Ensuring anonymity in comparison of institutional performance in large-scale register data using heatmap infused funnel plots

Comparing institutional performance in large-scale register studies while ensuring anonymity poses a challenge in terms of privacy preservation and accuracy of published results. This paper introduces a novel approach that combines heatmaps and funnel plots to address this challenge. Heatmap-infused funnel plots provide a visual representation of institutional performance while protecting privacy of individuals or institutions

Little Evidence for Genetic Susceptibility to Influenza A (H5N1) from Family Clustering Data

The apparent clustering of human cases of influenza A (H5N1) among blood relatives has been considered as evidence of genetic variation in susceptibility. We show that, by chance alone, a high proportion of clusters are expected to be limited to blood relatives when infection is a rare event

Characterisation and prognostic value of tertiary lymphoid structures in oral squamous cell carcinoma

BACKGROUND: Oral squamous cell carcinomas are often heavily infiltrated by immune cells. The organization of B-cells, follicular dendritic cells, T-cells and high-endothelial venules into structures termed tertiary lymphoid structures have been detected in various types of cancer, where their presence is found to predict favourable outcome. The purpose of the present study was to evaluate the incidence of tertiary lymphoid structures in oral squamous cell carcinomas, and if present, analyse whether they were associated with clinical outcome. METHODS: Tumour samples from 80 patients with oral squamous cell carcinoma were immunohistochemically stained for B-cells, follicular dendritic cells, T-cells, germinal centre B-cells and high-endothelial venules. Some samples were sectioned at multiple levels to assess whether the presence of tertiary lymphoid structures varied within the tumour. RESULTS: Tumour-associated tertiary lymphoid structures were detected in 21 % of the tumours and were associated with lower disease-specific death. The presence of tertiary lymphoid structures varied within different levels of a tissue block. CONCLUSIONS: Tertiary lymphoid structure formation was found to be a positive prognostic factor for patients with oral squamous cell carcinoma. Increased knowledge about tertiary lymphoid structure formation in oral squamous cell carcinoma might help to develop and guide immune-modulatory cancer treatments

Presence of tumour high-endothelial venules is an independent positive prognostic factor and stratifies patients with advanced-stage oral squamous cell carcinoma

Accepted manuscript version. The final publication is available at Springer via http://dx.doi.org/10.1007/s13277-015-4036-4Background: Staging of oral squamous cell carcinoma is based on the TNM system, which has been deemed insufficient for prognostic purposes. Hence, better prognostic tools are needed to reflect the biological diversity of these cancers. Previously, high numbers of specialized blood vessels called high-endothelial venules have been reported to be associated with prolonged survival in patients with breast cancer. In this study, we analysed the prognostic value and morphological characteristics of tumour-associated high-endothelial venules in oral cancer. Methods: The presence of tumour-associated high-endothelial venules was evaluated by immunohistochemistry in 75 patients with oral squamous cell carcinoma and analysed with correlation to clinicopathological parameters, patients’ survival, and vessel morphology. Ten of the samples were analysed at multiple levels to evaluate intratumoural heterogeneity. Results: The presence of tumour-associated high-endothelial venules was found to be associated with lower disease-specific death in multivariate regression analyses (P=0.002). High-endothelial venules were present in all (n=53) T1-T2 tumours, but only in two-thirds (n=14) of the T3-T4 tumours. The morphology of high-endothelial venules was heterogeneous and correlated with lymphocyte density. High-endothelial venules were found to be distributed homogeneously within the tumours. Conclusion: We found the presence of tumour-associated high-endothelial venules to be an easy-to-use, robust, and independent positive prognostic factor for patients with oral cancer. Absence of these vessels in advancedstage tumours might identify patients with more aggressive disease. Evaluating the presence of tumour-associated high-endothelial venules might help to tailor the treatment of oral cancer patients to their individual need

Presence of high-endothelial venules correlates with a favorable immune microenvironment in oral squamous cell carsinoma

Oral squamous cell carcinomas (OSCC) are associated with a poor prognosis, which may be partly due to functional impairment of the immune response. Lymphocyte recruitment to the tumor site is facilitated by high-endothelial venules (HEV), whereas expression of programmed-death ligand 1 (PD-L1) can impair T cell function. Thus, we hypothesize that these factors are important in shaping the immune response in OSCC. In the present study, we characterized the immune infiltrate in formalin-fixed, paraffin-embedded tumor samples from 75 OSCC patients. We used immunohistochemistry to determine the distribution of immune cell subsets, HEV and PD-L1, as well as quantitative real-time polymerase chain reaction to assess the expression of inflammatory cytokines and chemokines associated with lymphocyte trafficking. Finally, we calculated correlations between the presence of immune cell subsets, the gene expression patterns, HEV, PD-L1 and the clinicopathological parameters including patient survival. The presence of HEV correlated with increased number of CD3+ T cells and CD20+ B cells, higher levels of the chemokines CXCL12 and CCL21, and lower levels of CCL20, irrespective of the tumors’ T-stage. In univariate analysis, high levels of CD20+ B cells and CD68+ macrophages, positive HEV-status, and low T- and N-stages predicted longer patient survival. However, only the presence of HEV and a low T-stage were independent positive prognosticators. This indicates that HEV are important mediators and a convenient marker of an antitumor immune response in OSCC. Our findings support HEV as a potential immunomodulatory target in OSCC. PD-L1 staining in tumor cells correlated with lower T-stage, increased infiltration of CD4+ cells and higher expression of several inflammation-related cytokines. Thus, OSCC tumors rich in CD4+ cells may preferentially respond to PD-1/PD-L1 blockade therapy

