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A project team from the United Kingdom Oncology Nursing Society developed a blended e-learning website to facilitate nurses to further develop their confidence and competencies in a range of skills related to assessing the holistic needs of people with cancer. The project team identified three areas which were integral to an holistic needs assessment (HNA) implementation project. These were project support information, project management skills, and practical competencies delivered in a blended e-learning package containing a series of accessible video presentations, supporting documents, and practical activities. The team worked with internal and external partners to ensure that a robust and inspiring programme was created. www.hnaforcancer.com was launched in October 2012 as a blended learning programme that incorporates e-learning on core subjects. These subjects are packaged as videoed presentations with supporting learning material and can be accessed via the UKONS website. By the end of the programme participants were equipped to identify and explore the essential requirements for HNA and care planning, more able to recognise potential need, and initiate care to prevent or minimise the risk of complications. Participants had also developed confidence and competency in new skills, including basic project management. [ABSTRACT FROM AUTHOR]

This review briefly considers the testicular damage elicited by environmental chemical pollution. It includes a short comment on environmental toxicology as an introduction to environmental chemical pollution, highlighting the importance of this current field of study and its impact on male reproductive health. Furthermore an experimental animal model addressing the effect of organophosphorated agropesticides as a testicular toxicant is presented. Moreover two relevant chemical contaminants and their effect on the testis, such as the classical case of lead and the rarely reported case of Boron on spermatogenesis, are considered. Additionally, the subject of biosentinel species and their relevance for the monitoring of pollution in aquatic and/or terrestrial ecosystems is considered. In conclusion, it should be stressed that environmental health is closely related to the reproductive health of all living beings. [ABSTRACT FROM AUTHOR]

Abstract Background The Borough of Brent has one of the largest ethnic minority populations in England, with a growing number of refugee communities from Africa and Europe. Two important issues to be considered when developing culturally sensitive services in the hospital (including food provision) are that practices meet the religious and cultural requirements of the population that the hospital serves and that staff are equipped with the skills to understand cultural differences in illness and treatment. Aims To review accessibility and suitability of multicultural meals to minority ethnic communities across five hospital sites in Brent and determine the level of nursing staff knowledge of multicultural dietary competencies. Methods One survey was completed in each of the five hospital sites to gather information about current catering practices. Two separate questionnaires obtained information of the level of inpatient satisfaction with multicultural meals amongst Hindu, Muslim, Caribbean and Jewish patient groups and knowledge of nursing staff about multicultural competencies. Community groups representing minority ethnic populations participated in focus groups to establish feedback about dietary requirements in hospitals. Results Access to multicultural meals varied across hospital sites. Of 98 patients in the inpatient satisfaction survey, 74% were aware of the availability of multicultural meals with 51% of these patients not ordering any of the Asian vegetarian, Asian halal, Caribbean or kosher meals, citing satisfaction with European food as the main reason. Those ordering multicultural meals reported satisfaction most of the time (42%), satisfied most of the time (38%) and never satisfied (19%). The African Muslim group was the least satisfied with current halal meal provision. Forty-seven per cent of nurses questioned could accurately answer questions about multicultural dietary competencies. Conclusions Improvements could be made to improve... [ABSTRACT FROM AUTHOR]

We are concerned in this paper with the ideal structure of group rings of infinite simple locally finite groups over fields of characteristic zero, and its relation with certain subgroups of the groups, called confined subgroups. The systematic study of the ideals in these group rings was initiated by the second author in [15], although some results had been obtained previously (see [3, 1]). Let G be an infinite simple locally finite group and K a field of characteristic zero. It is expected that in most cases, the group ring KG will have the smallest possible number of ideals, namely three, (KG itself, {0} and the augmentation ideal), and this has been verified in some cases. In some interesting cases, however, the situation is different, and there are more ideals. We mention in particular the infinite alternating groups [3] and the stable special linear groups [9], in which the ideal lattice has been completely determined. The second author has conjectured that the presence of ideals in KG, other than the three unavoidable ones, is synonymous with the presence in the group of proper confined subgroups. Here a subgroup H of a locally finite group G is called confined, if there exists a finite subgroup F of G such that Hg)F`1 for all gG. This amounts to saying that F has no regular orbit in the permutation representation of G on the cosets of H. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the difference of tyrosine hydroxylase (TH)-positive dopaminergic (DA) neurons from human-induced pluripotent stem cells (hiPSCs) derived from schizophrenia (SZ) patients.

