Incidental cancer in patients surgically treated for benign thyroid disease. Our experience at a single institution

Increased incidence of incidental cancer in patients operated for benign thyroid disease has been reported. We report our experience about incidental thyroid cancer (ITC) in order to better characterize this nosologic entity. Between 2001 and 2009 a total of 568 patients underwent surgery for benign thyroid disease. Patients with preoperative cytology undetermined or positive for malignancy were excluded. The most frequent indication for surgery was multinodular or diffuse nontoxic goiter. We performed total thyroidectomy in 499 cases and emithyroidectomy in 69 cases. Final histology revealed ITC in 53 patients (9.3%): 44 had papillary carcinoma (20 classic variant and 24 follicular variant), 4 follicular carcinoma, 4 medullary carcinoma and 1 primitive thyroid paraganglioma. The preoperative diagnosis was multinodular or diffuse goiter in 45 cases of ITC and uninodular goiter in 8 cases. We performed total thyroidectomy in 46 case, emithyroidectomy in 4 patients with past history of lobectomy, emithyroidectomy in 3 patients with following radicalization and central neck dissection. In 14 patients the tumor was multifocal and in 12 of these patients the tumor foci were bilateral. The lesion was a microcarcinoma in 34 cases. Mean diameter of the ITC was 1.14 cm. We retrospectively reconsidered the results of preoperative ultrasound examinations in relation to the exact position of the tumor in the specimens and we found a statistically significant association between echogenicity and papillary histotype. Twenty-six patients were followed up at our Hospital. The mean follow-up period was 38.2 months. A relapse was observed in 3/26 patients. Incidental thyroid cancer in patients operated for benign disease has its own surgical and oncological relevance. A correct preoperative assessment, with a careful selection of nodules for fine-needle aspiration cytology on the basis of ultrasound pattern, could better address the choice of surgical procedure. The non irrelevant incidence of incidental thyroid cancer, the eventuality of multifocality and bilaterality and the possible occurrence of relapse, support that total thyroidectomy without residuum is a valuable option for treating benign thyroid conditions such as multinodular goitre. When an incidental cancer is diagnosed after emithyroidectomy, a radicalization with central neck dissection could be considered. We suggest that natural history of papillary microtumors and the correct surgical approach for these lesions could be better defined with a more extensive use of “Porto proposal” criteria. Incidental thyroid cancer, Papillary microcarcinoma, Papillary microtumors, Total thyroidectomy.

eLearning in the context of a one-year postgraduate course in macroscopy in pathology: benefits of a multifaceted and pluripotent concept

Performing Macroscopy in Pathology implies to plan and implement methods of selection, description and collection of biological material from human organs and tissues, actively contributing to the clinical pathology analysis by preparing macroscopic report and the collection and identification of fragments, according to the standardized protocols and recognizing the criteria internationally established for determining the prognosis. The Macroscopy in Pathology course is a full year program with theoretical and pratical components taught by Pathologists. It is divided by organ/system surgical pathology into weekly modules and includes a practical "hands-on" component in Pathology Departments. The students are 50 biomedical scientists aged from 22 to 50 years old from all across the country that want to acquire competences in macroscopy. A blended learning strategy was used in order to: give students the opportunity to attend from distance; support the contents, lessons and the interaction with colleagues and teachers; facilitate the formative/summative assessment.

