bluuebunny/crossref_metadata_2025 huggingface dataset:
Influences of amino acid features of glutathione S‐transferase fusion proteins on their solubility
Authors: Shimada Kiyo , Nagano Mihoko , Kawai Makoto , Koga Hisashi
Published: September 2005

We have previously described our strategy for high‐throughput (HT) production of recombinant antigens for anti‐mKIAA antibody generation, which involves using shotgun fragments generated during entire sequencing of mKIAA cDNAs. We applied this strategy to 1628 mouse KIAA (mKIAA) cDNA fragments, and 84.2% of the GST‐mKIAA fusion proteins were successfully purified. The solubility of the proteins was predicted by a small‐scale bacterial culture, and a large‐scale culture was then performed according to the expected results. Among them, 43.8% of the proteins were purified as a soluble form and 56.2% as an insoluble form. The average yield of the soluble proteins was 0.15 nmol/mL of bacterial culture, and that of the insoluble proteins was 0.55 nmol/mL Statistical analysis of the data revealed a significant correlation between amino acid features of the recombinant proteins and their solubility. To achieve the most effective and feasible protein expression, we constructed a decision tree in which the analyzed data were reflected. The information described here may provide practical guidelines for HT production of recombinant proteins.
In situ REM and ex situ SPM studies of silicon (111) surface
Authors: Aseev A. L. , Kosolobov S. S. , Latyshev A. V. , Song Se Ahn , Saranin A. A. , Zotov A. V. , Lifshits V. G.
Published: September 2005

Combination of experimental methods, including ultrahigh vacuum in situ reflection electron microscopy, scanning tunnelling microscopy and atomic force microscopy, has been applied for analysis of surface structure and dynamic processes on silicon (111) surfaces during sublimation, rapid temperature cooling, oxygen reactions and metal‐silicon surface phase formation. From analysis of triangular negative islands, 0.08 nm in depth, which were forming during quenching, it was deduced the effective activation energy of the island generation is equalled to ≈0.35 eV and made conclusion that the (1 × 1) ⇒ (7 × 7) phase transition on Si(111) assumes to be responsible for the negative island nucleation. On the base of the in situ REM study, the dependence of step motion, initiated by surface vacancies generation during oxygen‐silicon interaction, on the terrace width was measured. Peculiarities of the initial stages of silicon surface oxidation at low pressures were considered. From precision measurements, the top silicon atom density was determined for the metal‐silicon surface phase formed during Na, Ca, Mg and Ag deposition on clean silicon (111) surface. (© 2005 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)
High prevalence of subclinical hypothyroidism in patients with Anderson–Fabry disease
Authors: Hauser A. C. , Gessl A. , Lorenz M. , Voigtländer T. , Födinger M. , Sunder‐Plassmann G.
Published: September 2005

Anderson–Fabry disease is a rare lysosomal storage disorder. It results from a deficiency of the lysosomal α‐galactosidase A and leads to progressive accumulation of globotriaosylceramide in the endothelium and tissue cells of various organs. Some of the typical clinical findings such as tiredness, dry skin, myalgia and arthralgia as well as vague gastrointestinal complaints are also symptoms of hypothyroidism. Therefore, we studied the thyroid function in patients with Anderson–Fabry disease. Thyroid function was studied in 11 patients (6 female, 5 male) with Anderson–Fabry disease by measuring thyroid‐stimulating hormone (TSH) and free thyroxine serum levels. Nine patients had chronic kidney disease with stage 1 and two with stage 5. Subclinical hypothyroidism (normal serum free thyroxine concentrations along with elevated serum TSH levels) was found in 4 of 11 patients (36.4%). Subclinical hypothyroidism was observed in both male and female patients as well as in patients with stage 1 and stage 5 kidney disease. Subclinical hypothyroidism is a common finding in patients with Anderson–Fabry disease, showing an excess prevalence as compared to the normal population. The high frequency seems to be relevant regarding the potential consequences of a hypothyroid state.
Clinical and biochemical presentation of siblings with COG‐7 deficiency, a lethal multiple O‐ and N‐glycosylation disorder
Authors: Spaapen L. J. M. , Bakker J. A. , van der Meer S. B. , Sijstermans H. J. , Steet R. A. , Wevers R. A. , Jaeken J.
Published: September 2005

Congenital disorders of glycosylation (CDG) represent a group of inherited multiorgan diseases caused by defects in the biosynthesis of glycoproteins. We report on two dysmorphic siblings with severe liver disease who died at the age of a few weeks. Increased activities of lysosomal enzymes in plasma were found, though total sialic acid in plasma was strongly decreased. Isoelectric focusing of serum sialotransferrins showed a type 2‐like CDG pattern. Some of the known CDG subtypes were excluded. O‐Glycosylation was investigated by isoelectric focusing of apolipoprotein C‐III, which showed increased fractions of hyposialylated isoforms. In a consecutive study a defect in the conserved oligomeric Golgi complex was established at the level of subunit COG‐7, leading to disruption of multiple glycosylation functions of the Golgi. This report on patients with a new variant of CDG, due to a multiple Golgi defect, emphasizes in addition to sialotransferrins the importance of analysis of a serum O‐linked glycoprotein, e.g. apolipoprotein C‐III, in unclassified CDG‐X cases.
Gaucher disease and bone: Laboratory and skeletal mineral density variations during a long period of enzyme replacement therapy
Authors: Ciana G. , Addobbati R. , Tamaro G. , Leopaldi A. , Nevyjel M. , Ronfani L. , Vidoni L. , Pittis M. G. , Bembi B.
Published: September 2005

