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Nos quartzitos ferríferos do Membro Malhada da Formação Marão aflorantes no sinclinório de Moncorvo (Ordovícico Inferior), encontram-se intercalados níveis de depósitos metassedimentares, de granulometria fina e espessura máxima de 40 cm, que são constituídos essencialmente por quartzo e moscovite, contendo também fosfatos da série lazulite-scorzalite, zircão, turmalina, hematite, localmente com núcleos de magnetite, esfena e, mais raramente, monazite, xenótimo, rútilo, hidróxidos de Fe e Ti e clorite. A geoquímica de elementos tendencialmente imóveis (Ti, Zr, La e Sc) sugere que a sua deposição terá ocorrido próximo de uma margem continental ativa, sendo posteriormente afetados por processos metamórficos de baixo grau e metassomáticos/hidrotermais, relacionados com a Orogenia Varisca, que terão influenciado a sua mineralogia e geoquímica elementar e isotópica. Contudo, o contraste mineralógico, textural e granulométrico existente entre estes depósitos metassedimentares e os quartzitos ferríferos, bem como a ocorrência de episódios vulcânicos/vulcano-sedimentares na Zona Centro-Ibérica, durante o Ordovícico Inferior, sugere que estes depósitos teriam incorporado materiais detríticos resultantes da erosão de rochas vulcânicas/hipabissais com idade anterior à Idade Floiano superior-Dapingiano (471-467 Ma). Com efeito, os elevados teores em alguns elementos incompatíveis, a razão CaO/Na2O de 0,33 a 1,77, perfis de REE com (La/Lu)N = 3,37 a 7,96 e discreta anomalia negativa de Eu, valores de (87Sr/86Sr)i e εNdt variáveis entre 0,71156 e 0,71304 e -10,8 e -10,0, respetivamente, indicam que os materiais vulcânicos primordiais poderiam ter afinidade riodacítica, resultando da fusão parcial de metassedimentos semelhantes aos do Grupo do Douro e equivalentes do norte da Zona Centro Ibérica. A datação U-Pb, obtida por ID-TIMS em zircão, indica uma idade de 484,5 ± 3,0 Ma para a formação desses materiais vulcânicos primordiais. In the Moncorvo synclinorium, ferriferous quartzites of the Malhada Member of the Marão Formation (Lower Ordovician) comprise interbedded layers of fine grained metasedimentary deposits, with a maximum thickness of 40 cm, and mainly composed of quartz and muscovite, but also containing phosphates of the lazulite-scorzalite series, zircon, tourmaline, hematite, locally with magnetite cores, titanite, and, more rarely, monazite, xenotime, rutile, Fe and Ti hydroxides and chlorite. The geochemistry of immobile elements (Ti, Zr, La and Sc) suggests that the metasedimentary rocks have been deposited near an active continental margin, but the subsequent low grade metamorphism and metasomatic/hydrothermal processes, related to the Variscan Orogeny, had a significant influence on their mineralogy and elemental and isotopic geochemistry. The mineralogical, textural and granulometric contrast between these metasedimentary deposits and the ferriferous quartzite, as well as the occurrence of Lower Ordovician volcanic/volcano-sedimentary episodes in the Central Iberian Zone, suggest that these deposits could have incorporated detritus derived from volcanic/hypabyssal rocks, older than the upper Floian-Dapingian age (471-467 Ma). However, the high contents of some incompatible elements, the CaO/Na2O ratio between 0.33 and 1.77, the REE pattern with (La / Lu)N = 3.37 to 7.96 and a slight negative Eu anomaly, (87Sr/86Sr)i varying from 0.71156 to 0.71304 and εNdt values of -10.8 to -10.0 indicate that the primary volcanogenic materials could have had a rhyodacitic to dacitic affinity, deriving from partial melting of metasediments similar to those of the Douro Group and equivalents from the northern Central Iberian Zone. Dating of zircon by U-Pb ID-TIMS indicates a formation age of 484.5 ± 3.0 Ma for the original volcanogenic materials.

