Virus-Induced Cancers of the Skin and Mucosa:Are We Dealing with "Smoking Guns" or "Smoke and Mirrors" in the Operating Theatre?

Introduction: Human papillomavirus (HPV) alone is thought to cause ~610,000 cases of cancer per year, and is the dominant aetiological agent for ano-genital (esp. cervical) and head and neck cancers (esp. oropharyngeal). Merkel cell polyomavirus (MCV) is a more recently discovered virus which causes Merkel cell carcinoma, a rare but highly aggressive skin malignancy. Methods: We explored the available published evidence to see if transmission of live HPV or MCV virus in smoke generated by laser or diathermy was feasible, and would pose an infection risk. Long-term infection with such carcinogenic viruses would then pose an increased risk for the development of virus-induced cancers in medical personnel. Results: The morphological structures of both HPV and MCV are very similar, and the size, external capsids and genomic structures show striking similarity. Both viruses have a non-enveloped external protein capsid consisting of 72 capsomeres, and a double-stranded DNA core. Sizes of both viruses range from 50 to 60 nm. There are now recent data demonstrating live and infectious HPV in smoke, and that these viruses can be used to infect cells in vitro. Further, anecdotal reports of virus transmission leading to disease causation in the production of respiratory airway viral warts (benign disease), and, finally, reports of HPV-induced oropharyngeal carcinoma (malignant disease) in two gynaecological surgeons as an occupational health hazard have been published recently. Conclusion: There is now sufficient evidence to support the hypotheses that live infectious carcinogenic viruses can be transmitted via smoke generated from surgical procedures, and, in rare instances, actually cause significant disease. Protective measures such as smoke extraction and airway protection should be instituted for all healthcare personnel, particularly those with multiple repeated exposures such as gynaecological surgeons

Galileons as Wess-Zumino Terms

We show that the galileons can be thought of as Wess-Zumino terms for the spontaneous breaking of space-time symmetries. Wess-Zumino terms are terms which are not captured by the coset construction for phenomenological Lagrangians with broken symmetries. Rather they are, in d space-time dimensions, d-form potentials for (d+1)-forms which are non-trivial co-cycles in Lie algebra cohomology of the full symmetry group relative to the unbroken symmetry group. We introduce the galileon algebras and construct the non-trivial (d+1)-form co-cycles, showing that the presence of galileons and multi-galileons in all dimensions is counted by the dimensions of particular Lie algebra cohomology groups. We also discuss the DBI and conformal galileons from this point of view, showing that they are not Wess-Zumino terms, with one exception in each case.Comment: 49 pages. v2 minor changes, version appearing in JHE

Massive Gravity on de Sitter and Unique Candidate for Partially Massless Gravity

We derive the decoupling limit of Massive Gravity on de Sitter in an arbitrary number of space-time dimensions d. By embedding d-dimensional de Sitter into d+1-dimensional Minkowski, we extract the physical helicity-1 and helicity-0 polarizations of the graviton. The resulting decoupling theory is similar to that obtained around Minkowski. We take great care at exploring the partially massless limit and define the unique fully non-linear candidate theory that is free of the helicity-0 mode in the decoupling limit, and which therefore propagates only four degrees of freedom in four dimensions. In the latter situation, we show that a new Vainshtein mechanism is at work in the limit m^2\to 2 H^2 which decouples the helicity-0 mode when the parameters are different from that of partially massless gravity. As a result, there is no discontinuity between massive gravity and its partially massless limit, just in the same way as there is no discontinuity in the massless limit of massive gravity. The usual bounds on the graviton mass could therefore equivalently well be interpreted as bounds on m^2-2H^2. When dealing with the exact partially massless parameters, on the other hand, the symmetry at m^2=2H^2 imposes a specific constraint on matter. As a result the helicity-0 mode decouples without even the need of any Vainshtein mechanism.Comment: 30 pages. Some clarifications and references added. New subsection 'Symmetry and Counting in the Full Theory' added. New appendix 'St\"uckelberg fields in the Na\"ive approach' added. Matches version published in JCA