The usefulness of bone turnover markers in Gaucher disease is still unclear and their utility in monitoring the effects of enzyme replacement therapy (ERT) on bone metabolism has not yet been investigated exhaustively. Skeletal involvement seems to improve slowly during ERT, but only a few studies evaluating bone mineral density (BMD) changes during a long follow‐up period have been reported. The aim of this study was to assess the efficacy of ERT on bone involvement in a group of 12 type I Gaucher disease (GD I) patients by monitoring biochemical indices of bone resorption/formation and BMD measured by dual energy x‐ray absorptiometry (DEXA). Serum (calcium, phosphorus, bone alkaline phosphatase isoenzyme, carboxyterminal propeptide of type I procollagen (PICP), carboxyterminal telopeptide of type I collagen (ICTP), osteocalcin, intact parathyroid hormone) and urinary (calcium, phosphorus, hydroxyproline and free deoxypyridinoline) markers of bone metabolism and lumbar BMD were measured at baseline, after 6 and 12 months, and then every year for a mean ERT follow‐up period of 4.5 years (range 4.4–6 years). Twelve healthy adult subjects matched for age and sex were tested as negative controls. A significant decrease of PICP was detected in the patient group at baseline (mean value 100.52 ng/ml vs 142.45 ng/ml, p = 0.017), while ICTP was remarkably higher: mean value 3.93 ng/ml vs 2.72 ng/ml, p = 0.004 (two‐sided Student's t‐test). No changes in bone formation indices were observed during the follow‐up period, while urinary calcium excretion increased significantly from 0.065 to 0.191 mg/mg creatinine (p = 0.0014) (repeated measures ANOVA). A significant BMD improvement was also detected after an average ERT period of 4.5 years: Z‐score increased from −0.81 to −0.56 (p = 0.005) (two‐sided Student's t‐test). These data evidenced the ineffectiveness of the biochemical markers used in monitoring ERT efficacy in GD I skeletal involvement, whereas DEXA was demonstrated to be a reliable method with which to follow up BMD improvement.
Benzoate treatment and the glycine index in nonketotic hyperglycinaemia
Authors: Van Hove J. L. K. , Kerckhove K. Vande , Hennermann J. B. , Mahieu V. , Declercq P. , Mertens S. , De Becker M. , Kishnani P. S. , Jaeken J.
Published: September 2005

High‐dose benzoate treatment aimed at reducing plasma glycine levels to normal reduces seizures and increases wakefulness in patients with nonketotic hyperglycinaemia (NKH). Since benzoate metabolism is dependent on the available glycine pool, and since the glycine pool is variably affected by the deficiency in the glycine cleavage enzyme system, we examined the importance of interpatient variability in benzoate requirement. To correct for the dietary glycine contribution, the glycine index was introduced as the molar requirement of benzoate dose necessary to normalize plasma glycine levels and subtracting from that the dietary glycine intake, both corrected for weight. The glycine index varied between 3.62 and 4.87 mmol/kg per day in five patients with a poor neurodevelopmental outcome and between 0.92 and 1.90 mmol/kg per day in four patients with a better neurodevelopmental outcome, and was 2.54 mmol/kg per day in a single patient with an intermediate outcome. The glycine index was stable over time within each patient. Exceeding the balance by either increasing food glycine intake or decreasing the benzoate dose resulted in increased glycine levels. Exceeding the glycine tolerance by increasing benzoate resulted in elevated and toxic levels of benzoate. The glycine index is a stable, individually specific parameter in patients with NKH. It has clinical consequences for the dose of benzoate required and the role of dietary management. Through its correlation with neurodevelopmental outcome, the glycine index points to potential genetic factors that could contribute to the psychomotor retardation in NKH.
The ratio of α‐galactosidase to β‐glucuronidase activities in dried blood for the identification of female Fabry disease patients
Authors: Lukacs Z. , Keil A. , Kohlschütter A. , Beck M. , Mengel E.
Published: September 2005

Female heterozygous patients with Fabry disease are difficult to identify because of the relatively high residual activity of α‐galactosidase. We systematically evaluated the activities of various lysosomal enzymes in dried blood samples from Fabry patients and found that the β‐glucuronidase activity was frequently elevated. The ratio of α‐galactosidase to β‐glucuronidase proved to be a helpful tool for the diagnosis of female Fabry disease patients.
Acute encephalopathy associated with influenza virus infection in a patient with hyperprolinaemia type II
Authors: Kato Y. , Ihara K. , Miyako K. , Kuhara T. , Inoue Y. , Hara T.
Published: September 2005

We report a 4‐year‐old boy with hyperprolinaemia type II presenting acute encephalopathy associated with influenza virus type A infection. This case suggests that hyperprolinaemia may cause acute encephalopathy under certain conditions.
Ornithine aminotransferase deficiency: Diagnostic difficulties in neonatal presentation
Authors: Cleary M. A. , Dorland L. , de Koning T. J. , Poll‐The B. T. , Duran M. , Mandell R. , Shih V. E. , Berger R. , Olpin S. E. , Besley G. T. N.
Published: September 2005

We describe two unrelated cases of ornithine aminotransferase (OAT) deficiency with rare neonatal presentation of hyperammonaemia. The diagnosis in the neonatal presentation of OAT deficiency is hampered as hyperornithinaemia is absent. Enzyme and mutation studies confirmed the diagnosis. OAT deficiency should be included in differential diagnosis of neonatal hyperammonaemia.
Biochemical characteristics and increased tetraglucoside excretion in patients with phosphorylase kinase deficiency
Authors: Morava E. , Wortmann S. B. , van Essen H. Zweers , van Sambeek R. Liebrand , Wevers R. , van Diggelen O. P.
Published: September 2005

