bluuebunny/crossref_metadata_2025 huggingface dataset:
Contrarian Investment Strategies in a European Context
Authors: Brouwer Van Der Put Veld Iwan, Jeroen, Chris
Published: December 2006

In this paper we study value strategies for four European countries (France, Germany, the Netherlands and the United Kingdom). We find an outperformance for all four value variables which are investigated: the earnings‐to‐price (E/P) ratio, the cash‐flow‐to‐price (CF/P) ratio, the book‐to‐market (B/M) ratio and the dividend yield. This outperformance is especially remarkable for the CF/P ratio, which amounts to 20.8% between the top and bottom quintiles in a univariate model. In a regression analysis, in which all four value variables as well as a correction for the size effect are taken into account, we find a difference of 11.8% for the CF/P ratio. We demonstrate that this result cannot be explained by risk differences alone. Our findings confirm the outperformance of value strategies as found earlier by Chan, Hamao and Lakonishok (1991) and Lakonishok, Shleifer and Vishny (1994) for Japan and the United States respectively.
Share Prices and Macroeconomic Factors
Authors: Groenewold Fraser Nicolaas, Patricia
Published: December 2006

The APT with macroeconomic factors put forward by Chen, Roll and Ross (1986) was tested using monthly Australian sectoral share‐price indexes for 1980–1994. The inflation rate was found to be consistently priced. The significance of other factors was found to depend on the choice of sample period and estimation method. The model was compared to both an APT with artificial factors and the CAPM. Both versions of the APT were found to clearly out‐perform the CAPM but neither version of the APT was clearly superior to the other in terms of both within‐ and out‐of‐sample explanatory power.
The Timing and Subsequent Performance of Initial Public Offerings (IPOs) on the Johannesburg Stock Exchange
Authors: Page Reyneke Michael J., Ivan
Published: December 2006

Companies that have listed on the Johannesburg Stock Exchange by means of a public offering between 1980 and 1991 have subsequently performed poorly. This long run post issue performance is remarkably consistent with the South African evidence for seasoned rights issuing companies and the international evidence for both initial public offerings (IPOs) and seasoned equity offerings (SEOs). Over the four years post issue, the newly listed companies earned an average return of 18.0% as opposed to 81.5% for a size‐matched sample of seasoned companies. This study adds to the increasing body of international evidence suggesting the IPO under performance ‘puzzle’ referred to by Ibbotson (1975), Loughran and Ritter (1995) and Spiess and Affleck‐Graves (1995) is not simply sample or country specific.
The use of nitrous oxide in paediatric anaesthetic practice in the United Kingdom: a questionnaire survey*
Authors: Sheraton T. E. , Gildersleve C. D. , Hall J. E.
Published: December 2006

Nitrous oxide pollution is common in paediatric anaesthetic practice. A questionnaire was sent to all UK members of the Association of Paediatric Anaesthetists requesting details of three areas of their paediatric practice relating to nitrous oxide: attitudes to its use; current usage; and availability of alternatives. Replies were received from 296 (68%) consultants. Of these, 169 (57%) stated that their use of nitrous oxide had decreased over the last 5 years. One hundred and fifty‐eight (54%) considered theatre pollution a problem in paediatric anaesthesia. One hundred and sixty‐nine (57%) reported that in normal circumstances potential deleterious effects on patients influenced their use of nitrous oxide, whilst only 70 (24%) felt potential effects on staff influenced usage. Fifty‐five (18%) felt there should be some restriction in the availability of nitrous oxide.
The attitudes and beliefs of healthcare professionals on the causes and reporting of medication errors in a UK Intensive care unit
Authors: Sanghera I. S. , Franklin B. D. , Dhillon S.
Published: December 2006

Our aim was to explore the attitudes and beliefs of healthcare professionals relating to the causes and reporting of medication errors in a UK intensive care unit. Medication errors were identified by the unit pharmacist and semi‐structured qualitative interviews conducted with 13 members of staff involved with 12 errors. Interviews were analysed using a model of human error theory. Staff identified many contributing factors, including poor communication and frequent interruptions. Organisational factors included lack of clarity on the responsibility of the second nurse's check for medication administration, lack of feedback on medication errors, and a common and accepted practice of administering medication without a complete medication order. Barriers to reporting included administrative paperwork and lack of encouragement by management. Greater feedback on medication errors seems essential to improve current practice and increase reporting.
Treatment of the first known case of king cobra envenomation in the United Kingdom, complicated by severe anaphylaxis
Authors: Veto T. , Price R. , Silsby J. F. , Carter J. A.
Published: December 2006

We report the first known case of envenomation following snake bite by a king cobra in the UK. The patient required tracheal intubation and ventilation. Treatment with king cobra antivenom resulted in anaphylaxis (bronchospasm and hypotension), requiring adrenaline infusion. The patient's trachea was extubated 11 h after administration of antivenom.
Neurocardiogenic syncope in the obstetric patient
Authors: Saqr L. , Kumar M. M.
Published: December 2006

We report two patients who presented to our obstetric unit with a diagnosis of neurocardiogenic syncope. The first patient presented to the obstetricians in the second trimester having had two episodes of syncope during her pregnancy. The second patient had a pacemaker fitted prior to conceiving. We present the peri‐partum management of both these patients.
Tumour lysis syndrome developing during an operation
Authors: Lee M. H. , Cheng K. I. , Jang R. C. , Hsu J. H. , Dai Z. K. , Wu J. R.
Published: December 2006

