Advanced head and neck cancer: Long-term results of chemo-radiotherapy, complications and induction of second malignancies

Background: Chemo-radiotherapy is superior to radiotherapy alone in the treatment of advanced, inoperable head and neck cancer. The long-term treatment results, the induction of second malignant tumors, and other long-term toxicities are not well defined. Patients and Methods: 100 consecutive patients with advanced head and neck cancer who were treated at our center were studied. Treatment results, survival, the occurrence of late complications, and second malignant tumors (SMT) were investigated. 78 patients were treated with a protocol combining cisplatinum, 5-fluorouracil, folinic acid and hyper-fractionated irradiation. 22 patients were treated with other chemo-radiotherapy protocols. The relative risk of developing an SMT was compared with that within the normal population. Results: The cumulative total probability of survival was 51.1% at 2 years and 38.7% at 4 years. The probability of relapse-free survival was 39.9% at 2 years and 36.7% at 4 years. A total of 7 patients developed SMT (4 cases of lung cancer, 2 colon cancers, 1 skin cancer). After 6 years, a cumulative risk of SMT of 8.7% was observed. The relative risk of developing an SMT was significantly increased (4.45-fold in males) compared with a normal population. 13 of 38 evaluable patients (34.2%) had severe late complications like fibrosis of soft tissues, nerve lesions, or were dependent on tracheal cannulas. Conclusions: The treatment results and long-term prognoses in our population of unselected high-risk patients are unsatisfactory, but comparable to those from multicenter studies. About 35% of patients become long-term (> 4 years) survivors. SMT generally occur early, have a poor prognosis and, most likely, are not treatment-related. Approximately 30% of long-term survivors have severe, often incapacitating late effects. The treatment and - if possible - prevention of these late effects is important for the quality of life of patients who survived advanced head and neck cancer

Taktik und Taktiktraining

Chapter about decision-making and tactics in sports, in German

Preoperative Exercise Training to Prevent Postoperative Pulmonary Complications in Adults Undergoing Major Surgery. A Systematic Review and Meta-analysis with Trial Sequential Analysis.

Rationale: Poor preoperative physical fitness and respiratory muscle weakness are associated with postoperative pulmonary complications (PPCs) that result in prolonged hospital length of stay and increased mortality.Objectives: To examine the effect of preoperative exercise training on the risk of PPCs across different surgical settings.Methods: We searched MEDLINE, Web of Science, Embase, the Physiotherapy Evidence Database, and the Cochrane Central Register, without language restrictions, for studies from inception to July 2020. We included randomized controlled trials that compared patients receiving exercise training with those receiving usual care or sham training before cardiac, lung, esophageal, or abdominal surgery. PPCs were the main outcome; secondary outcomes were preoperative functional changes and postoperative mortality, cardiovascular complications, and hospital length of stay. The study was registered with PROSPERO (International Prospective Register of Systematic Reviews).Results: From 29 studies, 2,070 patients were pooled for meta-analysis. Compared with the control condition, preoperative exercise training was associated with a lower incidence of PPCs (23 studies, 1,864 patients; relative risk, 0.52; 95% confidence interval [CI], 0.41 to 0.66; grading of evidence, moderate); Trial Sequential Analysis confirmed effectiveness, and there was no evidence of difference of effect across surgeries, type of training (respiratory muscles, endurance or combined), or preoperative duration of training. At the end of the preoperative period, exercise training resulted in increased peak oxygen uptake (weighted mean difference [WMD], +2 ml/kg/min; 99% CI, 0.3 to 3.7) and higher maximal inspiratory pressure (WMD, +12.2 cm H <sub>2</sub> O; 99% CI, 6.3 to 18.2). Hospital length of stay was shortened (WMD, -2.3 d; 99% CI, -3.82 to -0.75) in the intervention group, whereas no difference was found in postoperative mortality.Conclusions: Preoperative exercise training improves physical fitness and reduces the risk of developing PPCs while minimizing hospital resources use, regardless of the type of intervention and surgery performed.Systematic review registered with https://www.crd.york.ac.uk/prospero/ (CRD 42018096956)

