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Surgery is the recommended treatment for resectable T4a laryngeal and hypopharyngeal carcinoma. Non-surgical treatment is an option in a select few patients.
This retrospective study was undertaken to assess the treatment outcomes in patients with resectable T4a carcinoma of the larynx and hypopharynx who received either surgical or non-surgical treatment at our institute and to assess factors influencing these outcomes.
A total of 120 patients were included in the study. They were divided into groups A, B and C based on the presence of extralaryngeal spread through laryngeal membrane, cartilage or both. The overall survival was better among patients who received surgery than those who received non-surgical treatment in the three groups. The factor influencing overall survival was the treatment given in the form of surgical versus non-surgical treatment.
Surgery is the preferred treatment for T4a laryngeal and hypopharyngeal carcinoma, even in patients with extralaryngeal spread without cartilage erosion.
The impact of modern high-precision conformal techniques on rare but highly morbid late complications of head and neck radiotherapy, such as necrosis of the bone, cartilage or soft-tissues, is not well described.
Medical records of head and neck cancer patients treated in prospective clinical trials of definitive high-precision radiotherapy were reviewed retrospectively to identify patients with necrosis.
Twelve of 290 patients (4.1 per cent) developed radiotherapy necrosis at a median interval of 4.5 months. There was no significant difference in baseline demographic (age, gender), disease (primary site, stage) and treatment characteristics (radiotherapy technique, total dose, fractionation) of patients developing radiotherapy necrosis versus those without necrosis. Initial management included antibiotics or anti-inflammatory agents, tissue debridement and tracheostomy as appropriate followed by hyperbaric oxygen therapy and resective surgery for persistent symptoms in selected patients.
Multidisciplinary management is essential for the prevention, early diagnosis and successful treatment of radiotherapy necrosis of bone, cartilage or cervical soft tissues.
The aim of this study was to audit the practise of Lithium monitoring on all patients over the age of 65 years, over a one-year period in North Tyneside General Hospital, against the recommended standards, and re-auditing the following year.
During the audit; data was collected from the medical notes of all patients prescribed Lithium, over 65 years in North Tyneside General Hospital. This was from January 2004 - January 2005. The standards used were the recommendations of The British National Formulary. The monitoring of urea, electrolytes, TSH and Lithium were recorded. The presence of an ECG, documentation of side effects, information leaflets’ distribution and patients lost to follow up were noted. Following the audit, recommendations were made and prescribing Consultants were informed. A re-audit was conducted on all patients on Lithium the next year from January 2006 - June 2006, using the same designed tool.
22 patient's notes were audited and 29 notes re-audited. 41% were males and 59% females in the audit, with similar distribution in the re-audit. 54% were between 65-75 years and 45% over the age of 75years in the audit. 41% and 59% respectively in the re-audit. Blood monitoring followed the standards in 86% in the audit and 95% in the re-audit. 32% had documentation of side effects in the audit, increasing to 72% in the re-audit. While 23% patients were lost to follow up in the audit, all were followed up in the re-audit.
The re-audit encouragingly showed significant improvement in practise.
The final stages of low-mass stellar evolution are characterized by significant mass loss due to stellar pulsations during the AGB phase, which lead to the development of planetary nebulae. Molecular masers of H2O, SiO, and ground state OH transitions are commonly detected in oxygen-rich late-type stars (OH/IR objects). In contrast, excited OH maser transitions are rare. We discuss our study of the carbon-rich pre-planetary nebula CRL618 (a prototypical post-AGB star). Observations conducted in May 2008 with the 305m Arecibo Telescope resulted in the first detection of a 4765MHz OH maser line in a late-type stellar object; the detection was confirmed a few months later also with Arecibo. Subsequent observations in 2015 and 2017 resulted in non-detection of the 4765MHz OH line. Our observations indicate that the 4765MHz OH maser in CRL 618 is highly variable, possibly tracing a short-lived phenomenon during the development of a pre-planetary nebula.
Double-chambered left ventricle is a rare cardiac anomaly. We report a case of double-chambered left ventricle in a one-and-half-year-old asymptomatic boy. We depict the use of three-dimensional echocardiography in the demonstration and diagnosis of the condition.
Most nutritional studies on the development of children focus on mother–infant interactions. Maternal nutrition is critically involved in the growth and development of the fetus, but what about the father? The aim is to investigate the effects of paternal methyl-group donor intake (methionine, folate, betaine, choline) on paternal and offspring global DNA (hydroxy)methylation, offspring IGF2 DMR DNA methylation, and birth weight. Questionnaires, 7-day estimated dietary records, whole blood samples, and anthropometric measurements from 74 fathers were obtained. A total of 51 cord blood samples were collected and birth weight was obtained. DNA methylation status was measured using liquid chromatography-tandem mass spectrometry (global DNA (hydroxy)methylation) and pyrosequencing (IGF2 DMR methylation). Paternal betaine intake was positively associated with paternal global DNA hydroxymethylation (0.028% per 100 mg betaine increase, 95% CI: 0.003, 0.053, P=0.03) and cord blood global DNA methylation (0.679% per 100 mg betaine increase, 95% CI: 0.057, 1.302, P=0.03). Paternal methionine intake was positively associated with CpG1 (0.336% per 100 mg methionine increase, 95% CI: 0.103, 0.569, P=0.006), and mean CpG (0.201% per 100 mg methionine increase, 95% CI: 0.001, 0.402, P=0.049) methylation of the IGF2 DMR in cord blood. Further, a negative association between birth weight/birth weight-for-gestational age z-score and paternal betaine/methionine intake was found. In addition, a positive association between choline and birth weight/birth weight-for-gestational age z-score was also observed. Our data indicate a potential impact of paternal methyl-group donor intake on paternal global DNA hydroxymethylation, offspring global and IGF2 DMR DNA methylation, and prenatal growth.
