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 firstname.lastname@example.org
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.
Life in the terrestrial and marine subsurface has adapted and evolved mechanisms to survive under extremes of energy limitation, temperature, pressure, radiation, and/or water availability. New developments in nucleic acid sequencing, high-pressure biochemistry, and high-pressure biophysics have expanded our understanding of the mechanisms used by deep life. This chapter synthesizes these new developments and highlights remaining gaps in understanding.
Dysphagia is common in patients presenting with oesophageal malignancy. This study aimed to determine the clinical effectiveness of biodegradable stents to help with malignant dysphagia due to radiotherapy for oesophageal cancer and furthermore to establish the complication and re-intervention rates associated with their use.
This was a retrospective, observational study of 22 patients between 2008 and 2013. Complications within 2 weeks and episodes of re-intervention required within 4 months of stent insertion prior to radiotherapy were recorded.
Pre-stent insertion, the mean O’Rourke dysphagia score was 3·5 (median 3, range 2–5). This improved to a mean score of 2·8 (median 3, range 1–4) 1–3 weeks following stent insertion. Complications occurred in seven patients (32%) in an immediate 2-week period, including: pain (2), dysphagia requiring dilatation (1), food obstruction not requiring intervention (1), food obstruction requiring intervention (2) and upper gastrointestinal bleed not requiring intervention (1). Re-intervention was required in 18% within a 4-month period.
We propose that biodegradable oesophageal stents are safe and may have benefit over self-expanding metal stents. We recommend they are placed alongside a radiologically inserted gastrostomy in a combined procedure prior to radiotherapy planning.
Lung surfactant (LS), a thin layer of phospholipids and proteins inside the alveolus of the lung is the first biological barrier to inhaled nanoparticles (NPs). LS stabilizes and protects the alveolus during its continuous compression and expansion by fine-tuning the surface tension at the air-water interface. Previous modelling studies have reported the biophysical function of LS monolayer and its role, but many open questions regarding the consequences and interactions of airborne nano-sized particles with LS monolayer remain. In spite of gold nanoparticles (AuNPs) having a paramount role in biomedical applications, the understanding of the interactions between bare AuNPs (as pollutants) and LS monolayer components still unresolved. Continuous inhalation of NPs increases the possibility of lung ageing, reducing the normal lung functioning and promoting lung malfunction, and may induce serious lung diseases such as asthma, lung cancer, acute respiratory distress syndrome, and more. Different medical studies have shown that AuNPs can disrupt the routine lung functions of gold miners and promote respiratory diseases. In this work, coarse-grained molecular dynamics simulations are performed to gain an understanding of the interactions between bare AuNPs and LS monolayer components at the nanoscale. Different surface tensions of the monolayer are used to mimic the biological process of breathing (inhalation and exhalation). It is found that the NP affects the structure and packing of the lipids by disordering lipid tails. Overall, the analysed results suggest that bare AuNPs impede the normal biophysical function of the lung, a finding that has beneficial consequences to the potential development of treatments of various respiratory diseases.
Branched-chain amino acids (BCAA) are essential amino acids that are necessary for muscle mass maintenance. Little is known about the plasma concentrations of BCAA and the protein intake in relation to sarcopenia. We aimed to compare the non-fasting plasma concentrations of the BCAA and the dietary protein intake between sarcopenic and non-sarcopenic older adults. Norwegian older home-dwelling adults (≥70 years) were invited to a cross-sectional study with no other exclusion criteria than age. Sarcopenic subjects were defined by the diagnostic criteria by the European Working Group on Sarcopenia in Older People. Non-fasting plasma concentrations of eight amino acids were quantified using NMR spectroscopy. Protein intake was assessed using 2×24-h dietary recalls. In this study, ninety out of 417 subjects (22 %) were sarcopenic, and more women (32 %) than men (11 %) were sarcopenic (P<0·0001). Sex-adjusted non-fasting plasma concentrations of leucine and isoleucine, and the absolute intake of protein (g/d), were significantly lower among the sarcopenic subjects, when compared with non-sarcopenic subjects (P=0·003, P=0·026 and P=0·003, respectively). A similar protein intake was observed in the two groups when adjusted for body weight (BW) and sex (1·1 g protein/kg BW per d; P=0·50). We show that sarcopenia is associated with reduced non-fasting plasma concentration of the BCAA leucine and isoleucine, and lower absolute intake of protein. More studies are needed to clarify the clinical relevance of these findings, related to maintenance of muscle mass and prevention of sarcopenia.
