bluuebunny/crossref_metadata_2025 huggingface dataset:
Switching the fiber knob of oncolytic adenoviruses to avoid neutralizing antibodies in human cancer patients
Authors: Raki Mari , Sarkioja Merja , Escutenaire Sophie , Kangasniemi Lotta , Haavisto Elina , Kanerva Anna , Cerullo Vincenzo , Joensuu Timo , Oksanen Minna , Pesonen Sari , Hemminki Akseli
Published: April 2011

Background

Oncolytic adenoviruses are an attractive strategy for treating cancers resistant to conventional treatments. However, their systemic utility could be limited as a result of the high prevalence of pre‐existing immunity towards the vector. Furthermore, neutralizing antibodies (NAbs) may prevent successful intravenous readministration of the same agent. Previous preclinical reports indicate that the NAb response can be partially overcome by modifying the adenoviral fiber knob. However, to date, this strategy has not been evaluated in human patients.

Methods

Twenty‐four human patients with advanced cancer were treated with two cycles of oncolytic adenoviruses, featuring three capsid variants: unmodified adenovirus serotype 5 (Ad5), serotype 5 with RGD motif in the HI‐loop of the fiber knob (Ad5‐RGD) and serotype 5 carrying fiber knob from serotype 3 (Ad5/3). A virus with different fiber structure was used for the second round of treatment and patient serum was analyzed for a neutralizing effect.

Results

All patients developed NAbs against the virus that they were treated with. However, the magnitude and velocity of the response varied considerably. When measured just before the second treatment cycle, a differential in serum NAb titer against the first versus second virus was seen in 83% of cases, suggesting that even minor changes in the fiber knob can circumvent neutralization in cancer patients. No correlation between NAb titers and outcome variables was observed.

Conclusions

The results obtained in the present study extend previous preclinical reports into human cancer patients and suggest that modification of the fiber knob is a feasible strategy for circumventing the NAb response in patients receiving multiple rounds of oncolytic adenoviruses. Copyright © 2011 John Wiley & Sons, Ltd.
ESI‐MS quantitation of iron as its 4‐(2‐pyridylazo)resorcinol (PAR) complex: application to pharmaceutical tablets containing iron oxide pigment
Authors: Susanto Dendi , English Ann M. , Sharma Ravi , Kwong Elizabeth
Published: April 2011

Quantitation of iron oxide (Fe2O3) in pharmaceutical formulations using electrospray ionization mass spectrometry (ESI‐MS) following iron complexation with 4‐(2‐pyridylazo)resorcinol (PAR) was evaluated. Complexation of FeIII with PAR was found to produce an intense mass spectral signal at low pH compared to the free ligand. Using the selected‐ion‐monitoring mode of a triple‐quadrupole mass spectrometer, the signal at m/z 484 arising from the singly charged [FeIII(PAR)2]+ complex gave a limit of detection of ∼2 µM for total iron. The linear range of the calibration curve was found to be 2–43 µM total iron. Trace iron interference was decreased to submicromolar levels by performing an optimized labware cleaning protocol and instrument replumbing using Polyetheretherketone (PEEK) tubing. The validation parameters of this ESI‐MS total iron analysis (specificity, linearity, precision, accuracy, robustness and stability) are within the acceptance criteria listed in the validation guidelines developed by the Food and Drug Administration for industry. Recovery of 93% of the added iron indicated a satisfactory extraction procedure for tablets containing Fe2O3 pigment. There was no statistical difference between the results obtained by ESI‐MS and the common elemental method, inductively coupled plasma‐optical emission spectroscopy. Since the proposed ESI‐MS method can be performed on a mass spectrometer equipped with an ESI source, which is standard instrumentation in the pharmaceutical industry, the method validated here provides an alternate method for metal ion analysis by ESI‐MS. Copyright © 2011 John Wiley & Sons, Ltd.
Electrothermal model of a power LED for SPICE
Authors: Górecki Krzysztof
Published: April 2011

In this paper an electrothermal model of the power LED dedicated for SPICE is proposed. In this model electrical, thermal and optical properties of the considered device are taken into account. The description of the model and some results of the experimental verification of this model are presented for two types of power LEDS: LXHL‐BW03 and LXHL‐LW3C produced by Lumileds. A good agreement between the results of measurements and calculations is obtained. Copyright © 2011 John Wiley & Sons, Ltd.
Modelling and fabrication of optimum structure of novel interdigital sensors for food inspection
Authors: Mohd Syaifudin A. R. , Mukhopadhyay S. C. , Yu P. L.
Published: April 2011

Modelling of an interdigital sensor‐based sensing system for the detection of dangerous contaminated marine biotoxin in seafood has been carried out. Three interdigital sensors having new electrode configurations have been analysed using COMSOL Multiphysics. All sensors were designed to have an equal number of electrodes with the same sensing area. Based on the maximum sensitivity, the best electrode configuration has been chosen. Experiments on raw seafood contaminated with domoic acid have been conducted using the new fabricated sensor and very good results were obtained. Copyright © 2011 John Wiley & Sons, Ltd.
An artificial tendon to connect the quadriceps muscle to the Tibia
Authors: Melvin Alan , Litsky Alan , Mayerson Joel , Stringer Keith , Melvin David , Juncosa‐Melvin Natalia
Published: April 2011

