bluuebunny/crossref_metadata_2025 huggingface dataset:
Observation of entrainment at the interface between monsoon flow and the Saharan Air Layer
Authors: Canut G. , Lothon M. , Saïd F. , Lohou F.
Published: September 2009

During the AMMA experiment, the French ATR aircraft flew in the lower troposphere in south Niger, with instruments that allow fast measurement of wind, temperature and humidity. Stacked legs flown between early June and mid‐August into the moist southwesterly monsoon flow and the dry northeasterly flow of the Saharan Air Layer (SAL) above, enable us to study the interaction between the two flows at the turbulence scale and the role of the planetary boundary layer (PBL) in the transfers between them. We describe the fluctuations observed at the top of the PBL and their evolution during the season. Dry tongues approximately 600 m wide and a few kilometres apart, intruding from the overlying SAL down into the PBL, are characteristic of the Sahelian region at that time of year. They are fully part of the entrainment process at the PBL top and responsible for large moisture fluxes in the upper PBL. They also skew the water vapour distribution which in turn impacts the water vapour scales. We evaluate the impact of the entrainment by use of a conditional analysis on combined fluctuations. The dry tongues play the largest role down to two thirds of the PBL depth. We find larger entrainment during early monsoon than during its active phase, and a large variability of the ratio of entrainment buoyancy flux over surface flux. Copyright © 2009 Royal Meteorological Society
A critical comparison of stratosphere–troposphere coupling indices
Authors: Baldwin Mark P. , Thompson David W.J.
Published: September 2009

Assessing stratosphere–troposphere coupling in observational data or model output requires a multi‐level index with high time resolution. Ideally, such an index would (1) represent spatial patterns in the troposphere that are most strongly coupled with stratospheric variability and (2) be robust and computationally feasible in both observations and standard model output.

Several of the indices used to diagnose extratropical stratosphere–troposphere coupling are based on the Northern and Southern Hemisphere annular modes. The annular mode indices are commonly defined as the leading empirical orthogonal functions (EOFs) of monthly‐mean, hemispheric geopotential height. In the lowermost troposphere, the structure of the annular modes is defined as the leading EOF of the near‐surface geopotential height field, and these patterns correspond well to the patterns of variability induced by stratospheric circulation changes. At pressure levels above the surface, the structure of the annular modes is typically found by either calculating the local EOF or regressing geopotential height data onto the leading principal component time series of near‐surface geopotential height.

Here we make a critical comparison of the existing methodologies used to diagnose stratosphere–troposphere coupling, including EOF‐based indices as well as measures based on zonal‐mean wind at a fixed latitude and geopotential height over the polar cap. We argue in favour of an alternative methodology based on EOFs of daily zonally‐averaged geopotential. We find that (1) the daily evolution of stratosphere–troposphere coupling events is seen most clearly with this methodology, and (2) the methodology is robust and requires few subjective choices, making it readily applicable to climate model output available only in zonal‐mean form. Copyright © 2009 Royal Meteorological Society
The benefits of meditation vis‐à‐vis emotional intelligence, perceived stress and negative mental health
Authors: Chu Li‐Chuan
Published: September 2009

This paper evaluates the benefits of meditation in regard to emotional intelligence (EI), perceived stress and negative mental health with cross‐sectional and experimental studies. It first studied 351 full‐time working adults with different amounts of experience in meditation for these factors in order to test the hypothesis that their differences in them were based on differences in meditation experience, and found that those participants with greater meditation experience exhibited higher EI, and less perceived stress and negative mental health than those who had less or none. It then randomly divided 20 graduate students with no previous experience of meditation into a mindfulness meditation group (n = 10) and a control group (n = 10), and measured them for the same variable pre‐treatment and post‐treatment to test the hypothesis that meditation training improves people's state, and found that those who completed the mindfulness meditation training demonstrated significant improvements compared to the control group. Copyright © 2009 John Wiley & Sons, Ltd.
Cross‐functional team selection concerning members' cooperative effects and capabilities overlap
Authors: Hsieh Ping Jung
Published: September 2009

The capabilities that are embodied in the members of the cross‐functional team represent a significant project resource. The extent to which there is a good fit among these resources and the project can impact on the effectiveness of operations. While cross‐functional project organizations have become common, many enterprises are not able to recognize the capabilities of individual project members or the teams as a whole. In this study, an integrated approach has been proposed. The assessment criteria of the proposed approach take into account interpersonal characteristics such as the non‐additive team members' cooperative effects and capability overlap, which have rarely been investigated and evaluated in previous studies. Specifically, instead of selecting candidate team members to form a team, this approach involves selecting a proper team from competitive project teams, which is a kind of team selection problem usually confronted in project‐based organizations. Several sound mathematical methods, including fuzzy measure, similarity analysis, and fuzzy programming, are used in the approach. An illustration from a real‐world six sigma project team selection demonstrates the implementation of the approach. Copyright © 2009 John Wiley & Sons, Ltd.
Synthesis and Characterization of Di‐ and Tricarbonylhydridomanganese(I) Complexes
Authors: Bolaño Sandra , Bravo Jorge , Castro Jesús , García‐Fontán Soledad , Lamas Elvira , Rodríguez Seoane Pilar
Published: September 2009

