Ex vivo development of functional human lymph node and bronchus-associated lymphoid tissue

We introduce a novel in vivo model of human mucosal immunity, based on the implantation of human fetal bronchial mucosa and autologous peribronchial lymph node (PLN) in the severe combined immunodeficiency (SCID) mouse. In the SCID host, human fetal bronchi implanted alone retain macrophages and mast cells but lose T cells. In contrast, fetal bronchi co-implanted with PLN contain, in addition to macrophages and mast cells, numerous T cells and B cells, often clustered in intramucosal bronchus-associated lymphoid tissue (BALT). Functionally, bronchus-PLN cografts are able to mount robust alphabeta and gammadelta T-cell-mediated immune responses to Pseudomonas aeruginosa and 3,4-epoxy-3-methyl-1-butyl-diphosphate challenges. No other autologous lymphoid organ (bone marrow, thymus, liver) allows for BALT development in co-implanted bronchi, which suggests special ontogenetic and functional relations between extramucosal PLN and intramucosal BALT. Overall, the bronchus-PLN cograft appears as a promising model for human bronchial immune development and function. Our study is the first to document long-term ex vivo maintenance of functional human lymph nodes as native appendices to mucosal tissue. Our results, therefore, suggest a simple strategy for developing similar experimental models of human immune function in other mucosae.     

Electrogram-guided isolation of the left superior vena cava for treatment of atrial fibrillation.

AIMS: Radiofrequency ablation targeting the pulmonary veins offers potential cure for patients with symptomatic paroxysmal atrial fibrillation (AF). Initiating ectopics can also arise from other sites including the major thoracic veins, vein of Marshall and more rarely, persistent left superior vena cava (LSVC). We report our experience with arrhythmogenic persistent LSVC initiating AF. METHODS AND RESULTS: The LSVC was present in four patients from an overall series of 204 patients undergoing AF ablation at our centre. All were males, mean age 50 +/- 11 years. All patients underwent pre-procedure transesophageal echocardiography. The mapping of the LSVC was performed with a circumferential mapping catheter following pulmonary vein isolation. Atrial ectopics from the LSVC were observed to initiate AF. Catheter ablation (power controlled mode; 65 degrees C and 30 W at irrigation flow rate of 30 mL/min) resulted in electrical isolation of the LSVC in all patients and was accompanied by termination of AF in one of four patients. There were no complications. All patients underwent multiple procedures (three procedures in one patient, two procedures in three patients). After a mean follow-up of 18 +/- 7 months (range 7-24 months), three of the four patients remained free of AF off antiarrhythmic medications. CONCLUSION: Arrhythmogenic foci within persistent LSVC can result in AF despite electrical isolation of pulmonary veins. This report demonstrates the importance of the LSVC as a potential source of atrial ectopics initiating and perpetuating AF.     

Factors Related to Employers’ Intent to Hire,Retain and Accommodate Cancer Survivors: The Singapore Perspective

Purpose Despite the growing importance of cancer and return-to-work issues in occupational rehabilitation literature in the last decade, academic discussion is largely limited to survivors’ perspectives and some exploratory studies from the employer side. This paper applies two classic theoretical models—Theory of Planned Behavior and Social Cognitive Theory—and key measures from previous studies to identify explicit relationships that explain employer factors to hire and retain cancer survivors. Methods Data were collected from online surveys with senior management executives and senior human resource specialists from various organizations in Singapore, with a total of 145 responses. The 72-item survey instrument included a series of independent variables: (1) Attitudes toward cancer and cancer survivors; (2) Employers’ efficacy; (3) Perceived moral obligation; (4) Employers’ experience; (5) Outcome expectations; (6) Employment situation; (7) Social norms; and (8) Incentives, and dependent variables: (a) Employers’ intention to hire cancer survivors; and (b) Employers’ intention to retain cancer survivors. Results Regression analyses showed that the top three factors related to employers’ intention to retain cancer survivors are perceived moral obligations (β = .39, p < .001), followed by attitudes toward cancer (β = .25, p < .01), and employment situation (β = .17, p < .05). Employers’ efficacy was associated with intention to hire (β = .22, p < .05), coupled with attitude toward cancer survivors (β = .22, p < .01). The findings also indicated the important role of existing relationship between an employer and an employee when it comes to retaining cancer survivors and government incentives for hiring cancer survivors in the workforce. Conclusions The present study provided an avenue to implement the proposed model—a potential study framework for the management of cancer survivors at work. Findings revealed that different messages should be tailored to employers toward hiring and retention issues and provided useful guidelines for employer education materials.     

