US-guided percutaneous radiofrequency thermal ablation for the treatment of solid benign hyperfunctioning or compressive thyroid nodules

The aim of the study was to define the effectiveness and safety of ultrasound-guided percutaneous radiofrequency (RF) thermal ablation in the treatment of compressive solid benign thyroid nodules. Thirty-one patients not eligible for surgery or radioiodine (¹³¹I) treatment underwent RF ablation for benign nodules; a total of 33 nodules were treated (2 patients had 2 nodules treated in the same session): 10 cold nodules and 23 hyperfunctioning. Fourteen patients complained of compressive symptoms. Nodule volume, thyroid function and compressive symptoms were evaluated before treatment and at 1, 3 and 6 mo. Ultrasound-guided RF ablation was performed using a Starbust RITA^® needle, with nine expandable prongs; total exposure time was 6 to 10 min at 95° C in one area or more of the nodule. Baseline volume (measured at the time of RF ablation) was 27.7 ± 21.5 mL (mean ± SD), but significantly decreased during follow-up: 19.2 ± 16.2 at 1 mo (–32.7%; p < 0.001), 15.9 ± 14.1 mL at 3 mo (–46.4 %; p < 0.001) and 14.6 ± 12.6 mL at 6 mo (–50.7%; p < 0.001). After treatment, all patients with cold nodules remained euthyroid: five patients with hot nodules normalized thyroid function, and the remaining sixteen showed a partial remission of hyperthyroidism. Besides a sensation of heat and mild swelling of the neck, no major complications were observed. Improvement in compressive symptoms was reported by 13 patients, with a reduction on severity scale from 6.1 ± 1.4 to 2.2 ± 1.9 (p < 0.0001). Radiofrequency was effective and safe in reducing volume by about 50% and compressive symptoms in large benign nodules. Hyperfunction was fully controlled in 24% of patients and partially reduced in the others. (E-mail: mdeandrea@libero.it)     

垂体细胞瘤1例并文献复习

目的 探讨垂体细胞瘤的临床病理学特征.方法 对1例垂体细胞瘤进行临床病理分析,并复习相关文献.结果 患者男性,46岁,临床表现为双眼视力下降,头颅MRI示鞍区占位,大体表现为实性肿瘤,镜下肿瘤由双极梭形细胞构成,呈束状、席纹状或旋涡状排列,肿瘤细胞Vimentin、S-100强阳性,GFAP局灶片状阳性,TTF-1阳性...     

The role of BDNF and HPA axis in the neurobiology of burnout syndrome

Chronic stress is known to affect the HPA axis. The few clinical studies which have been conducted on HPA-axis function in burnout have produced inconsistent results. The etiological relationship between sBDNF and burnout has not yet been studied. The aim of the current study was to investigate the role of BDNF and HPA axis in the neurobiology of burnout. In the current study 37 clinically diagnosed burnout participants were compared with 35 healthy controls in terms of BDNF, HPA axis, burnout symptoms, depression, anxiety and psychosomatic complaints. Basal serum cortisol, sBDNF and cortisol level after 1 mg DST was sampled. We found no significant differences in terms of HPA-axis function (for basal serum cortisol, p=0.592; for cortisol level after 1 mg DST, p=0.921), but we did find lowered sBDNF levels in burnout group (88.66+/-18.15 pg/ml) as compared to healthy controls (102.18+/-20.92 pg/ml) and the difference was statistically significant (p=0.005). Logistic Regression Analysis revealed that emotional exhaustion (p=0.05), depersonalization (p=0.005) and depression (p=0.025) were significantly associated with burnout. sBDNF levels correlated negatively with emotional exhaustion (r=-,268, p=0.026), depersonalization (r=-,333, p=0.005) and correlated positively with competence (r=0.293, p=0.015) sub-scales of burnout inventory. However, there were no significant relationships between cortisol levels and sBDNF levels (r=0.80, p=0.51), depression, anxiety, psychosomatic complaints and burnout inventory. Our results suggest that low BDNF might contribute to the neurobiology of burnout syndrome and it seems to be associated with burnout symptoms including altered mood and cognitive functions.     

Thyroid hormones promote differentiation of oligodendrocyte progenitor cells and improve remyelination after cuprizone-induced demyelination

In the present work we analyzed the capacity of thyroid hormones (THs) to improve remyelination using a rat model of cuprizone-induced demyelination previously described in our laboratories. Twenty one days old Wistar rats were fed a diet containing 0.6% cuprizone for two weeks to induce demyelination. After cuprizone withdrawal, rats were injected with triiodothyronine (T3). Histological studies carried out in these animals revealed that remyelination in the corpus callosum (CC) of T3-treated rats improved markedly when compared to saline treated animals. The cellular events occurring in the CC and in the subventricular zone (SVZ) during the first week of remyelination were analyzed using specific oligodendroglial cell (OLGc) markers. In the CC of saline treated demyelinated animals, mature OLGcs decreased and oligodendroglial precursor cells (OPCs) increased after one week of spontaneous remyelination. Furthermore, the SVZ of these animals showed an increase in early progenitor cell numbers, dispersion of OPCs and inhibition of Olig and Shh expression compared to non-demyelinated animals. The changes triggered by demyelination were reverted after T3 administration, suggesting that THs could be regulating the emergence of remyelinating oligodendrocytes from the pool of proliferating cells residing in the SVZ. Our results also suggest that THs receptor β mediates T3 effects on remyelination. These results support a potential role for THs in the remyelination process that could be used to develop new therapeutic approaches for demyelinating diseases.     

