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Objective: Large somatotrophic adenomas depict poor response to somatostatin receptor ligands (SRLs). Debulking has shown to enhance SRLs effect in some but not all cases and tumour volume reduction has been proposed as the main predictor of response. No biological studies have been performed so far in this matter. We aimed to identify molecular markers of response to SRLs after surgical debulking in GH‐secreting adenomas. Design: We performed a multicenter retrospective study. Patients: 24 patients bearing large GH‐producing tumours. Measurements: Clinical data and SRLs response both before and after surgical debulking were collected, and 21 molecular biomarkers of SRLs response were studied in tumour samples by gene expression. Results: From the 21 molecular markers studied, only two of them predicted enhanced SRLs response after surgery. Tumours with improved response to SRLs after surgical debulking showed lower levels of Ki‐67 (MKI67, FC = 0.17 and P =.008) and higher levels of RAR‐related orphan receptor C (RORC) (FC = 3.1 and P ˂.001). When a cut‐off of no detectable expression was used for Ki‐67, the model provided a sensitivity of 100% and a specificity of 52.6% with an area under the curve of 65.8%. Using a cut‐off of 2 units of relative expression of RORC, the prediction model showed 100% of sensitivity and specificity. Conclusions: High levels of RORC and low levels of Ki‐67 identify improved SRLs response after surgical debulking in large somatotropic adenomas. To determine their expression would facilitate medical treatment decision‐making after surgery. [ABSTRACT FROM AUTHOR]

In Physics, many quantities are vectors, and their use requires typical operations such as addition, subtraction, scalar multiplication, scalar product (dot product), vector product (cross product), and scalar triple product. This is a very basic topic in all General Physics courses for Engineering degrees. However, we have detected that some students lack a deep understanding of vector operations and their properties. In this study, we present a virtual laboratory (developed using the tool "Easy Java Simulations") for the study and understanding of these topics. The user can introduce the components of the input vectors and gets a three‐dimensional representation, which can be scaled and rotated for better visualization. Any of the aforementioned operations can be selected, and the result is shown both numerically and graphically. The user can also modify any represented vector. In this way, the virtual lab provides a real‐time visualization of how the change affects the result. The possibility of limiting the changes to either magnitude or direction is also included. The efficiency of the virtual laboratory has been tested analyzing the results obtained in two groups of students (virtual laboratory vs traditional resources). A satisfaction survey has been also carried out. [ABSTRACT FROM AUTHOR]

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Background Pegvisomant is an effective treatment for acromegaly. Objective To investigate escape (loss of biochemical control in patients previously controlled) and lipodystrophy in acromegalic patients treated with pegvisomant and to evaluate possible associations with clinical features. Patients and methods Multicentre retrospective study involving 19 Spanish centres. Results Ninety-seven patients were included (59% women, mean age at diagnosis 42 ± 13 years, 80% macroadenomas); mean follow-up on pegvisomant was 5 ± 2·5 years, and 89 (92%) achieved normal IGF-1. Escape was reported in 30/89 (34%) of responders, after a mean treatment duration of 25 ± 21 months. The mean initial dose of pegvisomant was 11 ± 5 mg/day, and mean dose at escape was 14 ± 7 mg/day. Most patients (26/30, 87%) achieved control with dose increase (57%), additional medical treatment (3%) or both (27%). Mean new dose that controlled IGF-1 after escape was 20 ± 7 mg/day. Treatments associated were somatostatin analogues ( SSA in 47%), cabergoline ( CAB in 47%) and both (6%). Lipodystrophy was observed in 15 patients (13 females), mild in six, moderate in six, severe in three and persistent in four. Among patients with lipodystrophy, three escaped and three were nonresponders to pegvisomant. Four patients discontinued the drug, and four had dose reductions because of lipodystrophy. It tended to be more frequent in females ( P = 0·06) and in patients treated with triple association SSA+ CAB+ PEG ( P = 0·018). No relationship between escape and clinical variables was found, except prior CAB ( P = 0·04) and metformin treatment (0·02) and grade of lipodystrophy ( P = 0·02). Conclusions A significant proportion of patients treated with pegvisomant escaped (34%); however, the majority (87%) was easily controlled with either dose increase, further medical treatment or both. Lipodystrophy developed in 15%, mostly females, and influenced the response to treatment. [ABSTRACT FROM AUTHOR]