Hydrido complexes [MnH(CO)3L1–3] [L1 = 1,2‐bis‐(diphenylphosphanoxy)‐ethane (1); L2 = 1,2‐bis‐(diisopropylphosphanoxy)ethane (2); L3 = 1,3‐bis‐(diphenylphosphanoxy)‐propane (3)] were prepared by treating [MnH(CO)5] with the appropriate bidentate ligand by heating to reflux. Photoirradiation of a toluene solution of complexes 1 and 2 in the presence of PPhn(OR)3–n (n = 0, 1; R = Me, Et) leads to the replacement of a CO ligand by the corresponding monodentate phosphite or phosphonite ligand to give new hydrido compounds of formula [MnH(CO)2(L1–2)(L)] [L = P(OMe)3 (1a–2a); P(OEt)3 (1b–2b); PPh(OMe)2 (1c–2c); PPh(OEt)2 (1d–2d)]. All complexes were characterized by IR, 1H, 13C and 31P NMR spectroscopy. In case of compounds 2 and 3, suitable crystals for X‐ray diffraction studies were isolated.
Effects of intra‐basolateral amygdala administration of rimonabant on nociceptive behaviour and neuronal activity in the presence or absence of contextual fear
Authors: Roche Michelle , Johnston Patrick , Mhuircheartaigh Orla Ní , Olango Weredeselam M. , Mackie Kenneth , Finn David P.
Published: September 2009

The basolateral amygdala (BLA) contains a high density of cannabinoid CB1 receptors and is critically involved in pain and fear‐related behaviour. We investigated the effects of bilateral intra‐BLA administration of the CB1 receptor antagonist/inverse agonist, rimonabant, on formalin‐evoked nociceptive behaviour, fear‐conditioned behaviour including analgesia, and associated brain regional alterations in Fos expression in rats. Intra‐BLA administration of rimonabant significantly reduced formalin‐evoked nociceptive behaviour in the absence, but not presence, of conditioned fear. Rimonabant attenuated a formalin‐evoked reduction in freezing while emitting 22 kHz ultrasonic vocalisation in the early part of the fear expression trial. Formalin‐evoked nociceptive behaviour was associated with increased Fos immunoreactivity (FI) in the CA2/3 region of the hippocampus and rostral ventromedial medulla, effects attenuated by intra‐BLA rimonabant. Formalin also decreased FI in the cingulate cortex, an effect which was not observed in fear‐conditioned rats. Contextually‐induced fear was associated with increased FI in the dorsal caudal periaqueductal grey in the absence, but not presence, of formalin‐evoked nociceptive tone. In conclusion, bilateral intra‐BLA administration of rimonabant reduces nociceptive behaviour in a model of tonic, persistent inflammatory pain, an effect associated with reduced activation of neurons in the CA2/3 hippocampus and rostral ventromedial medulla. The data also provide evidence for differential pain‐ and fear‐related brain regional activity in the presence or absence of contextually‐induced aversion and nociceptive tone.
Pain in arthritis
Authors: Caporali Roberto , Cavagna Lorenzo , Montecucco Carlomaurizio
Published: September 2009

Under the term arthritis are grouped a large number of diseases characterized by the occurrence of an inflammatory process within the joints; between the different types of chronic arthritis, rheumatoid arthritis (RA) is the prototypical example. With the increasing importance of early diagnosis and treatment, in the last years several subsets of chronic arthritis have been described, starting from the early arthritis (EAs), term that include all the arthritis of recent onset; within the EAs we recognize the undifferentiated polyarthritis (UPA), that does not fulfill the classification criteria for an established chronic arthritis but that can turn into an established form of chronic arthritis overtime, and the early RA (ERAs), e.g., the arthritis of less than one year of duration fulfilling the ACR classification criteria for RA. Independently to the diagnosis, pain is a very common finding in this setting, deeply affecting patients' quality of life and generally representing the first symptom of the disease and the reason of medical referral. Moreover, pain expression in chronic arthritis is not univocal, being influenced by several factors; in this paper we analyze the different aspects and the role of pain in chronic arthritis like (E)RA and UPA.
Systemic opioid and chronic pain
Authors: Varrassi Giustino , Angeletti Chiara , Guetti Cristiana , Marinangeli Franco , Paladini Antonella
Published: September 2009

Opioid analgesic drugs currently represent the most powerful choice in pain therapy. They elicit their effects by mimicking endogenous substances — opioid peptides — the natural ligands of the opioid receptors. These analgesic drugs interact with specific receptors physiologically present in the central nervous system (CNS) and in the periphery, where they serve different functions. The opioid receptors modulate well‐known functions related to nociceptive transmission, but this system is also involved in the regulation of gastrointestinal, endocrine, and autonomic functions. Opioids are being prescribed more frequently for treating pain, and physicians should be able to control pain before it becomes intractable. Recent research on new endogenous opioid pathways, the development of several administration routes, and the development of new drugs with reduced ability for abuse, will allow a deeper scientific understanding, better targeted therapy, and safer use of opiate drugs for the pharmacological control of pain. The goals in this field of research are important and future knowledge will help physicians to use all analgesic drugs correctly and effectively in the treatment of pain.
Efficacy of drugs in regional anesthesia: A review
Authors: Allegri Massimo , Delazzo Marco G. , Grossi Paolo , Borghi Battista
Published: September 2009

Local anesthetics and opioids are the most commonly used drugs in regional anesthesia. Several other drugs are used as adjuvants in addition to local anesthetics.

We will review the drugs currently used in regional anesthesia. In April 2009 we searched the PubMed database and found 143 articles related to the clinical use of drugs in regional anesthesia; we divided them into 3 major chapters: local anesthetics, opioids and adjuvants.

Among local anesthetics, ropivacaine and levobupivacaine can be considered the drugs of choice in neuraxial and peripheral techniques because their toxicity is low even in large volume administration; mepivacaine can be considered the drug of choice in peripheral techniques when a shorter blockade is needed.

