bluuebunny/crossref_metadata_2025 huggingface dataset:
XRD characterization of ZnO layers grown on GaAs(111)B, c‐plane and a‐plane sapphire substrates by plasma‐assisted MBE
Authors: Muranaka Tsutomu , Sakano Tatsumi , Mizuguchi Keiichi , Nabetani Yoichi , Akitsu Tetsuya , Matsumoto Takashi , Hagihara Shigeru , Abe Osamu , Hiraki Satoshi , Fujikawa Yuichiro
Published: March 2010

Structural evaluation of the ZnO epitaxial layers grown by plasma‐assisted molecular beam epitaxy (PAMBE) on the GaAs (111)B, c ‐plane (0001) and a ‐plane (11‐20) sapphire (α ‐Al2O3) substrates was demonstrated by using high‐resolution X‐ray diffraction (XRD). The in‐plane epitaxial relationships between the ZnO layers and the substrates were found to be ZnO(0001)<11‐20>II GaAs(111)<1‐10>, ZnO(0001)<11‐20>IIα ‐Al2O3(0001) <1‐100> and ZnO (0001)<11‐20>II α ‐Al2O3(11‐20)<0001>. All the ZnO layers were highly oriented to the c‐axis but larger fluctuations of the c‐axis were observed for the layers on the GaAs(111)B substrates. The lattice parameters of the ZnO layers were evaluated from the θ ‐2θ and ω ‐2θ scans, and reciprocal lattice mappings (RLMs). The in‐plane compressive strains up to 0.3% in the ZnO layers on both the c ‐plane and a ‐plane sapphire substrates, and the in‐plane tensile strains up to 0.4% in the ZnO films on the GaAs(111)B substrates were observed. (© 2010 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)
Investigations of strain in ZnMgSe/ZnSe microdisks by means of the micro‐Raman imaging
Authors: Panfilova Marina , Pawlis Alexander , Shchekin Alexey , Lemeshko Sergey , Lischka Klaus
Published: March 2010

Strain in the semiconductor multilayer structures of lasing devices has an important influence on their optical properties. Micro‐Raman spectroscopy is a suitable technique for non‐destructive direct analysis of the structural properties of semiconductor structures. The strain distribution in ZnMgSe/ZnSe microdisks has been measured by micro‐Raman spectroscopy. The frequency of the ZnSe longitudinal optical phonon shifts about 2.8 cm‐1 towards lower frequencies from the centre to the edge of the disk. In the central region of the disk the ZnSe quantum well and the ZnMgSe barriers are pseudomorphic strained on GaAs while in the free stranding region the ZnSe quantum well is pseudomorphic with the ZnMgSe barriers. Despite the strain relaxation alongthe radial direction of the disk, the microdisk is free of defects as demonstrated by the absence of the transverse optical phonon lines. These findings confirm sufficiently high quality values in such strained microdisk cavities to facilitate their application in optoelectronic devices. (© 2010 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)
Human performance in the task of port placement for biosensor use
Authors: King Brady W. , Reisner Luke A. , Ellis R. Darin , Klein Michael D. , Auner Gregory W. , Pandya Abhilash K.
Published: March 2010

Background

We conducted a study of participants' abilities to place a laparoscopic port for in vivo biosensor use. Biosensors have physical limitations that make port placement crucial to proper data collection. A new port placement algorithm enabled evaluation of port locations, using segmented patient data in a virtual environment.

Methods

Port placement scoring algorithms were integrated into an image‐guided surgery system. Virtual test scenes were created to evaluate various scenarios encountered during biosensor use. Participants were scored based on their ability to choose a port location from which points of interest could be scanned with a biosensor. Participants' scores were also compared to those of a port placement algorithm.

Results

The port placement algorithm consistently outscored participants by 10–25%. Participants were inconsistent from trial to trial and from participant to participant.

Conclusion

Port placement for biosensor procedures could be improved through training or augmentation. Copyright © 2010 John Wiley & Sons, Ltd.
Estimating conditional proportion curves by regression residuals
Authors: Han Bing , Lim Nelson
Published: March 2010

Researchers often derive a categorical outcome from an observed continuous measurementy. For example, human obesity status can be defined by the body mass index. They proceed to estimate the conditional proportion curvep(x) =P(y⩽c(x)|x) versus the covariatexby regular categorical data analysis. In doing so, they fail to fully use the rich information in the original continuous measurement. Researchers also face additional difficulties caused by the uncertainty of the cutoffc(x), which defines the categories. For example, some cutoff may cause artificial discontinuity or non‐smoothness in the conditional proportion curvep(x). We propose a fully nonparametric empirical estimator using the standardized regression residuals from the general location‐scale modely=m(x) +v(x)efor the original continuous measurement. We prove the consistency of the proposed estimator in regular settings. The proposed estimator has several attractive features: it readily provides estimates for alternative cutoff values, and easily accommodates the discontinuity inp(x) caused by special cutoff. Numerical examples demonstrate that our method has better performance in mean‐squared error than some alternative approaches. We also discuss a design‐adjusted version of the proposed estimators to accommodate survey designs. The proposed methods are applied to data on obesity measurements among female Hispanic Americans. This new approach can be applied to other epidemiological and socio‐economic research that needs to define population categories from underlying continuous measurements. Copyright © 2010 John Wiley & Sons, Ltd.
Liposome Destabilization by a 2,7‐Diazapyrenium Derivative Through Formation of Transient Pores in the Lipid Bilayer
Authors: Zappacosta Romina , Semeraro Monica , Baroncini Massimo , Silvi Serena , Aschi Massimiliano , Credi Alberto , Fontana Antonella
Published: March 2010