Caracterização da captura incidental de tartarugas marinhas pela pesca de espinhel pelágico no Nordeste do Brasil

The marine turtles biological characteristics and the impact they have been suffering in consequence of human activities have caused in the last decades the decrease of populations to unsustainable levels. All four of the species described in this paper are registered as endangered in a list by IUCN: Caretta caretta, Lepidochelys olivacea, Chelonia mydas, Dermochelys coriacea. The main causes of such impact include several fishing activities, mostly the surface longline. This paper discusses the monitoring of two foreigner longline fleet along the North East Brazilian coast between October of 2004 and September of 2005. Both operated in the West South Atlantic, one using the Chinese technique and the other the American. The American method s target species is the swordfish (Xiphias gladius), and it is characterized by using squid as bait, J 9/0 offset 5º hook, light sticks and night soaking. It also operates in shallower waters than the Chinese method. The source of information about the efforts and the catches came from onboard observers and were used to calculate the catching rate of turtles over 1000 hooks (CPUE). The American equipment caught more turtles (CPUE = 0,059; N= 103), mainly D. coriacea, while the Chinese longline caught mainly the L. olivacea and presented a CPUE= 0,018 (N= 89). The hooks were most frequently found attached to the mouth of C. caretta, C. mydas, and L. olivacea. The D. coriacea were most frequently caught by hooks externally attached to different parts of their body. There was no significant difference between the hook type catching and most turtles were still alive when released. The results suggest a greater potential of turtle catching by the American method. Besides the statistic tests have showed less interaction between the Chinese equipment and marine turtles, the catches of this fishing technique could have been underestimated due to miscommunication between the onboard observer and the vessel s crew plus the retrieve of the longline during night time

Survey on parasites of Rutilus frisii Kutum in South west of Caspian Sea with the emphasis of pathology of Dactylogyrus frisii and morphological identification of Paradiplozoon sp and Anisakis sp

Rutilus frisii Kutum is one of the most precious fish in the Caspian Sea. Investigation of the various aspects of its biocharactristics. Including its parasite fauna and ecological aspects are of prime importance. In this study the farmed kutum fry were on the focus of investigation in various seasons of the year and prior to their being released in the sea. This included also the study on the kutum spawners caught both from liver and the sea. The results were that 17 external and internal parasite species were distinct within different organs which were further identified down to genus and species. The single celled parasites identified included Ichthyophthirius multifilils, Chilodonella hexastica, Chilodonella pisicola, Trichodina sp Along with the monogene parasites that included Paradiplozoon chazaricum, D. rarissimus, D. turaliensis, D. nybelini, Dactylogyrus frisii. Meanwhile Diplostomum spathaceum constituted the single eyed parasites and the intestinal termatode were Aspidogaster limacoides, Asymphyoldora kubanicum as well as Bothriocephalus gowkongeniss as the sestads. The nematodes defrentiated were Raphidascaris acus, Dioctophyma renale, and Eustrongylides excisus followed by Lernaea cyprinacea as a crustacean. In this study, infestations by single celled parasites, crustaceans and sestod were found to be present only among the farmed kutum fry which varied in terms of percentage and intensity of infection as well as the parasite species and season of the year. The highest percentage of infection among kutum fry and spawners in both fresh water and in the sea during all seasons belonged to monogene parasites (33%). This was up to 100% among spawners. Infection caused by nematodes was exclusively detected among riverine spawners (7.5-5%) and the infection by Asymphyoldora kubanicum and Aspidogaster limacoides among Spawners caught at Sea and rivers varied within different seasons of the year. The infestation of Metacercer diplostomum spathaceum among kutum fry was 12% which compared to spawners was in slightly higher level. The study could identify Dioctophyma renale for the first time in the country and Eustrongylidis excisu was also detected among Rutilus frisii kutum.

Renal angiomyolipoma with renal vein thrombosis: an incidental finding

A 66-year-old female with history of endometrioid endometrial carcinoma was admitted to our institution with abdominal and pelvic pain. A CT scan revealed a mass within the right upper kidney with a tumour thrombus that extended through the right renal vein up to the point of confluence with the inferior vena cava (IVC). The imaging features of the mass strongly suggested a diagnosis of renal angiomyolipoma (AML) with renal vein thrombosis. The patient was proposed an open radical right nephrectomy with right renal thrombectomy for histopathological confirmation of the diagnosis of AML with extension to the right renal vein and preventing complications such as potentially fatal pulmonary thromboembolism. The implantation of a temporary IVC filter before surgery was recommended.

