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BACKGROUND Intraoperative mediastinal lymph node sampling (MLNS) is a crucial component of lung cancer surgery. Whilst several sampling strategies have been clearly defined in guidelines from international organizations, reports of adherence to these guidelines are lacking. We aimed to assess our center's adherence to guidelines and determine whether adequacy of sampling is associated with survival. MATERIALS AND METHODS A single-center retrospective review of consecutive patients undergoing lung resection for primary lung cancer between January 2013 and December 2018 was undertaken. Sampling adequacy was assessed against standards outlined in the International Association for the Study of Lung Cancer 2009 guidelines. Multivariable logistic and Cox proportional hazards regression analyses were used to assess the impact of specific variables on adequacy and of specific variables on overall survival, respectively. RESULTS A total of 2380 patients were included in the study. Overall adequacy was 72.1% (n= 1717). Adherence improved from 44.8% in 2013 to 85.0% in 2018 (P< 0.001). Undergoing a right-sided resection increased the odds of adequate MLNS on multivariable logistic regression (odds ratio 1.666, 95% confidence interval [CI]: 1.385-2.003, P< 0.001). Inadequate MLNS was not significantly associated with reduced overall survival on log rank analysis (P= 0.340) or after adjustment with multivariable Cox proportional hazards (hazard ratio 0.839, 95% CI 0.643-1.093). CONCLUSIONS Adherence to standards improved significantly over time and was significantly higher for right-sided resections. We found no evidence of an association between adequate MLNS and overall survival in this cohort. A pressing need remains for the introduction of national guidelines defining acceptable performance.

Introduction: Both migraine and mood disorders are prevalent disorders with many studies demonstrating that they are comorbid with each other with increased migraine-related disability in such patients. Aim: The aim of the study is to test the hypothesis that mood disorders are comorbid with migraine with increased disability and to identify any clinical features in migraineurs which may be associated with mood disorders. Materials and Methods: Patients presenting with complaints of headache to the Neurology Outpatient Department of a Tertiary CARE Hospital from August 01, 2016 to February 28, 2017, were subjected to International Classification of Headache Disorder 3 beta criteria to satisfy a diagnosis of migraine and were assessed in detail as to headache characteristics. Mood disorders were assessed by Hospital Anxiety and Depression Scale and migraine-related disability was assessed by Migraine Disability Assessment Questionnaire. Patients with serious medical complaints, known previous psychiatric disease, other types of headaches and recent prophylactic drug intake were carefully excluded. Results: A total of 133 patients were studied. The duration and frequency of migraine headaches were found to correlate with the presence of mood disorders and the migraine-related disability in patients with comorbid mood disorders was significantly higher. Factors such as total duration of migraine, aura, vomiting, phono, and photophobia were not found to be statistically correlated with mood disorders. Conclusions: Rates of depression and anxiety in migraine vary widely in various studies due to variations in study criteria, population characteristics and various scales used. We found a prevalence of 16.54% of anxiety and 9.02% of depression in migraineurs, a rate comparable to or less than many studies in international literature and a significantly increased disability in individuals with comorbid mood disorders and migraine. Routinely including questionnaires such as HAD in screening patients with migraine to rule out comorbid mood disorders may be warranted. Because we have carefully excluded all other primary (especially tension and medication overuse headaches) and secondary headaches and selected prophylactic drug naïve patients, we contend that this study provides a clear clinical profile of migraineurs with mood disorders.

Background: Epicrania fugax (EF) is a rare newly described primary headache characterized by paroxysms of unilateral pain radiating across one hemicranium. Aim: We aimed to describe 10 new cases of EF and assess the psychiatric comorbidity. Materials and Methods: Cases of EF were identified from patients attending the neurology outpatient department of a tertiary level referral and teaching hospital by the first author during a period extending from January 1, 2015 to April 31, 2017. Case ascertainment was done as per ICHD 3 beta criteria from among patients presenting with complaints of headache after detailed history and clinical examination. Clinical and demographic features were noted and patients were subjected to Mini Neuropsychiatric Interview to screen for psychiatric comorbidity followed by Becks Anxiety/Depression Inventory. Results: A total of 10 subjects were obtained during the study period, 4 males, and 6 females. Mean age of subjects was 45.3 years (standard deviation-10). Seventy percent had anteroposterior, and 30% had posteroanterior radiation of pain. The most common character of pain was stabbing (50%) followed by electrical (40%) and pressing (10%). None of the subjects had autonomic symptoms or focal symptoms in the scalp while 30% subjects had hyperesthesia in the affected area of the scalp. Six subjects (60%) patients had episodic course while 40% had chronic course. Sixty percent had comorbid anxiety while one (10%) had comorbid depression. A significant relation was obtained between duration of disease and occurrence of anxiety as well as Becks Anxiety Inventory scores while there was no correlation with attack duration. There was also a nonsignificant correlation between visual analog score and occurrence of anxiety symptoms. Conclusions: Our study conclusively proves the existence of EF as a rare, distinct primary headache syndrome in our study population. It has a significant psychiatric comorbidity consisting of 60% of generalized anxiety disorder, 10% of panic attacks, and 10% of depression.