The effect of the luminescent heteroaromatic electron acceptor N,N′‐dimethyl‐2,7‐diazapyrenium dichloride (DM‐DAP2+) on the stability of 1‐palmitoyl‐2‐oleoylphosphatydilcholine (POPC) liposomes is determined on the basis of the rate of release of different fluorescent probes entrapped within the liposome. The experiments show that DM‐DAP2+ exerts a substantial destabilizing action on the liposomal bilayer, particularly at low concentrations. Molecular dynamics simulations suggest that the activity of DM‐DAP2+ is related to its tendency to surround itself with water molecules, conceivably favoring the formation of transient pores across the bilayer.
Bone Marrow-Derived Hematopoietic Cells Undergo Myogenic Differentiation Following a Pax-7 Independent Pathway
Authors: Xynos Alexandros , Corbella Paola , Belmonte Nathalie , Zini Roberta , Manfredini Rossella , Ferrari Giuliana
Published: March 2010

Several reports showed that hematopoietic stem cells (HSCs) participate in muscle regeneration, raising hope for their therapeutic potential for degenerative muscle diseases. However, proof that HSCs are able to reprogram their fate and enter a myogenic pathway, remains elusive. We demonstrate that murine bone marrow (BM)-derived hematopoietic cells, carrying reporter genes controlled by muscle-specific regulatory elements from the Myf5, myosin light chain (MLC3F), or MCK genes, are induced by myoblasts to activate muscle-specific genes. This potential resides in the more undifferentiated progenitors, expressing surface markers typical of HSCs. Comparative gene expression profiling of CD45+/Sca1+ cells isolated from muscle or BM shows that hematopoietic cells participate to muscle regeneration, by undergoing a profound although incomplete myogenic reprogramming on interaction with the muscle microenviroment. These cells undergo specification and differentiation independently from Pax7 and MyoD, and lack Pax7-associated properties, such as self-renewal and proliferation, distinguishing from satellite cells. Our findings indicate that hematopoietic cells, on seeding in the muscle, become a distinct cell population endowed with myogenic potential.
Tight bounds for the first order Marcum Q‐function
Authors: Wang Jiangping , Wu Dapeng
Published: March 2010

In this paper, we develop new bounds for the first order Marcum Q‐function, which are extremely tight and tighter than any of the existing bounds to the best of our knowledge. The key idea of our approach is to derive refined approximations for the 0th order modified Bessel function in the integration region of the Marcum Q‐function. The new bounds are very tight and can serve as an effective means in bit error rate (BER) performance analysis for non‐coherent demodulation in digital communication. Copyright © 2010 John Wiley & Sons, Ltd.
Visitor interest in zoo animals and the implications for collection planning and zoo education programmes
Authors: Moss Andrew , Esson Maggie
Published: March 2010

As zoos have sought to further their conservation missions, they have become powerful providers of environmental education. Outside of “formal” education initiatives, such as those designed for school and other organized groups, or structured public talks programmes, much of the learning potential that the zoo has to offer is around the viewing of animals and the response of visitors to them. In this, zoo learning is a very personal construct, develops from the previous knowledge, and experiences and motivations of each individual. In this article, we make the assertion that learning potential, although difficult to quantify, is very much related to the attractiveness of animal species and the interest that visitors show in them. Using standard behaviorist measures of attraction and interest (the proportion of visitors that stop and for how long), we analyzed the relative interest in 40 zoo species held in a modern UK zoo and the variables that are significant in predicting that popularity. Further to this, the suggestion is made that the zoo collection planning process could use such information to make more informed decisions about which species should be housed for their educational value. Taxonomic grouping was found to be the most significant predictor of visitor interest—that is, visitors were far more interested in mammals than any other group—although body size (length), increasing animal activity and whether the species was the primary or “flagship” species in an exhibit or not, were all found to have a significant bearing on visitor interest. Zoo Biol 29:715–731, 2010. © 2010 Wiley‐Liss, Inc.
Risk‐Adapted Anastomosis for Partial Pancreaticoduodenectomy Reduces the Risk of Pancreatic Fistula: A Pilot Study
Authors: Niedergethmann Marco , Dusch Niloufar , Widyaningsih Rizky , Weiss Christel , Kienle Peter , Post Stefan
Published: March 2010

Background

Pancreatic fistula (PF) is the main cause of postoperative morbidity and mortality after pancreatectomy. Two reasons for PF are a “soft” pancreatic texture and a narrow pancreatic duct (high‐risk gland). Pancreaticojejunostomy (PJ) may lead to a higher fistula rate in such glands. In the literature there are no data available on risk‐adapted assignment of pancreatogastrostomy (PG) in a high‐risk gland. Therefore, an observational pilot study was conducted to address this issue.

Methods

Since January 2007 the concept of a “risk‐adapted pancreatic anastomosis” (RAP) was introduced (PG for high‐risk glands). The PF rate, morbidity, and mortality during this period (January 2007 to December 2008, n = 74) were compared to those between January 2004 and December 2006 (n = 119, only PJ). PF was defined according to the International Study Group on Pancreatic Surgery.

