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Consideration of ergonomic factors is important for the practice of safe and efficient minimally invasive surgery (MIS). Surgeons with smaller glove sizes have previously been reported to have increased difficulties with some minimally invasive instruments. We aim to investigate hand anthropometrics and their relationship to surgeon comfort when using MIS instruments.Male and female surgeons from two centres were surveyed on their experience of handling MIS instruments and images obtained of the dorsal and palmar aspects of their dominant hand. Photographs of hands were transformed to calibrated coordinates to enable anthropometric measurements of finger length and width as well as palm width and hand span photogrammetrically. Surgeon-perceived discomfort, fatigue, pressure points and techniques to mitigate difficulty handling instruments were compared to hand measurements.Questionnaires were completed by 58 surgeons; 20 (34%) were consultants, 17 (29%) were women. Glove size ranged from 6 to 8 (median 7.5). Male participants had significantly larger hands than females in all measured dimensions. Female surgeons and those with smaller finger and hand dimensions were significantly more likely to experience difficulty or discomfort across a range of variables when using MIS instruments.Surgeons with smaller hands reported increased problems handling MIS instruments. This represents an issue of equity in surgery, with women being more significantly affected than men. Hand size varies greatly between surgeons and anthropometric variability should be considered in design of MIS instruments.

Management of residual clefts of the alveolus and maxilla requires the coordinated effort of multiple members of the craniofacial team including surgeon, orthodontist, and when teeth are hypoplastic or absent, the prosthodontist to achieve complete habilitation. Such cooperation among specialists begins early in the patient's life and continues through completion of care.Although numerous publications on this topic exist, few present definitive multidisciplinary reconstructive outcomes with longterm results. In this review paper, the authors present our comprehensive, multidisciplinary protocols, experience, and techniques as they have evolved with over 35 years of practice at our Craniofacial Center.Details of our updated protocols for each intervention and procedure, including our current thoughts on appropriate timing, follow up and advantages from the incorporation of current technologies are discussed. Close cooperation among specialists at all stages of care, the use of evolving technology, and adherence to, and modification where indicated, of time honored team protocols enables us to consistently achieve successful functional and esthetic outcomes, while minimizing complications.

Brown adipose tissue (BAT) is essential to maintain body temperature. Its ability to convert chemical energy in glucose and free fatty acids to heat is conferred by a unique protein, UCP-1. BAT activity is greatest in children and adolescents, declining through adulthood. Blood glucose concentrations outside the normal non-diabetic range are common in type 1 diabetes and hyperglycaemia leads to insulin resistance in muscle and white adipose tissue, but whether this applies to BAT, is not known. To investigate the effect of type 1 diabetes on BAT activity, we measured the supraclavicular temperature of 20 children with type 1 diabetes and compared them to 20 age-matched controls, using infrared thermography. The diabetes group had lower stimulated supraclavicular temperatures (diabetes group: 35.03 (34.76-35.30)°C; control group: 35.42 (35.16-35.69)°C; p=0.037) and a reduced response in relative temperature following cold stimulation, after adjusting for BMI (diabetes group: 0.11 (0.03-0.18)°C; control group: 0.22 (0.15-0.29)°C; p = 0.034). In the diabetes group, there was no association between glycaemic measures and supraclavicular temperatures, but the method of insulin delivery may significantly affect the change in supraclavicular temperature with stimulation (injections: 0.01 (-0.07-0.09)°C; pump: 0.15 (0.04-0.26)°C; p=0.028). While further work is needed to better understand the glucose-insulin-BAT relationship, one possible explanation for the reduced supraclavicular temperature is that exogenous, unlike endogenous, insulin, is not suppressed by the activity of the sympathetic nervous system, preventing lipolysis-driven activation of BAT. This article is protected by copyright. All rights reserved.

Aromaticity and antiaromaticity, as defined by Huckel’s rule, are key ideas in organic chemistry, and are both exemplified in biphenylene1–3—a molecule that consists of two benzene rings joined by a four-membered ring at its core. Biphenylene analogues in which one of the benzene rings has been replaced by a different (4n + 2) π-electron system have so far been associated only with organic compounds4,5. In addition, efforts to prepare a zirconabiphenylene compound resulted in the isolation of a bis(alkyne) zirconocene complex instead6. Here we report the synthesis and characterization of, to our knowledge, the first 2-metallabiphenylene compounds. Single-crystal X-ray diffraction studies reveal that these complexes have nearly planar, 11-membered metallatricycles with metrical parameters that compare well with those reported for biphenylene. Nuclear magnetic resonance spectroscopy, in addition to nucleus-independent chemical shift calculations, provides evidence that these complexes contain an antiaromatic cyclobutadiene ring and an aromatic benzene ring. Furthermore, spectroscopic evidence, Kohn–Sham molecular orbital compositions and natural bond orbital calculations suggest covalency and delocalization of the uranium f2 electrons with the carbon-containing ligand. The synthesis of uranium- and thorium-containing metallabiphenylenes demonstrates the ability of the actinides to stabilize aromatic/antiaromatic structures where transition metals have failed.

