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Treatment of locally advanced hypopharyngeal cancer can cause significant morbidity and late toxicity. Pharyngo-laryngo-oesophagectomy can achieve adequate surgical margins, but data on survival and functional outcome are limited, especially in Wales. This study aimed to describe mortality, morbidity and functional outcome following pharyngo-laryngo-oesophagectomy in a Welsh population.
This study was a retrospective case note review of pharyngo-laryngo-oesophagectomy cases in Wales over 12 years.
Fifteen patients underwent pharyngo-laryngo-oesophagectomy; all but one underwent gastric pull-up. Median survival and disease-free survival were 17 months (range, 2–53 months) and 14 months. Censored 3-month, 1-year and 3-year survival was 93, 71 and 50 per cent, respectively. Common Terminology Criteria for Adverse Events grading of long-term dysphagia was 1 in 58 per cent, 2 in 33 per cent and 3 in 8 per cent, and 87.5 per cent achieved a ‘moderate’ or ‘good’ voice rehabilitation.
These results demonstrate favourable survival and reasonable functional outcome following pharyngo-laryngo-oesophagectomy, suggesting pharyngo-laryngo-oesophagectomy should be considered in all appropriate surgical candidates.
Previous work has shown that amygdala responsiveness to fearful expressions is inversely related to level of callous-unemotional (CU) traits (i.e. reduced guilt and empathy) in youth with conduct problems. However, some research has suggested that the relationship between pathophysiology and CU traits may be different in those youth with significant prior trauma exposure.
In experiment 1, 72 youth with varying levels of disruptive behavior and trauma exposure performed a gender discrimination task while viewing morphed fear expressions (0, 50, 100, 150 fear) and Blood Oxygenation Level Dependent responses were recorded. In experiment 2, 66 of these youth performed the Social Goals Task, which measures self-reports of the importance of specific social goals to the participant in provoking social situations.
In experiment 1, a significant CU traits-by-trauma exposure interaction was observed within right amygdala; fear intensity-modulated amygdala responses negatively predicted CU traits for those youth with low levels of trauma but positively predicted CU traits for those with high levels of trauma. In experiment 2, a bootstrapped model revealed that the indirect effect of fear intensity amygdala response on social goal importance through CU traits is moderated by prior trauma exposure.
This study, while exploratory, indicates that the pathophysiology associated with CU traits differs in youth as a function of prior trauma exposure. These data suggest that prior trauma exposure should be considered when evaluating potential interventions for youth with high CU traits.
Objective Chronic cerebrospinal venous insufficiency (CCSVI) has been hypothesized to be a risk factor for multiple sclerosis (MS). Venoplasty has been proposed as a treatment for CCSVI. The aim of our study was to gain a better understanding of the “real-world” safety and longitudinal effectiveness of venoplasty Methods: British Columbia residents who self-reported having had venoplasty and consented to participate in the study were interviewed and followed for up to 24 months post-therapy using standardized structured questionnaires Results: Participants reported procedure-related complications (11.5%) and complications within the first month after the procedure (17.3%). Initially, more than 40% of participants perceived that the venoplasty had had positive effects on their health conditions, such as fatigue, numbness, balance, concentration/memory and mobility. However, this improvement was not maintained over time Conclusions: Follow-up patient-reported outcomes indicated that the initial perception of the positive impact of venoplasty on the health conditions of MS patients was not sustained over time. In addition, venoplasty was not without associated morbidity.
