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Dispersants have been used in several oil spill accidents, but little information is available on their effectiveness in Baltic Sea conditions with low salinity and cold seawater. This study investigated the effects of dispersant use on petroleum hydrocarbon biodegradation rates and bacterial community structures. Microcosm experiments were conducted at 5 °C for 12 days with North Sea crude oil and dispersant Finasol 51 with open sea Gulf of Bothnia and coastal Gulf of Finland and Norwegian Sea seawater. Petroleum hydrocarbon concentrations were analysed with GC-FID. Bacterial community structures were studied using 16S rDNA gene amplicon sequencing, and the abundance of genes involved in hydrocarbon degradation with quantitative PCR. The highest oil degradation gene abundances and oil removal were observed in microcosms with coastal seawater from the Gulf of Bothnia and Gulf of Finland, respectively, and the lowest in the seawater from the Norwegian Sea. Dispersant usage caused apparent effects on bacterial communities in all treatments; however, the dispersant's effect on the biodegradation rate was unclear due to uncertainties with chemical analysis and variation in oil concentrations used in the experiments.

Sewage sludge is an inevitable byproduct produced in wastewater treatment. Reusing nutrient-rich sludge will diminish the amount of waste ending in soil dumping areas and will promote circular economy. However, during sewage treatment process, several potentially harmful organic chemicals are retained in sludge, but proving the safety of processed sludge will promote its more extensive use in agriculture and landscaping. Environmental risk assessment of sludge requires new methods of characterizing its suitability for various circular economy applications. Bioavailable and bioaccessible fractions are key variables indicating leaching, transport, and bioaccumulation capacity. Also, sludge treatments have a significant effect on chemical status and resulting environmental risks. In this study, the concentrations of polyaromatic hydrocarbons (PAHs), triclosan (TCS), triclocarban (TCC), methyl triclosan (mTCS), and selected active pharmaceutical ingredients (APIs) were determined in different sludge treatments and fractions. Passive samplers were used to characterize the bioavailable and bioaccessible fractions, and the sampler extracts along the sludge and filtrate samples were utilized in the bioassays. The TCS and PAH concentrations did not decrease as the sludge was digested, but the contents diminished after composting. Also, mTCS concentration decreased after composting. The API concentrations were lower in digested sludge than in secondary sludge. Digested sludge was toxic for Aliivibrio fischeri, but after composting, toxicity was not observed. However, for Daphnia magna, passive sampler extracts of all sludge treatments were either acutely (immobility) or chronically (reproduction) toxic. Secondary and digested sludge sampler extracts were cytotoxic, and secondary sludge extract was also genotoxic. The measured chemical concentration levels did not explain the toxicity of the samples based on the reported toxicity thresholds. Bioassays and sampler extracts detecting bioavailable and bioaccessible contaminants in sludge are complementing tools for chemical analyses. Harmonization of these methodswill help establish scientifically sound regulative thresholds for the use of sludge in circular economy applications., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

For reliable mussel monitoring programmes based on biomarkers, regionally relevant reference values and their natural variability need to be known. The Baltic Sea exhibits high inter-regional and seasonal variability in physical factors such as salinity, temperature and primary production. The aim of this pilot study is to depict the effects of season-related environmental factors in a selected battery of biomarkers in two environmentally different subregions of the Baltic Sea to help establishing reference data for biochemical, cellular and tissue-level biomarkers. In order to achieve that, mussels were collected from reference sites in Kiel (Germany) and Tvärminne (Finland) during three seasons: summer and autumn 2016, and spring 2017. Finally, in order to characterize the ecological situation, analysis of the chemical tissue burden was performed and chlorophyll‑a and particulate organic carbon concentration and temperature changes were analyzed at each sampling locality using satellite remote sensing images. An integrated biomarker response index was performed to summarize the biomarker responses of each locality and season. The biochemical endpoints showed seasonal variability regulated by temperature, food supply and reproductive cycle, while among the cellular endpoints only lipofuscin accumulation and lysosomal structural changes showed slight seasonal variation. Seasonal changes in tissue level biomarkers were observed only at the northern Baltic Sea site Tvärminne, dictated by the demanding energetic trade-off caused by reproduction. In conclusion, the characterization of the ecological variables and physico-chemical conditions at each site, is crucial to perform a reliable assessment of the effects of a hypothetical pollution scenario in the Baltic Sea. Moreover, reference levels of biomarkers and their responses to natural environmental conditions must be established., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