Patients with glycogen storage disease type IXa present with infantile hepatomegaly and a specific growth pattern, and variable biochemical alterations in blood. We studied the clinical and biochemical characteristics including the urinary oligosaccharide excretion of seven unrelated children. The urinary tetraglucoside excretion was increased in four children, three of whom had persistently high cholesterol and triglyceride concentrations. We propose screening for urine tetraglucoside excretion and the measurement of serum cholesterol in patients with growth delay and/or hepatomegaly to assess a possible glycogenosis.
A new fluorimetric enzyme assay for the diagnosis of Niemann–Pick A/B, with specificity of natural sphingomyelinase substrate
Authors: van Diggelen O. P. , Voznyi Ya. V. , Keulemans J. L. M. , Schoonderwoerd K. , Ledvinova J. , Mengel E. , Zschiesche M. , Santer R. , Harzer K.
Published: September 2005

6‐Hexadecanoylamino‐4‐methylumbelliferylphosphorylcholine (HMUPC) was shown to be a specific substrate for the determination of acid (lysosomal) sphingomyelinase (ASM; gene SMPD1). Fibroblasts (n = 27) and leukocytes (n = 8) from both the A and B types of Niemann–Pick disease showed < 6% and < 10% of mean normal ASM activity, respectively. Niemann–Pick A or B” appears to be used with a very specific meaning. The Summary should be able to stand entirely alone from the text: should the use of this notation be expanded/explained more fully here in the Summary [or is the phrase “bearing the Q292K mutation” sufficient]?} patients bearing the Q292K mutation had apparently normal ASM activity with our new artificial substrate. These patients with false‐normal sphingomyelinase activity, however, could readily be detected by determining the extent of inhibition of enzymatic hydrolysis of the artificial substrate HMU‐PC by an unlabelled natural substrate, in particular lysosphingomyelin. This approach is generally applicable. Our novel assay for ASM combines the ease of a rapid and robust enzyme assay using a fluorogenic substrate with the specificity of an ASM assay using a natural substrate. Such assays are obviously more convenient to the diagnostic laboratory, since radiolabelled substrates are not required.
Rapid binding of copper(I) to folded aporusticyanin
Authors: Alcaraz Luis A. , Donaire Antonio
Published: September 2005

Kinetics of copper uptake in both oxidation states by the folded and unfolded forms of the type 1 copper protein rusticyanin have been studied. The speed of the binding of copper(I) to the folded rusticyanin is fast, and of the same order of magnitude as copper(I) uptake by the unfolded form. Thus, the binding of copper can be subsequent to the protein folding, contrary to previous proposals. Implications for the mechanism of the formation of the active holoprotein in vivo are discussed.
Recurrence after Surgery for Dupuytren’s Disease: A Randomized Trial of Two Skin Incisions
Authors: CITRON N. D. , NUNEZ V.
Published: September 2005

We studied the influence of the type of skin incision on the recurrence rate following fasciectomy for Dupuytren’s disease. Patients were randomized to a longitudinal incision closed with Z-plasties or a modified Bruner incision closed by Y–V plasties. Follow-up was for at least 2 years or until a recurrence was noted. We found no statistical difference in recurrence rate between patients having these two skin incisions and closures.
The Effect of Age and Gender upon Symptoms and Surgical Outcomes in Carpal Tunnel Syndrome
Authors: HOBBY J. L. , VENKATESH R. , MOTKUR P.
Published: September 2005

There is conflicting evidence regarding the effectiveness of carpal tunnel release in older patients. This is a prospective study which evaluates the impact of age and gender upon symptoms, self-reported disability and surgical outcome in a series of 97 patients with carpal tunnel syndrome. Symptom severity, hand function and patient satisfaction were assessed using the Boston Carpal Tunnel Questionnaire and the Patient Evaluation Measure. A statistical correlation of age and gender with symptoms, hand function and surgical outcome was performed with questionnaires administered before open carpal tunnel decompression and 6 months after surgery. Women reported greater pre-operative symptoms and disability than men, but there was no gender-related difference in surgical outcome or patient satisfaction. There was no difference in surgical outcome between patients 60 and 70 years of age and younger patients. The majority of patients over the age of 70 reported an improvement in symptoms and function, but they were less satisfied with their treatment than younger patients. Some patients had problems with persistent numbness and loss of dexterity following surgery. The outcome of carpal tunnel release in terms of improvement in the symptom and functional scores is sufficient to justify surgery in the elderly, but surgical outcomes are less predictable than in younger patients and we recommend that this is explained to them when obtaining consent for surgery.
Central Column Reconstruction Following Total Resection of a Third Metacarpal Giant Cell Tumour
Authors: LEE J. Y. L. , PHO R. W. H. , YEO D. S. C.
Published: September 2005

A wide resection of a giant cell tumour involving the entire middle metacarpal is presented. Reconstruction preserving the central column and metacarpophalangeal joint was achieved using autologous iliac crest bone as a spacer and structural support. The fibro-osseous cartilage portion of the iliac graft was used as a “hemi-joint” replacement. By using a bridging bone graft and screw to fuse the adjacent proximal phalanges of the middle and index fingers, a stable “internal syndactyly” was achieved. Although independent index and middle finger motion was sacrificed, the approach allowed wide resection for local tumour control, re-established structural integrity, preserved metacarpophalangeal joint motion and allowed early motion. The aesthetic result was also good.
International supply relationships and non‐financial performance—A comparison of U.S. and German practices
Authors: Kaufmann Lutz , Carter Craig R.
Published: September 2005

Despite the fact that the international trade of goods continues to steadily increase, international supply management for manufacturing still represents a largely under‐researched topic. These omissions in the extant literature include a lack of focus upon the factors affecting the performance outcomes of international sourcing. This article examines the antecedents of the supply management performance of international buyer–supplier relationships. It does so from the perspective of the buying organization. The authors develop an integrative framework based on game theory and exchange theory, and linked with the resource dependence approach and transaction cost theory. Specifically, the relationships between four constructs are examined: the multi‐dimensional construct of uncertainty, the game‐theoretical construct of the shadow of the future, the exchange‐theoretical construct of social bonding, and supply management performance. Based on large‐scale surveys with supply managers, the framework is tested in a cross‐national study in the U.S. and in Germany.
Bacteriemia During Mastoidectomy and/or Tympanoplasty
Authors: Keleş Erol , Kizirgil Ahmet , Kaygusuz Irfan , Karlidaĝ Turgut , Yalçin Şinasi , Alpay Hayrettin Cengiz , Demir Yavuz Selim
Published: September 2005

OBJECTIVE

To investigate the risk of bacteriemia development during surgery in patients who underwent mastoidectomy and/or tympanoplasty for chronic otitis media.