No permanent, reliable artificial tendon exists clinically. Our group developed the OrthoCoupler™ device as a versatile connector, fixed at one end to a muscle, and adaptable at the other end to inert implants such as prosthetic bones or to bone anchors. The objective of this study was to evaluate four configurations of the device to replace the extensor mechanism of the knee in goats. Within muscle, the four groups had: (A) needle‐drawn uncoated bundles, (B) needle‐drawn coated bundles, (C) barbed uncoated bundles, and (D) barbed coated bundles. The quadriceps tendon, patella, and patellar tendon were removed from the right hind limb in 24 goats. The four groups (n = 6 for each) were randomly assigned to connect the quadriceps muscle to the tibia (with a bone plate). Specimens were collected from each operated leg and contralateral unoperated controls both for mechanical testing and histology at 90 days post‐surgery. In strength testing, maximum forces in the operated leg (vs. unoperated control) were 1,288 ± 123 N (vs. 1,387 ± 118 N) for group A, 1,323 ± 144 N (vs. 1,396 ± 779 N) for group B, 930 ± 125 N (vs. 1,337 ± 126 N) for group C, and 968 ± 109 N (vs. 1,528 ± 146 N) for group D (mean ± SEM). The strengths of the OrthoCoupler™ legs in the needled device groups were equivalent to unoperated controls (p = 0.6), while both barbed device groups had maximum forces significantly lower than their controls (p = 0.001). We believe this technology will yield improved procedures for clinical challenges in orthopaedic oncology, revision arthroplasty, tendon transfer, and tendon injury reconstruction. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29:1775–1782, 2011
Carpal tunnel and transverse carpal ligament stiffness with changes in wrist posture and indenter size
Authors: Holmes Michael W. R. , Howarth Samuel J. , Callaghan Jack P. , Keir Peter J.
Published: April 2011

This study investigated the effects of loading and posture on mechanical properties of the transverse carpal ligament (TCL). Ten fresh‐frozen cadaver arms were dissected to expose the TCL and positioned in the load frame of a servo‐hydraulic testing machine, equipped with a load cell and custom made indenters. Four cylindrical indenters (5, 10, 20, and 35 mm) loaded the TCL in three wrist postures (30° extension, neutral and 30° flexion). Three loading cycles with a peak force of 50 N were applied at 5 N/s for each condition. The flexed wrist posture had significantly greater TCL stiffness (40.0 ± 3.3 N/mm) than the neutral (35.9 ± 3.5 N/mm, p = 0.045) and extended postures (34.9 ± 2.8 N/mm, p = 0.025). TCL stiffness using the 10 and 20 mm indenters was larger than the 5 mm indenter. Stiffness was greatest with the 20 mm indenter, which had the greatest indenter contact area on the TCL. The 35 mm indenter covered the carpal bones, compressed the carpal tunnel and produced the lowest stiffness. The complexity of the TCL makes it an important part of the carpal tunnel and the mechanical properties found are essential to understanding mechanisms of carpal tunnel syndrome. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29:1682–1687, 2011
Capsule preservation improves short‐term outcome of hydraulic distension in painful stiff shoulder
Authors: Kim Keewon , Lee Kyu Jin , Kim Hee Chan , Lee Kun‐Jai , Kim Don‐Kyu , Chung Sun G.
Published: April 2011

The effect of intraarticular hydraulic distension (IHD) for a painful stiff shoulder (or adhesive capsulitis) has been affirmed, but whether rupturing the joint capsule during this process is beneficial remains controversial. By monitoring real‐time pressure–volume (PV) profiles during IHD, we could infuse the largest possible volume without rupturing the capsule. Using the novel technique, we compared the short‐term effects of IHD when the capsule was preserved versus when it was ruptured. Fifty‐four patients with a painful stiff shoulder underwent IHDs intended to preserve or rupture the capsule and then classified into capsule‐ruptured (n = 26) and capsule‐preserved (n = 20) groups, based on the obtained PV profiles. Their profiles were triphasic or biphasic; eight with flat profiles were excluded from the comparison. Clinical outcomes were evaluated at 3‐day and 1‐month follow‐ups, in terms of pain and range of motion (ROM). Although both groups showed significant increase in ROM and decrease in pain after IHD, the improvements were greater in the capsule‐preserved group than in the ruptured group at both follow‐up times, and in triphasic and biphasic cases. In conclusion, the therapeutic effects of IHD in short‐term follow‐ups were enhanced by preserving the capsule. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29:1688–1694, 2011
Determinants of outcomes in pancreatic surgery and use of hospital resources
Authors: Gupta Prateek K. , Turaga Kiran K. , Miller Weldon J. , Loggie Brian W. , Foster Jason M.
Published: April 2011

Background and Objectives

Outcomes for patients undergoing major pancreatic surgery have improved, but a subset of patients that significantly utilize more resources exists. Variables that can lead to an increase in resource utilization in patients undergoing pancreatic surgery were identified.

Methods

Patients undergoing pancreatic surgery for neoplasms were identified from the NSQIP database (2006–2008). Indices associated with increased resource utilization that we included were operative time (OT), length of stay (LOS), intraoperative RBC transfusion, return to operating room, and occurrence of postoperative complications. Analysis of covariance and multivariable logistic regression were performed.

Results

The 4,306 included patients had a median age of 66 years and 50.3% were males. The 30‐day morbidity and mortality were 29.3% and 3.2%, respectively. Median OT was 362 min and median LOS was 10 days. Malignancy, neoadjuvant radiation, and medical co‐morbidities were associated with increased OT (P < 0.0001 for all). Declining preoperative functional status was the most important predictor of LOS (P < 0.0001). Age, male gender, hypertension, severe COPD, and higher BMI were significantly associated with postoperative complications (P < 0.050 for all).