We describe an unusual case of tumour lysis syndrome in a child with a high‐grade lymphoma undergoing a staging laparotomy. The patient presented with a refractory ventricular arrhythmia, which required continuous resuscitation in the operating room and continuous venous‐venous haemodialysis in the intensive care unit. This case report suggests that surgery is a possible trigger for developing tumour lysis syndrome, so anaesthetists should be alert to this possibility during surgery in patients with pre‐existing high tumour burdens.
Anaesthesia services in developing countries: defining the problems
Authors: Hodges S. C. , Mijumbi C. , Okello M. , McCormick B. A. , Walker I. A. , Wilson I. H.
Published: December 2006

We describe the use of a questionnaire to define the difficulties in providing anaesthesia in Uganda. The results show that 23% of anaesthetists have the facilities to deliver safe anaesthesia to an adult, 13% to deliver safe anaesthesia to a child and 6% to deliver safe anaesthesia for a Caesarean section. The questionnaire identified shortages of personnel, drugs, equipment and training that have not been quantified or accurately described before. The method used provides an easy and effective way to gain essential data for any country or national anaesthesia society wishing to investigate anaesthesia services in its hospitals. Solutions require improvements in local management, finance and logistics, and action to ensure that the importance of anaesthesia within acute sector healthcare is fully recognised. Major investment in terms of personnel and equipment is required to modernise and improve the safety of anaesthesia for patients in Uganda.
A Neoproterozoic glacially influenced basin margin succession and ‘atypical’ cap carbonate associated with bedrock palaeovalleys, Mirbat area, southern Oman
Authors: Rieu R. , Allen P.A. , Etienne J.L. , Cozzi A. , Wiechert U.
Published: December 2006

The Ayn Formation of the Neoproterozoic Mirbat Group comprises <400 m of little‐deformed, glacially influenced basin margin deposits. These deposits are preserved in several palaeovalleys eroded in crystalline basement and overlain by a discontinuous cap carbonate. The Ayn Formation and the cap carbonate, which are superbly exposed along a 20 km SW–NE‐striking escarpment in south Oman, provide important insights into the processes operating on a basin margin during a Neoproterozoic glaciation and its demise. The Ayn Formation comprises units of glacimarine rain‐out diamictite and sediment gravity flow deposits, alternated with units of fluvial and deltaic sandstones and conglomerates, which may have formed by proglacial outwash. The stratigraphic evolution of the Ayn Formation indicates a highly active hydrological cycle during a phase of overall (glacio‐eustatic?) low stand when glaciers advanced into and receded upon bedrock valleys. The transgressive cap carbonate was deposited primarily in shallow marine or shallow lacustrine environments over palaeohighs during the deglaciation, and was partly reworked into deeper parts of the basin through sediment gravity flow processes. Locally, the cap carbonate transgresses over crystalline basement containing a network of fissures filled with carbonate originating from the cap. The δ13C isotopic composition of the cap carbonate varies systematically between −3.5 and +5.8‰ Pee Dee Belemnite standard, in common with other older Cryogenian examples.
Miocene extensional basin development in the Betic Cordillera, SE Spain revealed through analysis of the Alhama de Murcia and Crevillente Faults
Authors: Meijninger B. M. L. , Vissers R. L. M.
Published: December 2006

The Alhama de Murcia and Crevillente faults in the Betic Cordillera of southeast Spain form part of a network of prominent faults, bounding several of the late Tertiary and Quaternary intermontane basins. Current tectonic interpretations of these basins vary from late‐orogenic extensional structures to a pull‐apart origin associated with strike–slip movements along these prominent faults. A strike–slip origin of the basins, however, seems at variance both with recent structural studies of the underlying Betic basement and with the overall basin and fault geometry. We studied the structure and kinematics of the Alhama de Murcia and Crevillente faults as well as the internal structure of the late Miocene basin sediments, to elucidate possible relationships between the prominent faults and the adjacent basins. The structural data lead to the inevitable conclusion that the late Miocene basins developed as genuinely extensional basins, presumably associated with the thinning and exhumation of the underlying basement at that time. During the late Miocene, neither the Crevillente fault nor the Alhama de Murcia fault acted as strike–slip faults controlling basin development. Instead, parts of the Alhama de Murcia fault initiated as extensional normal faults, and reactivated as contraction faults during the latest Miocene–early Pliocene in response to continued African–European plate convergence. Both prominent faults presently act as reverse faults with a movement sense towards the southeast, which is clearly at variance with the commonly inferred dextral or sinistral strike–slip motions on these faults. We argue that the prominent faults form part of a larger scale zone of post‐Messinian shortening made up of SSE‐ and NNW‐directed reverse faults and NE to ENE‐trending folds including thrust‐related fault‐bend folds and fault‐propagation folds, transected and displaced by, respectively, WNW‐ and NNE‐trending, dextral and sinistral strike–slip (tear or transfer) faults.
Human Fanconi A cells are susceptible to TRAIL‐induced apoptosis
Authors: Pigullo Simona , Ferretti Elisa , Lanciotti Marina , Bruschi Maurizio , Candiano Giovanni , Svahn Johanna , Haneline Laura , Dufour Carlo , Pistoia Vito , Corcione Anna
Published: December 2006

