bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship of intertwin crown–rump length discrepancy to chorionicity, fetal demise and birth‐weight discordance
Authors: Bhide A. , Sankaran S. , Sairam S. , Papageorghiou A. T. , Thilaganathan B.
Published: June 2009

Objectives

To study the frequency and clinical significance of crown–rump length (CRL) discrepancy at 11–14 weeks of gestation in twin pregnancies from an unselected population.

Methods

This was a retrospective analysis of all twin pregnancies that underwent a routine 11–14‐week scan at a large teaching hospital. Fetal loss was defined as fetal demise of one or both twins after 14 weeks.

Results

A total of 507 twin pregnancies were studied; 382 (75.3%) were dichorionic and 125 (24.7%) were monochorionic twins. The discrepancy in CRL was expressed as a percentage of the CRL of the larger twin. The 95th and 99th centile for CRL discrepancy in twins was 12.2% and 19.3%, respectively. The discrepancy in CRLs in monochorionic and dichorionic twins was not significantly different (Mann–Whitney U = 22 406, P = 0.302). In 39 twin pairs, there was subsequent intrauterine death of one or both twins. Fetal loss was more common in monochorionic twins (24/125) than in dichorionic twins (15/382) (chi‐square = 30.9, P < 0.001). In monochorionic twins, the discrepancy in CRLs in the 24 cases with subsequent loss was significantly greater than in the 101 twin pairs with no subsequent loss (Mann–Whitney U = 896, P = 0.048). The discrepancy in CRLs in 15 dichorionic twins with subsequent loss was not different from that in the 367 twins with no loss (Mann–Whitney U = 2116.5, P = 0.129). The CRL discrepancy was significantly correlated with birth‐weight discordance in twins (Spearman's rho = 0.128, P = 0.006). However, this was due to a significant correlation in dichorionic twins (Spearman's rho = 0.127, P = 0.016) but not in monochorionic twins (Spearman's rho = 0.145, P = 0.14).

Conclusions

Fetal loss is significantly associated with discrepancy in CRL at the 11–14‐week scan in monochorionic twins and discordance in birth weights is significantly associated with discrepancy in CRL in dichorionic twins. However, intertwin CRL discrepancy is of limited value in screening for these adverse events. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd.
Quality of nuchal translucency measurements in The Netherlands: a quantitative analysis
Authors: Koster M. P. H. , Wortelboer E. J. , Engels M. A. J. , Stoutenbeek P. H. , Elvers L. H. , Visser G. H. A. , Schielen P. C. J. I.
Published: June 2009

Objective

The Dutch Centre for Population Research has specified quality demands for nuchal translucency (NT) measurement in The Netherlands. We performed an analysis of the quality of NT measurement in 2005–2006 and its influence on screening performance.

Methods

This was a retrospective study of records of NT measurements (n = 27 738) obtained between January 2005 and December 2006 retrieved from the Dutch National Institute for Public Health and the Environment (RIVM). The performance of each individual operator was analyzed with regard to the quality standards, which involved calculation of operator‐specific median NT‐multiples of the median (MoM) values. For the entire population of operators, a curve was determined describing the relationship between crown–rump length and NT. Detection rates (DR) and false‐positive rates (FPR) for Down syndrome were modeled with this new curve and compared to those originally obtained using previously published reference data.

Results

Only 22% of all operators met the quality requirement of performing more than 150 NT measurements per year. However, no relationship was found between the number of measurements per operator and their median NT‐MoM. The mean of all operator‐specific median NT‐MoM values was 0.94 (target value 1.0). Overall, operators with The Fetal Medicine Foundation certificate measured a significantly higher median NT‐MoM (mean of operator‐specific medians, 0.98) as compared to the non‐certified operators (0.92). During the study period, the monthly median NT‐MoM of all operators rose steadily, from 0.86 in January 2005 to 0.96 in December 2006. Recalculation of the risk for Down syndrome after adjusting the reference NT medians using our own data led to a modeled 4% increase in DR at a 5% FPR.

Conclusion

Improved monitoring of NT measurement put into effect during the study period seems to have led to an improvement in the accuracy of measurements. Strict quality demands, continued monitoring and scrupulous evaluation of individual operators is likely to lead to an even better performance. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd.
Dynamics of offshore floating wind turbines—model development and verification
Authors: Jonkman Jason M.
Published: June 2009

The vast deepwater wind resource represents a potential to use offshore floating wind turbines to power much of the world with renewable energy. Many floating wind turbine concepts have been proposed, but dynamics models, which account for the wind inflow, aerodynamics, elasticity and controls of the wind turbine, along with the incident waves, sea current, hydrodynamics, and platform and mooring dynamics of the floater, were needed to determine their technical and economic feasibility. This work presents the development of a comprehensive simulation tool for modelling the coupled dynamic response of offshore floating wind turbines and the verification of the simulation tool through model‐to‐model comparisons. The fully coupled time‐domain aero‐hydro‐servo‐elastic simulation tool was developed with enough sophistication to address limitations of previous studies and has features required to perform loads analyses for a variety of rotor‐nacelle assembly, tower, support platform and mooring system configurations. The developed hydrodynamics module accounts for linear hydrostatic restoring; non‐linear viscous drag; the added‐mass and damping contributions from linear wave radiation, including free‐surface memory effects; and the incident‐wave excitation from linear diffraction in regular or irregular seas. The developed mooring line module is quasi‐static and accounts for the elastic stretching of an array of homogenous taut or slack catenary lines with seabed interaction. The hydrodynamics module, the moorings module, and the overall simulation tool were tested by comparing to results of other models, including frequency‐domain models. The favourable results of all the verification exercises provided confidence to perform more thorough analyses. Copyright © 2009 John Wiley & Sons, Ltd.
Modelling and measuring flow and wind turbine wakes in large wind farms offshore
Authors: Barthelmie R. J. , Hansen K. , Frandsen S. T. , Rathmann O. , Schepers J. G. , Schlez W. , Phillips J. , Rados K. , Zervos A. , Politis E. S. , Chaviaropoulos P. K.
Published: June 2009

