The effectiveness of risk stratification systems in diagnosis of nodular thyroid disorders

2019 ◽  
Vol 65 (4) ◽  
pp. 216-226
Author(s):  
Yuri K. Aleksandrov ◽  
Elena A. Yanovskaya ◽  
Leonid B. Shubin ◽  
Artem D. Dyakiv
Keyword(s):  
Risk Stratification ◽  
Pituitary Tumors ◽  
Needle Aspiration ◽  
Decision Time ◽  
Outpatient Clinics ◽  
Significance Level ◽  
Combined Use ◽  
Pituitary Diseases ◽  
High Prevalence ◽  
Positive Effect

BACKGROUND: Risk stratification systems, one of the optimal solutions for differential diagnosis of nodular pituitary disorders, are currently under development. The high prevalence of pituitary diseases makes it necessary to evaluate the effectiveness of risk stratification systems and to widely implement them into routine clinical practice. AIM: To evaluate the effectiveness of modern risk stratification systems used to diagnose nodular pituitary disorders. MATERIAL AND METHODS: A total of 1,606 medical records of patients operated on for nodular pituitary disorders in 20062014 were analyzed. The preoperative ultrasonography results and cytological findings were evaluated. The ultrasonography results were classified using the TI-RADS system, while the biopsy data were classified using the TBSRTC system. The surgery protocol and the pathomorphological data were the truth criterion. The effectiveness of the TI-RADS and TBSRTC systems, as well as their contribution to the performance of endocrinologists in outpatient clinics, was analyzed. RESULTS: Cluster analysis revealed a significant volatility of ultrasonography signs in the TI-RADS category, while there was no dominant sign that could be considered the diagnostic standard. Factor analysis proved the consistency of the imaging TI-RADS system based on individual signs. The signs being evaluated are characterized by high significance level but different priorities depending on the type of putative pathology. Discriminant analysis revealed that TI-RADS was a robust and versatile system to be used for various types of nodular pituitary disorders. The overall effectiveness of the TI-RADS system in diagnosis of pituitary tumors was low: it was characterized by 75.4% sensitivity, 84.7% specificity, and 80.1% accuracy. However, this system concretized the indications for fine-needle aspiration biopsy and drew the cytologists attention to the likelihood of pituitary tumor. The implementation of the TBSRTC system reduced the percentage of non-informative (by 9.8%) and controversial results (by 1.7%). Cytological examination was more effective in detection of pituitary cancer compared to ultrasonography (91.0% accuracy, 94.9% specificity, and 76.5% sensitivity). The impressions of ultrasound technicians and cytologists were concordant in 873 (54.4%) cases. A survey conducted among endocrinologists in outpatient clinics showed that implementation of the TI-RADS and TBSRTC risk stratification systems reduced the decision time (p0.001) and errors both in diagnostics (p0.001) and treatment approach selection (p0.001). CONCLUSION: The combined use of the TI-RADS and TBSRTC systems allows one to personalize the treatment approaches for patients with nodular pituitary disorders. The implementation of these systems has a positive effect on endocrinologists performance as it reduces the decision time and the likelihood of making errors in diagnosis and treatment strategy selection.

The incidentaloma of the thyroid

2005 ◽  
Vol 44 (05) ◽  
pp. 213-224
Author(s):  
C. Kobe ◽  
M. Schmidt ◽  
H. Schicha ◽  
M. Dietlein
Keyword(s):  
Risk Stratification ◽  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Outcome Measurement ◽  
Needle Aspiration ◽  
Epidemiological Studies ◽  
Fine Needle ◽  
Small Cancer ◽  
The Family ◽  
Wait And See