PURPOSE Stratum 1 of ACNS1123 (ClinicalTrials.gov identifier: NCT01602666 ), a Children’s Oncology Group phase II trial, evaluated efficacy of reduced-dose and volume of radiotherapy (RT) in children and adolescents with localized nongerminomatous germ cell tumors (NGGCTs). The primary objective was to evaluate the impact of reduced RT on progression-free survival (PFS) with a goal of preserving neurocognitive function. PATIENTS AND METHODS Patients received six cycles of chemotherapy with carboplatin and etoposide alternating with ifosfamide and etoposide, as used in the Children’s Oncology Group predecessor study (ACNS0122; ClinicalTrials.gov identifier: NCT00047320 ). Patients who achieved a complete response (CR) or partial response (PR) with or without second-look surgery were eligible for reduced RT, defined as 30.6 Gy whole ventricular field and 54 Gy tumor-bed boost, compared with 36 Gy craniospinal irradiation plus 54 Gy tumor-bed boost used in ACNS0122. RESULTS A total of 107 eligible patients were enrolled. Median age was 10.98 years (range, 3.68 to 21.63) and 75% were male. Sixty-six of 107 (61.7%) achieved a CR or PR and proceeded to reduced RT. The 3-year PFS and overall survival and standard error values were 87.8% ± 4.04% and 92.4% ± 3.3% compared with 92% and 94.1%, respectively, in ACNS0122. There were 10 recurrences, prompting early study closure; however, after a retrospective central review, only disease in eight of 66 (12.1%) patients eligible for reduced RT subsequently progressed; six patients had distant spinal relapse alone and two had disease with combined local plus distant relapse. Serum and CSF α-fetoprotein and β-human chorionic gonadotropin levels were not associated with PFS. CONCLUSION Patients with localized NGGCT who achieved a CR or PR to chemotherapy and received reduced RT had encouraging PFS similar to patients in ACNS0122 who received full-dose craniospinal irradiation. However, the patterns of failure were distinct, with all patients having treatment failure in the spine.

The interaction between thyroid status and brown adipose tissue (BAT) activation is complex. We assessed the effect of autoimmune hypothyroidism (ATD) in female children on BAT activation, measured using infrared thermography. Participants with ATD had lower resting (hypothyroid, 34.9 +- 0.7°C; control, 35.4 +- 0.5°C; P = 0.03) and stimulated (hypothyroid, 35.0 +- 0.6°C; control, 35.5 +- 0.5°C; P = 0.04) supraclavicular temperatures compared with controls, but there was no difference between groups in the temperature increase with stimulation. BAT activation, calculated as the relative temperature change comparing the supraclavicular temperature to a sternal reference region, was reduced in participants with ATD (hypothyroid, 0.1 +- 0.1°C; control, 0.2 +- 0.2°C; P = 0.04). Children with ATD were frequently biochemically euthyroid due to replacement therapy, but, despite this, increased relative supraclavicular temperature was closely associated with increased TSH (r = 0.7, P = 0.01) concentrations. Girls with ATD had an attenuated thermogenic response to cold stimulation compared with healthy controls, but, contrary to expectation, those with suboptimal biochemical control (with higher TSH) showed increased BAT activation. This suggests that the underlying disease process may have a negative effect on BAT response, but high levels of TSH can mitigate, and even stimulate, BAT activity. In summary, thyroid status is a complex determinant of BAT activity in girls with ATD., This work was supported by a pump-priming grant from Nottingham University Hospitals Charity (Grant PP-Law-Nov12).

Background Evidence supporting the efficacy of stereotactic body radiotherapy (SBRT) for localized prostate cancer is accumulating, but comparative studies of patient-reported quality of life (QOL) following SBRT versus conventionally fractionated external beam radiotherapy (EBRT) or active surveillance (AS) are limited. Objective To compare QOL of patients pursuing SBRT and EBRT versus AS. Design, setting, and participants A population-based cohort of 680 men with newly diagnosed localized prostate cancer was prospectively enrolled from 2011 to 2013. Intervention SBRT, EBRT without androgen deprivation therapy, or AS. Outcome measurements and statistical analysis QOL was prospectively assessed before treatment (baseline), and at 3, 12, and 24 mo after treatment using the validated Prostate Cancer Symptom Indices, which contain four domains: sexual dysfunction, urinary obstruction/irritation, urinary incontinence, and bowel problems. Propensity weighting via logistic regression models was used to balance baseline characteristics, and the mean QOL scores of EBRT and SBRT patients were compared against AS patients as the control group. Results and limitations Compared with AS patients, EBRT patients had worse urinary obstructive/irritative symptoms and sexual dysfunction at 3 mo, and worse bowel symptoms at 3 and 24 mo. SBRT patients had similar scores as AS patients in all domains and across all time points; however, due to small sample size, worse sexual function and urinary incontinence in SBRT patients cannot be ruled out. Further research is needed to assess long-term outcomes. Conclusions In a nonrandomized cohort of men with localized prostate cancer, SBRT appeared to result in favorable QOL results through 2 yr of follow-up, but worse sexual function and urinary incontinence compared with AS cannot be ruled out completely. Larger studies with longer follow-up are needed to confirm these findings. Patient summary Stereotactic body radiotherapy (SBRT) and active surveillance appear to have similar quality of life outcomes through 2 yr, although worse sexual function and urinary incontinence from SBRT cannot be ruled out completely.