Tumour necrosis factor (TNF) contributes to the pathogenesis of bone marrow failure in Fanconi anaemia (FA) patients. The sensitivity of haematopoietic cells from FA, complementation group A (FANCA) subjects, who represent the majority of FA patients, to TNF‐related apoptosis‐inducing ligand (TRAIL) is unknown. The human lymphoblastoid FANCA HSC072 cell line and the genetically corrected counterpart HSC072FANCA‐neo were tested for apoptoptic response to TRAIL using flow cytometry and Western blotting. FANCA cells were more sensitive to TRAIL‐induced apoptosis than their corrected counterparts, indicating that TRAIL negatively regulates haematopoietic FANCA cell lines. This effect involved poly(ADP‐ribose) polymerase‐1 cleavage and caspase‐8 activation.
Purified allergens vs. complete extract in the diagnosis of plane tree pollen allergy
Authors: Asturias J. A. , Ibarrola I. , Amat P. , Tella R. , Malet A. , Cisteró‐Bahíma A. , Enrique E. , Malek T. , Martínez A.
Published: December 2006

Background
Plane tree pollen allergy is a clinical disorder affecting human population in cities of Europe, North America, South Africa, and Australia.

Objective
To compare IgE‐reactivity of the natural and recombinant forms of two major plane allergens, Pla a 1 and Pla a 2, with the reactivity of Platanus acerifolia pollen extract.

Methods
Forty‐seven patients with P. acerifolia allergy, 15 of them monosensitized, and 24 control subjects were included in the study. Natural Pla a 1 and Pla a 2 were purified by standard chromatographic methods and recombinant proteins were expressed in Escherichia coli. Skin prick test and determination of specific IgE were performed with commercial P. acerifolia extract and natural and recombinant purified allergens.

Results
Pla a 1 and Pla a 2 were responsible for 79% of the IgE‐binding capacity against P. acerifolia pollen extract. A high correlation has been found between the IgE response to nPla a 1 (R=0.80; P<0.001) or nPla a 2 (R=0.79; P<0.001) vs. P. acerifolia extract as well as between natural and recombinant Pla a 1 (R=0.89; P<0.001). Skin testing showed no significant differences between extract and nPla a 2, whereas a higher reactivity was found with nPla a 1. In contrast, rPla a 1 revealed markedly reduced sensitivity in comparison with extract by skin prick test and specific IgE. The sensitivity of the mix Pla a 1+Pla a 2 was 100% and 87.5% for monosensitized and polysensitized patients, respectively, with no false‐positive reactions detected.

Conclusion
Pla a 1 and Pla 2 are sufficient for a reliable diagnosis of P. acerifolia in most patients and induce comparable skin test reactivity as a whole extract.
Analysis of the inducible nitric oxide synthase gene polymorphisms in Czech patients with atopic diseases
Authors: Holla L. I. , Stejskalova A. , Znojil V. , Vasku A.
Published: December 2006

Background
Nitric oxide (NO) is an important mediator of physiologic processes in the airways; it plays a significant role in the regulation of the T helper type 1/type 2 balance and contributes to the development of atopic diseases.

Objective
We analysed several polymorphisms mainly in the promoter region of the inducible NO synthase (NOS2, iNOS) gene and investigated their associations with asthma and/or atopic phenotypes.

Methods
We performed a case–control study in 994 subjects (661 patients with atopic disorders, with subgroups of 304 patients with allergic asthma, and 333 healthy individuals), matched for sex, living in the same geographical area. Screening for polymorphisms was performed by combination of PCR and direct sequencing analysis.

Results
We analysed 14 nucleotide sequence variants, seven most common of which were typed in quite large groups of our asthmatic, atopic and control populations. None of these seven frequent polymorphisms was associated with the phenotype bronchial asthma or other atopic diseases. Nevertheless, three from six common promoter polymorphisms showed a significant relation to feather's positivity (P value from 0.01 to 0.03) and the NOS2 608Leu variant was significantly associated with asthma severity [pcorr=0.0005; odds ratio (OR)=5.00, 95% confidence interval (CI): 1.88–13.33]. In haplotype analysis, the most common −2447C/−1659C/−1026G/−0.7del/−277A/Ser608 haplotype was associated with a lower risk of asthma when compared with the common haplotypes with frequency more than 5% (P=0.01, pcorr<0.05; OR=0.65, 95% CI: 0.56–0.77).

Conclusion
Our findings suggest that inducible NOS can play a role in atopic disorders, and several polymorphisms in its gene may be important for asthma protection or susceptibility.
Cytokines and soluble CD14 in breast milk in relation with atopic manifestations in mother and infant (KOALA Study)
Authors: Snijders B. E. P. , Damoiseaux J. G. M. C. , Penders J. , Kummeling I. , Stelma F. F. , Van Ree R. , Van Den Brandt P. A. , Thijs C.
Published: December 2006

Background
Conflicting evidence exists concerning the protective role of breastfeeding in allergy and atopic disease aetiology. Breast milk contains biologically active molecules influencing the innate immune system of newborns.

Objective
We aim to assess whether cytokines (TGF‐β1, IL‐10 and IL‐12) and soluble CD14 (sCD14) in breast milk are influenced by maternal atopic constitution and modify the development of atopic manifestations in infants.

Methods
Milk samples were collected at 1 month post‐partum of 315 lactating mothers participating in the ongoing KOALA Birth Cohort Study. The cytokines and sCD14 were analysed by ELISA in the aqueous fraction. We compared the concentrations of cytokines and sCD14 in breast milk between mothers with and without an allergic history and also with and without allergic sensitization (specific IgE). Associations of cytokines and sCD14 with the development of eczema, wheezing in the first 2 years of life and allergic sensitization of infants at the age of 2 years were analysed by multivariate logistic regression analyses to correct for confounders.

