bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Transcriptome Sequencing Confirms Activation of a Cryptic Splice Site in Suspected SYNGAP1-Related Disorder
Authors: Brimble Elise , Lee-Messer Christopher , Nagy Peter L. , Propst Jennifer , Ruzhnikov Maura R.Z.
Published: August 2018

SYNGAP1 encodes a brain-specific Ras GTPase activating protein (GAP) that regulates synaptic strength in glutamatergic neurons. Pathogenic variants in this gene are associated with a neurodevelopmental disorder characterized by intellectual and developmental disabilities, generalized epilepsy, hypotonia, and autism spectrum disorders. We describe a young male with suspected SYNGAP1-related disorder given clinical overlap and identification of an intronic variant of uncertain significance; clinical transcriptome analysis demonstrated activation of a cryptic acceptor splice site resulting in frameshift and introduction of a stop codon. This report highlights the utility of functional studies newly available to clinical practice in confirming a suspected genetic diagnosis, which can directly impact medical management and preclude the need for additional diagnostic testing.
Optimising SME Potential in Modern Healthcare Systems: Challenges, Opportunities and Policy Recommendations
Authors: Horgan Denis , van Kranen Henk J. , Morré Servaas A.
Published: August 2018

The expansion of European small and medium-sized enterprises (SMEs) into the healthcare innovation arena suggests that this should be an important EU policy priority that can significantly benefit the economy, society and citizens, including patients. Deepening and widening of Europe’s SMEs’ growth and activities is part of the EU objectives as set out by the European Commission in its Communications “Small Business Act” for Europe [1] and “Small Business, Big World” [2]. However, innovative healthcare SMEs have struggled to get traction despite the sector being worth more than EUR 250 billion. The 1991 Maastricht Treaty gave the Union new competences in public health and more scope for cross-border cooperation in this area [3]. Nevertheless, health initiatives here have tripped over each other, due to the fact that the delivery of healthcare is a national competence [4]. As such, EU healthcare-driven policy has never truly found its footing as a singular policy area despite the fact that a tenth of the EU’s GDP is spent on healthcare and more than 17 million people are employed in Europe in this sector [5]. Taking into account the necessity of bringing innovation into healthcare, and the willingness of SMEs to undertake the risk to be at the forefront of it, there is a need for a renewed effort to support SMEs so as to provide solutions for citizens and patients throughout the bloc in different healthcare settings [6]. This policy paper brings together two separate strands of analysis: firstly, a policy review of the main challenges and opportunities; secondly, a proposal for policy recommendations.
A Systematic Review of the Prevalence of Atopic Diseases in Children on the Arabian Peninsula
Authors: Al-Herz Waleed
Published: August 2018

Objectives: To study the available data on the prevalence of atopic diseases and food allergy in children living on the Arabian Peninsula. Methods: A PubMed search for relevant published articles was conducted using the following search terms singly or in combination: “atopy,” “atopic disease,” “atopic disorder,” “International Study of Asthma and Allergies in Childhood,” “ISAAC,” “asthma,” “allergic rhinitis,” “eczema,” and “food allergy” in combination with the names of countries of the Arabian Peninsula (Kuwait, United Arab Emirates, Bahrain, Qatar, Oman, Kingdom of Saudi Arabia, and Yemen). The search captured studies published up to December 2017. Results: A total of 8 publications reporting prevalence rates of any type of atopic disease in children in 7 countries of the Arabian Peninsula were retrieved. The prevalence of all atopic disorders was comparable between countries of the Arabian Peninsula. The overall prevalence of asthma ranged from 8 to 23%, while the reported prevalence of eczema ranged from 7.5 to 22.5%. There was great variation in the prevalence rates of rhinoconjunctivitis, which ranged from 6.3 to 30.5%. The prevalence of food allergy (8.1%) was reported for 1 country only, the United Arab Emirates. Conclusions: The reported overall rates of atopic disease in countries of the Arabian Peninsula are comparable to those reported in other industrialized countries. This is probably related to the good economic status in the region, which is reflected in the living standards and lifestyle. Further, genetic factors, such as factors related to gene polymorphism, and the high rate of consanguinity in the region may contribute to the higher prevalence of atopic diseases.
The Groundwork for Dialectic in Statesman 277a-287b
Authors: Smith Colin C.
Published: August 2018

In Plato’sStatesman, the Eleatic Stranger leads Socrates the Younger and their audience through an analysis of the statesman in the service of the interlocutors’ becoming “more capable in dialectic regarding all things” (285d7). In this way, the dialectical exercise in the text is both intrinsically and instrumentally valuable, as it yields a philosophically rigorous account of statesmanship and exhibits a method of dialectical inquiry. After the series of bifurcatory divisions in theSophistand earlyStatesman, the Stranger changes to a non-bifurcatory method of dividing to account for the statesman, but does not explain the reason for this change. I argue that the change is prepared by the elements discussed in the digression from 277a2 to 287b2. Here the Stranger makes use of four concepts that are crucial for understanding this change: the notion ofparadigm, the paradigms ofcareandthe weaver, and the notion ofdue measure. I claim that the notion of paradigm clarifies the nature of dialectical inquiry, care and weaving act as paradigms appropriate to dialectical practice, and an account of due measure offers insight into the constitutive ratios that govern the structuring of kinds pursued through dialectical inquiry. I suggest that the non-bifurcatory method is intended to articulate knowledge in the strictest sense, or knowledge of the forms, presenting a method of inquiry into being and its structure that will foster the turning of the soul from things to forms that Socrates describes in theRepublic.
Redescription of Nigrobaetis rhithralis (Soldán & Thomas, 1983) (Ephemeroptera: Baetidae)
Authors: GODUNKO ROMAN J. , MARTYNOV ALEXANDER V. , GATTOLLIAT JEAN-LUC
Published: August 2018

