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The article discusses the influence of learning materials on the classroom environment and the development of an ecological system in the classroom. Topics include the article "Materials in the Classroom Ecology," which appeared the 2013 97th volume of the journal, by A.M. Guerrettaz and B. Johnston, the Discipline of Teaching English as an International Language (D-TEIL) at Glendon College/York University in Toronto, Canada, and the principle of environment-learner mutuality in the classroom ecosystem.

We report a late stage oxidative nucleophilic fluorination of N-arylsulfonamides, a class of compounds so far not considered as precursors to 4-fluorophenyl sulfonamides. By installing a para-positioned tert-butyl substituent on the aniline, oxidative fluorination takes place regioselectively in the presence of HF·pyridine and PIDA. This methodology has been shown to give good yields for a variety of ortho- and meta-functionalised N-arylsulfonamides and has been adapted for radiofluorination to give 4-[18F]fluorophenyl sulfonamides under carrier added conditions.

BackgroundLittle has been published regarding presenting symptoms, investigations and outcomes for patients with pancreatic cancer in Australia. Data from a series of patients undergoing attempted resection in Queensland, Australia, are presented with the aim of assisting development of consistent strategies in disease management.

The New York Stem Cell Foundation's "Fifth Annual Translational Stem Cell Research Conference" convened on October 12-13, 2010 at the Rockefeller University in New York City. The conference attracted over 400 scientists, patient advocates, and stem cell research supporters from 16 countries. In addition to poster and platform presentations, the conference featured panels entitled "Road to the Clinic" and "Regulatory Roadblocks."

Current technologies for managing acute and chronic pain have focused on reducing the time required for achieving high therapeutic efficiency. Herein a wearable transdermal patch is introduced, employing an acoustic droplet vaporization (ADV) methodology, as an effective noninvasive transdermal platform, for a fast local delivery of the anesthetic agent lidocaine. The skin-worn patch consists of a flexible drug reservoir containing hundreds of micropores loaded with lidocaine, and mixed with the perfluorocarbon (PFC) emulsion. The ultrasound-triggered vaporization of the PFC emulsion provides the necessary force to breach dermal barriers. The drug release kinetics of our model was investigated by measuring the amount of lidocaine that passed through phantom tissue and pigskin barriers. The ADV platform increases the payload skin penetration resulting in shorter treatment times compared to passive diffusion or ultrasound alone, holding considerable promise for addressing the delayed therapeutic action and slow pain relief of existing delivery protocols. It is envisioned that the integration of ADV-based transdermal devices could be expanded to the depth-dependent delivery of other pain management, vaccines, and gene therapy modalities.

Superoxide dismutase 1 (SOD1) is an important antioxidant previously shown to impact life span in Drosophila. We examined the consequences of manipulating Sod1 expression throughout the body or in the nervous system or musculature on life span and age-related locomotor impairment (ARLI) in Drosophila. Ubiquitous overexpression of SOD1 extended life span but did not substantially forestall ARLI, whereas ubiquitous knock-down of Sod1 shortened life span and accelerated ARLI. Interestingly, neither overexpression of Sod1 nor expression of Sod1 RNAi in the nervous system or muscle altered life span or ARLI. Our studies suggest that the control of reactive oxygen species by SOD1 in tissues other than the nervous system and musculature support life span and ARLI in Drosophila.

Objective: The authors report the recurrence pattern of oesophageal cancer after minimally invasive esophagectomy (MIE), comparing it to the recurrence pattern after open surgery and identify prognostic factors of recurrence. Summary Background Data: In efforts to improve long term survival for oesophageal cancer increasingly radical surgery has been reported, however recurrent disease remains a problem. Opinion is divided as to the adequacy of resection possible using minimally invasive techniques with concerns there would be an increase incidence of locoregional recurrence. Methods: A total of 222 patients who underwent esophagectomy at The Princess Alexandra Hospital without any neoadjuvant or adjuvant therapy were identified. Within this group 166 underwent (MIE) and 66 an open transthoracic esophagectomy (TTE). Patients were followed up for the detection of any symptomatic recurrence over a median period of 50 months. Results: Recurrence developed in 134/222 (60%). The pattern of recurrence in MIE was 4%, 8% and 46% for local, regional and distant recurrence respectively. The pattern of recurrence for TTE was 7%, 20% and 55% for local, regional and distant recurrence respectively. Operative approach was not a prognostic factor for any type of recurrence. Independent prognostic factors associated with local recurrence were positive margins and number of positive nodes. Factors associated with regional recurrence were positive margins and T stage. Distant recurrence was associated with distant recurrence was T stage, differentiation, tumor length >6 cm and number of positive nodes. Conclusion: Recurrence is not associated with operative approach. MIE can be performed with comparable recurrence patterns to open radical surgery.

