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No Means No
Every 2 1/2 minutes, a person is raped in this country. Join the Pace Community in raising awareness and fighting back against sexual assault at Sexual Assault Awareness Week, a series of events including Take Back the Night, self-defense workshops, and more.
The staggering facts:
20–25% of college women will be victims of attempted or completed rape during their college careers
90% of campus rapes involve alcohol use by the assailant or the victim
One in 12 of college males admit to having committed acts that met the legal definition of rape
95% of attacks are unreported, making sexual assault the "silent epidemic"
10% of sexual assaults and rapes happen to men
Pace students, faculty, and staff will engage in anti-violence activism during Sexual Assault Awareness Week, April 21–25, on the NYC Campus. Sexual Assault Awareness Week, planned in April in conjunction with national Sexual Assault Awareness Month, raises awareness about sexual assault and offers preventive measures and resources.
Information tables will be set up each day in the front lobby of One Pace Plaza to distribute facts, as well as giveaways. You can also stop by the Café to participate in the Clothesline Project, which addresses the issue of violence against women by providing a vehicle for the women to express their emotions by decorating a shirt.
Other events include:
Bystander and Intimate Partner Violence
Monday, April 21
2:30 p.m.–4:00 p.m.
W612, One Pace Plaza
If you see something, should you say something? Fifty years ago, for more than half an hour, 38 people witnessed a killer stalk and stab a woman in three separate attacks in Queens. Not one person called the police during the assault and just one witness called the police after the woman had died. Pace hosts a prevention workshop on bystanders and establishing a community of responsibility.
NYPD Sexual Assault Session
Tuesday, April 22
3:30 p.m.–4:30 p.m.
E328, One Pace Plaza
What does SVU actually do? NYPD's expert from its Special Victims Unit (SVU) will speak about sexual assault to Pace students.
NYPD Sexual Assault Session (PLV)
Wednesday, April 23
12:10 p.m.–1:15 p.m.
Miller Lecture Hall
Join us to hear a representative from the NYPD's Special Victim's Unit discuss what college students can do to stop sexual assault.
Take Back the Night March
Wednesday, April 23
12:00 p.m.
Front of One Pace Plaza
The event will begin with a flash mob and then Pace students, faculty, and staff will take to the streets to raise awareness of sexual assault at Take Back the Night (TBTN), a national vigil dedicated to survivors of "crimes of silence." Stand in solidarity for all those who have experienced attacks of sexual violence and march through the community holding posters and candles, wearing t-shirts, and chanting to shatter the silence and stop the violence.
Self-Defense with Brian Evans
Wednesday, April 23 at 6:00 p.m. in Fulton Hall 2nd Floor
Friday, April 25 at 2:00 p.m. in 41 Park Row, 9th Floor Lounge
Pace Professor and Faculty-in-Residence Brian Evans, EdD, will host a free self-defense workshop for the community, where you'll learn some basic techniques.
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For graduating student Lauren Landi '16, Pace's NYC location and connections with faculty and Career Services gave her access to her six internships including TODAY, Dateline, and 20/20, and ultimately a post-graduation job with the New York Jets.
Senior Testimonial: Lauren Landi
In just a couple of weeks we'll say goodbye to the Class of 2016. But before they walk the walk, we've got a few more details about dates, award ceremonies, speakers, and more to share.
Commence Commencement
From hiking mountains and snowshoeing through trails in her home state of New Hampshire to figuring out how to swipe her MetroCard just right and navigate the MTA system in New York City, graduating student Irene Schultz '16 shares some fun stops along her journey.
Senior Testimonial: Irene Schultz


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Helping Hand For Relief & Development Inc
Rating: 4.5 stars 2 2 reviews
12541 McDougall St Ste 100 Detroit MI 48212 USA
Reconstruction and Rehabilitation of the disaster affected areas, mainly by providing Emergency Relief, Food, Shelter, Vocational and Skills Development, Education, Water for Life, Orphans and Widow Support Programs
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3 people found this review helpful
I have donated and volunteered for this organization many times. They seem to be really straight forward when you ask them questions. They can provide proof of all their work and I like that about an organization when you ask them. It is hard for people to find trustworthy people to donate to but I can trust their work. I really like their Orphan Sponsorship program in which they tell you the kid that you helped and their progress (almost like a report card). I haven't been oversees to see their actual work like Haiti or Pakistan but have heard some young guys who have went and seen and did the work and describe it. I wish to go and do some of the work first hand as well.
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subset: commoncrawl


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2016-17 Registration and Information
Registration for the 2016-17 school year in Manhattan District 114 is now open in Homelogic. If you are new to the district, please click on the NEW FAMILY REGISTRATION link to the right, under Online Registration. Registration Fees for 2016-17 are the same as 2015-16. A link to the approved calendar for 2016-17 can be found at the bottom of this page. The First Day of Student Attendance is August 24, 2016.
Lincoln-Way West Welcomes Manhattan Students In Spectacular Fashion
Click on the link (heading) above to see how the Lincoln-Way West students have welcomed Manhattan students to Lincoln-Way West HS, beginning this August. A special thank you to Principal Monica Schmitt, Mr. Ben Gearman, and the entire staff and student body of L-W West.
Camp Invention was held at Wilson Creek for students entering grades 1-6 from June 13-17th. Click here to check out pictures from this year's camp!
The Staff, Administration, and Board of Education of Manhattan District 114 are committed to promoting excellence in student achievement and student behavior, enabling children to become successful life-long learners.
- We believe that the chief purpose of the school is the all-around development of each child as an individual and as a citizen.
- We believe that it is our duty as teachers to train pupils, that they may learn to live together peaceably, cooperatively, and efficiently as intelligent individuals in an increasingly changing world.
- We believe in a democratically operated school system at all levels. Pupils will learn the democratic way only as they have a chance to share it.
- We believe that the school should help develop in its pupils a strong sense of sound American patriotism together with a full understanding of the liberties and responsibilities which come under citizenship.
- We believe that community understanding, interest, and cooperation are necessary for the continuing success of any desirable school program.
- We believe that good classroom order and a healthy, cooperative working atmosphere are essential to the effective conduct of any class.
Notification of Rights under FERPA for Elementary and Secondary School
2015 School Report Card for Manhattan 114
Superintendent Letter to Parents about PARCC
PARCC Score Report Information for Parents
Lincoln Way 2015 PARCC Comparisons and State Averages
2012 2013
Welcome to the Manhattan School District
New Family Registration
New families that will be registering in the Manhattan Schools can click on the New Family Registration button above and fill out all of the forms online. Instructions to take you through the registration process can be found on our website. After you have completed all of the forms, please come to the District Office at Wilson Creek School to prove residency and show an original birth certificate.
Please bring with you:
- Proof of residency form, printed and filled out
- 1 supporting document from Category I
- 2 supporting documents from Category II
- Student's original birth certificate from the county where your child was born
- Copy of student's current physical
We will make copies of all original documents and return them to you.
It usually takes 2 school days after you prove residency and register for your student to start school.
Information regarding health requirements, registration fees, and school supplies can also be found on our website.
Manhattan named to TOP 25 SUBURBS (click link to go to article)
Manhattan, IL is a great place to live and raise your family. According to niche.com, Manhattan is #25 on the list of Top 100 suburbs to live in Illinois. Manhattan School District 114 is very proud to be a part of the reason why Manhattan is recognized as a great place to live, raise, your family, and educate your children.


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I'm looking for reasonably user-friendly, free virtualisation software that I can run on Windows 7. I want to install a Linux distro (though I don't know which one yet).
Can anyone recommend the virtualisation software and/or a Linux distro that would be good for virtualisation?
I'll be running this on an 64-bit Intel i7 quad-core with 6GB RAM, so I think I'll have the horse power for most things.


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Cancer Health Center
Cannabis and Cannabinoids (PDQ®): Complementary and alternative medicine - Patient Information [NCI] - Overview
- Cannabis, also known as marijuana, is a plant grown in many parts of the world which produces a resin containing compounds called cannabinoids. Some cannabinoids are psychoactive (acting on the brain and changing mood or consciousness) (see Question 1).
- The use of Cannabis for medicinal purposes dates back to ancient times (see Question 3).
- By federal law, the use, sale, and possession of Cannabis is illegal in the United States. However, a growing number of states and the District of Columbia have enacted laws to legalize medical marijuana (see Question 1).
- In the United States, Cannabis is a controlled substance requiring special licensing for its use (see Question 1 and Question 3).
- Cannabinoids are active chemicals in Cannabis that cause drug -like effects throughout the body, including the central nervous system and the immune system (see Question 2).
- Cannabinoids can be taken by mouth, inhaled, or sprayed under the tongue (see Question 5).
- Cannabis and cannabinoids have been studied in the laboratory and the clinic for relief of pain, nausea and vomiting, anxiety, and loss of appetite (see Question 6 and Question 7).
- Cannabis and cannabinoids may have benefits in treating the symptoms of cancer or the side effects of cancer therapies (see Question 7).