Nigrobaetis rhithralis (Soldán & Thomas, 1983) is completely redescribed at larval and imaginal stages of both sexes based on the type material. This species and the closely related Palaearctic species Nigrobaetis digitatus (Bengtsson, 1912) were compared to clarify their relationships. Several new distinguishing characters useful for separation of these two species are proposed and discussed; they may be further used to distinguish cryptic species within the genus Nigrobaetis Novikova & Kluge, 1987.
Odonata from protected areas in Colombia with new records and description of Cora verapax sp. nov. (Zygoptera: Polythoridae)
Authors: BOTA-SIERRA CORNELIO ANDRÉS , SÁNCHEZ-HERRERA MELISSA , PALACINO-RODRÍGUEZ FREDY
Published: August 2018

Colombia is one of the megadiverse countries in the world, but paradoxically it is one of the less explored. The recent red list assessments show the country has the highest number of endangered species in the Neotropical region. Nevertheless, the sampling effort is low especially in protected areas, which probably can harbor some of the rare species included in the red list. As a result of recent surveys in six protected areas of Colombia, we report twelve new records and describe Cora verapax sp. nov., a rare species, collected after more than 300 days of field surveys at the National Natural Park Tatamá. In addition, we compiled and mapped published Odonata records from 2001 until now for Colombian protected areas (136 spp.). Among the new records, some species were formerly known as endemics from Panama and Ecuador, and five species are reported for the first time inside protected areas, showing the importance of surveys in these special territories and bringing new data for conservation actions, as red list assessment or future management plans.
Relationships between Deep Convection Updraft Characteristics and Satellite-Based Super Rapid Scan Mesoscale Atmospheric Motion Vector–Derived Flow
Authors: Apke Jason M. , Mecikalski John R. , Bedka Kristopher , McCaul Eugene W. , Homeyer Cameron R. , Jewett Christopher P.
Published: August 2018

Rapid acceleration of cloud-top outflow near vigorous storm updrafts can be readily observed in Geostationary Operational Environmental Satellite-14 (GOES-14) super rapid scan (SRS; 60 s) mode data. Conventional wisdom implies that this outflow is related to the intensity of updrafts and the formation of severe weather. However, from an SRS satellite perspective, the pairing of observed expansion and updraft intensity has not been objectively derived and documented. The goal of this study is to relate GOES-14 SRS-derived cloud-top horizontal divergence (CTD) over deep convection to internal updraft characteristics, and document evolution for severe and nonsevere thunderstorms. A new SRS flow derivation system is presented here to estimate storm-scale (<20 km) CTD. This CTD field is coupled with other proxies for storm updraft location and intensity such as overshooting tops (OTs), total lightning flash rates, and three-dimensional flow fields derived from dual-Doppler radar data. Objectively identified OTs with (without) matching CTD maxima were more (less) likely to be associated with radar-observed deep convection and severe weather reports at the ground, suggesting that some OTs were incorrectly identified. The correlation between CTD magnitude, maximum updraft speed, and total lightning was strongly positive for a nonsupercell pulse storm, and weakly positive for a supercell with multiple updraft pulses present. The relationship for the supercell was nonlinear, though larger flash rates are found during periods of larger CTD. Analysis here suggests that combining CTD with OTs and total lightning could have severe weather nowcasting value.
On the Extraordinary Intensification of Hurricane Patricia (2015). Part I: Numerical Experiments
Authors: Qin Nannan , Zhang Da-Lin
Published: August 2018

Hurricane Patricia (2015) broke records in both peak intensity and rapid intensification (RI) rate over the eastern Pacific basin. All of the then-operational models predicted less than half of its extraordinary intensity and RI rate, leaving a challenge for numerical modeling studies. In this study, a successful 42-h simulation of Patricia is obtained using a quintuply nested-grid version of the Weather Research and Forecast (WRF) Model with the finest grid size of 333 m. Results show that the WRF Model, initialized with the Global Forecast System Final Analysis data only, could reproduce the track, peak intensity, and many inner-core features, as verified against various observations. In particular, its simulated maximum surface wind of 92 m s−1 is close to the observed 95 m s−1, capturing the unprecedented RI rate of 54 m s−1 (24 h)−1. In addition, the model reproduces an intense warm-cored eye, a small-sized eyewall with a radius of maximum wind of less than 10 km, and the distribution of narrow spiral rainbands. A series of sensitivity simulations is performed to help understand which model configurations are essential to reproducing the extraordinary intensity of the storm. Results reveal that Patricia’s extraordinary development and its many inner-core structures could be reasonably well simulated if ultrahigh horizontal resolution, appropriate model physics, and realistic initial vortex intensity are incorporated. It is concluded that the large-scale conditions (e.g., warm sea surface temperature, weak vertical wind shear, and the moist intertropical convergence zone) and convective organization play important roles in determining the predictability of Patricia’s extraordinary RI and peak intensity.
Enhancing Peer Network Interventions for Students With Complex Communication Needs
Authors: Biggs Elizabeth E. , Carter Erik W. , Bumble Jennifer L. , Barnes Kelli , Mazur Erica L.
Published: August 2018

