The isolated symptom of unilateral tonsillar enlargement has limited value in adults with a suspected head and neck cancer pathway

OBJECTIVE

Given the uncertainty regarding the predictive value of unilateral tonsillar enlargement and/or lesion in malignancies, this study aimed to evaluate the efficacy of unilateral tonsillar enlargement and/or lesion referral criterion in the adult suspected head and neck cancer pathway.

METHODS

All two-week wait referrals received in 2018-2019 were reviewed. All patients referred with unilateral tonsillar enlargement and/or lesion were included and analysed for patient demographic data, presenting symptoms, initial clinic outcomes and final diagnoses.

RESULTS

A total of 4934 urgent head and neck cancer referrals were analysed, and 1.9 per cent of these had unilateral tonsillar enlargement and/or lesion. Only 10 patients were diagnosed with tonsil cancer. All the positive tonsil cancer cases had at least one additional head and neck red flag symptom.

CONCLUSION

The referral criterion for unilateral tonsillar enlargement and/or lesion may be of limited benefit in an already economically challenged National Health Service. Further multicentre studies should be undertaken to refine conclusions on the value of unilateral tonsillar enlargement and/or lesion alone as a criterion for the head and neck cancer two-week wait pathway.

'Primum non nocere': how harmless is routine wide local excision for AJCC stage IA melanoma?

BACKGROUND

Management of primary cutaneous malignant melanoma is with initial excision biopsy followed by a wide local excision to achieve locoregional control. For low-risk thin melanomas, the added survival benefit from the wide local excision is minimal. In this study, we investigated the morbidities of wide local excision and evaluated the current clinical practice in managing stage IA malignant melanoma.

METHODS

Patients with confirmed stage IA malignant melanoma who had undergone a wide local excision in the 2013/14 period were identified using a specialist cancer multidisciplinary team-held database. Primary pathology, surgical data and follow-up documentation were analysed.

RESULTS

A total of 231 cases were identified; 95% of patients (n = 220) had malignant melanoma excised completely at first excision biopsy, mean margin 2.8mm (range 0.5-8.0mm). Postoperative morbidities occurred in 25% of patients (n = 57), including 6.6% wound problems, 10.9% scarring problems, 10.0% psychological stress and 0.4% cosmetic concern. Wide local excision reconstructions were performed with primary closure in 82% of patients, split skin grafts in 4%, full-thickness skin grafts in 3% and flaps in 10%. Of the total, 44% of patients (n = 101) had further excisions and 17 received new low-risk melanoma diagnoses.

CONCLUSIONS

We demonstrated that 1cm wide local excision is associated with significant morbidity, which can affect patients' physical, psychological and social wellbeing. Since wide local excision does not give a survival advantage, and its margin is already frequently reduced in cosmetically sensitive areas, the need for a second full 1cm wide local excision procedure for thin melanoma should be re-evaluated, especially when 95% of our study cohort had their malignant melanoma completely excised by the initial biopsy alone.

Simultaneous Adsorption of Malachite Green and Methylene Blue Dyes in a Fixed-Bed Column Using Poly(Acrylonitrile-Co-Acrylic Acid) Modified with Thiourea

Proper remediation of aquatic environments contaminated by toxic organic dyes has become a research focus globally for environmental and chemical engineers. This study evaluates the adsorption potential of a polymer-based adsorbent, thiourea-modified poly(acrylonitrile-co-acrylic acid) (T-PAA) adsorbent, for the simultaneous uptake of malachite green (MG) and methylene blue (MB) dye ions from binary system in a continuous flow adsorption column. The influence of inlet dye concentrations, pH, flow rate, and adsorbent bed depth on adsorption process were investigated, and the breakthrough curves obtained experimentally. Results revealed that the sorption capacity of the T-PAA for MG and MB increase at high pH, concentration and bed-depth. Thomas, Bohart-Adams, and Yoon-Nelson models constants were calculated to describe MG and MB adsorption. It was found that the three dynamic models perfectly simulate the adsorption rate and behavior of cationic dyes entrapment. Finally, T-PAA adsorbent demonstrated good cyclic stability. It can be regenerated seven times (or cycles) with no significant loss in adsorption potential. Overall, the excellent sorption capacity and multiple usage make T-PAA polymer an attractive adsorbent materials for treatment of multicomponent dye bearing effluent in a fixed-bed column system.

