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A subset S of an integral domain is called a semidomain if the pairs (S, +) and (S∖{0},⋅) are commutative and cancellative semigroups with identities. The multiplication of S extends to the group of differences 풢(S), turning 풢(S) into an integral domain. In this paper, we study the arithmetic of semisubtractive semidomains (i.e. semidomains S for which either s ∈ S or − s ∈ S for every s ∈풢(S)). Specifically, we provide necessary and sufficient conditions for a semisubtractive semidomain to be atomic, to satisfy the ascending chain condition on principals ideals, to be a bounded factorization semidomain, and to be a finite factorization semidomain, which are subsequent relaxations of the property of having unique factorizations. In addition, we present a characterization of factorial and half-factorial semisubtractive semidomains. Throughout the paper, we present examples to provide insight into the arithmetic aspects of semisubtractive semidomains. [ABSTRACT FROM AUTHOR]

The article focuses on why maintaining and protecting teaching professionalism is integral to effective teacher development. Topics discussed include continuing professional development (CPD) is a crucial part of any educator's life in the Grate Britain; and understood as practices to develop a teacher's expertise and professional standards beyond their initial education, with a focus on improving the quality of teaching and learning (DfE, 2016).

Transoral robotic surgery has shown significant promise in the management of oropharyngeal cancer since its description in 2007. The oncological efficacy of this procedure has been proven in several single-centre studies, multicentre collaborative publications and systematic reviews. The rapid take-up of transoral robotic surgery shows greater acceptance by professionals and is associated with a relatively short learning curve. This overview discusses the rationale and principles underlying the use of transoral robotic surgery in primary and recurrent oropharyngeal cancer and the emerging role for this technique in diagnosing the unknown primary site, and summarizes ongoing research in this field. [ABSTRACT FROM AUTHOR]

Neurofibroma is a slow growing benign tumour of the peripheral nerve sheath which is frequently associated with neurofibromatosis type 1 (Prakash et al., 2014). Isolated solitary occurrence of neurofibroma in the maxillary sinus is rare with only 29 reported cases in the literature. We present a rare case of a 70-year-old gentleman who was referred to ENT with a right maxillary sinus neurofibroma with extension into the right inferior orbit. He has significant proptosis, ptosis, and limitation in abduction of the right eye. He has a complicated past history of multiple neurofibromas which were completely excised. Craniofacial MRI shows a large mass filling the right maxillary antrum extending anteriorly into subcutaneous tissue towards nasal ala and posterolaterally into inferior temporal fossa and superiorly into orbit and cavernous sinus involvement. Biopsy of the right maxillary mass revealed cellular spindle cell tumour with wavy collagen bundles within myxoid stroma which is consistent with a neurofibroma. Patient’s case was discussed in the skull-base MDT and he has been referred to a specialist center for surgical removal of the neurofibroma with reconstructive surgery. Despite the rarity of this disease, otorhinolaryngologist should consider a possibility of neurofibroma of the paranasal sinuses. [ABSTRACT FROM AUTHOR]

An estimated 1 million new cases of cancer occur each year in India, with over 80% presenting at the point at which the disease is incurable. Around 60% of the patients will already be in significant pain, and just under half will be experiencing excruciating, unbearable pain. With only a handful of outpatient palliative care clinics in Kolkata, few patients are able to access essential pain medication and palliative care services. This narrative includes five case studies exploring differing aspects of palliative care: pain management, the difficulties faced in accessing morphine, the importance of compassion in end-of-life care, and the psychological effects on families. They illustrate the degree of suffering some patients and families face, and the relatively simple measures that can be taken to alleviate this. For the current situation in India to improve, there needs to be better access to essential pain medications such as morphine, education of health care professionals and the public, as well as the implementation of government pain management and palliative care policies. [ABSTRACT FROM AUTHOR]

Presents a personal narrative which explores the author's experience of attending workshops on playback theater in Cuba. INSET: Interview with Jonathan Fox.

Intrathecal synthesis of central nervous system (CNS)-reactive autoantibodies is observed across patients with autoimmune encephalitis (AE), who show multiple residual neurobehavioral deficits and relapses despite immunotherapies. We leveraged two common forms of AE, mediated by leucine-rich glioma inactivated-1 (LGI1) and contactin-associated protein-like 2 (CASPR2) antibodies, as human models to comprehensively reconstruct and profile cerebrospinal fluid (CSF) B cell receptor (BCR) characteristics. We hypothesized that the resultant observations would both inform the observed therapeutic gap and determine the contribution of intrathecal maturation to pathogenic B cell lineages. From the CSF of three patients, 381 cognate-paired IgG BCRs were isolated by cell sorting and scRNA-seq, and 166 expressed as monoclonal antibodies (mAbs). Sixty-two percent of mAbs from singleton BCRs reacted with either LGI1 or CASPR2 and, strikingly, this rose to 100% of cells in clonal groups with ≥4 members. These autoantigen-reactivities were more concentrated within antibody-secreting cells (ASCs) versus B cells (P < 0.0001), and both these cell types were more differentiated than LGI1- and CASPR2-unreactive counterparts. Despite greater differentiation, autoantigen-reactive cells had acquired few mutations intrathecally and showed minimal variation in autoantigen affinities within clonal expansions. Also, limited CSF T cell receptor clonality was observed. In contrast, a comparison of germline-encoded BCRs versus the founder intrathecal clone revealed marked gains in both affinity and mutational distances (P = 0.004 and P < 0.0001, respectively). Taken together, in patients with LGI1 and CASPR2 antibody encephalitis, our results identify CSF as a compartment with a remarkably high frequency of clonally expanded autoantigen-reactive ASCs whose BCR maturity appears dominantly acquired outside the CNS. [ABSTRACT FROM AUTHOR]

