Early Mortality after Radical Radiotherapy in Head and Neck Cancer - A Nationwide Analysis from the Danish Head and Neck Cancer Group (DAHANCA) Database.

AIMS: Curative-intent radiotherapy (RT) or chemoradiation (CRT) of squamous cell carcinoma of the head and neck (HNSCC) produces high survival rates, but is associated with substantial toxicity. However, there are no commonly accepted quality metrics for early mortality in radiation oncology. To assess the applicability of early mortality as a clinical quality indicator, this study investigated the temporal distribution, risk factors and trends of 90- and 180-day overall and non-cancer mortality in a nationwide cohort of HNSCC patients treated with RT/CRT. MATERIALS AND METHODS: Information on all HNSCC patients treated with curative-intent RT/CRT in Denmark between 2000 and 2017 was obtained from the national Danish Head and Neck Cancer Group clinical database. Deaths in patients with residual or recurrent disease after RT/CRT were classified as cancer-related. Possible risk factors were investigated using logistic regression analysis. RESULTS: Data from 11 419 patients were extracted. In total, 90- and 180-day mortality risks were 3.1% and 7.1%, respectively. There was a uniform temporal distribution of 180-day mortality. In multivariable analysis, increasing age, stage, performance status, earlier treatment year and hypopharyngeal cancer were significantly associated with an increased risk (P < 0.05). Risk factor estimates were comparable for 90- versus 180-day mortality as well as for overall versus non-cancer mortality. Between 2000 and 2017 there was a significant decrease in 180-day mortality, which was driven by a reduction in cancer-related events. CONCLUSION: The distribution of 180-day overall and non-cancer mortality did not indicate a well-defined early high-risk period. Moreover, risk factor estimates were highly similar across risk periods and groups. Taken together, our findings question the applicability of early mortality as a standard metric for treatment-associated toxicity.

The effect of docking length on the risk of tail biting, tail-directed behaviour, aggression and activity level of growing pigs kept under commercial conditions.

Tail biting in domestic pigs relates to a range of risk factors, primarily in the pigs' environment. Preventive tail docking is widely used, and various experimental approaches suggest that docking reduces the risk of tail biting. However, whether the docking length affects the prevalence of tail biting outbreaks is less studied, as is how a shortened tail will affect pigs' social behaviour. The aim of this study was to investigate how three different tail docking lengths, measured at docking, as well as retained intact tails (Short: 2.9 cm; Medium: 5.7 cm; Long: 7.5 cm; and Undocked) affected tail biting risk and behaviour directed at other finisher pigs with the same docking length treatment. Tail lesions were scored weekly, as was behaviour at pen level after introduction to finisher pens and until a potential outbreak of tail biting or slaughter. Pigs from four commercial herds (258 litters) entered the study. Before the pigs entered the finisher section and data collection started, some pigs were excluded, mainly due to tail biting outbreaks in the weaner section. The risk of a tail biting outbreak differed significantly between treatments (P=0.001), with a lowered risk of a tail biting outbreak in Short pens compared with Undocked (P<0.001) and Medium (P<0.05), and was affected by herd as well (P<0.001). Pens in the Long and Undocked treatments were pooled for the behavioural analysis due to low representation, especially in the Undocked treatment. The probability of tail contacts, where a pig interacted with a pen mate's tail, differed between docking length treatments and was highest in the Long/Undocked compared with the Short treatment (P<0.01), but docking length did not affect aggressive behaviour. Docking length affected the risk of a tail biting outbreak and the frequency of tail-directed behaviour in our participating herds, of which three reported a high prevalence of tail biting problems. Only the shortest docking length treatment (Short) reduced the tail biting risk, but did not completely prevent tail biting outbreaks.

Intraoperative Tumor Perforation is Associated with Decreased 5-Year Survival in Colon Cancer: A Nationwide Database Study.

BACKGROUND: It is a widely held belief that intraoperative tumor perforation in colon cancer impairs survival and causes local recurrence, although the prognostic importance remains unclear. AIM: The aim of this study was to assess the effect of unintended intraoperative tumor perforation on postoperative mortality and long-term survival. MATERIAL AND METHODS: This national cohort study was based on data from a prospectively maintained nationwide colorectal cancer database. We included 16,517 colon cancer patients who were resected with curative intent from 2001 to 2012. RESULTS: Intraoperative tumor perforation produced a significantly impaired 5-year survival of 40% compared to 64% in non-perforated colon cancer. Intraoperative tumor perforation was an independent risk factor for death, hazard ratio 1.63 (95% confidence interval: 1.4-1.94), with a significantly increased 90-day postoperative mortality of 17% compared to 7% in non-perforated tumors, p < 0.001. We showed that tumor fixation, emergency operations, and laparotomies were associated with an increased risk of intraoperative tumor perforation. CONCLUSION: This nationwide study demonstrates that intraoperative tumor perforation in colon cancer is associated with statistically significant reduced long-term survival and increased postoperative mortality.

