Insertion of Provox®2 voice prosthesis using the anterograde technique immediately after the secondary tracheoesophageal puncture

Insertion of a voice prosthesis through the tracheoesophageal puncture (TEP) is one way to restore the voice after total laryngectomy. The second generation Provox voice prosthesis is presently one of the most popular devices. Although TEP can be done primarily, there are many centres that prefer it to be done at a second stage for various reasons. However, secondary TEP for retrograde replacement of prosthesis can be difficult and general anaesthesia is very often necessary. Moreover, the presence of neck stiffness and fibrosis from the surgery or previous radiotherapy could affect the neck extension for proper positioning of the trocar. Similarly, it is difficult to insert the prosthesis if there is stenosis at the pharyngoesophageal segment. We describe a technique in which creation of secondary TEP and insertion of Provox2 is done with local anaesthesia under the same setting. The procedure is well tolerated and can be safely performed on an out-patient basis.published_or_final_versio

Differential expression, localization and activity of two alternatively spliced isoforms of human APC regulator CDH1

The timely destruction of key regulators through ubiquitin-mediated proteolysis ensures the orderly progression of the cell cycle. The APC (anaphase-promoting complex) is a major component of this degradation machinery and its activation is required for the execution of critical events. Recent studies have just begun to reveal the complex control of the APC through a regulatory network involving WD40 repeat proteins CDC20 and CDH1. In the present paper, we report on the identification and characterization of human CDH1β, a novel alternatively spliced isoform of CDH1. Both CDH1α and CDH1β can bind to the APC and stimulate the degradation of cyclin B1, but they are differentially expressed in human tissues and cells. CDH1α contains a nuclear localization signal which is absent in CDH1β. Intracellularly, CDH1α appears in the nucleus whereas CDH1β is a predominantly cytoplasmic protein. The forced overexpression of CDH1α in cultured cells correlates with the reduction of nuclear cyclin A, but the steady-state amount of cyclin A does not change noticeably in CDH1β-overexpressed cells. In Xenopus embryos, ectopic overexpression of human CDH1α, but not of CDH1β, induces cell-cycle arrest during the first G1 phase at the midblastula transition. Taken together, our findings document the differential expression, subcellular localization and cell-cycle-regulatory activity of human CDH1 isoforms.postprin

Microvascular free tissue reconstruction following extirpation of head and neck tumour: Experience towards an optimal outcome

Familiarity with four types of free tissues transfers allows appropriate reconstruction of most defects in the head and neck region functionally and aesthetically. These include jejunal graft, radial forearm, rectus abdominus myocutaneous and fibula osteocutaneous flaps. Free colonic and gastric patches were used occasionally. We report our experience of 215 free tissue transfers for reconstruction of defects in the head and neck region after tumour extirpation. The overall success rate was 94 per cent. The commonest cause of failure was related to arterial inflow (70 per cent). Three patients died in hospital, but their mortality was not related to the tissue transfers. Complications due to free tissue transfer at both the donor and recipient sites were few and manageable. The co-operation between the two surgical teams, together with the timely application of suitable salvage procedures, contribute to an optimal outcome.published_or_final_versio

Using jasmonates and salicylates to reduce losses within the fruit supply chain

The fresh produce industry is constantly growing, due to increasing consumer demand. The shelf-life of some fruit, however, is relatively short, limited by microbial contamination or visual, textural and nutritional quality loss. Thus, techniques for reducing undesired microbial contamination, spoilage and decay, as well as maintaining product’s visual, textural and nutritional quality are in high demand at all steps within the supply chain. The postharvest use of signalling molecules, i.e. jasmonates and salicylates seems to have unexplored potential. The focus of this review is on the effects of treatment with jasmonates and salicylates on the fresh produce quality, defined by decay incidence and severity, chilling injury, maintenance of texture, visual quality, taste and aroma, and nutritional content. Postharvest treatments with jasmonates and salicylates have the ability to reduce decay by increasing fruit resistance to diseases and reducing chilling injury in numerous products. These treatments also possess the ability to improve other quality characteristics, i.e. appearance, texture maintenance and nutritional content. Furthermore, they can easily be combined with other treatments, e.g. heat treatment, ultrasound treatment. A good understanding of all the benefits and limitations related to the postharvest use of jasmonates and salicylates is needed, and relevant information has been reviewed in this paper

