Rapid glaciation and a two-step sea level plunge into the Last Glacial Maximum.

The approximately 10,000-year-long Last Glacial Maximum, before the termination of the last ice age, was the coldest period in Earth's recent climate history1. Relative to the Holocene epoch, atmospheric carbon dioxide was about 100 parts per million lower and tropical sea surface temperatures were about 3 to 5 degrees Celsius lower2,3. The Last Glacial Maximum began when global mean sea level (GMSL) abruptly dropped by about 40 metres around 31,000 years ago4 and was followed by about 10,000 years of rapid deglaciation into the Holocene1. The masses of the melting polar ice sheets and the change in ocean volume, and hence in GMSL, are primary constraints for climate models constructed to describe the transition between the Last Glacial Maximum and the Holocene, and future changes; but the rate, timing and magnitude of this transition remain uncertain. Here we show that sea level at the shelf edge of the Great Barrier Reef dropped by around 20 metres between 21,900 and 20,500 years ago, to -118 metres relative to the modern level. Our findings are based on recovered and radiometrically dated fossil corals and coralline algae assemblages, and represent relative sea level at the Great Barrier Reef, rather than GMSL. Subsequently, relative sea level rose at a rate of about 3.5 millimetres per year for around 4,000 years. The rise is consistent with the warming previously observed at 19,000 years ago1,5, but we now show that it occurred just after the 20-metre drop in relative sea level and the related increase in global ice volumes. The detailed structure of our record is robust because the Great Barrier Reef is remote from former ice sheets and tectonic activity. Relative sea level can be influenced by Earth's response to regional changes in ice and water loadings and may differ greatly from GMSL. Consequently, we used glacio-isostatic models to derive GMSL, and find that the Last Glacial Maximum culminated 20,500 years ago in a GMSL low of about -125 to -130 metres.

Microscopic venous invasion is associated with disease free and cancer free survival in renal cell carcinoma.

AIM: The aim of this study was to investigate the significance of microscopic venous invasion (MVI) as a prognostic factor for patients with renal cell carcinoma (RCC). METHODS: The present study included 220 patients with non-metastatic RCC who underwent radical nephrectomy (RN). MVI was defined by the presence of a cancer cell in blood vessels based on microscopic examination of hematoxylin-eosin stained specimens. The impact of MVI on disease progression and survival after 37 (6-190) months of median follow-up and its correlation with known clinicopathological features were studied. Survival analyses using Kaplan-Meier and log-rank models for univariate comparisons and Cox proportional hazards model for multivariate analyses were performed. RESULTS: MVI was found in 68 patients (30.8%), and of these, 26 (38.2%) developed a tumor recurrence and 16 (23.5%) died of cancer progression, whereas only 18 (11.8%) of the remaining 152 patients without MVI presented with disease-recurrence and 8 (5.3%) died of cancer. In the multivariate analysis, MVI (P=0.014) Fuhrman's grade (P=0.028), and sarcomatoid differentiation (SD) (P=0.01) were the factors predicted a decreased disease-free survival (DFS). Meanwhile, MVI (P=0.04) and SD (P=0.029) were also found to be predictor of cancer specific survival (CSS) with necrosis (P=0.037) in multivariate analysis. CONCLUSION: The present study showed that MVI is associated with the vast majority of the adverse pathological features related with RCC. Furthermore, it was found to be an independent clinical prognostic factor for DFS and CSS.

Radiofrequency excision of a large postcricoid mucous cyst.

OBJECTIVES: To present the case of a patient with a large mucous cyst originating from the postcricoid region that was removed by radiofrequency excision. METHODOLOGY: A 75-year-old male who complained of progressive difficulty in breathing, dysphonia, and throat discomfort upon swallowing presented at our clinic. Computerized tomography imaging showed a 4 x 4 x 3 cm cystic mass in the hypopharyngeal region. The patient had been on medical therapy for rheumatoid arthritis for 25 years, and his ability to extend his neck was totally restricted. Thus, the Kleinsasser operating laryngoscope could not be inserted; instead, the blade of a flexible intubation laryngoscope and a 30 degree rigid nasal endoscope was used to visualize the lesion. RESULT: The walls of the cyst were excised from the postcricoid region using a radiofrequency device to avoid bleeding. CONCLUSION: Radiosurgery of these kinds of lesions produces less hemorrhage and may provide a suitable alternative to classical surgery.

