Autologous anti-SOX2 antibody responses reflect intensity but not frequency of antigen expression in small cell lung cancer

Background: Anti-SOX2 antibody responses are observed in about 10 to 20% of small cell lung cancer (SCLC) patients. The aim of this study was to determine whether such responses reflect a particular pattern of SOX2 protein expression in the tumor and whether this pattern associates with clinical outcome. Methods. Paraffin embedded tumor tissues, obtained from SCLC patients who had no evidence of paraneoplastic autoimmune degeneration, were evaluated for SOX2 expression by immunohistochemistry for both intensity and extent of staining. Sera from the same patients were tested for autologous antibodies against recombinant SOX2 by enzyme-linked immunosorbent assay (ELISA). Correlates between overall survival and various clinical parameters including SOX2 staining and serology were determined. Results: SOX2 protein expression was observed in tumor tissue in 89% of patients. Seventeen patients (29%) were seropositive for SOX2 antibodies and, in contrast to SOX2 staining, the presence of antibody correlated with limited disease stage (p = 0.05). SOX2 seropositivity showed a significant association with the intensity of SOX2 staining in the tumor (p = 0.02) but not with the frequency of SOX2 expressing cells. Conclusion: Anti-SOX2 antibodies associate with better prognosis (limited stage disease) while SOX2 protein expression does not; similar to reports from some earlier studies. Our data provides an explanation for this seemingly contrasting data for the first time as SOX2 antibodies can be observed in patients whose tumors contain relatively few but strongly staining cells, thus supporting the possible presence of active immune-surveillance and immune-editing targeting SOX2 protein in this tumor type. © 2014 Atakan et al.; licensee BioMed Central Ltd

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Dyspnoea waking from sleep

IntroductionObstructive sleep apnoea syndrome (OSAS), recurrent upper airway obstruction during sleep, increased respiratory effort against the obstructed airway, and is characterized by frequent sleep fragmentation. Obstructive sleep apnoea syndrome (OSAS) is a syndrome that affects society, in particular accounts for 5% of adults. This syndrome is the most common presenting symptoms of excessive daytime sleepiness and/or is snoring. Obesity, nasal obstruction, adenoid hypertrophy, macroglossia OSAS has been associated with such a large number of predisposing factors.Case63years old, female patient, respiratory arrest and not breathing during sleep at night, was admitted to the emergency room complaining of shortness of breath. History, there was one and a half years since the respiratory arrest during sleep, snoring, morning headaches, which, drowsiness during the day turned out to be complaints. The patient’s physical examination and investigations (chest X-ray, complete blood count, ECG, chest computed tomography) as a result, BMI: 25.4kg/m2, depending on the patient with obesity, obstructive sleep apnoea syndrome (OSAS) was considered. The patient was referred Department of Chest Diseases. Follow-up, the polisomnography (PSG) was also diagnosed with severe OSASDiscussionOSAS, as drivers working people, especially at night, is a disease that leads to serious consequences. Polysomnography is the gold standard for diagnosis and severity of the syndrome, apnoea-hypopnea index (AHI) is determined by; AHI=normal<5 , AHI=5–15 mild, 15–30 moderate AHI and AHI>30 is severe. From repetitive episodes of apnoea increased sympathetic nerve activity, oxidative stress, intrathoracic pressure swings, sudden jumps in systemic blood pressure, hypoxia and hypercapnia. Emergency services waking from sleep dyspnoea, lethargy and fatigue in patients admitted with complaints of snoring and OSAS cannot be forgotten

A comparative study of ozonation, homogeneous catalytic ozonation, and photocatalytic ozonation for C.I. Reactive Red 194 azo dye degradation

In this study, the decolorization, dearomatization, and mineralization efficiencies of different advanced oxidation processes (AOPs; namely O 3, O 3/Fe(II), O 3/Fe(II)/UVA, and O 3/TiO 2/UVA) were investigated for the azo dye C.I. Reactive Red 194 (RR194). The effects of pH (3-11), amount of TiO 2 (0.05-1g/L), and concentration of Fe(II) (0.1-1.6mM) were investigated for the applied methods. The decolorization and mineralization efficiencies of the photocatalytic ozonation system (O 3/TiO 2/UVA) were increased by decreasing the pH of the dye solution in contrast to the ozonation system (O 3). Decolorization of RR194 was increased in the photocatalytic ozonation system with an increasing amount of catalyst however, a decreasing was occurred for the homogeneous catalytic system (O 3/Fe(II)) when increasing the concentration of catalyst. The decolorization efficiency of the homogeneous catalytic system (O 3/Fe(II)) was enhanced when combined with UVA light. In our study, the most efficient method for dearomatization and mineralization was the O 3/TiO 2/UVA among the applied AOPs. © 2011 WILEY-VCH Verlag GmbH &amp; Co. KGaA, Weinheim

Cytokine Responses in Gills of Capoeta umbla as Biomarkers of Environmentalal Pollution

Immunological biomarkers reflect the effects of exposure to environmental contaminants. In this study, the suitability and sensitivity of cytokine responses, interleukin1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) in gill tissues of Capoeta umbla (Heckel, 1843), collected from different regions, as early warning indices of environmental pollution and ecosystem health was evaluated. Fish and water samples were taken from ten stations in March and September 2011 and 2012. Tumor necrosis factor-α, IL-1β and IL-6 levels were determined in samples of the gill tissues by using an ELISA kit. Significant variations of TNF-α, IL-1β and IL-6 levels observed between stations and seasons. The results of this study show that seasonal variations of cytokine responses in gills of Capoeta umbla are sensitive to the contaminants present in Uzuncayir Dam Lake (Tunceli, Turkey) water and are valuable biomarkers for environmental pollution and ecosystem healt