Background: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. Methods: The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Gr...

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2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.

Acute kidney injury (AKI) is a complex disorder for which currently there is no accepted definition. Having a uniform standard for diagnosing and classifying AKI would enhance our ability to manage these patients. Future clinical and translational research in AKI will require collaborative networks of investigators drawn from various disciplines, dissemination of information via multidisciplinary joint conferences and publications, and improved translation of knowledge from pre-clinical research. We describe an initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI. Members representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI participated in a two day conference in Amsterdam, The Netherlands, in September 2005 and were assigned to one of three workgroups. Each group's discussions formed the basis for draft recommendations that were later refined and improved during discussion with the larger group. Dissenting opinions were also noted. The final draft recommendations were circulated to all participants and subsequently agreed upon as the consensus recommendations for this report. Participating societies endorsed the recommendations and agreed to help disseminate the results. The term AKI is proposed to represent the entire spectrum of acute renal failure. Diagnostic criteria for AKI are proposed based on acute alterations in serum creatinine or urine output. A staging system for AKI which reflects quantitative changes in serum creatinine and urine output has been developed. We describe the formation of a multidisciplinary collaborative network focused on AKI. We have proposed uniform standards for diagnosing and classifying AKI which will need to be validated in future studies. The Acute Kidney Injury Network offers a mechanism for proceeding with efforts to improve patient outcomes.

Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Allergic rhinitis is a symptomatic disorder of the nose induced after allergen exposure by an IgE-mediated inflammation of the membranes lining the nose. It is a global health problem that causes major illness and disability worldwide. Over 600 million patients from all countries, all ethnic groups and of all ages suffer from allergic rhinitis. It affects social life, sleep, school and work and its economic impact is substantial. Risk factors for allergic rhinitis are well identified. Indoor and outdoor allergens as well as occupational agents cause rhinitis and other allergic diseases. The role of indoor and outdoor pollution is probably very important, but has yet to be fully understood both for the occurrence of the disease and its manifestations.

In 1999, during the Allergic Rhinitis and its Impact on Asthma (ARIA) WHO workshop, the expert panel proposed a new classification for allergic rhinitis which was subdivided into 'intermittent' or 'persistent' disease.

This classification is now validated. The diagnosis of allergic rhinitis is often quite easy, but in some cases it may cause problems and many patients are still under-diagnosed, often because they do not perceive the symptoms of rhinitis as a disease impairing their social life, school and work.

The management of allergic rhinitis is well established and the ARIA expert panel based its recommendations on evidence using an extensive review of the literature available up to December 1999. The statements of evidence for the development of these guidelines followed WHO rules and were based on those of Shekelle et al. A large number of papers have been published since 2000 and are extensively reviewed in the 2008 Update using the same evidence-based system. Recommendations for the management of allergic rhinitis are similar in both the ARIA workshop report and the 2008 Update. In the future, the GRADE approach will be used, but is not yet available.

Another important aspect of the ARIA guidelines was to consider co-morbidities. Both allergic rhinitis and asthma are systemic inflammatory conditions and often co-exist in the same patients. In the 2008 Update, these links have been confirmed.

The ARIA document is not intended to be a standard-of-care document for individual countries. It is provided as a basis for physicians, health care professionals and organizations involved in the treatment of allergic rhinitis and asthma in various countries to facilitate the development of relevant local standard-of-care documents for patients.

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Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)

Importance The coronavirus disease 2019 (COVID-19) pandemic, due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a worldwide sudden and substantial increase in hospitalizations for pneumonia with multiorgan disease. This review discusses current evidence regarding the pathophysiology, transmission, diagnosis, and management of COVID-19. Observations SARS-CoV-2 is spread primarily via respiratory droplets during close face-to-face contact. Infection can be spread by asymptomatic, presymptomatic, and symptomatic carriers. The average time from exposure to symptom onset is 5 days, and 97.5% of people who develop symptoms do so within 11.5 days. The most common symptoms are fever, dry cough, and shortness of breath. Radiographic and laboratory abnormalities, such as lymphopenia and elevated lactate dehydrogenase, are common, but nonspecific. Diagnosis is made by detection of SARS-CoV-2 via reverse transcription polymerase chain reaction testing, although false-negative test results may occur in up to 20% to 67% of patients; however, this is dependent on the quality and timing of testing. Manifestations of COVID-19 include asymptomatic carriers and fulminant disease characterized by sepsis and acute respiratory failure. Approximately 5% of patients with COVID-19, and 20% of those hospitalized, experience severe symptoms necessitating intensive care. More than 75% of patients hospitalized with COVID-19 require supplemental oxygen. Treatment for individuals with COVID-19 includes best practices for supportive management of acute hypoxic respiratory failure. Emerging data indicate that dexamethasone therapy reduces 28-day mortality in patients requiring supplemental oxygen compared with usual care (21.6% vs 24.6%; age-adjusted rate ratio, 0.83 [95% CI, 0.74-0.92]) and that remdesivir improves time to recovery (hospital discharge or no supplemental oxygen requirement) from 15 to 11 days. In a randomized trial of 103 patients with COVID-19, convalescent plasma did not shorten time to recovery. Ongoing trials are testing antiviral therapies, immune modulators, and anticoagulants. The case-fatality rate for COVID-19 varies markedly by age, ranging from 0.3 deaths per 1000 cases among patients aged 5 to 17 years to 304.9 deaths per 1000 cases among patients aged 85 years or older in the US. Among patients hospitalized in the intensive care unit, the case fatality is up to 40%. At least 120 SARS-CoV-2 vaccines are under development. Until an effective vaccine is available, the primary methods to reduce spread are face masks, social distancing, and contact tracing. Monoclonal antibodies and hyperimmune globulin may provide additional preventive strategies. Conclusions and Relevance As of July 1, 2020, more than 10 million people worldwide had been infected with SARS-CoV-2. Many aspects of transmission, infection, and treatment remain unclear. Advances in prevention and effective management of COVID-19 will require basic and clinical investigation and public health and clinical interventions.