Results

Through RAP the PF rate was reduced from 22 to 11% (P = 0.0503). Grade C PF rate was reduced from 6.7 to 1.4% (P = 0.1569) and grade A PF from 6 to 1.4% (P = 0.2537). The PF‐associated mortality was reduced from 3.4 to 1.4%. PG revealed a PF rate of 7% and PJ accounted for 19% of PFs (P = 0.1765). There was no incidence of grade C PF following PG. The incidence of intraluminal hemorrhage (P = 0.0422) and delayed gastric emptying (P = 0.0572) was higher following PG.

Conclusions

The rate of PF could be significantly reduced with the use of RAP. One should be cautious about the indication for PG, since it is associated with a higher rate of intraluminal hemorrhage and delayed gastric emptying. There are no long‐term results on PG with respect to its durability and function. A general recommendation for its use cannot currently be made.
Developing a management procedure robust to uncertainty for southern bluefin tuna: a somewhat frustrating struggle to bridge the gap between ideals and reality
Authors: Kurota Hiroyuki , Hiramatsu Kazuhiko , Takahashi Norio , Shono Hiroshi , Itoh Tomoyuki , Tsuji Sachiko
Published: March 2010

Fisheries management is conducted to achieve sustainable use of fishery resources, mainly through regulation of fishing activities. For almost a decade, the Commission for the Conservation of Southern Bluefin Tuna (CCSBT) struggled to reach agreement on a total allowable catch (TAC) for southern bluefin tuna (SBT) because of stock assessment uncertainties. To address this, in 2002 the CCSBT commenced development of a management procedure (MP), a pre‐agreed set of rules to determine how the TAC will be adjusted as new monitoring data become available. The CCSBT Scientific Committee tested various candidate MPs using operating models which simulate fish population and fishery dynamics as well as incorporate process, observation, and model uncertainties. Candidate MPs were evaluated using performance measures related to the following management objectives: maximize catches, avoid stock collapse, and minimize interannual catch variation. Of the MPs explored, some relied solely on empirical data [i.e., adjusted TAC based on catch per unit effort (CPUE) trends], whereas others were more complicated, based on population models. In 2005, the CCSBT adopted a model‐based MP that realized a moderate catch with low variability and avoided stock collapse. This MP struck a compromise between the risk‐prone and risk‐averse standpoints of the different stakeholders. However, despite this concerted scientific effort, the MP was not implemented because, shortly after its adoption, it became evident that historical catches may have been substantially underreported. This complication necessitates returning to near the beginning of the development process. MP approaches have various advantages and challenges to be explored further. However, it is essential to lessen human‐introduced uncertainty (such as catch misreporting) by enhanced enforcement, and to increase management robustness to biological uncertainties by implementing MPs.
Global stressors and the global decline of amphibians: tipping the stress immunocompetency axis
Authors: Kiesecker Joseph M.
Published: March 2010

There is a widespread consensus that the earth is experiencing a mass extinction event and at the forefront are amphibians, the most threatened of all vertebrate taxa. A recent assessment found that nearly one‐third (32%, 1,856 species) of the world's amphibian species are threatened. Amphibians have existed on the earth for over 300 million years, yet in just the last two decades there have been an alarming number of extinctions, nearly 168 species are believed to have gone extinct and at least 2,469 (43%) more have populations that are declining. Infectious diseases have been recognized as one major cause of worldwide amphibian population declines. This could be the result of the appearance of novel pathogens, or it could be that exposure to environmental stressors is increasing the susceptibility of amphibians to opportunistic pathogens. Here I review the potential effects of stressors on disease susceptibility in amphibians and relate this to disease emergence in human and other wildlife populations. I will present a series of case studies that illustrate the role of stress in disease outbreaks that have resulted in amphibian declines. First, I will examine how elevated sea‐surface temperatures in the tropical Pacific since the mid‐1970s have affected climate over much of the world and could be setting the stage for pathogen‐mediated amphibian declines in many regions. Finally, I will discuss how the apparently rapid increase in the prevalence of amphibian limb deformities is linked to the synergistic effects of trematode infection and exposure to chemical contaminants.
Exploring the Dynamics of Dyadic Interactions via Hierarchical Segmentation
Authors: Hsieh Fushing , Ferrer Emilio , Chen Shu-Chun , Chow Sy-Miin
Published: March 2010

In this article we present an exploratory tool for extracting systematic patterns from multivariate data. The technique, hierarchical segmentation (HS), can be used to group multivariate time series into segments with similar discrete-state recurrence patterns and it is not restricted by the stationarity assumption. We use a simulation study to describe the steps and properties of HS. We then use empirical data on daily affect from one couple to illustrate the use of HS for describing the affective dynamics of the dyad. First, we partition the data into three periods that represent different affective states and show different dynamics between both individuals’ affect. We then examine the synchrony between both individuals’ affective states and identify different patterns of coherence across the periods. Finally, we discuss the possibilities of using results from HS to construct confirmatory dynamic models with multiple change points or regime-specific dynamics.
The psychological impact of peer victimization: Exploring social‐cognitive mediators of depression
Authors: Barchia Kirstin , Bussey Kay
Published: March 2010