A clinical pathway for total shoulder arthroplasty-a pilot study

BACKGROUND: Appropriate pain management after total shoulder arthroplasty (TSA) facilitates rehabilitation and may improve clinical outcomes.; QUESTIONS/PURPOSES: This prospective, observational study evaluated a multimodal analgesia clinical pathway for TSA.; METHODS: Ten TSA patients received an interscalene nerve block (25cm(3) 0.375% ropivacaine) with intraoperative general anesthesia. Postoperative analgesia included regularly scheduled non-opioid analgesics (meloxicam, acetaminophen, and pregabalin) and opioids on demand (oral oxycodone and intravenous patient-controlled hydromorphone). Patients were evaluated twice daily to assess pain, anterior deltoid strength, handgrip strength, and sensory function.; RESULTS: The nerve block lasted an average of 18h. Patients had minimal pain after surgery; 0 (median score on a 0-10 scale) in the Post-Anesthesia Care Unit (PACU) but increased on postoperative day (POD) 1 to 2.3 (0.0, 3.8; median (25%, 75%)) at rest and 3.8 (2.1, 6.1) with movement. Half of the patients activated the patient-controlled analgesia four or fewer times in the first 24h after surgery. Operative anterior deltoid strength was 0 in the PACU but returned to 68% by POD 1. Operative hand strength was 0 (median) in the PACU, but the third quartile (75%) had normalized strength 49% of preoperative value.; CONCLUSIONS: Patients did well with this multimodal analgesic protocol. Pain scores were low, half of the patients used little or no intravenous opiate, and some patients had good handgrip strength. Future research can focus on increasing duration of analgesia from the nerve block, minimizing motor block, lowering pain scores, and avoiding intravenous opioids

Non-linear Realizations of Conformal Symmetry and Effective Field Theory for the Pseudo-Conformal Universe

The pseudo-conformal scenario is an alternative to inflation in which the early universe is described by an approximate conformal field theory on flat, Minkowski space. Some fields acquire a time-dependent expectation value, which breaks the flat space so(4,2) conformal algebra to its so(4,1) de Sitter subalgebra. As a result, weight-0 fields acquire a scale invariant spectrum of perturbations. The scenario is very general, and its essential features are determined by the symmetry breaking pattern, irrespective of the details of the underlying microphysics. In this paper, we apply the well-known coset technique to derive the most general effective lagrangian describing the Goldstone field and matter fields, consistent with the assumed symmetries. The resulting action captures the low energy dynamics of any pseudo-conformal realization, including the U(1)-invariant quartic model and the Galilean Genesis scenario. We also derive this lagrangian using an alternative method of curvature invariants, consisting of writing down geometric scalars in terms of the conformal mode. Using this general effective action, we compute the two-point function for the Goldstone and a fiducial weight-0 field, as well as some sample three-point functions involving these fields.Comment: 49 pages. v2: minor corrections, added references. v3: minor edits, version appearing in JCA

Zidovudine plus lamivudine in Human T-Lymphotropic Virus type-I-associated myelopathy: a randomised trial

BACKGROUND: No therapies have been proven to persistently improve the outcome of HTLV-I-associated myelopathy. Clinical benefit has been reported with zidovudine and with lamivudine in observational studies. We therefore conducted a randomised, double blind, placebo controlled study of six months combination therapy with these nucleoside analogues in sixteen patients. RESULTS: Primary outcomes were change in HTLV-I proviral load in PBMCs and clinical measures. Secondary endpoints were changes in T-cell subsets and markers of activation and proliferation. Six patients discontinued zidovudine. No significant changes in pain, bladder function, disability score, gait, proviral load or markers of T-cell activation or proliferation were seen between the two arms. Active therapy was associated with an unexplained decrease in CD8 and non-T lymphocyte counts. CONCLUSION: Failure to detect clinical improvement may have been due irreversible nerve damage in these patients with a long clinical history and future studies should target patients presenting earlier. The lack of virological effect but may reflect a lack of activity of these nucleoside analogues against HTLV-I RT in vivo, inadequate intracellular concentrations of the active moiety or the contribution of new cell infection to maintaining proviral load at this stage of infection may be relatively small masking the effects of RT inhibition

