bluuebunny/crossref_metadata_2025 huggingface dataset:
Temporal Bone Histopathological and Quantitative Analysis of Mitochondrial DNA in MELAS
Authors: Takahashi Katsumasa , Merchant Saumil N. , Miyazawa Tetsuo , Yamaguchi Toshikazu , McKenna Michael J. , Kouda Hiroko , Iino Yukiko , Someya Tsutomu , Tamagawa Yuya , Takiyama Yoshihisa , Nakano Imaharu , Saito Ken , Boyer Philip , Kitamura Ken
Published: November 2003

Objectives/Hypothesis Although hearing loss is common in MELAS (syndrome of mitochondrial encephalopathy, lactic acidosis and stroke‐like episodes), the histopathology of the temporal bone has not been reported. The majority of cases of MELAS are linked to a mitochondrial DNA (mtDNA) mutation at nucleotide 3243. In MELAS, normal mtDNA and mutant mtDNA coexist in a heteroplasmic manner. The purpose of the study was to report the otopathological findings from two patients with MELAS and quantitative mtDNA analysis in the inner ear of one of these patients.

Study Design Basic scientific histopathological examination and quantitative mtDNA analysis of the temporal bone.

Methods Temporal bones were embedded in celloidin and sectioned for light microscopic study. Graphic reconstruction of the cochlea was performed using the method described by Schuknecht. For quantitative mtDNA analysis, total DNA from the membranous part of the inner ear was collected, amplified by polymerase chain reaction, and digested with the restriction enzyme. The percentage of mutant/total mtDNA was measured by the ratio of fluorescence intensity.

Results Histopathological examination revealed severe degeneration of the stria vascularis and degenerative change of spiral ganglion cells in both patients. The quantitative DNA studies showed that the proportion of mutant to wild‐type mtDNA was similar in both histologically affected and histologically unaffected tissues within the inner ear.

Conclusion Dysfunction of the stria vascularis and spiral ganglion cells causes sensorineural hearing loss in MELAS.
Intravenous Anesthesia Provides Optimal Surgical Conditions During Microscopic and Endoscopic Sinus Surgery
Authors: Eberhart Leopold H. J. , Folz Benedikt J. , Wulf Hinnerk , Geldner Götz
Published: November 2003

Objectives/Hypothesis Controlled hypotension is used to improve surgical conditions during microscopic and endoscopic sinus surgery. New short‐acting anesthetics such as propofol and remifentanil allow exact control of intraoperative blood pressure and thus might be valuable tools to improve intraoperative conditions for the otorhinolaryngological surgeon. Intravenous anesthesia was compared with traditional balanced anesthesia by subjective assessment of surgical conditions made by two experienced otorhinolaryngological surgeons.

Study Design Prospective, randomized, patient‐ and observer‐blinded study.

Methods Ninety consecutive patients were randomly assigned to receive intravenous anesthesia with propofol 5 to 8 mg·kg−1·h−1 and remifentanil 10 to 30 μg·kg−1·h−1 or with isoflurane (0.4–1.0 vol%) and repetitive doses of 0.5 to 1 mg alfentanil. An injectable vasodilator was used in both groups to keep mean arterial pressure between 60 and 70 mm Hg (8–9.3 hecto‐pascal). The attending otorhinolaryngological surgeon was unaware of the type of anesthesia administered. Immediately after the operation the surgeons rated surgical conditions (bleeding from the surgical field) on a visual analogue scale (0–10 cm) and on a verbal rating scale.

Results Blood pressure was not different between the two groups, but heart rate was lower in the intravenous anesthesia group (mean heart rate in the intravenous anesthesia group, 62 beats per min [95% confidence interval, 52–72]; mean heart rate in the balanced anesthesia group, 75 beats per min [95% confidence interval, 67–83]). Surgical conditions were rated to be significantly better (P <.0001) during anesthesia with propofol‐remifentanil (median rating: 2.8; 25th/75th per‐centile: 2.0/3.4) compared with isoflurane‐alfentanil (median rating: 4.9; 25th/75th percentile: 3.6/7.6).

Conclusions Intravenous anesthesia using propofol‐remifentanil provides better surgical conditions compared with a traditional balanced anesthesia technique using isoflurane‐alfentanil. It is hypothesized that lower cardiac output caused by decreased heart rate during deep general anesthesia is responsible for this result.
The Effect of Nasal Polyp Epithelial Cells on Eosinophil Activation
Authors: Shin Seung‐Heon , Lee Sang‐Heon , Jeong Hyo‐Soon , Kita Hirohito
Published: November 2003

Objectives/Hypothesis Eosinophil infiltration into an inflammatory site is a characteristic histological finding in patients with chronic rhinosinusitis and nasal polyps. Most of the eosinophils in chronic rhinosinusitis are activated in the nasal cavity, but the exact activation mechanism of eosinophils is unknown. The study was designed to investigate the effect of human nasal epithelial cells on the activation of eosinophils.

Study Design Peripheral blood eosinophils were isolated from healthy volunteers and incubated in human nasal polyp epithelial cell conditioned media (HPECM). Superoxide production and eosinophil‐derived neurotoxin were measured to determine eosinophils activation. HPECMs were assayed by ELISAs for interleukin‐8 (IL‐8), granulocyte‐macrophage colony stimulating factor (GM‐CSF), eotaxin, and regulated on activation normal T expressed and secreted (RANTES). To identify the chemical mediators involved in the activation of eosinophils.