Descending cervical mediastinitis (DCM) is defined as spread of oropharyngeal or odontogenic infection into the mediastinum. It occurs uncommonly and has a high mortality rate. Six patients underwent surgery at our centre for DCM between November 2013 and October 2016. Five of six patients underwent drainage of neck collections via a cervical approach, and all six patients subsequently underwent thoracic surgery for drainage of pleural and mediastinal collections. Four patients required further surgical intervention, of which two subsequently required a third thoracic operation. The average length of stay was 73 days (range 4–193). There were no in-hospital deaths and all patients were discharged from our hospital. Following diagnosis, prompt surgical intervention from ENT and cardiothoracic surgeons is essential. Our experience demonstrates that favourable outcomes can be achieved in patients with DCM when they are managed aggressively and promptly in specialist centres with appropriate multidisciplinary team involvement.

Context: Nummular headache (NH) is a primary disorder characterized by head pain exclusively felt in a small-rounded area typically 2–6 cm in diameter. Aims: The aim of this review is to study the clinical and epidemiological features of NH in a patient population of South India and to compare this with that of described in the international literature. Settings and Design: A prospective, observational study conducted in a tertiary care center. Materials and Methods: Patients attending the medicine and neurology outpatient departments of a tertiary referral hospital in South India diagnosed to have NH as per the International Classification of Headache Disorders 3 beta (2013) criteria were studied over 30 months. All of the patients had a normal neurological examination. Neuroimaging findings were normal, except in one patient. Results: A total of 19 females and 10 males were studied. The mean age of onset was 47.62 years (range 36–60). The duration of headache varied from a minimum of 3 months to a maximum of 5 years, with a mean of 24.17 months. The site of headache was predominantly in the parietal area 15 (51.72%), followed by the occipital area 7 (24.13%). The mean diameter of the affected area was 3.23 cm. The intensity of the headache proved to be mild to moderate with a mean visual analog scale score of 5.03. The quality of pain was mainly felt as burning dysesthesia 12 (41.38%). In the majority of patients, i.e. 21 (72.41%), pain was chronic and continuous. None of the patients had any significant trophic change even though paresthesias, dysesthesias, and allodynia were reported by a significant minority of patients, i.e. 9 (31.03%). Only one (3.45%) patient gave a history of head injury. Ten (34.48%) out of 29 patients had other types of concurrent headaches; the majority of which proved to be migrainous, i.e. 7 (24.14%), 2 patients (6.89%) with tension headache, and 1 patient (3.45%) with trigeminal neuralgia. Conclusion: Our study proves the existence of the newly described primary headache syndrome called NH in South Indian population. In comparing our results with the international literature, the number of similarities is much greater than the differences. The etiology of pain in our series appeared to be primarily peripheral with a role for central pain sensitization in some cases due to a variety of concurrent central causes of head pain.