Current and prospective pharmacological targets in relation to antimigraine action

Migraine is a recurrent incapacitating neurovascular disorder characterized by unilateral and throbbing headaches associated with photophobia, phonophobia, nausea, and vomiting. Current specific drugs used in the acute treatment of migraine interact with vascular receptors, a fact that has raised concerns about their cardiovascular safety. In the past, α-adrenoceptor agonists (ergotamine, dihydroergotamine, isometheptene) were used. The last two decades have witnessed the advent of 5-HT1B/1D receptor agonists (sumatriptan and second-generation triptans), which have a well-established efficacy in the acute treatment of migraine. Moreover, current prophylactic treatments of migraine include 5-HT2 receptor antagonists, Ca2+ channel blockers, and β-adrenoceptor antagonists. Despite the progress in migraine research and in view of its complex etiology, this disease still remains underdiagnosed, and available therapies are underused. In this review, we have discussed pharmacological targets in migraine, with special emphasis on compounds acting on 5-HT (5-HT1-7), adrenergic (α1, α2, and β), calcitonin gene-related peptide (CGRP 1 and CGRP2), adenosine (A1, A2, and A3), glutamate (NMDA, AMPA, kainate, and metabotropic), dopamine, endothelin, and female hormone (estrogen and progesterone) receptors. In addition, we have considered some other targets, including gamma-aminobutyric acid, angiotensin, bradykinin, histamine, and ionotropic receptors, in relation to antimigraine therapy. Finally, the cardiovascular safety of current and prospective antimigraine therapies is touched upon

Stress transfer and deformation mechanisms around a diaphragm wall panel

Practicing engineers and researchers are becoming aware of the importance of ground movements and stress changes in the ground that may occur during the construction of a diaphragm wall type of retaining walls. In this paper, the construction sequence of a typical diaphragm wall panel in stiff clay is fully simulated using a three-dimensional finite difference program. Computed results are compared with some reported results of centrifuge model tests and relevant case histories. It has been found that the influence zone due to the diaphragm wall panel installation falls within a normal distance of approximately one panel depth, D, from the face of the panel, 1/3D below from the toe and 1/3L from the edge and along the length of the panel (L). Significant horizontal stress reduction behind the center of the panel is attributed to both the downward load transfer and the horizontal arching mechanisms. A settlement bowl appears behind the panel. The maximum settlement occurs at a distance of about 0.2D behind the wall and settlements beyond the influence zone are found to be insignificant

Broken needles

A 35-year-old male intravenous drug user was admitted for left groin swelling and fever. On examination, we found a football-sized abscess in his left groin and pitting oedema of the whole left lower limb. A radiograph showed many retained broken needles (figure). CT showed that some needles were in the rectus femoris, and some were pointing towards the skin surface. The patient had a deep vein thrombosis, his left femoral artery was patent and there was no pseudoaneurysm. Broken needles in intravenous drug users are not uncommon

Three-dimensional modelling of a diaphragm wall construction sequence

A three-dimensional back-analysis of the construction sequence of three diaphragm wall panels was conducted using the finite difference method. The presence of two stress transfer mechanisms, namely, the horizontal arching and downward load transfer mechanisms during diaphragm wall installation, was confirmed. These two mechanisms act simultaneously and result in an average reduction of horizontal stress directly behind the wall above the toe but an increase of horizontal stress in neighboring soil beyond the wall in the longitudinal direction and below the toe of the wall. The calculated horizontal stress increase beneath the toe by the present analysis is noticeably smaller than the value computed by the pseudo three dimensional analysis.link_to_subscribed_fulltex

Quality of life of patients with recurrent nasopharyngeal carcinoma treated with nasopharyngectomy using the maxillary swing approach

