Impact of the TNM staging system for thymoma.

BACKGROUND: Masaoka-Koga staging system remains the most frequently applied clinical staging system for thymic malignancy. However, the International Association for the Study of Lung Cancer (IASLC)/International Thymic Malignancy Interest Group (ITMIG) proposed a tumor-node-metastasis (TNM) staging system in 2014. This study aims to evaluate its impact on stage distribution, clinical implementation, and prognosis for thymomas. METHODS: We performed a single institution, retrospective analysis of 245 consecutive patients who underwent surgical resection for thymoma. 9 patients with thymic carcinoma were excluded. No patients were lost to follow up. Kaplan-Meier survival analysis was used to calculate overall survival. RESULTS: Median age was 62 years; 129 patients (53%) were female. The median overall survival was 158 months (range, 108-208 months), and disease-free survival 194 months (range, 170-218 months). At the end of follow up 63 patients were dead. Early Masaoka-Koga stages I (n=74) and II (n=129) shifted to the IASLC/ITMIG stage I (n=203). 8 patients were down staged from Masaoka-Koga stage III to IASLC/ITMIG stage II because of pericardial involvement. Advanced stages III (Masaoka-Koga: n=30; IASLC/ITMIG: n=22) and IV (Masaoka-Koga: n=12; IASLC/ITMIG: n=12) remained similar and were associated with more aggressive WHO thymoma histotypes (B2/B3). Masaoka-Koga (P=0.004), IASLC/ITMIG staging (P<0.0001) and complete surgical resection (P<0.0001) were statistically associated with survival. At multivariate analysis only R status was an independent prognostic factor for survival. CONCLUSIONS: The proportion of patients with stage I disease increased significantly when IASLC/ITMIG system used, whilst the proportion with stages III and IV were similar in both systems. Completeness of resection, Masaoka-Koga and the IASLC/ITMIG staging system are strong predictors of survival. The TNM staging system is useful in disease management and a strong predictor of overall survival.

Assistance and Therapy Dogs Are Better Problem Solvers Than Both Trained and Untrained Family Dogs.

When faced with unsolvable or difficult situations dogs use different behavioral strategies. If they are motivated to obtain rewards, they either try to solve the problem on their own or tend to interact with a human partner. Based on the observation that in problem situations less successful and less perseverant dogs look more at the humans' face, some authors claim that the use of social strategies is detrimental to attempting an independent solution in dogs. Training may have an effect on dogs' problem-solving performance. We compared the behavior of (1) untrained, (2) trained for recreational purposes, and (3) working dogs: assistance and therapy dogs living in families (N = 90). During the task, dogs had to manipulate an apparatus with food pellets hidden inside. We measured the behaviors oriented toward the apparatus and behaviors directed at the owner/experimenter, and ran a principal component analysis. All measures loaded in one factor representing the use of the social strategy over a more problem-oriented strategy. Untrained dogs obtained the highest social strategy scores, followed by dogs trained for recreational purposes, and assistance and therapy dogs had the lowest scores. We conclude that assistance and therapy dogs' specific training and working experience (i.e., to actively help people) favors their independent and more successful problem-solving performance. General training (mainly obedience and agility in this study) also increases problem-oriented behavior.