Summary:The incidentally detected thyroid nodule using sonography is described as incidentaloma; the most nodules have a diameter up to 1.5 cm. Sonography will detect thyroid nodules in more than 20% of the population in Germany. Epidemiological studies investigating the prevalence of malignancy in such incidentalomas are missing. The incidence of differentiated thyroid cancer is about 3 per 100,000 people and year. However, several monocentric studies have shown a prevalence of malignancy of up to 10% of the thyroid nodules in selected patients’ group. The histology did not found microcarcinomas only, but also small cancer with infiltration of the thyroid capsule, lymph node metastasis or multifocal spread. The studies were not designed for outcome measurement after early and incidental detection of small thyroid cancers. Hypoechogenity, ill defined borders, central hypervascularization or microcalcifications were used as combined criteria for risk stratification. The second method for risk stratification is scintigraphy and further tests are warranted for hypofunctioning nodule ≥1 cm. Additionally, the family history, patient’s age <20 years, former radiation of the neck, and measurement of calcitonin should be regarded. Without such a risk stratification selection for fine needle aspiration is impossible. Fine needle aspiration of non-palpable incidentalomas led to non-representative or unequivocal cytological findings in up to 40%. Because better outcome of incidentally detected small thyroid carcinomas is not proved and because sonography, scintigraphy and fine needle aspiration remain imprecise regarding dignity of incidentalomas, fine needle aspiration is not the standard for small, non-palpable thyroid nodules. Conclusion: For management of incidentaloma, sonographically unsuspicious, scintigraphically indifferent (nodules ≥1 cm) and without any risk factors in patients’ history, wait and see is justified when patient is informed about the problem.

Influence of xanthane on carraginan gel syneresis

Vsyo o myase ◽  
2020 ◽  
pp. 53-55
Author(s):  
Tunieva E.K. ◽  
◽  
Spiridonov K.I. ◽  
Keyword(s):  
Xanthan Gum ◽  
Combined Use ◽  
Positive Effect

The combined use of polysaccharide have a positive effect on reducing syneresis of gels. The article presents the results of determining the syneresis of carrageenan gel in the presence of different concentrations of xanthan gum. The dependence of the increase in the syneresis of the carrageenan gel during storage on the dosage of the polysaccharide was revealed. It was found that the use of a mixture of carrageenan: xanthan in a ratio of 1: 1 led to reduce syneresis by more than 70 % in comparison with carrageenan gel without gum.

scholarly journals Reappraising the Role of Trans-Sphenoidal Surgery in Prolactin-Secreting Pituitary Tumors

Cancers ◽  
2021 ◽  
Vol 13 (13) ◽  
pp. 3252
Author(s):  
Pier Paolo Mattogno ◽  
Quintino Giorgio D’Alessandris ◽  
Sabrina Chiloiro ◽  
Antonio Bianchi ◽  
Antonella Giampietro ◽  
...  
Keyword(s):  
Pituitary Tumors ◽  
Female Gender ◽  
Clinical History ◽  
Serum Prolactin ◽  
Cure Rate ◽  
Cross Sectional ◽  
Unique Challenge ◽  
Best Management ◽  
Pituitary Diseases

Background: Prolactinomas represent a unique challenge for endocrinologists and neurosurgeons. Considering recent innovations in surgical practice, the authors aimed to investigate the best management for prolactinomas. Methods: A retrospective, cross-sectional and monocentric study was designed. Consecutive patients affected by prolactinomas were enrolled if treated with a first-line treatment with a dopamine agonist (DA) or trans-sphenoidal surgery (TSS). Patients carried giant prolactinomas, and those with a follow-up <12 months were excluded. Results: Two hundred and fifty-nine patients were enrolled. The first treatment was DA for 140 patients and TS for 119 cases. One hundred and forty-six of 249 patients (58.6%) needed a second therapy. The mean follow-up was 102.2 months (12–438 months). Surgery highly impacted on the cure rate—in particular, in females (p = 0.0021) and in microprolactinomas (p = 0.0020). Considering the multivariate analysis, the female gender and surgical treatment in the course of the clinical history were the only independent positive predictors of a cure at the end of 5 years follow-up (p = 0.0016, p = 0.0005). The evaluation of serum prolactin (24 hours after TSS) revealed that 86.4% of patients with postoperative prolactin (PRL) ≤10 ng/mL were cured at the end of the follow-up (p < 0.0001). Conclusions: According to our experience, surgery allows a high cure rate of prolactinomas, particularly in females with microadenoma, with a good safety profile. TSS for prolactinomas should be considered as a concrete option, during the multidisciplinary evaluation, in centers of reference for pituitary diseases.

scholarly journals Effect of Fertilization with Urea and Inhibitors on Growth, Yield and CBD Concentration of Hemp (Cannabis sativa L.)