Learning English is Fun! Incidental vocabulary acquisition of music and traditional class ninth graders via listening to pop songs

Finnish youth are constantly exposed to music and lyrics in English in their free time. It is likely that this has a positive effect on vocabulary learning. Learning vocabulary while simultaneously accompanied with melodies is likely to result in better learning outcomes. The present thesis covers a study on the vocabulary learning of traditional and music class ninth graders in a south-western upper comprehensive school in Finland, mainly concentrating on vocabulary learning as a by-product of listening to pop music and learning vocabulary through semantic priming. The theoretical background presents viable linguistic arguments and theories, which provide clarity for why it would be possible to learn English vocabulary via listening to pop songs. There is conflicting evidence on the benefits of music on vocabulary learning, and this thesis sets out to shed light on the situation. Additionally, incorporating pop music in English classes could assist in decreasing the gap between real world English and school English. The thesis is a mixed method research study consisting of both quantitative and qualitative research materials. The methodology comprises vocabulary tests both before and after pop music samples and a background questionnaire filled by students. According to the results, all students reported liking listening to music and they clearly listened to English pop music the most. A statistically significant difference was found when analysing the results of the differences in pre- and post-vocabulary tests. However, the traditional class appeared to listen to mainstream pop music more than the students in the music class, and thus it seems likely that the traditional class benefited more from vocabulary learning occurring via listening to pop songs. In conclusion, it can be established that it is possible to learn English vocabulary via listening to pop songs and that students wish their English lectures would involve more music-related vocabulary exercises in the future. Thus, when it comes to school learning, pop songs should be utilised in vocabulary learning, which could also in turn result in more diverse learning and the students could, more easily than before, relate to the themes and topics of the lectures. Furthermore, with the help of pop songs it would be possible to decrease the gap between school English and real-world English.

Epothilone-d rescues cognition and attenuates alzheimer’s disease-like pathology in APP/PS1 mice

AIMS: Cognitive decline in Alzheimer's disease (AD) patients has been linked to synaptic damage and neuronal loss. Hyperphosphorylation of tau protein destabilizes microtubules leading to the accumulation of autophagy/vesicular material and the generation of dystrophic neurites, thus contributing to axonal/synaptic dysfunction. In this study, we analyzed the effect of a microtubule-stabilizing compound in the progression of the disease in the hippocampus of APP751SL/PS1M146L transgenic model. METHODS: APP/PS1 mice (3 month-old) were treated with a weekly intraperitoneal injection of 2 mg/kg epothilone-D (Epo-D) for 3 months. Vehicle-injected animals were used as controls. Mice were tested on the Morris water maze, Y-maze and object-recognition tasks for memory performance. Abeta, AT8, ubiquitin and synaptic markers levels were analyzed by Western-blots. Hippocampal plaque, synaptic and dystrophic loadings were quantified by image analysis after immunohistochemical stainings. RESULTS: Epo-D treated mice exhibited a significant improvement in the memory tests compared to controls. The rescue of cognitive deficits was associated to a significant reduction in the AD-like hippocampal pathology. Levels of Abeta, APP and ubiquitin were significantly reduced in treated animals. This was paralleled by a decrease in the amyloid burden, and more importantly, in the plaque-associated axonal dystrophy pathology. Finally, synaptic levels were significantly restored in treated animals compared to controls. CONCLUSION: Epo-D treatment promotes synaptic and spatial memory recovery, reduces the accumulation of extracellular Abeta and the associated neuritic pathology in the hippocampus of APP/PS1 model. Therefore, microtubule stabilizing drugs could be considered therapeutical candidates to slow down AD progression. Supported by FIS-PI12/01431 and PI15/00796 (AG),FIS-PI12/01439 and PI15/00957(JV)

