Chenani‐Nashri Tunnel, the longest road tunnel in India: the “Himalayan challenge” for design in heterogeneous rock masses

The 9 km long Chenani‐Nashri Tunnel, currently under construction, is the longest road tunnel in India and is part of the planned four‐lane widening of the NH‐1A between Udhampur and Banihal in the state of Jammu and Kashmir. Bypassing the existing NH‐1A from km 89 to km 130, the tunnel crosses a sub‐Himalayan formation with a maximum overburden of 1,050 m. With an escape tunnel running parallel to the main tunnel, excavation is performed by Leighton‐Welspun Contractors using the drill and blast method. Geodata Engineering (GDE) is providing consultancy services for detailed design and construction supervision including 3D‐geotechnical monitoring. Back‐analyses of already‐excavated sections are performed to better understand the behaviour of the heterogeneous rock mass in which the tunnels are excavated. The numerical models are fed with the actual geological and geomechanical conditions encountered during excavation and the monitoring results. The 3D‐monitoring system, specially implemented by GDE for this project, has played a key role in understanding the real rock mass behaviour, allowing the highlighting of potential risks, selecting the correct tunnel support class, checking of the effectiveness of countermeasures, identification of the tunnel stretches in which the final lining needs to be reinforced and providing cost‐effective solutions to speed‐up the construction process.

Global and regional factors responsible for the drowning of the Central Apennine Chattian carbonate platforms

This work discusses and interprets the factors responsible for the Oligocene–Miocene drowning of the Central Apennine platform deposits, based on facies and stable‐isotope analyses of two representative stratigraphic sections. The Mediterranean carbonate platforms were affected during the Oligocene–Miocene boundary by a carbonate production crisis that was induced by global factors and amplified by regional events, such as volcanic activity. The positive δ 13 C shift observed in the studied sections corresponds to vertical facies changes reflecting the evolution from middle carbonate ramp to outer ramp‐hemipelagic depositional environments. This drowning event is recorded not only in the Apennine platforms, but also in other Mediterranean platforms such as in southern Apulia, Sicily and Malta, and outside the Mediterranean Basin. The ~24–23.5 Ma Mi‐1 glacial maximum may have had a significant influence on this drowning event because it was associated with high rates of accumulation of continent‐derived sediments. The increased continental weathering and runoff sustained high trophic conditions. These probably were a consequence of the Aquitanian–Burdigalian volcanic activity in the Central‐Western Mediterranean, that may have led to an increase in nutrient content in seawater and an increase in atmospheric and marine CO 2 concentrations. Copyright © 2014 John Wiley & Sons, Ltd.

The role of CXCR4 in highly malignant human gliomas biology: Current knowledge and future directions

Given the extensive histomorphological heterogeneity of high‐grade gliomas, in terms of extent of invasiveness, angiogenesis, and necrosis and the poor prognosis for patients despite the advancements made in therapeutic management. The identification of genes associated with these phenotypes will permit a better definition of glioma heterogeneity, which may ultimately lead to better treatment strategies. CXCR4, a cell surface chemokine receptor, is implicated in the growth, invasion, angiogenesis and metastasis in a wide range of malignant tumors, including gliomas. It is overexpressed in glioma cells according to tumor grade and in glioma tumor initiating cells. There have been various reports suggesting that CXCR4 is required for tumor proliferation, invasion, angiogenesis, and modulation of the immune response. It may also serve as a prognostic factor in characterizing subsets of glioblastoma multiforme, as patients with CXCR4‐positive gliomas seem to have poorer prognosis after surgery. Aim of this review was to analyze the current literature on biological effects of CXCR4 activity and its role in glioma pathogenesis. A better understanding of CXCR4 pathway in glioma will lead to further investigation of CXCR4 as a novel putative therapeutic target. GLIA 2014;62:1015–1023

All things to all people? The provision of outreach by community mental health teams for older people in England: findings from a national survey

