bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of the novel contact heat evoked potential stimulator (CHEPS) for the assessment of small fibre neuropathy: correlations with skin flare responses and intra-epidermal nerve fibre counts
Authors: Atherton Duncan D , Facer Paul , Roberts Katherine M , Misra V Peter , Chizh Boris A , Bountra Chas , Anand Praveen
Published: August 2007

Background

The Contact Heat Evoked Potential Stimulator (CHEPS) rapidly stimulates cutaneous small nerve fibres, and resulting evoked potentials can be recorded from the scalp. We have studied patients with symptoms of sensory neuropathy and controls using CHEPS, and validated the findings using other objective measures of small nerve fibres i.e. the histamine-induced skin flare response and intra-epidermal fibres (IEF), and also quantitative sensory testing (QST), a subjective measure.

Methods

In patients with symptoms of sensory neuropathy (n = 41) and healthy controls (n = 9) we performed clinical examination, QST (monofilament, vibration and thermal perception thresholds), nerve conduction studies, histamine-induced skin flares and CHEPS. Skin punch biopsies were immunostained using standard ABC immunoperoxidase for the nerve marker PGP 9.5 or the heat and capsaicin receptor TRPV1. Immunoreactive IEF were counted per length of tissue section and epidermal thickness recorded.

Results

Amplitudes of Aδ evoked potentials (μV) following face, arm or leg stimulation were reduced in patients (e.g. for the leg: mean ± SEM – controls 11.7 ± 1.95, patients 3.63 ± 0.85, p = 0.0032). Patients showed reduced leg skin flare responses, which correlated with Aδ amplitudes (rs = 0.40, p = 0.010). In patient leg skin biopsies, PGP 9.5- and TRPV1-immunoreactive IEF were reduced and correlated with Aδ amplitudes (PGP 9.5, rs = 0.51, p = 0.0006; TRPV1, rs = 0.48, p = 0.0012).

Conclusion

CHEPS appears a sensitive measure, with abnormalities observed in some symptomatic patients who did not have significant IEF loss and/or QST abnormalities. Some of the latter patients may have early small fibre dysfunction or ion channelopathy. CHEPS provides a clinically practical, non-invasive and objective measure, and can be a useful additional tool for the assessment of sensory small fibre neuropathy. Although further evaluation is required, the technique shows potential clinical utility to differentiate neuropathy from other chronic pain states, and provide a biomarker for analgesic development.
Improvements in survival of the uncemented Nottingham Total Shoulder prosthesis: a prospective comparative study
Authors: Rosenberg Nahum , Neumann Lars , Modi Amit , Mersich Istvan J , Wallace Angus W
Published: August 2007

Background

The uncemented Nottingham Total Shoulder Replacement prosthesis system (Nottingham TSR) was developed from the previous BioModular® shoulder prosthesis taking into consideration the causes of the initial implant's failure.

We investigated the impact of changes in the design of Nottingham TSR prosthesis on its survivorship rate.

Methods

Survivorship analyses of three types of uncemented total shoulder arthroplasty prostheses (BioModular®, initial Nottingham TSR and current Nottingham TSR systems with 11, 8 and 4 year survivorship data respectively) were compared. All these prostheses were implanted for the treatment of disabling pain in the shoulder due to primary and secondary osteoarthritis or rheumatoid arthritis. Each type of the prosthesis studied was implanted in consecutive group of patients – 90 patients with BioModular® system, 103 with the initial Nottingham TSR and 34 patients with the current Nottingham TSR system.

The comparison of the annual cumulative survivorship values in the compatible time range between the three groups was done according to the paired t test.

Results

The 8-year and 11-year survivorship rates for the initially used modified BioModular® uncemented prosthesis were relatively low (75.6% and 71.7% respectively) comparing to the reported survivorship of the conventional cemented implants. The 8-year survivorship for the uncemented Nottingham TSR prosthesis was significantly higher (81.8%), but still not in the desired range of above 90%, that is found in other cemented designs. Glenoid component loosening was the main factor of prosthesis failure in both prostheses and mainly occurred in the first 4 postoperative years. The 4-year survivorship of the currently re-designed Nottingham TSR prosthesis, with hydroxylapatite coating of the glenoid baseplate, was significantly higher, 93.1% as compared to 85.1% of the previous Nottingham TSR.

Conclusion

The initial Nottingham shoulder prosthesis showed significantly higher survivorship than the BioModular® uncemented prosthesis, but lower than expected. Subsequently re-designed Nottingham TSR system presented a high short term survivorship rate that encourages its ongoing use
Paraganglioma of the greater omentum: Case report and review of the literature
Authors: Archontovasilis Fotios , Markogiannakis Haridimos , Dikoglou Christina , Drimousis Panagiotis , Toutouzas Konstantinos G , Theodorou Dimitrios , Katsaragakis Stilianos
Published: August 2007

Background

Extra-adrenal, intra-abdominal paraganglioma constitutes a rare neoplasm and, moreover, its location in the greater omentum is extremely infrequent.