Conclusions

Morbidity after pancreatic surgery remains high. Age, obesity, performance status, medical co‐morbidities, and neoadjuvant radiation affect outcomes and may lead to increased use of hospital resources. J. Surg. Oncol. 2011; 104:634–640. © 2011 Wiley Periodicals, Inc.
Preoperative portal vein embolization (PVE) for patients with hepatocellular carcinoma can improve resectability and may improve disease‐free survival
Authors: Okabe Hirohisa , Beppu Toru , Ishiko Takatoshi , Masuda Toshiro , Hayashi Hiromitsu , Otao Ryu , Hasita Horlad , Okabe Kazutoshi , Sugiyama Shinichi , Baba Hideo
Published: April 2011

Background

The aim of this study is to identify the efficacy of portal vein embolization (PVE) before right hepatectomy in patients with hepatocellular carcinoma (HCC) with regard to hepatic function, surgical stress, and survival benefit.

Methods

Fifty‐five patients with HCC underwent right hepatectomy between 1999 and 2009. Preoperative PVE was performed in 19 patients (PVE group) and was not applied in 36 patients (non‐PVE group). Changes in liver function and volume were investigated in PVE group. Short and long clinical outcomes after the surgeries were compared between the two groups.

Results

The percentage of future liver remnant (%FLR) before PVE was significantly lower (37.8%) in PVE group than in non‐PVE group (58.1%) but increased remarkably after PVE (from 37.8% to 55.0%, P < 0.0001). Cumulative disease‐free survival and overall survival rates in PVE group were significantly superior to those in non‐PVE group (P = 0.010 and 0.049, respectively). Although surgical stress estimated by E‐PASS scores and CRP value was not different between the groups, the postoperative value of PT on postoperative day 3 in PVE group was significantly better than in non‐PVE group.

Conclusions

Preoperative PVE improves resectability and may improve disease‐free survival for patients with HCC requiring right hepatectomy. J. Surg. Oncol. 2011; 104:641–646. © 2011 Wiley Periodicals, Inc.
Laparoscopic‐assisted microwave ablation for hepatocellular carcinoma: Safety and efficacy in comparison with radiofrequency ablation
Authors: Simo Kerri A. , Sereika Stephanie E. , Newton Kimberly N. , Gerber David A.
Published: April 2011

Background

Thermal ablation techniques are increasingly important in the search for improved locoregional therapy of hepatocellular carcinoma (HCC) in patients with cirrhosis. This study reports the largest US series using laparoscopic‐assisted microwave ablation (Lap‐MWA) with a 915‐MHz generator for HCC and compares it with a contemporary laparoscopic‐assisted radiofrequency ablation (Lap‐RFA) experience.

Methods

Thirty‐five patients with HCC underwent laparoscopic‐assisted ablation utilizing either MWA or RFA. Medical records, radiographic imaging, and histology were reviewed and outcomes analyzed.

Results

Twenty‐two patients underwent Lap‐RFA (27 tumors) and 13 received Lap‐MWA (15 tumors). Average ablation volumes were similar for Lap‐RFA and Lap‐MWA at 23.43 and 28.99 cm3, respectively (=0.69). Average operative times for Lap‐RFA were 149 ± 35 min versus 112 ± 40 min with Lap‐RFA (P = 0.004). Mean follow‐up was 19 months in the Lap‐RFA group: 50% alive without evidence of disease, 9% alive with disease, 36% deceased and 5% lost to follow‐up. Mean follow‐up in the Lap‐MWA group was 7 months: 54% alive without evidence of disease, 31% alive with disease and 15% deceased.

Conclusion

Lap‐MWA is a safe and efficacious locoregional therapy for HCC which achieves outcomes comparable to Lap‐RFA. Shorter operative times were realized with this modality and complete coagulative necrosis was confirmed histologically on explanted livers. J. Surg. Oncol. 2011; 104:822–829. © 2011 Wiley Periodicals, Inc.
Neoadjuvant GTX Chemotherapy and IMRT‐based chemoradiation for borderline resectable pancreatic cancer
Authors: Patel Manish , Hoffe Sarah , Malafa Mokenge , Hodul Pamela , Klapman Jason , Centeno Barbara , Kim Jongphil , Helm James , Valone Tiffany , Springett Gregory
Published: April 2011

Background and Objectives

To improve the likelihood of achieving a margin‐free resection, neoadjuvant induction chemotherapy with GTX (gemcitabine, docetaxel, and capecitabine) followed by 5‐FU‐IMRT was administered to patients with borderline resectable pancreatic cancer. The utility of computed tomography (CT), endoscopic ultrasound (EUS), positron emission tomography (PET), and CA 19‐9 during diagnostic workup and assessment of response was also examined.

Methods

Seventeen patients with borderline resectable pancreatic cancer received a median of three cycles of neoadjuvant GTX induction chemotherapy followed by 5‐FU‐IMRT with dose painting. CA 19‐9, CT mass size, and PET SUV were examined before and after neoadjuvant treatment.

Results

Diagnostic EUS and CT scans displayed similar mean mass sizes and extent of vascular involvement. Eight of the 17 patients achieved an R0 resection. Median CA 19‐9 levels, CT mass size, and PET SUV all significantly decreased after neoadjuvant therapy. The median progression‐free survival and overall survival were 10.48 and 15.64 months, respectively. Six patients are still alive.

