1,721,017 research outputs found
Sonographically estimated thyroid nodule malignancy risk: Strengths and limitations in clinical practice
No full textn recent years, the clinical relevance of thyroid ultra-sound has increased. Due to the development of risk-strati-fication systems that use a systematic assessment of thyroid nodule sonographic characteristics and tiered categories, such as the Thyroid Imaging Reporting and Data System (TI-RADS), a pattern of morphologic features is easily translated into a specific class, with an associated estimate of malignancy risk and suggestions for clinical manage-men
Branching with hyperplanes in the criterion space: The frontier partitioner algorithm for biobjective integer programming
Full text linkWe present an algorithm for finding the complete Pareto frontier of biobjective integer programming problems. The method is based on the solution of a finite number of integer programs. The feasible sets of the integer programs are built from the original feasible set, by adding cuts that separate efficient solutions. Providing the existence of an oracle to solve suitably defined single objective integer subproblems, the algorithm can handle biobjective nonlinear integer problems, in particular biobjective convex quadratic integer optimization problems. Our numerical experience on a benchmark of biobjective integer linear programming instances shows the efficiency of the approach in comparison with existing state-of-the-art methods. Further experiments on biobjective integer quadratic programming instances are reported
Manuale di Endocrinologia
No full textIl manuale, utilizzando un linguaggio accessibile anche ai non esperti della materia, ma scientificamente inappuntabile, cerca di andare oltre la nozionistica tradizionale, approfondendo le moderne ed affascinanti acquisizioni di genetica e di fisiopatologia delle ghiandole endocrine ed indicando i protocolli diagnostici e terapeutici più scientificamente corretti
Artificial intelligence: What is it and how can it expand the ultrasound potential in the future?
No full textDuring the past century, our ability to perform complex calculations massively increased, due to the availability of powerful processors, and diffuse, ubiquitious presence of personal computers for home and professional applications. Many physicians are worried by the application of Artificial Intelligence (AI) in medicine, envisioning an Asimov science-fiction scenario. But is this real? What the AI use in medicine and, particularly, ultrasonography actually entails
Molecular defects in thyroid dysgenesis
Full text linkCongenital hypothyroidism (CH) is a neonatal endocrine disorder that might occur as itself or be associated to congenital extra-thyroidal defects. About 85% of affected subjects experience thyroid dysgenesis (TD), characterized by defect in thyroid gland development. In vivo experiments on null mice paved the way for the identification of genes involved thyroid morphogenesis and development, whose mutation has been strongly associated to TD. Most of them are thyroid-specific transcription factors expressed during early thyroid development. Despite the arduous effort in unraveling the genetics of TD in animal models, up to now these data have been discontinuously confirmed in humans and only 5% of TD have associated with known null mice-related mutations (mainly PAX8 and TSHR). Notwithstanding, the advance in genetic testing represented by the next-generation sequencing (NGS) approach is steadily increasing the list of genes whose highly penetrant mutation predisposes to TD. In this review we intend to outline the molecular bases of TD, summarizing the current knowledge on thyroid development in both mice and humans and delineating the genetic features of its monogenetic forms. We will also highlight current strategies to enhance the insight into the non-Mendelian mechanisms of abnormal thyroid development
Metabolic adverse events of multitarget kinase inhibitors: a systematic review
No full textPurpose: Multitargeted kinase inhibitors (MKIs) are used for the treatment of several cancers. By targeting multiple signaling pathways, MKIs have become cornerstones of the oncologic treatment. Although their use leads to important results in terms of survival, treatment with MKIs can determine important side effects the clinician must be aware of. Among those, arterial hypertension, mucositis and skin lesions are universally reported, while data about metabolic alterations are scarce. In our review, we focused on glucose and lipid alterations in MKI-treated patients. Methods: We searched for articles, published between January 2012 and December 2022, evaluating the effects on lipid and glucose metabolism of four MKIs (Cabozantinib, Lenvatinib, Sorafenib, and Vandetanib) in adult patients with cancer. We focused on drugs approved for thyroid malignancies, since a worse metabolic control may potentially impact life expectancy, due to their better overall survival rate. Results: As for glucose metabolism, the majority of the studies reported elevation of glucose levels (prevalence: 1-17%) with different grades of severity, including death. As for cholesterol, 12 studies reported worsening or new-onset hypercholesterolemia (prevalence: 4-40%). Finally, 19 studies reported different grades of hypertriglyceridemia (prevalence: 1-86%), sometimes leading to life-threatening events. Conclusions: Despite some inherent limitations, our analysis may cast light upon some of the MKIs metabolic disorders that can impact on patients’ health, especially when long-term survival is expected. Future clinical trials should consider routine assessment of glucose and lipid levels, because underdetection and underreporting of alterations can lead to the overlooking of important adverse events
Thyroid hormone therapy in differentiated thyroid cancer
No full textSurgery-with or without postoperative radioiodine-is the standard of care for most patients with differentiated thyroid carcinoma (DTC). Thyroid hormone replacement therapy is the mainstay of long-term medical management. Patients treated with total thyroidectomy and some who undergo lobectomy alone require thyroid hormone therapy to restore euthyroidism with normal serum thyroid-stimulating hormone (TSH) levels. Because TSH acts as a growth factor for thyroid follicular cells (including those that are neoplastic), it can potentially affect the onset and/or progression of follicular-cell derived thyroid cancer. For this reason, some patients are placed on thyroid hormone therapy at doses that suppress secretion of TSH (suppression therapy). This mini-review looks at the potential benefits and risks of this practice in patients diagnosed with DTC. Aggressive TSH-suppressive therapy is of little or no benefit to the vast majority of patients with DTC. Practice guidelines, therefore, recommend a graded algorithm in which the potential benefits of suppression are weighed against the associated cardiovascular and skeletal risks. Large randomized controlled studies are needed to confirm the presumed oncological benefits of TSH-suppression and its causal role in adverse cardiac, skeletal, and quality of life effects and to assess the efficacy of TSH normalization in reversing or reducing these effects
Thyroid nodules: diagnosis and management
No full textThyroid nodules, with a prevalence of almost 25% in the general population, are a common occurrence. Their prevalence varies considerably depending on demographics such as age and sex as well as the presence of risk factors. This article provides a comprehensive overview of the prevalence, risk stratification and current management strategies for thyroid nodules, with a particular focus on changes in diagnostic and therapeutic protocols that have occurred over the past 10 years. Several sonography-based stratification systems (such as Thyroid Imaging Reporting and Data Systems (TIRADS)) might help to predict the malignancy risk of nodules, potentially eliminating the need for biopsy in many instances. However, large or suspicious nodules necessitate cytological evaluation following fine-needle aspiration biopsy for accurate classification. In the case of cytology yielding indeterminate results, additional tools, such as molecular testing, can assist in guiding the management plan. Surgery is no longer the only treatment for symptomatic or malignant nodules: active surveillance or local ablative treatments might be beneficial for appropriately selected patients. To enhance clinician–patient interactions and discussions about diagnostic options, shared decision-making tools have been developed. A personalized, risk-based protocol promotes high-quality care while minimizing costs and unnecessary testing
A rare association of the common carotid trunk and aberrant retroesophagealsubclavian artery.
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