bluuebunny/crossref_metadata_2025 huggingface dataset:
Polychlorinated naphthalenes and other dioxin-like compounds in Elbe River sediments
Authors: Brack Werner , Bláha Luděk , Giesy John P , Grote Matthias , Moeder Monika , Schrader Steffi , Hecker Markus
Published: February 2008

Contamination of Elbe River (Germany) sediments with dioxin-like toxicants was investigated following the 500-year flood (flood that statistically occurs once in 500 years) of 2002. It was hypothesized that large amounts of particulate matter from river beds and associated dioxin-like toxicants were mobilized and transported during this flood event. The investigation focused on polychlorinated naphthalenes (PCNs) that have not been determined previously in the Elbe River. The in vitro H4IIE-luc assay was used as an overall measure for toxicants capable of binding to the aryl hydrocarbon receptor (AhR). The assay was combined with congener-specific instrumental analyses and fractionation to quantify PCN contributions to total AhR-mediated activity relative to polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) and polychlorinated biphenyls (PCBs). Penta- to octachloron-aphthalene concentrations of 30 ng/kg dry weight up to 13 μg/kg dry weight were found in Elbe River sediments downstream of Bitterfeld. Concentrations of penta- to octachloronaphthalenes, however, were only approximately 3 μg/kg dry weight at a site in the vicinity of Bitterfeld, where a level of approximately 3 mg/kg dry weight was reported before the flood. Also, the congener pattern of PCNs at this site changed after the flood, and PCN patterns reported previously for Bitterfeld and assigned to chlor-alkali electrolysis with graphite electrodes could now be observed at the sites from downstream of Bitterfeld and Magdeburg. Whereas PCDD/Fs dominated the dioxin-like activity in the middle and lower Elbe River, PCNs contributed as much as 10% of the total AhR-mediated activity. The contribution of PCBs was less significant (maximum, 0.2%). Thus, in Elbe River sediments, PCNs should be considered as relevant contaminants and be included in future monitoring and risk assessment programs.
Increased sensitivity and variability of phytotoxicity responses in Arctic soils to a reference toxicant, boric acid
Authors: Anaka Alison , Wickstrom Mark , Siciliano Steven Douglas
Published: February 2008

Industrial and human activities in the Arctic regions may pose a risk to terrestrial Arctic ecosystem functions. One of the most common terrestrial toxicological end points, primary productivity, typically is assessed using a plant phytotoxicity test. Because of cryoturbation, a soil mixing process common in polar regions, we hypothesized that phytotoxicity test results in Arctic soils would be highly variable compared to other terrestrial ecosystems. The variability associated with phytotoxicity tests was evaluated using Environment Canada's standardized plant toxicity test in three cryoturbated soils from Canada's Arctic exposed to a reference toxicant, boric acid. Northern wheatgrass (Elymus lanceolatus) not only was more sensitive to toxicants in Arctic soils, its response to toxicants was more variable compared to that in temperate soils. The phytotoxicity of boric acid in cryosols was much greater than commonly reported in other soils, with a boric acid concentration of less than 150 μg/g soil needed to inhibit root and shoot growth by 20%. Large variability also was found in the phytotoxicity test results, with coefficients of variation for 10 samples ranging from 160 to 79%. The increased toxicity of boric acid in cryosols and variability in test response was not explained by soil properties. Based on our admittedly limited data set of three different Arctic soils, we recommend that more than 30 samples be taken from each control and potentially impacted area to accurately assess contaminant effects at sites in northern Canada. Such intensive sampling will insure that false-negative results for toxicant impacts in Arctic soils are minimized.
Clinical Research and Drug Development in Latin America
Authors: Rodrigues D. G.
Published: February 2008

Two decades ago, clinical trials were carried out only in developed countries. Drug development and the need to speed up clinical trials lead the conduction of clinical trials to other countries. Among the regions of interest, Latin America (LA) has played its role successfully. LA has a large number of naive patients, qualified investigators, established regulatory systems and reasonable costs. Furthermore, LA might be also considered as a new option for any company looking for international patterns on drug research and development. The region has good professionals with scientific qualifications, well-established multinational pharmaceutical bases and an expansive pharmaceutical regional market. This work summarizes the recent advances that have occurred in drug research and development in the region and the expansion of the clinical trial market in the last couple of years.
Azithromycin Protects against Hyperoxic Lung Injury in Neonatal Rats
Authors: Ballard Hubert O. , Bernard Philip , Qualls Joseph , Everson William , Shook Lori A.
Published: February 2008

