269 research outputs found
Surgical Approaches to Pre-Auricular Cutaneous Squamous Cell Carcinomas Extending to the Temporal Bone
No full textBackground
Standardized surgical approaches to advanced pre-auricular cutaneous squamous cell carcinomas (cSCC) are lacking.
Methods
Fifty–four patients who underwent lateral temporal bone resection (LTBR) for pre-auricular cSCC were grouped into “Levels” of increasing disease spread. Surgical approaches to achieve negative-margin resection were designed for each Level and replicated on cadaveric specimens.
Results
Level 1 extended to the external auditory canal, requiring LTBR ± superficial parotidectomy. Level 2 involved the retromandibular space ± temporomandibular joint, necessitating partial mandibulectomy, in addition to the above. Level 3 and 4 involved the deep parotid, being situated either away from (> 5 mm) or close (≤ 5 mm) to the anterior carotid sheath (ACS), respectively. These tumors require radical parotidectomy, with incorporation of the ACS for Level 4. Level 5 involved the ACS at the skull base and should be treated non-surgically.
Conclusion
This Level-based system will hopefully lead to further prospective studies and improvements in outcomes for advanced pre-auricular cSCC.Full Tex
Midwinter atmospheric temperature at altitude ~87km
No full textProgress Code: onGoingStatement: Measurements of winter mean hydroxyl layer (~87 km) temperatures above Davis station, Antarctica are to be compared with measurements at other sites around the globe. Excessive cooling rates, significantly exceeding model predictions, of up to 0.7 K per annum have been reported (Golitsyn et al., 1996) from northern hemisphere measurements of hydroxyl airglow. Initial determinations must derive the solar cycle variation at this site, then a comparison can be made with the excessive cooling rates (-0.7 Kpa) reported in the literature (by around 2006) and eventually with model-expected cooling associated with greenhouse gas increases (by around 2012). Variations in rates of cooling (lower atmosphere warming) associated with moderation of greenhouse gas emissions will hopefully be measurable thereafter.This indicator is no longer maintained, and is considered OBSOLETE. <br/><br/>See the metadata record "Davis_OH_airglow" for access to these data.<br/><br/>INDICATOR DEFINITION<br/>Midwinter atmospheric temperatures at ~87km above Davis station, Antarctica, are determined from hydroxyl airglow emissions. The temperature reported is determined over the interval, day-of-year (DOY) 106 to DOY 258.<br/><br/>TYPE OF INDICATOR<br/>There are three types of indicators used in this report:<br/>1.Describes the CONDITION of important elements of a system;<br/>2.Show the extent of the major PRESSURES exerted on a system;<br/>3.Determine RESPONSES to either condition or changes in the condition of a system.<br/><br/>This indicator is one of: CONDITION<br/><br/>RATIONALE FOR INDICATOR SELECTION<br/>Over the last century the concentration of greenhouse gases has risen in the atmosphere. Greenhouse gases result in warming of the lower atmosphere but enhanced cooling of the upper atmosphere. Enhanced cooling rates of the upper atmosphere may provide a more readily measurable indicator of 'global warming'.<br/> <br/>Midwinter hydroxyl layer temperatures, give a proxy temperature for an altitude of ~87km (just below the coldest region of the atmosphere in winter). Associated with anthropogenic greenhouse gas increases, this tenuous region of the atmosphere is expected to cool, with the magnitude of the cooling being significantly larger than the warming at ground level. When properly measured and interpreted, this may be the atmospheric region where variations in trends associated with anthropogenic climate change can be most rapidly and conclusively determined.<br/><br/>Hydroxyl airglow is emitted from an ~8km wide layer, centred at ~87 km.<br/><br/>DESIGN AND STRATEGY FOR INDICATOR MONITORING PROGRAM<br/>Spatial Scale: Point value at Davis station, Antarctica<br/><br/>Frequency: Winter averages<br/><br/>Measurement Technique: Hydroxyl airglow rotational temperatures are determined by the standard technique involving the ratios of the intensity of hydroxyl airglow line emissions. The difficulties encountered and methods adopted at Davis are detailed in Greet et al., 1998. Refinement to the absolute temperatures determined by this technique have been published by French et al., 2000.<br/><br/>RESEARCH ISSUES<br/>The values continue to be refined, though their relative difference between years is well quantified (see error estimates). The potential exists for determining some values at earlier epochs if instrumental uncertainties can be better quantified. This work is underway.<br/><br/>LINKS TO OTHER INDICATORS<br/>Noctilucent cloud observations<br/>Polar statospheric cloud observations<br/>Stratopause region parameters for Davis<br/>Tropospheric and lower stratospheric temperatures<br/>Monthly averages of daily maximum and minimum temperatures<br/>Monthly extremes of daily maximum and minimum temperatures<br/>Atmospheric concentrations of greenhouse gas species<br/><br/>The fields in this dataset are:<br/>Year<br/>Temperatur
