Enhancing Anti-Cancer Immune Response by Acidosis-Sensitive Nanobody Display.

One of the main challenges with many cancer immunotherapies is that biomarkers are needed for targeting. These biomarkers are often associated with tumors but are not specific to a particular tumor and can lead to damage in healthy tissues, resistance to treatment, or the need for customization for different types of cancer due to variations in targets. A promising alternative approach is to target the acidic microenvironment found in most solid tumor types.

Microfluidic measurement of the size and shape of lipid-anchored proteins.

The surface of a cell is crowded with membrane proteins. The size, shape, density, and mobility of extracellular surface proteins mediate cell surface accessibility to external molecules, viral particles, and other cells. However, predicting these qualities is not always straightforward, even when protein structures are known.

Enhancing Anti-Cancer Immune Response by Acidosis-sensitive Nanobody Display.

One of the main challenges with many cancer immuno-therapies is that they depend on biomarkers for targeting. These biomarkers are often associated with tumors but are not specific to a particular tumor, which can lead to damage in healthy tissues, resistance to treatment, and the need for customization for different types of cancer due to the variations in targets. A promising alternative approach is to target the acidic microenvironment found in most solid tumor types.

[Clinical Practice Guidelines for Vaccine Management in Ambulatory Care: a Systematic Review Following the AGREE II Approach].

Background: Breaches in the cooling chain with exposure of vaccines to temperatures outside the target range of +2°C to +8°C may reduce their efficacy and impair immune responses. Following the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach, this review assesses the quality and content of international clinical practice guidelines on vaccine management. The results were used to derive recommendations for the vaccine management in ambulatory care in Germany.

Learning from Latent Safety Threats Identified During Simulation to Improve Patient Safety.

Background: Latent safety threats (LSTs-characteristics of design, processes, or physical environment in health care compromising patient safety) are commonly revealed during simulation-based training. Methods of collecting, analyzing, and classifying LSTs are underdeveloped and not standardized. Building on a large simulation program in one organization, the authors aimed to collect LSTs systematically and develop a taxonomy to classify them.

Short- and long-term follow-up of patients with non-neoplastic esophageal perforation.

Purpose: Esophageal perforation is associated with high morbidity and mortality. In addition to surgical treatment, endoscopic endoluminal stent placement and endoscopic vacuum therapy (EVT) are established methods in the management of this emergency condition. Although health-related quality of life (HRQoL) is becoming a major issue in the evaluation of any therapeutic intervention, not much is known about HRQoL, particularly in the long-term follow-up of patients treated for non-neoplastic esophageal perforation with different treatment strategies.

The Use of Hybrid Lumbar Puncture Simulation to Teach Entrustable Professional Activities During a Medical Student Neurology Clerkship.

This article was migrated. The article was marked as recommended. In 2014, the Association of American Medical Colleges (AAMC) published a list of 13 Entrustable Professional Activities (EPAs) that medical school graduates should be able to perform upon starting residency.

The CARDIA-trial protocol: a multinational, prospective, randomized, clinical trial comparing transthoracic esophagectomy with transhiatal extended gastrectomy in adenocarcinoma of the gastroesophageal junction (GEJ) type II.

Background: Adenocarcinoma of the gastroesophageal junction (GEJ) Siewert type II can be resected by transthoracic esophagectomy or transhiatal extended gastrectomy. Both allow for a complete tumor resection, yet there is an ongoing controversy about which surgical approach is superior with regards to quality of life, oncological outcomes and survival. While some studies suggest a better oncological outcome after transthoracic esophagectomy, others favor transhiatal extended gastrectomy for a better postoperative quality of life.

Software improvement for evaluation of laryngopharyngeal pH testing (Restech) - a comparison between DataView 3 and 4.

Background: When gastroesophageal reflux contents reach above the upper esophageal sphincter, patients may, in addition to typical reflux symptoms, present with atypical, extraesophageal symptoms related to laryngopharyngeal reflux (LPR). Surgical treatment of LPR has shown to lead to 70% symptom improvement, however no gold standard for the diagnosis of LPR exists. In 2007, the Restech Dx-pH was released as a valid method to measure acid exposure above the upper esophageal sphincter.

Transdiaphragmatic herniation after transthoracic esophagectomy: an underestimated problem.

Diaphragmatic transposition of intestinal organs is a major complication after esophagectomy and can be associated with significant morbidity and mortality. This study aims of to analyze a large series of patients with this condition in a single high-volume center for esophageal surgery and to suggest a novel treatment algorithm. Patients who received surgery for postesophagectomy diaphragmatic herniation between October 2003 and December 2017 were included.

Extensive meningeal enhancement in acute central nervous system Lyme: Case series and review of literature.

Introduction: Clinical presentation of the central nervous system Lyme disease is nonspecific and therefore brain imaging and disease-specific serological testing is generally pursued to assist with diagnosis. Brain imaging findings are, however, rare and often unspecific.

Case Description: In the current report, we are presenting a rare magnetic resonance imaging (MRI) finding of extensive meningeal enhancement in two patients with acute Lyme disease.

Generation Y and surgical residency - Passing the baton or the end of the world as we know it? Results from a survey among medical students in Germany.

