Early experience of a nurse-led clinic in a tertiary centre

A busy head and neck or oral and maxillofacial (OMFS) National Health Service (NHS) clinic treats patients with many different conditions. A large proportion will have cancer of the head and neck, and they will be at different stages of their treatment. Their clinical needs may be different from a larger group of patients who have been referred through the “two-week wait” referral pathway, and who are present in the same clinic for their biopsy results. We present our early experience of “fast-track” referrals and their potential effect on the overall volume of work. They are only a small number of the patients who are typically seen in a nurse-led clinic

High Energy Neutrino Astronomy: Towards Kilometer-Scale Detectors

Of all high-energy particles, only neutrinos can directly convey astronomical information from the edge of the universe---and from deep inside the most cataclysmic high-energy processes. Copiously produced in high-energy collisions, travelling at the velocity of light, and not deflected by magnetic fields, neutrinos meet the basic requirements for astronomy. Their unique advantage arises from a fundamental property: they are affected only by the weakest of nature's forces (but for gravity) and are therefore essentially unabsorbed as they travel cosmological distances between their origin and us. Many of the outstanding mysteries of astrophysics may be hidden from our sight at all wavelengths of the electromagnetic spectrum because of absorption by matter and radiation between us and the source. For example, the hot dense regions that form the central engines of stars and galaxies are opaque to photons. In other cases, such as supernova remnants, gamma ray bursters, and active galaxies, all of which may involve compact objects or black holes at their cores, the precise origin of the high-energy photons emerging from their surface regions is uncertain. Therefore, data obtained through a variety of observational windows---and especially through direct observations with neutrinos---may be of cardinal importance. In this talk, the scientific goals of high energy neutrino astronomy and the technical aspects of water and ice Cherenkov detectors are examined, and future experimental possibilities, including a kilometer-square deep ice neutrino telescope, are explored.Comment: 13 pages, Latex, 6 postscript figures, uses aipproc.sty and epsf.sty. Talk presented at the International Symposium on High Energy Gamma Ray Astronomy, Heidelberg, June 200

A novel selection of optimal statistical features in the DWPT domain for discrimination of ictal and seizure-free electroencephalography signals

Properly determining the discriminative features which characterize the inherent behaviors of electroencephalography (EEG) signals remains a great challenge for epileptic seizure detection. In this present study, a novel feature selection scheme based on the discrete wavelet packet decomposition and cuckoo search algorithm (CSA) was proposed. The normal as well as epileptic EEG recordings were frst decomposed into various frequency bands by means of wavelet packet decomposition, and subsequently, statistical features at all developed nodes in the wavelet packet decomposition tree were derived. Instead of using the complete set of the extracted features to construct a wavelet neural networks-based classifer, an optimal feature subset that maximizes the predictive competence of the classifer was selected by using the CSA. Experimental results on the publicly available benchmarks demonstrated that the proposed feature subset selection scheme achieved promising recognition accuracies of 98.43–100%, and the results were statistically signifcant using z-test with p value <0.0001

Proteomic Analysis of Neisseria gonorrhoeae Biofilms Shows Shift to Anaerobic Respiration and Changes in Nutrient Transport and Outermembrane Proteins

Neisseria gonorrhoeae, the causative agent of gonorrhea, can form biofilms in vitro and in vivo. In biofilms, the organism is more resistant to antibiotic treatment and can serve as a reservoir for chronic infection. We have used stable isotope labeling by amino acids in cell culture (SILAC) to compare protein expression in biofilm and planktonic organisms. Two parallel populations of N. gonorrhoeae strain 1291, which is an arginine auxotroph, were grown for 48 h in continuous-flow chambers over glass, one supplemented with 13C6-arginine for planktonic organisms and the other with unlabeled arginine for biofilm growth. The biofilm and planktonic cells were harvested and lysed separately, and fractionated into three sequential protein extracts. Corresponding heavy (H) planktonic and light (L) biofilm protein extracts were mixed and separated by 1D SDS-PAGE gels, and samples were extensively analyzed by liquid chromatography-mass spectrometry. Overall, 757 proteins were identified, and 152 unique proteins met a 1.5-fold cutoff threshold for differential expression with p-values <0.05. Comparing biofilm to planktonic organisms, this set included 73 upregulated and 54 downregulated proteins. Nearly a third of the upregulated proteins were involved in energy metabolism, with cell envelope proteins making up the next largest group. Of the downregulated proteins, the largest groups were involved in protein synthesis and energy metabolism. These proteomics results were compared with our previously reported results from transcriptional profiling of gonococcal biofilms using microarrays. Nitrite reductase and cytochrome c peroxidase, key enzymes required for anaerobic growth, were detected as highly upregulated in both the proteomic and transcriptomic datasets. These and other protein expression changes observed in the present study were consistent with a shift to anaerobic respiration in gonococcal biofilms, although changes in membrane proteins not explicitly related to this shift may have other functions