PATIENTS AND METHODS

A total of 59 patients with chronic otitis media who were undergoing tympanoplasty operation with or without mastoidectomy were enrolled in this study. Smear cultures were obtained from outer ear canal and/or middle ears of all patients before the operation. Venous blood samples were obtained before and after the operation for bacteriologic analysis. Smear cultures were also obtained from the pressure dressing material that was applied during the operation for retrieval of the outer ear canal pressure.

RESULTS

There was a 13.5% difference between the outer ear canal and/or middle ear smear cultures and ear pressure dressing smear cultures of the same case. There was no growth in the blood cultures obtained before tympanoplasty in any of the involved cases, however, in 5 (8.4%) of the culture samples obtained immediately after the tympanoplasty operation, there was bacteriemia. In the pressure dressing smear cultures obtained after the operation, 11 patients had microbial growth.

CONCLUSION

Risk of bacteriemia should be considered in the preoperative period for the patients undergoing mastoidectomy especially in patients with cardiovascular diseases, this is of importance for the dramatic consequences that might arise after the operation. We also think that bacteriemia is also one of the factors that influences graft success rate.
Benefits Resulting from 1‐and 6‐Hour Parathyroid Hormone and Calcium Levels After Thyroidectomy
Authors: Payne Richard J. , Tewfik Marc A. , Hier Michael P. , Tamilia Michael , Namara Elizabeth Mac , Young Jonathan , Black Martin J.
Published: September 2005

OBJECTIVE

Previous studies have established the efficacy of post‐thyroidectomy hypocalcemia monitoring using parathyroid hormone (PTH) and corrected calcium levels at 1 and 6 hours. The goal of this study was to measure the impact of managing patients based on the above findings with respect to: duration of hospital stays, rates of transient hypocalcemia, number of blood tests, cost savings, and discharge from the hospital as early as 8 hours post‐thyroidectomy without compromising safety.

STUDY DESIGN AND SETTING

This is a prospective study involving 95 total thyroidectomy patients using historical data as controls. The previous protocol was modified in that all blood tests ceased for patients meeting the 6‐hour critical level of PTH ≥ 28 ng/L and simultaneous corrected calcium ≥ 2.14 mmol/L (8.56 mg/dL). Furthermore, patients with 1‐hour PTH levels ≤ 8 ng/L were prophylactically treated with calcium and vitamin D supplementation.

RESULTS

This study demonstrates lower rates of transient hypocalcemia from 28% to 9% (OR = 4.13, P = 0.016), a 10‐hour reduction in mean hospital stay, and fewer blood tests (23 vs 15) for patients undergoing total thyroidectomy since the implementation of the new protocol. Furthermore, the experimental protocol resulted in an average cost savings of $766 per patient.

CONCLUSIONS

The new algorithm resulting from PTH and corrected calcium monitoring at 1 and 6 hours post‐thyroidectomy has led to significant cost savings for our institution. It has also translated into greater patient satisfaction as a result of fewer blood tests, a lower incidence of transient hypocalcemia, and significantly shorter hospital stays.
Patterns of Use of Facial Nerve Monitoring During Parotid Gland Surgery
Authors: Lowry Thomas R. , Gal Thomas J. , Brennan Joseph A.
Published: September 2005

OBJECTIVE

To determine current patterns of use of facial nerve monitoring during parotid gland surgery by otolaryngologists in the United States.

STUDY DESIGN AND SETTING

A questionnaire encompassing surgeon training background, practice setting, patterns of facial nerve monitor usage during parotid gland surgery, and history of permanent facial nerve injury or legal action resulting from parotid surgery was mailed to 3139 otolaryngologists in the United States. Associations between facial nerve monitor usage and dependent variables were examined by using the χ2 test. Magnitudes of the associations were determined from odds ratios calculated using logistic regression.

RESULTS

A 49.3% questionnaire response rate was achieved. Sixty percent of respondents who perform parotidectomy employed facial nerve monitoring some or all of the time. Respondents were 5.6 times more likely to use the monitor in practice if they used it in training and 79% more likely to use it if they performed more than 10 parotidectomies per year. Respondents were 35% less likely to have a history of inadvertent nerve injury if they performed more than 10 parotidectomies per year. Surgeons who employed monitoring in their practice were 20.8% less likely to have a history of a parotid surgery‐associated lawsuit. Additional information regarding surgeon demographics, types of nerve monitors used, and reasons for and against monitor usage are discussed.

CONCLUSION

Permanent facial nerve paralysis after parotidectomy occurs in 0‐7% of cases. Currently, a majority of otolaryngologists in the United States are employing facial nerve monitoring during parotid surgery some or all of the time, even though no studies to date have demonstrated improved outcomes with its use. Physician training background and surgery caseload were significant factors influencing usage of facial nerve monitoring in this study.
Head Position Dependency of Induced Nystagmus to Ice‐Water Irrigation in Peripheral Vestibulopathy
Authors: Choi Byung Yoon , Koo Ja‐Won , Oh Seung Ha , Chang Sun O. , Kim Chong‐Sun
Published: September 2005

OBJECTIVE

Evaluation of head‐position dependency during the ice‐water test is essential when the test is indicated. Because ice‐water irrigation (IWI) in the prone position is frequently skipped in many laboratories, we investigated the importance of evaluating position dependency in an ice‐water test.

