bluuebunny/crossref_metadata_2025 huggingface dataset:
Biofilms and Mucosal Healing in Postsurgical Patients with Chronic Rhinosinusitis
Authors: Zhang Zi , Han Demin , Zhang Shengzhong , Han Yehua , Dai Wei , Fan Erzhong , Li Ying , Li Yunchuan , Wang Deyun
Published: February 2010

Background

Patients with chronic rhinosinusitis (CRS) often remain symptomatic after technically proficient functional endoscopic sinus surgery. Current hypothesis indicates biofilms may contribute to the persistence of infection. However, few studies showed biofilms in postoperative patients. This study was designed to identify bacterial biofilms on postoperative mucosa, as well as to investigate the healing of sinus mucosa after surgery.

Methods

After intraoperative mucosa was obtained for assessment of biofilms, 27 patients were followed up for 6 months. Postoperative medications and symptoms were recorded. As indicated by endoscopic evaluation, biopsy specimens of postoperative edema, scar, or adhesion were obtained. Samples were prepared for scanning electron microscopy (SEM) and hematoxylin and eosin (H&E) staining.

Results

Fifteen postoperative samples were taken from the 20 patients with intraoperative biofilms. Under SEM, postoperative biofilms were identified in 4/6 scar samples and 5/9 edema samples. There was no significant difference in biofilm presence between samples of scar and edema. Microcolonies were also identified on postoperative scar under H&E staining. The presence of intraoperative and postoperative biofilms was correlated with the severity of preoperative Lund-MacKay computed tomography score and postoperative Lund-Kennedy endoscopic score. Compared with intraoperative samples, postoperative samples from the same nine patients significantly recovered from ciliary damage, metaplasia, and basement membrane thickness. Postoperative cultures were positive in samples with and without postoperative biofilms.

Conclusion

Biofilms persist after treatment, and may cause the unfavorable outcomes of surgery for CRS. The mucosa with biofilms can recover after surgery. Apparent bacterial plaque can be identified by H&E staining.
Secondhand Tobacco Smoke Exposure and Chronic Rhinosinusitis: A Population-Based Case–Control Study
Authors: Reh Douglas D. , Lin Sandra Y. , Clipp Sandra L. , Irani Laili , Alberg Anthony J. , Navas-Acien Ana
Published: February 2010

Background

Rhinosinusitis is a costly disease that adversely affects quality of life (QOL). It is known to be influenced by environmental factors, but few studies have evaluated the association between secondhand tobacco smoke (SHS) exposure and chronic rhinosinusitis (CRS). To address this evidence gap, we evaluated the association of SHS and CRS risk in a community-based case–control study of adult nonsmokers.

Methods

In Washington County, MD, 100 cases with a confirmed diagnosis of CRS and 100 controls matched for age, sex, and smoking status (former–never) were recruited and interviewed. A validated questionnaire was used to assess past and present SHS exposure as well as disease-specific QOL.

Results

Compared with those who reported no SHS exposure, current or childhood SHS exposure was associated with significantly increased risk of CRS (odds ratio, 2.33; 95% CI, 1.02, 5.34). CRS cases exposed to SHS (n = 39) had worse mean scores in nasal obstruction/blockage (3.1 versus 2.5; p = 0.02), nasal discharge (3.3 versus 2.7; p = 0.03), headaches (2.4 versus 1.5; p = 0.01), and cough (2.1 versus 1.5; p = 0.04) than cases without SHS exposure (n = 61). Cases exposed to SHS were also more likely to use nasal decongestants (53.9% versus 34.4%; p = 0.05).

Conclusion

Exposure to SHS during childhood and adulthood may be a risk factor for CRS. Furthermore, compared with unexposed CRS cases, SHS exposed cases reported worse nasal symptoms and used more nasal decongestants compared with unexposed cases, suggesting SHS exposure is related to exacerbation and more severe symptoms.
Regression of Polypoid Nasal Mucosa after Systemic Corticosteroid Therapy: A Proteomics Study
Authors: Deroee Armin Farajzadeh , Oweinah Jasmin , Naraghi Mohsen , Hosemann Werner , Athari Bahador , Völker Uwe , Scharf Christian
Published: February 2010

Background

Nasal polyposis (NP) treatment and pathophysiology have always been challenging for otolaryngologists. Among the medical treatments for NP, glucocorticoids (GCs) have been always one of the mainstays but the mechanisms of their action are not well defined. Identifying and comparing the protein profile of chronic rhinosinusitis (CRS) with NP before and after treatment with GCs can help to clarify NP pathogenesis and mechanisms of corticosteroid effects on NP.

Methods

Samples of nasal polyps were taken from selected NP patients in workup for endoscopic sinus surgery. None of the patients used local or systemic GCs within 30 days before the sampling. The patients were given prednisone, 30 mg/day, for 4 days before the surgery to shrink the NP tissue. Nasal polyp samples were collected during surgery. Proteins from samples were extracted and separated by immobilized pH gradient–based two-dimensional difference gel electrophoresis (2D DIGE). Resulting 2D-gel images were statistically analyzed using Delta2D software and differently expressed protein spots were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.

Results

A reference map of 1963 proteins could be established. Expression of 20 proteins changed significantly (twofold, p < 0.05) after treatment of NP with GCs. Heat shock proteins and retinoic acid were induced by GCs. Ingenuity pathway analysis of all identified proteins indicated that apoptosis pathway is triggered in NP after GC administration.

