Impact of Combined Prophylactic Unilateral Central Neck Dissection and Hemithyroidectomy in Patients with Papillary Thyroid Microcarcinoma

Background  

Lymph node metastases occur frequently in patients with papillary thyroid carcinoma (PTC), and the central compartment of the neck is the most frequently involved site. Some authors advocate prophylactic central neck dissection (CND) during total thyroidectomy. However, little is known about the effects of prophylactic unilateral CND in papillary thyroid microcarcinoma (PTMC) patients who undergo hemithyroidectomy. This study was designed to investigate the impact of prophylactic unilateral CND in this population.     

A genetic polymorphism for translocator protein 18?kDa affects both in vitro and in vivo radioligand binding in human brain to this putative biomarker of neuroinflammation

Second-generation radioligands for translocator protein (TSPO), an inflammation marker, are confounded by the codominant rs6971 polymorphism that affects binding affinity. The resulting three groups are homozygous for high-affinity state (HH), homozygous for low-affinity state (LL), or heterozygous (HL). We tested if in vitro binding to leukocytes distinguished TSPO genotypes and if genotype could affect clinical studies using the TSPO radioligand [¹¹C]PBR28. In vitro binding to leukocytes and [¹¹C]PBR28 brain imaging were performed in 27 human subjects with known TSPO genotype. Specific [³H]PBR28 binding was measured in prefrontal cortex of 45 schizophrenia patients and 47 controls. Leukocyte binding to PBR28 predicted genotype in all subjects. Brain uptake was ∼40% higher in HH than HL subjects. Specific [³H]PBR28 binding in LL controls was negligible, while HH controls had ∼80% higher binding than HL controls. After excluding LL subjects, specific binding was 16% greater in schizophrenia patients than controls. This difference was insignificant by itself (P=0.085), but was significant after correcting for TSPO genotype (P=0.011). Our results show that TSPO genotype influences PBR28 binding in vitro and in vivo. Correcting for this genotype increased statistical power in our postmortem study and is recommended for in vivo positron emission tomography studies.     

Effects of a problem‐solving counseling program to facilitate intensified walking on Koreans with type 2 diabetes

Aim: This study aimed to evaluate the immediate and long‐term effects of a 12 week problem‐solving (PS) counseling program to facilitate intensified walking with machinery monitoring on persons with type 2 diabetes mellitus in Korea. Methods: The study used a quasi‐experimental design. The participants were 57 patients with diabetes from three endocrinology or internal medicine clinics in an urban city of South Korea. Moderate‐intensity walking and PS counseling were recommended to both groups. The difference between the two groups was whether the intensity of the exercise was monitored by an ambulatory heart rate monitor (experimental group) or was self‐regulated (comparison group). Those programs were evaluated in relation to BMI, glycemic control (blood glucose level, glycosylated hemoglobin [HbA1c]), a vascular complication index (total cholesterol, high‐density lipoprotein cholesterol, low‐density lipoprotein cholesterol, triglycerides, tissue plasminogen activator [t‐PA], plasminogen activator inhibitor‐1 [PAI‐1], Parma Cardiovascular Risk Index), and coping strategies at 3 and 6 months. Results: The experimental group members showed dramatic decreases in their glucose and HbA1c levels at 3 months. The values of t‐PA decreased significantly at baseline, compared to at 3 months. The levels of PAI‐1 continuously declined and the Parma Cardiovascular Risk Index score did not change significantly from baseline to at 3 months, but showed significant effects at 6 months. Conclusion: A combined program of intensified walking, using a heart rate monitor, with PS counseling is more helpful to prevent complications than self‐regulated exercise for persons with type 2 diabetes in Korea.     

Recurrence detection in differentiated thyroid cancer patients with elevated serum level of antithyroglobulin antibody: special emphasis on using 18F‐FDG PET/CT

Objective A clinical challenge is presented by differentiated thyroid cancer (DTC) patients who show increased serum antithyroglobulin antibody (TgAb) level with undetectable thyroglobulin (Tg) and negative radioiodine whole body scan (I‐WBS). The aim of this study is to investigate the recurrence in DTC patients with elevated TgAb by using ¹⁸F‐FDG PET/CT (PET/CT) in addition to I‐WBS and neck ultrasonography (USG). Subjects and design A total of 276 TgAb+ patients were enrolled. Recurrence was assessed and compared between TgAb+ and TgAb‐ patients. TgAb+ patients were further categorized into two groups of 35–140 U/ml (Group A) and 140 U/ml or greater (Group B), according to receiver operating characteristic (ROC) curve analysis. Tumoural status was evaluated regarding the TgAb positivity and the degree of increase of TgAb. Results Thirty‐seven (13·4%) of 276 TgAb+ patients were finally diagnosed with recurrence, compared with 21 (13·5%) of 156 TgAb‐ patients (P = 0·987). There was a correlation between TgAb level and recurrence (P = 0·032). Recurrence was more common in Group B than Group A (27·8% and 9·9%, respectively, P = 0·001). Recurrence was found in 37·5% of 24 TgAb+/Tg‐ patients who showed a gradually increasing tendency in serial measurements of TgAb. Sixteen cervical foci (21·1%) missed on neck USG and 17 lesions (22·4%) located outside the neck were additionally detected with PET/CT in TgAb+ patients. Conclusions TgAb plays a complementary role to Tg in the detection of recurrence of DTC. Tumour recurrence was more frequent in patients with elevated TgAb level over 140 U/ml or a trend toward increasing levels. PET/CT could provide additional information to I‐WBS and neck USG in detecting tumour recurrence in patients with elevated TgAb.     

