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Background: Consensus about the definition and treatment of oligometastatic oesophagogastric cancer is lacking. Objective: To assess the definition and treatment of oligometastatic oesophagogastric cancer across multidisciplinary tumour boards (MDTs) in Europe. Material and methods: European expert centers (n = 49) were requested to discuss 15 real-life cases in their MDT with at least a medical, surgical, and radiation oncologist present. The cases varied in terms of location and number of metastases, histology, timing of detection (i.e. synchronous versus metachronous), primary tumour treatment status, and response to systemic therapy. The primary outcome was the agreement in the definition of oligometastatic disease at diagnosis and after systemic therapy. The secondary outcome was the agreement in treatment strategies. Treatment strategies for oligometastatic disease were categorised into upfront local treatment (i.e. metastasectomy or stereotactic radiotherapy), systemic therapy followed by restaging to consider local treatment or systemic therapy alone. The agreement across MDTs was scored to be either absent/poor (

Building on a philosophical reconstruction of Aristotle, this dissertation argues for a non-intellectualist account of virtue education and practical deliberation. This dissertation will first examine the notion of habituation. It argues that habituation consists in immersing into a certain cultural context, through which one will develop one’s unique ethical sense and will know what is noble and fine. This rules out two intellectualist positions: that habituation gives us a firm understanding of eudaimonia, and that habituation itself involves the exercise of the practical intellect. The non-intellectualised account of habituation is further supported by a topic-specific study of Aristotle’s conception of children. In cultivating the seeds of virtues that are accessible even to children, one forms evaluative appearances about what is and what is not worth-pursuing by generalising from particular evaluative experiences. These experiences may come from early private education, perceptions, emotions, imitation of others’ attitudes and behaviour, and understanding one’s friends’ decisions. These experiences help shape one’s ethical sense. Developing friendship (philia) appears to be ethically important, since we learn about values through friendship, and since practical deliberation is more like imagining conversations between individuals we are familiar with. This is in stark contrast to the intellectualist account of excellent deliberation, which consists in deliberating through a comprehensive conception of human values. But ultimately, friendship is ethically indispensable because, as a form of intimate relationship between agents of equal status, it epitomises an Aristotelian ideal: an egalitarian ethical community. Arguably, this community constitutes the context for habituation (immersion). This dissertation shows how opposing positions concerning a variety of particular issues become an opposition between two philosophical packages, one of intellectualist and one of non-intellectualist, and why the non-intellectualist one is closer to the truth.

Objectives: Chronic pulmonary aspergillosis (CPA) is an emerging global disease with tuberculosis (TB) being the most important risk factor. Epidemiologic data on the seroprevalence of Aspergillus IgG and prevalence of CPA in different areas, especially in country with intermediate burden of TB, are lacking. Methods: We prospectively recruited healthy volunteers, TB close contacts, active TB patients and participants with old pulmonary TB in Taiwan during 2012–2019. We measured serum Aspergillus fumigatus and niger-specific IgG levels and assessed if the participants were having CPA. Results: A total of 1242 participants (including 200 healthy volunteers, 326 TB close contacts, 524 active TB patients and 192 old TB cases) were recruited. Using 27 mgA/L (milligrams of antigen-specific antibodies per liter) as cut-off level, the seropositive rate of A. fumigatus-specific IgG was 33.0% (66/200), 37.7% (123/326), 26.5% (139/524) and 43.2% (83/192) among the four groups, respectively. In multivariate logistic regression, pulmonary cavitation (OR 1.73; 95% CI 1.07–2.80), female sex (OR 1.49; 95% CI 1.14–1.95), old TB (OR 1.59; 1.05–2.42) were independent risk factors for Aspergillus IgG positivity. One (0.2%) active TB patient and four (2.1%) old TB patients developed CPA. Correlation between A. fumigatus and A. niger-specific IgG was high (Spearman correlation coefficient: 0.942). Discussion: Geographic variation in Aspergillus IgG seroprevalence and CPA prevalence exists. A universal cut-off value for Aspergillus IgG may not exist. In areas and populations in which background Aspergillus IgG level is unknown, Aspergillus IgG may be better used as a test of exclusion for CPA using prespecified cut-off level. © 2019 The Author(s)

Patients with diarrhea-predominant irritable bowel syndrome (IBS-D) appear to have increased intestinal permeability; it has been suggested that activation of protease-activated receptor-2 (PAR-2) receptors is responsible for this alteration. The aims of this study are to evaluate (1) if rectal (large bowel) permeability is increased in IBS-D and (2) if tryptase plays a critical role in the altered permeability. Rectal biopsies from 20 patients with IBS-D and 30 subjects without the condition (normal controls) were assessed for macromolecular permeability using horseradish peroxidase in Ussing chambers in the basal state and after addition of drugs to the basolateral side. Reverse-transcription polymerase chain reaction (RT-PCR) was performed using colonic biopsy tissues from patients with IBS-D and normal subjects. When tryptase was added to the basolateral (not mucosal) side of normal rectal biopsy tissues, permeability appeared to be proportional to the increase in tryptase concentration (P