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O experimento foi realizado em área de baixada litorânea do Estado de Sergipe, com o objetivo de avaliar o efeito do manejo das entrelinhas e do cultivo consorciado sobre o crescimento de coqueiros da variedade gigante-do-Brasil aos 18, 29 e 46 meses de idade, cultivados em sequeiro, em solo do tipo Latossolo Amarelo distrófico. Comparou-se o efeito da gradagem e da roçagem mecânica para controle da vegetação natural, em relação ao cultivo consorciado com mandioca e à testemunha, onde se utilizou controle manual das plantas daninhas. Avaliou-se também a alternância da gradagem no período seco e roçagem no período chuvoso. Nas subparcelas, testou-se o efeito da adubação dos coqueiros e da mandioca em presença e ausência. Os resultados obtidos aos 18 meses de idade indicaram superioridade dos tratamentos que fizeram uso da gradagem em relação à maioria dos parâmetros de crescimento avaliados. O cultivo consorciado apresentou nesta fase, valores significativamente inferiores, com destaque para o menor número de folhas vivas. As avaliações subsequentes realizadas aos 29 meses, confirmada aos 46, demonstraram a recuperação do consórcio, o qual se equiparou aos tratamentos com gradagem que apresentaram os melhores resultados. Os tratamentos que utilizaram somente roçagem no controle dasplantas daninhas se refletiram no menor crescimento dos coqueiros. Embora tenha sido observada interação positiva para o fator adubação para a maioria dos tratamentos, este efeito foi superado pelomanejo das entrelinhas que condicionou o crescimento das plantas.

We report quality of life and indirect costs from patient reported outcomes from the ROSEL randomized control trial comparing stereotactic ablative radiotherapy (SABR, also known as stereotactic body radiotherapy or SBRT) versus surgical resection for medically operable stage IA non-small cell lung cancer. ROSEL closed prematurely after accruing and randomizing 22 patients. This exploratory analysis found the global health related quality of life and indirect costs to be significantly favorable and cheaper, with SABR. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

Objectives: As suggested by in-vitro data, we hypothesize that subtypes of ICRAS mutated non-small cell lung cancer (NSCLC) respond differently to chemotherapy regimens.Methods: Patients with advanced NSCLC and known KRAS mutation, treated with first-line platinumbased chemotherapy, were retrieved from hospital databases. Primary objective: to investigate overall response rate (ORR), progression free survival (PFS) and overall survival (OS) between different types of platinum-based chemotherapy per type of KRAS mutation.Results: 464 patients from 17 hospitals, treated between 2000 and 2013, were included. The majority of patients had stage IV disease (93%), had a history of smoking (98%) and known with an adenocarcinoma (91%). Most common types of ICRAS mutation were G12C (46%), G12V (20%) and G1 2D (10%). Platinum was combined with pemetrexed (n =334), taxanes (n = 68) or gemcitabine (n = 62). Patients treated with taxanes had a significant improved ORR (50%) compared to pemetrexed (21%) or gemcitabine (25%; p Conclusion: KRAS mutated NSCLC patients treated with taxane-based chemotherapy had best ORR Response to chemotherapy regimens was different in types of ICRAS mutation. Especially patients with G12V had better response to taxane treatment. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

In this study we focus on idiopathic scoliosis with a primary thoracic curve and a secondary lumbar curve. We were interested in how the lumbar curve corrects following selective thoracic fusion and whether one can explain or predict the behaviour of the lumbar curve. In the literature it is said that, if the lower level of fusion is properly selected, the lumbar curve spontaneously corrects to balance the thoracic curve after selective thoracic fusion. Most authors have assumed a mechanism whereby improvement of the lumbar curve occurs through counterbalancing the surgical correction of the thoracic curve. The correction of the lumbar curve is said to echo the correction obtained for the thoracic curve. Because of these hypotheses, we postulate there should be a correlation between the correction of the lumbar and the thoracic curves of a scoliosis. To validate this hypothesis, we performed a retrospective study on 27 patients with King type II adolescent idiopathic scoliosis treated by selective thoracic fusion. The mean preoperative Cobb angles were 54 degrees for the thoracic curve and 34 degrees for the lumbar curve. Postoperatively they were 31 degrees and 22 degrees respectively. Using Pearson correlation analysis, we found no significant correlation between the relative corrections of the individual thoracic and lumbar curves. Moreover, there was a decrease in the correlation between the thoracic and lumbar curve after operation (preoperative R=0.787, postoperative R=0.364). These results show that the correction of the lumbar curve is not a reflection of the thoracic correction. The exact mechanism by which the lumbar spine corrects remains to be elucidated.

