bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of a hand training programme in five patients with myotonic dystrophy type 1
Authors: Aldehag Anna Sandin , Jonsson Hans , Ansved Tor
Published: January 2006

The aim of this study was to evaluate hand function and self‐rated occupational performance before and after specific hand training in five participants with myotonic dystrophy (MD) type 1. MD is the commonest of the muscular dystrophies with adult onset and is associated with muscle weakness, wasting and myotonia. Compensatory techniques and strategies are mostly offered as the only intervention therapy. In the present study, the participants were their own controls using pre‐ and post‐test measures. Each participant was tested at intervals a total of nine times before and nine times after hand training. A hand‐held myometer (Microfet2™), Grippit®, Purdue Pegboard and self‐rated myotonia were used as outcome measures. Occupational performance was assessed pre‐ and post‐test using the Canadian Occupational Performance Measurement (COPM) in which the participants rated their own performance and satisfaction in five self‐chosen occupational performance areas. The participants performed hand training for a total of three months, three times per week using a specific resistance training programme including Theraputty™, a silicone‐based putty.

Hand function was significantly increased and a positive change in self‐rated occupational performance was noted after the training period. This study indicates that hand training has a positive effect on hand function, i.e. motor function and occupational performance. The present results need to be replicated in a controlled study including a larger number of patients and over a longer period of time. Copyright © 2005 Whurr Publishers Ltd.
A strategy for supervising occupational therapy students at community sites
Authors: Mulholland Susan , Derdall Michele
Published: January 2006

Within the field of occupational therapy various innovative strategies have been used to provide students with effective clinical education (fieldwork) opportunities. One of the more unusual strategies involves the student participating in a placement at a site where there is no occupational therapist and no well‐defined role. The University of Alberta, Canada developed and piloted a new fieldwork supervisory position. Feedback was collected from both the sites and students to explore the impact of this position on the fieldwork experience for stakeholders. As well, sites and students were asked to give their opinions on more general aspects of these placements. Both sites and students positively endorsed the fieldwork educator for independent community placement's role. Most recommendations for improvement revolved around increasing the time dedicated to this position and making it permanent. Caution must be taken in generalizing the results of this study, as there may be various considerations that make this an appropriate supervision strategy in Alberta, Canada but not in other locations. Further research is required to determine whether this supervision strategy could be used with other students or professions in other locations. Copyright © 2005 Whurr Publishers Ltd.
Changes in accessibility and usability in housing: an exploration of the housing adaptation process
Authors: Fänge Agneta , Iwarsson Susanne
Published: January 2006

The purpose of a housing adaptation is to enhance daily activities and to improve housing accessibility and usability by removing physical barriers in the home. The aim of this study was to investigate longitudinal changes in housing accessibility among clients receiving grants for housing adaptations. Baseline assessments were administered one month before the housing adaptation, with the first follow‐up after two to three months, and the second follow‐up after eight to nine months. The Housing Enabler and the Usability in My Home instruments were used to collect data from 131 consecutively enrolled clients living in general housing. Accessibility and usability improved significantly, the number of physical environmental barriers decreased and dependence on mobility devices increased, but at different times along the process. The results indicate the complexity of the housing adaptation process and the need to consider person–environment interactions over time. The methodology seems useful for quality development of assessment, intervention and evaluation processes in housing adaptations performed by occupational therapists. Copyright © 2005 Whurr Publishers Ltd.
Capturing the spectral response of solar cells with a quasi‐steady‐state, large‐signal technique
Authors: Mäckel Helmut , Cuevas Andrés
Published: January 2006

A new approach to measure the spectral response of the short‐circuit current of solar cells is presented in this investigation. The main innovative feature is the light source, which produces a broad range of intensities, up to 10 suns in a quasi‐steady‐state mode, thus making the use of a bias light redundant. This results in large, integral signals that can be recorded directly without resorting to lock‐in amplification. Measurements of different solar cell structures with a conventional and the new measurement set‐up resulted in good agreement. Copyright © 2005 John Wiley & Sons, Ltd.
Early cycling test as a predictor of walking performance in stroke patients
Authors: Katz‐Leurer Michal , Shochina Mara
Published: January 2006

Background and Purpose.

To assess the relative contribution and the predictive value of an early cycling test to walking performance three months after stroke.

Method.

This follow‐up study included subjects who were inpatients after a first stroke (n = 44). A cycling test was performed at the beginning of rehabilitation, followed by three‐months' post‐stroke evaluation of walking performance. The independent variables were the ability to cycle at constant rhythm of 50 rpm, without and with resistance, lower extremity motor strength and walking function, scored by the Scandinavian Stroke Scale. Dependent variables were gait velocity, distance and stair‐climbing three months after stroke.

Results.

Multiple linear regression analysis demonstrated that rhythmic, constant cycling is the best predictor of walking velocity (r2 = 0.4), gait distance (r2 = 0.2) and number of stairs climbed (r2 = 0.26). Lower extremity motor strength and walking function had no additional separate contribution to the prediction of study outcomes.

Conclusions.

