To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
A case of salvage supracricoid laryngectomy with cricohyoidoepiglottopexy after failed radiation therapy and vertical partial laryngectomy had successful oncological and functional outcomes. This is the first reported application of salvage supracricoid laryngectomy with cricohyoidoepiglottopexy after the failure of two major treatments.
A 65-year-old man was referred for salvage supracricoid laryngectomy with cricohyoidoepiglottopexy. The right recurrent hemilarynx was successfully resected. After pexis, the right lobe of the thyroid gland was repositioned to overlap and reinforce the pexis gap and fill the devoid portion of the strap muscular closure. Multiple scattered foci (recurrent tumour–node–metastasis stage T2) were identified around the arytenoid cartilage and beneath the musculocutaneous flap. Four years after supracricoid laryngectomy with cricohyoidoepiglottopexy, the patient's recovery was following a favourable course and he had satisfactory laryngeal function.
Appropriate case selection and proficient surgical skills were essential for a successful outcome. Head and neck surgeons should not be afraid to adopt functional preservation open surgical procedures in well-selected and well-motivated patients. A requirement for more challenging surgical procedures and meticulous rehabilitation processes should not exclude appropriate treatments from a surgeon's repertoire.
This study used Langmuir-Schaefer (LS) method to produce thermo-responsive poly(N-isopropylacrylamide) (PIPAAm) modified surface. Block copolymer composed of polystyrene (PSt) and PIPAAm was synthesized by RAFT polymerization. PSt-block-PIPAAm (St-IP) with various chemical compositions was dropped on an air-water interface and formed Langmuir film by compression. Then, the Langmuir film changing a density was transferred on a hydrophobic modified glass substrate to produce St-IP transferred surface (St-IP LS surface). From the observation of atomic force microscope images, a nanostructure was observed on the transference of Langmuir films. Cell adhesion and detachment were also evaluated on the LS surfaces in response to temperature. Cell adhesion on LS surfaces at 37 °C was controlled by changing the chemical compositions and densities. After reducing temperature to 20 °C, adhering cells rapidly detached themselves with lower Am and higher composition of PIPAAm. Our method should be proved novel insights for investigating cell adhesion and detachment on thermo-responsive surfaces.
An ultra-small tactile sensor with functions of signal processing and digital communication has been prototyped based on MEMS-CMOS integration technology. The designed analog-digital mixed signal ASIC allows many tactile sensors to connect each other on a common bus line, which drastically reduces the number of wire. The ASIC capacitively detects the deformation of a force sensor and sends digital data to the common bus line when the force exceeds a threshold. The digital data contain a physical ID of each sensor, 32-bit sensing data and 16-bit cyclic redundancy check (CRC) code. In this study, a novel wafer-level integration and packaging technology were developed, and a chip-size-packaged tactile sensor with a small footprint (2.5mm×2.5mm) and a low profile (0.27mm) was prototyped and tested. The sensor autonomously sends digital data like a tactile receptor of human.
Supracricoid laryngectomy with cricohyoidoepiglottopexy is an organ-preserving procedure used to treat laryngeal cancer. However, the post-operative neoglottis tends to be variable in form and difficult to predict.
We retrospectively analysed three-dimensional images reconstructed from multidetector-row computed tomography data for 21 patients, assessing arytenoid motion and minimum neoglottic gap cross-sectional area.
While mean transverse and coronal motion was similar for bilateral and unilateral arytenoids, movement along the sagittal axis was greater for unilateral than bilateral arytenoids. The neoglottic gap during respiration was wider in patients with bilateral arytenoids, but both groups had a similar neoglottic gap during phonation.
Anterior shifting of the unilateral arytenoid plays an important role in compensating for the inability to achieve neoglottic closure. These two results demonstrate that the unilateral arytenoid alone is capable of achieving sufficient neoglottic narrowing to compensate for the resected arytenoid. Three-dimensional analysis was useful to evaluate the physiological status of the neoglottis after supracricoid laryngectomy with cricohyoidoepiglottopexy.
Supracricoid partial laryngectomy is a reliable laryngeal preservation procedure for tumour stage 2 and selected stage 3 to 4 laryngeal cancers. Of 70 patients thus treated, two (3 per cent) had ‘flaccid neoglottis’, i.e. redundant mucosa at the inner arytenoid edge which intermittently obstructed the neoglottis. We discuss the mechanism and management of this complication.