DESIGN AND SETTING

Twenty‐five unilateral peripheral vestibulopathy patients showing no nystagmus during warm irrigation were included. IWI was performed in supine and prone positions, and maximum slow‐phase velocity and direction of nystagmus were assessed by using video nystagmography.

RESULTS

Eleven cases showed head‐position dependency and were interpreted as hypofunctional. Fourteen cases showed no dependency, suggesting the absence of end organ function. In the latter group, 6 patients showing definite nystagmus in supine position could have been misinterpreted as hypofunctional, had it not been for prone‐position results.

CONCLUSIONS

Evaluation of head position dependency by using IWI is important in the determination of lateral semicircular canal function.
Growth and Phenotype of Low‐Density Nasal Septal Chondrocyte Monolayers
Authors: Hicks David L. , Sage August B. , Schumacher Barbara L. , Sah Robert L. , Watson Deborah
Published: September 2005

OBJECTIVE

To analyze the growth patterns and differentiation of human septal chondrocyte monolayers of different seeding densities.

STUDY DESIGN

Chondrocytes from 8 donors were plated at densities ranging from 20,000 cells/cm2 (high density) to 300 cells/cm2 (very low density). Confluency, cellularity, and glycosaminoglycan content were determined from days 1 to 15.

RESULTS

Confluency was attained at 5.8, 8.3, 11.0, and 14.8 days for high‐, intermediate‐, low‐, and very low‐density monolayers, respectively (P >0.001). Regression growth curves showed typical lag, logarithmic, and stationary phases. Confluent monolayers attained similar cellularity (power = 0.94) and differentiation (power = 0.88), regardless of initial density.

CONCLUSIONS

Human septal chondrocyte monolayers reach confluency from very low initial densities. Growth patterns, cellularity, and differentiation are similar to other starting densities.

SIGNIFICANCE

Very low‐density monolayers expanded cell number 838‐fold in 1 passage and therefore are sufficient for tissue‐engineering purposes. This is important because of the requirement of maintaining differentiation and the limitation of small tissue harvest specimens.
Airway Reconstruction in Pediatric Burn Patients
Authors: White David R. , Preciado Diego A. , Stamper Becky , Willging J. Paul , Myer Charles M. , Cotton Robin T. , Rutter Michael J.
Published: September 2005

OBJECTIVE

Reconstruction of the laryngotracheal airway in pediatric burn victims has been described anecdotally as less successful than reconstruction performed in other populations. To evaluate this clinical impression, outcomes of laryngotracheal reconstruction (LTR) in pediatric burn victims were compared with a randomly selected, matched control population of children receiving LTR.

DESIGN

Retrospective case control study.

SUBJECTS

The records of 34 pediatric burn victims undergoing LTR were reviewed. A control group of 48 children undergoing LTR for acquired stenosis was randomly selected from a population matched for age and grade of stenosis.

RESULTS

Decannulation rate after 1st procedure, number of open airway procedures required, and length of time after 1st procedure until decannulation were not significantly different between the 2 groups. Two deaths (both tracheostomy tube related) occurred in the burn group; 1 occurred in the control group. Two patients in the burn group and 3 patients in the control group remain tracheostomy tube dependent at least 1 year after the initial reconstructive attempt.

CONCLUSIONS

Long‐term outcomes of LTR in burn patients are not significantly different from outcomes of LTR in the pediatric acquired airway stenosis population.
Combined Open Septorhinoplasty and Functional Endoscopic Sinus Surgery
Authors: Lee Jonathan H. , Sherris David A. , Moore Eric J. , Lee Jonathan H. , Sherris David A. , Moore Eric J.
Published: September 2005

OBJECTIVE

To compare perioperative and early postoperative complication rates of performing open septorhinoplasty (OSR) and functional endoscopic sinus surgery (FESS) concomitantly or individually.

STUDY DESIGN AND SETTING

Retrospective chart review of 55 patients treated at an academic referral center who had undergone combined OSR and FESS. Complication rates for the combined procedures were compared with published complication rates for the individual procedures.

RESULTS

Patients’ ages ranged from 14 to 77 years (average, 43 years). Among the 55 cases, there were no major complications and 6 (11%) minor complications: 4 cases of cellulitis (7%; previously published risk, 1%‐3%) and 2 cases of postoperative epistaxis (4%).

CONCLUSION

OSR and FESS may be performed safely in combination without a clinically significant increased risk of complications.

SIGNIFICANCE

The slightly increased risk of cellulitis may warrant the use of intraoperative sinus irrigation and postoperative antibiotic prophylaxis after combined OSR and FESS.
Pediatric Invasive Fungal Rhinosinusitis in Immunocompromised Children With Cancer
Authors: Park Albert H. , Muntz Harlan R. , Smith Marshall E. , Afify Zeinab , Pysher Theodore , Pavia Andrew
Published: September 2005

OBJECTIVES

1) To determine the factors that predispose towards invasive fungal rhinosinusitis (FS) in immunocompromised children with cancer, and 2) to propose practice guidelines for management of pediatric FS in immunocompromised patients.

METHODS

Retrospective chart review of 9 patients who developed invasive FS compared to 8 patients who did not develop invasive FS during the study period. Presenting signs and symptoms, nasal endoscopic findings, radiographs, laboratory studies, histologic and microscopic samples, and outcomes were compared.