The aim of the present study was to monitor endometrial distribution and concentrations of oestrogen receptors alpha (ER alpha) and progesterone receptors (PR) by immunohistochemistry in Nelore cows (Bos taurus indicus) during the oestrous cycle. Blood samples were collected for progesterone measurement and endometrial samples were taken from the uterine horn contra lateral to the corpus luteum in 16 cows at days 0 (ovulation), 5, 9, 13 and 19 of the oestrous cycle. Immunostaining evaluation for ER alpha and PR in the glandular epithelium and uterine stroma was performed by two methods: positive nuclei counting and staining intensity of the nuclei. Specific positive staining reactions for both receptors were limited to cell nuclei and they were not identified in the cytoplasm. The proportion of ER alpha positive nuclei had a temporal variation throughout the oestrous cycle in both cell types evaluated and was higher in uterine stroma than the glandular epithelium (p0.05). The greatest proportion of ER alpha stained nuclei was observed at oestrus and during the initial and mid luteal phase (days 5, 9 and 13) (p0.05) in the glandular epithelium and at days 0, 5 and 9 in the uterine stroma (p0.01). The proportion of PR positive nuclei remained constant throughout the entire oestrous cycle for both cell types evaluated (p0.05). A higher proportion of PR positive nuclei was measured in the uterine stroma compared with the glandular epithelium (p0.05). Intensity of staining for ER alpha and PR varied throughout the oestrous cycle (p0.01). There was a higher staining intensity at days 0 and 5 in the stroma for ER alpha (p0.01) and PR (p0.01) and in the glandular epithelium at days 0, 5, 9 and 13 for ER alpha (p0.01) and at days 0, 5 and 9 for PR (p0.01) when compared with the other evaluated days. These data demonstrate that ER alpha and PR expression varied throughout the oestrous cycle in Nelore cows, in general with highest concentrations at oestrus and the lowest during the luteal phase. This is similar to patterns observed in Bos taurus taurus.

Dietary restriction extends lifespan substantially in numerous species including Drosophila. However, it is unclear whether dietary restriction in flies impacts age-related functional declines in conjunction with its effects on lifespan. Here, we address this issue by assessing the effect of dietary restriction on lifespan and behavioral senescence in two wild-type strains, in our standard white laboratory stock, and in short-lived flies with reduced expression of superoxide dismutase 2. As expected, dietary restriction extended lifespan in all of these strains. The effect of dietary restriction on lifespan varied with genetic background, ranging from 40 to 90% extension of median lifespan in the seven strains tested. Interestingly, despite its robust positive effects on lifespan, dietary restriction had no substantive effects on senescence of behavior in any of the strains in our studies. Our results suggest that dietary restriction does not have a global impact on aging in Drosophila and support the hypothesis that lifespan and behavioral senescence are not driven by identical mechanisms.

■ I am the coordinator of a training programme for English language teachers in a Canadian university which has signed two academic exchange agreements focussed on English language teaching (ELT) with Cuban universities, one with the E. A. Varona Higher Pedagogical Institute in Havana (ISP Varona) and another with the University of Havana. As a result, I travel to Cuba relatively often. During my 17 years' involvement in Cuban ELT, I have witnessed the expansion of languagelearning, especially of English, and the boom in English learning which Cuba is experiencing today. My first encounter with Cuban ELT was part of a Canadian response to one of the new policies Cuba developed as a means of adjusting to the difficult economic circumstances brought about by the 1990 collapse of their main trading partner, the Soviet Union. Breaking with tradition, the government chose mass tourism as one of the solutions to generate income. This goal required that a nationwide foreign language acquisition plan be established to train the small army of tourism workers needed.