A neonate who presented with circulatory collapse was found to have myocardial infarction caused by thrombotic occlusion of the left main coronary artery. At autopsy, a thrombus was found in the ductus venosus making paradoxical embolism through the foramen ovale the most likely mechanism of coronary occlusion. [ABSTRACT FROM AUTHOR]

A neonate who presented with circulatory collapse was found to have myocardial infarction caused by thrombotic occlusion of the left main coronary artery. At autopsy, a thrombus was found in the ductus venosus making paradoxical embolism through the foramen ovale the most likely mechanism of coronary occlusion. [ABSTRACT FROM AUTHOR]

Purpose: Intramedullary (IM) nail use for metaphyseal fracture management is problematic in long bones like the femur because the larger medullary cavity allows increased fracture motion and potentially increased implant failure and malunion/nonunion risk; Achieving effective distal femur fracture fixation is even more difficult in osteoporotic bone. Blocking screws to control IM nail movement are known to be effective for tibia fracture management. Few studies have evaluated IM nail and blocking screw use efficacy for distal femur fracture fixation in osteoporotic bone.Methods: This study used an osteoporosis simulation synthetic bone model to evaluate retrograde IM nail fixation of a standardized non-comminuted, extra-articular distal femur fracture with and without blocking screws. The hypothesis was that use of one or two blocking screws would increase IM nail fixation stability as evidenced by greater peak IM nail load and lesser movement. A servohydraulic device under displacement control collected loading force versus movement deflection data. Shapiro-Wilk tests confirmed data normality. One-way analysis of variance and Tukey post hoc tests were used to compare condition specific loading force and movement differences.Result: In the coronal plane, blocking screw conditions displayed greater loading ranges (38.3 ± 2 vs. 19.1 ± 2 N, 100.5% difference) (p < 0.0001) and lesser movement (2.0 ± 0.3 vs. 6.86 ± 0.4 mm, 243% difference) (p < 0.0001). In the sagittal plane, the two blocking screw condition displayed a significantly greater loading magnitude (29.9 ± 6 vs. 20.8 ± 2.3 N, 43.8% difference) than the identical control condition without blocking screws (p = 0.018); however, movements were comparable (p = 0.82). Long-axis rotational loading failed to reveal load magnitude differences (p = 0.28); however, two different blocking screw conditions displayed decreased movement (1.32 ± 0.2 vs. 2.05 ± 0.3 mm, 53.8% difference) compared to other conditions (p ≤ 0.018).Conclusions: Use of one or two blocking screws on the medial and lateral sides of the IM nail decreased coronal plane movement in the intramedullary canal. Combining retrograde IM nail implantation with blocking screws reduced medial-lateral IM nail movement and increased fracture stability. These characteristics may help prevent fixation failure, malunion, and even nonunion in patients with a distal femur fracture in osteoporotic bone. [ABSTRACT FROM AUTHOR]

Presents a case study of a man with diabetes and unexplained renal failure. Results from an ultrasonography; Diabetic control of patient; What a biopsy specimen of the normal-sized kidney, with a normal artery showed; Medical history of the patient.

Background Positive immunohistochemical staining for glucose transporter-1 protein (GLUT1) is a characteristic of cutaneous infantile haemangiomas. Objectives To examine GLUT1 expression in subglottic haemangiomas. Methods Review of clinical notes and biopsy tissue with immunostaining for GLUT1 in 14 patients with subglottic haemangiomas. Results GLUT1 immunostaining was negative in 11 cases, and focally positive in three. No subglottic haemangiomas demonstrated the intense diffuse positive GLUT1 staining seen in cutaneous infantile haemangiomas. Five patients had cutaneous as well as subglottic haemangiomas, one of whom had a GLUT1-negative subglottic haemangioma and a GLUT1-positive cutaneous haemangioma of the lip. Conclusions Subglottic haemangiomas appear immunohistochemically different from cutaneous infantile haemangiomas, which may reflect differences in endothelial cell differentiation or underlying aetiology. [ABSTRACT FROM AUTHOR]