Educators need effective ways to build the communication skills of students learning to use aided augmentative and alternative communication (AAC) and support their interactions with peers. This study used a multiple-probe-across-participants design to evaluate the effectiveness of a paraprofessional-facilitated peer network intervention to (a) increase peer interaction for students with complex communication needs and (b) investigate whether embedding peer-implemented aided AAC modeling within the intervention would increase students’ use of symbolic communication (i.e., aided AAC, signs, speech). Participants were four elementary-age students with intellectual disability or autism who used a speech-generating device or communication book. The peer network increased students’ overall interactions with peers but not their symbolic communication. Teaching peers to use aided AAC modeling through brief training and coaching resulted in increasing students’ use of symbolic communication within interactions with peers. Implications are offered related to supporting peer interaction, improving symbolic communication skills, and involving peers in social-communication interventions.
Commentary on Robert Romanyshyn’s “Diagnostic Fictions”
Authors: Kamens Donald
Published: August 2018

The practicing psychologist can only welcome the journey that Robert Romanyshyn invites us on, as he asks us to examine our daily work, our use of the Diagnostic and Statistical Manual of Mental Disorders, and imagine a different, literary model. In taking steps along those paths, we can only anticipate the release of his even more extensive work on the topics he approaches, a book, The Frankenstein Prophesies. Many of us await that release with anticipation for the additional gifts it no doubt will bear.
An Emergent Taxonomy of Public Personnel Management: Exploring the Task Environment of Human Resource Managers in Spanish Local Government
Authors: Herrera Justo , Miller Daniel M.
Published: August 2018

This study presents a taxonomy for public personnel management based on emergent profiles of local human resource managers in Spain. The analysis focuses on the task environments of managers defined by three salient constructs from strategic human resources management research. Specifically, this study looks at the level of participation of human resource managers in strategic-level policy-making processes, vertical and horizontal policy integration, and the flexibility of human resource managers in interpreting and implementing key functions of personnel management (i.e., recruitment, hiring, and remuneration). The results yield five distinct profiles that describe different approaches of human resource management. The five profiles include Technical Administrative (TA); Technical Functional (TF); Managerial Administrative (MA); Managerial Functional (MF); and Strategic Executive (SE). The profiles are not a linear typology of human resource management practices. However, they do fit within a larger theoretical framework that captures central constructs of strategic human resource management (SHRM).
Meta-Teams: Getting Global Work Done in MNEs
Authors: Santistevan Diana , Josserand Emmanuel
Published: August 2018

To allow for flexibility and global integration in multinationals, global teams are becoming more fluid, forming and dispersing quickly to address organizational needs. The coordination that takes place in these temporary agile teams is critical for global work. However, current conceptualizations of teams and methodological approaches do not provide a clear understanding of dynamic global teams and how they get global work done in multinational enterprises (MNEs). To address this, we mobilize the teaming perspective to explore global work in the complex matrix structure of Computer (a pseudonym), a large technology MNE. Our study includes interviews and observations from 40 global account teams. The findings suggest that an intermediate structure, which we call a meta-team, provides a referential space that supports teaming. Within the meta-team, operational practices and a common mind-set provide guidelines for member behavior and expectations. Additionally, teaming substructures form and change to adapt to activities. This study contributes to the literature by (1) demonstrating how dynamic global work gets done in MNEs through meta-teams and teaming; (2) showing how meta-teams address some of the challenges of global work, such as fluid collaboration and multiple-team participation; and (3) providing new insights for teaming in context and temporary work.
The role of space attributes in space-choice behaviour and satisfaction in an academic library
Authors: Cha Seung Hyun , Kim Tae Wan
Published: August 2018

Space attributes concern both users’ space-choice behaviour (i.e. where to sit) and satisfaction (i.e. level of satisfaction in the chosen seat). However, the effects of space attributes in academic libraries have most often been investigated with a separate focus on either space-choice behaviour or user satisfaction. Since library contexts vary greatly, it is unreasonable to compare findings from existing separate-focus studies. The present study thus aims to conjointly investigate the effects of space attributes on space-choice behaviour and user satisfaction from the same context of an academic library. For this purpose, a questionnaire survey was conducted and the data were explored in a series of statistical analyses. As a result, the study demonstrates that the influence of some space attributes differs between space choice and satisfaction. Once generalized in future studies of a wider variety of academic libraries, these findings should help architects to make better-informed decisions in library space-planning and design, leading to more efficient use of space and enhanced user satisfaction.
The Balancing Act: Mothers’ Experiences of Providing Care to Their Children With Cancer
Authors: Molinaro Monica L. , Fletcher Paula C.
Published: August 2018