Demands for mechanical accuracy of medical linear accelerators are increased due to the stereotactic and modulated rotational treatments. Mechanical inaccuracies affect the size and shape of the mechanical and radiation isocenters. In practice, the mechanical isocenter is defined by the intersection of rotational axes. However, there are no simple tools to check the properties of the mechanical isocenter in 3D. We introduce a new photography-based method for quick and sub-millimeter accurate determination of the mechanical isocenter. The method is based on image-processing algorithm and modified front pointer. The results demonstrate the quick measurement and visualization of the mechanical isocenter., (© 2017 The Authors.)

Background: Epiphora is a common complaint of nasolacrimal duct obstruction (NLDO) in adults. The precise pathogenesis of NLDO is still unknown, but inflammatory processes are believed to be predisposing factors. Endoscopic dacryocystorhinostomy (EN-DCR) is an effective surgical technique for treating symptomatic NLDO. The purpose of the procedure is to relieve the patient's symptoms by creating an opening, ie, a rhinostoma, between the lacrimal sac and the nasal cavity. Although the success rates after EN-DCR are high, the procedure sometimes fails due to onset of a fibrotic process at the rhinostomy site. The aim of this prospective comparative study was to investigate inflammation-related gene expression in the nasal mucosa at the rhinostomy site., Methods: Ten participants were consecutively recruited from eligible adult patients who underwent primary powered EN-DCR (five patients) or septoplasty (five controls). Nasal mucosa specimens were taken from the rhinostomy site at the beginning of surgery for analysis of gene expression. Specimens were taken from the same site on the lateral nasal wall for controls. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) was performed for the inflammatory genes interleukin (IL)-6, IL-1β, and CCL2, and because of a clear trend of increased inflammation in the EN-DCR samples, a wider PCR array was performed to compare inflammation-related gene expression in EN-DCR subjects and corresponding controls., Results: Our qRT-PCR results revealed a clear trend of increased transcription of IL-6, IL-1β, and CCL2 (P=0.03). The same trend was also evident in the PCR array, which additionally revealed notable differences between EN-DCR subjects and controls with regard to expression of several other inflammation-related mediators. At 6-month follow-up, the success rate after primary EN-DCR was 60%, ie, in three of five patients., Conclusion: The present study demonstrates that there is an intense inflammation gene expression response in the nasal mucosa of patients undergoing EN-DCR.

Purpose: Dacryocystorhinostomy (DCR) is an effective and safe procedure for patients with post-saccal obstruction of the nasolacrimal pathway. The aim of DCR is to relieve symptoms by creating a bypass between the lacrimal sac and the nasal cavity. The most common reason for failure is stenosis caused by a fibrotic process at the rhinostomy site. In this prospective study we assessed the expression of heat shock protein 47 (HSP47), a regulator of fibrosis, in the biopsies of nasal mucosa isolated from patients undergoing primary endoscopic DCR (EN-DCR)., Methods: Thirty consecutive primary EN-DCR procedures in 30 patients were performed using the powered instrumentation technique. The nasal mucosa specimens over the rhinostomy site were collected for histological analysis at the beginning of the operation and the expression of HSP47 was evaluated by immunohistochemistry. The outcome of EN-DCR was estimated in follow-up visits at 1 week, 2 months and 6 months after surgery., Results: At the 6-month follow-up, the overall success rate after primary EN-DCR was 83%. A metaplastic change and strong expression of HSP47 in nasal mucosa were associated with EN-DCR failure (p = 0.009)., Conclusions: HSP47 may be regarded as a novel marker to predict impaired EN-DCR outcome., (© 2009 The Authors. Journal compilation © 2009 Acta Ophthalmol.)

