Significance of Size of Lymph Node Metastasis on Postsurgical Stimulated Thyroglobulin Levels After Prophylactic Unilateral Central Neck Dissection in Papillary Thyroid Carcinoma

Background

The prognostic significance of size of central lymph node metastasis (CLNM) in papillary thyroid carcinoma (PTC) remains unknown. Because postsurgical detectable stimulated thyroglobulin (DsTg) after radioiodine ablation may imply persistent or recurrent disease, we evaluated the association between size of CLNM and rate of DsTg in patients with PTC who underwent unilateral prophylactic central neck dissection.

Methods

To be eligible for analysis, the prophylactic central neck dissection specimen with <3 central lymph nodes (CLNs) or size of CLNM ??1?cm as measured under the microscope was excluded. Of 132 specimens, 89 (67.4?%) were eligible. Forty patients (44.9?%) had no metastasis or pN0, 20 (22.5?%) had micrometastasis (<2?mm) or pN1mic and 29 (32.6?%) had macrometastasis (??2?mm) or pN1mac. Postablation sTg level was measured 9?months after surgery. A multivariable analysis was conducted to identify independent factors for postablation DsTg.

Results

Larger-sized CLNM correlated significantly with younger age (p?=?0.028), greater number of CLN retrieved (p?=?0.016), greater number of metastatic CLN excised (p?p?=?0.006) and postablation sTg level (p?=?0.012). In the multivariable analysis, after adjusting for tumor size and metastatic CLN ratio, size of CLNM was an independent predictor of postablation DsTg (odds ratio 1.56, 95?% confidence interval 1.09?C2.24, p?=?0.015). Relative to pN0, the odds ratios for postablation DsTg in pN1mic and pN1mac were 2.53 (95?% confidence interval 0.35?C19.00, p?=?0.351) and 5.81 (95?% confidence interval 1.22?C27.70, p?=?0.027), respectively.

Conclusions

Size of CLNM was an independent factor for DsTg 9?months after surgery. Patients with pN1mac were almost 6 times more likely to have postablation DsTg than those with pN0 or pN1mic.     

Long-term nasogastric tube feeding in elderly stroke patients — an assessment of nutritional adequacy and attitudes to gastrostomy feeding in asians

Background

Gastrostomy feeding is superior to long-term nasogastric (NG) feeding in patients with dysphagic stroke, but this practice remains uncommon in Asia. We sought to examine the nutritional adequacy of patients on long term NG feeding and identify barriers to gastrostomy feeding in these patients.

Methodology

A prospective comparison of Subjective Global Assessment (SGA), and anthropometry (mid-arm muscle circumference, MAMC; triceps skinfold thickness, TST) between elderly stroke patients on long-term NG feeding and matched controls was performed. Selected clinicians and carers of patients were interviewed to assess their knowledge and attitudes to gastrostomy feeding.

Results

140 patients (70 NG, 70 oral) were recruited between September 2010 and February 2011. Nutritional status was poorer in the NG compared to the oral group (SGA grade C 38.6% NG vs 0% oral, p<0.001; TST males 10.7 + 3.7 mm NG vs 15.4 + 4.6 mm oral, p<0.001; MAMCmales 187.9 + 40.4 mm NG vs 228.7 + 31.8 mm oral, p<0.001). 45 (64.3%) patients on long-term NG feeding reported complications, mainly consisting of dislodgement (50.5%), aspiration of feed content (8.6%) and trauma from insertion (4.3%). Among 20 clinicians from relevant speciliaties who were interviewed, only 11 (55%) clinicians would routinely recommend a PEG. All neurologists (100%) would recommend a PEG, whilst the response was mixed among non-neurologists. Among carers, lack of information (47.1%) was the commonest reason stated for not choosing a PEG.

Conclusion

Elderly patients with stroke on long term NG feeding have a poor nutritional status. Lack of recommendation by clinicians appears to be a major barrier to PEG feeding in these patients.     

Lung uptake of liposome-entrapped glutathione after intratracheal administration.

The intratracheal delivery of glutathione (GSH), in liposome-encapsulated form, prolongs retention of the drug in the rat lung. This study has been designed to determine the extent and time-course of pulmonary tissue uptake of administered 14C-labelled liposomes containing [3H]GSH. Liposomes, composed of dimyristoylphosphatidylcholine (DMPC), dipalmitoylphosphatidylcholine and distearoylphosphatidylcholine each with or without 30 mol% cholesterol showed a clearance greater than 80% from the bronchoalveolar lavage, 24 h after intratracheal instillation. Lung tissue content of 14C-lipid increased with time: by 72 h, 42-56% of the administered dose was recovered from the tissue. [3H]GSH was present in pulmonary tissue in relatively constant amounts throughout the 72 h, ranging from 14-35% of the administered dose. Vesicles composed of DMPC had a low entrapment for GSH. There were only minor differences in GSH entrapment efficiency and lung tissue uptake between vesicles of the other lipid compositions.     

The Role of the Orienting Response in the Anticipation of Information: A Skin Conductance Response Study

Theoretical positions concerning the role of the orienting response (OR) in information-processing and attention have viewed the OR either as indexing an active increase in information-processing efficiency, or as passively reflecting the results of information processing. This paper reports a skin conductance response (SCR) study of a two-stimulus anticipation experiment, where a warning stimulus (WS) informed subjects of the nature of an impending imperative stimulus (IS). The subjects' task was to identify as much of the IS as possible. Both the WS and the IS varied in information content and stimulus duration. SCR magnitude in the WS-IS interval varied according to the anticipated information processing requirements and was more sensitive to IS variation than WS variation. It is concluded that these responses index an anticipatory, activating process closely related to that suggested of the OR by Sokolov (1966), and consonant with the functional characteristics of the autonomic nervous system. Registration of information appears to be neither a necessary determinant of OR magnitude, nor a parsimoniously useful part of OR theory.