[Changes in Incidence and Mortality Trends of Head and Neck Cancer in Rhineland-Palatinate, 2000-2009]

BACKGROUND

Epidemiological data on HNC are often reported aggregated despite their anatomical and histological heterogeneity. In Germany, few studies have analyzed incidence and mortality trends separately for specific anatomic sites. Furthermore, little is known about whether the incidence of HPV-associated tumour entities of the head and neck region has increased.

METHODS

Based on cancer registry data from Rhineland-Palatinate from 2000 to 2009, age-standardized incidence and mortality rates were calculated for all HNC sites and localisation groups that might be HPV-associated according to the literature. Trends were analyzed by Joinpoint regression and reported as the annual percentage change (APC).

RESULTS

Throughout the study period, 8 055 incident cases and 3 177 deaths were identified. The incidence rates of overall HNC increased among women (APC:+2.2%) and declined slightly among men (- 0.9%). Significantly increasing incidence rates among women were seen for tumours of the oral cavity (+2.7%) and the oropharynx (+3.6%). Among men, a significant decrease in incidence rates for tumours of the hypopharynx (-3.4%) and the larynx (-2.7%) are noteworthy. Cancers at HPV-associated sites showed increased incidence rates in men (+3.3%) and women (+4.3%). A decrease in mortality was found for tumours of the larynx in both sexes (-5.8% men,-9.1% women).

CONCLUSIONS

A detailed analysis by localisation of HNC showed significant and often opposing trends for men and women regarding incidence and mortality.

[An update on bone anchored hearing aids]

Hearing loss represents a hidden handicapwith various repercussions on development and social life. In the majority of cases, classical hearing aids address most hearing losses. However, the enhancement required for severe deafness frequently involves sound distortions which are very uncomfortable for patients. With the advent of bone anchored hearing aids, conductive hearing losses as well as mixed hearing losses are now better rehabilitated. Recently their indications have been expanded to profound to severe sensorineural hearing loss. The emergence of new materials as well as subcutaneous implants has lead to lessen skin complications and has diminished the aesthetic discomfort of this type of hearing devices.

Measurement of ratios of νμ charged-current cross sections on C, Fe, and Pb to CH at neutrino energies 2-20 GeV

We present measurements of ν(μ) charged-current cross section ratios on carbon, iron, and lead relative to a scintillator (CH) using the fine-grained MINERvA detector exposed to the NuMI neutrino beam at Fermilab. The measurements utilize events of energies 2<E(ν)<20 GeV, with ⟨E(ν)⟩ = 8 GeV, which have a reconstructed μ(-) scattering angle less than 17° to extract ratios of inclusive total cross sections as a function of neutrino energy E(ν) and flux-integrated differential cross sections with respect to the Bjorken scaling variable x. These results provide the first high-statistics direct measurements of nuclear effects in neutrino scattering using different targets in the same neutrino beam. Measured cross section ratios exhibit a relative depletion at low x and enhancement at large x. Both become more pronounced as the nucleon number of the target nucleus increases. The data are not reproduced by GENIE, a conventional neutrino-nucleus scattering simulation, or by the alternative models for the nuclear dependence of inelastic scattering that are considered.

Prevention of unhealthy weight in children by promoting physical activity using a socio-ecological approach: what can we learn from intervention studies?

AIM

Our objectives was to identify the characteristics of interventions likely to successfully prevent overweight in youngsters by promoting physical activity (PA), with special focus on dimensions of the socio-ecological model of behaviour and health, and unresolved issues.

METHODS

This was a systematic review of population-based interventions either promoting PA or limiting sedentary behaviour in children with measure of weight status as an endpoint. The efficacy of studies was evaluated according to the levels of PA determinants in the socio-ecological model (individual, interpersonal, institutional environment, community) targeted by the interventions.