Conclusion

Identifying the changes of NP proteome due to GCs and the biological functions of proteins can lead to new ways of treatment and open new fields in NP research.
Wound Healing of Nasal Mucosa in a Rat
Authors: Khalmuratova Roza , Jeon Sea-Yuong , Kim Dae Woo , Kim Jin-Pyeong , Ahn Seong-Ki , Park Jung-Je , Hur Dong-Gu
Published: February 2010

Background

Postoperative wound healing of the nasal mucosa is a highly organized process. However, this process still has not been fully understood. The present study aimed to establish a wound healing model in a rat and describe histomorphological changes of the nasal mucosa after mechanical injury.

Methods

Unilateral wound in the nasal cavity was induced using the brushing technique in 4-week-old, Sprague-Dawley rats. Experimental rats were divided into five groups (n = 7 for each group). Animals were killed 1 hour and 2, 5, 14, and 28 days after injury. The histological sections were examined for inflammatory cell infiltration, goblet, and ciliated cell formation in hematoxylin and eosin staining. The subepithelial and epithelial thicknesses were measured and expressed as the subepithelial thickness index (STI) and epithelial thickness index (ETI). Fibrosis was evaluated by subepithelial fibrosis index (SFI) in Masson's trichrome–stained sections.

Results

Respiratory epithelial discontinuity and hemorrhage were observed 1 hour after injury. On day 2, edematous subepithelium and infiltration of neutrophils could be found on the injured site. Day 5 was characterized by the infiltration of monocytes and granulation tissue. SFI and ETI values increased significantly at day 14. Goblet cells and ciliated cells began to regenerate from day 14 and restored to near normal at day 28.

Conclusion

Using mechanical injury, the wound healing model of the nasal mucosa was established in a rat. The regeneration of respiratory mucosa was completed on day 28 after injury.
Controlled Steroid Delivery via Bioabsorbable Stent: Safety and Performance in a Rabbit Model
Authors: Li Peter F. , Downie David , Hwang Peter H.
Published: February 2010

Background

Middle turbinate lateralization, adhesions, and inflammation are causes of suboptimal sinus patency following surgery. A bioabsorbable drug-eluting stent has been developed to maintain sinus patency while providing controlled steroid delivery to the sinus mucosa. The aim of this study was to characterize the in vivo drug delivery efficacy and tolerance of this stent in a rabbit model.

Methods

Bioabsorbable stents coated with mometasone furoate were placed bilaterally in the maxillary sinuses of 31 rabbits via dorsal maxillary sinusotomy. Animals were sacrificed between 5 days and 18 weeks postoperatively. Efficacy was assessed by measuring tissue concentrations of steroid in maxillary sinus and nasal mucosa and by measurement of plasma steroid concentrations. Tolerance was assessed by histological evaluation of the sinus mucosa at different time points.

Results

Therapeutic mucosal drug concentrations were attained in a time-dependent fashion (range 175–28,189 ng/g). Plasma drug concentrations were generally near or below the lower limit of quantification (15 pg/mL). Histopathological examination of the mucosa showed no differences in the reaction to steroid-coated stents versus nondrug-coated control stents, with inflammation, epithelial ulceration, and bony reaction ranging from none to mild at all time points. Microscopic fungal hyphae were noted in a small proportion of both treatment and control sinuses, without evidence of associated adverse tissue reaction.

Conclusions

In a rabbit model, mometasone-coated bioabsorbable stents are able to provide local steroid delivery with negligible systemic absorption. Corticosteroid-eluting stents may prove useful following endoscopic sinus surgery in maintaining sinus patency and reducing inflammation.
Double-Blind, Placebo-Controlled Trial of Reformulated Azelastine Nasal Spray in Patients with Seasonal Allergic Rhinitis
Authors: Bernstein Jonathan A. , Prenner Bruce , Ferguson Berrylin J. , Portnoy Jay , Wheeler William J. , Sacks Harry J.
Published: February 2010

Background

Azelastine nasal spray is a topical antihistamine with a distinctive taste that may be objectionable to some patients. The primary objectives of this clinical trial were (1) to determine if a reformulated azelastine nasal spray (Astepro) with sucralose as a taste-masking agent provides comparable efficacy to the original formulation (Astelin) and (2) to evaluate dose–response relationships between groups.

Methods

Eight hundred thirty-five patients with seasonal allergic rhinitis were randomized to six treatment groups: (1) original azelastine nasal spray, 1 spray/nostril b.i.d.; (2) reformulated azelastine, 1 spray/nostril b.i.d.; (3) placebo, 1 spray/nostril b.i.d.; (4) original azelastine nasal spray, 2 sprays/nostril b.i.d., (5) reformulated, 2 sprays/nostril b.i.d.; and (6) placebo, 2 sprays/nostril b.i.d. The primary efficacy variable was the change from baseline to day 14 in total nasal symptom score (TNSS) consisting of runny nose, sneezing, itchy nose, and nasal congestion.

Results

Original azelastine nasal spray and the reformulated spray produced comparable improvements in the TNSS at both dosages. There was a dose-related difference in TNSS comparing the 1- and 2-spray dosages. The percentage changes from baseline in the TNSS in the 2-sprays/nostril dosage groups were 27.9% (p < 0.001) with the reformulated nasal spray, 23.5% (p < 0.01) with the original formulation, and 15.4% with placebo. The incidence of bitter taste was 7% with the reformulated spray and 8% with the original at the 2-sprays/nostril dosage.

Conclusion

The results of this study showed efficacy both with original azelastine nasal spray and with the reformulated nasal spray and a clear dose–response difference between the 1- and 2-spray dosages.
Cigarette Smoke Extract Stimulates Interleukin-8 Production in Human Airway Epithelium and is Attenuated by Superoxide Dismutase in Vitro
Authors: Mulligan Ryan M. , Atkinson Carl , Vertegel Alexey A. , Reukov Vladimir , Schlosser Rodney J.
Published: February 2010

Background

Cigarette smoke exposure (CSE) results in extensive inflammation in the upper and lower airways. Reactive oxygen species, such as superoxide, have been shown to be potent mediators of this inflammation.