Average power losses due to wind turbine wakes are of the order of 10 to 20% of total power output in large offshore wind farms. Accurately quantifying power losses due to wakes is, therefore, an important part of overall wind farm economics. The focus of this research is to compare different types of models from computational fluid dynamics (CFD) to wind farm models in terms of how accurately they represent wake losses when compared with measurements from offshore wind farms. The ultimate objective is to improve modelling of flow for large wind farms in order to optimize wind farm layouts to reduce power losses due to wakes and loads.

The research presented is part of the EC‐funded UpWind project, which aims to radically improve wind turbine and wind farm models in order to continue to improve the costs of wind energy. Reducing wake losses, or even reduce uncertainties in predicting power losses from wakes, contributes to the overall goal of reduced costs. Here, we assess the state of the art in wake and flow modelling for offshore wind farms, the focus so far has been cases at the Horns Rev wind farm, which indicate that wind farm models require modification to reduce under‐prediction of wake losses while CFD models typically over‐predict wake losses. Further investigation is underway to determine the causes of these discrepancies. Copyright © 2009 John Wiley & Sons, Ltd.
Orotic aciduria and uridine monophosphate synthase: A reappraisal
Authors: Bailey C. J.
Published: June 2009

Three subtypes of hereditary orotic aciduria are described in the literature, all related to deficiencies in uridine monophosphate synthase, the multifunctional enzyme that contains both orotate: pyrophosphoryl transferase and orotidine monophosphate decarboxylase activities. The type of enzyme defect present in the subtypes has been re‐examined by steady‐state modelling of the relative outputs of the three enzymic products, uridine monophosphate, urinary orotic acid and urinary orotidine. It is shown that the ratio of urinary outputs of orotidine to orotate provides a means of testing for particular forms of enzyme defect. It is confirmed that the type I defect is caused by loss of uridine monophosphate synthase activity. Cells and tissue of type I cases have a residual amount of activity that is qualitatively unchanged: the relative rates of the transferase and decarboxylase do not differ from those of wild‐type enzyme. The single claimed case of type II, thought to be due to specific inactivation of orotidine monophosphate decarboxylase, is shown to have a product spectrum inconsistent with that claim. It is proposed that this type II form does not differ sufficiently to be accepted as separate from type I. The third subtype, hereditary orotic aciduria without megaloblastic anaemia, occurs in two cases. It has the product spectrum expected of a defect in orotidine monophosphate decarboxylase. This form is the only one that appears to have a qualitatively different uridine monophosphate synthase. The possibility that orotidine monophosphate may control flux through the pyrimidine biosynthesis pathway in hereditary orotic aciduria is discussed.
IgM monoclonal component associated with type I Gaucher disease resolved after enzyme replacement therapy: A case report
Authors: Martinez‐Redondo C. , Ortuño F. J. , Lozano M. L. , Jerez A. , del Mar Osma M. , Giraldo P. , Vicente V.
Published: June 2009

The frequency of monoclonal gammopathy of undetermined significance (MGUS) is higher in patients with type I Gaucher disease (GD I) than in the general population. Although enzyme replacement therapy is effective in the control of the disease, its effect on MGUS is still controversial. We present the case of a 65‐year‐old woman with extensive GD I associated with IgM MGUS, in whom enzyme replacement therapy succeeded in eradicating the monoclonal component. This observation further supports the idea that enzyme replacement therapy decreases the chronic antigenic stimulation responsible for gammopathies in Gaucher disease.
A Facile Strategy for In Situ Core-Template-Functionalizing Siliceous Hollow Nanospheres for Guest Species Entrapment
Authors: Wang Jun , Gao Xin , Yang Xianyan , Gan Yilai , Weng Wenjian , Gou Zhongru
Published: June 2009

The shell wall-functionalized siliceous hollow nanospheres (SHNs) with functional molecules represent an important class of nanocarriers for a rich range of potential applications. Herein, a self-templated approach has been developed for the synthesis of in situ functionalized SHNs, in which the biocompatible long-chain polycarboxylates (i.e., polyacrylate, polyaspartate, gelatin) provide the framework for silica precursor deposition by simply controlling chain conformation with divalent metal ions (i.e., Ca2+, Sr2+), without the intervention of any external templates. Metal ions play crucial roles in the formation of organic vesicle templates by modulating the long chains of polymers and preventing them from separation by washing process. We also show that, by in situ functionalizing the shell wall of SHNs, it is capable of entrapping nearly an eightfold quantity of vitamin Bc in comparison to the bare bulk silica nanospheres. These results confirm the feasibility of guest species entrapment in the functionalized shell wall, and SHNs are effective carriers of guest (bio-)molecules potentially for a variety of biomedical applications. By rationally choosing the functional (self-templating) molecules, this concept may represent a general strategy for the production of functionalized silica hollow structures.
Early improvement as a predictor of remission and response in schizophrenia: Results from a naturalistic study
Authors: Jäger M. , Schmauß M. , Laux G. , Pfeiffer H. , Naber D. , G. Schmidt L. , Gaebel W. , Klosterkötter J. , Heuser I. , Maier W. , Lemke M.R. , Degner D. , Buchkremer G. , Gastpar M. , Möller H.-J. , Riedel M.
Published: June 2009

Objective

To examine the predictive validity of early improvement in a naturalistic sample of inpatients and to identify the criterion that best defines early improvement.

