bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance of a biofilter system with agave fiber filter media for municipal wastewater treatment
Authors: Vigueras-Cortés Juan Manuel , Villanueva-Fierro Ignacio , Garzón-Zúñiga Marco Antonio , de Jesús Návar-Cháidez José , Chaires-Hernández Isaías , Hernández-Rodríguez César
Published: August 2013

Agave plants grow in semi-arid regions and are used for mescal production. However, agave fiber by-products are considered waste materials. Thus, we tested agave fiber as a filter media and biofilm material carrier for removing pollutants from municipal wastewater. Three laboratory-scale biofiltration reactors were used in two trials with five hydraulic loading rates (HLRs = 0.27, 0.54, 0.80, 1.07 and 1.34 m3 m−2 d−1). One series was conducted using mechanical aeration (0.62 m3 m−2 h−1). To prevent compaction, decreasing pressure and clogging of the filter media, 4, 8 and 12 internal divisions were evaluated in the biofilter column. After 17 months of continuous operation at an HLR of 0.80 m3 m−2 d−1, the removal efficiencies of the aerated biofilters were 92.0% biochemical oxygen demand, 79.7% chemical oxygen demand, 98.0% helminth eggs, 99.9% fecal coliforms and 91.9% total suspended solids. Statistical analysis showed that the chosen operational parameters significantly influenced the removal efficiencies of the biofilters. The effluent quality obtained under these conditions complied with the Mexican and US EPA standards for agricultural irrigation and green spaces, except for coliforms, which is why the effluents must be disinfected. Thus, agave fiber is a favorable choice for use as a packing material in biofiltration processes.
Comparative study of fecal bacterial decay models for the simulation of plumes of submarine sewage outfalls
Authors: Feitosa Renato C. , Rosman Paulo C. C. , Carvalho João L. B. , Côrtes Myriam B. V. , Wasserman Julio C.
Published: August 2013

In the literature, analytical models have been shown to be extremely useful for estimating the decay rates of coliform as fecal indicator microorganisms, providing reliable predictions of bathing conditions in coastal and continental waters. Although a number of different formulations have been developed in the literature, each one may only be suitable for specific environments, and no comparison between these methods has ever been carried out. In the present article, a comparative analysis of bacterial decay models, calculated by eight different formulations, was performed in coastal outfall plumes, considering identical environmental conditions of solar radiation, temperature and salinity. A statistical approach was applied to identify the differences in means and in behaviors of the results obtained in the various simulations. The results indicate good agreement between bacterial decay rates calculated with at least four methods that were considered more reliable, and at least one of the models was shown to be suitable for estimating bacterial decay rates under night-time conditions, considering only the combined influences of temperature and salinity. Moreover, under daytime conditions, it provides consistent decay rates when compared with measurements taken in the field.
A socio-technical model to explore urban water systems scenarios
Authors: de Haan Fjalar J. , Ferguson Briony C. , Deletic Ana , Brown Rebekah R.
Published: August 2013

This article reports on the ongoing work and research involved in the development of a socio-technical model of urban water systems. Socio-technical means the model is not so much concerned with the technical or biophysical aspects of urban water systems, but rather with the social and institutional implications of the urban water infrastructure and vice versa. A socio-technical model, in the view purported in this article, produces scenarios of different urban water servicing solutions gaining or losing influence in meeting water-related societal needs, like potable water, drainage, environmental health and amenity. The urban water system is parameterised with vectors of the relative influence of each servicing solution. The model is a software implementation of the Multi-Pattern Approach, a theory on societal systems, like urban water systems, and how these develop and go through transitions under various internal and external conditions. Acknowledging that social dynamics comes with severe and non-reducible uncertainties, the model is set up to be exploratory, meaning that for any initial condition several possible future scenarios are produced. This article gives a concise overview of the necessary theoretical background, the model architecture and some initial test results using a drainage example.
Inventory models with ramp-type demand for deteriorating items with partial backlogging and time-varing holding cost
Authors: Karmakar Biplab , Choudhury Karabi
Published: August 2013

In this paper, an inventory model with general ramp-type demand rate, partial
backlogging of unsatisfied demand and time-varying holding cost is
considered; where the ?Time-varying holding cost? means that the holding cost
is a function of time, i.e. it is time dependent. The model is studied under
the following different replenishment policies: (1) starting with no
shortages (2) starting with shortages. Two component demand rate has been
used. The backlogging rate is any non-increasing function of the waiting time
up to the next replenishment. The optimal replenishment policy is derived for
both the above mentioned policies.
A better statistical method of predicting postsurgery soft tissue response in Class II patients
Authors: Lee Ho-Jin , Suh Hee-Yeon , Lee Yun-Sik , Lee Shin-Jae , Donatelli Richard E. , Dolce Calogero , Wheeler Timothy T.
Published: August 2013

Objective:

To propose a better statistical method of predicting postsurgery soft tissue response in Class II patients.

Materials and Methods:

The subjects comprise 80 patients who had undergone surgical correction of severe Class II malocclusions. Using 228 predictor and 64 soft tissue response variables, we applied two multivariate methods of forming prediction equations, the conventional ordinary least squares (OLS) method and the partial least squares (PLS) method. After fitting the equation, the bias and a mean absolute prediction error were calculated. To evaluate the predictive performance of the prediction equations, a leave-one-out cross-validation method was used.

