ThyroidPrint®: clinical utility for indeterminate thyroid cytology.

Molecular testing contributes to improving the diagnosis of indeterminate thyroid nodules (ITNs). ThyroidPrint® is a ten-gene classifier aimed to rule out malignancy in ITN. Post-validation studies are necessary to determine the real-world clinical benefit of ThyroidPrint® in patients with ITN. A single-center, prospective, noninterventional clinical utility study was performed, analyzing the impact of ThyroidPrint® in the physicians' clinical decisions for ITN. Demographics, nodule characteristics, benign call rates (BCRs), and surgical outcomes were measured. Histopathological data were collected from surgical biopsies of resected nodules. Of 1272 fine-needle aspirations, 109 (8.6%) were Bethesda III and 135 (10.6%) were Bethesda IV. Molecular testing was performed in 155 of 244 ITN (63.5%), of which 104 were classified as benign (BCR of 67.1%). After a median follow-up of 15 months, 103 of 104 (99.0%) patients with a benign ThyroidPrint® remained under surveillance and one patient underwent surgery which was a follicular adenoma. Surgery was performed in all 51 patients with a suspicious for malignancy as per ThyroidPrint® result and in 56 patients who did not undergo testing, with a rate of malignancy of 70.6% and 32.1%, respectively. A higher BCR was observed in follicular lesion of undetermined significance (87%) compared to atypia of undetermined significance (58%) (P < 0.05). False-positive cases included four benign follicular nodules and six follicular and four oncocytic adenomas. Our results show that, physicians chose active surveillance instead of diagnostic surgery in all patients with a benign ThyroidPrint® result, reducing the need for diagnostic surgery in 67% of patients with preoperative diagnosis of ITN.

Maternal Obesity Is Associated With Higher Cord Blood Adipokines in Offspring Most Notably in Females.

BACKGROUND: Deleterious long-term effects in the offspring from women with pregravid obesity have been described; however, the evidence supporting early metabolic and inflammatory markers in the offspring at birth and gender differences are conflicting. OBJECTIVE: The present study aimed to compare cord blood adipokines and cytokines concentrations and anthropometric characteristics of the offspring of women with maternal obesity (MO) and normal-weight mothers (NWM). Also, maternal and neonatal variables on the association of maternal body mass index (BMI) with cord blood adipokines were evaluated. METHODS: A cross-sectional analysis of a subsample of mother-child dyads participating in a cohort study (n = 221) was assessed. Anthropometrics, cord blood adipokines (leptin and adiponectin) and cytokines (interleukin [IL]-1ß, IL-4, IL-10, IL-12 p40, IL-12p70, IL-13, and tumor necrosis factor α) concentrations in the offspring of normal-weight women (BMI >18.5 and <24.9 kg/m2) and women with pregravid obesity (BMI > 30 kg/m2) without comorbidities was performed. RESULTS: Offspring from mothers with obesity had higher birth weight, a higher proportion of large for gestational age, higher ponderal index, and heavier placentae than offspring from normal-weight mothers (P < 0.05). Within the offspring from women with obesity, males had significantly higher weight, length, the proportion of large-for-gestational-age newborns, higher weight for length ratio. Males had more efficient placentas than females (P < 0.05). Higher adiponectin and leptin in both sexes and higher leptin in female offspring of mothers with obesity after adjusting for birth size (P < 0.05) were found. Higher IL-12p40 in the offspring of women with MO with no other differences in other cytokines among groups were evidenced. CONCLUSIONS: Maternal obesity associates with a higher concentration of adiponectin and leptin in their offspring at birth. There is a relevant effect on anthropometrics in male offspring and on leptin in female newborn. Further studies need to evaluate the extension of these effects in postnatal life. TRAIL IDENTIFICATION NUMBER: NCT02903134.

