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To determine factors affecting facial nerve outcome of vestibular schwannoma surgery.
Methods:
This retrospective cohort study comprised 652 patients. The outcome measure was House–Brackmann classification at two years post-operatively. Univariate and multivariate analyses were carried out to determine the factors affecting facial nerve outcome. The incidence rates of hemifacial spasm, metallic taste and crocodile tear syndrome were recorded.
Results:
For tumours less than 1.5 cm, 95 per cent of outcomes were normal, 100 per cent were satisfactory (House–Brackmann grades I–III) and 0 per cent were unsatisfactory (grades IV–VI). For tumours 1.5–2.4 cm, 83 per cent of outcomes were normal, 99 per cent were satisfactory and 1 per cent were unsatisfactory. For tumours 2.5–3.4 cm, 68 per cent of outcomes were normal, 96 per cent were satisfactory and 4 per cent were unsatisfactory. For tumours 3.5–4.4 cm, 52 per cent of outcomes were normal, 80 per cent were satisfactory and 20 per cent were unsatisfactory. For tumours larger than 4.4 cm, 50 per cent of outcomes were normal, 72 per cent were satisfactory and 28 per cent were unsatisfactory.
Conclusion:
Tumour size and operation year were significant predictors of facial nerve outcome. The surgical learning curve was steepest for the first 50 patients.
Leafhoppers in Utah frequently are parasitized to an important extent by the maggots of big-eyed flies. The following report deals largely with Pipunculus fiies collected in Utah canyons and apparently parasitizing the meadow and range leafhoppers which usually were abundant wherever the big-eyed flies were found in appreciable numbers. A number of the intermountain representatives of this important dipterous family appear to be undescribed.
Fe12%Cr was irradiated with 2MeV and 0.5MeV Fe+ ions at 320°C, to create a layer with a mean level of displacement damage of 6.18dpa to a depth of ∼800nm. Spherical indentation, with a nominal tip radius of 10μm, was used to investigate the mechanical properties of the damage layer. Indents produced with loads of 2mN, 3mN, 5mN and 10mN were cross-sectioned and fabricated into TEM foils using an in situ lift-out technique in a dual beam FIB-SEM microscope. The extent of the plastic zone beneath the indent was observed in the TEM for each indentation. The indentation results were analysed so as to give an indentation stress-strain curve, in which strain softening was found to occur beyond the yield point. At loads up to 3mN the plastic zone remained entirely within the damage layer, implying strain-softening of the damaged material. At higher indentation loads the plastic zone was observed to extend into the softer un-irradiated substrate, giving rise to a further fall in flow stress with increasing strain.
The performance of materials exposed to high doses of neutron radiation is currently of great interest for the development of nuclear fusion energy production. An Fe12%Cr alloy was subjected to high-dose (6 dpa) radiation with 2MeV Fe+ ions to simulate the damage structures caused by neutron radiation, resulting in a damage layer ∼0.7 μm in depth from the surface. Spherical nanoindentation, using indenters with radii of 5, 10, and 20 μm, was used to determine reliable values for the initial yield pressure, the evolution of plastic deformation and the elastic modulus of this material, in the irradiated and unirradiated condition. The results showed that the initial yield pressure within the damage layer can be determined and was approximately a factor of two higher than that of the same material in the unirradiated condition. The irradiated material appeared to display strain softening following yield.
This review was undertaken for the Faculty and Institute of Actuaries as part of their programme to encourage research collaborations between health researchers and actuaries in order to understand better the factors influencing mortality and longevity. The authors presented their findings in a number of linked sessions at the Edinburgh conference (Joining Forces on Mortality and Longevity) in October 2009 and contributed to this overview. The purpose is to review evidence for the impact on adult mortality of characteristics of the individual's lifetime socioeconomic or psychosocial environment or phenotype at the behavioural; multi-system (e.g. cognitive and physical function); or body system level (e.g. vascular and metabolic traits) that may be common risk factors for a number of major causes of death. This review shows there is growing evidence from large studies and systematic reviews that these individual characteristics, measured in pre-adult as well as the adult life, are associated with later mortality risk. The relative contribution of lifetime environment, genetic factors and chance, whether these contributions change with age, and the underlying social and biological pathways are still to be clarified. This review identifies areas where further life course research is warranted.
