Canal wall up tympanoplasty for middle ear cholesteatoma in adults: Modeling cartilage

SummaryObjectivesThe authors report their experience with a variant cartilage tympanoplasty technique in a canal wall up (CWU) procedure for middle ear cholesteatoma, comparing reliability with other techniques. Functional results are analyzed according to ossicular chain status.Materials and methodsA retrospective study was performed in adults operated on with CWU tympanoplasty for middle ear cholesteatoma. The surgical technique of “modeling” cartilage is described.ResultsOne hundred and nine patients were included (113 procedures). There were four recurrences (3.5%). Mean follow-up was 48 months (range, 24–96 months). In case of normal ossicular chain, postoperative pure-tone average air-bone gap was always less than 20dB, and less than 20dB following myringostapedopexy in 60% of cases with incus destruction.ConclusionModeling cartilage is a reliable reconstruction technique to prevent recurrent cholesteatoma, and contributes to the quality of functional results in ossiculoplasty

Thyroid gland invasion in laryngopharyngeal squamous cell carcinoma: Prevalence, endoscopic and CT predictors

SummaryObjectivesThe authors studied the prevalence of histological thyroid gland invasion in laryngopharyngeal cancer and the preoperative endoscopic and CT signs predictive of this invasion.Patients and methodsRetrospective study of patients with laryngopharyngeal squamous cell carcinoma (T3 and T4) treated by total laryngectomy or total laryngopharyngectomy associated with concomitant total thyroidectomy or ipsilateral lobectomy and isthmectomy.ResultsEighty-seven patients were included. Eleven patients (12.6%) presented thyroid gland invasion. Subglottic tumour extension greater than or equal to 10mm (P=0.008) and cricoid cartilage destruction on CT (P=0.001) were statistically correlated with histological thyroid gland invasion. An intact appearance of the laryngeal cartilages on CT was associated with a low probability of thyroid gland invasion.ConclusionThyroid gland invasion must not be underestimated in patients with advanced laryngopharyngeal cancer. Preoperative CT is an essential part of the preoperative work-up. Thyroidectomy must not be performed systematically

Pre-therapeutic histological and cytological assessment in head and neck squamous cell carcinomas. French Society of Otorhinolaryngology Guidelines – 2012

SummaryObjectivesThe authors present the French Society of Otorhinolaryngology (SFORL) guidelines for histopathologic assessment of head and neck cancer.Materiel and methodsA multidisciplinary workgroup set up by the SFORL performed an exhaustive review of the literature according to levels of evidence, following the 2000 guidelines of the French national health approvals and assessment agency (ANAES).ResultsComparison between histologic and clinical data is essential. In case of discrepancy between clinical, radiological and histological findings, reinterpretation or new biopsy may be required (professional consensus). Mere suspicion of carcinoma on fine-needle aspiration lymph-node biopsy only exceptionally warrants aggressive treatment (professional consensus). Exploration for HPV is not recommended as routine practice, being without therapeutic impact (professional consensus). Anti-p16 immunohistochemistry is optional, for epidemiological purposes (professional consensus). Tumor-bank tissue storage must conform strictly to prevailing legislation and good practice rules for sampling and preservation (professional consensus).ConclusionPathology assessment is mandatory in suspected H&N squamous cell carcinoma. The present guidelines are intended to optimize management

Content and Mechanism of Action of National Antimicrobial Stewardship Interventions on Management of Respiratory Tract Infections in Primary and Community Care

A major modifiable factor contributing to antimicrobial resistance (AMR) is inappropriate use and overuse of antimicrobials, such as antibiotics. This study aimed to describe the content and mechanism of action of antimicrobial stewardship (AMS) interventions to improve appropriate antibiotic use for respiratory tract infections (RTI) in primary and community care. This study also aimed to describe who these interventions were aimed at and the specific behaviors targeted for change. Evidence-based guidelines, peer-review publications, and infection experts were consulted to identify behaviors relevant to AMS for RTI in primary care and interventions to target these behaviors. Behavior change tools were used to describe the content of interventions. Theoretical frameworks were used to describe mechanisms of action. A total of 32 behaviors targeting six different groups were identified (patients; prescribers; community pharmacists; providers; commissioners; providers and commissioners). Thirty-nine interventions targeting the behaviors were identified (patients = 15, prescribers = 22, community pharmacy staff = 8, providers = 18, and commissioners = 18). Interventions targeted a mean of 5.8 behaviors (range 1–27). Influences on behavior most frequently targeted by interventions were psychological capability (knowledge and skills); reflective motivation (beliefs about consequences, intentions, social/professional role and identity); and physical opportunity (environmental context and resources). Interventions were most commonly characterized as achieving change by training, enabling, or educating and were delivered mainly through guidelines, service provision, and communications & marketing. Interventions included a mean of four Behavior Change Techniques (BCTs) (range 1–14). We identified little intervention content targeting automatic motivation and social opportunity influences on behavior. The majority of interventions focussed on education and training, which target knowledge and skills though the provision of instructions on how to perform a behavior and information about health consequences. Interventions could be refined with the inclusion of relevant BCTs, such as goal-setting and action planning (identified in only a few interventions), to translate instruction on how to perform a behavior into action. This study provides a platform to refine content and plan evaluation of antimicrobial stewardship interventions

Caractérisation et conservation de la diversité bactérienne d’un lait fermenté traditionnel breton, le Gwell en lien avec la préservation d’une race locale de vache, la Bretonne Pie Noir