Sufentanil is the opioid of choice in both neuraxial and peripheral techniques because it appears to improve the quality of anesthesia and to prolong sensory blockade in the postoperative period.

Among the adjuvants to local anesthetics, clonidine is by far the most used drug in regional anesthesia; its yield in improving and prolonging the effects of local anesthetics is apparent in neuraxial techniques. Other drugs have been studied as adjuvants to local anesthetics but clinical evidence of their benefit is controversial in many cases and further trials are unquestionably warranted.

In conclusion, since many different drugs are available for regional anesthesia, we must choose wisely the one that exhibits the best safety‐efficacy profile and that suits the chosen technique and type of anesthesia/analgesia best.
Pain and physical medicine
Authors: Toffola Elena Dalla , Bejor Maurizio
Published: September 2009

The first stage of any physical medicine intervention for a patient with pain is an accurate diagnosis. This allows a decision on the proposed therapy to be made according to the clinical picture. Recent classifications of pain allow us to divide pain management treatment into three specific groups, aimed at: (1) cancer pain, (2) pain (acute, sub‐acute or chronic) as a symptom of a specific pathology, and (3) chronic non‐malignant pain. In this article, we offer a summary of our clinical experience regarding the drafting of rehabilitation plans for patients with pain who have been referred to us.
Prevalence and awareness of cardiovascular risk factors in patients with schizophrenia: A cross-sectional study in a low cardiovascular disease risk geographical area
Authors: Bernardo M. , Cañas F. , Banegas J.R. , Casademont J. , Riesgo Y. , Varela C. ,   On behalf of the RICAVA Study Group
Published: September 2009

Objective

Prevalence of cardiovascular disease is high in schizophrenia. Our aim is to estimate the prevalence of cardiovascular risk factors (CVRF) among schizophrenia patients.

Method

National cross-sectional study in patients diagnosed with schizophrenia under treatment with second generation antipsychotics and admitted to short-stay hospitalisation units.

Results

A sample of 733 consecutively admitted patients was enrolled; the most prevalent CVRFs were smoking 71% (95% CI: 67–74%) and hypercholesterolemia 66% (61–70%) followed by hypertriglyceridemia 26% (26–32%), hypertension 18% (15–21%) and diabetes 5% (4–7%). Metabolic syndrome showed 19% (95% CI: 16–23%) prevalence or, according to updated definitions (Clin Cornerstone 7 [2005] 36–45), 24% (95% CI: 20–28%). The rate of patients within the high-risk range of a 10-year fatal cardiovascular event was 6.5%. CVRFs under routine management were diabetes (60%), hypertension (28%) and, to a lesser extent, dyslipemia (14%). Treatment for CVRFs was associated to gender, men for hypertension OR = 25.34, p < 0.03 and women for diabetes OR = 0.02, p < 0.03.

Conclusion

We found that CVRFs in schizophrenia were prevalent and under-diagnosed, and thus with insufficient therapeutic management.
A regulatory domain spanning the repeat sequence RE1 from herpes simplex virus type 1 has cell specific differential functions in trigeminal neurons and fibroblasts
Authors: Stevens Hannah C. , Fiskerstrand Carolyn , Bubb Vivien J. , Dalziel Robert , Quinn John P.
Published: September 2009

In this report we demonstrate that the herpes simplex virus type 1 reiteration element 1 (RE1) (nt: 117158–117353) in concert with its flanking sequences is both a cell specific and stimulus inducible regulatory domain. This region of the virus genome and specifically the RE1 supports differential reporter gene expression in both baby hamster kidney cells and disassociated rat trigeminal ganglia and is present within a region that is implicated in regulating latency of the virus in neuronal cells. Further we demonstrate that this locus is a transcriptional regulatory domain and a target for the transcription factor CCCTC binding protein.
Divergent intracellular pathways regulate interleukin‐1β‐induced miR‐146a and miR‐146b expression and chemokine release in human alveolar epithelial cells
Authors: Perry Mark M. , Williams Andrew E. , Tsitsiou Eleni , Larner-Svensson Hanna M. , Lindsay Mark A.
Published: September 2009

We have previously reported that IL‐β‐induced miR‐146a and miR‐146b expression negatively regulates IL‐8 and RANTES release in human alveolar A549 epithelial cells. To determine the intracellular pathways that regulate this response, we demonstrate IL‐1β‐induced activation of the nuclear factor (NF)‐κB, extracellular regulated kinase (ERK)‐1/2, c‐jun N‐terminal kinase (JNK)‐1/2 and p38 mitogen activated kinase (MAP) kinase pathways. Subsequent pharmacological studies show that IL‐1β‐induced miR‐146a, IL‐8 and RANTES production was regulated via NF‐κB and JNK‐1/2 whilst miR‐146b expression was mediated via MEK‐1/2 and JNK‐1/2. These divergent intracellular pathways likely explain the differential expression and biological action of the miR‐146 isoforms.
Factors associated with pathologic colposcopic and cytologic changes in 500 clinically asymptomatic women
Authors: Paçarada Myrvete , Lulaj Shefqet , Kongjeli Gyltene , Kongjeli Niltene , Qavdarbasha Hana
Published: September 2009

Objective

To determine the role of cytologic and colposcopic diagnosis in the early detection of pathologic cervical changes and the effect of the number of births, a history of abortion, the number of sexual partners, and contraceptive use on pathologic colposcopic and cytologic changes.

Method

The 500 study participants were seen at the Obstetric‐Gynecologic Clinic of Prishtina, Kosovo, in 2006 and 2007. They were assigned to 5 groups of 100 according to number of births, a history of abortion (whether spontaneous or induced), and total number of sexual partners, but the use of contraceptives was also analyzed. All participants underwent cytologic and colposcopic evaluations.