Objective The objective of this study is to identify the extent of outreach activity community mental health teams (CMHTs) for older people provide to mainstream services in light of the recommendations of the National Dementia Strategy. In particular, to determine the range of settings in receipt of support; to specify the form of this activity; to identify the professionals involved; and to explore the factors associated with the provision of such support. Methods A self‐administered postal questionnaire was sent to all CMHTs in England. The reported arrangements were categorised and reviewed according to a taxonomy of outreach developed from the literature. Results Three hundred and seventy six (88%) of the CMHTs responded. Although nearly all teams undertook some outreach work, much of this was informal in nature. Nevertheless, the vast majority of teams had some formal outreach arrangements in at least one mainstream setting. Just less than three‐quarters provided support (most typically education) to care homes, approaching half centres to day centres, and over a third to primary care practices, social services teams, home care providers and general hospitals, respectively. Link workers were the favoured means of supporting general hospital staff. Community mental health nurses were most commonly involved in providing outreach, and larger teams were more likely than smaller teams to have formalised arrangements. A significant minority of teams expressed concerns about their capacity to provide effective services. Conclusions The findings suggest that both more resources and more evidence will be needed to meet the National Dementia Strategy's aim of improving care for older people with mental health problems in mainstream settings. Copyright © 2013 John Wiley & Sons, Ltd.

Screening for cognitive and affective dysfunction in patients suspected of mild cognitive impairment

Objective Disturbances of affect expression and perception, as well as accuracy of predicting memory difficulties, have been reported in various brain dysfunctional groups. Screening tests of higher cerebral functions seldom sample these dimensions. The goal of this study was to determine if patients with mild cognitive impairment (MCI) of the amnestic type would demonstrate impairments in these domains, as well as show expected memory deficits. Methods Thirty‐nine French‐speaking patients with a clinical diagnosis of MCI were compared with 39 age‐ and education‐matched normal functioning individuals on the French translation of the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS). Patients and controls also made subjective ratings regarding their cognitive and affective functioning in everyday life. Results Patients with MCI performed significantly worse than controls on the BNIS subtests sampling memory, orientation, affect expression and perception, and accurate prediction of memory performance. They did not differ on other subtests of the BNIS, as predicted. Poor self‐awareness (i.e., inaccurate prediction of the number of words one could recall after distraction) correlated with self‐reported deficits in several areas of cognitive and affective functioning. Conclusion This sample of MCI patients demonstrated disturbances not only in memory but also in self‐awareness and affect expression and perception on the BNIS. These dimensions should be included in the neuropsychological assessment of patients suspected of MCI. Copyright © 2014 John Wiley & Sons, Ltd.

Comprehensive morphometry of subcortical grey matter structures in early‐stage Parkinson's disease

Previous imaging studies that investigated morphometric group differences of subcortical regions outside the substantia nigra between non‐demented Parkinson's patients and controls either did not find any significant differences, or reported contradictory results. Here, we performed a comprehensive morphometric analysis of 20 cognitively normal, early‐stage PD patients and 19 matched control subjects. In addition to relatively standard analyses of whole‐brain grey matter volume and overall regional volumes, we examined subtle localized surface shape differences in striatal and limbic grey matter structures and tested their utility as a diagnostic marker. Voxel‐based morphometry and volumetric comparisons did not reveal significant group differences. Shape analysis, on the other hand, demonstrated significant between‐group shape differences for the right pallidum. Careful diffusion tractography analysis showed that the affected parts of the pallidum are connected subcortically with the subthalamic nucleus, the pedunculopontine nucleus, and the thalamus and cortically with the frontal lobe. Additionally, microstructural measurements along these pathways, but not along other pallidal connections, were significantly different between the two groups. Vertex‐wise linear discriminant analysis, however, revealed limited accuracy of pallidal shape for the discrimination between patients and controls. We conclude that localized disease‐related changes in the right pallidum in early Parkinson's disease, undetectable using standard voxel‐based morphometry or volumetry, are evident using sensitive shape analysis. However, the subtle nature of these changes makes it unlikely that shape analysis alone will be useful for early diagnosis. Hum Brain Mapp 35:1681–1690, 2014 . © 2013 Wiley Periodicals, Inc.