Brown adipose tissue (BAT) is able to rapidly generate heat and metabolise macronutrients, such as glucose and lipids, through activation of mitochondrial uncoupling protein 1 (UCP1). Diet can modulate UCP1 function but the capacity of individual nutrients to promote the abundance and activity of UCP1 is not well established. Caffeine consumption has been associated with loss of body weight and increased energy expenditure, but whether it can activate UCP1 is unknown. This study examined the effect of caffeine on BAT thermogenesis in vitro and in vivo. Stem cell-derived adipocytes exposed to caffeine (1 mM) showed increased UCP1 protein abundance and cell metabolism with enhanced oxygen consumption and proton leak. These functional responses were associated with browning-like structural changes in mitochondrial and lipid droplet content. Caffeine also increased peroxisome proliferator-activated receptor gamma coactivator 1-alpha expression and mitochondrial biogenesis, together with a number of BAT selective and beige gene markers. In vivo, drinking coffee (but not water) stimulated the temperature of the supraclavicular region, which co-locates to the main region of BAT in adult humans, and is indicative of thermogenesis. Taken together, these results demonstrate that caffeine can promote BAT function at thermoneutrality and may have the potential to be used therapeutically in adult humans.

Three new uranium species (C5Me5)2U([double bond, length as m-dash]N-2,6-iPr2-C6H3)([double bond, length as m-dash]S), (C5Me5)2U([double bond, length as m-dash]N-2,6-iPr2-C6H3)(η2-S2), and (C5Me5)2U([double bond, length as m-dash]N-2,6-iPr2-C6H3)(S[double bond, length as m-dash]PMe3) were synthesized and fully characterized by a combination of NMR, IR, and UV/vis-NIR spectroscopies, elemental analysis, and cyclic voltammetry. The solid state structures of (C5Me5)2U([double bond, length as m-dash]N-2,6-iPr2-C6H3)([double bond, length as m-dash]S) and (C5Me5)2U([double bond, length as m-dash]N-2,6-iPr2-C6H3)(η2-S2) were also determined. The compound (C5Me5)2U([double bond, length as m-dash]N-2,6-iPr2-C6H3)([double bond, length as m-dash]S) is the first neutral uranium complex with a terminal sulphido ligand, and (C5Me5)2U([double bond, length as m-dash]N-2,6-iPr2-C6H3)(S[double bond, length as m-dash]PMe3) is the first uranium compound with a coordinated phosphine sulphide ligand. The phosphine sulphide adduct, (C5Me5)2U([double bond, length as m-dash]N-2,6-iPr2-C6H3)(S[double bond, length as m-dash]PMe3), can be synthesized either by reaction of the uranium(iv) complex (C5Me5)2U([double bond, length as m-dash]N-2,6-iPr2-C6H3)(thf) with S[double bond, length as m-dash]PMe3 or by the reaction of the uranium(vi) terminal sulphido complex (C5Me5)2U([double bond, length as m-dash]N-2,6-iPr2-C6H3)([double bond, length as m-dash]S) with PMe3.

Transferring sick premature infants between hospitals increases the risk of severe brain injury, potentially linked to the excessive exposure to noise, vibration and driving-related accelerations. One method of reducing these levels may be to travel along smoother and quieter roads at an optimal speed, however this requires mass data on the effect of roads on the environment within ambulances. An app for the Android operating system has been developed for the purpose of recording vibration, noise levels, location and speed data during ambulance journeys. Smartphone accelerometers were calibrated using sinusoidal excitation and the microphones using calibrated pink noise. Four smartphones were provided to the local neonatal transport team and mounted on their neonatal transport systems to collect data. Repeatability of app recordings was assessed by comparing 37 journeys, made during the study period, along an 8.5 km single carriageway. The smartphones were found to have an accelerometer accurate to 5% up to 55 Hz and microphone accurate to 0.8 dB up to 80 dB. Use of the app was readily adopted by the neonatal transport team, recording more than 97,000 km of journeys in 1 year. To enable comparison between journeys, the 8.5 km route was split into 10 m segments. Interquartile ranges for vehicle speed, vertical acceleration and maximum noise level were consistent across all segments (within 0.99 m . s−1, 0.13 m · s−2 and 1.4 dB, respectively). Vertical accelerations registered were representative of the road surface. Noise levels correlated with vehicle speed. Android smartphones are a viable method of accurate mass data collection for this application. We now propose to utilise this approach to reduce potential harmful exposure, from vibration and noise, by routing ambulances along the most comfortable roads.