Case presentation

A 46-year-old woman with an unremarkable medical history presented with an asymptomatic greater omentum mass that was discovered incidentally during ultrasonographic evaluation due to menstrual disturbances. Clinical examination revealed a mobile, non-tender, well-circumscribed mass in the right upper and lower abdominal quadrant. Blood tests were normal. Contrast-enhanced abdominal computed tomography (CT) scan confirmed a huge (15 × 15 cm), well-demarcated, solid and cystic, heterogeneously enhanced mass between the right liver lobe and right kidney. Exploratory laparotomy revealed a large mass in the greater omentum. The tumor was completely excised along with the greater omentum. Histopathology offered the diagnosis of benign greater omentum paraganglioma. After an uneventful postoperative course, the patient was discharged on the 4th postoperative day. She remains free of disease for 2 years as appears on repeated CT scans as well as magnetic resonance imaging (MRI) and scintigraphy performed with radiotracer-labeled metaiodobenzyl-guanidine (MIBG) scans.

Conclusion

This is the second reported case of greater omentum paraganglioma. Clinical and imaging data of patients with extra-adrenal, intra-abdominal paragangliomas are variable while many of them may be asymptomatic even when the lesion is quite large. Thorough histopathologic evaluation is imperative for diagnosis and radical excision is the treatment of choice. Since there are no definite microscopic criteria for the distinction between benign and malignant tumors, prolonged follow-up is necessary.
Microarray-based gene expression profiles in multiple tissues of the domesticated silkworm, Bombyx mori
Authors: Xia Qingyou , Cheng Daojun , Duan Jun , Wang Genhong , Cheng Tingcai , Zha Xingfu , Liu Chun , Zhao Ping , Dai Fangyin , Zhang Ze , He Ningjia , Zhang Liang , Xiang Zhonghuai
Published: August 2007

We designed and constructed a genome-wide microarray with 22,987 70-mer oligonucleotides covering the presently known and predicted genes in the silkworm genome, and surveyed the gene expression in multiple silkworm tissues on day 3 of the fifth instar. Clusters of tissue-prevalent and tissue-specific genes and genes that are differentially expressed in different tissues were identified, and they reflect well major tissue-specific functions on the molecular level. The data presented in this study provide a new resource for annotating the silkworm genome.
Complement C5a anaphylatoxin is an innate determinant of dendritic cell-induced Th1 immunity toMycobacterium bovisBCG infection in mice
Authors: Moulton Rachel A , Mashruwala Mary Anne , Smith Amanda K , Lindsey Devin R , Wetsel Rick A , Haviland David L , Hunter Robert L , Jagannath Chinnaswamy
Published: August 2007

During acquired immunity to Mycobacterium bovis bacillus Calmette-Guerin (BCG) infection in mice, dendritic cells (DCs) present mycobacterial antigens to naive T cells to prime an immune response. Complement C5a (anaphylatoxin) secreted by mycobacteria-infected macrophages regulates IL-12p70 production. As IL-12p70 regulates Th1 immunity against mycobacteria in mice, we examined the effects of C5a on IL-12p70 secretion by murine DCs and Th1 immunity. DCs cultured from C5-deficient (C5−/−) and -sufficient (C5+/+) mice were infected with BCG in the presence or absence of the C5a peptide. ELISA showed that C5−/− DCs secreted less IL-12p70 (600 pg/mL vs. 100 pg/mL) than C5+/+ DCs, and they secreted more IL-10. Using immunophenotyping, reduced CD40 expression was found on C5−/− DCs after BCG infection. BCG-primed DCs were then cocultured with naive or BCG-immune T cells to differentiate them into IFN-γ-secreting Th1 T cells. Coincident with increased IL-12p70 levels, BCG-primed C5+/+ DCs cocultured with naive or immune C5+/+ T cells showed a larger increase in CD4+ IFN-γ/CD8+ IFN-γ+ T cells compared with cocultured DCs and T cells from C5−/− mice. Thus, BCG-primed C5+/+ DCs were better able to drive a Th1 response. Furthermore, BCG aerosol-infected C5−/− mice showed reduced CD4 and CD8 IFN-γ-secreting T cells in the lungs, concurrent with an increased growth of BCG. Thus, C5a, an innate peptide, appears to play an important role in the generation of acquired immune responses in mice by regulating the Th1 response through modulation of IL-12p70 secretion from DCs.
Hypoxia causes an increase in phagocytosis by macrophages in a HIF-1α-dependent manner
Authors: Anand Rahul J , Gribar Steven C , Li Jun , Kohler Jeff W , Branca Maria F , Dubowski Theresa , Sodhi Chhinder P , Hackam David J
Published: August 2007

Phagocytosis is the process by which microbial pathogens are engulfed by macrophages and neutrophils and represents the first line of defense against bacterial infection. The importance of phagocytosis for bacterial clearance is of particular relevance to systemic inflammatory diseases, which are associated with the development of hypoxia, yet the precise effects of hypoxia on phagocytosis remain largely unexplored. We now hypothesize that hypoxia inhibits phagocytosis in macrophages and sought to determine the mechanisms involved. Despite our initial prediction, hypoxia significantly increased the phagocytosis rate of particles in vitro by RAW264.7 and primary peritoneal macrophages and increased phagocytosis of labeled bacteria in vivo by hypoxic mice compared with normoxic controls. In understanding the mechanisms involved, hypoxia caused no changes in RhoA-GTPase signaling but increased the phosphorylation of p38-MAPK significantly. Inhibition of p38 reversed the effects of hypoxia on phagocytosis, suggesting a role for p38 in the hypoxic regulation of phagocytosis. Hypoxia also significantly increased the expression of hypoxia-inducible factor-1α (HIF-1α) in macrophages, which was reversed after p38 inhibition, suggesting a link between p38 activation and HIF-1α expression. It is striking that small interfering RNA knockdown of HIF-1α reversed the effects of hypoxia on phagocytosis, and overexpression of HIF-1α caused a surprising increase in phagocytosis compared with nontransfected controls, demonstrating a specific role for HIF-1α in the regulation of phagocytosis. These data indicate that hypoxia enhances phagocytosis in macrophages in a HIF-1α-dependent manner and shed light on an important role for HIF-1α in host defense.
Evidence that Lipopolysaccharide-Induced Anorexia Depends upon Central, Rather than Peripheral, Inflammatory Signals
Authors: Wisse Brent E. , Ogimoto Kayoko , Tang Jingjing , Harris Marvin K. , Raines Elaine W. , Schwartz Michael W.
Published: August 2007

