Dysphagia in head and neck cancer patients following intensity modulated radiotherapy (IMRT)

BACKGROUND: To evaluate the objective and subjective long term swallowing function, and to relate dysphagia to the radiation dose delivered to the critical anatomical structures in head and neck cancer patients treated with intensity modulated radiation therapy (IMRT, +/- chemotherapy), using a midline protection contour (below hyoid, ~level of vertebra 2/3). METHODS: 82 patients with stage III/IV squamous cell carcinoma of the larynx, oropharynx, or hypopharynx, who underwent successful definitive (n = 63, mean dose 68.9Gy) or postoperative (n = 19, mean dose 64.2Gy) simultaneous integrated boost (SIB) -IMRT either alone or in combination with chemotherapy (85%) with curative intent between January 2002 and November 2005, were evaluated retrospectively. 13/63 definitively irradiated patients (21%) presented with a total gross tumor volume (tGTV) >70cc (82-173cc; mean 106cc). In all patients, a laryngo-pharyngeal midline sparing contour outside of the PTV was drawn. Dysphagia was graded according subjective patient-reported and objective observer-assessed instruments. All patients were re-assessed 12 months later. Dose distribution to the swallowing structures was calculated. RESULTS: At the re-assessment, 32-month mean post treatment follow-up (range 16-60), grade 3/4 objective toxicity was assessed in 10%. At the 32-month evaluation as well as at the last follow up assessment mean 50 months (16-85) post-treatment, persisting swallowing dysfunction grade 3 was subjectively and objectively observed in 1 patient (1%). The 5-year local control rate of the cohort was 75%; no medial marginal failures were observed. CONCLUSIONS: Our results show that sparing the swallowing structures by IMRT seems effective and relatively safe in terms of avoidance of persistent grade 3/4 late dysphagia and local disease control

Rapid and sensitive single-sample viral metagenomics using Nanopore Flongle sequencing

The ability of viral metagenomic Next-Generation Sequencing (mNGS) to unbiasedly detect nucleic acids in a clinical sample is a powerful tool for advanced diagnosis of viral infections. When clinical symptoms do not provide a clear differential diagnosis, extensive laboratory testing with virus-specific PCR and serology can be replaced by a single viral mNGS analysis. However, widespread diagnostic use of viral mNGS is thus far limited by long sample-to-result times, as most protocols rely on Illumina sequencing, which provides high and accurate sequencing output but is time-consuming and expensive. Here, we describe the development of an mNGS protocol based on the more cost-effective Nanopore Flongle sequencing with decreased turnaround time and lower, yet sufficient sequencing output to provide sensitive virus detection. Sample preparation (6 h) and sequencing (2 h) times are substantially reduced compared to Illumina mNGS and allow detection of DNA/RNA viruses at low input (up to 33-38 cycle threshold of specific qPCR). Although Flongles yield lower sequencing output, direct comparison with Illumina mNGS on diverse clinical samples showed similar results. Collectively, the novel Nanopore mNGS approach is specifically tailored for use in clinical diagnostics and provides a rapid and cost-effective mNGS strategy for individual testing of severe cases

Erfolgreiche Gespräche mit Jugendlichen gestalten: Jugendberatung in den verschiedenen Gesprächskontexten

Jugendliche sind eine wichtige Zielgruppe der Sozialen Arbeit. Der Prozess der Adoleszenz wird durch verschiedene psychologische, physiologische und soziologische Faktoren geprägt. Die Lebensphase der Jugend hält für ihre Angehörigen auf dem Weg zum Erwachsenwerden eine Reihe von einschneidenden Veränderungen und zu bewältigenden Herausforderungen (sog. Entwicklungsaufgaben) bereit, die von der Fachperson in der Beratungsarbeit mit Jugendlichen berücksichtigt und ernst genommen werden müssen. Die Soziale Arbeit ist in unterschiedliche Institutionen eingebunden. Ein Erstgespräch kann auf verschiedene Art und Weise zustande kommen, wobei man erbetene, angebotene und angeordnete Gesprächskontexte unterscheiden kann. Die Literatur wie auch die – anhand einer qualitativen Forschung ermittelten – Erfahrungen von Expertinnen und Experten der Jugendberatung zeigen auf, dass es einige Bedingungen gibt, die die Aussichten auf einen guten Beratungsprozess in den drei erwähnten Kontexten erschweren oder erleichtern. Gleichzeitig gibt es zahlreiche förderliche und hinderliche Faktoren, die es unabhängig vom Kontext des Beratungsgesprächs zu beachten gilt. So ist es beispielsweise generell von grosser Wichtigkeit, der Lebenswelt der Jugendlichen empathisch und offen zu begegnen und ihre Anliegen ernst zu nehmen