In the field of neurolaryngology, there has been a great interest in neurophysiological studies, such as neurography, for the assessment of the integrity of the laryngeal neural pathway. Such tools provide an indication about the site and the nature of the nerve lesion. We have tried to use a magnetically evoked potential to assess the corticolaryngeal pathway in order to provide normative data on laryngeal nerve conductivity and to evaluate the integrity of the laryngeal neural system in patients with vocal-fold mobility disorders. This study was conducted on 26 subjects (10 normal volunteers and 16 patients with vocal-fold immobility) who were primarily selected on the basis of a comprehensive laryngeal evaluation including laryngo-videostroboscopy assessment. Transcranial (cortical) and mastoid (peripheral) magnetic stimulations were performed to evoke muscle action potentials of the thyro-arytenoid (TA) and cricothyroid muscles (CT). In normal volunteers, cortical stimulation leads to contralateral responses (cortical latency) after 10.9 and 11.3 ms and ipsilateral responses after 8.3 and 9.4 ms for right CT and TA muscles, respectively. There was a significant prolongation of cortical latency of the left TA compared with the right TA muscle, whilst no such significant difference was observed in the CT muscles. Peripheral stimulation evoked response (peripheral latency) after 2.8 and 2.7 ms in the right CT and TA, respectively, with the same significant prolongation of the left TA response compared with the right side. Amongst the patient groups, variable patterns of laryngeal muscle response latencies occurred, including normal response latency, lack of response of CT and TA muscles, prolonged peripheral latency with secondary prolonged cortical latency and prolonged cortical latency with normal peripheral latency. The results indicate that the magnetically evoked potential of laryngeal muscles offers an easy, non-invasive technique and could have a role in the assessment of the integrity of corticolaryngeal pathways.

We studied whether thoracic Boston brace treatment changes the King type of scoliotic curves in a group of 50 patients with adolescent idiopathic scoliosis. Bending radiographs showed more flexibility of the lumbar curves than that of the thoracic curves. However, after initial application of the brace, the mean lumbar correction in degrees was less than the mean thoracic correction. After brace treatment we found a slight statistically significant increase in the mean lumbar curve, but no significant change in the mean thoracic curve. In 7 of our patients, we found a change in the King classification which seemed to be related to insufficient lumbar correction at the start of brace treatment. When classifying idiopathic scoliosis, one should bear in mind that the result may be temporary because scoliosis is a dynamic process. A change in curve type can occur during brace treatment.

Resume Objectif L’objectif de ce travail est de decrire, a partir de deux cas cliniques, les caracteristiques cliniques, radiologiques et histologiques du chondrosarcome larynge, et de discuter de sa prise en charge therapeutique. Presentation des cas Il s’agit de deux hommes, âges de 63 et 51 ans, qui ont presente un chondrosarcome de bas grade revele par une masse latero-cervicale pour le premier et par une dyspnee laryngee pour le second. La tomodensitometrie montrait un processus tumoral contenant des calcifications, developpe a partir du cartilage thyroide ou du cartilage cricoide. Une laryngectomie partielle a ete realisee pour un patient et une laryngectomie totale pour l’autre. Discussion C’est l’analyse conjointe des signes cliniques, radiologiques et histologiques qui permet d’etablir le diagnostic de chondrosarcome. Le diagnostic differentiel avec un chondrome peut etre difficile, en particulier pour les chondrosarcomes de grade 1. Conclusion Le chondrosarcome larynge est une tumeur rare dont le traitement est essentiellement chirurgical. Le pronostic, generalement favorable, depend principalement du grade histologique.

Medical students have to process a large amount of information during the first years of their study, which has to be retained over long periods of nonuse. Therefore, it would be beneficial when knowledge is gained in a way that promotes long-term retention. Paper-and-pencil drawings for the uptake of form-function relationships of basic tissues has been a teaching tool for a long time, but now seems to be redundant with virtual microscopy on computer-screens and printers everywhere. Several studies claimed that, apart from learning from pictures, actual drawing of images significantly improved knowledge retention. However, these studies applied only immediate post-tests. We investigated the effects of actual drawing of histological images, using randomized cross-over design and different retention periods. The first part of the study concerned esophageal and tracheal epithelium, with 384 medical and biomedical sciences students randomly assigned to either the drawing or the nondrawing group. For the second part of the study, concerning heart muscle cells, students from the previous drawing group were now assigned to the nondrawing group and vice versa. One, four, and six weeks after the experimental intervention, the students were given a free recall test and a questionnaire or drawing exercise, to determine the amount of knowledge retention. The data from this study showed that knowledge retention was significantly improved in the drawing groups compared with the nondrawing groups, even after four or six weeks. This suggests that actual drawing of histological images can be used as a tool to improve long-term knowledge retention.