The distribution of blood eosinophil levels in a Japanese COPD clinical trial database and in the rest of the world
No full textNeil Barnes,1,2 Takeo Ishii,3,4 Nobuyuki Hizawa,5 Dawn Midwinter,6 Mark James,3 Emma Hilton,1 Paul Jones1,71Respiratory Medicine Franchise, GlaxoSmithKline, Brentford, UK; 2William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK; 3Medical Affairs, GlaxoSmithKline K.K., Tokyo, Japan; 4Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; 5Department of Pulmonary Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan; 6Global Respiratory Department, GlaxoSmithKline, Stockley Park, UK; 7Institute of Infection and Immunity, St George’s University of London, London, UK Background: Blood eosinophil measurements may help to guide physicians on the use of inhaled corticosteroids (ICS) for patients with chronic obstructive pulmonary disease (COPD). Emerging data suggest that COPD patients with higher blood eosinophil counts may be at higher risk of exacerbations and more likely to benefit from combined ICS/long-acting beta2-agonist (LABA) treatment than therapy with a LABA alone. This analysis describes the distribution of blood eosinophil count at baseline in Japanese COPD patients in comparison with non-Japanese COPD patients.Methods: A post hoc analysis of eosinophil distribution by percentage and absolute cell count was performed across 12 Phase II–IV COPD clinical studies (seven Japanese studies [N=848 available absolute eosinophil counts] and five global studies [N=5,397 available eosinophil counts] that included 246 Japanese patients resident in Japan with available counts). Blood eosinophil distributions were assessed at baseline, before blinded treatment assignment.Findings: Among Japanese patients, the median (interquartile range) absolute eosinophil count was 170 cells/mm3 (100–280 cells/mm3). Overall, 612/1,094 Japanese patients (56%) had an absolute eosinophil count ≥150 cells/mm3 and 902/1,304 Japanese patients (69%) had a percentage eosinophil ≥2%. Among non-Japanese patients, these values were 160 (100–250) cells/mm3, 2,842/5,151 patients (55%), and 2,937/5,155 patients (57%), respectively. The eosinophil distribution among Japanese patients was similar to that among non-Japanese patients. Within multi-country studies with similar inclusion criteria, the eosinophil count was numerically lower in Japanese compared with non-Japanese patients (median 120 vs 160 cells/mm3).Interpretation: The eosinophil distribution in Japanese patients seems comparable to that of non-Japanese patients; although within multi-country studies, there was a slightly lower median eosinophil count for Japanese patients compared with non-Japanese patients. These findings suggest that blood eosinophil data from global studies are of relevance in Japan.Keywords: COPD, blood eosinophil count, percentage blood eosinophil, Japa
Vascular trauma: training the surgeon of the future
No full textSignificant changes in residency programs and exposure to vascular trauma cases during training and professional career, as well as new approaches to management of vascular injury, including the developments of endovascular techniques, mandate a reappraisal of how both vascular specialists and general surgeons are prepared to manage vascular trauma. New strategies in delivering both technical and nontechnical skills training are required to deliver quality care to the patient with a vascular injury. While specialist vascular surgeons will deliver some of this care, there are many situations where this is not practical; so nonvascular specialists must also have a skill set to deal with a patient whose complex injury includes a vascular injury. The ideal curriculum with unambiguous goals and with testable competencies is being defined. Courses are being developed to deliver vascular trauma training that uses a synthesis of techniques, including animal-model training, human cadaveric training, and simulation-based training. It has been recognized that crew resource management (CRM), as utilized in other safety critical industries such as aviation, is an important component in minimization of errors and requires team-based training. This chapter explores the current positions and solutions and looks to how, through future-defined curricula, surgeons may best use the technologies available to gain the necessary expertise to deliver the best care to patients with vascular injury
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