bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Evolution on the Eustachian Tube
Authors: Bluestone Charles D.
Published: February 2009

I posit that humans appear to be the only species that develops otitis media. If animals in the wild had developed middle‐ear disease to any significant degree, they would have been selected out during evolution because they would not have survived their predators given the associated hearing loss. Why do humans have otitis media? Evolution has had a significant impact. It is well known that humans are born 12 months too early, which is the result of adaptations to bipedalism and our big brain that, over time, resulted in a relatively small female pelvic outlet compared with nonhuman primates. As a consequence of too early a birth, not only is our immune system immature, but the eustachian tube is too short and floppy in the first year of life. But why is otitis media still common in older individuals? What other adaptation is uniquely human? We developed speech that was associated with descent of the larynx and hyoid bone, which, along with a decrease in prognathism (i.e., facial flattening), resulted in a change in palatal morphology as compared with other primates. Comparative anatomic and physiologic studies have demonstrated significant differences between humans and monkeys, especially in the muscles of the eustachian tube. Paradoxic constriction, as apposed to dilation, on swallowing is a common tubal dysfunction in humans and certain monkey models with chronic middle‐ear effusion. My hypothesis is that chronic otitis media with effusion in patients with tubal constriction is a consequence of adaptation for speech and that, most likely, the levator veli palatini muscle is the cause.
Vocal Nodules and Edema May Be Due to Vibration‐Induced Rises in Capillary Pressure
Authors: Czerwonka Lukasz , Jiang Jack J. , Tao Chao
Published: February 2009

Hypothesis: Vocal fold vibration may physically raise intravascular pressure to levels high enough to damage capillaries and result in leakage of erythrocytes. This type of injury is commonly seen in benign vocal fold lesions and is not well explained.

Study Design: Theoretical, retrospective.

Methods: The relationship of intravascular pressure to vibration frequency and amplitude is derived and confirmed with a physical blood vessel model, then applied to published human measurements to estimate human intravascular pressures.

Results: Vocal fold intravascular pressure is predicted to have a quadratic dependence on both frequency and amplitude. During speaking, the pressure may rise to over 20 cmH2O, and may reach levels far higher for screaming and singing. Such pressure magnitudes are known to trigger inflammatory cascades and can lead to fluid leakage. They also have the potential for pharmacologic control with β‐agonists.

Conclusions: Intravascular pressure likely rises significantly during vocal fold vibration and may lead to the type of injury seen in benign vocal fold lesions. The results support voice therapy aimed at reducing vibratory amplitude. More vibratory amplitude measurements need to be performed in a wider range of subjects before the full range of human vocal fold vascular pressures can be estimated.
Relation of Distortion Product Otoacoustic Emission With Tinnitus
Authors: Ami Mazita , Abdullah Asma , Awang Mahamad A. , Liyab Borhan , Saim Lokman
Published: February 2009

Objective: To investigate cochlear outer hair cell function based on distortion product otoacoustic emission (DPOAE) in patients with tinnitus.

Study Design: This is a case control study.

Subjects and Methods: The subjects are patients who attended the Otorhinolaryngology Clinic in Hospital Universiti Kebangsaan Malaysia over a period of 19 months from April 2005 until October 2006. All patients underwent a full ENT assessment and had tympanometry, pure tone audiometry, and DPOAE tests. The UKM Research and Ethics Committee reviewed and approved the study proposal prior to commencement of this study.

Results: The study population included 49 patients. They consisted of 16 patients (32 ears) with tinnitus and reduced hearing, 13 patients (26 ears) with tinnitus and normal hearing, 7 patients (13 ears) without tinnitus with reduced hearing, and 13 patients (26 ears) without tinnitus with normal hearing. Statistical analysis showed significant differences (P = .00) of mean DPOAE levels between the four groups of patients.

Conclusion: Our results suggest that reduced outer hair cell activity, as detected by reduced DPOAE levels, may manifest as tinnitus even before there is a shift on hearing threshold. We also postulate that further reduction of cochlear outer hair cell activity, as shown by further reduced DPOAE levels, may actually terminate the source of tinnitus.
Accuracy of Self‐Report in Detecting Taste Dysfunction
Authors: Soter Ana , Kim John , Jackman Alexis , Tourbier Isabelle , Kaul Arti , Doty Richard L.
Published: February 2009

Objective: To determine the sensitivity, specificity, and positive and negative predictive value of responses to the following questionnaire statements in detecting taste loss: “I can detect salt in chips, pretzels, or salted nuts,” “I can detect sourness in vinegar, pickles, or lemon,” “I can detect sweetness in soda, cookies, or ice cream,” and “I can detect bitterness, in coffee, beer, or tonic water.” Responses to an additional item, “I can detect chocolate in cocoa, cake or candy,” was examined to determine whether patients clearly differentiate between taste loss and flavor loss secondary to olfactory dysfunction.

Methods: A total of 469 patients (207 men, mean age = 54 years, standard deviation = 15 years; and 262 women, mean age = 54 years, standard deviation = 14 years) were administered a questionnaire containing these questions with the response categories of “easily,” “somewhat,” and “not at all,” followed by a comprehensive taste and smell test battery.

Results: The questionnaire items poorly detected bona fide taste problems. However, they were sensitive in detecting persons without such problems (i.e., they exhibited low positive but high negative predictive value). Dysfunction categories of the University of Pennsylvania Smell Identification Test (UPSIT) were not meaningfully related to subjects' responses to the questionnaire statements. Both sex and age influenced performance on most of the taste tests, with older persons performing more poorly than younger ones and women typically outperforming men.