- Two cannabinoids (dronabinol and nabilone) are drugs approved by the U.S. Food and Drug Administration (FDA) for the prevention or treatment of chemotherapy -related nausea and vomiting (see Question 7 and Question 10).
- Cannabis has been shown to kill cancer cells in the laboratory and to affect the immune system. However, there is no evidence that Cannabis' effects on the immune system help the body fight cancer (see Question 6).
- At this time, there is not enough evidence to recommend that patients inhale or ingest Cannabis as a treatment for cancer-related symptoms or side effects of cancer therapy (see Question 7).
- Cannabis is not approved by the FDA for use as a cancer treatment (see Question 9).
In this article
This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http:// cancer .gov or call 1-800-4-CANCER.
WebMD Public Information from the National Cancer Institute
Last Updated: May 28, 2015
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
Cannabis and Cannabinoids (PDQ®): Complementary and alternative medicine - Patient Information [NCI] Topics
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Coconut creek is a b & b, bed and breakfast, inn accomodation, homestay situated beside Kumarakom lake and bird sanctuary, in kottayam district of Kerala
Kumarakom Lagoon, 80 kms from Cochin airport is the most ideal place for dream vacation.
Golden Waters , Kumarakom, the genuine backwater resort .The resort itself lies facing the breathtaking backwaters of Kerala, and its cottages are uniquely
Coconut Lagoon Heritage Resort offers heritage modernized cottages hidden among palm trees on the eastern shore of Lake Vembanadu and is only accessible
Built on 18 acres, this five-star deluxe resort with one of the finest spas in the country is located in Kumarakom 85kms from Cochin and 16kms from Kottayam
The resort is located on the banks of Lake Vembanadu in natural backwater surroundings, 70 kms from Cochin International Airport. 42 a/c cottages with
Backwater Retreat is a cozy house that was converted into a hotel and is surrounded by natural beauty with views of the river that borders the property.
Spread over seven acres of meticulously landscaped exteriors in the expansive Vembanadu Backwater Lake Shore, this retreat houses 34 independent luxury
Surrounded by the scenic Lake Vembanad, this 3 Star hotel is a holiday makers paradise. There are 40 rooms with either a lake or the canal view to choose
The Cocobay Resort is located 43 miles from Cochin International Airport, 10 miles from Kottayam Railway Station, and 90 minutes by road from Cochin International
Browse thousands of listings for Kumarakom India.


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Eliah Kagan
Contact Info
Here on Ask Ubuntu / Stack Exchange: If you have enough reputation to talk in chat (20 network-wide), you can ping me in main chat, even if I'm not there at the time. I'll be notified (though I may not see or reply immediately). To do this, include @EliahKagan in your message. If you prefer, you can invite me to another chat room.
Email: firstname.lastname@example.com
Launchpad [profile]: degeneracypressure / Eliah Kagan
(This will probably yield better results than email if I haven't heard from your address before.)
If you message me on any of the following, and I don't reply, please don't assume I received it.
Google Talk (XMPP): email@example.com
AIM: Code Executioner
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I'm Occasionally Asked For My Comments (but not in the way you think ;-) )
Please feel free to use my pro-forma comments, most of which are derived from the defaults or the ones shared here rather than being written from scratch by me (some are even identical):
I do not claim original authorship of them, but if any of them turn out to be wrong or not very good, that is possibly my fault. :-)
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The names and faces are different; the cities and departments involved, too. Ultimately, though, the videos all depict the same thing: death of black people at the hands of law enf... Read more
Alton Sterling and Philando Castile are dead, joining a long roll call of black people killed by officials acting in the name of public safety. And so the nation now begins a proce... Read more
The full story of the killing of Trayvon Martin told by the writer and activist Gina McGill. Here you will find details that were withheld at trial and would have convicted Zimmerm... Read more
A British woman who has been on death row in Texas for 14 years has been given renewed hope that she might be spared execution after devastating evidence was presented that prosecu... Read more
An initiative that would repeal the death penalty and replace it with life imprisonment without possibility of parole has qualified for the November ballot, Secretary of State Alex... Read more
A Baltimore judge acquitted the police officer facing the most serious charges in the death of Freddie Gray on Thursday, delivering a broad rebuke of a case that he said lacked evi... Read more
The International Press Institute (IPI) renewed its call for the release of Dawit Isaak and all journalists detained there in connection with their work. Dawit has been in jail for... Read more
Just after Sunday's horrific massacre, when information was scant, the identification of a shooter with a name like Omar Mateen helped some sources quickly categorize him as an evi... Read more


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This study evaluates the anorectal and genitourinary function of patients treated by preoperative short-term radiotherapy (RT) or chemoradiotherapy (CRT) followed by surgery and surgery alone for rectal cancer.
For this study, a total of 613 patients, who were identified from a prospective rectal cancer database, underwent anterior resection of the rectum between October 2001 and December 2007. Standardized questionnaires were used to determine fecal incontinence, urinary, and sexual function. Relevant clinical variables were evaluated using univariate and multivariate analyses. Independent predictors of functional outcome were identified by a binary logistic regression analysis.
The data of 263 (43 %) patients were available for analysis. On multivariate analysis, neoadjuvant RT (P < 0.01) and low anterior resection (LAR) (P = 0.049) were associated with fecal incontinence. In univariate analysis, fecal incontinence was linked to preoperative neoadjuvant treatment (RT and/or CRT vs. LAR) (P < 0.01). The hazard ratio for developing fecal incontinence was 3.3 (1.6–6.8) for patients who received RT. One hundred twenty-five patients (51.2 %) experienced urinary incontinence following surgery, the majority of whom were female (P < 0.01). On univariate analysis, male sexual function was associated with age (P < 0.01), ASA class (P = 0.01) and LAR (P = 0.01).
Multimodal therapy of low rectal cancer increases the incidence of fecal incontinence and negatively affects sexual function. The potential benefits of RT or CRT need to be balanced against the risk of increased bowel dysfunction when determining the appropriate treatment for individual patients with rectal cancer.]]>
Infections are the leading cause of morbidity and mortality after colorectal surgery. Obesity is a well-known risk factor for wound infection, but it does not seem to increase the risk of other infectious complications. The aim of this study was to look for a relationship between the fatty tissue metabolism measured by adipocytokine levels and the risk of postoperative infection.
Preoperative plasma levels of eight adipocytokines, cholesterol, triglycerides, insulin and C-reactive protein (CRP) were measured in consecutive patients undergoing elective colorectal surgery between June 2008 and June 2011. Information about epidemiological and clinical characteristics was obtained for each patient. All infections in the 30 days following surgery were recorded.
Among the 174 patients included, 49 (28 %) presented with a postoperative infection: 41 surgical site infections and 8 other infections. Preoperative leptin, insulin and CRP were significantly higher in patients with postoperative infection (p = 0.025, p = 0.020 and p = 0.044, respectively), but only leptin was predictive of infection in multivariate analysis (odds ratio (OR) = 1.89, 95 % confidence interval (CI) 1.18–3.03, p = 0.008). The predictive value of leptin was slightly lower for surgical site infection (OR = 1.65, 95 % CI 1.06–2.55, p = 0.025). Leptin levels were independent of the other adipocytokine levels but not of the body mass index.
Although markers of inflammation and insulin resistance are also related to the onset of surgical infection, leptin correlates more closely with the risk of infection than does any other factor. However, its effect could be partially mediated by the body mass index.]]>
This study analyzed the current approaches for rectal cancer treatment in elderly patients.
We retrospectively studied 240 rectal cancer patients who had undergone radiotherapy from 2000 to 2008. The ages of the patients ranged from 65 and 75 years (group A, n = 127) and older than 75 years (group B, n = 113). The distribution of the Charlson comorbidity index was similar between the two groups, but the ECOG performance status (PS) differed between the groups (66 % of the patients of group A were PS 0, and 40 % were PS 0 in group B (p < 0.0001)). The tumor stages were comparable between groups.
The median age of the patients was 74.3 years (range 65–90.6). Treatment was discussed during a multidisciplinary cancer team meeting before treatment for 55 % of the cases in group A and 73 % of the cases in group B (p < 0.001), and treatment proposals were in accordance with guidelines in 96 % of the cases in group A and 76 % of the cases in group B (p < 0.001). Group B patients received slightly less concurrent chemotherapy (35 vs. 30 % for group A; p = 0.54), more hypofractionated radiotherapy (41 vs. 54 % for group A; p = 0.064), less surgery (92 vs. 80 % for group A; p = 0.014), and less adjuvant chemotherapy (34 vs. 10 % for group A; p < 0.001). Finally, 80 % of the patients in group A and 60 % of the patients in group B received treatment in accordance with guidelines (p = 0.007) and in the logistic regression model. Non-metastatic patients who were aged below 75 years were predicted for conformal management (HR = 0.323; 95 % CI = 0.152–0.684) irrespective of their performance status, comorbidity, or disease stage.
