bluuebunny/crossref_metadata_2025 huggingface dataset:
The Relationship between Iron Markers, Cortisol and Insulin Resistance in Gestational Diabetes Mellitus
Authors: Anwar Hina , Rana Muhammad Zeeshan , Khan Najeeb Ullah , Saeed Mariam , Mahmood Amal , Wahid Ayesha
Published: February 2024

Background: Gestational diabetes mellitus (GDM) is a significant metabolic disorder occurring during pregnancy, associated with serious maternal and fetal complications if left untreated. The global prevalence of GDM emphasizes the urgent need for research into its pathogenesis and contributing factors, including hormonal changes, insulin resistance, and the role of iron metabolism.
Objective: The aim of this study was to investigate the relationship between iron markers (hemoglobin, serum iron, and serum ferritin), cortisol, insulin resistance (measured by HOMA-IR), and the development of GDM in pregnant women between 24 and 28 weeks of gestation.
Methods: This analytical cross-sectional study included 150 pregnant women, divided into GDM and non-GDM groups based on oral glucose tolerance test results. Iron markers, cortisol, fasting plasma glucose, insulin, and HOMA-IR levels were measured. Data analysis was performed using SPSS version 25, employing descriptive and inferential statistics, including the Mann-Whitney U test for non-normally distributed variables.
Results: Women with GDM exhibited significantly higher mean levels of hemoglobin (12.41±0.68 g/dl), serum iron (19.57±1.14 μmol/L), serum ferritin (25.92±2.58 ng/ml), cortisol (451.32±25.20 nmol/L), fasting plasma glucose (6.83±0.46 mmol/L), insulin (12.50±1.72 μU/mL), and HOMA-IR (3.83±0.78) compared to non-GDM participants (p<0.001 for all comparisons). These findings underscore the pronounced biochemical and hormonal alterations associated with GDM.
Conclusion: The study identified a significant association between elevated levels of iron markers, cortisol, and insulin resistance with the development of GDM. These findings suggest that monitoring these parameters during pregnancy could be crucial for the early detection and management of GDM. Individualized iron supplementation strategies may be necessary to prevent iron overload and minimize GDM risk.
Accelerated Degradation Reliability Modeling Based on Multiple Uncertainty Wiener Processes
Authors: Yang Kongping , Qi Yuming
Published: February 2024

Numerous scholars' studies usually adopt the Wiener process to establish industrial robot performance degradation models and randomize the drift coefficients to characterize the differences in individual degradation rates, but they do not take into account the influence of measurement errors on the accuracy of the models. Aiming at the above problems, combining the Wiener process and the accelerated degradation model, the accelerated degradation reliability model of industrial robots based on the multi-uncertainty Wiener process is established, and by adding the factor of measurement error, the model is able to more accurately characterize the influence of external factors on the degradation process of industrial robots. Bayesian theory, Markov chain Monte Carlo method and Bootstrap method are used to estimate the unknown parameters in the model. Finally, the accuracy of the proposed parameter estimation method and model is verified by simulating the industrial robot performance degradation data with Monte Carlo method.
La orientación de la familia para su desempeño educativo. Una visión inclusiva
Authors: Rodríguez Sosa Dahimara , Díaz Vera Elizabeth
Published: February 2024

In Cuban families, in spite of the educational levels reached, there are difficulties that reveal an insufficient orientation of the family for its educational performance. At the Vladimir I Lenin elementary school in the municipality of Palmira, there are school children who fail to comply with their school duty because of behavioral alterations of an aggressive nature. In the same family, there are patterns of inappropriate behaviors, dysfunctional families, lack of affection and other difficulties, among which is aggression. The work presents a proposal of family orientation activities, they are dynamic and have novel contents that will help the parents of these students to help them and help their behavior improve so that they feel supported. In the research process, different methods were used, which allowed the determination of the needs and the solution of the scientific problem. This research is a novel experience, because it will achieve better parent-child communication, and will also strengthen the school-family relationship.
The Impact of IFRS 9 on Commercial Banks’ Performance: Evidence from Cambodia
Authors: Azhar Zubir
Published: February 2024

ABSTRACT Following the criticism directed at IAS 39, the IASB issued a standard for financial instruments IFRS 9. This study sheds light on the impact of applying this new standard on Cambodian commercial banks’ financial performance. Using ROA and ROE as proxies of financial performance of banks and employing data manually extracted from the annual reports of Cambodian commercial banks, we analyze the impact of adopting IFRS 9 and some bank specific characteristics based on a sample of 152 bank-year observations from 2014 to 2021 to compare the financial performance of these banks before and after applying IFRS 9. The practical outcomes of the regression analysis signified that the implementation of IFRS 9 has a significant and negative influence on the financial performance of Cambodian commercial banks. The results of this study provide useful explanations which are helpful to regulators and standard setters on how banks’ performance is affected by the implementation of this new standard. This study is expected to make significant contributions to the body of literature as it is one of the first studies to examine this issue in Cambodia and it provides new evidence about the effect of this new standard on the performance of commercial banks in emerging countries. Keywords: International Financial Reporting Standard (IFRS); International Accounting Standard (IAS); Financial performance; Return on assets; Return on equity
An Eco-translatology approach to investigating the translation of comics: Case study of
The Sayings of Zhuangzi
Authors: Chen Yi-Chiao
Published: February 2024

