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Turns out lowly thymus may be saving your life

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Re: Turns out lowly thymus may be saving your life

#21

Post by ReallyAnonymous »

bluepod4 wrote: post #17
maximilianburke wrote: post #11

Earlier quoted context omitted.

I think we're getting better about non-surgical interventions when it's not necessary. Appendicitis can, and is, treated with antibiotics, but the timing has to be spot on otherwise it needs to come out. I had to have mine removed because by the time I was seen in the hospital it had already burst. I think the only time that people pre-emptively remove appendixes is when you can't risk the chance of a burst; like if…

> Appendicitis can, and is, treated with antibiotics Yeah, kids don’t get tonsils removed anymore either. Just antibiotics.

surgeon here: antibiotic treatment works great as long as there's no peritonitis and/or no appendicolith seen on CT. However, statistics show that 30% of successfully treated patients go on to get appendicitis again within 1 year.

Anyway, I offer my patients a choice. Most choose surgery. Those conscientious enough without insurance usually choose nonoperative management because it's much cheaper.

Re: Turns out lowly thymus may be saving your life

#22

Post by spandrew »

This type article declaring a thymus revelation is published every few years.

We've known the thymus is saving our lives — it's where the t in t-Cells derives from for years. There are very old studies of removing it from older humans and statistically seeing a decline in health. Most doctors will not remove it without a decent cause in older patients (intractable infection, for example). In those cases it's not that removing the thymus was a good approach. It was just the least-bad approach the physician had on hand to help their patient.

Never forget that everything we do, medically, is a stall. I'm glad we have blood pressure pills and better health spans than our grandparents. Eat a healthy diet, run 3 times a week, manage stress and... die anyway. That's the deal we were given as living things.

Re: Turns out lowly thymus may be saving your life

#23

Post by Calavar »

This is a fluff piece. We've known for decades that the thymus is an important part of the immune system. It's not an organ that's been believed to be vestigial, like the appendix.

> For the study, Kooshesh mined data from 1,146 adult patients who had undergone thymus removal, alongside demographically matched control patients who had undergone similar surgeries but kept their thymus

Sure, you can demographically match all you want, but I don't think this is a research question that can be answered with a retrospective analysis. The problem is that you haven't controlled for why surgeons decided to remove the thymus in some cases and not in others. Was the disease more severe in patients who got thymectomies? Was it differences in training between the surgeons? Was it just an arbitrary decision on the part of the surgeons? This is a critical confounder regardless of whether you've matched the demographics. You really need a randomized control study to answer this sort of question.

> Although the risk of autoimmune disease did not differ substantially between the groups in the overall primary cohort (relative risk, 1.1; 95% CI, 0.8 to 1.4), a difference was found when patients with preoperative infection, cancer, or autoimmune disease were excluded from the analysis (12.3% vs. 7.9%; relative risk, 1.5; 95% CI, 1.02 to 2.2)

What? What is this? Was this subgroup analysis preregistered, or did they just go fishing when their primary hypothesis didn't pan out?

I'd categorize this study as mildly interesting, but not groundbreaking the way the press statement is selling it.

Re: Turns out lowly thymus may be saving your life

#24

Post by mlyle »

Calavar wrote: post #23

This is a fluff piece. We've known for decades that the thymus is an important part of the immune system. It's not an organ that's been believed to be vestigial, like the appendix. > For the study, Kooshesh mined data from 1,146 adult patients who had undergone thymus removal, alongside demographically matched control patients who had undergone similar surgeries but kept their thymus Sure, you can demographically mat…

This is a research question you can't answer with a prospective analysis either, because it's not ethical in most cases to randomize whether you're removing a body part.

The best we're going to do is a careful case control study (and research in animal models). And the evidence is enough to imply strongly that we should expend a little more effort to avoid removing the thymus.

Re: Turns out lowly thymus may be saving your life

#25

Post by jjtheblunt »

Calavar wrote: post #23

This is a fluff piece. We've known for decades that the thymus is an important part of the immune system. It's not an organ that's been believed to be vestigial, like the appendix. > For the study, Kooshesh mined data from 1,146 adult patients who had undergone thymus removal, alongside demographically matched control patients who had undergone similar surgeries but kept their thymus Sure, you can demographically mat…

Isn't the universally known T cell named with a T because of the thymus which imparts their programming? Like known for decades?