Bronchopulmonary dysplasia (BPD) is a pulmonary disorder that causes significant morbidity and mortality in premature infants. BPD is pathologically characterized by inflammation, fibrosis, and mucosal necrosis, which leads to emphysematous coalescence of alveoli. We tested the hypothesis that azithromycin, a macrolide antibiotic, would decrease the severity of lung injury in an animal model of BPD. Sixty-three rat pups were randomly divided equally into control, hyperoxia, and hyperoxia plus azithromycin groups. The hyperoxia groups were exposed to > 95% oxygen from days of life 4 to 14. On day 14, the animals were processed for lung histology and tissue analysis. Lung morphology was assessed by mean linear intercept, a measure of alveolar size, with larger values corresponding to lungs that are more emphysematous. The degree of lung inflammation was assessed by quantifying interleukin-6 (IL-6) from lung homogenate. Fifty pups survived to day 14 (control = 21, hyperoxia = 11, hyperoxia + azithromycin = 18). Mortality was increased in the hyperoxia group versus the control group ( p < .0001). Treatment with azithromycin improved survival in animals subjected to hyperoxia ( p < .05). Azithromycin significantly decreased lung damage as determined by the mean linear intercept in the hyperoxia groups ( p < .001). Finally, azithromycin-treated pups had lower levels of IL-6 in lung homogenate from the hyperoxia groups ( p < .05). Azithromycin treatment resulted in improved survival, less emphysematous change, and decreased IL-6 levels in an animal model of BPD.
Acetylcholinesterase Activity in Veterans of the First Gulf War
Authors: Concato John , Aslan Mihaela , Palmisano Margaret M. , Doebbeling Caroline Carney , Peduzzi Peter , Ofek Keren , Soreq Hermona , Doebbeling Bradley
Published: February 2008

Background

Factors affecting acetylcholine-mediated neurotransmission have been proposed as possible explanations for physical and mental health symptoms among veterans of the 1990-1991 Gulf War. This study was designed to examine relationships of deployment to the Gulf, as well as symptoms after military service, with postdeployment activity of acetylcholinesterase (AChE) and related enzymes.

Methods

The patient population included 488 veterans, originally from Iowa at enlistment, who served in the US military during August 1990 to July 1991. Demographic, military, and clinical characteristics were obtained from a population-based cohort study (in 1995-1996) and from a nested case-control study (in 1999-2002). Stored serum samples (from the 1999-2002 assessment) were analyzed for activity of AChE and related enzymes. These two data sources were merged, and multiple linear regression models estimated the association of deployment, stress (anxiety) or mood disorders, and symptoms compatible with Gulf War veterans’ illnesses (GWVIs), with enzyme activity.

Results

Seventy-four percent ( n = 361) of veterans had been deployed to the Gulf. At the time of evaluation, 23% ( n = 113) of participants reported anxiety and 15% ( n = 71) reported mood disorders; 49% ( n = 171 of 347 eligible veterans) had symptoms of GWVIs, and the median AChE activity was 839 units. AChE activity was similar for compared groups across all categories, including an adjusted difference of −27 units ( p = .50) for deployed versus nondeployed veterans and 87 units ( p = .13) for veterans with versus without symptoms of GWVIs.

Conclusions

Neither deployment to the Gulf nor symptoms compatible with GWVIs are associated with long-term serum AChE activity.
Evaluation of C-Reactive Protein in Primary and Secondary Prevention
Authors: Corrado Egle , Novo Salvatore
Published: February 2008

Inflammation is pivotal in atherosclerosis, and C-reactive protein (CRP) is an inflammatory marker that predicts cardiovascular events. Several population-based studies have demonstrated that baseline CRP levels predict future cardiovascular events. CRP testing may thus have a major adjunctive role in the global assessment of cardiovascular risk. Recently, the National Cholesterol Education Program, through the Adult Treatment Panel III guidelines, identified CRP and another marker of inflammation, the fibrinogen, as “emerging risk factors,” suggesting that their measurement may improve the estimations of absolute risk obtained using the traditional cardiovascular risk factors. In terms of clinical application, CRP seems to be a strong predictor of cardiovascular events such as low-density lipoprotein cholesterol and adds prognostic information to all levels of calculated Framingham Risk Score and to the cluster of risk factors of metabolic syndrome. Several pharmacologic agents proven to reduce vascular risk also reduce CRP levels. Among these, all statins lower CRP, with more potent statins having greater effects; on average, median CRP levels decline from 15 to 25% after 6 weeks of starting therapy. Although limitations concerning the inflammatory screening remain, available data suggest that CRP has the potential to play an important role in adding more information for the evaluation of global risk assessment in primary prevention of cardiovascular disease.
Hypotensive Hemostatis (Permissive Hypotension) for Ruptured Abdominal Aortic Aneurysm: Are We Really in Control?
Authors: van der Vliet J. Adam , van Aalst Dennis L. , Schultze Kool Leo J. , Wever Jan J. , Blankensteijn Jan D.
Published: February 2008

The purpose of this study was to investigate whether a protocol for permissive hypotension was feasible for patients admitted with a ruptured abdominal aortic aneurysm (RAAA). It was aimed to limit prehospital intravenous fluid administration to 500 mL and to maintain systolic blood pressure at a range of 50 to 100 mm Hg following admission, using nitrates when indicated. The diagnosis of RAAA was confirmed with sonography, and all patients with uncontrolled hypovolemic shock immediately underwent open aneurysm repair (OAR). In all other cases, computed tomographic (CT) angiography was performed to determine the eligibility for endovascular aneurysm repair (EVAR). From January 1, 2004, to December 31, 2006, 95 patients with a suspected RAAA were admitted. In 77 patients, the diagnosis of RAAA was confirmed. Twenty-eight cases (36%) underwent OAR for uncontrolled hemodynamic instability. Following CT-angiographic evaluation, 25 of the remaining 49 cases were considered unsuitable for EVAR and subsequently underwent OAR. In 24 of 77 cases (31%), the RAAA was treated with EVAR. Preoperative systolic blood pressure recordings in EVAR patients showed median values (± SD) of 98 (± 34.7) mm Hg in the emergency department and 114 (± 26.2) mm Hg in the operating theater. The desired systolic blood pressure range of 50 to 100 mm Hg was reached in 11 of 24 cases (46%). In 13 of 24 cases (54%), a systolic blood pressure higher than 100 mm Hg was recorded for a period longer than 60 minutes. The 30-day mortality was 32 of 77 (42%), with 6 of 24 (25%) in the EVAR group and 26 of 53 (49%) in the OAR group. This is the first published series of RAAA in which a protocol of permissive hypotension has been adopted. The concept appeared to be feasible in the majority of cases. Protocol violations were sparse ( n = 5). Uncontrolled hypotension occurred in 36% (28 of 77) of all patients, and the desired systolic blood pressure range was achieved in 46% (11 of 24) of the EVAR patients.
Transperitoneal Laparoscopic Left Gonadal Vein Ligation Can Be the Right Treatment Option for Pelvic Congestion Symptoms Secondary to Nutcracker Syndrome
Authors: Rogers Alistair , Beech Andrew , Braithwaite Bruce
Published: February 2008