Size Dependent Male Reproductive Tactic in the Two-Spotted Goby (Gobiusculus flavescens).

Male investment in testes and sperm duct gland in the polygamous nest breeding two-spotted goby Gobiusculus flavescens (Fabricius) was investigated in relation to time in reproductive season and individual physical parameters. This small teleost fish is most likely the most abundant species found along the rocky shores of the North East Atlantic. The two-spotted goby has a single reproductive season, during which nest-caring males can raise several clutches of offspring. According to the literature the males are on average larger than the females. Here we report for the first time a population showing a reversal of this trend, with males on average being smaller than females, a difference likely caused by a large proportion of small males. Early in the breeding season these small males have typical sneaker characters, with relatively large testes and small seminal duct glands compared to the larger dominant territorial males. The presence of these two alternative male reproductive tactics is confirmed by histological studies, which shows the presence of sperm in the sperm duct glands (SDG) of smaller males, but not in the SDG of intermediate and larger males. To our knowledge, males with typical sneaker characters have not been reported in earlier studied populations of two-spotted goby. Interestingly we found that testes investment declined significantly over the course of the breeding season, and that this reduction was significantly more pronounced in small compared to the large males. Further, a significant increase in seminal duct gland (SDG) mass was observed for the smaller males over the breeding season. We propose that this indicates a possible shift in mating tactic by smaller males from a parasitic to a nest-holding tactic over the course of the breeding season. Thus, the observed size dependent plasticity in investment in SDG over time suggests that the reproductive tactic of G. flavescens is conditional, and possibly influenced by mate availability and male--male competition.

Pathogenesis and pathology of shoulder ulcerations in sows with special reference to peripheral nerves and behavioural responses to palpation.

Shoulder ulcerations are common in breeding sows in production systems but the consequences for the animals in terms of pain or discomfort are not well-described. This study presents data from a histopathological examination of shoulders of sows, specially focusing on the peripheral nerves in the region and the behavioural responses towards palpation of animals with traumatic neuromas but without ulcers. The study included 155 sows from seven Danish herds initially screened and stratified according to absence/presence and size of shoulder ulcers 3-4 weeks post-partum, out of which 71 were free of ulcerations and 84 had different stages of ulceration. Before collection, sows were subjected to shoulder palpation and behavioural responses were registered. From the consecutive pattern of development of ulcerations it is evident that shoulder ulcerations develop from top-to-bottom. A high frequency of traumatic neuromas was found in both healed and unhealed lesions. The observation of viable nerve-ends in shoulder ulcerations makes it likely that ulcerations are associated with pain. Moreover, the presence of traumatic neuromas in healed ulcerations indicates that there is discomfort even after the lesions have healed. This is further supported by the behavioural finding that rubbing behaviour in response to palpation was increased on the day of sample collection of the shoulders in sows with traumatic neuromas but without shoulder ulcers (P=0.053). Further studies are needed for final confirmation but these results suggest that shoulder ulcers may be associated with pain even after healing.

The protection afforded by the outer layer to procercoids of Schistocephalus solidus during passage through the stomach lumen of their vertebrate host (Gasterosteus aculeatus).

Intestinal cestodes with complex life cycles have to pass through the acid stomach lumen of their vertebrate host(s) in order to reach their preferred site of development. The cestode's tegument is the only organ in constant contact with this hostile environment. Procercoids of Schistocephalus solidus (order Diphyllobothriidea) lose their outer layer on passing through the acidic stomach of their second intermediate host (Gasterosteus aculeatus). We wanted to investigate if the outer layer is an adaptation that enables passage through this hostile environment. We used fish bile to force the procercoid larvae to shed their outer layer. This allowed us to compare the survival of the normal procercoids and the transformed ones when exposed to hydrochloric acid. We observed that the presence of the outer layer significantly improved the survival and active period of the procercoid larvae. Thus we conclude that in cestodes which inhabit the digestive tracts of vertebrates, the outer layer is an adaptation which enables them to pass through the acidic stomach environment of their vertebrate host(s).