The inability to cycle at a constant rhythm for one minute, two weeks after stroke is a more significant predictor than lower extremity motor strength or walking function of walking performance at three months post‐stroke. Copyright © 2005 Whurr Publishers Ltd.
Investigation on barrier inhomogeneities in 4H‐SiC Schottky rectifiers
Authors: Ma Xianyun , Sadagopan Priyamvada , Sudarshan Tangali S.
Published: January 2006

In order to investigate the Schottky barrier height inhomogeneities in 4H silicon carbide Schottky rectifiers, two surface modification processes were developed to control the influence caused by the surface defects. Both forward and reverse electrical characteristics of Schottky contacts, fabricated on different surface conditions, indicated that the inhomogeneities could be precisely controlled, completely eliminated and exactly duplicated using reactive ion etching and hydrogen‐etching surface modification processes. After removing the barrier inhomogeneities, all contacts exhibited a wide linearity region (over nine decades) which can be well explained using thermionic emission theory. The calculated ideality factor n and the Schottky barrier height Φb were in the range of 1.17–1.20 and 1.12 eV–1.22 eV respectively. Most contacts exhibited a low reverse leakage, about 10–6 A/cm2 at the reverse bias of 300 V. Finally sharp‐apex growth pits were proposed as source defects to understand the Schottky barrier height inhomogeneities. (© 2006 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)
Atomic shells from the electron localizability in momentum space
Authors: Kohout M. , Wagner F. R. , Grin Y.
Published: January 2006

The electron localizability indicator in momentum space is proposed as a functional of the same‐spin momentum pair density. This functional yields a discrete distribution of values, which are proportional to the charge needed to form a fixed very small fraction of a same‐spin electron pair. It resolves all atomic shells for the examined atoms (Li–Kr) with reasonable occupation numbers, especially in the valence region. © 2006 Wiley Periodicals, Inc. Int J Quantum Chem, 2006
A stable isotope minimal model protocol with oral glucose administration
Authors: Bluck Leslie J. C. , Clapperton Allan T. , Coward W. Andy
Published: January 2006

A protocol for investigating glucose metabolism whereby stable isotope tracer is given intravenously after an oral glucose challenge is described. Frequent sampling of plasma glucose and insulin allows the tracer disappearance to be interpreted on the basis of established minimal models. We have investigated the glucose effectiveness and insulin sensitivity parameters and their reproducibility in a group of six healthy adults, each studied twice. A mono‐compartmental description of glucose distribution did not provide a physiological description of glucose kinetics, whereas a two‐compartment model gave adequate results in every case. The estimates of glucose effectiveness and insulin sensitivity were 2–3 times higher than those obtained in similar populations using the conventional protocol of the frequently sampled intravenous glucose tolerance test, and this appeared to be related to the kinetics of transport of glucose from accessible to remote pools. The indices of insulin sensitivity obtained in this way were highly reproducible, with a between‐test correlation of 93%. Copyright © 2006 John Wiley & Sons, Ltd.
Ecological consequences of hydropower development in Central America: impacts of small dams and water diversion on neotropical stream fish assemblages
Authors: Anderson Elizabeth P. , Freeman Mary C. , Pringle Catherine M.
Published: January 2006

Small dams for hydropower have caused widespread alteration of Central American rivers, yet much of recent development has gone undocumented by scientists and conservationists. We examined the ecological effects of a small hydropower plant (Doña Julia Hydroelectric Center) on two low‐order streams (the Puerto Viejo River and Quebradon stream) draining a mountainous area of Costa Rica. Operation of the Doña Julia plant has dewatered these streams, reducing discharge to ∼10% of average annual flow. This study compared fish assemblage composition and aquatic habitat upstream and downstream of diversion dams on two streams and along a ∼4 km dewatered reach of the Puerto Viejo River in an attempt to evaluate current instream flow recommendations for regulated Costa Rican streams. Our results indicated that fish assemblages directly upstream and downstream of the dam on the third order Puerto Viejo River were dissimilar, suggesting that the small dam (< 15 m high) hindered movement of fishes. Along the ∼4 km dewatered reach of the Puerto Viejo River, species count increased with downstream distance from the dam. However, estimated species richness and overall fish abundance were not significantly correlated with downstream distance from the dam. Our results suggested that effects of stream dewatering may be most pronounced for a subset of species with more complex reproductive requirements, classified as equilibrium‐type species based on their life‐history. In the absence of changes to current operations, we expect that fish assemblages in the Puerto Viejo River will be increasingly dominated by opportunistic‐type, colonizing fish species. Operations of many other small hydropower plants in Costa Rica and other parts of Central America mirror those of Doña Julia; the methods and results of this study may be applicable to some of those projects. Copyright © 2006 John Wiley & Sons, Ltd.
Thermal variability and stream flow permanency in an alpine river system
Authors: Brown Lee E. , Hannah David M. , Milner Alexander M.
Published: January 2006

Despite the importance of thermal conditions in influencing biodiversity of alpine river systems, knowledge of year round stream temperature variability is very limited. This paper advances understanding of alpine stream temperature dynamics using hourly resolution data collected over two consecutive years at five sites within a glacierized basin in the French Pyrénées. The potential utility of temperature for understanding river flow patterns at ungauged sites (most notably during winter) is explored. The results indicated marked heterogeneity in water column temperatures; groundwater streams were typically warmer and more thermally stable than those draining snow and ice. Based upon stream temperature patterns, it appears possible to differentiate between river flow conditions including: free‐flowing, surface freezing, dewatering and snow cover. Notably, groundwater‐fed streams appeared to exhibit greater flow permanency than meltwater‐fed streams, the latter freezing for extended periods. These new insights into long‐term alpine stream thermal conditions have major implications for understanding the strategies adopted by benthic macroinvertebrate taxa when overwintering, particularly where streams freeze. Copyright © 2006 John Wiley & Sons, Ltd.
Synthesis of TiO2–Au Composites by Titania‐Nanorod‐Assisted Generation of Gold Nanoparticles at Aqueous/Nonpolar Interfaces
Authors: Cozzoli P. Davide , Curri M. Lucia , Giannini Cinzia , Agostiano Angela
Published: January 2006