Metagenomics reveals a core macrolide resistome related to microbiota in chronic respiratory disease

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this recordRationale: Long-term antibiotic use for managing chronic respiratory disease is increasing however the role of the airway resistome and its relationship to host microbiomes remains unknown Objective: To evaluate airway resistomes, and, relate them to host and environmental microbiomes using ultra-deep metagenomic shotgun sequencing Methods: Airway specimens from n=85 individuals with and without chronic respiratory disease (severe asthma, COPD and bronchiectasis) were subjected to metagenomic sequencing to an average depth exceeding twenty million reads. Respiratory and device-associated microbiomes were evaluated based on taxonomical classification and functional annotation including the Comprehensive Antibiotic Resistance Database (CARD) to determine airway resistomes. Co-occurrence networks of gene-microbe association were constructed to determine potential microbial sources of the airway resistome. Paired patient-inhaler metagenomes were compared (n=31) to assess for the presence of airway-environment overlap in microbiomes and/or resistomes. Results: Airway metagenomes exhibit taxonomic and metabolic diversity and distinct antimicrobial resistance patterns. A ‘core’ airway resistome dominated by macrolide but with high prevalence of β-lactam, fluoroquinolone and tetracycline resistance genes exist, and, is independent of disease status or antibiotic exposure. Streptococcus and Actinomyces are key potential microbial reservoirs of macrolide resistance including the ermX, ermF and msrD genes. Significant patient-inhaler overlap in airway microbiomes and their resistomes is identified where the latter may be a proxy for airway microbiome assessment in chronic respiratory disease. Conclusion: Metag

Tuberculosis associated with Mycobacterium tuberculosis Beijing and non-Beijing genotypes: a clinical and immunological comparison

BACKGROUND: The Mycobacterium tuberculosis Beijing genotype is biologically different from other genotypes. We aimed to clinically and immunologically compare human tuberculosis caused by Beijing and non-Beijing strains. METHODS: Pulmonary tuberculosis patients were prospectively enrolled and grouped by their M. tuberculosis genotypes. The clinical features, plasma cytokine levels, and cytokine gene expression levels in peripheral blood mononuclear cells (PBMC) were compared between the patients in Beijing and non-Beijing groups. RESULTS: Patients in the Beijing group were characterized by significantly lower frequency of fever (odds ratio, 0.12, p = 0.008) and pulmonary cavitation (odds ratio, 0.2, p = 0.049). Night sweats were also significantly less frequent by univariate analysis, and the duration of cough prior to diagnosis was longer in Beijing compared to non-Beijing groups (medians, 60 versus 30 days, p = 0.048). The plasma and gene expression levels of interferon (IFN) γ and interleukin (IL)-18 were similar in the two groups. However, patients in the non-Beijing group had significantly increased IL-4 gene expression (p = 0.018) and lower IFN-γ : IL-4 cDNA copy number ratios (p = 0.01). CONCLUSION: Patients with tuberculosis caused by Beijing strains appear to be less symptomatic than those who have disease caused by other strains. Th1 immune responses are similar in patients infected with Beijing and non-Beijing strains, but non-Beijing strains activate more Th2 immune responses compared with Beijing strains, as evidenced by increased IL-4 expression

Flacourtia rukam: biochemistry, functions and utilization

Flacourtia rukam is a species of the Flacourtiaceae. The edible, cherry-like, sweet and sour fruits of the species are not known to be commercially exploited. Phenolic compounds and flavonoids are the main constituents of the fruits, which have also been reported to have good antioxidant properties. However, the available information on the phytochemical and pharmacological aspects of F. rukam indicated it to be very much an underutilized tropical fruit tree. Nevertheless, based on the ethnomedicinal uses of the fruits and other parts of the plant, its economic potential as a health giving food crop should be further investigated and properly evaluated

Dynamic phenotypic heterogeneity and the evolution of multiple RNA subtypes in Hepatocellular Carcinoma: the PLANET study

Intra-tumor heterogeneity (ITH) is a key challenge in cancer treatment, but previous studies have focused mainly on the genomic alterations without exploring phenotypic (transcriptomic and immune) heterogeneity. Using one of the largest prospective surgical cohorts for Hepatocellular Carcinoma (HCC) with multi-region sampling, we sequenced whole genomes and paired transcriptomes from 67 HCC patients (331 samples). We found that while genomic ITH was rather constant across TNM stages, phenotypic ITH had a very different trajectory and quickly diversified in stage II patients. Most strikingly, 30% patients were found to contain more than one transcriptomic subtype within a single tumor. Such phenotypic ITH was found to be much more informative in predicting patient survival than genomic ITH and explains the poor efficacy of single-target systemic therapies in HCC. Taken together, we not only revealed an unprecedentedly dynamic landscape of phenotypic heterogeneity in HCC, but also highlighted the importance of studying phenotypic evolution across cancer types