NUT carcinoma of the mandible in a child: case report and systematic review.

Nuclear protein of the testis (NUT) carcinoma is a rare, undifferentiated carcinoma that is characterized by NUTM1 gene rearrangements. Patients with NUT carcinoma have an overall survival of approximately 5% at 5 years despite a multimodal treatment approach. This report illustrates the management of mandibular NUT carcinoma in a pediatric patient, complemented by a systematic review of head and neck NUT carcinoma. A 5-year-old female presented with an enlarging jaw mass that was diagnosed as BRD4-NUTM1 carcinoma and was treated with hemimandibulectomy and chemoradiation. She remains disease-free 21 months after completion of therapy. A total of 63 patient cases reported in 34 articles were identified in the review. Only 26.9% (14/52) of tumors were correctly diagnosed initially as NUT carcinoma, whereas 73.1% (38/52) were incorrectly diagnosed as another malignancy; the initial diagnosis was not reported for 11 patients. The mandibular tumor subtype was among the rarest reported (n = 1; 1.6%). Combination therapy, including surgery and chemoradiation, was the most common treatment (55.2%). The patient case presented here is a novel case of pediatric mandibular NUT carcinoma. Due to the poor overall survival of patients with NUT carcinoma, aggressive upfront resection with 2-cm margins followed by adjuvant chemoradiation is advocated.

Low-loss arrayed waveguide grating at 760 nm.

An arrayed waveguide grating (AWG) at 760 nm is demonstrated with an insertion loss smaller than 0.5 dB. Interface roughness and waveguide length errors contribute much more to scattering loss and phase errors at 760 nm than at longer wavelengths, thus requiring improved design and fabrication. This Letter details how this is achieved by minimizing interfacial scattering, grating side-order excitation, and phase errors in the AWG. With silicon nitride core and silicon dioxide clad waveguides on silicon, this AWG is compatible with heterogeneously integrated lasers for on-chip spectral beam combining.

Advanced view factor analysis method for radiation exchange.

A raster-based method for determining complex view factor patterns is presented (HURES model). The model uses Johnson and Watson's view factor analysis method for fisheye lens photographs. The entire sphere is divided into 13 different view factors: open sky; sunny and shaded building walls, vegetation (trees) and ground surfaces above and below 1.2 m from the ground surface. The HURES model gave reasonable view factor results in tests at two urban study sites on summer days: downtown Nanaimo, B.C., Canada and Changwon, Republic of Korea. HURES gave better estimates of open sky view factors determined from fisheye lens photographs than did ENVI-met 3.1 and RayMan Pro. However, all three models underestimated sky view factor. For view factor analysis in outdoor urban areas, the 10° interval of rotation angle at 100 m distance of annuli will be suitable settings for three-dimensional computer simulations. The HURES model can be used for the rapid determination of complex view factor patterns which facilitates the analysis of their effects. Examples of how differing view factor patterns can affect human thermal sensation indices are given. The greater proportion of sunny view factors increased the computed predicted mean vote (PMV) by 1.3 on the sunny side of the street compared with the shady side during mid-morning in downtown Nanaimo. In another example, effects of differing amounts of open sky, sunny ground, sunny buildings and vegetation combined to produce only slight differences in PMV and two other human thermal sensation indices, PET and UTCI.

Mortality due to pandemic (H1N1) 2009 influenza in England: a comparison of the first and second waves.

Deaths in England attributable to pandemic (H1N1) 2009 deaths were investigated through a mandatory reporting system. The pandemic came in two waves. The second caused greater population mortality than the first (5·4 vs. 1·6 deaths per million, P<0·001). Mortality was particularly high in those with chronic neurological disease, chronic heart disease and immune suppression (450, 100, and 94 deaths per million, respectively); significantly higher than in those with chronic respiratory disease (39 per million) and those with no risk factors (2·4 per million). Greater mortality in the second wave has been observed in all previous influenza pandemics. This time, the explanation appears to be behavioural. This emphasizes the importance of maintaining public and clinical awareness of risks associated with pandemic influenza beyond the initial high-profile period.