Objective: To investigate factors affecting the quality of life (QOL) of patients with recurrent nasopharyngeal carcinoma who underwent a nasopharyngectomy using the maxillary swing approach. Design: Cross-sectional study using self-administered questionnaire data and medical chart review. Setting: Tertiary cancer referral center. Patients: Patients with recurrent nasopharyngeal carcinoma who underwent a nasopharyngectomy using the maxillary swing approach between January 1998 and December 2003, had a minimal follow-up of 3 months, and completed the questionnaire. Interventions: We measured QOL using the validated traditional Chinese version of the European Organization for Research and Treatment of Cancer core questionnaire and head and neck module. Main Outcome Measures: Descriptive analysis of the results and comparison of scores for each QOL domain, stratified by presence of postoperative trismus, presence of postoperative palatal fistula, sex, age (≤45 years and >45 years), duration of treatment (≤1 year and >1 year), and disease status at follow-up, were performed using nonparametric tests. Results: Of the 50 eligible patients, 41 (32 men and 9 women; mean [SD] age, 51.5 [10.4] years) participated in the study. The mean±SD global QOL scale score of the participants was 68.7±24.2. Social functioning score was the lowest (64.6±25.9) of the 5 functioning scales. Fatigue and financial difficulties were the most common general concerns. Dryness of mouth, sticky saliva, and limited mouth opening were the most common head and neck problems. Women were found to have significantly lower QOL scores in the fatigue (P=.03), diarrhea (P=.03), and emotional functioning (P=.05) domains than men. The presence of severe trismus after the maxillary swing approach was significantly associated with a low QOL score in the mouth opening (P=.001), sticky saliva (P=.006), mouth dryness (P=.02), and social eating (P=.05) domains. However, the presence of palatal fistula, age, duration of treatment, and disease status at follow-up did not result in any significant differences on the QOL scores. Conclusions: The QOL of patients treated with nasopharyngectomy using the maxillary swing approach to treat recurrent nasopharyngeal carcinoma was good. Female sex and the presence of postoperative trismus were factors significantly related to some of the QOL domain differences after surgery. ©2006 American Medical Association. All rights reserved.link_to_subscribed_fulltex

Stress transfer and deformation mechanisms around a diaphragm wall panel

Practicing engineers and researchers are becoming aware of the importance of ground movements and stress changes int the ground that may occur during the construction of a diaphragm wall type of retaining walls. In this paper, the construction sequence of a typical diaphragm wall panel in stiff clay is fully simulated using a three-dimensional finite difference program. Computed results are compared with some reported results of centrifuge model tests and relevant case histories. It has been found that the influence zone due to the diaphragm wall panel installation falls within a normal distance of approximately one panel depth, D, from the face of the panel, 1/3D below from the toe and 1/3L from the edge and along the length of the panel (L). Significant horizontal stress reduction behind the center of the panel is attributed to both the downward load transfer and the horizontal arching mechanisms. A settlement bowl appears behind the panel. The maximum settlement occurs at a distance of about 0.2D behind the wall and settlements beyond the influence zone are found to be insignificant. | Practicing engineers and researchers are becoming aware of the importance of ground movements and stress changes in the ground that may occur during the construction of a diaphragm wall type of retaining walls. In this paper, the construction sequence of a typical diaphragm wall panel in stiff clay is fully simulated using a three-dimensional finite difference program. Computed results are compared with some reported results of centrifuge model tests and relevant case histories. It has been found that the influence zone due to the diaphragm wall panel installation falls within a normal distance of approximately one panel depth, D, from the face of the panel, 1/3D below from the toe and 1/3L from the edge and along the length of the panel (L). Significant horizontal stress reduction behind the center of the panel is attributed to both the downward load transfer and the horizontal arching mechanisms. A settlement bowl appears behind the panel. The maximum settlement occurs at a distance of about 0.2/D behind the wall and settlements beyond the influence zone are found to be insignificant.link_to_subscribed_fulltex