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OBJECTIVE: Sudden hearing loss is a common presentation to ENT. In the authors' practice, patients often wait many weeks for formal hearing testing. This study aimed to assess whether a tablet-based hearing test, hearTest, could aid clinical decision-making within secondary care ENT. METHOD: This was a multi-centre, prospective, non-randomised study to assess the feasibility, usability and accuracy of hearTest. RESULTS: In the sample, hearTest was shown to be an acceptable method of testing for hearing loss by both patients and clinicians. The 0.5-4 kHz range had an average clinical agreement rate of 95.1 per cent when compared with formal pure tone audiometry, deeming it an accurate test to diagnose hearing loss. CONCLUSION: The authors propose that hearTest can be used within ENT as a clinical decision support tool when manual audiometry is not immediately available. Within the authors' practice, hearTest is used to aid diagnosis and management of sudden sensorineural hearing loss.
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Sordera , Pérdida Auditiva Sensorineural , Pérdida Auditiva Súbita , Humanos , Atención Secundaria de Salud , Estudios Prospectivos , Pérdida Auditiva Súbita/diagnóstico , Pérdida Auditiva Súbita/terapia , Audiometría de Tonos Puros/métodos , AudiciónRESUMEN
BACKGROUND: Coronavirus disease 2019 imposed dramatic changes on ENT service delivery. Pre-pandemic, such changes would have been considered potentially unsafe. This study outlines the impact of lockdown on the incidence and management of ENT emergencies at a large UK centre. METHODS: After modification of pre-pandemic guidelines, ENT emergency referrals data during the UK lockdown were prospectively captured. A comparative analysis was performed with retrospective data from a corresponding period in 2019. RESULTS: An overall reduction (p < 0.001) in emergency referrals (n = 119) and admissions (n = 18) occurred during the lockdown period compared to the 2019 period (432 referrals and 290 admissions). Specifically, there were reduced admission rates for epistaxis (p < 0.0001) and tonsillar infection (p < 0.005) in the lockdown period. During lockdown, 90 per cent of patients requiring non-dissolvable nasal packing were managed as out-patients. CONCLUSIONS: Coronavirus disease 2019 compelled modifications to pre-pandemic ENT guidelines. The enforced changes to emergency care appear to be safe and successfully adopted. Arguably, the measures have both economic and patient-related implications post-coronavirus disease 2019 and during future similar pandemics and lockdowns.
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Atención Ambulatoria/estadística & datos numéricos , COVID-19 , Epistaxis/terapia , Hospitalización/estadística & datos numéricos , Absceso Peritonsilar/terapia , Tonsilitis/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Oído , Enfermedades del Oído/epidemiología , Enfermedades del Oído/terapia , Urgencias Médicas , Servicio de Urgencia en Hospital , Epistaxis/epidemiología , Femenino , Cuerpos Extraños/epidemiología , Cuerpos Extraños/terapia , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Otorrinolaringológicas/epidemiología , Enfermedades Otorrinolaringológicas/terapia , Absceso Peritonsilar/epidemiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/terapia , Guías de Práctica Clínica como Asunto , Derivación y Consulta/tendencias , SARS-CoV-2 , Tonsilitis/epidemiología , Reino Unido/epidemiología , Adulto JovenRESUMEN
We report on the measurement of the γpâJ/ψp cross section from E_{γ}=11.8 GeV down to the threshold at 8.2 GeV using a tagged photon beam with the GlueX experiment. We find that the total cross section falls toward the threshold less steeply than expected from two-gluon exchange models. The differential cross section dσ/dt has an exponential slope of 1.67±0.39 GeV^{-2} at 10.7 GeV average energy. The LHCb pentaquark candidates P_{c}^{+} can be produced in the s channel of this reaction. We see no evidence for them and set model-dependent upper limits on their branching fractions B(P_{c}^{+}âJ/ψp) and cross sections σ(γpâP_{c}^{+})×B(P_{c}^{+}âJ/ψp).
