text:
Joel Humphrey, Tony Antonios*, Anatole Wiik, Laura Blake, Jennifer Billington and Alistair Tindall
Queen Elizabeth Hospital, London, UK
Received Date: October 27, 2016; Accepted Date: January 19, 2017; Published Date: January 30, 2017
Citation: Humphrey J, Antonios T, Wiik A, Blake L, Billington J, et al. (2017) Guidelines for Checking Blood Results on the Acute Surgical Wards. Trauma Acute Care 2:31. DOI: 10.21767/2476-2105.100031
Copyright: © 2017 Humphrey J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Introduction: Hospital blood tests are performed in high volume to facilitate clinical diagnosis and to monitor patients' response to therapeutic intervention. There is currently no academic literature or formal guidelines advising on optimum time frames when blood results should be checked. Our study aims to assess the time taken for junior doctors on acute surgical wards in a District General Hospital to review available blood results and implement guidelines if required, to maintain consistent clinical care and patient safety. Methods: Data was collected retrospectively during a month from three acute surgical wards (two general surgery wards and one orthopaedic trauma ward). All blood samples taken in this period were assessed to see the time frame that results were being reviewed. Results: 1,325 blood samples were received and analysed by the hospital laboratory. The time frames that these blood results were first accessed are <6 h 1,020 (77.0%), <12 h 1,111 (83.9%), <24 h 1,203 (90.8%), 24-48 h 1,247 (94.1%), 48-72 h (96.1%) and >72 h 1,325 (100%). Of the 122 blood results not reviewed within 24 hours all had at least one component of a test outside the normal reference range. Conclusion: Our results show time to checking blood results can be significantly improved. To ensure all patients are cared for as advocated by the Royal College Surgeons 'Good Surgical Practice', we propose all blood results should be checked and acted upon within 12 hours of the results being available or expeditiously if the clinical situation requires.
Blood tests; Guidelines; Acute surgical wards; Patient safety
Hospital blood tests are performed to facilitate clinical diagnosis and to monitor patients' response to therapeutic intervention. Junior ward doctors order and/or perform blood tests for patients as a part of their daily working duties. It is the responsibility of the doctor ordering the test to check the results once available and act accordingly. There is no academic literature, which dictates the optimum time frame in which blood results should be reviewed. The urgency arguably will vary depending on the indication, type of blood test and the patient's clinical condition. However, implementing standardised time frames to check blood results would ensure consistent patient safety, as advocated by the Royal College Surgeons Good Surgical Practice [1].
The objective of this work was to assess the time taken for junior doctors on acute surgical wards to review available blood results. This will provide an opportunity to standardise our clinical practice and improve quality of care, by initiating guidelines for checking blood results.
Data was collected retrospectively during a month from three acute surgical wards (two general surgery wards and an orthopaedic trauma ward) at a London district general hospital. All blood samples taken in this period were assessed to see the time frame that results were being reviewed. WinPath is the Laboratory Information Management System (LIMS) used in our hospital to access patients' pathology results. The in-built 'audit view' tool allocates each sample ordered a serial number. Each sample ordered in the same window can request a single test or multiple tests (e.g. full blood count and C-reactive protein). It subsequently records the time when the first results become available to be viewed and the time when a doctor first accesses the result. The system is protected under the Data Protection Act and all patient information was confidential.
The time taken to first access each blood result once available was allocated into one of six time-frame categories: <6 h, <12 h, <24 h, >24 h but <48 h, >48 h but <72 h, and >72 h. All blood results not accessed within 24 h were analysed, by identifying any abnormal results that were outside the reference ranges on the WinPath LIMS.
During the targeted week 1,361 blood samples were ordered from the three acute surgical wards. The hospital laboratory received and processed 1,325 (97.4%) of them. Each of the 3 wards has a capacity of 24 patients. The time frames that blood results were first accessed are <6 h 1,020 (77.0%), <12 h 1,111 (83.9%), <24 h 1,203 (90.8%), 24-48 h 1,247 (94.1%), 48-72 h (96.1%) and after 72 h 1,325 (100%) (Table 1). Of the 122 blood samples not reviewed within 24 hours all had at least one component of a test outside the normal reference range quoted on WinPath LIMS.
|Acute Surgical Ward (SW1)
|Acute Surgical Ward (SW2)
|Orthopaedic Ward (OW)
|Total (Cumulative %)
|Blood specimens received by the lab
|First review <6 hours
|381 (76.5 %)
|327 (75.5%)
|312 (78.9%)
|1020 (77.0%)
|First review <12 hours
|409 (82.1%)
|355 (82.0%)
|347 (87.6 %)
|1111 (83.9%)
|First review <24 hours
|451 (90.6%)
|391 (90.3%)
|361 (91.1%)
|1203 (90.8%)
|First review >24 hours and <48 hours
|463 (93.0%)
|411 (94.9%)
|373 (94.1%)
|1247 (94.1%)
|First review >48 hours and <72 hours
|476 (95.6%)
|419 (96.7%)
|379 (95.6%)
|1274 (96.1%)
|First review >72 hours
|497 (100 %)
|433 (100%)
|1325 (100.0%)
Table 1: Displaying the time frames blood test results was first accessed.
The main aim of our study, to retrospectively assess the time taken for junior doctors on acute surgical wards to review available blood results was met, as out of 1,325 samples analysed 83.9% were checked within 12 h and 90.8% checked within 24 h. Out of the blood results not checked after 24 h, 100% of those had at least one component, which was outside the normal reference range.
There are no specific time frame guidelines when blood results need to be checked, because of significant variation on indication, availability, test ordered, patient's condition and the clinical setting. Acute surgical patients on the General Surgery and Trauma Orthopaedic wards though can be categorised as a priority group. To ensure these patients are cared for appropriately and safely, we promote all blood results should be checked and acted upon within 12 h of the results are being available. We feel this is an acceptable time frame given there will be an evitable time lapse between the test being ordered, venesection and specimen being received by the laboratory. There will be situations when results need to be expedited much quicker and this decision lies with the doctors' clinical judgement.
The abnormal blood results not checked within 24 h could have potentially had an impact on patient safety and wellbeing. However, no further clinical significance can be inferred from a single value outside normal parameters in isolation. All abnormal values need to be interpreted in context of the clinical situation and analysed in conjunction with other available results. The retrospective data collection did not include any verbal reports over the telephone between the laboratory technicians and doctors, that may have occurred if a grossly abnormal result was detected i.e. critically high potassium level. However, this method avoided any potential bias through the Hawthorne effect [2], when junior doctors could have modified their actions in response to being audited.
Electronic systems are now generally the standard in National Health Service hospitals but the software package used will vary within each Trust. They allow swift access to blood results but with multiple clinicians accessing results it can potentially be unclear where the responsibility for action lies [3]. Other potential reasons for junior doctors not checking blood results within an acceptable time frame include multiple clinical duties, lack of prioritisation, unfamiliarity with electronic systems and poor handover. Furthermore, from financial prospective blood tests should not be ordered without clinical justification, so if performed they all need to be reviewed.
The ultimate responsibility for patients' care lies with the consultant but it is the duty of junior doctors to manage patients safely on their behalf. Blood results in the Emergency Department are often checked by a middle grade doctor to pickup any potential abnormalities that have not been acted upon. However, a study has concluded that the manual checking of all abnormal blood results is not worthwhile in that particular clinical setting [4]. It highlights the responsibility for reviewing results lies primarily with the requesting doctor so any abnormalities are not missed. We also advocate a similar practice on the acute surgical wards. This requires good communication and clarity about clinical responsibilities within the team structure. With dynamic working patterns a caveat to this is, if the result is not available at the end of a shift it can be handed over to a member of your team to check and act accordingly.
Our findings are a true reflection of clinical activity and time to checking blood results can be significantly improved. Firstly, all clinical members of staff must be fully informed of our new guidelines for promptly checking ordered investigations. This can be facilitated through hospital presentations, Trust e-mails, ward posters and during junior doctor induction. Secondly, iCare Software Program for patient health records has recently been introduced into our Trust, which generates electronic results that are sent directly to the patient's named consultant. This can be re-audited to assess whether highlighting the problem and implementing our changes have improved clinical practice.
We propose that new guidelines are implemented, recommending all blood results on acute surgical wards are checked and acted upon within 12 h of the results being available or expeditiously if the clinical situation requires. This will ensure patient safety and 'Good Surgical Practice' is maintained at a consistent level.
All Published work is licensed under a Creative Commons Attribution 4.0 International License
Copyright © 2019 All rights reserved. iMedPub LTD Last revised : August 21, 2019


text:
possibility of medicine can help teeth in Vietnam?, to withstand the excess food odors in the cavity is to treat and fix yellowed teeth for different agents of the right position on the jaw in the process of life. Especially, porcelain tooth socks also have people who reflect innovations, which are the solutions for salvage cases. Braces without braces have an outstanding aesthetic advantage. Due to heavy color trade. Disadvantages: Poor biocompatibility and high risk of elimination due to stimulation of immune response. Artificial bone grafting It is a form of bones with the main components are Hydroxy apatite or Beta-tricalcium phosphate, which is capable of digesting. Artificial bone grafts into the missing bone, creating space for the bone to grow itself. Every month the bone grows up to 1mm. Get the impression of the teeth, send signals to the lab for analyzing and making dental porcelain suitable.
Does implant dentistry hurt? The answer is no? Before making a dental implant, the doctor has performed local anesthesia. And with the advances in dentistry today, the anesthetics are so good that you cannot feel any discomfort at all. If so, just a little numbness in the jaw or slightly numbness at the site of the implant. In case the patient feels a little uncomfortable and is too scared, he or she will add a sedative so you can feel more comfortable sitting on the dentist's chair vietnam dentist prices
Some side effects after implantation of the implant can make your teeth a little swollen and bleeding. But this feeling will pass quickly, usually disappears after about 7-10 days.
If you feel some pain, you can use ice or warm water to help reduce swelling. In fact, implant dentistry lasts only 20-30 minutes when the doctor performs bone drilling and puts the cylinder inside so the patient does not need to worry too much about the pain.
There are several major factors that affect the feeling of tingling. If your case is complicated and requires bone grafting, it is more painful than usual. However, soon after the porcelain teeth are taken over, the pain will disappear very quickly. Saigon Vietnam dental implants
In addition, some side effects after planting implant teeth you can easily see it is bleeding and purple swelling. But do not worry, this is a very normal phenomenon and will disappear in about 7-10 days. Apply ice to the wound more quickly.
Complete restoration of missing teeth on the body and root
Allows the ability to integrate the bone of the artificial tooth well and the ability to heal wounds very quickly. No need to separate the gums when grafting
+ Stomach firmly, not only support the upper porcelain crowns, but also ensure the ability to withstand the chewing force. This will ensure that you eat as your real teeth.
+ Teeth durable, long life

