ASO Visual Abstract: Metastasectomy or Stereotactic Body Radiation Therapy With or Without Systemic Therapy for Oligometastatic Esophagogastric Cancer

Annals of Surgical Oncology -     

When a child says 'no': experiences of nurses working with children having invasive procedures

Experiencing invasive medical procedures can be a devastating experience for some children and their parents. The potential impact on staff who perform the procedure and who may have to restrain the child who is unwilling to have an essential procedure is a neglected area of research. Children's distress and their coping are affected by those around them so it is important to understand how nurses react in these situations. AIM: To explore the experiences of nursing staff involved in facilitating invasive procedures for children who do not want them. METHOD: Participants were selected at random from staff lists of one hospital in the West Midlands. Data collection was undertaken using unstructured qualitative interviews with ten paediatric nurses and in two focus groups. Theories generated from each interview were tested and validated with participants in subsequent interviews and then in the focus groups. FINDINGS: The most common experiences reported by the participants were 'getting upset' and 'getting stressed' by some aspect of the medical procedure, either because the child or parents became upset or the procedure had gone wrong in some way. Procedural protocols that exist to protect children, for example, by limiting the number of unsuccessful attempts to undertake the procedure, also protect staff by providing a framework to manage emotions during the procedure. Being able to explain the process and need for the procedure to the child and parents, obtaining consent where possible for the use of certain techniques, such as restraint, and having the time to adequately prepare a child for a procedure, all helped minimise the likelihood of an unsuccessful procedure, thereby reducing the risk of the nurse being emotionally affected by a distressed child. CONCLUSION: Nurses working with children who are unwilling to undergo invasive procedures experience negative emotions but these are short lived due to a combination of protective factors and coping strategies. Further research is needed to understand the experiences of medical staff and of nurses working outside paediatric environments who may not experience the same support and protection as those in paediatric settings.     

The expression of B cell surface receptors. III. The murine low-affinity IgE Fc receptor is not expressed on Ly 1 or 'Ly 1-like' B cells.

The distribution of IgE FcR (Fc epsilon R)-positive and -negative B cells was examined in normal adult mice. Using three-color flow cytometry, the expression of the Fc epsilon R was analyzed on various B-cell subsets present in the peritoneum and spleen. The results demonstrate that in the peritoneal cavity, the Fc epsilon R is not expressed on the large majority of Ly 1+ B cells and Ly 1-, Mac 1+ sister B cells. The receptor is present, however, on the small number of conventional B cells residing in the peritoneum. Although interleukin 4 (IL-4) can increase the levels of the Fc epsilon R on conventional B cells, incubation of Ly 1 and sister B cells with IL-4 did not result in the expression of the Fc epsilon R. When examining B cells present in the spleen, a small subset of B cells was consistently found to be Fc epsilon R-. These Fc epsilon R- cells were IgM-bright, IgD-dull and largely Ly 1- and Mac 1-negative. Staining of splenic tissue sections revealed that the Fc epsilon R- B cells were primarily localized to the marginal zones, whereas the Fc epsilon R+ B cells were found in the follicles. Taken together, the results indicate that the Fc epsilon R may be a useful marker in delineating the various B-cell subsets. In the peritoneum, the Fc epsilon R appears to discriminate conventional B cells from those of the Ly 1/sister lineage, and in the spleen it is likely to distinguish resting follicular B cells from Ly 1/sister and marginal zone B cells.     

B lymphocyte differentiation in the rat: production and characterization of monoclonal antibodies to B lineage-associated antigens

Three mouse monoclonal antibodies (mAb) directed against rat B lineage antigens were produced. The mAb, designated HIS14 (IgG1), HIS22 (IgM) and HIS24 (IgG2b), were characterized for binding to lymphoid and nonlymphoid tissues by immunoperoxidase staining of frozen sections and by (double-) immunofluorescence staining of single cell suspensions from lymphoid organs. HIS14 recognized a pan B cell determinant: it reacted with virtually all cells of each anatomic B cell compartment and with about 95% of surface (s)Ig+ cells in thoracic duct lymph and in suspensions of spleen and lymph nodes. HIS22 and HIS24 detected B lineage-associated antigens expressed by major subpopulations of B cells. HIS22 predominantly stained the lymphocyte corona, but not (or weakly) the germinal centers and splenic marginal zones, whereas HIS24 reacted with both corona and germinal center and not (or weakly) with marginal zone. In accordance with this, substantial proportions of sIg+ cells in spleen cell suspensions did not express HIS22 or HIS24 determinants (20% and 27%, respectively). In bone marrow the vast majority of cytomplasmic mu+ pre-B cells were HIS14+ and HIS24+, and up to one third also HIS22+, indicating an appearance of the determinants early in B lymphocytopoiesis. The antigens recognized by HIS14, HIS22 and HIS24 are lost during the final stage of B cell differentiation: none of the mAb bound to plasma cells. As far as detectable, neither cells of myeloid and erythroid lineages in bone marrow nor thymocytes were stained by HIS14, HIS22, or HIS24. In suspensions of peripheral lymphoid organs (spleen and lymph nodes) but not in thoracic duct lymph, HIS14 and HIS24 labeled a small proportion (12% and 14%, respectively) of Ig- cells. HIS22 did not bind to Ig- peripheral lymphocytes. Reactivity of HIS14, HIS22 and HIS24 with nonlymphoid tissues was virtually absent; HIS22 stained the high endothelial venules in lymph nodes and Peyer's patches. As determined by immunoblotting, the antigenic determinants on lymph node cells recognized by HIS14, HIS22 and HIS24 were present on molecules with an apparent molecular mass of 205 kDa, 210 (and 175) kDa and 205 kDa, respectively, which is similar to the molecular mass of the B cell form of the rat leukocyte common antigen. In addition, the antigens recognized by HIS14, HIS22 and HIS24 co-capped with the leukocyte common antigen. This suggests that each of the three mAb recognize determinants present on the B cell form of the leukocyte common antigen.     