2021 ◽  
Vol 13 (4) ◽  
pp. 2157
Author(s):  
Ioanna Kakabouki ◽  
Angeliki Kousta ◽  
Antigolena Folina ◽  
Stella Karydogianni ◽  
Charikleia Zisi ◽  
...  
Keyword(s):  
Plant Height ◽  
Field Experiments ◽  
Cannabis Sativa ◽  
Nitrification Inhibitor ◽  
Growth Yield ◽  
Urease Inhibitor ◽  
Significance Level ◽  
Yield And Quality ◽  
Positive Effect ◽  
Urea Fertilization

Field experiments were conducted during 2019 in two different locations in Greece (Athens and Farsala) to evaluate the effect of urea and urea fertilization with inhibitors on the agronomic yield and quality characteristics of two cannabis varieties (Cannabis sativa L.), “Uso31”and “Fedora 17”. The experimental design was split-plot with four different fertilization treatments—control, Urea (U), urea with Urease Inhibitor (UI), and urea with Nitrification Inhibitor (NI) and urease inhibitor (UI). The significance of differences between treatments was estimated by using Tukey’s test with a significance level of p = 0.05. The plant height was significantly affected by the different fertilizations and different varieties as well as by the two locations. The maximum plant height was 197 cm for “Fedora 17”in Farsala. The seed yield was higher forthe urea with inhibitors treatment in both varieties. The Cannabidiol (CBD) content was significantly affected by the fertilization—it was higher in urea with inhibitors in “Uso31”and “Fedora 17” treatments. The lowest CBD content value was 1.29% (control) and the highest was 1.69% (urea NI + UI). In conclusion, in both varieties, it seems that urea with inhibitors has a positive effect on their growth, as well as on the increase in cannabidiol (CBD) content.

Antibacterial treatment and hirudotherapy in hormono— dependent and inflammatory diseases of female genital organs

1998 ◽  
Vol 79 (4) ◽  
pp. 280-281
Author(s):  
R. I. Zhivoglyad
Keyword(s):  
Antibacterial Therapy ◽  
Inflammatory Diseases ◽  
Hirudo Medicinalis ◽  
Antibacterial Treatment ◽  
Pathologic Process ◽  
Combined Use ◽  
Biochemical Indices ◽  
Positive Effect ◽  
Female Genital

The results of the influence of the Hirudo medicinalis leeches and antibacterial therapy on homeostasis indices in patients with hormono dependent and inflammatory diseases of genital organs are analyzed. The positive effect of hirudotherapy courses on general and biochemical indices of blood changed as a result of the pathologic process progression is shown. The combined use of hirudotherapy and antibacterial treatment is recommended.

METAPHYLAXIS OF APPLICATION OF VETERINARY PREPARATIONS «MULTIOMYCIN 1%» AND «YUBERIN ORAL»

2021 ◽  
pp. 41-47
Author(s):  
E. V. Romanova
Keyword(s):  
Microbial Contamination ◽  
Veterinary Drug ◽  
Production Test ◽  
Combined Use ◽  
Negative Effect ◽  
The Impact ◽  
Daily Gain ◽  
Positive Effect ◽  
Experimental Group