Caracterização da captura incidental de tartarugas marinhas pela pesca de espinhel pelágico no Nordeste do Brasil

The marine turtles biological characteristics and the impact they have been suffering in consequence of human activities have caused in the last decades the decrease of populations to unsustainable levels. All four of the species described in this paper are registered as endangered in a list by IUCN: Caretta caretta, Lepidochelys olivacea, Chelonia mydas, Dermochelys coriacea. The main causes of such impact include several fishing activities, mostly the surface longline. This paper discusses the monitoring of two foreigner longline fleet along the North East Brazilian coast between October of 2004 and September of 2005. Both operated in the West South Atlantic, one using the Chinese technique and the other the American. The American method s target species is the swordfish (Xiphias gladius), and it is characterized by using squid as bait, J 9/0 offset 5º hook, light sticks and night soaking. It also operates in shallower waters than the Chinese method. The source of information about the efforts and the catches came from onboard observers and were used to calculate the catching rate of turtles over 1000 hooks (CPUE). The American equipment caught more turtles (CPUE = 0,059; N= 103), mainly D. coriacea, while the Chinese longline caught mainly the L. olivacea and presented a CPUE= 0,018 (N= 89). The hooks were most frequently found attached to the mouth of C. caretta, C. mydas, and L. olivacea. The D. coriacea were most frequently caught by hooks externally attached to different parts of their body. There was no significant difference between the hook type catching and most turtles were still alive when released. The results suggest a greater potential of turtle catching by the American method. Besides the statistic tests have showed less interaction between the Chinese equipment and marine turtles, the catches of this fishing technique could have been underestimated due to miscommunication between the onboard observer and the vessel s crew plus the retrieve of the longline during night time

Clustering of tau-immunoreactive pathology in chronic traumatic encephalopathy

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder which may result from repetitive brain injury. A variety of tau-immunoreactive pathologies are present, including neurofibrillary tangles (NFT), neuropil threads (NT), dot-like grains (DLG), astrocytic tangles (AT), and occasional neuritic plaques (NP). In tauopathies, cellular inclusions in the cortex are clustered within specific laminae, the clusters being regularly distributed parallel to the pia mater. To determine whether a similar spatial pattern is present in CTE, clustering of the tau-immunoreactive pathology was studied in the cortex, hippocampus, and dentate gyrus in 11 cases of CTE and 7 cases of Alzheimer’s disease neuropathologic change (ADNC) without CTE. In CTE: (1) all aspects of tau-immunoreactive pathology were clustered and the clusters were frequently regularly distributed parallel to the tissue boundary, (2) clustering was similar in two CTE cases with minimal co-pathology compared with cases with associated ADNC or TDP-43 proteinopathy, (3) in a proportion of cortical gyri, estimated cluster size was similar to that of cell columns of the cortico-cortical pathways, and (4) clusters of the tau-immunoreactive pathology were infrequently spatially correlated with blood vessels. The NFT and NP in ADNC without CTE were less frequently randomly or uniformly distributed and more frequently in defined clusters than in CTE. Hence, the spatial pattern of the tau-immunoreactive pathology observed in CTE is typical of the tauopathies but with some distinct differences compared to ADNC alone. The spread of pathogenic tau along anatomical pathways could be a factor in the pathogenesis of the disease.

The prevalence of tympanic membrane and related middle ear pathology in children:a large longitudinal cohort study followed from birth to age ten

OBJECTIVE: To record with video-otoscopy the appearance of the tympanic membranes of a cross section of children aged 9 to 10 years. STUDY DESIGN: Cross-sectional study nested within an established longitudinal study of childhood development, the Avon Longitudinal Study of Parents and Children. SETTING: South West England, U.K. PARTICIPANTS: Approximately 6908 of 7261 children with ages ranging from 105 to 140 months born between April 1, 1991, and December 31, 1992, were examined by trained technicians with video-otoscopy. MAIN OUTCOME MEASURES: Two photographs were taken of each child's tympanic membranes to show the features of the pars tensa and the pars flaccida. RESULTS: In just less than three quarters of the children, both ears were normal. Retraction of the pars flaccida was present in 9.6% of children, and that of the pars tensa was present in 7.9%. Most of these changes were mild with few severe retractions. There were 15 cases of overt or suspected cholesteatoma. CONCLUSION: The tympanic membrane changes reflect most of the middle ear disease seen in 9- to 10-year-old children. The prevalence is low, and few children have serious disease at this stage.