Adsorptive Removal of Methylene Blue from Aquatic Environments Using Thiourea-Modified Poly(Acrylonitrile-co-Acrylic Acid)

The paper evaluates the adsorptive potential of thiourea-modified poly(acrylonitrile-co-acrylic acid), (TA-poly(AN-co-AA)) for the uptake of cationic methylene blue (MB) from aquatic environments via a batch system. TA-poly(AN-co-AA) polymer was synthesized through redox polymerization and modified with thiourea (TA) where thioamide groups were introduced to the surface. Fourier transform infrared (FT-IR) spectroscopy, scanning electron microscopy (SEM), CHNS and Zetasizer were used to characterize the physico-chemical and morphological properties of prepared TA-poly(AN-co-AA). Afterwards, it was confirmed that incorporation of thioamide groups was successful. The adsorption kinetics and equilibrium adsorption data were best described, respectively, by a pseudo-second-order model and Freundlich model. Thermodynamic analysis showed the exothermic and spontaneous nature of MB uptake by TA-poly(AN-co-AA). The developed TA-poly(AN-co-AA) polymer demonstrated efficient separation of MB dye from the aqueous solution and maintained maximum adsorption capacity after five regeneration cycles. The findings of this study suggested that synthesized TA-poly(AN-co-AA) can be applied successfully to remove cationic dyes from aquatic environments.

Neutropenia and Agranulocytosis in Chinese Patients Prescribed Clozapine

OBJECTIVES

To examine the rate of neutropenia and agranulocytosis, and the pattern of development of these 2 disorders among Chinese patients prescribed clozapine treatment in a local psychiatric unit.

METHODS

Patients who were receiving clozapine when they were under the care of Pamela Youde Nethersole Eastern Hospital Psychiatric Unit, Hong Kong, from 1 January 1997 to 31 December 2012 and who developed neutropenia and agranulocytosis from 1 January 1997 to 30 June 2013 were retrospectively reviewed.

RESULTS

A total of 13 patients out of 980 clozapine recipients developed neutropenia and 3 developed agranulocytosis during treatment. Half of them were aged > 50 years and three quarters were female. The majority of patients who developed neutropenia and agranulocytosis were prescribed > 1 psychotropic medication in addition to clozapine. Half of the incidents occurred in the first 18 weeks of clozapine treatment.

CONCLUSION

Long-term monitoring of white cell count is necessary during clozapine treatment. The concurrent use of clozapine with other potentially leukopenic psychotropic drugs should be limited.

Psychiatric morbidity in Chinese women after cervical cancer treatment in a regional gynaecology clinic

OBJECTIVES

To identify the prevalence and factors associated with psychiatric disorders in Chinese cervical cancer survivors.

METHODS

A cross-sectional study was conducted from May 2011 to April 2012 at the specialist gynaecology outpatient clinic at Pamela Youde Nethersole Eastern Hospital, Hong Kong. All cervical cancer patients who had completed treatment were consecutively recruited. They were interviewed using the Chinese-Bilingual Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Research version. Socio-demographic data and clinical information were collected from the patients and their hospital records were reviewed.

RESULTS

A total of 113 patients were recruited into the study. The point prevalence of psychiatric disorders as a group in cervical cancer survivors was 37%. The point prevalence of depressive disorders, anxiety disorders, and schizophrenia were 31%, 16%, and 2%, respectively. Major depressive disorder was the most common mood disorder and generalised anxiety disorder the most common anxiety disorder. Younger age, a history of psychiatric illness, fatigue, menopausal symptoms, and pain were independent predictors of current psychiatric disorders.

