on average (22.1±5.8 vs 24.2±5.1; p=0.0001). Univariate trends demonstrated dose-dependent increases in frequency of most outcomes with rising frailty score ranges, with the most substantial changes over mortality (0.4% of non-frail to 14.7% most-frail), disposition to a skilled nursing facility (8% of non-frail to 27% most-frail), and extended length of stay (16% of non-frail to 44% most-frail). After adjusting for co-variates, patients with RAI-rev scores of 26-30 had aOR of 1.4 (95% CI: 1.2-1.6; p<0.001), 1.9 (95% CI: 1.6-2.2; p<0.001), and 2.4 (95% CI: 1.3-4.4; p<0.001) for extended stay, disposition to skilled nursing, and mortality respectively as compared to those with RAI-rev scores <25. Despite more non-significant aOR for women than men, trends were similar across genders in both univariate and multivariate analyses. CONCLUSION Our study is the first to find that outcomes other than mortality are significantly predicted by RAI-rev score ranges in lower extremity surgical revascularizations with similar associations regardless of gender. RAI-rev frailty scores >30 may help to identify frail patients at a higher risk of mortality, extended stay, and increased rehabilitation needs prior to lower extremity surgical revascularization to inform risk assessment and optimize patient recovery.
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Abstract
Patients with radioactive iodine (RAI) refractory locally advanced or metastatic differentiated thyroid cancer have a poor prognosis. This article reviews the definition of RAI-refractory thyroid cancer and the management approach. Watchful waiting should be considered for patients with asymptomatic and non-progressive disease, while oral targeted agent with tyrosine kinase inhibitors can be considered for patients who are symptomatic or whose disease would cause irreversible complications if treatment has not been initiated. Since these targeted agents only improve disease-free survival and are associated with adverse events, physicians should assess both clinical and tumor factors carefully to decide on the right timing of start of palliative treatment.
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Affiliation(s)
- Wendy W L Chan
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.
| | - Sonia Chan
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Dora L W Kwong
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
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Chahal M, Singh O, Bhardwaj P, Ganapuram S. Exploring spatial and temporal drought over the semi-arid Sahibi river basin in Rajasthan, India. Environ Monit Assess 2021; 193:743. [PMID: 34676445 DOI: 10.1007/s10661-021-09539-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 10/08/2021] [Indexed: 06/13/2023]
Abstract
Rajasthan state of India is prone to recurrent droughts; hence, exploring drought severities over the semi-arid Sahibi river basin is crucial for drought management. To investigate drought severity, the Rainfall Anomaly Index (RAI) was applied at two time spans, such as annual (January to December) and the monsoon season (June to September), using long-term daily rainfall data (1961-2017) for nine rain gauge stations. Similarly, for the examination of various drought characteristics like magnitude, duration and intensity, run theory analysis was used. Trends in rainfall, drought severity, magnitude, duration and intensity were computed by employing both parametric (simple linear regression) and non-parametric (Mann-Kendall and Sen's slope) tests, while spatial pattern maps of rainfall and drought characteristics were prepared using geographical information system. The analysis of rainfall records revealed a declining trend in eastern and central parts, whereas remaining areas of the basin witnessed an increasing trend during two time spans. During the study period, drought occurrence varied both geographically and temporally. The extreme, severe and moderate drought events were more common during monsoon season. Amongst the stations, Tapukara, Bairath and Mundawar rain gauge stations experienced the largest number of drought events compared to other stations. At both time scales, the most extreme droughts in the Sahibi basin occurred in 1979, 1986, 1987, 1989 and 2002. At the annual time span, the basin had the longest drought duration of 300 days, with a drought magnitude of - 758.3 mm. Likewise, the Tapukara rain gauge station had the longest dry spell of 310 days, followed by Behrod and Kotkasim (306 days each), Kotputli and Tijara (305 days each) and Mundawar (303 days). Finally, the findings of this study are expected to be useful to agricultural scientists, policymakers and water resource managers.
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Affiliation(s)
- Manpreet Chahal
- Department of Geography, Kurukshetra University, Kurukshetra, 136119, India
| | - Omvir Singh
- Department of Geography, Kurukshetra University, Kurukshetra, 136119, India
| | - Pankaj Bhardwaj
- Department of Geography, Government College, Bahu, Jhajjar, 124142, India
| | - Sreedhar Ganapuram
- Centre of Studies in Resources Engineering, Indian Institute of Technology, Mumbai, 400076, India
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14
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Adamska A, Tomczuk-Bobik P, Popławska-Kita AB, Siewko K, Buczyńska A, Szumowski P, Żukowski Ł, Myśliwiec J, Zbucka-Krętowska M, Adamski M, Krętowski AJ. Assessment of different markers of ovarian reserve in women with papillary thyroid cancer treated with radioactive iodine. Endocr Connect 2021; 10:1283-1290. [PMID: 34524978 PMCID: PMC8558897 DOI: 10.1530/ec-21-0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/15/2021] [Indexed: 11/08/2022]
Abstract
Treatment with radioactive iodine (RAI) in women with differentiated thyroid cancer is associated with decreased serum concentrations of anti-Müllerian hormone (AMH); however, other markers have not been investigated. Therefore, this study aimed to evaluate the effect of RAI treatment on antral follicle count (AFC) and the serum concentration of inhibin B, follicle-stimulating hormone (FSH), and AMH in women with papillary thyroid cancer (PTC) treated with RAI. We examined 25 women at a median age of 33 years treated with a single dose of RAI. We divided the participants into women over (n = 11) and under 35 years of age (n = 14). Serum concentrations of inhibin B, FSH, AMH, and AFC were assessed at baseline and 1 year after RAI treatment. We found decreased AFC (P = 0.03), serum levels of AMH (P < 0.01), inhibin B (P = 0.03), but not FSH (P = 0.23), 1 year after RAI treatment in comparison to baseline in the whole group. When we compared serum levels of AMH in younger vs older women separately, we observed a significant reduction of this hormone's serum level after RAI treatment in both groups (P < 0.01; P = 0.04, respectively). We concluded that RAI treatment significantly impacts the functional ovarian reserve in premenopausal women with PTC.
