A Literature Review of Factors Associated With Pain From Fine Needle Aspiration Biopsy of Thyroid Nodules

ObjectiveThyroid nodules are common, being detected in 19% to 67% of the population. A fine needle aspiration biopsy (FNAB) is recommended for suspicious thyroid nodules to rule out malignancy; however, the procedure can be painful for subsets of patients. It remains unclear what factors are more likely to be associated with pain during FNAB. This literature review aimed to investigate patient-, procedure-, and analgesic-related factors that affect pain levels during thyroid nodule FNAB.MethodsPredefined inclusion and exclusion criteria were set to search the Embase, MEDLINE, CINAHL, and Cochrane databases. The articles evaluating the factors affecting pain during FNAB were assessed for inclusion. The primary outcome of interest was scores evaluating pain level during FNAB.ResultsTwenty-two studies were included. The studies were a mix of cohort studies, randomized controlled trials, and clinical controlled trials. Under patient-related factor, nodule calcification was associated with increasing pain. The procedure-related factors potentially increasing pain included the number of needle passes and utilization of the aspiration technique (as opposed to capillary action), perpendicular needle placement (as opposed to parallel), and not using safety devices. Larger needle size, type of biopsy, operator expertise, and patient education did not appear to be correlated with pain. Subcutaneous lidocaine appeared to provide better pain relief than a topical analgesic.ConclusionWith increasing use of FNAB as the diagnostic test of choice for assessing thyroid nodules, understanding patient-, procedure-, and analgesic-related factors associated with optimal patient satisfaction is imperative.     

Crows flexibly apply statistical inferences based on previous experience

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Reduction of amygdaloid kindled seizures by an analog of ACTH/MSH

A behaviorally potent analog of ACTH/MSH(4–9), ORG-2766, markedly reduces both physiologic and behavioral components of convulsive seizures in an animal model of epilepsy—the amygdaloid kindled rat. We believe that such non-endocrine analogs of ACTH/MSH fragments may be clinically useful anticonvulsants, particularly in chronic applications, provided that their permeation of the blood-brain barrier can be improved.     

Evaluation of the concentration of selected elements in serum patients with intervertebral disc degeneration

Quantitative analysis of the trace element content of human intervertebral discs (IVDs) is essential because it can identify specific enzymes or metabolites that may be related to human intervertebral disc degeneration (IVDD). The goal of this study was to assess the concentrations of copper (Cu), iron (Fe), manganese (Mn), lead (Pb), zinc (Zn), sodium (Na), magnesium (Mg), potassium (K), phosphorus (P), and calcium (Ca) in serum samples obtained from patients with IVDD in comparison to healthy volunteers (a control group). The study group consisted of 113 Caucasian patients qualified by a specialist neurosurgeon for microdiscectomy. The control group consisted of 113 healthy volunteers who met the eligibility criteria for blood donors. The examined clinical material was the serum samples obtained from both groups.Based on the quantitative analysis of selected elements, there were statistically significantly (p 0.05) higher concentrations of Cu (1180 μg/L±800 μg/L vs. 1230 μg/L±750 μg/L), Zn (790 μg/L±300 μg/L vs. 850 μg/L±200 μg/L), and Mg (21730 μg/L±4360 μg/L vs. 23820 μg/L±4990 μg/L) in the serum of healthy volunteers compared to those in the study group. In addition, statistically significant changes were not detected in the concentrations of any elements among either sex in either the study or control group or in their body mass index (BMI) values (p > 0.05). In the serum samples from the study group, the strongest relationships were noted between the concentrations of Zn and Pb (r = 0.61), Zn and P (r = 0.69), Zn and Ca (r = 0.84), Zn and Cu (r = 0.83), Mg and Ca (r = 0.74), and Ca and P (r = 0.98).It has been indicated that, above all, the concentrations of Cu, Zn, Ca, and Mg depend on the advancement of radiological changes, according to the Pfirrmann scale. However, no influence on pain intensity was found, depending on the concentration of the assessed elements.The analysis indicates that the determination of serum Cu, Zn, Ca, and Mg concentrations may have diagnostic significance in predicting the onset of lumbosacral IVDD. The predictive evaluation of changes in the concentrations of selected elements in patients with degenerative lumbar IVD lesions appears to be a promising, cost-effective strategy.     