To determine the epidemiological characteristics of postoperative invasive Staphylococcus aureus infection following 4 types of major surgical procedures.
Design.
Retrospective cohort study.
Setting.
Eleven hospitals (9 community hospitals and 2 tertiary care hospitals) in North Carolina and Virginia.
Patients.
Adults undergoing orthopedic, neurosurgical, cardiothoracic, and plastic surgical procedures.
Methods.
We used previously validated, prospectively collected surgical surveillance data for surgical site infection and microbiological data for bloodstream infection. The study period was 2003 through 2006. We defined invasive S. aureus infection as either nonsuperficial incisional surgical site infection or bloodstream infection. Nonparametric bootstrapping was used to generate 95% confidence intervals (CIs). P values were generated using the Pearson x2 test, Student t test, or Wilcoxon rank-sum test, as appropriate.
Results.
In total, 81,267 patients underwent 96,455 procedures during the study period. The overall incidence of invasive S. aureus infection was 0.47 infections per 100 procedures (95% CI, 0.43–0.52); 227 (51%) of 446 infections were due to methicillin-resistant S. aureus. Invasive S. aureus infection was more common after cardiothoracic procedures (incidence, 0.79 infections per 100 procedures [95% CI, 0.62–0.97]) than after orthopedic procedures (0.37 infections per 100 procedures [95% CI, 0.32–0.42]), neurosurgical procedures (0.62 infections per 100 procedures [95% CI, 0.53–0.72]), or plastic surgical procedures (0.32 infections per 100 procedures [95% CI, 0.17¬0.47]) (P < .001). Similarly, S. aureus bloodstream infection was most common after cardiothoracic procedures (incidence, 0.57 infections per 100 procedures [95% CI, 0.43–0.72]; P < .001, compared with other procedure types), comprising almost three-quarters of the invasive S. aureus infections after these procedures. The highest rate of surgical site infection was observed after neurosurgical procedures (incidence, 0.50 infections per 100 procedures [95% CI, 0.42–0.59]; P < .001, compared with other procedure types), comprising 80% of invasive S. aureus infections after these procedures.
Conclusion.
The frequency and type of postoperative invasive S. aureus infection varied significantly across procedure types. The highest risk procedures, such as cardiothoracic procedures, should be targeted for ongoing preventative interventions.
The lowland rain-forest ecosystem in Sundaland (Borneo, Sumatra, Java, the Malay Peninsula south of 10°N, and associated islands) has been recognized as a biodiversity hotspot (Myers et al. 2000). However, it is suffering from huge amounts of disturbance, and it is predicted that South-East Asia will lose three-quarters of its rain forest by the turn of next century (Sodhi et al. 2004).
Background. Jacobs and Bovasso reported (Psychological Medicine 2000, 30, 669–678) that maternal death in childhood and chronic severe depression in adulthood were associated with subsequent breast cancer. We have examined the effects of parental loss in childhood and psychiatric disorder in adult life on breast cancer risk using a national birth cohort study.
Method. Eighty-three cases of breast cancer were diagnosed in a study of 2253 women followed from birth to age 59 years. Cox proportional hazards models were used to test whether breast cancer rates were higher in women who experienced parental death and divorce before age 16, psychiatric disorders between 15 and 32 years, symptoms of anxiety and depression at 36 years, or use of antidepressant medication at 31 or 36 years than in women who did not have these experiences.
Results. There was no overall association between parental death, parental divorce or psychiatric disorder and the incidence of breast cancer. There was some evidence that women with more severe psychiatric disorders between the ages of 15 and 32 years were more likely to develop breast cancer early. The interaction between parental divorce and severe psychiatric disorder was non-significant (p=0·1); however, the group who experienced both these events had an increased breast cancer risk compared with those who experienced neither [hazard ratio (HR) 2·64, 95% confidence interval (CI) 1·13–6·19].