Conclusion: Although it is commonly assumed that straight‐forward questions concerning taste may be useful in detecting taste disorders, this study suggests this is not the case. However, patients who specifically report having no problems with taste perception usually do not exhibit taste dysfunction. The difficulty in detecting true taste problems by focused questionnaire items likely reflects a combination of factors. These include the relatively low prevalence of taste deficits in the general population and the tendency of patients to confuse loss of olfaction‐related flavor sensations with taste‐bud mediated deficits.
The Quartile Benefit Plot: A Middle Ear Surgery Benefit Assessment Scheme
Authors: Schmerber Sébastien , Karkas Alexandre , Righini Christian A. , Chahine Karim A.
Published: February 2009

Objective: The purpose of this study is to present a new method for the assessment of hearing improvement following stapes surgery, taking into account additional, previously omitted evaluation criteria.

Study Design: Retrospective.

Methods: A quartile plot, based on the currently used Glasgow benefit plot, is structured to include two additional criteria of hearing assessment, namely the absence of postoperative sensorineural hearing loss and the closure of the air‐bone gap to <10 dB. Pre‐ and postoperative hearing results of 132 patients diagnosed with bilateral otosclerosis and treated with bilateral stapes surgery were plotted on both the classical Glasgow benefit plot and the new quartile benefit plot. The difference in success assessment due to stricter assessment criteria is demonstrated.

Results: Functional success rate following bilateral stapes surgery as plotted on the traditional Glasgow benefit plot was 51.5%. Success rate for bilateral stapes surgery assessed on the new quartile plot with the addition of the two new criteria was 38.64%. The difference in success rates was found to be statistically significant.

Conclusion: The basis of benefit assessment in stapes surgery solely on the mean deficit in air conduction results in overestimation of success rate. This study demonstrates that results that appear satisfactory when judged by the Glasgow benefit plot are of modest success when assessed by the new quartile plot. The quartile benefit plot presented in this paper provides a strict measure of presentation and evaluation of stapes surgery results.
Validation of a Networked Virtual Reality Simulation of Temporal Bone Surgery
Authors: O'Leary Stephen J. , Hutchins Matthew A. , Stevenson Duncan R. , Gunn Chris , Krumpholz Alexander , Kennedy Gregor , Tykocinski Michael , Dahm Marcus , Pyman Brian
Published: February 2009

Objectives: To assess the content validity and concurrent validity of a haptically (force feedback) rendered, virtual reality simulation of temporal bone surgery.

Methods: Eleven naive surgical trainees were given a 1‐hour lesson on the operation, cortical mastoidectomy, in the virtual environment with the trainer on a networked simulator and then asked to perform this procedure on a real temporal bone.

Results: The simulator was found to be a convincing representation of temporal bone drilling and could be said to exhibit face validity. The simulator was an effective means of teaching both the surgical anatomy and the surgical approach as judged by oral assessments made before and after the virtual reality training session. The trainees were successful in identifying most surgical landmarks during their first temporal bone dissection, and over two thirds found the landmarks at the correct time during the procedure. Some trainees exhibited acceptable or better technique with the drill despite this being their first temporal bone dissection. Subjective assessments indicated a high level of acceptance of simulated surgery for training, and there was perceived value in specific enhancements of the virtual environment that facilitated learning. Particular enhancements of value were the networked simulation, the option to make the model semitransparent to reveal anatomic relationships, and error reporting when the sigmoid sinus or facial nerve was injured.

Conclusions: Virtual reality simulation of temporal bone surgery was an effective method for teaching surgical anatomy and planning and was well accepted by trainees.
Growth Promoting Treatment Normalizes Speech Frequency in Turner Syndrome
Authors: Andersson‐Wallgren Gunnel , Ohlsson Ann‐Christine , Albertsson‐Wikland Kerstin , Barrenäs Marie‐Louise
Published: February 2009

Objective: To assess objective and subjective voice parameters among Turner syndrome (TS) women in relation to genotype, hearing, growth, and previous treatment with growth hormone (GH) and androgen given that lowering of speaking fundamental frequency (SFF) during treatment is regarded as a negative side effect.

Study Design: Cross‐sectional, controlled for karyotype and age.

Methods: Voice function was studied objectively (SFF) and subjectively (questionnaire) in 117 women with TS.

Results: SFF did not differ between treated and nontreated participants or between patients with a spontaneous versus induced puberty. SFF was dependent on karyotype but not age. Subjective voice change was reported four times more often among treated compared with nontreated TS women (odds ratio [OR] = 4.4; 95% confidence interval [CI]: 0.9–20.10), whereas voice and articulation problems were reported three times more often among untreated compared with treated cases (OR = 2.9; 95% CI: 1.0–8.3). Voice symptoms were over‐represented among patients having micrognathia (OR = 6.0; 95% CI: 1.6–22.3), hearing loss (OR = 8.6; 95% CI: 1.7–43.1), and monosomy (OR = 6.2; 95% CI: 0.8–36.2) but not among those with an arched palate.