Systemic inflammatory stimuli cause anorexia and weight loss by disrupting the physiological regulation of energy balance. Mice lacking MyD88, an intracellular mediator of signal transduction activated by Toll-like receptor 4 or IL-1β receptors, are resistant to anorexia induced by the bacterial endotoxin lipopolysaccharide (LPS), despite a significant circulating cytokine response. Thus, we hypothesized that induction of a peripheral inflammatory response is insufficient to cause LPS-induced anorexia when MyD88 signaling in the central nervous system and other tissues is absent. To test this hypothesis, we used bone marrow transplantation (BMT) to determine if LPS-induced anorexia can be restored to MyD88-deficient mice by reconstituting their bone marrow with wild-type (WT) immune cells. We found that restoring WT circulating immune cells to mice lacking MyD88 conferred only a mild, short-lived anorexia in response to LPS, such that food intake was fully normalized by 20 h post injection (LPS 4.1 ± 0.5 g vs. vehicle 4.3 ± 0.3 g), whereas LPS-induced anorexia was profound and sustained in WT controls after either autologous BMT or sham BMT. Similarly, LPS-mediated induction of hypothalamic mRNA encoding IL-1β and TNFα was robust in both WT control groups but was absent in chimeric MyD88 mice, despite comparable peripheral inflammatory responses across the three groups. We conclude that LPS reduces food intake via a mechanism dependent on MyD88 signaling within brain and/or other tissues and that in the absence of this effect, robust stimulation of circulating immune cells cannot induce sustained anorexia.
Sounds from the Past the Acoustics of Sultan Hassan Mosque and Madrasa
Authors: El-Khateeb Ahmed Ali , Ismail Mostafa Refat
Published: August 2007

The Sultan Hassan Mosque and Madrasa is considered to be stylistically the most compact and unified of all of Cairo's Islamic monuments. Beside its main function as a place for prayer, its design also allows separate schools for teaching the four Sunni rites; both functions imply the importance of phonological cognition and intelligibility of speech.

The acoustical environment within the main Iwan of the Madrasa and Mosque of Sultan Hassan has been investigated and examined through field measurements and room simulation utilizing ODEON to assess the degree of speech intelligibility. The significance of acoustical performance within this space is highlighted in relation to form and texture. Criteria for good acoustics are compared with the spatial requirements and design guidelines. Although field measurements show high reverberation time and echoes at some of the points examined, it does not badly affect the ability of worshipers to follow and understand clearly what is said either in the Mihrab, a half cylinder directed to the Holy Ka'aba in Macca, or Minber (Pulpit). On the contrary it adds the depth and width required for this kind of spiritual performance.
Sound Absorption at Low Frequencies: Room Contents as Obstacles
Authors: de Melo Gustavo da S. V. , Gerges Samir N. Y. , Gibbs Barry M.
Published: August 2007

A description is given of sound absorption in small-furnished rooms at low frequencies. The objective of the work was to characterise room absorption due to contents such as furniture and to develop a model of absorption appropriate for a modal description of contained sound fields at low frequencies. In this paper, a preliminary study of the influence of furniture on low frequency room response was performed by introducing a “reference obstacle” at three positions within an enclosure which previously had been numerically modelled. Eigenfrequency shifts and selective modal damping were observed throughout the frequency range of interest, 20–200 Hz, and the numerical model was able to take these effects into account, showing overall good agreement with measurements. It is shown that when a large solid item is introduced into a room there is little effect on the room frequency response for frequencies below 50 Hz. Between 50 Hz and 200 Hz the effect is more pronounced and the influence of location becomes apparent. Obstacles placed along a wall or in room corners will produce a greater change in room response, when compared with a central location.
Developing the Specialty Skills Project
Authors: Hyde Jonathan
Published: August 2007

Hidden behind the publicity smokescreen that has been the Medical Training Application Service, there has been an enormous amount of work going into educational priorities at the College, among which is the specialty skills project (SSP), an initiative under taken by the Raven Department of Education. In the wake of STEP™ and eSTEP™, this is another massive project with the specific goal of bringing surgical education in line with the new curriculum (www.iscp.ac.uk) and Modernising Medical Careers (MMC). It represents a complete revision of course content and a restructuring of the way in which the College will deliver educationally robust skills teaching.
Correspondence relating to recent Trainees' forum articles
Authors: Freudmann Matt
Published: August 2007

It's always good to see the trainees' forum stimulating a response from readers and a couple of our recent articles have provoked more letters than most. This month we take the opportunity to publish several of these.
Favourite things: more Treasures from the Library
Authors: Craig Tina
Published: August 2007

This is a final piece from me as I have now retired – and I envy my successor the many happy hours that I have spent identifying the subjects for these articles from the amazingly varied resources in the library collections. Here is a personal selection which, I think, sho ws their wide diversity.
Categorical perception of animal patterns
Authors: Goldstein Julie , Davidoff Jules
Published: August 2007