Task Integration Facilitates Multitasking

The aim of this study was to investigate multi-task integration in a continuous tracking task. We were particularly interested in how manipulating task structure in a dual-task situation affects learning of a constant segment embedded in a pursuit-tracking task. Importantly, we examined if dual-task effects could be attributed to task integration by varying the structural similarity and difficulty of the primary and secondary tasks. In Experiment 1 participants performed a pursuit tracking task while counting high-pitched tones and ignoring low-pitched tones. The tones were either presented randomly or structurally 250 ms before each tracking turn. Experiment 2 increased the motor load of the secondary tasks by asking participants to tap their feet to the tones. Experiment 3 further increased motor load of the primary task by increasing its speed and having participants tracking with their non-dominant hand. The results show that dual-task interference can be moderated by secondary task conditions that match the structure of the primary task. Therefore our results support proposals of task integration in continuous tracking paradigms. We conclude that multi-tasking is not always detrimental for motor learning but can be facilitated through task-integration

ESTUDO ANATOMOPATOLÓGICO DE ALEVINOS DE JUNDIÁ INFECTADOS EXPERIMENTALMENTE POR Ichthyophtirius multifiliis E SUBMETIDOS A TRATAMENTOS CONVENCIONAIS

The white spot disease is caused by Ichthyophthirius multifiliis (ich), a ciliated parasite characterized by its relatively large size, compared to other protozoans. Ich, one of the most devastating parasites affecting jundia culture, may destroy entire populations within a few hours. This study evaluated the histological effect of ich infection under some conventional treatments on jundia fingerlings. Fifteen fish (3-6 cm) were placed in 21 aquaria (10 L) for 5 days. The following treatments were used: C1: non infected control; C2: infected control; F: formalin (0.2 ml/L); M: malachite green (0.1ml/L); and S: NaCl 1% (10g/L). The treatments were used as 3 baths of 1 h between intervals of 48 h. Total mortality of F fish occurred within 48 h, showing that formalin was toxic to jundia under concentration recommended for parasite treatment of most tropical fish species. The lowest mortality rate (33%) was observed for S fish. The histological evaluation showed that ich caused hyperemia and hyperplasia of gill cells surrounding the parasite. At 96 h, trophozoites were observed with the help of microscope (40x) under the skin of C1 fish. Ich was not visible to the naked eye on C1 fish at the beginning of the experimental period. Tomites, a young stage of ich, burrowed into the skin of jundia, penetrated the subepithelial layer and caused damage. Upper layers of skin were sloughed off within 96 h from fish of all treatments, except S fish. Ich irritates fish tissues, mainly the gill cells, and causes high mortality rate within a very short period of time. Additionally, the employed therapeutic treatments cause adverse changes to different levels of severity, mainly on the gill tissue.A doença dos pontos brancos é causada pelo parasita ciliado Ichthyophthirius multifiliis caracterizado pelo seu tamanho relativamente grande quando comparado a outros protozoários. O ictio é responsável pelas maiores perdas observadas na criação do jundiá, podendo destruir toda a população de um viveiro em poucas horas. O presente estudo avaliou e descreveu as alterações patológicas macro e microscópicas causadas pelo ictio em alevinos de jundiá submetidos a tratamentos terapêuticos convencionais. Quinze peixes (3-6 cm) foram estocados em 21 aquários (10 L) e submetidos por cinco dias aos seguintes tratamentos: C1: controle não infectados; C2: controle infectados; F: formalina comercial (0,2ml/l); M: verde malaquita (0,1ml/l); e S: cloreto de sódio 1% (10g/l). Foram realizados três banhos com duração de uma hora e intervalos de 48 horas. Mortalidade total foi observada nos exemplares expostos a formalina por 48 horas, mostrando que alevinos de jundiá são sensíveis a esse produto na concentração recomendada para a maioria das espécies tropicais. A menor taxa de mortalidade (33%) foi registrada para os peixes submetidos ao sal. As análises histológicas denunciaram a presença de hiperemia e hiperplasia nas células do epitélio branquial próximas ao parasita. No grupo C1 foi registrada a presença de trofozoítos nos peixes coletados em 96 horas, sendo que os parasitas não foram observados naqueles peixes, a olho nu, no início do experimento. Tomitos, a forma jovem do parasita, alojaram-se na pele com localização subepidermal e causando lesões. Foi verificada irritação causada pelo ictio em diferentes níveis e em todos os tratamentos, principalmente nas células do epitélio branquial. Próximo ao final do período experimental foi observada esfoliação da pele de peixes de todos os tratamentos, exceto nos peixes submetidos ao sal comum. A infecção pelo ictio ocorre de forma muito rápida e intensa, causando alterações anatomopatológicas severas no tecido branquial e altas taxas de mortalidade em curto período de tempo. Adicionalmente, os tratamentos terapêuticos empregados causam reações adversas no jundiá em graus variados de severidade, principalmente no tecido branquial

A Feasability Study of Color Flow Doppler Vectorization for Automated Blood Flow Monitoring

