bluuebunny/crossref_metadata_2025 huggingface dataset:
Reduced Skeletal Muscle Capillarization and Glucose Intolerance
Authors: PRIOR STEVEN J. , MCKENZIE MICHAEL J. , JOSEPH LYNDON J. , IVEY FREDERICK M. , MACKO RICHARD F. , HAFER‐MACKO CHARLENE E. , RYAN ALICE S.
Published: February 2009

Objective: Reduced capillarization in hemiparetic skeletal muscle of chronic stroke patients can limit insulin, glucose, and oxygen supply to muscle, thereby contributing to impaired glucose metabolism and cardiovascular deconditioning. We hypothesized that compared to sedentary controls, stroke subjects have reduced skeletal muscle capillarization that is associated with glucose intolerance and reduced peak oxygen consumption (Vo2peak). Methods: Twelve chronic stroke subjects (ages, 62.1±2.8 years), and matched sedentary controls with impaired (n=12) or normal (n=12) glucose tolerance underwent oral glucose tolerance tests, exercise tests, and vastus lateralis biopsies. Results: Stroke subjects had lower capillarization in hemiparetic muscle than in nonparetic muscle and normal glucose tolerant controls (∼22 and ∼28%, respectively; P<0.05) and had similar bilateral capillarization, compared to controls with impaired glucose tolerance. Capillary density in hemiparetic muscle inversely correlated with 120‐minute glucose (r=−0.70, P<0.01) and glucose area under the curve (r=−0.78, P<0.01). Vo2peak was ∼40% lower in stroke subjects, compared to controls (P<0.001), but did not correlate with capillarization (P=n.s.). Conclusions: Hemiparetic muscle capillarization is reduced after stroke, and reduced capillarization is associated with glucose intolerance in stroke and control subjects. Interventions to increase skeletal muscle capillarization may prove beneficial for improving glucose metabolism in chronic stroke patients.
Impact of Arteriogenesis in Plastic Surgery: Choke Vessel Growth Proceeds via Arteriogenic Mechanisms in the Rat Dorsal Island Skin Flap
Authors: WILLIAMS BLAIR A. , CURRIE R. WILLIAM , MORRIS STEVEN F.
Published: February 2009

Objective: We examined the molecular mediators of postoperative choke‐vessel growth. Our focus was the possible overlap between choke‐vessel growth and arteriogenesis.

Methods: A rat perforator flap model, encompassing four vascular territories, was used. Flaps were surgically elevated, re‐inset, and allowed to survive for one, three, five, or seven days. Tissue samples for Western and histological analyses were collected from the choke zone along the dorsal midline. Tissue from territories linked by the choke zone was analyzed to distinguish between global and local effects. The proteins examined included CD11b, ICAM‐1, and MMP‐2, three markers associated with arteriogenesis, as well as Hsp70 and vascular endothelial growth factor, markers of physiological stress and hypoxia/ischemia.

Results: Arteriogenesis markers, as shown by Western analysis, increased at three and five days after flap elevation, and the increase was localized by immunohistochemistry to the growing arteries and veins. The marker of physiological stress increased at Days 5 and 7. The hypoxia‐ischemia marker did not increase in the choke zone.

Conclusions: The growth of choke arteries and veins proceeds in an inflammatory environment that resembles arteriogenesis. Ischemia did not appear to play a role in choke‐vessel changes.
Exoskeleton‐Based Robotic Platform Applied in Biomechanical Modelling of the Human Upper Limb
Authors: Ruiz Andres F. , Rocon Eduardo , Forner-Cordero Arturo
Published: February 2009

One of the approaches to study the human motor system, and specifically the motor strategies implied during postural tasks of the upper limbs, is to manipulate the mechanical conditions of each joint of the upper limbs independently. At the same time, it is essential to pick up biomechanical signals and bio‐potentials generated while the human motor system adapts to the new condition. The aim of this paper is two‐fold: first, to describe the design, development and validation of an experimental platform designed to modify or perturb the mechanics of human movement, and simultaneously acquire, process, display and quantify bioelectric and biomechanical signals; second, to characterise the dynamics of the elbow joint during postural control. A main goal of the study was to determine the feasibility of estimating human elbow joint dynamics using EMG‐data during maintained posture. In particular, the experimental robotic platform provides data to correlate electromyographic (EMG) activity, kinetics and kinematics information from the upper limb motion. The platform aims consists of an upper limb powered exoskeleton, an EMG acquisition module, a control unit and a software system. Important concerns of the platform such as dependability and safety were addressed in the development. The platform was evaluated with 4 subjects to identify, using system identification methods, the human joint dynamics, i.e. visco‐elasticity. Results obtained in simulations and experimental phase are introduced.
Necessary but Not Sufficient: A Comparison of Surveillance Definitions of Clostridium difficile–Associated Diarrhea
Authors: Fraser Thomas G. , Fatica Cynthia , Gordon Steven M.
Published: February 2009

In this article, we describe our comparison of the Cleveland Clinic surveillance definition of Clostridium difficile–associated diarrhe and the definition mandated by the Ohio Department of Health. We found the definitions to be concordant only 71% of the time; the Ohio Department of Health definition identified 278 of the 391 cases identified by the Cleveland Clinic definition. Surveillance definitions mandated by the Ohio Department of Health overrepresented the number of cases attributable to nosocomial transmission at our institution.
Prompt ignition of a unipolar arc on helium irradiated tungsten
Authors: Kajita Shin , Takamura Shuichi , Ohno Noriyasu
Published: February 2009