Results HPECM (n = 7) contained 31.48 ng/mL interleukin‐8, 533.43 pg/mL GM‐CSF, 5.90 pg/mL eotaxin, and 11.06 pg/mL RANTES. Eosinophils were activated by HPECM and inhibited only by anti–GM‐CSF antibody, not by the other chemical mediators.

Conclusion The results suggest that eosinophils in nasal secretions are activated by GM‐CSF, which is produced by nasal epithelial cells.
Vascularized Hemitracheal Autograft for Laryngotracheal Reconstruction: A New Surgical Technique Based on the Thyroid Gland as a Vascular Carrier
Authors: Zur Karen B. , Urken Mark L.
Published: November 2003

Background The management of extensive laryngotracheal stenosis has been a challenge confronting head and neck surgeons for over a century. The key to the successful restoration of a stable airway is providing a cartilaginous infrastructure to provide support to withstand both the negative and positive lumenal pressures produced during normal respiration and deglutition. We introduce a novel technique for restoration of such defects.

Methods The blood supply to the thyroid gland by way of the inferior thyroid artery and the superior thyroid artery and vein are mobilized for transfer. One half to two thirds of the circumference of the adjacent tracheal rings are mobilized on the basis of the requirements of the stenotic segment. This mucochondrial composite tracheal flap is advanced superiorly to the ipsilateral “laryngeal” region where insetting of the cartilage and the mucosa is performed. Primary reconstruction or, more likely, a staged repair of the secondary tracheal defect is performed.

Results Three case reports are presented. The patients were successfully decannulated postoperatively, continue to have an adequate voice, and are tolerating a diet (3–27 months postreconstruction).

Conclusion A new surgical technique for reconstruction of benign laryngotracheal stenoses is introduced to restore phonatory capability and a stable airway. The composite thyroid‐tracheal graft based on the inferior and superior thyroid arterial pedicles allows a single‐staged, primary reconstruction of the hemilarynx with a well‐vascularized composite thyrotracheal flap that allows resurfacing as well as replacement of the infrastructure of the glottis and subglottis. This technique would be an excellent method to restore the cricoid ring following partial resection for primary cartilaginous tumors.
Subacute Hypoglossal Nerve Paresis with Internal Carotid Artery Dissection
Authors: Lindsay Fred W. , Mullin David , Keefe Michael A.
Published: November 2003

Objectives To describe a case of an isolated hypoglossal nerve palsy in a patient with a spontaneous internal carotid artery dissection (ICAD). This condition is a well‐recognized cause of cerebral ischemic stroke in patients younger than 45 years of age. Isolated cranial nerve neuropathy is a rare presentation. More common manifestations include incomplete hemiparesis, hemicrania, Horner syndrome, cervical bruit, pulsatile tinnitus, and multiple cranial nerve palsies.

Methods A comprehensive literature search (Ovid, MEDLINE) for the presentation, diagnostic evaluation, treatment, and outcome of patients with internal carotid artery dissection was performed.

Results A 43‐year‐old man presented with a 3‐week history of mild dysarthria. There was no history of craniocervical trauma. The physical examination revealed an isolated left hypoglossal nerve paresis. Magnetic resonance imaging and angiography findings were consistent with a left skull base ICAD. The patient was successfully treated with anticoagulation therapy. The current rate of cranial nerve involvement is estimated at 10% of all ICADs. This is the second report of isolated hypoglossal nerve palsy without hemicrania in a case of atraumatic ICAD.

Conclusions Patients with an ICAD infrequently present to the otolaryngologist because of its head and neck manifestations. It is crucial to recognize atypical findings and to perform an accurate and prompt diagnostic evaluation. The foundation of treatment is aggressive anticoagulation, with surgical or radiologic intervention reserved for cases demonstrating life‐threatening progression.
Molecular Disruption of the MRN(95) Complex Induces Radiation Sensitivity in Head and Neck Cancer
Authors: O'Malley Bert W. , Li Daqing , Carney James , Rhee Joung , Suntharalingam Mohan
Published: November 2003

Objectives/Hypothesis The goal of the project was to develop a novel treatment strategy for head and neck cancer that induces radiation sensitivity. We hypothesized that the normal cellular DNA repair response in head and neck squamous cell carcinoma after radiation therapy can be blocked by a dominant negative disruption of the functioning MRN(95) protein complex. To test this hypothesis, we have developed a novel molecular therapy that inhibits the MRN(95) complex in tumor cells. Disruption the MRN(95) complex and thus DNA repair should result in enhanced tumor killing after classic external‐beam radiation therapy.

Study Design Experiments with human head and neck squamous cell carcinoma cell lines in vitro were performed.

Methods Recombinant adenovirus vectors carrying the genes for enhancing radiation were generated. Human head and neck squamous cell carcinoma cells were treated with recombinant adenovirus vectors carrying the mutated p95 gene (p95–300), which contains the C‐terminus 300 amino acids of the Nbs1(p95) protein. Tumor cells were also treated with adenovirus vector carrying full‐length p95 protein or DL312 control virus; then all cell lines were subjected to 2 Gy irradiation. Cell growth curves were determined through colorimetric tetrazolium salt assay.