Bilateral antrochoanal polyps in an adult: a case report.

Antrochoanal polyps (ACP) are almost always unilateral. Only two bilateral cases have been reported to date, both of them in children. There have been no investigations of the aetiology of the bilateral occurrence of these lesions, possibly due to the rarity of bilateral ACPs. In this paper, we report on the first adult case of bilateral ACPs and review the literature.

Interleukin-4, interleukin-8 and E-selectin levels in intranasal polyposis patients with and without allergy: a comparative study.

Intranasal polyposis is a chronic inflammatory upper airway disease with unknown aetiology. Interleukin (IL)-4 and IL-8 play very significant roles in allergic events and infectious inflammation, respectively. In contrast, E-selectin is important in the initiation and organization of inflammation. In this study, levels of IL-4, IL-8 and E-selectin were measured in nasal mucosa specimens of intranasal polyposis patients with and without allergic rhinitis, and healthy controls. Healthy controls had significantly higher IL-4 levels than allergic patients and non-allergic patients; IL-4 levels were similar in allergic and non-allergic patients. Allergic and non-allergic patients had significantly higher IL-8 levels than healthy controls; IL-8 levels were comparable in allergic and non-allergic patients. E-selectin levels were similar in all groups. The infection-based theory, represented by IL-8, seems to be more likely than the allergy-based theory, represented by IL-4, for the pathogenesis of nasal polyposis.

Treatment of tinnitus with transcutaneous electrical nerve stimulation improves patients' quality of life.

OBJECTIVES: Tinnitus can adversely affect patients' quality of life. Transcutaneous electrical nerve stimulation (TENS) may be effective in the management of tinnitus. No study has investigated the efficacy of TENS for the management of tinnitus by means of quality of life measures. In this study, we evaluated the efficacy of TENS for the management of tinnitus symptoms by using the visual analogue scale (VAS), tinnitus handicap inventory test, Nottingham health profile (NHP) and short form-36 (SF-36) questionnaires. METHODS: Twenty-two patients were included in this study (male/female, 16/6; mean age, 48.04 +/- 15.57 years). Nine patients had unilateral and 13 patients had bilateral tinnitus. RESULTS: After TENS, improvement measured by VAS was only marginally significant (p = 0.059). However, after TENS, there were statistically significant improvements regarding tinnitus severity scores, tinnitus handicap inventory scores, NHP fatigue, social isolation and emotional problems scores, and many parameters measured by the SF-36 (physical functioning, general health, vitality, social functioning, role limitations due to emotional problems, and mental health)(p < 0.05). CONCLUSION: Transcutaneous electrical nerve stimulation is a useful method to improve the quality of life of patients with tinnitus.

Morphometric analysis of the infraorbital foramen and its localization relative to surgical landmarks.

AIM: The infraorbital foramen (IOF) is an important anatomic landmark for maxillofacial surgery; therefore, its location should be well documented. In morphometric analyses of the IOF, various methods have been applied and differences have been found among the results of the measurements. The aim of this study was to facilitate localization of the IOF during clinical practice. METHODS: In the current study, in order to perform anatomic and morphometric analyses of the IOF, 112 skulls were used. The shortest distance from each IOF to certain determined points was identified and measured by digital calipers. RESULTS: The longest and the shortest diameters of the IOF were measured as 4.21±0.91 mm and 3.11±0.62 mm, respectively. The shortest distances between the IOF and the landmarks were measured as follows: the maxillary mid-line (ML) as 28.47±2.49 mm; the supraorbital foramen/supraorbital notch (SOF/SON) as 43.43±3.39 mm; the lower end of the nasomaxillary suture (LENS) as 26.47±3.05 mm; the lower end of the alveolar juga of the canines (LAJC) as 31.62±3.09 mm; the infra-orbital margin (IOM) as 6.98±1.72 mm; and the opposite IOF as 56.85±3.89 mm. CONCLUSION: Among the landmarks, the most useful ones in clinical practice might be the distances between the IOF and the IOM, IOF and LAJC, and even IOF and ML. SOF/SON and LENS provide more accurate localization when they are used together with the other parameters. Moreover, their importance increases when other parameters are not available for use (because of fractures or damage).