Early inter-hospital ambulance transport of premature babies is associated with more severe brain injury. The mechanism is unclear, but they are exposed to excessive noise and vibration. Smart-routing may help minimise these exposure levels and potentially improve outcomes.An app for Android smartphones was developed to collect vibration, noise and location data during ambulance journeys. Four smartphones, with the app installed, were provided to the local neonatal transport group to attach to their incubator trolleys. An example of route comparison was performed on the roads used between Nottingham City Hospital (NCH) and Leicester Royal Infirmary (LRI).Almost 1,700 journeys were recorded over the space of a year. 39 of these journeys travelled from NCH to LRI, comprising of 9 different routes. Analysis was performed on all recorded data which travelled along each road. For routes from NCH to LRI, the route with least vibration was also the quickest. Noise levels, however, were found to increase with vehicle speed. Ambulance drivers in the study did not tend to take the quickest, smoothest or quietest route.Android smartphones are a practical method of gathering information about the in-ambulance environment. Routes were found to vary in vibration, noise and speed, suggesting these could be minimised. The next step is to combine recorded and clinical data to try and define an ideal neonatal comfort metric which can then be fed into the routing. Roll-out of the app around the UK is also planned.Clinical relevance-Transferring preterm neonatal infants to specialist units lead to worse outcomes. By reducing the levels of vibration and noise the infants are exposed to during transport, we hope to improve outcomes.

© Copyright © 2020 McAusland, Lim, Morris, Smith-Herman, Mohammed, Hayes-Gill, Crowe, Fisk and Murchie. Advancements in availability and specificity of light-emitting diodes (LEDs) have facilitated trait modification of high-value edible herbs and vegetables through the fine manipulation of spectra. Coriander (Coriandrum sativum L.) is a culinary herb, known for its fresh, citrusy aroma, and high economic value. Studies into the impact of light intensity and spectrum on C. sativum physiology, morphology, and aroma are limited. Using a nasal impact frequency panel, a selection of key compounds associated with the characteristic aroma of coriander was identified. Significant differences (P < 0.05) were observed in the concentration of these aromatics between plants grown in a controlled environment chamber under the same photosynthetic photon flux density (PPFD) but custom spectra: red (100%), blue (100%), red + blue (RB, 50% equal contribution), or red + green + blue (RGB, 35.8% red: 26.4% green: 37.8% blue) wavelengths. In general, the concentration of aromatics increased with increasing numbers of wavelengths emitted alongside selective changes, e.g., the greatest increase in coriander-defining E-(2)-decenal occurred under the RGB spectrum. This change in aroma profile was accompanied by significant differences (P < 0.05) in light saturated photosynthetic CO2 assimilation, water-use efficiency (Wi), and morphology. While plants grown under red wavelengths achieved the greatest leaf area, RB spectrum plants were shortest and had the highest leaf:shoot ratio. Therefore, this work evidences a trade-off between sellable commercial morphologies with a weaker, less desirable aroma or a less desirable morphology with more intense coriander-like aromas. When supplemental trichromatic LEDs were used in a commercial glasshouse, the majority of compounds, with the exception of linalool, also increased showing that even as a supplement additional wavelength can modify the aromatic profile increasing its complexity. Lower levels of linalool suggest these plants may be more susceptible to biotic stress such as herbivory. Finally, the concentration of coriander-defining aromatics E-(2)-decenal and E-(2)-hexenal was significantly higher in supermarket pre-packaged coriander leaves implying that concentrations of aromatics increase after excision. In summary, spectra can be used to co-manipulate aroma profile and plant form with increasing spectral complexity leading to greater aromatic complexity and intensity. We suggest that increasing spectral complexity progressively stimulates signaling pathways giving rise to valuable economic traits.

Two new uranium metallacyclopropenes, (C5Me4R)2U(η2-Ph2PC CPPh2) (R = Me, Et) were prepared by reducing the corresponding (C5Me4R)2UCl2 complexes with KC8 in the presence of 1,2-bis(diphenylphosphino)acetylene (Ph2P C C PPh2). Both compounds were fully characterized by a combination of elemental analysis and multinuclear NMR, UV–visible–NIR, and IR spectroscopies. Differences in the electronic spectra of these novel compounds and the known (C5Me5)2U(η2-Me3SiC CSiMe3) are discussed. Also presented is the solid-state structure of (C5Me4Et)2U(η2-Ph2PC CPPh2), which reveals significant distortions of the coordinated 1,2-bis(diphenylphosphino)acetylene (Ph2P C C PPh2) ligand.

The terminal actinide fluoride bonds in (C 5 Me 5 ) 2 ThF 2 (py) (py = pyridine) and (C 5 Me 5 ) 2 UF 2 (O=PR 3 ) (R = Me, Ph) react with two equivalents of Me 3 SiN 3 in toluene to form the polymeric thorium bis(azide), [(C 5 Me 5 ) 2 Th(N 3 ) 2 ] ∞ , and a new class of monometallic uranium bis(azide) complexes, (C 5 Me 5 ) 2 U(N 3 ) 2 (O=PR 3 ), respectively. Full characterization of the novel complexes (C 5 Me 5 ) 2 ThF 2 (py) and (C 5 Me 5 ) 2 UF 2 (O=PR 3 ) are reported, including the solid-state structures of (C 5 Me 5 ) 2 ThF 2 (py) and (C 5 Me 5 ) 2 U(N 3 ) 2 (O=PPh 3 ). Electronic absorption spectral data are also reported for (C 5 Me 5 ) 2 AnF 2 (py) (An = Th, U) and (C 5 Me 5 ) 2 U(N 3 ) 2 (O=PR 3 ) to confirm metal oxidation state and enable elucidation of the fluoride and azide ligand bonding in these complexes.

