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2.
Eur Thyroid J ; 6(5): 271-275, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29071240

RESUMO

OBJECTIVE: Thyroid nodules are common within the general population. Cytological analysis of fine needle aspirates (FNAs) of these lesions allows for identification of those that require further surgery. A numerical classification system is in place to streamline reporting. The 3a category is used for lesions that are neither benign nor malignant but show atypia of undetermined significance. We reviewed our use and clinical outcomes of Thy3a over a 4-year period. METHODS: All thyroid FNAs performed at this institute from January 2012 to December 2015 were identified from our laboratory information system using SNOMED codes. Cytology was correlated with histology. RESULTS: Of the 1,259 FNAs reported at this institute, Thy3a constituted only 1.2% (n = 16) of all cases, with a malignancy rate of 7%. Five Thy3a cases had a repeat FNA that was reported as Thy2 (benign), 1 as Thy1c (cyst), 1 as Thy3f (follicular lesion), and 1 as Thy5 (malignant). Six cases without repeat FNA were follicular adenomas at resection. Two cases were lost to follow-up. Within all thyroid cytology categories in this 4-year period, we had a false-positive rate of 1.9% and a false-negative rate of 0.3%. CONCLUSIONS: The Thy3a subclassification has varied diagnostic criteria and lacks reproducibility. Despite the rare use of the Thy3a category at our centre, our diagnostic accuracy remained high. At this time, further Thy3a cohort studies are required to assess the real benefits of this category.

3.
J Environ Radioact ; 178-179: 411-418, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28689881

RESUMO

The National Health and Medical Research Council and Natural Resource Management Ministerial Council of Australia developed the current Australian Drinking Water Guidelines which recommend an annual radiation dose value of 1 mSv year-1. One of the potential major contributors to the radiation dose from drinking water is radium-228, a naturally occurring radionuclide arising from the thorium decay series. Various methods of analysing for radium-228 in water have been established and adapted by analytical radiochemistry laboratories. Seven laboratories in Australia participated in analysing radium-228 spiked water samples with activity concentrations ranging from 6 mBq L-1 to 20 Bq L-1. The aim of the exercise was to compare and evaluate radium-228 results reported by the participating laboratories, the methods used and the detection limits. This paper presents the outcome of the exercise.


Assuntos
Laboratórios/estatística & dados numéricos , Monitoramento de Radiação , Rádio (Elemento)/análise , Poluentes Radioativos da Água/análise , Austrália
4.
Cochrane Database Syst Rev ; (8): CD009849, 2012 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-22895991

RESUMO

BACKGROUND: Age-related decline in bone mass increases the risk of skeletal fractures, especially those of the hip, spine, and wrist. Steroidal contraceptives have been associated with changes in bone mineral density in women. Whether such changes affect the risk of fractures later in life is unclear. Hormonal contraceptives are among the most effective and most widely-used contraceptives. Concern about fractures may limit the use of these effective contraceptives. Observational studies can collect data on premenopausal contraceptive use as well as fracture incidence later in life. OBJECTIVES: We systematically reviewed the evidence from observational studies of hormonal contraceptive use for contraception and the risk of fracture in women. SEARCH METHODS: In May 2012, we searched for observational studies. The databases included MEDLINE, POPLINE, Cochrane Central Register of Controlled Trials (CENTRAL), LILACS, EMBASE, CINAHL, and Web of Science. We also searched for recent clinical trials through ClinicalTrials.gov and the ICTRP. For other studies, we examined reference lists of relevant articles and wrote to investigators for additional reports. SELECTION CRITERIA: We included cohort and case-control studies of hormonal contraceptive use. Interventions included comparisons of a hormonal contraceptive with a nonhormonal contraceptive, no contraceptive, or another hormonal contraceptive. The primary outcome was the risk of fracture. DATA COLLECTION AND ANALYSIS: Two authors independently extracted the data. One author entered the data into RevMan, and a second author verified accuracy. We examined the quality of evidence using the Newcastle-Ottawa Quality Assessment Scale (NOS), developed for case-control and cohort studies. Sensitivity analysis included studies of moderate or high quality based on our assessment with the NOS.Given the need to control for confounding factors in observational studies, we used adjusted estimates from the models as reported by the authors. Where we did not have adjusted analyses, we calculated the odds ratio (OR) with 95% confidence interval (CI). Due to varied study designs, we did not conduct meta-analysis. MAIN RESULTS: We included 14 studies (7 case-control and 7 cohort studies). These examined oral contraceptives (OCs) (N=12), depot medroxyprogesterone acetate (DMPA) (N=4), and the hormonal intrauterine device (IUD) (N=1). This section focuses on evidence from the six studies with moderate or high quality evidence that we included in the sensitivity analysis.All six studies examined oral contraceptive use. We noted few associations with fracture risk. One cohort study found OC ever-users had increased risk for all fractures (reported RR 1.20; 95% CI 1.08 to 1.34). However, a case-control study with later data from a subset reported no association except for those with 10 years or more since use (reported OR 1.55; 95% CI 1.03 to 2.33). Another case-control study reported increased risk only for those who had 10 or more prescriptions (reported OR 1.09; 95% CI 1.03 to 1.16). A cohort study of postmenopausal women found no increased fracture risk for OC use after excluding women with prior fracture. Two other studies found little evidence of association between OC use and fracture risk. A cohort study noted increased risk for subgroups, such as those with longer use or specific intervals since use. A case-control study reported increased risk for any fracture only among young women with less than average use.Two case-control studies in the sensitivity analysis also examined progestin-only contraceptives. One reported increased fracture risk for DMPA ever-use (reported OR 1.44 (95% CI 1.01 to 2.06), more than four years of use (reported OR 2.16; 95% CI 1.32 to 3.53), and women over 50 years old. The other noted increased risk for any past use, including one or two prescriptions (reported OR 1.17; 95% CI 1.07 to 1.29), and for current use of 3 to 9 or 10 or more prescriptions. In addition, one study reported reduced fracture risk for ever-use of the hormonal IUD (reported OR 0.75; 95% CI 0.64 to 0.87) and longer use of that IUD. AUTHORS' CONCLUSIONS: Observational studies do not indicate an overall association between OC use and fracture risk. Some reported increased risk for specific user subgroups. DMPA users may have an increased fracture risk. One study indicated hormonal IUD use may be associated with decreased risk. Observational studies need adjusted analysis because the comparison groups usually differ. Researchers should be clear about the variables examined in multivariate analysis.


