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This study aimed to determine the incidence of laryngeal penetration and aspiration in elderly patients who underwent supracricoid laryngectomy with cricohyoidoepiglottopexy for laryngeal cancer.
Method
A retrospective analysis of dynamic videofluoroscopic swallowing studies was performed in patients who had received supracricoid laryngectomy with cricohyoidoepiglottopexy as a treatment for laryngeal cancers. Digital analysis of videofluoroscopic swallowing studies included measurements of displacement and timing related to swallowing safety.
Results
Videofluoroscopic swallowing studies from 52 patients were analysed. All participants were male and over 65 years old. Studies were performed five years after surgery. Among 52 videofluoroscopic swallowing studies, analysis showed that elevated pharyngeal constriction ratio (pharyngeal constriction ratio more than 0.0875, odds ratio = 5.2, p = 0.016), reduced pharyngoesophageal sphincter opening time (pharyngoesophageal sphincter open less than 0.6 seconds, odds ratio = 11.6, p = 0.00018) and reduced airway closure time (airway close less than 0.6 seconds, odds ratio = 10.6, p = 0.00057) were significantly associated with aspiration.
Conclusion
Deteriorated pharyngeal constriction, shortened airway closure and reduced pharyngoesophageal sphincter opening time are key factors for predicting laryngeal penetration or aspiration after supracricoid laryngectomy with cricohyoidoepiglottopexy.
When diamond is synthesized at conditions of comparatively high temperature and pressure, the nucleation rate is high, as is the growth rate of the nuclei. Consequently the product is usually an aggregate of crystals with dendritic or skeletal structure. In this study the presence of gold or silver as an additive mixed with a catalyst was found to have the effect of suppressing nucleation. When a homogeneous mixture of graphite, catalyst, and additive was treated at conditions where skeletons and dendrites were produced in the absence of additive, euhedral crystals of octahedra were formed. When a special cell assemblage for high pressure experiments, in which the graphite was placed inside a cylinder of catalyst coated with additive, was used, prismatic and tabular crystals were synthesized.
Uniaxial compression tests were performed on samples of the Greenland Ice Gore Project (GRIP) deep ice core, both in the field and later in a cold-room laboratory, in order to understand the ice-flow behavior of large ice sheets. Experiments were conducted under conditions of constant strain rate (type A) and constant load (type B). Fifty-four uniaxial-compression test specimens from 1327-2922 m were selected. Each test specimen (25 mm x 25 mm x 90 mm) was prepared with its uniaxial stress axis inclined 45° from the core axis in order to examine the flow behavior of strong single-maximum ice-core samples with basal planes parallel to the horizontal plane of the ice sheet. The ice-flow enhancement factors show a gradual increase with depth down to approximately 2000 m. These results can be interpreted in terms of an increase in the fourth-order Schmid factor. Below 2000 m depth, the flow-enhancement factor increases to about 20-30 with a relatively high variability When the Schmid factor was > 0.46, the enhancement factor obtained was higher than expected from the .-axis concentrations measured. The higher values of flow-enhancement factor were obtained from specimens with a cloudy band structure. It was revealed that cloudy bands affect ice-deformation processes, but the details remain unclear.
This study evaluated the longitudinal and long-term effects of radiotherapy on swallowing function after tongue reconstruction.
Methods:
The study comprised 16 patients who had: undergone glossectomy and tongue reconstruction with free flap transfer, received adjuvant radiotherapy, and survived without recurrence for at least 1 year. Swallowing function, as indicated by tolerance of oral intake, was evaluated before radiotherapy, at radiotherapy completion, and at 6 and 12 months after radiotherapy completion.
Results:
Before radiotherapy, all patients could tolerate oral intake. At radiotherapy completion, only three patients could consume all nutrition orally. However, swallowing function improved over time, and by 12 months after radiotherapy completion it had returned nearly to that before radiotherapy.
Conclusion:
Acute dysphagia due to radiotherapy after tongue reconstruction is severe, but can improve gradually. Multidisciplinary support of patients during percutaneous endoscopic gastrostomy dependence is important to improve long-term functional outcomes.
The spatial peaks QRS-T angle accurately distinguishes children with hypertrophic cardiomyopathy from their healthy counterparts. The spatial peaks QRS-T angle is also useful in risk stratification for ventricular arrhythmias. We hypothesised that the spatial peaks QRS-T angle would be useful for the prediction of ventricular arrhythmias in hypertrophic cardiomyopathy patients under 23 years of age.
Methods
Corrected QT interval and spatial peaks QRS-T angles were retrospectively assessed in 133 paediatric hypertrophic cardiomyopathy patients (12.4±6.6 years) with versus without ventricular arrhythmias of 30 seconds or longer. Significance, positive/negative predictive values, and odds ratios were calculated based on receiver operating characteristic curve cut-off values.
