Effects of endocrine therapy on the prognosis of elderly patients after surgery for papillary thyroid carcinoma.

Papillary thyroid carcinoma (PTC) is a common thyroid malignancy. Elderly patients have more severe disease and more complications following postoperative endocrine therapy to control thyroid-stimulating hormone (TSH) levels. We aimed to identify optimal postoperative serum TSH levels in elderly patients to prevent recurrence and metastasis and minimize complications. This retrospective cohort study collected data of 87 consecutive elderly patients (age >75) who underwent surgery for PTC with postoperative levothyroxine therapy (50-150 µg/d) between January 2006 and June 2008 and were followed until 2013. After 24 patients with TSH fluctuations and incomplete data were excluded, 73 patients were grouped based on postoperative TSH levels: Group A, 0.3-0.5 mIU/mL; Group B, 0.1-0.3 mIU/mL; and Group C <0.1 mIU/mL (n = 24, 25, 24, respectively). Subjects' baseline, preoperative data, postoperative complications and 1-, 3- and 5-year follow-up data were compared between groups. No significant differences in gender, age (median age of 80 years old), surgery type or clinical characteristics were found between groups (all p value >0.05). Postoperatively, all subjects had normal ECG and neck ultrasound, no osteoporosis, and no differences in survival rate or metastasis. Five-year follow-up revealed significant differences in development of arrhythmias, osteoporosis, insomnia and anxiety between Groups B (0.1-0.3 mIU/mL) and C (<0.1 mIU/mL) compared to Group A (0.3-0.5 mIU/mL). Postoperative incidence of PTC recurrence and metastasis remained stable in elderly patients undergoing thyroid surgery and endocrine therapy but complications increased significantly with increasing TSH levels. Controlling TSH to lower limits of normal may help prevent PTC recurrence and metastasis and reduce complications in this high-risk population.

High salt intake and stroke: meta-analysis of the epidemiologic evidence.

Research on the potential impact of high salt intake on health has grown rapidly over the last decades. Recent studies have suggested that high salt intake could also be associated with adverse effects on cardiovascular system. The review evaluated the current level of epidemiologic evidence on the association between the level of habitual salt intake and stroke outcome. We also suggest further research direction. There were 21 independent samples from 12 studies, with 225,693 participants (follow-up, 3-19 years) and 8135 stroke events. High salt intake was associated with risk of stroke event (pooled odd ratio [OR], 1.34; 95% confidence interval [CI], 1.19-1.51), stroke death (1.40; 1.21-1.63) and stroke onset (1.11; 1.00-1.24), ischemic stroke death (2.15; 1.57-2.95), not associated with risk of ischemic stroke onset (1.07, 0.95-1.2), with no significant evidence of publication bias. High salt intake is associated with significantly increased risk of stroke event. Further research should be directed toward clarifying and quantifying these possible effects and generating testable hypotheses on plausible biologic mechanisms.

Meta-analysis of association between particulate matter and stroke attack.

AIMS: We conducted systematic review as well as meta-analyses on the association between particulate matter and daily stroke attack from a number of epidemiologic studies. METHODS: Twelve quantitative studies about the associations between particulate matter and stroke attack met the inclusive criteria. We evaluated the odds ratio (OR) of stroke attack associated with per 10 µg/m(3) increase of the concentration of PM(10) (particulate matter with aerodynamic diameter ≤ 10 µm) or PM(2.5) (particulate matter with aerodynamic diameter ≤ 2.5 µm) as effect scale, and a sensitivity analysis for the results was conducted. RESULTS: In the time-series design, PM(10) exposure wasn't related to an increased risk of daily stroke attack [OR per 10 µg/m(3) = 1.002, 95% confidence interval (CI): 0.999~1.005], PM(2.5) exposure were related to an increased risk of daily stroke attack (OR per 10 µg/m(3) = 1.006, 95%CI: 1.002~1.010]; but in the case-crossover studies, PM(10) exposure was related to increase in risk of daily stroke attack (OR per 10 µg/m(3) = 1.028, 95%CI: 1.001~1.057). PM(2.5) exposure was not significant association with daily stroke attack (OR per 10 µg/m(3) = 1.016, 95%CI: 0.937~1.097). Sensitivity analysis showed that the results for PM(10) , PM(2.5) and daily stroke attack were robust in the time-series design. CONCLUSIONS: We found some evidence for an effect of air pollutants on stroke attack risk.