Low expression of Bax predicts poor prognosis in patients with locally advanced esophageal cancer treated with definitive chemoradiotherapy.

PURPOSE: The present study evaluated the prognostic significance of apoptosis-related proteins, p53, Bcl-2, Bax, and galectin-3 in patients with locally advanced esophageal cancer treated with definitive chemoradiotherapy. EXPERIMENTAL DESIGN: A total of 63 patients with locally advanced esophageal cancer (squamous cell carcinoma: 62; adenocarcinoma: 1; stages II-IV) were treated with definitive chemoradiotherapy using 5-fluorouracil and cisplatin combined with radiotherapy. Pretreatment tumor biopsy specimens were analyzed for p53, Bcl-2, Bax, and galectin-3 expression by immunohistochemistry. RESULTS: High expression of Bax, p53, Bcl-2, and galectin-3 was observed in 67%, 47%, 24%, and 29% of patients, respectively. The median overall survival (OS) of total patients was 14 months with 16% of 3-year OS. High expression of p53, Bcl-2, and galectin-3 did not show correlation with clinicopathologic characteristics, including patient outcome. Low expression of Bax was significantly correlated with lack of clinical complete response (P=0.023). Low expression of Bax was also associated with poor OS (median, 8 months versus 16 months; P=0.0008) in univariate analysis. In multivariate analysis, low expression of Bax was the most significant independent predictor of poor OS (P=0.009), followed by low dose intensity of cisplatin and lack of clinical complete response. CONCLUSIONS: Low expression of Bax was significantly associated with the poor survival of patients with locally advanced esophageal cancer treated with chemoradiotherapy using 5-fluorouracil and cisplatin. Immunohistochemical staining for Bax with a pretreatment biopsy specimen might be useful to select the optimal treatment options for these patients.     

Kinetic Changes of COX-2 Expression during Reperfusion Period after Ischemic Preconditioning Play a Role in Protection Against Ischemic Damage in Rat Brain

A brief ischemic insult induces significant protection against subsequent massive ischemic events. The molecular mechanisms known as preconditioning (PC)-induced ischemic tolerance are not completely understood. We investigated whether kinetic changes of cyclooxygenase (COX)-2 during reperfusion time-periods after PC were related to ischemic tolerance. Rats were given PC by occlusion of middle cerebral artery (MCAO) for 10 min and sacrificed after the indicated time-periods of reperfusion (1, 2, 4, 8, 12, 18 or 24 h). In PC-treated rats, focal ischemia was induced by occlusion of MCA for 24 h and brain infarct volume was then studied to determine whether different reperfusion time influenced the damage. We report that the most significant protection against focal ischemia was obtained in rats with 8 h reperfusion after PC. Administration of indomethacin (10 mg/kg, oral) or rofecoxib (5 mg/kg, oral) 48 h prior to PC counteracted the effect of PC. Immunohistochemical analysis showed that COX-2 and HO-1 protein were induced in PC-treated rat brain, which was significantly inhibited by rofecoxib. Taken together, we concluded that the kinetic changes of COX-2 expression during the reperfusion period after PC might be partly responsible for ischemic tolerance.     

HIV gp41 binding phenolic components from Fraxinus sieboldiana var. angustata

By means of HIV gp41 binding affinity directed chromatographic fractionation, three phenylethanoid glycosides; calceolarioside A ( 1), calceolarioside B ( 2) and acteoside ( 3), along with four hydroxycoumarins; esculin ( 4), fraxin ( 5), fraxetin ( 6) and esculetin ( 7), and one lignan, (-)-olivil ( 8) were isolated from the n-butyl alcohol fraction of Fraxinus sieboldiana var. angustata. Among the isolated compounds, calceolarioside B ( 2) and esculetin ( 7) showed moderate binding affinity on HIV gp41 with IC 50 values of 0.1 mg/ml and 0.5 mg/ml, respectively. Calceolarioside A ( 1), calceolarioside B ( 2), acteoside ( 3), and (-)-olivil ( 8) were isolated for the first time from this plant.