A fibreform nanostructured layer is formed on a tungsten surface by helium plasma bombardment. The helium fluence was of the order of 1026 m−2, and the surface temperature and incident ion energy during helium irradiation were, respectively, 1900 K and 75 eV. By irradiating a laser pulse to the surface in the plasma, a unipolar arc, which many people have tried to verify in well-defined experiments, is promptly initiated and continued for a much longer time than the laser pulse width. The laser pulse width (∼0.6 ms) and power (∼5 MJ m−2) are similar to the heat load accompanied by type-I edge localized modes (ELMs) in ITER. The unipolar arc is verified from an increase in the floating potential, a moving arc spot detected by a fast camera and arcing traces on the surface. This result suggests that the nanostructure on the tungsten surface formed by the bombardment of helium, which is a fusion product, could significantly change the ignition property of arcing, and ELMs become a trigger of unipolar arcing, which would be a great impurity source in fusion devices.
Modelling resistive wall modes in ITER with self-consistent inclusion of drift kinetic resonances
Authors: Liu Yueqiang , Chu M.S. , Chapman I.T. , Hender T.C.
Published: February 2009

We investigate drift kinetic effects on the resistive wall mode (RWM) stability in ITER plasmas, due to the mode resonance with magnetic precession drifts and/or bounce motion of bulk plasma thermal particles. A toroidal drift kinetic model is self-consistently incorporated into the MHD formulation. Self-consistent simulations using the hybrid kinetic-MHD code MARS-K (Y.Q. Liu et al 2008 Phys. Plasmas
15 112503) predict a parameter space for ITER steady-state plasmas, where the RWM is fully stabilized by the drift kinetic effects combined with the toroidal plasma flow. A wider stable parameter space is predicted by the perturbative approach based on the ideal kink mode or the fluid RWM eigenfunction. The difference is attributed primarily to the self-consistent determination of the mode eigenvalue in the non-perturbative approach.
Local Hawking temperature for dynamical black holes
Authors: Hayward S A , Criscienzo R Di , Nadalini M , Vanzo L , Zerbini S
Published: February 2009

A local Hawking temperature is derived for any future outer trapping horizon in spherical symmetry, using a Hamilton–Jacobi variant of the Parikh–Wilczek tunneling method. It is given by a dynamical surface gravity as defined geometrically. The operational meaning of the temperature is that Kodama observers just outside the horizon measure an invariantly redshifted temperature, diverging at the horizon itself. In static, asymptotically flat cases, the Hawking temperature as usually defined by the Killing vector agrees in standard cases, but generally differs by a relative redshift factor between the horizon and infinity, this being the temperature measured by static observers at infinity. Likewise, the geometrical surface gravity reduces to the Newtonian surface gravity in the Newtonian limit, while the Killing definition instead reflects measurements at infinity. This may resolve a long-standing puzzle concerning the Hawking temperature for the extremal limit of the charged stringy black hole, namely that it is the local temperature which vanishes. In general, this confirms the quasi-stationary picture of black-hole evaporation in early stages. However, the geometrical surface gravity is generally not the surface gravity of a static black hole with the same parameters.
Functional Interactions between Sphingolipids and Sterols in Biological Membranes Regulating Cell Physiology
Authors: Guan Xue Li , Souza Cleiton M. , Pichler Harald , Dewhurst Gisèle , Schaad Olivier , Kajiwara Kentaro , Wakabayashi Hirotomo , Ivanova Tanya , Castillon Guillaume A. , Piccolis Manuele , Abe Fumiyoshi , Loewith Robbie , Funato Kouichi , Wenk Markus R. , Riezman Howard
Published: February 2009

Sterols and sphingolipids are limited to eukaryotic cells, and their interaction has been proposed to favor formation of lipid microdomains. Although there is abundant biophysical evidence demonstrating their interaction in simple systems, convincing evidence is lacking to show that they function together in cells. Using lipid analysis by mass spectrometry and a genetic approach on mutants in sterol metabolism, we show that cells adjust their membrane composition in response to mutant sterol structures preferentially by changing their sphingolipid composition. Systematic combination of mutations in sterol biosynthesis with mutants in sphingolipid hydroxylation and head group turnover give a large number of synthetic and suppression phenotypes. Our unbiased approach provides compelling evidence that sterols and sphingolipids function together in cells. We were not able to correlate any cellular phenotype we measured with plasma membrane fluidity as measured using fluorescence anisotropy. This questions whether the increase in liquid order phases that can be induced by sterol–sphingolipid interactions plays an important role in cells. Our data revealing that cells have a mechanism to sense the quality of their membrane sterol composition has led us to suggest that proteins might recognize sterol–sphingolipid complexes and to hypothesize the coevolution of sterols and sphingolipids.
gcExplorer: interactive exploration of gene clusters
Authors: Scharl Theresa , Leisch Friedrich
Published: February 2009

Summary: Cluster analysis plays an important role in the analysis of gene expression data since the early beginning of microarray studies and is routinely used to find groups of genes with common expression pattern. In order to make cluster analysis helpful for users, visualization of cluster solutions is of utmost importance. Here, we present the new R package gcExplorer for the interactive exploration of gene clusters. gcExplorer facilitates the interpretation of cluster results and allows to investigate extensive information about clusters.