The nutcracker phenomenon refers to compression of the left renal vein at the origin of the superior mesenteric artery and is often underdiagnosed. This can cause symptoms of pelvic venous congestion with retrograde venous flow and a dilated gonadal vein. Here we describe a case in a 39-year-old female, who following imaging investigations to confirm the diagnosis, underwent transperitoneal laparoscopic ligation of the left gonadal vein. Laparoscopic sterilization was also performed with the aid of the gynecologists. Multiparous women, who are more likely to develop pelvic congestion symptoms, more commonly request sterilization and thus we propose that a dual laparoscopic procedure in these cases could be the treatment of choice.
Kissing Stents in the Common Femoral Artery Bifurcation for Critical Limb Ischemia: Technical Description and Report of Three Cases
Authors: Mathisen Sven Ross , Åkesson Michael , Lindh Mats , Ivancev Krassi , Resch Timothy A.
Published: February 2008

The purpose of this article is to describe three cases of kissing stent placement in the common femoral artery bifurcation in patients unsuitable for open endarterectomy and patch plasty. In three patients with critical limb ischemia, caused by primary atherosclerotic disease or dissection-related injury when performing a lower extremity intervention, a technique of kissing stents was used to treat the flow-obstructing lesion in the common femoral artery bifurcation. Technical success was uniform, and during follow-up (4.5–8 months), all patients showed improved symptoms, wound healing, and duplex ultrasonography–verified patency of the stents. Kissing stents in the common femoral artery bifurcation are a feasible treatment option in patients with limited mobililty or contraindications to open repair. The short-term results seem promising, but longer follow-up and an increased number of patients will be needed to assess the durability of the reconstruction.
Temporal Trends in Eversion Carotid Endarterectomy for Carotid Atherosclerosis: Single-Center Experience with 5,034 Patients
Authors: Radak Djordje J. , Ilijevski Nenad S. , Nenezic Dragoslav , Popov Petar , Vucurevic Goran , Gajin Predrag , Jocic Dario , Kolar Jovo , Radak Sandra , Sagic Dragan , Matic Predrag , Milicic Miroslav , Otasevic Petar
Published: February 2008

The aim of this article is to review our experience in surgical treatment of carotid atherosclerosis using eversion carotid endarterectomy (ECEA) in 5,034 patients, with particular attention to temporal changes in patients' characteristics, diagnostic approach, surgical technique, medical therapy, and outcome in the early (group A, 1991–1997) versus late (group B 1998–2004) period of ECEA. From January 1991 to December 2004, 5,034 primary ECEAs were performed for high-grade carotid stenosis. Patients treated for restenosis after previous carotid surgery were excluded from the analysis. Group A consisted of 1,714 patients who underwent surgery between 1991 and 1997, and group B consisted of 3,320 patients who underwent surgery between 1998 and 2004. Follow-up included routine clinical evaluation and noninvasive surveillance, with duplex scanning at 1 month after surgery, after 6 months, and annually afterward. Only 3% of patients in group A and 0.6% in group B were asymptomatic, with 23% and 47% of them having preoperative stroke, respectively. In group A, angiography was used for the final diagnosis in 78% of patients. In group B, duplex scanning was performed in 82% of patients and angiography in only 18% ( p < .001). Clamping time was shorter in the latter group (12.4 ± 3.1 vs 14.5 ± 4.1 min, p < .01). Introperative shunting and regional anesthesia were rarely performed in both groups (1.4% vs. 0.4%, p < .01, and 2% vs 0.3%, p < .001). Total and neurologic morbidity was significantly higher in group A than in group B (6.41% ± 0.47% vs 4.81% ± 0.53%, p < .001, and 2.14% ± 0.31% vs 1.23% ± 0.29%, p < .001, respectively). Total mortality was also higher in group A than in group B (1.92% ± 0.24% vs 1.36% ± 0.50%, p < .05), but although there was a trend toward lower neurologic mortality, it did not reach statistical significance (1.04% ± 0.5% vs 0.57% ± 0.25%, p = .074). There was a lower rate of nonsignificant restenosis (< 50%) in group B (2% vs 5%, p < .01), but the incidence of restenosis ≥ 50% was identical between the groups (5.5% for both). Our data show that ECEA is a reliable surgical technique for the treatment of atherosclerotic carotid disease. Temporal trends in our patients demonstrated a decline in periopertive mortality and morbidity, despite a higher incidence of preoperative stroke.
Transilluminated Powered Phlebectomy in the Treatment of Varicose Veins
Authors: Passman Marc
Published: February 2008