Pulmonary carcinoids are neuroendocrine tumors histopathologically subclassified into typical (TC; no necrosis

The present study is the first on the trends in comorbidity among patients with small-cell lung cancer. In particular, hypertension and pulmonary, cardiac, and vascular disease have become more common. Multimorbidity and cardiac and digestive disease have affected survival in those with limited-stage disease, and cardiac and cerebrovascular disease have decreased the survival of patients with extensive disease. These data are relevant for treatment decisions and patient communication in daily clinical practice. Introduction: We evaluated the trends in the prevalence of comorbidity and its prognostic impact in a cohort of unselected patients with small-cell lung cancer (SCLC). Patients and Methods: All patients (n = 4142) diagnosed with SCLC from 1995 to 2012 were identified from the population-based Netherlands Cancer Registry in the Eindhoven region. Results: The prevalence of comorbidity increased from 55% in 1995 to 1998 to 76% in 2011 to 2012 and multimorbidity (ie, >= 2 concomitant diseases) from 23% to 51%. The prevalence of a comorbidity increased with age. Among the men, hypertension, cardiac disease, and diabetes, in particular, became more common (increased from 11% to 35%, from 19% to 36%, and from 7% to 18%, respectively). In the women, the rate of pulmonary disease, hypertension, and cardiac disease increased the most (increased from 18% to 30%, from 12% to 28%, and from 11% to 24%, respectively). Multimorbidity was associated with a slightly increased hazard of death, independent of treatment in those with limited-stage SCLC (hazard ratio [HR] for >= 2 comorbidities vs. no comorbidities, 1.2; 95% confidence interval [CI], 1.0-1.4). The prognostic effects of multimorbidity resulted from treatment in those with extensive-stage SCLC (HR for >= 2 comorbidities vs. no comorbidities, final model, 1.2; 95% CI, 1.0-1.2). The prognostic impact of the specific comorbidities varied, with digestive disease reducing the hazard and cardiac disease increasing the hazard in those with limited-stage SCLC (HR for digestive disease vs. no digestive disease, 0.7 [95% CI, 0.5-0.9], and HR for cardiac vs. no cardiac disease, 1.2 [95% CI, 1.0-1.3]). Also, cardiac and cerebrovascular disease increased the hazard in those with extensive-stage SCLC (HR 1.2 [95% CI, 1.0-1.3] and HR 1.3 [95% CI, 1.1-1.6], respectively). Conclusion: Comorbidity among patients with SCLC is very common and has been increasing. Multimorbidity was associated with a slightly increased hazard of death in those with limited-stage SCLC, independent of treatment. However, the prognostic effects in those with advanced-stage SCLC resulted from treatment. Digestive disease favorably affected survival and cardiac disease negatively affected the prognosis for those with limited-stage SCLC, and cardiac and cerebrovascular diseases had a negative prognostic effect for those with extensive-stage SCLC. With the burden of comorbidities in patients with SCLC increasing, more attention to individualized treatment approaches is needed. (C) 2015 Elsevier Inc. All rights reserved.

Background Birt-Hogg-Dubé syndrome (BHD) is a rare autosomal dominantly inherited disorder caused by germline mutations in the folliculin (FLCN) gene. Clinical manifestations of BHD include skin fibrofolliculomas, renal cell cancer, lung cysts and (recurrent) spontaneous pneumothorax (SP). All clinical manifestations usually present in adults > 20 years of age. Case presentations Two non-related patients with (recurrent) pneumothorax starting at age 14 accompanied by multiple basal lung cysts on thoracic CT underwent FLCN germline mutation analysis. A pathogenic FLCN mutation was found in both patients confirming suspected BHD. The family history was negative for spontaneous pneumothorax in both families. Conclusion Although childhood occurrence of SP in BHD is rare, these two cases illustrate that BHD should be considered as cause of SP in children.

Opioid use and opioid-related mortality have increased dramatically since the 1990s in North America. The effect of opioids on the liver is incompletely understood. Some studies have suggested that opioids cause liver damage and others have failed to show any harm. HIV/hepatitis C virus (HCV)-coinfected persons may be particularly vulnerable to factors increasing liver fibrosis. We aimed to describe opioid use in an HIV/HCV-coinfected population in Canada and to estimate the association between opioid use and liver fibrosis.We conducted a cross-sectional descriptive analysis of the Canadian Co-infection Cohort Study data to characterize opioid use. We then conducted a longitudinal analysis to assess the average change in aspartate aminotransferase-to-platelet ratio index (APRI) score associated with opioid use using a generalized estimating equation with linear regression. We assessed the progression to significant liver fibrosis (APRI ≥ 1.5) associated with opioid use with pooled logistic regression.In the 6 months preceding cohort entry, 32% of the participants had received an opioid prescription, 28% had used opioids illicitly and 18% had both received a prescription and used opioids illicitly. Neither prescribed nor illicit opioid use was associated with a change in the median APRI score [exp(β) 0.99 (95% confidence interval (CI) 0.82, 1.12) and exp(β) 0.95 (95% CI 0.81, 1.10), respectively] or with faster progression to liver fibrosis [hazard odds ratio (HOR) 1.20 (95% CI 0.73, 1.67) and HOR 1.09 (95% CI 0.63, 1.55), respectively].Although opioids were commonly used both legally and illegally in our cohort, we were unable to demonstrate a negative impact on liver fibrosis progression.