Declines in function1 are common manifestations of aging in many phyla (Arking, 1998). As functional senescence is thought to drive the increasing risk of death with age, understanding functional senescence is important for understanding aging. Experimental investigation of functional senescence requires one to quantitate and compare age-dependent declines in function between cohorts. Such quantitation and comparison is often difficult owing to complexities in functional senescence data sets. Here, we discuss issues related to describing and contrasting age-related declines in function. We parameterized functional senescence data in simple ways to generate descriptors for (1) the rate of functional decline, (2) the time to onset of functional decline and (3) total function. To illustrate how these descriptors can be used, we analyzed a hypothetical data set and one of our previously published data sets (Goddeeris et al., 2003). We conclude that no one descriptor sufficiently characterizes functional senescence. Useful distinctions between functional senescence in different cohorts can be made, however, when multiple descriptors are used in an integrated fashion.

A common cause of Parkinson disease are missense mutations in the leucine-rich repeat kinase 2 (LRRK2) catalytic Roc-COR domain, leading to a decrease in GTPase activity; and its kinase domain, leading to an increase in kinase activity and subsequent LRRK2 toxicity. Targeting LRRK2 with selective, brain-permeable kinase inhibitors is a promising approach to reduce toxicity, and thus is a major goal of clinical development. Understanding the specific signaling cascades triggered by LRRK2 mutations will be key to this aim. This article is part of a special issue on Parkinson disease.

Purpose A subset of patients with oesophageal cancer will have a complete response to neoadjuvant therapy. These patients have a greatly improved survival over nonresponders. By selecting only those who have a response to neoadjuvant therapy for surgery we could potentially improve overall survival as well as rationalizing the management of nonresponders. We have assessed the accuracy of oesophagogastroscopy in this setting. Methodology A prospective data base of 804 patients undergoing oesophageal resection for carcinoma was reviewed. 100 patients had undergone endoscopic assessment of response to neoadjuvant therapy prior to surgery. The endoscopic assessment of response to neoadjuvant therapies was compared with the pathological assessment of response. Kaplan-Meier estimates of survival were used for each level of response and the log rank test used to compare results. Results Oesophagogastroscopy has an accuracy of 52%, sensitivity of 65.2% and specificity of 50% for prediction of complete pathological response. Overall 3-year survival was 35.7 ± 6.0%. 3-year survival was improved in those with a pathologically confirmed complete response ( n = 23; 62.4 ± 12.9%). Those with microscopic residual disease also had an improved 3-year survival ( n = 33; 46.3 ± 12.2%) compared with patients with large volume residual disease ( n = 44; 16.3 ± 6.6%), however, oesophagogastroscopy failed to identify this subset. Conclusion Oesophagogastroscopy may be considered a useful tool in the assessment of tumour response to neoadjuvant therapies, however, its poor accuracy means it would not be appropriate to exclude patients from further therapeutic intervention on the basis of this assessment alone.

Background: Laparoscopic repair of ventral incisional hernias was first reported in 1993. Since then, there have been sporadic case reports and small series published about this procedure, but it has not been widely adopted. Newer types of composite prosthetic mesh may reduce the potential problem of bowel adhesion. Methods: Thirty cases of laparoscopic ventral incisional hernia repairs (carried out by two surgeons or their senior registrars) have been retrospectively reviewed and reported in this article. The data were obtained from patient records and subsequent phone surveys. Results: Thirty patients between 29 and 82 years (mean: 58 years) underwent this procedure. There were 14 men and 16 women. The average weight of the patients was 81 kg. The hernias were up to 6 or 7 cm in diameter. Mesh was used in 28 cases (polypropylene in 25 cases, expanded polytetrafluoroethylene in two cases and composite mesh in one case). Most meshes were laid intraperitoneally and fixed into position with laparoscopic spiral tacks. Twenty-nine cases were completed laparoscopically. One operation (3.3%) was converted to an open procedure because of severe bowel adherence to the hernia sac. The mean operating time was 52 min for laparoscopic ventral incisional hernia repairs only. All but two patients tolerated an oral diet within 24 h. The postoperative hospital stay ranged from 0 to 11 days, with 17 patients (57%) staying overnight and eight patients (27%) staying another day. Over 80% of the patients returned to house duties within a week. There was no mortality, and minor complications occurred in four patients (14%). One patient had a small bowel obstruction treated successfully by repeat laparoscopy with division of fibrinous adhesions to polypropylene mesh on day four. Follow up ranged from 1 to 69 months (mean: 12 months). One patient did not attend follow-up appointments. There were three cases of hernia recurrence (10%). Conclusion: The results suggest that laparoscopic repair of ventral incisional hernias is a safe, effective and technically feasible operation for small- to medium-sized hernias allowing shorter hospital stay, early recovery and resumption of normal activities. However, recurrence rates are comparable to open mesh hernioplasty especially for larger hernias.

