Definitive intensity modulated radiotherapy in locally advanced hypopharygeal and laryngeal squamous cell carcinoma: mature treatment results and patterns of locoregional failure.

PurposeTo assess clinical outcomes and patterns of loco-regional failure (LRF) in relation to clinical target volumes (CTV) in patients with locally advanced hypopharyngeal and laryngeal squamous cell carcinoma (HL-SCC) treated with definitive intensity modulated radiotherapy (IMRT) and concurrent systemic therapy.MethodsData from HL-SCC patients treated from 2007 to 2010 were retrospectively evaluated. Primary endpoint was loco-regional control (LRC). Secondary endpoints included local (LC) and regional (RC) controls, distant metastasis free survival (DMFS), laryngectomy free survival (LFS), overall survival (OS), and acute and late toxicities. Time-to-event endpoints were estimated using Kaplan-Meier method, and univariate and multivariate analyses were performed using Cox proportional hazards models. Recurrent gross tumor volume (RTV) on post-treatment diagnostic imaging was analyzed in relation to corresponding CTV (in-volume, > 95% of RTV inside CTV; marginal, 20¿95% inside CTV; out-volume, < 20% inside CTV).ResultsFifty patients (stage III: 14, IVa: 33, IVb: 3) completed treatment and were included in the analysis (median follow-up of 4.2 years). Three-year LRC, DMFS and overall survival (OS) were 77%, 96% and 63%, respectively. Grade 2 and 3 acute toxicity were 38% and 62%, respectively; grade 2 and 3 late toxicity were 23% and 15%, respectively. We identified 10 patients with LRF (8 local, 1 regional, 1 local¿+¿regional). Six out of 10 RTVs were fully included in both elective and high-dose CTVs, and 4 RTVs were marginal to the high-dose CTVs.ConclusionThe treatment of locally advanced HL-SCC with definitive IMRT and concurrent systemic therapy provides good LRC rates with acceptable toxicity profile. Nevertheless, the analysis of LRFs in relation to CTVs showed in-volume relapses to be the major mode of recurrence indicating that novel strategies to overcome radioresistance are required.

THE ULTRASTRUCTURAL ORGANIZATION OF THE HYPOGLOSSAL NUCLEUS IN THE RAT (SYNAPTOLOGY, CRANIAL NERVES)

An ultrastructural study of the hypoglossal nucleus (XII) in the rat has revealed two distinct neuronal populations. Hypoglossal motoneurons comprised the largest population of neurons in XII and were identified following injection of horseradish peroxidase (HRP) into the tongue. Motoneurons were large (25-50(mu)m), multipolar in shape and distributed throughout XII. The nucleus was large, round and centrally located, and the cytoplasm was characterized by dense lamellar arrays of rough endoplasmic reticulum. In contrast, a second population of small (10-18(mu)m), round to oval shaped neurons was found restricted to the ventral and dorsolateral regions of XII. The nucleus was markedly invaginated and eccentric, the cytoplasm scant and filled with free ribosomes, and the absence of lamellar arrays of rough endoplasmic reticulum was conspicuous. Neurons of this type were never found to contain HRP reaction product. These results demonstrate that the hypoglossal nucleus does not consist solely of motoneurons, but includes a distinctly separate, presumably non-motoneuronal pool. Arguments are presented in favor of this second neuron population being interneurons. The functional significance of these findings in relation to tongue control is discussed. ^

Emergency airway management by intensive care unit nurses with the intubating laryngeal mask airway and the laryngeal tube

When using the laryngeal tube and the intubating laryngeal mask airway (ILMA), the medium-size (maximum volume 1100 ml) versus adult (maximum volume 1500 ml) self-inflating bags resulted in significantly lower lung tidal volumes. No gastric inflation occurred when using both devices with either ventilation bag. The newly developed medium-size self-inflating bag may be an option to further reduce the risk of gastric inflation while maintaining sufficient lung ventilation. Both the ILMA and laryngeal tube proved to be valid alternatives for emergency airway management in the experimental model used.

Skin wounds and severed nerves heal normally in mice lacking tenascin-C.