Background: CNS innate immune cells, microglia and macrophages (MMs), are the largest component of the inflammatory infiltrate in glioblastoma (GBM). They initially participate in tumor surveillance, but are co-opted by GBM to further angiogenesis and invasion. There are no effective immunotherapies against GBM in part because GBM-associated MMs are not well understood. We hypothesized that the extent and inflammatory phenotype of MM infiltration into GBM is variable between patients. This variability could have important implications on immunotherapy selection and treatment outcomes. Methods: Using automated quantitation of fluorescently labeled human GBMs, flow cytometry/live cell sorting, collection of conditioned GBM-associated MM media, and corroboration with TCGA and previously published scRNA-seq data, we have uncovered there is surprisingly marked variation in the amount of MM infiltration between tumors. Results: MM infiltration can range from almost non-existent, to comprising ~70% of GBM cells. By detecting cell surface markers and secreted cytokines, we determined that a mixture of pro- and anti-inflammatory MMs are found in each tumor. The overall inflammatory phenotype did not depend on the amount of infiltration. Interestingly, IDH-mutant GBM-associated MMs are more pro-inflammatory and less heterogeneous than IDH-wildtype GBMs. Conclusions: Taken together, the highly variable immunologic status of GBMs suggests the success of immunotherapies hinges on selecting appropriately vulnerable tumors.
The aim of this study was to investigate the socioeconomic and demographic factors influencing the body mass index (BMI) of non-pregnant married Bangladeshi women of reproductive age. Secondary (Hierarchy) data from the 2011 Bangladesh Demographic and Health Survey, collected using two-stage stratified cluster sampling, were used. Two-level linear regression analysis was performed to remove the cluster effect of the variables. The mean BMI of married non-pregnant Bangladeshi women was 21.60±3.86 kg/m2, and the prevalence of underweight, overweight and obesity was 22.8%, 14.9% and 3.2%, respectively. After removing the cluster effect, age and age at first marriage were found to be positively (p<0.01) related with BMI. Number of children was negatively related with women’s BMI. Lower BMI was especially found among women from rural areas and poor families, with an uneducated husband, with no television at home and who were currently breast-feeding. Age, total children ever born, age at first marriage, type of residence, education level, level of husband’s education, wealth index, having a television at home and practising breast-feeding were found to be important predictors for the BMI of married Bangladeshi non-pregnant women of reproductive age. This information could be used to identify sections of the Bangladeshi population that require special attention, and to develop more effective strategies to resolve the problem of malnutrition.
Oil revenues enable the government to afford generous wages and expansive employment policies in Saudi Arabia. The availability of low-cost foreign labor combined with a rapidly growing working age population result in a large disparity between public and private sector salaries. This segmentation skews Saudi worker preferences for public sector employment and increases their reservation wages for private sector employment, resulting in high unemployment. Government initiatives such as those entailed by the 2011 royal decrees aiming at increasing public sector employment and compensations would further exacerbate unemployment in the long run. The main manifestation of the oil curse in Saudi Arabia is thus through labor market segmentation and the persistently high unemployment rate.
In recent years, the government of Bangladesh has encouraged private sector involvement in producing mid-level health cadres including Medical Assistants (MAs). The number of MAs produced has increased significantly. We assessed students’ characteristics, educational services, competencies and perceived attitudes towards health service delivery in rural areas.
We used a mixed method approach using quantitative (questionnaire survey) and qualitative (key informant interviews and roundtable discussion) methods. Altogether, five public schools with 238 students and 30 private schools with 732 students were included. Statistical analyses were performed using STATA v-12. Qualitative data were analyzed thematically.
The majority of the students in both public (66%) and private medical assistant training schools (MATS) (61%) were from rural backgrounds. They spent the majority of their time in classroom learning (public 45% versus private 42%) and the written essay exam was the common form of a students’ performance assessment. Compared with students of public MATS, students of private MATS were more confident in different aspects of educational areas, including managing emerging health needs (P<0.001); evidence-based practice (P=0.002); critical thinking and problem solving (P=0.02), and use of IT/computer skills (P<0.001). Students were aware of not having adequate facilities in rural areas (public 71%, private 65%), but they perceived working in rural areas will offer several benefits, including use of learnt skills; friendly rural people; and opportunities for real-life problem solving, etc.
This study provides a current picture of MATS students’ characteristics, educational services, competencies and perception towards working in rural areas. The MA students in both private and public sectors showed a greater level of willingness to serve in rural health facilities. The results are promising to improve health service delivery, particularly in rural and hard-to-reach areas of Bangladesh.
This paper, a report by the Clinical Governance and Audit Committee of the Scottish Otolaryngological Society, presents a consensus view of the minimal requirements for ENT clinics in National Health Service hospitals.