Increased hand washing reduces influenza virus surface contamination in Bangkok households, 2009–2010

Within a hand-washing clinical trial, we evaluated factors associated with fomite contamination in households with an influenza-infected child. Influenza virus RNA contamination was higher in households with low absolute humidity and in control households, suggesting that hand washing reduces surface contamination

A Waterborne Outbreak of Escherichia coli O157:H7 Infections and Hemolytic Uremic Syndrome: Implications for Rural Water Systems1

In the summer of 1998, a large outbreak of Escherichia coli O157:H7 infections occurred in Alpine, Wyoming. We identified 157 ill persons; stool from 71 (45%) yielded E. coli O157:H7. In two cohort studies, illness was significantly associated with drinking municipal water (town residents: adjusted odds ratio=10.1, 95% confidence intervals [CI]=1.8-56.4; visitors attending family reunion: relative risk=9.0, 95% CI=1.3-63.3). The unchlorinated water supply had microbiologic evidence of fecal organisms and the potential for chronic contamination with surface water. Among persons exposed to water, the attack rate was significantly lower in town residents than in visitors (23% vs. 50%, p<0.01) and decreased with increasing age. The lower attack rate among exposed residents, especially adults, is consistent with the acquisition of partial immunity following long-term exposure. Serologic data, although limited, may support this finding. Contamination of small, unprotected water systems may be an increasing public health risk

Transcending disciplines in architecture, structural and building services engineering: A new multidisciplinary educational approach

This paper reflects upon the mechanisms that enable development of curricular approaches to multidisciplinary architecture/engineering higher education. Building upon recent calls for integrated multidisciplinary building design practice, academics at UCL, industry partners and respective professional bodies embarked upon developing a new course that challenged disciplinary boundaries and defined the needs of a new design professional. Whilst there have been attempts internationally to better integrate architecture as well as engineering education, efforts have largely been focused on bolt-on solutions based on pre-existing education programmes. In addition, there has been little discussion (empirical or theoretical) on practical measures associated with developing multidisciplinary education in the built environment. Drawing on mixed data including documentary evidence, semi structured interviews and observations, the study begins to shed light on the approaches underpinning the development of a multidisciplinary built environment MEng course at UCL that integrates architecture, building services and civil engineering. The paper’s contribution is threefold. First, the findings have implications for developing multidisciplinary built environment education curricula, through revealing key mechanisms including the need for shared attitudes and expectations. Second, the paper highlights the conditions that enable the negotiation of multidisciplinary curricula including institutional support, shared values and a collective need and willingness to explore new solutions. Third, the paper reflects upon the value of design studio learning as a critical integrative component to the delivery of multidisciplinary education in the built environment and STEM more widely

Stromal impact on tumor growth and lymphangiogenesis in human carcinoma xenografts

Squamous cell carcinomas (SCCs) arising in the oral cavity are associated with poor survival, mainly due to metastatic disease. In contrast, skin SCCs rarely metastasize and are usually curable. To study influence of tongue and skin stroma on cancer growth and induction of lymphangiogenesis, xenograft tumors of human carcinoma cells were established either in tongue or skin of BALB/c nude mice. Two oral and two skin SCC cell lines were used, as well as an endometrial adenocarcinoma cell line. Tongue tumors established from all cell lines were larger than corresponding skin tumors. Peritumoral lymphatic vessel density was up to five times higher in tongue than in corresponding skin tumors, and mRNA level of the lymphangiogenic growth factor vascular endothelial growth factor (VEGF)-C was twice as high in tongue tumors compared with corresponding skin tumors. Contrary to lymphatic vessel density, blood vessel density was higher in skin tumors than in tongue tumors. In a cohort of patient samples, lymphatic vessel density was found to be higher in tongue SCCs compared with skin SCCs, supporting a clinical relevance of our findings. Our results show that the tumor stroma has a profound impact on cancer growth and induction of lymphangiogenesis and angiogenesis. The difference in lymphatic vessel density between tongue and skin tumors may be important in directing metastatic potential of tumors arising in these organs