Aggressive medullary thyroid cancer, an analysis of the Irish National Cancer Registry.

Aggressive medullary thyroid cancer, an analysis of the Irish National Cancer Registry.

Ir J Med Sci. 2016 Apr 15;

Authors: Lennon P, Deady S, White N, Lambert D, Healy ML, Green A, Kinsella J, Timon C, O' Neill JP

Abstract
BACKGROUND AND OBJECTIVES: Medullary thyroid cancer consists of a spectrum of disease that ranges from extremely indolent tumors to aggressive types associated with a high mortality rate. The objective of our study is to evaluate the prognostic factors and outcomes of patients diagnosed with MTC in a homogenous population, and to examine patients diagnosed with MTC for mutations in the RET proto-oncogene from the same period.
METHODS: A retrospective analysis of the National Cancer Registry in Ireland was undertaken, between 1998 and 2007. The Kaplan-Meier method was used to determine overall survival and factors predictive of outcome were determined by univariate and multivariate analysis by cox regression using Stata 13 software.
MAIN FINDINGS: Forty-three patients were diagnosed with medullary thyroid cancer, 55.8 % were female and 44.2 % were male. A median age of 52 was found. The overall median survival was 6.32 years and the 1- and 5-year overall survival was 88.37 and 62.79 %, respectively, with 10-year survival calculated at 48.63 %. On univariate analysis age, stage and surgical intervention were statistically significant indicators of prognosis. T stage and age remained statistically significant indicators of prognosis on multivariate analysis. Two patients with no history of MEN syndromes or family history of medullary thyroid cancer had RET proto-onocogene mutations.
CONCLUSIONS: Our patient cohort was substantially older and presented at an advanced T status than what is commonly seen in the literature. This may account for poor survival outcomes and the very low pick-up of RET mutations in sporadic medullary thyroid cancer.

PMID: 27083464 [PubMed - as supplied by publisher]

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Frequency of High Risk Characteristics Requiring Total Thyroidectomy for 1-4 cm Well Differentiated Thyroid Cancer.

Frequency of High Risk Characteristics Requiring Total Thyroidectomy for 1-4 cm Well Differentiated Thyroid Cancer.

Thyroid. 2016 Apr 15;

Authors: Kluijfhout WP, Pasternak JD, Lim J, Kwon JS, Vriens MR, Clark OH, Shen WT, Gosnell J, Suh I, Duh QY

Abstract
Background Extent of thyroidectomy for low risk well differentiated thyroid cancer (WDTC) remains controversial. Historically, total thyroidectomy (TT) has been recommended for WDTC ≥1 cm in size. However, recent NCCN and draft ATA guidelines recognize unilateral thyroid lobectomy as a viable alternative for 1-4 cm cancers due to their otherwise favorable prognosis, with TT remaining the preferred option for tumors with unfavorable pathological characteristics. We sought to determine how often a completion TT would be recommended based on these guidelines if lobectomy was initially performed in our patients with 1-4 cm WDTC without preoperatively known risk factors. Methods We retrospectively reviewed our patients who underwent thyroidectomy for 1-4 cm WDTC (January 2000 to January 2010). We excluded patients with preoperatively known high risk characteristics, including gross extra-thyroidal extension on preoperative imaging, clinically apparent lymph node metastases, distant metastases, history of radiation and positive family history. We evaluated the pathology specimens from the cancer-containing lobe for features that would lead to a recommendation for TT based on current guidelines, including aggressive histology, vascular invasion, microscopic extra-thyroidal extension (ETE), positive margins and any positive lymph nodes within the specimen. Results Of 1000 consecutive patients operated for WDTC, 287 would have been eligible for lobectomy as the initial operation. The mean age in this cohort was 45 years, and 80% were women. Aggressive tall cell variant histology was found in 1 patients (0.5%), angio-invasion in 34 (12%), ETE in 48 (17%), positive margins in 51 (18%), and positive lymph nodes in 49 (18%). Completion TT would have been recommended in 122/287 (43%) patients. Even in those with 1-2 cm cancers, completion TT would have been recommended in 52/143 (36%). Conclusions Nearly half of patients with 1-4 cm WDTC who are eligible for lobectomy under current guidelines would require completion TT based on pathological characteristics of the initial lobe. Surgeons, endocrinologists, and patients need to balance the relative benefits, risks, and costs of initial TT versus the possible need for reoperative completion TT.