Availability: The latest release of gcExplorer is always available at the Comprehensive R Archive Network CRAN: http://cran.R-project.org/package=gcExplorer. See the README file in the package for detailed installation instructions.

Contact:  theresa.scharl@ci.tuwien.ac.at

Supplementary information:  Supplementary data are available at Bioinformatics online.
Cell therapy generates a favourable chemokine gradient for stem cell recruitment into the infarcted heart in rabbits
Authors: Lee Bai‐Chin , Hsu Hsiu‐Ching , Tseng Wen‐Yih I. , Chen Ching‐Yi , Lin Hung‐Ju , Ho Yi‐Lwun , Su Ming‐Jai , Chen Ming‐Fong
Published: February 2009

Aims

Stem cell recruitment into the heart is determined by a concentration gradient of stromal‐derived factor 1 (SDF‐1) from bone marrow to peripheral blood and from blood to injured myocardium. However, this gradient is decreased in chronic myocardial infarction (MI). This study evaluated the effect of cell therapy using bone marrow stromal cells (BMSCs) on an SDF‐1 gradient in post‐infarction rabbits.

Methods and results

Myocardial infarction was induced in male New Zealand white rabbits (2.5–3 kg) by ligation of the left anterior descending coronary artery. Two months later, the rabbits were randomized to either saline or BMSC (2 × 106 autologous BMSCs injected into the left ventricular cavity) treatment. Four weeks after therapy, the SDF‐1 gradients from bone marrow to blood and from blood to myocardium increased in the BMSC group compared with the saline group. This was accompanied by an increase in cells positive for CD34, CD117, and STRO‐1 in the myocardium, resulting in more capillary density, better cardiac function, and a decrease in infarct size.

Conclusion

Generation of an SDF‐1 gradient towards the heart is a novel effect of BMSC‐based cell therapy. This effect facilitates stem cell recruitment into remodelled myocardium and supports improvement in cardiac function.
European cardiac resynchronization therapy survey: rationale and design
Authors:   The CRT Survey Scientific Committee
Published: February 2009

Aims

The European cardiac resynchronization therapy (CRT) Survey is a joint initiative taken by the Heart Failure Association (HFA) and European Heart Rhythm Association (EHRA) of the European Society of Cardiology. The primary objective is to describe the current European practice and routines associated with CRT/CRT‐D implantations based on a wide range of sampling in 13 countries.

Methods and results

The data collected should provide useful information, including demographics and clinical characteristics, diagnostic criteria, implantation routines and techniques, short‐term outcomes, adverse experience, and assessment of adherence to guideline recommendations.
Simulation-based management strategy evaluation: ignorance disguised as mathematics?
Authors: Rochet Marie-Joëlle , Rice Jake C.
Published: February 2009

Rochet, M-J. and Rice, J. C. 2009. Simulation-based management strategy evaluation: ignorance disguised as mathematics? – ICES Journal of Marine Science, 66: 754–762. Simulation-based management strategy evaluations are increasingly developed and used for science advice in support of fisheries management, along with risk evaluation and decision analysis. These methods tackle the problem of uncertainty in fisheries systems and data by modelling uncertainty in two ways. For quantities that are difficult to measure accurately or are inherently variable, variables are replaced by probability distributions, and system dynamics are simulated by Monte Carlo simulations, drawing numbers from these distributions. For processes that are not fully understood, arrays of model formulations that might underlie the observed patterns are developed, each is assumed successively, and the results of the corresponding arrays of model results are then combined. We argue that these approaches have several paradoxical features. Stochastic modelling of uncertainty is paradoxical, because it implies knowing more than deterministic approaches: to know the distribution of a quantity requires more information than only estimating its expected value. To combine the results of Monte Carlo simulations with different model formulations may be paradoxical if outcomes of concern are unlikely under some formulations but very likely under others, whereas the reported uncertainty from combined results may produce a risk level that does not occur under any plausible assumed formulation. Moreover, risk estimates of the probability of undesirable outcomes are often statements about likelihood of events that were seldom observed and lie in the tails of the simulated distributions, where the results of Monte Carlo simulation are the least reliable. These potential paradoxes lead us to suggest that greater attention be given to alternative methods to evaluate risks or management strategies, such as qualitative methods and empirical post hoc analyses.
Osteosarcomas of the Larynx
Authors: Athré Raghu S. , Vories Andrew , Mudrovich Steven , Ducic Yadranko
Published: February 2009

Objectives/Hypothesis: The objective was to review the etiology, presentation, treatment, and prognosis in patients with osteosarcoma of the larynx using an illustrative case example.

Study Design: Case report and literature review.

Methods: A case is reported, and a review of all available published cases of osteosarcoma of the larynx is presented.

Results: Osteosarcoma of the larynx may be a difficult clinical diagnosis. To be able to reach the correct diagnosis, a high index of suspicion and due diligence in obtaining deep biopsy specimens are important. Treatment is primarily surgical. Outcomes for this disease are generally poor, with most patients dying of the disease as a result of pulmonary metastasis.

