Effects of generalization descriptions on risk perception.

The study addresses the effects of generalization descriptions on risk perceptions. In a 1-factorial online experiment, 629 participants were randomly allocated to one of three groups. Group G1 received an excerpt of an original press release from the International Agency for Research on Cancer (IARC) regarding mobile phones and cancer, classifying RF EMF as possibly carcinogenic to humans. Group G2 received an additional explanatory text module, and Group G3 received a rewritten text, with both G2 and G3 highlighting that the possible cancer risk only refers to mobile phones. Risk perceptions regarding cell phones and related personal devices, base stations, and high voltage power lines were used as dependent variables measured before and after text reading. Further, the degree to which participants generalized from cell phone-related to other RF EMF exposures was assessed to determine whether this was predictive of their post-text risk perceptions. Regarding risk perceptions, no differences between the three groups were observed after reading the presented texts. Instead, all three experimental groups indicated increased risk perceptions for all electromagnetic field sources. However, we found significant differences according to the prevailing risk generalization belief. Respondents expressing a strong risk generalization belief showed significantly higher risk perceptions for all tested EMF sources (except mobile phones) than subjects with a weak risk generalization belief.

Effects of selective outcome reporting on risk perception.

The current study aimed to investigate how selective reporting of study results indicating increased health effects will influence its receiver's risk perception. Using the example of the Interphone Study from 2010 on mobile phone usage and cancer, an online experiment was conducted separating respondents into two groups. One group of subjects was informed selectively about a relationship between heavy mobile phone use and an elevated risk of glioma (brain cancer) only. The other group of subjects was informed about the full results of the analyses of glioma risk by cumulative call time, which suggests that other than for the heavy users, there were no statistically significant elevated risks related to mobile phone use. The results showed that selective reporting of risk information increased risk perception when compared to receiving the full information. Additionally, the selectively informed subjects revealed a stronger tendency towards overgeneralization of the 'elevated brain cancer risk' to all mobile phone users, although this did not extend to an overgeneralization to other electromagnetic field sources or differences in the perception of a usage time dependency for possible health risks. These results indicate that reporting of full results is an important factor in effective risk communication.

Framing effects in risk communication messages - Hazard identification vs. risk assessment.

The way in which risk communication messages are framed can influence recipients' risk perceptions. Despite this, there is a limited understanding of how framing is responsible for influencing risk perception. One particularly important element may be whether a risk communication message is framed as a completed 'risk assessment' (specifying a magnitude of risk to the public as a function of the exposure level), or as a 'hazard identification' (a statement regarding whether an environmental agent could in principle cause detrimental health effects in humans, without addressing whether such effects may occur in practice). The current study aimed to investigate for the first time whether framing a risk communication message regarding 'mobile phones and health' as a hazard identification or as a risk assessment affects the reader's risk perception. Using an online survey, participants were separated into three groups and shown either an original press release from the International Agency for Research on Cancer regarding mobile phones and cancer (Group 1), or the press release with additional text modules intended to frame the press release as either a risk assessment (Group 2) or a hazard identification (Group 3). The experimental manipulation was successful in that framing the message as a hazard identification reduced the number of people that believed the press release was a risk assessment, whereas framing it as a risk assessment was not able to increase the number of people who thought that it was a risk assessment. However, no differences in risk perception were found between the groups. In an attempt to ascertain the reason for this lack of framing effect on the radiofrequency electromagnetic fields risk perception measures, it was found that pre-existing interpretations of risk and hazard strongly predicted risk perception, regardless of experimental group. Participants who believed that the International Agency for Research on Cancer conducted a hazard identification perceived lower risks and were less convinced that radiofrequency electromagnetic field exposure from mobile phones increases cancer risks. The results of the study demonstrate the importance of understanding the distinction between a hazard identification and a risk assessment, and suggest that radiofrequency electromagnetic field risk communication needs to develop means for empowering the public to differentiate between hazards and risks.

Low-dose IL-2 induces CD56bright NK regulation of T cells via NKp44 and NKp46.