Parkinson's disease (PD) is characterized by motor disabilities that can be alleviated reasonably with appropriate medication. However, there is a lack of objective methods for quantifying the efficacy of treatment in PD. We applied here an objective method for quantifying the effects of medication in PD using EMG and acceleration measurements and analysis. In the method, four signal features were calculated from the EMG and acceleration recordings of both sides of the body: the kurtosis and recurrence rate of EMG, and the amplitude and sample entropy of acceleration. Principal component approach was used for reducing the number of variables. EMG and acceleration data measured from nine PD patients were used for analysis. The patients were measured in four different medication conditions: with medication off, and two and three and four hours after taking the medication. The results showed that in eight patients the EMG recordings changed into less spiky and the acceleration recordings into more complex after taking the medication. A reverse phenomenon in the signal characteristics was observed in seven patients 3-4 hours after taking the medication. The results indicate that the presented method is potentially useful for quantifying objectively the effects of medication on the neuromuscular function in PD.

Background: The incidence of nasolacrimal pathway obstruction increases with age, and dacryocystorhinostomy (DCR) is a commonly applied surgical technique to treat severe cases. However, no disease-specific tools to assess the symptoms and the subjective outcome after DCR have been established. We have developed a specific Nasolacrimal Duct Obstruction Symptom Score (NLDO-SS) questionnaire to evaluate the outcome, and tested it in a prospective clinical trial., Study Design: Prospective clinical follow-up study., Methods: Sixty-eight consecutive primary endoscopic dacryocystorhinostomy (EN-DCR) procedures were performed in 64 patients during 2004-2008. Preoperatively and during the three follow-up visits (at 1 week, 2 and 6 months), the patients filled in the NLDO-SS, and at the second and third follow-up visits they also filled in the Glasgow Benefit Inventory (GBI) questionnaire. At one year after the operation, a GBI questionnaire was sent to the patients., Results: The surgical success rate of EN-DCR was 93 %. EN-DCR resulted in a significant reduction in all of the eight symptoms scores of the NLDO-SS (p= 0.001). The GBI scores indicated a significant benefit at 2 months (+37 (SD; 28) and an even higher benefit at 6 months after surgery (+52 (SD; 29), p= 0.001), but no further improvement was found between 6 and 12 months (+52 vs +52, p= 1.0). The correlation between the total GBI and NLDO-SS was significant (p=0.001)., Conclusions: EN-DCR significantly improves the quality of life as measured by the GBI. The NLDO-SS correlated with the GBI and gave more information about the benefits after EN-DCR than GBI alone. The NLDO-SS proved to be an effective tool to evaluate lacrimal obstructions and EN-DCR benefits. Further studies to validate NLDO-SS are needed.

Objectives: To evaluate apparent diffusion coefficient (ADC) in cerebellar subregions in patients with stroke., Materials and Methods: The total counts and ADCs were bilaterally measured on cerebellar white matter, gray matters of medial (G1), intermediate (G2), and lateral zones (G3) on SPECT and ADC maps from 20 patients with supratentorial ischemic stroke within the first 48 h and on day 8 after onset. ADCs were also obtained from 15 age-matched controls., Results: Within 48 h, the ADCs were significantly increased bilaterally in the G3, and tended to be increased bilaterally in the white matter and G1, and contralateral G2 compared with controls. On day 8, the ADCs were significantly increased in all contralateral cerebellar subregions and in ipsilateral G1 and G2, and tended to be increased in ipsilateral G3. The ADC value was significantly higher in contralateral than in ipsilateral white matter on day 8. The interhemispheric asymmetry indices (AIs) of ADC and SPECT were significantly associated with each other in G2 and G3 within 48 h, but not on day 8. The AIs of ADC and SPECT were significantly related to each other in the G3 within 48 h and on day 8., Conclusions: Supratentorial ischemic stroke may cause mild cerebellar vasogenic edema., (Copyright © 2009 The Authors. Journal compilation © 2009 Blackwell Munksgaard.)

In this paper, we examine the potential of electromyographic (EMG) and acceleration measurements in discriminating patients with Parkinson's disease (PD) from healthy persons. Two types of muscle contractions are examined: static contractions of biceps brachii muscles and elbow extension movements. Twelve features are extracted from static and ten features from extension measurements. These features describe signal morphology and nonlinear characteristics, power spreading in EMG wavelet scalograms and spectral coherence. Principal component approach is applied separately for static and extension trial to reduce the number of features before discrimination. The discrimination between subjects is done in a two-dimensional space by applying cluster analysis to the best discriminating principal components. The discrimination power of the used method was estimated with EMG and acceleration data measured from 56 patients with PD and 59 healthy controls. In the cluster analysis, three clusters were formed: one cluster with most (85%) of the healthy persons and two clusters with 80% of patients. Patients were divided into two clusters based on their type of motor disability (problems during movement and/or static contraction). Discrimination results show that EMG and acceleration measurements are potential for discriminating patients with PD from healthy persons. Furthermore, they have potential in the objective clinical assessment of PD.