Results

Colposcopic atypia was observed in 70 participants (14%) and 77 (15.4%) had other findings. The degree of colposcopic atypia increased with the number of sexual partners, as did the frequency of infections. Most (91.2%) of the women with positive cytologic results were from groups 1 and 2, and the remaining 8.8% of these women were from groups 3, 4, and 5. From 44 patients with positive pathology results, 29 (65.9%) had chronic cervicitis, 13 (29. 5%) had hyperplasia, and 2 (4.5%) had carcinoma in situ.

Conclusion

Number of births, a history of abortion, number of sexual partners, and contraceptive use directly affected pathologic colposcopic and cytologic changes.
Resumption of sexual activity and regular menses after childbirth among women infected with HIV in Malawi
Authors: Makanani Bonus , Kumwenda Johnstone , Kumwenda Newton , Chen Shu , Tsui Amy , Taha Taha E.
Published: September 2009

Objective

To determine the factors associated with resumption of sexual activity and regular menses after childbirth among women infected with HIV‐1.

Methods

Information on sociodemographic, behavioral, and clinical factors was obtained from 2 HIV perinatal studies (NVAZ and PEPI trials) conducted in Malawi, 2000–2009. Factors associated with resumption of sexual activity and menses were analyzed using Cox proportional hazard models.

Results

A total of 1838 women from the NVAZ study and 2982 women from the PEPI study were included in the analysis. Resumption of sexual activity was primarily associated with sociodemographic factors (e.g. in the PEPI study, marital status [adjusted hazard ratio (aHR) 0.56, P < 0.001], use of contraceptive method [aHR 8.0, P < 0.001], and breastfeeding [aHR 0.52, P < 0.001]), whereas resumption of regular menses in the PEPI study was primarily associated with biological factors (e.g. plasma viral load [aHR 0.89, P < 0.006], and breastfeeding [aHR 0.23, P < 0.001).

Conclusion

HIV‐infected women need adequate counseling to take into account their HIV infection status before resuming sexual activity after childbirth.
Inequalities in cesarean delivery rates by ethnicity and hospital accessibility in Brazil
Authors: Freitas Paulo Fontoura , Drachler Maria de Lourdes , Leite José Carlos de Carvalho , Marshall Tom
Published: September 2009

Objective

To investigate inequalities in cesarean delivery rates in Brazil according to ethnic group and level of access to hospital delivery.

Methods

Cross‐sectional analysis of data for primiparous women with singleton deliveries between 2003 and 2004 from the National Information System of Live‐Births (6 064 799 live births). Robust Poisson regression modeling was applied to estimate prevalence ratios of cesarean deliveries for ethnic group and level of access to hospital delivery according to residence.

Results

There were 2 438 180 primiparous deliveries and the cesarean rate was 45.8%. Ethnic inequalities in cesarean delivery rates showed lower rates for all ethnic groups compared with white women, with the lowest rates recorded for indigenous women. The association between ethnicity and cesarean delivery was higher in states with lower access to hospital (P < 0.001). Multiple regression models showed that this association was, in part, explained by older maternal age and higher levels of education and prenatal care.

Conclusions

Overuse of cesarean delivery and strong evidence of ethnic inequalities in cesarean rates exist in Brazil. The inequalities are greater in states with lower access to hospital and were partially explained by socioeconomic factors and prenatal care, suggesting a misuse of medical technology at birth.
Preterm delivery and ultrasound measurement of cervical length in Gran Canaria, Spain
Authors: Barber Miguel A. , Eguiluz Idoya , Plasencia Walter , Medina Margarita , Valle Leonor , Garcia Jose A.
Published: September 2009

Objective

To study the relationship between cervical length measured by ultrasound and risk of preterm delivery.

Methods

We measured cervical length in 2351 women between the 18th and 22nd week of pregnancy. Preterm delivery was categorized as before 37 weeks, before 34 weeks, and before 30 weeks.

Results

Before the 37th week, the odds ratios (ORs) of spontaneous delivery for cervical lengths in the 3rd, 5th, and 10th percentiles were, respectively, 25.47 (95% confidence intervals [CI], 15.5–41.73); 16.98 (95% CI, 11.51–25.05); and 7.55 (95% CI, 5.44–10.5). Before the 34th week the ORs were 28.7 (95% CI, 14.54–41.73); 20.5 (95% CI, 11.51‐25.05); and 10.3 (95% CI, 5.44–10.5). And before the 30th week they were 29.8 (95% CI, 15.54–41.73); 23.1 (95% CI, 11.51–25.05); and 19.1 (95% CI, 7.44–31.5). In predicting premature delivery, the sensitivity, specificity, positive predictive value, and negative predictive value of cervical length were 26%, 98%, 63.6%, and 93.57% for the 3rd percentile; 34%, 97%, 51%, and 94% for the 5th percentile; and 39%, 92%, 31%, and 94% for the 10th percentile.

Conclusion

Transvaginal measurement of cervical length during routine fetal morphological examination between the 18th and 22nd week of pregnancy helps identify asymptomatic women at risk for preterm delivery.
Primary squamous cell carcinoma of the ovary associated with endometriosis
Authors: Acién Pedro , Abad Maida , Mayol Maria‐José , Garcia Salvador , Garde Javier
Published: September 2009

Objective

To analyze the clinical, therapeutic, and pathologic features of published cases presenting primary squamous cell carcinoma (SCC) of the ovary associated with endometriosis.

Methods

A case report, 15 cases of infiltrating SCC of the ovary associated with or arising from endometriosis, and 1 case of synchronous carcinoma in situ in the cervix and ovary from a review of the literature were studied.