Weight change with liraglutide and comparator therapies: an analysis of seven phase 3 trials from the liraglutide diabetes development programme.

AIM: We investigated the relationship between weight change and related factors in subjects with type 2 diabetes mellitus (T2DM) treated with liraglutide versus comparator diabetes therapies. METHODS: Twenty-six-week data from seven phase 3, randomized trials in the liraglutide T2DM development programme were analysed by trial and treatment group: liraglutide (1.2 and 1.8 mg), active comparator and placebo. Outcome measures included proportions of subjects in various weight change categories and their percentage weight change from baseline; impact of body mass index (BMI) and gastrointestinal (GI) adverse events (AEs) on weight change and correlation of weight change with change in glycosylated haemoglobin (HbA1c). RESULTS: A number of subjects experienced >5% weight loss during the trials (24.4% liraglutide 1.8 mg and 17.7% liraglutide 1.2 mg; 17.7% exenatide, 10.0% sitagliptin, 3.6-7.0% sulphonylurea, 2.6% thiazolidinedione and 2.6% glargine; 9.9% placebo). More weight loss was seen with liraglutide 1.2 and 1.8 mg than with active comparators except exenatide. Across trials, higher initial BMI was associated with slightly greater weight loss with liraglutide. Mean weight loss increased slightly the longer GI AEs persisted. Although HbA1c reduction was slightly larger in higher weight loss categories across treatments (including placebo), sample sizes were small and no clear correlation could be determined. Liraglutide-treated subjects experienced additional HbA1c reduction beyond that which appeared weight induced; thus, not all HbA1c-lowering effect appears weight mediated. CONCLUSIONS: The majority of liraglutide-treated T2DM subjects experienced weight loss in this analysis. Weight loss was greater and occurred more in glucagon-like peptide-1 receptor agonist-treated subjects than in active comparator-treated subjects.

Laboratory investigations of the effects of geologic heterogeneity on groundwater salinization and flush-out times from a tsunami-like event.

This intermediate scale laboratory experimental study was designed to improve the conceptual understanding of aquifer flushing time associated with diffuse saltwater contamination of coastal aquifers due to a tsunami-like event. The motivation comes from field observations made after the tsunami in December, 2004 in South Asia. The focus is on the role and effects of heterogeneity on flushing effectiveness. A scheme that combines experimentation in a 4.8m long laboratory tank and numerical modeling was used. To demonstrate the effects of geologic heterogeneity, plume migration and flushing times were analyzed in both homogeneous and layered media and under different boundary conditions (ambient flow, saltwater infiltration rate, freshwater recharge). Saltwater and freshwater infiltrations imitate the results of the groundwater salinization from the tsunami and freshening from the monsoon rainfall. The saltwater plume behavior was monitored both through visual observations (digital photography) of the dyed salt water and using measurements taken from several electrical conductivity sensors installed through the tank walls. The variable-density, three dimensional code HST3D was used to simulate the tank experiments and understand the fate and movement of the saltwater plume under field conditions. The results from the tank experiments and modeling demonstrated that macro-scale heterogeneity significantly influenced the migration patterns and flushing times of diffuse saltwater contamination. Ambient flow had a direct influence on total flush-out time, and heterogeneity impacted flush-out times for the top part of the tank and total flush-out times. The presence of a continuous low-permeability layer caused a 40% increase in complete flush-out time due to the slower flow of salt water in the low-permeability layer. When a relatively small opening was introduced in the low-permeability layer, salt water migrated quickly into a higher-permeable layer below causing a reduction in flush-out time. Freshwater recharge caused an early dilution of salt water in the top part of the tank in the case of a layered media, but also pushed the saltwater plume into the low-permeability layer which led to increased total flush-out times.

Optimality of the Münch mechanism for translocation of sugars in plants.

Plants require effective vascular systems for the transport of water and dissolved molecules between distal regions. Their survival depends on the ability to transport sugars from the leaves where they are produced to sites of active growth; a flow driven, according to the Münch hypothesis, by osmotic gradients generated by differences in sugar concentration. The length scales over which sugars are produced (Lleaf) and over which they are transported (L(stem)), as well as the radius r of the cylindrical phloem cells through which the transport takes place, vary among species over several orders of magnitude; a major unsettled question is whether the Münch transport mechanism is effective over this wide range of sizes. Optimization of translocation speed predicts a scaling relation between radius r and the characteristic lengths as r∼(Lleaf Lstem)1/3. Direct measurements using novel in vivo techniques and biomimicking microfluidic devices support this scaling relation and provide the first quantitative support for a unified mechanism of sugar translocation in plants spanning several orders of magnitude in size. The existence of a general scaling law for phloem dimensions provides a new framework for investigating the physical principles governing the morphological diversity of plants.