Methods

Mucosal biopsy specimens were collected from patients undergoing sinonasal surgery and were used as a source of primary epithelial cells. Human sinonasal epithelial (HSNE) cells and were isolated from sinus tissue, maintained in culture, and ultimately treated with varying concentrations of CSE with or without free superoxide dismutase (SOD). Supernatants and cell lysates were examined for the proinflammatory cytokine interleukin (IL)-8. Similar experiments were performed using normal human bronchial epithelial (NHBE) cell lines.

Results

CSE induces both secretion and intracellular production of the proinflammatory cytokine IL-8 by HSNE cells in a dose-dependent manner. Furthermore, this up-regulation can be suppressed by SOD. CSE induces secretion of IL-8 in NHBEs that is also suppressed by SOD.

Conclusion

Inflammation in the airway after CSE can be blocked by SOD in this in vitro model. The ability to attenuate CSE-induced inflammation with SOD could provide a therapeutic/preventative approach for individuals with cigarette smoke exposure.
The Effect of Myrtol Standardized on Human Nasal Ciliary Beat Frequency and Mucociliary Transport Time
Authors: Han Demin , Wang Nan , Zhang Luo
Published: February 2010

Background

This study was designed to observe the effects of myrtol standardized (Gelomyrtol forte), a secretomucolytic phytomedicine, on both ciliary beat frequency (CBF) in vitro and mucociliary transport time (MTT) in vivo.

Methods

Changes in cultured human nasal CBF in response to immediate treatment with 75, 150, or 300 ng/mL of myrtol standardized and prolonged treatment (12 or 24 hours) with 300 ng/mL of myrtol standardized were quantified by using high-speed digital microscopy. In addition, MTT before and after oral application of myrtol standardized (three times a day, 900 mg/day, 10 days) was determined using the saccharine test, and the effects of this treatment regime on nasal patency was measured by acoustic rhinometry and active anterior rhinomanometry in 22 patients with nonallergic chronic rhinitis. Another 10 patients without medication, who had the same examinations twice with a 10-day interval, were involved as controls.

Results

Neither immediate nor prolonged treatment with myrtol standardized produced a distinguishable change in CBF. Meanwhile, only in patients with treatment, MTT, as well as a unilateral minimum cross-sectional area, the volume of 0–5 cm inside the nasal cavity, the unilateral nasal resistance at 75 Pa and total symptom visual analog score were significantly improved after treatment.

Conclusion

Based on these results we propose that a 10-day treatment with an herbal medicine, myrtol standardized, improves nasal mucociliary clearance as well as nasal patency in patients with chronic rhinitis. However, it has no impact on ex vivo CBF.
Mucosal Expression of Nerve Growth Factor and Brain-Derived Neurotrophic Factor in Chronic Rhinosinusitis
Authors: Coffey Charles S. , Mulligan Ryan M. , Schlosser Rodney J.
Published: February 2010

Background

Allergic rhinitis (AR) is characterized in part by hyperresponsiveness to nonspecific stimuli, a phenomenon that reflects the fundamental role of nasal neural pathways in chronic airway inflammation. Neurotrophins may serve pivotal roles in mediating hyperresponsiveness in allergic airway disease, although the role of such neurogenic mediators in chronic rhinosinusitis (CRS) is not well understood. This study was designed to examine the expression of two potent neurotrophins, nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), in CRS.

Methods

Inferior turbinate and sinus mucosa were obtained from CRS patients with and without nasal polyps (NPs) and from nonallergic controls. Enzyme-linked immunosorbent assay was used for quantitative determination of tissue concentrations of NGF and BDNF.

Results

Ninety-four tissue samples from 48 patients were included. Mean concentration of NGF in sinus mucosa was significantly higher in CRS than controls. CRS without NPs was associated with a 60% increase in sinus NGF over controls ( p < 0.05), and CRS with NPs was associated with a 140% increase ( p < 0.05). Mean sinus NGF concentration was significantly elevated in allergic subjects compared with controls ( p < 0.01). A similar trend was noted in subjects with nonallergic CRS, although this did not reach significance. Mean BDNF concentration was decreased in CRS compared with controls, with the most significant decrease in patients with polyps (p < 0.05). Mean turbinate concentration of both NGF and BDNF were similar in controls and CRS.

Conclusion

Increased expression of NGF may contribute to neural hyperresponsiveness in CRS sinus mucosa, particularly those patients with NP and/or allergies. BDNF expression is decreased in CRS sinus mucosa. Alterations in neurogenic inflammation may contribute to the pathophysiology of CRS and provide alternative therapeutic targets.
Characterization of Bacterial and Fungal Biofilms in Chronic Rhinosinusitis
Authors: Foreman Andrew , Psaltis Alkis James , Tan Lor Wai , Wormald Peter-John
Published: February 2010

Background

Conclusive evidence exists that biofilms are present on the mucosa of chronic rhinosinusitis (CRS) patients. Less is known about the species constituting these biofilms. This study developed a fluorescence in situ hybridization (FISH) protocol for characterization of bacterial and fungal biofilms in CRS.

Methods

Fifty CRS patients and 10 controls were recruited. Bacteria FISH probes for Staphylococcus aureus, Haemophilus influenzae, and Pseudomonas aeruginosa and a universal probe for fungi were applied to sinus mucosal specimens and then analyzed using confocal scanning laser microscopy.