Background Adequate intra-operative lymph node sampling is a fundamental part of lung cancer surgery but adherence to standards, particularly in the United Kingdom is not well known. The International Association for the Study of Lung Cancer (IASLC) has defined adequate lymph node sampling as: at least 3 mediastinal lymph node stations, station 7 in all cases, station 5/6 with left upper lobe tumours and station 9 with lower lobe tumours; the sampling of at least 3 hilar lymph node stations is also recommended This study sought to measure the adequacy of intra-operative lymph node sampling at a regional Lung Cancer Centre, the factors which may influence this and impact on survival. Methods A retrospective review of the pathological reports for all patients who underwent surgical resection for NSCLC at the University Hospital of South Manchester between 2011 and 2014 (n = 1407) was performed. Lung cancer resection specimens are reported in line with the minimum dataset defined by the Royal College of Pathology and contain a record of all lymph node stations sampled intra-operatively and the histological findings from these lymph nodes. The influence of clinical variables on adequacy of lymph node sampling was investigated and survival data was obtained from national death registries. Results Adequate intra-operative lymph node sampling increased significantly from 13% (23/173) in 2011 to 51% (224/437) in 2014 coinciding with a dramatic increase in the volume of lung cancer surgery (Table 1). Secondary analysis also revealed that patients with a low or high T-stage, undergoing sublobar resections and undergoing left sided resections have significantly higher rates of inadequate lymph node sampling. Overall, there was no statistically significant difference in survival between patients with adequate and inadequate intra-operative lymph node sampling. Conclusion This study provides a much-needed benchmark of current thoracic surgical practice in lung cancer in the UK and provides important granularity to facilitate changes to improve adequacy of staging. Further improvement is needed to meet the standards as defined by the IASLC, however, what constitutes an “acceptable” level of adequacy is yet to be defined and this impact on survival is not clear.

Background: With the use of comprehensive neuropsychological assessments, a substantial proportion of patients with multiple sclerosis have been found to have substantial cognitive impairment. Although data generated from comprehensive examinations are useful in making recommendations for treatment interventions and compensatory strategies, the cost of such assessments prohibits their use with all patients. Objective: To develop a screening battery to detect cognitive impairment in patients with multiple sclerosis that is sensitive, specific, brief, and cost-effective, and could identify patients who might benefit from a more comprehensive neuropsychological examination. Design: On the basis of a comprehensive neuropsychological assessment battery, the presence of significant cognitive impairment was determined in patients with multiple sclerosis. The screening battery consisted of a subset of tests from the comprehensive battery. Performance on the screening battery was then used to predict presence of cognitive impairment on the comprehensive battery in validation and crossvalidation samples. Severity of impairment on the screening battery was also regressed on ratings of functional impairment derived from the Expanded Disability Status Scale. Results: In the validation sample, the screening battery had 100% sensitivity, 80% specificity, and 88.1% overall diagnostic accuracy. In the cross-validation sample, the screening battery had 100% sensitivity, 81.8% specificity, and an overall diagnostic accuracy rate of 90.7%. × 2 tests showed that the accuracy of the screening battery was significantly better than chance in both samples. Performance on the screening battery also predicted the level of disability ratings on the Expanded Disability Status Scale and functional systems scales. Conclusions: The screening battery had a high degree of sensitivity, specificity, and diagnostic accuracy, while maintaining a brief administration time and high cost-effectiveness. The screening battery also predicted higher levels of disability and functional impairment as assessed by the Expanded Disability Status Scale, thereby enhancing its clinical utility. Despite its advantages, the findings do not suggest that the screening battery may be an effective substitute for a more detailed examination.

We have investigated local variations in the optical properties of ${\mathrm{In}}_{0.06}$${\mathrm{Ga}}_{0.94}$As/GaAs using linearly polarized cathodoluminescence imaging and spectroscopy. The influence of substrate misorientation on the polarization anisotropy of excitonic luminescence in the ${\mathrm{In}}_{0.06}$${\mathrm{Ga}}_{0.94}$As films was examined. Local variations in excitonic polarization anisotropy and emission energy are found to correlate spatially with dark line defects which result from the formation of interfacial misfit dislocations.

We have investigated the effects of thermal cycling on the optical properties of In0.2Ga0.8As/GaAs single quantum well films bonded to Si(001) via the epitaxial lift-off technique. The optical and structural quality of the bonded films were monitored using cathodoluminescence (CL) imaging and spectroscopy. The films were stable through the temperature range (500–700 °C) used in normal InxGa1−xAs device processing. However, annealing at temperatures greater than ∼700 °C resulted in layer intermixing accompanied by a blue-shift in the CL peak energy. The shifts in the CL peak energy were modeled by considering In–Ga interdiffusion at the interface and solving the Schrodinger equation using appropriate band profiles for this region.

We have investigated the structural, electronic, and optical properties of partially strain‐relaxed InxGa1−xAs layers, grown by molecular beam epitaxy on both misoriented and nominally flat (001) GaAs substrates. We find large anisotropies in bulk strain relaxation, interfacial misfit dislocation density, dark‐line defect density, and electron mobility, as well as a polarization anisotropy in cathodoluminescence for epilayers grown on misoriented substrates, in comparison with those grown on flat substrates.