Dímeros D e hiperglucemia y mortalidad en COVID-19 en un centro hospitalario de México / D-dimers, hyperglycemia and mortality in COVID-19 in a hospital in Mexico

Resumen Objetivo: Evaluar la asociación entre la concentración de glucosa al ingreso y los niveles circulantes de dímeros D en pacientes hospitalizados por enfermedad por coronavirus 2019 (COVID-19). Pacientes y métodos: Se estudiaron 187 pacientes hospitalizados por COVID-19. Se evaluaron las características bioquímicas, la concentración de glucosa y dímeros D, la gravedad de la enfermedad definida por la presencia de neumonía y/o insuficiencia respiratoria que ameritó ventilación mecánica invasiva (VMI) y la causa del egreso hospitalario. Resultados: La edad promedio de los pacientes fue 52 años, el 68% eran hombres, un 40.8% con obesidad y un 23.5% con hipertensión. Del total de pacientes hospitalizados, el 45.5% presentaba diabetes o hiperglucemia a la admisión. La concentración de proteína C reactiva y de dímeros D (1,134 [646.5-4,135.0] vs. 755 [548.7-1,780.0] ng/ml; p = 0.04] fue superior en pacientes con diabetes e hiperglucemia, en comparación con los pacientes con glucosa normal. Los pacientes que requirieron VMI presentaron también mayor concentración de dímeros D. Se observó una correlación directa entre las concentraciones de glucosa inicial y dímeros D (r: 0.239; p = 0.003). Conclusión: En los pacientes con COVID-19 el estado hiperglucémico se asocia directamente con un incremento de la concentración de dímeros D. Los resultados de este estudio deben conducir a insistir en el control glucémico como estrategia fundamental en los pacientes con COVID-19.

Abstract Objective: To evaluate the association between glucose level at admission and circulating levels of D-dimers in patients hospitalized for coronavirus disease 2019 (COVID-19). Methods: 187 patients hospitalized for COVID-19 were studied. Biochemical characteristics, glucose and D-dimers levels, severity of disease, defined by the presence of pneumonia and/or respiratory failure that required invasive mechanical ventilation (IVM) and the cause of hospital discharge were evaluated. Results: Age was 52 years, 68% were male, 40.8% with obesity and 23.5% with hypertension. Of the total of hospitalized patients, 45.5% had diabetes or hyperglycemia upon admission. Patients with diabetes and/or admission hyperglycemia had higher levels of protein C-reactive and D-dimers [(1134 (646.5-4135.0) vs. 755 (548.7-1780.0) ng/ml, p = 0.04], compared to patients with normal glucose level. Patients who required IMV also had a higher concentration of D-dimers. A correlation between glucose and D-dimers levels was evidenced (r=0.239, p=0.003). Conclusions: In patients with COVID-19, the hyperglycemic state is directly associated with an increase in the concentration of D-dimers and severity of disease. The results of this study should lead to insisting on glycemic control as a fundamental strategy in patients with COVID-19.

The Combination of RET, BRAF and Demographic Data Identifies Subsets of Patients with Aggressive Papillary Thyroid Cancer.

The use of BRAFV600E and RET/PTC1 as biomarkers to guide the extent of surgery in patients with papillary thyroid cancer (PTC) remains controversial. We assessed the combined use of demographic data (sex and age) with mRNA expression levels and/or mutational status (BRAFV600E and RET/PTC1) to identify potential subsets of patients with aggressive histopathological features (lymph node metastases and extrathyroidal extension). In a cohort of 126 consecutive patients, BRAFV600E and RET/PTC1 mutations were found in 52 and 18%, respectively. By conditional bivariate analysis (CBVA), a 'high activity' profile of BRAF (BRAFV600E positive or high expression) and 'low activity' profile of RET (RET/PTC1 negative or low expression) was associated with extrathyroidal extension (ETE) (OR 4.48). Alternatively, a 'high activity' profile of RET (RET/PTC1 positive or high expression) and 'low activity' profile of BRAF (BRAFV600E negative or low expression) were associated with lymph node metastasis (LNM) (OR 12.80). Furthermore, in patients younger than 55 years, a low expression of BRAF was associated with LNM (OR 17.65) and the presence of BRAFV600E mutation was associated with ETE (OR 2.76). Our results suggest that the analysis of demographic and molecular variables by CBVA could contribute to identify subsets of patients with aggressive histopathologic features, providing a potential guide to personalised surgical management of PTC.