Featuring the interplay of verbal and visual content, the translation of comics has
received theorists’ attention in recent decades. To shed new light, this study analysed the
translation of comics from a new perspective, namely Eco-translatology. Selecting 自然的簫聲：莊子說
[The Sayings of Zhuangzi: The Music of Nature] and its English translation, The
Sayings of Zhuangzi: The Music of Nature, as the research texts, this study conducted
an in-depth analysis and obtained three major findings: (1) the translators have
professional knowledge and expertise to process the comic book appropriately, (2) the target
ecosystem shares a similar composition and creates the same effect as the source at the
micro- and meso-levels and (3) the target ecosystem is constructed in a composition that
attains harmony and interaction at the macro-level. Amplification, reduction/omission and
literal translation are the three most-adopted coping strategies to achieve linguistic and
cultural transformation, whereas the inclusion of an introduction and the use of footnotes
fulfill communicative transformation. This paper argues that translators attach the utmost
importance to the “comprehension of stories,” followed by “space constraints,” “fluency of
translation,” and “faithfulness to the original meaning.”
Quelle traduction ! A study of the translation of French quel and
English what exclamatives in political discourse
Authors: Troughton Faye
Published: February 2024

This paper reports on a study of the translation of English what and
French quel exclamatives spoken in European Parliament proceedings into French and
English respectively. It explores how these meaning-laden constructions are translated in
practice as well as the translation of associated degree modifying and performative
elements. This paper also argues that corpus-based translation studies can contribute to the
debate surrounding the definition of the embedded (non-matrix) exclamatives and touches upon
the comparative use of these exclamatives in the two languages.
Rapid translocation of NGR proteins drives polarization of PIN-activating D6 protein kinase during root gravitropism
Authors: Kulich Ivan , Schmid Julia , Teplova Anastasia , Qi Linlin , Friml Jiří
Published: February 2024

Root gravitropic bending represents a fundamental aspect of terrestrial plant physiology. Gravity is perceived by sedimentation of starch-rich plastids (statoliths) to the bottom of the central root cap cells. Following gravity perception, intercellular auxin transport is redirected downwards leading to an asymmetric auxin accumulation at the lower root side causing inhibition of cell expansion, ultimately resulting in downwards bending. How gravity-induced statoliths repositioning is translated into asymmetric auxin distribution remains unclear despite PIN auxin efflux carriers and the Negative Gravitropic Response of roots (NGR) proteins polarize along statolith sedimentation, thus providing a plausible mechanism for auxin flow redirection. In this study, using a functional NGR1-GFP construct, we visualized the NGR1 localization on the statolith surface and plasma membrane (PM) domains in close proximity to the statoliths, correlating with their movements. We determined that NGR1 binding to these PM domains is indispensable for NGR1 functionality and relies on cysteine acylation and adjacent polybasic regions as well as on lipid and sterol PM composition. Detailed timing of the early events following graviperception suggested that both NGR1 repolarization and initial auxin asymmetry precede the visible PIN3 polarization. This discrepancy motivated us to unveil a rapid, NGR-dependent translocation of PIN-activating AGCVIII kinase D6PK towards lower PMs of gravity-perceiving cells, thus providing an attractive model for rapid redirection of auxin fluxes following gravistimulation.
Pedalando para a fé: comportamento de consumo de ciclistas romeiros a partir da ótica da teoria da prática
Authors: Da Silva Antônio Cléber , De Souza Júlio César Mendes , Da Cruz Karina Kelen , De Rezende Daniel Carvalho
Published: February 2024

O ciclismo é uma prática que faz parte da história da sociedade, assim, buscando explorar as ações, hábitos e rotinas da experiência dessa prática e como o consumo se insere nesse contexto, a presente pesquisa teve por objetivo compreender o comportamento de consumo dos ciclistas participantes da romaria para Aparecida do Norte a partir da abordagem da Teoria da Prática. Para isso, realizou-se uma pesquisa de campo qualitativa, explicativa e descritiva, tendo por metodologia analítica, análise de conteúdo, a qual foi aplicada a ciclistas romeiros de dois municípios da microrregião Campos das Vertentes, estado de Minas Gerais. A partir dos resultados encontrados foi possível perceber que a prática do ciclismo é formada dinamicamente pelos materiais e competências envolvidos na prática, tais como, bicicletas, equipamentos, roupas, conhecimento, rotinas de treinos e alimentação, dentre outros, e os significados que tal dinâmica representa para os ciclistas. Acredita-se que a pesquisa contribui para o entendimento da interação entre cada um dos três elementos da prática (materiais, competências e significados) e como tal dinâmica é constituída pelas percepções e atuações dos praticantes.
Methylenetetrahydrofolate reductase 677C/T gene polymorphism, gastric cancer susceptibility and genomic DNA hypomethylation in an at‐risk Italian population
Authors: Graziano Francesco , Kawakami Kazuyuki , Ruzzo Annamaria , Watanabe Go , Santini Daniele , Pizzagalli Francesca , Bisonni Renato , Mari Davide , Floriani Irene , Catalano Vincenzo , Silva Rosarita , Tonini Giuseppe , Torri Valter , Giustini Lucio , Magnani Mauro
Published: August 2005