Hydrophobically coated anatase TiO2 nanorods can assist the reduction of AuCl4−ions at aqueous/nonpolar solvent interfaces, which results in the generation of organic‐soluble Au nanoparticles with tunable size in the absence of any metal ligands and/or phase‐transfer agents. The titania‐nanorod‐driven modulation of interfacial energy and catalysis of gold nucleation provide straightforward access to nanocomposite solutions of TiO2‐stabilized Au nanoparticles. Among colloidal approaches, this method represents a unique tool for the surfactantless, large‐scale preparation of nanostructured semiconductor–metal hybrid systems with relevant technological potential in catalysis, photocatalysis, and charge‐storage processes.
Inoperability input‐output modeling of disruptions to interdependent economic systems
Authors: Santos Joost R.
Published: January 2006

In this study, the Inoperability Input‐Output Model (IIM) is deployed for assessing the impacts of disruptive events on interconnected economic systems. The IIM is based on Wassily Leontief's input‐output model which is capable of describing the ripple effects of disruptions to interdependent systems. Besides describing economic impact in financial terms, the “inoperability” metric is also used in the IIM to quantify the percentage of a system's production that is affected relative to the desired level. To analyze the magnitude and extent of system linkages, an interdependency matrix based on the North American Industry Classification System (NAICS) is constructed. The study highlights four key features of the IIM. First, demand patterns in the aftermath of such events are modeled and analyzed using available sector‐based performance data. Second, the NAICS‐based capital flow data released for the first time in 2003 by the US Bureau of Economic Analysis enable applying a dynamic IIM to describe the temporal behavior of economic impacts associated with disruptive events. Third, a discussion on utilizing other sources of data, such as consumer confidence for forecasting system‐specific demand disruptions, is presented. Fourth, a visualization tool is presented for conducting a multi‐criteria ranking of the most‐affected systems using both economic loss and inoperability metrics. Ultimately, the study offers insights on describing the sensitivity of economic systems to various classes of disruptions. In the broader perspective, this can provide guidance toward policymaking activities. © 2006 Wiley Periodicals, Inc. Syst Eng 9: 20–34, 2006
Some future trends and implications for systems and software engineering processes
Authors: Boehm Barry
Published: January 2006

In response to the increasing criticality of software within systems and the increasing demands being put onto 21st century systems, systems and software engineering processes will evolve significantly over the next two decades. This paper identifies eight relatively surprise‐free trends—the increasing interaction of software engineering and systems engineering; increased emphasis on users and end value; increased emphasis on systems and software dependability; increasingly rapid change; increasing global connectivity and need for systems to interoperate; increasingly complex systems of systems; increasing needs for COTS, reuse, and legacy systems and software integration; and computational plenty. It also identifies two “wild card” trends: increasing software autonomy and combinations of biology and computing. It then discusses the likely influences of these trends on systems and software engineering processes between now and 2025, and presents an emerging scalable spiral process model for coping with the resulting challenges and opportunities of developing 21st century software‐intensive systems and systems of systems. © 2006 Wiley Periodicals, Inc. Syst Eng 9: 1–19, 2006
Do films about mentally disturbed characters promote ineffective coping in vulnerable youth?
Authors: Jamieson Patrick E. , Romer Daniel , Jamieson Kathleen Hall
Published: January 2006

Suicidal youth tend to doubt the effectiveness of professional mental health treatment. This study examined whether exposure to films about suicidal and mentally disturbed persons supports this lack of belief. Exposure to three popular films featuring suicides or the mentally ill was compared to films that featured a heroic suicide unrelated to mental illness as well as to films with violent and comedic content in a nationally representative survey of youth ages 14–22 (). Exposure to films about mental disturbance among “vulnerable” respondents who had experienced recent depressive and suicidal symptoms (24% of sample) was compared to those without these symptoms. Increasing exposure to films with mentally disturbed characters was related to belief in the treatment inefficacy of mental disorders. The findings suggest that exposure to fictional depictions of characters failing to get help for mental disorders may have long‐term effects on depressed and suicidal youth.
The course of high‐sensitive C‐reactive protein in correlation with pain and clinical function in patients with acute lumbosciatic pain and chronic low back pain—A 6 months prospective longitudinal study
Authors: Gebhardt Katja , Brenner Hermann , Stürmer Til , Raum Elke , Richter Wiltrud , Schiltenwolf Marcus , Buchner Matthias
Published: January 2006