Interest in brown adipose tissue has increased in recent years as a potential target for novel obesity, diabetes and metabolic disease treatments. One of the significant limitations to rapid progress has been the difficulty in measuring brown adipose tissue activity, especially in humans. Infrared thermography (IRT) is being increasingly recognized as a valid and complementary method to standard imaging modalities, such as positron emission tomography–computed tomography (PET/CT). In contrast to PET/CT, it is non-invasive, cheap and quick, allowing, for the first time, the possibility of large studies of brown adipose tissue (BAT) on healthy populations and children. Variations in study protocols and analysis methods currently limit direct comparison between studies but IRT following appropriate BAT stimulation consistently shows a change in supraclavicular skin temperature and a close association with results from BAT measurements from other methods.

Background\ud Obesity and its metabolic consequences are a major cause of morbidity and mortality. Brown adipose tissue (BAT) utilises glucose and free fatty acids to produce heat, thereby increasing energy expenditure. Effective evaluation of human BAT stimulators is constrained by current standard BAT assessment methods as positron emission tomography-computed tomography (PET-CT) requires exposure to high doses of ionising radiation. Infrared thermography (IRT) is a potential non-invasive, safe alternative, although direct corroboration with PET-CT has not previously been established.\ud Methods\ud IRT and 18F-fluorodeoxyglucose (¹⁸F-FDG) PET-CT data from 8 healthy male participants subjected to water jacket cooling were directly compared. Thermal images (TIs) were geometrically transformed to overlay PET-CT-derived maximum intensity projection (MIP) images from each subject and the areas of greatest intensity of temperature and glucose-uptake within the supraclavicular regions compared. Relationships between supraclavicular temperatures from IRT (TSCR) and the maximum rate of glucose uptake (MR(gluc)) from PET-CT were determined.\ud Results\ud Glucose uptake on MR(gluc)MIP was positively correlated with change in TSCR relative to a reference region (r² = 0.721; p=0.008). Spatial overlap between areas of maximal MR(gluc)MIP and maximal TSCR was 29.5±5.1%. Prolonged cooling to 60 minutes was associated with further TSCR rise compared with cooling to 10 minutes.\ud Conclusions\ud The supraclavicular hotspot identified on IRT closely corresponds to the area of maximal uptake on PET-CT-derived MR(gluc)MIP images. Greater increases in relative TSCR were associated with raised glucose uptake. IRT should now be considered a suitable method for measuring BAT activation, especially in populations where PET-CT is not feasible, practical or repeatable.

Facial procedures directed at gender affirmation are uniquely tailored to the individual patient and may affect soft tissue and skeletal structures over the entire face-from the chin through the upper forehead. Complete photographic and radiographic documentation that addresses these areas is important from the perspectives of surgical planning, evaluation of outcomes, research purposes, and communication between patient and provider, and amongst treating professionals. This work outlines pertinent skeletal anatomy that is uniquely addressed in gender affirmation procedures and means by which it can be effectively imaged. It provides historical insight into the evolution of computerized-tomography-based imaging. The authors provide detailed protocols for photodocumentation and computerized-tomography based skeletal imaging at their center.

The effective capacitance of an aqueous solution containing the nanoscale uranyl peroxide cage cluster U60 (Li48K12[UO2(O2)(OH)]60(H2O) n , n ≈ 310) was measured using cyclic voltammetry. The potential window (50–90 mV) for the measurements precluded changes to the oxidation state of U(VI) in the system. The effective capacitance for solutions containing 0.5–14.0 g L−1 U60 exhibited a dependence on cluster concentration caused by the dissociation of Li+ and K+ counterions from the clusters. The effective capacitance of U60 cluster solutions and salt solutions of KCl and LiCl were compared.

A new uranium metallacyclocumulene, (C5Me5)2U(η4-1,2,3,4-PhC4Ph), was synthesized by both reaction of (C5Me5)2UCl2 with 1,4-diphenylbutadiyne in the presence of KC8 and by ligand exchange between (C5Me5)2U(η2-Me3SiC2SiMe3) and 1,4-diphenylbutadiyne. Full characterization of (C5Me5)2U(η4-1,2,3,4-PhC4Ph) is reported, including the solid-state structure. (C5Me5)2U(η4-1,2,3,4-PhC4Ph) displays an unusually detailed UV–visible spectrum, which is rare for uranium(IV) metallocene complexes.

The reaction of (C5Me5)2AnCl2 (An = Th, U) with 2.8 or 4 equivalents of LiNMe2, respectively, affords (C5Me5)2An(NMe2)2 in high yields. In addition to improved syntheses, the solid-state structures, voltammetric data, and UV-visible–NIR spectra for these classic actinide bis(dimethylamido) complexes are presented for the first time.

Introduction Retrospective studies have evaluated the approach of stereotactic radiotherapy (SRT) to address oligoprogression in patients with EGFR mutant NSCLC on TKI therapy, it has never been prospectively studied. Materials and methods We treated 25 patients with EGFR mutant NSCLC on erlotinib who had 3 or fewer sites of extra-cranial progression with SRT to progressing sites, followed by re-initiation of erlotinib. Results Median PFS from the initiation of SRT was 6 months (95% CI 2.5 to 11.6) and median OS was 29 months (95% CI 21.7 to 36.3). Neither baseline nor changes in the Veristrat proteomic predicted PFS. Conclusions SRT and TKI continuation may be considered for select patients with EGFR mutant NSCLC and oligo-progression on EGFR TKI therapy.

