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Petah Tikva, Israel

Srbova L.,The Institute of Endocrinology | Gabalec F.,University of Hradec Kralove | Ryska A.,University of Hradec Kralove | Cap J.,University of Hradec Kralove
Cytopathology | Year: 2015

Objectives: To retrospectively reclassify the results of fine needle aspiration (FNA) cytology at our institution according to the Bethesda system for reporting thyroid cytopathology (TBSRTC), and to determine whether the introduction of the new classification system would have influenced the diagnostic accuracy compared with our existing system in which suspicious/indeterminate categories (categories III-IV) are managed according to clinical findings and cytopathologists' recommendations. Methods: FNAs performed under ultrasound guidance between 2001 and 2012, and subsequently verified by histology or repeat FNA and follow-up, were reviewed and retrospectively reclassified according to TBSRTC. Results: Among a total of 1310 histologically verified FNAs, the positive predictive values (%) for malignancy and neoplasia (carcinoma + follicular adenomas) for category I-VI according to the TBSRTC were 5.7/11.3, 2.6/5.5, 14.4/34.2, 23.6/55.0, 57.0/64.5 and 92.2/94.2, respectively. Although all the categories predict malignancy closely, the difference in malignancy rate between categories III and IV was not statistically significant; however, the difference in total neoplasia rate reached statistical significance. When patients with cytological and clinical follow-up were included, the malignancy rated dropped in category I to 2.4%, whereas, in category III, it remained at 13%. Repeat FNA instead of direct surgery spared half of the patients from surgery. The cytopathologists' recommendations for histological verification in category III were associated with an insignificant increase in malignancy rate, but the total neoplasia rate reached 57.5%. Conclusions: At our institution, the application of the TBSRTC did not improve the diagnostic accuracy for the detection of malignancy compared with current practice. In selected cases with cytological results falling into category III (according to clinical data and cytopathologists' opinions), direct lobectomy seems to be justified. © 2014 John Wiley & Sons Ltd. Source


Shapiro H.,The Institute for Nutrition Research | Tehilla M.,The Institute for Nutrition Research | Attal-Singer J.,The Institute of Endocrinology | Attal-Singer J.,Tel Aviv University | And 4 more authors.
Clinical Nutrition | Year: 2011

Objectives: The pharmacologic approach to disease management has not (as of yet) demonstrated safety and efficacy in nonalcoholic fatty liver disease (NAFLD). The current article introduces the long-chain omega-3 polyunsaturated fatty acids (LC-ω3s), and reviews the evidence and mechanisms by which their increased intake or supplementation may ameliorate NAFLD. Methods: A literature search was performed through Ovid Medline, using such terms as NAFLD, NASH, nonalcoholic, steatosis, polyunsaturated fatty acids, fish oil and omega-3. Results: The LC-ω3s display pleiotropic properties that are of benefit in cardiovascular disease. Deficiency of omega-3 fatty acids results in hepatic steatosis, whereas fish oil displays powerful hypotriglyceridemic properties. Intake and/or metabolism of omega-3 fatty acids are commonly impaired in NAFLD patients. A number of pre-clinical and clinical studies have demonstrated an ameliorative effect of supplemental fish oil, seal oil and purified LC-ω3s in reducing hepatic lipid content in NAFLD. There is less evidence that hepatic inflammation and fibrosis are safely reduced by LC-ω3s. Conclusions: Supplementation of LC-ω3s appears to safely reduce nutritional hepatic steatosis in adults. Whether other histopatholgic features of NAFLD also respond to LC-ω3s is being addressed by clinical trials. Any recommendation for omega-3 supplementation in NAFLD/NASH is contingent on these results. © 2010 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. Source


Ish-Shalom M.,The Institute of Endocrinology | Ish-Shalom M.,Tel Aviv University | Sack J.,The Institute of Endocrinology | Sack J.,Tel Aviv University | And 18 more authors.
Journal of Atherosclerosis and Thrombosis | Year: 2012

Aims: To determine whether low-dose calcitriol attenuates atherosclerosis in apoE-null mice and, if so, through which predominant mechanism. Methods: Starting at the age of 6 weeks, mice received intraperitoneal injections of either 0.25 ng/g body weight of calcitriol or the vehicle, every other day for 8 weeks. Results: Calcitriol treatment resulted in 35% reduction of atherosclerosis at the aortic sinus, and in a significant decrease in blood pressure. These effects were possibly mediated by downregulation of the renin-angiotensin system (RAS), as there was a 64% decrease in the aortic level of renin mRNA. None of the other components of the RAS or the prorenin receptor were affected by treatment. Lowdose calcitriol treatment did not modify the plasma level of monocyte chemoattractant protein-1, interferon γ, interleukin-4 and interleukin-10, which were similar in control and treated mice. Likewise, there was no difference in the percentage of splenic Foxp3 + regulatory T cells. Calcitriol treatment resulted in an unfavorable metabolic profile (glucose and lipids), as determined after a limited fast, a difference that disappeared after food was withheld for a longer time. Conclusions: At a relatively low dosage, calcitriol attenuates the development of atherosclerosis in apoE-null mice, most probably by down regulation of RAS, and not through immunomodulation; however, even at this low dose, calcitriol appears to elevate calcium and to have potentially adverse metabolic effects. Exploring the potential antiatherogenic effects of non-calcemic and safer analogues is therefore warranted. Source

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