Results
In total, 10 patients with ventricular arrhythmias were identified. Although the corrected QT interval did not differentiate those with versus without ventricular arrhythmias, the spatial peaks QRS-T angle did (151.4±19.0 versus 116.8±42.6 degrees, respectively, p<0.001). At an optimal cut-off value (124.1 degrees), the positive and negative predictive values of the spatial peaks QRS-T angle were 15.4 and 100.0%, respectively, with an odds ratio of 25.9 (95% CI 1.5–452.2).
Conclusion
In children with hypertrophic cardiomyopathy, the spatial peaks QRS-T angle is associated with ventricular arrhythmia burden with high negative predictive value and odds ratio.
A case of salvage supracricoid laryngectomy with cricohyoidoepiglottopexy after failed radiation therapy and vertical partial laryngectomy had successful oncological and functional outcomes. This is the first reported application of salvage supracricoid laryngectomy with cricohyoidoepiglottopexy after the failure of two major treatments.
Case report:
A 65-year-old man was referred for salvage supracricoid laryngectomy with cricohyoidoepiglottopexy. The right recurrent hemilarynx was successfully resected. After pexis, the right lobe of the thyroid gland was repositioned to overlap and reinforce the pexis gap and fill the devoid portion of the strap muscular closure. Multiple scattered foci (recurrent tumour–node–metastasis stage T2) were identified around the arytenoid cartilage and beneath the musculocutaneous flap. Four years after supracricoid laryngectomy with cricohyoidoepiglottopexy, the patient's recovery was following a favourable course and he had satisfactory laryngeal function.
Conclusion:
Appropriate case selection and proficient surgical skills were essential for a successful outcome. Head and neck surgeons should not be afraid to adopt functional preservation open surgical procedures in well-selected and well-motivated patients. A requirement for more challenging surgical procedures and meticulous rehabilitation processes should not exclude appropriate treatments from a surgeon's repertoire.
We have been monitoring the flux density of Sagittarius A* (Sgr A*) at 22 GHz since DOY=42 (11 Feb. 2013) with a sub-array of the Japanese VLBI Network in order to search the increase of 22-GHz emission from Sgr A* induced by the interaction of the G2 cloud with the accretion disk. The flux densities observed until DOY=322 (18 Nov. 2013) are consistent with the previously observed values before the approaching of the cloud. We have detected no large flare during this period.
In paediatric pulmonary embolism, cardiac findings and thromboembolic outcomes are poorly defined. We conducted a mixed retrospective-prospective cohort study of paediatric pulmonary embolism at the Children's Hospital Colorado between March, 2006 and January, 2011. A total of 58 consecutive children – age less than or equal to 21 years – with acute pulmonary embolism were enrolled. Data collection included clinical and laboratory characteristics, treatments, serial echocardiographic and electrocardiographic findings, and outcomes of pulmonary embolism non-resolution and recurrence. The median age was 16.5 years ranging from 0 to 21 years. The most prevalent clinical risk factors were oral contraceptive pill use (52% of female patients), presence of a non-infectious inflammatory condition (21%), and trauma (21%). Thrombophilias included heterozygous factor V Leiden in 21%; antiphospholipid antibody syndrome was established in 31% overall. Proximal pulmonary artery involvement was present in 34%. At presentation, nearly half of the patients had hypoxaemia and 37% had tachycardia. The classic electrocardiographic finding of S1Q3T3 was present in 12% acutely; tricuspid regurgitation greater than 3 metres per second, septal flattening, and right ventricular dilation were each present on acute echocardiogram in 25%. Nearly all patients received therapeutic anticoagulation, with initial systemic tissue plasminogen activator administered in 16% for occlusive iliofemoral deep venous thrombosis and/or massive pulmonary embolism. Pulmonary embolism resolution was observed in 82% by 6 months. Recurrent pulmonary embolism occurred in 9%. There were no pulmonary embolism-related deaths. Right ventricular dysfunction was rare in follow-up. These data indicate that acute heart strain is common, but chronic cardiac dysfunction is rare, following aggressive management of acute pulmonary embolism in children.
The current trends in stimulated Brillouin scattering and optical phase conjugation are overviewed. This report is formed by the selected papers presented in the “Fifth International Workshop on stimulated Brillouin scattering and phase conjugation 2010” in Japan. The nonlinear properties of phase conjugation based on stimulated Brillouin scattering and photo-refraction can compensate phase distortions in the high power laser systems, and they will also open up potentially novel laser technologies, e.g., phase stabilization, beam combination, pulse compression, ultrafast pulse shaping, and arbitrary waveform generation.