The Worldvolume Action of Kink Solitons in AdS Spacetime

A formalism is presented for computing the higher-order corrections to the worldvolume action of co-dimension one solitons. By modifying its potential, an explicit "kink" solution of a real scalar field in AdS spacetime is found. The formalism is then applied to explicitly compute the kink worldvolume action to quadratic order in two expansion parameters--associated with the hypersurface fluctuation length and the radius of AdS spacetime respectively. Two alternative methods are given for doing this. The results are expressed in terms of the trace of the extrinsic curvature and the intrinsic scalar curvature. In addition to conformal Galileon interactions, we find a non-Galileon term which is never sub-dominant. This method can be extended to any conformally flat bulk spacetime.Comment: 32 pages, 3 figures, typos corrected and additional comments adde

Indication for the disappearance of reactor electron antineutrinos in the Double Chooz experiment

The Double Chooz Experiment presents an indication of reactor electron antineutrino disappearance consistent with neutrino oscillations. A ratio of 0.944 $\pm$ 0.016 (stat) $\pm$ 0.040 (syst) observed to predicted events was obtained in 101 days of running at the Chooz Nuclear Power Plant in France, with two 4.25 GW$_{th}$ reactors. The results were obtained from a single 10 m$^3$ fiducial volume detector located 1050 m from the two reactor cores. The reactor antineutrino flux prediction used the Bugey4 measurement as an anchor point. The deficit can be interpreted as an indication of a non-zero value of the still unmeasured neutrino mixing parameter \sang. Analyzing both the rate of the prompt positrons and their energy spectrum we find \sang = 0.086 $\pm$ 0.041 (stat) $\pm$ 0.030 (syst), or, at 90% CL, 0.015 $<$ \sang $\ <$ 0.16.Comment: 7 pages, 4 figures, (new version after PRL referee's comments

High-spin States in \u3csup\u3e191, 193\u3c/sup\u3eAu and \u3csup\u3e192\u3c/sup\u3ePt: Evidence for Oblate Deformation and Triaxial Shapes

High-spin states of 191, 193Au and 192Pt have been populated in the 186W(11B, xn) and 186W(11B, p4n) reactions, respectively, at a beam energy of 68 MeV and their γ decay was studied using the YRAST Ball detector array at the Wright Nuclear Structure Laboratory at Yale University. The level scheme of 193Au has been extended up to Iπ = 55/2+. New transitions were observed also in 191Au and 192Pt. Particle-plus-Triaxial-Rotor (PTR) and Total Routhian Surface (TRS) calculations were performed to determine the equilibrium deformations of the Au isotopes. The predictions for oblate deformations in these nuclei are in agreement with the experimental data. Development of nonaxial shapes is discussed within the framework of the PTR model

Triaxial Deformation and Nuclear Shape Transition in \u3csup\u3e192\u3c/sup\u3eAu

Background: Nuclei in the A≈190 mass region show gradual shape changes from prolate through nonaxial deformed shapes and ultimately towards spherical shapes as the Pb region is approached. Exploring how this shape evolution occurs will help us understand the evolution of collectivity in this region. Purpose: The level scheme of the 192Au nucleus in A ≈ 190 region was studied in order to deduce its deformations. Methods: High-spin states of 192Au have been populated in the 186W(11B, 5n) reaction at a beam energy of 68 MeV and their γ decay was studied using the YRAST Ball detector array at the Wright Nuclear Structure Laboratory (WNSL), Yale University. Results: Based on double and triple γ-ray coincidence data the level scheme of 192Au has been extended up to Iπ = 32+ at an excitation energy of ∼6 MeV. Conclusion: The results are discussed in the framework of pairing and deformation self-consistent total Routhian surface (TRS) and cranked shell model (CSM) calculations. The comparison of the experimental observations with the calculations indicates that this nucleus takes a nonaxial shape similar to other Au nuclei in this region