RESULTS

A total of 54 studies met our inclusion criteria, most of them published within the last 5 years and targeting children aged 6-12 years. Twenty-three interventions targeted individual and/or interpersonal PA determinants only; 26 targeted determinants at three or four levels with at least one environment component at the institutional level; and five were multilevel community-based interventions. Our review indicated that programmes targeting PA determinants at the different levels of the socio-ecological model, including the social and organizational/built environments, had the greatest potential for preventing obesity in youngsters. Targeting various facets of PA, including everyday PA, might represent another key element for program efficacy on weight status.

CONCLUSION

Data regarding the efficacy of comprehensive PA interventions that simultaneously address individual attitudes and skills, the social context, and the environment, to prevent overweight in children are encouraging. Further studies are needed to evaluate the maintenance of the effects and whether such strategies apply to young children and older adolescents, and to different cultural contexts.

A UK national audit of hereditary and acquired angioedema

Hereditary angioedema (HAE) and acquired angioedema (AAE) are rare life-threatening conditions caused by deficiency of C1 inhibitor (C1INH). Both are characterized by recurrent unpredictable episodes of mucosal swelling involving three main areas: the skin, gastrointestinal tract and larynx. Swelling in the gastrointestinal tract results in abdominal pain and vomiting, while swelling in the larynx may be fatal. There are limited UK data on these patients to help improve practice and understand more clearly the burden of disease. An audit tool was designed, informed by the published UK consensus document and clinical practice, and sent to clinicians involved in the care of HAE patients through a number of national organizations. Data sets on 376 patients were received from 14 centres in England, Scotland and Wales. There were 55 deaths from HAE in 33 families, emphasizing the potentially lethal nature of this disease. These data also show that there is a significant diagnostic delay of on average 10 years for type I HAE, 18 years for type II HAE and 5 years for AAE. For HAE the average annual frequency of swellings per patient affecting the periphery was eight, abdomen 5 and airway 0·5, with wide individual variation. The impact on quality of life was rated as moderate or severe by 37% of adult patients. The audit has helped to define the burden of disease in the UK and has aided planning new treatments for UK patients.

Kidneys at higher risk of discard: expanding the role of dual kidney transplantation

Half of the recovered expanded criteria donor (ECD) kidneys are discarded in the United States. A new kidney allocation system offers kidneys at higher risk of discard, Kidney Donor Profile Index (KDPI)>85%, to a wider geographic area to promote broader sharing and expedite utilization. Dual kidney transplantation (DKT) based on the KDPI is a potential option to streamline allocation of kidneys which otherwise would have been discarded. To assess the clinical utility of the KDPI in kidneys at higher risk of discard, we analyzed the OPTN/UNOS Registry that included the deceased donor kidneys recovered between 2002 and 2012. The primary outcomes were allograft survival, patient survival and discard rate based on different KDPI categories (<80%, 80-90% and >90%). Kidneys with KDPI>90% were associated with increased odds of discard (OR=1.99, 95% CI 1.74-2.29) compared to ones with KDPI<80%. DKTs of KDPI>90% were associated with lower overall allograft failure (HR=0.74, 95% CI 0.62-0.89) and better patient survival (HR=0.79, 95% CI 0.64-0.98) compared to single ECD kidneys with KDPI>90%. Kidneys at higher risk of discard may be offered in the up-front allocation system as a DKT. Further modeling and simulation studies are required to determine a reasonable KDPI cutoff percentile.

Effective shielding to measure beam current from an ion source

To avoid saturation, beam current transformers must be shielded from solenoid, quad, and RFQ high stray fields. Good understanding of field distribution, shielding materials, and techniques is required. Space availability imposes compact shields along the beam pipe. This paper describes compact effective concatenated magnetic shields for IFMIF-EVEDA LIPAc LEBT and MEBT and for FAIR Proton Linac injector. They protect the ACCT Current Transformers beyond 37 mT radial external fields. Measurements made at Saclay on the SILHI source are presented.