Results

Thirty-six of 50 CRS patients had biofilms present in contrast to 0/10 controls, suggesting a role for biofilms in the pathogenesis of this disease. S. aureus was the most common biofilm-forming organism. Eleven of 50 CRS patients had characteristic fungal biofilms present.

Conclusion

This is the largest study of biofilms in CRS. It has validated mucosal tissue cryopreservation for delayed biofilm analysis. Fungal biofilms have been identified and the importance of S. aureus biofilms in the polymicrobial etiology of CRS is highlighted.
Involving Stakeholders to Optimize a Study Protocol on Secondhand Tobacco Smoke and Chronic Rhinosinusitis in Adults
Authors: Irani Laili , Lin Sandra Y. , Clipp Sandra L. , Alberg Anthony J. , Navas-Acien Ana
Published: February 2010

Background

Epidemiological evidence evaluating the association between secondhand smoke exposure and diseases of the upper airway in adults is limited by a small number of studies and a lack of established protocols. This study was designed to optimize a research protocol on secondhand tobacco smoke exposure and chronic rhinosinusitis for a future population-based case-control study in Washington County, Maryland, using a participatory research model.

Methods

We conducted three focus groups with health professionals, community members, and research practitioners for protocol development; 10 one-on-one cognitive testings with community members for protocol refinement; and a pilot testing of the full study protocol (10 cases and 10 controls) for full evaluation of the study protocol.

Results

Health professionals recommended, among other themes, enrolling patients with confirmed chronic rhinosinusitis (minimum 12-week symptom duration and objective inflammation). Community members and research practitioners discussed optimal strategies for participant recruitment and interviewing. The protocol, revised with the focus group's feedback, was further evaluated in one-on-one sessions with 10 Washington County residents (3 with chronic rhinosinusitis). In the pilot study, 10 nonsmoking chronic rhinosinusitis cases (5 clinic based and 5 community based) and their community-based age, sex, and former/never smoking-matched controls were recruited. Sinonasal symptoms scores were higher in cases than controls but similar for clinic versus community-based cases.

Conclusions

This protocol development framework involving stakeholders resulted in a comprehensive questionnaire that was successfully evaluated during a pilot study and is now ready to be used in population-based and clinical epidemiological studies of chronic rhinosinusitis in adults.
Zinc Increases Ciliary Beat Frequency in a Calcium-Dependent Manner
Authors: Woodworth Bradford A. , Zhang Shaoyan , Tamashiro Edwin , Bhargave Geeta , Palmer James N. , Cohen Noam A.
Published: February 2010

Background

Dynamic regulation of respiratory ciliary beat frequency (CBF) is regulated by fluxes in intracellular calcium (Ca2+). P2X receptors (P2XR) are extracellular ATP-gated, Ca2+-permeable, nonselective cation channels. Zinc increases intracellular Ca2+ in a sodium (Na+)-free environment through activation of P2XR channels. We hypothesize that topical zinc increases CBF in a Ca2+-dependent fashion as a result of this mechanism.

Methods

The apical surface of mouse sinonasal air–liquid interface cultures were bathed in zinc in a Na+-free solution with or without Ca2+. High-speed digital video imaging captured and analyzed CBF at a sampling rate of 100 frames/s.

Results

CBF significantly increased fourfold over baseline from 5.99 ± 3.16 Hz to 22.4 ± 4.33 Hz in the presence of zinc chloride (50 micromoles) and calcium chloride (3 mM). This effect is abolished in the presence of extracellular Na+ and was pH dependent.

Conclusions

Zinc stimulates CBF in the presence of Ca2+ likely through activation of P2X receptors. Thus, zinc represents a promising agent for stimulation of mucociliary clearance.
Expression of SPLUNC1 Protein in Nasal Polyp Epithelial Cells in Air–Liquid Interface Culture Treated with IL-13
Authors: Yeh Te-Huei , Lee Shiann-Yann , Hsu Wei-Chung
Published: February 2010

Background

Short palate, lung, and nasal epithelium clone 1 (SPLUNC1) protein is an airway epithelial cell–derived molecule exerting host defense against pathogen. However, the function and regulation of SPLUNC1 in nasal epithelial cells are still unclear. Chronic rhinosinusitis with nasal polyps (CRSwNPs) is a disorder characterized by eosinophilic Th2 inflammation and frequent microbial colonization. The pathogenesis has been postulated as a disturbed mucosal immune response. This study investigates the SPLUNC1 expression of nasal polyp epithelial cells in air–liquid interface (ALI) culture and after treating with Th2 inflammatory cytokines IL-13.

Methods

Human nasal polyp epithelial cells isolated from patients with CRSwNPs were put in different cell culture models at days 0 and 21 and were assessed for expression of SPLUNC1 by microarray. Cultured cells in ALI plus retinoic acid (ALI + RA) model were then incubated with 0, 1, 10, and 100 ng/mL human recombinant IL-13 for up to 5 days. The expression of SPLUNC1 was assessed by real-time quantitative polymerase chain reaction (RT-Q-PCR), reverse-transcriptase PCR (RT-PCR) and Western blot analysis.

Results

ALI + RA culture model harvesting ciliary differentiated nasal epithelial cells constitutively expressed high levels of SPLUNC1. In contrast, SPLUNC1 is reduced under classic submerged single layer culture. SPLUNC1 is also dose-responsively down-regulated after incubation with IL-13.