The effect of pediatric cancer and its treatment are overwhelming—these effects are multifaceted and felt by the entire family unit throughout the diagnosis and treatment process. Children experience a plethora of effects as a result of the treatment process; however, it is imperative to remember that a pediatric cancer diagnosis affects parents physically, emotionally, and psychologically as well. While much of the pediatric cancer treatment occurs at the hospital or in clinics, parents are often faced with additional caregiving responsibilities at home, and in many cases, it is mothers who provide care to their children, while also attempting to care for the siblings of their ill children. This secondary data analysis examines the caregiving responsibilities of mothers from Southern Ontario, Canada, during the time from diagnosis to after their children’s pediatric cancer treatment. Three subthemes emerged from the overall theme of caregiving: (1) “We tried to do as much as we could outside of the clinic,” (2) “I had to be there for everything,” and (3) “Most of the time we relied on other people.” Each will be discussed in turn. The findings from this work provides insight to health care professionals on how to create or improve the current supports and resources provided to caregivers of children with cancer.
Parent–Child Closeness and Parents’ Meaning in Life in Personal Meaning in Life
Authors: Yu Elizabeth A. , Chang Edward C.
Published: August 2018

We examined for ethnic differences in how parent–child closeness and parents’ meaning in life predict personal meaning in life between 187 Asian American and 201 European American college students. Results indicated that parent–child closeness predicted a significant amount of variance in personal meaning in life for both groups. Furthermore, parents’ meaning in life added a significant amount of variance, above and beyond parent–child closeness, in predicting personal meaning in life for Asian Americans, but not for European Americans. Our findings indicate that although parents play some role in contributing to college-aged individuals’ meaning in life, there are still important ethnocultural nuances to consider. Findings from the present study provide a foundation for further research to continue examining the role of parents and familial relationships in meaning in life and other well-being outcomes. Further discussion of the study’s findings and implications are discussed.
The Effects of Alcohol and Substance Use on a Couple System
Authors: Molla Elizabeth , Tadros Eman , Cappetto Michelle
Published: August 2018

This case study aims to analyze the effects of alcohol and substance use on a couple system. An African American, heterosexual couple was selected for analysis due to dual alcohol and substance use negatively impacting their relationship in addition to generalized anxiety and major depressive disorder. The reliance of alcohol and substance use to cope with relational stressors and mental health systems was detrimental to the relationship. The clients initially presented with trust issues stemming from infidelity; throughout the course of treatment, it became apparent the alcohol and substance use was hindering the couple’s ability to repair trust and meet their other clinical goals. The couple struggled to find alternative means of coping outside of alcohol and substance use, exacerbating their toxic patterns of interaction. This study displays how cognitive behavioral therapy interventions can be implemented within alcohol and substance abuse context to create change in a couple system.
Enhancing Lysosomal Activation Restores Neural Stem Cell Function During Aging
Authors: Audesse Amanda J , Webb Ashley E
Published: August 2018

Adult neurogenesis supports cognitive and sensory functions in mammals and is significantly reduced with age. Quiescent neural stem cells are the source of new neurons in the adult brain and emerging evidence suggests that the failure of these cells to activate and re-enter the cell cycle is largely responsible for reduced neurogenesis in old animals. However, the molecular mechanisms supporting quiescence and activation in the adult and aged brain remain undefined. Recent work published by Leeman et al. in Science uncovers a novel role for lysosomes in supporting neural stem cell activation, and reveals that loss of lysosome function during aging contributes to reduced neural stem cell activity. Using a combination of transcriptomics and functional analysis, the authors show that quiescent and activated neural stem cells employ different branches of proteostasis networks, with quiescent stem cells particularly dependent on the lysosome-autophagy system. Excitingly, stimulation of lysosomal activity in the aged quiescent population significantly enhanced their ability to activate and increased the frequency of activated neural stem and progenitor cells within the neural stem cell niche. This work for the first time identifies lysosomal dysfunction as a cause of reduced neurogenesis during aging, and shows that enhancing lysosomal function is sufficient to restore healthy stem cell activity in the aged brain.
Yearning for affection: Traumatic bonding between Korean ‘comfort women’ and Japanese soldiers during World War II
Authors: Ahn Yonson
Published: August 2018

This work analyses the complex and contentious issues of mutual affection and codependency in relationships between Korean ‘comfort women’ and Japanese soldiers during World War II. Drawing on a combination of interviews and published resources, it explores the groups’ perceptions of one another within the framework of ‘traumatic bonding’. Despite traumatic violence and stark inequalities, this article finds nuanced contributions from the parties involved. For the soldiers, the relationships provided a form of emotional relief from the violence of war and from the oppression they themselves were subjected to by those of superior rank within the military hierarchy, while the women often sought kindness and protection from the military men with whom they had formed relationships. However, underneath the yearning for human connection, these relationships were highly complex and deeply affected by the overarching power dynamics of gender and the racialised colonial hierarchy.
Children’s experiences of being diagnosed with cancer at the early stages of treatment; an interpretive phenomenological analysis
Authors: Mant Jill , Kirby Angela , Cox Kathy J , Burke Amos
Published: August 2018