PMID: 27083216 [PubMed - as supplied by publisher]

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Analysis of Risk Factors Contributing to Recurrence of Papillary Thyroid Carcinoma in Chinese Patients Who Underwent Total Thyroidectomy.

Analysis of Risk Factors Contributing to Recurrence of Papillary Thyroid Carcinoma in Chinese Patients Who Underwent Total Thyroidectomy.

Med Sci Monit. 2016;22:1274-1279

Authors: Zhang W, Jiao, Liu B, Sun S

Abstract
BACKGROUND Thyroid cancer is a very common endocrine malignancy, with a rate of total thyroidectomy reported to be up to 27.8%. However, studies analyzing the risk factors that contribute to recurrence of papillary thyroid carcinoma (PTC) after total thyroidectomy in China are still scarce. MATERIAL AND METHODS A total of 536 patients with PTC who underwent total thyroidectomy were retrospectively analyzed. Patients were divided into 2 groups: patients with no recurrent tumor were included in group 1 and patients with tumor recurrence were included in group 2. RESULTS Of 536 patients, 65 patients (12.1%) developed a recurrence of PTC, and 471 patients (87.9%) did not have a recurrence. Univariate analysis indicated that male sex, age ≥50 years, tumor ≥1 cm, poor differentiation, lymph node metastasis, bilaterality, and multifocality may be related to PTC recurrence. Additionally, the results of the logistic regression analysis indicated that male sex, age ≥50 years, primary tumor ≥1 cm, poor dedifferentiation of the tumor, lymph node metastasis, and multifocality may be independent factors contributing to PTC recurrence. CONCLUSIONS Male sex, age more than 50 years, primary tumor larger than 1 cm, poor dedifferentiation of the primary tumor, lymph node metastasis, and multifocality were found to increase the risk of PTC recurrence in patients who underwent total thyroidectomy. Additionally, it is necessary to use strictly aggressive and extensive surgery, as well as close monitoring, after the operation.

PMID: 27084873 [PubMed - as supplied by publisher]

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Aggressive medullary thyroid cancer, an analysis of the Irish National Cancer Registry.

Aggressive medullary thyroid cancer, an analysis of the Irish National Cancer Registry.

Ir J Med Sci. 2016 Apr 15;

Authors: Lennon P, Deady S, White N, Lambert D, Healy ML, Green A, Kinsella J, Timon C, O' Neill JP

Abstract
BACKGROUND AND OBJECTIVES: Medullary thyroid cancer consists of a spectrum of disease that ranges from extremely indolent tumors to aggressive types associated with a high mortality rate. The objective of our study is to evaluate the prognostic factors and outcomes of patients diagnosed with MTC in a homogenous population, and to examine patients diagnosed with MTC for mutations in the RET proto-oncogene from the same period.
METHODS: A retrospective analysis of the National Cancer Registry in Ireland was undertaken, between 1998 and 2007. The Kaplan-Meier method was used to determine overall survival and factors predictive of outcome were determined by univariate and multivariate analysis by cox regression using Stata 13 software.
MAIN FINDINGS: Forty-three patients were diagnosed with medullary thyroid cancer, 55.8 % were female and 44.2 % were male. A median age of 52 was found. The overall median survival was 6.32 years and the 1- and 5-year overall survival was 88.37 and 62.79 %, respectively, with 10-year survival calculated at 48.63 %. On univariate analysis age, stage and surgical intervention were statistically significant indicators of prognosis. T stage and age remained statistically significant indicators of prognosis on multivariate analysis. Two patients with no history of MEN syndromes or family history of medullary thyroid cancer had RET proto-onocogene mutations.
CONCLUSIONS: Our patient cohort was substantially older and presented at an advanced T status than what is commonly seen in the literature. This may account for poor survival outcomes and the very low pick-up of RET mutations in sporadic medullary thyroid cancer.

