bluuebunny/crossref_metadata_2025 huggingface dataset:
Conjugate gradient method
Authors: Nazareth J. L.
Published: July 2009

The conjugate gradient (CG) method for optimization and equation solving is described, along with three principal families of algorithms derived from it. In each case, a foundational CG algorithm is formulated mathematically and followed by a brief discussion of refinements and variants within its family. The hierarchical nature of the subject matter is highlighted, because each foundational CG algorithm presented is a descendant of one earlier in the list from which it inherits fundamental algorithmic properties. Copyright © 2009 John Wiley & Sons, Inc.

This article is categorized under:

Algorithms and Computational Methods > Numerical Methods
Metastasis of Right Upper Para‐Esophageal Lymph Nodes in Central Compartment Lymph Node Dissection of Papillary Thyroid Cancer
Authors: Lee Byung‐Joo , Lee Jin‐Choon , Wang Soo‐Geun , Kim Yong‐Ki , Kim In‐Ju , Son Seok‐Man
Published: July 2009

Background

Although some lymph nodes (upper para‐esophageal lymph nodes) that exist between the right recurrent laryngeal nerve and the esophagus should be involved in central‐compartment lymph node dissection (CLND) in patients with papillary thyroid cancer, the procedure can cause some injury to the nerve. We set out to assess the incidence of right upper para‐esophageal lymph node metastasis after routine CLND.

Methods

Records from 123 patients with PTC who underwent total thyroidectomy with CLND were reviewed.

Results

Fourteen of 123 patients exhibited nodal metastasis in right upper para‐esophageal lymph nodes. Metastasis of right upper para‐esophageal lymph nodes was usually associated with lesions of the right thyroid, comparatively large tumor size (more than 1 cm), and lateral cervical lymph node metastasis (p < 0.05).

Conclusions

Right upper para‐esophageal lymph nodes should be removed during operation for PTC in patients with lesions of the right thyroid gland, large tumor size, and lateral cervical lymph node metastasis.
Significance of Controlling Chronic Proliferative Cholangitis in the Treatment of Hepatolithiasis
Authors: Li Fu Yu , Cheng Nan Sheng , Mao Hui , Jiang Li Sheng , Cheng Jing Qiu , Li Quan Sheng , Munireddy Sanjay
Published: July 2009

Background

Recently, high stone recurrence and biliary restenosis rates in hepatolithiasis patients have been confirmed to be closely related to chronic proliferative cholangitis (CPC). However, the effective management of CPC has not yet been established.

Methods and results

A vicious cycle exists between the presence of intrahepatic calculi and CPC: both the stone itself and secondary biliary infection can stimulate persistent hyperplasia in the biliary duct wall, leading to the occurrence of CPC and biliary stricture. The recurrent attacks of CPC will, in turn, facilitate new stone formation via mucoglycoprotein production, or induced biliary stricture and cholestasis. Thus, even when the stone is completely removed and the biliary tract stenosis is corrected, residual CPC will persist and progress, with an underlying risk for postoperative stone recurrence and biliary tract restenosis. Therefore, the perfect hepatolithiasis treatment would target stone removal and correction of the biliary tract stricture, as well as control of postoperative residual CPC. In fact, CPC, the management of which has been traditionally ignored, is the key to breaking this vicious cycle.

Conclusions

Overall, the subsequent treatment of residual CPC after operation or choledochoscopic lithotomy would be helpful to decrease postoperative stone recurrence and the rate of biliary restenosis. Adding such treatment would reduce the incidence of surgical reintervention and choledochoscopic lithotomy, and it would also improve the postoperative hepatolithiasis outlook.
Fragiles-X Syndrom
Authors: Steinbach P.
Published: July 2009

Fragiles-X Syndrom, eine X-chromosomal vererbte neuronale Entwicklungsstörung, betrifft Knaben und Mädchen. Phänotypisch charakteristisch sind intellektuelle Defizite, somatische Merkmale und Verhaltensauffälligkeiten. Pathophysiologisch liegt der Verlust des Proteins FMRP („fragile X mental retardation protein“) zugrunde, in dessen Folge es zum Untergang von Synapsen mit metabotropen Glutamatrezeptoren kommt. Das Gen FMR1 („fragile X mental retardation 1“) enthält in der 5’-nichttranslatierten Genregion eine CGG-Wiederholungssequenz (CGG-Repeat). Bei fast allen Patienten mit Fragilem-X Syndrom liegt ein vollmutiertes, meist inaktives FMR1 mit >200 CGG-Repeats vor. Vollmutationen entstehen bei der Oogonienvermehrung im fetalen Ovar von Trägerinnen eines mitotisch instabilen Prämutationsallels (59–200 Repeats). Die Prämutation führt nicht zu Symptomen des Fragilen-X Syndroms, ist aber ein Risikofaktor für vorzeitige Ovarialinsuffienz und/oder fragiles X-assoziiertes Tremor/Ataxie Syndrom. Die Diagnostik beider Syndrome erfordert eine genetische Untersuchung zur Bestimmung der FMR1-CGG-Repeats. Die vorgeburtliche Diagnostik kann von allen Frauen mit prä- oder vollmutiertem Gen beansprucht werden.
Geistige Behinderung infolge Stoffwechselkrankheit
Authors: Moog U. , Hoffmann G.F. , Zschocke J.
Published: July 2009