Recent trends toward less invasive technologies for treating varicose veins have led to expanding interest in transilluminated powered phlebectomy. Although initial experience with transilluminated powered phlebectomy was variable, with the newer-generation system and modification of technique that allow for slower oscillation speed, higher suction, and extensive tumescence irrigation and drainage, these previous problems have been mostly eliminated. The following report reviews current instrumentation, operative technique, and reported outcomes for transilluminated powered phlebectomy.
Endovascular Management of Paget-Schroetter Syndrome
Authors: Landry Gregory J. , Liem Timothy K.
Published: February 2008

Spontaneous thrombosis of the axillary and subclavian venous segments in young, healthy adults (effort thrombosis or Paget-Schroetter syndrome) is a rare but potentially disabling affliction. The diagnosis should be suspected in any young patient presenting with unilateral arm swelling. Typically, the dominant arm is affected, and frequent, repetitive arm use is a common component of the patients' history. Although the diagnosis can often be confirmed with a venous duplex evaluation, the central location of the venous abnormality occasionally mandates cross-sectional imaging or contrast venography to confirm the diagnosis. The underlying pathophysiology of this disorder is felt to be repetitive venous trauma owing to arm motion in the narrow anatomic space between the clavicle and first rib. The treatment of Paget-Schroetter syndrome is controversial and varies according to individual, institutional, and regional preferences. In general, the trend is toward more aggressive endovascular treatment. Prompt anticoagulation is generally accepted as the minimal treatment offered. Catheter-directed thrombolysis has also acquired a prominent role in reestablishing venous patency. The importance of relieving the anatomic compression of the subclavian vein by first rib resection remains controversial, with some experts advocating surgical intervention in all affected patients, whereas others perform this procedure selectively in cases of persistent venous stenosis or ongoing symptoms. Angioplasty with or without stenting is generally discouraged in the absence of anatomic decompression but may play an adjunctive role in patients undergoing first rib resection.
Pathogenesis of Varicose Veins and Implications for Clinical Management
Authors: Naoum Joseph J. , Hunter Glenn C.
Published: February 2008

Varicose veins (VVs) classically result from venous hypertension owing to incompetence of the major communications between the superficial and deep veins of the lower extremity. In a significant number of patients, there is no demonstrable truncal saphenous reflux and varicosities are the result of isolated perforating and nonsaphenous vein incompetence. The clinical and histologic features of VVs are the result of disruption of the normal architectural structure of the venous wall as a consequence of remodeling of the extracellular matrix (ECM) in response to increased venous distention and altered hemodynamic shear stress. Although a number of genes, growth factors, proteases, and their inhibitors known to modulate the ECM have been implicated in the pathogenesis of VVs, their etiology remains unknown. The complex variations in venous anatomy in patients with VVs require detailed vein mapping to determine the source and drainage locations of reflux if the rates of residual and recurrent varicosities are to be reduced. The distinct pathogenic mechanisms involved in the development of VVs have important implications for the management of VVs that include a wide spectrum of treatment modalities ranging from reassurance, alternative medicines, conservative management or compression therapy, and surgical or endovascular therapy.
Optimization of production rate in diode laser hardening
Authors: Capello Edoardo , Previtali Barbara
Published: February 2008

The present paper is a contribution to the definition of optimal laser hardening conditions with production rate as the main goal. When the part to be treated is given, the optimization problem can be expressed in terms of minimal execution time subjected to two constraints: the depth of treatment and hardness of transformed layer. When the analytical expression of the objective function and the constraints was determined, the feasibility area was described and analyzed. Finally, an optimization algorithm was applied to identify the optimal solution as a function of the imposed constraints.
Surface preparation by using laser cleaning in thermal spray
Authors: Li H. , Costil S. , Liao H-L. , Coddet C. , Barnier V. , Oltra R.
Published: February 2008

Pulsed laser cleaning has emerged as a promising technology to challenge traditional surface preparation methods. This paper introduces the PROTAL® process, which combines an in situ pulsed laser cleaning with thermal spraying techniques. This laser surface preparation avoids some drawbacks of the traditional degreasing and sand-blasting stages prior to thermal spraying, which is especially meaningful for ductile and notch-sensitive materials. The laser induced phenomenon and the significant role of such laser irradiation in the coating deposition are presented.
Experimental investigation of remote welding with CO2 and Nd:YAG laser-based systems
Authors: Tsoukantas George , Stournaras Aristidis , Chryssolouris George
Published: February 2008

Remote welding provides new possibilities for highly productive and flexible joining of metal structures, especially in the automotive industry. This study presents an experimental investigation on the behavior of the lap welds’ geometrical characteristics with respect to the laser beam inclination. Two remote welding systems (RWSs) have been utilized: a large field RWS with a CO2 laser and a small field RWS with an Nd:YAG laser. The materials investigated include steels (noncoated, zinc-coated, and stainless) and an Al alloy. Conclusions are drawn related to the behavior of the process mechanism under different laser beam inclinations, useful for the industrial application of the process and for further research in the field.
Laser doping of chromium in 6H-SiC for white light emitting diodes
Authors: Bet Sachin , Quick Nathaniel , Kar Aravinda
Published: February 2008

