Atlantoaxial instability complicating radiation therapy for recurrent nasopharyngeal carcinoma. A case report

STUDY DESIGN: A case report of a patient in whom atlantoaxial instability developed secondary to repeat radiation therapy for recurrent nasopharyngeal carcinoma. OBJECTIVES: To illustrate a dramatic and previously unreported complication of local radiation to the posterior nasopharynx. SUMMARY OF BACKGROUND DATA: Nasopharyngeal carcinoma is an unusual tumor that usually is managed with local, external-beam radiation. It is not thought to involve the cervical spine directly, although local invasion of the skull base is common. METHODS: A review of the medical records and radiographs of the only patient known to develop this complication of radiation used to manage nasopharyngeal carcinoma. RESULTS: Atlantoaxial instability developed in a patient as a result of repeat radiation for a locally recurrent tumor. The instability was associated with intrusion of the anterior arch of C1 into the posterior nasopharynx and was managed successfully with a posterior stabilization using transarticular screws and supplemental wiring. CONCLUSIONS: Patients who have undergone local irradiation for nasopharyngeal carcinoma may be at risk for developing atlantoaxial instability.     

Determinants of early and late results of combined valve operations and coronary artery bypass grafting

BACKGROUND: Factors determining the outcome of operative correction of valvular abnormalities combined with coronary artery bypass grafting are still incompletely defined. METHODS: Determinants of early and late (more than 90 days) deaths and event-free survival were studied for combined valve operations and coronary artery bypass grafting in 741 patients using multivariate analysis. RESULTS: Ninety-day survival probability was 89% (95% confidence interval, 87% to 92%). Preoperative risk factors for early death were age, female sex, renal failure, New York Heart Association class IV or V, and mitral insufficiency. The operative risk factor was the duration of aortic cross-clamping. Five- and 10-year survival probabilities were 74% (95% confidence interval, 71% to 78%) and 43% (95% confidence interval, 36% to 50%), respectively. Preoperative risk factors for late death were age, preoperative renal failure, New York Heart Association class IV or V, vessel disease, and nonsinus rhythm. Five- and 10-year event-free survival probabilities were 57% (95% confidence interval, 53% to 61%) and 23% (95% confidence interval, 17% to 28%), respectively. Preoperative risk factors for non-event-free survival were age, female sex, reduced left ventricular function, mitral regurgitation, and pacemaker rhythm. CONCLUSION: The demographic factors of age and female sex; the comorbid condition of renal failure; the cardiac conditions of advanced New York Heart Association class, left ventricular function, mitral regurgitation, vessel disease, and cardiac rhythm; and the operative condition of ischemia time are the most important predictors of clinical outcome after combined valve operations and coronary artery bypass grafting.     

RP-HPLC binding domains of proteins

Procedures have been developed to identify the chromatographic binding domains of horse heart cytochrome c (Cyt c) and bovine growth hormone (bGH) during their interaction with reversed-phase sorbent materials. The procedure involves adsorption of the protein solute to the chromatographic sorbent, followed by proteolytic cleavage. Comparison of the proteolytic map obtained for Cyt c and bGH in free solution with the corresponding map obtained when these proteins are adsorbed to the chromatographic sorbent revealed significant differences in the digestion pattern. Following characterization of the peptides generated in both maps, the results indicated that specific regions on the surface of both Cyt c and bGH are inaccessible to tryptic cleavage when adsorbed to the hydrophobic surface of both a C-4 and a C-18 sorbent. Based on the assumption that the region of the protein surface that is in contact with the sorbent remains intact and bound to the sorbent during the digestion step, while the protein surface that is exposed to the solvent is accessible to proteolysis, the regions that were inaccessible to tryptic digestion were found to correspond to hydrophobic domains on the protein surface. These results also suggest that the three-dimensional structures of these proteins remain largely intact upon adsorption to the hydrophobic surface.     