subset: commoncrawl


text:
Snarky Puppy @ Carnegie Library Music Hall of Homestead - 5/8/2016/
Snarky Puppy's Grammy Award-winning music, by nature of its virtuosity and sheer brilliance, is respected in the highest regard by groove makers and audiences alike. Fans came to Sunday's show at the Carnegie Music Hall of Homestead to hear a fresh musical experience. They came out to the show to be wowed. The opportunity to see Snarky Puppy perform was an opportunity to watch masters in the technical art of music.
Opening act Charlie Hunter was a strong, pleasant introduction to the night. With a seven-string guitar/bass hybrid, he quickly piqued everyone's interest. His playing was soulful, awe-inspiring, bluesy, light-hearted, sweeping and impossible to imagine. He made his playing style look effortless. His charisma on stage was unmatched, further exemplified by playing two instruments at once. He knew how to make a crowd laugh. Charlie Hunter was a clown to the audience as much as he was an entertainer to his musicians. Or an entertainer to himself, for that matter. He plucked out little musical jokes with his guitar, laughing casually in response to his own goofy wit. Unexpectedly to Hunter, his voice projected through to the audience, both when he laughed and when he gave instructions to his band, Snarky Puppy drummer Jason Thomas and horn players Justin Stanton and Chris Bullock.
Snarky Puppy began their set with a light tune off of their 2015 album, Sylva. In their own unassuming way, Snarky set the tone for the rest for the night. The ethereal nature of the first tune was followed by some of the hardest-hitting fusion pieces in Snarky's arsenal from their latest release, Culcha Vulcha. The peaks and valleys created by bassist and bandleader Mike League's compositions developed an emotional experience akin to getting slapped in the face and hugged immediately afterward. Percussive starts and stops in the music had the crowd on edge for several individual moments within a single tune. Throughout these moments of unabashed virtuosity, each member of the band knew how to show off without losing any humility.
Despite missing a few of the all-star players that usually accompany the group, Snarky Puppy managed to win the crowd over by highlighting the star players they still had up on stage. The horn section, consisting of Jay Jennings, Mike Maher and Chris Bullock, glided into their notes like butter into beautiful legato harmonic resolutions. At the same time, the three horn players performed as individual soloists reminiscent of their fusion jazz forefathers. Percussionist Marcello Woloski and drummer Jason Thomas performed perfectly when in the background and during their features. There were drum battles that moved in and out of time with incomprehensible ease. Mike League played underneath the percussion with subtle grace, making full use of his individualistic approach to songwriting. League's ability to showcase the musicians on stage provided guitarist Bob Lanzetti with the space to mesmerize and captivate the audience with his solo.
The night's official set ended with an energetic swing/shuffle accompanied by massive Dixieland-style horns and a much deserved standing ovation. Unsurprisingly, the audience stood through Snarky Puppy's encore "What About Me?" The funky complexion of the song animated every listener, while maintaining a tight technical performance at its forefront. Snarky Puppy's show was an exemplary demonstration of musicianship. The group is a true champion of their craft.


text:
Fonts On Film
Helvetica is a feature-length independent film abouttypography, graphic design and global visual culture. It looks at the proliferation of one typeface (which will celebrate its 50th birthday in 2007) as part of a larger conversation about the way type affects our lives. The film is an exploration of urban spaces in major cities and the type that inhabits them, and a fluid discussion with renowned designers about their work, the creative process, and the choices and aesthetics behind their use of type.
Helvetica the movie is showing on October 17th at the Tower Theater at 6:30
Presented by the AIGA. More information at the AIGA Salt Lake City website. [Thanks Molly]


