High relapse-free survival after preoperative and intraoperative radiotherapy and resection for sulcus superior tumors

STUDY OBJECTIVES: Relapse-free survival in patients with sulcus superior tumors. DESIGN: Prospective registration study. SETTING: Department of surgical oncology of a university hospital. PATIENTS: Twenty-one patients treated with preoperative radiotherapy (46 Gy), lobectomy and chest-wall resection, and intraoperative radiotherapy (10 Gy). RESULTS: After a median follow-up of 18 months, 18 patients (85%) were free from locoregional relapse, while 8 patients were still alive. CONCLUSIONS: The results show that this protocol can achieve excellent local tumor control and can even be used for palliative treatment

The influence of perceived talker differences on the talker variability effect under cochlear implant simulation

Speech recognition is harder when communicating with multiple talkers. This “talker variability effect” has not been extensively examined for cochlear implant (CI) users, who have difficulty discriminating same-gender talkers but not different-gender talkers. A shadowing task was conducted with normal hearing listeners (N=19) under CI simulation. The test consisted of a single-talker condition (ST), and two multi-talker conditions with different male and female voices (MT-M) or only different female voices (MT-F). Response times were longer and accuracy was lower in MT-M compared to MT-F. Thus, the talker variability effect was observed only when talkers were perceptible under CI simulation

Antarctic climate, Southern Ocean circulation patterns, and deep water formation during the Eocene

We assess early-to-middle Eocene seawater neodymium (Nd) isotope records from seven Southern Ocean deep-sea drill sites to evaluate the role of Southern Ocean circulation in long-term Cenozoic climate change. Our study sites are strategically located on either side of the Tasman Gateway and are positioned at a range of shallow (Nd(t) = −9.3 ± 1.5). IODP Site U1356 off the coast of Adélie Land, a locus of modern-day Antarctic Bottom Water production, is identified as a site of persistent deep water formation from the early Eocene to the Oligocene. East of the Tasman Gateway an additional local source of intermediate/deep water formation is inferred at ODP Site 277 in the SW Pacific Ocean (εNd(t) = −8.7 ± 1.5). Antarctic-proximal shelf sites (ODP Site 1171 and Site U1356) reveal a pronounced erosional event between 49 and 48 Ma, manifested by ~2 εNd unit negative excursions in seawater chemistry toward the composition of bulk sediments at these sites. This erosional event coincides with the termination of peak global warmth following the Early Eocene Climatic Optimum and is associated with documented cooling across the study region and increased export of Antarctic deep waters, highlighting the complexity and importance of Southern Ocean circulation in the greenhouse climate of the Eocene

Isolated hypoxic hepatic perfusion with tumor necrosis factor-alpha, melphalan, and mitomycin C using balloon catheter techniques: a pharmacokinetic study in pigs

OBJECTIVE: To validate the methodology of isolated hypoxic hepatic perfusion (IHHP) using balloon catheter techniques and to gain insight into the distribution of tumor necrosis factor-alpha (TNF), melphalan, and mitomycin C (MMC) through the regional and systemic blood compartments when applying these techniques. SUMMARY BACKGROUND DATA: There is no standard treatment for unresectable liver tumors. Clinical results of isolated limb perfusion with high-dose TNF and melphalan for the treatment of melanoma and sarcoma have been promising, and attempts have been made to extrapolate this success to the isolated liver perfusion setting. The magnitude and toxicity of the surgical procedure, however, have limited clinical applicability. METHODS: Pigs underwent IHHP with TNF, melphalan, and MMC using balloon catheters or served as controls, receiving equivalent dosages of these agents intravenously. After a 20-minute perfusion, a washout procedure was performed for 10 minutes, after which isolation was terminated. Throughout the procedure and afterward, blood samples were obtained from the hepatic and systemic blood compartments and concentrations of perfused agents were determined. RESULTS: During perfusion, locoregional plasma drug concentrations were 20- to 40-fold higher than systemic concentrations. Compared with systemic concentrations after intravenous administration, regional concentrations during IHHP were up to 10-fold higher. Regional MMC and melphalan levels steadily declined during perfusion, indicating rapid uptake by the liver tissue; minimal systemic concentrations indicated virtually no leakage to the systemic blood compartment. During isolation, concentrations of TNF in the perfusate declined only slightly, indicating limited uptake by the liver tissue; no leakage of TNF to the systemic circulation was observed. After termination of isolation, systemic TNF levels showed only a minor transient elevation, indicating that the washout procedure at the end of the perfusions was fully effective. CONCLUSIONS: Complete isolation of the hepatic vascular bed can be accomplished when performing IHHP using this balloon catheter technique. Thus, as in extremities, an ideal leakage-free perfusion of the liver can now be performed, and repeated, without major surgery. The effective washout allows the addition of TNF in this setting