This review represents the Southern Ocean community’s satellite data needs for the coming decade. Developed through widespread engagement and incorporating perspectives from a range of stakeholders (both research and operational), it is designed as an important community-driven strategy paper that provides the rationale and information required for future planning and investment. The Southern Ocean is vast but globally connected, and the communities that require satellite-derived data in the region are diverse. This review includes many observable variables, including sea ice properties, sea surface temperature, sea surface height, atmospheric parameters, marine biology (both micro and macro) and related activities, terrestrial cryospheric connections, sea surface salinity, and a discussion of coincident and in situ data collection. Recommendations include commitment to data continuity, increases in particular capabilities (sensor types, spatial, temporal), improvements in dissemination of data/products/uncertainties, and innovation in calibration/validation capabilities. Full recommendations are detailed by variable as well as summarized. This review provides a starting point for scientists to understand more about Southern Ocean processes and their global roles, for funders to understand the desires of the community, for commercial operators to safely conduct their activities in the Southern Ocean, and for space agencies to gain greater impact from Southern Ocean-related acquisitions and missions.
Antarctica Bedmap2 datasets are used to calculate subglacial hydraulic potential and the area, depth and volume of hydraulic potential sinks. There are over 32 000 contiguous sinks, which can be thought of as predicted lakes. Patterns of subglacial melt are modelled with a balanced ice flux flow model, and water fluxes are cumulated along predicted flow pathways to quantify steady-state fluxes from the main basin outlets and from known subglacial lakes. The total flux from the continent is ~21 km3 a−1. Byrd Glacier has the greatest basin flux of ~2.7 km3 a−1. Fluxes from subglacial lakes range from ~1 × 10−4 to ~1.5 km3 a−1. Lake turnover times are calculated from their volumes and fluxes, and have median values of ~100 a for known ‘active’ lakes and ~500 a for other lakes. Recurrence intervals of a 0.25 km3 flood range from ~2 months to ~2000 a (median ≈130 a) for known ‘active’ lakes and from ~2 to ~2400 a (median ≈ 360 a) for other lakes. Thus, several lakes that have recently been observed to fill and drain may not do so again for many centuries; and several lakes that have not, so far, been observed to fill and drain have the potential to do so, even at annual to decadal timescales.
Endocrine disruption has rarely been reported in field populations of the edible
cockle and the context with the general health of the shellfish is unclear. This
study examined the reproductive state of two Cerastoderma edule
populations over a 6-month period to assess their reproductive condition, the
incidence of intersex and presence of parasitic infection. A further seven native
sites from south-west England were examined during the peak reproductive season to
identify the presence of intersex within the region. Laboratory exposures of
organisms collected from field populations showed a significantly female-biased sex
ratio compared with controls when exposed to the endocrine disrupting chemicals,
bisphenol-A (nominal concentration: 0.1 µg L−1) and 17β-oestradiol
(nominal concentration: 0.1 µg L−1), but none of the chemical exposures
induced intersex. Intersex was revealed in seven out of the nine native populations
of C. edule sampled at peak reproductive season. The highest
incidence and most severe case of intersex were reported at Lower Anderton on the
River Tamer which also had a significantly female-biased sex ratio. Additionally, the
dominant trematode family was the Bucephalaidae. Parasitic infection influences the
maturity of C. edule by lowering both mean gonad index and condition
index. These results suggest that endocrine disrupting chemicals could be
contributing factors towards the development of intersex in C.
Litigation is a rising financial burden on the National Health Service. This study aims to show if litigation is increasing in rhinology and which procedures lead to the most claims.
Ten years of data were obtained from the National Health Service Litigation Authority. Rhinology claims were examined for cost, injury, diagnosis and operation type.
Of the 123 rhinology claims identified, 52 per cent were successful. There was a 56 per cent increase in the average annual number of claims between the first half of the study period and the second (p = 0.0451). The commonest reasons for a claim were poor cosmesis (15.6 per cent) and lack of informed consent (14 per cent).
The number of claims in rhinology increased over the study period. Most claims resulted from poor cosmetic outcome, lack of consent or recognised complications. It is suggested that enhanced communication and management of patient expectations could reduce litigation and improve patient satisfaction.
Impulsivity is a core feature of borderline personality disorder (BPD) and is most frequently measured using self-rating scales. There is a need to find objective, valid and reliable measures of impulsivity. This study aimed to examine performance of participants with BPD compared with healthy controls on delay and probabilistic discounting tasks and the stop-signal task (SST), which are objective measures of choice and motor impulsivity, respectively.