Human body area factors for radiation exchange analysis: standing and walking postures.

Effective radiation area factors (f (eff)) and projected area factors (f (p)) of unclothed Caucasians' standing and walking postures used in estimating human radiation exchange with the surrounding environment were determined from a sample of adults in Canada. Several three-dimensional (3D) computer body models were created for standing and walking postures. Only small differences in f (eff) and f (p) values for standing posture were found between gender (male or female) and body type (normal- or over-weight). Differences between this study and previous studies were much larger: ≤0.173 in f (p) and ≤0.101 in f (eff). Directionless f (p) values for walking posture also had only minor differences between genders and positions in a stride. However, the differences of mean directional f (p) values of the positions dependent on azimuth angles were large enough, ≤0.072, to create important differences in modeled radiation receipt. Differences in f (eff) values were small: 0.02 between the normal-weight male and female models and up to 0.033 between positions in a stride. Variations of directional f (p) values depending on solar altitudes for walking posture were narrower than those for standing posture. When both standing and walking postures are considered, the mean f (eff) value, 0.836, of standing (0.826) and walking (0.846) could be used. However, f (p) values should be selected carefully because differences between directional and directionless f (p) values were large enough that they could influence the estimated level of human thermal sensation.

Audit of frequent attendees to an ENT emergency clinic.

OBJECTIVE: To audit the number of patients attending an ENT emergency clinic more than twice in the same clinical episode. METHOD: A completed audit cycle. The inclusion criterion for the retrospective arm was patients who had attended the ENT emergency clinic more than twice between 1 September to 30 November 2007. Data were analysed and interventions implemented. The re-audit, using the same inclusion criteria, was done between 1 March to 31 May 2008. RESULTS: The initial audit found that 38 patients were seen more than twice in the ENT emergency clinic, giving rise to 81 'excess' clinic appointments. After intervention, the re-audit identified 19 patients who were seen more than twice in the ENT emergency clinic, giving rise to 24 'excess' clinic appointments. CONCLUSION: By insisting that patients seen more than twice in the ENT emergency clinic were reviewed by a senior clinician, and by introducing a management guideline for acute otitis externa, we reduced excess clinic appointments by 70 per cent.

Measuring information strategies in oncology - developing an information satisfaction questionnaire.

The benefits of providing accurate and culturally sensitive information for patients are now undisputable and information strategies are generally being adopted nationally. Measuring their benefits and adapting strategies to local needs is now a new challenge. Although questionnaires to measure global satisfaction are available, no concise tool has previously existed to specifically measure the information aspects of care. The aims of this study are: to establish which aspects of information were most important to the patients during their cancer pathway; to develop a robust single-page questionnaire that is sensitive to patient priorities to measure and compare satisfaction between patient groups; and to audit information provision within routine clinical practice. Seventy-seven consecutive patients were asked to complete a priority list of which aspects of information were most important to them during their recent cancer care. A total of 303 answers were categorized into five final categories of equal weighting. The data were combined with demographic issues to produce a robust one-page questionnaire which has been adopted formally by the West Anglia Cancer Network. One hundred consecutive patients were then audited to highlight the information shortcomings of a busy community oncology department and the findings are reforming information services. We recommend the use of this practical audit tool in routine clinical practice, which can be downloaded free from cancernet.co.uk in seven languages.

Repellency of permethrin-treated battle-dress uniforms during Operation Tandem Thrust 2001.