Results:

The multivariate PLS method provided a significantly more accurate prediction than the conventional OLS method.

Conclusion:

The multivariate PLS method was more satisfactory than the OLS method in accurately predicting the soft tissue profile change after surgical correction of severe Class II malocclusions.
Spectral Resemblances and Elusive Connections: A Practice-led Research Dialogue between Poetry and Digital Imagery
Authors: Hetherington Paul , Fitton Anita
Published: August 2013

In the early 20th century the function of poetic imagery was given international attention through the Imagist movement in London and, ever since, many poets have self-consciously employed and exploited imagist techniques. At the same time poets and visual artists have frequently explored connections between each other’s works considering, as Art Berman writes, that “the visual can provide direct and even prelinguistic knowledge since the psyche presumably has operations that precede or take logical precedence over […] language” (49).

Interart comparisons suggest that poetry and the visual arts can be talked about as if “work in one medium […] were operating in another” (Dayan 3). However, it is often unclear what it might mean to describe a work of visual art as “poetic” or a poem as “visual.” This paper explores these ideas with reference to Paul Hetherington’s and Anita Fitton’s practice-led research project, Spectral Resemblances.

The project is investigating some of the ways in which written poetry and still visual imagery may convey related meanings. It asks whether meaningful connections between poetic and visual imagery are at best “spectral” and elusive. It explores how the juxtapositioning of complementary works in these different media may allow resonances to play back and forth in the conceptual spaces between them.
Becoming Animal, Becoming Others: What We Make with Art and Literature
Authors: Cope Karin
Published: August 2013

What is poetry for? How does poiesis or making - the Greek root of the words poetry and poetics - succeed in moving us, in getting under our skins? “Becoming Animal” argues that art and literature are crucial zones of play, transformative modes that work by mixing up self and other, inside and out, human, animal and other matter. The essay moves from a consideration of D.W. Winnicott’s psychoanalytic discussion of the relationship between play and creativity, self and other, to Howard Searles’ investigation of transference and counter-transference as possible models for engaged and sensuously attuned critical stances. The last section of the essay offers an account of the “transgenic” work of Eduardo Kac, which literally mixes genetic material as art. The essay concludes by arguing that art, as poiesis, works by engaging us in constant contact with what is not ourselves as a process of becoming ourselves; it argues that such ‘self-estrangement’ is the way we sort out how to live an ontologically rich and ethically meaningful life.
Study of the textural properties of some layered double hydroxides
Authors: Puscasu Cornelia-Magda , Gherasim Carmen , Mardare Dragos , Carja Gabriela
Published: August 2013

Layered double hydroxides (LDHs) are one of the nano ordered layered compounds. The importance of layered compound is based on their ability to retain chemical species with electrical charges compatible to those of the layers. They may be used in areas such as catalysis, industry, medicine, environmental protection, construction etc. Layered double hydroxides are anionic clays comprising positively charged layers with anions and water molecules intercalated in the interlayer region. The aim of this work was to obtain Cu and/or Ni substituted layered double hydroxides with different micromorphology characteristics. The obtained results pointed out that the relationship between LDHs composition and their textural properties can be controlled. The layered double hydroxides samples were fabricated by using direct coprecipitation method. Field Emission Scanning Electron Microscope (FE-SEM) and X-Ray Diffraction (XRD) analyses were used to study the textural characteristics and the structural characteristics of the samples.
Studies on adsorption capacity of cationic dyes on several magnetic nanoparticles
Authors: Vîrlan Constantin , Ciocârlan Radu George , Roman Tiberiu , Gherca Daniel , Cornei Nicoleta , Pui Aurel
Published: August 2013

In this study the dyes used are Basic fuchsin and Methylene blue. The adsorption was studied in relation to the metal in the ferrite, time of exposure and dye concentration. The highest adsorbtion capacity was observed for MgFe2O4 at a dye concentration of 0.06 mM, adsorption percent of 88% in 3 hours. Desorption was also studied by redispersion in ethanol. The main adsorption mechanism is thought to be through electrostatic interaction, mainly due to surfactant groups present on the nanoparticles. The nanoparticles have ferromagnetic behavior under magnetic field which allows for effective separation.
Recent developments and perspectives on the treatment of industrial wastes by mineral carbonation — a review
Authors: Bodor Marius , Santos Rafael , Gerven Tom , Vlad Maria
Published: August 2013

Besides producing a substantial portion of anthropogenic CO2 emissions, the industrial sector also generates significant quantities of solid residues. Mineral carbonation of alkaline wastes enables the combination of these two by-products, increasing the sustainability of industrial activities. On top of sequestering CO2 in geochemically stable form, mineral carbonation of waste materials also brings benefits such as stabilization of leaching, basicity and structural integrity, enabling further valorization of the residues, either via reduced waste treatment or landfilling costs, or via the production of marketable products. This paper reviews the current state-of-the-art of this technology and the latest developments in this field. Focus is given to the beneficial effects of mineral carbonation when applied to metallurgical slags, incineration ashes, mining tailings, asbestos containing materials, red mud, and oil shale processing residues. Efforts to intensify the carbonation reaction rate and improve the mineral conversion via process intensification routes, such as the application of ultrasound, hot-stage processing and integrated reactor technologies, are described. Valorization opportunities closest to making the transition from laboratory research to commercial reality, particularly in the form of shaped construction materials and precipitated calcium carbonate, are highlighted. Lastly, the context of mineral carbonation among the range of CCS options is discussed.
Influenza Vaccination in Patients with Suspected Egg Allergy
Authors: Settipane Russell A
Published: August 2013