Conclusions: When given to TS girls, GH (33–66 μg/kg/d) and androgen (0.05 mg/kg/d) normalized SFF and reduced voice and articulation problems in adulthood. The TS phenotype includes important voice and speech problems, which in turn are associated with hearing problems, although genotypic, monosomic, and isochromosome patients have more voice problems and also more high‐pitched voices than mosaic patients. Most TS women, despite their karyotype or age, exhibit a higher frequency of pitched voice than non‐TS women.
Optimization of Autologous Muscle Stem Cell Survival in the Denervated Hemilarynx
Authors: Halum Stacey L. , Hiatt Kelly K. , Naidu Moumita , Sufyan Ahmed S. , Clapp D. Wade
Published: February 2009

Objective: Current treatments for vocal fold paralysis are suboptimal in that they fail to restore dynamic function. Autologous muscle stem cell (MSC) therapy is a promising potential therapy for vocal fold paralysis in that it can attenuate denervation‐induced muscle atrophy and provide a vehicle for delivery of neurotrophic factors, thereby potentially selectively guiding reinnervation. The goal of this project was to characterize optimal conditions for injected autologous MSC survival in the thyroarytenoid (TA) muscle following recurrent laryngeal nerve (RLN) injury by local administration of adjuvant factors.

Study Design: Animal experiment.

Methods: Unilateral RLN transection and sternocleidomastoid muscle (∼1 g) biopsies were performed in 20 male Wistar rats. One month later, 106 autologous MSCs labeled via retroviral‐enhanced green fluorescent protein (EGFP) transduction were injected into the denervated hemilarynx of each animal with one of four adjuvant therapies: cardiotoxin [(CTX) 10−5 M], insulin‐like growth factor‐1 [(IGF‐ 1) 100 μg/mL], ciliary neurotrophic factor [(CNTF) 50 μg/mL], or saline. Animals were euthanized 1 month later and larynges harvested, sectioned, and analyzed for MSC survival.

Results: All specimens demonstrate extensive MSC survival, with fusion of the MSCs with the denervated myofibers. Based on mean fluorescent intensity of the laryngeal specimens, IGF‐1 and CNTF had the greatest positive influence on MSC survival. Myofiber diameters demonstrated myofiber atrophy to be inversely related to MSC survival, with the least atrophy in the groups having the greatest MSC survival.

Conclusions: Autologous MSC therapy may be a future treatment for vocal fold paralysis. These findings support a model whereby MSCs genetically engineered to secrete CNTF and/or IGF‐1 may not only promote neural regeneration, but also enhance MSC survival in an autocrine fashion.
Outcomes and Efficacy of Newborn Hearing Screening: Strengths and Weaknesses (Success or Failure?)
Authors: Korres S. , Nikolopoulos Thomas P. , Peraki E. E. , Tsiakou M. , Karakitsou M. , Apostolopoulos N. , Economides J. , Balatsouras D. , Ferekidis E.
Published: February 2009

Objective: To assess the outcomes of neonatal hearing screening with regard to the final diagnosis in a very large number of newborns and investigate related strengths and weaknesses of the program.

Subjects: In this study, 76,560 newborns were assessed.

Method: All neonates were assessed using transient evoked otoacoustic emissions (TEOAEs).

Results: From the 76,560 neonates screened, 1,564 (2%) failed the test. According to the screening protocol, all parents of failed neonates were asked to bring their children 1 month following discharge to repeat the test. Of the 541 (34.6%) newborns who repeated the test, 303 (56%) were found normal and 238 (44%) again failed TEOAE. The latter children were referred to two special public centers for full audiology evaluation. In addition, 124 neonates were also referred due to other reasons revealed in the screening process (family history, high levels of bilirubin, etc.). Of the 362 children who were referred to the two special audiology centers, 113 (31.2%) were evaluated by these two centers. In addition, 42 children who had failed initial screening and did not show up for a follow‐up appointment to repeat TEOAE were also assessed in the same centers. Of the 155 children who had a special audiologic evaluation, 56 (36.1%) were found to have hearing loss (HL) and 99 (63.9%) normal hearing. In detail, 28 had bilateral sensorineural HL greater than 40 dB, 10 had unilateral sensorineural HL greater than 40 dB, and 18 had otitis media with effusion or other conductive HL.

Conclusions: Derived from the present study: 1) repeated testing of “failed” newborns in the maternity hospital and before discharge leads to an acceptable referral rate of 2%; 2) the 1‐month follow‐up of “failed” newborns further limits the false positive results but leads to high rate of newborns lost to follow‐up; 3) a dedicated secretariat system should be implemented to follow‐up each “failed” newborn and remind parents about their follow‐up appointments; and 4) additional measures such as detailed educational material and parental friendly approach should also be implemented.
Failed Tube Extrusion is Not a Random Event in Children or Their Siblings
Authors: Azadarmaki Roya , Gaughan John P. , Isaacson Glenn
Published: February 2009

Objectives/Hypothesis: It has been assumed that prolonged retention of tympanostomy tubes was random, with an incidence of 4% to 12% per tube. We have noticed patterns of tube retention that suggested a genetic predilection. We undertook this study to validate or disprove this impression. Such information may shed light on the physiology of tube extrusion and may help better define the risks of tympanostomy tube placement.

Study Design: Retrospective, single‐surgeon, statistical analysis.

Methods: A computerized database of approximately 10,000 pediatric otolaryngology patients was queried. We identified all children treated by the senior author during a 6‐year period who underwent tube removal for failed extrusion 24 or more months after placement. Siblings with retained tubes and individuals requiring bilateral tube removal were further analyzed: 1) using the law of multiplication of independent factors, the chance of retaining tubes in both ears of an individual was compared with the observed rate of bilateral retention by calculating the difference in Poisson rates; 2) the rate of siblings who retained one or both tubes was compared with nonsiblings who retained one or both tubes using the Z test for independent proportions.

