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Gastric cancer (GC) is the fifth most common cancer worldwide, and mortality rates are still high. Primary preventive strategies, aimed to reduce risk factors and promote protective ones, will lead to a decrease in GC incidence. Helicobacter pylori infection is a well-established carcinogen for GC, and its eradication is recommended as the best strategy for the primary prevention. However, the role of other factors such as lifestyle, diet, and drug use is still under debate in GC carcinogenesis. Unfortunately, most patients with GC are diagnosed at late stages when treatment is often ineffective. CCT241533 Neoplastic transformation of the gastric mucosa is a multistep process, and appropriate diagnosis and management of preneoplastic conditions can reduce GC-related mortality. Several screening strategies in relation to GC incidence have been proposed in order to detect neoplastic lesions at early stages. The efficacy of screening strategies in reducing GC mortality needs to be confirmed. This review provides an overview of current international guidelines and recent literature on primary and secondary prevention strategies for GC. © 2020 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.In this issue of Medical Education, Dr. Lennon and colleagues explore factors affecting professional satisfaction among a large cohort of medical trainees in Australia1 . This article contributes to a growing body of research on physician wellness, a worthwhile endeavour considering the high prevalence of burnout amongst practicing physicians2 . Burnout is associated with low job satisfaction3 and affects both self-reported measures of health care professionals' well-being and human performance which can lead to medical errors and thus impact patient care4 . Residency training is a finite time period in a physician's journey towards clinical practice. Improving job satisfaction among trainees will hopefully enhance their resiliency and coping mechanisms when they ultimately face the challenges of clinical practice. This article is protected by copyright. All rights reserved.Recently our group tried an experiment while presenting at an international medical education conference. We placed 1,189 M+Ms in a transparent plastic bag and asked attendees to guess the number, and report their confidence in that guess, in two ways. First, each person guessed as they arrived at the session by writing their answers and submitting for our tabulation. This article is protected by copyright. All rights reserved.Trehalose dibehenate (TDB), a ligand for the macrophage inducible C-type lectin (Mincle), has shown promise as an adjuvant for preventative vaccines and also as an anti-cancer agent in murine assays. The potential for TDB to affect the anti-tumour immune response of human myeloid cells, however, has not been studied. We investigated the effect of the adjuvants TDB and Monosodium Urate Crystals (MSU) on the pro- or anti-tumour immune phenotype of human monocytes, macrophages (Mo-M) and dendritic cells (Mo-DCs). TDB treatment alone led to an inflammatory response in all three cell types, which was most pronounced when using human monocytes, with MSU augmenting this response. TDB also decreased cell surface markers associated with a pro-tumourigenic phenotype, with MSU showing some ability to augment this response. Notably, a significant reduction in CD115 was observed for all APCs upon TDB or TDB/MSU treatment. The potential to increase the antigen-presenting capabilities of the myeloid cells was also observed upon treatment with TDB and TDB/MSU, as indicated by the up-regulation of cell surface markers such as CD86 for all three cell types and a favourable IL-12p/IL-10 ratio for monocytes stimulated with TDB/MSU. There was no significant production of IL-12p by Mo-DC; however, in a mixed lymphocyte assay, TDB/MSU co-stimulation of Mo-DC led to a significant increase in CD4+ T cell numbers and in the IL-12p/IL-10 ratio. Taken together, these findings show for the first time the potential of TDB/MSU co-stimulation to favour a tumour suppressive phenotype in human-derived myeloid cells. This article is protected by copyright. All rights reserved.We report commissural fusion as a unique morphologic etiology of early bioprosthetic mitral valve failure in a woman with a history of rheumatic mitral stenosis. She had undergone mitral valve replacement with a 25-mm Edwards Magna Ease bovine pericardial bioprosthesis 3 years earlier and presented with progressive dyspnea. Transesophageal echocardiography revealed severe bioprosthetic stenosis due to commissural fusion. She underwent percutaneous valve-in-valve implantation with a 26-mm Edwards Sapien 3 prosthesis. Marked symptomatic improvement was noted postprocedurally. We speculate that commissural fusion may be a unique pathologic feature of failing bioprosthetic valves in patients with prior rheumatic mitral valve disease. © 2020 Wiley Periodicals, Inc.Dual-mode heart-cutting two-dimensional liquid chromatography (DMHC 2D-LC) was applied to isotope dilution mass spectrometry (IDMS) to reduce the bias in the quantitative analysis of a target analyte present in a limited quantity in human plasma. Based on a Waters I-Class LC system, the DMHC 2D-LC system was operated in one- and two-dimensional modes to facilitate the determination of heart-cutting time and the efficient trapping of the target LC eluate. Experiments to determine the feasibility of coupling with IDMS were performed with triple quadrupole mass spectrometry using folic acid standards and/or 13 C5 -folic acid. To validate the performance of the DMHC 2D-LC/IDMS system on a complex sample, human plasma was analyzed for folic acid and the result was compared with that obtained using conventional single-column LC. The total run time of the DMHC 2D-LC system was 20 min, the same as that of the single-column LC system. The peak profile of the spiked 13 C5 -folic acid obtained with single-column LC/MS was affected by matrix effects, but resolved with DMHC 2D-LC/MS, thus improving the accuracy of the analysis. The DMHC 2D-LC/IDMS system showed reliable performance in analyzing the target analyte in human plasma, eliminating matrix effects and saving analysis time. © 2020 John Wiley & Sons, Ltd.
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