Egg allergy is not necessarily a contraindication to influenza vaccination. For patients with suspected egg allergy, if the clinician determines benefits to outweigh risks, cautionary measures are available that can enhance safe vaccine administration. Batch to batch variability of egg content in extant influenza vaccines necessitates an informed and cautious approach to vaccination of an egg allergic individual. Although patients with egg allergy are likely to develop egg tolerance by late childhood, tolerance to ingestion of “baked egg” products may not predict tolerance to “native egg” proteins present in the influenza vaccine. Even in cases where the skin test to the vaccine is positive, vaccination may still be cautiously administered, if necessary, in a graded dose protocol.
Temporal Lobe Abscess in a Patient with Isolated Sphenoiditis
Authors: Stewart Thomas A. , Carter Cody S. , Seiberling Kristin
Published: August 2013

A 74-year-old immunocompetent man admitted for severe retro-orbital headache was diagnosed with isolated sphenoiditis. At the time of scheduled surgery, the patient was mildly obtunded, and a head CT revealed a temporal lobe abscess. The patient underwent a left temporal craniectomy and a bilateral endoscopic sphenoid sinusotomy, which revealed gross fungal debris. The patient made a full recovery with resolution of abscess and sinus findings. Suspicion for intracranial infection should be raised in any sinus patient with neurological changes. Early diagnosis with imaging studies is extremely important for surgical drainage before permanent neurological sequelae.
Is Routine Nasoendoscopy Warranted in Epistaxis Patients after Removal of Nasal Packing?
Authors: Makarawo Tafadzwa P. , Howe David , Chan Samuel K.
Published: August 2013

Fiberoptic nasoendoscopy (FNE) is a powerful investigative tool in ear, nose, and throat practice in which its use in the management of epistaxis is varied among clinicians. The practice of assessing the nasal cavity after removal of nasal packs is common but its usefulness has not been evaluated. Therefore, we assessed the benefits of routine FNE after removal of nasal packs in epistaxis patients. Our study was performed retrospectively involving 62 adult patients admitted over a 6-month period between 2005 and 2006. Data regarding the emergent management of epistaxis cases on presentation, the use of FNE, and the final diagnosis and outcome of each patient were specifically investigated during the study. Anterior rhinoscopy was performed in 27 patients at initial presentation, of whom 45% (10/27) had anterior bleeding points identified. FNE examination after removal of nasal packs in eight patients yielded evidence of a posterior bleeding point in only one case (12.5%). Of those patients in whom anterior rhinoscopy revealed no anterior bleeding point at presentation (17/27), 12 patients went on to have FNE after removal of their nasal packs, and of these, 33% (4/12) of patients were found to have a posterior bleeding vessel. Overall, FNE was performed in 24 patients, of whom only 1 (1/24) had an active posterior bleeding vessel needing nasal repacking. Four patients (4/24) had prominent posterior vessels that required no intervention, 1 patient (1/24) had new pathology identified, and in the remaining 18 cases (18/24), FNE yielded no additional information to modify management. The routine performance of FNE in all epistaxis patients after pack removal does not appear to convey any additional benefit. We advocate the use of FNE when anterior bleeding has been excluded or bleeding is persistent and that careful nasal examination by anterior rhinoscopy should be the cornerstone of assessment.
Allergic Reaction to Mint Leads to Asthma
Authors: Szema Anthony M. , Barnett Tisha
Published: August 2013

Respiratory and cutaneous adverse reactions to mint can result from several different mechanisms including IgE-mediated hypersensitivity, delayed-type hypersensitivity (contact dermatitis), and nonimmunologic histamine release. Reactions to cross-reacting plants of the Labiatae family, such as oregano and thyme, as well as to the chemical turpentine, may clue the clinician in on the diagnosis of mint allergy. Contact dermatitis can result from menthol in peppermint. Contact allergens have been reported in toothpastes, which often are mint-flavored. Allergic asthma from mint is less well-recognized. A case of a 54-year-old woman with dyspnea on exposure to the scent of peppermint is presented in whom mint exposure, as seemingly innocuous as the breath of others who had consumed Tic Tac candies, exacerbated her underlying asthma. This case highlights the importance of testing with multiple alternative measures of specific IgE to mint, including skin testing with mint extract, and skin testing with fresh mint leaves. Additionally, this cases suggests that asthma can result from inhaling the scent of mint and gives consideration to obtaining confirmatory pre- and postexposure pulmonary function data by both impulse oscillometry and spirometry.
Sinonasal Risk Factors for the Development of Invasive Fungal Sinusitis in Hematological Patients: Are they Important?
Authors: Fernandez Ignacio J. , Stanzani Marta , Tolomelli Giulia , Pasquini Ernesto , Vianelli Nicola , Baccarani Michele , Sciarretta Vittorio
Published: August 2013