text:
Effects of general anesthesia with or without epidural block on tumor metastasis and mechanisms
- Authors:
- Bin Yang
- Feng Qian
- Wenjia Li
- Yang Li
- Yangdong Han
- Published online on: January 26, 2018 https://doi.org/10.3892/ol.2018.7870
- Pages: 4662-4668
Primary liver cancer has the fifth-highest incidence of malignant tumors and is the third-leading cause of cancer-associated mortality, 90% of cases are hepatocellular carcinoma (HCC) (1). In certain areas of Asia and the Middle East, HCC ranks as the leading cause of cancer-associated mortality (2). Surgical resection, which is the first-choice treatment modality for HCC, can significantly improve the prognosis and prolong the survival time of patients. However, surgery inevitably induces neuroendocrine, metabolic and inflammatory responses (3,4), directly affecting post-operative recovery and the survival time of patients (5,6). Consequently, the induction of this immune response can be injurious to long-term prognosis during the perioperative period. Therefore, the perioperative period is a critical period for long-term prognosis. The primary method of improving the long-term prognosis of tumor patients is to understand the mechanisms of tumor metastasis and corresponding immune responses. Recently, substantial attention has been paid to the association between methods of anesthesia and long-term prognosis (7). As an important role in the whole perioperative period, the responsibility of the anesthetists to improve the long-term prognosis of cancer patients has been increasingly appreciated in recent years (8). Metastasis is one of the most important characteristics of malignant tumors, serving an important role in treatment efficacy and quality of life of patients (9). The metastasis of tumors comprises of a complex series of events and can be divided into a number of sequential steps: i) Release from the primary tumor and invasion into the surrounding tissues; ii) intravasation; iii) transition in the blood circulation; iv) arrest in the capillary bed; v) extravasation; and vi) growth at preferred sites (10). In this cascade, angiogenesis, the formation of a new blood supply from pre-existing vasculature, is a critical step of tumor metastasis (11). Angiogenesis is a complex multistage process that is regulated by the balance between angiogenic and angiostatic factors (12–14). Among these associated factors, vascular endothelial growth factor (VEGF) has been demonstrated to be one of the most important angiogenic mediators (15). VEGF is the most commonly studied angiogenic mediator and has been well established as a molecular target in clinical studies (16,17) In addition to its role in stimulating angiogenesis, VEGF induces vascular permeability to circulating macromolecules (16). Previous studies (18,19) have shown that signal transducer and activator of transcription 3 (STAT3) regulates angiogenesis primarily by modulating VEGF expression, although several other candidates affected by STAT3 have been reported to show distinct effects on angiogenesis.
General anesthesia (GA) and GA combined with epidural block (GEA) are the most commonly anesthetic methods in hepatectomy. GEA can prevent or attenuate the surgical stress response by blocking afferent neural transmission, which prevents harmful afferent input from reaching the central nervous system (20). Previous studies (21,22) have shown that the choice of anesthesia methods was only associated with perioperative stress and immune function for a short time. However, animal experiments and clinical studies (23,24) in recent years have reported that different anesthetic methods serve important roles in cancer recurrence or metastasis. Compared with GA, GEA significantly reduces the dependency on opioids (25). Opioids, including morphine, one of the most commonly used, can inhibit cellular and humoral immune function (26,27). An animal study (28) strongly indicated that opioids, including morphine and fentanyl, can promote tumor metastasis and recurrence. Clinical trials (29,30) have demonstrated that morphine can accelerate the growth of breast tumors. Consequently, paravertebral anesthesia and analgesia combined with GA led to a lower incidence of cancer recurrence or metastasis. Recent research indicates that the association of opioids with tumor behavior is complex and remains unclear (31).
The present study compared the anti-metastatic effect of GA and GEA on tumor-bearing rats with hepatectomy. The results revealed that the anti-metastatic effect of GEA is significant superior to GA. Furthermore, the mechanism of the two anesthesia methods on tumor metastasis and angiogenesis was investigated. As the results of the present study demonstrate, one possible mechanism by which GEA suppresses tumor metastasis and angiogenesis is the improvement of the expression of interferon-γ (IFN-γ) and the inhibition of transforming growth factor-α (TGF-α), VEGF and p-STAT3.
Materials and methods
The rat hepatic cancer cell line Morris hepatoma 3924A was purchased from American Type Culture Collection (Manassas, VA, USA) Morphine, bupivacaine and fentanyl were purchased from Shanghai Sangon Biotechnology Co., Ltd. (Shanghai, China). The cell line was cultured at 37°C in a humidified atmosphere containing 5% CO2 in Dulbecco's modified Eagle's medium with 10% fetal bovine serum (FBS), 100 U ml−1 penicillin and 100 mg ml−1 streptomycin (Gibco; Thermo Fisher Scientific, Inc., Waltham, MA, USA), 30 male American Certification Institute (ACI) rats (age, 12–18 weeks; weight, 200–250 g) were purchased from the Experimental Animal Center of Changchun Biological Institute (Changchun, China), and they were housed at a temperature of 20–22°C, relative humidity of 50–60% and 12/12 h light/dark cycles. They were also provided with free access to food and water. The 7-0 injury-free operative sutures were purchased from Shanghai Surgical Suture Company. ELISA kit and antibodies used in the present study were purchased from Invitrogen (Thermo Fisher Scientific, Inc.). Details were as follows: IFN-γ ELISA kit (cat no. BMS621); TGF-α ELISA kit (cat no. EHTGFA); VEGF ELISA kit (cat no. ERVEGFACL); phospho-STAT3 (Tyr705) polyclonal antibody (cat no. 44-380G; dilution, 1:1,000); and phospho-EGFR (Tyr1086) polyclonal antibody (cat no. 36-9700; dilution, 1:500). The anti-rabbit IgG secondary antibody, horseradish peroxidase (cat no. P7899; dilution, 1:100,000) was provided by Sigma-Aldrich (Merck KGaA; Darmstadt, Germany).
Animals and the tumor xenograft model
All animal experiments were performed in compliance with the Animal Management Rules of the Ministry of Health of the People's Republic of China (http://www.medste.gd.cn/Html/sciedu/sysgl/Class3141/24961720080910094400.html) and approved by the Animal Care and Use Committee of Jilin University (Changchun, China). All animals were pathogen-free and allowed ad libitum access to food and water. To produce the tumor xenograft model, MH3924A cells in the logarithmic phase were injected subcutaneously into the upper axillary fossa of the male ACI rats (12–18 weeks, n=10 per group). After 14 days, subcutaneous tumors were surgically removed. Fresh tumor tissues were chosen and divided into l-mm3 tumor pieces. The male rats were fixed on a frame prior to anesthesia, then the abdominal body hair was removed and the animals were disinfected with iodine. A 5-ml syringe was placed at the back of the fixed rats to raise the abdomen of the rats for surgical convenience. Next, when the size of incision in upper abdomen reached ~0.5 cm, the skin, subcutaneous tissue and peritoneal tissue was consecutively cut and then the rat liver was exposed. The left lobe was cleaned with wet cotton and the liver capsule was punctured with ophthalmic scissors, making a further long cut under the capsule. Next, the as-prepared tumor tissue was inserted into the long cut, which was closed with 7-0 microscopic sutures. Prior to abdominal closure, it should be confirmed that there was no blister tissue out and no bleeding.
When the tumor volume reached ~300 mm3, these tumor-bearing rats were randomly divided into three treatment groups: One group was treated with hepatectomy and general anesthesia combined with epidural block (group G + E), one group was treated with hepatectomy and general anesthesia (group G) and one group, the control group, did not undergo any treatment (group C). There were 10 rats included in each group.
A simple tumor resection was performed under general anesthesia. Specifically, sevoflurane together with oxygen was injected into a self-made anesthesia box. Next, the retraction response of rat toes to stimulus was continuously assessed to determine the degree of anesthesia. When the retraction response of rat toes to stimulus disappeared, tracheal incubation was conducted for the rat by transmission light intubation. Specifically, the 50-W illuminant was placed 5 cm away from the neck of the rat. In this way, the light could pass through the neck skin and trachea wall in sequence. A mini sized spatula with a 145° angle were used to push away the tongue for clear observation of the epiglottis and vocal cord movement under the transmitted light, thus an 18 G cannula was inserted under a bright view. The regular movement of the rat thorax was observed following connection with the ventilator with mechanical ventilation. The parameters of the ventilator were set as follows: Breathing rate, 55/min; tidal volume, 3 ml/100 g; inspiration rate: expiration rate, 1.5:1; sevoflurane concentration, 2–3% (v/v). To maintain the anesthesia effect, morphine (0.2 ml/100 g, 10% solution) was injected intraperitoneally. When the rats woke following surgery, the endotracheal tube was removed.
Epidural anesthesia
Perioperative epidural analgesia consisted of a bolus of 6–9 ml of 0.25% bupivacaine followed by a postoperative infusion of bupivacaine (0.1–0.2%) with or without 2 µg/ml of fentanyl at a rate of 6–9 ml/h. Specifically, the limbs and head of the rat were fixed following the success of tracheal incubation under general anesthesia. A self-made sterile PVC epidural catheter with diameter of 0.3 mm was inserted via removing the eighth or ninth thoracic spinous process using a vertical needling and was advanced 1 cm cephalad into the epidural space. Subsequently, 0.25% of bupivacaine was micro-injected via the epidural catheter.
According to observations, the tumor size was suitable for hepatectomy and no distant metastasis was observed at day 14 following inoculation with tumor cells. Hepatectomy was conducted following successful anesthesia with the assistance of undergraduate students majoring in liver surgery (Departments of General Surgery, China-Japan Union Hospital Jilin University, Changchun, China). Specifically, the skin, subcutaneous tissue and peritoneal tissue was consecutively removed from the original upper abdomen incision. Next, the left lobe of the liver was exposed and the megascopic in situ tumor tissue was removed, as was 5 mm normal liver tissue around the edge of tumor. The 7-0 microscopic suture was used to close the abdomen following the confirmation of no bleeding.
Blood sample collection and ELISA assay
Venous blood samples were collected from orbits of rats immediately prior to surgery and at 2, 7 and 30 days following surgery. The blood samples were left to clot at room temperature and then stored overnight in a refrigerator to contract the clot. The clot was removed and the remaining material was centrifuged at 4,000 × g for 5 min and the resulting serum was stored at −80°C until analysis. Plasma levels of IFN-γ, TGF-α and VEGF were measured by an ELISA. Plasma levels of each cytokine were measured in duplicate from one aliquot of each sample and the mean value from these two measurements was used as the final concentration. Quantification was achieved using an automated microplate reader. Concentrations of all cytokines were reported in pg/ml. The rats were sacrificed 30 days following surgery. The lungs were removed and collected for the following experiments. The metastatic nodes in the lungs of mice were visualized by fixing them in Bouin's solution (saturated picric acid: Formalin: Acetic acid, 15:5:1) at room temperature for 24 h and photographed using a high-definition digital camera (IXUS 110, Canon Inc., Tokyo, Japan) to evaluate the anti-metastatic effects of general anesthetic and general anesthetic with epidural block.
Western blot analysis
For each group, 0.1 g of the lung tissue was collected for protein extraction and lysed using a Dounce homogenizer (20 strokes) in 400 µl of buffer containing 50 mM tris (hydroxymethyl) aminomethane hydrochloride (Tris-HCl), pH 7.6, 42 mM KCl, 5 mM MgCl2, 1 mM dithiothreitol (DTT), 0.5% 3-[(3-cholamidopropyl) dimethylammonio]-1-propanesulfonate hydrate, 1 mM phenylmethylsulfonyl-fluoride and 1 µg/ml leupeptin (Sigma-Aldrich; Merck KGaA), and then centrifuged at 15,000 × g for 20 min at 4°C. The protein concentrations of the lysates were determined by BCA protein assay. Equal amounts (50 µg) of protein were separated on a 10% SDS-PAGE and transferred onto polyvinylidene difluoride membranes. The membranes were blocked with 5% non-fat milk in Tris-buffered saline/0.1% Tween-20 for 2 h, subsequently blotted with respective primary antibodies overnight at 4°C as described previously in the materials section, and then blotted with horseradish peroxidase-conjugated secondary antibody at 37°C for 1 h. The protein bands were visualized using an enhanced chemiluminescent agent (Fuzhou Maixin Biotech Co., Ltd., Fuzhou, China). Protein levels were quantified by density analysis using ImageJ software version 1.62 (National Institutes of Health, Bethesda, MD, USA), and expressed as the interest protein/internal control.
Statistical analysis
Data from ≥3 groups were compared using one-way analysis of variance followed by Dunnett's post-hoc test using the SPSS software package (version 13.0; SPSS Inc., Chicago, IL, USA). The experiments were performed in triplicate and the data are presented as the mean ± standard deviation. P<0.05 was considered to indicate a statistically significant difference.
The anti-metastatic effects of GA and GEA
The evaluation on the in vivo anti-metastatic activity of general anesthesia and epidural anesthesia was performed. In the in vivo experiment, the rats were sacrificed 30 days after surgery and the lungs were dissected. The average numbers of metastatic nodules on the lung surface in different groups were counted. Representative photos of the lungs with the metastatic nudes are presented in Fig. 1. As depicted in Table I, the number of metastasis nodules in the G + E group was 18±6, which was significantly (P<0.05) less than that in group C (40±6) or group G (38±5). This result indicated that GEA could effectively inhibit lung metastasis compared with GA following hepatectomy. The conditions of abdominal lymph node metastasis, the rate of malignant ascites and number of abdominal wall planting nodules also validated this conclusion. As presented in Table I, the number of animals for which there was a presence of abdominal lymph node metastasis was significantly lower for group G + E (1/10) than for group C (7/10) or group G (6/10). For group C and group G, the rates of malignant ascites were higher than that of group G + E, which demonstrated the low metastatic rate following surgery with epidural anesthesia. Abdominal wall-implanted nodules represented another important evaluation index for metastatic condition. According to Table I, the number of rats with abdominal wall-implanted nodules in group G + E was 2/10, which was significantly lower than that for group C (8/10) or group G (5/10). Hepatectomy with different anesthetic techniques revealed different rates of tumor metastasis. Notably, GEA could effectively inhibit tumor metastasis compared to GA following hepatectomy.
Figure 1.
The numbers of the lung metastasis nodes were observed and imaged using a camera after fixing with Bouin's solution.
Changes in cytokine concentration in the serum of rats that underwent different treatments determined by ELISA
As shown in Fig. 2A, there was no significant difference in IFN-γ levels between groups C, G and G + E on day 0. On day 2, the concentration of IFN-γ in group G + E (3,411±232 pg/ml) was significantly higher than that in group C (1,497±146 pg/ml) and G (2,578±165 pg/ml). On day 7 and day 30, there was no significant difference between group C and G, but these concentrations were significantly higher than those in group G + E. For group G + E, the concentration of IFN-γ at day 7 and day 30 was slightly lower than that on day 2. Similarly, there was no significant difference in regard to concentrations of TGF-α and VEGF between group C, G and G + E on day 0 (Fig. 2B and C). On the following days, concentrations of TGF-α and VEGF were significantly lower in group G + E than in groups C and G (P<0.05). Notably, the concentration of TGF-α increased slowly over time following surgery. However, the concentration of VEGF was at its minimum on day 7. Groups C and G exhibited increases in the concentration of TGF-α and VEGF, whereas the concentration in group G + E rats remained lower than those in groups C and G.
Figure 2.
Changes in cytokine concentration in serum of rats that underwent different treatments. The changes in (A) IFN-γ, (B) TGF-α and (C) VEGF concentration in tumor-bearing rats in groups C, G and G + E. *P<0.05. IFN-γ, interferon-γ; TGF-α, transforming growth factor-α; VEGF, vascular endothelial growth factor; group C, rats that did not undergo hepatectomy; group G + E, rats that underwent hepatectomy under general anesthetic with epidural block; group G, rats that underwent hepatectomy under general anesthetic.
Levels of phosphorylated STAT3 (p-STAT3) and p-VEGF in lung metastasis tissues determined by western blot analysis
To investigate the mechanism of the anesthesia-induced anti-metastatic effect further, levels of p-STAT3 and p-EGFR lung metastatic tissues were determined by western blot analysis (Fig. 3). The levels of p-STAT3 and p-EGFR in group G were slightly lower than those in group C. It was shown that there were significantly (P<0.05) lower levels of p-STAT3 and p-EGFR in group G + E than in groups C and G. Evidence indicates that aberrant STAT3 signaling promotes the initiation and progression of human cancer by either inhibiting apoptosis or inducing cell proliferation, angiogenesis, invasion and metastasis (32–34). Additionally, expression of EGFR is altered in a variety of human cancer types, including carcinoma of the lung, breast, head and neck, ovary and bladder, as well as in glioma (35–37). STAT3 and EGFR serve notable roles in tumor development and metastasis (34,38). The results of the present study indicated that GEA significantly inhibited tumor metastasis by reducing levels of p-STAT3 and p-EGFR.
Figure 3.
Western blot analysis. Levels of p-STAT3 and p-EGFR in tumor-bearing rats treated with and without GA and GEA. *P<0.05. p-STAT3, phosphorylated signal transducer and activator of transcription 3; EGFR, epidermal growth factor receptor; group C, rats that did not undergo hepatectomy; group G + E, rats that underwent hepatectomy under general anesthetic with epidural block; group G, rats that underwent hepatectomy under general anesthetic.
The perioperative period is a critical period of damage to the body's defense mechanism and has a substantial influence on the long-term prognosis of tumor patients. The role of anesthesia in improving the long-term prognosis of patients following surgery has been known and taken seriously in recent years.