Conclusion: Osteosarcoma of the larynx is a rare entity, with only 14 cases reported to date. Pathological confirmation of osteoid is required for diagnosis. It is likely that aggressive surgical intervention directed at complete tumor extirpation is the treatment of choice, although long‐term prognosis is poor.
Surface Electromyography of Continuous Drinking in Healthy Adults
Authors: Vaiman Michael , Gabriel Chaim , Eviatar Ephraim , Segal Samuel
Published: February 2009

Objectives: To give a description of normal surface electromyography (sEMG) aspects of uninterrupted (continuous) drinking and to establish normal sEMG values for swallowing 100 mL of water.

Study Design: Prospective observational study of healthy volunteers.

Subjects: Four hundred twenty apparently healthy male and female volunteers divided into three age groups (18–40, 41–65, 66+ years).

Methods: The evaluated parameters included the total duration, number of swallows, amount of water per swallow, and voltage of the EMG activity of the orbicularis oris, masseter, and submental‐submandibular muscles and the infrahyoid muscle groups covered by the m. platysma.

Results: The overall normal mean values for duration, number of swallows, and amplitude of muscle activity during continuous drinking were compiled. The age‐related increase in duration of swallows and of total drinking time was significant only in the older group (95% confidence interval, P < .05). There were no significant sex‐related differences for any age group (P ≥ .05). The mean electric activity (in μV) varied insignificantly among the age groups. The activity of the m. orbicularis oris was the least informative. An unexpectedly significant number of healthy subjects (14.25%, P < .05) performed a dry swallow after drinking.

Conclusion: The establishment of normal sEMG levels now makes this modality applicable for evaluating the swallowing mechanism among adults for potentially identifying and ruling out abnormalities. Its simplicity, noninvasiveness, and low level of discomfort also make it highly suitable for screening purposes.
Expression of Interleukin‐8 Receptor A Predicts Poor Outcome in Patients With Nasopharyngeal Carcinoma
Authors: Horikawa Toshiyuki , Kaizaki Yasuharu , Kato Hideaki , Furukawa Mitsuru , Yoshizaki Tomokazu
Published: February 2009

Objectives/Hypothesis: The authors recently demonstrated that interleukin‐8 (IL‐8) is induced by Epstein‐Barr virus encoding latent membrane protein 1 and that IL‐8 is overexpressed in tumor cells and correlates significantly with angiogenesis in nasopharyngeal carcinoma. The present objective was to investigate the expressions and the roles of IL‐8 receptors in nasopharyngeal carcinoma.

Study Design: Retrospective patient file review and immunohistochemical study of tissues of patients with nasopharyngeal carcinoma.

Methods: The authors examined the expressions of two high‐affinity IL‐8 receptors, IL‐8 receptor A (IL8RA) and IL‐8 receptor B (IL8RB), in 30 patients with nasopharyngeal carcinoma by immunohistochemical analysis.

Results: As expected, both IL‐8 receptors were expressed on microvessels in tumor nests and surrounding stroma. Interestingly, they were also abundantly expressed on tumor cells. The expressions of IL8RA and IL8RB had no associations with gender, metastasis, or clinical stage. However, the expression of IL8RA in tumors significantly correlated with a shorter overall survival rate (P = .0045). Although the estimated 5‐year overall survival rate for IL8RA‐negative patients was 68.2%, that in IL8RA‐positive patients was only 33.3%.

Conclusion: The study results suggest that the expression of IL8RA in tumor cells becomes an important indicator of poor prognosis in nasopharyngeal carcinoma.
Disequilibrium after Cochlear Implantation Caused by a Perilymph Fistula
Authors: Kusuma Shashidhar , Liou Steve , Haynes David S.
Published: February 2009

Objectives: Cochlear implantation has become a safe and effective method for the auditory rehabilitation of the profoundly hearing impaired. Incidence of disequilibrium and vertigo after cochlear implantation ranges from 13% to 74% in the literature. Most patients report resolution of these symptoms with medical therapy and vestibular rehabilitation. We present a case of persistent disequilibrium after cochlear implantation. Further workup of this patient revealed radiographic findings suggestive of a perilymphatic fistula, with immediate and complete resolution of symptoms after exploratory tympanotomy and packing around the cochleostomy.

Study Design: Case report.

Methods: A retrospective chart review of a patient with postoperative disequilibrium unresponsive to maximal medical and vestibular rehabilitation therapy.

Results: Diagnostic workup of the patient included a temporal bone computed tomography (CT) scan, which revealed air in the vestibule and the ampulla of the superior and lateral semicircular canals. After failure of 5 months of conservative therapy, the patient was taken to the operating room for middle ear exploration and repacking of the cochleostomy site. The patient reported immediate and complete resolution of vertigo postoperatively.

Conclusion: We present a case of disequilibrium as a result of an apparent perilymphatic fistula after cochlear implantation that was refractory to standard therapy. In such cases, appropriate workup should include a temporal bone CT scan to look for air in the vestibule or other abnormalities that may indicate potential etiology. Surprisingly, this patient had immediate and complete resolution of symptoms after surgery. If conservative therapy fails, middle ear exploration by way of an exploratory tympanotomy and packing of the cochleostomy with periosteum and muscle is a viable option and may lead to resolution of symptoms.
Common Clinical Features of Children With Enlarged Vestibular Aqueduct and Mondini Dysplasia
Authors: Wu Chen‐Chi , Chen Yuh‐Shyang , Chen Pei‐Jer , Hsu Chuan‐Jen
Published: February 2009

Objectives/Hypothesis: The purpose of the study was to investigate the etiological factors and the audiological data of different types of inner ear malformations, which the authors thought might be helpful in elucidating the inter‐relation among malformations and shedding light on pathogenesis.