Invasive fungal sinusitis (IFS) is a highly aggressive infection that can affect hematologic patients. The classically described general risk factors, however, do not fully explain the development of IFS in a small percentage of cases. This study examined the impact of anatomic sinonasal factors and environmental factors on the development of IFS in high-risk patients. Medical records and computed tomography (CT) scans of patients admitted to our institution who were at high risk of developing IFS were retrospectively reviewed. Twenty-seven patients of 797 fulfilled the inclusion criteria. Patients affected by IFS were compared with patients not affected to identify possible sinonasal and environmental risk factors of IFS. Seven patients were excluded because of the lack of adequate radiological images. Six of the 20 eligible patients were assigned to the study group of patients affected by IFS and the remaining 14 patients were assigned to the control group. All but one case developed the infection during the summer with a significantly higher mean environmental temperature (p = 0.002). Anatomic nasal alterations were found in all patients affected by IFS and were significantly more frequent than in the control group (p = 0.014). It would be advisable to have patients with hematologic risk factors of IFS, especially during the summer period, undergo endoscopic nasal assessment. Furthermore, a CT finding of anatomic nasal alterations, such as anterior nasal septum deviation causing nasal obstruction, should increase the suspicion of IFS in case of the occurrence of nasal symptoms.
Regulation of Dendritic Cell Functions against Harmful Respiratory Pathogens by a Cysteinyl Leukotrienes Receptor Antagonist
Authors: Matsuse Hiroto , Hirose Hiroko , Fukahori Susumu , Tsuchida Tomoko , Tomari Shinya , Kawano Tetsuya , Fukushima Chizu , Kohno Shigeru
Published: August 2013

Cysteinyl leukotriene receptor antagonist (LTRA) is a widely used medicine for asthma. Cysteinyl leukotrienes (cysLTs) are involved in the regulation of dendritic cell (DC) function. However, the effects of LTRA on DC-related antimicrobial immunity against harmful respiratory pathogens remain unknown. The purpose of this study was to examine the effects of LTRA administered in vivo on DC function against representative respiratory pathogens in vitro. Pulmonary DCs were isolated from four groups of mice: control, mite allergen sensitized (AS), and AS mice treated with the corticosteroid dexamethasone (Dex) or with the LTRA pranlukast (Prl). These DCs were incubated with mite allergen, lipopolysaccharide (LPS), Aspergillus fumigatus, or respiratory syncytial virus (RSV). IL-10 and IL-12 production was then determined. Dex treatment significantly inhibited lipopolysaccharide (LPS)-induced IL-10 and IL-12 production as well as baseline IL-12 production in AS mice. The Prl did not significantly inhibit LPS-induced IL-10 and IL-12 production in AS mice. More importantly, Prl significantly increased IL-10 and IL-12 in AS mice after RSV infection. This study shows that LTRA that is used for asthma potentially up-regulates antimicrobial immunity through modulation of DC function against some respiratory infections without immunosuppression.
Mite-induced Inflammation: More than Allergy
Authors: Sánchez-Borges Mario , Fernández-Caldas Enrique , Capriles-Hulett Arnaldo , Caballero-Fonseca Fernan
Published: August 2013

Clinical observations have suggested that there is an association of atopic conditions with hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs). This relationship has been especially present in patients allergic to mites. This study was designed to review clinical and experimental evidence linking atopy, mite allergy, and hypersensitivity to aspirin and NSAIDs and discuss the possible mechanisms explaining this association. A review of the medical literature concerning the association of atopic diseases, mite hypersensitivity, and intolerance to NSAIDs using PubMed and other relevant articles is presented. NSAID-sensitive patients are frequently atopic and allergic to mites, and patients who develop oral mite anaphylaxis (OMA) show an increased prevalence of NSAID hypersensitivity. The study of atopic, mite-sensitive patients, who experience urticaria and angioedema when exposed to NSAIDs and patients with OMA suggests an interesting interaction between atopic allergy and disorders of leukotriene synthesis or metabolism. Various mechanisms that could be involved in this interaction are presented, including genetic factors, inhibition of cyclooxygenase-1, and other effects (not related to IgE sensitization) of mite constituents on the immune system. The association of mite hypersensitivity with aspirin/NSAIDs intolerance has been confirmed and provides additional clues to various nonallergic pathways that may contribute to the acute and chronic inflammatory process observed in atopic, mite-allergic, individuals. The clinical relevance of these observations is presently under investigation.
Locally Destructive Skull Base Lesion: IgG4-related Sclerosing Disease
Authors: Alt Jeremiah A. , Whitaker Graham T. , Allan Robert W. , Vaysberg Mikhail
Published: August 2013