Conclusions

Neoadjuvant GTX induction chemotherapy followed by 5‐FU‐IMRT shows promise in improving the likelihood of resectability with negative margins in borderline resectable pancreatic cancer. CT and EUS play complimentary roles during diagnostic workup. CT scans, CA 19‐9, and PET scans are useful in judging response to neoadjuvant therapy. J. Surg. Oncol. 2011;104:155–161. © 2011 Wiley‐Liss, Inc.
Rate coefficients for the O(3P) + Cl2O gas‐phase reaction between 230 and 357 K
Authors: Papanastasiou Dimitrios K. , Burkholder James B.
Published: April 2011

Rate coefficients, k, for the gas‐phase reaction of O(3P) atoms with Cl2O (dichlorine monoxide) over a range of temperatures (230–357 K) at pressures between 12 and 32 Torr (N2) are reported. Rate coefficients were measured under pseudo‐first‐order conditions in O(3P) using pulsed laser photolysis to produce O(3P) atoms and atomic resonance fluorescence to detect its temporal profile. The rate coefficient temperature dependence is given by the Arrhenius expression k(T) = (1.51 ± 0.20) × 10−11 exp[−(477 ± 30)/T] cm3 molecule−1 s−1, and k(296 K) was measured to be (2.93 ± 0.30) × 10−12 cm3 molecule−1 s−1. The quoted uncertainty limits are at the 2σ (95% confidence) level and include estimated systematic errors. The rate coefficients determined in the present study, under conditions that minimized secondary losses of O(3P), are compared with previous results from other laboratories and the discrepancies are discussed. © 2011 Wiley Peiodicals, Inc.*

This article is a U.S. Government work and, as such, is in the public domain of the United States of America.

Int J Chem Kinet 43: 312–321, 2011
Transparapharyngeal and transpterygoid transposition of a pedicled occipital galeopericranial flap: A new flap for skull base reconstruction
Authors: Rivera‐Serrano Carlos M. , Snyderman Carl H. , Carrau Ricardo L. , Durmaz Abdullah , Gardner Paul A.
Published: April 2011

Objectives:

We present the anatomic and cadaveric foundations for novel modifications of the occipital galeopericranial flap for reconstruction of ventral skull base defects.

Study Design:

Anatomic description.

Methods:

Using cadaveric dissections and measurements, we investigated the feasibility of transposing pedicled occipital galeopericranial flaps into the nasal cavity and skull base. Two fresh and five preserved human specimens were dissected.

Results:

Pedicled occipital flaps were transposed into the nasal cavity via a transparapharyngeal–transpterygoid corridor into the nasopharynx. It was demonstrated that the pedicled occipital galeopericranial flap reaches the anterior skull base.

Conclusions:

Pedicled occipital flaps transposed into the nasal cavity can reach the anterior skull base and provide another option for vascularized reconstruction in selected patients.
Suction diathermy as an adjunct to endoscopic removal of inverted papilloma
Authors: Hughes Owain R. , Skilbeck Christopher J. , Kwame Ivor , Kwa Kelvin , Choa Dennis I.
Published: April 2011

No Obstract.
Malignancy in vestibular schwannoma after stereotactic radiotherapy: A case report and review of the literature
Authors: Tanbouzi Husseini Sami , Piccirillo Enrico , Taibah Abdelkader , Paties Carlo T. , Rizzoli Roberto , Sanna Mario
Published: April 2011

Objectives/Hypothesis:

A relation between conventional radiotherapy and the development of intracranial neoplasma is well known, but radiation‐associated tumor following stereotactic radiotherapy of vestibular schwannoma is underestimated.   In this article we will study this relation by doing a complete literature review on all the malignant intracranial tumors that appeared following radiosurgery and adding a case of malignant vestibular schwannoma following stereotactic radiotherapy in a Neurofibromatosis type 2 patient.

Methods:

Literature review and discussion.

Results:

We found 26 cases of malignant brain tumor following stereotactic radiotherapy including our case. In 13 cases the tumor occurred in context of Neurofibromatosis type 2. None of the patients had a tumor size less than 2.5 cm. and the mean latency period between the radiotherapy and malignant tumor development was 5.8 years.

Conclusion:

Patients with vestibular schwannoma should be made aware of the low incidence of the radiation‐induced malignant changes and long‐term follow‐up is mandatory.
Viagra deafness—Sensorineural hearing loss and phosphodiesterase‐5 inhibitors
Authors: Khan Afroze Shah , Sheikh Zishan , Khan Shahnawaz , Dwivedi Raghav , Benjamin Elliot
Published: April 2011

Background:

Viagra and PDE‐5 inhibitors use has mushroomed since its launch over a decade ago. A growing body of evidence indicates significant morbidity associated with the side effect profile of this class of drug. Hearing loss associated with PDE‐5 inhibitor use has recently been reported, but few studies have evaluated the causal link.

Aim:

To review and scrutinise the current literature on the subject and propose possible physiologic mechanisms and to investigate the global reporting of this side effect.

Methods and Materials:

Pharmacovigilance agencies around North America, Europe, and Australasia were contacted requesting reports of hearing loss associated with PDE‐5 inhibitors. Reports were scrutinised to exclude those where others causes of hearing loss existed.

Results:

Forty‐seven cases of sensorineural hearing loss with a temporal association with PDE‐5 inhibitor ingestion were obtained from both published literature and pharmacovigilance agencies. Cases had a mean age 56.6 years, male‐to‐female ratio of 7:1. Eighty‐eight percent of reports were unilateral with an even left/right distribution. Hearing loss occurred within 24 hours of ingestion of PDE‐5 inhibitor in 66.7% (n = 18) of cases. Sildenafil accounted for over 50% of cases.

Conclusion:

There is increasing evidence that PDE‐5 inhibitors may induce sensorineural hearing loss via plausible physiological mechanisms. There needs to be more awareness of this disabling side effect among healthcare professionals responsible for prescribing this drug.
Amyloid goiter: A case of primary thyroid amyloid disease
Authors: Sethi Yatin , Gulati Achal , Singh Ishwar , Rao Seema , Singh Neha
Published: April 2011

Amyloid goiter is an atypical presentation of an already rare disease, amyloidosis, which uncommonly comes across in previous review of literature. A patient presented with respiratory distress, which aroused a dilemma on diagnosis because the presentation mimicked that of malignancy. A high index of attentiveness should be kept whenever amyloid deposits are seen on fine needle aspiration cytology, as they are also established in medullary carcinoma. Amyloid deposits have been traced in goiter; however, it was astonishing to observe this condition causing a rapidly growing goiter, large enough to cause respiratory distress. The confirmative diagnosis rested on the histopathology of the specimen.
Superficial ulnar artery: A contraindication to radial forearm free tissue transfer
Authors: Bell Rachel A. , Schneider Daniel S. , Wax Mark K.
Published: April 2011

Objectives:

Superficial ulnar artery is a vascular anomaly that may be encountered during elevation of forearm flaps for head and neck reconstruction. This anomaly should be considered in patients with a positive Allen's test.