As part of the more general issue of whether culture can affect perception, the present paper addresses the Whorfian question of whether the language available to describe perceptual experience can influence the experience itself. It investigated the effect of vocabulary on perceptual classification by the study of a remote culture (Himba) which possesses a poor colour vocabulary but a rich vocabulary of animal pattern terms. Thus, the present study examined Categorical Perception (CP) with a type of visual stimulus not previously used to assess the effect of labels on perceptual judgments. For the animal patterns, the Whorfian view predicted that it would only be the Himba who showed superiority for cross‐category decisions as only they have the appropriate labels. The Whorfian view was upheld and confirmed previous findings that linked perceptual differences to labelling differences.
Habit vs. intention in the prediction of future behaviour: The role of frequency, context stability and mental accessibility of past behaviour
Authors: Danner Unna N. , Aarts Henk , de Vries Nanne K.
Published: August 2007

This research examined the role of habit and intention in the prediction of future behaviour by analysing that past behaviour frequency moderates the intention–behaviour relationship to the extent that the context in which the behaviour was performed is stable. In two correlational studies, it was found that habit interacted with intention when context stability was taken into account and not when merely past behaviour frequency was considered: intentions guided future behaviour when habits were weak (low frequency or unstable context), while this was not the case when habits were strong (high frequency and stable context). A third exploratory study investigated and confirmed the idea that, if habitual goal‐directed behaviour is directly activated by the context, mental accessibility of the behaviour (i.e. the ease of accessing the goal‐directed behaviour in memory) moderates the intention–behaviour relation in a similar way. These findings are discussed against the background of current research on goal‐directed habits and the cognitive processes underlying them.
Production of Aluminum-Silicon Carbide Composites Using Powder Metallurgy at Sintering Temperatures Above the Aluminum Melting Point
Authors: Khairaldien W. M. , Khalil A. A. , Bayoumi M. R.
Published: August 2007

The extensive utilization of aluminum reinforced with silicon carbide in different structural applications has motivated the need to find a cost effective technological production method for these composites. Homogeneity, machinability, and interfacial reaction of the constituents represent the significant problems pertaining to these composites. Production of a homogenous, high strength, and net-shape structural components made from aluminum-silicon carbide composites can be achieved using powder metallurgy (PM) technology. In the present work the problem of low strength of the aluminum-silicon carbide produced by powder metallurgy is solved by raising the sintering temperature of the composite above the melting temperature of the aluminum. This method produces a local fusing and welding of the aluminum particles. Using aluminum powder with a thick oxide layer surrounding the particles prevents the total melting of the composite. Green compacted specimens containing 0, 5, 10, 15, 20, 25, and 30 wt % silicon carbide were prepared. Samples from each composition were sintered at 650, 700, 750, 800, 850, and 900°C separately, while other specimens were left without sintering for comparison. Microstructure examination, a microhardness test, and a compression test were carried out for each of the 49 combinations of SiC contents and sintering temperatures to study the effect of sintering temperature and SiC contents on the composite properties and to detect the optimum sintering temperature for each SiC weight percent. Generally the results show the tendency for both strength and ductility to increase upon increase in the sintering temperature. These specific sintering temperature levels are found to be 650°C for the aluminum with no silicon carbide content, 700°C for composites containing both 5 and 10 wt % SiC, 750°C for composites containing 15 wt % SiC, 800°C for composites containing 20 wt % SiC, 850°C for composites containing 25 wt % SiC, and 900°C for composites containing 30 wt % SiC.
Typologically motivated over- vs. underspecification of gender in Germanic languages
Authors: Ronneberger-Sibold Elke
Published: August 2007

This paper investigates different means of expressing natural gender in personal terms, namely derivational suffixes, different inflectional classes, and the inflection of pronouns, adjectives, and determiners for grammatical gender in the history of Ger-man, English, and Swedish. These three languages were chosen as representatives of different routes of typological development among the Germanic languages. The major typological division, which can only in part be described in the classical terms of syntheticity vs. analyticity, separates English and Swedish on the one hand from German on the other. The differences in the expression of natural gender are related to these typological differences.
Endoglin Is Not Critical for Hematopoietic Stem Cell Engraftment and Reconstitution but Regulates Adult Erythroid Development
Authors: Moody Jennifer L. , Singbrant Sofie , Karlsson Göran , Blank Ulrika , Aspling Marie , Flygare Johan , Bryder David , Karlsson Stefan
Published: August 2007

Endoglin is a transforming growth factor-β (TGF-β) accessory receptor recently identified as being highly expressed on long-term repopulating hematopoietic stem cells (HSC). However, little is known regarding its function in these cells. We have used two complementary approaches toward understanding endoglin's role in HSC biology: one that efficiently knocks down expression via lentiviral-driven short hairpin RNA and another that uses retroviral-mediated overexpression. Altering endoglin expression had functional consequences for hematopoietic progenitors in vitro such that endoglin-suppressed myeloid progenitors (colony-forming unit-granulocyte macrophage) displayed a higher degree of sensitivity to TGF-β-mediated growth inhibition, whereas endoglin-overexpressing cells were partially resistant. However, transplantation of transduced bone marrow enriched in primitive hematopoietic stem and progenitor cells revealed that neither endoglin suppression nor endoglin overexpression affected the ability of stem cells to short-term or long-term repopulate recipient marrow. Furthermore, transplantation of cells altered in endoglin expression yielded normal white blood cell proportions and peripheral blood platelets. Interestingly, decreasing endoglin expression increased the clonogenic capacity of early blast-forming unit-erythroid progenitors, whereas overexpression compromised erythroid differentiation at the basophilic erythroblast phase, suggesting a pivotal role for endoglin at key stages of adult erythropoietic development.