Being given a diagnosis of cancer is a significant and highly distressing event for both children and their families, but little research has been done to explore and understand children’s feelings. This study aims to understand from the child’s perspective what it feels like to be told you have cancer, with the hope that increased understanding can lead to improved communication and support for children and families. The study uses qualitative methodology. Six children aged 8–12 years with a new diagnosis of cancer took part in two semi-structured interviews at least one week apart. The interviews were conducted using the draw and write technique. The results were analysed using interpretative phenomenological analysis. The report describes the five super-ordinate themes that were identified; initially I felt shocked and scared, chemo is an awful thing, please talk to me; the more I know the better I feel, I will accept treatment and quickly get used to it because I know I will get better and, finally, my family are vital. Implications for clinical practice are discussed. The report highlights the research limitations and areas for future studies.
Stereotactic Radiotherapy for Pulmonary Oligometastases From Colorectal Cancer: A Systematic Review and Meta-Analysis
Authors: Jingu Keiichi , Matsushita Haruo , Yamamoto Takaya , Umezawa Rei , Ishikawa Yojiro , Takahashi Noriyoshi , Katagiri Yu , Takeda Kazuya , Kadoya Noriyuki
Published: August 2018

Purpose:

The purpose of this study was to determine whether pulmonary oligometastases from colorectal cancer have greater radioresistance than that of pulmonary oligometastases from other cancers and whether good local control can be achieved by dose escalation in stereotactic body radiotherapy.

Materials and Methods:

This systematic review and meta-analysis were conducted according to the preferred reporting items for systematic reviews and meta-analyses statement and methods. Studies were obtained from a database search of PubMed, Web of Science, and Google Scholar for publications using search terms designed to identify studies on “oligometastases,” “lung,” “stereotactic radiotherapy,” and “colorectal cancer.” For meta-analysis 1, studies that showed the number of local failures after stereotactic body radiotherapy for pulmonary metastases from colorectal carcinoma and other cancers were included. For meta-analysis2, studies in which a comparison was made of local control rates of pulmonary metastases from colorectal carcinoma by stereotactic body radiotherapy with a higher dose and that with a lower dose were included. A meta-analysis was performed using Mantel-Haenszel statics with the fixed or random-effect model by Review Manager 5.3.

Results:

Eighteen retrospective studies with 1920 patients with pulmonary oligometastases were used in meta-analysis 1. The local control rate in patients with pulmonary oligometastases from colorectal cancer was significantly lower than that in patients with pulmonary oligometastases from other cancers (odds ratio = 3.10, P < .00001). Next, 8 retrospective studies with 478 patients were included in meta-analysis 2 for dose escalation. Better local control was achieved by a higher prescription dose than by a lower prescription dose (odds ratio = 0.16, P < .00001).

Conclusion:

Our meta-analysis indicated that local control of pulmonary oligometastases from colorectal cancer by stereotactic body radiotherapy was significantly worse than that of pulmonary metastases from other cancers; however, our results also indicated that good local control of pulmonary oligometastases from colorectal cancer can be achieved by dose escalation.
Comparative experimental studies of acoustic emission characteristics of sandstone and mudstone under the impacts of cyclic loading and unloading
Authors: Zhao Guangming , Wang Chao , Liang Dongxu
Published: August 2018

In this article, the acoustic emission tests of uniaxial cyclic load imposed on or released from the sandstone and mudstone were carried out. The deformation and failure characteristics and the law governing the acoustic emission activity were studied. The results of the study show that (1) the variation of acoustic emission events of sandstone and mudstone is law governed and is in agreement with the tendency of stress and strain curve development. (2) The acoustic emission activity of mudstone is most active before peak stress, while sandstone is at peak stress. For the sandstone, when the number of acoustic emission events is the most active, the corresponding acoustic emission energy is not the largest. However, the peak value of acoustic emission events and the peak energy of the mudstone coincide, and the acoustic emission events get to the most intense due to the peak energy. (3) The acoustic emission activity is more severe when a load is imposed on or released from the rock. Compared to loading, the rock damage caused by unloading is even greater. (4) The acoustic emission event at the splitting point is more concentrated. The line of acoustic emission point is basically consistent with the shape of the split.
Force transmission mechanism of a new joint of concrete-filled rectangular steel tubular column under axial compression
Authors: Xu Na , Zou Dujian , Fu Xueyi
Published: August 2018

In this study, a new joint of concrete-filled rectangular steel tube column was proposed and analyzed. The force transmission components include distribution beams and inner periphery ribs in the floor node area. The stress behavior of the new proposed concrete-filled rectangular steel tube column under axial compressive load was investigated. It was found that the force transmission components coordinate the force and deformation of external steel tube and internal concrete. This indicates that the steel tube and concrete can work together to bear external load. Our previous test results also show that arranging force transmission components in the floor node area can improve the mechanical behavior of a concrete-filled rectangular steel tube column. Finally, a design method of force transmission component distribution beam is proposed, which provides a reference for the structural designer to use the new concrete-filled rectangular steel tube joint in actual engineering.
Evaluation of Ultrastructural Changes in Paranasal Sinus Mucosa after Functional Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis
Authors: Keleş Nesil , Ahıshalı Bülent , Ilıcalı Ö. Cenker , Değer Kemal
Published: August 2018