We describe the case of a 27-year-old gentleman who developed late-onset clubbing and cyanosis. Transoesophageal echocardiography revealed a 27-mm ostium secundum atrial septal defect and a large, floppy Eustachian valve directing right atrial blood to the left side of the heart.
A prospective randomised study was conducted at a tertiary care hospital to evaluate the effects of financial incentives for smoking cessation targeted at a high-risk population.
Patients with a past history of head and neck cancer were voluntarily enrolled over a two-year period. They were randomised to a cash incentives or no incentive group. Subjects were offered enrolment in smoking cessation courses. Smoking by-product levels were assessed at 30 days, 3 months and 6 months. Subjects in the incentive group received $150 if smoking cessation was confirmed.
Over 2 years, 114 patients with an established diagnosis of head and neck cancer were offered enrolment. Twenty-four enrolled and 14 attended the smoking cessation classes. Only two successfully quit smoking at six months. Both these patients were in the financially incentivised group and received $150 at each test visit.
Providing a financial incentive for smoking cessation to a population already carrying a diagnosis of head and neck cancer in order to promote a positive behaviour change was unsuccessful.
The north eastern region (NER) of India receives a high amount of rainfall (2450 mm) both in terms of intensity and frequency. Most of the precipitation goes waste because of improper conservation measures and inadequate rainwater harvesting. Growing a second crop during winter (rabi) season on hill slopes and uplands without moisture conservation measure is almost impossible. A simple and very low-cost technique of in situ soil moisture conservation in maize (Zea mays L.)–toria (Brassica campestris L.) system has been developed using residue of preceding rainy season maize crop and mulching with locally available weed biomass Ambrosia artemisiifolia. Six residue mulching combinations tested were viz. control, Maize stalk cover (MSC), MSC + Ambrosia sp. 5 t/ha, MSC + Ambrosia sp. 10 t/ha, MSC + farmyard manure (FYM) 10 t/ha and MSC + Ambrosia sp. 5 t/ha + poultry manure 5 t/ha under zero tillage (ZT) and conventional tillage (CT) systems. Results showed that in situ residue retention of preceding maize crop along with green biomass of Ambrosia sp., applied before sowing of toria, maintained optimum soil moisture for good growth and higher yield of toria. The soil moisture content was consistently higher under residue mulched plots than that under control. All the residue mulching measures recorded higher crop yield for maize and toria than those observed under residue removal (control). The productivity of toria was enhanced by about 99%, only due to retention of MSC as mulch. Mulching with MSC + Ambrosia sp. 5 t/ha + poultry manure 5 t/ha recorded the highest seed yield of toria (four-year average: 641 kg/ha), which was 228% and 64% higher than no mulching (control) and MSC alone. MSC + FYM 10 t/ha (568.3 t/ha) and MSC + Ambrosia sp. 10 t/ha (517.4 t/ha) were found equally effective and produced significantly higher toria yield than that of control. MSC + Ambrosia mulch 10 t/ha gave the highest net returns and B:C ratio of the maize–toria system. The overall B:C ratios were better under ZT than CT. Thus, the study indicated that the integrated management of crop residues and weed biomass (Ambrosia sp.) under ZT created favourable soil moisture to support double cropping with high yield in hill eco-system of northeastern Indian Himalayas.
We undertook collagen injection laryngoplasty to achieve arytenoid augmentation in patients with dysphagia and persistent aspiration following partial laryngectomy, and we evaluated the efficacy of arytenoid augmentation in aiding neoglottic closure and ensuring airway safety.
Two patients with persistent swallowing impairment after partial laryngectomy were studied. Swallowing was evaluated using fibre-optic endoscopy, and modified barium swallow study. Collagen was then injected into the arytenoid mucosa to achieve neoglottic competence.
The patients were followed up for up to two years. Both patients showed a marked improvement in neoglottic competence, as evaluated by fibre-optic and flexible endoscopy at three-month and one-year follow-up appointments.
Arytenoid augmentation by injection laryngoplasty can be considered a safe and effective surgical tool for the treatment of dysphagia with persistent aspiration following partial laryngectomy.
Over a 2-year period, 25 families comprising of 181 individuals of all ages were longitudinally observed for the excretion of Campylobacter species. Faecal samples were taken from all persons with diarrhoea. Specimens were also taken from apparently healthy individuals and from domestic animals living within the confines of the study families at monthly intervals.