We performed a case‐control study to examine the relationship between MTHFR C677T gene polymorphism (MTHFR677C/T) and gastric cancer susceptibility in at‐risk populations in central Italy. To explore genomic DNA hypomethylation as a potential etiologic mechanism, this phenomenon was evaluated in carriers of the MTHFR677T/T genotype and carriers of the wild‐type MTHFR677C/C genotype. Lymphocyte genomic DNA from 162 gastric cancer patients and 164 controls was used for MTHFR677C/T genotyping. Unconditional regression analysis with ORs and 95% CIs was used to investigate the association of the polymorphism with disease. Genomic DNA methylation status by an established enzymatic assay that measures the DNA accepting capacity of methyl groups (inversely related to endogenous methylation) was assessed in a random sample of 40 carriers of the wild‐type MTHFR677C/C genotype and 40 carriers of the MTHFR677T/T genotype. The global allelic distribution was in Hardy‐Weinberg equilibrium. The MTHFR677T allele was significantly associated with gastric cancer risk with an OR of 2.49 (95% CI 1.48–4.20) in heterozygous MTHFR677C/T carriers and an OR of 2.85 (95% CI 1.52–5.35) in homozygous MTHFR677T/T carriers. This risk association was retained in subgroup analyses by tumor histotype and location. Genomic DNA hypomethylation status in MTHFR677T/T carriers was significantly higher than in subjects with wild‐type MTHF677C/C genotype (p = 0.012). In the studied population, MTHFR677T played the role of a moderate‐penetrance gastric cancer susceptibility allele. Possession of the MTHFR677T/T genotype was significantly associated with genomic DNA hypomethylation. These findings deserve further investigation in the context of novel strategies for gastric cancer prevention. © 2005 Wiley‐Liss, Inc.
The relevance of comorbidities for heart failure treatment in primary care: A European survey
Authors: Sturm Heidrun B. , Haaijer‐Ruskamp Flora M. , Veeger Nic J. , Baljé‐Volkers Corine P. , Swedberg Karl , van Gilst Wiek H.
Published: August 2005

Aim:

To assess the impact of comorbidities on chronic heart failure (CHF) therapy.

Methods:

The IMPROVEMENT‐HF survey included 11,062 patients from 100 primary care practices in 14 European countries. The influence of patient characteristics on drug regimes was assessed with multinomial logistical regression.

Results:

Combined drug regimes were given to 48% of CHF patients, consisting of 2.2 drugs on average. Patient characteristics accounted for 35%, 42% and 10% of the variance in one‐, two‐ and three‐drug regimes, respectively. Myocardial infarction (MI), atrial fibrillation (AF), diabetes, hypertension, and lung disease influenced prescribing most. AF made all combinations containing β‐blockers more likely. Thus for single drug regimes, MI increased the likelihood for non‐recommended β‐blocker monotherapy (OR 1.3; 95% CI 1.2–1.4), while for combination therapy recommended regimes were most likely. For both hypertension and diabetes, ACE‐inhibitors were the most likely single drug, while the most likely second drugs were β‐blockers in hypertension and digoxin in diabetes.

Conclusions:

Patient characteristics have a clear impact on prescribing in European primary care. Up to 56% of drug regimes were rational taking patient characteristics into account. Situations of insufficient prescribing, such as patients post MI, need to be addressed specifically.
Obese subjects with heart failure have lower N‐terminal pro‐brain natriuretic peptide plasma levels irrespective of aetiology
Authors: Rivera Miguel , Cortés Raquel , Salvador Antonio , Bertomeu Vicente , de Burgos Fernando García , Payá Rafael , Portolés Manuel , Taléns‐Visconti Raquel , Martinez‐Dolz Luis , Valero Ricardo , Sevilla Begoñ , Climent Vicente
Published: August 2005

N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) may be useful in the diagnosis of heart failure and ventricular dysfunction. Obesity is an independent cardiovascular risk factor. The purpose of this study was to measure NT‐proBNP plasma levels in obese and non‐obese subjects with heart failure and to compare levels in subjects with ischaemic and dilated aetiology.

In this study, obese subjects had 63% lower NT‐proBNP plasma levels than non‐obese subjects (p<0.01). In multivariate analysis, BMI was inversely associated with NT‐proBNP plasma levels (p<0.05) and a 17% decrease in natriuretic peptide levels was attributed to obesity (p<0.036). When we analyzed data according to the aetiology of heart failure, we found that both groups (ischaemic and dilated) had a 65% decrease in NT‐proBNP plasma levels in obese subjects compared to non‐obese subjects.
Left ventricular systolic dysfunction, total mortality, and sudden death in patients with myocardial infarction treated with n‐3 polyunsaturated fatty acids
Authors: Macchia Alejandro , Levantesi Giacomo , Franzosi Maria Grazia , Geraci Enrico , Maggioni Aldo Pietro , Marfisi RosaMaria , Nicolosi Gian Luigi , Schweiger Carlo , Tavazzi Luigi , Tognoni Gianni , Valagussa Franco , Marchioli Roberto ,   on behalf of the GISSI‐Prevenzione Investigators
Published: August 2005

Background

Sudden death (SD) has a major impact on mortality (M) in patients with left ventricular systolic dysfunction (SyD). In GISSI‐Prevenzione, treatment with n‐3 polyunsaturated fatty acids (PUFA) reduced M and SD in post‐MI patients, but their effect in patients with SyD is unknown.

Methods

11,323 patients with prior MI and NYHA class≤II were recruited. After excluding patients with no ejection fraction (EF) measurement (1684), and those with missing data (n=9), 9630 patients were available for analysis. Multivariate Cox regression adjusted models were fitted.

Results

Compared to patients with EF>50%, SyD patients had higher M (12.3% vs. 6.0%) and SD (3.4% vs. 1.4%) rates. PUFA reduced M similarly in patients with (RR 0.76 (0.60–0.96) P=0.02) and without SyD (RR 0.81 (0.59–1.10) P=0.17) (heterogeneity tests P=0.55). In contrast, the effect on SD was markedly asymmetrical: PUFA produced a marked reduction (RR 0.42 (0.26–0.67) P=0.0003) of risk in SyD patients whereas the effect was less evident (RR 0.89 (0.41–1.69) P=0.71) in patients with EF>50% (heterogeneity tests P=0.07). There was a significant increase in SD with worsening EF (P test for trend=0.02), the benefit on SD in patients with EF≤40% being 4‐fold higher than in those with EF>50%.

