Interventions for the treatment of oral and oropharyngeal cancers: surgical treatment.

BACKGROUND: Surgery is an important part of the management of oral cavity cancer with regard to both the removal of the primary tumour and removal of lymph nodes in the neck. Surgery is less frequently used in oropharyngeal cancer. Surgery alone may be treatment for early stage disease or surgery may be used in combination with radiotherapy, chemotherapy and immunotherapy/biotherapy. There is variation in the recommended timing and extent of surgery in the overall treatment regimens of people with these cancers. OBJECTIVES: To determine which surgical treatment modalities for oral cavity and oropharyngeal cancers result in increased overall survival, disease free survival, progression free survival and reduced recurrence. SEARCH STRATEGY: The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 17 February 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1), MEDLINE via OVID (1950 to 17 February 2011) and EMBASE via OVID (1980 to 17 February 2011). There were no restrictions regarding language or date of publication. SELECTION CRITERIA: Randomised controlled trials where more than 50% of participants had primary tumours of the oral cavity or oropharynx, and which compared two or more surgical treatment modalities or surgery versus other treatment modalities. DATA COLLECTION AND ANALYSIS: Data extraction and assessment of risk of bias was undertaken independently by two or more review authors. Study authors were contacted for additional information as required. Adverse events data were collected from published trials. MAIN RESULTS: Seven trials (n = 669; 667 with cancers of the oral cavity) satisfied the inclusion criteria, but none were assessed as low risk of bias. Trials were grouped into three main comparisons. Four trials compared elective neck dissection (ND) with therapeutic neck dissection in patients with oral cavity cancer and clinically negative neck nodes, but differences in type of surgery and duration of follow-up made meta-analysis inappropriate. Three of these trials reported overall and disease free survival. One trial showed a benefit for elective supraomohyoid neck dissection compared to therapeutic ND in overall and disease free survival. Two trials found no difference between elective radical ND and therapeutic ND for the outcomes of overall survival and disease free survival. All four trials found reduced locoregional recurrence following elective ND.A further two trials compared elective radical ND with elective selective ND and found no difference in overall survival, disease free survival or recurrence. The final trial compared surgery plus radiotherapy to radiotherapy alone but data were unreliable because the trial stopped early and there were multiple protocol violations.None of the trials reported quality of life as an outcome. Two trials, evaluating different comparisons reported adverse effects of treatment. AUTHORS' CONCLUSIONS: Seven included trials evaluated neck dissection surgery in patients with oral cavity cancers. The review found weak evidence that elective neck dissection of clinically negative neck nodes at the time of removal of the primary tumour results in reduced locoregional recurrence, but there is insufficient evidence to conclude that elective neck dissection increases overall survival or disease free survival compared to therapeutic neck dissection. There is very weak evidence from one trial that elective supraomohyoid neck dissection may be associated with increased overall and disease free survival. There is no evidence that radical neck dissection increases overall survival compared to conservative neck dissection surgery. Reporting of adverse events in all trials was poor and it was not possible to compare the quality of life of patients undergoing different surgeries

MECHANISM OF RECOVERY FROM SYSTEMIC VACCINIA VIRUS INFECTION : I. THE EFFECTS OF CYCLOPHOSPHAMIDE

Administration of Cytoxan in doses capable of inhibiting both humoral and cellular immunity markedly potentiated primary systemic vaccinia virus infection in mice. Immunosuppressed mice did not form neutralizing antibody to vaccinia virus and had a prolonged and more severe viremia than nonimmunosuppressed control mice. Passive transfer of physiologic amounts of neutralizing antibody late in the course of infection, at a time when nonimmunosuppressed mice had similar levels of serum antibody, largely reversed the effect of Cytoxan on vaccinia virus infection. Transfer of 100 million immune spleen cells was much less effective than antibody in reversing the effect of Cytoxan on vaccinia virus infection, and mice receiving these cells did make some antibody. Serum interferon levels were not affected by Cytoxan. The results suggest an essential role for humoral antibody, but not for cellular immunity, in recovery from primary vaccinia virus infection in the mouse

Liquid drop splashing on smooth, rough and textured surfaces

Splashing occurs when a liquid drop hits a dry solid surface at high velocity. This paper reports experimental studies of how the splash depends on the roughness and the texture of the surfaces as well as the viscosity of the liquid. For smooth surfaces, there is a "corona" splash caused by the presence of air surrounding the drop. There are several regimes that occur as the velocity and liquid viscosity are varied. There is also a "prompt" splash that depends on the roughness and texture of the surfaces. A measurement of the size distribution of the ejected droplets is sensitive to the surface roughness. For a textured surface in which pillars are arranged in a square lattice, experiment shows that the splashing has a four-fold symmetry. The splash occurs predominantly along the diagonal directions. In this geometry, two factors affect splashing the most: the pillar height and spacing between pillars.Comment: 9 pages, 11 figure

