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Concurrent chemotherapy with radiotherapy is the standard treatment for locoregionally advanced nasopharyngeal cancer. Cetuximab can be used in the treatment of head and neck squamous cell carcinoma. However, the randomised studies that led to approval for its use in this setting excluded nasopharyngeal cancer. In the context of limited data for the use of cetuximab in nasopharyngeal cancer in the medical literature, this review aimed to summarise the current evidence for its use in both primary and recurrent or metastatic disease.
A literature search was performed using the keywords ‘nasopharyngeal neoplasm’, ‘cetuximab’ and ‘Erbitux’.
Twenty studies were included. There were no randomised phase III trials, but there were nine phase II trials. The use of cetuximab in the treatment of nasopharyngeal carcinoma has been tested in various settings, including in combination with induction chemotherapy and concurrent chemoradiotherapy, and in the palliative setting.
There is no evidence of benefit from the addition of cetuximab to standard management protocols, and there is some evidence of increased toxicity. There is more promise for its use in metastatic or locally recurrent settings. This review draws together the existing evidence and could provide a focus for future studies.
Evidence from the literature shows that clinicians’ knowledge of rules and legislation surrounding driving can often be poor. A closed-loop audit was conducted to gauge the level of driving advice given to patients with dizziness.
The clinical notes of 100 patients referred to the vertigo clinic at a tertiary referral centre were retrospectively searched for evidence of driving advice. Education sessions were undertaken and a patient information leaflet was developed before a second cycle of the audit.
Results and conclusion
The proportion of patients having documented evidence of receiving driving advice increased from 6.3 per cent to 10.4 per cent. It is therefore clear that, despite this improvement, a significant proportion of patients’ notes did not contain documentation about driving. This is likely because of many reasons, including individual interpretation by clinicians. This paper provides a reminder of the rules, and discusses their interpretation and implementation in an increasingly medicolegal environment.
Childhood adversity (CA) increases the risk of subsequent mental health problems. Adolescent social support (from family and/or friends) reduces the risk of mental health problems after CA. However, the mechanisms of this effect remain unclear, and we speculate that they are manifested on neurodevelopmental levels. Therefore, we investigated whether family and/or friendship support at ages 14 and 17 function as intermediate variables for the relationship between CA before age 11 and affective or neural responses to social rejection feedback at age 18. We studied 55 adolescents with normative mental health at age 18 (26 with CA and therefore considered “resilient”), from a longitudinal cohort. Participants underwent a Social Feedback Task in the magnetic resonance imaging scanner. Social rejection feedback activated the dorsal anterior cingulate cortex and the left anterior insula. CA did not predict affective or neural responses to social rejection at age 18. Yet, CA predicted better friendships at age 14 and age 18, when adolescents with and without CA had comparable mood levels. Thus, adolescents with CA and normative mood levels have more adolescent friendship support and seem to have normal mood and neural responses to social rejection.
To verify the previously untested assumption that eating more salad enhances vegetable intake and determine if salad consumption is in fact associated with higher vegetable intake and greater adherence to the Dietary Guidelines for Americans (DGA) recommendations.
Individuals were classified as salad reporters or non-reporters based upon whether they consumed a salad composed primarily of raw vegetables on the intake day. Regression analyses were applied to calculate adjusted estimates of food group intakes and assess the likelihood of meeting Healthy US-Style Food Pattern recommendations by salad reporting status.
Cross-sectional analysis of data collected in 2011–2014 in What We Eat in America, the dietary intake component of the National Health and Nutrition Examination Survey.
US adults (n 9678) aged ≥20 years (excluding pregnant and lactating women).
On the intake day, 23 % of adults ate salad. The proportion of individuals reporting salad varied by sex, age, race, income, education and smoking status (P<0·001). Compared with non-reporters, salad reporters consumed significantly larger quantities of vegetables (total, dark green, red/orange and other), which translated into a two- to threefold greater likelihood of meeting recommendations for these food groups. More modest associations were observed between salad consumption and differences in intake and likelihood of meeting recommendations for protein foods (total and seafood), oils and refined grains.
Study results confirm the DGA message that incorporating more salads in the diet is one effective strategy (among others, such as eating more cooked vegetables) to augment vegetable consumption and adherence to dietary recommendations concerning vegetables.
In this paper, we summarise and critique a network meta-analysis (NMA) of antidepressant efficacy and tolerability for paediatric depression and an accompanying editorial. Although we agree that many of the extant studies are flawed, this meta-analysis showed clear efficacy of fluoxetine in the NMA, and for sertraline and escitalopram in pairwise analyses. Consequently, these papers underestimate the benefits of antidepressants for paediatric depression, and provide support for current practice guideline, which recommends the use of an antidepressant if the patient does not respond to psychotherapy. In these circumstances, fluoxetine should be the first choice, with escitalopram and sertraline as alternatives.