An ongoing issue in vascular medicine is the measure of the blood flow. Catheterization remains the gold standard measurement method, although non-invasive techniques are an area of intense research. We hereby present a computational method for real-time measurement of the blood flow from color flow Doppler data, with a focus on simplicity and monitoring instead of diagnostics. We then analyze the performance of a proof-of-principle software implementation. We imagined a geometrical model geared towards blood flow computation from a color flow Doppler signal, and we developed a software implementation requiring only a standard diagnostic ultrasound device. Detection performance was evaluated by computing flow and its determinants (flow speed, vessel area, and ultrasound beam angle of incidence) on purposely designed synthetic and phantom-based arterial flow simulations. Flow was appropriately detected in all cases. Errors on synthetic images ranged from nonexistent to substantial depending on experimental conditions. Mean errors on measurements from our phantom flow simulation ranged from 1.2 to 40.2% for angle estimation, and from 3.2 to 25.3% for real-time flow estimation. This study is a proof of concept showing that accurate measurement can be done from automated color flow Doppler signal extraction, providing the industry the opportunity for further optimization using raw ultrasound data

Phonons and related properties of extended systems from density-functional perturbation theory

This article reviews the current status of lattice-dynamical calculations in crystals, using density-functional perturbation theory, with emphasis on the plane-wave pseudo-potential method. Several specialized topics are treated, including the implementation for metals, the calculation of the response to macroscopic electric fields and their relevance to long wave-length vibrations in polar materials, the response to strain deformations, and higher-order responses. The success of this methodology is demonstrated with a number of applications existing in the literature.Comment: 52 pages, 14 figures, submitted to Review of Modern Physic

The dynamics of Early Celtic consumption practices: a case study of the pottery from the Heuneburg

The Early Celtic site of the Heuneburg (Baden-Wuerttemberg, Germany) has long been understood as a hallmark of early urbanization in Central Europe. The rich collection of Mediterranean imports recovered from the settlement, the elite burials in its surroundings and the Mediterranean-inspired mudbrick fortification wall further point to the importance of intercultural connections with the Mediterranean as a crucial factor in the transformation of Early Iron Age societies. We describe a new facet of this process by studying the transformation of consumption practices, especially drinking habits, brought about by intercultural encounters from the late 7th to the 5th century BC through the analysis of organic remains in 133 ceramic vessels found at the Heuneburg using Organic Residue Analysis (ORA). During the Ha D1 phase, fermented beverages, including Mediterranean grape wine, were identified in and appear to have been consumed from local handmade ceramics. The latter were recovered from different status-related contexts within the Heuneburg, suggesting an early and well-established trade/exchange system of this Mediterranean product. This contrasts with the results obtained for the drinking and serving vessels from the Ha D3 phase that were studied. The consumption of fermented beverages (wine and especially bacteriofermented products) appears to have been concentrated on the plateau. The ORA analyses presented here seem to indicate that during this time, grape wine was consumed primarily from imported vessels, and more rarely from local prestigious fine wheel-made vessels. In addition to imported wine, we demonstrate the consumption of a wide variety of foodstuffs, such as animal fats (especially dairy products), millet, plant oils and waxy plants, fruit and beehive products as well as one or several other fermented beverage(s) that were probably locally produced. Through this diachronic study of vessel function from different intra-site contexts, we inform on changing and status-related practices of food processing and consumption

Expert–novice differences in brain function of field hockey players

The aims of this study were to use functional magnetic resonance imaging to examine the neural bases for perceptual-cognitive superiority in a hockey anticipation task. Thirty participants (15 hockey players, 15 non-hockey players) lay in an MRI scanner while performing a video-based task in which they predicted the direction of an oncoming shot in either a hockey or a badminton scenario. Video clips were temporally occluded either 160 ms before the shot was made or 60 ms after the ball/shuttle left the stick/racquet. Behavioral data showed a significant hockey expertise × video-type interaction in which hockey experts were superior to novices with hockey clips but there were no significant differences with badminton clips. The imaging data on the other hand showed a significant main effect of hockey expertise and of video type (hockey vs. badminton), but the expertise × video-type interaction did not survive either a whole-brain or a small-volume correction for multiple comparisons. Further analysis of the expertise main effect revealed that when watching hockey clips, experts showed greater activation in the rostral inferior parietal lobule, which has been associated with an action observation network, and greater activation than novices in Brodmann areas 17 and 18 and middle frontal gyrus when watching badminton videos. The results provide partial support both for domain-specific and domain-general expertise effects in an action anticipation task