The purpose of this study was to compare the preoperative and postoperative ultrastructural changes of paranasal sinus mucosa in patients treated with functional endoscopic sinus surgery for chronic rhinosinusitis. Twelve patients undergoing functional endoscopic sinus surgery for the treatment of chronic rhinosinusitis were involved. The ethmoid sinus mucosa was sampled during the operation and ∼6 months after the operation. The ciliated epithelium of sinus mucosa was evaluated with transmission electron microscopy. The samples were taken at the Otolaryngology Department of Istanbul University School of Medicine. Electron microscopic study was performed at the Histology and Embryology Department of the same University. Preoperatively, ciliated epithelial cells of the sinus mucosa of the patients showed degenerated ultrastructure with decreased number of cilia, cytoplasmic protrusions, cisternal dilatations of endoplasmic reticulum, and mitochondrial swellings. Remnants of degenerated cells and cellular separations at cell junctions were evident in the diseased epithelium. Goblet cells were frequent along the epithelial lining. Postoperatively, normal architecture and ultrastructure of the ciliated epithelium was restored. These observations showed that unlike other surgical operations, paranasal sinus mucosa can regenerate and the ciliated epithelium can return to normal after functional endoscopic sinus surgery.
Endoscopic Resection of Esthesioneuroblastoma
Authors: Casiano Roy R. , Numa William A. , Falquez Alberto M.
Published: August 2018

Esthesioneuroblastoma (olfactory neuroblastoma) is a rare malignant neoplasm originating from neuroepithelial cells. Treatment for this tumor has traditionally required a craniofacial resection through an external approach. The safety and efficacy of transnasal endoscopic resection is unknown. A series of five patients with Kadish stage A or B lesions of the anterior skull base were resected and immediately reconstructed endoscopically over a nine-year period. There were 2 males and 3 females with a mean age of 64 years. Three patients were treated primarily and two were treated secondarily for recurrences after failing a traditional external craniofacial resection and postoperative radiotherapy. All primary lesions received adjuvant radiotherapy. The mean follow-up time was 31 months. All patients were discharged within 4 days or less. Operative complications included temporary postoperative infraorbital anesthesia (1 patient), unplanned cerebrospinal fluid leak (1 patient), and an orbital hematoma (1 patient). None of these complications resulted in any permanent sequelae. Two patients had prolonged nasal crusting for up to one year due to a variety of factors; large cavities, radiation therapy, and exposed lyophilized dural graft. However, all skull base defects healed without any short- or long-term sequelae. There have been no local recurrences. Two patients (1 primary and 1 secondary) developed regional metastasis to the orbit or cervical lymph nodes managed with primary transorbital excision or modified neck dissection, respectively. All but one patient remain free of disease by clinical, endoscopic, and radiographic (CT or MRI) surveillance. The remaining patient recurred distally as an undifferentiated carcinoma in his temporal bone and lungs 12 months after the initial resection. In experienced hands select cases of esthesioneuroblastoma can be safely excised and reconstructed endoscopically with comparable degrees of tissue removal as with external approaches. Short-term oncologic results in this small series of patients appear to be comparable to traditional methods. Longer follow-up on a larger series of patients is warranted.
An Immunohistological Study of the Localization Characteristics of Thymus and Activation-Regulated Chemokine in the Allergic Inferior Turbinate Mucosa with Reference to the Effectiveness of Trichloroacetic Acid Treatment
Authors: Yao Kazuo , Iguchi Yoshiaki , Sato Kentaro , Nishiyama Kouichiro , Suzuki Tatsutoshi , Yamamoto Kazuhiro , Okamoto Makito
Published: August 2018

To investigate the background of the effectiveness of trichloroacetic acid (TCA) treatment, we examined the localization of thymus and activation-regulated chemokine (TARC) on allergic inferior turbinate mucosa using immunohistological methods. After obtaining informed consent, only one side of the inferior turbinate was treated with 80% (wt/vol) TCA solution under topical anesthesia using 4% lidocaine with epinephrine in 19 cases of allergic rhinitis. Among those, 17 cases did not show clinical improvement and underwent nasal septal reconstruction surgery and turbinectomy. Bilateral inferior turbinate specimens were obtained. The untreated turbinate specimens showed positive TARC findings. The positive findings were confirmed in the outer side of cytoplasm in the stratified ciliated columnar epithelium but not in the goblet cell. In the lamina propria, the glandular tissue and a few of the infiltrated lymphocytes just beneath the epithelium up to the depth of 120 m were found TARC-positive (TARC+). The average number of positive cells in one microscopic visual field using 1003 magnification was 3.97 6 4.04. On the other hand, the epithelium of the TCA-treated side showed positive findings only in two cases. The TCA-treated side also showed a relative decrease in infiltrated cells. Even in areas where there still were infiltrated cells, they were confirmed to be TARC-negative (TARC2) after TCA treatment. It is considered that the regenerated epithelium after TCA treatment originates from the glandular epithelium with negative TARC expression existing in the area deeper than a 120-μm level and that this immunohistological change would lead to the effectiveness of TCA treatment.
Presence and Characterization of Sensitization to Staphylococcal Enterotoxins in Patients with Allergic Rhinitis
Authors: Okano Mitsuhiro , Takishita Teruaki , Yamamoto Takayoshi , Hattori Hisashi , Yamashita Yasuhiko , Nishioka Shinji , Ogawa Teruhiro , Nishizaki Kazunori
Published: August 2018