Methods

Two hundred and forty-seven inpatients who fulfilled ICD-10 criteria for schizophrenia were assessed with the Positive And Negative Syndrome Scale (PANSS) at admission and at biweekly intervals until discharge from hospital. Remission was defined according to the recently proposed consensus criteria, response as a reduction of at least 40% in the PANNS total score from admission to discharge.

Results

Receiver operating characteristic (ROC) analyses showed that early improvement (reduction of the PANSS total score within the first 2 weeks of treatment) predicts remission (AUC = 0.659) and response (AUC = 0.737) at discharge. A 20% reduction in the PANSS total score within the first 2 weeks was the most accurate cut-off for the prediction of remission (total accuracy: 65%; sensitivity: 53%; specificity: 76%), and a 30% reduction the most accurate cut-off for the prediction of response (total accuracy: 76%; sensitivity: 47%; specificity: 90%).

Conclusion

The findings of clinical drug trials that early improvement is a predictor of subsequent treatment response were replicated in a naturalistic sample. Further studies should examine whether patients without early improvement benefit from an early change of antipsychotic medication.
Clinicopathologic analysis of uterine sarcomas from a single institution in the Canary Islands
Authors: Benito Virginia , Lubrano Amina , Arencibia Octavio , Andújar Miguel , Álvarez Eva , Medina Norberto , Falcón Juan Miguel , Falcón Orlando
Published: June 2009

Objective

To evaluate the clinicopathologic data and prognostic factors for patients with uterine sarcomas treated at a single institution, with special emphasis on malignant mixed müllerian tumors (MMMT).

Methods

Medical and anatomic pathology records were reviewed. Survival rates were analyzed using the Kaplan‐Meier method.

Results

The study included 89 patients: 48.4% with MMMT; 22.4% with leiomyosarcomas; 20.2% with endometrial stromal sarcomas; and 9% with adenosarcomas. FIGO stages I, II, III, and IV were identified in 57.3%, 9.0%, 22.5%, and 7.8% of patients respectively. Event‐free survival rates after 2, 5, and 10 years were 70%, 61%, and 55% respectively, with a median time of 90 months (95% CI, 41–140 months). Overall survival rates after 2, 5, and 10 years were 50%, 45%, and 39% respectively, with a median time of 43 months (95% CI, 3–83 months). Multivariate analysis showed that stage, histology, tumor size, and parity had an independent influence on overall survival.

Conclusions

MMMT are the most aggressive tumors and their behavior strongly resembles that of high‐grade endometrial adenocarcinoma. Prognostic factors affecting survival were stage, histology, tumor size, and parity.
Alzheimer's disease and infection: Do infectious agents contribute to progression of Alzheimer's disease?
Authors: Honjo Kie , van Reekum Robert , Verhoeff Nicolaas P.L.G.
Published: June 2009

Infection with several important pathogens could constitute risk factors for cognitive impairment, dementia, and Alzheimer's disease (AD) in particular. This review summarizes the data related to infectious agents that appear to have a relationship with AD. Infections with herpes simplex virus type 1, picornavirus, Borna disease virus, Chlamydia pneumoniae, Helicobacter pylori, and spirochete were reported to contribute to the pathophysiology of AD or to cognitive changes. Based on these reports, it may be hypothesized that central nervous system or systemic infections may contribute to the pathogenesis or pathophysiology of AD, and chronic infection with several pathogens should be considered a risk factor for sporadic AD. If this hypothesis holds true, early intervention against infection may delay or even prevent the future development of AD.
Amyloid precursor protein transgenic mouse models and Alzheimer's disease: Understanding the paradigms, limitations, and contributions
Authors: Kokjohn Tyler A. , Roher Alex E.
Published: June 2009

Transgenic (Tg) mice that overexpress mutant familial Alzheimer's disease (AD) amyloid precursor protein (APP) genes have contributed to an understanding of dementia pathology, and support the amyloid cascade hypothesis. Although many sophisticated mice APP models exist, none recapitulates AD cellular and behavioral pathology. The morphological resemblance to AD amyloidosis is impressive, but fundamental biophysical and biochemical properties of the APP/Aβ produced in Tg mice differ substantially from those of humans. The greater resilience of Tg mice in the presence of substantial Aβ burdens suggests that levels and forms deleterious to human neurons are not as noxious in these models. Transgenic mice were widely used for testing AD therapeutic agents, and demonstrated promising results. Unfortunately, clinical trials resulted in unforeseen adverse events or negative therapeutic outcomes. The disparity between success and failure is in part attributable to evolutionary divergence between humans and rodents. These observations suggest that the pathogenesis of AD is by far more intricate than can be explained by a straightforward accumulation of Aβ.
Elevated C‐reactive protein levels are associated with prevalent dementia in the oldest‐old
Authors: Kravitz B. Adar , Corrada Maria M. , Kawas Claudia H.
Published: June 2009

Background

C‐reactive protein (CRP) is a nonspecific marker of inflammation that is increased in the brain and serum of patients with Alzheimer's disease (AD), and has been associated with increased risk of developing dementia. Inflammation increases with age, and the number of people reaching age 90 years and older is growing, making the association between inflammation and dementia increasingly relevant. Using a cross‐sectional design, we examined whether high levels of serum CRP are associated with increased odds of prevalent dementia in the oldest‐old.