CONCLUSION

Psychiatric disorders, predominantly depressive and anxiety disorders, are common in Chinese cervical cancer survivors. Identification of independent predictors can help gynaecologists detect these disorders earlier and arrange appropriate interventions.

Use of spent mushroom compost to bioremediate PAH-contaminated samples

Spent mushroom compost (SMC) is a bulky waste byproduct of mushroom industry and produced abundantly. The SMC of Pleurotus pulmonarius immobilized laccase (0.88 mmoles min(-1) g(-1)) and manganese peroxidase (0.58 mmoles min(-1) g(-1)) of which the optimal temperatures were 45 and 75 degrees C, respectively. In laboratory test, complete degradative removal of individual naphthalene, phenanthrene, benzo[a]pyrene and benzo[g,h,i]perylene (200 mg PAH kg(-1) sandy-loam soil) by 5% SMC was obtained in two days under continuous shaking at 80 degrees C. The SMC-treated PAH samples had significantly reduced or removed their toxicities as revealed by the Microtox bioassay. These results were confirmed by gas chromatography-mass spectrometry analysis on the breakdown products. A phthalic derivative which is reported as a degradative product of PAHs by ozonation or ligninolysis was also detected in the SMC-treated samples. The results demonstrate the potential in employing SMC in ex situ bioremediation.

Projections of purkinje cells in the translation and rotation zones of the vestibulocerebellum in pigeon (Columba livia)

Previous electrophysiological studies have shown that the pigeon vestibulocerebellum (ventral uvula, nodulus, and flocculus) can be divided into two parasagittal zones based on responses to optic flow stimuli. The medial zone (ventral uvula and nodulus) responds best to optic flow resulting from self-translation, whereas the lateral zone (flocculus) responds best to optic flow resulting from self-rotation. In this study we investigated the projections of the Purkinje cells in the translation and rotation zones of the vestibulocerebellum by using the anterograde tracer biotinylated dextran amine. Extracellular recording of Purkinje cell activity (complex spikes) in response to large-field visual stimuli were used to identify the injection sites. Injections into the translation zone resulted in extremely heavy terminal labeling in the cerebellovestibular process adjacent to the medial cerebellar nucleus. A moderate amount of terminal labeling was found in the medial cerebellar nucleus, the superior vestibular nucleus (laterally, dorsally, and medially), and the descending vestibular nucleus, particularly in the lateral half. Light terminal labeling was observed in the dorsolateral vestibular nucleus, the medial vestibular nucleus, the tangential nucleus, and the lateral vestibular nucleus pars ventralis. Injections into the rotation zone resulted in heavy terminal labeling in the superior vestibular nucleus (particularly dorsally and medially), the descending vestibular nucleus (particularly medially), and the medial vestibular nucleus. A moderate amount of terminal labeling was seen in the cerebellovestibular process adjacent to the lateral cerebellar nucleus, and the dorsolateral vestibular nucleus. A small amount of terminal labeling was found in the lateral cerebellar nucleus, the tangential nucleus, the prepositus hypoglossi, and the lateral vestibular nucleus pars ventralis.

Topographical organization of inferior olive cells projecting to translation and rotation zones in the vestibulocerebellum of pigeons

Previous electrophysiological studies in pigeons have shown that the vestibulocerebellum can be divided into two parasagittal zones based on responses to optic flow stimuli. The medial zone responds best to optic flow resulting from self-translation, whereas the lateral zone responds best to optic flow resulting from self-rotation. This information arrives from the retina via a projection from the accessory optic system to the medial column of the inferior olive. In this study we investigated inferior olive projections to translational and rotational zones of the vestibulocerebellum using the retrograde tracer cholera toxin subunit B. Extracellular recordings of Purkinje cell activity (complex spikes) in response to large-field visual stimuli were used to identify the injection sites. We found a distinct segregation of inferior olive cells projecting to translational and rotational zones of the vestibulocerebellum. Translation zone injections resulted in retrogradely labeled cells in the ventrolateral area of the medial column, whereas rotation zone injections resulted in retrogradely labeled cells in the dorsomedial region of the medial column. Motion of any object through space, including self-motion of organisms, can be described with reference to translation and rotation in three-dimensional space. Our results show that, in pigeons, the brainstem visual systems responsible for detecting optic flow are segregated into channels responsible for the analysis of translational and rotational optic flow in the inferior olive, which is only two synapses from the retina.