Results
We found higher sCD14 levels in mothers with a positive vs. negative allergic history (7.6 vs. 7.0 μg/mL; P=0.04) and in mothers who were sensitized vs. non‐sensitized (7.8 vs. 7.1 μg/mL; P=0.03). None of the studied immune factors were associated with infant's atopic outcomes. IL‐10 was not detected above the detection limit of 0.2 pg/mL.

Conclusion
Taking together the results of the present and previous studies, we conclude that there is no convincing evidence for a relation between TGF‐β1, sCD14, IL‐10 or IL‐12 in breast milk and atopic manifestations in infants.
How we do it: A novel approach to the skin–abutment interface of the bone‐anchored hearing aid: use of local skin flaps
Authors: Persaud R.A.P. , Papadimitriou N. , Siva T. , Kothari P. , Quinn J.S.
Published: December 2006

Keypoints

• Various techniques involving skin grafts have been described to obtain thin hairless immobile skin at the abutment interface of the bone‐anchored hearing aid (BAHA), but none are without significant complications such as necrosis and/or infection leading to total graft failure.

• A novel technique involving four local thin skin flaps was developed to prevent serious complications.

• The procedure essentially involves raising skin flaps at the intradermal level leaving the hair follicles in the subcutaneous tissue, which is subsequently excised.

• We have used the skin‐flap approach around 21 BAHAs on 19 patients (two patients had bilateral devices) and the only complications were minor skin loss immediately adjacent to the implants in two patients and mild skin infections, which settled with topical antibiotics, in three patients.

• The innovative technique described is simple and straightforward, and does not require any special instrumentation. Furthermore, it may have specific advantages, in terms of morbidity, over contemporary skin grafting methods primarily because of the retained intrinsic blood supply of the skin flaps.
How we do it: Diagrammatic recording of tympanomastoid procedures
Authors: Wasson J.D. , Kanegaonkar R.G. , Vaz F.M. , Thomas J.N.
Published: December 2006

Keypoints

• Accurate documentation of the operative findings of tympanomastoid procedures is essential for effective patient management and to satisfy the growing demands of clinical audit.

• Due to the three‐dimensional complexity of the middle ear, it is difficult to represent graphically.

• Consequently, most surgeons only describe subjectively their operative, otological findings.

•We present for the first time a simple middle ear template which provides an objective tool to improve the recording of tympanomastoid procedures.
Multidimensional assessment of female tracheoesophageal prosthetic speech
Authors: Kazi R. , Kiverniti E. , Prasad V. , Venkitaraman R. , Nutting C.M. , Clarke P. , Rhys‐Evans P. , Harrington K.J.
Published: December 2006

Objective:  The objective of this study was to undertake a multidimensional assessment of female tracheoesophageal prosthetic speech.

Study Design:  A cross‐sectional cohort study.

Setting:  Head and Neck Unit in a tertiary oncology referral centre.

Patients:  Ten female and 10 male total laryngectomy patients with no signs of recurrence and using voice prosthesis were compared to 10 normal female speakers.

Intervention(s):  Electroglottographic and acoustic analysis of voice parameters for both sustained vowel /i/ and connected speech, perceptual evaluation using GRBAS (with 2 experienced raters) and questionnaire assessment using the University of Washington Quality of Life and the Voice Handicap Index. Statistical analysis was done using the Statistical Package for Social Sciences, (v. 14, SPSS Inc., Chicago III).

Results:  Median age of the female larygectomy patiemts was 65 years (range: 41‐81), that of male laryngectomees was 66.5 years (range: 40‐79) and that of the normal female subjects was 47.5 years (range: 35‐72). All electroglottographic, acoustic parameters and GRBAS ratings of the female laryngectomy patients were significantly worse as compared with the normal female subjects. The median fundamental frequency (111.8 Hz) was comparable to male tracheoesophageal speakers (115.8 Hz). Mean composite University of Washington Quality of Life score and overall Voice Handicap Index score was 79.3(12.5) and 47.5(27.6) for the female laryngectomy patients and for the males was 81.2 (9.6) and 39.4(18.7).

Conclusions:  Gender frequency differences as seen in normal subjects are lost following a laryngectomy operation as evidenced by electroglottographic and perceptual data. Although the quality of life scores are comparable to the male tracheoesophageal speakers, they exhibit a greater voice handicap as compared to their male counterparts.
Changes in pulmonary dynamics in response to graded extrathoracic inspiratory resistive loading
Authors: Nouraei S.A.R. , Winterborn C. , Howard D.J. , Sandhu G.S.
Published: December 2006

Objectives.  To investigate the impact of changes in inspiratory airway resistance on pulmonary dynamics as measured with flow‐volume phase plots under controlled conditions, to simulate the variable extrathoracic airway obstruction that commonly manifests in patients with sub‐glottic airway stenosis as a selective impediment to inspiratory airflow, to assess whether flow‐volume loops could provide quantitative physiological indices for the diagnosis and monitoring of this condition.

Method.  We developed six selective inspiratory airway resistors by modifying Valsalva valves, and determined their airflow resistance characteristics using a flow‐pressure device. Maximum‐effort flow‐volume loops were recorded from fifteen healthy subjects, with the different inspiratory resistors, supplied at a random order, placed in series with the spirometer. The diagnostic and monitoring performances of the different indices derived from flow‐volume loops were assessed with Receiver Operator Characteristic plots, and Analysis of Variance respectively.

