bluuebunny/crossref_metadata_2025 huggingface dataset:
AnoEST: Toward A. gambiae functional genomics
Authors: Kriventseva Evgenia V. , Koutsos Anastasios C. , Blass Claudia , Kafatos Fotis C. , Christophides George K. , Zdobnov Evgeny M.
Published: May 2005

Here, we present an analysis of 215,634 EST and cDNA sequences of a major vector of human malaria Anopheles gambiae structured into the AnoEST database. The expressed sequences are grouped into clusters using genomic sequence as template and associated with inferred functional annotation, including the following: corresponding Ensembl gene prediction, putative orthologous genes in other species, homology to known proteins, protein domains, associated Gene Ontology terms, and corresponding classification into broad GO-slim functional groups. AnoEST is a vital resource for interpretation of expression profiles derived using recently developed A. gambiae cDNA microarrays. Using these cDNA microarrays, we have experimentally confirmed the expression of 7961 clusters during mosquito development. Of these, 3100 are not associated with currently predicted genes. Moreover, we found that clusters with confirmed expression are nonbiased with respect to the current gene annotation or homology to known proteins. Consequently, we expect that many as yet unconfirmed clusters are likely to be actual A. gambiae genes. [AnoEST is publicly available at http://komar.embl.de, and is also accessible as a Distributed Annotation Service (DAS).]
A social science gateway in a shifting digital world: shaping SOSIG for users’ needs of the future
Authors: Huxley Lesly , Joyce Angela
Published: May 2005

This paper considers two of the key challenges facing a mature UK subject gateway (SOSIG): the sustainability of a labour‐intensive service and innovation and evaluation needed to keep pace with user needs. SOSIG's history and changing contexts are sketched and issues of changing Internet search technologies, trends in user behaviour, and changes in higher education teaching or learning are analysed. Reflects on the “Google challenge” and the need to take a more strategic approach to engaging with the user community, given emerging audiences and technologies. Concludes with how SOSIG will be shaped for the future through collaboration, service design and user engagement.
E‐mail viruses: how organizations can protect their e‐mails
Authors: Shih Dong‐Her , Chiang Hsiu‐Sen
Published: May 2005

An e‐mail virus is an e‐mail that can infect other programs by modifying them to include a replication of itself. When the infected e‐mails are opened, the e‐mail virus spreads itself to others. Today's society has seen a dramatic increase in the use of e‐mails. As a result, organizations must take even more precautions to guard against the introduction of e‐mail viruses into their systems. This paper discusses how organizations can protect their e‐mails from the intrusion of e‐mail virus and how to develop their own e‐mail virus security plan.
Histologic placental lesions in women with recurrent preterm delivery
Authors: Ghidini Alessandro , Salafia Carolyn M.
Published: May 2005

Background.  The aim of this study was to evaluate whether particular placental histopathology lesions are associated with recurrent preterm birth.

Methods.  We analyzed a database of 413 consecutive singleton pregnancies delivered at <32 weeks with past reproductive history available. After the exclusion of nulliparous women, the pregnancies were divided according to the obstetrical history into group 1 (n = 328), women without prior preterm delivery (PTD); group 2 (n = 49), women with one prior preterm childbirth; and group 3 (n = 36), women with ≥2 prior preterm deliveries. Demographic and clinical variables were compared among the three groups by using Kruskal–Wallis test and chi‐square test for trend. Finally, the individual placental lesions (i.e. 42 lesions of acute or chronic inflammation, uteroplacental vascular pathology, and intraplacental villous lesions) were correlated with the number of prior preterm deliveries by using regression analysis. A two‐tailed P < 0·05 was considered significant.

Results.  No differences were found among the three groups in demographic or clinical variables. Regression analysis of scored placental lesions corrected for gestational age at delivery showed that the number of prior preterm deliveries was correlated only with chronic marginating choriodeciduitis (correlation coefficient = 0·13; P = 0·01) and acute choriodeciduitis (correlation coefficient = 0·14; P = 0·008).

Conclusions.  Among women delivered at <32 weeks, those with prior preterm birth have histologic findings compatible with acute or chronic inflammatory involvement of the uterine cavity, suggesting that a prepregnancy endometrial infection rather than an ascending intrapregnancy pathway may be responsible for some recurrences of PTD.
Interleukin‐6 and interleukin‐8 in cervical fluid in a population of Swedish women in preterm labor: relationship to microbial invasion of the amniotic fluid, intra‐amniotic inflammation, and preterm delivery
Authors: Holst Rose‐Marie , Mattsby‐Baltzer Inger , Wennerholm Ulla‐Britt , Hagberg Henrik , Jacobsson Bo
Published: May 2005

Background.  Intrauterine infection and inflammation in women with preterm labor are related to adverse perinatal outcome. Due to its subclinical nature, a correct diagnosis depends on retrieval of amniotic fluid. Amniocentesis is, however, not performed as a clinical routine because of its invasiveness. Hypothetically, cytokines in the cervical fluid may represent an alternative diagnostic approach. The aim was to examine cervical interleukin (IL)‐6 and IL‐8 in relation to microbial invasion of the amniotic fluid, intra‐amniotic inflammation, and preterm birth in women in preterm labor.

Methods.  Women with singleton pregnancies in preterm labor (<34 weeks of gestation) and intact membranes were included. Cervical (n = 91) and amniotic fluids (n = 56) were collected. Polymerase chain reaction for Ureaplasma urealyticum and Mycoplasma hominis and culture for aerobic and anaerobic bacteria were performed. IL‐6 and IL‐8 were analyzed with enzyme‐linked immunosorbent assay.

