Transoral laser resection versus lip-split mandibulotomy in the management of oropharyngeal squamous cell carcinoma (OPSCC): a case match study.

The objective of this study was to compare transoral laser microsurgery (TLM) with lip-split mandibulotomy (LSM) and radial forearm free-flap reconstruction, for the resection of squamous cell carcinoma of the oropharynx (SCCOP). This study is designed as a case-control study matching 24 patients treated with TLM for SCCOP with those treated with LSM. Patients were matched by age (in 5-year epochs), sex, TNM stage, tumour sub site and type of neck dissection. Each group comprised 20 males and 4 females (mean age 56 years). Seven patients treated with TLM had an elective tracheostomy compared with all patients undergoing LSM. Moreover, the time for decanulation was reduced in patients undergoing tracheostomy for TLM. Although similar rates of patients were able to swallow to some degree on discharge, 29% of patients having LSM were discharged requiring enterostomy feeding compared with 4% of patients treated using TLM. Of those able to swallow on discharge, patients who had TLM resumed swallowing in half the time taken for those having LSM. Moreover, those treated with TLM remained in hospital for half the length of time than those treated with LSM. Due to these factors, overall cost for TLM is reduced in comparison with LSM. In comparison with LSM, TLM for the treatment of SCCOP results in fewer tracheostomies and shorter time to decanulation; a quicker recovery of swallowing function and a reduced length of hospital stay. As a result of this, treatment with TLM is on average cheaper. These factors should be considered when deciding on the surgical treatment of a patient with SCCOP.

Heterotopic pregnancy.

Heterotopic pregnancy is a life-threatening condition. A recent case at our institution prompted a systematic review of the literature from 2005 to 2010. In the majority (71%) of cases reviewed, risk factors for a heterotopic pregnancy were present. However, in several instances (33%), previous sonographic reports of a normal intrauterine pregnancy gave false reassurance. These results highlight the complexity of diagnosis. In addition, our findings were compared with two previous reviews covering cases from 1971 to 2004. This comparison highlighted two important trends: first, the increasing role of ultrasound in the definitive diagnosis of a heterotopic pregnancy, and second, the development of conservative approaches to management. Medical knowledge and technology may be improving, but ultimately, even in the presence of a known intrauterine pregnancy, the simple dictum 'think ectopic' must not be forgotten.

Laparoscopic hysteropexy: the initial results of a uterine suspension procedure for uterovaginal prolapse.

OBJECTIVE: The aim of this study was to evaluate the outcome of laparoscopic hysteropexy, a surgical technique for the management of uterine prolapse, involving suspension of the uterus from the sacral promontory using bifurcated polypropylene mesh. DESIGN: The investigation was designed as a prospective observational study (clinical audit). SETTING: The study was undertaken at a tertiary referral urogynaecology unit in the UK. POPULATION: The participants comprised 51 consecutive women with uterovaginal prolapse, who chose laparoscopic hysteropexy as one of the available surgical options. METHODS: The hysteropexy was conducted laparoscopically in all cases. A bifurcated polypropylene mesh was used to suspend the uterus from the sacral promontory. The two arms of the mesh were introduced through bilateral windows created in the broad ligaments, and were sutured to the anterior cervix; the mesh was then fixed to the anterior longitudinal ligament over the sacral promontory, to elevate the uterus. MAIN OUTCOME MEASURES: Cure of the uterine prolapse was evaluated subjectively using the International Consultation on Incontinence Questionnaire for vaginal symptoms (ICIQ-VS), and objectively by vaginal examination using the Baden-Walker halfway system and the pelvic organ prolapse quantification (POP-Q) scale. Operative and postoperative complications were also assessed. RESULTS: The mean age of the 51 women was 52.5 years (range 19-71 years). All were sexually active, and at least three of them expressed a strong desire to have children in the future. All were available for follow-up in clinic at 10 weeks, and 38 have completed the questionnaires. In 50 out of 51 women the procedure was successful, with no objective evidence of uterine prolapse on examination at follow-up; there was one failure. Significant subjective improvements in prolapse symptoms, sexual wellbeing and related quality of life were observed, as detected by substantial reductions in the respective questionnaire scores. CONCLUSIONS: Laparoscopic hysteropexy is both a feasible and an effective procedure for correcting uterine prolapse without recourse to hysterectomy. It allows restoration of the length of the vagina without compromising its calibre, and is therefore likely to have a favourable functional outcome.

R-spondin 2 mediates neutrophil egress into the alveolar space through increased lung permeability.