Assuntos
Anticoncepcionais Orais Hormonais/efeitos adversos , Fraturas Ósseas/induzido quimicamente , Dispositivos Intrauterinos Medicados/efeitos adversos , Acetato de Medroxiprogesterona/efeitos adversos , Fatores Etários , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Progestinas/efeitos adversos , Fatores de Tempo
5.
Hepatology ; 56(2): 492-500, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22334511

RESUMO

UNLABELLED: Pegylated interferon-α (PEG-IFN-α) forms an integral part of the current treatment for hepatitis C virus (HCV) infection. PEG-IFN-α suppresses HCV production by augmenting the innate antiviral immune response. Recent studies have reported the induction of hepcidin, the iron regulatory hormone, by IFN-α in vitro. As hepcidin plays an important role in innate immunity, we hypothesized that this finding may be of clinical relevance to HCV and investigated the changes in iron homeostasis during the first 24 hours of treatment. Blood samples were obtained from HCV patients immediately prior to and 6, 12, and 24 hours following the first dose of PEG-IFN-α/ribavirin (RBV). Samples were analyzed for hepcidin, cytokine, iron levels, and HCV viral load, and hepcidin messenger RNA (mRNA) expression was quantified in peripheral blood mononuclear cells. Hepcidin induction by IFN-α was further analyzed in cell culture. In HCV patients a single dose of PEG-IFN-α/RBV resulted in a significant increase in serum hepcidin, peaking at 12 hours, coinciding with a 50% reduction in serum iron and transferrin saturation over the 24-hour period. Patients with a ≥ 2 log decline in HCV viral load over the first 24 hours had significantly lower SI and TS levels at 12 and 24 hours. Moreover, 24-hour SI levels were an independent predictor of the immediate HCV viral decline, an indicator of ultimate treatment outcome. In cell culture, a direct induction of hepcidin by IFN-α was seen, controlled by the STAT3 transcription factor. CONCLUSION: Hepcidin induction occurs following the initiation of PEG-IFN-α treatment for HCV, and is mediated by way of STAT3 signaling. The subsequent hypoferremia was greatest in those with the most significant decline in viral load, identifying systemic iron withdrawal as a marker of immediate interferon-α efficacy in HCV patients.


Assuntos
Peptídeos Catiônicos Antimicrobianos/sangue , Monitoramento de Medicamentos/métodos , Hepatite C/tratamento farmacológico , Interferon-alfa/uso terapêutico , Polietilenoglicóis/uso terapêutico , Ribavirina/uso terapêutico , Adulto , Idoso , Peptídeos Catiônicos Antimicrobianos/genética , Antivirais/uso terapêutico , Carcinoma Hepatocelular , Linhagem Celular Tumoral , Estudos de Coortes , Quimioterapia Combinada , Feminino , Genótipo , Proteína da Hemocromatose , Hepcidinas , Antígenos de Histocompatibilidade Classe I/genética , Humanos , Interferons , Interleucinas/genética , Ferro/sangue , Neoplasias Hepáticas , Masculino , Proteínas de Membrana/genética , Pessoa de Meia-Idade , Proteínas Recombinantes/uso terapêutico , Fator de Transcrição STAT3/metabolismo , Carga Viral/efeitos dos fármacos
6.
Del Med J ; 81(4): 155-60, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19552219

RESUMO

The Ask and Act program of the American Academy of Family Physicians promotes family physician tobacco cessation counseling. Smoking and cessation counseling rates were obtained by cross-sectional analysis of electronic medical record data before and after initiation of the Ask and Act program in Delaware. Before the intervention, 24% of the patient population sampled were smokers and 70% of smokers had been counseled to quit smoking. After the intervention, 17% of the patient population sampled were smokers and 98% of smokers had been counseled. Our observations suggest that the Ask and Act program increases counseling, thereby increasing smoking cessation.


Assuntos
Aconselhamento/organização & administração , Medicina de Família e Comunidade/métodos , Promoção da Saúde , Médicos de Família/normas , Avaliação de Programas e Projetos de Saúde/métodos , Abandono do Hábito de Fumar/métodos , Sociedades Médicas , Estudos Transversais , Delaware , Feminino , Humanos , Masculino
7.
Dalton Trans ; (1): 203-12, 2006 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-16357978

RESUMO

The reactivity of an electronically unsaturated tantalum methylidene complex [TolC(NSiMe(3))(2)](2)Ta(CH(2))CH(3) supported by [TolC(NSiMe(3))(2)] amidinate ligands is described. Electrophilic addition and olefination reactions of the Ta=CH(2) functionality are reported. Alkylidene participates in group-transfer reactions not observed in sterically similar, but electronically saturated, analogues. Reactions with substrates containing unsaturated C-X (X = C, N, O) bonds yield [Ta]=X compounds and vinylated organic products; carbon-sulfur cleavage reactions to produce tantalum thioformaldehyde and tantalum sulfido complexes.

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