Banff Borderline Changes Suspicious for Acute T Cell-Mediated Rejection: Where Do We Stand?

The definition of Banff Borderline became ambiguous when the Banff 2005 consensus modified the lower threshold from i1t1 (10-25% interstitial inflammation with mild tubulitis) to i0t1 (0-10% interstitial inflammation with mild tubulitis). We conducted a worldwide survey among members of the Renal Pathology Society about their approach to this diagnostic category. A web-based survey was sent out to all 503 current members (153 respondents). A database search yielded which threshold for Banff i was applied in the most influential manuscripts about Borderline. Among the 139 nephropathologists using the Borderline category, 67% use the Banff 1997 definition, requiring Banff i1. Thirty-seven percent admitted to sometimes exaggerating Banff i in the presence of tubulitis, to reach a diagnosis of Borderline. Forty-eight percent were dissatisfied with the definition of Borderline. The majority of the most influential manuscripts used the 1997 definition, contrary to the current one. There is considerable dissatisfaction with Borderline, and practice in Banff i thresholds is variable. Until additional studies inform a revision, we suggest leaving it to each pathologist's discretion whether to use i0 or i1 as the minimal threshold. In order to avoid future ambiguity, a web-based synopsis of all scattered current Banff definitions and rules should be created.

Nurses’ Perceptions of Phase I Clinical Trials in Pediatric Oncology: A Review of the Literature

A review of literature was conducted to explore nurses’ perceptions of phase I clinical trials in pediatric oncology. Specifically, nurses’ perceptions of the goals and outcomes, the nurse’s role, and the informed consent process in pediatric oncology phase I clinical trials were investigated. Findings on possible factors influencing the nurses’ perceptions and the quality of work-life of nurses working at pediatric phase I clinical trial centers were also searched. However, despite an extensive review of published works, no studies on nurses’ perceptions of phase I trials in pediatric oncology were found. Therefore, this literature review consists of findings in similar or related studies such as nurses’ perceptions of experimental therapies in the adult setting, adult patients’ perceptions, parents’ perceptions, or oncologists’perceptions of phase I clinical trials.

Minimizing Complications Related to Fever in the Postoperative Pediatric Oncology Patient

Fever is a common postoperative complication that is generally thought to be a benign, self-limiting event. However, for pediatric oncology patients who are often immunocompromised, a postoperative fever may indicate an infection, which can lead to significant complications if not treated promptly. A physical examination, which is an established cost-effective method to rule out infections in the general surgical population, may not be sufficient for oncology patients because clinical symptoms may be atypical or absent in immunocompromised hosts. Although a full septic workup may be unnecessary, additional investigations such as blood cultures may be warranted, and antibiotic therapy should be considered for some or all febrile postoperative cancer patients. No standardized approach to fever management in postoperative oncology patients currently exists, which can present a challenge for those who care for these patients. In the absence of such established practice standards, this article outlines some of the considerations that may be vital in minimizing complications related to fever in the postoperative pediatric oncology patient.

Can feeding the broiler breeder improve chick quality and offspring performance?

The impact of nutrition on the performance of broiler breeders in terms of bodyweight profile, egg production, egg size and shell quality, mortality, fertility and hatchability has been well documented. However, studies on the direct effects of breeder nutrition on subsequent chick quality and offspring performance are limited. The present paper reviews the nutritional factors in broiler breeders that may improve chick quality and progeny performance. Recent research has suggested that the feeding of low crude protein and medium to high energy breeder diets in both rearing and laying period will not only have a positive impact on egg production, egg size, breeder fertility, hatchability and embryonic livability, but also on offspring performance. Improvements include better chick quality, higher chick weight, lower mortality, increased immune responses, enhanced litter quality and broiler growth. Breast-meat yield in the progeny can be improved as the energy to protein ratio increases from the rearing phase to the laying phase, indicating that nutrition of pullets can also affect growth and yields. The effects of maternal diet on offspring performance may depend on the sex of the progeny, with male broilers responding more than female broilers to breeders’ dietary protein and energy concentrations. However, little work has been conducted on the effects of individual amino acids in breeder diets on the subsequent generation. There seems to be some benefits with the use of long-chain poly-unsaturated fats in breeder diets on carcass quality of offspring, but these effects appear inconsistent at this stage. There is substantial evidence that confirms the direct effects of vitamin D and E, and trace minerals, especially in organic form, such as selenium, zinc and manganese, on chick quality and progeny performance. In fact, the impact of breeder nutrition on progeny performance in the field is more likely to be greater under conditions of poor breeder-flock uniformity, low vitamin and trace mineral contents or certain types of stress in the broiler house.