Study Design:

Case report and retrospective review of forearm flaps performed at our institution.

Methods:

A 72‐year‐old man with a history of total laryngectomy presented for closure of a pharyngocutaneous fistula with radial forearm flap. A positive Allen's test and undetectable Doppler over the thenar eminence with radial artery occlusion was noted. An ulnar flap was felt to be the best alternative. A superficial ulnar artery was discovered upon elevation of the ulnar flap. Despite its anomalous course, the artery provided several fasciocutaneous branches, and the flap was successfully used to repair the patient's fistula. A retrospective review of forearm flaps and the incidence of superficial ulnar artery at our institution is presented.

Results:

A total of 690 forearm flaps (571 radial, 51 ulnar, and 68 osteocutaneous radial) were performed from 1998 to 2010. Superficial ulnar artery was encountered three times, yielding an incidence of 0.43%. In each case, the preoperative Allen's test suggested a dominant radial artery circulation. In all cases, a fasciocutaneous ulnar flap was successfully used.

Conclusions:

Superficial ulnar artery should be considered with a positive Allen's test. An ulnar fasciocutaneous flap based on the superficial ulnar artery is a safe alternative to the radial fasciocutaneous flap in this setting.
Comparison of full versus short induced‐sleep polysomnography for the diagnosis of sleep apnea
Authors: Gregório Marcelo G. , Jacomelli Márcia , Inoue Daniel , Genta Pedro Rodrigues , de Figueiredo Adelaide Cristina , Lorenzi‐Filho Geraldo
Published: April 2011

Objectives/Hypothesis:

Polysomnography (PSG) is the gold‐standard method for diagnosing obstructive sleep apnea (OSA). However, the gap between demand and capacity in performing PSG is a major health‐care problem. We sought to validate a short day‐time induced sleep for the diagnosis of OSA.

Study Design:

Prospective diagnostic method validation.

Methods:

We studied 25 consecutive patients referred to the sleep laboratory and 15 healthy volunteers. All subjects were evaluated by means of full overnight PSG (Full‐PSG) and short day‐time induced‐sleep PSG (Induced‐PSG). Sleep was monitored during both procedures (Embla, 16 channels). Sleep was induced by slow intravenous drip infusion of midazolam.

Results:

The population studied (N = 40) was 60% male (mean age, 42 ± 10 years; body mass index, 29 ± 6.5 kg/m2). Sleep was successfully induced in all subjects, and no complications were observed (midazolam doses, 6.2 ± 3.8 mg; time of induced sleep 41.5 ± 18.9 minutes). The apnea‐hypopnea index (AHI) and minimal oxygen saturation during Full‐PSG versus Induced‐PSG were similar: median AHI (with 25%–75% interquartile range) was 13 (3–35) events per hour versus 17 (4–36) events per hour, and median oxygen saturation was 84% (75–90) versus 85% (76–92); P =.89 and P =.53, respectively. The majority of the respiratory events during induced sleep were obstructive and similar to those observed during Full‐PSG. AHI and lowest oxygen saturation during Induced‐PSG correlated significantly with Full‐PSG (r = 0.67 and r = 0.77, respectively). Sensitivity and specificity for the diagnosis of OSA (AHI > 15 events per hour) by Induced‐PSG were 0.83 and 0.72, respectively.

Conclusions:

Induced‐PSG by midazolam during the day is safe and correlates with Full‐PSG; it therefore is a promising alternative method in the diagnosis of OSA.
Idiopathic ulcerative laryngitis
Authors: Simpson C. Blake , Sulica Lucian , Postma Gregory N. , Rosen Clark A. , Amin Milan R. , Merati Albert L. , Courey Mark S. , Patel Vatsal , Johns Michael M.
Published: April 2011

Objectives/Hypothesis:

Idiopathic ulcerative laryngitis (IUL) is a distinct, clinical entity that presents after a prolonged upper respiratory infection with cough. It is characterized by the development of bilateral ulcerations of the mid‐membranous vocal folds followed by a protracted course of healing. The purpose of this review was to characterize the typical patient presentation, clinical findings, and prognosis.

Study Design:

Multi‐institutional retrospective review

Methods:

Retrospective review of charts and videostroboscopic exams from patients with IUL at eight institutions.

Results:

Fifteen cases met the criteria for IUL and were included in the study. The mean age of the patients was 49 years, and 93% were female. All patients were nonsmokers. Multiple medical interventions were employed by the treating otolaryngologist during the course of the disease, none of which resulted in acute resolution of the ulcerations. The average time from initial presentation to resolution of the disease was 3.3 months. All of the patients reported that their voice was improved after resolution of the disease process. However, in the majority of the patients (60%) there were persistent vibratory abnormalities after resolution of the ulcerations.