Bent tail is a mouse model for human neural tube defects. Bent tail mice are characterized by a shortened, kinked tail. We have observed numerous aberrations in Bent tail embryos including exencephaly, rotation defects and occasionally omphalocele, orofacial schisis and situs abnormalities. Exencephaly was seen in >10% of all embryos and resulted from a closure defect of the hindbrain. Bent tail maps to the proximal part of the X chromosome. By haplotype analysis we have appointed the Bent tail locus to a 1.1 cM interval between markers DXMit159 and DXMit143. Subsequent analysis has revealed the presence of a deletion in all affected animals. The deletion is approximately 1 Mb in size and encompasses the gene for ZIC:3, a zinc finger transcription factor expressed in murine neuroectoderm and dorsal axial mesoderm during neurulation. ZIC:3 is a homolog of the Drosophila segmentation gene odd-paired. Although the Bent tail phenotype probably is the result of the deletion of several genes, combining data on ZIC:3 expression and function of ZIC: genes in the mouse shows that deletion of Zic3 alone is compatible with a major role of this gene in the congenital malformations of the Bent tail mouse. In man, mutations in ZIC3 are associated with situs abnormalities. These patients occasionally also show spina bifida, indicating that genetic variation in human ZIC3 may contribute to other congenital malformations, including neural tube defects.

BACKGROUND—Guidelines for asthma management focus on treatment with inhaled corticosteroids and on home recording of peak expiratory flow (PEF). The effect of maintenance treatment with inhaled corticosteroids on PEF variation and its relation to other parameters of disease activity were examined in 102 asthmatic children aged 7-14 years. METHODS—During 20 months of treatment with inhaled salbutamol, with or without inhaled budesonide (600 µg daily), forced expiratory volume in one second (FEV1), the dose of histamine required to provoke a fall in FEV1 of more than 20% (PD20), the percentage of symptom free days, and PEF variation were assessed bimonthly. PEF variation was computed as the lowest PEF as a percentage of the highest PEF occurring over 14 days, the usual way of expressing PEF variation in asthma self-management plans. For each patient using inhaled corticosteroids within subject correlation coefficients (ρ) were computed of PEF variation to the percentage of symptom free days, FEV1, and PD20. RESULTS—PEF variation decreased significantly during the first two months of treatment with inhaled corticosteroids and then remained stable. The same pattern was observed for symptoms and FEV1. In contrast, PD20 histamine continued to improve throughout the whole follow up period. In individual patients predominantly positive associations of PEF variation with symptoms, FEV1, and PD20 were found, but the ranges of these associations were wide. CONCLUSIONS—During treatment with inhaled corticosteroids the changes in PEF variation over time show poor concordance with changes in other parameters of asthma severity. When only PEF is monitored, clinically relevant deteriorations in symptoms, FEV1, or PD20 may be missed. This suggests that home recording of PEF alone may not be sufficient to monitor asthma severity reliably in children.

We have previously shown that p75 nerve growth factor receptor (p75NGFR) mediates apoptosis of approximately 25% of the cholinergic basal forebrain neurons in normal control mice between postnatal day 6 and 15, but only of cholinergic neurons that lacked the nerve growth factor receptor TrkA. Here, we investigated whether and when the cholinergic neurons of the neostriatum, which express TrkA and p75NGFR during early postnatal times, undergo p75NGFR-mediated death. The cholinergic neurons in the lateral neostriatal regions expressed choline acetyltransferase (ChAT) earlier (postnatal day 3-6) than those of the medial regions and TrkA appeared before ChAT in all regions. Between postnatal day 6 and 10, approximately 40% of the ChAT-positive neurons in the most lateral regions disappeared in control mice but not in p75NGFR-deficient mice. During this time, the neostriatum of control, but not p75NGFR-deficient, mice contained many apoptotic cells. This suggests that, similar to the cholinergic neurons of the basal forebrain, the neostriatal cholinergic neurons of control mice die and that this process is mediated by p75NGFR. However, the roles of p75NGFR and TrkA appear to be more complicated in the neostriatum where relatively few neurons express p75NGFR during the death phase (and predominantly in the lateral neostriatum where the neuronal loss is greatest), and TrkA-positive as well as TrkA-negative neurons may be lost.