Disclosure of potential conflicts of interest is found at the end of this article.
β-Catenin Signaling Promotes Proliferation of Progenitor Cells in the Adult Mouse Subventricular Zone
Authors: Adachi Kazuhide , Mirzadeh Zaman , Sakaguchi Masanori , Yamashita Toru , Nikolcheva Tania , Gotoh Yukiko , Peltz Gary , Gong Leyi , Kawase Takeshi , Alvarez-Buylla Arturo , Okano Hideyuki , Sawamoto Kazunobu
Published: August 2007

The subventricular zone (SVZ) is the largest germinal zone in the mature rodent brain, and it continuously produces young neurons that migrate to the olfactory bulb. Neural stem cells in this region generate migratory neuroblasts via highly proliferative transit-amplifying cells. The Wnt/β-catenin signaling pathway partially regulates the proliferation and neuronal differentiation of neural progenitor cells in the embryonic brain. Here, we studied the role of β-catenin signaling in the adult mouse SVZ. β-Catenin-dependent expression of a destabilized form of green fluorescent protein was detected in progenitor cells in the adult SVZ of Axin2-d2EGFP reporter mice. Retrovirus-mediated expression of a stabilized β-catenin promoted the proliferation of Mash1+ cells and inhibited their differentiation into neuroblasts. Conversely, the expression of Dkk1, an inhibitor of Wnt signaling, reduced the proliferation of Mash1+ cells. In addition, an inhibitor of GSK3β promoted the proliferation of Mash1+ cells and increased the number of new neurons in the olfactory bulb 14 days later. These results suggest that β-catenin signaling plays a role in the proliferation of progenitor cells in the SVZ of the adult mouse brain.

Disclosure of potential conflicts of interest is found at the end of this article.
Briefing: How recent case law affects the conduct of an expert
Authors: Winter J. , Davies L.
Published: August 2007

This article is intended to be a guide for those asked to be expert witnesses in legal proceedings, focusing particularly on the effect of recent case law in this area. It is not a substitute for looking directly at the terms of part 35 of the Civil Procedure Rules and the accompanying practice direction, nor the Protocol for the Instruction of Experts to Give Evidence in Civil Claims prepared by the Civil Justice Council.
Scour in hydraulic engineering
Authors: Hager W. H.
Published: August 2007

As a result of damage and failures due to undermining of foundations and the blockage of water flow caused by sediment aggradation downstream of scour holes, scour in hydraulic engineering has become an important issue in recent decades. This paper presents recent research on: (a) plunge pool scour in which a variety of effects were investigated; (b) bridge piers for which spatial and temporal scour development was described using particle image velocimetry for a test case; (c) the failure of riprap-protected spur dykes in a straight river reach. In all three fields, the main features of scour are described based on similitude according to Froude—that is, using the densimetric Froude number of the approach flow as the dominant parameter. The large number of parameters involved were controlled with suitable experimental setups allowing for the determination of the governing effects of a scour problem. Results are presented that readily apply to river engineering problems.
Expression of P-Glycoprotein 170 in Nasal Mucosa may be Increased with Topical Steroids
Authors: Henriksson Gert , Norlander Tomas , Zheng Xi , Stierna Pontus , Westrin Karl Magnus
Published: August 2007

The synthesis of P-glycoprotein 170 (P-gp), a “multidrug resistance” protein capable of extruding various drugs including 11-OH steroids from human cells, can be upregulated by certain glucocorticosteroids. This study demonstrates the presence of P-gp in the columnar surface epithelium and in glandular acini of healthy nasal mucosa with immunohistochemical technique. Furthermore, nasal polyps from 5 of 17 patients treated with clinical doses of a topical nasal steroid, budesonide, appear to show a stronger staining intensity for P-gp than polyps from 13 untreated patients. This suggests the possibility of local P-gp gene induction by topical glucocorticoid treatment. Upregulation of P-gp synthesis appears as a new possible cause of relative resistance to topical steroid medication in patients with nasal inflammatory disease.
Endonasal Sinus Surgery Improves Mucociliary Transport in Severe Chronic Sinusitis
Authors: Hafner Bernol , Davris Spiros , Riechelmann Herbert , Mann Wolf J. , Amedee Ronald G.
Published: August 2007

A total of 22 patients with extensive chronic sinusitis were examined before and 7.2 ± 1.1 months after microscopic endonasal sinus surgery. Pre- and postoperative nasal mucociliary transport was measured using a modified saccharine test and ciliary beat frequency of nasal respiratory cells using video interference contrast microscopy. In patients suffering from chronic sinusitis, nasal ciliary beat frequency was significantly lower (8.0 ± 1.8 Hz) than in normals (9.5 ± 1.7 Hz, p < 0.02). Following endonasal sinus surgery, ciliary beat frequency in patients with chronic sinusitis remained reduced (8.3 ± 1.2 Hz). Nasal mucociliary transport time was significantly (p < 0.05) longer (20.9 ± 9.4 minutes) in patients with chronic sinusitis than in normals (14.9 ± 8.4 minutes). Nasal mucociliary transport improved significantly (p < 0.05) to 13.8 ± 8.4 minutes in 17 of 22 patients without recurrent sinusitis and remained prolonged (20.6 ± 7.7 minutes) in 5 of 22 patients with recurrent disease. These data suggest that ciliary beat frequency of nasal respiratory cells and nasal mucus transport are impaired in patients suffering from chronic sinusitis. After microscopic endonasal sinus surgery, impaired mucociliary transport is improved, and ciliary beat frequency remains lower than in normals.
Olfactory Function after Microscopic Endonasal Surgery in Patients with Nasal Polyps
Authors: Klimek Ludger , Moll Bertram , Amedee Ronald G. , Mann Wolf J.
Published: August 2007