NMR study of the interaction of plastocyanin with chromium(III) analogues of inorganic electron transfer reagents

High resolution nuclear magnetic resonance spectroscopy has been used to examine the interaction of plastocyanins from French bean (Phaseolus vulgaris) and cucumber (Cucumis sativus) with three complexes—potassium hexacyanochromate(III), hexamminechromium(III) nitrate and tris(1,10-phenanthroline)-chromium(III) perchlorate—which are analogues of inorganic electron transfer reagents. The results indicate a high degree of specificity in the binding of these complexes and two binding sites on the protein are identified. One binding site is situated close to the copper atom and is clearly suited to outer sphere electron transfer through one of the histidine ligands. The other binding site is more distant from the copper atom and this mechanism cannot be operative. Electron transfer via hydrophobic channels or electron tunneling are possible mechanisms of electron transfer.     

An analog of MSH/ACTH 4–9 enhances interpersonal and environmental awareness in mentally retarded adults

In a double blind procedure, four doses (0, 5, 10 and 20 mg) of an orally active analog of ACTH/MSH 4–9 was administered to mentally retarded adults. Changes in behavior and in productivity were evaluated as subjects performed their job in a sheltered workshop. During the first week productivity suffered while behavior related to communication and sociability increased in clients receiving the peptide analog. During the second week, clients given the peptide were more productive and attentive to environmental events while differences in sociability stabilized. Five and 10 mg enhanced productivity of tasks requiring precision and concentration whereas 20 mg depressed performance of all tasks. Regression equations indicated that different doses of the peptide generated unique relationships between behavior and productivity with self-stimulation characterizing the clients given the peptide. The use of the peptide analog of ACTH/MSH as a potential treatment with the mentally retarded is encouraged by these findings.     

The Role of Iron In Protozoan and Fungal Infectious Diseases

To survive and replicate in vertebrate hosts, protozoan and fungal invaders must be capable of securing host iron. Successful pathogens obtain the metal from either extraction of heme, binding of siderophilins, binding of siderophores, and/or iron pools within host cells. The actual strategy can vary with the availability of iron in the particular host milieu. As a corollary, hosts have developed an elaborate iron withholding defense system. Conditions that can compromise the system as well as procedures that can strengthen it are reviewed.     

Fungal Taxa Target Different Carbon Sources in Forest Soil

Soil microbes are among the most abundant and diverse organisms on Earth. Although microbial decomposers, particularly fungi, are important mediators of global carbon and nutrient cycling, the functional roles of specific taxa within natural environments remain unclear. We used a nucleotide-analog technique in soils from the Harvard Forest to characterize the fungal taxa that responded to the addition of five different carbon substrates—glycine, sucrose, cellulose, lignin, and tannin-protein. We show that fungal community structure and richness shift in response to different carbon sources, and we demonstrate that particular fungal taxa target different organic compounds within soil microcosms. Specifically, we identified eleven taxa that exhibited changes in relative abundances across substrate treatments. These results imply that niche partitioning through specialized resource use may be an important mechanism by which soil microbial diversity is maintained in ecosystems. Consequently, high microbial diversity may be necessary to sustain ecosystem processes and stability under global change. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users. K. K. T., M. A. B., and M. D. W. conceived the project. C. A. H. performed the molecular work and sequence alignments. M. A. B. performed the substrate-induced respiration experiment. S. D. A. and K. K. T. analyzed the data. C. A. H. wrote the article with input from the other authors.     

Human platelet activation by an alkylacetyl analogue of phosphatidylcholine

The present study has evaluated the influence of semi-synthetic platelet-aggregating factor, (PAF) i.e., alkylacetylglycerophosphocholine, on human platelet morphology, biochemistry and function in order to determine if PAF serves as the corrective factor restoring sensitivity to refractory platelets after treatment with epinephrine. Threshold concentrations of PAF caused irreversible platelet aggregation which could be blocked by agents elevating endogenous levels or cyclic AMP or inhibited by antagonists of platelet prostaglandin synthesis and secretion. PAF did not stimulate platelets through α-adrenergic receptors or receptors for arachidonate, endoperoxides or thromboxanes. 24 h after aspirin ingestion, platelets could be aggregated irreversibly by high concentrations, but not by threshold amounts of PAF, even though they were still insensitive to arachidonate. Another less potent PAF derivative, alkenylacetylglycerophosphocholine, blocked aggregation of 24-h aspirin platelets by PAF, but did not inhibit restoration of arachidonate sensitivity and irreversible aggregation when the samples were treated first with epinephrine. Our findings indicate that threshold amounts of PAF activate human platelets in a physiologic manner and cause irreversible aggregation which is dependent on prostaglandin synthesis and the release reaction. The results do not support the concept that PAF is the mediator of the mechanism of membrane modulation through which epinephrine induces correction of the refractory state in prostaglandin I₂-treated or dissociated platelets, or cells obtained from individuals following aspirin ingestion. Thus, the mechanism of platelet membrane modulation is capable of securing irreversible aggregation of secretion, prostaglandin synthesis or PAF formation.