Mortar is of fundamental importance for the building technology. It is used to bind together masonry units and ease the building process. Several building techniques evolved to take advantage of the ...capacity of mortars to improve cohesiveness and form sound structures. In this paper, I discuss how lime and gypsum mortars were employed from the Antiquity to the Middle Ages. Gypsum mortars offered several advantages due to their adhesive properties and quick setting. Their use as a structural binding agent developed in regions rich in gypsum, and was particularly significant in vault construction. Lime mortars offered different advantages over gypsum ones, particularly in terms of mechanical resistance and resilience to humid conditions. The massive use of lime mortars started with the ancient Romans and continued throughout the centuries as the foremost binding material, until the introduction of Portland cement mortars in the nineteenth century.
Context:
TSH is the main factor involved in the control of proliferation of thyrocytes. Recently, a strong relationship between serum TSH and risk of thyroid malignancy has been reported.
Objectives:
...The aim was to review published papers about the relationship between serum TSH and frequency of differentiated thyroid cancer.
Evidence Acquisition:
PubMed was used to identify studies focused on the relationship between TSH and differentiated thyroid cancer.
Evidence Synthesis:
In patients with nodular thyroid disease, the risk of thyroid malignancy increases with serum TSH, and even within normal ranges, higher TSH values are associated with a higher frequency and more advanced stage of thyroid cancer. The likelihood of papillary thyroid carcinoma is reduced when TSH is lower, as in thyroid autonomy, and increased when TSH is higher, as in thyroid autoimmunity. Treatment with l-thyroxine (LT4), which reduces serum TSH, is associated with significantly lower risk of developing clinically detectable thyroid cancer.
Conclusions:
TSH plays a key role in the development of clinically detectable thyroid cancer, and LT4 treatment reduces the risk of thyroid malignancy in patients with nodular thyroid disease. According to the guidelines of the main scientific societies, LT4 therapy is not currently recommended for the treatment of patients with nodular goiter. Even if the available data are not sufficient to advise LT4 treatment in all patients with nodular goiter with the aim of reducing the risk of papillary thyroid carcinoma, we propose that this indication should be reconsidered, taking into account recent evidence reported in the literature.
Thyroid nodules are common in iodine deficient areas, in females, and in patients undergoing neck irradiation. High-resolution ultrasonography (US) is important for detecting and evaluating thyroid ...nodules. US is used to determine the size and features of thyroid nodules, as well as the presence of neck lymph node metastasis. It also facilitates guided fine-needle aspiration (US-FNA). The most consistent US malignancy features of thyroid nodules are spiculated margins, microcalcifications, a taller-than-wide shape, and marked hypoechogenicity. Increased nodular vascularization is not identified as a predictor of malignancy. Thyroid elastosonography (USE) is also used to characterize thyroid nodules. In fact, a low elasticity of nodules at USE has been related to a higher risk of malignancy. According to their US features, thyroid nodules can be stratified into three categories: low-, intermediate-, and high-risk nodules. US-FNA is suggested for intermediate and high-risk nodules.
Anaplastic thyroid carcinoma (ATC) is a rare malignancy, accounting for 1-2% of all thyroid cancers. Although rare, ATC accounts for the majority of deaths from thyroid carcinoma. ATC often ...originates in a pre-existing thyroid cancer lesion, as suggested by the simultaneous presence of areas of differentiated or poorly differentiated thyroid carcinoma. ATC is characterized by the accumulation of several oncogenic alterations, and studies have shown that an increased number of oncogenic alterations equates to an increased level of dedifferentiation and aggressiveness. The clinical management of ATC requires a multidisciplinary approach; according to recent American Thyroid Association guidelines, surgery, radiotherapy and/or chemotherapy should be considered. In addition to conventional therapies, novel molecular targeted therapies are the most promising emerging treatment modalities. These drugs are often multiple receptor tyrosine kinase inhibitors, several of which have been tested in clinical trials with encouraging results so far. Accordingly, clinical trials are ongoing to evaluate the safety, efficacy and effectiveness of these new agents. This Review describes the updated clinical and pathological features of ATC and provides insight into the molecular biology of this disease. The most recent literature regarding conventional, newly available and future therapies for ATC is also discussed.