Although the association between peer victimization and depression is well established (Hawker & Boulton, 2000; Nansel et al., 2001), little research has examined the processes whereby victimization may lead to depression. This study examined the social‐cognitive processes that mediate the relationship between peer victimization and depression. A questionnaire measuring peer victimization, depression, depression rumination, self efficacy to enlist support, and collective school efficacy to stop peer aggression at two time points during one school year was completed by 1167 secondary school children. Rumination, collective school efficacy and self efficacy to enlist support from a friend partially mediated the relationship between victimization and depression. Children who were victimized ruminated more, which lead to increased levels of depression. Victims were also less likely to believe that students and teachers could work together to stop peer aggression, which impacted their propensity to access the support of friends leading to higher depression.
Internet use and video gaming predict problem behavior in early adolescence
Authors: Holtz Peter , Appel Markus
Published: March 2010

In early adolescence, the time spent using the Internet and video games is higher than in any other present‐day age group. Due to age‐inappropriate web and gaming content, the impact of new media use on teenagers is a matter of public and scientific concern. Based on current theories on inappropriate media use, a study was conducted that comprised 205 adolescents aged 10–14 years (Md = 13). Individuals were identified who showed clinically relevant problem behavior according to the problem scales of the Youth Self Report (YSR). Online gaming, communicational Internet use, and playing first‐person shooters were predictive of externalizing behavior problems (aggression, delinquency). Playing online role‐playing games was predictive of internalizing problem behavior (including withdrawal and anxiety). Parent‐child communication about Internet activities was negatively related to problem behavior.
Core—Shell Droplets for Parallel DNA Ligation of an Ultra-Micro Volume Using an EWOD Microfluidic System
Authors: Lin Hung-Chia , Liu Yi-Ju , Yao Da-Jeng
Published: March 2010

An electrowetting-on-dielectric (EWOD) microfluidic system of coplanar electrode type was designed for parallel DNA ligation of an ultra-micro volume, which was applied to droplet manipulation containing DNA, a ligation enzyme and a multi-salt reaction buffer. For environmental reasons, we applied a concept of a water–oil core–shell droplet; such droplets of volume ∼0.3 μL were generated from reservoirs between one plate with coplanar electrodes and another plate with a hydrophobic surface free of electrodes. The experimental results show that the best mixing sequence for the DNA ligation involves mixing first the insert DNA and vector DNA, and then adding the ligase solution. The waiting time was less than 5 min. In one cloning test, the total usage of reagents in an ultramicro-volume EWOD chip was 2.1 μL with no wasted volume, for comparison with 85% waste according to the standard protocol was 15 μL. The results showed also that four parallel DNA ligations were accomplished without damage to a chip and without biomaterial annulment.
Microfluidic Immunoassays
Authors: Lin Chun-Che , Wang Jung-Hao , Wu Hui-Wen , Lee Gwo-Bin
Published: March 2010

Immunoassays have long been widely used in a variety of applications, such as for medical diagnostics, pharmaceutical analysis, environmental, food safety testing, and for basic scientific investigations because of its simplicity, sensitivity, and specificity. Microfluidic systems, also well known as a “lab-on-a-chip” or a “micro-total-analysis-system” have attracted a lot of attention in the past two decades because of advantages associated with miniaturization, integration, and automation. A promising platform for the combination of these two technologies, microfluidic immunoassays, has been extensively explored in recent years. The aim of this article is to review recent advancements in microfluidic immunoassays. A brief introduction to immunoassays and microfluidic devices will include a literature review, followed by an in-depth discussion of essential techniques in designing a microfluidic-based immunoassay from different perspectives, including device substrates, sample/reagent transportation, surface modification, immobilization, and detection schemes. Finally, future perspectives on microfluidic immunoassays will be provided. These developments with microfluidic immunoassays may provide a promising tool for automatic, sensitive, and selective measurements in practical applications.
Regulatory focus and reliance on implicit preferences in consumption contexts
Authors: Florack Arnd , Friese Malte , Scarabis Martin
Published: March 2010

The present research tested the assumption that implicit preferences fit the eagerness of a promotion focus, but not the need for safe judgments and decisions of a prevention focus. In three studies, we assessed individual differences in implicit preferences for consumer goods and investigated their influence on self‐regulatory behavior. In line with expectations, implicit preferences predicted choice intentions (Study 1), single and repeated choices between consumer goods (Study 2), and the amount of product consumption (Study 3) better for individuals in a promotion focus than in a prevention focus. The results were found with two different measures of implicit preferences.
Mentoring in otolaryngology training programs
Authors: Gurgel Richard K. , Schiff Bradley A. , Flint John H. , Miller Robert A. , Zahtz Gerald D. , Smith Richard V. , Fried Marvin P. , Smith Richard J.H.
Published: March 2010

Objective

The Accreditation Council for Graduate Medical Education's focus on outcome‐based training has made the mentoring process critical for resident education. It is unknown how otolaryngology training programs mentor residents. Our objective was to determine the current state of mentoring in otolaryngology training programs and describe resident perceptions of mentoring.

Study Design

Cross‐sectional survey.

Setting

Accredited U.S. otolaryngology training programs.

Subjects and Methods

All U.S. otolaryngology residents and program directors were contacted via e‐mail with a link to an online survey.