Potential distributional patterns of three wild ungulate species in a fragmented tropical region of northeastern Mexico

"In the northernmost American tropical forests of eastern Mexico, we analyzed the potential distribution of three ungulate species, Odocoileus virginianus, Mazama temama and Pecari tajacu, in response to several physical, climatic, biological, and anthropogenic variables, in order to identify environmental factors affecting distribution and potential key areas for ungulate conservation. Current presence records for these species were gathered, and potential distribution models were built using Maximum Entropy niche modeling (MaxEnt). Model suitability surfaces were used to calculate remaining potential habitat areas in the region, as well as the potential sympatric area and representation of these areas in Natural Protected Areas. Biological and anthropogenic variables were the best species distribution predictors. Landscape composition (the proportion of different land-use and land-cover classes: forest, agriculture, and pasture) within approximately 120 ha, was the most important variable for all models, influencing each species differently with respect to their tolerance of altered habitats. The remaining potential area of all three species is fragmented and has apparently been nearly lost in plains (<14% remaining). Distribution models allowed us to detect an important location in the western portion of our study area which may function as a large biological corridor in the Sierra Madre Oriental mastogeographic province, a region heavily transformed by land use change. In the context of habitat transformation, management promoting quality matrix at the landscape level promises to be a viable alternative for ungulate conservation in tropical regions of Mexico.

First Testing of Literature-Based Models for Predicting Increase in Body Weight and Adipose Tissue Mass After Kidney Transplantation

Introduction: Weight gain is a risk factor for poor clinical outcomes following kidney transplantation. Research Question: This study's aim was a first testing of 2 models to identify patients early after kidney transplantation who are at risk for weight gain and increase in adipose tissue mass in the first year after kidney transplantation. Design: The literature-based models were evaluated on longitudinal data of 88, respectively 79 kidney transplant recipients via ordinary and Firth regression, using gains ≥ 5% in weight and adipose tissue mass respectively as primary and secondary endpoints. Results: The models included physical activity, smoking cessation at time of kidney transplantation, self-reported health status, depressive symptomatology, gender, age, education, baseline body mass index and baseline trunk fat as predictors. Area under the curve was 0.797 (95%-CI 0.702 to 0.893) for the weight model and 0.767 (95%-CI 0.656 to 0.878) for the adipose tissue mass model-showing good, respectively fair discriminative ability. For weight gain ≥ 5%, main risk factors were smoking cessation at time of transplantation (OR 16.425, 95%-CI 1.737-155.288) and better self-reported baseline health state (OR 1.068 for each 1-unit increase, 95%-CI 1.012-1.128). For the adipose tissue mass gain ≥ 5%, main risk factor was overweight/obesity (BMI ≥ 25) at baseline (odds ratio 7.659, 95%-CI 1.789-32.789). Conclusions: The models have potential to assess patients' risk for weight or adipose tissue mass gain during the year after transplantation, but further testing is needed before implementation in clinical practice. Keywords: addictive; behavior; cardiovascular disease; clinical outcomes; depression; exercise outcomes; nutrition; performance improvement; quality; quality of life; quantitative methods; regression; research

Low and intermediate energy electron collisions with the C2−_2^- molecular anion

Calculations are presented which use the molecular R-matrix with pseudo-states (MRMPS) method to treat electron impact electron detachment and electronic excitation of the carbon dimer anion. Resonances are found above the ionisation threshold of C$_2^-$ with $^1\Sigma^+_g$, $^1\Pi_g$ and $^3\Pi_g$ symmetry. These are shape resonances trapped by the effect of an attractive polarisation potential competing with a repulsive Coulomb interaction. The $\Pi_g$ resonances are found to give structure in the detachment cross section similar to that observed experimentally. Both excitation and detachment cross sections are found to be dominated by large impact parameter collisions whose contribution is modelled using the Born approximation.Comment: 18 pages, 5 figures constructed from 8 file