A total of 20 participants with BPD and 21 healthy control participants completed delay and probabilistic discounting tasks and the SST. They also completed the Barratt Impulsiveness Scale (BIS), a self-rating measure of impulsivity.
Participants with BPD showed significantly greater delay discounting than controls, manifest as a greater tendency to accept the immediately available lesser reward rather than waiting longer for a greater reward. Similarly they showed significantly greater discounting of rewards by the probability of payout, which correlated with past childhood trauma. Participants with BPD were found to choose the more certain and/or immediate rewards, irrespective of the value. On the SST the BPD and control groups did not differ significantly, demonstrating no difference in motor impulsivity. There was no significant difference between groups on self-reported impulsivity as measured by the BIS.
Measures of impulsivity show that while motor impulsivity was not significantly different in participants with BPD compared with controls, choice or reward-related impulsivity was significantly affected in those with BPD. This suggests that choice impulsivity but not motor impulsivity is a core feature of BPD.
Considerable efforts have been made to provide cow-calf producers with information to help them make informed decisions about adding value to calves. Despite demonstrated market incentives to retain calves, many producers still sell right after weaning. We postulate this observed behavior is related to producer risk aversion. Our study concludes risk aversion is an important factor affecting calf retention as the most risk-averse producers have more than a 60% probability of selling calves at weaning and the most risk tolerant have less than a 20% probability of selling at weaning.
Ectoparasitic copepods have been reported in a wide range of aquatic animals, including crustacean shellfish. However, with the exception of the salmon louse, Lepeophtheirus salmonis, our knowledge of such parasites in commercial species is rudimentary. The current study examines the morphology and pathology of the parasitic copepod, Nicothoë astaci (the ‘lobster louse’) in its host, the European lobster, Homarus gammarus. Lobsters were sampled from waters surrounding Lundy Island (Bristol Channel, UK) and all individuals collected were found to harbour female adult N. astaci in their gills, with a mean of 47·3 parasites/lobster. The majority of N. astaci were found in the basal region of pleurobranch gills. The parasite was found to attach to gill filaments via its oral sucker, maxillae and maxillipeds, and to feed on host haemolymph (blood) through a funnel-like feeding channel. It caused varying degrees of damage to the host gill, including occlusion of gill filaments and disruption to the vascular system in the central axis. Although there was evidence of extensive host response (haemocytic infiltration) to the parasite, it was displaced from the parasite attachment site and thus was observed in the central gill axis below. The region of gill filament immediately underlying the parasite feeding channel was devoid of such activity suggesting that the parasite interferes with the cellular defence and haemostatic mechanisms of the lobster in order to maintain invasion of the host.
In this study, the relative acetylation levels of histone 3 in lysine 9 (H3K9ac) in cultured and cryopreserved bovine fibroblasts was measured and we determined the influence of the epigenetic status of three cultured (C1, C2 and C3) donor cell lines on the in vitro development of reconstructed bovine embryos. Results showed that cryopreservation did not alter the overall acetylation levels of H3K9 in bovine fibroblasts analysed immediately after thawing (frozen/thawed) compared with fibroblasts cultured for a period of time after thawing. However, reduced cleavage rates were noted in embryos reconstructed with fibroblasts used immediately after thawing. Cell passage affects the levels of H3K9ac in bovine fibroblasts, decreasing after P1 and donor cells with lower H3K9ac produced a greater frequency of embryo development to the blastocyst stage. Cryopreservation did not influence the total cell and ICM numbers, or the ICM/TPD ratios of reconstructed embryos. However, the genetic source of donor cells did influence the total number of cells and the trophectoderm cell numbers, and the cell passage influenced the total ICM cell numbers.