Study Design: Retrospective study from 1998 to 2002 at a tertiary care university hospital.

Methods: One hundred sixty consecutive children with a total of 302 affected ears undergoing high‐resolution computed tomography of the temporal bone for sensorineural hearing loss were enrolled. The image results were correlated with causes and origins, hearing loss patterns, hearing levels, and audiogram configurations.

Results: Inner ear malformation was present in 114 (38%) ears. The most common malformations were enlarged vestibular aqueduct, incomplete partition of cochlea (Mondini dysplasia), large vestibule, and semicircular canal dysplasia, presenting either as isolated finding or in combination. Eighty‐four (74%) ears had abnormalities confined to these four malformations; only 30 (26%) ears showed other malformations. Patients with complex of enlarged vestibular aqueduct, Mondini dysplasia, large vestibule, and semicircular canal dysplasia (EMVS complex) demonstrated a significantly higher incidence of fluctuating hearing loss (93%) and a better hearing level compared with those with other malformations. Homogeneity in audiological features among these four malformations was also disclosed.

Conclusion: The authors identified a distinct clinical entity, the EMVS complex, which is characterized by fluctuating hearing loss and a better hearing level. The authors proposed that malformations belonging to this complex result from a common pathogenetic mechanism.
Serotonin Inputs to Laryngeal Constrictor Motoneurons in the Rat
Authors: Berkowitz Robert G. , Sun Qi‐Jian , Goodchild Ann K. , Pilowsky Paul M.
Published: February 2009

Objectives/Hypothesis: The objective was to demonstrate close appositions between serotonin‐immunoreactive boutons and laryngeal constrictor (LCon) motoneurons in Sprague‐Dawley rats.

Study Design: Animal experimental.

Methods: LCon motoneurons were identified functionally by their antidromic responses to stimulation of the recurrent laryngeal nerve and postinspiratory modulation and were filled by intracellular injection of biotin amide (n = 6). The medulla was sectioned and, using immunohistochemical analysis, examined by light microscopy.

Results: Serotonin appositions were found on all 6 LCon motoneurons, with an average number of 17 ± 6 close appositions per neuron.

Conclusion: In comparison with the authors' previous study of inspiratory laryngeal motoneurons, the number of serotonin close appositions with LCon motoneurons was similar to that found with posterior cricoarytenoid motoneurons, but significantly less than that found with cricothyroid motoneurons. This finding may represent a basis for differences in tonic activity of laryngeal muscles observed in relation to the sleep‐wake cycle.
Success of Multiple, Sequential, Free Tissue Transfers to the Head and Neck
Authors: Varvares Mark A. , Lin Derrick , Hadlock Tessa , Azzizadeh Babak , Gliklich Richard , Rounds Mark , Rocco James , Deschler Daniel G. , Fabian Richard , Cheney Mack L.
Published: February 2009

Introduction: Free tissue transfer has become the primary reconstructive modality for significant ablative defects in the head and neck. The overall success rate is high, approaching 95% in most centers. The success rate of multiple sequential free flaps has been thought to be lower, based on the absence of optimal vessel availability and the presence of significant scar tissue in the previously operated patient. We evaluated a series of patients who underwent multiple free flaps at different time points to determine the overall success rate and to identify pitfalls encountered in this population.

Methods: Retrospective review, tertiary care medical center.

Results: From 1995 to 2002, 377 free flaps were performed by our reconstructive service. Of this group, 36 underwent multiple free flaps at different time points. Thirty‐two had two flaps, and four had three flaps. Reasons for performing sequential free flap procedures were as follows: recurrent disease/new primary (18), need for further augmentation (10), failed previous flap (6), delayed mandibular reconstruction after plate fracture (2), mandibular osteoradionecrosis (3), and delayed pharyngoesophageal stenosis (1). The overall failure rate on the second and third flap was 2 of 32 and 0 of 4, respectively, with an overall success rate of 94%.

Conclusion: Multiple, sequential, free tissue transfer for reconstruction of head and neck defects is a safe and reliable procedure with success rates equal to that in patients undergoing initial free flap reconstruction. Careful preoperative planning can result in optimal outcomes even in this difficult patient population.
Nocturnal Onset and Development of Bell's Palsy
Authors: Kanoh Naoyuki , Nomura Jun , Satomi Fumio
Published: February 2009

Objective/Hypothesis: To examine the mechanism and pathophysiology of idiopathic peripheral facial palsy (Bell's palsy), the mode of onset of facial palsy was investigated.

Study Design: Retrospective case review.

Methods: We identified the point at which patients with facial palsy first noticed their illness using our medical charts for 648 patients and information from 3,580 facial palsy cases who visited an Internet site; we found that the time of a patient's first awareness of his or her illness was mentioned in 258 (204 Bell's palsy) and 53 cases, respectively. These cases were divided into three periods: morning, afternoon, and night.

Results: The ratio of morning:afternoon:night in the two groups was 141:30:33 and 50:0:3, respectively. These findings indicate that the majority of patients first noticed their palsy in the morning.