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Neoplasias del Cuello Uterino , Abdomen , Quimioterapia Adyuvante , Femenino , Humanos , Histerectomía , Reino UnidoRESUMEN
BACKGROUND: There is increased proportional mortality from Parkinson's disease amongst livestock farmers. The hypokinesia of Parkinson's disease has been linked to Helicobacter pylori. H. suis is the most common zoonotic helicobacter in man. AIM: To compare the frequency of H. suis, relative to H. pylori, in gastric biopsies of patients with idiopathic parkinsonism (IP) and controls from gastroenterology services. METHODS: DNA extracts, archived at a Helicobacter Reference Laboratory, from IP patient and gastroenterology service biopsies were examined anonymously for H. suis, using species-specific RT-PCR. RESULTS: Relative risk of having H. suis in 60 IP patients compared with 256 controls was 10 times greater than that of having H. pylori. In patients with IP and controls, respectively, frequencies of H. suis were 27 (exact binomial 95% C.I. 15, 38) and 2 (0, 3)%, and of H. pylori, 28 (17, 40) and 16 (12, 21)%. Excess of H. suis in IP held when only the antral or corporal biopsy was considered. Of 16 IP patients with H. suis, 11 were from 19 with proven H. pylori eradication, 3 from 17 pre-H. pylori eradication, 2 from 24 H. pylori culture/PCR-negative. Frequency was different between groups (P = 0.001), greatest where H. pylori had been eradicated. Even without known exposure to anti-H. pylori therapy, H. suis was more frequent in IP patients (5/41) than in controls (1/155) (P = 0.002). Partial multilocus sequence typing confirmed that strains from IP patients (6) and control (1) differed from RT-PCR standard strain. CONCLUSIONS: Greater frequency of H. suis in idiopathic parkinsonism appears exaggerated following H. pylori eradication. Multilocus sequence testing comparison with porcine strains may clarify whether transmission is from pigs/porcine products or of human-adapted, H. suis-like, bacteria.
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Infecciones por Helicobacter/microbiología , Helicobacter heilmannii/aislamiento & purificación , Helicobacter pylori/aislamiento & purificación , Trastornos Parkinsonianos/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , ADN Bacteriano/análisis , Femenino , Infecciones por Helicobacter/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Trastornos Parkinsonianos/epidemiología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Riesgo , Adulto JovenRESUMEN
The beauty to up quark coupling constant |V(ub)| can be extracted from B â ρ e+ ν(e) combined with the form factors for D â K* e+ ν(e) and B â V â+ â- and D â ρ e+ ν(e). Using the entire CLEO-c ψ(3770) â DD event sample, corresponding to an integrated luminosity of 818 pb(-1) and approximately 5.4×10(6) DD events, we measure the form factors for the decays D0 â ρ- e+ ν(e) and D+ â ρ0 e+ ν(e) for the first time and the branching fractions with improved precision. A four-dimensional unbinned maximum likelihood fit determines the form factor ratios to be V(0)/A1(0)=1.48±0.15±0.05 and A2(0)/A1(0)=0.83±0.11±0.04. Assuming Cabibbo-Kobayashi-Maskawa unitarity, the known D meson lifetimes, and our measured branching fractions we obtain the form factor normalizations A1(0), A2(0), and V(0). We also present a measurement of the branching fraction for D+ â ω e+ ν(e) with improved precision.
