Hammer sound elicited tinnitus in car body repair worker cured by stapedial tenotomy – A case report

Abnormal auditory sensations or tinnitus caused by abnormal middle ear muscle contraction are extremely rare and uncomfortable for patients. A 67-year-old man who performed paint and body work for cars presented at our hospital with complaint of an audible and annoying abnormal sound that was synchronous with the striking of his hammer against the metal of the car body during his work. The patient reported that the sound was audible of left ear with a split-second delay after his hammer struck the metal.

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Improving performance evaluation of health, safety and environment management system by combining fuzzy cognitive maps and relative degree analysis

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Publication date: August 2016
Source:Safety Science, Volume 87
Author(s): Jian Kang, Jixin Zhang, Jiancun Gao
The performance evaluation of health, safety and environment management system (HSE-MS) is considered to be an effective way to eliminate out dated measures and help managers adopt proper rectification measures. The objective of this paper is to design a weight distribution model for HSE-MS performance evaluation, the importance of which stems from the current lack of integrated approaches for interpreting and ranking HSE-MS performance evaluation elements. Initially, Fuzzy Cognitive Maps (FCM) is adopted to illustrate the direct and indirect effects of HSE-MS elements on system performance indicators, and the results of FCM are used to develop leading factors helpful for decision making in an intensive management system. Then, the weight distribution from FCM is amended by Relative Degree Analysis (RDA), the aim of which is to combine the advantages of quantitative and qualitative knowledge-driven methods. Finally, the level of HSE-MS performance is obtained and analyzed. The whole performance evaluation framework highlights the potential correlations of evaluation elements as well as expert opinions, which will improve the reasonability of the HSE-MS performance evaluation.

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Modeling tunnel construction risk dynamics: Addressing the production versus protection problem

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Publication date: August 2016
Source:Safety Science, Volume 87
Author(s): Fan Wang, Lieyun Ding, Peter E.D. Love, David J. Edwards
Accidents remain a pervasive problem in tunnel construction. A major contributor to these accidents is a construction contractor’s inability to determine an appropriate trade-off between production and protection goals. Thus, to examine this issue, a systemic model, which integrates System Dynamics (SD), Bayesian Belief Networks (BBN) and smooth Relevance Vector Machines (sRVM) (referred to as ‘Organizational Risk Dynamics Observer’ (ORDO)), is developed to investigate the mechanism of risk migration that resulted from the interactions between a contractor’s organizational and technical systems. The model is demonstrated on an urban metro tunnel project that was constructed in Wuhan, China. It is revealed that when attention focused upon production, the propensity for minor accidents to occur increased, which triggered management to focus on protection. This increasing emphasis on protection may have muted the safe systems of working as incidents may be unreported, which can inhibit the motivation for safety awareness. When coupled with an increase in production pressure, the tunneling project could become prone to experiencing a major accident. Based on the results, it is suggested that the whole organization must continue to foster a sound safety culture by resisting production pressure at the expense of compromising safety.

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The spread of hepatitis C virus genotype 1a in North America: a retrospective phylogenetic study

Publication date: Available online 30 March 2016
Source:The Lancet Infectious Diseases
Author(s): Jeffrey B Joy, Rosemary M McCloskey, Thuy Nguyen, Richard H Liang, Yury Khudyakov, Andrea Olmstead, Mel Krajden, John W Ward, P Richard Harrigan, Julio S G Montaner, Art F Y Poon
BackgroundThe timing of the initial spread of hepatitis C virus genotype 1a in North America is controversial. In particular, how and when hepatitis C virus reached extraordinary prevalence in specific demographic groups remains unclear. We quantified, using all available hepatitis C virus sequence data and phylodynamic methods, the timing of the spread of hepatitis C virus genotype 1a in North America.MethodsWe screened 45 316 publicly available sequences of hepatitis C virus genotype 1a for location and genotype, and then did phylogenetic analyses of available North American sequences from five hepatitis C virus genes (E1, E2, NS2, NS4B, NS5B), with an emphasis on including as many sequences with early collection dates as possible. We inferred the historical population dynamics of this epidemic for all five gene regions using Bayesian skyline plots.FindingsMost of the spread of genotype 1a in North America occurred before 1965, and the hepatitis C virus epidemic has undergone relatively little expansion since then. The effective population size of the North American epidemic stabilised around 1960. These results were robust across all five gene regions analysed, although analyses of each gene separately show substantial variation in estimates of the timing of the early exponential growth, ranging roughly from 1940 for NS2, to 1965 for NS4B.InterpretationThe expansion of genotype 1a before 1965 suggests that nosocomial or iatrogenic factors rather than past sporadic behavioural risk (ie, experimentation with injection drug use, unsafe tattooing, high risk sex, travel to high endemic areas) were key contributors to the hepatitis C virus epidemic in North America. Our results might reduce stigmatisation around screening and diagnosis, potentially increasing rates of screening and treatment for hepatitis C virus.FundingThe Canadian Institutes of Health Research, Michael Smith Foundation for Health Research, and BC Centre for Excellence in HIV/AIDS.

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Apportioning blame in the North American hepatitis C virus epidemic

Publication date: Available online 30 March 2016
Source:The Lancet Infectious Diseases
Author(s): Anne C Spaulding, Lesley S Miller

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Risk factors for complications after pharyngolaryngectomy with total esophagectomy

Abstract

Background

Pharyngolaryngectomy with total esophagectomy (PLTE) is an effective surgical treatment for synchronous or metachronous hypopharyngeal or laryngeal cancer and thoracic esophageal cancer, although it is more invasive than esophagectomy and total pharyngolaryngectomy. The aim of this study was to identify risk factors for complications after PLTE.

