ABSTRACT
BACKGROUND: Chronic lymphocytic leukaemia (CLL) is associated with an increased incidence and aggressiveness of skin cancers, particularly cutaneous squamous cell carcinoma (cSCC), but little is known about cSCC incidence in Australasian CLL patients. AIM: In this retrospective study, we analysed the incidence of cSCC in patients seen at a tertiary hospital in New Zealand (NZ). METHODS: We retrospectively assessed the clinical history and histology data of CLL patients (n = 371) who presented to the Haematology Department, Christchurch Hospital, NZ during the period 1996-2015. Baseline characteristics, incidence of second cancers, treatment details and overall survival were analysed. RESULTS: During follow-up (median = 11.8 years), 221 second cancers were recorded in 88 patients. Of these cancers, 185 were cSCC, removed from 61 patients. In 56% of these patients, >1 cSCC was removed, and the majority of cSCC occurred following the treatment for CLL. The cumulative incidence of a first cSCC was 11% at 5 years, whereas the cumulative incidence of a subsequent cSCC was 88% at 5 years. The incidence of cSCC in male patients was threefold higher than that reported for the general NZ population. CONCLUSION: NZ CLL patients have a high incidence of cSCC relative to the levels observed in the general population, which are themselves among the highest in the world. The careful monitoring of CLL patients is warranted, particularly those who have a progressive disease or have had a first cSCC removed.
Subject(s)
Carcinoma, Squamous Cell/epidemiology , Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology , Neoplasms, Second Primary/epidemiology , Skin Neoplasms/epidemiology , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/therapy , Female , Follow-Up Studies , Humans , Incidence , Leukemia, Lymphocytic, Chronic, B-Cell/pathology , Leukemia, Lymphocytic, Chronic, B-Cell/therapy , Male , Middle Aged , Neoplasm Recurrence, Local , Neoplasms, Second Primary/pathology , Neoplasms, Second Primary/therapy , New Zealand/epidemiology , Retrospective Studies , Skin Neoplasms/pathology , Skin Neoplasms/therapyABSTRACT
Stricter regulations on volatile organic compounds and hazardous air pollutants have increased the demand for abatement technologies. Biofiltration, a process in which contaminated air is passed through a biologically active bed, can be used to remove these pollutants from air streams. In this study, a fungal vapor-phase bioreactor containing a strain of the dimorphic black yeast, Exophiala lecanii-corni, was used to treat a gas stream contaminated with toluene. The maximum toluene elimination capacity in short-term tests was 270 g m(-3) h(-1), which is 2 to 7 times greater than the toluene elimination capacities typically reported for bacterial systems. The fungal bioreactor also maintained toluene removal efficiencies of greater than 95% throughout the 175-day study. Harsh operating conditions such as low moisture content, acidic biofilms, and nitrogen limitation did not adversely affect performance. The fungal bioreactor also rapidly reestablished high toluene removal efficiencies after an 8-day shutdown period. These results indicate that fungal bioreactors may be an effective alternative to conventional abatement technologies for treating high concentrations of pollutants in waste gas streams.
Subject(s)
Bioreactors/microbiology , Exophiala/metabolism , Toluene/metabolism , Air Pollutants/metabolism , Biomass , Biotransformation/physiology , Carbon Dioxide/metabolism , Hydrogen-Ion Concentration , Quaternary Ammonium Compounds , VolatilizationABSTRACT
Change is a regular occurrence in the healthcare system, but individuals might see it as difficult, stressful and frustrating. Implementing change with strategic planning and support for staff is an effective method. This article describes the change process for introducing a formal education programme for phlebotomy staff in an acute paediatric and maternity NHS trust hospital.