RESULTS

Seventeen consecutive pediatric immunocompromised patients with hematologic and lymphoid neoplasms underwent nasal endoscopy and biopsy for possible FS. Nine patients were diagnosed with 10 episodes of FS; 1 patient developed FS with different organisms on 2 separate occasions separated by 6 months; 8 patients were not diagnosed with FS. Eight patients had acute myelogenous leukemia (AML); 6 patients had acute lymphoblastic leukemia (ALL); 1 patient had Burkitt's lymphoma, 1 patient had undifferentiated leukemia; and 1 patient had biphenotypic acute leukemia. All patients with FS had an absolute neutrophil count (ANC) 600 or less (range 0‐600). All patients with FS had either persistent fevers or sinus symptoms (facial pain, nasal congestion, rhinorrhea). Sinus CT scans were abnormal in all patients with FS and without FS. Two patients with FS had maxillary sinus retention cysts. Operative endoscopic findings were helpful diagnostically when necrosis or ulceration was found. All patients in the non‐FS group normalized their ANCs; 2 of the 9 patients in the FS group did not normalize their ANC. These 2 patients died from disseminated FS or from complications due to their immunosuppression.

CONCLUSION/SIGNIFICANCE

All patients with FS had either persistent fevers or symptoms localized to the sinuses (facial pain, nasal congestion, or rhinorrhea). Endoscopic examination was helpful when necrosis was detected. We recommend directed biopsies of suspicious lesions, the middle and inferior turbinate, in immunocompromised, neutropenic pediatric patients with cancer who present with either persistent fevers or localizing symptoms to the sinuses. We favor the use of “rush” biopsies over frozen sections because of the better‐quality sections and ability to perform appropriate stains.
Efficacy of Vestibular Rehabilitation Therapy in Reducing Falls
Authors: Macias John D. , Massingale Shelly , Gerkin Richard D.
Published: September 2005

OBJECTIVE

To assess the short‐term effectiveness of vestibular rehabilitation therapy in reducing fall risk in an at‐risk population.

STUDY DESIGN AND SETTING

Retrospective chart review of 70 patients older than 50 years of age at risk for falls treated at a tertiary vestibular therapy center. Fall risk was assessed by the Berg balance test.

RESULTS

Vestibular rehabilitation therapy resulted in a statistically significant improvement in Berg balance test scores (pretherapy, 36.8, to posttherapy, 46.4). Referring diagnosis, age, and gender had no impact on outcome.

CONCLUSION

Vestibular rehabilitation therapy significantly reduces the risk of falls in elderly at‐risk patients with improvement measured at the termination of therapy.

SIGNIFICANCE

Vestibular rehabilitation therapy plays an important preventive role in reducing falls in at‐risk elderly patients, with beneficial effects seen at termination of therapy. © 2005 American Academy of Otolaryngology‐Head and Neck Surgery Foundation, Inc. All rights reserved.
Auramine Orange Stain With Fluorescence Microscopy is a Rapid and Sensitive Technique for the Detection of Cervical Lymphadenitis Due to Mycobacterial Infection Using Fine Needle Aspiration Cytology: A Case Series
Authors: Cheng Alan G. , Chang Anthony , Farwell D. Greg , Agoff S. Nicholas
Published: September 2005

OBJECTIVE

We sought to evaluate the effectiveness of the auramine orange (AO) stain in diagnosing mycobacterial cervical adenitis (MCA) from fine needle aspiration (FNA) cytology. METHODS: A retrospective review of 19 patients evaluated at 2 urban hospitals from 2000 to 2003 for suspected MCA. FNA specimens were inoculated to culture media and had direct smears stained by the auramine acid fast method.

RESULTS

Mycobacteria were identified in 16 (84.2%) of 19 AO‐stained FNA specimens, with results available within 4 hours. Corresponding cultures were positive for mycobacteria in 12 specimens, 9 tuberculous and 3 nontuberculous, and grew Mycobacterium tuberculosis from the 3 AO‐negative specimens. Three of the 4 patients with negative cultures had previously taken anti‐mycobacterial medications.

CONCLUSION

The AO stain with fluorescence microscopy is a sensitive and rapid method for detecting tuberculous and nontuberculous mycobacteria. It is a valuable tool for the otolaryngologists and pathologists in the diagnosis of MCA. © 2005 American Academy of Otolaryngology‐Head and Neck Surgery Foundation, Inc. All rights reserved.
Rotational Chair (ROTO) Instead of Electronystagmography (ENG) as the Primary Vestibular Test
Authors: Arriaga Moisés A. , Chen Douglas A. , Cenci Kathleen A.
Published: September 2005

OBJECTIVES

To compare the sensitivity of rotational chair (ROTO) versus electronystagmography (ENG) in peripheral vestibular pathology.

METHODS

Retrospective chart review.

RESULTS

One thousand consecutive patients undergoing evaluation for dizziness and imbalance at a tertiary care referral balance center were reviewed. ROTO was the primary vestibular study used in all patients with ENG used as a confirmatory test at the discretion of the treating physician. A subgroup of 478 patients underwent both ROTO and ENG. Among the patients diagnosed with peripheral vestibulopathy, sensitivity for peripheral vestibulopathy was 71% for ROTO and 31% for ENG. However, specificity was 54% for ROTO and 86% for ENG.