The two cases are presented. A navigation system was used to assist surgery. Neoglottal spatial alteration (specifically cross-sectional area) was assessed pre- and post-operatively using three-dimensional computed tomography. Voice was also evaluated.
Inspiratory stridor and delayed stomal closure were the main symptoms. Minimum neoglottal cross-sectional area was smaller in case one than in non-affected patients. Both patients had relatively rougher and breathier voices, but had adapted well to this.
Flaccid neoglottis is mainly due to excessive anterior retraction of residual laryngeal mucosa and to excessive mucosal pliability with age. A navigation system was useful for confirmation, but the potential for incorrect image recognition should be kept in mind. Flaccid neoglottis was treatable, with improved laryngeal function.
After the Great Hanshin-Awaji Earthquake, the disaster countermeasures concerning medical care in Japan changed drastically. In 2005, the Japanese government began to develop a domestic, rapid, medical response system called Disaster Medical Assistance Team (DMAT) for the purpose of rapid medical correspondence in the acute phase. As of 12 July 2010, 393 institutions and 734 teams (3,700 persons) were trained. A DMAT is important not only to the response to large disasters such as earthquakes, but also the response to local disasters. It is important to establish the DMAT system of each prefecture and district.
The DMAT system at the local level was described at the 15th World Congress on Disaster and Emergency Medicine. During the present Congress, the development and activities of the DMAT system over the past three years will be reported.
Results and Conclusion
Eight local districts in the DMAT system have been developed, and progress has been made in the fields of policy, operative plans, and agreement among each province. The system of inter-prefecture mutual aid must be built upon in the near future.
Supracricoid laryngectomy with cricohyoidoepiglottopexy is an organ-preserving surgical technique used to treat laryngeal cancer. This procedure resects the vocal folds; however, it is unclear how the sound source and airway morphology are involved in phonation through the post-operative neoglottis.
Multidetector helical computed tomography scanning was performed on two patients who had undergone supracricoid laryngectomy with cricohyoidoepiglottopexy. The cricoid and arytenoid cartilages and the airway were visualised using three-dimensional images.
The mobility of the arytenoid cartilages was well preserved in the one patient with bilateral arytenoids, and in the other patient with only one arytenoid remaining. Two types of airway configuration were observed during phonation: one patient had a single stream airway, while the other had a combination of several streams.
In the patient with only one arytenoid remaining, the preserved arytenoid tended to be rotated excessively inward. Therefore, phonation may have also occurred in various airways followed by mucosal vibration, which may be a sound source.
The austenitic stainless steels so-called, the EHP steels with the extra high purity, are developed for improving the reliability of nuclear equipments materials used in the heavily corrosive irradiation environments. By considering the impurities segregation mechanism, the major impurities included in the EHP steels is controlled less than 100ppm by the new melting technology. It is two-step refining process composed of CCIM and EB for effectively removing both non-volatile and volatile harmful elements. The risk to cracking on melting and welding processes is also effectively minimized by enhancing both the eutectic point and the metallic bonding at grain-boundaries. In the EHP steels, it is possible to select the appropriate composition of Ni and Cr for stabilizing austenitic phase and enhancing corrosion resistance. The characteristics of the welding joints are as good as those of the base metal because the same filler metal is sed without the formation of residual delta ferrite. The resistance to IGC and SCC of the EHP steels is markedly improved by minimizing the refining effects, except for type 316 steels with Mo. The welding technique and the chemical composition range are selected for standardizing the EHP.
This study aimed to analyse vocal performance and to investigate the nature of the neoglottal sound source in patients who had undergone supracricoid laryngectomy with cricohyoidoepiglottopexy, using a high-speed digital imaging system.
High-speed digital imaging analysis of neoglottal kinetics was performed in two patients who had undergone supracricoid laryngectomy with cricohyoidoepiglottopexy; laryngotopography, inverse filtering analysis and multiline kymography were also undertaken.