A controlled prospective study on 31 patients with nasal polyps was performed to evaluate the time course of olfactory function after endonasal surgery. A modified Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory function test was used to measure olfactory threshold, odor identification ability, and odor discrimination ability. The test was performed in all patients 1–3 days before surgery (V1), 7–10 days after surgery (V2), and after 1 (V3), 2 (V4), 3 (V5), and 6 (V6) months. Mean olfactory threshold in the CCCRC butanol test was 4.19 at V1 (= moderate hyposmia). At V2, it decreased to 3.46 (= severe hyposmia), before increasing to 5.16 at V3 and 5.22 at V4 (= mild hyposmia). After the second postoperative month, olfactory threshold decreased again until the end of the study: 5.13 at V5 and 4.87 at V6 (= moderate hyposmia). The time course for odor identification ability and odor discrimination ability showed comparable results. This study demonstrates that olfactory function is impaired in patients with nasal polyps. Endonasal sinus surgery might improve olfactory function with best results within 3 months after surgery.
A Comparison of Aqueous Suspensions of Budesonide Nasal Spray (128 μg and 256 μg Once Daily) and Fluticasone Propionate Nasal Spray (200 μg Once Daily) in the Treatment of Adult Patients with Seasonal Allergic Rhinitis
Authors: Stern Martin A. , Dahl Ronald , Nielsen Lars P. , Pedersen Bente , Schrewelius Camilla
Published: August 2007

The efficacy of aqueous suspensions of budesonide nasal spray and fluticasone propionate nasal spray, in the treatment of seasonal allergic rhinitis, was compared in a large, placebo-controlled, two-center study. A 1-week baseline period was followed by a 4- to 6-week treatment period during which 635 adult patients, aged 18–72 years, were randomized to receive either placebo, budesonide 128 μg, or 256 μg once daily, or fluticasone propionate, 200 μg once daily. Nasal and eye symptoms, overall treatment efficacy and safety assessments were made during the study period. Combined, as well as individual, nasal symptoms were significantly improved in all three active treatment groups compared with placebo therapy. Treatment with 256 μg/day of budesonide was found to be significantly more effective in reducing the sneezing score compared with 200 μg/day of fluticasone propionate. Analysis of symptom scores on days when the pollen count was greater than 10 grains/m3 revealed 256 μg/day of budesonide therapy to be significantly more effective in reducing combined symptom scores as well as the individual scores for sneezing and runny nose, compared with 200 μg/day fluticasone propionate. The higher dose of budesonide (256 μg/day) was also more effective than the lower dose (128 μg/day) in reducing sneezing scores and statistical significance was almost reached for the reduction in combined symptom and runny nose scores. Substantial or total control of symptoms was achieved by 31.4%, 85.3%, 88.4%, and 81.9% of patients receiving placebo, 128 μg/day of budesonide, 256 μg/day of budesonide, and 200 μg/day of fluticasone propionate, respectively. The incidence of adverse events was low in all treatment groups. In conclusion, both budesonide and fluticasone propionate treatments were effective and well-tolerated in the treatment of seasonal allergic rhinitis. However, 256 μg/day of budesonide tended to be more effective than 200 μg/day of fluticasone propionate and 128 μg/day of budesonide, especially when patients were exposed to a higher pollen load.
Mucin mRNA Expression in Normal and Vasomotor Inferior Turbinates
Authors: Aust Michelle R. , Madsen Cathy S. , Jennings Anita , Kasperbauer Jan L. , Gendler Sandra J.
Published: August 2007

Mucins are the major glycoprotein component of respiratory tract secretions. Little is known about their expression in the upper respiratory tract. In order to define this expression, in situ hybridization was performed on 19 normal and 4 vasomotor rhinitis (VMR) inferior turbinates to identify mucin mRNA. MUC1, MUC2, MUC4, MUC5AC, MUC5B, and MUC7 were expressed in both the normal and VMR turbinates. MUC 4 and MUC5AC were the most highly expressed mucins. MUC1, MUC2, MUC4, and MUC5AC were expressed mainly by the epithelial border, whereas MUC5B and MUC7 were expressed by the submucosal glands. MUC1 and MUC4 exhibited a diffuse expression by multiple cell types along the mucosal border, whereas MUC2 and MUC5AC expression appeared to be limited to a subpopulation of epithelial cells, most likely goblet cells. Although MUC1, MUC4, and MUC5AC showed sporadic submucosal glandular expression, MUC5B and MUC7 appeared to be the predominant submucosal gland mucins in the inferior turbinates. MUC3 and MUC6 expression, which have been found primarily in the gastric mucosa, were not seen in any of the inferior turbinate samples examined. The only difference seen between normal and VMR turbinates was a slight decrease in MUC1 expression in the VMR group. The variety of mucins expressed and the diversity of their expression patterns may have significance in terms of the rheologic and particle clearance properties of nasal secretions. Understanding the expression patterns in normal turbinates will serve as the foundation for further study of these mucins in disease states.
The Inferior Turbinate Mast Cell Population of Patients with Perennial Allergic and Nonallergic Rhinitis
Authors: Berger Gilead , Goldberg Arnon , Ophir Dov
Published: August 2007