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Affiliation(s)
- Agnieszka Adamska
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Białystok, Poland
- Correspondence should be addressed to A Adamska:
| | - Paulina Tomczuk-Bobik
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Białystok, Poland
| | - Anna Beata Popławska-Kita
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Białystok, Poland
| | - Katarzyna Siewko
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Białystok, Poland
| | - Angelika Buczyńska
- Clinical Research Centre, Medical University of Bialystok, Białystok, Poland
| | - Piotr Szumowski
- Department of Nuclear Medicine, Medical University of Białystok, Białystok, Poland
| | - Łukasz Żukowski
- Department of Nuclear Medicine, Medical University of Białystok, Białystok, Poland
| | - Janusz Myśliwiec
- Department of Nuclear Medicine, Medical University of Białystok, Białystok, Poland
| | - Monika Zbucka-Krętowska
- Department of Gynecological Endocrinology and Adolescent Gynecology, Medical University of Bialystok, Białystok, Poland
| | - Marcin Adamski
- Faculty of Computer Science, Bialystok University of Technology, Białystok, Poland
| | - Adam Jacek Krętowski
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Białystok, Poland
- Clinical Research Centre, Medical University of Bialystok, Białystok, Poland
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15
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Toraih EA, Fawzy MS, Hussein MH, El-Labban MM, Ruiz EML, Attia AA, Halat S, Moroz K, Errami Y, Zerfaoui M, Kandil E. MicroRNA-Based Risk Score for Predicting Tumor Progression Following Radioactive Iodine Ablation in Well-Differentiated Thyroid Cancer Patients: A Propensity-Score Matched Analysis. Cancers (Basel) 2021; 13:4649. [PMID: 34572876 DOI: 10.3390/cancers13184649] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/07/2021] [Accepted: 08/27/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary The three-tiered American Thyroid Association (ATA) risk stratification helps clinicians tailor decisions regarding follow-up modalities and the need for postoperative radioactive iodine (RAI) ablation and radiotherapy. However, a significant number of well-differentiated thyroid cancers (DTC) progress after treatment. Current follow-up modalities have also been proposed to detect disease relapse and recurrence but have failed to be sufficiently sensitive or specific to detect, monitor, or determine progression. Therefore, we assessed the predictive accuracy of the microRNA-based risk score in DTC with and without postoperative RAI. We confirm the prognostic role of triad biomarkers (miR-2f04, miR-221, and miR-222) with higher sensitivity and specificity for predicting disease progression than the ATA risk score. Compared to indolent tumors, a higher risk score was found in progressive samples and was associated with shorter survival. Consequently, our prognostic microRNA signature and nomogram provide a clinically practical and reliable ancillary measure to determine the prognosis of DTC patients. Abstract To identify molecular markers that can accurately predict aggressive tumor behavior at the time of surgery, a propensity-matching score analysis of archived specimens yielded two similar datasets of DTC patients (with and without RAI). Bioinformatically selected microRNAs were quantified by qRT-PCR. The risk score was generated using Cox regression and assessed using ROC, C-statistic, and Brier-score. A predictive Bayesian nomogram was established. External validation was performed, and causal network analysis was generated. Within the eight-year follow-up period, progression was reported in 51.5% of cases; of these, 48.6% had the T1a/b stage. Analysis showed upregulation of miR-221-3p and miR-222-3p and downregulation of miR-204-5p in 68 paired cancer tissues (p < 0.001). These three miRNAs were not differentially expressed in RAI and non-RAI groups. The ATA risk score showed poor discriminative ability (AUC = 0.518, p = 0.80). In contrast, the microRNA-based risk score showed high accuracy in predicting tumor progression in the whole cohorts (median = 1.87 vs. 0.39, AUC = 0.944) and RAI group (2.23 vs. 0.37, AUC = 0.979) at the cutoff >0.86 (92.6% accuracy, 88.6% sensitivity, 97% specificity) in the whole cohorts (C-statistics = 0.943/Brier = 0.083) and RAI subgroup (C-statistic = 0.978/Brier = 0.049). The high-score group had a three-fold increased progression risk (hazard ratio = 2.71, 95%CI = 1.86–3.96, p < 0.001) and shorter survival times (17.3 vs. 70.79 months, p < 0.001). Our prognostic microRNA signature and nomogram showed excellent predictive accuracy for progression-free survival in DTC.
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16
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Piccardo A, Siri G, Ugolini M, Fiz F, Puntoni M, Bottoni G, Catrambone U, Pitoia F, Trimboli P. A Three-Domain Scoring System to Customize the Risk of Relapse of Differentiated Thyroid Carcinoma. Cancers (Basel) 2021; 13:cancers13174335. [PMID: 34503146 PMCID: PMC8430463 DOI: 10.3390/cancers13174335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE the validation of a new scoring model considering the principal risk factors of differentiated thyroid cancer (DTC) relapse. METHODS we evaluated all DTC patients treated with thyroidectomy and radioactive iodine (RAI) therapy. Three domains were considered: the demographic domain (age and gender), the surgical domain (histology and the American Thyroid Association risk categories), and the RAI-related domain (pre-RAI thyroglobulin and post-therapeutic 131I whole-body scan). The progression-free survival was assessed. The patients' sample was randomly split into a training and validation set. The three-domain score was calculated as the weighted sum of the levels of each significant factor, then scaled to an integer range (0-100) and, finally, stratified into terciles: mild risk 0-33, moderate risk 34-66, and severe risk 67-100. RESULTS 907 DTC patients were included. The RAI-related domain was the most relevant factor in the score calculation. The tercile stratification identified significantly different survival curves: patients within the two upper terciles showed approximately 6 to 30 times more progressive risk than patients at mild risk. CONCLUSION we have validated a three-domain scoring system and the principal impact on this score is provided by the peri-RAI findings, whose prognostic role seems to be essential in risk identification.
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Affiliation(s)
- Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. “Ospedali Galliera”, 16128 Genoa, Italy; (A.P.); (M.U.); (G.B.)
| | - Giacomo Siri
- Scientific Directorate, Galliera Hospital, 16128 Genoa, Italy;
| | - Martina Ugolini
- Department of Nuclear Medicine, E.O. “Ospedali Galliera”, 16128 Genoa, Italy; (A.P.); (M.U.); (G.B.)
| | - Francesco Fiz
- Department of Nuclear Medicine, E.O. “Ospedali Galliera”, 16128 Genoa, Italy; (A.P.); (M.U.); (G.B.)
- Correspondence: (F.F.); (P.T.); Tel.: +39-010-5634530 (F.F.)
| | - Matteo Puntoni
- Clinical & Epidemiological Research Unit, University Hospital of Parma, 43126 Parma, Italy;
| | - Gianluca Bottoni
- Department of Nuclear Medicine, E.O. “Ospedali Galliera”, 16128 Genoa, Italy; (A.P.); (M.U.); (G.B.)
| | - Ugo Catrambone
- Department of Surgery, E.O. “Ospedali Galliera”, 16128 Genoa, Italy;
| | - Fabián Pitoia
- Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, Buenos Aires C1053, Argentina;
| | - Pierpaolo Trimboli
- Servizio di Endocrinologia e Diabetologia, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland
- Facultà di Scienze Biomediche, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
- Correspondence: (F.F.); (P.T.); Tel.: +39-010-5634530 (F.F.)
