The Value of Autofluorescence Bronchoscopy Combined with White Light Bronchoscopy Compared with White Light Alone in the Diagnosis of Intraepithelial Neoplasia and Invasive Lung Cancer: A Meta-Analysis

ObjectiveTo compare the accuracy of autofluorescence bronchoscopy (AFB) combined with white light bronchoscopy (WLB) versus WLB alone in the diagnosis of lung cancer.MethodsThe Ovid, PubMed, and Google Scholar databases from January 1990 to October 2010 were searched. Two reviewers independently assessed the quality of the trials and extracted data. The relative risk for sensitivity and specificity on a per-lesion basis of AFB + WLB versus WLB alone to detect intraepithelial neoplasia and invasive cancer were pooled by Review Manager.ResultsTwenty-one studies involving 3266 patients were ultimately analyzed. The pool relative sensitivity on a per-lesion basis of AFB + WLB versus WLB alone to detect intraepithelial neoplasia and invasive cancer was 2.04 (95% confidence interval [CI] 1.72–2.42) and 1.15 (95% CI 1.05–1.26), respectively. The pool relative specificity on a per-lesion basis of AFB + WLB versus WLB alone was 0.65 (95% CI 0.59–0.73).ConclusionsAlthough the specificity of AFB + WLB is lower than WLB alone, AFB + WLB seems to significantly improve the sensitivity to detect intraepithelial neoplasia. However, this advantage over WLB alone seems much less in detecting invasive lung cancer

Prevalence of lymph node metastases in superficial esophageal squamous cell carcinoma

ObjectiveEndoscopic treatment of superficial esophageal carcinoma has been increasingly conducted around the world. Because no lymph nodes are removed in such a procedure, the risk of lymph node metastases (LNMs) should be clearly understood. The aim of the present study was to accurately clarify the pattern of lymphatic spread in patients with superficial esophageal squamous cell carcinoma and analyze the factors potentially related to LNMs.MethodsThe pattern of lymphatic spread was studied in 189 patients who had undergone radical lymphadenectomy from 2006 to 2011. The risk factors associated with LNMs were determined by multivariate logistic regression analysis. According to the depth of tumor invasion, mucosal tumors were classified as M1, M2, and M3 and submucosal tumors as SM1, SM2, and SM3.ResultsA total of 4252 lymph nodes were resected (average, 23 ± 9; range, 12-68). LNMs occurred in 49 patients (25.9%). The frequency of LNMs was 4.3% in those with mucosal and 33.1% in those with submucosal cancer. LNMs were found in 0%, 0%, 11.8%, 24.0%, 20.5%, and 43.8% of the M1, M2, M3, SM1, SM2, and SM3 cancer, respectively. For submucosal cancer, SM3 cancer (P = .006) and lymphovascular invasion (P = .001) were significant independent risk factors for LNMs. Paratracheal nodes were the most frequently involved. “Skip” metastases occurred in 20 of 49 patients (40.8%).ConclusionsEndoscopic treatment can be attempted when the tumor is limited to the lamina propria mucosa. However, 2-field radical lymphadenectomy with careful upper mediastinal lymph node resection should be conducted for submucosal squamous cell carcinoma

Can Determination of Circulating Endothelial Cells and Serum Caspase-Cleaved CK18 Predict for Response and Survival in Patients with Advanced Non–Small-Cell Lung Cancer Receiving Endostatin and Paclitaxel–Carboplatin Chemotherapy? A Retrospective Study