Decubital shoulder ulcers in sows: a review of classification, pain and welfare consequences.

Decubital shoulder ulcers are lesions on the shoulders of sows kept in production systems, reported to have a relatively high prevalence, and to some extent be comparable with human pressure ulcers. In sows, the ulcers are caused by pressure inflicted by the flooring, leading to oxygen deficiency in the skin and the underlying tissue. This paper reviews existing knowledge about decubital shoulder ulcers in sows, focusing on the pathogenesis, classification and consequences in terms of pain and animal welfare. On the basis of available human as well as animal literature, we describe the primary causal factors, underlying mechanisms, suggested direction of progression as well as temporal development. We review suggested scales for the classification of decubital shoulder ulcers, and argue that none of these are useful for the classification of decubital shoulder ulcers in live sows. The knowledge of the welfare consequences of decubital shoulder ulcers is limited. On the basis of the tissue structures that are involved, we assume that the development and presence of decubital shoulder ulcers in sows are a painful and prolonged condition. It is concluded that the extent of the welfare problem related to decubital shoulder ulcers cannot be fully determined until a valid ante-mortem classification system is available, and knowledge about the duration of the condition (including the various stages), as well as the possible consequences in terms of pain or discomfort have been established.

Brief report: biomarkers of aortic vascular prosthetic graft infection in a porcine model with Staphylococcus aureus.

Aortic vascular prosthetic graft infection (AVPGI) with Staphylococcus aureus is a feared post-operative complication. This study was conducted to evaluate the clinical signs and potential biomarkers of infection in a porcine AVPGI model. The biomarkers evaluated were: C-reactive protein (CRP), fibrinogen, white blood cells (WBC), major histocompatibility complex II (MHC II) density, lymphocyte CD4:CD8 ratio and tumour necrosis factor-alpha (TNF-α) in vitro responsiveness. Sixteen pigs were included in the study, and randomly assigned into four groups (n = 4): "SHAM" pigs had their infra-renal aorta exposed by laparotomy; "CLEAN" pigs had an aortic graft inserted; "LOW" and "HIGH" pigs had an aortic graft inserted and, subsequently, S. aureus were inoculated on the graft material (5 × 10(4) colony-forming units [CFU] and 1 × 10(6) CFU, respectively). Biomarkers were evaluated prior to surgery and on day 2, 5, 7, and 14 post-operatively in blood samples. Of all biomarkers evaluated, CRP was superior for diagnosing S. aureus AVPGI in pigs, with a sensitivity of 0.86 and a specificity of 0.75.

The effects of floor heating on body temperature, water consumption, stress response and immune competence around parturition in loose-housed sows.

The aim of the present study was to study whether floor heating from 12h after onset of nest building until 48 h after birth of the first piglet had any effect on measures related to body temperature, water consumption, stress response and immune competence in loose-housed sows (n=23). In conclusion, the present results indicate that floor heating for a limited period around parturition did not compromise physiological and immunological parameters, water intake and body temperature in loose-housed sows. The water intake peaked the day before parturition and the body temperature peaked on the day of parturition. A cortisol peak at parturition, a transient rise in the number of leucocytes and neutrophils and a transient reduction in the number of lymphocytes, erythrocytes and in the PCV value were observed. Around and after parturition some non-specific immunological variables seemed to be stimulated while others seemed to be compromised.

Model analysis of mechanisms controlling pneumatic soil vapor extraction.

The efficiency of traditional soil venting or soil vapor extraction (SVE) highly depends on the architecture of the subsurface because imposed advective air flow tends to bypass low-permeable contaminated areas. Pneumatic SVE is a technique developed to enhance remediation efficiency of heterogeneous soils by enforcing large fluctuating pressure fronts through the contaminated area. Laboratory experiments have suggested that pneumatic SVE considerably improves the recovery rate from low-permeable units. We have analyzed the experimental results using a numerical code and quantified the physical processes controlling the functioning of the method. A sensitivity analysis for selected boundary conditions, initial conditions and parameters was carried out to examine how the method behaves under conditions different from the experimental set-up. The simulations show that at the laboratory level the pneumatic venting technology is superior to the traditional technique, and that the method is particularly efficient in cases where large permeability contrasts exist between soil units in the subsurface.