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The electromagnetic structure of the lightest hadrons, proton, pion, and kaon is studied by high-precision measurements of their form factors for the highest timelike momentum transfers of |Q2|=s=14.2 and 17.4 GeV2. Data taken with the CLEO-c detector at sqrt[s]=3.772 and 4.170 GeV, with integrated luminosities of 805 and 586 pb(-1), respectively, have been used to study e+ e- annihilations into π+ π-, K+ K-, and pp. The dimensional counting rule prediction that at large Q2 the quantity Q2F(Q2) for pseudoscalar mesons is nearly constant, and should vary only weakly as the strong coupling constant αS(Q2) is confirmed for both pions and kaons. However, the measurements are in strong quantitative disagreement with the predictions of the existing quantum chromodynamics-based models. For protons, it is found that the timelike form factors continue to remain nearly twice as large as the corresponding spacelike form factors measured in electron elastic scattering, in significant violation of the expectation of their equality at large Q2. Further, in contrast to pions and kaons, a significant difference is observed between the values of the corresponding quantity |Q4|G(M)(|Q2|)/µ(p) for protons at |Q2|=14.2 and 17.4 GeV2. The results suggest the constancy of |Q2|G(M)(|Q2|)/µ(p), instead, at these large |Q2|.
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The data for 9.3 million Υ(2S) and 20.9 million Υ(1S) taken with the CLEO III detector have been used to study the radiative population of states identified by their decay into 26 different exclusive hadronic final states. In the Υ(2S) decays, an enhancement is observed at a ~5σ level at a mass of 9974.6±2.3(stat)±2.1(syst) MeV. It is attributed to η(b)(2S) and corresponds to the Υ(2S) hyperfine splitting of 48.7±2.3(stat)±2.1(syst) MeV. In the Υ(1S) decays, the identification of η(b)(1S) is confirmed at a ~3σ level with M[η(b)(1S)] in agreement with its known value.
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OBJECTIVE: To estimate the risk of primary epithelial ovarian cancer (EOC) and slow growing borderline or Type I and aggressive Type II EOC in postmenopausal women with adnexal abnormalities on ultrasound. METHODS: This was a prospective cohort study in the ultrasound group of the UK Collaborative Trial of Ovarian Cancer Screening of postmenopausal women with ultrasound-detected abnormal adnexal (unilocular, multilocular, unilocular solid and multilocular solid, solid) morphology on their first scan. Women were followed up through the national cancer registries and by postal questionnaires. Absolute risks of EOC and borderline, Type I and Type II EOC within 3 years of initial scan were calculated. RESULTS: Of 48 053 women who underwent ultrasound examination and had complete scan data, 4367 (9.1% (95% CI, 8.8-9.3%)) had abnormal adnexal morphology. Median follow-up was 7.09 (25(th) -75(th) centiles, 6.03-7.92) years. Forty-seven (32 borderline or Type I, 15 Type II) were diagnosed with EOC. The overall absolute risk of EOC associated with abnormal adnexal morphology was 1.08% (95% CI, 0.79-1.43%); for borderline and Type I it was 0.73% (95% CI, 0.5-1.03%); and for Type II it was 0.34% (95% CI, 0.33-0.79%). In the subgroup (n = 741) with solid elements (unilocular solid, multilocular solid and solid) overall absolute risk was 4.45% (95% CI, 3.08-6.20%), for borderline and Type I it was 3.1% (95% CI, 1.9-4.6%) and for Type II it was 1.3% (95% CI, 0.6-2.4%). 11 982 women had both ovaries visualized and normal annual scans throughout the 3-year follow-up period. In this group, no borderline or Type I and eight Type II cancers were diagnosed. CONCLUSION: Asymptomatic postmenopausal women with ultrasound-detected adnexal abnormalities with solid elements have a 1 in 22 risk for EOC. Despite the higher prevalence of Type II EOC, the risk of borderline or Type I cancer in women with ultrasound abnormalities seems to be higher than does the risk of Type II cancer. This has important immediate implications for patients with incidental adnexal findings as well as for any future ultrasound-based screening.