Objective: Cochlear implantation is now a well-accepted procedure in the paediatric population. The objective of this study was to evaluate the use of small postaural incision for cochlear implantation in children.Methods: This study is a retrospective review of patients who had cochlear implantation using small postaural incision. Patient records of 34 patients who were implanted using this incision are reviewed. The technique involves drilling the bony well for the implant inside a small subperiosteal pocket standing opposite the operated ear. The rest of the steps were the same as for standard cochlear implantation.Results: The technique proved to be very successful in all the cases. Three patients (3/34) had complications, of which two (CSF gusher and otorrhoea) were unrelated to the incision and one patient developed a mild keloid in the incision. None of the patients developed haematomas or wound infection. The incision healed well in all the cases. The average operating time was 2.5 h (which includes trainees operating and difficult cases) which dropped to 2h when the entire operation was done by the senior surgeon. In none of the cases did the incision have to be extended for exposure. The average postoperative follow up was 18 months. Patient and parent satisfaction with the small incision was extremely high.Conclusions: Cochlear implantation using small postaural incision approach has shown good results in this series. It has been well accepted by children, their parents and the other members of the cochlear implant team. It reduces morbidity associated with a big incision and helps in quicker recovery from the operation. [ABSTRACT FROM AUTHOR]

The pattern and sequence of cellular degradation during the course of leaf senescence remains obscure and the nature of the trigger that induces cell senescence is unknown. In order to probe the pre-mortem phase of senescence temporal changes in cell ultrastucture were studied in aging leaves of light-grown achlorophyllous Hordeum vulgare L. cv. Dyan mutant seedlings. Electron microscope examination of the ultrastructure of mesophyll cell plastids revealed the absence of ribosomes and a highly disorganized prolamellar body. Both the number and size of plastoglobuli increased with aging and this change coincided with depletion of starch grains and dilation of lamellar membranes. Aging of mesophyll cells occurred coincident with a decline in ribosome content of the cytoplasm and loss of matrix granularity. Loss of ribosomes associated with the outer nuclear envelope membrane and a reduction in chromatin were also apparent. Only after 10 days was there evidence of loss of internal membrane integrity and swelling of mitochondrial cristae. Compartmentation was thus maintained during the aging process with membrane dissolution occurring late in senescence. These results suggest that an inability to produce chlorophyll and carotenoids and form thylakoid stacks due to the absence of plastid ribosomes, contributes to the rapid onset of senescence in light-grown achlorophyllous seedlings. Furthermore, disruption of chloroplast ribosome synthesis/assembly may constitute part of the plastid signal involved in triggering cell senescence. [ABSTRACT FROM AUTHOR]

We studied 23 children with steroid-sensitive nephrotic syndrome (SSNS), 21 children with steroid-resistant types of nephrotic syndrome and 32 children with other types of nephritis. Our controls were 43 apparently healthy children. We measured the urinary excretion of N-acetyl-β-D-glucosaminidase (NAG) and the low molecular weight (LMW) proteins β[sub 2] -microglobulin (B2M), retinol-binding protein (RBP), α[sub 1] -microglobulin (A1M) and urine protein 1 (UP1). Results for B2M were considered only for a urine pH greater than 6.0. Comparisons were made with urine albumin excretion, glomerular filtration rate (GFR) and tubular abnormalities in selected renal biopsy samples. We found that abnormalities of LMW protein excretion occurred in between 50% (B2M) and 88% (UP1) of all subjects. In children with SSNS, A1M (r = 0.73), UP1 (r = 0.65) and NAG (r = 0.54) excretion were significantly correlated with albumin excretion, but not RBP or B2M excretion. Increased fractional excretion of A1M, B2M and UP1 and increased plasma A1M were demonstrated in 9 children with SSNS, suggesting competition for tubular reabsorption with albumin, most marked for UP1. In the steroid-resistant nephrotic and nephritic syndromes, correlation with albumin was found for all proteins. In these subjects, RBP (r = 0.37), B2M (r = 0.42) and A1M (r = 0.28) were inversely correlated with GFR, but not UP1, NAG or albumin. We found that RBP excretion was significantly greater in the presence of severe tubular abnormalities in 11 children with recent renal biopsies, but not A1M, UP1 or NAG. We conclude that LMW proteinuria is common in children with glomerular disease, and does not necessarily imply a poor prognosis. Factors other than histologically proven tubular abnormality may account for elevated LMW protein excretion. RBP is the LMW protein most closely associated with structural abnormality and least affected by increasing albuminuria. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about the surgical procedure used for the closure of tracheocutaneous fistula in children.