Results and conclusion:
The provision of adequate equipment and staff has gained increasing importance as the vast majority of ENT procedures can be safely performed in the out-patient or office setting.
Iron (Fe) and zinc (Zn) contents in hexaploid wheat are very low and are further reduced because of the removal of micronutrient-rich bran of wheat grains during milling and processing. Therefore, hexaploid wheat, its wild species and wheat–Aegilops kotschyi substitution lines were evaluated to identify the genome(s) carrying gene(s) for high Fe and Zn concentrations in bran and endosperm fractions of grains. It is reflected from the results that Triticum monococcum (acc. W463) may serve as a promising donor for biofortification of Fe, and Aegilops speltoides (acc. 3804) may serve as a promising donor for biofortification of Zn in the endosperm of cultivated wheat. Further, among the three wheat–Ae. kotschyi substitution lines, the higher concentration of Fe and Zn in endosperm fraction was observed in BC2F4 63-2-13-1. The work on precise transfer of useful gene(s) from 7Uk chromosome of this line is in progress to reduce linkage drag.
Risk for depression is expressed across multiple levels of analysis. For example, parental depression and cognitive vulnerability are known markers of depression risk, but no study has examined their interactive effects on children's cortisol reactivity, a likely mediator of early depression risk. We examined relations across these different levels of vulnerability using cross-sectional and longitudinal methods in two community samples of children. Children were assessed for cognitive vulnerability using self-reports (Study 1; n = 244) and tasks tapping memory and attentional bias (Study 2; n = 205), and their parents were assessed for depression history using structured clinical interviews. In both samples, children participated in standardized stress tasks and cortisol reactivity was assessed. Cross-sectionally and longitudinally, parental depression history and child cognitive vulnerability interacted to predict children's cortisol reactivity; associations between parent depression and elevated child cortisol activity were found when children also showed elevated depressotypic attributions as well as attentional and memory biases. Findings indicate that models of children's emerging depression risk may benefit from the examination of the interactive effects of multiple sources of vulnerability across levels of analysis.
Background: Although some prior studies have provided evidence to question the historical belief that pulmonary vascular resistance index ⩾6 Wood Units×m2 should be a contraindication to heart transplantation in children, no national analyses specific to the modern area have addressed this question. Methods: Data were analysed for paediatric heart transplant recipients from 1 January, 2002 to 1 September, 2012 (n=699). The relationship between pulmonary vascular resistance and all-cause 30-day mortality was evaluated using univariate and multivariate analyses. Results: The 30-day mortality included 10 patients (1.43%), which is lower than in the previous analyses. Receiver operating curve analysis of pulmonary vascular resistance index as a predictor of mortality yielded a cut-off value of 3.37 Wood Units×m2, but the area under the curve and specificity of this threshold was weaker than in previous analyses. Whereas pulmonary vascular resistance index treated as a dichotomised variable was a significant predictor of mortality in univariate (odds ratio 4.92, 95% confidence interval 1.04–23.33, p=0.045) and multivariate (odds ratio 5.26, 95% confidence interval 1.07–25.80, p=0.041) analyses, pulmonary vascular resistance index treated as a continuous variable was not a significant predictor of mortality in univariate (p=0.12) or multivariate (p=0.11) analyses. Conclusions: The relationship between pulmonary vascular resistance and post-heart transplant mortality in children is less convincing in this analysis of a comprehensive, contemporary database than in previous series. This suggests the possibility that modern improvements in the management of post-transplant right ventricular dysfunction have mitigated the contribution of pulmonary hypertension to early mortality.
The head and neck region harbours crucial structures and hence the surgical technique used to remove schwannomas from this region should cause minimal damage to these structures, with complete removal of pathology.
This study entailed a retrospective analysis of 10 patients with head and neck schwannomas that were excised using a nerve-sparing subcapsular dissection technique. The primary aims were to assess the functional impact of the surgical technique on the structure of origin and to evaluate local control.
One patient with parapharyngeal schwannoma developed symptoms suggestive of ‘first bite syndrome’ in the late post-operative period. Another patient with facial nerve schwannoma had House–Brackmann grade II weakness in the immediate post-operative period, which subsequently resolved. None of the patients developed recurrence during a median follow-up period of two years.
The nerve-sparing subcapsular dissection technique provided effective local control of tumour pathology, with relative preservation of neural function post-operatively.