In this prospective longitudinal study with a follow‐up of 6 months, the course of serum concentration of C‐reactive protein was measured by an ultrasensitive immunoassay in 31 patients with acute lumbosciatic pain and 41 patients with chronic low back pain. High‐sensitive CRP (hsCRP), pain and clinical function were assessed at ten fixed time‐points during follow‐up. The course of hsCRP values was assessed in relation to the course of pain and clinical function adjusting for possible confounding factors. At the beginning of the study, there were no statistically significant differences in mean hsCRP levels in patients with acute lumbosciatic pain (1.49 mg/l) compared to the levels obtained in patients with chronic low back pain (1.30 mg/l) and those in a control group from the general population (1.26 mg/l). In patients with acute lumbosciatic pain, hsCRP declined significantly in the initial period of 3 weeks with a corresponding decrease in pain and improvement in function and clinical evaluation as assessed with the straight leg raising test (SLR), whereas after this period, the course of the hsCRP did not correspond with the clinical parameters. In patients with chronic low back pain, hsCRP remained approximately constant throughout the whole period with no correlation with pain or function. As a conclusion, according to this study levels of hsCRP do not have a major clinical relevance when evaluating the long‐term course of patients with acute lumbosciatic pain and chronic low back pain and therefore should not be taken into primary consideration when decisions on therapy are made.
Endocannabinoid, anandamide in gingival tissue regulates the periodontal inflammation through NF‐κB pathway inhibition
Authors: Nakajima Yumiko , Furuichi Yasushi , Biswas Kamal Krishna , Hashiguchi Teruto , Kawahara Ko-ichi , Yamaji Kazuyo , Uchimura Tomonori , Izumi Yuichi , Maruyama Ikuro
Published: January 2006

Anandamide (AEA) exhibits anti‐inflammatory effects. However, its role in the periodontal field remains unknown. Here, we found that gingival crevicular fluid contained a detectable level of AEA. The cannabinoid receptors CB1 and CB2 were expressed by human gingival fibroblasts (HGFs), and markedly upregulated under pathological conditions. AEA significantly reduced the production of pro‐inflammatory mediators (IL‐6, IL‐8 and MCP‐1) induced by Porphyromonas gingivalis LPS in HGFs, and this effect was attenuated by AM251 and SR144528, selective antagonists of CB1 and CB2, respectively. Moreover, AEA completely blocked LPS‐triggered NF‐κB activation, implying that AEA may regulate hyperinflammatory reactions in periodontitis.
The AP‐1/CJUN signaling cascade is involved in muscle differentiation: Implications in muscle wasting during cancer cachexia
Authors: Moore-Carrasco Rodrigo , García-Martínez Celia , Busquets Sílvia , Ametller Elisabet , Barreiro Esther , López-Soriano Francisco J. , Argilés Josep M.
Published: January 2006

The aim of the present study was to investigate a possible role of the AP‐1 signaling cascade in the process of wasting associated with cancer cachexia at the level of skeletal muscle. The injection of virus containing the TAM67 protein (a blocker of the AP‐1 protein) to the gastrocnemius muscle of tumour‐bearing rats resulted in a significant recovery of the muscle mass (which is dramatically reduced as a result of tumour burden), therefore suggesting that AP‐1 is certainly involved in the signaling associated with muscle protein accretion. In conclusion, the gene therapy approach presented here clearly suggests an important role for AP‐1 in muscle signaling during catabolic states.
A mutant pyruvate dehydrogenase E1 subunit allows survival of Escherichia coli strains defective in 1‐deoxy‐d‐xylulose 5‐phosphate synthase
Authors: Sauret-Güeto Susanna , Urós Eva María , Ibáñez Ester , Boronat Albert , Rodríguez-Concepción Manuel
Published: January 2006

The 2‐C‐methyl‐d‐erythritol 4‐phosphate pathway has been proposed as a promising target to develop new antimicrobial agents. However, spontaneous mutations in Escherichia coli were observed to rescue the otherwise lethal loss of the first two enzymes of the pathway, 1‐deoxy‐d‐xylulose 5‐phosphate (DXP) synthase (DXS) and DXP reductoisomerase (DXR), with a relatively high frequency. A mutation in the gene encoding the E1 subunit of the pyruvate dehydrogenase complex was shown to be sufficient to rescue the lack of DXS but not DXR in vivo, suggesting that the mutant enzyme likely allows the synthesis of DXP or an alternative substrate for DXR.
Construction of a fully active truncated alternansucrase partially deleted of its carboxy‐terminal domain
Authors: Joucla Gilles , Pizzut Sandra , Monsan Pierre , Remaud-Simeon Magali
Published: January 2006

Recombinant expression of the large alternansucrase (2057 amino acids) was hindered in E. coli due to poor enzyme solubility and protein degradation. The effects of deletions of the alternansucrase C‐terminal CW‐like and APY repeated motifs on enzyme solubility and specificity were investigated. A truncated variant deleted of the APY repeats but harboring four C‐terminal CW‐like repeats displayed a high specific activity and the same specificity of product synthesis as the native enzyme. It is more soluble and suffers less degradation than full length alternansucrase. Hence this truncated variant is a promising tool for the further structural and kinetic study of this interesting enzyme.
Snake remedies and eosinophilic granuloma complex in cats
Authors: Aboutboul Ronit
Published: January 2006

Eosinophilic granuloma complex (EGC) is a syndrome occurring in cats, characterized by lesions affecting the skin and the oral cavity. Conventional treatment is mainly symptomatic and may have undesirable side effects.

This paper summarizes homeopathic treatment with snake remedies of cats suffering from EGC. Snake remedies were chosen by individual repertorizations and administered in different dilutions. Reactions were mostly quick, leading to significant improvements, including complete recoveries.
Homeopathic approach in the treatment of patients with mental disability
Authors: Dolce Filho R.
Published: January 2006

The author describes his experience assisting mentally disabled patients with homeopathy. In these patients’ anamneses, common traits shared by some syndromes, pathologies and behaviour, were taken into consideration, mainly to choose the most characteristic symptoms in each case. The study includes 58 cases of patients suffering from this pathology: 28 females and 30 males, ages ranging from 1 to 49 years (mean 20). Forty-seven had some improvement.

