The recently developed Local Climate Zones (LCZ) classification system was initially not designed for mapping, but to classify temperature observation sites. Nevertheless, as a need arose to ...characterize areas based on their distinct thermal climate, utilizing LCZ classes for mapping was a logical step. The objectives of this study were (1) to develop GIS methods for the calculation of different surface parameters required for LCZ classification; (2) to identify and delineate the LCZ types within the study area using the calculated parameters; and (3) to select re presentative station sites for an urban monitoring network utilizing both the mapped LCZs and the modelled mean annual temperature surplus pattern in Szeged, Hungary. The study used remotely sensed data, maps and GIS databases of the city and its surroundings. The basic area of calculation was the lot area polygon, consisting of a building and its close vicinity. Adjoining polygons classified with identical or similar parameters were merged to obtain LCZs of appropriate size. As a result, 6 built LCZ types were distinguished in the studied urban area. The temperature pattern in the city was provided by an empirical model. The siting of stations took both the LCZ map and the modelled temperature pattern into account. The lampposts onto which the stations were to be mounted were determined by field surveys. The bias between the temperature pattern interpolated from the 24 stations and the initially estimated distribution by the model was found to be small. LCZ mapping is the first step in the development of urban climate maps (UCMs) that carry information on the spatial distribution and magnitude of the heat stress (thermal loads) and on the ventilation ability (dynamical potential) of different urban areas.
In this study, an urban roughness mapping method is presented on the example of a large study area in Szeged, Hungary, as an example. With this roughness mapping procedure, the potential ventilation ...paths of the city can be located. Our calculations of the roughness parameters are based on a 3D building database; however, this new approach using the lot area polygons provides more detailed results than other recent studies. The detected ventilation paths could play a significant role in the development of the urban heat island circulation and result in the reduction of air pollution in the central parts of the city. Based on our results, we can mark out the areas where the city government should keep the advantages of the ventilation paths considering the human comfort aspects of the urban climate, thus providing important input data for urban planning procedures.
AbstractObjectiveTo characterize temporal trends in treatment patterns for oropharyngeal carcinoma, and to evaluate the emerging role of surgical therapy in the era of transoral robotic surgery ...(TORS). MethodsPatients with oropharynx cancer between 2004 and 2016 identified using the National Cancer Database. Demographics and primary treatment modalities were obtained. Treatment was classified as surgery alone, surgery with radiation/chemotherapy, or primary radiation/chemotherapy. Annual distribution of cases treated by the various modalities was tabulated by site and early (I/II) versus late (III/IV) stage disease (AJCC 7th edition). The “TORS era” was defined as beginning in 2010. Results149,534 patients were identified. The majority (56.8%) were treated with radiation ± chemotherapy. 53,069 patients had surgery as part of treatment, 72.6% (N = 38,533) of which received adjuvant therapy. 5293 TORS procedures were performed between 2010 and 2016 with trends away from open and other endoscopic procedures. Despite a 31.0% increase in the number of cases treated surgically from before TORS (2009) to 2016, the percentage of cases treated surgically decreased from 35.0% to 32.7%, with a 44.2% increase in non-surgical therapy. Increases in the percentage of patients treated surgically were observed for base of tongue tumors (24.3–25.2%) and early stage disease (59.9–62.2%). ConclusionDespite the increase in the overall number of patients with oropharynx cancer, the percentages of patients treated surgically remains relatively stable. Notable increases were observed for base of tongue tumors and early stage disease.
Peripheral blood oxygen monitoring via chemoreceptors in the carotid body (CB) is an integral function of the autonomic cardiorespiratory regulation. The presence of the purinergic P2Y12 receptor ...(P2Y12R) has been implicated in CB; however, the exact role of the receptor in O
sensing and signal transduction is unknown.
The presence of P2Y12R was established by immunoblotting, RT qPCR and immunohistochemistry. Primary glomus cells were used to assess P2Y12R function during hypoxia and hypercapnia, where monoamines were measured by HPLC; calcium signal was recorded utilizing OGB-1 and N-STORM Super-Resolution System. Ingravescent hypoxia model was tested in anaesthetized mice of mixed gender and cardiorespiratory parameters were recorded in control and receptor-deficient or drug-treated experimental animals.