Objectives:To describe our experience and provide guidelines for maximum safe balloon sizes according to age in children undergoing balloon dilatation.Method:A retrospective review was conducted of children undergoing balloon dilatation for subglottic stenosis in a paediatric tertiary unit between May 2006 and February 2016.Results:A total of 166 patients underwent balloon dilatation. Mean ( ± standard deviation) patient age was 4.5 ± 3.99 years. The median balloon size was 8 mm, the median balloon inflation pressure was 10 atm, and the mean balloon inflation time was 65.1 ± 18.6 seconds. No significant unexpected events occurred. The Pearson correlation co-efficient for the relationship between patient age and balloon size was 0.85 (p = 0.001), suggesting a strongly positive correlation.Conclusion:This study demonstrated that balloon dilatation is a safe procedure for airway stenosis. The results suggest using a balloon diameter that is equal to the outer diameter of the age-appropriate endotracheal tube +1 mm for the larynx and subglottis and +2 mm for the trachea. [ABSTRACT FROM AUTHOR]

Purpose Head and neck rhabdomyosarcoma (HNRMS) survivors are at increased risk of developing pituitary dysfunction as an adverse event of radiotherapy. Our aim was to investigate the frequency and risk factors for pituitary dysfunction in these survivors. Secondly, we aimed to compare the prevalence of pituitary dysfunction between survivors treated with external beam radiation therapy (EBRT) and survivors treated with the ablative surgery, moulage technique after loading brachytherapy, and surgical reconstruction (AMORE) procedure. Methods Eighty HNRMS survivors treated in London (EBRT based) and Amsterdam (AMORE based: AMORE if feasible, otherwise EBRT) in the period 1990–2010 and alive ≥2 years post-treatment were evaluated. Survivors were evaluated in multidisciplinary late-effects clinics, with measurement of linear growth, determination of thyroid function, and growth hormone parameters. Additional data, such as baseline characteristics, anthropometrics, pubertal stage, and the results of additional laboratory investigations, were retrieved from patient charts. Results Pituitary dysfunction was diagnosed in 24 in 80 (30%) survivors, after a median follow-up time of 11 years. Median time to develop pituitary dysfunction after HNRMS diagnosis was 3.0 years. Risk factors were EBRT-based therapy (odds ratio [OR] 2.06; 95% confidence interval [CI] 1.79–2.46), parameningeal tumour site (OR 1.83; 95% CI 1.60–2.17) and embryonal RMS histology (OR 1.49; 95% CI 1.19–1.90). Conclusions Radiotherapy used for the treatment of HNRMS confers a significant risk of the development of pituitary dysfunction. AMORE-based treatment in children with HNRMS resulted in less pituitary dysfunction than treatment with conventional EBRT. Our findings underscore the importance of routine early endocrine follow-up in this specific population. [ABSTRACT FROM AUTHOR]

Objective:Treatment options for large subglottic haemangioma include steroids, laser ablation, open excision, tracheostomy and, more recently, propranolol. This article aims to present the Great Ormond Street Hospital guidelines for using propranolol to treat infantile isolated subglottic haemangioma by ENT surgeons.Methods:The vascular malformations multidisciplinary team at Great Ormond Street Hospital has developed guidelines for treating infantile haemangioma with propranolol.Results:The Great Ormond Street Hospital guidelines for propranolol treatment for infantile subglottic haemangioma include investigation, treatment and follow up. Propranolol is started at 1 mg/kg/day divided into three doses, increasing to 2 mg/kg/day one week later. On starting propranolol and when increasing the dose, the pulse rate and blood pressure must be checked every 30 minutes for the first 2 hours. Lesion response to treatment is assessed via serial endoscopy.Conclusion:Recent reports of dramatic responses to oral propranolol in children with haemangioma and acute airway obstruction have led to increased use. We advocate caution, and have developed guidelines (including pre-treatment investigation and monitoring) to improve treatment safety. Propranolol may in time prove to be the best medical treatment for subglottic haemangioma, but at present is considered to be still under evaluation. [ABSTRACT FROM AUTHOR]