Results Both the Ad‐p95–300 and Ad‐p94‐his (full‐length wild‐type gene) demonstrated significant antitumor effect alone and in combination with radiation therapy compared with control samples. Cell cycle analysis demonstrated a shift toward the G2/M phase of the cell cycle. Analysis of telomerase activity demonstrated a significant decrease in telomerase activity after molecular therapy alone, and a greater decrease when combined with radiation therapy.

Conclusion Adenovirus‐mediated mutant or full‐length p95 molecular therapy demonstrated efficacy for the treatment of head and neck squamous cell carcinoma in vitro. This novel molecular therapy strategy induced significant radiation sensitization, induced a relative G2/M arrest, and decreased telomerase activity, all of which enhance the benefit of radiation therapy.
Long‐term effect of adenotonsillectomy on quality of life in pediatric patients
Authors: Flanary Valerie A.
Published: November 2003

Hypothesis: Adenotonsillectomy improves general and disease‐specific quality of life for properly selected patients suffering for upper airway obstruction secondary to adenotonsillar hypertrophy (UAO) and obstructive sleep apnea (OSA). Study Design: Prospective, nonrandomized questionnaire. Specific Aims: To evaluate quality of life in patients with UAO and OSA using general quality of life instruments as well as disease‐specific instruments. The results will be compared both pre‐ and postoperatively. Methods: Fifty‐five patients aged 2 to 16 with the clinical diagnosis of UAO or OSA were recruited. The caregivers completed Children's Health Questionnaire Parent Form‐28 (CHQPF‐28) and OSA‐18 quality of life measures both pre‐ and postoperatively in the long and short term. Statistical analysis was performed using the unpaired Student t test, P value less than .05, and Spearman Rank coefficient. Results: CHQ‐PF28 scores were improved in the Physical Summary parameter in long‐term follow‐up. Psychosocial scores did not improve significantly. OSA‐18 scores showed improvement in both the short‐and long‐term scores. Physical findings and symptoms did not impact scores in any domain. Conclusions: Quality of life in children with OSA does improve after adenotonsillectomy. Disease‐specific clinometric instruments show improvement in domains affected by the disease process. However, instruments used to assess general quality of life may show physical improvement but not psychosocial.
Contralateral suppression of distortion‐product otoacoustic emissions declines with age: A comparison of findings in CBA mice with human listeners
Authors: Jacobson Michael , Kim Sunghee , Romney Joshua , Zhu Xiaoxia , Frisina Robert D.
Published: November 2003

Objectives/Hypothesis: The auditory efferent system plays presumed roles in enhancing signals in noise, maintaining the cochlea for optimal acoustic signal processing, and may have a protective role in preserving auditory function in the face of ototoxic events. The objective of the study was to measure age‐related changes of the medial olivocochlear efferent system in mice by comparing distortion‐product otoacoustic emissions generated with and without contralateral white noise stimulation. Consistent with prior work, distortion‐product otoacoustic emissions were typically reduced in magnitude when white noise was presented to the contralateral ear. This contralateral suppression is attributed to activation of the medial olivocochlear efferent system, which has an inhibitory effect on the cochlear hair cell system. By studying contralateral suppression on cochlear output in subjects of different ages, it is possible to describe aging effects on the medial olivocochlear system. Study Design: CBA mice were divided into three age groups: young adult, middle‐aged, and old‐aged animals (21, 13, and 22 animals per group, respectively), and auditory brainstem responses were obtained before distortion‐product otoacoustic emission testing to assess overall hearing abilities. Methods: 2f1‐f2 distortion‐product otoacoustic emission recordings were obtained from individual subjects (anesthetized with ketamine/xylazine) in each age group under two conditions: 1) in quiet and 2) in the presence of a contralaterally applied wideband noise. Results: Principal findings were that distortion‐product otoacoustic emission levels decreased with age for mice in a way similar to humans, when correcting for the absolute difference in life spans. In addition, contralateral suppression declined in middle‐aged and old‐aged groups relative to the young adults for mice in a manner similar to humans. The contralateral suppression decline at low frequencies preceded that of the decline in distortion‐product otoacoustic emissions with age. Conclusion: Functional decline of the medial olivocochlear efferent system with age precedes outer hair cell degeneration. Loss of medial olivocochlear suppressive function may play a role in the development of presbycusis in both clinical cases and animal models.
A tympanometric comparison of tympanoplasty with cartilage palisades or fascia after surgery for tensa cholesteatoma in children
Authors: Uzun Cem , Cayé‐Thomasen Per , Andersen Janne , Tos Mirko
Published: November 2003