Results

Of the 1411 residents contacted, 27.7 percent responded, representing 71 of the 103 accredited otolaryngology programs. Of the 103 program directors contacted, 37.9 percent responded. Of these programs, 26 had formal mentoring programs, 45 did not have formal mentoring programs, and 12 programs were listed in both categories. Fifty‐one percent of male residents and 49 percent of female residents had mentors. The most important mentor characteristics were personality match, good clinical role model, and similar subspecialty interests. Least important characteristics were race, gender, and age. Twenty‐six percent of residents felt that mentoring was critical to their training, while 63 percent of residents listed mentoring as important but not critical. Programs with fewer faculty and residents were less likely to offer formal mentoring (P = 0.007 and 0.054, respectively). Of residents who did not have mentors, 80 percent lacked a mentor because their residency had no formal mentoring program.

Conclusion

Residents perceive mentoring as important, and formal mentoring programs should be incorporated into otolaryngology training programs.
A novel surgical technique for management of tinnitus due to high dehiscent jugular bulb
Authors: El‐Begermy Mohamed A. , Rabie Amr N.
Published: March 2010

Objectives

To assess the effectiveness of middle ear floor reconstruction in management of vascular tinnitus due to high jugular bulb with dehiscent middle ear floor.

Study Design

Case series with chart review.

Setting

Tertiary academic medical center.

Subjects and Methods

We reviewed the medical records of seven patients with high dehiscent jugular bulb, presenting with incapacitating pulsatile roaring tinnitus that was abolished by digital compression of the ipsilateral jugular vein, from January 2002 to December 2006. The diagnosis was confirmed by CT scan of the temporal bone (bone window, coronal views). The seven patients were surgically explored, five under local anesthesia (to monitor the results with possible intraoperative revision) and two under general endotracheal anesthesia, for middle ear floor reconstruction that was done using bone dust, perichondrium, and tragal cartilage (mean follow‐up 28 months).

Results

Of the seven patients, tinnitus disappeared in four (57%) and decreased in one. The overall improvement was five of seven (71%). One patient had postoperative increased intracranial pressure.

Conclusion

The preliminary results suggest that surgical reconstruction of the middle ear floor under local anesthesia offers valuable treatment for patients with incapacitating tinnitus due to dehiscent middle ear floor. However, the risk of sigmoid sinus thrombosis should be considered. To our knowledge, this is the first trial of multilayer reconstruction of the middle ear floor dehiscence to manage high jugular bulb causing tinnitus.
Disease relapse after segmental resection and free flap reconstruction for mandibular osteoradionecrosis
Authors: Suh Jeffrey D. , Blackwell Keith E. , Sercarz Joel A. , Cohen Marc , Liu Jerome H. , Tang Christopher G. , Abemayor Elliot , Nabili Vishad
Published: March 2010

Objective

The objective of this study was to assess the outcomes, complications, and incidence of disease recurrence of mandibular osteoradionecrosis (ORN) after resection and microvascular free flap reconstruction.

Study Design

Case series with chart review.

Setting

Academic medical center.

Subjects And Methods

Retrospective patient data review of 40 patients with mandibular ORN who were treated by segmental mandibulectomy and microvascular reconstruction between 1995 and 2009. All patients received radiation therapy for previous head and neck cancer, and 12 of 40 patients received concurrent chemotherapy. All patients failed to respond to conservative management. There were 26 males and 14 females, with a median age of 62 years. Median follow‐up was 17.4 months.

Results

There were no free flap failures. The incidence of wound‐related complications was 55 percent. Median time to complication was 10.6 months. Ten (25%) patients developed symptoms of residual or recurrent ORN, with 70 percent of the recurrences arising in unresected condyles that were adjacent to the segmental mandibulectomy. Statistical analysis revealed that current smokers were at reduced risk to develop residual or recurrent ORN.

Conclusion

This present study confirms that microvascular free flaps are reliable for treatment of advanced mandibular ORN. Nevertheless, there remains a 55 percent incidence of wound‐healing complications. The lack of objective clinical criteria to judge the appropriate amount of mandible resection in patients with ORN remains an unresolved issue that resulted in the development of recurrent ORN in 25 percent of patients. Further investigations are needed to better understand the pathophysiology of ORN to prevent postoperative wound complications and disease recurrence.
Intratympanic gentamicin treatment of patients with Ménière's disease with normal hearing
Authors: Silverstein Herbert , Wazen Jack , Van Ess Mark J. , Daugherty Julie , Alameda Yadiel A.
Published: March 2010

Objective

Understand the safety and outcomes of intratympanic gentamicin treatment in patients with Ménière's disease with normal hearing.

Study Design

Case series with chart review.

Setting

Tertiary referral center.

Subjects and Methods

A total of 224 patients with disabling Ménière's disease treated between May 1996 and June 2007 were grouped according to the American Academy of Otolaryngology–Head and Neck Surgery (AAO‐HNS) 1995 Committee on Hearing and Equilibrium staging guidelines: stage 1 (<25 dB pure‐tone average [PTA]); stage 2 through 4 (>25 dB PTA). Patients underwent self‐treatment with intratympanic gentamicin (10 mg/mL) three times daily for one to eight weeks. Outcome measures included pre‐ and post‐treatment speech discrimination score (SDS), PTA, electronystagmography, vertigo relief, and statistical analysis utilizing the Pearson χ2 test.

Results

Twenty‐two (88%) of 24 patients with stage 1 Ménière's disease showed unchanged or improved SDS. All 24 patients showed a mean PTA loss of 8 dB. Seventeen (71%) patients reported complete or improved vertigo control. One hundred sixteen (59%) of 200 patients with stage 2 through 4 Ménière's disease showed unchanged or improved SDS. All 200 patients showed a mean PTA loss of 11 dB. One hundred forty‐eight (74%) patients reported complete or improved vertigo control.

