Role of intra- and peritumoral budding in the interdisciplinary management of rectal cancer patients

The presence of tumor budding (TuB) at the invasive front of rectal cancers is a valuable indicator of tumor aggressiveness. Tumor buds, typically identified as single cells or small tumor cell clusters detached from the main tumor body, are characterized by loss of cell adhesion, increased migratory, and invasion potential and have been referred to as malignant stem cells. The adverse clinical outcome of patients with a high-grade TuB phenotype has consistently been demonstrated. TuB is a category IIB prognostic factor; it has yet to be investigated in the prospective setting. The value of TuB in oncological and pathological practice goes beyond its use as a simple histomorphological marker of tumor aggressiveness. In this paper, we outline three situations in which the assessment of TuB may have direct implications on treatment within the multidisciplinary management of patients with rectal cancer: (a) patients with TNM stage II (i.e., T3/T4, N0) disease potentially benefitting from adjuvant therapy, (b) patients with early submucosally invasive (T1, sm1-sm3) carcinomas at a high risk of nodal positivity and (c) the role of intratumoral budding assessed in preoperative biopsies as a marker for lymph node and distant metastasis thus potentially aiding the identification of patients suitable for neoadjuvant therapy.

[Interdisciplinary AWMF guideline for the treatment of primary antibody deficiencies]

Currently, management of antibody deficient patients differs significantly among caregivers. Evidence and consensus based (S3) guidelines for the treatment of primary antibody deficiencies were developed to improve the management of these patients.

Interdisciplinary expert consensus document on management of type B aortic dissection

An expert multidisciplinary panel in the treatment of type B aortic dissection reviewed available literature to develop treatment algorithms using a consensus method. Data from 63 studies published from 2006 to 2012 were retrieved for a total of 1,548 patients treated medically, 1,706 patients who underwent open surgery, and 3,457 patients who underwent thoracic endovascular repair (TEVAR). For acute (first 2 weeks) type B aortic dissection, the pooled early mortality rate was 6.4% with medical treatment and increased to 10.2% with TEVAR and 17.5% with open surgery, mostly for complicated cases. Limited data for treatment of subacute (2 to 6 weeks after onset) type B aortic dissection showed an early mortality rate of 2.8% with TEVAR. In chronic (after 6 weeks) type B aortic dissection, 5-year survival of 60% to 80% was expected with medical therapy because complications were likely. If interventional treatment was applied, the pooled early mortality rate was 6.6% with TEVAR and 8.0% with open surgery. Medical treatment of uncomplicated acute, subacute, and chronic type B aortic dissection is managed with close image monitoring. Hemodynamic instability, organ malperfusion, increasing periaortic hematoma, and hemorrhagic pleural effusion on imaging identify patients with complicated acute type B aortic dissection requiring urgent aortic repair. Recurrence of symptoms, aortic aneurysmal dilation (>55 mm), or a yearly increase of >4 mm after the acute phase are predictors of adverse outcome and need for delayed aortic repair ("complicated chronic aortic dissections"). The expert panel is aware that this consensus document provides proposal for strategies based on nonrobust evidence for management of type B aortic dissection, and that literature results were largely heterogeneous and should be interpreted cautiously.

Language, Thought, Relativism, Nationalism: An Interdisciplinary Study

Ms. Neumer and her team began their project with a critical analysis of the various theories of the relationship between language and thought. Their aim was to develop a theoretical position concerning the issue of universalism versus relativism. This issue is closely bound up with one of the main questions of the history of East and Central Europe, namely, the question of the nation, and the possibility of mutual understanding between national cultures. The team attempted to avoid falling into an all-too-common trap, that of allowing a political perspective to obscure the central theoretical issues. In a project whose outcome totalled over 1000 pages of manuscript in German, English and Hungarian, they touched on cognitive psychological, linguistic, semiotic, socio-semiotic, and other such themes. Their experience has convinced them of the fruitful heuristic possibilities of the interaction of scientific and philosophical approaches in this area of research. A preliminary analysis of the history of philosophy and inquiries into conceptual fields revealed that, in order to reach strong relativist conclusions concerning the unity of thought and language, it is required to take as a point of departure the widest possible sense of these concepts. But in fact, such an option ends up refuting itself: pursuing the premises to their final conclusion one arrives at the restriction of relativism. The team outlined a theory of the understanding of the Other which, borrowing from analytical as well as continental-hermeneutic trends, does not underestimate, on the one hand, the difficulties of understanding between various forms of life, cultures, and languages, but, on the other hand, can provide an alternative solution to the theory of incommensurabiltiy. Within the boundary of this problematic the team studied the problems of translatability, the acquisition of the mother and foreign languages, and natural or cultural determinacy of kind terms. The team regards its most original contribution to be the association of the problem of relativism-universalism and the language-thought relation with contemporary investigations into the question of orality, literacy, and secondary orality. Their conclusion was that, although certain connections can be revealed both between forms of communication and the thesis of the unity of language and thought, and between periods in the history of communication and the predominance of relativistic or universalistic tendencies, forms of communication do not unequivocally determine the answers to these questions.

Designing a Liberal Arts Curriculum that Develops the Capacity for Effective Practice

A new agenda has been coalescing for residential liberal arts education in the United States. At its core are various forms of experiential learning that had long been relegated to the margins of institutions in which pure intellectual achievement was largely separated from, and prized above, practical application of knowledge. Recent years have brought growing student interest in opportunities to engage in experiential learning, including community service, internships, student-faculty research partnerships, study abroad, or co-operative education. All types of colleges and universities have been investing in these programs and in curricular modifications intended to begin integrating them into a coherent educational program. With support from several major associations, foundations, and research collaborations, this twenty-first century reframing of the aims of education has included a persistent call for better evaluative data to gauge the extent to which college students are actually meeting learning goals that faculty are being encouraged to specify more fully.

Designing a Liberal Arts Curriculum that Develops the Capacity for Effective Practice

A new agenda has been coalescing for residential liberal arts education in the United States. At its core are various forms of experiential learning that had long been relegated to the margins of institutions in which pure intellectual achievement was largely separated from, and prized above, practical application of knowledge. Recent years have brought growing student interest in opportunities to engage in experiential learning, including community service, internships, student-faculty research partnerships, study abroad, or co-operative education. All types of colleges and universities have been investing in these programs and in curricular modifications intended to begin integrating them into a coherent educational program. With support from several major associations, foundations, and research collaborations, this twenty-first century reframing of the aims of education has included a persistent call for better evaluative data to gauge the extent to which college students are actually meeting learning goals that faculty are being encouraged to specify more fully.