In case one, laryngotopography demonstrated two vibrating areas: one matched with the primary (i.e. fundamental) frequency (75 Hz) and the other with the secondary frequency (150 Hz) at the neoglottis. In case two, laryngotopography showed two vibrating areas matched with the fundamental frequency (172 Hz) at the neoglottis. The interaction between the two areas was considered to be the sound source in both patients. The waveform of the estimated volume flow at the neoglottis, obtained by inverse filtering analysis, corresponded well to the neoglottal vibration patterns derived by multiline kymography. These findings indicated that the specific sites identified at the neoglottis by the present method were likely to be the sound source in each patient.
High-speed digital imaging analysis is effective in locating the sites responsible for voice production in patients who have undergone supracricoid laryngectomy with cricohyoidoepiglottopexy. This is the first study to clearly identify the neoglottal sound source in such patients, using a high-speed digital imaging system.
The authors prepared a near-UV to red wavelength conversion thick film containing 38.8 wt% of YVO4:Bi3+,Eu3+ nanoparticles of 10.8 ± 1.6 nm in size. This nanoparticle film shows a high transparency in the visible region, e.g., the transmittance at 619 nm is ∼ 96% irrespective of the film thickness. The photoluminescence intensity at 619 nm corresponding to the f-f transition of Eu3+ for this nanoparticle film increases with increasing the film thickness up to 400 μm, whereas that of the film containing micron-sized particles reaches the maximum at the film thickness of ∼ 40 μm. On the other hand, YVO4:Bi3+,Eu3+ nanoparticles have a sufficient photostability for practical use over 15 years outside, as confirmed by the light fastness test. These results suggest that the transparent film of YVO4:Bi3+,Eu3+ nanoparticles are potentially applicable to the spectral convertor for photovoltaic cells from the aspects of low light-scattering loss and high photostability.
Three-dimensional organic field-effect transistors with multiple sub-micrometer channels are developed to exhibit high current density and high switching speed. The sub-micrometer channels are arranged perpendicularly to substrates and are defined by the height of a multi-columnar structure fabricated without using electron-beam-lithography technique. For devices with dinaphtho[2,3-b:2',3'-f]thieno[3,2-b]thiophene, extremely high current density exceeding 10 A/cm2 and fast switching within 200 ns are realized with an on-off ratio of 105. The unprecedented performance is beyond general requirements to control organic light-emitting diodes, so that even more extensive applications to higher-speed active-matrices and display-driving circuits can be realized with organic semiconductors.
Attractiveness of organic field-effect transistors are in their low-cost and easy fabrication processes as well as their mechanical flexibility, while a significant drawback has been their poorer transistor performances than those of silicon and oxide semiconductors because of lower carrier mobility in organic semiconductors. We have developed an easy MEMS-based process to fabricate three-dimensional organic transistors with metal-insulator-semiconductor structures of multiple vertical channels on plastic platforms. The design maximizes the space availability and the output current per area. The flexible three-dimensional organic transistors indeed present outstanding current of ∼ 0.5 A/cm2, which is more than sufficient for driving pixels of typical organic light-emitting diodes. High on-off ratio up to 107 is also demonstrated.
Secondary-gate electrodes are introduced in organic thin-film transistors to reduce carrier-injection barriers into air-stable organic semiconductors. The additional gate electrodes buried in the gate insulators under the source and drain electrodes form “carrier-rich regions” in the vicinity of source and drain electrodes with the application of sufficiently high local electric fields. Fabricating the structure with dinaphtho[2,3-b:2′,3′-f]thieno[3,2-b]thiophene, known for its excellent air-stability, it turned out that the contact resistance is drastically reduced especially when operated at low gate voltage in the main channel. The result demonstrates carrier injection with a minimized potential barrier realizing that from the same semiconductor material in the absence of peculiar interfacial trap levels at metal-to-semiconductor junctions.
We have performed supracricoid laryngectomy with cricohyoidoepiglottopexy or with cricohyoidopexy for tumour (T) stage T2 and T3 laryngeal cancer cases and some T4 cases. We report the clinical symptoms and management, using this technique to avoid complications.
Among patients undergoing the procedure, two cases manifested laryngeal chondritis following laryngectomy with cricohyoidoepiglottopexy. This complication was caused by C3–4 cervical osteophytes physically contacting the cricoid cartilage. Laryngeal microlaryngoscopy was performed, which revealed white, necrotic tissue in the posterior wall of the pharynx and persistent oedema of the neoglottis.