Introduction: The purposes of the present study were to compare the flow defect volumes on perfusion-weighted magnetic resonance imaging (PWI) and (99m)Tc-labeled ethylcysteinate dimer ((99m)Tc-ECD) single photon emission computed tomography (SPECT) at acute and subacute stages of ischemic stroke and to analyze the relationship between the detected flow defects on the two methods and neurological status and clinical outcomes., Methods: Perfusion defects on PWI and SPECT were measured within 48 h and on day 8 of the onset of stroke from 22 patients with their first-ever acute supratentorial ischemic stroke. The primary neurological status was evaluated prior to the imaging. Clinical outcome was assessed at 3 months after the onset of the stroke., Results: The volumes of cerebral blood flow (CBF) defects did not differ between SPECT and PWI within the 48-h examinations. However, the volume of CBF defect was significantly larger on SPECT than on PWI on day 8 (p = 0.03). Within the 48-h examinations, the CBF defect volumes on SPECT and PWI were comparably related to the neurological status. On day 8, the CBF defect volume on SPECT showed higher correlation to the neurological status and more precisely predicted the clinical outcomes at 3 months than PWI., Conclusions: (99m)TC-ECD-SPECT and PWI both have ability to detect cerebral hypoperfusion in patients with ischemic stroke but with some differences. The value of SPECT is more accurate in terms of the delayed outcome, such as prognosis and rehabilitation planning.

A novel method for discrimination of dynamic muscle contractions between patients with Parkinson's disease (PD) and healthy controls on the basis of surface electromyography (EMG) and acceleration measurements is presented. In this method, dynamic EMG and acceleration measurements are analyzed using nonlinear methods and wavelets. Ten parameters capturing Parkinson's disease (PD) characteristic features in the measured signals are extracted. Each parameter is computed as time-varying, and for elbow flexion and extension movements separately. For discrimination between subjects, the dimensionality of the feature vectors formed from these parameters is reduced using a principal component approach. The cluster analysis of the low-dimensional feature vectors is then performed for flexion and extension movements separately. The EMG and acceleration data measured from 49 patients with PD and 59 healthy controls are used for analysis. According to clustering results, the method could discriminate 80 % of patient extension movements from 87 % of control extension movements, and 73 % of patient flexion movements from 82 % of control flexion movements. The results show that dynamic EMG and acceleration measurements can be informative for assessing neuromuscular dysfunction in PD, and furthermore, they may help in the objective clinical assessment of the disease.

Objective: The purpose of this study was to assess clinical and neurophysiological changes after 6 mos of transcutaneous electrical stimulation in patients with unresolved facial nerve paralysis., Design: A pilot case series of 10 consecutive patients with chronic facial nerve paralysis either of idiopathic origin or because of herpes zoster oticus participated in this open study. All patients received below sensory threshold transcutaneous electrical stimulation for 6 mos for their facial nerve paralysis. The intervention consisted of gradually increasing the duration of electrical stimulation of three sites on the affected area for up to 6 hrs/day. Assessments of the facial nerve function were performed using the House-Brackmann clinical scale and neurophysiological measurements of compound motor action potential distal latencies on the affected and nonaffected sides. Patients were tested before and after the intervention., Results: A significant improvement was observed in the facial nerve upper branch compound motor action potential distal latency on the affected side in all patients. An improvement of one grade in House-Brackmann scale was observed and some patients also reported subjective improvement., Conclusions: Transcutaneous electrical stimulation treatment may have a positive effect on unresolved facial nerve paralysis. This study illustrates a possibly effective treatment option for patients with the chronic facial paresis with no other expectations of recovery.