It has been reported that there are four major mechanisms that surgery could contribute to an increase in tumor metastasis: i) The operation and touch of the tumor during surgery increased the chance of tumor cells releasing into the bloodstream (39); ii) Tumors in situ (TIS) serve a role in inhibiting angiogenesis: In surgery, the resection of TIS disrupts this line of defense, with the residual lesions promoting diseases and inducing the growth of blood vessels to increase the risk of tumor metastasis (40); iii) Perioperative immune suppression: Levels of epinephrine and norepinephrine during the perioperative period are substantially increased, which is considered to be the key to the connection between stress response and cancer progression (41); iv) The increase in local and systemic growth factor (EGF and VEGF) release in surgery promotes the recurrence of local and distant tumors (42). Furthermore, anti-angiogenic factors, including angiostatin and endostatin, decrease during surgery (43). Catecholamine promotes growth in a variety of tumor types by activating the STAT3 signaling pathway to increase the level of VEGF and inhibit the cellular immune response (5).
In the present study, the levels of IFN-γ in the plasma of rats in group G + E were higher than those in the two other groups, whereas the levels of VEGF and TGF-α in group G + E were lower than those in other two groups, as was the degree of STAT3 activation. The present study indicates that compared with GA, GEA can reduce the incidence of liver cancer metastasis following surgery. A possible mechanism may include the inhibition of STAT3 and relevant cytokines, including IFN-γ and TGF-α.
IFN-γ, which is secreted by T cells, can suppress tumor cell proliferation, upregulate the expression of surface major histocompatibility complex antigens and tumor necrosis factor and prevent tumor growth via inhibition of tumor angiogenesis and other mechanisms (44). A previous study demonstrated that IFN-γ can decrease the defense of tumors cells escaping immune system by regulating expression of the Fas cell surface death receptor/Fas ligand and enhancing sensitivity to Fas-mediated apoptosis, thus inhibiting the malignant proliferation of tumor cells (45).
EGFR is a membrane-bound receptor tyrosine kinase that belongs to the ErbB subfamily (46). On ligand binding, EGFR initiates the activation of a series of cellular signal transduction pathways that regulate cell proliferation and survival (47). The primary ligands for EGFR include EGF and TGF-α in liver cells (48). TGF-α produced by liver cells can bind with EGFR to promote the proliferation of liver cells by autocrine, or increase the proliferation of the vascular endothelium by paracrine (6). EGFR is activated by ligand binding, which causes it to homodimerize, activating downstream pathways, including the RAS proto-oncogene, GTPase/Raf proto-oncogene, serine/threonine kinase mitogen-activated protein kinase pathway, the Janus kinase (JAK)/STAT pathway and the phosphoinositide 3-kinase/RAC serine/threonine-protein kinase pathway (49). Two possible pathways for STAT3 activation exist, a JAK-dependent mechanism and a JAK-independent one, which initiates dimer formation of STAT3 in the cytoplasm. Thereafter, activated STAT3 transfers into the nucleus, binds to specific DNA sequences and induces transcription of target genes (47,50). This sequential process promotes tumor cell proliferation and inhibits apoptosis by regulating expression of the apoptosis suppressor genes, such as MCL1, BCL2 family apoptosis regulator and BCL2-like 1, and cell cycle regulatory factors, such as cyclin D1/D2 and MYC proto-oncogene, BHLH transcription factor (3).
In the present study, the expression levels of VEGF and TGF-α in group C were significantly higher than those in group G; however, those in group G were higher than those in group G + E. Overexpression of EGFR and its relevant ligands or the sequential activation of downstream signal pathways is observed in numerous tumor types (37,38). The formation of tumors is promoted by the following methods: Overexpression of EGFR triggers the enhancement of downstream signal transduction (51); the mutation of EGFR or overexpression of its ligands results in continuous EGFR activation (52); the function of autocrine loop is enhanced (53), mechanisms of downregulation of oncogenic receptors are lost (54); and abnormal signal transduction pathways are activated (55). In the present study, the increase in the expression of EGFR and its ligand demonstrated that the EGFR signal transduction pathway alters the formation of liver cancer metastasis via at least two mechanisms: The overexpression of TGF-α and EGFR, leading to the formation of an autocrine loop and increased downstream signal transduction, respectively. STAT3 is an oncogene that is closely associated with tumor development, evolvement, differentiation and immunity (18,19). The sustained activation or overexpression of STAT3 is frequently observed in skin, lung and breast cancer (56). To the best of our knowledge, mutations to STAT3 have not yet been observed, so we hypothesize that the sustained activation of STAT3 is triggered by enhancement of the intensity of upstream signal transduction pathways.
Song and Grandis (57) demonstrated that cell lines overexpressing TGF-α exhibited sustained activation of STAT3, and the addition of exogenous TGF-α could enhance the activation of squamous cell carcinoma of the head and neck. For certain tumors, the sustained activation of STAT3 resulted in the enhancement of activation of EGFR signal transduction pathways (57). STAT3 binds to activated EGFR via SH2 domains; stimulation of EGFR induces Tyr705 phosphorylation of STAT3, which is a prerequisite for dimerization of STATs, which again occurs via the SH2 domains (58). The dimerization of tyrosine-phosphorylated STATs leads to their nuclear accumulation, DNA binding at specific sites and the transcriptional activation of target genes (57). Research on breast cancer, squamous cell carcinoma of the head and neck and epidermoid cancer has revealed that sustained activation of STAT3 is relevant to the formation of the EGFR/TGF-α autocrine loop (59–61).
The present study revealed that the metastasis of liver cancer was decreased in rats that underwent surgery with GEA compared with those that underwent GA. The results demonstrated that the mechanism by which this occurred may be associated with the inhibition of STAT3 and certain relevant cytokines. However, these results were obtained from animal experiments, which require careful consideration and further confirmation in clinical trials.
Zhu RX, Seto WK, Lai CL and Yuen MF: Epidemiology of hepatocellular carcinoma in the Asia-pacific region. Gut Liver. 10:332–339. 2016. View Article : Google Scholar : PubMed/NCBI
Llovet JM: Updated treatment approach to hepatocellular carcinoma. J Gastroenterol. 40:225–235. 2005. View Article : Google Scholar : PubMed/NCBI
Buggy DJ and Smith G: Epidural anesthesia and analgesia: Better outcome after major surgery? Growing evidence suggests so. BMJ. 319:530–531. 1999. View Article : Google Scholar : PubMed/NCBI
Ogawa K, Hirai M, Katsube T, Murayama M, Hamaguchi K, Shimakawa T, Naritake Y, Hosokawa T and Kajiwara T: Suppression of cellular immunity by surgical stress. Surgery. 127:329–336. 2000. View Article : Google Scholar : PubMed/NCBI
Ben-Eliyahu S: The price of anticancer intervention. Does surgery promote metastasis? Lancet Oncol. 3:578–579. 2002.PubMed/NCBI
Ben-Eliyahu S, Page GG, Yirmiya R and Shakhar G: Evidence that stress and surgical interventions promote tumor development by suppressing natural killer cell activity. Int J Cancer. 80:880–888. 1999. View Article : Google Scholar : PubMed/NCBI
Deiner S and Silverstein JH: Long-term outcomes in elderly surgical patients. Mt Sinai J Med. 79:95–106. 2012. View Article : Google Scholar : PubMed/NCBI
Deflandre E and Lacroix S: It is time for anesthetists to act as perioperative physicians. Minerva Anestesiol. 82:257–258. 2016.PubMed/NCBI
Martin TA, Ye L, Sanders AJ, Lane J and Jiang WG: Cancer invasion and metastasis: Molecular and cellular perspectiveMetastatic Cancer Clinical Biological Perspectives 2013. Jandial R: Landes Bioscience; Austin, TX: pp. 135–168. 2013
Tsuchiya Y, Sawada S, Yoshioka I, Ohashi Y, Matsuo M, Harimaya Y, Tsukada K and Saiki I: Increased surgical stress promotes tumor metastasis. Surgery. 133:547–555. 2003. View Article : Google Scholar : PubMed/NCBI
Ucuzian AA, Gassman AA, East AT and Greisler HP: Molecular mediators of angiogenesis. J Burn Care Res. 31:158–175. 2010. View Article : Google Scholar : PubMed/NCBI
Distler JH, Hirth A, Kurowska-Stolarska M, Gay RE, Gay S and Distler O: Angiogenic and angiostatic factors in the molecular control of angiogenesis. Q J Nucl Med. 47:149–161. 2003.PubMed/NCBI
Simons M: Integrative signaling in angiogenesis. Mol Cell Biochem. 264:99–102. 2004. View Article : Google Scholar : PubMed/NCBI
Chen Z and Han ZC: STAT3: A critical transcription activator in angiogenesis. Med Res Rev. 28:185–200. 2008. View Article : Google Scholar : PubMed/NCBI
Hoeben A, Landuyt B, Highley MS, Wildiers H, Van Oosterom AT and De Bruijn EA: Vascular endothelial growth factor and angiogenesis. Pharmacol Rev. 56:549–580. 2004. View Article : Google Scholar : PubMed/NCBI
Senger DR, Galli SJ, Dvorak AM, Perruzzi CA, Harvey VS and Dvorak HF: Tumor cells secrete a vascular permeability factor that promotes accumulation of ascites fluid. Science. 219:983–985. 1983. View Article : Google Scholar : PubMed/NCBI
Leung DW, Cachianes G, Kuang WJ, Goeddel DV and Ferrara N: Vascular endothelial growth factor is a secreted angiogenic mitogen. Science. 246:1306–1309. 1989. View Article : Google Scholar : PubMed/NCBI
Xie TX, Wei D, Liu M, Gao AC, Ali-Osman F, Sawaya R and Huang S: Stat3 activation regulates the expression of matrix metalloproteinase-2 and tumor invasion and metastasis. Oncogene. 23:3550–3560. 2004. View Article : Google Scholar : PubMed/NCBI
Xie TX, Huang FJ, Aldape KD, Kang SH, Liu M, Gershenwald JE, Xie K, Sawaya R and Huang S: Activation of stat3 in human melanoma promotes brain metastasis. Cancer Res. 66:3188–3196. 2006. View Article : Google Scholar : PubMed/NCBI
Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E and Sessler DI: Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiology. 105:660–664. 2006. View Article : Google Scholar : PubMed/NCBI
Bauer M, Rensing H and Ziegenfuss T: Anesthesia and perioperative immune function. Anaesthesist. 47:538–556. 1998.(In German). View Article : Google Scholar : PubMed/NCBI
Borsook D, George E, Kussman B and Becerra L: Anesthesia and perioperative stress: Consequences on neural networks and postoperative behaviors. Prog Neurobiol. 92:601–612. 2010. View Article : Google Scholar : PubMed/NCBI
Marshall L, Khan AH and Buggy DJ: Can anaesthetic and analgesic techniques for cancer surgery affect cancer recurrence and metastasis? Curr Anesthesiology Rep. 5:190–202. 2015. View Article : Google Scholar
Vahabi S and Eatemadi A: Effects of anesthetic and analgesic techniques on cancer metastasis. Biomed Pharmacother. 87:1–7. 2017. View Article : Google Scholar : PubMed/NCBI
Ogren SO and Holm AC: Test-specific effects of the 5-HT reuptake inhibitors alaproclate and zimelidine on pain sensitivity and morphine analgesia. J Neural Transm. 47:253–271. 1980. View Article : Google Scholar : PubMed/NCBI
Sacerdote P, Bianchi M, Gaspani L, Manfredi B, Maucione A, Terno G, Ammatuna M and Panerai AE: The effects of tramadol and morphine on immune responses and pain after surgery in cancer patients. Anesth Analg. 90:1411–1414. 2000. View Article : Google Scholar : PubMed/NCBI
Yeager MP, Colacchio TA, Yu CT, Hildebrandt L, Howell AL, Weiss J and Guyre PM: Morphine inhibits spontaneous and cytokine-enhanced natural killer cell cytotoxicity in volunteers. Anesthesiology. 83:500–508. 1995. View Article : Google Scholar : PubMed/NCBI
Sasamura T, Nakamura S, Iida Y, Fujii H, Murata J, Saiki I, Nojima H and Kuraishi Y: Morphine analgesia suppresses tumor growth and metastasis in a mouse model of cancer pain produced by orthotopic tumor inoculation. Eur J Pharmacol. 441:185–191. 2002. View Article : Google Scholar : PubMed/NCBI
Ash SA and Buggy DJ: Does regional anaesthesia and analgesia or opioid analgesia influence recurrence after primary cancer surgery? An update of available evidence. Best Pract Res Clin Anaesthesiol. 27:441–456. 2013. View Article : Google Scholar : PubMed/NCBI
Gupta K, Kshirsagar S, Chang L, Schwartz R, Law PY, Yee D and Hebbel RP: Morphine stimulates angiogenesis by activating proangiogenic and survival-promoting signaling and promotes breast tumor growth. Cancer Res. 62:4491–4498. 2002.PubMed/NCBI
Cao LH, Li HT, Lin WQ, Tan HY, Xie L, Zhong ZJ and Zhou JH: Morphine, a potential antagonist of cisplatin cytotoxicity, inhibits cisplatin-induced apoptosis and suppression of tumor growth in nasopharyngeal carcinoma xenografts. Sci Rep. 6:187062016. View Article : Google Scholar : PubMed/NCBI
Rahaman SO, Vogelbaum MA and Haque SJ: Aberrant Stat3 signaling by interleukin-4 in malignant glioma cells: Involvement of IL-13Ralpha2. Cancer Res. 65:2956–2963. 2005. View Article : Google Scholar : PubMed/NCBI
Lamprecht B, Kreher S, Anagnostopoulos I, Jöhrens K, Monteleone G, Jundt F, Stein H, Janz M, Dörken B and Mathas S: Aberrant expression of the Th2 cytokine IL-21 in Hodgkin lymphoma cells regulates STAT3 signaling and attracts Treg cells via regulation of MIP-3alpha. Blood. 112:3339–3347. 2008. View Article : Google Scholar : PubMed/NCBI
Yue P, Zhang X, Paladino D, Sengupta B, Ahmad S, Holloway RW, Ingersoll SB and Turkson J: Hyperactive EGF receptor, Jaks and Stat3 signaling promote enhanced colony-forming ability, motility and migration of cisplatin-resistant ovarian cancer cells. Oncogene. 31:2309–2322. 2012. View Article : Google Scholar : PubMed/NCBI
Sordella R, Bell DW, Haber DA and Settleman J: Gefitinib-sensitizing EGFR mutations in lung cancer activate anti-apoptotic pathways. Science. 305:1163–1167. 2004. View Article : Google Scholar : PubMed/NCBI
Ali SM, Wang K, Johnson A, Rodriguez AA, Elvin JA, Vergilio JA, Suh JH, Chumsri S, Morosini D, Yelensky R, et al: Abstract P6-03-02: EGFR genomic alterations in 5,605 cases of refractory and metastatic breast cancer. Cancer Res. 76 Suppl 4:P6–03-02. 2016. View Article : Google Scholar
Milagre CS, Gopinathan G, Everitt G, Thompson RG, Kulbe H, Zhong H, Hollingsworth RE, Grose R, Bowtell DD, Hochhauser D and Balkwill FR: Adaptive upregulation of EGFR limits attenuation of tumor growth by neutralizing IL6 antibodies, with implications for combined therapy in ovarian cancer. Cancer Res. 75:1255–1264. 2015. View Article : Google Scholar : PubMed/NCBI
Falchook GS, Naing A, Wheler JJ, Tsimberidou AM, Zinner R, Hong DS, Fu S, Piha-Paul SA, Janku F, Hess KR, et al: Dual EGFR inhibition in combination with anti-VEGF treatment in colorectal cancer. Oncoscience. 1:540–549. 2014. View Article : Google Scholar : PubMed/NCBI
Engilbertsson H, Aaltonen KE, Björnsson S, Kristmundsson T, Patschan O, Rydén L and Gudjonsson S: Transurethral bladder tumor resection can cause seeding of cancer cells into the bloodstream. J Urol. 193:53–57. 2015. View Article : Google Scholar : PubMed/NCBI
Zhang W, Liu JN and Tan XY: Vaccination with xenogeneic tumor endothelial proteins isolated in situ inhibits tumor angiogenesis and spontaneous metastasis. Int J Cancer. 125:124–132. 2009. View Article : Google Scholar : PubMed/NCBI
Ramírez MF, Huitink JM and Cata JP: Perioperative clinical interventions that modify the immune response in cancer patients. Open J Anesthesiology. 3:133–139. 2013. View Article : Google Scholar
Wang X, Cao W, Mo M, Wang W, Wu H and Wang J: VEGF and cortactin expression are independent predictors of tumor recurrence following curative resection of gastric cancer. J Surg Oncol. 102:325–330. 2010. View Article : Google Scholar : PubMed/NCBI
Chavira E, Wilson M, Assaf SA, Ingles SA, Llanes A and Chmait R: Anti-angiogenic state in twin-twin transfusion syndrome ameliorated after laser surgery. Ame J Obst Gynecology. 206:S52. 2012. View Article : Google Scholar
Zielinski CE, Mele F, Aschenbrenner D, Jarrossay D, Ronchi F, Gattorno M, Monticelli S, Lanzavecchia A and Sallusto F: Pathogen-induced human TH17 cells produce IFN-γ or IL-10 and are regulated by IL-1β. Nature. 484:514–518. 2012. View Article : Google Scholar : PubMed/NCBI
O'Connell J, Bennett MW, O'Sullivan GC, Collins JK and Shanahan F: The Fas counterattack: Cancer as a site of immune privilege. Immunol Today. 20:46–52. 1999. View Article : Google Scholar : PubMed/NCBI
Müller CB, De Bastiani MA, Becker M, França FS, Branco MA, Castro MA and Klamt F: Potential crosstalk between cofilin-1 and EGFR pathways in cisplatin resistance of non-small-cell lung cancer. Oncotarget. 6:3531–3539. 2015. View Article : Google Scholar : PubMed/NCBI
Gao SP, Mark KG, Leslie K, Pao W, Motoi N, Gerald WL, Travis WD, Bornmann W, Veach D, Clarkson B and Bromberg JF: Mutations in the EGFR kinase domain mediate STAT3 activation via IL-6 production in human lung adenocarcinomas. J Clin Invest. 117:3846–3856. 2007. View Article : Google Scholar : PubMed/NCBI
Abbott BD, Buckalew AR, DeVito MJ, Ross D, Bryant PL and Schmid JE: EGF and TGF-alpha expression influence the developmental toxicity of TCDD: Dose response and AhR phenotype in EGF, TGF-alpha, and EGF + TGF-alpha knockout mice. Toxicol Sci. 71:84–95. 2003. View Article : Google Scholar : PubMed/NCBI
Weaver CT, Harrington LE, Mangan PR, Gavrieli M and Murphy KM: Thl7: An effector CD4 T cell lineage with regulatory T cell ties. Immunity. 24:677–688. 2006. View Article : Google Scholar : PubMed/NCBI
Sen B, Saigal B, Parikh N, Gallick G and Johnson FM: Sustained src inhibition results in signal transducer and activator of transcription 3 (STAT3) activation and cancer cell survival via altered Janus-activated kinase-STAT3 binding. Cancer Res. 69:1958–1965. 2009. View Article : Google Scholar : PubMed/NCBI
Juergens RA and Brahmer JR: Adjuvant treatment in non-small cell lung cancer: Where are we now? J Natl Compr Canc Netw. 4:595–600. 2006. View Article : Google Scholar : PubMed/NCBI
Smith RA and Glynn TJ: Epidemiology of lung cancer. Radiol Clin North Am. 38:453–470. 2000. View Article : Google Scholar : PubMed/NCBI
Fossella FV, DeVore R, Kerr RN, Crawford J, Natale RR, Dunphy F, Kalman L, Miller V, Lee JS, Moore M, et al: Randomized phase III trial of docetaxel versus vinorelbine or ifosfamide in patients with advanced non-small-cell lung cancer previously treated with platinum-containing chemotherapy regimens. The TAX 320 non-small cell lung cancer study group. J Clin Oncol. 18:2354–2362. 2000. View Article : Google Scholar : PubMed/NCBI
Herrera B, van Dinther M, Ten Dijke P and Inman GJ: Autocrine bone morphogenetic protein-9 signals through activin receptor-like kinase-2/Smad1/Smad4 to promote ovarian cancer cell proliferation. Cancer Res. 69:9254–9262. 2009. View Article : Google Scholar : PubMed/NCBI
Jean GW and Shah SR: Epidermal growth factor receptor monoclonal antibodies for the treatment of metastatic colorectal cancer. Pharmacotherapy. 28:742–754. 2008. View Article : Google Scholar : PubMed/NCBI
Siveen KS, Sikka S, Surana R, Dai X, Zhang J, Kumar AP, Tan BK, Sethi G and Bishayee A: Targeting the STAT3 signaling pathway in cancer: Role of synthetic and natural inhibitors. Biochim Biophys Acta. 1845:136–154. 2014.PubMed/NCBI
Song JI and Grandis JR: STAT signaling in head and neck cancer. Oncogene. 19:2489–2495. 2000. View Article : Google Scholar : PubMed/NCBI
Morlacchi P, Robertson FM, Klostergaard J and McMurray JS: Targeting SH2 domains in breast cancer. Future Med Chem. 6:1909–1926. 2014. View Article : Google Scholar : PubMed/NCBI
Lapeire L, Hendrix A, Lambein K, Van Bockstal M, Braems G, Van Den Broecke R, Limame R, Mestdagh P, Vandesompele J, Vanhove C, et al: Cancer-associated adipose tissue promotes breast cancer progression by paracrine oncostatin M and Jak/STAT3 signaling. Cancer Res. 74:6806–6819. 2014. View Article : Google Scholar : PubMed/NCBI
Penuel E, Kapp AV, Do A, Tam R, Sumiyoshi T, Marathe C, Sa S, Peale F, Lackner M, Holden S, et al: Biomarker evaluation in a randomized phase 2 study of MEHD7945A (MEHD) versus cetuximab (Cet) in ≥2 line recurrent/metastatic (R/M) squamous cell carcinomas of the head and neck (SCCHN) [MEHGAN]. Cancer Res. 75 Suppl 15:15532015. View Article : Google Scholar
Luwor RB, Baradaran B, Taylor LE, Iaria J, Nheu TV, Amiry N, Hovens CM, Wang B, Kaye AH and Zhu HJ: Targeting Stat3 and Smad7 to restore TGF-β cytostatic regulation of tumor cells in vitro and in vivo. Oncogene. 32:2433–2441. 2013. View Article : Google Scholar : PubMed/NCBI