Results.  Non‐lactobacillus‐dominated biota was detected in cervical secretion in 25% (22/89) and the presence of micro‐organisms in the amniotic fluid in 16% (9/56) of the patients. The presence of U. urealyticum in the cervical fluid (21/46) was associated with significantly higher levels of IL‐6 in the secretion. IL‐6 and IL‐8 were significantly higher in cervical fluid of women with intra‐amniotic infection and inflammation and in women who delivered ≤7 days and/or before 34 weeks of gestation. Cervical IL‐6 ≥ 1.7 ng/ml was related to intra‐amniotic inflammation (relative risk: 2.67; range: 1.50–4.74) and had a sensitivity, specificity, positive predictive value, and negative predictive value of 58, 83, 75, and 69%, respectively, in the identification of intra‐amniotic inflammation. Similar data were obtained for IL‐8 ≥ 6.7 ng/ml.

Conclusions.  High levels of cervical IL‐6 and IL‐8 are moderately predictive of intrauterine infection/inflammation and preterm delivery.
Preterm birth in Sweden 1973–2001: Rate, subgroups, and effect of changing patterns in multiple births, maternal age, and smoking
Authors: Morken Nils‐Halvdan , Källen Karin , Hagberg Henrik , Jacobsson Bo
Published: May 2005

Background.  The objectives of this report are to evaluate changes in the preterm birth rate in Sweden 1973–2001. Furthermore, describe the proportion of spontaneous and indicated preterm births and assess risk factors for the subgroups of preterm birth during the period from 1991 to 2001.

Methods.  A population‐based register study of all births occurring in Sweden from 1973 to 2001 registered in the Swedish Medical Birth Register was designed. The analysis of subgroups was restricted to the period 1991–2001. Gestational age was calculated using last menstrual period and best estimate. Odds ratio for preterm birth related to risk factors was calculated for the subgroups' spontaneous and indicated preterm birth.

Results.  After an increase in the beginning of the 1980s, the preterm birth rate has decreased from 6.3% in 1984 to 5.6% in 2001 (P < 0.0001). The proportion of multiple births born preterm of the total birth rate increased from 0.34% in 1973 to 0.71% in 2001 (P < 0.0001).

Spontaneous preterm births account for 55.2% and iatrogenic preterm births for 20.2% of all preterm births. The strongest association with maternal smoking in early pregnancy was found at gestational age <28 weeks and spontaneous preterm birth [odds ratio (OR) smoking versus no smoking: 1.55, 95% confidence intervals (CI): 1.42–1.69]. The strongest association for maternal age was found between gestational age <28 weeks and indicated preterm birth (OR 5‐year increase: 1.34, 95% CI: 1.21–1.47).

Conclusions.  The preterm birth rate in Sweden has decreased since the mid 1980s. The composition of different subtypes of preterm birth in a Scandinavian low‐risk population seems to be similar to populations with higher incidence of preterm birth and perinatal infections.
Biomarkers for the prediction of preterm delivery
Authors: Vogel Ida , Thorsen Poul , Curry Allison , Sandager Puk , Uldbjerg Niels
Published: May 2005

This structured review discusses the current literature on selected biomarkers and their ability to predict preterm delivery (PTD).

Among symptomatic women, the likelihood ratio (LR+) for the prediction of PTD was found to be greater than 10 using amniotic fluid (AF) interleukin‐6 (IL‐6), AF Ureaplasma urealyticum, as well as a multi‐marker consisting of cervical IL‐6, cervical IL‐8, and cervical length (CL). The LR+ was found to be between 5 and 10 for serum C‐reactive protein (CRP). An LR+ between 2.5 and 5 was recorded for serum corticotropin‐releasing hormone (CRH), cervical fetal fibronectin (fFN), cervical IL‐6, serum relaxin, and a multi‐marker consisting of fFN and CL. CL and bacterial vaginosis (BV) both predicted PTD in women with preterm labor with an LR+ of less than 2.5.

In asymptomatic women, AF U. urealyticum and a multimarker consisting of five individual markers [fFN, CL, serum alpha‐fetoprotein (AFP), serum alkaline phosphatase, and serum granulocyte colony‐stimulating factor (G‐CSF)] predicted PTD with an LR+ greater than 10. The LR+ was between 5 and 10 for serum relaxin and CL. LRs+ recorded for serum alkaline phosphatase, salivary estriol, serum CRH, serum G‐CSF, cervical IL‐6, AF IL‐6, cervical fFN, AFP, and Chlamydia all ranged between 2.5 and 5. Finally, an LR+ below 2.5 has been documented for serum ferritin, serum CRP, BV, and cervical ferritin.
Monocyte chemotactic protein‐2 and ‐3 in amniotic fluid: relationship to microbial invasion of the amniotic cavity, intra‐amniotic inflammation and preterm delivery
Authors: Jacobsson Bo , Holst Rose‐Marie , Andersson Bengt , Hagberg Henrik
Published: May 2005

Objective.  To evaluate the presence of monocyte chemotactic protein (MCP)‐2 and MCP‐3 in cervical and amniotic fluid in women in preterm labor.

Study design.  Cervical and amniotic fluid was sampled from women with singleton pregnancies (≤34 weeks) in preterm labor (n = 58).