Results.  The ratio between peak expiratory and inspiratory flows (PEF/PIF) had a sensitivity of 89% and a specificity of 70% for diagnosing extrathoracic obstruction, and could identify increases in airway resistance of over 10 cmH2O/s/L (P < 0.05; anova). The ratio of areas under the expiratory and inspiratory curves (AUCexpir/AUCinspir) of the flow‐volume loop provided the most sensitive index, with a sensitivity of 97.4%, and a specificity of 90.5%. Other previously‐reported indices, like the Empey ratio were significantly less sensitive.

Conclusions.  Flow‐volume loop studies are non‐invasive and simple to perform, and can be used to add a quantitative physiological dimension to the initial diagnosis, and ongoing monitoring of patients with extrathoracic airway stenosis throughout treatment.
Characterisation of the bacterial flora of the larynx
Authors: Gillett S. , Rees L. , Coogan T. , Birchall M. , Bailey M.
Published: December 2006

Objectives:  Damage to epithelial integrity has been implicated in inflammatory disease and neoplasia. Bacterial species such as Pseudomonas and Helicobacter have been shown to cause disease by tight cell junction breakdown and loss of epithelial integrity in the gut (1) There has been one description of the bacterial flora of the human larynx and its variation between individuals, using traditional culture techniques. (2) Sub‐site variation has not been characterised. We have compared methods of bacterial species identification and laryngeal sub‐site variation.

Methods:  Bacteria were identified by sequencing of variable regions of the 16S RNA gene, obtained by PCR amplification of DNA from supra‐ and sub‐glottic laryngeal biopsies from pigs. Sequences were aligned with those of known bacteria using the blast nucleotide search engine. Concurrently, bacterial swabs from each larynx subsite were plated on to blood agar. Bacterial colonies isolated by this method were identified by 16S sequencing.

Results:  A total of 6 Bacterial species were identified in the supra‐glottis compared to eight identified in the sub‐glottis by culture techniques. 10 bacterial species were identified in the supra‐glottis by cloning techniques, including fastidious species.

Conclusion:  Bacterial species vary between supra and sub‐glottis.Cloning techniques are superior at identifying bacterial species when compared with traditional culture techniques.

References 1 Sawada N et al. (2003) Med. Electron Microsc.36,147–156

2 Tanaka I et al. (1996)Acta Otoloaryngol.525 (Suppl.), S44–50
MHC molecule expression in laryngeal epithelium of patients with laryngopharyngeal reflux compared to normal subjects
Authors: Birchall M. , Rees L. , Phillips A. , Johnston N. , Postma G. , Koufman J , Bailey M.
Published: December 2006

Objectives.  We recently demonstrated an increase in the MHC‐associated molecule, β‐2‐microglobulin in laryngeal epithelium from patients with laryngopharyngeal reflux (LPR). This could not be accounted for by an increase in MHC Class I, particularly in the superficial layers where Class I is weakly expressed. We hypothesised that this reflected an increase in CD1d, a non‐classical MHC molecule.

Methods.  Posterior laryngeal biopsies were obtained from 10 controls and 11 LPR patients. Multicolour immunofluorescence microscopy was used to measure expression of CD1d, CD161 (NK/NKT marker), CD4/8 T‐cells, macrophage, neutrophil and eosinophil antigens. Two‐way analysis of variance and unpaired T‐tests were performed on transformed data.

Results.  Expression of CD1d increased from basal to superficial layers, and was marginally raised in LPR (P = 0.067), whilst CD161 increased significantly (P = 0.02). While CD161(+) cells were distributed throughout the epithelium, CD8(+) T‐cells were localised to the deep, MHC class I‐expressing layers. EMBP was significantly reduced in LPR (P = 0.01).

Conclusions.  CD1d and MHC class I exhibit reciprocal expression patterns, which are reflected by the distribution of cells expressing their respective ligands (NKT cells and CD8(+) T‐cells). An increase in CD1d in LPR may be responsible for the increase in β‐2‐microglobulin observed, and is associated with a significant increase in NKT‐cells. The CD1d‐NKT cell axis may be a crucial part of maintaining tolerance in the laryngeal mucosa and changes in this system may be responsible for the persistence of inflammation in LPR.
Does the benefit of adenoidectomy in addition to ventilation tube insertion persist long‐term?
Authors: Daniel M. , Vaghela H. , Philpott C. , Thomas R.S.A. , Gannon M. , Spencer H. , Haggard M.
Published: December 2006

Objectives.  TARGET randomised 376 children with persistent OME to 3 regimens: watchful waiting (WW), ventilation‐tubes only (VTO), and ventilation tubes‐adenoidectomy (VTA). At 2‐year follow‐up, the demonstrated greater benefits of VTA than VTO in terms of respiratory problems and hearing thresholds were still present. Records from the largest centre were examined to determine how long benefits of +adenoidectomy continue beyond 2 years.

Methods.  Retrospective records analyses of Leicester children captured consultations and treatments outside the TARGET protocol, plus pure‐tone‐average (0.5–4 kHz) at latest clinical entry.

Results.  Ninety‐four of 95 notes (99%) were available, with time‐lags of 7.5–11.6 years. On intention‐to‐treat analysis, children receiving treatment additional to allocation comprised 61% of WW, 59% of VTO, and 44% of VTA, with average surgical procedures numbering 1.0, 2.1, and 1.7. Proportions of children requiring >1 additional procedure were 13%, 34%, and 15%. Differences (VTO‐VTA) for consultations, operations and combined were marginal for this single centre but consistent with the significant all‐centre data for 3–6 years from randomisation. Mean latest pure‐tone‐averages were 15.84, 11.73, and 12.44 dBHL.

