The phenotype of newly diagnosed Graves' disease in Italy in recent years is milder than in the past: results of a large observational longitudinal study.

OBJECTIVE: The Merseburg triad (hyperthyroidism, goiter, and orbitopathy) characterizes classical description of Graves' disease (GD). Aim of this observational, longitudinal study was to evaluate the current clinical features of newly diagnosed GD in Italy. MATERIALS AND METHODS: In two Northern Italy centers (Varese and Pavia), 283 consecutive patients (211 women, 72 men; mean age 47.4 years) with newly diagnosed GD were recruited in the years 2010-2014. Diagnosis was based on established criteria, and thyroid volume was assessed by ultrasonography. A clinical severity score (CSS) to assess the overall disease severity was developed by grading each component of the Merseburg triad. RESULTS: At diagnosis, 45 % of patients had no goiter, and 30 % had a small goiter. The proportion of goitrous patients was much lower than in two Italian studies performed 20-30 years ago. Hyperthyroidism was subclinical in 16 % and mild in 29 % of patients, and Graves' orbitopathy was present in 20 %, usually mild, and active in only 2.5 % of patients. Using the CSS, less than half (44 %) of the patients had severe GD, while 22 % had mild and 34 % moderate disease. CSS was associated with a significantly higher risk of poorly controlled hyperthyroidism at 6 months. CONCLUSIONS: In Italy, a relevant proportion of Graves' patients at diagnosis have mild to moderate GD; about half of them have no goiter, slightly less than one-fifth have subclinical hyperthyroidism, and only 20 % have GO. Thus, the clinical phenotype of GD is milder than in the past, possibly due to both earlier diagnosis and treatment, and improved iodine nutrition.

Outcome Prediction of Treatment of Graves' Hyperthyroidism with Antithyroid Drugs.

Graves' disease is the most common cause of hyperthyroidism in iodine-replete areas and is ultimately due to antibodies interacting with the TSH receptor on thyroid follicular cells [TSH-receptor antibody (TRAb)]. Antithyroid drugs (ATDs) belonging to the family of thionamides are the first-line treatment in Europe. ATD treatment is commonly continued for 18-24 months. Its major limitation is the high rate of relapses after drug withdrawal. Factors particularly bound to subsequent relapses are the large thyroid volume, smoking habit, persistence of TRAb in the circulation at the end of treatment, and the post-partum period. Under these conditions, consideration should be given to a definitive therapy for hyperthyroidism (radioiodine treatment, thyroidectomy), particularly if the patient is at risk of cardiovascular complications that might be exacerbated by persistence or recurrence of hyperthyroidism.

Effect of eye lateralization on contralateral suppression of transient evoked otoacoustic emissions.

Several studies have previously demonstrated that postural changes modify evoked otoacoustic emission. In order to evaluate a possible interaction between eye muscles and ciliated cells in the inner ear, we studied the effects of eye lateralization on the contralateral suppression of transient evoked otoacoustic emissions (TEOAEs). Thirty-eight normal hearing subjects with TEOAEs were recruited. Their TEAOEs at threshold level were recorded with contralateral suppression (white noise) via straight ahead fixation and right or left lateral fixation. Eye lateralization in the same direction of the white noise significantly decreased the suppression at 4 kHz (p = 0.003). The signal-to-noise ratio in the suppression condition with straight ahead was 1.54 (± 4.610) dB, while the ratio was 3.48 (± 4.631) dB in the suppression condition with gaze toward the white noise. Eye lateralization seems to reduce the contralateral suppression effect of TEOAEs at 4 kHz. However, further studies are necessary to investigate the possible mechanisms of this phenomenon.

New technology for noninvasive brain monitoring: continuous cerebral oximetry.