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El Kawkgi OM, Ross DS, Stan MN. Comparison of long-term antithyroid drugs versus radioactive iodine or surgery for Graves' disease: A review of the literature. Clin Endocrinol (Oxf) 2021; 95:3-12. [PMID: 33283314 DOI: 10.1111/cen.14374] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/30/2020] [Accepted: 11/18/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The management of Graves' disease (GD) in the US is shifting towards increased use of anti-thyroid drugs (ATD). If patients fail to achieve remission after a standard course of therapy of 12-18 months, long-term treatment with ATD (≥24 months) may be chosen over definitive therapy with radioiodine (RAI) or surgery. Clinicians will need to contrast this strategy to ablative therapies as they help patients in decision making. SUMMARY Review of the literature illustrates that long-term ATD delivers euthyroidism with minimal complications, low financial cost and with an advantageous profile regarding quality of life (QoL) and other biological outcomes. CONCLUSIONS Long-term ATD is a viable alternative to ablative therapies in the management of GD offering advantages across multiple patient centred outcomes. Decision making must factor differences in this approach compared to ablative therapies and ultimately be tailored to individualized patient situations.
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Affiliation(s)
- Omar M El Kawkgi
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Douglas S Ross
- Division of Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Marius N Stan
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
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18
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Albano D, Dondi F, Zilioli V, Panarotto MB, Galani A, Cappelli C, Bertagna F, Giubbini R, Casella C. The role of Hashimoto thyroiditis in predicting radioiodine ablation efficacy and prognosis of low to intermediate risk differentiated thyroid cancer. Ann Nucl Med 2021; 35:1089-1099. [PMID: 34152569 PMCID: PMC8408084 DOI: 10.1007/s12149-021-01644-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/13/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The baseline treatment of differentiated thyroid cancer (DTC) consists of thyroidectomy followed by postoperative risk-adapted radioiodine therapy (RAIT) when indicated. The choice of most appropriate RAI activities to administer with the aim to reach an efficient remnant ablation and reduce the risk of recurrence is yet an open issue and the detection of basal factors that may predict treatment response seems fundamental. The aim of this study was to investigate the potential role of Hashimoto thyroiditis (HT) in predicting 1-year and 5-year treatment response after RAIT and prognosis. METHODS We retrospectively included 314 consecutive patients (174 low-risk and 140 intermediate-risk) who received thyroidectomy plus RAIT. One-year and 5-year disease status was evaluated according to 2015 ATA categories response based upon biochemical and structural findings. RESULTS HT was reported histopathologically in 120 patients (38%). DTC patients with concomitant HT received a higher number of RAITs and cumulative RAI activities. Initial RAIT reached an excellent response in 63% after one year and 84% after 5 years. The rate of excellent response one year and 5-year after first RAIT was significantly lower in HT groups, compared to not HT (p < 0.001). Instead, HT did not have a prognostic role considering PFS and OS; while stimulate thyroglobulin (sTg) at ablation was significantly related to survival. CONCLUSIONS HT may affect the efficacy of RAIT in low to intermediate risk DTC, particularly reducing the successful rate of excellent response after RAIT. Instead, HT did not have a prognostic impact such as stimulated sTg.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy.
| | - Francesco Dondi
- Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Valentina Zilioli
- Nuclear Medicine Department, ASST Spedali Civili Brescia, Brescia, Italy
| | | | - Alessandro Galani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, SSd Medicina ad Indirizzo Endocrino-Metabolico, University of Brescia, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Claudio Casella
- Department of Molecular and Translation Medicine, Surgical Clinic, University of Brescia, Brescia, Italy
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Yun C, Wu M, Xiao J, Liu Y, Zhang W, Cao J. Analysis of Curative Effect and Influencing Factors of N1 Stage Papillary Thyroid Micro-Carcinoma and Papillary Thyroid Non-Micro Carcinoma After Initial Radioactive Iodine Ablation Therapy. Cancer Manag Res 2021; 13:1427-1434. [PMID: 33613032 PMCID: PMC7887430 DOI: 10.2147/cmar.s292395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/19/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To compare the efficacy and influencing factors of initial radioactive iodine (RAI) ablation therapy for postoperative N1 stage papillary thyroid micro-carcinoma (PTMC) and papillary thyroid non-micro carcinoma (PTC), and to explore the necessity of RAI for N1 stage PTMC. Methods A retrospective analysis of patients with N1 stage papillary thyroid cancer who underwent RAI in our department from January 2018 to June 2019. According to the tumor diameter, papillary thyroid carcinoma was divided into PTMC group (≤ 1.0cm) with 129 patients and PTC group (> 1.0 cm) with 214 patients. According to the 2015 ATA guidelines, the patient’s treatment response was evaluated 6–8 months after discharge from the hospital: excellent response (ER), indeterminate response (IDR), biochemical incomplete response (BIR), and structural incomplete response (SIR). IDR, BIR, and SIR were classified into NER group. Chi-squared test, independent sample t-test, Mann–Whitney U test, and binary logistic regression analysis were used to compare the differences between PTMC and PTC patients. Results The ps-Tg of the PTMC group was significantly lower than that of the PTC group (P = 0.001), and the ER ratio of the PTMC group was higher (χ2 = 5.445, P < 0.05). The ER ratio of PTMC patients in the N1a group was significantly higher than that of PTC patients (80%, 66.7%, χ2 = 4.076, P < 0.05), while the ER ratio of PTMC in the N1b group was not significantly different from that of PTC. Gender, N stage, and ps-Tg were found to be independent factors of RAI treatment response. Conclusion The efficacy of the initial RAI of PTMC patients was significantly better than that of PTC patients. There was no significant difference in the efficacy of RAI between males with PTMC, N1b stage, ps-Tg ≥ 5.87ng/mL and PTC patients, which suggested that RAI is necessary for these patients.
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Affiliation(s)
- Canhua Yun
- Department of Nuclear Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People's Republic of China
| | - Meiling Wu
- Department of Nuclear Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People's Republic of China
| | - Juan Xiao
- Center of Evidence-Based Medicine, Institute of Medical Sciences, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People's Republic of China
| | - Yong Liu
- Department of Nuclear Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People's Republic of China
| | - Wei Zhang
- Department of Nuclear Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People's Republic of China
| | - Jingjia Cao
- Department of Nuclear Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People's Republic of China
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20
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Abstract
Distant metastasis (DM) is the dominant negative prognosis for thyroid carcinoma.
Radioactive iodine (RAI) therapy serves as an effective treatment for thyroid
carcinoma. However, resistance to RAI occurs in patients with DMs. The present
study aims to discriminate patients who may benefit from RAI. We extracted
patients with thyroid cancer in the Surveillance, Epidemiology, and End Results
program and analyzed thyroid cancer–specific survival after radiotherapy based
on age and grade subgroups. A total of 1608 patients having DMs were eligible,
including 521 (32.4%) cases with bone metastasis, 90 (5.6%) cases with brain
metastasis, 158 (9.8%) cases with liver metastasis, 995 (61.9%) cases with lung
metastasis, and 50 (3.1%) cases with other metastases. Advanced age, poor
differentiation, follicular carcinoma, lymphatic metastasis, tumor size >10
mm, and extracapsular invasion are associated with pulmonary metastases. With
respect to patients with DM, RAI therapy improved the survival in the age <45
years group and the well-/moderately differentiated group. For patients with
pulmonary metastasis, RAI improved the survival in the higher grade group but
did not have a strong effect in the better grade group. Our data indicate that
the disparity of metastatic sites has different risk factors. Similarly, this
finding indicates that RAI should be precisely applied to patients who undergo
DM but are young and have well-/moderately differentiated tumors and may improve
survival in pulmonary metastasis patients with poor grade tumors.
