Cutaneous Head and Neck Squamous Cell Carcinoma with Regional Metastases: The Prognostic Importance of Soft Tissue Metastases and Extranodal Spread

Extranodal spread (ENS) is an established adverse prognostic factor in metastatic cutaneous squamous cell carcinoma (cSCC); however, the clinical significance of soft tissue metastases (STM) is unknown. The aim of this study was to evaluate the prognosis of patients with STM from head and neck cSCC, and to compare this with that of node metastases with and without ENS. Patients with cSCC metastatic to the parotid and/or neck treated by primary surgical resection between 1987 and 2007 were included. Metastatic nodes > 3 cm in size were an exclusion criterion. A Cox proportional hazard model was used to determine the effect of STM adjusting for other relevant prognostic factors. The population included 164 patients with a median follow-up of 26 months. There were 8 distant and 37 regional recurrences. There were 22 were cancer-specific deaths, and 29 patients died. STM was a significant predictor of reduced overall (hazard ratio 3.3; 95% confidence interval 1.6-6.4; P = 0.001) and disease-free survival (hazard ratio 2.4; 95% confidence interval 1.4-4.1; P = 0.001) when compared to patients with node disease with or without ENS. After adjusting for covariates, STM and number of involved nodes were significant independent predictors of overall and disease-free survival. In metastatic cSCC of the head and neck, the presence of STM is an independent predictor of reduced survival and is associated with a greater adverse effect than ENS alone

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

Parametric roll resonance monitoring using signal-based detection

Extreme roll motion of ships can be caused by several phenomena, one of which is parametric roll resonance. Several incidents occurred unexpectedly around the millennium and caused vast fiscal losses on large container vessels. The phenomenon is now well understood and some consider parametric roll a curiosity, others have concerns. This study employs novel signalbased detection algorithms to analyse logged motion data from a container vessel (2800 TEU) and a large car and truck carrier (LCTC) during one year at sea. The scope of the study is to assess the performance and robustness of the detection algorithms in real conditions, and to evaluate the frequency of parametric roll events on the selected vessels. Detection performance is scrutinised through the validation of the detected events using owners’ standard methods, and supported by available wave radar data. Further, a bivariate statistical analysis of the outcome of the signal-based detectors is performed to assess the real life false alarm probability. It is shown that detection robustness and very low false warning rates are obtained. The study concludes that small parametric roll events are occurring, and that the proposed signal-based monitoring system is a simple and effective mean to provide timely warning of resonance condition