Exotoxins derived from Staphylococcus aureus appear to be involved in the pathogenesis of allergic diseases, especially atopic dermatitis (AD). However, little is known about sensitization to enterotoxins in cases of respiratory allergies. Because the nasal cavity is a primary site of colonization by S. aureus, we sought to determine the prevalence and role of serum immunoglobulin E (IgE) antibodies against staphylococcal enterotoxin A (SEA) and SEB in patients with allergic rhinitis (AR). The presence of SEA- and SEB-specific IgE was determined in 40 patients with AR and 16 healthy control subjects. In the rhinitis group, nasal symptom score, total serum IgE, sensitization to other inhaled allergens and the presence of sinusitis were determined. Twenty-five percent of patients with AR were sensitized to SEA/SEB whereas 6.3% of controls were sensitized to the toxins. Sensitization to SEB was predominant relative to SEA. There were no significant differences in the severity of nasal symptoms and complications of other allergic diseases including AD and bronchial asthma, between patients with or without sensitization to SEA/SEB. However, patients sensitized to these toxins were likely to show increased total serum IgE and polyvalent sensitization, suggesting that exposure and subsequent sensitization to SEA/SEB may be involved in polyvalent sensitization.
Antibiotic Prophylaxis in Rhinosurgery
Authors: Bandhauer Florian , Buhl Daniela , Grossenbacher Rudolf
Published: August 2018

Background

This study investigated the in vivo efficacy of nasal packing containing an antibiotic substance after septal and turbinate surgery on the potentially infectious nasal flora (Staphylococcus aureus, etc.) without systemic administration of antibiotics.

Methods

The study was designed as an exploratory randomized trial. Three types of packings were used on 110 patients because of septoplasty and/or turbinate surgery. Packings were distributed randomly among three groups. The first and second groups received an antibiotic-free sample (polyvinyl acetate sponge and cotton gauze strips with sea-salt ointment) and the third group received an antibiotic one (cotton gauze strips with polymyxin-B-sulfate and oxytetracycline ointment). The nasal flora was determined by microscopy and cultures, both preoperatively and after elimination of the packing.

Results

Significantly less growth of the potentially infectious nasal flora overall and of S. aureus in particular was found in the group with the antibiotic packing.

Conclusion

Antibiotic-containing nasal packing effectively inhibits potentially infectious germs (including S. aureus) in the nasal flora and secondarily may diminish the incidence of postoperative infections.
Correlation between the Minimal Cross-Sectional Area of the Nasal Cavity and Body Surface Area: Preliminary Results in Normal Patients
Authors: Jurlina Martin , Mladina Ranko , Dawidowsky Krsto , Ivanković Davor , Bumber Zeljko , Šubarić Marin
Published: August 2018

Nasal symptoms often are inconsistent with rhinoscopic findings. However, the proper diagnosis and treatment of nasal pathology requires an objective evaluation of the narrow segments of the anterior part of the nasal cavities (minimal cross-sectional area [MCSA]). The problem is that the value of MCSA is not a unique parameter for the entire population, but rather it is a distinctive value for particular subject (or smaller groups of subjects). Consequently, there is a need for MCSA values to be standardized in a simple way that facilitates the comparison of results and the selection of our treatment regimens. We examined a group of 157 healthy subjects with normal nasal function. A statistically significant correlation was found between the body surface area and MCSA at the level of the nasal isthmus and the head of the inferior turbinate. The age of subjects was not found a statistically significant predictor for the value of MCSA. The results show that the expected value of MCSA can be calculated for every subject based on anthropometric data of height and weight.
The Effect of Topical Xylometazoline on the Mucosal Temperature of the Nasal Septum
Authors: Lindemann Jörg , Leiacker Richard , Rettinger Gerhard , Keck Tilman
Published: August 2018

Background

The purpose of this study was to determine the short-term influence of the α2-adrenoreceptor agonist xylometazoline on the nasal mucosal temperature.

Methods

Thirty healthy subjects were enrolled into the study. Fifteen of these subjects got xylometazoline and 15 subjects, matched to age, got saline solution as control. A miniaturized thermocouple was used for continuous detection of the septal mucosal temperature without interruption of nasal breathing before and after application of nose spray.

Results

In the anterior nasal segment, the mucosal temperatures before decongestion were significantly higher than after decongestion (p < 0.05). These changes could not be found in the control group after saline solution. The mean end-expiratory mucosal temperatures were significantly higher than the end-inspiratory ones in both study groups (p < 0.005).

