Do salivary bypass tubes lower the incidence of pharyngocutaneous fistula following total laryngectomy? A retrospective analysis of predictive factors using multivariate analysis

Salivary bypass tubes (SBT) are increasingly used to prevent pharyngocutaneous fistula (PCF) following laryngectomy and pharyngolaryngectomy. There is minimal evidence as to their efficacy and literature is limited. The aim of the study was to determine if SBT prevent PCF. The study was a multicentre retrospective case control series (level of evidence 3b). Patients who underwent laryngectomy or pharyngolaryngectomy for cancer or following cancer treatment between 2011 and 2014 were included in the study. The primary outcome was development of a PCF. Other variables recorded were age, sex, prior radiotherapy or chemoradiotherapy, prior tracheostomy, type of procedure, concurrent neck dissection, use of flap reconstruction, use of prophylactic antibiotics, the suture material used for the anastomosis, tumour T stage, histological margins, day one post-operative haemoglobin and whether a salivary bypass tube was used. Univariate and multivariate analysis were performed. A total of 199 patients were included and 24 received salivary bypass tubes. Fistula rates were 8.3% in the SBT group (2/24) and 24.6% in the control group (43/175). This was not statistically significant on univariate (p value 0.115) or multivariate analysis (p value 0.076). In addition, no other co-variables were found to be significant. No group has proven a benefit of salivary bypass tubes on multivariate analysis. The study was limited by a small case group, variations in tube duration and subjects given a tube may have been identified as high risk of fistula. Further prospective studies are warranted prior to recommendation of salivary bypass tubes following laryngectomy

Modelling international price relationships and interdependencies between the stock index and stock index futures markets of three EU countries : A multivariate analysis

This paper addresses the important relationship between stock index and stock index futures markets in an international context. By simply examining the spotfutures relationship within a single country as most of the extant literature does and thus ignoring possible market interdependencies between countries, the dynamics of price adjustments may be misspecified and thus findings misleading. The main contribution of the paper is to improve our understanding of the pricing relationship between spot and futures markets in the light of international market interdependencies. Using a multivariate VAREGARCH methodology, the paper investigates stock index and stock index futures market interdependence, that is leadlag relationships and volatility interactions between the stock and futures markets of three main European countries, namely France, Germany and the UK. In addition, the paper explicitly accounts for potential asymmetries that may exist in the volatility transmission mechanism between these markets. The main conclusions of the paper imply that investors need to account for market interactions across countries to fully and correctly exploit the potential for hedging and diversification

Association between ankle muscle strength and postural sway in older adults

Our study aimed to investigate the relationship between the strength of ankle muscles and postural sway in older adults during upright standing tasks of varying difficulty. Forty-three elderly participants (20 women) performed maximal isometric contractions and three distinct postural tasks: normal quiet stance (60 s), tandem stance (20 s), and one-legged stance (10 s) on a pressure platform. Postural sway was comprehensively assessed, considering center of pressure velocity, peak-to-peak amplitude, and standard deviation of center of pressure displacement in both anterior/posterior and medio/lateral directions. Additionally, weight distribution asymmetry in both directions served as a quantifiable index. Surface electromyographic (EMG) activity of the Tibialis Anterior, Medial Gastrocnemius, Rectus Femoris, and Semitendinosus was recorded during the postural tasks. Throughout the balance tasks, isometric plantar and dorsiflexion torque exhibited a consistent decrease as posture variables increased (p < 0.001). Narrowing the base of support led to significant increases in all postural variables and EMG activity (p < 0.01), with a more pronounced effect on ankle muscles compared to hip muscles (p < 0.0005). In the normal quiet stance (r =.683) and tandem stance (r =.641), greater center of pressure velocity correlated with a more symmetrical weight distribution between the legs. These results suggest that ankle muscle strength serves as a reliable predictor of static balance control, particularly in postures involving a narrow stance. Therefore, the enhancement of plantar flexors and dorsiflexors, rather than an exclusive focus on symmetrical weight distribution, is more likely to contribute to improved static balance control in older adults