Successful feeding by mosquitoes through permethrin-treated battle-dress uniforms (BDUs) was observed in the Shoalwater Bay Training Area (SWBTA), Queensland, Australia, during Operation Tandem Thrust 1997 (TT97). Therefore, during Operation Tandem Thrust 2001, the repellency of permethrin-treated BDUs was evaluated. Washing permethrin-treated BDUs 1 time reduced the permethrin concentration by 60%, but permethrin concentration was not reduced further after subsequent washings (up to 20 times). The probing time of Ochlerotatus vigilax landing on permethrin-treated BDUs was reduced to the greatest extent on the treated, unwashed uniform (7.5-fold reduction). Treated, washed uniforms also reduced probing time (2.5 times) compared to the untreated control uniform containing no permethrin. Reduced probing time should reduce feeding success and protect operational forces from bothersome mosquitoes and the associated risk of mosquito-borne disease in SWBTA. Observations of successful mosquito feeding made during TT97 could be attributed to the use of old and well-worn BDUs and seasonal differences in mosquito population density.

Diagnosis of militarily relevant diseases using oral fluid and saliva antibodies: fluorescence polarization immunoassay.

This laboratory is developing fluorescence polarization (FP) methods as diagnostic tools to assay antibodies in saliva and other oral fluids. FP provides quantitation of molecular interaction, such as antigen-antibody binding, of a single, small-volume sample in real time and without prior separation of components such as blood cells. There is potential for wide-spread use of these homogeneous assays as noninvasive tests, especially as more compact, simplified fluorescence polarimeters become available. FP tests can be designed that are applicable to a wide spectrum of microorganisms and may be used in a clinic or far-forward deployed setting to aid in diagnosis of disease or verification of vaccination. Rapid salivary diagnostics, including FP, have been identified by the Office of Naval Research as requirements for future naval capabilities in basic and applied medical research for warfighter protection in casualty prevention. The applications of FP salivary diagnostics for determination of tuberculosis exposure and of anthrax immunization status are discussed as examples.

Neurohormones and oxidative stress in nonischemic cardiomyopathy: relationship to survival and the effect of treatment with amlodipine.

OBJECTIVES: The purpose of this study was to assess the effects of amlodipine on neurohormones and oxidative stress in nonischemic cardiomyopathy, and determine the relationship between baseline and posttreatment levels of these markers with survival. BACKGROUND: Neurohormones and oxidative stress are important in the pathophysiology of heart failure. Calcium-channel blockers are associated with poor outcomes in patients with heart failure, in part due to neurohormonal activation. In contrast, amlodipine, a second-generation dihydropyridine, has a more favorable clinical profile. METHODS: In the Prospective Randomized Amlodipine Survival Evaluation 2 (PRAISE-2) trial, a subset of 181 patients with nonischemic cardiomyopathy were randomized to amlodipine (10 mg/day) or placebo. Blood samples were evaluated at baseline, 2 weeks and 26 weeks for norepinephrine, epinephrine, angiotensin II, dopamine, N-terminal pro-atrial natriuretic peptide (Nt-pro-ANP), brain natriuretic peptide (BNP), adrenolutin and malondialdehyde. RESULTS: There was no difference in levels of neurohormones or oxidative stress markers between the amlodipine and placebo groups at the different times. Both Nt-pro-ANP and BNP decreased at 2 weeks and at 26 weeks. Baseline Nt-pro-ANP correlated with survival in multivariate analysis (P =.001). A strong relationship was found between a reduction in BNP at 26 weeks and survival, with a hazard ratio of 0.153 (95% CI 0.051-0.461, P =.017). No relationship was found between markers of oxidative stress and survival. CONCLUSIONS: We conclude that amlodipine does not affect circulating neurohormones and oxidative stress markers in patients with nonischemic cardiomyopathy treated with angiotensin-converting enzyme inhibitors, digoxin and diuretics. In addition, low circulating Nt-pro-ANP and a reduction in BNP over time confers a good prognosis.

Prognostic importance of the oxidized product of catecholamines, adrenolutin, in patients with severe heart failure.