Adherencia a la ingesta de los productos del Programa de Alimentación Complementaria del Adulto Mayor (PACAM) desde la subjetividad de los adultos mayores de la comuna de Hualpén, Chile / Understanding older adults' adherence to the consumption of products provided by the Supplementary Food Program for Older Adults (PACAM ) by exploring the point of view of users from the municipality of Hualpén, Chile

INTRODUCCIÓN. El Programa de Alimentación Complementaria del Adulto Mayor (PACAM) es un programa chileno destinado a prevenir y recuperar el daño nutricional en los adultos mayores. La escasa adherencia de los últimos años motiva este estudio. OBJETIVO. Comprender cuáles son los motivos de la baja adherencia de las personas mayores a la ingesta de los productos del PACAM (bebida láctea y crema en polvo fortificada llamada 'Años Dorados'), con el fin de proponer alternativas de mejora del programa desde los propios intereses y valoraciones de los usuarios adultos mayores. MÉTODO. Es un estudio cualitativo de carácter fenomenológico y hermenéutico enfocado en la interpretación del significado de las experiencias individuales subjetivas. El estudio realizado el primer semestre del 2017, conllevó 20 entrevistas semiestructuradas realizadas a los adultos de ambos sexos beneficiarios del PACAM de la comuna de Hualpén, Chile. RESULTADOS Y CONCLUSIÓN. Olor, sabor, consistencia, formas de preparación y cantidad de los formatos son algunos de los elementos organolépticos definidos por las personas mayores, mientras los elementos externos incluyen calidad de vida, red social, influencia de otros usuarios, relación con los profesionales en los servicios de salud, cotidianidad y hábitos.

INTRODUCTION. The Supplementary Food Program for Older Adults (known by the acronym PACAM) is a Chilean program aimed at preventing and/or supporting elderly individuals' recovery from malnutrition. Poor adherence to PACAM in recent years motivates this study. OBJECTIVES. To understand the reasons for the low adherence of older adults to the consumption of PACAM products (milk drink and a fortified powdered soup known as "Golden Years Cream"), in order to propose alternatives for improving the program based on the interests and preferences of elderly users. METHODS. A qualitative study, with a phenomenological and hermeneutical approach, was conducted, focused on interpreting the meaning of the users' subjective experiences. The study, which was carried out during the first semester of 2017, consisted of 20 semi-structured interviews conducted with older adults of both sexes, who were beneficiaries of PACAM in the Chilean municipality of Hualpén. RESULTS AND CONCLUSIONS: Food odor, taste, consistency, preparation, and quantity were some of the organoleptic properties identified by the subjects, while the external factors included quality of life, social networks, the influence of other users, relationships with professionals in the health centers, daily life, and habits.

Intususcepción íleo-ileal secundaria a un pólipo fibrinoide inflamatorio / Ileoileal intussusception secondary to inflammatory fibrinoid polyp

Introducción. El pólipo fibrinoide inflamatorio es una lesión inflamatoria no neoplásica que se presenta especialmente en el estómago, aunque puede ocurrir en cualquier parte del tubo digestivo, en donde puede ocasionar episodios de intususcepción y obstrucción intestinal. Presentación del caso. Se presenta el caso de una mujer de 49 años de edad, con un cuadro clínico de una semana de evolución consistente en episodios intermitentes de dolor abdominal, distensión abdominal y emesis. Ingresó a urgencias de la Clínica CES de Medellín, donde se le practicó una tomografía de abdomen que mostró una invaginación intestinal en el íleon, por lo que se programó para una laparotomía exploratoria. Se encontró una intususcepción secundaria a una lesión polipoide que ocupaba la luz del íleon, se resecó el segmento comprometido y se hizo una anastomosis látero-lateral, sin complicaciones. El estudio anatomo-patológico y la inmunohistoquímica confirmaron el diagnóstico de pólipo fibrinoide inflamatorio. Conclusión. El pólipo fibrinoide inflamatorio es una entidad poco frecuente, benigna, que al presentarse en el íleon puede causar intususcepción y obstrucción intestinal. Los estudios imaginológicos proporcionan hallazgos indirectos. Sin embargo, su diagnóstico definitivo se logra con los estudios anatomo-patológico y de inmunohistoquímica después la resección quirúrgica completa, la cual es curativa en la inmensa mayoría de los casos.Palabras clave: enfermedades intestinales; pólipos intestinales; neoplasias intestinales; obstrucción intestinal.