Declaration of interest
D.A.B. receives royalties from Guilford Press, has or will receive royalties from the electronic self-rated version of the C-SSRS from eResearch Technology, Inc., is on the editorial board of UpToDate, and is a reviewer for Healthwise. R.D.G. serves as an expert witness for the US Department of Justice, Pfizer, Wyeth and GSK; and is the founder of Adaptive Testing Technologies. P.W. receives personal fees from Lundbeck and Takeda. B.D. reports a licensing agreement with Lundbeck for a psychosocial treatment manual for depression. No other disclosures were reported.
Zinc is an essential trace element necessary for the activity of numerous enzymes. Supplemental zinc is considered normal for ruminant livestock to ensure that requirements are met. Although zinc deficiency is not generally recognised in the UK, there is considerable evidence that this supplemental zinc is beneficial. The aim of this study was to investigate the effect of partially replacing zinc oxide with a zinc proteinate in the diet of ewes in late pregnancy and lactation on performance and health of ewes and lambs.
Secondary copper deficiency in ruminant animals is induced by high dietary levels of molybdenum (Mo), iron (Fe) or sulphur (S). Within the rumen, sulphur reacts with Mo to form a series of thiomolybdate molecules (TM) which may chelate copper. This reduces copper absorption or if TM is absorbed, inhibits copper metallo-enzyme activities. Parental administration of TM has resulted in an increase in Cu to the brain and an increase in Mo to the pituitaries (Haywood et al., 1998). This redistribution may alter neurological, endocrine and reproductive function. However, there are no reports on effects of endogenously produced TM on brain or pituitary trace element accumulation. The objective of this study was to determine the effect of dietary Mo or Fe on copper status and mineral retention in the pituitary gland and ovary of growing lambs.
There is anecdotal evidence that certain sheep breeds, reared in a particular way, produce unusual or characteristic tastes in cooked meat. Such effects could be linked to differences in meat fatty acid composition associated with the consumption of different diets. This study investigated eating quality and fat composition in 4 distinctively different breed x feeding system groups.
Four groups of 20 ram lambs were obtained as follows: Pure Soays (SO) finished off grass in April from commercial breeders; Pure Welsh Mountain (WM) finished off upland grass in October from ADAS Pwllpeiran; Suffolk x Mules from Harper Adams College finished off concentrates (grains) (SC) in April; and Suffolk x mules from the same source finished off grass (SG) in May. The animals were transported to Langford where they were slaughtered in Bristol University's abattoir.
Fishmeal is a suitable protein source for pregnant and lactating ewes, providing higher levels of undegradable protein (UDP) than vegetable protein sources, with an improved biological value (Robinson, 1987). The lower amounts of UDP supplied by vegetable protein sources may however be improved by formaldehyde treatment. The objective of the current experiment was to compare the effects of feeding concentrates containing fishmeal with concentrates containing vegetable protein sources with or without formaldehyde treatment.
Fishmeal is a suitable protein source for pregnant and lactating ewes, providing higher levels of undegradable protein than vegetable protein sources, with an improved biological value (Robinson, 1987). Vegetable protein sources may however be improved by formaldehyde treatment to reduce protein degradability and by the addition of rumen-protected amino acids. The objective of the current experiment was to compare the effects of feeding concentrates containing fishmeal with concentrates containing soya-bean meal, formaldehyde treated soya-bean meal and formaldehyde treated soya-bean meal with rumen-protected methionine.
Fishmeal is a suitable protein source for pregnant and lactating ewes, providing high levels of undegradable protein (UDP) with a high biological value (Sheehan and Hanrahan, 1989). Vegetable protein sources supply a lower proportion of UDP and lack in supply of essential amino acids, but the quality can be improved by heat / chemical treatment and by adding amino acids. It has also been shown that concentrates can be partially replaced by supplementary feed blocks based on soluble sugars and urea with no adverse effects on production and simplifying the feeding regime (Chapple et al, 1996). The objective of the current experiment was to compare the effects of feeding barley based concentrates containing either fishmeal or a protected vegetable protein as the main protein source and the partial replacement of concentrates with a supplementary feed based on soluble sugars and urea (blocks) on the performance and metabolism of pregnant and lactating ewes.