Laser doping has been utilized for fabricating white light emitting diodes with 6H-SiC wafers. The emission of different colors to ultimately generate white light is tailored on the basis of donor acceptor pair (DAP) recombination mechanism for luminescence. Chromium (Cr), which is an unconventional dopant that produces multiple acceptor sites per atom, was incorporated into SiC and conventional dopants such as aluminum (Al) and nitrogen (N) were also laser-doped to produce acceptor and donors states, respectively. A p−n junction was fabricated with these dopants and an electroluminescent broad spectrum (400–850 nm) corresponding to white light was observed. This white light is a result of the combination of red, green, and blue lights formed due to DAP recombination between Al–N (blue, 460–498 nm), Cr–N (green, 521–575 nm) and additional other impurity state transitions (red, 698–738 nm).
Nanostructure and sp1/sp2 clustering in tetrahedral amorphous carbon thin films grown by femtosecond laser deposition
Authors: Hu A. , Rybachuk M. , Alkhesho I. , Lu Q.-B. , Duley W.
Published: February 2008

Diamondlike amorphous carbon films have been deposited on silicon and quartz substrates by laser ablation of graphite using 120 fs pulses from an amplified Ti:sapphire laser operating at 800 nm. Ultraviolet/visible (UV/VIS) and micro-Raman spectra of these materials have shown that the sp3-bonded carbon fraction in these films is ≈27%, 55%, and 20% when deposition occurs at substrate temperatures of 77, 300, and 573 K, respectively. The presence of sp1 chains in these films is indicated by the appearance of an excitation band at 2000–2100 cm−1 in UV-Raman spectra. We also find a remarkable increase in the Tauc energy gap calculated from in situ UV/VIS optical spectra immediately after exposure to air together with a 1 eV redshift of the C 1s core-level energy in x-ray photoelectron spectra of these samples. The properties of sp1-, sp2- and sp3-bonded components of these materials have also been studied using UV/VIS Raman spectroscopy. The enhanced stability of sp1 chains in tetrahedral carbon matrix is discussed. The present study sheds light on novel tetrahedral carbon materials embedded with both sp1 chains and sp2 clusters.
Macroecological patterns and niche structure in a new marine food web
Authors: Yvon-Durocher Gabriel , Montoya Jose , Emmerson Mark , Woodward Guy
Published: February 2008

The integration of detailed information on feeding interactions with measures of abundance and body mass of individuals provides a powerful platform for understanding ecosystem organisation. Metabolism and, by proxy, body mass constrain the flux, turnover and storage of energy and biomass in food webs. Here, we present the first food web data for Lough Hyne, a species rich Irish Sea Lough. Through the application of individual-and size-based analysis of the abundance-body mass relationship, we tested predictions derived from the metabolic theory of ecology. We found that individual body mass constrained the flux of biomass and determined its distribution within the food web. Body mass was also an important determinant of diet width and niche overlap, and predator diets were nested hierarchically, such that diet width increased with body mass. We applied a novel measure of predator-prey biomass flux which revealed that most interactions in Lough Hyne were weak, whereas only a few were strong. Further, the patterning of interaction strength between prey sharing a common predator revealed that strong interactions were nearly always coupled with weak interactions. Our findings illustrate that important insights into the organisation, structure and stability of ecosystems can be achieved through the theoretical exploration of detailed empirical data.
Amphotericin B Irrigation for the Treatment of Chronic Rhinosinusitis without Nasal Polyps: A Randomized, Placebo-controlled, Double-blind Study
Authors: Liang Kai-Li , Su Mao-Chang , Shiao Jiun-Yi , Tseng Hung-Cheng , Hsin Chung-Han , Lin Jen-Fu , Jiang Rong-San
Published: February 2008

Background

Fungus-driven inflammation is proposed to play an important role in the pathogenesis of chronic rhinosinusitis (CRS). Previous studies tested the efficacy of intranasal antifungal agents for patients with nasal polyps. The purpose of this study was to evaluate the efficacy of intranasal amphotericin B (AMB) in patients who have CRS without nasal polyps (CRSsNP).

Methods

Patients diagnosed with CRSsNP were enrolled in this study. They were assigned randomly to receive irrigation with AMB solution (20 mg of AMB in 500 mL of normal saline) or placebo (yellowish dye in 500 mL of normal saline) for 4 weeks. The outcome measures included the Chinese version of the Rhinosinusitis Outcome Measure 31 (CRSOM-31), nasal endoscopy, and bacterial and fungal cultures.

Results

Seventy patients were enrolled and 64 patients completed this study. There was significant improvement in the AMB group (n = 32) both in endoscopic (p = 0.013) and CRSOM-31 scores (p < 0.0001). The placebo group (n = 32) showed significant improvement in CRSOM-31 scores (p < 0.0001). CRSOM-31 scores were significantly lower in the AMB group than in the placebo group after 2-week treatment (p = 0.018) and remained lower after 4-week treatment, although the difference was not significant (p = 0.091). There were no significant differences in endoscopic scores and bacterial or fungal culture rates between two groups after treatment.