CONCLUSIONS

We conclude that in this retrospective cohort with the authors’ clinical diagnoses, ROTO is a more sensitive diagnostic study of peripheral vestibular pathology. The higher sensitivity of ROTO and the higher specificity of ENG may support the use of ROTO as the primary vestibular study and ENG as a supplemental vestibular study. Prospective analysis with distinct diagnostic criteria and defined inclusion criteria are necessary before these results can be widely extrapolated.
Cost‐Utility Analysis of Tympanomastoidectomy for Adults with Chronic Suppurative Otitis Media
Authors: Wang Pa‐Chun , Jang Chul‐Ho , Shu Yu‐Hsiang , Tai Chih‐Jaan , Chu Ko‐Tsung
Published: September 2005

OBJECTIVE

To undertake cost‐utility analysis for tympanomastoid surgery to analyze its cost‐effectiveness in treating adult chronic suppurative otitis media (CSOM).

METHODS

Seventy‐seven patients with CSOM were evaluated with the Chronic Ear Survey (CES) before and 1 year after tympanomastoid surgery. Direct health care cost data during the 1st year after operation were retrieved. The utility gain was defined as change in the CES total score. The cost‐utility ratio (CUR) was defined as cost per utility gain. Patients were stratified by disease type into wet‐ear and dry‐ear groups.

RESULTS

The average total direct cost attributable to tympanomastoid surgery is (in New Taiwan dollars [NT$]) 45,716.3 in the 1st postoperative year, and the average CUR is NT$ 1850.9. The lower CUR of NT$ 1280.9 for the wet‐ear group is due to the greater utility gain (37.6 ± 3.4 versus 24.4 ± 6.8, P >0.05) despite its higher cost (NT$ 48,163.2 versus NT$ 38,419.7, P >0.05).

CONCLUSIONS

Treating continuously or intermittently draining ears is more cost‐effective, as compared with managing a quiescent infection, because of its favorable utility gain.
Does Successful Segmental Tracheal Resection Require Releasing Maneuvers?
Authors: Merati Albert L. , Rieder Anthony A. , Patel Nalin , Park Debra L. , Girod Doug
Published: September 2005

OBJECTIVES

Tracheal resection is a well‐established option for the management of airway stenosis. Releasing maneuvers have been described to reduce anastomotic tension. The aim of this study is to report on a series of tracheal resections performed without the use of these maneuvers.

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary hospital.

METHODS

All patients undergoing tracheal resection by the first author over a 6‐year period were reviewed.

RESULTS

Patients (n = 17; 7 men and 10 women, ages 23‐76) were managed with tracheal resection and anastomosis without stenting or postoperative tracheotomy. 16/17 (94%) patients had successful treatment of their stenosis. 1/17 (6%) failed and 1/17 (6%) required dilation. There was no postoperative swallowing dysfunction.

CONCLUSIONS

Segmental tracheal resection without releasing maneuvers was successful in 16/17 (94%) patients.

SIGNIFICANCE

Though extrapolation from this series may be limited, future practitioners may consider forgoing additional releasing maneuvers for tracheal resection in many cases. © 2005 American Academy of Otolaryngology‐Head and Neck Surgery Foundation, Inc. All rights reserved.
Major Secretory Mucin Expression in Chronic Sinusitis
Authors: Ali Mahmoud S. , Hutton David A. , Wilson Janet A. , Pearson Jeffrey P.
Published: September 2005

OBJECTIVE

The aim of this study was to investigate mucin expression in chronic sinusitis compared to that in normal nasal mucus.

STUDY DESIGN AND SETTING

Sinus mucus samples were collected during functional endoscopic sinus surgery (FESS). The expression of 3 airway mucins, MUC2, MUC5AC, and MUC5B, was determined by ELISA.

RESULTS

The 3 mucins are expressed in chronic sinusitis and in normal nasal mucus. MUC5AC and MUC5B represent a major component in sinus mucins while MUC5B and MUC2 predominated in normal nasal mucin. In sinus mucins, upregulation of MUC5AC was associated with downregulation of MUC2 and vice versa. This inverse relationship was strengthened in the presence of nasal polyps.

CONCLUSION

At least 3 mucins are expressed at various levels in chronic sinusitis. An inverse relationship was identified between expression of MUC5AC and MUC2. Large prospective studies are required to unravel the complexities of sinus mucus in chronic sinusitis.

SIGNIFICANCE

Mucins may be used as markers for assessment of disease severity and may also help as prognostic indicators following medical or surgical treatment.
Efficacy of Thyroid Hormone Suppression for Benign Thyroid Nodules: Meta‐Analysis of Randomized Trials
Authors: Sdano Matthew T. , Falciglia Mercedes , Welge Jeffrey A. , Steward David L.
Published: September 2005

OBJECTIVE

To determine the efficacy of thyroid hormone suppressive therapy (THST) to decrease benign thyroid nodule volume.

DESIGN

Meta‐analysis.

METHODS

Systematic search using electronic databases (PubMed, Medline, Cochrane Library) through August 2004, paper review, and contacting experts and drug manufacturers. Only randomized controlled studies of THST vs no treatment or placebo, for reduction of benign thyroid nodule volume, were included. Exclusion criteria were: >6‐month treatment, lack of ultrasound volume measurement, and region of endemic goiter. Primary outcome was clinically relevant nodule volume reduction (>50%), with a random effects model (RevMan4.2).

RESULTS

Nine randomized trials were included (609 subjects). Subjects were 88% more likely to experience >50% nodule volume reduction with THST than placebo or no treatment (relative risk = 1.88; 95% CI = 1.18‐3.01; P = 0.008). However, 8 subjects must be subjected to the risk of cardiac and skeletal side effects from THST, for one to benefit from therapy (number needed to treat = 8, risk difference = 0.13; 95% CI = 0.06‐0.19; P = 0.0003). Sensitivity analysis reveals that 15 null studies would have to have been missed to reverse statistical significance (fail‐safe N = 15). Review of the only study with long‐term treatment (5 years) suggests no significant difference in nodule volume reduction between THST and placebo. Further, studies with follow‐up after THST withdrawal demonstrate rapid increase in thyroid nodule and goiter volumes.