OBJECTIVE: R-spondin 2 (RSPO2) is required for lung morphogenesis, activates Wnt signaling, and is upregulated in idiopathic lung fibrosis. Our objective was to investigate whether RSPO2 is similarly important in homeostasis of the adult lung. While investigating the characteristics of bronchoalveolar lavage in RSPO2-deficient (RSPO2-/-) mice, we observed unexpected changes in neutrophil homeostasis and vascular permeability when compared to control (RSPO2+/+) mice at baseline. Here we quantify these observations to explore how tonic RSPO2 expression impacts lung homeostasis. RESULTS: Quantitative PCR (qPCR) analysis demonstrated significantly elevated myeloperoxidase (MPO) expression in bronchoalveolar lavage fluid (BALF) cells from RSPO2-/- mice. Likewise, immunocytochemical (ICC) analysis demonstrated significantly more MPO+ cells in BALF from RSPO2-/- mice compared to controls, confirming the increase of infiltrated neutrophils. We then assessed lung permeability/barrier disruption via Fluorescein Isothiocyanate (FITC)-dextran instillation and found a significantly higher dextran concentration in the plasma of RSPO2-/- mice compared to identically treated RSPO2+/+ mice. These data demonstrate that RSPO2 may be crucial for blood-gas barrier integrity and can limit neutrophil migration from circulation into alveolar spaces associated with increased lung permeability and/or barrier disruption. This study indicates that additional research is needed to evaluate RSPO2 in scenarios characterized by pulmonary edema or neutrophilia.

Vision: Visual space is not what it appears to be.

The location of visual objects in the world around us is reconstructed in a complex way from the image falling on the retina. Recent studies have begun to reveal the different ways in which the brain dynamically re-maps retinal information across eye movements to compute object locations for perception and directing actions.

Vision: getting to grips with the Ebbinghaus illusion.

It is well known that visual illusions can have a dramatic effect upon our visual perception of such properties as an object's size. It remains the subject of much debate, however, whether visual illusions have a similar influence on visually guided actions. Recent studies have thrown new light on this debate.

Links between vision and somatosensation. Vision can improve the felt position of the unseen hand.

During reaching movements, sensory signals must be transformed into appropriate motor commands. Anatomical, electrophysiological, and neuropsychological evidence suggest that there is no single, supramodal map of space that is used to guide reaching. Instead, movements appear to be planned and controlled within multiple coordinate systems, each one attached to a different body part. Recent neuropsychological investigations demonstrating that somatosensory impairments can be ameliorated by visual cues, and visual impairments by proprioceptive cues, have been interpreted as evidence that arm-centered representations may exist in humans. A critical difference between the findings obtained in the monkey and in humans, however, is that in the latter case, vision of the limb appears be critical for visual somatosensory binding. Here, we report a case study of a patient (C.T.) recovering from unilateral somatosensory impairment, including tactile extinction, who executed reaches toward visually defined or proprioceptively defined locations. We demonstrate that when the target location of a reach was defined proprioceptively, by passively positioning our patient's impaired hand beneath the table surface, vision of the workspace immediately adjacent to the unseen hand dramatically increased the endpoint accuracy of her reaching movements, even though such cues could not possibly signal the position of the target directly.

Posterior parietal cortex and the dissociable components of prism adaptation.

Recent evidence has implicated posterior parietal cortex (PPC) in adaptation to optical displacing prisms. It has been suggested that PPC contributes to the strategic component of prism adaptation necessary for perceptual realignment (true adaptation). It has also been suggested, however, that the part of PPC responsible for corrections to ongoing movements (a putative strategic component) may not be necessary for successful adaptation. A patient presenting with bilateral posterior parietal damage (patient JJ) was tested with both hands on two versions of a prism adaptation task--one using prism goggles and one using a virtual prism arrangement. JJ displayed independent deficits: his right hand failed to show strategic control, yet adapted fully to the prisms whereas his left hand showed evidence of strategic control without subsequent adaptation. The data indicates that the ability to implement control strategies may not be necessary for successful adaptation to prisms. A proposed model for the role of posterior parietal cortex in prism adaptation is also presented.

Visuomotor functions of the lateral pre-motor cortex.

Recent studies have provided new insights into the visuomotor functions of the dorsal and ventral regions of the lateral pre-motor cortex. Anatomical and physiological investigations in non-human primates have demonstrated that these regions have differing patterns of cortical connectivity and distinctive neuronal responses. Brain-imaging techniques and lesion studies have begun to probe the functions of homologous regions in humans.

Using advance information in dynamic cognitive control: an ERP study of task-switching.