Conclusions.  (1) Additional adenoidectomy has enduring benefits over VTO, although most clinical benefit appears to arise in the early years. (2) The two fifths of children randomised to WW not requiring surgery merit detailed epidemiological characterisation. (3) The benefits of surgery in OME are modest, requiring large‐number trials, but are genuine.
An autonomous surgical robot for drilling a cochleostomy–porcine trial
Authors: Coulson C.J. , Taylor R.P. , Griffiths M.V. , Proops D.W. , Brett P.N.
Published: December 2006

Objectives.  Cochlea implantation involves drilling a cochleostomy through which the electrode array can be inserted. This is a freehand procedure requiring great accuracy. On breaking through the medial bony cochlea wall the drill penetrates through the endosteal membrane traumatizing the basilar membrane and scala tympani and contaminates them with bone dust. This probably causes a destruction of any residual hearing. Our objective was to produce an autonomous surgical drilling robot capable of drilling a cochleostomy but stopping prior to disrupting the endosteal membrane.

Method.  The autonomous surgical robot senses the force and torque at the tool point and uses this information to predict the start of breaking through the medial bony cochlea wall. Drilling is stopped prior to penetrating the endosteal membrane. The autonomous robot was used to drill a cochleostomy in 5‐porcine cochlea's.

Results.  In all 5 procedures the autonomous surgical drilling robot stopped at the point of breakthrough. The endosteal membrane was not perforated in any of the specimens. The intact membrane was visible at the base of the cochleostomy.

Conclusions.  The autonomous surgical robot can drill a cochleostomy that minimizes damage to the membranous cochlea. The effect of this increased accuracy on residual hearing and post‐operative infection is under further investigation.
Anatomical characterisation of voltage gated sodium channels in the mammalian cochlear nerve spiral ganglia
Authors: Prasai A. , Mulheran M. , Grubb B.D.
Published: December 2006

Introduction.  There is evidence that Voltage Gated Sodium Channels (VGSC) may represent novel therapeutic targets for treatment of certain types of tinnitus and hearing loss. It is also known that the different VGSC types vary in their affinity for differing VGSC blockers. Parallels have been drawn with certain types of tinnitus, chronic pain and epilepsy (1) These conditions are thought to arise from pathological VGSC activity (2) There has also been empirical interest in the use of VGSC blockers as tinnitolytics, with the best known of these being intravenous lignocaine.

Aim.  The aim of this study was first begin to characterise VGSCs in the mammalian cochlear nerve spiral ganglion.

Method.  After sacrifice, guinea pigs were perfused with heparin and then 2% paraformaldehyde. The bony matrix of the cochleae was decalcified in buffer containing EGTA (8%). Decalcified tissues were embedded; frozen and 20‐micron cryosections were made through the cochleae. Immunocytochemistry was then carried out using antibodies that selectively bind to individual sodium channel α‐subunits. Sections were then analysed and photographed using either an epifluorescence or a confocal microscope.

Results and Conclusions.  Sodium channel type 1.6 and 1.7 were shown to be expressed in the cochlear nerve spiral ganglion. Further work is being carried out to see if there are changes in the expression of these VGSC after ototrauma. These findings may help us to target our therapy to treat certain types of tinnitus and hearing loss.

References 1 Smith P.F., Darlington C.L. (2005) Drug treatments for subjective tinnitus: serendipitous discovery versus rational drug design. Curr. Opin. Investig. Drugs.6, 712–716

2 Taylor C.P., Meldrum B.S. (1995) Na+ channels as targets for neuroprotective drugs. Trends. Pharmacol. Sci. 16, 309–315
N‐terminal pro‐brain natriuretic peptide used for the prediction of coronary artery stenosis
Authors: Wolber T. , Maeder M. , Rickli H. , Riesen W. , Binggeli C. , Duru F. , Ammann P.
Published: December 2006

Background  The level of the inactive N‐terminal fragment of pro‐brain (B‐type) natriuretic peptide (NT‐proBNP) is a prognostic marker in patients with acute and chronic coronary artery disease (CAD). It might also be valuable for non‐invasive diagnosis of coronary artery disease.

Materials and methods  The NT‐proBNP was measured in 781 consecutive patients with normal left ventricular function referred for coronary angiography owing to symptoms or signs of CAD. The diagnostic value of NT‐proBNP was assessed for predicting CAD at angiography.

Results  Elevated NT‐proBNP levels were associated with the extent of CAD and with the female sex (P < 0·001). The ability of NT‐proBNP to predict significant coronary disease at angiography was assessed separately for men using a cut‐off point of 85 pg mL−1, positive likelihood ratio 2·2 (95% CI, 1·7–3·0), negative likelihood ratio 0·53 (95% CI 0·45–0·63) and area under the receiver‐operating‐characteristic (ROC) curve 0·72: for women, it was assessed using a cut‐off point of 165 pg mL−1, positive likelihood ratio 2·4 (95% CI, 1·7–3·4), negative likelihood ratio 0·55 (95% CI, 0·44–0·70) and area under ROC curve 0·71. In multiple logistic‐regression analysis, NT‐proBNP added significant independent predictive power to other clinical variables in models predicting CAD (odds ratio 2·76, 95% CI, 1·76–4·32, P < 0·001).