Aromaticity and antiaromaticity, as defined by Hückel's rule, are key ideas in organic chemistry, and are both exemplified in biphenylene

Background Because primary nasal correction by the time of lip repair has been incorporated into the treatment approach, many patients have benefitted from this combined procedure. However, primary nasal correction cannot guarantee an excellent result. Although overcorrection has been mentioned as a treatment rationale of the unilateral cleft lip nasal deformity, a detailed approach and quantitative evidence of the rationale are rare. This study evaluates whether overcorrection in the primary repair results in a quantitative improvement in nasal appearance. Patients and methods In this retrospective study, the inclusion criteria were patients with complete unilateral cleft lip and palate who underwent primary lip and nose repair by the age of 3 to 4 months. Primary nasal overcorrection was achieved by application of muscle to septal base suture, alar cinching suture and Tajima reversed U incision method. Patients were further divided into an overcorrected (n = 19) and nonovercorrected group (n = 19). The following parameters were identified on basilar photos of all patients taken at least 12 months after repair, ratios of cleft to noncleft side in each patient were taken and the mean for each parameter calculated: Ac angle (ACA/ACA'), alar height (AH/AH'), alar width (AW/AW'), nostril height (NH/NH`), nostril width (NW/NW'), and columellar deviation from the midline (CD/NW). The means of the overcorrected and nonovercorrected groups were then compared using the t test. Results From all investigated measuremens, Alar height (AH/AH': overcorrected, 0.983 to nonovercorrected, 0.941; P = 0.03) and nostril height ratio (NH/NH') (NH/NH': covercorrected, 0.897 to nonovercorrected, 0.680; P = 0.003) showed statistically significant differences favoring the overcorrected group at least 12 months after surgery. Conclusions Primary nasal overcorrection including muscle to columella base suture, alar cinch suture, and Tajima method resulted in quantitatively more long-term symmetric alae and nostril height compared to nonovercorrected patients.

This work demonstrates that the oxidation state and chemistry of uranium hydrides can be tuned with temperature and the stoichiometry of phenylsilane. The trivalent uranium hydride [(C5Me5)2U–H]x (5) was found to be comprised of an equilibrium mixture of U(III) hydrides in solution at ambient temperature. A single U(III) species can be selectively prepared by treating (C5Me5)2UMe2 (4) with 2 equiv of phenylsilane at 50 °C. The U(III) system is a potent reducing agent and displayed chemistry distinct from the U(IV) system [(C5Me5)2U(H)(μ-H)]2 (2), which was harnessed to prepare a variety of organometallic complexes, including (C5Me5)2U(dmpe)(H) (6), and the novel uranium(IV) metallacyclopentadiene complex (C5Me5)2U(C4Me4) (11).

Two organometallic 1D infinite coordination polymers and two organometallic monometallic complexes of thorium diazide have been synthesized and characterized. Steric control of these self-assembled arrays, which are dense in thorium and nitrogen, has also been demonstrated: infinite chains can be circumvented by using steric bulk either at the metallocene or with a donor ligand in the wedge.

Three new uranium species (C5Me5)2U([double bond, length as m-dash]N-2,6-iPr2-C6H3)([double bond, length as m-dash]S), (C5Me5)2U([double bond, length as m-dash]N-2,6-iPr2-C6H3)(η2-S2), and (C5Me5)2U([double bond, length as m-dash]N-2,6-iPr2-C6H3)(S[double bond, length as m-dash]PMe3) were synthesized and fully characterized by a combination of NMR, IR, and UV/vis-NIR spectroscopies, elemental analysis, and cyclic voltammetry. The solid state structures of (C5Me5)2U([double bond, length as m-dash]N-2,6-iPr2-C6H3)([double bond, length as m-dash]S) and (C5Me5)2U([double bond, length as m-dash]N-2,6-iPr2-C6H3)(η2-S2) were also determined. The compound (C5Me5)2U([double bond, length as m-dash]N-2,6-iPr2-C6H3)([double bond, length as m-dash]S) is the first neutral uranium complex with a terminal sulphido ligand, and (C5Me5)2U([double bond, length as m-dash]N-2,6-iPr2-C6H3)(S[double bond, length as m-dash]PMe3) is the first uranium compound with a coordinated phosphine sulphide ligand. The phosphine sulphide adduct, (C5Me5)2U([double bond, length as m-dash]N-2,6-iPr2-C6H3)(S[double bond, length as m-dash]PMe3), can be synthesized either by reaction of the uranium(iv) complex (C5Me5)2U([double bond, length as m-dash]N-2,6-iPr2-C6H3)(thf) with S[double bond, length as m-dash]PMe3 or by the reaction of the uranium(vi) terminal sulphido complex (C5Me5)2U([double bond, length as m-dash]N-2,6-iPr2-C6H3)([double bond, length as m-dash]S) with PMe3.

