Do salivary bypass tubes lower the incidence of pharyngocutaneous fistula following total laryngectomy? A retrospective analysis of predictive factors using multivariate analysis

Salivary bypass tubes (SBT) are increasingly used to prevent pharyngocutaneous fistula (PCF) following laryngectomy and pharyngolaryngectomy. There is minimal evidence as to their efficacy and literature is limited. The aim of the study was to determine if SBT prevent PCF. The study was a multicentre retrospective case control series (level of evidence 3b). Patients who underwent laryngectomy or pharyngolaryngectomy for cancer or following cancer treatment between 2011 and 2014 were included in the study. The primary outcome was development of a PCF. Other variables recorded were age, sex, prior radiotherapy or chemoradiotherapy, prior tracheostomy, type of procedure, concurrent neck dissection, use of flap reconstruction, use of prophylactic antibiotics, the suture material used for the anastomosis, tumour T stage, histological margins, day one post-operative haemoglobin and whether a salivary bypass tube was used. Univariate and multivariate analysis were performed. A total of 199 patients were included and 24 received salivary bypass tubes. Fistula rates were 8.3% in the SBT group (2/24) and 24.6% in the control group (43/175). This was not statistically significant on univariate (p value 0.115) or multivariate analysis (p value 0.076). In addition, no other co-variables were found to be significant. No group has proven a benefit of salivary bypass tubes on multivariate analysis. The study was limited by a small case group, variations in tube duration and subjects given a tube may have been identified as high risk of fistula. Further prospective studies are warranted prior to recommendation of salivary bypass tubes following laryngectomy

Measurement of proton, deuteron, triton, and alpha particle emission after nuclear muon capture on Al, Si, and Ti with the AlCap experiment

Background: Heavy charged particles after nuclear muon capture are an important nuclear physics background to the muon-to-electron conversion experiments Mu2e and COMET, which will search for charged lepton flavor violation at an unprecedented level of sensitivity. Purpose: The AlCap experiment aimed to measure the yield and energy spectra of protons, deuterons, tritons, and α particles emitted after the nuclear capture of muons stopped in Al, Si, and Ti in the low-energy range relevant for the muon-to-electron conversion experiments. Methods: Individual charged particle types were identified in layered silicon detector packages and their initial energy distributions were unfolded from the observed energy spectra. Results: The proton yields per muon capture were determined as Y p ( Al ) = 26.64 ( 28 stat. ) ( 77 syst. ) × 10 − 3 and Y p ( Ti ) = 26.48 ( 35 ) ( 80 ) × 10 − 3 in the energy range 3.5–20.0 MeV, and as Y p ( Si ) = 52.5 ( 6 ) ( 18 ) × 10 − 3 in the energy range 4.0–20.0 MeV. Detailed information on yields and energy spectra for all observed nuclei are presented in the paper. Conclusions: The yields in the candidate muon stopping targets, Al and Ti, are approximately half of that in Si, which was used in the past to estimate this background. The reduced background allows for less shielding and a better energy resolution in these experiments. It is anticipated that the comprehensive information presented in this paper will stimulate modern theoretical calculations of the rare process of muon capture with charged particle emission and inform the design of future muon-to-electron conversion experiments

The promise and perils of regulating ipso facto clauses

It is common for contracts to include a clause that provides that on an event of default the counterparty has an unconditional right to terminate the contract or accelerate payment (an ipso facto clause). The regulation of ipso facto clauses has become a topic of debate in recent years with a number of jurisdictions introducing constraints on such clauses as part of broader restructuring reform packages. These jurisdictions include Germany in 2021 (as part of its implementation of the EU Restructuring Directive) and the United Kingdom in 2020. For jurisdictions introducing such constraints for the first time, there is much to learn from those, such as Canada, that have had constraints on ipso facto clauses in place for much longer. This article examines the experience in Canada alongside the constraints introduced in the United Kingdom, the EU Restructuring Directive and Germany, and identifies a series of steps that policymakers should follow when revising a regime on ipso facto clauses. Although there are a number of common themes that emerge, it is clear that different jurisdictions often make quite distinct policy choices regarding the rationale for any constraints on ipso facto clauses as well as on the specific nature and scope of the provisions. Different jurisdictions find different points of balance between the interests of individual creditors in upholding their freedom of contract and the rights of the debtor and creditors as a whole in preserving the business as a going concern. The range of choices is not per se problematic as long as they are implemented with clarity and transparency, so that debtors and creditors can bargain ex ante in the light of any legislative provisions