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Affiliation(s)
- Chenyuan Li
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China.,Authors contributed equally to this article
| | - Qi Wu
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China.,Authors contributed equally to this article
| | - Shengrong Sun
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
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21
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Piccardo A, Siri G, Raffa S, Castellana M, Foppiani L, Bottoni G, Ugolini M, Cistaro A, Catrambone U, Altrinetti V, Massollo M, Arlandini A, Giovanella L, Cabria M, Trimboli P. How to better stratify the risk of differentiated thyroid carcinomas: the key role of radioactive iodine therapy, age, and gender. Eur J Nucl Med Mol Imaging 2020; 48:822-830. [PMID: 32955602 DOI: 10.1007/s00259-020-05020-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/31/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE The risk of relapse of differentiated thyroid carcinomas (DTC) and their indication for radioactive iodine therapy (RAI) are assessed according to ATA risk stratification system principally based on tumor-nodes-metastasis (TNM) staging. However, while establishing the indication for RAI may be a "dilemma," performing it can improve the risk stratification. We aimed to evaluate whether (1) the stratification of risk of recurrence differs when TNM is considered with or without peri-RAI findings and (2) the assessment of the risk of disease-specific mortality is improved by adding age and gender. METHODS From our database, all DTC patients treated with thyroidectomy and RAI from 1992 to 2017 were included. Subjects with a follow-up shorter than 1 year and positive thyroid antibodies were excluded. Patients were classified into (1) a three-category ATA model based on TNM (basic model) and (2) a five-category model based on TNM plus peri-RAI findings, i.e., thyroglobulin and 131I whole-body scan (advanced model). Relapse was proven by histology and/or imaging. Differences in disease-free survival (DFS) and overall survival (OS) were assessed. RESULTS We enrolled 907 patients; of these, 4.4% died and 21% suffered recurrence. According to the basic model, there were 11.8% high-risk, 32.9% intermediate-risk, and 55.3% low-risk patients. According to the advanced model, 29.9% of patients were re-classified in a higher risk category and the five categories of this model displayed significantly different risks of relapse and death. The estimate of DFS was significantly higher in the advanced model than in the basic one (ΔC-index = + 6.8%, P < .001). By adding age and gender to the advanced model, the highest performance in predicting death was achieved (ΔC-index = + 5.1%, P < .001). CONCLUSIONS The peri-RAI findings are essential in order to carefully stratify the risk of DTC recurrence. Integrating these data with age and gender enables those cases at highest risk of death to be identified.
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Affiliation(s)
- Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura delle Cappuccine 14, 16128, Genoa, Italy.
| | - Giacomo Siri
- Department of Mathematics, University of Genoa, Genoa, Italy.,Scientific Directorate, Galliera Hospital, Genoa, Italy
| | - Stefano Raffa
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Castellana
- National Institute of Gastroenterology "Saverio De Bellis", Castellana Grotte, Bari, Italy
| | - Luca Foppiani
- Department of Internal Medicine, E.O. "Ospedali Galliera", Genoa, Italy
| | - Gianluca Bottoni
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Martina Ugolini
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Angelina Cistaro
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura delle Cappuccine 14, 16128, Genoa, Italy
| | | | - Vania Altrinetti
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Michela Massollo
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura delle Cappuccine 14, 16128, Genoa, Italy
| | | | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Manlio Cabria
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Mura delle Cappuccine 14, 16128, Genoa, Italy
| | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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22
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Abstract
OBJECTIVE. The paradigm of theranostics is based on tailoring therapy for the purpose of optimizing outcomes. This principle is being applied to radioactive iodine therapy. Consequently, thyroid cancer therapy protocols are evolving. The purpose of this article is to promote a modern approach to radioiodine therapy. CONCLUSION. This article highlights guidelines and position statements, summarizes the prognostication systems of thyroid cancer, and reviews which prescribed activities of 131I.
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23
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Albano D, Bonacina M, Durmo R, Bertagna F, Giubbini R. Efficacy of low radioiodine activity versus intermediate-high activity in the ablation of low-risk differentiated thyroid cancer. Endocrine 2020; 68:124-131. [PMID: 31784881 DOI: 10.1007/s12020-019-02148-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/20/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE The aim of our study was to compare the efficacy of thyroid remnant ablation using low (1.1 GBq) and intermediate-high radioiodine (RAI) activity (1.85-3.7 GBq) in low-risk differentiated thyroid carcinoma (DTC) and to evaluate the staging role of the whole body scan (WBS) in detection extrathyroidal disease. MATERIALS AND METHODS We retrospectively included 277 patients who underwent total thyroidectomy and RAI for low-risk DTC and divided them in two groups according to RAI activity at ablation: group 1 (n = 174) treated with low activity (1.1 GBq), and group 2 (n = 103) with intermediate-high activity (1.85-3.7 GBq). To evaluate the successful ablation rate, the WBS 1 year after RAI was visually interpreted using a three-point scale: score 0 in case of absence of visible RAI uptake in thyroid bed; score 1 in presence of faint uptake in the thyroid bed; and score 2 in case of significant RAI uptake in thyroid bed. RESULTS The success ablation rate was significantly higher in group 2 than group 1 (p < 0.001) with the presence of a positive WBS (score 1-2) in 65% low-activity group and 33% in intermediate-high group. Considering response to therapy categories, excellent response rate was significantly higher in group 2 (p = 0.020), while indeterminate response was higher in group 1 (p value = 0.005). Post RAI imaging revealed extrathyroidal uptake in 27 cases: 17 laterocervical nodal and 10 distant metastases. In both groups similar detection rate of nodal and distant metastases were recognized without any statistical difference. CONCLUSIONS The ablation rate with intermediate-high RAI activity (1.85-3.7 GBq) was better than with a low activity (1.1 GBq). First WBS may help to recognize nodal and distant metastases in about 10% of cases changing clinical stage and subsequent management.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, University of Brescia, Brescia, Italy.