Conclusions

Patients with stage 1 Ménière's disease appear to have similar vertigo control with better hearing preservation than patients with advanced disease when treated with low‐dose intratympanic gentamicin (10 mg/mL).
Neck restaging with sentinel node biopsy in T1‐T2N0 oral and oropharyngeal cancer: Why and how?
Authors: Burcia Vincent , Costes Valérie , Faillie Jean Luc , Gardiner Quentin , de Verbizier Delphine , Cartier César , Jouzdani Elham , Crampette Louis , Guerrier Bernard , Garrel Renaud
Published: March 2010

Objective

To evaluate the lack of accuracy in neck staging with the classical technique (i.e., neck dissection and routine histopathology) with the sentinel node (SN) biopsy in oral and oropharyngeal T1‐T2N0 cancer.

Study Design

Cross‐sectional study with planned data collection.

Setting

Tertiary center care.

Subjects and Methods

In 50 consecutive patients, the pathological stage of sentinel node (pSN) was established after analyzing SN biopsies (n = 148) using serial sectioning and immunohistochemistry. Systematic selective neck dissection was performed. The pN stage was established with routine histopathologic analysis of both the non‐SN (n = 1075) and the 148 SN biopsies.

Results

The sensitivity and negative predictive value of pSN staging were 100 percent. Conversely, if one considers pSN staging procedure as the reference test for micro‐ and macro‐metastasis diagnosis, the sensitivity of the classical pN staging procedure was 50 percent (9/1; 95% CI 26.9‐73.1) and its negative predictive value was 78 percent (95% CI 61.9‐88.8). Fifteen patients (30%) were upstaged, including nine cases from pN0 to pSN ≥ 1 and six cases from pN1 to pSN2. Two of the pN0‐pSN1 upstaged patients died with relapsed neck disease.

Conclusion

The SN biopsy technique appeared to be the best staging method in cN0 patients and provided evidence that routinely undiagnosed lymph node invasion may have clinical significance.
The Baha system in patients with single‐sided deafness and contralateral hearing loss
Authors: Wazen Jack J. , Van Ess Mark J. , Alameda Jadiel , Ortega Carmello , Modisett Michelle , Pinsky Karen
Published: March 2010

Objective

To evaluate the effectiveness of the Baha system in cases of single‐sided deafness (SSD) and mild to moderate hearing loss in the better‐hearing ear.

Study Design

Prospective trial.

Setting

Tertiary otologic referral center.

Subjects and Methods

Twenty‐one patients with SSD and mild to moderate hearing loss in the contralateral ear implanted with the Baha system between June 2006 and March 2008 were evaluated following Baha implantation and fitting with the Divino and Intenso processors. Pure‐tone air and bone conduction thresholds, sound‐field testing (aided and unaided in quiet and noise) of consonant nucleus consonant words (Northwestern University Auditory Test No. 6 words), and Hearing in Noise Test sentences were obtained. Patient satisfaction questionnaires were administered pre‐ and post‐intervention for either device.

Results

Patients with SSD and mild to moderate hearing loss in the contralateral ear showed a statistically significant improvement in all measures with the use of the Divino or Intenso processors compared with the unaided situation. Change in hearing, as measured in noise testing word recognition scores, revealed a statistically significant difference between the two aided conditions favoring the Intenso (P < 0.05). The Glasgow Benefit Inventory revealed that 91 percent of the patients reported improvement in their quality of life and would recommend the procedure to others.

Conclusion

The Baha system is effective in the rehabilitation of patients with SSD and mild to moderate hearing loss in the only hearing ear. Results of the current study suggest that either the Divino or Intenso processor was successful in reestablishing hearing from the deafened side.
H1N1 influenza A presenting as bacterial tracheitis
Authors: Hopkins Brandon S. , Johnson Kaalan E. , Ksiazek Jeff M. , Sun Gordon , Greinwald John H. , Rutter Michael
Published: March 2010

Six cases of bacterial tracheitis (BT) occurring early in the 2009 flu season have been isolated in conjunction with the H1N1 strain of influenza A (H1N1). No previous H1N1 cases have presented as BT in the literature to date. We would like to discuss viral coinfection in BT patients and how this new strain may affect the rate and type of presentation encountered. The life‐threatening potential of BT and the pandemic proportion of H1N1 highlight a possibly dangerous combination that should be recognized by the otolaryngology community. In hospitalized patients with presumed BT, consideration should be given to routine H1N1 testing and the addition of antiviral medication when indicated as this entity is further investigated.
Complications of esophagoscopy in an academic training program
Authors: Tsao Gabriel J. , Damrose Edward J.
Published: March 2010

Objective

To assess the efficacy and safety of flexible versus rigid esophagoscopy in an academic training setting.

Study Design

Case series with chart review.

Setting

Tertiary academic training center.

Subjects and Methods

A retrospective medical record review was performed on all adult patients undergoing esophagoscopy from 2002 to 2007.

Results

A total of 546 procedures were performed with flexible (n = 276) or rigid (n = 270) endoscopes. Seven esophageal perforations (2.6%) occurred, all in association with rigid endoscopy and all in patients with a history of head and neck cancer. Esophageal perforation rates were associated with attending level of experience. There were no deaths. No synchronous esophageal cancers were found in any patient undergoing panendoscopy for the evaluation of a head and neck cancer.