text:
Wednesday, November 14, 2018
Amy Ray and Her Band
- Doors Open: 7:30 pm
- Show Starts: 8:00 pm
- Ticket Price: $25
- Genre: Americana/Alt-Country
New country-flavored music from an Indigo Girl
Amy Ray teamed up with Emily Saliers while in high school, and soon the duo became a staple in the Atlanta music scene. In 1981, their independent music career began with a basement recording called Tuesday's Children. One thing led to another, and they signed with Epic Records in 1988. Despite almost polar-opposite styles, they met on the common ground of harmony and the love of meaningful music. Ray brought fire and earth, Saliers the wind and water. Since the release of her 2001 album, "Stag," however, she's had an independent career that is different from, and complements, that of the parent duo. Amy has released seven albums, and she comes to The Ark with an eighth, the country-flavored "Holler." Tennessee "Southern gothic" songwriter Amythyst Kiah opens.


text:
369 Days: How To Survive A Year of Worst-Case Scenarios provides a roadmap of a challenging year (plus 4 days) in my life, and inspiration on how to navigate through trials and tribulations, and come out of those experiences a better person.
Here's Chapter One, free of charge :)
Chapter 1: In the Beginning…
How does a kid who grew up in Pontiac, and Waterford, Michigan end up in Toronto, Ontario?
I know, I know. Toronto, Canada? That frozen wasteland full of beavers and igloos? How did a guy who, for the first two decades of his life, never lived more than a ten-minute drive away from his parents' place, end up in Ta-ronnah? (Pronounce that with a heavy Don Cherry accent.)
Sixteen years ago, we were still dealing with the aftermath of 9/11 (Ever notice that the Euros don't call it 11/9? Always seemed weird to me). I was working at an Internet start-up (you don't hear that phrase anymore) in downtown Chicago.
After many steps, multiple career changes, lots of moves (I hate moving), and lots of lessons learned, I ended up moving north of the border.
Now, here I am, in the land of poutine and Tim Hortons. (No, I didn't miss an apostrophe there. It used to be Tim Horton's, but the apostrophe cost millions of dollars in printing, so the punctuation took it in the teeth, much to the chagrin of English teachers throughout the land.)
Oh, before we go much further, let me explain the stuff (in these curved brackets). I started using the (parentheses) in my writing long ago. I'm not sure why I use 'em, but I'm guessing it has something to do with a written version of ADHD (I've always wanted one of those AD/HD shirts that look like the AC/DC band logo, but I don't want to offend people who genuinely suffer from the disorder).
Anyway, back to Pontiac, Michigan. Pontiac is named after Chief Pontiac (look him up—interesting guy), as well as the name of a "Generous Motors" (GM) line of cars, which they tragically eliminated in 2010.
The City of Pontiac is a classic example of putting all your eggs in one basket. When GM left town, so did the lifeblood of the city. Yes, people still live there, and there are pockets of viability, but it has never returned to the glory of yesteryear.
Of course, you could say that about every town. I don't think we're supposed to stay the same. We're supposed to change, try new things, explore, invent, and thrive. I'm thankful for my time and experiences in Pontiac. They shaped me, and they shaped how I deal with different cultures. Growing up in Pontiac, my school was about 75 percent African-American, 20 percent Caucasian, and 5 percent Hispanic. Thus, I was a minority in the eyes of society. I was too young to care.
I only had the sixteen-count box of Crayola crayons as a child. I eventually would be bestowed with the infamous sixty-four-count box, with that piece-of-crap "sharpener" that didn't sharpen anything—but until that day, my color vocabulary was limited to the labels on those sixteen little tubes of wax.
One time, when someone said that my friend was black, I shot back, "he's not black, he's brown, and I'm peach, not white." I didn't know much about the labels society gave different groups of people, and I didn't care. All I knew was that this guy needed to get his Crayola colors straight!
I still don't care what color you are. You're a human being, with a soul, a heart, a mind, hurts, joys, triumphs, and stories. You matter to me.
I had a great childhood, a great brother, loving parents, and friends whom I still have to this day, nearly forty years later. I knew at an early age what I would likely do: become an accountant. It might sound boring to you, but it was the most exciting subject in the world to me! I knew I would enjoy this field, because I loved reading the backs of baseball cards (the 1978 Topps Cards are still the best set of baseball cards ever). I would look at the stats and figure out how they calculated those statistics. #NerdAlert
I did well in school, and continued that way in college (there were a few semesters that were iffy, but I still passed!). My younger years were filled with adventure, and . . . well, you know what your teenage years and early adult years looked like. I am beyond thankful that social media did not exist back then. The things that happened would make Snapchat blush (I'm a good boy, Mom, honest!).
My first job out of high school, and throughout my college years, was with a CPA firm in my hometown. I spent eight years there, and the foundations that experience created continues to impact how I do things today.
In the mid-1990s, I got married, and my wife and I spent eighteen months in Florida, the Sunshine State. I was tired of the Midwest weather, and I wanted something warm and consistent. We got just that—mid-nineties temperatures for eight months straight! Winter was cooler, but still quite warm.
By fate, just when I started missing the change of seasons, I learned that the software company my employer used was hiring IT network installers in Chicago. Through my long-time buddy Mark, I was hired. I left Florida at seventy-two degrees, and arrived in Chicago to negative twenty-seven degrees—nearly a hundred-degree swing. What have I done? I asked myself as my teeth chattered in the subzero cold.
The next decade I was in the IT field, working for a large software firm, an executive recruitment firm, a division of the Big Three automakers, and then a large Internet market research firm. Back in the 90s, there were not enough IT personnel to go around, so switching jobs for pay increases was the norm.
Then the dot-com bubble went pop! and IT jobs started disappearing left and right. My wife and I had started a family, and I was looking for something a bit more stable than the IT world. Every company needs to keep track of spending, so I returned to the bean-counting world.
I worked for a small software and consulting firm in the Detroit area for four years. As my daughters were approaching school age, and because of the current economic struggles that Michigan was facing, we decided that Michigan, once again, would not be where we should stay. We explored moving back to Chicago, but family and friends were in Detroit, so we decided to move to Windsor, Ontario, Canada, which is right across the river. My wife is from Windsor, so that would be the gateway for me to immigrate to the Great White North.
Two years and several thousand dollars later, we moved to Canada. I received my Canadian citizenship 2011, so now I can vote in two countries. (Note: I will not have any political conversation in this book. It's a no-win situation. I love everybody!)
After crossing the US-Canada border for work for three years, I finally found a job close to home in Windsor. The job market is limited in Windsor, so being an American didn't help. They would rather employ a Canadian than an American. That's understandable, but my personal perspective is different. I don't care where you're from. Can you do the job? Do you fit in our culture? You're hired!
I saw an advertisement in the local paper for an administrator for a brand-new medical clinic. I looked at the details of the job, and thought, What the heck, I'll go for it. It was around the corner from home, and the compensation was good.
A few weeks later the phone rang, and the organization wanted to meet me. So I interviewed with them. Then, there was a second interview, and they requested references. Thankfully, I had left most of my jobs on great terms, so I had rock-solid references from bosses, friends, and co-workers. The organization called them all. I guess they really wanted to make sure this American was all he was cracked up to be.
Apparently I was. They hired me. Eighty-five people applied for the role. They performed thirteen phone interviews, five face-to-face interviews, and three final interviews. I was the only person in the finalists who had zero healthcare experience. I didn't even know what the heck an Autoclave was. (Note: It's a really expensive dishwasher.) So I gave my notice, and I started my career in healthcare management.
Do you want a better start to your day? I have a free e-book on six easy steps to a better day, that I personally follow after I experienced a significant health scare. If you would like this free e-book, please click the link below.
Six Steps to a great Morning (Besides coffee)