Methods

Serum CRP levels of 305 participants (mean age ± standard deviation, 94.3 ± 2.9 years) from the 90+ Study, a longitudinal cohort study of people aged 90 years and older, were evaluated with respect to all‐cause dementia. Levels of CRP were divided into three categories: undetectable (<0.5 mg/dL), detectable (0.5–0.7 mg/dL), and elevated (>0.8 mg/dL). Odds ratios (ORs) were calculated using logistic regression, and were adjusted for covariates.

Results

Relative to participants with undetectable CRP levels, participants with detectable or elevated CRP levels had increased odds of all‐cause dementia (detectable: OR, 3.0; 95% confidence interval, 1.2–7.3; elevated: OR, 5.0; 95% confidence interval, 1.9–12.9). When participants were subdivided by gender, significantly increased ORs were seen only in women.

Conclusions

In the oldest‐old, high CRP levels are associated with increased odds of all‐cause dementia, particularly in women. Prospective studies are necessary to confirm whether increased CRP levels are associated with an increased risk of developing dementia in this age group.
When are moods most likely to influence consumers' product preferences? The role of mood focus and perceived relevance of moods
Authors: White Katherine , McFarland Cathy
Published: June 2009

This program of research examined the hypothesis that moods are most likely to be used as a source of information in making evaluations and choices when consumers both focus on their moods (i.e., acknowledge and pay attention to their feelings) and perceive that moods are a relevant source of information for forming judgments. Support for this prediction was obtained when the relevance of moods was examined by manipulating relevance instructions, varying advertising cues, and manipulating product type. Further, the boundary conditions under which the combination of mood focus and perceived relevance is most influential on product preferences are identified.
Persistent pediatric obstructive sleep apnea and lingual tonsillectomy
Authors: Lin Aaron C. , Koltai Peter J.
Published: June 2009

Objective

To describe a new method and the indications for lingual tonsillectomy with endoscopy and coblation, and to document its utility for treating children with persistent obstructive sleep apnea after previous tonsillectomy and adenoidectomy.

Study Design and Setting

Case series with chart review in a tertiary pediatric medical center.

Subjects and Methods

Twenty‐six patients aged 3 to 20 met the inclusion criteria of polysomnography‐proven persistent obstructive sleep apnea after tonsillectomy and adenoidectomy, as well as diagnosis of lingual tonsillar hypertrophy made by flexible fiberoptic sleep endoscopy. Endoscopic‐assisted coblation lingual tonsillectomies were performed between June 2005 and January 2008. Preoperative and postoperative nocturnal polysomnogram data were paired and analyzed statistically.

Results

Statistically significant reductions in the respiratory distress index (RDI) were seen when preoperative and postoperative data were compared (mean, 14.7 vs 8.1). There were similar reductions in the number of obstructive apneas and hypopneas. The mean minimum O2 saturation did not change. Two patients in this series developed adhesions between the epiglottis and tongue base; there appeared to be no consequence for airway or feeding issues.

Conclusion

Endoscopic‐assisted coblation lingual tonsillectomy is an effective technique for the treatment of lingual tonsillar hypertrophy causing persistent obstructive sleep apnea in some children.
Article Commentary: Role of vestibular testing in diagnosis of benign paroxysmal positional vertigo
Authors: López‐Escámez José A.
Published: June 2009

Diagnosis and treatment of benign paroxysmal positional vertigo (BPPV) is a mixture of empiricism of particle repositioning with the rationally‐based knowledge obtained from clinical observations, histopathology, and neurophysiological experiments. The recently published clinical practice guideline on BPPV makes recommendations on the management of BPPV. One of the statements discourages the use of radiographic or vestibular testing, unless the diagnosis was uncertain or there were additional signs or symptoms unrelated to BPPV. The role of video‐oculography in diagnosis and treatment of BPPV is argued, since vestibular testing has provided key relevant information to understand positional nystagmus in patients with BPPV.
Sensorineural hearing loss in patients with cystic fibrosis
Authors: Cheng Alan G. , Johnston Patrick R. , Luz Jennifer , Uluer Ahmet , Fligor Brian , Licameli Greg R. , Kenna Margaret A. , Jones Dwight T.
Published: June 2009

Objective

To determine the prevalence of sensorineural hearing loss (SNHL) in cystic fibrosis (CF) patients and its relationship to antibiotic use.

Study Design

Case series with chart review.

Setting

Tertiary care pediatric hospital.

Subjects and Methods

We reviewed the medical records of CF patients seen in our children's hospital between March 1994 and December 2007. Data collected included patient demographics, audiograms, tympanograms, genotype, and use of potentially ototoxic antibiotics.

Results

Seven of 50 (14%) patients had SNHL. Three percent of patients who received ≤10 courses of intravenous aminoglycosides had SNHL versus 43 percent of those who received >10 courses (P < 0.01). No patients who received five or fewer courses of nasal irrigation with aminoglycosides had SNHL versus 23 percent of those who received more than five courses (P < 0.05). Nine percent of patients who received five or fewer courses of macrolides had SNHL versus 60 percent of those who received more than five courses (P = 0.079).