Ultrasound biomicroscopy in the diagnosis and management of anterior segment tumors

BACKGROUND: High-frequency ultrasound biomicroscopy has allowed eye care specialists to evaluate posterior extension of anterior segment tumors. This article evaluates the role of ultrasound biomicroscopy for the diagnosis and management of anterior segment tumors. METHODS: Fourteen patients with anterior segment tumors were selected for evaluation. Each patient underwent a complete clinical examination followed by slit-lamp photography and ultrasound biomicroscopy. RESULTS: Unlike standard ultrasonography of anterior segment tumors, high-frequency ultrasound biomicroscopy allowed quantitative measurements of tumor size, extension within and posterior to the iris, as well as differentiation of solid and cystic lesions. These characteristics were used to differentially diagnose anterior segment tumors and document the response of iridociliary body melanomas to radiotherapy. CONCLUSIONS: This study demonstrates how ultrasound biomicroscopy has become an effective and necessary procedure, used for both the diagnosis and management of anterior segment tumors.     

Metastatic carcinoma of the prostate mimicking primary carcinoid tumor of the lung and mediastinum

AIMS: To investigate the current use of thrombolytic therapy in the management of patients with acute myocardial infarction and to determine the potential for an increased use of thrombolysis or percutaneous transluminal coronary angioplasty (PTCA). METHODS AND RESULTS: All hospitalised cases of acute myocardial infarction were identified in three health districts in the UK (population of 960,000) in patients under the age of 76 years during a 2-year period; 2439 patients had acute myocardial infarction, of whom 1264 (52%) received thrombolytic therapy. Failure to administer thrombolytic therapy was a result of the absence of diagnostic electrocardiograms in 712 (29.2%) patients, late presentation in 127 (5.2%), therapeutic error in 112 (4.6%), presence of a bleeding risk in 139 (5.7%) and other miscellaneous reasons in 80 (3.3%) patients. Thirty-eight of the 139 patients in whom bleeding risk was reported as a contra-indication could, in retrospect, have received thrombolytic therapy and a further 76 would have been suitable for primary PTCA. CONCLUSIONS: The potential for increasing the use of thrombolytic therapy seems to be limited and is unlikely to make a major impact on the in-hospital mortality from acute myocardial infarction. However, primary PTCA should be considered in those who are ineligible for thrombolysis because of bleeding risk as a contra-indication.     

Assessing terrestrial wildlife populations in the Toronto and Region Area of Concern

Beneficial use impairments (BUIs) under the Great Lakes Water Quality Agreement identify environmental issues requiring remedial action within the Great Lakes Areas of Concern (AOCs). We conducted this study to support the assessment of the wildlife component of BUI 3: degradation of fish and wildlife populations. We compared bird and amphibian (frogs and toads) data from the Toronto and Region Conservation Authority’s Terrestrial Long-term Monitoring Program in the Toronto and Region AOC to an adjacent, but otherwise similar, reference watershed, Duffins Creek. Twelve of 13 targets were met within the AOC for forest bird, wetland bird, meadow bird and amphibian populations based on averages of mean annual values at sites within the AOC that were within two standard deviations of averages at sites in the Duffins Creek reference watershed between 2008 and 2017. Even though wildlife populations within the AOC were within the normal range of variability expected from a reference watershed, they were often at lower levels than within the Duffins Creek reference watershed. In addition, forest bird and amphibian populations were negatively affected by urbanization within the AOC and meadow bird indices declined. We conclude that while wildlife populations within the AOC currently meet targets for BUI 3, they continue to be negatively impacted by numerous stressors that are primarily related to past and ongoing urbanization. Thus, continued restoration of wildlife habitat and protection of existing habitat within the AOC is highly recommended.     

Experimental and computational study of gas–solid fluidized bed hydrodynamics

The hydrodynamics of a two-dimensional gas–solid fluidized bed reactor were studied experimentally and computationally. Computational fluid dynamics (CFD) simulation results from a commercial CFD software package, Fluent, were compared to those obtained by experiments conducted in a fluidized bed containing spherical glass beads of 250– in diameter. A multifluid Eulerian model incorporating the kinetic theory for solid particles was applied in order to simulate the gas–solid flow. Momentum exchange coefficients were calculated using the Syamlal–O’Brien, Gidaspow, and Wen–Yu drag functions. The solid-phase kinetic energy fluctuation was characterized by varying the restitution coefficient values from 0.9 to 0.99. The modeling predictions compared reasonably well with experimental bed expansion ratio measurements and qualitative gas–solid flow patterns. Pressure drops predicted by the simulations were in relatively close agreement with experimental measurements at superficial gas velocities higher than the minimum fluidization velocity, U_mf. Furthermore, the predicted instantaneous and time-average local voidage profiles showed similarities with the experimental results. Further experimental and modeling efforts are required in a comparable time and space resolutions for the validation of CFD models for fluidized bed reactors.     