Conclusion

The 2.6 percent esophageal perforation rate observed in this study is higher than that typically reported for rigid esophagoscopy. When performed as part of routine panendoscopy, no synchronous esophageal tumors were found, questioning the value of esophagoscopy in this setting. All perforations occurred in patients with a history of head and neck cancer and were associated with the level of the surgeon's experience in performing rigid endoscopy.
Palatine tonsil size in obese, overweight, and normal‐weight children with sleep‐disordered breathing
Authors: Wang Jong Hwan , Chung Yoo‐Sam , Cho Young‐Wook , Kim Do‐Youn , Yi Jong Sook , Bae Ji Seon , Shim Myung Joo
Published: March 2010

Objective

To assess palatine tonsil size relative to degree of obesity in children with sleep‐disordered breathing (SDB).

Study Design

Case‐control study.

Setting

Tertiary care rhinology clinic.

Subjects and Methods

We compared the subjective and objective tonsil size, including tonsil height (TH), tonsil width (TW), tonsil thickness (TT), tonsil weight (TWt), and tonsil volume (TV), in 26 obese children and 26 age‐ and gender‐matched control children with SDB, and in 29 overweight children and 29 matched controls with SDB.

Results

Despite similar subjective tonsil size in obese and control children, the objective tonsil size, including TH, TW, TT, and TWt, was larger in obese than in control children, and the mean TV was significantly greater in obese than in control children with SDB (8.53 ± 3.30 mL vs 6.90 ± 2.05 mL; 95% confidence interval [CI] of the difference 0.03‐3.25; P = 0.019). In contrast, mean TV (7.38 ± 3.43 mL vs 7.65 ± 1.97 mL; 95% CI −1.92 to 1.37; P = 0.320) as well as the other parameters of objective palatine tonsil size, including TH, TW, TT, and TWt, did not differ significantly between overweight children and controls.

Conclusion

Obese children with SDB had larger palatine tonsils than did normal‐weight children with SDB. This finding suggests that larger palatine tonsils may have a greater effect on upper airway obstruction in obese than in normal‐weight children with SDB.
Validation of a clinical practice ability instrument for surgical training
Authors: Shin Jennifer J. , Page John H. , Shapiro Jo , Gray Stacey T. , Cunningham Michael J.
Published: March 2010

Objective

To develop and validate an instrument to measure the progression of clinical practice ability among surgical trainees.

Study Design

Prospective validation study.

Setting

Three academic training institutions: Massachusetts Eye and Ear Infirmary, Brigham and Women's Hospital, Harvard School of Public Health.

Subjects and Methods

A clinical practice instrument (CPI) was created and prospectively validated in otolaryngology trainees at three institutional sites. The instrument is completed during an oral examination of a trainee who is presented with a patient scenario; the scenario yields one clinical diagnosis, one therapeutic intervention, and one interventional complication. On the basis of the trainee's responses, 21 item scores are calculated focusing on key areas within the diagnostic and management paradigm. Internal consistency, reproducibility, inter‐rater reliability, discriminant and criterion validity, and responsiveness to change over time were evaluated.

Results

There were 87 administrations of the instrument over a period of 22 months. The subjects (n = 32) spanned the range of training from medical student to clinical fellow. There was strong internal consistency within each domain (Cronbach's alpha 0.85‐0.94, one‐sided 95% confidence interval > 0.81). Inter‐rater reliability was high (kappa 0.66, absolute agreement 72%). Reproducibility of item scores was excellent (intraclass correlation coefficient [ICC] final summary score 0.78, global item score 0.83). Discriminant validity (P < 0.0001), criterion validity (P = 0.03), and responsiveness to change (P = 0.0055) were also established.

Conclusion

The CPI serves as a reliable, reproducible, and valid means to measure the progression of clinical practice ability in trainees as they transition from “novice” to “attending equivalent” surgeons.
Extracts from The Cochrane Library: Scopolamine (hyoscine) for preventing and treating motion sickness
Authors: Burton Martin J. , Roland Peter S. , Rosenfeld Richard M.
Published: March 2010

The “Cochrane Corner” is a quarterly section in the Journal that highlights systematic reviews relevant to otolaryngology–head and neck surgery, with invited commentary to aid clinical decision making. This installment features a Cochrane Review entitled “Scopolamine (hyoscine) for preventing and treating motion sickness,” which concludes that scopolamine is more effective than placebo, but no conclusions can be made regarding comparative efficacy with other interventions or the ability of scopolamine to treat established symptoms.
Long-term pain, neuroinflammation and glial activation
Authors: Hansson Elisabeth
Published: March 2010

Nociceptive and neuropathic pain signals are known to result from noxious stimuli, which are converted into electrical impulses within tissue nociceptors. There is a complex equilibrium of pain-signalling and pain-relieving pathways connecting PNS and CNS. Drugs against long-term pain are today directed against increased neuronal excitability, mostly with less success.