Low-dose interleukin (IL)-2 has shown clinical benefits in patients with autoimmune and inflammatory diseases. Both regulatory T cells (Tregs ) and natural killer (NK) cells are increased in response to low-dose IL-2 immunotherapy. The role of regulatory T cells in autoimmune diseases has been extensively studied; however, NK cells have not been as thoroughly explored. It has not been well reported whether the increase in NK cells is purely an epiphenomenon or carries actual benefits for patients with autoimmune diseases. We demonstrate that low-dose IL-2 expands the primary human CD56bright NK cells resulting in a contact-dependent cell cycle arrest of effector T cells (Teffs ) via retention of the cycle inhibitor p21. We further show that NK cells respond via IL-2R-ß, which has been shown to be significant for immunity by regulating T cell expansion. Moreover, we demonstrate that blocking NK receptors NKp44 and NKp46 but not NKp30 could abrogate the regulation of proliferation associated with low-dose IL-2. The increase in NK cells was also accompanied by an increase in Treg cells, which is dependent on the presence of CD56bright NK cells. These results not only heighten the importance of NK cells in low-dose IL-2 therapy but also identify key human NK targets, which may provide further insights into the therapeutic mechanisms of low-dose IL-2 in autoimmunity.

Modification of fasciocutaneous radial forearm free flap to achieve two-layer closure during reconstruction of circumferential hypopharyngeal defects.

Circumferential defects of the hypopharynx are a reconstructive challenge. Various local, regional and free flaps have been described with each having advantages and disadvantages in terms of functional outcomes. The fasciocutaneous radial forearm free flap (RFFF) is one of the most common free flaps used for reconstructing circumferential hypopharyngeal defects. The skin paddle is pliable and reasonably matches the native hypopharyngeal wall. It is easy to raise, has predictable vascular anatomy and a long pedicle. Unlike the anterior lateral thigh (ALT) flap, the RFFF is associated with higher rates of pharyngo-cutaneous fistula. This was thought to be due to the difficulty in achieving two-layer closure. However, in a post treatment neck or in patient with large body habitus, the use of ALT or other free flaps may not be possible leaving the RFFF as the only viable option. To aim to reduce the risk of fistula and wound dehiscence, we describe a novel design of RFFF, which provides two-layer closure. We believe that our design gives the reconstructive surgeon another reconstructive option, which should be considered in challenging circumferential hypopharyngeal defects.

Hypopharyngeal cancer: United Kingdom National Multidisciplinary Guidelines.

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. With an age standardised incidence rate of 0.63 per 100 000 population, hypopharynx cancers account for a small proportion of the head and neck cancer workload in the UK, and thus suffer from the lack of high level evidence. This paper discusses the evidence base pertaining to the management of hypopharyngeal cancer and provides recommendations on management for this group of patients receiving cancer care. Recommendations • Cross-sectional imaging with computed tomography of the head, neck and chest is necessary for all patients; magnetic resonance imaging of the primary site is useful particularly in advanced disease; and computed tomography and positron emission tomography to look for distant disease. (R) • Careful evaluation of the upper and lower extents of the disease is necessary, which may require contrast swallow or computed tomography and positron emission tomography imaging. (R) • Formal rigid endoscopic assessment under general anaesthetic should be performed. (R) • Nutritional status should be proactively managed. (R) • Full and unbiased discussion of treatment options should take place to allow informed patient choice. (G) • Early stage disease can be treated equally effectively with surgery or radiotherapy. (R) • Endoscopic resection can be considered for early well localised lesions. (R) • Bulky advanced tumours require circumferential or non-circumferential resection with wide margins to account for submucosal spread. (R) • Offer primary surgical treatment in the setting of a compromised larynx or significant dysphagia. (R) • Midline lesions require bilateral neck dissections. (R) • Consider management of silent nodal areas usually not addressed for other primary sites. (G) • Reconstruction needs to be individualised to the patients' needs and based on the experience of the unit with different reconstructive techniques. (G) • Consider tumour bulk reduction with induction chemotherapy prior to definitive radiotherapy. (R) • Consider intensity modulated radiation therapy where possible to limit the consequences of wide field irradiation to a large volume. (R) • Use concomitant chemotherapy in patients who are fit enough and consider epidermal growth factor receptor blockers for those who are less fit. (R).

Surgical management of medullary thyroid cancer: which guidelines should we follow?