PMID: 27083464 [PubMed - as supplied by publisher]

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Frequency of High Risk Characteristics Requiring Total Thyroidectomy for 1-4 cm Well Differentiated Thyroid Cancer.

Frequency of High Risk Characteristics Requiring Total Thyroidectomy for 1-4 cm Well Differentiated Thyroid Cancer.

Thyroid. 2016 Apr 15;

Authors: Kluijfhout WP, Pasternak JD, Lim J, Kwon JS, Vriens MR, Clark OH, Shen WT, Gosnell J, Suh I, Duh QY

Abstract
Background Extent of thyroidectomy for low risk well differentiated thyroid cancer (WDTC) remains controversial. Historically, total thyroidectomy (TT) has been recommended for WDTC ≥1 cm in size. However, recent NCCN and draft ATA guidelines recognize unilateral thyroid lobectomy as a viable alternative for 1-4 cm cancers due to their otherwise favorable prognosis, with TT remaining the preferred option for tumors with unfavorable pathological characteristics. We sought to determine how often a completion TT would be recommended based on these guidelines if lobectomy was initially performed in our patients with 1-4 cm WDTC without preoperatively known risk factors. Methods We retrospectively reviewed our patients who underwent thyroidectomy for 1-4 cm WDTC (January 2000 to January 2010). We excluded patients with preoperatively known high risk characteristics, including gross extra-thyroidal extension on preoperative imaging, clinically apparent lymph node metastases, distant metastases, history of radiation and positive family history. We evaluated the pathology specimens from the cancer-containing lobe for features that would lead to a recommendation for TT based on current guidelines, including aggressive histology, vascular invasion, microscopic extra-thyroidal extension (ETE), positive margins and any positive lymph nodes within the specimen. Results Of 1000 consecutive patients operated for WDTC, 287 would have been eligible for lobectomy as the initial operation. The mean age in this cohort was 45 years, and 80% were women. Aggressive tall cell variant histology was found in 1 patients (0.5%), angio-invasion in 34 (12%), ETE in 48 (17%), positive margins in 51 (18%), and positive lymph nodes in 49 (18%). Completion TT would have been recommended in 122/287 (43%) patients. Even in those with 1-2 cm cancers, completion TT would have been recommended in 52/143 (36%). Conclusions Nearly half of patients with 1-4 cm WDTC who are eligible for lobectomy under current guidelines would require completion TT based on pathological characteristics of the initial lobe. Surgeons, endocrinologists, and patients need to balance the relative benefits, risks, and costs of initial TT versus the possible need for reoperative completion TT.

PMID: 27083216 [PubMed - as supplied by publisher]

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Table of Contents

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Information for Readers

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Position Statement on Nurse Practitioner Prescriptive Privileges

The National Association of Pediatric Nurse Practitioners (NAPNAP) advocates that all nurse practitioners (NPs) have full prescriptive authority and dispensing privileges based on their education, training, licensure, and certification. Pediatric nurse practitioners (PNPs) have completed a formal educational program in pediatric health care and have met their state board's regulations that govern advanced practice nursing (American Nurses Association, NAPNAP, & Society of Pediatric Nurses, 2015).

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Society

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Summer-Safe, Trauma-Wise: Advocating for Preventative Legislation

Advocacy remains an extremely important role of the pediatric health care provider. Pediatric nurse practitioners are challenged to focus on supporting the most critical policies that govern child health, especially in the areas of safety and injury prevention within their own states and neighborhoods. The summer months of June through August are considered "trauma season," a time of year when children are most likely to sustain injuries on the road as pedestrians or occupants of motor vehicles; in the sports arena; and as a result of participating in activities like swimming or hiking.

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Continuing Education Posttest

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Letter to the Editor

In the article entitled "First We Have to Engage Them: A Mixed Methods Assessment of Low-Income Parents' Preferences for and Barriers to Receiving Child Health Promotion Information" (Davis et al., 2015), the authors conclude that "new health information delivery methods are needed that take into account the barriers associated with parenting in the context of poverty." However, several examples of new delivery methods do exist.