Objective/Hypothesis Fine-needle aspiration biopsy is the most accurate diagnostic test for thyroid nodules, its only limitation being the diagnosis of follicular neoplasm that does not distinguish between benign and malignant follicular lesions. Study Design To determine the utility of intraoperative frozen-section analysis in cases of a cytological diagnosis of follicular neoplasm, a retrospective review of 66 patients with a solitary thyroid nodule and follicular neoplasm who underwent thyroid surgery was carried out. Methods Fine-needle aspiration was classified following the Papanicolaou Society of Cytopathology Classification, and frozen section was defined as malignant or 'deferred.' If a malignant diagnosis was made by frozen-section analysis, a total thyroidectomy was carried out. The extension of thyroid surgery in the deferred cases was based on the definitive histological diagnosis. Results Sixty-four cases were classified as deferred, and two as suspect for malignancy. Among the 64 deferred cases, 15 were malignant in the final pathological findings, and 49 were benign. The two suspect cases were papillary carcinoma. Frozen-section analysis classified 2 of 17 (11.7%) cases as follicular variant of papillary carcinoma that could not be diagnosed by cytological study. However, these two cases had a strong clinical evidence of malignancy. Conclusion The routine use of frozen-section analysis is useless in cases of cytological diagnosis of follicular neoplasm on fine-needle aspiration biopsy, because of the low probability of achieving the diagnosis of follicular carcinoma and the inability to provide additional information apart from the clinical and the cytological data. [ABSTRACT FROM AUTHOR]

OBJECTIVEPostpartum has been considered as a period of risk for developing postpartum depression (PD) by some but not all authors, and this PD has been linked with postpartum thyroid dysfunction (PPTD). The major aim of this study was to evaluate the relation between the presence of PPTD and PD. DESIGN and PATIENTSSix hundred and forty-one healthy Caucasian women recruited between their 36th week of pregnancy and fourth day postpartum underwent clinical and laboratory evaluation and were checked again at 1 (n = 605), 3 (n = 552), 6 (n = 574), 9 (n = 431), and 12 (n = 444) months postpartum. MEASUREMENTSAt baseline and at each clinical evaluation, Beck Depression Inventory (BDI) was administered to screen PD. The definitive diagnoses of PD was performed by a psychiatrist according to the DSM-III-R criteria. At each visit, we determined serum free T4 and TSH concentrations. Thyroperoxidase and thyroglobulin antibodies were determined only in patients with abnormal hormone concentrations. Postpartum thyroiditis (PPT) was considered to be present in women with overt or subclinical transient hyperthyroidism between 1 and 3 months postpartum and/or overt or subclinical hypothyroidism between 3 and 6 months postpartum. RESULTSFifty-six women developed postpartum thyroid dysfunction (PPTD), corresponding to an incidence rate of 11%: 45 with PPT [incidence rate 7·8%; confidence interval (CI) 5·6–10%], eight with Graves' disease (incidence rate 1·5%; CI 0·5–2·5%) and three with nonpalpable toxic thyroid adenoma (incidence rate 0·5%; CI 0–1·5%). Five hundred and eighty of the evaluated women (incidence rate 90·5%; CI 95% 88·2–92·8) presented BDI scores below 21 and therefore the PD diagnoses was excluded. In 50 cases (incidence rate 7·8%; CI 95% 5·7–9·8), we detected a BDI score over 21 in some evaluations, but the PD diagnosis was not confirmed. Another 11 (incidence rate 1·7%; CI 95% 0·7–2·7) were diagnosed as having PD and required psychiatric treatment. None of the PPTD was diagnosed as having PD. The BDI scores frequency over 21 was similar between healthy women and those with PPTD. Patients with a previous history of depression developed PD more often (P < 0·0001). One hundred and ninety women breast fed their babies for more than 2 months, without observing a higher PD rate or BDI scores over 21 (P = 0·5). CONCLUSIONSWe found a general PD incidence rate of 1·7% in our group of patients. This figure is not higher in women with hormone abnormalities caused by PPTD. Women with a past history of depression present a higher risk of PD while those who breast fed did not have an increased risk. [ABSTRACT FROM AUTHOR]