BACKGROUND: Surgery is currently the only curative treatment for medullary thyroid cancer. Unfortunately, the surgical strategy that will offer patients at each disease stage the best chance of a biochemical cure remains unclear. The American Thyroid Association and British Thyroid Association guidelines offer different strategies. METHODS: A retrospective analysis of the surgical management of 47 patients with medullary thyroid cancer diagnosed between 1994 and 2013 was performed. Surgical management was compared with current American Thyroid Association and British Thyroid Association guidelines. Outcome was defined as the first post-operative calcitonin measurement. RESULTS: All patients with stage I-III disease achieved a post-operative biochemical cure regardless of the guidelines followed. The overall biochemical cure rate for patients with stage IVa disease was significantly reduced to 10 per cent (p < 0.01), but the biochemical cure rate for stage IVa disease patients who underwent bilateral lateral lymph node dissection was 33.3 per cent. CONCLUSION: The conservative, surveillance-driven approach recommended by the American Thyroid Association is appropriate for stage I-III disease. However, the more aggressive approach advocated by the British Thyroid Association might provide stage IVa disease patients a greater chance of achieving a biochemical cure.

Somatic CALR mutations in myeloproliferative neoplasms with nonmutated JAK2.

BACKGROUND: Somatic mutations in the Janus kinase 2 gene (JAK2) occur in many myeloproliferative neoplasms, but the molecular pathogenesis of myeloproliferative neoplasms with nonmutated JAK2 is obscure, and the diagnosis of these neoplasms remains a challenge. METHODS: We performed exome sequencing of samples obtained from 151 patients with myeloproliferative neoplasms. The mutation status of the gene encoding calreticulin (CALR) was assessed in an additional 1345 hematologic cancers, 1517 other cancers, and 550 controls. We established phylogenetic trees using hematopoietic colonies. We assessed calreticulin subcellular localization using immunofluorescence and flow cytometry. RESULTS: Exome sequencing identified 1498 mutations in 151 patients, with medians of 6.5, 6.5, and 13.0 mutations per patient in samples of polycythemia vera, essential thrombocythemia, and myelofibrosis, respectively. Somatic CALR mutations were found in 70 to 84% of samples of myeloproliferative neoplasms with nonmutated JAK2, in 8% of myelodysplasia samples, in occasional samples of other myeloid cancers, and in none of the other cancers. A total of 148 CALR mutations were identified with 19 distinct variants. Mutations were located in exon 9 and generated a +1 base-pair frameshift, which would result in a mutant protein with a novel C-terminal. Mutant calreticulin was observed in the endoplasmic reticulum without increased cell-surface or Golgi accumulation. Patients with myeloproliferative neoplasms carrying CALR mutations presented with higher platelet counts and lower hemoglobin levels than patients with mutated JAK2. Mutation of CALR was detected in hematopoietic stem and progenitor cells. Clonal analyses showed CALR mutations in the earliest phylogenetic node, a finding consistent with its role as an initiating mutation in some patients. CONCLUSIONS: Somatic mutations in the endoplasmic reticulum chaperone CALR were found in a majority of patients with myeloproliferative neoplasms with nonmutated JAK2. (Funded by the Kay Kendall Leukaemia Fund and others.).

No increased sensitivity in brain activity of adolescents exposed to mobile phone-like emissions.

OBJECTIVE: To examine the potential sensitivity of adolescents to radiofrequency electromagnetic field (RF EMF) exposures, such as those emitted by mobile phones. METHODS: In a double-blind, randomized, crossover design, 22 adolescents aged 11-13 years (12 males) underwent three experimental sessions in which they were exposed to mobile phone-like RF EMF signals at two different intensities, and a sham session. During exposure cognitive tasks were performed and waking EEG was recorded at three time-points subsequent to exposure (0, 30 and 60 min). RESULTS: No clear significant effects of RF EMF exposure were found on the waking EEG or cognitive performance. CONCLUSIONS: Overall, the current study was unable to demonstrate exposure-related effects previously observed on the waking EEG in adults, and also provides further support for a lack of an influence of mobile phone-like exposure on cognitive performance. SIGNIFICANCE: Adolescents do not appear to be more sensitive than adults to mobile phone RF EMF emissions.