Conclusion: Because several hours are required for facial palsy to develop before becoming apparent, this suggests that the onset and development of facial palsy occurred during sleep, when circulatory dynamics are reduced. In humans, ischemia is more likely to occur and produce facial palsy than virus reactivation.
Endoscopic Measurement of Vocal Fold Movement during Adduction and Abduction
Authors: Dailey Seth H. , Kobler James B. , Hillman Robert E. , Tangrom Kittisard , Thananart Ekawudh , Mauri Marcelo , Zeitels Steven M.
Published: February 2009

Objectives/Hypothesis: Whereas vibration of the vocal folds has been analyzed and modeled in detail, less attention has been paid to quantifying the slower motions of abduction and adduction. Because these gestures reflect neuromuscular function, cartilage geometry, and joint mobility, objective measurement might improve assessment and treatment of patients with neuromuscular or structural disease.

Study Design: Prospective, observational.

Methods: Twenty‐one normal adult volunteers performed a repeated “ee‐sniff” task at three rates during flexible endoscopy. Distortion in the images was corrected and frame‐by‐frame analysis of the angle between the true vocal folds (glottic angle) yielded measures of maximum abduction angle (MAA) and mean angular velocities of abduction (MVAB) and adduction (MVAD).

Results: Reliability tests indicated interjudge variability of 3.8 degrees (deg). The mean MAA was 51 deg and ranged from 31 to 77 deg across subjects. The mean MVADs were 229, 309, and 475 deg/s for slow, medium, and fast rates, respectively, and the mean MVABs were 330, 388, and 441 deg/s for slow, medium, and fast rates, respectively. Statistical analysis showed greater influence of gesture rate on adduction than on abduction.

Conclusions: The glottic angle can be reliably measured from flexible endoscopic images and angular velocities of vocal fold abduction and adduction can be determined from analysis of sequential video frames. Accuracy is significantly enhanced by correction of distortion in the images. This approach holds promise for objective characterization of vocal fold function in patients with a variety of disorders.
Quality of Life Correlates After Surgery for Laryngeal Carcinoma
Authors: Bindewald Julian , Oeken Jens , Wollbrueck Dorit , Wulke Cornelia , Dietz Andreas , Herrmann Esther , Schwarz Reinhold , Singer Susanne
Published: February 2009

Objectives: To assess the correlation of operation mode, postoperative radiotherapy, and disease stage factors with the health‐related quality of life (HRQL) measures after surgery for laryngeal carcinoma.

Study Design: Reanalysis of data of two multi‐institutional cross‐sectional studies.

Patients and Methods: We interviewed 218 laryngectomees and 153 partial laryngectomy patients in and near Leipzig, Germany, in two cross‐sectional studies, using the general and the head‐ and neck‐specific quality of life questionnaires of the European Organization for the Research and Treatment of Cancer (EORTC QLQ‐C30 and EORTC QLQ‐H&N35). Multifactorial univariate and multivariate models were calculated, with laryngectomy vs. partial laryngectomy, radiotherapy (irradiated or not), and disease stage (International Union Against Cancer [UICC] stages I/II vs. III/IV) as influencing factors and the HRQL scales and items as dependent variables. Analyses were adjusted for the patient's age and the time elapsed since the operation.

Results: Laryngectomees were more affected in their sense of smell (P ≤ .000). Among irradiated patients, functioning levels and many symptom scales showed worse results (P ≤ .05). Both operation mode and postoperative radiotherapy were independently associated with head‐ and neck‐specific HRQL in multivariate analysis. Differences between disease stage groups, however, were not significant. Patient's age was an influencing factor on HRQL, but time since operation was not.

Conclusions: Postoperative radiotherapy seems to have the greatest impact on patients' HRQL independent of other clinical factors following surgery for laryngeal carcinoma. Aftercare of irradiated laryngeal carcinoma patients should focus more on the patient's quality of life.
A “Fenestration Approach” for Arytenoid Adduction Through the Thyroid Ala Combined With Type I Thyroplasty
Authors: Tokashiki Ryoji , Hiramatsu Hiroyuki , Tsukahara Kiyoaki , Kanebayashi Hidenori , Nakamura Mari , Motohashi Rei , Yamada Tetsuya , Suzuki Mamoru
Published: February 2009

Objective: To develop and evaluate the voice outcomes of an approach of arytenoid adduction (AA) through a fenestration of the thyroid ala for unilateral vocal cord paralysis.

Study Design: Twelve consecutive patients with severe unilateral vocal cord paralysis, whose maximum phonation times (MPTs) were less than or equal to 5 seconds, underwent laryngoplasty using an approach of AA performed through a fenestration of the thyroid ala combined with type I thyroplasty.

Method: Two surgical windows were made in the lower part of the thyroid ala. The anterior window was for typical type I thyroplasty, and the posterior window was for AA. AA was performed by pulling the lateral cricoarytenoid muscle (LCA) (5 patients) or muscular process (7 patients) through the posterior fenestration in the contractile direction of the LCA without releasing the cricoarytenoid joint. The operation was performed under local anesthesia with sedation except in two patients who underwent general anesthesia using a laryngeal mask. The vocal cord medialization was confirmed endoscopically during the operation. For all patients, the MPT and mean airflow rate (MFR) were measured before and after the operation. The postoperative voices were analyzed using shimmer and jitter.

Result: All patients achieved a MPT of over 12 seconds. The MFR, which ranged from 340 to 1902 mL/second before the operation, improved to less than 200 mL/second, except in one patient whose MFR was 210 mL/second. Shimmer and jitter improved significantly after the operation. Perceptual evaluation using the GRBAS (grade, roughness, breathiness, aesthenia, strain) scale also improved significantly.