Conclusions

Increasing SyD is associated with elevated risk of SD and with increasing benefit from PUFA. The effect of PUFA on SD reduction was greater in patients with SyD. Prospective trials testing the effect of PUFA in populations with SyD are required.
The Modification of Diet in Renal Disease (MDRD) equations provide valid estimations of glomerular filtration rates in patients with advanced heart failure
Authors: O'Meara Eileen , Chong Kwok S. , Gardner Roy S. , Jardine Allan G. , Neilly James B. , McDonagh Theresa A.
Published: August 2005

Background:

Glomerular filtration rate (GFR) has major prognostic implications in heart failure. Our objective was to validate the MDRD prediction equations for GFR in patients with advanced heart failure, and to compare their predictive performance to that of the Cockcroft–Gault (CG) equation.

Methods:

We analysed GFR in 45 patients referred for heart transplantation evaluation. 51Cr–EDTA‐measured GFR was compared to GFR estimates obtained by MDRD1 and MDRD2 equations, CG equation using actual body weight, and ideal body weight. Regression analyses and Pearson correlations were performed, and Bland and Altman plots were drawn. ROC curves were obtained to illustrate each equation's ability to predict a GFR less than 60 ml/min/1.73 m2 (moderate renal impairment).

Results:

Patients had a mean age of 52 years, and 69% were in NYHA class III. The mean EDTA‐measured GFR was 46.9±17.2 ml/min/1.73 m2. The MDRD1 equation provided the best predictive model (narrowest limits of agreement; r=0.766, p<0.001), and the highest performance in predicting a GFR less than 60 ml/min/1.73 m2 (area under curve: 0.901).

Conclusions:

MDRD equations, especially MDRD1, adequately predict GFR in advanced heart failure, with higher accuracy than the CG equation. MDRD1 also has higher performance in predicting a GFR less than 60 ml/min/1.73 m2.
Progressive left ventricular hypertrophy after withdrawal of long‐term ACE inhibition following experimental myocardial infarction
Authors: Westendorp Bart , Schoemaker Regien G. , Buikema Hendrik , Boomsma Frans , van Veldhuisen Dirk J. , van Gilst Wiek H.
Published: August 2005

Background:

Although discontinuation of chronic ACE inhibitor (ACEi) therapy after myocardial infarction (MI) is common in clinical practice, some clinical studies reported an increased incidence of ischemia‐related events after withdrawal. To further address this issue, we assessed hemodynamic, neurohormonal and vascular consequences of withdrawing long‐term ACEi treatment after experimental MI.

Methods:

Rats were subjected to coronary ligation to induce MI, and received quinapril (15 mg/kg/day) from 2 weeks to 14 months post‐MI. Subsequently, surviving rats were randomized to sacrifice at 0, 4, and 6 weeks after ACEi withdrawal. Rats were studied for signs of heart failure, hemodynamics and cardiac function, neurohormones, and vascular edothelial function.

Results:

After discontinuation of ACEi treatment, plasma aldosterone levels increased between 0—4 weeks without further increment thereafter, suggesting persistent RAAS activation. Acetylcholine‐induced aortic relaxation was impaired at 4 and 6 weeks, indicating rapid and sustained development of endothelial vasodilator dysfunction after withdrawal. Moreover, 24% of the rats developed heart failure signs (edema, dyspnea), and 3 rats died, all within 4 weeks after withdrawal. Significantly increased N‐ANP levels and lung weights at 4, but not at 6 weeks suggest a transient volume overload. Finally, LV/body weight ratios significantly increased between 0—4 as well as 4—6 weeks, indicating progressive LV hypertrophy.

Conclusions:

The observed alterations after withdrawing long‐term post‐MI quinapril treatment in the present study may account for an increased risk for ischemic events. Thus, our findings highlight the potentially harmful effects associated with abrupt discontinuation of long‐term post‐MI ACE inhibition, and imply careful clinical consideration in this matter.
Short‐term effects of levosimendan and prostaglandin E1 on hemodynamic parameters and B‐type natriuretic peptide levels in patients with decompensated chronic heart failure
Authors: Moertl Deddo , Berger Rudolf , Huelsmann Martin , Bojic Anja , Pacher Richard
Published: August 2005

Background:

Both levosimendan and prostaglandin E1 (PGE1) have beneficial effects on hemodynamic parameters and outcome compared to dobutamine in decompensated chronic heart failure (CHF).

Aims:

We compared short‐term effects of levosimendan versus PGE1 on hemodynamic parameters and B‐type natriuretic peptide levels (BNP) in patients with decompensated CHF.

Methods and results:

73 patients (cardiac index <2.5 L/min/m2 pulmonary capillary wedge pressure (PCP)> 15 mmHg) with decompensated CHF were randomised to treatment with either a 24 h‐infusion of levosimendan (n=38) or a chronic infusion of PGE1 (n=35). Hemodynamic parameters and BNP were measured at baseline, 24 and 48 h, BNP levels were also measured after 1 week. Baseline characteristics including concomitant medication were similar in both groups. Levosimendan and PGE1 increased cardiac output (CO) after 24 and 48 h. Levosimendan increased CO twice as much as PGE1 (24 h: Levosimendan +1.1±0.1 L/min, PGE1 +0.6±0.1 L/min, p>0.001). Both drugs produced a comparable reduction in PCP and pulmonary artery pressure after 24 and 48 h. Levosimendan decreased BNP by 28% after 24 h and 22% after 48 h, but effects disappeared after 1 week. In contrast, PGE1 decreased BNP by 15% after 48 h (no change at 24 h), but a decrease of 20% was sustained at 1 week.