Angeborene Stoffwechselerkrankungen („inborn errors of metabolism“, IEM) sind seltene Ursachen einer geistiger Behinderung (GB) und finden sich in etwa 1% der GB-Fälle der kaukasischen Bevölkerung. Im Gegensatz zu den Empfehlungen für andere diagnostische Tests bei der Abklärung von GB, z. B. einer Chromosomenanalyse, besteht kein Konsens bezüglich der Stoffwechseldiagnostik. IEM sind jedoch potenziell behandelbar, und ihre Diagnose ist bei den Betroffenen für die Prognose, das Wiederholungsrisiko und die Möglichkeiten der Pränataldiagnostik von großer Bedeutung. Aufgrund der aktuell vorliegenden Evidenz lassen sich folgende wichtige IEM hervorheben, die zu unspezifischer GB oder zu Krankheitsbildern mit GB als Hauptmerkmal führen können: Kreatinmangelsyndrome (v. a. Kreatintransportermangel), Mukopolysaccharidose III (v. a. IIIB), β-Mannosidose, einige Organazidopathien, Homozystinurie, angeborene Glykosylierungsstörungen (CDG, „congenital disorders of glycosylation“) und spezifische Störungen des Purin- und Pyrimidinstoffwechsels. Außerdem kommen Harnstoffzyklusdefekte, Sterolsynthesedefekte und weitere Aminoazidurien in Betracht. Die entsprechende Stoffwechseldiagnostik bei ungeklärter GB wird vorgestellt.
Syndromale Formen geistiger Behinderung
Authors: Gillessen-Kaesbach G.
Published: July 2009

Die geistige Behinderung bei syndromalen Krankheitsbildern kann sehr verschieden stark ausgeprägt sein. Auch können Betroffene mit dem gleichen Syndrom einen unterschiedlichen Schweregrad der geistigen Behinderung aufweisen. Die Diagnosestellung stellt eine große Herausforderung für den klinischen Genetiker dar, insbesondere wegen der unterschiedlichen phänotypischen Ausprägung. Neben einer exakten Erhebung der Familienanamnese und der körperlichen Befunde ist die Beachtung von Leitsymptomen wie Adipositas, Makrosomie, Mikrozephalie, prä- oder postnatalem Kleinwuchs oder spezifischer Fehlbildungsmuster hilfreich bei der klinischen Diagnostik. Die modernen zytogenetischen und molekularzytogenetischen Diagnostiken wie CGH-Array (CGH: „comparative genomic hybridization“) tragen dazu bei, eine ätiologische Klärung herbeizuführen und Krankheitsentitäten zu definieren.
Familien mit geistig behinderten Kindern
Authors: Schindelhauer-Deutscher H.J. , Henn W.
Published: July 2009

Die Geburt eines geistig behinderten Kindes erfordert von den betroffenen Eltern in aller Regel schwierige und belastende kognitive und emotionale Anpassungs- und Bewältigungsleistungen sowie eine Fülle an organisatorischen und zeitlichen Umstrukturierungen innerhalb des Lebensalltags. Dabei sind professionelle Experten wie Ärzte und psychosoziale Fachkräfte wichtige Informationsvermittler, denen jedoch der „Mangel“ des unmittelbaren Betroffenseins durch ein eigenes gleichermaßen behindertes Kind und damit fehlende alltägliche Erfahrungen im Umgang mit einem solchen anhaftet. Diese Lücke zu füllen, ist die wichtigste Aufgabe von Selbsthilfegruppen, deren Bedeutung und Zahl seit Anfang der 1970er Jahre permanent gewachsen ist. Bei der Suche nach geeigneten Selbsthilfeinitiativen leisten Internetdatenbanken wichtige Wegweiserdienste. Am Beispiel einer Studie zum Down-Syndrom werden die Erfahrungen von Eltern eines Kindes mit geistiger Behinderung mit Selbsthilfegruppen dargestellt. Als Fazit werden Möglichkeiten zur besseren Verzahnung von Selbsthilfegruppen und professionellen ärztlichen Angeboten aufgezeigt.
A comparison of continuous subcutaneous paliperidone infusion and repeated subcutaneous injection of risperidone free-base in rats
Authors: Marchese G. , Pittau B. , Casu G. , Peddio G. , Spada G.P. , Pira M. , Deriu A. , Portesani F. , Pisu C. , Lazzari P. , Pani L.
Published: July 2009

It is proposed that to achieve a therapeutic effect in schizophrenia patients, dopamine D2-receptor occupancy by antipsychotics within the striatum must exceed 60−65%. However, at high levels of D2-receptor occupancy, the risk of extrapyramidal symptoms (EPS) is increased. Following oral dosing of antipsychotics, peaks and troughs in plasma drug concentrations may be mirrored by fluctuations in D2-receptor occupancy. Paliperidone, a novel antipsychotic available as extended-release tablets (paliperidone ER), is the major active metabolite of risperidone and exhibits a plasma pharmacokinetic profile with reduced peak−trough fluctuations and consistent D2-receptor occupancy compared with conventional oral antipsychotic formulations. Using formulations that resemble those in clinical practice, this study provides a preclinical evaluation of the pharmacological properties of paliperidone ER and risperidone immediate-release formulation in terms of consistent antipsychotic efficacy over time and extrapyramidal symptom liability. Significant fluctuations in inhibition ofd-amphetamine-induced hyperlocomotion were observed for repeated subcutaneous (SC) risperidone injections, whereas stable inhibitory efficacy was demonstrated during continuous SC paliperidone infusion. Similarly, significant fluctuations in latency on-bar were observed with repeated SC risperidone injections, whereas significantly lower latency on-bar was demonstrated following continuous SC paliperidone infusion. These results in an animal model suggest that although risperidone and paliperidone demonstrate similar pharmacologic effects, continuous administration of paliperidone achieves more stable antipsychotic efficacy with reduced motor impairment, akin to the effects observed with paliperidone ER in clinical studies.
Binding of divalent cations is essential for the activity of the organellar peptidasome in Arabidopsis thaliana, AtPreP
Authors: Bäckman Hans G. , Pessoa João , Eneqvist Therese , Glaser Elzbieta
Published: July 2009