Conclusions

A microenvironmental milieu containing IL-13 may be detrimental to the host innate immunity response, at least in part, through the inhibition of SPLUNC1 production.
Pathogenetic Role of Increased Nasal Resistance in Obese Patients with Obstructive Sleep Apnea Syndrome
Authors: Tagaya Mitsuhiko , Nakata Seiichi , Yasuma Fumihiko , Noda Akiko , Morinaga Mami , Yagi Hidehito , Sugiura Makoto , Teranishi Masaaki , Nakashima Tsutomu
Published: February 2010

Background

The role of increased nasal resistance in obstructive sleep apnea syndrome (OSAS) remains controversial. The aim of this study was to examine the pathogenetic role of nasal obstruction in obese patients with OSAS.

Methods

Patients with OSAS (n = 125) at a university hospital were divided into three groups according to body mass index (BMI): nonobese (BMI < 25 kg/m2), mildly obese (25 kg/m2 ≤ BMI < 30 kg/m2), and obese (BMI ≥ 30 kg/m2). The subjects underwent nasopharyngoscopy, measurement of nasal resistance, and polysomnography.

Results

We studied 42 nonobese, 47 mildly obese, and 36 obese patients with OSAS. Among the obese, but not the nonobese and mildly obese patients, we found significant correlations between the oxygen desaturation index (ODI) and bilateral nasal resistance (BNR; r = 0.412; p = 0.013), between the ODI and unilateral higher nasal resistance (UHNR; r = 0.413; p = 0.012), and between the apnea index and UHNR (r = 0.334; p = 0.046). Multiple regression analysis incorporating all patients showed that BMI (p < 0.001) and BNR (p = 0.033) were independently related to the ODI.

Conclusions

In obese patients with OSAS, increased nasal resistance could play an important pathogenetic role in hypoxemic apnea.
Evaluation of the Presence of B-cell attractant Chemokines in Chronic Rhinosinusitis
Authors: Patadia Monica , Dixon Julian , Conley David , Chandra Rakesh , Peters Anju , Suh Lydia A. , Kato Atsushi , Carter Roderick , Harris Kathleen , Grammer Leslie , Kern Robert , Schleimer Robert
Published: February 2010

Background

B-cell responses may play a role in the pathogenesis of nasal polyposis via local IgA and IgE production and activation of eosinophils and mast cells. B-cell attracting chemokines may therefore have relevance in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNPs)

Methods

Polyp and inferior turbinate tissues were obtained from CRSwNPs, CRS without NPs (CRSsNPs), and control patients; ELISA and reverse-transcription polymerase chain reaction were used to detect levels of protein and mRNAfor selected B-cell chemokines (B-cell attracting chemokine 1 [CXCL13/BCA-1/BLC]), thymus expressed chemokine (CCL25/TECK), mucosae-associated epithelial chemokine (CCL28/MEC), stromal cell–derived factor-1alpha (CXCL12/SDF-1alpha), and selected chemokine receptor genes (CXCR4, CXCR5, and CXCR7).

Results

BCA-1 and SDF-1alpha protein levels were significantly increased in polyp tissue compared with turbinate tissue from CRSsNP patients and controls (p < 0.05 and p < 0.01, respectively). Differences in TECK and MEC were not significant. For mRNA, expression of BCA-1 was significantly up-regulated in polyp tissue and levels correlated with CD20 mRNA expression. Additionally, significant up-regulation of mRNA for the SDF-1alpha receptors CXCR7 and CXCR4 was detected in polyps, while there was a trend for up-regulation of the BCA-1 receptor CXCR5.

Conclusions

Elevated levels of the BCA-1 and SDF-1alpha and their receptors may account for an increased presence of B cells and their products, contributing to eosinophilic inflammation in patients with CRSwNP.
The Congestion Quantifier Five-Item Test for Nasal Congestion: Refinement of the Congestion Quantifier Seven-Item Test
Authors: Stull Donald E. , Meltzer Eli O. , Krouse John H. , Roberts Laurie , Kim Susan , Frank Lori , Naclerio Robert , Lund Valerie , Long Aidan
Published: February 2010

Background

Patients report that nasal congestion is the most bothersome symptom of allergic rhinitis (AR). Recently, a short, patient-reported congestion screener questionnaire, the Congestion Quantifier Seven-Item Test (CQ7), was developed to identify a level of congestion that may warrant patients seeking evaluation and possible treatment. We explored further item reduction of the CQ7 and examined the psychometric properties of this reduced set of items in a 15-day study of patients with confirmed AR or self-identified and clinician-confirmed congestion.

Methods

The CQ7 was subjected to item reduction methods and the psychometric properties of the reduced set of items were assessed.

Results

Two items were dropped—sinus pressure/pain and impact on work/school—because of lower item-rest correlations. The resulting Congestion Quantifier Five-Item screener (CQ5) performed comparably with the CQ7. Internal consistency reliability of both instruments were identical (alpha = 0.93); test–retest reliability from baseline to day 15 was similar (CQ7, alpha = 0.85; CQ5, alpha = 0.79). Both instruments were comparable in discriminating patients and controls (CQ7, area under the curve [AUC] = 0.97; CQ5, AUC = 0.96). A CQ5 score of 6 provided optimum balance of sensitivity (89.4%), specificity (88.6%), and correct classification (89%) for detecting congestion.