Conclusions:

The differential beneficial effects of levosimendan (greater increase in CO) and PGE1 (sustained decrease in BNP) may have a potential impact on clinical outcome.
Practical recommendations for the use of ACE inhibitors, beta‐blockers, aldosterone antagonists and angiotensin receptor blockers in heart failure: Putting guidelines into practice
Authors: McMurray John , Cohen‐Solal Alain , Dietz Rainer , Eichhorn Eric , Erhardt Leif , Hobbs F.D. Richard , Krum Henry , Maggioni Aldo , McKelvie Robert S. , Piña Ileana L. , Soler‐Soler Jordi , Swedberg Karl
Published: August 2005

Surveys of prescribing patterns in both hospitals and primary care have usually shown delays in translating the evidence from clinical trials of pharmacological agents into clinical practice, thereby denying patients with heart failure (HF) the benefits of drug treatments proven to improve well‐being and prolong life. This may be due to unfamiliarity with the evidence‐base for these therapies, the clinical guidelines recommending the use of these treatments or both, as well as concerns regarding adverse events. ACE inhibitors have long been the cornerstone of therapy for systolic HF irrespective of aetiology. Recent trials have now shown that treatment with beta‐blockers, aldosterone antagonists and angiotensin receptor blockers also leads to substantial improvements in outcome. In order to accelerate the safe uptake of these treatments and to ensure that all eligible patients receive the most appropriate medications, a clear and concise set of clinical recommendations has been prepared by a group of clinicians with practical expertise in the management of HF. The objective of these recommendations is to provide practical guidance for non‐specialists, in order to increase the use of evidenced based therapy for HF. These practical recommendations are meant to serve as a supplement to, rather than replacement of, existing HF guidelines.
Exploring symptoms in chronic heart failure
Authors: Ekman Inger , Cleland John G.F. , Andersson Bert , Swedberg Karl
Published: August 2005

Symptoms in patients with chronic heart failure (CHF) are the cry for help, reflecting not only the physical aspects of the disease but the impact on lifestyle, anxiety, depression and expectations of the patient. Studies consistently show a difference in patients' self‐assessed functional classification compared to investigator reported NYHA classification. Moreover, patient self‐assessed symptoms have recently been shown to independently predict hospitalisation and mortality over 5 years. Recognition of symptoms and appreciation of their importance justifies the use of a structured assessment in order to provide optimal medical care for patients with CHF. A model of how to structure symptom assessment equally with signs is presented in this paper.
Surgical left ventricular remodeling in heart failure
Authors: Tønnessen Theis , Knudsen Cathrine Wold
Published: August 2005

The high mortality and morbidity of patients in terminal heart failure are a therapeutic challenge to modern medicine. Surgically, cardiac transplantation is an excellent treatment for many patients. However, lack of donors combined with an increasing number of patients has led to the search for other surgical strategies. Patients with symptomatic large left ventricular aneurysms have been treated with resection of the aneurysm and closure of the left ventricle either directly (linear closure, first reported by Cooley) or by implantation of a patch (endoventricular patch plasty or Dor procedure). Akinetic areas of the left ventricle have also been successfully treated by the latter method. According to the law of Laplace, large dilated ventricles have increased wall tension and thus increased oxygen consumption. Based on this fact, Batista and coworkers have reduced the volume of enlarged left ventricles in patients in terminal heart failure by removing a wedge of myocardium from the apex of the heart towards the base of the left ventricular free wall. Although a favorable outcome has been reported in selected patients, this method is currently not recommended for treatment of heart failure because of high surgical failure rates.

The present paper reviews some of the relevant literature regarding surgical left ventricular remodeling in heart failure. Two new techniques (Myosplint and CorCap cardiac support device) are also briefly described.
Local Anesthesia for Middle Ear Surgery
Authors: Caner Gül , Olgun Levent , Gültekin Gürol , Aydar Levent
Published: August 2005

The adequacy of anesthesia and comfort during surgery was assessed for 100 consecutive patients undergoing middle ear surgery using local anesthesia, both by the patients themselves and by the surgeon. The possibility of inducing an iatrogenic facial weakness was also evaluated. Both the surgeon and the majority of patients were pleased with the quality of anesthesia and little adverse effects occured as a consequence of local anesthesia itself.
Orbital Decompression in Graves' Ophthalmopathy by Medial and Lateral Wall Removal
Authors: Sellari‐Franceschini Stefano , Berrettini Stefano , Santoro Amelia , Nardi Marco , Mazzeo Salvatore , Bartalena Luigi , Mazzi Barbara , Tanda Maria Laura , Marcocci Claudio , Pinchera Aldo
Published: August 2005

Objective

The objective of this study is to describe a technique for balanced orbital decompression and to analyze the results.

Methods and Materials

We conducted a retrospective study of 140 patients (276 orbits). Orbital decompression was carried out by removal of the medial orbital wall by ethmoidectomy and complete removal of the lateral wall by bringing out the entire sphenoid wing together with part of the zygomatic bone down to the inferior orbital fissure.

Results

One hundred thirty‐six patients underwent bilateral decompression, 4 patients underwent monolateral decompression. Proptosis was reduced on average by 5.3 mm; 28 (20%) patients showed onset or worsening of diplopia.