OBJECTIVES: To evaluate whether infliction of peritoneal trauma would promote tumor cell adherence to damaged peritoneal surfaces; to investigate whether peritoneal damage could promote tumor growth of extraperitoneal tumors; and to evaluate whether the amount of trauma correlated with the degree of tumor cell adherence and local and distant tumor growth. BACKGROUND DATA: After potentially curative resection of colorectal carcinoma, the most common site for recurrence is locoregional. We previously demonstrated that surgical trauma induces a cascade of events leading to adhesion formation. The same mechanisms may be responsible for improved tumor cell adherence and growth facilitation in early local recurrence. METHODS: A reproducible rat model was used in which peritoneal damage was inflicted by standardized rubbing of the peritoneum with surgical gauzes of different texture. In the first experiment, tumor cell adherence and growth at traumatized and nontraumatized peritoneal sites were assessed semiquantitatively 3 weeks after perioperative intra-abdominal injection of CC-531 tumor cells. In the second experiment, the effect of peritoneal trauma on ectopic tumor growth was investigated (CC-531 implanted under the renal capsule). In the final experiment, we evaluated how soon after peritoneal traumatization tumor cell adhesion and growth-promoting factors were active and whether they could be passively transferred to naive nontraumatized abdominal cavities. RESULTS: A significant correlation between the amount of peritoneal trauma and the degree of tumor take at damaged peritoneal surfaces was found (p < or = 0.018). Tumor take at remote peritoneal sites not directly traumatized was also significantly higher after severe trauma than after moderate trauma of the peritoneum (p < or = 0.005). In addition, a significant correlation between the degree of peritoneal trauma and the growth of ectopic tumors under the renal capsule was observed (p < or = 0.009). The final experiment demonstrated that within a few hours after infliction of peritoneal trauma, tumor growth-promoting effects could be passively transferred to naive recipients. CONCLUSIONS: Surgical trauma is an important factor in the promotion of local recurrence. The enhancing effect of trauma is not restricted to the inflicted site but rather has a generalized character. Avoidance of unnecessary surgical trauma by using gentle techniques and materials is therefore indicated.

Although home recording of peak expiratory flow (PEF) is considered useful in managing asthma, little is known about the relationship of PEF variation to other indicators of disease activity. We examined the relationship of PEF variation, expressed in various ways, to symptoms, atopy, level of lung function, and airways hyperresponsiveness in schoolchildren with asthma. One hundred and two asthmatic children (aged 7-14 yrs) recorded symptoms and PEF (twice daily) in a diary for 2 weeks after withdrawal of all anti-inflammatory maintenance medication. PEF variation was expressed as amplitude % mean, as standard deviation and coefficient of variation of all recordings, and as low % best (lowest PEF as percentage of the highest of all values). Atopy and level of forced expiratory volume in one second (FEV1) % predicted were not significantly related to PEF variation. The provocative dose of histamine causing a 20% fall in FEV1 (PD20) and symptom scores were significantly, but weakly, related to PEF variation. The index, low % best, proved easy to calculate and effective in identifying a short-term episode of reduced PEF. We conclude that peak expiratory flow variation in children with stable, moderately severe asthma is significantly, but weakly, related to symptoms and airways hyperresponsiveness. These three phenomena, therefore, all provide different information on the actual disease state. Expressing peak expiratory flow variation as low % best is easy to perform and appears to be clinically relevant.

The functions of the low-affinity p75 nerve growth factor receptor (p75(NGFR)) in the central nervous system were explored in vivo. In normal mice, approximately 25 percent of the cholinergic basal forebrain neurons did not express TrkA and died between postnatal day 6 and 15. This loss did not occur in p75(NGFR)-deficient mice or in normal mice systemically injected with a p75(NGFR)-inhibiting peptide. Control, but not p75(NGFR)-deficient, mice also had fewer cholinergic striatal interneurons. Apparently, p75(NGFR) mediates apoptosis of these developing neurons in the absence of TrkA, and modulation of p75(NGFR) can promote neuronal survival. Cholinergic basal forebrain neurons are involved in learning and memory.