Homeopathy is a useful alternative to relieve pathologies associated with mental disability. In those cases in which there were similarities between remedy and whole symptomatology, improvements in adaptation skills and in overall health were observed.
Poetry and homeopathy: an exploration
Authors: Mardon Jacqueline M.
Published: January 2006

This paper explores a relationship between poetry and homeopathy. It proposes we expand and enlighten our knowledge of the patient and develop our consultation through our experience of poetry. Within each consultation is a poem. Heightened awareness of this and many other aspects can improve the sensibilities of the practitioner and enhance deeper healing of the patient. We are challenged to respond.
Fourth Branchial Pouch Sinus: From Diagnosis to Treatment
Authors: Garrel Renaud , Jouzdani Elham , Gardiner Quentin , Makeieff Marc , Mondain Michel , Hagen Paul , Crampette Louis , Guerrier Bernard
Published: January 2006

BACKGROUND

Fourth branchial pouch sinus (FBPS) is rare and frequently unknown to clinicians. Misdiagnosis is common and definitive surgery is often made difficult by previous episodes of infection and failed attempts at excision. The purpose of this paper is to clarify the diagnostic criteria and the methods used for the surgical management of FBPS.

MATERIALS AND METHOD

From a series of 265 head and neck cysts and fistulae, 7 cases of FBPS were retrospectively reviewed. The surgical technique is detailed.

RESULTS

Six cases were located on the left side and one on the right. CT scanning showed an air‐filled structure on both sides of the lesser horn of the thyroid cartilage in 2 cases out of 4, and barium swallow found a FBPS in 1 case out of 3. Direct pharyngoscopy allowed confirmation of the diagnosis in all cases and permitted catheterization of the tract with the spring guidewire of a vascular catheter which helped surgical location and subsequent dissection. The recurrent laryngeal nerve was systematically dissected to avoid inadvertent damage. A hemi‐thyroidectomy was performed in one case. A transient laryngeal paralysis (lasting 9 months) was noted in a 3‐week‐old newborn operated on. None of the 7 cases had a recurrence after complete resection of the FBPS (3.7 years average follow‐up).

CONCLUSION

Symptoms on the right side do not exclude the diagnosis of a FBPS. Endoscopy is the key investigation. It allows confirmation of the diagnosis and catheterization of the tract, which aids the surgical dissection. Total removal of the sinus tract tissue with dissection and preservation of the recurrent laryngeal nerve is recommended.

EBM rating: A‐1
Recurrent Periorbital Cellulitis: An Unusual Clinical Entity
Authors: Sorin Alexander , April Max M. , Ward Robert F.
Published: January 2006

OBJECTIVES

To discuss the cause and management of recurrent periorbital cellulitis (RPOC).

STUDY DESIGN

Retrospective case series and review of literature.

MATERIALS AND METHODS

In the past 11 years, we have treated 6 patients for recurrent periorbital cellulitis (RPOC). Inclusion criteria were a minimum of 3 episodes of periorbital cellulitis (POC) within a 1‐year period, with interval convalescence lasting at least 1 month. All patients were followed for at least 1 year after resolution.

RESULTS

The causes of RPOC were as follows: (1) 2 patients developed RPOC attributed to environmental allergies; (2) 1 was diagnosed with underlying recurrent sinusitis resistant to medical management with resolution attained through surgery; (3) 1 patient with vesicular RPOC was diagnosed with herpetic RPOC and treated medically with antiviral therapy; (4) 1 patient had allergic contact dermatitis from cosmetic make‐up use; and (5) 1 patient was suspected of malingering via repeat subcutaneous self‐injection of an irritant.

CONCLUSIONS

Although periorbital cellulitis is a commonly encountered and treatable condition, recurrent periorbital cellulitis is rare and may be challenging to manage. In our experience, the causes of recurrence varied, but resolution was achieved by identifying the underlying cause through continuous clinical reassessment and by appropriate medical or surgical management.

EBM rating: C‐4
Supraesophageal Reflux: Validation of a Symptom Questionnaire
Authors: Dauer E. , Thompson D. , Zinsmeister A. R. , Dierkhising R. , Harris A. , Zais T. , Alexander J. , Murray J. A. , Wise J. L. , Lim K. , Locke G. R. , Romero Yvonne
Published: January 2006

OBJECTIVES

To develop and validate a questionnaire for supraesophageal manifestations of reflux (SER) that will facilitate its study in clinical and research settings.

STUDY DESIGN

The Supraesophageal Reflux Questionnaire (SERQ) and previously validated Reflux Symptom Index (RSI) were subjected to multiple types of validity testing, including content validity, concurrent validity, reproducibility, and predictive validity.

RESULTS

The concurrent validity and reproducibility of both instruments was good to excellent for most items tested. The predictive validity of the SERQ was superior to the RSI when it included the covariates of history of sinusitis, use of over‐the‐counter antacid medications, age, gender, and body mass index.

CONCLUSIONS

The SERQ will serve as both a useful clinical and research tool by offering not only SER symptom information, like the RSI, but also information about the patient's medical history and medication usage that will facilitate use of the SERQ in research protocols.