The number of mast cells in the inferior turbinates of patients with perennial allergic rhinitis and perennial nonallergic rhinitis was compared with normal controls. Mast cell counts expressed as the mean number in 100 high-power fields, assessed after Carnoy's fixation and toluidine blue staining were 1.84 in normal controls (n = 11), 4.39 in patients with perennial allergic rhinitis (n = 13), and 4.00 in those with perennial nonallergic rhinitis (n = 26). Statistical analysis confirmed that the density of mast cells in allergic as well as in nonallergic patients was significantly higher than in normal controls, whereas no significant difference was found between the number of mast cells in allergic and nonallergic patients. It is concluded that the number of mast cells in the inferior turbinate mucosa of patients with perennial rhinitis is increased compared with normal controls, and the increased number is not necessarily allergy-dependent.
Follow-Up of University of Virginia Experience with the Modified Lothrop Procedure
Authors: Gross Charles W. , Zachmann Gregory C. , Becker Daniel G. , Vickery Christopher L. , Moore David F. , Lindsey William H. , Gross William E.
Published: August 2007

Current surgical treatment of the frontal sinus disease include external approaches to obliterate or ablate the sinus and both external and transnasal methods to restore drainage into the nasal cavity. The original Lothrop procedure resects the medial frontal sinus floor, superior nasal septum, and intersinus septum, creating a large frontonasal communication. However, as described, the external approach used in this procedure often allowed medial collapse of soft tissue and the stenosis of the nasofrontal communication. This report further relates our experience with the modified transnasal endoscopic Lothrop procedure using suction drills for cases in which frontal recess exploration had failed to relieve obstruction of the frontal sinus. We present an update of the University of Virginia experience in performing the modified Lothrop procedure in 20 patients from 10/93 to 4/95. Our findings over the follow-up period (average 12 months) have verified that this procedure is effective, with a 95% patency rate for the surgically enlarged frontal sinus ostium. When compared to osteoplastic flap with fat obliteration, the modified transnasal Lothrop procedure offers the advantages of a less invasive procedure with a shorter and usually no hospitalization, less morbidity, and the increased ability to evaluate post-operatively for recurrent disease. A patient charge analysis was also performed comparing patients undergoing frontal sinus obliteration during the same time period, revealing an additional benefit of decreased patient costs for the modified transnasal Lothrop procedure. None of our patients experienced complications, and all showed significant improvement, if not complete resolution of their symptoms. Although this procedure has produced favorable results, it should be noted that this procedure is technically demanding and will require further long term follow-up to verify its efficacy and proper role in the spectrum of surgical approaches for the treatment of chronic sinusitis.
Endonasal Frontal Sinusotomy in Surgical Management of Chronic Sinusitis: A Critical Evaluation
Authors: Hosemann W. , Kühnel Th. , Held P. , Wagner W. , Felderhoff A.
Published: August 2007

Frontal sinusotomy was performed on 110 patients undergoing routine endoscopic endonasal ethmoidectomy and the minimum diameter of the frontal sinus neo-ostium was determined intraoperatively. A total of 82 patients could be subjected to follow-up and redetermination of the neo-ostium diameter 13 months later. A postoperative CT was scheduled in 62 cases. The average minimum diameter of the frontal sinus neo-ostium, measured intraoperatively, was 5.6 mm (0–11 mm). After completion of wound healing, 81% of the frontal sinuses could be explored by probing or even inspected by rigid endoscopy. The average minimum diameter of the neo-ostia determined postoperatively was 3.5 mm (0–11 mm). Patients exhibiting aspirin sensitivity or diffuse nasal polyposis showed a more pronounced scarred constriction of the frontal sinus access compared to other cases. Neo-ostia exceeding 5 mm intraoperatively were preserved with a considerably higher percentage than those with diameters of less than 5 mm. Radiologically, the fenestrated frontal sinuses frequently showed continued or even increasing mucosal congestion. No conclusive relationship was found to exist between such post-operative clouding and frontal sinus accessibility (endoscopy and/or probing) or patient complaints. The investigations confirm the safety and reliability of frontal sinusotomy in surgical management of chronic paranasal sinusitis. The mucosa of the frontal sinus often reacts to surgery in the form of persistent or even newly developing mucosal swelling to which a specific pathophysiological significance cannot always be attributed.
Management of Sinusitis in Adult Cystic Fibrosis
Authors: Marks Steven C. , Kissner Dana G.
Published: August 2007