Ensuring that behavior remains appropriate over time requires dynamic, flexible control. We used the task-switching procedure to investigate the mechanisms whereby advance information is used to control behavior under conditions of frequently changing task-rules. The color of target stimuli signaled which task-set (or behavioral 'rule') was required on each trial. We provided different forms of advance information in two conditions and found a double dissociation in their effects: visual precues ('precueing') facilitated task-switching, whereas a fixed task-sequence ('predictability') facilitated task-repetition. In addition, precueing was associated with a late parietal positive ERP which preceded target onset, whereas predictability produced an increase in the target-locked centro-parietal P3b ERP. We suggest that these results indicate the activity of two distinct mechanisms. The first, driven by a task-cue and indexed by the late parietal positivity, may drive efficient task-performance on precued switch trials but occurs too late on non-precued switch trials to index an anticipatory task-set reconfiguration process. The second may constitute active consolidation or maintenance of a particular task-set which occurs at least one trial ahead, when task-repetitions are predictable, and results in facilitation of target stimulus evaluation.

Applications of Hairpin DNA-Functionalized Gold Nanoparticles for Imaging mRNA in Living Cells.

Molecular imaging agents are useful for imaging molecular processes in living systems in order to elucidate the function of molecular mediators in health and disease. Here, we demonstrate a technique for the synthesis, characterization, and application of hairpin DNA-functionalized gold nanoparticles (hAuNPs) as fluorescent hybridization probes for imaging mRNA expression and spatiotemporal dynamics in living cells. These imaging probes feature gold colloids linked to fluorophores via engineered oligonucleotides to resemble a molecular beacon in which the gold colloid serves as the fluorescence quencher in a fluorescence resonance energy transfer system. Target-specific hybridization of the hairpin oligonucleotide enables fluorescence de-quenching and subsequent emission with high signal to noise ratios. hAuNPs exhibit high specificity without adverse toxicity or the need for transfection reagents. Furthermore, tunability of hAuNP emission profiles by selection of spectrally distinct fluorophores enables multiplexed mRNA imaging applications. Therefore, hAuNPs are promising tools for imaging gene expression in living cells. As a representative application of this technology, we discuss the design and applications of hAuNP targeted against distinct matrix metalloproteinase enzymes for the multiplexed detection of mRNA expression in live breast cancer cells using flow cytometry and fluorescence microscopy.

Visual control of hand action.

Recent investigations in normal and brain-damaged individuals have begun to identify the types of visual information used to plan and guide reaches. Binocular visual cues have been shown to be important for both movement planning and on-line guidance of hand movements, while emerging evidence suggests that dynamic visual analysis of the moving limb may provide a rich source of information for precise control of the hand in flight. Reaching movements appear to be planned to follow what is perceived to be a straight trajectory in peripersonal space. Furthermore, the process of selecting visual targets appears to influence hand trajectories, with hand movements curving away from non-target objects. This behaviour may be explained most effectively by a dynamic representation of space which is sculpted by attentional mechanisms into selected (target) and inhibited (non-target) regions. The role of attention in movement planning in individuals with attentional disorders is controversial. Patients with visual neglect have impairments of visuomotor control including reaches that, under certain conditions, are significantly more curved than those of normal individuals. The representations of space that neglect patients use to plan reaches may be distorted by impairments in the mechanisms that normally act to select target regions and inhibit non-target zones.

Platelet volume: laboratory measurement and clinical application.

Modern cell analyzers routinely produce platelet indices, but many clinicians do not utilize them in clinical decision-making. In part this can be attributed to difficulties with their laboratory measurement. The mean platelet volume is dependent on a number of variables, including time of analysis after venepuncture, method of analysis, anticoagulant used and specimen storage temperature. The influence of these laboratory variables is significant and reproducible mean platelet volumes are dependent on standardized laboratory methodology. When pre-analysis factors are controlled, alterations in platelet volume can be demonstrated in a number of disease states and assessment of platelet volume can be useful in the monitoring and diagnosis of patients. An understanding of the pathophysiology of alterations in platelet volume and of the inverse relationship between platelet volume and count is a prerequisite for the successful clinical application of platelet volume measurements.

Prism adaptation produces neglect-like patterns of hand path curvature in healthy adults.

Visuospatial neglect is a common consequence of brain injury in which patients fail to respond appropriately to stimuli or events occurring within their contralesional hemispace and may restrict eye and hand movements to objects or events occurring within ipsilesional space. Emerging evidence suggests, however, that neglect is a syndrome consisting of several components, including the impaired representation of corporeal and extrapersonal space. To better understand the neglect syndrome it is important to develop experimental models of each of these components. Here we develop an experimental model of the spatial impairment associated with visuospatial neglect based upon adaptation to laterally displacing optical prisms. We demonstrate that after a short period spent adapting to rightward displacing prisms, healthy subjects exhibit increases in hand-path curvature during reaches executed under visual guidance, but, not during reaches executed to proprioceptively-defined targets without vision.

Serial reaction time learning and Parkinson's disease: evidence for a procedural learning deficit.