Influenza-Associated Hospitalizations,Singapore, 2004–2008 and 2010–2012

Studies of influenza-associated hospitalizations in tropical settings are lacking. To increase understanding of the effect of influenza in Singapore, we estimated the age-specific influenza-associated hospitalizations for pneumonia and influenza during 2004–2008 and 2010–2012. The rate of hospitalization was 28.3/100,000 person-years during 2004–2008 and 29.6/100,000 person-years during 2010–2012. The age-specific influenza-associated hospitalization rates followed a J-shaped pattern: rates in persons >75 years of age and in children <6 months of age were >47 times and >26 times higher, respectively, than those for persons 25–44 years of age. Across all ages during these 2 study periods, ≈12% of the hospitalizations for pneumonia and influenza were attributable to influenza. The rates and proportions of hospitalizations for influenza, particularly among the very young and the elderly, are considerable in Singapore and highlight the importance of vaccination in protecting populations at risk.     

What are the Health Needs, Familial and Social Problems of Thai Migrants in a Local Community in Australia? A Focus Group Study

This study explored the health needs, familial and social problems of Thai migrants in a local community in Brisbane, Australia. Five focus groups with Thai migrants were conducted. The qualitative data were examined using thematic content analysis that is specifically designed for focus group analysis. Four themes were identified: (1) positive experiences in Australia, (2) physical health problems, (3) mental health problems, and (4) familial and social health problems. This study revealed key health needs related to chronic disease and mental health, major barriers to health service use, such as language skills, and facilitating factors, such as the Thai Temple. We concluded that because the health needs, familial and social problems of Thai migrants were complex and culture bound, the development of health and community services for Thai migrants needs to take account of the ways in which Thai culture both negatively impacts health and offer positive solutions to problems.     

Long-term outcomes in children with swallowing dysfunction

Purpose: To evaluate swallowing function using a videofluoroscopic swallow study (VFSS), and to identify factors related to long-term swallowing function in children with swallowing dysfunction.

Methods: Ninety children, aged 1–120 months (mean 27.5 months) were randomly selected from among children referred for the evaluation of swallowing dysfunction. We retrospectively reviewed the charts, and long-term outcomes were tracked up to 5 years.

Results: Baseline American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) scale was 3.4?±?2.5. Supraglottic penetration and subglottic aspiration comfirmed by VFSS were detected in 30 children. After follow-up, oral feeding was possible in 74 patients, and the ASHA NOMS swallowing scale improved significantly, from 3.4?±?2.5 to 5.8?±?2.0. Baseline VFSS severity, serum albumin concentration, baseline weight percentile and neurologic conditions were significantly correlated with long-term swallowing function.

Conclusions: The long-term outcomes in children with swallowing dysfunction were favorable, and baseline videofluoroscopic severity was significantly correlated with long-term swallowing function.     

Standards for Endovascular Neurosurgical Training and Certification of the Society of Korean Endovascular Neurosurgeons 2013

The need for standard endovascular neurosurgical (ENS) training programs and certification in Korea cannot be overlooked due to the increasing number of ENS specialists and the expanding ENS field. The Society of Korean Endovascular Neurosurgeons (SKEN) Certification Committee has prepared training programs and certification since 2010, and the first certificates were issued in 2013. A task force team (TFT) was organized in August 2010 to develop training programs and certification. TFT members researched programs and systems in other countries to develop a program that best suited Korea. After 2 years, a rough draft of the ENS training and certification regulations were prepared, and the standard training program title was decided. The SKEN Certification Committee made an official announcement about the certification program in March 2013. The final certification regulations comprised three major parts: certified endovascular neurosurgeons (EN), certified ENS institutions, and certified ENS training institutions. Applications have been evaluated and the results were announced in June 2013 as follows: 126 members received EN certification and 55 hospitals became ENS-certified institutions. The SKEN has established standard ENS training programs together with a certification system, and it is expected that they will advance the field of ENS to enhance public health and safety in Korea.     

Idiopathic Hypertrophic Spinal Pachymeningitis with an Osteolytic Lesion

Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a chronic, progressive, inflammatory disorder characterized by marked fibrosis of the spinal dura mater with unknown etiology. According to the location of the lesion, it might induce neurologic deficits by compression of spinal cord and nerve root. A 58-year old female with a 3-year history of progressive weakness in both lower extremities was referred to our institute. Spinal computed tomography (CT) scan showed an osteolytic lesion involving base of the C6 spinous process with adjacent epidural mass. Magnetic resonance imaging (MRI) revealed an epidural mass involving dorsal aspect of cervical spinal canal from C5 to C7 level, with low signal intensity on T1 and T2 weighted images and non-enhancement on T1 weighted-enhanced images. We decided to undertake surgical exploration. At the operation field, there was yellow colored, thickened fibrous tissue over the dura mater. The lesion was removed totally, and decompression of spinal cord was achieved. Symptoms improved partially after the operation. Histopathologically, fibrotic pachymeninges with scanty inflammatory cells was revealed, which was compatible with diagnosis of idiopathic hypertrophic pachymeningitis. Six months after operation, motor power grade of both lower extremities was normal on physical examination. However, the patient still complained of mild weakness in the right lower extremity. Although the nature of IHSP is generally indolent, decompressive surgery should be considered for the patient with definite or progressive neurologic symptoms in order to prevent further deterioration. In addition, IHSP can present as an osteolytic lesion. Differential diagnosis with neoplastic disease, including giant cell tumor, is important.