Predictive factors of type 2 diabetes remission 1 year after bariatric surgery: impact of surgical techniques

Type 2 diabetes (T2D) remission after bariatric procedures has been highlighted in many retrospective and some recent prospective studies. However, in the most recent prospective study, more than 50 % of patients did not reach T2D remission at 1 year. Our aim was to identify baseline positive predictors for T2D remission at 1 year after bariatric surgery and to build a preoperative predictive score. We analysed the data concerning 161 obese operated on between June 2007 and December 2010. Among them, 46 were diabetic and were included in the study-11 laparoscopic adjustable gastric banding (LAGB), 26 Roux-en-Y gastric bypass (RYGB) and 9 sleeve gastrectomy (SG). We compared anthropometric and metabolic features during 1 year of follow-up. A receiver operating characteristic analysis was performed to predict T2D remission. RYGB and SG were similarly efficient for body weight loss and more efficient than LAGB; 62.8 % of patients presented with T2DM remission at 1 year, with no significant difference according to the surgical procedure. A 1-year body mass index (BMI) <35 kg m(-2) was predictive of T2DM remission whatever the procedure. The preoperative predictive factors of diabetes remission were baseline BMI ≤50 kg m(-2), duration of type 2 diabetes ≤4 years, glycated haemoglobin ≤7.1 %, fasting glucose <1.14 g/l and absence of insulin therapy. A short duration of diabetes and good preoperative glycaemic control increase the rate of T2DM remission 1 year after surgery. Preoperative metabolic data could be of greater importance than the choice of bariatric procedure.

Abnormal semantic processing in females with fragile X-associated tremor/ataxia syndrome

Fragile X-associated tremor/ataxia syndrome (FXTAS), a neurodegenerative disorder, affects fragile X (FMR1) gene premutation carriers in late life. Studies have shown cognitive impairments in FXTAS including executive dysfunction, working memory and visuospatial deficits. However, less is known about cognition in females with FXTAS. Thus, we examined semantic processing and verbal memory in female FXTAS patients with event-related potentials (ERPs) and neuropsychological testing. Sixty-one females (34 FXTAS, Mage  = 62.7; 27 controls, Mage  = 60.4) were studied with 32-channel ERPs during a category judgment task in which semantically congruous (50%) and incongruous items were repeated approximately 10-140 seconds later. N400 and P600 amplitude data were submitted to analysis of covariance. Neuropsychological testing demonstrated lower performance in verbal learning and executive function in females with FXTAS. Event-related potential analyses showed a significant reduction of the N400 congruity effect (incongruous - congruous) in the FXTAS group. The N400 congruity effect reduction in females with FXTAS was mainly due to increased N400 amplitude to congruous new words. No significant abnormalities of the N400 repetition effect or the P600 repetition effect were found, indicating preserved implicit memory and verbal memory, respectively, in females with FXTAS. The decreased N400 congruity effect suggests abnormal semantic expectancy and/or semantic network disorganization in female FXTAS patients. The enhanced N400 amplitude to congruous new words may reflect decreased cognitive flexibility among FXTAS women, making access to less typical category exemplar words more difficult.

[Reconstruction of maxillary defects using a free scapular angle flap]

BACKGROUND

In addition to prosthetic rehabilitation, maxillary defects can also be surgically reconstructed. Soft-tissue reconstruction employs a radial forearm or latissimus dorsi muscle flap, while bony reconstruction can be achieved using a fibula, iliac crest, or scapular flap. Reconstruction using a scapular flap is further divided into two subgroups: the traditional scapular flap with the circumflex scapular artery as the donor vessel and the scapular angle flap with the angular artery originating from the thoracodorsal artery as the donor vessel.

MATERIALS AND METHODS

We report on four patients who underwent successful reconstruction with a free scapular angle flap between 2009 and 2011, following maxillary resection due to malignancy.

RESULTS

Vertical positioning of the scapular angle flap enables reconstruction of the facial contour, whereas its horizontal alignment and microvascular anastomosis makes a bony reconstruction of the hard palate possible.

CONCLUSIONS

The versatility, low rate of donor site morbidity and shape of the scapular angle flap--which resembles that of the hard palate--render it ideal for plastic reconstruction. The suitability of bone quality for dental rehabilitation with implants is a topic of controversial discussion. The scapular angle flap represents an alternative to obturator prosthesis for the reconstruction of maxillary defects ≥ grade I according to Okay et al.