The dopamine active transporter 1 (DAT1) gene is implicated in psychopathology risk. Although the processes by which this gene exerts its effects on risk are poorly understood, a small body of research suggests that the DAT1 gene influences early emerging negative emotionality, a marker of children's psychopathology risk. As child negative emotionality evokes negative parenting practices, the DAT1 gene may also play a role in gene–environment correlations. To test this model, children (N = 365) were genotyped for the DAT1 gene and participated in standardized parent–child interaction tasks with their primary caregiver. The DAT1 gene 9-repeat variant was associated with child negative affect expressed toward the parent during parent–child interactions, and parents of children with a 9-repeat allele exhibited more hostility and lower guidance/engagement than parents of children without a 9-repeat allele. These gene–environment associations were partially mediated by child negative affect toward the parent. The findings implicate a specific polymorphism in eliciting negative parenting, suggesting that evocative associations play a role in elevating children's risk for emotional trajectories toward psychopathology risk.
Chondrodermatitis nodularis chronica helicis is a common benign condition of the pinna. It presents as a painful, well demarcated nodule on the pinna that may be associated with surrounding erythema or an overlying crust.
This paper describes techniques for the excision of chondrodermatitis nodularis chronica helicis on both the helix and anti-helix, and reconstruction of the defect.
Both methods give an excellent cosmetic result and can be performed under local anaesthetic. Excising and smoothing down the cartilage decreases the likelihood of recurrence as a smooth contour to the ear is achieved.
Various techniques are used to maintain retraction of the skin flap during open-approach rhinoplasty.
This report aims to present the use of maxillofacial retractors in open-approach rhinoplasty, a previously undescribed technique.
Use of these retractors provides excellent exposure of the lower lateral cartilages for surgery of the nasal tip, as well as access for surgery on the upper lateral cartilages. This technique allows the surgeon and assistant to proceed with surgery without needing to maintain retraction with a hand-held instrument.
SrRuO3 (SRO) thin films were grown on SrTiO3 (100) substrates using the pulsed laser deposition method. The films' growth properties widely changed in response to different working oxygen partial pressures. An island growth mode was dominant for low pressures up to 10 mTorr followed by a step flow growth mode at 60 mTorr and step flow plus 2 D growth at 200 mTorr then reverting back to island growth at 300 mTorr. Significant out-of-plane strains of SRO films were observed for low growth pressures (up to 10 mTorr) but became notably reduced at 60 mTorr and continued to decrease gradually with further pressure increases. Formation of Ru vacancies occurs regardless of the working pressure values and appears to be minimized at 60 mTorr. Highest TC's were obtained in films exhibiting the step flow growth mode. The role of Ru deficiencies in relation to strain, growth mode, and magnetic properties is discussed.
In late 2002, health professionals from the ministries of health and academia of Jordan, the Palestinian Authority and Israel formed the Middle East Consortium on Infectious Disease Surveillance (MECIDS) to facilitate trans-border cooperation in response to infectious disease outbreaks. The first mission of MECIDS was to establish a regional, laboratory-based surveillance network on foodborne diseases. The development of harmonized methodologies and laboratory capacities, the establishment of a common platform of communication, data sharing and analysis and coordination of intervention steps when needed were agreed upon. Each of the three parties selected the microbiological laboratories that would form the network of sentinel laboratories and cover the different districts of each country and also designated one laboratory as the National Reference Laboratory (NRL). Data analysis units have been established to manage the data and serve as a central point of contact in each country. The MECIDS also selected a regional data analysis unit, the Cooperative Monitoring Centre (CMC) located in Amman, Jordan, and established a mechanism for sharing data from the national systems. Joint training courses were held on interventional epidemiology and laboratory technologies. Data collection started in July 2005 with surveillance of salmonellosis as the first target. This network of collaboration and communication established in an area of continuous dispute represents an important step towards assessing the burden of foodborne diseases in the region and is expected to be fundamental for coordination of public health interventions and prevention strategies.
We present a previously unreported technique which we have found useful for closure of the donor site created by a paramedian forehead flap, during nasal reconstruction.
An 80-year-old woman was referred to the ENT department for management of a large tumour involving the left nasal dorsum. The lesion measured 2.5 × 2.5 cm, and an incisional biopsy confirmed moderately differentiated squamous cell carcinoma. Complete excision with an interpolated paramedian forehead flap reconstruction was performed. The pedicle was divided three weeks post-operatively, and the 2 × 2 cm forehead defect was closed at this time. A frontalis muscle flap and full thickness skin graft were used to close the donor site.
A frontalis muscle flap is a novel method of closing large forehead defects created by a paramedian forehead flap. A frontalis muscle flap provides a healthy base for a full thickness skin graft, which allows good skin colour matching and an enhanced cosmetic result.