Conclusions

The CQ5, a patient-reported outcome screener, is slightly shorter but equally reliable, valid, and responsive as the CQ7 for evaluating differences in levels of severity of nasal congestion. It may have wider applicability than the CQ7 because of exclusion of the work/school impact item.
The Effects of Serum and Urinary Cortisol Levels of Topical Intranasal Irrigations with Budesonide Added to Saline in Patients with Recurrent Polyposis after Endoscopic Sinus Surgery
Authors: Welch Kevin C. , Thaler Erica R. , Doghramji Laurie L. , Palmer James N. , Chiu Alexander G.
Published: February 2010

Background

The delivery of topical intranasal corticosteroid sprays has traditionally been the primary method of treating recurrent nasal polyposis. An emerging treatment for polyposis is budesonide nasal irrigations. Delivered at concentrations nearly 100 times greater than found in prescription nasal sprays, there have been little studies on the effects of budesonide irrigation on the adrenal axis. Therefore, we investigated whether irrigation with budesonide solution was associated with any increase in serum cortisol and 24-hour urinary cortisol levels.

Methods

Patients who previously had undergone endoscopic sinus surgery and were not taking prednisone for 3 months were prospectively enrolled in this study. Patients irrigated twice daily with 0.5 mg/2 mL of budesonide mixed with 240 mL of saline solution. Serum cortisol and 24-hour urinary cortisol were collected before drug administration and 6 weeks after continuous use.

Results

Ten patients completed this study. The average serum cortisol and 24-hour urinary cortisol before drug administration were 9.8 ± 5.4 μg/dL and 28.1 ± 15.1 μg/24 hours, respectively. After 6-week follow-up, the average serum cortisol and 24-hour urinary cortisol were 12.8 ± 3.5 μg/dL and 16.5 ± 5.6 μg/24 hours, respectively. Normal ranges for serum cortisol and 24-hour urinary cortisol are 5–25 μg/dL and 4–50 μg/24 hours, respectively. Conclusions: Irrigation with budesonide, 0.5 mg/2 mL, in 250 mL of saline solution does not result in decreases of serum cortisol and 24-hour urinary cortisol levels. Based on this, we feel irrigation with budesonide solution is safe to perform in patients as an alternative to traditional aerosolized steroid sprays or systemic corticosteroids.
Management of Sinonasal Inverted Papillomas and Comparison of Classification Staging Systems
Authors: Gras-Cabrerizo Juan R. , Montserrat-Gili Joan R. , Massegur-Solench Humbert , León-Vintró Xavier , De Juan Julia , Fabra-Llopis Josep M.
Published: February 2010

Background

The aim of this study was to describe treatment results in patients with sinonasal inverted papilloma and to compare recent classification staging systems.

Methods

We performed a retrospective study of 79 patients with primary paranasal sinus inverted papilloma from 1978 to 2008.

Results

The median age at diagnosis was 59 years. There were 68 men (86%) and 11 women (14%). Sixty inverted papilloma (76%) were located in the ethmoidal sinus complex, 16 (20%) were in the maxillary sinus, 2 were in the sphenoid sinus (3%), and 1 was in the septum (1%). Malignancy was simultaneously associated in four cases (5%). Intracranial extension was found in five patients (6%) and we did not find orbital content involvement. The external approach was used in 22 cases (28%) and 57 patients were treated with endoscopic nasal resection (72%). The overall recurrence rate in the total population was 21%. Recurrences were observed in 7 cases (32%) in the group of patients who received external approach and in 10 (17%) patients in the endoscopic group. Recurrences according to the Krouse system were 0% in T1 stage, 16% in T2 stage, 25% in T3 stage, and 60% in T4 stage (p = 0.05). Recurrences for groups A, B, and C stages using the Cannady staging system were 12, 26, and 60%, respectively (p = 0.039). Recurrences according to Han's system were 19% in both T1 and T2, 20% in T3, and 60% in T4 (p > 0.05).

Conclusions

Our results support the endoscopic approach as the treatment of choice when feasible in patients with inverted papilloma, combined in selected cases with external approaches. The Krouse and Cannady systems provided a good distribution of patients according to local control.
The Efficacy of a Novel Chitosan Gel on Hemostasis and Wound Healing after Endoscopic Sinus Surgery
Authors: Valentine Rowan , Athanasiadis Theo , Moratti Stephen , Hanton Lyall , Robinson Simon , Wormald Peter-John
Published: February 2010

Background

Postoperative bleeding and adhesion formation are the two most common complications after endoscopic sinus surgery (ESS). Continued bleeding risks airway compromise from the inhalation of blood clots and from the aspiration of blood-stained vomitus. Additionally, adhesion formation is the most common reason for patients requiring revision surgery. This study aimed to determine the efficacy of a novel chitosan/dextran (CD) gel on hemostasis and wound healing after ESS.

Methods

A randomized controlled trial was performed involving 40 patients undergoing ESS for chronic rhinosinusitis. Immediately after surgery a baseline Boezaart Surgical Field Grading Scale was taken. Computer randomization was performed with one side receiving CD gel and the other side receiving no treatment (control). Boezaart bleeding scores were then calculated for each side every 2 minutes. Patient's endoscopic features of wound healing were assessed at 2, 6, and 12 weeks after surgery.

Results

CD gel achieved rapid hemostasis with the mean time to hemostasis at 2 minutes (95% CI, 2–4 minutes) compared with 10 minutes (95% CI, ≥6 minutes) for the control (p < 0.001). There were significantly less adhesions at all time points with CD gel versus control: 2 versus 18 at 2 weeks (p < 0.001), 3 versus 16 at 6 weeks (p < 0.001), and 2 versus 12 at 3 months (p < 0.001). There was no significant difference between CD gel and control with respect to crusting, mucosal edema, infection, or granulation tissue formation.

Conclusions

CD gel is rapidly hemostatic immediately after ESS and prevents adhesion formation, addressing two of the most common complications of sinus surgery.
Objective Improvement in Nasal Congestion and Nasal Hyperreactivity with Use of Nasal Steroids in Persistent Allergic Rhinitis
Authors: Wandalsen Gustavo F. , Mendes Aline I. , Solé Dirceu
Published: February 2010

Objective

Our objective was to evaluate the action of topical nasal steroid in nasal congestion and nasal hyper-reactivity in children and adolescents with persistent allergic rhinitis.