Objectives: To analyse the oncological outcomes following primary Transoral Robotic Surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC). Design: Observational case series. Setting: Tertiary centre; first TORS practice to commence in the UK. Participants: All consecutive patients undergoing primary TORS with curative intent, with or without adjuvant treatment. Main outcome measures: Descriptive analysis of patient and tumour pathology variables. Survival outcomes: Overall, Disease‐Specific, Progression‐Free and Locoregional control. Results: The cohort comprised of 120 patients undergoing TORS with minimum 12‐month follow‐up data and the following characteristics: mean age 58 years, 91 males (76%), 78 tonsil (65%) and 34 base of tongue primaries (28%), 89% HPV‐related OPSCC. The surgical pathology revealed 14 (12%) with positive margins, 19 (16%) had close margins <2mm and 31% with extranodal extension. The treatment was as follows: 39 (33%) treated with TORS alone, 50 (42%) received adjuvant radiotherapy and 31 (26%) received adjuvant radiotherapy with chemotherapy. There were 15 recurrences. Estimated survival for all patients at 3 years (95% CI): overall 85% (78‐92), disease‐specific 90% (85‐96), progression‐free 86% (79‐92) and locoregional control 90% (84‐96). The equivalent survival figures for the HPV‐related cases alone were as follows: overall 88% (82‐94), disease‐specific 93% (87‐98), progression‐free 88% (81‐95) and locoregional control 92% (87‐98). Conclusions: Whilst TORS has become a common practice in the management of OPSCC in the UK, these are the first reported oncological outcomes. For selected patients, TORS with or without adjuvant therapy is an appropriate treatment modality. [ABSTRACT FROM AUTHOR]

In the article, the author discusses developments in the efforts to train the next generation of academic primary care (APC) clinicians, particularly in Europe, as of September 2016. Also cited are the workshop held by the Royal College of General Practitioner's Junior International Committee that tackled the scope of primary care research training, and the training opportunities in Great Britain like the Academic Clinical Fellowship.

A letter to the editor is presented in response to articles about innovative strategies for supporting primary care workforce in Rwanda in a previous issue.

The purpose of this observational study was to assess the impact of COVID-19 on the presentation, stage and management pattern on newly presented HNC patients during the pandemic era. The data on all newly diagnosed HNC patients at our centre during April-December 2020 (COVID-19 cohort) were collected, and it was compared against the baseline pre-COVID-19 cohort (all new HNC patients diagnosed between April and December 2019). During the COVID-19 pandemic, it was postulated that there might be a delay in cancer patients' presentation, stage migration and changes in management leading to excess cancer mortality.1 However, there is a paucity of real-time objective data to support this, particularly in HNC. [Extracted from the article]

Purpose: Diagnostic tonsillectomy is rarely an oncologic operation owing to close or positive margins. The standard of care is for further treatment to the primary site, typically with adjuvant radiotherapy.Methods: 14 patients with close or positive margins following a diagnostic tonsillectomy underwent transoral robotic surgery (TORS) and lateral oropharyngectomy; five patients with the longest follow-up had their excision specimens examined with a step serial sectioning technique (SSS).Results: Conventional histopathological examination of the TORS resection specimens did not demonstrate residual carcinoma in 13 patients, confirmed by examination using SSS in 5 patients. There were no post-operative complications or long-term functional deficit. Seven patients received surgery alone with 100% overall and disease specific survival, respectively (median follow-up 27.5 months; range 5.2-50.4).Conclusions: This prospective study suggests that TORS lateral oropharyngectomy alone is an oncologically safe treatment when close or positive margins are identified on diagnostic tonsillectomy in HPV-positive SCC. [ABSTRACT FROM AUTHOR]

Objectives: This study reports oncological outcomes of transoral robotic surgery (TORS) and neck dissection (ND) alone for head and neck squamous cell carcinoma (HNSCC) and aims to analyse the influence of resection margins on local recurrence rates.Materials and Methods: Fifty-one patients treated with curative intent for HNSCC, with TORS and ND alone between 2013 and 2019 at two tertiary centres were included in this observational multi-centre prospective cohort study. Oncological outcomes are reported on 47 patients for whom the aim was to treat with TORS and ND alone; this excluded four patients who were recommended adjuvant radiotherapy based on resective pathology but did not receive treatment. Local control is the primary endpoint; disease specific, progression free and overall survival are secondary outcomes.Results: With a median follow up of 43 months, estimated outcomes at 3 years (n = 47) were as follows: local control 92%, progression free survival 80%, disease specific survival 94%, and overall survival 84%. Presence of a positive margin on the main specimen was the only statistically significant predictor of local recurrence on univariate Cox regression analysis. Time dependent receiver operating characteristic curve identified margins of 1.1 mm as a threshold for local control, with area under the curve 0.788 (95% CI 0.616-0.960), indicating a good classifier.Conclusion: This is the first UK surgery alone series reporting mature oncological outcomes following TORS and ND. Positive margins on the resected specimen are the strongest predictor of local recurrence, with conventional definitions of "close margins" having no impact. [ABSTRACT FROM AUTHOR]