AtPreP1 (uniprotkb:Q9LJL3) enzymaticly reacts (MI:0414) hPrPss (uniprotkb:P04156) by protease assay (MI:0435)
Transcription factors down‐stream of Ras as molecular indicators for targeting malignancies with oncolytic herpes virus
Authors: Esfandyari Tuba , Tefferi Ayalew , Szmidt Anna , Alain Tommy , Zwolak Pawel , Lasho Terra , Lee Patrick W. , Farassati Faris
Published: July 2009

Overactivation in Ras signaling has been under intensive study as the molecular basis for development of cancer. Such overactivation can occur in the presence or absence of mutations in Ras gene resulting in activation of a series of down‐stream effectors such as transcription factors. Different studies have shown the activation of Ras down‐stream effectors in non‐Hodgkin lymphoma (NHL) although mutations in Ras are not prevalent in this malignancy. Since overactivation in Ras signaling also increases permissiveness of cancer cells to infection by oncolytic versions of herpes simplex virus (e.g. R3616), we were interested in evaluating the value of transcription factors down‐stream of Ras as molecular indicators for permissiveness to herpes therapy. In order to accomplish this, and also to assess the permissiveness of lymphoma cells to infection with R3616, we used NHL cell lines Daudi, Jurkat, NC37, Raji, Ramos and ST486. Once the levels of phosphorylation (activation) of extracellular‐signal regulated kinase (ERK, a Ras effector pathway) and its down‐stream transcription factor ELK were evaluated, Raji and NC37 showed a significant increase in the phosphorylation levels of both molecules while ATF2 (another transcription factor down‐stream of p38‐kinase pathway) seemed to be activated in all studied cells. Raji and NC37 cells were also most permissive cells to infection with R3616 while their permissiveness was decreased upon treatment of cells with an inhibitor of ELK‐DNA binding portraying ERK/ELK as a suitable predictive indicator for selection of cancer cells with increased sensitivity to R3616. This study, therefore, for the first time documents permissiveness of lymphoma cells to oncolytic herpes viruses and introduces ELK as a suitable factor for predicting tumor susceptibility to these novel anticancer agents.
Upper Airway Reconstructive Surgery Long‐Term Quality‐of‐Life Outcomes Compared with CPAP for Adult Obstructive Sleep Apnea
Authors: Robinson Sam , Chia Michael , Carney A. Simon , Chawla Sharad , Harris Penelope , Esterman Adrian Esterman
Published: July 2009

OBJECTIVE

To measure long‐term quality‐of‐life (QOL) improvement following contemporary multilevel upper airway reconstruction surgery, compared with continuous positive airway pressure (CPAP) therapy. Secondary aims were to investigate factors determining clinical effectiveness and QOL impact of reported side effects.

DESIGN

Cohort study.

SUBJECTS AND METHODS

Consecutive, simultaneously treated adult patients with moderate‐severe obstructive sleep apnea (OSA) having upper airway surgery (N = 77) or CPAP (N = 89) therapy were studied by questionnaire. Glasgow Benefit Inventory (GBI), change in snoring status and Epworth Sleepiness Scale (ESS), subjective CPAP compliance, and side effects in both groups were measured at mean ± SEM 44.12 ± 5.78 months (3.68 ± 0.48 years) after commencement of therapy.

RESULTS

No significant difference was seen between surgical outcomes for GBI, snoring, or ESS and CPAP controls. Multivariate analysis showed reduction in Respiratory Disturbance Index (RDI) predicted postoperative snoring and ESS, but not GBI outcomes. Snoring control and GBI were related to CPAP compliance (P < 0.001). CPAP side effects (reported in 26%) significantly reduced the QOL benefit of treatment, independent of compliance. Surgical complications (occurring in 44%) did not affect QOL treatment benefit.

CONCLUSION

Patients with poor CPAP compliance and/or significant side effects of CPAP therapy (45% of cases in this series) should be evaluated for contemporary upper airway reconstructive surgery.
Pectoralis Myofascial Flap during Salvage Laryngectomy Prevents Pharyngocutaneous Fistula
Authors: Patel Urjeet A. , Keni Sanjay P.
Published: July 2009

OBJECTIVE

To determine the rate of pharyngocutaneous fistula after salvage laryngectomy and assess if pectoralis myofascial flap reinforcement over primary pharyngeal closure prevents pharyngocutaneous fistula.

STUDY DESIGN

Case series with chart review.

SETTING

Tertiary‐care public hospital.

SUBJECTS AND METHODS

This study included 43 patients undergoing total laryngectomy between 2003 and 2008. Pectoralis myofascial flap reinforcement of the pharyngeal closure during salvage laryngectomy was performed on patients after June 2006. The main outcome measure was pharyngocutaneous fistula after primary laryngectomy, salvage laryngectomy, and salvage laryngectomy with pectoralis flap reinforcement.

RESULTS

Of the 43 patients, 26 were treated with primary total laryngectomy while 17 received salvage laryngectomy. Seven of 26 patients (27%) undergoing primary total laryngectomy developed pharyngocutaneous fistula. All patients in this group were closed primarily with no flap reinforcement. For salvage laryngectomy, four of seven patients (57%) with primary pharyngeal closure developed pharyngocutaneous fistula; however, none of 10 patients (0%) undergoing salvage laryngectomy with pectoralis myofascial flap reinforcement developed fistula (P < 0.02; 0%‐23%; 95% CI).