Conclusions

Medial and lateral approach allows a balanced orbital decompression. As some patients may present different degrees of proptosis and visual impairment, we stress the importance of carefully weighing the preoperative conditions of the individual patient when choosing the surgical approach.
Tongue Base Suspension Combined with UPPP in Severe OSA Patients
Authors: Omur Mehmet , Ozturan Dilaver , Elez Feyzi , Unver Celal , Derman Sabri
Published: August 2005

Objective:

Tongue base surgery in the severe OSA patients may improve the success of uvulopalatopharyngoplasty (UPPP) as the collapse is multilevel. The aim of this study was to evaluate the long‐term objective and subjective effectiveness of the minimally invasive tongue base suspension combined with UPPP in severe OSA patients.

Study Design and Setting:

We conducted a retrospective analysis of 22 OSA patients undergoing UPPP and the tongue base suspension for the treatment of severe OSA.

Results:

Twenty‐two men who had their preoperative and postoperative polysomnography had a 54% reduction in the preoperative Respiratory Disturbance Index (RDI), from 47.50 ± 15.74 to a level of 17.31 ± 14.17. The standard surgical cure rate which is a >50% reduction in the RDI and a postoperative RDI of <20 events/hour was 81.81%. All patients had some degree of subjective improvement in their snoring, daytime sleepiness, and the Epworth sleepiness scale.

Conclusions:

The tongue base suspension combined with UPPP has been shown to reduce RDI better than UPPP alone. This minimally invasive technique is highly successful at 81.81% when combined with UPPP in the severe OSA patients with multilevel airway collapse.

Significance:

This study shows the benefits of minimally invasive tongue base suspension combined with UPPP in severe obstructive sleep apnea syndrome.
Unilateral Opacification of Paranasal Sinus CT Scans
Authors: Ahsan F. , El‐Hakim H. , Ah‐See K. W.
Published: August 2005

Objectives

The aim of study was to describe the histopathology in patients with unilateral sinus opacification and to identify variables that may predict neoplastic pathology.

Study Design

A retrospective review of paranasal sinus CT scans performed between 2000 and 2003 was conducted to identify patients with unilateral sinus opacification.

Results

Twenty‐eight of 1118 CT scans showed unilateral sinus opacification. Twelve patients had neoplastic disease, 13 had inflammatory disease. Nasal discharge was more common in inflammatory than neoplastic disease (P = 0.009). A polyp or mass lesion was more common on nasendoscopy in neoplastic than inflammatory disease (P = 0.01). Bony erosion was only identified in malignant disease.

Conclusion

A wide variety of pathologies present with unilateral sinus opacification on CT scanning. In our series, neoplastic disease was more associated with a visible polyp or mass lesion and less with nasal discharge. Bony erosion on CT scan was only seen in malignant disease. Histologic confirmation remains obligatory for diagnosis.
Cochlear Implant Magnet Displacement With Minor Head Trauma
Authors: Yun James M. , Colburn Michelle W. , Antonelli Patrick J.
Published: August 2005

Objectives:

Manufacturers have introduced cochlear implants (CIs) with removable magnets to allow for magnetic resonance imaging after placement. The purpose of this study was to describe magnet displacement as a new CI complication and to suggest apossible treatment option to prevent its recurrence.

Study Design:

Retrospective case series.

Methods:

The records of 3 young males who experienced CI magnet dislodgement were reviewed and compared against records from the institutional implant database.

Results:

Magnet displacement was observed only in young males (14% of male children) who received CI with removable magnets. This occurred 13‐14 months after CI placement. Magnets were replaced under general anesthesia, and the scalp was bolstered with a dermal allograft. Recurrent magnet dislodgement was encountered in 1 patient, 6 months later.

Conclusions:

Magnet displacement may be a relatively common complication after minor head trauma in pediatric patients with certain CIs that have removable magnets.
Bilateral Congenital Vocal Cord Paralysis: A 16‐Year Institutional Review
Authors: Miyamoto R. Christopher , Parikh Sanjay R. , Gellad Walid , Licameli Greg R.
Published: August 2005

Objective:

To review the management and outcome of bilateral congenital true vocal cord paralysis in 22 patients treated over a 16‐year period and to review the role of tracheostomy in these patients.

Design:

Retrospective chart review.

Setting:

Pediatric tertiary hospital.

Patients:

Twenty‐two pediatric patients diagnosed with bilateral congenital true vocal cord paralysis.

Interventions:

Flexible or rigid diagnostic evaluation, tracheostomy, and vocal cord lateralization procedures.

Main Outcomes Measures:

Vocal cord recovery and decannulation.

Results:

With a mean follow up of 50 months, 15 of 22 patients (68%) with bilateral vocal cord paralysis required tracheostomy for airway securement. Of the 15 tracheotomized patients, 10 were successfully decannulated (8 had spontaneous recovery, whereas 2 required lateralization procedures). Eleven of these patients with tracheostomy had comorbid factors, including neurologic abnormalities (midbrain/brainstem dysgenesis, Arnold‐Chiari malformation, global hypotonia, and developmental delay). Of the 7 patients not requiring tracheostomy, 6 recovered vocal cord function (86%).

Conclusion:

In our series of 22 patients with bilateral vocal cord paralysis, 14 had spontaneous recovery of function. Patients managed with tracheostomy were noted to have a high incidence of comorbid factors. In this series, recovery rates were found to be higher in nontracheostomized patients than in tracheostomized patients. Patients can be carefully selected for observation versus tracheostomy at the time of diagnosis based on underlying medical conditions.
Penicillin Reduces Eustachian Tube Gland Tissue Changes in Acute Otitis Media
Authors: Andersen Henrik , Thomsen Jens , Cayé‐Thomasen Per
Published: August 2005

Objective:

The volume of the mucous paratubal glands and the number of the mucus‐producing goblet cells in the middle ear and Eustachian tube (ET) are increased after experimental acute otitis media (AOM). The present investigation examines a potential effect of penicillin on the changes in goblet cell density and gland structures of the ET during and after AOM.