Conclusion: A fenestration‐based approach simplified the combination of AA and type I thyroplasty because the two treatments could be performed in the same operating field and provided good voice improvement. Pulling the AA braid in the contractile direction of the LCA and endoscopic vocal cord observation during surgery may have contributed to the positive results.
Nonpharmacologic Effects of Botulinum Toxin on the Life Quality of Patients with Spasmodic Dysphonia
Authors: Anari Shahram , Carding Paul N. , Hawthorne Maurice R. , Deakin Jayne , Drinnan Michael J.
Published: February 2009

Objective: Botulinum toxin (BT) injection improves objective and subjective voice measurements in spasmodic dysphonia; however, it is not clear whether the results are entirely caused by the neuromuscular blocking effects of BT or whether other factors (e.g., psychological or emotional) play a part. The aim of this study is to investigate whether nonpharmacologic factors contribute to the changes observed in the quality of life (QoL) after BT treatment of spasmodic dysphonia.

Study Design: Prospective cohort study.

Methods: Thirty‐eight consecutive spasmodic dysphonic patients attending for repeat BT injections were investigated by recording their Voice Handicap Index (VHI) scores at three time points: 1) immediately prior to injection (baseline), 2) 1 day postinjection (when least pharmacologic change is expected), and 3) 2 weeks postinjection (when most pharmacologic change is expected). The changes in the total and domain VHI scores were compared between the two postinjection scores and the baseline value using two‐way analysis of variance and the post hoc Bonferroni test.

Results: Most of the change in VHI score occurred between the baseline and first postinjection measurement. For two of the domains (total and emotional), the change was statistically significant. The change between the two postinjection assessments was minimal, and no domain showed statistically significant change.

Conclusions: Our data indicate that the early improvements in QoL after BT injection can only in small part be attributed to the neurotoxic effects of the agent. We cannot say whether the reported effects in our study are attributable to a strong placebo response or are a real consequence of the patient's changing emotional state.
Airway Reconstruction With Carrier‐Free Cell Sheets Composed of Autologous Nasal Squamous Epithelium
Authors: Koo Jaseok P. , Kim Chang‐Hoon , Lee Jeung‐Gweon , Kim Kyung‐Su , Yoon Joo‐Heon
Published: February 2009

Objectives/Hypothesis: Although skin has been the most effective graft material for reconstructing the airway lumen, the use of squamous epithelium has many problems. If autologous airway squamous epithelium could differentiate into mucociliary epithelium after in vivo grafting, it could be an answer to these problems. In this study, we wanted to examine whether carrier‐free nasal epithelial cell sheets composed of autologous squamous epithelium could be used as a substitute for skin in airway luminal reconstruction in three maxillectomy patients.

Study Design: In vitro biochemical experiments with in vivo applications.

Methods: We cultured nasal squamous epithelium from three maxillary cancer patients prior to maxillecotmy. These squamous cell sheets were grafted on the forearm free flap, and, after maxillectomy, the surgical defect was reconstructed with a prefabricated myocutaneous radial forearm free flap with the cultured nasal squamous epithelium. At 1 and 3 month intervals after the reconstructive surgery, the cultured cell grafted area was investigated with histologic phenotype, comparing the skin grafted area.

Results: The autologous nasal squamous epithelial cell sheet differentiated into mucociliary epithelium without the crust or mucus stagnation that is usually observed in cases in which skin graft is used for airway reconstruction.

Conclusions: We suggest that autologous cultured nasal squamous epithelium, which differentiates into mucociliary epithelium after in vivo grafting, can be used as a clinically relevant substitute for skin graft in airway luminal reconstruction.
Organ Preservation Surgery for Advanced Unilateral Glottic and Subglottic Cancer
Authors: Delaere Pierre , Goeleven Ann , Poorten Vincent Vander , Hermans Robert , Hierner Robert , Vranckx Jan
Published: February 2009

Objectives: Functional surgery of unilateral T2b to T3 glottic cancer and cricoid chondrosarcoma is possible using the technique of tracheal autotransplantation. The objective of this paper is to report the functional and oncologic outcome of 24 consecutive patients treated with this technique between 2001 and 2007.

Methods: Seventeen patients, of whom nine were previously irradiated, had unilateral glottic cancer with impaired mobility of the vocal fold. Clinical staging was T2b to 3N0. Seven patients had a chondrosarcoma of the cricoid cartilage. In a first operation, an extended hemilaryngectomy was performed, and a radial forearm flap, comprising a distal fascial and a proximal skin component, was transferred to the neck. The fascial paddle was wrapped around the upper 4‐cm segment of cervical trachea, and the skin paddle was used for temporary closure of the extended hemilaryngectomy defect. The definitive reconstruction was performed after 2 to 3 months and consisted of removal of the skin paddle from the laryngeal defect and a transplantation of a patch of revascularized cervical trachea to reconstruct the laryngeal defect.

Results: Swallowing and speech were restored after the first operation. The glottic and subglottic airway lumen was restored during the second operation. The tracheostomy could be closed in 20 patients. After a median follow‐up period of 33 (range, 1–66) months or almost 3 years, 23 patients remained free of tumor recurrence.