Historically, brown adipose tissue has been elusive and not easy to detect, hence its relative obscurity in human physiology until its rediscovery in 2009. At that point, it was proven that the symmetrical artefacts frequently detected on positron emission tomography-computed tomography (PET-CT), which resolved if the environment was kept warm, were brown adipose tissue deposits. PET-CT has remained the stalwart of human brown adipose tissue research and is still considered the gold standard. However, PET-CT exposes the participant to ionising radiation, limiting studies to large, but retrospective, review of clinical imaging or a small-scale, but prospective, design. Within this context, alternative imaging modalities have been sought. Due to the heat-generating properties of brown adipose tissue, infrared thermography is a natural candidate for measuring its activity and the supraclavicular depot is relatively superficial, allowing detection of the heat signature. Infrared thermography is a non-invasive, non-contact technique for measuring temperature remotely. Recent developments in image analysis techniques have facilitated the use of infrared thermography to study brown adipose tissue activation in populations, and in ways, not previously feasible.

Objective: To quantitatively measure the extent of 3D asymmetry of the facial skeleton in patients with unilateral cleft lip and palate (UCLP) using an asymmetry index (AI) approach, and to illustrate the applicability of the index in guiding and measuring treatment outcome. Method: Two groups of subjects between the ages of 15 and 20 who had archived CBCT scan were included in this study. Twenty-five patients with complete UCLP were compared with 50 age-matched noncleft subjects. The CBCT scans were segmented and landmarked for 3D anthropometric analysis. An AI was calculated as a quantitative measure of the extent of facial skeletal asymmetry. Results: For the control group, the AI ranged from 0.72 ± 0.47 at A point to 4.77 ± 1.59 at Gonion. The degree of asymmetry increased with the increasing laterality of the landmark from the midsagittal plane. In the UCLP group, the values of AI significantly increased compared to the control group at nearly all measured landmarks. The extent of the asymmetry to involve the upper, middle, and lower facial skeleton varied widely with the individual patient with UCLP. Conclusion: The asymmetry index is capable of capturing the 3D facial asymmetry of subjects with UCLP and as a basis for classification of the extent of the asymmetry. We found the index to be applicable in surgical planning and in measuring the outcome in improving the symmetry in patients who have undergone orthognathic surgery.

The unfavorable result in plastic surgery , The unfavorable result in plastic surgery , کتابخانه مرکزی دانشگاه علوم پزشکی تهران

Purpose: To describe a case report of lungradiosurgery in which defining a target using a maximal intensity projection CT omitted a portion of the target due to an overlapping projection of the diaphragm. Methods: A Lung 4DCT was obtained, and all ten breathing phases from 0% to 90% were reconstructed. The gating window was set to treat phases 30% to 70%, and the corresponding Maximum Intensity Projection (MIP) was generated. An ITV was contoured on the MIP. Tumor GTVs were contoured on all phases. Another ITV was generated by using the overlapped projection of all GTVs in the gating window when suspicion arose that part of the target was omitted. The volumes of the ITVs and GTVs were calculated. DVHs were analyzed on the plan generated to cover the MIP ITV. Results: The initial ITV based on the MIP omitted 15% of the target Since the ITVs of the diaphragm and the tumor overlap in the MIP, and the imaging technique cannot differentiate them, contouring tumor only on MIP has risk of missing part of the tumor. We have also found that the volumes of all 10 phases fluctuate with a standard deviation of 5.6%. This indicates the imperfection of 4DCT generation. If the treatment plan was generated based on MIP ITV, DVH shows the lack of coverage for the true ITV. Conclusions: We propose two methods to accurately delineate tumor ITV from 4DCT for cases in which the target is located adjacent to diaphragm. If it is desired to start with contouring ITV on MIP, thorough QA needs to be done by going through all gating phases to adjust the ITV accordingly. A more straightforward method is to contour the GTV on all gating phases and use the overlapped projections as the ITV.

Purpose To better define patterns of practice for patients with non-small cell lung cancer (NSCLC) in the United States. Methods and Materials A survey of 36 questions was designed to collect information regarding practice patterns of radiation oncologists for the management of patients with NSCLC. All American Society for Radiation Oncology members were invited to respond. Results Four hundred twenty-four responses from radiation oncologists in the United States were received. The response rate for the survey was approximately 20%. Substantial discrepancies were seen in the use of stereotactic body radiation therapy (SBRT) for patients with peripherally and centrally located early-stage tumors and in the recommended SBRT dose. There was a near consensus opinion regarding the use of concurrent chemotherapy and the radiation dose for patients with inoperable stage II and III NSCLC with a good performance status; however, in patients with a poor performance status or in patients with stage IV disease treatment recommendations differed remarkably. Additionally, the use of elective nodal irradiation and the assessment of tumor motion during simulation were highly variable. Thoracic radiation oncologists were more likely to prescribe higher doses, omit elective nodal irradiation, and use advanced technologies ( P Conclusions Substantial variations were seen in the management of patients with stage I and IV NSCLC in addition to the incorporation of new technology. This information can be used to help design meaningful clinical trials.