Conclusion

CF patients receiving aminoglycosides are at high risk for developing SNHL.
Immunological investigation in the adenoid tissues from children with chronic rhinosinusitis
Authors: Shin Seung‐Youp , Choi Gil‐Soon , Park Hae‐Sim , Lee Kun‐Hee , Kim Sung‐Wan , Cho Joong‐Saeng
Published: June 2009

Objective

Chronic rhinosinusitis (CRS) is characterized by persistent inflammation and tissue remodeling of the nasal mucosa. Adenoidectomy is an effective surgical treatment in pediatric CRS. To evaluate the effect of pediatric CRS on the severity and characteristics of adenoid inflammation, the authors evaluated the expressions of inflammatory cell activation markers and tissue remodeling in adenoid tissues associated with cytokines tissue‐remodeling‐associated cytokines in adenoid tissues.

Study Design and Setting

A prospective controlled study on 40 pediatric patients admitting for adenotonsillectomy.

Subjects and Methods

Immunoassays were performed on adenoid tissues homogenates from 16 children with CRS and from 24 children without CRS to quantify the levels of inflammatory cell activation markers, such as soluble interleukin (IL)‐2 receptor (sIL‐2R), soluble CD23 (sCD23), IL‐6, eosinophilic cationic protein (ECP), and tryptase, and the levels of cytokines associated with tissue remodeling, such as transforming growth factor (TGF)‐β1, matrix metalloproteinase (MMP) 2 and 9, and tissue inhibitor of metalloproteinase (TIMP)‐1.

Results

The mean levels (the ratio to albumin level) of sIL‐2R, TGF‐β1, MMP‐2, MMP‐9, and TIMP‐1 were significantly higher in adenoid tissues of patients with CRS (27.31 ± 30.32, 4894.65 ± 2388.77, 500.13 ± 604.59, and 23.06 ± 10.37, respectively) than those without it (16.27 ± 10.93, 2635.51 ± 1448.63, 120.87 ± 321.50, 16.74 ± 11.10, and 7.39 ± 3.12, respectively; all P < 0.05). Regarding the severity of CRS, ECP level was significantly higher in patients with severe CRS than in those with mild to moderate CRS (P = 0.033).

Conclusions

Adenoid tissues in pediatric CRS patients had higher levels of tissue‐remodeling–associated cytokines, which may explain the relationship between pediatric CRS and adenoid inflammation.
Minimally invasive radioguided parathyroidectomy performed for primary hyperparathyroidism
Authors: Adil Eelam , Adil Tabrez , Fedok Fred , Kauffman Gordon , Goldenberg David
Published: June 2009

Objective

Parathyroid surgery is often challenging due to considerable variability in anatomy. Minimally invasive radioguided parathyroidectomy (MIRP) is a directed surgical approach that has been made possible by the advent of new imaging techniques, specifically sestamibi scanning. In this study, we review our experience and outcomes with MIRP in one of the largest case series reported in the literature.

Study Design

Case series with chart review.

Setting

Tertiary care center.

Subjects and Methods

Subjects were 305 patients who underwent MIRP in our institution between 1997 and 2007. Data including symptoms, preoperative and postoperative calcium levels, and PTH levels were collected. Analyses were performed using Excel AnalysisPak.

Results

MIRP in this series had a 100 percent rate of success in removing a hyperfunctional parathyroid gland. The mean preoperative calcium was 10.9 whereas the mean postoperative level was 9.8. There was a significant difference between preoperative and postoperative calcium levels (both ionized and total) (P < 0.01). Mean preoperative and postoperative serum PTH levels were 138 and 50, respectively. PTH levels were therefore significantly lower postoperatively (P < 0.01). Rapid PTH testing showed a similar pattern. There were no cases of recurrent laryngeal nerve palsy.

Conclusion

MIRP is an effective method for removal of image‐localized hyperfunctional parathyroid glands.
Prevalence of depression and antidepressant use in an otolaryngology patient population
Authors: Chandra Rakesh K. , Epstein Victoria A. , Fishman Andrew J.
Published: June 2009

Objective

To determine the prevalence of depressive diagnoses and antidepressant use in various subsets of otolaryngology patients.

Study Design

Academic practice EMR database query.

Subjects and Methods

Over 12,000 consecutive otolaryngology patients were analyzed by primary diagnosis and in three groups: Group 1 (tinnitus, vertigo), Group 2 (rhinosinusitis), and Group 3 (sleep apnea). The number with depressive diagnoses and/or those taking antidepressants was determined.

Results

The prevalence of any depressive diagnosis was 11 percent, and 18 percent had been prescribed antidepressants. The prevalence of depression was 13 percent, 10 percent, and 14 percent for Groups 1, 2, and 3, respectively. Antidepressants had been prescribed in 21 percent, 15 percent, and 28 percent, respectively. The primary‐encounter diagnosis with the highest incidence of depression (21%) and antidepressant use (46%) was sleep apnea with insomnia.