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Nonsuicidal Self-Injury

Nonsuicidal self-injury (NSSI) is a serious and prevalent problem within the adolescent population. NSSI is associated with a variety of psychiatric diagnoses and behavioral concerns. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, has recognized NSSI as its own separate diagnosis. Although there are unique differences between NSSI and suicidal behaviors, a link exists between these behaviors. It is crucial that pediatric nurse practitioners who provide care for adolescents possess a thorough understanding of NSSI.

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Position Statement on Reimbursement for Nurse Practitioner Services

Nurse practitioners (NPs) provide comprehensive, cost-effective, high-quality health care services in diverse settings across the care and age continuum (Institute of Medicine, 2010; Newhouse et al., 2011). The National Association of Pediatric Nurse Practitioners (NAPNAP) believes that NPs must receive equitable reimbursement from all payers in order to provide the communities they serve with the full scope of health care services. NAPNAP understands the unique contribution that NPs make to the U.S.

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Editorial Board

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Dishevelled proteins are significantly upregulated in chronic lymphocytic leukaemia

Abstract

Dishevelled (DVL) proteins are components of the Wnt signalling pathways, and increased expression is associated with various malignancies. Information on DVLs in chronic lymphatic leukaemia (CLL) is limited. The aim of the present study was to investigate the role of DVLs in CLL cells and association with Wnt pathways downstream of ROR1. DVL1, 2 and 3 were exclusively expressed in CLL cells as compared to normal peripheral blood mononuclear cells (PBMCs). The expression of DVL1 and DVL3 proteins was significantly more pronounced in progressive than in non-progressive disease (p < 0.01), whereas the level of DVL2 was significantly higher in non-progressive as compared to progressive disease (p < 0.001). Treatment of CLL cells with anti-ROR1 specific monoclonal antibodies induced dephosphorylation of ROR1 as well as of tyrosine and serine residues of both DVL2 and DVL3. However, gene silencing of DVLs in the CLL cell line (EHEB) did not induce detectable apoptosis. Non-progressive CLL patients had a different protein activity pattern with regard to Wnt signalling pathway proteins as GSK-3β, β-catenin and AKT as compared to progressive disease. The DVL2 protein may play a role in the activation of signalling pathways in CLL during early stages of the disease, while DVL1 and 3 may have a role in later phases of the leukaemia.

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Table of Contents

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Information for Readers

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Position Statement on Nurse Practitioner Prescriptive Privileges

The National Association of Pediatric Nurse Practitioners (NAPNAP) advocates that all nurse practitioners (NPs) have full prescriptive authority and dispensing privileges based on their education, training, licensure, and certification. Pediatric nurse practitioners (PNPs) have completed a formal educational program in pediatric health care and have met their state board's regulations that govern advanced practice nursing (American Nurses Association, NAPNAP, & Society of Pediatric Nurses, 2015).

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Professional Conduct and Social Media

Our personal, portable electronic communication devices are with us everywhere: in the workplace, in the classroom, in committee meetings, and in clinical settings. We are using texting and e-mail to accomplish our work more efficiently. The use of apps has revolutionized the way we provide health care, with clinical guidelines at our fingertips and at the point of care. We also turn to social media sites to communicate with friends, as well as with colleagues and professional groups.

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Table of Contents

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Information for Readers

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Position Statement on Nurse Practitioner Prescriptive Privileges

The National Association of Pediatric Nurse Practitioners (NAPNAP) advocates that all nurse practitioners (NPs) have full prescriptive authority and dispensing privileges based on their education, training, licensure, and certification. Pediatric nurse practitioners (PNPs) have completed a formal educational program in pediatric health care and have met their state board's regulations that govern advanced practice nursing (American Nurses Association, NAPNAP, & Society of Pediatric Nurses, 2015).

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Society

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Summer-Safe, Trauma-Wise: Advocating for Preventative Legislation

Advocacy remains an extremely important role of the pediatric health care provider. Pediatric nurse practitioners are challenged to focus on supporting the most critical policies that govern child health, especially in the areas of safety and injury prevention within their own states and neighborhoods. The summer months of June through August are considered "trauma season," a time of year when children are most likely to sustain injuries on the road as pedestrians or occupants of motor vehicles; in the sports arena; and as a result of participating in activities like swimming or hiking.