Estimating granular house price distributions in the Australian market using Gaussian mixtures

A new methodology is proposed to approximate the time-dependent house price distribution at a fine regional scale using Gaussian mixtures. The means, variances and weights of the mixture components are related to time, location and dwelling type through a non linear function trained by a deep functional approximator. Price indices are derived as means, medians, quantiles or other functions of the estimated distributions. Price densities for larger regions, such as a city, are calculated via a weighted sum of the component density functions. The method is applied to a data set covering all of Australia at a fine spatial and temporal resolution. In addition to enabling a detailed exploration of the data, the proposed index yields lower prediction errors in the practical task of individual dwelling price projection from previous sales values within the three major Australian cities. The estimated quantiles are also found to be well calibrated empirically, capturing the complexity of house price distributions.Comment: 36 pages and 10 figure

The role of ocean gateways in the dynamics and sensitivity to wind stress of the early Antarctic Circumpolar Current

The date of inception of the Antarctic Circumpolar Current is debated due to uncertainty in the relative opening times of Drake Passage and the Tasman Seaway. Using an idealized eddy-resolving numerical ocean model, we investigate whether both ocean gateways have to be open to allow for a substantial circumpolar current. We find that overlapping continental barriers do not impede a circumpolar transport in excess of 50Sv, as long as a circumpolar path can be traced around the barriers. However, the presence of overlapping barriers does lead to an increased sensitivity of the current's volume transport to changes in wind stress. This change in sensitivity is interpreted in terms of the role of pressure drops across continental barriers and submerged bathymetry in balancing the momentum input by the surface wind stress. Specifically, when the pressure drop across continents is the main balancing sink of momentum, the zonal volume transport is sensitive to changes in wind stress. Changes in zonal volume transport take place via altering the depth-independent part of the circumpolar transport rather than that arising from thermal wind shear. In such a scenario, isopycnals continue to slope steeply across the model Southern Ocean, implying a strong connection between the deep and surface oceans. This may have consequences for the meridional overturning circulation and its sensitivity to wind stress

Changes in ocean vertical heat transport with global warming

Heat transport between the surface and deep ocean strongly influences transient climate change. Mechanisms setting this transport are investigated using coupled climate models and by projecting ocean circulation into the temperature-depth diagram. In this diagram, a “cold cell” cools the deep ocean through the downwelling of Antarctic waters and upwelling of warmer waters and is balanced by warming due to a “warm cell,” coincident with the interhemispheric overturning and previously linked to wind and haline forcing. With anthropogenic warming, the cold cell collapses while the warm cell continues to warm the deep ocean. Simulations with increasingly strong warm cells, set by their mean Southern Hemisphere winds, exhibit increasing deep-ocean warming in response to the same anthropogenic forcing. It is argued that the partition between components of the circulation which cool and warm the deep ocean in the preindustrial climate is a key determinant of ocean vertical heat transport with global warming

Talker variability in word recognition under cochlear implant simulation:Does talker gender matter?

Normal-hearing listeners are less accurate and slower to recognize words with trial-to-trial talker changes compared to a repeating talker. Cochlear implant (CI) users demonstrate poor discrimination of same-gender talkers and, to a lesser extent, different-gender talkers, which could affect word recognition. The effects of talker voice differences on word recognition were investigated using acoustic noise-vocoder simulations of CI hearing. Word recognition accuracy was lower for multiple female and male talkers, compared to multiple female talkers or a single talker. Results suggest that talker variability has a detrimental effect on word recognition accuracy under CI simulation, but only with different-gender talkers