Treatment of Advanced Carcinoma of the Larynx and Hypopharynx with Laser Followed by External Radiotherapy

Introduction: Radical laryngeal surgeries for extensive laryngeal and hypopharyngeal tumors often require a permanent tracheostomy, which has an immense impact on the quality of life of patients. A minimally invasive technique such as transoral laser microresection (TLM) followed by radiotherapy can preserve the functions of the voice and swallowing. The aim of this study is to evaluate the role of laser debulking in the treatment of carcinoma of the larynx and hypopharynx, to evaluate the response of the tumor to subsequent radiotherapy, and also to assess the usefulness of laser in avoiding tracheostomy and functional preservation of the voice and swallowing.    Materials and Methods: This prospective cohort study included patients with carcinoma of the larynx and hypopharynx unwilling to have definitive surgery and those medically unfit for radical surgery. The clinical profile of patients at presentation,  tumor status following laser debulking, immediately after radiotherapy (RT), 6 weeks post RT, 3 months post RT, and at the end of study; short term complications associated with laser surgery; and usefulness of laser in avoiding tracheostomy and in functional preservation of the voice were evaluated.   Results: There were 18 (90%) male patients and 2 (10%) female patients. Age ranged from 24 to 78 years with a mean age of 55. Hoarseness of voice was the most frequent presenting complaint (90%) followed by progressive dysphagia (45%), odynophagia (40%), otalgia (40%), and dyspnoea (25%). 11 (55%) patients had T3 tumors, while 6 (30%) were T2,  and 3 (15%) were T4 lesions. 65% of  patients were free of lymph node metastasis at presentation. 2 (10%) had N1 and 5 (25%) had N2  nodes. At presentation 10 (50%) patients had Stage III disease and 6 (30%) had stage IV disease. 13 patients (65%) had moderately differentiated squamous cell carcinoma. None of the risk factors and co-morbid illnesses showed any statistically significant difference among the tumor sites. Apart from the 2 (10%) patients who had residual disease, 2 (10%) patients developed a recurrent tumor in the course of their follow up. None had neck recurrence. Two patients underwent tracheostomy, before laser surgery, for compromised airway and both had recurrence of their tumor and continued to be on tracheostomy.   Conclusion: Laser debulking followed by radiotherapy is a viable alternative in the management of malignancies of the larynx and hypopharynx for those who refuse radical surgery and for those patients in whom radical open surgery is impractical due to physiological reasons such as advanced age and poor pulmonary reserve

Charged particle tracking with quantum annealing-inspired optimization

At the High Luminosity Large Hadron Collider (HL-LHC), traditional track reconstruction techniques that are critical for analysis are expected to face challenges due to scaling with track density. Quantum annealing has shown promise in its ability to solve combinatorial optimization problems amidst an ongoing effort to establish evidence of a quantum speedup. As a step towards exploiting such potential speedup, we investigate a track reconstruction approach by adapting the existing geometric Denby-Peterson (Hopfield) network method to the quantum annealing framework and to HL-LHC conditions. Furthermore, we develop additional techniques to embed the problem onto existing and near-term quantum annealing hardware. Results using simulated annealing and quantum annealing with the D-Wave 2X system on the TrackML dataset are presented, demonstrating the successful application of a quantum annealing-inspired algorithm to the track reconstruction challenge. We find that combinatorial optimization problems can effectively reconstruct tracks, suggesting possible applications for fast hardware-specific implementations at the LHC while leaving open the possibility of a quantum speedup for tracking

Public views on principles for health care priority setting: findings of a European cross-country study using Q methodology

International audienc

Costs and health effects of screening and delivery of hearing aids in Tamil Nadu, India: an observational study

Contains fulltext : 79601.pdf (publisher's version ) (Open Access

Harmonizing brain magnetic resonance imaging methods for vascular contributions to neurodegeneration

Introduction Many consequences of cerebrovascular disease are identifiable by magnetic resonance imaging (MRI), but variation in methods limits multicenter studies and pooling of data. The European Union Joint Program on Neurodegenerative Diseases (EU JPND) funded the HARmoNizing Brain Imaging MEthodS for VaScular Contributions to Neurodegeneration (HARNESS) initiative, with a focus on cerebral small vessel disease. Methods Surveys, teleconferences, and an in-person workshop were used to identify gaps in knowledge and to develop tools for harmonizing imaging and analysis. Results A framework for neuroimaging biomarker development was developed based on validating repeatability and reproducibility, biological principles, and feasibility of implementation. The status of current MRI biomarkers was reviewed. A website was created at www.harness-neuroimaging.org with acquisition protocols, a software database, rating scales and case report forms, and a deidentified MRI repository. Conclusions The HARNESS initiative provides resources to reduce variability in measurement in MRI studies of cerebral small vessel disease

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Use of the Client Oriented Scale of Improvement (COSI) and International outcome inventory of hearing aids (IOI-HA) as a clinical outcome measure in a rural community

The burden of hearing loss among adults is large and a significant proportion of the world’s population with hearing disorders goes undetected, as a result relatively few people are fitted with hearing aids. In a developing country this problem becomes magnified due to lack of resources. This study was done in rural area of Vellore district. Hearing rehabilitative services were provided to the rural people and benefit of hearing aids was assessed using self benefit assessment measures Nal-COSI and IOI-HA. A total of 111 clients were followed up for a period of 6 months. It was found that patients having moderately severe to severe hearing loss have more problems and are in need for hearing rehabilitative services. This model of self benefit assessment measures gives the client a realistic picture and also provides the caregiver the details of hearing aid usage. This model of provision of rehabilitation services of hearing loss can be applied in all developing countries