- Nuclear Medicine, Spedali Civili Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
| | - Mattia Bonacina
- Nuclear Medicine, Spedali Civili Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Rexhep Durmo
- Nuclear Medicine, Spedali Civili Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
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24
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Hindié E, Ain KB, Zerdoud S, Avram AM. Association of Radioactive Iodine Treatment of Hyperthyroidism With Cancer Mortality: An Unjustified Warning? J Clin Endocrinol Metab 2020; 105:5687008. [PMID: 31875905 DOI: 10.1210/clinem/dgz305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/21/2019] [Indexed: 02/13/2023]
Affiliation(s)
- Elif Hindié
- Department of Nuclear Medicine, Bordeaux University Hospitals, Hôpital Haut-Lévêque, Pessac, France
| | - Kenneth B Ain
- Department of Internal Medicine, Thyroid Oncology Program, University of Kentucky, Lexington, Kentucky, US
| | - Slimane Zerdoud
- Department of Nuclear Medicine, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Anca M Avram
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, University of Michigan, Ann Arbor, Michigan, US
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25
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Albano D, Panarotto MB, Durmo R, Rodella C, Bertagna F, Giubbini R. Clinical and prognostic role of detection timing of distant metastases in patients with differentiated thyroid cancer. Endocrine 2019; 63:79-86. [PMID: 30112608 DOI: 10.1007/s12020-018-1713-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/07/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE Distant metastases (DM) from DTC occur in 5-25% of cases and are correlated to lower survival; the prognostic significance of the temporal onset of DM is unclear. Our aim was to retrospectively analyze the prevalence of DM and to assess the prognostic role of the timing of manifestation of DM regarding the outcome. MATERIALS AND METHODS We included 174 patients (mean age 64 years). According to the time of manifestation, DM were divided in two groups: synchronous DM (SDM, n = 108) defined as metastases present at initial diagnosis and metachronous DM (MDM, n = 66) as diagnosed during follow-up. SDM were further sub grouped in pre-RAIT when diagnosed during pre-surgery work-up (n = 35) and baseline-RAIT when detected by first whole body scan after RAIT (n = 73). Disease-specific survival (DSS) was analyzed using the Kaplan-Meier method. RESULTS Total RAI activities and number of treatments were significantly higher in MDM, also loss of RAI avidity was more frequent in MDM. Forty-four patients died during follow-up, of which 41 were DTC-related deaths, 5-year and 10-year DSS were 80% and 56%. On univariate analysis MDM had significantly shorter DSS; also histotype and RAI avidity were significant risk factors of impaired survival. On multivariate analysis, only loss of RAI avidity remained as independent negative predictor (p = 0.043). Considering SDM, DSS was significantly shorter in pre-RAIT group than baseline-RAIT (p = 0.004). Instead there was no significant difference between pre-RAIT-SDM and MDM in survival outcome (p = 0.875). CONCLUSIONS In DTC with DM, loss of RAI uptake has an important role in survival. No significant difference in survival outcome was discovered between SDM and MDM; but, among SDM, pre-RAIT had significant shorter DSS than baseline-RAIT.
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Affiliation(s)
| | | | - Rexhep Durmo
- Nuclear Medicine, Spedali Civili Brescia, Brescia, Italy
| | - Carlo Rodella
- Health Physics Department, Spedali Civili, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
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26
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Marti JL, Morris LG, Ho AS. Reply to: Selective history of radioactive iodine in medicine: Inexactitudes no longer. Eur J Surg Oncol 2018; 45:713-714. [PMID: 30224249 DOI: 10.1016/j.ejso.2018.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 08/07/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Luc Gt Morris
- Head & Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Allen S Ho
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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27
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Tang J, Kong D, Cui Q, Wang K, Zhang D, Liao X, Gong Y, Wu G. The role of radioactive iodine therapy in papillary thyroid cancer: an observational study based on SEER. Onco Targets Ther 2018; 11:3551-3560. [PMID: 29950860 PMCID: PMC6016280 DOI: 10.2147/ott.s160752] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Papillary thyroid cancer (PTC) is a common endocrine malignancy with relatively good prognosis. Radioactive iodine (RAI) is considered effective for patients with total or nearly total thyroidectomy, but the beneficial effects of RAI are still controversial. MATERIALS AND METHODS To determine whether RAI therapy could improve the survival rates of PTC patients, we conducted a retrospective analysis using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. Disease-specific survival (DSS) was obtained using multivariate Cox proportional hazard regressions. RESULTS DSS was improved by RAI ablation in patients with tumor >2 cm, age >45 years and gross extrathyroidal or lymph node metastasis. In a further analysis, RAI therapy did not improve the DSS in patients with tumor <2 cm except those with distant metastasis. For patients with tumor >2 cm, those involving gross extrathyroidal extension, age >45 years or disease in the lymph nodes, DSS was improved after RAI therapy. Patients with distant metastasis always benefited from RAI ablation. CONCLUSION RAI ablation should be recommended to patients with tumor <2 cm and distant metastasis or patients with tumor >2 cm and one of the following risk factors: gross extrathyroidal extension, age >45 years, lymph node and distant metastases.
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Affiliation(s)
- Jianing Tang
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Deguang Kong
- Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qiuxia Cui
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Kun Wang
- Department of Breast and Thyroid Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Zhang
- Department of Breast and Thyroid Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing Liao
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yan Gong
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Gaosong Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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28
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Chen M, Lash M, Nebesio T, Eugster E. Change in BMI after radioactive iodine ablation for graves disease. Int J Pediatr Endocrinol 2017; 2017:5. [PMID: 28588625 PMCID: PMC5455212 DOI: 10.1186/s13633-017-0044-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/17/2017] [Indexed: 11/24/2022]
Abstract
Background We aimed to determine the extent of post-treatment weight gain that occurs in pediatric patients in the first year following radioactive iodine (RAI) therapy for Graves disease (GD) and its relationship to clinical characteristics. Methods A retrospective chart review of patients receiving RAI therapy for GD between 1998–2015 was performed. Change in BMI SDS (∆BMI SDS) from baseline to one year after treatment was determined. We also investigated whether individual clinical and/or biochemical factors were associated with the weight trajectory in these patients. Results One hundred fifty seven patients aged 12.7 ± 3 years (80% girls) were included in the analysis. Average ∆BMI SDS was 0.70 ± 0.71 (p < 0.001) at 1 year. Patients with weight loss at presentation had a greater ∆BMI SDS than those without (0.92 vs 0.56, p = 0.005), whereas no association was seen with gender, pubertal status, use of antithyroid drugs, history of ADHD, or Down syndrome. Baseline BMI SDS was negatively correlated with ∆BMI SDS, with a stronger correlation in males. From baseline to 1 year, the proportion of overweight and obese patients increased from 9.6% to 18.5% and from 6.4% to 21%, respectively. In a subset of 81 patients, a positive correlation was noted between time to euthyroidism and ∆BMI SDS, particularly in boys. Conclusions The number of our patients in the overweight category doubled and the number in the obese category more than tripled in the first year following RAI treatment for GD. Anticipatory guidance regarding this important issue is badly needed.