Projections from the accessory optic system and pretectum to the dorsolateral thalamus in the pigeon (Columbia livia): a study using both anteretrograde and retrograde tracers

In birds, optic flow is analyzed by two retinal-recipient nuclei: the nucleus of the basal optic root (nBOR) of the accessory optic system (AOS), and the pretectal nucleus, lentiformis mesencephali (LM). Previous anatomical studies have shown that both of these nuclei have descending projections to structures involved in oculomotor, head movement, and postural control. In this report, using biotinylated dextran amine (BDA) and cholera toxin subunit B (CTB) for anterograde and retrograde labelling, respectively, we investigated projections from the nBOR and LM to the dorsal thalamus. After injections of BDA into the nBOR and LM, terminals were consistently found in the nucleus dorsolateralis anterior pars lateralis and pars medialis, and the nucleus dorsalis intermedius ventralis anterior of the thalamus. Some terminals were also found in the nucleus dorsolateralis anterior, nucleus dorsomedialis anterior pars magnocellularis, nucleus dorsolateralis posterior, nucleus superficialis parvocellularis, and the ventrointermediate area. Injections of CTB into the dorsal thalamus resulted in retrogradely labelled cells in the pretectal region, including LM. Numerous cells were also seen in the nBOR pars lateralis and pars dorsalis, but fewer were seen in the nBOR proper. We suggest that the AOS is providing input to a thalamotelencephalic system that may be involved in several functions including: (1) multi-sensory analysis of self-motion, (2) perception of self-motion, (3) perception of the three-dimensional layout of the environment, (4) distinguishing object-motion from self-motion, and (5) spatial cognition.

Projections of the nucleus of the basal optic root in pigeons (Columba livia) revealed with biotinylated dextran amine

The nucleus of the basal optic root (nBOR) of the accessory optic system is known to be involved in the analysis of the visual consequences of self-motion. Previous studies have shown that the nBOR in pigeons projects bilaterally to the vestibulocerebellum, the inferior olive, the interstitial nucleus of Cajal, and the oculomotor complex and projects unilaterally to the ipsilateral pretectal nucleus lentiformis mesencephali and the contralateral nBOR. By using the anterograde tracer biotinylated dextran amine, we confirmed these projections and found (previously unreported) projections to the nucleus Darkshewitsch, the nucleus ruber, the mesencephalic reticular formation, and the area ventralis of Tsai as well as ipsilateral projections to the central gray, the pontine nuclei, the cerebellar nuclei, the vestibular nuclei, the processus cerebellovestibularis, and the dorsolateral thalamus. In addition to previous studies, which showed a projection to the dorsomedial subdivision of the contralateral oculomotor complex, we found terminal labelling in the ventral and dorsolateral subdivisions. Individual fibers were reconstructed from serial sections, and collaterals to various nuclei were demonstrated. For example, collaterals of fibers projecting to the vestibulocerebellum terminated in the vestibular or cerebellar nuclei; collaterals of fibers to the inferior olive terminated in the pontine nuclei; many individual neurons projected to the interstitial nucleus of Cajal, the nucleus Darkshewitsch, and the central gray and also projected to the nucleus ruber and the mesencephalic reticular formation; collaterals of fibers to the contralateral nucleus of the basal optic root terminated in the mesencephalic reticular formation and/or the area ventralis of Tsai; neurons projecting to the nucleus lentiformis mesencephali also terminated in the dorsolateral thalamus. The consequences of these data for understanding the visual control of eye movements, neck movements, posture, locomotion, and visual perception are discussed.