Conclusion

Otolaryngology patients may exhibit greater prevalence of depression than is observed in the general population (7.3%). Highest prevalence was found in patients with inner ear disease and sleep apnea. Depression may be a cause of significant comorbidity in patients with chronic otolaryngic conditions.
Climate and vegetation history from a 14,000-year peatland record, Kenai Peninsula, Alaska
Authors: Jones Miriam C. , Peteet Dorothy M. , Kurdyla Dorothy , Guilderson Thomas
Published: June 2009

Analysis of pollen, spores, macrofossils, and lithology of an AMS 14C-dated core from a subarctic fen on the Kenai Peninsula, Alaska reveals changes in vegetation and climate beginning 14,200 cal yr BP. Betula expansion and contraction of herb tundra vegetation characterize the Younger Dryas on the Kenai, suggesting increased winter snowfall concurrent with cool, sunny summers. Remarkable Polypodiaceae (fern) abundance between 11,500 and 8500 cal yr BP implies a significant change in climate. Enhanced peat preservation and the occurrence of wet meadow species suggest high moisture from 11,500 to 10,700 cal yr BP, in contrast to drier conditions in southeastern Alaska; this pattern may indicate an intensification and repositioning of the Aleutian Low (AL). Drier conditions on the Kenai Peninsula from 10,700 to 8500 cal yr BP may signify a weaker AL, but elevated fern abundance may have been sustained by high seasonality with substantial snowfall and enhanced glacial melt. Decreased insolation-induced seasonality resulted in climatic cooling after 8500 cal yr BP, with increased humidity from 8000 to 5000 cal yr BP. A dry interval punctuated by volcanic activity occurred between 5000 and 3500 cal yr BP, followed by cool, moist climate, coincident with Neoglaciation. Tsuga mertensiana expanded after ~ 1500 cal yr BP in response to the shift to cooler conditions.
Dynamic Programming for Single Nucleotide Polymorphism ID Identification in Systematic Association Studies
Authors: Yang Cheng‐Hong , Chuang Li‐Yeh , Cheng Yu‐Huei , Wen Cheng‐Hao , Chang Hsueh‐Wei
Published: June 2009

Single nucleotide polymorphisms (SNPs) play an important role in personalized medicine. However, the SNP data reported in many association studies provide only the SNP nucleotide/amino acid position, without providing the SNP ID recorded in National Center for Biotechnology Information databases. A tool with the ability to provide SNP ID identification, with a user‐friendly interface, is needed. In this paper, a dynamic programming algorithm was used to compare homologs when the processed input sequence is aligned with the SNP FASTA database. Our novel system provides a web‐based tool that uses the National Center for Biotechnology Information dbSNP database, which provides SNP sequence identification and SNP FASTA formats. Freely selectable sequence formats for alignment can be used, including general sequence formats (ACGT, [dNTP1/dNTP2] or IUPAC formats) and orientation with bidirectional sequence matching. In contrast to the National Center for Biotechnology Information SNP‐BLAST, the proposed system always provides the correct targeted SNP ID (SNP hit), as well as nearby SNPs (flanking hits), arranged in their chromosomal order and contig positions. The system also solves problems inherent in SNP‐BLAST, which cannot always provide the correct SNP ID for a given input sequence. Therefore, this system constitutes a novel application which uses dynamic programming to identify SNP IDs from the literature and keyed‐in sequences for systematic association studies. It is freely available at http://bio.kuas.edu.tw/SNPosition/.
Adherence to A Diabetic Care Plan Provides Better Glycemic Control in Ambulatory Patients With Type 2 Diabetes
Authors: Chiu Yi‐Wen , Chang Jer‐Ming , Lin Li‐Ing , Chang Pi‐Yu , Lo Wan‐Ching , Wu Ling‐Chu , Chen Tun‐Chieh , Hwang Shang‐Jyh
Published: June 2009

Tight control of blood sugar improves the outcomes for diabetic patients, but it can only be achieved by adhering to a well‐organized care plan. To evaluate the effect of a diabetes care plan with reinforcement of glycemic control in diabetic patients, 98 ambulatory patients with type 2 diabetes who visited our diabetes clinic every 3–4 months and who completed four education courses given by certified diabetes educators within 3 months after the first visit, were defined as the Intervention group. A total of 82 patients fulfilling the inclusion criteria for the Intervention group but who missed at least half of the diabetes education sessions were selected as controls. Both groups had comparable mean hemoglobin A1c (HbA1c) levels at baseline, which decreased significantly at 3 months and were maintained at approximately constant levels at intervals for up to 1 year. The HbA1c decrement in the Intervention group was significantly greater than that in the Control group over the 1‐year follow‐up period (HbA1c change: −2.5 ± 1.8% vs. −1.1 ± 1.7%, p < 0.01). The maximal HbA1c decrement occurred during the first 3 months, and accounted for 95.6% and 94.6% of the total HbA1c decrements in the Intervention and Control groups, respectively. In the multiple regression model, after adjustment for age, body mass index, and duration of diabetes, the Intervention group may still have a 12.6% improvement in HbA1c from their original value to the end of 1 year treatment compared with the Control group (p < 0.05). Diabetes care, with reinforcement from certified diabetes educators, significantly improved and maintained the effects on glycemic control in ambulatory patients with type 2 diabetes.
Ortner's Syndrome—a Rare Cause of Unilateral Vocal Cord Paralysis: A Case Report
Authors: Chen Rong‐Feng , Lin Chen‐Tung , Lu Chih‐Hao
Published: June 2009

Hoarseness attributed to vocal cord palsy is associated with injury to the recurrent laryngeal nerve. Hoarseness resulting from left recurrent laryngeal nerve palsy, cardiovocal syndrome (Ortner's syndrome), has rarely been reported. We present the case of a 79‐year‐old male suffering from hoarseness in the absence of significant clinical manifestations. A flexible laryngoscope was used to identify a paralyzed left vocal cord, and contrast‐enhanced computed tomography showed a large thrombus‐filled aneurysmal dilation of the aortic arch. The severity of the vocal cord paralysis was improved by surgical intervention. This case illustrates that life‐threatening cardiovascular comorbidities can cause hoarseness and that an impaired recurrent laryngeal nerve might be correctable.
Suppression of Atrial Fibrillation Following Successful Ablation of Atrioventricular Nodal Reentrant Tachycardia: A Case Report
Authors: Tsai Wei‐Chung , Lee Kun‐Tai , Cheng Kai‐Hung , Huang Chih‐Hsing , Lin Hsin‐Chin , Sheu Sheng‐Hsiung , Lai Wen‐Ter
Published: June 2009