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Affiliation(s)
- Melinda Chen
- Department of Pediatrics, Section of Pediatric Endocrinology, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Drive, Room # 5960, Indianapolis, IN 46202 USA
| | - Matthew Lash
- Department of Pediatrics, Naval Medical Center, 34800 Bob Wilson Dr, San Diego, CA 92134 USA
| | - Todd Nebesio
- Department of Pediatrics, Section of Pediatric Endocrinology, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Drive, Room # 5960, Indianapolis, IN 46202 USA
| | - Erica Eugster
- Department of Pediatrics, Section of Pediatric Endocrinology, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Drive, Room # 5960, Indianapolis, IN 46202 USA
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29
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An JH, Kim HY, Kim SG, Dralle H, Randolph GW, Piantanida E, Tanda ML, Dionigi G. Endpoints for screening thyroid cancer in the Republic of Korea: thyroid specialists' perspectives. J Endocrinol Invest 2017; 40:683-685. [PMID: 28008561 DOI: 10.1007/s40618-016-0596-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 12/05/2016] [Indexed: 01/02/2023]
Abstract
Cancer screening is aimed primarily at reducing deaths from the specific cancer. Thyroid-specific cancer mortality may be the most ambitious endpoint for obtaining estimates of screening effect. Numerous observations have accumulated over the years, indicating that thyroid cancer mortality endpoint has been difficult to study and is confounded by population heterogeneity, provision of randomization, and requirement of large cohorts with sufficiently long follow-up due to the excellent prognosis of the cancer. Accordingly, it may be important to reconsider how to best measure thyroid cancer screening efficacy. Recommendations against thyroid cancer screening should be based upon trials designed to evaluate its effectiveness not only in significant reduction in cancer mortality, but also of other distinct endpoints. It is desirable to evaluate derivative endpoints that can reliably predict reductions in mortality. The term "derivative" means a variable that is related to the true endpoint and is likely to be observable before the primary endpoint. Derivative endpoints may include thyroid cancer incidence, the proportion of early-stage tumors detected, more treatable stage, the identification of small tumors (to maintain in observation), decrease in the number of people who develop metastatic disease, the increased chance of lesser extent surgery, and the application of minimally invasive approaches, as well as no need for lifelong thyroid replacement therapy, a consistent follow-up, low-dose or no RAI administration and risk factor assessments where case findings should be continuous. The Korean guidelines for thyroid cancer national-level screening were published by a relevant group of multidisciplinary thyroid experts. It was concluded that the evidence is insufficient to balance the benefits and harms of thyroid cancer screening. However, the paper seems to raise the necessary investments in future research and demand a complete analysis for derivative endpoints, and offer screening participants with complete information necessary to make decisions that will provide them with the most value when a small thyroid cancer is screen-identified.
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Affiliation(s)
- J H An
- Division of Endocrinology, Department of Internal Medicine, KUMC Thyroid Center, Korea University College of Medicine, Seoul, Korea
| | - H Y Kim
- Department of Surgery, KUMC Thyroid Center, Korea University College of Medicine, Seoul, Korea.
| | - S G Kim
- Division of Endocrinology, Department of Internal Medicine, KUMC Thyroid Center, Korea University College of Medicine, Seoul, Korea.
| | - H Dralle
- Section of Endocrine Surgery, Department of General, Visceraland Vascular Surgery, University Hospital Essen, Essen, Germany
| | - G W Randolph
- Division of Thyroid and Parathyroid Surgery, Harvard Medical School, Boston, MA, USA
| | - E Piantanida
- Division of Endocrinology, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - M L Tanda
- Division of Endocrinology, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - G Dionigi
- 1st Division of General Surgery, Department of Surgical Sciences and Human Morphology, Research Center for Endocrine Surgery, University of Insubria (Varese-Como), via Guicciardini 9, 21100, Varese, Italy
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30
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Abstract
BACKGROUND Racial disparities in the management of differentiated thyroid cancer (DTC) exist in the United States. There is a paucity of data examining their temporal trends. It was hypothesized that racial disparities in care provided to patients with DTC have improved over the past 15 years. METHODS Adult patients undergoing surgery for DTC were included from the National Cancer Data Base (1998-2012). Temporal trends in appropriate extent of thyroidectomy and radioactive iodine therapy (RAI) were described for different racial groups. Multivariable logistic regression models were employed to estimate the adjusted association of receipt of appropriate extent of surgery and RAI, specifically under- and over-treatment, among different racial groups. RESULTS Among 282,043 DTC patients, 80.3% were non-Hispanic white (white), 8.1% Hispanic, 7.2% non-Hispanic black (black), and 4.4% Asian. Black versus white race/ethnicity was associated with lower odds of receiving appropriate surgery (odds ratio [OR] = 0.78 [confidence interval (CI) 0.71-0.87]; p < 0.001). Appropriate RAI treatment was higher in blacks (OR = 1.07 [CI 1.02-1.12]; p = 0.01) and lower for Hispanics (OR = 0.90 [CI 0.86-0.95]; p < 0.001) compared with whites. There was a higher likelihood of RAI under-treatment in minority groups (Hispanic OR = 1.27, black OR = 1.26, Asian OR = 1.25; p < 0.001), and a lower likelihood of RAI over-treatment (Hispanic OR = 0.89, black OR = 0.83, Asian OR = 0.79; p < 0.001) compared with whites. Over time, an increasing proportion of black and white patients underwent appropriate extent of thyroidectomy (1998 vs. 2012: 78% vs. 88% and 81% vs. 91%, respectively). Compared with 1998, fewer patients in 2012 were under-treated with RAI: whites (48% vs. 29%, respectively), blacks (51% vs. 33%), Hispanics (51% vs. 37%), and Asians (55% vs. 39%). The extent of RAI over-treatment increased (1998 vs. 2012): whites (1% vs. 4%), blacks (2% vs. 4%), Hispanics (2% vs. 4%), and Asians (2% vs. 3%), respectively. CONCLUSIONS Appropriate utilization of surgery and RAI for DTC has improved over time. However, the proportion of patients receiving appropriate thyroid surgery is consistently lower for blacks compared with whites. RAI over-treatment increased for all races over the study period. Efforts are needed to standardize DTC care among minority patients.