Establishment of antibody panels and histochemical techniques in routine tumor diagnosis in Veterinary Pathology

In Portugal, Veterinary Pathology is developing rapidly, and in recent years we assist to the emergence of private laboratories and the restructuring of universities,polytechnics and public laboratories.The Portuguese Society of Animal Pathology,through its actions and its associates has been keeping the discussion among its peers in order to standardizethe criteria of description,classification and evaluation of cases which are the subject of our daily work.One of the last challenges is associated with the use of routine histochemical techniques and immunohistochemistry, in an effort to establish standardized panels for tumour diagnosis, which could eventually reduce each analysis cost.For this purpose a simple survey was built, in which all collaborators answered questions about the markers used for carcinoma, sarcoma and round cell tumour diagnosis, as well as general questions related with the subject. We obtained twenty-one answered to the questions, from public and private laboratories.In general, in most cases immunohistochemical and histochemical methods are used for diagnosis.The wide spectrum cytokeratins are universally used to confirm carcinoma, and vimentin for sarcoma. The CD3 marker is used by all laboratories to identify T lymphocytes. For the diagnosis of B-cell lymphoma, the marker used is not consensual. In each laboratory there are different markers for more specific situations and only two labs perform PCR techniques for diagnosis. These data will be presented to promote extended discussion,namely to reach a consensus when different markers are used.

Skin as a promising biomatrix for the early detection of misfolded proteins by RT-QuIC in neurodegenerative diseases

Real-Time Quaking-Induced Conversion (RT-QuIC) is an ultrasensitive assay capable of detecting pathological aggregates of misfolded proteins in biospecimens. In recent years, efforts have been made to find a more feasible and convenient biomatrix as an alternative to CSF, and skin biopsy may be a suitable candidate. This project aimed to evaluate the diagnostic performance of skin RT-QuIC in 3 different cohorts of patients: 1. Creutzfeldt-Jakob disease (CJD), 2. Lewy body disease (LBD), and 3. Isolated REM sleep behavior disorder (iRBD). We studied 71 punch skin samples of 35 patients with CJD, including five assessed in vitam, using 2 two different substrates: Bank vole 23-230 (Bv23-230) and Syrian hamster 23-231 (Ha23-231) recombinant prion protein. Skin prion RT-QuIC showed a 100% specificity with both substrates and a higher sensitivity with the Bv23-230 than Ha23-231 (87.5% vs. 65.6%, respectively). Forty-one patients underwent both lumbar puncture (LB) and skin biopsy; CSF and skin RT-QuIC showed a high level of concordance (38/41, 92.7%). Then, we analyzed samples taken in vitam (n=69) or postmortem (n=49) from patients with Parkinson’s disease (PD), dementia with Lewy bodies (DLB), incidental Lewy body pathology, and neurological controls. Skin α-syn RT-QuIC distinguished LBD patients with an overall accuracy of 94.1% in the two cohorts (sensitivity, 89.2%; specificity, 96.3%). Seventy-nine patients underwent both CSF and skin α-syn RT-QuIC, and the two assays yielded similar diagnostic accuracy (skin, 97.5%; CSF, 98.7%). Finally, we studied 91 iRBD patients and 41 control. In the skin, RT-QuIC showed a sensitivity of 76.9%, specificity of 97.6%, and 82.0% accuracy. 128 participants (88 patients plus 40 controls) underwent both CSF and skin RT-QuIC. The two protocols showed 99.2% of concordance. These works confirmed that skin punch biopsies might represent a valid and convenient alternative to CSF analysis for an early diagnosis of prion diseases and LB-related pathologies.