Study Design:

Middle ear inoculation of Streptococcus pneumoniae in 50 rats. Two days later, 25 rats were given penicillin V as one daily dose for 5 days. Twenty‐five rats received no treatment. Five animals from each group were sacrificed on days 4, 8, 16, 90, and 180. The ET was dissected and decalcified, followed by paraffin embedding, serial transverse sectioning, and PAS/alcian blue staining. The goblet cell density and the paratubal gland composition and volume were determined in every 20th section, using a light microscope.

Results:

Penicillin reduced the increase of goblet cell density from day 8 and through 6 months, whereas the increase of the paratubal mucous gland volume was unaffected by treatment.

Conclusion:

We conclude that penicillin reduces the increase of ET goblet cell density during and after acute otitis media, whereas the paratubal gland volume remains unaffected. An increased mucosal secretory capacity and indicated excessive secretion of mucus may contribute to the deteriorated ET function found after AOM and thus predispose, sustain, or aggravate middle ear disease. This may be prevented by penicillin treatment.
Physiologic Model of Oropharyngeal Swallowing Revisited
Authors: Martin‐Harris Bonnie , Michel Yvonne , Castell Donald O.
Published: August 2005

Objective:

The purposes of this investigation were to determine whether the temporal onsets of swallow events segment into oral and pharyngeal phases, to test the interdependence of temporal onsets of swallow events, and to determine the influence of age on total swallow duration.

Study Design and Setting:

The onsets of swallowing and respiratory measures were studied in 76 healthy normal individuals.

Results:

Confirmatory factor analysis revealed a 2‐factor solution but did not support the hypothesized 2‐phase structure (ie, oral and pharyngeal). Two of the onsets, apnea onset and apnea offset, formed a single factor that explained 12.6% of the variation among the 11 onset times. The other 9 onsets formed a second factor that explained 66.4% of the variation. Age accounted for modest variation in total swallow duration.

Conclusions:

The two factors, oropharyngeal and respiratory, explained 79% of the variation among the 11 onset times.

Significance:

This finding speaks to the overlap between the initiation of oral and pharyngeal components of swallowing in adults and highlights the artificiality of separating the swallowing continuum into isolated phases.
A Simple and Valuable Approach for Measuring Customer Satisfaction
Authors: Kinney William C.
Published: August 2005

OBJECTIVE:

To determine the financial impact of poor customer satisfaction and the value of information gained from using a 1‐question customer‐satisfaction survey in a medical setting.

STUDY DESIGN AND SETTING:

A single‐question customer‐satisfaction survey was collected from customers presenting to an academic otolaryngology head and neck surgery outpatient clinic.

RESULTS:

The overall response rate was 25%, overall net promoter score was 67.3%, lowest net promoter score occurred on Wednesday and Friday, overall net potential referrals were 872, and potential lost revenue from dissatisfied customers equaled $2.3 million.

CONCLUSION:

A single‐question customer‐satisfaction survey may help identify areas of customer dissatisfaction that lead to a significant source of lost revenue.

SIGNIFICANCE:

The competitive forces in today's health care environment require medical practices to address issues related to customer satisfaction.
Transpalatal Advancement Pharyngoplasty Outcomes Compared With Uvulopalatopharygoplasty
Authors: Woodson B. Tucker , Robinson Sam , Lim Hyun J.
Published: August 2005

Objective:

Uvulopalatopharyngoplasty (UPPP) success rates in patients classified with Friedman stage 3 is reported as 8%. Surgical failure may result from persistent obstruction at the palate, which may be addressed by pharyngoplasty with palatal advancement (PA). The effectiveness of PA versus UPPP was evaluated by using polysomnographic outcomes in a retrospective cohort of patients classified with Friedman stage 3.

Methods:

Surgical records were reviewed for PA (n = 47) and UPPP (n = 124). Clinical records were reviewed and reclassified by Friedman stage. Respiratory data were collected from overnight polysomnography. Statistical analysis was conducted of continuous variables (ANOVA), categorical variables (χ2), and adjusted odds ratios by using logistic regression.

Results:

PA (n = 30) and UPPP (n = 44) did not differ in baseline apnea hypopnea index (AHI), age, or BMI. Both PA (48.3 ± 24.6 to 19.8 ± 16.8 events per hour, P < 0.000) and UPPP (47.9 ± 30.0 to 30.9 ± 24.2 events per hour, P < 0.000) improved with surgery. In the PA group, final AHI was lower (17.1 ± 30.1 versus 28.5 ± 25.6, P < 0.04) and postoperative change was greater (30.9 ± 24.2 versus 19.8 ± 16.8, P < 0.02). For patients with Friedman stage 3, odds ratio of having an AHI of <20 events per hour and a greater than 50% reduction with PA compared with UPPP was 3.80 (95% CI, 1.41‐10.29, P < 0.013). Adjusted for age, body mass index, preoperative apnea severity, and tongue‐base surgery, OR was 5.77 (95% CI of 1.80‐17.98).

Conclusions:

Polysomnographic outcomes using AHI support the use of palatopharyngoplasty using palatal advancement as an effective treatment of obstructive sleep apnea. PA may offer benefit over UPPP alone in patients classified with Friedman stage 3.
Diagnosis and Management of Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo
Authors: White Judith A. , Coale Kathleen D. , Catalano Peter J. , Oas John G.
Published: August 2005

Objective:

Describe the diagnosis, treatment, and outcome of a group of 20 patients with lateral semicircular canal benign paroxysmal positional vertigo (LSC‐BPPV).