Treatment proposals and administered therapy differed according to age.]]>
With current diagnostic methods, the majority of patients with symptomatic colorectal anastomotic leakage (CAL) is identified approximately 1 week after operation. The aim of this study is to determine whether real-time polymerase chain reaction (RT-PCR) for detection of Escherichia coli and Enterococcus faecalis on drain fluid can serve as a screening test for CAL in the early postoperative phase.
All patients included in this multicenter prospective observational study underwent left-sided colorectal resection for both malignant and benign diseases with construction of an anastomosis. In all patients, an intra-abdominal drain was placed during operation. During the first five postoperative days, drain fluid was processed for RT-PCR. The quantitative results of the RT-PCR on days 2 to 5 were compared to the results of day 1 in order to detect concentration changes.
In total, 243 patients, with both benign and malignant diseases, were included of whom 19 (7.8 %) developed symptomatic CAL. An increase in E. coli concentration was found in significantly more patients with CAL on day 4 and 5 [p = 0.0004; diagnostic odds ratio (DOR) 7.9]. For E. faecalis, this result was found for days 2, 3, and 4 (p < 0.003) with highest DOR on day 3 (31.6). Sensitivity and negative predictive values were 92.9 and 98.7 %, respectively, virtually ruling out CAL in case of negative test results on the third postoperative day.
Quantitative PCR for E. faecalis performed on drain fluid may be an objective, affordable and fast screening tool for symptomatic colorectal anastomotic leakage.]]>
Ulcerative colitis (UC) has been recognised as a systemic immune disorder that is not as restricted as colitis. UC-related gastrointestinal lesions with bleeding can develop soon after colectomy and can progress rapidly. Therefore, we considered the clinical features and treatment of these UC-related lesions.
We reviewed the patient data in our UC surgery database to evaluate its prevalence and features.
We found 7/1,100 patients with UC-related lesions between January 2000 and April 2013. These lesions developed at a mean of 24 (range 8–480) days after colectomy. Six of the seven patients suffered from gastrointestinal bleeding as an initial symptom that rapidly developed into massive bleeding or perforations. All of the patients were diagnosed with pancolitis; at the time of colectomy, fulminant, severe, moderate, and mild colitis were presented by four, one, one, and one patients, respectively. All patients with enteritis had consecutively developed other infectious complications, including anastomotic leakage, pyoderma gangrenosum, wound infection, and pneumonia. Although patients with bleeding did not respond to treatment with corticosteroids, they responded well to infliximab soon after its administration. Although six of the seven patients showed cytomegalo virus re-activation in blood or pathological examinations, ganciclovir was not effective in its elimination.
Although UC-related lesions with an unknown aetiology can occur after colectomy, immediate examination and treatment are required if gastrointestinal bleeding is found after surgery. Because gastrointestinal bleeding from UC-related lesions can worsen rapidly and may be related to mortality, early potent immunosuppressive therapy should be considered.]]>
Sun et al
First, amphiregulin and epiregulin are two important epidermal growth factors that are involved in the tumorigenesis and progression of colorectal cancer through the activation of EGFR.
Zindl CL, Lai JF, Lee YK, et al. IL-22-producing neutrophils contribute to antimicrobial defense and restitution of colonic epithelial integrity during colitis. Proc Natl Acad Sci USA 2013;110:12768–73.
Interleukin 22 (IL-22) belongs to the IL-10 cytokine family and is known to play an important role in mucosal epithelial cell homeostasis. It has pro-inflammatory as well as tissue protective roles, promoting mucosal epithelial antimicrobial defence and mucosal barrier integrity. Studies have shown that in acute models of colitis, MyD88/TNF-α signals, triggered by microbial insults, result both in recruitment of macrophages and granulocytes and also increased IL-22 production. Recently, it has been demonstrated that neutrophils also play a protective role in the host response in acute models of colitis and play a dual role in host protection: opsonisation (direct killing of microbes) and also indirectly signalling via IL-22 to...]]>
The digestive enzyme chymotrypsin C (CTRC) protects against pancreatitis by promoting degradation of trypsinogen, thereby curtailing potentially harmful trypsinogen activation. Loss-of-function variants in CTRC increase the risk for chronic pancreatitis. The aim of the present study was to perform comprehensive functional analysis of all missense CTRC variants identified to date.
We investigated secretion, activity and degradation of 27 published and five novel CTRC mutants. We also assessed the effect of five mutants on endoplasmic reticulum (ER) stress.
None of the mutants exhibited a gain of function, such as increased secretion or activity. By contrast, 11 mutants showed marked loss of function, three mutants had moderate functional defects, whereas 18 mutants were functionally similar to wild-type CTRC. The functional deficiencies observed were diminished secretion, impaired catalytic activity and degradation by trypsin. Mutants with a secretion defect caused ER stress that was proportional to the loss in secretion. ER stress was not associated with loss-of-function phenotypes related to catalytic defect or proteolytic instability.
Pathogenic CTRC variants cause loss of function by three distinct but mutually non-exclusive mechanisms that affect secretion, activity and proteolytic stability. ER stress may be induced by a subset of CTRC mutants, but does not represent a common pathological mechanism of CTRC variants. This phenotypic dataset should aid in the classification of the clinical relevance of CTRC variants identified in patients with chronic pancreatitis.
Sclerotherapy is the treatment of choice for first-grade haemorrhoidal disease. Numerous studies have shown that sclerotherapy with foamed sclerosants is more efficacious than liquid in the treatment of varicose veins. The aim of this study was to assess the efficacy and safety of polidocanol foam in comparison with liquid for haemorrhoidal disease.
A total of 130 patients were randomised to foam or liquid sclerotherapy (polidocanol 3 %). Patients with first-grade haemorrhoidal disease were included and blinded to treatment assignment. The primary endpoint was the stopping of perianal bleeding after one sclerotherapy session. Sclerotherapy was repeated until patients were free of bleeding (2-week intervals). The final follow-up was 12 weeks after the last sclerotherapy session.
In the foam group, significantly more patients (88 %) were treated successfully after one sclerotherapy session compared to the liquid group (69 %; p = 0.01). There was high patient satisfaction in both groups, but significantly more patients were satisfied with their treatment in the foam group than in the liquid group (99 vs. 84 %; p = 0.009). Additionally, in the foam group, significantly less treatment sessions were required (p < 0.001), and the total amount of injected polidocanol was reduced (p < 0.001).
In the therapy of first-grade haemorrhoidal disease, polidocanol 3 % foam is more effective and equally safe compared to liquid polidocanol. The results of this trial show that foam sclerotherapy is a new, innovative, effective and safe non-surgical treatment option for haemorrhoidal disease.]]>
To assess the efficacy and safety of single-incision laparoscopic appendectomy (SILA), we conducted a meta-analysis of randomized controlled trials (RCTs) comparing conventional three-port laparoscopic appendectomy (CTLA).
RCTs comparing the effects of SILA and CTLA were searched for in PubMed, the Cochrane Central Register of Controlled Trials, and Embase. Operative time, the pain visual analogue scales scores (VAS scores), dose of analgesics, postoperative complications, hospital charges, and duration of postoperative hospitalization in SILA and CTLA were pooled and compared by meta-analysis. Odds ratios and weighted mean differences (WMDs) were calculated with 95 % confidence intervals (CIs) to evaluate the effect of SILA.
Eight original RCTs investigating 760 adults and 684 children, 1,444 patients in total, of whom 721 received SILA only and 723 received CTLA only, met the inclusion criteria. Both in adults and children, the mean operative time was significantly longer in SILA than CTLA (WMD5.45, 95 % CI 2.15 to 8.75, p = 0.01). Compared with CTLA, in children, SILA have higher analgesic consumption (WMD 0.69, 95 % CI 0.08 to 1.3, p = 0.03) and greater hospital charges (WMD 0.87, 95 % CI 1.26 to 1.48, p = 0.005), which was not statistically different in adults (p > 0.05). Pooling the results for SILA and CTLA revealed no significant difference in VAS scores, wound infection rate, overall complications, and postoperative hospital stay.
SILA failed to show any obvious advantages over CTLA in perioperative and postoperative outcomes. Therefore, it represents a possible alternative to conventional three-port laparoscopic appendectomy.]]>
The underlying mechanism responsible for motility changes in colonic diverticular disease (DD) is still unknown. In the present study, our aim was to investigate the structural and in vitro motor changes in the sigmoid colon of patients with DD.
Muscle bath, microelectrodes and immunohistochemical techniques were performed with samples obtained from the left and sigmoid colon of patients with DD and compared with those of patients without DD.
The amplitude and area under the curve of the spontaneous rhythmic phasic contractions were greatly reduced in patients with DD whereas their frequency and tone remained unaltered. Electrical field stimulation induced a neurally mediated, enhanced ON-contraction (amplitude) in patients with DD and increased the duration of latency of OFF-contractions. The resting membrane potential of smooth muscle cells was hyperpolarized and the amplitude of the inhibitory junction potential was increased in patients with DD. In contrast, no significant histological differences were observed in patients with DD as smooth muscle (circular and longitudinal layers), interstitial cells of Cajal, glial cells and myenteric neurons densities remained unaltered.