Effect of mild heat stress and mild infection pressure on immune responses to an E. coli infection in chickens.

Outdoor or organic farming demands robust chickens that are able to combat common infections before they spread to the flock. Priming the immune system of the chickens early in life with micro-organisms that they will encounter later in life prepares chickens to a life in environments where they are subjected to a more natural level of infection pressure. Also, exposure to non-infectious stressful situations may prepare the immune system to combat infectious challenges. The present study investigated whether the immune system could be primed by applying small doses of infective material to the chicken flock or by exposure to short-term non-infectious stimulation, and whether the effect of those stimuli would depend on the genetic material chosen. The effect of the stimulations was examined on selected immunological variables in two chicken strains, using small amounts of manure and litter from other chickens or short-term heat stress, respectively. After 6 weeks of treatment, all chickens were subjected to an Escherichia coli infection and followed for another 3 weeks. Measures of body weight gain, chicken mannan-binding lectin (cMBL), percentage of CD4+ and MHCII+ lymphocytes, mean fluorescence intensity (m.f.i.) of CD4 on CD4+ cells and MHCII on MHCII+ cells and antibody titres to E. coli were taken. In conclusion, the chickens redistribute lymphocyte populations in peripheral blood in response to potentially infectious agents as well as to stressful non-infectious treatments. Responses to stress situations were dependent on the frequencies of stress exposures and on the chicken breed. This may reflect the superiority of one breed over another in adapting to treatments or in discriminating whether a treatment is harmless or dangerous. However, the differences did not influence the disease resistance to infection with a mixture of E. coli O2, O11 and O78 in the present study.

Experimental investigation of pneumatic soil vapor extraction.

Soil Vapor Extraction (SVE) is a common remediation technique for removing volatile organic compounds from unsaturated contaminated soils. Soil heterogeneities can however cause serious limitations to the applicability of SVE due to air bypassing low permeable areas of the soil, leading to diffusion limitation of the remediation. To enhance removal from areas subject to diffusion limitation a new remediation technique, pneumatic soil vapor extraction, is proposed. In contrast to traditional SVE, in which soil vapor is extracted continuously by a vacuum pump, pneumatic SVE is based on enforcing a sequence of large pressure drops on the system to enhance the recovery from the low-permeable areas. The pneumatic SVE technique was investigated in the laboratory using TCE as a model contaminant. 2D-laboratory tank experiments were performed on homogeneous and heterogeneous sand packs. The heterogeneous packs consisted of a fine sand lens surrounded by a coarser sand matrix. As expected when using traditional SVE, the removal of TCE from the low permeable lens was extremely slow and subject to diffusion limitation. In contrast when pneumatic venting was used removal rates increased by up to 77%. The enhanced removal was hypothesized to be attributed to mixing of the contaminated air inside the lens and generation of net advective transport out of the lens due to air expansion.

Immune response to a killed infectious bursal disease virus vaccine in inbred chicken lines with different major histocompatibility complex haplotypes.

The influence of MHC on antibody responses to killed infectious bursal disease virus (IBDV) vaccine was investigated in several MHC inbred chicken lines. We found a notable MHC haplotype effect on the specific antibody response against IBDV as measured by ELISA. Some MHC haplotypes were high responders (B201, B4, and BR5), whereas other MHC haplotypes were low responders (B19, B12 and BW3). The humoral response of 1 pair of recombinants isolated from a Red Jungle Fowl (BW3 and BW4) being identical on BF and BG, but different on BL, indicated that part of the primary vaccine response was an MHC II restricted T-cell dependent response. The humoral response in another pair of recombinant haplotypes originating in 2 different White Leghorn chickens being BF21, BL21, BG15 (BR4) and BF15, BL15, BG21 (BR5) on the MHC locus indicated that the BG locus may perform an adjuvant effect on the antibody response as well. Vaccination of chickens at different ages and in lines with different origin indicated that age and background genes also influence the specific antibody response against inactivated IBDV vaccine.

Molecular characterization of major histocompatibility complex class I (B-F) mRNA variants from chickens differing in resistance to Marek's disease.