EBM rating: B‐2b
Allergy Practice in the Academic Otolaryngology Setting: Results of a Comprehensive Survey
Authors: Lin Sandra Y. , Mabry Richard L.
Published: January 2006

OBJECTIVES

To survey academic otolaryngology centers and obtain information regarding their practice of otolaryngic allergy.

STUDY DESIGN

A 12‐item multiple‐choice survey was sent to all academic otolaryngology department chairmen and program directors, as well as all academic liaisons known to the American Academy of Otolaryngic Allergy.

RESULTS

Representatives of 71 of 102 (69.6%) accredited otolaryngology programs responded; 52 of 84 respondents reported an active otolaryngic allergy practice at their institution. The testing method most widely employed by those surveyed is intradermal dilutional testing (IDT). The majority of respondents (74.5%) felt that the addition of allergy increased referrals to their department, and a similar majority (72%) were operating at a profit. The most common reasons cited for adding allergy services were to meet educational and residency requirements.

CONCLUSIONS

The majority of academic otolaryngology programs in the United States currently offer otolaryngic allergy services. The primary reason cited for adding these services is for educational purposes, but there appear to be potential financial benefits as well.

EBM rating: C‐4
Decreased E‐Cadherin but not β‐Catenin Expression is Associated with Vascular Invasion and Decreased Survival in Head and Neck Squamous Carcinomas
Authors: Kurtz Kevin A. , Hoffman Henry T. , Zimmerman M. Bridget , Robinson Robert A.
Published: January 2006

OBJECTIVES

We wished to correlate the expression of E‐cadherin and β‐catenin in squamous carcinomas of the head and neck to outcome and other clinicopathologic variables.

STUDY DESIGN AND SETTING

This retrospective study was carried out in a tertiary care setting. The tumors of 45 patients who had their head and neck squamous carcinoma primarily treated by resection were evaluated immunohistochemically with antibodies to E‐cadherin and β‐catenin. Thirty‐two tumors arose in the oral cavity, 9 tumors originated in the larynx, and 4 tumors began in the hypopharynx. Patient outcome and the clinicopathologic variables of tumor site, tumor stage, cervical lymph node status, tumor differentiation, perineural invasion, and vascular invasion were correlated to immunohistochemical expression of E‐cadherin and β‐catenin.

RESULTS

Low expression of E‐cadherin in the tumors was significantly associated with decreased overall survival (P = 0.004), disease‐free survival (P = 0.007), and vascular invasion (P = 0.02) but not with other clinicopathologic variables. β‐catenin expression was not significantly associated with any of the studied clinicopathologic variables.

CONCLUSION

Decreased E‐cadherin but not β‐catenin expression is associated with decreased survival in patients with head and neck squamous carcinomas.

SIGNIFICANCE

Detection of loss of E‐cadherin expression may help predict which patients with head and neck squamous cell carcinoma will experience a worse outcome compared to patients whose tumors have not lost this tumor suppressor.

EBM rating: C‐4
Internal Nasal Valve: Revisited with Objective Facts
Authors: Cem Miman Murat , Deliktaş Hacim , Özturan Orhan , Toplu Yüksel , Akarçay Mustafa
Published: January 2006

OBJECTIVES

Comprehensive examination of the internal nasal valve (INV) using objective methods.

STUDY DESIGN AND SETTING

In this prospective study, 248 nasal cavities were examined by nasal endoscopy, acoustic rhinometry (ARM), and rhinomanometry (RMM).

RESULTS

Endoscopic examination allowed to suggest a novel classification of INV: convex, concave, sharp angle, blunt angle, twisted caudal border, and angle occupied by the septal body. The INV angle occupied with septal body type was found to have increased nasal resistances compared with the sharp‐angled internal nasal valve type (P < 0.05). Convex, concave, and sharp‐angle types of INV angles were found different (P < 0.01).

CONCLUSIONS

INV should be examined objectively before any INV surgery. A novel description of the INV configurations and their effects on nasal respiration found in this study may increase our understanding and lead surgical approaches more adequately. A surgical attempt to augment INV angle value may impact positively on nasal resistance.

EBM rating: C‐4
Genomic Instability in the Progression of Sporadic Nasopharyngeal Carcinoma
Authors: Tan Guolin , Chu Yumin , Chen Jiangbo , Li Heqing
Published: January 2006

OBJECTIVE

Genomic instability reflecting the susceptibility of the genome to acquire multiple genetic alterations plays a major role in tumorigenesis and tumor progression. We evaluated the prognostic significance of the extent of genomic instability in nasopharyngeal carcinoma.

STUDY DESIGN AND SETTING

Genomic instability was assessed by inter—simple sequence repeats polymerase chain reaction (inter‐SSR PCR) in 38 patients with nasopharyngeal carcinoma. Characterization and verification of band alterations shared in different tumors were carried out by sequencing and nest PCR.

RESULTS

31 (81.6%) of 38 patients showed genomic alterations, and genomic instability index ranged from 0 to 16.2%. A gain‐based genomic damage shared in 6 tumors was identified on chromosome 6q27, a new mutator phenotype in nasopharyngeal carcinoma. Significantly more genomic alteration was found in patients without 5‐year survival than that with 5‐year survival (P < 0.05), suggesting that higher genomic instability predicts a poor prognosis in nasopharyngeal carcinoma.