Study Design and Setting:

Retrospective review of 20 patients with LSC‐BPPV (10 with geotropic and 10 with apogeotropic nystagmus) presenting to a tertiary balance center. Diagnosis was confirmed with infrared nystagmography in Dix‐Hallpike positioning tests and supine positional tests. Patients were treated with one or more particle repositioning maneuvers.

Results:

Addition of supine positional nystagmus tests to Dix‐Hallpike positioning testing improves sensitivity in the diagnosis of LSC‐BPPV. Treatment outcomes in the apogeotropic LSC‐BPPV group were poorer than the geotropic LSC‐BPPV group.

Significance:

Adding supine positional testing to routine vestibular diagnostic testing will increase the identification of LSC‐BPPV. Apogeotropic LSC‐BPPV is more challenging to treat.
Symptom and Disease Severity Differences Between Nasal Septal Deviation and Chronic Rhinosinusitis
Authors: Bhattacharyya Neil
Published: August 2005

OBJECTIVE:

To determine whether patients with chronic rhinosinusitis (CRS) exhibit more severe sinonasal symptom scores as compared with patients with nasal septal deviation (NSD) alone.

METHODS:

Two patient cohorts were prospectively identified: patients undergoing surgery for NSD alone and those undergoing endoscopic sinus surgery for CRS without NSD. Patients in the NSD group were required to have normal paranasal sinus CT scans, whereas patients in the CRS group were required to have radiographic evidence of CRS. All patients completed the Rhino‐sinusitis Symptom Inventory (RSI). Statistical comparisons were conducted between cohorts with respect to RSI symptom domains and medical resource utilization.

RESULTS:

A total of 42 patients were identified in the NSD group (mean age, 40.8 years) and 155 patients were identified in the CRS group (mean age, 44.9). Patients with CRS demonstrated higher severity scores for the nasal symptom domains (60.3 [CRS] versus 53.9 [NSD], P = 0.037). Oropharyngeal symptoms and total symptoms were also worse for the CRS group versus the NSD group (29.8 versus 23.1, P = 0.014 and 43.0 versus 37.0, P = 0.030). Facial and systemic symptom scores did not differ between groups. Patients with CRS demonstrated significantly higher utilization rates for topical nasal steroids (21.2 versus 12.2 weeks, P = 0.006) and oral antibiotics (7.9 weeks versus 2.1 weeks, P < 0.001), but not for oral antihistamines (P = 0.420).

CONCLUSIONS:

Although patients with CRS manifest higher sinonasal symptom scores than patients with NSD alone, differentiating these 2 diagnoses on the basis of symptoms alone is difficult. These data suggest that as a disease process, CRS confers a significant disease burden with more significant negative symptom impact.
Pediatric Tracheotomies in an Asian Population: The Singapore Experience
Authors: Ang Annette H. C. , Chua Dennis Y. K. , Pang Kenny P. , Tan Henry K. K.
Published: August 2005

Objective:

Over the past 2 decades, tracheotomy in children and infants has evolved from a primarily emergent procedure for upper airway obstruction into a semielective procedure for airway access in assisted ventilation. We present a 12‐year retrospective review of tracheotomies performed in the pediatric population in Singapore.

Study Design and Setting:

We reviewed all tracheotomies performed in children below the age of 16 years in 2 tertiary pediatric medical centers in Singapore from January 1991 to December 2003. Indications for surgery are reviewed, and outcomes in terms of morbidity rate, mortality rate, postoperative rehabilitation, and duration of decannulation process were analyzed.

Results:

Tracheotomies were performed in 48 children during the study period. The mean age of patients was 3.24 years, with ages ranging from 16 days to 14 years. Sixty‐three percent of tracheotomies were done within the 1st year of life. The chief indication was airway access for assisted ventilation. The overall complication rate was 31%. There were 13 attempts at decannulation, with 9 successes. No tracheotomy‐related deaths occurred.

Conclusion:

Tracheotomy is a relatively safe procedure in children and infants. Lower decannulation rates and the evolving role of tracheotomy for early access in assisted ventilation permits earlier discharge with tracheotomy in situ.
Does Hydrogen Peroxide Mouthwash Improve the Outcome of Secondary Post‐Tonsillectomy Bleed? A 10‐year Review
Authors: Pai Irumee , Lo Stephen , Brown Satsuki , Toma Abbad G.
Published: August 2005

Objective:

To determine whether hydrogen peroxide (H2O2) mouthwash influences the outcome of secondary post‐tonsillectomy hemorrhage in children.

Study Design:

Ten‐year retrospective study of all children with secondary post‐tonsillectomy hemorrhage.

Setting:

Tertiary otolaryngology center.

Results:

Of the 156 patients, 59 received H2O2 and 97 did not. All patients received broad‐spectrum intravenous antibiotics. The average rehospitalization duration due to hemorrhage was 1.7 days (H2O2 group) and 1.6 days (control group). In the H2O2 group, 8.5% required surgery, compared with 10.3% in the control group. Further hemorrhage episodes requiring readmission occurred in 3.4% of the H2O2 group and 3.1% of controls. There was no difference between the 2 groups in rehospitalization duration (P = 0.49), rate of surgical intervention (P = 0.85), and rate of readmission with further hemorrhage (P = 0.92).

Conclusion:

Hydrogen peroxide mouthwash does not improve the outcome of secondary post‐tonsillectomy hemorrhage in pediatric patients.

Significance:

This study does not support the common practice of treating post‐tonsillectomy hemorrhage with H2O2.