Conclusion

Our results showed that AMB irrigation improved symptoms and endoscopic scores but did not show superiority to saline irrigation alone in patients who have CRSsNP.
The Effect of Bacterial Biofilms on Post-sinus Surgical Outcomes
Authors: Psaltis Alkis J. , Weitzel Erik K. , Ha Kien R. , Wormald Peter-John
Published: February 2008

Background

Although the existence of biofilms on the sinus mucosa of patients with chronic rhinosinusitis (CRS) is now well established, the role that these structures play remains unclear. It is thought that biofilms may contribute to the recalcitrant and persistent nature that characterizes CRS, but little research exists documenting the effect that they have on postoperative mucosal outcomes. This article presents a retrospective analysis of sinus surgical patients and correlates the presence of biofilms with mucosal outcomes. This study was performed to evaluate the role that bacterial biofilms have on post-sinus surgical outcomes.

Methods

A retrospective analysis of prospectively collected data was performed on 40 patients undergoing endoscopic sinus surgery (ESS) for CRS. Preoperative demographic, clinical, and radiologic data were recorded from each patient and, intraoperatively, sinus culture specimens and mucosal samples were obtained for microbiological and microscopic examination. Biofilm determination was performed using confocal scanning laser microscopy. Postoperatively, patients were followed up for a minimum of 8 months with endoscopic evaluation of their sinonasal mucosa. The presence of ongoing symptoms was recorded also.

Results

Bacterial biofilms were found in 20 (50%) of the 40 CRS patients. Patients with biofilms had significantly worse preoperative radiological scores and, postoperatively, had statistically worse postoperative symptoms and mucosal outcomes. The only other factor that was statistically related to an unfavorable outcome was the presence of fungus at the time of surgery. In this study the presence of polyps, eosinophilic mucin, or pus was not related to poor outcomes.

Conclusion

This retrospective study showed that bacterial biofilms and fungus were correlated with the persistence of postoperative symptoms and mucosal inflammation after sinus surgery for CRS. This provides evidence that biofilms indeed may play an active role in perpetuating inflammation in CRS patients and may explain the recurrent and resistant nature of this disease. Therapies targeted at removing biofilms may be important in the management of recalcitrant CRS.
No Significant Role for Angiogenesis in Nasal Polyposis
Authors: Ahmed Shahzada K. , Williams James L. , Drake-Lee Adrian , Egginton Stuart
Published: February 2008

Background

Nasal polyposis is a common disease of which little is currently known. Recent studies have shown up-regulation of several proangiogenic factors. The aim of this study was to assess and quantify how much angiogenesis occurs in nasal polyps and therefore whether angiogenesis is involved in the etiology of polyposis.

Methods

Biopsy specimens of polyp tissue and inferior turbinate (IT) were taken from patients undergoing polypectomy and compared with IT samples from control patients. Five patients were used per study group. Biopsy specimens were either stained with a fluorescent lectin for confocal microscopy or snap frozen and sectioned for histology for the examination of multiple measures of angiogenesis.

Results

No significant differences in capillary density, capillary-associated proliferation, capillary surface density, or capillary volume density were seen between the three study groups, and the regression of surface density versus volume density described a linear relationship. Polyp samples showed increases in capillary diameter and interstitial proliferation.

Conclusion

These results show no active angiogenesis occurring in the polyp or changes in capillary bed architecture, although capillaries seem more edematous in the polyp. As the capillary supply increases in line with the physiological needs of the growing polyp, we conclude that angiogenesis is not a driving force in the etiology of nasal polyposis.
Transient Receptor Potential Vanilloid Type 4 Channel Expression in Chronic Rhinosinusitis
Authors: Bhargave Geeta , Woodworth Bradford A. , Xiong Guoxiang , Wolfe Steven G. , Antunes Marcelo B. , Cohen Noam A.
Published: February 2008

Background

Transient receptor potential (TRP) channels are a novel class of nonvoltage gated membrane cation channels that can be activated by mechanical stimulation and temperature change. Recently, TRP vanilloid type 4 (TRPV4) has been implicated in detecting viscosity changes in fallopian tube epithelial cells and inducing a compensatory response in ciliary activity and, as such, represents a possible molecular trigger for modulating respiratory ciliary activity. Thus, the goal of this study was to establish the expression pattern of TRPV4 in human sinonasal mucosa and determine whether expression is altered in chronic rhinosinusitis (CRS).

Methods

Sinus mucosal biopsy specimens were obtained from patients with CRS, CRS with nasal polyps (NPs), and healthy controls. TRPV4 mRNA and protein expression were confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) and immunoblot analysis, respectively. TRPV4 gene expression was measured next using quantitative RT-PCR. Immunofluorescence was performed on sinus mucosal explants and respiratory epithelial air–liquid interface cultures to localize cellular expression.

Results

TRPV4 mRNA and protein were expressed in all samples. There was a statistically significant increase (p < 0.05) in TRPV4 gene expression in nonpolypoid CRS patients, but no difference in CRS with NP. Dual label immunofluorescence showed TRPV4 expression to be mutually exclusive of ciliated cells.