Conclusions  The NT‐proBNP is a marker of non‐obstructive CAD and of significant coronary stenosis. In conjunction with other clinical information, measurement of NT‐proBNP with the use of sex‐specific reference ranges may improve the non‐invasive prediction of CAD.
Effects of cardioversion of atrial fibrillation on endothelial function in hypertension or diabetes
Authors: Guazzi M. , Belletti S. , Lenatti L. , Bianco E. , Guazzi M. D.
Published: December 2006

Background  Cardioversion (CV) to sinus rhythm corrects endothelial dysfunction secondary to atrial fibrillation (AF). As AF often complicates hypertension and diabetes (disorders associated with impaired endothelial function) the study probed whether these comorbidities to AF produced an additive effect and to what extent CV might be advantageous.

Materials and methods  Brachial artery flow‐mediated dilatation (FMD) was evaluated before and after CV in 17 lone AF patients (group 1), 16 patients with AF + hypertension (group 2) and 17 patients with AF + diabetes type II (group 3), while in supine and head‐up tilting (HUT) positions, as this is when endothelial vasodilation is emphasized as a counterbalance to neurogenic vasoconstriction.

Results  After 2 weeks, CV in group 1 increased (P < 0·01) supine FMD (from 7·22→9·50%) and restored its HUT potentiation (from 9·31→17·22%). In group 2, FMD also improved significantly with CV (supine from 4·92→7·11% and HUT from 5·29→11·83%; P < 0·01). In group 3, CV did not promote significant FMD changes (supine from 5·12→4·92% and HUT from 4·98→4·73%). After 3 months, FMD improvement persisted in groups 1 and 2 with enduring sinus rhythm, but not in those with AF relapse. In group 3, FMD remained unchanged regardless of cardiac rhythm.

Conclusions  Cardioversion persistently increases supine shear stress endothelial responsiveness and restores the orthostatic modulation in AF alone or in association with hypertension, but not with diabetes. Differences in background endothelial impairment may explain the presence (hypertension) or the absence (diabetes) of an additive AF effect in comorbidities, as well as CV results.
Serum concentrations of the tissue polypeptide specific antigen in patients suffering from non‐alcoholic steatohepatitis
Authors: Tarantino G. , Conca P. , Coppola A. , Vecchione R. , Di Minno G.
Published: December 2006

Background Liver histology is the gold standard for diagnosis of non‐alcoholic fatty liver disease. Ethical considerations and patient choice often preclude performing a liver biopsy, especially considering the rare but potential risk. Searching for a good serological marker substitute for the invasive procedure was the aim of our study. Keratins, mainly 8 and 18, play not only a mere structural role providing mechanical stability to hepatocytes, but also represent a target via toxic stress ultimately inducing apoptosis/necrosis. Tissue polypeptide‐specific antigen (TPS), a serological mirror of keratin 18, is widely used as a marker for various cancers. This antigen was assessed in three different groups who were overweight or obese.

Materials and methods In this cross‐sectional case–control study, 48 cancer‐free patients with non‐alcoholic steatohepatitis (NASH, Group 1), 48 patients with pure fatty liver (FL, Group 2), and 47 volunteers (Group 3) were studied. All of them were referred to our metabolic unit for routine evaluation.

Results The median (range) TPS levels were 123 (56–286) ng mL−1in NASH patients. FL patients and volunteers had significantly lower TPS levels, 76 (38–98) ng mL−1and 64 (28–87) ng mL−1, respectively (P = 0·0001). A value of 88 ng mL−1in patients with underlying bright liver was associated with a high probability of NASH (sensitivity and specificity = 92% and 96%, respectively). One patient (2·1%) with FL had a TPS value > 88 ng mL−1, but in the same group, 29 FL patients (60·4%) had an alanine aminotransferase value > 40 U L−1. Based on a recent classification of liver fibrosis, the median (range) TPS values were significantly different among the stages:F1 (n = 23) = 100 (76–264) ng mL−1;F2 (n = 21) = 134 (56–276) ng mL−1; andF3 (n = 4) = 199·5 (123–286) ng mL−1, respectively (P = 0·014).

Conclusions Our study shows that TPS is a better marker than alanine aminotransferase activity, ultrasonography or the combination of both parameters in differentiating NASH from FL.
Invertebrate responses to short‐term water abstraction in small New Zealand streams
Authors: DEWSON ZOË S. , JAMES ALEXANDER B. W. , DEATH RUSSELL G.
Published: December 2006

1. Small permanent streams are coming under increasing pressure for water abstraction. Although these abstractions might only be required on a short‐term basis (e.g. summer time irrigation), the highest demand for water often coincides with seasonal low flows.

2. We constructed weirs and diversions that reduced discharge in three small streams (<4 m width) to test the hypotheses that short‐term water abstractions would decrease habitat availability and suitability for invertebrates, resulting in increased invertebrate drift, reduced taxonomic richness and decreased benthic invertebrate densities.

3. We sampled benthic invertebrates, invertebrate drift and periphyton at control (upstream) and impact (downstream) sites on each stream before and during 1 month of discharge reduction.

4. Discharge decreased by an average of 89–98% at impact sites and wetted width decreased by 24–30%. Water depth decreased by 28–64% while velocity decreased by 50–62%. Water conductivity, temperature and dissolved oxygen showed varying responses to flow reduction among the three streams, whereas algal biomass and pH were unaffected in all streams.

5. The densities of invertebrate taxa tended to increase in the impact reaches of these streams, even though invertebrate drift increased at impact sites in the first few days following discharge reduction. There were a higher proportion of mayflies, stoneflies and caddisflies at the impact site on one stream after flow reduction. There were no changes to the number of taxa or species evenness at impact sites.