Initially, the expression of P2Y12R in adult murine CB was confirmed. Hypoxia induced a P2Y12R-dependent release of monoamine transmitters from isolated CB cells. Receptor activation with the endogenous ligand ADP promoted release of neurotransmitters under normoxic conditions, while blockade disrupted the amplitude and duration of the intracellular calcium concentration. In anaesthetised mice, blockade of P2Y12R expressed in the CB abrogated the initiation of compensatory cardiorespiratory changes in hypoxic environment, while centrally inhibited receptors (i.e. microglial receptors) or receptor-deficiency induced by platelet depletion had limited influence on the physiological adjustment to hypoxia.
Peripheral P2Y12R inhibition interfere with the complex mechanisms of acute oxygen sensing by influencing the calcium signalling and the release of neurotransmitter molecules to evoke compensatory response to hypoxia. Prospectively, the irreversible blockade of glomic receptors by anti-platelet drugs targeting P2Y12Rs, propose a potential, formerly unrecognized side-effect to anti-platelet medications in patients with pulmonary morbidities.
The objective was to examine the impact of travel distance on stage of presentation and treatment choices in head and neck squamous cell carcinoma in the rural setting.
6029 cases diagnosed from 2002 ...to 2011 were obtained from the state cancer registry. Travel time was calculated to the nearest academic medical centers, otolaryngologist, and radiation treatment facilities. Multivariate logistic regression was used to examine the association of travel time with stage of presentation as well as the likelihood of appropriate therapy after adjustment for other demographic variables.
Patients in the highest quartile for travel distance to academic centers were 33% more likely to present with early stage disease (p = 0.02), and 42% more likely to receive appropriate surgical therapy for oral cavity cancer. Patients were 70% more likely to receive appropriate surgery if they were farthest from the nearest radiation center (p = 0.03). Proximity to otolaryngology care was not significant.
Increased travel distance to academic medical centers is associated with increased likelihood of proper therapy for surgically treated tumors of the head and neck. Impact on these findings on improvements in access to care is discussed.
This case report describes the use of trans-oral robotic surgery (TORS) for the excision of a combined laryngocele. Mixed or combined laryngoceles extend from the supraglottic larynx through the ...thyrohyoid membrane into the neck. Surgical excision for these benign lesions often requires combined external (transcervical) and internal (transoral endoscopic) approaches which carry significant morbidity. We present the case of a 37-year-old male who was diagnosed with a large laryngopyocele and was subsequently managed with a transoral excision using the da Vinci Si surgical robot system. The procedure was without complications and the patient was discharged on the second post-operative day on a full liquid diet supplemented with a naso-gastric feeding tube. Postoperative stroboscopy performed 1 month later demonstrated a well-healed hemilarynx and a normal voice. The patient is on a regular diet and now over three years removed from surgery with no evidence of recurrence. We conclude that TORS is an effective tool in the management of benign laryngeal pathology including combined laryngoceles, resulting in reduced morbidity.
Abstract In cardiac surgery, postoperative low cardiac output has been shown to correlate with increased rates of organ failure and mortality. Catecholamines have been the standard therapy for many ...years, although they carry substantial risk for adverse cardiac and systemic effects, and have been reported to be associated with increased mortality. On the other hand, the calcium sensitiser and potassium channel opener levosimendan has been shown to improve cardiac function with no imbalance in oxygen consumption, and to have protective effects in other organs. Numerous clinical trials have indicated favourable cardiac and non-cardiac effects of preoperative and perioperative administration of levosimendan. A panel of 27 experts from 18 countries has now reviewed the literature on the use of levosimendan in on-pump and off-pump coronary artery bypass grafting and in heart valve surgery. This panel discussed the published evidence in these various settings, and agreed to vote on a set of questions related to the cardioprotective effects of levosimendan when administered preoperatively, with the purpose of reaching a consensus on which patients could benefit from the preoperative use of levosimendan and in which kind of procedures, and at which doses and timing should levosimendan be administered. Here, we present a systematic review of the literature to report on the completed and ongoing studies on levosimendan, including the newly commenced LEVO-CTS phase III study ( NCT02025621 ), and on the consensus reached on the recommendations proposed for the use of preoperative levosimendan.
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