Introduction: Inflammatory fibrinoid polyp is a non-neoplastic inflammatory lesion, which occurs especially at gastric level, but may also occur anywhere in the gastrointestinal tract, where it can cause episodes of intussusceptions and intestinal obstruction. Case report: We report the case of a 49 year old woman with clinical presentation of one week of evolution consisting in episodes of intermittent abdominal pain, abdominal distension and emesis. She presented at the emergency department of Clinica CES (Medellín, Colombia), where a CT scan of the abdomen reported ileal intussusception. At exploratory laparotomy an intussusception secondary to a polypoid lesion that occupied the ileal lumen was found, and resection of the involved segment and anastomosis were performed without complications. Pathology and immunohistochemistry study confirmed the diagnosis of Inflammatory fibrinoid polyp. Conclusion: The inflammatory fibrinoid polyp is a rare, benign entity that when located in the ileum may cause intussusception and intestinal obstruction. Imagening studies exhibit indirect findings. However, definitive diagnosis is made with pathology and immunohistochemistry studies followimg complete surgical resection, which is curative in the majority of cases.

Influence of operator's experience on root canal shaping ability with a rotary nickel-titanium single-file reciprocating motion system.

INTRODUCTION: The aim of this study was to evaluate the influence of the operator's experience on the shaping of double-curvature simulated root canals with a nickel-titanium single-file reciprocating motion system. METHODS: Sixty double-curvature root canals simulated in methacrylate blocks were prepared by 10 students without any experience in endodontics and by 10 professionals who had studied endodontics at the postgraduate level. The Reciproc-VDW system's R25 file was used in the root canal preparation. The blocks were photographed before and after the instrumentation, and the time of instrumentation was also evaluated. Changes in root canal dimensions were analyzed in 6 positions. RESULTS: Significant differences (P < .05) were found in the apical transport of the first root canal curvature, with a larger percentage of increase of the root canal occurring in the novice group than in the expert one, as well as in the canal deviation at the beginning of the curvatures, whereas no significant results were obtained in the growth rate of the canal area. There was difference in the time of instrumentation, with 3.76 minutes observed in the novice group, as opposed to 2.05 minutes in the expert group. CONCLUSIONS: The use of the single-file reciprocating motion system Reciproc is not seen to be influenced by the operator's experience regarding the increase of the canal area. Previous training and the need to acquire experience are important in the use of this system, in spite of its apparent simplicity.

Natural killer cell cytotoxicity is not regulated by folic acid in vitro.

OBJECTIVES: Folate supplementation may be associated with an increased risk of developing several types of cancer and a derangement of immune function. Among the latter, Natural killer (NK) cells are involved in non-MHC-restricted natural immunity against malignant target cells. Abnormalities in NK cell number or function have been associated with a higher cancer risk. The aim of this study was to study in vitro the possible effect of different concentrations of 5-methyltetrahydrofolic acid (5-MTHF) or folic acid on NK cell cytotoxic function, and expression of the stimulatory and inhibitory receptors KIRDL4, KIRDL3, and NKG2D. METHODS: Volunteer-derived peripheral mononuclear cells (PBMC) and highly enriched NK cells (95% CD56+ CD16+) were grown in folic acid free-RPMI 1640, supplemented either with folic acid or 5-MTHF (15-100 nM) during 72 h to 96 h. RESULTS: No differences in the cytolytic activity of PBMC and enriched NK cells were observed. After 96 h of in vitro culture without folate or supplemented with FA or 5-MTHF (30 or 100 nM), there were no changes in the percentage of HPNK receptor-positive cells. CONCLUSIONS: Our data indicate that a high dose of 5-MTHF or folic acid does not influence NK cell function in vitro.