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Anexos Uterinos/anomalías , Anexos Uterinos/diagnóstico por imagen , Detección Precoz del Cáncer/métodos , Neoplasias Glandulares y Epiteliales/diagnóstico por imagen , Neoplasias Glandulares y Epiteliales/epidemiología , Neoplasias Ováricas/diagnóstico por imagen , Neoplasias Ováricas/epidemiología , Ovario/diagnóstico por imagen , Anciano , Carcinoma Epitelial de Ovario , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Posmenopausia , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Ultrasonografía , Reino Unido/epidemiologíaRESUMEN
Using 586 pb(-1) of e+ e- collision data at E(c.m.) = 4170 MeV, produced at the Cornell Electron Storage Ring collider and collected with the CLEO-c detector, we observe the process e+ e- â π+ π- h(c)(1P). We measure its cross section to be 15.6±2.3±1.9±3.0 pb, where the third error is due to the external uncertainty on the branching fraction of ψ(2S) â π0 h(c)(1P), which we use for normalization. We also find evidence for e+ e- â ηh(c)(1P) at 4170 MeV at the 3σ level and see hints of a rise in the e+ e- â π+ π- h(c)(1P) cross section at 4260 MeV.
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BACKGROUND: The work in this study appraised photodynamic treatment (PDT) as a treatment method for vulval intraepithelial neoplasia (VIN) using a novel bioadhesive patch to deliver aminolevulinic acid. An analysis of changes in expression of apoptotic and cell cycle proteins (p53, p21, Mdm2, Blc-2, Bax, Ki-67) in response to PDT was evaluated. METHODS: PDT was performed using non-laser light, either as a one or two-cycle treatment, with clinical and pathological assessment following after 6 weeks. Twenty-three patients with 25 VIN lesions underwent 49 cycles of PDT. Patches were designed to conform to uneven vulval skin and contained 38 mg cm(-2) aminolevulinic acid. Assessment was carried out at 6 weeks post-treatment. Patient-based treatment assessment, along with clinical and pathological changes, were monitored. Immunohistochemical staining was used to elucidate a possible biomolecular basis for induced cellular changes. RESULTS: Most patients (52%) reported a symptomatic response, with normal pathology restored in 38% of lesions. The patch was easy to apply and remove, causing minimal discomfort. Fluorescence inspection confirmed protoporphyrin accumulation. Pain during implementation of PDT was problematic, necessitating some form of local analgesia. Changes in expression of cell cycle and apoptotic-related proteins suggested involvement of apoptotic pathways. Down regulation of p21 and inverse changes in Bcl-2 and Bax were key findings. CONCLUSION: Treatment of VIN lesions using a novel bioadhesive patch induced changes in cell cycle and apoptotic proteins in response to PDT with possible utilisation of apoptotic pathways. The efficacy of PDT in treating VIN could be improved by a better understanding of these apoptotic mechanisms, the influence of factors, such as HPV status, and of the need for effective pain management.
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Ácido Aminolevulínico/administración & dosificación , Portadores de Fármacos/química , Displasia del Cuello del Útero/tratamiento farmacológico , Neoplasias de la Vulva/tratamiento farmacológico , Administración Tópica , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Fármacos Fotosensibilizantes/administración & dosificación , Adhesivos Tisulares/química , Resultado del Tratamiento , Neoplasias de la Vulva/patología , Displasia del Cuello del Útero/patologíaRESUMEN
Using 2.45x10;{7} psi(2S) decays collected with the CLEO-c detector at the Cornell Electron Storage Ring we present the most precise measurements of magnetic dipole transitions in the charmonium system. We measure B(psi(2S)-->gammaeta_{c})=(4.32+/-0.16+/-0.60)x10;{-3}, B(J/psi-->gammaeta_{c})/B(psi(2S)-->gammaeta_{c})=4.59+/-0.23+/-0.64, and B(J/psi-->gammaeta_{c})=(1.98+/-0.09+/-0.30)%. We observe a distortion in the eta_{c} line shape due to the photon-energy dependence of the magnetic dipole transition rate. We find that measurements of the eta_{c} mass are sensitive to the line shape, suggesting an explanation for the discrepancy between measurements of the eta_{c} mass in radiative transitions and other production mechanisms.