We present an advanced method for feature extraction and cluster analysis of surface electromyograms (EMG) and acceleration signals in Parkinson's disease (PD). In the method, 12 different EMG and acceleration signal features are extracted and used to form high-dimensional feature vectors. The dimensionality of these vectors is then reduced by using the principal component approach. Finally, the cluster analysis of feature vectors is performed in a low-dimensional eigenspace. The method was tested with EMG and acceleration data of 42 patients with PD and 59 healthy controls. The obtained discrimination between patients and controls was promising. According to clustering results, one cluster contained 90% of the healthy controls and two other clusters 76% of the patients. Seven patients with severe motor dysfunctions were distinguished in one of the patient clusters. In the future, the clinical value of the method should be further evaluated.

Objective: Postoperative debridement is considered essential after endoscopic sinus surgery (ESS), however, its effect on postoperative symptoms is largely unexplored., Methods: In the present study 90 patients undergoing ESS were randomized to debridement of the nasal cavities either three times during the first postoperative week (intervention group), or once on the 7th postoperative day (control group). Postoperative saline douching was used in both groups. The primary outcome measure was the postoperative Lund-MacKay Symptom Score., Results: The patients in the intervention group reported less severe symptoms on all domains of the Lund-MacKay Score compared with the patients in the control group both at one and four weeks. The difference between the groups was statistically significant in discharge at one week (4.1 +/- 2.3 in the intervention group and 5.4 +/- 2.6 in the control group, p = 0.0025). At four weeks, significantly fewer nasal cavities presented with nasal secretions in the intervention group compared with the control group (14/84 vs. 38/93)., Conclusions: Repeated debridement during the first postoperative week produced minor symptomatic benefit in patients recovering from ESS. Therefore, in terms of subjective recovery and health care costs repeated debridement is not justified during the first postoperative week after ESS.

Purpose: To determine whether measuring signal intensity (SI) fluctuations in MRI time series data from acute stroke patients would identify ischemic tissue., Materials and Methods: Prebolus perfusion-weighted MRI data from 32 acute ischemic stroke patients (N = 32) was analyzed as a time series. Ischemic and normal tissue regions were outlined and compared., Results: The magnitude of the measured SI fluctuations was significantly lower in ischemic regions relative to normal tissue. Spatial differences in these fluctuations occurred in a manner that was different than other perfusion-based metrics., Conclusion: Prior studies have shown that SI fluctuations in MRI time series data correspond to the presence of physiological "noise," which includes vasomotion, an autoregulatory phenomenon that affects the tissue response to ischemia. In this study, SI fluctuations were found to decrease in ischemia, consistent with the notion that small vessels will remain open (fluctuations in vessel diameter will decrease) when there is a challenge to flow. Spatial variation in SI fluctuations appeared to be different from spatial variation seen on other perfusion-based metrics, suggesting that a separate contrast mechanism is responsible, one that might be of diagnostic and prognostic value in acute stroke in which the ability of tissue to withstand ischemia is currently not well visualized., ((c) 2008 Wiley-Liss, Inc.)

Background: Endoscopic dacryocystorhinostomy (EN-DCR) is an effective procedure when treating saccal and postsaccal obstructions of the nasolacrimal pathway. The benefit of silicone tubing after DCR is still controversial. We conducted a prospective, randomized study to evaluate the necessity of bicanalicular silicone tubes after primary EN-DCR., Methods: Forty-six consecutive primary EN-DCR procedures were performed in 42 patients during 2004-2007. The patients were randomized into two study groups according to whether silicone tubing was used or not., Results: The overall success rate after primary EN-DCR was 89%: with silicone tubes it was 78%, and without silicone tubes it was 100%. The difference between these two groups was statistically significant (p<0.049). The follow-up period was 6 months and included three follow-up visits: 1 week, 2 months, and 6 months postoperatively. If inserted, the silicone tubes were removed at the 2-month visit., Conclusion: The results of our prospective, randomized study showed that the use of silicone tubes after primary EN-DCR is not necessary.