Introduction:Early prediction of the efficacy of a combination of an antiangiogenic drug with cytotoxic chemotherapy is a significant challenge. In that regard, circulating endothelial cells (CECs) and cytokeratins (CKs) seem to reflect their roles in both tumor angiogenesis and tumor cell death.Methods:Patients with advanced, previously untreated non–small-cell lung cancer were randomly assigned to an endostatin treatment group (paclitaxel + carboplatin + endostatin) and a control group (paclitaxel + carboplatin + placebo). A total of 122 patients were evaluated, of whom 107 had measurements of blood CECs, CK8, caspase-cleaved CK18 (ccCK18), and uncleaved CK18 (CK18) before and at weeks 3 and 6 of treatment, respectively.Results:Higher baseline CECs in patients with a tumor response (partial remission + stable disease, p = 0.002 for the entire group; p = 0.000 for the treatment group) were observed. The number of CECs decreased significantly after endostatin treatment (p = 0.000), whereas CK levels increased. Increased levels of ccCK18 and CK18, but not CK8, reached significance (p = 0.001 and p = 0.048, respectively) when compared with the baseline. Tumor response showed a strong correlation with reduction of CECs (p = 0.000) and increase of ccCK18 (p = 0.040) after endostatin therapy. Cutoff values of changes of CECs and ccCK18 for prediction of survival were 0.58/μl and 19.6 ng/ml, respectively. Reduction of CECs and increase of ccCK18 significantly correlated with longer median survival (p = 0.013 and p = 0.016 for progression-free survival; p = 0.009 and p = 0.012 for overall survival, respectively).Conclusions:CECs and CKs could be biomarkers for selecting patients with non–small-cell lung cancer who will benefit from treatment with endostatin in combination with paclitaxel plus carboplatin

Neurochemical characterization of brainstem Pro-opiomelanocortin cells

Financial Support: Work was supported by the Wellcome Trust (WT081713, WT098012 and 204815/Z/16/Z to LKH; 093566/Z/10/A to LKH/LKB), the Biotechnology and Biological Sciences Research Council (BB/K001418/1, BB/NO17838/1 to LKH), and the Medical Research Council (MRC; MC/PC/15077 to LKH). The Genomics and Transcriptomics Core facility utilized was supported by the MRC (MRC_MC_UU_12012/5) and Wellcome Trust (100574/Z/12/Z).Peer reviewedPublisher PD

Systemic Therapy of Bronchioloalveolar Carcinoma: Results of the First IASLC/ASCO Consensus Conference on Bronchioloalveolar Carcinoma

Introduction:Bronchioloalveolar carcinoma (BAC) is a subtype of adenocarcinoma of the lung with unique pathological, clinical, and molecular characteristics.Methods:This consensus conference group reviewed studies performed specifically in BAC and data from patients with BAC who were included in clinical trials of all non–small-cell lung cancer (NSCLC) subtypes.Results:Although BAC as defined by the World Health Organization represents less than 5% of adenocarcinomas, as many as 20% of adenocarcinomas have BAC features. These latter tumors are more likely to have mutations in the epidermal growth factor receptor (EGFR) gene and to be sensitive to the EGFR tyrosine kinase inhibitors gefitinib and erlotinib. Although most patients are men and have a history of smoking cigarettes, proportionally more are women and never smokers. Patients with BAC are routinely treated with drugs and regimens appropriate for patients with all subtypes of adenocarcinoma of the lung; four studies have been performed specifically in this disease.Conclusions:There is insufficient evidence to confirm or refute the assertion that the sensitivity of BAC to chemotherapy is different from that of other lung cancer histologic types. The unique clinical and molecular characteristics associated with BAC led this panel to conclude that future clinical trials should be designed specifically for persons with BAC. Recommendations for trial design and research questions are proposed