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Affiliation(s)
- Syed A Shah
- 1 Department of Surgery Virginia Commonwealth University , VCU Medical Center, Richmond, Virginia
| | - Mohamed A Adam
- 2 Department of Surgery, Duke University , Duke University Medical Center, Durham, North Carolina
| | - Samantha M Thomas
- 3 Department of Biostatistics, Duke University , Duke University Medical Center, Durham, North Carolina
- 4 Department of Bioinformatics, Duke University , Duke University Medical Center, Durham, North Carolina
| | - Randall P Scheri
- 2 Department of Surgery, Duke University , Duke University Medical Center, Durham, North Carolina
| | - Michael T Stang
- 2 Department of Surgery, Duke University , Duke University Medical Center, Durham, North Carolina
| | - Julie A Sosa
- 2 Department of Surgery, Duke University , Duke University Medical Center, Durham, North Carolina
- 5 Department of Medicine (Oncology), Duke University , Duke University Medical Center, Durham, North Carolina
| | - Sanziana A Roman
- 2 Department of Surgery, Duke University , Duke University Medical Center, Durham, North Carolina
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31
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Goffredo P, Jillard C, Thomas S, Scheri RP, Sosa JA, Roman S. Minimally invasive follicular carcinoma: predictors of vascular invasion and impact on patterns of care. Endocrine 2016; 51:123-30. [PMID: 26077949 DOI: 10.1007/s12020-015-0649-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
Some studies have reported that minimally invasive follicular carcinoma (MIFC) with vascular invasion is associated with compromised prognosis, leading to an ongoing debate regarding extent of surgery for MIFC. Our goal was to identify predictors of vascular invasion and determine its impact on patterns of care. Adult patients with MIFC were culled from the National Cancer Database, 2010-2011, and segregated according to the presence/absence of capsular or vascular invasion. Variables of interest were examined using Chi-square and student's t tests. Multivariate analysis was performed with logistic regression. A total of 617 patients with MIFC were identified: 54% with capsular invasion only and 46% with vascular invasion. Demographic characteristics were similarly distributed between the two groups. Tumor size was larger in patients with vascular invasion (mean = 35.7 vs. 29.2 mm capsular invasion only, p < 0.001); a 2% increase in risk of vascular invasion was observed with each 1 mm increase in size. The rate of total thyroidectomy was similar for MIFCs with vascular invasion compared to capsular invasion only (72.9 vs. 75.1%, p = 0.537). The RAI administration rate was higher in patients with vascular invasion (62.1 vs. 52.6% capsular invasion only, p = 0.017). In multivariate analysis, the presence of vascular invasion was independently associated with increased likelihood of receiving RAI (OR 1.641, p = 0.007). MIFC remains aggressively treated despite current guidelines favoring a more conservative approach. Building consensus around MIFC management is important for standardization of practice patterns and improvement in quality of care.
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Affiliation(s)
| | - Christa Jillard
- Section of Endocrine Surgery, Department of Surgery, Duke University Medical Center, Duke University School of Medicine, Erwin Road, Durham, NC, 27710, USA
| | - Samantha Thomas
- Department of Biostatistics, Duke University, Durham, NC, USA
| | - Randall P Scheri
- Section of Endocrine Surgery, Department of Surgery, Duke University Medical Center, Duke University School of Medicine, Erwin Road, Durham, NC, 27710, USA
| | - Julie Ann Sosa
- Duke Clinical Research Institute, Durham, NC, USA
- Section of Endocrine Surgery, Department of Surgery, Duke University Medical Center, Duke University School of Medicine, Erwin Road, Durham, NC, 27710, USA
| | - Sanziana Roman
- Section of Endocrine Surgery, Department of Surgery, Duke University Medical Center, Duke University School of Medicine, Erwin Road, Durham, NC, 27710, USA.
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Chiu SN, Shao PL, Wang JK, Chen HC, Lin MT, Chang LY, Lu CY, Lee PI, Huang LM, Wu MH. Severe bacterial infection in patients with heterotaxy syndrome. J Pediatr 2014; 164:99-104.e1. [PMID: 24112867 DOI: 10.1016/j.jpeds.2013.08.051] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/10/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the incidence of sepsis in patients with heterotaxy syndrome. STUDY DESIGN From our institutional database, we identified patients with heterotaxy syndrome and other complex congenital heart disease (CHD) born between 2001 and 2011. Severe bacterial infection was defined as sepsis with positive culture result or infection with abscess formation. RESULTS We enrolled 95 patients with heterotaxy syndrome (88 with right atrial isomerism and 7 with left atrial isomerism) and 142 patients with complex CHD. With 1026 person-years follow-up, the 5-year survival was 52% and 65.7% in heterotaxy and complex CHD groups, respectively (P = .239). Community-acquired severe bacterial infection occurred only in heterotaxy syndrome (13 episodes in 10 patients, 3 of whom had spleen noted at imaging study) with 2- and 5 years cumulative severe bacterial infection rate of 9.6% and 14.5%, respectively. The overall mortality rate of those with community-acquired severe bacterial infection was 31%. Pneumococcus and Citrobacter freundii were the most common pathogens. Nosocomial severe bacterial infection occurred in 33.3% of all patients and 12.5% of all procedures. The rates (0.59 and 0.52/100 hospitalization days in heterotaxy and complex CHD group) and the pathogens of nosocomial severe bacterial infection were similar between heterotaxy and complex CHD groups. CONCLUSIONS Patients with heterotaxy syndrome are at high risk for community-acquired severe bacterial infection and also have high mortality rate whether the spleen is present or not. The risk of nosocomial severe bacterial infection seems similar to that of patients with other complex CHD.
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Affiliation(s)
- Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital Medical College, National Taiwan University, Taipei, Taiwan
| | - Pei-Lan Shao
- Department of Pediatrics, National Taiwan University Hospital Medical College, National Taiwan University, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital Medical College, National Taiwan University, Taipei, Taiwan
| | - Hui-Chi Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital Medical College, National Taiwan University, Taipei, Taiwan
| | - Luan-Yin Chang
- Department of Pediatrics, National Taiwan University Hospital Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-Yi Lu
- Department of Pediatrics, National Taiwan University Hospital Medical College, National Taiwan University, Taipei, Taiwan
| | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Hospital Medical College, National Taiwan University, Taipei, Taiwan
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital Medical College, National Taiwan University, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital Medical College, National Taiwan University, Taipei, Taiwan.
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Ouchari M, Chakroun T, Abdelkefi S, Romdhane H, Houissa B, Jemni Yacoub S. Anti-D auto-immunization in a patient with weak D type 4.0. Transfus Clin Biol 2013; 21:43-6. [PMID: 24365172 DOI: 10.1016/j.tracli.2013.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 10/01/2013] [Indexed: 11/19/2022]
Abstract
We report the case of a 56-year-old patient with blood group O+C-c+E-e+K-, followed for a myelodysplasic syndrome and treated by regular pheno-identical and compatible (RBCs) transfusion since December 2007. In June 2009, a positive crossmatch was found with 2 RBCs O+C-c+E-e+K-. A positive anti-body screening with a positive autocontrol was detected and anti-D was unidentified in the patient's serum. The DAT was positive (IgG) and elution identified an anti-D. The following assumptions were then made: it could be a partial D phenotype with anti-D alloantibodies or RH: 1 phenotype with an anti-D auto-antibodies. Molecular analysis by multiplex PCR and sequencing have depisted a weak D type 4.0 phenotype. In October 2009, over three months of RH:-1 RBC transfusion, the antibody screening and DAT (IgG) remained positive, and an eluate made from the patient's erythrocytes contained an anti-D. All these funding confirmed the autoimmune nature of the anti-D. This case report illustrates the importance of a well-conducted and immunohematological laboratories test in order to distinguish between auto- or allo-immune of anti-D in a RH: 1 poly-transfused patients. This distinction is of great importance for transfusion support.