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Using a 281 pb-1 data sample collected at the psi(3770) resonance with the CLEO-c detector at the Cornell Electron Storage Ring, we report the first observation of D+ --> etae + nue. We also set upper limits for D+ --> eta'e + nue and D + --> varphie + nue that are about 2 orders of magnitude more restrictive than those obtained by previous experiments.
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Using a total of 2.74 x 10(7) decays of the psi(2S) collected with the CLEO-c detector, we present a study of chi(cJ)-->gammaV, where V=rho(0), omega, phi. The transitions chi(c1)-->gammarho(0 and chi(c1)-->gammaomega are observed with B(chi(c1)-->gammarho(0))=(2.43+/-0.19+/-0.22) x 10(-4) and B(chi(c1)-->gammaomega)=(8.3+/-1.5+/-1.2) x 10(-5). In the chi(c1)-->gammarho(0) transition, the final state meson is dominantly longitudinally polarized. Upper limits on the branching fractions of other chi(cJ) states to light vector mesons are presented.
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A precision measurement of the mass of the h_{c}(1P1) state of charmonium has been made using a sample of 24.5x10;{6} psi(2S) events produced in e;{+}e;{-} annihilation at the Cornell Electron Storage Ring (CESR). The reaction used was psi(2S)-->pi;{0}h_{c}, pi;{0}-->gammagamma, h_{c}-->gammaeta_{c}, and the reaction products were detected in the CLEO-c detector. Data have been analyzed both for the inclusive reaction and for the exclusive reactions in which eta_{c} decays are reconstructed in 15 hadronic decay channels. Consistent results are obtained in the two analyses. The averaged results of the present measurements are M(h_{c})=3525.28+/-0.19(stat.)+/-0.12(syst.) MeV, and B(psi(2S)-->pi;{0}h_{c})xB(h_{c}-->gammaeta_{c})=(4.19+/-0.32+/-0.45)x10;{-4}. Using the ;{3}P_{J} centroid mass, DeltaM_{hf}(1P) identical withM(chi_{cJ})-M(h_{c})=+0.02+/-0.19+/-0.13 MeV.
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By using 1.8x10{6} DDpairs, we have measured B(D{0}-->pi{-}e{+}nu{e})=0.299(11)(9)%, B(D{+}-->pi{0}e{+}nu{e})=0.373(22)(13)%, B(D{0}-->K{-}e{+}nu{e})=3.56(3)(9)%, and B(D{+}-->K{0}e{+}nu{e})=8.53(13)(23)% and have studied the q;{2} dependence of the form factors. By combining our results with recent lattice calculations, we obtain |V{cd}|=0.217(9)(4)(23) and |V{cs}|=1.015(10)(11)(106).
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Using e+e--->Ds*-Ds+ data collected near the peak Ds production energy, Ecm=4170 MeV, with the CLEO-c detector, we present the first observation of the decay Ds+-->pn. We measure a branching fraction B(Ds+-->pn)=(1.30+/-0.36(-0.16)+0.12)x10(-3). This is the first observation of a charmed meson decaying into a baryon-antibaryon final state.
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AIMS: Traditional management of advanced ovarian carcinoma is surgical debulking followed by chemotherapy; however, there is an increasing tendency for neoadjuvant chemotherapy followed by surgery. The morphology of ovarian carcinoma following chemotherapy often differs markedly from native tumour. This study aimed to compare the immunophenotype of post-chemotherapy ovarian carcinomas with that of untreated tumour. METHODS: Post-chemotherapy ovarian carcinomas (n = 16) were stained with a range of antibodies. In six cases, pre-chemotherapy core biopsies were also stained; all were high-grade serous carcinomas. Antibodies used in the study were CK7, CA125, WT1, ER, PR, p53, p16, p63 and MIB1. RESULTS: In eight post-treatment cases, there was minimal or no morphological response to chemotherapy, and in eight there was a significant response (in two additional cases, no residual tumour was identified). All pre-chemotherapy biopsies showed diffuse positivity of the tumour cells with CK7, CA125 and WT1. ER, p53 and p16 were diffusely positive in five, four and three cases respectively. One case was focally PR positive, and all were p63 negative. MIB1 staining was high; all but one case exhibited a proliferation index of >60%. Post-chemotherapy tumours exhibited a similar immunophenotype: diffuse positivity with CK7 in all cases and with CA125, WT1, ER, p53 and p16 in the majority, an immunophenotype in keeping with a serous carcinoma. All were negative with p63, and all but two with PR. The MIB1 proliferation index was lower in those cases exhibiting a significant morphological response, and p53 was less likely to be positive in cases with minimal or no response. CONCLUSIONS: The immunophenotype of post-chemotherapy ovarian carcinomas is very similar to that of native untreated tumours, illustrating that CK7, CA125, WT1, ER, p53 and p16 may be of value in identifying residual tumour cells and in subtyping the neoplasm if a pre-chemotherapy biopsy has not been obtained.