Skin Nodules After Semipermanent Cosmetic Dermal Filler

The authors present what they believe is only the third reported incidence of orofacial granulomas after injection of semipermanent cosmetic filler.     

Surgical Treatment of Solitary Thyroid Nodules Via Fine-Needle Aspiration Biopsy and Frozen-Section Analysis

Background Fine-needle aspiration biopsy (FNAB) and frozen-section analysis of managing solitary thyroid nodules continue to generate considerable controversy. Methods This study was a retrospective review of 619 patients with solitary thyroid nodules who underwent thyroidectomy. Results Of 540 FNABs, 35 (6.5%) were positive for malignancy, 276 (51.1%) were benign, and 229 (42.4%) were suspicious. Only 5.1% were false negative, and 11.4% were false positive. Diagnostic FNAB sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for malignancy were 86.1%, 59.7%, 33.0%, 94.9%, and 64.6%, respectively. Of 569 patients analyzed by frozen section, diagnosis was deferred in 86 (15.1%) patients, and results were positive for malignancy in 92 (16.2%) and benign in 391 (68.7%). No false-positive results were noted, but 2.3% (391) were false negative. Of 86 deferred frozen sections, 11 (12.8%) patients had malignant tumors confirmed by permanent section. Diagnostic frozen-section sensitivity, specificity, PPV, NPV, and accuracy for carcinoma were 82.1%, 100%, 100%, 95.8%, and 96.5%, respectively. Sensitivity, specificity, PPV, NPV, and accuracy for frozen-section analysis for diagnosis of carcinoma in patients with suspicious FNAB were 83.9%, 100%, 100%, 94.9%, and 96.0%, respectively. Conclusions FNAB is a sensitive diagnostic modality in selecting patients who require surgery. Routine use of frozen-section analysis is unwarranted for benign FNAB results. Frozen section is specific and cost-effective in determining the extent of surgery in patients with suspicious or malignant FNABs.     

温针灸治疗成人甲状腺功能低下的临床疗效探析

目的观察温针灸治疗甲状腺功能低下的临床疗效。方法按照随机数字表法,将合格受试病例分成两组,分别采用温针灸、西药口服治疗来观察两组治疗前后血清三碘甲状腺原氨酸（T3）、甲状腺素（T4）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、血清促甲状腺激素（TSH）水平变化情况,通过疗效标准以评定疗效。结果本研究入组病例依从性良好,治疗组总有效率为93.3%,对照组为80.0%,差异有统计学意义（P〈0.05）。治疗组所选穴位为临床常用穴位,在治疗过程中均无晕针、滞针、弯针、断针、血肿等不良反应记录。对照组患者无不良反应发生。结论温针灸法治疗成人甲状腺功能低下比西药疗法有更好的临床疗效,且具有方便、省时、刺激温和、费用低廉的优点。     

Lack of Alterations in Thyroid Hormones Following Exposure to Polybrominated Diphenyl Ether 47 during a Period of Rapid Brain Development in Mice

Thyroid alterations have been shown to occur following exposure to polybrominated diphenyl ether (PBDE) mixtures, possibly indicating that disruptions in thyroid hormone levels may underlie behavior deficits observed in animals following postnatal PBDE exposure. This study determined whether acute postnatal exposure to PBDE-47 would alter thyroid hormones. Mice were dosed with PBDE-47 on postnatal day 10, and serum collected either 1, 5, or 10 days after the dose. No effect was observed on thyroxine and triiodothyronine levels at any age examined. This suggests that the neurological abnormalities reported in mice exposed to PBDE-47 are not due to acute changes in circulating thyroid hormones at these observed periods.     

Pubertal exposure to bismerthlazol inhibits thyroid function in juvenile female rats

Bismerthiazol, as a thiadiazole fungicide, is widely used in China. The structure of bismerthiazol shows a close relationship to N,N-methylene-bis (2-amino-1,3,4-thiadiazole) (Bis-A-TDA), which is a teratogen. A few studies have shown that this fungicide acts as an endocrine disruptor in mature rats via disturbance in thyroid hormone homeostasis at a certain dose. Little is known about the effect of pubertal exposure to bismerthiazol on the development in pubertal female rats. Based on the protocol of the 20-Day Pubertal Female Assay, postnatal days (PND) 22 old SD rats were administered with bismerthiazol daily by oral gavage at doses of 0, 10, 20 or 40 mg/kg/day for 20 days. After treatment, the rats were sacrificed for blood collection; the reproductive organs, liver, pituitary, adrenal and thyroid gland were harvested. The results indicated that changes in thyroid endpoints following bismerthiazol administration were decreased serum triiodothyronine (T₃) and thyroxine (T₄) concentrations, increased thyroid stimulating hormone (TSH) concentrations and the ratios of thyroid gland weights, and produced thyroid gland hyperplasia. No histological changes were observed in the uterus and ovaries; moreover, the age and weight at vaginal opening (VO) were unaffected by bismerthiazol in all treatment groups.These data and changes demonstrate that bismerthiazol is likely a thyroid disrupter in female rat following exposure during development, but does not affect the development of pubertal female rats. Further studies using environmentally relevant doses are needed for hazard identification.