Results: The observed rate of bilateral retention (228/6,000 = 0.038) far exceeded the theoretical rate (0.0682 = 0.0046; P < .001). Siblings were more likely to retain tubes than nonsiblings (difference = 0.042; P = .085). This difference was more pronounced in unilateral (difference = 0.048; P = .014) than in bilateral retention (difference = 0.005; P = .856).

Conclusions: Tympanostomy tube retention is not a random occurrence. Patterns of nonextrusion in individuals and siblings suggest a genetic mechanism. Implications for patient counseling and research are discussed.
Secreting Jugulotympanic Paraganglioma With Venous Involvement into the Thorax
Authors: Daramola Opeyemi O. , Shinners Michael J. , Levine Samuel C.
Published: February 2009

Paragangliomas are highly vascular tumors that arise from chief cells in extra‐adrenal paraganglia of the autonomic nervous system. Jugulotympanic paragangliomas involve the middle ear and jugular fossa. Secreting jugulotympanic paragangliomas with thoracic extension are rare. We report a case with unexpected involvement of the internal jugular vein. Otolaryngologists should be aware that the jugulotympanic paragangliomas traverse variable anatomic pathways. Multiple imaging options, including magnetic resonance venography, are useful and should include the neck for definitive characterization of tumor anatomy. Patients with refractory hypertension and masses suspicious for paraganglioma should be examined for functional tumors.
Chondrosarcoma of the Hyoid Bone: Imaging, Surgical, and Histopathologic Correlation
Authors: Saki Nader , Akhlagh Soheila Nik , Mostofi Neptone Emad , Ahmadi Khashayar
Published: February 2009

Objectives/Hypothesis: Rare diseases must be diagnosed with great caution, so we present this case to familiarize clinicians with the presentation and treatment of chondrosarcoma of the hyoid bone, a rare disease.

Study Design: Case report and review of the literature.

Methods: We report one case of chondrosarcoma of the hyoid bone which presented with upper midline neck mass. In addition, we review the literature published in English regarding chondrosarcoma of the hyoid bone.

Results: Chondrosarcoma of the hyoid bone is a rare disease of which only 14 cases have been reported until now. Patients with this disease have no sexual or racial preponderance, and most presented with a mass in the upper neck which has splotchy calcification in radiologic imaging without enhancement. The preferred treatment is wide excision.

Conclusion: Because chondrosarcoma have indolent growth, are locally noninvasive, and appear encapsulated during operation, they may be mistaken for a benign mass and conservatively resected. On the other hand, incomplete tumor resection may lead to recurrence, which is associated with increased risk of dedifferentiation and histologic grading of tumor. Surgeons should approach this surgery with caution.
Relationship Between Rhinitis Duration and Response to Nasal Decongestion Test
Authors: Ciprandi Giorgio , Pistorio Angela , Tosca Mariangela , Cirillo Ignazio
Published: February 2009

Objectives/Hypothesis: Nasal obstruction depends on allergic inflammation. Decongestion tests evaluate the reversibility of nasal airflow limitation. It has been previously reported that duration of persistent allergic rhinitis (PER) may involve important functional consequences. The purpose of the study was to evaluate the impact of the duration of rhinitis on the response to nasal decongestion test in a cohort of patients with PER.

Methods: A total of 312 patients with moderate‐severe PER were prospectively and consecutively evaluated: 234 males and 78 females, mean age 23.6 years. A detailed clinical history was taken and complete physical examination, nasal endoscopy, skin prick test, rhinomanometry, and nasal decongestion test were performed for all patients.

Results: A strong inverse correlation was observed (Pearson's r = −0.81) between rhinitis duration (years) and posttest percentage change of nasal airflow values.

Conclusions: The duration of PER may induce a progressive impairment of the response to nasal decongestion test.
Impact of Second Primary Tumors on Survival in Head and Neck Cancer: An Analysis of 2,063 Cases
Authors: Rennemo Erlend , Zätterström Ulf , Boysen Morten
Published: February 2009

Objective/Hypothesis: To investigate the impact of second primary tumors on prognosis for patients with head and neck squamous cell carcinoma (HNSCC).

Study Design: Prospectively recorded data on HNSCC patients treated at an academic tertiary referral center.

Methods: An analysis of 2,063 patients treated over a 15 year period for tumors of the upper aerodigestive tract, with a minimum follow‐up of 10 years.

Results: A total of 351 (17%) patients developed a second primary, mean time to diagnosis of the second tumor being more than 4 years from the date of the initial tumor. Median overall survival from the date of the first tumor among patients who later developed a second primary was 6 years versus 3 years among all other patients (P < .05). During the first 6 years after treatment of the initial tumor, cancer specific survival was better in the second primary group. After diagnosis of a second primary tumor, median survival was 12 months. A positive correlation was found between second primaries and stage I/II primary disease, low patient age, and initial tumors of the larynx and oral cavity.

Conclusions: The group of patients with the highest risk of a second primary tumor was younger patients with limited initial tumors. A high proportion of patients who later developed a second primary were complete responders after treatment of the first tumor. However, prognosis was poor after the actual diagnosis of the second primary tumor.
Comparison of Effects of 2 Harvesting Methods on Fat Autograft
Authors: Park Hyoungshin , Williams Rachel , Goldman Nathan , Choe Hannah , Kobler James , Lopez‐Guerra Gerardo , Heaton James T. , Langer Robert , Zeitels Steven M.
Published: February 2009

Objectives/Hypothesis: Fat preparation for vocal‐fold injection medialization is typically done by scraping of excised fat or by lipo‐aspiration; however, lipo‐aspiration is substantially more efficient. Considering this, we compared viability of fat tissues obtained by these two techniques. We also examined whether basic fibroblast growth factor (bFGF) would increase cell proliferation in samples harvested by these methods.