A unique case of IgG4+ sclerosing disease was diagnosed in the sphenoid sinus, a previously unreported location, and was treated in a novel manner. This study describes the clinical presentation and management of IgG4 sclerosing disease in the paranasal sinuses. A retrospective case review and review of the medical literature were performed. A 38-year-old woman with a 2-year history of constant frontal headaches presented to our clinic. Imaging showed bony destruction of the sphenoid sinus and sellar floor. The patient underwent a right-sided sphenoidotomy with debridement and biopsy. Pathological evaluation showed a dense plasmacytic infiltrate with >150 IgG4+ cells/high-power field. She was subsequently started on a nasal corticosteroid with improved patency of the sphenoid antrostomy. We report an unusual case of a middle-aged woman who presented with IgG4-sclerosing disease (IGSD) isolated to the sphenoid sinus. Although our knowledge concerning treatment in extrapancreatic organs is lacking, there is evidence that glucocorticoid treatment improves nasal sinus opacification on CT findings (Sato Y, Ohshima K, Ichimura K, et al., Ocular adnexal IgG4-related disease has uniform clinicopathology, Pathol Int 58:465–470, 2008). This case study and literature review adds to the growing literature describing IGSD in the head and neck and more specifically isolated to the sphenoid sinus with preliminary data concerning local control with topical steroids.
Relationships between IL-17A and Macrophages or MUC5AC in Eosinophilic Chronic Rhinosinusitis and Proposed Pathological Significance
Authors: Ono Noritsugu , Kusunoki Takeshi , Ikeda Katsuhisa
Published: August 2013

Recently, some researchers have reported that macrophages and neutrophils were related to severe asthma. Mucus hypersecretion and persistent airway inflammation result from increased expression of mucin gene (MUC5AC). Eosinophilic chronic rhinosinusitis (ECRS) is considered as intractable rhinosinusitis. From the viewpoint of “one way one disease,” we examined whether ECRS is associated with infiltrating macrophages, neutrophils, their promotive factors, and MUC5AC. We examined 21 nasal polyps with CRS. Each specimen was fixed in 10% phosphate-buffered formalin, embedded in paraffin, processed routinely, and then prepared as semithin sections (3.5 μm). We immunohistochemically observed the macrophages by using CD68, neutrophils by using neutrophil elastase and the promotive factors, monocyte chemotactic protein (MCP) 1, IL-17A, and IL-8, in both ECRS and non-ECRS. The number of macrophages (CD68+ cells), IL-17A, and MUC5AC+ cells in ECRS were significantly greater than in non-ECRS. The mean number of MCP-1+ cells in ECRS was greater than that in non-ECRS, but not significantly. There was a significant correlation in all cases between IL-17A and macrophages or MUC5AC+ cells. Neither the numbers of neutrophils (positive cells for neutrophil elastase) nor the IL-8+ cells showed any significant differences between ECRS and non-ECRS. Our study suggested that infiltrating macrophages, IL-17A and MUC5AC, as well as eosinophils could have roles in the development of ECRS.
Measurement of Osteotomy Force during Endoscopic Sinus Surgery
Authors: Joice Paul , Ross Peter D. , Wang Dong , Abel Eric W. , White Paul S.
Published: August 2013

Greater understanding of the surgeon's task and skills are required to improve surgical technique and the effectiveness of training. Currently, neither the objective measurement of osteotomy forces during endoscopic sinus surgery (ESS) nor the validity of the properties of cadaver materials, are well documented. Measurement was performed of peak axial osteotomy force during ESS. A comparison was made of results with previously published cadaver data to validate the force properties of cadaver models. A prospective, consecutive cohort of 25 patients was compared with data from 15 cadaver heads. A modified Storz sinus curette measured osteotomy force from uncinate, bulla ethmoidalis, and ground lamella. Independent variables were osteotomy site, age, gender, indication for surgery, and side. Corresponding cadaver data were analyzed for the independent variables of osteotomy site, side, and gender and then compared with the live patient data. Mean osteotomy force in live patients was 9.6 N (95% CI, 8.9–10.4 N). Mean osteotomy force in the cadaver heads was 6.4 N (95% CI, 5.7–7.0 N). Ethmoid osteotomy of live patients required 3.2 N (95% CI, 2.1–4.3 N) more force than the cadaver heads (p = 0.0001). This relationship was statistically significant at the bulla ethmoidalis (p = 0.002) and the ground lamella (p = 0.0001) but not at the uncinate (p = 0.068). Osteotomy in female live subjects required 1.6 N (95% CI, 0.1–3.1 N) more force than male live subjects (p = 0.03). Cadaver tissue may underestimate the mean osteotomy force required in osteotomy of living ethmoid sinus lamellae by a factor of 1.5 times. Caution may be required in extrapolating force estimates from cadaver tissue to those required in living patients.
Diffusion Lung Capacity of Carbon Monoxide: A Novel Marker of Airways Remodeling in Asthmatic Children?
Authors: Piacentini Giorgio L. , Tezza Giovanna , Cattazzo Elena , Kantar Ahmad , Ragazzo Vincenzo , Boner Attilio L. , Peroni Diego G.
Published: August 2013