TIFA, an inflammatory signaling adaptor, is tumor suppressive for liver cancer

TIFA (TNF receptor associated factor (TRAF)-interacting protein with a Forkhead-associated (FHA) domain), also called T2BP, was first identified using a yeast two-hybrid screening. TIFA contains a FHA domain, which directly binds phosphothreonine and phosphoserine, and a consensus TRAF6-binding motif. TIFA-mediated oligomerization and poly-ubiquitinylation of TRAF6 mediates signaling downstream of the Tumor necrosis factor alpha receptor 1 (TNFaR-I) and interleukin-1/Toll-like receptor 4 (TLR4) pathways. Examining TIFA expression in hepatocellular carcinoma (HCC) tissues microarrays, we noted marked decreases TIFA reactivity in tumor versus control samples. In agreement, we found that HCC cell lines show reduced TIFA expression levels versus normal liver controls. Reconstituting TIFA expression in HCC cell lines promoted two independent apoptosis signaling pathways: the induction of p53 and cell cycle arrest, and the activation of caspase-8 and caspase-3. In contrast, the expression of a non-oligomerizing mutant of TIFA impacted cells minimally, and suppression of TIFA expression protected cells from apoptosis. Mice bearing TIFA overexpression hepatocellular xenografts develop smaller tumors versus TIFA mutant tumors; terminal deoxynucleotidyl transferase dUTP nick end labeling staining demonstrates increased cell apoptosis, and decreased proliferation, reflecting cell cycle arrest. Interestingly, p53 has a greater role in decreased proliferation than cell death, as it appeared dispensable for TIFA-induced cell killing. The findings demonstrate a novel suppressive role of TIFA in HCC progression via promotion of cell death independent of p53.

Maternal language and adverse birth outcomes in a statewide analysis

Limited English proficiency is associated with disparities across diverse health outcomes. However, evidence regarding adverse birth outcomes across languages is limited, particularly among U.S. Asian and Pacific Islander populations. The study goal was to consider the relationship of maternal language to birth outcomes using statewide hospitalization data. Detailed discharge data from Hawaii childbirth hospitalizations from 2012 (n = 11,419) were compared by maternal language (English language or not) for adverse outcomes using descriptive and multivariable log-binomial regression models, controlling for race/ethnicity, age group, and payer. Ten percent of mothers spoke a language other than English; 93% of these spoke an Asian or Pacific Islander language. In multivariable models, compared to English speakers, non-English speakers had significantly higher risk (adjusted relative risk [ARR]: 2.02; 95% confidence interval [CI]: 1.34-3.04) of obstetric trauma in vaginal deliveries without instrumentation. Some significant variation was seen by language for other birth outcomes, including an increased rate of primary Caesarean sections and vaginal births after Caesarean, among non-English speakers. Non-English speakers had approximately two times higher risk of having an obstetric trauma during a vaginal birth when other factors, including race/ethnicity, were controlled. Non-English speakers also had higher rates of potentially high-risk deliveries.

The time taken for the regional distribution of ventilation to stabilise: an investigation using electrical impedance tomography

Electrical impedance tomography is a novel technology capable of quantifying ventilation distribution in the lung in real time during various therapeutic manoeuvres. The technique requires changes to the patient's position to place the electrical impedance tomography electrodes circumferentially around the thorax. The impact of these position changes on the time taken to stabilise the regional distribution of ventilation determined by electrical impedance tomography is unknown. This study aimed to determine the time taken for the regional distribution of ventilation determined by electrical impedance tomography to stabilise after changing position. Eight healthy, male volunteers were connected to electrical impedance tomography and a pneumotachometer. After 30 minutes stabilisation supine, participants were moved into 60 degrees Fowler's position and then returned to supine. Thirty minutes was spent in each position. Concurrent readings of ventilation distribution and tidal volumes were taken every five minutes. A mixed regression model with a random intercept was used to compare the positions and changes over time. The anterior-posterior distribution stabilised after ten minutes in Fowler's position and ten minutes after returning to supine. Left-right stabilisation was achieved after 15 minutes in Fowler's position and supine. A minimum of 15 minutes of stabilisation should be allowed for spontaneously breathing individuals when assessing ventilation distribution. This time allows stabilisation to occur in the anterior-posterior direction as well as the left-right direction.