CONCLUSIONS

With pectoralis myofascial flap reinforcement, pharyngocutaneous fistula rate after salvage laryngectomy dropped to 0 percent in this study (0%‐23%; 95% CI). This is a simple, reliable technique that prevents postoperative pharyngocutaneous fistula and its associated morbidity after salvage laryngectomy.
Histopathologic Assessment of Fibrosis and nEw Bone Formation in Implanted Human Temporal Bones Using 3D Reconstruction
Authors: Fayad Jose N. , Makarem Andres O. , Linthicum Fred H.
Published: July 2009

OBJECTIVE

To evaluate new bone formation and fibrosis in implanted human temporal bones and relate that to neurosensory elements preservation.

STUDY DESIGN

Human temporal bone histopathology study.

SETTING

Temporal bone laboratory.

SUBJECTS AND METHODS

Ten human temporal bones from eight patients with multichannel cochlear implants and one single‐electrode implant were examined under light microscopy and reconstructed with AMIRA 4.1 3D reconstruction software. Volumes of new bone formation, fibrosis, and patent area were calculated in each bone.

RESULTS

The amount of fibrosis and new bone formation postimplantation varied among bones. There were no statistically significant relationships between age at implantation or duration of implantation and the overall amount of new tissue in the implanted ear. There was a relationship between total amount of new tissue and preservation of neurosensory elements only in segment I of the cochlea (Rho = −0.75, P < 0.013). Most of the new tissue was located in segments I and II, segment III had little to no new tissue formation, and segment IV was clear in all of the subjects.

CONCLUSION

New tissue formation postimplantation was related to preservation of neurosensory elements primarily in segment I of the cochlea. In an era of hearing preservation surgery and hybrid cochlear implants, soft surgical techniques are advocated as a means to decrease surgical trauma.
Anterior Palatoplasty for the Treatment of OSA
Authors: Pang Kenny P. , Tan Raymond , Puraviappan Puravi , Terris David J.
Published: July 2009

OBJECTIVE

Review long‐term results of the modified cautery‐assisted palatoplasty (mod CAPSO)/anterior palatoplasty for the treatment of mild‐moderate obstructive sleep apnea (OSA).

STUDY DESIGN

Prospective series of 77 patients. All patients were >18 years old, type I Fujita, body mass index (BMI) < 33, Friedman clinical stage II, with apnea‐hypopnea index (AHI) from 1.0 to 30.0. The mean follow‐up time was 33.5 months. The procedure involved an anterior soft palatal advancement technique with or without removal of the tonsils. The procedure was done under general or local anesthesia.

RESULTS

There were 69 men and eight women; the mean age was 39.3 years old; and mean BMI was 24.9 (range 20.7–26.8). There were 38 snorers and 39 OSA patients. The AHI improved in patients with OSA, 25.3 ± 12.6 to 11.0 ± 9.9 (P < 0.05). The overall success rate for this OSA group was 71.8 percent (at mean 33.5 months). The mean snore scores (visual analog score) improved from 8.4 to 2.5 (for all 77 patients). Lowest oxygen saturation also improved in all OSA patients. Subjectively, all patients felt less tired.

CONCLUSION

This technique has been shown to be effective in the management of patients with snoring and mild‐moderate OSA.
Article Commentary: Case Studies in Corporate Compliance
Authors: Shah Udayan K. , Schmidt Richard J. , Hussain S.S. Musheer , Cook Steven P. , Smith Gina M. , Ziv Barbara E. , Reilly James S.
Published: July 2009

An interdisciplinary, proactive perspective allows providers to engage in productive, long‐term collaborative relationships with corporations, while 1) maintaining patient care improvements; 2) maintaining legality; 3) enhancing technical and clinical innovation; and 4) providing fair compensation for work done. The case study approach is used to demonstrate an effective approach to compliant behavior.
Differential Expression of SKI Oncogene Protein in Hemangiomas
Authors: Teresa M. O , Tan Melin , Tarango Mark , Fink Lou , Mihm Martin , Ma Yupo , Waner Milton
Published: July 2009

OBJECTIVE

The pathogenesis for benign tumorigenesis in hemangiomas is unknown. Oncogene proteins may be influential in this process. SKI proteins have been previously described in various malignancies. We investigated the differential expression of the SKI (sarcoma viral oncogene) protein in hemangiomas.

STUDY DESIGN

Prospective basic science study.

SUBJECTS AND METHODS

Paraffin‐embedded hemangioma tissues were obtained from the senior author from 2005 to 2006. We created the first vascular tissue array composed of 12 hemangioma specimens at various stages of growth and anatomic location. Two cores were taken from each sample. Controls were also included. Immunohistochemical studies were performed using SKI, CD31, and Ki67.

RESULTS

All 12 hemangioma tissues overexpressed the SKI protein. The staining pattern was perinuclear within the endothelial cells. The intensity of staining was inversely proportional to the growth stage. The endothelial cells that were SKI‐positive were involved in active cell division.

CONCLUSION

SKI oncogene protein is differentially and specifically expressed in hemangioma tissues. SKI acts as a transcriptional co‐repressor and inhibits the TGF‐β pathway, thus leading to uncontrolled cellular proliferation and transformation. All vascular controls were negative for SKI staining.

CLINICAL SIGNIFICANCE OF STUDY

The SKI oncogene protein is upregulated by hemangiomas and may play a role in hemangioma tumorigenesis.
Functional Outcomes after Transoral Robotic Surgery for Head and Neck Cancer
Authors: Iseli Tim A. , Kulbersh Brian D. , Iseli Claire E. , Carroll William R. , Rosenthal Eben L. , Magnuson J. Scott
Published: July 2009

OBJECTIVE

To evaluate functional outcomes following transoral robotic surgery for head and neck cancer.