Objective:Anterior tongue reduction is indicated when macroglossia causes problems with oral hygiene, airway compromise, deglutition, articulation or orthognathic complications. Causes of macroglossia include hypothyroidism, mucopolysaccharide and lipid storage disease, lymphangioma, haemangioma, neurofibroma, and muscular macroglossia. This paper presents an 11-year experience of anterior tongue reduction at Great Ormond Street Hospital.Method:Retrospective study of patient medical records identified from the hospital ENT database. Anterior wedge resection was the preferred technique.Results:Anterior tongue reduction was performed on 18 patients, due to cystic hygroma with tongue involvement (nine patients), Beckwith–Wiedemann syndrome (eight) and Down's syndrome (one). Anterior wedge resection was preferred, using electrocautery in the majority, except for four cases involving CO2 laser. All but one patient had a good surgical outcome (i.e. tongue in mouth at rest). One patient subsequently required multiple laser procedures for recurrent macroglossia.Conclusion:Anterior tongue reduction can be a safe procedure, with limited post-operative morbidity, consistently resulting in good surgical outcomes and improvement in macroglossia symptoms. Speech development does not appear to be adversely affected. [ABSTRACT FROM PUBLISHER]

A letter to the editor is presented regarding the extended Sistrunk procedure for treating thyroglossal duct cyst (TGDC) among children.

Objective: Airway compromise due to paediatric intubation injuries is well documented; however, intubation injuries may also cause severe voice disorders. We report our experience and review the world literature on the voice effects of traumatic paediatric intubation. Case series: We report five cases of children referred to Great Ormond Street Hospital for Children who suffered traumatic avulsion of the vocal fold at the time of, or secondary to, endotracheal intubation. All children had significant dysphonia and underwent specialist voice therapy. Conclusions: The mechanisms of injury, risk factors and management of the condition are discussed. Children suffering traumatic intubation require follow up throughout childhood and beyond puberty as their vocal needs and abilities change. At the time of writing, none of the reported patients had yet undergone reconstructive or medialisation surgery. However, regular specialist voice therapy evaluation is recommended for such patients, with consideration of phonosurgical techniques including injection laryngoplasty or thyroplasty. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about the use of camera mobile phone to assess emergency otolaryngology radiological investigations.

andrews p. j., chorbachi r., sirimanna t., sommerland b. & hartley b. e. j. (2004) Clin. Otolaryngol. 29, 10–17 Hearing thresholds in children with a cleft palate prior to cleft palate repair are not widely documented, and audiological criteria for short-term ventilation tube insertion do not exist. The aims of this prospective study are to estimate hearing thresholds in 40 children with a cleft palate by 3-month developmental age with auditory brainstem responses (ABRs) under natural sleep and to estimate a hearing threshold guideline for short-term ventilation tube insertion. Our results show a wide range of air conduction hearing thresholds using click ABRs (2–4 Hz), which ranged from 25 to 102 dBnHL in the left ear and from 25 to 80 dBnHL in the right ear with means of 53 and 49 and standard deviations of 17 and 13 respectively. The bone conduction thresholds ranged from 0 to 55 dBnHL with a mean of 26 and a standard deviation of 13. Eighty-three per cent of children had flat, type B, on high-frequency tympanograms, indicative of middle ear effusion. Thirty per cent of the infants had a cleft palate associated with a known syndrome. Currently, it is the authors' practice to use short-term ventilation tubes on a selective basis at the time of cleft palate repair when there is a conductive hearing loss of more than 55 dBnHL in the better ear as determined by ABR with type B high-frequency tympanograms. This threshold level takes into account electrophysiological and auditory pathway maturation discrepancies. With this as the guideline, between 28% and 35% of the children in this study would be eligible for surgery. This criterion still requires further validation. [ABSTRACT FROM AUTHOR]