Inducible atrioventricular nodal reentrant tachycardia was demonstrated by electrophysiological studies in a 55‐year‐old female who suffered from intermittent palpitation, in which paroxysmal atrial fibrillation (AF) was consistently documented by electrocardiogram recordings. After ablation of the slow pathway, the atrioventricular nodal reentrant tachycardia and AF were not inducible. During 2 years of follow‐up, there were no recurrences of AF in terms of symptoms or findings from Holter electrocardiograms. We suggest that the AF was triggered by the atrioventricular nodal reentrant tachycardia and the successful ablation of atrioventricular nodal reentrant tachycardia was associated with freedom arising from ablation of AF.
Ischemic Stroke in Williams‐Beuren Syndrome: A Case Report
Authors: Lee Wei‐Der , Hsu Jui‐Jen , Huang Feng‐Chen , Chao Mei‐Chyn , Chang Yu‐Li , Huang Mao‐Hsiung
Published: June 2009

A 15‐year‐old girl was admitted because of an acute onset of facial palsy and right hemiparesis. The patient had a history of moderate mental retardation and developmental delay. On admission, her vital signs were stable, except for high blood pressure. Magnetic resonance imaging demonstrated an infarct involving the left internal capsule and putamen. Because of the patient's young age, an extensive stroke survey was performed. Williams‐Beuren syndrome was finally confirmed by fluorescent in situ hybridization. Compared with the previously reported cases, no evidence of cerebral arterial stenosis or cardiac abnormalities was found by noninvasive imaging techniques. Because Williams‐Beuren syndrome is a complex, multiple congenital anomaly syndrome with prominent cardiovascular features, regular assessment and antihypertensive treatment are necessary to minimize the lifelong cardiovascular risk in patients with this syndrome.
Endoscopic Management of A Ureteral Obstruction Caused by Endometriosis: A Case Report
Authors: Juan Hsu‐Cheng , Yeh Hsin‐Chih , Hsiao Hsi‐Lin , Yang Shean‐Fang , Wu Wen‐Jeng
Published: June 2009

Ureteral obstruction secondary to endometriosis is relatively uncommon. We present a 49‐year‐old female (gravida 3, para 2, abortion 1), who was identified as suffering from right hydronephrosis while undergoing her regular health examination. Retrograde pyelography demonstrated a partial obstruction of the right ureter in the distal third. She underwent ureteroscopy and biopsy to remove a right ureteral tumor. Histological examination confirmed ureteral endometriosis. During follow‐up at the obstetrics and gynecology outpatient department, an abdominal echo was detected that revealed a right endometrioma (size, 7.5 × 4.8 × 5.5 cm) on the ovary. As a result, a total hysterectomy and bilateral salpingo‐oophorectomy was performed. Although the patient had right residual hydronephrosis, the creatinine level improved to 1.2 mg/dL during follow‐up.
Reflecting on the Essence of our Problem‐Based Learning Discussions: The Importance of Faculty Development and our Continuous Quest for Applications of Problem‐Based Learning
Authors: Chan Engle Angela
Published: June 2009

While problem‐based learning (PBL) is a teaching strategy to promote critical thinking, creativity and self‐directedness in learning is very important. It is the meaning of the learning, with a contextual understanding, that marks the significance of this approach in our healthcare education. At the 2008 Kaohsiung Medical University International Conference and Workshop on PBL, the scholarly discourse on sharing empirical findings and practical experience with various aspects of PBL brought forth the importance of the teachers' continued learning about the meaning, the dynamics of the process, and the pragmatic details of PBL. This quest for a continuous learning and understanding about PBL parallels our search to extend the classroom PBL into students' clinical experience. The development of clinical teachers in the understanding of PBL was explored as part of their experiential learning in clinical teaching after their PBL workshops. While the clinical teachers who participated in the project appreciated the merits of clinical PBL, the complex balance between patient service and student teaching—in an unpredictable clinical setting—has led to the use of a simulated clinical environment with simulated patients. We also piloted PBL for interprofessional education of undergraduate students of nursing and social work. The ways we can adopt PBL in various settings with different intents will help prepare our healthcare graduates in meeting the challenges of our ever more complex healthcare systems, and the demands of holistic patient care.
History of the Soul: A Chinese Writer, Nietzsche, and Tiananmen 1989
Authors: Henning Stefan
Published: June 2009

In December of 1984, Zhang Chengzhi, a thirty-six-year-old ethnologist from Beijing and an important novelist in contemporary Chinese literature, reached a small village on the loess plateaus of northwestern China. An impoverished farmer, Ma Zhiwen, hosted Zhang during his brief stay and introduced him to the local community of Muslims who practiced Sufism, a form of mystical Islam. Night after night, the Muslim villagers sought Zhang out to tell him about events in the history of their Sufi order, the Zheherenye. Zhang learned that Zheherenye Sufis carefully cultivated historical memories reaching back to the mid-eighteenth century when the order was founded by a Chinese Sufi returned from Yemen. Since then, the order had been led by amurshid, the Arabic word for mentor or spiritual guide. During the last dynasty of the Chinese empire, which fell in 1911, the Zheherenye were often outlawed and clashed repeatedly with the imperial army in regional wars that the Sufis always lost. Interpreting their defeats as martyrdom, the Zheherenye narrated the lives of the successivemurshidin their transmission of oral histories, but also in handwritten histories that were often written in Persian or Arabic.
The Development of Wahhabi Reforms in Ghana and Burkina Faso, 1960–1990: Elective Affinities between Western-Educated Muslims and Islamic Scholars
Authors: Kobo Ousman
Published: June 2009