Causes and differentials of childhood mortality in Iraq

<p>Abstract</p> <p>Background</p> <p>Limited information is available in Iraq regarding the causes of under-five mortality. The vital registration system is deficient in its coverage, particularly from rural areas where access to health services is limited and most deaths occur at home, i.e. outside the health system, and hence the cause of death goes unreported. Knowledge of patterns and trends in causes of under-five mortality is essential for decision-makers in assessing programmatic needs, prioritizing interventions, and monitoring progress. The aim of this study was to identify causes of under-five children deaths using a simplified verbal autopsy questionnaire.</p> <p>The objective was to define the leading symptoms and cause of death among Iraqi children from all regions of Iraq during 1994–1999.</p> <p>Methods</p> <p>To determine the cause structure of child deaths, a simplified verbal autopsy questionnaire was used in interviews conducted in the Iraqi Child & Maternal Mortality Survey (ICMMS) 1999 national sample. All the mothers/caregivers of the deceased children were asked open-ended questions about the symptoms within the two weeks preceding death; they could mention more than one symptom.</p> <p>Results</p> <p>The leading cause of death among under-five children was found to be childhood illnesses in 81.2%, followed by sudden death in 8.9% and accidents in 3.3%. Among under-five children dying of illnesses, cough and difficulty in breathing were the main symptoms preceding death in 34.0%, followed by diarrhea in 24.4%. Among neonates the leading cause was cough/and or difficulty in breathing in 42.3%, followed by sudden death in 11.9%, congenital abnormalities in 10.3% and prematurity in 10.2%. Diarrhea was the leading cause of death among infants in 49.8%, followed by cough and/or difficulty in breathing in 26.6%. Among children 12–59 months diarrhea was the leading cause of death in 43.4%, followed by accidents, injuries, and poisoning in 19.3%, then cough/difficulty in breathing in 14.8%.</p> <p>Conclusion</p> <p>In Iraq Under-five child mortality is one of the highest in the Middle East region; deaths during the neonatal period accounted for more than half of under-five children deaths highlighting an urgent need to introduce health interventions to improve essential neonatal care. Priority needs to be given to the prevention, early and effective treatment of neonatal conditions, diarrheal diseases, acute respiratory infections, and accidents. This study points to the need for further standardized assessments of under-5 mortality in Iraq.</p

Data for wetlandscapes and their changes around the world

Geography and associated hydrological, hydroclimate and land-use conditions and their changes determine the states and dynamics of wetlands and their ecosystem services. The influences of these controls are not limited to just the local scale of each individual wetland but extend over larger landscape areas that integrate multiple wetlands and their total hydrological catchment – the wetlandscape. However, the data and knowledge of conditions and changes over entire wetlandscapes are still scarce, limiting the capacity to accurately understand and manage critical wetland ecosystems and their services under global change. We present a new Wetlandscape Change Information Database (WetCID), consisting of geographic, hydrological, hydroclimate and land-use information and data for 27 wetlandscapes around the world. This combines survey-based local information with geographic shapefiles and gridded datasets of large-scale hydroclimate and land-use conditions and their changes over whole wetlandscapes. Temporally, WetCID contains 30-year time series of data for mean monthly precipitation and temperature and annual land-use conditions. The survey-based site information includes local knowledge on the wetlands, hydrology, hydroclimate and land uses within each wetlandscape and on the availability and accessibility of associated local data. This novel database (available through PANGAEA https://doi.org/10.1594/PANGAEA.907398; Ghajarnia et al., 2019) can support site assessments; cross-regional comparisons; and scenario analyses of the roles and impacts of land use, hydroclimatic and wetland conditions, and changes in whole-wetlandscape functions and ecosystem services

Lee Strasberg's Method

Lee Strasberg (1901–1982) is a divisive figure whose method of acting is often misunderstood. Few people really know what it is or how it works, or what is its true relationship to the Stanislavski System. This is due to a number of misconceptions about the nature of his training with its emphasis on the development of the sensory imagination. This paper aims to challenge some of the myths about the Method, and to clarify Strasberg’s unique contribution to actor training

Kuhnian revolutions in neuroscience: the role of tool development.

The terms "paradigm" and "paradigm shift" originated in "The Structure of Scientific Revolutions" by Thomas Kuhn. A paradigm can be defined as the generally accepted concepts and practices of a field, and a paradigm shift its replacement in a scientific revolution. A paradigm shift results from a crisis caused by anomalies in a paradigm that reduce its usefulness to a field. Claims of paradigm shifts and revolutions are made frequently in the neurosciences. In this article I will consider neuroscience paradigms, and the claim that new tools and techniques rather than crises have driven paradigm shifts. I will argue that tool development has played a minor role in neuroscience revolutions.The work received no fundin