Abstract
Context
The dramatic rise in the incidence of thyroid cancer over the last 30 years is largely attributable to the increasing diagnosis of papillary microcarcinomas (mPTCs). Current ...guidelines endorse an observational management approach in properly selected cases.
Objective
To evaluate the feasibility of active surveillance in mPTC in Italy, its impact on real life, and to identify risk factors of progression.
Design and setting
In 2014 we started a prospective–observational study of active surveillance in mPTC patients.
Patients
Included patients demonstrated a single Thy4 or Thy5 thyroid nodule, with largest diameter ≤1.3 cm, and no suspicious laterocervical lymph nodes by neck ultrasonography. Of 185 eligible subjects, 50.3% (93/185) enrolled in the observational management protocol while the others opted for surgery and were excluded from this analysis.
Intervention
Enrolled patients were followed with neck ultrasound at 6- to 12-month intervals. Disease progression was defined as the appearance of abnormal lymph nodes or nodule enlargement during follow-up. In these cases, patients were directed to surgery.
Results
Three patients (3/93, 3%) showed clinical progression and required surgery. Another 19 patients (19/93, 20%) decided to transition to surgical intervention even though there was no evidence of disease progression. All operated patients had excellent response to initial treatment despite the delayed surgery.
Conclusions
Within an Italian medical context, active surveillance appears to be a feasible and safe alternative to immediate surgery in healthy mPTC patients. Only 3% of mPTC demonstrated disease progression during a median follow-up of 19 months (range 6–54) and importantly demonstrated excellent outcomes after surgical intervention in a short-term follow-up.
El artículo analiza una consolidación antigua en una pared de la gran terma en Iasos de Caria. El análisis se basa en la observación del uso inusual de elementos de hierro, insertados abundantemente ...en las juntas de una pared del caldarium. La inspección y estudio de las características constructivas del muro permitieron identificar un deterioro del revestimiento. Este último, formado por grandes y pesados bloques apenas esbozados y no unidos al núcleo del muro, se desprendió quizás por efecto de un terremoto. El uso de la cuña de hierro para crear contraste entre las piedras de un paramento constituía una solución óptima para consolidar la mampostería sin tener que desmontar todo el revestimiento.
it L’articolo analizza un consolidamento antico su una parete delle grandi terme a Iasos di Caria. L’analisi si basa sull’osservazione dell’impiego inconsueto di elementi di ferro, inseriti in abbondanza nei giunti di una parete del caldarium. Il rilievo e lo studio delle caratteristiche costruttive del muro hanno condotto all’identificazione di un dissesto del paramento. Quest’ultimo, formato da grandi e pesanti blocchi appena sbozzati e non ammorsati al nucleo della muratura in conglomerato, si distaccò forse per effetto di un terremoto. L’impiego di zeppe di ferro per creare contrasto tra le pietre di un paramento dissestato, costituiva una soluzione ottimale per consolidare la muratura senza dover smontare l’intero paramento.
Thyroid ultrasound (US) features associated with malignancy in thyroid nodules are microcalcifications, hypoechogenicity, irregular margins or absent halo sign, solid aspect, intranodular ...vascularization, and shape (taller than wide).These patterns, taken singly, are poorly predictive. When they are simultaneously present the specificity increases at the expense of sensitivity. US elastography (USE) is a powerful new diagnostic tool that assesses hardness as an indicator of malignancy in thyroid nodules. USE has high specificity and sensitivity independent of the nodule size, and this predictive value is maintained in follicular lesions. Available data suggest that USE is the best available non-invasive tool comparable to fine-needle aspiration (FNA) for the evaluation of thyroid nodules, provided that the nodule is solid and devoid of coarse calcifications. Thus, conventional US retains its importance for selecting nodules in which USE is predictive. In conclusion, USE has great potential as a new tool for the diagnosis of thyroid cancer, especially in nodules with indeterminate cytology.
Purpose
To evaluate the risk of mass enlargement and endocrine function modification in patients with adrenal incidentaloma (AI).