Objective: The aim of the present study is to compare the tympanometric and functional findings of cartilage palisade tympanoplasty with those of tympanoplasty with temporalis fascia grafting after one‐stage surgery in children with tensa cholesteatoma. Study Design: In children aged 5 to 15 years (mean, 9.5 years) with tensa cholesteatoma, cartilage palisade tympanoplasty was performed in 32 ears and fascia tympanoplasty in 29 ears. Tympanometry was performed in 31 ears with cartilage palisade tympanoplasty (the palisade group) and 28 ears with fascia tympanoplasty (the fascia group) at follow‐up a median of 48 months after surgical removal of the cholesteatoma (range, 3‐75 months). Main Outcome Measures: Postoperative perforations, tympanometric parameters (tympanogram type, compliance, tympanometric width), and hearing. Results: All postoperative re‐perforations occurred in the fascia group. However, there was no difference between the palisade group and the fascia group in terms of tympanometric parameters, nor between the two groups when dividing into tensa retraction and sinus cholesteatoma subgroups. When comparing the types of tympanoplasty, the type II group reconstructed with cartilage palisades contained a higher number of ears with a normal compliance (0.2‐1.6 mL) but a higher number of ears with a tympanometric width of more than 150 mmH2O. Regarding the number of ears with normal tympanometries, there was no significant difference between the palisade and the fascia group. The late functional hearing results were better in ears reconstructed with cartilage palisades, with functional success in 71%, compared with 54% in the group with fascia grafting. This difference in functional results was particularly pronounced in ears with an abnormal tympanogram (68% vs. 29%). Conclusion: Compared to fascia grafting, the present study showed better late functional hearing results after drum reconstruction using cartilage palisades, despite comparable tympanometric findings. Cartilage palisade reconstruction seems to provide better functional results, especially in ears with a poor tubal function, which is the common situation after cholesteatoma surgery.
Identification of thyroid hormone receptors in the human larynx
Authors: Altman Kenneth W. , Haines G. Kenneth , Vakkalanka Sarah K. , Keni Sanjay P. , Kopp Peter A. , Radosevich James A.
Published: November 2003

Purpose: Thyroid hormone is essential for normal development, growth, and function of the majority of tissues. Among the many clinical signs associated with hypothyroidism, alterations in the voice may occur even in cases of mild thyroid failure, suggesting that the larynx is a target tissue for thyroid hormone. The objective of our study is to further understand the effects of thyroid hormone on the larynx by first identifying the presence and locations of its receptors. Methods: Two human cadaveric larynges (one male and one female) were harvested, formalin‐fixed, and paraffin‐embedded. Sections were immunostained with antibodies reactive with the two identified thyroid hormone receptors, TR‐α and TR‐β. The slides were examined under light microscopy. Results: Both male and female specimens revealed consistent patterns of staining for thyroid hormone receptors. The staining pattern for TR‐α included the fibrous connective tissue of the lamina propria, the cartilage, and the glandular elements. The staining pattern for TR‐β included the fibrous connective tissue of the lamina propria only. No receptors were identified in the respiratory mucosa or muscle. Conclusions: Thyroid hormone receptors are present in both the male and the female human larynx. These findings imply a role for thyroid hormone within the human larynx, through both TR‐α and TR‐β.
C‐terminal hydrophobic interactions play a critical role in oligomeric assembly of the P22 tailspike trimer
Authors: Gage Matthew J. , Robinson Anne Skaja
Published: November 2003

The tailspike protein from the bacteriophage P22 is a well characterized model system for folding and assembly of multimeric proteins. Folding intermediates from both the in vivo and in vitro pathways have been identified, and both the initial folding steps and the protrimer‐to‐trimer transition have been well studied. In contrast, there has been little experimental evidence to describe the assembly of the protrimer. Previous results indicated that the C terminus plays a critical role in the overall stability of the P22 tailspike protein. Here, we present evidence that the C terminus is also the critical assembly point for trimer assembly. Three truncations of the full‐length tailspike protein, TSPΔN, TSPΔC, and TSPΔNC, were generated and tested for their ability to form mixed trimer species. TSPΔN forms mixed trimers with full‐length P22 tailspike, but TSPΔC and TSPΔNC are incapable of forming similar mixed trimer species. In addition, mutations in the hydrophobic core of the C terminus were unable to form trimer in vivo. Finally, the hydrophobic‐binding dye ANS inhibits the formation of trimer by inhibiting progression through the folding pathway. Taken together, these results suggest that hydrophobic interactions between C‐terminal regions of P22 tailspike monomers play a critical role in the assembly of the P22 tailspike trimer.
Three‐dimensional crystallization of the Escherichia coli glycerol‐3‐phosphate transporter: A member of the major facilitator superfamily
Authors: Lemieux M. Joanne , Song Jinmei , Kim Myong Jin , Huang Yafei , Villa Anthony , Auer Manfred , Li Xiao‐Dan , Wang Da‐Neng
Published: November 2003

Here we report the successful three‐dimensional crystallization of GlpT, the glycerol‐3‐phosphate transporter from Escherichia coli inner membrane. GlpT possesses 12 transmembrane α‐helices and is a member of the major facilitator superfamily. It mediates the exchange of glycerol‐3‐phosphate for inorganic phosphate across the membrane. Approximately 20 phospholipid molecules per protein, identified as negatively charged phosphatidylethanolamine, phosphatidylglycerol, and cardiolipin, were required for the monodispersity of purified GlpT. Analytical size‐exclusion chromatography proved to be efficient in identifying detergents for GlpT monodispersity. Nine such detergents were later used for GlpT crystallization. Screening for crystal nucleation was carried out with a variety of polyethylene glycols as the precipitant over a wide pH range. Subsequent identification of a rigid protein core by limited proteolysis and mass spectroscopy resulted in better‐ordered crystals. These crystals exhibited order to 3.7 Å resolution in two dimensions. However, the stacking in the third dimension was partially disordered. This stacking problem was overcome by using a detergent mixture and manipulating the ionic interactions in the crystallization solution. The resulting GlpT crystals diffracted isotropically to 3.3 Å resolution and were suitable for structure determination by X‐ray crystallography.
Double‐stranded DNA‐induced localized unfolding of HCV NS3 helicase subdomain 2
Authors: Liu Dingjiang , Windsor William T. , Wyss Daniel F.
Published: November 2003

