Schlenker EH, Hora M, Liu Y, Redetzke RA, Morkin E, Gerdes AM. Effects of thyroidectomy, T4, and DITPA replacement on brain blood vessel density in adult rats. Am J Physiol Regul Integr Comp Physiol 294: R1504-R1509, 2008. First published March 19, 2008 doi:10.1152/ajpregu.00027.2008.-In hypothyroid patients, altered microvascular structure and function may affect mood and cognitive function. We hypothesized that adult male hypothyroid rats will have significantly lower forebrain blood vessel densities (BVD) than euthyroid rats and that treatment with 3,5-diiothyroprionic acid (DITPA) (a thyroid hormone analog) or thyroxine (T4) will normalize BVDs. The euthyroid group received no thyroidectomy or treatment. The other three groups received thyroidectomies and pellets. The hypothyroid group received a placebo pellet, the DITPA group received an 80-mg DITPA-containing pellet, and the T4 group received a 5.2-mg T4 slow-release pellet for 6 wk. Body weights, cardiac function, and body temperatures were measured. A monoclonal antiplatelet endothelial cell adhesion antibody was used to visualize blood vessels. The euthyroid group averaged body weights of 548 Ϯ 54 g, while the hypothyroid group averaged a body weight of 332 Ϯ 19 g (P value Ͻ 0.001). Relative to the euthyroid group, the DITPA-treated group was significantly lighter (P value Ͻ 0.05), while the T4-treated group was comparable in body weight to the euthyroid group. The same trends were seen with body temperature and cardiac function with the largest difference between the euthyroid and hypothyroid groups. BVD in the euthyroid group was 147 Ϯ 12 blood vessels/mm 2 and in hypothyroid group 69 Ϯ 5 blood vessels/mm 2 (P ϭ 0.013) but similar among the euthyroid, DITPA, and T4 groups. These results show that hypothyroidism decreased BVD in adult rat forebrain regions. Moreover, DITPA and T4 were efficacious in preventing effects of hypothyroidism on cardiac function and BVD.hypothyroid; angiogenesis; echocardiography; thyroid hormones HYPOTHYROIDISM IS A RELATIVELY common disorder affecting ϳ5% of adults and 15% of older women (2, 10). Consequences of hypothyroidism in adults include fatigue, cold intolerance, exertion, cognitive and mood dysfunction, decreased body temperature, elevated levels of triglycerides and cholesterol, hoarseness, sleep apnea, and cardiovascular dysfunction (2,14,29). Although less investigated, hypothyroidism may also decrease blood vessel density, which in turn decreases delivery of oxygen and nutrients to tissues. Since hypothyroidism may depress ventilation, leading to hypoxemia (26), the consequences of decreased blood vessel density could be enhanced in hypothyroid patients who have cardiac disease or suffer from sleep apnea and exacerbate altered cognition, mood disturbances, and fatigue.Thyroid hormone supplementation directly affects the cardiovascular system to increase cardiac contractile function and hypertrophy, as well as cause vasodilatation (17). Recent studies indicate that thyroid supplementation also may increase blo...

OBJECTIVES The aim of this study is to evaluate the efficacy of chest computed tomography (CT) to predict the pathological stage of thymic epithelial tumours (TET) using the recently introduced tumour, node and metastasis (TNM) staging with comparison to the modified Masaoka staging. METHODS Preoperative chest CT examinations in cases of resected TET with sampled lymph nodes (2006–2016) were retrospectively reviewed by 2 thoracic radiologists and radiologically (r) staged using both staging systems. A thoracic pathologist reviewed all cases for the pathological (p) stage. Concordance between r-staging and p-staging was assessed by % agreement and unweighted kappa statistics. Associations between r-stage and p-stage with outcomes were assessed using the Cox proportional hazards regression. RESULTS Sixty patients with TET were included (47 thymomas, 12 thymic carcinomas and 1 atypical carcinoid tumour). Sixteen patients (26.7%) had received neoadjuvant therapy. Fifty-four patients (90.0%) had complete resection. The overall agreement between the r-stage and p-stage was 66.7% (κ = 0.46) for TNM staging and 46.7% (κ = 0.30) for modified Masaoka staging. Agreement between r-assessment and p-assessment of the T, N and M components of the TNM stage was 61.7% (κ = 0.28), 86.7% (κ = 0.48) and 98.3% (κ = 0.88), respectively. CT overstaged 12 patients (20.0%) for TNM staging and 12 patients (20.0%) for modified Masaoka staging and understaged 8 (13.3%) and 20 (33.3%) patients for TNM staging modified Masaoka staging, respectively. The r-TNM staging accuracy was lower for patients with neoadjuvant therapy (50.0% with vs 72.7% without). During a median follow-up of 2.6 years (range 0.1–10.5 years), 12 patients had metastases and/or recurrence; 11 patients died (4 of disease). The r-TNM stage and modified Masaoka stage were associated with overall survival and progression-free survival (P < 0.001). CONCLUSIONS Preoperative chest CT is able to accurately predict p-TNM stage in two-thirds of surgically resected TET, with an agreement between radiological staging and pathological staging superior to the modified Masaoka staging.