Conclusions:

This is the first multi‐institutional study to define the complete disease course of IUL and to establish diagnostic criteria. IUL is a rare yet well‐recognized clinical entity; however, there is no established etiology for this condition and no definitive treatments have emerged. Further study is needed to establish the etiology/risk factors of this condition and to determine optimal medical management.
Methylglyoxal‐infused honey mimics the anti‐Staphylococcus aureus biofilm activity of manuka honey: Potential Implication in Chronic Rhinosinusitis
Authors: Jervis‐Bardy Joshua , Foreman Andrew , Bray Sarah , Tan Lorwai , Wormald Peter‐John
Published: April 2011

Objectives/Hypothesis:

Low pH, hydrogen peroxide generation, and the hyperosmolarity mechanisms of antimicrobial action are ubiquitous for all honeys. In addition, manuka honey has been shown to contain high concentrations of methylglyoxal (MGO), contributing the relatively superior antimicrobial activity of manuka honey compared to non‐MGO honeys. In high concentrations, manuka honey is effective in killing Staphylococcus
aureus biofilms in vitro. Lower concentrations of honey, however, are desirable for clinical use as a topical rinse in chronic rhinosinusitis in order to maximize the tolerability and practicality of the delivery technique. This study, therefore, was designed to evaluate the contribution of MGO to the biofilm‐cidal activity of manuka honey, and furthermore determine whether the antibiofilm activity of low‐dose honey can be augmented by the addition of exogenous MGO.

Study Design:

In vitro microbiology experiment.

Methods:

Five S.
aureus strains (four clinical isolates and one reference strain) were incubated to form biofilms using a previously established in vitro dynamic peg model. First, the biofilm‐cidal activities of 1) manuka honey (790 mg/kg MGO), 2) non‐MGO honey supplemented with 790 mg/kg MGO, and 3) MGO‐only solutions were assessed. Second, the experiment was repeated using honey solutions supplemented with sufficient MGO to achieve concentrations exceeding those seen in commercially available manuka honey preparations.

Results:

All honey solutions containing a MGO concentration of 0.53 mg/mL or greater demonstrated biofilm‐cidal activity; equivalent activity was achieved with ≥1.05 mg/mL MGO solution.

Conclusions:

MGO is only partially responsible for the antibiofilm activity of manuka honey. Infusion of MGO‐negative honey with MGO, however, achieves similar cidality to the equivalent MGO‐rich manuka honey.
Do contemporary temporal bone fracture classification systems reflect concurrent intracranial and cervical spine injuries?
Authors: Sun Gordon H. , Shoman Nael M. , Samy Ravi N. , Cornelius Rebecca S. , Koch Bernadette L. , Pensak Myles L.
Published: April 2011

Objectives/Hypothesis:

Temporal bone fractures (TBFs) are a frequent manifestation of head trauma. We investigated the prevalence of concurrent intracranial injuries (ICIs) and cervical spine injuries (CSIs) in a series of patients with TBFs and attempted to identify significant associations between current TBF classification systems and either ICI or CSI.

Study Design:

Retrospective case series with chart review.

Methods:

The records of all patients ≥18 years of age diagnosed with a basilar skull fracture, including TBF, at a level I trauma center from 2004 to 2009 were reviewed. Patient demographics, mechanism of injury, and Glasgow Coma Scale (GCS) scores were collected. Imaging studies were reviewed to classify TBF using the traditional longitudinal‐transverse‐mixed and otic capsule–sparing versus –involving systems and identify concurrent ICI and CSI.

Results:

Of 1,279 patients, 202 (15.8%) met inclusion criteria. There were 160 (79.2%) males. Sixteen (7.9%) patients had bilateral TBFs. Falls (n = 66, 32.7%) represented the most common mechanism for TBF. Longitudinal (n = 96, 44.0%) and otic capsule–sparing (n = 209, 95.9%) fractures were the most prevalent subtypes. There were 184 (91.1%) patients who sustained ICI and 18 (8.9%) who demonstrated CSI. Longitudinal, transverse, mixed, otic capsule–sparing, or otic capsule–involving TBF subtypes had no statistically significant associations with mechanism of injury, GCS score, or concomitant ICI or CSI.

Conclusions:

More than 90% of patients sustaining TBF presented with concomitant ICI, and 9% sustained CSI. Current TBF classification systems do not correlate with these outcomes. A more sophisticated, multidisciplinary classification system encompassing radiographic and clinical findings may better predict neurologic, neuro‐otologic, and skull base complications.
Narrow‐band imaging for diagnosing adenoid hypertrophy in adults: A simplified grading and histologic correlation
Authors: Wang Wen‐Hung , Lin Yen‐Chun , Weng Hsu‐Huei , Lee Kam‐Fai
Published: April 2011

Objectives/Hypothesis:

To investigate the use of narrow‐band imaging (NBI) endoscopy to detect the appearance of a light crest (LC) on the epithelial surface of the nasopharyngeal mucosa, which is suggested to be a distinctive endoscopic finding associated with the presence of adenoid hypertrophy.

Study Design:

Cross‐sectional study.

Methods:

A total of 79 consecutive adults with a high suspicion of malignancy underwent NBI endoscopy and nasopharyngeal biopsy to validate the diagnostic accuracy of the novel endoscopic technique. The degree of correlation between the LC grading and the histologic examinations of lymphoid hyperplasia, including the number of mucin‐producing cells and lymphoid follicles, was then assessed.

Results:

The appearance of an LC on NBI endoscopy correlated with the histologic evidence of lymphoid hyperplasia with a sensitivity of 92.1%, a specificity of 95.1%, a positive predictive value of 94.6%, a negative predictive value of 92.9%, a false‐positive value of 4.9%, a false‐negative value of 7.9%, and an accuracy of 93.7%. The screening performance of NBI endoscopy for the presence of adenoid hypertrophy is significantly superior to that of conventional endoscopy (P =.0003). The LC grading was significantly correlated with the number of mucin‐producing cells and lymphoid follicles (P <.001).