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Continuing Education Posttest

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Letter to the Editor

In the article entitled "First We Have to Engage Them: A Mixed Methods Assessment of Low-Income Parents' Preferences for and Barriers to Receiving Child Health Promotion Information" (Davis et al., 2015), the authors conclude that "new health information delivery methods are needed that take into account the barriers associated with parenting in the context of poverty." However, several examples of new delivery methods do exist.

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Nonsuicidal Self-Injury

Nonsuicidal self-injury (NSSI) is a serious and prevalent problem within the adolescent population. NSSI is associated with a variety of psychiatric diagnoses and behavioral concerns. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, has recognized NSSI as its own separate diagnosis. Although there are unique differences between NSSI and suicidal behaviors, a link exists between these behaviors. It is crucial that pediatric nurse practitioners who provide care for adolescents possess a thorough understanding of NSSI.

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Position Statement on Reimbursement for Nurse Practitioner Services

Nurse practitioners (NPs) provide comprehensive, cost-effective, high-quality health care services in diverse settings across the care and age continuum (Institute of Medicine, 2010; Newhouse et al., 2011). The National Association of Pediatric Nurse Practitioners (NAPNAP) believes that NPs must receive equitable reimbursement from all payers in order to provide the communities they serve with the full scope of health care services. NAPNAP understands the unique contribution that NPs make to the U.S.

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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174

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Editorial Board

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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174

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Dishevelled proteins are significantly upregulated in chronic lymphocytic leukaemia

Abstract

Dishevelled (DVL) proteins are components of the Wnt signalling pathways, and increased expression is associated with various malignancies. Information on DVLs in chronic lymphatic leukaemia (CLL) is limited. The aim of the present study was to investigate the role of DVLs in CLL cells and association with Wnt pathways downstream of ROR1. DVL1, 2 and 3 were exclusively expressed in CLL cells as compared to normal peripheral blood mononuclear cells (PBMCs). The expression of DVL1 and DVL3 proteins was significantly more pronounced in progressive than in non-progressive disease (p < 0.01), whereas the level of DVL2 was significantly higher in non-progressive as compared to progressive disease (p < 0.001). Treatment of CLL cells with anti-ROR1 specific monoclonal antibodies induced dephosphorylation of ROR1 as well as of tyrosine and serine residues of both DVL2 and DVL3. However, gene silencing of DVLs in the CLL cell line (EHEB) did not induce detectable apoptosis. Non-progressive CLL patients had a different protein activity pattern with regard to Wnt signalling pathway proteins as GSK-3β, β-catenin and AKT as compared to progressive disease. The DVL2 protein may play a role in the activation of signalling pathways in CLL during early stages of the disease, while DVL1 and 3 may have a role in later phases of the leukaemia.

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Table of Contents

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Information for Readers

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Position Statement on Nurse Practitioner Prescriptive Privileges

The National Association of Pediatric Nurse Practitioners (NAPNAP) advocates that all nurse practitioners (NPs) have full prescriptive authority and dispensing privileges based on their education, training, licensure, and certification. Pediatric nurse practitioners (PNPs) have completed a formal educational program in pediatric health care and have met their state board's regulations that govern advanced practice nursing (American Nurses Association, NAPNAP, & Society of Pediatric Nurses, 2015).

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Society

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Summer-Safe, Trauma-Wise: Advocating for Preventative Legislation

Advocacy remains an extremely important role of the pediatric health care provider. Pediatric nurse practitioners are challenged to focus on supporting the most critical policies that govern child health, especially in the areas of safety and injury prevention within their own states and neighborhoods. The summer months of June through August are considered "trauma season," a time of year when children are most likely to sustain injuries on the road as pedestrians or occupants of motor vehicles; in the sports arena; and as a result of participating in activities like swimming or hiking.

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Continuing Education Posttest

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Letter to the Editor

In the article entitled "First We Have to Engage Them: A Mixed Methods Assessment of Low-Income Parents' Preferences for and Barriers to Receiving Child Health Promotion Information" (Davis et al., 2015), the authors conclude that "new health information delivery methods are needed that take into account the barriers associated with parenting in the context of poverty." However, several examples of new delivery methods do exist.

