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

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Nature and significance of small volume fall deposits at composite volcanoes: Insights from the October 14, 1974 Fuego eruption, Guatemala

The first of four successive pulses of the 1974 explosive eruption of Fuego volcano, Guatemala, produced a small volume (∼0.02 km3 DRE) basaltic sub-plinian tephra fall and flow deposit. Samples collected within 48 h after deposition over much of the dispersal area (7–80 km from the volcano) have been size analyzed down to 8 φ (4 µm). Tephra along the dispersal axis were all well-sorted (σ φ = 0.25–1.00), and sorting increased whereas thickness and median grain size decreased systematically downwind. Skewness varied from slightly positive near the vent to slightly negative in distal regions and is consistent with decoupling between coarse ejecta falling off the rising eruption column and fine ash falling off the windblown volcanic cloud advecting at the final level of rise. Less dense, vesicular coarse particles form a log normal sub-population when separated from the smaller (Mdφ < 3φ or < 0.125 mm), denser shard and crystal sub-population. A unimodal, relatively coarse (Mdφ = 0.58φ or 0.7 mm σ φ = 1.2) initial grain size population is estimated for the whole (fall and flow) deposit. Only a small part of the fine-grained, thin 1974 Fuego tephra deposit has survived erosion to the present day. The initial October 14 pulse, with an estimated column height of 15 km above sea level, was a primary cause of a detectable perturbation in the northern hemisphere stratospheric aerosol layer in late 1974 to early 1975. Such small, sulfur-rich, explosive eruptions may substantially contribute to the overall stratospheric sulfur budget, yet leave only transient deposits, which have little chance of survival even in the recent geologic record. The fraction of finest particles (Mdφ = 4–8φ or 4–63 µm) in the Fuego tephra makes up a separate but minor size mode in the size distribution of samples around the margin of the deposit. A previously undocumented bimodal–unimodal–bimodal change in grain size distribution across the dispersal axis at 20 km downwind from the vent is best accounted for as the result of fallout dispersal of ash from a higher subplinian column and a lower “co-pf” cloud resulting from pyroclastic flows. In addition, there is a degree of asymmetry in the documented grain-size fallout pattern which is attributed to vertically veering wind direction and changing windspeeds, especially across the tropopause. The distribution of fine particles (<8 µm diameter) in the tephra deposit is asymmetrical, mainly along the N edge, with a small enrichment along the S edge. This pattern has hazard significance