Asthma is universally considered a chronic inflammatory disorder of the airways. Several noninvasive markers, such as exhaled nitric oxide (FeNO) and exhaled breath temperature (PletM), have been proposed to evaluate the degree of airway inflammation and remodeling in asthmatic children. The aim of this study was to evaluate the relationship between diffusion lung capacity of carbon monoxide (DLCO) and these inflammatory markers in asthmatic children. We compared data of FeNO, PletM, and DLCO collected in 35 asthmatic children at admission (T0) and discharge (T1) after a period spent in a dust-mite–free environment (Misurina, Italian Dolomites, 1756 m). PletM showed a reduction from 29.48°C at T0 to 29.13°C at T1 (p = 0.17); DLCO passed from 93 to 102 (p = 0.085). FeNO mean value was 29.7 ppb at admission and 18.9 ppb at discharge (p = 0.014). Eosinophil mean count in induced sputum was 4 at T0 and 2 at T1 (p = 0.004). Spearman standardization coefficient beta was 0.414 between eosinophils and FeNO and −0.278 between eosinophils and DLCO. Pearson's correlation index between DLCO and PletM was −0.456 (p = 0.019). A negative correlation between DLCO and PletM was found. However, DLCO did not show a significant correlation with FeNO and eosinophils in the airways. Additional studies are needed to clarify the role of DLCO as a potential tool in monitoring childhood asthma.
The Rate of Epinephrine Administration Associated with Allergy Skin Testing in a Suburban Allergy Practice from 1997 to 2010
Authors: Swender David A. , Chernin Leah R. , Mitchell Chris , Sher Theodore , Hostoffer Robert , Tcheurekdjian Haig
Published: August 2013

Allergy skin testing is considered a safe method for testing for IgE-mediated allergic responses although anaphylactic events can occur. Reported rates of anaphylaxis per patient are not consistent and range from 0.008 to 4%. The aim of this study was to determine the rate of epinephrine use associated with allergy skin-prick testing (SPT) and intradermal testing (IDT) in a suburban practice over 13 years. This retrospective chart review used billing and procedure coding records during the time period from January 1997 to June 2010 to identify encounters where epinephrine was administered after SPT or IDT. Patient encounters with procedure codes for skin testing plus either parenteral epinephrine, corticosteroid, antihistamine, or i.v. fluid administration were identified. These patient charts were reviewed to determine if epinephrine was administered, whether systemic reactions developed, and rates of epinephrine administration were calculated. There were 28,907 patient encounters for SPT and 18,212 for IDT. Epinephrine was administered in six patient encounters (0.02%) where SPT was performed; no IDT encounters led to epinephrine administration. There were no fatalities. Allergy skin testing to a variety of allergens, when administered by well-trained personnel, is a safe procedure. This study, involving the largest population to date, showed a rate of systemic reactions requiring epinephrine of 20 per 100,000 SPT visits. No epinephrine was given after IDT.
Satisfaction with Maxillary Sinus Surgery Might be Influenced by Risk Factors
Authors: Myller Jyri P. , Luukkainen Annika T. , Huhtala Heini S. A. , Torkkeli Tommi V. M. , Rautiainen Markus E. P. , Toppila-Salmi Sanna K.
Published: August 2013

Chronic rhinosinusitis (CRS) is an inflammation of the nose and paranasal sinuses lasting for ≥12 weeks. Endoscopic sinus surgery (ESS) is considered during difficult to treat CRS. The minimally invasive technique focuses on the transition areas rather than on the ostia. The aim of this study was to evaluate symptoms, the number of acute sinusitis episodes, and satisfaction after ESS with either preservation or enlargement of the maxillary sinus ostium. Thirty patients with moderate nonpolypous CRS were enrolled. Uncinectomy only and additional middle meatal antrostomy were randomized for each side of each patient and performed single blindly. The symptoms questionnaires were filled at four time intervals. Significant symptom reduction was achieved independently of operation technique. The number of acute sinusitis episodes indicating the exacerbation rate decreased significantly at 9 and, on average, 68 months postoperatively. However, the exacerbation rate began to increase after 9 months postoperatively. Three revisions were performed on the side with uncinectomy only and one on the side with additional antrostomy. Most patients reported good satisfaction with both procedures. There was a trend for patients with asthma and/or job exposure to report insignificantly more frequently no satisfaction with surgery, especially with the uncinectomy-only procedure. Both procedures seem to be efficient in providing symptom relief and satisfaction. More studies are needed to evaluate if patients with risk factors benefit more from an ostium-enlarging procedure.
Postnasal Drip due to Inferior Turbinate Perforation after Radiofrequency Turbinate Surgery: A Case Report
Authors: Aslan Gaffar
Published: August 2013

Management of inferior turbinate hypertrophy includes surgical options in case of failure with medical treatment and the main goal of turbinate surgery is to relieve the patient's symptoms of chronic nasal congestion while preserving mucosal surfaces with reduction of the submucosal and bony tissue. In this regard, radiofrequency volumetric tissue reduction has been a thermal technique associated with satisfactory results and fewer side effects. Historical detail on onset, timing, duration, and severity of symptoms and aggravating and relieving factors are important in the differential diagnosis of postnasal drip (PND). Here, we report development of intractable PND due to inferior turbinate perforation after radiofrequency turbinate surgery for the first time in the literature and the successful improvement via removal of pathological anatomic structure under nasal endoscopy-directed surgery in a 35-year-old female patient. The patient had a good functional outcome postoperatively with no further complications or signs of recurrence occurring, to date, within a postoperative follow-up period of 1 year.
Should we Test the Prothrombin Time in Anticoagulated Epistaxis Patients?
Authors: Soyka Michael B. , Holzmann David
Published: August 2013