CONCLUSION

THST appears more likely than placebo or no treatment to significantly reduce benign thyroid nodule volume, but long‐term treatment may be less effective and regrowth is likely following cessation of therapy. Given the risks of THST, routine use is not recommended for benign nodules.
Environmental factors on the SARS epidemic: air temperature, passage of time and multiplicative effect of hospital infection
Authors: LIN KUN , YEE-TAK FONG DANIEL , ZHU BILIU , KARLBERG JOHAN
Published: September 2005

The study sought to identify factors involved in the emergence, prevention and elimination of severe acute respiratory syndrome (SARS) in Hong Kong during 11 March to 22 May 2003. A structured multiphase regression analysis was used to estimate the potential effects of weather, time and interaction effect of hospital infection. In days with a lower air temperature during the epidemic, the risk of increased daily incidence of SARS was 18·18-fold (95% confidence interval 5·6–58·8) higher than in days with a higher temperature. The total daily new cases might naturally decrease by an average of 2·8 patients for every 10 days during the epidemic. The multiplicative effect of infected hospital staff with patients in an intensive care unit (ICU) and the proportion of SARS patients in ICUs might respectively increase the risk of a larger SARS epidemic in the community. The provision of protective gear in hospitals was also a very important factor for the prevention of SARS infection. SARS transmission appeared to be dependent on seasonal temperature changes and the multiplicative effect of hospital infection. SARS also appeared to retreat naturally over time.
Differentiation between serological responses to Brucella suis and Yersinia enterocolitica serotype O[ratio ]9 after natural or experimental infection in pigs
Authors: JUNGERSEN G. , SØRENSEN V. , GIESE S. B. , STACK J. A. , RIBER U.
Published: September 2005

False-positive serological reactions (FPSR) due to infections with Yersinia enterocolitica serotype O[ratio ]9 (YeO[ratio ]9) are a problem in tests for brucellosis. In the present study, FPSR in classical and novel tests for brucellosis following experimental infections of pigs with YeO[ratio ]9 were compared with responses of B. suis biovar 2-inoculated pigs. FPSR were limited to 2–9 weeks post-YeO[ratio ]9 inoculation, while B. suis-infected pigs were test-positive throughout the 21-week period of investigation. Although YeO[ratio ]9-inoculated pigs exhibited FPSR in Brucella tests for a limited period of time, the serological responses in a YeO[ratio ]9-purified O-antigen indirect ELISA did not decrease accordingly. Analysis of available cross-sectional serum samples from pig herds naturally infected with YeO[ratio ]9 or B. suis biovar 2 confirmed that the observed difference in the duration of the serological responses between the two infections could be used to discriminate between herds infected with B. suis biovar 2 and YeO[ratio ]9.
Surface displacements and source parameters of the 2003 Bam (Iran) earthquake from Envisat advanced synthetic aperture radar imagery
Authors: Funning Gareth J. , Parsons Barry , Wright Tim J. , Jackson James A. , Fielding Eric J.
Published: September 2005

The Mw 6.6, 26 December 2003 Bam (Iran) earthquake was one of the first earthquakes for which Envisat advanced synthetic aperture radar (ASAR) data were available. Using interferograms and azimuth offsets from ascending and descending tracks, we construct a three‐dimensional displacement field of the deformation due to the earthquake. Elastic dislocation modeling shows that the observed deformation pattern cannot be explained by slip on a single planar fault, which significantly underestimates eastward and upward motions SE of Bam. We find that the deformation pattern observed can be best explained by slip on two subparallel faults. Eighty‐five percent of moment release occurred on a previously unknown strike‐slip fault running into the center of Bam, with peak slip of over 2 m occurring at a depth of ∼5 km. The remainder occurred as a combination of strike‐slip and thrusting motion on a southward extension of the previously mapped Bam Fault ∼5 km to the east.
Variability of the net air–sea CO2 flux inferred from shipboard and satellite measurements in the Southern Ocean south of Tasmania and New Zealand
Authors: Rangama Y. , Boutin J. , Etcheto J. , Merlivat L. , Takahashi T. , Delille B. , Frankignoulle M. , Bakker D. C. E.
Published: September 2005

We determine the distribution of oceanic CO2 partial pressure (pCO2) with respect to remotely sensed parameters (sea surface temperature (SST) and chlorophyll (Chl)) in order to gain an understanding of the small‐scale (10–100 km) pCO2 variability and to estimate the net air–sea CO2 flux in the region (125°E–205°E; 45°S–60°S), which represents 22% of the Southern Ocean area between 45°S and 60°S. We split the study area into several biogeochemical provinces. In chlorophyll‐poor regions, pCO2 is negatively correlated with SST, indicating that pCO2 is mostly controlled by mixing processes. For Chl > 0.37 mg m−3, pCO2 is negatively correlated with Chl, indicating that pCO2 variability is mostly controlled by carbon fixation by biological activity. We deduce fields of pCO2 and of air–sea CO2 fluxes from satellite parameters using pCO2‐SST, pCO2‐chlorophyll relationships and air–sea gas exchange coefficient, K, from satellite wind speed. We estimate an oceanic CO2 sink from December 1997 to December 1998 of −0.08 GtC yr−1 with an error of 0.03 GtC yr−1. This sink is approximately 38% smaller than that computed from the Takahashi et al. (2002) climatological distribution of ΔpCO2 for the 1995 year but with the same K (−0.13 GtC yr−1). When we correct ocean pCO2 for the interannual variability between 1995 and 1998, the difference is even larger, and we cannot reconcile both estimates in February–March and from June to November. This strengthens the need of new in situ measurements for validating extrapolation methods and for improving knowledge of interannual pCO2 variability.