Although the central nervous system is the primary endpoint of most general anesthetics, it is still the least monitored organ in clinical anesthesiology. In the last decade, technological research has expanded the application of near-infrared spectroscopy to allow continuous, non-invasive, and bedside monitoring of cerebral oxygen saturation (rSO(2)) through the scalp and skull, providing accurate information on the balance between brain oxygen supply and demand. The aim of this review is to provide an overview on relevant technological issues of cerebral oximetry, describe a systematic approach to its use, and summarize current information on its possible impact on our daily practice. We reviewed studies published on peer-reviewed journals about technological development and clinical application of rSO(2) monitoring in different fields of application to clinical practice. Due to the wide patient-to-patient variability of baseline rSO(2) values in each patient the baseline value should be determined before inducing general anesthesia, and cerebral ischemia is related more to the changes from baseline than to the absolute value: a reduction of 20% from baseline is usually accepted as clinical threshold of cerebral ischemia. If baseline rSO(2) is lower than 50% the critical threshold should be reduced to 15%. Routine use of rSO(2) monitoring in patients undergoing cardiac surgery to guide the anesthesia plan has been demonstrated to improve patient outcome and shorten hospital stay. However, rSO(2) monitoring does not seem to provide information accurate enough to indicate the placement of a Javid's shunt during carotid endarterectomy. In patients with neurological pathology or head trauma rSO(2) monitoring has been reported accurate enough in detecting early changes in cerebral blood flow that might result in cerebral ischemia. In aged patients undergoing major abdominal surgery rSO(2) monitoring to guide the anesthesia plan has been reported to reduce the exposition to cerebral ischemia with less effects on cognitive decline and shorter hospital stay. In conclusion several clinical conditions routinely encountered in our daily practice have the potential to disrupt the balance between the brain oxygen supply and demand, exposing to the risk of intraoperative cerebral ischemia. These alterations in brain oxygen balance remain totally undiagnosed if we do not specifically monitor it; while the possibility of monitoring regional cerebral oxygen saturation through a simple and totally non-invasive device has the potential for optimizing our anesthesia plan to the real needs of our main targeted organ: the brain.

[Role of assisted breathing in severe traumatic brain injury]. / La ventilazione assistita nel trauma cranico grave.

BACKGROUND: Based on available data, there is no definite clinical research describing option, timing and effects of assisted as opposed to controlled ventilation to successfully treat acute severely brain-injured patients. This study demonstrates pressure support ventilation as a possible alternative to controlled ventilation in the acute phase of brain injury. We illustrated which factors influenced the shift from total (CPPV) to partial ventilatory support (PS-SIGH) and the consequences of assisted ventilation on cerebral hemodynamics. METHODS: a) EXPERIMENTAL DESIGN: Retrospective, cohort study. b) SETTING: Adult intensive care unit of a university hospital. c) Patients population: Forty-two severe head-trauma victims (GCS

Activated estrogen receptor mediates growth arrest and differentiation of a neuroblastoma cell line.

Several reports demonstrate estrogen receptor involvement in specific brain functions. In addition, estrogen receptors are expressed at early stages of brain development, suggesting that estrogens or related molecules may play an instructive role in the differentiation of specific brain areas. The lack of model systems in which these phenomena could be studied prompted us to develop a neuroblastoma cell line expressing the estrogen receptor. The cell line expresses the hormone receptor at levels compatible with a physiological activity. The activated estrogen receptor is capable of blocking proliferation of the cells without exerting toxic effects. Following growth arrest, the cells display a neuron-like morphology and express tau and synaptophysin, two proteins synthesized in differentiating neurons. The cell line generated will provide a valuable model system for molecular and biochemical studies of the activity of estrogens in neural-derived cells.

Nucleotide sequence of estrogen receptor cDNA from Sprague-Dawley rat.

The cDNA of the Sprague-Dawley rat estrogen receptor was sequenced. With respect to the published Wistar rat estrogen receptor sequence, a single amino acid difference (tryptophan instead of asparagine) was found in the hormone binding site. Since tryptophan was found at the same position in chicken, human and mouse estrogen receptors, it is proposed that the Wistar rat could represent an interesting natural mutant for estrogen receptor studies.