Advanced studies on two animal models, murine and fish. RadKI21A626T mouse model: new insights into molecular mechanisms of enteric neuro-epithelial pathology. European sea bass: study of the effects of essential oils in different diets on the gastric system.

My PhD research period was focused on the anatomical, physiological and functional study of the gastrointestinal system on two different animal models. In two different contexts, the purpose of these two lines of research was contribute to understand how a specific genetic mutation or the adoption of a particular dietary supplement can affect gastrointestinal function. Functional gastrointestinal disorders are chronic conditions characterized by symptoms for which no organic cause can be found. Although symptoms are generally mild, a small subset of cases shows severe manifestations. This subset of patients may also have recurrent intestinal sub-occlusive episodes, but in absence of mechanical causes. This condition is referred to as chronic intestinal pseudo-obstruction, a rare, intractable chronic disease. Some mutations have been associated with CIPO. A novel causative RAD21 missense mutation was identified in a large consanguineous family, segregating a recessive form of CIPO. The present thesis was aimed to elucidate the mechanisms leading to neuropathy underlying CIPO via a recently developed conditional KI mouse carrying the RAD21 mutation. The experimental studies are based on the characterization and functional analysis of the conditional KI Rad21A626T mouse model. On the other hand aquaculture is increasing the global supply of foods. The species selected and feeds used affects the nutrients available from aquaculture, with a need to improve feed efficiency, both for economic and environmental reasons, but this will require novel innovative approaches. Nutritional strategies focused on the use of botanicals have attracted interest in animal production. Previous research indicates the positive results of using essential oils (EOs) as natural feed additives for several farmed animals. Therefore, the present study was designed to compare the effects of feed EO supplementation in two different forms (natural and composed of active ingredients obtained by synthesis) on the gastric mucosa in European sea bass.

Advanced imaging study in cerebrovascular pathology for the personalization of therapy: from the capillary microcirculation to the vessel wall

Objectives: To investigate the use of intravascular optical coherence tomography (IVOCT) for carotid artery stenting (CAS) procedures in patients with atherosclerotic stenosis. Examine possible markers that might identify the onset of new cerebral ischemic lesions on MRI. Specifically, attention was drawn to the morphological features of the used dual layer stent, which could be underestimated during traditional CAS procedures. Secondary goals are to compare the safety and efficacy of different CAS techniques and the accuracy of the vessel analysis software’s on pre-operative CTA examination used to quantify ICA stenosis with the gold standard IVOCT. Material and Methods: Ten patients underwent CAS procedure with flow-arrest technique and IVOCT evaluations prior to and following stent deployment, while five matched patients underwent CAS procedure with distal embolic protection device (EPD) technique. All patients underwent 24-hours 3T MRI examination to check for ischemic lesions; all patients were treated with the same dual-layer stent. Results: Patients with new ischemic lesions demonstrated peculiar stent configuration in the distal end, and a strong Spearman’s rank order correlation was found among the volume of new DWI lesions and the stent configuration in its distal end (Rs: 0.81; p <0.001). No statistically significant differences were observed in the total burden of new ischemic lesions for each technique. The vessel analysis software's on CTA comparison demonstrated a higher diagnostic accuracy in the degree of ICA stenosis compared to the gold standard of IVOCT of the specialized software (ROC curve = 0.63; p = 0.06) compared to the general software (ROC curve = 0.57, p = 0.31). Conclusions: Study’s results support the use of IVOCT to allow recognition of potential features that can predict the onset of new cerebral ischemic lesions. Additionally, IVOCT made it possible to evaluate specialized software's increased accuracy in the pre-operative evaluation of ICA atherosclerotic stenosis.