Outcomes following pharyngolaryngectomy reconstruction with the anterolateral thigh (ALT) free flap.

We retrospectively reviewed 15 cases of pharyngolaryngectomy for advanced laryngeal carcinoma reconstructed with the anterolateral thigh (ALT) free flap. Thirteen patients had primary surgery and adjuvant treatment (radiotherapy or chemoradiotherapy), and two had salvage surgery. Thirteen had stage III or IV disease, and eight had cervical nodal extracapsular spread. In this series all the flaps survived, and at median follow-up of 14.5 months (range 3.7-31.2), 12 of the 15 patients were alive. One patient developed a chronic pharyngocutaneous fistula, and five required repeat balloon dilatations for late pharyngeal strictures. Six patients enjoyed restoration of full oral intake, seven were able to take a soft diet, and two were dependent on feeding by percutaneous endoscopic gastrostomy. Four patients developed adequate tracheo-oesophageal speech, and one successfully developed oesophageal speech. In this series many of the surgical problems associated with pharyngolaryngectomy reconstruction were addressed successfully by the ALT, but late dysphagia remained troublesome in an appreciable minority. While adjuvant radiotherapy could have contributed to this, future innovations will focus on the reduction of late strictures.

Functional results of pharyngo-laryngectomy and total laryngectomy: a comparison.

OBJECTIVE: To compare the key functional results (regarding swallowing and voice rehabilitation) in patients treated by pharyngo-laryngectomy with flap reconstruction, versus standard, wide-field, total laryngectomy. METHOD: We studied 97 patients who had undergone total laryngectomy and pharyngo-laryngectomy with flap reconstruction. The main outcome measures were swallowing (i.e. solid food, soft diet, fluid or enteral feeding) and fluent voice development. RESULTS: There were 79 men and 18 women, with follow up of one to 19 years. Voice (p = 0.037) and swallowing (p = 0.041) results were significantly worse after circumferential pharyngo-laryngectomy than after non-circumferential pharyngo-laryngectomy. There was no significant difference in voice (p = 0.23) or swallowing (p = 0.655) results, comparing total laryngectomy and non-circumferential pharyngo-laryngectomy. The presence of a post-operative fistula significantly influenced voice (p = 0.001) and swallowing (p = 0.009) outcomes. CONCLUSION: The additional measures involved in pharyngo-laryngectomy do not confer any functional disadvantage, compared with total laryngectomy, but only if the procedure is non-circumferential. Functional results of circumferential pharyngo-laryngectomy are worse than those of both non-circumferential pharyngo-laryngectomy and total laryngectomy. If oncologically possible and safe, it is better to keep a pharyngo-laryngectomy non-circumferential.

Effects of 2G and 3G mobile phones on human alpha rhythms: Resting EEG in adolescents, young adults, and the elderly.

The present study was conducted to determine whether adolescents and/or the elderly are more sensitive to mobile phone (MP)-related bioeffects than young adults, and to determine this for both 2nd generation (2G) GSM, and 3rd generation (3G) W-CDMA exposures. To test this, resting alpha activity (8-12 Hz band of the electroencephalogram) was assessed because numerous studies have now reported it to be enhanced by MP exposure. Forty-one 13-15 year olds, forty-two 19-40 year olds, and twenty 55-70 year olds were tested using a double-blind crossover design, where each participant received Sham, 2G and 3G exposures, separated by at least 4 days. Alpha activity, during exposure relative to baseline, was recorded and compared between conditions. Consistent with previous research, the young adults' alpha was greater in the 2G compared to Sham condition, however, no effect was seen in the adolescent or the elderly groups, and no effect of 3G exposures was found in any group. The results provide further support for an effect of 2G exposures on resting alpha activity in young adults, but fail to support a similar enhancement in adolescents or the elderly, or in any age group as a function of 3G exposure.

Anterior spinal artery syndrome: a rare complication of head and neck surgery.