Sigmoid strips from patients with asymptomatic DD showed an altered motor pattern with reduced spontaneous motility and enhanced neurally mediated colonic responses involving both excitatory and inhibitory motor pathways. No major neural and muscular structural elements were detected at this stage of the disease. These findings could be valuable in understanding the pathophysiology of this prevalent digestive disease.]]>
The prognosis for colorectal cancer (CRC) patients with unresectable metastases is dismal. This study compared outcomes of different metastatic treatments.
We collected 653 CRC cases with unresectable metastases including 490 cases receiving primary tumor resection then chemotherapy (surgery group) and 163 patients receiving neoadjuvant chemotherapy then did or did not receive operations (chemotherapy (C/T) group) from 2004 to 2010. The statistical endpoint was overall survival from the date of diagnosis.
In the C/T group, 124 (76 %) patients received an operation after 9.0 ± 6.2 months of chemotherapy, including 57 (34.9 %) patients with curative surgery. The C/T group had a higher proportion of T4 lesions (37.4 %) than the surgery group (26.9 %). Survival of the C/T group was longer than that of the surgery group (28.8 ± 8.8 vs. 24.3 ± 7.5 months; p = 0.043). Survival of 57 patients receiving curative surgery was 36.0 ± 6.3 months, which was significantly better than that of the 67 patients receiving palliative resection (25.2 ± 5.6, p < 0.001). In the surgery group, 42 (8.6 %) patients received curative metastasectomy after 8.5 ± 7.1 months of postoperative chemotherapy; survival was 30.8 ± 7.8 months, which was significantly better than that of patients who did not receive metastasectomy (22.4 ± 6.3 months). In multivariate analysis, poor differentiation, lymphovascular invasion, isolated cancer nodules, clinical risk score, and curative surgery were independent prognostic factors of overall patient survival.
Neoadjuvant chemotherapy can improve outcome of CRC patients with unresectable metastases.]]>
Lymph node ratio (LNR) is increasingly accepted as a useful prognostic indicator in colorectal cancer. However, variations in methodology, statistical stringency and cohort composition has led to inconsistency in respect of the optimally prognostic LNR.
The aim was to apply a robust regression-based analysis to generate and appraise LNRs optimally prognostic for colon and rectal cancer, both separately and in combination.
LNR was established for all patients undergoing either a colonic (n = 379) or rectal (n = 160) cancer resection with curative intent. The optimal LNR associated with disease-free and overall survival were established using a classification and regression tree technique. This process was repeated separately for patients who underwent either colonic or rectal resection and for the combined cohort. Survival associated with differing LNR was estimated using the Kaplan–Meier method and compared using a log-rank test. Relationships between LNR, disease-free survival (DFS) and overall survival (OS) were further characterised using Cox regression analysis. All statistical analyses were conducted in the R programming environment, with statistical significance was taken at a level of p < 0.05.
Optimal LNRs differed between each cohort, when either overall or disease-free survival was considered. LNRs generated from combined cohorts also differed from those generated by individual cohorts. In relation to DFS, LNR values were obtained and included 0.18 for the colon cancer cohort and 0.19 for the rectal and combined colorectal cancer cohorts. In relation to OS, multiple LNR values were obtained for colon and combined cohorts; however, an optimal LNR was not evident in the rectal cancer cohort. Survival patterns according to LNR closely resembled those associated with standard nodal staging.
Application of a data-driven approach based on recursive partitioning generates differing lymph node ratios for colon, rectal and combined colorectal cohorts. In each cohort, LNR was similarly prognostic to standard nodal staging in respect to overall and disease-free survival. Overall survival was associated with a multiplicity of LNR values, whilst disease-free survival was associated with a single LNR only. The paper demonstrates the merits of utilising a data-driven approach to determining lymph node ratios from specific patient cohorts. Utilising such an approach enabled the generation of those LNRs that were most associated with particular survival trends in relation to overall and disease-free survival. These differed markedly for colon cancer, rectal cancer and combined cohorts. In general, the survival patterns associated with LNRs generated were similar to those observed with standard nodal staging.]]>
Prolonged post-operative ileus (PPOI) increases post-operative morbidity and prolongs hospital stay. An improved understanding of the elements which contribute to the genesis of PPOI is needed in the first instance to facilitate accurate risk stratification and institute effective preventive measures. The aim of this retrospective cohort study was to therefore determine the perioperative risk factors associated with development of PPOI.
All elective intra-abdominal operations undertaken by the Colorectal Unit at Auckland District Health Board from 1 January to 31 December 2011 were accessed. Data were extracted for an assortment of patient characteristics and perioperative variables. Cases were stratified by the occurrence of clinician-diagnosed PPOI. Univariate and regression analyses were performed to identify correlates and independent risk factors, respectively.
Two hundred and fifty-five patients were identified of whom 50 (19.6 %) developed PPOI. The median duration for PPOI was 4 days with 98 % resolving spontaneously with conservative measures. Univariate analysis identified increasing age; procedure type; increasing opiate consumption; elevated preoperative creatinine; post-operative haemoglobin drop, highest white cell count and lowest sodium; and increasing complication grade as significant correlates. Logistic regression found increasing age (OR 1.032, 95 % CI 1.004–1.061; p = 0.026) and increasing drop in pre- to post-operative haemoglobin (OR 1.043, 95 % CI 1.002–1.085; p = 0.037) as the only independent predictors for developing PPOI. An important limitation of this study was its retrospective nature.
Increasing age and increasing drop in haemoglobin are independent predictors for developing PPOI. Prospective assessment is required to facilitate more accurate risk factor analysis.]]>
Diverting stomas following rectal cancer surgery can affect patients' quality of life, and their complications may negatively affect patients' long-term outcomes and quality of life. The purpose of this study is to investigate the relationship between diverting stoma-related complications and nutritional status.
In a retrospective study of 114 patients aged 65 years and older who underwent diverting loop ileostomy following rectal cancer surgery between June 2004 and March 2011, we analyzed retrospectively diverting stoma-related complications and nutrition status for the following time periods: before stoma construction, before stoma closure, and after stoma closure.
Complications related to the diverting stoma developed in 24 (21.1 %) patients and complications related to stoma closure in 11 (9.6 %) patients. Nutritional screening performed prior to stoma closure showed that patients who experienced stoma formation-related complications had lower albumin levels (P = 0.016) and lower total lymphocytes (P = <0.0001). Body weight loss was more severe in patients with stoma-related complication (P = 0.036).
Diverting stoma-related complications may affect patient's nutritional status. Stoma closure operation and proper nutritional support may be important for avoiding complications and improving patients' long-term outcomes and quality of life.]]>
Molecular testing for epidermal growth factor receptor (EGFR) mutations has recently become a standard practice for the management of patients with non-squamous none small cell lung cancer. Primary small intestine adenocarcinoma (SIA) is an uncommon malignancy, and EGFR mutation in the cancer has not been well characterized due to its rarity.
A micro-tissue array with 53 SIAs and 24 surgically resected primary non-ampullary SIAs were studied. EGFR mutations were analyzed by DNA sequencing in 24 cases with formalin-fixed paraffin-embedded blocks. All 77 cases were examined by immunohistochemistry (IHC) using antibodies specific for the EGFR E746-A750 deletion in exon 19 (DEL), L858R point mutation in exon 21 (L858R), and total EGFR. EGFR amplifications were detected by fluorescence in situ hybridization.
A positive reaction of DEL-specific, L858R-specific, and total EGFR antibodies was detected in seven (9.1 %), 5(6.5 %) and 35 (45.5 %) of 77 SIAs by IHC, respectively. Positive reaction of the three antibodies was not significantly correlated with patient's age, gender, differentiation, and stage. EGFR gene amplification was assayed in 77 SIAs in micro-tissue array. Of 24 SIA samples that had DNA sequencing, two (8.3 %) harbored exon 19 deletion and one (4.2 %) harbored L858R point mutation. Only one case with EGFR amplification and two cases with polysomy were shown.
Our findings suggested that mutations and amplification in EGFR genes are minor events, and most of SIAs may be unsuitable to EGFR-TKIs treatment.]]>
Our aims were to evaluate protein tyrosine phosphatase nonreceptor type 22 (PTPN22) gene polymorphisms in ulcerative colitis (UC) and explore PTPN22 mRNA levels in colonic biopsies of UC patients in central China.
A total of 165 Chinese UC patients and 300 healthy controls were enrolled in this study. PTPN22 −1123G/C, +1858C/T, and +788G/A polymorphisms were genotyped by PCR-restriction fragment length polymorphism method. PTPN22 mRNA expressions in colonic biopsies and serum C-reactive protein (CRP) levels were determined by quantitative PCR and immunonephelometry, respectively.