We studied the effect of the antimicrobial drug «Multiomycin 1 %» on the hematological and biochemical pa-rameters of blood, the activity of digestive enzymes (amylase, alkaline phosphatase, protease), the structure of the mi-crobiocenosis of the small and large intestines, and the quality of the products. Based on the results of preclinical stud-ies, a production test was carried out in conjunction with the veterinary drug «Yuberin oral», as well as an assessment of the impact on the productivity of poultry was given. «Multiomycin 1 %» did not adversely affect the chickens. The drug had a positive effect on the activity of the digestive processes, increased their activity. Contributed to a decrease in the total microbial contamination in the contents of the small and large intestines and an increase in the content of bifidobacteria and lactobacilli. Combined use with yuberin contributed to an increase in safety, an increase in the aver-age daily gain, as well as a decrease in the incidence of gastroenteritis. The weight gain at the end of the experiment in the chickens of the experimental group was 3,74 % higher than in the control. The use of the veterinary drug «Multiomycin 1 %» did not have a negative effect on the quality of the products.

scholarly journals Current NAFLD guidelines for risk stratification in diabetic patients have poor diagnostic discrimination

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Valentin Blank ◽  
David Petroff ◽  
Sebastian Beer ◽  
Albrecht Böhlig ◽  
Maria Heni ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Liver Stiffness ◽  
Diabetic Patients ◽  
Alcoholic Fatty Liver ◽  
Referral Rates ◽  
Specialist Referral ◽  
High Prevalence ◽  
Referral Strategy ◽  
Sensitivity Specificity ◽  
Diagnostic Pathways

Abstract Patients with type 2 diabetes (T2D) are at risk for non-alcoholic fatty liver disease (NAFLD) and associated complications. This study evaluated the performance of international (EASL-EASD-EASO) and national (DGVS) guidelines for NAFLD risk stratification. Patients with T2D prospectively underwent ultrasound, liver stiffness measurement (LSM) and serum-based fibrosis markers. Guideline-based risk classification and referral rates for different screening approaches were compared and the diagnostic properties of simplified algorithms, genetic markers and a new NASH surrogate (FAST score) were evaluated. NAFLD risk was present in 184 of 204 screened patients (age 64.2 ± 10.7 years; BMI 32.6 ± 7.6 kg/m2). EASL-EASD-EASO recommended specialist referral for 60–77% depending on the fibrosis score used, only 6% were classified as low risk. The DGVS algorithm required LSM for 76%; 25% were referred for specialised care. The sensitivities of the diagnostic pathways were 47–96%. A simplified referral strategy revealed a sensitivity/specificity of 46/88% for fibrosis risk. Application of the FAST score reduced the referral rate to 35%. This study (a) underlines the high prevalence of fibrosis risk in T2D, (b) demonstrates very high referral rates for in-depth hepatological work-up, and (c) indicates that simpler referral algorithms may produce comparably good results and could facilitate NAFLD screening.

scholarly journals Coronavirus Effects on the Economy of Jordan

2020 ◽  
Vol 11 (5) ◽  
pp. 129
Author(s):  
Khaled Abdalla Moh'd AL-Tamimi
Keyword(s):  
Economic Growth ◽  
Health Service ◽  
Empirical Literature ◽  
Negative Effects ◽  
Economic Sectors ◽  
Significance Level ◽  
Quarterly Data ◽  
Explanatory Variables ◽  
Positive Effect

This paper reports the effects of coronavirus on Jordan's economic growth by using quarterly data for the period (2018/2019 Q1 – 2019/2020 Q4), where the numbers of people who are sick with coronavirus and those that have died from the virus are explanatory variables, and economic growth is an affected variable. The research concentrates on analyzing reviews of theoretical and empirical literature to show the effect of coronavirus on economic growth and explaining this effect in Jordan in this period by using the ARDL technique in Eviews. By using quarterly data for (2018/2019 Q1 – 2019/2020 Q4) at a significance level of 5%, this research demonstrates that the numbers of people who are ill with coronavirus and those that have died from the virus have a weak positive effect and a negative but significant effect on the economic growth of Jordan, respectively. The research also shows a recommendation of limiting the negative effects of coronavirus by reducing the number of deaths via strengthening the health service and opening some economic sectors to boost economic growth in the country.

Sign in / Sign up

Export Citation Format

Share Document