In this paper, we bring out modern methods that are potential in analysing differences in the dynamic surface electromyographic (EMG) and acceleration measurements between patients with Parkinson's disease (PD) and healthy persons. These methods are the correlation dimension of EMG, the recurrence rate of EMG, the power of acceleration and the sample entropy of acceleration. In this study, these methods were used to extract features from surface EMG and acceleration recordings measured during elbow flexion and extension movements. The extracted features were used to form high-dimensional feature vectors and the dimensionality of these vectors was then reduced by using the principal component approach. Finally, the feature vectors were discriminated between subjects by using the principal components. The discrimination power of the presented approach was tested with EMG and acceleration data measured from 46 patients with PD (on-medication) and 59 healthy controls. Discrimination results showed that the present method was able to discriminate dynamic EMG and acceleration recordings between patients with PD and healthy controls. Therefore, dynamic surface EMG and acceleration measurements may have potential in the objective and quantitative assessment and diagnosis of PD.

A novel approach is presented for the analysis of surface electromyogram (EMG) morphology in Parkinson's disease (PD). The method is based on histogram and crossing rate (CR) analysis of the EMG signal. In the method, histograms and CR values are used as high-dimensional feature vectors. The dimensionality of them is then reduced using the Karhunen-Loève transform (KLT). Finally, the discriminant analysis of feature vectors is performed in low-dimensional eigenspace. Histograms and CR values were chosen for analysis, because Parkinsonian EMG signals typically involve patterns of EMG bursts. Traditional methods of EMG amplitude and spectral analysis are not effective in analyzing impulse-like signals. The method, which was tested with EMG signals measured from 25 patients with PD and 22 healthy controls, was promising for discriminating between these two groups of subjects. The ratio of correct discrimination by augmented KLT was 86% for the control group and 72% for the patient group. On the basis of these results, further studies are suggested in order to evaluate the usability of this method in early stage diagnostics of PD.

This study evaluated the relationship between crossed cerebellar diaschisis (CCD) and (1) lesion volume and location in the acute phase and 1 week after stroke onset and (2) clinical outcome. Twenty-two patients with cerebral ischemic stroke underwent single-photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI) within 48 h and on day 8 from onset. Interhemispheric asymmetric indices (AI) on SPECT were calculated for medial, intermediate, and lateral zones of the cerebellum. Lesion volumes and locations were obtained from diffusion-weighted MRI. Neurological status and 3-month clinical outcome were evaluated. Within 48 h, lesion locations in the temporal association cortex and pyramidal tract of the corona radiata were independent determinants for the AI of the medial zone (R(2)=0.439). Lesion locations in the primary, premotor, and supplementary motor cortices, primary somatosensory cortex, and anterior part of the posterior limb of the internal capsule were determinants for the AI of the intermediate zone (R(2)=0.785). Lesions in the primary motor cortex, premotor, and supplementary motor cortices and in the genu of the internal capsule were determinants for the AI of the lateral zone (R(2)=0.746). On day 8, the associations were decreased. The AIs of the intermediate and lateral zones and lesion location in the parietal association cortex were independently associated with the 3-month clinical outcome (R(2)>0.555). Acute CCD is a result of functional deafference, while in the subacute phase, transneuronal degeneration might contribute to CCD. CCD in the intermediate and later zones is a better indicator than that in the medial zone.

Objectives: The possible connection between diseases among drivers and traffic accidents was examined for traffic safety purposes., Methods: We studied medical conditions of drivers and passengers in all motor vehicle crashes with fatalities in Finland in 2001 and 2002 by using reports of road accident investigation teams, including autopsy reports. We analyzed a total of 542 crashes with 640 fatalities. Findings were also compared with available epidemiological data in Finland., Results: An insignificant difference in the number of reported diseases was present between the different parties involved in crashes. However, among killed key drivers, so-called A-parties, psychiatric diseases, especially alcoholism, depression, and unspecific mental disorders, were diagnosed more often than in the groups of other drivers or passengers. In addition, A-parties were reported to more frequently suffer from cerebral arteriosclerosis and arterial hypertension., Conclusions: Drivers' diseases can be a risk factor for traffic accidents. Fitness to drive should therefore be considered in medical practice, particularly in patients with alcoholism and other psychiatric disorders.