STUDY DESIGN

Case series with planned data collection.

SETTING

Academic hospital.

SUBJECTS AND METHODS

Between March 2007 and December 2008, 54 of 62 candidate patients underwent transoral robotic tumor resection. Outcomes include airway management, swallowing (MD Anderson Dysphagia Inventory), and enterogastric feeding.

RESULTS

Tumors were most commonly oropharynx (61%) or larynx (22%) and T1 (35%) or T2 (44%). Many received radiotherapy (22% preoperatively, 41% postoperatively) and chemotherapy (31%). Endotracheal intubation was retained (22%) for up to 48 hours, tracheostomy less frequently (9%), and all were decannulated by 14 days. Most commenced oral intake prior to discharge (69%) or within two weeks (83%). A worse postoperative Dysphagia Inventory score was associated with retained feeding tube (P = 0.020), age >60 (P = 0.017), higher T stage (P = 0.009), laryngeal site (P = 0.017), and complications (P = 0.035). At a mean 12 months' follow‐up, 17 percent retained a feeding tube (9.5% among primary cases). Retained feeding tube was associated with preoperative tube requirement (P = 0.017), higher T stage (P = 0.043), oropharyngeal/laryngeal site (P = 0.034), and recurrent/second primary tumor (P = 0.008). Complications including airway edema (9%), aspiration (6%), bleeding (6%), and salivary fistula (2%) were managed without major sequelae.

CONCLUSION

Transoral robotic surgery provides an emerging alternative for selected primary and salvage head and neck tumors with low morbidity and acceptable functional outcomes. Patients with advanced T stage, laryngeal or oropharyngeal site, and preoperative enterogastric feeding may be at increased risk of enterogastric feeding and poor swallowing outcomes.
Association of Heartburn and Laryngopharyngeal Symptoms with Endoscopic Reflux Esophagitis, Smoking, and Drinking
Authors: Lin Chang‐Chun , Wang Ya‐Yu , Wang Kai‐Li , Lien Han‐Chung , Liang Ming‐Tai , Yen Ting‐Ting , Wang Jing‐Ping , Liu Shi‐An , Wang Chen‐Chi
Published: July 2009

OBJECTIVES

This study was conducted to investigate the association of laryngopharyngeal symptoms and heartburn with endoscopic esophagitis, smoking, and drinking. The clinical importance of the Reflux Symptom Index (RSI) in predicting endoscopic esophagitis was also evaluated.

STUDY DESIGN

Case series with planned data collection.

SUBJECTS AND METHODS

From November 2006 to February 2007, 156 adults received a whole‐body physical check‐up. They filled out the RSI questionnaire and were dichotomized into either a “no problem group” or a “possible patients group” according to their scores on the RSI. All subjects received an esophagoscopy. The relationship between RSI score and endoscopic esophagitis, smoking, and drinking was analyzed.

RESULTS

Voice change, but not heartburn, was significantly associated with endoscopic reflux esophagitis. Based on the RSI scores, some items in addition to voice change were significantly associated with smoking or drinking but not with endoscopic esophagitis.

CONCLUSIONS

While screening patients for reflux esophagitis by using the RSI questionnaire, there is little value in using heartburn to predict endoscopic esophagitis in Taiwanese people. On the other hand, a husky voice might be a good clinical indicator of patients at risk of having reflux esophagitis.
Extracts from The Cochrane Library
Authors: Burton Martin J. , Couch Marion E. , Rosenfeld Richard M.
Published: July 2009

The “Cochrane Corner” is a quarterly section in the Journal that highlights systematic reviews relevant to otolaryngology–head and neck surgery, with invited commentary to aid clinical decision making. This installment features a Cochrane Review entitled “Homeopathic medicines for adverse effects of cancer treatments,” which finds preliminary data to support efficacy of topical calendula for radiation‐induced dermatitis and a proprietary mouthwash for chemotherapy‐induced stomatitis.
An unusual Minerva-Fortuna figurine from Hinxworth, Hertfordshire
Authors: Burleigh Gilbert , Jackson Ralph
Published: July 2009

A figurine unique for Roman Britain is described and analysed, showing that its attributes conflate those of several classical deities, all of whom might have been associated in the mind of the donor with the Romano-Celtic goddess, Senuna.
A late iron age neck-ring from Pentire, Newquay, Cornwall, with a note on the find from Boverton, vale of Glamorgan
Authors: Nowakowski Jacqueline , Gwilt Adam , Megaw Vincent , La Niece Susan
Published: July 2009

The chance discovery in 2007 at Pentire, on the outskirts of Newquay, Cornwall, of a leaded bronze neck-ring offers an opportunity to update our knowledge of other neck-rings of the ‘Wraxall’ class, predominantly from south-western Britain. The shared metallurgy and stylistic similarities of the neck-rings confirm previous opinion that the ‘Wraxall’ class belongs to a period when indigenous communities were being influenced by provincial Roman technology, while maintaining elements of indigenous art forms.
Mechanisms involved in the immunostimulation by probiotic fermented milk
Authors: Galdeano Carolina Maldonado , de Moreno de LeBlanc Alejandra , Carmuega Esteban , Weill Ricardo , Perdigón Gabriela
Published: July 2009