Pasts and pagan practices: moving beyond Stonehenge

Theorizing the past is not restricted to archaeology and interpretations of 'past' both influence and are themselves constituted within politicized understandings of self, community and in certain instances, spirituality. 'The past in the imagination of the present' is appropriated, variously, to give meaning to the present or to justify actions and interpret experiences. Summer solstice at Stonehenge, with an estimated 21,000 celebrants in 2005, is only the most publicized appropriation (by pagans and other adherents of alternative spirituality and partying) of a 'sacred site'; and conflicts and negotiations occurring throughout Britain are represented in popular and academic presentations of this 'icon of Britishness'. This paper presents work from the Sacred Sites, Contested Rites/Rights Project (http://www.sacredsites.org.uk) project, a collaboration of archaeology and anthropology informed by pagan and alternative approaches and standpoints investigating and theorizing discourse and practice of heritage management and pagan site users. Whether in negotiations around the Stonehenge solstice access or in dealing with numerous other sites, boundaries between groups or discourses are not clearly drawn - discursive communities merge and re-emerge. But clearly 'past' and 'site' are increasingly important within today's Britain, even as television archaeology increases its following, and pagan numbers continue to grow.</p

Spall And Dynamic Yielding Of Aluminum And Aluminum Alloys At Strain Rates Of 3X10(6) S(-1)

We have explored the role that grain size, impurity particles and alloying in aluminum play in dynamic yielding and spall fracture at tensile strain rates of similar to 3x10(6) We achieved these strain rates shocking the aluminum specimens via laser ablation using the Z-Beamlet Laser at Sandia National Laboratories. The high purity aluminum and 1100 series aluminum alloy produced very different spall strengths and nearly the same yield strengths. In contrast, various grain-sized Al + 3 wt. % Mg specimens presented the lowest spall strength, but the greatest dynamic yield strength. Fracture morphology results and particle analysis are presented along with hydrodynamic simulations to put these results in context. Impurity particles appeared to play a vital role in spall fracture at these fast strain rates. Alloying elements such as Mg seem to be the dominant factor in the dynamic yield results.Mechanical Engineerin

Dynamics of grain ejection by sphere impact on a granular bed

The dynamics of grain ejection consecutive to a sphere impacting a granular material is investigated experimentally and the variations of the characteristics of grain ejection with the control parameters are quantitatively studied. The time evolution of the corona formed by the ejected grains is reported, mainly in terms of its diameter and height, and favourably compared with a simple ballistic model. A key characteristic of the granular corona is that the angle formed by its edge with the horizontal granular surface remains constant during the ejection process, which again can be reproduced by the ballistic model. The number and the kinetic energy of the ejected grains is evaluated and allows for the calculation of an effective restitution coefficient characterizing the complex collision process between the impacting sphere and the fine granular target. The effective restitution coefficient is found to be constant when varying the control parameters.Comment: 9 page

THE EFFECT OF INDIVIDUALISED COACHING INTERVENTIONS ON ELITE YOUNG FAST BOWLERS‘ TECHNIQUE

Fast bowling in cricket is an activity well recognised as having a high injury prevalence. Previous research has associated lower back injury with aspects of fast bowling technique. Coaching interventions that may decrease the likelihood of injury, whilst maintaining or increasing ball speed, remain a priority within the sport. Selected kinematics of the bowling action of 14 elite young fast bowlers were measured using an 18 camera Vicon Motion Analysis System. Subjects were tested before and after a two year coaching intervention period, during which subject-specific coaching interventions were provided. Mann-Whitney tests were used to identify significant differences in the change in the selected kinematics between those bowlers who were coached or un-coached on each specific aspect. Coached athletes demonstrated a significant change in shoulder alignment at back foot contact (more side-on, P = 0.002) and shoulder counter-rotation (decreased, P = 0.001) relative to un-coached athletes. There was no difference in the amount of change in flexion angles of the front or back knee or lower trunk side-flexion between those who received coaching intervention and those that did not. This study shows that specific aspects of fast bowling technique in elite players can change over a two year period and may be attributed to coaching intervention

Large droplet impact on water layers

The impact of large droplets onto an otherwise undisturbed layer of water is considered. The work, which is motivated primarily with regard to aircraft icing, is to try and help understand the role of splashing on the formation of ice on a wing, in particular for large droplets where splash appears, to have a significant effect. Analytical and numerical approaches are used to investigate a single droplet impact onto a water layer. The flow for small times after impact is determined analytically, for both direct and oblique impacts. The impact is also examined numerically using the volume of fluid (VOF) method. At small times there are promising comparisons between the numerical results, the analytical solution and experimental work capturing the ejector sheet. At larger times there is qualitative agreement with experiments and related simulations. Various cases are considered, varying the droplet size to layer depth ratio, including surface roughness, droplet distortion and air effects. The amount of fluid splashed by such an impact is examined and is found to increase with droplet size and to be significantly influenced by surface roughness. The makeup of the splash is also considered, tracking the incoming fluid, and the splash is found to consist mostly of fluid originating in the layer

Splash control of drop impacts with geometric targets

Drop impacts on solid and liquid surfaces exhibit complex dynamics due to the competition of inertial, viscous, and capillary forces. After impact, a liquid lamella develops and expands radially, and under certain conditions, the outer rim breaks up into an irregular arrangement of filaments and secondary droplets. We show experimentally that the lamella expansion and subsequent break up of the outer rim can be controlled by length scales that are of comparable dimension to the impacting drop diameter. Under identical impact parameters, ie. fluid properties and impact velocity, we observe unique splashing dynamics by varying the target cross-sectional geometry. These behaviors include: (i) geometrically-shaped lamellae and (ii) a transition in splashing stability, from regular to irregular splashing. We propose that regular splashes are controlled by the azimuthal perturbations imposed by the target cross-sectional geometry and that irregular splashes are governed by the fastest-growing unstable Plateau-Rayleigh mode