Forty-four patients with early RA who had participated in a six months double-blind trial, comparing cyclosporine A (CsA) (n = 22) with chloroquine (Chl) (n = 22), were followed for a further 18 months irrespective of their treatment status. At two years follow up, the mean CsA dose was 2.7 +/- 1.1 mg/kg/day (n = 15) and the dose of Chl (n = 11) was 100 mg/day in every patient. Maximal difference in efficacy (represented by the percentage of patients who fulfilled the Paulus 50% response) was reached at one year (CsA group: 68% and Chl group: 36%; p = 0.07). At two years, the differences in efficacy and toxicity between the two groups had diminished. The conclusions of this follow-up study are: 1. maximal efficacy of low dose CsA in early RA patients is reached after one year of therapy. 2. CsA can maintain clinical efficacy and safety comparable to Chl for a period of at least two years.

Recently, we showed that complement resistance is an important virulence factor of Moraxella (Branhamella) catarrhalis. Our study used a serum bactericidal assay to determine complement resistance in M. catarrhalis. Although the serum bactericidal assay is considered the "gold standard" for determining complement resistance, it is laborious and time-consuming and therefore not well suited for large-scale studies. Using a large number (n = 324) of M. catarrhalis isolates obtained from the sputa of patients with lower respiratory tract infections (n = 200) and young carriers (n = 124), we assessed the value of a simple "culture-and-spot" test as an alternative to the serum bactericidal assay. For both groups of isolates, the degree of concordance between the two tests used was very significant (P < 0.0001). The agreement between the two assays was estimated to be "excellent beyond chance" (as determined by Cohen's kappa test). The culture-and-spot assay is a valuable alternative to the serum bactericidal assay, not only for screening purposes as shown here but also for studying the mechanism of complement resistance in M. catarrhalis at the molecular level.

The aim of the study was to evaluate the survival and locoregional recurrence in patients with advanced oral and oropharyngeal squamous cell carcinoma treated by surgery with free flap reconstruction followed or not by radiochemotherapy.A retrospective study was performed on 188 patients treated by surgery with microvascular reconstruction with or without postoperative radiochemotherapy for an advanced stage squamous carcinoma of the oral cavity and/or of the oropharynx. All patients underwent free flap reconstruction. The study parameters were survival and recurrence rates.The 5-year overall survival, disease specific survival, and disease free survival rates were 54%, 65%, and 61% respectively. A high level of comorbidity was the only factor that influenced the survival rate. The overall recurrence rate was 34%. Only 9% of patients having recurred were treated successfully. The survival rate after locoregional recurrence and metastasis was 6% at 2 years.Surgery and postoperative radiochemotherapy allows for an acceptable survival rate for patients with advanced oral and oropharyngeal squamous cell carcinoma.

Residues of antineoplastic drugs in canine excretion products may represent exposure risks to veterinary personnel, owners of pet dogs and other animal care-takers. The aim of this study was to measure the extent and duration of platinum (Pt) excretion in pet dogs treated with carboplatin. Samples were collected before and up to 21 days after administration of carboplatin. We used validated, ultra-sensitive, inductively coupled plasma-mass spectrometry assays to measure Pt in canine urine, faeces, saliva, sebum and cerumen. Results showed that urine is the major route of elimination of Pt in dogs. In addition, excretion occurs via faeces and saliva, with the highest amounts eliminated during the first 5 days. The amount of excreted Pt decreased over time but was still quantifiable at 21 days after administration of carboplatin. In conclusion, increased Pt levels were found in all measured excretion products up to 21 days after administration of carboplatin to pet dogs, with urine as the main route of excretion. These findings may be used to further adapt current veterinary guidelines on safe handling of antineoplastic drugs and treated animals.

The objective of this study was to determine the surface contamination with platinum-containing antineoplastic drugs in veterinary and human oncology centres. Inductively coupled plasma mass spectrometry was used to measure platinum levels in surface samples. In veterinary and human oncology centres, 46.3 and 68.9% of the sampled surfaces demonstrated platinum contamination, respectively. Highest platinum levels were found in the preparation rooms (44.6 pg cm(-2)) in veterinary centres, while maximal levels in human centres were found in oncology patient-only toilets (725 pg cm(-2)). Transference of platinum by workers outside areas where antineoplastic drugs were handled was observed in veterinary and human oncology centres. In conclusion, only low levels of platinum contamination attributable to carboplatin were found in the sampled veterinary oncology centres. However, dispersion of platinum outside areas where antineoplastic drugs were handled was detected in veterinary and human oncology centres. Consequently, not only personnel, but also others may be exposed to platinum.