Study Design: Harvesting techniques (scraping and lipo‐aspiration) were compared using both human and ferret fat. In vitro assays were used to assess tissue viability and cell proliferation.

Methods: Human (n = 5) and ferret (n = 15) abdominal fat specimens were harvested by scraping and lipo‐aspiration, for a total of 40 specimens. Alamar Blue and glycerol‐3‐phosphate dehydrogenase assays were used to quantitatively assess metabolic activity and cellular damage immediately after harvest. PicoGreen assays assessed cell proliferation by quantifying total DNA in harvested specimens after 0, 14, or 21 days in culture. The effects of bFGF (10 ng/mL) on proliferation were measured for the same timepoints.

Results: The glycerol‐3‐phosphate dehydrogenase assay indicated that lipo‐aspiration caused more initial tissue damage (12 ± 5 mU/mL) than scraping (5 ± 3 mU/mL), but cell metabolic activity was similar in both groups based on the Alamar Blue assay. Cell proliferation at 14 and 21 days was significantly higher for lipo‐aspirated fat than for scraped fat (92.5 ± 8.8 vs. 55.1 ± 1.3 ng DNA at 14 days and 111.1 ± 10.5 vs. 44.6 ± 4.1 ng DNA at 21 days). bFGF increased fibroblast‐like cell proliferation significantly for both harvesting methods at day 21.

Conclusions: Lipo‐aspiration caused more initial damage than scraping, but may yield better long‐term viability based on increased proliferation. bFGF may enhance cellularity of the stromal component grafted adipose tissue.
Gentamicin Increases Nitric Oxide Production and Induces Hearing Loss in Guinea Pigs
Authors: Heinrich Ulf‐Rüdiger , Helling Kai , Sifferath Marco , Brieger Jürgen , Li Huige , Schmidtmann Irene , Mann Wolf J.
Published: February 2009

Objectives/Hypothesis: Gentamicin application is an important therapeutic option for Ménière's disease. However, even if given at intervals, a destruction of the cochlea was often observed in various animal models together with an increased content of nitric oxide (NO) and reactive oxygen species. The present study was undertaken to identify the correlation between hearing threshold alteration and the NO production in the lateral wall and organ of Corti of the guinea pig in response to gentamicin application.

Study Design: Prospective animal study in guinea pigs.

Methods: A single dose of gentamicin (10 mg/kg body weight) was injected intratympanally into male guinea pigs and the auditory brainstem responses were recorded before treatment and 1, 2, and 7 days after application. The organ of Corti and the lateral wall were removed from the bulla, incubated separately for 6 hours in cell culture medium and the amount of NO production was determined by chemiluminescence.

Results: Gentamicin application resulted in a hearing threshold shift beginning on the second day after gentamicin application. This hearing impairment correlates simultaneously with an increased NO2− content—the stable oxidation product of NO—in the lateral wall. In the organ of Corti, a slight increase in NO2− production was seen as early as on day 1 after gentamicin injection.

Conclusions: The correlation between hearing threshold shift and NO production in the cochlea leads to the assumption that increased NO contributes to gentamicin‐induced hearing impairment.
Does Nasal Obstruction Mean That the Nose Is Obstructed?
Authors: Kjærgaard Thomas , Cvancarova Milada , Steinsvåg Sverre K.
Published: February 2009

Objectives/Hypothesis: It is still a matter of controversy to what extent the sense of nasal obstruction is associated with objective measures for nasal space and airflow. Knowledge about this is important in the evaluation of nasal complaints and the planning of its treatment. In this study, we evaluated the relationship between subjective nasal obstruction and the corresponding anatomic and physiological nasal parameters using acoustic rhinometry (AR) and peak nasal inspiratory flow (PNIF).

Study Design: Two thousand five hundred twenty‐three consecutive patients were included in this cross‐sectional study. Eligible subjects were adults referred to the Ear, Nose, and Throat Department, Sørlandet Hospital, Kristiansand, Norway, for evaluation of chronic nasal or sleep related complaints.

Methods: Subjects underwent AR and nasal flow measurements. Subjective grading of nasal obstruction was obtained by a nasal obstruction visual analogue scale. Associations between nasal obstruction visual analogue scale scores, AR, and PNIF were assessed using multiple linear regression, adjusting for age, gender, body mass index, and asthma, allergy, and smoking history.

Results: The sense of nasal obstruction was associated with nasal cavity volumes in both anterior and middle segments of the nasal cavities, with minimal cross‐sectional areas in middle segments and for the nasal cavity as a whole, and with PNIF. Associations with minimal cross‐sectional areas in anterior segments did not reach significance.

Conclusions: The present study demonstrates highly significant associations between the subjective sensation of nasal obstruction and corresponding measures for nasal cavity volume, area, and airflow. We conclude that AR and PNIF are valuable objective instruments for evaluation of subjective nasal obstruction.
The Natural History of Patients With Squamous Cell Carcinoma of the Hypopharynx
Authors: Hall Stephen F. , Groome Patti A. , Irish Jonathan , O'Sullivan Brian
Published: February 2009

Objectives/Hypothesis: To provide the baseline information on the natural history of patients with squamous cell carcinoma of the hypopharynx to help clinicians, researchers, and patients assess the relative effectiveness of treatment options when the best treatment is not known and newer treatments are being proposed.

Study Design: Retrospective population‐based design.

Methods: The patient descriptors, treatments, and outcomes for 595 patients across the province of Ontario, Canada from January 1990 to December 31, 1999 based on electronic data and chart review.