Results.  Monocyte chemotactic protein‐2 (range: 80–583 pg/ml) and MCP‐3 (range: 36–649 pg/ml) were detectable in 7/58 women in preterm labor. Monocyte chemotactic protein‐3 was found significantly more often in amniotic fluid of women delivered within 7 days (P < 0.001), <34 weeks (P = 0.002), or with intra‐amniotic inflammation (P < 0.001) and microbial invasion of the amniotic fluid (P = 0.003). Women in preterm labor had detectable levels of MCP‐2 significantly more often if they gave birth before 34 weeks of gestation (P = 0.038) or had intra‐amniotic inflammation (P = 0.042).

Conclusions.  The presence of MCPs in amniotic fluid of women in preterm labor was associated with preterm birth before 34 weeks of gestation (MCP‐2 and MCP‐3), microbial invasion (MCP‐3), and inflammation (MCP‐2 and MCP‐3) of the amniotic cavity.
Progesterone supplementation for preventing preterm birth: a systematic review and meta‐analysis
Authors: Dodd Jodie M. , Crowther Caroline A. , Cincotta Robert , Flenady Vicki , Robinson Jeffrey S.
Published: May 2005

Aim.  The aim of this study is to assess the role of progesterone in preterm birth prevention.

Methods.  A MEDLINE search (from 1966 to the present; date of last search January 2005) was performed – using the key words progesterone, pregnancy, preterm birth, preterm labor, and randomized, controlled trial – in order to identify randomized, controlled trials in which progesterone (either intramuscular or vaginal administration) was compared with placebo or no treatment. Data were extracted and a meta‐analysis was performed.

Results.  Seven randomized, controlled trials were identified. Women who received progesterone were statistically significantly less likely to give birth before 37 weeks (seven studies, 1020 women, RR = 0.58, 95% CI = 0.48–0.70), to have an infant with birth weight of ≤2.5 kg (six studies, 872 infants, RR = 0.62, 95% CI = 0.49–0.78), or to have an infant diagnosed with intraventricular hemorrhage (one study, 458 infants, RR = 0.25, 95% CI = 0.08–0.82).

Conclusions.  For progesterone supplementation to be advocated for women at the risk of preterm birth, the prolongation of gestation demonstrated in this meta‐analysis must translate into improved infant outcomes, including a reduction in mortality. There is currently insufficient information to allow recommendations regarding the optimal dose, route, and timing of administration of progesterone supplementation.
Maternal smoking and causes of very preterm birth
Authors: Kyrklund‐Blomberg Nina B. , Granath Fredrik , Cnattingius Sven
Published: May 2005

Background.  Smoking increases the risk of preterm birth. The present study was made to elucidate the relation of smoking to causes of very preterm birth.

Methods.  In a case‐control study on all very preterm births in two regions of Stockholm 1988–1992, prospectively collected data were extracted from antenatal and delivery records on smoking, other maternal characteristics, pregnancy complications, and causes of preterm birth. Cases were live single births with a gestational age of ≤32 weeks and 0 days, and controls were live singletons delivered at 37 weeks or later (n = 295, respectively). Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with logistic regression.

Results.  Compared with non‐smokers, adjusted ORs of very preterm birth among moderate smokers (1–9 cigarettes per day) and heavy smokers (≥10 cigarettes per day) were 1.4 (95% CI 0.8–2.4) and 2.9 (95% CI 1.5–5.7), respectively. Compared with non‐smokers, risk of preterm labor was increased among moderate and heavy smokers [ORs 1.9 (95% CI 1.0–3.6) and 2.6 (95% CI 1.1–1.6), respectively]. These risks remained essentially unchanged in women without an identifiable cause of preterm labor (‘idiopathic preterm labor’). Smoking was also associated with dose‐dependent increases in risks of preterm birth due to preterm premature rupture of membranes and late pregnancy bleedings. There was no association between smoking and risk of very preterm birth caused by hypertensive diseases.

Conclusions.  Smoking increases the risk of very preterm birth caused by preterm labor (including idiopathic preterm labor), preterm premature rupture of membranes, and late pregnancy bleedings.
Term breech delivery in Sweden: mortality relative to fetal presentation and planned mode of delivery
Authors: Herbst Andreas
Published: May 2005

Objectives. To compare perinatal and infant mortality in breech and cephalic presentations and between planned vaginal and cesarean section (CS) breech deliveries in Sweden.

Methods. The study comprised two parts. Study A is a national cohort study for the period 1991–2001, including 22 549 breech presentations and 875 249 cephalic presentations born at ≥38 completed weeks. Study B is a case–control study, including all 164 breech deliveries with perinatal or 1‐year infant death (during 1991–1999 in Sweden) and controls.

Results. Study A: Among non‐malformed infants, the total mortality rate was 0.46% in breech and 0.28% in cephalic presentations [adjusted odds ratio (OR) 1.6; 95% confidence interval 1.3–1.9]. Non‐malformed breech babies were at an increased risk of antenatal death (breech versus cephalic hazard ratio: 2.7, 2.1–3.6). The infant mortality among non‐malformed breech deliveries was higher in vaginal birth than in delivery by CS before labor (OR 2.5, 1.2–5.3). The perinatal + infant mortality among non‐malformed breech babies was higher at delivery after 39 completed weeks than at CS delivery at 38 weeks (0.53% versus 0.14%; OR 3.5, 1.9–6.4). The estimated needed number of CS to avoid one death was 400. Study B: In breech presentations without malformations, OR for perinatal or infant death was 3.1 (1.7–5.8) at planned vaginal delivery compared with planned CS delivery, and when breech presentations not diagnosed at 37 gestational weeks were excluded, OR was 3.7 (1.6–9.2).