CONCLUSIONS AND SIGNIFICANCE

Our data suggests that genomic instability can be an early event marker in carcinogenesis of nasopharyngeal carcinoma. Also, aggravation of genomic alterations is a poor prognosis for cancer recovery.
An Anatomical Study of the Arteries of the Anterior Nasal Septum
Authors: Chiu Tor , Shaw Dunn John
Published: January 2006

OBJECTIVES

The anterior nasal septum is a clinically important area, yet anatomical descriptions of its arterial pattern are hitherto incomplete. This study aimed to test the hypothesis that the arteries of the anterior nasal septum form a fine random network of vessels.

STUDY DESIGN

The arterial pattern of the nasal septum was traced by microdissection of 12 cadaveric septa (24 sides).

SETTING

Each septum was microdissected with a Watson‐Barnet dissecting microscope. Specimens were photographed and the vascular patterns were analyzed.

RESULTS

The anterior septum has a consistent large arterial anastomotic triangle receiving major contributions from sphenopalatine, anterior ethmoidal, and superior labial arteries.

CONCLUSION

Systematic microdissections clearly demonstrate that the arteries of the anterior septum do not form a random network. Instead, they form a consistent arterial anastomotic triangle consisting of large, thin vessels.

SIGNIFICANCE

The study provides background material useful to the understanding of nasal physiology and pathology including epistaxis.
The Development of a Snoring Symptoms Inventory
Authors: Douglas Susan A. , Webster Simon , El Badawey Mohammed Reda , Drinnan Michael , Matthews John N. S. , Gibson G. John , Wilson Janet A.
Published: January 2006

OBJECTIVES

To develop a patient‐derived snoring questionnaire, the Snoring Symptoms Inventory (SSI), and explore its structure and relationship to the Epworth Sleepiness Scale (ESS); and to assess the sensitivity of the SSI to change.

STUDY DESIGN AND SETTING

The SSI was developed from an open‐ended questionnaire given to 120 habitual snorers. The 25 symptoms reported compose the SSI. This study examines 261 subsequent snorers assessed between April 1998 and August 2002, who completed both the SSI and the ESS. Fifty‐five of them underwent laser uvulopalatoplasty and their preoperative and postoperative SSI results were compared.

RESULTS

The total SSI score is the key outcome derived. Principal component analysis identified two further dimensions, one contrasting family/social with work‐related problems and another comparing physical problems with embarrassment. The total score correlated weakly with the ESS. Laser uvulopalatoplasty significantly reduced patients' overall symptom severity and family and socially related problems.

CONCLUSION

The SSI is a comprehensive and sensitive measure for assessing snoring, making it a useful clinical outcome tool for snoring treatment.

SIGNIFICANCE

The SSI is a new, useful snoring questionnaire.

EBM rating: B‐2b
A Targeted Endoscopic Approach to Chronic Isolated Frontal Sinusitis
Authors: Landsberg Roee , Segev Yoram , Friedman Michael , Fliss Dan M. , Derowe Ari
Published: January 2006

OBJECTIVES

Chronic isolated frontal sinusitis occurs infrequently. In this condition, most of the ethmoid cells are well aerated and the frontal sinus is involved secondary to anatomical obstruction or inflammatory changes confined to the frontal recess. The purpose of this study was to evaluate a targeted endoscopic technique where standard anterior ethmoidectomy is unnecessary in the treatment of chronic isolated frontal sinusitis.

STUDY DESIGN AND SETTING

This retrospective study was conducted in a large university‐affiliated hospital and included 11 patients with chronic isolated frontal sinusitis who underwent endoscopic sinus surgery limited to the frontal sinus outflow. The ethmoid bulla was untouched in all cases. Follow‐up continued for 19 to 40 months (mean 28.6 months).

RESULTS

Frontal sinus outflow patency was verified in 9 patients (81.8%). Nine patients, including one with an apparent nonpatent frontal ostium, reported improvement. Two patients—one of whom had a patent frontal ostium—reported no improvement. There were no complications.

CONCLUSION

Chronic isolated frontal sinusitis can be effectively treated in selected cases by a targeted endoscopic procedure, limited to reestablishment of frontal sinus outflow.

EBM rating: C‐4
Noninvasive Measurement of Ablation Crater Size and Thermal Injury after CO2 Laser in the Vocal Cord with Optical Coherence Tomography
Authors: Torkian Behrooz A. , Guo Shuguang , Jahng Alexander W. , Liaw Lih‐Huei L. , Chen Zhongping , Wong Brian J. F.
Published: January 2006

OBJECTIVES

To characterize tissue destruction after CO2 laser‐ablation of the vocal cords with the use of optical coherence tomography (OCT).

STUDY DESIGN AND SETTING

OCT was used to image fresh porcine vocal cords after laser ablation. OCT and histology estimates of the ablation crater dimensions and the depth of thermal injury were obtained.

RESULTS

The vocal cord substructures up to 2.29 mm in depth at 10 μm resolution, and the thermal disruption after laser ablation were identified by OCT. OCT and histology estimates of the lesion dimensions showed no significant differences. Crater depth is directly proportional to laser power, whereas crater width and the zone of thermal injury appear to be unrelated to laser power.