Results

Young age, advanced stage of the disease, and hypogastric pain were frequent at the time of diagnosis. There was no ascites, but infiltration of neighboring organs was common. The tumor was associated with 80% patient mortality in the first few months. Adjuvant chemotherapy with paclitaxel and carboplatin or cisplatin appeared to improve the results.

Conclusion

Primary SCC of the ovary associated with endometriosis is extremely rare and has a poor prognosis. The best therapeutic results are obtained with paclitaxel and carboplatin or cisplatin after radical surgery.
Thyroid stimulation with recombinant human thyrotropin in healthy cats, cats with non-thyroidal illness and in cats with low serum thyroxin and azotaemia after treatment of hyperthyroidism
Authors: van Hoek Ingrid M , Vandermeulen Eva , Peremans Kathelijne , Daminet Sylvie
Published: September 2009

This study investigated the recombinant human thyrotropin (rhTSH) stimulation test in healthy cats (group 1), cats with non-thyroidal illness (group 2) and cats with low serum total T4(TT4) and azotaemia after131I treatment (group 3). Serum TT4responses and thyroidal pertechnetate uptake after administration of 25 μg rhTSH IV were assessed. Baseline serum TT4was significantly lower in group 3 compared with group 1, but not between other group pairs. Serum TT4increased significantly in groups 1 and 2 but not in group 3 after rhTSH administration. Post-rhTSH serum TT4concentrations differed significantly between groups 1 and 3 and groups 2 and 3, but not between groups 1 and 2. Thyroid/salivary gland uptake ratio (T/S uptake ratio) differed only significantly between groups 1 and 3. Stimulation with rhTSH is valuable to differentiate euthyroidism from iatrogenic hypothyroidism in cats.
Progesterone Receptors Identified in Vascular Malformations of the Head and Neck
Authors: Duyka Landon J. , Fan Chun Y. , Coviello‐Malle Jean M. , Buckmiller Lisa , Suen James Y.
Published: September 2009

OBJECTIVE

To identify hormone receptors within vascular malformations (arteriovenous malformations [AVMs], venous malformations [VMs], and lymphatic malformations [LMs]) of the head and neck.

STUDY DESIGN

Immunohistochemical staining for estrogen receptor (ER) and progesterone receptor (PR) was performed on archival vascular malformation tissue collected from both pediatric and adult patients.

SETTING

Tertiary referral center from 2006 to 2008.

SUBJECTS AND METHODS

Twelve AVM, 10 VM, and eight LM specimens were stained for both ER and PR. Ten breast carcinoma specimens were used as controls, with the carcinoma cells serving as positive controls, and the endothelium and smooth muscle cells of the blood vessels serving as negative controls. Five normal supraglottic mucosal samples served as head and neck controls. The Fisher exact test was used for statistical analysis.

RESULTS

Ten of the 12 (83%) AVM specimens stained diffusely positive for PR within the nuclei of the endothelium and smooth muscle of the malformed vessels (P < 0.0001). Five of the 10 (50%) VM specimens stained positive for PR (2 [20%] focal, 3 [30%] diffuse) within the nuclei of the endothelium and smooth muscle of the malformed vessels (P = 0.0325). Four of the eight (50%) LM specimens stained focally positive for PR within the nuclei of the endothelium of the malformed vessels (P = 0.0229). None of the vascular malformation specimens stained positive for ER.

CONCLUSION

Our data suggest that PR, but not ER, is expressed in AVMs, VMs, and LMs of the head and neck.
Role of Acidic Mammalian Chitinase and Chitotriosidase in Nasal Polyps
Authors: Park Seong Kook , Cho Hong Wook , Heo Kyung Wook , Hur Dae Young , Lee Hyun‐Kyung
Published: September 2009

OBJECTIVE

Chitin is a recognition element for tissue infiltration by innate cells implicated in allergy and helminth immunity, and this process can be negatively regulated by vertebrate chitinases. Acidic mammalian chitinase (AMCase) and chitotriosidase (ChT) have chitinolytic activity, but little is known about their roles in nasal polyps.

STUDY DESIGN

A prospective controlled study.

SETTING

A tertiary referral center.

SUBJECTS AND METHODS

Nineteen subjects with nasal polyps and 12 subjects with deviated nasal septums were recruited to obtain inferior turbinate mucosa samples. The expression levels of AMCase and ChT were compared in nasal polyp and inferior turbinate tissue samples. The tissue samples were analyzed by reverse transcription‐polymerase chain reaction, Western blotting, and immunohistochemical staining.

RESULTS

AMCase and ChT were detected in all nasal polyps and inferior turbinate tissues. AMCase and ChT messenger RNA and protein expression were significantly higher in nasal polyps than in inferior turbinate tissues. In nasal polyps, AMCase‐positive and ChT‐positive cells were detected in the epithelium, inflammatory cells, and submucosal gland.

CONCLUSIONS

AMCase and ChT may be important mediators in the pathogenesis of nasal polyps. Nasal polyps appear to have elevated levels of chitinases, and the presence or growth of chitin‐containing pathogens might enhance chitinase expression, resulting in nasal polyp formation and growth in susceptible individuals.
Voice Outcomes Following Repeated Surgical Resection of Laryngeal Papillomata in Children
Authors: Holler Theresa , Allegro Jennifer , Chadha Neil K. , Hawkes Michael , Harrison Robert V. , Forte Vito , Campisi Paolo
Published: September 2009

OBJECTIVES

1) To apply perceptual and acoustic voice assessments to children treated for juvenile‐onset recurrent respiratory papillomatosis (JORRP); 2) to compare voice outcomes following treatment for JORRP using microdebrider versus carbon dioxide (CO2) laser.