Introduction: The current student generation have their own expectations toward professional life and pay particular attention to their work-life balance. Less interest in work-intensive specialties leads to a shortage of skilled candidates especially in surgery. In order to motivate students into a surgical residency, new priorities become important.

Late-onset monomelic amyotrophy in a Caucasian woman.

We describe a 53-year-old Caucasian woman with a 19-year history of an evolving amyotrophy confined to her dominant right arm and hand. Although this atypical case of a late-onset monomelic amyotrophy in some respects mimics Hirayama disease or O'Sullivan-McLeod syndrome, it does not conform precisely with either of those disorders. We compare this individual's difficulties and clinical temporal profile to other disorders considered in the differential diagnoses with regard to her evolving clinical setting.

Frequency and predictors of stroke death in 5,888 participants in the Cardiovascular Health Study.

Background: Few population-based studies have examined in detail issues of stroke-related deaths in elderly people.

Methods: Participants in the Cardiovascular Health Study (CHS) are 65 years of age or older, have had extensive baseline evaluations, and have been followed-up for fatal and nonfatal cardiovascular and cerebrovascular disease outcomes. Investigators adjudicated these outcomes and classified strokes by types and subtypes.

Measurement of hemostatic indexes in conjunction with transcranial doppler sonography in patients with ventricular assist devices.

Background And Purpose: Clinical thromboembolism (TE) remains an impediment to the chronic application of ventricular assist devices (VADs). Microembolic signals (MES) have been detected by transcranial Doppler ultrasound (TCD) in patients with VADs, although their origin and relation to TE remain undefined. We have investigated the hypothesis that hemostatic alterations are related to MES and that MES are associated with TE in a group of 27 VAD patients.

Oral anticoagulation in patients with atrial fibrillation: adherence with guidelines in an elderly cohort.

Purpose: To determine adherence with practice guidelines in a population-based cohort of elderly persons aged 70 years or older with atrial fibrillation.

Subjects And Methods: This was a cross-sectional analysis of a subgroup of participants in the Cardiovascular Health Study, a prospective observational study involving four communities in the United States. Subjects were participants with atrial fibrillation on electrocardiogram at one or more yearly examinations from 1993 to 1995.

Relationships of cerebral MRI findings to ultrasonographic carotid atherosclerosis in older adults : the Cardiovascular Health Study. CHS Collaborative Research Group.

Cerebral magnetic resonance imaging (MRI) has demonstrated a high prevalence of infarct-like lesions, white matter hyperintensities, and evidence of cerebral atrophy in older adults. While these findings are generally believed to be related to ischemia and atherosclerosis, their relationship to atherosclerosis in the carotid arteries remains to be explored. Study subjects were part of the multicenter Cardiovascular Health Study, a cross-sectional study of 3502 women and men >/=65 years of age undergoing cranial MRI and carotid ultrasonography.

Prevalence and associations of MRI-demonstrated brain infarcts in elderly subjects with a history of transient ischemic attack. The Cardiovascular Health Study.

Background And Purpose: MRI is more sensitive than CT, but the significance of brain abnormalities seen on MR images obtained in older subjects with transient ischemic attack (TIA) is not clear. We studied the prevalence and risk factors associated with MRI-demonstrated infarcts in elderly subjects with a history of TIA.

Methods: Participants of the Cardiovascular Health Study, aged 65 years or more and without prior stroke, were studied with brain MRI (n=3456).

Natural history, prognosis, and lipid abnormalities of idiopathic ischemic childhood stroke.

A study was performed to assess the natural history, prognostic factors, and lipid and apolipoprotein abnormalities of idiopathic ischemic childhood stroke. A case series of 42 children, retrospectively identified with idiopathic ischemic strokes, were reassessed an average of 7.4 years (range, 1 to 19 years) after presentation.

MR findings in listerial rhombencephalitis.

We describe a case of listerial rhombencephalitis in a previously healthy 40-year-old man. The diagnosis was based on the clinical findings, results of cerebrospinal fluid analysis, blood culture, and MR imaging findings. The treatment was started before culture results were available, and the patient had a full clinical recovery.

Cerebrovascular disease in women.

Cerebrovascular disease is one of the leading causes of death in women in the United States. Pregnancy and hormonal therapy have been associated with an increased risk of stroke in young women. Other conditions, more common in women, such as migraine headaches, rheumatologic disorders and antiphospholipid antibodies predispose women to cerebral ischemia.

Auditory stimulation effect on a comatose survivor of traumatic brain injury.

The purposes of this case study were (1) to determine whether a comatose patient responded differentially to four types of auditory stimuli--voices of family members and friends, classical music, popular music, and nature sounds--and (2) to determine what physiological measures and behavioral observations best captured changes in responsiveness. The patient participated in 28 sessions that were videotaped for later behavioral analysis. During all sessions, measures were taken of pulse rate, respiration rate, and skin resistance.

Etiology of stroke in Broca's aphasia.

We reviewed clinical and diagnostic data from 36 patients with Broca's aphasia due to stroke who were evaluated at the University of Iowa Hospitals and Clinics between 1982 and 1989. The group consisted of 20 women and 16 men, aged 28-80 (median, 63.5; mean, 57.