Conclusions. These large population‐based and case‐control studies both show a significant reduction of perinatal and infant mortality with planned CS in term breech pregnancy.
Radial nerve injury after general anaesthesia in the lateral decubitus position*
Authors: Tuncali B. E. , Tuncali B. , Kuvaki B. , Cinar O. , Doğan A. , Elar Z.
Published: May 2005

A 43‐year‐old female patient underwent pyelolithotomy in the left lateral decubitus position. Her upper right arm was placed on a padded armboard. Surgery lasted for 240 min. Postoperatively, she complained of numbness of the dorsal part of her right hand and wrist drop. Neurological examination revealed hypoaesthesia of the dermatome of the right forearm and hand innervated by the radial nerve. Electromyography revealed advanced axonal degeneration of the radial nerve below the level of the elbow. Treatment with diclofenac, vitamin B and physiotherapy was started. Her symptoms improved gradually and at the 60th postoperative day, motor weakness had completely resolved. In order to prevent peri‐operative nerve injury, careful positioning of every patient on the operating table with proper padding is essential, with attention paid to time‐dependent risks. If an injury occurs, diagnosis and treatment should be started as rapidly as possible.
Long‐term outcome after 60 days of intensive care
Authors: Venker J. , Miedema M. , Strack van Schijndel R. J. M. , Girbes A. R. J. , Groeneveld A. B. J.
Published: May 2005

Patients with a long stay in the intensive care unit because of chronic critical illness consume many resources, and yet their outcome may be poor. We evaluated the long‐term outcome of patients spending more than 60 days in the intensive care unit. We performed a retrospective cohort and prospective follow‐up study of 78 patients staying more than 60 days in the 19–26 bed mixed intensive care unit of a university hospital from November 1995 to January 2003. The mortality in the intensive care unit was 38%; at 1 and 5 years it was 56% and 67%, respectively. Advanced age, prior pulmonary disease, long duration of renal replacement therapy, a low oxygenation ratio and platelet count and high Simplified Acute Physiology Score II and Sequential Organ Failure Assessment scores on day 60 influenced long‐term mortality. A Simplified Acute Physiology Score II of 50 or a Sequential Organ Failure Assessment score of 8 or higher was associated with 100% mortality during follow‐up. The overall 5‐year survival rate of 33% suggests that prolonged intensive care may be worth the effort in certain patients.
The influence of the military on civilian uncertainty about modern anaesthesia between its origins in 1846 and the end of the Crimean War in 1856
Authors: Metcalfe N. H.
Published: May 2005

Examination of primary and secondary sources suggests that the military did not significantly help establish the position of modern anaesthesia in society until evidence and experience from the Crimean War was obtained and disseminated.
Methylthioninium chloride: pharmacology and clinical applications with special emphasis on nitric oxide mediated vasodilatory shock during cardiopulmonary bypass
Authors: Faber P. , Ronald A. , Millar B. W.
Published: May 2005

Vasodilatory shock after cardiopulmonary bypass is a common complication requiring treatment with high doses of inotropes and prolonged stays in the intensive care unit. The vasodilatory shock is initiated by an inflammatory response to the extracorporeal circuit. The inflammatory response results in endothelial synthesis and release of nitric oxide resembling the clinical features observed in vasodilatory shock caused by septicaemia. During vasodilatory shock, the inhibition of nitric oxide synthase and the nitric oxide/cyclic guanylyl monophosphate pathway is an attractive adjunct to therapy with traditional inotropes. Methylthioninium chloride inhibits nitric oxide/cyclic guanylyl monophosphate mediated vasodilation and can successfully be used as a supplement in the treatment of vasodilatory shock associated with cardiopulmonary bypass. The application of methylthioninium chloride in septicaemia has not produced comparable positive clinical results.
A physiologically‐based early warning score for ward patients: the association between score and outcome*
Authors: Goldhill D. R. , McNarry A. F. , Mandersloot G. , McGinley A.
Published: May 2005

We analysed the physiological values and early warning score obtained from 1047 ward patients assessed by an intensive care outreach service. Patients were either referred directly from the wards (n = 245, 23.4%) or were routine critical care follow‐ups. Decisions were made to admit 135 patients (12.9%) to a critical care area and limit treatment in another 78 (7.4%). An increasing number of physiological abnormalities was associated with higher hospital mortality (p < 0.0001) ranging from 4.0% with no abnormalities to 51.9% with five or more. An increasing early warning score was associated with more intervention (p < 0.0001) and higher hospital mortality (p < 0.0001). For patients with scores above one (n = 660), decisions to admit to a critical care area or limit treatment were taken in 200 (30.3%). Scores of all physiological variables except temperature contributed to the need for intervention and all variables except temperature and heart rate were associated with hospital mortality.
Delayed haemolytic transfusion reaction and hyperhaemolysis complicating peri‐operative blood transfusion in sickle cell disease
Authors: McGlennan A. P. , Grundy E. M.
Published: May 2005

We present a case of delayed haemolytic transfusion reaction and hyperhaemolysis syndrome in a patient with sickle cell disease. A 32‐year‐old woman with a history of sickle cell disease was scheduled for total hip replacement. She was transfused pre‐operatively and suffered a delayed haemolytic transfusion reaction. Postoperatively the patient continued to haemolyse, despite the use of antigen compatible blood, suggesting that she had developed hyperhaemolysis syndrome following her delayed haemolytic transfusion reaction. Although rare, both conditions must be borne in mind when dealing with patients who have undergone multiple transfusions.
Direct thrombin inhibitors: pharmacology and clinical relevance
Authors: Kam P. C. A. , Kaur N. , Thong C. L.
Published: May 2005