Methods
In this retrospective study, we examined clinical and ...hormonal characteristics of 310 patients with AI (200 females and 110 males; age: 58.3 ± 12.9 years), followed up for a median (interquartile range) of 31.4 months (13.0–78.6) and evaluated for possible modification in adrenal mass size and hormonal function. The hormonal evaluation included morning serum cortisol and plasma ACTH at 8 a.m., aldosterone, plasma renin activity/direct renin concentration, and 24-h urine metanephrines/normetanephrines. One microgram overnight dexamethasone suppression test (DST) was performed. Autonomous cortisol secretion (ACS) was diagnosed in the presence of cortisol after 1 mg DST > 5 μg/dl (138 nmol/l) or >1.8 and ≤5 μg/dl (50–138 nmol/l) and at least one of the following: (i) low ACTH; (ii) increased 24-h urinary-free cortisol; (iii) absence of cortisol rhythm; and (iv) post-LDDST cortisol level > 1.8 μg/dl (50 nmol/l). When there was no biochemical evidence of adrenal hormonal hyperactivity, AIs were classified as nonfunctioning (NFAIs). The mass was considered significantly enlarged when the size increase was more than 20% and at least 5 mm compared to baseline.
Results
At diagnosis, NFAIs were found in 209 patients, while ACS and overt adrenal hyperfunction were diagnosed in 81 and 20 patients, respectively. During follow-up, 3.3% and 1.5% of patients with NFAI developed subtle and overt endocrine hyperfunction, respectively, while a significant mass enlargement was observed in 17.7% of all AIs. The risk of developing ACS was significantly higher in patients with adenoma >28 mm (hazard ratio HR 12.4; 95% confidence interval CI, 2.33–66.52,
P
= 0.003), in those with bilateral adrenal tumors (HR: 5.36; 95% CI, 1.17–24.48,
P
= 0.030), and with low/suppressed ACTH values (HR: 11.2, 95% CI 2.06–60.77;
P
= 0.005). The risk of mass enlargement was lower for patients in the fourth quartile of body mass index than those in the first quartile (HR 0.33; 95% CI, 0.14–0.78;
P
= 0.012).
Conclusions
In patients with AI, the risk of developing hormonal hyperfunction and mass enlargement is overall low, although some tumor characteristics and anthropometric features might increase this risk. Taking account of all these aspects is important for planning a tailored follow-up in AI patients.
A recent clinical trial has shown a beneficial effect of the antioxidant agent selenium in Graves' orbitopathy (GO). In order to shed light on the cellular mechanisms on which selenium may act, this ...study investigated its effects in cultured orbital fibroblasts.
Primary cultures of orbital fibroblasts from six GO patients and six control subjects were established. Cells were treated with H
O
to induce oxidative stress, after pre-incubation with selenium-(methyl)selenocysteine (SeMCys). The following assays were performed: glutathione disulfide (GSSG), as a measure of oxidative stress, glutathione peroxidase (GPX) activity, cell proliferation, hyaluronic acid (HA), and pro-inflammatory cytokines.
H
O
induced an increase in cell GSSG and fibroblast proliferation, which were reduced by SeMCys. Incubation of H
O
-treated cells with SeMCys was followed by an increase in glutathione peroxidase activity, one of the antioxidant enzymes into which selenium is incorporated. At the concentrations used (5 μM), H
O
did not significantly affect HA release, but it was reduced by SeMCys. H
O
determined an increase in endogenous cytokines involved in the response to oxidative stress and GO pathogenesis, namely tumor necrosis factor alpha, interleukin 1 beta, and interferon gamma. The increases in tumor necrosis factor alpha and interferon gamma were blocked by SeMCys. While the effects of SeMCys on oxidative stress and cytokines were similar in GO and control fibroblasts, they were exclusive to GO fibroblasts in terms of inhibiting proliferation and HA secretion.
Selenium, in the form of SeMCys, abolishes some of the effects of oxidative stress in orbital fibroblasts, namely increased proliferation and secretion of pro-inflammatory cytokines. SeMCys reduces HA release in GO fibroblasts in a manner that seems at least in part independent from H
O
-induced oxidative stress. Some effects of SeMCys are specific for GO fibroblasts. These findings reveal some cellular mechanisms by which selenium may act in patients with GO.
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