The effects of dietary sucrose on the metabolic rate of plasma glucose and ruminal propionate as well as the change in nitrogen kinetics were examined in four mature wethers fitted with rumen fistulas in Tsukuba, Japan in 1990. Wethers were fed at 12 equal intervals daily on crushed lucerne hay cubes (1233 g DM/day), with or without 204 g/day of sucrose. Plasma urea and glucose kinetics were determined following a single intravenous injection of [I5N]urea and [U-13C]glucose respectively; and the kinetics of ruminal ammonia and propionate were determined following a single intraruminal injection of [15N]ammonium chloride and [2–13c]sodium propionate respectively. Following supplementation of sucrose to the diet, nitrogen retention was increased (P < 0·05) with a decrease in plasma urea concentration (P < 0·05) and urinary urea excretion (P < 0·05). Sucrose supplementation decreased (P < 005) the concentration and irreversible loss rate of ruminal ammonia. Urinary allantoin excretion did not change with sucrose treatment, but the flow rate of non-ammonia-nitrogen from the rumen was increased P < 0·05). The transfer rate of ruminal ammonia to plasma urea was also decreased (P < 0·01), whilst the transfer rate of plasma urea to ruminal ammonia was increased (P < 0·05) by dietary sucrose. Sucrose supplementation resulted in a higher concentration of propionate and butyrate (P < 0·05) in the rumen with no significant change in acetate or pH. The concentration of plasma glucose did not change with sucrose treatment, but the concentration of insulin, pool size (P < 0·05) and the irreversible loss rate of glucose (P < 0·01) were increased, reflecting the increase in the production rate of ruminal propionate (P < 0·05). It was concluded that the supplementation of sucrose affected the metabolism of urea and glucose in plasma via a change in ruminal production rate of ammonia and propionate, respectively.
Recent progress in research on Light Ion Beams-Inertial Confinement Fusion (LIB-ICF) at ILE, Osaka University is summarized. We report on pulsed power compression using PEOS, a super high voltage source, on diode physics, on beam trajectory control for focusing, on beam-target interactions and on a conceptual reactor design (Rokko I) in this article.
Light ion beams for the energy drive for inertial confinement fusion (ICF) research have been studied on a super high voltage generation system (SHVS) using an inductive voltage adder system. A simple analysis implied the capability of the output voltage of several tens of MV. This system has a feasibility of acceleration of ions heavier than proton. The two-stage charge stripping ion diode is considered a SHVS diode. This diode reduces the size of the induction adder module and extends the possible power range in operation. We have constructed a prototype SHVS, which consists of eight stages of induction cavities (4MV, 40kA, 100ns) powered by a Reiden IV pulse power machine. The first ion diode experiments on the induction adder were performed with the beam extraction type ion diode (Br applied magnetic field). The injection plasma ion source was used to control the diode impedance and then the diode voltage. The time delay of ion current turn-on was reduced from 15–20 ns to less than 5 ns by this ion source.
Inertial Confinement Fusion (ICF) research has been extensively advanced with the increase of the focusable power on target by the development of glass laser technology and its higher harmonic generation (Yamanaka & Kato et al. 1981) and by CO2 lasers (Yamanaka & Nakai et al. 1981) which cover the wavelength range from 10 μm to 0·25 μm and power densities up to 1017 W/cm2. With improved understanding of the implosion in the fuel pellet, breakeven conditions, or ignition, are expected to be achieved within the 1980's with the construction of lasers in the region of 100 kJ and 100 TW output power.
A three-dimensional model to calculate X-ray intensity distribution on an indirectly driven fusion target is presented. The model includes conversion of laser light into X rays, radiation reemission from X-ray-heated wall of a cavity, and influence of an inner pellet (i.e., a fuel capsule) on radiation redistribution. Intensity distribution of an X ray inside a cylindrical cavity heated by intense blue laser light (wavelength 351 nm, energy 5.2 kJ, duration 0.7 ns) was determined by measuring a burn-through signal from a diagnostic foil integrated onto the cavity. The experimental result is well replicated by the model calculation. By using this model, optimum conditions for uniform irradiation of afusion capsule by X-ray radiation are evaluated for use in Gekko XII laser fusion experiments.
Experiments are presented that demonstrate the high stopping power of fully ionized hydrogen plasma for low-energy heavy ions. A plasma with electron densities up to 7.1016 cm–3 at temperatures above 1 eV was created by an electrical discharge. In the described experiment, a stopping power of 1.08 GeV/(mg/cm2) was measured using singly charged krypton ions at 45–keV/u energy. The measured stopping power exceeds the corresponding value in cold hydrogen gas by a factor of 35. These measurements confirm the theoretical stopping power predictions close to the expected maximum in a fully ionized plasma.