Although heparin has been a cornerstone of treatment for the prevention of thrombosis, it is limited by its adverse effects and unpredictable bioavailability. Direct thrombin inhibitors are a novel class of drugs that have been developed as an effective alternative mode of anticoagulation in patients who suffer from heparin‐induced thrombocytopaenia, and for the management of thromboembolic disorders and acute coronary syndromes. The main disadvantages of the direct thrombin inhibitors are the lack of an antidote or readily available clinical monitoring. The mechanism of action, the properties of direct thrombin inhibitors and their potential to replace currently available anticoagulants are reviewed.
How we do it: the Farrior‐Olaizola mastoidectomy technique in the management of squamous chronic otitis media
Authors: Harar R.P.S. , Abramovich S. , Mace A.D. , Panesar J. , Benjamin E.
Published: May 2005

Keypoints

• In the Farrior‐Olaizola mastoidectomy the connection between the antrum and attic is closed with a cartilage plate –‘the antrum exclusion and attic elimination on demand technique’. This prevents future tympanic membrane retraction and recurrent disease.

• It is a suitable treatment for most cases of cholesteatoma, including children.

• As a canal wall up technique residual disease occurred in 18% of adults and 22% of children in our series. These have been discrete encapsulated epithelial pearls easily removed at the second look stage.

• Recurrent disease was uncommon (3.5%).
Activated eosinophils in nasal polyps: a comparison of asthmatic and non‐asthmatic patients
Authors: Bateman N.D. , Shahi A. , Feeley K.M. , Woolford T.J.
Published: May 2005

Objectives:  There is a recognized clinical association between nasal polyps and asthma. Nasal polyps and the airways of asthmatic patients demonstrate marked eosinophilia suggesting that this inflammatory cell may have a key role to play in both conditions. The objective of this study was to determine whether nasal polyps from patients with asthma had a greater density of activated eosinophils than patients with no associated respiratory disease.

Design:  Archived specimens were retrieved from patients who had undergone nasal polyp surgery and their case notes reviewed. Activated eosinophils were identified using immunohistochemistry for a monoclonal antibody to secreted eosinophil cationic protein (EG2).

Setting:  Teaching hospital otolaryngology unit.

Participants:  Consecutive patients who had undergone nasal polyp surgery in 1994 were recruited. The diagnosis of asthma was based on a documented physician diagnosis and appropriate drug treatment. Twenty‐four asthmatic and 35 non‐asthmatic patients were studied.

Main outcome measures:  Eosinophil density was measured using a standardized counting technique.

Results:  Asthmatic patients were significantly more likely to have had previous polyp surgery (chi‐square test: P < 0.05). Areas of intense eosinophilia were identified in all samples. There was a significant greater degree of activated eosinophilia in the asthmatic patients (t‐test: P < 0.05).

Conclusions:  We have demonstrated a higher number of previous operations in asthmatic patients, and also a greater degree of activated eosinophilia in asthmatic polyps compared with non‐asthmatics. This would suggest that eosinophil activity has a role to play in the pathogenesis of nasal polyps.
Double‐blind randomized controlled study of coblation tonsillotomy versus coblation tonsillectomy on postoperative pain in children
Authors: Arya A.K. , Donne A. , Nigam A.
Published: May 2005

Objectives:  The purpose of this study was to establish if children experienced any difference in pain, between coblation tonsillectomy and coblation tonsillotomy.

Design:  A double‐blind randomized controlled trial was performed.

Setting:  District general hospital department of Otolaryngology.

Participants:  Eighteen children listed for tonsillectomy were recruited into the study. Each was randomly assigned either tonsillotomy or tonsillectomy in the right tonsil. The contralateral tonsil was removed by the other method. In the first 24‐h period (while in hospital) the children were interviewed at 2, 5, 10 and 24 h to quantify the pain they perceived in right and left sides. There was a four point visual analogue scoring system for monitoring pain. The power of the study was 80%. In this study the patients were their own controls.

Main outcome measures:  Visual analogue pain scores were plotted against time and the area under the curves was calculated (AUC).

Results:  The AUC mean difference was 0.47. A t‐test for the difference gives a P‐value of 0.85 and a 95% confidence interval for difference is −0.79 to 5.73, which clearly contains zero. Using AUC as a combined pain score there is no statistically significant difference between tonsillotomy and tonsillectomy (power value of 80%).

Conclusions:  There is no demonstrable statistical difference between techniques when measuring pain experienced by children in the 24‐h postoperative period.
How we do it: Jain Tonsil ‘A’ Frame – a solution to slipping rods
Authors: Jain K. Parmod
Published: May 2005

Keypoints

• Tonsillectomy is the commonest ENT procedure performed in UK.

• A Boyle‐Davis mouth gag with tongue blade is used to keep the mouth open during the surgery.

• Draffin bipod rods are commonly used to keep the gag in place.

• These rods can slip during the procedure and can cause considerable harm especially when laser is in use.

• The tonsil ‘A’ frame is a useful instrument to overcome the disadvantages of other suspension devices.
The use of camera mobile phone to assess emergency ENT radiological investigations
Authors: Eze N. , Lo S. , Bray D. , Toma A.G.
Published: May 2005

Objectives:  To determine the accuracy of assessment of common ENT emergency radiological investigations using mobile phone digital images.

Design:  Prospective case controlled series.

Setting:  Tertiary referral otolaryngology centre.

Participants:  Fourteen randomly selected patients who underwent emergency ENT radiological investigations over a 1‐month period.

Main Outcome Measures:  The accuracy and confidence of six ENT consultants and five specialist registrars in making diagnoses based on a brief history and assessment of CT scans and X‐ray images taken from and transmitted via a mobile phone, compared with examination of the same films on a conventional X‐ray box.