This paper presents evidence in support of a serial reaction time (SRT) deficit associated with Parkinson's disease, and related to the acquisition or execution of serial-order information. Eleven patients with idiopathic Parkinson's disease, and 10 age-matched but otherwise healthy control subjects, were compared on a variant of the SRT task introduced by Nissen and Bullemer (Cognit. Psychol. 19, 1-32, 1987). The results of this study clearly demonstrate that PD patients produce a quite different pattern of RT performance to that of control subjects. Such a pattern of results may reflect either: (1) a deficit in the patients' ability to learn the temporal order information provided by a repeating sequence of target locations in the SRT task; or (2) a deficit in the patients' ability to express temporal order information provided by the repeating sequence of target locations in the SRT task.

Reaching movements may reveal the distorted topography of spatial representations after neglect.

It has been proposed that patients with spatial neglect fail to respond appropriately toward stimuli opposite their brain lesion because they have an impairment of directing attention. However, a disorder of 'intention' - or movement initiation - has also been demonstrated in this condition. Recently, the paths of neglect patients' reaches have been shown to be abnormally curved, but it is unclear whether this impairment is visual or motor. Here, we show for the first time that reaches to and from identical positions executed by three patients recovering from neglect are significantly more curved to visually defined targets compared to when the same targets are defined proprioceptively. These findings indicate that abnormal hand paths in neglect result from an impairment in the visual representation of space used to guide reaches but without any general failure of spatial representation of target position. Furthermore, the curved hand paths reveal how the topography of that representation is distorted in spatial neglect.

Recovery from rhabdomyolysis after allogeneic BMT: report of a case with speculation on causation.

A case of fulminant rhabdomyolysis occurring 4 months after allogeneic BMT for CML is reported. The patient developed rhabdomyolysis following the empiric institution of antibacterial and anti-tuberculous medication. His inpatient course was complicated by the development of acute anuric renal failure and a severe myopathy. With aggressive supportive care, both of these complications resolved, making this patient the only reported survivor of rhabdomyolysis occurring after BMT.

Admission of bone marrow transplant recipients to the intensive care unit: outcome, survival and prognostic factors.

The role of ICU support in BMT patients is controversial. In an era of constrained resources, the use of prognostic factors predicting outcome may be helpful in identifying patients who are most likely (or unlikely) to benefit from this intervention. We attempted to define the survival of patients admitted to ICU following autologous or allogeneic BMT and to identify those factors important in determining patient outcome. A retrospective study of all adult BMT recipients admitted to intensive care over a 6 year study period was performed to determine overall and prognostic indicators of poor outcome. Pre-treatment, pre-ICU admission and ICU admission data were analyzed to identify factors predicting long-term survival. 116 patients were admitted to ICU on 135 separate occasions with the primary reasons for admission being respiratory failure (66%), sepsis associated with hypotension (10%), and cardiorespiratory failure (8%). No pre-ICU characteristics were predictive of survival. Univariate analysis identified the number of support measures required, the need for ventilation or hemodynamic support, the APACHE II score, the year of ICU admission and the serum bilirubin as significant predictors of post-discharge survival. On multivariate analysis the year of ICU admission, the need for hemodynamic support and the serum bilirubin remained significant. The APACHE II score significantly underestimated survival in the 46% of patients with scores less than 35, and could only be used to predict 100% mortality when it exceeded 45. Twenty-three percent of all BMT patients admitted to the ICU and 17% of ventilated patients survived to hospital discharge. Of the 27 patients surviving to leave hospital, 16 remain alive with a median follow-up of 4.2 years and a mean Karnofsky performance status of 90. Although mortality in BMT recipients admitted to ICU is high our results indicate that intensive care support can be lifesaving and that the outcome in patients requiring ventilation and ICU support may not be as poor as has been previously reported. No single variable was identified which could be used to predict futility but patients requiring both hemodynamic support and mechanical ventilation, and those with an APACHE II score greater than 45 have a very poor prognosis and are unlikely to benefit from lengthy ICU support.

Pathological perceptual completion in hemianopia extends to the control of reach-to-grasp movements.

The neuropsychological phenomenon of blindsight is observed when patients who are cortically blind exhibit residual visual processing capabilities for stimuli presented within their scotoma to which they are otherwise unaware. Cortically blind patients may also exhibit the phenomenon of pathological visual completion in which, paradoxically, they can become aware of a complete visual stimulus even when a significant portion of that stimulus falls within their blind hemifield. In this study, the ability of a blindsight patient (G.Y.) to use visual information to control reach-to-grasp movements to static objects presented within his blind hemifield was investigated. The results indicate that while G.Y. was insensitive to variations in object size when reaching for objects presented entirely within his blind hemifield, his ability to accurately grasp objects located within his blind field was vastly improved if part of the object to be grasped extended into his seeing hemifield. This finding demonstrates that visual awareness can facilitate the visuomotor processing of object form within G.Y.'s apparently blind field, and suggests that the primary deficit in blindsight may be an impairment of visual consciousness rather than an absolute loss of visual function.