Epistaxis is one of the most frequent emergencies in rhinology. Patients using anticoagulative medication are at increased risk for epistaxis. We evaluated the prothrombin time and the international normalized ratio (INR) in anticoagulated epistaxis patients. Patients suffering from epistaxis were prospectively included in a database and results from prothrombin testing were analyzed in the context of anticoagulation. One hundred sixteen of 591 epistaxis cases were identified to be on oral anticoagulation. The INR was found to be above therapeutic levels in 19 (16%) of these cases. We strongly recommend prothrombin time and INR testing in all epistaxis patients taking any sort of vitamin K antagonists.
Assessment of Mucocele Formation after Endoscopic Nasoseptal Flap Reconstruction of Skull Base Defects
Authors: Husain Qasim , Sanghvi Saurin , Kovalerchik Olga , Shukla Pratik A. , Choudhry Osamah J. , Liu James K. , Eloy Jean Anderson
Published: August 2013

Advances in endoscopic skull base (SB) surgery have led to the resection of increasingly larger cranial base lesions, resulting in large SB defects. These defects have initially led to increased postoperative cerebrospinal fluid (CSF) leaks. The development of the vascularized pedicled nasoseptal flap (PNSF) has successfully reduced postoperative CSF leaks. Mucocele formation, however, has been reported as a complication of this technique. In this study, we analyze the incidence of mucocele formation after repair of SB defects using a PNSF. A retrospective review was performed from December 2008 to December 2011 to identify patients who underwent PNSF reconstruction for large ventral SB defects. Demographic data, defect site, incidence of postoperative CSF leaks, and rate of mucocele formation were collected. Seventy patients undergoing PNSF repair of SB defects were identified. No postoperative mucocele formation was noted at an average radiological follow-up of 11.7 months (range, 3–36.9 months) and clinical follow-up of 13.8 months (range, 3–38.9 months), making the overall mucocele rate 0%. The postoperative CSF leak rate was 2.9%. Proper closure of SB defects is crucial to prevent CSF leaks. The PNSF is an efficient technique for these repairs. Although this flap may carry an inherent risk of mucocele formation when placed over mucosalized bone during repair, we found that meticulous and strategic removal of mucosa from the site of flap placement resulted in a 0% incidence of postoperative mucocele formation in our cohort.
Outbreak of NDM-1-producing Acinetobacter baumannii in France, January to May 2013
Authors: Decousser J W , Jansen C , Nordmann P , Emirian A , Bonnin R A , Anais L , Merle J C , Poirel L
Published: August 2013

We report the first outbreak of carbapenem-resistant NDM-1-producing Acinetobacter baumannii in Europe, in a French intensive-care unit in January to May 2013. The index patient was transferred from Algeria and led to the infection/colonisation of five additional patients. Concurrently, another imported case from Algeria was identified. The seven isolates were genetically indistinguishable, belonging to ST85. The blaNDM-1 carbapenemase gene was part of the chromosomally located composite transposon Tn125. This report underscores the growing concern about the spread of NDM-1-producing A. baumannii in Europe.
Intercontinental spread of OXA-48 beta-lactamase-producing Enterobacteriaceae over a 11-year period, 2001 to 2011
Authors: Potron A , Poirel L , Rondinaud E , Nordmann P
Published: August 2013

OXA-48 beta-lactamase producers are emerging as an important threat mostly in the Mediterranean area. We report here the molecular epidemiology of a collection of OXA-48 beta-lactamase-positive enterobacterial isolates (n=107) recovered from European and north-African countries between January 2001 and December 2011. This collection included 67 Klebsiella pneumoniae, 24 Escherichia coli and 10 Enterobacter cloacae. Using the EUCAST breakpoints, ninety-eight isolates (91.6%) were of intermediate susceptibility or resistant to ertapenem, whereas 66% remained susceptible to imipenem. Seventy-five per cent of the isolates co-produced an extended-spectrum beta-lactamase, most frequently CTX-M-15 (77.5%). Susceptibility testing to non-beta-lactam antibiotics showed that colistin, tigecycline, amikacin, and fosfomycin remain active against most of the isolates. Multilocus sequence typing indicated that the most common sequence types (ST) were ST101 and ST38 for K. pneumoniae and E. coli, respectively. The blaOXA-48 gene was located on a 62 kb IncL/M plasmid in 92.5% of the isolates, indicating that a single plasmid was mainly responsible for the spread of that gene. In addition, this study identified multiple cases of importation of OXA-48 beta-lactamase producers at least in Europe, and spread of OXA-48 beta-lactamase producers giving rise to an endemic situation, at least in France.
International infectious disease surveillance during the London Olympic and Paralympic Games 2012: process and outcomes
Authors: Jones J , Lawrence J , Payne Hallström L , Mantero J , Kirkbride H , Walsh A , Jermacane D , Simons H , Hansford K M , Bennett E , Catchpole M , on behalf of the international team Collective
Published: August 2013