The overall diarrhoea attack rate was 19 episodes per 100 person-years with peak incidence in the 1- to 4-year-old age group (76/100 person-years). Eight (11·5%) of the total episodes were campylobacter-associated and the overall rate of campylobacter positive diarrhoeal episodes were 2·2 per 100 person-years. Of the 1002 stool samples from healthy individuals 32 (3·2/100 samples) were positive for campylobacter. The organism was most frequently isolated from children under 1 year of age both during diarrhoeal episodes (11·5 per 100 person-years) and non-diarrhoeal (11·1 per 100 samples). Multiple infections in a family were rare. In 19·4% of the occasions one or more animals were campylobacter positive. However, only in 7·7% of these occasions was a human infection recorded within 1 month after the animal was found to be positive.
The study showed that the epidemiology of campylobacteriosis in this community was distinct compared to that observed in developed countries.
Salmonella infection on two pig farms and its relation to infection in pigs at slaughter was studied. On the first farm feed ingredients were mixed on the farm, and these included fish meal which was found to be contaminated with salmonellas. The feed was pumped to pigs in liquid form. There was a high salmonella isolation rate at slaughter when the contaminated fish meal was fed hi liquid feed, but it was significantly lower when no fish meal was fed to the pigs examined at slaughter. In some instances the same serotypes were found in fish meal and pig excreta on the farm and in caecal contents of the pigs at slaughter. No serotype was repeatedly isolated from any source and it appeared that the serotypes were not able to establish themselves in the pigs. It is concluded that infection found at slaughter originated on the farm where fish meal introduced and maintained infection. There was an opportunity for salmonellas to have multiplied in the liquid feed for several hours each day.
On a second farm environmental conditions were similar, but feed was given in the form of ready-made pellets and nuts. Salmonellas were not isolated from the feed. At slaughter there was a significantly lower isolation rate than on the first farm.
Sixty-nine strains of Vibrio cholerae 01 isolated at different times were analysed to investigate if there were any differences among the 01 strains isolated before, during and after the advent of the O139 serogroup. Of the 69 01 strains examined, 68 belonged to the Ogawa serotype while one belonged to the Inaba serotype. With the exception of one strain all other strains of V. cholerae 01 belonged to the eltor biotype. A single O1 strain isolated before the emergence of the O139 serogroup could not be classified as either eltor or classical biotype because it was resistant to both classical and eltor specific bacteriophages. Marked variations in the susceptibility to antibiotics of V. cholerae O1 isolated during the different periods were observed. In addition, strains of V. cholerae isolated after the epidemic of serogroup O139 in Calcutta showed an expanding R-type with resistance to a variety of drugs as compared to the 01 strains isolated before the advent of the O139 serogroup. From this study, it is clear that there is a substantial mobility in genetic elements of V. cholerae Ol which necessitates a continuous monitoring to keep abreast of the changing traits of the etiologic agent of cholera.
Starting from a set of equations that lead to a linear dispersion relation coupling kinetic Alfvén waves and ion-acoustic waves, three-dimensional KdV equations are derived for these waves. These equations are then used to investigate the three-dimensional stability of solitary kinetic Alfvén waves and ion-acoustic waves by the small-k perturbation expansion method of Rowlands and Infeld. For kinetic Alfvén waves it is found that there is instability if the direction of the plane-wave perturbation lies inside a cone, and the growth rate of the instability attains a maximum when the direction of the perturbation lies in the plane containing the external magnetic field and the direction of propagation of the solitary wave.
The total energies and cohesive properties of 29 Au–Sn intermetallics (stable, metastable, and virtual) are calculated from first-principles density-functional theory (DFT) employing ultrasoft pseudopotentials (USPP) and both local-density approximation (LDA) and generalized gradient approximation (GGA) for the exchange-correlation functional. Among the intermetallics considered, the ground-state structures are found to be AuSn, AuSn2, and AuSn4. Another phase Au5Sn, though present in the equilibrium diagram, lies slightly above the ground state convex hull. The formation energies of stable phases calculated using USPP–LDA and USPP–GGA are nearly the same. Except for AuSn, calorimetric data for enthalpies of formation show a good agreement with the calculated formation energies. Based on our first-principles results, it is argued that the structures of two metastable phases are cP52-type γ brass (isotypic with Al4Cu9) at Au–20.5 at.% Sn and hP1-type γ (isotypic with HgSn6–10) at Sn–8 at.% Au. For the intermetallics considered in this study, we provide optimized values of lattice parameters and Wyckoff positions. The experimental lattice parameters show a better agreement with those calculated using USPP–LDA than with USPP–GGA. The results presented here form the basis for creating a reliable thermodynamic database to facilitate calculations of stable and metastable phase diagrams of binary and multicomponent systems containing Au and Sn, relevant to electronic packaging and many other joining applications.
We have carried out a multi-wavelength study of the star forming region NGC 1893 to make a comprehensive exploration of the effects of massive stars on low mass star formation. Using deep optical U BV RI broad band, Hα narrow band photometry and slit-less spectroscopy along with archival data from the surveys such as 2MASS, MSX, IRAS and NVSS, we have studied the region to understand the star formation scenario in the region.