Results: The typical patient is 65 years old, male, unemployed, and poor. They are heavy drinkers with significant comorbidity compromising functional status. The tumors are advanced (over 50% stage 4). After curative treatment 20% had residual disease, recurrences tended to appear in the first year and 50% of first recurrences included metastases. Overall, 47% of patients were disease free at 3 years but eventually 64% of patients died of their cancer.

Conclusions: This information can be used by clinicians and researchers to understand the natural history of the patient group to critically assess both the selection bias and effectiveness of treatments.
Age‐Related Changes in Intranasal Air Conditioning in the Elderly
Authors: Lindemann Joerg , Sannwald Diana , Wiesmiller Kerstin
Published: February 2009

Objectives/Hypothesis: Elderly patients frequently complain about the feeling of a dry nose and recurrent crusting probably due to age‐related degenerative effects of the nasal mucosa. Data on intranasal air conditioning in elderly patients are missing. The aim of the study was to compare intranasal heating and humidification of respiratory air in elderly subjects and a younger control group. Additionally, rhinomanometrical and rhinometrical data were examined.

Study Design: The study was conceived as randomized, prospective study.

Methods: Forty study subjects (median age, 70 years; range, 61–84) and 40 control subjects (median age, 27 years; range, 20–40) were included in the study. In vivo air temperature and humidity values were simultaneously measured at defined intranasal sites. Active anterior rhinomanometry and acoustic rhinometry also were performed in every subject.

Results: In the study group, the median end‐inspiratory air temperature (°C)/absolute humidity (g/m3) values were 24.0°C/13.8 g/m3 within the nasal valve region and 24.3°C/14.7 g/m3 anterior to the head of the middle turbinate. In the control group, the corresponding values were 27.0°C/15.5 g/m3 and 26.7°C/17.0 g/m3. Temperature and humidity values were significantly lower in the study group (P < .05). The minimal cross‐sectional areas and volumes were significantly higher in the study group (P < .05).

Conclusions: Nasal complaints in elderly patients are a consequence of lower intranasal air temperature and humidity values combined with relatively enlarged nasal cavities due to involution atrophy of the nasal mucosa.
An Automatic Method to Quantify Mucosal Waves Via Videokymography
Authors: Jiang Jack J. , Zhang Yu , Kelly Michael P. , Bieging Erik T. , Hoffman Matthew R.
Published: February 2009

Objective/Hypothesis: Vocal fold vibration is associated with four distinct vibratory patterns: those of the right‐upper, right‐lower, left‐upper, and left‐lower vocal fold lips. The purpose of this study was to propose a least squares method to quantify the vibratory properties of each of the four vocal fold lips via videokymography (VKG).

Study Design: This was a methodological study designed to examine the impact of subglottal pressure and line‐scan position on mucosal wave parameters.

Methods: VKG, a line‐scan imaging technique, has proven to be an effective method for studying vocal fold vibratory patterns. This study used VKG images and an automatic mucosal wave extraction method to examine the vibration of each individual vocal fold lip of 17 excised canine larynges under differing subglottal pressures and line‐scan positions.

Results: Varying subglottal pressure led to results consistent with previous studies. Examination of the vocal folds at different line‐scan positions along its length revealed that amplitude is greatest at the midpoint of the vocal fold, followed by the anterior portion of the vocal fold, with the posterior portion having the lowest amplitude (P < .001). Frequency and phase delay did not change significantly throughout the length of the vocal fold.

Conclusions: The method used in this study allows for easy determination of four sets of vibratory parameters, and examination of the effect of biomechanical parameters on vocal fold vibrations.
Vestibular Schwannoma Quantitative Polymerase Chain Reaction Expression of Estrogen and Progesterone Receptors
Authors: Patel Andrew K. , Alexander Thomas H. , Andalibi Ali , Ryan Allen F. , Doherty Joni K.
Published: February 2009

Objectives/Hypothesis: Determine the role of estrogen receptor (ER) and progesterone receptor (PR) expression in sporadic and neurofibromatosis 2 (NF2)‐related vestibular schwannomas (VS). Growth and proliferation signaling in human VS tumorigenesis may play a key role in molecular therapeutic targeting. VS carry mutations of the NF2 gene encoding the tumor suppressor, merlin, which interacts with ErbB2 in Schwann cells, implicating ErbB receptors in VS tumorigenesis. ErbB receptor family members are overexpressed or constitutively activated in many human tumors, and are effective therapeutic targets in some human cancers. VS occur more frequently in women and are larger, more vascular, and demonstrate increased growth rates during pregnancy. ER and PR may play a role in ErbB pathway activation and VS progression.

Study Design: Quantitative real‐time polymerase chain reaction (qRT‐PCR) for ER and PR messenger RNA was performed using greater auricular and vestibular nerve controls (n = 8), sporadic VS (n = 23), and NF2‐related VS (n = 16) tissues.

Methods: The qRT‐PCR data were normalized with standardization to a single constitutively expressed control gene, human cyclophylin.

Results: Reverse transcription of messenger RNA from control and tumor specimens followed by RT Q‐PCR demonstrated differences in ER and PR gene expression between sporadic and NF2‐related VS.