Intensification of the meridional temperature gradient in the Great Barrier Reef following the Last Glacial Maximum.

Tropical south-western Pacific temperatures are of vital importance to the Great Barrier Reef (GBR), but the role of sea surface temperatures (SSTs) in the growth of the GBR since the Last Glacial Maximum remains largely unknown. Here we present records of Sr/Ca and δ(18)O for Last Glacial Maximum and deglacial corals that show a considerably steeper meridional SST gradient than the present day in the central GBR. We find a 1-2 °C larger temperature decrease between 17° and 20°S about 20,000 to 13,000 years ago. The result is best explained by the northward expansion of cooler subtropical waters due to a weakening of the South Pacific gyre and East Australian Current. Our findings indicate that the GBR experienced substantial meridional temperature change during the last deglaciation, and serve to explain anomalous deglacial drying of northeastern Australia. Overall, the GBR developed through significant SST change and may be more resilient than previously thought.

"Sandwich technique" in the surgical treatment of primary complex fractures of the femur and humerus.

In this prospective study, our aim was to determine the clinical and radiographic outcomes of the surgical treatment of primary complex problem femoral and humeral shaft fractures treated by a new technique called "sandwich technique." A total of 45 patients with comminuted, complex and/or osteopoenic fractures of the femur or humerus (30 femoral and 15 humeral fractures) were treated using this technique. The patients were followed up for a mean of 25 months. In 24 (85.7%) of 28 patients with femoral fractures and in 14 (93.3%) of 15 patients with humeral fractures, union was achieved within 3-6 months of the operation (mean: 4.5 months). The total union rate was 88.4%. The pseudoarthrosis rate was 12%. There was no infection or implant failure seen during the follow-up period. The cortical allograft struts can be used to provide collateral support to weakened osteopoenic/osteoporotic bone. This technique provides a union rate of about 88% in osteoporotic and/or complex primary humerus or femur fractures.

Surgical outcome of thoracolumbar burst fractures with flexion-distraction injury of the posterior elements.

Between 1991 and 2002 we treated 48 patients surgically for thoracolumbar burst fractures associated with flexion-distraction injury of the posterior elements. The degree of kyphotic deformity and the degree of vertebral wedging deformity were measured on plain lateral radiographs. The spinal canal compromise was measured on computer tomography. The mean postoperative follow-up was 70 (24-108) months. The preoperative kyphosis averaged 25.7 degrees and the mean sagittal index was 28.8 degrees . The mean wedging deformity of the fractured vertebral body was 46% (24-66%). The mean preoperative spinal canal compromise secondary to retropulsed bony fragments was 64%. Immediately after surgery, the correction of kyphosis averaged 98%. There was no loss of correction at the final follow-up. A satisfactory reduction and good stabilisation with solid fusion were achieved in all cases.

Myositis ossificans of psoas muscle: magnetic resonance imaging findings.

Myositis ossificans is a benign, localized, self-limiting ossifying soft tissue mass with unknown pathogenesis. It may be confused with a malignant tumor of bone or soft tissues, especially in the early stages of the disease. In this report, we present a case of myositis ossificans affecting unilateral psoas muscle, which to our knowledge is a very uncommon location. There was no history of trauma. We describe the imaging findings and clues to early diagnosis of myositis ossificans.

Links between climate and sea levels for the past three million years.

The oscillations between glacial and interglacial climate conditions over the past three million years have been characterized by a transfer of immense amounts of water between two of its largest reservoirs on Earth -- the ice sheets and the oceans. Since the latest of these oscillations, the Last Glacial Maximum (between about 30,000 and 19,000 years ago), approximately 50 million cubic kilometres of ice has melted from the land-based ice sheets, raising global sea level by approximately 130 metres. Such rapid changes in sea level are part of a complex pattern of interactions between the atmosphere, oceans, ice sheets and solid earth, all of which have different response timescales. The trigger for the sea-level fluctuations most probably lies with changes in insolation, caused by astronomical forcing, but internal feedback cycles complicate the simple model of causes and effects.