Progression of brain atrophy in the early stages of Parkinson's disease: A longitudinal tensor‐based morphometry study in de novo patients without cognitive impairment

The presence of brain atrophy and its progression in early Parkinson's disease (PD) are still a matter of debate, particularly in patients without cognitive impairment. The aim of this longitudinal study was to assess whether PD patients who remain cognitively intact develop progressive atrophic changes in the early stages of the disease. For this purpose, we employed high‐resolution T1‐weighted MR imaging to compare 22 drug‐naïve de novo PD patients without cognitive impairment to 17 age‐matched control subjects, both at baseline and at three‐year follow‐up. We used tensor‐based morphometry to explore the presence of atrophic changes at baseline and to compute yearly atrophy rates, after which we performed voxel‐wise group comparisons using threshold‐free cluster enhancement. At baseline, we did not observe significant differences in regional atrophy in PD patients with respect to control subjects. In contrast, PD patients showed significantly higher yearly atrophy rates in the prefrontal cortex, anterior cingulum, caudate nucleus, and thalamus when compared to control subjects. Our results indicate that even cognitively preserved PD patients show progressive cortical and subcortical atrophic changes in regions related to cognitive functions and that these changes are already detectable in the early stages of the disease. Hum Brain Mapp 35:3932–3944, 2014 . © 2014 Wiley Periodicals, Inc .

Transoral laser microsurgery followed by radiation therapy for oropharyngeal tumors: The mayo clinic arizona experience

Background The purpose of this study was to report the treatment outcomes of patients with advanced oropharyngeal cancer treated with transoral laser microsurgery (TLM) followed by radiation therapy (RT) at Mayo Clinic in Arizona. Methods A retrospective study of 80 patients treated from January 1, 2000 to November 7, 2011 was performed. All patients had stage III/IV oropharyngeal tumors and underwent TLM with neck dissection. Adjuvant RT was then given. Thirty‐seven patients received concurrent adjuvant chemotherapy. The primary outcome was locoregional control. Results Median follow‐up was 47.3 months (range, 9.7–139.2 months). The 3‐year locoregional control, recurrence‐free survival, and overall survival rates were 98.6% (95% confidence interval [CI], 91% to 100%), 91.1% (95% CI, 81% to 96%), and 93.7% (95% CI, 84% to 98%), respectively. There were a total of 5 treatment failures, 1 regional and 4 distant. Twenty‐six patients underwent neck only RT with exclusion of the primary site. Conclusion TLM followed by RT for advanced oropharyngeal cancer results in excellent locoregional control rates. © 2013 Wiley Periodicals, Inc. Head Neck 36: 220–225, 2014

Primary orbital eosinophilic angiocentric fibrosis with intranasal extension

Background Eosinophilic angiocentric fibrosis is a chronic, idiopathic disorder that usually involves the upper respiratory tract and features progressive submucosal perivascular fibrosis of unknown etiology. To our knowledge, only 5 cases of eosinophilic angiocentric fibrosis with primary orbital involvement have been reported. Methods and Results We report the case of a 46‐year‐old man with right proptosis and lateral globe displacement caused by a primary eosinophilic angiocentric fibrosis extending from the orbit into the anterior ethmoid. The nasal extension of the lesion helped in establishing the correct diagnosis. Conclusion Physicians involved in the treatment of orbital pathologies should be familiar with this entity, because it may manifest as an intraorbital mass growing primarily or secondly into the orbit. The clinical manifestations of eosinophilic angiocentric fibrosis with orbital involvement often mimic other more common ophthalmological diseases. Biopsies are necessary for diagnosis and treatment planning, although cures are usually of palliative effect. © 2013 Wiley Periodicals, Inc. Head Neck 36 : E8–E11, 2014

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