text:
The Centre for Colonial and Postcolonial Studies has a long-standing history at the University of Sussex and reflects significant interdisciplinary and cross-school interests. Colleagues involved in the Centre work on the histories and cultures of colonialism, in postcolonial studies, including the literature of terror and trauma, and on the politics of knowledge production inherent in colonial and imperial endeavours.
The Centre's remit includes:
- acting as the forum for discussion of themes associated with the Centre, including of work in progress among its members
- providing an intellectual 'home' for research students with interests in these themes across the Arts and Humanities and Social Sciences
- hosting occasional international conferences and symposia
- raising the profile of research at Sussex outside of the university
At the core of these activities is a series of informal discussions of work in progress by the centre's members. Anyone interested is welcome to attend, register as an affiliate of the centre and join in an open consultation about its activities.
The Director of the Centre for Colonial and Postcolonial Studies is Prof Gurminder K Bhambra (International Relations).
The Co-Directors and Steering Committee is comprised in addition of: Prof Alan Lester (Geography), Dr Minoli Salgado (English), Dr Althea Maria Rivas (International Development) and Dr Fillipo Osella (Anthropology).


text:
Tweets by @AircraftCommrce
Structuring a M&E IT system to achieve a range of functionalities and meet long-term requirements is a complex process. The first main issues to consider are how to configure a system to get all desired engineering, content management and job card production functionalities.
Problems with this site? Call our technical support +44 1403 230 700 | Privacy Policy
© 2018 Aircraft Commerce is copyright of Nimrod Publications Ltd. All rights reserved.


text: Kentucky needs to follow Virginia's lead for moving into the 21st century. Workerscompenstion.com recently posted a piece about the Virginia WCC going paperless. The agency's on-line portal will allow individuals to file claims, insurance companies to file reports of injury, and attorney's to view and manage case files. Read the post here.


text:
MSC scFLOW V14 | 4.1 Gb
scFLOw is developed to become the new state-of-the-art tool with the breadth of new technologies and simple practical features. The software is currently equipped with a new solver designed with higher stability and up to three times faster calculation speed than before. The new preprocessor helps entry-level users build complicated models and high-quality meshes.


text:
Please enter your email address below. You will receive a link to reset your password.
You have no items in your shopping cart.
Modern valet in Lucite with engraved name of 'Howard Katz' on the front.
Show more info
Mid-Century Modern valet in walnut wood crafted in Rome, Italy during the 1960s.
1960's Italian gentlemen's brass valet detailed with lion heads and terminating in paw feet.
A Maison Jansen valet influenced by neoclassical themes with ram's head motif and produced in midcentury Italy.
1950s-1960s Italian brass standing towel rack or valet in the Hollywood Regency style.
Our buyer guarantee allows you to shop with confidence at Showplace Antique + Design Center. This pledge to uphold our standard of excellence includes the following guarantees:
We take pride providing reliable service to all of our customers. If you have any questions about this guarantee or any of the services that we provide, please don't hesitate to contact our customer support specialists at firstname.lastname@example.com.