STUDY DESIGN

Prospective cohort study.

SETTING

This study was conducted at a tertiary pediatric academic center (March 2008‐March 2009).

SUBJECTS AND METHODS

Children with active JORRP were assessed using perceptual and acoustic voice analysis following treatment with either CO2 laser or microdebrider. Outcome measures included overall severity rating, jitter, shimmer, and noise‐to‐harmonic ratio (NHR). The unpaired Student t test and Pearson correlation tests were used to explore the statistical significance of hypothesis tests.

RESULTS

Eleven patients (8 male, 3 female) aged three to 17 years were enrolled. There were six children in the CO2 laser cohort and five children in the microdebrider cohort. The immediate postoperative scores were significantly lower in the microdebrider cohort (vs the CO2 cohort) for jitter, shimmer, NHR, and perceptual scores (P < 0.05), indicating a better voice quality in the microdebrider group. Jitter, shimmer, and NHR showed a significant positive correlation with the proportion of CO2 laser procedures (P < 0.05).

CONCLUSION

This is the first study to use perceptual and objective acoustic evaluations to compare voice outcomes following microdebrider or CO2 laser treatment of JORRP. The results of this study suggest that treatment with the microdebrider results in a better immediate and early postoperative voice outcome. Moreover, the data demonstrate a correlation of worsening voice quality with increased exposure to the CO2 laser.
Topical Clindamycin in Post‐Adenotonsillectomy Analgesia in Children: A Double‐Blind, Randomized Clinical Trial
Authors: Miura Mauricio Schreiner , Saleh Catia , de Andrade Marina , Assmann Melina , Lima Lucélia Hernandes , Faibes Lubianca Neto José
Published: September 2009

OBJECTIVES

Tonsillectomy, with or without adenoidectomy, is one of the most common surgical procedures in pediatric otolaryngology. Pain is the main cause of morbidity in the postoperative period, where it is serious in some cases, leading to odynophagia and resultant complications such as dehydration. We evaluated the effect of topical clindamycin in the reduction of oropharyngeal pain in children who underwent adenotonsillectomy. Secondary outcomes were otalgia, analgesic use, oral bacterial count, type of diet, secondary bleeding, vomiting, fever, and weight loss.

STUDY DESIGN

Double‐blind, randomized clinical trial.

SETTING

Tertiary hospital.

SUBJECTS AND METHODS

Eighty‐two children of both sexes between four and 12 years of age who underwent adenotonsillectomy were allocated to receive topical clindamycin or placebo in the immediate preoperative, intraoperative, and eight‐to12‐hours postoperative periods. Pain was measured using a faces pain scale for five days.

RESULTS

Reduction of oropharyngeal pain was significant with the use of clindamycin only on the first postoperative day (95% confidence interval, 2.22 to 4.41 [clindamycin] vs 4.53 to 6.3 [placebo]; P =. 002). No difference was observed in the aerobic and anaerobic counts by tongue swab between premedication and third‐postoperative‐day samplings. There were no differences with respect to reduction in otalgia, paracetamol use, return to normal diet, variation in weight, secondary hemorrhage, vomiting, and fever.

CONCLUSION

The use of topical clindamycin was beneficial in reducing pain on the first postoperative day, without effect on subsequent days. Future investigations could examine the use of topical clindamycin not only in the first 12 hours but also during five days of follow‐up.
Visual Analog Scale (Vas) and Nasal Obstruction in Persistent Allergic Rhinitis
Authors: Ciprandi Giorgio , Mora Francesco , Cassano Michele , Gallina Anna Maria , Mora Renzo
Published: September 2009

OBJECTIVE

Nasal airflow resistance, as measured by rhinomanometry, is frequently impaired in allergic rhinitis (AR). However, rhinomanometry is scarcely available. The aim of this study was to verify the suitability of the use of visual analog scales (VAS) as a surrogate for rhinomanometry in quantifying nasal obstruction in patients with persistent allergic rhinitis.

STUDY DESIGN

Prospective study on patients with allergic rhinitis.

SETTING

ENT clinic.

SUBJECTS AND METHODS

Fifty patients (27 males, mean age 23 years, SD 2.24) were studied. VAS for nasal obstruction and other AR symptoms and rhinomanometry were performed in all patients.

RESULTS

A significant, very strong correlation has been observed between VAS for nasal obstruction and nasal airflow resistance (Spearman r = 0.879, P < 0.001). Moreover, a significant correlation exists between VAS for rhinorrhea and resistance (Spearman r = 0.313, P = 0.027).

CONCLUSION

The use of VAS for assessing the nasal obstruction appears clinically relevant in that it allows, with good reliability, the quantification of this symptom in the absence of rhinomanometry.
Relationship Between Clinical Measures and Histopathologic Findings in Chronic Rhinosinusitis
Authors: Soler Zachary M. , Sauer David A. , Mace Jess , Smith Timothy L.
Published: September 2009

OBJECTIVE

Describe detailed histopathologic findings from a cohort of patients with chronic rhinosinusitis and evaluate whether histologic measures correlate with baseline clinical factors.

STUDY DESIGN

Cross‐sectional study with planned data collection.

SETTING

Tertiary medical center.

SUBJECTS AND METHODS

Adult patients with chronic rhinosinusitis were prospectively enrolled and demographic data and medical comorbidities recorded. Disease severity was measured by computed tomography (CT), endoscopy, Smell Identification Test (SIT), the Chronic Sinusitis Survey, Rhinosinusitis Disability Index, and SF‐36 General Health Survey. Mucosal specimens were assessed for the presence of mucosal inflammation, including cellular (eosinophils, neutrophils, lymphocytes, mast cells, plasma cells, macrophages), epithelial (squamous metaplasia, basement membrane thickening, goblet cells), and stromal markers (subepithelial edema, fibrosis). Histopathologic findings were correlated to baseline clinical factors.