The intestinal ecosystem contains a normal microbiota, non-immune cells and immune cells associated with the intestinal mucosa. The mechanisms involved in the modulation of the gut immune system by probiotics are not yet completely understood. The present work studies the effect of a fermented milk containing probiotic bacteriumLactobacillus(Lb.)caseiDN114001 on different parameters of the gut immune system involved with the nonspecific, innate and adaptive response. BALB/c mice received the probiotic bacteriumLb. caseiDN114001 or the probiotic fermented milk (PFM). The interaction of the probiotic bacteria with the intestine was studied by electron and fluorescence microscopy. The immunological parameters were studied in the intestinal tissue and in the supernatant of intestinal cells (IC). Results showed that the probiotic bacterium interact with the IC. The whole bacterium or its fragments make contact with the gut associated immune cells. The PFM stimulated the IC with IL-6 release, as well as cells related to the nonspecific barrier and with the immune cells associated with the gut. This last activity was observed through the increase in the population of different immune cells: T lymphocytes and IgA+ B lymphocytes, and by the expression of cell markers related to both innate and adaptive response (macrophages). PFM was also able to activate the enzyme calcineurine responsible for the activation of the transcriptional factor NFAT. PFM induced mucosal immune stimulation reinforcing the non-specific barrier and modulating the innate immune response in the gut, maintaining the intestinal homeostasis.
Lactoferrin concentrations in bovine milk prior to dry-off
Authors: Newman Kari A , Rajala-Schultz Päivi J , Lakritz Jeffrey , DeGraves Fred J
Published: July 2009

Concentration of natural protective factors (NPFs) which have the ability to inhibit growth of mastitis-causing pathogens increase rapidly following the cessation of milking of dairy cows. One such NPF is lactoferrin, an iron-binding protein present in high concentrations in dry-cow secretions. Earlier studies have demonstrated that intermittent milking at the end of lactation increases levels of NPFs in milk and may decrease prevalence of intramammary infections at calving; however, most of these studies date back several decades and may not apply to current high-producing cows. The objective of this study was to assess whether an intermittent milking schedule prior to dry-off increases the concentration of lactoferrin in mammary secretions at the end of lactation and what other factors influence lactoferrin concentration at dry-off. One week prior to dry-off (pre-dry), cows were randomly assigned to an intermittent milking schedule or they continued to be milked twice daily. Duplicate quarter milk samples for microbiological culture were taken at pre-dry and at dry-off to determine infection status of quarters. Quarter somatic cell counts (SCC) were measured on the day of dry-off. Lactoferrin concentrations were quantified by ELISA. Intermittent milking, mean SCC for the last three months prior to dry-off, SCC at dry-off, lactoferrin concentration at pre-dry, quarter infection status at pre-dry and dry-off, days in milk at dry-off, breed, parity, cumulative milk yield for the final week of lactation and season were considered as potential explanatory variables. Their effect on lactoferrin concentration at dry-off was assessed using a mixed-effects linear regression model. Lactoferrin concentration increased significantly during the final week of lactation for cows on an intermittent milking schedule and was significantly associated with initial lactoferrin concentration and infection status at dry-off.
Use of serum amyloid A and milk amyloid A in the diagnosis of subclinical mastitis in dairy cows
Authors: Gerardi Gabriele , Bernardini Daniele , Azzurra Elia Carla , Ferrari Vanni , Iob Luciano , Segato Severino
Published: July 2009

Mastitis is the most frequent and costly disease in dairy herds, as it negatively affects yield and milk quality. The presence of clinical mastitis is quite easy to asses, whereas the diagnosis of the subclinical form can be more difficult and requires laboratory assays. Somatic cell count (SCC) is widely used as a rapid and low-cost indicator of mastitis, even if is not useful in discriminating between the clinical and subclinical form. As amyloid A has been investigated as a marker of mastitis, the aim of this study was to assess the potential value of measuring amyloid A in serum and milk and the correlation with SCC in the diagnosis of subclinical mastitis. The reliability of two different ELISA kits for the measurement of amyloid A in milk was also tested. During a 1-month trial period, 21 cows were assigned to three experimental groups according to their health status: 6 cows with clinical mastitis (CM), 10 cows with subclinical mastitis (SM) and 5 healthy cows (HE). Amyloid A was measured both in serum (SAA) and in quarter milk samples (mAA) with a serum ELISA kit, and in quarter milk samples (MAA) with a milk ELISA kit. SCC, total microbial count (TMC) and bacterial examination of the milk were also carried out. After a log transformation, the data were submitted to ANOVA and linear regression. TMC was significantly higher in cows with clinical mastitis, while no differences were observed between the other two experimental groups. SCC and MAA levels were significantly different among the three groups. mAA concentrations were similar between cows with subclinical and clinical mastitis, and SAA was not affected by mastitis. A significant correlation between SCC and MAA or mAA was detected, while no correlation was recorded between SAA and mAA. A close relationship between MAA and mAA was noticeable even at low concentrations, suggesting MAA as a potential physiological marker of subclinical mastitis.
Interferon-gamma in suppurative otitis media: significance of otorrhoea type and disease outcome
Authors: Lasisi A O , Olayemi O , Arinola O G , Omilabu S A
Published: July 2009

Background:

Interferon-γ has been reported to have an immunoregulatory role in otitis media with effusion. However, such a role remains to be determined in acute suppurative otitis media.

Aim:

To determine the levels of interferon-γ in middle-ear secretion in children with acute suppurative otitis media, and to determine the significance of interferon-γ to the nature of otorrhoea and the outcome of otitis media.

Settings and design:

Prospective, longitudinal follow up of patients selected from community and tertiary health centres.

Methods:

We selected children with acute suppurative otitis media, diagnosed as otorrhoea of less than three months' duration. Middle-ear secretions were collected by pipetting and stored at −80°C. Interferon-γ was assayed using enzyme-linked immunosorbent assay. The patients were treated and followed up for nine to 12 months, to separate those with resolved acute suppurative otitis media from those with chronic suppurative otitis media.