Conclusions: Tracheal autotransplantation can be recommended as a functional treatment for selected T2b to T3 glottic cancers and for unilateral chondrosarcomas of the cricoid cartilage. The technique is oncologically robust while resulting in good postoperative function.
Intracapsular vs. Extracapsular Tonsillectomy: A Comparison of Pain
Authors: Cohen Michael S. , Getz Anne E. , Isaacson Glenn , Gaughan John , Szeremeta Wasyl
Published: February 2009

Objective: To measure differences in postoperative pain in children undergoing intracapsular tonsillectomy vs. extracapsular tonsillectomy.

Study Design: Prospective clinical trial carried out at a tertiary children's hospital over 1 year.

Methods: The study included 43 patients age 5 to 19 years with adenotonsillar hypertrophy, 27 undergoing extracapsular tonsillectomy and 16 undergoing intracapsular tonsillectomy. Tonsillectomy was performed in either an intracapsular or extracapsular fashion using bipolar electrosurgical scissors and monopolar suction cautery for hemostasis. Residents under faculty supervision performed all operations. Postoperative pain was assessed using the Wong‐Baker Faces Pain Scale through postoperative day 10. The patients recorded in a standardized diary pain scores and analgesic use. The main outcome measure was postoperative pain as measured by the Wong‐Baker Faces Pain Scale. The quantity of postoperative pain medicine consumed was a secondary outcome measure.

Results: Average postoperative pain for extracapsular tonsillectomy was 5.21 on a 10‐point scale versus 2.75 for intracapsular tonsillectomy (P < .0001).

Conclusions: Intracapsular tonsillectomy with bipolar scissors results in less postoperative pain than extracapsular tonsillectomy with bipolar scissors in children age 5 to 19 years.
Cadaveric and Engineering Analysis of the Septal L‐Strut
Authors: Mau Ted , Mau Sheng‐taur , Kim David W.
Published: February 2009

Objectives: To identify patterns of failure of the L‐strut, to identify elements of the nasal framework that support the L‐strut, and to investigate the effect of altering L‐strut design on its stability.

Study Design: Laboratory study with human cadaveric heads and computational modeling.

Methods: Directional forces were applied to cadaveric L‐struts and patterns of failure with incremental force were noted. Computational modeling using the finite element method (FEM) was employed to determine quantitatively the effect of various modifications on the stability of the L‐strut.

Results: The L‐strut was found to respond to frontal force initially by buckling. This buckling was reversible until the force exceeded a certain threshold when the L‐strut broke at the bony‐cartilaginous junction. The threshold force varied depending on the length of the overlap with the bony vault. Intact mucoperichondrium provided significant stability. Modeling with FEM showed that the preservation of a triangular piece of cartilage at the dorsal anchor of a narrowed L‐strut can offset some of the loss in mechanical stability.

Conclusions: Intrinsic elasticity of the septal cartilage, the mucoperichondrial flap, and overlap with the bony vault all contribute to the stability of the L‐strut, which is enhanced by preserving a small segment of cartilage at the bony‐cartilaginous junction of the dorsal L‐strut.
Cerebrospinal Fluid Leak After Anterior Cervical Disc Fusion: An Unusual Cause of Dysphagia and Neck Mass
Authors: Schaberg Madeleine R. , Altman Jason I. , Shapshay Stanley M. , Woo Peak
Published: February 2009

Objective: Dysphagia after anterior cervical disc fusion (ACDF) is a common complaint. We present two cases of dysphagia caused by a rare complication after ACDF: cerebrospinal fluid (CSF) leak into the neck.

Study Design: A case series of two patients.

Methods: Both patients underwent a chart review, comprehensive history, physical examination, flexible nasolaryngoscopy, and radiographic imaging. A literature review of the MEDLINE database (1966–2006), using key words “dysphagia” and “anterior discectomy,” was performed.

Results: We present two patients with persistent dysphagia after ACDF surgery caused by CSF leak into the neck. Their clinical presentation, physical and radiographic examination findings, and hospital course will be discussed.

Conclusions: CSF collection presenting as dysphagia and neck mass after ACDF must be included in the differential diagnosis because incision and drainage is contraindicated, and fine needle aspiration (FNA) must be performed under sterile conditions. Treatment including lumbar drain or re‐exploration is appropriate.
Coronoidectomy for the Treatment of Trismus in Head and Neck Cancer Patients
Authors: Bhrany Amit D. , Izzard Mark , Wood Andrew J. , Futran Neal D.
Published: February 2009

Objectives: Trismus is a common adverse effect of tumor extension or treatment for those with head and neck malignancy. Physical therapy is the mainstay of treatment, but many patients still fail to maintain adequate mouth opening. Coronoidectomy is a treatment option for those with trismus, and the purpose of this study was to evaluate the effectiveness of coronoidectomy in treating trismus refractory to physical therapy.

Study Design: Prospective case series.

Methods: Eighteen head and neck cancer patients with interincisal distances less than or equal to 20 mm underwent coronoidectomy after failing physical therapy for at least 3 months. All patients had undergone maximal radiation therapy, half after tumor resection.

Results: Postcoronoidectomy, mean interincisal distances improved 22.1 mm and 21.8 mm at 6 and 12 months, respectively, with all patients maintaining an interincisal distance greater than or equal to 35 mm. Tumor location, tumor histology, or the addition of surgical resection had no impact on outcome.

Conclusion: Coronoidectomy is effective at improving trismus refractory to physical therapy in head and neck cancer patients.