OBJECTIVES: The purpose of this study was to assess whether adrenolutin, the inert product of the highly reactive molecules aminochromes, is increased in severe chronic heart failure and whether it is associated with a poor prognosis. BACKGROUND: Experimental evidence suggests that oxidative products of catecholamines, aminochromes, are more cardiotoxic than unoxidized catecholamines and may be increased in heart failure. METHODS: Adrenolutin was measured at baseline and at 1 and 3 months in 263 patients with chronic New York Heart Association class III or IV heart failure and a left ventricular ejection fraction of 22% +/- 7%. Adrenolutin levels were compared with normal levels, and their relation to prognosis was evaluated. RESULTS: Baseline adrenolutin was increased (55 +/- 90 pg/mL vs 8.4 +/- 9.1 pg/mL for control, P <.02) and remained increased at 1 month (49 +/- 65 pg/mL). During a mean follow-up of 309 +/- 148 days (22-609 days), 57 patients died. Baseline adrenolutin levels correlated with mortality rates by univariate and multivariate analyses (relative risk 1.06, 95% CI 1.01-1.10 for each 17.9-pg/mL rise, P =.032). Left ventricular ejection fraction (P =.013) and New York Heart Association class (P =.009) were the only other variables associated with survival. Age, sex, plasma creatinine, plasma N-terminal atrial natriuretic peptide, and plasma norepinephrine levels were not retained in our model. Adrenolutin levels 1 month after random assignment were not significantly correlated with total mortality rate (P =.061) but were correlated with mortality rate from low output (relative risk 1.14, 95% CI 1.06-1.22, P =.002). CONCLUSIONS: Plasma adrenolutin is increased in patients with heart failure and correlates with a poor prognosis independent of other important predictors of survival. This finding has potentially important pathophysiologic, prognostic, and therapeutic implications.

Isolation of west nile and sindbis viruses from mosquitoes collected in the Nile Valley of Egypt during an outbreak of Rift Valley fever.

As part of an evaluation of potential vectors of arboviruses during a Rift Valley fever (RVF) outbreak in the Nile Valley of Egypt in August 1993, we collected mosquitoes in villages with known RVF viral activity. Mosquitoes were sorted to species, pooled, and processed for virus isolation both by intracerebral inoculation into suckling mice and by inoculation into cell culture. A total of 33 virus isolates was made from 36,024 mosquitoes. Viruses were initially identified by indirect fluorescent antibody testing and consisted of 30 flaviviruses (all members of the Japanese encephalitis complex, most probably West Nile [WN] virus) and three alphaviruses (all members of western equine encephalitis complex, most probably Sindbis). The identity of selected viruses was confirmed by reverse transcriptase-polymerase chain reaction and sequencing. Culex antennatus (Becker) and Culex perexiguus Theobald accounted for five (17%) and 23 (77%) of the WN virus isolations, respectively. Despite isolation of viruses from 32 pools of mosquitoes (both WN and Sindbis viruses were isolated from a single pool), RVF virus was not isolated from these mosquitoes, even though most of them are known competent vectors collected during an ongoing RVF outbreak. Thus, it should be remembered, that even during a known arbovirus outbreak, other arboviruses may still be circulating and causing disease.

The utility of four biochemical markers in the triage of chest pain patients.

Four biochemical markers, creatine kinase (CK)-MB isoenzyme, myoglobin, myosin light chains and troponin I, were studied in 1,338 patients presenting to the emergency department with chest pain suggestive of coronary artery disease (CAD). One hundred and eighty-seven patients had an acute myocardial infarction (MI). At least one of the four markers was over the threshold on the first sample in 78% of MI patients, as compared to only 40% with an elevated CK-MB. After 4 h, 88% had at least one marker elevated. None of the 69 patients with atypical chest pain, no history of CAD, no markers over threshold on the first sample and a normal electrocardiogram had an acute MI or unstable angina. If we had discharged this group, we would have saved USD 264,000, estimating a cost of USD 2,000 per day. Using four biochemical markers improved the early diagnosis of CAD and may help identify groups suitable for early discharge.