An injury often starts with acute physiological pain, which becomes inflammatory, nociceptive, or neuropathic, and may be transferred into long-term pain. Recently a low-grade inflammation was identified in the spinal cord and along the pain pathways to thalamus and the parietal cortex. This neuroinflammation is due to activation of glial cells, especially microglia, with production of cytokines and other inflammatory mediators within the CNS. Additionally, substances released to the blood from the injured region influence the blood–brain barrier, and give rise to an increased permeability of the tight junctions of the capillary endothelial cells, leading to passage of blood cells into the CNS. These cells are transformed into reactive microglia. If the inflammation turns into a pathological state the astrocytes will be activated. They are coupled into networks and respond to substances released by the capillary endothelial cells, to cytokines released from microglia, and to neurotransmitters and peptides released from neurons. As the astrocytes occupy a strategic position between the vasculature and synapses, they monitor the neuronal activity and transmitter release. Increased release of glutamate and ATP leads to disturbances in Ca2+ signalling, increased production of cytokines and free radicals, attenuation of the astrocyte glutamate transport capacity, and conformational changes in the astrocytic cytoskeleton, the actin filaments, which can lead to formation and rebuilding of new synapses. New neuronal contacts are established for maintaining and spreading pain sensation with the astrocytic networks as bridges. Thereby the glial cells can maintain the pain sensation even after the original injury has healed, and convert the pain into long-term by altering neuronal excitability. It can even be experienced from other parts of the body. As astrocytes are intimate co-players with neurons in the CNS, more knowledge on astrocyte responses to inflammatory activators may give new insight in our understanding of mechanisms of low-grade inflammation underlying long-term pain states and pain spreading. Novel treatment strategies would be to restore glial cell function and thereby attenuate the neuroinflammation.
Sensory disturbances and neuropathic pain after inguinal hernia surgery
Authors: Magnusson Niklas , Hedberg Mats , Österberg Johanna , Sandblom Gabriel
Published: March 2010

Objectives

The aim of this study was to explore how the handling of nerves affects the risk for developing sensory disturbances (SDs) following groin hernia surgery.

Patients and methods

All patients 18 years or older undergoing surgery for inguinal hernia at Mora Hospital, Sweden, during an eight-month period in 2006, were eligible for inclusion. The surgical procedure was recorded prospectively according to a standardised protocol. One year postoperatively all patients were requested to answer the Inguinal Pain Questionnaire as well as a set of 18 sensory and affective pain descriptors. They were also invited to clinical examination including sensory testing.

Results

Of the 157 hernia repairs in Mora during the period of study, 128 repairs in 116 patients, were registered prospectively according to the study protocol. Laparoscopic total extraperitoneal (TEP) repair was performed in 36 (28%) of the patients. Ninety-two (79%) patients, including five patients operated bilaterally, underwent postoperative examination. SDs were found in 33 (34%) of the groins examined. No descriptor was found that significantly predicted the presence of altered examination findings. No significant association between the intraoperative handling of nerves and SD was seen. In the TEP-group, no SDs were seen. Infiltration of local anaesthetic agents and blockade of the ilioinguinal nerve prior to surgery were found to be significantly associated with SD more than 2 cm away from the scar (both p < 0.05). The presence of SD was not associated with significant pain.

Conclusions

SDs are common after open hernia surgery, but are not associated with persistent postoperative pain.
Hyperesthesia one year after breast augmentation surgery increases the odds for persisting pain at four years A prospective four-year follow-up study
Authors: Kaasa Torill , Romundstad Luis , Roald Helge , Skolleborg Knut , Stubhaug Audun
Published: March 2010

In this long-term follow-up study of 175 women, we investigated the prevalence of and factors associated with persisting pain and sensory changes four years after augmentation mammoplasty. Previously the women had participated in an acute postoperative pain study, and follow-up investigations at 6 weeks and 1 year after surgery. In the present study, the women were mailed questionnaires about pain, sensory changes, and affection of daily life, quality of life and pain catastrophizing 4 years after surgery.

One hundred and sixteen women answered the questionnaire. The fraction of women reporting evoked- and/or spontaneous pain during the last 24 h had declined from 20% at 1 year to 14% at 4 years. Hyperesthesia had declined from 46% at 1 year to 32% at 4 years, while the change in hypoesthesia was small, 47% at 1 year to 51% at 4 years. Methylprednisolone and parecoxib given pre incisionally reduced acute postoperative pain and reduced the prevalence of hyperesthesia after 6 weeks/1 year, but after 4 years we found no significant differences between the test drug groups. Those having concomitant pain and hyperesthesia at 6 weeks and 1 year had high odds for persisting pain at 4 years (OR 7.8, 95% CI 2.1–29.8, P = 0.003; OR 13.2, 95% CI 2.5–71.3, P = 0.003). In patients without pain but with hyperesthesia at 1 year, the hyperesthesia increased the odds for pain at 4 years (OR 2.6 95% CI 1.1–6.1, P = 0.03). Hypoesthesia at 6 weeks or at 1 year did not affect the odds for pain at 4 years. A good general health condition (mental and physical) was associated with reduced odds for pain at 4 years (OR = 0.56, 95% CI 0.35–0.88, P = 0.01). However, using the Short Form health survey, SF-12, the Mental Component Summary Score seemed to affect the odds for chronic pain more than the Physical Component Summary Score.

To conclude, the prevalence of pain and hyperesthesia after breast augmentation declined from 1 to 4 years. Nevertheless, the most striking finding in the current trial was that pain coinciding with hyperesthesia at 6 weeks and 1 year resulted in highly increased odds for persistent postoperative pain. Even hyperesthesia alone, without pain, increased the odds for chronic postsurgical pain. Thus, the present study suggests hyperesthesia as an independent risk factor for chronic postsurgical pain.