Background: The treatment of common bile duct stones discovered at routine intraoperative cholangiography includes postoperative endoscopic retrograde cholangiography or intraoperative laparoscopic common bile duct exploration. Given the equivalence of short-term outcome data for these two techniques, the choice of one over the other may be influenced by long-term follow-up data. We aimed to establish the long-term outcomes following laparoscopic common bile duct exploration and compare this with endoscopic retrograde cholangiography. Methods: One hundred and fifty consecutive patients underwent laparoscopic common bile duct exploration between March 1998 and March 2006 carried out by a single surgeon. All were prospectively studied for 1 month followed by a late-term phone questionnaire ascertaining the prevalence of adverse symptoms. Patients presented with a standardized series of questions, with reports of symptoms corroborated by review of medical records. Results: In 150 patients, operations included laparoscopic transcystic exploration (135), choledochotomy (10) and choledochoduodenostomy (2). At long-term follow up (mean 63 months), 116 (77.3%) patients were traceable, with 24 (20.7%) reporting an episode of pain and 18 (15.5%) had more than a single episode of pain. There was no long-term evidence of cholangitis, stricture or pancreatitis identified in any patient. Conclusion: Laparoscopic bile duct exploration appears not to increase the incidence of long-term adverse sequelae beyond the reported prevalence of postcholecystectomy symptoms. There was no incidence of bile duct stricture, cholangitis or pancreatitis. It is a safe procedure, which obviates the need and expense of preoperative or postoperative endoscopic retrograde cholangiography in most instances.

Purpose: To examine the efficacy of fundoplication for patients with uncomplicated gastro-oesophageal reflux disease (GORD) and Barrett's oesophagus (BO) and to compare the outcomes for patients with BO following either Nissen or Toupet fundoplication. Methods: A prospectively collected database identified 2990 patients who underwent either Nissen or Toupet laparoscopic fundoplication for GORD or BO between 1991 and 2008. Pre- and post-operative outcomes were measured using a simplified DeMeester scoring system. The scores were recorded for up to 5 years by the same research nurse and compared using small sample statistics. Results: Of the 2990 patients, 390 (13%) had BO and 2600 (87%) had GORD. Preoperatively, the BO group experienced significantly more symptoms of heartburn than did the GORD group (86 vs. 91% p < 0.01). However, both groups responded equally favourably to fundoplication with high patient satisfaction at 5 years (88 vs. 93%, p = NS). There were no statistically significant differences in post-operative medication and re-operations rates between the two groups. Nissen and Toupet procedures were both equally effective for patients with Barrett's disease with respect to heartburn and regurgitation. At five years there was an increased occurrence of dysphagia in the Toupet group (17%) compared with the Nissen group (4%, p = 0.01). This may follow from the Toupet procedure being favoured for patients with documented primary oesophageal motility disorder (Toupet 47% vs. Nissen 30%, p < 0.01). Conclusions: The symptoms of uncomplicated GORD and BO respond very well to fundoplication. Both the Nissen and Toupet procedures are equally effective in patients with Barrett's oesophagus.

Purpose: Short term outcomes for laparoscopic liver resection (LLR) have been well reported in the literature, however there are few published data on long-term survival after LLR for colorectal liver metastases (CLM) and no studies have determined that the prognosis after LLR for CLM is comparable to open liver resection (OLR). Direct retrospective comparison of survival between laparoscopic versus open series is difficult due to the selection bias of the laparoscopic group. Published predictive indices in OLR enable the prediction of survival based on the patient's clinical risk score. Our aim is to determine the long term survival after LLR for CLM and to compare this to these published indices based on the patients’ clinical risk factors. Methodology: Retrospective analysis of a prospectively maintained database. Results: 44 patients underwent LLR for CLM, including 13 right hepatectomies, 2 left hepatectomies, 16 left lateral sectionectomies and 13 non-anatomical resections. 36% had >1 tumour, 33% had a maximal tumour diameter of ≥5 cm, 61% a node positive primary and 43% a CEA >60. Median follow up was 30.8 months. 5 year survival was 46.1% (26.4–63.6%) and median survival was 46.7 months (36.3–88.6 months). Actuarial survival curves are compared to published survival curves. Conclusions: Long-term survival after LLR for CLM is comparable to published results for OLR.