The frequency of C carrier was higher in UC patients than in healthy controls (66.7 vs. 53.3 %, P = 0.005, odds ratios = 1.75, 95 % CI 1.18–2.60) and associated with extensive colitis (P = 0.029). PTPN22 mRNA levels were elevated in UC patients than in healthy controls (P < 0.001). Among UC patients, PTPN22 mRNA expression levels were higher in biopsies of inflamed colonic tissue compared with noninflamed tissue (P < 0.001) and were correlated with CRP levels (r = 0.578, P < 0.001). PTPN22 mRNA expression levels were elevated in extensive colitis compared to proctitis (P = 0.008) and to left-sided colitis (P = 0.029) and were higher in moderate and severe disease than in mild disease (P = 0.005).
Our study showed the potential association between PTPN22 −1123G/C polymorphism and UC in central China. PTPN22 mRNA levels were highly expressed in UC, especially in active disease, and were correlated with CRP levels, disease location, and disease severity in UC patients.]]>
Emerging research suggests that preventative swallowing rehabilitation, undertaken before or during (chemo)radiotherapy ([C]RT), can significantly improve early swallowing outcomes for head and neck cancer (HNC) patients. However, these treatment protocols are highly variable. Determining specific physiological swallowing parameters that are most likely to be impacted post-(C)RT would assist in refining clear targets for preventative rehabilitation. Therefore, this systematic review (1) examined the frequency and prevalence of physiological swallowing deficits observed post-(C)RT for HNC, and (2) determined the patterns of prevalence of these key physiological deficits over time post-treatment. Online databases were searched for relevant papers published between January 1998 and March 2013. A total of 153 papers were identified and appraised for methodological quality and suitability based on exclusionary criteria. Ultimately, 19 publications met the study's inclusion criteria. Collation of reported prevalence of physiological swallowing deficits revealed reduced laryngeal excursion, base-of-tongue (BOT) dysfunction, reduced pharyngeal contraction, and impaired epiglottic movement as most frequently reported. BOT dysfunction and impaired epiglottic movement showed a collective prevalence of over 75 % in the majority of patient cohorts, whilst reduced laryngeal elevation and pharyngeal contraction had a prevalence of over 50 %. Subanalysis suggested a trend that the prevalence of these key deficits is dynamic although persistent over time. These findings can be used by clinicians to inform preventative intervention and support the use of specific, evidence-based therapy tasks explicitly selected to target the highly prevalent deficits post-(C)RT for HNC.]]>
The purpose of this study was to investigate the reliability of tongue and handgrip strength and endurance measurements in healthy adults using the Iowa Oral Performance Instrument. Fifty-one healthy participants (21 males, 30 females; age range = 19–57 years) were tested on four occasions 1 week apart to determine test–retest reliability. The primary outcome measures were isometric tongue and handgrip strength (best of three trials) and sustained isometric endurance. Small increases (changes in group mean) in both anterior (1.7 %) and posterior (2.5 %) tongue strength and handgrip strength (5 %) between weeks 1 and 2 were observed with no change in subsequent weeks, suggesting that there is only a small learning effect for these measurements. The within-subject variation (mean-typical error expressed as a coefficient of variation [CV]) indicated higher than desirable initial variation for anterior (CV 10.8 %) and posterior (CV 11.8 %) tongue strength and handgrip strength (CV 15.2 %) but this was reduced in weeks 2–4. Intraclass correlation coefficients (ICC) indicated acceptable and improved reliability for both anterior (ICC 0.77–0.90) and posterior (ICC 0.79–0.86) tongue strength and handgrip strength (ICC 0.69–0.91) after week 1. Additional exploratory analyses were conducted with a subset of data to determine whether two values within 5 kPa (tongue) or 15 kPa (handgrip) provide superior strength reliability. Neither tongue nor hand endurance measurements were sufficiently reliable. These findings suggest that tongue and handgrip strength values demonstrate acceptable reliability, especially if familiarization is provided. Further investigation is needed to reduce sources of variability in tongue endurance measurements.]]>
Videofluoroscopy is commonly used for evaluating oropharyngeal swallowing but requires radiopaque contrast (typically barium). Prior studies suggest that some aspects of swallowing, including timing measures of oral and pharyngeal bolus transit, vary depending on barium concentration. The aim of our study was to identify timing differences in healthy swallowing between "thin" (40 % w/v concentration) and "ultrathin" (22 % w/v concentration) barium solutions. Twenty healthy adults (Ten women; mean age = 31 years) each performed a series of three noncued 5-ml swallows each of ultrathin and thin liquid barium solutions in videofluoroscopy. Timing measures were compared between barium concentrations using a mixed-model ANOVA. The measures of interest were stage transition duration, pharyngeal transit time, and duration of upper esophageal sphincter opening. Significant differences were observed in the timing measures of swallowing with respect to barium concentration. In all cases, longer durations were seen with the higher barium concentration. Barium concentration influences timing parameters in healthy swallowing, even between ultrathin and thin concentrations. Clinicians need to understand and control for the impact of different barium stimuli on swallowing physiology.]]>
Barium may affect the perception of taste intensity and palatability. Such differences are important considerations in the selection of dysphagia assessment strategies and interpretation of results. Eighty healthy women grouped by age (younger, older) and genetic taste status (supertaster, nontaster) rated intensity and palatability for seven tastants prepared in deionized water with and without 40 % w/v barium: noncarbonated and carbonated water, diluted ethanol, and high concentrations of citric acid (sour), sodium chloride (salty), caffeine (bitter), and sucrose (sweet). Mixed-model analyses explored the effects of barium, taster status, and age on perceived taste intensity and acceptability of stimuli. Barium was associated with lower taste intensity ratings for sweet, salty, and bitter tastants, higher taste intensity in carbonated water, and lower palatability in water, sweet, sour, and carbonated water. Older subjects reported lower palatability (all barium samples, sour) and higher taste intensity scores (ethanol, sweet, sour) compared to younger subjects. Supertasters reported higher taste intensity (ethanol, sweet, sour, salty, bitter) and lower palatability (ethanol, salty, bitter) than nontasters. Refusal rates were highest for younger subjects and supertasters, and for barium (regardless of tastant), bitter, and ethanol. Barium suppressed the perceived intensity of some tastes and reduced palatability. These effects are more pronounced in older subjects and supertasters, but younger supertasters are least likely to tolerate trials of barium and strong tastant solutions.]]>
Oropharyngeal dysphagia is a highly prevalent comorbidity in neurological patients and presents a serious health threat, which may le to outcomes of aspiration pneumonia ranging from hospitalization to death. Therefore, an early identification of risk followed by an accurate diagnosis of oropharyngeal dysphagia is fundamental. This systematic review provides an update of currently available bedside screenings to identify oropharyngeal dysphagia in neurological patients. An electronic search was carried out in the databases PubMed, Embase, CINAHL, and PsychInfo (formerly PsychLit), and all hits from 2008 up to December 2012 were included in the review. Only studies with sufficient methodological quality were considered, after which the psychometric characteristics of the screening tools were determined. Two relevant bedside screenings were identified, with a minimum sensitivity and specificity of ≥70 and ≥60 %, respectively.]]>
The purpose of this prospective, double-blinded, multirater, systematic replication study was to investigate agreement for aspiration risk, in the same individual, between videofluoroscopic swallow studies (VFSS) and the Yale Swallow Protocol. Participants were 25 consecutive adults referred for dysphagia testing who met the inclusion criteria of completion of a brief cognitive assessment, oral mechanism examination, and no tracheotomy tube. First, all participants were administered the Yale Swallow Protocol by two experienced speech-language pathologists trained in protocol administration. Failure criteria were inability to drink the entire amount, interrupted drinking, or coughing during or immediately after drinking. Second, all participants completed a VFSS within 5–10 min of protocol administration. A speech-language pathologist, blinded to protocol results, reviewed the VFSS to determine aspiration status in a binary (yes/no) manner. Inter-rater agreement between two speech-language pathologists was 100 % for identification of aspiration risk with the Yale Swallow Protocol. Inter-rater agreement between the speech-language pathologist and the radiologist for identification of aspiration status with VFSS was 100 %. Twenty percent of VFSS recordings were viewed again 3–6 months after initial data collection, and intrarater agreement for identification of thin liquid aspiration was 100 %. Sensitivity for the Yale Swallow Protocol = 100 %, specificity = 64 %, positive predictive value = 78 %, and negative predictive value = 100 %. Importantly, all participants who passed the protocol did not aspirate during VFSS. Multiple, double-blinded raters and VFSS as the reference standard agreed with previous research with a single, nonblinded rater and FEES as the reference standard for identification of aspiration risk. The clinical usefulness and validity of the Yale Swallow Protocol for determining aspiration risk in a small sample size of male participants has been confirmed. Future research is needed with a larger and more heterogeneous population sample.]]>
Temporal parameters such as stage transition duration, bolus location at swallow onset, and pharyngeal transit time are often measured during videofluoroscopy, but these parameters may vary depending on assessment instructions. Specifically, "command" (cued) swallows have been observed to alter timing compared to spontaneous (noncued) situations in healthy older adults. The aim of our study was to confirm whether healthy young people show timing differences for thin liquid swallows between cued and noncued conditions. Twenty healthy young adults swallowed 10-cc boluses of ultrathin barium in videofluoroscopy. The cued condition was to hold the bolus in the mouth for 5 s before swallowing. Three noncued swallows were also recorded. In the cued condition, bolus advancement to the pyriform sinuses prior to swallow initiation was seen significantly less frequently. Stage transition durations showed a nonsignificant trend toward being shorter. Pharyngeal transit times and pharyngeal response time (a measure capturing the interval between hyoid movement onset and bolus clearance through the upper esophageal sphincter) were both significantly longer in the cued condition. Our study in healthy young adults confirms findings previously observed in older adults, namely, that swallow onset patterns and timing differ between cued and noncued conditions. In particular, bolus advancement to more distal locations in the pharynx at the time of swallow onset is seen more frequently in noncued conditions. This pattern should not be mistaken for impairment in swallow onset timing during swallowing assessment.]]>
When chewing solid food, part of the bolus is propelled into the oropharynx before swallowing; this is named stage II transport (St2Tr). However, the tongue movement patterns that comprise St2Tr remain unclear. We investigated coronal jaw and tongue movements using videofluorography. Fourteen healthy young adults ate 6 g each of banana, cookie, and meat (four trials per foodstuff). Small lead markers were glued to the teeth and tongue surface to track movements by videofluorography in the anteroposterior projection. Recordings were divided into jaw motion cycles of four types: stage I transport (St1Tr), chewing, St2Tr, and swallowing. The range of horizontal tongue motion was significantly larger during St1Tr and chewing than during St2Tr and swallowing, whereas vertical tongue movements were significantly larger during chewing and St2Tr than during swallowing. Tongue movements varied significantly with food consistency. We conclude that the small horizontal tongue marker movements during St2Tr and swallowing were consistent with a "squeeze-back" mechanism of bolus propulsion. The vertical dimension was large in chewing and St2Tr, perhaps because of food particle reduction and transport in chewing and St2Tr.]]>
We analyzed published dose–volume data of the structures related to late radiotherapy-induced swallowing disturbances in head-and-neck cancer to estimate their sensitivity, specificity, and predictive value and to propose minimal criteria for future studies.