RESULTS

A total of 147 subjects were enrolled with histologic samples available for review. Presence of inflammatory markers was diverse, with lymphocytes present in 100 percent of subjects, eosinophils in 49.7 percent, and neutrophils found in 0.7 percent. Total eosinophil counts correlated with the presence of nasal polyposis (r = −0.367; P < 0.001), asthma (r = 0.264; P = 0.001), and aspirin intolerance (r = 0.279; P = 0.001). Mucosal eosinophilia correlated with worse disease severity on CT (r = 0.414; P < 0.001), endoscopy (r = 0.376; P < 0.001), and SIT (r = −0.253; P = 0.002), with the highest correlations seen in subgroups without nasal polyps. Histopathologic findings did not significantly correlate with any quality‐of‐life measure.

CONCLUSION

Mucosal eosinophilia correlates with objective disease severity as defined by CT, endoscopy, and SIT scores. Although other histologic markers of inflammation are present, none show similar correlations. The presence of mucosal eosinophils does not correlate with quality‐of‐life scores.
Biofilms Correlate with TH1 Inflammation in ihe Sinonasal Tissue of Patients with Chronic Rhinosinusitis
Authors: Hekiert Adrianna M. , Kofonow Jennifer M. , Doghramji Laurel , Kennedy David W. , Chiu Alexander G. , Palmer James N. , Leid Jeffery G. , Cohen Noam A.
Published: September 2009

OBJECTIVE

Determine the prevalence of bacterial biofilms in surgical chronic rhinosinusitis (CRS) patients and characterize the inflammatory response associated with biofilm CRS.

STUDY DESIGN

Cross‐sectional.

SETTING

Tertiary care academic center.

SUBJECTS AND METHODS

Sinonasal mucosa and peripheral blood were collected from 60 CRS patients. Mucosal biofilms were demonstrated by scanning electron microscopy. Leukocyte subpopulations were determined by flow cytometry. Cytokines were identified with a luminex‐based assay on the lysate of homogenized tissue or plasma.

RESULTS

Of the 60 samples, 17 were determined to be positive for the presence of biofilms. Oral steroid‐naive CRS patients with biofilm demonstrated a local TH1 inflammatory response with significantly elevated levels of interferon‐γ (INF‐γ), granulocyte colony‐stimulating factor, macrophage inflammatory protein‐1 β, and neutrophils in the sinonasal mucosa. No differences were present at the systemic level.

CONCLUSION

Sinonasal bacterial biofilms correlate to a TH1 skewed local but not systemic inflammatory response in CRS. This difference is abrogated by the use of oral steroids.
Comparison of Ligasure Vessel Sealing System, Harmonic Scalpel, and Conventional Hemostasis in Total Thyroidectomy
Authors: Pons Yoann , Gauthier Jérome , Ukkola‐Pons Elsa , Clément Philippe , Roguet Eric , Poncet Jean‐Luc , Conessa Claude
Published: September 2009

OBJECTIVE

The aim of the study was to compare the efficiency, safety, and cost of the different methods of hemostasis (conventional hemostasis versus LigaSure vessel sealing system [LVSS] versus harmonic scalpel) currently available for thyroid surgery.

STUDY DESIGN

Randomized, controlled trial.

SETTING

The study was conducted from September 2007 to December 2008 in a university hospital.

PATIENTS AND METHODS

Sixty patients (48 females and 12 males) underwent a total thyroidectomy for multinodular goiter. They were randomly assigned into three groups: group one (n = 20), conventional hemostasis; group two (n = 20), LigaSure; and group three (n = 20), harmonic scalpel.

RESULTS

For group three, the mean operative time was 37 minutes shorter than group one (P < 0.001) and eight minutes shorter than group two (P = 0.04). The complications rate was similar among the three groups. The mean postoperative paracetamol consummation in group one was 1.4 g greater than in group two (P = 0.016) and 1.3 g greater than in group three (P = 0.02). The overall average operative cost was 11 and 85 dollars cheaper for groups two and three than for group one, respectively (P < 0.001).

CONCLUSION

Total thyroidectomy using the harmonic scalpel was the fastest procedure because it was bloodless, and hemostasis and sectioning were controlled with a single instrument; it was, therefore, the most inexpensive procedure because of the reduction of operative time and staff cost. The operative safety was similar for all three procedures. In our series, the harmonic scalpel and the LVSS caused less pain than the conventional hemostasis.
HER2 Expression Predicts Improved Survival in Patients with Cervical Node‐Positive Head and Neck Squamous Cell Carcinoma
Authors: Tse Gary M. , Yu Kwok Hung , Chan Anthony W. H. , King Ann D. , Chen George G. , Wong Ka‐Tak , Tsang Raymond K. Y. , Chan Amy B.W.
Published: September 2009

OBJECTIVE

To investigate the prognostic value of HER2 and p63 expression in head and neck squamous cell carcinoma (HNSCC).

STUDY DESIGN

A case review of 186 HNSCCs from the oral tongue, palate, maxillary sinus, floor of mouth, oropharynx, hypopharynx, and larynx.

SUBJECTS AND METHODS

All primary tumor specimens were evaluated by immunohistochemistry for HER2 and p63 expressions, which were correlated with clinical parameters including age, sex, grade, lymph node metastases, stage, and survival.