Methods

From November 2002 to December 2014, a total of 8 patients underwent PLTE at the Shizuoka Cancer Center Hospital, Shizuoka, Japan. We investigated the clinicopathological characteristics, surgical procedures, and postoperative complications of these patients.

Results

Of the 8 patients, 5 underwent one-stage PLTE and 3 underwent staged PLTE. There was no mortality in this study. Two cases of tracheal necrosis, two of anastomotic leakage, and one of ileus were observed as postoperative complications. Two patients who underwent one-stage PLTE with standard mediastinal lymph node dissection developed tracheal necrosis and severe anastomotic leakage.

Conclusion

One-stage PLTE and standard mediastinal lymph node dissection were identified as the risk factors for severe postoperative complications. Staged PLTE or transhiatal esophagectomy should be considered when PLTE is performed and standard mediastinal lymph node dissection should be avoided when one-stage PLTE is performed with transthoracic esophagectomy.

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Treatment outcomes of cervical esophageal cancer patients

Abstract

Background

Although systemic therapy for esophageal carcinoma has advanced dramatically over the last several decades, the consensus of treatment for cervical esophageal carcinoma (CESCC) has yet remained controversial.

Patients and methods

We analyzed 56 CESCC patients who underwent various therapies in our hospital between January 2000 and December 2013.

Results

Thirteen cases underwent surgery without neo-adjuvant therapy (NAT), while 20 cases underwent surgery after NAT. Definitive chemo-radiotherapy (dCRT) was administered to 23 cases. Five cases underwent salvage surgery after dCRT. Three-year overall survival rates (3-year-OS) were similar between the NAT and dCRT groups (53.3 vs. 51.5 %). These cases were divided into clinical T2/T3 and T4 cases, and a differential analysis was performed. The 3-year-OS achieved by NAT in T2/T3 cases (90.9 %) tended to be better than that by dCRT (62.5 %). In contrast, the 3-year-OS achieved by NAT in T4 cases (12.5 %) tended to be worse than that by dCRT (34.2 %). The prognosis of CESCC patients undergoing salvage surgery after dCRT was very good, with 3-year-OS of 100 % in T2/T3 cases and 66.6 % in T4 cases. A comparative analysis of postoperative complications was performed between CESCC patients undergoing surgery after neo-adjuvant chemotherapy and chemo-radiotherapy to evaluate the operative risk for CESCC patients after CRT. The rates of postoperative complications were similar between these groups.

Conclusion

We analyzed the treatment outcomes of CESCC patients by dividing them according to the clinical tumor invasion depth. Salvage surgery may be an effective therapy for CESCC patients and needs to be considered.

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Mixed spindle and epithelioid cell type gastrointestinal stromal tumor of the esophagus: a case report

Abstract

Fewer than 1 % of gastrointestinal stromal tumors (GISTs) are of the esophagus. This report describes a 63-year-old female diagnosed with mixed spindle/epithelioid cell GIST of the esophagus. She was admitted to our hospital with symptoms of nausea and hematemesis. Preoperative imaging showed a huge submucosal tumor in the lower thoracic and abdominal esophagus. Pathologic examination of an endoscopic biopsy sample suggested squamous cell carcinoma. She underwent subtotal esophagectomy and reconstruction with a gastric tube. Postoperative pathological diagnosis revealed a mixed spindle/epithelioid cell type GIST. The tumor measured 8 × 6 cm, with 30–50 mitotic counts per high power field, immunohistochemical positivity for C-kit (CD117) and CD34 and high risk by modified Fletcher classification. Adjuvant chemotherapy with imatinib mesylate was started 3 months after surgery. Preoperative pathological examination, including staining for CD117 and CD34, of biopsy samples of apparently stromal tumors may be required to rule out rare subtypes of GIST.

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IFC/ Editorial Board

Publication date: 15 March 2016
Source:Experimental Cell Research, Volume 342, Issue 2

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Comparison of retrospective PET and MRI-DWI (PET/MRI-DWI) image fusion with PET/CT and MRI-DWI in detection of cervical and endometrial cancer lymph node metastases

Abstract

Objectives

The aim of this study was to compare the accuracy of retrospective image fusion of PET/MRI-DWI with that of PET/CT and MRI-DWI alone in detecting metastatic lymph nodes in patients with cervical and endometrial carcinoma.

Materials and methods

Twenty-seven patients with endometrial (n = 14) and cervical (n = 13) cancer who had undergone preoperative MRI-DWI and PET/CT for staging were retrospectively evaluated. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PET/CT, MRI-DWI, and PET/MRI-DWI image fusion were calculated on a per-patient basis and on a per-node basis. Histopathological and follow-up imaging results were used as the gold standard.

Results

On a per-patient basis PET/MRI-DWI had the same sensitivity (87.5 %), specificity (84.2 %), diagnostic accuracy (85.1 %), PPV (70 %), and NPV (94.1 %) as PET-CT, but on a per-node basis PET/MRI-DWI showed better sensitivity (89 vs 70.2 %), specificity (91.6 vs 90.5 %), diagnostic accuracy (91.2 vs 87 %), PPV (68.7 vs 60.4 %), and NPV (97.6 vs 93.6 %) than PET-CT. Comparison of the areas under the ROC curves for the detection of metastatic lymph nodes demonstrated a non-significant difference (p = 0.055) between PET/CT and fused PET/MRI-DWI.

Conclusion

PET/MRI-DWI may be a valuable technique for N-staging patients with endometrial and cervical cancer, but more studies are needed to investigate its potential clinical utility.

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