We performed a systematic literature search to identify dose–volume correlates with late swallowing disturbances. Study design, dose–volume data, toxicity evaluation, and statistical methods were considered in the analysis.
Seven studies were found, among which one prospective study reported exact dose–volume correlates for individual swallowing structures. Four studies identified dose–volume correlates without reporting exact numbers. One study did not find any correlate of dose–volume data of the swallowing structures with late swallowing disturbances. Variations in patient characteristics, study design, methodology, and statistics made any comparison difficult. However, mean dose to the pharyngeus constrictor muscles appeared to be the most demonstrative predictor of late swallowing disturbances, e.g., reducing the mean dose to the pharyngeal constrictor muscles from 61–64 to 52–55 Gy resulted in fewer swallowing disturbances. There were no available data to estimate sensitivity, specificity, or predictive value of the reported dose–volume correlates.
Mean dose to the pharyngeal constrictor muscles appeared to be the most important dosimetric predictor of late swallowing disturbances. Suggested dose–volume correlates require validation in prospective well-designed clinical trials, applying appropriate statistical methods that would account for possible interfering factors.]]>
Spinocerebellar ataxias (SCAs) are a group of neurodegenerative disorders frequently associated with autosomal dominant inheritance. SCA type 3 (SCA3) and SCA type 6 (SCA6) are the most common forms in Japan as well as the rest of the world. SCA3 affects multiple nervous systems while SCA6 affects mainly the cerebellar system. Dysphagia is clinically important since aspiration pneumonia is the most common cause of death in patients with SCA. We retrospectively studied dysphagia in 7 patients with SCA3 and 13 with SCA6 by videofluoroscopic examination of swallowing (VF). This is a larger series of patients with SCA6 than in previous studies, which had inconsistent results. Dysphagia was evaluated according to the scale established by the Japanese Society of Dysphagia Rehabilitation and the dysphagia outcome severity scale, an internationally used scale. The former separately evaluates oral and pharyngeal phases, while the latter concurrently grades both phases. Dysphagia according to the Japanese scale was mild but statistically significant in SCA6 and severe in SCA3. DOSS indicated abnormalities in SCA3 but not in SCA6. The swallowing abnormalities in SCA3 or SCA6 did not parallel the duration of disease or physical disability, suggesting that even patients with early disease or with well-preserved physical functions were at risk for aspiration. Our patients with dysphagia received percutaneous endoscopic gastrostomy-tube feeding at an appropriate time and underwent rehabilitation of swallowing. No patient had aspiration pneumonia. In conclusion, evaluation of swallowing ability by VF is essential for preventing aspiration in patients with SCA.]]>
We aimed in this study to evaluate dysphagia in early stroke patients using a bedside screening test and flexible fiberoptic endoscopic evaluation of swallowing (FFEES) and electrophysiological evaluation (EE) methods and to compare the effectiveness of these methods. Twenty-four patients who were hospitalized in our clinic within the first 3 months after stroke were included in this study. Patients were evaluated using a bedside screening test [including bedside dysphagia score (BDS), neurological examination dysphagia score (NEDS), and total dysphagia score (TDS)] and FFEES and EE methods. Patients were divided into normal-swallowing and dysphagia groups according to the results of the evaluation methods. Patients with dysphagia as determined by any of these methods were compared to the patients with normal swallowing based on the results of the other two methods. Based on the results of our study, a high BDS was positively correlated with dysphagia identified by FFEES and EE methods. Moreover, the FFEES and EE methods were positively correlated. There was no significant correlation between NEDS and TDS levels and either EE or FFEES method. Bedside screening tests should be used mainly as an initial screening test; then FFEES and EE methods should be combined in patients who show risks. This diagnostic algorithm may provide a practical and fast solution for selected stroke patients.]]>
In our randomized trial on hyperbaric oxygen (HBO), it was shown that HBO could reduce dysphagia and xerostomia, which are frequently encountered after (chemo-) radiotherapy (RT) and/or surgery for head and neck cancer (HNC). A risk model and nomogram are developed to select those patients who most likely will respond to HBO treatment. A total of 434 HNC patients treated from 2000 to 2008 were analyzed and filled out the EORTC QLQC-30 and H&N35 questionnaires. Age, gender, chemotherapy, T and N stages, site, radiotherapy technique, RT boost, surgery of the primary tumor and neck, bilateral RT, and dose were analyzed in a statistical model. The discriminative value of the model was evaluated based on receiver operating characteristics (ROC), the area under the curve (AUC), sensitivity, specificity, and proportion of correctly classified measures. Significant factors in predicting swallowing problems are age, follow-up duration, tumor site, chemotherapy, surgery of the primary tumor and neck, and dose. For dry mouth, the significant factors are age, gender, tumor site, N stage, chemotherapy, and bilateral irradiation. For dysphagia and xerostomia, the area under the ROC curve is 0.7034 and 0.7224, respectively, with a specificity of 89/77 %, sensitivity of 27/58 %, and a positive predictive value of 83/67 % for dysphagia and xerostomia, respectively. The developed predictive risk model could be used to select patients for costly hyperbaric oxygen treatment to prevent or reduce severe late side effects of HNC treatment. Our model serves as a guideline for the Department of Radiation Oncology to reduce costs by excluding patients not amenable to hyperbaric oxygen protocols. The nomogram presented is a useful tool for clinicians in assessing patient risks when deciding on follow-up strategies (e.g., hyperbaric oxygen treatment) after RT or surgery for HNC.]]>
The aim of this study was to investigate the existence of Helicobacter pylori (HP) in patients with benign and malignant vocal fold pathologies. This was a prospective clinical study conducted at a tertiary-care academic medical center. Fifty consecutive patients who had undergone microlaryngoscopy between August 2007 and July 2009 were included in the study. The patients with a reflux symptom index (RSI) above 12 and a reflux finding score (RFS) above 6 were accepted as having laryngopharyngeal reflux. Patients with urea breath test (UBT), HP-IgG, and HP cytotoxin-associated gene A (CagA)-IgG positivity were diagnosed as HP positive. During laryngoscopy, two surgical specimens were obtained, one from the primary vocal fold pathology and one from the interarytenoid region. The interarytenoid biopsy specimen was used for HP culture and PCR. The specimen from the vocal fold pathology was used to investigate the presence of HP. RSI was positive in 23 (46 %) patients. The RFS positivity was 56 %. The presence of HP was confirmed by UBT in 35 (70 %), HP-IgG in 37 (74 %), and HP CagA-IgG in 38 (76 %) patients. There was no difference between RFS-positive and RFS-negative patients in terms of HP-IgG and UBT. None of the interarytenoid or vocal fold specimens showed the presence of HP. HP was not found in the histological specimens of vocal fold pathologies and the interarytenoid region. The presence of HP in the gastric mucosa does not have an effect on the RFS and RSI.]]>
Changes in morphometry of head and neck muscles have received little attention in research relative to limb muscles. While recent literature suggests that high-frequency ultrasound transducers can provide superior spatial resolution compared to that of magnetic resonance imaging (MRI), no studies have compared these imaging methods for investigating the submental muscle group. This preliminary study sought to compare ultrasound and MRI as a method of quantifying the cross-sectional area (CSA) of the submental muscle group. Measurements were taken from coronal ultrasound and MRI images in 11 healthy participants. Comparisons were limited to the anterior belly of the digastric muscle because of differences in imaging resolution. Ultrasound CSA measurements were smaller than MRI measurements (p = 0.01) by 10 % (95 % CI = −18 to −2). Correlations were significant and relatively high (left: r = 0.909, p < 0.001; right: r = 0.776, p = 0.005). Ultrasound imaging has the advantages of natural participant positioning, superior clarity of muscle borders of the submental muscles, requires less acquisition time, and is a less expensive method of imaging compared to MRI. This preliminary study has shown that ultrasound is a viable imaging modality for quantitative measurements of the anterior belly of the digastric muscle and has advantages over MRI beyond cost and accessibility.]]>
