Environmental governance in China: Interactions between the state and "nonstate actors".

In the West, limited government capacity to solve environmental problems has triggered the rise of a variety of "nonstate actors" to supplement government efforts or provide alternative mechanisms for addressing environmental issues. How does this development - along with our efforts to understand it - map onto environmental governance processes in China? China's efforts to address environmental issues reflect institutionalized governance processes that differ from parallel western processes in ways that have major consequences for domestic environmental governance practices and the governance of China "going abroad." China's governance processes blur the distinction between the state and other actors; the "shadow of the state" is a major factor in all efforts to address environmental issues.

Prognostic factors in metastatic cutaneous squamous cell carcinoma of the head and neck.

Metastatic cutaneous squamous cell carcinoma (SCC) of the head and neck poses a significant therapeutic challenge due to its aggressive biologic behavior. We conducted a retrospective study of 71 patients-58 men and 13 women, aged 28 to 88 years (mean: 71)-who had been treated at our university-affiliated tertiary care medical center for metastatic cutaneous SCC over a 15-year period. In addition to demographic data, we compiled and analyzed information on tumor characteristics, the site and extent of metastasis, treatment, follow-up, and outcome.

Post-laryngectomy voice rehabilitation: comparison of primary and secondary tracheoesophageal puncture.

Background: Voice restoration following total laryngectomy is an important part of patients' rehabilitation and long-term quality of life.

Objectives: To evaluate the long-term outcome of indwelling voice prostheses inserted during (primary procedure) or after (secondary procedure) total laryngectomy.

Methods: The study group included 90 patients who underwent total laryngectomy and tracheoesophageal puncture (TEP) with placement of voice prosthesis at a tertiary medical center during the period 1990-2008.

Obstructive sleep apnea after radial forearm free flap reconstruction of the oral tongue.

Objectives/hypothesis: To determine whether radial forearm free flap reconstruction of the tongue after partial glossectomy is associated with obstructive sleep apnea.

Study Design: Retrospective case series.

Methods: Fifteen patients (5 men, 10 women) treated for tongue cancer in 2006-2010 by partial glossectomy and immediate radial forearm free flap reconstruction completed the Epworth Sleepiness Scale and underwent polysomnographic studies.

Cancer of the head and neck region in solid organ transplant recipients.

Background: Solid organ recipients are at an increased risk of developing various malignancies. We investigated the incidence, clinical features, and outcome of patients diagnosed with head and neck cancer after organ transplantation.

Methods: A retrospective analysis was undertaken of patients who underwent solid organ transplantation (kidney, liver, lung, heart) treated at our institution from 1992 to 2010.

Cost-effectiveness analysis of primary arthroscopic stabilization versus nonoperative treatment for first-time anterior glenohumeral dislocations.

Purpose: The purpose of this study was to compare the cost-effectiveness of initial observation versus surgery for first-time anterior shoulder dislocation.

Methods: The clinical scenario of first-time anterior glenohumeral dislocation was simulated using a Markov model (where variables change over time depending on previous states). Nonoperative outcomes include success (no recurrence) and recurrence; surgical outcomes include success, recurrence, and complications of infection or stiffness.

Prognostic significance of nodal ratio in cutaneous squamous cell carcinoma of the head and neck.

The TNM classification is not specific for head and neck skin cancer and makes no allowance for disease extent. Studies have shown that the relative number of metastatic-to-examined lymph nodes, termed the Nodal ratio, is a reliable independent prognosticator in several types of cancer. The study was designed as a retrospective analysis in a university affiliated tertiary care center setting.

Laryngeal carcinoma in nonsmoking patients.

Objectives: Smoking is a known risk factor for laryngeal carcinoma. We sought to describe the clinicopathologic characteristics and outcomes of nonsmoking patients with laryngeal carcinoma.

Methods: Of 1,443 patients treated for laryngeal carcinoma between 1960 and 2006, 55 (3.

Sentinel node-guided evaluation of drainage patterns for melanoma of the helix of the ear.

The head and neck region, and especially the ear and its helix, is notorious for its ambiguous pattern of lymphatic drainage. Therefore, the primary nodal drainage basins in melanoma of the helix of the ear are often unpredictable. The aim of the study was to examine the value of sentinel lymph node biopsy in melanoma of the helix of the ear and to describe the natural history of the disease.

A biodegradable button to augment suture attachment in rotator cuff repair.

Recent experimental studies suggest that the use of suture anchors for rotator cuff tear (RCT) repair transfers the "weak link" to the suture-tendon interface where failure occurs as the sutures cut through the tendon. The purpose of this study was to evaluate the effect of using a suture augmentation button on the fixation strength of rotator cuff tendon repair. A 1.

Sentinel node guided surgery for melanoma in the head and neck region.

Sentinel lymph node biopsy may be more technically challenging for melanoma of the head and neck compared with other locations because of the complex lymphatic drainage patterns. This study demonstrates the value of sentinel node biopsy for head and neck melanoma, and highlights the associated difficulties. Thirty consecutive patients with primary cutaneous melanoma of the head and neck (n=26) or draining to the neck (n=4) underwent preoperative lymphoscintigraphy.

Expression of MMP-9, TIMP-1, CD-34 and factor-8 as prognostic markers for squamous cell carcinoma of the tongue.

Squamous cell carcinoma (SCC) of the tongue is characterized by an unpredictable course, ranging from relatively benign to a high degree of locally aggressive growth and metastasis. Treatment guidelines have been developed according to TNM stage, but they do not always accurately predict clinical outcome. The aim of the present study was to evaluate the expression of the matrix metalloproteinases (MMPs) that degrade the extracellular matrices, their inhibitors (TIMPs), and angiogenic factors (factor-8 and CD-34) in tumor cells and to correlate these findings with the clinicopathological features and patient outcome.

Revision parathyroidectomy guided by intraoperative radionuclide imaging.

Background: Technetium-99m sestamibi scintigraphy has become one of the most popular techniques for localization of the parathyroid gland after failure of primary neck exploration.

Objective: To examine the efficacy of sestamibi with the hand-held gamma ray detecting probe for the identification of parathyroid adenomas during revision parathyroidectomy.

Methods: We reviewed six cases of probe-assisted neck exploration for parathyroid lesions following unsuccessful primary exploration.

Transoral reconstruction of the mobile tongue, using radial forearm free flap.

Tongue resection has significant influence on the patient's quality of life, because it interferes with masticatory and speech functions and affects facial aesthetics. To avoid the disadvantages of the traditional lip-splitting used to approach partial tongue reconstruction for resection (40% of the tongue or more), we recommend a completely transoral approach, with the radial forearm free flap as a donor flap. Between 1999-2001, the suggested technique was applied in 11 patients with squamous-cell carcinoma of the mobile tongue.