Conclusion

Although TRPV4 represents an ideal molecular trigger for ciliary modulation, absent expression of the channel in ciliated cells precludes this function. However, altered expression of the channel in CRS and presumed expression of TRPV4 in secretory cells of the mucosa indicate a potential role in mucus homeostasis and CRS pathogenesis.
Innate Immunity in the Paranasal Sinuses: A Review of Nasal Host Defenses
Authors: Ooi Eng Hooi , Wormald Peter-John , Tan Lor Wai
Published: February 2008

Background

Chronic rhinosinusitis (CRS) is a common inflammatory disorder of the paranasal sinuses. An abnormal host response to common bacterial or fungal pathogens is thought to be an important factor in the disease process. Host sinonasal epithelium plays an important role in initially recognizing the presence of microbes and responding by increasing production of antimicrobial peptides and cytokines, with recruitment of phagocytes and lymphocytes of the adaptive immune system, to eliminate the infection. Recently, the innate immune system and its complex interplay with the adaptive immune system are increasingly being recognized as important in the pathogenesis of chronic inflammatory diseases such as asthma and CRS.

Methods

Review of recent findings on innate immunity in the pathogenesis of CRS.

Results

New areas of research into potentially novel therapies for CRS are highlighted in this review, with emphasis on toll-like receptors, antimicrobial peptides (cathelicidins and defensins), and surfactant proteins.

Conclusion

This review provides an overview of innate immunity in the sinonasal tract and discusses potential use of innate immune peptides as treatments against fungi, biofilms, and superantigens in CRS.
Nasal Conditioning after Endonasal Surgery in Chronic Rhinosinusitis with Nasal Polyps
Authors: Kappe Thomas , Papp Judit , Rozsasi Ajnacska , Leiacker Richard , Rettinger Gerhard , Keck Tilman
Published: February 2008

Background

Endoscopic sinus surgery (ESS) is a frequently performed operation for chronic rhinosinusitis (CRS). The aim of this study was to investigate nasal conditioning after ESS with/without septoplasty and turbinoplasty in patients with CRS with nasal polyps and to determine its relation to nasal patency and geometry.

Methods

Twenty-one patients were enrolled into this study. Nasal conditioning, AAR, and acoustic rhinometry were measured before and 4-8 months after endonasal surgery.

Results

The temperature and humidity gradient across the nose increased significantly after operation. High nasal volumes and patency were positively correlated with elevated nasal conditioning. No correlation between preoperative and postoperative changes in nasal geometry and nasal airflow with changes in conditioning values was found.

Conclusion

Patients with CRS with nasal polyps seem to profit from ESS with/without septoplasty and turbinoplasty because nasal conditioning is improved postoperatively. Properly performed ESS has its importance within the variety of nasal surgical procedures ensuring improved nasal function.
Surgical treatment of blood blister–like aneurysms of the supraclinoid internal carotid artery with extracranial–intracranial bypass and trapping
Authors: Başkaya Mustafa K. , Ahmed Azam S. , Ateş Özkan , Niemann David
Published: February 2008

Object

Blood blister–like aneurysms (BBAs) arise from the supraclinoid internal carotid artery (ICA) at non-branching sites. These aneurysms are challenging to treat primarily with either surgical clip placement or endovascular therapy. The authors describe a series of 4 patients who presented with high-grade subarachnoid hemorrhage (SAH) due to a BBA, which was treated with an extracranial–intracranial (EC–IC) bypass followed by trapping of the aneurysm.

Methods

Four patients presented with SAH due to a BBA of the ICA. Three of these patients were treated with an endovascular procedure; following the vasospasm period, definitive treatment with EC–IC bypass followed by trapping of the aneurysmal parent vessel was performed.

Results

Two of the patients who were treated endovascularly suffered rebleeding prior to bypass and trapping. Three of the 4 patients had a good outcome (modified Rankin Scale Score 1 or 2), and 1 patient who suffered 2 episodes of rebleeding died.

Conclusions

Treatment of BBAs of the ICA remains difficult, particularly in the setting of high-grade SAH. Patients with this challenging condition often require multiple procedures and have a high incidence of rebleeding. Definitive treatment of these aneurysms consists of EC–IC bypass and surgical or endovascular trapping.
Wingspan stenting of symptomatic extracranial vertebral artery stenosis and perioperative evaluation using quantitative magnetic resonance angiography: report of two cases
Authors: Brisman Jonathan L.
Published: February 2008

✓The best management strategy for symptomatic vertebrobasilar ischemia is currently not well-defined. Noninvasive Optimal Vessel Analysis (NOVA, VasSol, Inc.) is computer software that, using quantitative magnetic resonance (MR) angiography technology, represents the only commercially available means of noninvasively measuring blood flow within the human vasculature.

The author used quantitative MR angiography to study cerebral blood flow in 2 patients who underwent angioplasty and stenting for medically refractory extracranial cervical vertebral artery (VA) stenosis using the recently Food and Drug Administration–approved WingSpan stent (Boston Scientific, Target). WingSpan stents were successfully placed after balloon angioplasty in both patients without complications. At the 5-month clinical follow-up examination, 1 patient was symptom free and the other had had a possible transient ischemic attack without sequelae. The WingSpan stent may represent an alternative management scheme for symptomatic vertebrobasilar ischemia from extracranial VA stenosis. Quantitative MR angiography can readily measure blood flow in the vertebrobasilar system, and these values correlated with the angiographic outcomes in the 2 patients treated in the present study.
Long-term outcome of superficial temporal artery–middle cerebral artery bypass for patients with moyamoya disease in the US
Authors: Mesiwala Ali H. , Sviri Gill , Fatemi Nasrin , Britz Gavin W. , Newell David W.
Published: February 2008

Object

The authors report the long-term results of a series of direct superficial temporal artery–middle cerebral artery (STA–MCA) bypass procedures in patients with moyamoya disease from the western US.