Usually, fibroblasts are frozen in dimethyl sulphoxide (DMSO, 10% v/v) at a cooling rate of 1 °C/min in a low-temperature (−80 °C) freezer (LTF) before storage in liquid nitrogen (LN2); however, a LTF is not always available. The purpose of the present study was to evaluate apoptosis and viability of bovine fibroblasts frozen in a LTF or conventional freezer (CF; −20 °C) and their subsequent ability for development to blastocyst stage after fusion with enucleated bovine oocytes. Percentages of live cells frozen in LTF (49.5%) and CF (50.6%) were similar, but significantly less than non-frozen control (88%). In both CF and LTF, percentages of live apoptotic cells exposed to LN2 after freezing were lower (4% and 5%, respectively) as compared with unexposed cells (10% and 18%, respectively). Cells frozen in a CF had fewer cell doublings/24 h (0.45) and required more days (9.1) to reach 100% confluence at the first passage (P) after thawing and plating as compared with cells frozen in a LTF (0.96 and 4.0 days, respectively). Hypoploidy at P12 was higher than at P4 in cells frozen in either a CF (37.5% vs. 19.2%) or in a LTF (30.0% vs. 15.4%). A second-generation cryo-solution reduced the incidence of necrosis (29.4%) at 0 h after thawing as compared with that of a first generation cryo-solution (DMEM + DMSO, 60.2%). The percentage of apoptosis in live cells was affected by cooling rate (CF = 1.9% vs. LFT = 0.7%). Development of bovine cloned embryos to the blastocyst stage was not affected by cooling rate or freezer type.
We report the first case in the world literature of laryngeal spindle cell carcinoma metastasising to the orbit. A 65-year-old woman was previously treated for T3 N0 Mx laryngeal spindle cell carcinoma, with laryngectomy and post-operative radiotherapy. Five months following this treatment, she developed proptosis, diplopia and reduced right visual acuity, secondary to an enlarging mass within the right orbit. This was biopsied, and subsequent histology confirmed a diagnosis of metastatic spindle cell carcinoma. Subsequent post-mortem examination demonstrated additional pulmonary, hepatic and cardiac metastatic disease, in the absence of any other primary tumour or locoregional disease. The radiological investigation of patients with laryngeal spindle cell carcinoma is discussed and contrasted with that of laryngeal squamous cell carcinoma.
The modelling of fluid-particle acceleration in homogeneous isotropic turbulence in terms of stochastic models for the Lagrangian velocity, acceleration and a dissipation rate variable is considered. The basis for the Reynolds model (A. M. Reynolds, Phys. Rev. Lett. vol. 91, 2003, 084503) is reviewed and examined by reference to direct numerical simulations (DNS) of isotropic turbulence at Taylor-scale Reynolds number (Rλ) up to about 650. In particular, we show DNS data that support stochastic modelling of the logarithm of pseudo-dissipation as an Ornstein–Uhlenbeck process and reveal non-Gaussianity of the acceleration conditioned on fluctuations of the pseudo-dissipation rate. The DNS data are used to construct a new stochastic model that is exactly consistent with Gaussian velocity and conditionally cubic-Gaussian acceleration statistics. This model captures the effects of small-scale intermittency on acceleration and the conditional dependence of acceleration on pseudo-dissipation (which differs from that predicted by the refined Kolmogorov hypotheses). Non-Gaussianity of the conditionally standardized acceleration probability density function (PDF) is accounted for in terms of model nonlinearity. The large-time behaviour of the new model is that of a velocity-dissipation model that can be matched with DNS data for conditional second-order Lagrangian velocity structure functions. As a result, the diffusion coefficient for the new model incorporates two-time information and its Reynolds-number dependence as observed in DNS. The resulting model predictions for conditional and unconditional velocity autocorrelations and time scales are shown to be in very good agreement with DNS.
Methicillin resistant Staphylococcus aureus (MRSA) is becoming ever more prevalent in the UK, and the proportion of MRSA to methicillin sensitive Staphylococcus aureus (MSSA) seems to be increasing. New strains of MRSA are ever developing resistance to antibiotic treatment, increasing morbidity and mortality of infection.
