Prognostic Factors for Early and Long-Term Remission in Pediatric Differentiated Thyroid Carcinoma: The Role of Sex, Age, Clinical Presentation, and the Newly Proposed American Thyroid Association Risk Stratification System.

BACKGROUND: The incidence of pediatric differentiated thyroid carcinoma (DTC) has been rising in recent years, and the main risk factors for recurrence are lymph node and distant metastasis at diagnosis. Other clinical features remain unclear, such as the impact of age, sex, and puberty. Furthermore, until now, this population has been treated using the same strategies used to treat adults. In 2015, the American Thyroid Association (ATA) published the first guidelines targeted at this age group. The aims of this study were to investigate the prognostic factors for early and long-term remission and also to validate the ATA risk stratification proposal in a population outside the United States. METHODS: Clinical records from 118 patients <18 years old followed in two referral centers were reviewed. The median age was 12 years (range 4-18 years), and 20.3% (24 patients) were <10 years old at diagnosis. The median follow-up was 9.1 years. The majority were female (72%) and received total thyroidectomy and radioiodine therapy (RAI), and 61.8% were treated with more than one dose of RAI. The majority were classified as high risk (48.3%) by the new ATA pediatric guidelines due to distant metastasis (30 patients) or extensive lymph node involvement (27 patients). The remained were classified as low risk (31.3%) and intermediate risk (20.4%). RESULTS: Females with no lymph node or distant metastasis and low ATA pediatric risk were more likely to have no evidence of disease (p < 0.05) within the first year and also in the long term. In this study, age did not significantly predict outcomes. Furthermore, patients also benefitted from multiple doses of RAI, but when the cumulative activity was >400 mCi, this benefit was diminished. CONCLUSIONS: This study shows that the ATA risk stratification proposal for pediatric patients is useful in predicting early and long-term outcomes in pediatric patients with DTC. In addition, it shows that sex and metastatic disease are important prognostic factors in pediatric populations.

Assessment of arterial stiffness in type 1 diabetes using digital pulse contour analysis: Is it a reliable method?

AIMS: The aim of this study was to assess the arterial stiffness in patients with type 1 diabetes compared with a control group and determine the associated potential risk factors for its occurrence. METHODS: Fifty-seven subjects with type 1 diabetes and fifty-three healthy controls were submitted to clinical and laboratory evaluation. The peripheral waveform pressure was analyzed to assess arterial stiffness according to the reflection and stiffness index. RESULTS: Arterial stiffness did not differ between the controls and patients with type 1 diabetes. Pulse pressure showed no difference among both groups. In the group of patients with type 1 diabetes, the stiffness index was correlated with diabetes duration (r = 0.59, p < 0.001), body mass index (r = 0.27, p = 0.03), diastolic blood pressure (r = 0.33, p = 0.001), triglycerides (r = 0.35, p = 0.007), and age (r = 0.46, p < 0.001). The reflection index was correlated with the systolic blood pressure (r = 0.29, p = 0.02), diastolic blood pressure (r = 0.30, p = 0.02), and cardiac frequency (r = 0.48, p < 0.001). In the stepwise multivariate analysis, disease duration, diastolic blood pressure, and HDL cholesterol were the most important independent variables associated with arterial stiffness in patients with type 1 diabetes. CONCLUSIONS: We concluded that in the studied population, arterial stiffness showed no difference between patients with diabetes and controls; thus, the use of this method should not be indicated for routine clinical practice in type 1 diabetes.