Definitive hypofractionated radiotherapy for early glottic carcinoma: experience of 55Gy in 20 fractions

Introduction: A wide variety of fractionation schedules have been employed for the treatment of early glottic cancer. The aim is to report our 10-year experience of using hypofractionated radiotherapy with 55Gy in 20 fractions at 2.75Gy per fraction. Methods: Patients treated between 2004 and 2013 with definitive radiotherapy to a dose of 55Gy in 20 fractions over 4 weeks for T1/2 N0 squamous cell carcinoma of the glottis were retrospectively identified. Patients with prior therapeutic minor surgery (eg. laser stripping, cordotomy) were included. The probabilities of local control, ultimate local control (including salvage surgery), regional control, cause specific survival (CSS) and overall survival (OS) were calculated. Results: One hundred thirty-two patients were identified. Median age was 65 years (range 33–89). Median follow up was 72 months (range 7–124). 50 (38 %), 18 (14 %) and 64 (48 %) of patients had T1a, T1b and T2 disease respectively. Five year local control and ultimate local control rates were: overall - 85.6 % and 97.3 % respectively, T1a - 91.8 % and 100 %, T1b - 81.6 and 93.8 %, and T2 - 80.9 % and 95.8 %. Five year regional control, CSS and OS rates were 95.4 %, 95.7 % and 78.8 % respectively. There were no significant associations of covariates (e.g. T-stage, extent of laryngeal extension, histological grade) with local control on univariate analysis. Only increasing age and transglottic extension in T2 disease were significantly associated with overall survival (both p <0.01). Second primary cancers developed in 17 % of patients. 13 (9.8 %) of patients required enteral tube feeding support during radiotherapy; no patients required long term enteral nutrition. One patient required a tracheostomy due to a non-functioning larynx on long term follow up. Conclusions: Hypofractionated radiation therapy with a dose of 55Gy in 20 fractions for early stage glottic cancer provides high rates of local control with acceptable toxicity

Current Advances in Internet of Underground Things

The latest developments in Internet of Underground Things are covered in this chapter. First, the IOUT Architecture is discussed followed by the explanation of the challenges being faced in this paradigm. Moreover, a comprehensive coverage of the different IOUT components is presented that includes communications, sensing, and system integration with the cloud. An in-depth coverage of the applications of the IOUT in various disciplines is also surveyed. These applications include areas such as decision agriculture, pipeline monitoring, border control, and oil wells

The impacts of climate change on the winter water cycle of the western Himalaya

Some 180 million people depend on the Indus River as a key water resource, fed largely by precipitation falling over the western Himalaya. However, the projected response of western Himalayan precipitation to climate change is currently not well constrained: CMIP5 GCMs project a reduced frequency and vorticity of synoptic-scale systems impacting the area, but such systems would exist in a considerably moister atmosphere. In this study, a convection-permitting (4 km horizontal resolution) setup of the Weather Research and Forecasting (WRF) model is used to examine 40 cases of these synoptic-scale systems, known as western disturbances (WDs), as they interact with the western Himalaya. In addition to a present-day control run, three experiments are performed by perturbing the boundary and initial conditions to reflect pre-industrial, RCP4.5 and RCP8.5 background climates respectively. It is found that in spite of the weakening intensity of WDs, net precipitation associated with them in future climate scenarios increases significantly; conversely there is no net change in precipitation between the pre-industrial and control experiments despite a significant conversion of snowfall in the pre-industrial experiment to rainfall in the control experiment, consistent with the changes seen in historical observations. This shift from snowfall to rainfall has profound consequences on water resource management in the Indus Valley, where irrigation is dependent on spring meltwater. Flux decomposition shows that the increase in future precipitation follows directly from the projected moistening of the tropical atmosphere (which increases the moisture flux incident on the western Himalaya by 28%) overpowering the weakened dynamics (which decreases it by 20%). Changes to extreme rainfall events are also examined: it is found that such events may increase significantly in frequency in both future scenarios examined. Two-hour maxima rainfall events that currently occur in 1-in-8 WDs are projected to increase tenfold in frequency in the RCP8.5 scenario; more prolonged (one-week maxima) events are projected to increase fiftyfold

Zonal variability in primary production and nitrogen uptake rates in the southwestern Indian Ocean and the Southern Ocean

Hydrographic parameters along with the primary and new production measurements were carried out during the austral summer, 2009, in the southwestern Indian Ocean and Indian sector of the Southern Ocean (SO). The production varies from 185 to &gt;900mgCm -2d -1 in different zones of SO. The zonal variations in production accompany variations in SST, salinity and nutrients. Further, the new production (0.3 to 4.1mmolNm -2d -1) covaries with the overall production, while the uptake of reduced forms of nitrogen (both NH 4 and urea) show opposite trends. In the NO 3 limiting environment (north of subtropical convergence), NH 4 uptake dominates the total regenerated production, whereas, urea uptake dominates the regenerated production under Si, light and micronutrient (e.g., Fe) limiting conditions (found between the subtropical convergence and Antarctica). On the basis of the C and N uptake data, the studied region can be divided into five zones (from the south to the north) viz., located between (i) the Antarctic continent and the polar front (Antarctic zone; ANZ), (ii) the polar and subantarctic fronts (SAF) (Polar frontal zone; PFZ), (iii) SAF and Agulhas Retroflection fronts (ARF) (South Subtropical front; SSTF), (iv) subtropical frontal zone (STFZ), and (v) ARF and the north subtropical front (Subtropical zone; STZ). Except at SSTF, regenerated production dominates in all the zones. From the south to the north, this could be due to different reasons e.g., light, grazing by zooplankton, supply of key micronutrients (probably Fe), Si-limitation, or NO 3-limitation. In the absence of such limitations, the maximum possible f-ratio in SO could be as high as 0.78±0.12 and under such conditions the region could export most of the total production to the deep. Supply of micronutrients through the Agulhas return current and from the Crozet Island supports the higher chl a, C uptake and new production at the 48°E transect relative to the 57.5°E transect. The C:N assimilation ratio is found to be 5.64, marginally lower than the canonical Redfield ratio. This slight difference is likely due to the variation in the composition of phytoplankton and NO 3-limitation in some zones. A comparison with earlier results shows that seasonal and spatial variations in f-ratios in these zones are much higher than its inter-annual variability

Population aging in japan : a lesson for brazil

The purpose of this study was to compare demographic trends in the aging of the Japanese and Brazilian populations on the basis of health indicator data collected by the statistics bureaus of the Japanese and Brazilian governments. The demographic and health indicator data from surveys by the Statistics Bureaus of the Japanese and Brazilian governments and other sources were obtained from websites. The data showed that Japan has an aging population, that the number of elderly persons in Japan is increasing and that the Government of Japan has a plan to address future demands for health resources by this aging population, whereas Brazil has a rapidly population aging but no plan for its future health services. Brazil may need to increase the number of hospitals and hospital beds and develop a medical care plan for the elderly within its Unified Health System