A large number of functions have been demonstrated for tenascin-C by antibody perturbation assays and in vitro cell culture experiments. However, these results contrast sharply with the lack of any apparent phenotype in mice with a genetic deletion of tenascin-C. A possible explanation for the lack of phenotype would be expression of some altered but functional tenascin-C in the mutant. We report the generation of an independent tenascin-C null mouse and conclude that the original tenascin-C knockout, which is genetically very similar to ours, is also a true null. As found previously, the absence of tenascin-C has no influence on development, adulthood, life span, and fecundity. We have studied in detail two models of wound healing. After axotomy, the regeneration of the sciatic nerve is not altered without tenascin-C. During healing of cutaneous wounds, deposition of collagen I, fibulin-2, and nidogen is identical in mutant and wild-type mice. In contrast. fibronectin appears diminished in wounds of tenascin-C-deficient mice. However, the lack of tenascin-C together with the reduced amount of fibronectin has no influence on the quality of the healing process.

Cryptorchidism and homeotic transformations of spinal nerves and vertebrae in Hoxa-10 mutant mice.

Homozygous mice mutated by homologous recombination for the AbdB-related Hoxa-10 gene are viable but display homeotic transformations of vertebrae and lumbar spinal nerves. Mutant males exhibit unilateral or bilateral criptorchidism due to developmental abnormalities of the gubernaculum, resulting in abnormal spermatogenesis and sterility. These results reveal an important role of Hoxa-10 in patterning posterior body regions and suggest that Hox genes are involved in specifying regional identity of both segmented and nonovertly segmented structures of the developing body.

The war of nerves with Iran - consequences for the South Caucasus and Russia. OSW Commentary No. 75, 2012-04-25

Tensions over Iran’s nuclear programme have risen considerably in recent months. This has been visible in numerous threats of – and much speculation about – an imminent Israeli (and US) attack on Iran’s nuclear installations. In this context, the support for the attacks that the countries of the South Caucasus (and Azerbaijan in particular) could provide has been the subject of lively debate, as has been the prospect of a Russian political and military offensive in the Caucasus in response to the attacks on Iran. It seems that the ongoing war campaign in the media has been aimed primarily at putting pressure on Iran and the international community to find a political solution to the Iranian problem. This also applies to the Caucasus’s involvement in the campaign. Given the outcome of the Istanbul round of talks on a political solution to the Iranian issue (14 April), which warrants moderate optimism, the threat of a conflict now appears more distant and this also indirectly proves the effectiveness of the campaign. The war of nerves with Iran, however, is already now actually affecting the stability of the Southern Caucasus. While it seems that Azerbaijan is not Israel’s partner in the preparations to attacks, and that there is no real link between the Iranian problem and the ongoing and planned movements of Russian troops in the Caucasus, the tensions between Iran and Azerbaijan are indeed high. Moreover, the global image of the Caucasus is deteriorating, the USA’s position in the region is becoming more complicated, and Russia’s room for manoeuvre is expanding.

A dissertation upon the nerves, containing an account : I. Of the nature of man, 2. Of the nature of brutes, 3. Of the nature and connection of soul and body, 4. Of the threefold life of man, 5. Of the symptoms, causes and cure of all nervous diseases /

Mode of access: Internet.

Observations on the nature cause and cure of those disorders which have been commonly called nervous, hypochondriac, or hysteric : to which are prefixed some remarks on the sympathy of the nerves /

Mode of access: Internet.

An essay on the use of the ganglions of the nerves /

Mode of access: Internet.

Anatomical remembrancer or complete pocket anatomist : containing a concise description of the bones, ligaments, muscles, and viscera, the nerves ...

Mode of access: Internet.

The Dublin dissector, or manual of anatomy : comprissing a concise description of the bones, muscles, vessels, nerves and viscera, also the relative anatomy of the different regions of the human body.../

Mode of access: Internet.

The anatomy of the human bones, nerves and lacteal sac and duct .../

Mode of access: Internet.

References to nerves : being tabular views of the motor nerves to muscles, the nervous supply of the principal articulations and of the skin, the deep and superficial origins of the cranial nerves; with the most important effects following solution of continuity of nerves.

Mode of access: Internet.

The Dublin dissector, or Manual of anatomy; comprising a description of the bones, muscles, vessels, nerves, and viscera; also the relative anatomy of the different regions of the human body, together with the elements of pathology.

Original edition, Dublin, 1827; an American edition issued 1848 under title: A text-book of practical anatomy.