CONCLUSIONS

OCT may be used to accurately characterize the native states and the laser‐induced thermal injury of laryngeal mucosa, within the inherent limitation in its depth of penetration. OCT may be a useful diagnostic and monitoring tool in an otolaryngology practice.
Preservation of Natural Frontal Sinus Outflow in the Management of Frontal Sinus Osteomas
Authors: Dubin Marc G. , Kuhn Frederick A.
Published: January 2006

INTRODUCTION

Management of frontal sinus tumors has traditionally been through open approaches with obliteration of the sinus. Recently, increased comfort with endoscopic techniques has made endoscopic resection an alternative to more morbid approaches. However, many skilled endoscopists still champion obliteration of the frontal sinus after the open treatment of large osteomas.

METHODS

A retrospective review of the senior author's experience with frontal sinus osteomas was performed.

RESULTS

Twelve frontal sinus osteomas were treated surgically without obliteration. All patients with greater than 2 cm vertical extension of their tumor into the frontal sinus required an open approach (n = 4), whereas the remainder (n = 8) were treated endoscopically. Frontal ostia were stented if greater that 40% of the mucosa of the frontal recess was denuded. Eleven of 12 patients had patent, functional frontal sinuses.

CONCLUSION

Successful resection of frontal sinus osteomas can be performed with preservation of the natural drainage of the frontal sinus in almost all cases.

EBM rating: C‐4
Long‐Term Effectiveness of Ear‐Level Devices for Tinnitus
Authors: Folmer Robert L. , Carroll Jennifer R.
Published: January 2006

OBJECTIVES

This study was undertaken to assess long‐term changes in tinnitus severity exhibited by patients who purchased and used ear‐level devices (hearing aids or sound generators).

STUDY DESIGN AND SETTING

Patients were evaluated and treated within a comprehensive tinnitus management program. Follow‐up questionnaires were mailed to patients 6 to 48 months after their initial appointment.

RESULTS

Follow‐up questionnaires from 150 patients were reviewed. Fifty patients purchased and used hearing aids, 50 patients purchased and used in‐the‐ear sound generators for an average of 18 months after their initial appointment; 50 patients did not use ear‐level devices. At follow‐up, all 3 groups of patients exhibited significant reductions in Tinnitus Severity Index scores and self‐rated tinnitus loudness. Patients who used ear‐level devices reported greater improvement than patients who did not use hearing aids or sound generators.

CONCLUSIONS

Ear‐level devices such as hearing aids or sound generators can help a significant number of patients who experience chronic tinnitus. Both types of devices reduce patients' perception of tinnitus and can facilitate habituation to the symptom. Amplification provides additional benefits of improved hearing and communication.
Malondialdehyde Level and Adenosine Deaminase Activity in Nasal Polyps
Authors: Okur Erdogan , Inanc Fatma , Yildirim Ilhami , Kilinc Metin , Kilic M. Akif
Published: January 2006

OBJECTIVES

Although there are many reports on adenosine deaminase (ADA) activities in different tissues, no information is available about the enzyme activity in nasal mucosa and polyp tissues. Whereas ADA is related to the production of free radicals by neutrophils, malondialdehyde (MDA) is an indicator of lipid peroxidation that is a general mechanism of tissue damage by free radicals. This study is aimed at determining and comparing the ADA activity and MDA level in nasal polyps and normal mucosa.

STUDY DESIGN AND SETTING

Twenty‐three patients with nasal polyps and a control group consisting of 14 patients with septal deviation and lower turbinate hypertrophy were included in the study. Tissue MDA level was measured by the method of Okawa with modification and tissue ADA activity by the method of Giusti.

RESULTS

In patients with nasal polyp, mean tissue MDA level and ADA activity were 2.43 ± 0.38 nmol/mg protein (Pr) and 0.235 ± 0.055 U/mg Pr, respectively, which were significantly higher than those of control nasal mucosa (1.03 ± 0.41 nmol/mg protein and 0.056 ± 0.011 U/mg Pr, respectively) (P < 0.05). In addition, tissue MDA level was positively correlated to ADA activity in nasal polyps (r = 0.701, P < 0.001).

CONCLUSIONS

The present study showed the presence of detectable ADA activity in nasal mucosa, and also significant increases in both tissue MDA level and ADA activity in NP tissue when compared to normal turbinate tissue.

EBM rating: B‐2b
Consequences of Increased Rigidity in Palatal Implants for Snoring: A Randomized Controlled Study
Authors: Skjøstad Ketil W. , Kari Stene Brit , Norgård Ståle
Published: January 2006

OBJECTIVES

Palatal implants have seen an increased role in the treatment of snoring. In this study, we evaluate the safety and possible treatment effect of adding further stiffness to the palate through the use of a more rigid implant.

STUDY DESIGN

Randomized double‐blind study of 20 patients with primary snoring. Three polyethylene teralphate implants were placed in the soft palate with the patient under local anesthesia. Ten patients received regular implants (rigidity 1.0) and 10 patients received stiffer implants (rigidity 1.8). The patients and their bed partners were followed for 6 months with questionnaires and office visits. A sleep study was performed preoperatively and at the last follow‐up.

RESULTS

Four of the 10 patients with stiffer implants had 5 partial extrusions in the observation period. There was a nonsignificant reduction in snoring intensity from 8.1 to 6.1 evaluated by the bed partner on a visual analogue scale in this group. No extrusions were seen in the group with regular implants. This group showed a significant reduction in snoring intensity from 7.7 to 4.7. No other major adverse events were observed.

CONCLUSIONS AND SIGNIFICANCE

Rigid implants cause short time extrusions with loss of treatment effect. Regular implants reduce palatal snoring intensity with high patient and bed partner satisfaction.

EBM rating: A‐1b