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Affiliation(s)
- M Ouchari
- Unité de recherche « UR06SP05 », centre régional de transfusion sanguine, hôpital Farhat-Hached Sousse, Sousse, Tunisia
| | - T Chakroun
- Unité de recherche « UR06SP05 », centre régional de transfusion sanguine, hôpital Farhat-Hached Sousse, Sousse, Tunisia
| | - S Abdelkefi
- Unité de recherche « UR06SP05 », centre régional de transfusion sanguine, hôpital Farhat-Hached Sousse, Sousse, Tunisia
| | - H Romdhane
- Unité de recherche « UR06SP05 », centre régional de transfusion sanguine, hôpital Farhat-Hached Sousse, Sousse, Tunisia
| | - B Houissa
- Unité de recherche « UR06SP05 », centre régional de transfusion sanguine, hôpital Farhat-Hached Sousse, Sousse, Tunisia
| | - S Jemni Yacoub
- Unité de recherche « UR06SP05 », centre régional de transfusion sanguine, hôpital Farhat-Hached Sousse, Sousse, Tunisia.
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Lubans DR, Lonsdale C, Plotnikoff RC, Smith J, Dally K, Morgan PJ. Development and evaluation of the Motivation to Limit Screen-time Questionnaire (MLSQ) for adolescents. Prev Med 2013; 57:561-6. [PMID: 23954182 DOI: 10.1016/j.ypmed.2013.07.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/24/2013] [Accepted: 07/27/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to design and evaluate a brief scale to assess adolescents' motivation to limit their screen-time using a self-determination theory (SDT) framework. METHODS The development and evaluation of the Motivation to Limit Screen-time Questionnaire (MLSQ) involved three phases. In Phase 1, experts in SDT were asked to review the content validity of the MLSQ items. In Phase 2, adolescent boys (N=342, mean age=12.7 ±.5 years) completed the MLSQ and the factorial validity of the model was explored. In Phase 3, adolescent boys (N=48, mean age=14.3 ± 1.3 years) completed the MLSQ on two occasions separated by 1-week. Phases 2 and 3 were conducted in New South Wales, Australia in 2012. RESULTS Twenty four SDT experts reviewed the original scale items. Validity coefficients associated with six of the original eight items exceeded the threshold value (V>.68, p<.01). In Phase 2, the revised three-factor (9-items) model provided a good fit to the data (SRMR=.07, CFI=.96). The intraclass correlation (ICC) values were .67 for amotivation and .70 and .82 for controlled and autonomous motivation, respectively. CONCLUSION This study has provided preliminary evidence for the validity and reliability of the MLSQ in adolescent boys.
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Affiliation(s)
- D R Lubans
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Newcastle, Australia.
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Krämer B, Kamphuis E, Hanschmann KM, Milne C, Daas A, Duchow K. A multi-dose serological assay suitable to quantify the potency of inactivated rabies vaccines for veterinary use. Biologicals 2013; 41:400-6. [PMID: 24144483 DOI: 10.1016/j.biologicals.2013.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/22/2013] [Accepted: 08/23/2013] [Indexed: 11/21/2022] Open
Abstract
The mouse vaccination-challenge test, which is the most widely used method for determining the potency of inactivated rabies vaccines, is imprecise, time-consuming, and causes severe distress to the test animals. An alternative single-dose serological method has been implemented in the European Pharmacopoeia Monograph 0451 to replace the mouse challenge test for batch release. This single-dose limit method provides semi-quantitative results, but is not suitable for quantifying potency. We have now extended this serological method to a multi-dose format which allows a quantification of vaccine potency. In studies including all rabies vaccine strains relevant for Europe, we found dose-dependency for all vaccines and standard preparations. We have demonstrated that the multi-dose serological approach provides reliable quantitative potency results and is more precise than the mouse vaccination-challenge test. We have shown that adjuvanted vaccines can be calibrated against non-adjuvanted material, and that reference material can be calibrated against the International Standard. The method is therefore capable of assigning potency with the additional advantage of requiring fewer animals and reducing distress. Once the applicability of the method has been further verified in a collaborative study, it can complement the single-dose assay and eventually eliminate the need for the mouse challenge test.
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Abstract
Objective To describe the association of the rare and serious complication of liver toxicity in previously healthy Grave’s disease (GD) patients after the treatment with radioactive iodine 131I (RAI). Case presentation We report the clinical, laboratory and pathologic findings of 2 cases of severe liver toxicity associated with the treatment with RAI in previously healthy patients with GD. Clinical examination and laboratory investigations excluded viral hepatitis, autoimmune hepatitis, granulomatous disease, primary biliary disease, extrahepatic biliary obstruction, and heart failure. Case 1: A previously healthy 52-years old man reportedly having a typical GD but following RAI treatment, concomitantly developed severe liver toxicity that required 1 week of treatment in hospital. Case 2: A previously healthy 34-years old woman is reported as having a typical GD but developed jaundice following RAI treatment that required several weeks of in hospital treatment in the hepato-biliary department. In both cases, the liver dysfunction resolved after intensive treatment with hepato-protective agents. In this report the therapeutic considerations as well as the pathogenetic possibilities are reviewed. Conclusion To the best of our knowledge, this is the first description of the association observed, which is rare but may be severe and should be considered in any case of thyrotoxicosis where a liver dysfunction develops after the treatment with radioactive iodine 131I.
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Affiliation(s)
- Navina Priya Jhummon
- Department of Endocrinology and Metabolism, Tenth People's Hospital of Tongji University, Tongji University, School of Medicine, Shanghai, 200072, China
| | - Bhavna Tohooloo
- Department of Endocrinology and Metabolism, Tenth People's Hospital of Tongji University, Tongji University, School of Medicine, Shanghai, 200072, China
| | - Shen Qu
- Department of Endocrinology and Metabolism, Tenth People's Hospital of Tongji University, Tongji University, School of Medicine, Shanghai, 200072, China
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Sørbye LW, Hamran T, Henriksen N, Norberg A. Home care patients in four Nordic capitals - predictors of nursing home admission during one-year followup. J Multidiscip Healthc 2010; 3:11-8. [PMID: 21197351 PMCID: PMC3004595 DOI: 10.2147/jmdh.s8979] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Indexed: 11/23/2022] Open
Abstract
The aim was to predict nursing home admission (NHA) for home care patients after a 12-month follow-up study. This Nordic study is derived from the aged in home care (AdHOC) project conducted in 2001–2003 with patients at 11 sites in Europe. The participants in the cohort study were randomly selected individuals, aged 65 years or older, receiving homecare in Oslo, Stockholm, Copenhagen, and Reykjavik. The Resident Assessment Instrument for Home Care (version 2.0) was used. Epidemiological and medical characteristics of patients and service utilization were recorded for 1508 home care patients (participation rate 74%). In this sample 75% were female. The mean age was 82.1 (6.9) years for men and 84.0 (6.6) for women. The most consistent predictor of NHA was receiving skilled nursing procedures at baseline (help with medication and injections, administration or help with oxygen, intravenous, catheter and stoma care, wounds and skin care) (adjusted odds ratio = 3.7, 95% confidence interval: 1.7–7.8; P < 0.001). In this Nordic material, stronger emphasizing on higher qualified nurses in a home care setting could prevent or delay NHA.
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