The NS3 helicase of the hepatitis C virus (HCV) unwinds double‐stranded (ds) nucleic acid (NA) in an NTP‐dependent fashion. Mechanistic details of this process are, however, largely unknown for the HCV helicase. We have studied the binding of dsDNA to an engineered version of subdomain 2 of the HCV helicase (d2ΔNS3h) by NMR and circular dichroism. Binding of dsDNA to d2ΔNS3h induces a local unfolding of helix (α3), which includes residues of conserved helicase motif VI (Q460RxxRxxR467), and strands (β1 and β8) from the central β‐sheet. This also occurs upon lowering the pH (4.4) and introducing an R461A point mutation, which disrupt salt bridges with Asp 412 and Asp 427 in the protein structure. NMR studies on d2ΔNS3h in the partially unfolded state at low pH map the dsDNA binding site to residues previously shown to be involved in single‐stranded DNA binding. Sequence alignment and structural comparison suggest that these Arg–Asp interactions are highly conserved in SF2 DEx(D/H) proteins. Thus, modulation of these interactions by dsNA may allow SF2 helicases to switch between conformations required for helicase function.
GenJam in Perspective: A Tentative Taxonomy for GA Music and Art Systems
Authors: Biles John A.
Published: November 2003

GenJam is an interactive genetic algorithm (GA) that models a human jazz improviser and performs regularly as the author's sideman on jazz gigs. GenJam learns to improvise full-chorus solos under the guidance of a human mentor and “trades fours” in real time with a human performer in “chase” choruses. In this article, the author first briefly describes GenJam's architecture, representations, genetic operators and performance characteristics. He then places GenJam in the context of a proposed taxonomy for GA-based music and art systems.
An Application Framework for Building Evolutionary Computer Systems in Music
Authors: Pazos Alejandro , Santos Antonino , Arcay Bernardino , Dorado Julián , Rodriguez Juan Romero and Jose
Published: November 2003

The authors present a musical composition model that creates rhythmic patterns through a system based on genetic algorithms, involving the interaction of several artificial musicians. In this environment, various composer systems and human musicians may interact within a system based on artificial life.
Aristotle's Two Modal Theses Again
Authors: Makin Stephen
Published: November 2003

This paper offers an interpretation of the arguments Aristotle offers in Metaphysics 9.4, 1047b14-30, for the two modal theses [1] if (if A is the case then B is the case) then (if A is possible then B is possible) [2] if (if A is possible then B is possible) then (if A is the case then B is the case) Aristotle's arguments for these theses have not typically impressed commentators. I offer two arguments which are relatively faithful to Aristotle's text. The arguments rest on the following pair of claims concerning conditionals and possibility respectively [COND] 'if A then B' is true if and only if in any circumstances in which A obtains, B obtains also [TEST] 'possibly A' is true in a range of circumstances C1 . . . Cn if and only if assuming A true in any Ci gives rise to no impossibilities, once any further required adjustments are taken into account The arguments and the premises on which they rest are stated without formalisation of the theses [1] and [2]. The argument for [1] is a defensible and persuasive argument. The argument for [2] is invalid, though plausible. That is consistent with our differential verdicts on [1] and [2]. [2] appears to be false: the argument provided for [2] explains why Aristotle might nevertheless have asserted it. The aim of the paper is to justify a more positive verdict on Aristotle's arguments than is usual among commentators.
Wang Tieya: Our Dear Friend and Colleague
Authors:   Jennings
Published: November 2003

No Abstract
John Torpey. The Invention of the Passport; Surveillance, Citizenship and the State
Authors:   Zieck
Published: November 2003

No Abstract
Bio-Bibliographical Key to the Membership of the Institut de Droit International, 1873-2001
Authors:   Macallster-Smith
Published: November 2003

No Abstract
Editorial
Authors: Macdonald
Published: November 2003

No Abstract
Jean Bodin et l'Europe de son temps
Authors: Legohérel
Published: November 2003

No Abstract
Editorial Policy
Authors: Macdonald
Published: November 2003

No Abstract
Multi-pass turning operations optimization based on genetic algorithms
Authors: Onwubolu G C , Kumalo T
Published: November 2003

The paper proposes a new optimization technique based on genetic algorithms for determination of the cutting parameters in multi-pass machining operations by simultaneously considering multi-pass rough machining and finish machining. The optimum machining parameters are determined by minimizing the unit production cost subject to twenty practical machining constraints. The cutting model formulated is a non-linear, constrained programming problem. Experimental results show that the proposed genetic algorithm based approach is both effective and efficient.
A Supported Nickel Phthalocyanine Complex as a Selective Catalyst for the Production of Styrene
Authors: Hassan Salah A. , Zahran Afaf A. , Yehia Fatma Z.
Published: November 2003