Conclusions:

In NBI endoscopy, observation of an LC on the epithelial surface of the nasopharyngeal mucosa is a highly accurate predictor of the presence of adenoid hypertrophy.
Transantral balloon dilation plus posterior ethmoidectomy
Authors: Kizhner Victor , Setzen Michael , Krespi Yosef P.
Published: April 2011

Objectives/Hypothesis:

Transantral endoscopic balloon dilatation (TABD) was recently introduced for the management of limited mild maxillary and ethmoid disease. An expanded approach by inserting surgical tools into the antrum via a second port, directed toward the maxillary ostium, ethmoid infundibulum, and posterior ethmoids will allow for the treatment of moderate disease as well.

Study Design:

Retrospective data review.

Methods:

A study including all TABD procedures performed between January and December 2009 was performed. Sublabial approach with two working channels, one for the endoscope and a second port for balloon dilatation or other surgical instrumentation, was devised. Both channels were created via mini‐trephine aimed toward the osteo‐meatal complex (OMC) with different angulations. The same approach was used for transantral posterior ethmoidectomy (TAPE). Data collected included demographics, Sino‐Nasal Outcome Test (SNOT) scores, Lund‐Mackay score, and complications.

Results:

Thirty‐five patients with 64 dilated sinuses and 10 TAPE procedures were enrolled. All SNOT scores showed statistically significant improvement decreasing from 1.77 to 0.83. Complication rate was minimal. Only a small number of procedures were converted to standard endoscopic septoplasty (ESS) owing to severity of OMC disease. TAPE proved to be a minimally invasive procedure.

Conclusions:

Two trocars inserted through the canine fossa can achieve a successful result in moderate antral disease for TABD and allow TAPE to be performed, thus creating a bridge between mild disease and one requiring standard full ESS. The minimally invasive approach proved to be particularly useful.
Efficacy and comparative effectiveness of sirolimus as an anticancer drug
Authors: Hu Melissa , Ekshyyan Oleksandr , Ferdinandez Lilantha Herman , Rong Xiaohua , Caldito Gloria , Nathan Cherie‐Ann O.
Published: April 2011

Objectives/Hypothesis:

To evaluate antitumor efficacy of the generic mammalian target of rapamycin (mTOR) inhibitor sirolimus in preclinical animal models of head and neck squamous cell carcinoma (HNSCC) and compare its effects with those of the patented analogue temsirolimus.

Study Design:

In vivo study.

Methods:

To develop xenograft established tumor model (ETM) of HNSCC, FaDu cells were injected subcutaneously into nude mice. When tumors reached 50 to 60 mm3, mice were randomized into five groups and treated daily intraperitoneally with sirolimus at various doses for 5 days per week for 3 weeks. Tumor volumes were measured. The results were compared with historical data on temsirolimus effects. In the minimal residual disease (MRD) model, surgical wounds were created and FaDu cells implanted. After 72 hours, animals were randomized into two groups and were injected intraperitoneally with 0 or 5 mg/kg sirolimus for 5 days per week for 30 days.

Results:

In the ETM, sirolimus significantly inhibited tumor growth (P < .01), although there was no overall significant difference in tumor growth inhibition between sirolimus and temsirolimus. In the MRD model, sirolimus significantly suppressed growth of tumors (P < .001) and improved survival compared with controls (P < .01). There was a significant decrease in pS6 expression, indicating mTOR inhibition.

Conclusions:

In this study, we demonstrate that the generic mTOR inhibitor sirolimus shows potent antitumor activity in HNSCC and produces comparable effects to the patent drug temsirolimus. Sirolimus has the potential of serving as an economic and comparative targeted agent to temsirolimus in the treatment of HNSCC.
Contralateral ansa cervicalis‐to‐recurrent laryngeal nerve anastomosis for unilateral vocal fold paralysis: A long‐term outcome analysis of 56 cases
Authors: Wang Wei , Chen Shicai , Chen Donghui , Xia Siwen , Qiu Xiaoxia , Liu Yuehong , Zheng Hongliang
Published: April 2011

Objectives/Hypothesis:

To evaluate the long‐term efficacy of contralateral ansa cervicalis‐to‐recurrent laryngeal nerve (RLN) anastomosis for unilateral vocal fold paralysis (UVFP), when the ansa cervicalis on the side of the paralyzed vocal fold was absent or there was any question about its viability.

Study Design:

We retrospectively reviewed 56 consecutive cases of delayed laryngeal reinnervation with contralateral ansa cervicalis for UVFP.

Methods:

Between January 1996 and January 2008, a total of 56 UVFP patients were enrolled in this study. All patients underwent contralateral ansa cervicalis‐to‐RLN anastomosis. Videostroboscopy, acoustic analysis, perceptual evaluation and maximum phonation time (MPT), and laryngeal electromyography (LEMG) were performed pre‐ and postoperatively.

Results:

Analysis of videostroboscopic findings indicated that the glottic closure, vocal fold edge, vocal fold position, phase symmetry, and regularity were significantly improved (P < .001, post‐ vs. preoperative). Perceptual evaluation of dysphonia severity showed that overall grade, roughness, breathiness, asthenia, and strain were also significantly decreased postoperatively (P < .001). Postoperative values of jitter (local), shimmer (local), and mean noise‐to‐harmonics ratio were significantly lower than the corresponding preoperative values (P < .001). The postoperative MPT value was significantly longer than the preoperative one (P < .001). LEMG showed that there was a significant postoperative improvement in voluntary motor‐unit recruitment during phonation (P < .001).

Conclusions:

In cases with a lack of viable ansa cervicalis on the side of a paralyzed vocal fold, contralateral ansa cervicalis‐to‐RLN anastomosis is a feasible and effective approach in the treatment of UVFP and can restore physiologic laryngeal phonatory function.
Pediatric acute mastoiditis in the post–pneumococcal conjugate vaccine era
Authors: Choi Sukgi S. , Lander Lina
Published: April 2011

Objectives/Hypothesis:

To determine whether the characteristics of acute mastoiditis in children have changed in the post–heptavalent pneumococcal conjugate vaccine (PCV7) era.