Mice rendered completely deficient of the complement components C3 or C4 were used to determine the influence of complement activation in the heterologous phase of the anti-GBM disease model. In wild-type animals the disease is characterized by a neutrophil infiltrate, capillary thrombosis, proteinuria and C3 and C4 deposited within the glomerulus. The early infiltration of neutrophils into the glomeruli is greater in wild-type mice (2.8 ± 0.3) compared with C3-deficient (1.4 ± 0.2) and C4-deficient (1.2 ± 0.003) mice. Deficiency also protects against the subsequent development of proteinuria (2.99 ± 1.11 mg/24h, 0.059mg/24h and 0.327 ± 0.14mg/24h in wild-type, C3-deficient and C4- deficient mice, respectively) and decreases glomerular capillary thrombosis in both C3- and C4- deficient mice. The degree of protection is greater in the C3-deficient than the C4-deficient animals, suggesting both classical and alternative pathway involvement. These studies support a critical role for complement in the development of anti-GBM disease. However, the protective effect of complement deficiency can be broken if the dose of nephritogenic antibody is increased. [ABSTRACT FROM AUTHOR]

Repeated low-dose injections of mercuric chloride (HgCl2) in the brown Norway (BN) rat result in polyclonal activation which includes the induction of anti-glomerular basement membrane (GBM) autoantibodies. We examined the kinetics of various autoantibodies produced in vivo, general features of polyclonal activation such as total IgG levels and immune complex formation, and the relationship between organ specific autoimmunity and tissue injury in the kidney and thyroid The production of immune complexes and autoantibodies to GBM and thyroglobulin was short lived and the increase in levels of total IgG and antibodies to ssDNA and dsDNA was prolonged; the antibody response to collagen types land II was intermediate in duration. Autoantibodies induced by HgCl: caused only mild and variable tissue injury in the kidneys and did not induce abnormalities in the thyroid. These studies demonstrate that immunostimulation by mercury may result in the formation of a range of autoantibodies with variable kinetics and pathogenicity. [ABSTRACT FROM AUTHOR]

Introduction: CHARGE syndrome is a congenital collection of anomalies of various organs including various functional and structural anomalies of the ears. Surgical management of hearing loss in CHARGE syndrome is challenging due to various anatomical malformations of the middle and inner ear. Cochlear implantation surgery for profound sensorineural hearing loss is technically difficult due to these malformations whilst cochlea nerve hypoplasia or aplasia may compromise outcomes. Aberrant facial nerve position may increase perioperative morbidity whilst developmental delay often makes global assessment of patients with CHARGE difficult. We aim to provide surgical guidance on managment of patients with CHARGE Methods: We performed a systematic review of all trials involving cochlear implantation in CHARGE syndrome. We searched Cochrane Central Register of Controlled Trials, PubMed, EMBASE through Ovid SP and Web of Science. Primary outcome measures included Health-related quality of life, audiological outcomes as well as adverse events and complications. We also assessed the most commonly recorded ear anomalies including the findings of aberrant facial nerve positon. A retrospective series of patients with CHARGE syndrome assessed for cochlear implantation at Great Ormond Street Hospital was also performed. Results: 15 patients with CHARGE were assessed at our centre between 1993 and 2017 with ten cochlear implantations performed. Semicircular canal aplasia and vestibulocochlear dysplasia were seen in all patients. All patients had abnormal facial nerve anatomy. These findings were in keeping with the findings of our systematic review which consisted of case series/retrospective reviews. No randomised controlled trials were identified. Data from the systematic review is presented in an easy-to-interpret table. Conclusions: Cochlear implantation in CHARGE patients is surgically challenging with variable outcomes. We describe our experience and compare this to the literature through a systematic review of published outcome data. [ABSTRACT FROM AUTHOR]

The article focuses on role of interleukin-5 recognizing antibody mepolizumab on oral corticosteroid (OCS) dependent asthma population. Topics discussed include mepolizumab DREAM study conducted comparing population demographics, medical conditions and efficacy responses of OCS and non-OCS dependent group, mepolizumab found to reduce peripheral and sputum eosinophils and exacerbation risk and several charts given showing characteristics and exacerbation rate of OCS and non-OCS dependent group.