Results:  With 14 films, a total of 154 cases were assessed by the 11 subjects. All doctors made the correct diagnosis for every case examined. Overall, the relative confidence of diagnosis was ranked highly for both image media, although the overall confidence of diagnosis using the X‐ray box was significantly greater than the mobile phone (95% CI upper bound = 1.6 lower bound = 0.9; paired t‐test P < 0.0001). The seniority of the clinician did not predict a difference in the confidence of diagnosis (P = 0.3). There is no statistical relationship between confidence of diagnosis of the original films and degradation of film quality on the mobile phone (P = 0.7).

Conclusions:  The accuracy and confidence of diagnosis of common ENT emergency radiological investigations using mobile phone digital images seem compatible with X‐ray box. Financially it is a much cheaper than conventional telemedicine technology. It may be used to augment information sent to non‐resident specialists in the management of emergency ENT cases.
Clinical predictors in obstructive sleep apnoea patients with calibrated cephalometric analysis – a new approach1
Authors: Hsu P.P. , Tan A.K.L. , Chan Y.H. , Lu P.K.S. , Blair R.L.
Published: May 2005

Aim:  Utilization of a new method to accurately quantify differences in cephalometric parameters between obstructive sleep apnoea (OSA) and normal patients, and to identify good predictors for OSA. To illustrate the ethnic differences in cephalometry.

Method:  This prospective study involves 106 South‐east Asians. A calibrated catheter is inserted into the upper airway during standard cephalometry to obtain the precise magnification and allow exact measurement of anatomical parameters of cephalometry in both erect and supine positions.

Results:  The OSA patients have longer lower‐facial length, narrower skull base, shorter and receding mandible, smaller posterior airway space (PAS), narrower retropalatal space, longer and thicker soft palate, smaller hard and soft palate angles longer tongue length and more inferiorly displaced hyoid. For the palatal level, retropalatal distance of 11.2 mm cut‐off/predictive value for male (receiver operating characteristics (ROC) = 0.8414 with PPV = 77.46, NPV = 90.00) and 5.5 mm for female (ROC = 0.9180 with PPV = 100.00, NPV = 84.21) at erect position were selected. For retrolingual level, erect PAS of 10.1 mm cut‐off/predictive value for male (ROC = 0.7000 with PPV = 78.38, NPV = 37.78), 5.3 mm for female (ROC = 0.7227 with PPV = 75.00, NPV = 75.00) were selected. Our study showed that South‐east Asians have different cephalometric values compared with White people, Black people and Hispanics.

Conclusion:  This new method of cephalometry using a calibrated catheter provides an accurate and simple method of obtaining precise cephalometric measurements. There is no cephalometric data on OSA from South‐east Asia available. These results suggested that surgeons managing OSA patients and using cephalometry as a diagnostic method should have a set of normative and OSA cephalometric values that apply to their local populations.
Interobserver reliability in evaluating postural stability between clinicians and posturography
Authors: Loughran S. , Tennant N. , Kishore A. , Swan I.R.C.
Published: May 2005

Objectives:  To assess the interobserver reliability in assessing postural stability and to compare with results obtained by computerized posturography.

Design:  Cross‐sectional study.

Setting:  Balance clinic, teaching hospital.

Participants:  81 patients attending with a primary complaint of imbalance.

Main outcome measures:  Inter‐rater reliability between two clinicians and the modified Clinical Test for the Sensory Interaction on Balance (mCTSIB) as assessed by the Neurocom VSRTM Balance Master platform.

Results:  Inter‐rater reliability scores were high (0.53–0.81) for all conditions of the mCTSIB except for the easiest, i.e. firm surface eyes open, where concordance levels were poor to fair.

Conclusions:  Overall there was good agreement between observers and the computerized mCTSIB.
The impact of recurrent acute otitis media on the quality of life of children and their caregivers
Authors: Brouwer C.N.M. , Rovers M.M. , Maillé A.R. , Veenhoven R.H. , Grobbee D.E. , Sanders E.A.M. , Schilder A.G.M.
Published: May 2005

Objective:  To assess the quality of life of 384 Dutch children aged 1–7 years with recurrent acute otitis media (AOM), and compare it with that of children from four reference populations: (i) children from a general population; (ii) children with mild‐to‐moderate asthma, (iii) children with mild‐to‐moderately severe chronic illness, and (iv) US children with persistent or recurrent otitis media.

Design:  Survey.

Setting:  A general and an academic hospital (study population of children with recurrent AOM, n = 384); general population (n = 225 and 117); primary care (children with asthma, n = 64); community care (children with chronic illness, n = 82); and a general hospital (children with persistent or recurrent otitis media, n = 169).

Participants:  A total of 384 children aged 1–7 years who had experienced at least two episodes of AOM in the preceding year and their caregivers.

Main outcome measures:  Generic and disease‐specific quality of life as judged by the children's caregivers. Age‐adjusted total and subscale scores were compared with those of the reference populations.

Results:  For all generic questionnaires, children with recurrent AOM had poorer scores than children from the general population. Quality of life of children with four or more episodes of AOM in the preceding year was poorer than that of children with two to three episodes.

Children with recurrent AOM scored lower on the health‐related questionnaire than children with mild‐to‐moderately severe chronic illness. Quality of life of the present study population was similar to those of children with asthma and US children with chronic otitis media with effusion or recurrent AOM.