text:
The on-going chronicle of all things related to the George and Laura Roediger House (c. 1905) in the historic Holly Avenue Neighborhood of downtown Winston-Salem, NC. More info and pictures can be found at RoedigerHouse.com.
Wednesday, May 31, 2017
Meal No. 1836: Seasoned Crusted Pork Chops
My May to-do list is pretty extensive but last week I managed to tackle quite a few items on it. Friday ended up being a bit busy with a lot of appointments and running around, so when dinnertime rolled around, I was rolling easy: my friend Cindy's seasoning crust approach to pork chops, along with baked potatoes. That was it. That was all. That was the deal. That was good.
Posted by Ray at 4:11 AM No comments:
Tuesday, May 30, 2017
Meal No. 1835: Indiana Chicken & Corn Chowder
A lot of rain has come down here in Winston-Salem over the last few days, and we were briefly under a tornado watch this past Wednesday afternoon (with the emergency horn going off from downtown and everything!). It seemed like a good night for Indiana chicken and corn chowder, which was served up to the four of us at the table that night.
"Indiana Corn and Potato Chowder," by Brannon Soileau of Maize, An American Grill (formerly of Lafayette, IN). In Indiana Cooks!, by Christine Barbour and Scott Feickert with photographs by Tom Stio. Bloomington, IN: Quarry Books (2005), p. 64-65. Recipe originally shared with me by my sister Allison on December 31, 2006. You can find this, and quite a few other Indiana recipes, if you scroll to the bottom of this article: "Indiana Can Cook."
Posted by Ray at 4:00 AM No comments:
Labels: get recipe, meals, pork, soup
Monday, May 29, 2017
Meal No. 1834: Not So Cajun Chicken
The fourth time in 2017 that I've made this meal, so I might be stuck in a rut. But what a good rut: not so cajun chicken over rice, with Caesar salad to boot.
"Not So Cajun Chicken," a dish I regularly enjoyed at Crowley's Old Time Favorites restaurant and bar on Medlin Drive in Raleigh, NC. Credit to Jimmy Randolph for helping track the recipe down. (Another version of the recipe can be found here.)
Posted by Ray at 4:41 AM 1 comment:
Labels: get recipe, meals, RoHo pdf, salad
Sunday, May 28, 2017
Meal No. 1833: Ribeyes and French Fries
On a Monday evening, after a day of short bursts of can-do energy interspersed with indulgent downtimes, I went outside and grilled ribeyes and fried fries. The belly said it's all right.
Posted by Ray at 4:24 AM No comments:
Saturday, May 27, 2017
Classic Yellow Cake with Rich Chocolate Frosting (and Double Chocolate Liqueur Ice Cream!)
Last Sunday night, dessert happened: classic yellow cake with a delicious chocolate frosting. On the one other occasion I made this, I prepared it as a two-layer cake...and while it was good, the layers were a bit on the tall side. This time I made three separate layers and tried to watch out for the adjusted cooking time. In the end, it was made all the better because, well, frosting!
But what's cake without ice cream, I ask you?! So I also whipped up a batch of double chocolate liqueur ice cream to boot, and it's always so darned tasty.
"Classic Yellow Cake," by Robyn Stone. Found online at addapinch.com.
"Super-Simple Chocolate Frosting," from King Arthur Flour. Posted 01/01/2010.
"Double Chocolate Liqueur Ice Cream," by Kita Roberts. From her Pass the Sushi blog.
Posted by Ray at 3:34 AM No comments:
Labels: cake, desserts, get recipe, ice cream
Friday, May 26, 2017
Meal No. 1832: Frisco Patty Melts
After spending the afternoon in Greensboro for the Fisher Park Home Tour, with some of the crew from the Guilford County Schools Mission Possible Team, I settled on a simple filling supper once I was back at home: frisco patty melts, with buttered toasted bread, classic burger sauce, and two kinds of cheese.
Classic Burger Sauce
from Cook's Illustrated, July-August 2008, p. 11.
4 T mayonnaise
2 T ketchup
1 tsp sweet pickle relish
1 tsp sugar
1 tsp white vinegar
1/2 tsp ground black pepper
Whisk all ingredients together in a small bowl.
Posted by Ray at 4:29 AM No comments:
Labels: beef, get recipe, meals
Thursday, May 25, 2017
Meal No. 1831: Kung Pao Chicken
Saturday night at the Roediger House: a delicious bowl of stirfry goodness, in the guise of kung pao chicken with sweet red bell peppers and asparagus cuts...all made in a brand-new wok.
On a side note: May has flown by, no doubt, and I'm mindful of the fact that my yard efforts have been pretty slim so far this spring. Other than trying to keep the bird feeders filled (a definite challenge of late!), weeding is the only substantive thing I've really done, although with Sumner's trips out for doggie business in the yard, I'm definitely trying to do a thoughtful survey and make rough plans for what needs to be tackled.
"Kung Pao [Chicken]" (p. 80) with Szechwan Marinade (p. 28) and Spicy Peanut Stir-Fry Sauce (p. 27). In Wok Fast, by Hugh Carpenter and Teri Sandison. Ten Speed Press (Berkeley/Toronto), 2002.
Posted by Ray at 4:19 AM No comments:
Wednesday, May 24, 2017
Meal No. 1830: Texas Thick-Cut Smoked Pork Chops
Friday night was festive at the Roediger House, with Amy and Gern and Kristen and Mookie over for hanging out and for dinner. The late afternoon storms passed on and it was perfect for grilling (with Mesquite smoke added in for good measure!). Our plates were laden with Texas thick-cut smoked pork chops, topped with Virginia Pruitt's perfect barbecue sauce; sweet onion corn bake; and Brussels sprouts gratin. It was a delightful night, as always.
"Texas Thick-Cut Smoked Pork Chops," by Ashley Moore. In Cook's Country, June/July 2016, p. 4-5.
"Virginia Pruitt's Perfect Barbecue Sauce," by Fred Thompson of Grillin' with Gas. Recipe found on epicurious.com.
"Sweet Onion Corn Bake," by Jeanette Travis of Fort Worth, TX. Published in Taste of Home, April/May 2003, p. 37-38.
"Brussels Sprouts Gratin," by Alison Roman. From Cooking on newyorktimes.com.
Posted by Ray at 4:18 AM No comments:
Labels: get recipe, grilling, meals, pork
Tuesday, May 23, 2017
Meal No. 1829: Bourbon Chicken
Thursday was my last day of work for the academic school year, and it was spent with instructional leaders at two different schools in Mount Airy City. Greeted exceptionally excitedly by Sumner when I got back to the house late afternoon, on an unseasonably warm May day, it was nice to chill, do a bit of weeding, tackle a small amount of paperwork, and then surrender to the seduction of an easy dinner: bourbon chicken. Filling and tasty, and there was still room for the last of the cake batter ice cream.
"Bourbon Chicken," by LinMarie. From Food.com.
Posted by Ray at 4:29 AM No comments:
Monday, May 22, 2017
Meal No. 1828: Moroccan-Spiced Chicken Thighs
It's been about six months since I last made this easy house favorite, which I've tended to refer to in honor of a former student who shared his recipe for it: Brendan's Moroccan Bistro Chicken. In the steamy remains of last Wednesday's hot day, this is what I served up for delightful neighbors Alaina and Deborah. Served over rice and with fresh steamed broccoli on the side, we made a great evening of it.
Posted by Ray at 4:46 AM No comments:
Sunday, May 21, 2017
Kentucky Butter Cake and Cake Batter Ice Cream
With some whiskey sauce left over from the New Orleans Pecan Pie Bread Pudding I made over the weekend, and in search of a purpose, I figured I'd try out a new Bundt cake recipe: Kentucky Butter Cake.
And, to go with it: you won't be able to accuse me of getting all fancy with this latest new ice cream I made: it's a simplified copycat of Carvel's and Cold Stone Creamery's cake batter ice cream, and it's good enough as a quick and easy ice cream on a sunny day in May.
"Kentucky Butter Cake," from Laura Davis on JustAPinch.com.
"Cake Batter Ice Cream," by smstemp on food.com.
Posted by Ray at 2:16 AM No comments:
Labels: cake, desserts, fun foods, get recipe, ice cream
Saturday, May 20, 2017
Meal No. 1827: Chicken with Coronation Sauce
By special request this past Monday night: chicken with coronation sauce over rice.
"Coronation Sauce for Chicken," from 400 Sauces, by Catherine Atkinson, Christine France, and Maggie Mayhew. Hermes House (2006, 2008), p. 155.
Posted by Ray at 4:49 AM No comments:
Friday, May 19, 2017
Meal No. 1826: Miso-Glazed Salmon Filets
With downtown just a bit a-buzz with it being Mother's Day and graduation weekend for Wake Forest University, it was nice to have a quiet meal inside the comforting abode known as the Roediger House. I served up wonderfully thick (and perfectly cooked!) salmon filets with a miso-mirin glaze and chilled rosemary-dijon cream sauce; garlic-spiced pearl couscous; and Caesar salad. No dessert needed on this night of such good food.
Miso Glaze from "Miso-Glazed Salmon Steaks," in Bon Appétit, May 2011, p. 58.
"Chilled Rosemary-Dijon Cream Sauce," in The Ultimate Southern Living Cookbook, compiled and edited by Julie Fisher Gunter. Birmingham, AL: Oxmoor House (1999), p. 216.
Couscous recipe based partially on "Toasted Israeli Couscous with Pine Nuts and Parsley, from Bon Appétit, December 2004.
Posted by Ray at 4:19 AM No comments:
Labels: get recipe, meals, salad, seafood
Thursday, May 18, 2017
Meal No. 1825: Chicken & Cheese Quesadillas
When the time for the Saturday evening meal rolled around, I had both giant tortillas and rotisserie chicken on hand, and that made chicken and cheese quesadillas a natural choice for dinner while watching a couple more episodes of the original Batman series.
Preparation and cooking based on "Quesadillas for a Crowd," by Morgan Bolling. In Cook's Country, August/September 2015, p. 18.
"Fajita Seasoning Mix," from ForTheMommas.com. Adapted from "Fajita Seasoning Mix Recipe" on Food.com.
Posted by Ray at 4:40 AM No comments:
Wednesday, May 17, 2017
New Orleans Pecan Pie Bread Pudding
Last Friday night, in addition to a scrumptious meal for the four of us, I also managed to put together a delicious dessert: New Orleans pecan pie bread pudding with whiskey sauce. Lord have mercy.
"New Orleans Pecan Pie Bread Pudding," from King Arthur Flour online.
"Whiskey Sauce," based on a recipe from Mimi's Cafe (found online).
Tuesday, May 16, 2017
Meal No. 1824: Braised Chicken over Brussels Sprouts
It was a delightful evening with four at the table this past Friday night, and in order to preserve time for playing pool, I decided I'd go with braised chicken over Brussels sprouts and shallots, along with rosemary roasted baby Dutch potatoes.
"Braised Chicken and Brussels Sprouts," in Everyday Food, Issue 97, November 2012, p. 22.
Posted by Ray at 4:15 AM No comments:
Monday, May 15, 2017
Meal No. 1823: Breakfast for Dinner
After a good but full day spent split between two different schools in Mount Airy on Thursday, I decided to make dinner from whatever was on hand in the cupboard. Since it included Neese's hot country sausage, I settled on breakfast for dinner, with fried eggs, creamy grits, and toast with mixed fruit jelly. Heck, yeah.
"Creamy Grits," from Luquire Family Stone Ground Grits, milled in Greenwood, SC.
Posted by Ray at 3:57 AM No comments:
Sunday, May 14, 2017
Meal No. 1822: Shrimp Po'Boys
This past Wednesday night represented a return to an easy favorite that's the best version I've found for shrimp po'boys. It was a stripped-down take that night, with wonderful creole-spiced fried shrimp on baguettes with a zingy remoulade sauce.
"Shrimp Po'Boy," in Bon Appétit, June 2011, p. 118-119.
"Cajun Remoulade Sauce," by Remoulader. Found online at Food.com.
Posted by Ray at 4:15 AM No comments:
Labels: get recipe, meals, seafood, shrimp
Saturday, May 13, 2017
Meal No. 1821: Chicken Tenders on Caesar Salad
This past Monday night, with three at the table, I had planned a bit of lighter fare: Caesar salad topped with fresh buttermilk fried chicken tenders. And I'm so glad there was still some wonderful chocolate meringue pie to keep it all from seeming too skimpy and healthy.
"Buttermilk Fried Chicken Tenders," by Jenn Segal of OnceUponAChef.com.
Guidance on Hard-Boiled Eggs: "The Hard Truth about Hard-Boiled Eggs," by J. Kenji López-Alt, Managing Culinary Director of SeriousEats.com.
Posted by Ray at 4:22 AM No comments:
Labels: get recipe, meals, salad
Friday, May 12, 2017
Chocolate Meringue Pie
When former Wake Forest grad student Bradley Phillis passed through last Sunday night and stopped in for supper, I knew I had to choose carefully the dessert. Why? He hates cake. The solution? Chocolate meringue pie. The result? Amazing. Glad he was here to inspire me to make it.
"Chocolate Meringue Pie," based on a classic and common recipe.
Thursday, May 11, 2017
Butter Toffee Cookies for Northern Guilford Middle
As is often the case, I'd made a promise to come bearing cookies with one of the schools I've been working with this spring. On a recent Wednesday, the recipients were the instructional leadership team at Northern Guilford Middle School. I didn't think they (meaning: the cookies) were quite up to par, but they were reasonably acceptable.
"Butter Toffee Cookies," originally from King Arthur Flour. The catalog that comes periodically from KAF has recipes in it, which is where I originally got this. But, as sometimes happens, it is not available on their website. I'm glad someone posted it to Food.com.
Wednesday, May 10, 2017
Meal No. 1820: Lamb Köfte with Yogurt Sauce and Muhammara
It's been just shy of two years since I last made the dish that was served up Sunday night, on the special occasion of a pass-through visit by Bradley Phillips. On the menu: lamb köfte with yogurt tahini sauce and muhammara (a roasted red pepper sauce). All of that sat with caramelized onions on some middle eastern flatbread. It was darned good, if I may say so. I'm a softe for kofte.
"Lamb Köfte with Yogurt Sauce and Muhammara," from Bon Appétit, January 2010. [clipping]
Posted by Ray at 4:42 AM No comments:
Labels: get recipe, lamb, meals
Tuesday, May 9, 2017
Meal No. 1819: Country Ham and Biscuits
Very much like my mother used to make and an easy meal for last Saturday night: country ham, biscuits, and rice, with a tall glass of milk.
Posted by Ray at 4:15 AM No comments:
Monday, May 8, 2017
Meal No. 1818: Herb-Roasted Whole Chicken with Savory Pan Gravy
Friday was a perfect night for a feast-like meal, with Kristen and Mookie over, and I hope it did not disappoint. The main feature was a delicious herb-roasted whole chicken, and from the pan I extracted the drippings to get a savory herbilicious gravy. Macaroni and cheese casserole and buttered garden peas seemed a natural fit to go with it all, and I couldn't help but indulge yet again in the buttermilk'd and buttery biscuit hoecakes that I've been trying to perfect.
"Herb-Roasted Whole Chicken with Savory Pan Gravy," in Tupelo Honey Cafe: Spirited Recipes from Asheville's New South Kitchen, by Elizabeth Sims with Chef Brian Sonoskus. Kansas City: Andrews McMeel Publishing, LLC (2011), p. 136-137.
"Macaroni and Cheese Casserole," by Sarah Gabriel. In Cook's Country, June/July 2012, p. 17.
"Fluffy Southern-Style Hoecakes," by Erica of My Busy Bees and Me. Recipe first encountered through her YouTube video.
Posted by Ray at 4:30 AM No comments:
Sunday, May 7, 2017
Chocolate Pecan Pie (a/k/a: Blender Pie)
For a pie that's been a Jones family favorite for decades, I sure don't make this one nearly as much as I should: chocolate pecan pie, typically whipped up in the blender. The recipe came from Lib Keith in Harnett County (she passed away in 2012). It didn't set up well this time but the flavor was still amazing.
Posted by Ray at 4:48 AM No comments:
Saturday, May 6, 2017
Meal No. 1817: Peanut Butter Bacon Burgers
The second day of May was a stunner, ladies and gentlemen, and I'm glad I had the day off and had plenty of time to take Sumner on a couple of great long walks. That sure helped me to work up a better appetite for the special and amazing and funky dinner that Tuesday evening: peanut butter bacon burgers. Finding good-looking boneless beef short ribs and top sirloin (on sale, at that!) when I'm doing my regular grocery shopping is about all it takes for me to put this on the menu. Even though I've now made these nearly 30 times over the last (nearly) seven years, they are neither routine nor repetitive. I'd say they're always a treat.
A review of key points about the Roediger House peanut butter bacon burgers, on the occasion of their 27th appearance on the kitchen table:
- Inspired by Yo Mama's in the French Quarter of New Orleans
- First Made: Meal No. 180
- Last Made: Meal No. 1779
- Fresh Home-Ground Beef, typically from boneless beef short ribs and top sirloin
- Homemade Peanut Butter
- Homemade Classic Burger Sauce (recipe below)
- Labeled Sample "Final Product" Burger: Guide to Meal No. 234
Classic Burger Sauce
from Cook's Illustrated, July-August 2008, p. 11.
4 T mayonnaise
2 T ketchup
1 tsp sweet pickle relish
1 tsp sugar
1 tsp white vinegar
1/2 tsp ground black pepper
Whisk all ingredients together in a small bowl.
Guidance on grinding, shaping, and cooking burgers from "Best Old-Fashioned Burgers," by J. Kenji Alt, in Cook's Illustrated, No. 93 (July/August 2008), p. 10-11.
Original bacon braid guidance from "Bacon Sheets," from MyFridgeFood.com. See also: "How to Make a Bacon Weave for the World's Best BLT," a nice video demonstration, from Justin Chapple's Mad Genius Tips on the Food & Wine website [published 02 March 2015].
Posted by Ray at 5:53 AM No comments:
Labels: beef, get recipe, meals, PBBB, pork
Friday, May 5, 2017
Meal No. 1816: One-Pan Pork Tenderloin
When long-time Wake Forest University chum Chris Burris came for dinner this past Monday night, the menu included one-pan pork tenderloin and roasted whole green beans. I also think I finally nailed the way Ree Drummond wanted me to make her version of creamy mashed potatoes. This time, I used red potatoes and suffered from no hesitation about the amount of butter to go into them. That might have been the key.
"One-Pan Pork Tenderloin with Green Beans and Potatoes," by Christie Morrison. In Cook's Country, October/November 2015, p. 27.
"Creamy Mashed Potatoes," from Ree Drummond, the Pioneer Woman. Published online 03 November 2007.
Posted by Ray at 3:42 AM No comments:
Labels: get recipe, meals, pork
Thursday, May 4, 2017
Meal No. 1815: Chicken Scaloppini
On the final night of April, I was ready to try a new recipe, and it was a good one: chicken scaloppini, with roasted red potato wedges.
"Chicken Scaloppini," by Cristin Walsh in Cook's Country, April/May 2014, p. 23.
Posted by Ray at 4:38 AM 1 comment:
Wednesday, May 3, 2017
Meal No. 1814: Juicy Kickin' Burgers
By the time I'd taken Sumner for three walks last Saturday, and also cut the grass late afternoon in the hot humidity that had strangely settled on Winston-Salem, I just wanted burgers for dinner.
"Grilled Juicy Burgers," from Pillsbury Classic Cookbooks recipe magazine.
Posted by Ray at 3:42 AM No comments:
Labels: beef, get recipe, grilling, meals
Tuesday, May 2, 2017
Meal No. 1813: Slow-Roasted Beef Tenderloin
Whole beef tenderloins were on a great special at Lowe's Foods, and Mookie and Kristen had missed the grand Easter night meal, so I thought: Guess we just need to have that same meal again. That's what happened Friday night at the Roediger House...a wonderfully-cooked slow-roasted beef tenderloin was dipped by some in a spicy horseradish sauce, and all of us had respectable piles of green bean casserole and company mashed potatoes to go with it. We were also glad there was still some of Jen Martin's delicious strawberry pie to finish us out!
"Slow-Roasted Beef Tenderloin," from J. Kenji López-Alt, Managing Culinary Director of SeriousEats.com.
"Spicy Horseradish Sauce" from "Beef Tenderloin in Wine Sauce," from The All-New Ultimate Southern Living Cookbook. Compiled and Edited by Julie Fisher Gunter. Oxmoor Press (2006), p. 295, 296.
"Company Mashed Potatoes," a Jones family favorite.
"Layered Green Bean Casserole," from my sister Allison in Rossville, Indiana.
Posted by Ray at 4:12 AM No comments:
Labels: beef, get recipe, meals, RoHo pdf
Monday, May 1, 2017
Meal No. 1812: Copycat Chic-Fil-A Sandwiches
Dinner this past Thursday night brought me back to a recipe that's been MIA at the Roediger House since 2015: Hilah Johnson's marvelous copycat version of Chic-Fil-A sandwiches. I love that I can make mine with no pickles (or removed pickles leaving green yuckiness soaked into the bun).
And when Jen Martin visited at lunchtime that day, she came bearing this wonderful strawberry pie that she'd made, which served as an awesome dessert after the chicken sandwiches!
"Chic-Fil-A Copycat Sandwich," by Hilah Johnson. From Hilah Cooking.
Posted by Ray at 4:07 AM No comments:
Subscribe to: Posts (Atom)