Conclusions. Our study does not provide strong support for the hypothesis that early loss or adult psychiatric disorders are associated with breast cancer. A meta-analysis is needed that uses data from all available cohort studies and investigates possible interactive effects on breast cancer risk.
High expressed emotion in carers predicts relapse in psychosis, but it is
not known why this is so. In our cognitive model of psychosis, we
postulated that the effect is mediated through affective changes.
Aims
To investigate the relationships between carer expressed emotion,
patients' symptoms and carer characteristics during a recent relapse of
psychosis.
Method
A total of 86 patients and carers were investigated in a cross-sectional
design.
Results
Patients whose carers showed high expressed emotion had significantly
higher levels of anxiety and depression, but not more psychotic symptoms
or lower self-esteem. Linear regression showed that carers' critical
comments predicted anxiety in patients. Critical comments were related to
low carer self-esteem and avoidant coping strategies. Low carer
self-esteem was also related to carer depression, stress and carer
‘burden’, and to low patient self-esteem.
Conclusions
Our hypothesis was partially supported. Carer criticism was associated
with patient anxiety, low carer self-esteem and poor carer coping
strategies. Family interventions should focus on improving these after a
relapse of symptoms of psychosis.
This paper evaluates the outcome of retrosigmoid microvascular decompression of the facial nerve in a series of patients suffering from hemifacial spasm who had been referred to the skull-base team (comprising senior authors DAM and DGH). The paper is a retrospective review of 15 patients who underwent retrosigmoid microvascular decompression of the facial nerve at Addenbrooke's Hospital between 1985 and 1995. In this series it was possible to obtain complete resolution of hemifacial spasm in 93.3 per cent of cases in the short term and in 80 per cent in the long term. Twelve patients (80 per cent) were symptom-free post-operatively. Two patients had minor recurrence of symptoms occurring within six months of the procedure. One patient with no identifiable vascular impingement of the facial nerve had no improvement following surgery. Three patients suffered sensorineural hearing loss. Two patients complained of post-operative tinnitus, and transient facial palsy was noted in one patient.
Retrosigmoid microvascular decompression of the facial nerve provides excellent long-term symptom control in a high percentage of patients with hemifacial spasm.
In February and in June 1998, two people developed acute hepatitis B following in-patient care in a district general hospital. Initial enquiries indicated their infections were not attributable to staff undertaking exposure-prone procedures (EPPs). We report the findings and implications of the subsequent investigation: a multi-disciplinary, multi-agency investigation, including molecular epidemiological analysis. Occupational Health records showed that staff involved in EPPs with the patients were HBsAg negative. No contact between the patients was identified nor were there failures in sterilization. The patients' HBV strains were identical, indicating a common source. A total of 231 out of 232 staff who might have treated either patient were tested for HBsAg; the remaining doctor, working abroad, was HBsAg- and HBeAg-positive and had the same HBV strain as the patients. On two occasions the doctor's hand had been cut while breaking glass vials, but there was no documentation linking these events to the two patients. The doctor had been vaccinated in 1993 and tested for anti-HBs prior to commencing work in 1997. The doctor was recalled to Occupational Health but did not attend and was not followed up. In total, 4948 patients potentially treated by the doctor received an explanatory letter and 3150 were tested for HBsAg. Only one was positive, and HBV sequencing showed no link to the doctor. Occasionally transmission of HBV from heath-care workers can occur in a non-EPP setting and the implications of this require examination by those setting national policy. Occupational Health Services should investigate clinical heath-care workers who do not respond to vaccination. They should ensure HBV carriers are identified and offer them appropriate advice to prevent transmission to patients.
Cavernous haemangiomas are rare lesions of the cerebello-pontine angle that can mimic the more commonly occurring vestibular schwannoma. A case report involving a patient with a cavernous haemangioma of the internal auditory canal (IAC) highlights this as a diagnostic possibility for lesions of the IAC by comparing and contrasting the clinical and radiological findings with the more commonly occurring vestibular nerve and facial schwannomas.