Use of an oral mechanism examination is ubiquitous and long-standing despite a paucity of research supporting its clinical utility in dysphagia diagnostics. The purpose of this study was to investigate whether components of an oral mechanism examination, i.e., binary judgments (complete/incomplete) of labial closure, lingual range of motion, and facial symmetry, were associated with increased odds of aspiration as confirmed by subsequent instrumental testing. Study design was a single-group consecutively referred case series with a single judge. A total of 4,102 consecutive inpatients from a large, urban, tertiary-care teaching hospital were accrued, with 3,919 meeting the inclusion criterion of adequate cognitive ability to participate in an oral mechanism examination followed immediately by a fiberoptic endoscopic evaluation of swallowing. Stepwise multiple logistic regression analysis indicated that participants with incomplete lingual range of motion had an odds of aspiration that was 2.72 times the odds of aspiration of those with complete lingual range of motion (95 % confidence interval [CI] = 1.96–3.79, p < 0.0001), and incomplete lingual range of motion was an independent risk factor for aspiration regardless of labial closure and facial symmetry. Participants with incomplete facial symmetry had an odds of aspiration that was 0.76 times the odds of aspiration of those with complete facial symmetry (95% CI = 0.61–0.95, p = 0.017). Isolated incomplete labial closure did not affect the odds of aspiration (p > 0.05). New and clinically relevant information was found for lingual range of motion and facial symmetry, i.e., when incomplete, the clinician should be alerted to potential increased odds of aspiration during subsequent instrumental dysphagia testing.]]>


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The Sixth Annual Strides for Life, a 3 mile fun/run walk supporting the Lung Cancer Research Foundation, is being held on Sunday, August 14, 2011 around Lake Agawam in Southampton, NY. This event is the largest annual fund raising event for lung cancer research on Long Island and is the signature event for the Lung Cancer Research Foundation. The main race begins at 8:45am with a children's 50 yard dash and award ceremony to follow. Rosanna Scotto from Fox 5 News, host of Good Day New York, will serve as Mistress of Ceremonies at this year's event. For more information on how to register, please visit our website at www.lungfund.org. We look forward to your participation at this year's event!!!
ACTIVE is the leader in online event registrations from 5k running races and marathons to softball leagues and local events. ACTIVE also makes it easy to learn and prepare for all the things you love to do with expert resources, training plans and fitness calculators.


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Spicy Aubergine (Eggplant) and Red Pepper Tapenade - Dip
Total Time
Prep 10 mins
Cook 45 mins
This is a "throw it in the oven & blend it all together" recipe which is always a great hit any time of the year. I have called it a Tapenade; a Tapenade contains olives, anchovies & capers normally, with a few regional variations, but this reminded me of the consistency of a Tapenade, so that's what it's called! (There are NO anchovies in this one!) I use this for dips, spreads, sauces, grilled sandwiches plus grilled meat & vegetables. It is very versatile & stores for up to 2 weeks in the fridge - with a coating of olive oil on top. This recipe makes enough to fill a 1lb jar; it is very easy to increase the quantities. Please note, there is no need to salt the aubergines OR take the skin off after they have cooked.
Ingredients Nutrition
- 1 large aubergine, chopped into 2-inch dice
- 1 large red pepper, de-seeded with the white membrane cut out & chopped into 2-inch dice
- 6 garlic cloves, peeled
- 4 tomatoes, roughly chopped
- 1 tablespoon olive oil
- 1 teaspoon ground cumin
- 1 teaspoon ground coriander
- 1 teaspoon chili powder
- salt & pepper
- 2 sprigs fresh coriander (Cilantro)
- 1 teaspoon harissa (optional)
- 4 sun-dried tomatoes packed in oil, drained (reserve 1 tablespoon of the sun-dried oil or olive oil)
- Preheat the oven to 200°C or 400°F.
- Take a sturdy oven proof tin or dish and add the aubergines, red peppers, garlic cloves, tomatoes, cumin, coriander, chili powder and the olive oil.
- Mix thoroughly, so everything has a light coating of oil.
- Roast in the oven on the top shelf for 30 to 45 minutes, or until charred and tinged brown on the edges and soft to the touch.
- Take out and leave to cool slightly.
- Add the fresh coriander (cilantro), harissa paste if using and sun-dried tomatoes. Season well with salt & pepper.
- Tip all the mixture into a large bowl and blend it all together with a hand mixer/blender.
- Do NOT over mix - it should be smooth but not pureed!
- Serve in an attractive bowl and dribble the remaining olive oil over the top, garnish with some fresh coriander (cilantro) or chopped flat leaf parsley. You can also add an olive or two.
- Store in a container in the fridge with olive oil on the top for up to 2 weeks.
Most Helpful
Absolutely delicious! So rich in flavor with just the right amount of spice. Loved the caramelized veggies and garlic in this tapenade. Did not change a thing about this recipe and will definitely make this again. Placing this recipe in my Best of 2014 Cookbook. Made for Zaar Chef Alphabet Soup tag, February, 2014.
Delicious and easy! The spices add just the right amount of excitement to this tapenade. I served this with a greek dinner, as a condiment. Tomorrow I am going to use it to make a panini sandwich with mozarella and arugula. I did stir in the juice of 1/2 a lemon to give it a little acid, substituted cayenne for chili powder and scattered on some red pepper flakes before baking too. I am going to cook up a big batch and can it to put in holiday gift baskets. Yum! Highly recommend.
This was actually pretty simple to make. Unfortunately, I couldn't find harissa so I just omitted it from the recipe. I didn't find this dish overly garlicky like another reviewer reported they did. Very tasty! I will make this again!


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The heartbreaking story of Walker Wilbanks, a 17-year-old Jackson Prep football player who died on Monday, has been shared all over the metro area and beyond.
And yesterday on Twitter, Walker's brother, Landon, shared that his brother's heart was going to save the life of a 14-year-old.
Other social media accounts are saying there's more, and we are trying to track down the extent of Walker's amazing gift to others.
For more information about organ donation, visit Mississippi Organ Recovery Agency.


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Valiant is proud to to present an advance preview of Shadowman #15 â the next nerve-shattering chapter of "Fear, Blood, and Shadows" by legendary writer Peter Milligan and acclaimed artists Roberto de la Torre and Al Barrionuevo!
Shadowman must die! Jack Boniface is out of control, and a monstrous supernatural force called Tremble now threatens to destroy Shadowmanâ¦if the ghosts that haunt Jack donât tear him apart first! But before he cracks, the Abettors â sworn to aid the Shadowman and shield him from the forces of darkness â must take drastic measures to protect the world from Jackâs terrible power. Can Jack defeat the evil thatâs coming to kill himâ¦and save himself from the allies trying to drive a knife into his back?


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Guitar Hero: Aerosmith - A Behind the Scenes Look
Written Tuesday, June 17, 2008 By Dan WebbView author's profile
Like it or not, Guitar Hero: Aerosmith is just around the corner and will be in our consoles next month. Whether or not you think its a cash in title doesn't matter cause this bad boy will have DMC in it which is always a great thing! Join DMC as he discusses his involvement in the game and how his relationship with Aerosmith came to fruition.


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Our Own Big Dig
This cautionary tale about waterfront tunnels, written by Boston urban designer Thomas Oles, ran in this month's Belltown Messenger. In it, Oles convincingly compares Seattle's proposed Alaskan Way Viaduct tunnel to Boston's disastrous Big Dig, noting that the transportation engineers who designed that monstrously expensive (and notoriously leaky) waterfront tunnel have recently acknowledged that "tunnels-surprise-will do nothing to reduce congestion, that traffic has already reached the levels predicted for the end of the decade."
Oles continues:
Now I learn that what I fled in Boston is about to happen in Seattle, even involving some of the same actors. And cost overruns, graft, and faulty construction in Boston? Not to worry, right?-these are the products of corrupt East Coast political machines, of politicians with Italian names and friends who can get your legs broken. This is so much feel-good, back-patting Northwest pabulum: Large tunnel projects invite corruption and almost always run over budget and past completion date, and our local politicians are just as corrupt even if their personal style is more yoga-and-hiking-boots. To an ignorant observer it might seem the viaduct proposal is designed to assure that the project fails as spectacularly as possible while giving the most meager public benefit, continuing the proud lineage of transportation debacles-the bus tunnel, Sound Transit, and the Monorail-in Seattle over the last two decades.