Methods

Twenty atopic children and adolescents (6 to 18 years) with moderate-to-severe persistent allergic rhinitis (PAR) were treated with mometasone furoate (100 μg once a day) for 21 days. At the beginning and end of treatment, the following were recorded: a) nasal symptoms score; b) several parameters of nasal congestion measured by acoustic rhinometry (SRE 2000 Rhinometrics); c) degree of nasal hyper-reactivity to histamine (concentration of histamine necessary to induce at least 100% increase in total nasal resistance during nasal provocation test). Data were compared with those from 20 controls.

Results

Compared to controls, PAR patients had significantly higher score of symptoms, as well as higher degree of nasal hyper-reactivity and lower nasal volumes. After treatment, there was a significant decrease in the mean nasal symptoms score (8.0 versus 3.8; p < 0.001) and in the nasal hyper-reactivity (histamine concentration: 0.72 mg/ml versus 2.60 mg/ml; p < 0.001). Congestion improvement was observed by the increase in all acoustic rhinometry parameters. Among all studied volumes, the volume in the segment between 2 and 5 cm showed the highest mean increase (19.8%).

Conclusions

Treatment with topical nasal steroid objectively reduced nasal congestion and nasal histamine hyper-reactivity in children and adolescents with PAR.
Why Do School Order and Safety Matter?
Authors: Cornell Dewey G. , Mayer Matthew J.
Published: February 2010

School safety and order are essential conditions for learning but represent a relatively new field of study, stimulated in large part by repeated episodes of school violence that have generated considerable public concern and triggered substantial changes in school discipline and security practices over the past two decades. This article sets the stage for the current special issue of Educational Researcher (ER), in which the study of school violence is recast into the broader and conceptually more fertile framework of school safety and order. Each article addresses key practical questions that map a school safety perspective to multiple bodies of education research as well as to broader transdisciplinary interests.
How Can We Improve School Safety Research?
Authors: Astor Ron Avi , Guerra Nancy , Van Acker Richard
Published: February 2010

The authors of this article consider how education researchers can improve school violence and school safety research by (a) examining gaps in theoretical, conceptual, and basic research on the phenomena of school violence; (b) reviewing key issues in the design and evaluation of evidence-based practices to prevent school violence; and (c) suggesting new directions for a translational science agenda that can inform policy and practice. The authors describe international empirical approaches that help match annual school safety monitoring data with specific evidence-based practices for each school site, school district, or region. The systemic exploration of successful large-scale applications of evidence-based programs at the district, regional, and state levels could inform theoretical paradigms, empirical databases, and practice.
The Achievement Gap and the Discipline Gap
Authors: Gregory Anne , Skiba Russell J. , Noguera Pedro A.
Published: February 2010

The gap in achievement across racial and ethnic groups has been a focus of education research for decades, but the disproportionate suspension and expulsion of Black, Latino, and American Indian students has received less attention. This article synthesizes research on racial and ethnic patterns in school sanctions and considers how disproportionate discipline might contribute to lagging achievement among students of color. It further examines the evidence for student, school, and community contributors to the racial and ethnic patterns in school sanctions, and it offers promising directions for gap-reducing discipline policies and practices.
Rival bishops, rival cathedrals: the election of Cormac, archdeacon of Sodor, as bishop in 1331
Authors: Thomas Sarah E.
Published: February 2010

On 6 July 1331, two procurators arrived in Bergen claiming that Cormac son of Cormac had been elected bishop of Sodor by the clergy of Skye and the canons of Snizort. Their arrival is recorded in a letter sent by Eiliv, archbishop of Nidaros, to two canons of the church of Bergen ordering that there be an examination of the election in the cathedral of Bergen on 12 July 1331. Cormac's election was contentious for three main reasons: firstly, there was already a new bishop of Sodor; secondly the right to elect a bishop of Sodor seems to have lain with the clergy of Man; and thirdly the king of Scots had the right to present the candidate to the archbishop of Nidaros. This paper examines the identities and careers of both Cormac and his successful rival, Thomas de Rossy, and the potential reasons for Cormac's claim and its ultimate failure. Therefore, this study reveals some of the underlying geopolitical realities of the diocese of Sodor in the mid-fourteenth century.
The Relation between Evenness and Diversity
Authors: Jost Lou
Published: February 2010

Contrary to common belief, decomposition of diversity into independent richness and evenness components is mathematically impossible. However, richness can be decomposed into independent diversity and evenness or inequality components. The evenness or inequality component derived in this way is connected to most of the common measures of evenness and inequality in ecology and economics. This perspective justifies the derivation of measures of relative evenness, which give the amount of evenness relative to the maximum and minimum possible for a given richness. Pielou’s [1] evenness measure J is shown to be such a measure.
Trends and Stabilization up to 2022 in Overweight and Obesity in Switzerland, Comparison to France, UK, US and Australia
Authors: Schneider Heinz , Dietrich Eva S. , Venetz Werner P.
Published: February 2010

In Switzerland a rapid increase in the total overweight population (BMI ≥ 25) from 30.3% to 37.3% and in the obese segment (BMI ≥ 30) from 5.4% to 8.1% was observed between 1992 and 2007. The objective of this study is to produce a projection until 2022 for the development of adult overweight and obesity in Switzerland based on four National Health Surveys conducted between 1992 and 2007. Based on the projection, these prevalence rates may be expected to stabilize until 2022 at the 2007 level. These results were compared with future projections estimated for France, UK, US and Australia using the same model.
Using Lidar-Derived Vegetation Profiles to Predict Time since Fire in an Oak Scrub Landscape in East-Central Florida
Authors: Angelo James  J. , Duncan Brean  W. , Weishampel John  F.
Published: February 2010