Result:

The study initially included 358 cases of acute suppurative otitis media. Nine-month follow up was achieved in 304 patients (85 per cent). Of these patients, acute suppurative otitis media resolved in 187 (61 per cent), while chronic suppurative otitis media was evident in 117 (39 per cent). The children with completed follow up comprised 173 boys and 131 girls, aged between four months and nine years (mean age 6.6 years; standard deviation 1.32). These children had purulent otorrhoea in 171 cases (56 per cent) and mucoid otorrhoea in 133 cases (44 per cent). The children's middle-ear secretion interferon-γ concentrations ranged from 12 to 126 pg/ml. The mean middle-ear secretion interferon-γ concentration was 27.2 pg/ml (standard deviation 8.8) in patients whose acute suppurative otitis media resolved, and 73.1 pg/ml (standard deviation 9.5) in those progressing to chronic suppurative otitis media. In children with purulent otitis media, the mean middle-ear secretion interferon-γ concentration was 43.5 pg/ml (standard deviation 15.6); in those with mucoid otitis media, it was 74.3 pg/ml (standard deviation 19.1). Univariate analysis revealed significant differences in middle-ear secretion interferon-γ concentration, comparing resolved acute suppurative otitis media and chronic suppurative otitis media cases (p = 0.00), and comparing purulent and mucoid otitis media cases (p = 0.00). Pearson correlation testing revealed significant inverse correlation between interferon-γ concentration and middle-ear secretion immunoglobulin G concentration (p = 0.01), immunoglobulin E concentration (p = 0.03) and immunoglobulin A concentration (p = 0.00).

Conclusion:

A high concentration of interferon-γ in middle-ear secretions promotes chronicity of suppurative otitis media. Further research in this area may lead to the development of agents which assist the control of suppurative otitis media chronicity.
Extra-pulmonary small cell carcinoma of the neopharynx: case report and review of neopharyngeal tumours after total laryngectomy
Authors: George A , Uppal H , Phelan C , Hughes R
Published: July 2009

Objective:

We report the first documented case in the world literature of primary extra-pulmonary small cell carcinoma occurring in the neopharynx following laryngectomy.

Method:

We present a case report and a review of the world literature regarding the management of tumours of the neopharynx and extra-pulmonary small cell carcinoma.

Results:

The paucity of cases of extra-pulmonary small cell carcinoma has resulted in many departments managing this neoplasm similarly to pulmonary small cell cancer. However, the site of the primary can have an impact on disease survival and treatment options.

Conclusion:

Neopharyngeal small cell carcinoma has not previously been reported. It should be managed in the same way as other extra-pulmonary small cell carcinomas occurring within the pharynx or larynx, with combined multi-drug chemotherapy and radiotherapy. Surgery has a limited role due to the aggressiveness of the disease and the high risk of local and distant spread at presentation.
Turbulent spectra in the solar wind plasma
Authors: SHAIKH DASTGEER , ZANK G. P.
Published: July 2009

Observations of interstellar scintillations at radio wavelengths reveal a Kolmogorov-like scaling of the electron density spectrum with a spectral slope of −5/3 over six decades in wavenumber space. A similar turbulent density spectrum in the solar wind plasma has been reported. The energy transfer process in the magnetized solar wind plasma over such extended length scales remains an unresolved paradox of modern turbulence theories, raising the especially intriguing question of how a compressible magnetized solar wind exhibits a turbulent spectrum that is a characteristic of an incompressible hydrodynamic fluid. To address these questions, we have undertaken three-dimensional time-dependent numerical simulations of a compressible magnetohydrodynamic fluid describing super-Alfvénic, supersonic and strongly magnetized plasma. It is shown that the observed Kolmogorov-like (−5/3) spectrum can develop in the solar wind plasma by supersonic plasma motions that dissipate into highly subsonic motion that passively convect density fluctuations.
Transjudicial Dialogue and the Rwandan Genocide: Aspects of Antagonism and Complementarity
Authors: SADAT LEILA
Published: July 2009

The Rwandan genocide remains one of the most horrific atrocities of the twentieth century, resulting in the death of an estimated 500–800,000 human beings, massacred over a 100-day period. In the fourteen years since the genocide, attempts at justice and reconciliation in Rwanda have involved a delicate interplay between national legal systems and the international legal order. This article examines three fora in which Rwandans have been tried for involvement in the genocide: the International Criminal Tribunal for Rwanda, Rwandan courts including Gacaca tribunals, and French attempts to exercise universal jurisdiction. Using Rwanda as a case study, the article illustrates the issues, concerns, and difficulties that arise when multiple jurisdictions assert a right to exercise criminal jurisdiction over the perpetrators of serious atrocity crimes. Beginning with a discussion of the political context, this article considers what the competing narratives and litigation in various fora have meant for the project of international and transnational criminal justice. Cases involving the commission of atrocities pose unique challenges for the international legal order. As the normative structure of international criminal law has arguably been strengthened, political constraints increasingly come to the fore. As illustrated by Rwanda, universal jurisdiction or other bases of jurisdiction may remain necessary vehicles for justice and reconciliation, or, at the very least, they may serve as a catalyst for change in Rwanda itself.
International Law in the Historical Present Tense
Authors: DE LA RASILLA DEL MORAL IGNACIO
Published: July 2009

