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Total laryngectomy is often utilised to manage squamous cell carcinoma of the larynx or hypopharynx. This study reports on surgical trends and outcomes over a 10-year period.
A retrospective review of patients undergoing total laryngectomy for squamous cell carcinoma was performed (n = 173), dividing patients into primary and salvage total laryngectomy cohorts.
A shift towards organ-sparing management was observed. Primary total laryngectomy was performed for locoregionally advanced disease and utilised reconstruction less than salvage total laryngectomy. Overall, 11 per cent of patients developed pharyngocutaneous fistulae (primary: 6 per cent; salvage: 20 per cent) and 11 per cent neopharyngeal stenosis (primary: 9 per cent; salvage: 15 per cent). Pharyngocutaneous fistulae rates were higher in the reconstructed primary total laryngectomy group (24 per cent; 4 of 17), compared with primary closure (3 per cent; 3 of 90) (p = 0.02). Patients were significantly more likely to develop neopharyngeal stenosis following pharyngocutaneous fistulae in salvage total laryngectomy (p = 0.01) and reconstruction in primary total laryngectomy (p = 0.02). Pre-operative haemoglobin level and adjuvant treatment failed to predict pharyngocutaneous fistulae development.
Complications remain hard to predict and there are continuing causes of morbidity. Additionally, prior treatment continues to affect surgical outcomes.
The rocky shores of the north-east Atlantic have been long studied. Our focus is from Gibraltar to Norway plus the Azores and Iceland. Phylogeographic processes shape biogeographic patterns of biodiversity. Long-term and broadscale studies have shown the responses of biota to past climate fluctuations and more recent anthropogenic climate change. Inter- and intra-specific species interactions along sharp local environmental gradients shape distributions and community structure and hence ecosystem functioning. Shifts in domination by fucoids in shelter to barnacles/mussels in exposure are mediated by grazing by patellid limpets. Further south fucoids become increasingly rare, with species disappearing or restricted to estuarine refuges, caused by greater desiccation and grazing pressure. Mesoscale processes influence bottom-up nutrient forcing and larval supply, hence affecting species abundance and distribution, and can be proximate factors setting range edges (e.g., the English Channel, the Iberian Peninsula). Impacts of invasive non-native species are reviewed. Knowledge gaps such as the work on rockpools and host–parasite dynamics are also outlined.
Pessoa's (2013) integrative model of emotion and cognition can be strengthened in two ways: first, by clarification and refinement of key concepts and terminology, and second by the incorporation of an additional key neural system into the model, the locus coeruleus/norepinephrine system.
We have produced synthetic analogues of cosmic silicates using the Sol Gel method,
producing amorphous silicates of composition
Using synchrotron X-ray powder diffraction on Beamline I11 at the Diamond Light Source,
together with a newly-commissioned gas cell, real-time powder diffraction scans have been
taken of a range of silicates exposed to CO2 under non-ambient conditions. The
SXPD is complemented by other techniques including Raman and Infrared Spectroscopy and SEM
Facilities for studying gas-solid interactions on beamline I11 at the Diamond Light
Source are described. Sample evolution in low and high gas pressure capillary cells
(1 × 10-7 to 100 bar) with non-contact cooling and heating (80 to 1273 K) can
be monitored structurally (X-rays) and spectroscopically (Raman). First results on the
dehydration of MgSO4.7H2O, the formation of CO2 clathrate
hydrate and the reaction of amorphous CaSiO3 grains with CO2 gas to
form CaCO3 are presented to demonstrate the application of these cells to
laboratory investigations involving the processing of cosmic dust simulants and planetary
Consciousness of the kind we value often takes narrative forms. This chapter adopts the psychological stance of Bruner who writes that narrative deals in human or human-like intention and action and the vicissitudes and consequences that mark their course. It discusses the interaction-type elements and story-type elements of narrative, and explores whether consciousness has causal properties. The chapter explains the evolution and development of consciousness, and the developmental psychology of narrative consciousness. The chapter presents a debate of a protagonist and an antagonist. It proposes that we accept not only Dennett's metaphor of self-as-novelist but also that, different conclusions may be drawn than those offered by Dennett. The chapter explores the idea of a conscious unitary self, based on functional properties of narrative. It discusses four aspects of consciousness: the Helmholtzian consciousness, Woolfian consciousness, Vygotskyan consciousness, and Meadean consciousness.