Characterizing the deformation of cold-rolled copper sheet

An advanced x-ray diffraction technique allows the development of texture components to be monitored and provides supplementary information about the cold work and residual stresses in cold-rolled copper sheet. The new technique confirms the results of an ultrasonic test, except for the ultrasonic test’s sensitivity to grain size. The new x-ray diffraction technique could be adapted to provide in-process, nondestructive evaluation of thin copper sheet, even for material moving at high speeds.     

Resting respiratory tract dendritic cells preferentially stimulate T helper cell type 2 (Th2) responses and require obligatory cytokine signals for induction of Th1 immunity

Consistent with their role in host defense, mature dendritic cells (DCs) from central lymphoid organs preferentially prime for T helper cell type 1 (Th1)-polarized immunity. However, the "default" T helper response at mucosal surfaces demonstrates Th2 polarity, which is reflected in the cytokine profiles of activated T cells from mucosal lymph nodes. This study on rat respiratory tract DCs (RTDCs) provides an explanation for this paradox. We demonstrate that freshly isolated RTDCs are functionally immature as defined in vitro, being surface major histocompatibility complex (MHC) II lo, endocytosishi, and mixed lymphocyte reactionlo, and these cells produce mRNA encoding interleukin (IL)-10. After ovalbumin (OVA)-pulsing and adoptive transfer, freshly isolated RTDCs preferentially stimulated Th2-dependent OVA-specific immunoglobulin (Ig)G1 responses, and antigen-stimulated splenocytes from recipient animals produced IL-4 in vitro. However, preculture with granulocyte/macrophage colony stimulating factor increased their in vivo IgG priming capacity by 2-3 logs, inducing production of both Th1- and Th2-dependent IgG subclasses and high levels of IFN-gamma by antigen-stimulated splenocytes. Associated phenotypic changes included upregulation of surface MHC II and B7 expression and IL-12 p35 mRNA, and downregulation of endocytosis, MHC II processing- associated genes, and IL-10 mRNA expression. Full expression of IL-12 p40 required additional signals, such as tumor necrosis factor alpha or CD40 ligand. These results suggest that the observed Th2 polarity of the resting mucosal immune system may be an inherent property of the resident DC population, and furthermore that mobilization of Th1 immunity relies absolutely on the provision of appropriate microenvironmental costimuli.     

Chemotherapy in non-small cell lung cancer: a review

Lung cancer, of which non-small cell carcinoma is the most common, has been a significant therapeutic challenge for decades and will remain so for decades to come. Despite its prevalence, progress in the management of non-small cell lung cancer has been relatively slow. This is in part due to the pessimism of most physicians treating this disease, which has resulted in a relatively lackadaisical attitude with regards to clinical trials when compared to other solid tumours like breast or colorectal cancers. Nevertheless, the past decade has seen significant progress, specifically with regards to the management of locally advanced disease. Chemotherapy, though shown to be biologically active in non-small cell lung cancer, is considered an ineffective palliative tool in the setting of metastatic disease due to its toxicities and the "less than encouraging" response rates generated by the cisplatin-based combination regimen which is generally considered to be the most active currently available. The advent of new active agents such as paclitaxel and vinorelbine which are potentially less toxic may change this view. Conversely, the response rate of locally advanced disease to chemotherapy is significantly higher and this has resulted in numerous multimodality trials of neoadjuvant chemotherapy prior to surgery and/or radiation. To date, a number of randomised trials have shown that this approach can result in significant survival benefit for patients with locally advanced disease. An alternative approach makes use of the potential synergism between certain chemotherapeutic agents (such as cisplatin) and radiation when used concurrently. However, data on concurrent chemoradiotherapy in locally advanced disease have been largely based on single-arm studies and are inconclusive. Three randomised trials on concurrent chemoradiotherapy have been shown benefit for the use of combined modality in locally advanced disease. Hence, treatment of locally advanced disease should include chemotherapy as part of the combined modality approach. However, the optimal sequencing of these modalities would require well-designed randomised trials to determine.