Conclusions

The reduction of the nasal mucosal blood flow because of vasoconstriction and the increase of the nasal cavity volume after decongestion with xylometazoline seem to cause a significant decrease of the septal mucosal temperature in the anterior nasal segment. This might be one possible causative factor of the common symptom of the “dry nose” in patients with nasal decongestant abuse.
Long-Term Follow-Up of Cellular Proliferation as a Predictive Index for the Relapse of Nasal Polyposis
Authors: Bruno Ernesto , Mohamed Ehab I. , Alessandrini Marco , Russo Sabino , Schiaroli Stefania , De Lorenzo Antonino , Di Girolamo Alberto
Published: August 2018

Background

The objective of this study was to identify a reproducible clinical parameter for predicting relapses of nasal polyposis after surgery.

Methods

Ninety-three patients who had undergone ethmoidectomy of bilateral nasal polyps were followed for 3 years. Nasal polyps were obtained from all patients, and cellular suspensions were analyzed individually using flow cytometry. Based on the percentage of cells in the S phase, we identified three groups of patients (high, medium, and low percentages).

Results

A relapse of nasal polyposis was observed in 15.00, 70.00, and 100.00% of patients from the low-, medium-, and high-percentage groups, respectively. Patients suffering relapses had a high percentage of cells in the S phase.

Conclusions

We identified two cutoff values for the percentage of cells in the S phase; above the first cutoff, some of the patients suffered relapses; above the second cut-off, all patients suffered relapses.
The Economic Burden and Symptom Manifestations of Chronic Rhinosinusitis
Authors: Bhattacharyya Neil
Published: August 2018

Background

The aim of this study was to delineate patient symptoms and economic burdens of chronic rhinosinusitis (CRS).

Methods

Adult patients with CRS were assessed prospectively with a survey instrument. Symptom scores for major and minor symptoms of CRS, medication use, physician visits for CRS, and work days missed were determined. Cost analyses were conducted.

Results

Three hundred twenty-two patients were studied prospectively (mean age, 42.3 years). Nasal obstruction and facial congestion were the most common and severe major symptoms, and headache and fatigue were the most common and severe minor symptoms. Patients received an average of 2.7 antibiotic courses and used nasal steroids and prescription antihistamines 18.3 and 16.3 weeks, respectively, in a 12-month period. Mean medical resource costs were $921 per patient-year. CRS caused an average of 4.8 days of missed work per 12-month period. The overall yearly economic cost of CRS was $1539 per patient.

Conclusion

Nasal and facial symptoms prevail over systemic and oropharyngeal symptoms in CRS. Significant medical resource expenditures and global economic costs accompany CRS.
The ABCs of Rhinophyma Management
Authors: Stucker Fred J. , Lian Timothy , Sanders Kenneth
Published: August 2018

Background

Rhinophyma is a benign inflammatory growth of the nose. It usually involves the caudal one-third of the nose in men. It not only affects the patient's appearance, but also can have profound functional implications. Many difficult treatment methods have been advocated, often with acceptable success. Because there appears to be no distinct advantages in the different therapeutic modalities, no one modality is universally endorsed.

Methods

We performed a retrospective review of patients from 1990–2001 who underwent treatment of their rhinophyma at Louisiana State University, Health Science Center and Overton Brooks Veteran's Hospital in Shreveport, LA. The tumescent anesthesia, Weck blade excision and argon beam coagulator technique (TWA) was used on 51 patients.

Results

Patients undergoing this technique have operating times no greater than ten minutes. The average blood loss was less than 5cc. No surgical complications were noted.

Conclusion

The TWA technique yields good cosmetic results and is cost-effective.
Phase Contrast Microscopy with Modified Hansel's Staining: Mast Cell Identification and Activity-Related Changes in Cell Membrane Refractivity in Allergic Nasal Smears
Authors: Masuko Masatoshi , Goto Fumiyuki
Published: August 2018

Background

A new technique called phase contrast microscopy with modified Hansel's staining (used with bright field microscopy) was developed to identify mast cells (MCs) and granulocytes (eosinophil/neutrophil/basophil [E/N/B]).

Methods

Nasal scratching smears from 618 patients with Japanese cedar pollinosis were examined using this new technique.

Results

This technique permitted accurate morphological identification. MCs can be discriminated from E/N/Bs. The surface of the cell membrane appeared as low refractile (lr), moderately refractile (mr), or high refractile (hr). This was caused by the light, which is not related to the phase difference, but rather originated from the difference in the refraction of the direct light. In specimens from the onset stage (i.e., 1–3 days after onset), lr-MC and mr/hr-E/N/B were dominant. In specimens from the early stage (i.e., 4–7 days after onset), lr-E/N/B significantly increased in number.

Conclusion

The phospholipid bilayers of the cell membrane exhibit a phase transition after the onset, and phase refractivity of the cell membrane is closely related to the activity of the cell. This indicates that in the onset stage, MCs are already activated, whereas most of the E/N/Bs are not. In contrast, the latter cell types become activated subsequently in the early stage.