Symptoms such as hearing loss and facial paralysis that are disproportionate to the size of the lesion or fluctuate with hormonal changes such as those seen in pregnancy are suggestive of haemangioma. Radiological imaging demonstrating a lesion enchancing with gadolinium and containing areas of calcification is also suggestive of haemangioma. It is important to consider the possible diagnosis of haemangioma as early recognition of this entity may improve the chances of preserving the functional integrity of the facial nerve.
The successful demonstration of sequentially drying, calcining and vitrifying an oxalate slurry in the Drain Tube Test Stand (DTTS) vessel provided the process basis for testing on a larger scale in a cylindrical induction heated melter. A single processing issue, that of batch volume expansion, was encountered during the initial stages of testing. The increase in batch volume centered on a sintered frit cap and high temperature bubble formation. The formation of a sintered frit cap expansion was eliminated with the use of cullet. Volume expansions due to high temperature bubble formation (oxygen liberation from cerium reduction) were mitigated in the DTTS melter vessel through a vessel temperature profile that effectively separated the softening point of the glass cullet and the evolving oxygen from cerium reduction. An increased processing temperature of 1470°C and a two hour hold time to fine any remaining bubbles successfully reduced bubbles in the poured glass to an acceptable level. The success of the preliminary process demonstrations provided a workable process basis that was directly applicable to the newly installed Cylindrical Induction Melter (CIM) system, making the batch flowsheet the preferred option for vitrification of the americium-curium surrogate feed stream.
Une méthode de synthèse simple, permettant de faire croître des
monocristaux de
composition ${\rm Hg}_{{\rm l}-x}{\rm M}_x{\rm Ba}_2{\rm Ca}_{n-1}{\rm Cu}_n
{\rm O}_{2n+2+\delta}$ (n = 1, 2 et 3) sans utiliser de boîte à gants ou de
techniques sous hautes pressions, a été developpée en substituant
partiellement le mercure par un
cation M (M = Bi, Cu, Ti). Des études par microscopie électronique
couplées avec des analyses
EDX ont confirmé les modes d'empilement et l'introduction de 1'é1ément M
sous la forme de
couches mixtes ${\rm Hg}_{0,8}{\rm M}_{0,2}$. Les études structurales réalisées par
diffraction de rayons X sur
monocristal ont mis en évidence un éclatement du site oxygène lié à la
couche mercure. Ces
monocristaux, bruts de synthèses, présentent des Tc comparables à
celles observées dans les
céramiques "tout mercure" correspondantes. L'étude des propriétés
d'ancrage des vortex, menée
sur les cristaux dopés au bismuth, confirme la position intermédiaire
du terme n = 1 par rapport aux
termes n = 2 et n = 3. De plus, une comparaison entre les cristaux de
type 1223 (n = 3) dopés
successivement au titane (${\rm Hg}_{0,6}{\rm Ti}_{0,4}{-}1223$) et au bismuth
(${\rm Hg}_{0,8}{\rm Bi}_{0,2}{-}1223$) semble mettre en avant
les valeurs du rapport Hg/M et du paramètre c sur ces propriétés.
The physics, chemistry and biology of the sea surface are closely interrelated. Plankton in the water column produce an abundance of particulate and dissolved organic material, some of which is transported to the surface either passively by floatation or actively by bubble transport. Atmospheric deposition also enriches the sea surface with natural and anthropogenic compounds, which often accumulate there in relatively high concentrations compared with those in the water column. The abundance of organic matter at the sea surface provides a substrate for the growth of organisms that inhabit the sea surface microlayer: the neuston. Most studies suggest that the sea surface represents a highly productive, metabolically active interface. Organisms from most major divisions of the plant and animal kingdoms either live, reproduce or feed in the surface layers. Of particular interest are the microneuston, which may be involved in biogeochemical cycling, and neustonic eggs and larvae of commercially important fish and shellfish.
The quantities and types of anthropogenic chemicals entering the earth's atmosphere continue to grow. Many of these chemicals, some of which are highly toxic, are now globally distributed in the atmosphere and deposit to the sea surface even in remote areas. Due to stratospheric ozone depletion, ultraviolet-b (UV-B) radiation reaching the sea surface is increasing annually.