This essay examines the relationship between Western notions of modernity and Wahhabi-inclined Islamic reform in Ghana and Burkina Faso (Upper Volta until 1984) during the early decades of independence. I will highlight ways in which Western/secular education facilitated the early diffusion of this genre of reform. Over the past decade or so, historians have explored the extent to which the appeal of the Wahhabi movement in urban West Africa, toward the end of French and British colonialism, can be traced to Muslim attempts to find a middle ground between Western “modernity” and authentic spiritual purity. In what follows, I employ comparative, ethnographic, and historical analyses to draw attention to the pivotal roles Western-educated urban Muslim professionals played in the development of this reform. Despite the active participation of these professionals in transforming the Wahhabi message into urban mass movements, scholars have paid scant attention to the factors that drew them to the Wahhabi doctrine in the first instance.
Territorializing Piety: Genealogy, Transnationalism, and Shi‘ite Politics in Modern Lebanon
Authors: Shaery-Eisenlohr Roschanack
Published: June 2009

Genealogies—representations of kinship and narratives of origin—are in the transnational Shi‘ite world intimately connected to politics of piety, the production of nationalism, and struggles over authority. In this essay, I am concerned with certain inflections in the links between genealogy and piety that make these terms central to contests over notions of territoriality in contemporary Shi‘ite politics. Nationalism replaces the sovereignty of God with the exclusive sovereignty of a “people” over a clearly demarcated territory, but religious language, identifications, and imagery often play prominent roles in how the imagined community of the nation is fashioned and delimited. Here I will show how, mediated through genealogy, religious leaders and pious movements with transnational ties produce religious authority, and create links to territory, to assert themselves as exemplary cultural citizens.
Just like England: On the Liberal Institutions of the Circassians
Authors: Manning Paul
Published: June 2009

With Pushkin's narrative poemPrisoner of the Caucasus(1822), Circassians entered the Russian imperial imaginary as exemplary personifications of the savagery and freedom of the Caucasus as a whole (Layton 1994; 1997; Grant 2005; 2007). Accordingly, the Russian imagination of Circassian polity, now as egalitarian “free societies,” now as hierarchical aristocracies, now as “noble savages,” now as ignoble brutes, Muslim “fanatics,” or “Asiatic despots,” was a microcosm of the Russian colonial engagement with the Caucasus as a whole, often as not reflecting tensions in the self-perception of imperial autocracy and its elites more than indigenous political organization of Caucasian groups like Circassians in reality (Layton 1997; Jersild 2002; Grant 2005). Inasmuch as such imperial imaginings informed the fantasies of young men, causing them to enlist in search of the poetry of warfare, or informed fantasies of conquest among agents of the Russian state, these imaginings became real in their consequences for various Caucasian groups (Layton 1994; 1997). Nor was the exemplary alterity accorded Circassians limited to Russian audiences; it exerted a considerable fascination across Europe as well (King 2007: 241–45).
“Applied Orientalism” in British India and Tsarist Turkestan
Authors: Morrison Alexander
Published: June 2009

Writing in 1872, Sir Alfred Lyall, Governor of the North-Western Provinces of British India, was talking about the reluctance amongst many of the old Muslim scholarly class of North India to embrace the modern, enlightened learning of the West. For Lyall, to be an “Orientalist” was to be one of those Anglo-Indian advocates of state support for “Oriental Learning”—the study of Arabic, Persian, and Sanskrit—in the tradition established by Warren Hastings and Sir William Jones, who had been worsted by the “Anglicists” led by Lord Macaulay in 1835. To adopt the meaning popularized by Edward Said, we might say that while Lyall makes a classic “Orientalist” judgment about the value of Eastern civilization, he is also making an observation about the relationship between knowledge and power that still resonates today. Lyall is consciously echoing Macaulay's notorious statement, “A single shelf of a good European Library was worth the whole literature of India and Arabia,” which has often been taken as a byword for the arrogance of Europeans confronted with an Orient to which they felt themselves superior. The obvious point is that Macaulay had no interest in Oriental knowledge or knowledge of the Orient: he was not an Orientalist at all. Perhaps this is why Said dealt with him only tangentially.
Postcommunist Political Capitalism: A Weberian Interpretation
Authors: Ganev Venelin I.
Published: June 2009

“Political capitalism” is a term frequently deployed in analyses of the economic systems that emerged in the former Soviet block after the implosion of communist autocracy. This crisp, evocative phrase effectively expresses the shared feeling that the transmogrifications of the formerly “planned economies” did not lead to the desired consolidation of a “normal” capitalism. Many would say that by the mid-2000s several East European countries had reached a state approximating “Western ordinariness.” But even they would agree that, at least during the first dozen years of postcommunist changes, the somewhat mysterious dynamics shaping postcommunist “economic domains” were marred by persisting “anomalies,” enduring “atavisms,” and recurring “distortions” which originated in the realm of “politics.” One cannot in good faith dispute that there was something “political” about the way the idiosyncratic postcommunist economies functioned throughout the 1990s.