A nickel phthalocyanine complex (NiPc) supported on bentonite clay (Bihar, India) was used as a selective catalyst for the dehydrogenation of ethylbenzene to styrene. Maximum activity was observed for the catalyst sample containing 1.0 wt% NiPc/bentonite. A higher loading of complex (> 1.4 wt%) exhibited no activity and resembled polycrystalline NiPc. The texture of the studied catalyst and the mode of surface dispersion of the supported NiPc were investigated through the adsorption of N2 and O2, respectively. The activity of the diluted samples could be attributed to the presence of separate highly dispersed molecules of NiPc on the bentonite surface without having a marked effect on its pore system for most active samples. The selectivity towards styrene was found to depend strongly on the NiPc surface area and the degree of dispersion. The activity was a function of the whole structure including modifications of both acid sites through different interactions and of the pore system through a penetration mechanism.
Promoting Dentistry as a Career: A Local Initiative
Authors: Shore Nicholas , Pritchard Elizabeth
Published: November 2003

Aim

This was to ascertain reasons for pupils’ interest in dentistry, and what appealed to them from their current knowledge of the profession. The findings were compared with those of undergraduates and practising dentists.

Materials and Method

Three different groups of subjects (school pupils, fourth-year dental undergraduates and general dental practitioners) in West Yorkshire were asked to complete a single-sided A4 questionnaire

Results

All respondents completed the questionnaire fully.

Conclusion

Promotion of dentistry as a career should be targeted at the 14–15-year-old age group and above. Advice on a career in dentistry may be sought from general dental practitioners (who should keep up to date with dental degree/career information), careers fairs, and written information (which should be well-presented and informative). Dental schools might provide information via ‘predental advisers’ and recruiting courses, with help for applicants from professionals with relevant experience.
The Use of Geographical Information Systems in Examining Variations in Sociodemographic Profiles of Dental Practice Catchments: A Case Study of a Swansea Practice
Authors: Higgs Gary , Richards Wayne
Published: November 2003

Aim

The aim of this paper is to use a case study approach to illustrate the potential for using geographical information systems (GIS) to examine the provision of dental services in the UK. A major benefit of using GIS to examine sociodemographic profiles of patients on a dental register is to inform policy makers.

Method

We illustrate the advantages of such an approach by using a post-coded list of registered patients for a dental practice in Swansea. To be of value in this context, the maintenance of up-to-date and fully postcoded information by practitioners is vital. We draw attention to the advantages (and current limitations) of using deprivation indices in conjunction with such lists.

Result

GIS has significant potential in analysing patterns of registration, and utilisation, of such services but, to date, there has been a relative dearth of studies that have developed such systems.

Conclusion

We conclude by drawing attention to wider benefits of such software tools in the dental profession and outline a research agenda to take these issues further.
Saving Pulps—A Biological Basis. An Overview
Authors: Murray Peter E , Smith Anthony J
Published: November 2003

Aim

Cavity preparation and restoration variables have an uncertain relationship to pulp injury and repair responses. The purpose of this paper is to determine the importance of cavity preparation and restoration variables, by ranking them according to their effect on pulp injury (odontoblast survival) and pulp repair (reactionary dentine secretion).

Method

The seven studies reviewed are all based on the protocols described by Murray, Smith and colleagues in 2000 and 2001.

Results

The studies reviewed provide new perspectives on the importance of cavity preparation and restoration variables in mediating pulp activity.

Conclusions

The onset of post-operative complications may be most productively minimised by focusing practitioner attention to aspects of treatment highlighted in this review.
Cough Syrup Addiction and Rampant Caries: A Report of Two Cases
Authors: Siu Adam SC , Chu Frederick CS , Yip Hak Kong
Published: November 2003

Sugar-containing syrups such as cough medications have been recognised as potentially cariogenic, especially for chronically sick children suffering from otitis media, seizure disorder, congenital cardiac diseases and asthma. Unfortunately, an increasing number of juveniles are addicted to cough syrups containing centrally-acting drugs and these individuals not only end up with medical and social problems, but also with dental manifestations. This paper addresses the latter problem with the help of two illustrative cases.
Creating Local Brands in Multilingual International Markets
Authors: Zhang Shi , Schmitt Bernd H.
Published: November 2003

Despite the importance of decisions regarding international brand names, research on brand naming has focused primarily on English name creation. The authors conceptualize the local brand-name creation process in a multilingual international market. The authors present a framework that incorporates (1) a linguistic analysis of three translation methods—phonetic (i.e., by sound), semantic (i.e., by meaning), and phonosemantic (i.e., by sound plus meaning)—and (2) a cognitive analysis focusing on the impact of primes and expectations on consumer name evaluations. Using dual English-and-Chinese brand names, the authors show that the effectiveness of the translation depends on the emphasis of the original English name (versus the Chinese name) and the method of translation used previously for brand names within the same category.
Why Some New Products are More Successful than Others
Authors: Henard David H. , Szymanski David M.
Published: November 2003