When encountering a patient with an excessive osteophyte formation at the level of C3–4, one needs to take extra precautions when undertaking laryngectomy with cricohyoidoepiglottopexy or with cricohyoidopexy.
We demonstrate that Franz-Keldysh oscillations (FKOs) observed by photoreflectance (PR) spectroscopy are highly sensitive to the surface morphology of AlxGa1−xN layers in AlxGa1−x N heterostructures. Three Al0.2Ga0.8N/GaN heterostructures with different surface-morphology profiles, which are confirmed with atomic force microscopy, have been investigated. The X-ray-diffraction patterns are hardly affected by the Al0.2Ga0.8N/GaN-layer morphology. In contrast, it is revealed that cracks and pits dominating the morphology remarkably reduce the amplitude of the FKOs from the Al0.2Ga0.8N/GaN layer, which is attributed to the following two mechanisms related to the cracks and pits. One is lifetime broadening due to carrier scattering, and the other is the suppression of the modulation magnitude for the built-in electric field, which is caused by the trapping and recombination of photogenerated carriers at the surface.
Two patients who received supracricoid laryngectomy with cricohyoidoepiglottopexy to treat laryngeal cancers, underwent intra-operative electromyography analysis. After the lesion was removed and the electrodes were inserted into the remaining intrinsic laryngeal muscles, the depth of anaesthesia was carefully reduced. Gentle tactile stimulations were applied to the pharynx to trigger the reflex movement of the remaining arytenoids. Recordings were made when reflex movement was achieved.
Case one: Electromyography (EMG) of the remaining arytenoid demonstrated clear phase differences indicating reciprocal activities between the adductor group (lateral cricoarytenoid muscle, interarytenoid muscle) and the abductor muscle (posterior cricoarytenoid muscle). Case two: EMG of the remaining arytenoid demonstrated reciprocal activities between the interarytenoid muscle and the posterior cricoarytenoid muscle. Activity of the lateral cricoarytenoid muscle was not evident because the muscle was excised during removal of the paraglottic space. Mobility of the arytenoid was attributed to interaction between the interarytenoid muscle and posterior cricoarytenoid muscle. Reciprocal interaction between the interarytenoid muscle and posterior cricoarytenoid muscle alone is also capable of maintaining post-operative laryngeal functions after supracricoid laryngectomy with cricohyoidoepiglottopexy.
Background and objective: Thiopental has been reported to reduce sympathetic tone, however, it is not clear whether change in heart rate variability is associated with depth of anaesthesia. The purpose of the present study was to evaluate changes in heart rate variability at different depths of hypnosis during induction of anaesthesia with thiopental. Methods: We studied 17 ASA I patients scheduled for minor surgery. The depth of hypnosis was monitored by the BIS. Spectral analysis of heart rate variability using a maximum entropy method resulted in a characteristic power spectrum with two main regions, a high frequency and a low frequency. Haemodynamics, entropy, low frequency, high frequency and low frequency/high frequency were monitored in an awake state and after the induction of anaesthesia. Results: Heart rate increased in a BIS-dependent manner, whereas blood pressure showed no significant changes during the study period. High frequency, entropy and low frequency decreased with a reduction in the BIS value. Low frequency/high frequency showed no significant change during the study period. Conclusions: Induction of anaesthesia with thiopental increased heart rate and decreased high frequency, entropy and low frequency in a BIS-dependent manner, indicating that thiopental reduces cardiac parasympathetic tone depending on the depth of hypnosis.
A new simple method for measuring a long-range electrostatic attractive force between metal and semiconductor substrate and charged polymer surfaces has been developed to make clear the effect of the electronic nature of substrate surfaces. Nickel, titanium, and silicon wafer substrates were subjected to various surface pretreatments. The surfaces of polystyrene and polytetrafluoroethylene sheets were positively and negatively charged by triboelectrification, respectively. A progressive increase in the attractive force was observed with a decrease in the distance between the substrate and polymer surfaces. The magnitude of the attractive force was greatly influenced by the substrate pretreatments and the polymers with the oppositely charged surface. The electronic nature of the substrate surfaces evaluated by temperature programmed photoelectron emission method was well correlated with the attractive force. The electrostatic induction generated at the substrate surface is considered to govern the attractive force.