Cardiac herniation after pneumonectomy is recognized as a rare complication. This case report describes two cases. The mortality rate of this complication remains high as reported in the literature; in early-recognized cases 50 % and in late or unrecognized cases 100 %. In the following two cases a pneumonectomy was performed as a treatment for lung cancer. Within 48 h after the initial operative treatment, the clinical situation of the patients got worse and radiographic examinations showed a strongly deviated heart. After suspicion of the diagnosis, the patients were immediately transferred to the operation theatre for emergency thoracotomy. Per-operative the diagnosis was confirmed and the heart was returned into its original position while the defect in the pericardial sac was closed with a bovine pericardial patch. Both patients survived these procedures and did not suffer from any further complication.

Objective The primary objective of this study was to determine the clinical and pathological prognostic factors in locally advanced oral cavity cancers treated by primary surgery. Methods All patients treated by primary surgery with free-flap reconstruction for locally advanced oral cavity squamous cell carcinoma in our institution between 2000 and 2010 were included in this retrospective study. Overall, cause-specific and locoregional disease-free survivals were determined by Kaplan-Meier analyses. Clinical and histological prognostic factors were assessed by univariate (Log Rank tests) and multivariate (Cox models) analyses. Results A total of 149 patients (102 men and 47 women; mean age = 61.3 ± 12.1 years) were included in the study. Five-year overall, cause-specific and locoregional disease-free survivals were 55%, 68% and 71%, respectively. Age, comorbidity and tumour size (histological evaluation) were significantly correlated with overall survival (P

Aperture arrays have been studied extensively for application in the next generation of large radio telescopes for astronomy, requiring extremely low noise performance. Prototype array systems need to demonstrate the low noise potential of aperture array technology. This paper presents noise measurements for an Aperture Array tile of 144 dual-polarized tapered slot antenna (TSA) elements, originally built and characterized for use as a Phased Array Feed for application in an L-band radio astronomical receiving system. The system noise budget is given and the dependency of the measured noise temperatures on the beam steering is discussed. A comparison is made of the measurement results with simulations of the noise behavior using a system noise model. This model includes the effect of receiver noise coupling, resulting from a changing active reflection coefficient and array noise contribution as a function of beam steering. Measurement results clearly demonstrate the validity of the model and thus the concept of active reflection coefficient for the calculation of effective system noise temperatures. The presented array noise temperatures, with a best measured value of 45 K, are state-of-the-art for room temperature aperture arrays in the 1 GHz range and illustrate their low noise potential., 6 pages, 6 figures, accepted for publication in the IEEE Transactions on Antennas and Propagation

This was the first study to specifically demonstrate the validity of ablative surgery and free flap reconstruction for elderly patients with oral or oropharyngeal cancer in terms of oncologic and functional outcomes.The aim of our study was to evaluate the impact of advanced age on oncologic and functional outcomes after ablative surgery and free flap reconstruction in patients with oral or oropharyngeal cancer.We conducted a retrospective review of the medical records of all patients who underwent ablative surgery and reconstruction with free flap for primary oral or oropharyngeal cancer at our institution between 2000 and 2009. The impact of advanced age (≥70 years) on oncologic and functional outcomes was assessed in univariate and multivariate analyses.Advanced patient age had a worse impact on overall (p = 0.006), specific (p = 0.02) and disease-free (p = 0.03) survival in univariate analysis, but had only a worse impact on overall survival (p = 0.03) in multivariate analysis. In the elderly patients, overall, specific and disease-free survival rates at 5 years were 43%, 51% and 49%, respectively. There was no significant difference in functional outcomes between elderly and young patients.

Summary Introduction Cervical schwannoma is a benign peripheral nerve tumor specifically developing from Schwann cells. Cervical sympathetic chain schwannoma is rare. Following a case report, the authors describe its specific radiological and histological characteristics. Treatment is surgical. Clinical case A 56-year-old woman consulted for an isolated left lateral cervical mass of several years’ standing, but with recently associated pharyngeal discomfort. Cervical CT revealed a vascularized retrostyloid mass with venous-time enhancement, inducing anterior displacement of the jugulo-carotid axis. The tumor could not be identified on fine-needle aspiration cytology, and surgical resection was performed by cervicotomy. Surgical exploration found a tumor developing from the cervical sympathetic nerve, posterior to the jugular vein and carotid sheath. Histopathologic examination diagnosed schwannoma. Postoperative outcome featured Horner's syndrome. Conclusion Cervical sympathetic chain schwannoma is a rare benign tumor, to be suspected in the presence of an isolated lateral cervical mass. Preoperative CT is mandatory to guide diagnosis; treatment is surgical, to confirm histologic diagnosis. Postoperative Horner's syndrome often confirms cervical sympathetic chain involvement.

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