Disturbance plays a fundamental role in determining the vertical structure of vegetation in many terrestrial ecosystems, and knowledge of disturbance histories is vital for developing effective management and restoration plans. In this study, we investigated the potential of using vertical vegetation profiles derived from discrete-return lidar to predict time since fire (TSF) in a landscape of oak scrub in east-central Florida. We predicted that fire influences vegetation structure at the mesoscale (i.e., spatial scales of tens of meters to kilometers). To evaluate this prediction, we binned lidar returns into 1m vertical by 5 × 5 m horizontal cells and averaged the resulting profiles over a range of horizontal window sizes (0 to 500 m on a side). We then performed a series of resampling tests to compare the performance of support vector machine (SVM), k-nearest neighbor (k-NN), logistic regression, and linear discriminant analysis (LDA) classifiers and to estimate the amount of training data necessary to achieve satisfactory performance. Our results indicate that: (1) the SVMs perform significantly better than the other classifiers, (2) SVM classifiers may require relatively small training data sets, and (3) the highest classification accuracies occur with averaging over windows representing sizes in the mesoscale range.
Fabrication and Characterization of CMOS-MEMS Thermoelectric Micro Generators
Authors: Kao Pin-Hsu , Shih Po-Jen , Dai Ching-Liang , Liu Mao-Chen
Published: February 2010

This work presents a thermoelectric micro generator fabricated by the commercial 0.35 μm complementary metal oxide semiconductor (CMOS) process and the post-CMOS process. The micro generator is composed of 24 thermocouples in series. Each thermocouple is constructed by p-type and n-type polysilicon strips. The output power of the generator depends on the temperature difference between the hot and cold parts in the thermocouples. In order to prevent heat-receiving in the cold part in the thermocouples, the cold part is covered with a silicon dioxide layer with low thermal conductivity to insulate the heat source. The hot part of the thermocouples is suspended and connected to an aluminum plate, to increases the heat-receiving area in the hot part. The generator requires a post-CMOS process to release the suspended structures. The post-CMOS process uses an anisotropic dry etching to remove the oxide sacrificial layer and an isotropic dry etching to etch the silicon substrate. Experimental results show that the micro generator has an output voltage of 67 μV at the temperature difference of 1 K.
Structural Aspects of Drug Resistance and Inhibition of HIV-1 Reverse Transcriptase
Authors: Singh Kamalendra , Marchand Bruno , Kirby Karen A. , Michailidis Eleftherios , Sarafianos Stefan G.
Published: February 2010

HIV-1 Reverse Transcriptase (HIV-1 RT) has been the target of numerous approved anti-AIDS drugs that are key components of Highly Active Anti-Retroviral Therapies (HAART). It remains the target of extensive structural studies that continue unabated for almost twenty years. The crystal structures of wild-type or drug-resistant mutant HIV RTs in the unliganded form or in complex with substrates and/or drugs have offered valuable glimpses into the enzyme’s folding and its interactions with DNA and dNTP substrates, as well as with nucleos(t)ide reverse transcriptase inhibitor (NRTI) and non-nucleoside reverse transcriptase inhibitor (NNRTIs) drugs. These studies have been used to interpret a large body of biochemical results and have paved the way for innovative biochemical experiments designed to elucidate the mechanisms of catalysis and drug inhibition of polymerase and RNase H functions of RT. In turn, the combined use of structural biology and biochemical approaches has led to the discovery of novel mechanisms of drug resistance and has contributed to the design of new drugs with improved potency and ability to suppress multi-drug resistant strains.
Anatomical and safety considerations in establishing portals used for canine elbow arthroscopy
Authors: Crevier-Denoix N. , Moissonnier P. , Viateau V. , Jardel N.
Published: February 2010

Objectives: To describe the relationship of the major muscular, ligamentous and neurovascular structures in relation to standard medial elbow arthroscopic portals used in dogs, and to evaluate their potential iatrogenic lesions.

Design: Anatomical study using 20 canine cadaveric elbows.

Methods: Arthroscopic explorations were performed using medial portals. Three 4 mm orthopaedic pins were introduced in place of the arthroscope, egress canula and instrumental portals. Limbs were dissected. Distances between pins and neurovascular structures were measured. Muscle, ligament and cartilage lesions were recorded.

Results: Minimal muscular lesions were observed. No ligament injury was evidenced. Superficial iatrogenic cartilage lesions were observed in three joints. The arthroscopic portal was 23.1 mm (range: 16 to 28.5 mm) caudal to the brachial artery, 21.0 mm (13–30.5 mm) caudal to the median nerve, and 4.0 mm (1–7 mm) cranial to the ulnar nerve. The instrumental portal was 16.3 (9–24 mm) caudal to the brachial artery, 13.5 mm (7–24.5 mm) caudal to the median nerve, and 11.8 (8–18 mm) cranial to the ulnar nerve. The egress portal was 21.4 mm (12–37 mm) caudal to the ulnar nerve.

Conclusions and clinical relevance: The study confirmed the safety of elbow medial arthroscopic portals. Care must be taken when placing the camera portal so as to avoid injury of the ulnar nerve. Should extensive intra-articular procedures be needed, manipulation of instruments should be done cautiously in the cranio-medial compartment of the joint due to the proximity of the median nerve to the capsule.