In many ways the tunnel, with road capacity not at issue, is even more egregious than the Central Artery Tunnel: For the sake of 100,000 cars that could be carried on a series of large city streets or a shoreline boulevard like the universally admired Passeig de Colom in Barcelona, the Viaduct "solution" will create a 180-foot-wide new rip in the city at its south end in Pioneer Square, as well as leaving a piece of elevated expressway-historic preservation Seattle-style?-for tourists at the Pike Place Market.
In the face of all their obvious shortcomings, there must be some other reason why officials and planners love tunnels-and, for that matter, subterranean parking. Really. it is not a matter of faster trips to the airport, or more cars, or greenbelts, or any of the rest of it. What tunnels do for us is this: They mask the physical and moral ugliness of what Margaret Thatcher called the "Great Car Society" by pandering to our nostalgia, by sustaining our illusions of urban cleanliness and order. They are like the modern toilet designed to let us forget that we shit.


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From what ive seen of WAR is graphly like WoW so the gameplay and other aspects could be simuiler.
As for GW2, well theres hardly and infomation on this game as yet.
Personaly, im more looking forward too AoC (Age of Conan), due too is great looking graphics and the fact that is a Mature game, blood, head chopping, nudity etc. No little people getting in the way.
You are not allowed to request a sticky.


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This is a reservations-only program, suitable for adults and children over 5. Programs often sell out. Our limit is 15. For planning, please RSVP here but you must also reserve at http://action.sierraclub.org/site/Calendar?id=169261&view=Detail. Your trip leader is reserving and paying for the group in advance, so deadline for sign-ups is July 29th. This part is a tax-deductible donation to Chimney Rock Interpretive Association: adults $27, kids $12.50. Ignore part on final pager that says 'additional gift portion': it's trying to say that $25 is tax-deductible but it's really $27; your credit card will not be charged any more than what you enter on ticket-order page.
One of America's newest National Monuments - a place of mystery, a sacred place, a celestial observatory and seasonal calendar for the Ancestral Puebloans over 1,000 years ago. Chimney Rock lies within the San Juan National Forest - between Durango and Pagosa Springs in southwestern Colorado. The Monument encompasses 4,726 acres, preserving hundreds of prehistoric sites that dot the landscape around the twin
spires known as Chimney Rock and Companion Rock. Go south on HWY 151 off US[masked] miles west of Pagosa Springs, about 6 hrs' drive from Denver.
Sat. Aug. 10: Daily Tour We will be taking the Guided walking tour at 9:30 am. Walking tours at Chimney Rock National Monument begin at the Visitor Center. Guests drive in their own vehicles to the High Mesa following a tour guide. The drive is two and a half miles up a winding gravel road to the upper parking lot where the walking tours begin. Visitors on the walking tour should wear comfortable, sturdy walking shoes and a hat. Bring water, sunscreen, and bug repellant. Be aware, this is high desert country with possible hot summer days. Dress for the outdoors, and don't forget your camera!
Pueblo Trail The unimproved Pueblo trail is 2/3 mile round trip with a 200-foot elevation gain, topping out at 7,600-feet elevation. The Pueblo Trail features a multi-family dwelling, now known as Ridge House, and several crater mounds (unexcavated structures). At the top, Chimney Rock's Chacoan-style Great House Pueblo is spectacular against the backdrop of the San Juan Mountains.
Great Kiva Trail The one-third-mile Great Kiva trail is paved and ADA accessible. Guests will see a 44-foot diameter excavated great kiva, probably a community gathering place for those who lived at the site 1000 years ago. Also on this easy trail, there's an excavated pit house, a typical residence of the ancient ones.
Itinerary: Fri. 6p.m.: cold picnic at Chimney Rock; astronomy program 7pm-10pm w/minimal walking. Camp @ Ute NFS Camp, north side US 160 1 mile west of Chimney Rock turn; RVs ok but no hookups: has outhouses & pump water & bear-proof trash dumpsters. Probably no fires but stoves ok. You may arrive any time after 6p.m. Thurs. Aug. 8 to set up & join Sierra Club for additional Fri. hike; however, the Sierra Club trip officially starts at 6 p.m. Fri. at Chimney Rock Picnic Grounds. [Back up campground in case Ute is full=Lower Piedra, located 9 miles west of Ute and on north side of US 160.]
Sat. 9:30a.m: full tour of archeological site.
afternoon: short guided hike along Piedra thru gorgeous pine/fir forest!
7pm: potluck at campground
Sun. a.m.: after breakfast: SC trip officially ends.
Weather: Chimney Rock is 7903' elevation. Camping is bit lower, but while days will be warm-hot, evenings can get chilly. Dress accordingly.
Chimney Rock Pet policy While service animals are welcome, pets are not permitted on tours. Shaded kennels are available at the Visitor Center on a first-come, first-served basis. Pets must be leashed while in campground.
Car pooling: in the interests of facilitating the logistics of some outings, it is customary that participants make car pooling arrangements. The Sierra Club does not have insurance for car pooling arrangements and assumes no liability for them. Car pooling, ride sharing or anything similar is strictly a private arrangement among the participants. Participants assume the risks associated with this travel. It is customary for car pooling participants to share or reimburse gas expenses to the driver. When you register, there is an option you can check that will share your contact info with others.
Because this is an overnight trip, you may also agree to form tenting [tent spaces are limited] and cooking groups. We are permitted only 2 tents but up to 8 persons/site.
Liability Waivers: In order to participate on one of the Sierra Club's outings, you will need to sign a liability waiver at the site. This waiver is a document that releases the Sierra Club and its leaders from liability for events that may happen on an outing. By signing a liability waiver, the participant acknowledges the risks involved in the outing or activity, assumes those risks, and agrees to not hold the Sierra Club and its leaders responsible for injuries and/or death related to the outing or activity.
RMC Sierra Club encourages all hikers to buyCORSAR Cards. If you are rescued by dedicated volunteer search and rescue teams, costs are often in the thousands of dollars. By purchasing a CORSAR card you are contributing to the Search and Rescue Fund, which will reimburse these teams for costs incurred in your search and rescue. Many local Sierra Club groups, including this trip leader, sell these cards &the vendor's portion goes toward their work. Let leader know if you want card. http://www.colorado.gov/cs/Satellite/DOLA-Main/CBON/1251592090523 THE "TEN ESSENTIALS" - The Sierra Club recommends the following be carried at all times when hiking in the backcountry: Navigation (map and compass)Fire (matches, lighters, and accelerant)Signaling Device (whistle or mirror)Sun Protection (sunglasses and sunscreen)Insulation (extra clothing) Nutrition (extra food)Hydration (extra water and tablets)Illumination (headlamp/flashlight)First aid kit Emergency Shelter (tarp, bivy sack, tent)Repair kit, (tools, knife, cord, tape)
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- Miss Florida 2017 stripped of crown days after win - US Weekly
- Lindsay Lohan steps out amid relationship drama - TMZ
- Was Taylor Swift snubbed by the VMAs? - Gossip Cop
- Rachel Platten sings "Fight Song" with lots of stars - Just Jared Jr
- Farrah Abraham sizzles in a revealing bikini - Radar
- New pics from the Clooneys' Italian summer - Lainey Gossip
- Fox News snubs major DNC moment - The Hollywood Reporter
15 June 2014 at 2:41 PM
Kate Middleton Brings Prince George to William's Polo Match!
About this photo set: Kate Middleton (aka Catherine, Duchess of Cambridge) holds her adorable, 10-month-old son Prince George while attending a match at the Cirencester Park Polo Club… Read More Here
Photo #: 3135961
Posted to Kate Middleton, Prince George, Prince Harry, Prince William
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Video Industry News Video Company News Technology Industry News Technology Company News Novelty Industry News Novelty Company News Gay Industry News Gay Company News Legal Industry News All Company News
Released: Jan 21st, 2008
Running Time: 100 Min.
Companies: Hundies, Pure Play Media
Distribution Companies: Pure Play Media
Cast: Delete Me 4, Todd (I), Crissy Moon, Ellie Idol, Lexi Belle, Howard, Jocelyn Jayden, Kylie King
Critical Rating: AAA 1/2
Genre: Gonzo
Internet-based studio Hundies does a great job of recruiting pretty young girls to star in their scenes. From super-slender Rachel Starr to cute pixie Ellie Idol, the girls are fun to watch as they interview prior to performing.
Jocelyn Jayden, for example, is a chatty blonde from Virginia who turned to porn after being fired from her Hyundai dealership job for fucking many of the sales guys. While it's most likely Jayden is embellishing her story, her retelling of the experience gives the viewer a glimpse into her personality.
The editing, however, does hinder the flow of each scene.
Retailing: Stock in your teen section.