Conclusions: ER and PR expression in VS might have implications for development of a VS‐specific drug delivery system using antihormone and ErbB pathway small molecule inhibitors, due to crosstalk between these receptors. These signals may be critical for re‐establishing ErbB‐mediated cell density dependent growth inhibition.
Dissecting transcription regulatory pathways through a new bacterial one-hybrid reporter system
Authors: Guo Manman , Feng Hui , Zhang Jun , Wang Wenqin , Wang Yi , Li Yuqing , Gao Chunhui , Chen Huanchun , Feng Ying , He Zheng-Guo
Published: February 2009

Sequence-specific DNA-binding transcription factors have widespread biological significance in the regulation of gene expression. However, in lower prokaryotes and eukaryotic metazoans, it is usually difficult to find transcription regulatory factors that recognize specific target promoters. To address this, we have developed in this study a new bacterial one-hybrid reporter vector system that provides a convenient and rapid strategy to determine the specific interaction between target DNA sequences and their transcription factors. Using this system, we have successfully determined the DNA-binding specificity of the transcription regulator Rv3133c to a previously reported promoter region of the gene Rv2031 inMycobacterium tuberculosis. In addition, we have tested more than 20 promoter regions ofM. tuberculosisgenes using this approach to determine if they interact with ∼150 putative regulatory proteins. A variety of transcription factors are found to participate in the regulation of stress response and fatty acid metabolism, both of which comprise the core of in vivo-induced genes whenM. tuberculosisinvades macrophages. Interestingly, among the many new discovered potential transcription factors, the WhiB-like transcriptional factor WhiB3 was identified for the first time to bind with the promoter sequences of most in vivo-induced genes. Therefore, this study offers important data in the dissection of the transcription regulations inM. tuberculosis, and the strategy should be applicable in the study of DNA-binding factors in a wide range of biological organisms.
A three-dimensional hybrid framework based on novel [Co4Mo4] bimetallic oxide clusters with 3,5-bis(3-pyridyl)-1,2,4-triazole ligands
Authors: Zhai Quan-Guo , Li Shu-Ni , Hu Man-Cheng , Jiang Yu-Cheng
Published: February 2009

In the title organic–inorganic hybrid complex, poly[[[μ-3,5-bis(3-pyridyl)-1,2,4-triazole]tri-μ3-oxido-tetra-μ2-oxido-oxidodicobalt(II)dimolybdenum(VI)] monohydrate], {[Co2Mo2O8(C12H9N5)]·H2O}n, the asymmetric unit is composed of two CoIIcenters, two [MoVIO4] tetrahedral units, one neutral 3,5-bis(3-pyridyl)-1,2,4-triazole (BPT) ligand and one solvent water molecule. The cobalt centers both exhibit octahedral [CoO5N] coordination environments. Four CoIIand four MoVIcenters are linked by μ2-oxide and/or μ3-oxide bridges to give an unprecedented bimetallic octanuclear [Co4Mo4O22N4] cluster, which can be regarded as the first example of a metal-substituted octamolybdate and exhibits a structure different from those of the eight octamolybdate isomers reported to date. The bimetallic oxide clusters are linked to each other through corner-sharing to give two-dimensional inorganic layers, which are further bridged bytrans-BPT ligands to generate a three-dimensional organic–inorganic hybrid architecture with six-connected distorted α-Po topology.
Powder study of poly[(μ2-2,2-dimethylpropane-1,3-diyl diisocyanide)-μ2-iodido-silver(I)]
Authors: Rukiah Mwaffak , Al-Ktaifani Mahmoud
Published: February 2009

In order to explore the chemistry of the bidentate ligand 2,2-dimethylpropane-1,3-diyl diisocyanide and to investigate the effect of counter-ions on the polymeric structure of (2,2-dimethylpropane-1,3-diyl diisocyanide)silver(I) complexes, the title polymeric compound, [AgI(C7H10N2)]n, was synthesized by treatment of 2,2-dimethylpropane-1,3-diyl diisocyanide with AgI. X-ray powder diffraction studies show, as expected, a polymeric structure, similar to the very recently reported Cl−and NO3−analogues [AgX(C7H10N2)]n(X= Cl−or NO3−). In the title structure, the AgIcentre is bridged to two adjacent AgIneighbours by bidentate 2,2-dimethylpropane-1,3-diyl diisocyanide ligandsviathe NC groups to form [Ag{CNCH2C(CH3)2CH2NC}]nchains. The iodide counter-ions crosslink the AgIcentres of the chains to form a two-dimensional polymeric {[Ag{CNCH2C(CH3)2CH2NC}]I}nnetwork. This study also shows that this bidentate ligand forms similar polymeric structures on treatment with AgX, regardless of the nature of the counter-ionX−, and also has a strong tendency to form polymeric complexes rather than dimeric or trimeric ones.
Lupeol
Authors: Corrêa Rodrigo S. , Coelho Carla P. , Santos Marcelo H. dos , Ellena Javier , Doriguetto Antônio C.
Published: February 2009

The title compound [systematic name: 3β-lup-20(29)-en-3-ol], C30H50O, was isolated from the leaves ofGarcinia brasiliensis(common name: bacupari; a member of the Guttiferae family) and has been shown to have many useful medicinal and biological properties. The lupeol molecule consists of four six-membered rings (adopting chair conformations) and one five-membered ring (with an envelope conformation), all fused intransfashion. Lupeol is isomorphic with the pentacyclic triterpene 3β,30-dihydroxylup-20(29)-ene, which differs from lupeol due to the presence of an additional hydroxy group. The crystal packing is stabilized by van der Waals interactions and intermolecular O—H...O hydrogen bonds, giving rise to an infinite helical chain along thecaxis.
Meta‐analysis: antibiotic prophylaxis in elective laparoscopic cholecystectomy
Authors: ZHOU H. , ZHANG J. , WANG Q. , HU Z.
Published: February 2009

Background  Current guidelines do not support routine antibiotic prophylaxis during elective laparoscopic cholecystectomy. However, routine antibiotic prophylaxis for elective laparoscopic cholecystectomy is still popular in many clinical settings.