Limitations of access have long restricted exploration and investigation of the cavities beneath ice shelves to a small number of drillholes. Studies of sea-ice underwater morphology are limited largely to scientific utilization of submarines. Remotely operated vehicles, tethered to a mother ship by umbilical cable, have been deployed to investigate tidewater-glacier and ice-shelf margins, but their range is often restricted. The development of free-flying autonomous underwater vehicles (AUVs) with ranges of tens to hundreds of kilometres enables extensive missions to take place beneath sea ice and floating ice shelves. Autosub2 is a 3600 kg, 6.7 m long AUV, with a 1600 m operating depth and range of 400 km, based on the earlier Autosub1 which had a 500 m depth limit. A single direct-drive d.c. motor and five-bladed propeller produce speeds of 1–2 m s−1. Rear-mounted rudder and stern-plane control yaw, pitch and depth. The vehicle has three sections. The front and rear sections are free-flooding, built around aluminium extrusion space-frames covered with glass-fibre reinforced plastic panels. The central section has a set of carbon-fibre reinforced plastic pressure vessels. Four tubes contain batteries powering the vehicle. The other three house vehicle-control systems and sensors. The rear section houses subsystems for navigation, control actuation and propulsion and scientific sensors (e.g. digital camera, upward-looking 300 kHz acoustic Doppler current profiler, 200 kHz multibeam receiver). The front section contains forward-looking collision sensor, emergency abort, the homing systems, Argos satellite data and location transmitters and flashing lights for relocation as well as science sensors (e.g. twin conductivity–temperature–depth instruments, multibeam transmitter, sub-bottom profiler, AquaLab water sampler). Payload restrictions mean that a subset of scientific instruments is actually in place on any given dive. The scientific instruments carried on Autosub are described and examples of observational data collected from each sensor in Arctic or Antarctic waters are given (e.g. of roughness at the underside of floating ice shelves and sea ice).
Preston et al (1976) and Burke (1982, these proceedings) have long extolled the virtues of launching a radio telescope into space to increase VLBI baseline lengths and thus angular resolution, and to provide a much enhanced image formation capability. The scientific motivation for this has been covered in a number of memoranda referenced by Burke in these proceedings, and by Anderson et al (1982). Efforts to mobilise western astronomical support for space VLBI met with success in late 1982 at a meeting of US and European radio astronomers in Toulouse, France, at which a decision was taken to propose a joint mission to ESA and NASA. Shortly thereafter, a formal proposal was made to ESA (Anderson et al 1982) for a free flying satellite in an elliptical orbit out to 15000 km from the Earth, designed to observe in concert with the major ground-based VLBI networks and arrays. The mission, dubbed QUASAT, was received favourably in both ESA and NASA, with the result that formal Assessment Studies are scheduled to begin in both agencies in October 1983.
Shells may be the result of the disruption of a small companion in the potential of a much larger galaxy (e.g., Hernquist & Quinn, 1986; Dupraz & Combes, 1985), the disturbance of a disk system in a tidal encounter (Toomre, 1972), an accumulation of resonant stellar orbits (Binney, pers.comm.) or the result of some shock phenomenon in a hot galactic atmosphere (e.g., Williams & Christiansen, 1985; Wilkinson & Bailey, 1985;). To distinguish between these formation mechanisms, CCD direct images in B and R have been obtained at the Anglo-Australian 3.8m telescope for 66 of the 74 galaxies in the range 01h 40′ α < 13h 46' in the Malin-Carter (1983) catalogue of shell galaxies.
We present an investigation of the halo dynamics of M31 using planetary nebulae velocities. We have performed on-band [OIII] and off-band continuum imaging for a 3.6 square degree area centred on M31 and follow-up spectroscopy for over 600 planetary nebulae candidates. In the future the halo mass will be measured and the mass distribution and velocity anisotropy will be constrained as a function of radius.
The Jodrell-IAC CMB experiments at Teide Observatory, Tenerife consisting of switching radiometers operating at 10, 15 and 33 GHz, and a 33 GHz short baseline interferometer, have covered up to an area of 1 steradian at angular scales from 1° to 10° (l = 20 − 210). Sensitivities of 10μK per beam area have been reached for a combination the most sensitive experiments allowing a measure of the CMB fluctuation amplitude of 30±8μK using mapping techniques which fully exploit the whole data set. Attempts have been made to separate out galactic radio foregrounds and to place limits on a possible spinning dust contribution.
Jodrell Bank Observatory is responsible for the Front end modules (FEMs) for 30 GHz for LFI, with IAC being responsible for the hybrids and any phase switch. The University of Cantabria are responsible for the Back end modules (BEMs). Developments have been made to test prototypes both warm and cold for the FEMs. This is evolving towards flight hardware through an elegant breadboard phase EBB. Results of system performance show both white noise and 1/f characteristics.
Cosmic Microwave Observations at 1° scales are extremely important on the understanding of modern Cosmology. At those angular scales the CMB power spectrum presents the first Doppler Peak. The position and amplitude of this peak provide strong constraints on cosmological parameters as H0 and Ω0. The JBO-IAC interferometer has observed those angular scales as well as the BOOMERANG and MAXIMA teams. The results from these groups show the existence of the first Doppler Peak. We present a detailed estimate of the galactic contribution to the JBO-IAC interferometer data set using data from the Tenerife and COSMOSOMAS experiments.
Gravitational lenses typically consist of either two or four images (doubles and quads) of the background source. However, it has been shown that gravitational lensing by transparent extended matter distributions should produce an odd number of images. An upper limit for the flux of the missing ‘odd image’ can be obtained using high sensitivity radio observations, such as 5GHz MERLIN (Multi-Element Radio Linked Interferometer Network) data. Limits on the ‘odd image’ flux can then be converted into an upper limit on the core radius of the lensing galaxy.