Surveillance for possible international infectious disease threats to the Olympic and Paralympic Games in London, United Kingdom, was conducted from 2 July to 12 September 2012 by a collaborative team comprising representatives from the Health Protection Agency (Public Health England since April 2013), the European Centre for Disease Prevention and Control and the National Travel Health Network and Centre. Team members enhanced their usual international surveillance activities and undertook joint risk assessments of incidents identified as relevant through an agreed set of criteria designed for the Games and using tools developed for this purpose. Although team members responded to a range of international disease incidents as part of their routine roles during this period, no incident was identified that represented a threat to the Games. Six incidents were highlighted by the team that were likely to attract media attention and hence could generate political and public concern. Responding to such concern is an important aspect of the overall public health management of mass gathering events. The lessons learned about the process and outcomes of the enhanced international surveillance will help inform planning by future hosts of similar events.
Angiographic Comparison of Coronary Artery Disease between Diabetic Men and Women
Authors: Mamun Md. Sk. , Majumder AAS , Ullah M , Alam S
Published: August 2013

Background: Cardiovascular diseases are the leading cause of death and morbidity in diabetic patients and this group is two to four times as likely to develop cardiovascular disease than the nondiabetic group, women being specially involved in this situation. In women , diabetes appear to be a stronger risk factor for the development of coronary heart disease than in men regardless of age ,menopausal status and whether or not the patient is insulin or non-insulin dependent. Objective of this study was to compare the angiographic extent of coronary artery disease between diabetic men and diabetic women. Method: This observational study was undertaken on 100 diabetic patients ( 50 women and 50 men) admitted inNational Institute of Cardiovascular disease (NICVD) during the period of July, 2006 to April ,2007.Diabetic women with coronary artery disease constitute the study group-I and diabetic men with coronary artery disease matched for age (±5 years) and risk factors , the study group-II . Coronary angiography was done in all patients & findings were analyzed. Segmental distribution method for coronary artery lesions was used to describe the distribution of atherosclerotis in coronary artery. Results: The mean age of group I was 51.02 ±8.93 years and that of the group II was 50.99± 9.83 years. In this study it was found that Diabetic women with coronary artery disease (CAD) had a higher coronary artery score, CAS (11.02±5.034) as compared to the diabetic men with CAD ( 8.04±4.866) (p<0.001). Diabetic women had also higher number of diseased vessels ( 78.67% vs 67.34%; p<0.01) and higher number of vessel score 3 ( 58% vs 34%; p<0.001). As compared to the diabetic men, diabetic women had a higher total number of coronary artery lesions (183 vs 136; p<0.001), a higher number of lesions per patient (3.66/ patients vs 2.72/patients; p<0.001) and a higher number of diffuse vessels (13.56% vs 8.91%;p<0.05). Conclusion: Diabetic women with coronary artery disease have more severe disease on coronary angiography as compared to diabetic men with coronary artery disease. The diffuse coronary artery involvement was also significantly higher in diabetic women than men. Cardiovascular Journal Volume 6, No. 1, 2013, Page 3-9 DOI: http://dx.doi.org/10.3329/cardio.v6i1.16108
Mitral Annular Calcification is Associated with Severe Coronary Artery Disease in Patients Under 65 Years Old
Authors: Rahman Mohammad Arifur , Majumder AAS , Chowdhury NA , Rahman MZ , Islam AKMM , Ullah M , Razzaque MA , Romel SMA
Published: August 2013

Background: Mitral annular calcification (MAC) is degenerative, fibrous calcification of the mitral valve annulus. It is more common in people over 70 years old. It is a marker of increased cardiovascular risk which occurs in a graded fashion by MAC severity. The aim of this study was to evaluate the association of Mitral annular calcification with severity of coronary artery disease (CAD) in patients under 65 years old. Methods: A total of 140 patients with IHD were enrolled by purposive sampling. Study populations were divided into MAC group and non MAC group. MAC was detected by Trans-thoracic echocardiography as an intense echo-producing structure located at the junction of the atrio-ventricular groove and posterior mitral leaflet in parasternal long axis view. MAC is measured in millimeters from the leading anterior to the trailing posterior edge and quantified as mild to moderate (1 to 4 mm) and severe (>4 mm) considering its thickness. Assessment of angiographic severity of CAD was done in the same hospital stay by Vessel score, Friesinger score and Leaman score. Results: Patients of MAC and non MAC groups were similar in terms of age and sex. Smoking (p=0.001) and family history of IHD (p=0.03) were significantly higher in MAC group. Anterior MI was significantly higher in MAC group (p=0.03). Left main and TVD were significantly higher in MAC group (p=0.001, p=0.01) whereas normal vessels were more in non MAC group (p=0.001). Intermediate and high Friesinger score (e5) were significantly higher in MAC group whereas low Friesinger score (<5) were more in non MAC group. There was significant (p=0.01) positive correlation between MAC and CAD severity in terms of vessel score (r=0.76) Friesinger score (r=0.75) and Leaman score(r=0.42). Multivariate logistic regression analysis showed that MAC was independent predictors of significant CAD (p=0.02, OR= 2.84). Conclusion: Echocardiographically detected mitral annual calcification (MAC) can be an independent predictor of significant coronary artery disease. There is positive correlation between severity of MAC and severity of CAD. Cheap, available and radiation free nature of the echocardiographic detection of MAC may be a marker of significant CAD. Cardiovascular Journal Volume 6, No. 1, 2013, Page 10-16 DOI: http://dx.doi.org/10.3329/cardio.v6i1.16109