Purpose: Oesophagectomy remains the mainstay of curative treatment for localised oesophageal cancer. Despite this there is a paucity of data reporting actual 5 year survivors following oesophagectomy. This study was undertaken to identify and characterise actual 5 year survivors who underwent oesophagectomy. Methods: A prospectively maintained database identified 526 patients who underwent oesophagectomy from 1987 to 2008. Patients were followed for a minimum of 5 years or until death. Clinico-pathologic factors associated with 5 year disease-specific survivorship were analysed. Median follow-up for all patients was 40 months. Results: Median disease specific survival (DSS) was 32 months. Neoadjuvant therapy was administered to 248/526 (47%). There were 95/526 (18%) actual 5-year survivors. On multivariate analysis, 5-year survivors were significantly lower T stage, N stage and less likely to have received blood transfusion compared with patients who died less than 5 years after surgery. There were 76/526 (14%) patients with positive margins and of these 6 patients were 5 year survivors. Amongst 5-year survivors, 41 (43%) had neoadjuvant therapy. Of the 95 5-year survivors, 14 (14%) subsequently died of oesophageal cancer. The prognostic factors for DSS after 5 years were dysphagia or odynophagia at presentation. Stage was no longer a prognostic factor after surviving to 5 years. Conclusion: No single clinico-pathological variable negated survival to 5 years. Prognostication in 5 year survivors is difficult, but odynophagia and dysphagia at presentation are still active as prognostic factors after 5 years. The majority of 5-year survivors can be considered cured of oesophageal cancer.

Background: High grade dysplasia (HGD) in Barrett's oesophagus is a pre-cancerous condition, where oesophagectomy eliminates the risk of malignancy but can incur significant morbidity. Endoscopic therapies and expectant surveillance have been increasingly adopted. Given that the timing of malignant transformation cannot be predicted, the optimal treatment for HGD is unclear and is evolving. This study aims to evaluate the outcome of a cohort of patients with HGD in Barrett's oesophagus. Methodology: There were 84 patients with biopsy-proven HGD treated at our institution between 3/1992 and 12/2008 documented prospectively onto a database. Records were reviewed for patient characteristics, presence of occult cancer, treatment and outcomes including operative mortality and morbidity, and malignant transformation. Results: The primary treatment was oesophagectomy in 48 patients, endoscopic mucosal resection (EMR)/ablation in 18 and observation in 18. Following oesophagectomy, 19 (40%) had an occult invasive carcinoma. Following endoscopic therapy, (median FU 36 months), 2 patients were diagnosed with cancer requiring resection. In those patients observed, due to co-morbidity or patient's choice, (median FU 74 months) 9 (50%) developed malignancy leading to resection (6), EMR (1) and radiotherapy (2). Following resection there was 1 death (2%) with 34 patients (62%) having a complication. Conclusion: Resection of HGD is a curative treatment but post-operative morbidity is not insignificant. Medium term outcome data for endoscopic therapies is encouraging but patients need long term careful follow-up. Patients with HGD need to be fully informed of the different treatment options and their limitations.

Introduction: Laparoscopic liver surgery is being practiced more widely. We would like to report an experience of 170 laparoscopic liver resections. Methods: Data was collected in a prospective fashion from five surgeons, beginning in 1997 with left lateral sectionectomy, and right hepatectomy in 1999. Parenchymal transection was effected with linear cutting staplers, harmonic shears, and most recently, the Ligasure bipolar device. Results: We attempted 27 major resections, 63 sectionectomies, and 80 minor resections. Only rarely were procedures hand-assisted, or “hybrid”. The conversion rate was 8%. Median blood loss was 250 ml. (Range 0–41) Median operative time was 120 minutes. Fifty-one percent of resections were for malignancy. Margins were positive in 5 patients. The overall post operative morbidity was 12%. There were 4 bile leaks. There was one death. Discussion: The indications for surgery should be the same as for open liver resection, however tempting it may be to offer definitive diagnosis by removing peripheral, probably benign, lesions. Approximately 20% of our liver resections are attempted laparoscopically. Most left lateral sectionectomies are performed this way. Major hepatectomies should be attempted only if the tumour is well clear of the plane of transection. Non-anatomic resections require intraoperative ultrasound to ensure adequate margins and to identify large vessels. The ability to suture laparoscopically is essential. Conclusion: The evolving technology of parenchymal transection devices makes laparoscopic liver surgery an exciting frontier. Surgeons must be skilled in open liver surgery and advanced laparoscopy before attempting more than the simplest of procedures.