Follicular nodules (Thy3) of the thyroid: is total thyroidectomy the best option?

BACKGROUND: Identification of the best management strategy for nodules with Thy3 cytology presents particular problems for clinicians. This study investigates the ability of clinical, cytological and sonographic data to predict malignancy in indeterminate nodules with the scope of determining the need for total thyroidectomy in these patients. METHODS: The study population consisted of 249 cases presenting indeterminate nodules (Thy3): 198 females (79.5%) and 51 males (20.5%) with a mean age of 52.43 ± 13.68 years. All patients underwent total thyroidectomy. RESULTS: Malignancy was diagnosed in 87/249 patients (34.9%); thyroiditis co-existed in 119/249 cases (47.79%) and was associated with cancer in 40 cases (40/87; 45.98%). Of the sonographic characteristics, only echogenicity and the presence of irregular margins were identified as being statistically significant predictors of malignancy. 52/162 benign lesions (32.1%) and 54/87 malignant were hypoechoic (62.07%); irregular margins were present in 13/162 benign lesions (8.02%), and in 60/87 malignant lesions (68.97%). None of the clinical or cytological features, on the other hand, including age, gender, nodule size, the presence of microcalcifications or type 3 vascularization, were significantly associated with malignancy. CONCLUSIONS: The rate of malignancy in cytologically indeterminate lesions was high in the present study sample compared to other reported rates, and in a significant number of cases Hashimoto’s thyroiditis was also detected. Thus, considering the fact that clinical and cytological features were found to be inaccurate predictors of malignancy, it is our opinion that surgery should always be recommended. Moreover, total thyroidectomy is advisable, being the most suitable procedure in cases of multiple lesions, hyperplastic nodular goiter, or thyroiditis; the high incidence of malignancy and the unreliability of intraoperative frozen section examination also support this preference for total over hemi-thyroidectomy

Tyrosinase Inhibitor Activity of Coumarin-Resveratrol Hybrids

In the present work we report on the contribution of the coumarin moiety to tyrosinase inhibition. Coumarin-resveratrol hybrids 1-8 have been resynthesized to investigate the structure-activity relationships and the IC50 values of these compounds were measured. The results showed that these compounds exhibited tyrosinase inhibitory activity. Compound 3-(3’,4’,5’-trihydroxyphenyl)-6,8-dihydroxycoumarin (8) is the most potent compound (0.27 mM), more so than umbelliferone (0.42 mM), used as reference compound. The kinetic studies revealed that compound 8 caused non-competitive tyrosinase inhibition

Disease activity states, reasons for discontinuation and adverse events in 1038 Italian children with juvenile idiopathic arthritis treated with etanercept

The advent of biologic medications has increased considerably the potential for treatment benefit in juvenile idiopathic arthritis (JIA), with clinical remission being now achievable in a substantial proportion of patients. However, there is a need of data from the real world of clinical practice to evaluate thoroughly the efficacy and safety profile of the biologic agents currently approved

PREDICTION OF OPTIMAL WARFARIN MAINTENANCE DOSE USING ADVANCED ARTIFICIAL NEURAL NETWORKS

Introduction. The individual response to vitamin K antagonists (VKA) is highly variable, being influenced by clinical factors and genetic variants of enzymes that are involved in the metabolism of VKA (CYP2C)) and vitamin K (VKORC1). Currently, the dose of VKA is adjusted based on measurements of the prothrombin time. In the last years, mathematical algorithms were developed for estimating the appropriate VKA dose, based on different mathematical approaches working on clinical and genetic data. Artificial Neural Networks (ANN) are computerized algorithms resembling interactive processes of the human brain, which allow to study very complex non-linear phenomena like biological systems. Aim. To evaluate the performance of new generation ANN on a large data base of patients on chronic VKA treatment. Methods. Clinical and genetic data from 377 patients (186 m; 191 f) treated with a VKA (warfarin) average weekly maintenance dose (WMD) of 23.7 mg (11.5 SD) were used to create a dose algorithm. Forty-eight variables, including demographic, clinical and genetic data (5 CYP2C9 and 3 VKORC1 genetic variants) were entered into Twist\uae system, which can select fundamental variables during their evolution in search for the best predictive model. The final model, based on 23 variables expressed a functional approximation of the actual dose within a validation protocol based on a tripartite division of the data set (training, testing, validation). Results. In the validation cohort, the pharmacogenetic algorithm reached high accuracy, with an average absolute error of 5.7 mg WMD. In the subset of patients requiring 6421 mg (45 % of the cohort) and 21-49 mg (51 % of the cohort) the absolute error was 3.86 mg and 5.45 with a high percentage of subjects being correctly identified (72%, 74% respectively). Conclusion. ANN can be applied successfully for VKA maintenance dose prediction and represent a robust basis for a prospective multicentre clinical trial of the efficacy of genetically informed dose estimation for patients who require VKA

