SFE-AFCE-SFMN 2022 Consensus on the management of thyroid nodules : What is the role of functional imaging and isotopic treatment?

The SFE-AFCE-SFMN 2022 consensus deals with the management of thyroid nodules, a condition that is a frequent reason for consultation in endocrinology. In more than 90% of cases, patients are euthyroid, with benign non-progressive nodules that do not warrant specific treatment. The clinician's objective is to detect malignant thyroid nodules at risk of recurrence and death, toxic nodules responsible for hyperthyroidism or compressive nodules warranting treatment. The diagnosis and treatment of thyroid nodules requires close collaboration between endocrinologists, nuclear medicine physicians and surgeons, but also involves other specialists. Therefore, this consensus statement was established jointly by 3 societies: the French Society of Endocrinology (SFE), French Association of Endocrine Surgery (AFCE) and French Society of Nuclear Medicine (SFMN); the various working groups included experts from other specialties (pathologists, radiologists, pediatricians, biologists, etc.). This section deals with the role of thyroid scintigraphy in the diagnosis of autonomous thyroid nodules, nuclear medicine in nodules with indeterminate cytology and iodine treatment for autonomous thyroid nodules.     

SFE-AFCE-SFMN 2022 consensus on the management of thyroid nodules: Synthesis and algorithms

The SFE-AFCE-SFMN 2022 consensus deals with the management of thyroid nodules, a condition that is a frequent reason for consultation in endocrinology. In more than 90% of cases, patients are euthyroid with benign and non-progressive nodules that do not warrant specific treatment. The clinician's objective is to detect malignant thyroid nodules at risk of recurrence and death, toxic nodules responsible for hyperthyroidism or compressive nodules warranting treatment. The diagnosis and treatment of thyroid nodules requires close collaboration between endocrinologists, nuclear medicine physicians and surgeons but also involves other specialists. Therefore, this consensus statement was established jointly by 3 societies, the French Society of Endocrinology (SFE), the French Association of Endocrine Surgery (AFCE) and the French Society of Nuclear Medicine (SFMN); the various working groups included experts from other specialties (pathologists, radiologists, pediatricians, biologists, etc.). This specific text is a summary chapter taking up the recommendations from specific sections and presenting algorithms for the exploration and management of thyroid nodules.     

Anterior segment changes after pharmacologic mydriasis using Pentacam and optical coherence tomography in angle closure suspects

AIM:To compare the dynamic changes of anterior segment parameters especially iris morphology induced by pharmacologic mydriasis between angle closure suspects and normal controls.METHODS:The study group comprised 19 eyes of 19 angle closure suspects and 19 eyes of 19 age- and sex-matched normal open-angle eyes. Pentacam and optical coherence tomography measurements before and 30min after instillation of compound tropicamide eye drop were performed and compared. Biometric evaluations of iris tomography and anterior chamber angle were estimated by a customized image-processing software.RESULTS:Baseline axial length, iris cross sectional area and volume did not differ significantly between angle closure suspects and normal controls. Angle closure suspects had smaller pupil size, narrower anterior segment dimension and axial length, thinner iris with greater curve in comparison with normal controls. Pharmacologic mydriasis led to significant increments in iris thickness at 750 μm, anterior chamber depth and volume, whereas significant decrements in iris curve, cross sectional area and volume in both groups. Angle opening distance at 500 μm was increased significantly in normal controls (from 0.465±0.115 mm to 0.539±0.167 mm, P=0.009), but not in angle closure suspects (from 0.125±0.100 mm to 0.145±0.131 mm, P=0.326). Iris volume change per millimeter of pupil dilation (△IV/△PD) decreased significantly less in angle closure suspects than normal controls (-2.47±1.33 mm² vs -3.63±1.58 mm², P=0.019). Linear regression analysis showed that the change of angle opening distance at 500 μm was associated most with the change of central anterior chamber depth (β=0.841, P=0.002) and △IV/△PD (β=0.028, P=0.002), followed by gender (β=0.062, P=0.032).CONCLUSION:Smaller iris volume decrement per millimeter of pupil dilation is related significantly with the less anterior angle opening in angle closure suspects after pharmacologic mydriasis. Dynamic iris change may be as a prospective indicator of iris compressibility and angle closure glaucoma.     

Zafirlukast attenuates advanced glycation end-products (AGEs)-induced degradation of articular extracellular matrix (ECM)

Zafirlukast, a leukotriene receptor antagonist, has been shown to exert a wide range of effects including anti-asthmatic, anti-inflammatory and oral anti-bacterial. Osteoarthritis is one of the most prevalent age-related public health burdens in the modern world. In the present study, we applied zafirlukast in the treatment of human primary chondrocytes and found that it exerts potent anti-osteoarthritic effects. Zafirlukast inhibited AGEs-induced degradation of the articular extracellular matrix by suppressing expression of MMPs, ADAMTS, NOX-4, generation of ROS, and activation of NF-κB via the IκBα/JNK/AP-1 pathway through targeted inhibition of CysLTR1. These findings suggest that zafirlukast possesses a protective effect against AGEs- induced damage and dysfunction in human chondrocytes.     

Langerhans cells proliferation in ectopic micronodular thymoma with lymphoid stroma: a case report

Ectopic micronodular thymoma (MNT) is a rare tumor. We described a 76-year-old woman, who was referred to our institutional for a mass in the left cervical region. The Magnetic Resonance Imaging (MRI) scan showed a 3.7 cm × 1.7 cm × 2.0 cm mass. The neoplasm was composed of epithelial tumor cells arranged in a micronodular growth pattern set in a stroma showing lymphoid hyperplasia with germinal centers. Immunohistochemical studies showed that the neoplastic epithelial cells were reactive for AE1/AE3, CK5/6, P63, and the lymphoid component to be of mixed B- and immature T-cell lineage. Langerhans cells were confirmed within epithelial nodules for the first time with langerin, S-100, CD1a expression. We report a case of cervical ectopic MNT to emphasize the langerhans cells proliferation and the histopathologic features and differential diagnosis of the rare lesion to promote a better and broader understanding of this less understood subject.     

专科护理质量敏感指标管理模式在神经内科住院患者中的应用

目的:探讨专科护理质量敏感指标管理模式在神经内科住院患者中的应用效果。方法:选取2018年10月1日~2019年10月31日神经内科收治的患者80例,将2018年10月1日~2019年3月31日收治的40例患者作为对照组,采取传统护理质量管理模式;将2019年4月1日~10月31日收治的40例患者作为观察组,采取专科护理质量敏感指标管理模式。比较两组改进项目质量评价情况、护理风险事件发生情况及护理满意度。结果:观察组分级护理落实率、护理技术规范率、风险应对合格率和康复训练落实率均高于对照组(P<0.05,P<0.01);观察组护理风险事件发生率低于对照组(P<0.01);观察组护理态度、专业能力、综合服务质量评分及护理满意度总评分均高于对照组(P<0.01)。结论:在神经内科住院患者中应用专科护理质量敏感指标,能有效改善护理服务质量,降低护理风险事件发生率,提高护理满意度。