Until recently, cystic fibrosis was frequently fatal during childhood. However, with current medical management, many patients are living into adulthood. This has created a new population of patients with chronic sinusitis and severe medical problems. In this report, experience with 22 patients, eight of whom have undergone sinus surgery, is presented, and recommendations for management are proposed. Presenting symptoms are typical of sinusitis, but in a few patients, severe debilitating headaches predominate. Oral antibiotics are often of little use due to the numerous courses of high dose intravenous antibiotics used for resistant pulmonary infections. Topical nasal steroids and mucolytics have been of some benefit. Fourteen operative procedures were performed on eight patients. These procedures included 12 endoscopic sphenoethmoidectomies, four Caldwell-Luc procedures, two frontal sinus obliterations, and one transseptal sphenoidotomy (many of these were in combination.) Results from this experience indicate 1) Failure of endoscopic surgery to control frontal and maxillary sinus disease; 2) Delayed healing of the ethmoid cavity with persistent crusting; and 3) Significant, albeit short term, symptomatic relief following surgical intervention. Based on this limited series, we conclude that surgery should be delayed until absolutely necessary and that an aggressive approach should be adopted when surgery is performed. In our hands this included initial endoscopic sphenoethmoidectomy with open surgical techniques used for removal of trapped inspissated secretions. We recommend long term intravenous antibiotics postoperatively and frequent cleaning of the ethmoid cavity after surgery, continuing indefinitely, to optimize the benefit of surgery.
Hereditary Hemorrhagic Telangiectasia: What the Otolaryngologist Should Know
Authors: Byahatti S. V. , Rebeiz E. E. , Shapshay S. M.
Published: August 2007

Hereditary hemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease is a systemic autosomal dominant disorder involving blood vessels. Phenotypically, the disease presents with telangiectases that involve all areas of the body. Ninety percent of patients experience epistaxis and are referred to the otolaryngologist for evaluation. Because otolaryngologists may be the primary physicians caring for these patients, it is critical they be knowledgeable about high risk groups, screening protocols for arteriovenous malformations, antibiotic prophylaxis, and genetic screening. It is important that they be aware of the many therapeutic modalities available for the treatment of epistaxis. In this article, the diagnosis, screening, treatment, and molecular genetics of HHT will be discussed. In addition, our experience with 20 patients treated with the Nd:YAG laser for recurrent epistaxis will be reviewed.
Budesonide Aqueous Nasal Spray and Pressurized Metered Dose Inhaler in the Treatment of Adult Patients with Seasonal Allergic Rhinitis
Authors: Day James , Alexander Michael , Drouin Michel , Frankish Charles , Mazza Jorge , Moote William , Patel Piyush , Ramsdale Helen , Yang William
Published: August 2007

Budesonide, a topical corticosteroid used in the treatment of seasonal allergic rhinitis, can be administered to the nose as an aerosol via a pressurized metered dose inhaler (pMDI) or as a metered nasal pump spray. Studies have shown that about 64% (256 μg) of a nominal dose of 400 μg budesonide pMDI preparation is delivered to the patient compared with 100% of the nominal dose of the pump spray. The present study was undertaken to assess the efficacy and safety of budesonide delivered via a nasal pMDI twice daily (Rhinocort® pMDI, at 400 μg/day) with an aqueous suspension of budesonide delivered via a metered nasal pump spray once daily (Rhinocort® Aqua, at 256 μg/day or 400 μg/day). The multicenter, double-blind, randomized, placebo-controlled, parallel-group study was conducted in 318 patients (154 men, 164 women; aged 12–67 years) with ragweed-induced seasonal allergic rhinitis. A 1-week baseline period was followed by a 3-week treatment. Nasal symptoms were recorded by the patients, adverse events were noted, an overall evaluation of treatment efficacy was made, and urine cortisol and creatinine levels were measured. Substantial or total control of symptoms was achieved in 83.8% of patients treated with 256 μg of aqueous budesonide, 76.3% with 400 μg of aqueous budesonide, and 80.8% with 400 μg of budesonide pMDI; these were all significantly different (p < 0.001) compared with placebo (23.4% of patients). There were no significant differences in the 24-hour urine cortisol levels between the groups and there were few, infrequent adverse events, similar between the groups and resolved completely on discontinuation of treatment. It was concluded that budesonide, given once daily as 256 μg or 400 μg in an aqueous suspension or twice daily as 400 μg in a pMDI provides good alleviation of the symptoms of seasonal allergic rhinitis with no significant risk of suppression of urine cortisol.
Repair of Nasal Septal Perforation
Authors: Yousef-Mian Mohammed
Published: August 2007

The management of nasal septal perforation remains unsatisfactory. Various operative techniques have been described, with modest success. A novel method for repair of septal perforations up to 2.6 cm in diameter was investigated. A double layer closure of nasal septal perforation was designed, one with the cartilage and the other by a flap based on the anterior septal branches of the sphenopalatine artery. Fourteen patients have been operated upon. The current analysis reveals a success rate of 13 patients (93%) who had complete closure and one patient (7%) with incomplete closure. The operative techniques and results are reported here.
Mode suppression in a microcavity solid-state dye laser
Authors: Popov Sergei , Ricciardi Sébastien , Friberg Ari T. , Sergeyev Sergey
Published: August 2007

A solid-state dye laser with a microcavity whose size is comparable to the lasing wavelength, is modeled by means of the finite element method. The position of the pumping source affects the lasing mode spectrum. In comparison with a single point source at the edge of the cavity, a random distribution of excitation sources in the central gain part of the microcavity leads to suppression of odd longitudinal modes and to higher output efficiency of the laser radiation in even modes. The modeling and simulation results are explained by simple physical considerations.
Industry Payments to US Physicians by Specialty and Product Type
Authors: Sayed Ahmed , Ross Joseph S. , Mandrola John , Lehmann Lisa Soleymani , Foy Andrew J.
Published: March 2024

This study examines the distribution of payments within and across specialties and the medical products associated with the largest total payments.