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Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review.

The current invention concerns galectin-1 binding peptide, preferably linked to a tracer or contrast agent suitable for being used in a medical imaging methodology and therapeutic use.

Galectin-1 binding peptides and use thereof for diagnostic and therapeutic purpose

In Reference to Quantitative Analysis of Syndecan-1 Expression in Dysplasia and Squamous Cell Carcinoma of the Oral Cavity. Authors' reply

How Could Technology Revolutionize the Management of Laryngopharyngeal Reflux

The authors are thankful for the very interesting comments about our article entitled “impact of age on laryngopharyngeal reflux disease presentation: a multi-center prospective study” [1] in the letter to the editor entitled “laryngopharyngeal reflux disease in the elderly”. We wish briefly to reply to the questions raised by the author of the letter. The author rightly suggested the existence of many conditions or cofactors able to bias the presentation of signs, symptoms, and voice quality evaluations at baseline and throughout proton pump inhibitors (PPIs) trial in elderly patients with laryngopharyngeal reflux (LPR). The first cofactor reported by the author concerns hoarseness caused by localized ischemia and cerebral infarction, which can cause vagitis and hoarseness. According to recent review of the literature, clinical presentations of patients with small infarct(s) mainly include, in decreasing order of frequency, pure motor stroke (50–66%), pure sensory stroke, sensorimotor stroke, ataxic hemiparesis, and dysarthria with motor impediment of one hand [2]. Naturally, hoarseness related to ischemia or cerebral infarction may be part of these clinical presentations but, in most cases, the neurological picture is associated with other neurological signs and symptoms. To conduct our study, the first author (JRL) performed precise anamnesis, clinical examination (ear, nose, and throat, and, if necessary, general examination) and assessment of many exclusion criteria. Precisely, as described in another publication [3], patients were excluded of our study if they met the following conditions: neurological disease affecting voice, psychiatric illness, upper respiratory tract infection within the last month, an antacid treatment already started (i.e., PPI(s), gastroprokinetic, or antihistamine), previous history of cervical surgery or radiotherapy, laryngeal trauma, vocal cord paralysis/paresis, benign vocal fold lesions, pharyngolaryngeal malignancy, seasonal allergies, asthma, chronic obstructive pulmonary disease, PPI hypersensitivity, untreated thyroid disease, prior antireflux surgery, or chemical exposure causing laryngitis. Moreover, active smokers, alcoholics, and pregnant and lactating women were also excluded. With strict application of these exclusion criteria, we aimed to have the “purest” population of LPR subjects. Thus, our patients did not have the other cofactors presented by the author to be able to bias the evaluations (i.e. respiratory tract disease, uncontrolled diabetes, active allergy, or psychiatric disorder). In other words, the implementation of these exclusion criteria led us to exclude a lot of patients where we had a doubt concerning the cause of laryngeal symptoms. The methodology of our study and the comments of the author highlight the difficulty to make the LPR diagnosis. As suggested by the author, and regarding the lack of gold standard for the LPR diagnosis, we think that the best way to select LPR patients involves the evaluation of both signs and symptoms, and the exclusion of a maximum of cofactors able to bias the clinical presentation of LPR. That is why we only had 80 patients in this multi-center trial because LPR diagnosis was only confirmed in these patients regarding the response to PPIs trial or according to positive result of pH impedance metry. Indeed, we prefer to make the LPR diagnosis with empirical therapeutic trial (PPIs), which, combined with adequate exclusion criteria, is quite competitive than pH impedance metry [4]. However, This reply refers to the comment available at https://doi. org/10.1007/s00405-017-4802-6.

Reply to the letter "Laryngopharyngeal reflux disease in the elderly".

1. Riestra-Ayora J, Yanes-Diaz J, Penuelas O, Molina-Quiros C, Sanz-Fernández R, Martin-Sanz E. Safety and prognosis in percutaneous vs surgical tracheostomy in 27 patients with COVID19 [published online May 26, 2020]. Otolaryngol Head Neck Surg. doi:10.1177/0194599820931801 2. McGrath BA, Brenner MJ, Warrillow SJ, et al. Tracheostomy in the COVID-19 era: global and multidisciplinary guidance [published online May 15, 2020]. Lancet Respir Med. doi:10.1016/ S2213-2600(20)30230-7 3. Michetti CP, Burlew CC, Bulger EM, Davis KA, Spain DA. Performing tracheostomy during the Covid-19 pandemic: guidance and recommendations from the Critical Care and Acute Care Surgery Committees of the American Association for the Surgery of Trauma. Trauma Surg Acute Care Open 2020;5(1): e000482. doi:10.1136/tsaco-2020-000482 4. Takhar A, Walker A, Tricklebank S, et al. Recommendation of a practical guideline for safe tracheostomy during the COVID19 pandemic. Eur Arch Otorhinolaryngol. 2020;1–12. doi:10. 1007/s00405-020-05993-x

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Papers

Galectin-1 binding peptides and use thereof for diagnostic and therapeutic purpose

In Reference to Quantitative Analysis of Syndecan-1 Expression in Dysplasia and Squamous Cell Carcinoma of the Oral Cavity. Authors' reply

How Could Technology Revolutionize the Management of Laryngopharyngeal Reflux

Reply to the letter "Laryngopharyngeal reflux disease in the elderly".

The Association Between Reflux and Laryngeal Neoplasia Is Still Not Demonstrated.