Conclusion:  Recurrent AOM has a considerable negative impact on the quality of life of children and causes concern to their caregivers. These effects are proportional to the severity of the condition. Professionals involved in the care of children with OM should be aware that OM not only affects physical functioning but also general well‐being of the child and its family. These outcomes should therefore be included in the evaluation of the child with otitis media both in the clinical and research setting.
Prognostic significance of p27Kip1, p45Skp2 and Ki67 expression profiles in Merkel cell carcinoma, extracutaneous small cell carcinoma, and cutaneous squamous cell carcinoma
Authors: Fernández‐Figueras M T , Puig L , Musulen E , Gilaberte M , Ferrándiz C , Lerma E , Ariza A
Published: May 2005

Aims:  To compare the immunohistochemical expression of prognostic markers p27Kip1, p45Skp2 and Ki67 in Merkel cell carcinoma (primary neuroendocrine carcinoma of the skin, MCC), small cell neuroendocrine carcinoma of lung and urinary bladder (SNC), and cutaneous squamous cell carcinoma (SCC).

Methods and results:  Immunohistochemistry was performed using antibodies directed against p27Kip1, p45Skp2 and Ki67 on 72 tumour cases: 24 MCC, 25 SCC, and 23 SNC (15 from the lung and eight from the urinary bladder). Percentages of positive cells were determined for each marker and statistically analysed. Expression profiles on MCC and SCC were significantly different for all three markers. MCC and SNC exhibited significant similarities in their p27Kip1 and p45Skp2 expression profiles. In contrast, MCC and SNC differed significantly in their Ki67 proliferation indices, which were much higher in SNC. Additionally, MCC cases showed an association between increased proliferation indices and the appearance of local recurrence(s) and/or metastases.

Conclusion:  The immunohistochemical profile of MCC differs from that of SCC, in spite of their common oncogenesis and the supposed metaplastic origin of MCC, and resembles that of SNC, except for Ki67 levels, which were higher in the latter (characterized by greater biological aggressiveness). High levels of Ki67 also appear to be a prognostic factor in MCC.
Sox2 expression in human stomach adenocarcinomas with gastric and gastric‐and‐intestinal‐mixed phenotypes
Authors: Tsukamoto T , Mizoshita T , Mihara M , Tanaka H , Takenaka Y , Yamamura Y , Nakamura S , Ushijima T , Tatematsu M
Published: May 2005

Aims:  Other than ectopic expression of intestinal transcription factors, Cdx1 and Cdx2, the molecular mechanisms underlying gastric and intestinal phenotypes of human stomach adenocarcinomas have yet to be clarified in detail. We have reported that Sox2, an HMG‐box gastric transcription factor, is expressed in normal gastric mucosa and down‐regulated in intestinal metaplasia.

Methods and results:  We analysed mRNA levels of Sox2 and other differentiation markers in 50 surgically resected stomach adenocarcinomas, immunohistochemically classified into gastric (G), gastric‐and‐intestinal (GI)‐mixed, solely intestinal (I), and null (N) types. Sox2 was found to be transcribed in G and GI‐mixed type adenocarcinomas in accordance with MUC5AC and MUC6 expression, while Cdx1 and Cdx2 were up‐regulated in GI‐mixed and I types along with the expression of MUC2 and villin. In the N type, both gastric and intestinal transcription factors were suppressed. Immunohistochemistry confirmed expression of Sox2 in MUC5AC+ lesions and Cdx2 localization together with MUC2. A stomach adenocarcinoma cell line, KATOIII, demonstrated both MUC5AC and Sox2, although MUC5AC mRNA was not detected in the Sox2+ AGS cell line.

Conclusions:  Sox2 may play an important role in maintaining a gastric phenotype in stomach cancers as well as in normal tissue, in cooperation with other cofactor(s).
Effectiveness of single‐ versus multiple‐visit endodontic treatment of teeth with apical periodontitis: a systematic review and meta‐analysis
Authors: Sathorn C. , Parashos P. , Messer H. H.
Published: May 2005

Aim  The clinical question this review aimed to answer is: does single‐visit root canal treatment without calcium hydroxide dressing, compared to multiple‐visit treatment with calcium hydroxide dressing for 1 week or more, result in a lower healing (success) rate (as measured by clinical and radiographic interpretation)?

Methodology  CENTRAL, MEDLINE, EMBASE and HEALTH STAR databases were used. Reference lists from identified articles were scanned. A forward search was undertaken on the authors of the identified articles. Papers that had cited these articles were also identified through Science Citation Index to identify potentially relevant subsequent primary research.

Review methods  The included studies were randomized controlled clinical trials (RCTs) comparing healing rate of single‐ and multiple‐visit root canal treatment in humans. The outcome measured was healing of radiographically detectable lesions. Data in those studies were independently extracted.

Results  Only three RCTs were identified and included in the review, covering 146 cases. Sample size of all three studies was small; none demonstrated a statistically significant difference in healing rates. Risk differences of included studies were combined using the inverse variance‐weighted method (RDPooled = −6.3%; 95% CI: −20.3–7.8).

Conclusion  Based on the current best available evidence, single‐visit root canal treatment appeared to be slightly more effective than multiple visit, i.e. 6.3% higher healing rate. However, the difference in healing rate between these two treatment regimens was not statistically significant (P = 0.3809).
Growth at high pH increases Enterococcus faecalis adhesion to collagen
Authors: Kayaoglu G. , Erten H. , Ørstavik D.
Published: May 2005

Aim  To evaluate the effect of growth at pH levels from 7.1 to 9.5 on the adherence of Enterococcus faecalis to bovine serum albumin (BSA) and collagen type I.