Objectives/hypothesis: Early recovery and pain management after endoscopic sinus surgery (ESS) are largely unexplored regardless of the large number of ESSs performed by otorhinolaryngologists. In the present study, we evaluated whether scheduled administration of acetaminophen (paracetamol) for pain management after ESS would allow faster recovery to normal daily activities compared with acetaminophen administered on an as needed basis., Study Design: Open, prospective, randomized, controlled clinical trial with two parallel groups., Methods: There were 78 patients who were undergoing ESS and were randomized into two groups. The "scheduled" group (n = 38) was instructed to take two acetaminophen 665 mg modified-release tablets three times a day during the first five postoperative days, whereas the "as needed" group (n = 40) was given instructions to use acetaminophen 665 mg tablets only on an as needed basis. Patients filled in a questionnaire at the follow-up visits on the 7th and 30th postoperative days. The main outcome measures were return to normal daily activities (primary endpoint) and pain during the first week after surgery and patients' satisfaction with pain management (secondary endpoints)., Results: Patients returned to their normal daily activities in 8.8 (SD 4.8) days in the "scheduled" group versus in 10.3 (SD 7.0) days in the "as needed" group (mean difference 1.5; 95% CI of the difference -1.3 to 4.2; P = .29). In the "scheduled" group, the mean of worst pain was 3.4 (2.9) compared with 5.2 (3.0) in the "as needed" group on an 11-point scale (mean difference 1.7; 95% CI of the difference 0.4-5.2; P = .019). The patients in both groups were equally satisfied with pain management., Conclusions: The present study suggests that patients recover in 9 to 10 days after ESS when provided with appropriate pain management. Our data indicate that by prescribing scheduled acetaminophen, postoperative pain after ESS can be controlled effectively without the need for opioid analgesics.

Background: Versican, an extracellular matrix proteoglycan, has been noted to be expressed in several malignant tumours and has been suggested to play an important role in cancer development and tumour growth., Aims: To investigate whether the versican expression level in the peritumoural stromal tissue of primary oral squamous cell carcinoma (OSCC) predicts relapse-free or disease-specific survival. Also, to study the associations between versican expression and several other clinicopathological variables, as well as tumour cell proliferation., Methods: Immunohistochemistry was used to study the expression of versican and tumour cell proliferative activity in 139 OSCCs. All pertinent clinical data were collected retrospectively from the hospital records., Results: In this cohort, versican expression did not correlate with the clinicopathological factors or tumour cell proliferation. In univariate analyses, higher risk for disease recurrence was associated with higher stromal versican expression score (p = 0.02), positive neck node status (p = 0.02), lower Karnofsky performance status (p = 0.03) and higher tumour cell proliferation index (p = 0.04). Increased disease-specific risk of death was associated with high stromal versican expression score (p = 0.005) higher T class (p = 0.002), positive neck node status (p<0.001), higher stage (p<0.001), poorer histological differentiation (p = 0.005), worse general condition of the patient (p = 0.049) and increased tumour cell proliferative index (p = 0.02). In multivariate disease-specific survival analysis, high stromal versican expression score (p = 0.048), poorer histological differentiation (p = 0.047) and higher stage (p = 0.002) independently predicted poorer disease outcome., Conclusions: In this cohort, increased stromal versican expression correlated with both increased risk for disease recurrence and shortened survival. High stromal versican expression may thus be considered an independent and adverse prognostic marker in OSCC.

Background and Purpose: The severity of the neurological deficit after ischemic stroke is moderately correlated with infarct volume. In the current study, we sought to quantify the impact of location on neurological deficit severity and to delineate this impact from that of volume., Methods: We developed atlases consisting of location-weighted values indicating the relative importance in terms of neurological deficit severity for every voxel of the brain. These atlases were applied to 80 first-ever ischemic stroke patients to produce estimates of clinical deficit severity. Each patient had an MRI and National Institutes of Health Stroke Scale (NIHSS) examination just before or soon after hospital discharge. The correlation between the location-based deficit predictions and measured neurological deficit (NIHSS) scores were compared with the correlation obtained using volume alone to predict the neurological deficit., Results: Volume-based estimates of neurological deficit severity were only moderately correlated with measured NIHSS scores (r=0.62). The combination of volume and location resulted in a significantly better correlation with clinical deficit severity (r=0.79, P=0.032)., Conclusions: The atlas methodology is a feasible way of integrating infarct size and location to predict stroke severity. It can estimate stroke severity better than volume alone.