Aim  To evaluate the role of antibiotic prophylaxis in elective laparoscopic cholecystectomy.

Methods  Electronic databases and manual bibliographical searches (updated to April 2008) were conducted. A meta‐analysis of all trials evaluating antibiotic prophylaxis in elective laparoscopic cholecystectomy was performed.

Results  Fifteen trials were included, involving 2961 patients. After pooling all the trials, 48 wound infections occurred (48/2961, 1.62%), 22 in antibiotic prophylaxis group (22/1494, 1.47%) and 26 in control group (26/1467, 1.77%). The pooled odds ratio (OR) was 0.79 (95%CI: 0.44, 1.41). Four major infections occurred (4/2961, 0.14%), 3 in antibiotic prophylaxis group (3/1494, 0.20%), and one in control group (1/1467, 0.07%). The pooled OR was 2.51 (95%CI: 0.35, 17.84). Fifteen distant infections occurred (15/2961, 0.51%), six in antibiotic prophylaxis group (6/1494, 0.40%) and nine in control group (9/1467, 0.61%). The pooled OR was 0.53 (95%CI: 0.19, 1.50). Sensitivity analyses also failed to support antibiotic prophylaxis’s preventive effect.

Conclusions  Considering the absent role of antibiotic prophylaxis in reducing the infectious complications, we suggest that antibiotic prophylaxis is unnecessary and should not be routinely used in low‐risk elective laparoscopic cholecystectomy patients.
Long‐term sequential deferiprone–deferoxamine versus deferiprone alone for thalassaemia major patients: a randomized clinical trial
Authors: Maggio Aurelio , Vitrano Angela , Capra Marcello , Cuccia Liana , Gagliardotto Francesco , Filosa Aldo , Romeo Maria Antonietta , Magnano Carmelo , Caruso Vincenzo , Argento Crocetta , Gerardi Calogera , Campisi Saveria , Violi Pietro , Malizia Roberto , Cianciulli Paolo , Rizzo Michele , D’Ascola Domenico Giuseppe , Quota Alessandra , Prossomariti Luciano , Fidone Carmelo , Rigano Paolo , Pepe Alessia , D’Amico Gennaro , Morabito Alberto , Gluud Christian
Published: February 2009

A multicentre randomized open‐label trial was designed to assess the effectiveness of long‐term sequential deferiprone–deferoxamine (DFO–DFP) versus DFP alone to treat thalassaemia major (TM). DFP at 75 mg/kg, divided into three oral daily doses, for 4 d/week and DFO by subcutaneous infusion (8–12 h) at 50 mg/kg per day for the remaining 3 d/week was compared with DFP alone at 75 mg/kg, administered 7 d/week during a 5‐year follow‐up. The main outcome measures were differences between multiple observations of serum ferritin concentrations. Secondary outcomes were survival analysis, adverse events, and costs. Consecutive thalassaemia patients (275) were assessed for eligibility; 213 of these were randomized and underwent intention‐to‐treat analysis. The decrease of serum ferritin levels during the treatment period was statistically significant higher in sequential DFP–DFO patients compared with DFP‐alone patients (P = 0·005). Kaplan–Meier survival analysis for the two chelation treatments did not show any statistically significant differences (long‐rank test, P = 0·3145). Adverse events and costs were comparable between the groups. The trial results show that sequential DFP–DFO treatment compared with DFP alone significantly decreased serum ferritin concentration during treatment for 5 years without significant differences regarding survival, adverse events, or costs. This trial was registered at http://www.clinicaltrials.gov as # NCT00733811.
Multisite management study of menorrhagia with abnormal laboratory haemostasis: a prospective crossover study of intranasal desmopressin and oral tranexamic acid
Authors: Kouides Peter A. , Byams Vanessa R. , Philipp Claire S. , Stein Sidney F. , Heit John A. , Lukes Andrea S. , Skerrette Nyasha I. , Dowling Nicole F. , Evatt Bruce L. , Miller Connie H. , Owens Sally , Kulkarni Roshni
Published: February 2009

The optimal management of menorrhagia among women with abnormal laboratory haemostasis is uncertain. In a crossover study, 116 women with menorrhagia [pictorial blood assessment chart (PBAC) score >100], negative gynaecological evaluation and abnormal laboratory haemostasis were randomly assigned to either intranasal desmopressin (IN‐DDAVP) or tranexamic acid (TA) therapy for two menstrual cycles. The subjects then crossed over to the second study drug for two additional cycles. Menstrual blood loss (MBL) was measured by PBAC scores at baseline and after each menstrual cycle. Quality of life (QOL) was assessed with four validated instruments. There was a statistically significant decrease in PBAC scores for both treatments. On average, the estimated decrease in the PBAC from baseline was −64·1 [95% confidence interval (CI) = −88·0, −40·3] for IN‐DDAVP and −105·7 (95% CI = −130·5, −81·0) for TA. The decrease in PBAC score was greater for TA than IN‐DDAVP (a difference of 41·6, P‐value = 0·0002, 95% CI = 19·6, 63·6). The test for treatment‐type effect was significant (P < 0·0001) suggesting a greater reduction in PBAC score with TA. Use of both IN‐DDAVP and TA improved QOL by all four instruments. We conclude that both medications reduced MBL and improved QOL among females with menorrhagia and abnormal laboratory haemostasis, but TA proved more effective.