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Biomarcadores de Tumor/metabolismo , Cistadenocarcinoma Seroso , Neoplasias Ováricas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biopsia , Quimioterapia Adyuvante , Cistadenocarcinoma Seroso/tratamiento farmacológico , Cistadenocarcinoma Seroso/metabolismo , Cistadenocarcinoma Seroso/patología , Femenino , Humanos , Técnicas para Inmunoenzimas , Inmunofenotipificación , Proteínas de Neoplasias/metabolismo , Neoplasia Residual/metabolismo , Neoplasia Residual/patología , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/inmunología , Neoplasias Ováricas/metabolismo , Neoplasias Ováricas/patologíaRESUMEN
OBJECTIVES: Endometrial polyps are a common cause of abnormal uterine bleeding. Rarely, a hyperplasia, either complex or atypical in type, is identified within a polyp in a biopsy or polypectomy specimen. Currently, it is not known whether the hyperplasia is likely to be confined to the polyp or also involve nonpolypoid endometrium. We aim to assess the likelihood of hyperplasia being confined to an endometrial polyp. DESIGN: In this study, we identified 32 women from pathology archives in whom endometrial hyperplasia was present within a polyp. The number of endometrial polyps during the study period was 1031 and therefore 3.1% of all endometrial polyps diagnosed during the study period contained a hyperplasia. SETTING: A major teaching hospital in the UK. METHODS: The biopsies were retrieved from the pathology archives of Royal Group of Hospitals, Belfast, between 2000 and 2006. We traced any follow-up biopsy or hysterectomy specimens to evaluate the status of the surrounding endometrium. RESULTS: The hyperplasias were complex (n = 23) or atypical (n = 9) in type. In 14 of 27 (52%) women in whom nonpolypoid endometrium was available for histological evaluation, either on the original biopsy or in a follow-up specimen, hyperplasia involved the nonpolypoid endometrium, and in three other women, hyperplasia was present in a polyp in follow-up specimens. Women with atypical hyperplasia in a polyp were slightly more likely to have hyperplasia in the surrounding endometrium than those with complex hyperplasia. CONCLUSIONS: Our study illustrates that the risk of endometrial hyperplasia in a polyp concurrently involving nonpolypoid endometrium is significant. We suggest a strategy for the management of women with hyperplasia identified within an endometrial polyp in a biopsy or polypectomy specimen.
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Hiperplasia Endometrial/patología , Neoplasias Endometriales/patología , Endometrio/patología , Pólipos/patología , Adulto , Anciano , Anciano de 80 o más Años , Biopsia/métodos , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Using data collected with the CLEO III detector at the CESR e+e- collider, we report on a first observation of the decay Upsilon(3S)-->tau+tau-, and precisely measure the ratio of branching fractions of Upsilon(nS), n=1, 2, 3, to tau+tau- and mu+mu- final states, finding agreement with expectations from lepton universality. We derive absolute branching fractions for these decays, and also set a limit on the influence of a low mass CP-odd Higgs boson in the decay of the Upsilon(1S).