Reply: Is CD1a involved in antitumour immune responses during carcinogenesis?

© 2004 Cancer Research UKPresents a response by the authors to a letter to the editor about their article "Is CD1a involved in antitumour immune responses during carcinogenesis?," published in the February 23, 2004 issue of the "British Journal of Cancer"B.J. Coventry and S. Heinze

Is treatment of depression cost-effective in people with diabetes? A systematic review of the economic evidence

PublishedJournal ArticleResearch Support, Non-U.S. Gov'tReviewOBJECTIVES: Depression is common in diabetes and linked to a wide range of adverse outcomes. UK policy indicates that depression should be treated using conventional psychological treatments in a stepped care framework. This review aimed to identify current economic evidence of psychological treatments for depression among people with diabetes. METHOD: Electronic search strategies (conducted in MEDLINE, EMBASE, PsycINFO, CINAHL, NHS EED) combined clinical and economic search terms to identify full economic evaluations of the relevant interventions. Prespecified screening and inclusion criteria were used. Standardized data extraction and critical appraisal were conducted and the results summarized qualitatively. RESULTS: Excluding duplicates, 1,516 studies for co-morbid depression and diabetes were screened. Four economic evaluations were identified. The studies found that the interventions improved health status, reduced depression and were cost-effective compared with usual care. The studies were all U.S.-based and evaluated collaborative care programs that included psychological therapies. Critical appraisal indicated limitations with the study designs, analysis and results for all studies. CONCLUSIONS: The review highlighted the paucity of evidence in this area. The four studies indicated the potential of interventions to reduce depression and be cost-effective compared with usual care. Two studies reported costs per QALY gained of USD 267 to USD 4,317, whilst two studies reported the intervention dominated usual care, with net savings of USD 440 to USD 612 and net gains in patient free days or QALYs

Control and protection sequence for recovery and reconfiguration of an offshore integrated MMC multi-terminal HVDC system under DC faults

AbstractA comprehensive process of the control and protection against a DC fault in a voltage source converter (VSC) based high-voltage direct current (HVDC) system typically includes fault detection, fault isolation and system recovery. Regarding an offshore wind farm (OWF) integrated modular multilevel converter (MMC) based multi-terminal HVDC (MTDC) system with two control paradigms, i.e. master-slave control and droop control under DC faults, this paper presents the fault isolation, including the isolation of the faulted line section, with detailed control and protection sequence, which would be useful for practical engineering. The control and protection sequence at the system recovery/reconfiguration phase is comprehensively investigated, which includes: (1) when to start the recovery/reconfiguration control; (2) the sequence between deblocking the MMCs and reclosing the AC circuit breakers (AC CBs); and (3) the recovery sequence of each HVDC terminal. Based on the analysis of the system characteristics, a preferred recovery/reconfiguration scheme is proposed. Simulation results on the real-time digital simulator (RTDS) validate the proposed scheme and demonstrate the advantages through comparison with a different recovery sequence. The impact of transient and permanent DC faults on the system recovery/reconfiguration control is discussed. In addition, the recovery/reconfiguration control of the MTDC in radial and meshed topologies is compared and demonstrated. Based on the analytical and simulation studies, a general guideline on the recovery/reconfiguration control of MMC MTDC systems is proposed

CD1a expression by Barrett's metaplasia of gastric type may help to predict its evolution towards cancer

As emerging in the recent literature, CD1a has been regarded as a molecule whose expression may reflect tumour evolution. The aim of the present work was to investigate the expression of CD1a in a series of Barrett's metaplasia (BM), gastric type (GTBM), with and without follow-up, in order to analyse whether its expression may help to diagnose this disease and to address the outcome. Indeed, GTBM may be confused sometimes with islets of ectopic gastric mucosa and its evolution towards dysplasia (Dy) or carcinoma (Ca) could not be foreseen. We showed a significant higher expression of CD1a in GTBM than in both Dy and Ca; nevertheless, the number of positive GTBM was significantly lower in the group of cases that at follow-up underwent Dy or Ca. Our data address that CD1a may be a novel biomarker for BM and that its expression may help to predict the prognosis of this pathology

Development and validation of a computational model of the knee joint for the evaluation of surgical treatments for osteoarthritis

A three-dimensional (3D) knee joint computational model was developed and validated to predict knee joint contact forces and pressures for different degrees of malalignment. A 3D computational knee model was created from high-resolution radiological images to emulate passive sagittal rotation (full-extension to 658-flexion) and weight acceptance. A cadaveric knee mounted on a six-degree-of-freedom robot was subjected to matching boundary and loading conditions. A ligamenttuning process minimised kinematic differences between the robotically loaded cadaver specimen and the finite element (FE) model. The model was validated by measured intra-articular force and pressure measurements. Percent full scale error between FE-predicted and in vitro-measured values in the medial and lateral compartments were 6.67% and 5.94%, respectively, for normalised peak pressure values, and 7.56% and 4.48%, respectively, for normalised force values. The knee model can accurately predict normalised intra-articular pressure and forces for different loading conditions and could be further developed for subject-specific surgical planning

CD1a-positive infiltrating-dendritic cell density and 5-year survival from human breast cancer

© Churchill LivingstoneInfiltrating CD1a+ dendritic cells (DCs) have been associated with increased survival in a number of human cancers. This study investigated DC infiltration within breast cancers and the association with survival. Classical established prognostic factors, of tumour size, lymph node status, histological grade, lympho-vascular invasion, the KI-67 (MIB-1) fraction and the Nottingham Prognostic Index (NPI) were also compared. A total of 48 breast cancer patients were followed from the time of surgery and CD1a density analysis for 5 years or until death. Our data set validated previous studies, which show a relationship between survival and the NPI (P<0.001), tumour size (P<0.01) and lymph node status (P<0.05). Although more patients were alive at the 5-year time point in the group with higher CD1a DC density than the lower CD1a DC group, this failed to reach statistical significance at the P=0.05 level. Analysis at 10 years postsurgery is required to investigate the association further.B.J.Coventry and J. Morto

Dendritic cell density and activation status in human breast cancer – CD1a, CMRF-44, CMRF-56 and CD-83 expression

Low CD1a-positive putative dendritic cell numbers in human breast cancer has recently been described and may explain the apparent ‘poor immunogenicity’ previously reported in breast cancer. Little attention has been given to dendritic cell activation within the tumour microenvironment, which is another reason why the in-situ immune response may be severely deficient. We have therefore examined CD1a expression as a marker for dendritic cells, together with CMRF-44 and -56 as markers of dendritic cell activation status, in 40 human breast cancers. The results demonstrate few or no CD1a-positive putative dendritic cells and minimal or no expression of the dendritic cell activation markers. Both dendritic cell number and dendritic cell activation appear substantially deficient in human breast cancers, regardless of tumour histological grade

Towards testing of a second-generation bladed receiver

A bladed receiver design concept is presented which offers a >2% increase in overall receiver efficiency after considering spillage, reflection, emission and convection losses, based on an integrated optical-thermal model, for a design where the working fluid is conventional molten salt operating in the standard 290–565°C temperature range. A novel testing methodology is described, using air and water to test the receiver when molten salt facilities are not available. Technoeconomic analysis shows that the receiver could achieve a 4 AUD/MWhe saving in levelised cost of energy, but only if the bladed receiver design can be implemented at no additional cost