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Nonsuicidal Self-Injury

Nonsuicidal self-injury (NSSI) is a serious and prevalent problem within the adolescent population. NSSI is associated with a variety of psychiatric diagnoses and behavioral concerns. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, has recognized NSSI as its own separate diagnosis. Although there are unique differences between NSSI and suicidal behaviors, a link exists between these behaviors. It is crucial that pediatric nurse practitioners who provide care for adolescents possess a thorough understanding of NSSI.

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Dishevelled proteins are significantly upregulated in chronic lymphocytic leukaemia

Abstract

Dishevelled (DVL) proteins are components of the Wnt signalling pathways, and increased expression is associated with various malignancies. Information on DVLs in chronic lymphatic leukaemia (CLL) is limited. The aim of the present study was to investigate the role of DVLs in CLL cells and association with Wnt pathways downstream of ROR1. DVL1, 2 and 3 were exclusively expressed in CLL cells as compared to normal peripheral blood mononuclear cells (PBMCs). The expression of DVL1 and DVL3 proteins was significantly more pronounced in progressive than in non-progressive disease (p < 0.01), whereas the level of DVL2 was significantly higher in non-progressive as compared to progressive disease (p < 0.001). Treatment of CLL cells with anti-ROR1 specific monoclonal antibodies induced dephosphorylation of ROR1 as well as of tyrosine and serine residues of both DVL2 and DVL3. However, gene silencing of DVLs in the CLL cell line (EHEB) did not induce detectable apoptosis. Non-progressive CLL patients had a different protein activity pattern with regard to Wnt signalling pathway proteins as GSK-3β, β-catenin and AKT as compared to progressive disease. The DVL2 protein may play a role in the activation of signalling pathways in CLL during early stages of the disease, while DVL1 and 3 may have a role in later phases of the leukaemia.

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Table of Contents

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Information for Readers

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Position Statement on Nurse Practitioner Prescriptive Privileges

The National Association of Pediatric Nurse Practitioners (NAPNAP) advocates that all nurse practitioners (NPs) have full prescriptive authority and dispensing privileges based on their education, training, licensure, and certification. Pediatric nurse practitioners (PNPs) have completed a formal educational program in pediatric health care and have met their state board's regulations that govern advanced practice nursing (American Nurses Association, NAPNAP, & Society of Pediatric Nurses, 2015).

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Society

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Summer-Safe, Trauma-Wise: Advocating for Preventative Legislation

Advocacy remains an extremely important role of the pediatric health care provider. Pediatric nurse practitioners are challenged to focus on supporting the most critical policies that govern child health, especially in the areas of safety and injury prevention within their own states and neighborhoods. The summer months of June through August are considered "trauma season," a time of year when children are most likely to sustain injuries on the road as pedestrians or occupants of motor vehicles; in the sports arena; and as a result of participating in activities like swimming or hiking.

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Continuing Education Posttest

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Letter to the Editor

In the article entitled "First We Have to Engage Them: A Mixed Methods Assessment of Low-Income Parents' Preferences for and Barriers to Receiving Child Health Promotion Information" (Davis et al., 2015), the authors conclude that "new health information delivery methods are needed that take into account the barriers associated with parenting in the context of poverty." However, several examples of new delivery methods do exist.

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Nonsuicidal Self-Injury

Nonsuicidal self-injury (NSSI) is a serious and prevalent problem within the adolescent population. NSSI is associated with a variety of psychiatric diagnoses and behavioral concerns. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, has recognized NSSI as its own separate diagnosis. Although there are unique differences between NSSI and suicidal behaviors, a link exists between these behaviors. It is crucial that pediatric nurse practitioners who provide care for adolescents possess a thorough understanding of NSSI.

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Position Statement on Reimbursement for Nurse Practitioner Services

Nurse practitioners (NPs) provide comprehensive, cost-effective, high-quality health care services in diverse settings across the care and age continuum (Institute of Medicine, 2010; Newhouse et al., 2011). The National Association of Pediatric Nurse Practitioners (NAPNAP) believes that NPs must receive equitable reimbursement from all payers in order to provide the communities they serve with the full scope of health care services. NAPNAP understands the unique contribution that NPs make to the U.S.

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Editorial Board

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