Re-evaluation of the spectroscopic data and redox properties

Eur. J. Biochem. 270, 3904–3915 (2003)The cytochrome c nitrite reductase is isolated from the membranes of the sulfate-reducing bacterium Desulfovibrio desulfuricans ATCC 27774 as a heterooligomeric complex composed by two subunits (61 kDa and 19 kDa) containing c-type hemes, encoded by the genes nrfA and nrfH,respectively. The extracted complex has in average a 2NrfA:1NrfH composition. The separation of ccNiR subunits from one another is accomplished by gel filtration chromatography in the presence of SDS. The amino-acid sequence and biochemical subunits characterization show that NrfA contains five hemes and NrfH four hemes. These considerations enabled the revision of a vast amount of existing spectroscopic data on the NrfHA complex that was not originally well interpreted due to the lackof knowledge on the heme content and the oligomeric enzyme status. Based on EPRandMo¨ ssbauer parameters and their correlation to structural information recently obtained from X-ray crystallography on the NrfA structure [Cunha, C.A., Macieira, S., Dias, J.M., Almeida, M.G., Gonçalves, L.M.L., Costa, C., Lampreia, J.,Huber,R., Moura, J.J.G., Moura, I. & Romão, M. (2003) J. Biol. Chem. 278, 17455– 17465], we propose the full assignment of midpoint reduction potentials values to the individual hemes.NrfAcontains the high-spin catalytic site ()80mV) as well as a quite unusual high reduction potential (+150 mV)/low-spin bis-His coordinated heme, considered to be the site where electrons enter. In addition, the reassessment of the spectroscopic data allowed the first partial spectroscopic characterization of theNrfH subunit. The four NrfH hemes are all in a low-spin state (S ¼ 1/2).One of them has a gmax at 3.55, characteristic of bis-histidinyl iron ligands in a noncoplanar arrangement, and has a positive reduction potential

Nachhaltigkeit : wo steht der Schweizer Mittelstand?

Mazars und die Zürcher Hochschule für Angewandte Wissenschaften (ZHAW) haben untersucht, wie der Schweizer Mittelstand den Trend zu mehr Transparenz in der Nachhaltigkeit umsetzt. Haben die Gesellschaften eine klare Nachhaltigkeitsstrategie, wird diese nach aussen kommuniziert und erfolgt dies nach einem Standard oder Regelwerk

Apnoeic oxygenation during paediatric tracheal intubation: a systematic review and meta-analysis

Abstract Background Supplemental oxygen administration by apnoeic oxygenation during laryngoscopy for tracheal intubation is intended to prolong safe apnoea time, reduce the risk of hypoxaemia, and increase the success rate of first-attempt tracheal intubation under general anaesthesia. This systematic review examined the efficacy and effectiveness of apnoeic oxygenation during tracheal intubation in children. Methods This systematic review and meta-analysis included randomised controlled trials and non-randomised studies in paediatric patients requiring tracheal intubation, evaluating apnoeic oxygenation by any method compared with patients without apnoeic oxygenation. Searched databases were MEDLINE, Embase, Cochrane Library, CINAHL, ClinicalTrials.gov, International Clinical Trials Registry Platform (ICTRP), Scopus, and Web of Science from inception to March 22, 2023. Data extraction and risk of bias assessment followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) recommendation. Results After initial selection of 40 708 articles, 15 studies summarising 9802 children were included (10 randomised controlled trials, four pre-post studies, one prospective observational study) published between 1988 and 2023. Eight randomised controlled trials were included for meta-analysis (n=1070 children; 803 from operating theatres, 267 from neonatal intensive care units). Apnoeic oxygenation increased intubation first-pass success with no physiological instability (risk ratio [RR] 1.27, 95% confidence interval [CI] 1.03–1.57, P=0.04, I2=0), higher oxygen saturation during intubation (mean difference 3.6%, 95% CI 0.8–6.5%, P=0.02, I2=63%), and decreased incidence of hypoxaemia (RR 0.24, 95% CI 0.17–0.33, P<0.01, I2=51%) compared with no supplementary oxygen administration. Conclusion This systematic review with meta-analysis confirms that apnoeic oxygenation during tracheal intubation of children significantly increases first-pass intubation success rate. Furthermore, apnoeic oxygenation enables stable physiological conditions by maintaining oxygen saturation within the normal range. Clinical trial registration Protocol registered prospectively on PROSPERO (registration number: CRD42022369000) on December 2, 2022

Exploring the intrinsic Lorentz-violating parameters at DUNE

Neutrinos can push our search for new physics to a whole new level. What makes them so hard to be detected, what allows them to travel humongous distances without being stopped or deflected allows to amplify Planck suppressed effects (or effects of comparable size) to a level that we can measure or bound in DUNE. In this work we analyze the sensitivity of DUNE to CPT and Lorentz- violating interactions in a framework that allows a straightforward extrapolation of the bounds obtained to any phenomenological modification of the dispersion relation of neutrinos