RESULTS

One hundred forty‐one patients had stage III‐IV disease and 109 had lymph node metastases. For all cases, T and N stages were significant prognostic predictors for both overall and disease‐free survivals. In the node‐positive subgroup, T stage and HER2 expression were significant prognostic predictors for both overall and disease‐free survivals.

CONCLUSION

HER2 may be associated with longer survival in node‐positive patients with HNSCC.
Planned Neck Dissection Following Primary Chemoradiation for Advanced‐Stage Head and Neck Cancer
Authors: Sabatini Peter R. , Ducic Yadranko
Published: September 2009

OBJECTIVES

To determine the prevalence of residual cancer in planned neck dissection specimens for advanced‐stage squamous cell carcinoma following chemoradiation.

STUDY DESIGN

A case series.

SETTING

A single‐surgeon community‐based head and neck practice.

SUBJECTS AND METHODS

Twenty‐six patients were identified during 2000 to 2007. All patients were treated with external beam radiation; the average dose to the neck was 60 Gy (range 50‐72 Gy). Concurrent chemotherapy was given with cisplatin and 5‐fluorouracil. Patients presenting with greater than N2 cervical disease and at least one node greater than 3 cm were considered advanced. Post‐chemoradiation physical examinations were performed by the primary surgeon and oncologist. Absence of physical evidence of disease was deemed a complete clinical response.

RESULTS

Fourteen of 21 (67%; 95% confidence interval [CI], 0.449‐0.854) patients were found to have carcinoma in their neck specimens. Seven patients were noted to have a clinically complete response, and two of seven (29%; 95% CI, 0.053‐0.659) patients with a clinically complete response were found to have carcinoma in their neck specimens. Fourteen patients were noted to have an incomplete response to therapy. Two of these 14 (14%; 95% CI, 0.026‐0.419) patients had negative pathology in their neck dissection specimens. Three patients had local recurrence and succumbed to their disease.

CONCLUSION

Planned neck dissection in the setting of advanced neck disease following chemoradiation should remain an important consideration when counseling patients presenting with advanced cervical metastasis from squamous cell head and neck cancer.
Proposal for Staging Airway Hemangiomas
Authors: Perkins Jonathan A. , Chen Eunice Y. , Hoffer Fredric A. , Manning Scott C.
Published: September 2009

OBJECTIVE

To describe a method of airway infantile hemangioma staging using standardized assessment of airway narrowing, and hemangioma location and volume, as determined with endoscopy and CT angiography.

STUDY DESIGN

Case series with chart review.

SETTING

Tertiary pediatric hospital, 2003‐2008.

SUBJECTS AND METHODS

Subjects included airway hemangioma patients evaluated at a tertiary pediatric hospital. Data collected were age at first symptoms, diagnostic evaluation, percent airway compromise, and estimated hemangioma volume. Data were analyzed with descriptive and Fisher exact statistics.

RESULTS

Twelve patients were identified and seven had complete data sets. Mean age at first symptoms was 1.9 months (SD 1.09 months, range 0.5‐4 months). Evaluation consisted of nasopharyngoscopy, microlaryngoscopy, CT angiography, and/or MRI. Mean laryngeal airway narrowing was estimated at 63.75 percent (SD 19.0%, range 40%‐90%). Total hemangioma volume was less in patients with isolated (focal) endolaryngeal hemangiomas compared with airway hemangiomas associated with extralaryngeal (segmental) hemangiomas. Airway hemangioma stages were stage one (5 of 12; 41.6%), stage two (6 of 12; 50.0%), and stage three (1 of 12; 8.3%).

CONCLUSION

This method of airway hemangioma staging may be applicable to treatment planning and used to measure treatment outcomes.
Prognostic Relevance of CD105‐Assessed Microvessel Density in Laryngeal Carcinoma
Authors: Zvrko Elvir , Mikic Anton , Vuckovic Ljiljana , Djukic Vojko , Knezevic Milan
Published: September 2009

OBJECTIVE

To examine immunohistochemical expression of CD105 among patients with laryngeal cancer and investigate the prognostic significance of CD105‐assessed microvessel density (MVD).

STUDY DESIGN

Cross‐sectional study.

SETTING

University hospital.

SUBJECTS AND METHODS

The study comprised 80 patients with laryngeal squamous cell carcinoma who underwent complete excision. Clinicopathological data were collected retrospectively. Immunohistochemical analysis was performed with CD105 (endoglin) antibody. Positive‐stained microvessels for CD105 were counted on hot spots of tumors at ×200 magnification.

RESULTS

Average CD105‐assessed MVD in considered laryngeal squamous cell carcinomas (SCCs) was 12.9 (SD 3.84). High expression of CD105 correlated significantly with advanced T (tumor) classification (P = 0.008), advanced TNM (tumor, node, metastasis) stage (P = 0.001), tumor recurrence (P = 0.001), and age ≥65 years (P = 0.026). The multivariate logistic regression showed that a high CD105+ MVD (odds ratio [OR] 4.27; P = 0.019) and advanced TNM stage (OR 3.72; P = 0.047) were independent markers of tumor recurrence. High MVD, advanced clinical stage, the presence of lymph node metastasis at the time of diagnosis, and age <66 years were associated with worse disease‐free survival. Cox regression analysis revealed that expression of CD105 (P = 0.016) and advanced clinical stage (P = 0.05) were the independent factors for disease‐free survival.

CONCLUSION

The present results suggest that MVD evaluation with CD105 is a promising prognostic factor for the outcome of patients with laryngeal SCC. CD105‐assessed MVD could help to identify patients with more aggressive disease and increased risk of developing malignancy recurrence after treatment.