Product innovation is increasingly valued as a key component of the sustainable success of a business's operations. As a result, there has been a noticeable increase in the number of studies directed at explicating the drivers of new product success. To help managers and researchers synthesize this growing body of evidence, the authors conduct a meta-analysis of the new product performance literature. Of the 24 predictors of new product performance investigated, product advantage, market potential, meeting customer needs, predevelopment task proficiencies, and dedicated resources, on average, have the most significant impact on new product performance. The authors also find that the predictor–performance relationships can vary by measurement factor (e.g., the use of multi-item scales, subjective versus objective measures of performance, senior versus project management reporting, time elapsed since product introduction) or contextual factor (e.g., services versus goods, Asian versus North American markets, competition in high-technology versus low-technology markets). They discuss the implications of these findings and offer directions for further research.
Minimal Blood Loss in Patients Undergoing Radical Retropubic Prostatectomy
Authors: Barré Christian , Pocholle Philippe , Chauveau Philippe
Published: November 2003

The objective of this study was to evaluate blood loss in patients undergoing radical retropubic prostatectomy. Blood loss and operating time were evaluated in a series of 197 consecutive patients with prostate cancer who underwent radical retropubic prostatectomy by a two‐surgeon team. The patients were positioned supine with the table flexed and the patient in about 35
degrees Trendelenburg position. Results were compared with those recorded for an earlier series of 40 patients operated in the supine position alone. The influence of parameters that might affect blood loss (peridural and hypotensive anesthesia, bilateral hypogastric artery clamping) was assessed in multivariate analyses. Since adoption of a Trendelenburg position with flexion of the hips, the mean intraoperative blood loss has decreased by 80%, to a low level of 260
cc; and transfusions have become exceptional (0.5%). The decrease in blood loss correlated with a decrease in operating time, which was reduced to an average of 90 minutes. Whereas epidural anesthesia decreased blood loss by a modest 27%, intraoperative blood pressure,
bilateral hypogastric artery clamping, and nerve sparing had little or no significant effect. Patient position and the surgical skill of a two‐man team can virtually eliminate the risk of blood loss during radical retropubic prostatectomy. There is thus no need always to resort to other procedures or to preoperative autologous blood donation.
Dysphagia and Clinical Outcome after Laparoscopic Nissen or Rossetti Fundoplication: Sequential Prospective Study
Authors: Contini Sandro , Zinicola Roberto , Bertelé Anna , Nervi Giorgio , Rubini Patrizia , Scarpignato Carmelo
Published: November 2003

Laparoscopic fundoplication represents the most widely used operation in the surgical treatment of gastroesophageal reflux disease (GERD). Besides being operator‐dependent, the clinical outcome
(efficacy and side‐effects) seems also to be dependent on the specific surgical technique. In this prospective trial we compared the results of two groups of patients who were submitted sequentially to the Rossetti or Nissen fundoplication procedure. Dysphagia, other side effects, and clinical outcome were evaluated early after surgery and at 6 and 12 months after the operation.
Although both procedures were clinically effective, there was a significant trend toward less postoperative dysphagia in the Nissen group. In these patients the incidence of early dysphagia was significantly lower than that observed in those submitted to the Rossetti fundoplication. In addition, Nissen patients experienced a significantly smaller number of days with dysphagia. One year after surgery, however, the two procedures proved equally successful without any significant difference in dysphagia incidence. Complete fundic mobilization should therefore be advised to reduce the incidence of early troublesome dysphagia.
Liver Surgery in the Era of Tissue‐preserving Resections: Early and Late Outcome in Patients with Primary and Secondary Hepatic Tumors
Authors: Redaelli Claudio A. , Wagner Markus , Krähenbühl Lukas , Gloor Beat , Schilling Martin K. , Dufour Jean‐François , Büchler Markus W.
Published: November 2003

During recent decades, the understanding of the segmental‐oriented liver anatomy has enabled development of resection of isolated liver segments or sectors as dictated by the localization and extent of the mass lesion. These newer surgical procedures provide the advantage of maximal preservation of functional parenchyma, therefore minimizing the occurrence of postoperative liver failure and, at the same time, expanding the indications for surgery. We analyzed the results after classical hemihepatectomies and segment‐based resections in a consecutive, nonselected patient group. During the 7‐year period between November 1993 and November 2000, 270 patients with primary or secondary liver tumors were treated in our hospital; 167 of these patients underwent curative resections and their relevant data were entered into a statistical database. There were 77 classical hemihepatectomies and 90 tissue‐preserving resections. Total mortality and morbidity for the series was 3.6% and 29.9%, respectively. Morbidity but not mortality was significantly lower after tissue‐preserving resections than after classical hemihepatectomy. Median follow‐up was 36 months. Survival was comparable for the two different surgical approaches for patients with secondary liver malignancies. In contrast, patients with hepatocellular carcinomas lived significantly longer after tissue‐preserving resections. Tissue‐preserving liver resection is a safe technique allowing maximal preservation of functional parenchyma without compromising radicality. Therefore, tissue‐preserving resection is especially useful for patients with hepatocellular carcinomas and cirrhosis.
Perforated Peptic Ulcer: Main Factors of Morbidity and Mortality
Authors: Noguiera Carlos , Silva António Sérgio , Santos Jorge Nunes , Silva António Gomes , Ferreira Joaquim , Matos Eduarda , Vilaça Hernani
Published: November 2003