6. Our results suggest that for these small streams, the response of invertebrates to short‐term discharge reduction was to accumulate in the decreased available area, increasing local invertebrate density.
Geostatistical modelling on stream networks: developing valid covariance matrices based on hydrologic distance and stream flow
Authors: PETERSON ERIN E. , THEOBALD DAVID M. , VER HOEF JAY M.
Published: December 2006

1. Geostatistical models based on Euclidean distance fail to represent the spatial configuration, connectivity, and directionality of sites in a stream network and may not be ecologically relevant for many chemical, physical and biological studies of freshwater streams. Functional distance measures, such as symmetric and asymmetric hydrologic distance, more accurately represent the transfer of organisms, material and energy through stream networks. However, calculating the hydrologic distances for a large study area remains challenging and substituting hydrologic distance for Euclidean distance may violate geostatistical modelling assumptions.

2. We provide a review of geostatistical modelling assumptions and discuss the statistical and ecological consequences of substituting hydrologic distance measures for Euclidean distance. We also describe a new family of autocovariance models that we developed for stream networks, which are based on hydrologic distance measures.

3. We describe the geographical information system (GIS) methodology used to generate spatial data necessary for geostatistical modelling in stream networks. We also provide an example that illustrates the methodology used to create a valid covariance matrix based on asymmetric hydrologic distance and weighted by discharge volume, which can be incorporated into common geostatistical models.

4. The methodology and tools described supply ecologically meaningful and statistically valid geostatistical models for stream networks. They also provide stream ecologists with the opportunity to develop their own functional measures of distance and connectivity, which will improve geostatistical models developed for stream networks in the future.

5. The GIS tools presented here are being made available in order to facilitate the application of valid geostatistical modelling in freshwater ecology.
The effect of evapoconcentration on dissolved organic carbon concentration and quality in lakes of SW Greenland
Authors: ANDERSON N. JOHN. , STEDMON COLIN A.
Published: December 2006

1. Dissolved organic carbon (DOC) concentration was determined for a range of lakes of varying conductivity (30–4000 μS cm−1) in the low Arctic of SW Greenland. DOC concentration range from <1 to >100 mg C L−1, occasionally approaching 200 mg C L−1 in meromictic, oligosaline lakes. DOC concentration was strongly related to [log10] conductivity and total nitrogen.

2. Peak DOC concentrations (>80 mg L−1) occur in lakes located approximately 50 km from the present ice sheet margin, a zone of low effective precipitation; evaporative concentration is the first‐order control on DOC concentration. Lakes at the coast and closer to the ice margin had lower DOC concentrations (<20 mg C L−1). Local factors, notably the presence or absence of an outflow and catchment morphometry, resulted in considerable variability in concentration (20–100 mg C L−1) within the area of maximum concentration around 51°W.

3. Despite their high DOC concentration, these lakes are essentially colourless. Dissolved organic matter (DOM) absorption (a375) was low in most lakes (<10 m−1) with maximum values (approximately 20 m−1) occurring in one humic‐stained lake in the area. Absorption values corrected for DOC concentration () were very low (<0.6 m2 g−1 C) for all lakes apart from those at the coast, perhaps reflecting greater allochthonous inputs at these sites.

4. S, the spectral slope coefficient, ranged from 16 to 27 μm−1 and was weakly correlated with DOC concentration. Both a375 and S showed similar distribution patterns along the sampling gradient as did DOC, with maximum values at approximately 51°W. High and low S may indicate fresher, more rapidly flushed, systems with less degraded DOM or greater inputs from their catchments.

5. The lakes closer to the head of the fjord with higher conductivity, had low (<0.2 m2 g−1 C) and high S (>21 μm−1) and this may reflect increasingly longer lake water residence times, greater DOM age and photochemical degradation.
Fluctuating deposition of ocean water drives plant function on coastal sand dunes
Authors: GREAVER TARA L. , STERNBERG LEONEL S. L.
Published: December 2006

Sea‐level rise will alter the hydrology of terrestrial coastal ecosystems. As such, it becomes increasingly important to decipher the present role of ocean water in coastal ecosystems in order to assess the coming effects of sea‐level rise scenarios. Sand dunes occur at the interface of land and sea. Traditionally, they are conceived as freshwater environments with rain and ground water as the only water sources available to vegetation. This study investigates the possibility of ocean water influx to dune soils and its effect on the physiology of sand dune vegetation. Stable isotopes are used to trace the path of ocean water from the soil to the vegetation. Soil salinity, water content and δ18O values are measured concurrently with stem water and leaf tissue of eight species during the wet and dry season and from areas proximal and distal to the ocean. Our results indicate the dune ecosystem is a mixed freshwater and marine water system characterized by oceanic influence on dune hydrology that is spatially heterogeneous and fluctuates temporally. Ocean water influx to soil occurs via salt spray in areas 5–12 m from the ocean during dry season. Accordingly, vegetation nearest to the sea demonstrate a plastic response to ocean water deposition including elevated integrated water use efficiency (δ13Cleaf) and uptake of ocean water that comprised up to 52% of xylem water. We suggest physiological plasticity in response to periodic ocean water influx may be a functional characteristic common to species on the leading edge of diverse coastal habitats and an important feature that should be included in modeling coastal ecosystems. Rising sea level would likely cause a repercussive landward shift of dune species in response to encroaching maritime influences. However, human development would restrict this process, potentially causing the demise of dune systems and the protection from land erosion they provide.