In this study, the relative distributions of two alternatively polyadenylated chicken major histocompatibility complex (MHC) mRNA isoforms of approximately 1.5 and 1.9 kb were analysed in spleen cells from chickens homozygous for the MHC haplotypes B21 and B19v1 as well as in heterozygous B19v1/B21 birds. Both isoforms are likely to encode classical MHC class I (B-F) alpha chains. The B19v1 and B21 MHC haplotypes confer different levels of protection against Marek's disease (MD), which is caused by infection with MD virus (MDV). In spleen cells, MD-resistant B21 birds were shown to have the highest percentage of the 1.5 kb variant relative to the total MHC class I expression, MD-susceptible B19v1 birds the lowest and B19v1/B21 birds an intermediate percentage. Infection of 4-week-old chickens with the GA strain of MDV was shown to cause a significant increase in the relative amount of 1.5 kb transcripts in B21 birds 32 days postinfection (dpi). Alternatively polyadenylated mRNA isoforms may encode identical proteins, but differences in the 3' untranslated region (UTR) can influence polyadenylation, mRNA stability, intracellular localization and translation efficiency. It was shown that the increased 1.5 kb percentage in B21 birds 32 days postinfection may be a result of a change in the choice of poly(A) site rather than a locus-specific upregulated transcription of the BF1 gene that preferentially expresses the 1.5 kb variant. Furthermore, the 3' end of the 1.5 kb mRNA variants deriving from B19v1 and B21 chickens was characterized by Rapid Amplification of cDNA Ends (RACE) and sequencing. No potentially functional elements were identified in the 3' UTR of the RACE products corresponding to this short isoform. However, variation in polyadenylation site was observed between the BF1 and BF2 mRNA transcripts and alternative splicing-out of the sequence (exon 7) encoding the second segment of the cytoplasmic part of the mature BF2*19 molecules. This alternative exon 7 splice variant was also detected in other MD-susceptible haplotypes, but not in the MD-resistant B21 and B21-like haplotypes, suggesting a potential role of exon 7 in MHC-related MD resistance.

On spurious water flow during numerical simulation of steam injection into water-saturated soil.

Numerical simulation of steam injection into a water-saturated porous medium may be hindered by unphysical behavior causing the model to slow down. We show how spurious water flow may arise on the boundary between a steam zone and a saturated zone, giving rise to dramatic pressure drops. This is caused by the discretization of the temperature gradient coupled with the direct relation between pressure and temperature in the steam zone. The problem may be a severe limitation to numerical modeling. A solution is presented where the spurious water flow is blocked and this widely enhances the performance of the model. This new method is applied to a previously reported example exhibiting numerical problems. Furthermore, it is applied to the simulation of 2-D sandbox experiments where LNAPL is remediated from a smearing zone by steam injection. These experiments would have been difficult to analyze numerically without the adjustment to prevent spurious flow.

Remediation of NAPL below the water table by steam-induced heat conduction.

Previous experimental studies have shown that NAPL will be removed when it is contacted by steam. However, in full-scale operations, steam may not contact the NAPL directly and this is the situation addressed in this study. A two-dimensional intermediate scale sand box experiment was performed where an organic contaminant was emplaced below the water table at the interface between a coarse and a fine sand layer. Steam was injected above the water table and after an initial heating period the contaminant was recovered at the outlet. The experiment was successfully modeled using the numerical code T2VOC and the dominant removal mechanism was identified to be heat conduction induced boiling of the separate phase contaminant. Subsequent numerical modeling showed that this mechanism was insensitive to the porous medium properties and that it could be evaluated by considering only one-dimensional heat conduction.

Removal of NAPLs from the unsaturated zone using steam: prevention of downward migration by injecting mixtures of steam and air.

Steam injection for remediation of porous media contaminated by nonaqueous phase liquids has been shown to be a potentially efficient technology. There is, however, concern that the technique may lead to downward migration of separate phase contaminant. In this work, a modification of the steam injection technology is presented, where a mixture of steam and air was injected. In two-dimensional experiments with unsaturated porous medium contaminated with nonaqueous phase liquids, it was demonstrated how injection of pure steam lead to severe downward migration. Similar experiments, where steam and air were injected simultaneously, resulted in practically no downward migration and still rapid cleanup was achieved. The processes responsible for the prevention of downward migration when injecting steam-air mixtures were analyzed using a nonisothermal multiphase flow and transport model. Hereby, three mechanisms were identified and it was demonstrated how the effectiveness of these mechanisms depended on the air-to-steam mixing ratio.