Since it is traditionally labelled the most neglected aspect of the field, different triggering factors might account for the so-called ‘historical turn’ in international law in the post-Cold War era. On the material side, the preconditions for professional work in this area have been met by a certain democratization of research brought about by the progressive incorporation of new technologies and a trendy rising demand for international lego-historically oriented work from the publishing side. The emergence of specialist journals, the consecration – as a matter of editorial policy – of special issues in reputed publications to key historical doctrinal figures of international law, and the appearance of a number of emblematic book-length works (which have, in their turn, contributed to feeding the industry of historical international legal commentary) feature both as cause and as nurturing ongoing effect of the contemporary ‘global surge of interest in the history of international law and its scholarship’. While admittedly receptive in its evolutionary dynamics to these favourable background material academic conditions, a number of intra-disciplinary rationales should be concomitantly examined so as to account for the accompanying scholarly spiritual drive that has made it possible that the history of international law might today claim a disciplinary status of its own.
Models of the Doctor-Patient Relationship and the Ethics Committee: Part One
Authors: Thomasma David C.
Published: July 2009

Models of the doctor-patient relationship determine which value will predominate in the interaction of the parties. That value then significantly colors and even sometimers alters the nature of the ethical discussion. For example, if an institution predominately prides it-self on its competitive posture, ethical issues arising therein will necessarily be colored by entrepreurial rather than deontological ethics. By contrast, a physician who underlines patient decision making will tend to place autonomy first above all other principles, casting that relationship in a libertarian tone.
Everything You Always Wanted to Ask a Lawyer about Ethics Committees
Authors: Cohen Morton , Hartz Jay , Schwartz Robert , Shapiro Robyn
Published: July 2009

It should come as no surprise that we will get three different answers to the same question since we have three lawyers on the panel. The law is a matter of policy, and there is usually no single “right” answer to these questions. Each lawyer will come to a question from a very different perspective and bring a different approach to the answer.
Facilitating Medical Ethics Case Review: What Ethics Committees Can Learn from Mediation and Facilitation Techniques
Authors: West Mary Beth , Gibson Joan McIver
Published: July 2009

Medical ethics committees are increasingly called on to assist doctors, patients, and families in resolving difficult ethics issues. Although committees are becoming more sophisticated in the substance of medical ethics, little attention has been given to the processes these committees use to facilitate decision-making. In 1990, the National Institute for Dispute Resolution in Washington, D.C., provided a planning grant from its Innovation Fund to the Institute of Public Law of the University of New Mexico School of Law to look at what ethics committees can learn from facilitation and mediation techniques. The study's thesis was that, if adapted for use by medical ethics committees, facilitation and mediation techniques can be helpful to those bodies in case review consultations and in other internal committee processes. This article reports on that project.
Bioethics: The Dangers of Rhetoric
Authors: Warnock Baroness Mary
Published: July 2009

After the second World War, a cliché was repeated so often as to provoke, I fear, either yawns or giggles: “our moral sense was lagging behind our technical invention,” i.e., science had, as it were, outstripped morality. In those days, of course, the bogey scientists thought to have left morality behind were physicists, especially those who had made possible the nuclear bomb. A wholly new kind of war weapon did indeed seem to have changed the world and to require a new dimension of moral thought and moral philosophy, if we were not all to be destroyed.
Jeremy Bentham and the Patient in Room 326
Authors: Goldworth Amnon
Published: July 2009

There is large, imposing-looking box in a wing of University College, London, that contains the lifelike remains of the English philosopher, Jeremy Bentham. Bentham requested that upon his death, which occurred in 1832, his body should first be used for purposes of a medical lecture and then be place on display. His request was entirely utilitarian in character. For as a famous individual, Bentham could argue that it made less sense to be buried and then have a statue constructed of his likeness than to eliminate the burial by having himself made into a statue. He called the latter an auto-icon.
Pipes, Colanders, and Leaky Buckets: Reflections on the Futility Debate
Authors: Paris John J.
Published: July 2009

The issue of physician refusal of requested treatment has fueled a two-pronged debate in our society-one on the meaning of futility and the other on the limits of patient autonomy. The latter is a genuinely philosophic dispute; the former, it seems, is a modern relapse into nominalism.

It is not the meaning of a word, but the moral basis for the actions of the par-ticipants that should be the focus of our attention, Yet the medical literature distracts us with articles titled “Medical Futility: Its Meaning and Ethical Implica-tions” “The Problem with Futility” “Who Defines Futility?,” “The Illusion of Futility,” and even “Beyond Futility.”

The history of the futility debate, which was launched by a 1983 study of Bedell and Delbanco that demonstrated the ineffectiveness of CPR for certain catego-ries of patients, has been documented elsewhere. Here we will inquire if the term, and its rapid intrusion into the medical lexicon, serves a useful purpose or if, as Truog suggested, we would all be better off if this new buzzword were jettisoned.
Medical Futility: The Duty Not to Treat
Authors: Jecker Nancy S. , Schneiderman Lawrence J.
Published: July 2009

Partly because physicians can “never say never,” partly because of the seduction of modern technology, and partly out of misplaced fear of litigation, physicians have increasingly shown a tendency to undertake treatments that have no realistic expectation of success. For this reason, we have articulated common sense criteria for medical futility. If a treatment can be shown not to have worked in the last 100 cases, we propose that it be regarded as medically futile. Also, if the treatment fails to restore consciousness or alleviate total dependence on intensive care, we propose such treatment be judged futile. This definition provides clear end points and encourages the profession to review data from the past and perform, prospective clinical studies that not only report treatments that work but also treatments that do not work. We have also argued that, in a variety of settings, physicians have no ordinary ethical obligation to offer futile interventions (Schneidermanet al.unpublished). Although physicians should inform, and discuss all decisions to withhold or withdraw medical treatments with patients, they need not obtain the patient's permission to desist from futile interventions.