We present a web-based probability distribution elicitation tool: The MATCH Uncertainty Elicitation Tool. The Tool is designed to help elicit probability distributions about uncertain model parameters from experts, in situations where suitable data is either unavailable or sparse. The Tool is free to use, and offers five different techniques for eliciting univariate probability distributions. A key feature of the Tool is that users can log in from different sites and view and interact with the same graphical displays, so that expert elicitation sessions can be conducted remotely (in conjunction with tele- or videoconferencing). This will make probability elicitation easier in situations where it is difficult to interview experts in person. Even when conducting elicitation remotely, interviewers will be able to follow good elicitation practice, advise the experts, and provide instantaneous feedback and assistance. © 2013 The Authors.

Background Changes in tumor volume are seen on magnetic resonance imaging within weeks after stereotactic radiosurgery (SRS), but it remains unclear what clinical outcomes early radiological changes portend. Objective We hypothesized that rapid, early reduction in tumor volume post-SRS is associated with prolonged local control and favorable clinical outcome. Methods A retrospective review of patients treated with CyberKnife SRS for brain metastases at the University of North Carolina from 2007 to 2009 was performed. Patients with at least 1 radiological follow-up, minimal initial tumor volume of 0.1 cm, no previous focal radiation, and no recent whole-brain radiation therapy were eligible for inclusion. Results Fifty-two patients with 100 metastatic brain lesions were analyzed and had a median follow-up of 15.6 months (range, 2-33 months) and a median of 2 (range, 1-8) metastatic lesions. In treated metastases in which there was a significant tumor volume reduction by 6 or 12 weeks post-SRS, there was no local progression for the duration of the study. Furthermore, patients with metastases that did not reduce in volume by 6 or 12 weeks post-SRS were more likely to require corticosteroids (P = .01) and to experience progression of neurological symptoms (P = .003). Conclusion Significant volume reductions of brain metastases measured at either 6 or 12 weeks post-SRS were strongly associated with prolonged local control. Furthermore, early volume reduction was associated with less corticosteroid use and stable neurological symptoms.

This chapter provides an operative dictation template for a superiorly based pharyngeal flap. It outlines the indications for the procedure and potential complications and provides a detailed guide to the individual steps of the procedure.

This chapter provides an operative dictation template for a double opposing palatoplasty. It outlines the indications for the procedure potential complications and provides a detailed guide to the individual steps of the procedure.

Orthognathic surgery involves correction of patients with skeletal deformities of the mandible and maxilla whether of congenital, developmental, or acquired in origin. This chapter details the bilateral sagittal split osteotomy (BSSO) of the mandibular ramus. The procedure was initially described by Hugo Obwegeser in 1955 and remains an essential procedure in the plastic and maxillofacial surgeons’ surgical tool chest. The BSSO allows the surgeon to reposition (advancement, setback, and rotation) the mandible in relationship to the maxilla to establish a functional occlusion. The BSSO in combination with the LeFort I and the genioplasty allows the surgeon to disassemble the facial skeleton and allow three-dimensional reconstruction to optimize the occlusion and facial form relative to the cranial base.

Orthognathic surgery involves correction of patients with skeletal deformities of the mandible and maxilla whether of congenital, developmental, or acquired in origin. This chapter details the LeFort I osteotomy of the maxilla. The procedure was initially described by Hugo Obwegeser in 1965 and remains an essential procedure in the plastic and maxillofacial surgeons’ surgical tool chest. The LeFort I allows the surgeon to reposition the maxilla in relationship to the mandible to establish a functional occlusion. The LeFort I in combination with the BSSO and the genioplasty allows the surgeon to disassemble the facial skeleton and allow three-dimensional reconstruction to optimize the occlusion and facial form relative to the cranial base.

Object Experience with whole-brain radiation therapy for metastatic tumors in the brain has identified a subset of tumors that exhibit decreased local control with fractionated regimens and are thus termed radioresistant. With the advent of frameless radiosurgery, fractionated radiosurgery (2–5 fractions) is being used increasingly for metastatic tumors deemed too large or too close to crucial structures to be treated in a single session. The authors retrospectively reviewed metastatic brain tumors treated at 2 centers to analyze the dependency of local control rates on tumor radiobiology and dose fractionation. Methods The medical records of 214 patients from 2 institutions with radiation-naive metastatic tumors in the brain treated with radiosurgery given either as a single dose or in 2–5 fractions were analyzed retrospectively. The authors compared the local control rates of the radiosensitive with the radioresistant tumors after either single-fraction or fractionated radiosurgery. Results There was no difference in local tumor control rates in patients receiving single-fraction radiosurgery between radioresistant and radiosensitive tumors (p = 0.69). However, after fractionated radiosurgery, treatment for radioresistant tumors failed at a higher rate than for radiosensitive tumors with an OR of 5.37 (95% CI 3.83–6.91, p = 0.032). Conclusions Single-fraction radiosurgery is equally effective in the treatment of radioresistant and radiosensitive metastatic tumors in the brain. However, fractionated stereotactic radiosurgery is less effective in radioresistant tumor subtypes. The authors recommend that radioresistant tumors be treated in a single fraction when possible and techniques for facilitating single-fraction treatment or dose escalation be considered for larger radioresistant lesions.