Staphylococcus aureus is part of the normal flora of the nose, and MRSA colonizes the nose in infection. However, nasal surgery is rarely complicated by staphylococcal infections, and MRSA infection following nasal surgery is rare.
The authors present a literature review of MRSA infection, its relation to the nasal cavity, and infection following nasal surgery.
Background. Although there is good evidence that cognitive therapy (CBT) lessens relapse and recurrence in unipolar depression, the duration of this effect is not known.
Method. One hundred and fifty-eight subjects, from a randomized controlled trial of CBT plus medication and clinical management versus medication and clinical management alone, were followed 6 years after randomization (4½ years after completion of CBT) and the longitudinal course assessed.
Results. Effects in prevention of relapse and recurrence were found to persist, with weakening, and were not fully lost until 3½ years after the end of CBT. Residual symptoms were also lessened.
Conclusions. The effect of CBT in reduction of relapse and recurrence persists for several years. The potential value of subsequent additional CBT some time after cessation should be explored.
Polysynthetically-twinned TiAl crystals were deformed by compression with loading axis parallel and perpendicular to the lamellar interfaces. The deformation structures on the free surfaces were scanned using a dimension AFM with scan directions parallel and perpendicular to the lamellar interfaces. Abnormal deformation behaviors were observed to occur in both orientations. When the compression axis is parallel to the lamellar interfaces, the gamma and alpha lamellae deform primarily by shear in planes inclined with the lamellar interface, while the shear vectors lie in the interface. However, in-plane shear, shear in slip planes parallel to the lamellar interfaces, also occurs along the lamellar interfaces. When the loading axis is perpendicular to the lamellar interface, in-plane shear was found to be dominant at the beginning stage of plastic deformation and contributes more to the macroscopic strain. These behaviors are controversial to the Schmid's Law since the applied resolved shear stress for these deformation systems is zero. The abnormal phenomenon was explained by the large coherency stresses along the lamellar interfaces.
PST TiAl samples of different orientations were prepared and deformed by compression at room temperature. The deformation structures on the free surfaces were scanned using an AFM. It was found that when the angle between the lamellar interfaces and the loading axis is between 20 degree and 80 degree, PST samples deform primarily by shear in slip planes parallel to the lamellar interfaces. When the angle is below 20 degree, both the gamma phase and the alpha 2 phase deform by shear in slip planes inclined with the lamellar interfaces, but the shear vectors lie in the interface. When the angle is close to 90 degree, complex deformation behavior occurs. Shear in planes parallel to the lamellar interfaces contributes more to the overall strain in the directions perpendicular to the loading axis and the out-of-plane shear contributes to the strain in the compression direction. The characteristic U-shape curve of the yield stress versus the angle between the loading axis and the lamellar interfaces can be explained quite well using different C.R.S.S. for the three different deformation modes.
The electrical and thermal transport properties (electrical resistivity, thermopower, heat capacity and thermal conductivity) of the crystalline phase of the binary Cd6Yb system has been measured over a temperature range from 10 K to 300 K. Evidence for a phase transition in Cd6Yb is observed in the electrical transport properties with distinct changes in the temperature dependence of the resistivity and thermopower around T ≈ 110K. An anomaly in the heat capacity and a thermal conductivity is also observed at this same temperature. Hysteretic behavior is not evident in the temperature dependence of any of the electrical and thermal transport properties. In addition, the elastic properties using resonant ultrasound (RUS) techniques have been investigated over a similar temperature range. A large “resonance dip” is observed in the RUS data at T ≈ 110K, which is indicative of some type of structural change in the crystalline material at this temperature. These data will be presented and discussed in context of the undergoes reversible order-disorder transition in the 1/1 cubic approximant at about 110 K, which makes the system very interesting compared to the quasicrystal phase Cd5.7Yb