Study Design:

Case series.

Methods:

Clinical data for all patients admitted for acute mastoiditis at an urban tertiary children's hospital from July 1, 1996, to June 30, 2009, were reviewed. Patients with a known immune deficiency or cholesteatoma were excluded. Patients were divided into pre‐PCV7 (July 1996 to December 2002; n = 38) and post‐PCV7 (January 2003 to June 2009; n = 58) groups. Statistical analyses were used to compare the two groups.

Results:

Ninety‐six children met the inclusion criteria. There was a 53% increase in admission for acute mastoiditis in the post‐PCV7 era. The pre‐ and post‐PCV7 groups had similar demographic features, presenting history, signs and symptoms, laboratory study results, and medical management. Computed tomography scan abnormalities seen in the two groups were similar except for subperiosteal abscess, which was seen more frequently in the post‐PCV7 group. Streptococcus pneumoniae was the most common pathogen isolated in both groups. The patients in the post‐PCV7 group had shorter hospital stays, despite undergoing more extensive surgery to address their disease.

Conclusions:

The number of acute mastoiditis admissions did not decrease with the widespread use of PCV7. Computed tomography findings and surgical procedures required to address acute mastoiditis indicate that the post‐PCV7 group had more advanced disease. S pneumoniae remains the main pathogen in acute mastoiditis, and its nonsusceptibility to penicillin and ceftriaxone may be increasing.
Does the length of uvula affect the palatal implant outcome in the management of habitual snoring?
Authors: Akpinar Meltem Esen , Yigit Ozgur , Kocak Ismail , Altundag Aytug
Published: April 2011

Objectives/Hypothesis:

To evaluate the impact of the uvular length on the efficacy of palatal implants in primary snoring.

Study Design:

Prospective case series, tertiary hospital, snoring and respiratory sleep disorders center.

Methods:

Forty subjects with inserted palatal implants and diagnoses of primary snoring were included. All met the inclusion criteria of age >18 years, body mass index <30, apnea‐hypopnea index <5, tonsil grade <3, soft‐palate length >25 mm, and Friedman tongue position <3 following clinical, endoscopic, and polysomnographic evaluation. Epworth sleepiness scale (ESS) and the snoring‐intensity visual analogue scale (VAS) were recorded before and 9 months after the implant. Four subjects with extruded implants were excluded; the remaining 36 subjects were divided into two groups, Group I and Group II, with uvular lengths of ≤15 mm and >15 mm, respectively. The study assessed and compared subjective outcome measures including the partner's satisfaction (PS), partner's reported improvement (PRI), 50% VAS and ESS reduction, and subjective success (SS) defined as 50% VAS reduction. The Student t test, χ2 test, and logistic regression models were used for statistical evaluation.

Results:

SS (50% VAS reduction), PS, PRI, and 50% ESS reduction were significantly higher in Group I (P < .001, P = .0257, P = .027, P < .001). The overall SS, PRI, PS, and 50% ESS reduction were 33%, 78%, 50%, and 50%, respectively. The uvular length was found to be the determinant factor of SS (P = .005; odds ratio = 0.75), PRI (P = .039; odds ratio = 0.83), and 50% ESS reduction (P = .038; odds ratio: 0.84) following implant insertion through stepwise logistic regression analysis.

Conclusions:

Excess uvular length (>15 mm) is an important anatomic feature decreasing the efficacy of palatal implants in snoring, and additional measures, such as uvulectomy, should be considered simultaneously for better outcomes (level 4).
STT3A, C1orf24, TFF3: Putative Markers for Characterization of Follicular Thyroid Neoplasms From Fine‐Needle Aspirates
Authors: Patel Mihir R. , Stadler Michael E. , Deal Allison M. , Kim Hungsuk S. , Shores Carol G. , Zanation Adam M.
Published: April 2011

Objectives/Hypothesis:

The goals of this study were to characterize gene expression using fine‐needle aspirates (FNAs) from follicular neoplasms to distinguish follicular adenomas (FAs) from follicular thyroid carcinomas (FTCs) and follicular variant of papillary thyroid carcinomas (FVPTCs); and to use FNA material to distinguish benign from malignant follicular neoplasms.

Study Design:

Retrospective expression analysis of diagnosed follicular neoplasms (level of evidence 2b); prospective cohort of FNA from the operating room after thyroid lobectomy (level of evidence 1b).

Methods:

Gene expression analysis via reverse‐transcription polymerase chain reaction (rt‐PCR) of nine genes previously noted to be differentially expressed in follicular neoplasms was performed on formalin‐fixed, paraffin‐embedded archived normal thyroid tissue (n = 63) and follicular neoplasms as diagnosed on preoperative FNA: FA (n = 16), FTC (n = 13), FVPTC (n = 24), and papillary thyroid carcinomas (PTCs) (n = 10). All cases were originally read as follicular neoplasms on preoperative FNA. To determine if these results could be translated into fresh tissue, ex vivo FNA was performed on follicular neoplasms (n = 17) in the operating room after thyroidectomy.

Results:

Quantitative gene analysis detected differential TFF3 expression in FA versus FTC, FVPTC, and PTC (P = .02). Rt‐PCR of FNA samples demonstrated that malignant nodules overexpress STT3A as compared with benign disease (P = .046). The combination of STT3A overexpression/Clorf24 underexpression identified malignant disease (P = .03) on FNA samples.

Conclusions:

Gene‐expression data suggest a difference in expression between STT3A, Clorf24, and TFF3 in FAs versus carcinomas that may be detected from an FNA sample. Findings must be validated from preoperative FNAs in larger numbers.