OBJECTIVE: We report a case of anterior spinal artery syndrome, an extremely rare complication, following head and neck surgery. METHOD: A case report and literature review concerning anterior spinal artery syndrome is presented. RESULTS: A 64-year-old man developed an anterior spinal artery infarction following total laryngectomy and bilateral neck dissections for post-radiotherapy glottic carcinoma. Anterior spinal artery infarction is a rare syndrome. It typically presents with weakness, loss of pain and temperature sensation below the level of the injury, with relative sparing of position and vibratory sensation. Recovery is variable. CONCLUSION: To the best of our knowledge, this is the first case report in the English language literature of anterior spinal artery syndrome following a head and neck procedure. This case report highlights a rare complication, and also the susceptibility of head and neck surgery patients to different complications. In head and neck cancer patients suffering anterior spinal artery syndrome following primary surgical treatment, we recommend that the management of this complication should be as aggressive as that of the primary cancer.

Two distinct types of murine blast colony-forming cells are multipotential hematopoietic precursors.

Two types of blast colonies can be stimulated to develop in semisolid agar cultures of murine bone marrow cells. Typically, these are either multicentric colonies stimulated by stem cell factor (SCF) plus interleukin-6 (IL-6) or dispersed colonies stimulated by Flt3 ligand (FL) plus IL-6. Both types of blast colony-forming cells (BL-CFCs) can generate large numbers of lineage-committed granulocyte-macrophage progenitor cells and exhibit some capacity for self-generation and the formation of eosinophil and megakaryocyte progenitor cells. However, the two populations of BL-CFCs are largely distinct and partially separable by fluorescence-activated cell sorting and are distinguished by differing capacity to form granulocyte-committed progeny. Both types of BL-CFCs can generate dendritic cells and small numbers of lymphocytes but the FL-responsive BL-CFCs have a greater capacity to form both B and T lymphocytes. Both types of blast colonies offer remarkable opportunities to analyze multilineage commitment at a clonal level in vitro.

Ear protection as a treatment for disruptive snoring: do ear plugs really work?

BACKGROUND: In the absence of surgical treatments with demonstrable long-term efficacy, conservative treatments for snoring remain appropriate. Only limited evidence evaluating the use of ear protection by partners has been published. METHODS: Eligible couples were invited to participate in a two-month trial, with each partner using custom-moulded ear plugs. Five questionnaires were completed by patients and their partners, at baseline and after two months: the snoring outcomes survey (SOS) or the spouse/bed partners survey (SBPS), the Epworth sleepiness scale (ESS), the general health questionnaire-12 (GHQ-12), the Nottingham health profile (NHP) and the Golombok-Rust inventory of marital status (GRIMS). RESULTS: After two months, there was a significant improvement in the SOS score for patients (p = 0.005), the SBPS score for partners (p = 0.001) and the ESS for partners (p = 0.004). CONCLUSIONS: For selected couples, ear plugs represent an effective short-term treatment for some of the social effects of disruptive snoring, as determined by the SOS, SBPS and ESS questionnaires.

Negative pathology following endoscopic resection of T1a squamous carcinoma of the glottis.

Endoscopic CO(2) laser excision for T(1a) glottic cancer is a recognized treatment modality producing equivalent disease-free and voice results to external beam radiotherapy. On reviewing a series of 15 patients who had undergone endoscopic resection of a T(1a) glottic squamous cancer, it was noted that five patients had negative excisional pathology following the initial biopsy of an invasive squamous carcinoma. The histopathology of each patient's resected specimen was reviewed by a second pathologist who confirmed the accuracy of the results in all cases. We conclude that a significant number of early squamous carcinomas of the glottis present with very small localized, minimally invasive disease and that a proportion may be treated by biopsy alone.

Interobserver reliability in evaluating postural stability between clinicians and posturography.

OBJECTIVES: To assess the interobserver reliability in assessing postural stability and to compare with results obtained by computerized posturography. DESIGN: Cross-sectional study. SETTING: Balance clinic, teaching hospital. PARTICIPANTS: 81 patients attending with a primary complaint of imbalance. MAIN OUTCOME MEASURES: Inter-rater reliability between two clinicians and the modified Clinical Test for the Sensory Interaction on Balance (mCTSIB) as assessed by the Neurocom VSR Balance Master platform. RESULTS: Inter-rater reliability scores were high (0.53-0.81) for all conditions of the mCTSIB except for the easiest, i.e. firm surface eyes open, where concordance levels were poor to fair. CONCLUSIONS: Overall there was good agreement between observers and the computerized mCTSIB.