We report the first realization on nonplanar patterned substrates of optically active three‐dimensionally confined semiconductor volumes created in situ via a one‐step molecular beam epitaxial growth. Growth is carried out on pyramidal mesas on (111)B substrates and in a regime that results in the emergence of three equivalent {110} side facets which overtake the as‐patterned {100} side facets and lead to mesa pinch‐off. Transmission electron microscopy along with spatially and spectrally resolved cathodoluminescence provide evidence for emission from laterally confined regions with lateral linear dimensions ≲100 nm.

We have examined the effects of electron‐hole plasma generation on excitonic absorption phenomena in nipi‐doped In0.2Ga0.8As/GaAs multiple quantum wells (MQWs) using a novel technique called electron beam‐induced absorption modulation imaging. The electron‐hole plasma is generated by a high‐energy electron beam in a scanning electron microscope and is used as a probe to study the MQW absorption modulation. The influence of structural defects on the diffusive transport of carriers is imaged with a μm‐scale resolution.

The performance of InGaAs/GaAs pseudomorphic high electron mobility transistors is anticipated to improve with increased channel thickness due to reduced effects of quantum confinement. However, greater channel thicknesses increase the probability of forming misfit dislocations which have been reported to impair device properties. We characterized the composition and thickness of the active layer in Al0.25Ga0.75As / In0.21Ga0.79As structures with different channel thicknesses (75 Å - 300 Å) to within ± 0.005 and ± 8 Å using high resolution x-ray techniques. We determined, using Hall and rf measurements, that the device properties of these structures improved with increasing thickness up to about 185-205 Å; degraded properties were observed for thicker channel layers. Cathodoluminescence results indicate that the mosaic spread observed in x-ray triple axis rocking curves of these device structures is due to the presence of misfit dislocations. Thus, even though misfit dislocations are present, the device structure performs best with a channel thickness of ∼185 Å. These results demonstrate that one can fabricate functional devices in excess of critical thickness considerations, and that these x-ray techniques provide an effective means to evaluate structural properties prior to device processing.

The fabrication and characterization of struc- migration also ensures that the (211) layers are tures with their electronic states confined in three thinner than the (111)B mesa top layers. The dimensions (i.e. quantum dots) is an area of ac- (11 1)B GaAs layers are thus surrounded from all tive research. The maskless one-step in-situ ap- lateral directions by the thinner and thus higher proach that exploits growth kinetics to create band gap GaAs quantum wells growing on the suitable size templates upon which nanostruc- (211) side facets. This difference in band gap tures can be realized via growth alone offers provides the lateral electronic confinement. Verpotential advantages [1] over ex-situ approaches. tical confinement is provided by the AlGaAs layPhotolithography followed by wet chemical ers. The continuous shrinkage of the mesa top etching of the (111)B face of GaAs yields trun- layers results in the mesa pinching off at the 8th

The realization of three‐dimensionally confined GaAs/AlGaAs structures on GaAs (111)B and GaAs (001) substrates via one step in situ molecular beam epitaxy is reported. Growth is carried out on nonplanar patterned substrates with crystallographically equivalent mesa top edges. Equivalent side facets evolve during growth and completely surround the mesa top. Adatom migration from these facets to the mesa top result in shrinkage of the mesa top area leading to mesa pinch‐off. Scanning and transmission electron microscopy provide evidence for the realization of structures with lateral linear dimensions ≲500 A. Cathodoluminescence images from the (111)B structures attest to their high optical quality.

Cladribine provides immunomodulation through selective targeting of lymphocyte subtypes. We report the results of a 96-week phase 3 trial of a short-course oral tablet therapy in patients with relapsing–remitting multiple sclerosis. We randomly assigned 1326 patients in an approximate 1:1:1 ratio to receive one of two cumulative doses of cladribine tablets (either 3.5 mg or 5.25 mg per kilogram of body weight) or matching placebo, given in two or four short courses for the first 48 weeks, then in two short courses starting at week 48 and week 52 (for a total of 8 to 20 days per year). The primary end point was the rate of relapse at 96 weeks. Among patients who received cladribine tablets (either 3.5 mg or 5.25 mg per kilogram), there was a significantly lower annualized rate of relapse than in the placebo group (0.14 and 0.15, respectively, vs. 0.33 ; P