text:
Welcome to the Tower Center
The SMU Tower Center was created to commemorate the late US senator, John G. Tower, whose life was dedicated to public service and education. In the spirit of John Tower's commitment to educate and inspire a new generation of thoughtful leaders, the Tower Center seeks to bridge the gap between the world of ideas, scholarship and teaching, and the practice of politics. The primary mission of the Tower Center is to promote the study of politics and international affairs and to stimulate an interest in ethical public service among undergraduates. The Tower Center is an academic center where all parties and views are heard in a marketplace of ideas, and the Center will pursue its mission in a non partisan manner.
The Tower Center in SMU's Dedman College reaches students from middle school through post-doctoral studies, with particular emphasis on undergraduate teaching. The Tower Center supports several programs of study at SMU. Nearly 10 percent of undergraduates have a Tower Center connection.
The Tower Center enables the brightest scholars to pursue independent research in domestic and foreign policy. Research programs focus on national security and defense, the international political economy, and American democracy and political development.
Through classes, seminars, public lectures and international conferences, the Tower Center contributes to informed debate on public policy challenges that confront our nation and the world. The center fosters important dialogue by bringing leaders to Texas like Richard Butler, Dick Cheney, William Cohen, Richard Fisher, Tony Garza, Tamar Jacobi, Henry Kissinger, Richard Lugar, Gillian Sorensen, Ruth Wedgwood and James Woolsey, among many others.
To support these programs and vital research, join the SMU Tower Center Forum. Membership gives you the opportunity to advance the pursuit of solutions to the important issues facing the world. You also will be invited to compelling conferences, lectures, briefings and other events with the leading voices shaping public policy today. For information, visit the web site or call 214-768-1900.
John Goodwin Tower was born in Houston, Texas on September 29, 1925. He was educated in the public schools of Houston and Beaumont, Texas. During the Second World War, while attending Southwestern University in Georgetown, Texas, he enlisted in the U.S. Navy and was assigned to an amphibious gunboat in the Pacific. He was discharged with the rank of seaman first class in 1946. Throughout his life he was a member of the U.S. Naval Reserve, earning the rank of chief boatswain's mate.
Following his military service, John Tower received a B.A. degree from Southwestern University. In 1953, he earned a Masters degree from SMU. He also attended the London School of Economics and Political Science. He became a member of the faculty at Midwestern University in Wichita Falls, Texas, where he taught history and Political Science from 1951 to 1960.
John Tower was elected on May 27, 1961 to Lyndon Johnson's U.S. Senate seat, after Lyndon Johnson became vice president. At 35, he was the youngest member of the Senate in the 87th Congress, as well as the first Republican elected to the U.S. Senate from Texas since the Reconstruction. Senator Tower won this landmark election in a field of 71 candidates.
Senator Tower was reelected three times to the U.S. Senate, where he served from 1961 until 1985. He served as chairman of the Republican Policy Committee from the 93rd to the 98th Congress, and was chairman of the Committee on Armed Services for the 97th and 98th Congresses.
Following his retirement from the Senate, he was appointed by President Ronald Reagan in 1985 to serve as a member of the United States arms negotiation team in Geneva. He also served as chairman of the Tower Commission in 1987 investigating the Iran Contra scandal.
In 1989, Senator Tower was nominated by President George Bush to be Secretary of Defense, but was not confirmed by the Senate. He subsequently founded John Tower and Associates, a consulting firm, with offices in Dallas and Washington, DC. He was also a member of President Bush's Foreign Intelligence Advisory Board.
Senator Tower served as a member of the SMU Board of Trustees from 1968-87.
Senator Tower and his daughter Marian G. Tower died in the crash of a commercial aircraft near Brunswick, Georgia, on April 5, 1991.
Southwestern University's Tower Library holds a collection of Senator Tower's papers. A small exhibit from the papers of John G. Tower can be seen in room 231 of the Tower Center, on the second floor of the Carr Collins building at Southern Methodist University. In 2008, Southwestern University and SMU completed a collaborative project to digitalize the documents in the Tower Library, the John G. Tower Media Collection.


text:
The Prince of Peace
Meg Chaney
He's called the Prince of Peace. When He came into this world 2000 years ago, many expected a political hero, a powerful man who would ride in on a handsome stead and physically save them from the rule of the Romans and return the land of Israel to what it had been.
But He didn't come that way. No, instead, He came quietly, innocently, as a poor babe born in a manger. It's what we celebrate this time of year, that babe being born in a manger. We remember the great gift that was given to us on that night.
No, He didn't come as a great political hero, He came for a much greater purpose. A purpose that would be realized years later, when He died on the cross of all of our sins. Peace? He didn't bring political peace 2000 years ago. In fact, to this day the world is still in upheavel. Kingdoms and countries still rise and fall. People still make terrible decisions with large ramifications, resulting in pain, hurt, and changed lives.
We don't live in a world at peace.
In my own family, we're feeling the pain of sickness, suffering, and confusion right now.
A world of peace?
Not really.
But Jesus came to give us so much more.
He's called the Prince of Peace for a reason.
He came to give us a peace that would never end.
A peace that isn't seen in the world around us.
A peace that comes from within.
A peace in knowing that our eternity is set with Him.
By coming in the form of a child, growing as a sinless man, dying on the cross, and rising again, He did something no one else could do. He took all of the sin, all of the brokenness of this world, and He paid the price for it all. He covered the gaps. He made us whole. When we accept His precious gift, we're given eternity with Him. An eternity of peace. An eternity, where the unheaval of this life will no longer exist. Where the pain, the suffering, the grief will all be wiped away. Those things will no longer be remembered. And in their place will be peace.
We read this verse in Revelation at church last Wednesday, and the words rang so true for me. Oh how I long for eternity with Him! Oh how I long to no longer have pain, tears, or suffering.
He is the Prince of Peace, because he's the only one who could pay the price for such peace.
Amen? Amen!