This paper summarizes research activities in National Institute of Radiological Sciences (NIRS) for evaluation of the radiation effects on selected terrestrial and aquatic organisms as well as the ecosystems. Seven organisms, conifers, fungi, earthworms, springtails, algae, daphnia and Medaka are presently selected to study. For the estimation of possible radiation dose, transfers of radionuclides and related elements from medium to organisms are evaluated. Dose-effect relationships of acute gamma radiation on the survival, growth, and reproduction of selected organisms have been studied. Studies on the effect of chronic gamma radiation at low dose rate were also started. In order to understand the mechanism of radiation effects and to find possible indicators of the effects, information of genome- and metagenome-wide gene expression has been collected. Evaluation of ecological effects of radiation is more challenging task. Study methods by using three-species microcosm were established, and an index for the holistic evaluation of effects on various ecological parameters was proposed. The microcosm has been simulated as a computer simulation code. Developments of more complicated and practical model ecosystems have been started. The Denaturant Gradient Gel Electrophoresis (DGGE) has been applied on soil bacterial community in order to evaluate the radiation effects on soil ecosystems.
We have performed supracricoid laryngectomy with cricohyoidoepiglottopexy or with cricohyoidopexy for tumour (T) stage T2 and T3 laryngeal cancer cases and some T4 cases. We report the clinical symptoms and management, using this technique to avoid complications.
Case report:
Among patients undergoing the procedure, two cases manifested laryngeal chondritis following laryngectomy with cricohyoidoepiglottopexy. This complication was caused by C3–4 cervical osteophytes physically contacting the cricoid cartilage. Laryngeal microlaryngoscopy was performed, which revealed white, necrotic tissue in the posterior wall of the pharynx and persistent oedema of the neoglottis.
Conclusions:
When encountering a patient with an excessive osteophyte formation at the level of C3–4, one needs to take extra precautions when undertaking laryngectomy with cricohyoidoepiglottopexy or with cricohyoidopexy.
Two patients who received supracricoid laryngectomy with cricohyoidoepiglottopexy to treat laryngeal cancers, underwent intra-operative electromyography analysis. After the lesion was removed and the electrodes were inserted into the remaining intrinsic laryngeal muscles, the depth of anaesthesia was carefully reduced. Gentle tactile stimulations were applied to the pharynx to trigger the reflex movement of the remaining arytenoids. Recordings were made when reflex movement was achieved.
Case one: Electromyography (EMG) of the remaining arytenoid demonstrated clear phase differences indicating reciprocal activities between the adductor group (lateral cricoarytenoid muscle, interarytenoid muscle) and the abductor muscle (posterior cricoarytenoid muscle). Case two: EMG of the remaining arytenoid demonstrated reciprocal activities between the interarytenoid muscle and the posterior cricoarytenoid muscle. Activity of the lateral cricoarytenoid muscle was not evident because the muscle was excised during removal of the paraglottic space. Mobility of the arytenoid was attributed to interaction between the interarytenoid muscle and posterior cricoarytenoid muscle. Reciprocal interaction between the interarytenoid muscle and posterior cricoarytenoid muscle alone is also capable of maintaining post-operative laryngeal functions after supracricoid laryngectomy with cricohyoidoepiglottopexy.
Mathematical computer model is developed to simulate the population dynamics and dynamic mass budgets of the microbial community realized as a self sustainable aquatic ecological system in the tube. Autotroph algae, heterotroph protozoa and saprotroph bacteria live symbiotically with interspecies' interactions as predator-prey relationship, competition for the common resource, autolysis of detritus and detritus-grazing food chain, etc. The simulation model is the individual-based parallel model, built in the demographic stochasticity, environmental stochasticity by dividing the aquatic environment into patches. Validity of the model is checked by the multifaceted data of the microcosm experiments. In the analysis, intrinsic parameters of umbrella endpoint regarding to lethality are manipulated at the individual level, and tried to find the population level, community level especially focused on predator-prey relationship, and revealed the indirect effect of chronic exposure of radiation on the probability of Tetrahymena's extinction.
Let $V$ be a commutative valuation domain of arbitrary Krull-dimension, with quotient field $F$, let $K$ be a finite Galois extension of $F$ with group $G$, and let $S$ be the integral closure of $V$ in $K$. Suppose that one has a 2-cocycle on $G$ that takes values in the group of units of $S$. Then one can form the crossed product of $G$ over $S$, $S\ast G$, which is a $V$-order in the central simple $F$-algebra $K\ast G$. If $S\ast G$ is assumed to be a Dubrovin valuation ring of $K\ast G$, then the main result of this paper is that, given a suitable definition of tameness for central simple algebras, $K\ast G$ is tamely ramified and defectless over $F$ if and only if $K$ is tamely ramified and defectless over $F$. The residue structure of $S\ast G$ is also considered in the paper, as well as its behaviour upon passage to Henselization.