It is well stated in the literature that medical treatment for peptic ulcer is based on a combination of proton pump inhibitors (PPIs) and antibiotics to eradicate Helicobacter pylori. This treatment is associated with a high rate of immediate success and a low rate of recurrence at 12 months, although it is not effective in all patients. Peptic ulcer (PU) perforation is a serious problem that leads to high complication and mortality rates. Surgical treatment, with its various possibilities, constitutes the ideal treatment. Surgical intervention in these cases, however, can be directed to treating the perforation alone, or it can offer definitive treatment of the ulcer itself. With the hope of establishing why such complications and mortality were seen in the patients in our hospital population, we gathered the facts about PU perforations and the types of surgery performed. We studied 210 consecutive patients (150 men, 60 women) who had undergone surgery at our hospital because of perforation between January 1, 1990 and December 31, 2000. The patients’ median age was 53.0 ± 20.6 years (men 47.7 ± 17.3 years; women 66.3 ± 22.0 years). Altogether, 86 patients had significant associated illnesses, 62 were admitted more than 24 hours after the perforation, and 25 were admitted in shock. We performed resections in 10 patients; 88 patients were treated by suturing the perforation with or without a patch of epiploon; and 112 underwent a troncular vagotomy with drainage (VT + Dr). A total of 21 patients died (10%). Significant risk factors that led to complications were identified by statistical studies. They were a perforation that had been present more than 24 hours, the coexistence of significant associated illnesses, and resection surgery. The significant risk factors that led to death were the presence of shock at admission, the coexistence of significant illnesses, and resection surgery. There was no statistically significant difference concerning morbidity and mortality between simple closure of the perforation and definitive surgery (VT + Dr).
Impact of Advanced Age on the Outcome of Liver Resection
Authors: Aldrighetti Luca , Arru Marcella , Caterini Roberto , Finazzi Renato , Comotti Laura , Torri Giorgio , Ferla Gianfranco
Published: November 2003

The aim of this retrospective study was to evaluate the influence of age on the outcome of liver resection. A total of 129 consecutive liver resections were divided into two groups: ≥ 70 years old [old group (O‐group)] and < 70 years old [young group (Y‐group)]. The two groups were first compared for the variables potentially affecting the postoperative course, including diagnosis, concomitant diseases, previous abdominal surgery, type of operation (major or minor resection), associated procedures, presence and length of portal clamping, intraoperative blood losses and transfusions, and length of operation. The outcome of liver resections was evaluated in terms of postoperative mortality, morbidity, transfusions, and length of hospitalization. The Y‐group included 97 resections in 95 patients, aged 55.9 ± 10.5 years (mean ± SD; range: 23–69 years), and the O‐group included 32 resections in 32 patients, aged 73.7 ± 3.2 years (mean ± SD; range: 70–82 years. The O‐group included more hepatocellular carcinomas (46.9% versus 20.6%, p = 0.002) and cardiovascular diseases (15.2% versus 1.0%, p = 0.004). The two groups were comparable (p > 0.05) when evaluated for all other listed variables. As regards the postoperative outcome, the length of hospitalization was similar (median, range: 9.5 days, 5–60 days in the Y‐group and 9 days, 5–48 days in the O‐group) and the need for postoperative transfusions were not statistically different. Mortality included one case among young patients, while no deaths were recorded among elderly patients. Postoperative morbidity was higher in Y‐group than in O‐group (21.6% versus 9.4%, p = 0.2). In conclusion, the age factor does not negatively affect the outcome of liver resections.
Patient Safety in Surgery: Error Detection and Prevention
Authors: Etchells Edward , O’Neill Catherine , Bernstein Mark
Published: November 2003

Error in medicine is becoming a well recognized phenomenon. The U.S. Institute of Medicine’s publication in 1999 included estimations that medical error is the eighth leading cause of death in the United States and results in up to 100,000 deaths annually. Retrospective studies and a few prospective studies are shedding more light on this challenging problem. Strategies to reduce error and increase patient safety have not been widely developed or embraced by surgeons for a variety of reasons. We provide a review on patient safety aimed at surgeons that includes definitions, incidence of errors including those in the surgical literature, causes of error, methods of error detection, and strategies to minimize errors and maximize patient safety.
Preservation of Form and Function in the Management of Head and Neck Skin Cancer
Authors: Poulsen Michael , Burmeister Bryan , Kennedy Dan
Published: November 2003

Optimal cosmetic and functional results are achieved through the appropriate selection of treatment modality and meticulous attention to technique in the treatment of skin cancers of the head and neck. A multidisciplinary approach is required in the more difficult cases. Adequate histologic analysis of margins and assessment of adverse prognostic features are crucial in the selection of therapy.
Ethics Curricula in Surgery: Needs and Approaches
Authors: Kodner Ira J.
Published: November 2003

Surgeons practice an intense form of applied ethics. The growing complexity of medical and surgical interventions combined with reduced opportunity to serve as ethical role models for trainees necessitates formal ethics curricula in surgery and the development of continued ethics education for surgeons through all stages of their careers. The Royal College of Physicians and Surgeons of Canada and the American College of Surgeons ethics curricula provide practical methods for dealing with the ethical issues that confront surgical residents each day. We can improve and expand upon curricula for surgical residents by taking into consideration the evolutionary stages of life of a surgeon: the pre‐surgeon, the medical student, the beginning resident, the midlevel resident, the senior resident, the young to midlevel surgeon, and the advanced surgeon.