Re: Turns out lowly thymus may be saving your life

#26

Post by anon84873628 »

jjtheblunt wrote: post #25
Calavar wrote: post #23

This is a fluff piece. We've known for decades that the thymus is an important part of the immune system. It's not an organ that's been believed to be vestigial, like the appendix. > For the study, Kooshesh mined data from 1,146 adult patients who had undergone thymus removal, alongside demographically matched control patients who had undergone similar surgeries but kept their thymus Sure, you can demographically mat…

Isn't the universally known T cell named with a T because of the thymus which imparts their programming? Like known for decades?

Yes, but some believed this function was most relevant in adolescence, with the importance fading in adulthood. The purpose of the research is to understand the role of the organ in later age.

Re: Turns out lowly thymus may be saving your life

#27

Post by Calavar »

mlyle wrote: post #24
Calavar wrote: post #23

This is a fluff piece. We've known for decades that the thymus is an important part of the immune system. It's not an organ that's been believed to be vestigial, like the appendix. > For the study, Kooshesh mined data from 1,146 adult patients who had undergone thymus removal, alongside demographically matched control patients who had undergone similar surgeries but kept their thymus Sure, you can demographically mat…

This is a research question you can't answer with a prospective analysis either, because it's not ethical in most cases to randomize whether you're removing a body part. The best we're going to do is a careful case control study (and research in animal models). And the evidence is enough to imply strongly that we should expend a little more effort to avoid removing the thymus.

> This is a research question you can't answer with a prospective analysis either, because it's not ethical to randomize whether you're removing a body part.

But that's exactly what we did with the appendix, multiple times [1, 2].

[1] https://pubmed.ncbi.nlm.nih.gov/26080338/

[2] https://www.nejm.org/doi/full/10.1056/nejmoa2014320

Re: Turns out lowly thymus may be saving your life

#28

Post by anon84873628 »

Calavar wrote: post #23

This is a fluff piece. We've known for decades that the thymus is an important part of the immune system. It's not an organ that's been believed to be vestigial, like the appendix. > For the study, Kooshesh mined data from 1,146 adult patients who had undergone thymus removal, alongside demographically matched control patients who had undergone similar surgeries but kept their thymus Sure, you can demographically mat…

Well, if the study had found no significant correlation, that would have been interesting information. I'll still applaud the researchers on this one.

Re: Turns out lowly thymus may be saving your life

#29

Post by mlyle »

Calavar wrote: post #27
mlyle wrote: post #24

Earlier quoted context omitted.

This is a research question you can't answer with a prospective analysis either, because it's not ethical in most cases to randomize whether you're removing a body part. The best we're going to do is a careful case control study (and research in animal models). And the evidence is enough to imply strongly that we should expend a little more effort to avoid removing the thymus.

> This is a research question you can't answer with a prospective analysis either, because it's not ethical to randomize whether you're removing a body part. But that's exactly what we did with the appendix, multiple times [1, 2]. [1] https://pubmed.ncbi.nlm.nih.gov/26080338/ [2] https://www.nejm.org/doi/full/10.1056/nejmoa2014320

I had thought about this and had amended this to "in most cases" before you posted.

If the standard of care is removing the appendix, and you have a strong reason to believe that something less may be superior, you may be able to conduct a randomized trial.

But any other combination of facts is going to be hard for an IRB to swallow.

Re: Turns out lowly thymus may be saving your life

#30

Post by joe__f »

Calavar wrote: post #23

This is a fluff piece. We've known for decades that the thymus is an important part of the immune system. It's not an organ that's been believed to be vestigial, like the appendix. > For the study, Kooshesh mined data from 1,146 adult patients who had undergone thymus removal, alongside demographically matched control patients who had undergone similar surgeries but kept their thymus Sure, you can demographically mat…

I believe that the appendix is now understood to be a store for gut flora so that the microbiome can regrow after an infection or bad episode of diarrhoea etc.
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