Methodology  Enterococcus faecalis strain A197A was grown in broth of adjusted pHs varying between 7.1 and 9.5. Aliquots of bacterial suspensions were added to wells coated either with BSA or with collagen type I. Bacteria adhering to the surfaces were stained with crystal violet. Spectrophotometric measurements of the dissolved stain were used to assess the number of bacteria adhering to the surfaces. The data obtained were analysed using the Kolmogorov–Smirnov test, Levene's test and Student's t‐test, with α = 0.05 as the level for statistical significance.

Results  The adhesion of E. faecalis to BSA‐coated surfaces decreased inversely with alkalinity of the growth medium. The pH 7.1‐grown bacteria bound to BSA significantly more than the other BSA groups. On the contrary, the adhesion to collagen type I‐coated surfaces of bacteria grown at pH 8.0 and 8.5 was significantly greater than for those grown at pH 7.1.

Conclusions  A minor increase in pH up to 8.5, which may be a consequence of insufficient treatment with alkaline medicaments such as calcium hydroxide, increases the collagen‐binding ability of E. faecalis, in vitro. This can be a critical mechanism by which E. faecalis predominates in persistent endodontic infections.
Endodontic complications after plastic restorations in general practice
Authors: Whitworth J. M. , Myers P. M. , Smith J. , Walls A. W. G. , McCabe J. F.
Published: May 2005

Aim  To test the hypothesis that dentine and pulp protection by conditioning‐and‐sealing is no less effective than using a conventional calcium hydroxide lining.

Methodology  A cohort of healthy adults requiring a new or replacement restoration in a posterior tooth was recruited in six general practices. All procedures received local Ethics Committee approval. Exclusion criteria included signs and symptoms of pulp necrosis or inflammation, and patients unable to commit to a long‐term trial. Cavity preparations were randomized to receive a calcium hydroxide lining or conditioning‐and‐sealing with a smear‐removing bonding system. Choice of bulk restorative material (composite resin or amalgam) was at the discretion of the dentist. The key outcome measure was evidence of pulpal breakdown identified at unscheduled (emergency) or scheduled recall examinations. Postoperative sensitivity was recorded on 100 mm VAS at 24 h, 4 days and 7 days. Pulp status was assessed at 6, 12, 24 and 36 month recall, and at any emergency recall appointment. The relationship between pre‐treatment and treatment variables and pulp breakdown was assessed by logistic regression (P = 0.05).

Results  A total of 602 teeth were recruited, with comparable numbers of cavities lined (288, 47.8%) or conditioned and sealed (314, 52.2%). The majority (492, 81.7%) were replacement restorations, and amalgam was the most common bulk restorative material (377, 62.6%). A total of 390 (64.8%) restored teeth were reviewed at 6 months, 307 (51%) at 12 months, 363 (60.3%) at 24 months, and 279 (46.3%) at 36 months post‐restoration. Sixteen cases of pulp breakdown were identified within 36 months of restoration placement, 11 presenting as emergencies and five detected at routine recall examination. Logistic regression showed that preoperative pain, cavity treatment by lining or conditioning‐and‐sealing and the use of rubber dam isolation had no association with pulp breakdown. Pulp breakdown was associated with deep or pulpally exposed cavities (P < 0.001, odds ratio 7.8) and with composite rather than amalgam restorations (P = 0.001, odds ratio 2.13). Re‐coding to identify teeth with pulp exposures revealed that pulpal exposure was the key determinant of adverse pulp outcomes (P < 0.0001, odds ratio 28.4) and that composite resin restorations were again more likely to be associated with pulp breakdown than amalgam (P = 0.017, odds ratio 3.92).

Conclusions  Considered within the context of routine primary dental care,

Dentists can be confident that pulps will be equally well protected from post‐restorative breakdown up to 36 months by calcium hydroxide lining and conditioning‐and‐sealing with adhesive resins.

Residual dentine thickness appears to be a key determinant of pulp responses after restorative dental treatment.

In deep and pulpally exposed cavities in posterior teeth, composites were associated with more pulpal breakdown than amalgams.
The Balearic Islands: a reservoir of cpDNA genetic variation for evergreen oaks
Authors: López‐de‐Heredia Unai , Jiménez Pilar , Díaz‐Fernández Pedro , Gil Luis
Published: May 2005

Aim  To analyse the role of the Balearic Islands as a refuge area for evergreen Quercus (cork oak: Quercus suber L., holm oak: Q. ilex L., kermes oak: Q. coccifera L.), by using molecular, historical and palaeobotanical data.

Location  The Western Mediterranean Basin (Balearic Islands, eastern Iberia, Provence, Sardinia, Corsica, Sicily, Malta, Italy, Northern Africa).

Methods  We sampled 108 populations and used the PCR‐RFLP technique with five universal cpDNA primers to define haplotypes in the sampled populations. Diversity, differentiation parameters and spatial analysis of the populations, using a spatial version of amova, were linked to the geological history of the Western Mediterranean Basin in order to explain the present spatial pattern of the evergreen Quercus populations in the Balearics.

Results  Evergreen Quercus cpDNA shows a complex structure, with remnants of ancient diversity in the Balearics. Balearic populations of holm oak are related to Iberian populations, while for cork and kermes oaks, we found both Tyrrhenian and Iberian haplotypes.

Main conclusions  The complex spatial patterns of cpDNA in Balearic evergreen Quercus appears explicable in terms of a combination of physical (vicariance and long distance dispersal) and biological (introgressive hybridization) factors. The Balearics constitute a glacial refuge area and a reservoir of genetic variation with traces of ancient diversity from Messinian–Pliocene stages.