e18640 Background: Limited English proficiency (LEP) has been shown to exacerbate health inequities in the US due to difficulties navigating a complex health system and assimilating complicated information regarding diagnosis, and treatment. Advances in multiple myeloma (MM) care have improved clinical outcomes but added complexity to diagnosis and treatment. However, there is limited data on whether LEP impacts health inequities in MM care. We sought to assess the impact of primary language on MM care and outcomes at our safety net hospital, serving a culturally and linguistically diverse population where patients have equal access to novel agents and autologous stem cell transplant (SCT). Methods: We retrospectively studied 213 patients with newly diagnosed MM between January 1st, 2000, and December 31st, 2021. Data were extracted from electronic medical records. Patients were classified as LEP or EP based on self-reported language at the time of diagnosis. Patients were subsequently propensity matched based on age, sex, type of insurance, Charlson comorbidity index, creatinine, LDH, year of MM diagnosis, ISS stage, presence of high-risk cytogenetics, and receipt of SCT. Type of insurance was used as a surrogate for socioeconomic status. Kaplan Meier estimate and log rank tests were used to assess overall (OS) and progression free survival (PFS). Results: Of 213 patients, 75 (35.2%) had LEP, 135 (63.4%) were black, 49 (23.0%) were white, 22 (10.3%) patients were of another race, and 7 (3.3%) did not self-identify. Mean age was 63.6 (SD ± 11.4), and 114 (53.5%) patients were male. Median follow-up of the entire cohort was 56.9 months. At baseline, there were no statistically significant differences in the covariates above between LEP and EP patients except for increased incidence of diabetes mellitus in EP patients (84.0% vs. 89.1%, p 0.02). More LEP patients were inpatients at the time of diagnosis compared to EP patients (36.0% [27/ 75] versus 23.9% [33/138]). Median number of hospitalizations and ED visits in the first 6 months of diagnosis were 4 and 3 versus 1 and 2 in LEP versus EP patients, respectively. There were no differences in adjusted PFS or OS between propensity matched LEP and EP patients. Conclusions: In our cohort, there were no significant differences in demographics, clinical parameters, socioeconomic status, or transplant utilization between LEP and EP patients, which allowed us to assess the association of primary language with any observed health inequities. In a setting where all patients have access to novel treatments, SCT, patient navigators, interpreters, and social workers, there were no differences in PFS or OS. However, language barriers may explain health inequities related to later diagnosis and increased healthcare utilization. LEP patients with MM may benefit from additional language-concordant resources to improve disparities.

Altered microvascular structure and function may affect mood and cognitive function in hypothyroid patients. We hypothesized that adult hypothyroid (H) rats will have significantly lower forebrain blood vessel densities (BVD) than euthyroid (E) rats, and that treatment with DITPA (D)‐ (a thyroid hormone analogue) or T4(T) will normalize BVD's. Twenty male rats were divided into 4 age‐matched groups. The E group received no thyroidectomy and no treatment. The other three groups received thyroidectomies and pellets. The H group received a placebo pellet, the D group received an 80mg DITPA‐containing pellet, and the T group received a 5.2mg T4 slow release pellet for 6 weeks. Prior to sacrifice, body weights (BW) and body temperatures (BT) were measured. Immunohistochemistry on forebrain regions was performed on 20μm sections using a monoclonal anti‐platelet endothelial cell adhesion molecule to visualize blood vessels. Blood vessels were counted in 20 fields per animal to calculate BVD. The E group averaged BW's of 548 ± 54g, while the H group averaged BW of 332 ± 19g (p‐value < 0.001). Relative to the control group the D‐treated group was significantly lighter (p‐value < 0.00393) while the T‐treated group was comparable in BW to the E group. The same trends were seen with BT with the largest difference between the E and H groups (p‐value = 0.002). BVD in the E group was 147 ± 12 blood vessels per mm2, and in H group 69 ± 5 blood vessels per mm2 (P=0.013), but similar among the E, D, and T groups. These results show that hypothyroidism decreases BVD in adult rat forebrain regions. Moreover, DITPA and T4 are efficacious in reversing the effects of hypothyroidism on BVD.

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