Le Gwell est un lait fermenté traditionnel spécifique de la Bretagne. Il est obtenu à partir de lait de vaches de race Bretonne Pie Noir, inoculé avec une portion de la fabrication précédente (appelé ferment) sans aucun recours à des levains commerciaux. Les productions de Gwell partagent une texture ferme et onctueuse et un gout frais et acidulé, avec des caractéristiques organoleptiques propres à chaque producteur. Les producteurs sont malheureusement parfois confrontés à la perte de leur ferment et doivent alors avoir recours à la solidarité d’autres producteurs pour réacquérir un ferment opérationnel. Ces pertes de ferments sont un frein au développement de la production de Gwell et donc à la valorisation de lait issu de vaches Bretonne Pie Noir. Cette race emblématique de la Bretagne, caractérisée par une rusticité hors du commun et un lait très riche en matière grasse totalisait au milieu du 19ème siècle près de 900 000 têtes. La modernisation des pratiques agricoles alliée à une orientation productiviste forte a conduit à une quasi extinction de l’espèce, ce qui a conduit à initier en 1976 un programme de sauvegarde de l’espèce. Le nombre de vaches s’élève ainsi aujourd’hui à près de 2500 femelles. La transformation du lait en Gwell est, pour les éleveurs, un moyen de valoriser la qualité du lait de Bretonne Pie Noir en conservant sa valeur ajoutée. Les éleveurs qui transforment le lait en Gwell œuvrent ainsi à la sauvegarde de l’espèce Bretonne Pie Noir, mais aussi à la préservation de la diversité microbienne, du patrimoine et des savoir-faire paysans associés. La caractérisation de l’écosystème microbien du ferment Gwell, pour mieux maitriser sa conservation et sécuriser ainsi la production de Gwell, participe de ce fait au maintien de la race Bretonne Pie Noir. Dans ce contexte notre étude visait à caractériser l’écosystème microbien du Gwell pour sécuriser les souches à l’origine de la typicité du produit. Nous avons ainsi montré que toutes les productions de Gwell avaient une flore bactérienne dominante similaire, composée de deux sous-espèces de la bactérie lactique Lactococcus lactis (subsp. lactis et subsp. cremoris). En fonction des producteurs, le nombre de souches de chaque sous-espèce peut varier avec dans certain cas la présence de Streptococcus thermophilus. De plus, nous avons identifié et caractérisé des souches spécifiques à chaque producteur et montré une forte résilience de l’écosystème pouvant expliquer en partie les différences organoleptiques observées entre les Gwell de différents producteurs

Trapped in the prison of the mind: notions of climate-induced (im)mobility decision-making and wellbeing from an urban informal settlement in Bangladesh

The concept of Trapped Populations has until date mainly referred to people ‘trapped’ in environmentally high-risk rural areas due to economic constraints. This article attempts to widen our understanding of the concept by investigating climate-induced socio-psychological immobility and its link to Internally Displaced People’s (IDPs) wellbeing in a slum of Dhaka. People migrated here due to environmental changes back on Bhola Island and named the settlement Bhola Slum after their home. In this way, many found themselves ‘immobile’ after having been mobile—unable to move back home, and unable to move to other parts of Dhaka, Bangladesh, or beyond. The analysis incorporates the emotional and psychosocial aspects of the diverse immobility states. Mind and emotion are vital to better understand people’s (im)mobility decision-making and wellbeing status. The study applies an innovative and interdisciplinary methodological approach combining Q-methodology and discourse analysis (DA). This mixed-method illustrates a replicable approach to capture the complex state of climate-induced (im)mobility and its interlinkages to people’s wellbeing. People reported facing non-economic losses due to the move, such as identity, honour, sense of belonging and mental health. These psychosocial processes helped explain why some people ended up ‘trapped’ or immobile. The psychosocial constraints paralysed them mentally, as well as geographically. More empirical evidence on how climate change influences people’s wellbeing and mental health will be important to provide us with insights in how to best support vulnerable people having faced climatic impacts, and build more sustainable climate policy frameworks

A versatile method for simulating pp -> ppe+e- and dp -> pne+e-p_spec reactions

We have developed a versatile software package for the simulation of di-electron production in $pp$ and $dp$ collisions at SIS energies. Particular attention has been paid to incorporate different descriptions of the Dalitz decay $\Delta \to N e^+e^-$ via a common interface. In addition, suitable parameterizations for the virtual bremsstrahlung process $NN \to NN e^+e^-$ based on one-boson exchange models have been implemented. Such simulation tools with high flexibility of the framework are important for the interpretation of the di-electron data taken with the HADES spectrometer and the design of forthcoming experiments

An upper limit on hypertriton production in collisions of Ar(1.76 AGeV)+KCl

A high-statistic data sample of Ar(1.76 AGeV)+KCl events recorded with HADES is used to search for a hypertriton signal. An upper production limit per centrality-triggered event of $1.04$ x $10^{-3}$ on the $3\sigma$ level is derived. Comparing this value with the number of successfully reconstructed $\Lambda$ hyperons allows to determine an upper limit on the ratio $N_{_{\Lambda}^3H}/N_{\Lambda}$, which is confronted with statistical and coalescence-type model calculations

Production of Sigma{\pm}pi?pK+ in p+p reactions at 3.5 GeV beam energy

We study the production of Sigma^+-pi^+-pK^+ particle quartets in p+p reactions at 3.5 GeV kinetic beam energy. The data were taken with the HADES experiment at GSI. This report evaluates the contribution of resonances like Lambda(1405$, Sigma(1385)^0, Lambda(1520), Delta(1232), N^* and K^*0 to the Sigma^+- pi^-+ p K+ final state. The resulting simulation model is compared to the experimental data in several angular distributions and it shows itself as suitable to evaluate the acceptance corrections properly.Comment: 15 pages, 5 figure