The vascular flora of the Marine Protected Area of "Capo Carbonara" (SE-Sardinia)

This study aims at presenting an updated inventory of the vascular flora of the Capo Carbonara Marine Protected Area, including the Sites of Community Importance “Isola dei Cavoli, Serpentara, Punta Molentis e Campulongu” and partially of “Costa di Cagliari”, in Sardinia (Italy). A total of 653 taxa are reported, 84% of which are native (5% endemics) and 16% non-native (10% neophytes, 6% archaeophytes). The native component includes 406 species, 135 subspecies, two variety and one hybrid, belonging to 75 families and 313 genera. The non-native taxa are 94 species, 13 subspecies, one variety and one hybrid, belonging to 40 families and 81 genera. Life-form analysis of native species revealed a prevalence of therophytes (49%) followed by hemicryptophytes (21%), geophytes (14%) and chamaephytes (7%). Therophytes (33%) fol lowed by phanerophytes (32%) are prevalent among the non-native taxa. Biogeographically, among native species, the Mediterranean element is largely prevailing (81%), mainly consisting of Circum-Mediterranean (39%) and Euro-Mediterranean (27%) taxa, while the American ele ment (35%) prevails over the Mediterranean species (29%) among the non-native taxa. Among endemics, the Sardo-Corsican taxa are dominant (55%), followed by Sardo-Corsican-Tuscan Archipelago (14%) and Sardinian (10%) taxa

Floristic Inventory and Diversity of Urban Green Spaces in the Municipality of Assemini (Sardinia, Italy)

Urban greenery is a key component of green infrastructure, contributing to environmental sustainability and urban well-being. Between 2019 and 2020, a comprehensive inventory of ornamental flora was conducted in Assemini (Sardinia, Italy), documenting 198 vascular plant taxa, including 155 exotic, 41 native, and 2 cryptogenic species from 65 families. Among the exotic species, most were neophytes (63%), and 14% were archaeophytes. In terms of life forms, scapose phanerophytes, with a tree-like growth habit, dominated (45%), while Mediterranean and American chorotypes were the most represented, each accounting for 21%. A total of 7356 plants were recorded, comprising trees (61.3%), shrubs (32.3%), and climbers (5.7%), belonging to 90 shrub, 89 tree, and 19 climber taxa. The highest number of plants was found in "Green Areas" and "Schools", which also exhibited the greatest biodiversity, with 136 different taxa each. The most planted species were Quercus ilex, Nerium oleander, and Olea europaea. The survey also identified 21 allergenic, 36 toxic, and 35 mechanically harmful species, primarily located in "Green Areas" and "Schools". Biodiversity analysis using the Shannon Index revealed significant diversity, with Fabaceae, Apocynaceae, and Fagaceae emerging as the most represented families. These findings highlight the importance of plant inventories in urban green space management for sustainable planning. Well-maintained green spaces can enhance ecological resilience, improve public health, and promote social cohesion in future urban developments

Seed germination report for Limonium merxmuelleri subsp. merxmuelleri (Plumbaginaceae)

The present report illustrates the first germination data of Limonium merxmuelleri subsp. merxmuelleri, a pioneer species of mine waste materials of Iglesiente region (South-West Sardinia). After harvesting, seeds were subjected to germination tests at the Sardinian Germplasm Bank (BG-SAR). The results show a high germination capability and germination rate at each tested temperature, with a slight germination reduction at the highest temperature (25°C) that simulates the aridity of the summer period

Using Mediterranean Native Plants for the Phytoremediation of Mining Sites: An Overview of the Past and Present, and Perspectives for the Future

Mining exploitation in the Mediterranean Basin has left evident scars on the environment, and poses serious risks for human health and biodiversity, especially when mine wastes are left abandoned. This review analysed the main issues of metal(loid)s pollution related to mine exploitation in the Mediterranean Basin. Here, a list of Mediterranean native plant species studied for phytoremediation is given and, considering their biological forms, vegetational types, and ecology, we categorised them into halotolerant and hydro/hygrophilous vegetation, annual and perennial meadows, garrigues and maquis, and high maquis and woods. The main conclusions of the review are as follows: (1) plant communities established on mine environments are often rich in endemic taxa which ensure a high biodiversity and landscape value, and can help in the psychophysical health of local inhabitants; (2) political and land management should take greater account of the use of native plants for the remediation of contaminated soils; (3) a multidisciplinary approach that includes, among others, studies on biochemical response to metal(loid)s as well as the application of innovative soil amendments gives better results; (4) phytoextraction applications require a detailed recovery plan that takes into consideration several issues, including the negative influence on biodiversity due to extensive use of monotypic plantations, disposal of harvested hazardous plants, and the risk of phytoextracts entering the food chain; and (5) more studies are necessary to increase knowledge and to detect suitable species—especially halophytic ones—for phytoremediation purposes