Methods

All patients with moyamoya disease treated at the University of Washington from 1990 through 2004 (39 patients) were included in this study. Patients underwent pre- and postoperative evaluation of cerebral perfusion dynamics. Surgical revascularization procedures were performed in all patients with impaired cerebral blood flow (CBF) findings.

Results

The mean age of patients at diagnosis was 34 years (range 10–55 years). All 39 patients had impaired CBF and/or vasomotor reserve and underwent revascularization procedures: 26 patients underwent bilateral operations, 13 unilateral (65 total procedures). An STA–MCA bypass was technically possible in 56 procedures (86.2%); saphenous vein interposition grafts were required in 3 procedures (4.6%); encephaloduroarteriosynangiosis was performed in 6 procedures (9.2%). Three patients died due to postoperative complications, yielding a procedure-related mortality rate of 4.61%, and 8 experienced non–life threatening complications (for a procedure-related rate of 12.3%). Long-term follow-up appeared to indicate a reduction in further ischemic events in surviving patients compared with the natural history. Cerebral perfusion dynamics improved postoperatively in all 36 surviving patients.

Conclusions

Moyamoya disease may differ in the US and Asia, and STA–MCA bypass procedures may prevent future ischemic events in patients with this condition.
Moyamoya disease in pediatric patients: outcomes of neurosurgical interventions
Authors: Veeravagu Anand , Guzman Raphael , Patil Chirag G. , Hou Lewis C. , Lee Marco , Steinberg Gary K.
Published: February 2008

✓Neurosurgical interventions for moyamoya disease (MMD) in pediatric patients include direct, indirect, and combined revascularization procedures. Each technique has shown efficacy in the treatment of pediatric MMD; however, no single study has demonstrated the superiority of one technique over another. In this review, the authors explore the various studies focused on the use of these techniques for MMD in the pediatric population. They summarize the results of each study to clearly depict the clinical outcomes achieved at each institution that had utilized direct, indirect, or combined techniques. In certain studies, multiple techniques were used, and the clinical or radiological outcomes were compared accordingly.

Direct techniques have been shown to aid a reduction in perioperative strokes and provide immediate revascularization to ischemic areas; however, these procedures are technically challenging, and not all pediatric patients are appropriate candidates. Indirect techniques have also shown efficacy in the pediatric population but may require a longer period for revascularization to occur and perfusion deficits to be reversed. The authors concluded that the clinical efficacy of one technique over another is still unclear, as most studies have had small populations and the same outcome measures have not been applied. Authors who compared direct and indirect techniques noted approximately equal clinical outcomes with differences in radiological findings. Additional, larger studies are needed to determine the advantages and disadvantages of the different techniques for the pediatric age group.
Progression of disease in unilateral moyamoya syndrome
Authors: Smith Edward R. , Scott R. Michael
Published: February 2008

Object

Progression of vasculopathy associated with moyamoya syndrome is extremely variable. The authors review their experience in patients with unilateral moyamoya syndrome to identify factors predictive of contralateral clinical and imaging-documented disease progression.

Methods

The authors reviewed the clinical and imaging records of all patients with moyamoya syndrome and unilateral disease who underwent cerebral revascularization surgery between January 1985 and June 2006 by using a standardized surgical procedure, pial synangiosis.

Results

Of 235 surgically treated patients with moyamoya syndrome, 33 (14%) presented with unilateral disease (4 adults and 29 children). There were 16 female and 17 male patients, with an average age of 10.4 years (26.8 years for adults and 8.1 years for children; range 1.5–39 years). Twenty patients presented with left-sided disease and 13 with right-sided disease.

The average follow-up after surgery was 5.3 years (3.1 years for adults and 5.6 years for children; range 1–16 years). During this period, 10 (30%) of 33 patients progressed to bilateral disease. The mean time until disease progression was 2.2 years (range 0.5–8.5 years). Factors associated with progression in this series included contralateral abnormalities on initial angiography, previous history of congenital cardiac anomaly, cranial irradiation, Asian ancestry, and familial moyamoya syndrome. Young age at diagnosis was associated with a more rapid rate of progression (age < 7 years, 0.9 years to progression and age ≥ 7 years, 3.1 years to progression).

Conclusions

Of patients with unilateral moyamoya syndrome, 30% will have progression of arteriopathy during long-term follow-up. In this series, the average time of progression from unilateral to bilateral angiographic disease was 2.2 years. Several factors, including contralateral abnormalities on initial imaging, congenital cardiac anomaly, previous cranial irradiation, Asian ancestry, and familial moyamoya syndrome, were associated with an increased risk of progression. Patients with known unilateral angiographic disease should undergo continued monitoring by using MR imaging and MR angiography at regular intervals. Treatment with pial synangiosis is safe and confers durable protection against stroke in patients with both bilateral and unilateral moyamoya syndrome.
Thirty-year follow-up after extracranial–intracranial bypass surgery
Authors: Reichman O. Howard , Duckworth Edward A. M. , Anderson Douglas E. , Origitano Thomas C.
Published: February 2008

✓The conventional wisdom resulting from the international, multicenter, trial of extracranial–intracranial bypass surgery is that this procedure offers no benefit. Because of the complex and unique circumstances of some, clinical experience and judgment must sometimes overrule some statistical conclusions.