Many of the IgA producing plasma cells in murine gut are derived from self-replenishing precursors in the peritoneal cavity

Long term B lineage chimeras are used here to study the originof plasma cells in the mouse. Chlmeric mice are constructedby reconstituting lethally irradiated mice with peritoneal cells(PerC) and bone marrow cells from congenic pairs of mice differingIn Igh-C allotype. All conventional B cells in these mice expressthe allotype of the bone marrow donor and nearly all Ly-1 Blineage cells express the allotype of the PerC donor. FACS analysisand immunohistology of these mice shows that virtually all (sig⁺)B cells in peripheral lymphoid organs are derived from the bonemarrow donor. However, despite this overwhelming number of bonemarrow-derived B cells in these animals, immunohistologicalstaining of lymphold organs and gut shows that nearly half ofthe IgM, IgG, and IgA plasma cells derive from the PerC donor.These data demonstrate that the peritoneal cavity contains amajor reservoir of self-replenishing cells that play a significantrole in the mucosal immune response. The possibility that theseare B cells that belong to the Ly-1 B lineage is discussed.     

Postpartum amenorrhoea-galactorrhoea associated with hyperprolactinaemia and pituitary enlargement in primary hypothyroidism

We report a 36-year-old woman with primary hypothyroidism revealed by postpartum amenorrhoea-galactorrhoea associated with hyperprolactinaemia and suprasellar pituitary enlargement on magnetic resonance imaging (MRI). On thyroid hormone replacement therapy all clinical, biochemical, radiological and endocrine abnormalities disappeared. Hyperplasia of pituitary thyrotrophs and/or lactotrophs seems to be responsible for the pituitary enlargement seen on MRI.     

Use of E mu-PIM-1 transgenic mice short-term in vivo carcinogenicity testing: lymphoma induction by benzo[a]pyrene, but not by TPA

E mu-pim-1 transgenic mice are predisposed to develop lymphomas. Due to their low spontaneous tumour incidence and their increased sensitivity towards the lymphomagen ethylnitrosourea these mice may present an interesting model for short-term carcinogenicity testing. Here, we report on the further exploration of this transgenic mouse model with two additional carcinogens known to have, among others, the lymphohaematopoietic system as target, i.e. benzo[a]pyrene (B[a]P) and 12-O-tetradecanoylphorbol-13-acetate (TPA). B[a]P, given three times a week (by gavage) for 13 weeks at 4.3, 13 or 39 mg/kg body weight, resulted in a dose-related increase in lymphomas up to a 90% incidence in E(mu)-pim-1 mice during the observation period of 40 weeks. B[a]P also induced tumours of the forestomach within this observation period, though at a lower incidence and apparently equally effective in wildtype and transgenic mice. TPA, on the other hand, was unable to induce lymphomas (or tumours in any other organ) in either transgenic or wildtype animals within the observation period of 44 weeks, when applied dermally at the maximum tolerated dose of 3 microg/mouse, twice a week for 35 weeks. Molecular analysis showed that B[a]P-induced lymphomas in transgenic mice were of T-cell origin, 80% of which had elevated levels of c-myc expression. None of the lymphomas had increased N-myc expression and mutation analysis of the ras-gene family revealed a K-ras mutation in only one out of eight tumours investigated. Also, none of the lymphomas showed aberrant expression of p53 as determined by immunohistochemistry. It is concluded that the E mu-pim-1 mouse model will not be very suitable for short-term carcinogenicity testing in general: only genotoxic chemicals that have the lymphohaematopoietic system as target for carcinogenesis in wild- type mice, appear to be efficiently identified.      

Intriguing issues of EGFR targeting in head and neck cancer

We have read the recent comprehensive review by Cruz et al.[1] regarding the targeting of receptor tyrosine kinases andtheir therapeutic perspectives in head and neck squamous cellcarcinomas (HNSCC). The major focus of this report was epidermalgrowth factor receptor (EGFR) biology and targeting. However,we feel